SCE Orange County: Help patients embrace the discomfort

If there was a common thread of clinical advice from a diverse group of presenters on day one of this week's Summit for Clinical Excellence in Anaheim, Calif., , it could be summarized as, “Sometimes you have to help patients face challenges they'd rather avoid.”

It might require their processing of painful experiences, or embracing one's imperfections, or disengaging from screen time in favor of real connection. Speakers at the Institute for the Advancement of Behavioral Healthcare's March 1-2 event East Meets West: Multiple Perspectives on Trauma and Addiction offered attendees numerous suggestions for modeling healthy behaviors and helping patients get to a similar place.

“The absolute level of challenge is not the critical variable. The critical variable is the capacity to bear pain,” said Ronald D. Siegel, PsyD, a member of the board of directors at the Institute for Meditation and Psychotherapy and author of The Mindfulness Solution: Everyday Practices for Everyday Problems. Siegel, who is also an assistant professor of psychology at Harvard Medical School, questioned prominent therapeutic approaches that encourage patients to avoid uncomfortable emotions.

In a talk on how mindfulness practice can assist in the treatment of anxiety and depression, Siegel said, “So many people are trying to teach coping skills that go away from the anxiety.” This partly explains why many patients are attracted to benzodiazepines, which can become psychologically addictive because patients crave the experience of the anxiety stopping.

Instead, “We need to encourage people to go toward [the anxiety], not away from it,” Siegel said, with mindfulness-based approaches an important strategy for managing the anxiety.

Risk factors for trauma response

Andrea Barthwell, MD, founder of the Two Dreams treatment center in North Carolina, sounded similar themes in a talk on a recovery-focused approach to trauma. Now that the therapy field has shunned a 1980s-era mindset of not opening the discussion of topics that it might struggle to close, “We have to have generalists in every [treatment] environment who can deal with [addressing trauma],” said Barthwell, who is also medical adviser to the CEO at Treatment Management Behavioral Health.

Trauma is not defined by what happens to a person, she said, but how that person experiences it. She listed factors that increase the probability of a trauma response, included the unexpected nature of an event or its repeated occurrence. She also outlined risk factors for a lifelong experience of trauma, from the event's taking place as part of a series of losses to its timing early in childhood.

Barthwell also discussed the important link to substance-using behavior, stating that young people who use alcohol are more likely to experience post-traumatic stress disorder (PTSD) after trauma. “The longer you delay initiation, the less pronounced the adult deficits can be,” she said.

Going dark

Britten Devereux, a co-founder of D'Amore Healthcare, opened her 90-minute talk by challenging attendees to disengage from their computer screens and smartphones for the duration of her presentation. Devereux discussed several paradoxes facing the “digital hamsters” that clinicians, patients and just about everyone else in modern society have become:

• “I am so connected. I am disconnected.”

• “It's augmenting our reality, but we still don't feel cared for.”

• “We want companionship. We settle for 'likes.'”

How her mental health treatment agency handles this challenge with patients involves banning screen time at first, but then allowing them to earn the time over the course of their treatment, Devereux said.