The Child Mind BlogBrainstorm
Therapy Goes Bananas
March 4, 2014 Rachel Ehmke
When most people hear the word "therapy" they still picture someone lying on a couch talking while their mostly silent therapist takes notes. While this kind of therapy still happens, the science and art of therapy has evolved a lot since the days of Freud. It's moved so far away, in fact, that one psychologist takes patients out to the street, where the task is to walk a banana on a leash.
In a piece for Scientific American Mind, that psychologist, Jerry Bubrick, who works at the Child Mind Institute, describes the kind of work he does with severely anxious children. It's a form of cognitive-behavior therapy, and Dr. Bubrick gives an interesting history of it, going back to the 1950s, when the first psychologist made the move away from psychoanalysis towards a more active and goal-oriented treatment.
Instead of trying to resolve past childhood issues—how traditional psychotherapists explained anxiety disorders—CBT therapists focus on changing the negative thoughts and behaviors that accompany anxiety. So while anxious kids want to avoid the things that make them anxious, Dr. Bubrick helps them learn to habituate to their anxiety. Enter the pet banana.
For the severely anxious boy Dr. Bubrick was working with, who had been paralyzed by fear of looking foolish around other people, such a thing would have been unimaginable before treatment. But he and Dr. Bubrick worked up to it, getting used to feeling anxious during more mundane things—asking strangers questions, asking strangers questions while in a ridiculous wig, ordering coffee at Starbucks in the wig, and so on.
Dr. Bubrick goes into more detail in the story, explaining how the therapy works and giving several patient case histories. It's a must-read for people who want to know more about what really great therapy—especially for kids—can look like. It's behind a pay wall at Scientific American Mind, but you can read it for free if you use this link.View Comments | Add Comment
John Travolta, Dyslexia and the Oscars
March 4, 2014 Beth Arky
Two days after the Oscars, people are still buzzing about the way John Travolta mispronounced Idina Menzel's name—only now, dyslexia is part of the quickly moving story. We live in a time when social media has made mockery a national pastime, so it's no surprise that the internet was quick to pounce on Travolta's introduction of "Adele Dazim" before Menzel was about to perform the nominated song "Let It Go" from Frozen.
A Twitter account with the mangled name popped up (it's since been suspended) and it wasn't long before Slate had posted a "handy widget" that allowed users to "Travoltify" their own names. (In the name of full disclosure, I am embarrassed to admit that I tried it.)
But now it's Day 2 and the internet is deep into debate over whether Travolta has dyslexia and, if he does, whether the learning disorder caused the gaffe.
If one good thing has come out in the midst of conflicting reports about possible dyslexia and Travolta's claims that Scientology "cured" him, it's this: The brouhaha has brought the common learning disorder front and center.
As Zanthe Taylor wrote for Psychology Today, while Travolta doesn't need her sympathy, "What about all the dyslexics who aren't rich and famous, who have to stand up in front of a classroom, in front of coworkers, in front of professors and bosses, and suffer the fear of knowing they may screw up just the way he did?"
And screwing up has consequences, even if you're not on stage at the Oscars, she notes: "It's extremely common for a child who can't read, write, or speak correctly in public to be labeled as dumb, while he or she may have normal or even extraordinary intelligence by any other measure."
Taylor points out that one of the most insidious problems with learning disorders is their invisibility. "Would we have made fun of Michael J. Fox for mangling an introduction?" she asks. "Would someone with a physical disability be laughed at for stumbling on stage?"
It's because dyslexics appear "perfectly sound in body and mind," she writes, that "their errors are not met with similar empathy."
According to the Yale Center for Dyslexia & Creativity, about one out of five, or 20 percent of all people, suffers from dyslexia, the most common reading disorder, yet many remain undiagnosed and untreated. And learning disorders like dyslexia can lead to impairing anxiety in children, according to Dr. Matthew Cruger of the Child Mind Institute. This anxiety can, in turn, lead to disruptive behavior and depression.
Whatever happened to Travolta at the Dolby Theatre, one thing is clear: More awareness and acceptance of hidden disabilities like dyslexia are needed to improve both learning and the quality of children's lives.View Comments | Add Comment
Rosie Perez on PTSD and Her Road to Recovery
March 4, 2014 Jessica Kashiwabara
Rosie Perez has been many things in her career —dancer, choreographer, Oscar-nominated actress, and AIDS activist—and now she adds survivor to the list. The Do the Right Thing actress recently spoke candidly with TIME magazine about her difficult childhood and what it felt like to be diagnosed with posttraumatic stress disorder (PTSD). In her words, "It sucked," but only at first. Perez gradually accepted her diagnosis and eventually felt relief, a weight lifted off from the years of fighting back.
