Author Archives: Ronnie Siddique

Anxiety and Elections

Anxiety is an ancient emotion that can help us assess and respond to future risks to our safety and security, a basic human psychological need as Maslow taught us, in his hierarchy of needs.  Anxiety refers to a prolonged state of apprehension brought on by uncertainty about future threats. Past threats logged in our neural memories and unconscious can also influence our view of upcoming risk. As such, anxiety is a natural emotion and vital for survival.

In contrast to anxiety, fear is an acute or phasic response to an immediate and identifiable threat. Anxiety has apparently persisted over human history, indicating that it has an important evolutionary role. Simply put, the evolutionary advantage of anxiety could be that it leads individuals to take fewer risks, seek safety, and focus on doing things well. On the other hand, anxiety can limit the risk-taking that advances mental flexibility, growth, and adaptability.

Interestingly, across the data, anxiety has a curvilinear relationship with behavior. For example, if you are moderately anxious, it can spur action and involvement. However, once over the hump of the curve, when anxiety becomes excessive, it leads to destabilizing and even shutting down of behaviors that are productive.
There are certainly plenty of reasons to be anxious about the state of the nation: the coronavirus pandemic, the economy, climate instability, physician burnout, mental and medical health, homeschooling, and racism, among other societal and personal psychosocial stressors. Some mental health professionals are calling 2020 the most challenging year they’ve ever seen.

Also, partisan political warfare, civil unrest, and terrifying conspiracy theories on TV, news media, and the internet. The actual polls confirm intuition: we are a nervous nation. In May 2020, the US Census Bureau found major depressive disorder at the highest level since they recorded statistics. Earlier this year, my professional organization, the American Psychological Association, conducted a “Stress in America” survey, in which they found more than half (about 56%) respondents identified the 2020 election as a significant stressor. At the end of June, the Centers for Disease Control reported that the highest rising levels of anxiety were among young adults, as well as black and Latinx people of all ages.

The physical and psychological symptoms of anxiety, such as feeling tense or having trouble concentrating, can be so uncomfortable that they cause behavioral changes. Fight or flight stress responses range from avoidance to aggression, as well as self-medicating with alcohol and drugs. One can also have anxiety about one’s very existence and the purpose of one’s life. That is called existential anxiety disorders, as coined by the psychologist, Irvin Yalom.

In terms of evolutionary psychology, anxiety helps us survive. We look for threats. One way that anxiety can do this is to organize our cognitive functions quickly in response to danger. Another body of research indicates that isolation induces anxiety. For most of us, being with community helps alleviate anxiety. we need people. What else helps? Keeping to routines and schedules, self-care, engaged participation, and hope through improved mental well-being. And, when needed, seeking mental health professionals. 

Executive functioning and COVID-19

Many of you are excellent teachers, and probably didn’t know it. I’m a clinical psychologist of 23 years with a neural science background, and I have worked with children and teens every one of those years. I have literally met and spoken in detail with thousands of children and families. They are MY teachers.

When you show your kids that they, and you, don’t wear masks, don’t social distance, hang out in public places, pick fun over health, and disregard safety of others,  you are teaching LOTS. 

  • Rules don’t apply to you.
  • Impulse control doesn’t matter, do what YOU wanna do.
  • Being uncomfortable, physically or emotionally, is just too hard.
  • Fun before safety.
  • Others don’t matter, it’s about you.
  • You are healthy right now, so why worry. 
  • Emerging research doesn’t matter; it’s changing anyway, so it’s irrelevant.
  • Uncertainty is unbearable.
  • Everyone else is doing it, so why not.

Unfortunately, children with their developing frontal lobes do not apply these rules, which are aspects of executive functioning, to a single situation. They are generalized and integrated at the neuronal level. They are learning, growing beings.

[“But Doctor, Junior will not follow basic household rules. They only think about themselves. And she goes out every weekend and does risky things. It’s so frustrating.”]

Um. 

Obviously, there are many families working hard, and I mean hard, to keep others and themselves safe. I know it’s not easy, I hear from you every day. Big respect. There are also creative solutions. May you all have a healthy summer and fall.

Parenting Tips for Homeschooling

As homeschooling seems to stretch endlessly for many families, certainly school districts try to provide guidance and curriculum. These are some tips offered by my offices to ease the course. And even make it enjoyable.

Establish structure
The success of homeschooling depends on your willingness to commit to a structure and a schedule and your willingness to be on top of it. I have families maintain a large calendar, or even whiteboard, that has all the family activities on it, to be able to see them at a single glance. This includes outdoor activities, family time, special events, social commitments, downtime (described below), class time, and, of course, homework. Homeschooling is not just about schoolwork.

