0 Cyberbullying: an Update on Intimidation in the Digital Playground

By Arshya Vahabzadeh, M.D.

Follow @VahabzadehMD

American Psychiatric Association Leadership Fellow

Resident Physician in Child and Adolescent Psychiatry at
MGH/McLean/Harvard Medical School

What is cyberbullying?

Cyberbullying
is bullying,
intimidation, and harassment that happens with the aid of electronic technology.
Cyberbullying can happen through text messaging, social media, and emails. The
boundaries of cyberbullying continue to expand as new communication
technologies emerge.

Cyberbullying is emerging as a major
problem, with new research from the Bureau for Justice Statistics revealing
that 9% of teenagers aged 12-18 have reported being cyberbullied in a given
year.

Female
students are more likely to experience cyberbullying. The most common forms of
cyberbullying include harassment by text or instant messaging, or the posting
of hurtful information on the internet. Despite the high levels of
cyberbullying, an adult is notified in only a quarter of cases.

How is cyberbullying different than traditional bullying?

Cyberbullying
can continue 24 hours a day and is not dependent on location. While traditional
bullying often requires the physical presence of a bully, a child can be
cyberbullied at anytime and anywhere they are in contact with communication
technology, including their own cell phone. There may be no “safe” zone and
this may intensify the level of distress that the cyberbullying can produce.

Material
such as digital pictures, text messages, or social media posts designed to hurt
an individual can be rapidly distributed to a large group of people. Often it
is difficult to find out the source of the information, giving a degree of
anonymity to the cyberbully.

Harassing
and intimidating material, once distributed through digital means are also much
more difficult to remove. Often videos or pictures may stay indefinitely
available through digital means.

What are the effects of cyberbullying?

People who are
cyberbullied are thought to be at risk of the same consequences of traditional
bullying. These effects include increased depression, decreased self-worth,
hopelessness, and loneliness. There is some evidence to suggest that being
cyberbullied may result in suicidal feelings in 20% of teenagers, a higher rate
than in traditional bullying.

What can we do about cyberbullying?

Promote Good
Digital Habits

• Keep
  your children informed about the risks of the technology they are using.


• Engage
  your children in a discussion on how to best deal with cyberbullying by
  formulating a plan for dealing with text messages or other digital content that
  is upsetting to them. Children should be made to feel as comfortable as
  possible in discussing their experiences with trusted adults.


• Review
  and teach them about privacy settings for digital media. Talk to them about
  limiting the amount of private information they share about themselves.


• Tell
  children to keep their passwords safe and not to share them with friends or
  people they don’t know.

Take Action

• Approach
  a child if you notice signs of changing behavior, especially if it is happening
  when they are using the computer, their cell phone, or any other communication
  device.


• Consider
  discussing the situation with the suspected bullies’ parents, the child’s
  school, and other organizations they may be involved in.


• Identify
  and archive the cyberbullying material, it may be useful when contacting the Internet service provider, cell phone company, or in severe circumstances, the
  police.


• Consider
  closing down targeted social media accounts or changing cell phone numbers.


• Some
  cyberbullies thrive on obtaining a reaction, avoiding replying to messages or
  engaging with the cyberbully may also be useful in some situations.

Public Service Announcement:


Where can I get more information?

More on cyberbullying from stopbullying.gov and girlshealth.gov
 and onguardonline.gov

More on
bullying



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0 Need to relax? How meditation can help you stay calm

By ElanaMiller, M.D., Resident Psychiatrist, UCLA Follow @ElanaMD 

Arshya Vahabzadeh, M.D., Resident Psychiatrist, Harvard University/Mass.General/McLean

Follow @VahabzadehMD

For many of us, daily
life doesn't lend itself well to relaxation and reflection. We find ourselves
running around from task to task. We wake up hurriedly, rush to work, get
bombarded with calls and emails throughout the day, speed through meals, try to
fit in a workout, and schedule time with friends / spouses / kids. . . which leaves us with little to zero time for ourselves. It's a tough way to live, day in and day out.
Meditation is one tool we can use to find some calm.

Put simply, meditation
is the practice of focused, mindful attention. One starts focusing on the
breath, following the breath in and out. Inevitably, we get distracted, and our
mind wanders: Did I feed the dog? That was so annoying what Bill did at
work today. Oh, I'm getting distracted, I'm so bad at meditating! 

