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The Mental Health Connection Sunday, May 8th, is the day we celebrate our mothers. But May is also the month we bring awareness to the importance of mental health and treatment options available to those suffering with mental health issues. I’d like to propose a challenge to each of you. This month, discover something new that can help you with your treatment or interactions with a patient. Then implement what you learned. As a reminder, there’s still time to cast your votes in the 2022 San Diego’s Best Poll. We’re pushing for first place in the “In-Home Non-Medical” category this year! Voting takes place through May 10 Winners will be announced July 31 Thanks in advance for voting for us, and I hope you all accept the challenge. I’d love to hear how what you’ve learned has helped someone. Annette Conway, PsyD President Help Therapy May Focuses on Two Observances May is Mental Health Awareness Month and Borderline Personality Disorder Awareness Month. Mental Health Awareness Month Millions of Americans suffer from a mental illness or live with someone who does. Although the stigma around mental health issues and treatment is slowly dissolving, many people hesitate to seek help or even talk about it for fear of being judged. Mental Health Awareness Month shines a light on the importance of sound mental health and its relationship to physical health. One of the best ways to celebrate Mental Health Awareness Month is by talking about it. The more we talk about mental health and treatment, the more accepted it will become. Borderline Personality Disorder Awareness Month Borderline Personality Disorder (BPD) is the third leading cause of death among females 15-24 and affects about 14 million Americans. Yet, the diagnosis of BPD is frequently missed or misdiagnosed, especially in men. 3-Day Weekends for Californians? A new proposed bill could lead to Californians enjoying 3-day weekends. Under this bill, a standard workweek would be reduced from 40 hours to 32 hours—without employees losing any pay or benefits. The History of the 40-Hour Workweek The concept of the 40-hour workweek started in the 19th century when employees were commonly working 80 to 100 hours each week. After the Industrial Revolution, activists and labor union groups advocated for better working conditions. Then in 1869, President Ulysses S. Grant issued a proclamation guaranteeing eight-hour workdays for government employees. This decision encouraged private-sector workers to campaign for the same rights. But it wasn’t until 1926 that Henry Ford popularized the 40-hour workweek. His research revealed that working more hours resulted in only a slight increase in productivity. What's more, that productivity was short-lived. Then, in 1938, Congress passed the Fair Labor Standards Act, which required employers to pay overtime to all employees who worked more than 44 hours per week. It was later amended two years later to reduce the standard workweek to 40 hours per week and became law in 1940. Trying Out New Work Structures Much has changed since 1940—even before the pandemic. As a result, more companies have tried out or have implemented alternative work structures. Work from home, flextime and condensed workweeks are becoming more common arrangements. But these alternative working styles are still typically based on a 40-hour (or more) workweek. In fact, many people are working more with these alternative working arrangements without realizing it—especially when working from home. It’s often difficult to separate at-work time from at-home time when you’re working from home. Not all companies will be legally obligated to comply with this new workweek structure if the bill passes—only employers with more than 500 employees, according to the proposed legislation. Although the proposed 4-day, 32-hour workweek may not make a difference in the number of days and hours worked for some, it has the potential to help many people have a better work-life balance. The Components of a Psychological Evaluation for Bariatric Surgeries Help Therapy offers reference guides to partner therapists to assist them with psychological evaluations pertaining to bariatric surgery and spinal cord stimulator implants. However, therapists should always refer to the current standards and requirements of the pertinent State Board of Psychology before assessing patients. The principal goals of psychological pre-surgical evaluation are to: Determine a patient’s readiness for surgery Identify any psychological factors, obstacles or contraindications for surgery Screen candidates who may benefit from psychological treatment before surgery and to maximize the long term success of the surgery Identify patients who may need further psychological support after surgery Propose an alternative treatment when patients do not meet the criteria for bariatric surgery The most widely accepted psychiatric contraindications to bariatric surgery include: Active substance abuse Psychosis Mood disorders Major life stressors A history of problematic adherence to prior treatment plans and disagreement about binge eating disorder When psychosocial issues are identified, moving forward with the surgery may or may not be advisable. A therapy and treatment plan can be developed to address the patient's particular mental health challenges. This treatment may improve the outcome of the surgery. Types of tests for bariatric surgery readiness generally fall under one (or more) of the following categories: Personality Eating disorders Mood disorders Substance abuse Cognitive Development Physical Conditions Quality of Life Outcome measures [READ MORE] Welcome New Help Therapy Mental Health Provider Partners These mental healthcare practitioners are new to our network and offer psychological evaluations and other types of therapy with a range of specialties. They are accepting new patients and provide telehealth appointments. California Dr. Shalila Douglas Dr. Klayton Smith Dr. Bob Orkin Dr. Erin Gonzales Dr. Balaji Nettimi Remy Preston. LCSW Nicole Horne, LMF Dr. Lanique Ruffin Patricia Narez, LCSW Dr. Sasha Kassai Dr. Tikesha Leslie-Jones Texas Dr. Anna Felsl Washington Cynthia Langston, LCSW Featured Practitioner Dr. David Eagle, PsyD Dr. Eagle has been in practice for 45 years. His practice focuses on people with anxiety, depression or both—many with other chronic medical conditions like kidney failure or diabetes. He uses an eclectic approach to help patients experience more happiness and less anxiety or depression for a fuller and richer life. Although he primarily works with individuals, he does help couples as well. Dr. Eagle prefers in-person sessions in the patient's home but is open to telephone appointments. This Month's Tip Celebrate Mother’s Day in a New Way When you think of celebrating Mother’s Day, what comes to mind? Flowers? Brunch? See’s candy? For many, these are the traditional symbols of Mother’s Day. But why not give her something she will cherish even more? Your time! Give a Helping Hand Tackle a few tasks mom’s been putting off. Use the day as an opportunity to help check off items on her to-do list. Clean out garage Organize the pantry Fix the creaking door, uneven step… Weed the garden or repot a plant in a decorative planter Hire a handyman Encourage Self-Care Mom is sure to appreciate a few hours of self-care—especially if you can be by her side. Enjoy a mani-pedi Have a spa day Join a yoga in the park group Take a fitness class Explore nature Take a photo journey Photos have a special way of bringing up memories and emotions. Experience them together on her special day. Organize old photos Revisit old photo albums Create a new album Remember Her Remember your mother and celebrate her life by donating to a favorite charity or organization. Plant a tree Volunteer Give a memorial tribute Events World Maternal Mental Health Day May 4, 2022 See WMMH for more information. National Mental Health Counseling Week May 6-12, 2022 See AMHCA for more information. National Children’s Mental Health Awareness Day May 9, 2022 See SAMHSA National Prevention Week May 11-17, 2022 See NPW for more information. “What mental health needs is more sunlight, more candor, and more unashamed conversation" -Glenn Close Partner With Us Are you a psychologist, LCSW or LMFT? We’re always looking for exceptional mental healthcare providers. Visit helptherapy.com for more information and fill out the quick and easy application. Benefits: Stream of new patients Billing off your plate Flexibility and Freedom Credentialing assistance No hidden costs Do you have something to share? We’d love to hear about your successes and accomplishments! Have you: Written an article? Given a presentation? Been featured on a podcast? Contact us at info@helptherapy.com. We welcome your feedback. What would you like to see in this newsletter? Do you have a topic you would like discussed? Have questions? Want to learn more about Help Therapy? Visit helptherapy.com, call 858-481-8827 or email info@helptherapy.com

