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Showing posts from October, 2012

The What-If's

I recently was talking to a good friend of mine who also has a chronic illness, and she expressed to me something that I think many people go though. She talked about the idea of growing up too fast, since her diagnosis was at 18. Typically, when a teenager is diagnosed with a chronic illness, it can really alter their social/emotional growth, as not only do they have to face significant health challenges, which their peers are not facing, but they also have to learn to fit in despite these issues, all while taking care of themselves and managing their illness. Many adolescents we see at our practice are struggling with the concept of identity and fitting in. Will they be able to live a "normal" college life? Will they be able to hold down a job? Will their peers really "get it"? Developmentally, teens and college students are sorting through all sorts of identity issues, but chronic illness can throw a wrench in things. 
Often times, illnesses prevent young adults …

The Slow Road to Parity

If you've ever tried to use your health insurance for mental health services, you may have experienced some challenges.  Things like need for prior authorization to see a therapist, limits on the number of sessions you can have, or limits on the amount of coverage your plan allows (to name a few).  Starting in 1996, congress passed a law that aimed to create "parity," or equality, between coverage for mental health and physical health conditions.  This law stated that insurance companies cannot have different lifetime benefit limits for mental health care. It was a start; unfortunately it took 12 years for the issue to be revisited.

In 2008, the Mental Health Parity and Addiction Equity Act (MHPAEA) was passed, adding to the 1996 law that health insurance issuers cannot require higher co-pays or deductibles, or restrict the number of treatment visits for mental health conditions.  So why are people still experiencing hurdles when it comes to using insurance for mental …

Treatments & Adolescents

The Lupus Foundation of America reports a new study on the effects of lupus and its treatments on teenage girls.  The researchers evaluated how both the illness and a common treatment, oral steroids, can affect the teens' mood and feelings about their appearance.  They found that feelings of depression were present in most of the teens they studied, and over 90% felt unattractive because of their condition.

A little side note on the effects of oral steroids.  These are powerful medications that are used in a wide variety of conditions to reduce inflammation.  They have been around a long time and are considered safe, but come with a host of side effects that patients often struggle with.  These include increased blood pressure, weight gain, acne, swelling of the cheeks (patients sometime call these "chipmunk cheeks") or the back of the neck, mood swings, increased appetite, weakening of the immune system, and general swelling or fluid retention.  Many of our clients have …

EGIDs, Kids, & Psychology

Recently when doing some research, I came across a journal article in Children's Health Care, which talked about Psychological Functioning of Children and Adolescents With Eosinophil-Associated Gastrointestinal Disorders. EGIDs are growing in numbers, but there has not been a lot of literature on the psychosocial aspects of these disorders. The article was written by various clinicians and psychologists (Cortina et al) at the Cincinnati Children's Hospital and examined the health-related quality of life and adjustment among children with EGIDs compared to their healthy peers. (To note, my colleague Tiffany Taft has written multiple articles in the field of EGID's since 2004!) 
Similar to Inflammatory Bowel Diseases, EGIDs are an inflammatory condition of the digestive tract, but only since 2004 have they been described in medical literature. Some of the frustrations revolve around eating and children's food hypersensitivity, so mealtimes can pose significant challenges …

Guest Post: Massage Therapy & Chronic Illness

This week we have a guest blogger, Melanie Bowen, of the Mesothelioma Cancer Alliance who writes about the benefits of massage therapy for people living with a chronic illness.  Melanie is an awareness advocate for natural health and cancer treatment alternatives.  She highlights the great benefits of alternative nutritional, emotional, and physical treatments on those diagnosed with cancer and other serious illness.  She also assists in social media outreach efforts to spread awareness.  Thank you, Melanie, for contributing!  Visit her blog.

Benefits of Massage Therapy for Cancer Patients

Numerous cancer treatment facilities are now offering massage therapy to patients suffering from cancer as a complementary treatment to radiation or chemotherapy. While massage isn't meant to be a treatment for cancer on its own, it can go a long way toward helping these people relieve many of their cancer symptoms and the side effects of the treatments.

