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What is Trauma Incident Reduction (TIR) in Behavioral Healthcare?

Traumatic experiences are often sudden, one-time incidents, such as a car accident, natural disaster, or school shooting. Other traumas may occur over a longer period of time, such as a lengthy illness, financial difficulties, or domestic abuse.

While some people can recover from trauma without long-lasting effects, many others develop mental-health symptoms that can last for years. There are several therapeutic approaches for addressing trauma, such as Traumatic Incident Reduction (TIR) therapy.

What is Traumatic Incident Reduction (TIR)?

TIR is a form of psychotherapy first developed in the 1980s by California psychiatrist Dr. Frank Gerbode. TIR is meant to help a person become desensitized to painful experiences, which can reduce or eliminate their negative impact.

TIR is a rapid treatment method, compared to more traditional psychotherapy. This method involves a client re-experiencing their past trauma in a safe, judgment-free environment, without distractions or subjective interpretations.

In general, TIR is delivered in one-on-one sessions between the client and a trained facilitator. These sessions are usually weekly sessions of 60-90 minutes in length. The number of sessions depend on the individual client.

The idea behind TIR is that, when a person experiences a physical or emotional trauma, they can either fully confront and experience it, or try to block it from their awareness. When the person faces the incident and does not try to escape the negative effects or emotions involved, then the event is “completed” and it becomes part of their past.

However, if the person tries to block the experience, or repress it, the incident cannot be “completed” and becomes a kind of “unfinished business” that continues to have negative effects. In this case, the person’s existence can become too tied up in the past, preventing them from fully experiencing the present.

With TRI, the person can enter a “safe space” in which they can more fully examine and experience the incident that they had previously blocked. This way, they can release their resistance to it, as well as the negative emotions and thought patterns associated with it. Thus, the traumatic incident is “completed” and no longer affects the present.

Who benefits most from TIR?

Clients who are aware of a specific, traumatic event and how it has affected them are the most likely to benefit from TIR. However, it may also help individuals who experience unwanted emotions, sensations, or attitudes without knowing what specific traumas may have caused them. TIR may also help treat addiction, though this application requires further research.

When fully completed, TRI has been able to eliminate symptoms of Post-Traumatic Stress Disorder (PTSD) for many clients. They also may gain new, helpful insights of their own, and even increase their quality of life.

One study conducted in the Tallahassee Federal Correction Institute in Florida examined the effectiveness of TIR in 123 female inmates who had experienced interpersonal violence. Participants who were assigned to TIR experienced a statistically significant decrease in symptoms of PTSD, depression, and anxiety, compared to the control group.

Demand for behavioral health services are on the rise, and current events may lead to an increase in trauma that will further drive individuals to seek mental health care. Whether you provide services that address PTSD, substance misuse, ADHD, depression, or other behavioral health needs, BestNotes offers EHR solutions that help you save time, stay profitable, and improve client outcomes. Contact us today to learn how our customizable solutions can fit your practice’s workflow.

date:  Mar 01, 2021
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School Programs, Medical Marijuana Debates, and Other Idaho Behavioral Health News

Like other parts of the country, Idaho has faced increased mental health and substance misuse challenges during the last year. Here we look at a few recent stories of behavioral health in Idaho.

Behavioral Health Services Fragmented, Uneven in Idaho Schools

A new survey of Idaho schools, conducted by Education Northwest with support from the State Department of Education, found that behavioral health programs in the state’s K-12 schools vary widely. The survey asked about the availability of behavioral health services before the COVID-19 pandemic.

Although most school leaders say that behavioral health services benefit students and teachers, only 60 precent of districts have a strategy or practice that supports all students. Only 27 percent reported that they had a “‘structured program.” Rural and charter schools offered fewer behavioral health services, but non-rural districts said they lacked the resources to expand their behavioral health offerings. What programs are available were rarely assessed.

