August 23, 2021

In compliance with the governor’s mask mandate, all clients and staff will be required to wear masks at all times in the building, regardless of vaccination status. If you are feeling ill or have been exposed to COVID, please call to change your appointment to telehealth.

August 2, 2021

Due to the recent increase in COVID cases in our area, the contagious nature of the new variants, and breakthrough cases in those already vaccinated, our staff has re-instated mask wearing. For clients, masks are highly recommended in all waiting areas and will be required in group settings for the time being. As a healthcare organization, we are committed to the safety and well-being of our community, our clients, and our employees. If you are experiencing any symptoms of illness, we ask that you change your appointment to telehealth. We appreciate your understanding and cooperation.

July 22, 2021

Masks are encouraged but not required.

April 23, 2021

Our staff, the majority of whom are fully vaccinated, remain committed to the safety and well-being of all who enter the building. Temperature checks, masks, and socially distant seating (whenever possible) are in place.

Our services offered are currently a hybrid of telehealth and in-person, based on client/clinician preference and insurance coverage. Please be advised that at some point in the future, your health insurance carrier could change their stance on telehealth parity and no longer cover Zoom sessions with your clinician.

IOP has fully returned in person without incident. Appropriate precautions are in place, especially in our dining area.

Outpatient groups are either virtual or in person, depending on the nature of the group, number of attendees, and participant/group facilitator preference.

We appreciate your understanding over the past 13 months and for the foreseeable future. If you have any questions or concerns, they can be directed to our practice manager or clinical director.

September 28, 2020

We are pleased to announce that we will be returning to in-person IOP as of October 1^st!

Just like our transition back to in-person appointments in the office, we are taking several precautions (see our last update for more information!) and clients will be screened as they come in each day. We are requiring clients to wear masks and socially distance, and have set up appropriate precautions so that we can have a safe and effective group and meal group experience.

Following protocols respectfully and working together to ensure both client and staff safety is paramount to being able to effectively transition back to in-person services. We appreciate your patience and cooperation as we navigate these unprecedented circumstances. We are excited to be able to start resuming some sense of normalcy in how we deliver our care. If you have any questions or concerns, please do not hesitate to reach out to our clinical director, Kendra Wilson.

August 31, 2020

Dear Valued Client,

This will be a fairly lengthy update to let you know about our intentions to begin offering some in-person services effective September 1, 2020.

Starting this month, each clinician will be offering limited in person sessions. Your provider(s) may or may not have availability to accommodate you in person and will therefore also continue to offer tele-health. We are transitioning slowly and minimizing daily client volume to help decrease exposure risks.

Beginning October 1, 2020 (provided there is not an uptick in COVID cases), availability for in-person services will expand. When you schedule appointments for the winter quarter (October-December), please discuss with your clinician and the administrative staff your preference for being seen in-person versus virtually. Again, availability is different for each clinician and we cannot guarantee that you will be able to be seen in-person.

Alternatively, you may also continue to be seen via tele-health if you desire to remain being seen virtually or if we cannot accommodate you in person. This will also be dependent upon your insurance company continuing to cover this service. Please note, each insurance plan is different and coverage for tele-health is subject to change in the future. If you have questions about this, please contact our administrative/billing staff. You can also elect to self-pay if your insurance company terminates coverage for tele-health.

Our office has done extensive preparations and will be following stringent protocols in light of the pandemic. We have taken the advisement of the Joint Commission, Centers for Disease Control, and the Department of Health and Human Services into account. Prior to being seen in person, you will be asked to read and sign our COVID-19 Informed Consent (which follows). Each time you come in for services, you will be asked a series of screening questions and have your temperature taken. Per our state requirement, you will also be asked to wear a mask at all times. If you do not have a mask when you enter our building, admin staff will provide you with a disposable one. If you are experiencing any symptoms of illness, we ask that you change your appointment from in-person to tele-health.

Our office is taking the following precautions to protect our clients and help slow the spread of the coronavirus:

• Office seating in the waiting rooms, group rooms, and in therapy/testing rooms has been arranged for appropriate physical distancing wherever possible.
• Our staff and clients wear
• Our staff maintains safe
• Restroom soap dispensers are maintained and everyone is encouraged to wash their
• Hand sanitizer that contains at least 60% alcohol is available in the therapy/testing rooms, the waiting rooms, the group rooms, and at the reception counters.
• We schedule appointments at specific intervals to minimize the number of people in the waiting room.
• We give clients the option to wait in their cars or outside until their appointment time.
• Credit card pads, pens and other areas that are commonly touched are thoroughly sanitized after each We will continue to use the credit card on file as the main form of payment in order to minimize contact with administrative staff.
• Physical contact is not permitted.
• Tissues and trash bins are easily accessed. Trash is disposed of on a frequent
• Common areas are thoroughly disinfected throughout the day.
• Our office is professionally cleaned on a regular basis.

Following protocols respectfully and working together to ensure both client and staff safety is paramount to being able to effectively transition back to in-person services. We appreciate your patience and cooperation as we navigate these unprecedented circumstances. We are excited to be able to start gradually resuming some sense of normalcy in how we deliver our care. If you have any questions or concerns, please do not hesitate to reach out to our practice manager, Sarah Snyder.

COVID Informed Consent

 

 

July 21, 2020

Dear clients and community,

Chrysalis has decided to wait to see what develops with the announcement about going back to school  before we make a decision about returning to the office and what that will look like. The form that returning to school takes will dictate many clients’ and employees’ schedules and may bring changes that we do not want to try to anticipate.

That said, we really do miss seeing you in the office. When we do return, we will be asking everyone to wear masks in public spaces and whenever social distancing cannot be managed appropriately. Our office is set up to be an intimate and comfortable safe space, and as such most of our offices do not meet the social distancing requirement to be six feet apart at all times.

We do plan to continue providing tele-health services as long as possible, even if clinicians do return to the office for some in person sessions. We continue to abide by Joint Commission standards, which have not changed. We still feel that tele-health is more conducive to a productive therapeutic relationship than wearing masks. Being able to see the emotions on each other’s faces is such an important aspect of our work together.

We urge you to continue to connect with your therapist and/or dietitian for support. Tele-health options include phone or video sessions. We are also offering our outpatient groups via Zoom, in addition to virtual Intensive Outpatient Programming (IOP) and our psychiatric nurse practitioner. Please stay safe and well and know that we are here to help!

