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What Should Behavioral Health Providers Know About Polyvagal Theory?

“Polyvagal Theory” describes a group of ideas related to the role of the vagus nerve in human psychology. According to this theory, the vagus nerve serves an important role in emotional regulation, social behavior, and fear response. Stephen Porges, director of the Brain-Body Center at the University of Illinois at Chicago, first introduced Polyvagal Theory in 1994.

What is the vagus nerve?

The vagus nerve, also called the pneumogastric nerve, is a cranial nerve made up of sensory and motor fibers. It is also the longest nerve of the human autonomic nervous system (ANS). The ANS controls and regulates many bodily functions, usually unconsciously. Such functions include heart rate, digestion, respiratory rate, and urination.

The ANS is important for the human body’s stress response and defense mechanisms. One branch of the ANS, the sympathetic nervous system, is connected to the “fight-or-flight” response. Another branch, the parasympathetic nervous system, controls what is sometimes called the “freeze-or-faint” response. In stressful situations, these systems may work together, or one may inhibit the other.

What is Polyvagal Theory?

Under Polyvagal Theory, human beings can immediately, even unconsciously decide if an environment is safe or threatening because of information sent via the vagus nerve.

When responding to their environment, Polyvagal Theory proposes that humans use not only the fight-or-flight and freeze-or-faint responses, but another division of the ANS. This third division includes a social communication and engagement system, which includes facial muscles, middle ear function, and vocalizing.

According to Polyvagal Theory, a person who, with the information sent via their vagus nerve, has determined that an environment is secure can feel safe in using their social engagement system. This includes a calm heart and respiratory rate, and the free use of vocal and facial expressions.

However, if the environment is not safe, it will trigger the fight-or-flight response. If that system somehow fails, then the freeze-or-faint response kicks in, and the affected person is less able to relate to the world socially. Porges also suggests that the body can remember a traumatic experience and become “stuck” in one of these trauma response states.

Polyvagal Theory in Mental Health

Psychologists and therapists who are interested in Polyvagal Theory often use it to inform decisions about anxiety, fear, and trauma.

According to Bessel van der Kolk, professor of psychiatry at the Boston University School of Medicine and author of The Body Keeps the Score, the Polyvagal Theory “makes us look beyond the effects of fight or flight and put social relationships front and centre in our understanding of trauma. It also suggested new approaches to healing that focus on strengthening the body’s system for regulating arousal.”

Because Polyvagal Theory is a relatively recent idea, supporting evidence remains limited. While it has been used to help inform trauma treatment, Polyvagal Theory has also been criticized for this lack of research. Additional research may be necessary before the theory is more widely incorporated into behavioral health clinical practice.

Trauma recovery is just one of many challenging areas for behavioral health providers. In particular, mental health and addiction treatment professionals can prepare to see an increased demand for services related to trauma connected to the COVID-19 pandemic.

You use different treatment approaches for different clients, so it’s important to make sure your EHR solution is just as flexible. BestNotes EHR solutions can be customized to your unique needs to help you save time, reduce frustration, improve profitability, and meet documentation and reporting requirements. Contact us today to learn more or schedule a demo.

date:  Apr 16, 2021
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This Spring, Consider the Link Between Green Space and Mental Health

Spring is finally here, bringing longer days, warmer temperatures, and new growth. As a behavioral health provider, this is the perfect time for you to encourage your clients to enjoy the benefits of green space.

Green Health Benefits

An increasing body of research shows that green spaces and nature can be a vital part of mental and physical health. For example, a World Health Organization report in 2016-17 noted that greenery and natural features can specifically help counteract the stress, lack of physical activity, and environmental hazards associated with urban living.

Experts have not yet determined exactly why we benefit from green space, but the effects are fairly obvious. Health benefits include:

Encouraging physical movement
Space to socialize (a notable benefit during the era of COVID-19, when people still need social interaction but many places have limited indoor gatherings)
Lower air and noise pollution
Exposure to beneficial microbes that can improve immune function
Reduced stimulation, leading to a more relaxed mind and increased ability to concentrate, remember, and learn

A Danish study published in 2019 suggests that, among those with behavioral health disorders, the benefits of green space may be greatest for individuals with mood disorders, depression, neurotic behavior, and stress-related concerns.

