Search Results

The air is getting cooler, the sun is setting earlier, and holiday season is finally upon us. While the holidays can be an exciting time to get together with loved ones and celebrate, it can also lead to feelings of stress, frustration, loneliness, and overwhelm. Here are 7 tips you can use to help manage difficult emotions and care for yourself this holiday season: 1. Cope ahead or create an intention. If you’re expecting to have tough experiences during your holiday season, why not prepare for it as you would prepare for anything else? Prepare for the holidays by identifying what situations usually tick you off, who usually ticks you off, and how you would like to cope with these stressors. Whether you’re spending the holidays alone or with others, coping ahead can help alleviate stress by deciding ahead of time how you would like to handle difficult experiences or feelings. Think about how you would like to approach your holiday season by creating an intention or mantra that you can return to if you begin to feel overwhelmed or off-balance. 2. Observe negative thoughts and check the facts. “I’ll never be able to handle the holidays.” “My brother-in-law is going to get too drunk again.” “Oh boy, this is going to be a repeat of the disaster that happened last year.” Whoa! Those are some heavy thoughts coming up! If you notice yourself having negative or judgmental thoughts, imagine viewing them on an assembly line in front of you. Observe the thought, be curious and nonjudgmental about the thought, and let it drift away from you down the assembly line. If observing your thoughts feels too challenging, try checking the facts. Think about the facts of the situation and try to be as objective as possible. Once you’ve identified the facts, consider reframing your negative thought to be more objective and fact-based. Being curious and nonjudgmental about your thoughts allows you to create distance between the thought and yourself, rather than allowing one negative thought to sour your mood. 3. Reduce your vulnerability to tough emotions. Remember the Snickers candy commercials where the baby is having a temper tantrum, and after he eats a Snickers bar he turns into a calm and rational adult? The reason that commercial works is because we’re often grumpier and more likely to have a temper tantrum when we’re hungry! Think about what makes you more vulnerable to a bad mood, and steer clear of those mood manipulators. Eating healthy and filling meals, exercising, getting enough sleep, caring for yourself if you feel sick, taking prescribed medications and vitamins, and avoiding mood-altering substances are all ways to reduce vulnerability to feelings of grouchiness, stress, and irritability. Reducing your vulnerabilities can be as simple as eating breakfast when you usually skip it or refraining from drinking that third glass of wine! 4. Self-soothe. Get out of your head and calm your nerves by using your five senses. Think about different ways to soothe your senses of vision, hearing, taste, touch, and smell. Make a cup of hot coffee or tea in the morning, and soothe your senses of touch, smell and taste by holding the warm mug in your hands and drinking your beverage as slowly and mindfully as you can. Soothe your senses of hearing and touch by turning on calming music when you take a shower and relax into the moment. 5. Use communication skills to get your needs met. Spending time with family or friends over the holidays can be an excellent time to squeeze in some interpersonal skill practice. Maintain your self-respect by saying “no” to requests you do not want to do. Say “yes” to things you are interested in doing. Utilize “I language” to effectively communicate how another person’s behaviors impact you by following this script: “I feel ______ (your emotion), when you ______ (other person’s behavior), because ______ (consequence of other person’s behavior).” 6. Practice sitting with discomfort. Perhaps your go-to strategy for dealing with stress is smoking a cigarette. Maybe it’s online shopping or zoning out in front of the television. While distracting from negative emotions certainly has its place, it can also be useful to practice sitting with and experiencing feelings of discomfort. Over the holidays, if you notice yourself feeling frustrated, nervous or sad, and if it feels tolerable enough to sit with, ask yourself these questions: “Right now, what sensations do I notice in my body?” “Right now, what thoughts are going through my head?” “Right now, what emotions am I feeling?” Be curious and nonjudgmental about your answers. Remind yourself that whatever emotion you’re experiencing is temporary. Each time you practice sitting with uncomfortable emotions, you’re strengthening your ability to tolerate similarly difficult emotions in the future. Exercise your mind and strengthen your emotional resilience! 7. Radical acceptance. You can use all of the coping skills in the world, and you may still end up in a situation that you dislike or hoped would be different. Radical acceptance can be used if you’re unable to keep painful events or emotions from coming towards you. Refusing to accept reality can keep you stuck in feeling of bitterness, hopelessness, or resentment. Radical acceptance is accepting the situation you are currently in; not the situation you want to be in, and not the situation you think is fair. Radical acceptance is NOT agreeing with the situation, approving of it, or even liking it. Nor is it being complacent in a situation where you are being physically or emotionally abused. It is recognizing and accepting that reality is what it is. If you are in a batting cage and refuse to accept that baseballs are being hurled towards you, it will not make the baseballs go away. If you accept the situation you are in, it gives you more space to tolerate your emotions and make changes where you are able to make change. Practice radical acceptance by noticing if you are questioning or fighting reality by thinking “it shouldn’t be this way” or “why me?”. Remind yourself that the reality cannot be changed and that there are causes for the reality. Practice accepting your situation with your mind, body and spirit. #stress #anxiety

Anxiety is a normal part of life. You likely feel keyed up or on edge when you’re waiting for medical test results, when a car suddenly pulls out in front of you, or when you realize you’re running short on money and payday is still a week away. Anxiety is a normal reaction to these events because all three examples share one thing in common: they’re threats. Bad news from the doctor and a car pulling out in front of you can both mean your life is in danger. Running out of money can mean you might lose your home or won’t have enough to eat. Normal anxiety is useful. It can energize you and help you focus on your final exam. It can help you react quickly to avoid an auto accident. It can help you figure out the solution to a problem. When anxiety reaches a level to where it is causing you distress and is going on for some time, you may have an anxiety disorder or possibly posttraumatic stress disorder (PTSD). People with anxiety disorders often report ongoing fear and worry, irritability, sleep disturbance, muscle tension, and other symptoms. What is a panic attack? Some people with anxiety occasionally experience panic attacks. While anxiety gradually builds up, a panic attack is a sudden, intense bout of anxiety that usually lasts for several minutes and rarely more than an hour. During a panic attack, you may feel an extreme sense of dread, racing heart, shortness of breath, sweating, shaking, chest tightness, dizziness, and feeling disconnected from yourself or your surroundings. You likely feel exhausted and still at least somewhat anxious after a panic attack subsides. Panic attacks are terrifying, and sufferers often feel like they are dying or going crazy. Fortunately, neither of these are true – panic attacks are actually harmless. You can’t stop a panic attack once it starts; it will stop on its own. If you’ve had your first panic attack, please see a physician to ensure that your symptoms are not caused by something else. If you know you’re having a panic attack, here are some steps you can take to help you cope while it is occurring. RESCUE Rx FOR PANIC ATTACKS: When you feel a panic attack starting: 1. Talk to yourself. It’s helpful to identify the panic attack, because the nature of panic is to frantically search, either in your head or in your environment, for any source of danger. In a panic attack, you cannot run from it or fight it, as there is no source of danger. Stay in the present. During a panic attack, you may have scary and negative thoughts like “What if I’m losing my mind?” or “What if I pass out?” Interrupt these thoughts as they come. Instead, say to yourself, “I’m having a panic attack. I know I’m not in any danger, I’m not going crazy, and I’m not dying. I know this will be over soon.” Try repeating a specific phrase to yourself, such as “I am okay” or “Ride it out.” 2. Choose your position. Some people find that sitting or lying down is most helpful during a panic attack. Sometimes, sitting on the floor is best because it feels more stable. Other people find that pacing is more soothing, just stay where you are if you can. You don’t have to leave where you are for the panic to subside – relief will come to you. 3. Breathe. Focus on slowing your breathing by inhaling through your nose to a count of five. Fill your lungs with air all the way down to the very bottom. Your stomach should expand before your chest rises. It may help to place one hand on your stomach and the other on your chest. As you breathe in, make sure your belly expands. Then breathe out through your mouth to a count of five. Repeat until your panic attack begins to abate. 