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Showing posts with label mental health. Show all posts
Showing posts with label mental health. Show all posts

Monday, June 4, 2018

The Struggle is Not Only Real, It is Necessary


By: Angela Currie, Ph.D.
Pediatric Neuropsychologist

From an early age, we are subliminally taught that stress is a bad thing. Whether frustrated because your LEGO tower broke or confused about which two paint colors to mix to get green, you were more likely to hear “Calm down – no reason to get stressed,” than you were to hear “Let’s use your stress to help us make a plan for how to solve this problem.”

For most adults, the natural, well-meaning response to a child’s expression of stress, or most any unwanted feeling, is to try to fix it, make it go away, avoid it, or make it seem like it isn’t such a big deal. We do this by saying things like:

“Don’t be sad.”
“No need to worry about it.”
“It’s not as bad as you think it is.”
“Just try thinking about something else.”
“Let me do that for you.”

We all say and do these things, and the good intention is clear. Nobody likes to see a child struggle or experience discomfort. Unfortunately, manageable stress and discomfort is necessary for growth. When we minimize, distract, or dismiss a child’s emotional reaction, we are sending the message that feelings are unimportant, untrustworthy, and bad. This means that we are also missing the opportunity to teach the child about why we have feelings, and how even the unwanted ones are incredibly useful.

Stress and anxiety are at an all-time high nowadays. It is important to think about small things that we can do each day to help children feel more confident and competent in their ability to navigate this stressful world. One of the best ways we can help them to become more resilient is by creating an environment where emotions are acknowledged, accepted, and used in a functional manner. To start doing this, here are some basic things to keep in:

1) Feelings are information. They are telling us that something is important and may require our attention.
2) Feelings are never bad or “negative,” though they may be unwanted.
3) Stress is often a good thing – without it we would not prepare for tests, show up to work, or care about our relationships. Life without stress would be pretty unfulfilling.
4) The goal is not to control stress or other unwanted feelings – the goal is to recognize, use, and cope with them.
5) Acknowledging and accepting unwanted emotions is one of the best ways to reduce their impact.
6) Regular, casual discourse about wanted and unwanted feelings is healthy and normal. If we talk about the day to day feelings, it will make it easier to talk about the “big ones.”
7) Let children struggle sometimes. Don’t feel the need to fix things right away. Help them express how they're feeling, gently guide them toward problem solving, and praise their persistence in the face of challenge.

About the Author 

Dr. Currie specializes in the evaluation of anxious children and teens, working to tease apart the various factors lending to their stress, such as underlying learning, attentional, or emotional challenges. She particularly enjoys working with the seemingly “unmotivated” child, as well as children who have “flown under the radar” for years due to their desire to succeed.

Monday, May 28, 2018

Education for Life: Social Emotional Learning


By: Nancy Roosa, Psy. D.
Pediatric Neuropsychologist

The agonizing discussion around the tragedy of school shootings – happening on a weekly basis in this country -- too often devolves into a polarized argument about whether the main problem is guns OR mental health. The argument seems moot, since BOTH access to a firearm and mental health problems have to come together – in one troubled individual - to result in one of these large-scale school massacres. Therefore, while the discussion about gun control is an important one, I’m going to leave that for another forum. In this blog, in my role as a psychologist, I’d like to focus on how we can improve the mental health of our children.

There is no clear answer as to why some students choose to go on a deadly rampage against members of their own community – the peers and adults they spend time with every day – although clearly something has gone very wrong for them in that community. Some research does link bullying and social isolation to school shootings. The U.S. Secret Service and the U.S. Department of Education in a 2004 report found that “almost three-quarters of the (school shooting) attackers felt persecuted, bullied, threatened, attacked, or injured by others prior to the incident. In several cases, individual attackers had experienced bullying and harassment that was long-standing and severe. In some cases, the experience of being bullied seemed to have a significant impact on the attacker and appeared to have been a factor in his decision to mount an attack at the school.”

