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Hikikomori & The Future of Anxiety Disorders

Posted on by scottc

In the 1990s, when I was the young president of an international college with campuses in Tokyo and Osaka, Japan was a country under pressure. There was profound political division, a looming recession, and a surge in crime and terrorism – including the Sarin subway attack of 1995.   Despair was so ubiquitous that I was late to work about once a week due to suicide by train – and that was just on my subway line.  This social and economic uncertainty increased the perceived necessity to attend a prestigious university, driving admissions standards and tuition costs to unattainable heights.  For college-oriented families, failure to gain admission to a preferred college meant, simply, failure, and even academically talented young people were folding under the pressure. 

Hikikomori

By almost all measures, the world seemed pretty scary to many Japanese youth in the ’90s, and the resulting fear elicited a number of different reactions.  

My high achieving students at Keio and Tokyo University, where I was an adjunct professor, doubled down on their pursuit of safe, traditional corporate jobs.  To gain admission into these elite schools, they had forgone high school sports, extracurriculars, and leisure time in favor of grueling and expensive “cram schools,” where they prepped for college admissions exams after school and on weekends until well into the night, often seven days a week.

The quirky kids at the small, funky college I ran – a “kokusai daigaku” with transfer agreements to S.U.N.Y and other American and European universities – came to class wearing pajamas, neon hair, gyrary makeup, and other clear but harmless symbols of their rejection of, and rejection by, mainstream Japanese culture. They enrolled at the daigaku to escape Japan. While I enjoyed my high achieving Keio and Todai students, I loved my funky gakusei – an eclectic crew of smart, sweet, anxious, “square pegs” who refused to give up on themselves just because their society did. They would be okay, I knew, because they were still trying, still fighting. They were still fighting, I suspected, because someone close to them – a parent, grandparent, teacher, aunt-believed in them and would not let them give up.

Another group of Japanese youth also wore their pajamas all day, but as an act of retreat, not rebellion.  These young people were termed Hikikomori, by famed psychiatrist Tamaki Saito.  The Hikikomoris’ response to a scary world was to avoid it completely.  These young people opted out of society by the hundreds of thousands, simply refusing to leave their bedrooms.  

The American School-Refusal Epidemic

Now, twenty years later, the U.S. is experiencing similar pressures and a phenomenon not unlike Hikikomori.  Like 1990’s Japan, the U.S. is experiencing intense political division, a looming recession, an increase in crime and terrorism, a spike in despair and suicide, and extreme college admissions pressure. Add to all this a pandemic, and we now have our own pajama crisis.  

Our version of Hikikomori, aka school refusal, is an epidemic of anxiety-based withdrawal from a scary world.  Prior to the COVID pandemic, the National Institutes of Health estimated that as many as 5%, or 2.5 million young people refused school and were, as a result, homebound.  According to research conducted jointly by Stanford University and the Associated Press, another 230,000 students never returned to school after the pandemic, and that’s just in the 21 states that provided data.  

Japan’s Hikikomori crisis of the 90s and America’s school refusal crisis of today share another common feature – cultural accommodation.  Rather than aggressively addressing Hikikomori as the public-health crisis that it was, many in Japan chose to view the massive withdrawal of youth from society as just a modern manifestation of the ancient Japanese ancestral desire for solitude. In other words, they found a way to explain away Hikikomori as a cultural phenomenon.  As such, Hikikomori has been rationalized and normalized and, as a result, has gone largely unchallenged. 

Similarly, America’s school refusal epidemic coincides with a cultural movement toward safety, protection, and accommodation.  These safety responses are not limited to objectively dangerous phenomena, but to any perceived threat, whether physical, emotional, or social. Hyper-protective safety behaviors* are increasingly promoted as culturally evolved safeguards against previously underestimated threats. 

Our media and social media provide constant, inescapable reminders of the dangers of daily life, magnifying these dangers to the point that sticks and stones may break my bones, and words, differences of opinion, and microaggressions can also really harm me.  Our response to these often-exaggerated threats is to accommodate retreat through safe spaces, school withdrawal, social avoidance, and staying home.   Compounding these social forces is the fact that our terrified youth now have the perfect camouflage for their retreat, as homebound behaviors have become suddenly and profoundly normalized post pandemic.   The pandemic also provided massive accommodations for retreat through the proliferation of home-based services like video conferencing, distance learning, food delivery, telehealth, and remote therapy.   