4. Look at something or just close your eyes. Since your vision becomes very acute during a panic attack, visual stimuli can be overwhelming. Choose an object to focus on. If it’s helpful, describe the object by saying its name, color, shape, purpose, etc. If closing your eyes helps more, do that. 5. Wait it out. Although it feels like it will never end, a panic attack, by definition, is time-limited. Read more about that below. Relief will come no matter what, so just wait. Between panic attacks: 1. Know what they are, and what they aren’t. Knowledge is power. Knowing what is going on in your body when you’re having a panic attack can help you cope and prevent you from misinterpreting the symptoms as something more severe. We share an amazing survival feature with most of the animal kingdom: the fight or flight response. Be grateful you have this ability – when faced with real danger, it can save your life! Your body keeps a reservoir of a chemical called adrenaline at the ready in case it is needed. When faced with an immediate, life-threatening danger, your brain quickly sends signals to your body to help you survive. Your body dumps the adrenaline (and another chemical, cortisol), which causes physical changes that help you to defend yourself or escape. Your heart rate increases to pump blood more quickly into your large muscle groups. Your pupils dilate to help you perceive the environment more clearly. Your energy level soars. Your digestion slows to divert energy to your muscles. Along with these effects, you feel terrified and may experience shaking, sweating, skin flushing, chest tightness, shortness of breath, elevated blood pressure, tunnel vision, and dry mouth. A panic attack is a sort of “misfiring” of this natural response to danger. When the fight-or-flight response begins due to non-lethal stress or no apparent stressor at all, we call it a panic attack. You can see why panic attacks are so terrifying and distressing! Fortunately, your adrenaline reservoir “burns out” in a short period of time, and the panic attack ends. It takes your body a certain amount of time to rebuild that reservoir of adrenaline so that it is ready for the next time it is needed. 2. Learn and practice relaxation techniques. Relaxation is the opposite of anxiety. When you learn and practice relaxation-inducing behaviors, your anxiety is reduced. Just like training for a marathon, you must practice these techniques for them to help you. Too many anxiety sufferers try these techniques once and decide they don’t work. You didn’t develop your anxiety problem overnight, and you won’t cure it overnight. Make a commitment to yourself to practice relaxation techniques every single day, whether or not you feel anxious. Some types of relaxation techniques that have been shown to be helpful include abdominal breathing, progressive muscle relaxation, mindfulness, and visualization. 3. Exercise regularly. Did you know that exercise is one of the best mental health treatments? Exercise helps relieve anxiety as well as depression. It really doesn’t matter what kind of exercise you do, but aerobic exercise may produce the best mental health effects. Yoga is also a great way to reduce anxiety, as it combines physical activity with deep breathing and mental focus. 4. Seek support. Keeping a good social support system can help you by knowing you are not alone, increasing your quality of life, helping you feel connected, and even helping you live longer. Stay in regular contact with friends and family, even if it is just to ask them how they’re doing. 5. Get help. Panic attacks usually begin after you’ve been under a lot of stress over a period of time. Counseling can help you learn to manage your day-to-day stress so that it does not build up. A mental health counselor can help you learn the techniques you need to manage your anxiety and stress as well as cope during panic attacks. Our counselors in Cary can provide the anxiety treatment you need. There are medication options for people with chronic anxiety and panic attacks. If medication is needed, we can refer you to psychiatrists in Cary and the surrounding areas to discuss medicine that might help. If you have struggled long enough and want to talk about your symptoms with a therapist who understands, give us a call. We are happy to help you. #anxiety #panicattack #PTSD

My name is Kali, and I am the HIPAA privacy and security officer for Etheridge Psychology. It is my job to make sure our office stays HIPAA compliant and that your protected health information is not improperly shared. We take your privacy very seriously. Our counselors and psychologists know that the information you’re sharing is very private and personal; you may share things you’ve never told anyone else before. We also know that if you weren’t confident that information was protected, it would be less likely that you would share it. What is HIPAA, exactly? It stands for the Health Insurance Portability and Accountability Act. HIPAA can be confusing for patients and healthcare professionals alike. At its core, it is a federal law designed to protect patients and their health records. There are lots of other aspects to this law, but I will focus on the privacy aspect. Here are some HIPAA related terms that you may have seen or heard in your practitioners' offices before: PHI – This stands for protected health information. That means any information that can be used to identify you, such as your name, date of birth, address, or social security number. Disclosure – The act of releasing protected health information. This cannot be done without your authorization (except under certain circumstances which will be stated in more detail below). Authorization – The patient may authorize that a healthcare provider can release or disclose their protected health information to a third party by signing a release form. There are some instances that mental health professionals cannot keep information confidential. If the patient discloses information to the clinician that leads him or her to believe that abuse or neglect of a child, elderly person, or disabled adult is happening, they must report it to the Department of Social Services. If you are an imminent danger to yourself or others, your clinician will take the necessary steps to ensure that you or someone else is not harmed (they may need to share your PHI with family members, the police, or the individual that could be harmed). Lastly, a court can subpoena a clinician’s records, and they are required to disclose whatever the court has requested in the order. It is also worth noting that minors and dependent adults have very limited right to keep their information private from their parents. Here at Etheridge Psychology, we take a number of safeguards to make sure your mental health records are protected and disclosed properly. Some of the things we do here are: Technology – All of our computers are secured to stringent HIPAA standards. Paper – Most paper documents that contain patient information are shredded. Anything we do keep hard copies of are protected by lock and key. Authorization/Release forms – These forms can be confusing, as HIPAA requires certain specific information on a release form for it to be valid. Our administrative staff and clinicians will help you with release forms if needed so that you’re confident that you know what you are signing. Our office frequently performs risk assessments to make sure your information stays protected. If you have any questions about HIPAA or your privacy rights as it pertains to your treatment here, we are happy to help. If you would like to learn more about HIPAA, please click the following link: HIPAA for Individuals