I do not want to blame the victims, by somehow implying that the social environments at Columbine, Sandy Hook, Parkland and Santa Fe – and all the other sites of horrific massacres - were particularly cruel or harsh. We know that some students at every school feel ostracized and alone, and some are also coping with other serious life stresses, i.e. living in families stressed by poverty, addiction, and/or mental health challenges. But just because this is commonplace doesn’t mean we should accept it. Our society needs a stronger safety net, so that all children are safely housed, well fed and emotionally nurtured in their families, outside of school.

In addition, schools are increasingly recognizing their part in raising the next generation of emotionally mature and secure individuals, and many are attempting to include “social-emotional learning (SEL)” in the curriculum. But while everyone might agree that SEL is a good idea, few people seem to know how to teach it. A recent study by the nonprofit organization CASEL (Collaborative for Academic, Social, and Emotional Learning) found that 83% of principals believe that social-emotional learning is important and a full 95% say they are committed to developing their students’ social and emotional skills. However, only 38% of them had a plan for implementing such learning. Clearly the importance of SEL has been recognized, but doing it well – or doing it at all – still leaves many educators at a loss. Implementing an effective SEL program does require substantial resources – time, money and expertise. Teachers and staff must be trained and then spend time and energy every day implementing the plan. How can we expect schools to find those additional resources when they are already underfunded for the many tasks they are currently charged with? Adding SEL effectively will require that we provide adequate funding to our schools.

Yet, some research shows that the resources invested in SEL bring a hefty payback, not just in social emotional health, which is clearly hard to measure, but also in students’ academic achievement. In 2011, a meta-analysis published in the journal Child Development found that students who participated in a well-implemented SEL program showed an 11 percent gain in academic achievement. In 2015, a study in the Journal of Benefit-Cost Analysis found an $11 benefit for every $1 spent on a rigorous SEL program.

Here in Boston, we have our own success stories involving SEL. One local school, the Mildred Avenue K-8 School in Mattapan, was, 5 years ago, one of the district’s lowest performing schools, at risk of a takeover; now it’s classified as a “level 1” school, the highest category, based on student achievement. Last fall, they were awarded the coveted School on the Move prize by the nonprofit organization Edvestors, which has, for the past 12 years, awarded this prize to a school within the Boston public school district that has made the most progress, based on quantifiable data about student achievement. This school, as well as the other two finalists at this year’s award ceremony in November, highlighted that one important factor was implementing social-emotional learning across the curriculum. They also spoke about the importance of teacher empowerment and creating a sense of an inclusive community in their schools.

Clearly SEL works. Let’s look a bit more closely at what it involves. The cornerstone of SEL learning is gaining five essential skills and competencies, according to CASEL.
1. Self-awareness: recognizing and labeling one’s feelings and accurately identifying one’s strengths and limitations.
2. Self-management: regulating emotions, delaying gratification, managing stress, motivating oneself, and setting and working toward achieving goals.
3. Social awareness: showing empathy, taking others’ perspectives, and recognizing and mobilizing diverse and available supports.
4. Relationship skills: clear communication, active listening, cooperation, nonviolent and constructive conflict resolution, knowing when and how to be a good team player and leader.
5. Responsible decision making: making ethical choices based on consideration of feelings, goals, alternatives and outcomes, and planning and enacting solutions with potential obstacles anticipated.

This is an ambitious list, and we don’t expect these skills to be mastered by 10th grade along with the ability to write a 5-paragraph essay. These are skills that one can—and should!—spend a life time learning. But just pondering this list for a few minutes makes me realize that these are the qualities I value in the people I interact with—my colleagues, friends, and family members—and they are the main qualities that determine whether one lives a productive, satisfying life … much more so than one’s MCAS score.

Will implementing SEL in our schools stop all mass shootings? Sadly, probably not. But will it allow more of the next generation of Americans to grow into socially and emotionally competent individuals? I’d suspect that answer is yes. So let’s start the conversation about this – in every home, in every neighborhood, in every school. Let’s keep our Eyes on this Prize: educating every child for life.

There are a plethora of programs claiming to promote SEL, and a few important guides to distinguish among the programs. Anyone interested in learning how to implement an SEL program could start with one of the following guides.
· The 2015 CASEL Guide: Effective Social and Emotional Learning Programs (CASEL.org).
· How to Implement Social and Emotional Learning at Your School, by Maurice J. Elias, Edutopia, March 24, 2016.
· Selecting the Right SEL Program, by Leah Shafer, June 20, 2017. Harvard Graduate School of Education.

