College: A Generation at Risk

A College diploma is a goal for millions of Americans, yet graduation rates have never been lower and those who do graduate take 6 years on average compared to the 4 years of previous generations.  Recent research has helped us understand that these dismal outcomes are not because students cannot handle the coursework, because the vast majority of students can grasp the academic content; rather mental health issues are now the prominent struggle in College.   

The statistics tell a rather grim story at first glance.  A study by the APA in 2017 found 

86% of students with psychological and learning challenges left school without a diploma. The CDC discovered that suicide is currently the 2nd leading cause of death among college students and this year, WHO found that 1 in 20 full-time college students have seriously considered suicide. 

There is one statistic, however, that gives hope to these startling facts.  94% of high school students with emotional and learning differences receive some form of assistance. In contrast, only 17% of college students with the same challenges do so.  The remaining 74% still need assistance in navigating the new world of College life, but faced with logistical and financial constraints, Colleges will have to adapt quickly when it comes to providing services for the mental health of its students.  Currently, there is a nation-wide average of 2,500 students for every one counselor and this clearly isn’t enough. 

The good news, if you or someone you know needs help while in school, there are a couple of private and non-profit companies filling the gap in the state of Utah so please reach out for hope, healing, and help. 

Originally published on http://utvalleywellness.com/

An Ethic to Live: Building Barriers to Suicide Around Ourselves & Those We Love

In cities throughout the world, notable high buildings and bridges increasingly have additional fencing built atop of them with the specific purpose of preventing suicides. Suicide fences tend to work because research has shown that suicidal actions are frequently impulsive, hence such fences serve to forestall that impulse and buy individuals precious time to further think about their decisions. In studies of suicide fences, it appears that individuals don’t leave such barriers to go look for another bridge or tall building to end their lives from, but instead return to the business of living for yet another day.  

Presently suicide is the leading cause of death among young people ages 10-17 here in Utah, and over the last decade, it’s also doubled amongst adults in our state. As concerned friends, neighbors, and parents, how do we help our community build more barriers to suicide; protecting and empowering those we love? Over the next year, I’ll be writing a series of articles in answer to this question; offering my perspective as both a therapist, who has stood on sacred ground in helping others walk back from suicidal thinking, and as one who’s felt and ultimately rejected the dark pull to end my life amidst heavy times.   

Perhaps you’ve already noted that there’s no way to build suicide fences everywhere or to somehow block all of the endless ways in which someone might consider ending their life. Sound public policies on prevention and physical barriers like suicide fences are only some of the important ways to help. So in addition to these forms of prevention, the focus of my writing will be on how to build barriers to suicide directly into the thinking and values of individuals, and into the culture of our community as a whole. In this first article, I want to introduce how we help foster an ethic to live within ourselves and in others as a key barrier to suicide.  

An ethic to live means valuing our lives and holding a commitment within ourselves to continue living — even when we’re unsure of how we’ll cope or move forward. In my experience, helpful conversations about consciously building an ethic to live, begin by first taking care to turn our attention to the reality that to live is to be vulnerable to an array of difficult life experiences, with the potential to evoke within us the thought to end one’s life to escape them. Throughout human history, individuals and peoples have had to confront extremely painful and unjust challenges which have overwhelmed their sense of being able to continue on, and it’s important to acknowledge that when we confront such considerable pain, it is the most human thing in the world to want relief from it. This is real; excruciating human suffering beyond one’s current sense of how to reduce or stop it is real, and in these concentrations of pain, we may find ourselves having suicidal thoughts.  

When we acknowledge and honor that such excruciating life experiences do show up for many of us, it’s then that we can locate where we need to begin building internal fences to prevent suicide. It’s here that we recognize the need to develop a strong ethic to live even though there are times that we might not yet fully know how we’ll cope or be able to see brighter ways forward. It’s also here that we find the need to define as individuals what makes life worth living with specificity to our own life experiences, as well as the need to find a listener who we can turn to and voice what’s going on inside of us. 

As you navigate life’s difficulties, no matter how hard things may get, make the commitment now to live and identify your personal reasons to do so. Additionally, identify suicidal thoughts as a  sign to find a listener who you feel safe enough to talk to. It’s worth thinking about right now who it is you might feel comfortable turning to during your hardest times. By doing so, you’ll begin to build your own internal fence between you and suicide as well as have greater insight as to how to help others you care about to do the same.  

