Why Men and Teenage Boys Avoid Seeking Help for Their Stress

Why Men and Teenage Boys Avoid Seeking Help for Their Stress

In our society people do not discuss mental health and it is something people feel embarrassed about. They also feel shame if they have mental health issues or if they go to a psychotherapist. However, our lives have become very complex and difficult, especially for children and teenagers. Besides coping with everyday life issues, we now face mass shootings and killings on a regular basis. Technology is advancing very quickly and the way we do things is changing very quickly too. As soon as we learn one thing, there is a new way to do the task that we need to learn. This makes our lives stressful and creates anxiety.

While we have this negative stigma about mental health, teenagers worry about it a great deal. Especially since 1 out of 5 teenagers deal with mental health issue. As a psychotherapist who treats teenagers, I see a large number of teens for panic attacks especially boys. I believe teenage boys are more prone to anxiety attacks because of the stereotype that boys don’t cry and they see emotions as weak. However, in our society men do cry and have emotional problems. Emotions are not a sign of weakness for men and boys. The documentary, “The Mask You Live In,” address this issue that men and boys face. I recently read an article by the basketball player, Kevin Love, which addresses this issue and explains how it impacts men and boys. I have included what he wrote so you can understand what men and boys face in our society.

On November 5th, right after halftime against the Hawks, I had a panic attack.

It came out of nowhere. I’d never had one before. I didn’t even know if they were real. But it was real — as real as a broken hand or a sprained ankle. Since that day, almost everything about the way I think about my mental health has changed.

“I DID ONE SEEMINGLY LITTLE THING THAT TURNED OUT TO BE A BIG THING.”

Kevin Love discusses his decision to seek help after suffering from a panic attack. (0:54)

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I’ve never been comfortable sharing much about myself. I turned 29 in September and for pretty much 29 years of my life I have been protective about anything and everything in my inner life. I was comfortable talking about basketball — but that came natural. It was much harder to share personal stuff, and looking back now I know I could have really benefited from having someone to talk to over the years. But I didn’t share — not to my family, not to my best friends, not in public. Today, I’ve realized I need to change that. I want to share some of my thoughts about my panic attack and what’s happened since. If you’re suffering silently like I was, then you know how it can feel like nobody really gets it. Partly, I want to do it for me, but mostly, I want to do it because people don’t talk about mental health enough. And men and boys are probably the farthest behind.

I know it from experience. Growing up, you figure out really quickly how a boy is supposed to act. You learn what it takes to “be a man.” It’s like a playbook: Be strong. Don’t talk about your feelings. Get through it on your own. So for 29 years of my life, I followed that playbook. And look, I’m probably not telling you anything new here. These values about men and toughness are so ordinary that they’re everywhere … and invisible at the same time, surrounding us like air or water. They’re a lot like depression or anxiety in that way.

So for 29 years, I thought about mental health as someone else’s problem. Sure, I knew on some level that some people benefited from asking for help or opening up. I just never thought it was for me. To me, it was form of weakness that could derail my success in sports or make me seem weird or different.

PHOTO BY CHRISTIAN PETERSEN/GETTY IMAGES

Then came the panic attack.

It happened during a game.

It was November 5th, two months and three days after I turned 29. We were at home against the Hawks — 10th game of the season. A perfect storm of things was about to collide. I was stressed about issues I’d been having with my family. I wasn’t sleeping well. On the court, I think the expectations for the season, combined with our 4–5 start, were weighing on me.

I knew something was wrong almost right after tip-off.

I was winded within the first few possessions. That was strange. And my game was just off. I played 15 minutes of the first half and made one basket and two free throws.

After halftime, it all hit the fan. Coach Lue called a timeout in the third quarter. When I got to the bench, I felt my heart racing faster than usual. Then I was having trouble catching my breath. It’s hard to describe, but everything was spinning, like my brain was trying to climb out of my head. The air felt thick and heavy. My mouth was like chalk. I remember our assistant coach yelling something about a defensive set. I nodded, but I didn’t hear much of what he said. By that point, I was freaking out. When I got up to walk out of the huddle, I knew I couldn’t reenter the game — like, literally couldn’t do it physically.

Coach Lue came up to me. I think he could sense something was wrong. I blurted something like, “I’ll be right back,” and I ran back to the locker room. I was running from room to room, like I was looking for something I couldn’t find. Really I was just hoping my heart would stop racing. It was like my body was trying to say to me, You’re about to die. I ended up on the floor in the training room, lying on my back, trying to get enough air to breathe.

The next part was a blur. Someone from the Cavs accompanied me to the Cleveland Clinic. They ran a bunch of tests. Everything seemed to check out, which was a relief. But I remember leaving the hospital thinking, Wait … then what the hell just happened?

PHOTO BY JED JACOBSOHN/THE PLAYERS’ TRIBUNE

I was back for our next game against the Bucks two days later. We won, and I had 32. I remember how relieved I was to be back on the court and feeling more like myself. But I distinctly remember being more relieved than anything that nobody had found out why I had left the game against Atlanta. A few people in the organization knew, sure, but most people didn’t and no one had written about it.

