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Black Friday Isn’t Great for Your Mind: 10 Mental Health Alternatives

Black Friday Hype Isn't Great for Your Mind: 10 Mental Health Alternatives

November 21, 2022

As the holiday season kicks into full gear, the pressure to spend on gifts and gadgets steadily increases. 

 

One of the biggest offenders is Black Friday, which encourages shoppers to make impulsive buys on once-a-year sales at big box retailers. Whether due to a desire to snag some cool tech or a more altruistic motive of getting friends and family the best gifts they can, many feel compelled to partake in the Black Friday deals. In 2021, 155 million Americans shopped on Black Friday.

 

Though the impact can be mundane, Black Friday shopping often isn’t the best thing to do for one’s mental health. Whether it be the stress of straining one’s budget or the disappointment that follows an impulse buy, participating in Black Friday can leave you feeling down and depressed. 

 

While Black Friday shopping can seem almost irresistible, the truth is that there are several accessible alternatives.

 

Check out 10 of our favorite options below. 

10 Alternatives to Black Friday Shopping

#1 Focus on Your Financial Health

Instead of stretching your budget on items you may not need or end up using, try using Black Friday as an opportunity to adopt healthier financial habits. Helena Hernandez, a physician assistant at Heading Health, recommends “establishing financial boundaries.” Take some time to review your budget and decide on your limits. Then make a point of sticking to them to maintain your financial wellness during the holiday season.

#2 Volunteer or Donate to a Charity

Studies show that doing good deeds makes us feel good. To improve your mental health while helping those in need, consider volunteering or donating to charity. Check out Charity Navigator to find causes that align with your values, or go to Volunteer Match to find volunteer opportunities in your local area. 

#3 Start a Gratitude Journal

Black Friday pushes us to feel like what we have isn’t enough. If it didn’t, we wouldn’t go out and spend more. Unfortunately, while an extra product or two might temporarily leave you feeling more fulfilled, that sensation is unlikely to last. A better solution is to turn your attention away from what you don’t have and toward what you do. Consider making a list a running list of things about your life that bring you joy and focus on them every morning or whenever you feel a bit down.    

#4 Throw a Leftover Dinner Party

According to the nonprofit organization Feeding America, Americans waste 130 billion meals every year. Instead of buying more products that might also go to waste, consider holding a leftover dinner party to 

make full use of the resources you already have. With a cleaner fridge and a house full of friends, you’ll surely have a better time than waiting in line for another Black Friday deal.  

#5 Celebrate Bright Friday

Another way to combat the waste associated with Black Friday is by celebrating Bright Friday, which was created to raise awareness about textile waste in fashion and e-commerce. Shoppers are encouraged to maximize the value of what they already have by swapping, restyling, and refashioning their clothing.

#6 Connect with Nature

Instead of spending time waiting inside in long lines or at home playing with your new gadgets, use Black Friday as a reminder to tap into nature’s protective effects on mental health

Visit a national park if you can access one, or go to a local nature site. Check out All Trails to find nearby places to hike, mountain bike, camp, and more. 

#7 Talk to Your Kids About the Value of Experiences

A recent study found that, by and large, experiences make people happier than possessions. Lead Author and Marketing Professor Amit Kumar notes:

 

If you want to be happier, it might be wise to shift some of your consumption away from material goods and a bit more toward experiences, […] That would likely lead to greater well-being.

 

Use Black Friday as an opportunity to instill this knowledge in your children. Take them on one of their favorite outings and document the experience so they can re-live the joy of that day and internalize the value of experiences over possessions.  

#8 Wait for Small Business Saturday

In contrast to the big box retailers that are the focus of Black Friday, Small Business Saturday is about shopping at small, brick-and-mortar stores. If you’ve got to do some deal hunting, consider saving it for Small Business Saturday and support local business owners in the process.

#9 Go Somewhere That’s Normally Too Busy

With so many people either shopping at home or flocking to retail stores, other services are likely to experience a drop in attendance. Use this as a chance to enjoy an ordinarily bustling activity in peace and quiet. For example, consider going to your local coffee shop, gym, or favorite restaurant. Of course, some of these places might still see heavy traffic, so be sure to call ahead and ask how busy they are.  

#10 Consider What Your Loved Ones Would Say

Even with all these alternative activities in mind, participating in Black Friday might still seem tempting, especially when purchasing gifts for the Holiday season. To help curb its residual pull, consider what your loved ones might say. Would they want you to strain your budget and risk your mental wellness to get them a gift? Reflecting on this fact will likely undermine our more altruistic reasons for doing a bit of Black Friday shopping. 

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Yes, Insurance May Cover Ketamine. Here’s Where To Start


Yes, Insurance May Cover Ketamine. Here's Where To Start

November 18, 2022

Ketamine-based therapies have proven to be a game-changing solution for many individuals struggling with mental health conditions, providing rapid relief after several other options have failed.

 

With any mental health intervention, it’s important for patients to determine whether it’s covered by insurance. This is especially so when it comes to ketamine and its newer cousin, SpravatoOut of pocket, Ketamine treatments can be expensive. For example, a round of six ketamine infusions can cost several thousand dollars at local clinics here in Austin, Texas, and online providers costs are similar with just a few months of treatment quickly adding up to thousands of dollars. Additionally, the effects of ketamine may not be robust or long-lasting when not supplemented with therapy or maintenance infusions. Studies have found the antidepressant effects of a single ketamine infusion last between four to seven days, while repeated infusions can extend this to several weeks.