What is Massage Therapy?

Massage is the kne…

Monday Metacognition #6

I'm taking a detour this week from the topic I was going to post about to share some interesting findings from Dennis Charney, MD who is a leading expert at Mount Sinai Medical Center on mood disorders and "resilience" - or our ability to overcome stress brought on by adversity.  Resilience is a bit of a buzz word in psychology these days, but there are some important topics that Dr. Charney covered in a recent interview on the Shrink Rap podcast on 10/19/2012.  You can hear the whole interview here.  Dr. Charney discussed 7 elements that are key to being a resilient person:

Realistic versus Blind or "Polly Anna" Optimism:
Realistic optimism is when we stop and realistically evaluate our situation, compare the resources we have on hand to face the adversity, and conclude that we can, in fact, prevail.  Blind optimism does not involve this assessment, and is what I like to call the "sunshine, puppies, and roses perspective."  Optimism is somewhat genet…

Insurance- to take or not to take?

Since Tiffany recently mentioned insurance in her post on October 14th, I figured I would chime in with my perspective as well. Insurance is a tricky topic. Why do so many therapists refuse to take insurance? Well, as you may know from being a patient, insurance companies are not always the easiest to deal with. When a therapist accepts insurance, they are basically saying they are willing to take a large pay-cut (because of the current rates the insurance companies pay), as well as also deal with the details that come along with submitting the billing and advocating for their patients. This is extra time that therapists are not paid for, and something that can be quite time-consuming.

As I was researching this, I found a great explanation in a blog stating that "different insurance policies by the same company can have different payment rates, so someone has to call for each patient, verify the insurance, find out the terms, co-pays, deductibles, and this involves sitting on ho…

Counseling Obese Moms-To-Be

A new Belgian study published in the International Journal of Obesity  found that "motivational counseling" helped reduce the amount of weight gained in obese moms-to-be from an average of 30lbs in those getting standard care to 23lbs in those participating in the treatment.  Not only did the counseling, which occurred in a group format, keep moms-to-be from gaining excessive amounts of weight, but it also helped reduce feelings of anxiety and depression.

I should emphasize that this study was for moms-to-be who were already obese prior to getting pregnant, as the recommended weight gain during pregnancy for an average weight woman is between 25 and 30 lbs.  As a relatively new first time mom, I learned a few things about pregnancy and the downright contradictory social expectations that pregnant women often encounter.  I won't get into them all here but I want to highlight a few.

"Go ahead, you're eating for 2 now!" ...."My God, you're HUGE!  Are …

We're rePresenting!

On November 2nd, the CURED Foundation - a patient advocacy group dedicated to people living with Eosinophilic GI Diseases such as Eosinophilic Esophagitis or Eosinophilic Gastroenteritis - is hosting its first annual Patient Education Symposium at Cincinnati Children's Hospital.  And we've been asked to speak!

Stephanie and I are giving 2 talks on Saturday.  The first is on health related quality of life for adults living with these conditions, including some of the main concerns that patients have, the effects of the treatments (especially restricted diets), and how these concerns are related to other things like mental health and illness symptom activity.  The second will be for parents of kids with EGIDs and what we understand about caregiver stress, including how it's related to the child's illness, treatments, and behavior.  Both of these talks are from research studies that I did at Northwestern University Feinberg School of Medicine in the Center for Psychosocia…

Monday Metacognition #5

Today's Topic:  Probability Overestimation.  The tendency to believe that whatever prediction you may be making about a certain situation that it's at or near 100% likely to be true.  This thinking trap is often paired with others I've talked about the past few weeks, especially catastrophizing and mind reading.

It's only nature to believe that what you think is correct and that there's only a very small chance that something else may be true.  This serves as a protective quality, but can really turn up the stress dial when combined with negative expectations.

Back to our friend Shannon with UC:

Last week, Shannon was certain that a polyp that was removed in her colon meant that eventually she was going to develop colon cancer and die (catastrophizing).  Not only did she think this was her fate, she was 99% sure that it would happen (probability overestimation).  Needless to say, her worry was off the charts, she had trouble sleeping and couldn't concentrate v…

There's A Pill For That...