A few more days passed. Things were going great on the court, but something was weighing on me.

Why was I so concerned with people finding out?

It was a wake-up call, that moment. I’d thought the hardest part was over after I had the panic attack. It was the opposite. Now I was left wondering why it happened — and why I didn’t want to talk about it.

Call it a stigma or call it fear or insecurity — you can call it a number of things — but what I was worried about wasn’t just my own inner struggles but how difficult it was to talk about them. I didn’t want people to perceive me as somehow less reliable as a teammate, and it all went back to the playbook I’d learned growing up.

This was new territory for me, and it was pretty confusing. But I was certain about one thing: I couldn’t bury what had happened and try to move forward. As much as part of me wanted to, I couldn’t allow myself to dismiss the panic attack and everything underneath it. I didn’t want to have to deal with everything sometime in the future, when it might be worse. I knew that much.

So I did one seemingly little thing that turned out to be a big thing. The Cavs helped me find a therapist, and I set up an appointment. I gotta stop right here and just say: I’m the last person who’d have thought I’d be seeing a therapist. I remember when I was two or three years into the league, a friend asked me why NBA players didn’t see therapists. I scoffed at the idea. No way any of us is gonna talk to someone. I was 20 or 21 years old, and I’d grown up around basketball. And on basketball teams? Nobody talked about what they were struggling with on the inside. I remember thinking, What are my problems? I’m healthy. I play basketball for a living. What do I have to worry about? I’d never heard of any pro athlete talking about mental health, and I didn’t want to be the only one. I didn’t want to look weak. Honestly, I just didn’t think I needed it. It’s like the playbook said — figure it out on your own, like everyone else around me always had.

PHOTO BY JEFF HAYNES/NBAE/GETTY IMAGES

But it’s kind of strange when you think about it. In the NBA, you have trained professionals to fine-tune your life in so many areas. Coaches, trainers and nutritionists have had a presence in my life for years. But none of those people could help me in the way I needed when I was lying on the floor struggling to breathe.

Still, I went to my first appointment with the therapist with some skepticism. I had one foot out the door. But he surprised me. For one thing, basketball wasn’t the main focus. He had a sense that the NBA wasn’t the main reason I was there that day, which turned out to be refreshing. Instead, we talked about a range of non-basketball things, and I realized how many issues come from places that you may not realize until you really look into them. I think it’s easy to assume we know ourselves, but once you peel back the layers it’s amazing how much there is to still discover.

A message from Kevin Love’s Grandma

“HAPPY BIRTHDAY, KEVIN.”

Kevin’s grandmother records a greeting for his 25th birthday in 2013. (0:33)

Since then, we’ve met up whenever I was back in town, probably a few times each month. One of the biggest breakthroughs happened one day in December when we got to talking about my Grandma Carol. She was the pillar of our family. Growing up, she lived with us, and in a lot of ways she was like another parent to me and my brother and sister. She was the woman who had a shrine to each of her grandkids in her room — pictures, awards, letters pinned up on the wall. And she was someone with simple values that I admired. It was funny, I once gave her a random pair of new Nikes, and she was so blown away that she called me to say thank you a handful of times over the year that followed.

When I made the NBA, she was getting older, and I didn’t see her as often as I used to. During my sixth year with the T-Wolves, Grandma Carol made plans to visit me in Minnesota for Thanksgiving. Then right before the trip, she was hospitalized for an issue with her arteries. She had to cancel her trip. Then her condition got worse quickly, and she fell into a coma. A few days later, she was gone.

I was devastated for a long time. But I hadn’t really ever talked about it. Telling a stranger about my grandma made me see how much pain it was still causing me. Digging into it, I realized that what hurt most was not being able to say a proper goodbye. I’d never had a chance to really grieve, and I felt terrible that I hadn’t been in better touch with her in her last years. But I had buried those emotions since her passing and said to myself, I have to focus on basketball. I’ll deal with it later. Be a man.

The reason I’m telling you about my grandma isn’t really even about her. I still miss her a ton and I’m probably still grieving in a way, but I wanted to share that story because of how eye-opening it was to talk about it. In the short time I’ve been meeting with the therapist, I’ve seen the power of saying things out loud in a setting like that. And it’s not some magical process. It’s terrifying and awkward and hard, at least in my experience so far. I know you don’t just get rid of problems by talking about them, but I’ve learned that over time maybe you can better understand them and make them more manageable. Look, I’m not saying, Everyone go see a therapist. The biggest lesson for me since November wasn’t about a therapist — it was about confronting the fact that I needed help.

