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Assessing for Pediatric Mania | Part 2 of 2

Dr. Himanshu Agrawal, MDby Dr. Himanshu Agrawal, MD.

Disclaimer: This blog is merely a personal opinion about psychiatric issues. It does not equate to a psychiatric consultation and does not imply doctor-patient relationship.
In Part 1, Dr. Agrawal introduces his assessment of pediatric mania. Part 2 begins with additional considerations. Click here for part one.


The Power of Pilates

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by Lisa Courchaine, CAPSW 

Northwest Passage III Therapist 

Ok I admit it, I began practicing Pilates 10 years ago because it was the” hip” new workout, and I was curious what all the buzz was about.  Over time, I have realized the many benefits Pilates has to offer, and recent studies suggest the same.  For instance, in a recent study, college students participated in a 15 week movement based class on Pilates, Taiji quan, or GYROKINESIS.  Results found that overall; these students had increased levels of mindfulness, which were associated with improved sleep, self-regulation, mood, and perception of stress.  Now, first things first, according to Marsha M. Linehan, who brilliantly developed Dialectical Behavior Therapy (DBT), the core concept of mindfulness is all about being able to pay attention, non-judgmentally to the present moment.

Principles-of-PilatesAfter reading about the study, I was intrigued to research exactly how the movement based classes increased levels of mindfulness.  When looking at the core principles of Pilates, I found numerous connections to the mental health world, particularly DBT, which is the core treatment modality we use with the girls at Northwest Passage III.  The first core principle of Pilates is Concentration, as it requires intense focus on your entire body throughout the entire routine, which is an excellent way to actively distract oneself from intense emotions, as DBT teaches us.  The second core principle of Pilates is Control, as it teaches us that we are in control of our body, and not at its mercy, which aligns with the DBT philosophy of skillfully being able to tolerate distress and regulate emotions, and not being at the mercy of our emotions.  The third core principle of Pilates is Centering, which emphasizes use of the abdomen, lower and upper back, hips, buttocks, and inner thighs as the “powerhouse” or source of strength for the exercises, which aligns with diaphragmatic or “deep belly breathing” used in the mindfulness module of DBT.  The fourth core principle of Pilates is the Flow or Efficiency of Movement, with emphasis on smooth transitions from one exercise to the next, which aligns with the DBT mindfulness concept of “radical acceptance“ and being in control over the only thing we can control, ourselves.  The fifth core principle of Pilates is Precision, as it requires few and concentrated efforts, rather than countless and half-hearted efforts, which aligns with the DBT concept of mindfulness and paying attention to the present moment.  The sixth core principle of Pilates is Breathing, which focuses on the increased intake of oxygen to the body (which promotes blood circulation) and to the brain (which lowers anxiety).

It seems as though Pilates naturally incorporates elements of DBT, particularly mindfulness and self-regulation, and according to the recent study, may then lead to improved sleep, which is HUGE in terms of regulating our emotions (being less vulnerable to negative/problematic emotions).

You don’t need money, a gym membership, or fancy equipment.  All you need is a mat and yourself.  I try to teach the girls that taking care of yourself is “cool”, and sometimes comment on how much suffering I could have avoided as a teen, had I known about DBT.  Pilates is one of many ways to incorporate DBT and mindfulness into our lives,  we just have to be creative and willing.  One thing I’ve come to know for sure, is that it will always be “hip” to take care of your body and mind.  Keep calm and DBT on.

Assessing for Pediatric Mania | Part 1 of 2

Dr. Himanshu Agrawal, MD

Dr. Himanshu Agrawal, MD

by Dr. Himanshu Agrawal, MD.

Disclaimer: This blog is merely a personal opinion about psychiatric issues.It does not equate to a psychiatric consultation and does not imply doctor-patient relationship.

In my humble opinion, in the world of Child Psychiatry, there is nothing murkier than the answer to this question “What does pediatric mania look like?

It seems that there are several differing opinions endorsed by different schools of thought spread across USA. (more…)

Using Dialectical Behavioral Therapy (DBT) Principles in Daily Life | Part 3 of 3

by: Kira Yanko, MS, LPC  |  Northwest Passage III Therapist

Don’t Have a Cow?!

For therapists like me, thankfully DBT is highly structured.  There are times in every clinician’s work that we are challenged and these difficulties lead to self doubt.  In addition to hashing this out through consultation, DBT’s stages and targets allow for grounding and focus in session.  They provide a framework to approach clients and guide treatment.  This is especially important when working with clients who are emotionally dysregulated because often they will enter session with a new “COW” (Crisis Of the Week) that they would like to discuss.  Often these are chaotic and crisis ridden problems that are loosely related to the overall goals of treatment.  As such, it would be easy to spend each week addressing these COWs and never get to the gestalt, to the greater pattern of underlying distress, and the need to build a live worth living.  Avoiding COWs is a term I heard in a training several years back.  In my own practice, I tend to refer to these as “shiny objects” because it is easy to become super distracted by them in session.  The stages and targets of DBT help provide a framework to make COWs or “shiny objects” less clinically alluring.  They also offer guidance to what problems areas and issues should be addressed when – something that can be of use even outside of the therapy office.  (more…)

Using Dialectical Behavioral Therapy (DBT) Principles in Daily Life | Part 2 of 3

by: Kira Yanko, MS, LPC  |  Northwest Passage III Therapist

Nurtured and Nudged…

The first and foremost principle of DBT is dialectics, hence the name.  This is the idea that two concepts that seem to be completely opposite from one another can both exist and be true at the exact same time.  A person can both love and hate someone.  They can seek independence and dependence at the same time.  A client can be doing the best that they can and simultaneously need to do better.  This isn’t a new idea (and Marsha doesn’t suggest that it is…after all it is the basis of the serenity prayer written in the late 40’s, early 50’s), but for the first time it was encapsulated and formalized it into a therapeutic approach.  It is often the belief that only one truth exists that leads to both internal and external turmoil for our clients.  If we interact with any of our clients purely from one static vantage point, we present them with opportunities to “power struggle” and this can destroy our alliance – the key aspect of any therapeutic relationship (and I’m not just referring to therapeutic relationship in terms of therapist and client, but in terms of any relationship between two people that can have therapeutic value).


