The Mental Health Social Worker

WASHINGTON, DC—As Black Friday nears and national unemployment levels push into double digits for the first time in decades, the American Psychological Association’s (APA) newest Stress in America survey finds that Americans continue to cite financial concerns as leading sources of stress.

Approximately seven in ten Americans report that money is a significant source of stress (71 percent), according to APA’s 2009 Stress in America survey, with similarly high percentages reporting stress resulting from work (69 percent) and the economy (63 percent). More than half of adults (55 percent) also cited family responsibilities as a significant source of stress in their lives.

“According to our survey three quarters of adults in this country already report moderate to high levels of stress,” says psychologist Katherine Nordal, PhD, APA’s executive director for professional practice. “The holiday season can bring with it additional emotional and financial stressors that can negatively impact both physical and mental health.”

Psychologists urge parents to pay particular attention to the stress their children may experience during the holidays. APA’s Stress in America survey found that children are nearly two times more likely to worry about financial concerns than their parents realize. Specifically, 30 percent of youth say they worry about their family having enough money, while only 18 percent of parents report that this is a source of stress for their child.

“While the holidays are stressful for many people, there are some things we can all do to manage that stress and enjoy the season,” says Dr. Nordal. “Given the concerns our young people are reporting about stress and money, parents need to be good models for managing stress in healthy ways.”

APA suggests the following strategies to manage holiday stress and enjoy the season:

1. Take time for yourself. Taking care of yourself helps you to take better care of others in your life. Go for a long walk or take time out to read or listen to your favorite music. By slowing down you will actually have more energy to accomplish your goals.
2. Volunteer. Many charitable organizations face new challenges as a result of the ongoing economic downturn. Find a local charity, such as a soup kitchen or a shelter, where you and your family can volunteer together. Helping others who are less fortunate can put hardships in perspective and can build stronger family relationships.
3. Set realistic expectations. No holiday celebration is perfect; view inevitable missteps as opportunities to demonstrate flexibility and resilience. Create a realistic budget and remind your children that the holidays aren’t about expensive gifts.
4. Remember what’s important. Commercialism can overshadow the true sentiment of the holiday season. When your holiday expense list is running longer than your monthly budget, scale back. Remind yourself that family, friends and the relationships in our lives are what matter most.
5. Seek support. Talk about stress related to the holidays with your friends and family. Getting things out in the open can help you navigate your feelings and work toward a solution. If you continue to feel overwhelmed, consider talking with a professional such as a psychologist to help you develop coping strategies and better manage your stress. A psychologist has the skills and professional training to help people learn to manage stress and cope more effectively with life problems, using techniques based on best available research and their clinical skills and experience, and taking into account an individual’s unique values, goals and circumstances. Psychologists have doctoral degrees and are licensed by the state in which they practice. They receive one of the highest levels of education of all health care professionals, spending an average of seven years in education and training after they receive their undergraduate degrees.

Stress in America is part of APA’s Mind/Body Health public education campaign. For additional information on stress and lifestyle and behavior, visit www.apahelpcenter.org, read the campaign blog www.yourmindyourbody.org, and follow @apahelpcenter on Twitter.

Psychologists are available immediately for interviews related to holiday stress prevention and management. To request an interview, contact Angel Brownawell or Luana Bossolo at Luana Bossolo.

Methodology

The 2009 Stress in America Survey was conducted online within the United States by Harris Interactive on behalf of the American Psychological Association, between July 21, 2009 and August 4, 2009 among 1,568 adults aged 18+ who reside in the U.S. This report also includes the results of a YouthQuery survey conducted between August 19 and 27, 2009 among 1,206 young people aged 8-17 years old. Results were weighted as needed for age, sex, race/ethnicity, education, region, and household income. Propensity score weighting was also used to adjust for respondents’ propensity to be online. No estimates of theoretical sampling error can be calculated; a full methodology is available.

The American Psychological Association, in Washington, D.C., is the largest scientific and professional organization representing psychology in the United States and is the world’s largest association of psychologists. APA’s membership includes more than 150,000 researchers, educators, clinicians, consultants, and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession, and as a means of promoting health, education, and human welfare.

