New Program Helps Mental Health Patients Stop Smoking By Rick Nauert PhD

Experts say that tobacco use among mental health patients account for nearly half of all cigarettes consumed in the United States.

A program developed by the division of addiction psychiatry at the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School to address this addiction has received national recognition by the American Psychiatric Association (APA).

The program, called CHOICES – Consumers Helping Others Improve Their Condition by Ending Smoking – utilizes peer counselors to promote smoking cessation in mentally ill patients.

The counselors, who receive 30 hours of intensive training, are nonsmokers or former smokers who are moderately impaired or disabled by mental illness.

Their goal is not to provide treatment, but to assist smoking patients who are in mental health centers, psychiatric hospitals, group homes and self-help centers, by linking them to treatment, referrals, advocacy and support for smoking cessation in New Jersey.

“Peers are less threatening than professionals,” said Jill Williams, MD, associate professor of psychiatry at Robert Wood Johnson Medical School and co-founder and medical director of the program.

“CHOICES symbolizes empowerment and personal choice in recovery by involving persons with mental illness talking with peers with mental illness who smoke, and who may have low motivation to address their tobacco use.”

A salient feature of the CHOICES program is the unique peer-to-peer approach to promoting tobacco cessation.

In the October issue of its journal Psychiatric Services, the APA said, “The CHOICES program exemplifies many aspects of a successful wellness and recovery initiative. For example, it targets a group with a vital health care need; seeks to reduce tobacco’s harm in a vulnerable group; focuses its efforts in the community, which best accommodates the target population; employs peers to reduce educational and cultural barriers; and develops successful partnerships with key stakeholders for sustainability.”

According to Dr. Williams and co-founder Marie Verna, the program’s advocacy director and senior training and consultation specialist at UMDNJ-University Behavioral HealthCare’s Center for Excellence in Psychiatry, the CHOICES team has conducted more than 280 community visits, reaching more than 9,600 smokers with mental illness, since the program’s inception in 2005. The team also visits consumer conferences and health-related fairs.

An outcome study of the program showed success at reducing the number of cigarettes smoked by consumers each day and an increase in the number of quit attempts following individualized intervention.

Program participants reported that within six months after meeting with a peer counselor, they had talked to their mental health provider about getting help with quitting smoking. Patients also reported that peer counselors were extremely knowledgeable about tobacco and interested in their smoking. Seventy percent of those surveyed said that talking to a peer about their smoking was much easier than talking to a mental health professional.

Peer counselors also reported improvements of their own recoveries from mental illness as a result of participating in CHOICES. They reported on the achievement of personal milestones including participation in publications and conferences on wellness and recovery, and pursuing additional formal education.

Source: >Robert Wood Johnson Medical School

Depression: The thief that took my joy

By Christine Stapleton

On my bedside table there are stacks of books, most on depression. On the table next to my beside table, there are stacks of book, most on depression. I have not read any of them. Sometimes I read a few pages from one. Then I put it back on the stack.

I did not buy these books. My friends gave them to me. I appreciate every one of those books. Each book represents someone trying to help me. I am grateful and touched by each book. That is why I keep them on my beside table and the table beside my bedside table.

The oddity of this struck me upside the head yesterday. I accepted an invitation to have lunch with a group of journalists to discuss the fate future of journalism. Someone asked me about writers who have influenced me. I easily named other hard-core news journalists whose work I admire. But mental health writers, I could only think of one: Sylvia Plath - my teenage role model)

It is not because there are no good writers writing about their struggle with mental illness. I mean, William Styron was a brilliant writer. But I only read a couple dozen pages of his classic, Darkness Visible, and then put it down. I haven’t even cracked Kay Jamison’s An Unquiet Mind or Noral Vincent’s Voluntary Madness. I really should read these books. I really want to read these books. I can’t seem to do it.

I don’t want to read about another person’s misery right now. Been there. Done that. Don’t want to read about it. Believe me, I get the irony. Using my own logic, why would anyone want to read my writing? Good question.