 

Though through concurrent therapy, a much more sustained effect can be achieved, this is not widely offered – which is something we remedy with our team approach.

 

The truth is information about ketamine and insurance can be very confusing. For example, we looked at clinics in our nearby area of Austin. One clinic claims that ketamine is generally not covered by insurance, and many mention they do not accept insurance. As a result, while insurance can cover ketamine, those interested in receiving treatment will need to take special precautions to ensure they get the financial support they are entitled to through their plan.

 

Our team at Heading has worked hard to ensure we can provide coverage for the majority of our patients. 

How to Assess Whether Your Treatment Will Be Covered

While you won’t know for certain if any treatment will be covered before your insurance company receives a claim, you can gather strong evidence with the following steps.

#1 Ask Your Insurance Company if They Cover Ketamine-Based Treatments

Insurance coverage is determined on a case-by-case basis. Some companies don’t cover it at all. Before pursuing treatment or completing any other steps for assessing the likelihood that your treatment would be covered, call your insurance company and ask them if your policy covers ketamine for mental health conditions under any circumstances.

 

If the treatment is covered in specific scenarios, ask your insurance provider for specifics. For example, most insurance companies that cover ketamine require evidence of previous trials with other antidepressants (more on this below).

#2 Review Your Treatment History

Knowing your insurance company covers ketamine is a step in the right direction, but you’ll also need to know if they’ll cover your particular case.

 

Insurance companies generally want evidence that the treatment is 1) necessary and 2) likely to be effective enough to justify the cost of covering it. Demonstrating this often involves providing medical documentation proving you have tried several other interventions with unsatisfactory results. For example, when deciding whether to provide coverage for Spravato for a case of treatment-resistant depression (TRD), insurance companies most often want to know that you’ve tried two to three oral antidepressants (e.g., Prozac, Zoloft, Lexapro, etc.) and have not experienced a significant improvement.

 

The good news is that providing this information is simple if you know your history.

 

Your treatment history will be part of your evaluation with the prescribing physician at the clinic where you’ll be receiving your ketamine-based therapy. From there, they relay your treatment history and their recommendation to the insurance company, who will make a final determination.

#3 Check if Your Clinic Works with Insurance Companies

Despite the high cost and the need for repeat sessions of ketamine-based treatments, most clinics cannot secure coverage for their patients. Before settling on a treatment center, be sure to check if they work with insurance and ask how often they are able to secure coverage for patients. If you are considering at-home providers, do your research on insurance coverage and reach out to the company regarding finances prior to starting treatment.

#4 Determine Whether You’ll be Receiving Ketamine or Spravato (Esketamine)

If you’re looking around for ketamine-based treatments for your mental health condition, you’ve probably heard about ketamine and Spravato. Ketamine is a dissociative anesthetic whose antidepressant properties were first confirmed in 2000. Esketamine is structurally and therapeutically similar and is the active ingredient in Spravato.

 

Source: NeuroMend

Despite their commonalities, they are often treated very differently by insurance companies. Spravato is far more likely to be covered. The main reason is that Spravato is approved by the U.S. Food and Drug Administration (FDA) to treat TRD and major depressive disorder (MDD) with suicidal ideation.

 

Ketamine is not approved for any psychiatric conditions. This means that when ketamine is prescribed to treat a mental illness, it’s considered an “off-label” use. As Simon Tankel, CEO of Heading Health, notes, while insurance companies often cover off-label prescriptions for oral antidepressants, they are much more reluctant to do so in the case of ketamine because it’s significantly more expensive.

What to Do if Ketamine is Not Covered

Even if your ketamine treatments aren’t covered, you can take steps to make covering the cost of treatment more manageable. 

#1 Check if Your Clinic Offers Payment Plans

Though most clinics can’t secure insurance coverage for ketamine for their patients, many offer zero-interest payment plans that allow them to pay off the treatment in low-cost installments.

#2 Try to Get Reimbursed

Insurance companies that won’t cover the cost upfront might be willing to reimburse you after you have paid out-of-pocket.

 

When submitting a claim for reimbursement, it can be helpful to send your insurance company what is known as a “superbill.” This document contains several important pieces of information, including all of the services you received, along with relevant clinical data regarding your medical history. These superbills act as a “proof of service” and will help your insurance company decide whether they can offer you a partial or full reimbursement.

#3 Consider the Benefits of Psychotherapy and Ketamine Concurrently

Though not insurance specific, per se, it is important to consider how to foster longer-lasting effects and faster healing. Not only does faster healing improve your quality of life, it impacts your financial health too. Studies suggest that when psychotherapy and medication protocols align, it fortifies the benefits of ketamine treatment.

 

While psychotherapy is important regardless of whether insurance is covering your treatment, it’s absolutely essential when you’re paying the full price. Consider providers that can offer both or seek out a therapist or counselor familiar with ketamine treatment to ensure more optimal outcomes for your health and your wallet.

Is Ketamine Covered at Heading?

Yes. At Heading, we are proud to say that we are able to provide insurance coverage for both Spravato and Ketamine for the majority of our patients. Our team has worked closely with a wide array of insurance companies to highlight the advantages of ketamine-based therapies and demonstrate why it’s in their interest to cover them. Click here for a complete list of participating providers.  

 

Talk with your doctor to determine whether one of these treatments is right for you, or you can schedule an appointment with one of our psychiatrists or therapists to advise you on potential treatments for depression, including ketamine, Spravato, and TMS. Call us at 805-204-2502 or request an appointment here.