In her new memoir, Handbook for an Unpredictable Life, Perez dives into her past and writes about growing up in the rough streets of Brooklyn. Her mother, who struggled with mental illness, first left her with a loving aunt and then abruptly placed Perez (only 2 years old) in a Catholic home for children. There, she was surrounded by vicious fights between girls and abusive counselors. Visits with her mother were not any easier, as she writes, "I was always walking on eggshells, waiting for the insanity to hit. And when it hit, it hit hard and fast—leaving deep emotional and physical scars."
For Perez, accepting PTSD was a struggle because she wanted to believe she was over her childhood trauma. But it was "a big part of my life," she writes. "And I've hated that fact. I'm a forward-moving and positive-thinking person, and it was hard to have that albatross hanging around my neck."
Perez's desire to move forward led her to finally seek professional help, something she admits she resisted for years. Dr. Jamie Howard, an expert on PTSD at the Child Mind Institute, says this is common. "A lot of people who experience PTSD are uncomfortable with it because it seems like a weakness," she says. "But you can still be tough and have PTSD—you can be tough by putting one foot in front of the other and living your life with PTSD."
It is clear writing this memoir has been a huge step in Perez's recovery. "Part of the treatment for PTSD is to face traumatic memories, not to avoid or numb them," explains Dr. Howard. "A lot of people do. When you've had this kind of longterm childhood trauma, the narrative is long."
Though it wasn't easy to write the book, Perez says she felt it was a responsibility. "The point is to get it out, to validate my feelings, to communicate how good it feels to no longer live in fear of what others may think, and to share my journey and move on," she writes.
Dr. Howard is glad to see Perez so open about her experiences and believes her story could help change the perception of PTSD. "I think she's really brave and it could really help people," she says, "especially those who grew up in her community, and communities like hers, where it's really valued to be tough."
Many of us will always see Rosie Perez as that hard-as-nails woman in the opening credits of Do the Right Thing, but now she offers a new view of herself—vulnerable yet fighting back for happiness. Here's how she ends her preface:
After a couple of years of therapy, and I don't know exactly when or how it happened, I noticed my depression wasn't there and the PTSD subsided considerably. I felt joyful, secure, and empowered. My inner strength and sense of self had never been stronger. I guess I allowed time to play its role, and I did my part by working hard on myself to grow past the pain. Gosh I sound so full of shit there. Let me be more honest: I grew past most of the pain and continue to do the work. Every day it gets better. xo.View Comments | Add Comment
Adam Levine Speaks Out About His ADHD
Feb. 25, 2014 Beth Arky
Maroon 5 frontman Adam Levine is lending his voice to the chorus seeking understanding, acceptance and treatment of ADHD with a new PSA for the "Own It" campaign.
Let's say right up front that Levine was paid by pharmaceutical company Shire, which makes Adderall, to participate in the video campaign. But it's been carried as news all over the country. Guess that's what happens when you're the "Sexiest Man Alive" and engaged to a Victoria's Secret model.
The Voice mentor, 34, told Us magazine, "When I was first diagnosed with ADHD, it wasn't a surprise because I had difficulty in high school focusing. And I think now, people notice my ADHD as an adult on a daily basis.
"When I can't pay attention, I really can't pay attention."
Levine is far from shy about endorsements—he's lent his name to guitars, jeans, leather jackets, fragrances, and acne medication, among other things. And he's happy to bare all for a cause he believes in. In 2011, he appeared naked in a Cosmo UK ad to raise awareness for prostate and testicular cancer.
Still, it is nice to see Levine acknowledging that he had ADHD as a kid, and he didn't outgrow it—as more than one third of kids don't.
"It was affecting my career the way it had affected me in school," he wrote in an earlier piece in ADDitude magazine, so he saw a doctor and learned that he still had ADHD.
And that's the advice he gives others in the new video: If you think you have a problem, go see a doctor. There's a quiz with the video to help you decide, which we're told was developed by PsychCentral.View Comments | Add Comment
Fear of Vomiting and Exposure Therapy
Feb. 25, 2014 Caroline Miller
The fear of vomiting is a very, very common one in the world of anxiety disorders. Scott Stossel, in his bestseller, My Age of Anxiety, makes it clear that it's not just a matter of feeling queasy at the thought of vomiting (who doesn't feel that way?) but an anxiety so toxic you find yourself arranging your life meticulously, painstakingly to avoid it. The challenge is that this phobia can ambush you practically anywhere—if you think about it, where could you not, hypothetically, vomit?