Our priority is the safety and well-being of clients and staff and we seek to minimize the impact of COVID on our community by continuing to adhere to best practices laid out by the Joint Commission. Our admin team is still operating and can assist you in your scheduling needs. We continue to accept new clients. Please don’t hesitate to call us at 910-790-9500 or email administration@chrysaliscenter-nc.com. We will look forward to seeing you in person in the future, but until then we are committed to offering high quality virtual individual, group, and IOP services.

We are all in this together and hope to continue to provide services that will help you get through these difficult times.

 

June 22, 2020

Dear clients and community,

We miss you so much! As much as we would like to go back to in person visits as soon as possible, out of an abundance of caution, we are going to continue tele-health through the end of July. We know that there are a lot of opposing views out there, but with the recent uptick in the number of cases in Wilmington and the surrounding areas, we intend to continue tele-health sessions as long as possible before returning to the office.

As you may know, we are Joint Commission accredited and are required to abide by their standards, which have not shifted: both clients and staff would be required to wear masks in the building. Our office is set up to be an intimate and comfortable safe space, and as such most of our offices do not meet the social distancing requirement to be six feet apart at all times. We feel that tele-health is more conducive to a productive therapeutic relationship than wearing masks. Being able to see the emotions on each others’ faces is such an important aspect of our work together.

Mental health services are considered essential and we could not agree more! We know these are uncertain and challenging times and urge you to continue to connect with your therapist and/or dietitian for support. Tele-health options include phone or video sessions. We are also offering our outpatient groups via Zoom, in addition to virtual Intensive Outpatient Programming (IOP) and our psychiatric nurse practitioner, Celeste Shamel. She is now offering tele-health sessions and accepting new patients. Please stay safe and well and know that we are here to help!

Our priority is the safety and well-being of clients and staff and we seek to minimize the impact of COVID on our community by continuing to adhere to best practices laid out by the Joint Commission. Our admin team is still operating and can assist you in your scheduling needs. We continue to accept new clients. Please don’t hesitate to call us at 910-790-9500 or email administration@chrysaliscenter-nc.com. We will look forward to seeing you in person in the future, but until then we are committed to offering high quality virtual individual, group, and IOP services.

June 1, 2020

Valued Clients and Community,

As we reach the third month of the COVID-19 crisis, we want to update you with our plans. Right now, we do not intend to return to the office through the month of June. We will continue tele-health for the next 30 days and then re-assess. As a Joint Commission (JC) accredited facility, we are required to follow their guidelines, not just those of the state Department of Health and Human Services (NC DHHS) or the Center for Disease Control and Prevention (CDC). The current recommendation of the JC is to continue tele-health services as long as possible. If anyone comes into the office, both clients and providers have to wear cloth masks. It is unclear how long this mandate will stay in place, but we think that tele-health is more conducive to effective therapy than everyone wearing a mask would be! We want to provide the best possible experience for our clients and believe that this is the most viable option at this time. We will continue to follow the changing rules and recommendations and inform you if anything changes.

Our priority is the safety and well-being of clients and staff and we seek to minimize the impact of COVID on our community by continuing to practice social distancing for the near future. Our admin team is still operating and can assist you in your scheduling needs. We continue to accept new clients. Please don’t hesitate to call us at 910-790-9500 or email administration@chrysaliscenter-nc.com.

 

May 7th, 2020

To our Valued Clients,

Thank you for your adaptability and patience as we’ve transitioned to telehealth over the past 6 weeks. Although shelter in place will be lifted this Friday, our office will remain closed for in-person visits through the end of May. Insurance companies are still allowing telehealth without restrictions for the remainder of the month; we intend to benefit from their flexibility by continuing to provide therapy via video or phone to ensure everyone’s safety.  We hope to protect our clients and staff and do our part to “flatten the curve”. In addition, we do not feel in-person visits while wearing masks is conducive to effective therapy.

Chrysalis is delighted to be offering a 4 week wellness workshop for frontline workers. For county, state, and New Hanover Regional Medical Center employees, this will be FREE with your insurance benefits. We are excited to offer support and care for those most impacted by COVID in their workplace.

Stay safe and be well!

 

April 4th, 2020

To Our Valued Clients,

We will continue to remain closed for in-person sessions throughout the duration of the shelter in place order. Mental health services are considered essential and we could not agree more! We know these are uncertain and challenging times and urge you to continue to connect with your therapist and/or dietitian for support. Telehealth options include phone or video sessions. We are also offering our outpatient groups via Zoom, in addition to virtual Intensive Outpatient Programming (IOP). We are excited to welcome a new addition to our staff- our psychiatric nurse practitioner, Celeste Shamel. She is now offering telemedicine sessions and accepting new patients. Please stay safe and well and know that we are here to help!

Stay well and be safe!

 

March 26, 2020

Dear Valued Chrysalis Client,

As many of you know, we have successfully launched telehealth over the past week and a half and are now offering phone or video sessions in addition to virtual groups and virtual IOP. In light of the current circumstances, we are electing to remain closed through April 5^th at this time. We will continue monitoring the situation and make decisions on a week by week basis about re-opening the practice to clients for in person sessions. Our number one concern is the safety and well-being of clients and staff and we seek to minimize the impact of COVID on our community by practicing social distancing for the near future. Our admin team is still operating and can assist you in your scheduling needs. Please don’t hesitate to call us at 910-790-9500 or email administration@chrysaliscenter-nc.com.

Stay well!

 

March 20, 2020

We are now offering all appointments through online or telephone sessions. This is for all existing clients and new clients. Contact our office at 910-790-9500 or email administration@chrysaliscenter-nc.com to schedule your appointment.

 

March 17, 2020

Our leadership team has come to the decision to end in-person office visits effective close of business today, through the end of the month. We want to ensure the well-being of all clients and staff and minimize the impact COVID-19 has on our community. Effective 3/18/20, all individual counseling and nutrition appointments will be offered via telehealth. This is temporarily being allowed by all insurance companies in light of the current situation. We hope to add video conferencing capabilities in the very near future, but due to the unprecedented demands on the servers of the various telehealth platforms, this option is not fully functional at this time and therefore we will be conducting therapy via telephone only to ensure uninterrupted care free from technical glitches. For now, all outpatient groups and IOP services are suspended until our HIPPA compliant virtual platform is more sound. We will inform you as that occurs.

We understand that this is an anxiety provoking time and we are committed to helping you through it. We will periodically add updates to our website and social media and will have administrative staff working remotely to answer your calls and emails.

Our administrative staff will be contacting you to discuss the logistics of this change in delivery of services (i.e. you will be expected to electronically sign a telehealth informed consent) and answer any questions you may have. Your regularly scheduled appointment(s) stand and your clinician will look forward to talking you then.

