News from Benchmark Psychology

Using e-Mental Health to Help Our Clients

As part of the Australian Government’s recommended stepped care model of mental healthcare, ‘e-Mental Health’ services (low-intensity online mental health interventions and resources) are becoming a much more important part of our mental health system.

With 1 in 5 Australians experiencing mental health difficulties, low intensity interventions can provide an ideal option for individuals with mild-moderate mental health symptoms where other options (e.g. psychologist referral, medication) might not be suitable. However, e-Mental Health services need not be an either-or choice when compared with face-to-face treatment. In fact, e-Mental Health services can fill multiple roles in the space between an individual seeking help from their GP and accessing treatment with a Psychologist, from initial psychoeducation and increasing acceptability of face-to-face services for first-time help-seekers, to crisis support between appointments, to providing interim support and brief intervention for busy periods where they may be on a waitlist.

Below is a brief guide to the range of e-Mental Health services available (Table 1), as well as an outline of the various roles e-Mental Health can play, and which services are most appropriate.

All listed programs have been developed by credible sources, such as the Australian Government, universities, and national nongovernment organisations.

Table 1. e-Mental Health Service categoriesHere is an outline of some of the ways e-Mental Health can be used to help our clients:

Head to Health (https://headtohealth.gov.au/) Previously ‘mindhealthconnect’, this is the Australian Government’s portal to mental health information and e-Mental Health services. It enables consumers to search for information and receive advice about their mental health needs.
Telephone and Webchat	Telephone and online chat services, most often free and used for crisis support, information-seeking, or brief counselling.	Lifeline Kids Helpline eHeadspace Suicide Callback Service Beyond Blue Support Service
Psychoeducation Websites	Freely accessible websites providing mental health information, and often general tips and strategies for wellbeing.	Beyondblue - www.beyondblue.org.au Black Dog Institute - www.blackdoginstitute.org.au ReachOut - https://au.reachout.com/ Centre for Clinical Interventions - www.cci.health.wa.gov.au
Online programs	Online self-guided courses that are either transdiagnostic (i.e. targeting common core mental health symptoms), or address a specific problem (e.g. Social Anxiety, PTSD). Some programs offer limited guidance from a therapist via phone or email. The majority of programs are free, with a few being low-cost.	Mindspot - https://mindspot.org.au/ Moodgym - https://moodgym.com.au/home This Way Up - https://thiswayup.org.au/ myCompass - https://www.mycompass.org.au/ OnTrack - https://www.ontrack.org.au/ Mental Health Online - https://www.mentalhealthonline.org.au/
Apps	Easy and convenient to use (as they are mobile- or tablet-based). However, due to the number of apps available on the market and the relative ease in creating them (compared to the more comprehensive online programs), many do not have experimental validation. As such, it is important to thoroughly check the content and credentials of any app before referring to it.	BeyondNow Suicide Safety Planning app (developed by Beyondblue) MoodPrism and MoodMission (developed by Monash University) AIMhi Stay Strong App (developed by Menzies School of Health Research for practitioners developing a mental health plan with ATSI clients)

1. As crisis support:

Telephone and webchat services are a great option for clients to contact if they need immediate support out of hours or between appointments with their healthcare professional.
Apps such as the BeyondNow Suicide Safety Planning app can help clients and their healthcare professional create a strong, structured plan for dealing with ongoing crises and distress.

2. Psychoeducation for first-time or hesitant help-seekers:

Head to Health, the government’s mental health information portal, is a great place to direct clients to in the first instance.
Psychoeducation websites are fantastic tool for providing information about general stress and wellbeing, specific diagnoses (e.g. generalised anxiety, eating disorders), or specific problem areas (e.g. parenting, relationship issues, work stress) to first time help-seekers.
Online programs (particularly the transdiagnostic programs that don’t focus on a specific diagnosis, such as myCompass) are a great option for help-seekers who are hesitant or uncertain about face-to-face mental health intervention.

3. Interim support:

If clients are on a waitlist or aren’t able to access timely support due to situational circumstances, online programs and apps can provide a great option to help them start working on their wellbeing in the meantime (which also means they can hit the ground running when they are able to commence face-to-face intervention).

4. To complement face-to-face treatment:

Online programs and apps can help build on the skills being taught in therapy, such as CBT strategies, mindfulness and positive psychology. Whilst using these resources as a complementary tool can involve a little extra work on the part of the clinician (i.e. to be able to get to know the programs available and find ones that complement their work), it can really help to strengthen and reinforce the work done in session.