Idaho Lawmakers Divided on Marijuana Use

The Idaho Senate has approved a measure to amend the state constitution to prevent the legalization of any psychoactive drug not approved by the FDA, including marijuana. This proposal, Senate Joint Resolution 101, was approved 24-11. If passed, the amendment would prohibit legalization of such drugs for any purpose, including medical use. All seven Democratic senators voted against the amendment, partly to keep the legalization of medical cannabis as an option for Idaho.

At the same time, the House is preparing to introduce a bill that moves in a different direction. Idaho Rep. Mike Kingsley (R-Lewiston) is partnering with House Minority Leader Ilana Rubel (D-Boise) and others to propose a bill that would legalize medical marijuana, with restrictions. Part of the intent of this bill would be to keep medical marijuana from becoming recreational, to reduce use of opioid pain medications, and discourage Idahoans from entering neighboring states to purchase marijuana for pain management.

Donations Go to Help Mental Health in Rural Idaho

Four Idaho nonprofits have received a total of $1.3 million from Cambia Health Solutions to address behavioral health needs in rural Idaho. These donations include:

$1 million to help the Idaho Primary Care Association expand access to mental health services and reduce the stigma of mental health issues
$145,700 to help NAMI Idaho hire additional staff for its peer support network
$100,000 to the Idaho Suicide Prevention Hotline to help its messaging and create partnerships with other organizations in rural communities
$100,000 to Empower Idaho to expand its work addressing social determinants of health

Alcohol Consumption Rises in Idaho

U.S. alcohol consumption has increased significantly during the pandemic., which provides resources related to substance misuse treatment, found that Idaho on average became a “heavy drinker.” According to the CDC, “heavy drinking” is defined as more than 14 drinks per week for men over 12 months, and more than 7 per week for women. The average Idaho adult consumed about 14 standard-size drinks per week in 2020. However, this still falls beneath the national average of 17 per week.

Struggling to keep up with rising demand for behavioral health services? BestNotes is pleased to support mental health and addiction treatment providers in Idaho and across the nation. Contact us today to learn about how our services, with customizable features like telehealth capabilities and eprescribing, can help you stay ahead of your workload, improve patient outcomes, and increase profitability.

date:  Feb 15, 2021
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Have Eating Disorders Increased During the Pandemic?

Previously we’ve examined how behavioral health issues, including anxiety, depression, and substance abuse, have increased during the COVID-19 public health emergency. One behavioral health concern that has received less attention, however, is the variety of eating disorders that can affect people of all ages.

Eating disorders can take many forms and show many different symptoms. Some key signs, however, are:
Preoccupation with weight
Fixation on parts of the body
Skipping meals
Forming odd eating habits
Refusing to eat particular food groups

COVID-19 and Eating Disorders

Experts across the United States have reported increased rates of eating disorders since the beginning of the COVID-19 pandemic. According to the National Association of Anorexia Nervosa and Associated Disorders, calls to their helpline have almost quadrupled, from about 80 calls a month before the pandemic to about 230. This is largely due to feelings of isolation, as well as concerns about an uncertain future, says Executive Director Lynn Slawsky.

The National Eating Disorders Association has also reported a 78-percent increase to its helpline since March 2020. Clinicians have also seen local increases in people seeking help for eating disorders. In California, UCSF has seen a doubling in hospitalizations for eating disorders. Disrupted circumstances, including stockpiling food and supplies and messages from social media, have also worsened eating disorder symptoms.

Treatment for Eating Disorders

The best treatment for eating disorders will depend on the disorder and symptoms involved. It also will involve treating any health problems that the eating disorder has caused. Treatment options include:

Psychological therapy and counseling
Nutrition education
Medical monitoring
Inpatient programs

Researchers continue to study how effective different types of therapies can be for eating disorders. For example, day treatment programs are often promoted as an alternative to inpatient treatment, but are not regularly used. One study looked at 148 patients with various eating disorders who under went 8 weeks of day treatment followed by outpatient treatment in a naturalistic setting. During the treatment phase, patients significantly reduced binge eating, purging, or fasting behavior. These improvements generally remained stable during follow-up. The study was published in Eating and Weight Disorders.

