February 17th is National Caregivers Day!

SIMEDHealth Psychologist, Dr. Bensadon discusses the physical and emotional toll it takes to be a caregiver. 

What defines a caregiver?

A caregiver is someone who provides direct care to someone else. Types of care vary and often depend on the health status, condition, and needs of the care recipient. The United States health care system is generally an acute and sub-acute model even though our aging society has led to significant increases in chronic, incurable conditions. As a result, many Americans must self-manage their chronic conditions and this generally requires efforts from both patients and informal, non-professional/unpaid caregivers, who are often family members. According to the Centers for Disease Control and Prevention (CDC):

• 58% of caregivers are women.
• Almost one-third of caregivers provide care at least 20 hours a week.
• Caregivers typically learn as they go and aren’t formally trained.
• 79% of caregivers care for adults aged 50 or older, and 76% of care recipients are aged 65 years and older.² 
• One in 6 non-caregivers expects to become a caregiver within two years.

What are the challenges a caregiver faces?

Caregivers often face the same challenges as those for whom they provide care. Caregiver burden is a well-established concept that encapsulates these challenges. It can be broken down into objective and subjective burden. Objective burden is a measure of the amount of duties and tasks required in the caregiving role, while subjective burden is the degree to which the caregiver feels and perceives their role as burdensome. In truth, people vary in what they consider burdensome. What one person perceives as a burden another may perceive as a privilege.   

Why is self-care important for a caregiver?

Caregiving can be rewarding but can also be draining. Caregivers often perform duties which are not acknowledged by others. This lack of recognition can result in caregivers feeling they are in a thankless position. Perceived lack of appreciation for one’s efforts can accelerate frustration, deplete energy, and lead to emotional exhaustion, a core component of burnout. No one is immune to burnout. This applies to professional caregivers (e.g., doctors, nurses) and non-professional caregivers (family, friends) alike. Self-care can help caregivers preserve themselves and buffer burnout. Ultimately this can help caregivers remain in the caregiver role longer, and with fewer negative consequences. Care recipients and caregivers each have needs. Balance is vital. Without it, it is not uncommon for caregiver health to deteriorate more rapidly than the health of their care recipients.  

How can a caregiver support their mental health?

Fortunately, many of the challenging psychosocial realities of caregiving are amenable to psychological intervention. Caregivers need and can benefit from support just like anyone else. A key challenge, however, is caregivers often focus more on care recipients’ needs  than their own, and as a result may have difficulty prioritizing or even acknowledging their own needs. Caregivers often feel they cannot afford (emotionally, financially) to take the time to focus on themselves, and if they do, they often feel guilty about doing so.

What are some resources available for caregivers?

The National Alliance for Caregiving https://www.caregiving.org/

Caregiver Action Network https://www.caregiveraction.org/

Family Caregiver Alliance https://www.caregiveraction.org/

National Alliance on Mental Illness https://www.nami.org/Home

To schedule an appointment with Dr. Bensadon, click here.

Post-Traumatic Stress Disorder (PTSD) is becoming a household name. Although this condition is most associated with those who have served in the military, anyone can have PTSD.  This condition affects 7% of the U.S. population (roughly 300 million people). PTSD develops after experiencing a traumatic event, such as a hurricane, car accident, physical or sexual abuse, serious injury, threatened death or a near-death experience.

“This condition has tremendous attention right now because it shows up in so many ways in our society,” said Dr. Bernie Marrero of SIMEDHealth Psychology. 

 “PTSD manifests in many different ways. It can be persistent or a one-time event. It leaves a marked effect on the person’s emotional sense of wellbeing that remains persistent in their overall state and sense of security and safety,” he said.

Even though you are physically safe, you may feel that you aren’t or may experience flashbacks during a situation that reminds you of a traumatic event, Dr. Marrero said. For example, hurricane survivors may have a PTSD experience during strong winds or rain even though it is not hurricane season.

Symptoms of PTSD are different for everyone who experiences it. This includes heightened anxiety, feeling vulnerable, disassociating from your surroundings and from social life, being hypervigilant or aware of your surroundings, exaggerated startle response and substance/alcohol abuse.

“We understand PTSD a lot more now than we have in the past,” Dr. Marrero said. “We know PTSD is related to the limbic system in your brain which is responsible for producing a sensation of fear, anxiety, and distress when needed for our fight or flight response.”

When adrenaline is released during our fight or flight response, our heart rate increases, our breath shortens and we have a heightened sense of fear. Without proper treatment, these symptoms can begin to affect other areas of your health as well. PTSD can affect your cardiac health and lead to insomnia, a weakened immune system, lack of concentration, lack of memory, irritability and in some cases may affect the digestive tract. Before symptoms progress to that level, it’s important to provide support for those in need, Dr. Marrero said.

