SMCPA WINTER NEWSLETTER: STRESS AND ANXIETY
Posted By AnnetteTaylor on December 22, 2011
From the desk of the President, Lea Goldstein, Ph.D.
Posted By AnnetteTaylor on December 22, 2011
As is customary for many of us as the New Year begins, I am both reflecting back on 2011 and the first year of my term as president of SMCPA and looking ahead to 2012. I began the year with a few lofty goals; some of which have been reached and others that are still to be accomplished.
The Year in Review: At our 2010 Annual Holiday Party, John Bradshaw, one of our Past Presidents, told me that we had never been able to break the 100 member mark. Growing our chapter became my priority goal for 2011, and I’m pleased to say that we currently have over 110 members. Nancy Marx, our Membership Chair, diligently put this goal into action.
A second goal was to establish new initiatives to welcome and engage new members. Nancy hosted new member gatherings (and Nancy has another one planned for January) as an opportunity for members to network and describe their work. Additionally, new members have become actively involved. Patty Bardina, Laura Kaufman, Alisa Stern, Carol Wong, and Cynthia Medina all joined our chapter in 2011, and they now make up our Newsletter Committee. And Lupita Kirklin, another new member in 2011, is taking on the position of Diversity Chair. Additionally, we will have a new Treasurer for 2012: Charlotte Ormond.
We held a well-attended continuing education event on Psychology and Digital Media. What was noteworthy about this event is that we didn’t have a CE Chair and convened an ad hoc committee, who pulled it off with aplomb. I want to thank Glory Denkers, Linda Schneider, Evelyn Marchini, and Lorita Bank for stepping up to take on this additional role.
Our CLASP committee, under the leadership of June Martin, sent out a survey to find out how we’re all dealing with the stresses of our profession and what self-care strategies members our using. June put this information together just in time for this newsletter on Stress and Anxiety. We also held a successful talk on the psychology of retirement and investment planning for psychologists with Mike Kriegel.
Nancy Wesson, who has coordinated our successful Book Club, has applied for and secured continuing education credits for those who attend.
Thank You: SMCPA could not continue without the dedication of our Executive Committee and Committee Chairs. We are fortunate to have the following members serving in various capacities on a regular basis: Bev Conrad, Past President; Sarah Burdge, Secretary; Kathy Allard, Treasurer; Lorita Bank, Nanette Rowe, Shirley Waldum, and Leta Zweibel, Members at Large; Linda Schneider, CPA Representative; Evelyn Marchini, Governement Affairs; Nancy Marx, Membership; Mark Howard, Speakers Bureau; June Martin, CLASP; Edna Esnil, Diversity; Glory Denkers, Ethics; Marilyn Foley, Disaster Response; Hospital Privileges, Rick Weiss.
Looking ahead to 2012: I again want to focus on membership this next year. My special focus will be on early career psychologists and attracting student members to our chapter. I plan to establish a Mentor Program and regularly scheduled Early Career Psychologists meetings. Your assistance and participation in these efforts will be greatly appreciated.
Happy New Year: In closing, I would like to wish you all a year of health and prosperity. And may your own goals become a reality.
Anxiety – Additional burdens for the LGBT community by Sarah Burdge, Ph.D.
Posted By AnnetteTaylor on December 22, 2011
Anxiety is a common struggle for many Americans, especially those living in the fast paced life of metropolitan areas. In fact, anxiety is the most common mental health complaint in the USA. It is estimated that 40 million adults struggle with anxiety issues. Unfortunately, only about 1/3 of these adults seek therapeutic assistance. Often this is due to a lack of understanding of the symptoms and common treatments for anxiety. Coping with being a member of a minority group can further pre-dispose an individual to be susceptible to anxiety issues. This article will explore the intersection between anxiety and one minority group: LGBT (Lesbian, Gay, Bi-sexual, and Transgender) individuals.