There's an article out via the New York Times about a physician in Georgia who's prescribing ADHD meds to children who live in poor neighborhoods, and don't have ADHD, to help them concentrate and boost school performance.  His rationale is because we, as a nation, aren't investing in changing these kids' environments, the only other option is to "change the kid."  This story bothers me immensely for several reasons, but it got me thinking about my role as a clinical psychologist; or specifically psychologists as a collective, especially those in private practice.

I did a poll with my friends at the Great Bowel Movement about mental health care and living with IBD.  One of the questions I asked was "If you've considered seeing a therapist, what are some of the barriers that you've encountered." People could check off as many items as they wanted - things such as "not enough time," "finding a therapist who specializes in I…

8 Questions to Ask Your Potential Therapist

You've decided to seek help from a therapist and you've found a few in your area that you're considering. Before setting up your first appointment, any good therapist will take time to answer your questions on the phone to make sure that you and him/her are likely to be a good fit.  Research shows that the "fit" between you and your therapist is as important as the type of treatment they provide.  Since we're dedicated to people living with chronic illness, our list is specific to this.

Here are 8 questions that everyone should ask:

What is your approach to treatment?
As we'll talk about in a future blog post, there are MANY approaches to psychological treatment out there.  Your experience will be different depending on this, so it's important to know what theory the therapist works under. Common answers include Cognitive Behavioral Therapy (CBT), Interpersonal Therapy, Psychodynamic or Psychoanalytic, Humanistic/Existential, Family Systems, Acceptance…

Exciting Times!

We have 2 really exciting pieces of news to share today....
First, we've been nominated for the Silver Stethoscope Award in this year's WEGO Health Activist Awards!  We're really honored by this, especially since we've just gotten started.  So thank you for this great recognition! If you'd like to endorse us, please use the badge on the right side of our page ---->

Second, Steph and I are putting on our first of hopefully many patient education groups on November 14th from 6:30-8:00 p.m. at the Buzz Cafe in Oak Park, IL.  This session is devoted to people living life with Inflammatory Bowel Disease (IBD).  We'll be talking about some of the common issues people with IBD face in their social and emotional lives, and giving some tips on how to manage these.  Space is limited, so please RSVP by November 9th at or 312-725-6175.

Stress Reduction toolbox

I work with a variety of patients who are undergoing medical treatments, and recently one of my adult oncology patients mentioned an article in the Chicago Tribune about meditation and its benefits. I found this interesting as my monthly cancer support group I lead addressed this topic as well. Meditation and mindfulness is becoming more and more mainstream, and something that doctors are pausing to consider as its popularity and research base grows. There are many studies that have recently documented the benefits of meditation and mindfulness for patients of all types. Even though the article above is pertaining to breast cancer patients, I wanted to share the importance of exploring this realm and developing your own "relaxation toolbox" that works for you. Everyone encounters stress in their life, some good, some bad, but patients with chronic illness need to be especially aware of where they carry their stress and how to manage it. Whether its tai chi, massage, visualiz…

Best of The Web #1

We fully admit that we're not the only awesome resource on the web for information about living with a chronic illness.  Here are some other sites that we think are worth checking out:

The Crohn's & Colitis Social Network

An Itchy Little World:  Blog about allergies, asthma and eczema by Jennifer dedicated to parents of kids affected by these conditions.

Thriving:  Pediatric Health Blog run by the staff at Children's Hospital in Boston
Inflamed & Untamed - A personal blog by Sara Ringer, Crohn's patient, advocate, and overall cool-person

Dr. Jen 4 Kids:  A fantastic pediatrician located in Franklin, WI.
The Great Bowel Movement - Patient advocacy organization started by a couple of our friends, Andrea Meyer and Megan Starshak.  Their mission is to get people talking about IBD to increase awareness and decrease stigma. http://www.thegre…

Monday Metacognition #4

This week:  Catastrophizing

This week's thinking trap is one of my favorites - Catastrophizing.  By looking at it you can probably guess what it is by its root word, catastrophe.  To catastrophize is to expect the worst case scenario to be the only possible outcome to a situation, or what I like to call "blowing-things-out-of-proportion-itis."  Catastrophizing usually takes place with another trap we'll cover next week, probability overestimation.  Together, these traps make for some pretty tense times.