This is okay - and even expected. When the mind wanders we simply bring the focus back to the breath. When a very strong emotion of physical sensation calls our attention
away, we can make that sensation the new object of meditation, watching as it
gets stronger or weaker. When the sensation isn't so strong anymore, we return
to the breath. Training the mind is like training a puppy - when it runs
away, we bring it back, over and over.

So how does this simple
practice help cultivate relaxation in daily life?

1. Meditation helps you stay in the present

So much of our time is
spent in the past and the future that we rarely are present in the moment. We
spend so much time remembering, regretting, planning, and worrying that we miss
the moments of joy and spontaneity that are right in front of us.

Meditation helps train
the mind to focus on the present moment. Instead of regretting things we can't
change, or worrying about bad things that haven't even happened yet, we can
learn to accept and appreciate our current circumstances.

2. Meditation teaches you how to redirect your mind

Sometimes we get caught
up thinking (obsessing!) about a big problem, and we have the idea that if we just think
hard enough we can solve it - but that's rarely the case. The best insights
usually come in those "in between" moments - in the shower, when
you're driving, when you're enjoying a cup of tea.

But even if we're aware
that worrying and ruminating won't solve our problems, we don't know how to
shut our minds off. Meditation can teach you this skill! Like any skill, it
requires practice. But with dedicated practice, even five or ten minutes a day,
we can learn how to let go of worries and redirect our mind to the present
moment.

3. Meditation teaches you to be more aware of your thoughts and
emotions

Too often we have a
thought and react to it without considering why. We get angry at someone and
start yelling. We hear a critical remark and get defensive. Instead of taking
our thoughts and assumptions as facts and immediately reacting (possibly saying
or doing something we'd regret), we can pause and consider what's really going
on. 

Maybe we feel angry but
are really hurt. Maybe we feel defensive because part of what the other person
said is true. Meditation teaches us to be more aware of our deepest
thoughts and emotions, so that we can choose to react to conflict in a wise
way.

4. Meditation helps you tolerate difficult emotions

Some people have a
misunderstanding that meditation somehow helps you get rid of all negative
emotions - after all, isn't that what enlightenment is?

The truth is, though,
that painful emotions like sadness, anger, and shame are part of being human. We
make things worse when we fight against these emotions or blame ourselves for
having them.

Instead of getting
caught up in the narratives of our emotions, we can learn to experience them
just as they are. Anger can feel like a tightness and burning of the chest.
Shame can be a flushed feeling of the face and churning feeling in the stomach. Meditation teaches us to experience these emotions without getting caught
up in the story.

Does Meditation really
work? What are the basic elements?

According to a
government survey, almost 1 in 10 adults use meditation each year to help them
cope with conditions such as anxiety, depression, pain, stress, insomnia, and
symptoms associated with chronic illness. It is believed that meditation can
improve the ability to focus attention and improve how we handle our emotions.
These improvements may have broader benefits for our daily lives including
personal relationships.

Researchers have linked
meditation to some beneficial changes in the human body. Some experts have
suggested that meditation may dampen down our body’s sympathetic nervous
system, the system responsible for our “fight or flight” response. There is
also continuing interest on how meditation can alter different parts of the
brain, although the answer remains unclear and research is ongoing.

The National Center for Complementary and Alternative Medicine, a federally funded research organization, suggests that there are several elements that are important when you are trying any type of meditation. These elements include finding a quiet location, a comfortable posture, being able to focus your attention, and having an open attitude to the experience.

Interested in learning
more about how meditation can help you lead a happier and more relaxed life?

Check out zenpsychiatry.com where Elana Miller, M.D., blogs about
integrative strategies to be happy, live well, and fulfill your greatest
potential. To get tips and helpful advice sent straight to your inbox, sign up
for her free newsletter.

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0 What You Should Know About Binge Eating Disorder: 3 Doctors Discuss

By Arshya Vahabzadeh, M.D. Follow @VahabzadehMD



Holly Peek, M.D., MPH Follow @PsychGumbo



Mona Amini, M.D., MBA Follow @MonAmiMD

What Causes Binge Eating Disorder? 

