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Questions about assessment services? We’ve got answers!

There are many people who advertise that they provide assessment services. What do I look for in a provider?

Pretty much everyone who seeks out assessment has a question they want answered…and generally it’s not a question simple enough for a Google search!

Learning more about a provider’s background and approach can help you determine whether they are a good fit to answer your question. People can mean many different things when they refer to assessment on a website. You will want someone who:

  • uses science-based, standardized measures with demonstrated validity and reliability;
  • selects the most appropriate tests for your questions, rather than using the same testing battery for everyone;
  • uses up-to-date measures;
  • seeks out multiple sources of information;
  • and has enough knowledge of diagnoses to differentiate between presentations that look similar but have different underlying causes.

Some practices provide assessment that is educational in nature, with staff who have backgrounds in education but who are unable to give mental health diagnoses that might be contributing to or underlying the presenting concern. For example, aspects of ADHD and anxiety can look similar in a young child, and there are also times when both are present and a child will benefit most from receiving both diagnoses and intervention for each.

Why choose a psychologist for assessment?

In short, because training in assessment is one factor that differentiates psychologists from other mental health providers! Psychology is the study of the mind and behavior, and psychologists are experts in the diagnosis and treatment of mental health concerns. Psychologists are required to complete intensive coursework in diagnostic assessment and testing when obtaining their doctoral degree (PhD or PsyD).

Some practices work with bachelor’s or master’s level technicians who administer and score tests, while the supervising psychologist selects the tests that are administered, interprets the findings, and writes the report. Our practice finds value in the first-hand knowledge we gain from working one-on-one with a child and having a psychologist complete all aspects of the evaluation personally.

Why do some practices not take insurance?

Some practices, including ours, choose not to be in-network with insurance companies. Often, this comes from a desire to provide comprehensive assessment where the psychologist and family have autonomy in decision-making based on the family’s presenting concern. This also allows for transparent pricing in the form of a flat fee that covers testing, scoring, interpretation, feedback session, and comprehensive report. Families may be able to receive partial reimbursement from their insurance company. Those interested in this would contact their insurance company and inquire about their out-of-network coverage, deductible, and the percentage they would be reimbursed.

What if my child has a meltdown or doesn’t comply with directions?

Many families who are seeking an evaluation due to behavioral concerns voice this question and our response is…how lovely that we get first-hand knowledge of the challenges you and your child are experiencing! It makes for rich observational data that informs our testing, interpretation, and recommendations. We are skilled clinicians when it comes to working with children and obtaining good, useful data. We genuinely enjoy learning about and connecting with your specific child, and we work hard to make the experience a pleasant one for them.

What happens after I receive the report?

After receiving the report, many families need to take a moment to absorb all the information. Our reports contain information about your child’s strengths as well as areas of challenge or need. Based on your child’s unique ways of thinking and learning, we provide resources and empirically-supported treatment recommendations for how to support your child moving forward. For many families, this serves as a guide that gives them direction in identifying and connecting with professionals who work together to meet their child’s needs.

It is also true that parents/caregivers experience their own emotional reactions to receiving information about their children’s areas of challenge. Some may feel relief to have answers, some may feel guilt for not having sought information earlier, some might need the space and time to grieve aspects of their child’s life that might be harder for them than their peers. Some parents might find themselves eager to connect with resources and implement treatment recommendations, while others might feel overwhelmed. However you feel afterward, know that we are here to support you and make space for that as well. We have a shared goal of seeing your child thrive.

Why are masks provoking anger and division among people?

Why are masks triggering anger and a divide among people?

This is my (a psychologist’s) attempt to explain how masks have come to provoke such strong emotional responses from people. This is not meant to be a debate, but to create space for us to understand the “WHY.” When we understand “why” we are feeling, thinking, or behaving in a certain way, THEN we can create change.

What is it about a seemingly neutral piece of protective gear that can be so inflammatory? Like many points of controversy, it’s not the thing itself but what it represents.