Using e-Mental Health to Help Our ClientsTania McMahon2023-08-21T15:02:35+10:00

Parent Self-Care: The Important Flow On Effect

by Dr Alison Bocquee

There is a lot written in social media and print about being a good parent, good enough parent, ‘the best you can be parent’. We hear of the importance of looking after ourselves as parents before or so we can best look after our little people. Anyone who has travelled by aeroplane will have heard the air hostesses instructing parents to put on their own oxygen masks first before attending to their child. It seems counterintuitive, but let’s look at the detail as to why this matters.

Self-care – who takes care of the parent? When the parent is constantly giving to others, do they ever think about how much they are giving of themselves? It’s probably not something that parents ask themselves or even consider often, until they are overwhelmed, feeling exhausted and irritable with their children. Then comes the guilt because they are not being the parent that they ideally want to be.

Let’s put it simply. We cannot give what we haven’t got. So if you, as a parent, are not looking after yourself, not showing yourself the love you show your loved ones, not treat yourself the way you want others to treat you (i.e., with respect), this not only affects you but potentially every member of your family.

Children can be viewed as the barometers of the parent’s functioning. Their behavioural outbursts or emotionality or sensitivity may reflect their parents’ imbalance of ‘all work and looking after the family’ but not themselves. When the parents are balanced (i.e., calm, consistent, non-reactive) there is a much better chance the children will be too. Hence the very important flow on effect of parent self-care.

Self-care includes aspects such as sufficient sleep, regular physical movement, nutrition, rest and relaxation, social connection, and engagement in pleasurable activities. Self-care is giving yourself a break, to recharge, taking time off. Self-care shows you matter. It models to your family the importance of your needs, that each member of the family is important. It reduces stress. Self-care is good for your well-being and that of your family.

Further engagement in each of these aspects of self-care demonstrates and models to your little people important life, coping and self-regulation skills. This is much more powerful than anything you could say or ‘lecture’ your child about. Demonstrating to your child that when you’re frustrated you engage in deep breathing, or when you’re anxious you run a bath, or at the end of the day if you’re tired you go to bed a bit earlier, and so on, are invaluable life lessons.

Self-care doesn’t have to be time intensive. Even engaging in breathing exercises for 2 minutes or watching the clouds, or listening to your preferred music is likely to shift your energy and provide you with a little joy. Getting up a little earlier than your little people to plan or consider your intentions for the day, perhaps whilst you sip a cup of tea, is also important self-care. You’ll likely be more calm, and therefore more intentional in your interactions with your loved ones and less reactive overall.

Our team of highly skilled and professional clinical psychologists are able to compassionately support your journey to being the parent you want to be, that makes your heart sing, a parent who prioritises their own self-care because they acknowledge their own importance and their own needs; and that ultimately flows on to a more contented family. Opening yourself to growth by learning and incorporating skills such as relaxation and mindfulness of thoughts and emotions techniques, means you are prioritising your own wellbeing and that of each member of your family.

Parent Self-Care: The Important Flow On EffectEllie Raymond2023-08-21T15:04:39+10:00

Freeing Ourselves From Avoidance

By Dr Jasmine Pang

As human beings, we are encoded to survive by avoiding things that are likely to cause us pain, which we have learnt in the past to induce pain or which is stressful or unpleasant: be it that giant spider sitting on the clothing line, that shoulder pain that has been ongoing for a while, or an article that you have promised to write for your upcoming practice newsletter.

In the initial phases, avoidance can work very well. By just using the part of the clothes line that the spider has not occupied, by not thinking about the article I need to write or by working around my sore shoulder, I can pretend that everything is ok and continue on my merry way. We work around it. The problem is that things very seldom remain the same. My resident clothesline spider decides to expand his territory and take up more and more of my clothesline, my shoulder pain worsens to a point that I cannot reach up beyond my shoulder and my practice manager starts sending me “reminder emails” that I cannot avoid anymore. Whilst some avoidance can be a very successful strategy to keep us safe from stressful situations, unpleasant experiences or threats, it can also become counter productive

So what have I learnt about avoidance?

1. Avoidance can be helpful when threats are real. If that spider on the clothesline turns out to really be that gastly dangerous “it’ll kill a grown man within an hour” species that Australia seems prone to having, avoiding it is probably a good idea. We can never totally avoid all the things that we want to avoid. It is seldom that avoidance makes things go away. The spider is still on the line, my shoulder still hurts and the looming newsletter article deadline is still there.

