Psychological News You Can Use - December 2008

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Equal Rights for Mental Health - At Last!

In October 2008, historic legislation was passed into law making mental health services more easily accessible and affordable for all consumers. Benefits for mental health /substance use problems and medical/ surgical benefits must now be comparable in most ways. Thus, 113 million Americans will no longer encounter discrimination with respect to the following insurance requirements:

• · Deductibles, co-pays, and coinsurance
• · Out-of-pocket expenses
• · Frequency of treatment, number of visits, and days of coverage
• · Annual and lifetime limits

While this law does not address the problem of some insurance companies not providing any mental health or substance use coverage, it will hopefully increase the number of people accessing mental health care.

The Wellstone- Domenici Mental Health Parity and Addiction Equity Act takes effect on January 1, 2010 and will apply to all group health insurance plans covering 50 or more employees.

Leadership by the American Psychological Association and Pennsylvania Psychological Association played important roles in securing passage of this law. Professional psychologists work hard to help you get the help you need.

Adapted by Vince Morello, Ph.D., from the APA web site. Vincent Morello Ph.D. is a psychologist in private practice in Wayne and Langhorne. He specializes in ADHD for adults and children.

One of the side effects of the current economic turmoil has been a great deal of psychological and emotional stress. Many mental health providers are noting as much as a twenty-five percent increase in the demand for psychotherapy. However, this increased demand may be short-lived if the economic downturn persists for more than a year, as many people who have been laid off will no longer be able to afford the COBRA extended insurance expense to maintain their health insurance or they will have lost any employment termination benefits they received. Many people wonder what they will do if they need new or continuing psychological treatment. Here are some ideas to help you.

First, if you are already in treatment, ask your psychologist what the standard “out-of-pocket” fee is for people paying cash. Current rates are anywhere from about $90 to $150 per session; however, most psychologists will reduce their fee to help you be able to continue in treatment. Don’t expect to receive treatment for free, but you can anticipate that s/he will work with you to help reduce the cost.

If you aren’t in treatment, you should still seek help from any mental health provider of your choice, but it may be more difficult to find a reduced fee. You should ask anyway, as many psychologists understand the economic burden many people face today, and they are prepared to negotiate a reduced fee to help you get the treatment you need – and stay in business at the same time. It is also considered a part of our professional obligation to give back to our communities. Some psychologists even have a policy of providing one or two clients with pro bono service (that means free) for a limited number of sessions.

For military veterans, many organizations offer free services. Giveanhour.org is a non-profit organization devoted to recruiting mental health providers to give one hour of their work week for pro bono services for the military. If still covered by military benefits, the veteran can check with their closest VA hospital, which might have additional information on low-cost or no-cost services.

Some regional professional psychological associations have listings of psychologists that donate a limited amount of time. For example, the Philadelphia Society of Clinical Psychologists operates a program that provides low-cost or no-cost services by a licensed psychologist for individuals and families with limited income. Services can be accessed by calling 215-885-2562. For other regional psychological associations call the Pennsylvania Psychological Association at 717-232-3817 or visit www.PaPsy.org.

Community mental health centers offer another option for people with limited income or no insurance. Sometimes, the local community mental health center will assist clients in qualifying for medical assistance benefits. Children are covered through CHIP services and because of this program, no child should go without receiving the mental health services they need. You can find the phone number of your local community mental health center in the blue pages of your phone directory.

Although these difficult economic times make it more challenging to seek mental health treatment, there are options available for all consumers. No one should ever have to go without getting the psychological services they need. Persistence and the willingness to ask for help is all that’s necessary.

Richard Johnson, Ph.D. is founder, Co-director, and Chief Executive Officer of Psychological Services & Human Development Center, Inc., Fort Washington, PA.

Feeling kind of blah during the winter? Or do you suffer from the more serious winter blues?

Blahs: You feel bored or lazy. You become a couch potato, slacking off exercise and gaining a few pounds. But overall you still enjoy life and get your work done without much extra effort. When you have bad moods, they don’t last long.

Blues: You’re chronically tired and lethargic, no matter how much sleep you get (and it seems that all you want to do is sleep.) You crave sugary or starchy foods more than normal. You may have mood swings, trouble concentrating, low tolerance for stress, and a generally sad or hopeless mood, which persists for weeks or months. Just getting through the day takes great effort. Come spring, you start to feel like your old self again.