* If you or someone you care about is currently having thoughts of ending their life, caring help is available 24/7 by texting 741741 from anywhere in the USA or you can call 1-800-273-8255 to speak directly with a Counselor from the National Suicide Prevention Lifeline. 

Bio: Laura Skaggs Dulin holds a master’s degree in Marriage and Family Therapy from San Diego State University. She currently sees clients at the Spanish Fork Center for Couples and Families and at Encircle LGBT Youth and Family Resource Center in Provo.  

Looking for Happiness and Finding Addiction

Our community is the epitome of mainstream America. We have deeply rooted family values, safe streets, moral standards, and most families stand guarded against outside influences that threaten our happiness. Recently, however, Utah achieved the 7th highest drug overdose rate in the nation. How can a community named Happy Valley have some of the highest rates of adult mental illness and teenage suicide in the country? 

Treating addiction is clearly a necessity. However, explaining these alarming and confusing statistics may also come down to understanding some myths, or assumptions, about happiness.  

Myth No. 1: I Should Be Happy All the Time 

Some aspects of our local community amplify and reinforce the well-intended message that “good people” or “my kid” should not or would not encounter pain. At times, we may even feel entitled to getting our way and therefore feel betrayed when we stress and we encounter unwanted but normal life struggles. These challenges show up as: loneliness, divorce, work stress, relationship issues, domestic violence, bullying, prejudice, low self-esteem, and chronic pain to mention a few.  

Myth No. 2: If I’m Not Happy, Something is Wrong with Me 

For decades, mental health symptoms have been twisted and misunderstood to the point that painful or overwhelming thoughts and feelings are now presumed to be products of weak, faulty, and unworthy minds. Labels like ‘Anxious’, or ‘Addict’ are now used so frequently and in such negative ways it distracts us from the real issue at hand. Those labels not only build a wall but also mask the reality that we all struggle in similar ways. Combine these objectifying terms with a competitive culture this myth grows more powerful and exponential.  

Myth No. 3: For a Better Life, I Must Get Rid Of Negative Feelings  

Every single one of us experiences self-judgment, fear, and shame of not measuring up. It can be overwhelming and discouraging. Unfortunately, we live in a culture that promotes numbing and hiding as the solution to any pain or discomfort.   

Anger, over-working, blaming, over-booking schedules, and isolation has been dependable sources of distraction for years. Some argue how safe and how little impact these behaviors have on themselves and others. Ironically, they assume that dependent or ‘addictive’ thinking and behaviors are only appropriate if describing illicit drugs and alcohol. Recently, more camouflaged options like sugar, caffeine, over the counter medication, smoking, power drinks, and trendy diets have become legal and justified ways to remedy unwanted thoughts or deal with social pressures. All of these behaviors, and others, are designed to alter reality, enhance social performance, and reduce stress. Unbeknownst to us, we end up trading one form of addiction for another.  

Everyone considers himself or herself an unwilling and/or unaware accomplice and each would avoid the road of undue suffering if possible. Here are three practical take home ideas that can help you start breaking yourself free from the shackles of these myths and identify and strengthen your core values so you can stay connected with reality.  

  1. Take time and energy to notice core values that you have and may share with others. Write down and/or share thoughts, feelings, and memories that help identify and strengthen your core values. Yoga, meditation, and other quiet activities will improve focus and self-awareness. 
  2. Compare less. Look for opportunities to learn about and accept the uniqueness of others. Admitting and accepting our weakness and vulnerability to others actually creates meaningful emotional and social bonds.  
  3. React less. Take a deep breath and refocus values that you can practice today.  

All of us long for acceptance, empathy, and connection from others but sometimes get stuck in the attractive web of addictive behaviors. If help is needed, reach out to others or professionals. Enjoy the search for happiness in the everyday pursuit of values, not distractions.  

Forced Apologies

My four-year-old daughter placed herself in the middle of our living room to play with blocks. She was so engrossed with building a wooden castle that she didn’t notice her two-year-old sister walking towards her with her right arm stretched far back to slap her older sister across the head. When that slap came, my older daughter went from happy to surprise to anger and then lots of tears. She ran towards me seeking justice. “Mommy, she hit me!” My younger daughter remained still, looking innocent. I immediately walked over to her with my older daughter in hand and said, “Hands are not for hitting. Say sorry for hitting please.”  I’m sure many parents can relate to this scenario. Teaching our children the skills for making amends is an important life skill and is not so much about saying the words “I’m sorry”.  