The 2030 Problem

The problem with extreme accommodation is that it perpetuates and magnifies our fear of objectively harmless phenomena. Uncontested, avoidance responses are self-reinforcing, isolating our youth and decreasing engagement, self-efficacy, and resiliency.  Since Japan has a twenty-year jump on this problem, Hikikomori provides us with a window into how this problem might evolve in the US.  

Now, two decades after its emergence, Hikikomori has become what the Japanese are calling the “2030 Problem.”  Because Hikikomori has gone largely unchallenged, many of the pajama-clad legion from my days in Japan are still homebound.  Their parents, many now approaching their eighties, won’t be around much longer to take care of them.  What then?  To many Japanese, the situation seems hopeless. 

The Hope

Assuming, however, as I do, that Japanese Hikikomori and American school refusal are just anxiety-disorders on an epidemic level, the situation for both countries is actually far from hopeless.  Clinical research and practice make it clear that anxiety and related disorders are highly treatable; in fact, anxiety is among the most treatment-responsive of all mental-health problems.  With clinically significant anxiety, as with most mental-health challenges, it is critical for loved ones and mental health practitioners to begin their intervention by meeting the sufferer where she is.  But it’s equally critical not to stay there.  In the case of bedroom-bound hikikomori and school refusers, we meet them where they are so that we can leave together.   

It is this “leaving together” that is the most important but challenging aspect of effective anxiety interventions, especially in a culture that values comfort and perceived safety above all else.   In fact, the most research – supported treatment modality – exposure and response prevention therapy, or ERP – is downright counterculture.  ERP is predicated on the simple but profound notion that the only way to overcome disabling fears is to face them, which is easy to say but hard to do.  This approach requires enormous courage; courage that we, as caregivers, must first cultivate in ourselves so that our children and our clients can borrow it from us until they are able, through a combination of challenge and support, to develop it in themselves.  

The only way to avoid our own “2050 Problem” is to actively challenge the cultural trend toward accommodation and withdrawal.   In the fight or flight equation that so often defines anxiety, this constitutes a commitment to fight.   We must fight the “two lies of anxiety,” as described by Dr. Ellen Hendriksen in a recent New York Times article: first, that our children’s fears are actual threats; second, that our children are too weak to face those fears. Rebutting those lies requires that we believe in our children’s innate strength, resiliency, and self-efficacy in ways that have become, tragically, counterculture.  

I saw this fight twenty years ago in my pajama’d gakusei. I see it today in our Mountain Valley residents and their brave parents. Most of these bright, sensitive people would not describe themselves as fighters or as brave, counter-culture rebels. But that’s exactly what they are. And it will save them.

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Mountain Valley’s Narrative Approach

Posted on by scottc

CEO Will Laughlin discusses Mountain Valley’s new phased approach to treatment with Executive Program Director Zack Schafer.

Will: Can you tell me how you are using a narrative approach to structuring treatment at Mountain Valley? 

Zack: Yes, of course. There tends to be a typical arc to how residents progress through treatment at Mountain Valley. Sort of organic stages that they pass through and benchmarks of progress and growth that are thematically typical but that also vary, of course, per resident. Our assessment of a given resident’s passage through those stages, however, tended to be subjective in nature. So, we have applied a narrative reasoning approach to provide a structured overlay to our program; it consists of three stages, or phases, that more specifically define and sequence the experiences, skills, and competencies that make for a successful Mountain Valley experience. This allows our inputs- both clinical and milieu based- to be more intentional while also making our assessment of progress more objective and concrete. Every resident’s experience here unfolds as a unique story; using a narrative reasoning approach allows us to track and measure that story. 

Will: There are three stages, or phases, to this narrative structure. Can you describe each one? 

Zack: Sure. As I mentioned, the overlay is informed by the burgeoning body of research called narrative psychology and, more specifically, narrative reasoning- an approach used extensively in the field of occupational therapy. While there are many ways we could have structured our program phases, we borrowed from Joseph Campbell’s hero’s journey because it aligns so well with our foundational modality of exposure and response prevention, or ERP. Specifically, the hero’s journey supports the ERP concept that if you face things you are afraid of, you’re likely to come out the other side a better person and/or more true to who you are and were always meant to be.  The way our website states it, facing fears is the best path to “finding the person you’ve always been.” 