Thank you for your patience during this ever-evolving situation. We hope you stay well and will look forward to being able to connect again in person.

 

March 14, 2020

To our Valued Clients:

In light of the recent concerns over COVID-19, we wanted to assure you we are committed to the safety and well-being of all our clients and staff. To that end, we are following CDC recommendations regarding sanitation and taking all precautions necessary. As a Joint Commission accredited facility, we have infection prevention protocols in place and hope to maintain a germ-free environment. Everyone that enters our building is expected to abide by our protocols.

If you or someone you live with is experiencing symptoms, please contact our office to determine if telehealth services are an appropriate option for you. We offer a confidential and HIPAA compliant platform for telehealth should you need to utilize this service.

As of now, we are operating on a normal schedule for all services. We will continue to monitor the situation and abide by all recommendations by the CDC and government officials.

If you have any questions or concerns, please call our office at 910-790-9500 or email administration@chrysaliscenter-nc.com

Thank you for your understanding and cooperating during this time.

Gyms closing may actually be a blessing in disguise. 

Fellow food and fitness professionals, fervent self-proclaimed gym rats, and fat-phobic fearmongers of the “quarantine fifteen” (a phrase that belongs in the trash alongside “cheat meals” and “empty calories”) may consider the above statement blasphemous, but I stand by it. Don’t get me wrong – as a former competitive athlete and current certified specialist in sports dietetics (CSSD), I appreciate the myriad physical and psychological benefits movement allows, as well as the sense of community, camaraderie, routine, and progress various gyms can provide. And, as a dietitian who has fully recovered from my own eating disorder and supports others in their journeys of the same pursuit, I also believe that we can take care of, strengthen, and respect our bodies by exploring movement in different ways!

I think it’s safe to say that most of this year has been nothing short of a clusterduck. A global pandemic, subsequent quarantine, many parents becoming newly-minted home-school teachers, civil unrest, and Yeezy casting his election bid for president exemplify how 2020 is turning out to be a year full of stressful surprises – most of which we could have never even imagined. It has been increasingly difficult to take care of ourselves amidst the “new norm” and many of us have probably hit our breaking point multiple times. Moving your body in a mindful way, which means engaging in the present moment without judgment, can be a wonderful way to de-stress and break up the monotony of your day. The good news is, this is totally doable while most gyms remain closed!

Thinking of ways to stay active outside the gym may in fact encourage you to explore more enjoyable forms of exercise and develop a happier, more sustainable relationship with movement and your body. Before calorie-tracking apps and arbitrary step goals existed, the vast majority of people moved in ways that felt less regimented, less structured, less obligatory – and more as a part of their daily lives. More neutral. More fun. More as an activity and a part of living, and less as a chore and a part of compensating.

Some days you might want to do some high-intensity movement because you feel energized and want to get that energy out. Other days, you may feel “blah” and gentle movement might be a more realistic way of taking care of yourself. These tidbits can help you navigate the days ahead.

• Remember your intention. Are you moving your body to increase blood flow, decrease stress, condition your lungs, strengthen your muscles, get out of the house, or a combination of any of the above?
• Variety is the spice of life. And necessary to prevent boredom and burn-out! This applies to many things, and definitely includes movement. Now is the perfect time to try something new if you previously found yourself using the same five machines!
• Practice some self-compassion. Concerns around job security, finances, relationships, loved ones, and more have led to enough stress as is. Remember that you are doing the best you can, and 5-10 minutes of movement is still movement. If you’re able to include several shorter activities throughout the day, those minutes add up.
• Remember that this is temporary. Nobody can really say for how much longer, but the barbells and squat rack will be patiently waiting for you if you choose to return to them.

So, how can you start incorporating movement into your “new norm”? Here are some ideas to get started.

• Get outside when you can. As part of your morning routine, in between Zoom meetings and classes, on your lunch break, after you clock out for the day…a change of scenery and time away from screens can help you decompress and remember that this rock we all call home is still turning, even if it doesn’t feel like it right now. The trees are still standing tall, flowers are still blooming, and bugs have yet to return to the brimstone from whence they came. Make a point to breathe the fresh air – not just smell it, but a real, honest-to-goodness deep belly breath, in through your nose and out through your mouth. Do that several times and you might experience a brief sense of calm and peace (woah, what are those?!).
• Yoga or stretch when you can. Stretching increases flexibility and encourages deep breathing and body connection, all of which help decrease stress and improve mindfulness. Think of times when you default to sitting still – between Zoom calls, while unwinding and watching TV, etc – and how you can include some gentle yoga or stretching to get your blood flowing.
• Intentionally explore nature and what your local area has to offer. Individually or with a group of close friends – socially-distanced, of course. Walk along the beach, explore local hiking trails, go paddle-boarding or kayaking, have a picnic, and walk, bike, or rollerblade around a local park. Take your pick!
• Play with kids or your own inner child. Despite all we’ve been conditioned to believe, movement has no age limits. No decree is made once you hit a certain age that says exercise is limited to the treadmill, elliptical, spin-bike, or any other stationary machine. Having fun with movement doesn’t make it any less effective. Tag, Twister, virtual games (Wii sports, Switch), dancing, rollerblading, hula-hooping, rock-climbing, skate-boarding, and kicking or throwing a ball around are just some ideas to get your heartrate up without even thinking about it.
• Bring your favorite equipment to you. While exploring options naturally available to us outside of the gym can be fun and effective, you may still want to do some exercises that are really only doable with certain tools. Get creative by using what’s already available around your house (compost-filled buckets, water jugs, etc) or by buying smaller, cost-effective equipment you can use at home (dumbbells, resistance bands, med balls, etc). This may mean doing more resistance, body-weight, and free weight exercises instead of using machines, and that’s ok; you are still able to strengthen and challenge yourself, even if it looks a little different than what you’re used to!

Whatever you choose to do, I invite you to embrace this time of opportunity to play outside, stay curious, and shake up your usual routine!

Lizzie Briasco, MSc, RD, CSSD, LDN, is a certified sports dietitian who strives to live boldly and passionately and works toward empowering others to do the same through food, movement, and body respect.

Four months ago, all of our lives changed due to COVID-19. For many, it felt, and still feels, as though the world’s turned upside down. While everyone’s circumstances and responses to the pandemic are different, there is one common thread running through this collective experience, and that is grief and loss.

