Tag Archives: Mental Health

Study: Genetic wiring as a ‘morning person’ associated with better mental health

By Bethany Bray February 11, 2019

Are you a morning person or a night owl?
Most people consider themselves to be one or the other, with a natural inclination for productivity either in the morning or after sunset.

Not only are these tendencies wired into our genes, but they have a correlation to mental well-being, according to a study published Jan. 29 in the journal Nature. A cohort of researchers found that the genetic tendency toward being a morning person is “positively correlated with well-being” and less associated with depression and schizophrenia.

“There are clear epidemiological associations reported in the literature between mental health traits and chronotype [a person’s ‘circadian preference,’ or tendency toward rising early or staying up late], with mental health disorders typically being overrepresented in evening types. … We show that being a morning person is causally associated with better mental health but does not affect body mass index (BMI) or risk of Type 2 diabetes,” the researchers wrote.

A person’s tendency toward what the researchers refer to as “morningness” is wired into the genes that regulate our circadian rhythm. In addition to sleep patterns, the body’s circadian rhythm affects hormone levels, body temperature and other processes.

Using data from more than 85,000 people, the researchers found that the sleep timing of those in the top 5 percent of morning persons was an average of 25 minutes earlier than those with the fewest genetic tendencies toward morningness.

The study also highlights the connection, reported by previous research, between schizophrenia and circadian dysregulation and misalignment, as well as the increased frequency of obesity, Type 2 diabetes and depression in people who are night owls.

“One possibility which future studies should investigate is whether circadian misalignment, rather than chronotype itself, is more strongly associated with disease outcomes,” wrote the researchers. “For example, are individuals who are genetically evening people but have to wake early because of work commitments particularly susceptible to obesity and diabetes?”

 

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Read the full study in the journal Nature: nature.com/articles/s41467-018-08259-7

 

From the Australian Broadcasting Corporation: “Early birds have a lower risk of mental illness than night owls, genes show

 

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Related reading from Counseling Today:

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

 

Counseling Connoisseur: Cannabidiol and mental health therapy

By Cheryl Fisher February 4, 2019

Carol presented with concerns related to continuous panic attacks that were jeopardizing her work as a medical professional. “I can’t think straight when they happen and I cannot be this debilitated when I see patients,” she explained. Carol had also been self-medicating with alcohol on the weekends to “ease the stress.” Throughout a year and half of intensive therapy, Carol’s panic disorder began to subside, but her general anxiety continued. One day during therapy Carol announced, “I have not been anxious for two weeks!” Thrilled for her, I asked what had caused such a significant change. She looked sheepishly at me and whispered, “cannabis.” I inquired whether she had shifted to smoking marijuana versus drinking alcohol (which she had recently begun cutting back on). She quickly responded, “Oh no! That would get me fired from my job. I am taking a cannabidiol tincture.”

 

Geraldine came to therapy having returned from a year deployment to a country that is without sunlight for months at a time and has very limited pharmaceutical access. She had been without her medication for anxiety and depression and was feeling overwhelmed. “I can’t function,” she lamented. She had contacted a psychiatrist, but the only available appointment was a month away. We identified some tools she could use to help ease her symptoms while she waited, but they only worked for short periods of time. As a result, she was constantly anxious and depressed. Three weeks into our work together, Geraldine announced that she was feeling much better and attributed it to the cannabidiol-infused honey that she was using in her morning oatmeal.

 

Tim presented with depression and insomnia related to chronic pain caused by lupus. He had been taking psychotropic medication for years, but it no longer brought him any relief. Despite taking sleep aids, he was unable to get a good night’s sleep. Tim worked hard in therapy and was able to ease some, but not all, of his symptoms through regular mindfulness meditation. To my surprise, Tim appeared one afternoon smiling in delight. “I slept all night this week!” he exclaimed. Again, the answer to his dilemma was cannabidiol, which he consumed in capsules.