A Political Divide

Face masks have become tied to the political conflict over our national response to the coronavirus. Those who lean left politically tend to see the virus as a more dire threat; those on the right are more likely to downplay its seriousness or compare it to less contagious/deadly viruses like the flu, often following the lead of conservative politicians. Accordingly, masks may be seen as a marker of political loyalty, triggering feelings of us-versus-them. A politically liberal person may assume that someone wearing a mask is “on their team,” while those who don’t wear masks must be Fox News-watching Republicans. The anger they feel is not simply about the mask, but about believing the non-mask wearer is a certain type of person. Similarly, a person who does not wear a mask may assume those who do want to take away their individual freedoms. Being asked to wear a mask then becomes not just a request to protect the health of others, but to give up their worldview and political allegiance. For a lighter example, it may feel like asking a San Antonio Spurs fan to put on a Dallas Mavericks jersey!

We don’t like limits placed on behaviors

Our response to a perceived threat or loss of a behavioral freedom is referred to as “psychological reactance.” This reactance throws a person into a state or desire to regain that freedom. According to reactance theory, when people feel coerced into a certain behavior, they will react against the coercion. They often demonstrate an increased preference for the behavior that is restrained and may perform the behavior opposite to that desired. [proposed in 1966 Jack W. Brehm]

**It should be noted that this goes both ways…if people were “banned” from wearing a mask into a business or any place, they would be as equally upset as those being required to wear a mask. **

Now, cue embarrassment! When people feel embarrassed or humiliated, they really have two main ways to respond…they experience shame and/or guilt OR feel anger. When someone is asked to wear a mask in a building or asked to leave for not wearing a mask, the likely feel judged and embarrassed which can result in an aggressive reaction. Now focus is drawn to the feeling they are experiencing, and it's no longer about the mask. 

Conflicting Information

The amount of miscommunication and inconsistent information is alarming at best. Realistically, it has created a communication disaster! People have not received consistent information about the pandemic in general and specifically mask wearing. 

This is not to say that wearing a mask in public is simply a matter of personal choice. Masks aren’t like seatbelts: wearing a seatbelt is about ensuring your own safety. (Though, just like wearing a helmet on a motorcycle or bike, there is a societal benefit to avoiding serious, costly injuries that tax our medical resources and contribute to higher insurance rates.) While a mask helps protect the wearer, its most important benefit is in preventing the spread of coronavirus to others.

Consider viewing these sites for information about mask wearing:

https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/about-face-coverings.html

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/when-and-how-to-use-masks

https://www.aap.org/en/news-room/news-releases/aap/2021/american-academy-of-pediatrics-updates-recommendations-for-opening-schools-in-fall-2021/

A Constructive Response

If you’re reluctant to wear a mask when required, question any automatic thoughts you have about others trying to take away your freedom. Try to allow space to be curious about your emotion (what it feels like, where is it coming from, etc.). Most likely their goal is just to keep everyone safe, not to make you buy into a certain worldview.

As a psychologist, I would strongly urge all adults and parents to maintain awareness that children are watching. Whether you are wanting to be a role model or not, children are paying attention to how you talk about others and make decisions! They are watching how we handle conflict, what we do with our emotions, and how we respond to others. Even if you think you are keeping the mask conversation private, children are more perceptive than you think and they are aware of the emotional involved. It's best to talk with then directly about what is happening in a fact based way.

Why do people believe conspiracy theories or become extreme thinkers?

Belief in conspiracy theories and extreme beliefs is rooted in neuroscience and how the brain thinks. 

The brain does not like chaos and seeks to find answers and control. This goes back to what psychologists call the fear network, involving the amygdala, hippocampus, and frontal lobe. See previous post about this at:  https://www.rosetherapycenter.com/anxiety/

We naturally seek an explanation for events. These “answers” typically comfort us or fit into our worldview.

During times of uncertainty, our brain tends to seek explanations that match the intensity of our feelings. When thinking about the coronavirus, the idea that the world came to a screeching halt because a virus jumped from a bat to another animal to a human seems too insignificant an explanation. But a conspiracy theory that has thousands of people in cahoots seems more proportional. Does that make it true? NO, but does the conspiracy theory match the intense feelings we have? Yes!

