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Intuition Wellness Center Welcomes Child and Family Clinician

For several months, Intuition Wellness Center embarked on a very focused search to fill our position for a Child and Family Clinician– someone who possessed the knowledge and skills necessary to assist us in providing services of the highest quality to Tucson area children, adolescents and their families. We searched for someone who was, not only qualified, but embodied Intuition Wellness Center’s values, including our commitment to the community and providing services of the highest quality, which are ethically and clinically-sound, culturally sensitive and rooted in science.

We were fortunate to receive applications from many qualified professionals. Graziella “Grazi” Martins, a Licensed Clinical Social Worker, who specializes in children, adolescents, and families recently joined our team and we couldn’t be more pleased to be working alongside and with her! Ms. Martins brings with her experience working in multiple settings and with a variety of presenting problems.

Ms. Martins is a gregarious and down-to-earth therapist who truly embodies the compassionate and collaborative nature of our small group practice. She takes a fun and directive approach that integrates talk, behavioral and play therapy modalities. Ms. Martins is currently accepting new clients, ages 3-20. Call us today to schedule an initial appointment with Ms. Martins.

Welcome, Ms. Martins!

–Dr. Yoendry Torres and Dr. Brandy Baker

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Raising Resilient Kids, Part 2

A few weeks back, I ventured into blogland just briefly to share some thoughts about resilience in Part 1 of this series. A few days later, I was fortunate enough to speak to a group of parents about promoting resilience through an event hosted by the Northbrook Citizens for Drug and Alcohol Awareness (NCDAA). Through our discussion, it became clear to me that there is a common misperception that resilience is dichotomous—a have or have not—a pretty scary notion if you think about it and an awful lot of pressure for concerned parents to be carrying around. The good news is that everyone is resilient to some degree. The bad news is, after re-reading my last blog, I realized that I may have fed into this unfortunate misperception by suggesting that resilience is something only exhibited by the “outliers” in society. So, I’m here to clarify and maybe to put some minds at ease. Whether you consider yourself an outlier or not, you are resilient! Your children are resilient! We are all resilient! That said, there are things that can be done to maximize each person’s resilience quotient.

http://www.jcfscommunities.org/blog/2012/12/4/raising-resilient-kids-part-2.html

By Brandy Baker, PsyD, Clinical Psychologist

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Raising Resilient Kids, Part 1

A couple of weeks ago, Jewish Child and Family Services (JCFS) promoted me to guest blogger and invited me to write about a topic of my choosing. I have been interested in the concept of resilience for quite awhile and pounced on the opportunity to share some of my knowledge in a blog format. Part One of the blog is currently posted on the JCFS blog site with Part Two set to air soon.

One thing that I always struggle with is finding an accurate way to define resilience as it looks different for each of us. In your opinion, what does resilience look like?

Author: Dr. Brandy Baker, Clinical Psychologist

 

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Depression 101: Treatment & Tips To Ward Off Depression

Stress Management
Depression is a common mental health illness in the US and around the world. In fact, the Center for Disease Control and Prevention states that 1 in 10 adults in the US report experiencing depression. What is most troubling to me is that only about 51% of those people suffering from depression seek out treatment according to the National Institute of Mental Health. Depression may begin at any age and may be caused by any number of triggers such as bullying, parental or marital conflict, sense of isolation, loss, seasonal causes, etc.

As a result, I wanted to write a blog post specifically on depression, its treatment, and offer wellness tips to ward off depression. Please note that depression is one of several mood disorders and is different than bipolar, dysthymia, and other mood disorders. This blog post will focus on depression technically known as Major Depressive Disorder. I also want to make it very clear that depression is a treatable illness but, like many illnesses, it can require ongoing “maintenance.”

First let me review the symptoms of depression, followed by the treatment, and then offer some tips to ward off depression.

Symptoms of Depression: To meet criteria, five or more symptoms must be present for at least a 2 week period according to the Diagnostic and Statistical Manual of Mental Disorders. It is also very important to rule out physiological effects of a substance/drug, other psychiatric disorders such as bereavement, and medical conditions such as thyroid problems that may cause depressive symptoms.

