Category: Blog

Existential Concerns and the COVID-19 Pandemic

The COVID-19 pandemic has had incredibly devastating and often lasting impacts both globally and on an individual scale. For some, it has even provoked a sense of chaos, making it increasingly challenging to make sense of the world. Historically, philosophers have tried to answer questions about the meaning of life and what our purpose might be as human beings. Existential psychology, which is rooted in philosophy, allows individuals to explore themes such as freedom, responsibility, and the search for meaning. It encourages us to grapple with the concerns of existence, including the existential dread and angst- states of anguish, despair, and insecurity related to the central existential themes- which are part and parcel of the human experience. You may be familiar with the more common term, “existential crisis,” which can cause symptoms of depression and anxiety. Below, I outline the ways in which the pandemic can give rise to existential concerns and how we may overcome them:

Dealing with Loss and the Finitude of Life

For those who had not faced the loss of a loved one before, it is likely that the pandemic had you worrying about the health of someone you care about or even worse, grieving the loss of a loved one. At some point in our lives, we are forced to contend with the fact that our existence is finite. This can induce anxiety, as we think about the close bonds or attachments we do not want to let go of, the people we do not want to leave behind, and the limited time we have to see out our life goals. It is normal to be deeply affected by these experiences or even the mere idea of them. It is important that we allow ourselves to feel the full spectrum of emotions that ensues from loss or anticipatory grief (feelings of grief associated with knowing that you are losing a loved one). In these difficult moments, there are unique opportunities to let people in our lives know how we feel about them and to help them understand the profound impact they have had on us. Furthermore, the pandemic has prompted us to reflect on what we value in life, which may lead us to alter our priorities. We can use these difficult experiences as a way to deepen our connections, reflect on who or what matters most to us, and to make significant changes that we may have been putting off, such as spending an hour less working in order to spend quality time with family.

Isolation

Prior to the pandemic, many of us led eventful lives with little time to spare. Although the pandemic gave us the opportunity to press the pause button on life, it has also kept us apart from our loved ones: grandparents who were not able to spend time with beloved grandchildren, groups of friends no longer planning get-togethers, or travel restrictions preventing people from visiting family in different parts of the world. These are a few examples of how we could no longer connect with others in ways that we are accustomed to or perhaps even took for granted before the term social distancing was even part of our vocabulary. The positive side of this is that we may now have a greater appreciation for those who enrich our lives when we are lucky enough to spend time with them. During quarantine, we were able to bear witness to the interconnectedness we all crave and need, as video calls became part of our daily routines. The pandemic showed us how resourceful we can be when it comes to staying connected, as we learned to grow our online communities, become friendlier with our neighbors, and forged deeper bonds with coworkers who could relate to our hardships.

Managing Uncertainty

For those of us who thrive in structured environments and value stability, the year 2020 certainly took a toll on our well-being. Even for those who appreciate spontaneity, the overwhelming sense of unpredictability has been challenging to navigate. We have had to manage frequent changes in the way we perform our jobs or attend school, how we socialize with others, the way we travel, and the way we manage our health, to name a few. This has made it abundantly clear that change can happen when we least expect it, forcing us to adapt. Although this can make us feel uneasy, it is worthwhile to learn to deal with change, which is a constant in life. When things feel or are out of our control, what we can do is shift our focus to what we do have control over. This could translate to practicing a balanced routine where we provide ourselves with the structure we need, such as setting work hours if we are working remotely, eating healthier, setting aside time for physical activity, engaging in fulfilling activities or hobbies, and staying connected with others in some capacity. It is also critical that we practice acceptance, one of the many attitudes of mindfulness. We can do this by establishing some sort of breathing or meditation practice or with a positive affirmation, all of which can help us feel grounded despite the lack of certainty.

These unexpected and sudden changes have caused us to ask profound questions and perhaps compelled us to find the subjective meaning in our lives. Despite the vicissitudes of this pandemic, we can reflect on our growth and find the inadvertent improvements to our quality of life. If you are having difficulty doing so or want to further explore these existential concerns in a supportive therapeutic setting, seeking therapists who practice from a humanistic-existential framework may be beneficial. You may also want to read books that deal with existential topics, such as Viktor Frankl’s Man’s Search for Meaning.

References

Bland, A. M. (2020). Existential Givens in the COVID-19 Crisis. Journal of Humanistic Psychology, 60(5), 710–724. https://doi.org/10.1177/0022167820940186

Koole, Sander. (2010). Existential Psychology. 10.1002/9780470479216.corpsy0329.

Price, M. (2011, November). Searching for meaning. Monitor on Psychology, 42(10). 

 http://www.apa.org/monitor/2011/11/meaning

 

Yalom, I. (1980). Existential psychotherapy. New York: Basic Books.

How the Pandemic Forced Us to Redefine Productivity  

Written by Dr. V. John Nguyen

 

I am not a productivity guru.

As a matter of fact, if you look at my phone, you’ll see a graveyard of productivity apps that were once downloaded with such promise. I also have sticky notes that have fallen to the ground around my desk over the years with things that I never got to. I’ve spent countless hours researching ways to be productive when I could have just been productive (whatever that means). Despite my public confession, I can’t deny the appeal of getting things done and I’ll probably always be attracted to new methods. There’s something oddly satisfying about checking things off a list, even if I went back to add it after I already did it.

The coronavirus pandemic changed the way that we perceive productivity in ways that will likely continue to unfold as we move toward our “new normal.” Early on, many of us took the opportunity to learn a new skill – like baking bread, cutting hair, and making masks. We also got unusually comfortable pairing work shirts with sweatpants but that’s a different discussion for a different day. But when the dust settled, and we realized that we would be in quarantine much longer than we had anticipated, it was time to get back to business. Perhaps during this phase of quarantine, you found it difficult to determine whether you were being “productive” or not. Compartmentalizing work life and home life became challenging because we did everything at home.

What follows are some tips on how to remain productive even if you aren’t sure what it means to be productive.

 

Try Not to Resist Change

The pandemic has tested our ability to accept change. While resistance can be good at times, it can cause unnecessary challenges in life – especially if it’s our default response to everything (I’m looking in the mirror). Here are some questions that can help you identify resistance and figure out if it’s working for you or not:

  • How do you know when you are in resistance?
  • Can you describe what is happening when you are resisting an experience?
  • Is the resistance benefitting you in any way?
  • How might the resistance not be serving you?

 

Prioritize Quality Over Quantity

Nothing groundbreaking, we hear this all the time. Checking items off a list can be nice but can become a rote exercise in futility if we can’t maintain or improve the quality of our work. Try and focus on the quality of time spent on projects, on interactions with coworkers, and on reaching the standards that you pride yourself on. You may not get the project done as quickly as you wanted but it the final product might better meet your standards (and needs).

 

Plan For Tasks to Take Longer Than You Think

Inevitably, things come up and derail us from completing tasks. This causes us to fall behind and feel bad that we did. Remember the three P’s: Planning, prioritizing, and pacing your activities. Planning can prevent you from putting too much on your plate at once while ignoring the possibility that something will come up. Prioritizing can give you an idea of what needs to be done today and what can be either pushed to tomorrow or even eliminated. Pacing can allow you to complete tasks without becoming physically and emotionally exhausted. It may seem like you’re doing less than you were able to because of frequent breaks, but you may find that you’re getting more done overall. Your energy level and productivity will become more predictable and thus more under your control.

 

Set Clear (and Realistic) Boundaries

Working from home blurs the lines between work life and home life. Creating boundaries involves designating both physical and mental spaces to complete your work. Scheduling blocks of time for certain tasks may be helpful in compartmentalizing your life even if you’re doing it in the same space. Adjust your boundaries as you see fit and do your best to adhere to them. You may be surprised at how well the people around you respond to your boundaries and how much you can get done.

 

Consider Self-Care Productive Time

Plan and engage in activities that promote self-care. This may take some time to get used to but consider self-care activities “productive.” These activities may not be related to the tasks in front of you but being in an improved state of mind can certainly improve the quality of your work – and who knows, might even make it enjoyable. Being in a better mood can also enhance your ability to problem solve and shift your attention away from the negative aspects of your day (beneficial during the daily reviews you conduct as soon as your head hits the pillow).

 

Focus On What Has Been Done vs. What Hasn’t Been Done

Focusing on what hasn’t been done might be your default setting. You may find yourself setting goals for the day, reaching them, and then adding new goals to your list. While this is consistent with today’s “hustle culture” mentality, it creates a never ending to do list. What tends to happen is, you’ll remember what you haven’t finished and forget about what you did finish.

 

Keep Things Simple

Don’t be like me. Keeping your productivity system simple will increase the likelihood that you’ll keep doing it. Try not to overthink things and focus on what it is that you’re trying to get done. Do you really need 20 apps to light up your phone with notifications to remind you to take your vitamins?

 

Here are some fairly simple productivity systems that you might find helpful:

 

The Getting Things Done Method

The Getting Things Done Method (GTD) was developed by productivity and organizational consultant David Allen in 2001. This method involves 5 steps with the goal of “applying order to chaos.” The steps are as follows:

  1. Capture: Collect what has your attention. Write, record, or gather all everything that has your attention into a collection tool. A collection tool could be a notebook, fancy notetaking app, or a wide array of colorful sticky notes.
  2. Clarify: Look at your notes and process what they mean. It is at this point that you decide whether the items are actionable. If actionable, decide on the next step(s).
  3. Organize: Put reminders of your categorized content in the appropriate place, grouping similar tasks together, and scheduling blocks of time to complete them.
  4. Reflect: Update and review all pertinent system contents to regain control and focus.
  5. Engage: Take action using the system you just created with confidence and clarity.

 

The Pomodoro Technique/Time Blocking

The Pomodoro technique is a time management system that encourages you to work with the time that you have, rather than against it. This method simply involves breaking your workday (or activities) into 25-minute chunks (called “Pomodoros”) followed by 5-minute breaks. After the 5-minute break, reset the timer for 25 minutes and start again. After completing four “Pomodoros”, reward yourself with a longer break – usually 15-30 minutes.

 

Bullet Journaling

Bullet journaling is a highly customizable productivity system that involves keeping and maintaining a single journal that is used to track almost everything in your life – schedule, goals, appointments, events, thoughts, and anything else you might find useful. Journal entries are meant to be simple bullet points with user defined symbols or colors to organize items.

 

The Daily Trifecta

This system involves creating a list of three key things you want to get done each day by writing them down the night before. This system might be useful if you tend to overload your to-do list. It is also helpful in that it allows you to be realistic about accomplishing the most essential tasks, not every task.