How do people become susceptible to believing false information? Below is a simplified explanation:

  • Confirmation bias: Confirmation bias refers to our tendency to become attached to our beliefs and to search for or interpret information in ways that confirm our preconceptions. Once we settle in on a conviction, we will search for, remember, and accept only evidence that supports it, while ignoring disconfirming evidence. Here is a generic example, If I have a belief that Sally is a jerk, I then look for information to confirm my thought (Sally interrupted me on purpose, she rolled her eyes when I walked in the room, etc.). Cognitive Behavior Theory works directly to question and reframe thoughts. This is done by focusing on the FACTS! In this case, I don’t know (or have proof) why Sally acted the way she did. Therefore, I cannot hold the belief that her behavior was directly intended for me.
  • Fundamental attribution error: This is our tendency to prefer dispositional explanations (assigning the cause of behavior to an internal characteristic of a person) to situational ones. When we observe an event, we are much more likely to attribute it to some intentional, internal motive than to circumstance or happenstance. Conspiracy theories are naturally dispositional, “Someone planned this for a purpose.”
  • Pattern recognition: This goes back to the fear network. Our brains developed and evolved in a dangerous environment. For survival, the brain developed the ability to “fill in the blanks” rather quickly which led to survival advantages. If you can make out the hidden predator in the bushes, you were more likely to survive. The brain is able to specialize in meaning making and pattern finding. However, without an identifiable pattern, the brain will INVENT one and impose it on the world. The brain seeks order, understanding of cause and effect, and intentionality. Unfortunately, life is filled with unpredictability, chaos, and chance. We, naturally, become stressed during these times. To reduce stress, the brain finds comfort in stories that fit its demands rather than ones that are based on facts.
  • Feeling uniquely knowledgeable: We have all heard the saying, “knowledge is power.” Humans prefer to feel powerful rather than powerless. Having knowledge is satisfying for us because it provides a sense of certainty which makes life feel less overwhelming. When thinking about conspiracy theories or extreme beliefs…having unique knowledge which conspiracy theories provide, makes people feel knowledge and powerful. Unfortunately, this hinders their ability to fact check.  

Why is this important when children are involved?

Remember the cliché saying, “If your friend jumped off a bridge, would you?” What is being implied? The implication is that as parents, we want our children to be leaders, be able to discern information and make a decision on their own (preferably a “smart” one). This idea should also be applied to other areas of their lives such as political and social views, not just peer pressure.

For instance, we know that children often accept the same beliefs as their parents. We see this all the time, especially now with the presidential election and pandemic. However, we also want our children to learn to use critical thinking skills to make an informed decision or belief…so they don’t jump off that bridge.

How are we, the parents, facilitating this?

Are you encouraging your child/children to question information…perhaps even your own personal views? It is perfectly okay to show children uncertainty, “I don’t know if that is true.” Or “I don’t know why that happened.” Are you talking and demonstrating flexibility in thinking (being able to see both the pros and cons of a situation)? These habits help children develop critical thinking skills so that they can make the “smart or right” decisions in adolescence and ultimately adulthood.

What is critical thinking?

Thinking critically is more than just thinking clearly or rationally; it is about thinking independently. It means formulating your own opinions and drawing your conclusions regardless of outside influence. It is about the discipline of analysis and seeing the connections between ideas. It is being wide open to other viewpoints and opinions.

How to teach critical thinking skills (Dewar, 2009):

  • Young children might not be ready for lessons in formal logic. However, they can be taught to give reasons for their conclusions. Children can evaluate the reasons given by others. Start early by giving examples of cause and effect (using science experiments, etc.)
  • Avoid pushing dogma. When we tell kids to do things in a certain way, we should give reasons.
  • Encourage children to challenge assumptions. An assumption is something that you accept as true without question or proof.
    • Encourage kids to ask questions. Parents should foster curiosity in children. If a rationale doesn’t make sense to a child, he/she should be encouraged to voice their objection or difficulty. This doesn’t mean we allow negotiations…bedtime is still bedtime…and there is good data as to why kids need sleep; a lot of it!
    • Teach kids to fact check. Is there proof for their thought or assumption. If the answer is “no”, then they must consider alternate information (thoughts, information, beliefs, etc.).
    • Ask kids to consider alternative explanations and solutions. It is nice to get the right answer, but many problems yield themselves to more than one solution. When kids consider multiple solutions, they become more flexible thinkers.
  • Get kids to clarify meaning. Kids should practice putting things in their own words (while keeping the meaning intact). Kids should be encouraged to make meaningful distinctions.
  • Talk about biases. Even grade school students can understand how emotions and motives can influence our judgments. 
  • Don’t confine critical thinking to purely factual or academic matters. Encourage kids to reason about ethical, moral, and public policy issues.
  • Get kids to write. As many teachers know, the process of writing helps students clarify their explanations and sharpen their arguments.