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How to Support Grieving Loved Ones During the Holidays


How to Support Grieving Loved Ones During the Holidays

Julia Lopez

November 17, 2022

The spirit of the holiday season is one of joy, hope, and gratitude. Yet, for many people, it can also be the most difficult time of the year.

 

Be it the loss of a loved one, relationship turmoil, distance, or financial instability, there are many reasons why the pressure of get-togethers, transitions, and gift-giving can bring up heavy emotions. It’s likely that you know someone who experiences grief during the holiday season, and it is also likely that we all, at some point in our lives, will experience loss that feels more profound and intense as special dates on the calendar draw near. 

 

We asked clinical staff at Heading Health, a mental health care service and clinic based out of Austin, Texas, for their thoughts on how to best support loved ones who struggle with grief and loss during the holiday season. 

Be Proactive 

When people experience grief, they may not outwardly make their feelings known. It can be difficult to know exactly what to say and easy to interpret someone’s silence as “ok-ness.”  Psychiatric Physician Assistant at Heading Health, Helena Hernandez, suggests being proactive when it comes to checking in with someone who may be hurting during the holidays. 

“Make time to talk to your loved one alone. Take time to sit with them at dinner,” Helena shares. She added, “And if your loved one is far away, make time to check on them from a distance.”

Acknowledge that Grief Looks Different for Everyone

The journey through loss has no road map. Acknowledging your loved one’s unique experience and grieving process can convey not only your love for them but also your respect. 

“It’s important to remember there is no ‘normal’ time frame for processing grief and loss,” said Victor Furtik, a licensed professional counselor at Heading who specializes in working with people who experience anxiety, depression, and those navigating big life changes. 

Victor emphasized the importance of asking questions and remaining open to the answers, “A simple question like, “What kind of support would be most helpful right now?’ can help empower your loved one to articulate and identify their needs and let them know that you care.”

Even If it’s Awkward, Reach Out Anyway

Sometimes, in an effort to avoid saying the wrong thing, it can be tempting to not do anything at all. Remember that a simple gesture, outreach, or loving sentiment can go a long way in letting people know they are not alone. 

There are never perfect words to say, but considering what is within your reach rather than what is not can stimulate courage to offer support even if you’re not quite sure of what to say. 

“Reach out. Offer support within your own limits,” suggests Andrea Marquez LCSW, a therapist at Heading Health.

Finally, if you know someone who is dealing with mental illness, grief, or loss and you feel that they are in a dark place, know that help is always available. 211texas.org is a digest of resources, including hotlines for those in crisis. 988 is also the new suicide hotline offering a simple and easy-to-remember three-digit number offering support via phone or text when people need it most.

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Alternative Treatments for ADHD


Alternative Treatments for ADHD

November 14, 2022

Over 1.6 million U.S. adults have attention deficit hyperactivity disorder (ADHD). Characterized by symptoms such as a short attention span, distractibility, forgetfulness, and impulsivity, the condition can pose a significant challenge to maintaining a successful job, managing relationships, and accomplishing personal goals.

Stimulants such as Adderall, Ritalin, and Concerta are the standard treatments for ADHD. These medications work by increasing chemical messengers called dopamine and norepinephrine in the brain’s central nervous system. While highly effective, these medications aren’t the best choice for everyone. Some individuals have other conditions that stimulants can exacerbate, such as:

  • Heart problems
  • Glaucoma
  • An anxiety disorder
  • Tourette’s syndrome
  • A history of psychosis

Even when there are no conflicts with other conditions or difficult side effects, stimulants may not be fully effective. Studies have found that 10 to 30 percent of patients do not respond adequately to stimulants

As a result, it’s important for individuals with ADHD to be aware of the alternatives that can either replace or supplement stimulants.

Non-Stimulant Medications

While stimulants are the most common type of medication used to treat ADHD, they aren’t the only option. Some examples of non-stimulant ADHD medications include:

  • Straterra
  • Clonidine
  • Intuniv
  • Qelbree

As Heading Health Psychiatrist Dr. Arif Noorbaksh notes, while these medications may be less effective, they are “generally safer and better tolerated than stimulants.”

Talk with your physicians to determine whether these non-stimulant alternatives are right for you.

Talk Therapy

Medications aren’t the only way to treat the symptoms of ADHD. For example, research has found that cognitive behavior therapy (CBT) can help with procrastination, time management, and planning.

Aside from addressing the symptoms of ADHD, therapists can also help with some of the stressors it can cause, such as job losses or relationship problems. They can also treat other mental health conditions, such as anxiety and depression, which can exacerbate the symptoms of ADHD. 

Coaching

Therapists are not the only types of professionals who can help individuals with ADHD overcome their symptoms. ADHD coaches work closely with clients to help them carry out their daily activities in a focused and organized fashion. They provide feedback and suggestions to help them out with tangible goals. They can also help with accountability by checking in on clients to see their progress.

Behavioral Strategies

Even without a professional to guide you, you can make a range of simple changes to your environment and routine that can help you stay focused. Here are a few suggestions

  • Create a checklist: Having a clear list of what needs to get done can help keep you on track and ensure you don’t forget essential tasks.
  • Decrease distractions: Make a point to limit easy distractions. Make a list of common distractions and avoid them while working on important tasks. Some common anti-distraction strategies may include setting your phone and computer to do-not-disturb mode and avoiding working around your TV. 
  • Try out a fidget device: ADHD can result in excessive fidgeting. Devices designed to channel that fidgeting (e.g., a fidget spinner) can channel it in a healthy way and prevent it from interfering with your ability to concentrate.
  • Set time limits: Though ADHD is associated with distractibility, it can also cause hyper-focused states where individuals zero in on one task for prolonged periods of time. While this can be useful, it can pose a problem if it happens at the expense of other goals. Setting a timer is a quick way to avoid this problem.
  • Create your personal reward system: Positive reinforcement is a well-established technique promoting desired behaviors. Try to give yourself simple rewards, such as a walking break, gold star on a tracking system, or a tasty snack like a piece of chocolate, when you’ve completed a task.  