The pandemic forced us into figuring out how to balance our work and home lives. For some of us, there was significant overlap between the two. It forced us to prioritize and change the way we view productive time. If there is a silver lining in this, it’s that the definition of productivity is not entirely dependent on tangible rewards or outcomes. We can still be productive, even when we’re not feverishly crossing off items on a checklist or sacrificing self-care.

 

 

References

Curran, E. (2021, April 21). Work from Home to Life Productivity By 5% in Post-Pandemic U.S. Bloomberg.

https://www.bloomberg.com/news/articles/2021-04-22/yes-working-from-home-makes-you-more-productive-study-finds

 

Hickok, H. (2021, January 7). How The Pandemic Could Redefine Our Productivity Obsession. BBC.

https://www.bbc.com/worklife/article/20201230-how-the-pandemic-could-redefine-our-productivity-obsession

 

Pontefract, D. (2021, June 4). Productivity Better Be Top Of Mind In Post-Pandemic Work World. Forbes.

https://www.forbes.com/sites/danpontefract/2021/06/04/productivity-better-be-top-of-mind-in-a-post-pandemic-hybrid-work-world/?sh=1ac8d1865a58

 

Moore, K. (2019, November 12). Six Productivity Systems You Should Know. Monday.

https://monday.com/blog/productivity/6-productivity-systems-know/

 

 

What is Coronasomnia and What Do We Do About It?

Written by Sarah Jurick, Ph.D.

For most of us, the last year and a half has been difficult for many reasons. Many have lost loved ones, fallen ill, cared for sick individuals, found themselves out of work, and missed celebrations of important milestones with friends and family. Not surprisingly, these adjustments have led to ‘tandemics’—epidemics that run in tandem and are caused and exacerbated by the pandemic—such as increased rates of mental health disorders.

Poor sleep has been one of the many consequences of the COVID-19 pandemic, leading to the term ‘coronasomnia’, which is essentially insomnia that has been caused or worsened by the COVID-19 pandemic.

Sleep Changes During the Pandemic

Research studies have begun to document these changes in sleep. Perhaps, unsurprisingly, around one-third of healthcare workers report insomnia since the rise of COVID-19, with the highest prevalence among frontline workers directly working with patients diagnosed or at-risk of developing COVID-19 (Lai et al., 2020; Zhang et al., 2020). However, this is not unique to healthcare workers. Widespread complaints of sleep loss, poor sleep quality, and insomnia are also present in the general population (Cellini et al., 2020).

Effects of COVID-19 on Sleep

Additionally, a recent study found that 6 months following hospitalization for COVID-19, sleep difficulties were among the most common lingering concerns with 26% reporting continued sleep difficulties (Huang, 2021). The authors cited multiple possible reasons for sleep difficulties following COVID-19, including direct effects of the virus, the body’s immune response, corticosteroid treatment, staying in the intensive care unit, social isolation, and stigma related to contracting COVID-19.

The Role of Stress and Changing Work Schedules

In addition to the potential direct effects of the virus, the COVID-19 pandemic has impacted sleep through increased stress levels, confinement at home, and atypical work schedules (Morin et al., 2020). Specifically, sleep quality and duration are highly dependent on how long we are awake, daylight exposure, and routines that we engage in (e.g., rising at the same time each day with an alarm, meals, exercise, work, and social/leisure activities). Lately for many of us, routines have been thrown off by shift work schedules, remote work that can end up running late into the evening, and less exposure to daylight, leading sleep to suffer. In the short-term, poor sleep can cause low mood and decreased immunity. Consequences of long-term poor sleep include hypertension, diabetes, and depression.

“Sleep Hygiene” Techniques:

Fortunately, there are some relatively simple ‘sleep hygiene’ techniques we can engage in that have the potential to improve sleep in a big way. Adapted from Morin et al.(2020):

1) Maximize daylight exposure, particularly earlier in the day, by opening curtains, getting outside, and turning on lights. This will regulate circadian and sleep-wake rhythms.

2) Try to wake up and go to sleep as close to the same time each day. Having a consistent schedule with meal times and work will also help your body to know what to expect each day and make falling asleep and waking up easier.

3) Limit naps and if you need one, try to take a short nap (15-20 minutes) early in the day. This will help you feel tired when it is time for bed.

4) Avoid using electronics before bed as well as in the bedroom. The light from our cell phone and tablets sends signals to our brain that it is time to wake up, not go to bed.

5) Reserve the bed and bedroom for sleep and sex only. This will train your brain to associate your bedroom with sleep and not stressful things that keep your mind active.

6) Make sleep a priority and aim for 7-8 hours per night.

Although these behavioral techniques are helpful, if you are experiencing insomnia several nights a week, it will likely be necessary to seek professional help. Very effective, short-term therapies such as cognitive behavioral therapy for insomnia described here are available.

 

References:

Cellini, N., Canale, N., Mioni, G., & Costa, S. (2020). Changes in sleep pattern, sense of time, and digital media use during COVID-19 lockdown in Italy. Journal of Sleep Research (preprint).

Huang, C., Huang, L., Wang, Y., Li, X., Ren, L., Gu, X., … & Cao, B. (2021). 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. The Lancet, 397(10270), 220-232.

Lai J, Simeng M, Wang Y, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Network Open. 2020;3(3):e203976. doi: 10.1001/jamanetworkopen.2020.3976.

Morin, C. M., Carrier, J., Bastien, C., & Godbout, R. (2020). Sleep and circadian rhythm in response to the COVID-19 pandemic. Canadian Journal of Public Health, 111(5), 654-657.

Zhang, C., Yan, L., Liu, S., et al. (2020). Survey of insomnia and related social psychological factors among medical staffs involved with the 2019 novel coronavirus disease outbreak. Frontiers in Psychiatry.

Long-Haul COVID-19: What We Know, and What We Don’t

Written by: Delia Silva, PsyD, ABPP-CN

What is Long-Haul COVID?

“Long-Haul COVID” is a term that has been used extensively in the media to describe people who have experienced persisting physical, cognitive, or emotional symptoms for months following recovery from the acute phase of the SARS-CoV-2 (COVID-19) infection. The reported symptoms have included: “brain fog,” sleep problems, temperature dysregulation, gastrointestinal problems, tachycardia with mild exercise or standing (Vanderlind et al., 2021) dizziness, headache, generalized aches or pain, and loss of smell or taste (Broche-Perez & Medina-Navarro, 2021).  While we may hear about “long-haulers” a lot in the news or may even know people who have experienced these symptoms, there continues to be very little scientific research about this phenomenon. The purpose of this blog article is to summarize what we do know, so far (as of August 2021), about the scientific underpinnings of long-haul COVID-19, particularly with brain functioning.

How Might COVID-19 Affect the Brain?

The way in which the SARS-CoV-2 virus might actually affect the brain is still largely unknown, but there are three main theories:

Cerebrovascular Ischemia:

What appears to be prominent in the scientific studies that have found neurological changes in COVID-19 patients is that these particular patients have had severe respiratory symptoms during the acute infection that required hospitalization, and in most cases, intubation. Additionally, people who are at risk for experiencing severe COVID-19-related symptoms tend to be older in age or have medical co-morbidities, such as high blood pressure or diabetes, which also increases their risk of having a stroke. People who require medical ventilation are at higher risk of experiencing hypoxia, or a lack of oxygen to the brain. There is insufficient research to state that the SARS-CoV-2 virus itself causes strokes or hypoxia. There are hypotheses that require further research about the virus leading to constricting of small blood vessels that could potentially lead to cerebrovascular events.

Secondary Neuroinflammatory Response:

There continues to be a lack of research with this theory, but the hypothesis is that the body’s immune system goes into overdrive to fight off the COVID-19 virus and produces a maladaptive inflammatory response cause more harm to the body’s tissue and organs, maybe more so than the virus itself. Essentially, the immune system may go into overdrive and attack the healthy body tissue. We know this happens with autoimmune disorders such as multiple sclerosis and lupus.

Direct Viral Infection of the Brain:

The evidence for this is still sparse, but there is a theory that the virus may enter the brain through the olfactory pathways in the brain. Loss of smell is a very common symptom reported by patients experiencing a COVID-19 infection, regardless of the severity of other symptoms (deMaria et al., 2020; Voruz et al., 2021). Some mainstream magazines have recently mentioned that the COVID-19 virus appears to specifically attack astrocytes (a specific type of brain cell involved in many “worker” functions), particularly within the limbic system (Douaud et al., 2021). However, those studies have not yet gone through the peer-review process required for publication into scientific journals, and therefore should be looked at with extra scrutiny.

Cognitive Functioning

There are very limited neuropsychological studies examining the neuropsychological profiles for COVID-19 patients at the present time, and the few studies that are available inconsistently exclude people from the sample that might have pre-existing cognitive impairment.

However, what does appear to be emerging from the research is that persisting cognitive symptoms appears to be most prevalent in COVID-19 survivors who have had severe symptoms that required hospitalization. This group of people was at higher risk for experiencing delirium, strokes, and hypoxia. People who experienced delirium during their hospitalization appear to be at highest risk for having persisting cognitive impairment (Burdick & Millett., 2021).

One meta-analytic study (Vanderlind et al., 2021) combined the results of 26 studies and determined that approximately 15-40% of the total participants who underwent formal neuropsychological testing were documented as having abnormal cognitive performance, 10-105 days following hospital discharge. Compared to matched controls, there were significant differences in performance on measures of sustained attention, executive functioning, visuospatial processing, attention, memory, and language. All of these participants had been hospitalized with severe COVID-19 symptoms. Patients who were treated in the ICU and required oxygen therapy were found to have lower scores across most cognitive domains.

On studies that solely looked at self-reported or observer-reported questionnaires that were collected 4-15 weeks after hospital discharge or recovery from the acute phase of COVID-19, approximately 25% reported cognitive complaints (de Graaf et. Al, 2021). People who had medical co-morbidities tended to report problems with concentration and memory loss more often (Mannan et al., 2021).

One study showed that poor cognitive performance was correlated with increased inflammatory markers (Zhou et. Al, 2020).

Psychiatric Symptoms

Psychiatric symptoms are commonly seen in COVID-19 survivors, regardless of the severity of the COVID-19 illness or if they were hospitalized. In some studies, people who had mild COVID-19 infections actually reported having higher levels of depression, stress, anxiety, and reported more cognitive complaints that people who had more severe COVID-19 symptoms (Vanderlind et al., 2021).

Depression

Approximately 10-42% of patients who were previously hospitalized due to COVID-19 reported moderate to severe depression, two to three months following discharge. Survivors reporting the most severe levels of depressive symptoms tended to have a prior psychiatric history (Vanderlind et al., 2021).