 

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As a counselor, I strive to create the best evidence-based, holistic and individualized treatment plans through collaboration with my clients. In addition to traditional talk therapy, I use a variety of therapeutic approaches, including a wide range of expressive arts and animal and nature-assisted therapies. Recently multiple clients have reported symptom improvement through the use of an over-the-counter supplement that works with the body’s endocannabinoid system (ECS). Approved in the form of an oral solution (Epidiolex) in June 2018 by the U.S Food and Drug Administration (FDA) for the treatment of Lennox-Gastaut syndrome and Dravet syndrome — rare and severe forms of epilepsy — cannabidiol (CBD) has also drawn interest as a therapeutic agent for use on a variety of neuropsychiatric disorders.

 

What is cannabidiol?

CBD is a naturally derived, non-psychoactive hemp derivative. Proponents describe CBD as a food supplement that provides the therapeutic element of cannabis without tetrahydrocannabinol (THC), which is the component that produces a high. It can be found as a tincture, vapor, infused in honey or creams and is used in food products such as smoothies. Reported side effects include possible positive drug screening results, appetite changes and sleepiness.

How does it work?

CBD affects the ECS, which consists of endogenous cannabinoids, cannabinoid receptors and the enzymes that synthesize and degrade endocannabinoids. As noted in a 2018 article in the journal Frontiers in Molecular Neuroscience, research has found that the ECS plays a significant role modulating physiological functions such as mood, cognition, pain perception and “feeding behavior.” The ECS also interacts with the immune system and moderates inflammatory processes. Animal studies and anecdotal observations have shown that modulating the ECS can have beneficial effects on mood, but the authors note that numerous additional factors, such as the placebo effect, could be influencing these findings.

Research that focuses specifically on targeting the ECS with CBD has also been intriguing. In a 2015 article appearing in the journal Neurotherapeutics, a review of studies on animal and limited human populations concluded that acute doses of CBD can reduce anxiety. The authors call for research on chronic doses and note that because past human studies of CBD were conducted with healthy volunteers, future work should focus on clinical populations.

Overall, current research indicates that CBD has significant potential as a treatment for a number of mood disorders.

What does this mean for counselors?

As counselors, it is important to be informed about supplements clients are using to manage mental and physical disease. While we cannot prescribe medications and should refer clients to their doctors for medical advice around pharmacology and supplements, we do have a duty to provide our clients with psychoeducation and research.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

 

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EDITOR’S NOTE: Counselors should be aware that according to a U.S. Food and Drug Administration (FDA) statement issued in December 2018, although hemp has been removed from the Controlled Substances Act, it is still illegal to add CBD to consumer food products or to market it as a dietary supplement.

Some jurisdictions, such as the cities of New York and Los Angeles, have begun ordering restaurants to stop selling food containing CBD. The FDA is not currently preventing the manufacture of CBD as a dietary supplement. However, counselors and clients should be aware that like all dietary supplements, those containing CBD are not subject to set standards regarding dose or strength.

 

Learn more about risk management issues related to client marijuana use (ACA members only): counseling.org/docs/default-source/risk-management/ct-risk-management-july-2018.pdf

 

FDA statement on CBD cannabis regulation: fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm628988.htm

 

FDA and marijuana Q+A: fda.gov/NewsEvents/PublicHealthFocus/ucm421168.htm#enforcement_action

 

 

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Cheryl Fisher

Cheryl Fisher is a licensed clinical professional counselor in private practice in Annapolis, Maryland. She is director and assistant professor for Alliant International University California School of Professional Psychology’s online MA in Clinical Counseling.  Her research interests include examining sexuality and spirituality in young women with advanced breast cancer; nature-informed therapy; and geek therapy. She may be contacted at cyfisherphd@gmail.com.

 

 

America’s mental health disparities

By Bethany Bray December 10, 2018

Mental health care availability and access vary tremendously depending on where you live in the United States. In Massachusetts, for example, there is one mental health care provider for every 180 residents. That ratio is far different in Texas and Alabama, however, where there are more than 1,000 residents for every one provider.

Mental Health America (MHA) recently released its annual report of mental health indicators across the U.S. For the ratios above, MHA included counselors, psychiatrists, psychologists, licensed clinical social workers, marriage and family therapists, and nurses specializing in mental health care in its categorization of “mental health provider.”

