All posts by Mark Wilhelm

National Clean Off Your Desk Day: Exploring the Link Between Clutter, Stress and Productivity

Do you have a desk or dedicated work space at your job, or even in your home office? If you do, take a moment to examine it the next time you’re using it.

What does it look like? Is the surface clean and ready for use, or is it covered in dust and dirt? Is it tidy and well organized, or are there papers, writing utensils and other supplies scattered about haphazardly? Most importantly, when you look at it at the beginning of your day, does it make you feel calm and ready to get to work or stressed and ready to go back to bed?

The second Monday of every January is National Clean Off Your Desk Day, an invitation to begin the new year right by tidying up our work space. This isn’t just for the sake of cleanliness, however. Maintaining an organized desk or work space can help us focus on our work—and it can even have beneficial effects on our mental health and wellness.

In this blog post, we’ll explain how a simple task like cleaning off your desk can have a significantly positive effect on our peace of mind. A neat, clutter-free work space can be beneficial in two main ways: by decreasing stress and increasing productivity.

Clutter, the Enemy of Calm

We often associate stress—in this case, the negative form of stress, which is called “distress”—with high-stakes situations or demands on our attention. Think of an important job interview, a heated argument with a family member, or even a big date with a romantic partner, and you’ll know the discomfort that stress can create.

However, even a chaotic environment can cause us stress if we spend a lot of time in it. For example, one scientific study found that women who described their homes as cluttered also had heightened levels of the stress hormone cortisol. In addition, “Women with higher stressful home scores had increased depressed mood over the course of the day, whereas women with higher restorative home scores had decreased depressed mood over the day,” the authors wrote.

Living in a state of chronic stress is not only unpleasant, but it can also have negative long-term effects on physical and mental health. According to the Mayo Clinic, chronic stress may lead to anxiety, depression, digestive problems, headaches, heart disease, sleeping problems, weight gain, or impairment of memory and concentration.

Finally, a cluttered home environment can even negate the psychological sense of well-being that our home normally provides. “We conceptualize psychological home as a reflection of one’s need to identify self with a physical environment,” wrote the authors of one research study. “Findings reveal that…Clutter had a negative impact on psychological home and subjective well-being.”

This last point is especially relevant for the home offices and work-from-home environments that have become more common since the COVID-19 pandemic began.

How Chaotic Environments Affect Productivity

Working in a messy environment doesn’t just make us more susceptible to stress; it can also affect our ability to concentrate on our work. This can make us less productive than we would otherwise be in a clean, well-organized work space.

Human beings can only pay attention to so many things at once. For example, it’s often said that people can only hold 5–9 items or ideas in our short-term memory. According to the authors of a study on visual working memory, we can typically remember the details of three or four visual objects at a time, but this number decreases when other objects in our visual field distract us.

In short, items in our work space that are unrelated to the work we’re doing can pull our attention away from the things we ought to be focusing on. Some people are naturally good at ignoring these distractions, but other people aren’t quite so good at this. As the authors of the above study write, “Individuals [with high working memory capacity] actively suppress salient distractors, whereas low-capacity individuals are unable to suppress salient distractors in time to prevent those items from capturing attention.”

Whether you have a relatively large or small visual working memory, there’s a simple way to improve your focus: by removing unimportant items from your view. Another study on attention and the visual field found that “attentional modulation was greatest when neural competition was little influenced by bottom-up [stimulus driven] mechanisms.” In other words, it’s easiest to focus our attention on a task when there are fewer objects in our line of sight.

As it turns out, then, there is some truth to the old adage, “Out of sight, out of mind.” Fewer items in our view means fewer distractions and a greater ability to focus on our work.

Tips and Suggestions for Cleaning Off Your Desk

So you’ve decided that your desk or work space could use some tidying up, but what should that look like, exactly? How can you transform something that makes you feel stressed and distracted into something that makes you feel calm and focused?

Here are a few simple steps you can follow to put your work space in order:

  1. Remove everything from your desk or work space. While it’s cleared off, use a rag and cleaning solution to wipe away any dust, dirt and grime. This will ensure that your new work space is not only organized, but also clean!
  2. Take stock of everything that was on your desk. Think carefully about what you actually need on your desktop and what you don’t need.
  3. Replace all items that you truly need on your desktop each day. As you do so, wipe down hard surfaces with your rag and cleaning solution. You should also be sure to organize the items so you’ll know where to find them later. Group similar items into categories such as writing utensils, paper documents, and office supplies, and place them on your desk neatly.
  4. If there are any items that you still need for work but don’t necessarily need on your desktop, file them away in a drawer or other storage area. Again, clean each item before you put it away, and try to store everything in a logical, organized manner.
  5. Throw away any items that you no longer need for your work. If you don’t need them anymore, there’s no sense hanging onto them!
  6. Finally, if you use a computer for your work, take the time to clean off your virtual desktop, as well. Group your application icons neatly, consolidate infrequently used shortcuts into folders, and delete any shortcuts that you no longer need.

Any environment that we spend considerable time in can have an effect on our mental health, and our work environment is one that many people encounter frequently! Cleaning off your work space is a small thing anyone can do to decrease the amount of stress and distraction they experience in their work environment. We encourage you to start your year off right by tidying up your work space and seeing if you notice a difference in your peace of mind. You might be surprised!

Looking for more tips to help you manage and bolster your mental wellness? You might enjoy our blog posts on “flow” and WRAP below!

Explaining Flow: How “Getting in the Zone” Can Help with Mental Wellness
The Wellness Recovery Action Plan: Creating an Instruction Manual for Your Mental Health

Electronic Health Records: What Consumers Should Know about Cummins’ New System

Have you ever given much thought to your personal health records?

If you’re like most people, then this isn’t a subject that comes up often in your day-to-day life. However, the detailed records kept by your various health care providers play a vital role in your overall well-being. These records help providers track the progress of your health and any treatments you’ve received, which keeps everyone up to date so they can provide you with the best possible care.

These records have traditionally been kept in the form of paper documents and patient charts, but this is beginning to change as computer technologies become ever more pervasive. Many health care providers are now using digital versions of patient forms, known as electronic health records, or EHRs, to do everything from document consent to treat to return lab results and store medical information.

Here at Cummins, we have recently adopted an EHR system in order to better serve our consumers. However, this new system brings a few important changes to the way our consumers can engage with their care. In this blog post, we explain how EHRs enable better person-centered care for consumers and what changes you should expect as a result of our new system!

The Ins and Outs of EHR

As we mentioned above, an electronic health record is essentially a digital or electronic version of the paper charts in your health care provider’s office. You can think of it like a virtual filing cabinet, not unlike the “files” stored on a computer. The information in an EHR can be stored and accessed using specifically-designed software applications.

HealthIT.gov explains, “EHRs are real-time, patient-centered records that make information available instantly and securely to authorized users. While an EHR does contain the medical and treatment histories of patients, an EHR system is built to go beyond standard clinical data collected in a provider’s office and can be inclusive of a broader view of a patient’s care.”

For example, an EHR may include the following information about a patient:

  • Medical history
  • Diagnoses
  • Prescribed medications
  • Current treatment plans
  • Immunization records
  • Allergies
  • Radiology images
  • Lab and test results

EHR software can automate and streamline the data information and retrieval that care providers must perform, and most importantly, allow them to easily share this information with providers at other health care organizations. HealthIT.gov continues, “EHRs are built to share information with other health care providers and organizations—such as laboratories, specialists, medical imaging facilities, pharmacies, emergency facilities, and school and workplace clinics—so they contain information from all clinicians involved in a patient’s care.”

How EHRs Benefit Health Care Consumers

The features and functionality of an EHR can improve a consumer’s care experience in several important ways.

First, EHRs can improve quality of care by helping providers adhere to evidence-based guidelines for treatment. One 2011 review of EHR systems states, “EHRs, especially those with clinical decision support tools, have been empirically linked to an increased adherence to evidence-based clinical guidelines and effective care. Despite the best intention of providers, various factors may result in patient encounters that do not adhere to best practice guidelines. Some reasons for this nonadherence include i) clinicians not knowing the guidelines, ii) clinicians not realizing that a guideline applies to a given patient, and iii) lack of time during the patient visit.”

Second, the digital nature of EHRs makes it easier for health care providers to share forms and information with each other. For example, this means that your therapist can share updates on your treatment and any new medications you may be taking with your primary care physician and any other clinicians you see. According to the U.S. Department of Health & Human Services, “When doctors, pharmacies, labs, and other members of your health care team are able to share information, you may no longer have to fill out all the same forms over and over again, wait for paper records to be passed from one doctor to the other, or carry those records yourself.”