Similarly, in COVID-19 survivors who were not hospitalized, depression ranged from 15-68%. Risk factors for depression in those groups included female gender, older age, and decreased sense of smell (Vanderlind et al., 2021).

Anxiety

Across 25 studies, clinically significant anxiety symptoms ranged anywhere from 5 to 55.2% of COVID-19 patients. Risk factors for anxiety included: COVID-19 illness severity, co-morbid medical conditions, reduced quality of life, persistent shortness of breath, younger age, having close relatives with COVID-19, having a decreased sense of smell, and having a prior psychiatric history (Vanderlind et al., 2021).

Anxiety related to COVID-19 may be related to the unknowns of the disease process, as we simply still don’t know what to expect. This lack of information about the virus leading to frequent changes in public policies and the emergence of conspiracy theories and “alternative facts” certainly do not help the collective mental health for our society! More in-depth discussion about the day-to-day impact of the pandemic on our mental health can be seen in other articles in our blog series.

Stress most definitely has an impact on the brain and body. The stress response is mediated by the pathways between the hypothalamus, the pituitary gland, and the adrenal gland (“HPA axis”) which sends signals to the body to activate our primitive “fight-or-flight response” while inhibiting our ability to activate our higher-order thinking skills. The high rate of stress in individuals who have experienced COVID-19 infections may be a factor in the cognitive difficulties reported in the long-haulers.

Fatigue

Fatigue following severe COVID-19 infection appears to be the most common finding, with 40-69% of COVID-19 survivors endorsing ongoing fatigue that interfered with their quality of life, two to three months after hospital discharge (Vanderlind et al., 2021).

Sleep

On one study, about 26% of COVID-19 survivors reported persisting sleep difficulties, six months after being discharged from the hospital (Huang et al., 2021).

What Can We Do Now?

Overall, there’s still a lot more to learn about the long-term effects of COVID-19, particularly on people who have experienced mild cases of COVID-19 without severe respiratory distress. While the medical science is still figuring out the biological effects of the virus on the body and the brain, it appears that reducing inflammation may be a goal in treating long-haul COVID-19 symptoms. Nutrition should certainly not be ignored, as it is known that specific foods can lead to inflammation and others can help to reduce it. Meeting with a registered dietitian to determine an optimal diet is something to consider. Likewise, depression, anxiety, and chronic stress is known to have a physical impact on the body by mechanism of increased production of stress hormones and neurotransmitters (Vogelzangs et al., 2013; Salim et al., 2012). Therefore, psychological treatment for anxiety or depression should be considered as an essential part of a multi-disciplinary approach to treatment of persisting COVID-19 symptoms. Of course, following up with your primary care physician and recommended medical specialists while you continue to experience physical symptoms is recommended to obtain the latest treatment as the science develops.

 

References:

Almeria M, Cejudo JC, Sotoca J, et al. . Cognitive profile following COVID-19 infection: clinical predictors leading to neuropsychological impairment. Brain Behav Immun Health 2020; 9:100163.

Burdick, K. E., & Millett, C. E. (2021). The impact of COVID-19 on cognition in severe cases highlights the need for comprehensive neuropsychological evaluations in all survivors. Neuropsychopharmacology, 1-1.

de Graaf MA, Antoni ML, Ter Kuile MM, et al. . Short-term outpatient follow-up of COVID-19 patients: a multidisciplinary approach. EClinicalMedicine 2021; 32:100731.

De Maria, A., Varese, P., Dentone, C., Barisione, E., & Bassetti, M. (2020). High prevalence of olfactory and taste disorder during SARS-CoV-2 infection in outpatients. Journal of medical virology, 92(11), 2310–2311.

Douaud, G., Lee, S., Alfaro-Almagro, F., Arthofer, C., Wang, C., Lange, F., … & Smith, S. M. (2021). Brain imaging before and after COVID-19 in UK Biobank. medRxiv.

Mannan A, Mehedi HMH, Chy N, et al. . A multicentre, cross-sectional study on coronavirus disease 2019 in Bangladesh: clinical epidemiology and short-term outcomes in recovered individuals. New Microbes New Infect 2021; 40:100838.

Mazza MG, De Lorenzo R, Conte C, Poletti S, Vai B, Bollettini I, Melloni EMT, Furlan R, Ciceri F, Rovere-Querini P, COVID-19 BioB Outpatient Clinic Study group., Benedetti F Brain Behav Immun. 2020 Oct; 89():594-600.

Medina-Navarro, C. M. (2021). Neuropsychological & Cognitive Sequelae in COVID-19 Patients. MEDICC review23(2), 78.

Namdar, P., Mojabi, N. A., & Mojabi, B. (2021). Neuropsychological and Psychosocial Consequences of the COVID-19 Pandemic. Neurophysiology, 1-10.

Salim, S., Chugh, G., & Asghar, M. (2012). Inflammation in anxiety. Advances in protein chemistry and structural biology88, 1-25.

Vanderlind, W. M., Rabinovitz, B. B., Miao, I. Y., Oberlin, L. E., Bueno-Castellano, C., Fridman, C., … & Kanellopoulos, D. (2021). A systematic review of neuropsychological and psychiatric sequalae of COVID-19: implications for treatment. Current opinion in psychiatry34(4), 420. 

Vogelzangs, N., Beekman, A. T. F., De Jonge, P., & Penninx, B. W. J. H. (2013). Anxiety disorders and inflammation in a large adult cohort. Translational psychiatry3(4), e249-e249.

Voruz, P., Allali, G., Benzakour, L., Nuber-Champier, A., Thomasson, M., Jacot, I., … & Peron, J. A. (2021). Long COVID neuropsychological deficits after severe, moderate or mild infection. medRxiv.

Zhou H, Lu S, Chen J, et al. . The landscape of cognitive function in recovered COVID-19 patients. J Psychiatr Res 2020; 129:98–102.

Have You Heard About “Languishing”?

Written by Stacy Ann Aquipel, PsyD

If you’ve noticed yourself feeling more blah or meh in the past year, you’re not alone. Last April, a viral New York Times article identified languishing as possibly the dominant emotion of 2021. The term was coined by a sociologist named Corey Keyes, who compared it to the concept of flourishing, or a combination of “feeling good about and functioning well in life.” On the contrary, languishing can be experienced as not just surviving, but not quite thriving – or perhaps not overwhelmed necessarily, but certainly whelmed. The French also have a similar expression: ennui. Given the unpredictability and prolonged nature of the COVID-19 pandemic, not to mention social, political, racial, and even climate-related concerns and collective stress and grief, it makes sense that many of us have felt as though we’re stuck in a holding pattern, trudging along with less motivation, energy, enthusiasm, or even control than in the “beforetimes.” Here are a few tips and reminders to consider as we continue to weather this storm together:

Reframe: Languishing May Be Beneficial

It may be helpful to keep in mind that, just like every emotion and sensation we experience as humans, languishing may serve important functions and provide us with opportunities to grow in self-awareness. For instance, if we take cues from nature, there are reasons why some animals hibernate in winter, and why many plants do not flower all year long. We may be experiencing a summer heat wave in SoCal at the moment, but emotionally and existentially speaking, we’ve had quite a long winter – and one that doesn’t seem to be letting up. Fittingly, it may actually be helpful for us to conserve our energy, slow down, and maintain a little extra protection from the elements in the current climate (even if that means putting on a few extra pandemic pounds).

Make It a Habit to Check In with Yourself

While some of the changes you may have experienced over the past year have been obvious, such as shifts in daily routines, social activities, and eating and sleeping patterns, other changes may be less visible. For example, you may have noticed becoming uncomfortable in crowds since lockdown and now prefer increased physical distance in public spaces. Or perhaps watching the news has made you more irritable or upset than before. Or, if you’re like me, it may take you longer these days to complete tasks (such as writing this blog post!). Checking in with your emotions, physical sensations, and comfort level in different situations over time may help you better identify your current needs and boundaries, as well as promote a sense of safety and security.

Be Gentle with Yourself and Those Around You

In times of stress, it’s common to become more self-critical and compare yourself to others (or to who you used to be). You may also become so focused on “getting back to normal” or increasing productivity that it becomes easy to dismiss the hardships you’ve undergone, as well as forget how you have changed. It may be beneficial – and kind – to remind yourself and your loved ones that we’re living in unprecedented and challenging times, and that it’s okay to adjust our expectations, boundaries, perspectives, and standards as new situations arise, as well as celebrate the small accomplishments we have made along the way. Frustration and anger may be contagious, but so are kindness and empathy, and we always have the choice to cut ourselves and others some slack.

Be Creative (And Spoiler: You Already Are!)

When Darwin talked about survival of the fittest, he wasn’t referring to physical strength; rather, he meant that those that can adapt the best to change are the ones that survive. Back in 2019, could you have even imagined what your current day-to-day life looks like? We’ve already had to exercise profound adaptability and imagination to get to where we are today, mostly out of necessity. Now that the current realities have had time to set in, we can tap into our creativity more intentionally. For instance, we can explore what has helped us recharge our emotional batteries – or at least what has helped us conserve what energy we have left in the tank! We can also consider all the innovative ways we have been able to keep in contact with those around us, or if we’ve been feeling more isolated, perhaps we can start planting seeds to reconnect, if that’s what we want. But for now, if we sense that languishing is a dominant state of being, we can approach it with curiosity and discover new ways to befriend it.

References

Grant, A. (2021, April 19). There’s a name for the blah you’re feeling: It’s called languishing. New York Times. https://www.nytimes.com/2021/04/19/well/mind/covid-mental-health-languishing.html

Keyes, C. L. M., Dhingra, S. S., & Simoes, E. J. (2010). Change in Level of Positive Mental Health as a Predictor of Future Risk of Mental Illness, American Journal of Public Health, 100(12), 2366-2371. https://doi.org/10.2105/AJPH.2010.192245

Leon, A. K. (2021, April 26). I’m not languishing, I’m dormant. https://austinkleon.com/2021/04/26/im-not-languishing-im-dormant/

Lessons from the COVID-19 Pandemic Series: Work-Life Balance, Going From Survival Back to Thriving

Written By: Angela J. Patino, Psy.D.

 

The future is unwritten, 2020 is history, and one way we can improve our present is by reflecting on the lessons learned thus far. The following PNBC blog series will focus on highlighting lessons learned from the pandemic, with an emphasis on mental health.