I know this: I could not read or write - two of my greatest passions - when I was depressed and that scared the hell out of me. I could not read the newspaper I had been writing for over 20 years. I asked over and over, “It’s going to come back, right? I’m going to be able to read and write again, right?”

“Yes,” my therapist and nurse practitioner assured me. It did, but it took awhile. At first I could read only short, simple stories in the newspaper. Then magazines. Then books. Then I wrote and wrote and wrote. When I decided to write a column on mental health policy and my own experience with depression, bipolar and alcoholism, I wrote from my illness: little words, short sentences, simple thoughts. No long articles. Short columns, digestible thoughts. That is all I could handle when I was sick. That is all I wanted to write.

For all I know Styron, Jamison and Vincent write this way, too. It would do me good to read them. Still, I just can’t seem to do it yet. Someday I will. In the meantime, I’ll stick with journal articles about treatment and research, news events involving mental illness and an occasional movie - like A Beautiful Mind.

I am going to keep these books on my bedside table. They inspire me just sitting there. And they are starting to embarrass me, too. I think it’s time to try again. If I am not ready, I’ll just keep coming back. They’re not going anywhere.

Christine Stapleton has been a reporter for The Palm Beach Post for 23 years and in 2006, began writing a column entitled, Kicking Depression.

9 Myths of Bipolar Disorder by John M Grohol PsyD

Bipolar disorder has been the focus of attention in recent years, as a new slew of psychiatric medications have been developed to help treat it. Such medications drive pharmaceutical marketing and increased educational efforts surrounding bipolar disorder (for better or worse).

But many myths surround bipolar disorder — what it is, what it means, and how it’s treated. Here’s to busting a few of the most common ones.

1. Bipolar disorder means I’m really “crazy.”

While bipolar disorder is a serious mental disorder, it is no more serious than most other mental disorders. Having a mental disorder doesn’t mean you’re “crazy,” it just means you have a concern that is negatively impacting how you live your life. Left unaddressed, this concern can cause a person significant distress and problems in their relationships and life.

2. Bipolar disorder is a medical disease, just like diabetes.

While some marketing propaganda might simplify bipolar disorder into a medical disease, bipolar disorder is not — according to our knowledge and science at this time — a medical disease. It is a complex disorder (called a mental disorder or mental illness ) that reflects its basis in psychological, social, and biological roots. While it has significant neurobiological and genetic components, it is no more of a pure medical disease than ADHD or any other mental disorder. Treatment of bipolar disorder that focuses solely on its “medical” components often results in failure.

3. Manic depression is different than bipolar disorder.

Manic depression is simply the old name for bipolar disorder. The name was changed to more accurately describe the type of mood disorder it is — someone who experiences swings between two poles of mood (or emotion). Those two poles are mania and depression.

4. I’ll have to be on medications for the rest of my life.

While the default assumption by most mental health professionals is that most people with bipolar disorder will need to be on medications for the rest of your life, nobody can predict how exactly you, as an individual, will react to such medications or what the future holds for your specific needs. So it is a myth to say that all people with bipolar disorder will absolutely be on medications for the rest of their lives. As many people age with this disorder, they find their swings between mania and depression lessen significantly, and the need for medication may decrease, and may even be discontinued without any harmful repercussions.

5. I’m feeling better since taking my medications, which means I probably don’t need them any more, right?

Wrong. Once a person starts feeling better because of the medication, they often discontinue taking the medication, leading to an eventual relapse. This is a common problem in the treatment of bipolar disorder and is something professionals like to call “treatment compliance.” This is just a fancy way of saying that a person needs to continue taking their medication as prescribed, no matter how good they may be feeling. It is perhaps one of the most insidious issues in the treatment of bipolar disorder, and leads many people to greater distress than if they just kept taking their medications.

