Tagged Therapy and Rehabilitation

How to Start Healing During a Season of Grief

There is no singular way to respond to heartache or sorrow. Find the strategy that works best for you.

We are all grieving right now.

Perhaps you’re one of the millions who has lost a loved one to the brutalities of Covid-19, or maybe you’re grieving another kind of loss: missed time with family and friends, a postponed wedding, a former job. Many of us have also grieved circumstances or deaths unrelated to the coronavirus — each made even more difficult in the context of a pandemic.

Every loss deserves to be acknowledged and addressed. So we gathered advice from bereavement experts and asked people who have recently experienced grief to tell us how they are finding peace.

There are a wide variety of strategies. But it’s important to acknowledge that many people “don’t have the luxury of attending fully to grief and mourning,” said Therese A. Rando, the clinical director of the Institute for the Study and Treatment of Loss in Warwick, R.I. “That’s one of the most insidious things about the pandemic.”

If you’re running on adrenaline and still living in survival mode, start small and see if one of the methods below might be helpful to you, too.

Lean on your virtual community

“In initial stages of bereavement, many grievers find the most helpful resource to be other supportive people,” said Sherry Cormier, a psychologist and bereavement trauma specialist in Edgewater, Md. “This is because grief can feel like abandonment, and because it can feel isolating.”

Finding this kind of support in person can be a challenge during the pandemic, but video chats with helpful friends or family are often useful substitutes for get-togethers, she added.

Online resources like Grieving.com and Grief Healing Discussion Groups offer moderated group discussion forums, and the websites National Covid-19 Day and Modern Loss have additional resources for people who need support.

What people tend to find most helpful during the grieving process is “acknowledgment, and an ongoing invitation to share their experiences,” said Rebecca Soffer, the co-founder and chief executive of Modern Loss. “This has become all the more urgent as grieving people have had to endure the process in relative isolation for more than a year.”

Online religious services can also provide a sense of community.

Elizabeth Sanford, 58, who lives in Atlanta, said she started listening to the morning prayers of a monastery in Cumbria, England, a few months after her father died and the country went into lockdown. She watches nearly every morning on Facebook Live at 3 a.m., which is when she now tends to wake up.

“It’s like getting a hug,” she said. “The bells ring. The guided imagery helps me cry. The prayers bring peace.”

Finally, keep an eye out this spring for a new online guide with nearly 80 websites pertaining to grief during the pandemic. The guide, which is being curated by Camille B. Wortman, an expert on grief and a professor emeritus of psychology at Stony Brook University in New York, will cover topics as varied as how to process feelings of guilt or lack of closure; how to explain death to a child; and how to help those who are mourning.

Learn something new

“It’s hard to be grieving actively when you are learning something new,” Dr. Cormier said. “It’s stimulating to our brain, and it takes our mind off of our struggle.”

Whether you start volunteering, foster a pet or take up a hobby, you are giving yourself a mental break from grieving, the experts said.

That was the case for Allyn Young, 43, who lives in Manhattan. After her father died of Covid in December, she said, she became “obsessed with horses.”

She started reading books about horses, following horse rescues on Instagram and watching a documentary series that described how horses are used for therapy.

“I had no idea!” she said. “Right now I’m trying to get in touch with the stables around N.Y.C. to take lessons and volunteer. My newfound and totally random excitement at the idea of petting a horse has been bringing me joy.”

Mark Seaman, 51, a cake decorator who lives in Chicago, said he became sad and fearful when his husband started suffering from serious health problems in December of 2019. A few months later Mr. Seaman began teaching himself to crochet by watching a how-to video on the website Craftsy, and started to feel more at ease.

“The repetitive nature of the activity distracted me so fully from the reality of the pandemic that the world was experiencing that I felt calm,” Mr. Seaman said.

Explore podcasts and books

Many people who are in the depths of grief find inspiration and connection while listening to podcasts, Dr. Cormier said.

In “Everything Happens,” Kate Bowler, a professor at Duke Divinity School, talks with people about what they’ve learned in dark times; “Terrible, Thanks for Asking” is hosted by Nora McInerny, an author who asks people to share their complicated and honest feelings about how they are actually doing; and “Unlocking Us,” with Brené Brown, a research professor at the University of Houston, aims to reveal the “messiness of what it means to be human.”

Then there are books — far too many examples to mention here, including “Finding Meaning: The Sixth Stage of Grief” by David Kessler (2019); and “It’s OK That You’re Not OK: Meeting Grief and Loss in a Culture That Doesn’t Understand” by Megan Devine (2017).

Dr. Cormier has also written a book, “Sweet Sorrow: Finding Enduring Wholeness After Loss and Grief” (2018), based in part on her own experience with cumulative grief. In the span of six years, she lost her father, husband, mother and sister.

“I really get what people are going through. I get the heartbreak. I get the wanting to stay under the covers all day,” she said.

If you have young children or teenagers, there are a variety of books and films that can help them cope with loss, too. And check out these articles about how to talk with children about death and how to help children with pandemic grief.

Speak with a grief counselor, religious leader or other professional

Kristin Taylor, 39, of Oak Park, Ill., who lost her mother to pancreatic cancer in November, had tried it all: meditation, talking with friends who lost their parents, long walks, writing in a journal and yoga. “Nothing helped too much,” she said.

Then she started speaking with a grief counselor once a week.

“I feel I have a place to not only openly weep and mourn without burdening another person, but I also now have someone to help me sort out the trauma I experienced while caregiving and witnessing an aggressive and ruthless cancer take over my mother’s body,” Ms. Taylor said.

A November survey of more than 800 U.S. adults who lost someone to Covid-19 found that two-thirds of the respondents were suffering from debilitating levels of grief, a type of mourning that can disrupt a person’s ability to live life normally.

If you are using drugs or alcohol to cope, or if you are having trouble functioning, it’s important to speak with a professional, said Sherman A. Lee, an associate professor of psychology at Christopher Newport University in Newport News, Va., and one of the authors of the study. Dr. Lee’s website, The Pandemic Grief Project, offers a short test that people can use to assess their level of distress: A score of seven or higher suggests that additional assessment or treatment is needed.

The demands of the pandemic have made it even more difficult for some people to find a mental health provider, however, especially one who takes insurance.

Psychology Today maintains a large list of providers that you can filter by location, insurance, specialty or other criteria. But if you can’t find a provider who is accepting new patients, ask the providers you contacted or your primary care provider for referrals.

Online therapy services may also be worth exploring if you need to speak with someone quickly.

Get active

Sayrah Garrison, 47, a licensed clinical social worker and dance teacher, is grieving the death of her mother-in-law, and missing her family’s California home now that they have moved across the country to New Jersey to be closer to her father-in-law. In March, she found a “grief dancer” workshop, rooted in the meditative 5Rhythms movement practice, to be cathartic and enlightening.

“I realized how much I actually missed our home in Oakland and how much I missed my regular students and the incredibly healing dance spaces we shared together,” she said.

Aerobic exercise may also release mood-elevating endorphins, the chemicals that can help you feel relaxed and happy after a workout.

Yoga is another option that helps strengthen your body and build flexibility, while offering an added spiritual component that can be calming in times of stress.

Tania Bunik of Minneapolis, Minn., 55, said the Down Dog yoga app, which she uses every day, helped preserve her mental health during a time of chaos by giving her the space to do something therapeutic for herself.

“It allows you to tailor your yoga session by the amount of time you have, the pace, the background music, the areas of your body you want to work on,” she said. “It gave me a sense of control because I had choices.”

Spend time in nature

Several people who are grieving told us that they have found it relaxing to take walks in nature; nurture their garden; or simply sit outside and observe.

“I was determined to make our backyard a nature sanctuary with a lot of beautiful flowers in the gardens, a bird bath and feeders,” said Carol Struve, 70, an artist and retired nurse who lives in Kingston, N.Y. Last year, Ms. Struve fractured her sternum, mourned the deaths of three older relatives and then grappled with a uterine cancer diagnosis.

“I restored the vintage, rusty patio furniture and bought a new umbrella for the table,” said Ms. Struve, who spent many afternoons making drawings of the flowers and gardens. “This helped me find my way through the cancer diagnosis and surgery, along with the support of my therapist and friends.”

If you don’t have easy access to a scenic spot, watching tranquil scenes on video can also be soothing. Dr. Wortman said that she and her husband take about 15 minutes a day to watch nature videos featuring scenic landscapes and animals.

It is easy and comforting, she added, and “it shows you that there’s still beauty in the world.”

For Some Teens, It’s Been a Year of Anxiety and Trips to the E.R.

For Some Teens, It’s Been a Year of Anxiety and Trips to the E.R.

During the pandemic, suicidal thinking is up. And families find that hospitals can’t handle adolescents in crisis.

Lisa, a mother of three in Asheville, N.C., said that months of virtual classes and social isolation had changed her extroverted 13-year-old son “in profound ways I would never have anticipated.”
Lisa, a mother of three in Asheville, N.C., said that months of virtual classes and social isolation had changed her extroverted 13-year-old son “in profound ways I would never have anticipated.”Credit…Jacob Biba for The New York Times
Benedict Carey

  • Published Feb. 23, 2021Updated Feb. 24, 2021, 5:00 a.m. ET

When the pandemic first hit the Bay Area last spring, Ann thought that her son, a 17-year-old senior, was finally on track to finish high school. He had kicked a heavy marijuana habit and was studying in virtual classes while school was closed.

The first wave of stay-at-home orders shut down his usual routines — sports, playing music with friends. But the stability didn’t last.

“The social isolation since then, over all this time, it just got to him,” said Ann, a consultant living in suburban San Francisco. She, like the other parents in this article, asked that her last name be omitted for privacy and to protect her child. “This is a charming, funny kid, also sensitive and anxious,” she said. “He couldn’t find a job; he couldn’t really go out. And he started using marijuana again, and Xanax.”

The teenager’s frustration finally boiled over this month, when he deliberately cut himself.

“We called 911, and he was taken to the emergency room,” his mother said. “But there they just stitched him up and released him.” The doctors sent him home, she said, “with no support, no therapy, nothing.”

Ann and her son are like many families over the last year. Surveys and statistics show that for young people who are anxious by nature, or feeling emotionally fragile already, the pandemic and its isolation have pushed them to the brink. Rates of suicidal thinking and behavior are up by 25 percent or more from similar periods in 2019, according to a just-published analysis of surveys of young patients coming into the emergency room.