“You can be emotionally supportive just by listening. You shouldn’t feel the need to rescue them, but this person should feel they can share their feelings, fears, and concerns. This can help them to not feel so alone and threatened by their thoughts,” Dr. Marrero said.

“It’s important to gain that person’s trust and help them understand that they should receive the help they need to improve their quality of life,” he said.

So when is the right time to receive that help? Right after a traumatic event, Dr. Marrero said.

If someone with PTSD does not receive the help they need it can not only lead to worsening physical symptoms but patterns of self-medicating, turning against one’s support system and general fears that expand beyond a traumatic event.

“At SIMEDHealth, we have therapists who are aware of the needs of our community. We’re able to properly diagnose PTSD, its side effects and find the right clinical treatment plan,“ Dr. Marrero said.

Once within the SIMEDHealth network of integrated services, no matter how your PTSD manifests, you’ll get the support you need, he said.

Click here to learn more about SIMEDHealth psychology and click here to request an appointment.

Many people have dealt with depression or know someone who has struggled with it. This can make everyday tasks difficult to perform and take the fun out of hobbies and passions. Sometimes people may not know what to do, if they should seek help, or if they even have depression. We spoke with SIMED Health Psychologist Dr. Kristy Quackenbush-Orr. She shared tips on how to help friends and family. She also provided information on when you should see a doctor and what symptoms people with depression usually present. 

It's important to know there are different severity levels of depression. You may not cry daily, have suicidal thoughts, or sleep all the time, but you can still experience depression. It can be more subtle, like feeling fatigued, having difficulty sleeping, not engaging in activities you used to enjoy, or not feeling motivated. 

Symptoms include:

1. Feelings of sadness

2. Feelings of hopelessness

3. Feelings of helplessness

4. Anhedonia (Inability to experience pleasure from activities usually found enjoyable like hobbies) 

5. Difficulty sleeping

6. A change in appetite

7. Fatigue

8. Thoughts of suicide

9. Poor concentration

10. Poor motivation

When should you see a doctor? If you notice any changes in mood or behavior for two weeks, complete a depression screening. You can get a screening through a SIMED Health Psychologist or SIMED Psychiatrist.

Why should you get a depression screening? You can do a depression screening to find out if you have the disorder and the level of severity you experience. Screenings can be completed online or in paper-pencil format; a medical provider can also verbally ask questions. Once a screening is completed, a score is calculated which should indicate whether someone is experiencing a level of depression that requires further assistance. You should get a screening if you have been tearful, experiencing loss of interest in activities, feeling helpless, having thoughts of ending your life, feeling hopeless, or feeling lonely.

Here are additional tips you can suggest to those struggling with depression.

1. Exercise – You should exercise at least 30 minutes every day as approved by your physician. Exercise has been shown to improve mood and reduce anxiety.

2. Eat Healthy – Research recommends a Mediterranean diet and eating few sugary, processed foods.

3. Use Positive Coping Skills Daily – Coping skills help with handling stress in an effective manner. Coping skills include: journaling, deep breathing exercises, meditation, drawing, working out, gardening, going to church, spending time with friends, and engaging in a hobby.

4. Use Your Resources - Many resources are available to people with depression, and you are not alone. You can find resources online or in your local community.

5. Attend a support group – You can find support groups in most cities including Gainesville and Ocala.

6. See a therapist – You should see either a psychologist or a licensed mental health counselor to be evaluated to determine if medication is recommended. Psychotherapy or "talk therapy" can teach individuals how to change their automatic thoughts or their negative thought patterns. In psychotherapy, patients will also learn how to use cognitive reframes to change the way they think about situations. Therapy also addresses ways to incorporate positive coping skills daily into life. SIMED Health Psychologists offer psychotherapy.

7. Increase your social support – Spend more time with friends and reach out to friends for support and to help you cope. 

If you know someone experiencing anxiety or depression, let them know that you are here to support them through this time as you listen to their concerns and fears.

Click here to request an appointment online with a SIMED Psychologist and learn more about treatment options. 

If you or someone you know have thoughts of suicide, we encourage you to contact the suicide hotline (https://suicidepreventionlifeline.org/) at 1-800-273-8255. Confidential help is available for free 24/7.

According to the American Institute of Stress (AIS), 73% of the population regularly experiences psychological symptoms due to stress. April is Stress Awareness Month, which allows us to reflect on how we can prepare for the stress of finding the right summer child care, finishing the school year or semester or even planning family vacations.

Dr. Danielle Jahn, of SIMEDHealth Psychology, said picking up on the signs of stress is essential because any type of unmanaged stress can lead to anxiety, depression, and even physical symptoms.