We call our first phase The Departure. This is when a resident leaves home to come here. It’s a time to settle in and build a foundation for the treatment experience. During the phase, we help residents get used to a new routine, new environmental factors-like the absence of tech, a different sleep/wake cycle, dietary changes, et cetera. Also, before they can do deep therapeutic work, they have to build strong trust and rapport staff, including their assigned clinician. So, trust and rapport building is a real emphasis now and is why there is more accommodation during The Departure than there will be later in the program. This is also the phase in which we establish an initial treatment plan.  

The second phase is called The Adventure. In this stage, you’ve settled in and now you are ready face some hard things.  This phase is all about facing challenges and actively seeking out opportunities for growth, which is crux of a resident’s therapeutic experience. Typically, our residents encounter one or more turning points during this phase; usually these come in the form of a particularly challenging moment.  It’s these moments that often provide our residents with a revelation that allows them to change the way they relate to the world and their own anxiety. This can take the form of a primary event, whether in the form of a planned exposure or an organic, unplanned stressor. It shows up as one big event for some residents and a few smaller crisis points for others. It’s these “adventures” that really help push the resident forward. 

The third phase is called The Return. This is less a reference to your literal home than it is to returning “home” to the person you’ve always known yourself to be. It’s also about preparing for whatever home will be after Mountain Valley. For some residents that might be college, for others it’s boarding school or a step-down treatment program, and for many it’s the home from which they came to Mountain Valley. This phase is about planning for what’s next and preparing to bring your new skills and confidence with you.  

Will: So, just as a resident’s “return” is really a return to who you most authentically are, the “departure” is a departure of old ways of being. 

Zack: Yes. You’re departing from familiar and unhelpful patterns of engaging, or disengaging from, a world you’ve come to fear. 

Will: What are you most excited about in implementing this new program overlay? 

Zack: Because there are defined skills, experiences, and assessment tools built into each phase, this approach helps us focus clinically and more objectively monitor progress. That helps us ensure consistent quality and allows us to pace the program to match a resident’s capacity for change. Also, it gives residents a clearer sense of their own growth; they sometimes express fear that maybe they’re not progressing or that they’re not progressing fast enough. The phases help ground them and see and celebrate their progress.  It uses ceremonies to mark and celebrate progress all along the way, not just at the two most obvious big events of arriving and graduating. Finally, and perhaps most importantly, this approach helps bring our therapists into the milieu where their psychotherapeutic work can inform- and be informed by- the work of our residential and milieu staff. This sort of activates our psychotherapeutic work by grounding in real-life experiences. 

Will: How did background as a licensed psychotherapeutic occupational therapist inform your approach to this program structure?

Zack: Two big things. First, the narrative reasoning approach. There is a whole field of narrative psychology that has recently gained popularity among researchers and practicing psychotherapists. But narrative reasoning has always been at the core of what we do as OTs. We ask: what’s the story of this individual and how do we weave that story into their therapeutic process? Using story is something that comes naturally to OTs from how we write up our clinical notes to how we implement the therapeutic process. 

The second thing is what we call activity analysis and activity breakdown. OTs are really skilled at this process of breaking down an activity into its component parts; we are very strategic about how we deconstruct a life skill so that we can construct a clear and sequential strategy for learning. With something as seemingly simple as brushing your teeth, for example, an OT might ask “what range of motion do they need in their elbows, shoulders, and knees? What kind of sensory tolerance is required? What kind of visual strength is indicated?” Whether a physical, social, or emotional task, we seek to understand every little component, what does it take to do this activity. Our narrative program overlay, therefore, takes the big overarching goal of graduating from Mountain Valley and breaks it down into a step-by-step process. OTs are good at designing a practical, manageable path to achieving things that might otherwise seem very abstract, philosophical, or just really hard. 

Will: By the time a resident completes the phases and is ready for The Return, what should they be able to do? 

