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

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.”

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.

What Is Penikese

As perhaps you have heard, the Becket Family of Services, working with the Family Support Collaborative, has been asked to create a new vision for the former Penikese Island School. This new program, Penikese, will be a small, non-profit, residential treatment program for young men (ages 14 to17) with substance abuse issues – and will be located on Penikese Island in Massachusetts’s Buzzards Bay. We plan to open on July 1.

The following is the profile of whom we serve.

Penikese is designed to address the specific, co-occurring treatment needs of older adolsecents and young men, ages 14-17, suffering from Substance Use Disorders and “internalizing” mental health conditions (i.e., disorders of anxiety, mood, attachment and trauma).

Substance Use Disorders at Penikese

Substance Use Disorders range across a spectrum of severity. One common assumption about a SUD is that one must hit rock bottom in order to be ready for treatment. At Penikese we believe quite the opposite. Our goal is to catch a young person at the earliest possible recognition of a SUD and to simultaneously treat the underlying internalizing mental health condition. We seek to prevent problematic use that is recurrent and already resulting in significant adverse consequences from becoming chronic, habitual and compulsive.
While there are a range of SUDs, the most common ones associated with the young me we serve include:

  • Cannabis Abuse Cannabis Dependence
  • Alcohol Abuse; Alcohol Intoxication
  • Inhalant Related Abuse
  • Sedative and Anxiolytic Abuse (Sleep Medication and Anti-Anxiety Medication)
  • Amphetamine Abuse (ADHD stimulant Medication Misuse and Abuse)

Treatment is possibly indicated and Penikese may be an appropriate setting when parents, teachers and friends of the young person begin to observe and witness substance abuse and some the following significant adverse behavioral changes:

  • Sudden personality changes that include abrupt changes in work or school attendance, quality of work, work output, grades, discipline
  • Unusual flare-ups or outbreaks of temper
  • Withdrawal from responsibility
  • General changes in overall attitude
  • Loss of interest in what were once favorite hobbies and pursuits
  • Changes in friends and reluctance to have friends visit or talk about them
  • Greater difficulty in concentration, paying attention
  • Sudden jitteriness, nervousness, or aggression
  • Increased secretiveness
  • Deterioration of physical appearance and grooming
  • Association with known substance abusers
  • Unusual borrowing of money from friends, co-workers or parents
  • Secretive behavior regarding actions and possessions; poorly concealed attempts to avoid attention and suspicion.

Penikese Focuses on Internalizing Mental Health Conditions

Mental health conditions are often characterized as being externalized or internalized. Words commonly associated with young persons with externalized behavior include extroverted, under-controlled and acting out. Conversely, those with internalized conditions are often characterized as being introverted, depressed and disinterested. Persons suffering from internalized conditions often experience a diminished or lost interest in their previous patterns of activities of life, including social activities, work, school and activities of daily living.

Based on our focus on treating SUDs and co-occurring internalizing mental health conditions, we typically work with young persons diagnosed with one or more of the following diagnosis:

  • The Mood Disorders: Major Depressive Disorder, Bi-Polar Disorders, Dysthymic Disorder.
  • The Anxiety Disorders: Generalized Anxiety Disorder, Social Anxiety Disorders, Panic Disorder, Separation Anxiety, Obsessive Compulsive Disorder, PTSD, and Specific Phobias.
  • Autistic spectrum disorders: Aspergers Disorder, Non Verbal Learning Disorder, Childhood disintegrative disorder, Pervasive developmental disorder not otherwise specified.

Whom We Do Not Serve

At Penikese, we do not seek to focus on the entire spectrum of co-occurring mental health conditions. Penikese is a small and highly integrated community. We do not have the ability to “divide and conquer” populations that research indicates should either not be mixed during treatment or could require a different treatment regimen that is not available at Penikese. In addition, severe addictions are best treated in alternative environments where symptoms of withdrawal can be better monitored and addressed. Accordingly, Penikese has developed exclusionary criteria that include the following:

  • Primary diagnosis of Oppositional Defiant Disorder, ADHD or Conduct Disorder
  • Need for medical detoxification
  • Requirement for opiate replacement therapy
  • Current or recent history of suicidal ideation
  • History of requiring a highly restrictive setting as the result of acting out or anti-social behaviors.

Rationale
Most adolescents who present with a SUD also suffer from another mental health disorder. In order to maximize the likelihood of recovery both disorders should be treated at the same time. Adolescents with co-occurring disorders are less likely to recover from SUD when the mental health condition is left untreated. They are also more likely to be treatment resistant and more greatly inclined to drop out of treatment.

Many adolescents presenting with SUD begin using and drinking as a way to self-medicate untreated mental health disorders. In some cases mental health symptoms do not appear until the young person begins to use and drink. This may point to the fact that the drugs and alcohol either accelerate or cause the mental illness to manifest. In any event, the research points to the fact that if one of the co-occurring disorders is not treated there is a high risk that they will both get worse and even open the possibility for further complications to surface.

Over the past several decades there have been many studies highlighting the prevalence of both internalized (e.g., anxiety and mood) and externalized (e.g., conduct or oppositional defiance) disorders co-occurring with SUD. Adolescents presenting with SUD and co-occurring externalizing behaviors have received significant attention and much of the resources allocated for co-occurring disorders. Perhaps because of the internalized nature of the behaviors, there has been less focus on the treatment of internalizing disorders and SUD. Penikese seeks to respond to this need.
Of further note, adolescents with mood disorders, anxiety disorders and disorders related to trauma and attachment have particularly poor outcomes when their SUD is not treated simultaneously with their mental health disorder. A 2007 study (Buckner, et al.) found that Social Anxiety Disorder serves as a unique risk factor for the onset of cannabis and alcohol dependence. The prevalence of co-occurrence of SUD and internalizing disorders has been suggested by the empirical data as being as high as 47.9% (O’Neil, et al. 2011). The relationship between these disorders relative to which came first is unclear. What is clear is that early intervention in treating both disorders simultaneously gives the greatest chance that the adolescent will avoid the devastating implications of a bottom and begin to develop skills and discover strengths that will help protect him from relapse.