Dewar, Gwen. 2009. Teaching critical thinking: An evidence-based guide. https://www.parentingscience.com/teaching-critical-thinking.html

Shpancer, Noam. 2020. Why we love a good cabal: Conspiracy theories are byproducts of how the brain thinks. 

Anxiety: How it develops and how to tame it.

How does Anxiety Develop?

The short answer is…it starts in the brain. There is a tiny, almond shaped part of the brain called the amygdalalocated deep into the limbic system or what is commonly referred to as our “emotional brain.The emotional brain is the oldest, most primitive part of our brain, which was only ever designed to ensure physical survival.

Why would we need this?

Because long ago, physical safety was very important and a real problem. Think about cavemen who had to defend themselves against animals, reptiles, and other cavemenBack then, humans needed a quick, hyper-vigilant brain that functioned automatically and unconsciously 

Now fast forward several centuries…our brains generally no longer need to have a heightened sense of physical safety to surviveAlong the way, likely through evolution, the brain adapted to needs that are different in the modern world. Now, the brain doesn’t have to prepare for physical safety, but more for social or psychological survival.  

So, how does this relate to anxiety?

One belief is that anxiety is related to a hyperactive amygdalaHowever, scientists have found that anxiety is the result of constant chatter between a number of different brain regionsThey refer to this as a fear network (amygdala, hippocampus, and frontal lobe)In short, the frontal lobewhere thoughts and sensations come together, is the “thinking brain.  When that is overridden by the emotional brain, in this case the amygdala, anxiety happens.

Let me try to explain more…

When we sense danger is present (e.g., you hear screeching tires as you are crossing the street), the amygdala reacts automatically and activates the fight, flight, or freeze response. This allows us to quickly get out of harm’s way. While this is extremely helpful, what about when the fear isn’t physical or logical? The modern world is full of psychological stress, from big (traumatic events in the news, social media, natural disasters) to small (getting a shot, talking in front of a group, going to a party, etc.).  

With these examples, we want to let our thinking brain run the show. The thinking brain (frontal lobe) processes information to determine if danger really is present and finds the most logical response to it.  

In scenarios that present mild to moderate threats, the frontal lobe can override the amygdala and allow you to function (i.e., not have an anxiety attack). However, when a threat is perceived as strong, the amygdala acts automatically and can overpower the frontal lobe.  

Remember the fear network? When we have a physiological response (increased heart rate, blood pumping to extremities, increased ability to take in oxygen) to a stimulus (fearful event, etc.), the hippocampus stores that into memory. So later when you feel the same or a similar physiological response, your brain thinks you are in actual danger and responds…sometimes causing a “false alarm."

How do you treat anxiety?

It’s not as simple as saying something positive! Remember, the amygdala fires automatically and unconsciously, meaning you cannot control that it fires or activates. You will experience physiological symptoms. Your goal is not let those symptoms overpower you  

Important note: The amygdala only learns when it is activated! That’s right, you have to feel anxious to be able to “teach” your brain to calm down.  When you feel calm and are thinking about interventions to utilize, your amygdala isn’t learning a thing!

The amygdala isn’t trained by language, it is trained by actions!

Below are some steps to consider: 

  • Acknowledge that you feel threatened or stressed and that your fight, flight, or freeze response has been activated. For kids, you may help label their feeling (scared, nervous, frightened…).   

  • Once you acknowledge the amygdala is activated, then you can work to calm down or control it.  

  • Remind yourself that the feeling is an automatic response, not necessarily the “right” or logical response.  

  • Breathing cannot be underestimated! Take slow and deep breaths (using the diaphragm). It will take more than 3 to calm down! A simple trick to know if you are breaking correctly: when you inhale, your belly should go OUT…and when you exhale through your mouth, your belly should go IN. (You can also try placing a hand on your belly and a hand on your chest. The hand on your chest should not move, while the hand on your belly will go out and in.) 

