Quelling Anxiety Across the Chesapeake

Driving over the Chesapeake Bay Bridge stirs fear in the hearts of no small number of Baltimore and Washington residents, an anxiety that resumed its seasonal peak over the Memorial Day weekend and the start of the annual pilgrimage to the beach towns and quaint sailing harbors of the Eastern Shore.

“Everyone talks about the fear of crossing the bridge,” said Carolyn Casey, who lives in Washington with her family and has a second home near St. Michaels, Md., across the bridge.

On Friday, she pulled her silver Lexus S.U.V. to the side of the road before the western end of the bridge, which stretches more than four miles. The passenger seat was piled with Whole Foods bags, and two Labrador retrievers were curled in the cargo area. As Ms. Casey climbed into the back seat with her 3-year-old daughter and a nanny, Alex Robinson got in behind the wheel.

“When I told people I’d found someone to drive me over the bridge, they laughed,” said Ms. Casey, 41, a homemaker whose husband is a consultant. “But it all came out — everyone is afraid of the bridge.”

Mr. Robinson, 27, runs Kent Island Express, which charges $25 each way to shuttle people in their own vehicles across a bridge that Travel Leisure magazine ranks as one of the world’s scariest.

As he drove to pick up one customer, he fielded the kind of telephone call he receives all day. “Do you have a lot of people you drive because they’re afraid?” a woman asked, with uneasiness in her voice.

“About 5,800 people use our service,” Mr. Robinson told her.

“Whoa,” the woman said. “That makes me feel better.”

Mr. Robinson’s business, which he took over last year from his mother and stepfather after they had run it for five years, has made him an amateur psychologist. He hires only upbeat drivers so as not to further alarm clients. “Their stress and anxieties feed off of your mood,” he tells employees.

He knows to talk about anything but the bridge during the 10 to 15 minutes it takes to cross: first, a disconcerting dogleg curve, then a precipitous climb over the initial suspension span; then downhill and over a second span, a cantilever whose boxy sides and roof feel like a suffocating tunnel.

“Most people, when they’re nervous, they babble,” Mr. Robinson said. “They talk about their first boyfriend. Their kids. People will tell you about their entire life story.”

But not everyone. Construction workers have been known to ride in the back seat of their pickup trucks, hats pulled over their eyes and their ears plugged. A woman once rode with a blanket over her head. A man asked to be put in his trunk, an offer that was refused.

The fear of bridges has a name, gephyrophobia. Psychotherapists say it is common and often traces back to a panic attack during a particular crossing, even after years of driving over the same bridge without incident.

Kathleen Busch, who retired from the human resources department of a Baltimore company, said she could cross carefree “when I could wear a bikini.” Her fear began after she was stuck in the Baltimore Harbor Tunnel for hours. (Experts say the fear of bridges and tunnels are sometimes linked.)

Trying to drive through the tunnel later, “everything went white,” Ms. Busch recalled. “I had a full-blown panic attack,” with racing heart and shortness of breath. “I thought I was going to pass out.”

In the two years since she and her husband bought a retirement home on the Eastern Shore, she has not tried to drive on the Bay Bridge for fear of causing an accident.

The bridge, officially the William Preston Lane Jr. Memorial Bridge, is not the only one with a service to help anxious drivers. The five-mile-long Mackinac Bridge in Michigan, one of the world’s longest suspension bridges, offers a free drivers’ assistance program. In the Florida Keys, enterprising college students have been known to wait at either end of the Seven Mile Bridge to drive tourists.

Mental Health Resource

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School mental health services stretch to meet increased need, staff says

With increasingly severe emotional disorders seen among students, resources for mental health services in public schools do not adequately address the county’s needs, according to one school official.


Symptoms of mental illness have grown more intense in recent years and are seen at much younger ages, said Ann Hammond, the county’s supervisor of psychological services and school therapists. But Frederick County Public Schools’ budget restrictions have kept school mental health staff from increasing to accommodate the growing demand.

Nineteen full-time school psychologists served in the county’s 51 public schools during the 2000-2001 school year, Hammond said. Though the county has gained 13 public schools since 2001, only one part-time psychologist position has been added.

“Schools often are the biggest mental health providers for children because they are with us for such a large part of the day,” Hammond said. “We’re not keeping up, and that’s just the honest truth.”

More than 3,000 children in the county have some form of mental illness, Hammond said. The school system does not keep statistics of the number of its students with mental illnesses.

School psychologists and counselors deal most often with students who have anxiety issues such as obsessive-compulsive disorder or separation anxiety; mood disorders such as depression; attention-deficit (hyperactivity) disorder and trauma from abuse, neglect or loss of a loved one, Hammond said.