6. There’s no need for psychotherapy in bipolar disorder.

This varies from person to person (just as the need for taking medications does), but this is a myth insomuch that many people and professionals believe that psychotherapy doesn’t help much in the treatment of bipolar disorder. Psychotherapy can be very helpful and effective in the treatment of bipolar disorder, since medications alone can’t teach a person new coping skills or how to deal with feelings of an impending manic or depressive episode. Psychotherapy can help a person with bipolar disorder learn to live with the disorder in their lives without as much stress or upset. While many people with bipolar disorder forgo psychotherapy, it is usually a helpful treatment to consider when first diagnosed.

7. Atypical antipsychotics are only for schizophrenia.

In the U.S. in 1990, a new class of medications was introduced called “atypical antipsychotics.” These newer medications are not used to treat only psychosis (such as that found in schizophrenia), but also a wider range of psychiatric symptoms. One of their approved uses is in the treatment of bipolar disorder in adults. They may also be approved in short time for use in teenagers and children 10 years and older (although they are already sometimes prescribed by doctors for “off label use” in teens and children). So don’t let the name of the class of medications fool you — they treat far more than just psychosis.

8. Atypical antipsychotics have little to no side effects.

Atypical antipsychotics are often the primary drug doctors use to treat bipolar disorder. In the U.S., the Food and Drug Administration has determined that such drugs are both safe and effective for this use. However, like all medications, atypical antipsychotics have their own set of risks and side effects.

These medications have a different side effect profile than the medications they replace. While initially marketed as a “better” side effect profile, research since 1990 has shown that the side effects they do produce in many people can be just as worrisome as older medications. Chief among the typical side effects are weight gain and metabolism problems, which can be precursors to type 2 diabetes, increased risk of stroke, and heart problems (including an increase in cardiac arrhythmias which can lead to sudden death).

9. I may just have depression.

Many times, bipolar disorder mimics clinical depression, because one of the primary symptoms of bipolar disorder is clinical depression. Up to 25 percent of people who have bipolar disorder are initially misdiagnosed with depression. Why does this occur? Because many people first go to their primary doctor for a diagnosis, and primary doctors do not always ask enough questions to make the proper diagnosis. This can occur with mental health professionals who also fail to probe enough when a person presents with clinical depression in their office.

An incorrect initial diagnosis can lead to incorrect treatment, such as the prescription of antidepressant. Generally, antidepressants are not used in the treatment of bipolar disorder, and in fact, can make the disorder worse in the person. So if you’ve ever had an episode of increased energy for no particular reason (not because you just drank a liter of Coke), make sure you share that information with your mental health professional.

Want to learn more?
Stay up-to-date on the latest bipolar news, research, information and opinions over at our bipolar blog, Bipolar Beat!

Dr. John Grohol is the CEO and founder of Psych Central. He has been writing about online behavior, mental health and psychology issues, and the intersection of technology and psychology since 1992.

Helping Yourself with Depression Help

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If you're currently feeling so out of it, totally out of your normal system and just basically hating and ignoring almost, always everything and anyone that comes along, try to get yourself checked by a psychiatrist because you those little mood swings and erratic Ally McBeal-ish behavior that you're trying to ignore for some long may actually be symptoms of depression. Act fast because if you do, it'll certainly be a lot harder for you to be able to have yourself cured from this illness, especially once self-delusion starts to kick in.

Actually start by hauling your depressed ass into the hospital and get yourself diagnosed by a reputable psychiatrist, one that'll actually help you with your depression concerns, answer all the possible questions that you may have when it comes to depression as well as provide you with the best available to depression treatment that'll make you give yourself some good-old, yet extremly effective depression help. All it needs is the right attitude.