The pace of our lives has become very fast. With our busy schedules, the 24-hour news cycle, social media, and even electronic devices that send texts and emails to our watches, it can be hard to slow down and unplug. Mindfulness is a strategy that can help us slow our minds and bodies and calm the churning thoughts in our heads. It has been a media buzzword in recent years, but many people aren’t quite sure what it is or how to do it. Modern day mindfulness is derived from ancient Buddhist and Yoga practices and is an open and friendly awareness of what is going on inside and outside of ourselves at any given moment without judgment. When we are mindful, we notice the feeling of sun on our skin, the taste of our morning coffee, a wave of sadness or frustration come over us, or a thought that popped into our minds. Being mindful helps us to pull out of autopilot mode to focus our attention, understand our thoughts and feelings, reduce stress, reduce emotional reactivity, and to promote a general sense of health and well-being. Here are some simple mindfulness exercises that can be used in every day life to help handle stress: Come Back If you find yourself feeling stressed, and your mind can’t let go of worries, kindly notice that this is happening and gently say to yourself, “Come back.” Then take a calm breath in through your nose and out through your mouth and focus on what you are doing right now. Calm Breathing Focusing on the breath can be an easy way to be more present in any given moment. Count your inhale and see if you can make your exhale a little longer. This technique helps you slow down your breathing, and it lengthens the breath out , forcing you to release more carbon dioxide, slowing your heart rate, calming you down, and restoring emotional equilibrium. Finger Breathing Finger breathing is a different version of counting your breath. Hold one hand in front of you with your palm facing towards you. With the index finger of your other hand, trace up the outside length of your thumb while you breath in, pausing at the top of your thumb and then trace it down the other side while you breath out. That’s one breath. Trace up the side of the next finger while you breathe in, pause at the top, and then trace down the other side of that finger while you breathe out. That’s two breaths. Keep going, tracing along each finger as you count each breath. When you get the end of the last finger, come back up that finger and do it in reverse. This exercise can help you to focus your attention and have something to do with your hands, especially if you are anxious or in a place where there are distractions. Three Senses Notice what you are experiencing right now through three senses – sound, sight, touch. Take some calm breaths and ask yourself: What are three things I can hear? (ex: clock ticking, a bird outside, my breath) What are three things I can see? (this table, that sign, the tree out the window) What are three things I can feel? (the chair under me, the shoes on my feet, my clothing on my skin) Some useful mindfulness meditations can be accessed through these websites: https://www.uclahealth.org/marc/mindful-meditations http://www.mindfulness-solution.com/DownloadMeditations.html

1. We see tears every day. Crying can be embarrassing, and we understand that. Please feel free to express your emotions with us; that is exactly why we are here for you. 2. We learn a lot from you. You tell us some amazing things sometimes. Whether it’s a unique insight you have based on your experiences, a piece of wisdom that you share with us, or your life experiences, we learn from you. You help us grow as therapists and as individuals. 3. We can’t always help you. If you are not ready to change, we will try to help you get there, but it may not be the right time for you. Conversely, if you enter into therapy with the expectation that your therapist can solve all of your problems, you may be disappointed. Finally, we aren’t trained in everything. If we feel as though we lack training in your area of need, we will be honest with you about it and help you find a therapist that better fits your needs. 4. We may do some re-parenting with you. This is not to suggest that we will become your long-lost mother or father. A lot of adult problems stem from childhood, and sometimes we find ourselves teaching you a skill you should have learned from your parents. This does not mean your parents were awful; sometimes it’s the result of what we call “accidental parenting,” which is what happens when a parent means well but misses an important part of child-rearing. No parent is perfect, and we will not spend our time blaming your parents. In fact, forgiving your parents for not being perfect is very healing. We will help you fill in the gaps. 5. We are very strict about confidentiality. Mental health professionals have protected your confidentiality with fervor since far before HIPAA was a thing. We are diligent about computer security, shredding papers, and keeping your secrets. In fact, if we find out that you and another client may know each other, we will schedule you on different days and not even tell you. While there are some legal exceptions to confidentiality, it's a part of our job we take seriously. 6. We don’t want to send you to a psychiatric hospital. Patients are wary of discussing their suicidal thoughts with us for fear we will have them locked up in a hospital. The fact is, we will do everything in our power to avoid hospitalization. Talking about your suicidal thoughts is important, and we can’t help if you don’t tell us. We will only initiate involuntary hospitalization if we feel that you are at imminent risk of going through with a plan of seriously harming yourself or someone else. Additionally, we are mandatory abuse reporters, which includes abuse of any child, disabled adult, or elderly person. 7. We don’t take credit for your success. We didn’t help you get better any more than the hardware store helped you fix your toilet or the gym got you in shape. We give you the tools, but you do all the changing. 8. Nothing you tell us will shock us. Not only have we heard it all, but we won’t judge you. You are not your behaviors or feelings. We are here to help you, and if you need to tell us embarrassing or difficult things for us to help you, we want you to disclose it without fear of judgement. 9. Health insurance is really frustrating to us. We try to verify benefits before patients come to see us, but sometimes the insurance company gives us the wrong information. For example, your insurance company may tell us to charge you just a $25 copayment, but then they apply the visit to your deductible when they process the claim, leaving you with a large bill. We have no control over what the insurance company says or does, and sometimes patients don’t understand that. With insurance requiring more and more out-of-pocket costs to the patient, we’re as frustrated as you are. 10. Crisis is self-defined. If something is important to you, it is important to us. We will never tell you that you are worrying over nothing or that your problems are not important. Need a therapist in Cary? Click here to contact us. We provide counseling both in the office and online!

With August on the horizon, most families are trying to savor the last month of summer. For many parents, students and teachers, embedded within the end of the summer is also the anticipated transition back into a new school year. For some families this might be a happy change, while for others, transitions can be a time of stress. The “unknowns” of a new school year can create feelings of anxiety, which can affect the whole family. While everyone experiences anxious feelings in their own way, there are steps you can take to mitigate the stress of a transition. 1. Increase predictability through routine While it is recommended to re-establish a sleep and wake cycle consistent to the anticipated school schedule a week beforehand (Fritz, 2014), you can ease into a new schedule even earlier. Changing a bedtime routine by 10-15 minute increments is discrete enough for most children to gradually adjust, and will eventually get you to the new routine over the course of weeks. Fatigue and exhaustion can contribute to anxiety and moodiness, so ensuring that your family is getting enough sleep when school starts can be one less factor to worry about. 2. Increase comfort through familiarity Anxiety can be a reaction to anticipating a bad outcome, or a “worst case scenario.” Envisioning what potentially can happen prepares us mentally, but when we anticipate a distressing outcome, it is natural to be wrought with worry. Exposure to what is “real” and “actual” helps to reduce stress over what we picture “could” happen. Knowing the items on an exam before taking the test would certainly boost a person’s confidence in their performance. Visiting a classroom, meeting a teacher, playdates with classmates BEFORE starting the school year could help to ease a student’s worry by providing them with pieces of “known” data. 3. Increase confidence through preparation Having the tools needed in the classroom can create a sense of comfort and confidence. Imagine, it’s the first day of school, and a teacher asks their students to pull out their calculator. Now imagine the feeling a student would experience if they did not bring a calculator to school. How do you think that would affect their confidence and comfort going into the second day of school? Going through the checklist of school supplies and expectations with your family members BEFORE starting school will increase their confidence in their preparation and improve their comfort. 4. Increase confidence through choice and empowerment Not every moment of the first few days of the new school year will go perfectly, but letting your child know that you believe that they can handle the bumps in the road will provide more support for their confidence. Allowing your student to feel as if they have some control over themselves and their world creates a sense of empowerment. Providing opportunities for your child to feel that they have some effect on their lives, and you trust that they can make good decisions, helps to build confidence within themselves. What do you want to wear tomorrow? It is homework time, what would you like to work on first? Even if it is a choice between two options (I can drop you off or you can take the bus), creates a sense of ownership. Feelings of powerlessness can contribute to anxiety, so offering opportunities to feel more in control of their world creates some sense of empowerment. 5. Let us help Lastly, if you feel that anxiety or worry is affecting your loved one negatively, help is available. Here at Etheridge Psychology, we offer individual anxiety counseling for children, adolescents, and adults. We use cognitive behavioral therapy, which is an established effective intervention for the treatment of anxiety. We also offer an intensive anxiety and stress group for teens. If your high school student is suffering from excessive worrying or stress, they are not alone. Group therapy provides an excellent resource for support and skills building to alleviate stress. From everyone at Etheridge Psychology – we hope that you enjoy the remainder of your summer! #teens #anxiety #children #stress

