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In a lamp lit room, a group of six casually dressed people sit in chairs which are arranged in a circle.  All, but one, seem to be engaged in two or three different conversations as a more formally dressed woman enters the room. She sits in one of the vacant seats of the circle as the people in the room gradually turn their eyes toward her. “Good morning,” she says, “you guys are a bubbly group this morning.” She smiles wryly as a tall gray-haired man in the group says, “Well, Amy started it.” He turns his gaze onto a thirty-year-old blonde woman sitting to his left who smiles as she begins to explain, “I picked up my six-month chip last night. It’s the longest I have been sober since I started drinking fifteen years ago.” Members of the group all offer her their congratulations in various ways. John, the quiet one, glances up quickly and says in a flat voice, “Keep up the good work, Amy.” “You don’t seem yourself today, John. What is going on with you,” asks the more formally dressed woman, a therapist facilitating this relapse prevention therapy group. Looking down at the floor, John reveals to the group that he used yesterday.

Like everyone else in this therapy group, John is an addict. Most of the people in the room have at least 90 days clean and are now working on relapse prevention skills. If they are not actively using drugs or alcohol, why are they still in treatment? What are relapse prevention skills? And, what is a “relapse”?

One reason to remain in treatment after discontinuing the use of substances is because the physiological addiction is only part of the challenge. Long after the individual has ceased substance use, the psychological and behavioral elements of addiction remain. Many addicts struggle with how to cope with stress, celebrate, socialize, or even go to sleep without relying on a substance.    These elements of addiction need to be addressed or most addicts slip right back into substance use.

Another aspect to consider is that “withdrawal symptoms” can actually last for up to two years after cessation of use. While the acute symptoms may alleviate within a few weeks, there are “post acute” withdrawal symptoms that follow. During this time, changes that occur in the brain, as the brain is adjusting to no longer having the effects of the substance use, can trigger a person to want to use. It can even cause them to have very vivid dreams of using that are so real, the individual may have trouble telling the difference between the dream and reality.

This is what happened to John mentioned earlier. He awoke one morning having had a “using dream.” It felt real, as if he had used his drug of choice and actually felt high. Realizing this was a dream, he tried to put it out of his mind, but he just kept thinking about it. He didn’t share his struggles with anyone, feeling like a dream was a silly thing with which to trouble his sponsor and other friends. Later that day, he received a call from an old using buddy whose car had broken down and who needed a ride. John picked up his friend, and when he dropped that friend off, the friend repaid him for his help with his drug of choice. John tried to decline, but his friend left the drugs on the seat of the car and waved goodbye. John returned home to an empty apartment and used.

The bottom line is, getting sober is different from staying sober. To recover from substance addiction requires learning a new lifestyle, developing a support system that will help you maintain that lifestyle, and learning how to cope with life on life’s terms… without using. The relapse prevention phase of treatment focuses on achieving these goals. While someone, like John, might slip up and use while in the process of learning such skills, they can remain connected with support and treatment, using the experience as a learning tool, and preventing a complete return to his/her former way of life.

After John shared with the group, they offered him support. Amy said, “John, I know how hard it was to come in here and say that. I know I’d be worried that people would judge me, so thank you for sharing and showing us that it is safe to do so.” Others chimed in and echoed Amy’s commendation. One group member shared, “When I feel like I  want to use, I call someone from our group and call my sponsor. I keep calling numbers until I get someone on the phone.” Another said, “When I am craving, I get out of wherever I am and go somewhere safe. I like to walk on the beach. It clears my mind and calms me down.” Then, the therapist facilitated a discussion around the various elements of John’s story and the skills that any group member could use should any of them face similar things in the future.

  • I am a Psychologist and Clinical Addictions Specialist at the Chrysalis Center. I have successfully treated individuals who struggle with addiction for eight years. I also treat individuals with binge eating, anxiety, depression, and trauma challenges. To schedule an appointment to see me, please call the Chrysalis Center at 910.790.9500. ~Lillian Hood, LPA, LCAS

*John and Amy are fictional characters used to demonstrate the real experience that individuals under these circumstances tend to face.