After actually being honest with yourself when it comes to actually being a patient who is suffering from depression, quit turning yourself into a victim and find out from these various types of depression the actual one that you're suffering from: Manic or Bipolar depression - characterized by sudden and extreme changes in one's mood wherein one minute he or she is in an elevated state of euphoria while the next minute (day or week) he or she is feeling to be in a personal hell, Postpartum depression - characterized by a prolonged sadness and a feeling of emptiness by a new mother wherein physical stress during child birth, an uncertain sense of responsibility towards the new born baby can be just some of the possible factors why some new mother go through this, Dysthimia - characterized by a slight similarity with depression, although this time, it's been proven to be a lot less severe, but of course with any case, should be treated immediately, Cyclothemia - characterized by a slight similarity with Manic or Bipolar depression wherein the individual suffering from this mental illness may occasionally suffer from severe changes in one's moods, Seasonal Affective Disorder - characterized by falling in a rut only during specific seasons (i.e. Winter, Spring, Summer or Fall) studies however, prove that more people actually fall in to a rut more during the Winter and Fall seasons and lastly, Mood swings, wherein a person's mood may shift from happy to sad to angry in just a short time. But in spite of how scary or how daunting a task is the road towards a sound mental health is, depression help abounds and is just up to you if you’re willing to take in some of that depression help, may it be from your family, friends, support group and mainly starting from yourself, there really is a lot of depression help to go around.

The old adage, slowly but surely greatly applies in trying to treat depression, as the patient continues taking the prescribed medicines for his/her depression treatment, as well as the corresponding therapy sessions with the cognitive behavior therapist, a patient being treated from depression needs all the support and depression help that he or she can get.

While being treated for depression, the patient as well as his or her family and other loved ones are advised to make realistic goals concerning depression wherein, to not assume that their depression can be easily treated in a snap. Depression help begins with trying to understand the patient’s situation and continue on being patient as well as always extending your help because depression help is never easy nor is the depression treatment itself, which is why both patients and loved ones need to help each other out through every step of the way. Never set goals that are high above your reach, give yourself some depression help by not being too hard on yourself, believe that you are good and strong enough to achieve your goals but only one step at a time.

Timothy Kendrick International

The Myth of Chronic Anxiety: "Disorder" — Or Evidence That Your Brain Works Fine? By Robert Mantell, Ph.D., C.M.Ht.

The Myth of Chronic Anxiety: "Disorder" — Or Evidence That Your Brain Works Fine?
By Robert Mantell, Ph.D., C.M.Ht.

Phobias.
Panic attacks.
Agoraphobia.
Post-traumatic stress.
Obsessive-Compulsive Disorder.
Social Phobia.

Pretty scary sounding stuff for most of us. And even more scary if you are among the 1 in every 12 Americans who suffers with some form of chronic anxiety problem serious enough to seek professional help.

When a person finds him or herself experiencing disturbing levels of anxiety too often, the first thing most people do is open the Yellow Pages and start looking around for a counselor or psychotherapist. Upon a first meeting, the well-meaning therapist listens, takes notes, looks for emotional and behavioral patterns, and armed with that information, consults a professional manual known as The Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-IV).

Based on the presence of one or more prescribed elements therein, the therapist develops a diagnosis of one or more mental disorders to explain what's "wrong" with you. And, of course, once you've been diagnosed, the therapist uses the totality of his or her knowledge base and experience to attempt to help you "recover".

Depending on the branch of medical or psychological help consulted, the doctor or therapist may choose to begin individual or group psychotherapy. Many purported specialists in the field of anxiety treatment may go a step further in utilizing an approach called Cognitive-Behavioral Therapy (or CBT), currently considered the "state-of-the-art" in anxiety treatment. Using a process known as progressive desensitization (also called graduated exposure therapy), or in its most protracted form, flooding, this approach often requires the patient to endure extended periods of direct exposure to their feared stimulus. Many such specialists will suggest or prescribe medications such as Xanax, Paxil, Klonopin, Celexa, Zoloft and others to augment the psychological interventions being employed.

* * * *

How exactly the therapist attempts to "cure" such a person is not the point of this article. The fact that he or she is even attempting to cure something that he or she thinks is "wrong" with you and needs to be "cured" is the point.