Support Groups

As with any mental health condition, talking with others who have ADHD can be helpful. Learning that other people experience similar difficulties can mitigate the sense of shame and guilt that individuals with ADHD can experience. Success stories can be a powerful motivator and provide unique strategies for coping with their symptoms and improving overall functioning. Like coaching, support groups can also be helpful for accountability purposes. Knowing that you’ll meet with a group to discuss how you’ve been managing your ADHD may provide additional motivation to stick with your tools and strategies.

Nutrition and Lifestyle Changes

While nutrition and lifestyle habits may not cause ADHD, specific diets and behaviors can help mitigate the symptoms. Sally Twellman, nutritional therapist at Heading Health, recommends:

  • A high-fiber plant-rich diet
  • Brightly colored fruits and vegetables that are high in antioxidants
  • Avoiding processed foods, especially those high in preservatives and artificial dyes
  • Checking for food sensitivities (e.g., gluten allergies).

Aside from diet, exercise has been investigated as a potential tool for alleviating the symptoms of ADHD. For example, a recent meta-analysis found that exercise improves executive function (i.e., mental abilities associated with memory, organization, planning, attention, etc.). Importantly, they found that exercise intensity did not impact the therapeutic effects of exercise, meaning even moderate exercise can help with ADHD.


A good night’s sleep can also have a significant on ADHD symptoms. Though ADHD can make it difficult to get a good night’s rest, a few simple techniques can make sleeping well easier. 


Here are some suggestions:

  • Avoid napping within four hours of your bedtime.
  • Don’t consume caffeine within 12 hours of your bedtime.
  • Go to bed around the same time every time.
  • Develop a calming bedtime routine.
  • Use a blue light filter when looking at screens close to bedtime.

If you feel you need to see a mental health professional or could use help deciding which service is right for you, please give us a call at 805-204-2502 or fill out an appointment request here. We have a wide variety of providers, including therapists, psychiatrists, nurse practitioners, and nutritional therapists, who can see you in as little as one day via teletherapy. 

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Six Tips for Having Supportive Conversations with Veterans


Six Tips for Having Supportive Conversations with Veterans

November 7, 2022

Veterans returning to civilian life often struggle to communicate with civilians about their experience as active military members, leaving them feeling isolated and disconnected. At the same time, civilians eager to engage with veterans may worry about saying the wrong thing, triggering past trauma, or otherwise having an unhelpful conversation.

In our Veteran’s Day speaker series event, Femi Olukaya, a therapist and military veteran, and Teressa Carter, a social worker with experience serving and treating active duty service members, sat down to discuss this issue, among several others. 


Take a deeper dive into their advice and explore six tips civilians can use to have healthy, supportive, and productive conversations with veterans about their experiences in the military below.

#1 Ask Them What They Want You to Know

As Carter points out, an easy way to avoid pressuring veterans to discuss issues they aren’t ready to discuss is to ask them what they want you to know. That way, you’ll only hear what they feel comfortable revealing and believe it would be most helpful for you to know.

# 2 Be Accepting

Military culture often discourages vulnerability. That’s why when a veteran decides to open up about their military experiences, it’s vital that you meet them with love and acceptance.

Aside from a culturally ingrained aversion to vulnerability, veterans are often reluctant to reveal what they’ve gone through because they fear judgment from civilians. Olukoya notes that:

When [veterans] say certain things, they don’t want to scare civilians with what they’ve seen, how they’ve lived, and how they think. So, they have to find a safe space where they can actually express themselves without being judged.


As a result, civilians must create an emotionally safe space for the veteran to speak in. Make it clear that you’ll be compassionate, empathetic, and understanding.

#3 Be Prepared to Discuss Trauma

Veterans may talk about the trauma they experienced as active military members. Civilians looking to engage with military members and learn about their experience must be prepared for this. As Carter points out:

You don’t ever want to knock on their door of trauma and open it if you’re not ready to receive and help them with it. So, while you’re inviting somebody to share their traumatic experience to feed your curiosity, you could be opening a deep wound for them. Are you going to be able to be there to heal it for them once you do?

Of course, civilians don’t need to be trained experts in handling trauma, but they must be prepared to discuss it in a sensitive, compassionate way.

#4 Don’t Minimize Their Experiences or Reactions

When hearing someone talk about a painful experience, you may feel tempted to encourage them to see things in a more optimistic light. While done with good intentions, this strategy is often counter-productive. From the veteran’s perspective, it can feel as though you are minimizing their problems or that you feel they are overreacting.

Instead of dismissing their feelings, validate them. Often, all someone in pain is looking for is a compassionate recognition of their suffering.

#5 Be Sincere

Sincerity is critical to having impactful conversations that help soldiers feel connected, heard, and valued. As a result, it’s important that when civilians ask veterans questions or express their gratitude, they do so sincerely. Veterans can often sense when a civilian’s attempt to engage with them is driven by a sense of obligation rather than genuine interest.

Olukoya points out that the phrase “thank you for your service” is a common example of an interaction that feels inauthentic.

I feel like 70 percent of veterans hate that statement because it feels like such a generic textbook thing to say whenever you meet somebody that’s served, so it turns into something that’s not even sincere.

