• Reframing negative thinking

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    Do you ever find yourself jumping to the worst possible conclusions in everyday situations? When you’re facing an upsetting scenario, do you find yourself preparing for negative outcomes as if they’ll inevitably come true? If so, you’re “catastrophizing” — and you’re not alone. Catastrophizing is a distorted way of thinking that causes people to assume the most destructive outcomes, typically without much justification, sending them spiraling into a loop of fearful thoughts. It’s a behavior that can be easy to fall into and hard to overcome.

    Clinical Licensed Psychologist, Patrick Moran, PhD explains, “Catastrophizing takes an often-minor true experience and projects the probability of it being a reality in the future without sufficient and reliable evidence, usually in larger proportions than the original experience. It’s often comprised of ‘Fortune Teller Error,’ and ‘Mind Reading’ where people believe in their accuracy in predicting future outcomes and/or what others are thinking. It can make people very anxious when catastrophic thinking habits are not balanced by contradictory facts, or if the facts are dismissed or minimized.”

    The mind-body connection of catastrophizing

    Beyond the effects on your mental health, this kind of fearful thinking can trigger strong physical reactions in your body. The amygdala, located in the center of the brain, is activated by fear and alerts the nervous system. This causes a release of adrenaline and the stress hormone, cortisol, which can trigger your “fight or flight” instinct. This instinct results in elevated heart rate, blood pressure, and respiration as well as increased blood flow to your limbs to help you “fight” or “run for your life”.

    While this “fight or flight” response is meant to prepare us for danger, the increased adrenaline affects our cerebral cortex, the area of the brain that controls judgment and reasoning, cognitive functioning, and ability to think clearly — ultimately coloring our decision making.

    How can I stop catastrophizing?

    If this is a common experience for you, you may want to try cognitive reframing, a psychological method that involves identifying and changing the way you view experiences, events, or emotions in order to stop yourself from “making a mountain out of a molehill”. The technique allows you to shift your mindset so you're able to look at a situation, person, or relationship from a slightly different perspective and replace your negative thoughts.

    For example, if you find yourself catastrophizing frequently at work, consider some of the situations that may trigger those thoughts. Is it conversations with specific people or working on specific projects? If you identify those potential triggers, you can practice reframing your thinking in advance of the situation to help avoid fearful thoughts. Before facing the triggers you’ve identified, envision positive scenarios and ideal outcomes. Expect the best instead of preparing yourself for negative results or failure. Be specific and walk yourself through an ideal experience. Include details like positive conversations and outcomes. Envisioning these scenarios with a positive mindset can help you avoid fearful thinking and the effects that come with it.

    What strategies or tips do you find helpful to promote positive thinking?

    If you've found this article helpful, please feel free to share it! Be sure to read the other articles in this series, including The End Of The Mental Health Care Stigma.

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  • The end of the mental health care stigma

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    Mental health concerns are not a new topic by any stretch of the imagination, but what is new is the validation and support that has been desperately needed by so many... for so long. Throughout history, people with mental illness have been ostracized, lobotomized, institutionalized, and demonized, but as our understanding of many of these common conditions has grown, so has our capacity for compassion and treatment.

    If recent events have taught us anything, it’s that we are all facing private battles, often waged internally. In the United States, an estimated 15% of kids and 20% of adults are living with a mental health condition at any one time. While many feel comfortable talking about mental health, others are still lacking support to find the resources they need.

    Culturally, there is still a wide range of thinking when it comes to conditions such as depression and anxiety. While some communities still prefer to encourage their members to internalize their struggles or share them only with leaders, many others have adopted a broader mindset on mental health resources by setting up support groups and treatment centers and speaking openly on topics that were once considered “sensitive”. This mindset shift has led to a more global normalization of mental health concerns — and not a minute too soon.

    Here are a few ways you can reduce stigma and bring more awareness to mental health concerns in your community.

    • Speak openly about mental health. Stigma is rooted in ignorance, so educating yourself and those around you helps counteract lingering negativity. If you feel comfortable speaking about your own mental health with a trusted person in your life, it may help that person feel safe to do the same.
    • Utilize local support groups. Open dialogue often leads to discovery, so having available resources at the ready could be a game-changer for the next person you talk to!
    • Share relevant articles. Social media’s influence stretches way past the bounds of what we’re eating for dinner, so if you find an article with a positive spin on mental health, share, share, share!
    • Reach out to the experts. If you're looking for someone to talk to about your mental health, we’ve gathered some additional mental health resources to help you find support and information.