So it's not surprising that one of the most dramatic parts of the book (and, in shortened form, the Atlantic excerpt) is Stossel's account of his misadventure with what he calls exposure therapy, designed to rid him of his vomiting phobia. It turns into a disaster when the ipecac he takes to make him vomit—in order to diminish the massive anxiety attached to it—fails to make him vomit. Instead, it just makes him violently ill, curled on the floor of a clinic bathroom for hours on end, and more anxious than before. (He notes, by way of humor, that the fiasco did succeed in making his therapist vomit.)
I mention this because the scene is so vividly memorable that I worry that it will give exposure therapy a bad name. And it's so unlike the kind of exposure therapy we're familiar with at the Child Mind Institute that I asked Dr. Jerry Bubrick, an expert in treating anxiety, what might have gone wrong in Stossel's case.
Dr. Bubrick notes that most exposure therapy works by introducing the source of the fear in tiny increments, so that the patient learns to tolerate them one at a time, and doesn't move from one to the next until he is so over being anxious at each step that he is actually bored. The patient and doctor create a hierarchy of fears that run from, say, writing the word vomit to watching a video of someone vomiting, and the patient becomes habituated to each before moving on to actually doing the things that he associates with vomiting—let alone vomiting.
Dr. Bubrick showed me a piece of paper covered with the word vomit that was the work of an 8-year-old he happens to be treating right now who shares Stossel's phobia. This little girl was so anxious at the outset that just hearing the word vomit made her curl into a ball and check out of the session, so Dr. Bubrick said he backed up and started with something easier, having her write the word vomit, first in tiny letters and then progressively bigger—and finally in purple.
There are clinicians, Dr. Bubrick said, who believe in extreme exposures—"going to the top of the hierarchy as quickly as possible." But that could only work, he said, if the patient really buys into the model, has confidence that he will be able to handle the anxiety and habituate to it. That confidence, along with trust in the clinician, generally comes from those earlier baby steps, and it's clear from Stossel's account that he didn't have it.
It takes time and patience. "You can't expect someone to face his worst possible fear and get bored quickly," he notes. "But when I expose patients to things much lower in intensity, that cause much less fear, and they understand the mechanics of exposure, time and time again, and it's working more and more, they'll be much more motivated to face their biggest baddest fear and it will be much more effective when we do it."
Dr. Bubrick notes that he got a picture the other day from the mom of a 10-year-old boy who graduated last fall from treatment for a vomiting phobia. It was a picture of a pumpkin her son had carved for Halloween—and the pumpkin was vomiting.
Dr. Bubrick, by the way, would love to treat Scott Stossel.View Comments | Add Comment
Inside a Parent Training Session
Feb. 25, 2014 Caroline Miller
Practice, practice, practice. It's what parents find themselves urging (or cajoling or harassing) their kids to do when it comes to the piano or tennis. But practicing is also what parents do when they go through parent training. And it's practice that's the secret of the training's well-documented success at diminishing kids' problem behavior.
In a terrific article in the magazine Scientific American Mind, Ingrid Wickelgren takes us inside a session of Parent-Child Interaction Therapy (PCIT) with Dr. Steven Kurtz at the Child Mind Institute. We get to look in on a mom playing with a six-year-old boy who has serious behavior problems. We see what happens when he responds to her commands (lots of very specific praise) and when he doesn't (lots of time in the time out chair, and the back-up time-out room). By the end of the session, everyone is exhausted—but also excited by the progress they've made. In a related blog, you can even hear Dr. Kurtz coaching a mom, via an earbud, from the other side of the one-way mirror.
Wickelgren also takes us back to the origins of Parent-Child Interaction Therapy in the early 1970s, when a clinical psychology named Sheila Eyeberg, who was treating children with play therapy, noticed that in sessions the kids seemed to calm down, self-correct, and try to please her. But they weren't doing the same things for their parents, and the behavior changes didn't carry over at home.
The evolution of the treatment and range of things it's been used for are fascinating. And—to get back to practice—an analysis of many studies into parent training programs, Wickelgren writes, found that "requiring parents to practice the appropriate actions with their children during the training sessions seemed to be critical to correcting parent behavior."
And changing parent behavior, we know, can be the key to changing children's behavior.View Comments | Add Comment
An Intimate Look at Anxiety
Feb. 17, 2014 Caroline Miller
You don't have to be a seriously anxious person, or the parent of one, to find Scott Stossel's new book, The Age of Anxiety, (and the excellent excerpt in the Atlantic) riveting. Stossel's account of his experience with anxiety is so vivid and so candid that it's almost unnerving.