The Mental Health Connection Spring is a time of renewal and rebirth. A celebration of life. Unfortunately, this particular Spring brings chaos and destruction to some parts of the World—specifically, the ongoing humanitarian crisis in the Ukraine. It’s situations like this upheaval in Ukraine that puts everything into perspective. We may wish some things were different in our lives, but we need to remember to be grateful for our lives the way they are, no matter what difficulties we face. This was brought to the forefront of our minds during the pandemic. We began to focus on what's most important to us and appreciate each day given to us. Now we can reflect on another of our blessings that is not universal and celebrate the freedom we enjoy living in the United States. The freedom we often take for granted. Our hearts go out to those individuals and families affected by war and displacement in Ukraine, and anyone with family or friends there. Annette Conway, PsyD President Help Therapy April is Sexual Assault, Stress and Autism Awareness Month Sexual Assault Awareness Every 68 seconds another American is sexually assaulted. At the start of Sexual Assault Awareness Month (SAAM) in the early 2000s, the goal was awareness. By the mid-2000s, SAAM added prevention—changing behaviors and promoting respect. A teal-colored ribbon became the symbol of this movement. This month marks the 21st anniversary of Sexual Assault Awareness Month. The focus is on online harassment. Although not viewed by some as being as psychologically damaging as in-person harassment, it can affect victims more publicly. Stress Awareness We often think of stress as affecting adults as they join the workforce, start a family and plan for the future. In fact, statistics show 80% of millennials are stressed about money. But stress is commonly experienced much earlier: Teenagers report a stress level of 5.8 out of 10 during the school year One in five college students has thought about suicide To bring more awareness to this far-reaching concern, April has been recognized as Stress Awareness Month since 1992. Autism Awareness One in 54 children has autism. Every April, since 1972, the Autism Society works to build an inclusive community where those with autism are embraced and supported. Autism Awareness Month emphasizes the need for public awareness to promote acceptance, celebrate the differences, and be more inclusive towards autistic individuals. Before Surgery—The Pre-Surgical Psychological Evaluation Process Why are Psychological Assessments (or Evaluations) Required Before Undergoing Surgery? Psychological Assessments are often required for specific surgeries, such as Spinal Cord Stimulation (SCS) surgery and Bariatric surgery, among others. They’re used not only to identify factors that may interfere with a positive outcome of the surgery but also to assess the readiness of the patient to undergo surgery and willingness to make the necessary lifestyle adjustments after the procedure. The results of Psychological Assessments have been proven to correlate with the success of the surgery. The more mental and physical stress an individual is under (or has experienced in the past), the less likely the surgery will be beneficial. Pre-existing Conditions Pain and mental health play significant roles in determining whether or not an individual is a good candidate for surgery. Pain is experienced differently by different people. The Central Texas Spine Institute reports that studies have shown that the more pain-sensitive a person is, the less likely the surgery, such as SCS, will have a positive outcome. Plus, the more prolonged pain is experienced, and the older the patient is, the less likely the result of the surgery will be favorable. [READ MORE] Another Reason to Use Care with Social Media Although continuing to grow in popularity and variety, Meta (Facebook), Twitter, Instagram, Tik Tok, YouTube and the like, new dangers of using these platforms are being discovered. These dangers can be particularly threatening to those with pre-existing mental health and neurological conditions, such as Tourettes. Tourette Syndrome typically develops in childhood, worsens in adolescence, and improves or disappears in adulthood. It’s often accompanied by other conditions such as ADHD, OCD, anxiety and depression. It can have multiple causes and numerous triggers. Research is finding that social media can be one of those triggers for many. Several studies have suggested that social media use can worsen symptoms in those with a tic disorder—adversely affecting their quality of life. A 2019 study of adolescents ages 12-15 found that spending more than 3 hours per day on social media may present a greater risk for mental health problems, including depression and anxiety. During the pandemic, results of a recent survey showed: 65% of respondents used social media an average of 5.6 hours per day. Approximately 90% reported increased use of social media during the pandemic. About half indicated social media adversely affected their tics. 85% said their tic frequency worsened during the pandemic. Davide Martino, MD, Ph.D., associate professor of neurology and director of the Movement Disorders Program, University of Calgary, said the survey is "very timely" as there has been limited research on the effects of social media consumption in individuals with tics. To reduce tic severity, it's important to identify triggers, including spending time on social media and then learn to manage them. It’s vital for those suffering from a tic disorder who experience certain social media content as a trigger to recognize the effect of this exposure on their symptoms. They can then decide what social media they want to consume and the amount of time spent on it—putting them in control of managing their symptoms. Dr. Martino recommends that "As we return to a lifestyle that is closer to pre-pandemic standards, this study prompts clinicians to follow more closely social media consumption in people with tics.” Welcome New Help Therapy Mental Health Providers Dr. Robin Abraham (AZ) Dr. Bernadette Heid (CA) Dr. Nina Nehring (CA) Dr. Benjamin Sandler (CA) Dr. Kim Mitchell (CA) Dr. Lisa Talerico (CA) LMFT Michelene Wasil (CA) Dr. Yanet Collazo (CA) Dr. Shalila Douglas (CA) Dr. Klayton Smith (CA) Dr. Lucy Papillon (CA) Featured Practitioner Dr. Roudabeh Rahbar, Psy.D Dr. Rahbar assists her clients along their life’s journey and helps them overcome obstacles that may be making the journey difficult. She uses her empathetic heart and mind, alongside her training and experience to collaborate with her clients and guide them on a path to a more fulfilling life. Her specialties include anxiety, depression, PTSD, cultural issues, couples therapy and psychological assessments. This Month's Tip 7 Activities to get you in the Spring Spirit 1. Visit a botanic garden or flower field Walking outdoors, surrounded by plants, trees and colorful flowers, can be relaxing and exhilarating. Spring is the perfect time to see a rainbow of colors. It may also inspire you to plan your own garden. 