  • Sad or depressed mood most of the day, almost every day.
  • Anhedonia, which is loss of interest in previously enjoyed activities.
  • Sleep problems, usually hypersomnia but can also be insomnia.
  • Weight gain or loss not due to diet or exercise.
  • Low of energy or fatigue even with sufficient rest.
  • Psychomotor agitation or retardation, which is usually moving or talking slower.
  • Poor concentration or ability to think.
  • Feeling of worthlessness or excessive guilt.
  • Thoughts of death or suicide, which could be the most serious of all the symptoms and must be taken seriously even in children.

Here are some other symptoms to look for that are frequently present in depression:

  • Thoughts of helplessness
  • Thoughts of hopelessness
  • Isolation
  • Changes in appetite
  • Irritability
  • Crying
  • Decrease in sex drive

Treatment for Depression
Treatment for depression begins with an evaluation by a licensed mental health professional to determine severity of depression, to rule out other possible issues, and to refer for appropriate services. Treatment usually entails either counseling or psychotropic medication or a combo of both, depending on severity. Severe depression usually requires a psychiatric evaluation by a psychiatrist for psychotropic medication to help improve symptoms enough for counseling to be effective, while mild to moderate depression can usually be treated with counseling alone. It is important to know there are a countless approaches to counseling such as cognitive behavior, psychodynamic, humanistic, and many more. Many approaches explore the person’s feelings, thoughts, and behaviors. The trust developed between the client-therapist relationship is what many approaches have in common and what research has found to be an essential ingredient to effective treatment. That is why it is imperative that one choose a therapist that is a good fit.

In addition, there are other interventions or activities such as exercise and meditation that have been found to be effective treatment for mild to moderate depression. Family therapy can also be helpful at alleviating tensions at home that may be impacting one’s depression and hindering treatment progress.

Tips to Ward Off Depression

  • Exercise Regularly as it has been found to be fantastic not only for managing stress and preventing physical problems but also at reducing depression and anxiety.
  • Be Present is where people often report being happy while being in the future can create anxiety and being in the past can lead to feelings of regret, guilt, and depression. Focus on being more mindful about how you are feeling right now rather than how you felt weeks or years ago.
  • Seek Support from licensed mental health professionals, friends, family and even animals, whom can be helpful. Surround yourself with people that are positive and validating.
  • Know the Signs of depression so that you know when you or someone you in your life needs help.
  • Know your Depression and be proactive. If you know that you happen to be extra susceptible to depression during the winter months, prepare for it by scheduling regular activities or seeking extra support during this time.
  • Get Outside because sunlight can be helpful and so can nature. Experiencing the grandeur nature can help put one’s problems into perspective and when our problems seem small they don’t bother us as much.
  • Find Meaning or a reason for living as it can be a powerful motivation to keep living. One’s meaning can be their partner, children, or even a cause.
  • Sleep is vital to good health and mental functioning. Avoid sleep problems by having a regular bedtime even on weekends, keeping distractions from the bedroom (e.g., TV), and creating a bedtime that is conducive for relaxation.
  • Visit Your Primary Care Doctor regularly to prevent, catch, or treat medical illnesses early that can create depressive symptoms.
  • Eat Healthy meals to improve physical, mental, and emotional functioning. Eating unhealthy foods erodes your physical health, impairs cognitive functioning, and also impacts how you feel about yourself.
  • Respect your Emotions rather than stuffing them. Bottling your feelings can be toxic to your body while expressing how you feel can be very relieving especially when your feelings are validated.

Author: Yoendry Torres, Psy.D., Clinical Psychologist

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Mental Illness Stigma – A Silent Killer

The stigma of mental illness is a significant problem in our society that may be killing us silently. I cannot count the times that a new client shook their head no while saying “I’m not crazy” or a family member pointed their finger exclaiming “I’m not crazy, they’re the problem.” I also witnessed many times pedestrians on the street, commuters on a bus, or shoppers at a supermarket ridiculing someone because of a perceived mental illness. Not surprisingly, the feelings of shame and embarrassment come to mind among others that would hinder one’s ability to seek treatment in the first place and take full advantage of treatments available for mental illness.