For these teenagers, there aren’t many places to turn. They need help, but it’s hard to come up with a psychiatric diagnosis. They are trying to manage a surprise interruption in their lives, a vague loss. And without a diagnosis, reimbursement for therapy is hard to come by. And that is assuming parents know what kind of help is appropriate, and where to find it.

Finally, when a crisis hits, many of these teenagers end up in the local emergency department — the one place desperate families so often go for help.

Many E.R. departments across the country are now seeing a surge in such cases. Through most of 2020, the proportion of pediatric emergency admissions for mental problems, like panic and anxiety, was up by 24 percent for young children and 31 percent for adolescents compared to the previous year, according to a recent report by the Centers for Disease Control and Prevention.

And the local emergency department is frequently unprepared for the added burden. Workers often are not specially trained to manage behavioral problems, and families don’t have many options for where to go next, leaving many of these pandemic-insecure adolescents in limbo at the E.R.

“This is a national crisis we’re facing,” Dr. Rebecca Baum, a developmental pediatrician in Asheville, N.C. “Kids are having to board in the E.R. for days on end, because there are no psychiatric beds available in their entire state, never mind the hospital. And of course, the child or adolescent is lying there and doesn’t understand what’s happening in the E.R., why they’re having to wait there or where they’re going.”

What Adolescents Are Feeling

Most teenagers and young adults have done fine through this pandemic year, provided that their families have stayed healthy and economically stable. They may be irritable or missing their friends, but their support networks have been enough to get them through the pandemic.

For the young people coming undone, however, pandemic life presents unusual challenges, pediatricians say. Most are temperamentally sensitive and after months of being socially cut off from friends and activities, they have much less control over their moods.

“What parents and children are consistently reporting is an increase in all symptoms — a child who was a little anxious before the pandemic became very anxious over this past year,” said Dr. Adiaha I. A. Spinks-Franklin, an associate professor of pediatrics at the Baylor College of Medicine. It is this prolonged stress, Dr. Spinks-Franklin said, that in time blunts the brain’s ability to manage emotions.

Jean, an artist and mother of two living in Hendersonville, N.C., said that her 17-year-old son was doing fine through last spring. But the months of virtual classes and loss of simple social pleasures — hanging out with friends, playing chess — changed him through the fall months.

“Now, he’s become very reclusive, he has mood swings, he cries a lot,” Jean said. “This giant boy, crying — it’s terrible to see.” The young man has had panic attacks, twice followed by a blackout. During one, he fell and injured his face.

Dr. Adiaha I. A. Spinks-Franklin, an associate professor of pediatrics at the Baylor College of Medicine, says it’s the prolonged stress that blunts the brain’s ability to manage emotions.
Dr. Adiaha I. A. Spinks-Franklin, an associate professor of pediatrics at the Baylor College of Medicine, says it’s the prolonged stress that blunts the brain’s ability to manage emotions.Credit…Brett Deering for The New York Times

Lisa, a mother of three in Asheville, said that the months of virtual classes and relative social isolation had changed her extroverted 13-year-old son “in profound ways I would never have anticipated.”

His grades slipped badly, and he began to withdraw. “Next, he was telling us he couldn’t make himself do the work, that he didn’t want to disappoint us all the time, that he was worthless. Worthless.”

These young people do not necessarily qualify for a psychiatric diagnosis, nor are they “traumatized” in the strict sense of having had a life-threatening experience (or the perception of one.) Rather, they are trying to manage an interruption in their normal development, child psychologists say: a sudden and indefinite suspension of almost every routine and social connection, leaving a deep yet vague sense of loss with no single, distinct source.

The result is grief, but grief without a name or a specific cause, an experience some psychologists call “ambiguous loss.” The concept is usually reserved to describe the experience of immigrants, displaced from everything familiar, who shut down emotionally in a new and strange country. Or to describe disaster survivors, who return to neighborhoods that are hollowed out, transformed.

“Everything that used to be familiar and give structure to their lives, and predictability, and normalcy, is gone,” said Sharon Young, a therapist in Hendersonville. “Kids need all these things even more than adults do, and it’s hard for them to feel emotionally safe when they’re no longer there.”

System Overload

The resulting changes in behavior can seem sudden: A bright sixth-grader is found cutting herself; a sweet-natured sophomore takes a swing at a parent or sibling. Parents, frightened, often don’t know where to go for appropriate help. Many don’t have the resources or knowledge to hire a therapist.

Families that land in the emergency departments of their local hospitals often find that the clinics are poorly equipped to handle these incoming cases. The staff is better trained to manage physical trauma than the mental variety, and patients are often sent right back home, without proper evaluation or support. In severe cases, they may linger in the emergency department for days before a bed can be found elsewhere.

In a recent report, a research team led by the C.D.C. found that less than half of the emergency departments in U.S. hospitals had clear policies in place to handle children with behavior problems. Getting to the bottom of any complex behavior issue can takes days of patient observation, at minimum, psychiatrists say. And many emergency departments do not have the on-hand specialists, dedicated space or off-site resources to help do the job well.

For Jean, diagnosing her son has been complicated. He has since developed irritable bowel syndrome. “He has been losing weight, and started smoking pot due to the boredom,” Jean said. “This is all due to the anxiety.”

Nationwide Children’s Hospital in Columbus, Ohio, has an emergency department that is a decent size for a pediatric hospital, with capacity for 62 children or adolescents. But well before the arrival of the coronavirus, the department was straining to handle increasing numbers of patients with behavior problems.

“This was huge problem pre-pandemic,” said Dr. David Axelson, chief of psychiatry and behavioral health at the hospital. “We were seeing a rise in emergency department visits for mental health problems in kids, specifically for suicidal thinking and self-harm. Our emergency department was overwhelmed with it, having to board kids on the medical unit while waiting for psych beds.”

Last March, to address the crowding, Nationwide Children’s opened a new pavilion, a nine-story facility with 54 dedicated beds for observation and for longer-term stays for those with mental challenges. It has taken the pressure off the hospital’s regular emergency department and greatly improved care, Dr. Axelson said.

Over this pandemic year, with the number of admissions for mental health problems up by some 15 percent over previous years, it is hard to imagine what it would have been like without the additional, devoted behavioral clinic, Dr. Axelson said.

Other hospitals from out of state often call, hoping to place a patient in crisis, but there is simply not enough space. “We have to say no,” Dr. Axelson said.

“We had a shaky system of care in pediatric mental health prior to this pandemic, and now we have all these added stressors on it,” said  Dr. Rebecca Baum, a developmental pediatrician in Asheville, N.C.Credit…Jacob Biba for The New York Times

Dr. Rachel Stanley, the chief of emergency medicine at Nationwide, said that most hospitals have far fewer resources. “I worked at a hospital in Michigan for years, and when these kinds of kids come in, everyone dreaded seeing them, because we didn’t feel like we had the tools to help,” she said. “They have to go into a safe room; they can’t be in a shared area. You have to provide a sitter for the child, a staff person to stay with them all the time to make sure they’re not suicidal or homicidal. It could take hours and hours to get social workers involved, and all this time they’re getting worse.”

Anne, the consultant in the Bay Area, said that her son’s visit to the emergency room this month was his third in the past 18 months, each time for issues related to drug withdrawal. On one visit, he was misdiagnosed with psychosis and sent to a locked county psychiatric ward. “That experience itself — locked for days in a ward, with no one telling him why, or how long he’d be there — was the most traumatic thing he’s experienced,” she said.

Like many other parents, she is now looking after an unstable child and wondering where to go next. A drug rehab program may be needed, as well as regular therapy.

Lisa has hired a therapist for her son, a Zoom session every other week. That seems to have helped, she said, but it is too early to tell. And Jean, for the moment, is hoping the infection risk will diminish soon, so her son can get a safe job.

All three parents have become keen observers of their children, more aware of shifting moods. Listening by itself usually helps relieve distress, therapists say. “Trying to educate parents is a routine part of the job,” said Dr. Robert Duffey, a pediatrician in Hendersonville. “And of course we need these kids back in school, so badly.”

But medical professional say that until the health care system finds a way to equip and support emergency departments for what they have become — the first and sometimes last resort — parents will be left to navigate mostly on their own, leaning on others who have managed similar problems.

“Covid has put our system under a microscope in terms of the things that don’t work,” said Dr. Baum, the pediatrician in Asheville. “We had a shaky system of care in pediatric mental health prior to this pandemic, and now we have all these added stressors on it, all these kids coming in for pandemic-related issues. Hospitals everywhere are scrambling to adjust.”

If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK). You can find a list of additional resources at SpeakingOfSuicide.com/resources.

For Some Teens, It’s Been a Year of Anxiety and Trips to the E.R.

For Some Teens, It’s Been a Year of Anxiety and Trips to the E.R.

During the pandemic, suicidal thinking is up. And families find that hospitals can’t handle adolescents in crisis.

Lisa, a mother of three in Asheville, N.C., said that months of virtual classes and social isolation had changed her extroverted 13-year-old son “in profound ways I would never have anticipated.”
Lisa, a mother of three in Asheville, N.C., said that months of virtual classes and social isolation had changed her extroverted 13-year-old son “in profound ways I would never have anticipated.”Credit…Jacob Biba for The New York Times
Benedict Carey

  • Feb. 23, 2021, 3:48 p.m. ET

When the pandemic first hit the Bay Area last spring, Ann thought that her son, a 17-year-old senior, was finally on track to finish high school. He had kicked a heavy marijuana habit and was studying in virtual classes while school was closed.

The first wave of stay-at-home orders shut down his usual routines — sports, playing music with friends. But the stability didn’t last.

“The social isolation since then, over all this time, it just got to him,” said Ann, a consultant living in suburban San Francisco. She, like the other parents in this article, asked that her last name be omitted for privacy and to protect her child. “This is a charming, funny kid, also sensitive and anxious,” she said. “He couldn’t find a job; he couldn’t really go out. And he started using marijuana again, and Xanax.”

The teenager’s frustration finally boiled over this month, when he deliberately cut himself.

“We called 911, and he was taken to the emergency room,” his mother said. “But there they just stitched him up and released him.” The doctors sent him home, she said, “with no support, no therapy, nothing.”

Ann and her son are like many families over the last year. Surveys and statistics show that for young people who are anxious by nature, or feeling emotionally fragile already, the pandemic and its isolation have pushed them to the brink. Rates of suicidal thinking and behavior are up by 25 percent or more from similar periods in 2019, according to a just-published analysis of surveys of young patients coming into the emergency room.

