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From the Desk of the Executive Director – “Not All Therapists are Created Equal”

Posted on by Justin Alvin

Recently, Mountain Valley Treatment Center, along with our partners International OCD Foundation state affiliates from New Hampshire and Massachusetts, hosted the first Seacoast Anxiety Symposium in Portsmouth, NH.  The Symposium was designed to share information about and facilitate a conversation on OCD and anxiety disorders.  An impressive line-up of presenters and an expectation exceeding group of attendees made this inaugural event a huge success.

One of the presentations, delivered by Szu-Hui Lee, Ph.D. and Beth Ohr, Psy.D., focused on what effective anxiety treatment looks like across a continuum of care and within different settings.  Dr. Lee is a psychologist at Phillips Exeter Academy, a private practice psychologist, and President of NH OCD.  Dr. Ohr is a private practice psychologist and with the NH APA.  Szu-Hui and Beth, who specialize in treating OCD and anxiety disorders, identified the essential elements of the CBT-based modality of Exposure and Response Prevention (ERP), the “gold standard” in treating debilitating anxiety and obsessive compulsive disorders, within an outpatient, residential and in-patient setting.  Their presentation shared information to an audience of varied experience in Cognitive Behavioral Therapy about exposure therapy, the challenges of treatment and – most importantly – the full commitment  of a therapist to properly treat it.  They presented this information from a perspective of what a consumer should look for and ask of their therapist before engaging with them.

Beth and Szu-Hui referenced the article by Michael Jenike, M.D. ( https://iocdf.org/about-ocd/treatment/how-to-find-the-right-therapist) on the International OCD Foundation’s web site.  Here is a summary of what Drs. Lee and Ohr shared and the specifics from Dr. Jenike’s article.

First of all, for a sufferer of life-interrupting anxiety and/or OCD, you deserve to get the right help and therefore you should take control of vetting a therapist.  Ask questions.  Dr. Jenike recommends specifically and at a minimum, these questions should be asked:

  1. “What techniques do you use to treat OCD?”
    If the therapist is vague or does not mention cognitive behavioral therapy (CBT) or Exposure and Response Prevention (ERP), use caution.
  2. “Do you use Exposure and Response Prevention to treat OCD?”
    Be cautious of therapists who say they use CBT but won’t be more specific.
  3. “What is your training and background in treating OCD?”
    If they say they went to a CBT psychology graduate program or did a post-doctoral fellowship in CBT, it is a good sign. Another positive is if a therapist says they are a member of the International OCD Foundation (IOCDF) or the Association of Behavioral and Cognitive Therapists (ABCT). Also look for therapists who say they have attended specialized workshops or trainings offered by the IOCDF like the Behavior Therapy Training Institute (BTTI) or Annual OCD Conference.
  4. “How much of your practice currently involves anxiety disorders?”
    A good answer would be over 25%.
  5. “Do you feel that you have been effective in your treatment of OCD?”
    This should be an unqualified “Yes.”
  6. “What is your attitude towards medication in the treatment of OCD?”
    If they are negative about medication, this is a bad sign. While not for everyone, medication can be a very effective treatment for OCD.
  7. “Are you willing to leave your office if needed to do behavior therapy?”
    It is sometimes necessary to go out of the office to do effective ERP.

The last question regarding whether a therapist is willing to get out of their office to work with a client – to do exposures in real-life (in-vivo) settings – was highlighted and strongly reinforced by Beth and Szu-Hui.  Exposure therapy cannot only occur in an office setting and within a 45 minute to one hour session.  This treatment is difficult and requires not only a dedicated client, but a dedicated and properly trained clinician.

Don Vardell, Executive Director

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MVTC Grad, Joelle, Travels from Hawaii for Reunion 2016 – And Shares a Powerful Video Message Regarding Teen Suicide

Posted on by Justin Alvin

As many of you know, we held our 5th Reunion at Mountain Valley this past weekend. One very special MVTC graduate, Joelle, and her father joined us all the way from Hawaii. This morning, Joelle sent us the note below, as well as a link to a video she did recently for Speak Life Hawaii, an organization created by four high school students dedicated to initiating the conversation of suicide and mental health, engendering a more educated and empathetic community, and directing suicidal teenagers towards resources for help.