Instead, he recommends saying, “I appreciate your sacrifice,” which he feels helps veterans feel “seen.”

One way to show sincerity during conversations is by listening actively (i.e., asking meaningful questions that show you are attentive and engaged). However, it is important to balance active listening by letting veterans tell their stories at their own pace and without excessive interruptions.

#6 Remain Mindful of What You Can’t Understand:

When a veteran is opening up about their experiences, Carter suggests it’s best to avoid the phrase “I understand.” But why is this true? Part of the answer is that, as a civilian, complete understanding isn’t possible. Some of their experiences are so drastically different from anything a civilian may have encountered that there is simply no way to truly comprehend what things were like for them or how they feel. As a result, it’s best to be mindful of your gaps in knowledge and understanding and avoid implying that you can really know what active military service was like for them.

If you feel you need to see a mental health professional or could use help deciding which service is right for you, please give us a call at 805-204-2502 or fill out an appointment request here. We have a wide variety of providers, including therapists, psychiatrists, nurse practitioners, and nutritional therapists, who can see you in as little as one day via teletherapy. If you feel a veteran is experiencing a crisis, please call the national suicide hotline (988).

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Speaker Series: Battlefield to Civilian Life

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In this edition of our Speaker Series we sit down with Teressa Carter and Femi Olukoya to discuss mental health and our veterans. 


Many aspects of military life has unique challenges. In this conversation Sally, Teressa, and Femi discuss the difficulties of transition from military to civilian life both from the veteran’s perspective and military family perspectives, the complexity of relationships for veterans transitioning out of military service, why veteran mental health matters to civilians, and how we can do better by those who have served. 


Teressa is a licensed clinical social worker based in Texas, her family has a long history of military service and she has spent many years embedded on base and with military units offering mental health services. 

Femi is a licensed professional counselor and also a U.S. Navy Veteran. Femi’s story is special as he morning he graduated from bootcamp was the morning of 9/11. He draws upon his active duty experience to offer points of connection and care for the active duty and veteran clients he treats now as an LPC. 

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Provider’s Perspective: Veteran Mental Health and the Invisible Wounds of War


Provider's Perspective: Veteran Mental Health and the Invisible Wounds of War

November 4, 2022
Teressa Carter – LCSW

This post was written by Teressa Carter, a therapist at Heading Health with extensive experience serving and treating active-duty service members and their families

 

In celebrating Veteran’s Day, I am honored to create a space to salute all who have served, and the sacrifices made by members of the U.S. armed forces and their families to preserve our freedom. This day is very personal for me as my family, and I celebrate the service and sacrifice of both my maternal and paternal grandfather, as well as my father, who all served in the United States Army. My six-year-old son is reminded that his father is a hero, having served in the United States Marine Corps. Aside from my familial connections to the military, I have had the privilege and the honor of providing mental health services to active-duty service members and their families of all branches.

A Military Mental Health Crisis

Veteran’s Day allows us to explore and assess how we can better support our veterans, especially when navigating their mental health. Recent research suggests 11 to 20 percent of veterans experience post-traumatic stress disorder (PTSD) in a given year. Suicide rates of military service members and veterans are also at an all-time high, with deaths by suicide having increased by 25% during 2020.

 

Despite the prevalence of mental health needs, veterans often struggle to find and stick with care. One study found that among the veterans with mental health needs, 55 percent did not seek treatment from Veterans Affairs. Some of the more commonly cited reasons for avoiding or not continuing with treatment include:

 

Given all of this, it’s vital that veterans have the tools to receive and stick with effective care and that clinicians know how to reach out and provide support to service members in need.

Advice for Veterans in Need of Mental Health Care

If you are a Veteran in need of mental health treatment, you are not alone, and great support is out there. I strongly encourage veterans to reach out to someone, whether your medical provider, your VA liaison, family, or friends, who can support and assist them in finding the right mental health treatment for their needs. Here are some other tips:

 

  • Look for clinicians that have either military experience or experience training to treat military-related issues.
  • The VA or Military OneSource are great resources for finding treatment options.
  • Prepare for your first intake. There will be a lot of information gathering. This is also where you have the opportunity to interview the therapist to make sure this is a good fit for you and that you feel comfortable.
  • Remember, mental health treatment is a process and should not be rushed. Prepare for this by viewing your treatment as a journey.
  • Share your feelings, hesitations, limitations, and boundaries with your therapist.
  • Always remember that getting help is a sign of strength and resilience.

Tips For Therapists Treating Veterans

There are several steps mental health professionals can take to ensure they are effectively reaching out to veterans in need and providing them with adequate care. 

Market Your Services to Veterans

The civilian mental health community should ensure they are marketing services to the veteran population. Here are some suggestions.

 

  • Add any military experience or previous work with the veteran population or armed services to your professional online profile.
  • Highlight if you have specialized training to treat conditions prevalent among veterans, such as PTSD, anxiety, depression, and addiction-related issues.
  • Advertise your services to agencies that cater to the veteran community, such as your local Veterans Affairs office, TRICARE, or Military OneSource. Make your services known and available through the base coordinator that assists Active-Duty service members transitioning to veteran status.
Build Rapport

In my career working with active-duty service members and veterans, I found building an initial rapport centered around trust, understanding, and respect was an absolute must. Here are 10 simple strategies I use to build rapport and develop a strong relationship with service members and veterans.