The increase in mental health problems, particularly anxiety and depression, can be linked to the stresses children face as a result of a shaky economy, she said.

“As people lose jobs and have less money, families become less stable,” Hammond said. “Everybody is more stressed. Families are losing homes, families are moving in together, so there’s a lot of people living together in less space.”

Job stress can cause parents to have less patience with or pay less attention to their children, Hammond said. When families lose health insurance, they are less likely to be able to afford medicine or therapy for children.

The school system provides a number of services to help students cope with mental illness, including in-school psychological consultations, counseling sessions, and group or one-on-one teaching. Outside health care professionals are also brought into schools through partnerships with the county’s departments of social and health services.

School system staff conducted 1,369 student psychological evaluations, 51 student threat assessments and 320 suicide interventions during the 2011-2012 school year, according to school records.

About 240 students in Frederick County have emotional disabilities that require special education services, Hammond said.

However, there are other students with mental disabilities who do not need special education because of adequate medication and support by family and schools, she said.

Janet Shipman, who oversees the county’s school counselors, said her staff has tried to “fine-tune” the counseling process by educating teachers and students on the importance of reporting unusual changes in their peers’ personalities.

This helps school counselors reach out to students who may consider suicide, whether or not they have expressed the desire to harm themselves.

The number of elementary students who say they intend to hurt themselves has increased from 53 during the 2011-2012 school year to 64 to date in the current school year, Shipman said. The number of such cases among middle and high school students in the current school year has dropped from 118 to 113 and 149 to 108, respectively.

Despite the decline of suicide threats in middle schools and high schools so far this school year, Shipman said she has observed a general increase in serious mental health issues.

The current ratio of counselors to students varies based on the school, Shipman said. One counselor may be placed in a school with 500 students, while another works in a school of more than 900.

The school system’s fiscal 2013 budget allocated about $6.4 million for student health services, accounting for slightly more than 1.2 percent of the overall budget.

The fiscal 2014 budget request asks for more than $6.7 million, an increase of 6.1 percent in student health funding.

Stretching resources and personnel to meet the county’s needs can be a struggle, Hammond said.

“It’s been very, very hard because we as a system haven’t seen a lot of increases in funding,” she said. “Working within what we have, we do support kids amazingly. We have good people doing their jobs really well.”

School counselors are only a short-term solution, Shipman said, and schools are fortunate to have connections with community resources.

“I know in working with the health department and working with different agencies, there’s a lot of groups of people who are trying to increase awareness, trying to think outside of the box,” Shipman said. “I don’t foresee things getting worse.”

Follow Rachel S. Karas on Twitter: @rachelkaras.

BY THE NUMBERS

240 students in special education for emotional disabilities

Fiscal 2013 FCPS budget: $6.37 million for student health services

Fiscal 2014 request: $6.76 million

Increase of 6.1 percent

2000-2001 51 schools, 19 psychologists2012-2013 64 schools, 19 full time, 1 part time

2011-12 school year:

1,369 student psychological evaluations51 student threat assessments320 suicide interventions

More than 3,000 children in the county have some form of mental illness

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Goodbye to the DSM-V

By Matthew McKay, PhD, New Harbinger Publications co-founder and publisher

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) is here, and it’s dead on arrival. A few weeks ago, the National Institute of Mental Health (NIMH) announced it will no longer fund research based on DSM symptom clusters — for the simple reason that the DSM is irrelevant to determining the cause and treatment of psychological problems. Here’s why:

A huge disconnect exists between DSM categories and treatment.
Some diagnoses have no viable treatments, some have the same treatment (for example, David Barlow’s unified treatment for emotional disorders), and some have multiple evidence-based treatments. If DSM diagnosis doesn’t inform treatment, what good is it? The answer is one, to facilitate the exchange of money between payers and providers, and two, to create silos for focused research. With the NIMH announcement, scratch number two.

The DSM is a topographical symptom map that doesn’t point to the actual causes — underlying mechanisms — that drive and maintain disorders.
These mechanisms, sometimes called transdiagnostic factors and/or vulnerabilities, are how we now formulate and explain psychological pain. Transdiagnostic factors like experiential avoidance, rumination, and cognitive misappraisal, along with vulnerabilities like intolerance of uncertainty, hyperarousal, and negative schemas create psychological disorders. Our treatments must be aimed at these causative mechanisms rather than outdated symptom clusters.