Harris Interactive is a global leader in custom market research. With a long and rich history in multimodal research that is powered by our science and technology, Harris Interactive assists clients in achieving business results. Harris Interactive serves clients globally through its North American, European, and Asian offices and a network of independent market research firms. For more information, please visit www.harrisinteractive.com.

Treatment that includes medication plus a structured training program for parents reduces serious behavioral problems in children with autism and related conditions, according to a study funded by the National Institute of Mental Health (NIMH). The study, which was part of the NIMH Research Units on Pediatric Psychopharmacology (RUPP) Autism Network, was published in the December 2009 issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

Results from a previous RUPP study reported in 2002 showed that the antipsychotic medication risperidone (Risperdal) reduced such behavior problems as tantrums, aggression and self-injury in children with autism. However, most children’s symptoms returned when the medication was discontinued. Although effective, risperidone is associated with adverse effects such as weight gain, which can lead to metabolic changes, obesity and related health problems.

“Medication alone has been shown to help with some symptoms of autism, but its potential is limited,” said NIMH Director Thomas R. Insel. “This study shows promise of a more effective treatment protocol that could improve life for children with autism and their families.”

In the study, the RUPP group tested the benefits of medication alone compared to medication plus a parent training program that actively involves parents in managing their children’s severely disruptive and noncompliant behavior. Parents were taught to modify their children’s behavior and learned to enhance their children’s daily living skills.

The 24-week, three-site trial included 124 children ages 4 to 13 with pervasive developmental disorders (PDD) such as autism, Asperger’s or related disorders accompanied by tantrums, aggression and self-injury. The children were randomized to a combination of risperidone and parent training, or to risperidone only. Parents in combination therapy received an average of 11 sessions of training over the course of the study.

Although both groups improved over the six-month trial, the group receiving combination therapy showed greater reduction in behavioral problems like irritability, tantrums and impulsiveness compared to the group receiving medication only. The combination therapy group also ended the trial taking an average dose of 1.98 milligrams (mg) per day of risperidone, compared to 2.26 mg/day in the medication-only group—a 14-percent lower dose. However, children in both groups gained weight, indicating “a need to learn more about the metabolic consequences of medications like risperidone,” said the authors.

“The combination group was able to achieve its gains with a lower dose of medication. Plus, it appeared that the benefits of added behavioral treatment increased over time, a strong signal that actively including parents in the treatment of children with PDD could only benefit families, ” said lead author Michael Aman, Ph.D., of the Ohio State University.

“Future studies will evaluate whether the benefits of parent training endure over a long period of time,” concluded the authors. The investigators also plan to apply the parent training to younger children with PDD to prevent the evolution of serious behavioral problems. Future studies may also look for ways in which the parent training program can be used in schools and community clinics.

Reference

Aman MG, McDougle CJ, Scahill L, Handen B, Arnold LE, Johnson C, Stigler KA, Bearss K, Butter E, Swiezy NB, Sukhodolsky DD, Ramadan Y, Pozdol SL, Nikolov R, Lecavalier L, Kohn AE, Koenig K, Hollway JA, Korzekwa P, Gavaletz A, Mulick JA, Hall KL, Dziura J, Ritz L, Trollinger S, Yu S, Vitiello B, Wagner A, for the Research Units on Pediatric Psychopharmacology Autism Network. Medication and parent training in children with pervasive developmental disorders and serious behavior problems: results from a randomized clinical trial. Journal of the American Academy of Child and Adolescent Psychiatry. 2009 Dec. 48(12):1143-1154.

Long-term treatment of adolescents with major depression is associated with continuous and persistent improvement of depression symptoms in most cases, according to the most recent analysis of follow-up data from the NIMH-funded Treatment of Adolescents with Depression Study (TADS). The report, along with a commentary compiling the take-home messages of the study, was published in the October 2009 issue of the American Journal of Psychiatry.

Background

The TADS team randomly assigned 439 adolescents aged 12 to 17 to one of four treatment strategies for 36 weeks—the antidepressant fluoxetine (Prozac) only, cognitive behavioral therapy (CBT) only, the combination of the two, or placebo (inactive or “sugar” pill). After the first 12 weeks, the placebo group was discontinued, while the participants assigned to the active interventions continued treatment for another six months. Overall, the combination therapy was found to be the most effective in speeding up remission. Visit the NIMH website for more information about TADS results.

