Physician burnout is a world-wide phenomenon that has increased during recent decades. Various sources report that roughly half of physicians display burnout symptoms. This article looks beyond past burnout stereotypes to its global definition, associated signs, and contributors. Assessment resources and methods are presented and discussed.

Although article content touches on the overall risks burnout presents within healthcare systems, the primary focus is on those physicians at risk for and suffering because of burnout’s toll. Heightening awareness of this occupational phenomenon is required to identify and research solutions, particularly by linking contributors with systems and organizational function.

Burnout BasicsThe history of burnout dates back to the 1970s and 80s when Freudenberger described a set of symptoms as “burn-out.” Maslach has provided further discussion and study of this phenomenon, including its occurrence among medical personnel. Regardless of occupation, Maslach and colleagues describe three definitions, or indicators, of burnout, those being:

• Emotional exhaustion,
• Depersonalization, and
• Low personal accomplishment.

Each of these three definitions is associated with various signs discussed in burnout literature and included in the World Health Organization (WHO) description. It notes that burnout is an occupational phenomenon that is listed in the International Classification of Diseases (ICD). The ICD-11 has added detail to the definition provided in the ICD-10. The updated definition includes signs found throughout burnout literature, such as:

• Energy depletion,
• Mental distancing from work, often with associated cynicism, and
• Reduction in professional efficacy.

WHO makes particular note that burnout is not a medical condition. Rather, it refers specifically to phenomena in the occupational context and is not appropriate for application to other areas of one’s life. This point is especially vital when considering burnout contributors, much as occurs in this article’s primary section.

Various relatively current sources indicate the rate of reported and/or assessed burnout at almost 1 in every 2 physicians. In a 2019 report, 44% of more than 15,000 physicians in at least 30 specialties reported to Medscape that they feel burned out. This reflects a steady increase since 2013.

Levels of burnout across specialties range from 28 to 54%. Women are more likely than men to report burnout with data comparisons of 50 to 39%, although males accounted for 60% of survey respondents. Self-report of burnout, as applied in the Medscape report, has been noted to have an accuracy rate 72% of the time when compared with the Maslach Burnout Inventory. Although this is older data, it is worthy of consideration given the proportion of physicians reporting burnout at an increasing rate.

Burnout: Its Definition and How It’s Assessed    This article’s opening paragraphs provided burnout definitions presented by Maslach and the WHO as part of an overview discussion. Burnout assessment involves expanded discussion of its definition with particular emphasis on how it is described by those living with feelings associated with burnout.  

Definition Overview
Although emotional exhaustion has been noted to be a primary burnout indicator, others report that depersonalization is more likely associated with negative outcomes. These physicians have high cynicism scores, reflective of being detached and uncaring. Those who score high in emotional exhaustion report feeling over-extended as well as physically and emotionally drained. A high inefficacy score is related to physicians having diminished confidence and doubting that their work matters. It is reported that healthcare burnout researchers omit low personal accomplishment, replacing it with job satisfaction measures.

Burnout Assessment
The National Academy of Medicine (NAM) provides information about valid and reliable instruments for measuring burnout and other related factors. The page links to sources that offer additional guidance for organizations. It presents the most commonly used assessment as being The Maslach Burnout Inventory (MBI) that assesses the three areas noted above and measurement of workplaces factors that may be contributing to burnout.

Mind Garden offers the MBI and other assessments. The Maslach Burnout Toolkit for medical personnel includes, as part of its survey, items that measure work environment factors that may contribute to burnout. The entire assessment, including workplace and individual measures, can be completed in about 30 minutes. Discussion presented by the NAM and other researchers indicate successful use of a limited number of MBI queries to improve response rates.

Woven within discussion in the resources presented thus far are burnout contributors. Given that about half of physicians report regular feelings of burnout, there is compelling need to examine contributing factors. Doing so leads to inquiry that ultimately can provide solutions.

Burnout: The Burden of ContributorsThis article examines contributors that are systems and/or organizational in origin. Doing so is well supported in medical burnout literature, including resources cited here. Consider that burnout among physicians is double that of other American workers, even with controls applied.

At times, this discussion seems personal. That is because loss of sleep, financial concerns, and extended work hours are just that—very personal. As are concerns about depression, coping mechanisms, and work/life imbalance.

The 2019 Medscape report asked respondents to report on what contributed most to burnout. Almost 60% indicated this to be too many bureaucratic tasks including charting and paperwork. The next highest ranked at 34% was too much time at work, followed by increases in technology use such as EHRs/EMRs at 32%, and lack of respect from administrators and colleagues at 30%.