Eating Disorder Awareness Week

For the National Eating Disorder Association (NEDA)’s Eating Disorder Awareness Week (February 26-March 4), the theme is “Let’s Get Real.” The goal is to highlight the stories we don’t hear as often and to open the conversation to everyone.

For more info from NEDA, please go to https://www.nationaleatingdisorders.org/, and if you are concerned you might have an eating disorder, use their Helpline 1-800-931-2237 or their screening tool https://www.nationaleatingdisorders.org/screening-tool.

According to statistics provided by NEDA, 30 million Americans struggle with a “full blown” eating disorder, and countless more struggle with eating and body image concerns. Because of the stereotypes and stigma attached to mental illness and eating disorders, a lot of people don’t reach out for help.

Last year, the theme was “It’s Time To Talk About It” and Kelly Broadwater, LPA here at Chrysalis Center highlighted the high mortality rate, the lack of funding for research, the negative messages about food and weight we get bombarded with every day, getting help, and having hope. To read more from this blog post, go to http://chrysaliscenter-nc.com/its-time-to-talk-about-it/.

Truths About Eating Disorders

There are a lot of stereotypes about eating disorders. How many of those are even real? Instead of going through all the myths about eating disorders, here are some truths:

  • An eating disorder is not a choice; it is a mental illness with serious physical, cognitive, and psychological implications.
  • It is not possible to “just snap out of it.”
  • There is no one cause for an eating disorder, it is a different root for every person.
  • It is a big deal.
  • Anorexia is not the only eating disorder, even if it is the one we think of most often – bulimia, binge eating disorder, and avoidant/restrictive food intake disorder are also serious, life threatening illnesses that need to be taken seriously.
  • Just because you don’t see it physically, doesn’t mean it’s not there or that you should ignore signs because it doesn’t fit the stereotype.
  • There are a lot of other issues linked to eating disorders, including anxiety, depression, and trauma.
  • People need their support system, including friends, family, and treatment team, to recover.
  • Men can have eating disorders, and the CDC found that about 1/3 of all eating disorder sufferers are male.
  • Children as young as five can develop eating disorders, and many people who struggle with eating disorders as a child or adolescent will continue to struggle with them as an adult unless they receive help.
  • It is not just about food.

For people with these disorders, one of the biggest obstacles is the secrets and shame that go along with those behaviors.

Say Something!

Too often, loved ones will see something wrong and not say anything – if we are going to “Get Real” that needs to change. People are afraid to bring things up, but that is one of the things that keeps the stigmas about mental health and eating disorders alive.

Why not ask, or express concern? What is wrong with talking about it, really? It can be a difficult topic, but if it is approached with concern, caring, and empathy, people will rarely shut down the conversation.

If this seems too stressful or delicate to do on your own, seek help from a professional (a therapist or dietician who specializes in eating disorders) to help you have the conversation.

As an eating disorder specialist, the most important message I want people to hear is that truth and honesty is necessary from everyone affected – the person with the eating disorder and their loved ones.

Don’t walk on eggshells – but don’t smash them either. If you try to get real, make sure you are coming from a genuine place of caring before you try to open the conversation. If it is approached with compassion, the conversation has a much better chance of being productive for the person with the eating disorder and their loved ones.

#NEDAwareness

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This posts shares some information about a supportive, evidence based treatment for trauma and PTSD symptoms: Prolonged Exposure.

What is PTSD?

Post traumatic stress disorder is a common mental health problem following trauma. Individuals with PTSD often have difficulties with emotion regulation, managing symptoms of arousal, and other related symptoms. Co-occurring problems such as eating disorders, substance use disorders, depression, and self-injury are also common. You can read more about PTSD in my prior Chrysalis blog about PTSD.

What is prolonged exposure?

Prolonged exposure (PE) is a well established evidence based treatment for PTSD. It has been shown to yield long term improvement in PTSD symptoms.  PE can be applied with individuals who have co-occurring problems as part of a comprehensive treatment plan.

PE s a form of Cognitive-Behavioral Therapy (CBT) for PTSD, developed by Edna Foa, PhD. PE typically takes 8-12 sessions with at home practice in between sessions. Before working on traumatic memories, the PE therapist teaches the patient various safe techniques for relaxation from anxiety and arousal.  After the patient learns theses techniques, the PE therapist helps the client begin to work on traumatic memories. As part of this process, the trauma survivor intentionally recalls a traumatic memory that is contributing to PTSD symptoms. This is done through the use of verbal or written narratives while under the careful supervision of the PE therapist. These memories are recalled and then the safe relaxation techniques are employed. This is done long enough and often enough to experience a reduction in PTSD symptoms.