Please take a few minutes to read Joelle’s letter and watch her powerful video. How fortunate we are to be able to work with such amazing kids. Mahalo, Joelle.

Dear Friends of Mountain Valley:

I did this video for Speak Life Hawaiʻi about a year ago, so when Carl asked me to write an introduction, it took me awhile to think about what Iʻd like to say. I write this sitting in my car about to go to school. Itʻs a typical Monday morning, but I had nowhere near a typical weekend. Especially after going back and watching this video, I knew traveling to Mountain Valley and back to Hawaiʻi for the reunion over the weekend was no doubt the best decision I/my parents could have ever made.

I truly do believe there is something magical about Pike, New Hampshire… like an overwhelming moment of mindfulness that seems to just linger in the air. Mountain Valley and the things that happen there are so amazing that when you aren’t there, it almost seems fictional. There isn’t a day where I don’t think of Mountain Valley and the magical people there who have become part of my ʻohana. I am, and forever will be, immensely grateful to those magical people who taught me how to live again.

And that is why I wanted to use this intro to thank all the staff and residents I met at Mountain Valley who have given me the greatest gift of all – happiness. Mountain Valley will forever be my home away from home.

Love, Joelle

https://www.youtube.com/watch?v=h-rAT_k-RRo

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From the Desk of the Executive Director – Adolescent Anxiety and OCD: Why Residential Treatment?

Posted on by Justin Alvin

In my travels across the country, meeting with clinical and educational professionals, we frequently discuss the topic of when residential treatment is indicated and the process of bringing families – and teens – on board with the idea of going to a residential program. While in many cases the need is painfully clear, describing the benefits of what a residential placement option can provide, over and above an intensive out-patient program, putting it all into terms that resonate is important for gaining buy-in from skeptical kids and families.

When someone’s fear and avoidance or obsessive thoughts and behaviors get to a place where they get “stuck” in their out-patient work – or cannot get to their appointments, it’s time to think about a residential placement. Residential treatment is designed to break the cycle of dysfunction and disability and create momentum in an otherwise stagnate situation. Resuming more adaptive daily functioning in a therapeutic, supportive and expert environment will lead to positive change. Residential treatment, and the clinical and experiential programming that is part of it, not only provides the opportunity for intense treatment and daily living skills, but also provides a much needed social milieu and group interactions that are essential for growth and overcoming specific anxiety disorders such as social anxiety.

When it is determined that a residential placement is needed, a program with a structure and model that supports the consistent delivery of Cognitive Behavioral Therapy-based Exposure and Response Prevention (ERP) is the standard. A comprehensive and specialized anxiety treatment program that utilizes ERP would typically include:

1. A population (milieu) of clients with anxiety and OCD as the primary disorder. Many quality treatment programs say they treat anxiety – which they do, but have a mix of client presentations and co-occurring disorders such as substance abuse, attachment disorders, and personality disorders.
2. A model of gradual exposure work – imaginary, followed by interoceptive, followed by in-vivo practice.
3. Intra and Inter-session exposure work with a trained therapist or specialist, and opportunities to “rehearse” confronting fears in real world (”in vivo”) situations.
4. Multiple and extended ERP Groups weekly where clients will receive education about ERP and participate in exposure activities.
5. Individual and cohort work on exposure scenarios where clients can develop an exposure plan for similar fears.
6. Data collection during the exposure assignments that includes cumulative rating of the anxiety (scale of 1-10), documenting and communicating thoughts, describing physical sensations, and acknowledging safety behaviors.
7. Exposure work supplemented by weekly individual and family therapy.

While a residential program that specializes in anxiety with a strong clinical component is paramount, the programmatic structure of a residential program should also be fun and include an environment to support exposure therapy. Opportunities for experiential and recreational activities to develop skills and explore passions will make the overall experience more enjoyable and offer opportunities for organic and “accidental” exposure work. Ideally, the program should include other evidenced-based elements to help with anxiety such as mindfulness activities like yoga, nutrition education and healthy meals, fitness and outdoor activities.