 

  1. Always thank the service members for their sacrifices.
  2. Share your background and personal experience with the military.
  3. Be honest about where your gaps in knowledge or understanding of the military lifestyle are.
  4. Emphasize your willingness to learn.
  5. Be curious. Inquire about their branch of service, rank, years of sacrifice, and duty stations.
  6. Explain that you are trying to obtain a deeper understanding of their unique service and experience.
  7. Create a safe space. Make sure your clinical area is quiet, private, and free from sudden noises or distractions that could trigger PTSD symptoms. Invite your veteran clients to share as much or as little of their military experience as they are comfortable disclosing.
  8. Allow veterans to speak freely and at their own pace.
  9. Never say, “I understand.” This could trigger the veteran client to be upset if you do not have military experience, especially direct combat experience.
  10. Refrain from using a lot of clinical jargon and acronyms. Veterans are used to clear, concise, and direct communication because of their military experience. Too much clinical jargon may create space for miscommunication and confusion.
Utilize Available Resources

An important aspect of providing mental health treatment to veterans is to have a working knowledge of available resources in the community and helping clients get connected to them. Here are some resources that may be helpful:

 

Address Family Needs 

Mental health providers will also need to address family needs when working with veterans, as families have also served and sacrificed. Additionally, the family is transitioning with their service members. For example, families may be transferring medical, educational, and social services from on-base providers to civilian providers. As a result, they must adapt to new doctors and mental health providers. They may also be moving to new homes in new neighborhoods, meaning the children will be transferring schools and making new friends. Adjusting to these changes can be challenging and added support can be helpful.  

Conclusion

As we gather to celebrate this upcoming holiday, please take a moment to acknowledge and honor the sacrifices of our veterans and active-duty service members. Please be an advocate in your community, workspace, and even your organization for increased support and resources for the veteran community. When you see a veteran, thank them for their sacrifice. Thank you to all who have served and the families that served along with them. 

 

If you know a veteran who may be experiencing mental health issues, please help them get care. You can do this by enrolling in their local VA and requesting mental health services. If you feel a veteran is experiencing a crisis, please call the national suicide hotline (988).

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Can Ketamine Treat PTSD?


Can Ketamine Treat PTSD?

November 3, 2022
health.hardvard.edu

Post-traumatic stress disorder (PTSD) is a debilitating psychiatric condition caused by exposure to a terrifying or traumatic event. Individuals with PTSD may experience flashbacks, nightmares, severe anxiety, and uncontrollable or intrusive thoughts about the event. About eight percent of the population will experience PTSD over the course of their life. This condition is significantly more common among combat veterans, with nearly a quarter developing it during their lifetimes.

 

The standard treatment involves some form of psychotherapy, oral anti-depressants, or some combination. Many psychotherapies (e.g., exposure therapy, cognitive behavioral therapy, cognitive processing therapy, etc.) require patients to confront aspects of the traumatic event or how they think about it. While these therapies can be effective, they can also be stressful, causing many to stop treatment early.

 

The FDA has approved two medications, sertraline, and paroxetine, for the treatment of PTSD. These medications have several drawbacks. They take four to six weeks to start working. They also come with many side effects that lead many to stop taking them. Even when patients stick with the medications, only around 30 percent achieve remission. While other medicines have been used, the evidence for their efficacy remains questionable. As a result, there is a desperate need for faster, more effective, and more tolerable treatments for PTSD.

Why Test Ketamine for PTSD?

Over the past few years, ketamine has been explored as a potential solution. Researchers have turned to this medication for several reasons. One reason has to do with how ketamine acts in the brain. Ketamine is an N-methyl-D-aspartate receptor (NMDA) receptor antagonist. This means that it increases the amount of glutamate (a chemical messenger in the brain) and brain-derived neurotrophic factor (BDNF), which helps neurons grow and form new connections.

Credit: Yang H. Ku/C&EN

Early animal studies indicate that glutamate and BDNF play important roles in PTSD. One study found low levels of glutamate in mice exhibiting PTSD-like behavior after exposure to stress. Other experiments have found that several brain regions associated with fear and mood regulation had shrunk in mice after similar stress tests, suggesting BDNF might help rebuild these atrophied areas.

 

Ketamine is also well-established as a rapid-acting antidepressant. Since depression is a prominent symptom of PTSD, it should help with this part of the condition.

The Studies

Initial Experiments

With all this in mind, researchers turned theory into practice and began testing ketamine as a treatment for PTSD in human participants. In a 2013 study, an army veteran who was given a single infusion of ketamine experienced rapid and robust relief of his PTSD symptoms that lasted 15 days. 

 

Following this finding, another group of researchers conducted a randomized controlled trial (RCT), meaning they gave one group ketamine and another a placebo. They found that PTSD levels were significantly lower in the ketamine group 24 hours after the infusion, and the effects persisted for around seven days.  

 

Experimenters, hoping to extend the amount of time before symptoms returned, tried giving subjects repeated infusions of ketamine. In one study, patients received six infusions over two weeks. Eighty percent of patients achieved remission for 41 days on average

 

Ketamine With Psychotherapy

While 41 days is a significant amount of time, more sustained relief would be ideal. Instead of using more ketamine treatments, some researchers have explored whether the effect could be extended when combined with psychotherapy. 

 

One of the commonly cited reasons for doing this is that PTSD is associated with deficits in what is known as  “memory reconsolidation,” which occurs when a recalled memory is changed or altered in some way. Normal memories decay or degrade over time. Some theorists believe that for patients with PTSD, their trauma memories remain as clear and vivid as the day they were formed. Many therapies target this process of reconsolidation. 