Use available resources

  • KhanAcademy.org has also added new features and functionality as a result of the pandemic, including daily learning schedules for children ages 2 to 18.
  • thinkwell.com offers classes for homeschoolers taught by acclaimed professors in subjects ranging from high school and Advanced Placement mathematics and science to American Government, Economics, History and even public speaking.
  • audible.com has free books for kids.
  • math-drills.com has free math sheets for kids

Model the value of dealing with uncertainty.
At Embolden, we call this emotion coaching. The pandemic, so often referred to as unprecedented times, really is. Mental flexibility is a hallmark of executive functioning, and incredibly valuable as a life tool. Teaching and discussing as a family how to deal with not knowing is invaluable.

Change your expectations.
Things are not the same. Expecting a similar level, duration, or output of work is unrealistic. Set the kids up to enjoy the experience. Before worrying that you or your child are underperforming, remember that having and maintaining close emotional connections with kids during this time is a priority.

Play
Free time, is an incredible stress reducer for children, and so is outdoor time. One family I know it takes a family walk most evenings of the week. Parents have told me that kids really open up to them on these outings. Another option is quiet time, an hour away everyone has to entertain themselves, whether they choose to read, play games, or even text with friends.

Encourage fun chores
Homeschooling is not just about school. I have many of the kids I work with plan a menu or recipe, make the grocery list, and make a meal for the family once a week. Other kids and teens I work with enjoy working in the garden with parents or family, or taking care of indoor plants. Start with less demanding tasks, and reinforce the importance of a family home and all its members.

Be easy on yourself. And them.
It’s important to remember that homeschooling isn’t going to be perfect. It’s a stressful time for both you and your child. Teachers, parents, and students have all noted in studies, that it can be hard, and even tiring. So if you need to put on a movie to get through the afternoon, or call it quits for the day, that’s okay.

Movement
Stretching, walking around, playing with a furry family companion, and even going outside for short breaks have all been shown to increase concentration. 

On pandemic and homeschooling

Several of my local school systems as well as private schools in my work in Maryland, Virginia, and Washington DC have made it known that they are going to have a very limited schedule or no in vivo teaching this fall.

I work with many parents and educators. It’s been an incredibly difficult process, since March, to parent, work from home, do home schooling, manage health concerns, and still try to have quality of life and self care.

I have the deepest respect for the challenges involved. But it’s essential to help children feel safe, keep healthy routines, manage their behavior and build resilience.

Here are some tips to help your children feel safe.
– Address children’s fears directly
Children rely on their parents for safety, both physical and emotional. Reassure your children that you are there for them and that your family will get through this together.

-Answer questions about the pandemic simply & honestly. Talk with children about any frightening news they hear or see. It is OK to say people are getting sick or passing, but say following rules like hand washing and staying home will help your family stay healthy. Explain to them why they may not be able to see their friends easily in a calm fashion. Making things seem like they are falsely positive it’s not helpful for children, because they will know that there is something wrong

-Recognize your child’s feelings. Calmly say, for example, “I can see that you are upset because you can’t have your friends over.” Guiding questions can help older children and teens work through issues. (“I know it is disappointing not to be able to hang with your friends easily right now. How do you think you can stay in touch with them?”)

-Keep in touch with loved ones, friends, and family. Children may also worry about a grandparent or family member who is living alone or a relative or friend with an increased risk of getting COVID-19. Video chats can help ease their anxiety

-Model how to manage feelings. Dr. Siddique calls this emotion coaching. Just like a coach can help you be a better athlete or student, emotions also require practice, feedback, and implementation.

Talk through how you are managing your own feelings. (“I am worried about Grandma or Auntie, since I can’t go visit her. The best I can do is to check in with her more often by phone. I will put a reminder on my phone to call her in the morning and the afternoon until this outbreak ends.”

-Acknowledge compromises. Yes, working from home is hard. I have to make a lot of adjustments. I know mommy is in the study all the time. It’s like being at the office but now it’s here at home. Sometimes when I’m here in the house, I can’t always talk to you. But we will have our time later.

-Tell your child before you leave the house for work or essential errands. In a calm and reassuring voice, tell them where you are going, how long you will be gone, when you will return, and that you are taking steps to stay safe. More than ever, communication matters.

-Look forward with realistic optimism. Tell them that scientists are working hard to figure out how to help people who get ill, and that things will get better.

-Offer extra hugs and say “I love you” more often. Being affectionate matters.

-Keep healthy routines
During the pandemic, it is more important than ever to maintain bedtime and other routines. They create a sense of order to the day that offers reassurance in a very uncertain time. All children, including teens, benefit from routines that are predictable yet flexible enough to meet individual needs. go to bed within a certain time range and wake up at the same time. Model that unfortunate times do not have to create chaos.