For these teenagers, there aren’t many places to turn. They need help, but it’s hard to come up with a psychiatric diagnosis. They are trying to manage a surprise interruption in their lives, a vague loss. And without a diagnosis, reimbursement for therapy is hard to come by. And that is assuming parents know what kind of help is appropriate, and where to find it.

Finally, when a crisis hits, many of these teenagers end up in the local emergency department — the one place desperate families so often go for help.

Many E.R. departments across the country are now seeing a surge in such cases. Through most of 2020, the proportion of pediatric emergency admissions for mental problems, like panic and anxiety, was up by 24 percent for young children and 31 percent for adolescents compared to the previous year, according to a recent report by the Centers for Disease Control and Prevention.

And the local emergency department is frequently unprepared for the added burden. Workers often are not specially trained to manage behavioral problems, and families don’t have many options for where to go next, leaving many of these pandemic-insecure adolescents in limbo at the E.R.

“This is a national crisis we’re facing,” Dr. Rebecca Baum, a developmental pediatrician in Asheville, N.C. “Kids are having to board in the E.R. for days on end, because there are no psychiatric beds available in their entire state, never mind the hospital. And of course, the child or adolescent is lying there and doesn’t understand what’s happening in the E.R., why they’re having to wait there or where they’re going.”

What Adolescents Are Feeling

Most teenagers and young adults have done fine through this pandemic year, provided that their families have stayed healthy and economically stable. They may be irritable or missing their friends, but their support networks have been enough to get them through the pandemic.

For the young people coming undone, however, pandemic life presents unusual challenges, pediatricians say. Most are temperamentally sensitive and after months of being socially cut off from friends and activities, they have much less control over their moods.

“What parents and children are consistently reporting is an increase in all symptoms — a child who was a little anxious before the pandemic became very anxious over this past year,” said Dr. Adiaha I. A. Spinks-Franklin, an associate professor of pediatrics at the Baylor College of Medicine. It is this prolonged stress, Dr. Spinks-Franklin said, that in time blunts the brain’s ability to manage emotions.

Jean, an artist and mother of two living in Hendersonville, N.C., said that her 17-year-old son was doing fine through last spring. But the months of virtual classes and loss of simple social pleasures — hanging out with friends, playing chess — changed him through the fall months.

“Now, he’s become very reclusive, he has mood swings, he cries a lot,” Jean said. “This giant boy, crying — it’s terrible to see.” The young man has had panic attacks, twice followed by a blackout. During one, he fell and injured his face.

Dr. Adiaha I. A. Spinks-Franklin, an associate professor of pediatrics at the Baylor College of Medicine, says it’s the prolonged stress that blunts the brain’s ability to manage emotions.
Dr. Adiaha I. A. Spinks-Franklin, an associate professor of pediatrics at the Baylor College of Medicine, says it’s the prolonged stress that blunts the brain’s ability to manage emotions.Credit…Brett Deering for The New York Times

Lisa, a mother of three in Asheville, said that the months of virtual classes and relative social isolation had changed her extroverted 13-year-old son “in profound ways I would never have anticipated.”

His grades slipped badly, and he began to withdraw. “Next, he was telling us he couldn’t make himself do the work, that he didn’t want to disappoint us all the time, that he was worthless. Worthless.”

These young people do not necessarily qualify for a psychiatric diagnosis, nor are they “traumatized” in the strict sense of having had a life-threatening experience (or the perception of one.) Rather, they are trying to manage an interruption in their normal development, child psychologists say: a sudden and indefinite suspension of almost every routine and social connection, leaving a deep yet vague sense of loss with no single, distinct source.

The result is grief, but grief without a name or a specific cause, an experience some psychologists call “ambiguous loss.” The concept is usually reserved to describe the experience of immigrants, displaced from everything familiar, who shut down emotionally in a new and strange country. Or to describe disaster survivors, who return to neighborhoods that are hollowed out, transformed.

“Everything that used to be familiar and give structure to their lives, and predictability, and normalcy, is gone,” said Sharon Young, a therapist in Hendersonville. “Kids need all these things even more than adults do, and it’s hard for them to feel emotionally safe when they’re no longer there.”

System Overload

The resulting changes in behavior can seem sudden: A bright sixth-grader is found cutting herself; a sweet-natured sophomore takes a swing at a parent or sibling. Parents, frightened, often don’t know where to go for appropriate help. Many don’t have the resources or knowledge to hire a therapist.

Families that land in the emergency departments of their local hospitals often find that the clinics are poorly equipped to handle these incoming cases. The staff is better trained to manage physical trauma than the mental variety, and patients are often sent right back home, without proper evaluation or support. In severe cases, they may linger in the emergency department for days before a bed can be found elsewhere.

In a recent report, a research team led by the C.D.C. found that less than half of the emergency departments in U.S. hospitals had clear policies in place to handle children with behavior problems. Getting to the bottom of any complex behavior issue can takes days of patient observation, at minimum, psychiatrists say. And many emergency departments do not have the on-hand specialists, dedicated space or off-site resources to help do the job well.

For Jean, diagnosing her son has been complicated. He has since developed irritable bowel syndrome. “He has been losing weight, and started smoking pot due to the boredom,” Jean said. “This is all due to the anxiety.”

Nationwide Children’s Hospital in Columbus, Ohio, has an emergency department that is a decent size for a pediatric hospital, with capacity for 62 children or adolescents. But well before the arrival of the coronavirus, the department was straining to handle increasing numbers of patients with behavior problems.

“This was huge problem pre-pandemic,” said Dr. David Axelson, chief of psychiatry and behavioral health at the hospital. “We were seeing a rise in emergency department visits for mental health problems in kids, specifically for suicidal thinking and self-harm. Our emergency department was overwhelmed with it, having to board kids on the medical unit while waiting for psych beds.”

Last March, to address the crowding, Nationwide Children’s opened a new pavilion, a nine-story facility with 54 dedicated beds for observation and for longer-term stays for those with mental challenges. It has taken the pressure off the hospital’s regular emergency department and greatly improved care, Dr. Axelson said.

Over this pandemic year, with the number of admissions for mental health problems up by some 15 percent over previous years, it is hard to imagine what it would have been like without the additional, devoted behavioral clinic, Dr. Axelson said.

Other hospitals from out of state often call, hoping to place a patient in crisis, but there is simply not enough space. “We have to say no,” Dr. Axelson said.

“We had a shaky system of care in pediatric mental health prior to this pandemic, and now we have all these added stressors on it,” said  Dr. Rebecca Baum, a developmental pediatrician in Asheville, N.C.Credit…Jacob Biba for The New York Times

Dr. Rachel Stanley, the chief of emergency medicine at Nationwide, said that most hospitals have far fewer resources. “I worked at a hospital in Michigan for years, and when these kinds of kids come in, everyone dreaded seeing them, because we didn’t feel like we had the tools to help,” she said. “They have to go into a safe room; they can’t be in a shared area. You have to provide a sitter for the child, a staff person to stay with them all the time to make sure they’re not suicidal or homicidal. It could take hours and hours to get social workers involved, and all this time they’re getting worse.”

Anne, the consultant in the Bay Area, said that her son’s visit to the emergency room this month was his third in the past 18 months, each time for issues related to drug withdrawal. On one visit, he was misdiagnosed with psychosis and sent to a locked county psychiatric ward. “That experience itself — locked for days in a ward, with no one telling him why, or how long he’d be there — was the most traumatic thing he’s experienced,” she said.

Like many other parents, she is now looking after an unstable child and wondering where to go next. A drug rehab program may be needed, as well as regular therapy.

Lisa has hired a therapist for her son, a Zoom session every other week. That seems to have helped, she said, but it is too early to tell. And Jean, for the moment, is hoping the infection risk will diminish soon, so her son can get a safe job.

All three parents have become keen observers of their children, more aware of shifting moods. Listening by itself usually helps relieve distress, therapists say. “Trying to educate parents is a routine part of the job,” said Dr. Robert Duffey, a pediatrician in Hendersonville. “And of course we need these kids back in school, so badly.”

But medical professional say that until the health care system finds a way to equip and support emergency departments for what they have become — the first and sometimes last resort — parents will be left to navigate mostly on their own, leaning on others who have managed similar problems.

“Covid has put our system under a microscope in terms of the things that don’t work,” said Dr. Baum, the pediatrician in Asheville. “We had a shaky system of care in pediatric mental health prior to this pandemic, and now we have all these added stressors on it, all these kids coming in for pandemic-related issues. Hospitals everywhere are scrambling to adjust.”

If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK). You can find a list of additional resources at SpeakingOfSuicide.com/resources.

Mental Health Providers Struggle to Meet Pandemic Demand

‘Nobody Has Openings’: Mental Health Providers Struggle to Meet Demand

With anxiety and depression on the rise during the pandemic, it has been challenging for people to get the help they need.

Credit…Jo Zixuan Zhou
Christina Caron

  • Feb. 17, 2021, 5:26 p.m. ET

After Jessica W. was laid off from her job as an executive assistant in November, she began backsliding into the eating disorder that she thought she had overcome.

“I started to not want to eat again,” Jessica, 33, said. “Those thoughts and behaviors — they’re just debilitating and they drain you. It becomes a constant battle with yourself.”

Jessica, whose last name has been withheld to protect her privacy as she searches for a new job, was also struggling with anxiety and depression. So she went online and started searching for mental health providers in Connecticut, where she lives. One of the therapists she called wasn’t accepting new patients. Two of them told Jessica that they didn’t have the right skill sets to help her. Others simply didn’t respond.

“It’s emotionally draining to tell your story,” she said. “You have to be resilient.”

Since the first coronavirus case was confirmed in the United States more than a year ago, the number of people in need of mental health services has surged. But many say that they are languishing on waiting lists, making call after call only to be turned away, with affordable options tough to find. Providers, who have long been in short supply, are stretched thin.

“Never at any time in my practice have I had a five-person waiting list,” said Brooke Huminski, a psychotherapist and licensed independent clinical social worker in Providence, R.I., who specializes in treating people with eating disorders.

Dr. Gregory Scott Brown, the director of an outpatient psychiatry clinic in Austin, Texas, said he recently had to hire an additional nurse practitioner to help care for more patients. “I’m busier than ever and just don’t have room,” he said. “I’m full.”

A rise in demand

According to an American Psychological Association poll of nearly 1,800 psychologists published in November, 74 percent said they were seeing more patients with anxiety disorders compared with before the pandemic, and 60 percent said they were seeing more patients with depressive disorders. Nearly 30 percent said they were seeing more patients overall.

But according to Vaile Wright, the senior director of health care innovation at the A.P.A., this might not capture the full extent of the demand for mental health practitioners because the survey did not ask the therapists whether they had to turn away clients because they were already booked.