2. Plant a garden Planning a garden and going to a nursery to pick out plants and flowers is something many of us look forward to each Spring. No yard? No problem. A balcony, patio or sunny window are great places to grow and display potted plants. 3. Welcome Spring into your home Nothing says Spring like Spring flowers. Tulips Daffodils Crocuses Irises Lilies… If you bring home one of these potted plants, you can save the bulbs and plant them again in late Fall. With a bit of luck, you’ll be rewarded with flowers next Spring. 4. Do some Spring cleaning Cleaning doesn’t seem to be an activity that will lift your spirits, but the results are sure to. A neat and freshly cleaned home relaxes the mind. Having a lot of clutter and disorganization in your environment can cause stress—even if you’re not aware of it. 5. Color eggs You don’t have to be the Easter Bunny to have fun coloring eggs. You don’t even need to have young children around. A creative and relaxing activity, like coloring eggs, can be therapeutic. 6. Have a picnic Being outdoors in nature is good for the mind and body. Invite a friend; bring your children, or go on a date with your partner. 7. Explore Spring wildlife Find a pond, river or lake and watch for sunning turtles, fish, ducks, geese and other birds. You may even see some ducklings or goslings. Events National Sorry Charlie Day April 6, 2022 See kidadl for more information. RAINN Day April 13, 2022 See RAINN for more information. International Moment of Laughter Day April 14, 2022 See national today for more information. “No matter how many mistakes you make or how slow you progress, you are still way ahead of everyone who isn't trying" -Tony Robbins Partner With Us Are you a psychologist, LCSW or LMFT? We’re always looking for exceptional mental healthcare providers. Visit helptherapy.com for more information and fill out the quick and easy application. Benefits: Stream of new patients Billing off your plate Flexibility and Freedom Credentialing assistance No hidden costs Do you have something to share? We’d love to hear about your successes and accomplishments! Have you: Written an article? Given a presentation? Been featured on a podcast? Contact us at info@helptherapy.com. We welcome your feedback. What would you like to see in this newsletter? Do you have a topic you would like discussed? Have questions? Want to learn more about Help Therapy? Visit helptherapy.com, call 858-481-8827 or email info@helptherapy.com

Help Therapy offers reference guides to partner therapists to assist them with psychological evaluations pertaining to bariatric surgery and spinal cord stimulator implants. However, therapists should always refer to the current standards and requirements of the pertinent State Board of Psychology before assessing patients. The principal goals of psychological pre-surgical evaluation are to: Determine a patient’s readiness for surgery Identify any psychological factors, obstacles or contraindications for surgery Screen candidates who may benefit from psychological treatment before surgery and to maximize the long term success of the surgery Identify patients who may need further psychological support after surgery Propose an alternative treatment when patients do not meet the criteria for bariatric surgery The most widely accepted psychiatric contraindications to bariatric surgery include: Active substance abuse Psychosis Mood disorders Major life stressors A history of problematic adherence to prior treatment plans and disagreement about binge eating disorder When psychosocial issues are identified, moving forward with the surgery may or may not be advisable. A therapy and treatment plan can be developed to address the patient's particular mental health challenges. This treatment may improve the outcome of the surgery. Types of tests for bariatric surgery readiness generally fall under one (or more) of the following categories: Personality Eating disorders Mood disorders Substance abuse Cognitive Development Physical Conditions Quality of Life Outcome measures There are a multitude of test batteries under these categories to choose from, such as: Alcohol Use Disorder Test-Core (AUDIT-C) Drug Abuse Screening Test (DAST) Millon Behavioral Medicine Diagnostic (MBMD) Multidimensional Health Locus of Control (MHLC) Scales Questionnaire on Weight and Eating Patterns-Revised (QEWP-R) Beck Depression Inventory (BDI) Eating Expectancy Questionnaire Shipley Institute of Living Scale Spielberger State-Trait Anger Expression Inventory (STAXI) Spielberger State-Trait Anxiety Inventory (STAI) Weight and Lifestyle Inventory (WALI) Million Behavioral Medicine Diagnostic (MBMD) Battery for Health Improvement 2 (BHI 2) Minnesota Multiphasic Personality Inventory-2- Restructured Form (MMPI-2-RF) Eating Inventory (EI) Quality of Life Inventory (QOLI) Personality Assessment Inventory (PAI) Eating Disorder Inventory-2 The Treatment Self-Regulation Questionnaire (TSQR) Perceived Competence Scale (PCS) Health Care Climate Questionnaire (HCCQ) General Causality Orientations Scale (GCOS) Attitudes towards Behavior Perceived Behavior Control (PBC) Brief Pain Inventory (BPI) Symptom Checklist-90-Revised (SCL-90-R) Beck Anxiety Inventory (BAI) As you can see, the options can become overwhelming. It’s important to include the necessary tests while keeping in mind the stress they may cause the patient and the length of time each of these tests take to complete. Some evaluations may take 5 minutes, such as the Beck Anxiety Inventory (BAI), while others may take close to 2 hours, such as the Minnesota Multiphasic Personality Inventory-2- Restructured Form (MMPI-2-RF). Before selecting your test battery, consider these questions: 1. Is the measure appropriate for this patient? 2. Does the test (or combination of tests) address the relevant issues, such as: General psychopathology Enduring personality traits or characterological problems Emotional symptoms Behavioral predispositions such as: Detrimental eating attitudes and behaviors Substance abuse Suicidal thoughts Impulsivity Maladaptive coping style Difficulty with attention Motivation for procedure The likelihood of complying with treatment and adherence to self-management guidelines When the patient completes the selected test batteries and they are scored and all other assessments are finished, the psychological evaluation is then written. This assessment generally includes the following sections: Tests Administered Brief History and Reason for Referral Medical and Pain Interview Behavioral Observation Test Results Recommendations Psychological evaluation of patients before bariatric surgery is a critical step. This process can not only identify risk factors for surgery but also better understand the patient's motivation, readiness, behavioral challenges and emotional factors that may be detrimental to their ability to cope with and adjust to post-surgery lifestyle changes properly. The psychologist's challenge is to collect data while simultaneously educating and motivating the patient in their pursuit of improved health and quality of life. For some patients, the initial evaluation is all they need to move forward. However, it’s just the beginning for many, as they will need additional psychological support to maintain the lifestyle changes essential for long-term post-operative success. If you’re a Help Therapy provider partner, you can request a copy of the Psychological Evaluations Bariatric Surgery Manual and Reference Guide by emailing us at info@helptherapy.com.