After the trial ended, the teens who had been assigned to the active treatments were assessed up to four times during the following year to determine if improvements were sustained over time. TADS treatments were no longer offered, but participants were encouraged to continue to seek treatment within their communities.

Participants who had been assigned to the placebo group received open treatment during the one-year follow-up period and were not included in this follow-up assessment. About 66 percent of TADS subjects (not including those who had been in the placebo group) participated in at least one assessment during the follow-up year.

Results of the Study

By the end of the 36-week trial, 82 percent of participants had improved and 59 percent had reached full remission. During the follow-up year, most participants maintained their improvements, and the remission rate climbed to 68 percent. However, about 30 percent of the participants who were in remission at week 36 became depressed again during the following year.

In addition, while 91 percent of participants showed no evidence of suicidal thinking or behavior at the end of the trial, 6 percent developed suicidal thinking during the follow-up year, with no statistically significant differences among the treatment groups.

Significance

The longer-term treatment of TADS, regardless of treatment strategy, was associated with lasting benefits for the majority of participants. However, a significant number of those who had recovered worsened during the follow-up period, indicating a need for continuous clinical monitoring and further improvement in long-term treatment of youth with major depression.

What’s Next?

The final results of TADS suggest that for most teens with depression, long-term, evidence-based treatments are effective and sustainable. But future research should concentrate on improving treatment strategies to reduce the rate of depression relapse or deterioration. The authors suggest that a randomized maintenance therapy trial would help determine how long active treatment should last to ensure the effects of treatment will endure over time.

References

TADS Team. The Treatment for Adolescents with Depression Study (TADS): Outcomes over one year of naturalistic follow-up. American Journal of Psychiatry. 2009 Oct. 166(10): 1141-1149.

March JS and Vitiello B. Take home messages from the Treatment for Adolescents with Depression Study (TADS). American Journal of Psychiatry. 2009 Oct.166(10):1118-1123.

Numerous studies have suggested that depression runs in families. Children of depressed parents are 2–3 times as likely to develop depression as compared to children who do not have a family history of the disorder.¹ Other studies have shown that remission of depression in mothers is associated with improvements in psychiatric symptoms in their children.² Despite all signs encouraging mothers to prioritize their own mental health, many suffer from untreated depression while managing treatment for their children’s emotional or behavioral problems.³

An NIH Challenge grant was awarded on behalf of NIMH to Judy Garber, Ph.D., of Vanderbilt University, to develop and test a method encouraging depressed mothers to follow treatment recommendations. For this study, Garber is recruiting 200 mothers of children receiving psychiatric treatment at a community mental health center.

All study participants will receive a referral for treatment and an information pamphlet describing the symptoms of depression and anxiety, possible effects of depression on children, and different types of treatments. Randomly assigned participants will also receive a brief, one-session Enhanced Motivation Intervention (EMI). EMI uses special interviewing techniques to identify and resolve a person’s concerns about and practical barriers to treatment.

The researchers anticipate that EMI will result in more participants getting treatment for mental disorders compared with the control group. If successful, such interventions would not only benefit the depressed individual, but may improve the well-being of her children as well.

The NIH Challenge Grants in Health and Science Research program is a new initiative funded through the American Recovery and Reinvestment Act of 2009 (Recovery Act). This program supports research on 15 broad Challenge Areas that address specific scientific and health research challenges in biomedical and behavioral research that will benefit from an influx of significant two-year funds to quickly advance the area.

Within these Challenge Areas, NIMH identified 35 topics of particular funding interest that advance the Institute’s mission and the objectives outlined in the NIMH Strategic Plan, the Trans-NIH Plan for HIV-Related Research, and the National Advisory Mental Health Council report on research training. These topics can be found at NIMH’s Challenge Grant web page.

Citations

¹Weissman MM, Wickramaratne P, Nomura Y, Warner V, Pilowsky D, Verdeli H. Offspring of depressed parents: 20 years later. Am J Psychiatry. 2006 Jun;163(6):1001-8. PubMed PMID: 16741200.