Penikese stands alone in its commitment to treating co-occurring internalizing disorders (disorders of mood, anxiety and trauma) simultaneously with SUD.

Best tips to overcome anxiety disorders naturally! – Zee News

Best tips to overcome anxiety disorders naturally!Most of us experience the feelings of anxiety and nervousness prior to an important occasion- it could be exams, interviews, meetings, first date, etc, which is quite normal. But, anxiety disorders are serious mental illnesses that fill people’s lives with overwhelming worry and fear that are chronic. In the long run, it can cause such misery that it interferes with a person’s ability to lead a normal life.

Several types of anxiety disorders are there– panic attacks, social anxiety disorders, obsessive compulsive disorders, post-traumatic stress disorders, generalized anxiety disorders, and phobias.
First of all one needs to identify what type of anxiety he/she is suffering from in order to get rid of it. While a combination of therapy, medicines and self-care can heal all of these disorders, here are some of the tips to help you in dealing with problems naturally:

Meditation: Using the right form of meditation can be useful for many people. Since lots of people dealing with anxiety problems are always in a dream-like state, the connective properties between mind and body that are used in meditation can do wonders.

Exercise: Daily exercise can drastically reduce your anxiety. Studies have shown that there is an incredibly strong link between anxiety and exercise.

Yoga/deep breathing: People who practice yoga regularly can keep themselves calmer and are often at peace. Deep breathing, which is very useful in dealing with panic attacks, is frequently taught in yoga. Doing yoga every day can help you relax from anxiety disorder besides toning your body.

Caffeine elimination: Anxiety may be reduced for some people by eliminating caffeine consumption.

Healthy diets: Eating a healthy diet is the key in combating anxiety disorders. Taking lots of fruits and vegetables and a diet rich in vitamins B, C, D and E as well as zinc, calcium and magnesium will be of great help in combating this disorder.

Compiled by: Salome Phelamei

Not Otherwise Specified: Anxiety & the Work of Dr. Robert Hudak

Not Otherwise Specified: Anxiety  the Work of Dr. Robert HudakSouthwest Pennsylvania National Alliance on Mental Illness (NAMI) held its annual conference at the beginning of April, and one of their afternoon breakout workshop presenters was Dr. Robert Hudak, assistant professor of psychiatry at Western Psychiatric Institute Clinic, University of Pittsburgh. “Pathways to Hope: Shaping a Positive Future in Uncertain Times” was the conference topic; Dr. Hudak’s contribution was “Coping with Anxiety and Panic Attacks.”

I communicated with Dr. Hudak recently, to clarify some questions, get his take on some extrapolations of anxiety and even to inquire about an interesting diagnostic title he proposed in his presentation.

Conference breakout workshops, be they NAMI or just about any organization, can never do justice to a topic in the short time allotted, but it is always good to get a small group together to at least begin a dialogue.

In his session, Dr. Hudak defined anxiety, reviewed the disorders as classified by the old and up-and-coming Diagnostic and Statistical Manual (DSM), discussed when and how to treat anxiety, and addressed referral concerns. Most of the content described herein is directly from his slide presentation, combined with quotes from my interview with him.

Interestingly, anxiety is “the only psychiatric symptom that is also experienced by individuals with no psychopathology.” Think about what that means. It can be found in normal emotion, or in psychiatric illness. But it can show up as “secondary to a medical or psychiatric illness, or as a primary symptom of a medical illness.” There are two states– not just psychological but also physiological — and four components — somatic, emotional, cognitive, and behavioral.

It is hardly a secret that even mild anxiety can show up in our bodies. The onset of hives for me during teen years, personally, was definitely emotionally-based, no matter how physically those deep red welts marred my arms. And as the emotional and behavioral components of anxiety are “givens,” in a sense, I asked Dr. Hudak to elaborate a bit on some of the cognitive components that might surface.

“The main one is an inability to concentrate or an inability to focus or pay attention,” he replied. “People sometimes complain to me that they feel like they have ADHD because their concentration is so bad.”

Due to internal family conversations that I have witnessed and been a part of at NAMI groups, though, I was thinking along the lines of more severe cognitive impairment even if acutely, as in stress-induced psychotic symptoms, disorganized thinking in how one presents to others, disassociation, or any manipulative behavior.

Given a chance to respond further, Dr. Hudak explained that “diistorted thoughts absolutely occur secondary to anxiety.” He gave the example of a mother who may not let ever her kids leave the house due to fear that they might get into a car accident and die.

“If they do leave, they may be required to check in every few minutes to ensure her they have not died, which most people would consider very extreme.” He goes on to say that “cognitive restructuring (in order to get her to realize that the chances of this happening are extremely unlikely and her reactions are extreme) is a part of the treatment, but only part. Simply doing that alone won’t work. Other behavioral methods are needed as well.”

As for stress induced psychotic-like symptoms, Dr. Hudak felt them “extremely rare” (but I know many family members through NAMI who might disagree!) Most important, as stressed in his workshop, “anxiety is expressed in a wide variety of ways by different individuals.”

The outgoing DSM has obsessive-compulsive disorder (OCD) as an anxiety disorder, but it will apparently be given its own weighted place elsewhere in the new one. Anxiety Disorder NOS (Not Otherwise Specified) will still be there, though, and Dr. Hudak curiously had it labeled “Hudak’s Syndrome.”

“This is a joke I tell to drive home a point. Every major psychiatric category has a NOS category which is generally used as a wastebasket term, for symptoms that don’t appear to be a diagnosable psychiatric condition…. I don’t feel it is a wastebasket term but is an actual separate illness that people can have, and to emphasize that it is different from generalized anxiety disorder.”