Why are Psychological Assessments (or Evaluations) Required Before Undergoing Surgery? Psychological Assessments are often required for specific surgeries, such as Spinal Cord Stimulation (SCS) surgery and Bariatric surgery, among others. They’re used not only to identify factors that may interfere with a positive outcome of the surgery but also to assess the readiness of the patient to undergo surgery and willingness to make the necessary lifestyle adjustments after the procedure. The results of Psychological Assessments have been proven to correlate with the success of the surgery. The more mental and physical stress an individual is under (or has experienced in the past), the less likely the surgery will be beneficial. Pre-existing Conditions Pain and mental health play significant roles in determining whether or not an individual is a good candidate for surgery. Pain is experienced differently by different people. The Central Texas Spine Institute reports that studies have shown that the more pain-sensitive a person is, the less likely the surgery, such as SCS, will have a positive outcome. Plus, the more prolonged pain is experienced, and the older the patient is, the less likely the result of the surgery will be favorable. Besides these physical factors, psychological health plays a vital role in the success of the surgery. Some of these mental health concerns include: Depression Anxiety Substance abuse Trauma No social support system Two tiers of risk factors can be identified—Red Flags and Yellow Flags. Red Flags (Primary Risk Factors) Include: Suicidal, homicidal or psychotic tendencies Active substance abuse Severe psychological instability (above a 99 percentile) If a red flag is detected, it’s recommended that the patient not have the surgery at this time (in elective cases). A reassessment can be done after addressing the current psychological concerns. Yellow Flags (Secondary Risk Factors) include: Depression Anxiety Coping with pain Poor physical functioning Somatization Job dissatisfaction, etc Almost all patients have more than one secondary risk factor. It’s the number of these risk factors that can affect the ultimate results of the surgery. The more secondary risk factors there are, the less likely the patient will have a successful outcome. The presence of 4 or more risk factors increases the risk of a mental health disorder by 14% and increases the risk of the patient not returning to work by 50%. How Does an Evaluation Work? Before a patient is cleared for surgery, a physician may refer a patient to a mental healthcare professional for a clinical interview and psychological testing. The purpose is to determine if they are a good candidate for a specific surgery, such as SCS implantation or Bariatric surgery. Although each mental health therapist may use their own testing and evaluation variation, the process below is common. The Process The evaluation process includes gathering information on the patient’s: Health history Pain history Psychosocial history Mood and mental health status Understanding and expectations of the procedure Various assessment tools are used to determine the patient's candidacy for the surgery. Some of these tools include: A Clinical Interview A Health Psychology Intake Form A Pain Intensity Test A Mini Mental Status Exam An Anxiety Inventory A Beck Depression Inventory A Suicide Assessment The Recommendation Based on the findings of all the information gathered, a recommendation for or against the surgery is determined. Along with this recommendation, additional suggestions may be advised, such as psychological counseling and pain management classes. Specific recommendations for the patient may include: Working with a psychiatrist to manage medication Participating in psychotherapy to improve mood from depression and anxiety Exercising and stretching to improve mental and physical health Starting an anti-inflammatory diet Education about the emotional component of pain and building coping skills for chronic pain Education about sleep hygiene Reevaluating after implementing psychosocial and behavioral treatments It’s important to note that if a surgery prospect is not recommended for surgery at the initial evaluation, the assessment can be repeated after addressing concerns that may prevent the patient from getting the most out of the procedure.