MHA ranked Massachusetts as the best state for mental health care availability, followed by the District of Columbia, Maine, Oregon, Vermont, Oklahoma, New Mexico, Rhode Island, Alaska and Connecticut. All of these states and the District of Columbia have fewer than 300 residents per mental health care provider.

On the other end of the spectrum, Alabama (with 1,180 residents for every one provider) and Texas (1,010:1) were the lowest-ranked states, along with West Virginia (890:1), Georgia (830:1), Arizona (820:1), Mississippi and Iowa (760:1), Tennessee (740:1), and Florida and Indiana (700:1).

Although Oregon was near the top of MHA’s list for mental health care availability, it also ranked highest for prevalence of mental illness among adults. Nationwide, 18.07 percent of adults – or more than 44 million people – have a mental illness, defined as “a diagnosable mental, behavioral or emotional disorder, other than a developmental or substance use disorder.”

See MHA’s full report, “The State of Mental Health in America 2019,” at mentalhealthamerica.net

In Oregon, that prevalence was 22.61 percent, followed by Utah (22.27 percent), Kentucky (22.08 percent), Idaho (21.62 percent) and Arkansas (21.02 percent). West Virginia, Vermont, Washington, Montana, Colorado and Alaska followed with rates that were between 20 and 21 percent.

States with the lowest prevalence of adult mental illness included New Jersey (15.5 percent), Hawaii (15.55 percent), Illinois (15.73 percent), Texas (16.04 percent) and Maryland (16.59 percent). North Dakota, California, Florida, Louisiana, Michigan, Mississippi, Arizona, New York, Maine, Delaware, Iowa, Georgia and South Dakota all had rates between 17 and 18 percent.

MHA, a Virginia-based nonprofit advocacy organization, compiles a report titled The State of Mental Health in America each year from nationwide survey data, including information from the Substance Abuse and Mental Health Services Administration and the Centers for Disease Control and Prevention. Released this fall, MHA’s current report includes statistics on access to mental health care, uninsured citizens, rates of substance abuse, suicide indicators, youth depression and other factors.

See MHA’s full report, “The State of Mental Health in America 2019,” at mentalhealthamerica.net

 

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Mental Health America’s The State of Mental Health in America 2019

When it comes to mental health, how does your state stack up?

View the full report and state rankings at mentalhealthamerica.net

 

See MHA’s full report, “The State of Mental Health in America 2019,” at mentalhealthamerica.net

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

 

Team sports vs. solo exercise: Which is better for your mental health?

By Bethany Bray December 3, 2018

Professional counselors often recommend exercise to clients as a way to improve mood and overall wellness. In addition to boosting serotonin, a neurotransmitter connected to feelings of well-being, exercise offers the chance to unplug from the busyness of daily life and process one’s thoughts.

A recent journal study in The Lancet Psychiatry takes that recommendation one step further, connecting team sports to improved mental health. A cohort of researchers studied four years of recent survey data from more than 1 million American adults.

They found that individuals who exercised experienced 43 percent fewer days of poor mental health in a one-month period than did people who didn’t exercise at all. Individuals who experienced the greatest mental health benefits, however, were those who participated in team sports, followed by those who rode bicycles or did aerobic and gym activities (in durations of 45 minutes, three to five times weekly).

Jude and Julius Austin, American Counseling Association members who played soccer both in college and at the professional level, stress that the study’s correlational findings do not mean causation.

“We think further research needs to be done regarding the lived experience of athletes in team sports who struggle with mental health issues,” said the brothers in a co-written statement to Counseling Today on the Lancet findings.

Although mental health improvements are not caused by exercise, physical activity does, when done appropriately, have biological, cognitive and social benefits — which Jude, an assistant professor in the counseling program at the University of Mary Hardin-Baylor in Texas, and Julius, an assistant professor in the marriage and family therapy and counseling studies program at the University of Louisiana Monroe, say they experienced as soccer players.