DSM categories are not discrete.
In other words, the same symptom can show up in many different diagnoses. Sadness/dysphoria is listed as a criterion symptom in more than a dozen disorders. If the DSM categories were useful and distinct, this smearing of symptoms across diagnoses wouldn’t happen. It forces clinicians, who observe anger symptoms for example, to rule out attention deficit hyperactivity disorder, bipolar disorder, borderline personality disorder, narcissistic personality disorder, post-traumatic stress disorder, substance use disorder, grief, intermittent explosive disorder, and six other DSM categories. And if one successfully wades through all these choices, there is still no understanding of why the disorder exists or what to do about it.

The DSM fails to account for comorbidity.
If you have obsessive-compulsive disorder, you’re likely to struggle with other anxiety disorders as well. And depression co-occurs with anxiety 60 percent of the time. All this is unexplained by the DSM. The only way to account for high rates of comorbidity is that many disorders are driven by the same underlying (transdiagnostic) mechanisms. Rumination, for example, is a major driver for both depression and anxiety — that’s why they are so often seen together. Though rumination may focus on different things (e.g., personal failures in depression vs. future catastrophes in anxiety) it is a required target of treatment across both diagnoses.

In light of its failures, one might reasonably ask: why a new DSM? In truth, this fifth edition is just moving a few deck chairs on a sinking ship. Dumping the multiaxial system and Asperger’s disorder while adding binge eating, hoarding, and excoriation disorder (skin picking) has brought us no closer to a classification system that explains what’s wrong and guides evidence-based treatment decisions. Soon we’ll need to finish what the NIMH started — lower the lid, hammer it down, and bury the Diagnostic and Statistical Manual of Mental Disorders.

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Skin picking classified as distinct disorder

“I went through years, I just felt so embarrassed and had so much shame,” says Hartlin, 26, who began digging at her skin at about age 13. “I thought I was the only one for years, and I think that is the worst part, that disorders such as this feed into that isolation and make it worse.”

What Is Depression

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Local teen hopes to increase awareness of service dogs

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SPECIAL | HPE

Becca Hart and Mike have been companions for two years now, and Mike has done wonders toward helping Becca with her heart condition, lupus and OCD.


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SPECIAL | HPE

Becca Hart, shown here with her service dog Mike, created Harts 2 Paws to help educate the public about service dogs.


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SPECIAL | HPE

An otherwise normal teenager, Becca Hart sends a text with one hand while holding Mike’s paw with the other.


Becca Hart is young, smart, kind and pretty — all qualities that are easy to see. On the surface, she’s exactly what you would expect the reigning Miss High Point Teen USA to be.
What you don’t immediately see when you meet this amiable 17-year-old, though, are the bumps in the road that have shaped — and continue to shape — so much of her life:
• Heart surgery at age 12, and residual heart issues that continue to this day.
• Lupus, an unpredictable, often misdiagnosed and misunderstood autoimmune disease.
• Obsessive-compulsive disorder, or OCD, an anxiety disorder that can be characterized by irrational fears and, in some cases, repetitive behaviors such as hand-washing to avoid contamination from germs. Becca, for example, takes a daily two-hour shower. She knows it’s irrational, but she can’t help it — that’s what OCD is.
“My OCD is so severe that just getting through a day can be nearly impossible,” she says.
Bridging the gap between what you see in Becca and what you don’t see is her constant companion, Mike, a 9-year-old brindled greyhound that acts as her service dog.
Mike can sense when Becca’s heart rhythm changes, when she’s experiencing — or about to experience — a panic attack, and when she’s in pain. If she needs assistance, he can provide it or go get someone who can.
“He really is an amazing dog,” Becca says, glancing over at Mike as he rests on his dog bed in a corner of the Hart living room.
Like many greyhounds you see around here, Mike is a rescue, retired from a career of racing in Florida. Truth be told, though, Becca’s family didn’t just rescue Mike.
He’s rescued them, too.