Working in this careful manner with a PE therapist, the patient learns new ways for the brain and body to respond to traumatic reminders. This allows the traumatic memories to lose their power to elicit PTSD symptoms. To be successful, PE needs to target the traumatic memories that are most related to PTSD symptoms. However, individuals can experience improvement  without discussing every trauma or all aspects of their trauma.

How does prolonged exposure work?

PTSD can be seen the inability of the brain to stop the fight-or-flight response. Reminders of the trauma trigger distressing thoughts, feelings, and harmful behaviors, even when there is no current danger. Escape and avoidance behaviors develop to provide temporary relief; unfortunately, over time they can lead to PTSD and co-occurring problems.

By intentionally approaching traumatic reminders safely under the therapeutic guidance of a PE trained therapist, new learning can happen to decrease PTSD symptoms. Over the course of PE, the brain starts to learn that traumatic memories and reminders are not dangerous, that anxiety does not last forever and that it is possible to have some power and control over traumatic memories.

What if I feel too afraid to start prolonged exposure?

It is natural to feel afraid at the start of PE. It is common not to feel quite to start PE or even feel afraid. All of that is totally okay. In fact, the first steps of PE address these concerns and give patients tools to decrease these anxious feelings, relax and regain control before working on traumatic memories.

PE should only be done in the context of a strong therapeutic relationship with a licensed clinician who has received formal training in PE. PE is a gradual process where the patient is in control and works collaboratively with the PE therapist. As part of this collaboration, fears about PE should be discussed about openly with your PE clinician throughout the process. This should help decrease initial fears and keep later fears manageable. It is okay to feel afraid and PE will help you gain strength and confidence.

What if I am ready to start prolonged exposure?

If you think you may have PTSD and that PE might be helpful, talk with your primary clinician or  contact Chrysalis to set up an initial evaluation. PE is compatible with ongoing therapy for other difficulties. PE can be added for 8-12 weeks in conjunction with your primary therapist in a collaborative approach to your treatment. At Chrysalis, we offer PE by a licensed psychologist who has been intensively trained in PE.  You can contact Chrysalis for more information about getting started. Recovery from PTSD is possible and within reach!

Dr. Kate Brody Nooner is a licensed clinical psychologist and associate professor of psychology at UNCW. She also holds an adjunct appointment at Duke University and is the principal investigator of NIH-funded grants aimed at reducing child and adolescent trauma and preventing alcoholism.



The journey towards recovery can take many forms, but every person has to follow their own path towards health and make choices along the way. Some of these choices may come in the form of different treatment centers or levels of care to address the difficulties someone is having at that stage of their recovery. Every person’s process is different.

Eating disorders are very complex illnesses that require specialists to treat not only the emotional and behavioral facets of an illness, but the medical one as well. For these reasons, the American Psychological Association (APA) established guidelines for appropriate levels of care with eating disorders.

Chrysalis Center is an outpatient program and will soon be adding intensive outpatient (IOP) services. The other levels include partial hospital (PHP), residential, and inpatient levels; these last two are sometimes combined into an “IP-Res” format. To see the full APA criteria for eating disorders, click here. There are some other resources for eating disorder treatment in North Carolina, including Veritas Collaborative, Carolina House, and UNC’s Center for Eating Disorders.  Other treatment centers around the country specialize in eating disorders as well, and sometimes these other programs are a better fit for clients in terms of their individual needs and experiences.  Though not for eating disorders, there are several other levels of care in the Wilmington area for adolescents and adults in general psychiatry.

Usually, these difficult conversations start when we as clinicians recommend a higher level of care for someone who we do not think is appropriate for outpatient or IOP treatment. To be appropriate for outpatient or IOP, a person must be:

  • Medically and psychologically stable to the point that they are not a danger to themselves or others
  • Motivated to recover
  • Cooperative
  • Self-sufficient
  • Able to control their thoughts and behaviors using appropriate social support

 

When someone needs a higher level of care, they are usually:

  • Medically compromised (by weight, bloodwork, EKG, etc.)
  • Unable to manage their behavior
  • Un- or under-motivated
  • Not functioning in their lives in some significant way (work, family, relationships, etc.)
  • Unable to manage a co-morbid condition (psychological or medical) because of their eating disorder

Levels of care indicate how much structure, support, and observation a client requires at that stage in their recovery.