Zack: By the time a resident leaves Mountain Valley, they should be able to do ERP on their own. They now see challenges as opportunities for self-directed exposures and growth. Like, when I’m in Starbucks today can I push myself out of my comfort zone to say something to a stranger? Can I challenge my own fear of judgment? By this point, our residents have rewritten the narrative about their relationship to anxiety. They may have arrived at Mountain Valley thinking, “I hate my anxiety; it takes everything away from me.” They return home knowing, “my anxiety is there to serve me; it’s there to call me to things that are challenging and if I can answer that call, I’m going to come out stronger on the other side.”

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A Reflection on the Holidays, the New Year, and Values from MVTC’s Clinical Director

Posted on by Carl Lovejoy

A Reflection on the Holidays, the New Year, and Values

As we enter the holiday season, I have had some time to reflect and relax a bit with my family, went to church, and then was able to spend time with the current residents on campus playing games and checking in.  I also spent time thinking about my values, the values of this holiday season, and the values of Mountain Valley.  Values are commonly discussed in ACT and other forms of therapy and it’s easy for me to be reminded of this during this time of the year.

Some Core Values of Mountain Valley:

1.) We want to help

This may seem a bit cliché, but it’s the reason that we go to work at MV each day.  It’s part of the reason that Mountain Valley was created; to provide the highest-quality anxiety and OCD treatment using CBT, ERP, and ACT.  And, it’s part of what drives us in teaching our residents and guiding our families through challenging times.

2.) Freedom

At Mountain Valley, we are working to help our residents and their families become free from the constraints of anxiety and OCD.  As related to the holiday, one value that comes across in Chanukah is that of freedom from oppression.  In the Mountain Valley context, I tend to view this as freedom from the anxieties that keep us from engaging in our lives and doing that which is important to us…the anxieties that oppress us and keep us trapped and stuck.

3.) Perseverance and Courage

The values of perseverance and courage are what continues to motivate us to overcome obstacles and to take on challenges especially when it is tough.  We work to harness these values in our residents and families to help them through their anxiety and OCD.  I think about this often in the context of exposure therapy and how it is inherently a challenging endeavor.  I’ve also been thinking about this in the context of Christmas – the story of a child, Jesus, being born homeless into a life of challenge, but who also lived a life full of meaning and whose message of peace is still present today.

On a more light-hearted note, I was also reminded of perseverance and courage recently by the famous cowboy John McClane, who overcame his fear of flying, heights, tight spaces, and worries about letting others down.  Against all odds, his perseverance and courage helped him to truly save his family and the Nakatomi Plaza Christmas Party of 1988.

4.) Acceptance 

Acceptance has two meanings at Mountain Valley.  In one way, it is about accepting your circumstances and still finding a way forward and living your life.  It’s about not letting your anxiety or OCD keep you down.  Much like the story of Ralphie and the Red Ryder BB gun (“You’ll shoot your eye out!”), sometimes the dogs get your Christmas dinner before you do, but, you still have to make the best of it and find a way forward.  Sometimes it even turns out better than you anticipated.

In another way, acceptance is more about fitting in and feeling connected to others.  Rudy the Red-Nose Reindeer had a hard time starting out and did not fit in with the other reindeer.  I heard that they used to laugh, call him names, and not even let him play reindeer games, like Monopoly!  Eventually, he found his groove though and found acceptance.  At Mountain Valley, our residents are some of the best you could ever ask for.  They are truly what makes this a wonderful program.  I’m consistently impressed with their genuine and heartfelt care and support for each other.

5.) Family

Renowned food additive designer Clark Griswold, also well-known for his value of family and tradition, would stop at nothing to ensure a wonderful holiday for his family.  He would also do so with enough cheer and positivity for all.  Much like Clark, though less accident-prone and with fewer lights on our campus, Mountain Valley values the families with whom we work.  We work to guide families through the challenges of anxiety and OCD and to develop new ways of supporting each other and helping each other grow.  We understand that for many parents, leaving their teen in treatment is one of the most difficult things that they’ll ever do.  We appreciate this and will continue to work to the best of our abilities to do right by you and your family.

Wishing you all peace on Earth and psychological flexibility this holiday season!