PHOTO BY BRANDON DILL/AP IMAGES

One of the reasons I wanted to write this comes from reading DeMar’s comments last week about depression. I’ve played against DeMar for years, but I never could’ve guessed that he was struggling with anything. It really makes you think about how we are all walking around with experiences and struggles — all kinds of things — and we sometimes think we’re the only ones going through them. The reality is that we probably have a lot in common with what our friends and colleagues and neighbors are dealing with. So I’m not saying everyone should share all their deepest secrets — not everything should be public and it’s every person’s choice. But creating a better environment for talking about mental health … that’s where we need to get to.

Because just by sharing what he shared, DeMar probably helped some people — and maybe a lot more people than we know — feel like they aren’t crazy or weird to be struggling with depression. His comments helped take some power away from that stigma, and I think that’s where the hope is.

I want to make it clear that I don’t have things figured out about all of this. I’m just starting to do the hard work of getting to know myself. For 29 years, I avoided that. Now, I’m trying to be truthful with myself. I’m trying to be good to the people in my life. I’m trying to face the uncomfortable stuff in life while also enjoying, and being grateful for, the good stuff. I’m trying to embrace it all, the good, bad and ugly.

I want to end with something I’m trying to remind myself about these days: Everyone is going through something that we can’t see.

I want to write that again: Everyone is going through something that we can’t see.

The thing is, because we can’t see it, we don’t know who’s going through what and we don’t know when and we don’t always know why. Mental health is an invisible thing, but it touches all of us at some point or another. It’s part of life. Like DeMar said, “You never know what that person is going through.”

Mental health isn’t just an athlete thing. What you do for a living doesn’t have to define who you are. This is an everyone thing. No matter what our circumstances, we’re all carrying around things that hurt — and they can hurt us if we keep them buried inside. Not talking about our inner lives robs us of really getting to know ourselves and robs us of the chance to reach out to others in need. So if you’re reading this and you’re having a hard time, no matter how big or small it seems to you, I want to remind you that you’re not weird or different for sharing what you’re going through.

Just the opposite. It could be the most important thing you do. It was for me.

Dr. Michael Rubino is a psychotherapist with over 20 years of experience treating teenagers and children. For more information about Dr. Rubino’s work or private practice visit his website http://www.RubinoCounseling.com or follow him on Twitter @RubinoTherapy.

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Dealing with Grief During the Holidays

Dealing with Grief During the Holidays

The Holidays are typically a happy time for many people. However, for others it can be a very difficult time. If you lost someone close during the year, the first Holiday season can be very difficult. Also maybe the death occurred last year, you can still be grieving the loss of your loved one. Our society doesn’t really acknowledge grief and that makes it very difficult on the person who is grieving.

Part of the grieving process is learning how to continue your life without your loved one. This can be a difficult process especially depending on how the death occurred and if you had a chance to say good bye. Regardless of if it was sudden or expected there is a grieving process people undergo. There are stage theories about grief, but I encourage people not to worry about those theories, grief is an individual process and you need to allow yourself to experience it the way you need to.

In terms of the feeling of grief, the best way I have heard it explained is think about it as an ocean wave. You never know when the wave will come in or when it will go out so you just have to experience as it happens. However, you know the wave will eventually go out so you do your best to deal with it until it goes back out. However, it’s important to remember it will be back again until you are finished grieving.

During the Holidays you need to take care of yourself and ask others to understand and be supportive. Maybe you cannot do what you have always done during the Holidays. Maybe this year you need to do something totally different such as go on a trip. Maybe you need to allow yourself some quiet time so you can remember your loved one in the way which feels appropriate to you. The important thing is to do what you feel is appropriate for you.

It’s also important to remember that you need to be flexible. You may have a plan for the Holidays which sounds like it will work and at the last minute you discover it won’t work and you need to change it. If that is the situation, then change your plans at the last minute. You need to do what you need to in order to get through the Holiday.

When developing a plan include the immediate family because everyone is grieving and you can support each other. If there are children involved, pay close attention to the children. They may have difficulty expressing their thoughts and feelings and may be very confused.

Also remember there is no timeline on grief. So it may take you a year to process your grief, while it may take someone else two or three years. The main point is do not impose a time frame on yourself or anyone else. If you notice grief is paralyzing you or a family member, you may want to suggest therapy so they can get the additional support they need. Again grief is a very individual process so some people may need psychotherapy and others may not.

The main point is to remember this Holiday will be very different and not to put a lot of expectations on yourself. Do what you can and if you cannot do something do not force yourself. Do not be embarrassed to ask others for emotional support or to cry. Cry as much as you need to. The bottom line is this Holiday is going to be different and you may not be happy and filled with joy. If that is the case, you are not doing anything wrong. You are simply experiencing your grief and it is important to allow yourself to grieve.

On last point, some people find volunteering at a homeless shelter or food bank to be helpful. Helping others and helping others to live without having to struggle can help with some of the helplessness you may be experiencing. Again, do what you and your family need to in order to make it through the Holiday. Do not worry how others may possibly be judging if they are judging you. They are not dealing with the grief, you and your family are dealing with the grief.