When someone needs a higher level of care, it can be a very difficult discussion between provider and client. Sometimes, we all know it is coming and have been trying to avoid it but it just is not working. Other times, clients may take a sudden turn. This could be for many reasons, but the important thing is that clients get the help that they need to recover from their eating disorder and co-occurring disorders. Our goal is always to help our clients and keep them focused on living healthy and productive lives, and we try to balance all their individual needs while keeping the goal of a full recovery foremost in our minds.

It is important to use the right tool to complete a task, and sometimes that tool needs to be a higher level of care in order for someone to truly recover. Often, IP-Res levels of care can get clients back on track faster than outpatient could and sometimes that is necessary for someone’s well being or even survival. PHP and IOP levels can provide support to keep someone out of the hospital or they can provide support as a step-down program. The transition between inpatient and home can be very stressful and there are a lot of facets to consider including social, family, academic, or work stressors. All of these are affected by or contribute to eating disorder behavior. A person cannot live in a vacuum so all of these need to be managed before someone goes back to their regularly scheduled lives.

By adding IOP services, Chrysalis hopes to provide a bridge for clients on their journey in recovery. It is an important stage or facet in that process. If you need us, we will be honored to work with you on that journey.

 

Kendra is a Senior Staff Therapist and soon to be Clinical Director of Chrysalis’s new Intensive Outpatient (IOP) program with 13 years of experience working with eating disorders in various settings, including inpatient, PHP, IOP, and outpatient treatment facilities.



As parents, there is no one who we love more than our children. From the moment they are born, our mission becomes to do whatever it takes to make sure that our children have happy, healthy lives. This can involve going to great lengths to help our children when they are sick or in pain. When our child is sick and not getting well, we are quick to seek help from medical professionals and rightly so. But for some reason that fast action does not translate as directly when it comes to our children’s mental health. Why is it that it is okay to ask for help for a physical health problem but when it comes to our child’s mental health, we are supposed to have all of the answers?

As a child and adolescent mental health specialist, I have found that people often make the mistaken assumption that parents are the problem, which could not be farther from the truth. The parents who come through my door are heroes. They have already done so much to get it right. Unlike some parents who are struggling on their own, the parents who come to me for treatment have taken the important action of seeking professional help when they have reached their limits. They have put aside the myth that they must have all of the answers when it comes to their child’s emotional or behavioral problems.

Really, our children’s mental health is no different than their physical health. If our child has a virus, we take them to the pediatrician to be checked and to receive advice on how to help them get well. Similarly, if our child is struggling with peers or in school, we can do the same by taking them to a mental health professional. Research has shown that seeking treatment for our children not only vastly accelerates the pace of recovery from mental health problems but it also prevents more serious problems down the road.

The majority of mental health problems that adults experience can be traced back to untreated mental health problems in childhood and adolescence. It is a myth that children are resilient and will grow out of their problems. Just like leaving your child’s ear infection unchecked can have serious negative consequences, allowing your child to endure bullying without the aid of professional help could also lead to lasting problems.

To the parents who have taken that crucial step and brought their child to my office door, you have already conquered half of the battle to solving your child’s mental health problem. You are serving as a role model for your child by demonstrating that it is okay to seek help from professionals when you are struggling. For those who are hesitant to do so, I encourage you to think about what you would do if your child had a serious stomach bug and suggest that you take the same action if your child is experiencing anxiety, depression, inattention, bullying, or other changes in behavior that are negatively impacting your family or your child’s day to day life.

As a parent, you are the best expert on your child and you should always let your expertise as a parent guide your decisions for your child. This should include listening to yourself when your expertise tells you that you have reached your limits and need help. By seeking help you are not only putting your child first, you are also putting your child on a path of lifelong mental health and well being. There is no greater gift than that.