There is a belief amongst some parents that enforcing premature apologies on children is not effective. Their reasoning is that premature apologies teach children to lie and encourage insincerity. It also creates shame and embarrassment. Other studies show that young children have the ability to be empathetic even before they can speak; therefore, parents should encourage apologies (Smith, Chen, Harris; 2010). As I reflected on my research and my knowledge as a Marriage and Family Therapist, I recognized several things we can do as parents to create productive apologies: 

  1. Keep yourself in check: It’s frustrating to see your children fight, especially when it happens at inconvenient times. However, it’s important to remain calm and model for your children how to handle frustration.   
  2. Be immediate when possible: When you see an incident occur between your children, address it. The best time for learning and growth is when the incident is still fresh in their minds. However, when there are time constraints and the issue cannot be addressed right away, it is important to tell your children when and where it will be addressed. Be consistent when using the alternative and follow through.  
  3. Ask instead of tell: Avoid lecturing. Ask questions instead. “Tell me what happened?” “What were you feeling when you hit your sister?” Validate the expressed emotion and help them to understand that it is okay to feel frustration and sadness; however, it is not okay to hit or throw things. Help them to also make the connection between emotion and action. “Look at her face, how do you think she’s feeling right now?” Asking these types of questions enhances empathy. 
  4. Problem Solve: Ask questions about what they think they should do when they feel frustrated or sad. Help them to come up with solutions.  Ask questions about how they can make things better with their sibling/s. 
  5. Have them practice a do-over: When your child identifies the solution, have them practice it with the other sibling/s. Praise them for their efforts at the end.    

What is more important than the phrase “I’m sorry” is what children take away from the experience. We can facilitate and enhance learning opportunities by not focusing on the phrase “I’m sorry” but instead more on what can be learned from this situation and how can we improve.  

Behavioral Health: Integrated Care and the Future of Whole-Person Treatment

The term behavioral health has gained exposure and popularity more recently, particularly among medical providers and those involved in healthcare reform in the United States. Burg & Oyama1 define behavioral health as, “the psychosocial care of patients that goes far beyond a focus on diagnosing mental or psychiatric illness… [encompassing] not only mental illness but also factors that contribute to mental well-being”. This is the first of a series of articles which will introduce essential concepts and goals for integrated behavioral health treatment.  Why is this important?  The correlation between comorbid mental health and medical issues has mounting evidence for impacting healthcare cost, treatment outcomes, and patient satisfaction.  Comorbidity in this sense refers to the presence of two co-occurring issues influencing the progression and prognosis of either condition.  Well researched comorbid conditions include diabetes & depression2asthma & anxiety/panic3, and chronic pain & psychosocial issues4.  The good news is we are learning innovative ways to effectively treat comorbid conditions concurrently, thereby increasing the likelihood of successful outcomes and improved quality of life for patients. 

The sustainable future of healthcare in the U.S. will likely require efforts to improve consultation/communication, cross-discipline competency, and collaboration among clinical teams.  Traditionally, mental health specialists (i.e. psychologists, LMFTs, LCSWs, LPCs, CMHCs, etc.) have operated in relative isolation from the medical community.  Aside from psychiatrists, who are primarily trained as Medical Doctors (MD), many practicing psychotherapists have minimal training in the biomedical model of treatment.  And the inverse is true as well, wherein medical practitioners often have limited understanding of psychotherapeutic theory, psychosocial problem etiology, and effective behavioral intervention.  This is exceptionally problematic for the patient because practitioners involved in treatment may have dramatically different, and often conflicting, beliefs about mental health problems and their respective solutions.  Sperry5  suggests, “the goal of health care integration is to position the behavioral health counselor to support the physician… bring more specialized knowledge… identify the problem, target treatment, and manage medical patients with psychological problems using a behavioral approach”.  The future of medicine may very well be found in systems which prioritize such supportive collaboration, encourage patient-centered policy, and deliver on whole-person treatment options.  