“There’s always been more demand for services than there are mental health providers to provide them,” Dr. Wright said. “I think what the pandemic has done is really laid bare that discrepancy.”

Online therapy platforms have seen a rise in demand during the pandemic as well. Mindy Heintskill, the chief growth officer of MDLive, a telehealth provider with more than 62 million members in the United States, said their online therapy and psychiatric care services increased fivefold in 2020 compared with 2019. Nearly half of these patients cited stress and anxiety as the main reasons for scheduling their visits, Ms. Heintskill added.

In August, the Centers for Disease Control and Prevention published a report which concluded that in late June, 40 percent of adults in the United States had been struggling with mental health or substance abuse issues, and rates of depression and anxiety had risen since 2019. In addition, a study of almost 190 million emergency department visits found that visit rates for mental health conditions, suicide attempts, drug overdoses and child abuse and neglect were higher in mid-March through October 2020, than the same period in 2019.

While companies that provide online counseling or psychiatric services like MDLive, Talkspace and BetterHelp have helped to improve access for some, mental health experts have said that these outlets cannot alone address the chronic inequities and provider shortages that were already plaguing the country.

A 2018 study published in the American Journal of Preventive Medicine found that there was an unequal distribution of psychiatrists, psychologists and psychiatric nurse practitioners across the United States, with more pronounced deficiencies in non-metropolitian counties.

‘Every single person I see needs therapy right now’

Ms. Huminski, the psychotherapist in Rhode Island, has tried to accommodate more patients by scheduling people at odd times, but that hasn’t been enough, she said. She can no longer take new clients, in part because her current ones are seeking more sessions than they have in the past. She would offer to make referrals, she added, but “nobody has openings right now.”

Even Ms. Huminski’s local hospital, which has an intensive therapy day program where she sometimes refers patients, is fuller than usual. In the past, she said, it would usually take up to four weeks to get in. Now, she added, it’s around four months.

Jennifer Kittler, a clinical psychologist who is also based in Providence, said that she, too, has had almost no availability for new clients over the past 10 months. As her case loads have increased, she’s taking steps to prevent burnout.

“In my case, it has led to my being less willing to extend my hours or schedule — in an effort to prioritize family time and self-care,” said Dr. Kittler, who is working from home while her 12-year-old learns remotely for at least half of the week.

Finding the right team can be even more difficult for patients who require both a psychiatrist and a therapist.

“Every single person I see needs therapy right now,” said Dr. Jessi Gold, a psychiatrist based in St. Louis, Mo., who mostly sees college students and health care workers. “They come back and say, ‘I’ve called 20 people and I don’t know what to do.’”

Bailey, 27, a medical student in New York who did not want to use her last name for privacy reasons, said that last fall she started searching for both a therapist and a psychiatrist who took Medicaid and was “striking out all over the place.”

In November, she spoke to therapists from the Telemedicine platforms BetterHelp and Happier Living, but the cost per session was too much for Bailey to afford long-term. Earlier, she had tried speaking with the therapist at her medical school, but “our personalities just didn’t click,” Bailey said.

She’s currently on several wait lists and is receiving psychiatric prescriptions from her primary care provider.

As for Jessica, who had been searching for a therapist and a psychiatrist in Connecticut, after two weeks of intensive research she finally located an in-network therapist, and recently started seeing an out-of-network psychiatrist.

In many ways, Jessica was more fortunate than most. She still had insurance through her husband’s employer. And she was already well versed in the process of finding mental health providers.

“I have my insurance card ID memorized,” she said. “Like, that’s not normal.”

How to find help if you’re struggling

If you need to see a mental health provider but can’t find one that is taking new patients, don’t just say ‘OK’ and hang up after calling them, Dr. Brown said.

“Ask if they happen to know someone who may be accepting new patients,” he said. “Usually, if I’m not able to help, I can surely point a potential patient in the right direction to a colleague who can.”

If that leads to a dead end, you might try asking a primary care provider for referrals or treatment.

“Some of them do have enough basic training in mental health to be able to help a little bit,” said Dr. Amy Alexander, a psychiatrist who sees students at Stanford University. “Some are even comfortable starting medications for mild to moderate mental health problems.”

If you still can’t find help, try calling local colleges or universities and ask to see a clinician in training. Large academic institutions with outpatient psychiatry departments might also have appointments or provide referrals. Consider also expanding your search to other types of experts. If you were hoping to see a psychologist, a licensed clinical social worker might be a comparable option. Or if you were planning to see an individual provider, think about group therapy options.

Psychology Today maintains a large list of providers that you can filter by location, type of insurance covered, specialty or other criteria. The federal government also has a website where you can search for facilities that treat substance use disorders, addiction and mental illness.

If you’re looking for support groups, check out the resources at the National Alliance on Mental Illness, the National Eating Disorders Association, Alcoholics Anonymous or the Depression and Bipolar Support Alliance.

For those with insurance, an in-network provider will typically be the most affordable option. But if you can’t find someone, check if your plan has out-of-network benefits to help broaden your choice. Online therapy services may also be worth exploring since they can help you speak with someone quickly and in some cases, may reduce out-of-pocket costs.

If you are uninsured, search for providers who offer low- or no-cost options. You may find some who charge fees based on a sliding scale, or interns or postdoctoral fellows at private group practices who may see clients at lower fees, Dr. Kittler said. And government-funded community-based health care centers provide care to patients regardless of ability to pay.

If you have a job, check whether your employer offers certain benefits, like a flexible spending or a health savings account, which allow you to use pretax money for certain medical expenses.

Finally, if you are having serious symptoms that need to be addressed quickly, go to your local emergency room. The doctors there are trained to address mental health crises, Dr. Alexander said.

If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK).

How Many Are Struggling to Book Appointments With Mental Health Providers Through Pandemic

‘Nobody Has Openings’: Mental Health Providers Struggle to Meet Demand

With anxiety and depression on the rise during the pandemic, it has been challenging for people to get the help they need.

Credit…Jo Zixuan Zhou
Christina Caron

  • Feb. 17, 2021, 5:26 p.m. ET

After Jessica W. was laid off from her job as an executive assistant in November, she began backsliding into the eating disorder that she thought she had overcome.

“I started to not want to eat again,” Jessica, 33, said. “Those thoughts and behaviors — they’re just debilitating and they drain you. It becomes a constant battle with yourself.”

Jessica, whose last name has been withheld to protect her privacy as she searches for a new job, was also struggling with anxiety and depression. So she went online and started searching for mental health providers in Connecticut, where she lives. One of the therapists she called wasn’t accepting new patients. Two of them told Jessica that they didn’t have the right skill sets to help her. Others simply didn’t respond.

“It’s emotionally draining to tell your story,” she said. “You have to be resilient.”

Since the first coronavirus case was confirmed in the United States more than a year ago, the number of people in need of mental health services has surged. But many say that they are languishing on waiting lists, making call after call only to be turned away, with affordable options tough to find. Providers, who have long been in short supply, are stretched thin.

“Never at any time in my practice have I had a five-person waiting list,” said Brooke Huminski, a psychotherapist and licensed independent clinical social worker in Providence, R.I., who specializes in treating people with eating disorders.

Dr. Gregory Scott Brown, the director of an outpatient psychiatry clinic in Austin, Texas, said he recently had to hire an additional nurse practitioner to help care for more patients. “I’m busier than ever and just don’t have room,” he said. “I’m full.”

A rise in demand

According to an American Psychological Association poll of nearly 1,800 psychologists published in November, 74 percent said they were seeing more patients with anxiety disorders compared with before the pandemic, and 60 percent said they were seeing more patients with depressive disorders. Nearly 30 percent said they were seeing more patients overall.

But according to Vaile Wright, the senior director of health care innovation at the A.P.A., this might not capture the full extent of the demand for mental health practitioners because the survey did not ask the therapists whether they had to turn away clients because they were already booked.

“There’s always been more demand for services than there are mental health providers to provide them,” Dr. Wright said. “I think what the pandemic has done is really laid bare that discrepancy.”

Online therapy platforms have seen a rise in demand during the pandemic as well. Mindy Heintskill, the chief growth officer of MDLive, a telehealth provider with more than 62 million members in the United States, said their online therapy and psychiatric care services increased fivefold in 2020 compared with 2019. Nearly half of these patients cited stress and anxiety as the main reasons for scheduling their visits, Ms. Heintskill added.

In August, the Centers for Disease Control and Prevention published a report which concluded that in late June, 40 percent of adults in the United States had been struggling with mental health or substance abuse issues, and rates of depression and anxiety had risen since 2019. In addition, a study of almost 190 million emergency department visits found that visit rates for mental health conditions, suicide attempts, drug overdoses and child abuse and neglect were higher in mid-March through October 2020, than the same period in 2019.

While companies that provide online counseling or psychiatric services like MDLive, Talkspace and BetterHelp have helped to improve access for some, mental health experts have said that these outlets cannot alone address the chronic inequities and provider shortages that were already plaguing the country.

A 2018 study published in the American Journal of Preventive Medicine found that there was an unequal distribution of psychiatrists, psychologists and psychiatric nurse practitioners across the United States, with more pronounced deficiencies in non-metropolitian counties.

‘Every single person I see needs therapy right now’

Ms. Huminski, the psychotherapist in Rhode Island, has tried to accommodate more patients by scheduling people at odd times, but that hasn’t been enough, she said. She can no longer take new clients, in part because her current ones are seeking more sessions than they have in the past. She would offer to make referrals, she added, but “nobody has openings right now.”

Even Ms. Huminski’s local hospital, which has an intensive therapy day program where she sometimes refers patients, is fuller than usual. In the past, she said, it would usually take up to four weeks to get in. Now, she added, it’s around four months.

Jennifer Kittler, a clinical psychologist who is also based in Providence, said that she, too, has had almost no availability for new clients over the past 10 months. As her case loads have increased, she’s taking steps to prevent burnout.

“In my case, it has led to my being less willing to extend my hours or schedule — in an effort to prioritize family time and self-care,” said Dr. Kittler, who is working from home while her 12-year-old learns remotely for at least half of the week.

Finding the right team can be even more difficult for patients who require both a psychiatrist and a therapist.

“Every single person I see needs therapy right now,” said Dr. Jessi Gold, a psychiatrist based in St. Louis, Mo., who mostly sees college students and health care workers. “They come back and say, ‘I’ve called 20 people and I don’t know what to do.’”