The Mental Health Connection There are three things we are incredibly excited about this month: 1. The CICAMH Conference 2. Our efforts in reaching people outside the San Diego area 3. San Diego Best Poll Nominations First, if you haven’t already, be sure to register for The 7th Annual Critical Issues in Child & Adolescent Mental Health Conference (CICAMH), held in person and virtually March 11, 2022, in San Diego. This year's focus will be mental health issues involving children and adolescents in the pandemic era—with particular emphasis on special needs children. Come visit us at our booth! You can register to participate in person or virtually for the event here. Second, our network of practitioners inside and outside the San Diego area continues to grow. We’ve added 13 new mental health professionals in February to help people not only in California but in Arizona, Texas and Washington as well. A list of these new provider partners is further down in this newsletter. Third, it’s time to cast your votes. The San Diego Best Poll is out. Last year we placed 2nd in San Diego’s Best Company for “In-Home Non-Medical.” This year we’re pushing for 1st! You can help us achieve this goal by casting your votes here. Thanks in advance for voting for us, and we look forward to seeing you at CICAMH! Annette Conway, PsyD President Help Therapy March Focuses on Three Observances Self-Injury Awareness Month It’s been reported that 90 percent of self-injury cases begin in adolescence. Although many believe it to be an uncommon affliction, self-injury is, unfortunately, more common than most people realize. In fact, it’s estimated that 15% of teenagers will experience some form of self-injury during this often challenging time in their lives. The three most common types of self-injury are: Skin cutting Headbanging Skin burning Self-injury Awareness Month is a time to recognize and understand this mental health issue and be open about treatment options for those experiencing this alienating condition. Learn more here. National Developmental Disabilities Month As reported by the CDC, about 17% of children 3 - 17 years old have one or more developmental disabilities. Yet, people with developmental disabilities still sometimes face barriers. Each March, the National Association of Councils on Developmental Disabilities (NACDD) works with other organizations to create a social media campaign to promote awareness and inclusion. Learn more here. Brain Injury Awareness Month According to the Brain Injury Association, more than 3.6 million people sustain an acquired brain injury each year. What’s more, it’s estimated that at least 5.3 million Americans live with a traumatic brain injury-related disability. Many of these people feel defined by their brain injury. Each March, this campaign gives individuals a chance to see past these limiting beliefs and change how they view themselves and their lives. Learn more here. Artificial Intelligence for Mental Healthcare In a world where Siri recommends a Sushi restaurant, Alexa orders dog food and Google directs you to the nearest gas station, what effect will AI have for mental healthcare providers? We’ve already seen the rise in telehealth, due in part to the pandemic. As more and more people become accustomed to using various forms of technology to get what they want or need, 24/7, more AI to assist healthcare practitioners and patients are being developed. For example, Intel has collaborated with Scripps Research Institute to develop a deep learning algorithm. This algorithm was used to identify patients with high heart disease risk undetected by traditional methods. It had an accuracy of 85%. Other examples are Google DeepMind and IBM Watson—leaders in mining medical records. This type of healthcare AI aims to create what’s termed a “cognitive assistant.” Along with its reasoning and analytical abilities, this AI is armed with a range of clinical knowledge. Similarly, a study published in the Journal of Internet Research (JMIR) examined the feasibility of using an AI-powered mental health chatbot. This chatbot, named Woebot, was designed to address substance use disorders. It focuses on cravings and urges and helps individuals build self-awareness regarding their thinking patterns and moods. Woebot is based on Cognitive Behavioral Therapy (CBT), Interpersonal Psychotherapy (IPT) and Dialectical Behavioral Therapy (DBT) and has a tailored empathy component in the messages it sends. Woebot gets to know the individual through quick conversations and check-ins and then suggests clinically-tested tools and approaches. New genetic data and neuroimaging are helping to unlock the key to understanding mental health and how the brain works. With this knowledge, partnerships between industry and the academic community are needed to develop AI to address mental illness's complexity and help mental healthcare providers improve patient care. Why We Should Limit Our News Exposure Negative news is everywhere. We don’t even need to seek it out—it comes to us. It’s hard to avoid and can become almost addictive. And like other addictions, it can affect our mental health. Negative news can cause mental and physical symptoms such as anxiety, depression, fatigue and digestive problems. Consuming too much news can cause many people to live in a stressful state of worry, impending doom and helplessness. Some people are affected more than others. Some people are affected but don’t realize it or correlate their anxiety, depression or other mental health issues as being caused by repeated exposure to negative news. Watching negative media coverage of a traumatic event can cause some individuals to experience it as though they were there themselves. Doomsday scenarios and improbable threats perpetuated by the media, such as a black hole devouring Earth, can cause anxiety and fear in people who were unaware that a possibility (no matter how extreme) exists. Seeing, reading or hearing something in the news gives it credibility and is taken as fact. Negative news is difficult to avoid unless you don’t have a TV, radio, computer, smartphone or any other device capable of reporting the news. But of course, there are also tabloids and magazines lining the checkout lanes, full of shocking headlines. Even if you manage to avoid all these news sources, friends, family, colleagues and others are often eager to share the latest tragedy. [READ MORE] Welcome New Help Therapy Mental Health Providers These mental healthcare practitioners are new to our network —some in practice for over 20 years. They offer evaluations and various types of therapy, with a range of specialties, including LGBTQ+, substance abuse and parenting. They are accepting new patients and provide telehealth appointments. Arizona Dr. Brooke DeBoy Dr. Debra Gold, PsyD Dr. Marci Haines, PsyD Dr. Maria Mendoza-Rodriguez, PSYD California Dr. Eric Greene Dr. Darya Harrison Dr. Jamie McLaren Dr. Heather O’Neill Marsha Orman, LCSW Dr. Amber Stickerod Texas Dr. Anita Mancini-Michell, PsyD Dr. Amie Yanover, PSYD Washington Dr. Jacob Engelskirger Featured Practitioner Matthew Brown, LMFT Matthew Brown is a Licensed Marriage and Family Therapist, practicing individual, couples and group therapy. Matthew utilizes a client-centered approach and meets each individual with compassion and empathy. He works with diverse populations, including veterans and other trauma survivors and people with severe mental illness, depression and anxiety. He also helps those with substance dependence and individuals and families living with domestic violence (survivors and perpetrators). His training includes Cognitive Behavioral Therapy (CBT) and Eye Movement Desensitization and Reprocessing Therapy (EMDR). Matthew is passionate about helping people achieve their personal mental health goals. He accepts teletherapy appointments and in-office appointments at his Vista, California practice. This Month's Tip Treating Mental Health Issues in Pregnancy Some women experience the first onset of a mental health issue during pregnancy. Depression and anxiety during pregnancy have been associated with a variety of adverse outcomes for both the mother and her baby. But treating mental illness with medication also has its risks. When