Finally, EHRs give consumers an opportunity to take increased ownership over their care. Most EHRs include a “patient portal” through which consumers may access their care records, receive test results, review their treatment plan, and communicate with their care team. These features give consumers more ways to take control of their care, which can help to ensure that it is truly centered on the individual.

“EHRs and other health IT developments tend to make many patients more active participants in their own health care,” HealthIT.gov concludes.

Getting Started with Cummins’ New EHR System

Using Cummins’ new EHR will require you to familiarize yourself with the Patient Portal. The EHR system we use is called Streamline, and you’ll need to create a patient account on Streamline in order to begin using the portal. You can follow the steps below to get started.

Logging into Your Patient Portal

To access the Patient Portal, you’ll need to use the Google Chrome web browser on your mobile phone, tablet or PC. If you don’t have Google Chrome, you can download the browser by visiting https://www.google.com/chrome/ and clicking the “Download Chrome” button.

From the Google Chrome browser, you can either:

  1. Navigate to https://www.cumminsbhs.org/ and click the MyLink icon in the top right corner of the screen if you are on desktop, or find it in the menu sidebar if you are using a mobile device
  2. Navigate directly to https://cbhsc.smartcarenet.com/CBHSmartcareProd/Login.aspx
MyLink location on the desktop site
Location of menu sidebar on the mobile site
MyLink location within the menu sidebar

Updating Your Password and Security Questions

The first time you log into the Patient Portal, you’ll need to reset your password and choose your security questions. At the login screen, enter the username and password you were given by your care provider.

If you’ve forgotten your username and password, please make sure you have your personal information and identification number available, and then call our Centralized Access Department at (888) 714-1927. At the automated menu, press 5 to speak with other departments, then press 2 for Business Records & Health Information System.

After entering your username and password, click the Login button. You will see this message:

streamline-password-expired

Click the OK button, and then you will see the following form:

streamline-change-password

Enter the password you were given in the “Old Password” field, and then enter a new password of your choice in the “New Password” and “Confirm Password” fields. Then click the OK button.

This will return you to the login screen with your username and new password pre-filled in the fields:

If for some reason your username and new password are not pre-filled, simply enter them in the fields. Then click the Login button.

You will then be presented with a form that asks you to select and answer three security questions:

streamline-security-questions

Click the Save button when you’re finished, and you’ll be redirected to the Patient Portal homepage, which looks like this:

streamline-portal-home

Changing Your Preferences

Once inside the Patient Portal, you can change your password, security questions, and contact preferences at any time. To do so, click the “My Office” tab at the top left of the screen, select “My Work” from the left-hand menu, and then select “My Preferences.”

streamline-preferences-location

You will be directed to the following screen:

streamline-preferences-home

After making any desired changes, click the green Save button in the top right corner.

Completing Registration Documents

Finally, new Cummins consumers will need to complete several forms inside the Patient Portal before their first appointment.

Adult consumers will need to complete the following forms:

  • Consent for treatment
  • Consent for virtual services
  • Physical health screening
  • PHQ-9
  • GAD-7

Child consumers (ages 5–11) will need to have the following forms completed by their parent or legal guardian:

  • Consent for treatment
  • Consent for virtual services
  • Physical health screening
  • Youth – CRAFFT
  • Parent Vanderbilt
  • Youth Symptom Checklist

Adolescent consumers (ages 12–17) will need their parent or legal guardian to complete the following forms:

  • Consent for treatment
  • Consent for virtual services
  • Physical health screening
  • Youth – CRAFFT
  • Parent Vanderbilt

In addition, adolescent consumers will also need to complete these forms by themselves:

  • PHQ-A
  • GAD-7

All of these forms can be found on the Patient Portal homepage. Make sure you’ve selected the tab with your name at the top left of the screen, then examine the left-hand menu and click on the form you’d like to fill out.

streamline-portal-forms-list

Electronic health records, like any new technology, can take some getting used to for both providers and consumers of behavioral health care. However, they’ve been shown to significantly improve quality of care, and they empower consumers to take greater control over their own health care!

We’re very excited to be using Streamline EHR to improve the services we provide here at Cummins Behavioral Health! If you have any questions about the new system, feel free to contact our Centralized Access Department at (888) 714-1927.

Tips for Nutrition and Healthy Eating During the Holiday Season

The end-of-year holidays have arrived, and for many people, the holiday season is closely connected to food.

Those of us who celebrate Christmas typically bake cookies, pies, and other sweets and cook traditional Christmas dinners featuring an abundance of hearty dishes. Celebrants of Hanukkah eat a variety of fried dough or fried potato treats like sufganiyot, latkes, and fritas de prasa, and they might also prepare feasts with roast goose. And although New Year’s Eve is often associated with alcoholic beverages, some Americans choose to celebrate the New Year by eating pork, cabbage, black-eyed peas, and lentil soup.

With all this food around, many people worry about gaining weight due to holiday-related eating. However, the effect of the food we eat goes beyond our waistline. As we’ve previously discussed on our blog, nutrition can also have a significant impact on our mental health. This is because the same nutrients that change our bodily functioning also affect the chemical processes in our brains, which can lead to changes in cognition and emotion.

Just as a little overindulgence won’t hurt our bodies in the long run, neither will it severely impact our mental health—but a consistently poor diet over a long period of time can be quite damaging to our physical and mental health. That’s why it’s important to be mindful of what and how much we eat, especially when we’re tempted by an abundance of delectable dishes.

In this blog post, we highlight several nutritional facts you should keep in mind to practice healthy eating throughout the holiday season!

Binge Eating and Mood Disorders

It’s very easy to overeat during the holidays, and many people end up consuming more calories than normal. Eating large amounts of food in a short period of time is known as “binge eating,” which isn’t particularly dangerous to our health if we only do it once in a while.

However, some people may feel the urge to binge eat more frequently, as often as one or more times each week. When this is the case, they may suffer from binge eating disorder, which the Mayo Clinic defines as “a serious eating disorder in which you frequently consume unusually large amounts of food and feel unable to stop eating.” People with binge eating disorder may feel that they can’t control how much they eat, and they may feel shame or disgust with themselves after binging.

It’s not surprising, then, that binge eating disorder tends to co-occur with mood and anxiety disorders. A person who has binge eating disorder may eat in order to improve their mood, but the resulting guilt about their actions may end up worsening their mood instead. Even people who experience depression alone may feel negatively about themselves after a period of binge eating, even if they only overeat a single time.

For these reasons, people who suffer from binge eating disorder or a mood or anxiety disorder should be cautious about overeating during the holidays.

Fatty Foods and Brain Health

For many years, nutritionists and dietitians have been sounding the alarm about high-fat diets and their harm on the human body. Most notably, diets that are high in cholesterol, saturated fats and trans fats are heavily associated with heart disease, which is the leading cause of death for both men and women in the U.S. These same “bad” fats can also cause irregularities in our brains.

The brain, like the rest of the body, actually needs a certain amount of dietary fats for healthy functioning. Medical writer Dr. Maria Cohut notes, “The brains of mammals, including humans, actually need certain fatty acids—such as omega-3—to function correctly. Humans bodies, in particular, cannot synthesize fatty acids on their own, and so they need to absorb these nutrients from food. However, not all fatty acids are as healthful, and the overaccumulation of fatty acids in the body can lead to health problems.”

For example, some research has linked fatty acid buildup in the brains of laboratory mice with symptoms of depression. “It seems the high levels of palmitic acid in the hypothalamus alter a signaling pathway that researchers associate with traits of depression,” Cohut writes. “Thus, in mice at least, the researchers were able to confirm that the absorption of certain dietary fats has a direct impact on brain-signaling pathways that influence the development of depression.”

Other research has shown that high-fat diets can cause inflammation in the hypothalamus, which may send signals that cause us to eat more and gain weight. All of which is to say that we should limit our consumption of highly fatty foods like red meat, processed meat, butter, palm oil, pastries, and full-fat dairy products.

Sugar, Cognition, and Cravings

Sugar, like fat, is an essential part of any diet. In fact, it’s an especially important nutrient for our brains. “The brain uses more energy than any other organ in the human body and glucose is its primary source of fuel,” writes Dr. Joel Fuhrman. But like many other dietary nutrients, too much sugar can be a bad thing for both our bodies and our minds.

