The Mindfulness Prescription

I am smiling with gratitude as I write this post. Why? Dr. Lidia Zylowska, a UCLA trained psychiatrist, Diplomate of the American Board of Integrative Holistic Medicine and award winning author of the book called, “The Mindfulness Prescription for Adult ADHD: An 8-step Program for Strengthening Attention, Managing Emotions, and Achieving your Goals” was a guest on my podcast this week. Dr. Zylowska’s body of work is to be commended as she and her colleagues at UCLA have built upon the knowledge of the great sages throughout history coupled with the work of modern day visionaries such as Professor Emeritus at University of Massachusetts Jon Kabat-Zinn Ph.D., founder of scientifically based Mindfulness Based Stress Reduction (MBSR). Dr. Zylowska and I discussed the evolution of her interest in her mindfulness research and the practical applications of being mindful for overall health and wellbeing in our daily lives.

What is mindfulness?

It seems to be a buzzword these days in our modern day vernacular. Jon Kabat-Zinn defines mindfulness as “The awareness that emerges through paying attention on purpose, in the present moment, and nonjudgementally to the unfolding of experience moment by moment.” During our interview, Dr. Zylowska spoke about mindfulness being the attunement of breath and body, the dropping into awareness, the self observing without judgement and provides many more examples and guided exercises in her amazing book. She discussed how the act of gardening and being truly present in the now is something she uses as one of her examples with her clients. I shared with her my experience of recommending meditation to a teen with ADHD, “Meditation is a trigger word for me Dr. McDermott. I cannot imagine sitting still that long ever.” When I started discussing the importance of finding your own “mindfulness style” with the teen her ears perked up. I spoke with her about how a mindfulness mantra of ‘be loving, be kind,’ was my go to phrase throughout the day and served as a “reset” into the now moment. She was relieved and said, “I thought chanting ‘OM’ sitting for an extended period of time was the only way to do this!” She decided that ‘be calm and kind’ was going to be her reset back into the now if she became too cerebral or began to ruminate or get distracted. Dr. Zylowska and I both agreed that it is important to find your own meditation and mindfulness style.

Being healthy and well requires a level of physical and emotional awareness for all of us. The act of sitting in silence or paying attention to our breath can seem overwhelming with all of our modern day interruptions that we face each day. When we are able to be in the now our ability to pay attention on a multidimensional level allows us to thrive. The long-term benefits of a mindfulness practice include reduced anxiety, improved mood, increased focus, improved cognition, broadened self awareness and more!

There are many tools out there to start a regular practice of mindfulness and meditation. Many of my patients love the headspace app which you can find on www.headspace.com. It really is “meditation made simple.” The integration of mindfulness has started in elementary schools across the United States thanks to Goldie Hawn’s Mind UP program. If your school district is interested in an integration of mindfulness into their curriculum you can direct them to: (thehawnfoundation.org/mindup). You can also order Dr. Zylowska’s book, which includes mindfulness exercises: www.lidiazylowska.com/book. There are many other tools on-line, classes to explore and you can also check out what your community has to offer!

I prescribe mindfulness as part of every mental health thrive plan for children, teens and adults.

When our children (adults included too!) are aware of how their bodies and mind feel they are self aware which can foster self-love and wellbeing. The parents and kids in my practice often here me say, “You need to be your own best friend.” I believe that self awareness and self love lead to a compassionate awareness, a “heartfulness.” When individuals thrive our society thrives.

Thank you Dr. Zylowska for being a guest this week, it was an inspiring interview on mindfulness.

Listen here: Dr. Lidia Zylowska Interview on The Dr. Denise Show

Remember:

-It is never too late or too early to start your mindfulness practice.

-Being self aware coupled with compassion leads to “heartfulness.”

-The benefits of mindfulness are endless: improved focus, improved mood, reduced stress, increased creativity, improved cognition, a greater self awareness and more.

So what are you waiting for? Find your mindfulness style. Doctor’s orders!

Dr. Denise

The Dr. Denise Philosophy

I encourage my patients to be the best version of themselves and ask them, “What would your best life look like?” Then, together we create a tailored plan that supports their wellness. This may include what brings them the most joy in their lives and makes them feel passionate such as yoga, walking, skiing, creative writing, etc…

I believe in prescribing the least amount of medication as possible and always start assessing from a holistic perspective where I treat the person as an individual.

I strongly believe that you are not your symptoms. I don’t want people to feel stigmatized. One of the hardest things for me is that people feel bad when they walk in my door. I am committed to changing that mindset.

I want people to embrace their mental health in a positive way.

I do validate the “illness” part of suffering yet I explain to my patients that our thoughts and word choice are an essential part of the “fast track to wellness”. I use language that is appropriate for each age group. I embrace Western medicine coupled with all paths to wellness. I value the viewpoint of my patients.

You have to know that your doctor is well trained, compassionate, and empathic. How do you figure this out? You get to spend time with them. You listen carefully to not only the facts they educate you with but how they deliver the information.

Here are some questions that you can ask yourself when choosing the right Doctor for you:

Do you feel like they want you to be well?

Are they treating you like a person and not like you are a “walking target symptom”?