    Do you have any ideas to share on reducing the stigma of mental health in your community?

    Be sure to check out our article on improving your mental health at work!

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  • Why a US task force is recommending anxiety screening in kids 8 and older

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    (THE CONVERSATION) The U.S. Preventive Services Task Force issued a draft statement in April 2022 recommending screening for anxiety in children and adolescents between the ages of 8 and 18. This recommendation – which is still open for public comment – is timely, given the impact of the COVID-19 pandemic on children’s mental health. The Conversation asked Elana Bernstein, a school psychologist who researches child and adolescent anxiety, to explain the task force’s new draft recommendations and what they might mean for kids, parents and providers.

    1. Why is the task force recommending young kids be screened?

    Nearly 80% of chronic mental health conditions emerge in childhood, and when help is eventually sought, it is often years after the problem’s onset. In general, recommendations to screen for mental health disorders are based on research demonstrating that youths do not typically seek help independently, and that parents and teachers are not always skilled at correctly identifying problems or knowing how to respond.

    Anxiety is the most common mental health problem affecting children and adolescents. Epidemiological studies indicate that 7.1% of children are diagnosed with anxiety disorders. However, studies also estimate that upwards of 10% to 21% of children and adolescents struggle with an anxiety disorder and as many as 30% of children experience moderate anxiety that interferes with their daily functioning at some time in their life.

    This tells us that many kids experience anxiety at a level that interferes with their daily functioning, even if they are never formally diagnosed. Additionally, there is an established evidence base for treating childhood anxiety.

    The opportunity to prevent potentially chronic lifelong mental health conditions through a combination of early identification and evidence-based treatment certainly informed the task force’s recommendation. Untreated anxiety disorders in children result in added burdens to the public health system. So from a cost-benefit perspective, the cost-effectiveness of screening for anxiety and providing preventive treatment is favorable, while, as the task force pointed out, the harms are negligible.

    The task force recommendation to screen kids as young as age 8 is driven by the research literature. Anxiety disorders are most likely to first show up during the elementary school years. And the typical age of onset for anxiety is among the earliest of all childhood mental health diagnoses.

    Anxiety disorders can persist into adulthood, particularly those disorders with early onsets and those that are left untreated. Individuals who experience anxiety in childhood are more likely to deal with it in adulthood, too, along with other mental health disorders like depression and an overall diminished quality of life.

    2. How can care providers identify anxiety in young kids?

    Fortunately, in the past three decades, considerable advances have been made in mental health screening tools, including for anxiety. The evidence-based strategies for identifying anxiety in children and adolescents are centered on collecting observations from multiple perspectives, including child, parent and teacher, to provide a complete picture of the child’s functioning in school, at home and in the community.

    Anxiety is what’s called an internalizing trait, meaning that the symptoms may not be observable to those around the person. This makes accurate identification more challenging, though certainly possible. Therefore, psychologists recommend including the child in the screening process to the degree possible based on age and development.
    In general, it is easier to accurately identify anxiety when the child’s symptoms are behavioral in nature, such as refusing to go to school or avoiding social situations. While the task force recommended that screening take place in primary care settings, the research literature also supports in-school screening for mental health problems, including anxiety.

    Among the youths who are actually treated for mental health problems, nearly two-thirds receive those services at school, making school-based screening a logical practice.

    3. How would the screening be carried out?

    Universal screening for all children is a preventive approach to identifying youths who are at risk. This includes those who may need further diagnostic evaluation or those who would benefit from early intervention.

    In both cases, the aim is to reduce symptoms and to prevent lifelong chronic mental health problems. But it is important to note that a screening does not equal a diagnosis. Diagnostic assessment is more in-depth and costs more, while screening is intended to be brief, efficient and cost-effective. Screening for anxiety in a primary care setting may involve completion of short questionnaires by the child and/or parent, similar to how pediatricians frequently screen kids for attention-deficit/hyperactivity disorder, or ADHD.

    The task force did not recommend a single method or tool, nor a particular time interval, for screening. Instead, it pointed to multiple tools such as The Screen for Child Anxiety Related Emotional Disorders and the Pediatric Symptom Checklist. These assess general emotional and behavioral health, including questions specific to anxiety. Both are available at no cost.

