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Phoebe Manchester on turning mistakes into wins.

Phoebe Manchester, M.S., one of Mountain Valley’s talented therapists, has an extensive background in athletics – as a player, coach and administrator. A member of Dartmouth College’s Women’s Hockey Team in the mid-1990s, she went on to be the head coach of two NCAA hockey programs before becoming the Director of Facilities Operations for the Pittsburgh Penguins’ training facility. Since then, she has, among other things, coached at various USA Hockey levels and officiates youth, high school and prep school games.

In the wake of the many articles posted recently about how high-profile college and professional athletes deal with anxiety and perfectionism, we asked Phoebe to reflect on her experiences working with anxious athletes.

Many of the Mountain Valley residents with whom I work are perfectionists, and have a lot in common with many of the athletes with whom I worked both in college and in the National Hockey League. One of the comparisons that I made as a coach that is also appropriate for many of my residents is this:

The best players in the game have worked their entire lives, and continue to practice day in and day out, and get paid millions of dollars to be the best at what they do…and they still make mistakes. Why? Because hockey, like life, is a game of mistakes. The true value of a player is not judged by how many mistakes they make, but by how they respond to those mistakes. A player could make a silly mistake and give the puck away, but if they work hard to win it back – it is no longer a mistake – it just becomes part of the game.  In response, the player gets to demonstrate their work ethic and tenacity and, perhaps, make something even better out of what could have been considered a mistake. If that player had given up after losing the puck, then it would have only been a mistake. The same is true for life: if we quit when we make a mistake, there is no chance to show our grit and determination, just a chance to make a mistake.

A player with whom I once worked was an NCAA Division 1 caliber player in practice, but as soon as a game started, she seemingly disappeared, unable to compete due to her overwhelming anxiety. I wish MVTC existed at that time – she would have been perfect for our program! Anxiety can render even the most skilled players essentially powerless. The more anxious they become, the less they are able to access their skills. Anxiety is a second “opponent” that talented, albeit anxious players have to overcome.

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Guest Blogger, Dr. Lisa Rosen, Mountain Valley’s Newly Appointed Parent Support Advisor

We asked Dr. Lisa Rosen, MVTC’s recently appointed Parent Support Advisor, to share some thoughts on her own family’s Mountain Valley experience. As both a parent of a former Mountain Valley resident and a clinical professional who has worked with adolescents for more than 20 years, Dr. Rosen is uniquely qualified to serve in her new role. Her responsibility is to offer support and guidance to parents at three very critical stages of their Mountain Valley journey – prior to enrollment, while their child is at MVTC and after graduation. By working closely with the clinical team, Dr. Rosen offers an additional layer of support to parents throughout their child’s MVTC experience – listening to their concerns, helping them overcome their fears, and assuaging any doubts they might have.

We thank Dr. Rosen for sharing her thoughts!

My youngest daughter has battled anxiety, OCD, panic disorder, school avoidance and depression since she was 13 years old.  She has been in and out of public school, private school, homeschooling and one on one schooling off and on until the beginning of 10th grade when she felt she had no more fight left in her.  She had been in every form of therapy available and known to be successful with these mental health issues.  She was on nine different classes of psychotropic medications.  She was so tired of fighting her own brain, and our family felt her pain and suffering so acutely, it was hard for any of us to function well.

We had heard of Mountain Valley Treatment Program from a friend whose son had graduated months earlier.  Over an emotional Labor Day weekend, we made our first contact with the incredible team at Mountain Valley.  On a Sunday afternoon, Jennifer Fullerton spent hours listening to our story,  comforting us and guiding us with knowledge and kindness.  For years we had felt our story was met with questions and concern.  On that Sunday, our story was familiar, one MV had heard over and over, one that the team at Mountain Valley heard and responded to with knowledge, guidance, expertise and empathy.  The confidence I heard in the voices of the team there – that they could help our daughter and our family and that we were making the bravest and wisest decision – left me speechless.  We were finally hopeful.

The next 76 days for our daughter were filled with tears and tremendous challenges and also triumphs and incredible pride in the hurdles she was able to overcome using the skills and strategies she was taught at MV.  She also graduated having made connections to an incredible team of support and friendships that she values and accesses daily.  For our family, we feel we have literally pressed a reset button and have begun to travel a new path filled with hope and confidence that while our daughter will always have an anxious brain, she and we all now have the tools, the team and the confidence that we need to ’sit with it’ – to survive and thrive.

Since her stay at MV, our daughter has successfully transitioned back to school.  She is planning to travel on a summer program to Australia – a trip that we would never have had the confidence she could manage before.  Our family will be forever grateful to MV.

