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Intensive Outpatient Therapy Helps Children With Depression And Anxiety

We all have our anxious moments or times when we are depressed. It’s normal to feel these emotions when we are in stressful situations. In children, anxiety and depression can manifest differently than it does in adults. We often see more dramatic signs of frustration, irritability, and even anger. Kids might be restless, withdraw socially, or lose their appetite.

Usually these conditions go away once conditions improve. For many children, however, anxiety or depression can drag on and on. It may get worse over time and might even start to interfere with their school life, social relationships, or daily activities. When it reaches this point, it is likely that the child has an anxiety or mood disorder that requires treatment from a child psychologist. Be assured that these conditions are highly treatable.

Traditionally, children who are undergoing treatment for anxiety or depression will see their therapist once or twice a week for 30-60 minute sessions. These sessions often continue for three to four months, but could go on much longer depending on the severity of the child’s disorder. However, a relatively new concept in psychotherapy, called intensive outpatient therapy, is showing promise for helping kids get better faster.

What Is Intensive Outpatient Therapy?

Intensive outpatient therapy is focused therapy that is given over longer treatment sessions. For example, intensive treatment might be concentrated into daily, three-hour sessions given five days in a row over a two to four week period.

Just as with a regular psychotherapy session, intensive treatment uses methods like cognitive behavior therapy CBT, mindfulness, and exposure response and prevention (ERP). The idea behind the intensive sessions is to teach strategies to decrease the child’s symptoms and provide support, but to do it within a framework that allows them to live at home and continue school and family activities.

An intensive outpatient therapy program includes:

  • Comprehensive treatment planning
  • Learning to recognize unhealthy behaviors
  • Building successful problem solving abilities
  • Learning coping strategies and skills
  • Methods and practice to aid in asking for and getting support
  • Follow up sessions to reinforce these new skills

Although intensive therapy is fairly new, research is showing that it is just as beneficial as long term therapy or in-patient centered therapy. A 2012 study of adults by Ritschel, Cheavens, and Nelson at the Emory University School of Medicine reported that, “Depression and anxiety scores decreased significantly and hope scores increased significantly over the course of treatment.“

Children who have anxiety and depression make similar advances when they undergo intensive outpatient therapy. These gains are long-lasting, just as they are for traditional treatment.

Intensive therapy involves parents as well as children. During treatment, family meetings are held so that parents can better understand the therapy process and learn how to best support their child.

Additionally, children may interact with other kids so they can see that others are going through similar challenges. This is also an opportunity for them to relate to children their own age in a way they may not be able to with their peers or siblings who don’t face the same concerns.

If you are looking for an intensive program for your child, be sure that whichever one you choose utilizes therapists who have been highly trained in treating anxiety and depression in children and teens.

Also, you want the program to be individualized to your child. They should feel a connection with the therapist. The therapist should work with your child to develop a plan specifically for their needs in order to maximize the outcome of their treatment.

Who Would Benefit From Intensive Outpatient Therapy?

Sometimes a child struggles with depression or anxiety symptoms while still being able to function in their daily life. At other times, they may need more focused therapy and support. Intensive outpatient treatment would work for both children. Intensive therapy can also provide rapid and effective management in someone with severe symptoms who has taken time away from school for their recovery.

To be most effective, children who participate in intensive therapy should:

  • Attend every session. This can be difficult if they are having bad days, but they will get the most benefit by coming to every appointment.
  • Allow themselves time to process what they are learning.
  • Treat themselves gently while they learn that it’s okay to make mistakes
  • Trust in the therapy and therapist.

Learning coping skills and effective management of symptoms may continue on and off during a child’s life. Sometimes kids need a “booster” even after intensive therapy, but trusting that the psychotherapists and treatment will help can aid in quickly reducing and managing moderate to severe anxiety and depression.

Learn More About Our Upcoming Intensive Outpatient Therapy Sessions For Children – Starting Soon!

For more information about our upcoming intensive outpatient therapy sessions for children and teens, talk to the professionals at the Children’s Center for Psychiatry, Psychology and Related Services in Delray Beach, Florida. Contact us or call us today at (561) 223-6568.