There's the cocktail of Xanax, Inderal and vodka he consumes before making public appearances, to keep from bolting from the stage—which he says he's done. The panicked search for restrooms on a trip to Rome, including one at a gelateria near the Trevi Fountain, "where a series of impatient Italians banged on the door while I bivouacked there." He describes standing at the altar at his own wedding, drenched in sweat, shaking so badly that he has to hold on to his wife to keep from keeling over.
Stossel's anecdotes, which the New York Times reviewer calls "bravely intimate," are valuable in a couple of ways to parents of very anxious children. First, they're a powerful reminder of how physical anxiety is, how overwhelming and debilitating it can be whether you're 5 or 45 years old. They're a reminder of how real the anxiety is, even if the fears that generate it—and Stossel's list of phobias is very, very long—seem absurd. They're also a reminder of how many anxious children (and adults) hide their anxiety and manage to function—even function exceptionally well—at great cost in suffering.
But Stossel also explores all the thorny issues surrounding how we think about and treat anxiety. Is it inherited? Is it learned? Is it a condition of life in the 21st century? In his own family he sees an inherited predisposition to anxiety on his father's side, and in his mother's family, a proudly held conviction that emotion should be avoided at all costs. "Thus, me," he writes: "a mixture of Jewish and WASP pathology—a neurotic and histrionic Jew suppressed inside a neurotic and repressed WASP. No wonder I'm anxious: I'm like Woody Allen trapped inside John Calvin."
In writing about Stossel, Donna Wick, a clinical psychologist and founder of Mind to Mind Parent, notes an interesting thing about the heritability of anxiety. What's actually inherited seems to be what researchers call a "highly reactive temperament," but that doesn't always lead to an anxiety disorder. When parents respond to a highly reactive baby by figuring out how to soothe him, it can "have lasting, long term effects, as we now know that relationships can change the way the brain is wired," she writes on the Huffington Post. On the other hand, parents whose highly reactive babies make them anxious can inadvertently escalate the child's anxiety, and there is more suffering all around.
But Dr. Wick and Stossel both write about the positive effects of anxiety, which can be a powerful motivator towards achievement of all kinds. "So in addition to treating unhealthy levels of anxiety," Dr. Wick writes, "don't forget to appreciate, and even more importantly, teach your child to appreciate the other side of the coin. It will help him understand, value, and ultimately manage aspects of his personality that might otherwise appear 'bad' or negative."View Comments | Add Comment
Lindsey Vonn, 'The Biggest Loser' and the Fat Police
Feb. 11, 2014 Beth Arky
Attacking women's bodies—and self-esteem—seems to be a sport that's never out of season. The latest salvo (and one of the more unusual ones) comes from American Olympic gold medal skier Lindsey Vonn, who is out of the competition in Sochi with an injury but still in the spotlight for bashing women she deems to be too thin and not athletic enough.
In an interview with Self that's getting a lot of attention on tabloid websites, the Olympic gold medalist criticized movie stars' bodies after attending a gala last May with the likes of Gwyneth Paltrow, Jennifer Lawrence, Beyoncé and Ann Hathaway:
"It was hard to go to the Met ball with people who eat lettuce and a Diet Coke for dinner. It's difficult to be at events with a room full of women who weigh half as much as you do. That's always tough. I don't envy them, though, because so many of them are skinny-fat. They have more cellulite than most people. I feel like I need to give them a cheeseburger. It's sexy and beautiful to be strong."
Vonn may think she's speaking out for being healthy, not model-thin, but what she's really doing is trashing other women for cellulite (!) and for not making the same choices she has. It's too bad because her important message about her depression (she's "normal again, now that I'm on medication") was drowned out by her nasty pot shots.
The Vonn story comes days after the uproar over the extreme weight loss of Biggest Loser winner Rachel Frederickson, who shed 60 percent of her body weight from her 5-foot-4-inch frame to go from 260 pounds to 105 pounds. The focus on Fredrickson's "scary," "shocking" loss again diverted attention from the more salient point.
We live in a culture where thin is the goal. Let's be clear here: Loser, which just wrapped its 15th season on NBC, is not a weight loss show, where contestants work to maintain a healthy lifestyle; it's a game show competition where participants battle like Roman gladiators to lose the most weight.
As one style blogger wrote: "Therein lies the whole problem not only with the concept of the show, but the whole cultural dieting complex: This shallow obsession with numbers has more to do with appearance than with actual health, despite protests to the contrary. And that preoccupation with and scrutiny of appearance—even when it's well-intentioned, as in the case of all the Twitter users expressing "concern" over Fredrickson's reveal—ultimately undermines healthy weight loss."