I have also included a link to a website that provides additional information about grieving during the Holidays. Having a list to refer back to can be helpful. Please take care of yourself and family during this emotional time. Coping with grief and loss during the holidays – https://go.shr.lc/2AoQ1yR via @Shareaholic.

Dr. Michael Rubino is a psychotherapist with over 20 years experience treating children and teenagers and working with people who are grieving. For more information about his work or private practice visit his website http://www.RubinoCounseling.com or his Facebook page http://www.Facebook.com/drrubino3.

The Truth about Suicides during the Holiday Season

The Truth about Suicides during the Holiday Season

The Holiday Season is just around the corner. Many people assume the Holidays and depression go together. In addition to assuming the Holidays and depression go together, people assume that suicide rates increase during this time of year. Well according to the statistics from the CDC, suicide rates actually drop during the Holiday Season. The study by the CDC is not sure why they drop but they do. May be they drop because during this time of year we pay more attention to depression and suicide. There are a number of ads and social media posts where people can call if they feel suicidal.

What the CDC did find is that loneliness increases during this time of year. During the Holidays there are songs and plenty of television shows regarding getting together with family and friends. You also have people talking about all the Christmas parties that they have to go to. However, this is not the case for everyone.

If you are a military family, a loved one may be stationed overseas and won’t be home for Christmas. Also during the year some close friends or loved ones may have died during the year. It is during this time when most people are talking about family and friends that you remember the people you have lost over the year. The first Holiday Season without a close loved one or friend can be very difficult. You may not feeling like celebrating or you may have to change Holiday traditions which can make some one feel sad and lonely.

Another common difficulty during this time of year is money. Many people feel like they need to spend a great deal of money to show love. They may just be able to pay their monthly bills and cannot afford Holiday gifts. Why do we need to spend money to show that we care? What if you write a letter to someone telling them how important they are to you and how much you appreciate them. Isn’t that the real purpose of the Holiday Season? Isn’t this the time of year we take to tell people in our lives how much we appreciate them. Also it’s an opportunity to tell people we tend to ignore, people sleeping on the street or who are dealing with mental illness that they are important too?

As a psychotherapist, I have seen that people dealing with mental illness feel lonely and out of place during this time of year. They don’t often feel the joy of the season. Sometimes they struggle just to make it through the day. Also mental illness is something we don’t discuss as a society. We tend to act like it doesn’t exist so we ignore the issue. Also since it is an uncomfortable issue for many people the feelings of shame and embarrassment become associated with mental illness. This makes it less likely for people dealing with it or families who have a family member dealing with it to talk about it or seek help. This can make people feel lonely and isolated especially during this time of year.

We seldom acknowledge the daily struggle that people and families dealing with mental illness go through on a daily basis. It is important to acknowledge that mental illness is not a weakness it is a medical condition. There is no reason to look down on someone with mental illness. We offer encouragement and support to people with cancer, why can’t we do the same for people with mental illness?

I have included a link to a video where a teenager discusses dealing with depression https://youtu.be/dAzqGcOLXBs. Listen to what he has to say and answer the question, does he deserve to be looked down upon because he is depressed?

Also remember the Holidays can be a lonely time for people. So if you see someone who looks like they are having a hard time or know someone who is struggling during this season, try to help. Do something kind for them. Another thing to remember, being kind to people should be a year round activity for all of us. We should not just be kind during the Holidays. If we try to be kind all year, we may be able to decrease how many people feel lonely and depressed. Also if we are kind and offering support year round may be we can eliminate the negative stereotype associated with mental health.

Dr. Michael Rubino specializes in treating depression and suicide especially depressed and suicidal children and teenagers. For more information about Dr. Rubino visit his website at http://www.rcs-ca.com or his Facebook page http://www.Facebook.com/drrubino3

Preventing Suicidal Feelings in Teenagers

Preventing Suicidal Feelings in Teenagers

Different months of the year are dedicated to different issues. For example, May is dedicated to Mental Health Care. This article discusses a number of reasons why teenagers have mental health issues and how we can help. Some of the issues I treat teenagers for are suicide, cutting, bullying, drug abuse, early sexual activity and poor performance at school. A number of these issues can lead to a teenager feeling suicidal. September is dedicated to suicide prevention. Suicide is the third leading cause for death for children 10 to 18 years old. If we are going to prevent suicide we must prevent the issues which can result in suicidal feelings and actions.

I have been working with teenagers for over 20 years. In those years I have seen many teenagers for many different reasons. However, when the teenager tells me why they are doing what they are doing, I often hear very similar answers for a number of different issues. It sounds odd and surprising, but when you look at it from the teenager’s point of view it makes sense.

What I have heard very often over the last 20 years is that the teenagers who are bullying, cutting, depressed, using drugs or having sex, do not feel loved by their families. In fact, they feel no one cares about them and no one cares how they feel or what they do. Therefore, they act out. They have decided negative attention is better than no attention. So if they are bullying someone, coming home high, threatening suicide or having sex, they will get attention for their negative behavior.