Unfortunately, that mentality is a commonly held societal belief that is problematic and detrimental to treatment. Consider some of the harmful effects of the stigma of mental illness as outlined by the Mayo Clinic:

  • Lack of understanding by family, friends, colleagues or others you know
  • Discrimination at work or school
  • Difficulty finding housing
  • Bullying, physical violence or harassment
  • Health insurance that doesn’t adequately cover your mental illness
  • The belief that you will never be able to succeed at certain challenges or that you can’t improve your situation
  • Stigma of mental illness is also a major barrier to psychological treatment because it prevents some people from seeking treatment in the first place. This is a major problem because according to the National Institute of Mental Health about 10% of adults in U.S. suffer from a mood disorder and another 18% from an anxiety disorder in any 12 month period. Only 51% of those experiencing a mood disorder and 37% of those experiencing an anxiety disorder are receiving treatment. To make matters worse, there is an overwhelming amount of research linking mental illness to suicide. The American Association of Suicidology reported that “in 2006, suicide was the eleventh leading cause of death in the U.S., claiming 33,300 lives per year” and “the risk of suicide in people with major depression is about 20 times that of the general population.” That same report cited research by Isacsson and others (2000) adding that “the suicide risk among treated patients is 141/100,000,” which is significantly lower than 20% for untreated depression.

    Stigma also prevents others from fully engaging or benefiting from the therapeutic process. Let me illustrate how stigma associated with seeking services can hinder effective treatment with an example from my clinical experience:

      About a year ago, I began treating an adolescent client who was experiencing several symptoms of depression, including sadness, isolation, irritability, thoughts of worthlessness, and thoughts of death, as well as attention-seeking behaviors. After a couple of months of weekly meetings with the youth, it became clear that she felt ignored by one withdrawn parent. She responded to that parent’s withdrawal by engaging in problematic behaviors intended to gain attention. I made numerous attempts to engage that parent into family therapy with little success. During one brief individual meeting, that parent stated “I’m not crazy, my child has the problem” and refused to participate in family therapy. Although it was beneficial for that youth to learn to cope and express her feelings appropriately, including her parent in sessions would have expedited therapeutic progress if the parent would have been willing to take a look at what their role in the ongoing problems were and make some changes. Moreover, it could have been fruitful for that parent also, as it could have provided some insight into their daughter’s problematic behavior and possibly lead to an improved and more satisfying relationship. This client went on to make substantial progress, seeing decreases in many symptoms especially thoughts of death, but it took many more months than if her parent had attended and participated in therapy sessions. Sadly, the youth’s relationship with her parent was not repaired.

    It could be extremely productive for children and adolescents to involve parents or guardians into family therapy, as this approach can improve dysfunctional interactions and poor communications that plague the family. Below are a few strategies that clinicians, physicians, or anyone else who wants to eliminate the stigma of mental illness might consider utilizing.

    Strategies for Overcoming Mental Illness Stigma

    Motivate. Many people will not engage fully into any activity they do not see a value in or worthwhile. The same is true for psychotherapy. Explain how counseling will benefit them, but be specific providing examples of how exactly therapy would make their life easier, happier, more fulfilling, etc.

    Redefine. Many people still consider people who are homicidal or psychotic to be “crazy” and the only ones receiving mental health care. In actuality, people seek treatment for all types of issues including behavioral problems, depression, and marital conflict just to name a few.

    Engage, engage, engage! Do not give up after your first attempt to encourage someone to begin treatment. Be persistent. I have found that it is useful to “trouble shoot” and find solutions to obstacles preventing them from participating in treatment.

    Educate. Information helps people make informed decisions. If you are informed about mental illness, its consequences, and its treatment, share your knowledge.

    Be Patient. Many people hold on to long-held beliefs due to societal or cultural influences. Be aware that it takes time to make change, especially one that involves reframing our worldview. Be patient and do not give up or blame the individual.

    Recruit. There is strength in numbers. Recruit allies such as family members, friends, service providers or others to help overcome the stigma of mental illness.