It's a case of your damned if you do, damned if you don't. Don't be too fat but don't be too skinny. And if you think everyone is finding fault with your body, you're right. That's exactly what makes it so hard for girls struggling with eating disorders to recover successfully.View Comments | Add Comment
NFL Prospect Michael Sam: I'm a Lineman, Gay, and Proud
Feb. 11, 2014 Harry Kimball
The Super Bowl may be past, but now we have the more exciting, potentially groundbreaking story of Michael Sam, a top defensive player for the University of Missouri football team who is widely expected to be drafted by the National Football League. Sam just came out in an interview published yesterday in the New York Times. Though professional athletes have come out after their playing days were over, should Sam be drafted he would be the first NFL player to enter the league as a publicly gay man.
There are two ways that Sam's actions can help young people and our culture at large. The first is as a civil rights issue. As Joe Posnanski shows brilliantly in a piece on NBC Sports, the situation Sam finds himself in is eerily similar to that of Jackie Robinson in 1947. Many sneakily pragmatic arguments have come from the NFL coaching establishment as to why Sam wouldn't be a good fit in the pros or the clubhouse—they've all been said before, and they were all proven to be not only prejudiced, but ludicrous. The fact is, the inclusion of minorities in our nation's popular pastimes has had real and society-changing outcomes before, and we don't need to wait until "ten years from now," where one GM put the timeline for change.
But there's one important way in which sexual orientation is not like skin color. Jackie Robinson was not able to be in the closet. And here is where Sam can be another kind of hero—as a role model for kids who struggle with their sexuality and with being honest about it.
We know that kids who don't feel accepted for their sexual orientation are at risk for depression and suicide. And for many of them it can seem impossible to find a mentor who understands. Without guidance and good information, it can feel like peers are not on the same planet. And isolation can be a young person's very worst enemy.
Enter Sam. As a public figure, he is aware of the uncertain future he has brought upon himself in a sport that has been hostile to even the idea of homosexuality. "I'm not naïve," he told the Times. "I know this is a huge deal." And he is also aware of how the media can twist your words, even your persona. "I just want to make sure I could tell my story the way I want to tell it," he continued.
But it is his story about coming out to his teammates, about finding people he could trust and being himself with, that I hope rings true for young people who struggle with a hidden part of themselves. "Once I became official to my teammates, I knew who I was," he said. "I was so proud of myself and I just didn't care who knew."
Thanks to Sam it seems inevitable that some people might soon find it easier to believe that a football player can be gay. Others, that a gay man can be a football player. Both are big steps forward. After he came out to his team, he said, "If someone on the street would have asked me, 'Hey, Mike, I heard you were gay; is that true?' I would have said yes."
That didn't happen, Sam said, for an understandable reason. "I guess they don't want to ask a 6-3, 260-pound defensive lineman if he was gay or not." Here's hoping that it just got a little better for young people of any size who struggle with who they are.View Comments | Add Comment
Lifetime Revives Tired Stereotypes About Bipolar
Feb. 10, 2014 Beth Arky
For every Silver Linings Playbook, there is, unfortunately, a Girl He Met Online. While the Oscar-winning Playbook destigmatized bipolar disorder as a chronic yet treatable mental illness, Lifetime's recent Girl featured a vilified bipolar character whose "anger knows no bounds."
It's stunning that a show so regressive would be made at a point when so many people have moved beyond this stereotype. The main character, named Gillian, attracts suitors, then scares them off, then goes ballistic when they dump her.
In a post that's gotten a lot of attention, blogger Elaina J. Martin wrote that Girl was egregious in part because it's such a tired, clichéd portrayal. "They made Gillian dangerous and they made it appear that her bipolar disorder was the cause of this," Martin wrote. "Don't get me wrong. People like me with bipolar disorder do get irritable. I have admitted to getting angry myself. But I don't kill people. (Obviously). I don't strangle people. I don't drug people with sleeping pills." In fact, people with mental illness are much more likely to hurt themselves than others.
The character of Gillian brings to mind Glenn Close's bunny-boiling Alex in Fatal Attraction. Some 25 years after making that movie and in Newtown's aftermath, Close said she regretted that her role increased the stigma around mental illness. In fact, Close's sister has bipolar.
As for Girl, "They portrayed Gillian to be the general population's expectation of 'crazy' and it isn't fair," Martin wrote. "It isn't fair to people like me, who live and thrive with this disorder, to be compared to someone like Gillian. This is the reason there is so much misunderstanding about mental illness—because the media feeds us bullshit."
It would seem Lifetime is creating something of a franchise based on the dangers of internet dating. We can only hope the network doesn't continue to perpetuate cartoon stereotypes about people with mental illness, who need our understanding, acceptance and help.View Comments | Add Comment