2. Avoidance feeds fear and is an all consuming voracious creature. The more we avoid the greater the problem often becomes. This is particularly so with anxiety. The more anxious I feel, the more I avoid. The more I avoid, the more anxiety I feel. As time goes by, our world becomes smaller and smaller and we feel more and more trapped.

3. Avoidance prevents us from learning that something different can happen or that what we were so fearful of is not as bad as we expected it to be. It prevents us from really experimenting and checking it out, to determine if something is really a threat or not.

What have I learnt to do about it?

1. Acknowledge the problem. We cannot do anything about a problem until we acknowledge it. For me, it was acknowledging that I had a problem in my shoulder (and in all likelihood had torn a ligament), that I was frightened of that spider and that the thought of having to sit down and write an article brought back traumatic memories of writing my thesis.

2. Start small. Be it writing notes on what you’d like to include in the article, finding out about physiotherapists or reading up about whether your resident spider is indeed as dangerous as you imagined it to be. Keep pushing yourself to be at the edge of your comfort zone. Don’t try to aim for the big wins. Small sustainable goals are more likely to get you there. Remember the tortoise and the hare.

3. Get support and help. Having someone to walk you through the journey can be invaluable. It helps give you perspective, keeps you accountable and gives you someone to whine to at the end of the day. This is particularly so if you have been avoiding a situation because of traumatic experiences. Until you stop avoiding, it will continue to intrude in your life and limit you. It might be uncomfortable but keep practicing and trying. Eventually it becomes the new normal.

To quote loosely from Vivian Greene, perhaps life is not about trying to avoid the storms but learning how to dance in the rain. Now excuse me whilst I get a broom to try to relocate my eight-legged friend for the fifth time before I head out for my physiotherapy appointment.

Freeing Ourselves From AvoidanceEllie Raymond2023-08-21T15:05:33+10:00

When Baby Makes 3 – tips for making the adjustment to Parenthood

By Dr Kylee Forrest

It is no secret that bringing home a baby is time if immense love and joy. Yet it also signifies a time of enormous change for each new parent as an individual, as well as for the couple relationship. Thanks to excellent initiatives from Beyond Blue and public health groups, there is now much greater understanding and acknowledgement of postnatal depression and the benefit of seeking help. While this is fantastic, there are other dimensions to becoming a parent that also deserve to be spoken about.

1. I’m just not “me”

Not every new mum experiences PND, in fact most don’t. But what every new mum does undergo a significant transformation of herself. All of a sudden she is not doing the things that she often took for granted, the sorts of things that allowed her to be her. Formal work may suddenly stop, leisure activities and sports cannot be engaged in, the ways she socializes need to be adjusted, even going to the loo in privacy needs to be reconsidered! Beyond that, the woman’s post-birth body continues to experience vast physical and hormonal changes. Some of these changes are temporary, while others may not be regained for months, or years, if ever at all. In his book The Birth of a Mother, psychiatrist Dr Daniel Stern calls attention to the fact that all of these changes often mean that new mums must create a new identity. While some of this is easy to do, other parts tend to take new mums completely by surprise. The more I come across this phenomenon in new mums, the more I wonder why there isn’t more discussion or preparation for what seems to be a very normal event.

What you can do: The more we can raise awareness that the transition to motherhood includes changes to a mum’s identity (in positive and challenging ways), the better-placed new mums will be. If you, or someone you know are on the path to motherhood, try talking with them about how they think they will manage the good and not-so-easy parts of this change

2. Don’t forget Dad!

Even though the hormones and physiological changes aren’t an issue for new dads, the adjustment that men go through on a practical and psychological level is still worthy of some attention. Unfortunately, there is often so much focus on babies, and to a lesser degree on mums at this time that dads are often forgotten about. Up to 1 in 10 new dads experience postnatal depression and many others report heightened anxiety about their new role as protector/provider. There are fewer social supports in place to support new dads and, knowing what their partner has going through during pregnancy and labour, many men feel uncomfortable talking about their own struggles.

What you can do: Partners, friends and family can help to change this by remember to ask a new dad “how are you going amongst all of this change?”

Take the time to listen, to acknowledge the struggles of fatherhood as well as the good times. This will go a long way to changing the pressures felt by new dads.