Common symptoms of Anxiety may include any of the following: excessive worry, restlessness, fatigue, difficulty concentrating, irritability, muscle tension or shaking, sleep disturbance, breathing problems, relational problems, work related problems, social or other phobias, obsessions, compulsions, panic attacks and/or challenges connecting to others. Symptoms can also mimic medical symptoms such as high blood pressure, chronic back and neck pain, gastro-intestinal problems, headaches, chronic unexplained pain, and sleep problems, among others. Although medical interventions can be an important adjunct to therapy, if the psychological aspects of anxiety, including minority status, are not addressed then medical treatments are likely to be less effective. Furthermore, many medical personnel are unprepared to deal with the unique challenges facing LGBT patients.
There are many causes of Anxiety including general life pressures, life transitions, work pressures, childrearing stresses, childhood abuse, exposure to any number of traumas, and being the child of an anxious parent. In addition, being a member of a minority ethnic group or minority sexual orientation can add a constant background stress to life. Individuals who have suffered from Anxiety for a long period of time have psychological and neurological patterns or ‘wiring’ that perpetuates the anxiety. Recent discoveries in the field of Interpersonal Neurobiology tell us that the brain is capable of changing (called neuro-plasticity). To actually change brain ‘wiring’ requires time and healthy relationships which could include the help of trained clinicians. Furthermore, research demonstrates that a large part of our regulatory abilities are formed as a result of being a part of a family and community that is able to understand our experiences and attune to our needs. These experiences are important in childhood as the brain is forming but they remain formative throughout our lives.
Thus, the ideal environment for the human brain to develop and maintain maximum anxiety regulation is one in which the individual is part of a loving, present, empathic, attuned family and community. This experience is often hard to come by for LGBT individuals. Let’s use a holistic model of understanding the self as a way to get a lens into the regulatory world of a LGBT individual. A holistic model includes understanding the person from the following perspectives: social, political, physical, emotional, spiritual, familial, and intellectual. I will discuss a few of these below.
Safety and the experience of attunement in the social world ideally would include being able to engage in the community with a sense of belonging and connection. This includes hundreds of everyday assumptions such as being able to find the foods that nourish us, finding clothes that fit, being safe walking down the street, and hearing music and seeing advertisements that help us feel like we are part of a bigger culture. Imagine yourself on a daily basis hearing and seeing messages from the media and other information sources, peers, colleagues, shop keepers, etc. that do not include an important aspect of your identity. If you imagine this you will probably feel your body respond with some type of stress or anxiety response.
Safety and attunement in the political world ideally includes a sense that the values being discussed by law makers and those in all levels of government hold some commitment to one’s well-being. Although there is always discussion about details of what that might look like related to any given issue, it can feel particularly stressful if the discussion is about your basic right to exist, have a family, or receive basic health care or other benefits, as is the daily reality for LGBT individuals.
Safety and attunement in the physical world means that one feels comfortable inhabiting their body in a way that feels authentic. Of course, many of us struggle with this due to media pressure of all types, but this struggle can be magnified for an LGBT individual who has non gender-stereotypic heterosexual body language. As we go deeper, imagine that your primary relationship, instead of being highly acclaimed and revered by your parents and peers, is either not accepted or is not supported in similar pro-active ways as with heterosexual marriages. Part of a functioning family and culture depends on knowing that we can turn to our community for support when we are struggling within our family. This is an important function that churches, synagogues and many other community organizations provide without even realizing it. LGBT individuals often feel that they are not or may be minimally welcome in these community groups and thus often are left on their own to deal with the normal stresses that can arise in family life.
Safety and attunement in the spiritual world involves a basic premise that the individual practitioner is accepted as a worshiper and can benefit from the teachings and support of a given religious doctrine. Many communities across varied religious faiths are actively working at being more accepting and welcoming to LGBT members. Religion, however, is also a large cultural source of outright hatred and non-acceptance towards LGBT individuals. Thus, even churches and synagogues with open-minded leadership are often visited and/or joined by LGBT individuals with trepidation and cautiousness, if not outright fear.
These are just a few examples of what I refer to as “background” stress that is experienced by LGBT individuals. Thus, it may take more intentionality and therapeutic support for LGBT individuals to successfully manage anxiety provoking situations in life in general. From an interpersonal neurobiology perspective, the raw materials of social and familiar safety needed to provide a ‘good enough’ environment for the brain to have solid regulatory abilities may be constantly compromised or stressed for LGBT individuals.