Dr. Timothy DiGiacomo, Clinical Director

 

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A Complete Guide To School Refusal & Anxiety

Posted on by Carl Lovejoy

As we transition back to a post-COVID world, where you are expected to get “back to normal”, are you finding that returning to a daily routine is easier said than done? Is it hard to return to sports, work, social events and school? Where does the difficulty stem from? Is it: fear, sadness, stagnation, or anxiety? Often, this difficulty to return to normal is a sign that there are big emotional challenges ahead. School refusal can be the “canary in the coal mine”; a sign that you are facing some mental health challenges that are becoming insurmountable.

How School Refusal Manifests

Anxiety and depression coupled with a long period of isolation in the home can lead to school avoidance and refusal. Whether the anxiety is based on academics, safety, or social interactions, school is often a hot bed of uncomfortable situations. Around every corner a young person faces the real threat of discomfort, stress, and challenges. It is far easier to stay at home where life is safe and secure, than to learn to sit with discomfort and push through anxious feelings. This can lead to school phobia or a general pattern of school avoidant behavior.

Feelings of stress or anxiety is a normal part of life. It is a natural reaction to a dangerous situation, whether it be real or just perceived. When feelings of anxiety increases in severity or frequency, this normal discomfort could become an anxiety disorder. An anxiety disorder is characterized by intense, excessive and persistent worry and fear about everyday situations. People with excessive anxiety may anticipate disaster and be overly concerned about school, health, family, friends, or other issues. And while anxiety can occur at any age, it can be especially detrimental to the development of teens and adolescents.

Like other mental health diagnoses, anxiety has symptoms that can affect people of all ages and walks of life. Anxiety typically presents itself with both mental and physical signs.

Common Anxiety Signs and Symptoms Include:

  • Nervousness, restlessness or tenseness
  • A sense of impending danger, panic or doom
  • Increased heart rate and rapid breathing
  • Moodiness
  • Exhaustion or unexplainable tiredness
  • Trouble concentrating during daily tasks
  • Difficulties with sleep
  • Somatic symptoms such as headaches, muscle aches or stomach distress
  • The urge to avoid things that trigger anxiety

When symptoms of anxiety in a young person becomes overwhelming, or begins to affect quality of life, they might be diagnosed with an anxiety disorder. The most common anxiety diagnosis is Generalized Anxiety Disorder (GAD) which is marked by persistent anxiety that is out of proportion with actual circumstances. Other anxiety diagnoses include: Agoraphobia, Panic Attacks, Selective Mutism, Separation Anxiety, Social Anxiety, Obsessive Compulsive Disorder, and Specific Phobias.

The Larger Concerns That School Avoidance Signifies

School avoidance and refusal is often the “emergent situation’ that highlights that normal stress has transformed to a true anxiety disorder. Refusing to attend school is a symptom of the larger problem; it’s important to treat the anxiety in order to return to normal daily activities. The goal is to determine the roots of the anxiety and then help develop new skills and strategies to overcome these feelings.

Treating School Anxiety Disorders

Treatment programs, such as Mountain Valley, help young people learn more about their school anxiety and develop tools to overcome it. Each resident at Mountain Valley receives an individualized treatment plan that includes: therapy, academics, and fun. Every activity at Mountain Valley focuses on the tenets of Cognitive Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP) . CBT and ERP helps young people face the foundation of their anxious feelings and learn how to overcome those feelings. This helps them shatter the cycle of anxiety with a deliberate, careful, and kind approach.

Through approaching school refusal and anxiety by treating the underlying problem, we are able to develop new skills to tackle any discomfort a young person might face. By utilizing evidence based practice to overcome barriers to daily living, young people are able to learn how to “sit with it” and become more comfortable with the inherent challenges that come with being a young person.

 

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How Exposure And Response Prevention Therapy Can Help Families And Teens With OCD And Anxiety

Posted on by Carl Lovejoy

Unwanted or alarming thoughts creep into everyone’s head from time to time. Many people are aware of these thoughts and recognize that they are meaningless and temporary. People with obsessive-compulsive disorder (OCD) often experience these thoughts as intensely frightening and extremely real. As a result, they often develop ritualized responses or avoidance in order to lessen the discomfort and as a perceived way to decrease the chances of a feared outcome occurring.