* * * *

Becca’s journey with Mike began a couple of years ago, when she was diagnosed with lupus and OCD, which is considered a byproduct of the lupus.
In addition to irregular heart rhythms she’s had since her surgery at age 12, and the joint pain and fatigue associated with her lupus, Becca struggles mightily with the symptoms of her OCD. Obsession with germs is only one facet of the disease for her; she also experiences irrational anxiety triggered by certain types of floor textures, extreme cold, and even the touch of paper.
“You don’t realize how much a day that you touch paper,” Becca says. “Even something as simple as going to get the mail is an issue. OCD is a very real thing — it’s the 10th most debilitating disease in the world. A lot of people discount it, but it’s definitely real.”
Becca’s OCD doctor, who owns greyhounds, suggested their calm, gentle demeanor might them a complementary companion that could help ease some of her anxiety.
“She suggested a greyhound for distraction techniques and to kind of be therapeutic for me,” Becca explains. “We got Mike, and he was learning everything we needed, but what we didn’t realize when we got him was that he can actually detect when my heart doesn’t beat correctly.”
At first, Becca’s cardiologist didn’t believe Mike could sense her irregular heart rhythm, but he’s seen it happen enough times now that he’s a believer, according to Becca’s mom, Tonya Hart.
Now, Mike is also learning to get help for Becca when she’s on the verge of a panic attack.
“When I feel panic coming on,” she explains, “I’ll say a certain word to him, and he will be trained to either go find my parents or push a button to call them, and then if they don’t answer, it will call 911.”
The Harts say Mike can also sense Becca’s pain and will touch the source of her pain — for example, her leg or her stomach — when he senses it.
Trained by Elite Canine of Winston-Salem, Mike is a certified service dog, which is unusual for greyhounds. He’s registered with the N.C. Department of Health and Human Services, and he wears a vest indicating he’s a service dog.
Still, there were skeptics.
“Some people didn’t believe he was a service dog, because I wasn’t in a wheelchair or wasn’t blind or didn’t have any kind of physical symptoms that they could see,” Becca says. “That’s why we started Harts 2 Paws.”

* * * *

Harts 2 Paws is a nonprofit foundation, established by Becca and her family, “to change the perception of what somebody’s service dog should look like, and to educate about the laws related to service dogs,” Becca says.
Tonya Hart says the foundation grew out of their frustration.
“Because (Becca’s) challenges are not as visible as someone that may be sight-impaired, she has encountered many situations in public that have led to her — and us — being very frustrated,” Tonya says.
“So we had two choices — get angry, and nothing would change, or we could educate the public on seeing people’s challenges and service animals from a different perspective.”
To that end, Becca has begun speaking at schools, churches, civic group meetings and other gatherings to talk about the Americans with Disabilities Act as it relates to service dogs, and the importance of the proper etiquette when encountering a service dog.
Becca’s also writing a children’s book about service dogs, and she has chosen Harts 2 Paws as her official platform when she competes in the Miss North Carolina Teen USA Pageant in High Point this fall.
Despite her anxiety issues, Becca says she’s not nervous about competing in the pageant.
“I’m more nervous about doing well to get my cause out there, because it’s something I have a real heart for,” she says. “So I guess I’m nervous only because I care so much about Harts 2 Paws.”

jtomlin@hpe.com | 888-3579

Interested?

For more information about the Harts 2 Paws nonprofit foundation, visit the website at www.harts2paws.org or on Facebook at Harts2Paws.
To book a speaking engagement for Becca Hart (and her service dog, Mike), call Tonya Hart at (336) 995-3138 or send an email to harts2paws@yahoo.com.
 

Mental illness alliance planning walk at MCCC

If you’re looking for a reason to get outside and moving, May 18 will bring five chapters of a national organization together for a good cause.

On that morning, the National Alliance on Mental Illness will host its annual Greater Philadelphia NAMIWalk on and around the campus of Montgomery County Community College in Whitpain.

This year’s NAMIWalk 5K will begin with registration at 8 a.m. and the walking itself kicks off at 10 a.m., and will bring together five local chapters of the national program meant to raise awareness of mental illnesses: NAMI chapters from North Philadelphia, Northwest Philadelphia, Montgomery County, Bucks County, and the Main Line will all take part.

The Montgomery County chapter is headquartered inside the Centennial Plaza building at 100 West Main Street, and is one of more than 80 chapters nationwide established to help those with mental illnesses along with their families and friends.

There’s no registration fee, and the walk route and all walk facilities are accessible to those with disabilities – and a “Walking in place” section will have activities for those unable to walk the entire distance. Donations and sponsorships collected by those who walk will help support NAMI programs in the greater Philadelphia area, which include peer support and education for families and individuals suffering from mental illnesses, and advocacy and research for illnesses including schizophrenia, bipolar disorder, major depression, obsessive-compulsive disorder, anxiety disorders, post traumatic stress disorder and attention deficit hyperactivity disorder.

Walkers are encouraged to recruit teams of family members, friends, organizations or agencies that would like to take part, and those teams can register online or that morning. As of press time, teams had raised a combined total of more than $61,000 to help support NAMI and its activities, with the top individual and team fundraisers recognized on the walk’s website.

Walkers who raise $100 or more for NAMI through sponsorships or donations will receive official NAMIWalks event t-shirts, and companies, businesses or organizations who’d like to learn more about sponsorships – or volunteers who would like to help out – can do so by contacting NAMI-MC Executive Director Carol Caruso at CCaruso@NAMI.org or calling (215) 361-7784.