prescribing medications during pregnancy, the practitioner must consider the dangers associated with prenatal exposure, including the possibility of neonatal toxicity and long-term cognitive and behavioral disorders. For women with bipolar disorder, maintenance treatment during pregnancy can significantly reduce the risk of relapse. However, many medications commonly used to treat bipolar disorder carry some risk when used during pregnancy. Since 2011, the FDA has required all antipsychotic drugs to include warnings regarding the use of these drugs during pregnancy. Decisions regarding the initiation or maintenance of drug therapies during pregnancy need to consider both the risks associated with fetal exposure to a particular medication and the risks associated with untreated mental illness in the mother. Events International Women’s Day March 8, 2022 See IWD for more information. Sleep Awareness Week March 13-19, 2022 See NSF for more information. World Sleep Day March 18, 2022 See World Sleep for more information. World Down Syndrome Day March 18, 2022 See DSI for more information. National Autism Awareness Week March 29- April 3, 2022 See AAM for more information. World Bipolar Day March 30, 2022 See IBPF for more information. "What you do today can change all the tomorrow's of your life.” - Zig Ziglar Partner With Us Are you a psychologist, LCSW or LMFT? We’re always looking for exceptional mental healthcare providers. Visit helptherapy.com for more information and fill out the quick and easy application. Benefits: Stream of new patients Billing off your plate Flexibility and Freedom Credentialing assistance No hidden costs Do you have something to share? We’d love to hear about your successes and accomplishments! Have you: Written an article? Given a presentation? Been featured on a podcast? Contact us at info@helptherapy.com. We welcome your feedback. What would you like to see in this newsletter? Do you have a topic you would like discussed? Have questions? Want to learn more about Help Therapy? Visit helptherapy.com, call 858-481-8827 or email info@helptherapy.com

Negative news is everywhere. We don’t even need to seek it out—it comes to us. It’s hard to avoid and can become almost addictive. For some, obsessive and constant checking for new articles on computers and smartphones has become harmfully habitual; it’s referred to by many as “doom scrolling.” This has become much more common during the Covid-19 pandemic. And like other addictions, it can affect our mental health. The Effect of News on Our Mental and Physical Health Negative news can cause mental and physical symptoms such as anxiety, depression, fatigue and digestive problems. Consuming too much news can cause many people to live in a stressful state of worry, impending doom and helplessness. Some people are affected more than others. Some people are affected but don’t realize it or correlate their anxiety, depression or other mental health issues as being caused by repeated exposure to negative news. Watching negative media coverage of a traumatic event can cause some individuals to experience it as though they were there themselves. Doomsday scenarios and improbable threats perpetuated by the media or social media, such as a black hole devouring Earth, can cause anxiety and fear in people who were unaware that a possibility (no matter how extreme) exists. For many, seeing, reading or hearing something in the news or reading a post by a trusted source gives it credibility and is taken as fact. Negative News Surrounds Us Negative news is difficult to avoid unless you don’t have a TV, radio, computer, smartphone or any other device capable of reporting the news. But of course, there are also tabloids and magazines lining the checkout lanes, full of shocking headlines. Even if you manage to avoid all these news sources, friends, family, colleagues and others are often eager to share the latest tragedy. What makes the impact of the news even more powerful are the images. Film crews are no longer essential for a reporter when covering a story. The public can often provide “caught on tape” and other at-the-scene footage of events and disasters. Many of these images are much more graphic than would “normally” be shown to the public if filmed by the news crew. Not all news is negative. There are a few uplifting stories sprinkled in—like a dog rescued from a raging river. But even these seemingly harmless reports can lead to anxiety—triggering individuals to go down the “what if” rabbit hole. What’s more, you don’t need to be consciously paying attention to the news for it to cause mental or physical symptoms. Some use the news as background noise, and although consciously they may not notice the effects of the negativity on their psychological or physical health. But the results are the same. How to Limit News Exposure There are ways to limit our exposure to negative news and its effects on our mental and physical health while still keeping informed. A few options are: Limit time spent with the radio or TV on (even as background noise) Limit online news consumption Limit time spent on social media Unsubscribe to email newsletters with negative views Turn off social media notifications on phones and computers Don’t engage in conversations related to news (Change the subject) Don’t consume news close to bedtime (It can make it difficult to sleep) In the current state of the country and the world, it’s more important than ever to protect ourselves from the influences of negativity that are all around us. It can help to talk about our fears and anxiety with a mental healthcare professional. They listen without judgment and can create a plan to help improve our mental health.

If used correctly, social media can be a means of entertainment, information and active engagement. But, since the development of social media platforms, concerns over adverse health effects these platforms may be causing continue to rise as the way people use these platforms evolve. Long gone are the times when people turned to social media as just a place to post vacation photos and watch videos of cats doing tricks. These platforms have evolved as the go-to for constant updates on what’s happening in the world. And as with most trending news, it’s not usually good news. The isolation brought on by the ongoing COVID-19 pandemic has caused more people to turn to social media to stay connected, keep up with the latest news and just pass the time. And, those already using social media regularly before the pandemic rely on it even more. As the effects of isolation, negativity, despair and other consequences of the pandemic come to light, obsession with social media expands far beyond FOMO. It’s further enabled “doom scrolling” or “doom surfing.” These are terms used to describe the tendency to fixate on news, events and scenarios resulting in severe agitation, causing physical discomfort. Constantly viewing negativity can lead to catastrophizing— focusing on the negative in all situations. Over time, this can lead to a host of mental health issues. Of course, the effects of this negativity can be devastating for those already suffering from anxiety, depression or other mental health conditions. Until more people become aware of the possible dangers of using social media and the real mental health issues that can arise, people suffering from “doom surfing” will continue.

In our last newsletter, we talked about the No Surprise Act taking effect on January 1, 2022. This month, we address another billing-related change—telehealth codes. Also as of January 1, 2022, mental healthcare providers are now required to use a new code showing where the therapy was provided when billing Medicare and other insurance providers. Specifically, POS code 02 is revised and a new POS code 10 now exists. The previous definition of POS code 02 simply indicated that a telehealth service was provided. It didn’t specify where the patient was—at home, in a hospital, in a nursing home… Now it makes a difference. When providing telehealth services to patients in their own homes, therapists should use POS code 10, not POS code 02. However, POS 02 will continue to be used for patients in hospitals, nursing homes and assisted living facilities.