For example, when a loved one leaves your home, you might think, “I hope they return home safely.” In a typical circumstance, you probably would not think much more about it. A person with a fear of harm OCD would likely experience that same situation very differently. They might experience an exceptionally intense fear that harm will befall their loved ones, a feeling that will be persistent and convincing that danger is imminent. They might even experience intrusive images in their mind of something terrible happening to their loved one. As a result, they may engage in checking compulsions, such as checking the weather forecast repeatedly or checking the news for stories of a tragedy involving their loved one. They might experience brief relief each time they refresh the weather forecast but the urge to check will quickly return. They might even call or text their loved ones to check on them, often repeatedly and urgently. This loved one might kindly reassure them that all is well, unaware that reassurance actually perpetuates and worsens OCD. This is where Exposure and Response Prevention Therapy has proven results.

Exposure and Response Prevention (ERP) Therapy provides deliberate and graduated exposure to situations that provoke obsessive thoughts, and the resulting distress while helping to prevent their compulsive responses. It also provides supported opportunities to learn new patterns of behavior without avoiding feared situations. This functions to increase an individual’s distress tolerance and opportunities to learn how to cope effectively. It also simultaneously allows someone with OCD to realistically test out the likelihood of a feared outcome and potentially develop a sense of self-efficacy about coping with a feared outcome. 

ERP leads to a change in one’s relationship with anxiety-provoking situations, thoughts, and intrusive images. Such change often leads to an eventual decrease in symptoms of anxiety and OCD, an increase in functionality, and an ability to engage in the world rather than isolate and avoid.

About the Author:

Brittany Little, LICSW, is a Clinician at Mountain Valley Treatment Center. Brittany has a BA in Music Therapy and her MSW from the University of North Carolina. She is intensively trained in Dialectical Behavior Therapy, Cognitive Behavioral Therapy, Exposure and Response Prevention and other evidence-based anxiety treatments.

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Utilizing Nonviolent Communication Skills in Teen Anxiety Treatment

Posted on by Carl Lovejoy

Nonviolent Communication (NVC) is a formula for communication that is meant to encourage compassion both with others and with oneself. The formula was devised by a renowned conflict mediator named Marshall B Rosenberg, who spent many years helping nations and individuals find peace between each other. NVC provides a framework to focus attention on what we are observing, feeling, and needing, rather than insulting, judging, and blaming. NVC is a “language of compassion,” as Rosenburg puts it in his book Nonviolent Communication: a Language of Life. Using NVC, we can unlock a deeper understanding of what is going on inside ourselves. It provides a way for us to develop empathy not just for other people, but for ourselves. This self-empathy can have a profound influence on teen anxiety treatment as it teaches young people skills that diverts their attention away from judging themselves and turns it towards their emotions and the needs that fuel them.  

 

Nonviolent Communication includes four components that can be applied to both sides of communicating: listening and expressing: 1) make observations without evaluations, 2) identify one’s emotions, 3) identify one’s needs and how they affect the emotions, and 4) make a request that would enrich life and get needs met. While the formula is simple, it is admittedly difficult to remember to go through these steps while conversing normally, let alone while talking to someone with emotions running high. It can be equally difficult to apply these steps when talking to oneself, which is something most of us do when we are angry and sad. It can be difficult, but with practice, these tools can become readily available even in the most emotional situations.

 

Imagine you’ve recently done something you regret. Maybe you were arguing with your mother; she told you that you need a new career path because you’re not making enough money at your job. But you love your job, so you got angry and yelled at her. Now, a few days have passed and you are berating yourself for being so mean to your mother. In this example, emotion has been identified: anger. Observation has also been made: you yelled at your mother. Making an observation and identifying an emotion are the first two components of NVC. The third component is identifying the needs that are affecting the emotions.  

 

To satisfy the third component, NVC asks “what needs were you trying to meet by yelling at your mother?” You’re pursuing a career that you find meaningful, even if it doesn’t earn a lot of money. Your mother, though, doesn’t seem to understand that. The unmet need in question here is “understanding from your mother.”

 

The ability to identify your unmet needs can be a big relief; it tells you that there was some rationale behind your behaviors. Understanding that there was some rationale behind our behaviors is a step toward self-empathy. Self-empathy is a crucial step toward growth, as it allows us to love ourselves. Loving ourselves can give us the sense of security we need to sit with anxiety and discomfort. 