    4. What are care providers looking for when screening for anxiety?

    A child’s symptoms can vary depending on the type of anxiety they have. For instance, social anxiety disorder involves fear and anxiety in social situations, while specific phobias involve fear of a particular stimulus, such as vomiting or thunderstorms. However, many anxiety disorders share symptoms, and children typically do not fit neatly into one category.

    But psychologists typically observe some common patterns when it comes to anxiety. These include negative self-talk such as “I’m going to fail my math test” or “Everyone will laugh at me,” and emotion regulation difficulties, like increased tantrums, anger or sensitivity to criticism. Other typical patterns include behavioral avoidance, such as reluctance or refusal to participate in activities or interact with others.

    Anxiety can also show up as physical symptoms that lack a root physiological cause. For example, a child may complain of stomachaches or headaches or general malaise. In fact, studies suggest that spotting youths with anxiety in pediatric settings may simply occur through identification of children with medically unexplained physical symptoms.

    The distinction we are aiming for in screening is identifying the magnitude of symptoms and their impact. In other words, how much do they interfere with the child’s daily functioning? Some anxiety is normal and, in fact, necessary and helpful.

    5. What are the recommendations for supporting kids with anxiety?

    The key to an effective screening process is that it be connected to evidence-based care. One strategy that is clearly supported by research is for schools to establish a continuum of care that involves universal screening, schoolwide prevention programming and evidence-based treatment options.

    The good news is that we have decades of high-quality research demonstrating how to effectively intervene to reduce symptoms and to help anxious youth cope and function better. These include both medical and nonmedical interventions like cognitive behavioral therapy, which studies show to be safe and effective.  

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  • 'Handle With Care' helps schools address growing student trauma

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    In San Antonio, Texas, traumatic experiences involving domestic violence and drive-by shootings are increasingly shaping the lives of students. As a result, the San Antonio Independent School District has turned to a support model, known as Handle With Care, to support children and teens exposed to traumatic events.

    Since the 2019-20 school year, Handle With Care has helped San Antonio schools quickly connect students to needed resources, particularly those addressing mental health, said Estella Garza, director of the district’s family and student support services.  

    Without the program, it would be more difficult to track chronically absent students who are likely to drop out of school, Garza said. The program has further helped the district better understand what students are going through, she added.

    “I think some of these kids that were referred to us would have been lost,” Garza said.  

    Under the program, when a child faces a traumatic event involving emergency responders — such as police, firefighters or emergency medical response workers — the responder provides the child’s name along with the phrase “Handle With Care” to their school. No other details are given about the traumatic incident.

    Schools using the program train all staff to be sensitive to and aware of the signs of a student going through trauma so potentially damaging effects from the event are not worsened, said Andrea Darr, director of the West Virginia Center for Children’s Justice, which helped pioneer Handle With Care. On top of that, schools are expected to provide on-site therapy services by certified professionals for children identified as needing extra support.

    More districts shift to Handle With Care

    Handle With Care has surged in popularity among school districts nationwide, especially during the pandemic, Darr said.

    So far, Darr's team has confirmed at least 33 states contain districts using Handle With Care. Five of those — West Virginia, Nevada, New Jersey, Kentucky and Oklahoma — have statewide systems in place implementing the model, Darr said.

    Years before the pandemic created even more trauma in children's lives, Handle With Care launched in 2013. It grew out of a partnership between the West Virginia Center for Children’s Justice and the U.S. Attorney’s Office for the Southern District of West Virginia.

    The program had emerged to address findings in a 2009 study by the National Survey of Children’s Exposure to Violence that more than 60% of children surveyed had been directly or indirectly exposed to violence within the previous year.  

    A role in the ongoing mental health crisis

    As schools now witness a nationwide increase in mental health crises worsened by the pandemic, it’s even more important for districts to be notified when students experience traumatic events, said Jon Duffy, director of counseling and testing at Kanawha County Schools in Charleston, West Virginia.

    Student trauma can look different from one location to another. The national opioid crisis has led to students in the district witnessing family members overdosing, Duffy said. Kanawha students have also been commonly exposed to domestic violence, he said.

    Kanawha County Schools was the first district to pilot Handle With Care in 2013. What began in just a few schools has now been implemented countywide for at least the past six years, Duffy said, adding that the program has helped provide both acute and longer-term mental health care services for students.

    Handle With Care “allows the school to intervene in an early way to support students who have been exposed to trauma,” he said. The district saw an uptick in Handle With Care notices during the pandemic, he added.