Dr. Kate Brody Nooner is a licensed clinical psychologist and associate professor of psychology at UNCW. She also holds an adjunct appointment at Duke University and is the principal investigator of NIH funded grants aimed at reducing child and adolescent trauma and preventing alcoholism.



 

Today kicks off National Eating Disorder Awareness Week 2017 (February 24- March 3) with this year’s theme appointed, “It’s Time to Talk about It”.

It’s time to talk about the public health crisis that eating disorders pose, as 30 million individuals of all ages and genders suffer from these illnesses in the United States. If you think you could be one of them, take a few minutes to complete this confidential online screening. http://nedawareness.org/get-screened

It’s time to talk about the fact that eating disorders have the highest mortality rate of any other mental health disorder; more people die from eating disorders than any other psychiatric condition. http://www.something-fishy.org/memorial/memorial.php

It’s time to talk about binge eating disorder being the most common eating disorder, greatly contributing to our country’s obesity epidemic. http://bedaonline.com/resources/

It’s time to talk about the inadequate funding for eating disorder research. According to the National Institutes of Health in 2011, research dollars spent on Alzheimer’s averaged $88 per affected individual. For autism, the amount was $44. For eating disorders, the average amount of research dollars per affected individual was just $0.93.  In response, the Eating Disorders Coalition is an organization whose mission is to advance the recognition of eating disorders as a public health priority. To learn more about how you can get involved: http://www.eatingdisorderscoalition.org/inner_template/get_involved/take-action.html#/

It’s time to talk about the messages that Americans are bombarded with about food, weight, and unachievable body ideals that add to the prevalence of eating disorders. Why else would 47% of elementary school girls who look at popular magazines say the pictures make them want to lose weight? Body positivity campaigns need to be the norm, not the exception. http://selfesteem.dove.us/

It’s time to talk about the loved ones who are impacted by their family members’ illness and the toll it takes on them. There is now more support than ever out there for caregivers. http://www.feast-ed.org/

It’s time to talk about how to get help. The earlier a person seeks treatment for an eating disorder, the greater the likelihood of full physical and emotional recovery. To search for treatment near you, https://www.edreferral.com/treatment. Locally if you are looking for support, Chrysalis Center offers individual, group, and nutritional counseling for people with any type of eating disorder. Our SOAR group (Staying Open about Recovery) and dietitian led meal support groups are currently open to new participants.

Most importantly, it’s time to talk about hope for the recovery process. As a certified eating disorders specialist, I’ve learned the most over the years not from scholarly articles or expert led workshops, but from my amazing clients and their families who have battled these deadly diseases and overcome them. To honor those who are walking this path, this week our blog and Facebook page will be publishing writing from the real experts- those in the process of recovery. Thank you to these brave individuals for sharing their powerful stories, taking the time to “talk about it”.

From a client:

“For the first time in my life, I don’t have to work to find the positives.

In high school, when the dark thoughts and voices began to take over, I challenged myself to sit down every night and make a list of three positive things that happened that day. Most nights, I struggled to come up with one.

It wasn’t easy, but after time, this helped me focus on the positives in my life instead of the negatives. I began to see treatment and therapy as an opportunity to grow instead of a punishment. I began to view my eating disorder as a challenge to radically love myself and the world around me. I began to have hope again.

The hardest part is talking about it. I kept my eating disorder a secret for three years before I confided in a friend. I stayed quiet for another two years before I reached out for help. I let five years go by while I suffered silently.

I’m working today on unapologetically being open about my experience. I have nothing to be ashamed of. It has taken me six years to believe that my eating disorder is not something I need to hide.

You have the strength to talk about it. You have the ability to take back control over your life. One small step towards recovery today will amaze you in the future when you look back on your journey.

This life is so beautiful and you deserve to enjoy it.”

 

Kelly Broadwater, LPA, LPC, CEDS is a psychologist and professional counselor who holds the distinction of Certified Eating Disorders Specialist from the International Association of Eating Disorder Professionals. She co-founded the Chrysalis Center in 2003 and is proud of the team of experts she’s assembled to treat eating disorders and other mental health concerns.


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At Chrysalis, we believe that a supportive, healing environment is essential in order for change and growth to occur. We seek to offer such an environment to clients and help them create that in their lives and relationships. Read More

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