Holiday Greetings from Behavioral Health Institute
This December 2009 issue of our E-Newsletter is the 1st of our quarterly series. We want you to know about our practice, the services we provide, the staff that make up our professional team, and to provide some articles that may be of interest. We hope you enjoy it.
If you have any questions or would like to share your comments you can contact us at office@behavioralhealthpsych.com or phone us at 954-340-0888. To learn more about our practice, visit us at www.bhifl.com.
At this time, let us wish you all a Joyous Holiday Season and a Happy and Healthy New Year – from all of us at BHI.
Ellie Nelson-Wernick, Ph. D.
BHI E-Newsletter Editor
E-Newsletter Articles:
- When the Holidays Hurt
- ADD - Evaluation, Treatment and Prognosis
- Many People Suffer from Chronic Pain: How Psychology Can Help
- Spotlight On... Dr. Monica Pedemonte
by Elaine Karbonik, Psy. D.
It’s hard to believe, but the holiday commercials and store decorations are signs of a new hurdle
to face. The first holiday season following a loss is particularly acute. As with grieving in general,
there is no quick-fix for the pain of a first holiday without a loved one. The pain of each loss is
as unique as the people we love.
As much as possible, discuss holiday plans with family members in advance. While it may be comforting to stick to as many traditions as before, in some instances this may be traumatic. Before the holiday season is underway, try to express your needs and wishes.
Sometimes it’s hard to know when to ask for help, but realize that you don’t have to do it all yourself. If, in the past, you were primarily responsible for carrying out the holiday traditions, don’t feel pressured to continue that pattern. Ask – and allow – family and friends to help with shopping, baking, decorating, etc. It is especially important to clarify your own level of participation, and if necessary, allow yourself to let go of unnecessary obligations.
Prepare for a flood of memories. If you decide to decorate, getting the decorations out can be emotional, as the memories of past holidays return. Inside those boxes is the stocking that won’t be hung this year, and the hand-made decorations, as well as numerous other reminders of family experiences. Additionally, as friends and family reconnect during this time of year be prepared for others’ grief. Some friends may just be finding out about your loss.
During the holidays you may want to do something symbolic such as lighting a special candle, or hanging a special holiday ornament, or planting a tree on New Year’s Day in remembrance. Or, consider donating some of the money you would have spent buying their gifts to a meaningful cause.
Above all, be gentle with yourself. Realize that you are in charge of your level of participation in all holiday activities, but try not to isolate yourself. The connection with supportive family and friends is an important element in healing. Connect when you can, and take time for yourself when you need to. Lastly, the importance of self-care cannot be overemphasized, including eating regular meals, and trying to maintain a regular sleep routine. And know that as quickly as the holidays came upon you, they will soon be behind you.
By Frederick M. Kravitz, Ph. D.
While there has been a lot of publicity in the past few years about children being diagnosed and
treated for Attention Deficit Disorder, there still seems to be much confusion over the nature of
the disorder, how we evaluate and treat it and the long-term prognosis for ADD kids.
ADD is a neurological disorder that negatively affects many aspects of a child’s life. The disorder causes problems in a child’s ability to control his behavior, leading to difficulties attending to tasks, completing work and organizing as well as others his age. These children are impulsive, easily distracted and quite disorganized. While there is no one cause, heredity, perinatal factors and head injuries have been cited. Some theories postulate an insufficiency of neurotransmitters, chemicals in the brain that regulate the flow of messages between brain cells. Regardless of cause, ADD is a group of behaviors including difficulty paying attention, focusing, staying on task and regulating one’s own behavior. Some ADD children are hyperactive; some are inattentive. The latter are often times harder to recognize since they may appear attentive and focused while they are in fact daydreaming and not with the program. When called upon in class they may have no idea what’s being asked of them. Whether a child is hyperactive or inattentive, these kids bore easily and often engage in self-stimulative behaviors.