Another study found that music therapy could have potential in treating individuals with eating disorders. Researchers reviewed existing literature on the effect of music in people with anorexia nervosa (AN) and bulimia nervosa (BN). The review was published in Psychiatria Danubina. While additional studies are needed, they found that:

Listening to classical music was found to be beneficial for the food consumption of inpatients with AN.
Group singing also reduced post-prandial anxiety in individuals with AN.
Vodcasts (also called video podcasting or vlogging) that carried positive visual or autobiographical stimuli helped with anxiety and body image for BN patients.
At the same time, watching music videos reinforced preoccupation with physical appearance.

Behavioral health clinicians and addiction treatment providers are struggling to keep up with the increased demand for their services, including treatment for individuals struggling with eating disorders. This is the ideal opportunity to reconsider your practice’s workflow and how you can streamline your operations to be more efficient, increase profitability, and improve client outcomes. Contact BestNotes today to learn about how our EHR and other solutions can help your practice stay on top of demand.

date:  Feb 11, 2021
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Is COVID-19 Linked to Later Mental Health Issues?

By now you have seen that behavioral health needs have skyrocketed during the COVID-19 pandemic. We’ve already talked about how substance use and mental health issues like anxiety and depression are on the rise.

These issues occur whether or not individuals were exposed to the novel coronavirus or developed COVID-19. Newer research, however, suggests a possible link between COVID-19 and later development of mental health symptoms.

A New York Times article has described cases of individuals who developed psychiatric symptoms for the first time after being diagnosed with COVID-19. One patient developed paranoia that her children would be kidnapped. Another began to experience visual hallucinations.

There are a relatively few number of these cases, but they highlight the complicated connection between COVID-19 and behavioral health. Here are some recent findings by researchers around the world.

The Lancet Examines Links Between COVID and Mental Healthcare

An editorial in an upcoming issue of The Lancet notes the ongoing need for high-quality information about the effects of both the virus and the measures used to fight it.

This article points out that one study of U.S. electronic health records found an increased incidence of a first-time psychiatric diagnosis within 90 days of a COVID-19 diagnosis. However, the cause-and-effect connection was uncertain.

Another study, however, found that being recently diagnosed with a mental disorder was associated with an increased risk for COVID-19 infection. This association was exacerbated among African Americans and women. There was also a higher frequency of some adverse infection outcomes.

Possible Causes of Mental Health Issues After COVID-19

A group of authors from Spain have described in Psychiatry Research their observations of psychotic symptoms in COVID-19 patients. They noted that:

Psychotic symptoms in patients diagnosed with COVID-19 were more frequent in patients who had been admitted to intensive-care units.
Some psychiatric symptoms may be linked to the medications used to treat COVID-19.
Many psychotic episodes were resolved with low doses of antipsychotics.

Brain Inflammation in COVID

Inflammation in the central nervous system has been proposed as one cause of psychiatric symptoms in COVID-19 patients. However, one study in Germany indicates that this has little effect.

This study looked at neuropathological features in the brains of 43 COVID-19 patients who died between March 13 and April 24, 2020, in Hamburg, Germany. The researchers found generally mild neuropathological changes in patients with COVID-19. The most common finding was pronounced neuroinflammatory changes in the brainstem. However, the presence of the novel coronavirus in the central nervous system was not associated with the severity of neuropathological changes.

As additional research and other information emerges, we can hope to learn more about the mental-health effects of COVID-19. In the meantime, behavioral health providers should be aware of this risk among the people they serve.

As many populations and individuals struggle with mental health concerns during the COVID-19 pandemic, behavioral health services remain critical. If you’re a behavioral health provider who has not yet launched telehealth services, or you are struggling with your current telehealth system, it’s not too late. BestNotes EHR solutions offer secure, HIPAA-compliant, integrated tools to make your telehealth program a success. Contact us today to schedule a demo and learn more!

date:  Feb 08, 2021
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