If this describes you, you may be one of the 40 million Americans who suffer from seasonal affective disorder (acronym: SAD), a form of clinical depression. This depression can be quite severe, in some cases requiring hospitalization.

What causes SAD?

Certain groups of people are more vulnerable to becoming depressed during the dark winter months. SAD tends to run in families, although the exact genetic mechanism is unknown. Women are more likely to suffer than men, especially women in their 20s, 30s and 40s.

Sunlight deprivation plays a major role in SAD. The rate of SAD in New Hampshire, where winter daylight hours are very short, is twice that of Florida. In general, communities closer to the equator have less incidence of SAD than those farther from the equator (although there are some exceptions).

No one knows for sure how daylight interacts with body processes to trigger SAD, but some research suggests that the pineal gland, a small structure in the brain, may be involved. This gland produces the hormone melatonin, which helps regulate daily body rhythms in response to light transmitted through the eyes. Other research suggests that the brain chemical serotonin may also be implicated in SAD.

What can you do about it?

One of the most effective ways to counteract SAD is to increase your exposure to as much natural light as possible:

• Spend time outdoors in daylight every day. This is especially important if you work in a windowless environment. Take a brisk walk outside during your break or lunch hour. If you dress for it, you won’t feel cold after the first minute or two.
At home, take a walk or do a little yard work. Keep the blinds open during the day and sit near a window whenever possible.

It’s also important to maintain a regular schedule:

• Go to sleep and wake up at the same time each day
• If you have trouble getting up in the morning, set your bedroom light on a timer to turn on lights 15-20 minutes before your alarm goes off.
• Eat meals at the same time every day.
• Eat food that is nutritious. The more healthful food you eat, the less you’ll crave junk, and the better you’ll feel.
• Make exercise a part of your daily routine.

Avoid hiding from the world:

• Schedule time with friends.
• Play with your kids (or your neighbor’s kids.)
• Get season tickets to concerts, theater performances or sports events.
• Make a phone call to someone you haven’t talked to in a while.
• Help someone who is worse off than you.

Tried the above and still depressed?

• Consult a health professional to make sure that your symptoms are not the result of other problems. Many medical conditions are accompanied by fatigue, depression and trouble concentrating.

• If you need professional treatment, there are three options. You may need to experiment to see which of these therapies work best for you:

1. Light therapy: 20-30 minutes of exposure to very bright light (10,000 lumens) early in the morning has been shown to alleviate depression in some people diagnosed with SAD. Specially designed light boxes, available without a prescription, cost about $150 to $300.
2. Psychotherapy: Cognitive behavioral therapy with a psychologist can help you learn to think in a more positive way, and to change your self-defeating behaviors.
3. Medication: Certain antidepressants have been approved for the treatment of SAD. They are most effective when combined with light therapy and/or psychotherapy.

• In extreme cases, none of the above interventions will help. That’s when it’s time to consider moving south.

For more information:

BOOKS:
Rosenthal, N: Winter Blues, Revised Edition: Everything You Need to Know to Beat Seasonal Affective Disorder Guilford Press, 2006. Written by the doctor who coined the term “seasonal affective disorder,” this book is a useful guide to understanding and managing SAD.

Smith, L., and Elliott, C.: Seasonal Affective Disorder For Dummies, For Dummies Publishers, 2007. Tons of tips, presented in simple, direct format.

WEB SITES:
MedlinePlus: http://www.nlm.nih.gov/medlineplus/seasonalaffectivedisorder.html
This is a government-sponsored portal to overviews, research articles, news items, coping advice, and more.

SAD Association: http://www.sada.org.uk/
This is the world first and largest organization specifically focused on SAD.

Online support group: http://health.groups.yahoo.com/group/S-A-D/

Pauline Wallin, Ph.D., is a psychologist in Camp Hill, PA, and author of "Taming Your Inner Brat: A Guide for Transforming Self-defeating Behavior." Visit her website: www.drwallin.com

With our current global economic crisis, pressures of the upcoming holidays, and other issues, strong personal connections can serve as a buffer for minimizing stress and depression.

Social support networks contribute to our happiness and well-being. Lack of adequate support poses health risks and may result in the use of poor coping strategies. Maintaining these important connections requires effort. It is natural for these connections to change over time as people’s lives are constantly evolving.