Like all thinking traps, we all experience catastrophizing from time to time.  If you tend to be a "glass half empty" type of thinker, it may happen to you more often.  But catastrophic thinking can happen to even the most optimistic person.  Let's go back to our friend Shannon for an example.

Shannon has been feeling pretty well the past year or so, but her gastroenterologist decides that she would like to do a colonoscopy to check Shannon's colon f…

Parent-Caregivers and "Chronic Sorrow"

Today I want to discuss the experiences of parents of kids affected by a chronic illness.  Recently I did a research study on parent-caregiver stress in parents of children diagnosed with eosinophilic GI diseases that was published in the Journal of Pediatric Psychology.  Lo and behold I found that these parents (moms, really) are stressed, and this stress is related to other things like the parent's mental-health and their child's behavior.  I'll be presenting these findings at the first annual CURED patient education symposium in Cincinnati in November.

There's an interesting article on PsychCentral discussing how parents often find a lot of support during the initial stages of a diagnosis or illness, but then they find themselves feeling isolated as friends may drift away.  In this article, the term "Chronic Sorrow," first coined by Simon Olshansky in 1967 is discussed as:

"...however much a family embraces the child they have, they are nonetheless repe…

The Emotions of Chronic Illness

This may be an over share, but a few months ago, I was reading AARP. Not sure why I had it in my possession, but there was an article on chronic illness which struck my eye. It featured the NBC newscaster, Meredith Vieira, and her husband Richard Cohen who openly shared how his multiple sclerosis, which he has been dealing with since age 25. This degenerative disease has now taken his eyesight and Meredith spoke of the balance of realism and denial they have shared as she figures out how to balance their time together and her news career. She and her husband offer an honest and unique perspective as a couple is thriving despite this hard illness. One quote I found particularly inspiring.
"In some ways, the course of a chronic illness parallels the indignities of aging. Most of us, if we live long enough, will realize that we've driven our last car or scaled our last fence. But with chronic disease, the process is accelerated and tinged with cruelty. As we get older things are…

Getting Help: Shrinks 101

So you've decided that you  might want to get help from a professional about depression, anxiety, stress, or other issues that are weighing on your mind.  But how do you decide who to see, how do you find them, and what can you expect from your visits?  In our "Getting Help" series, we're going to hopefully break this down for you to make navigating the mental health field a little less daunting, and make sure you're connected with the right resource.  
This week:  Shrinks 101
There are many people who provide mental health services.  These include:  psychiatrists, psychologists, licensed clinical social workers, licensed clinical counselors, marriage and family therapists, hypnotherapists, life coaches, psychoanalysts, and I'm sure I'm missing a few.  Here's a few in more detail:
Psychiatrists:  These are medical doctors (MDs) who attended medical school then did advanced training in psychiatry. Therefore they can prescribe psychiatric medications, s…

Monday Metacognition #3

This week:  Personalization.  The tendency to see negative events as some indication of a negative trait or quality in yourself.  Or, taking personal responsibility for events that were beyond your doing or control.

We've all been told "Don't take it personally!"  But, c'mon, it can be really hard sometimes to not think that we had a hand in some negative event, or that some subtle negative comment was directed at us.  And sometimes we do take things personally because it's appropriate, so that's not what we're getting at when we talk about Personalization as a thinking trap.  Rather, it's the tendency to place too much responsibility on ourselves and ignore other information that offers alternative explanations.  Take this example with our friend "Shannon":

Shannon goes to see her doctor for a routine follow up visit, someone she's been seeing for years and feels like she has a really good relationship with.  Normally she takes tim…