He goes on to say that he has certainly heard others comment, as well, that anxiety NOS is an actual illness and not just an NOS category.

His presentation gives an integrated approach for the treatment of all anxiety disorders, with consideration of medications and behavioral therapy, yet he definitely feels, as most, that “cognitive-behavioral therapies are the only ones shown to be effective for anxiety disorders.” These include specific physical techniques to help people cope with anxiety, as well as cognitive ones, such as self-record keeping and progress-tracking. “Thinking skills” also help individuals face situations that cause anxiety.

In his presentation, Dr. Hudak covered panic attacks in depth. I found it interesting to note that he included explaining the harmlessness of panic attacks as a specific, disarming therapeutic technique to be included in treatment.

A thorough look at the latest medications, and the symptoms they best treat, was given via his slide lecture. Some interesting points definitely stood out. He mentions FLAMS (Frontal Lobe Amotivational Syndrome) as a potential severe side effect of SSRI meds. Individuals being treated with these may “feel apathetic and emotionless…. very difficult to treat.”

“Exposure with Response Prevention” was one of Dr. Hudak’s slides and topics. This “teaches people that the physical symptoms of anxiety are normal and OK.” In treatment, a careful attempt to try to raise the heart rate will take place (by doing triggering behaviors and mechanisms).

Dual diagnosis — mental illness and co-occurring substance abuse — is a problem for many. Whether attending AA or NA, or on a treatment with an agonist like suboxone, it has been documented that acute anxiety is one of the most common co-occurring conditions with these patients.

Dr. Hudak feels that the the best way to determine the cause of the anxiety in these circumstances is to get patients sober. Nevertheless, anxiety can and will present in myriad forms, for myriad people, as is clearly pointed by his research and effective presentation.

An effective workbook is referenced in Dr. Hudak’s material — Mastery of Your Anxiety and Worry, by Zinbarg, Craske and Barlow, as well as some local resources for OCD, one of Dr. Hudak’s specialties.


 

Scientifically Reviewed
    Last reviewed: By John M. Grohol, Psy.D. on 11 May 2013
    Published on PsychCentral.com. All rights reserved.

 

Chronic pain sufferers often experience anxiety as well – Zee News

Chronic pain sufferers often experience anxiety as wellWashington: Researchers have suggested that patients coping with chronic pain should also be evaluated for anxiety disorders.

Lead author Kurt Kroenke, M.D., professor of medicine at Indiana University in Indianapolis, noted that health care providers are more aware of the common occurrence of depression in patients with chronic pain, and there has been less of an emphasis on anxiety.

In the new study, researchers evaluated 250 primary care patients who were being treated at a Veterans Medical Center in the Midwest. All patients had moderate to severe chronic joint or back pain that had lasted at least 3 months despite trying pain medications.

The participants were screened for five common anxiety disorders: generalized anxiety, characterized by persistent worry; panic, or sudden, repeated attacks of fear; social anxiety, characterized by overwhelming anxiety in everyday social interactions; post-traumatic stress, or a repeated feeling of danger after a stressful event; and obsessive-compulsive disorder, characterized by repeated thoughts or rituals that interfere with daily life.

They were also screened for health-related quality of life issues, such as fatigue, sleep habits, and work productivity.

The study found that 45 percent of the pain patients screened positive for at least one or more of the common anxiety disorders. And those who had an anxiety disorder also reported significantly worse pain and health-related quality of life than patients without a disorder.

“It is important to note that patients in our study screened positive for an anxiety disorder but not all would have a full-blown anxiety disorder if they had a diagnostic psychiatric interview,” said Kroenke.

“Some may just have anxiety symptoms and not all would warrant active treatment. However, probably at least 1 in 5 might have some type of anxiety disorder,” the researcher added.

The researchers also found that it was common for the five different types of anxiety conditions to occur in combination with each other and with depression.

“Psychological comorbidities are common in patients with chronic low back pain and other studies have also shown a high prevalence of depression, anxiety and other psychological conditions,” said pain expert Roger Chou, M.D., an assistant professor of medicine at Oregon Health and Science University.

Chou added that the guidelines on evaluating and managing lower back pain do recommend clinicians assess patients for psychological factors that may be contributing to a poorer prognosis and address them with appropriate treatments.

“Many patients benefit from cognitive behavioral therapy to help them in coping with the pain and related anxiety,” Chou continued.

The research was published in General Hospital Psychiatry.

ANI

Dunbar: Coping with obsessive-compulsive disorder

Dunbar: Coping with obsessive-compulsive disorder

May 9, 2013

During seventh grade, I was diagnosed with obsessive-compulsive disorder. For those who haven’t taken Intro to Psych, this disorder consists of two parts: obsessions and compulsions. Obsessions are persistent, anxiety-inducing thoughts, while the compulsions consist of certain acts or behaviors you carry out to alleviate the anxiety caused by the obsessions.

I tend to get obsessed with certain ideas. For example, when I was reading “Jane Eyre,” I was obsessed with why Jane decides to go back to Mr. Rochester. As a result, I repeated sentences in my head with the same meaning but different syntax: Jane left because she realized she needed Mr. Rochester. Realizing Jane needed Mr. Rochester, she went back to him. Jane realized she needed morality and love. Jane realized she needed both morality and love. Realizing she needed morality and love, she left her cousin John and went back to Mr. Rochester.

I also check things because I am always afraid I will forget something. I’ll be driving in the car and have to check my purse for my wallet. I also have to have things arranged in exact order. For example, books must be placed on a desk with perfect rectangles surrounding it.

I thought my OCD would improve as I grew older and moved away from my high school. At the very least, I believed I would learn to control it. But it turns out college just made me more stressed. So far, I haven’t really experienced the fun part of college, and I’m not the only one.

A couple weeks ago, my good friend suffered a psychotic break. She came down with mono and was prescribed a steroid to bring down the inflammation of her lymph nodes. Unfortunately, the steroid interacted with the Prozac she takes to reduce her anxiety. The result? She went a bit crazy — literally. Truth be told, however, I wasn’t entirely surprised. The stress and anxiety overload was bound to catch up with her.