You see, I have questions about whether or not the presence of chronic, even debilitating anxiety — or any other emotional or behavioral problems, for that matter — are truly evidence that a mental disease or disorder is present in the first place.

Don't get me wrong — I know that people with these kinds of problems are feeling ways they don't want to be feeling, and/or behaving in ways they don't want to be behaving — and that, ostensibly, they've sought professional assistance in alleviating their symptoms because they can't seem to help it.

But is that evidence that there's something actually wrong with the person? That they have a mental disease or a mental disorder? I don't know.

You see, when you take the time to carefully examine a person's history, almost without fail, you begin to see how the presence of anxiety-related symptoms in a person's life could actually make a lot of sense.

Let me tell you what I mean by this.

I believe the brain has a positive intent for everything it does — everything — including causing a person to experience chronic and debilitating forms of anxiety such as phobias, panic attacks, post-traumatic stress, agoraphobia, social phobia, and OCD. (By the way, I believe this notion extends to emotional problems that most would consider even psychotic by nature, including schizophrenia, bipolar disorder, and so forth.)

I believe the positive intent on the part of the subconscious mind for objectifying any chronic emotional or behavioral symptoms in a person's life is simply to protect that person from pain — specifically, the same kind of pain they experienced earlier on in life, usually (but not always) in childhood. Thus, the positive purpose for the presence of the various expressions of anxiety in a person's life is to act as a kind of protective barrier, if you will, from the kinds of situations, circumstances, people or things the brain greatly fears will lead to pain, based on past experience.

From this standpoint, the presence of clinical anxiety could be considered a useful, and even a healthy response.

LET'S TAKE AN EXAMPLE

Suppose Lisa has been a little too busy, with too much on her plate, and has not paid nearly enough attention to creating balance in her life. Over the preceding weeks, months or even years, Lisa has been plagued with chronic psychosomatic symptoms such as headaches, backaches, tight muscles, stomach cramps, and so forth. These kinds of psychosomatic symptoms, by the way, are often the brain's "signal" — it's calling card, if you will — that one has organized their life in such a way that it is terribly out of balance, and requires some serious balancing now!

Because the brain does not speak English, Lisa doesn't get what's really going on here — the message being delivered from her subconscious mind by way of these physical symptoms: "Mellow out, slow down... Stop working so hard, so often. Slow it down for awhile and smell the roses for a change! If you don't, I'll soon be unable to manage all the stress you're creating, and eventually I won't be able to keep it suppressed any longer!"

Suppose Lisa doesn't get the message being offered by her subconscious mind, and eventually, sure enough, all that pent-up stress finally boils over. This is called a panic attack, folks.

And suppose Lisa unexpectedly experiences this panic attack while she's in the car driving. If you've never had a panic attack, I can tell you that it usually comes upon a person for the first time seemingly from out of nowhere — often at the most unexpected times, and in the most unexpected places. I can also tell you that the experience of a full-blown panic attack is extremely fear-provoking, often causing a person to imagine that he/she is losing her mind, or perhaps that he or she may even be having a heart attack! Yup... Scary stuff, for sure.

REMEMBER PSYCHOLOGY 101? LET'S REVIEW CLASSICAL CONDITIONING

Recall that the brain's “prime directive”, if you will, is to protect the person from pain in any way possible. One of the ways the brain does this is to link fear with whatever's going on in the environment when the person is in such distressed state. Utilizing a well-known learning process called classical conditioning, the person's brain makes a mental note (sort of like a taking a mental snapshot) of what exactly was going on in the person's environment when he/she was so terribly uncomfortable.

This kind of powerful neuro-associative pairing is so deeply ingrained, that days, weeks, months or even years could go by before the person may find him or herself in a similar situation or context, and when they do, BAM! The person goes right back into the same kind of traumatized state they experienced the first time they encountered the fear-provoking situation.

Thus, now, whenever this person even THINKS about returning to the same kind of environment wherein she experienced the original trauma, she experiences great fear and will (for example) avoid the actual experience of getting back in the car and driving at almost all costs.