Relationships come in many forms. Family and friends can provide much needed social support. Now face-to-face connections are increasingly finding competition from online social networks such as Facebook, MySpace, blogs, Internet chat rooms, and similar electronic forums. All of these can have value if used appropriately, and a combination of interaction types can be beneficial since no one type can meet all of your needs.

Qualities of a good friend include loyalty, trust, and dependability. Relationships are built over time, so if you don’t have many connections now you will need to expand your social network. If you currently have a good network of relationships, then you will want to continue to nurture them. Try to increase your face-to-face contacts and don’t rely solely on Internet connections. (You will not be able to have deeply enriching and healthy relationships with 1,000 online “friends.”) Appreciate the strengths of each of your relationships and work to resolve the weaknesses. Communicate openly and frequently with your closest friends and family members.

During this time of year many individuals can use some help as they are confronted with winter doldrums and losses that may be more apparent around the holidays, such as deceased family and friends, declining health, or unfulfilled goals and dreams. It is important to remember that you are not alone and that others care about you.

The approaching new year provides an opportunity to enlist the help of loved ones as you work toward your goals of finding a job, losing weight, starting an exercise program, stopping smoking, going back to school, or whatever you aim to accomplish. Sharing and supporting others’ goals can result in more balanced and successful interactions. Making connections by helping others or contributing to charitable causes can help us be thankful for our blessings and what we can offer others.

Informal networks of acquaintances and relatives are great, but sometimes a professional is needed. If you are going through a really difficult time and are not making much progress on your own, do not hesitate to contact a psychologist, physician, clergyperson, financial advisor, attorney, or other trained professional who can help you with your problem. Many different types of people can support you on your journey through life.

Dr. Sybil L. Holloway is a Psychological Counselor/Assistant Professor at Bloomsburg University as well as a freelance writer. For three years, she wrote a monthly “Stressbusters” column for The Morning Call of Allentown, PA.

With the growing financial crisis and the rising costs of gas, food, and healthcare, it is clear that Americans are experiencing stress. In today’s fast-paced and ever-connected world, stress has become a fact of life. Stress can cause people to feel overwhelmed or pushed to the limit. While low to moderate levels of stress can be good for you when managed in healthy ways, extreme stress takes both an emotional and physical toll on the individual.

With the consequences of poorly managed stress ranging from fatigue to heart disease and obesity, it is important to know how to recognize high stress levels and take action to handle it in healthy ways. Being able to control stress is a learned behavior, and stress can be effectively managed by taking small steps toward changing unhealthy behaviors.

The American Psychological Association offers the following tips on how to manage your stress:

• Understand how you experience stress. Everyone experiences stress differently. How do you know when you are stressed? How are your thoughts or behaviors different from times when you do not feel stressed?
• Identify your sources of stress. What events or situations trigger stressful feelings? Are they related to your children, family, health, financial decisions, work, relationships or something else?
• Learn your own stress signals. People experience stress in different ways. You may have a hard time concentrating or making decisions, feel angry, irritable or out of control, or experience headaches, muscle tension or a lack of energy. Gauge your stress signals.
• Recognize how you deal with stress. Determine if you are using unhealthy behaviors (such as smoking, drinking alcohol and over/under eating) to cope. Is this a routine behavior, or is it specific to certain events or situations? Do you make unhealthy choices as a result of feeling rushed and overwhelmed?
• Find healthy ways to manage stress. Consider healthy, stress-reducing activities such as meditation, exercising or talking things out with friends or family. Keep in mind that unhealthy behaviors develop over time and can be difficult to change. Don't take on too much at once. Focus on changing only one behavior at a time.
• Take care of yourself. Eat right, get enough sleep, drink plenty of water and engage in regular physical activity. Ensure that you have a healthy mind and body through activities such as yoga, taking a short walk, going to the gym or playing sports that will enhance both your physical and mental health. Take regular vacations or other breaks from work. No matter how hectic life gets, make time for yourself — even if it's just simple things like reading a good book or listening to your favorite music.
• Reach out for support. Accepting help from supportive friends and family can improve your ability to manage stress. If you continue to feel overwhelmed by stress, you may want to talk to a psychologist, who can help you better manage stress and change unhealthy behaviors.

Adapted from the American Psychological Association’s Help Center by Judith Blau, Ph.D. For more information on this and other important topics, visit www.apahelpcenter.org.