Picture this: It’s dark outside, you’re feeling warm and comfortable tucked into your bed, and your eyes blink open. It doesn’t feel like it’s time to wake up, so you glance over at your alarm clock - it reads 2:15 AM. It isn’t late enough to start your morning, but you can’t fall back asleep. Your mind races as you think about your upcoming responsibilities, work tasks, and home duties that need to be done even though you feel like you haven’t gotten a good night of sleep in weeks. Sound familiar? Unfortunately, frequent nights of tossing and turning feel all too familiar in our society. Rather than addressing the source of the problem, it can feel easier to soothe a rough night of sleep with several cups of coffee or eating more sugary foods. Poor sleep quality can impact your ability to attend to daily responsibilities and increase your vulnerability to negative emotions. One way to improve sleep quality and quantity is to decrease maladaptive sleep habits and incorporate healthy sleep skills into your routine. Sleep hygiene activities are habits people engage in to increase the quality and quality of sleep and to assist with signaling to the body and mind that it is time for bed. Here are some sleep hygiene “do’s” and “don’t’s” to help you figure out how to get a better night of rest tonight. DO: Turn off electronic devices. Dim the lights in your home. Do some light stretching or yoga. Do some reading or journaling. Work on a Sudoko or crossword puzzle. Write down a list of tasks to do tomorrow. Drink a cup of caffeine-free tea. If you can’t sleep within 15 minutes- GET OUT OF BED! This has been the number one tip that has helped me improve my sleep. Rather than tossing and turning at night, I’ll get up out of bed, sit on the couch in my living room, and read a scientific magazine. I find the articles to be soothing and distracting. DON’T: Watch television before bed. The light and sound from the television signal to your brain that it is time to be awake. Eat a large meal. Digestion is an active process in the body, and eating a large meal before bed can make it harder for you to fall asleep. Eat, read, or watch television in bed. Doing other activities in bed can make it difficult for your brain to associate your bed with sleep. Try to use your bed for sleep and sex only. Negative sleep patterns may be an indication of medical or mental health challenges. If your poor sleep persists for several weeks, contact your primary care physician for a physical and reach to one of our counselors. Give your body a break, and start working today to sleep better tonight. #sleep #insomnia

You may have noticed on our home page that Etheridge Psychology offers three main types of services: counseling, psychological testing and assessment, and forensic psychological services. Each of our clinicians has a unique background of education and experience, and we are pleased to be able to serve children, adolescents, and adults with a wide variety of needs. Our counseling services range from supportive therapy for life changes and events to therapy for a specific mental disorder such as an anxiety disorder, depression, bipolar disorder, personality disorders, obsessive-compulsive disorder, or PTSD. Our evaluation services include clinical psychological evaluations, neuropsychological testing, and psychoeducational testing. One part of our practice is forensic psychology. What is forensic psychology? Forensic psychology refers to the interaction between psychology and the law. Forensic psychologists working in a private practice setting assist the courts by conducting psychological assessments of individuals involved in the legal system. They also provide consultation services to attorneys who have questions about a psychological topic that pertains to a legal issue. They often testify in court as expert witnesses. Some forensic psychologists also work in other settings, such as prisons, juvenile detention facilities, and police departments. What forensic services do you provide? At Etheridge Psychology, our forensic psychologists conduct psychological evaluations in various areas. We also provide consultation services to attorneys and testify in court. Our job in a forensic evaluation is to answer questions posed by the court. Following are some examples of questions we answer in our work: Does this individual have a mental disorder that is affecting their functioning? Is this individual fit to have unsupervised visitation with, or custody, of their minor child? What is a child custody arrangement that is in the best interests of this minor child? Does this individual have the capacity to handle their financial and personal affairs? Did this individual have the capacity to waive their Miranda rights? Does this individual have the capacity to stand trial? Was this individual criminally responsible for the crime they committed? Is this individual at risk for committing a violent or sexual crime? In civil court, we are often involved in divorce and child custody proceedings as well as guardianship cases and immigration cases. In criminal court, we are often involved in cases involving abuse (e.g., child abuse, elder abuse), violence, sexual violence, and homicide. Evaluations of violent individuals are conducted in jails and prisons. We are sometimes asked to conduct a forensic psychological evaluation outside of the court system, but still for a legal purpose. Examples include psychological fitness evaluations, which are typically requested by a workplace or educational institution. This type of evaluation may be requested after an incident at work or school or if a workplace or educational institution has reason to believe that a worker or student has a mental disorder that might affect their ability to perform or their safety with coworkers or classmates. An evaluation may also be requested at the beginning of employment in a high-risk profession such as police officer. How is a forensic evaluation different from a regular psychological evaluation? An entire article could be written solely to explain all the differences between clinical and forensic evaluations, but here are some of the main differences. A “regular,” clinical psychological evaluation is done for the purpose of diagnosing a mental health condition and recommending treatment for that condition. It is a healthcare service in which a patient receives services by a doctor. People visit us for clinical evaluations when they have mental health related symptoms and want to know if they have a mental disorder. They may also be referred to us by a physician or counselor. A forensic evaluation is not done for healthcare purposes; it is a legal service. As such, the individual being evaluated is not considered a patient, and no healthcare services are provided. Since a forensic psychological evaluation is not a medical service, it is not covered by health insurance. None of our current contracts with health insurance companies permit us to bill them for a forensic evaluation. The results of the evaluation are typically released to the individual’s attorney or directly to the court rather than to the individual being evaluated. Where can I learn more? You can find more information here: American Psychological Association iresearch.net Psychology Today #forensicpsychology