 

While we continue to recover from the whirlwind year of 2020, the increased vaccination rates have a provided our communities a pivotal moment in the pandemic. Of course, in no way is the pandemic quite over, yet, the aftershocks are still very present. However, many states have re-opened, schools are expected to resume in-person this fall, and the employment sector is in a hiring/rehiring spree. Some individuals never stopped working – hats off to all essential workers! Some are slowly getting back into the grind. While others are trying to figure out their return to work. Whichever position you find yourself in, IT IS OK. Remember the year we all just had?

 

One of the first crossroads that many individuals faced at the start of the pandemic was maintaining a work-life balance. Now, maintaining a work-life balance was already a tough task for most, even before the pandemic. Combining the promoted work culture of high productivity, eating meals on the go, long work hours, and answering emails after hours, is a recipe for disaster. For many, especially for parents of school-aged children, this balance continues to remain in “survival mode.” As we enter a different phase of the pandemic, a new normalcy is settling in, and this work-life balance needs to switch back to a “thriving mode” for the sake of our mental health. The following recommendations bring light to different aspects of our day-to-day work environment and interactions that can be used to help achieve a more aligned work-life balance and decrease burnout.

Time management

What are your working hours? Are you sticking to them or running over time more often than not? Do you take your meal break or eat on the go? It is important to give yourself enough time to complete your duties and set appropriate resting points. Prioritize tasks into urgent vs non-urgent. If you find yourself frequently having trouble meeting deadlines, this may be a sign that you are doing too much and there may be a need for delegation.

Assertive communication

In connection to the last point, if you have too much on your plate, speak up! Being assertive in the workplace is vital as it allows you to speak your mind, share your ideas, express your needs, and wants in an effective, respectful, and clear manner. Hostile work environments feed on passivity and aggression. Assertive communication is a great way to place boundaries, which brings us to the next point.

Place healthy boundaries

From your labor rights to professional etiquette, learn when to say no. Prioritize what is important to you. Is staying an extra hour worth missing out on _______? The same can be applied at home, do you feel overwhelmed with household chores, can some duties be delegated to a partner or roommate?

Let go of perfectionism

Do you have perfectionist tendencies? Perfectionism is difficult to achieve, and someone who takes pride in perfecting their craft, may have difficulty clocking out. This often leads to long work hours with limited personal time, a perfect combination for burnout. A great read for embracing imperfection is “The Gifts of Imperfection” by Brené Brown (link: https://brenebrown.com/thegifts-hub/#close-popup).

Make time for exercise

The documented benefits of exercise are exhaustive; no, really just do an engine search! A healthy body = clarity in mind = improved mood = better you. Prioritize your exercise as if your health depended on it.

Relaxation

What do you practice to promote relaxation? Yoga, meditation, music or just deep breathing exercises help us recharge and obtain mind clarity.

Sleep

Are you getting the recommended 7-8 hours of sleep? Or are you answering emails during your usual bedtime? Similar to exercise, sleep is crucial to our overall health.

Nurturing relationships outside of work

Positive social support is also important to our mental health. Research has shown that social support helps ward off the effects of stress on depression, anxiety, and other health problems; this is especially so for women and older adults (Cohen, 2004; Harandi et al., 2017). People found creative ways to maintain social contact during the pandemic, be it through a glass door, parking lot car-meal meet-ups, or videoconferencing calls. Human nature calls for human connection.

Time-off

This year brought unprecedented times in more ways than we can count. Even taking just one day off to unwind and detach from work can have positive effects on your mental health. It is important to realize when it is time to “take a break, before you break.”

Seek professional help

If you find yourself struggling to maintain a work-life balance, especially through the pandemic, you are not alone. None of us could have predicted the challenges that have come our way this year. Ensuring your mental health is being managed properly is important. If you think that talking to a mental health professional about your struggles may benefit you, PNBC is here to help.

 

The following hotlines also provide free and confidential emotional support 24 hours a day, 7 days a week:

National Suicide Prevention Lifeline: English 1-800-273-8255; Spanish 1-888-628-9454

San Diego Access and Crisis Line: 1-888-724-7240

 

References:

Cohen, S. (2004). Social relationships and health. American Psychologist, 674-84.

Harandi, T., Taghinasab, M., & Nayeri, T. (2017). The correlation of social support with mental health: A meta-analysis. Electronic physician, 9(9), 5212–5222. https://doi.org/10.19082/5212

Hart, S. (2020). The Differences Between America’s Working Culture and the Rest of the World. The National Digest. Retrieved from https://thenationaldigest.com/the-differences-between-americas-working-culture-and-the-rest-of-the-world/

NOW HIRING: Spanish-Speaking Psychologist or Therapist (Master’s or Doctoral-Level; Interns Considered) and Neuropsychological Technician

Seeking a Spanish-speaking psychologist, licensed master’s level counselor, or intern (either doctorate or master’s level) to join a small and thriving mental health practice in San Diego (Pacific Neurobehavioral Clinic). The clinician would be working collaboratively alongside a neuropsychologist and other psychologists. Depending on the level of experience, supervision and/or consultation would be provided. This position has two primary duties:

 

1) THERAPY: The clinician would be providing individual therapy to primarily adult, Spanish-speaking patients, most of whom are dealing with chronic pain, adjustment to medical conditions, depression, anxiety, and PTSD. At least two days per week would be required, though opportunities to add more days for a greater caseload are certainly possible.

 

2) NEUROPSYCHOLOGICAL TESTING: The clinician would administer and score a wide range of neuropsychological tests, and work as a technician at least one day out of the week for the neuropsychologists at the practice (Drs. Silva and Jurick). Full training on administration and scoring of the neuropsychological tests would be provided prior to beginning this job.

 

Group consultation meetings occur on at least a monthly basis at the practice. Weekly supervision consistent with the requirements for registered psychological assistant or master’s level intern would be provided on an individual basis.

 

This is a great opportunity for a motivated, savvy therapist willing to expand their clinical skills in working with medical populations.

 

PNBC strives to provide high-quality services to the community. We believe that keeping a good work-life balance for our staff helps us provide better care to our patients.

 

Pay is based on experience level. Health and retirement benefits (after vesting period) are available for full-time employees.

 

REQUIREMENTS:

– Minimum completion of a Master’s degree in Psychology or Counseling.

– Fluent in Spanish, as most patients seen in therapy will be monolingual Spanish-speakers.

– Experience in a primary healthcare or medical setting preferred.

– Licensed preferred.

 

To apply, please submit a letter of interest, your CV, and three references to dsilva@neuropacific.com.

Welcome, Dr. John Nguyen!

We’re pleased to introduce Dr. John Nguyen to the PNBC team!

Dr. Nguyen is a clinical psychologist licensed in California (PSY32365). He has over 10 years of experience and has worked in a variety of clinical settings including community mental health, medical, and outpatient clinics. In addition to providing psychotherapy, Dr. Nguyen has a vast knowledge of community resources through his work in community mental health clinics where he served as a clinician/case manager and clinical team lead.

He treats a wide range of concerns, including chronic pain, depression, anxiety, trauma, and life transitions – particularly for clients coping with chronic medical illnesses. Additionally, he has a special interest in issues of diversity, particularly in working with underserved populations such as Asian Americans and older adults (age 60+).

Dr. Nguyen’s approach to treatment can be described as collaborative and solution-focused. He approaches treatment invention/planning from a biopsychosocial perspective and uses evidence-based practices such as Cognitive-Behavioral Therapy (CBT), Mindfulness-Based Stress Reduction (MBSR), biofeedback, and applied psychophysiology. Before deciding on the course of treatment, Dr. Nguyen takes time to gain a better understanding of his patients, particularly, the factors that trigger and maintain symptoms. Dr. Nguyen’s eclectic approach to therapy allows him to utilize interventions that match the needs and preferences of his patients, which has been shown to lead to more favorable outcomes.

Behavioral Changes After a Traumatic Brain Injury

In a previous blog post, I discussed the emotional changes that may result from traumatic brain injury (TBI). Another consequence of TBI that patients may not recognize themselves are behavioral changes. It is crucial that loved ones pay attention to shifts in behavior in order to provide support and connect patients with the care they need. It is important to note that behavioral changes resulting from brain injury can vary significantly, given that no two brain injuries are identical. In this post, I outline several changes that survivors and their loved ones or caregivers may benefit from understanding.

Changes in Personality After a TBI

Brain injury survivors may display the same personality traits as prior to their injury; however, these traits may be amplified. For instance, an individual who was calm and not easily excitable prior to their brain injury may come across as apathetic or aloof post-injury. There may even be instances where the individual displays traits that are conflicting with their pre-injury temperament, as in the case of someone who was demure but becomes highly outspoken and outgoing. Regardless of the type of personality change, it can be challenging for the individual to accept or even acknowledge. Increased understanding and acceptance from loved ones and friends is imperative to adapting to changes in personality. Making negative comments or judgments about how different the individual’s personality is can be detrimental to their emotional and mental well-being.

Executive Functions & Memory Changes Impacting Behavior

In a blog post about the importance of routines and TBI, I described executive functions as higher-order cognitive tasks, which include planning, attention, problem-solving, working memory, emotional self-regulation, initiation and inhibition of behavior. Below I have outlined the ways in which impaired cognitive functions, in particular, the executive functions, may impact behavior.

  • Impulsivity: Reduced control over the initiation and inhibition of behaviors can lead to impulsivity. Brain injury survivors, particularly those who have experienced frontal lobe injuries, may engage in more risky activities without considering the consequences. Such activities may include impulsive spending or reckless driving to name some examples. The individual may also be more willing to speak out on things that others might choose to filter and make crude, hurtful, or inappropriate remarks. Inappropriate remarks or behaviors may even be sexual in nature. Angry outbursts can also be a hallmark of impulsivity, even if this was not at all part of the individual’s temperament prior to the injury. It is important to understand that brain injury survivors do not have control over these behaviors but can be provided with tools to manage them. These tools may include thoughtful feedback, practicing appropriate social skills, as well as implementing cues that indicate the individual should reflect on their actions in the moment.
  • Mental Flexibility: Mental flexibility can be compromised as a result of brain injury. TBI survivors may be more rigid in their thinking. In other words, they may have difficulty adapting to changes that arise from situations or their environment. Generally, people can modify their thoughts and/or actions to adapt to unforeseen changes; however, this can be particularly taxing on those dealing with TBI. Survivors may also have diminished ability to see more than one solution to a problem. It is crucial to acknowledge that these reactions to a lack of structure and predictability are not a desire to be “difficult” or “stubborn” on the part of the injured person. Sometimes perseveration, which can be described as the repetition of thoughts, behaviors, or statements, may also be prevalent. Although individuals with TBI may become aware of perseverative behaviors, they may not be able to cease them on demand. Patience, the use of cues, and encouraging task switching is essential when dealing with this particular symptom.
  • Memory and Concentration: It is common for TBI survivors to experience memory deficits. In some instances, they will not be able to remember periods of time, particularly those that occur post-injury. It is common for short-term memory to be adversely affected, making learning new concepts a major challenge. Compensatory strategies, such a writing things down, repetition, experiential learning, and maintaining routine/structure, can address memory deficits. Individuals who have suffered a brain injury may be more prone to distractibility, which may manifest as having difficulty focusing on more than one task or maintaining focus during a conversation. This may also impact ability to learn new concepts or remember details. Loved ones should be patient and understanding, creating an environment that seeks to reduce distractions, prevent overstimulation, and enhance memory cues.