With up to 4 million Americans having binge eating disorder, it's a significant health issue for our nation.  Binge eating disorder has a wide variety of causes, and sometimes it can be caused by several different reasons, even in the same individual.

To understand why someone develops binge eating disorder, we need to recognize binging triggers. These triggers often result in binging behavior, and they are often negative feelings or thoughts toward body shape, weight, or food. Triggers to binging may also include worry, anxiety, difficult relationships with loved ones, or even boredom. Some people binge eat because it helps them numb these feelings in the short term. But later, they find the binge eating to be harmful to their own self-perception.

Sometimes dieting may be a major factor for binge eating. While dieting tends to happen after binge eating disorder has started, missing meals or not eating enough can lead to binging episodes. If left untreated, binging behaviors become more and more ingrained and harder to control.

Depression has also been linked to binge eating disorder. People who have depression or have been depressed in the past are more at risk. Binge eating is also higher in people who have bipolar disorder or anxiety disorder. Some evidence suggests that it may be more common in people who have addictions to recreational drugs.

Binge eating disorder may be more common in families where the condition is already present. Therefore it seems that our genetics are also an important factor to consider. Researchers continue to explore more scientific explanations on why binge eating disorder happens including studying the neurochemicals and pathways of the brain. 

How is Binge Eating Disorder Treated? 

The treatment goal for binge eating disorder focuses on binge eating and weight control. Treatment also addresses conditions that commonly occur with binge eating disorder, including depression, difficulty in work or relationships, and distortions in body image.

Treatment outcomes are generally good with psychological treatment often being more helpful than medication based management, although in some cases both are used. There is evidence that cognitive behavioral therapy (CBT), a type of talk therapy, is successful in treating binge eating disorder. Multiple research studies point to benefits with its use. CBT works by disrupting the “binge-diet cycle” by promoting healthy and structured eating patterns, improving body shape and weight concerns, and encouraging healthy weight-control behaviors.

Another type of talk therapy used in treatment is interpersonal psychotherapy (IPT). IPT helps people express and manage their negative feelings without turning to food to cope. Research shows that 20 sessions of CBT and IPT can provide improvements for more than 70% of people with binge eating disorder.

Reading self-help guides like Overcoming Binge Eating by Christopher Fairburn in combination with therapy sessions can also have substantial benefits.

Medications may also be used to ease binge eating disorder symptoms. Serotonin selective reuptake inhibitors (SSRIs), commonly used for anxiety and depression, have been found effective for reducing some binge eating disorder symptoms as well. SSRIs can help with depression often occurring in people with binge eating disorder. Continued research will examine how other medications, including anti-obesity medication and mood stabilizers, may also treat people suffering from binge eating disorder. 

What Should I Say to My Friend / Family Member Who is Suffering?

It is important to take the approach of talking to your loved one with serious intent. Though some people can overcome eating disorders, seeking professional help usually has more lasting positive results. In seeking the care of a professional, both the patient and his/her family benefit from the information presented by the doctor. The first step to talking to someone you care about who has an eating disorder may feel nearly impossible.

• Patience is key. Being patient and learning facts about eating disorders will guide you (and your loved one). Due to the complexity of binge-eating disorders, communicating your concerns regarding their eating habits and other behaviors will initiate a cumulative effect.


• Be prepared for a range of responses. Rejection, denial, anger, and shame are just some of the emotions that your loved one may express when you approach her/him for the first time.


• Avoid judgment, criticism, and simple solutions to disorder. Instead, you should provide encouragement and compassion regarding their feelings and relationships. Your concern and support may be enough for them to seek professional help but know that this is not guaranteed.


• Recognize binge eating may be just tip of the iceberg. Understanding that binge eating disorder, or any eating disorder, involves food and weight issues as mere symptoms of a deeper and more complex behavioral problem will help your loved one realize they need to acquire healthier coping tools.


• Know when to ask for assistance. Don't forget that health professionals can alleviate some of the imminent issues that may need to be treated before full recovery is possible. 

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0 Is It Time For A Timeout? 4 Tips For Managing Your Anger

By Uyen-Khanh Quang-Dang, M.D., M.S., Resident Psychiatrist, UCSF School of Medicine &

Arshya Vahabzadeh, M.D., Resident Psychiatrist, Emory University School of Medicine Follow @VahabzadehMD

When does anger become a problem?