Don Vardell Jr., Executive Director

For more information about residential treatment, Mountain Valley Treatment Center, or to discuss whether residential treatment is appropriate for a client with whom you are working, contact Dr. Alex Young, PsyD., Director of Clinical Outreach at ayoung@mountainvalleytreatment.org.

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Bryan Randolph Takes a Look at Anxiety in the 21st Century: Current Trends and Treatment Modalities

Posted on by Justin Alvin

Anxiety can simply be defined as “an individual’s response to real or perceived danger.” In general, this response is normal, healthy and adaptive, yet for those with an anxiety disorder, “safe” would be the last word used to describe the feeling of being anxious. This article covers factors that contribute to the development of unhealthy anxiety and describes current treatment modalities.

Prevalence
The National Institute of Mental Health (NIMH) estimates that the lifetime prevalence rate for an anxiety disorder among 13 – 18 year olds is 25.1%. NIMH further estimates that 5.9% of these cases are labeled as “severe.” Additionally, NIMH cites that only about 32 percent of children diagnosed with an anxiety disorder age 8 – 15 sought out professional treatment. Clearly, anxiety is an emerging health issue for teens and youth and one that may not be receiving proper treatment.

Pathological Anxiety
Pathological anxiety is excessive anxiety in the absence of a real life threatening event. This includes anxiety disorders like Social Anxiety Disorder (SAD), Social Phobia (SP), Generalized Anxiety Disorder (GAD) and Panic Disorder. This also includes conditions including Post-Traumatic Stress Disorder (PTSD), Obsessive-Compulsive Disorder (OCD), Body Dysmorphic Disorder (BDD), and Somatic Disorders /Illness Anxiety Disorder. Individuals with an anxiety disorder experience an excessive anxiety response on a physiological and cognitive level which then drives pathological behavior such as avoidance, isolation and social withdrawal or defiance/resistance. The anxiety response is largely driven by the sympathetic nervous system which can also be thought of as the body’s “Fight, Flight, or Freeze” response.

Certain physiological changes occur in order for the body to prepare to face a dangerous situation (fight), run away from danger (flight) or hide/avoid (freeze). Individuals with an anxiety disorder become sensitized to these sensations and experience them as distressing and dangerous. In some individuals, these sensations become an anxiety trigger themselves which can lead to escalating anxiety. This can result in episodes labeled as “panic attacks.”

Cognitively, pathological anxiety is experienced as excessive doubt, fear and worry. Many individuals with anxiety describe their thoughts as “racing” or overwhelming and find themselves endlessly analyzing past mistakes or future catastrophes. Individuals with pathological anxiety believe that their fears are founded and that the feared items, situations, thoughts, memories or sensations really are in fact dangerous. Individuals with anxiety disorders often have problematic beliefs regarding anxiety itself such as “If my anxiety does not go away, I will go crazy,” or “I can’t let anyone see me when I am anxious because I will be irreversibly negatively judged.” Unhealthy anxiety is a result of a combination of overestimating the danger inherent in a situation and underestimating one’s ability to cope with the situation.

Factors contributing to anxiety among teens
The etiology of pathological anxiety is complex. Many individuals have a genetic vulnerability which causes the body’s anxiety response system to activate too intensely and too easily at the perception of danger. In cases of clinical anxiety, this perception is based on faulty beliefs. There are several proposed pathways to the development of these unhealthy behaviors.

Classical conditioning involves the association of a response with a previously neutral stimulus. For example, a child who felt humiliated by a teacher who chided him/her for not turning in homework may not only feel anxious around that teacher in the future but also may feel anxious simply walking into the school building. The building, which was previously neutral, has become associated with danger (humiliation by teachers) and will now evoke a conditioned anxious response. Vicarious learning involves learning to be anxious through another’s experience. A child who watches a friend faint and become injured by hitting his or her head on the ground may become anxious about fainting even though she or has never fainted his or herself. Informational Transmission involves being told by others that certain objects or situations are dangerous. This is common in children and adolescents who themselves have anxious parents. Anxiety disorders seem to have a genetic component and it is common for anxious children to be raised in an “anxious family.”