If you are concerned about a new dad, encourage him to speak with his GP about a referral to a psychologist. More information about postnatal distress in Dads can be found here: https://www.panda.org.au/info-support/how-is-dad-going And don’t forget that June 18 is International Father’s Mental Health Day

3. Three is a crowd

When a new baby steals its parents’ hearts and relies on them for basically everything, it is easy to slip into a pattern where the needs of the couple relationship are entirely neglected. Approximately 70% of couples experience a sharp decline in relationship closeness and happiness when a baby comes along.

What you can do: While some of this is a normal adjustment of sharing attention between 2 to 3, there are simple things that new parents can do to nurture their couple relationship alongside nurturing their baby.

Don’t forget that you are not just parents! Ensure that you talk about parts of the day that didn’t involve baby.
Get out of the house. Going for a walk as a family gives benefits to everyone. While the sensory stimulation will be good for your bub, some fresh air and exercise in great for parents too, releasing endorphins that promote positive feelings.
Simple touch. Don’t forget that hugs, holding hands, or snuggling up on the couch are an effortless way to maintain intimacy even when you are exhausted. Like exercise, physical contact with a loved one releases chemicals in our brains that also promote positive feelings.
Connect, on and off devices. While mobile phones can be great for new parents to keep in touch during the day, try to make sure that you have some device-free time when you at home together too.

Bringing baby home means big changes for every part of a family, in good and challenging ways. Being aware of these changes in advance will help to make adjusting to these changes as smooth as possible.

When Baby Makes 3 – tips for making the adjustment to ParenthoodEllie Raymond2023-08-21T15:07:56+10:00

When Cracks Appear – Referring Couples for Relationship Therapy

By Dr Jennifer Wilson

Positive, supportive relationships can help us withstand many of the expected or unexpected challenges life might throw at us. At times of stress, knowing there is at least one special other to turn to, who we can trust to hear and respond to us, strengthens our capacity to cope. Conversely, when that need for support at a critical time is not met, we can feel profoundly hurt by those we rely on for care
and comfort. At these times, instead of pulling together to face life’s difficulties, partners can become disconnected and even hostile with each other.

This is where a trained couples therapist can help. As health professionals, you are likely to be caring for patients who are going through just the kinds of difficult life events that can place strain on relationships. Here are a few tips on how you can encourage your patients to seek help for their relationship.

At Benchmark Psychology, we have psychologists trained in Emotionally Focused Therapy (EFT) for Couples. According to recent studies, 90% of couples who see a well-trained Emotionally Focused Therapist experience improvement, and 70% report full repair of their relationship. Unfortunately, many couples are reluctant to seek therapy because of a range of fears and misconceptions, and
couples therapy is often seen as a last resort before breaking up.

Here are some common concerns couples have about therapy -

1. The therapist will take sides.
We are trained to recognise and understand how both partners contribute to their pattern of disconnection and distress, and to assist partners to understand the painful emotions that underlie their partners’
attempts to reach them.

2. The therapist will tell us we should break up.
The decision about whether to continue in a relationship always belongs to the couple. The role of an EFT therapist is to help couples understand how their relationship has gone wrong, and to guide them, for as long as they are willing to try, in how to repair it.

3. We are too far gone; the situation is hopeless.
Even longstanding problems can be resolved or improved with EFT. The intensity of distress does not indicate the relationship cannot be improved.

4. Talking about our problems will make things worse.
Many couples have experienced that their own attempts to talk about their problems have made things worse, so this concern is understandable! However, an EFT Therapist is trained to create a safe space where problems can be discussed productively. In many cases, the therapist will be able to help partners see each other’s struggles in new ways that open the door to healing and reconciliation.

5. Couples therapy is a waste of time and does not work.
EFT has years of research demonstrating its effectiveness in helping couples improve their relationships, and follow-up studies show these improvements are long lasting. EFT is one of a handful of couple therapies designated as empirically supported by the American Psychological Association (APA).

6. We (or he or she) need individual therapy first.
A growing body of evidence suggests that successful couple therapy can reduce an individual’s symptoms of depression, anxiety, posttraumatic stress and other psychological disorders. At the very least, a stronger, more supportive relationship will reduce the suffering both partners experience when one is struggling with a psychological disorder. Couple therapy may not be the only treatment needed when a partner has significant psychological symptoms can help partners to join hands in working together on the challenges they are facing individually.