As grief expert, Dr. Alan Wolfelt, explains: “Grief is everything we think and feel inside of us whenever our attachments are threatened, harmed, or severed.” This encompasses our attachment to life as we knew it, our attachment to other people, to our jobs, our routines, our hopes and dreams, and more.

The pandemic has affected our relationships with others in a multitude of ways. We may have lost people we care about to this terrible virus. We may have lost the opportunity to physically see family members who are vulnerable. We may have lost the comforting power of touch after months of not being able to hug friends. We may be losing patience and positivity with our partners.

Other pandemic-related losses include the loss of livelihoods, loss of security, loss of routine, loss of structure, loss of a sense of normalcy, loss of ability to engage in rituals and events, including funerals, birthday celebrations, school plays, weddings, graduations, and once-in-a-lifetime trips; which can all contribute to a loss of meaning and purpose, loss of motivation, loss of identity. Grief sets in.

In grief, “we experience shock and disbelief,” writes Wolfelt. “We are anxious…We become sad and possibly lonely. We get angry. We feel guilty or regretful. The sum total of all these and any other thoughts and feelings we are experiencing as a result of the coronavirus pandemic is our grief.”

We are also experiencing anticipatory grief, which can manifest as feelings of dread and fear about future losses and about the uncertainty of what lies ahead. “Our minds and hearts are naturally trying to anticipate and prepare for what’s to come” (Wolfelt, 2020).

Grief is a normal, necessary, and universal response to loss. It is an ongoing, nonlinear process that knows no timeline and is not confined to discrete stages. Grief is not a problem to be solved, but rather an experience to be tended to. We cannot be cured of our grief, but we can heal over time.

In addition to the symptoms listed above, grief can include feelings of emptiness, yearning, hopelessness, hurt, confusion, and groundlessness. Grief is a whole body experience, affecting our physical, cognitive, emotional, psychological, and social functioning. Lynn Jonen, clinical psychologist at Sierra Tuscon treatment center, speaks to the individual nature of each grief journey, stating: “Our experience of grief is shaped by circumstances surrounding the death or loss and by the sum total of our cultural beliefs, life experiences, family, religion, and personality.”

But regardless of the different paths we all take in grief, contemporary grief literature points to two key elements involved in healthy navigations of loss, and those are:

1. Finding ways to express our grief

2. Having our grief witnessed

While there are many theoretical models through which to better understand and work through grief, I have chosen to share Alan Wolfelt’s Six Needs of Mourning, which he has adapted in a recent article called “Coronavirus and the Six Needs of Mourning” in order to focus on the grief needs of pandemic-related losses. The six needs are as follows:

Need 1: To acknowledge the reality of the pandemic and our grief. Acknowledging the reality of COVID-19 includes learning the facts about it, the precautions to take, and getting information from credible sources. Addressing the reality of our grief includes talking to others on a regular basis, and opening up and being honest about our thoughts, feelings, and fears.

Need 2: To honor all of our emotions. It is normal to experience a wide range of feelings about this pandemic, and for many of those feelings to be difficult to cope with. By being aware of them, naming them, and expressing them in some capacity, we can soften them.

Need 3: To think about the positives by spending some time each day considering the people and aspects of our lives that we are grateful for. Identify ways to feel, acknowledge, and/or express that gratitude, whether it’s by writing a card to someone who means a lot to us, saying a little prayer of thanks at the end of the day, keeping a gratitude journal, or paying it forward with a gesture of kindness toward someone else.

Need 4: To be kind to ourselves. It’s important to treat ourselves with patience, tenderness, care, and compassion – to treat ourselves as we would a good friend; to take care of our physical, cognitive, emotional, social, and spiritual realms. If we neglect one or more of those five parts of ourselves, we risk becoming unbalanced and intensifying our grief. Examples of how we can attend to ourselves during this difficult time include taking a walk, FaceTiming a friend, playing a board game with family, or doing a guided meditation.

Need 5: To search for meaning. It is common to now think of our lives as divided into “Before” the pandemic, and “After.” We are in a period of transition where life feels suspended and the future is full of unknowns. This can be a scary and certainly uncomfortable place to be. But when we stay with that discomfort and confront the kinds of spiritual questions that often come up in this “liminal” space, we are learning and growing in profound ways. When we are present to our pain, transformation occurs. Practicing mindfulness also enables us to soak up moments of pleasure, contentment, and joy. Focusing our awareness on the here and now, without judgment, as we engage in activities we enjoy, is an essential part of coping with coronavirus-related grief.

Need 6: To reach out to others to give and accept support. Human beings need contact and connection with others. Lean on other people during this time; deepen your relationships, and build new ones. Express your concerns to those that you trust, and try to be empathic as they lean on you, too. We now have to rely on technology more than ever before, and it’s important to utilize the tools at our disposal even if they’re not our ideal or preferred modes of communication. Video calls tend to feel the closest to in-person encounters, second to phone calls. Emailing, texting, and chatting through social media can also be helpful when used intentionally. While often forgotten, handwritten letter writing can also be a special way to stay in touch. The important thing is maintaining the kind of contact that facilitates reciprocal support and compassion.

 Mourning is the most difficult work we will do in our lifetimes, but when mourning is done “well,” says Wolfelt, we can gain clarity about what really matters in our lives, and let go of some things that don’t. Dr. Jonen hopes that our collective experience with this global pandemic will provide our society the wakeup call we need to start appropriately addressing grief, which is too often seen as something we have to deal with by ourselves and “get past” as quickly as possible.

“…it almost seems as if something this catastrophic was needed to shake us out of complacency and the subscription to our culture of ‘more, more, more, speed, information, keep going no matter what’ mentality,” she states. “COVID shut us all down very quickly; it forced us to stay in our homes, many of us to leave our jobs, all of us to reevaluate priorities… We have an extraordinary opportunity at this moment to collectively transform how we move through grief and trauma.”

Sources:

Jonen, L.P., PhD. (2020). Understanding Grief and Trauma in Today’s World [PowerPoint slides]

https://naccme.s3.amazonaws.com/Sierra+Tucson+July+2020/Sierra+Tucson+July+2020+Webinar.pdf

Wolfelt, A.D., PhD. (2020, April 20). Coronavirus and the Six Needs of Mourning. Center for Loss and Life Transition.

Retrieved from https://www.centerforloss.com/2020/04/coronavirus-six-needs/

Emily Lockamy, MA, LCMHC offers individual grief therapy and grief support groups at Chrysalis Center.

Call 910-790-9500 to set up an initial appointment.