Stress is a normal part of life. However, if you notice you’re feeling worried more often than not, your moods are frequently negative, or your grades are beginning to suffer, there is a good chance your anxiety is becoming problematic. Anxiety is the number one mental health problem facing teens today, and it is far more common than most parents realize. Anxiety symptoms and anxiety disorders in teens are associated with “impaired school functioning and school absenteeism, negative school environment, poor coping skills, and difficulties in relationships (Raknes et al., 2017).” Teen anxiety symptoms can be associated with depression, substance use, and difficulty envisioning adulthood. Knowing the signs to look for can be helpful in making a decision about seeking help. Here are some signs that your stress or anxiety is getting out of control: Frequently feeling overwhelmed Feeling edgy or even afraid without a clear reason Experiencing negative thoughts or expecting the worst to happen Having difficulty turning your mind off at night to fall asleep Waking up during the night and struggling to get back to sleep Feeling tired during the day Biting your nails or picking at your skin Having a racing heart, clammy hands, or feeling short of breath Having stomachaches or headaches Frequently worrying about various things, such as grades, friendships, the future, etc. Feeling irritable or grumpy Feeling tense, nervous, or on edge Believing that everyone around you is judging you or thinking poorly of you Struggling to concentrate or remember things Experiencing muscle tension Panic attacks or anxiety attack symptoms If you can relate the any of the symptoms listed, it would be helpful to speak to a professional in the mental health field. Anxiety is nothing to be embarrassed about, in fact there are a lot of people out there who can relate. Feeling anxious is your brain’s way of telling you that you’re struggling, and the good news is that it can get better. Counselors can help you with managing and/or reducing your anxiety by talking about the problem one-on-one, helping you identify and change thought patterns that are keeping you anxious, and teaching you skills to reduce your anxiety. Teen anxiety counseling can make a world of difference in your day-to-day life. One helpful type of therapy is cognitive behavioral therapy, but we draw from other evidence-based therapy methods as well. Group therapy for anxiety involves meeting with other teens in a confidential environment and learning anxiety-reducing skills together. Teens say that the group therapy environment is helpful because they realize that they’re not alone in their struggles and benefit from what has helped their peers. In the meantime, here are some things you can do to help yourself feel better: Write down your worries Draw a picture or create some other type of art Take a walk Do some physical activity you like, such as weightlifting, skateboarding, or playing a sport Try herbal tea Take a warm bath or shower Listen to music Talk to someone you trust Take slow, deep breaths, making sure you fill up your lungs all the way to the bottom Interrupt negative thinking Get enough sleep If you would like to seek professional help for yourself or a teen in your life, Etheridge Psychology would be happy to schedule your appointment. Adolescent support groups specializing in teen anxiety will be starting soon, and we are also taking individual clients. Give us a call to get on our anxiety support group list or to schedule for individual counseling with one of our child therapists or our child psychologist in Cary. #anxiety #depression #teens #grouptherapy

We all have times when we might say we feel depressed, but does that mean you have "clinical depression?" What are the symptoms of clinical depression? Clinical depression is a disabling mental disorder that can interfere with your sleep, appetite, and sexual drive. It can contribute to pain, headaches, and gastrointestinal problems. It takes away your interest in activities you once enjoyed, saps your energy, and can leave you feeling worthless or guilt-ridden. Depression can destroy your marriage, wreak havoc on your career, and drive your friends away. It leaves you feeling as though you're on an island, alone in a sea of seemingly happy people. It can also result in suicidal thoughts and behaviors. Depression, if left untreated, can be a downward spiral, with its symptoms driving away needed supports when the sufferer needs them the most. Feeling sad because a friend moved away, a loved one passed on, or you didn’t get an expected promotion is certainly normal. Feeling temporary sadness for no identifiable reason is still considered to be within the range of normal. In both cases, even though you may not have a diagnosed mental disorder, a depression counselor can help. In therapy, you can talk about your feelings, work through any life problems that are bothering you, and learn techniques to help you reduce your symptoms. When your symptoms persist or worsen, you may be clinically depressed. First, “clinical depression” isn’t really an official term; it is used informally and loosely to describe a group of conditions more officially known as depressive disorders. To determine whether your sadness or gloomy mood is in the range of normal, it’s helpful to know when it’s not normal. As you read on, please keep in mind that having some of these symptoms does not necessarily mean that you have a disorder. There’s no way to know for sure if you have clinical depression without a diagnosis from a doctor or mental health professional. Did you know that you don’t have to feel sad or cry all the time to have clinical depression? Some people have other symptoms that, together, represent a depressive disorder. Types of Depression There are different types of depression, but all types share some of the same symptoms. Mental health counselors and psychologists don’t call it a depressive disorder unless you have a certain number of symptoms, the symptoms are of a certain severity, and you’ve had the symptoms for a certain amount of time. For all depressive disorders (actually most mental disorders), the symptoms must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. What does that mean? Clinically significant distress means that your symptoms are severe enough that they are really bothering you. Clinically significant impairment means that some aspects of your daily life are affected. For example, you’re having a hard time getting your work done, you’re distancing yourself from family and friends, or your pantry is bare because you can’t muster up the motivation to go grocery shopping. The Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition (DSM-5) identifies several specific depressive disorders: Major Depressive Disorder Persistent Depressive Disorder (Dysthymia) Disruptive Mood Dysregulation Disorder Premenstrual Dysphoric Disorder Substance/Medication-Induced Depressive Disorder Depressive Disorder Due to Another Medical Condition Other Specified Depressive Disorder You may have heard of Seasonal Affective Disorder (SAD), which is a type of Major Depressive Disorder that tends to occur only during the winter or more gloomy months of the year. You may be surprised to learn that some people with SAD only experience symptoms during spring and summer. It is important to note that there is another class of disorders that include depression symptoms. Bipolar Disorder is a class of disorders that is separated in the DSM-5 from depressive disorders. The depressive disorders most commonly seen in our practice are Major Depressive Disorder and Persistent Depressive Disorder (Dysthymia). Major Depressive Disorder (MDD) MDD sufferers have at least five of these symptoms all present during the same 2-week period. Most symptoms must be significant and be present most of the day, nearly every day. Feeling depressed. You may feel sad, empty, and/or hopeless. Lowered interest in activities or decreased pleasure in activities you used to enjoy. Increase or decrease in appetite, possibly with weight loss or weight gain. An increase or decrease in sleep. Restless behaviors such as pacing, hand wringing, and difficulty being still. Alternately, you may experience a slowing of movement and reactions, such as slower speech, moving and completing tasks slowly, and having difficulty doing routine things such as getting ready for work. Fatigue or loss of energy. Feelings of worthlessness or guilt. Difficulty thinking, concentrating, or making decisions. Recurrent thoughts of death, suicidal thoughts, or suicide attempt. At least one of the symptoms must be depressed mood or loss of interest or pleasure. It’s important to note that you may have other symptoms not listed above as part of MDD. For example, anxiety often co-occurs with depression. Depression counseling can help with your other symptoms as well. You may appear to meet the diagnostic criteria if you have recently endured a significant loss, such as death of a loved one, financial ruin, or being diagnosed with a serious medical condition. If that is the case, MDD is not typically diagnosed. This is because depressive symptoms are an expected reaction to one of these devastating events. Persistent Depressive Disorder (Dysthymia) Persistent Depressive Disorder used to be known as dysthymia or dysthymic disorder. For the purpose of brevity, I will refer to it as PDD. PDD is different from MDD in that fewer symptoms are required for the diagnosis, but the symptoms have been ongoing for a much longer period of time – at least two years. A person with PDD experiences a depressed mood for most of the day, for more days than not, for at least two years. Additionally, two or more of these symptoms are present for much of the time: Increase or decrease in appetite. Difficulty sleeping or sleeping too much. Low energy or fatigue. Low self-esteem. Poor concentration or difficulty making decisions. Feeling hopeless. As you can see, you do not have to be holed up in a dark room and crying uncontrollably for weeks at a time to meet the diagnostic criteria for a depressive disorder. Many sufferers of clinical depression get up on time, go to work, and play with their children every day despite their symptoms and inner turmoil. On the other hand, some sufferers have significant difficulty getting out of bed and going through the basic motions of life. The range of symptoms and severity is large. It is important, however, that you get an accurate diagnosis. You may know you are depressed, but getting evaluated for depression ensures that you determine what kind of depression you have, rule out other possible causes of your symptoms, and get the right treatment for your specific symptoms. You may have