    Advocate. There are many local and national organizations that are fighting the stigma of mental illness by educating the public about mental health issues, lobbying congress for mental health parity and to prevent discrimination towards people with mental illness, conducting research, and offering support. Get involved! There are many ways one can take action and help end the stigma of mental illness. The National Alliance on Mental Illness (NAMI) is one such organization worth looking into if you are interested in advocacy.

    Author: Dr. Yoendry Torres, Clinical Psychologist

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    Stress & Anxiety: Wellness Tips

    Stress Management

    According to the National Institute of Mental Health about 18% of adults in the United States experience an anxiety disorder while only 37% of those receive treatment. Meaning that about 63% of adults affected do not seek out services for treatable anxiety disorders. There are many triggers that increase stress and anxiety such as relationship conflicts, financial hardship, and school or work demands. According to a Centers for Disease Control and Prevention National Institute for Occupational Safety and Health report 26% to 40% of workers responding to surveys reported that their jobs were very stressful. That is important because stress and anxiety impairs functioning whether that be academic or occupational, leading to injury or lower productivity. The first step to wellness is becoming aware of your physical and psychological reactions to stress and anxiety. Below are some common signs of stress and anxiety:

    • Headaches or backaches
    • Muscle tension and stiffness
    • Diarrhea or constipation
    • Nausea, dizziness
    • Insomnia
    • Chest pain, rapid heartbeat
    • Weight gain or loss
    • Skin breakouts (hives, eczema)
    • Loss of sex drive
    • Frequent colds (impaired immune functioning)

    Furthermore, scientific evidence suggests that stress impacts your physical health. Many medical conditions are caused or exacerbated by stress, including:

    • Chronic pain
    • Migraines
    • Ulcers
    • Heartburn
    • High blood pressure
    • Heart disease
    • Diabetes
    • Asthma
    • PMS
    • Obesity
    • Infertility
    • Autoimmune diseases
    • Irritable bowel syndrome
    • Skin problems

    Wellness Tips

    1. Know yourself – Understanding how you experience stress is a vital step towards identifying what is causing you stress and preparing for or preventing it in the future.
    2. Identify causes of stress – Knowledge is power. Once you know what your triggers for stress or anxiety are, you can take steps to minimize its effect.
    3. Eat healthy – Good physical health promotes good mental health and vice versa. Stressed people tend to overeat or make unhealthy nutritional choices, so choose healthy foods and eat in moderation.
    4. Be proactive not passive – Don’t just sit with your hands crossed waiting to feel better, cope with stress actively by engaging in healthy stress relieving activities such as exercise, art, music, or dance.
    5. Get plenty of Zzzzzz – Poor sleep hygiene can leave you tired and cranky in the morning making you more susceptible to stress, so get the recommended 8 hours of sleep on a regular basis.
    6. Laugh, it is good for the heart – Laughing produces feel-good brain chemicals that relief stress and promote wellbeing.
    7. Live in the now: Many people experience anticipatory anxiety for something that hasn’t happened or ruminate over past events not realizing that in the actual moment there is nothing stressing them.
    8. Social support – The ability to seek out and have social support has been associated with resilience, the ability to bounce back from stress. There is a reason why humans are social beings.
    9. Seek professional help: When symptoms persevere and begin to impact functioning in other areas of your life such as school or work, therapy has been shown to help.

    Author: Dr. Yoendry Torres, Clinical Psychologist

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    Couples Gridlock – 8 Tips to Improve Communication

    Couples Gridlock

     

     

     

     

     

     

     

     

     

     

     

     

    Quite often problematic communication styles are the primary contributors to dysfunction in couples and families, leading to misunderstanding, resentment, and anger towards each other, not to mention gridlock. There are several common problematic communication styles that can be disastrous to any relationship. Here are a few common problematic communication styles that have been found to be detrimental to relationships by renowned couples therapists and researchers, Drs. John and Julie Gottman:

    • Harsh startup – Arguments starting with attacks using, for example, criticism or sarcasm rather than hearing out the partners options, thoughts, and feelings about a matter.
    • Criticism – Direct attacks to a partner’s character often using disrespectful and offensive words to describe their faults.
    • Contempt – Demeaning one’s partner using sarcasm and cynicism, often time expressing disgust by eye-rolling, sneering, mockery, or hostile humor.
    • Stonewalling – Withdrawing from the conversation in an attempt to avoid the conflict or tune out the partner, for example by turning away.
    • Defensiveness – Denying responsibility for any part of the conflict and instead blaming one’s partner or finding excuses.