Written by Zjanya Arwood-Wenke, BS.  Zjanya is a doctoral student in the Department of Psychology at the University of North Carolina – Wilmington and is currently completing her doctoral internship at Chrysalis.

Adverse Childhood Experiences (ACEs) refer to traumatic or potentially traumatic events, ranging from childhood abuse and neglect to family dysfunction (i.e., domestic violence, parental risky substance use, divorce, severe parental mental illness, early parental loss)¹. These experiences are highly prevalent, with about 46 percent of children in the U.S experiencing at least one ACE². This estimate is likely lower than the actual number of children who have experienced ACEs, as ACEs are often under or unreported due to the fact that they typically occur behind closed doors ³.

ACEs are often associated with a myriad of poor behavioral, cognitive, social, and physiological outcomes with a dose-related response; meaning the more ACEs one experiences, the more adverse outcomes there will be⁴. A common deleterious outcome linked to ACEs is substance use, which includes: illicit drug use, prescription/other drug misuse, alcohol misuse, and substance use related disorders⁵. Indeed comorbidity between trauma-related disorders and substance use disorders ranges from 26% to 52%⁹. Several mechanisms for this comorbidity have been identified; some of which include brain related changes that induce neuroendocrine changes and/or morphological changes that may contribute to impulsivity.

In particular research has indicated that trauma and substance use may be the result of a dysregulated stress response system^7,8, which means that our body may be more sensitive to acute stress than it previously would have. For example, one with a dysregulated stress response may have the same physiological response to spilling a cup of coffee as they would losing a job. Overtime this heightened response leaves the body tired, so in an attempt to find balance it will down-regulate the stress response system. This down-regulation has been linked to more fatigue, risk for mood-related disorders, and addiction⁸. With respect to the latter, substances offer an artificial means to re-regulate that stress response system; thus, essentially re-balancing the down-regulated system. Unfortunately, as tolerance develops so to does substance-dependence which can increase risk for experiencing future trauma, cardiac diseases, abnormal brain development, impaired thinking & judgement, etc.

Another way that substance use may develop following trauma is related to alterations in brain development that occur in response to trauma. Specifically research has found changes within the prefrontal cortex (PFC), which is an area of the brain that helps to regulate impulsive behavior. This area of the brain develops well into adulthood, and thus is more sensitive to trauma. These changes in the PFC following trauma have been shown to be related to an increased risk for impulsivity and thus impacts risk for substance use disorders⁹.

Although these brain changes may sound permanent, comorbid trauma-related and substance use disorders are common, manageable, and treatable. The best evidence-based treatment modalities for trauma-related and substance use disorders are Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT)¹⁰. Both treatment modalities are collaborative approaches between client and therapist that aim to alter unhelpful thoughts or behaviors underlying the traumatic event and then teach alternative coping strategies to process trauma and day-to-day stressors.

Sources

1. Felitti, V.J., Anda, R.F., Nordenberg, D., Williamson, D.F., Spitz, A.M., Edwards, V., Koss, M.P., Marks, J.S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245-258, doi: 1016/S0749 3797(98)00017-8
2. National Survey of Children’s Health, 2016
3. US Department of Health and Human Services, 2013
4. Bick, J., & Nelson, C. A. (2016). Early Adverse Experiences and the Developing Brain. Neuropsychopharmacology, 41(1), 177–196. http://doi.org/10.1038/npp.2015.252
5. (Dube S.R., Felitti V.J., Dong D.P., Chapman W.G., Giles W.H., Anda R.F. (2002). Childhood abuse, neglect and household dysfunction and the risk of illicit drug use: The Adverse Childhood Experience Study. Pediatrics. 111,564–572
6. Shin, S. H., Miller, D. P., & Teicher, M. H. (2013). Exposure to childhood neglect and physical abuse and developmental trajectories of heavy episodic drinking from early adolescence into young adulthood. Drug and Alcohol Dependence,127(1-3), 31-38. doi:10.1016/j.drugalcdep.2012.06.005
7. Danese, A., & McEwen, B. S. (2012). Adverse childhood experiences, allostasis, allostatic load, and age-related disease. Physiology & Behavior,106(1), 29-39. doi:10.1016/j.physbeh.2011.08.019
8. Koob GF, Schulkin J. Addiction and stress: An allostatic view. Neurosci Biobehav Rev. 2019;106:245-262. doi:10.1016/j.neubiorev.2018.09.008
9. Twardosz, S., & Lutzker, J. R. (2010). Child maltreatment and the developing brain: A review of neuroscience perspectives. Aggression and Violent Behavior, 15(1), 59–68.
10. Dam, D. V., Vedel, E., Ehring, T., & Emmelkamp, P. M. (2012). Psychological treatments for concurrent posttraumatic stress disorder and substance use disorder: A systematic review. Clinical Psychology Review, 32(3), 202-214. doi:10.1016/j.cpr.2012.01.004

Post-traumatic stress disorder (PTSD) can occur after you have been through a trauma. According to US Department of Veterans Affairs, approximately 8 out of every 100 (around 7-8% of the population) people in the U.S. will have PTSD at some point in their lives (Gradus, 2020). A common emotional symptom that individuals suffer from with PTSD is shame. This can be true even if there is nothing objectively to be ashamed of. PTSD symptoms can be intense and impact many facets of a person’s life. Shame or guilt can interrupt our beliefs about ourselves and our worldview (Johnson & O’Brian, 2013). Self-compassion can be an important but difficult step in trauma recovery.

 

“Self-compassion refers to healthy ways of relating to oneself in times of suffering, whether suffering is caused by failure, perceived inadequacy, or general life difficulties. Self-compassion allows individuals to accept themselves as they are, including the limitations and imperfections that make them human.”
(Braehler & Neff)

 

Self-compassion includes three main components:

• Kindness: Being caring instead of attacking or ignoring the pain. Meeting suffering or pain with feelings of kindness, care, warmth and concern.
• Common Humanity: Recognizing that pain is a shared human experience and can connect us to others if we let it. Trauma can happen to anyone. According to the VA, about 6 of every 10 men (or 60%) and 5 of every 10 women (or 50%) experience at least one trauma in their lives.
• Mindfulness: Noticing and being sensitive to the fact that some sort of suffering or pain is occurring. Suffering could be some sort of distressing struggle with emotional pain, mental pain or physical pain.

Preliminary research has shown that increasing self-compassion decreases PTSD symptoms. It can reduce avoidance and self-destructive behaviors. It can also reduce flashbacks and panic attacks. Although self-compassion can be difficult to practice in the beginning, it can be an effective tool in healing from a trauma. Try out different strategies and see what works best for you! Remember, you are not alone and there is support available.