My experiences with the MV team before my daughter arrived, while she was there, and after she has left, have motivated me to want to be a voice of support for new families beginning this very emotionally challenging process. I, of course, know firsthand what can go on in a parent’s mind while their child is away.  I know the struggles and the fears, and feel very strongly that I can help parents navigate these emotional hurdles and ease the fears given both my clinical background and my personal journey.  I am so thrilled to be joining this amazing team, and look forward to working alongside the MV staff for many years to come.

 

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Blogger of the Week – Liz Edwards – Improv for Anxiety

This week’s blogger is Liz Edwards, MVTC’s Director of Clinical and Community Outreach for greater New York City.  Liz, a Licensed Creative Arts Therapist and Registered Drama Therapist, provides connection and maintains relationships between MVTC and Manhattan and its surrounding communities, and includes the families, educators and mental health professionals who help support our mission.

 

When I was living in Los Angeles as an actor, I signed myself up for an improv class at Upright Citizens Brigade. As a Musical Theater major in college, I had exposure to improv in the form of warm-up games, but less exposure to longer form improvisation. Naturally, I was terrified. The day of the first class came around, and instead of showing up enthusiastically, I spent a good 10 minutes sitting in my car convincing myself I should go. I was so nervous that I wouldn’t be funny enough, or smart enough, or that I would be judged harshly by others. I’m so happy to report that the experience was the direct opposite of what I feared.

After speaking with Becca Barish, LCSW, the Head of the Wellness Program at Second City in Chicago, I realized that I’m not the only one to feel the anticipatory anxiety, and then a release after participating in improvisation. Becca runs the Improvisation for Anxiety classes at Second City, which falls under the Wellness Program, which also incorporates yoga into their programming. This unique class offers improvisation sessions for adolescents ages 13 to 18 over the course of eight weeks, with one week including their parents at the culmination of the course. A two-hour class includes improvisation with a Second City instructor for the first hour, and then a clinician coming in to take over, offering a CBT-oriented session for the second. Barish shared that she often sees a significant shift in participants over the time they spend in the class. She stated participants often “surprise themselves” with what they can do spontaneously in their last few class sessions.

So why would anyone subject themselves to this kind of an exercise? After all, it is incredibly anxiety-producing, even for professionally trained actors and actresses to get on stage and improvise without a script. Barish shared that there are so many aspects of improvisation that help abate symptoms of Anxiety Disorders, even though it might seem counterintuitive at first. Barish shared that the best part of the class is to see participants relating to each other and breaking down barriers that their disorder may have put up for themselves to avoid their symptoms. When given a playful and most importantly, fun outlet, participants are able to feel that they can relate their experiences to others, particularly those that they may not have known shared their symptoms otherwise. As Barish says, it can be “humanizing to connect with others who make you feel like you aren’t alone,” and may create more ability for interpersonal connection within a disorder that can often be isolating.

In addition to breaking down barriers, improvisation can make treatment for anxiety disorders more fun. The leading forms of treatment for anxiety are Cognitive Behavioral Therapy and Exposure and Response Prevention Therapy, both primary forms of treatment practiced at Mountain Valley. At times, it can be difficult, particularly for teens, to feel motivated to take part in activities that incite anxiety, despite that being the best method to treat it. Through playful games, exercises and improvised role play, participants are not only able to feel more inspired and motivated, but are able to access a more childlike part of themselves. As Barish says, “Exposures are a drag, it’s better for teens to feel like they are playing.” One of the core rules for improvisation is to say “yes, and” to the partners with which one is sharing the stage. This creates an environment where one can never be rejected, and is given unconditional positive regard, which allows the freedom to play. When participants feel safe and trusting of the environment, it sets the stage for more authenticity: something you may be hard-pressed to find in a high school hallway or cafeteria.

Another core principle within improvisation is that the participant does their best not to think too much about what they are doing or saying, but rather to follow their first instincts. Barish noted that this aspect is also helpful to those who suffer from anxiety disorders, as they don’t have as much time to ruminate or obsess over whatever they are going to do or say, but rather they are present in the current moment. Doing versus thinking is a great way to be prepared for real-life situations, where you may have to act spontaneously and make decisions without much time to consider options. These are situations that could produce anxiety for those who suffer from the disorder, but through improvisation, Barish has seen participants grow more confident in being grounded. They are better able to take risks, to tell a joke on the spot, or to lead the group in a warm up—something they previously would not have believed they were able to do.