Adapted from Ruth Jampol, PhD, Licensed Psychologist Certified EFT Therapist,
Supervisor-in-Training Board of Directors, Philadelphia Center for EFT

When Cracks Appear – Referring Couples for Relationship TherapyEllie Raymond2023-08-21T15:10:05+10:00

3 Ways To Tell If Your Child Might Have Social Anxiety

Written by By Dr Cate Hearn

Shy or Self-Conscious

Compared to other children their own age, socially anxious children appear shyer and more self-conscious. They may:

Find it hard to talk to other children

Find it hard to make new friends

Feel left out or awkward, or worry they’ll embarrass themselves

Have less well developed social skills than children their own age

Dislike being the centre of attention

Worry a lot about their appearance

Worry that their friends don’t really like them

Be quiet in large social situations

Speak softly to those they don’t know well

Avoidance

Socially anxious children fear and avoid a range of social situations. They may:

Avoid new social situations

Make excuses not to go, by saying, “I’m just a homebody”, “I don’t feel like going”, “I don’t like parties”

Dread sports days or swimming carnivals

Dislike giving orals or talks in class

Be too anxious to raise their hand/answer questions in class

Play alone often

Tummy pains, headaches

Anxiety and worry can manifest in physical symptoms, and socially anxious children may:

Report pains in the stomach, headaches, nausea or sore/aching arms/legs especially before school or social events

Become withdrawn or irritable before social events or before school

Won't they just grow out of it?

Research shows that a great many children with social anxiety do not just ‘grow out’ of it.

Left untreated, social anxiety can persist and cause significant interference in children’s lives. Child friendly cognitive behaviour therapy for social anxiety can help children overcome social anxiety.

At Benchmark Psychology, we have a number of therapists who can provide child friendly therapy to socially anxious children. Ask for Dr Cate Hearn (who’s PhD thesis was in child and adolescent social anxiety), Dr Alison Bocquee, Dr Kylee Forrest, Dr Jasmine Pang or Dr Leona Chun.

3 Ways To Tell If Your Child Might Have Social AnxietyEllie Raymond2023-08-21T15:11:48+10:00

Five Screen-Time Life Hacks

Written By Dr Tania McMahon

It’s 9pm. You’re exhausted. You’ve just finished dinner, maybe putting the kids to bed, tidying up around the house and vaguely thinking about what you have on tomorrow, and you have approximately one hour before you drag yourself, bleary-eyed, into bed to get some sleep and do it all again tomorrow. It’s time for some ‘you’ time! What about checking social media for a few minutes before figuring out what you could do to relax?

It’s 10:15pm, you realise with a start, as you peel your eyes up from Instagram and check the clock. “A few minutes” has turned into over an hour, and any time that could have been spent tinkering on that craft project, strumming on the guitar, or pulling a new book off the shelf has now been sucked up by the black hole of your digital device. While you have a vague sense of being mildly entertained over the past hour, you can’t remember exactly what it was you were looking at, and your brain is in a strange state between buzzing with alertness and feeling strangely fatigued. As you scramble to get ready for bed, you can’t help but notice a strange feeling of discomfort, a low-level frustration that something hasn’t been tended to, or you didn’t finish something; a feeling of being left unsatisfied.

Sound familiar? You’re not alone. Our devices embody an almost perfect solution to temporary boredom: brief, instant entertainment, on demand. Yet when we find ourselves turning to them at every idle moment, day after day, night after night, we start to realise that they are taking us away from all those things we’d “love to be doing more of”, but that take a little more time and effort to get into. And when we do less and less of those activities we value, we fall more and more into the same trap of turning to our digital devices whenever we have a moment of boredom.

So, how do we hack our way out of this digital ditch? Here are five quick tips to get you started:

1. Categorise screen time into ‘work’ and ‘leisure’.

We all know that some screen time is unavoidable – emails, online banking, checking the bus schedule, and so on. However, this ‘necessary’ screen time need not get mixed in with checking social media, playing games, and browsing the web. By mentally categorising each function, app and activity on your device as ‘work’ or ‘leisure’, you can start to build awareness of your use, and then start to make decisions about how much ‘leisure’ time you really want to spend on it.

2. Track your use

Devices have a funny habit of ‘warping’ time while we’re on them, making it seem like only 10 minutes has passed, when it’s actually been much longer than that. It follows, then, that all of us are rather poor judges of how much time we’re spending on them. By downloading an app that tracks your use (popular options include ‘Quality Time’ for Androids and ‘Moment’ for iPhones), you’ll be able to analyse your use over days, weeks and months, as well as look at patterns of use across the different apps on your device. By knowing when, were and how you use your device the most, you’ll be able to set your own personalised goals for what you’d prefer your use to be like.