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Suicide Contagion And The Parkland Tragedy

It’s just one month past the first anniversary of the massacre at Marjorie Stoneman Douglas High School and we have all been saddened to hear that two students who survived the attack recently took their lives within days of each other. Also, the father of a child who was killed in the 2012 Sandy Hook school shootings died this week in an apparent suicide. Now experts are concerned that these deaths may be the result of suicide contagion.

What Is Suicide Contagion?

There is strong evidence to suggest that suicides can occur in groups. When the media reports that someone famous has died by suicide, it seems that other, similar deaths quickly follow. It is almost as if suicide somehow becomes “contagious.”

We saw this happen last summer when Anthony Bourdain took his own life within days of Kate Spade’s death. Now we have this most recent suicide cluster involving the Parkland students and the Sandy Hook father. Were they due to suicide contagion?

Suicide contagion is also known as the Werther Effect – a phrase coined in the 1970s by suicide researcher, David Phillips. The name refers to a character called Werther from a 1774 novel by Johann Wolfgang von Goethe. In the book, Werther takes his life when he learns that the woman he loves has married another man.

After its release, Goethe’s novel was blamed for numerous copycat suicides across Europe. In this early example of suicide contagion, many of the victims died in a similar manner to the way the Werther character killed himself in the book. Some people used the same type of gun and some dressed in the style of clothing that Werther wore. Some were even found with a copy of the novel on or near their bodies.

The News Media’s Connection To Suicide Contagion

Phillips’ research into suicide clusters led him to conclude that copycat suicides rise when there is excessive news coverage of the suicide of famous figures. In addition to Phillips’ investigations, several other studies have found that suicide rates go up after media coverage of a notable death. These rates also fall when the media coverage stops.

“The way suicide is reported is a significant factor in media-related suicide contagion, with more dramatic headlines and more prominently placed (i.e., front page) stories associated with greater increases in subsequent suicide rates,” says Dr. Madelyn Gould, a suicide researcher from Columbia University.

As with Goethe’s book, suicide clusters also occur when fictional characters die by their own hand. Dr. Gould has reported that, “Research into the impact of media stories about suicide has demonstrated an increase in suicide rates after both nonfictional and fictional stories about suicide.”

There is an ongoing debate among experts about why suicide contagion follows these reports. Is it that the news coverage itself causes someone else to take their own life or do they do it because they are already in a vulnerable state?

Regardless of the reason, media guidelines for reporting a death by suicide have been in place in many parts of the world since the end of the twentieth century. Both the Centers for Disease Controls and Prevention (CDC) and the World Health Organization (WHO) have issued policies for how news reports should cover notable and celebrity suicides.

Today, however, we have a new concern. In the twenty-first century, we rely less on standard media reporting and depend more on online sources to find out what is going on in the world. In particular, young people get their news from social media and the internet. These methods can spread a topic far more quickly than a news broadcast and – unfortunately – will do so with no filtering.

Suicide Risk Factors

In the case of the Parkland tragedy, we know that the first student to take her life was struggling with post-traumatic stress disorder (PTSD). She also suffered with survivor’s guilt, as do many of the teens who were at the school that day.

Suicide is already the second leading cause of death for young people between the ages of 10 and 24 and this is without factoring in the trauma of a massacre like the one in Parkland. Clearly, we need to talk more openly with young people about suicide prevention.

We all can help avert this type of suicide by watching for youth suicide signs and risk factors and by asking direct questions.

A risk factor can’t predict if someone will take their own life, but having one or more of them makes it more likely the person will either consider or attempt suicide. These risk factors are:

  • Talking a lot about the suicide of someone important (or having recently lost someone close to them)
  • Making jokes about dying or about suicide
  • Losing interest in activities or relationships they used to enjoy
  • Sharing feelings of self-contempt or worthlessness, or talking about feeling hopeless and unsure if they will ever being happy again
  • Giving away possessions they used to care a lot about, such as favorite clothes or mementos
  • Isolating themselves
  • May exhibit extreme mood swings or have violent outbursts of grief or anger
  • Might have insomnia or may over-sleep or be lethargic
  • Indulging in risky behavior, especially if this is not characteristic of the person

Asking Questions That Can Help

The first step in preventing a suicide is the awareness that someone is considering ending their life. The next step is determining whether immediate intervention is needed.