Sometimes I look at my and my friends’ lives and think, “What’s with all the stress?” I don’t have to worry about money or paying for college. I go to a great school. I have friends and parents who love me. I even have a car, so I can go wherever I need to go. Nevertheless, the majority of the time I’m so consumed with anxiety that I can’t sleep.

But even with all of this, college isn’t what it was 30 years ago. Now it seems like nothing is ever enough. Education becomes a competition that never ends. Most of the students at Northwestern spent their four years of high school breaking their backs to take AP classes, get high grades and participate in numerous extracurricular activities. I thought I would finally be able to relax once I was accepted to college, but I was mistaken. In college, it all starts over – the grades, the extracurricular activities, the internships – and it starts from scratch. Everything is a resume builder, and one bad grade feels like the invariable downfall of your GPA. College is a never-ending flow of anxiety and exams and applications.

We’re trapped in a hot, cramped box with no way out. The contents are under pressure. It is no wonder people are suffering.

Since my friend’s psychotic break, I got to thinking. If our high school records get wiped clean, eventually won’t our college records be forgotten? Ten years down the road, no one is really going to care whether you graduated cum laude or magna cum laude, just like ACT scores stopped being important once you set foot on a college campus. We spend so much time worrying about the future that we forget we have no idea what’s actually going to happen. We forget that what the world revolves around today won’t matter much in the future.

I’m not saying college isn’t important. I’m just saying that the quiz you bombed when you were hungover or that interview you were late to isn’t going to determine your life in 20 years. Most likely, it will just get lost in a pile of memories.

Having fun shouldn’t have to be so hard. After all, we only have so much time to do it.

Blair Dunbar is a Weinberg sophomore. She can be reached at blairdunbar2015@u.northwestern.edu. If you would like to respond publicly to this column, email a Letter to the Editor to opinion@dailynorthwestern.com.

I am Royce White: Living and working with anxiety disorder

I am Royce White.

I am not 6’ 8. I can barely grow a beard, much less one of the epic varieties that White often sports. I’ve never been named “Mr. Basketball” in Minnesota, or anywhere else for that matter. In fact, my basketball career ended before I finished high school.

I’m also not a former top-five NCAA basketball player, nor was I the 16th overall selection of the 2012 NBA Draft. Royce White plays basketball better than most people on the planet. I’ve merely worked typical 9-to-5 office jobs, worked in publicity, and I’m a journalist with credits for ESPN, Wired, Esquire, Details, and many other outlets.

So it’s clear that I’m not, in fact, Royce White. Physically and financially, White and I are worlds apart. Despite these differences, however, in the one way that might matter the most, I am Royce White.

I’ve been dealing, mostly in secret, with a mixture of generalized anxiety disorder, panic attacks, and obsessive-compulsive disorder for nearly 10 years now (and probably even longer than that). My family knows. A few of my closest friends know, and (generally out of necessity) some former co-workers and employers know. I haven’t, however, been completely honest with most of the people that know me — the online community, the same community that, because of my anxiety, has become an integral part of my daily socialization.

Royce White’s battle with his employer, the Houston Rockets, over what accommodations they will make and what provisions they will allow him to have in order to feel “safe” at work while also dealing with his anxiety disorder, has made me painfully aware that I’ve been hiding. It’s time for me to step out from behind the anonymity of the Internet to give my thousands of Twitter followers and Facebook friends, the kind people who read my articles in various publications, and those that consider themselves my friends a chance to understand who I really am — a guy not all that different from Royce White. We’re both trying to navigate the professional working world while also dealing with serious anxiety disorders.

I am not just Royce White. Royce White is also Scott Neumyer. And he’s also anyone else with the same problem.

You never forget your first.

The first time I can remember consciously having a full blown panic attack — the kind of panic attack that isn’t just a fleeting few moments of anxiety, but one that turned my body into a viscous fluid, barely able to stand and form coherent sentences — I was in the upper deck of Philadelphia’s Lincoln Financial Field waiting to see Bruce Springsteen. Moments later I was sitting in a bathroom stall at one of the country’s newest sports stadiums with my head between my knees, sweating from every pore of my body.

Everybody has anxiety. It’s one of nature’s greatest tricks. It keeps us alive, alert, and ready to brace for impact in the case of dangerous situations. It’s one of the most important things your body can do and it’s helped humans survive for many years.

This was not that.

This was what happens when your mind and your body start going haywire, firing synapses, blasting adrenaline through your veins, and causing your fight-or-flight response to start binging out of control even when you’re in no immediate danger. That is what happens during a panic attack.

How you react to that first instance of panic determines just how deeply you’re about to slide into a panic and anxiety disorder. Once you decide to internalize that attack — once you ingrain that harried moment of maximum anxiety into your brain — you become sensitized. Personally, it makes me feel like my head is in a guillotine and, at every moment of every day, the man in the black hood might cut the rope.

I worry that something is going to happen and that something is probably going to kill me. I worry about being unable to stop that nameless something from happening. I worry about every single thing I do and every single move I make, wondering if the slightest change, feeling, emotion, or mistake could make that terrible, nameless, faceless something happen.

I worry about worrying.

And then it just starts going around and around in a circle. A (seemingly) never-ending fucking circle that goes round and round and round and round and round and round and round.

An old adage often attributed to Albert Einstein states, “Insanity [is] doing the same thing over and over again and expecting different results.” This is what it feels like to have panic and anxiety disorder. Only you’re never really expecting different results. Instead, you’re always expecting the same result: worry. At times, you literally feel like you’re going insane. It could be generalized anxiety, agoraphobia, or some other specific form of anxiety in the spectrum, but the feeling is the same. It feels like a lonely, hopeless, worry-filled hell.

Now you know what I worry about, and what Royce White worries about.