Ultimately, Barish doesn’t pretend that improvisation is a “cure” for anxiety. She shared that many participants in her class might say things like “I just want it [my anxiety] to go away…” We know from our work at Mountain Valley that there isn’t a magic pill to make anxiety cease to exist for a person, but the more one is able to manage their symptoms and believe that they are more capable than they realize, they have more power over the disorder. And why not receive applause for your work in the meantime?

To learn more about the courses offered for kids and teens at Second City in Chicago, visit their site: https://www.secondcity.com/chicago/find-a-class/lets-get-started/

 

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Former Resident Writes Grateful Email to MVTC Community

Mountain Valley frequently receives cards and emails from former residents and their parents.  Yesterday’s email from a graduate was truly special, and with his permission, is copied below for all to enjoy.

Dear Carl (and all of MVTC),

In just a few weeks, I will be coming up on my anniversary of being admitted to Mountain Valley. This got me thinking and it made me want to write you all a letter just expressing how grateful I am for all of you who helped me take my life back.

Going to Mountain Valley and the work that I did at Mountain Valley was some of the most challenging work that I have ever done. At times it was painful. If it weren’t for Bryan, the therapists, and especially the residential staff I have no idea how I would have made it. But you all helped me through some of the toughest moments of my life. I am extremely grateful for that. Thank you.

After graduating Mountain Valley in July, I joined a gym in my town, which was a surprise to my whole family as I would have never gone to the gym in fear that I might see someone I knew. I got my drivers license! I also returned to Marvelwood, and all of my teachers kept on saying “The old (before panic attack) Lee was back.” I returned to being a tour guide, a RA in the dorm, and was voted Junior Class President! I also have made the high honor roll for my Fall and Winter term. I have even become apart of a management team for a program at the American Red Cross, which I couldn’t have done last year because of my panic. It was thanks to all of you and the work that Mountain Valley enabled me to do that made all of this possible.

Right now I am looking at colleges and what I want to do with the rest of my life. I have been looking in to Psychology programs at different schools up in Boston and NYC. I want to try to give help to people like me who suffer from anxiety and depression.

I hope I get to come see Mountain Valley (and the new campus) soon!

Again, thank you so much for all you have done for my family and me.

Lee

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From the Desk of the Executive Director – Finding Help for the “Kids Who Can’t”

In the October 15th edition of the New York Times Magazine, where the epidemic of severe anxiety disorders and how schools, parents and teens struggle to get the right kind of help, the work at Mountain Valley Treatment Center was featured.  The article highlighted the gold standard of treatment, the empirically supported Cognitive Behavioral Therapy (CBT) or, more specifically, the modality of Exposure and Response Prevention (ERP) or “exposure therapy.”

At Mountain Valley we regularly hear from our parents how long it took them to find the right kind of help – all while their son or daughter’s anxiety, obsessions and compulsions became more entrenched and the family became more stressed and challenged.  Finding a qualified, experienced, and properly trained clinician is not easy in some locales. The good news is once a family finds the right kind of help, treatment is time limited and is incredibly effective.  Because exposure therapy is difficult for clients to embrace (who wants to confront those things that cause us worry and fear?), and the homework an outpatient clinician may give the family is challenging to consistently do, kids can get “stuck” and avoidance to school and outside the home activities can increase, and the home environment can become “stress machine.”  This is when a higher level of care may be warranted.

When a family member’s world has become incredibly small due to their worries, fears and thoughts, stress and strain can permeate the entire family system.  For adolescents and emerging adults who should be in school – but can’t get to school or, if they do, can’t stay there long – life can be challenging.  Parents need to get to work and other children may need to get to activities or school.  Life must go on.

Many families have been able to adjust somewhat to the turmoil and strain by making accommodations for their child who is suffering.  This is understandable and common.  This “family accommodation” or “maintenance” of the anxiety or obsessive-compulsive behaviors does not lead to long-term symptom reduction and will ultimately increase and entrench the behaviors.  Allowing a child to stay home from school, meeting a child in the school parking lot at lunch time because their social anxiety is such that they cannot go into the lunch room, or waking a child up early to complete their rituals before school so they won’t be late, are just a few examples with which many Mountain Valley parents have struggled with before finding treatment.

When looking for a comprehensive treatment program, it is important to note what type of family therapy and psycho-education is provided.  Yes, kids suffering from OCD and severe anxiety need help, but families also need time to heal and lots of support.  Time-limited treatment means that the family will be together sooner rather than later.  The system needs to evolve so negative patterns do not pop up and everything is back to square one.  The best support a family can get before, during and after their child’s treatment, is education.  Getting past the place of trying to figure out where it all came from simply wastes time.  Finding a good therapist and doing the homework will support positive outcomes.