The Mental Health Connection 2022 is off to a great start here at Help Therapy! Our network of practitioners inside and outside the San Diego area is growing. We’re expanding our reach into Arizona and Texas for psychological evaluations and since January, we’ve added nine providers. Besides offering evaluations, these mental healthcare practitioners provide other services and therapies, including pre-surgical screenings, personality assessments and ketamine therapy. A list of these provider partners is further down in this newsletter. Help Therapy is also proud to sponsor CICAHM 2022. This year’s theme is Managing Change in a Changing World. It will focus on mental health issues of children and adolescents in the age of the pandemic. It takes place March 11, 2022 in San Diego. For more information and to register to attend, visit CICAHM 2022. We look forward to seeing you there! Annette Conway, PsyD President Help Therapy February is Black History and Teen Dating Violence Awareness and Prevention Month Black History Month In 1915, fifty years after the Thirteenth Amendment abolished slavery in the United States, the Association for the Study of Negro Life and History was founded. Now known as the Association for the Study of African American Life and History, the group sponsored a national Negro History week in 1926. In 1976, fifty years after the first celebration honoring the contributions of African Americans, President Gerald R. Ford urged Americans to “seize the opportunity to honor the too-often neglected accomplishments of black Americans in every area of endeavor throughout our history.” That year, Black History Month was proclaimed. In 2021, President JOSEPH R. BIDEN JR also proclaimed February as Black History Month, stating, “It is long past time to confront deep racial inequities and the systemic racism that continue to plague our Nation”. Read the proclamation here. Black History Month honors the struggles and triumphs of African Americans throughout U.S. history and brings awareness to the racial inequities that still plague our nation. National Teen Dating Violence Awareness and Prevention Month According to one report, youths between 12 to 19 experience the highest rates of rape and sexual assault in the U.S. One study also revealed that approximately 10% of adolescents reported being the victim of physical violence by an intimate partner during the year prior to the study. Girls and young women are more vulnerable to experiencing violence in their relationships and often suffer long-term health effects—both physical and psychological. President Barack Obama proclaimed February as National Teen Dating Violence Awareness and Prevention Month in 2013. Read the proclamation here. Bringing “Doom Scrolling” to Light If used correctly, social media can be a means of entertainment, information and active engagement. But, since the development of social media platforms, concerns over adverse health effects these platforms may be causing continue to rise as the way people use these platforms evolve. Long gone are the times when people turned to social media as just a place to post vacation photos and watch videos of cats doing tricks. These platforms have evolved as the go-to for constant updates on what’s happening in the world. And as with most trending news, it’s not usually good news. The isolation brought on by the ongoing COVID-19 pandemic has caused more people to turn to social media to stay connected, keep up with the latest news and just pass the time. And, those already using social media regularly before the pandemic rely on it even more. As the effects of isolation, negativity, despair and other consequences of the pandemic come to light, obsession with social media expands far beyond FOMO. It’s further enabled “doom scrolling” or “doom surfing.” These are terms used to describe the tendency to fixate on news, events and scenarios resulting in severe agitation, causing physical discomfort. Constantly viewing negativity can lead to catastrophizing— focusing on the negative in all situations. Over time, this can lead to a host of mental health issues. Of course, the effects of this negativity can be devastating for those already suffering from anxiety, depression or other mental health conditions. Until more people become aware of the possible dangers of using social media and the real mental health issues that can arise, people suffering from “doom surfing” will continue. Kidney Disease and Depression: The Need for Support When it comes to chronic medical conditions, diabetes, high blood pressure and heart disease are often top of mind. But there is another chronic disease that needs attention—especially as it relates to depression. That disease is Chronic Kidney Disease (CKD). According to the CDC: 37 million adults in the U.S. have CKD—over 14% As many as 9 in 10 adults with CKD don’t know it About 2 in 5 adults with severe CKD don’t realize it This disease has caught the attention of some, specifically Monogram Health—a tech-empowered kidney disease management company. This start-up received $160 million in funding from Humana in June 2021 and is building a national network of nurses, nephrologists, dieticians, pharmacists and social workers. But another health care professional plays an essential role in managing CKD—the mental health practitioner. There’s a high prevalence of depression and anxiety among patients with CKD. Depression has long been associated with end-stage kidney disease. But, as high as 34.5% of patients on dialysis are likely to develop depression and close to 24% of patients with CKD suffer from depression. Another study published in the American Journal of Kidney Diseases found that 20% of patients with early-stage chronic kidney disease also suffered from depression. A patient with CKD may or may not be on dialysis, and the damage to the kidney may be reversible. CKD is a progressive disease that can move through five stages diagnosed by specific tests. Following stage five is End-Stage Renal Disease (ESRD). A patient diagnosed with ESRD requires ongoing dialysis or a kidney transplant. It’s not reversible. As reported by the National Kidney Foundation, people with CKD (even in its earliest stages) who are unemployed, have diabetes or other chronic medical condition or have other mental health issues are more prone to experience depression. [READ MORE] Welcome New Help Therapy Mental Health Providers These mental healthcare practitioners are new to our network and offer psychological evaluations as well as other types of therapy, with a range of specialties. They are accepting new patients and provide telehealth appointments. Most accept Medicare. Arizona Dr. Frank Bevacqua - Scottsdale California Kathryn Greene - Carlsbad Dr. Jill Saulque - Cathedral City Dr. Cindy Tafoya - Commerce Dr. Adrian Rubly - Eastvale Dr. Janelle Fisher - McClellan Dr. Victoria Kuhl - Pasadena Dr. Elaine Dove - San Diego Washington Dr. Linda Bowman - Lakewood Featured Practitioner Dr. Maya Bailey Dr. Bailey has over 30 years of experience as a Clinical Psychotherapist. She works from the principle that symptoms of mental health issues are the result of subconscious self-limiting beliefs. Her unique approach helps patients identify, release and reprogram their beliefs through Subconscious Reprogramming. Although her specialties include anxiety, addiction and depression, Dr. Baily treats patients with a wide range of challenges, including eating disorders, divorce, learning disabilities and more. She’s recently become more involved with Veterans and finds satisfaction in helping them enjoy a life of well-being, increased confidence and success This Month's Tip What You Need to Know About 2022 Billing Code Changes In our last newsletter, we talked about the No Surprise Act taking effect on January 1, 2022. This month, we address another billing-related change—telehealth codes. Also as of January 1, 2022, mental healthcare providers are now required to use a new code showing where the therapy was provided when billing Medicare and other insurance providers. Specifically, POS code 02 is revised and a new POS code 10 now exists. The previous definition of POS code 02 simply indicated that a telehealth service was provided. It didn’t specify where the patient was—at home, in a hospital, in a nursing home… Now it makes a difference. When providing telehealth