Once again, higher levels of sugar consumption have been scientifically linked to higher instances of depression among the general population. And among people who have type 2 diabetes, elevated blood sugar levels have also been associated with feelings of both sadness and anxiety.

In addition, excessive amounts of sugar can have negative effects on our cognitive functioning. For example, studies have found that some diabetics suffer from  decreased cognitive performance that may worsen over time, leading to deficits in learning, memory, and motor speed. Fuhrman adds, “Even in those without diabetes, higher sugar consumption is associated with lower scores on tests of cognitive function. These effects are thought to be due to a combination of hyperglycemia, hypertension, insulin resistance, and elevated cholesterol.”

Finally, research suggests that sugar may activate the brain’s reward center in much the same way as alcohol and other addictive substances, which means that eating large amounts of sugar might make it harder to resist the craving for more. This is all the more reason to eat fewer sugary treats than we might like to this holiday season.

It’s hard to avoid a bit of unhealthy eating during the holidays, but we should always try to keep our health in mind as we celebrate! We encourage you to limit your dietary fats and sugars, avoid excessive overeating, and adhere to your regular diet as much as possible to help manage your mental health and wellness this holiday season.

On behalf of all of us at Cummins Behavioral Health, we wish you a very happy holiday season and a prosperous New Year!

Crisis De-Escalation: Tips and Advice for Defusing Difficult Situations

Think back to the last time you witnessed another person become very upset or agitated. What caused them to feel this way, and what did they do in response? Did you or another person attempt to calm them down? What did you try, and how effective was it? Was the situation defused successfully, or did it escalate?

When someone is extremely annoyed, angry or afraid, they may react with hostility toward the person or situation that caused these feelings. This can often lead to conflict between two or more people, which might include verbal argument or even physical violence. In some situations, the person may enter a state of crisis, which Merriam-Webster dictionary describes as a [sudden and violent] attack of pain, distress, or disordered function.”

A person who is in crisis may be especially dangerous during a conflict. Because they are highly agitated, they may act on their emotions without stopping to consider the consequences, which could bring harm to themselves or others. Knowing how to effectively calm a person in crisis— known as crisis de-escalation or intervention—is a highly valuable skill in these situations.

However, de-escalation can be a complicated task. The intervening person must be able to assess the situation and react in a way that will disarm it rather than inflame it. They must understand what has upset the person in crisis and know which words and actions have the best chance of calming them down.

To learn more about crisis de-escalation, we spoke with Carmen Bergman, MSW, LSW, a school-based therapist in Fort Wayne, IN. Bergman is a Master-level instructor of Nonviolent Crisis Intervention, a popular de-escalation model taught by the Crisis Prevention Institute. As an experienced trainer in the CPI model, Bergman explained how someone can identify when a crisis is developing, what they can do to defuse that crisis, and how they can stay calm and focused during the difficult work of de-escalation.

Spotting the Signs of Crisis

Carmen Bergman, MSW, LSW
Carmen Bergman, MSW, LSW, school-based therapist and Master-level instructor of CPI crisis de-escalation

To begin, it’s important to note that the goal of de-escalation is to defuse crises before they reach the point of physical aggression or violence. “When you talk about nonviolent crisis intervention, some people immediately think of holding skills and how to protect yourself from physical attacks. But that’s only a small chunk of it,” Bergman explains. “All the rest is about preventing escalation to the point where it becomes physical.”

Under the Nonviolent Crisis Intervention model, also known as the CPI model or simply CPI, the person doing de-escalation must think about the safety and well-being of everyone involved in a crisis situation. Bergman says, “The main philosophy is care, welfare, safety and security for all. It’s not just for the person who’s in crisis and the person handling the crisis; it’s also for any people who are witnessing the event.”

The first element of successful de-escalation is early identification that a crisis may be developing. Many factors go into this process, but it largely involves being aware of the person’s behavior and the larger situation at hand. Bergman explains some of the things she considers when looking for signs of crisis: “I’m assessing what’s in the room and who is in the room. I’m assessing nonverbal communication, because it’s not what someone says, but how they say it. I’m looking at facial expressions, I’m looking at body language, I’m looking at the spatial piece, like how close they are to me and how close I am to the exit. I’m also looking at how they’re speaking—their tone, their volume, and their cadence.”

Once we’ve assessed the potential for crisis—or how far the crisis has already progressed—we can begin to determine the appropriate response. Bergman illustrates what this might look like:

“As I’m collecting all this information, I use what’s called the ‘decision-making matrix’ to assess the situation. Whether it’s somebody I’ve worked with before or somebody I’ve never worked with before, I take all the information that’s coming in and continually use the decision-making matrix to assess: Do I just need verbal de-escalation? Or do I need to use disengagement skills, like protecting myself if somebody tries to hit or kick me, or if they’re grabbing at me? Or is it to the point where there’s immediate risk of harm to myself or others? Do I need to use a holding skill?”

Strategies for Verbal De-Escalation

Whenever possible, de-escalation should begin with a conversation between the person in crisis and the person attempting to intervene—otherwise known as verbal de-escalation. As always, the goal is to defuse the situation by making the agitated person feel heard, understood and respected.

The way we speak to a person during de-escalating is just as important as the words we say to them. “When I teach de-escalation, I talk about paraverbal and nonverbal communication. Paraverbal communication is the tone, the volume and the cadence,” Bergman explains. “For example, I immediately ask everybody, ‘Who speaks sarcasm as a second language?’ Because if you approach someone with sarcastic, dry humor to try to lighten the mood, it’s going to make it worse. Put the sarcasm away and just use very natural, even-keeled, even-toned patterns of communication.”

The volume of our speech is also important in these situations, and we can even use it to help lower the level of tension. Bergman says, “Sometimes if somebody is screaming and yelling, I’ll bring my volume down a notch, and sometimes they’ll match me. And I’ll bring it down a bit more, and they’ll match me again until we’re having a nice, even, calm conversation.”

Other strategies for verbal de-escalation include: lowering yourself to the other person’s eye level if you are taller than them, which can make you appear less threatening; persuading them to sit down with you, which can help them feel more calm; and standing beside them rather than across from them, which can make the conversation feel less confrontational.

It’s also important to remember that the individual in crisis may respond negatively to your de-escalation attempts, so you should try not to take any insults or aggression personally. Bergman explains,

“We talk about rationally detaching and not taking it personally. You know, it’s not about you. Sometimes we can get very egocentric, like, ‘If you don’t respect me, I don’t have to respect you.’ That’s kind of like two fools arguing; nobody wins in that situation. There have been times when I’ve taken it personally, and I needed to step back and take a breath. It’s not about me, but it became about me when I let that power struggle happen. If I’m met with rudeness and disrespect, I’m going to still respect the other person as a human being, because that’s who I am, and that’s my character.”

Staying Centered During De-Escalation

Unfortunately, crisis de-escalation can be very stressful work. It can be difficult to deal with aggression and negativity without reflecting it back to the person in crisis. Therefore, we need to know how to manage our own emotions and mental well-being in order to stay focused and effective during de-escalation.

Self-awareness is the first component of this. In order to regulate our emotions, we need to monitor how we feel and understand what things are likely to upset us. Bergman says, “What makes you anxious? What are the things that make you fearful? What are you worried about?” Once we know the answers to these questions, we’ll be better prepared to handle upsetting words and actions without becoming agitated.

Self-care is another vital part of maintaining resilience. Dealing with other people’s crises is mentally and emotionally taxing, which is why we must find ways to replenish that spent energy. Bergman refers to this as “refilling your Care Cup”: “We’re absorbing so much negative energy that we need to do something positive to fill up our Care Cup. We’re pouring so much out that if we don’t fill it up again, we’re not going to be useful anymore.” Normal wellness behaviors like getting plenty of sleep, eating a health diet, exercising regularly and practicing mindfulness can help with this.

Bergman points out that de-escalating with a team can be an excellent option if others are available to help. In these situations, one person can lead the de-escalation while the others provide support as needed. “When you respond as a team, sometimes the leader is the first person who arrives, sometimes it’s the person who has the best rapport with the individual, and sometimes it’s just the person who is most competent and confident,” Bergman says.

Finally, sometimes the best we can do just isn’t good enough. When this happens, it’s best to cut our losses and let someone else take over, if possible. “When I teach, I talk about ‘tap outs,’ “ Bergman explains. “If somebody is starting to add fuel to the fire—if you’re trying to de-escalate, but the person is mad at you—have somebody else step in. It’s not that you aren’t doing your job well enough. It has nothing to do with you. It’s just what’s best for that person at that moment.”