  • After breathing, now you can activate your thinking brain (frontal lobe). 

  • Remember, the amygdala has to be activated for you to teach it new things! This is a part of exposure therapy. We have to approach the feared situation (meaning the amygdala is activated), stay until the physiological response has subsided, and then leave the situation. If you leave the situation before the body has calmed, you have only strengthened the amygdala’s response to that particular situation.  

  • This is the time to think about the situation, develop logical solutions, change thoughts.  

  • For instance, rather than thinking, “I can’t handle this, it is going to be awful.” Remind yourself “I’ve been here before; I can get through this.” Or “Feelings can’t last forever, this will end.”  

Questions: Please contact Dr. Rose at DrRose@rosetherapycenter.com

Surviving COVID-19 at Home with Children

Surviving COVID-19 at Home with Your Children

I think it’s relatively safe to say that most of us did not expect to be in this position…schools closed and finding ways to manage work and family at home.  

This can be a very stressful time for parents who cannot easily work from home.  Over the week, I’ve been asked several questions: Why are people buying out toilet paper…how do I talk to my child…what I should do about my own worry…? Here is my attempt to answer these questions and provide support.

Why are people acting crazy?

It’s a valid question… Anxiety and “fear of the unknown” plays a big role.  Here’s why: Our brains are hardwired to sense danger and ultimately protect ourselves.

Unfortunately, emotion sometimes impairs our perception of risk.  In general, we fear unlikely, catastrophic events, more than common deadly events.  In the case of COVID-19, assessing risk has proved difficult because we don’t have enough objective knowledge as the disease is still evolving. 

When humans feel a “perceived lack of control” we start to see people take on more unusual behaviors like stockpiling on toilet paper or panic-buying for months.  Another explanation for this odd behavior is what psychologists call “availability bias” and observational learning.  We (humans) tend to let an example that easily comes to mind affect decision-making or reasoning.  A simple and benign example of observational learning is while out to eat with friends, one person takes a drink of water and shortly after other people at the table pick up their drinks and take a sip.  To us, this happens unconsciously, but our brains have been simultaneously processing the conversation at the table and observing behavior. 

Complicating matters, we are uniquely bad at spotting misinformation online, in part because we don’t take the time, or don’t know how, to properly fact-check.  Our memories play tricks on us, encouraging us to believe things we read repeatedly, to look for information that validates our thoughts, and to remember things that elicit strong emotions.  The non-stop media coverage certainly isn’t helping our brains take a break.    

What can adults do?

*Facts minimize fear: Get information from reputable resources, not necessarily posts being passed around on social media.  The Centers for Disease Control (CDC) and World Health Organization (WHO) are good places to start. 

* Take a break from media (news channels and social media).

*Attempt to reframe how you are thinking about this event.  Instead of viewing it as an inconvenience, think of it as a sort of “pause” button that may allow you to connect with your child or spouse in a way you haven’t been able to in a while.  Pay attention to the "good" and how people are working together to support each other.

* Use HUMOR: Humor is a wonderful gift and reduces worry. 

* Practice healthy hygiene.

*Enjoy your child/children.  This is easier said than done when simultaneously managing work from home.  However, even 5-10 minutes of quality time goes a long way with kids.  Create new memories, teach them a new skill, let them help in the kitchen, get outside, etc. 

Ask yourself, “When this is all over, how do I want to remember this event.”  Let that question dictate your feelings and behaviors!!

How to talk to children?

Most importantly, parents set the tone for how children will respond to this event.  It is very important for you to find ways to control your worry and fear so that it is not placed on children.  Too much information can be a bad thing when it comes to kids.  Here is a great resource for how to talk with children about the virus:

https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/talking-with-children.html

Below is a Google doc listing with an enormous amount of educational activities for children.  Remember, there is a lot of good happening in this time of crisis…someone has already worked super hard to compile this list!!

https://docs.google.com/document/d/1fceqmG0nYAI8uGm5Uv_Ilv5PI72b8iTmGdKag3elrDY/edit?usp=sharing

As always, if you need to talk, don’t hesitate to reach out for help.  It is available!

Kristin Rose, PsyD.

DrRose@RoseTherapyCenter.com

www.RoseTherapyCenter.com

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