Interested in learning more?

Here are some resources:

http://www.self-compassion.org

https://www.ptsd.va.gov/appvid/video/index.asp

https://chrisgermer.com

 

Sources:

Braehler, C. and Neff, K. (2020) Self-Compassion in PTSD. In: Tull, M. and Kimbrel, N. (eds.) Emotion in Posttraumatic Stress Disorder. Elsevier, 567-596. ISBN 9780128160220

Gradus, J. VA.gov: Veterans Affairs. Retrieved June 14, 2020, from https://www.ptsd.va.gov/professional/treat/essentials/epidemiology.asp

Johnson, E. & O’Brian, K.A. (2013). Self-compassion soothes the savage ego threat system: effects on negative affect, shame, rumination, and depressive symptoms. Journal of Social and Clinical Psychology, 32 (9), 939-963.

What is PTSD?
Post-traumatic Stress Disorder (PTSD) occurs when a person experiences or witnesses a traumatic event and is unable to cope or return to functioning levels prior to the event, with symptoms persisting for at least one month. These symptoms include intrusion (i.e. nightmares, flashbacks), avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity.

What are eating disorders?
Eating disorders (EDs) can broadly be defined as psychological illnesses with severe disturbances in eating behaviors that are rooted in the psyche. Restriction, binging, purging, preoccupation with weight or food, negative and/or distorted body image, and fear of weight gain are just some key indicators of eating disorder presentation.

 

How are PTSD and EDs related?
PTSD and EDs are often co-morbid; research shows that nearly 25% of individuals with an ED also struggle with PTSD (1). One study specifically demonstrated that 74% of women participating in residential eating disorder treatment, one of the most intensive levels of care, reported experiencing a traumatic event and 52% reported trauma-related symptoms consistent with a PTSD diagnosis (2). This overlap exists because eating disorders can develop indirectly as a way to deal with trauma and PTSD. As trauma impacts feelings of safety and control, self-esteem, identity and sense of self, and/or body image, individuals may turn to severely disordered behaviors around food, movement, and body as a means for coping with negative or uncomfortable thoughts and emotions as well as environmental stressors. It may seem illogical, but even though ED behaviors can seem obviously destructive from an outsider’s perspective, someone engaging in them may find a deep sense of comfort, relief, normalcy, and escape, which can be very hard to let go of.

How does one heal from PTSD and an ED?
Healing and recovery are not always easy, but they are always possible. Treatment involving a multidisciplinary team which includes a qualified therapist, dietitian, medical professional, and possibly a psychiatrist is strongly recommended for the most effective and comprehensive treatment. Once an individual can understand the purpose of their ED behaviors, healthier alternative coping skills can be learned and developed, and their trauma can be processed.

The most common evidence-based treatment modalities for PTSD and EDs are Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT). These therapeutic models are used to help the individual uncover underlying emotions and cognitions related to the traumatic event(s) and teach them adaptive coping skills to process their trauma and leave their eating disorder behaviors behind. While CBT and DBT encompass general strategies and specific techniques, treatment should be tailored to meet the needs of each unique individual.

Sources:
1. Tagay, S., Schlottbohm, E., Reyes-Rodriguez, M. L., Repic, N., & Senf, W. (2014).
Eating disorders, trauma, PTSD and psychosocial resources. National Institute of Mental Health.10.1080/10640266.2014.857517.
2. Gleaves, D.H., Eberenz, K.P., & May, M.C. (1998). Scope and significance of posttraumatic symptomatology among women hospitalized for an eating disorder. International Journal of Eating Disorders. 24(2),147‐156. 10.1002/(sici)1098-108x(199809)24:23.0.co;2-e

We’re back to introduce you to another clinician on the team! This week – our newest (and only!) psychiatric nurse practitioner, Celeste Kehoe. Celeste is currently seeing clients virtually and will continue to see clients in our office once we return to in-person counseling. We’re excited to have her on our team! Find out a little more about Celeste in this interview and call our office today (910) 790-5000 to schedule your first appointment with her.

Why did you decide to become a nurse practitioner (NP)?

I had worked as a registered nurse for several years prior to returning to graduate school to become a nurse practitioner. While active duty in the US Navy, I had the opportunity to work on an inpatient psychiatric unit and this is where I found my calling to work in psychiatry. I have always enjoyed talking with and listening to clients and the nurse practitioner role afforded me the chance to expand my role as a nurse. As a nurse practitioner, I feel I am still able to provide individualized care and take the time to truly form a therapeutic relationship with my clients.

“I’ve never met with an NP or psychiatric provider. What should I expect during my first appointment with you?”

During our initial appointment, I will collect information regarding your history and symptoms that you are experiencing. After listening to your concerns and answering any questions you may have, I will offer treatment recommendations. We will then collaboratively decide which treatment option, if any, would be best for you. I strongly believe that my clients should have an active role in their treatment. The best approach in most cases is the combination of therapy and medications. My role is to listen to your concerns and symptoms, make treatment recommendations and monitor your response to medications so that you have an optimal outcome.

“I have concerns starting or switching medications. Any insight or advice?”

Starting any medication whether it be for medical or psychiatric reasons can be worrisome. Whether we have decided together to try a new medication for the first time or switch from another, my approach is to go low and slow. This helps to minimize any side effects and allows you to adjust to the medication.

What book are you currently reading or podcast are you currently listening to?

I try to read a new book each month. Currently for pleasure reading I am reading, “Before We Were Yours” by Lisa Wingate. As I feel it is important to continuously keep abreast of new information and continuing education, I am also reading “Eating Disorders – A guide to Medical Care and Complications” by Dr. Philip Mehler and Dr. Arnold Andersen.

One thing you want your clients to know about you?

I have worked in a variety of settings including outpatient clinics, clinical research trials, correctional facilities and on a university campus. All of these experiences have helped me grow as a prescriber and nurse practitioner.

No one could have prepared for the impact coronavirus would have on our lives, our work, our families, or our mental health. In the last few weeks, there are three areas that have come up the most in my clinical practice: how to manage staying at home, how to be mindful in a crisis, and how to help people with eating disorders manage most effectively.