“It is exciting to see [researchers] investigating things we believe most athletes can collectively, albeit anecdotally, agree on,” wrote Jude, a licensed professional counselor in residency and Julius, a provisionally licensed professional counselor. “In our experience playing team sports, it feels great to survive a particularly tough practice. Pushing ourselves through seemingly impossible physical tasks with others reinforced that we have everything we need to handle life’s challenges. There is something healing about being swept away by the team’s mentality during a game; pressing or absorbing pressure, counterattacking or keeping possession, the ebb and flow of defense to offense, being in the zone. Even if it’s only for a moment, those sweeping moments were where we received social support, affirmation, genuineness, empathy and unconditional positive regard. These are all therapists’ offered conditions in an effective therapeutic relationship. We could not say this with empirical certainty, but we would imagine that receiving these conditions from a team can cause lessening of mental health issues.”

ACA member Sarah Fichtner, a former Division I women’s soccer player for the University of Maryland (UMD), has mixed feelings about the Lancet study. While there is little doubt that exercise in general benefits both mental and physical health, it can be taken to the extreme when sports are played at a high level, she says.

“I am a firm believer that exercise improves an individual’s mental health, as it produces feel-good endorphins and releases chemicals such as norepinephrine which alleviate stress and anxiety,” Fichtner says. “As an exercise and health enthusiast myself, there is not a doubt in my mind that exercise has many positive implications. However, I am a bit skeptical of the [Lancet] findings pertaining to team sports. I do see the benefits of exercise groups [in] that they provide accountability, comradery and support, but in terms of competitive team sports — particularly at the collegiate level — the environment is extremely different.”

Fichtner is a counselor intern at Hackensack Meridian Behavioral Health and is working on completing a master’s degree in clinical mental health counseling at Kean University in New Jersey. After her experience as a DI athlete, she calls for balance when it comes to competition and team sports.

“During my time as a student-athlete and captain at the University of Maryland, I saw firsthand the detrimental consequences of the collegiate world. When a player is recruited to play at the DI level, he or she is expected to perform. Coaches have one goal in mind, and that is to win,” she explains. “Practices are intense, to say the least, and the idea of healthy competition goes out the window. A player is competing against his or her teammates every day to secure a starting position. They are competing to be the fastest, fittest, slimmest and most technical or tactical player. And every day, their coaches are telling them, ‘You are not good enough,’ ‘You need to lose five more pounds to be in the running for a starting position,’ ‘Your teammates are working harder than you’ and ‘Ask your teammate so-and-so for help. She is outperforming you. She has great skills.’ This high-intensity environment can lead to many mental health challenges such as eating disorders, anxiety, depression and low self-esteem, which I witnessed during my four years at UMD. Thus, when I think about team sports, specifically at the collegiate level, the word balance comes to mind.”

“Aside from the intense environment, there were many positives takeaways from my time as a student-athlete,” Fichtner adds. “I made lifelong friendships, competed at the highest level of collegiate sports, was privileged to visit many states, had top-notch gear, learned important life lessons and would do it all over again in a heartbeat. Nevertheless, now as a mental health counselor, I see the collegiate world through a different lens. Many of the challenges we athletes faced on a daily basis seemed both normal and absolute. But now as I grow both personally and professionally, I realize that colleges need to establish a balance between a healthy competitive environment, where athletes are pushed and held accountable, and a debilitating, harmful environment, in which athletes are placed in harm’s way [of] mental health challenges. Balance is key to any exercise regimen, especially in the collegiate world.”

 

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Read the Lancet study in full: thelancet.com/journals/lanpsy/article/PIIS2215-0366(18)30227-X/fulltext#seccestitle10

 

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ACA members: Interested in exploring connections between sports and mental health? Join ACA’s Sports Counseling Interest Network.

 

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Bethany Bray is a staff writer and social media coordinator for Counseling Today. Contact her at bbray@counseling.org.

 

Follow Counseling Today on Twitter @ACA_CTonline and on Facebook at facebook.com/CounselingToday.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Life after traumatic brain injury: Lessons from a support group

By Judy A. Schmidt October 8, 2018

Support groups are wonderful opportunities for people with similar life experiences to meet each other, share their stories and encourage one another. Group members benefit from learning coping strategies and everyday tips for dealing with various experiences. For people with traumatic brain injury (TBI), support groups offer informal opportunities for understanding a shared experience that greatly changed their lives, often within a few seconds’ or minutes’ time. They are left with physical, cognitive and emotional outcomes that impact their relationships, work and independence, often leading to loneliness and isolation.