²Pilowsky DJ, Wickramaratne P, Talati A, Tang M, Hughes CW, Garber J, Malloy E, King C, Cerda G, Sood AB, Alpert JE, Trivedi MH, Fava M, Rush AJ, Wisniewski S, Weissman MM. Children of depressed mothers 1 year after the initiation of maternal treatment: findings from the STAR*D-Child Study. Am J Psychiatry. 2008 Sep;165(9):1136-47. Epub 2008 Jun 16. PubMed PMID: 18558646.

³Verdeli H, Ferro T, Wickramaratne P, Greenwald S, Blanco C, Weissman MM. Treatment of depressed mothers of depressed children: pilot study of feasibility. Depress Anxiety. 2004;19(1):51-8. PubMed PMID: 14978786.

ARLINGTON, Va. (Nov. 16, 2009) – Persons convicted of serious crimes by age 23 did not have the normal heightened response to cues associated with loud, unpleasant noise when they were tested at 3 years of age, according to a new study published in The American Journal of Psychiatry.

The finding strengthens evidence that early brain dysfunction increases the risk for criminal offending, since learning to associate a cue with a frightening outcome, known as fear conditioning, relies on the amygdala and prefrontal cortex.

Nearly 1,800 children were studied over 20 years by Yu Gao, Ph.D., and colleagues in the United States and the United Kingdom. When subjects were 3 years of age, fear conditioning was assessed by measuring electrical activity of the skin after presentation of two types of long auditory tones. One tone was usually followed by a short, loud, unpleasant sound, conditioning the child’s reaction to this tone due to anticipation of the unpleasant noise. The other tone served as a control tone, which was deeper in pitch and had no unpleasant association. Skin conductance measures the nervous system’s control over sweat secretion that is part of the body’s fear response.

Normal fear conditioning would result in greater skin responses to the conditioned tone than to the control tone. According to the authors, poor fear conditioning is hypothesized to predispose to crime because “individuals who lack fear are less likely to avoid situations, contexts, and events that are associated with future punishment—resulting in a lack of conscience.”

By age 23, 137 subjects had convictions for serious crimes. These individuals showed a lack of fear conditioning at age 3 whereas noncriminal subjects with similar characteristics, including social adversity, exhibited normal fear conditioning.

The report will appear online on November 16 at AJP in Advance, the online advance edition of The American Journal of Psychiatry (AJP), the official journal of the American Psychiatric Association. Data collection was supported by the Medical Research Council (U.K.), Wellcome Trust (U.K.), and National Institute of Mental Health.

The American Journal of Psychiatry is the oldest continuously published medical specialty journal in the United States and was recently named one of the “Most Influential Journals in Biology & Medicine of the Last 100 Years.” Statements in this press release or the articles in the Journal are not official policy statements of the American Psychiatric Association.

The American Psychiatric Association is a national medical specialty society whose more than 38,000 physician members specialize in diagnosis, treatment, prevention and research of mental illnesses including substance use disorders. Visit the APA at www.psych.org and www.HealthyMinds.org.

Sound Therapy Program Currently Prescribed for Treatment of PTSD,

Stress, Compassion Fatigue in VA and U.S. Army Hospitals

Contacts: Steve Vetzner, (703) 797-2588 or svetzner@mentalhealthamerica.net

Jared Klose, (302) 434-8707 or jklose@stargroup1.com

ALEXANDRIA, Va. (November 10, 2009)-Mental Health America today announced it is partnering with Prescription Audio, a Philadelphia-area based firm (Voorhees, N.J.), to make the company’s scientifically based sound therapy available without charge as a download to veterans, active duty servicemen and women, their family members and health care providers.

“We applaud Prescription Audio for making this therapy available for free and are proud to partner with them,” said David Shern, Ph.D., president and CEO of Mental Health America. “It is a valuable stress management and anxiety reduction tool that can immediately help our active duty troops, veterans, their families and caregivers.”

Similar Prescription Audio sound therapy is currently being prescribed within the Department of Veterans Affairs and US Army hospitals to aid in the treatment of Post-Traumatic Stress Disorder (PTSD), insomnia, high stress and compassion fatigue.

In honor of Veterans Day, and in light of recent events including the Fort Hood shootings, 250,000 copies of the download are being made available at no charge to any veteran, active duty servicemen and women, their families, as well as compassion fatigued healthcare providers suffering from mental health symptoms related to the treatment of PTSD and other related conditions. The value of the products and services being donated is approximately 5 million dollars.