White doesn’t like to pin his initial introduction to anxiety and panic attacks to one specific moment, but much has been made about his experience one day as a 10 year old. After running wind sprints during basketball practice, his best friend collapsed right in front of Royce. Watching his good buddy on the court, drooling uncontrollably, and then riding alongside him in the ambulance on the way to the hospital, where he would be saved from a heart condition, certainly had an impact on White, but he’s not ready to say that’s the moment when his anxiety began.

Photo Credit: USA Today Sports Images

“It’s tough for me to just say that it’s that incident,” White said during a lengthy phone conversation, “just because I know so much now about anxiety disorder. I might have been predisposed to [my anxiety]. That’s how far along the science has come for anxiety. My mom deals with it. My grandmothers dealt with it. There’s a lot of alcoholism in the history of my family. Those things are all prevalent. But the incident did happen. I’m just not comfortable with putting the information out there that that’s where it started.”

Most anxiety sufferers can point to their first internalized panic attack, but once you start to recognize that you live with an anxiety disorder, it’s easy to look back at your life and see many different moments growing up that you never thought twice about when they happened and think, “Ah, that was probably a panic attack.”

Looking back now, I can point to dozens of moments throughout my childhood that, if they happened now, I’d instantly call them panic attacks: the time in second grade when I broke down crying, during class, because 8 x 10 and 40 x 2 couldn’t both possibly equal 80; the way I refused to sit on a certain side of the car in the backseat because it “just wasn’t right”; and the time at baseball camp eight hours away from home at Virginia Wesleyan College when I spent an entire night vomiting into an industrial-sized garbage can that my roommate dragged in for me before he left the room to sleep on the couch in the lounge. At the time, I blamed it on the chicken fried steak I’d eaten for dinner (a food that I, to this day, still can’t even look at on a menu without getting a little nauseous). Looking back, it was most certainly anxiety.

White can relate.

“I would start to feel sick to my stomach when I was a kid,” he said, reminiscing about his childhood experience with, what he now knows was actually, anxiety. “I would be so scared of actually throwing up that I would end up making myself throw up.”

What makes anxiety disorders so difficult to pinpoint and so misunderstood is that anxiety is an incredibly unique emotion. No two people with an anxiety disorder are alike — there is no obvious wound or manifestation. Each victim experiences different symptoms, handles the situation differently, and internalizes the attack differently after it has passed.

“Mental health is the most individualistic health condition on the planet,” White said. “It’s cognitive. There is no other health condition as dynamic because the brain is so unique to each person.”

“At one point,” White continued, “my anxiety had a lot to do with my own health and I was worried -from the event that I saw as a teenager at practice – that maybe I had a heart condition nobody knew about or my lungs were faulty. Or maybe I had some other type of illness that nobody would know about. You always hear about somebody finding out about their sickness once it’s already too late.”

Prior to having an anxiety disorder myself, I watched someone very close to me suffer through several years of panic attacks (before they pursued medication, professional help, and came out being able to manage their anxieties successfully), so I knew what anxiety looked like — or thought I did. What I didn’t know at the time, however, was that their anxiety would differ so greatly from what I would come to experience.

The Bruce Springsteen concert was supposed to be my reward for a job well done, a thoughtful thank you gift from a colleague and something that I’d undoubtedly remember forever. I do. I remember it as one of the most difficult nights of my life.

In 2003, I was 23 years old studying for my teaching certification and working as a substitute in the schools I attended as a kid.

I’d left a job in pharmaceuticals that paid well because I couldn’t pretend to be interested in chemicals and numbers and Excel spreadsheets any longer. I wanted to be surrounded by books and students writing and other teachers and learning and all the romantic clichés imaginable.

I spent my days wandering the halls, being the “cool sub” (mostly because I was young and let the kids get away with harmless things that most of the older substitutes wouldn’t tolerate) while also serving as assistant coach for the high school baseball team, the same team I had played on only a few years before.

After a successful season full of sunflower seed spitting, the head coach handed me a ticket to join him and his best friend at brand-new Lincoln Financial Field for a summer night with The Boss. He wasn’t just a fan of Bruce Springsteen. He was a Bruce fanatic, hard-core, and had seen The Boss live more times than I had years on the earth.

Photo Credit: USA Today Sports Images

I’d grown up rushing down suburban New Jersey roads in my dad’s brown pickup listening to eight-tracks of classic rock, but it had been a long time since I really listened intently to any Springsteen. I could sing along to “Born to Run” and a few lines of “Rosalita (Come Out Tonight),” but that was it. There was no way I could possibly hold court with Coach, so perhaps my nerves were already on high alert before we’d headed down the Garden State Parkway en route to Philly in my friend’s SUV. My goal was to try to have fun, but also make sure I didn’t ruin his night.

We arrived a few hours early, set up a couple of battered lawn chairs in the parking lot behind his SUV, popped a few beers, and listened closely to hear the faint sounds of the E-Street Band doing their sound check. So far, so good.

After downing the beers, I needed to pee. I held it in for a while then let the guys know and headed off on a slow jog toward the stadium. I ran perhaps a half-mile before finding the back of a line to the Porta Johns that was way longer than it should have been.

I waited 15 more long, increasingly painful and uncomfortable minutes before I was finally able to relieve myself. On the way back I met up with Coach and his buddy making their way toward the stadium.

Our seats were right along the edge of the upper deck. Perfect view. Great sound. And Bruce was just about ready to come out.

Yet as I sat down in my seat next to Coach, something didn’t feel right. It’s hard to describe the initial feeling, but now that I’ve experienced similar feelings so many times I can take a pretty good stab at it: I felt my hands slowly getting clammy. I felt disoriented and my vision began to blur. Flop sweat started to form at the top of my brow, and my stomach was turning. It wasn’t yet rolling so hard that I felt like I was going to vomit, but it was uncomfortable like the onset of motion sickness you might get trying to read while driving in the backseat of a car. I just wasn’t right.