"Stress can exacerbate a wide variety of conditions, like ADHD, anxiety, depression, bipolar disorder, and cognitive issues. All sorts of mental health diagnoses can certainly be worsened or exacerbated by stress," Dr. Jahn said. 

According to Dr. Jahn, stress activates the sympathetic nervous system. This is the part of our nervous system that reacts during the fight or flight response. Because our brain perceives stress as a threat, that’s when our heart rate increases, blood flow changes, and our breathing becomes faster and shallow.

Over time, chronic stress can cause physical symptoms such as having a hard time sleeping, inflammation in the body, a weakened immune system, worsened pain from preexisting medical conditions, and flare-ups of autoimmune disorders.

To help reduce your feelings of stress and avoid physical complications, here are five techniques that Dr. Jahn recommends.

Deep Breathing:

Deep breathing tells your brain to activate the parasympathetic nervous system, which is the part of our nervous system that slows everything back down until you’re calm again. It puts the brakes on the stress response that the sympathetic nervous system has started.

Dr. Jahn recommends practicing deep breathing as a skill at least a couple minutes per day to help de-stress.

Muscle Relaxation:

This technique is used to identify where we carry tension from stress in our bodies, and to help release that tension. Dr. Jahn recommends starting from your head and working your way down.

Tense and hold a specific muscle group for 5-10 seconds and then completely relax those muscles. Work through your whole body doing that as a way to identify where your stress is and let it go.

Mindfulness:

Being mindful means slowing down and being present in the moment, Dr. Jahn said. The example she likes to use is that you can either mindfully brush your teeth or unmindfully brush your teeth. If you are brushing your teeth and thinking about everything you didn’t get done yesterday or everything that you need to do later, you’re not being present.

“If you stop and focus in on that moment of brushing your teeth, you’re helping your mind be present,” she said. “Being present and not allowing your thoughts to race or wander helps reduce feelings of stress.”

Acceptance:

Acceptance means understanding that things are going to go wrong, she said.

“This summer you may plan the perfect vacation and it ends up raining the whole time or one of the kids gets sick. So practicing acceptance is the idea that we can’t control everything.” Dr. Jahn said.

We can either choose to dwell on those negative things, which will cause us more stress, or we can choose to accept that they’ve happened and turn our attention to other more positive things. This technique can help us reduce our feelings of stress even though those negative things have happened.

Living by your values:

“Living consistently with your values just means knowing what’s really important to you and doing things that are consistent with that,” Dr. Jahn said.

The example she used is: Let’s say your most important value is your family. Ask yourself if you really need to take on all the extra tasks your boss asks of you, or if you need to bake for the event at your kids’ school since those tasks will probably mean less quality time with your family. Saying yes to all those requests is just going to create additional stress in your life and not make you feel more fulfilled.

Dr. Jahn’s final words of wisdom for Stress Awareness Month are:

"There are a lot of great things we can do on our own to help manage stress. But if at any point you're feeling like its overwhelming and you aren't managing it well on your own, then it's probably time to consult somebody. You can talk always to your primary care provider or you can come see us in psychology."

Click here to learn more about Dr. Jahn, or request an appointment in a SIMEDHealth Psychology department closest to you.

SIMED is excited to announce Dr. Danielle Jahn Ph.D. is joining SIMED Health Psychology. Dr. Jahn earned her Ph.D. in Psychology from Texas Tech University and is a licensed psychologist in the state of Florida. She completed her clinical internship at the VA Eastern Colorado Health Care System and she later completed her fellowship in serious mental illness at VA VISN 5 Mental Illness Research, Education, and Clinical Center. 

"SIMED has a positive reputation in the community," says Dr. Jahn. She is excited to work in an integrated healthcare system and serve the North Central Florida community.

Dr. Jahn's specialty throughout her years of practice has been suicidology and geropsychology. She is available for individual therapy, adult ADHD assessments, and cognitive assessments in our Gainesville and Chiefland offices.

To schedule your appointment with Dr. Jahn, call us our Gainesville office at (352) 332-9441, our Chiefland at (352) 332-9551 or request an appointment online at SIMEDHealth.com. 

The holiday seasons can be full of stress. We talked with SIMED Healthy Psychologist Dr. Kristy Quackenbush about why the holidays cause so much anxiety and what you can do to reduce that stress.

Why are the holidays stressful?

We tend to experience more stress during the holiday season for many reasons!

First, people put pressure on themselves to buy the “perfect” gift for loved ones. Gift buying often leads to people feeling overwhelmed about spending money (that they often do not have). According to the American Research Group, the average American is planning on spending $983 on Christmas presents, which is more than the average American makes in a week!