3. Set regular screen-free times

While everyone’s screen time rules are ultimately going to be different, a good general rule for everyone to apply is to set at least one regular screen-free time. Some choose a screen-free breakfast, so they can connect meaningfully with their family first thing in the morning; some choose the train or bus trip to work, so they can use it as ‘thinking time’; many choose the hour before bed, because of the strong evidence linking screen use before bed to sleep difficulties. The options are numerous!

4. Change your notification settings

Notifications are designed to catch our attention – a red badge here, a blinking light there. The more we see, the more we feel the compulsion to check them, irrelevant of how important or urgent they actually are (and let’s face it, how many times have those notifications been utter time-wasting distractions??). A simple solution to this is to change your Notification settings so that you only receive Push notifications for things you feel are absolutely necessary. Or, be daring and change them all to Manual!

5. Make your leisure screen time as goal-directed as possible

Get into the habit of asking yourself ‘what am I wanting to achieve by looking at my device right now?’ and ‘is this my preferred use of my time right now’? More often than not, you may find that mindlessly scrolling through social media is not your preferred use of your time. Sure, the answers might be ‘I want some quick entertainment’ and ‘yes, as long as I start making dinner in 10 minutes’, but at least it means that you are consciously making that choice, and that you have defined a meaningful limit to your use. That way, if more than 10 minutes go by and you realise you haven’t started making dinner, you know it's no longer a good use of your time.

Dr Tania McMahon is a clinical psychologist with a particular passion for helping people manage their screen usage. Tania often treats internet and gaming addictions at Benchmark Psychology.

Five Screen-Time Life HacksEllie Raymond2023-08-21T15:12:49+10:00

Trauma Informed Care in Primary Health Settings

Dr Jasmine Pang describes the impact early adverse childhood experiences have on individual later-life health and well-being, with advice for general practitioners and health providers in how to provide trauma-informed care.

Primary health settings provide a unique environment for the provision of trauma informed care. Many trauma survivors do not seek mental health services but look for help in primary care settings. Neither patient nor providers may be aware of the link between their current physical complaints and the connection to past trauma. Yet research has clearly shown a wide-ranging impact of Adverse Childhood Experiences (ACE).

The CDC-Kaiser Permanente Adverse Childhood Experiences (ACE) Study is one of the largest investigations of childhood abuse and neglect and the links to later-life health and well-being. ACEs investigated included emotional abuse, physical abuse, sexual abuse, household intimate partner violence, household substance abuse, household mental illness, parental separation or divorce and incarcerated household members.

Results of the study found that almost two thirds of study participants reported at least one ACE, and more than one in five reported three or more ACEs. The study also found a graded dose response relationship between ACEs and negative health and well being outcomes across the life course.

The study showed that as the number of ACEs increases so does the risk for the following-

Depression
Fetal death
Health-related quality of life
Illicit drug use
Ischemic heart disease
Liver disease
Poor work performance
Financial stress
Risk for intimate partner violence
Multiple sexual partners
Sexually transmitted diseases
Smoking
Suicide attempts
Unintended pregnancies
Early initiation of smoking
Early initiation of sexual activity
Adolescent pregnancy
Risk for sexual violence
Poor academic achievement

ACEs continue to have a lifelong impact from conception to death as it disrupts neurodevelopment. This results in social, emotional and cognitive impairment, which causes the adoption of high health risk behaviours leading to disease, disability and social problems.

Role of General Practitioners

Despite the increasing evidence of the lifelong health impact of ACEs, research shows that less than one-third of primary care doctors screen for ACEs on a regular basis [1]. This was often due to a lack of knowledge of the prevalence of ACEs, discomfort with asking screening questions and perceived role. Yet, the primary care physician is uniquely positioned to play a critical role in the identification of ACEs and facilitating appropriate treatment. Interacting with adults, children and their families at regular intervals can allow patients and providers to develop a trusting relationship, which can facilitate the disclosure of ACEs. Contrary to popular belief, research has shown that screening for adversity is acceptable amongst patients. In an adult primary care setting, 79% of patients were comfortable being asked about ACEs and 86% felt comfortable being screened for ACEs[2]. However, patients would only disclose if asked directly in a safe supportive manner. In a study at the Health Appraisal Clinic at Kaiser Permanente of San Diego, there was a 35% decrease in office visits and an 11% decrease in emergency room visits among participants compared to the prior year[3] when they started screening for ACEs. Addressing childhood adversity in medical settings offers clinicians a more complete picture of important social determinants of health and has a great potential to improve health care utilization and encourage help seeking behavior.