Anger is an emotion that everyone experiences at some point in their life. Anger in and of itself is not a bad thing. Anger becomes a problem when the anger itself, or how we express the anger, causes problems in our lives. For example, anger can be felt too intensely, too frequently, or it can be expressed inappropriately, leading to harm to oneself or to others. Poorly managed anger can result in damage to our mental health, physical well-being, social relationships, and employment.

When we feel angry, the most important consideration is how we manage this emotion. In many cases, we may manage anger in a similar way to people around us. Many children learn how to deal with anger from observing their parents and other family members. The way that we respond to anger may also be as a result of what happens when we become angry; it may help us to get things that we want, thereby reinforcing our behavior. There are many practical strategies which may be adopted to help overcome problems with anger management. Here are four tips on how to deal with anger:

#1 Make a list of events or situations that trigger your anger. It can be a helpful perspective to notice that each of us get triggered by different things – while some of us may get outraged by an inconsiderate roommate who leaves dishes in the sink, others may instead fume while driving in congested traffic. Having a better awareness of triggering events will help you to better manage and possibly prevent your anger.

#2 Take a timeout. Timeouts aren’t just for kids – they are an essential anger management strategy that should be in everyone’s anger management “toolbox”. Basically, timeouts help us think instead of impulsively reacting in the heat of the moment. Timeout strategies can range from taking a few deep breaths and taking note of how your anger is experienced in your body, to leaving the situation that is causing the anger. You can have a pre-arranged agreement where any of the parties involved can call a timeout during an upsetting interaction and return to the conversation at a later point.

#3 Engage in Exercise! We all know that exercise is good for your physical health, but it’s also great for your mental and emotional health as well. Regular exercise can be an effective preventative anger management strategy. In addition to cardiovascular exercise, try yoga – either in live classes or through videos available on iPad apps and YouTube videos if live classes are too expensive.

#4 Use the A-B-C-D Model. The A-B-C-D Model (developed by Albert Ellis) helps us to change our underlying irrational beliefs that perpetuate our anger.

“A” stands for an activating event that triggers our anger.

“B” stands for our beliefs about the activating event. What do you tell yourself in reaction to the triggering event? What are your beliefs and expectations of others? For example, when a friend arrives late, you may tell yourself, “This friend is a bad friend. If he respected me, he wouldn’t be late. I can’t be friends with this person.”

“C” stands for consequences – emotional responses about the triggering event based on your self talk. For example, you may feel sadness or contempt.

“D” stands for dispute, where you examine your beliefs related to the event, identify any irrational beliefs, and dispute them with more rational or realistic ways of reacting to the activating event. The point of this model is to replace maladaptive self-statements that exacerbate anger with adaptive self-statements that reduce anger and help you have a more realistic reaction to the event.

While these tips may be helpful, you may need support from a counselor or mental health professional. Keep in mind that you don’t have to deal with anger all on your own. There are effective anger management therapies available in individual and group settings that can help you learn healthy ways of managing anger. 

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0 Depression in People with Parkinson’s Disease

By Dr Mizrab Khan MRCPsych Member of the Royal College of Psychiatrists, United Kingdom

Arshya Vahabzadeh, M.D. Resident Psychiatrist, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine Follow @VahabzadehMD

Since April is Parkinson’s Awareness Month, we wanted to discuss its connection to clinical depression.

Parkinson’s and Mental Health

Parkinson’s disease is a chronic and progressive neuropsychiatric condition that affects more than one million Americans, with over 60,000 people being diagnosed every year. People with Parkinson’s often develop physical symptoms such as tremors at rest, stiffness, and a general slowing of movement.

Today, there’s a better understanding of the psychiatric and mental health concerns of people with Parkinson’s disease. Parkinson’s disease affects several parts of the brain connected to control of mood. This may cause depression and other mental illnesses that harm the quality of life of people with Parkinson’s disease.