Don Vardell, Executive Director

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MOVING MOUNTAINS

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Mt. Washington Ascent on the Cog Railway – A Blog by Colleen Donohue

A relaxing start to Sunday morning as residents gathered together to depart for the Mt. Washington Cog Railway.  The roads leading were winding and filled with new scenery around every corner.  The van was filled with music and singing, as well as questions like “how much longer?!?”  The first sight of Mt. Washington made most of the residents “oooo” and “awww” as they were unaware of just how big the mountain really is.

As we arrived to the base, it was a quick walk to the platform where we were greeted by the various engineers.  The bright orange car was awaiting our arrival – the world’s first mountain-climbing cog railway.  The residents were able to move freely throughout the car and ask any questions they may have had.  The cog climbed for about an hour with stops along the way to allow other trains by. The vastness of the mountains caused some of the residents mouths to drop.  The visibility was over 90 miles, which is near to perfect.  They were fascinated by the pitch of the train and just how high we were climbing.  Once at the top of Mt Washington, standing 6,288 ft tall, residents moved about the lookout points, and walked through the historic sites nestled in the rocks on the summit.   Some residents felt compelled to one day climb the mountain to know what it feels like to have the satisfaction of accomplishing the highest mountain in New Hampshire.  On the descent residents were able to see a new perspective on the scenery.

The day came to an end with a rewarding snack in the parking lot and a view of Mt. Washington stuck in the rear view mirrors.

Colleen Donohue                                                                             Residential Counselor/Adventure Module Leader

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From the Desk of the Executive Director – The Other 23 Hours

THE OTHER 23 HOURS

During a recent trip to the Philadelphia area where I met with several experts in the treatment field of OCD and anxiety disorders, the topic of the importance of what happens out of the therapy session or therapist’s office, within a residential setting doing exposure work.  After discussing the clinical component of Mountain Valley – the multiple individual therapy sessions per week, how we implement the enhanced exposure and response prevention (ERP) work within our clinical programming and in the therapeutic milieu; the role of the clinician vs. the role of the residential team in effecting our Cognitive Behavioral Therapy-based ERP clinical program came into the conversation.

As we discussed the above and how effective exposure work can be, especially within the ‘container’ of a 60 to 90-day specialized residential treatment program, we also discussed the type of training for the residential program staff in supporting the clinically-driven exposure work.   I shared with this psychologist the Mountain Valley- developed training curriculum for our residential staff.  “Residential Exposure Specialist” (RES) training is provided for all of our residential staff and is delivered by our clinical team and supervised by the residential program and clinical directors.  She appreciated our focus on this, highlighting the importance of the “the other 23 hours.”

About Our Residential Exposure Specialist Training

After 90 days of successful employment and after receiving our basic curriculum centered around safety-related issues such as, driving, therapeutic boundaries, and instruction in CBT and ERP for OCD and anxiety, residential staff are enrolled in the Residential Exposure Specialist (RES) training.  RES training consists of a blend of didactic instruction from the clinical staff including utilization of the Behavioral Tech™ (http://behavioraltech.org/ol/index.cfm0 on-line training platform, documented supervision by our clinical director – a licensed psychologist and supervisor of the clinical team and program – “in vivo” work with each therapist and their caseloads, and finally a written test.  After successfully completing the RES training, residential staff are given an hourly raise and are then eligible for designing and implementing clinician assigned exposures during residential programming time, such as on a hike, or a trip off campus into one of the local communities, etc.

Mountain Valley’s residential program staff are typically recent college graduates who are drawn to our unique program model not only for the professional experience of working within our setting and with our population, but also because of the unique, holistic programmatic model we provide.  Our residential staff typically have bachelor’s degrees and specific credentials related to our programming such as degrees in Health Education and Promotion, Therapeutic Recreation, Environmental Science and Psychology.  These “millennials” bring an energy and a desire to work on a team and grow personally and professionally.  Offering a competitive salary and good leadership is key, but training and growth opportunities are paramount to making their professional experience rewarding and thus ensuring our clients get the best possible treatment.  Residential Exposure Specialist training as well as other opportunities for continuing education are additional ingredients in what sets Mountain Valley apart.

Mountain Valley’s Clinical Programming – ERP

Mountain Valley uses empirically supported treatment modalities for OCD and anxiety disorders. Our program and facility are managed using industry best practices. We are licensed by the State of New Hampshire, Department of Health and Human Services and nationally accredited by the Commission on Accreditation for Rehabilitation Facilities (CARF). Residents are typically with us for 60 to 90 days.