“I’m going to hit the bathroom,” I told Coach before popping out of my seat and looking back toward the stairs. “I’ll be back in a minute.”

Coach looked at me and, seeing the beads of sweat now dripping down my forehead and into my eyes, sensed something was wrong.

“You OK?” he asked me. “You need anything?”

“Yeah,” I said. “I’m OK. Just not feeling the best at the moment. I think I just have to go to the bathroom.”

Maybe Coach thought I just couldn’t handle a couple beers and needed to hit the bathroom for a little drunken puke. Maybe he thought I was scared of heights. Or maybe he didn’t really care because his hero was about to take the stage. I can tell you with near certainty, however, that he didn’t know that I was having a panic attack. At that very moment, I didn’t even know.

I found the bathroom, claimed an open stall, sat down, and ripped off a few sheets of toilet paper to wipe away the sweat that was dripping down my face. I thought I’d use the restroom, feel better, and be dancing and singing in my seat in no time.

Still not feeling very well, I soon headed back out. I didn’t want to be gone for too long. I didn’t want Coach to worry.

As soon as I reached my seat, my head started to spin. I felt dizzy and started to lose a grip on my surroundings. I knew where I was, but I was beginning to feel that insular singularity that often comes with panic attacks. I was having trouble focusing on anything outside of myself.

“Scott,” I heard Coach say over the early guitar chords coming from the stage. “You sure you’re OK? You don’t look so hot. Too many beers?”

Of course that’s what he thought. He just assumed I was a lightweight. That was fine. It didn’t matter to me, as long as I didn’t screw up his night.

“Not really,” I told him, getting up from my seat again. “I’m going to hit the bathroom again. I’m not sure what’s going on.”

I rushed back to the bathroom, found the same stall available, swung open the door, slammed it shut and locked it. I sat down on the toilet — pants still on — and pulled out my candy bar-shaped orange Nokia phone.

“Hey,” my girlfriend (now my wife) said when she answered my call. “Aren’t you supposed to be at the concert?”

“I am,” I told her. “I’m in the bathroom. I’ve been in here a couple times now. I’ve spent more time in here than out at my seat.”

“Why?” she asked, not yet sounding that concerned or worried.

“Denise,” I said as quietly as I could while still loud enough for her to hear me, “I think I’m having a panic attack.”

Royce White is certainly not the first athlete to suffer from panic attacks or generalized anxiety disorder. Former broadcaster and Pro Football Hall of Fame coach John Madden very famously, hated to fly so much that he ended up riding around the country in his Madden cruiser, an RV that cost more than many single-family homes. The difference with White is that he’s the first athlete to demand certain accommodations as a player in the NBA.

Photo Credit: Getty Images

White wants to drive to as many games as possible so he doesn’t have to make 98 panic-inducing flights during the season. He also wants specific conditions met, conditions that, if they come to fruition, will set a brand new precedent in sports. He wants the Rockets to view his condition as a chronic illness and he wants to determine his treatment according to his own needs, not those of the team, conditions he has pressed for since being drafted.

White’s main sticking point is the mental health protocol that he wants in place. White wants an independent doctor to be the one that makes the call day in and day out as to whether he is fit to practice, play, or train, a doctor whose primary concern is White’s health, and not the Rockets’ record. He doesn’t want the team’s doctor to make the call.

The Rockets are reticent about providing such a provision. Not only would it create an additional expense to pay for an independent doctor, it also leaves the daily status of one of their players in the hands of someone not in their employ. White has no issue with the team doctor — the same doctor who can clear Jeremy Lin to play if he has a bad ankle or declare James Harden unfit to play due to a broken leg — determining this physical condition. White, however, wants an independent and impartial doctor to determine his mental condition, whether or not he is able to play, practice, or fly. And never before in the history of the NBA (and possibly all of organized professional sports) has such a protocol been put in place. To no surprise, Houston has balked at the idea.

The 2012-13 NBA season began without White suiting up in a Rockets jersey. He had yet to play a second before they suspended him on Jan. 6, 2013 for “refusing to provide services.” Twenty days later, White and the Rockets mutually agreed to put their differences aside for the time being while White reported to the Rio Grande Valley Vipers (of the NBA Development League) on Feb. 11.

White debuted for the Vipers on Feb. 12 against the Maine Red Claws. He played 18 minutes and grabbed eight boards, scored seven points, and had four assists. Still, the issues were far from resolved.

“It’s not resolved and that’s the truth,” White said to me afterwards. “I’m a straight shooter and I’m sure there will be more stories in the future, but it’s not resolved. What we did is that we signed an agreement that said we were going to scratch all the fines and everything that was going on. We were going to start over fresh. I took less money, obviously, because the season had gone on a little bit. I took, I think, $500,000 or $600,000 less than my regular contract, for this season. We said we’re going to reset and, on paper, acknowledge that I have an anxiety disorder and we’re going to acknowledge that anxiety disorder is a disability and needs to be reasonably accommodated.”

But what about White’s sticking point, that oh-so-important “mental health protocol” and the independent doctor?

“As far as the protocol that I kept preaching about, it was to my understanding – and this is part of the reason I came down to join the Vipers – that if I came down and showed that I wanted to play — because there was skepticism about whether or not I even wanted to play anymore — they would start to work on the protocol that we discussed. It hasn’t happened yet, but I’m very hopeful that it will. The Rockets and the NBA know that I’m very firm and I’m not going to forget about it.”

And White has not forgotten. On March 21, he announced via Twitter that he would no longer play for the Vipers. He missed three road games but then returned for their final six regular-season (home) games.

On April 5, White played 34 minutes for the Vipers against the Austin Toros and showed flashes of just why the Rockets gambled on him with the 16th pick in the 2012 draft. White’s line? 28 points, 9 rebounds, 6 assists, 4 steals, and 1 block.