Burnout’s root causes noted above are affected by organizational structure and functionality. Consider how healthcare organizations and systems affect these contributors:

1. Lack of power/control: Physicians who have historically served in leadership roles that guide clinical decisions have had to relinquish these to administrators. This power shift toward business models causes concerns that the focus is now on money, rather than on optimum patient care and physician satisfaction.
   • There is a notable increase of burnout for those who spend less than 20% of their work effort on personally meaningful endeavors.
2. QI programs: “Quality Improvement“ (QI) programs that require more paperwork,  another bureaucratic, busy-work burden for physicians. It fulfills a requirement rather than encouraging professional systems in which physicians develop their own QI strategies by listening to patients to continually enrich practice expertise. 
   • From the same report noted in item 1, there is burnout increase due to “clerical burden.”
3. Inefficient workflow: Clinical functions should be stream-lined to benefit the medical professionals providing patient care by having non-medical tasks efficiently handled by staff. This approach frees time to see more patients, increase revenue, and allow you to do the most enjoyable part of medicine – seeing patients.
4. Electronic medical records (EMR’s) were designed to increase productivity and efficiency though that has not come to fruition. Moving through numerous pages or screens to complete an encounter is neither efficient nor satisfying.  
   • These are regularly cited as a burden, including the task of physician order entry with computers.
5. Staff shortcomings: Physicians are caring individuals who believe staff are trustworthy and able to complete tasks efficiently. Regardless of cause, when an employee does not meet job expectations, it is time to document their behavior and have a personal discussion about short-comings. Inability to improve needs to result in termination.
6. The 2019 Medscape study noted lack of respect from patients as a 16% cause of physician burnout. This can cause practitioners to feel abused and powerless, especially considering the added effects of those 30% of physicians who reported burnout due to lack of respect from employers, colleagues, and staff.
7. Lack of leadership training: There has been a recent rise in physicians starting a private practice. Although taking this step can be stressful, it is very rewarding to design a clinic around your needs and those of your patients. Once the clinic is up and running, many physicians run into issues that require a firm handle on leadership, financial, legal, and marketing skills. Think too of how lack of physician leadership training limits workplace functionality without fully accessing the decision-making capacity of bright, caring professionals.

It is particularly relevant to consider all of the above in relation to reports that organizations that offer physicians control over workplace issues result in higher professional satisfaction and less stress.

Other burnout contributors are associated with workload and workplace culture. Added to these are a physician culture that would benefit from shorter shifts, heightened peer support, and reversal of blame. Until workplace factors improve, these contributors to burnout will continue:

1. Skipping lunch: Physicians may habitually skip lunch or eat a snack while charting to complete documentation and catch up due to workload and workplace inefficiencies. If the workplace culture condones this practice, physicians sacrifice their deserved breaks and mealtime.
2. 50+ hour work weeks: The 2019 Medscape survey notes that burnout reporting increases with number of hours worked. Emotional exhaustion sets in, particularly as practitioners sacrifice their personal and family needs. Towards the end of a 60-hour week, physicians wonder how many others lack the mental stamina to maintain their high level of work.
   • Each additional hour of work and night or weekend call increases burnout risk by 3 to 9%. Think of how quickly that adds up.
3. High Debt is common among physicians due to extended education that is expensive and not sufficiently relieved by loan forgiveness incentives. There is then the draw to accept added hours to meet financial obligations, adding to the catch-22 of burnout. 
4. Neglecting sleep at the end of a long day or week is tempting in order for physicians to spend time with family, friends, or participating in a hobby. Balancing these with household responsibilities leaves physicians stretched thin and sleep suffering. Sleep deprivation and exhaustion affect the quality of patient care and an overall drop in mood/patience.
5. Ignoring one’s own advice. It is fascinating to listen to physicians complaining about their patients not following preventive care tips and healthy habits when they themselves aren’t doing so either. If patients take the advice, so should physicians. Caring for self and monitoring one’s own health are hallmarks of wellness.
6. Vitamin D deficiency. The evidence supporting vitamin D deficiencies and depression is mixed, yet everyone should get some quality time outdoors. Enjoying the sunlight and getting outside is quite refreshing. Consider the value of workplaces that encourage all staff to get outside to enjoy and appreciate nature and soak up some vitamin D.
7. Charting on weekends is unpaid work. Apparently there are healthcare settings in which physicians save their charting for the weekends. The idea of procrastinating on documentation and then trying to remember what was done days ago is likely associated with job dissatisfaction and workplace issues. 
8. Under-utilization of other professionals such as attorneys and accountants. Physicians have invested over a decade achieving an education to be excellent physicians. They know patient care, yet have not learned about tax laws, investing, home repair, and the basics of contracts. Unless physicians outsource these tasks to improve work/life balance by enjoying off-time, burnout concerns will continue.

This article’s broad discussion of physician burnout prompts a number of questions about workplace factors, the effects of burnout on patient outcomes, and how to transform healthcare systems. Each contributor to physician burnout holds answers on how to improve systems, from education to documentation, on behalf of physicians, those they care for, and those who care for these noble practitioners. As noted on one of the Mind Garden physician burnout solutions pages, “In order to fully remedy and prevent burnout, solutions must focus on organization change—not personal change.”  
 
Request Dr. Jared Heathman for speaking engagements on physician burnout.  Contact our office at 281-849-4080 with your information for further details.
 