recognized some of the symptoms in yourself and perhaps do not feel that you have the minimum number of symptoms or do not meet some other diagnostic criteria. If that is the case, and you are distressed or struggling, there may be something else going on. You may have a different type of disorder (like bipolar disorder or perhaps PTSD), you may be grieving a loss of some kind, or you may be experiencing the effects of general stress or a specific psychosocial stressor. A mental health professional can help you figure this out. What Causes Clinical Depression? Most professionals believe, based on years and years of studies, that depression is caused by a combination of biological, psychological, and social factors. Biological factors may be rooted in the genes you inherited from your parents, a medical disease or condition you have, a drug (prescription or otherwise) that you’re taking, hormonal levels, and possibly even gut bacteria. Psychological factors can include your thinking patterns, beliefs, self-esteem, personality characteristics, and coping skills. Social factors include the quality of your relationships and support system, difficult events in your life, and even the way you were parented as a child. Since there are so many potential contributing factors, there is no way to tell for sure all of the exact causes of any given individual’s depression. A good evaluation by a mental health professional can pinpoint likely causes, and this is enough to create a treatment plan tailored to your specific needs. What are the Treatments for Depression? I like to categorize treatment options into three categories: self-help, psychological help, and medical help. Self-help options include activities such as reading books and reputable online articles about depression, writing down your thoughts and feelings in a journal, exercising regularly, making an effort to get together with family and friends, getting a little direct sunlight when you can, and keeping a regular sleep schedule. Psychological help involves working with a psychologist, therapist, or mental health counselor. Therapy for depression can help you explore the roots of your symptoms, identify any thinking patterns that may be contributing to your distress, and help you change some behaviors that will get you on your way to feeling like yourself again. Medical help starts with a physical examination to look for possible physical causes of some of your symptoms. A medical doctor, such as a primary care physician or a psychiatrist, may also prescribe an antidepressant medication. Suicidal Thoughts Most people have had fleeting thoughts of wanting to die at some point in their lives. When you are having repeated suicidal thoughts, your thoughts are becoming more and more specific (e.g., you start considering methods of killing yourself), or you begin taking steps toward suicide (e.g., obtaining a method, writing a note, arranging your affairs), you need immediate professional help. Many individuals are concerned that if they seek counseling for suicidal thoughts, they will be committed to a psychiatric hospital. This is not necessarily the case. It is perfectly fine to discuss your suicidal thoughts with your counselor. In fact, therapy is sometimes the only place you can feel safe talking about those dark thoughts and feelings. It is only when your counselor believes that you are at an immediate and serious risk of harming yourself or someone else that they are required to take steps to protect your life or someone else’s life. If you or someone you love are having suicidal thoughts and feel that you need immediate assistance, please click on our “Crisis Resources” link at the bottom right of this web page. A Final Note Whether or not you have “clinical depression,” you deserve to feel better. You do not have to have a mental illness to seek and benefit from counseling for depression. We offer depression therapy for children, teens, and adults. #depression #suicide

Suffering posttraumatic stress is not a sign of weakness but rather an expected consequence of war. With that said, the degree and nature of the impact of trauma varies wildly from person to person and experience to experience. For some, the impact is immediate and sometimes requires removal from combat settings. For the majority of combatants, the signs and symptoms of PTSD slowly emerge over the course of many years. PTSD is a “for life” condition with no cure, as the memories of combat will always exist and will always be emotionally charged. On a positive note, PTSD is very manageable and is known to respond to psychoeducation and therapy. Medications and other treatments are often employed, but these treatments are not considered first line treatments except with some severe cases or cases that involve multiple mental health conditions. Before getting into the standard signs, symptoms, and treatment of PTSD, it is important to know a little more about the opening stages of PTSD and common functional complications. One aspect that is often overlooked in the literature is the utility of the emotional numbing and detachment associated with the condition. PTSD: A Friend? PTSD starts out as a friend to combatants. Why? It begins with the trauma itself and an emotional separation from the horrific event that is occurring. The experience is best described as surreal. When faced with death and/or serious injury to self or others, people often feel fear or horror. That said, they are often able to separate themselves enough and avoid processing what they are witnessing in order to maintain control of their behavior. This allows them to complete the job they are there to perform without an overt emotional response that could endanger the lives of themselves and others in the engagement zone. They should be scared beyond definition, but there is no time for that in combat. This is why military personnel are asked to repeat drills and exercises at their stateside bases on a non-stop basis. I hated these drills when I served, and I never appreciated the rationale… until I did. The goal of the military machine is to prepare individuals to perform their duties even when injured and/or discombobulated. This is known as achieving “fingertip knowledge” of each person’s identified role which is achieved through repetitive learning. The machine needs everyone to know their duties without having to think too much while taking on enemy fire. Standard Operating Procedure: The Black Box and Post Combat Life During months of combat deployment, the ability to detach from combat experiences and related emotions becomes second nature. Even after leaving the danger zone, the combat veteran often maintains that detachment, as reliving the memories and horror of military trauma is just too much. However, those curbed experiences are not discarded from memory. In fact, all details of the traumatic experience - the sights, sounds, smells, and other sensations - are recorded in such detail. These in-theater experiences are stored in the “black box” of traumatic memories in the dark net of the veteran’s mind, often outside conscious awareness. One could say that the veteran’s mind is protecting him or her from that trauma. As the veteran returns from combat and are asked to complete a PDHA (Post Deployment Health Assessments) during post-deployment processing (back stateside), medical and behavioral health staff hope to get a jump on the eventual stress. These efforts are often thwarted, however, as the trauma suffered APPEARS to be safely tucked away in that black box. Still more, keeping things in that box seems prudent, as the contents are understood as horrific events best left in country. Matters are not helped by the unspoken understanding that behavioral health referrals are considered career killers by service members. Once stateside, the combat veteran begins to re-engage in his or her community. This is where the timing and severity of post-combat stress symptoms varies dramatically from person to person. With that said, most service members report a noticeable change in their experience of life after war. Small things in their daily routine, once benign, suddenly trigger a new experience of internal discomfort, anxiety, fear, depression, and/or anger. This continued difficulty in re-engagement is often accompanied by impairments in social, marital, and familial relations and occupational functioning. Consider the following example: Sgt. Tucker and his wife are headed to a nearby lake on a beautiful weekend day and decide to stop at a gas station for a drink. Sgt. Tucker walks into the store in a happy, relaxed mood. He returns to the car with his drink but begins to curse at his wife because of a napkin on the floor in the car. Perplexed, his wife stares at him wondering what just happened. This only serves to enrage Sgt. Tucker who begins saying things to his wife he never imagined he would. He observes himself acting irrationally and out of control and slips into a shame spiral. There are feelings of humiliation, decreased self-worth, and depression. Unknown to both Sgt. Tucker and his wife is the fact that he was triggered by something in the gas station that caused his mood shift, anxiety, and meltdown. The word “trigger” is a formal way of saying that the black box, the one tucked away in the subconscious, gets plucked from time to time by various things in