Using Dialectical Behavioral Therapy (DBT) Principles in Daily Life | Part 1 of 3

 by: Kira Yanko, MS, LPC  |  Northwest Passage III Therapist

A Rather Loose Metaphor…

In the world of mental health, Dialectical Behavioral Therapy is all the rage.  It’s the Channing Tatum of psychotherapies…can you tell I’ve worked with adolescent girls for the past eight years?!  Although starting primarily with clients diagnosed with Borderline Personality Disorder who possessed a high suicide risk, research has shown DBT to be an effective treatment for any client whose underlying struggle is rooted in emotional dysregulation.   Just as Channing has proved he is here to stay in the cinematic world, any early concern that DBT was simply a “buzz word” in the therapy world or a passing fad has long been laid to rest.  Also like Channing, DBT is easy on the eyes…so to speak.  DBT’s popularity amongst clinicians (aside from its efficacy, of course) comes from how it took aspects of behavioralism, CBT, mindfulness, and emotional regulation and added some “zhush” transforming it into a package that is more palatable by clients leading to greater adherence and success in treatment. (more…)

Cognitive Disabilities | In-Home Recommendations for Parents (part two)

Part 2 of 2:

by Melissa Gendreau, MS, LPC – Child and Assessment Center Therapist

In part one, we introduced several environmental factors that can be helpful for parents – part two will expand upon additional strategies. Read part one here

  • Utilize emotion charts- Make a poster with multiple facial expressions on it to help the child identify what emotion he is having. This can be even more useful when incorporating pictures of the child’s various emotions as well as the parents.
  • Validate his emotional distress and then work to help problem solve the situation. Making statements like “I can see you’re angry right now” “Let’s figure out what you can do until…”


Cognitive Disabilities | In-Home Recommendations for Parents (part one)

Melissa Gendreau, MS, LPC

Melissa Gendreau, MS, LPC

Part 1 of 2:

A child’s environment is vital to his/her future health and success. For the parents of children with a cognitive disability, the task of creating an appropriate environment can be daunting.  Children with this diagnosis require an environment that is calm, predictable, and supportive.  Children with cognitive disabilities require simple, concrete behavioral expectations in their environment.  In addition, they must experience immediate, consistent, non-shaming consequences (that are appropriate for their individual level of functioning) for not meeting those expectations.  Short-term behavior goals matched with equally short-term consequences may be the most effective method for children with cognitive disability.  The important aspect to remember is to ensure that it is a realistic goal for the individual child. Incorporating all of the above aspects is no small feat.

These children often require intense supervision and structure in the environment.  They often do best in their environment when they came to understand the schedule and routine of the day.  Parents with children who function at an intellectually disabled level often find their child will require multiple parenting and teaching strategies for him/her to be more successful.


Lifestyle, Mental Health and the New Year’s Resolution Syndrome


Dr. David Ammend, MD

Dr. David Ammend, MD

by Dr. David Ammend 

As a general pediatrician by training, I have been taught to try to look at children as a whole when attending to their health needs.  In my role as Medical Director of Northwest Passage residential treatment programs over the past 18 years, my practice has been focused on the health of children with a very particular set of problems, and there can be a tendency for me to pay insufficient attention to children’s general health as we are sometimes faced with a child and family in extreme distress due to mental illness.  However, my ability to keep the “whole child” in mind has been sharpened by the growing recognition that it is exactly the issue of “lifestyle” in its broadest sense has a profound impact on mental health.  Here I would like to discuss some of the challenges that anyone involved with the care of children face when trying to promote a “healthy lifestyle”.

Over the past 5-6 years I have been working with some of my Northwest Passage colleagues to better understand the role of a healthy diet and physical activity in promoting mental health, and to use that knowledge to inform our work with the kids we serve.  What has become increasingly clear to me over that time is that there is a large and growing body of scientific evidence that one’s lifestyle – and in particular one’s diet and level of physical activity – can have a significant impact on both the maintenance of mental health and treatment of mental illness.  I have been pleased to see evidence of a growing recognition among health care professionals and the lay public that these factors are connected.  Sadly, I have also witnessed a seeming glacier pace of tangible progress in the society-wide promotion and achievement of healthier lifestyles for our children.

As a measure of the slow response of our institutions, I believe that a look at the reality of the progress achieved by our schools in the areas of nutrition and physical activity is instructive.  I do not mean here to “pick on” our schools, nor do I wish to paint all schools with the same (largely negative) brush.  But overall the evidence shows that by-and-large our nation’s schools have done a poor job of promoting healthy living.  To those who would say that we already ask our schools to do too much, and give them too much blame, I would say that in general that may be true.  However, when it comes to fundamental lifestyle issues like diet and exercise, I don’t see how we can achieve better health for our kids WITHOUT including the schools, given that kids eat 1 or 2 meals per day (plus snacks) and spend nearly one half of their waking hours 5 days/week for 9 months of the year at school.


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