I would like to note that similar anxieties are often experienced by other minority groups although in a different configuration. For instance, acceptance in churches and synagogues may not be as anxiety producing for most racial minorities, but social anxieties may be greater. Regardless, when assessing your clients for symptoms of anxiety and ascertaining causes or contributing influences, taking into account LGBT status is an important indicator. Depending on your client’s presentation and areas of challenge, you may want to refer your client or seek consultation with someone who specializes in working with the LGBT community.
Sarah Burdge, Ph.D., is a licensed psychologist with a private practice in Menlo Park. She specializes in the treatment of depression, anxiety issues, trauma survivors, LGBT issues, Posttraumatic Stress Disorder (PTSD), relational challenges, sexuality issues, sexual identity issues, and women’s issues.
Anxiety in Children and Adolescents by Patricia Bardina, Ph.D.
Posted By AnnetteTaylor on December 22, 2011
Children and adolescents often experience anxiety. The anxiety could be about feared objects, separating from parents, or concerns about how others perceive them. Because these experiences are typical, it can be difficult to know when anxiety becomes a disorder.
When a fear or worry persists or interferes with a child’s activities, a specific anxiety disorder should be considered. For instance, when a child with separation anxiety worries about their parent’s safety, has trouble sleeping alone, resists going to school, or has physical symptoms for a month or more, then the child might meet criteria for Separation Anxiety Disorder. When a child or adolescent frequently worries about doing something embarrassing in front of others, which results in fear of those situations, then the child might have Social Phobia. If children experience significant distress or spend excessive amounts of time washing, checking, doing behaviors in a specific order, or repeating words silently, they may have Obsessive-Compulsive Disorder. However, Group A betahemolytic streptococcal infection can also result in compulsive behaviors, so consultation with the child’s pediatrician might be helpful. Pervasive Developmental Disorders might also be considered if the child exhibits social difficulties as well. Children and adolescents with Generalized Anxiety Disorder worry excessively about several areas, often school performance, social interactions, new situations, or safety, but many of these children do not express all of their worries to adults who in turn might not understand the extent of the anxiety’s impact on the child or adolescent.
The prevalence rate of having at least one anxiety disorder during childhood ranges from 6-20%.
In order to determine if a child or adolescent is experiencing an anxiety disorder, it is important to gather information from multiple sources, including the child or adolescent, the parents, and teachers, because each person could have a different perspective of the frequency and severity of the symptoms. Furthermore, anxiety disorders in children and adolescents often co-occur with other disorders, including depressive disorders, learning disorders, Attention-Deficit/Hyperactivity Disorder (ADHD), language disorders, and substance abuse. Therefore, it is important to assess these areas as one or more may affect the child’s functioning.
For mild anxiety, psychotherapy is recommended. In particular, extensive research supports the use of cognitive-behavioral therapy (CBT). “CBT for childhood anxiety disorders has five components: psychoeducation, somatic management skills training, cognitive restructuring, exposure methods, and relapse prevention plans (Albano & Kendall, 2002).” Psychoeducation, or teaching the client about anxiety, helps develop the client’s awareness. Somatic management skills include relaxation techniques that reduce the physiological arousal associated with anxiety. Cognitive restructuring occurs when the client becomes aware of maladaptive thoughts and learns more realistic thoughts and coping strategies. Exposure to the feared object or situation is the primary focus in the treatment of phobias and should be controlled, graduated, and systematic. Finally, a relapse prevention plan identifies how to maintain the therapeutic gains over time and environments.
A few manualized treatment programs have been effective for children. The Coping Cat program by Kendall and Hedke has been shown to be effective in the treatment of Separation Anxiety Disorder, Generalized Anxiety Disorder, and Social Phobia. The Cool Kids Program from the Macquarie University Anxiety Research Unit is especially helpful when treating specific fears such as phobias. Both programs can be used in individual therapy or group therapy. In addition, workbooks such as The Anxiety and Phobia Workbook and The OCD Workbook can be used in therapy even though they were designed to be more widely distributed as self-help books. While these books are based on research, their own effectiveness typically has not been examined by research.