Cognitive Behavioral Therapy
Cognitive Behavioral Therapy (CBT) focuses on correcting problematic beliefs and interpretations and eliminating behaviors that prevent behavioral change. This is achieved through the use of cognitive restructuring techniques and Exposure and Response Prevention therapy (ERP).

ERP therapy is the process of helping an individual experience a fear trigger while eliminating the use of behaviors that prevent the individual from fully facing the feared stimulus. These behaviors are referred to as “safety behaviors” and include avoidance, OCD rituals, reassurance seeking or defiance. During therapy, individuals create a subjective scale, referred to as Subjective Units of Distress (SUDS). Throughout the exposure process, individuals rate and scale their anxiety level. The reduction of intensity of anxiety symptoms over time is referred to as “habituation.” Traditionally, ERP therapists were taught to aim for a reduction of SUDS to half the level of the peak anxiety experienced to achieve within-session habituation. An exposure task is repeated until the feared stimulus no longer elicits an unmanageable level of anxiety.

Some therapists are hesitant to use exposure therapy due to concerns that a client’s anxiety level will not be able to habituate within the time frame of the session. However, emerging research suggests that within-session habituation is not necessary for corrective learning of problematic beliefs to occur. Exposures should be designed in a way to test anxious predictions in order for clients to experience that their “worst case” scenario does not occur or if it does that it is not as scary or dangerous as they believe it to be. The goal of an exposure is not solely to achieve habituation, but to also create new adaptive learning which then competes with and inhibits the older fear based learning. This inhibitory learning decreases the anxiety aroused by a situation and contributes to an increase in self-confidence and self-efficacy.

Some individuals may be so affected by their anxiety that they are unable or unwilling to participate in ERP therapy. In these cases, residential treatment in a facility experienced in facilitating ERP therapy may help these individuals become “unstuck” and reclaim their lives from anxiety. Residential treatment can provide the opportunity to capture exposure therapy moments present in everyday life which in turn enhances treatment compliance and positive outcomes.

Acceptance and Commitment Therapy
The shift in thinking in ERP therapy from a focus on habituation to one of fear tolerance is similar to another type of treatment used for anxiety called Acceptance and Commitment Therapy (ACT). Sometimes referred to as a “third-wave” in therapeutic modalities, ACT is part of a movement that focuses on accepting difficult thoughts and feelings rather than seeking to fundamentally change them. This is done through identifying personal values and then committing to act in a way that may cause distress in order to live these values and achieve desired goals.

Family Therapy
In the context of anxiety treatment, family accommodation refers to changes made in order to help a family member manage their anxiety. Accommodations that prevent an individual from facing the source of their anxiety reinforce and maintain pathological anxiety. These changes often result from a lack of anxiety psychoeducation within the family and from difficulties tolerating the anxious individual’s distress. Family therapy for anxiety focuses on changing patterns of accommodation and helping the entire family develop tools for managing the increase in distress caused by changing these patterns. When residential treatment is utilized for adolescent or young adults with anxiety, it is crucial that treatment focuses on addressing family patterns as well. This will allow the entire family to function in a healthier way through making decisions that are based on what is best for the family and not ones driven by anxious thinking.

Medication
Medication can be an important part of anxiety treatment. Is it recommended that anxious individuals seek out the guidance of a trained psychiatrist and that medication be used in conjunction with psychotherapy.

Hope
Individuals with an anxiety disorder often live a life controlled by fear. This fear can make seeking out or being compliant with treatment difficult. Anxious teens and adolescents who are unable or unwilling to participate in treatment may need residential treatment in order to engage in therapy in a safe, structured and supportive environment. The supportive environment of a residential treatment center often yields positive results for many of these teens. Although anxiety may be a rising issue in today’s society, with the proper care and treatment, anxious individuals are able to gain the skills and tools they need to live happy, healthy and productive lives.