What is trauma informed care?

A programme, organization or system that is trauma informed realizes the widespread impact of trauma and understands potential paths for healing; recognizes the signs and symptoms of trauma in staff, clients and others involved with the system; and responds by fully integrating knowledge about trauma into policies, procedures, practices and settings.

What can General Practitioners do?

Learn more about the provision of trauma informed care and about trauma. Understand that “problem behaviours” may be manifestations or symptoms of trauma, or coping skills that served to protect them when surviving their trauma.
Routinely ask patients about trauma history and trauma symptoms. This can be done using formal screening tools (E.g. Primary Care PTSD Screen, Brief Trauma Questionnaire) or by asking if patients had ever experienced one of the 10 ACEs identified in the ACEs study. Find out more about how to do so in a way that patients can feel supported to disclose.
Discuss the impact of identified traumatic events if the patient screens positive. Not everybody who has experienced ACEs have ongoing difficulties. It is important to explore if current functioning has been impacted and the patient continues to experience distress from the traumatic experience
Provide a referral if needed
Follow up with the patient

[1] Weinreb, L., et al (2010) Primary Care Companion Journal of Clinical Psychiatry, Screening of trauma in adult primary care settings, 12(6)

[2] Goldstein, E., Athale, N., Sciolla, A. F., & Catz, S. L. (2017). Patient Preferences for Discussing Childhood Trauma in Primary Care. The Permanente Journal, 21.

[3] Felitti, V. J., & Anda, R. F. (2014). The lifelong effects of adverse childhood experiences. Chadwick’s child maltreatment: sexual abuse and psychological maltreatment, 2, 203-15.

This article was written by Dr Jasmine Pang at Benchmark Psychology. Jasmine has a particular interest in supporting children, adolescents, parents and adults who have experienced traumatic or difficult life circumstances and is passionate about ensuring high quality services be made available to them.

Trauma Informed Care in Primary Health SettingsRebecca Frost2019-04-01T12:56:39+10:00

The myth of watch and wait

Something’s not quite right

James was like any other 9-year-old, but at the first mention of school his whole body would shrink and he would stare at the floor. Even though he had some good friends and wasn’t being bullied, he really didn’t like school. He didn’t have any ‘obvious’ issues, but he just couldn’t seem to keep up with the schoolwork and even started to call himself ‘the dumb kid’.

Chloe needed constant help to do her homework and was embarrassed to read in front of others. She was losing her confidence and every day became a battle to make it through the afternoon. Her parents were worried because they could see that if they didn’t do something she would be left behind, and their cheerful little girl would slowly withdraw away.

Parents are the experts on their children. They know their children better than anyone else, and they know when things aren't quite right.

Ryan has always seemed a little different from his brother. He didn’t play the same games and would spend hours alone, lost in “Ryan’s World”. He seemed to be a bright kid, but he never quite got it when it came to friends. One moment he would be smiling up at his parents and the next he would be on the ground. His parents were lost for how to help him.

The myth of watch and wait

These stories are ones we hear every day. Unfortunately, parents concerned about their child’s development are all too often told to ‘watch and wait’. They’re told that they are just ‘anxious’ parents and that their child’s problems are ‘just a phase’. These messages are not only invalidating for parents – they leave children behind and leave families and educators lost.

The path to helping children develop begins with understanding.

Parents are the experts on their children. They are number one. They know their children better than anyone else, and they know when things aren't quite right. Trusting this intuition as a parent and getting support as soon as possible, can help children reach their potential and be the best they can be before a small problem becomes a big one.

Finding a path for your child

Sometimes parents feel like they’ve tried everything to help their child and nothing seems to make much difference. They feel like they are sailing in the dark – not knowing which direction to turn. The real issue is that often we don’t have a clear understanding of the child’s thinking style or view of the world.

The path to helping children who are experiencing challenges in their social, emotional, behavioural, or academic development begins with understanding. A developmental assessment can provide this key and open up the pathway to change.Assessments for children can include a range of developmental areas. For example, cognitive assessments help parents to understand their child’s way of looking at the world.

Assessments for children can include a range of developmental areas. For example, cognitive assessments help parents to understand their child’s way of looking at the world, and can detect if a child is struggling to keep up, if they need more help, or if they have difficulty with a particular area of learning (such as problems with reading or paying attention). Assessments can also target specific developmental challenges, such as Autism Spectrum Disorders or Asperger’s Syndrome, Attention Deficit Hyperactivity Disorder, and clinical anxiety.