 

Understanding your needs can help you move on to the fourth component of NVC and make a specific request that would get your needs met. By teaching NVC in anxiety treatment, the client begins to develop a strategy for difficult emotions. The self-empathy that results from acknowledging the needs is more conducive to growth than focusing on the difficulty at hand. To a teen suffering anxiety, this self-empathy can be life-changing. 

 

About the author

 

With a B.A in Environmental Studies, Nathan graduated from Prescott College in Prescott, AZ in 2014. Shortly thereafter he moved to Vermont and ever since has worked as a land steward, a youth mentor, an environmental educator, and an animal trainer. Additionally, he has served his local community by volunteering his time for restorative justice, animal rescue, and community dinners in the Upper Valley. Through all this work, he has discovered in himself an inherent desire to listen, be it to the land, the birds, or to the people around him. At Mountain Valley, he intends to use that desire to help the residents find validation, peace, and power.

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Courage & Perseverance at MVTC – Omar Shah, MVTC Psychiatry Fellow

Posted on by Carl Lovejoy
Omar
Rotating at Mountain Valley Treatment Center (MVTC) has been a great experience for me. It has brought to life, the theory I have read, regarding therapy for OCD (Obsessive Compulsive Disorder), anxiety and depression. No longer is Cognitive Behavioral Therapy just a theoretical tool to be used for me. It is practical and an effective method of treatment for severe mental health symptoms. On the surface, it appears patients are doing well and are merely having some dysregulation with their mood and/or anxiety. But under the surface, they feel they are drowning and they cannot function the way they want to any longer.

Like many psychiatric residents, I have read endlessly about the benefits of psychotherapy for mental illness. I have provided therapy myself to many patients. However, interning in a residential facility which hosts patients with few other options, has been a real eye opener for me. I have found that a tremendous amount of work goes into treatment here, both by providers and by patients. Interactions are intimate, subtle and profoundly meaningful. The power of active listening, emotional validation and eliciting information in a nonjudgmental manner is not lost on me. Therapy consists of sharing real life experiences, purposeful progression and encouragement every step of the way. After my experience here, I do not think it can be any other way. It seems a multi prong approach is necessary to fight the anxiety and depression the patients are dealing with. For example, OCD can be severely debilitating. It takes courage and faith on the patient’s part to tackle their compulsions. I’ve learned it is difficult to challenge OCD without a supportive environment and having good morale. It is not as simple as a quick fix with some medications and some exposure response prevention (ERP) treatment. There are lifestyle changes involved and perseverance is needed. The patient’s family support and academics are just part of the overall picture.

My respect for the patients and their providers has grown over the course of my rotation at MVTC. Treatment for the patients may at times feel slow or even futile because of the nature of the illness they are suffering from. But with vigorous therapy and positivity, it seems the illness eventually succumbs to the will of the patient. They learn to master their problems to the point of being able to live with them, if not completely getting rid of them. They regain the peace of mind and function they once enjoyed. It is truly humbling and joyful to see this transition taking place.

The experiential learning of various therapies for OCD, anxiety and depression has been very beneficial for me. When I read about these treatments or refer a patient for treatment, I am more appreciative of what that entails. I can visualize the frustration the patients might be having or the fear they may be experiencing, dealing with their mental illness head on. I am also more aware of the belief in themselves, they are leaning on, for the tasks in front of them. I feel I will be a stronger source of support for my patients now than I was before my rotation at MVTC.

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Inside One Teen Girl’s Struggle to Manage Anxiety during the Pandemic

Posted on by Carl Lovejoy

The pandemic has created challenges for all of us. People Magazine recently published a profile of our resident, Kaylie, who is one of the growing number of American teens who suffer from an anxiety disorder.

Her mom Lisa explains: ‘Mountain Valley was the first time Kaylie had to take care of Kaylie and do the hard work on her own.’

[button href=”https://people.com/health/inside-one-teen-girls-struggle-to-manage-anxiety-during-the-pandemic/” target=”_blank” style=”primary” alignment=”center” color=”normal”]Learn More[/button]

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