Furthermore, teens are now forming friendships with other teens who bully, use drugs, are suicidal or sexually active. This common bond makes them feel someone else understands and cares about them. This is how gangs form and pressure members to do things they usually would not do. The teenager feels they have a family and people who care about them. They are so desperate for love that they will do anything to stay as a gang member. They will do anything to avoid that lonely, empty feeling.

This really should not be surprising. We have seen and heard about this is in the popular media for years. The Disney movie, Frozen, mentions that people make poor choices and mistakes if they do not feel loved. The movies, The Breakfast Club & Good Will Hunting, both demonstrate the point of teens acting out and doing anything for friends so they feel loved. The play, West Side Story, is another good example. Also in her last show Oprah said that one thing she had learned is that everyone wants to know, “am I important to you, do you hear me, do you see me?.” The teenagers that I have worked with all tell me the same thing. Also it is amazing that when they test me enough and they see that I do care how they are willing to try to change.

The problem is that with society today everyone is concentrating on their own lives and they have little time to acknowledge the people around them. Parents are having to work two to three jobs to support their families. Parents assume that their teenagers will see how hard they are working and know their parents are working that hard because they love them. However, teenagers’ brains are not fully developed yet so their reasoning skills are not like an adult’s reasoning. Teenagers need to hear, I love you, from their parents and need one on one time with their parents.

Parents cannot be the only people letting teenagers know that they are important. We are asking too much of parents to be the only ones. Teachers need to show they care by staying after school to help teens who have questions or are confused or need to talk. We need to look at the movies, television and music that teenagers are listening to. Also we need to look at society. Society gives a message of looking at for number one. There are not a lot of role models encouraging teens to accept one another as they are and to support each. Look at the President and how he bullies and insults minorities, women and people who disagree with him on Twitter on a daily basis.

What is the answer? We need to change our priorities and tell our teenagers and children that we love them and care about them. Schools need to bring in programs such as Challenge Day which teach teenagers to accept each other and care for each other. We need to encourage our teenagers to follow the Harlem Globetrotter’s program. They refer to it as the ABC program. A is for being assertive, B is for being brave and C is for compassion. In other words, when you see someone being a bully or harassing someone, speak up and say it is wrong, report it and show the victim some compassion. If every time a teenager notices that someone in their class seems down and they ask the person if they are alright we can make a big change in these negative behaviors such as suicide, bullying and drug use. Also if parents ask their teenager how they are doing without judgement or fear of punishment we could change a lot of these negative statistics. Think about it, why would a teenager say yes I have been using drugs or cutting if they are afraid of getting into trouble?

Summing it up, if we are going to solve issues such as bullying, domestic violence, suicide and cutting to name a few, we need to all work together. We need to let people know that we care and show it. We also need to be brave enough and assertive and speak up when we notice someone being bullied or report when we have noticed someone vandalizing someone’s property. We need to provide teenagers with positive role models and insist that our schools use programs such as Challenge Day and Alive & Free. We all need to work together and speak up about things that are wrong if we want things to change.

Dr. Michael Rubino is a psychotherapist in private practice with over 20 years experience working with teenagers and children. He is considered an expert in the treatment of teens and children. For more information regarding his work or private practice visit his website www.rcs-ca.com or visit his Facebook page at http://www.facebook.com/drrubino3.

Why Sleep is Important for Teenagers’ Mental Health

Why Sleep is Important for Teenagers’ Mental Health

School is back in session but many elementary, middle school and high school students are still trying to adjust their sleep pattern to accommodate school. Many children and especially teenagers have become use to staying up late and sleeping in because they were on summer break. However, this pattern needs to change now that school has started. Sleep is very important for children and teenagers. In fact, research shows that sleep has a big impact on our mental health and physical health. Research has shown that sleep deprivation can cause a person to suffer a psychotic break or if the depreciation is really severe it can even result in a person’s death. I recently received some very good information regarding sleep and mental health. It was provided by Jenny Thompson who is associated with www.bettermattressreviews.com. I think it is valuable information for everyone so I have provided it below.

Mental health and sleep are closely related. Sleep problems frequently accompany mental illness, and can even be the first warning sign of a disorder. In turn, lack of sleep worsens mental health symptoms, creating a vicious cycle.

Mental illness is common, with almost 20 percent of Americans suffering from at least one mental health disorder. While only 10 to 18 percent of the general population experience sleep issues, as many as 50 to 80 percent of people with mental illness have trouble sleeping.

Mental health disorders are the largest cause of insomnia. 40 percent of insomniacs and over 46.5 percent of hypersomnias have a comorbid mental health disorder. On the other hand, only 16.4 percent of people have a mental health disorder without any kind of sleep issues.

Sleep problems are closely correlated with ADHD, anxiety disorders, bipolar disorder, depression, and schizophrenia. Below we’ll review how sleep affects several mental health disorders, and provide tips for getting better sleep.