If you think someone you know may be at risk, you can help them by using the Columbia Protocol suicide risk assessment. The Columbia Protocol was developed jointly by researchers from Columbia University, the University of Pennsylvania, and the University of Pittsburgh, along with the National Institute of Mental Health (NIMH). It was adopted by the CDC in 2011 and today it is used worldwide to assess at-risk individuals.

The Columbia Protocol is a series of three to six direct questions that you ask the person you are worried about. Their answers will provide enough information to know if they need help and if urgent action is necessary (click here to download the free Columbia Protocol toolkit now).

If your child or someone you know tells you they are considering suicide, don’t judge them. Instead, show empathy for their feelings and let them know you care about them. Next, get help from a mental health professional or a suicide crisis hotline. A crisis hotline is especially critical if the person is in immediate danger of attempting suicide.

Never leave someone alone if they are threatening suicide. If you believe they are in immediate danger, call 911 or the National Suicide Prevention Lifeline at 800-273-TALK (800-273-8255) in the United States. The line is open 24/7.

Talk To Us

If you are worried about your child or a loved one who may be at risk for suicide, talk to the specially trained mental health professionals at the Children’s Center for Psychiatry, Psychology and Related Services in Delray Beach, Florida. Contact us or call us today at (561) 223-6568.

References

Forum on Global Violence Prevention; Board on Global Health; Institute of Medicine; National Research Council. Contagion of Violence: Workshop Summary. Washington (DC): National Academies Press (US); 2013 Feb 6. II.4, THE CONTAGION OF SUICIDAL BEHAVIOR.Available from: https://www.ncbi.nlm.nih.gov/books/NBK207262/

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Protecting Kids From The Momo Challenge

Protecting Kids From The Momo Challenge

Recently, the media has been reporting that 2018’s online Momo challenge has resurfaced. They talk about children encountering it in seemingly innocent YouTube videos. Originating on WhatsApp, the reemergence of the scary social media game has prompted schools and police stations to issue warnings about the challenge so that parents can discuss it with their kids.

What Is The Momo Challenge?

The Momo figure was actually a sculpture called “Mother Bird”. It was created by Japanese artist, Keisuke Aisawa. The sculpture featured a wraith-like figure with bulging eyes and long, stringy hair. To date, no evidence suggests that the artist or his special effects company had anything to do with the Momo challenge and the sculpture has since been destroyed.

Reports say that when the game first started, children were contacted to participate in the Momo challenge through their interaction with WhatsApp. More recently, however, the media is warning that the figure has apparently been popping up in Peppa Pig or Fortnight YouTube videos.

When a child participates in the game, they are actually interacting with someone who tells them to perform certain tasks to avoid being “cursed.” Reportedly, these assignments often require the child to do something harmful to themselves or others. They might be told to take pills or stab or otherwise hurt someone. The tasks even go as far as telling the child to take their own life.

The Momo figure asks the child to prove they have completed a task by providing a photograph of themselves while engaged in the assignment. To advance through the game, the child must show this proof. At the end of the game, the child’s final assignment is to commit suicide while recording it for social media.

Is The Momo Challenge A Hoax Or A Real Thing?

When the Momo game initially came out on social media, critics were quick to dismiss it as a hoax. While there have been a few child suicides that were thought to have been a result of the challenge, there has never been any definitive proof linking them to the game.

Additionally, it is difficult to find online images of kids participating in the game. Doubters think that if the challenge was real, there would be many more social media pictures of Momo collaborations.

ReignBot, a YouTuber who is famous for videos that explore creepy things on the Internet says, “Finding screenshots of interactions with Momo is nearly impossible and you’d think there’d be more for such a supposedly widespread thing.”