This list is not exhaustive by any means. It is essential for those with TBI and their loved ones to be open to ongoing learning in order to maximize potential for rehabilitation and to manage adapting to changes. A lack of insight or self-awareness can be an effect of TBI and can very well cause impediments to addressing such behavioral changes. Clinicians at PNBC are equipped with the skills and training to promote insight, improve optimism and self-esteem, as well as provide a sense of control over what can feel like dramatic changes for patients and family members alike. We aim to foster growth and self-empowerment by educating patients and their families, while keeping in mind the barriers that require empathy and understanding.

Written by: Beverly Sharifian, MA, APCC

Ms. Sharifian is an associate professional clinical counselor at Pacific Neurobehavioral Clinic, PC.

Exercise For Your Body and Mind

“What is good for the body is good for the brain”. It’s a common adage that I typically tell patients, family, friends, or whoever will listen. I often discuss the positive impact exercise has on our ability to think—to learn and remember new information, focus, generate novel ideas, and be creative. Furthermore, exercise has positive impacts on mood, which can alleviate symptoms associated with mental health conditions such as depression and anxiety.

In addition, individuals who are physically active are less likely to experience cognitive decline in older adulthood and have a lowered risk for developing neurodegenerative conditions such as Alzheimer’s disease. This is because physical activity increases oxygen to the brain which leads to the development of new blood vessels and brain cells. Moreover, exercise lowers the risk for chronic diseases that are associated with dementia such as coronary artery disease and hypertension.

Despite my own knowledge on the topic, though, while writing this I realized that I hadn’t exercised within the past 24 hours. Or even within the past 48! It made me think—even though many of us are well aware of the positive impacts of exercise—it can be so difficult to actually get going! Maybe it’s because our schedules are filled to the brim. Or because we feel out of shape and are worried about how we may look to ourselves or others when we finally get back to it. Financial and other logistical barriers can also be limitations, particularly during the COVID-19 pandemic. Speaking from my own experience, it can often be easier to find reasons not to exercise than to follow Nike’s instructions and “just do it”.

If you are struggling to exercise, these strategies may help:

  • Break your goal up into small chunks. If your goal is to be able to run 2 miles, start where you feel comfortable and work your way up to that. For example, start by running a half mile a couple times per week and then increase your mileage by a half mile each week after.
  • Get an “accountabilibuddy”. A friend or loved one with shared goals can be a companion to exercise with, which can be a motivator to show up even on days where it feels difficult to get going. If this is difficult due to the COVID-19 pandemic, an accountabilibuddy can still be helpful to touch base with by text or calling to keep each other accountable.
  • Don’t overdo it. Overexertion may lead to excessive soreness and fatigue, which could lead to being less likely to return to exercise the next day.
  • Finally, find an exercise that you enjoy! If running isn’t your thing, there are plenty of other ways to get your blood pumping including dance, walking at a fast pace, and high-intensity interval training. Many online courses are currently available currently due to the COVID-19 pandemic.

Although the jury is still out on how much and what type of exercise is best, current CDC guidelines suggest 150 minutes of moderate intensity activity for adults 18 and older, with at least 2 days a week of activities that strengthen muscles. Whatever form that may take for you, the most important thing is that some activity is better than none, so get out and start somewhere!

 

Written by Sarah Jurick, Ph.D. Dr. Jurick is a neuropsychologist at Pacific Neurobehavioral Clinic, PC. 

Welcome to Alexia Salcedo, Patient Care Coordinator

Introducing Ms. Alexia Salcedo, recently hired at PNBC as an Administrative Assistant and Patient Care Coordinator!

Prior to working at PNBC, Alexia worked as a Paralegal for just over a year resolving fire claims.  Before receiving her Paralegal certificate she had been in the medical field for a decade where she has worked with various types of clients, from workers’ compensation to professional athletes and has successfully managed their cases along the way while working alongside attorneys and insurance companies to ensure the patient is given the best care.

Alexia is fluent in Spanish , she takes pride in assisting patients, allowing them to communicate comfortably, feel heard, and understood.

 

 

Food and the Brain

You are what you eat. It’s a cliché phrase that most of us have heard but probably have not put much thought into. We know that certain types of diets can lead to health problems, such as obesity, diabetes, and high cholesterol, but did you know that what you eat can also have an impact on your brain? Which, in turn, can have affect your mood, energy level, and cognitive functioning?

Historically, nutritional science has not been emphasized in the study of psychiatric or neurologic conditions. It has only been within the last few years that we are beginning to have a better understanding of the relationship between nutrition and the brain. The following lists just a few tidbits of information to demonstrate the importance of food on our brain functioning.

Food and the Developing Brain

Nutritional deficiencies in childhood could have an impact on the developing brain. For example, iron deficiencies and lack of essential fatty acids have been associated with poor myelination of brain cells[1], which could lead to problems with processing speed and attention. Studies have also shown that children diagnosed with ADHD also have a very high rate of magnesium deficiency. In one study, 95% of the ADHD group tested had a magnesium deficiency! [2] Thus, ensuring proper nutrition in children exhibiting behavioral or cognitive problems is an essential first step before moving to more drastic measures such as prescribing controller prescription medications.

Food and the Adult Brain

A healthy diet still has its uses in the adult brain. Our brain is a very busy organ that is not only in charge of our thinking processes and feelings but sending signals to the rest of our body to control its functioning. The brain requires a lot of energy to run, and the source of that energy is largely in the food that we eat. Just as putting in high-grade gasoline can keep a car running efficiently in the long-term, the quality of the food that we eat will also maximize our brain health.

It is important to eat a wide variety of food that provides all the essential nutrients that our bodies need to function efficiently. A poor diet lacking in certain nutrients can lead to “brain fog” symptoms such as fatigue, difficulties concentrating, and slower processing. We have all experienced these symptoms to some degree (think to when you last tried to do something cognitive complex while on an empty stomach!)

Furthermore, nutritional deficiencies have been associated with a number of different neuropsychological symptoms. For example. vitamin D and vitamin B (particularly B12)[3] deficiencies are associated with depression as well as cognitive impairment.[4]  However, too much of a mineral can also lead to problems, as this often leads to development of free radicals that can damage cells. Iron toxicity has been associated with neurodegenerative diseases like Alzheimer’s disease or Parkinson’s disease.[5]

Preventing Risk Factors for Cerebrovascular Disease

Using the analogy of food as fuel, think of your blood vessels as the pumps that are feeding your brain. Diets that are high in unhealthy fats can lead to clogging of those pumps which can lead to reduced blood and oxygen flow to the brain over time. Likewise, too much protein or too much glucose in the bloodstream can also lead to oxidation and hardening of blood vessels over time, which narrows the pathways for blood flow. This is why hypertension is considered to be the biggest risk factor for strokes. Diabetes and high cholesterol are other conditions that can lead to cerebrovascular changes over time. A proper diet to reduce these risk factors is vital.

Special Diets to Prevent Neurological Symptoms

In general, a balanced diet with lots of vegetable varieties, complex carbohydrates, and healthy fats is best for our general physical and brain health. However, some people may require a different ratio of macronutrients (proteins, fats, carbohydrates) to help with specific health conditions. For example, several studies have shown that keto diets may be effective in preventing seizures in children with epilepsy.[6] More recent studies are also looking into ketones providing a neuroprotective effect against neurodegenerative conditions, such as Alzheimer’s disease, though this is still up for debate.[7] However, it is cautioned that a ketogenic diet can lead to deprivation of nutrients that would be found in a more balanced diet. Consideration of starting a keto diet should be discussed with one’s physician and ideally a dietitian to determine a healthy meal plan.

The Microbiome

Most recently, there has been an explosion of research investigating the microbiome, which is the universe of bacteria that lives within our bodies. These bacteria outnumber our human cells, and they play a role in digestion and the immune system. Gut bacteria imbalances have been associated with inflammatory conditions such as irritable bowel disease.[8]

Furthermore, we have learned that there is bidirectional communication between the gut and the brain through several different pathways. Studies have suggested that, at least in rats, certain bacteria found in the gut appears to influence the development of emotional behavior, stress- and pain-modulation systems, and brain neurotransmitter systems.[9] Further research is being conducted on how this translates to human beings.

In short, science is finally catching up to examine the interconnection between nutrition with neuropsychiatric conditions. There is still much to learn, but it is apparent that what we eat can have profound effects on our general health, which includes our brain!

Nutritional Counseling at PNBC

Nutrition is something that is often overlooked that we at PNBC feel is important to include as part of a comprehensive treatment plan for neuropsychological conditions. We are happy to announce that we will soon be offering nutritional counseling services with a registered dietitian (RD) who will work in tandem with our psychologists and therapists.

 

Written by Delia Silva, PsyD, ABPP-CN. Dr. Silva is a board-certified neuropsychologist and owner of Pacific Neurobehavioral Clinic.

 

Subscribe to our newsletter to get e-mails when new posts such as this one come out, and for news about happenings at Pacific Neurobehavioral Clinic, PC.


 

 

[1] Yehuda, S., Rabinovitz, S., & Mostofsky, D. I. (2006). Nutritional deficiencies in learning and cognition.

[2] Kozielec, T., & Starobrat-Hermelin, B. (1997). Assessment of magnesium levels in children with attention deficit hyperactivity disorder (ADHD). Magnesium Research10(2), 143-148.

[3] Oh, R., & Brown, D. L. (2003). Vitamin B12 deficiency. American family physician67(5), 979-986.

[4] Etgen, T., Sander, D., Bickel, H., Sander, K., & Förstl, H. (2012). Vitamin D deficiency, cognitive impairment and dementia: a systematic review and meta-analysis. Dementia and geriatric cognitive disorders33(5), 297-305.

[5] Altamura, S., & Muckenthaler, M. U. (2009). Iron toxicity in diseases of aging: Alzheimer’s disease, Parkinson’s disease and atherosclerosis. Journal of Alzheimer’s Disease16(4), 879-895.