In fact, the study also found that children who grew up with the least exposure to green space had up to 55 percent higher risk of developing a psychiatric disorder. This was independent of other known risk factors.

Not Just Any Green Space

But are all green spaces created equal? Not necessarily, some research suggests.

One study in the United Kingdom, published in Frontiers in Psychology in 2018, found that biodiversity in urban green spaces was best for mental health. Study participants reported significantly more “psychological restoration” from urban parks with more biodiversity. Where mental health is concerned, parks with a variety of plants and other natural features are more beneficial than cultivated landscapes and modern amenities.

Different people also may respond to green space differently. One 2014 study found that the relationship between urban green space and health can vary by age and sex. Researchers report in the Journal of Epidemiology and Community Health that the benefit of more green space was most apparent in early to mid-adulthood for men. Among older women, those with moderate access to green space had better mental health.

Other research has found that green space access can have specific benefits for children. In the Journal of Pediatric Nursing in 2017, researchers reported that access to green space was associated with better health and cognitive development for children. Green space access was linked to attention and memory restoration, stress moderation, improved behaviors, and even higher standardized test scores.

Behavioral health clinicians can use these findings to encourage green space exposure and outdoor activities in clients of all ages. Consider discussing these benefits with your clients and working with them to determine the best outdoor locations and activities for their particular mental and physical health needs.

With behavioral health services in greater demand than ever, you need to strike the right balance between improving client outcomes, keeping your practice profitable, and staying compliant with regulatory bodies. BestNotes EHR solutions, built and customized specifically for behavioral health clinicians, helps you accomplish all three. Contact us to learn more about how our solutions can help your practice.

date:  Apr 12, 2021
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Should You Discuss Nutritional Psychology With Your Behavioral Health Clients?

Do the foods we eat influence our mental health? That’s the idea behind nutritional psychology, also called nutritional psychiatry.

Support for Nutritional Psychology

Studies suggest there is, indeed, a connection between food and mental health. After all, our brains require food for fuel, just like any other organ. It makes sense that the kind of fuel is important.

Plus, the gastrointestinal tract is responsible for producing 95 percent of the body’s serotonin, a neurotransmitter involved in mood regulation. The condition of the gastrointestinal tract, including the presence of beneficial bacteria or harmful inflammation, could affect both digestion and emotions.

One systematic review, published in 2018 in Molecular Psychiatry, analyzed more than 40 studies that looked at the connection between following a healthy diet and depressive symptoms or clinical depression. Results indicated that a healthy diet may offer some protection against depression.

Stanford Medicine, the medical school at Stanford University, established the Metabolic Psychiatry Clinic, the first academic specialty clinic in the United States that evaluates and treats patients with psychiatric illness and metabolic abnormalities. Compared to the general population, people with psychiatric illness have a higher proportion of obesity, diabetes, and heart disease. Many patients also may experience metabolic abnormalities from taking certain medications for mental health conditions.

Behavioral health clinicians who encourage healthy lifestyle choices could help improve their clients’ outcomes. Positive lifestyle behaviors can also improve physical health, especially when encouraged in partnership with the rest of a client’s care team.

An Ideal Mental Health Diet?

There may not be a single, ideal diet that everyone should follow for their mental health. Each person is different, with different nutritional needs. However, some research offers insight that behavioral health providers and other clinicians might use to guide their clients’ nutritional decisions.

For example, the Molecular Psychiatry study found support for the use of a Mediterranean diet in treating depression. Generally, this diet includes relatively high consumption of olive oil, legumes, fruits and vegetables, and fish, with moderate consumption of dairy products and wine, and limited meat products.