A few studies have examined the efficacy of psychodynamic psychotherapy on anxiety in children and adolescents. The results suggest that psychoanalysis or psychodynamic psychotherapy seems to be more effective for more pervasive anxiety disorders rather than focused disorders such as a phobia. Adding a parent component to CBT or psychodynamic psychotherapy has been shown to have greater benefit as improved parent-child relationships reduce anxiety and parents can help coach their children and implement the treatment plan. Family therapy may be beneficial, but more research is needed.
Combining psychotherapy with medication is recommended for moderate to severe anxiety with acute symptoms that need alleviation or when psychotherapy has resulted in only a partial response. In particular, SSRIs have been shown to be most effective. However, the effects of SSRIs should be carefully monitored, particularly for children who have a primary diagnosis of depression.
Patricia Bardina, Ph.D., is a licensed psychologist in private practice in San Mateo. She specializes in the treatment of children and adolescents with anxiety, depression, ADHD, and/or behavior problems.
References:
Albano AM & Kendall PC (2002). Cognitive-behavioural therapy for children and adolescents with anxiety disorders: clinical research advances. International Review of Psychiatry, 14:129-134.
Bourne EJ (2010). The Anxiety & Phobia Workbook, Fifth Edition.
Connolly SD, Bernstein GA, & The Work Group on Quality Issues (2007). Practice Parameter for the Assessment and Treatment of Children and Adolescents with Anxiety Disorders. Journal of American Academy of Child and Adolescent Psychiatry 46:267-283.
Hyman BM & Pedrick C. (2010). The OCD Workbook, Third Edition.
Lyneham HJ, Abbott MJ, Wignall A, & Rapee RM (2003). The Cool Kids Family Program – Therapist Manual.http://www.kidsmatter.edu.au/primary/programs-guide/cool-kids-school-version/
Kendall PC & Hedtke KA (2006). Cognitive-Behavioral Therapy for Anxious Children: Therapist Manual, Third Edition.
Impact of Parental Stress on Children: An Attachment Theory Perspective by Alisa Nowik Stern, Psy.D.
Posted By AnnetteTaylor on December 22, 2011
This time of the year can be particularly stressful, and children are susceptible to their caregivers’ stress as well. Parents may be scrambling to prepare for the holidays and coping with children’s out-of-school schedules and activities. We, as adults and parents, are often unaware of just how much stress we are under. However, children can be acutely tuned into the emotional climate around them.
From birth, human beings are adapted and equipped to interact with their caregivers in order to ensure their needs are met. Children use their caregivers’ facial and emotional expressions to figure out if a given situation is safe or not. Think of the toddler who ventures out a few feet away from her mother to explore a new toy in the room or an interesting object. She toddles out a bit but then looks back at her mother to visually check-in as if to say, “Is this okay? Am I going to be okay this far away from you? Are you still going to be there for me even if I go out a bit further?” Children are hard-wired from birth to use their caregivers as secure bases from which to explore the big world stretched out before them.
So what happens to this intricate dance of looks and feelings and attachment that occurs between parents and children when the parent is under stress? The answer is that children can tell when the parent is stressed. So even if the parent is trying to maintain a calm outward appearance in the midst of their stress, the child can sense the discrepancy between the look and the feel of their parent. Children have an uncanny ability to “read between the lines” or to detect the emotional content of what is being said to them aside from the words being used. Stress on the parent’s face and in her tone of voice signals a lack of safety, a sense of uncertainty, and an unsettling feeling for the child. Despite our best efforts to “hold it all together” in front of our kids, children are able to pick up on the emotional valence of what is going on around them.