References 
Dyrbye, L. N., Shanafelt, T. D., Sinsky, C. A., Cipriano, P. F., Bhatt, J., Ommaya, A.,…Meyers, D. (2017). Burnout among healthcare professionals: A call to explore and address this unrecognized threat to safe, high-quality care. Retrieved from https://medschool.ucsd.edu/som/hear/resources/Documents/Burnout-Among-Health-Care-Professionals-A-Call-to-Explore-and-Address-This-Underrecognized-Threat.pdf
 
Kane, L. (2019). Medscape national physician burnout, depression & suicide report, 2019.
 
Mind Garden. (2018). Maslach burnout tool for medical personnel. Retrieved from https://www.mindgarden.com/documents/Maslach-Burnout-Toolkit-for-Medical-Personnel-Intro-Sheet.pdf
 
Mind Garden. (2019). Physician burnout solutions. Retrieved from https://www.mindgarden.com/content/34-physician-burnout-solutions#horizontalTab1
 
National Academy of Medicine. (2020). Action collaborative on clinician well-being and resilience. Retrieved from https://nam.edu/initiatives/clinician-resilience-and-well-being/
 
Ostrov, B. F. (2018). Stanford’s chief wellness officer aims to end physician burnout. Retrieved from https://californiahealthline.org/news/stanfords-chief-wellness-officer-aims-to-prevent-physician-burnout/
 
Stehman, C. R., Testo, Z., Gershaw, R. S., & Kellogg, A. R. (2019). Burnout, dropout, suicide: Physician loss in emergency medicine, Part I. Western Journal of Emergency Medicine, 20(3): 485-494. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6526882/
 
West, C. P., Dyrbye, L. N., & Shanafelt, T. D. (2018). Physician burnout: Contributors, consequences, & solutions. Journal of Internal Medicine, 283(6): 516-529. Retrieved from https://onlinelibrary.wiley.com/doi/full/10.1111/joim.12752
 
World Health Organization. (2019). Burn-out an “occupational phenomenon”: International Classification of Diseases. Retrieved from https://www.who.int/mental_health/evidence/burn-out/en/

Sports therapists provide a range of services to athletes and individuals involved in sports to improve overall performance.  Did you know that the reigning champion Houston Astros has a full-time sports therapist on staff to maximize the skills of individual players?  If you want to take your game to the next level, think about all of the ways a sports therapist could help you:

1. Mental skills training: A sports therapist can help you develop mental skills such as goal-setting, visualization, relaxation, focus, and self-talk to improve your performance and manage the stress of competition.  Have you ever watched Texas Christian University baseball play?  The majority of the hitters approach the plate and individual pitches the same way.  They meet with the same therapist and work to develop the ideal way to approach each pitch.  
   
2. Performance enhancement: A sports therapist can work with you to identify the factors that may be holding you back from achieving your best performance and help you overcome them.  Ever heard of the "yips"?  The yips are an unexplained loss of peak ability in athletes.  Working with a sports therapist can help you overcome the obstacle.  
   
3. Injury rehabilitation: A sports therapist can assist you in coping with the psychological effects of injury and support you during the recovery process.  It can be incredibly frustrating when you encounter set-backs in your training.  Becoming discouraged can lead to further delays in recovery.  
   
4. Team building: A sports therapist can work with teams to improve communication, build team cohesion, and develop a positive team culture.  Many sports like baseball, basketball, and football require players to be continually working together to achieve ideal outcomes.  How well does your team communicate and work together?
   
5. Career transitions: A sports therapist can provide guidance and support during career transitions, such as retiring from sport, changing sports, or transitioning to a new role within the sport.  Not everyone can play sports professionally.  If you have played sports since you were a child, it is likely that your sport has become a part of who you are as a person.  Leaving the sport entirely can create a large void.  Have you thought about ways that you can transition to a new role within the sport and continue to get enjoyment out of it?
   
   

Attention Deficit Hyperactivity Disorder, or ADHD, is a neurological disorder that affects millions of people worldwide. This disorder can be characterized by inattention, impulsivity, and hyperactivity, which can make it difficult for individuals to function in their daily lives. Although ADHD is typically diagnosed in childhood, it can also be diagnosed in adulthood. If you or a loved one may have ADHD, seeking treatment can be life-changing.  Give us a call for a thorough evaluation.  In this article, we will discuss the top 10 reasons why you should get treatment for ADHD.

1. Improve academic or work performance 

One of the most common reasons people seek treatment for ADHD is to improve their academic or work performance. The symptoms of ADHD can make it difficult for individuals to focus and concentrate, leading to poor performance in school or at work. However, with proper treatment, individuals with ADHD can learn coping mechanisms and strategies to help them stay focused and productive.

2. Enhance interpersonal relationships 

ADHD can also impact interpersonal relationships, particularly in romantic relationships and friendships. People with ADHD may struggle to communicate effectively, remember important dates or events, or prioritize tasks. This can lead to frustration and misunderstandings between individuals. Treatment for ADHD can help improve communication skills, increase the ability to remember important details, and prioritize tasks, leading to stronger and healthier relationships.