-Structure. With the usual routines thrown off, establish new daily schedules. Break up schoolwork and chores when possible. Older children and teens can help with schedules, but they should follow a general order, such as:
Wake-up routines, getting dressed, breakfast and some active play in the morning, followed by quiet play and snack to transition into schoolwork.
Lunch, chores, exercise, some online social time with friends, and then homework in the afternoon.

-As recommended by Dr. Siddique: Fun, food, and family time before bed.
Chat, play, read, or watch a great show. How you complete the day sets the stage for the next one.

-Avoid any physical punishment. Per pediatric research: Spanking, hitting, and other forms of physical or “corporal” punishment risks injury and isn’t effective in any scientific study. Physical punishment can increase aggression in children over time, fails to teach them to behave or practice self-control, and can even interfere with normal brain development. Corporal punishment may take away a child’s sense of safety and security at home, which are especially needed now. They can also manifest and difficult or unhealthy relationships in the future, because people who love you can hurt you.

-Neuropsychology research: Embolden reminds parents and caregivers never to shake or jerk a child, which could cause permanent injuries and disabilities and even result in death.

-Self care. Caregivers also should be sure to take care of themselves physically: eat healthy, exercise, and get enough sleep. Find ways to decompress and take breaks. If more than one parent is home, take turns watching the children, if possible.

Mental Health and John Lewis

In 2014, APA President Dr. Nadine Kaslow, presented Rep. John Lewis with a presidential citation honoring the congressman as a truly effective champion of the application of psychology to promote human rights, health, well-being and dignity.

He epitomized the American Psychological Association’s values to strive for social justice, diversity and inclusion, from his early days as a heroic young Freedom Rider, and fighting a long, hard struggle to end racial discrimination and segregation throughout our nation.

Little Known Facts:
Lewis fought to improve the child welfare system, eliminate pay disparities for women, further LGBT rights, and aid disadvantaged families, among many other accomplishments. He supported biomedical and behavioral research at the National Institutes of Health, which helped to advance research to enhance health and well-being by including attention to behavioral factors, such as unhealthy diet and lack of exercise, that play a significant role in cancer, heart disease, and many other serious disorders, especially in people of color. Truly a hero in every way. 

Reopening: Community Mental Health Clinic

Dear Friends:

This week, I reopened the community mental health clinic I’ve been running for over 18 years, started by my previous beloved mentor, Dr. Neil Schiff. We have been closed since March for safety reasons. I am indebted to the community in Washington DC and Maryland for giving me the trust that they have all of these years. As we maintain extreme precautions, I am also grateful for again seeing the local community that I care for deeply.

While gratitude helps me through each day, my gratitude is tempered with outrage. Longstanding and deeply rooted health care inequities—based on race, ethnicity, and income—have been thrown into relief by the COVID-19 pandemic that cannot be minimized. Everyone is suffering, but communities of color are suffering more. The shortcomings of our system with respect to caring for the elderly are painfully visible. The risks associated with incarceration are vivid. While none of these problems originated with this pandemic, the crisis has exacerbated these injustices in devastating and tragic ways.

I am striving in joining with others to do the urgent work needed to dismantle the barriers to health that persist for so many. As you know, while this has been a long-term focus of mine, this crisis presents an opportunity to design and demand real change. These barriers threaten all of us, not just those who face them directly. COVID-19 has indubitably demonstrated that fact. None of us are untouchable.

A few years ago, the gifted Vermont artist Stephen Huneck, who suffered from chronic pain, died by suicide. He was soon thereafter followed by his wife, Gwen.

He ran a beautiful chapel near the Canadian border in Vermont, called Dog Mountain, in honor of dogs and love. His artwork graces my office. In 2015, my English Lab, Asia, and I hiked the mountain to pay homage. It was a moving experience.

In 2019, there were 1.5 million suicide attempts in the United States, that were documented. On average, there are 132 suicide attempts per day, with notably numerous ones listed as ideation and undoubtedly more that are not documented at all.

Please visit the American Foundation for Suicide Prevention for more info and suicide statistics.

  

Racism and Mental Health

I was recently interviewed for a mental health blog by a psychiatrist/professor/writer from Georgetown
on the topic of Racism and Mental Health.

Here’s our conversation:
How did you get interested in racism and mental health?

When I was growing up, my father was head of the English department at a historically black college. One of the classes he taught was Race Relations. These conversations were part of my childhood even though my family was not black. Other children would hang posters of musicians and actors in their rooms, and for my birthday I would get Martin Luther King and Malcolm X.

I went on to study genetics, microbiology, and clinical psychology. In addition to practices in Northern Virginia and Montgomery County, I have been Clinical Director at a community health clinic in DC for 18 years, where half my patients have been from communities of color. I have listened and learned a lot from my patients.