About the Author 

Nancy Roosa, Psy.D. has been engaged in providing neuropsychological evaluations for children since 1997. She enjoys working with a range of children, particularly those with autism spectrum disorders, as well as children with attentional issues, executive function deficits, anxiety disorders, learning disabilities, or other social, emotional or behavioral problems.

Dr. Roosa’s evaluations are highly-individualized and comprehensive, integrating data obtained from a wide range of standardized assessment tools with information gained from history, input from parents, teachers and providers, and important observations gleaned from interacting with the child. Her approach to testing is playful and supportive.

Her evaluations are particularly useful for children with complex profiles and those whose presentations do not fit neatly into any one diagnostic box.

Monday, March 12, 2018

Intensive Cognitive-Behavioral Therapy (CBT) for Anxiety


By: Ryan Ruth Conway, Psy.D.
Clinical Psychologist, NESCA

Deciding to enroll your child in mental health treatment is a big step in and of itself. Before initiating the process, there is often a trial and error period of interventions to improve the situation, whether at home or in school, and then coming to terms with the fact that they might not be enough to sufficiently address your child’s needs. Finding the right therapy and therapist match for your child can also prove challenging. Not only are there numerous therapeutic approaches available, but there are also varying levels of care depending on the severity of your child’s symptoms and amount of support he or she requires. This ranges from once weekly outpatient therapy to day treatment programs to inpatient hospitalizations for more acute psychiatric issues that may require crisis stabilization (i.e., suicidality, self-harm, etc.)

One type of treatment that has garnered considerable empirical support for treating youth anxiety and depression (conditions we regularly treat at NESCA) is Cognitive-Behavioral Therapy (CBT). CBT focuses on the intersection between our thoughts, emotions, bodily sensations and behaviors. The goal of CBT is to better manage overall emotional distress and reduce physiological symptoms by changing negative thoughts or unhelpful thinking patterns, ineffective coping strategies, and maladaptive behaviors that might be reinforcing uncomfortable feelings. CBT aims to teach children and their parents new, adaptive coping skills while providing opportunities both in and between sessions to practice these skills. CBT is a short-term, targeted treatment that promotes “approach” behaviors (as opposed to “avoidance”) through “exposures,” or exercises designed to practice facing fears gradually, in a safe environment. CBT might also include learning mindfulness, emotion regulation, and distress tolerance; techniques that have been shown to enhance treatment outcomes.

While some youth make progress in meeting with a therapist once per week, others benefit from a condensed, “intensive” format where they receive CBT treatment daily and over a shorter period of time. The accelerated nature of these types of programs, offered in both outpatient and hospital-based settings, allows for quicker acquisition of strategies, substantial exposure practice, and generalization of newly learned skills to other settings in a child’s life. Think of it as a crash-course in CBT.

You may want to consider an intensive therapy program for your child if:
  • Your child’s symptoms are greatly interfering with his or her life, such as attending school or school performance, family life, and friendships.
  • Your child has tried different therapies in the past but there has been minimal carryover from session to session and/or you haven’t noticed much progress overall.
  • Your child is experiencing distress but other commitments during the school year have hindered attending therapy on a consistent basis, making school breaks or the summer an ideal time to work on it.
At NESCA, we are pleased to offer a highly specialized and immersive therapy experience through our 2-Week Summer Intensive CBT Program for anxiety. We work with children and adolescents who present with all types of anxiety, including generalized anxiety, separation anxiety, social anxiety, specific fears (e.g., dog phobia, vomit phobia, etc.) and obsessive-compulsive disorder (OCD).