Conflict and crisis can be frightening and stressful when they occur. A person who is experiencing an emotional crisis may pose a danger to themselves and others, which is why proper de-escalation is so important.

We encourage you to use the information and strategies in this blog when attempting to de-escalate someone who is in crisis. However, you shouldn’t hesitate to seek out professional assistance when necessary. If you ever feel overwhelmed or afraid for your safety while attempting de-escalation,  get help from someone with more training and experience handling difficult situations!

With the right help, crises can be de-escalated and individuals who experience them can get the behavioral health care they deserve!

For advice on handling other types of difficult situations, we recommend reading our blog posts on Conscious Discipline and domestic violence intervention below!

Conscious Discipline: A Constructive Approach to Behavior Modification for Children
Domestic Violence Intervention: How Rehabilitating Abusers Helps Victims

The Wellness Recovery Action Plan: Creating an Instruction Manual for Your Mental Health

Imagine you wake up one day and discover that you feel a bit “off.” Maybe you’re more irritable than usual, or maybe you just feel unmotivated. Maybe you find yourself straying from your normal morning routine. You can tell that something is different, but you can’t quite put your finger on it, so you try to go about your day as normal.

Later that day, something happens that upsets you. Perhaps someone makes a rude comment toward you, or perhaps you receive a piece of troubling news. This only worsens your mood, and you’re unable to stop thinking about the upsetting event as the day progresses. You keep revisiting it in your mind, but you don’t know what to do to make yourself feel better, so you simply try to ignore these thoughts as much as possible and make it through the rest of the day.

You succeed, but you don’t feel any better the next day. Or the day after that. Or next week. In fact, you seem to be getting worse. Little things that bother you keep happening each day, and your mood just won’t improve. You feel like there’s a dark cloud hanging over you everywhere you go. You’ve lost all interest in things you used to enjoy, and you realize that if something doesn’t change soon, your mental health is going to be in a very bad place. But no matter how hard you try, you can’t figure out what you need to do to start feeling better again.

At times like these, you might wish you had an instruction manual to tell you what’s wrong with your mental health and how you can fix it. The bad news is that no such manual exists—but the good news is that it’s possible to create one. It’s called a Wellness Recovery Action Plan (or WRAP), and it’s a tool you can use to track your mental wellness, identify sources of stress, and regain control when your health takes a turn for the worse.

In this blog post, Cummins’ Carman Allen, a Certified Recovery Specialist and Recovery Coach, walks us through the ins and outs of WRAP and how anyone can use it to create a personal instruction manual for their mental health.

Getting a Handle on WRAP

Carman Allen, Certified Recovery Coach at Cummins Behavioral Health
"WRAP is for individuals who are trying to identify their own process for recovery. It's a way to give them some tools," says Carman Allen, Certified Recovery Specialist at Cummins Behavioral Health.

The Wellness Recovery Action Plan was first developed in 1997 by a group of people who were searching for ways to overcome their own mental health challenges. The most prominent of these individuals was Mary Ellen Copeland, PhD, who remains the public face of WRAP today.

At its core, WRAP is a self-determined, evidence-based tool that a person can use to get well and stay well. The key to WRAP lies in self-observation, self-awareness, and thoughtful planning. As we said above, you can think of it as an instruction manual for your mental health that tells you what to do to stay well and how to start feeling better if you become unwell. “WRAP covers a vast amount of techniques people can use to be able to help themselves,” explains Cummins’ Carman Allen.

A WRAP (sometimes called a WRAP plan) consists of seven major elements:

  1. Wellness toolbox: These are activities you do in your life that help you feel well. They might include a wide variety of activities that are beneficial for your mental health, such as getting plenty of sleep every night, eating a healthy diet, exercising, talking with friends or family members, journaling, practicing relaxation techniques, practicing gratitude, receiving counseling, reading a book, enjoying nature, and so on.
  2. Daily plan, or what you’re like when you’re well: This is the routine you should follow every day to help yourself stay well. You can also look at this section as a description of what you do and how you feel on a day-to-day basis when you are mentally well.
  3. Stressors (also called triggers): These are external events and situations that might make you feel uncomfortable if they happen to you. Although it’s normal to be upset by these things, they can be detrimental to our wellness if we don’t have some method of dealing with them. A few common examples might include having someone argue with you or receiving bad news.
  4. Early warning signs: These are internal, subtle indications that you are beginning to feel worse. For example, you might feel more irritable then normal, sadder than normal, or you might find yourself replaying an upsetting event in your mind.
  5. When things are breaking down: These signs occur when you are feeling much worse than normal and are nearing a state of mental and emotional crisis. Some examples include feeling sad or angry all the time, problems at work or in school, problems in your relationships, or even hallucinations.
  6. Crisis plan: If your mental health deteriorates to the point that you are in crisis, you may not be able to make good decisions for yourself during that time. Your crisis plan identifies who should make important decisions for you and gives instructions about the types of assistance you do and do not want. Some of the details included in a crisis plan are: who should and should not assist with your care, which medications and treatments are preferred and which are not acceptable, what you do and do not want from your supporters during a crisis, and how they will know when you’re able to take care of yourself again.
  7. Post-crisis plan: This section lays out tasks and timelines for healing and returning to everyday life after a mental health crisis. This plan can be started prior to a crisis, but it will likely need to be completed or adjusted as you are beginning to recover from the crisis, as you should then have a clearer picture of what you need to do for yourself to get well.

How to Assemble Your Own WRAP

The nice thing about WRAP is that it isn’t too difficult to begin putting together a plan of your own. The WRAP website provides a variety of tools and resources you can use to start creating your own WRAP, including several reasonably-priced textbooks and workbooks. However, it’s also common to work with a behavioral health professional as you put your plan together. “Some people have the support of a therapist, or they can use it with a peer recovery specialist,” Carman says.

Although your WRAP should follow the basic structure laid out above, the details of each section should fit your personality and specific life circumstances. “What I love about the WRAP plan is that you, the person, the individual, get to identify what needs to go in it,” Carman explains. Even when she’s assisting a client with creating their WRAP, she is careful to act only as a guide and sounding board, ultimately leaving the final decisions to them. “I’m just there to help that person navigate the plan and identify their wellness tools, and that’s empowering,” she says.

When working on your WRAP, it’s important to remember that nothing is set in stone. In fact, you should expect the information in your plan to change as your life circumstances change. According to Carman, this is a normal part of keeping your WRAP up to date:

“Let me make this clear: this is a living, breathing document. Personally, I have a WRAP plan. I started my WRAP plan several years ago when I first got into mental health services myself. And since then, I have readdressed it over the years as I’ve gotten a job, as I’ve gotten better, as I’ve gotten married—every change in my life. Because those sections—triggers, early warning signs, when things are breaking down—all of those things are constantly changing. So I’m constantly reinventing it to meet where my needs are at that time. Where your plan starts off today, more than likely it will not stay there, because you’re going to hopefully get better, and you may find out, ‘Hey, this isn’t triggering me anymore,” or, “Things are getting better, so that’s absolutely not an early warning sign for me now.’ It will continue to take a life of its own.”

Tips for Living by Your WRAP

Let’s say you’ve reviewed a number of WRAP resources, you’ve done some brainstorming or spoken with a behavioral health professional, and you’ve put together your own plan. What happens next? How can you apply this personal instruction manual you’ve created to monitor and manage your mental health?

According to Carman, it all begins with understanding what you’re like when you’re well. “I have a mental illness,” she explains. “I understand this from many standpoints. My personal perspective is this: How do I know when I’m symptomatic? I know because I have identified what I’m like when I’m well. That is the first and most important part.”

Carman continues,

“For me, one of my big things when I’m well is I love to get up, open my curtains, do my daily meditations, all that kind of stuff. Suppose I don’t do that for two or three days. That’s not a big issue; maybe I just don’t feel like it. If I’m looking at seven to ten days that I haven’t done it, I understand that something else is going on here. I’ve created my own gauge. And it’s not an open-ended thing, like, ‘Oh, it’s OK, it’ll be alright next week.’ I know I have a time frame. As another example, some people with depression may understand that, ‘If I lay around for two or three days, or four days, or even a week, that’s not the worst it’s been for me. Now, if I’m going into two weeks, now I need to do something different.’ So, the basis is to first identify what you’re like when you’re well, and then you figure out, what do I do for myself when I’m well? And that’s not necessarily every day, but it’s more days than not.”