services to patients in their own homes, therapists should use POS code 10, not POS code 02. However, POS 02 will continue to be used for patients in hospitals, nursing homes and assisted living facilities. Events World Cancer Day February 4, 2022 See World Cancer Day for more information. Safer Internet Day February 8, 2022 See Safer Internet for more information. National Make a Friend Day February 11, 2022 See National Today for more information. Random Acts of Kindness Day February 17, 2022 See Random Acts of Kindness for more information. National Eating Disorders Awareness Week February 21-27, 2022 See NEDA for more information. Partner With Us Are you a psychologist, LCSW or LMFT? We’re always looking for exceptional mental healthcare providers. Visit helptherapy.com for more information and fill out the quick and easy application. Benefits: Stream of new patients Billing off your plate Flexibility and Freedom Credentialing assistance No hidden costs "Sometimes the people around you won’t understand your journey. They don’t need to, it’s not for them.” - Joubert Botha Do you have something to share? We’d love to hear about your successes and accomplishments! Have you: Written an article? Given a presentation? Been featured on a podcast? Contact us at info@helptherapy.com. We welcome your feedback. What would you like to see in this newsletter? Do you have a topic you would like discussed? Have questions? Want to learn more about Help Therapy? Visit helptherapy.com, call 858-481-8827 or email info@helptherapy.com

When it comes to chronic medical conditions, diabetes, high blood pressure and heart disease are often top of mind. But there is another chronic disease that needs attention—especially as it relates to depression. That disease is Chronic Kidney Disease (CKD). The Stats According to the CDC: 37 million adults in the U.S. have CKD—over 14% As many as 9 in 10 adults with CKD don’t know it About 2 in 5 adults with severe CKD don’t realize it This disease has caught the attention of some, specifically Monogram Health—a tech-empowered kidney disease management company. This start-up received $160 million in funding from Humana in June 2021 and is building a national network of nurses, nephrologists, dieticians, pharmacists and social workers. But another health care professional plays an essential role in managing CKD—the mental health practitioner. There’s a high prevalence of depression and anxiety among patients with CKD. Depression has long been associated with end-stage kidney disease. But, as high as 34.5% of patients on dialysis are likely to develop depression and close to 24% of patients with CKD suffer from depression. Another study published in the American Journal of Kidney Diseases found that 20% of patients with early-stage chronic kidney disease also suffered from depression. A patient with CKD may or may not be on dialysis, and the damage to the kidney may be reversible. CKD is a progressive disease that can move through five stages diagnosed by specific tests. Following stage five is End-Stage Renal Disease (ESRD). A patient diagnosed with ESRD requires ongoing dialysis or a kidney transplant. It’s not reversible. As reported by the National Kidney Foundation, people with CKD (even in its earliest stages) who are unemployed, have diabetes or other chronic medical conditions, or have other mental health issues are more prone to experience depression. Depression is the most widely acknowledged psychosocial factor seen in patients with CKD and is associated with poor outcomes. The Effect on Caregivers A study exploring the prevalence of depression among patients with chronic kidney disease and their caregivers found caregivers of patients undergoing dialysis experience depression, anxiety, fatigue, social isolation, relationship strains and more. Despite the burdens experienced by caregivers, they are not often given the support they need. Studies done among caregivers of patients with chronic illnesses showed that depression, anxiety, excessive medication use and impaired quality of life were associated with caregiving of these patients. Plus, caregivers experiencing these issues were found to have higher mortality rates. Yet, the report also revealed that only 56% of the caregivers know they are at risk for depression. CKD patients and their caregivers need to be educated on their risk of depression and the factors that can influence the development of depression. Psychological and social support for both the patient and caregiver—especially if a spouse or other close relative— should become an integral part of the treatment plan before symptoms of depression or other mental health issues develop.

The No Surprise Act is in effect. Beginning January 1, 2022, Psychologists and other healthcare providers will need to provide estimated costs of services before starting treatment. Here are some guidelines: Ask if the patient has health insurance coverage (including through government insurance programs) whether or not the patient intends to submit a claim to that insurance. Inform all uninsured and self-pay patients that a good faith estimate of expected charges will be provided before treatment. The requirements of the estimate include: Being available in a clear and understandable written document and other accessible formats Being available in the language spoken by the patient Provided orally when a patient asks about costs or when an appointment is scheduled Provide a good faith estimate of expected charges, including typical additional services or items. This estimate must be provided in the following timeframes: If an appointment is scheduled at least three business days in advance, no later than one business day after scheduling If an appointment is scheduled at least ten business days in advance, no later than three business days after scheduling If a self-pay or uninsured patient requests a good faith estimate without scheduling an appointment, no later than three business days after the request If a patient reschedules an appointment, a new estimate is required within the specified timeframes listed above You can find more information about the requirements of this act here.

The holidays bring anticipation, excitement and joy for many. But when it’s all over, some find returning to normal, everyday life more challenging than others. Seasonal depression, occurring after the holidays, can stem from several common causes. One cause is the letdown after the holiday festivities. Another is financial concerns about paying off holiday spending. A third is the anxiety caused by giving up on New Year’s Resolutions after a few days or weeks. Combine these situations with the thought that there may be nothing much to look forward to in the coming months—characterized by colder and drearier weather. It can be overwhelming. Dreary weather is a cause of Seasonal Affective Disorder too. Researchers believe that the lack of sunlight during Fall and Winter causes changes in our body’s internal clock and rhythms. These changes can cause depression. SAD often lasts through Winter until Spring. The difference between SAD and other types of depression is that symptoms generally improve as the days lengthen during Spring and Summer with SAD. The symptoms of Seasonal Affective Disorder are similar to other forms of depression: Sadness Fatigue and lack of energy Sleeping too much or trouble sleeping Difficulty concentrating Loss of interest in activities SAD is more common for those living in northern regions as they have the least amount of sunlight during Fall and Winter. But SAD can strike in sunnier areas as well, including Southern California. Like other forms of depression, SAD is treatable. Talk therapy can help identify and treat SAD, as it treats other forms of depression—with or without the aid of medication. Light therapy is also often effective in treating SAD. Light therapy involves a particular device that emits light similar to natural outdoor light and replaces sunlight, which can be inadequate during the Fall and Winter months. Other ways that may help relieve depression, especially SAD: Getting outside during the day—especially when it’s sunny Letting the light in and face the window or door when possible Getting some form of exercise daily Diagnosing SAD or Seasonal Depression is the first step. Patient awareness is key to starting a path to recovery.