[6] Levy, R. G., Cooper, P. N., Giri, P., & Weston, J. (2012). Ketogenic diet and other dietary treatments for epilepsy. Cochrane database of systematic reviews, (3).

[7] Włodarek, D. (2019). Role of ketogenic diets in neurodegenerative diseases (Alzheimer’s disease and Parkinson’s disease). Nutrients11(1), 169.

[8] Morgan, X. C., & Huttenhower, C. (2012). Human microbiome analysis. PLoS Comput Biol8(12), e1002808.

[9] Mayer, E. A., Tillisch, K., & Gupta, A. (2015). Gut/brain axis and the microbiota. The Journal of clinical investigation125(3), 926-938.

CBT-I for Troubled Sleep

Having trouble sleeping lately? Whether it involves difficulty falling asleep, staying asleep, and/or feeling restless the next day, it is no wonder that with the ongoing pandemic, there has been a surge of troubled sleepers worldwide. Some experts are even coining the term “coronasomnia” for the increased COVID-19-related sleep issues, creating a vicious “insomnia-causes-stress-causes-more-insomnia cycle” (UC Davis Health, 2020).

 

A recent report from the National Institutes of Health (NIH; Morin & Carrier, 2020) emphasized a study that revealed increased rates of clinically significant insomnia along with more acute stress, anxiety and depression in response to the pandemic (Lin et al., 2020). There is sufficient evidence demonstrating how a lack of sleep can have a range of negative health impacts, ranging from depression to an increased risk for heart conditions. Of concern, is that these sleep disturbances may become chronic and endure well after the pandemic. Thus, the individuals who develop sleep disturbances during COVID-19 may be at greater risk for long-term adverse health outcomes, exemplifying the “call for concerted public health interventions” (Morin & Carrier, 2020). Correspondingly, the European CBT-I Academy Task Force has compiled some practical recommendations available to the public to help individuals manage sleep disturbances during the pandemic (Altena et al., 2020), you may find that article here.

 

What is CBT for Insomnia (CBT-I)?

If you feel that your insomnia is getting out of control and you are having difficulty sleeping lasting for weeks, you may benefit from Cognitive Behavioral Treatment for Insomnia (CBT-I). CBT-I was developed and tested by Dr. Gregg Jacobs at Harvard Medical School and the University of Massachusetts Memorial Medical Center (Jacobs, 2020). This treatment is a structured, evidence-based program which aims to help individuals relearn how to sleep. The program is brief (i.e., six weeks), which includes an initial evaluation followed by five sessions with a CBT-I certified provider. Furthermore, CBT-I is covered by most insurance companies.

 

During the CBT-I sessions, individuals are taught:

  • how to change sleep thoughts and behaviors.
  • lifestyle habits that improve sleep
  • relaxation skills

 

Moreover, CBT-I has been endorsed by the NIH, New England Journal of Medicine, the Lancet, American Psychological Association (APA), Consumer Reports, and the American College of Physicians as an effective and preferred method for treating chronic insomnia (Jacobs, 2020).

 

How Effective is CBT-I?

Research on CBT-I (Jacobs, Benson, & Friedman, 1996; Jacobs, Pace-Schott, Stickgold, & Otto, 2004; Morin, 2004; Morin et al., 1999, 2004, 2006; Wu, Bao, Zhang, Deng, & Long, 2006; Wu, Appleman, Salazar, & Ong, 2015) shows that:

  • 75% of insomnia patients experience significantly improved sleep
  • 85- 90% reduce or eliminate sleeping pills
  • CBT is more effective than sleeping pills

 

Find a CBT-I Therapist

If you are interested in learning more about CBT-I, please feel free to contact PNBC for additional information.

 

Written by Angela J. Patino, Psy.D. Dr. Patino is a bilingual clinical and forensic psychologist and CBT-I certified provider at PNBC. She is currently offering CBT-I telehealth sessions with select clients.

 

References:

Altena, E., et al. (2020). Dealing with sleep problems during home confinement due to the COVID-19 outbreak: Practical recommendations from a task force of the European CBT-I Academy. Journal of Sleep Research. doi: 10.1111/jsr.13052.

Jacobs, G. (2020). CBT-I Treatment. Retrieved from https://www.cbtforinsomnia.com/cbt-i-treatment/

Jacobs, G., Benson, H., & Friedman, R. (1996). Perceived benefits in a behavioral medicine insomnia program: A clinical report. American Journal of Medicine, 100, 212-216.

Jacobs, G., Pace-Schott, E., Stickgold, R., & Otto, M. (2004). Cognitive behavioral therapy and pharmacotherapy for insomnia: A randomized controlled trial and direct comparison. Archives of Internal Medicine, 164, 1888-1896.

Lin, L., et al. (2020). The immediate impact of the 2019 novel coronavirus (COVID-19) outbreak on subjective sleep status. Sleep Medicine, S1389-9457(20)30221-5. doi: 10.1016/j.sleep.2020.05.018

Morin, C. (2004). Cognitive-behavioral approaches to the treatment of insomnia. Journal of Clinical Psychiatry, 65(16), 33-40.

Morin, C., Bastien, C., Guay, B., Radouco-Thomas, M., Leblanc, J., & Vallieres, A. (2004). Randomized clinical trial of supervised tapering and cognitive behavior therapy to facilitate benzodiazepine discontinuation in older adults with chronic insomnia. American Journal of Psychiatry, 161, 332-342.

Morin, C., Bootzin, R., Buysse, D., Edinger, J., Espie, C., & Lichstein, K. (2006). Psychological and behavioral treatment of insomnia: Update of the recent evidence (1998-2004). Sleep, 29(11), 1398-1414. doi: 10.1093/sleep/29.11.1398

Morin, C. & Carrier, J. (2020). The acute effects of the COVID-19 pandemic on insomnia and psychological symptoms. Sleep Medicine. doi: 10.1016/j.sleep.2020.06.005

Morin, C., Hauri, P., Espie, C., Spieldman, A., Buysse, D., & Bootzin, R. (1999). Nonpharmacologic treatment of chronic insomnia: An American Academy of Sleep Medicine review. Sleep, 22(8), 1134-1156. doi: 0.1093/sleep/22.8.1134

UC Davis Health. (2020). COVID-19 is wrecking our sleep with coronasomnia – tips to fight back. Retrieved from https://health.ucdavis.edu/health-news/newsroom/covid-19-is-wrecking-our-sleep-with-coronasomnia–tips-to-fight-back-/2020/09

Wu, J., Appleman, E., Salazar, R., & Ong, J. (2015). Cognitive behavioral therapy for insomnia comorbid with psychiatric and medical conditions: A meta-analysis. JAMA Internal Medicine, 175(9), 1461-1472. doi: 10.1001/jamainternmed.2015.3006

Wu, R., Bao, J., Zhang, C., Deng, J., & Long, C. (2006). Comparison of sleep condition and sleep-related psychological activity after cognitive-behavior and pharmacological therapy for chronic insomnia. Psychotherapy and Psychosomatics, 75, 220-228.

Making Self-Care a Priority 

It is hard to believe 2021 is less than 90 days way. This year, with all of the many challenges, seems to be flying by. With the transition to working from home, many employees have found themselves even busier than when they were working in the office. Add to thatschool-aged and/or college-aged distance learnersand perhaps another adult or two also working from home, you can begin to feel like an afterthought in your own mind. The demands for your attention, your great ideas, your support, your space, your time…can feel endless. It is easy to get caught up in the next thing on your to do lists, help a colleague with the new account at work, volunteer for that special committee, or other ways you prioritize other people’s needs over your own.  

When you continue in these cycles of constant giving, without taking time to refuel or refill yourself back up, the quality of your giving can deteriorate without you realizing it. Your patience may run thin, your temper may shorten, and before long the “giving” that once gave you pleasure, now feels exhausting. Simple acts of self-care can keep you energized and strengthen to thrive even when it feels as though you are constantly giving. 

What is Self-Care?  

Self-care is intentionally being good to yourself; taking care of yourself in a way that is sustaining for youThis will look different from person to person, and that is okay. What I need can be different than what you need because we are different people. Self-care is not being selfish, particularly if there are many people around you that need you and rely on you. It does not have to be an expensive purchase or all-day adventure…although those could certainly qualify as self-careThink about the last time you boarded an airplane and found yourself waiting for the flight to take off. The flight attendants begin their safety presentation and give instructions on how to use the oxygen masks if they become available. The flight attendants instruct you to put on your own oxygen mask before helping anyone else with their oxygen mask. Why? Because to help others, you need to have already been helped yourself. Prioritizing your self-care is essential when there are demands on you to care for others around you. 

How do you do it?  

Start small. With the COVID-19 social distancing restrictions, there may not be very many options available outside of the home, so use what you have or what you can easily obtainIt may be easiest to incorporate self-care in activities you are already doing. Think about ways to enhance the things that you are already doing and be intentional about experiencing the pleasures in the moments. Perhaps use an aromatherapy body wash and inhale the relaxing or rejuvenating scent while showering. Or, take a few extra minutes and run a warm bath and add essential oils, bubble bath, or soothing bath salts. You need to bathe, so why not take a few moments to enhance the experience before going to bed or starting your day? When you have your morning coffee or afternoon tea, take a moment to walk outsidebreath in fresh air and enjoy the flavor of your warm (or iced) beverage. When you are out grocery shopping, pick up a new fresh herb to add to your pasta or saladgrab a new sauce for your protein, or grab that fruit or vegetable you have all ways wanted to try. These small actions can have lasting impact on you, your well-being, and the care your give to others. 

 

What are some ways you can begin to practice self-care? 

 

Written by Takisha Corbett, Ph.D. Dr. Corbett is a clinical psychologist at Pacific Neurobehavioral Clinic, PC.

 

 

Emotional Effects of Traumatic Brain Injury

Survivors of traumatic brain injury are often left to deal with unforeseen changes and symptoms. Impact to various regions of the brain, such as the area responsible for regulating emotions, can cause survivors of TBI to sense a lack of control over their feelings. Adjusting to life after brain injury may also trigger stress and lead to adverse emotional states. Below are some of the emotional symptoms that may manifest following traumatic brain injury:

  • Mood Fluctuations: Depending on the area of impact, TBI can cause sudden shifts in mood, such as fluctuating from content to irritable without any triggering event. In some instances, survivors of TBI may find themselves laughing for extended periods or experiencing sudden bursts of crying. This can be particularly challenging to manage because the emotional expression is often incongruent with the individual’s internal feelings. In other words, the individual is unable to control or cease laughter, when in actuality, they are feeling down or depressed. These exaggerated shifts in mood are referred to as emotional lability. This symptom can be concerning to both survivors and their loved ones due to its unpredictable nature and the individual’s lack of control over the expression of emotion.