The challenge with mental wellness is that even when we’re doing all the things we should to stay well, we can still take a turn for the worse. When this happens, we need to be extra vigilant about stressors/triggers. Carman says, “In the course of those days that I’m not feeling my best, I’m also trying to be aware of what triggers can create another barrier. Suppose I’m feeling depressed, I haven’t gotten up, and now I have some bad news. Now I have a compound issue.”

The most important thing to remember about stressors/triggers is that sometimes they can’t be avoided. In these situations, we need to be able to deal with them in a way that minimizes risk for our mental health. As Carman points out, your WRAP can also help you with this:

“What have I put in place for that trigger, and what can I do now that the trigger is here? Because the fact is that triggers are going to happen, and we don’t have to stop our lives because they happen. What I do is I go back and I figure out, ‘OK, when this happens, this is what I said I’m going to do.’ Because the WRAP plan is set up in this way: not only do you identify the trigger, you identify your action plan for the trigger. So it’s not just, ‘That’s my trigger, I don’t know what to do about it.’ That would not be very helpful. Once you identify those triggers as much as you can—and you’ll continue to do that, because as I said, this is a living, breathing document—’OK, this is what triggered me.’ Maybe anxiety, maybe fear. ‘OK, what am I fearful of?’ I’m going to ask the questions, I’m going to talk to somebody. And so now I’m pulling in my responsibility, what I’m accountable for. Because people can’t help you if they don’t know.”

WRAP is an easy-to-assemble, highly flexible, effective tool for managing your mental health on a day-to-day basis. As Carman Allen says, “The purpose of the WRAP plan is to help people identify how to get through mental health challenges. Because you talk to people all the time, and you say, ‘How did you get through that?’ And they say, ‘I don’t know, I just did it.’ The fact is, I need to know how I got through it, because more likely than not, I’m going to need to get through something else at another time. And the quicker I can pull that to my remembrance and start practicing that, the quicker I can get through it and get back to feeling better.”

We would highly encourage all our readers to take the time to put together a WRAP for use in their own lives. If you’d like assistance from a behavioral health professional, please give us a call at (888) 714-1927 to see if services at Cummins Behavioral Health might be right for you!

If you liked this article about the Wellness Recovery Action Plan, then you might also enjoy our blog on the Stages of Change model and how you can use it to make meaningful changes in your life!

time-for-a-change-3842467_640
How to Change Your Life Using the Stages of Change Model, with Cummins Therapist David Bonney

Domestic Violence Intervention: How Rehabilitating Abusers Helps Victims

Domestic violence, also known as family violence or intimate partner violence, affects millions of individuals in the U.S. every year. The National Domestic Violence Hotline reports that 12 million women and men are the victims of sexual assault, physical violence or stalking by an intimate partner each year. In addition, 678,000 U.S. children were the victims of child abuse or neglect in 2018, according to the federal government’s 2018 Child Maltreatment Report.

One of the primary ways abusive behavior gets countered is through preventative action like education and advocacy. Government agencies, mental health care providers, and anti-abuse organizations spend much time and money working to stop domestic violence before it happens. But the fact remains that it still does happen millions of times a year, and for each person who suffers abuse, there is another person who has perpetrated it. What happens to the abuser after abuse has already occurred?

A domestic violence intervention program, also called a batterers intervention program (or BIP), is a learning curriculum aimed at rehabilitating individuals who have committed domestic violence. These programs challenge all types of abusive behavior and attempt to show participants that they alone are responsible and accountable for their harmful actions. Ultimately, intervention programs seek to protect potential victims by ending the cycle of abuse before it can start again.

Abuse Awareness and Accountability (or AAandA) is one such BIP that Cummins partners with in Montgomery County. To learn more about domestic violence intervention and why it matters, we spoke with Adam Myszak from AAandA and Mindy Frazee from our Crawfordsville outpatient office. Together, they explained how domestic violence intervention fills the gaps that prevention alone misses.

An Introduction to Domestic Violence Intervention

"Like most other things, not talking about abuse or violence does not make it go away," says Mindy Frazee, LMHCA, one of our outpatient therapists who collaborates with AAandA.

When we think about behaviors that constitute domestic violence, we often think of things like physical and sexual assault. However, domestic violence encompasses any and all behaviors that achieve control over another person through abusive methods. Besides physical and sexual abuse, a person may also commit verbal abuse, emotional abuse, mental abuse, spiritual abuse, or economic abuse.

Batterers intervention programs aim to root out and confront all forms of abuse. These programs teach offenders responsibility and accountability for their actions, emphasizing that their behavior was wrong and must change in the future. In Indiana, BIPs must be certified by the Indiana Coalition Against Domestic Violence (ICADV) and must consist of at least 26 weekly sessions lasting 90 minutes or longer.

According to Mindy, this intervention is intended to help both perpetrators and victims of domestic violence. She says, “While I can understand how it may be difficult to discuss offering an individual treatment based on some of their behaviors, I think it’s important to zoom out of the topic and think about how treatment and support can impact not only the individual coming in for treatment, but also those around the individual. For example, their children, partners, friends, colleagues, and community members. Each of us touches many lives, and by offering an individual support on breaking abusive or unhealthy patterns, we can see how systems can also be impacted.”

Adam agrees. “It’s important to get these individuals the tools and education to change their patterns of abusive behavior,” he says. Without intervention, perpetrators will continue to use power and control and abuse their victims. We all agree that intervention is second to prevention, but if we can help stop the violence at any level, then we can help put victims’ safety first.”

Intervention in Action

A typical BIP class, such as those offered by Abuse Awareness and Accountability, consists of a lesson and group discussion facilitated by an instructor. The primary goal is to help participants identify abusive behaviors so they can begin to reinterpret their own actions in an objective light.

“For the most part, our clients do not see themselves as perpetrators and believe their actions were in the right,” Adam explains. “They have learned to blame the victim, and in that feel no guilt. They feel justified and have excuses, and they minimize their abuse because of this thinking error.” 

According to Mindy, this cognitive error may be caused by numerous factors in a person’s life: “There are often patterns in behavior that either come from early childhood or from things picked up along the way in one’s life. It can also be from lack of needs being met (i.e. their own emotional deprivation, lack of financial resources, lack of proper nutrition). Over time the client, with the support of their treatment team, can recognize their abusive patterns and begin to challenge them and replace them with healthy responses.

These behavioral patterns are often so deep-rooted that they do not change easily. As Adam mentioned, most people who have abused do not even believe that they need to change. “There is no excuse for abusing anyone, and that is why the Stages of Change start with pre-contemplation,” he says. “The critical thinking error that is present in these cases needs to be brought to the surface and held accountable. In order to intervene and make changes to behavior that has hurt and destroyed others, the client is challenged to first accept the behavior as abuse and then work though how to handle things without using power and control.”

As a person progresses through the program and starts to come to terms with their past behavior, they can benefit from additional support in the form of individual therapy or counseling outside of BIP classes. Mindy provides services of this type for some clients of AAandA. If they are in classes with Adam, then I like to explore what class was about that week and support them in processing their experience and how it applies to them on an individual level. And whether they’re in the class or not, I often support clients on improving communication, disrupting old patterns of thinking and acting, boundary setting, and emotion regulation,” she explains.

The Gift of a Second Chance

As we have said, the primary duty of any domestic violence intervention program is to protect victims of violence. If a person who has committed abuse can be persuaded to change their behavior, then other people will be protected from future instances of abuse. However, these programs also offer abusers a chance to change for the better.

Again, the most challenging part of rehabilitation is convincing the person that they have a problem. The group framework of a BIP class helps with this. “Working through the learned and chosen abusive behavior in a group setting allows for clients to let down their wall of resistance and let in that idea: ‘Do I have a problem, or am I abusive?’ ” Adam says.Once the client can take accountability without any minimizing or blame shifts for their behavior—100% accountability that no matter what, their actions were wrong—then partnering with individual therapeutic services is critical. At that stage, the therapist has a willing client ready to do some work on themselves and not resist the therapeutic work because ‘it’s somebody else’s fault.’ “

Mindy agrees that much of this work is best done in individual therapy, with the support of a trained therapist: If we know certain things upset us, or if we can recognize when we feel fear, shame, confusion, or we become agitated, we can work on identifying ways to decrease reactions that lead to abusive behaviors based from these difficult emotions and increase responses that can lead to healthier behaviors by acknowledging the emotions. When given a chance to explore the self in a safe, nonjudgmental space, then the opportunity to grow and find new ways to cope and live a life with more meaningful relationships, including the one with the self, is possible.”