    Mental Health Implications

    According to the U.S. Census Bureau divorce rates have risen from 15.1 million (from a total of 112.6 million married) in 1990 to 23.2 million (from a total of 130.3 million married) in 2009. Besides the higher likelihood of relationship dissatisfaction, separation, or divorce, children are also affected by their parents’ difficulty in resolving conflicts. There is a wealth of research indicating that children’s mental health is negatively impacted by parental discord affecting their psychological health in adulthood. For example, in a Report from the Department of Health and Human Services (2009), it was noted that “marital conflict has been found to elicit negative, aggressive behaviors in children, in both boys and girls” and that “the ability of parents to resolve their conflicts successfully was associated with self-reported levels of anxiety in children (Kerig, 1996). That is, parents who more constructively resolved their conflicts had children who reported lower levels of anxiety.” Moreover, children exposed to parental discord may experience symptoms of anxiety such as racing thoughts, poor concentration, feeling nervous, and sleep problems. Such symptoms may contribute to diminished academic functioning or problematic behavior. The impact on children alone is a compelling reason to improve one’s ability to communicate effectively.

    8 Communication Tips

    1. Respect each other – Harsh startups using criticism or contempt will just make your partner more defensive and angry. Instead, set ground rules for arguing; for example, no name calling or sarcasm.
    2. Truly listen and reflect – Listening includes the ability to reflect back and summarize what you heard. So try not to be defensive or think of a counter-argument while listening to the other person speak, instead check in with them to make sure you understood their side correctly.
    3. Be honest – Integrity, or owning up to one’s mistakes or shortcomings, is critical in order to move passed gridlock.
    4. Body language – One’s true intent and emotion is communicated through one’s body language. Just as yelling does not communicate love or understanding, watching TV or talking on the phone while a partner attempts to communicate with you suggests that you are disinterested.
    5. Take a break – When one becomes angry, a number of physiological reactions occurs, including increased heart rate and blood pressure, making it difficult to think clearly or rationally. Take an hour or more to calm down before attempting to repair things again.
    6. Provide solutions – When discussing a problem with your partner don’t just complain about what they are doing wrong, rather come up with what you would like them to do, which would help improve the situation.
    7. Be a team – Many times couples begin to lose sight of their common goal and begin to see each other as rivals. Instead, view each other as team members, refocus goals, and work towards them together.
    8. Seek professional help – It is difficult to see one’s problems objectively from within and seeking outside professional help may allow you to learn and practice healthier communication styles in a safe, confidential setting.

    The American Psychological Association has more communication tips specifically geared toward improving communication with one’s children.

    Author: Dr. Yoendry Torres, Clinical Psychologist

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    Obesity in the US – Mental Health Implications & Recommendations

    US Obesity Trends Map

     

     

     

     

     

     

     

     

     

     

     

     

    Obesity in the United States is a major public health concern affecting not only an individual’s physical health but also their mental health and the emotional health of their family. Obesity is defined as having a Body Mass Index (BMI) of 30 or higher, which is calculated using one’s weight and height. Weight gain and obesity result from consuming more calories than the body requires given the level of physical activity.

    Two of the leading culprits of obesity are sedentary lifestyles and the quantity and quality of one’s diet. Some other factors that impact obesity include genetics, metabolism, endocrine problems, and culture. The Surgeon General (2010) recommends 60 minutes of moderate physical daily exercise for children and teenagers and at least 150 minutes weekly for adults. The United States Department of Agriculture (USDA) has updated its Dietary Guidelines for Americans recommending half your plate be fruits and vegetables and half be grains and protein.

    Here are some alarming statistics from the Surgeon General 2010 Report that will hopefully move one to make meaningful lifestyle changes that lead to happier and healthier lives.