Depression in People with Parkinson’s

People with Parkinson’s disease often suffer from clinical depression (more than one third of individuals). Depressive symptoms include apathy as well as changes in sleep, appetite, and self-esteem. It’s far more than feeling sad or “blue” after being diagnosed with Parkinson’s. Studies show that clinical depression may even come before the development of physical symptoms of Parkinson’s. Becoming depressed is also thought to be independent of the physical symptoms, with some people with mild Parkinson’s developing severe mood symptoms. Detecting the depression may be more difficult in Parkinson’s disease because there’s an overlap between the signs of depression and the physical symptoms of Parkinson’s.

If someone with Parkinson’s disease is increasingly apathetic with changes in mood, sleep, appetite, or low self-esteem, then he or she should see a doctor for a psychiatric assessment. People with Parkinson’s are at a higher risk of suicidal thoughts and actions, so it’s important to pay close attention to these warning signs and seek a mental health evaluation.

Can Depression in Parkinson’s Disease be Treated?

Yes, just as depression can be treated for those without Parkinson’s, depression in people with Parkinson’s disease can be improved using both psychological and medication treatments. However, a personalized treatment plan should be created, and any antidepressant medication should be prescribed by a physician who is aware of the other medications that are commonly used in Parkinson’s disease. Ongoing research will help determine the best method to treat this depression.  

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0 What to expect for your first visit with your psychiatrist

By David Goldsmith, M.D., & Arshya Vahabzadeh, M.D. Follow @VahabzadehMD

Resident Psychiatrists, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine

Your Psychiatrist’s Training

A psychiatrist is a physician who is specially trained to diagnose and treat people who are experiencing a wide range of issues, from emotional distress to more severe mental health concerns. People may make their first appointment to visit a psychiatrist when they are having difficulties at work, in relationships, or even as a result of medical conditions. These patients could be experiencing many different symptoms including sadness, lack of energy, anxiety, or mood swings. Other symptoms could include problems with sleep, memory, or appetite. In some circumstances, the symptoms may be much more severe and include hallucinations or suicidal thoughts.

Following medical school, a psychiatrist must undergo at least four years of residency training. He/she will spend that time seeing a wide variety of patients with different psychiatric and medical issues. Some psychiatrists may have additional expertise like treating children or people suffering from drug addiction.

Psychiatrists learn to understand and diagnose complex mental illnesses, including schizophrenia, depression, bipolar disorder, and anxiety. As such, psychiatrists are trained to realize that talking about some issues is quite difficult, so they know how to work with patients who can become very emotional or anxious.

Your First Appointment

The first appointment with a psychiatrist is often an initial evaluation, or intake visit, when the psychiatrist will want to get to know you and what difficulties you are experiencing. These appointments may vary in length but are typically between 40-90 minutes. Your psychiatrist will ask you what kind of issues are concerning you, and how are they affecting your life?

You will be asked about a range of symptoms, and how you have tried to cope with them. Your psychiatrist will want to know about any medical conditions you have now or had in the past. He or she will want to know about past visits with mental health professionals. Many medical and psychiatric conditions may run in families, and usually the psychiatrist will ask you about your family’s health history. They will also ask you about your current medications, both for medical and psychiatric conditions.

Once your psychiatrist has asked you these questions, he or she will make a plan with you and may recommend that you see a particular specialist or have some laboratory tests. Your psychiatrist may suggest a style of talk therapy (psychotherapy) or in some instances, suggest a medication to help with your symptoms.

Your doctor will likely schedule another appointment, so that you can discuss how the treatment plan is going and whether your symptoms have improved. It is very important to ask questions about anything you may not understand, or why you are being prescribed a certain medication or type of therapy. Your psychiatrist will be more than happy to answer your questions and explain things to you in more detail.

Tips for Your First Visit

• Write down a list of symptoms that you have been having if you feel you may forget to mention them.


• Bring along any medical or mental health records that you believe are important.


• It may help to bring a list of your medications.


• You can ask a friend or family member to come to your appointment if you feel that they can provide a unique perspective and make you feel less anxious.


• Always feel free to ask questions about the diagnosis and about any treatments offered.

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0 Sleep Hygiene: 5 practical tips for more refreshing sleep

By Arshya Vahabzadeh, M.D. Follow @VahabzadehMD

Sleep is an essential part of our lives. Unfortunately, a growing number of Americans are not getting enough quality sleep. Some 70 million Americans have diagnosable chronic sleep problems. Key symptoms include reduced daytime alertness and disturbed sleep at night.