Bailey, 27, a medical student in New York who did not want to use her last name for privacy reasons, said that last fall she started searching for both a therapist and a psychiatrist who took Medicaid and was “striking out all over the place.”

In November, she spoke to therapists from the Telemedicine platforms BetterHelp and Happier Living, but the cost per session was too much for Bailey to afford long-term. Earlier, she had tried speaking with the therapist at her medical school, but “our personalities just didn’t click,” Bailey said.

She’s currently on several wait lists and is receiving psychiatric prescriptions from her primary care provider.

As for Jessica, who had been searching for a therapist and a psychiatrist in Connecticut, after two weeks of intensive research she finally located an in-network therapist, and recently started seeing an out-of-network psychiatrist.

In many ways, Jessica was more fortunate than most. She still had insurance through her husband’s employer. And she was already well versed in the process of finding mental health providers.

“I have my insurance card ID memorized,” she said. “Like, that’s not normal.”

How to find help if you’re struggling

If you need to see a mental health provider but can’t find one that is taking new patients, don’t just say ‘OK’ and hang up after calling them, Dr. Brown said.

“Ask if they happen to know someone who may be accepting new patients,” he said. “Usually, if I’m not able to help, I can surely point a potential patient in the right direction to a colleague who can.”

If that leads to a dead end, you might try asking a primary care provider for referrals or treatment.

“Some of them do have enough basic training in mental health to be able to help a little bit,” said Dr. Amy Alexander, a psychiatrist who sees students at Stanford University. “Some are even comfortable starting medications for mild to moderate mental health problems.”

If you still can’t find help, try calling local colleges or universities and ask to see a clinician in training. Large academic institutions with outpatient psychiatry departments might also have appointments or provide referrals. Consider also expanding your search to other types of experts. If you were hoping to see a psychologist, a licensed clinical social worker might be a comparable option. Or if you were planning to see an individual provider, think about group therapy options.

Psychology Today maintains a large list of providers that you can filter by location, type of insurance covered, specialty or other criteria. The federal government also has a website where you can search for facilities that treat substance use disorders, addiction and mental illness.

If you’re looking for support groups, check out the resources at the National Alliance on Mental Illness, the National Eating Disorders Association, Alcoholics Anonymous or the Depression and Bipolar Support Alliance.

For those with insurance, an in-network provider will typically be the most affordable option. But if you can’t find someone, check if your plan has out-of-network benefits to help broaden your choice. Online therapy services may also be worth exploring since they can help you speak with someone quickly and in some cases, may reduce out-of-pocket costs.

If you are uninsured, search for providers who offer low- or no-cost options. You may find some who charge fees based on a sliding scale, or interns or postdoctoral fellows at private group practices who may see clients at lower fees, Dr. Kittler said. And government-funded community-based health care centers provide care to patients regardless of ability to pay.

If you have a job, check whether your employer offers certain benefits, like a flexible spending or a health savings account, which allow you to use pretax money for certain medical expenses.

Finally, if you are having serious symptoms that need to be addressed quickly, go to your local emergency room. The doctors there are trained to address mental health crises, Dr. Alexander said.

If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK).

When I Was Labeled a ‘Troubled’ Teen, I Obliged

The author in the Adirondack Mountains of upstate New York in 2007, during his second stay in a wilderness therapy program. 
The author in the Adirondack Mountains of upstate New York in 2007, during his second stay in a wilderness therapy program. Credit…via Kenneth R. Rosen

Voices

When I Was Labeled a ‘Troubled’ Teen, I Obliged

I was sent to three “tough love” programs meant to redirect me. Trying to run away from one made me feel that I had no choice but to become what I had been told I was.

The author in the Adirondack Mountains of upstate New York in 2007, during his second stay in a wilderness therapy program. Credit…via Kenneth R. Rosen

Kenneth R. Rosen

  • Jan. 12, 2021, 5:00 a.m. ET

All I heard was rain, my thumping heart harmonizing with the tempo of the tempest outside. I waited for the night watchman’s light to sweep over my bunk. He disappeared into the hallway, into the next room of clients who he noted to himself were present and asleep and so moved to the next room.

When he entered another room, I hurried behind him, crouching, to the central alcove, from where I made my escape. My plan included a list — backpack, peanut butter, headlight, rain gear, stolen MapQuest printouts, knife — and a destination, Boston. I’d run to an unfamiliar city, across a state to which I’d been taken against my will, to meet a future I could not be certain was any better. The rain seemed less like a portent, more an encouragement, as if each wind gust carried with its rivulets the words, It’s your time. They’ll never find you. Go now.

They were the escorts. Transporters. Redirection specialists. They, usually two men who take unsuspecting teenagers in the middle of the night to therapeutic programs across the country, went by different names. I was certain they were coming for me. They had come for me several months before the night of my escape, in late winter 2007, at the request of my parents who saw no other way to set me straight. My mom and dad hired the men, after consulting with school officials, psychologists and an education consultant, to take me from my bed and to deliver me like a wasted soul to an experiential therapy program in the Adirondack Mountains in upstate New York. They believed they were practicing “tough love,” making the difficult choice to send their child away to forge a better future away from home.

Some of the gear the group carried through remote stretches of New York State. 
Some of the gear the group carried through remote stretches of New York State. Credit…Kenneth R. Rosen

From New York I’d go on to a program in Massachusetts. I did not know it then, but I’d become one of the tens of thousands of “troubled” or “at-risk” teenagers carted off to these unregulated, private industries each year.

The years leading up to my being taken and the eventual break out is now a blur of misanthropy. I was reckless, taking my mom’s car out for joy rides without permission, skipping class, distrusting authority figures like the high school principal and local municipal authorities sent to curb my behavior, to put me back on a path more, how should we say, normal.

In the nearly 12 months I’d spend between the experiential wilderness therapy program (twice), a therapeutic boarding school in Massachusetts and a residential treatment center on a ranch in Utah, I lived up to the designation of a troubled teen. The programs were what the media called part of a tough love movement, which flourished in the early aughts but still exists today.

The Academy at Swift River, a former therapeutic boarding school for troubled children, in Cummington, Mass., in spring 2007. The author spent months here before trying to escape, after which he was sent to a remote ranch in Southern Utah.Credit…Kenneth R. Rosen

I’d return that type of love to my parents, ignoring their written letters, our only form of communication, vetted and censored by my “therapists.” I felt betrayed and discarded. They pleaded with me to accept the programs and to do my best to succeed in them. It felt like they wanted me gone. Really, I was being groomed for institutionalization. The juvenile and criminal justice systems the programs ventured to save me from instead prepared me for adult incarceration. By the end of my time away I recognized a bliss associated with handcuffs. Lockup and lockdown meant the familiarity of strip searches, drug tests, isolation cells and men who handled me like I was worthless: hallmarks of the programs that became synonymous with the word homebound.

But losing any self-actualization and inner-direction came later. On the night of my escape, I still believed I held some agency over my future, shrouded in uncertainty though it was. What would I do in Boston? I didn’t care. How would I earn money? Where would I stay? I would figure it out once I was far away from this place.

My parents were no longer trustworthy. They were part of the growing number of my adversaries working to keep me from personal liberties. At the program I was restricted access to food. I was allowed only communication with my parents, not my friends back home. If I chose not to respond to my parents, I would also be cut off from my peers in the programs. Either way, I’d lose.

The night the author tried to run away from the Academy at Swift River, he started from this alcove.Credit…Kenneth R. Rosen

I was given prescription medication to ease my anxiety and depression, which left me hollow and numb. I was made to answer questions about my life and emotions until, I was told, I got them right, framing things in a way the program and therapists felt more accurately told a story about my deviance that I then internalized. My journals were confiscated, their private contents used against me in “therapy sessions.”

I wasn’t troubled or bad. I was alone, all the angst and hormonal shifts of adolescence compounded and weaponized against me. I was backed into a corner and told to change, made to think I’d become reproachable and unwanted. What they wanted from me — to be happy, well-adjusted, open to therapy and the mind-numbing boredom I associated with schooling — seemed a betrayal of the very thing they wanted me to be: myself.

Meanwhile, I had broken a number of rules at the school — “cheeking” medication, drinking hand sanitizer, fraternizing with girls. I was certain then, by the fourth month at the program, that I was doomed for another “transport.” Then one night they came.

I’d been waiting, staring deep into the white ceiling overhead, my inability to sleep soundly forever cemented. Before I could jump down from the top bunk bed, the escorts announced that they were there for a different boy, my roommate. He stood from his bed, his head hanging. He pulled a pre-packed suitcase from underneath his bed (we all had our own type of go-bag), gave a weak smile, shrugged, told me he’d see me again, however unlikely, and left with the men flanking him out the door, choosing to go, as they called it, the “easy way.” He had already gone the “hard way.”

Picked off. Kidnapped. Taken. Call it what you wish, but trying to sleep each night with the notion that a pair of strangers could come to lift you from your bed, whether your actions were deserving of this treatment or not, haunts me, haunts thousands. Having watched my roommate get taken was surreal. It made real for the first time what had happened to me, brought into context that it was happening to others, and eventually sold me on my own desire to flee. I would not wait to be taken. I had to get out. No one would take me. I would lead myself away.

Now, standing outside the central alcove with my back to the doorways of the program, I stared into the fields of the Berkshire mountains, another expanse of seclusion and remove, the rain washing over me in blinding sheets. I bent into the storm, leaning into the wind that soon turned, pushed at my back, leading me away from this place into the deep, heaving thicket at the far end of the program’s property.

The author’s room at the academy in spring 2007. Sometimes the boys played Monopoly at night in the bathroom, seeking a rare opportunity for unsupervised recreation. Credit…Kenneth R. Rosen

I vaulted a fence and tore my rain pants. Water and a cold breeze swept into the tear. I began to shiver. Boston seemed farther than ever, the return to my previous life an impossibility. My mother once told me “to strive, to seek, to find, and never to yield,” cribbed from the Tennyson poem. But yield I would, turning around and greeting my future and any hope I had for making it my own. I was told I was troubled and believed it and ran because that’s what bad kids did.

I unceremoniously turned myself in to the night watchman because I had lost all strength to continue being bad. I wanted to be good, loved. It was as much a desire to get away that drove me from the program as it was a display of disapprobation and the final displacement of my waning emotional strength. I would fold into the programs, accepting that if I were to change it would be by a force better accepted than rejected, one that had overpowered and broken me into a shell of my former self.

Those programs are now a distant memory, but the contours of those inescapable feelings of rejection and dismissal, of living up to the expectations held by others and not myself, follow me. When I find the energy to keep those memories from chaining me to a different person, a different time, I do my best never to yield.