    Kingsport City Schools in Tennessee began its own Handle With Care program in August, said Jim Nash, the district's chief student services officer. As of mid-April, the district had received about 65 Handle With Care alerts for the current school year, he said.  

    Both local law enforcement and school counselors were eager to bring the model to Kingsport, he said. School counselors told Nash the model has helped improve awareness among teachers and staff regarding student trauma.  

    “It gives you potentially an explanation if a student is not acting as they normally do,” Nash said. “It just helps to have a full picture of the child and an understanding of what they’re going through."  

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  • LGBTQ students face increasing access barriers to counseling

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    [Editor's note: This article was first published on May 4, 2022.]

    Dive Brief:

    Nearly two-thirds of LGBTQ youth could not get the mental health counseling they sought in the past year, up from just under half the year before, according to The Trevor Project’s annual National Survey on LGBTQ Youth Mental Health.  

    This increase, from 48% in 2021 to 60% in 2022, comes despite a majority of schools offering in-person learning and mental health services this school year. It also comes after 70% of LGBTQ youth stated last year that their mental health was "poor" most of the time or always during COVID-19 — a percentage that improved to 56% this year.  

    LGBTQ students who found their schools to be supportive of their identity were less likely to attempt suicide, according to the report. However, while 55% of LGBTQ youth found their school to be affirming, nearly 4 in 10 LGBTQ youth reported living in a community that is somewhat or very unaccepting of LGBTQ people.   

    Dive Insight:

    Students cited multiple barriers to accessing mental healthcare in schools, the top three being fear of discussing mental health, concerns with obtaining parent or guardian permission, and worry of not being taken seriously. A total of 33,993 LGBTQ youth ages 13-24 were included in the national survey results.

    "These factors reinforce the notion that the most critical and overwhelming barrier that is preventing LGBTQ young people from accessing the care they need is the stigma that surrounds issues of mental health," said Myeshia Price, senior research scientist at The Trevor Project, in an email.  

    Peer relationships could help spread awareness and get rid of the stigma around mental health, experts and advocates said during a virtual panel hosted Tuesday afternoon by the American Psychological Association.  

    "Students are often the first one on the frontline to know what their peers are going through, so how do we leverage that knowledge?" asked Melanie Zhou, a freshman at Stanford University and co-founder of Oasis Mental Health, an organization that works to bring physical safe spaces to high schools.  

    One model that has shown promise is Kennedy High School's Green Bandana Project in Cedar Rapids, Iowa, which facilitates a school-based peer crisis response team. Students in the group who respond to a peer mental health crisis often tap qualified professionals for help or sometimes even defuse escalating situations themselves, according to Amanda Williams, a student and peer support specialist at the school.

    Training for teachers to identify mental health issues and crises would also help avoid stigma and create better responses to student mental health challenges, Williams added.  

    And it's not just students or teachers who should address these concerns, experts on the panel agreed. School counselors and psychologists, administrators, mental health advocates, parents and the overall community should all be involved in building a culture that promotes mental health awareness, they said.  

    School-based supports could include culturally reflective curriculum and practices in the classroom, said Dwayne Williams, a licensed school psychologist. He has heard Black and Hispanic students, for example, express interest in becoming psychologists themselves after learning that hip hop and poetry could be vehicles to process trauma.

    But "there is a cause for great concern for new education laws being enacted that would restrict LGBTQ topics and discussion in schools," Price said. More than a dozen states are considering or have already passed bills designed to limit conversations around race, sexual orientation and gender in classrooms. Some states have also passed legislation limiting the kinds of facilities and athletic teams transgender youth have access to.  

    According to the Trevor Project survey, 91% of transgender and nonbinary youth said they have worried about transgender people being denied access to the bathroom due to state or local laws, and 83% said the same about sports teams.

    "Given this research, it is vital that schools, public health officials, and all youth-serving mental health organizations continue this important work of fostering inclusive and affirming environments," Price said, adding that districts should work to tailor mental health services toward LGBTQ youth, especially in states debating or enacting limiting legislation.

    To circumvent what have become political buzzwords, Caren Howard, director of policy and advocacy for Mental Health America, recommends focusing on helping students build "life skills" rather than calling it "social emotional learning." SEL has recently been criticized by politically conservative parents and community members as a vehicle to teach critical race theory in schools or to control students.

    "It's very unfair that there are different political leanings across the spectrum, but it seems that the language that is successful regardless of political background is helping your child build life skills," Howard said.

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