Helping children with transitions

By R. Scott Benson, M.D.

Before the New Year I shared the story of the family who was having trouble getting going in the morning. I touched on a couple of general principles for improving behavior. Structure, not punishment. Measuring the problem, and measuring the results.  Let me give another example.

Many children have trouble with transitions – moving from one planned activity to the next. The underlying problem is likely anger at being deprived of the fun of this activity and a little bit of anxiety about the unknown of the next activity. They might know in their thinking brain that the next activity will be fun, but the impulsive emotion for many children is fear. They have to “get a grip” on this fear in order to move to the next activity.

A mother asked for help with managing the meltdowns her four year old had when it was time to leave grandmother’s to go home. And it was frustrating because there had been a similar meltdown when they first left home to go to the grandmother. And he was having a great time while he was there.

Our plan – engage her child in a discussion. And these discussions are much later, even another day, or a Saturday morning. “I have noticed that when we are at grandmother’s and I say ‘It’s time to go home.’ Ka-boom. A meltdown. (You need to find a name for the behavior you want to eliminate. That way you have a code word for what you are measuring). Well, is there another way I could say it so that you didn’t get into your meltdown and waste 15 or 20 minutes.”

Your child might have a suggestion or no clue. Offer something silly like – “The lettuce is wilting.” This absurd statement when it is time to go will get him in his thinking brain trying to figure out what you are talking about. Use this as a starting point to script him for the transition. “I will say, ‘The lettuce is wilting.’ And you will say, ‘Does that mean it is time to go?’ And I will say, ‘Yes.’”

Practice this script two or three times until everybody has their words right. Then take it for a field test at grandmother’s. If there is success keep track with punch cards that can be traded for something reflecting the “time saved”. Maybe a movie.

If unsuccessful, re-work the script and practice, practice, practice.

Are there other behaviors that are a challenge at your house? Have you found strategies for success?

Are You Shocked?

By Gariane Phillips Gunter, M.D.

I recently came across an interesting article in the Marie Claire magazine entitled, I Had Shock Therapy… And I’d Do It Again and thought we could talk about this type of therapy a bit. A special thank you to this woman for sharing her story with the world.

What is it? Electroconvulsive therapy also known as ECT, is a well-established psychiatric treatment in which seizures are electrically induced in anesthetized patients for therapeutic effect. Today, ECT is most often used as a treatment for severe major depression which has not responded to other treatment, and an estimated 1 million people worldwide receive ECT every year, usually in a course of 6–12 treatments administered 2 or 3 times a week.

Is ECT Effective? The 1999 U.S. Surgeon General's Report on Mental Health summarized psychiatric opinion at the time about the effectiveness of ECT. It stated that both clinical experience and published studies had determined ECT to be effective (with an average 60 to 70 percent remission rate) in the treatment of severe depression, some acute psychotic states, and mania. The report stated that ECT does not have a long-term protective effect against suicide and should be regarded as a short-term treatment for an acute episode of illness, to be followed by continuation therapy in the form of drug treatment or further ECT at weekly to monthly intervals.

What are the side effects? Aside from effects in the brain, the general physical risks of ECT are similar to those of brief general anesthesia. Immediately following treatment the most common effects are confusion and memory loss which usually disappears after a few hours.

Famous people who have undergone ECT

Kitty Dukakis, wife of former Massachusetts governor and 1988 Democratic presidential nominee Michael Dukakis and author of Shock, a book chronicling her experiences with ECT.

Carrie Fisher, American actress and novelist. Fisher speaks at length of her experiences with ECT in her autobiography Wishful Drinking.

In my experience, I have come across many people who feel that ECT saved their lives as well as others who did not feel that it was effective. Careful discussion with a mental health professional can help you make the decision that is best for you. I wish you all a healthy and happy 2010.





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RELAX: Feel the stress melt away

By Felicia K. Wong, M.D.

The winter snow may still be months away from melting, but now that the hubbub of the holiday season has passed, it’s time to rest, relax and de-stress!

Easier said than done right? For many of us, finishing one project just means we can start the next. We live in a fast-paced society where there is a lot of pressure (both external and internal) to “go-go-go”. In other words, we live in a world that is full of stressors and stress.

Our body responds to stress by producing stress hormones. These hormones help you respond to “fight or flight” situations and historically helped our ancestors run to safety from lions. However, these days there are (usually) no lions to run from and instead, when the body is chronically stressed, these hormones can take a toll on physical and mental health. People who are under a lot of stress are often emotional – anxious, irritable and depressed.

Ideally, you can try to change the situation that is causing your stress. But if the situation is fixed, there are relaxation methods that can be useful strategies to cope with stress.