Do they make eye contact when they are talking to you?

Do they listen to your viewpoint?

I encourage my patients to understand that the key to moving from crisis to thriving is the belief in your ability to get well. My patients end up thriving and turning their lives around in profound ways by this unique approach. I teach my golden rule which is be loving, be kind, be respectful to yourself and others. As we do this in our lives we foster peace to our families, communities and the world.

Remember:

1) Be the best version of yourself.

2) No matter what diagnosis you have, you are not flawed.

3) You are not your symptoms.

4) There is no shame in seeing a psychiatrist.

5) What does it look like for you to thrive? Not just exist.

6) Focus on the end point of thriving.

7) Be loving and be kind.

8) Call upon your best work and your highest self.

9) Embrace your mental health.

Don’t forget that your strengths can be your weaknesses. Empower yourself and set an intention everyday to thrive in your life. Find a way. You can do it.

Dr. Denise

It Starts with Love and Ends with Love

What an honor to interview fashion designer, YouTuber, makeup lover and reality TV personality Matt Sarafa this week. Matt describes his love of fashion that was sparked at age 7 watching Project Runway. During the interview he reports his “guilty pleasure” being reality television. Guess what? His passion for fashion and the path he paved for himself landed him on the Lifetime reality show Project Runway Junior! He described making friends with the other contestants that share his love for fashion as a gift that he will cherish lifelong. It gets even more exciting for Matt… Kelly Osborne rocked his ‘Hot Mess’ jacket on Instagram and again on a Cosmopolitan video during this exciting launch of his fashion career. His ‘Hot Mess’ clothing line will be out end of summer/early autumn 2016 just as he starts as a freshman at UCLA!

“Once I discovered fashion I became less anxious. I have always been an anxious person,” Matt described during his interview. He reports his anxiety vanishing once he was aligned with his pursuit of a career in fashion coupled with coming out as a gay male to his family. He reports spending many years,”caring about what other people thought of me.” “It really does not matter what other people think of you. It really does not matter,” Matt stated with conviction.

We talked about the importance of self -love and being your own best friend.

Matt was grateful to have such loving friends and family during his coming out process. “I wish I would have done it sooner. I have 100’s of teens reaching out to me on social media about their fears about coming out as gay, bisexual, or transgender.” His advice on coming out, “Do it when you are ready.” Matt discussed the strong influence of social media with his generation. His tips are: be kind, be authentic and be positive with this powerful medium.

Matt and I discussed his strong desire to continue to be a role model and to be of service, “I am addicted to giving back.” His mother was a social worker at Children’s Hospital Los Angeles before Matt was born and a yearly Sarafa family tradition is to adopt a family in need at the hospital during the holidays. Matt is setting the intention to carry the spirit of service throughout his life and has set hopes with the success of his fashion career that he can give to charities that support HIV research and to charities that raise awareness and support the LGBT community.

Professionally as a psychiatrist and personally as a trusted friend, I have had the privilege of being a listening ear when people are experiencing fear or anxiety about self-expression of sexuality or gender identity. While I was in residency at Emory University I was fortunate to be asked by my gay colleagues to be a co-therapist of a gay and lesbian group in which young adults were at different phases of self acceptance with their sexuality and their coming out process. I felt honored to have been chosen to have this experience and as a doctor I found it invaluable for my work as a mental health professional.

“Love is love,” was the biggest take home point I learned.

As a child psychiatrist I have had teens struggle with their sexual and gender identity and parents who feared for their children if it was true that they were gay. One Mom in my practice was labeled by her son as the “trophy Mom” as she had handled her son’s coming out process with flying colors. He did not know that she had sought out therapy with me and attended an LGBT parent group before he had formally told her. Being open, loving and accepting is crucial for the best support of yourself and your loved one.

Here are some tips that I have found helpful throughout the years:

-Do not force or rush your (or your loved one’s) self discovery of sexual preference or gender identity. It is a very personal process.

-Confiding in a trusted friend, or loved one is invaluable.

-Seek out therapy as you feel necessary as there are many feelings to sort out; having a neutral party can be extremely helpful.

-Remember there are LGBT support groups for teens, adults and parents to call upon in your community.

-Be patient with loved ones that have different beliefs about sexuality and gender preference. You cannot control their initial reactions whether they respond in a positive, neutral or negative way.

-Self love and being “your own best friend” is an essential ingredient for mental health and wellbeing.

Thank you Matt Sarafa for sharing your wisdom and your thrive story this week on my podcast. To listen: (Matt Sarafa Podcast on the Dr. Denise Show).

Dr. Denise

Pediatric Addiction

Are you ready for the latest on pediatric addiction? I was fortunate to attend the American Physician Institute 6^th Annual MasterPsych conference in Laguna, California. I was struck by the passion, enthusiasm and compelling data presented at a lecture on Substance Use Disorders in Children and Adolescents by Dr. Ximena Sanchez-Sampler, a Harvard addiction psychiatrist. She shared with us that someone she loved experienced a fatality that was substance use related. The room was silent, you could sense the compassion we all felt for her. With strong conviction she reminded us that, “Adolescents are not little Adults!” All adolescents, regardless of demographic, racial or ethnic factors, are at risk for substance use and associated problems.