3. Reduce impulsivity 

Impulsivity is a common symptom of ADHD, which can lead to impulsive decisions and behaviors. This can include anything from impulsive spending to engaging in risky behaviors, such as substance abuse or unsafe sexual practices. Seeking treatment for ADHD can help individuals learn to manage their impulses and make more thoughtful decisions.

4. Decrease anxiety and depression 

Individuals with ADHD are at a higher risk for developing anxiety and depression. This is partly due to the challenges of managing the symptoms of ADHD, as well as the potential for negative feedback from others. Seeking treatment for ADHD can help individuals manage their symptoms, which can lead to a decrease in anxiety and depression.

5. Improve sleep 

ADHD can also impact sleep, with individuals often struggling to fall asleep or stay asleep. This can lead to fatigue and other negative consequences, such as poor academic or work performance. Treatment for ADHD can help individuals learn coping mechanisms to improve sleep habits, leading to better overall health and wellness.

6. Increase self-esteem 

The challenges of managing ADHD can take a toll on an individual's self-esteem. Seeking treatment for ADHD can help individuals learn to manage their symptoms and develop coping mechanisms, which can increase self-esteem and confidence.

7. Improve physical health 

Untreated ADHD can have negative impacts on overall physical health, with individuals often struggling with higher blood pressure, obesity, and sleep issues. Poor time management leads to more frequent use of fast food, neglecting gym time, and getting stuck longer at the office.  Seeking treatment for ADHD can help individuals manage these symptoms, leading to better overall health and wellness.

8. Learn coping mechanisms 

Individuals with ADHD can learn valuable coping mechanisms through treatment, which can be useful throughout their lives. Coping mechanisms can include anything from meditation and mindfulness to cognitive-behavioral therapy. Learning coping mechanisms can help individuals manage their symptoms and lead a more fulfilling life.

9. Decrease risk of substance abuse 

Individuals with ADHD are at a higher risk for substance abuse, as they may turn to drugs or alcohol as a way to manage their symptoms. Seeking treatment for ADHD can help individuals learn alternative coping mechanisms, which can decrease the risk of substance abuse.

10. Improve overall quality of life 

Finally, seeking treatment for ADHD can improve overall quality of life. By learning to manage symptoms and developing coping mechanisms, individuals with ADHD can lead a more fulfilling life, with better academic or work performance, stronger relationships, and better overall health and wellness.

In conclusion, seeking treatment for ADHD can be life-changing. It can improve academic or work performance, enhance interpersonal relationships, reduce impulsivity, and decrease the odds of other mental health conditions.  Call us today at 281-849-4080.

Post-traumatic stress disorder (PTSD) is a mental health condition that affects people who have experienced or witnessed a significantly traumatic event and have ongoing impairment. Symptoms of PTSD include flashbacks, nightmares, and intrusive thoughts about the trauma, avoidance of reminders of the event, negative changes in mood and thinking, and heightened arousal and reactivity. PTSD was first recognized as a distinct diagnosis in the 1980s, but it is only in recent years that its prevalence has become a significant public health concern. In this article, we will explore why PTSD is more common today than it has been in the past.


Increased awareness and diagnosis
One of the primary reasons why PTSD is more common today is that there is greater awareness of the condition, and healthcare providers are better able to diagnose it. In the past, PTSD was often misdiagnosed or not diagnosed at all, particularly among military veterans and survivors of sexual assault. Today, there is more recognition that PTSD can result from a range of traumatic experiences, and healthcare providers are trained to identify the symptoms and provide appropriate treatment.

Less time to process trauma
In our fast paced society, there is not as much time to process trauma as the past.  Even in military settings, boats returning soldiers home took much longer than with current easy access to flights.  A popular hypothesis was that soldiers would spend their time talking and processing their trauma during their longer travels.  Now soldiers are often expected to immediately return home and function well in society.  Outside of military settings, society is increasingly available for work tasks with smartphones and internet access.  After trauma, many employers want employees back at work quickly.  There is less time for self-care, counseling, treatment, and other coping mechanisms.


Greater exposure to trauma
Another factor contributing to the increased prevalence of PTSD is the fact that people are being exposed to trauma at higher rates than in the past. Traumatic events such as mass shootings, natural disasters, and terrorist attacks are more frequent and widely reported in the media. The media is increasingly negative and will repeatedly show events that spike ratings.  Additionally, social media has made it easier for people to be exposed to traumatic events that are happening in real-time, which can lead to vicarious trauma.


Changes in the nature of trauma
The nature of trauma has also changed over time, which may be contributing to the increase in PTSD cases. For example, in the past, traumatic events were more likely to be acute and short-lived, such as a car accident or physical assault. Today, people are more likely to experience chronic, ongoing trauma, such as childhood abuse or living in a war zone. This type of trauma can have a cumulative effect, leading to more severe and persistent symptoms of PTSD.