Hopefully this educational introduction to behavioral health integration can serve as a starting point for further interest and exploration of the topic.  While this is a relatively new concept, I predict we will see a dramatic increase of integrative efforts emerge over the next several years as clinicians, administrators, policy makers, and third-party payers (i.e. insurance companies) recognize the cost-effectiveness and clinical efficacy of interdisciplinary collaboration.  We do not live our lives in a vacuum, and our problems are rarely isolated conditions in themselves.  Therefore, we will need innovators across various disciplines to create efficient and effective systems which benefit all parties involved with the daunting task of healthcare reform.  As patients, we can empower ourselves with education about how the biopsychosocial model might positively influence our role and options in treatment.  So, the next time you are at the doctor’s office and they ask you questions about mood and/or behaviors, and you think, “What does this have to do with my medical problem?”, now you’ll know.   

References 

1.Burg, M.A., & Oyama, O. (2016).  The behavioral health specialist in primary care: Skills for integrated practice. New York, NY:  Springer Publishing Company.   

 

  1. de Groot, M., Golden, S.H., & Wagner, J. (2016).  Psychological conditions in adults with diabetes. American Psychologist, 71(7), 552-562.    

 

  1. Ritz, R.,Meuret, A., Trueba, A.F., Fritzche, A., & von Leupoldt, A. (2013).  Psychosocial factors and behavioral medicine interventions in asthma.  Journal of Consulting and Clinical Psychology, 81(2), 231-250.  

 

  1. Gatchel, R.J.,McGeary, D.D., McGeary, C.A., & Lippe, B., (2014).  Interdisciplinary chronic pain management.  American Psychologist, 69(2), 119-130. 

 

  1. Sperry, L. (2014). Behavioral health: Integrating individual and family interventions in the treatment of medical conditions.  New York, NY: Routledge.  

 

Discovering You Have ADHD as an Adult

Attention-Deficit/Hyperactivity Disorder (ADHD) is not just a childhood disorder. As a neurodevelopmental disorder, ADHD is usually identified in childhood, but several individuals reach adulthood without being accurately identified as having the condition. An estimated 8 million adults in the United States suffer from ADHD. In many of these cases, it is attention, rather than hyperactivity, which is the primary problem; this form of the disorder, formerly called “ADD,” is one of the more common types of ADHD in adults.  

 Missing ADHD in Childhood 

While all adults who meet criteria for ADHD will always manifest some form of significant symptoms in childhood, the level of impact of these symptoms can be quite variable. Several children do not manifest the hyperactive or impulsive symptoms sometimes associated with the condition. Their behavior in the classroom and at home may not be entirely problematic. Instead of being disruptive, talkative, or irresponsible, they may only appear forgetful or flighty. Some children learn how to hide their distractibility or compensate for attention concerns. They may be embarrassed by their limitations, but may be motivated to keep up appearances. Some children are able to compensate for attention concerns with high intelligence, perseverance, flexibility, creativity, and other strengths. Many children might have difficulty understanding their symptoms. They might lack insight into whether there is a problem. They might not verbalize their symptoms in a way which would impel an adult to seek a consultation. 

Because of these reasons, the full impact of ADHD-related symptoms in a child may not be obvious to others. When parents or teachers do not see that there could be a problem, it is unlikely that the child will be referred for an assessment. Even more obvious cases are not always given the opportunity to be assessed for ADHD. Some parents may believe that there is a problem, but may be hesitant to access mental health services. 

 Noticing the Impact of ADHD 

As academic demands, work demands, and household responsibilities increase in adulthood, problems with attention can become more noticeable and more frustrating. Some adults may question whether they themselves have a problem as they see their siblings or their own children struggle with symptoms of the disorder. Many of the risk factors for ADHD, after all, are genetic factors. Adults who previously felt like they had effectively covered up their attention problems may sense that their coping mechanisms are losing their effectiveness.   

How ADHD can be Identified 

For adults who believe their own attention problems may have flown under the radar, there is a way to determine whether ADHD is present. Self-report questionnaires, used to compare an individual’s symptoms to hundreds or thousands of other individuals, can be helpful in providing information about the problem, but these are just one aspect of a comprehensive evaluation. An individual’s developmental history is important and this is usually obtained through a comprehensive interview with a psychologist, psychiatrist, or other qualified mental health provider. Computerized tests and performance-based tests can also help to assess the full extent of the problem. 

Sometimes attention problems can be due to normal forgetfulness. Sometimes these problems can be directly caused by depression or anxiety. Sleep problems and other medical problems can also negatively influence attention. Not everything that looks like ADHD is ADHD. Participating in a psychological assessment with a qualified provider can be an effective way to know the difference. Understanding the cause of symptoms is the first step in finding ways to improve.  