 

Ketamine is associated with neurogenesis. Recent studies have found that neurogenesis is important in reconsolidation. As a result, researchers have tested whether therapy might extend the effects of ketamine. One study which combined ketamine with prolonged exposure therapy found that after 90 days, the ketamine group had lower PTSD symptoms when compared to the group that received a placebo. 

Prevention Vs. Treatment

Aside from comparing ketamine with and without therapy, researchers have tested its effects on PTSD when administered at different stages in the PTSD process. A recent meta-analysis compiled all the research on combat veterans and found some surprising results. Most notably, they found that when given during the early stages of PTSD (1-3 months after the traumatic event), ketamine exacerbated their symptoms. However, when administered beyond this stage, ketamine was consistently helpful. Exactly why the timeline is so important is unclear. 

Conclusion

Ketamine appears to be a powerful treatment for PTSD. With that said, there are some caveats. When administered on its own, the effects are short-lasting. Repeated infusions can extend the benefits, but only to around 41 days. Psychotherapy may prolong the therapeutic results further, but more research will need to be done to confirm this. Lastly, the treatment may not work for all PTSD patients, especially those who experienced their trauma more recently.

 

 

If you feel you need to see a mental health professional or could use help deciding which service is right for you, please give us a call at 805-204-2502 or fill out an appointment request here. We have a wide variety of providers, including therapists, psychiatrists, nurse practitioners, and nutritional therapists who can see you in as little as one day via teletherapy.  

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Dia de los Muertos and the Impact of Culture on Grief and Mourning


Dia de los Muertos and the Impact of Culture on Grief and Mourning

November 1, 2022

This post was written by Patricia Hernandez, a therapist at Heading Health. Patricia is a licensed clinical social worker who strives to provide a diverse and culturally sensitive perspective.

 

 

Culture encompasses religion, food, what we wear, how we wear it, our language, marriage, music, what we believe is right or wrong, how we sit at the table, how we greet visitors, how we behave with loved ones and a million other things.” Cristina De Rossi, Anthropologist at Barnet and Southgate College in London.

Mexican-American Culture and Grief 

As a young child growing up in a Mexican-American household, culture was a significant part of my interpretation of death and the grieving and mourning process. For example, it was common to see ofrendas (an altar to honor the dead) year-round in my own home and those of my family members. These ofrendas were filled with pictures of deceased family and friends, religious candles, and saints. It was also commonplace to speak to the deceased, celebrate their birthdays, and express gratitude for their believed guidance and protection in our daily lives. 

 

It was not until I was introduced to other cultures that I learned this expression of grief and mourning was, in some ways, unique to Mexican American culture. 

 

Near the beginning of November, ofrendas grow to a larger scale in planning for Dia de los Muertos. Dia de los Muertos is a celebration deeply rooted in Mexican culture celebrated annually on November 1 and 2. It is believed that on these dates, the deceased cross the realm of the spirit world into the world of the living, and ofrendas help guide them on their journeys. 

 

Although there is no right or wrong way to have an ofrenda, most utilize the elements of Earth, Wind, Fire, and Paper to guide the deceased on their return to the world of the living. These elements are represented on the ofrenda by having food, water, candles, and papel picado (i.e., colorful and intricately cut paper)  that is said to move when the deceased are present. 

 

Grief Vs. Mourning

Though often used interchangeably, grief and mourning are notably different, and each plays a critical role in how we react to death and loss. Psychology Today distinguishes mourning as  the outward response to griefsuch as creating altars, planting a tree, and playing a song. In contrast, grief is defined as “the emotional response to a loss,” such as feeling sad, hopeless, or angry. 

 

Grief and mourning also differ in terms of their stages or components. The often cited stages of grief are denial, anger, bargaining, depression, and acceptance. The parts of mourning are equally important but less well-known. 

 

Psychologist J. William Worden divided the process of mourning into four tasks.

 

  • Task 1 –  “Accept the reality of the loss.” Here, an individual begins to move past the sense of disbelief by integrating death into their reality. 
  • Task 2 – “Process the pain of the grief,” where one begins to experience grief  “emotionally, cognitively, physically, and spiritually.” Doing so assists in refraining from avoidance. 
  • Task 3 – “Adjust to the world without the deceased.” These adjustments occur externally, internally, and spiritually. Externally, one may take on new responsibilities, internally one creates an understanding of who they are now as an individual, and spiritually, one may develop a new understanding of their belief systems.
  • Task 4 – “Find the balance of an enduring connection with the deceased while embracing a new version of a meaningful life.”

The tasks of mourning, much like the stages of grief, are nonlinear processes without a timeline.

 

The beliefs and traditions of Dia de los Muertos are a tangible example of how culture impacts not only grief but also mourning. Dia de los Muertos is a culturally accepted expression of love and remembrance that can help an individual through the tasks of mourning. It’s also a joyful time to commemorate the love that lives on for the deceased by creating altars, playing music, joining with loved ones, sharing memories, and continuing to honor the memory of the dead and integrate their memory into the present day.  This allows one to outwardly embrace the connection with the deceased as they proceed with life. 

Other Cultures and Grief 

Cultural norms related to grief and mourning can both support and impede one’s own individual grieving and mourning process. According to Grief Speaks, “stoic attitudes are common” among Asian-American cultures, whereas  “Haitians express grief with the physical manifestation of great emotion.” As there are differences in emotional expressions, there are also differences in timelines associated with mourning rituals. In Eastern Orthodox Christian funerals, it is normal to mourn loved ones up to 40 days after the funeral.” Mourning periods can also vary depending upon the relation of the deceased. In some Islamic communities, the mourning period can even be extended to four months and ten days for those who are widowed, whereas in some Jewish communities, the mourning period can last up to one year after the death of a parent. 