Higher rates of sexual assault
Sexual assault is a particularly traumatic experience that can lead to PTSD. Unfortunately, rates of sexual assault have been increasing in recent years, particularly on college campuses. This may be due in part to greater awareness and reporting of sexual assault, but it is also a reflection of broader social and cultural issues related to gender and power. 


Increased stress and anxiety
In addition to exposure to traumatic events, people today are experiencing higher levels of stress and anxiety than in the past. Economic uncertainty, job insecurity, peer pressure, social media enhanced expectations, social isolation, and other factors can contribute to chronic stress, which can lead to the development of PTSD symptoms. Additionally, people today may be more likely to experience a traumatic event when they are already experiencing high levels of stress, which can make them more vulnerable to the effects of trauma.


Changes in the healthcare system
Changes in the healthcare system may also be contributing to the increased prevalence of PTSD. For example, the opioid epidemic has led to an increase in the number of people seeking treatment for substance use disorders, many of whom have also experienced trauma. Additionally, the trend towards deinstitutionalization of people with mental illness has led to more people living in the community, where they may be exposed to trauma and have less access to mental healthcare.

In conclusion, PTSD is more common today than it has been in the past due to a range of factors, including increased awareness and diagnosis, greater exposure to trauma, changes in the nature of trauma, higher rates of sexual assault, increased stress and anxiety, and changes in the healthcare system. While these trends are concerning, there is reason for hope. Greater awareness and understanding of PTSD can lead to better prevention and treatment, and there is a growing recognition that addressing trauma is essential for improving public health and well-being. By working together to address the underlying causes of trauma, we can better treat PTSD.  Even you believe you are experiencing PTSD, do not hesitate to seek treatment.  

Prozac, also known as fluoxetine, is a type of antidepressant medication that is commonly used to treat depression, anxiety, and other mental health disorders. It is one of the most popular and widely prescribed antidepressants on the market today and has been in use since the 1980's. While Prozac has proven to be effective for many people, there are also some drawbacks to using this medication. In this article, we will explore the pros and cons of Prozac (fluoxetine) in more detail.


Pros of Prozac:

1. Proven effectiveness: Prozac is a widely studied and tested medication that has been shown to be effective in treating depression, anxiety, and other mental health disorders. It is part of a group of medications called selective serotonin reuptake inhibitors (SSRI's), which work by increasing the levels of serotonin in the brain. Serotonin is a neurotransmitter that is associated with feelings of well-being, peacefulness, and happiness. By increasing the levels of serotonin in the brain, Prozac can help to alleviate symptoms of depression and anxiety.
   
2. Fewer side effects: Compared to other types of antidepressants, Prozac is known for having fewer side effects. This is because it is a relatively new medication that has been developed specifically to target the serotonin system in the brain. Some of the common side effects of Prozac include nausea, insomnia, and sexual dysfunction. However, these side effects are usually mild and most tend to go away over time.  Talk with your physician if sexual dysfunction occurs.  There are possible solutions to this including changing medications or adding other medications to counteract this affect.  Prozac also has fewer withdrawal symptoms than many other mental health medications.
   
3. Long-term safety: Prozac has been in use for over 30 years and has a well-established safety record. Prozac is FDA approved for Major Depressive Disorder or Depression in as young as age 8.  No other medication is FDA approved for depression in children this young. This means that it can likely be used safely over the long-term to manage chronic depression and anxiety.
   
4. Easy to use: Prozac is available in tablets, capsules, and oral solution to help with ease of administration.  It is also sometimes used 1x/week, but talk to your Houston psychiatrist if this is something you are interested in.  Not all dosages are designed for weekly use. This makes Prozac easy to use and convenient for people who are managing their mental health symptoms.
   
   
   

Cons of Prozac:

1. Slow onset of action: One of the drawbacks of Prozac is that it can take several weeks to start working. Some will see benefit in the first 48 hours, but there is a wide range or response times.  This means that people who are experiencing severe depression or anxiety may need to wait a while before they start feeling better. This slow onset of action can be frustrating for some people, and may lead them to discontinue the medication prematurely.  Talk with your psychiatrist about faster options if needed.
   
2. Sexual dysfunction: One of the most common side effects of Prozac is sexual dysfunction. This can include decreased libido, difficulty achieving orgasm, and erectile dysfunction. For some people, these side effects can be severe enough to interfere with their quality of life.  Many mental health medications can affect sexual functioning (increased or decreased).  Psychiatrists at Your Family Psychiatrist regularly engage in questions about sexual functioning.  These questions will not be met with shame or judgement.  We have heard it all before.  
   
3. Interaction with other medications: Prozac can interact with some other medications, including over-the-counter medications and herbal supplements. This means that people who are taking Prozac need to be careful about what other medications they are taking and should always consult with their healthcare provider before starting any new medications.
   