Kenneth R. Rosen is the author, most recently, of “Troubled: The Failed Promise of America’s Behavioral Treatment Programs.”

A Rare Pandemic Silver Lining: Mental Health Start-Ups

A Rare Pandemic Silver Lining: Mental Health Start-Ups

Using teletherapy, metrics and matching algorithms, entrepreneurs are focusing on addressing aspects of the mental health care system that they view as broken.

Credit…Romy Blümel

By

  • Dec. 7, 2020, 5:00 a.m. ET

Ariela Safira was on a mission. Shaken by the attempted suicide of a friend during her freshman year at Stanford University in 2013, Ms. Safira sought to understand the opaque mental health care system. She soon learned of the shortage of qualified therapists and, even where they are more plentiful, of the hurdles to obtaining care. Although a computer science and math major, she eventually enrolled in a clinical psychology graduate program at Columbia University.

But she kept coming back to a fundamental view: that there is often a mismatch between need and services, an essential supply-and-demand question. “It’s very difficult to start and keep up a therapy business,” Ms. Safira said. “It’s a 10-person job, not a one-person job, from marketing yourself, doing your own financing and managing your own rent. But even before you get to a place where you manage all those things, what’s so challenging is making a name for yourself so that people want to go to you.”

And so, in 2019, she founded Real Therapy, a small business designed to tackle mental health and overall wellness by easing access and offering a range of services to answer clients’ needs.

Driven by personal experience — and further motivated by the pandemic, which has caused an increase in anxiety and depression among the general population, including among young adults — entrepreneurs like Ms. Safira are focusing on addressing aspects of the mental health care system that they view as broken. They seem undeterred by the complicated nature of that system: a byzantine insurance process, a wide range of provider types, and elusive fits between patient and therapist.

“It’s a crowded space,” Alex Katz, the founder of Two Chairs, which opened its doors with a single clinic in San Francisco in 2017, said of the mental health start-up scene. Nonetheless, he said, “because the problems are massive, we need a lot of great companies working in innovative ways to address the different populations, diagnoses and delivery of care.”

Mr. Katz, another Stanford graduate, began working at Palantir, the data analytics and software company, but sought to understand mental health services when his partner “was going through a tough time in her life.” He eventually quit his job and began to tap into his network of friends and family to understand the mental health care system.

He soon learned that one of the system’s biggest challenges was matching a therapist with a patient, something he thought technology could solve. Yet, after interviewing clinicians, he chose to start a physical clinic, rather than a virtual one. In trying to raise funds for his fledgling business, “I joke that I had three strikes against me: I was a first-time, solo founder of a bricks-and-mortar company in health care.” But from its inception, Two Chairs has relied on technology, using a frequently updated proprietary algorithm to match client and therapist after a prospective client’s first intake meeting.

Although both Ms. Safira and Mr. Katz initially focused on in-person care, with virtual therapy as a long-term goal, they had no choice but to change direction once the pandemic hit. Ms. Safira and her small team quickly had to shift from the Manhattan space they carefully designed and renovated, but never opened, to go completely remote. Within eight long days, she produced a remote platform to provide five types of services, largely group-oriented (one-on-one sessions will wait until the in-person location opens). Mr. Katz — whose company had grown to seven locations in the Bay Area, with a new one set to open in Los Angeles next year — also made the decision in March to continue his business by going fully virtual.

Because both had planned, eventually, to offer remote services, they already knew that the efficacy of remote sessions was already proven. David Mohr, the director of the Center for Behavioral Intervention Technologies at Northwestern University’s Feinberg School of Medicine, who has studied the issue, said that researchers had long found that teletherapy could be as effective as in-person therapy.

“There are no substantial differences in outcomes between remote and face-to-face” therapy, he said, adding that a remote option can solve issues of distance and time constraints that often discourage people from seeking therapy. (Dr. Mohr, through his work at Northwestern, is the principal investigator for IntelliCare, a university program that provides pre-therapy tools for anxiety and depression.) Practitioners have been resistant to this change, but the pandemic has forced their hands.

“We are at an inflection point,” he said. “There is a greater acceptance of the use of technology in mental health care, while at the same time there is a tremendous decrease in the stigma” that had been associated with emotional problems.

Like Ms. Safira, it was personal experience that propelled Kyle Robertson to explore a platform for virtual therapy. The son of a psychiatrist and therapist, Mr. Robertson had difficulty finding help in dealing with his own depression and anxiety while a student at Wharton School of the University of Pennsylvania. He said his parents were hands-off but “definitely pushed early on for making sure that there was integration across medication and therapy,” which they all viewed as sometimes lacking in current practice, whether remote or in-person (only psychiatrists can prescribe medication).

After running a beta test of roughly 100 users at the end of 2019, he co-founded Cerebral in 2019. His timing, of course, proved prescient, and he has secured significant venture funding as well an uptick in clients throughout the year.

As with Two Chairs, Cerebral clients can schedule individual therapy, though group sessions are not yet available. The platform asks clients to keep track of their symptoms and report them monthly. Those responses can trigger a notification to the clinician to alert them if there is any worsening of conditions. If someone doesn’t respond, then someone on the team will reach out to check in, Mr. Robertson said.

All three companies seek to provide access quickly — the first interviews can be the same day after a client has signed up, in an effort to pre-empt mental health emergencies. The goal, Mr. Robertson said, is for new clients to speak to someone “within 10 minutes, something we’re able to do with a network of clinicians across geographies.” (Some of the regulations regarding licensing have been relaxed during the pandemic to enable telemedicine across all specialties, not just mental health care.)

And though these providers must comply with the stringent privacy laws that govern medical care, they are able to use data that they gather to analyze outcomes. “It’s been hard to aggregate data and use it in an effective way in the past,” Mr. Robertson said. “Many therapists are in the equivalent of mom-and-pop shops who don’t have the resources, or the time, to analyze the data.”

The three entrepreneurs are all working with insurance companies to have their services covered. Ms. Safira said that clients could use funds in their health savings or flexible spending accounts, and Mr. Robertson is negotiating with insurers. Mr. Katz said that while his company’s services have been out of network, “we will begin working with insurance companies more broadly in 2021.”

Their platforms welcome all ages. Mr. Robertson says that though some older clients seem less comfortable with the remote format, there are many who adapt.

Ultimately, all three companies hope to connect clients with the right type of therapy and to possibly contribute to the understanding of how to make a match.

“There’s not much research on how to make a match, but there’s a lot that speaks about the importance of the alliance” between therapist and patient, Mr. Katz said. “At the end of the day, if you form a great bond, the quality of care is so much higher.”

With Hippotherapy, the Horse Provides the Therapy

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Credit Whitten Sabbatini for The New York Times NYTCREDIT: Whitten Sabbatini for The New York Times

Three-year-old Jack Foster sat on his mother’s lap as she wrapped a towel carefully around his neck.

“Jack has cerebral palsy and low muscle tone,” said his mother, Emily Foster, of Northbrook, Ill. “The biggest challenge is holding his head up.”

With help from his occupational therapist, Ms. Foster fit a riding helmet on Jack’s head and clicked the chinstrap buckle into place. She then watched as the occupational therapist and two volunteers positioned her young son onto a red pony. Jack seemed delighted as one volunteer stood to his right and softly sang, while another led the pony slowly around the arena.

Jack was at Horsefeathers Therapeutic Riding in Lake Forest, Ill., for hippotherapy, a form of equine-assisted therapy conducted by licensed physical, occupational and speech therapists to improve muscle tone, speech and other functions (“hippos” is the Greek word for horse; the American Hippotherapy Association has a therapist locator at americanhippotherapyassociation.org). Hippotherapy is used to treat a variety of conditions, including brain injuries, cerebral palsy, spine curvature, intellectual disabilities, language disorders and sensory processing disorders.

The natural movements of the horse and the environmental cues enable therapists to work toward treatment goals in a setting that might feel like fun, but that research shows can have real benefits. A recent study in Physical & Occupational Therapy in Pediatrics, for example, found that children with cerebral palsy had increased body control after only 10 sessions of hippotherapy. Gross and fine motor skills also improved.

A horse striding around the barn takes around 100 steps a minute, said Dr. Tim Shurtleff, an instructor with the occupational therapy program at Washington University in St. Louis. Each stride pushes the rider’s pelvis forward, so after 35 minutes, a rider undergoes more than 3,000 repetitions of “trunk challenge,” in which the trunk is pushed forward and back. With each step the horse takes, the rider must subtly work to stay upright.

“That’s the power of this – it’s an intensive movement experience,” Dr. Shurtleff said. “The person on the horse is forced to respond to that movement.”

For riders like Jack Foster, who has been doing hippotherapy for over a year, the pelvic thrust helps to strengthen the low muscle tone in his neck and trunk, while relaxing the muscles in his hips and thighs. In his daily life “he will arch and extend, which makes his hips and his thighs really tight,” Ms. Foster said. “Sitting on the horse stretches it.”

During a typical therapy session, Jack sits on this horse facing both forward and backwards. Sessions can include a ball toss or placing rings onto long rods and cones, designed to improve trunk and neck control as well as his reaching abilities.

Researchers are now testing hippotherapy as an intervention for adults with multiple sclerosis and other neurological disorders. Dr. Deborah Silkwood-Sherer, the program director for the physical therapy department at Central Michigan University, said hippotherapy can also boost motivation in children who have disabilities and have been in therapy for years.

“People don’t realize they are working hard on a horse,” Dr. Silkwood-Sherer said. The visual and sensory input of a barn and stable setting provides additional stimulation. “For kids, they never think they are doing therapy.”

Meredith Bazaar of Ringwood, N.J., a speech and language pathologist, uses hippotherapy to treat clients, including those with apraxia, a brain disorder that makes it difficult to articulate or speak words.

“The movement of the horse is so repetitive and coordinated,” she said, allowing her to manipulate a client’s lips, chin or cheeks with her hands to help them make a desired sound. With every stride the horse takes, the client repeats the target sound, such as “ga,” which might double as a command to have the horse “go.”

At Horsefeathers, the founder and executive officer Nick Coyne has 10 gentle horses and ponies he uses for both hippotherapy and adaptive riding, which enables people with physical and mental disabilities to ride horses. He refers to some of his animals as “bomb horses,” meaning a bomb could go off and the horse would not react.

The horses are all trained to stop promptly if they sense a rider is slipping and to ignore the sudden, delighted shrieks a rider might make, as well as spastic movements, Mr. Coyne said.