What is an example of a case you have seen in your practice that involves racism affecting mental health?
A case that comes to mind I think illustrates what can happen. I was treating a woman who was high functioning with a good job. Her supervisor held her back from promotions and would cut her off in meetings when she tried to express herself. This can happen to all women but especially to minority women. Under this supervision, she deteriorated to the point that this high functioning individual was not able to function. These microaggressions can have a cumulative effect. When this occurs in an area such as your job, these repetitive traumas can accumulate and affect your livelihood.

What are some important findings on racism and mental health?
Some research has found that in patients with a history of discrimination and racism, there can be an overactive amygdala, a similar finding to that in brains of individuals with Post-Traumatic Disorder (PTSD). Also, Dr. Monnica Williams at Louisville discusses race-based PTSD or racial trauma which she describes as PTSD symptoms as a result of racism. The diagnosis of PTSD is a group of symptoms that occur after a single traumatic event. But complex PTSD occurs after repeated trauma in which a number of traumas pile on to one another. Race based stress can be a lifetime of psychological effects and not necessarily something you can leave or get away from. In a recent study, when children were exposed to racism through their lifetime, by the age of 12, there were higher rates of substance abuse and decreased self esteem.

What are your thoughts about the recent events in our country?
One of the hard things about the current events from the wrongful deaths of civilians to the pepper spray of peaceful protesters is the vicarious trauma it is producing for individuals miles away. People see these things and it can feel like it is happening to them. There is intense grief and anger it produces on top of a history of discrimination for many.

The inequities in housing, education, health care, and rental approvals have been longstanding. We all need to listen with an open ear so that people feel seen and heard. As clinicians we need to be careful to not overdiagnose. Someone feeling like the world is out to get them or that they can’t walk down the street might not be simply exhibiting paranoid ideation, but this may be their sense of reality.

How can the medical profession help?
In a number of instances, the medical profession experimented on black women as their scientific subjects. J. Marion Sims, The Father of Gynecology, believed their sensory nerves to be different so they would not feel pain. There is sometimes still a lack of trust in scientists and doctors. As clinicians, we need to be careful in how we interpret and how we understand these complex situations. Psychotherapy research shows that Black Americans begin therapy with optimism, but within a few sessions, they become less optimistic and drop out at higher rates and are unlikely to return. Patients can sometimes feel misheard, misinterpreted, blamed. Race and the experience around this should be part of clinical intakes routinely. Listening with an open ear is crucial to the doctor-patient relationship.

On the Power of the Self-Hug

Hugs are good medicine. During times of stress, they provide an immediate release and relief. Yet in the time of social distancing and pandemic, we may have much LESS access to touch, even when we might need it the most.

Hugs boost oxytocin levels. Elevated oxytocin levels lead to lessening of feelings of anger, loneliness, and isolation.

Hugs raise serotonin levels. Elevated Serotonin levels improve your mood, create a sense of well being, and help to regulate your sleep cycle.

Hugs release endorphins. Endorphins are the body’s natural pain relievers, so getting a hug will actually help soothe aches and pains.

Hugs increase production of dopamine. Dopamine is produced in the reward center of the brain and makes you feel happy, relieves depression, and just makes you feel good.

Hugs reduce levels of circulating cortisol in the blood. Cortisol is known as the stress hormone. By reducing the amount of cortisol circulating in the blood, hugs can alleviate stress and calm the mind.

Hugs lower blood pressure. Hugs activate pressure receptors in the skin called pacinian corpuscles, which send signals to the part of your brain responsible for lowering blood pressure.

Hugs strengthen your immune system. Hugs can help stimulate the thymus gland which regulates the body’s production of white blood cells, which fight off disease.

Hugs relax your muscles. Hugs relieve tension in the body and soothe pain. As a result, they increase circulation to the soft tissue and alleviate bodily tension.

So what happens, during periods of physical distancing and social isolation? Using the findings, I just described about the neuropsychology of hugs, we can actually learn to hug ourselves. What does someone do when they want to comfort another in distress? They may place their hand on their shoulder or rub their arm. This starts the beginning of a cascade of dopamine and another neurotransmitter called GABA. 

GABA is found throughout the brain (cortex). It functions to regulate anxiety using all of your senses, including touch, sound, and vision. Wrap your arms around yourself, crossing them across your chest. Slowly, stroke up and down your arms and shoulders. If you do this as part of a self soothing practice, the brain starts simulating the same effects as if someone you care for is actually hugging you. Someone you care for IS hugging you. You.

Embolden Psychology
Embolden

Embolden offers the ADOS-2, the gold standard assessment for kids on the spectrum.

Combined with psychoeducational testing, it helps provide comprehensive information and recommendations to help children and teens six and up.

Thank you for contacting us.