Author:
Bryan Randolph MS, LICSW
Therapist
Mountain Valley Treatment Center

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“A Year Ago” – MVTC Resident Reflects on Life After Graduation

Posted on by Justin Alvin

We received the letter below from Emily M., a wonderful former resident who graduated from Mountain Valley “a year ago.” We share the letter with Emily’s permission.

A year ago today I was packing up my room in Farmhouse. A year ago today I was freaking out about going to a new place, having to ‘start over’. A year ago today we were sitting in the blue room and I finally got to smash my plate.

Today I’m writing to you from school. This semester I’ve been going to the local public high school instead of the school on-campus at my current program, and it’s been terrifying and amazing. I went to the districts-level music festival with my choir and sang a solo at our spring expo. I’ve finished and actually turned in a semester’s worth of difficult school assignments, and only a few of them have been late. I’ve failed a test and survived it. I’ve been home at least once a month. I’ve made an amazing group of friends. It’s been hard, no denying that, but it’s been good.

In ten days, I graduate from my current program and go home for the year until I go away again – this time to college. This coming year, though, is so incredibly exciting – I only have eight more credits that I need to graduate from high school. That goal of graduation is one that I know I can achieve now, when a year ago or even six months ago, I wasn’t sure. I’m enrolled at my local community college as a dual enrollment student, and I auditioned into the top level choir at my high school. I’m taking driver’s ed this summer. I’ve taken all the usual standardized tests, and exceeded my own expectations both in sitting for the tests and accepting the scores that I’ve gotten back. I feel like I’m actually headed somewhere, and it’s a direction I’m really liking.

Anyway. Today is kind of hard for me, partially because I miss Mountain Valley so much, and partially because thinking about where I was a year ago is weird and terrifying. I could hardly imagine feeling this hopeful and this accomplished when I left Mountain Valley, and now, even though I experienced it, I can’t imagine being back in a place where I felt that. A year has made a lot of difference.

I just wanted to let you know. Thanks for everything.

Emily M.

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Mother of MVTC Graduate Celebrates Son’s Success with Anniversary Thank You Email

Posted on by Justin Alvin

Hi Carl,

It’s hard to believe, but four years ago today, May 18th, Jake graduated from Mountain Valley Treatment Center. Every year I celebrate the anniversary, remembering the joy I felt when we brought him home, and then each year, reveling in his accomplishments, all made possible because of the dedicated and caring therapists and staff at MVTC.

This anniversary is even more bittersweet… after four successful years in high school, he will be leaving this fall for Ithaca College. I am thrilled to watch him prepare for this next phase, and so very grateful that he is able to embrace this new journey,using the skills he learned with you.

This year on Mother’s Day, Jake made me a card, and quoted one of my favorite authors, Ann Patchett. She wrote, “just because things hadn’t gone the way I had planned didn’t mean they had gone wrong”. Wise words.  And then he thanked me for helping him find the way…..

Thank you Carl, and everyone at Mountain Valley, for helping him find the way. I can’t wait to see what mountains he conquers next.

With gratitude,

Phyllis Leary

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Grateful Mother of Enhanced Academic Phase Graduate Shares Thoughts

Posted on by Justin Alvin

The mother of a recent graduate of Mountain Valley’s Enhanced Academic Phase recently wrote to Don, expressing gratitude for the success her daughter is now experiencing.  With permission, we share a slightly edited version of her email.

_____________________________________________________________________________________________

Dear Don:

I received an email from Carl a week or so ago and that got me thinking about Mountain Valley again as I so often do. It occurred to me that you may want to know how, and what, your graduates are doing.  To that end, I thought I’d share with you that our daughter has completed her first semester at college, has received all A’s, and has signed up for next semester.  The much bigger win for her, and for us, is that despite her anxiety and occasional illness, she didn’t miss a single class!  She is learning what works for her and how better to manage things.  What a tremendous success.