Why? Because fear is the brain's most effective tool for keeping a person away from things that could potentially cause the same kind of intense pain they experienced earlier in life. Well, if once upon a time a person had experienced great pain in a particular situation or circumstance, now, whenever the person so much as thinks about being in such a situation, he/she experiences tremendous anxiety.

In the example of Lisa's panic attack in the car, because that experience was so terribly upsetting, her brain linked up pain with the idea of being back in the car. Now, every time she thinks about what it would be like to be driving (essentially mentally recreating the same conditions that were present in the earlier painful experience), she experiences intense anxiety. The positive purpose for the brain's objectifying that tremendous fear is to protect Lisa from possibly returning to the same sort of context that led to great pain for her in the past.

This fear is what some people would now think of as a phobia to driving.

(Ever drink too much whisky, wine or beer, and get very, very sick?? if so, I'm willing to bet that now, whenever you so much as THINK of that substance, you can feel yourself getting sick. In a not so dissimilar way, your aversion to that substance can be thought of as a kind of "phobia" to it.)

And even though the ongoing fear of driving may not necessarily be a desirable mental "program" to maintain over time, the fact is, considering this person's past, this fear — this phobia — seems to make a lot of sense, doesn't it? In fact, this phobic behavior could even be considered healthy, reasonable and biologically adaptive — hardly justification to diagnose someone with this kind of problem as mentally ill, with a phobic “disorder” of some kind!

AN ALTERNATIVE APPROACH TO THE RESOLUTION OF CLINICAL ANXIETY

Rather than treat this kind of challenge as evidence of a mental disease, as though something is truly psychologically "wrong" with the person, we find it preferable to view this person's anxiety-related symptoms as nothing more than the brain's best strategy — the brain's best self-defense mechanism, if you will — to keep a person out of the same kind of intense pain they had when they were younger. And fascinatingly, it's almost always effective! It's ingenious, in fact. (In fact, if it weren't effective, the brain wouldn't continue to invest energy in maintenance of the behavior — the anxiety symptom would disappear, all on its own.)

Thus, rather than try to “fix” something that is regarded as wrong with the person, we believe that the anxiety-related behavior simply requires to be recognized first by the subconscious mind as an old and outdated strategy for protection, and then released when the brain comes to understand that it is no longer necessary to be maintained as a protective mechanism. And because the brain works on something called the Principle of Economy of Effort (more on this later in another article), the brain will be only too glad to stop wasting energy on maintenance of a behavior that it finds is not worth the investment.

For example, although the response may have made a lot of sense when the person was younger, the brain may come to understand that it's probably OK to let the behavior go at this point because, chances are, the person is now bigger, better, stronger and faster then they ever were when they were younger. And they are probably in possession of far greater resources now, should they encounter the same kind of troublesome situation, than they ever could have brought to bear in their younger years due to their relative inexperience at the time.

There are many ways to communicate and demonstrate this to the person's subconscious mind. These brief therapeutic treatment modalities range from hypnosis, to direct behavioral intervention, to outright disruption of a person's mental “recipe” for creating their age-old anxiety-related response.

Regardless of the specific method used to make the change, the bottom line is that when a person learns to perceive differently whatever they used to fear, they can't help but feel, and therefore respond, differently to it.

Is it really appropriate to think of this as "fixing" what's gone mentally wrong with a person?

We prefer to assign no more meaning to it than simply the process of helping our client to change a behavior that clearly doesn't work for them. This approach is more congruent with how we like to think of our clients. We like to think of our clients as individuals who are simply doing the very best they can at any given moment in time with the resources they have available to them. We feel our job is merely to assist our clients to gain access to greater and more powerful resources, and in the process, enjoy greater behavioral choice and flexibility in the old, formerly troublesome contexts.


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Dr. Robert Mantell is the Founder and Executive Director of BrightLife Phobia and Anxiety Release Center

Brought to you by Timothy Kendrick International