What does NESCA’s 2-Week Summer Intensive Program consist of?
  • Intake evaluation – A meeting is held with the child and parents to gain a comprehensive understanding of the child, provide an assessment of symptoms and discuss goals for treatment, all of which will inform the treatment plan.
  • 1:1 therapy sessions – Individual CBT therapy sessions with the child or teen are conducted 5 days/week for 90 minutes. Homework will also be assigned between therapy sessions to reinforce skills learned.
  • Parent involvement – Parent participation is vital in treating childhood anxiety. Parent sessions are held 5 days/week for 30 minutes. During these meetings, parents will be educated about their child’s anxiety, receive progress updates and also acquire tools to better support their child. Parents might also be asked to help children practice the new skills they are learning.
  • Discharge planning – Families will be assisted in determining follow up support that will be helpful in order to maintain treatment gains.
  • Treatment summary – Following the conclusion of the program, families will receive a written summary that reviews the course of treatment, progress made and discharge recommendations.
There are circumstances in which the frequency, duration and/or structure of the program can be modified to best fit your child’s needs.

For more information about NESCA’s Summer Intensive CBT Program or to find out if the program is appropriate for your child, please contact Dr. Ryan Ruth Conway at (617) 658-9831 or [email protected].

About the Author:

Dr. Ryan Ruth Conway is a licensed clinical psychologist who specializes in Cognitive Behavioral Therapy (CBT), behavioral interventions, and other evidence-based treatments for children, adolescents and young adults who struggle with mood and anxiety disorders as well as behavioral challenges. She also has extensive experience conducting parent training with caregivers of children who present with disruptive behaviors and Attention-Deficit/Hyperactivity Disorder. Dr. Conway has been trained in a variety of evidence-based treatments, including Parent-Child Interaction Therapy (PCIT), Dialectical Behavior Therapy (DBT), and Exposure with Response Prevention (ERP). Dr. Conway conducts individual and group therapy at NESCA utilizing an individualized approach and tailoring treatments to meet each client’s unique needs and goals. Dr. Conway has a passion for working collaboratively with families and other professionals. She is available for school consultations and provides a collaborative approach for students who engage in school refusal. 

Monday, February 19, 2018

Sleep Hygiene and Sleep Debt


By: Rebecca Girard, LICSW, CAS
Licensed Clinical Social Worker, NESCA

For many students, teachers, and families in Massachusetts (and several other states throughout the country), this week marks a vacation and a time for rest. In that spirit, this week on NESCA News & Notes, we are highlighting the importance of good sleep hygiene for children, a vital element of wellness, mental health, and learning. Check out this short TEDx talk by Roxanne Prichard of the University of St Thomas about the importance of sleep for children. Highlights of the talk include:
  • Sleep is an essential for a healthy brain
  • United States school children are ranked 1st among nations with academic problems directly attributable to sleepiness
  • A 2014 Sleep in America poll found that fewer than 1 in 5 teens is getting the minimum amount of recommended sleep

Benefits of a good night’s sleep include:
  • Better regulated vital systems including growth and immune responses
  • Better memory and ability to retain new information
  • Boosts mood

Tips for good sleep health (according to the CDC):
  • Be consistent. Make sure your child goes to bed at the same time each night and gets up at the same time each morning, including on the weekends (as much as possible)
  • Make sure the bedroom is quiet, dark, relaxing, and at a comfortable temperature
  • Remove electronic devices, such as TVs, computers, and smart phones, from the bedroom
  • Avoid screens 30 minutes before bedtime. Promote reading, drawing or another quiet, non-screen activity to wind down
  • Avoid large meals, caffeine, and sugar right before bedtime
  • Make sure your child is getting some exercise. Being physically active during the day can help a child fall asleep more easily at night.

So how much sleep does a child need?


For more information on Dr. Roxanne Prichard as well as sleep hygiene, visit the following web sites:
About the Author:

Rebecca Girard, LICSW, CAS is a
licensed clinical social worker specializing in neurodivergent issues, sexual trauma, and international social work. She has worked primarily with children, adolescents, adults with Autism Spectrum Disorders and their families for over a decade. Ms. Girard is highly experienced in using Cognitive Behavior Therapy (CBT) as well as Socio-dramatic Affective Relational Intervention (SDARI), in additional to a number of other modalities. She is excited to provide enhanced psychotherapy to children with ASD at NESCA as well as to provide therapeutic support to youth with a range of mood, anxiety, social and behavioral challenges. Her approach is child-centered, strengths-based, creative and compassionate.


