How To Thrive During a Crisis

Child Psychiatry Crisis’ come in many flavors. I am going to list some of the most common chief complaints I experience from the parents of my patients:

“My son’s grades went from B’s to D’s & F’s. We have done everything. Tutors. Therapy. Help!”

“My daughter is complaining of stomach aches.  She has missed almost a month of school. The pediatrician has ruled everything out. I tend to have some anxiety and it is heartbreaking to see her suffer like this.”

“My son is just not able to keep up in school or socially.  He also is having trouble making friends. Therapy is helping a bit yet we need to figure this out.”

“My daughter was always a good eater until she took this nutrition class. She always likes to be perfect and she followed the nutrition tips to the point now where she is counting calories, has lost 15 lbs, and will not eat at the dinner table with us.”

“My kid was bullied last year. We were hoping a break from that group would help. It started again. He is sad. He wants to change schools now.”

Do you know how hard it is for someone to call a Child Psychiatrist for his or her child?  Really, really hard.  Parents often tell me that they waited three to six months to make the call. They report: “I was just hoping it would be a phase.”  They also mention that they think calling me means: “I have to put my child on meds.”

I make it very clear that is always done based on clinical presentation (severity and true indication) and that I would choose all other modalities of wellness before going the medicine route.

By the time someone calls me they have already tried therapy, tutors, nutrition changes. You name it.  Parents want their child to thrive.  So do I. You can see that a Child Psychiatrist is usually the last line of defense.

When the call comes in a child is usually in crisis.  I educate parents about the process of the evaluation and clearly state: “My goal is to prescribe the least amount of doctors appointments and the least amount of medications.  The end point is for your child to move out of crisis, feel empowered and thrive.”

My patients thrive. Bottom line. It does happen.

I spend time on the phone before a family comes into my practice so patient education and therapeutic intention is known.  My patient, their parents and myself are going to all be working towards thriving and mental wellness.  I set that expectation and hold them accountable for engaging in their life and treatment. I am a Doctor and a Facilitator of Wellness. I believe that everyone needs to realize how powerful and important their thoughts, actions and behavior are.

I validate the “illness” part of suffering yet explain 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 practice with an open mind and heart and this leads to the best outcome for my patients.

If you are seeking a doctor for you or your child it is important to know if they are 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. 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?

The key to going from crisis to thriving is the belief in your ability to get well, the belief in your doctor’s expertise and empathy, and your determination to follow the outlined path to wellness and “engage” in your health.

We as Child Psychiatrists have the data to utilize medication, cognitive behavior therapy and other indicated treatment modalities thanks to our “Academic Mental Health Warriors.”  I want to express gratitude to my colleagues at UCLA and Emory University and all of the “Pioneers of Child Mental Health” that have been doing the clinical trials to gain the knowledge and data we have at this point in history.

When you or your loved one is going through a crisis, remind yourself or them that on the other side of that is stabilization and that everyone has the ability to maintain a place of thriving.

We all want what is best for our children.  I want to take it a step further and push the envelope of wellness.  As a society we need to embrace mental health and wellness in every environment. We need to be proactive not reactive. We all thrive when individuals thrive.

Focus on the end point of THRIVING – not just the current crisis. Take that first step and look at the areas in your life that make you feel energized. Ask yourself, how can I create my best life? Make a list and begin to focus on those things. With the right support, the right plan, you will begin to turn your life around and thrive.

Dr. Denise

Create The Best Version of Yourself with Meditation & Mindfulness

Meditation and mindfulness are not considered “fads” in the medical and science community anymore. I recommend twenty minutes or longer a day for your mental wellness. As you practice everyday, it will become second nature to you – just like brushing your teeth. It is good for you. It can be done anywhere. Studies show it reduces stress, a depressed mood, anxiety, pain, and helps with focus.  You can do a “moving meditation” with exercise, a traditional chant, engage in yoga, or just focus on your breath.

Usually when someone comes to see me they have tried everything to be well.  I always incorporate the recommendation to practice meditation and/or mindfulness daily. An example of mindfulness that I share with my clients is a phrase I use throughout the day: “Be kind. Be loving.” These phrases are helpful in staying “present”.

Develop a practice that works for you. Define what your mode of relaxation is and incorporate that into your daily practice as a meditation. Think positive thoughts, visualize the best version of yourself, and send loving thoughts to yourself, your loved ones and the world. As you incorporate this daily, you will begin to see the positive difference it will make in your life.

I have gratitude for the research of Neuroscientist Sara Lazar of Harvard University. She is a “Meditation Scientist Super Star” in my mind! She was so inspired after taking a yoga class, that she switched her Ph.D. studies from molecular biology to the neuroscience of meditation. She is one of the first scientists to test the benefits of meditation and mindfulness with brain scans.

Her interview by the Washington Post on 5/26/15 discussed her group’s neuroimaging studies. Her first study looked at long-term meditators. A 50-year-old meditator’s brain had the same amount of gray matter in the prefrontal cortex as a 25 year old.  The frontal cortex is associated with working memory and executive decision-making.

When you are mindful you are paying attention to your breathing, sounds and present moment and shutting cognition down. This allows you to still and quiet your mind, which allows you to relax.

Her second study looked at people in an eight-week mindfulness stress reduction program who had never meditated before and had a non-participating control group called “non-meditators”.

I was pleasantly surprised by Sara Lazar’s study results. Here is what she found:

The meditators showed thickening in areas of the brain that correlate with an improvement in self-relevance, learning, cognition, memory, emotional regulation, perspective taking, empathy and compassion.

Does this sound too good to be true? There is more…

The amygdala, “the fight or flight part of the brain” which is important for anxiety, fear and stress got smaller in the group that went through the mindfulness-based stress reduction program. The change in the amygdala was also correlated with less stress!

Her group’s study showed changes in the brain after just eight weeks. The participants took a weekly class and were told to meditate 40 minutes a day. In her study they averaged 27 minutes a day.

Her Harvard group continues to do studies to work on the functional significance, quantity, and quality of practicing meditation and mindfulness. Thank you Sara!

I know what I want our children to do right after the pledge of allegiance…

Meditate at school.

I would love to see this “be the norm.”

Dr. Denise’s Wellness Tips:

  • Meditation and Mindfulness are considered a natural mind medicine.
  • Be flexible with yourself. Start with 5-20 minutes a day.
  • Find a word, phrase, or thought that honors your mindfulness style and repeat it throughout the day.
  • Parents, teachers, doctors: start your children as young as possible with this essential wellness tool.


Dr. Denise