Evaluating a child for ADD requires the input of parents, teachers and other caregivers. While it is normal for children to become restless and inattentive at one time or another, ADD should be considered only if these symptoms interfere with functioning at home and at school. The ADD evaluation typically includes a developmental history, teacher ratings of classroom behaviors, parent ratings of behavior at home, and psychological testing and observations. While there is no single test for ADD, psychologists typically administer a continuous performance test to see how a child’s ability to sustain his attention on a tedious task compares with their same-age peers. Often times an intelligence test and/or an achievement test are administered to assess the child’s ability to stay on task and to rule out other learning difficulties that may be contributing to the child’s misbehavior and poor academic performance.
Once a diagnosis is made, treatment options may include the following:
- classroom accommodations (priority seating, closer supervision, the opportunity to take tests in a quiet room without distractions or time constraints)
- parent training in behavior management (consistent discipline, predictable consequences, extensive use of praise)
- individual counseling for the child to learn self-control strategies, focusing techniques and when appropriate , self-esteem building and social skills training
- referral to the child’s pediatrician, a pediatric neurologist or a pediatric psychiatrist to assess whether a trial of medication is advisable
The physician’s decision to medicate is typically based on the data presented by the treating psychologist. Specific stimulant medications are estimated to each have a 75% positive response rate. Overall, more than 90% of children respond well to one of the available stimulants. These medications control the ADD; they do not cure it. These medications are considered safe. Side effects are usually manageable: decreased appetite at lunchtime and a small delay in falling asleep at night.
As far as prognosis goes, we used to think that ADD children outgrew the disorder in adolescence. We now know that many of the symptoms persist throughout the life-cycle. However we also find that many children learn to compensate as they get older; they acquire new skills and may no longer need medication to function adequately in their later schooling or in their adult life. The career choices made by ADD adults may also reduce the need for treatment by providing stimulation with a minimum of tedium. ADD’s effects are most apparent when an individual is in a classroom with the passive role of listening and learning. Once these individuals are out in the world working the effects are very different.
While some people have questioned whether we are over diagnosing ADD, scholars remind us that the world we live in is increasingly complex and requires that we stop and focus and try to keep up. The demands of modern life are clearly beyond the demands made on previous generations. The complexities of modern life have not caused ADD, but have revealed it.
How Psychology Can Help
by Todd D. Giardina, Ph. D.
A recent article in The Journal of Pain (Miller & Cano, 2009) reported that as many as 22%
of people in the community may be suffering from chronic pain, i.e., pain lasting more than
several months. While this figure may be surprising, what is even more noteworthy is that 35%
of those chronic pain sufferers are likely to be depressed.
In addition, while we don’t know how to account for this, the current research indicates some individuals are at greater risk for developing chronic pain: females, African-Americans, those who are middle-aged, or who are in a lower income or education bracket. Also, if you are already depressed or distressed you are likely to experience your pain more often, more intensely, or with a more debilitating effect.
Pain is a complicated phenomenon. While someone may say, “I feel your pain,” in actuality, pain is subjective – no one but you can know what your pain feels like. Pain is also relative – meaning, stubbing your toe may rate a 3 out of 10 on a pain scale, but for another person it might feel like a 5 out of 10 – same injury, but a different experience of pain.
Perhaps the most complex aspect of pain is how it affects, and is affected by, your emotions. With acute pain -- the kind that passes in a short time -- it is common to feel anxiety. When the pain becomes chronic, with no clear end in sight, it can lead to feelings of frustration, helplessness, hopelessness, and eventually depression.
So how can psychologists help? Using cognitive-behavioral therapy we can teach you to change your psychological perspective and thus lessen your distress. For instance, we know that the types of thoughts we have influence how we feel and behave. If you are thinking, “This couldn’t possibly be worse. My pain completely incapacitates me and I am worthless,” there is a greater chance that you will feel more hopeless and depressed, experience higher levels of pain, and be less active and functional. We can help you recognize that although chronic pain may have caused some dramatic changes in your life, the reality is you still have many strengths, abilities, and means to contribute to your family. By learning to change the way you think, you can begin to improve your mood and your ability to manage your pain.