Originally published on Utah Valley Health and Wellness Magazine

CCD Smiles: One in a million

I am the only one in my family with CCD (Cleidocranial Dysplasia), which was a random mutation. Having CCD influenced my studies and career choices. I have always been fascinated by the body, genetics, and helping others with physical or emotional health problems. I started my career as an emergency room registered nurse. I did my Master’s thesis on CCD and then went on to obtain a Doctorate in Nursing Practice (DNP) degree. I have been a nurse practitioner for the past 14 years, working in family medicine and mental health. My background in medicine helps me better understand CCD. I want to share my experience and medical understanding with others.  

I was born in Reedley, California in 1975. When I was born, it was obvious to my parents and doctors that something was wrong. My body, mostly my head, was shaped differently than a “normal” baby’s. At 3 months of age, I was diagnosed with Cleidocranial Dysplasia. 

I grew up knowing I was different. The most difficult part of CCD was all the oral and facial surgeries. My baby teeth never fell out on their own, my permanent teeth didn’t grow in on their own, and I had several extra teeth which had to be surgically removed. Everything in my mouth had to be done manually. I started having oral surgeries at age 7 and I spent most of my Christmas, Spring, and Summer breaks undergoing surgery. My last major surgery was when I was 19 years old. 

 CCD dental treatment was not easily navigated. My dentists, orthodontists, and oral surgeons had never treated anyone with CCD. Everything they tried was experimental. 

Medical insurance and dental insurance did not cover the cost of my surgeries. Medical insurance considered my teeth problems to be dental. Dental insurance considered the surgeries cosmetic. My parents were paying for my surgeries until I was in college. 

When I was growing up, I didn’t know anyone with CCD. In 2001, technology helped me to connect with other people with CCD for the first time. I heard about other people’s experiences as I conducted phone interviews for my Master’s thesis “CCD: The lived experience.” Eight years ago, I met Steffani and her daughter Hally, who have CCD, for the very first time. 

 CCD Smiles 

I felt inspired to create a nonprofit organization to help others with CCD. I started working on the foundation in 2013. In 2016, Gaten Matarazzo’s dad contacted me. Together, we made CCD Smiles an official IRS approved nonprofit organization in January 2017. Since it’s official beginnings, we have had gatherings and fundraisers across the country. I have met 38 other people with CCD, which has been a tremendous blessing in my life.  

 Gaten Matarazzo, from the series Stranger Things, is a huge part of bringing awareness to CCD. As his popularity in Hollywood has grown, so has familiarity with CCD and CCD Smiles.  

CCD Smiles is still in its infancy, but you can go to www.ccdsmiles.org to learn more about us and watch us grow! Currently, the website is a place for donations, purchasing CCD swag and education about CCD. In the future, the website will be a place where those with CCD can connect, share pictures, exchange stories, and find hope. I want others to know they are not alone. It will also provide current and accurate medical information, written in plain English. Doctors, dentists, orthodontists, and surgeons can come together and discuss treatment, research, and options for their patients. 

As CCD Smiles grows and donations are made, we can help cover the costs of oral/facial surgeries. If insurance isn’t going to help, then we can. I don’t want the medical/dental expense to keep parents from being able to provide beautiful smiles for their children. 

My ultimate dream is coming true. July 13-15, 2018 will be the first national CCD conference in Salt Lake City.  Watch the website for more information. If anyone is interested in donating time, money, or talents to this event, please email me at kellywosnik@ccdsmiles.org. 

CCD Smiles Mission Statement: We bring global awareness, provide assistance for dental care, and support research to improve outcomes and quality of life for individuals with cleidocranial dysplasia. 

CCD Smiles can be found in the media and on social media— Instagram, Facebook and Twitter (@ccd_smiles, #ccdsmiles) 

Originally published on Utah Valley Health and Wellness Magazine

Now accepting SelectHealth insurance

We are excited to announce that we are now paneled with Select Health. This includes the following plans – Select Choice, Select Care and Select Med. Call us to set up an appointment today!

Now accepting SelectHealth insurance

We are excited to announce that we are now paneled with Select Health. This includes the following plans – Select Choice, Select Care and Select Med. Call us to set up an appointment today!

Utah Valley Health and Wellness magazine September/October 2017

Check out articles on health and wellness from our therapists!