   
   

In conclusion, Prozac is a widely used and effective medication for managing depression, anxiety, and other mental health disorders. While it has many benefits, there are also some drawbacks to using this medication. People who are considering Prozac should carefully weigh the pros and cons before starting treatment, and should always work closely with their healthcare provider to ensure that they are using the medication safely and effectively.

Starting therapy can be a daunting experience for many individuals. Despite the potential benefits of therapy, such as improved mental health and well-being, the thought of opening up to a stranger about one's deepest emotions and vulnerabilities can feel overwhelming. In this article, we will explore some of the reasons why starting therapy can be scary.


Fear of being judged
One of the main reasons why starting therapy can be scary is the fear of being judged. Many individuals worry that their therapist may view them as weak or flawed for seeking help. This fear can be particularly strong for individuals who have grown up in cultures or families that stigmatize mental health issues or therapy. However, it is important to remember that therapists are trained to provide a non-judgmental and empathetic space for their clients. They are there to help individuals work through their challenges and provide support, not to judge them.


Fear of vulnerability
Opening up about one's deepest emotions and vulnerabilities can be scary. Many individuals worry that they may be too emotional or that they may become overwhelmed during therapy sessions. Others may feel uncomfortable with the idea of being vulnerable with a stranger. However, it is important to remember that vulnerability is a normal part of the therapeutic process. Therapy is a safe and supportive space for individuals to explore their emotions and experiences without judgment.


Fear of the unknown
Starting therapy can be scary because it is often an unknown experience. Individuals may feel anxious about what to expect during therapy sessions, how to open up to their therapist, or whether therapy will be helpful. This fear can be particularly strong for individuals who have never been to therapy before or who are not familiar with the therapeutic process. However, it is important to remember that therapy is a collaborative process between the therapist and the client. The therapist will work with the individual to set goals and determine the best approach for their needs.


Fear of change
Many individuals are afraid of change, even if it means making positive changes in their lives. Starting therapy can be scary because it often means confronting difficult emotions and experiences that may have been avoided or ignored in the past. The therapeutic process can be challenging, as it requires individuals to examine their thoughts, behaviors, and emotions and make changes where necessary. However, it is important to remember that therapy can be a transformative and empowering experience. By confronting their challenges and working through them with the support of a therapist, individuals can make positive changes in their lives and improve their mental health and well-being.


Fear of the stigmaThere is still a stigma surrounding mental health issues and therapy in some communities. Many individuals worry that seeking therapy may be perceived as a weakness or that it may be used against them in the future. This fear can be particularly strong for individuals who are in professions or social circles that do not view mental health issues or therapy favorably. However, it is important to remember that seeking therapy is a sign of strength and self-awareness. It takes courage to confront one's challenges and seek support when needed.


In conclusion, starting therapy can be scary for a variety of reasons. The fear of being judged, vulnerability, the unknown, change, and stigma are all common concerns for individuals considering therapy. However, it is important to remember that therapy is a safe and supportive space for individuals to explore their emotions and experiences without judgment. By seeking therapy, individuals can make positive changes in their lives, improve their mental health and well-being, and gain the tools and skills to navigate life's challenges. If you are considering therapy, it is important to remember that you are not alone and that seeking help is a sign of strength and self-awareness.

Panic attacks are characterized by sudden and intense feelings of fear, anxiety, and discomfort. During a panic attack, individuals may experience a wide range of physical symptoms, including shortness of breath, palpitations, dizziness, sweating, and chest pain. Chest pain is one of the most common symptoms experienced by individuals during a panic attack, and it can be a source of significant distress and concern.


Chest pain during a panic attack is often described as a tightness or pressure in the chest that may feel like a heart attack. This sensation can be frightening and can exacerbate feelings of anxiety and panic. However, it is important to note that chest pain during a panic attack is not usually a sign of a serious medical condition.


So, why do panic attacks cause chest pain?


There are several reasons why panic attacks can cause chest pain. The first reason is related to the physical symptoms of anxiety. During a panic attack, the body's fight or flight response is activated, triggering the release of stress hormones such as adrenaline and cortisol. These hormones can cause physical changes in the body, including an increased heart rate, rapid breathing, and muscle tension. This can lead to chest pain, as the muscles in the chest become tense and constricted, making it difficult to breathe and causing discomfort.


Another reason why panic attacks can cause chest pain is related to the psychological symptoms of anxiety. During a panic attack, individuals may experience intense feelings of fear, dread, and impending doom. These feelings can trigger a range of physical sensations, including chest pain. The fear of having a heart attack or other serious medical condition can also exacerbate the physical symptoms of anxiety, leading to chest pain and other discomfort.


In addition to the physical and psychological symptoms of anxiety, panic attacks can also cause chest pain due to hyperventilation. Hyperventilation is a common symptom of panic attacks, and it occurs when individuals breathe too quickly or deeply. This can lead to an imbalance in oxygen and carbon dioxide levels in the body, causing symptoms such as dizziness, lightheadedness, and chest pain.