Mindfulness is not difficult, but it does require practice. It can help quiet the fear and help us become more aware, in the moment, of our thoughts and behaviors. Think about how often you touch your face. Think about the sensations that go with washing your hands. Think about what to do instead of shaking hands – perhaps this will encourage us to make eye contact and to think about our intentions more when interacting with other people. We can become aware of how connected we all really are when we think about our intentions and interactions. When you are afraid of something like getting sick from the coronavirus, really think about the thoughts, feelings, and sensations that make up that feeling and allow them, without judging. Keep moving through them, listen to them, and perhaps dissecting your fear will diminish its power. The behaviors of fear can also reinforce it – think about decisions you make regarding where you go or who you spend time with, what you buy at the grocery store, how much news you are watching and what other things you are doing with the extra time you have at this moment. If you are mindful of these thoughts, feelings, and decisions then you allow your values and needs (as opposed to wants and shoulds) to guide you.

How to manage stay-at-home

There are a lot of things that can make a positive difference, the first being awareness.

Most of us never think about what is healthiest for us; we go about our days and change things as something comes up. Right now, we are still in a pretty reactive phase when it comes to COVID-19 and its various impacts; however, being away from our normal routines affords us a great opportunity to increase our awareness in a way that everyday life would not. Maybe we can learn to be proactive instead of reactive when it comes to managing our own stress.

What do you need? Do you need a dedicated workspace, a structured schedule, regular social interaction, daily naps, or something totally different to make staying and working from home bearable? A lot of us are in limbo, and likely will be for a while. It is important to figure out what makes you feel positive and productive. There is a lot of information published about how to make working from home a bit easier, but some of the things that seem to be universal are:

• Stick to your routine as closely as you can (get up at the same time, work at the same time, etc.) and simulate your work environment as closely as possible if you are working from home
• Put on pants (real ones, not PJ’s), brush your teeth and your hair, take a shower, etc. every day
• Get outside every day (weather permitting)

How to be mindful in a crisis

While it might seem stressful to add mindfulness to your list, it can help us manage the stress of this very unusual situation. After all, this is a time no one every expected to have.

Here are some ways to use mindfulness to cope with stress in general as well as some ways that we can all increase our mindful awareness.

1. Practice gratitude and acceptance – If there is only one part of this list that you implement, let it be this. Practicing gratitude through journaling, affirmations, meditation or prayer has been proven over and over to increase general life satisfaction, improve medical outcomes, and elevate happiness scores. Just thinking about gratitude is enough to get the positive effects – even better if you are able to do it every day. Also, saying thanks to others helps you share that gift with the people you care about. Acceptance operates in much the same way, but it allows you to get un-stuck from the worries, demands, or people that might get you down. If you are able to identify those situations beyond your control that are getting you stuck, sometimes all it takes is acknowledgement to accept the situation and move through it. We cannot control what happened with coronavirus, but we can acknowledge a need to accept the situation as it is, not as we wish it would be.  The same way you write, speak, or think gratitude works for acceptance. If you are having trouble with acceptance, consider backing off of watching or reading the news as often – things change every day with this situation, and the news is not necessarily helpful in managing our anxiety, especially when there are conflicting or changing messages.
2. Be aware of your own needs – it is important to be open to and make space for your own needs, thoughts, and feelings. We all have different associations with staying at home – family, past experiences, loss – and need space to process them in our own ways. Do not forget to take care of yourself and be good to yourself. If you need your own space, alone time, social time, quiet time, now is the time to figure that out. Everyone also has different energy levels and preferences when it comes to productivity or creativity. Some people want to tackle projects they haven’t had time for, and some people want to learn to meditate or take up a new skill. All are reasonable – but try not to impose your preferences on others in your household.
3. Allow yourself some peace – letting go of judgement, enjoying experiences and not focusing on the outcomes, doing less, unplugging, and spending some time alone are just some of the ways we can attain some peacefulness and space in our lives. Everyone on the planet needs that in their lives. But we need to remember that everyone has different levels of need for connection and it is important to give yourself and others in your household room to do that in their own ways.
4. Play – having fun is sometimes lost in the midst of all this worry. Adults need playtime too! Think about something you liked as a child and do it with your own kids, your dog, or your partner. What makes you smile? Make it happen!
5. Practice compassion – compassion and lovingkindness are two important concepts to apply to yourself as well as others. When we keep compassion in the forefront of our minds, it allows us to take care of ourselves, and be more attentive and more relaxed. Usually, that also makes us kinder and more open to others, keeping our spirits uplifted. Hope is hugely important in a crisis, and compassion is the quickest road to hope.

How to help yourself or a loved one manage eating disorder recovery during this crisis

For those whose loved ones are suffering with an eating disorder, here are some other ways to manage food stress:

1. Don’t be the “food police” – for adults, it is not anyone else’s responsibility to manage their food choices, it is something each individual has to decide. If you have an eating disorder, try to stick with the plan that you and your therapist and dietitian have worked out. If you are supporting someone, talk about what would be helpful to them ahead of time and follow through.
2. Pick your moments – walking on eggshells or avoiding difficult topics might let your family dinner be more peaceful, but some issues do need to be addressed. If you are concerned about someone’s eating behavior, or even just their stress level, it is important to talk about it (but probably not at the dinner table or in front of your friend on a virtual group chat who gossips about everyone all the time). If you do confront them or attempt to have a conversation, make sure you are being honest and saying what you mean to say. It might even be helpful to have a plan, especially if you have tried to talk about it before and it hasn’t gone well.
3. Let go of judgment (and practice compassion) – mindfulness is all about not judging. There are lots of stereotypes that stigmatize eating disorders – do not assume you know what their experience is like (or vice versa). Family can sometimes trigger judgment and criticism – try to notice when you are judging yourself or internalizing messages from others. Next, take a step back and try to observe the feelings without judging them and you might be able to give yourself some much needed space for kindness, empathy, and compassion.
4. Use “I” statements – eating disorder or not, it is never a good idea to assume you know where the other person is coming from. “I” statements – “I feel (an emotion)   when you        do this behavior or say this specific thing)             .” help solve this problem. By expressing your own feelings, you increase your ability to connect and reduce defensiveness. Stick to pointing out what you have observed and keep your non-verbal communication calm and open.
5. Here are some things that are never appropriate – “Just eat!” and “Just stop!” are not useful comments. Never comment on the weight or someone with an eating disorder or tell them they look” healthy” – try not to make any comments about that, especially when food is involved. Commenting on what they are eating, especially during a meal, is not helpful (unless they ask you for feedback directly).

Everyone is struggling with the “new normal” and no one knows what changes the virus will create when all is said and done. Take from this post what works for you. And remember that there are a lot of people who need help right now, and there are a lot of people willing to help others. Teletherapy is an option that was not available for everyone before and could be useful to manage the anxiety, stress, and uncertainty that comes not only from the coronavirus, but also from all the changes that will result from it.