The effects of poor sleep can impact every aspect of our lives. Lack of sleep has been associated with problems at work, difficulties in relationships, medical and mental conditions, and an overall reduced quality of life. While some of these problems would benefit from a visit to your doctor, there are practical tips you can try for improved sleep. In this post on “sleep hygiene,” I discuss a useful set of practices for better sleep.

1. Resist coffee & other caffeinated drinks close to bedtime.

Caffeine is a stimulant and will keep you awake. Caffeine can be found in a range of products including coffee, tea, soft drinks, herbal supplements, and chocolate. Some people find it difficult to stop drinking coffee or soda. In that case, consider reduced or caffeine free versions. Also, drinking these products earlier in the day may reduce the effects of caffeine when it’s bedtime.

2. Don’t watch TV in bed.

Your body needs to associate your bed with sleep. Working, watching TV, or playing computer games in bed can disturb this association. This may lead to confusion for your body about what you want to do when you lie down in bed.

3. Keep your bedroom comfortable.

Make sure you have a suitable bed that’s comfortable; check the temperature of your bedroom; and remove any sources of bright lights or loud sounds. Bright lights close to bedtime can breakdown melatonin, a chemical which helps to regulate the sleep-wake cycle.

4. Exercise!

Being physically active or exercising can help to tire you out so you fall asleep more easily. But you should not do any strenuous exercise right before bedtime because this may be counterproductive. If you want to exercise close to bedtime, try something relaxing like yoga.

5. Establish a sleep routine & stick to it.

Go to bed and wake up at the same times every night and day. Avoid daytime naps or staying up late and sleeping in on weekends.

If you’ve tried these tips and still struggle with sleep, you should talk to your doctor. Depression and anxiety can cause disturbances in sleep. Your primary care physician or a psychiatrist can help find a solution.

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0 Safety Tips for Children with Autism Who Wander

By Arshya Vahabzadeh, M.D. Follow @VahabzadehMD

Resident Psychiatrist and Research Assistant, Emory & Marcus Autism Centers

With 1 in 88 children in the United States having autism, an increasing number of parents and caregivers face the challenges of caring for an autistic child. One of the most difficult areas is dealing with a child who repeatedly wanders away. This can be particularly dangerous for children with autism, as they may have little understanding of their own safety and have a limited ability to communicate to others for help.

Close to half of children with autism have attempted to wander away from a safe situation, and many parents report "near misses" that could have easily resulted in their child drowning or being injured by a vehicle. Sadly, injuries to children with autism are all too common.

In this post, I'll share several ways to help keep your child with autism safe when dealing with wandering behavior.

Understand what causes your child to wander away

This is much easier said than done! Look for subtle clues in their environment. Is the wandering / running aimed at going towards something your child is interested in, like a toy or place; or is your child escaping from situations like a room with many people, a loud TV, or something which is unfamiliar to them? Also look at the response of other people to the behavior -- if wandering / running away results in your child getting something he or she wants, like a candy bar, then this "rewarding" may cause the behavior to happen again.

Increase awareness and identification

Other family members and neighbors should know to get help if they see your unaccompanied child wandering. Some parents give their children medical ID bracelets or plastic wristbands with their child's information and condition. Parents may also use monitoring devices for their child like a personal GPS tracking device.

Keep the house safe

Many parents invest in extra locks and safety latches for the house. Some install window locks and have fencing around their yards. Especially important, because of the risk of drowning, pools and other water containing structures should be fenced or emptied if possible.

Talk to the school and local police

Make school staff aware of your child's risk for wandering or running away so they can keep a closer eye on your child. If possible, attend field trips or make a special plan with the school. Informing local police about your child's condition makes it easier for them to take action if they see him or her walking around unaccompanied. You should carry around a recent photo of your child and pay close attention to what your child is wearing on a daily basis in case you need to describe his or her clothing to a third party.

Sleep is important too

Parents often worry about what could happen to their child when they are asleep. This may be a bigger problem if their child is staying awake during the night. Decreasing the amount of caffeine your child drinks can help. Setting a sleep routine and avoiding daytime napping may also be useful. Sleeping disorders are common among children with autism. If your child's sleep continues to be a problem, talk to your family doctor or see a specialist.

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