This would never have been possible without Mountain Valley and, especially, your Enhanced Academic Phase program (https://mountainvalleytreatment.org/academics/enhanced-academic-phase/) – which I hope is continuing to expand and becoming even more robust. I believe it is a desperately needed and integral part of future success for kids going through your program.  It’s my observation that anxiety for these kids so centrally impacts school, which in turn impacts their lives.  When our daughter attended MV the first time, there was no EAP.  She returned better than when she went to you, but was still unable to attend a main stream school. The second time, with the EAP program beginning, she was able to attain her goal of high school graduation and attend a “real” school, (college no less), which is something she hadn’t been able to do in four years.

All of the Knower personnel were professional and helpful and we are grateful to all, but I specifically wish to acknowledge JoAnn

Marchant for being instrumental in our daughter being on the path she is now. Her school here at home was problematic on many levels.   Once JoAnn appeared on the scene, she was able to streamline the overly cumbersome and delayed work exchange, diplomatically handle an extremely difficult situation at the home school, and help our daughter realize her goal of a May graduation.  I sincerely believe that without JoAnn, her May graduation goal would not have been realized and, consequently, it is very likely that she would have given up on high school and higher education entirely.  JoAnn is an asset to be treasured!

Our daughter talks often of her times at Mountain Valley and the special people she met there, especially you, Don, Carl, Jay, Jon, Ryan and JoAnn. Ryan, you worked with her extremely well, and did fantastic work!   As this New Year is beginning, I’m reaching out to you in gratitude and hoping that you are able continue the good things that you make happen there.

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MVTC Alum Celebrates Anniversary of her Graduation with Email to her “Momma Goose”

Posted on by Justin Alvin

The heartfelt email, below, was written to a Mountain Valley therapist by a special young woman who graduated from MVTC in January 2015 – almost a year to the day. It says so much about the wonderful kids with whom we work – and the talented professionals who have such an impact on them. With the permission of both author and recipient, we share the email.

To My Momma Goose,

These past three years have put so much weight on my family’s shoulders. With constant change in med…ications, to shock treatments to my brain, we didn’t know what to do next. But then a gift was given to us. Mountain Valley Treatment Center is a gift that will always be cherished in my family. 2015 has become the best year for me because of them.

I learned that transitioning back home would be tough. I learned that little steps at a time was the greatest thing. I graduated high school after thinking I’d have to stay back a year. I got my first job, where I learned that people might not fight for you, and you have to do what’s best for yourself. I got my license and became so much more independent, but most of all, I learned how to respect myself, and to know that I deserve more than the words and actions I was being given. I learned just how strong and beautiful I really am. I finally became a true woman.

I want to thank so many people for their influence in this past year for me. Most importantly I want thank a woman that became an angel to me. My Momma Goose.

Sharon, you taught me so much strength and courage. You never backed down on anything with me. You showed me how some of my fears were normal but didn’t have to be in the way of my life.
Even though the chugging of seltzer water will always have me curse your name, you gave me hope, and my family hope.

You became an angel for me.

I hope the start to your 2016 is as beautiful and strong as you are.

Happy New Years, Momma Goose.

Emily K.

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Alicia Huysmans and Staff Thanked for Support of Holiday Event

Posted on by Justin Alvin

We received a special email this morning from Denise Castonguay, Adult Living Coordinator for Mount Prospect Academy in Plymouth, NH, thanking Alicia Huysmans and the MVTC staff for their recent support of MPA’s holiday event. Denise’s email is copied below – great job Alicia and Co.!

There is nothing glamorous about raising funds for new programs. The average person may care about homelessness and veterans in need, but gets uncomfortable getting close enough to become part …of the solution. Thankfully this is not true about Alicia and the faculty at Mountain Valley Treatment.

When the director for The Bridge House, Cathy Bentwood and I decided to pull off a spur of the moment holiday event directly linked to our veterans advocacy program, our backs were up against the wall. We had a tight time frame, no data base of supporting volunteers, and a community already saturated with request for help.

Alicia, and the faculty at Mountain Valley, immediately raised their hands and asked how they could help. With little guidance from us, they created and supported one of the free events offered for families at the Cookie Walk. The generosity and creativity they brought to our fund raiser gave parents exactly the quality experience necessary for success.

Thank you for this unique partnership and for sharing our vision of community based leadership between area agencies.

With gratitude, Denise

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