Schizophrenia and sleep

Schizophrenia affects 1 percent of people, or 3 million Americans. Onset often occurs in late adolescence or the early 20s. Individuals with schizophrenia suffer from psychoses such as delusions and hallucinations, and experience difficulty focusing their thoughts and expressing themselves.

Up to 80 percent of people with schizophrenia have sleep problems, including:

Irregular sleeping hours. They may fall asleep anytime during the day or night rather than during the typical overnight sleep period of most people. They may have consistently delayed melatonin release that shifts their sleep pattern later than normal, slowly shift their circadian rhythm later and later each day, or follow no consistent sleep-wake patterns at all.

Irregular sleep quantity. They may get too much (hypersomnia) or too little (insomnia) sleep, as a result of medication side effects, fear or anxiety due to hallucinations (which may cause them to sleep more to escape, or conversely to be afraid of nightmares), or the irregular sleep hours cited above.

Sleep apnea. Individuals with sleep apnea literally stop breathing during the night, due to blocked airways or a miscommunication between the brain and the breathing muscles.

Less refreshing sleep overall. Due to the issues described above, people with schizophrenia experience less refreshing sleep overall because they have trouble getting sufficient amounts of REM sleep.

For many people with schizophrenia, an onset of sleep problems can be a warning sign that psychosis is starting or returning.

A 2012 study of mice found that abnormalities in the SNAP-25 gene are linked to schizophrenia as well as disrupted sleep-wake cycle, suggesting that resolving sleep issues may less or resolve schizophrenia symptoms.

Anxiety disorders and sleep

Generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, social phobias, and PTSD are all associated with having anxious thoughts while trying to fall asleep at night and related insomnia.

Source: The National Academies Press

Panic episodes may waken an individual with panic disorder from sleep, thus disrupting their overall sleep quality. Likewise, individuals with PTSD are prone to vivid re-experiencing traumatic nightmares which heighten their bedtime anxiety and also cause interrupted sleep.

Individuals with mood and anxiety disorders may be prescribed various medications such as antidepressants and mood stabilizers which can further interfere with sleep.

Insomnia not only accompanies anxiety; it can cause it. When individuals experience chronic sleep deprivation, it disrupts their serotonin and gamma-Aminobutyric acid neurotransmitter levels, which can result in anxiety. One study found that having insomnia increased one’s risk to have yet another mood or anxiety disorder one year later.

Depression and sleep

Insomnia is one of the biggest risk factors for depression. Lack of sleep worsens mood, and the effect is even worse for individuals with a mood disorder. Depressed people with sleep issues have a higher risk of suicide than depressed individuals without sleep problems.

Treatment is also complicated. While antidepressants boost mood and alertness to help treat depression, that same alertness makes the insomnia persist – and not addressing the insomnia can make individuals less responsive to treatment. But certain prescription drugs for insomnia, like Rozerem, may worsen depression. The key is to find a treatment plan that helps both issues, but not at the expense of either.

Depression and sleep issues are bidirectional. That means the problems of one can worsen the other. The good news is, that also means the improvement of one often fixes the other. For example, 35 million Americans suffer from mild depression (dysthymia). For many, their comorbid insomnia goes away once they begin taking antidepressants.

Bipolar disorder and sleep

Bipolar disorder affects 3 percent of Americans, or 6 million adults. In addition to severe changes in mood, behavior, and energy levels, individuals with bipolar disorder may also experience the following sleep problems:

Insomnia, or difficulty falling or staying asleep

Hypersomnia, or oversleeping, especially during depressive episodes

General sleeplessness, where individuals feel fine even when they’ve had significantly less sleep, although this abnormal sleeping pattern eventually catches up with them

Delayed sleep phase syndrome, where the individual has a delayed circadian rhythm, causing them to naturally start to fall asleep or wake up later than others and experience excessive daytime sleepiness as a result

Irregular sleep-wake patterns from manic episodes and related hyperactivity at night

REM sleep issues like vivid nightmares

Sleep apnea affects one-third of individuals with bipolar disorder, resulting in less restful sleep overall and excessive daytime sleepiness

For individuals with bipolar disorders, different sleep issues may arise depending on when they are in a manic or depressive state.

In fact, for 75 percent of individuals with bipolar disorder, sleep problems are one of the biggest warning signs that they are about to experience a manic episode. For example, sleep loss from chronic sleep deprivation or even a night of jet lag can induce a manic episode. Manic periods are so arousing that individuals can go for days without sleep, or sleep drastically less amounts than usual and not feel tired. However, that lack of sleep makes its mark in other ways, as they’ll still experience the other symptoms of sleep deprivation felt by everyone, including increased irritability, trouble focusing, reduce judgment, depressed mood.

As they enter depressive episodes, bipolar people may experience insomnia or hypersomnia, both extremes which cause further imbalances in mood and increased anxiety.

In between manic and depressive episodes, individuals with bipolar disorder experience poorer quality sleep, occasional insomnia, and interrupted sleep.