Making personal changes of this magnitude is difficult, but as Adam explains, BIPs such as AAandA have been proven successful at creating this change in their clients. Therefore, evidence-based intervention combined with individual therapy can provide a second chance for both perpetrators and victims of domestic violence.

“As our program is the largest certified program for perpetrator services in the state of Indiana by the Coalition Against Domestic Violence, I think that we offer such a curriculum because we know the possibility of change is apparent, and the only way we can keep victims safe is to offer the opportunity,” Adam says.

Cummins Behavioral Health is proud to support Abuse Awareness and Accountability in its mission to protect victims of domestic violence and reform those who have committed abuse. As Mindy Frazee puts it:When you have two entities passionate about what they do for the communities they serve, it is priceless. Clients who are able to engage in both AAandA and therapy will know they are on a solid path toward recovery.

If you are interested in learning more about batterers intervention programs for yourself or someone else, we encourage you to visit the Abuse Awareness and Accountability website and look into their classes available throughout Indiana. Classes are open to court-mandated as well as voluntary participants, and you can sit in on a session for free to see if the program might be right for you. Recovery and rehabilitation from domestic violence is possible!

Compassion Fatigue: Overcoming a Common Challenge for People Who Help Others

Any type of work that puts people under large amounts of stress for extended periods of time can lead to burnout. Burnout is often identified by feelings of physical and emotional exhaustion, a reduced sense of accomplishment, and loss of personal identity. High-stress professions such as law enforcement, nursing and legal work are notorious for high rates of burnout, which can also lead to high employee turnover.

However, individuals who work in the “helping professions”—such as nurses, physicians, educators, social workers and counselors—may also experience a special type of burnout known as compassion fatigue. With this type of burnout, a helping professional may feel overwhelmed by the struggles and challenges of their clients, which can create emotional distress in their own lives.

Rachele Love, one of our life skills specialists, has personal experience with the challenges that can come with working in a helping profession. Consider Rachele’s story about her close brush with compassion fatigue when she first joined our team in Putnam County.

Rachele Love’s Story of Professional Stress and Adaptation

Rachele Love, Life Skills Specialist at Cummins Behavioral Health
Rachele Love, Life Skills Specialist at Cummins Behavioral Health

Before she joined Cummins, Rachele Love already had a wealth of experience working in the helping professions. She previously spent 17 years working as a paraeducator, assisting school-aged children and teens who had mild, moderate and severe disabilities. In addition, she also served five years active duty in the U.S. Army, which instilled her with a strong sense of duty and personal achievement. “When you’re a soldier, you’re given a directive, and you don’t just meet it—you exceed it. That’s just what’s been ingrained in my life,” Rachele says.

When Rachele joined our team at Cummins, she knew she wanted to continue her work with children, so she became a school-based life skills specialist (or LSS) at Cloverdale middle school and high school. Although the work was different than it had been in a special education environment, Rachele took to it quickly. Many of the youths she counseled had behavioral problems rather than mental illnesses or developmental disabilities, but Rachele had little difficulty connecting with them. “The rapport and relationship with all of my kids was great,” she says.

However, scheduling appointments with her consumers soon became an issue. Rachele was only permitted to pull students from non-core classes such as computers, physical education, art and music, but she also needed to rotate through these electives so her students didn’t miss any one class too many times. Despite her best efforts, these restrictions caused her to start falling short of her counseling expectations. “My position was productivity-based,” Rachele explains. “The expectation was 25 hours of direct clinical care each week, and I was struggling to meet that. It was a huge problem for me.”

Rachele’s supervisors, for their part, were very supportive. They encouraged her not to worry about her hours and just focus on providing high-quality care for her students. But even with this reassurance, Rachele had trouble accepting her own perceived shortcomings. “I was definitely stressed out about it, and I would say a little bit depressed as well, because it’s really a punch in the gut when I can’t meet an expectation,” she says. “I felt like I was letting myself and everyone else down.”

Rachele was struggling, and she knew that the situation would only get worse if it continued. Clearly, something needed to change.

Shelby Rusk on the What, Why and How of Compassion Fatigue

Shelby Rusk, MSW, LSW, Youth Therapist at Cummins Behavioral Health
"In this field, we're trained to have empathy and compassion toward others, but sometimes that compassion and empathy can become overwhelming. Then our consumer's stressors can become our stressors," says Shelby Rusk, MSW, LSW, Youth Therapist at Cummins Behavioral Health.

Rachele’s story is not a textbook example of compassion fatigue, but it does bear many similarities. As mentioned above, compassion fatigue is a sort of burnout caused by repeated exposure to people who are experiencing difficult life circumstances. The psychologist Charles Figley, the so-called “Father of Compassion Fatigue,” has described it as “vicarious traumatization”—a phenomenon that occurs when therapists and other helping professionals personally experience the trauma felt by the people they are helping.

“Compassion fatigue is very similar to burnout, but it can affect us faster,” says Shelby Rusk, a Youth Therapist at our Montgomery County office. “We take on the suffering of our consumers, and we start to feel what our consumers feel. Having intrusive thoughts, having trouble sleeping, maybe being irritable, withdrawing from our supports or not wanting to do things that previously brought us joy— these would definitely be some things to look for.”

According to the American Institute of Stress, some other common symptoms of compassion fatigue include:

  • More intense emotions
  • Diminished cognitive abilities
  • Feelings of isolation
  • Depression and post-traumatic stress
  • Loss of self-worth
  • Loss of hope and personal sense of meaning
  • Anger toward people or situations that have caused harm to others

Why does compassion fatigue happen in the first place? As human beings, it is natural for us to feel concern when we witness another person suffering. Those who work in the helping professions encounter suffering much more often than the average person—and perhaps more than our brains are equipped to handle. “Every hour is a new traumatic story, and hearing all these traumatic stories can really wear on a person,” Shelby says.

In addition, Shelby speculates that individuals who join the helping professions may be especially sensitive to other people’s suffering. “I think people who come into these fields just naturally want to help others. A lot of times, we want to fix problems, so we take on a lot of responsibilities for our consumers,” she says.

Returning from the Brink of Exhaustion

If compassion fatigue is caused by overexposure to other people’s suffering, then it can be prevented by limiting this exposure and focusing more energy on ourselves. But how is this possible for someone whose entire profession revolves around helping others?

It begins with basic self-care routines like getting plenty of sleep, exercising regularly, eating a healthy diet, and practicing mindfulness whenever possible. According to Shelby, it’s also important to focus on positive outcomes and situations when working in the helping professions, which is where gratitude exercises can come in handy. “You are going to see more challenges with people than not, so it’s important to focus on the positives and the successes you had,” she says.

However, it’s also crucial that helping professionals have access to good support systems both inside and outside of work. Shelby says, “Having a positive support system at work is huge. Ideally, we need co-workers who can help us have fun and not get stuck in negative ruts, and we also need leaders who can give us guidance. But that support system outside of work is very important, as well, to help you separate your two lives. You have to separate them, and it can be hard when you live and breathe work.”

Having said that, let’s return now to Rachele’s story. Was she able to find balance in her work and turn back from the brink of burnout and compassion fatigue? Fortunately, she was.

“I have to give credit to Anna Harmless,” Rachele says. “She was my team lead, and she was just so helpful, and just incredible. I met with Anna and I told her, ‘We have to talk, because this isn’t working for me. But I love this company and I don’t want to leave.’ “ For Rachele, the solution was not to change her line of work, but to change her assignment within the organization. She left the school-based environment and started working as an LSS at Green Willows, a supported group living home operated by Cummins. “Green Willows sounded perfect for me, because it was very close to what I had done for three years prior to joining Cummins,” she says.

Today, Rachele’s story shows that it is possible to recover from the stress and fatigue that sometimes afflicts those who work in the helping professions. “It’s been awesome. I’m just so happy here,” she says.

For more information about challenges that helping professionals may face in their line of work, we recommend our blog posts on multitasking and the Imposter Syndrome below!

Stress Can Be Good For You (as in this picture of a woman doing her homework)
Multitasking, Attention-Deficit Trait, and Boundaries
Perfectionism and 'Hurry Worry'
Embracing Your Inner Expert: Perfectionism and the Impostor Syndrome in Mental Health

How Motivational Interviewing Helps Create Positive Life Change During Counseling

“Everything changes and nothing stands still.” — Hereclitus of Ephesus, ancient Greek philosopher

Change is one of the few things about life that never changes. No matter who we are or how old we get, the circumstances of our lives never stay the same forever. Sometimes change is unplanned, unexpected, or outside of our control—we may lose our job or be offered a new job, meet a new friend or lose an old one, live through a natural disaster or be gifted a large sum of money. Other times, change occurs because of actions we take to create it.