Parenting is a tough job, perhaps one of the toughest jobs out there. And it is a job that is often hard to do without proper support and encouragement from others. As a child psychologist, I often find that some of my most productive work to help children is actually done with the parent. That is, if a parent is able to have a place to off-load some of their tensions, stressors, conflicts, and worries, then the child directly benefits from this. The more that parents can take care of themselves emotionally, they will be taking care of their children’s emotional well-being as well. Psychologists who treat adults who are parents may better serve them by checking in to see how the parent’s stress level might be affecting the family. Likewise, psychologists who treat children should assess how stressed their clients’ parents are and make appropriate referrals for the parent as needed.
Alisa Nowik Stern, Psy.D., is a licensed psychologist who has a private practice in both Palo Alto and San Mateo. She specializes in working with pregnant women, new mothers, and families with very young children. She sees both children and adults in her practice.
Managing traumatic stress: Tips for coping with disasters and other traumatic events by Marilyn Foley, Ph.D.
Posted By AnnetteTaylor on December 22, 2011
Not knowing when, or if, an emergency situation (San Bruno Explosion and Fire, Loma Prieta Earthquake) will come our way can increase stress levels. In some cases, there are no outwardly visible signs of physical injury, but there is nonetheless a serious emotional toll. It is common for people, including trained mental health professionals who have experienced traumatic situations, to have very strong emotional reactions. Understanding normal responses to these abnormal events can aid you in coping effectively with your feelings, thoughts and behaviors, and help you along the path to recovery. In case of an emergency situation, the following tips can help you and your clients:
- Practicing normal stress reduction strategies is important for you and your family; consider use of relaxing music, visual imagery, family games, stretching, etc.
- In the case of a disaster you will be notified if specific actions need to be taken. Staying calm helps you and is especially important for children. Rely on facts, not rumors that can elicit fear.
- Know that you are not alone. There are many local agencies that are well trained and available to assist you, specifically the San Mateo Chapter of the local Red Cross at 1710 Trousdale Dr, Burlingame, CA. Phone: 800-520-5433.
- Maintain open communication. Assure children they are safe and will be protected. Limit children’s exposure as well as your own to graphic images of the incident. Stay informed with official updates.
- Check-in with neighbors/family and share in offering support to each other. Check your supplies without overstocking or doing panicky buying.
- Recall times when you have handled previous challenges and call on those abilities at this time. Focusing on your strengths will enhance effective coping.
- Keep an optimistic outlook and put the matter into perspective.
- Maintain a normal schedule when possible. Consider volunteering for ARC or other agencies; it can enhance feelings of usefulness and of being in control.
- Stay hydrated, eat a healthy diet, and maintain sufficient sleep and exercise.
Attention to the factors that have been outlined will enhance your chances of being able to function at your optimal level in the event of a disaster in your area. And it will put you in the best position to fulfill your responsibilities as a psychologist in serving the people you work with and those whose lives you affect.
Marilyn Foley, Ph.D., is a licensed psychologist located in downtown Redwood City at the corner of Broadway and Main Streets. She has over 15 years of experience with addiction, mood, and personality disorders. Her background and training was very traditional and psychodynamic, but over the years as she saw more patients with substance abuse issues and patients with severe emotional vulnerability, her focus shifted towards evidence-based treatments, such as Dialectical Behavioral Therapy and Mentalization Based Therapy. In her private practice she sees individuals (18 and up) and facilitates DBT Skills groups for individuals and family members. She has been a member of the San Mateo Psychological Association since 2008, and holds the position of co-chair of the Disaster Response Network.
References:
Diane Bridgeman, Ph.D; mental health volunteer
APA Managing traumatic stress: Tips for recovering from disasters and other traumatic events
CPA Disaster Preparedness for Your Practice by Ain Roost, Ph.D, Mar/Apr 2007
CPA Board Meeting October 29, 2011 Highlights by Linda R. Schneider, Ph.D.
Posted By AnnetteTaylor on December 22, 2011
Lea Goldstein, Ph.D, and I were in Burlingame for the last CPA Board of Directors meeting for 2011. The following are some of the highlights:
The MCEP Accrediting Agency will be dissolved on January 1, 2013. California is the only state using such an agency for CEU’s. Psychologists will still be expected to obtain at least 36 units for two years but the Board of Psychology will then randomly audit for compliance. CPA does derive an important income from MCEP and so adjustments will have to be made in the
2013 budget to compensate.