It is important to note that chest pain during a panic attack is usually not a sign of a serious medical condition. However, if you are experiencing chest pain or discomfort, it is always a good idea to seek medical attention to rule out any serious underlying health issues.  Heart attacks can cause similar symptoms which is why patients with panic attacks often are diagnosed first in the emergency room.


In conclusion, chest pain is a common symptom experienced by individuals during a panic attack. This discomfort can be caused by a range of physical and psychological factors, including muscle tension, hyperventilation, and feelings of fear and anxiety. While chest pain during a panic attack can be distressing, it is usually not a sign of a serious medical condition. If you are experiencing chest pain or discomfort, it is important to seek medical attention to rule out any underlying health issues and to find ways to manage and reduce the symptoms of anxiety.

What is psychodynamic psychotherapy?
Ever wondered - Why do I become more like my mom or dad even though I am doing everything I can to avoid it?  Why am I attracted to partners with the same problems? According to psychodynamic theory, early life experiences in relationships shape the way that we interact with others for the rest of our lives. The familiar is comforting to us, so we unknowingly repeat the past. Avoidance of the past can paradoxically lead to repeating it. Until we break the cycle, the past may continue repeating itself.  Psychodynamic psychotherapy (also called psychoanalysis) looks for patterns from the past (for example early family relationships) that persist into our present. 


You and your therapist examine present relationships and how they compare to past relationships. The therapist’s job is to understand the relational dynamics happening in session and help change the dynamic which can help break the cycle. Clients learn to stop avoiding distressing thoughts, feelings, and sensations and learn to sit in discomfort, something that psychodynamic therapy has in common with mindfulness based therapies like Acceptance and Commitment Therapy (ACT). The theory is that when we learn to recognize internal conflicts, we can also learn to deal with them in healthy ways, which will lessen symptoms. 


What does psychodynamic theory look for? 
Psychodynamic theory looks for uncomfortable feelings and thoughts that lead to avoidance. According to psychodynamic theory, uncomfortable thoughts and feelings are pushed down and can lead to symptoms in our bodies. Our bodies struggle to bring these conflicts to the surface and thus into our awareness. Examples of possible bodily symptoms are muscle aches, headaches, stomach pain, and loss of feeling in arms and legs or less commonly in other body parts. 


What makes psychodynamic theory different from other theories in treatment?
What makes psychodynamic therapy special is that it focuses on deep-seated issues in order to alleviate symptoms rather than focusing only on the symptoms themselves. This makes psychodynamic therapy more typically long-term. The theory focuses on creating greater, long-term change rather than what are perceived as short-term and surface-level changes via cognitive, behavioral, or solution-focused therapies. 


What can I expect and who benefits from psychodynamic psychotherapy?
Some favorite interventions utilizing psychodynamic therapy involve dream work, art therapy, describing fantasies, and exploring themes and symbols. These types of activities are thought to awaken unconscious content and bring forth important information about inner conflicts and family dynamics. If you enjoy abstract thinking, fantasies, and being creative, you may feel drawn to psychodynamic therapy. 


Psychodynamic therapy has been shown to be helpful in managing depression, anxiety including panic disorder, somatoform disorder, eating disorders, personality disorders including borderline personality disorder, and substance-related disorders

Ketamine has been in use as an anesthetic and sedative in operating and emergency rooms for the last 40+ years. More recently, studies have demonstrated its effectiveness in mental health, most notably in patients with chronic, treatment-resistant conditions like anxiety, depression, PTSD, and chronic pain. Ketamine Assisted Psychotherapy (KAP) is an emerging treatment in psychiatry and psychotherapy.  It combines the medicinal effects of ketamine with therapy in a state that better allows you to access difficult emotions and memories.  

Ketamine is the only current psychedelic substance approved by the Federal Drug Administration (FDA). The effects of Ketamine can lead to relief of everyday distressing emotional, physical, and mental states. Ketamine is thought to be helpful therapeutically as the psychedelic effects lead to non-ordinary state of consciousness where fear of difficult feelings, thoughts, and sensations are lessened.  This can allow for more advanced therapy to occur.

Ketamine shows promise in clinical studies for rapid symptom reduction for individuals with treatment-resistant depression including a reduction in suicidal thoughts.  The rapid reduction of symptoms stands out against common psychiatric medications that require weeks for full effect and traditional talk therapy, which can take months for significant symptom reduction.  Ketamine is considered a NMDA receptor antagonist, but some theorize that ketamine works by encouraging neuroplasticity (neuronal growth). 

Ketamine assisted psychotherapy takes place in the office under the care of dedicated, trained staff. Psychiatrists analyze patient fitness for ketamine: individuals with chronic heart issues, hyperthyroidism, uncontrolled hypertension, among others, should not take ketamine. It is important to disclose all over-the-counter and prescription medications to staff to avoid interactions. Studies that focus on ketamine often utilize a treatment plan that begins with approximately six sessions in the first 2-4 weeks and then tapered maintenance sessions.  Treatment that involves therapy will typically include being in the clinic for 2-3 hours.