Other pain management strategies, such as breathing exercises and relaxation techniques, can help relieve physical tension and release endorphins, which are like natural antidepressants or painkillers. You can regain a sense of control over your body and your pain.
Comprehensive pain management usually involves a team approach, including the patient, psychologist, physicians, and physical therapists. Also, for a pain management protocol to be most effective it needs to be tailored to the individual patient. Family members are also involved at times.
I am a psychologist who specializes in treating chronic pain, and I welcome the opportunity to be of help. For further information about chronic pain and psychology, please visit my website at www.PainAndMentalHealth.com. Also, to contact me or schedule an appointment, please call THE BEHAVIORAL HEALTH INSTITUTE at 954-340-0888.
Reference
Miller, L. R. & Cano, A. (2009). Comorbid chronic pain and depression: Who is at risk? The Journal of Pain, 10, 619-627.
By Robert L. Wernick, Ph. D.
Allow us to introduce Monica Pedemonte, PsyD. Monica has been with BHI for 9 years and is the
cornerstone of our bilingual services. She has been a wonderful addition to the BHI staff from
the time she arrived here. She just fit in right away.
However, things weren’t always like that for Monica. She was born in Mendoza, Argentina where Spanish was her first language. At the age of 9 her family emigrated and came to the United States – for the same reason that has brought generations of immigrants before – to have a better life for the family. They moved to Chicago where a family friend sponsored them. The family left behind friends, relatives and all things familiar. They did not speak English and even moved into an Italian neighborhood. It was far from a “seamless” transition – and needless to say, Monica did not feel that she “fit in” right away.
Perhaps this was when her interest in learning new things really began. In order to “fit in” with peers and school, Monica learned English as quickly as possible. She and her family also learned that they shared similar interests and culture with their Italian neighbors. Cooking, sharing food, making friends, friends becoming “like family” – the warmth of the kitchen and the warmth of the heart – thus began a lifelong pattern for Monica.
After graduating from an all-girls high school, Monica attended the University of Illinois in Chicago and graduated with a double major in Education and Spanish. The double major allowed her to embrace two passions – her heritage and learning. She taught school for a few years and then decided to move to Florida as her parents had already moved here.
Again, she taught for a couple of years – and then back to school for a masters degree in guidance counseling. Upon completion, she worked as a guidance counselor for a couple of years before returning to school once again to get her doctorate in psychology. After an internship at the VA Medical Center in Chicago, she has worked for the Department of Children and Families, Biscayne Rehabilitation Institute, and in private practice. She still enjoys working with children and families and contributing to people’s growth.
Monica also finds time to “give back” to the community. Her volunteer work has built on her interests and passions for helping people grow and helping people “fit in”. She has volunteered at the Light of the World Clinic/Clinica Luz del Mundo for about 10 years. This clinic provides health care to the poor, mostly Latin-Americans, of Broward County and is primarily staffed by volunteer physicians. Many of the thousands of patients seen annually struggle with severe social stressors including immigration and acculturation issues.
Monica has been a volunteer interviewer for the Veterans Oral History Project sponsored through the Library of Congress. This project has focused on veterans of World War II. The interviews are recorded and housed at the Library of Congress. She was particularly interested in the role of our female veterans and has interviewed over two dozen women who were WWII veterans. She found this work to be truly inspirational.
Ever learning and growing herself, Monica went through the training to become a Guardian ad Litem (GAL) this year. GAL’s look out for the interests of children in Dependency court. These children are often in the Foster Care system; goals for these children may range from reunification with parents to adoption. She has also become trained to conduct Social Investigations and develop Parenting Plans for families going through separation and divorce. Again, the roles allow one to look out for the best interests of children in very trying circumstances.
In her leisure, Monica enjoys cooking and sharing social time over meals. In fact, she even likes to read cookbooks! She is also a “chocolate lover” but stops short of calling herself a “chocoholic”. She also enjoys traveling with her family.
As you can see, Monica has gone through a lifelong pattern of learning and growing. Her professional work – and her volunteer activities – continues the cycle of learning, growing and helping others. We are proud to have Dr. Pedemonte as part of our BHI family.