Quality matters

At Benchmark Psychology, we have a team of clinicians experienced in a range of developmental assessments for children and young people. Assessments are conducted directly by registered a clinical psychologist or clinical neuropsychologist with experience in assessments and postgraduate university qualifications.

We only use the gold-standard measures for assessment, such as the Weschler Intelligence Scale for Children (WISC), Weschler Individual Attainment Scale (WIAT), and Autism Diagnostic Observation Schedule (ADOS-2).

Every family is engaged in their child’s assessment process from start to finish. Parents receive a written report, outlining the assessment steps, the findings, and detailed recommendations to help parents decide where to from here. Parents also attend a feedback session with the clinician to go through the report together, discuss the results, and ask any questions.

Benchmark Psychology also offer families full assessment packages at a low cost (compared to other psychological practices in South-East Queensland).

To find out more or book an assessment today, call (07) 3349 5511.

This post was written for us by Dr Grace Sweeney and Dr Richard Wellauer from Benchmark Psychology.

The myth of watch and waitRichard Wellauer2023-08-21T15:15:41+10:00

Pokemon GO might treat depression, but will it make your OCD worse?

Pokemon GO is a mobile game that gets people walking around with their phones in the real world to collect virtual animals, items, and experience points. The app uses your phone’s GPS to work out where you and then allows you to collect different rewards in the game.

Already people are reporting that it’s helped them get out and about and as a consequence they feel more positive and are overcoming mental health issues such as depression. (Check out this article from the ABC for details.)

Although there’s not yet any published scientific evidence that playing Pokemon GO will improve your mental health, the rationale that Pokemon GO will improve mental health disorders like depression is pretty strong. However, there are also risks, and it’s possible that playing a game like this could also worsen some mental health symptoms.

Depression

Depression symptoms include low mood and a reduced level of activity. There is strong research evidence that exercise alone can improve depression symptoms, particularly for mild to moderate depression. Another key intervention is called ‘behavioural activation’ or ‘pleasant event scheduling’, which involves helping people to engage more in activities that they used to find enjoyable. Pokemon GO encourages people to get our more and increase their activity levels, so it’s likely that it would help with symptoms of depression.

Fear of the outdoors (agoraphobia)

Some people feel very anxious being outside or leaving the house, and if these issues significantly interfere with their daily life, they might be struggling with agoraphobia (fear of being outdoors). Cognitive behavioural therapy treatment involves gradually encouraging people to challenge themselves so they become desensitized to the feared situation. Pokemon GO could enhance motivation for people to overcome this fear, so it’s likely to help.

Social phobia

People with social phobia have an overwhelming fear that they’ll make a social faux pas or won’t know what to do or say in a conversation and so avoid social interactions and isolate themselves from others. Pokemon GO could help someone with social phobia to get out more and it also gives people something to talk about with other gamers, but a game like this can encourage people to avoid interacting in social situations and instead to get out their phones. Although the game has social aspects, it doesn’t really encourage people to use or improve their social skills and may not help people feel more confident in real life social situations.

Obsessive compulsive disorder (OCD)

People with obsessive compulsive disorder (OCD) have an overwhelming preoccupation with things being ordered and clean (contamination) or difficulty getting rid of possessions (hoarding). Pokemon GO encourages people to collect and collect and collect so that they can be the best and is likely to involve the same neural reward circuits in the brain that reward people for following their OCD impulses. Pokemon GO could encourage hoarding-type symptoms of OCD and also encourages people to spend more and more time on their phones to the exclusion of other activities.

Problem gambling

People with gambling issues are so focused on the next reward or payoff that they neglect their other responsibilities or values. Pokemon GO encourages people to spend more time chasing after rewards and points and also allows you to spend real money to improve your status. If you’ve got a gambling problem Pokemon GO might be healthier than blowing thousands of dollars on the pokies but isn’t likely to cure your addiction.

Conclusion

Games like Pokemon GO can really help to improve people’s motivation to get out and about but they have a real potential to become addictive and lead to people neglecting other important areas of life. When used carefully they are likely to improve mental health for a substantial number of people, however, you need to be aware of potential negatives. There’s no blanket rule about when things like Pokemon GO should and shouldn’t be used but if people monitor both their game use and their mental health symptoms they can make a decision for themselves about whether or not a strategy like this is helpful or harmful for their situation.