Sleep tips for individuals with mental health disorders

There are various psychotherapies that treat mental illness, sleep therapies for sleep problems, and other behavioral changes that can help individuals with mental health disorders sleep better at night.

1. Practice good sleep hygiene.

It all starts with good sleep habits. Good sleep hygiene includes keeping the bedroom cool, dark, and quiet, and limiting stimulating activity before bed, such as watching television, using the computer, or engaging in heavy exercise. Heavy meals, as well as alcohol, drugs, and caffeine, should be avoided in the early evening and late night hours.

2. Be careful with napping.

For individuals with excessive daytime sleepiness, power naps of 20 minutes can help give a sense of refreshment. However, naps longer than 20 minutes should be avoided as they can contribute to insomnia later that night.

3. Try sleep therapy.

There are various psychotherapy options that assist individuals with mental health disorders. There are also many specific therapies designed to treat comorbid sleep problems.

Cognitive behavioral therapy (CBT) has proven very effective for treating insomnia. CBT first helps the patient recognize their harmful or disruptive thought patterns and habits. Then, they learn to replace them with positive thoughts and better ways to cope so they can calm anxieties surrounding sleep as well as the rest of their lives. One study in particular found that six 20-minute sessions of CBT resulted in a nearly 50 percent decrease in insomnia, 20 percent decrease in depression and anxiety, and 25 percent decrease in paranoid thoughts, and 30 percent decrease in hallucinations.

Sometimes taught as part of CBT, meditation and deep breathing exercises can soothe anxious thoughts and help relax the body for sleep. You can find audio files of guided meditation and relaxation exercises on the MIT Medical website.

Sleep restriction therapy involves setting a strict bedtime and waketime, and only staying in bed for that allotted amount of time, regardless of how much sleep the individual actually enjoys. Eventually the body gets used to the new sleep-wake cycle and begins to sleep and wake at the proposed appropriate time. A small 2013 study found that sleep restriction therapy improved sleep and reduced symptoms of insomnia for patients with bipolar disorder.

Chronotherapy works similarly by gradually adjusting the bedtime and waketime. It’s a newer therapy and the research is still bearing out.

Bright light therapy helps reset a person’s circadian cycle and make them feel more awake in the morning. Exercising outside in the morning in areas of bright sunlight can provide a similar effect.

4. Explore natural remedies.

Melatonin supplements help kickstart melatonin production in the brain. These can be helpful for insomnia or anyone who has difficulty falling asleep due to a period of mania or delayed sleep-phase syndrome. Valerian root can also help induce sleep. Both melatonin supplements and valerian root are widely available at pharmacies.

5. Keep a sleep diary.

If you’re concerned you may have a comorbid sleep disorder, a sleep diary can help you track your sleep habits. Note when you fell asleep and when you woke up, the total amount of time you were asleep, and anything abnormal that happened during your sleep, such as nightmares or snoring. If you find you’re not getting enough sleep, you can meet with a sleep specialist for a diagnosis and share your diary with them.

You may also want to consult a mental health professional for an evaluation and/or your primary care physician.

Dr. Rubino has over 20 years experience as a psychotherapist treating children and teenagers. Many children and teenagers have undiagnosed sleep problems. For more information regarding Dr. Rubino’s work or private practice visit his websites www.rcs-ca.com or www.RubinoCounseling.com or visit his Facebook page www.Facebook.com/drrubino3.

Teenagers use Cough Medicine as a Drug

Teenagers use Cough Medicine as a Drug

Many parents who are raising teenagers know they need to be concerned that their teenager may abuse alcohol, marijuana, ecstasy and many other drugs. However, many parents do not think they need to worry about their teenager abusing cough medicine. Some parents may be concerned because some cough medicines contain alcohol. However, teenagers are abusing Robitussin on a frequent basis. They are not abusing it for the alcohol, they are abusing it for the dextromethorphan (DXM). This substance is high dosages can cause hallucinations and symptoms similar to using LSD.

Teenagers have been using Robitussin for a while and the amount of teenagers abusing DXM has been increasing. A study in 2008, showed the overall use of DXM since 2000 increased by a factor of 10. However, for teenagers the increase is by a factor of 15. In order for a teenager to have hallucinations from DXM, they have to use 10 to 50 times the recommended amount to use. Many parents may wonder will this amount of DXM be enough to cause their teen to overdose. Most teenagers do not overdose on DXM. However, many teenagers typically use alcohol or other drugs along with DXM. This combination can be lethal.

DXM has been around since the 1950’s. However, as I stated above since 2008 the amount of teens using DXM has increased by a factor of 15. Also DXM is used in many over the counter drugs for the cold and flu. So Robitussin is the most common over the counter medication teenagers are using, there are many other over the counter drugs that contain DXM and that teenagers are abusing. The increase has been occurring since 2008, I have had teenagers talking about how they sneak it out of their house, get it from a friend or steal it from CVS or Walgreens.