stateside environments. Let’s say that the trigger in this example was a child wearing a Pittsburgh Steelers shirt in the gas station. Although Sgt. Tucker had no idea at the time, his black box was plucked (triggered) by remembering Joey from Ohio. Joey was a soldier with whom Sgt. Tucker served. Joey was a big Steelers fan and would talk about his team to anyone who would listen until an IED cut him into pieces. Sgt. Tucker’s unit was tasked with collecting his body parts. Sgt. Tucker’s conscious mind does not recall that trauma at the time because he has that black box of traumatic memories in lockdown. Outside of his conscious awareness, Sgt. Tucker recalls Joey’s death which stimulates activation of psychological and biological systems associated with PTSD. PTSD: The Psychological Fueled by a Hard-Wired Biological The psychological component of PTSD is best conceptualized as an anxiety condition on steroids. PTSD is an anxiety condition, and anxiety is a fear-based condition. A chronic fear of unknown threats lurking nearby is fueled by combat experiences that leave most veterans believing that this is a dangerous world. In terms of the psychological seed of PTSD, it can be described as a mushroom that thrives in darkness. Knowledge is the antidote. To understand the biological part, it is important to know what happens to your brain and body when faced with danger. When your brain perceives danger, a series of events very quickly occurs. To summarize, your store of adrenaline is dumped into your body, and this also triggers the release of another hormone, cortisol. Nearly immediately, you perceive a jolt of energy, your heart rate increases, your pupils dilate, digestion slows, and blood is quickly pumped into your large muscle groups. Other effects also occur, and these events effectively prepare your body to fight or run. As a result, you become temporarily more focused, strong, and able to defend yourself or flee. It is a beautiful process that we share with most other animal groups and helps us survive. Emotionally, this can feel like fear or even anger. Humans have another process that often occurs shortly after the fight-or-flight response is triggered. Our frontal lobe, which is the “smart” part of our brain involved in decision-making and other executive processes, helps us to make decisions about the danger. For example, you might become enraged at someone at a bar, causing you to puff up and triggering the fight-or-flight response. Fortunately, your frontal lobe kicks in, you reason out the situation, and you ultimately decide that a bar fight tonight just is not worth it. The biological part of PTSD/anxiety is most simply understood as the outcomes of communication between the frontal lobe (our smart brain also known as the executive processor) and those parts of the brain involved in the fight-or-flight response (we’ll call this our “ape brain”). Combat veterans trust their ape brain, because listening to it meant life or death in warzones. There was no time for reasoning, only action. The problem is that, in individuals with PTSD, the fight-or-flight response is easily triggered by things that are not objectively dangerous but subconsciously remind them of a prior traumatic experience. While this fight-or-flight reaction is quite helpful in country, these sudden unexplained biological responses at their son’s little league game or at Walmart are exhausting and psychologically stressful. Many veterans find themselves avoiding going out because of these reactions. Remember when I mentioned that memories of trauma are stored in detail, even if the combat veteran cannot actively recall the experience? There is a good survival reason we keep those memories – so that we can instantly identify similar danger in the future and act even more quickly. If a deer is attacked by a coyote and survives, that deer becomes hyper-aware of any sign a coyote is near and can avoid it more quickly. It may be a certain scent, a pattern of rustling in the leaves, or movement detected in the periphery. That’s just survival. In PTSD, however, these “signs” extend to things that trigger traumatic memories and result in fear but are not objectively dangerous, such as the sound of a firecracker on July 4 or even a heavy rainstorm. Without treatment, Sgt. Tucker’s life becomes a scattered series of odd mood swings and biologically fueled anxiety attacks with no clear rhyme or reason. As he encounters more and more triggers leading to more outbursts, shame spirals, and fear of the world around him, Sgt. Tucker begins to feel hopeless. Left untreated, the onset of another condition, depression, is common as persons feel powerless to control their symptoms and life. Furthermore, the use of alcohol is a common self-treatment that is more acceptable in military culture than seeking behavioral health treatment. Substance abuse risk is high for PTSD populations. PTSD: Severity Levels The severity of each person’s PTSD varies as does the progression of PTSD. Without treatment, PTSD may remain mild for the remainder of one’s life or it may progress from mild to moderate to severe. Severity levels are commonly determined by the depth and breadth of symptoms and understood impact on social, marital, familial, and occupational functioning. My more informal definition is as follows: With mild PTSD, persons attack or vent against safe targets such as spouses and family. With moderate PTSD, persons act aggressively against bosses, co-workers, and strangers. Maintaining employment can become difficult. With severe PTSD, persons cuss out police officers and judges, commonly suffer co-occurring conditions, and are often unemployable. PTSD Signs and Symptoms PTSD includes a broad range of symptoms across many criteria but is best identified as follows: combat or some form of trauma is present and is persistently re-experienced via nightmares, flashbacks, or other internal/external triggers. Post-trauma symptoms result in a fundamental change in psychological and emotional functioning such as emotional detachment, depression, suicidal thoughts, anxiety, survivor’s guilt, and anger. There is also a presence of hyperarousal symptoms which includes impaired sleep, always scanning one’s environments for threats (hypervigilance), exaggerated startle responses, and extreme irritability. Treatment Many treatments for PTSD are evidence-based. This means that various treatments have been measured and scientifically determined to be effective in managing PTSD. When seeking treatment, people should inquire about evidence-based practices. The primary treatment tool is psychoeducation, which is a component of cognitive behavioral therapy or CBT. Other common techniques include cognitive processing therapy (CPT), eye movement desensitization and reprocessing (EMDR) therapy, group therapy, and medication management. With CBT and CPT, clinicians help the veteran open that black box so they can unmask the boogey man by identifying the things in their environment that trigger their symptoms. Proper treatment teaches combat veterans how to neutralize threats (and associated anxiety) by identifying the environmental cues that are linking to prior experiences. From a psycho-babble standpoint, our smart brain disarms our ape brain with knowledge, which results in reduction of anxiety, depression, and related PTSD symptoms. In Sgt. Tucker’s case, therapy would help him to unload the Joey experience from the black box. Bringing this to his conscious mind would allow Sgt. Tucker to identify the child in the Steelers jersey as the trigger to the sudden anxiety he felt walking into the store. He would then be able to engage his frontal lobe to tell himself that he is not currently in danger, it’s just that the child triggered the fear he felt when his friend was killed in combat. The psychological fear and biological response is neutralized by knowledge. He could then employ skills, such as relaxation techniques and self-talk, to help himself calm down and enjoy the day with his wife. Treatment Cautions and Advice Service members and veterans are often funneled to psychiatry and group therapy treatments by the VA due to staffing shortages. Individual therapy may not be offered, but it is a crucial part of treatment. The best course of action is to begin with individual therapy to determine the breadth and severity of the symptoms. After multiple sessions, the veteran and therapist are better informed as to the need for medication. In my experience, when combat veterans finally muster the courage to seek help, the last thing they want is to be in a room full of other patients. Group therapy is an excellent adjunct to treatment; however, it may be best to wait until after the groundwork has been laid down in individual therapy. In summary, when starting the treatment process, begin with individual therapy. You should use this modality to map further treatment. A Note to Family Spouses and family should understand that many of the behaviors observed after combat are products of a deeply ingrained fear-based anxiety. As the symptomatic experiences described above unfold, veterans may begin to struggle with social anxiety, decreased self-confidence, and increased irritability. This is followed by relational conflict and suffering anxiety about anxiety which is followed by feelings of decreased empowerment and impaired ability to emotionally connect to others. Wives/Husbands/Partners and family that offer unconditional love become safe targets for venting. Please do not take these events personally. Another common complaint from spouses/partners I work with is combat veterans’ refusal to discuss combat experiences. They feel like their loved ones are not trusting them with this life experience, and it ushers in feelings of resentment and hurt. The truth is, it can be difficult for combat veterans to begin dialogue about their experiences due to a lack of shared experience and a desire to keep the black box welded shut. Still more, most veterans do not know where or how to begin. A common example I offer to families is as follows: asking veterans to describe their combat experiences and feelings is like asking a mother to describe childbirth to a man. While one mother describing child birth to another mother can be accomplished with a few words and a nod, a man can never really know what that event is like. Bottom line; be patient and rest assure that your spouse/partner is not purposefully withholding or withdrawing. Finally If you are a combat veteran and in need of immediate help, please call the VA’s Veterans Crisis Line at 1-800-273-8255 and Press 1 for free, confidential support 24 hours a day. Families and loved ones may also call this number. #veterans #PTSD #trauma