Another 2018 study, published in the World Journal of Psychiatry, looked at the most nutrient-dense foods and how they might help prevent or mitigate depression. They found a connection between 12 “Antidepressant Nutrients” and the prevention and treatment of depressive disorders. These nutrients include:

Long-chain omega-3 fatty acids (EPA and DHA)
Vitamin A
Vitamins B6 and B12
Vitamin C

Foods with the highest concentrations of these nutrients were found to be:

Various seafoods (including oysters and mussels)
Organ meats
Leafy greens and lettuces
Cruciferous vegetables

The study authors recommended that further research examine these nutrients and foods, and that clinicians consider their dietary value in supporting clients with depression.

When you recommend a treatment for your client—whether that’s lifestyle changes, medications, or a type of psychotherapy—how do you know it’s working? Tracking outcomes is not only important for your clients, but is required in some form by various state and federal agencies. The right outcome tracking and documentation is vital for your practice’s success.

The OutcomeTools system by BestNotes helps reduce the hassle of recording and tracking outcome data. You can get OutcomeTools as a standalone tool, or as part of the BestNotes EHR solution. Contact us today to learn how OutcomeTools can help your behavioral health practice stay compliant, profitable, and effective.

date:  Mar 25, 2021
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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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How Working Remotely Affects You – And What to Do About It

Telecommuting was already increasing when the COVID-19 pandemic gave it a big, sudden push forward. How does remote work affect individuals and relationships? Let’s take a look.

Remote Work: Pros and Cons

The benefits of remote work are easy to see. Workers have more time and flexibility for daily life, whether that means just being home for deliveries or spending more time with family. The lack of commute also saves time and gas money, can reduce your carbon footprint, and reduces your risk getting involved in a traffic collision.

Work itself often benefits from telecommuting. Fewer interruptions from coworkers or distractions in the office means increased productivity and engagement. It also reduces your exposure to people who may be ill.

Remote work also has different disadvantages compared to traditional commuting. Organizations may have more difficulty onboarding and training new employees. Individuals may struggle to manage their own time with less oversight.

Personal difficulties associated with telecommuting may include loneliness due to isolation and distance from colleagues, especially for remote workers who live alone. Separating work from a personal life is also harder to accomplish.

Loneliness and Working From Home

Loneliness is an obvious drawback of working from home. It can also have some of the worst side effects. One study found that social loneliness can increase health risks as much as alcoholism or smoking 15 cigarettes a day. Loneliness may be twice as harmful to physical and mental health as obesity.

In older adults, social isolation is associated with a 50-percent increase in dementia risk. It can increase depression, anxiety, and suicidal ideation.

Try these tips to reduce loneliness:

Early in the week, schedule face-to-face social interactions; plan a safe activity or setting that everyone is comfortable with.
Use videoconferencing software when possible; this not only allows you to see a friendly face, but can minimize miscommunication and thus save time.
Join a digital community, such as a local or national HIMSS group, an online conference, or a hobby-related forum.
Make time for family and friends before you feel too lonely.

Managing Stress While Working Remotely

The challenges of remote work can increase stress levels, which causes adverse effects for 43 percent of U.S. adults. In fact, some estimates say that 75-90 percent of all doctor visits are stress-related. Such conditions include:

High blood pressure
Sleep issues
Skin conditions

The best way to deal with stress is to identify and address underlying causes. If your work situation is creating stress, try to:

Discuss possible changes with your organization, manager, or teammates.
Look for ways to manage your time more effectively.
Create a workspace with few distractions.
Keep to a morning and evening routine.

Your physical health may affect stress levels. Try to:

Exercise regularly.
Get enough sleep at night.
Make and eat healthy meals.
Learn and practice relaxation techniques, such as meditation or yoga. Accept that there are always things you cannot control.

Practice being assertive, not aggressive or passive-aggressive, in your interactions with others. Assert your feelings, opinions, or beliefs in a respectful way. Set boundaries with housemates, family members, and colleagues.

Working remotely can be a big change for many people, but many of the challenges can be overcome. If you’re a behavioral health or addiction treatment organization, BestNotes EHR has features that leverage low-cost telehealth solutions, such as Zoom or GoToMeeting.

Contact our team to learn more, or schedule a free demo!

date:  Sep 04, 2020
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