A performance like that is the very reason that White’s situation is so divisive. He clearly has the talent and ability to play at the highest level, but his steadfast refusal to play under conditions that he feels are “unsafe” is making life hell for everyone — White, the Rockets, and the fans.

Provided that White sticks to his plan of not playing during the Vipers’ playoff schedule, he will have played a total of 16 games in the 2012-13 season averaging just over 25 minutes per game, 11.4 points, 5.7 rebounds, and 3.3 assists.

“The NBA drew the short straw,” he said, “because they’re not just going to be able to give me a Xanax and say, ‘Here, go get on a plane,’ because I’m not taking no damn Xanax because I know it’s addictive. That’s something that I shouldn’t have to do in order to play basketball.”

So far, however, it seems the Houston Rockets believe otherwise.

While I successfully made it through the entire Bruce Springsteen concert, and actually ended up enjoying it quite a bit, that August night in 2003 is the last live concert I’ve seen and the last time that I’ve been in a large sports stadium. It was also the beginning of the end of my teaching career.

When school started again in September, I had no plans of quitting. My panic attack at the Springsteen concert over the summer was a terrible night for me, but I hadn’t yet internalized it to the point of becoming afraid of every waking moment. I moved on and for the first month of the school year I continued to substitute teach.

Sometimes anxiety begins over the most miniscule things. For me, it was the day when I was substituting for the high school’s gym teacher and the gym was too full to use for my class. I had to take my students to the school’s library, tiny and already packed with students.

Photo Credit: USA Today Sports Images

That slight change set me off completely. Halfway through class, as I sat at a table while the kids enjoyed a free period, I began sweating. Nearly every single symptom that I experienced in the upper deck of Lincoln Financial Field began to course through my body as 30 students in my charge romped around the library.

I vividly remember sitting there while one of my students started talking to me. I usually enjoyed hearing about their lives outside of school, the crazy thing that happened over the weekend or who was hooking up with who. It was one of the perks of being the young substitute; I felt like they actually enjoyed my company. This day, however, I couldn’t focus on a word he was saying. My eyes felt like they were bulging out of my head and my mouth was so dry you’d think I’d just eaten a boxful of chalk. I was out of my mind with anxiety.

When the bell mercifully rang, I ran out of the library, down the hallway to the main office, told the secretary that I was sick, headed home, and dove under the covers on my bed for hours.

I never worked another minute as a teacher, substitute or otherwise. If we’re keeping score, I did end up passing my teaching certification test. I’d already signed up and paid to take the test, so I thought I might as well take it anyway. I ran into an old high school classmate at the testing center, had a panic attack two minutes before the test began, aced it anyway, and went home knowing I’d never teach.

“This is not only a really fascinating topic,” sports psychology expert and coach Bill Cole tells me, “but I think potentially groundbreaking. I think it could turn sports on its head.”

Cole, a former tennis professional and Division I tennis coach has worked with athletes for years. He’s had golfers with the yips, gymnasts experiencing “blocking,” and players from every sport dealing with choking. He has heard and seen nearly everything possible in the sports psychology world. Yet even he thinks Royce White’s situation is uncharted territory.

“Normally, institutional sport is one of the last bastions of really institutionalized abuse, in a lot of ways,” Cole said. “Maybe discriminating against people with mental difficulties is one of those arenas. So maybe White is doing everybody a really big favor by putting the spotlight on it and, at the minimum, making people think about it.”

That’s precisely what White thinks.

“This is actually going to be a great thing for the league,” White said, “and a great thing for me and my career. There’s going to be a lot of stories coming out of this where people go, ‘Ah, if they had that protocol when this person was in the league, maybe they wouldn’t have had issues or dropped out.’ I’m not just talking about a phobia of flying. I’m talking about alcoholism, drug abuse, sex addiction, and many other things.”

From what White tells me, he has plenty of athletes in all sports in his corner.

“So many athletes have contacted me and told me to keep doing what I’m doing,” he said, “athletes of old and athletes that are still playing today. They told me how they ended up dealing with [their anxieties] by drinking or some other way. I had athletes that told me, ‘I was scared of flying too, but I ended up taking Ambien, and then I had to check myself into rehab because I couldn’t get the sleep without the Ambien.’ When you talk about taking 98 Ambien a year, that’s not safe. We know that now. And things like Xanax. That’s not safe. The NBA actually banned benzodiazepines because it’s so addictive.”

Benzodiazepines, like Xanax, are psychoactive drugs widely prescribed to treat a variety of metal and physical health issues, from insomnia to anxiety. They can also be addictive as hell and cause a host of health issues themselves. Even SSRIs (selective serotonin re-uptake inhibitors), drugs like Paxil, Zoloft, and Lexapro, that work in a less dramatic way to, in layman’s terms, rebalance a chemical imbalance in the body and help with managing anxiety and depression, can have annoying, strange, and sometimes severe side effects. The decision to take any of these drugs is not like taking a cortisone shot to fix a sore knee.

Trust me, I’ve tried many of these drugs before finding one that works best for me on a daily basis (Zoloft). Paxil did nothing for me. Lexapro showed no positive results when I tried it. Even the generic form of Zoloft (Sertraline) was akin to taking nothing at all. The worst, however, was a period of several weeks when I took Cymbalta.

After giving the medication a few weeks to work its way into my system (an unavoidable evil of all SSRIs), Cymbalta made me dizzy and gave me vision problems. My doctor started to wean me off the drug little by little (another unavoidable evil of taking SSRIs — you can’t just stop). The next week and a half I lay on the couch alternately shivering and sweating. At times, I had brief hallucinations and felt like bugs were literally crawling under my skin. Despite never having used an illegal drug stronger than marijuana in my entire life, I felt like what I imagined a “dope sick” junkie feels like during withdrawal.

What most people that call for White to stop “whining” and play, or hang it up and get a real job, don’t realize is that mental illness is just that — an illness.