Often, the warnings about dangerous online challenges spread farther and faster than the actual game. That said, it is potentially dangerous for a child who is vulnerable to self-esteem and other psychological issues to be exposed to something that could be harmful.

Talking To Your Kids About Momo

Regardless of whether the game is real, experts agree that parents need to address the topic with their children preemptively. Dr. Ryan Seidman, a child and adolescent psychologist and the Clinical Director at our Children’s Center, says parents should warn their kids about these online challenges.

“Discuss with younger children what to do if they see the face,” she advises. You might start by asking the child if they have heard of Momo, then tell them to get a parent or other adult if something scary or threatening ever pops up on an app or video.

For teens and adolescents who want more independence, it’s good to have periodic discussions about online encounters, as well as anything in their lives that is frightening or threatening to them.

Encourage your kids to tell you if they are being bullied (by the way, Momo is a form of cyber-bullying). Be sure they understand that you are trusting them to let you know.

Self Harm And Suicide – Who Is At Risk From The Momo Challenge?

It’s unlikely that an online challenge would affect a psychologically healthy child, but it could push kids who self harm or who are contemplating suicide to act on their thoughts.

Self Harm

Self harm isn’t restricted to a certain age group or race, or to someone with a certain socioeconomic or educational background. Anyone may engage in self harm, but the behavior happens most often in teens and young adults.

Self harm happens most frequently in:

  • People who have difficulty expressing their emotions
  • Those individuals who have a background of childhood trauma, such as physical, verbal, or sexual abuse
  • People who don’t have a strong social support network. Conversely, we know it happens more often in those who have friends who also self harm
  • Those who also have post traumatic stress disorder (PTSD), obsessive compulsive disorder (OCD), borderline personality disorder, eating disorders, or in those who engage in substance abuse

Suicide

Keep in mind that suicide is the result of a mental illness. People who are vulnerable to online cyber-bullying and content like the Momo challenge are often already suffering from mental health issues, such as low self esteem, anxiety, or depression.

As mentioned above, the Momo game is thought to have led to several teen suicides last year, although the link hasn’t been proven.

Suicide is the second leading cause of teen deaths, but could a dangerous challenge increase risky behavior in an susceptible teen?

Madelyn S. Gould, Ph.D., a psychiatrist at Columbia University, thinks so. She says, “The magnitude of the increase [in the number of suicides] is proportional to the amount, duration, and prominence of media coverage. We know from a number of studies that the celebrity status of a suicide victim increases the impact of the suicide.”

Add to that the feeling of being alone in their pain and it’s possible a challenge could push a distressed teen over the edge.

Adolescents and teens who are considering suicide usually give unmistakable warning signs:

  • Making jokes about dying or about suicide
  • Sharing feelings of self-contempt or worthlessness, or talk about feeling hopeless and unsure they will ever being happy again
  • Giving away possessions they used to care a lot about, such as favorite clothes or  mementos
  • Losing interest in activities or relationships they used to enjoy
  • Talking a lot about the suicide of someone important (or may have recently lost someone close to them)
  • Isolating themselves
  • Might have insomnia or may over-sleep, may be lethargic
  • May exhibit extreme mood swings or have violent outbursts of grief or anger
  • An increase in drug or alcohol use
  • Indulging in risky behavior, especially if this is not characteristic of the person

Your child needs to know you are taking them seriously and that you care about them. If you are concerned that they are exhibiting some of these signs, ask the child directly if they are considering suicide (or have someone else they trust ask them). Be assured that it is okay to use the word “suicide” – saying the word will not raise the chance that they will act on the idea.

If your child admits that they are considering suicide, be empathetic about their feelings – don’t judge them. Seek help from a mental health professional such as those at our Children’s Center, from your child’s pediatrician, or from a suicide crisis hotline. The crisis hotline is especially critical if you think your child is in imminent danger of attempting suicide.

Worried about the Momo challenge’s influence on your child? Talk with a Child Psychologist at our Children’s Center

For more information about our children’s mental health services,  contact the Children’s Center for Psychiatry Psychology and Related Services in Delray Beach, Florida or call us today at (561) 223-6568.

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