CPA’s finances are currently stable, but that picture could potentially change depending upon such things as the retention rate in 2012 of psychologists who were members of a local chapter and then joined CPA at a special introductory rate this year. CPA’S past, current and future priority is to advance and protect psychologists’ scope of practice. This may be more important in the years to come given the changes that may be on the horizon with changes in healthcare.
A CPA task force, the Health Care Think Task Force, has been meeting the last few months. It is hopeful of sponsoring a one or two day event in the fall of 2012, which would bring together invited experts from a variety of professions to explore collaborative relationships in which psychologists would have a central role in the healthcare reform. This is yet another example of CPA being in the forefront to protect and advance our profession.
The depth and breadth of CPA’s legislative advocacy is always substantial and comprehensive. Please follow on the CPA website (cpapsych.org). CPA members and staff review every bill of the thousands presented to California to determine the potential impact both on psychologists and on consumers who utilize their services. CPA’s Government Affairs staff, working with the Government Affairs Steering Committee and the Board of Directors, determines CPA’s position on each bill.
The helmet bill made it to Governor’s desk only to be vetoed. There was some discussion understanding Governor Brown and strategies for future bills of legislative interest to CPA. Some bills are being actively lobbied while some are being watched. CPA joins with other mental health entities as appropriate in supporting or opposing certain bills. Recent advances have been made in bills protecting seniors. Bills regarding child custody evaluations are being followed.
The Board of Psychology Sunsets in January 2013. Our profession has been at risk over the past few years with the proposal that the BOP be consolidated with the MFT/LCSW Board. CPA will continue to actively lobby for an independent Board of Psychology.
YOUR SUPPORT OF CPA-PAC enables this kind of necessary legislative work. Please go to the CPA Bill Box in the Advocacy Section of the CPA website to see all of CPA’s legislative positions.
Not as an official part of the meeting, I talked with Jo Linder-Crow, Ph.D, Executive Director of CPA, and Chuck Faltz in separate conversations to understand what position CPA might be able to take in SMCPA’s effort to reign in illegal or inappropriate advertising by those not psychologists giving the impression of offering Psychological Services.
Respectfully submitted,
Linda R. Schneider, Ph.D.
CPA Board of Directors
San Mateo Chapter
San Mateo County Psychological Association Speakers Bureau
Posted By AnnetteTaylor on December 22, 2011
Hey Everyone—Do you like to give public presentations—even a little? Then the Speakers’ Bureau is for you. The Speakers’ Bureau is a major part of our Association’s involvement with our community. Through the Speakers Bureau we benefit members of our community by providing information about various mental health issues. We also build relationships with the community and SMCPA.
Participating in the Speakers Bureau brings recognition to the speakers and their practice. Most members of the community appreciate the talks we give and find the information helpful. The public exposure that results from a talk brings benefits to members of the Speakers Bureau and indirectly all members of SMCPA.
As Chair of the Speakers’ Bureau I am exploring more venues in the community that would welcome a talk by one of our members. I ensure that the process for each talk runs smoothly and that both parties have relevant information. I investigate the venue to assure it is supportive to our members needs.
So, I hope you will consider offering a talk for our community. If you are interested in joining the Speakers’ Bureau, please send me your contact information, e.g., telephone number, email address, practice address and a list of presentation topics.
Best,
Mark
Mark Howard, Ph.D.
Chair, Speakers Bureau, SMCPA
Email:drmarkhoward@comcast.net
Telephone: (650) 255-0460
Announcements
Posted By AnnetteTaylor on December 22, 2011
Carol Wong, Ph.D., is now forming social skills groups for preschoolers through college-age students with social challenges or on the Autism Spectrum. For more information, contact Dr. Wong at (650) 646-0055.
Patty Bardina, Ph.D., is now forming social skills groups for children and adolescents with anxiety or attention issues. For more information, contact Dr. Bardina at (650) 303-7292.
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Posted By AnnetteTaylor on December 22, 2011
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