As we’ve discussed in a previous post, any change that we make to our own lives follows a predictable pattern known as the Stages of Change. First comes precontemplation, the stage in which we haven’t even begun to consider the change we’d like to make. Next come contemplation and preparation, when we begin to consider and make plans for the upcoming change. Then we reach the action stage, where we take the necessary steps to implement our change, and finally maintenance, where we work to continue whatever behaviors brought about the change.

However, it’s impossible to make a conscious change to our life if we don’t know what we want to change. With all the daily duties and distractions that occupy our thoughts, we may sometimes find it difficult to envision how we’d like to improve our lives. We can become stuck in the precontemplative stage of behavior change, in need of a spark to ignite positive change like a rocket taking off from its launch pad.

Motivational interviewing is a counseling method that can help with this indecision. By focusing on the consumer’s values and life goals, a counselor using motivational interviewing (or MI) can help someone discover their internal source of inspiration, providing that much needed spark to jump start the process of change. In this blog post, Cummins’ Tracy Waible and Tim Grzeskiewicz explain what principles motivational interviewing is based upon, what it looks like in practice, and why it’s a highly effective tool for eliciting positive life change.

Principles of Motivational Interviewing: “A Dance, Not a Wrestling Match”

Tracy Waible, LCSW, LCAC
"For me, motivational interviewing is a way of connecting with another human being and ensuring they feel valued and heard," says Tracy Waible, LCSW, LCAC, Director of Recovery Services at Cummins BHS and a DMHA-certified trainer in motivational interviewing for the State of Indiana.

To understand motivational interviewing, it helps if we recognize how it is different from other forms of counseling.

In traditional counseling or therapy, the care provider’s job is to impart knowledge and guidance to the recipient. The assumption is that the person in counseling has a problem that only the counselor knows how to solve. We can see this even in the definition of the word “counsel,” which means to advise. By contrast, to “interview” someone means to question or talk with (them) to get information. In motivational interviewing, the counselor does not tell the consumer how they should change, but rather asks them if and how they would like to change.

“When you’re using MI, the provider is focused on the thoughts, values and goals of the person coming in for services,” says Tracy Waible. “It’s not about what I think is best for you or how I think you need to go about changing, but rather, what do you think? How do you think you can get there? What are your reasons for change?”

When working with a consumer using motivational interviewing, care providers utilize a set of person-centered skills known as “OARS+A”:

  • Open-ended questions: Instead of asking simple “yes or no” questions, the provider poses questions that prompt the consumer to elaborate. E.g. “How do you feel about that?” or “What do you want to do about it?”
  • Affirmations: The provider comments positively on the consumer’s intentions and efforts to change, which helps build confidence in their ability to change. E.g. “I think you’re making great progress toward your goal, well done.”
  • Reflections: The provider repeats back the consumer’s thoughts and feelings to let them know they’re being heard and understood. E.g. “It sounds like you feel frustrated about this aspect of your life.”
  • Summaries: The provider connects the dots between the consumer’s thoughts to help them better understand their own feelings and desires. E.g. “You’ve told me that you always feel stressed at work, you dread getting up in the morning, and you would quit your job if you could. It sounds to me like you aren’t very happy in your current line of work. Does that sound right to you?”
  • + Advice with permission: If the consumer is open to suggestions, the provider may offer advice about what they should do next. E.g. “Based on what I’ve heard, I think you should consider changing your sleep habits.”

According to Tracy, motivational interviewing is ultimately about collaborating with the consumer to help them make the changes they want to make in their life. “Motivational interviewing views people as very values-driven. For any behavior that’s happening, there’s a value or an emotion behind it,” she says. “Our job as providers is to tap into that. A lot of therapy techniques are very confrontational or directive, where the provider just asks people a bunch of questions and they don’t really feel a part of the process. MI is more like a partnership. It should feel like a dance versus a wrestling match.”

Motivational Interviewing in Practice: Continuously Increasing Insight

Tim Grzeskiewicz, LMHA, QBHP, Substance Use Disorder Therapist at Cummins Behavioral Health
"No matter how long someone's been in therapy or in recovery, and no matter how motivated they are for change, I think there's always room for increasing insight and awareness," says Tim Grzeskiewicz, LMHA, QBHP, Substance Use Disorder Therapist at Cummins Behavioral Health.

As we’ve explained, the goal of motivational interviewing is to help consumers discover why and how they want to change their lives. But how does this translate into a typical counseling session?

According to Tim Grzeskiewicz, who uses MI in his work treating individuals with substance use disorder, it all begins with the initial assessment for services. “Let’s say someone has gone through the intake assessment, they’ve been identified as needing IOT, and they’re ambivalent or arguably resistant,” he says. “They come to my office, and I just kind of lay it out there. I say, ‘You’re in my office because somewhere along the line, somebody said you have a substance use problem. What do you think?’ “

Depending on how the consumer responds, Tim begins to determine their willingness to change and how to proceed with counseling. “There’s a great tool that I like to use called ‘branching,’ “ he explains. “You ask that first open-ended question, and then you continually branch questions down from there. If the response is, ‘Yeah, obviously I’ve been using a little more than I should, that’s why I’m here,’ there’s a different question that follows that versus if the response was, ‘Yeah, my wife’s a little worried. It’s not a problem for me, but it is for her.’ “

No matter what a consumer believes or how open they are to change, the ultimate goal of motivational interviewing is to continuously build insight regarding potential problems in their life. As Tim explains, this is the best way to help a consumer identify opportunities for change:

“As people, we aren’t stupid, we just have blind spots. We don’t want to think that we’re making bad decisions, but when we hear them out loud, we might realize they aren’t healthy for us. That’s the whole thing with motivational interviewing: it leads people to their own insights. Because I could tell you, ‘You need to change. Look at the scores on this assessment. You have a problem.’ If I do that, you’re probably not going to make a change. But if I lead you to the discovery, now you’re thinking about it, so I just helped you move from precontemplation to contemplation. Then you might say, ‘Wow, do I need to change something?’ and I would say, ‘I don’t know, let’s talk about that.’ And then we would be moving toward preparation and planning.”

Even after a person has successfully made a change to their life, the usefulness of motivational interviewing doesn’t end. “Therapeutically, I’m always using MI,” says Tim Grzeskiewicz. “If I’m in session with someone I’ve been seeing for two years, and we’re exploring whatever’s happening in their personal life, I’m still asking open-ended questions so they can develop insight into areas of their life that they may want to change.”

At Cummins Behavioral Health, motivational interviewing is one of the primary tools our providers use to help consumers achieve their behavioral health goals. As Tracy Waible says, “Our view at Cummins is that MI is the lining in any hat you’re wearing. Even if we’re using other treatment modalities, we can always embody the spirit of MI.”

Looking for inspiration for your next positive life change? Our blogs posts on nutrition, exercise, sleep and mindfulness might provide you with a few interesting ideas!

Fruits and vegetables
How Nutrition Affects Mental Health with Cummins’ Jaime Selby and Hendricks Regional Health’s Kaitie Delgado
Exercise for mental health
Exercise and Mental Health: How Physical Activity Improves Mood, Cognition, and Overall Wellness
Dr. Ashleigh Woods Explains How—and Why—to Get a Good Night’s Sleep
Using Art to Practice Mindfulness with Holly Combs and MHA’s Karen Martoglio

Family Therapy: Restoring Cohesion through Validation and Compromise

“Family is not an important thing. It’s everything.” — Michael J. Fox

Since the beginnings of human history, the family has always been our most vital social unit. Across all times and civilizations, people have always developed rules and customs for how to act within a family, which indicates the universal importance of this closest form on human connection. As Cummins therapist Melanie Gibbs puts it, “Our culture is really based on family systems. I don’t know of any culture where families are not the basis of what holds that culture together and drives it.”

Because families are our most fundamental social groups, it’s extremely important for our mental and emotional health that our family unit is cohesive. Generally speaking, a cohesive family is one in which the members live together harmoniously and each person is free to grow and express themselves as individuals. However, some amount of conflict within a family is virtually unavoidable.

Conflict can occur between two people anytime their needs or desires interfere with each other’s. Within families, this may be especially likely during periods of change and transition, such as when children are born or begin schooling, when a parent loses a job or begins a new one, when the family moves to a new geographic location, or when the parents become separated or divorced. When conflict arises, it is in everyone’s best interest to find a resolution that maintains or restores family cohesion as fully as possible.