 

Coronavirus is a virus that causes an infection in your nose, sinuses, or upper throat and can range from mild to severe symptoms. We know those with compromised immune systems are more likely to be affected. Avoiding people who are sick, washing your hands and avoiding touching your face, mouth & nose are all great methods to protect yourself, I’m here to help you take it to the next level and really give your immune system a boost!

Here are 7 helpful ideas to ramp up your body’s own immune system: 

• • Vitamin C  We can boost the immune system with a vitamin C regimen of 1,000-2,000 mg per day which may reduce severity of symptoms and shorten the duration of the illness. Consuming adequate produce is simple way to boost immunity since colorful fruits and veggies are loaded with Vit C and other antioxidants. A few favorites to add are citrus fruit, berries, kiwi, cabbage, broccoli, pumpkin, kale, sweet potato, brussel sprouts, apples, peppers and spinach.
    You could also supplement with Emergen-C or Airborne.
  • Probiotics  Include in your meal planning a healthy level of good bacteria. Incorporating probiotics is valuable in restoring levels of these healthy bacteria in our body to protect us from infection.  Your gut 70-80% of your immune cells.  A quality probiotic supplement is recommended but remember to always take after antibiotic use. Introduce fermented foods into your diet such as tempeh, kimchi, kefir, yogurt (make sure the label says it contains “live active culture”) and sauerkraut.
  • Water  We experience fevers because the body’s defense mechanism is heating up in effort to kill the virus. This can cause loses of vital fluids, especially if you experience vomiting & diarrhea, so it’s crucial to be hydrated. Keeping the kidneys hydrated will naturally support the immune & lymphatic system.
    Our lymphatic system filters out foreign invaders and is comprised of mostly water. Since our lymphatic system and immune system work synergistically,
    it’s imperative to keep drinking those fluids to keep everything moving smoothly.
  • Sleep  Physical exhaustion is a common symptom of an illness. Light meals such as chicken or veggie soup with homemade bone broth let the body divert it’s energy to the
  • healing process rather than straining to digest a large meal. Let yourself rest to allow your body to recuperate. Good sleep cycles help the immune system work well.
  • Food Is Medicine  Reach for garlic & onions (which will also keep your friends 6 feet away)! It helps your body suppress infection while enhancing immune function. These two powerful foods are antibiotic, antimicrobial, antiviral and antibacterial.  Ginger is a powerful anti-inflammtory, antioxidant with antimicrobial effects. It is a muscle relaxant and may have the power to reduce coughing & inflammation. Add 1-2 tsp of raw honey to ginger tea. A cough can be a good thing; your body is trying to get rid of mucus that may be collecting in your lungs. However, a persistent cough may be annoying if it keeps you up at night. Ginger can help with nausea too.  Season your meals with oregano & thyme. Oregano has antiseptic and antibiotic properties .
    Thyme is also an antiseptic and promotes expectoration making it an excellent excellent remedy for respiratory infections & coughs.
  • Supplements  Down to Earth Has an essential oil called Burglar Blend which is a great anti-bacterial, anti-viral combination to use in a diffuser to combat airborne illness & bacteria.  Lovey’s Natural Foods Market has organic Elderberry juice for an herbal immunity booster.
    Gaia Herbs online offers Immune Shine which is a powerful blend of wild mushrooms, chaga, elderberry & ginger.
  • Sunshine  Spend time in the sunshine.  Our skin makes Vit D when exposed to sunlight.  Vit D deficiency is linked to increased susceptibility to illness. Sunlight  directly activates key immune cells by increasing their movement. Sunlight is germicidal and there is evidence it can kill viruses.  Fresh outdoor air is a natural disinfectant so if you don’t deal with seasonal allergies, spend some time taking deep breaths outside and enjoying the warmth of some sunlight on your skin.

Robert Urich states “A healthy outside starts from the inside!”
Please join me in nourishing our own bodies so we can come together and take care of one another during this stressful time.

This week the NBCC and organizations nationwide are recognizing Medicare Mental Health Week. Dr. Kerri Schroder shares some insight on this topic.

“Loneliness and the feeling of being unwanted is the most terrible poverty.” ~ Mother Teresa

These words describe the feeling of many of the elderly in our country. Despite longer life expectancy, increased facilities and technology that medical and social systems provide to elderly, loneliness and depression are all too common.

Loneliness is not a new concept only beginning during senior years.  Loneliness is not synonymous with being alone, nor does being with others guarantee protection from feelings of loneliness. Loneliness has been described as a complex set of feelings that occurs when intimate and social needs are not adequately met and that drives individuals to seek the fulfillment of these needs. It is a universal phenomenon found in the humans and is closely associated with changing life circumstances.

We can also distinguish emotional and social loneliness. Emotional loneliness is missing an intimate partner, such as a spouse or sibling and is accompanied by feelings of isolation and insecurity, and of not having someone close.  Social loneliness is lacking a circle of friends and acquaintances that can provide a sense of belonging, of companionship and of being a member of a community.

Studies have found that increased age, absence of partner, dependency; institutionalization and health impairment were associated with increased risk of loneliness.  And loneliness is linked to depression, lower quality of life and increased vulnerability to both physical and mental health problems of the elderly. Factors like cognitive function and limitations in activities of daily living were not related to loneliness. Other factors: education, income, marital status, and perceived stress are not predictive of loneliness.

Coping mechanisms are cognitive and behavior efforts to manage perceived overwhelming demands, whether external or internal. The way these difficulties are faced directly influences levels of health and psychological well-being They can be divided into two categories.  Adaptive coping mechanisms are fairly active, and include instrumental and emotional support, planning, acceptance, humor, positive re-framing and religion.  Mal-adaptive coping mechanisms are more passive and include behavioral disengagement, denial, self-distraction, self-blame, substance abuse and venting.  Often time seniors react to feelings of loneliness with sad passivity, distancing, and denial as a way to cope due to a sense that this is what is expected at their stage of lie.

Not surprisingly the use of adaptive coping strategies are associated optimism and active engagement and result in less loneliness and less depression.

Engaging in therapy to learn and practice adaptive coping skills is a pathway to overcome loneliness.  Practical strategies are offered:  how to distinguish between loneliness and solitude, volunteering & teaching opportunities, finding other sources of nurturing (caring for pets, plants), figuring out what is missing from your life, and taking steps to connect with others.

Kerri Schroder is a licensed psychologist who specializes in geriatric mental health.