  • Anger: Irritability is another common emotional change following TBI. Impact to brain regions that control emotional expression, in addition to difficulty adjusting to changes in recovery and experiencing intense pain, may all contribute to increased irritability and anger. Some survivors have diminished patience and find it difficult to control their temper. Regardless of the individual’s temperament prior to injury, angry outbursts may include yelling or screaming, using profanity, threatening others, and throwing or slamming things. These feelings can be unfamiliar to some survivors of TBI who had rarely experienced or expressed them in this manner prior to the onset of injury.

  • Depression: It can be particularly difficult to distinguish symptoms of depression from the symptoms of brain injury. Sudden onset of symptoms may be attributed to the injury, whereas gradual onset tends to point to depression. General feelings of sadness can be expected throughout the recovery process, given the experience of significant life changes. However, when feelings become overwhelming or impair functioning, they may be indicative of depression. Depressive symptoms may include low mood, loss of pleasure in activities, lack of motivation, changes in appetite, sleep disturbances, isolation, fatigue, hopelessness, and thoughts of dying. Feelings of guilt may complicate this experience, as survivors may feel that they are to blame for their injury or that they should have gratitude for surviving the event.

  • Anxiety: Survivors of brain injury may become more sensitive to stimuli and find that daily tasks, such as making decisions about what to wear, are stressful. The pressure of not being able to return to work or modifications in daily routines due to sensory overload can trigger anxiety. Feelings of anxiety may be physiological (increased heart rate, difficulty breathing) or cognitive (excessive worry, difficulty concentrating). Survivors of TBI may even suffer from panic attacks, which occur suddenly and unexpectedly without any particular trigger, causing behavioral changes (avoidance). Given the significant life adjustments following injury and throughout the recovery process, anxiety may be a temporary response. However, it is wise to consult with a professional in order to determine the cause of anxiety, as well as the appropriate interventions.

Managing Emotional Symptoms

 

Communicating feelings can seem unfeasible when individuals cannot quite understand what it is that they are feeling or experiencing. It is nevertheless important to express needs and feelings to loved ones/caregivers who may also observe these emotional changes but are uncertain about what they can do to help. Isolating from others can compound problems and make the symptoms feel increasingly unmanageable. It is crucial to ask for support when needed. Survivors of TBI may find peer support, either in the form of mentoring or TBI support groups, more effective than leaning on loved ones. Consulting with medical providers about symptoms can provide clarity regarding treatment options, which may include medication management or counseling services. It is important to note that each individual’s experience with TBI is unique, resulting in distinct needs that require tailored interventions.

Clinicians at PNBC use empirically-based interventions and psychoeducation to help TBI survivors distinguish the symptoms of injury from symptoms that may be indicative of a mood disorder. The clinicians’ diverse backgrounds and specializations enable clients to receive care attuned to their needs. Examples of interventions include cognitive behavioral therapy to address negative thought processes and manage pain, relaxation strategies such as grounding techniques or progressive muscle relaxation to reduce anxiety, and trauma-informed approaches that may relieve post-traumatic stress. Therapy can increase insight into symptoms, reducing the unknowns and making the recovery process feel more manageable.

Written by Beverly Sharifian, MA, APCC.

Pre-Surgical Psychological Clearance for a Spinal Cord Stimulator (SCS) Trial

Have you been recommended a spinal cord stimulator (SCS) trial implantation by your treating physician? Are you wondering what to expect from the required pre-surgical psychological evaluation? Are you asking yourself, why is a psychological evaluation even required? Well then, read this article, you shall.

 

What is a Spinal Cord Stimulator?

In brief, an SCS trial is usually recommended to patients by a medical provider after all other conservative forms of medical treatment have failed to provide an optimal level of pain relief. Conservative treatment may include medication(s), injection(s), physical therapy, or other non-surgical treatments. Essentially, spinal cord stimulation may help relieve pain and improve the quality of life in people with chronic pain, such as low back and leg pain. Spinal cord stimulation works by blocking pain signals in nerves from reaching the brain, where pain is processed (Highsmith, 2019). A spinal cord stimulator is a small device implanted under the skin, which then delivers a slight electrical impulse that masks or changes pain signals before they reach the brain (Highsmith, 2019). The SCS trial period, which usually lasts at least 5 to 7 days, determines whether the permanent version of the treatment will be beneficial to the patient.

 

Both the SCS trial and permanent procedures are considered to be minimally invasive. Permanent implantation is, well, permanent; thus, full commitment is required from the patient. As with any procedure, there are both benefits and risks with an SCS implantation, and not all patients with chronic pain are considered to be treatment candidates. Therefore, it is highly recommended that patients obtain an adequate understanding of the procedure, risks, and expectations from the referring physician.

 

What Should I Expect with A Pre-Surgical Psychological Evaluation?

Among the factors considered to determine whether a patient is an appropriate candidate for the SCS trial implantation, includes the patient’s mental health. An abundance of studies have shown that the presence of certain mental health symptoms and/or conditions may affect the outcomes of some surgical procedures, such as the SCS implantation (Bruns & Disorbio, 2009; Celestin, Edwards, & Jamison, 2009; den Boer et al., 2006). Thus, most insurance companies, and even some states, now require pre-surgical psychological clearance for SCS implantation.

 

Typically, the psychological evaluation consists of a clinical interview between the patient and a trained psychologist to discuss the patient’s medical, social, family, education, and mental health history. Questionnaires, and/or psychological tests, are provided to obtain more information about how the patient manages his or her pain, mood, and overall daily functioning. In general, chronic pain patients are more likely (i.e., four times more likely) than the general public to experience symptoms of depression, irritability, and anxiety (Kleiber, Jain, & Trivedi, 2005). The pre-surgical psychological evaluation can offer recommendations to help improve these symptoms. The appointment time for an evaluation usually takes up to three hours and is completed in one appointment. However, depending on the individual’s needs, the appointment may take longer. Ultimately, most people are cleared for the SCS trial. The small percentage of individuals who do not get cleared are recommended alternative ways of managing their pain.

 

If you are considering the SCS trial to help manage your pain, please consult with your pain management specialist and/or treating physician to explore if this treatment would be beneficial to you. If you are already scheduled for your pre-surgical psychological evaluation at PNBC, please feel free to ask your evaluating psychologist any remaining questions you may have.

 

Written by Angela Patino, PsyD. Dr. Patino is a psychologist at Pacific Neurobehavioral Clinic, PC.

 

References

Bruns, D., & Disorbio, J. M. (2009). Assessment of biopsychosocial risk factors for medical treatment: A collaborative approach. Journal of Clinical Psychology in Medical Settings, 16(2), 127-147.

 

Celestin, J., Edwards, R., & Jamison, R. (2009). Pretreatment psychosocial variables as

predictors of outcomes following lumbar surgery and spinal cord stimulation: A

systematic review and literature synthesis. Pain Medicine, 10(4), 639-653.

 

den Boer, J., Oostendorp, R., Beems, T., Munneke, M., Oerlemans, M., & Evers, A. (2006). A

systematic review of bio-psychosocial risk factors for an unfavourable outcome after

lumbar disc surgery. European Spine Journal, 15(5), 527-536.

 

Highsmith, J. (2019). What is spinal cord stimulation? How spinal cord stimulation can help reduce chronic back and extremity pain. Spine Universe. Retrieved from https://www.spineuniverse.com/treatments/pain-management/spinal-cord-stimulation/what-spinal-cord-stimulation

 

Kleiber, B., Jain, S., & Trivedi, M. (2005). Depression and pain: Implications for symptomatic presentation and pharmacological treatments. Psychiatry. 2(5), 12-18.

 

 

 

Anxiety’s Impact on Cognitive Functioning

Anxiety is an emotion that we feel in response to a threat or a potential threat. Often, it helps us out. For example, anxiety can motivate us to practice an upcoming presentation for class, take a step back when standing at the edge of a tall building, or prepare for an important occasion like meeting in-laws for the first time.

 

However, anxiety can become unmanageable and unhelpful.

 

It can cause physiological symptoms such as shortness of breath, racing heart, and shakiness. Anxiety can also cause us to change our behavior. For example, we may frequently check that the front door is locked or avoid doing things we want or need to do (e.g., speak up in a work meeting). Finally, it can impact our thoughts such as worrying about things that could happen in the future like trouble paying bills or upcoming social events.

 

These anxiety-related symptoms can capture and maintain our attention, and make it harder to focus on the task at hand. When anxiety has reached the level that it feels unmanageable or difficult to control, it can make the very things we are anxious about more difficult. For example, when anxious during a presentation at school, we may begin to feel ourselves sweat and shake. Soon, all we can focus on are the physiological symptoms we are experiencing and the thought, “everyone must be noticing how anxious I am right now.” We may decide to cut the presentation short, which may temporarily relieve the anxiety but teach us that we couldn’t handle that experience, making it harder the next time around.

 

This situation is just one example of how anxiety can cause cognitive problems, such as difficulty focusing, remembering important details, and making decisions. Some experience anxiety in social situations and can have thinking difficulties when around new or influential people, such as coworkers or a boss, or when anticipating being in that situation. Others feel anxious in relation to a traumatic or stressful event that occurred in the past and may have difficulty focusing when thoughts of the event arise and/or in response to specific reminders of the event. For some, anxious thoughts are nearly constant, and may generalize to just about any stressful situation that could arise such as worry about losing loved ones or becoming ill.

 

If you have anxiety along with other conditions, such as: trouble sleeping, depression, attention deficit hyperactivity disorder (ADHD), chronic pain, traumatic brain injury (TBI), and/or alcohol and substance use, that can have a negatively compounding effect on cognitive functioning. Imagine that your ability to think (e.g., memory, attention, problem solving) is a pie, and each of these conditions represent a piece. If you have anxiety, it eats a piece of the pie. ADHD eats up another one. Poor sleep eats up another one. Pain eats up another one. Then you are left with only a couple pieces to get through the day—whether it be work, school, and/or caring for loved ones—it just doesn’t seem like enough!

 

Here is the good news. There are many great strategies to help manage anxiety including breathing techniques and mindfulness, physical activity, and engaging in self-care. That being said, sometimes anxiety and related conditions are too much to manage on our own. Seeing a clinician can be really helpful as a guide through these techniques and to provide treatments that have been shown to improve anxiety and cognitive abilities in large-scale studies. Clinicians at PNBC provide psychotherapy to individuals with anxiety and commonly co-occurring conditions who may be experiencing cognitive difficulties in their everyday life.