What We Treat

  • Mountain Valley is uniquely organized to treat the following:
  • Obsessive-compulsive disorder
  • OC-spectrum disorders
  • Generalized Anxiety Disorder
  • Panic disorder and agoraphobia
  • Social anxiety disorder
  • Tic disorders, Body Focused Repetitive Behaviors such as Dermatillomania or skin picking disorder
  • Co-morbid disorders such as:
    • ADHD
    • Depression
    • Disordered and “finicky” eating
    • Somatization disorders (conversion disorders)

Treatment Modalities and Services Provided

  • Enhanced Exposure and Response Prevention (ERP) – individualized and group work
  • Individual Treatment Planning – Three individual sessions per week
  • Family therapy and education – centered around family accommodation of anxiety
  • Thematic Group Therapy – DBT skills, Expressive Arts
  • Mindfulness based Cognitive Therapy
  • Clinically-informed academic component
  • Therapeutic Equine Program
  • Trauma-Focused CBT
  • Recreation Therapy
  • Medication Management
  • Executive Functioning support

The above programming takes a team of talented and supported clinicians and energetic residential program staff.  Engaged managers ensure we are maintaining a robust, creative and continuity of care based on current practice guidelines.

To schedule a visit to Mountain Valley’s White Mountains Region of New Hampshire, contact Don Vardell at dvardell@mountainvalleytreatment.org.  For more information go to www.mountainvalleytreatment.org.

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From the Desk of the Executive Director – Learning and ERP

Maximizing learning when designing and implementing exposures for clients with debilitating anxiety and OCD is well documented.  Balancing the teaching of skills and acceptance with reducing the fear response seems to predict the most successful treatment outcomes.

Here at Mountain Valley Treatment Center, located in New Hampshire’s White Mountains Region, we embody this practice of maximizing exposure opportunities for our co-educational adolescent and emerging adult residents during their 90-day residential treatment.  Focusing the psychoeducation, design, and execution of individualized exposures on campus and in nearby communities optimizes the inhibitory learning process while reducing fear without the emphases being solely on fear reduction or habituation.

Mountain Valley’s CBT-based ERP curriculum and therapeutic milieu consists of individual, group and family therapy along with a holistic experiential education curriculum focused on mindfulness, environmental stewardship, recreation, and health and wellness.  Residents co-design their treatment and exposure plans, participate in individual therapy, thematic group therapy, and specific ERP focused groups.  ERP specific groups consist of psycho-education, hierarchy development, individual exposure practice – interoceptive and in-vivo – and group review.

Be sure to follow Mountain Valley on Instagram and Facebook to see how we are implementing ERP work in our unique environment.

Don Vardell, Executive Director

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Dr. Alex Young’s Latest Blog Post on Interoceptive Exposure

In today’s blog, Dr. Alex Young, Mountain Valley’s Director of Clinical Outreach, writes about Interoceptive Exposure.

Mountain Valley is currently under construction and, like everything at Mountain Valley, we are building with Exposure Therapy in mind.

Unhelpful beliefs about body sensations are common issues amongst residents at Mountain Valley.  Often, our residents feel their normal body sensations are warning them of danger–danger they might be getting sick, something bad might happen, or that they might draw negative attention to themselves. These unhelpful and often inaccurate beliefs about body sensations play a monumental role in maintaining anxiety. Biased beliefs often result in biased behavior, with the most typical biased behavior being avoidance. Our residents are very good at avoiding the things that make them uncomfortable. This avoidance makes sense–nobody wants to purposefully do something they think will be uncomfortable or embarrassing. However, even though avoidance works in the short term, the biased thinking that drives the avoidance tends to grow and spread into all aspects of life. Eventually, life becomes more about avoiding than participating and life gets very limited.

At Mountain Valley, we help our residents systematically re-engage with these threatening body sensations and test out their biased beliefs. This is a therapeutic process known as Interoceptive Exposure. Interoceptive exposures target typical body sensations such as shortness of breath, increased heart rate, dizziness, lightheadedness, etc. In order to stimulate these sensations, we have our residents engage in activities such as breathing through cocktail straws, sprinting for short distances, spinning around in chairs, and holding their breath. It is with this type of exposure in mind that we have designed a new building on the Mountain Valley campus. Set to be finished in mid-2017, our retrofitted exposure barn will include balance beams, tire swings, and other recreational space to help our therapists and exposure specialists facilitate these types of exposures in a safe and fun atmosphere.