Knowing your benefits, benefits you! The new year has rolled in, and while you are working hard on keeping those new year’s resolutions, you may be overlooking one detail that can benefit you. Insurance! I know, it’s not exactly an exciting word, but the more you know about your particular insurance policy, the better off you’ll be. My name is Cassandra, and I am the Office Manager at Etheridge Psychology. Part of my job is to help patients the best I can to use their health insurance benefits with us. Because your health insurance plan represents a contract between you and them (not us and them), it’s always best if you know your own benefits. First, a disclaimer. We are not health insurance professionals at Etheridge Psychology, so we recommend that you read all materials that came with your plan and call your insurance company directly with any questions. We are, however, in-network with some health insurance plans and want you to be able to use your health insurance benefits with the maximum possible benefit and the least possible confusion. You should verify the information provided here with your own insurance company. Here is some information that might help you. Let’s start by going over some insurance-related terms: Benefit Period. The start and stop dates of your current plan. For many people, their benefit period runs from January 1 through December 31. Check your insurance card to be sure, as some plans start and stop on other dates during the year. Covered Services (or Covered Benefits). A list of medical benefits/services, such as tests, drugs and treatments that insurance has agreed to cover at a certain cost based on your policy. Allowed Amount. The dollar value for a service that the health insurance company and your provider have agreed upon. If your provider is in-network with your plan, the allowed amount is the most you are required to pay. For example, if our full fee is $200 for a particular service, and the allowed amount is $150, the maximum amount you pay is $150 and we discount the remaining $50 per our agreement with your plan. Deductible. The amount you must pay for covered services each benefit period (for certain services or all services, depending on your plan) before your insurance kicks in. This means that you pay the full allowed amount for healthcare services until you have paid your full deductible amount. After the deductible is met, you may then have to pay coinsurance or nothing at all, depending on the details of your plan. Co-Payment. A flat amount that you pay for a covered service, typically paid per office visit. Some plans do not have a co-payment and are deductible and/or coinsurance only. Coinsurance. Your share of the cost of a covered service, expressed as a percent of the allowed amount. Coinsurance is often paid after the deductible is met, but not always. Not all plans include coinsurance. Out-of-pocket limit/max. The most you’ll have to spend from your own pocket for covered services during the benefit period. In-network. A specific provider contracted to cover services on your plan. You may still have to pay deductible, co-payment, and/or coinsurance directly to the provider. Out-of-Network. A provider not covered under your plan. You pay that provider’s full fee, and your insurance may or may not include out-of-network benefits. Preauthorization. If a service requires preauthorization, the provider must contact the insurance company (by telephone or by completing a form), typically after you have been seen for your initial visit with the provider. The provider must receive authorization from the insurance company prior to rendering that service to you, or the service will not be covered. Knowing your benefits can help keep money in your pocket. You need to know five main pieces of information when you see a healthcare provider: Is my specific provider considered to be in-network with my plan? Is the service I will be getting a covered benefit under my plan? Is the diagnosis I receive a covered diagnosis? Is preauthorization required for this service? (If so, let us know before you get the service or it will not be covered!) How much will I have to pay out of my own pocket to the provider for this service? As you may have guessed, you may not know some of this information until AFTER you see the provider. Unfortunately, that is a risk of using health insurance. You cannot know what diagnosis the provider will render until the provider assesses you. You may not even know what service(s) the provider is going to recommend until you are assessed at your appointment. If you have any questions about the services to be provided, you can ask the provider for the service they recommend and then call your insurance company to find out if it is covered. The provider can even give you what’s known as a CPT code that identifies that service to the insurance company. Keep in mind that, even if a service is “covered,” you will likely still have some out-of-pocket costs such as a copayment, coinsurance, or deductible. Many people assume that when they go see a provider or are referred to a provider, their services will be covered. While most provider’s offices try to check/verify benefits before a patient arrives for an appointment, this is done as a courtesy and may not always be the case. Every insurance policy is written differently. Blue Cross and Blue Shield (BCBS), for instance, has different plans available such as Blue Value, Blue Local, Blue Options, Blue Medicare, Anthem and so on. Your provider may be in-network with BCBS, but that does not mean that your provider is in-network with all the individual plans that BCBS offers. Each policy is written differently and can even be written differently between each type, especially if an employer or a self-insured has opted out of certain coverage/services. If you receive a service that is considered non-covered or see a provider that is out of network, the entirety of the bill falls on you. How do you know what is and is not covered? Read the materials that came with your plan or call your health insurance company directly. The amount you must pay out of pocket is not always easy to determine, so calling your insurance company is usually the best bet. Even if your plan is deductible-only, you still save money by using an in-network provider and receiving covered services because you only have to pay the allowed amount. Many people are unaware that their health insurance plan represents a contract between the health insurance company and the patient, not the health insurance company and the provider. This means that, if a service is not covered or gets denied, you are responsible for paying the provider for the service and must contact your health insurance company directly to dispute the result. Health insurance companies hold the patient responsible for understanding and abiding by the terms of the plan, even if those terms are confusing. The good news is that your insurance company wants you to know your rights and provides manuals and customer service numbers to get your questions answered. We are happy to call your insurance company for you in many cases, but we can only tell you what they told us and cannot guarantee a service will be covered. So, to keep more money in your pocket, know your benefits. Call your insurance company, make sure your provider is in-network, that the service (and diagnosis, if available) is covered, and how much you will have to pay out of your own pocket for the service. Don’t be afraid to ask questions. We are always happy to help and do everything we can, but we are sometimes provided misinformation about benefits. You are the best defense to keep this from happening. When you call your insurance company, always write down the date and time of your call, the representative’s name, the reference number for the call, and what the representative told you during the call. Why don’t we all add contacting our insurance company to our resolutions list this year and next and let the savings begin! #healthinsurance