What’s “Normal” Grief?

Cultural rituals related to the grief and mourning process can help create predictability in a time of uncertainty. For many, these cultural norms are a sense of support, whereas for others, it may be a source of conflict if their current beliefs, or the beliefs of the deceased, are misaligned with the cultural norms. So the question is, what is normal when it comes to grief and mourning?

 

According to the DMS-5, a diagnostic and classification tool of mental disorders, a diagnosis of prolonged grief disorder is considered when “the loss of a loved one occurred at least a year ago for adults, and at least six months ago for children and adolescents.” Symptoms related to prolonged grief disorder can include intense loneliness, avoiding reminders of the deceased, and difficulty reintegrating into social groups, work, personal obligations, etc. With any diagnosis, it is also important to consider the symptomology in relation to social, cultural, or religious norms. However, not all grief leads to prolonged grief disorder. Depression, anxiety, and/or trauma, dependent on the events related to the death, can also occur. To meet the criteria for a diagnosis of any of the aforementioned conditions, impairment in daily functioning must be present. 

Seek Support 

For as much togetherness as many cultural norms bring to the grieving process, grief is also individualized and sometimes isolating. But there are means to seek support to help ease the feelings of loneliness, confusion, and isolation that can accompany grief. Seeking support and comfort in the predictability and structure of cultural norms can help ease the process of grief and the tasks of mourning. Seeking therapy can also help normalize and validate the thoughts, emotions, behaviors, and timelines associated with grief and mourning in both a cultural and individual context.

 

If you feel you need to see a mental health professional or could use help deciding which service is right for you, please give us a call at 805-204-2502 or fill out an appointment request here. We have a wide variety of providers, including therapists, psychiatrists, nurse practitioners, and nutritional therapists, who can see you in as little as one day via teletherapy. 

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Upcoming Events and Content in Honor of Veteran’s Days


Upcoming Events and Content in Honor of Veteran's Day

October 28, 2022

During the week of Veterans Day, Heading Health will be hosting events and publishing articles to honor our military veterans. We will be taking a close look at the mental health issues veterans face, highlighting providers who specialize in treating veterans and gathering insights from their experience, as well as discussing the therapeutic potential of psychedelics as treatments for service-induced mental health conditions.

 

Check out the details of these events and others in the Austin area below.

 

Heading Health Speaker Series: What Now? How Veterans Can Overcome Post-Deployment Hurdles to Happiness

Teressa Carter – LCSW

In the Heading Health Speaker Series events, we highlight perspectives from our team of mental health professionals to learn from their unique backgrounds, experiences, and viewpoints.

Femi Olukaya – LPC

 

In our Veteran’s Day edition, nutritional therapist Sally Twellman will interview Femi Olukaya, a therapist and military veteran, and Teressa Carter, a social worker with experience serving and treating active duty service members. They will explore the difficulties veterans face when integrating back into civilian and family life, the problems this can cause, and what we can do to soften the landing and ease their transitions back home. 

 

This event will be recorded and available to stream on YouTube. Stay tuned for more details.

 

Articles

Provider’s Perspective: Why Veterans Struggle to Seek Mental Health Care and What to Do About It

Despite the prevalence of mental health issues among veterans, many struggle to seek out help. In this article, Teressa Carter, will take a deep dive into this problem, offer suggestions for veterans and active military members unsure of whether or how to seek care, and provide advice for clinicians to help them perform patient outreach and build rapport with military clients. 

 

Ketamine for PTSD

Estimates suggest that 10-20 percent of veterans have post-traumatic stress disorder (PTSD), characterized by flashbacks, nightmares, and severe anxiety caused by exposure to a terrifying event. Recent research shows that ketamine may help veterans recover from this debilitating illness. This post will summarize the research, highlight key findings, and explore what this means for future treatments for PTSD.

 

Other Events in the Austin Area

The Rebirth: A Veterans Day Celebration Exploring Psychedelic Medicine

This three-part event will highlight the healing power of psychedelics for veterans. Specifically, it will include:

 

  1. A showing of the documentary film From Shock to Awe, which covers the lives of U.S. military combat veterans and highlights the transformational impact psychedelics have had on their mental health
  2. An expert panel which will discuss the importance of psychedelics and the urgent need to increase accessibility to these alternative treatments.
  3. A chance to hang out, listen to music, and catch up with friends at famed music club, Antonne’s

 

This event will take place on Friday, November 11, from 3:00 PM – 11:00 PM CST.

 

Get your tickets here.

 

 

The Mission Within: Psychedelics & Healing the Wounds of War

Founded by Dr. Martin Polanco, The Mission Within offers psychedelics such as ibogaine, 5-MeO-DMT, and psilocybin to treat veterans with traumatic brain injury (mTBI), PTSD, depression, and addiction as a result of experiences during military service.

 

In this panel, you’ll hear from veterans who participated in The Mission Within and how psychedelics helped them overcome service-related trauma and heal their relationships with loved ones.

 

This event will take place on November 3, from 6:45 PM – 8:30 PM CST.

 

RSVP here.

 

 

 

If you feel you need to see a mental health professional or could use help deciding which service is right for you, please give us a call at 805-204-2502 or fill out an appointment request here. We have a wide variety of providers, including therapists, psychiatrists, nurse practitioners, and nutritional therapists who can see you in as little as one day via teletherapy.  

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