The holidays can also be stressful when gathering family members under one roof. Past negative interactions, past psychological injuries, different life views (I.e. Political views), judgmental/rude comments (“Did you gain weight?” “Are you still single?!”), and unsolicited advice given from fellow family members can be overwhelming and anxiety inducing.

Furthermore, setting unrealistic expectations for the holidays also increases holiday stress.

Another stressor is food! The American culture centers many holidays around the food. For some, cooking is overwhelming. Some people have food allergies. Some people have health complications that can be affected by food. Some people worry about their weight. The holidays are a time when many are tempted to overeat or eat food that will negatively affect their health.

Last but not least, people tend to travel for the holidays, and whether you’re traveling via car, plane, or train, traveling can be stressful.

What are some indicators that I might be stressed about the holidays?

Symptoms of stress include:

1. Poor sleep
2. Change in appetite
3. New physical complaints (such as headaches, tightness in the neck, stomach aches, shortness of breath, nausea, diarrhea)
4. Being more forgetful
5. Being more irritable
6. Crying
7. Yelling/arguing

Our body is always providing us with information, and often we are “too busy” to listen. Pay attention to your physical symptoms/cues and take stock of the basic life necessities (I.e. “Have I been sleeping well?”, “Did I eat and drink enough water today?”).

I’ve figured out I’m stressed. What can I do to feel better?

These tips will help you feel better in no time.

1. Get around 8 hours of sleep.
Avoid electronics (I.e. cellphones, televisions, IPads, etc.) at least 30 minutes before bed.
Avoid caffeine in the evening.

2. Eat well.
Avoid eating just one large meal.
Eat vegetables and fruits.
Limit alcohol intake.
Limit sugar.
Drink water.
When we are not sleeping or eating well, our physical health, mood, and memory can be negatively impacted.

3. Exercise.
Exercise is beneficial for our physical health, decreasing stress, improving mood, and improving memory.
A 30-minute walk outside in a local park can assist with decreasing stress.
Consider listening to your favorite music while walking or working out.

4. Continue to engage in hobbies/activities you enjoy.
This will give you a break from the stressors of the day.

5. Engage in a mindfulness activities.
For example, while eating your favorite food or spending time outside, stop and ask yourself: What do I see? What do I feel? What do I hear? What do I taste? What do I smell? Take time engaging in all your senses. Stop and smell the roses!

6. Continue to take your medications as prescribed!
People have a tendency to forget to take their medications due to changes in daily routine (I.e. traveling) or the excitement of the holiday.

If none of these tips are helpful, contact a mental health provider such as a psychologist, mental health counselor, or psychiatrist.

Remember to also focus on the positives!

1. Use cognitive reframes (I.e. Yes, I have a flat tire, but at least, I have a vehicle or did not get injured!).
2. Take time to enjoy the holiday by learning about loved ones (I.e. ask questions: What was your favorite toy as a child? If you could travel anywhere in the world, where would it be?)
3. Remember that a more expensive gift does not mean you love someone more. Spending time with a person is an invaluable gift.
4. Consider looking into a local church or finding an Alcoholics Anonymous or Narcotics Anonymous meeting if you are traveling out of the area.

Stress not only has short-term repercussions (I.e. muscle tension, diarrhea, poor sleep, low libido, depression, anxiety, etc.), but it can also lead to ulcers, high blood pressure, heart disease, memory impairment, and more. Managing stress is important, even during the holidays, when you feel like you need to prioritize so much else.

Dr. Quackenbush sees patients in Ocala and Lady Lake who are coping with a physical illness. To schedule an appointment with her or another health psychologist in Ocala or Lady Lake, call (352) 732-3110. You can also schedule an appointment online.

SIMED Health Psychologists are also available in Gainesville and Chiefland at (352) 332-9441 or via an appointment request online, and SIMED Psychiatry is offered in Lady Lake/The Villages at (352) 753-6887 or online.

Happy Holidays!

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SIMED is pleased to announce Cathleen Civiello, PhD is joining SIMED Health Psychology.  Dr. Civiello earned her PhD in Clinical Psychology from the California School of Professional Psychology and a Masters in Public Administration from Troy State University.  Dr. Civiello is also Board Certified in Clinical Psychology and Organizational and Business Consulting Psychology.

Dr. Civiello provides evaluations and mental health counseling for patients and their families who are dealing with chronic and acute diseases and injuries.  She also provides anxiety and depression counseling, disability evaluations and social security disability evaluations.  Dr. Civiello is available for patients in our Lady Lake / The Villages office.

To schedule your appointment with Dr. Civiello, call us at (352) 732-3110 or request an appointment online at SIMEDHealth.com.