Relaxation is a skill. It is something that we are not necessarily born knowing how to do. Good news! Relaxing techniques can be learned and practiced.

I’d like to share with you a relaxation technique called Progressive Muscle Relaxation (PMR). This is a great way to reduce overall body tension. Here is a video to introduce the practice and help you get started:


Each person will find for themselves unique ways to relax – be it through exercise, yoga, music or meditation. PMR is just one strategy. There is no right or wrong way to relax, and no one technique that will work for everyone. So, find out which ones work the best for you and get started!

Before practicing PMR, consult with your physician if you have a history of serious injuries, muscle spasms, or back problems, because the deliberate muscle tensing of the PMR procedure could exacerbate these pre-existing conditions.

Coping During Disasters

By Gabriela Cora, M.D., M.B.A.


The earthquake in Haiti hit the most impoverished nation in the Western hemisphere. A land already struck by hurricanes, the loss of life in the thousands magnifies the catastrophe exponentially. What to do onsite and what to in the States when family members worry about loved ones?

Aside from the physical devastation caused by natural disasters, the psychological short and long-term impact may be even more damaging. Keeping up to date with the latest news while not overdoing this all day long will help you cope with the situation. 


Additionally, taking control of simple habits, accepting help, eating, drinking clear water and having some sleep will help through the difficult aftermath. One particularly challenging area is keeping children safe both physically as well as psychologically. As an adult in charge of your own children or caring for other children during a disaster, it’s most important to provide for physical safety, keep them busy helping out others, if they can, and allow them to share their fears and worries. 

Visit Switchboard Miami for additional hotline assistance, available in Creole.

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Making Resolutions You Can Keep

By Gina Newsome Duncan, M.D.

Happy New Year! If you’re like most people, you’ve made some resolutions for 2010. How are you doing with keeping them? Losing weight and improving finances are probably two of the most common resolutions people make. Unfortunately, for many of us, our resolutions have often been broken before February starts.

When making resolutions or setting goals in general, think SMART. Goals should be:

Specific

Measurable
Achievable
Realistic
Time-bound

You can always ramp up your efforts. But if your expectations are too high at the beginning you'll get discouraged and give up.

Set yourself up for success!

An Ounce of Prevention is Worth a Pound of Cure in Mental Health Treatment

By Roberto Blanco

Benjamin Franklin’s quote, “an ounce of prevention is worth a pound of cure,” can be applied to many arenas of life. From my experience in the mental health system, I believe that it is also quite an appropriate saying for mental health.

I work at a local crisis and assessment center in North Carolina and see many patients who come in with psychiatric emergencies. For a variety of reasons, a lot of these patients arrive in a dangerous state or have substance abuse problems that are out of control. They are in crisis and often need immediate action in order to assure their safety.


While many crises are an unfortunate result of untreated mental illness or painful circumstances, it is hard to ignore the great number of crises that could have been averted with some preventative mental hygiene. Many people become sick because they aren’t doing things that can keep them out of hospitals such as taking medicine regularly, going to therapy, or getting support from friends, family or community centers.

Just as you would not want to meet with your financial counselor to plan out retirement the day before you retire, you should be taking regular, proactive steps to take good care of your mental health before a crisis is at hand or, ideally, in order to prevent a crisis.

Here are some things you or your loved ones can do to help prevent mental health crises:

1. Engage in regularly scheduled therapy sessions.

2. Attend psychiatric appointments regularly and take medications as prescribed.

3. Create a Crisis Plan (a plan to follow in case of an emergency). These plans should include techniques to try to calm the situation (i.e. going for walks, deep breathing exercises, or listening to music are some favorites) along with the names and phone numbers of close supports, on-call mental health professionals, and emergency agencies. Keep this plan close at hand at all times.

4. If a significant portion of the problem is with a close relationship, consider going to family or couples counseling.

5. If you are running out of medication, call for refills at least 3-4 business days (7-9 business days for controlled substances or stimulants) before you will be out of medicine. This will assure that your doctor can supply you with the appropriate refill of medication in time.

6. Engage in regular, renewing self-care activities such as exercise, sleep, and fulfilling hobbies. Lack of sleep is often a cause and symptom of most mental illnesses.

7. Educate and advocate for yourself and your family. Learn as much as you can from many different perspectives about your illness. The National Institute of Mental Health has patient information available on a variety of diagnoses and topics. In addition, our very own APA Healthy Minds site has useful information on a variety of topics. Consider joining the National Alliance on Mental Illness and find your local chapter meeting location and time for support from other mental health consumers and families.