As noted by the Brain Injury Association of America, more than 2.5 million adults and children experience a TBI in the United States each year, and support groups play a vital role in their continued recovery and re-entry to everyday life. A TBI dramatically interrupts life for these individuals and their families. Extended hospitalizations for physical recovery and long-term cognitive training for rewiring the brain alter all aspects of life, with treatment continuing for up to a year after the incident.

 

Effects of TBI

The effects of TBI are varied and highly individualized. The extent of the physical and psychosocial impacts depends on the type of injury (closed, open or acquired) and the severity of the injury. Thus, depending on the area of injury, people with TBI may deal with deficits in memory, executive functioning issues and poor judgment.

Frontal lobe injuries may lead to changes in mood and personality, difficulty making decisions and difficulty with expressive language, all of which are executive functions.

Injuries to the parietal lobe, which helps with perceptual abilities, may lead to difficulties naming words (anomia), finding words (agraphia) or reading (alexia), as well as problems with perceptual abilities that integrate sensory information. The ability to distinguish right from left may also be affected.

Damage to the temporal lobe may involve hearing loss, Wernicke’s aphasia (difficulty grasping the meaning of spoken language), problems categorizing information such as objects and short-term memory problems.

Brain injuries to the occipital lobe, which controls our vision, may lead to visual field problems, distorted perception and difficulty with reading, writing and word recognition.

Injury to the base of the skull at the site of the cerebellum creates difficulties with balance, equilibrium and coordination, as well as slurred speech.

Acute and long-term rehabilitation from TBI involves physical, occupational and speech therapy, as well as cognitive neuropsychological evaluations. As individuals recover from the physical damage, it is important for counselors to be a part of the rehabilitation team to manage adjustment to the physical injuries, acute stress and cognitive disability. In addition, the psychosocial aspects of TBI are very disruptive. They can be long-lasting as these individuals and their families begin to adapt to everyday life. Counselors are needed to provide individual and family counseling, as well as psychoeducation about TBI and recovery.

 

Psychosocial aspects of TBI

The psychosocial aspects of TBI are also related to the area of brain damage. People with frontal lobe damage may have difficulty making decisions, maintaining attention to tasks and controlling impulsive behaviors.

When the parietal lobe is damaged, difficulties occur with eye-hand coordination, reading, math and writing.

Temporal lobe damage interferes with communication skills, learning and memory. Learning difficulties due to recognition and visual field problems may result from occipital lobe damage.

In assisting people with TBI and their families, it is important to understand how psychosocial areas of life are affected and how these areas impact the potential return to daily living. For example, an individual may not return to his or her pre-injury abilities and can experience problems returning to work or school. Difficulties with problem-solving, understanding others’ emotions and social cues, or just being able to carry on a conversation may isolate the person with the TBI and increase his or her feelings of loss. Other areas of life that may be affected include the ability to drive, participate in sports and exercise, which can create deficits in the person’s social life. Problems with executive functioning can lead to challenges making sound decisions. Because safety is a major concern, the individual with a TBI may need to be monitored consistently by family, which can lead to tensions and other problems.

These are all skills that most of us take for granted or complete without much planning and forethought. But for individuals with TBI, family and personal relationships can grow strained, and the ability to build new relationships is impacted. The person’s independence and self-esteem suffer greatly.

 

Lessons learned

As a rehabilitation counselor for an acute inpatient rehabilitation program, I work with individuals who have TBIs, as well as their families, to provide counseling for stabilization, adjustment to disability and assistance with developing coping strategies. Providing support to these patients and their families as they begin realizing the extent of the brain damage and start dealing with feelings of loss is a crucial part of recovery.

For three years, I facilitated a monthly outpatient support group for people with TBI and found the experience fascinating. Hearing stories of people having car accidents, motorcycle accidents, work accidents, anoxia (deprivation of oxygen) and other unexpected accidents was difficult and often heart-wrenching. Yet these shared experiences forged a bond among group members that was undeniable and very moving.

They shared what it was like to not remember exactly what had happened to cause their brain injury. They shared what it was like to lose track of time and details and to have to trust the information told to them by health care providers, family members and friends. The fact that they each had “lost a period of time” from their lives and hadn’t been the same since seemed to build a sense of trust and caring among the group.