Alex Brock, 22 of Lake Bluff, Ill., has microcephaly and cerebral palsy, and is also nonverbal and incontinent and has difficulty processing language. He aged out of the public school system, but once a week he eagerly leaves his wheelchair to work with Mr. Coyne as an adaptive rider.

His mother, Trina Brock, was initially incredulous when she heard about adaptive riding at Alex’s former high school. “My first thought was, how is he going to ride a horse?” she said. But she said her son now eagerly anticipates his weekly visits to the barn, and says the exercise helps strengthen his trunk.

It takes three people to help Alex ride, and Ms. Brock said the first time she saw her son on a horse, “I cried.”

Hippotherapy is not suitable for everyone. Ms. Bazaar said some clients turn out to have horse allergies, and allergy medications can make them too drowsy to participate. People with spinal abnormalities like spina bifida may not be good candidates either, and those with Down syndrome and other conditions should be first examined by a physician to determine if their spines are stable enough to endure the rides, she said.

But for children like Jack Foster, riding a horse can open up new opportunities. “It was the first therapy he had done without me,” his mother said.

Sibling Rivalry: The Grown-Up Version

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The cast of “The Humans,” from left, Reed Birney, Cassie Beck, Jayne Houdyshell, Sarah Steele, Lauren Klein, and Arian Moayed.

The cast of “The Humans,” from left, Reed Birney, Cassie Beck, Jayne Houdyshell, Sarah Steele, Lauren Klein, and Arian Moayed.Credit Sara Krulwich/The New York Times

At a recent dinner party, one guest said, “My brothers have not been in the same room for 16 years.” Another is estranged from a sister who she feels over-guards their widowed mother. Yet another lives in the same building as a brother with whom she no longer talks.

Welcome to sibling rivalry, the grown-up variety. There is no law that says we have to love the ones we were raised with, or even that we must reconcile before the grand finale. But as millions of baby boomers hit Act Three, the issue is rankling a generation that grew up believing in sharing, openness and the concept of “closure.”

“I’ve always thought that the psychological field does not give enough attention to the huge impact of siblings,” said Dr. Anna Fels, a psychiatrist in private practice in New York. She is not alone in that sentiment. Dr. Roger Gould, also a New York psychiatrist, agrees: “As I think about my current caseload, every one has a strained, difficult relationship with at least one of their siblings.”

If you have any doubts, look at the culture. On stage in New York recently, “The Humans,” “Dot,” “Familiar,” “Hold On to Me Darling,” “Buried Child” and “Head of Passes” all touch on siblings dealing with money, memories and taking care of ailing parents. The television show “Transparent” may purport to be about a 70-year-old man-turned woman, but it is really about the family’s next generation, acting more like children than children. The Netflix series “Bloodline” has just returned for a second season and deals with four siblings, one of whom — spoiler alert — drowned another at last season’s end. In the film “Alice Through the Looking Glass,” sibling rivalry nearly stops time.

Three books on the best-seller list deal with feuding siblings, including “The Nest” (“Jack and Leo were brothers but they weren’t friends”; “Miller’s Valley,” in which two sisters live on the same property but don’t speak to each other; and “The Nightingale,” about two very different sisters during World War II.

“Readers want to recognize themselves in fiction,” says Anna Quindlen, author of “Miller’s Valley,” “and I think most have some aspect of sibling conflict. In terms of those power relationships, there is no such thing as being grown up. At some level I will be an oldest child until the day I die.”

Most assume the fractures have to do with money, as parents die. What to give away, what to save or how to split? But is it really that simple?

“Usually these start out being about dividing up money, but underneath, it’s about things the siblings have avoided for decades,” says Frederick Hertz, a financial mediator based in Oakland, Calif., who is writing a book with the working title,  “Can I Divorce My Sister?” “Their childhood is such an integral part of their identity, and it sometimes becomes hard to put that aside enough to engage in practical decisions. I recently met with a brother and sister during which she stormed out saying, ‘He’s lived off our parents for 50 years!’ All that kind of stuff comes up.” That “stuff” may include one sibling feeling another was favored, thinking he or she was not defended against some form of abuse, or simply being a living reminder of disappointment and distress.

When in doubt, we can always blame Mom and Dad. A 70-year-old man told me he was close to his younger brother in childhood. “I sort of took on the father role. There was minimal parental praise, and let’s say I got less bad attention.” But the boy for whom he wrote class papers and took to the orthodontist, turned into the man who one day said, “I used to think you were the best and now you are the worst brother.” They have not spoken in 10 years.

Envy also can rear its ugly head after all these years. “In my sister’s mind, my arrival signaled the end of her seven-year reign on a pedestal,” a 55-year-old woman told me. A few years ago, she flew from New York to Seattle for her sister’s lung cancer operation. “She came out of recovery, saw me, and said, without the slightest sense of gratitude, ‘What are you doing here?’.” The act was not reciprocated when the younger sister developed breast cancer.  She recalled, “My sister said, ‘Of course you would get the cancer that is more treatable.’”

Occasionally a bar mitzvah or wedding may bring squabbling siblings together, but then the parties tend to go back to their corners. More likely, reconciliation comes when an end is in sight. Says Dr. Gould: “Whenever a crisis or death occurs — even though old wounds are opened — the rawness of the experience makes old slights irrelevant and the old image of ‘the other’ vanishes.”

Such occasions can prompt an effort toward reconciliation. Or not. Dr. Vivian Diller, a psychologist, said: “Being aware that we are living longer gives some a sense of new beginnings, with new choices. The byproduct can result in leaving behind poor sibling relationships or working on ones that are worth the effort.”

Experts suggest that parents encourage more family togetherness and extend equal love early on. As they grow, siblings should acknowledge one another’s flaws, which can help to lower expectations. Seeking help from therapists or mediators can bring the real issues out into the open.

“I do see more of a willingness to get therapy,” Dr. Fels said. “Professionals can also help people to recognize — and perhaps even accept — that a sibling might have legitimate mental health issues,” she said. All of the above may improve matters in some families. But there is no guarantee.

Michele Willens is a freelance writer and podcaster for NPR’s Robinhoodradio.


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A Shocking Way (Really) to Break Bad Habits

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Credit Kim Murton

Every January for the past decade, Jessica Irish of Saline, Mich., has made the same New Year’s Resolution: to “cut out late night snacking and lose 30 pounds.” Like millions of Americans, Ms. Irish, 31, usually makes it about two weeks.

But this year is different.

“I’ve already lost 18 pounds,” she said, “and maintained my diet more consistently than ever. Even more amazing — I rarely even think about snacking at night anymore.”

Ms. Irish credits a new wearable device called Pavlok for doing what years of diets, weight-loss programs, expensive gyms and her own willpower could not. Whenever she takes a bite of the foods she wants to avoid, like chocolate or Cheez-Its, she uses the Pavlok to give herself a lightning-quick electric shock.

“Every time I took a bite, I zapped myself,” she said. “I did it five times on the first night, two times on the second night, and by the third day I didn’t have any cravings anymore.”

As the name suggests, the $199 Pavlok, worn on the wrist, uses the classic theory of Pavlovian conditioning to create a negative association with a specific action. Next time you smoke, bite your nails or eat junk food, one tap of the device or a smartphone app will deliver a shock. The zap lasts only a fraction of a second, though the severity of the shock is up to you. It can be set between 50 volts, which feels like a strong vibration, and 450 volts, which feels like getting stung by a bee with a stinger the size of an ice pick. (By comparison, a police Taser typically releases about 50,000 volts.)

Other gadgets and apps dabble in behavioral change by way of aversion therapy, such as the $49 MotivAider that is worn like a pager, or the $99 RE-vibe wristband. Both can be set to vibrate at specific intervals as a reminder of a habit to break or a goal to reach. The $80 Lumo Lift posture coach is a wearable disk that vibrates when you slouch. The $150 Spire clip-on sensor tracks physical activity and state of mind by detecting users’ breathing patterns. If it detects you’re stressed or anxious, it vibrates or sends a notification to your smartphone to take a deep breath.

But the Pavlok takes things a step further, delivering a much stronger message.

To test the device, I wore it for a week, zapping myself every time I ate dessert. My goal was to curb my craving for sweets after dinner. First I zapped myself before and after I ate a square of dark chocolate, and did it again later in the week after eating ice cream, a red velvet cupcake and a chocolate chip cookie.

Set on low, it feels like a strong tickle. Set on high, it hurts. A lot.

It should be noted that the creator of Pavlok, Maneesh Sethi, once hired a woman to sit next to him and slap him on the face every time she saw him using Facebook, so he could increase his productivity. I called Mr. Sethi and told him that if we ever met, I’d try not to punch him in the face for creating such an awful torture device. “Yeah, I get that a lot,” Mr. Sethi said with a chuckle. “People either love it or hate it.”

“It’s not designed to be painful,” he added. “It’s instantaneous, a surprise sensation, a shock that knocks you out of automatic mode.”

But does this kind of self-imposed aversion therapy actually work?

“The most clever thing about this gadget is the name,” said Dr. Peter Whybrow, a Los Angeles author, psychiatrist and neuroscientist. “It’s an expensive spin on the idea of wearing an elastic band that you snap on your wrist to stop a certain behavior.”

Dr. Marc Potenza, a professor of psychiatry at Yale, says researchers have questioned the ethical nature of shock intervention when more comfortable options like cognitive behavioral therapies, pharmaceutical interventions and 12-step programs are available.

The practice of aversion therapy has been around for 80 years. Schick Shadel Hospital, based in Seattle, reports that it has successfully treated more than 65,000 people for alcohol or drug addiction using counter-conditioning methods like emetic drugs, which make people feel nauseated if they drink alcohol, or supervised shock therapy. The hospital’s medical director, Dr. Kalyan Dandala, said that he was interested in using Pavlok to help people continue recovery once they finish the 10-day inpatient treatment, but added that the device should be professionally supervised.

“It’s better suited as a prescribed tool for behavior modification,” Dr. Dandala said. “The company needs to refine it, put more education in the tool, and have more oversight.”

Michelle Freedland, a psychiatric nurse practitioner in Manhattan, has worked with five patients who use the device for nail biting, addictions, compulsive behaviors and more.

“When one of my patients told me he was using it last year to help him get out of bed in the morning, I was skeptical at first,” she said. “I mean, the notion of being shocked — you can have a little reservation. But when you understand how to use it properly and people are more engaged in their own treatment, they tend to follow through with it more.”

Mr. Sethi, the founder, said the company had just begun to collect data on the long-term success of the device, and was planning a clinical trial later this spring. The Pavlok has been available since November, and he said about 10,000 people had used it.