“It took me a long time to understand that this was mental illness,” former Team Canada Inline Hockey goalie Kendra Fisher tells me during a phone interview. “This wasn’t just something that was in my head. It wasn’t something I chose from day to day. It was an illness and I was sick. I had to learn how to recover and get to a state of recovery that allows me to cope and live my life accordingly.”

As a young ice hockey goalie on her way up, Fisher was poised to join Team Canada until anxiety, depression, obsessive-compulsive disorder, and agoraphobia got in the way. During tryouts, Fisher started to experience panic attacks and severe anxiety.

“I was ending up in the emergency room every day,” she said, “not knowing what was wrong.”

Fisher got to camp and ended up on a red-eye flight back home shortly thereafter.

“Unfortunately, before I left,” Fisher told me, “when I had gone to the coach and tried to explain what was going on and what was wrong, the question I was posed with was, ‘Is it going to help you any if you know you’ve made the team? Is it going to help you if you know that we want you to come play for Team Canada?’ That certainly made it a memorable moment, but unfortunately not for one I’d like to remember.”

The difference, however, between Fisher and White is that Fisher suffered in silence for years, never letting her teams know the severity of what she was feeling.

“I certainly wasn’t at the top of my game for a while,” she said. “It was scary. It was petrifying to be on the ice some nights. Goaltending is a lonely position and when you’re struggling with being alone and you’re spending all but three or four minutes active, on the ice, by yourself in that net trying to talk yourself out of panic attack after panic attack. It wasn’t something I allowed people to know I was going through, which made it more of a struggle.”

Fisher is now an advocate for mental health awareness and speaks regularly about her experience and struggles with anxiety and depression. She, like White, wants people to know, “It can be absolutely devastating, but it can also be coped with, and it can be something that you live with successfully.”

It took me nearly six months to crawl out of my anxiety-ridden bed and get a new job after I left teaching, six months of medication and exposure and cognitive behavior therapy and extremely supportive loved ones. But when I did get back into the workforce, I found myself, like White, struggling with how to navigate the professional world while also dealing with an anxiety disorder.

I’ve had two different day jobs in the past nine years. The first was an office job. All I had to do was put in my hours behind a desk, and clock out at night before heading home. Yet even that filled me with anxiety.

Every single time I saw my boss near lunchtime, I quivered in fear that he would ask me to hop in his expensive car and join him for a quick business lunch. It wasn’t the fear of actually going to lunch that I was afraid of, because I knew I would never go. It was the fear of having to tell the man who signs my paychecks, “No.”

After a year of dodging him, I finally scheduled a sit-down in his office and spilled my guts, telling him my anxiety disorder made me terrified to go to lunch with him. I told him that it wasn’t personal and that I’d be happy to have lunch right there in the cafeteria, or his office, if he liked, but dining out wasn’t ever going to happen.

To my surprise, he took it extremely well. He was understanding, kind, and supportive. That alone made me feel almost comfortable enough to go to lunch with him. Almost.

After leaving that job, I took another more suited to my condition. I started working from home for a company on the other side of the country — simultaneously the best and worst possible situation for me. Although it allowed me to focus on work rather than my anxiety, it also sheltered me from interacting with the world.

I lasted almost a year before I ran out of excuses as to why I couldn’t just hop on a plane to join them for meetings and parties and client introductions. Then I had the very same sit-down with my new bosses as I had with my previous one. Only, this time, it was on Skype.

Fortunately, my bosses were equally as amendable to my mental health situation. While they would love it if I could fly across the country in what I view as an enormous metal death-machine, they understood and were willing to work around it. I’ve been there ever since.

The first thing I thought when I read about Royce White was how I felt so much empathy for him. I knew exactly what it was like to have to deal with your job while also dealing with an immense amount of soul-crushing anxiety. I knew what White was going through. My first reaction was to defend him every time some sportswriter or fan told him to “just suck it up.”

I wanted to call him up and tell him to keep doing what he’s doing and to speak out because it can only make things better.

Now, after speaking with White, I realize that I didn’t need to tell him anything. He already knew, possibly better than I did.

Photo Credit: USA Today Sports Images

“My teams have always known about it, White said. “The University of Minnesota knew I had anxiety. The teams all knew about it. Coach Hoiberg, from the day I got on campus, made sure that I felt incredibly comfortable in communicating with him what I needed for my disorder. That is all he did and that is all he needed to do. That’s all anybody needs to do when dealing with mental health. Just have an open ear to what the person needs in order to cope. He’s the reason why I ended up taking a lot of flights when I was at Iowa State.”

And he’s right. From the moment I told my bosses about my illness, my situation vastly improved because only through dialogue and open discussion can people understand more about anxiety, depression, and mental health. Only then can they feel empathy, begin to understand, and even help.

Kendra Fisher said, “People are more supportive when you give them the opportunity to be supportive,” and she couldn’t be more right.

But where do Royce White, the Houston Rockets, the NBA, and even people like me go from here?

“I think we’re getting there,” White said. “The number one thing that was needed was recognition. The next biggest step is genuine action or genuine care. The next step is about how much is the NBA going to buy in? How much are the Rockets going to buy in?”

That’s the question we can ask of any employer, friend, family member, or fan. How much are they willing to sit down, educate themselves, and begin to understand that this illness (which you can’t see as you can see a broken leg or a twisted ankle) is something very, very real?

In the end, maybe that doesn’t matter to Royce White.

“I’m waiting to see what my next move is going to be,” he said, “because mental health will be a priority wherever I am.”

Or maybe, just maybe, for Royce White, me, and everyone else suffering from anxiety, it’s the only thing that matters. ★


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About the Author

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Scott Neumyer is a journalist whose work has appeared online and in print for ESPN, Esquire, Wired, Details, Slate, Popular Mechanics, and many more publications. He lives in central New Jersey with his wife and daughter, and loves bacon far too much. You can read more of his work at scottwrites.com and follow him on Twitter @scottneumyer