I soon learned that as a rehabilitation counselor, I could understand the medical, cognitive, vocational and emotional results of their injuries, but I couldn’t fully appreciate the daily psychosocial impact that their injuries had taken and continued to take on their lives.

The time since being injured varied among the support group members — anywhere from two years to 18 years. Regardless, the psychosocial effects they experienced were extensive. They talked about their school and work being interrupted, about having to settle for less challenging options or not being able to pursue their goals at all. Some shared tales of broken marriages and relationships, of losing custody of their children.

Others talked about losing their sense of independence because they had to rely on their families for almost everything. Some could no longer live at home due to the need for constant supervision, so they had to learn to live in group homes. Pursuing sports or other recreation choices was hard because of physical limitations. Another significant loss was no longer being able to drive and depending on others for transportation. The lack of money for “extras” was particularly difficult for those group members with children.

Holidays posed another challenge for these support group members because of sensory issues with noise, lights and too many people talking at once. Others discussed experiencing the stigma of having a TBI and being considered “different now” by family members and friends. This was felt particularly strongly at social gatherings, where family and friends made infrequent contact with them. Isolation and loneliness were prevalent themes in their stories. Depression, anxiety and low self-esteem made daily life a struggle.

Research conducted by Jesse Fann and colleagues in 2009 and by Annemieke Scholten and colleagues in 2016 and subsequently published in the Journal of Neurotrauma shows that the rate of depression during the first year after a TBI is 50 percent. The rate is close to 60 percent within seven years after the TBI. So, it is crucial for counselors to have this awareness of serious mental health issues in people with TBI to properly assist them and their families in seeking appropriate treatment.

Members of the support group I facilitated discussed that being on medication was difficult due to the side effects and to the cost of the medication if they had little or no insurance. They felt that cognitive retraining programs and daily psychosocial programs modeled after those for people with serious and persistent mental illness helped tremendously. The aspects of these programs that they reported helping most were receiving cognitive behavior therapy and continuing to learn more about TBI. The psychosocial programs were highly regarded because of the increase in social activities, access to vocational rehabilitation and supported employment services, and integration back into the community.

At times, the support group was difficult to manage because of the cognitive and emotional deficits with which the individuals dealt. However, the members had their unique ways of helping each other and redirecting the conversations. It was very clear that they respected one another.

Our time together as a support group transformed us into a unique family, particularly because the group remained fairly constant in its membership. The members trusted each other and understood the struggles being discussed. However, they also felt safe in correcting each other and being bluntly honest (which people with TBI are). We did have some new members join along the way. They were welcomed with open arms, and veteran members exhibited an unabashed eagerness to help. It was always interesting to hear about the creative accommodations that our members developed to live life each day and how the professionals in their lives assisted them.

As the group grew stronger, the members felt it was important for me to record what they wanted others to know about TBI and people with TBI. Their primary messages were:

  • “Conversation and expressing one’s self can be difficult.”
  • “People with TBI may not like the same things as they previously did, so don’t force us.”
  • “Tasks may take longer for people with TBI, so wait for us.”
  • “Social situations can overload people with TBI.”
  • “TBI affects everyone around the person.”
  • “Those with TBI are still the same people they were before.”

During my time with the support group, I learned many lessons. First of all, I learned that life after a TBI requires constant adjustments that must be made each day to be productive and involved. I also came to understand that time does offer healing when abundant respect and empathy are present. But most important, I learned about living life as it happens from a wonderful group of resilient individuals.

 

 

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Judy A. Schmidt is a clinical assistant professor in the clinical rehabilitation and mental health counseling program in the Department of Allied Health Sciences, and an adjunct clinical assistant professor in the Department of Physical Medicine and Rehabilitation, School of Medicine, at the University of North Carolina (UNC) at Chapel Hill. She is the rehabilitation counselor for the acute inpatient rehabilitation unit for UNC Hospital, where she provides counseling services to patients and their families after traumatic brain injury, stroke, spinal cord injury and other neurological trauma. Contact her at judy_schmidt@med.unc.edu.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.