“In these trying times, we felt like we had to do something to support our warriors, veterans, their families and the mental health professionals that serve them,” said Jill Slane, CEO of Prescription Audio. Individuals can learn more about sound therapy, discover how it can start helping them and access the download by going to Mental Health America’s Operation Healthy Reunion’s site at http://www.mentalhealthamerica.net/reunions/resources.cfm or by clicking here.

Prescription Audio was developed by Jill and Rod Slane, a husband-wife team, in 2005. Rod Slane has used his more than 40 years experience as a composer and innovative sound engineer to create the Life Program, followed by Natural Wellness Therapy in 2006.

One of the company’s early aims was to help ease the anguish of veterans suffering from PTSD.  By using proprietary sound technology, Prescription Audio’s array of MP3 and CD programs provide natural mental and general health solutions that diminish anxiety and its many detrimental manifestations, while enabling anyone to quickly and easily achieve a meditative state of mind.

Prescription Audio provides products and services through its Life Program^TM to the U.S. military’s Institute of Surgical Research Stress Management Program for Healthcare Providers, a strong testament to the power and effectiveness of their approach. In this application, vibrational sound therapy is utilized to help reduce the high rate of turnover in trauma healthcare workers within military hospitals by teaching stress management tactics, leading to improved mental health and increased resiliency.

About Mental Health America

Mental Health America is the country’s leading nonprofit dedicated to helping all people live mentally healthier lives. With our century of service to America and our more than 300 affiliates nationwide, we represent a national movement that promotes mental wellness for the health and well-being of the nation – everyday and in times of crisis.

About Prescription Audio

Prescription Audio is the developer of Sound Solutions for a Healthier Life. By using proprietary sound technology, Prescription Audio provides natural mental and physical health solutions that diminish stress and its many detrimental manifestations, while enabling anyone to quickly and easily achieve a meditative state of mind.  The company offers a wide variety of portable MP3 and CD programs that promote healthy living through natural wellness.  Prescription Audio’s natural wellness solutions utilize audio vibrations embedded within a proprietary multi-layered sound technology to assist with positive metamorphosis in total mind-body well-being.  Please visit www.PrescriptionAudio.com to learn more.

Computer-based Training in Creating and Responding to Facial Expressions May Improve Social Interactions

Most children with autism spectrum disorders (ASD) seem to have trouble engaging in everyday social interactions. They may seem to have no reaction to other people or may respond atypically when others show anger or affection. Their own facial expressions, tone of voice, and body language may not match what they are saying, making it difficult for others to respond appropriately. Such barriers to communication can isolate children with ASD from their peers.

To help overcome these barriers, NIH awarded a Challenge grant on behalf of NIMH to support the development of a new training program that incorporates two existing computer programs. One program, called Let’s Face It!, helps children with ASD recognize facial expressions of others and understand the corresponding emotions. The other program, called the Computer Expression Recognition Toolbox, detects a user’s facial expression in real-time, based on 37 different facial expression dimensions (for example, widening one’s eyes, raising the inner or outer corners of one’s eyebrows, wrinkling one’s nose, etc.) and their intensity.

In the new study, Marian Bartlett, Ph.D., of the University of California San Diego, and colleagues will use the two programs as a basis for developing and testing a new computer-assisted program to train children with ASD how to respond to facial expressions of others and how to produce facial expressions conveying particular emotions to others. The researchers will also characterize facial expression production in children who do not have ASD, which can provide important information for research on the normal development of motor skills for social communication.

The NIH Challenge Grants in Health and Science Research program is a new initiative funded through the American Recovery and Reinvestment Act of 2009 (Recovery Act). This program supports research on 15 broad Challenge Areas that address specific scientific and health research challenges in biomedical and behavioral research that will benefit from an influx of significant two-year funds to quickly advance the area.

Within these Challenge Areas, NIMH identified 35 topics of particular funding interest that advance the Institute’s mission and the objectives outlined in the NIMH Strategic Plan, the Trans-NIH Plan for HIV-Related Research, and the National Advisory Mental Health Council report on research training. These topics can be found at NIMH’s Challenge Grant web page.