Despite the potential for pain and the lack of science backing a long-term effect, user feedback on Facebook groups and message boards has been enthusiastic about the device, especially as a last resort for problems like overeating and binge drinking.

Bud Hennekes, 24, a blogger in St. Louis, said he had used Pavlok to kick a nearly two-pack-a-day cigarette habit. “When I tried to quit before, I still had the craving to smoke,” he said. “When I used Pavlok, the cravings completely went away. I don’t know if it’s science or a placebo effect or what, and I don’t really care because it worked.”

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Mind-Based Therapies May Ease Lower Back Pain

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Credit Stuart Bradford

Sixty-five million Americans suffer from chronic lower back pain, and many feel they have tried it all: physical therapy, painkillers, shots. Now a new study reports many people may find relief with a form of meditation that harnesses the power of the mind to manage pain.

The technique, called mindfulness-based stress reduction, involves a combination of meditation, body awareness and yoga, and focuses on increasing awareness and acceptance of one’s experiences, whether they involve physical discomfort or emotional pain. People with lower back pain who learned the meditation technique showed greater improvements in function compared to those who had cognitive behavioral therapy, which has been shown to help ease pain, or standard back care.

Participants assigned to meditation or cognitive behavior therapy received eight weekly two-hour sessions of group training in the techniques. After six months, those learning meditation had an easier time doing things like getting up out of a chair, going up the stairs and putting on their socks, and were less irritable and less likely to stay at home or in bed because of pain. They were still doing better a year later.

The findings come amid growing concerns about opioid painkillers and a surge of overdose deaths involving the drugs. At the beginning of the trial, 11 percent of the participants said they had used an opioid within the last week to treat their pain, and they were allowed to continue with their usual care throughout the trial.

“This new study is exciting, because here’s a technique that doesn’t involve taking any pharmaceutical agents, and doesn’t involve the side effects of pharmaceutical agents,” said Dr. Madhav Goyal of Johns Hopkins University School of Medicine, who co-wrote an editorial accompanying the paper.

Dr. Goyal said he sees many patients with chronic lower back pain who become frustrated when they run out of treatments. “It may not be for everybody,” he said, noting that some people with back pain find yoga painful. “But for people who want to do something where they’re using their own mind to help themselves, it can feel very empowering.”

One of the strengths of the study, published in JAMA on Tuesday, was its sheer size. It included 342 participants ranging in age from 20 to 70. They were randomly assigned in equal numbers to either mindfulness-based stress reduction, cognitive behavioral therapy, or to continue doing what they were already doing.

Sixty-one percent of participants who received meditation training experienced meaningful improvement in functioning six months after the program started, slightly more than the 58 percent who improved with cognitive behavioral treatment but far exceeding the 44 percent who improved with their usual care.

Those who got cognitive behavioral therapy had greater improvement when it came to a measure called “pain bothersomeness,” with 45 percent gaining meaningful improvement compared with 44 percent in the meditation group. But both these treatments were more effective than the usual treatment, which led to improvement in only 27 percent of people.

The benefits were limited, but that’s not really surprising, said the study’s lead author, Daniel Cherkin of Group Health Research Institute in Seattle. “There are no panaceas here. No treatment for nonspecific back pain has been found to make a whole lot of difference for many people.” While some treatments may help some people, he said, they don’t work well for others, which is why it’s important to be able to offer lots of options.

Mindfulness-based stress reduction was developed in the 1970s by Jon Kabat-Zinn, a scientist in Massachusetts who adapted Buddhist meditation practices for an American audience. The goal is for meditators to increase their awareness of their experience and of “how it’s affecting them and how they’re responding to it,” said Dr. Cherkin, adding that the idea is for participants “to change their mind-set and, in a way, almost befriend the pain, and not feel it’s oppressing them.”

The new study is the second showing that meditation may help people manage chronic lower back pain. Earlier this month, researchers at the University of Pittsburgh School of Medicine reported in JAMA Internal Medicine that mindfulness meditation helped older adults manage their pain for up to six months, though the improvements in function did not persist.

Access to mindfulness-based stress reduction can be problematic, however. Training by certified instructors is not available everywhere, and may not be covered by health insurance.

But the need is tremendous. Back pain is a leading cause of disability worldwide and the second most common cause of disability for American adults.

One in four adults in the United States has had a bout of back pain within the past month, according to national health figures, and back pain that has no clear underlying cause can be tough to treat, often improving only to flare up again weeks to months later.

Dr. Cherkin said mindfulness-based stress reduction may be particularly helpful for people because even if their use lapses, they develop a skill they can draw on later when they need it.

“That suggests that training the mind has potential to change people on a more lasting basis than doing a manipulation of the spine or massage of the back,” techniques that may be “effective in the short term but lose effects over time,” Dr. Cherkin said. “You can practice it by waiting at the bus stop and just breathing.”

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Turning Your Pet Into a Therapy Dog

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Credit Paul Rogers

It did not take long for me to recognize the therapeutic potential of Max, the hypoallergenic 5-month-old Havanese puppy I adopted in March 2014. He neither barked nor growled and seemed to like everyone, especially the many children that come up and down our block.

When I asked if a crying child passing by would like to pet a puppy, the tears nearly always stopped as fluffy little Max approached, ready to be caressed.

So I signed us up for therapy dog training with the Good Dog Foundation, which met conveniently in my neighborhood. If we passed the six-week course, we would be certified to visit patients in hospitals and nursing homes, children in schools, and people in other venues that recognize the therapeutic potential of well-behaved animals.

Training involves a joint effort of dog and owner, usually in groups of four to eight pairs. The dog can be any size, any breed, but must be housebroken; nonaggressive; not fearful of strangers, loud or strange noises, wheelchairs or elevators, and able to learn basic commands like sit, lie down and leave it. Good temperament is critical; a dog that barks incessantly, nips or jumps on people uninvited would hardly be therapeutic.

During our first visit to patients at my local hospital, a woman who said she’d had a “terrible morning” invited Max onto her bed, showered him with affection and, crying with pleasure, thanked me profusely for bringing him around to cheer her up.

Moments later, on the pediatrics ward, a preverbal toddler hospitalized with croup spotted Max and came charging down the hall squealing with delight. The two met eye-to-eye; Max even appeared to smile, and she giggled as she patted his head.

I don’t know about Max, but I was hooked. I agreed to bring him for monthly patient visits, with a promise to do more if my schedule permitted, and I was able to do the required pre-visit bath.

A therapy dog need not be small and fluffy. A neighbor with a “mush” of a 90-pound American pit bull named Pootie has had similar experiences at the Veterans Affairs New York Harbor Healthcare System’s Brooklyn campus. During the first visit, one patient told him repeatedly, “You made my day.”

But while a hospital’s voluntary pet therapy program is designed to aid patients, in my experience the chronically-stressed hospital staff benefits as much if not more from pet visits. “Can I pick him up?” is the typical request from hospital personnel I encounter, and some don’t even wait for me to say yes.

Therapy pets differ from service animals like those that guide the blind, detect impending health crises for people with epilepsy or diabetes, or stimulate learning for children with autism or cerebral palsy.

Pet therapy most often involves privately owned animals – usually dogs, but also cats, rabbits, even kangaroos, birds, fish and reptiles – that their owners take to facilities to enhance the well-being of temporary or permanent residents. Thus, in addition to relieving the monotony of a hospital stay or entertaining residents in a nursing home, Max might visit a school where young children wary of reading aloud will happily read to a dog that does not care about mistakes.

At my local hospital, therapy dogs often attend group sessions for psychiatry patients. Cynthia Chandler, a counseling professor at the University of North Texas and author of “Animal Assisted Therapy in Counseling,” reports that visits by her dog Bailey increased patient participation in group therapy and improved hygiene and self-care among those with severe mental illness.

At Veterans Affairs hospitals, not only therapy dogs but also parrots have reduced anxiety and other symptoms among patients being treated for post-traumatic stress disorder.

Valerie Abel, a psychologist who coordinates the pet therapy program at the Brooklyn Veterans Affairs hospital, said, “The presence of therapy dogs makes such a difference. Many ask when they’ll next be back. A big dog can put its head on patients’ beds and you can actually see them relax.”

Studies have shown that after just 20 minutes with a therapy dog, patients’ levels of stress hormones drop and levels of pain-reducing endorphins rise. Endorphins are the brain’s natural narcotic, the substance responsible for the runner’s high that helps injured athletes ignore pain.

In elderly patients with dementia, depression declines after they interact with a therapy animal. And researchers at the University of Southern Maine showed that therapy dog visits can calm agitation in patients with severe dementia.

In a controlled study of therapy dog visits among patients with heart disease, researchers at the University of California, Los Angeles, found a significant reduction in anxiety levels and blood pressure in the heart and lungs in those who spent 12 minutes with a visiting animal, but no such effect occurred among comparable patients not visited by a dog.

Therapy dogs are often described as better than any medicine. They know instinctively when someone needs loving attention. Last winter, when I was felled by the flu (despite my annual shot), 1-year-old Max lay at the foot of my bed for hours on end, making none of his usual demands for attention and play.

In an intriguing pet therapy program, sometimes called pets behind bars, benefits accrue to both the animals and the humans with whom they interact. Shelter dogs considered unadoptable and living on “death row” are assigned to be cared for and trained by selected prison inmates, including convicted killers and rapists, many of whom have serious anger issues.

The inmates work to socialize the dogs, teaching them to trust people, behave appropriately and obey simple commands. In turn, violence and depression among the inmates is lessened; they learn compassionate behavior, gain a sense of purpose, and experience unconditional love from the dogs in their care.

At the completion of training, rehabilitated dogs are offered to people who want to give a shelter animal a permanent home. Through the Safe Harbor Prison Dog Program at Lansing Correctional Facility in Lansing, Kansas, for example, some 1,200 dogs have been adopted as pets.

In a related program, veterans back from service in Iraq and Afghanistan are giving basic obedience training to shelter dogs, a project that helps the vets readjust to being home and offers the dogs a chance to gain a home of their own.

Before signing up for therapy dog training, you’d be wise to find out first what the program involves and its cost and what will be required of you by the facilities you hope to visit. I’ve had to provide annual documentation of Max’s vaccinations and freedom from intestinal parasites, which typically requires a visit to the vet. I too had to show I was immune to multiple infectious diseases and free of H.I.V., and the hospital had to test me for drug abuse.

Still, the rewards Max and I have accrued as hospital volunteers more than compensate for these requirements.

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