 

Written by Sarah Jurick, Ph.D. Dr. Jurick is a neuropsychologist at Pacific Neurobehavioral Clinic, PC. 

Parenting While Coping With Chronic Pain

One of the concerns reported by my chronic pain clients who are also parenting is feeling like they are not as engaged with their children as they would like to be. In addition to generating feelings of guilt and shame around their parenting, this also frequently leads to stress and conflict with the other parent, or the household in general.

Individuals with chronic pain frequently experience symptoms like fear of re-injury, worry about the future and their health, low motivation, and fatigue, to name a few. These can lead to being less active and having no desire to participate in engaging with their children and family. Some of my clients also report that they frequently feel irritable and snap at their immediate family members, including their children, further straining relationships. When this is combined with chronically experiencing pain and coping with various limitations as a result, it can lead to feelings of sadness, hopelessness, low mood, isolation and more.

The biggest challenge for individuals experiencing chronic pain is learning to live in a “new normal.” Shifting their expectations and reframing their thoughts and ideas about what it means to live a fulfilling life, who they are, and how they matter and engage within their families and communities. In reference to parenting in particular, it is important to first have honest, developmentally appropriate conversations with children and family members, about what the person is experiencing in terms of pain and emotionally, as well as how other people in the family are feeling. This helps establish mutual understanding and can lead to having a positive support system for the person experiencing pain.

This is beneficial because it helps create empathy and space for everyone to be able to positively communicate their emotions and needs. If someone is having a particularly tough day with pain, for example, when there is already a foundation of knowledge and understanding, it may be easier to ask for down time, alone time and a break from activities, or whatever else helps the person cope best. It may also help make it easier for family members and children to hear, without internalizing this as a form of rejection.

It is also important to note that with flexibility and some creativity, people experiencing chronic pain can continue to share experiences with their family and play with their children. Many times, we get stuck in thinking that if we can’t do something how we always have, we cannot do it at all. This is what frequently leads to not wanting to engage with children and family. If we shift our focus to what we can do, versus what we can’t, we may discover new ways of doing things that will help us connect with our family and children.

This is not to say we are to ignore our emotions and feelings of grief or loss about what we cannot do, because they are very real and valid. These emotions deserve attention and space for individuals to process and feel them. What it does mean, is that we don’t get stuck there. We flow between giving tough emotions space, and then making room for some positives ones as well, leading to a more balanced state.

Some activities for parents and children to do, which with some adaptation can be done standing, sitting or even laying down, depending on individual needs include:

*Playing with Play-Doh
*Making art
*Making a puzzle
*Reading a book
*Taking the children to the park and watching them play
*Flying a kite
*Legos
*Watching something together
*Cooking together
*Sharing mealtime conversations
*Having a picnic
*Listening to music
*Watering plants
*Going on a nature walk
*Go watch their extracurricular activities
*Take a picture taking walk
*Go swimming

Another consideration is a person’s ability to focus and be present, as well as being able to cope with irritability when in pain. Some ways to cope with this is being spontaneous and taking advantage of the times when they are feeling better or having a ‘good day’, to help balance the days when they need to make themselves a priority and need space for themselves; making these interactions short (quality versus quantity of time), but more frequent; choosing calming or relaxing activates; or having another adult participate so they don’t have to lead or be responsible for full engagement.

Many times, children mainly want a parent’s attention and presence. If parents can adapt to the necessary changes in interaction and find time to engage, while making sure to be as comfortable as possible, they will find that they can be more present with their children, and more active in parenting. This will lead to positive feelings for everyone involved, and a more balanced emotional state for the parent experiencing chronic pain.

 

Written by Taina Aceves, MA, LMFT. Ms. Aceves is a therapist at Pacific Neurobehavioral Clinic, PC.

The Impact of Sheltering in Place on Mental Health and Chronic Pain

Since shelter in place orders began to take effect in March, many of my own clients have seen increases in pain and mental health symptoms. While sheltering in place has placed many restrictions on people, as well as significantly changed how we all experience our day to day lives, there are two things that directly impact pain and mental health: social distancing and restricted, limited or no physical activity. Human connection and physical activity are important parts of managing chronic pain and mental health symptoms. Both are tools and behavioral changes I recommend to my clients in therapy.

First, it is worth noting that following shelter in place orders, including social distancing and mask wearing, is important to help slow the spread of COVID, until a solution can be found. The following are recommendations on how to try and compensate for these restrictions, not a call to avoid following the orders.

Having a support system, being able to have conversations, spending time with friends and loved ones, and connecting with co-workers are important to our overall well-being and help us cope with chronic pain and mental health symptoms, including anxiety, depression and stress. Being able to engage in social activities with others serves as a positive distraction from pain and difficult emotions, and it also helps create positive experiences that improve our mood and outlook, by helping to balance negative focus and thoughts. In addition, the benefits of being able to physically touch or be touched by others are many, and include stress reduction, increases in oxytocin and may even help improve the immune system.

The first question is: how do you cope with not being able to have as much human connection as before, particularly in-person contact?

If you have other members in your household whom you are sheltering in place with, you may have an easier time meeting this need than someone who lives alone. Make time to share quality time with your household members, that do not fall into the ordinary, daily routine. Backyard dates or picnics, movie nights, game nights, and cooking together are some ideas. When appropriate, engage in physical touch, like hugging.

If you live alone, make use of technology to try and stay connected to others. Engage in video or voice conversations, participate in virtual hangouts, game nights or dates, and maybe try virtually cooking new recipes with others. Massaging yourself may also be helpful for both emotional and physical well-being. Shelters across the United States reported a sharp increase in pet adoptions since the pandemic began, so if you have the desire, time and resources to care for a pet, this can also be a great option. Just keep in mind that caring for your pet will still be necessary once the shelter in place orders lift, and you should be willing and prepared to continue to love and care for your pet, even after this is all over.

The second question is: how do you balance sheltering in place and engaging in physical activity?

Many of us are unsure about what is and is not permitted under shelter in place, and this has led to a decrease in physical activity for many of us. The first tip is to work out inside your home, especially if you are having difficulty managing anxiety about leaving your home or are a high-risk individual for COVID. If you are having trouble getting motivated, think about virtually working out with someone. At this point, it is worth mentioning that getting some sun and fresh air does the mind and the body good. Which leads us to the second option: get outdoors. Though it is important to understand that as long as there is a pandemic, there will be risk associated with leaving our homes, it is also important to know that there are ways which decrease the risk of contracting COVID while engaging in outdoor physical activity. These include wearing a mask, avoiding crowded places, going out during ‘off hours’ (for example, avoiding the beach on the weekend) and staying physically distanced from other people. You can start with short walks around your neighborhood, during the times when there are less people out. Schedule these outings into your week to help you follow through. You can also engage in outdoor activity with others, as long as you practice social distancing and wear your masks.

The bottom line is- get creative and make the best of it. Try to find ways in which you can safely practice things that do you good, like socializing and activity. They may not be perfect, ideal, or exactly what you need, but something will be better than nothing, and keeping yourself and others safe during this pandemic is worth it. During shelter in place, it is beneficial to adopt an attitude of adaptation versus all or nothing. It is for your own good, and your mind and body will thank you!

Written by Taina Aceves, MA, LMFT. Taina is a therapist at Pacific Neurobehavioral Clinic, PC, in San Diego, CA.

Coping with Hospital Stays During the COVID-19 Pandemic

As the country begins the process of re-opening and lifting some restrictions, we find many activities are resuming. These include medical procedures that may have been postponed, as hospitals and medical facilities everywhere braced and prepared for treating individuals with COVID-19 back in March. If you are one of many patients who are being scheduled for procedures and treatments that require hospitalization, you and your family members are probably being confronted with the likelihood that no one will be allowed to enter the hospital with you, or stay with you during recovery. Medical care facilities around the country are implementing strict policies that ban visitors to try and limit the spread and risk of COVID-19 within their facilities, and there is no sign that these restrictions will be lifted in the near future.

 

Getting medical treatments that require hospital stays are generally anxiety producing for patients and their loved ones. If we add to this that they will likely need to go through this without a support person by their side, and the added concerns due to the COVID-19 pandemic, it is to be expected that patients and their loved ones will experience and increase in worry and anxiety.

Here are some tips that may help decrease some of those worries and anxiety:

 

  • You and your family can inquire as to what precautions are in place to protect patients from COVID, if this is something that you are feeling concerned about. Going into the situation as informed as possible will help you and your loved ones feel more in control and less anxious, setting you up for a better experience.
  • Ensure your family knows who and where to call for information if they are unable to reach you, to help decrease their concern and worry. If they feel more at ease, there is less opportunity that you will be impacted by their anxiety too.
  • Set up reliable communication. Make sure you have a phone, a charger, headphones (if allowed) and that you know how to use them all. If possible, make use of video calls to communicate with your loved ones- you may find they bring more emotional connection and comfort than voice calls or text messages alone.
  • Pack some activities that your doctor pre-approves, and you enjoy, to keep yourself entertained during your stay. Crossword puzzles, art, reading material, or a smart device with downloaded (in case streaming is not possible) shows, movies or games, are some examples. The more entertained you are, the less time you will have to focus on worries or being alone.
  • Be prepared to implement some relaxation techniques during your stay, to use when you feel the need. Some examples are listening to your favorite music, breathing exercises, progressive muscle relaxation, grounding techniques and visualization.
  • If permitted, pack some of your favorite, doctor-approved, non-perishable snacks to enjoy as you recover.
  • Remember that some anxiety around medical procedures and hospital stays is completely normal. Tell yourself this to prevent being critical of yourself or putting yourself down for having these emotions. Instead, focus on taking care of yourself, being kind to yourself and implementing positive coping tools to help you manage these feelings.
  • Sleep! Rest is an important part of recovery. If you find yourself having trouble sleeping, practice some of the relaxation techniques mentioned above. If allowed, come prepared with essential oils that may help you wind down, or request a permitted caffeine free tea to enjoy.

Before implementing any of the above suggestions, be sure to discuss these with your doctor, to ensure everything you want to implement is allowed by the medical facility and approved by your physician. During times of high stress or anxiety, you can help manage how you are feeling by focusing on what you are able to control, such as seeking helpful and necessary information, and implementing tools that help you feel more calm. Keep in mind that the treatment you are receiving is meant to help your body and improve your health outlook, and you will soon be reunited with your loved ones. As the saying goes, “this too shall pass”.

Written by Taina Aceves, LMFT. Ms. Aceves is currently accepting therapy patients via telehealth at Pacific Neurobehavioral Clinic, PC.