One of the primary reasons teenagers are abusing DXM is that it is cheaper than LSD or other drugs that create hallucinations. Also because these medications are over the counter it was a very easy way for them to obtain the DXM. However, now most drugs containing DXM are kept behind the pharmacy desk and in order to buy them you need to show identification to the pharmacy. Most pharmacies require people to be 18 years or older in order to purchase medicine containing DXM.

Even with these medicines being kept behind the pharmacy counters, many teenagers have figured out ways to obtain over the counter medications containing DXM. Many teenagers know that pharmacists are aware that they are watching Robitussin so they are using other over the counter medications containing DXM. Teenagers have developed their own terms for these medications so parents may not know if their teenager is using DXM because their teenager is using different terms than referring to specific medications. I have included a link to the slang terms that teenagers are using to refer to DXM. The slang terms can be found in the following article https://www.webmd.com/parenting/glossary-dxm-drug-abuse. Parents I would strongly recommend reading this article so you can be aware if your teen is using DXM but referring to it with a different name.

Since DXM has been around for a while and more and more teenagers are using it because it is cheap and easy to get, in addition that it is in many over the counter medications, parents may have a difficult time knowing if their teenager is abusing DXM. Therefore, I have also included a link to an article which lists the symptoms you would see when someone is under the influence of DXM. Besides listing the symptoms of being under the influence, this article also lists the daily behavior changes you will see in a teenager who is abusing DXM. Here is the link to the article with the symptoms and behavior changes associated with DXM abuse https://drugabuse.com/library/dextromethorphan-abuse/#signs-and-symptoms.

As a psychotherapist who specializes in treating teenagers, I can say I have seen a significant increase in the number of teenagers using DXM. Ten years ago, occasionally one of the teenagers I would be working with had a history of using or were currently using DXM. Today it is very common. In fact it is almost as common as marijuana. Therefore, my recommendation to parents is to take the time and read the links I have provided and do your own research. While by its self alone DXM is not typically lethal, teenagers combine this drug with other drugs which can cause someone’s death. Also what I have observed is that DXM tends to lead to teenagers trying other drugs that can be very deadly.

Dr. Michael Rubino is a psychotherapist with over 20 years experience. He is recognized as an expert in the treatment of children and teenagers. For more information regarding his work or private practice visit his website www.rcs-ca.com or follow him on Twitter @RubinoTherapy.

Helping College Students with Disability Issues Find Help

Helping College Students with Disability Issues Find Help

Working with children and adolescents I have had many parents ask about 504 plans and Individual Educational Plans (IEP). Parents tend to focus on the assistance their child may need in elementary or high school due to a learning disability or mental health issues. From my 20 years experience as a psychotherapist, what I have seen is that if a child need assistance in elementary and high school, they typically need assistance in college.

From my experience, most families assume there is no assistance in college. However, typically if a child has an IEP, they are also entitled to assistance in college. Most colleges in their Counseling departments have programs designed to help disabled students. A student with a physical or learning disability or mental health issue such as ADHD or depression would qualify for assistance by the Disabled Students Program at a college.

Also if you live in California and you have a physical or learning disability or a mental health issue and had an IEP while in school, you may qualify to be a client of the California Department of Rehabilitation. This Department is responsible for assisting people in California ,with a disability, find a job and get the education they may need to find a job. The Department may assist their clients by providing tuition assistance for community or state colleges and provide financial assistance to buy text books and school supplies. What they are able to do depends on the State budget.

This is another reason for parents to insist when their child does need an IEP that the school district places the child on an IEP. The lies schools tell parents that an IEP will prevent their child from getting into a college, the military or getting a job is not true. Another reason to insist on the IEP, if your child qualifies for an IEP, is because your child can be granted accommodations on the SAT or ACT that students need to take when they apply for college. I have had many teens with ADHD come to me seeking accommodations on the SAT or ACT. A common requirement that the testing boards require is that a student needs to have had an IEP if they are seeking accommodations on these tests.

Therefore, many students who have disabilities or mental health issues can receive assistance in college. While many people may be surprised, it is true. However, for many college students finding the assistance can be confusing and overwhelming. For a Freshman in college dealing with heath or mental health issues the confusion and embarrassment people deal with because of society stereotypes can cause students to give up. However, I was contacted by bettercollege.com with a resource guide they developed for college students with mental health issues. While their guide was created for students with mental health issues, it can also be used as a guide for students with physical or learning disabilities.

Since I feel this is a valuable guide to Freshman students and their families, I am including a link to this resource guide below:

Guide to College Planning for Psychiatrically Impaired Students – https://www.bestcolleges.com/resources/college-planning-with-psychiatric-disabilities/

Dr. Michael Rubino is a psychotherapist with over 20 years experience working with children, teenagers and college students. For more information about Dr. Rubino’s work and private practice visit one of his web sites www.RubinoCounseling.com or www.rcs-ca.com or his Facebook page www.Facebook.com/drrubino3.