Monday, February 12, 2018

Acupuncture and its Role in Treating Anxiety


By: Holly Pelletier, L.Ac.
Licensed Acupuncturist, NESCA

Whether or not you’re familiar with acupuncture, you may be wondering what role it could possibly play in the field of mental health. Most people associate acupuncture with the treatment of pain conditions, and although it has gained recent popularity and prevalence in our little corner of the world, it is often only given a portion of the credit it deserves when it comes to the scope of treatment possibilities. 

Acupuncture is a branch of Chinese medicine based upon a meridian system that runs throughout the entire body. On the meridians, there are acupuncture points that can be accessed through different means such as needling, acupressure, or by using a warming herb called mugwort. The purpose of using these points is to move blockages of energy, blood, or fluids (i.e. lymph) in the body. By using different needling techniques and various point combinations you can either add to a deficient area or move an excess one. 

How does acupuncture work with anxiety and other mental health concerns? To explain fully, we can look at it from two different perspectives: 

The first is a more traditional “western” approach where we look at things on a biochemical level. Acupuncture points are specific areas beneath the surface of the skin that have high concentrations of nerve endings, mast cells, lymphatic vessels and capillaries. When an acupuncture needle is inserted into a point, it stimulates the sensory receptor, which in turn stimulates the nerve and transmits impulses to the brain. In this sense, it can be viewed as a “feedback loop” that directly affects your brain, your hormones, and your glands. So, the relaxed feeling you get after an acupuncture session is real, it is not just a placebo or “in your head”. The needles directly adjust imbalances in the body and allow the person to begin the healing process with a “blank slate." This unique aspect, specific to acupuncture, is extremely powerful because it allows the body to access its own, innate power to heal itself. 

The second approach is the stance of Chinese medicine, which frames anxiety as a symptom of something out of balance. If everything was functioning as it should, there would be no symptoms, we would live pain and stress free every single day of our lives. When something is “off”, tiny sensations start surfacing that at first may seem like nothing at all - a foggy head, fatigue, or tight shoulders. But as time goes by, symptoms worsen and the imbalance becomes larger, making it harder to reverse. 

Zooming in even closer to examine just the anxiety is helpful as well. Anxiety comes in all forms. If you have only seen or felt it one way in yourself or your child, it may surprise you that there is a wide array of symptoms that can show up when someone experiences anxiety. Some may have digestive upset while others get headaches or a racing heart, and others may have trouble breathing or dissociate from the world around them. Often, a person is treated for anxiety and given the same medication as someone else, regardless of their symptoms. Rather than treating someone for anxiety and having one specific point protocol or herbal approach, acupuncture treats those symptoms associated with the anxiety instead. For instance, the headaches, or the palpitations that signal stress to the body. Therefore, each person is looked at individually and each case/course of treatment is completely unique. 

As mentioned above, acupuncture is only a part of a much larger system of medicine. Other branches of the system include nutrition, meditation, herbs, and Qi Gong to name a few. Incorporating these other aspects allows the patient to not only feel better temporarily, but to possibly relieve the anxiety fully. 


If you have any questions about acupuncture and want to see if you or your child would be a good candidate, please contact our acupuncturist, Holly at: [email protected]

To read Holly’s Blog with simple ways to incorporate Chinese Medicine in daily life, visit: http://holisticallyinspiredblog.blogspot.com/

About the Author:

Holly Pelletier, L.Ac. is a licensed acupuncturist who practices part-time at NESCA. Holly Pelletier has been working with children of varying ages, in many different capacities since 2004. Prior to treating kids with acupuncture, she worked as a teacher, coach, and mentor. She exceptionally enjoys working with children and acupuncture because of their speedy response time and genuine excitement about this form of medicine. Holly has a very gentle technique and has specific training in non-insertive acupuncture styles, which does not require needling directly into the skin. In additions to working with children, Holly is also very passionate about working with issues involving women’s health, nutrition/herbs, neurological disease, and psychological challenges such as anxiety and depression.

For more information on our acupuncturist, Holly visit: http://www.hpelletieracu.com/