The optimal dosage and modality (oral, intramuscular) are determined based on the ketamine experience by the patient and assessment by the psychiatrist. Therapists working with clients will reassure, validate, and deeply listen to each patient while anchoring the KAP session. In this safe environment, the patient is able to engage with the effects of ketamine and begin the journey to long term change.

While some clinics focus on providing ketamine intravenously in a medical setting, we believe long term change better occurs when combining ketamine with counseling in a more relaxed setting.  Accessing and addressing our trauma, frustrations, and emotions that hold us back can better allow for change to occur.

Common side effects are: out of body experience, increased heart rate and blood pressure, dizziness, nausea, and sedation. These side effects typically dissipate within a few hours. Patients in ketamine treatment are not safe to drive for approximately 12 hours, thus must leave the office with a designated driver. 

Ketamine treatment is for patients who have tried psychiatric medications or are looking for another option for treatment-resistant depression and other disorders. Ketamine, however, is not the only alternative. Other options for treatment-resistant depression include transcranial magnetic stimulation (TMS) and electroconvulsive therapy (ECT). Symptom alleviation may not be permanent, and may require further ketamine treatments. 

If you believe you may be a candidate for Houston ketamine assisted psychotherapy, contact our office at 281-849-4080 for a psychiatric consultation. 

Regular and consistent sleep patterns are an important aspect of children’s mental wellness. During sleep, children’s minds process information from daily experiences and stressors. Regular and consistent sleep can lead to greater self regulation and less likelihood for behavioral issues resulting from tiredness and sleepiness.

In short, when children are rested, they feel calmer, less anxious, and more in control of their emotions and responses. Restful activities combined with routines are more likely to lead to good sleep hygiene. The steps to creating a successful nighttime routine include consistency, a calm environment, connection, and preparation for potential hiccups. 


Routine
Create a bedtime routine that includes the routine essentials but also incorporates calming activities. Bedtime routines optimally begin 1-2 hours before sleep, but can take less time once the routine is internalized. This window of time prepares the child for rest both emotionally and physically. Create a bedtime poster with your child, list the activities (written or drawn), and discuss why each step in the routine is important for the child’s health and wellness.

Increase self-efficacy by asking your child how he/she feels after they complete each task. For children who become distracted or are overwhelmed easily, following the steps on the chart will keep them on task and organized. Include options and privileges. For example, when kindergartner Caroline completes her bedtime routine, she may choose one of three calming bedtime activities: story time, coloring, or playing with a fidget toy. Watching electronics at bedtime should be avoided as the graphics, colors, movements, and sounds will activate the brain leading to restlessness rather than rest. 


Environment
Create a calm environment at the start of the bedtime routine. Dim the lights or switch from overhead lighting to lamps. Close the blinds or curtains. Turn on calm music. The child’s sleep area should be as uncluttered as possible in order to decrease distractions and anxiety. Include favorite stuffed animals in their bed.

Select a corner or area of the room in which the child has easy access to calming toys and books. Include comfortable seating, whether a floor pillow, rocker, beanbag chair or tent. Create physical boundaries by naming what rooms/areas of the house are within or off limits during the bedtime routine. 


Connect
Finish the routine with a short mindfulness or loving-kindness exercise to promote a calm mental state for sleep. Ask your child to list three people he/she is grateful for or list one thing that went surprisingly well today.  


Recite a mantra: “ I feel calm in my body. I feel calm in my mind. I feel calm in my heart.” Whatever your activity, take this moment to connect with your child. Caregiver connection, even for short periods, enables co-regulation between parent and child. 


Hiccups
When routines are interrupted, behavior changes due to dysregulation can result. Factors like hunger and tiredness can lead to outbursts or hyperactivity. Introduce a calming activity before beginning the bedtime routine. Explain to your child that calming activities, as moments for self regulation, are neither privilege nor punishment, but essential for healthy emotional regulation development.

​When your child is dysregulated, attune yourself by bringing your body to their level, using an even and calm tone, and looking them in the eyes. If your child is unable to focus on you, touch them gently, for example by lightly touching their arms. “I see that you have a lot of energy. It is time to sleep. Let’s take a few minutes to calm down with a quiet activity.” Narrating behavioral issues without shame will make the child feel seen by the caregiver and also help the child recognize behaviors and triggers over time. 


When nightmares and specific fears add to bedtime anxiety, try these strategies. Take your child with you as you check around their room for common fears like monsters, spiders, or snakes. Keep it lighthearted. This will validate the child’s fears and show that their safety and wellbeing are important to you. Reframe fears by asking your child if there is anything interesting or likable about the thing they fear. Name exceptions to fears. Ask your child: “What about you could be scary to the monster?” Your local librarian can recommend books about common fears. For example, Seaver the Weaver by Paul Czajak and Verdi by Janell Cannon impart child-like struggles upon a spider (Czajak) and a snake (Cannon). When monsters acquire human-like qualities, children’s fears deflate as children recognize that all things, even monsters, have fears.