    • Obesity contributes to an estimated 112,000 preventable deaths annually (Surgeon General, 2010).
    • Obesity increases one’s health risk of developing diabetes and cardiovascular disease (Surgeon General, 2010).
    • Mental health problems such as depression are associated with obesity (Surgeon General, 2010).
    • Obesity is also an increasing problem for children, rising from 5% in 1980 to 17% in 2008 (Surgeon General, 2010).
    • There are disparities among some racial groups: 29% of non-Hispanic black teenagers and 17.5% of Hispanic teenagers are obese, while the prevalence for non-Hispanic white teenagers is 14.5% (Surgeon General, 2010).
    • Obesity is “more prevalent in persons with mental illness with some reports indicating 83% of people with serious mental illness being overweight or obese” (Surgeon General, 2010).

    These statistics are shocking and getting worse every year, just check out the CDC US Obesity Trends by State Map. Many health providers and even First Lady Michelle Obama with her Let’s Move initiative have seen this crisis as a call for action and are working hard to ameliorate this issue. However, the focus has usually been on the physical impact of obesity, often neglecting or downplaying the mental health implications.

    MENTAL HEALTH IMPLICATIONS
    Given the increasing number of obese or overweight people in the United States and the associated mental health problems such as depression, one can speculate that depression rates will also increase. Addressing depression and other mental health issues associated with obesity is important because one’s emotional state can affect compliance with treatment plans and medications. Depressive symptoms include:

    • Low energy
    • Low motivation
    • Fatigue
    • Poor concentration
    • Anhedonia (i.e., diminished interest in previous enjoyable activities)
    • Depressed mood
    • Irritability
    • Decreased or increased appetite
    • Decreased or increased weight
    • Insomnia or hypersomnia
    • Feelings of worthlessness
    • Thoughts of death and suicide

    Each of the above depressive symptoms can complicate treatment for obesity; for example, having low energy, motivation, and fatigue reduce the likelihood of following through with workout routines, taking medications, complying with treatment plans, or adhering to nutritional recommendations. Furthermore, family members are affected by partners and children who are depressed, as it can be difficult living with a depressed individual who may be easily irritated or has little to no interest in doing anything fun. Not surprisingly, children of depressed parents are at higher risk for their own psychiatric problems, interpersonal difficulties, and academic challenges.

    RECOMMENDATIONS TO REDUCE THE RISKS OF OBESITY AND MENTAL HEALTH IMPLICATIONS

    • Seek professional help – Just like you go to a doctor to treat diabetes or go to a mechanic to fix your car, seek professional counseling/psychotherapy to treat depression or other mental health illnesses.
    • Make lifestyle changes – Implement longterm health driven changes to your diet and exercise routines rather than temporary ones.
    • Manage stress – Stress can zap your energy leaving you tired and irritable, so manage it actively by incorporating coping skills such as meditation, exercise, or play into your daily routines.
    • Make exercise fun – Discover alternative ways to get exercise by joining a group fitness class, enrolling in a martial arts school, taking dance lessons, going for a bike ride, or training with a friend.
    • Take a hike – The magnificence of nature can be therapeutic so go for a hike at a nearby trail to burn some calories and reflect on life.
    • Limit TV – Keep TV out of children’s rooms and limit TV time. Instead encourage children to participate in sports or other physical activities that foster moral and social development.
    • Get plenty of sleep – Lack of sleep not only impacts your energy level but also your mood and concentration so get to bed early on a regular basis. Create nighttime wind down routines to relax and promote good sleep.
    • Eat in moderation – Do not supersize your meals, instead eat smaller, recommended portions. Don’t forget to manage your stress as it can increase emotional eating.
    • Eat healthy foods – Avoid greasy, fatty, processed, fried foods and put down sugary drinks such as sodas. Eat more fruits and vegetables and drink lots of water. Make healthy snacks easily accessible at home.
    • Make it a family event – Working out with your partner can be motivating and reinvigorating to your relationship while going to a park with your children to play can create stronger bonds and teach family values.
    • Lead by example – You are your children’s biggest role model, if you start eating fruits and veggies and begin exercising so will they.

    Author: Dr. Yoendry Torres, Clinical Psychologist