Dr. Sanchez-Sampler discussed that until recently, brain development was thought to be complete by age 10. “Through brain imaging technology (fMRI) we have learned that maturation process of the human brain is not complete until age 24 or 25.”

Why is this important?

Adolescence is a time of critical brain development, especially in the parts of the brain needed for complex tasks, organization, planning and judgment.

Remember a teen brain and an adult brain respond differently to a few drinks. “Dr. McDermott, I am less shy and I am more fun when I have a few drinks at a kick-back.” Teens let loose, are socially disinhibited and this makes the experience rewarding enough to repeat. Adults usually just get tired and fall asleep!

Did you know that 47% of children who have their first drink before age 13 are at risk of an alcohol disorder in contrast to 9% who have their first drink after 21? (Arch Pediatr Adolesc Med. 2006;160:739-746)

Did you know that 17% of children who first use marijuana before age 13 are at risk of a marijuana disorder in contrast to 4% who have their first use after 21?(Substance Abuse and Mental Health Service Administration (2010))

Fact: Addiction is a pediatric disease. Early intervention, education and prevention are essential to change the statistics above.

Can research-based programs prevent drug addiction in youth? Yes! To access the data and the recommendations go to drugabuse.gov and type in NIDA’s Preventing Drug Use Among Children and Adolescents: A Research Based Guide for Parents, Educators and Community Leaders.

I find that kids do better when a discussion about substance use comes up organically. The headlines, sitcoms, movies, and advertisements give all of us plenty of opportunity to offer teaching points. It is always better to ask open-ended questions such as “What do you think about that?” Quality time with your child or teen leads to open communication. It is important to spend time doing fun activities with each other which will foster respectful relationships with one another.

Another Tip: Substance Abuse often travels with undiagnosed mental health issues.

Ready for a thrive story? I am! John’s (pseudonym) first use of marijuana at age 12 was followed by abuse of multiple substances. He was caught dealing drugs, expelled, and sent away to residential treatment. Today he is re-enrolled in school, is at home with his parents and is being treated for his Generalized Anxiety disorder, ADHD, and his Substance Dependence. I find that keeping it real and direct with the teens in my practice is appreciated. Recently, I pointed out to him how happy I was that he was alive. He looked at me stunned when I said this and then smiled and said: “I could have been dead at least 30 times!” We discussed in therapy how his “savvy skills” and need for what I call “healthy adrenaline rushes” need to be put to good use. He is going to ask his Dad if he can take a real estate class this summer while still in high school as he has an entrepreneur itch that he wants to satisfy. He started seeing me while he was in acute crisis and now he is heading towards his “thrive zone.”

In summary:

Adolescent brains are not the same as Adult brains.

Addiction is a pediatric disease.

Substance Abuse often travels with undiagnosed mental health issues.

Your child can thrive if they know the facts about addiction and have early intervention with any other behavioral issues.

Dr. Denise

Childhood/Adolescent Depression

Can a child or teen suffer from depression? Yes. A thorough clinical assessment needs to happen and every environmental, physical and emotional dimension needs to be taken into account. Kids can experience “feeling sad” or “irritable” for many reasons: for being bullied, for dealing with parents getting a divorce, for moving to a new home, for not being able to do their homework. The list goes on. If your child is having marked changes in mood I recommend a visit to the pediatrician to make sure there are not medical contributing factors (thyroid disorder, metabolic problems). The pediatrician is a great starting point to help guide you to the next step.

As a society we need to hold our mental health and wellness in the highest regard. It is essential in assessing a change in your child’s mood, irritability or sadness level to include a highly trained professional that has assessed childhood depression and knows how to address safety issues including suicidal thoughts and self harm. My professional opinion is that a child psychiatrist is the best choice to make this assessment. You would be surprised to know how often kids present with suicide or cutting behavior and I was the first one they shared this with. One complicating factor in providing adequate mental health services is that there is a shortage of child psychiatrists to provide the care that is needed. The solution is prevention, education and early screening as well as psychiatrists having collaborative relationships with pediatricians, psychologists, educators, other professionals and parents. This is a societal issue not just a medical issue. We need to build the infrastructure to support our children in a unified way.

The data shows that depression affects ~5% of all adolescents.

In clinical practice when assessing a child or teen for depression or any other presenting behavior a Child Psychiatrist follows the practice parameters of AACAP. A clinical interview with the child and the parents separately is standard of care. A review of report cards, standardized testing, behavioral rating scales, and gathering any other relevant information is part of the assessment. If a diagnosis is made then treatment is determined after weighing in on all of the factors for your child.

I believe that it is essential for psychoeducation to weigh in all the factors of treatment. Cognitive behavior therapy is an absolute part of the treatment of childhood depression whether medication is indicated or not. Coping strategies, family, and school environment are essential for the best long-term outcome. I am happy to say that I have many “thrive stories” of young adults that I see ~three times a year now that had appropriate treatment for depression as teens. They are attending top colleges, having children, and getting promotions at work.

Dr. Denise