Sometimes families need help working through conflict and returning to cohesive functioning. This is both understandable and normal; in fact, more than half of the work we do at Cummins Behavioral Health involves children and families. Melanie Gibbs, LCSW, has been a provider of behavioral health therapy for over 20 years, and she has helped many families heal from conflict during that time. In this blog post, Melanie explains how therapy can help a family overcome internal conflicts using the key principles of validation and compromise.

Mistrust: The Result of Communication Breakdown

Melanie Gibbs, LCSW, Outpatient Therapist at Cummins Behavioral Health
"One thing that's so easy to forget is families are systems, and what impacts one member of the family impacts everyone," says Melanie Gibbs, LCSW, Outpatient Therapist at our Putnam County office.

As we said above, conflict usually arises between two people when the things one person wants interfere with the things the other person wants. It’s often possible for the two parties to resolve their conflict if they listen to each other’s perspectives and agree on a mutually acceptable compromise. When a conflict escalates, it’s typically due to a breakdown of respectful communication between the individuals in dispute.

This is usually the stage of conflict a family has reached when they choose to begin therapy. “Typically, feelings are very hurt, and people have been dealing with that hurt by either withdrawing or attacking back, typically with words,” Melanie explains. “Over time, that starts to erode feelings of trust and safety within the family. Trust diminishes, trust diminishes, trust diminishes, until there’s really no communication and no trust.”

If it is not addressed, this lack of trust will ultimately drive a family apart. The goal of therapy is to rebuild trust within the family, and the first step toward rebuilding trust is reestablishing constructive communication. “My job is to get people to hear each other—and to keep hearing each other until the message sent is the message received,” Melanie says.

In therapy, this is primarily achieved by validating the feelings and desires of each family member, as Melanie explains:

“I want each person in the room to tell me their perception of the story that brought them to therapy. What do they think is going on? How do they see it? I’ve been doing therapy for 20 years, and I’m not sure that I’ve ever had a conversation with anyone where I could not find some validity in what they were saying and how they were seeing it. A person’s backstory influences how they see things and what they need, so if you have four people in a room and everyone tells their story one by one, it’s easy to say, ‘Yes, I understand you because of this and this. This is the way this feels to you, and this is what’s going on in your mind.’ Everyone can feel heard and respected, and they can still come together to solve the problem.”

Dismantling the Fallacy of “Right and Wrong”

When two people are engaged in a conflict, it’s only natural for each person to believe that they are right and the other person is wrong. However, taking the time to listen to each person’s perspective helps us realize that this is not true. “People often anticipate that there’s going to be a ‘right’ and a ‘wrong,’ and they worry they’re going to be in the wrong and their feelings are going to be invalidated. But that’s not what family work is,” Melanie says. “It’s not my job to call out right and wrong. There is no right and wrong.”

To accept that neither person is right or wrong means two things: first, that each person has behaved reasonably given their point of view, and second, that each person may have unintentionally contributed to the problem. As Melanie explains, this is easier for people to do if they believe their own perspective is being taken into consideration:

“Until someone feels heard, they can’t be open to hearing anyone else. Their mind is full of everything they need to say. So before you can ask people to change, and before you can ask them how they think they’ve contributed to the problem, you have to hear their feelings, their perceptions, their experience, their hopes, and you have to say, ‘OK, I hear you. I see that these particular things are very important to you, and I understand why they’re important to you, and we’re going to remember that.’ It’s called ‘creating safety.’ You have to create emotional safety so people can begin to relax and be more open to hearing other people.

In the case of family therapy, everyone must ultimately must work together to find an acceptable compromise that will keep the family together. “One of the premises that I promote in couples or families work is: instead of solving a problem in terms of who’s right and who’s wrong, how do you solve a problem in a way that everyone can most live with?” Melanie says. “What’s the solution that everyone can genuinely be the most on-board with? That’s the solution you want to go with, because in the end, holding the family system together in a way that people can feel seen, honored, respected and safe is much more important than the particular decision you make.”

Some amount of conflict within a family is normal, but conflict that escalates and goes unresolved can seriously threaten family cohesion. Family therapy can help to restore harmony by validating the thoughts and feelings of each person and working to find a compromise that everyone in the family can live with.

At Cummins Behavioral Health, we are committed to promoting healthy families and family resiliency among our consumers. If you are experiencing dysfunction in your family and think that family therapy might be right for you, please give us a call at (888) 714-1927 to discuss your options and schedule an appointment!

Looking for more services and interventions that can help strengthen family functioning? You might like our blog posts on wraparound services and Conscious Discipline below!

Wraparound Services: 360-Degree Support for Youth with Greater Behavioral Health Needs
Conscious Discipline: A Constructive Approach to Behavior Modification for Children

Mental Health IOT: Meeting the Need for Intensive Outpatient Therapy in Indiana

Just as no two individuals are the same, so too are everyone’s behavioral health needs unique. Even when two people suffer from the same mental illness—such as depression, anxiety or schizophrenia—the severity of their condition can vary greatly. Depending on the individual, a mental health issue could be a minor inconvenience in their life or a debilitating condition that impairs their day-to-day functioning.

When a person seeks treatment to help manage a mental illness, the level of care they receive should match the severity of their needs. For consumers with lesser needs, standard outpatient therapy (which typically consists of 30-minute to one-hour sessions no more than once or twice a week) is often sufficient to help them with their challenges. On the other hand, consumers who are experiencing a period of extreme need may be admitted to a psychiatric hospital for inpatient care. But what if a person’s needs are somewhere in between—too great for outpatient care to fully address, but not severe enough to warrant hospitalization?

Consumers who struggle with substance use disorder have the option of Intensive Outpatient Treatment (or IOT) if they fall within this category. However, consumers with other mental health challenges have not traditionally had access to this level of care, which is a gap that Sarah Gunther of KEY Consumer Organization has been passionate about filling. Gunther explains,

“I am on the Cummins Consumer Advisory Board, where I’m able to give some direction on ways that Cummins can improve. Every time we’ve had a conversation about substance use IOT, I’ve advocated for general mental health IOT as well. I thought it could help a lot of people as a step between purely outpatient and inpatient treatment. Not everyone benefits from hospitalization, which can actually be harmful for some people, but they might benefit from more intensive help than they get with regular outpatient care.”

Sarah Gunther, Executive Director of KEY Consumer Organization
Sarah Gunther, Executive Director of KEY Consumer Organization

At the suggestions of Gunther and other advocates, Cummins Behavioral Health has begun providing Intensive Outpatient Treatment for consumers with challenges not related to substance use disorder. We believe this program will help more people get the right kind of help for their behavioral health challenges, right when they need it. In this blog post, IOT group facilitator Christina Kerns explains who the program benefits, how it works, and exactly what it does help individuals with greater mental health struggles.

MHIOT: How It Works and Who It Can Help

Christina Kerns, Outpatient Therapist and MHIOT Group Facilitator at Cummins Behavioral Health
Christina Kerns, Outpatient Therapist and MHIOT Group Facilitator at Cummins Behavioral Health

Mental health IOT (or MHIOT) is a relatively simple program in practice, though it does require a large time commitment from consumers. Therapy is administered in a group setting, with group members meeting three days a week for three hours each day. During sessions, group members discuss whatever mental health difficulties they’re experiencing, provide input and communal support for each other, and learn life skills that can help them through their struggles.

As the group facilitator, Christina’s primary job is to ensure that the session runs smoothly. “I help keep the discussion moving,” she says. “I’m there to give feedback on any issues, help group members reach their treatment goals, and assist them in identifying common themes with one another so they can work together and help each other heal and grow. It’s so important because group members learn how to problem solve and cope with their challenges together.”

As mentioned above, the program is ideal for people whose needs are too great for standard outpatient treatment but not severe enough for inpatient treatment. In practice, many consumers are referred to MHIOT as a means of preventing hospitalization or as follow-up care after a stay in the hospital. “Our hope is to provide consumers with additional services so that we can help prevent crisis situations and hospitalizations from occurring,” Christina explains. “And if anyone has been hospitalized within the last month, we like to check and see if our group would be appropriate as a step-down for them.”

Although it has only been running since the end of June, Christina reports that many consumers of MHIOT have responded favorably to the program. It’s her opinion that the group format has been especially beneficial for helping members achieve their mental health goals. “The mental health IOT group is extremely important to Cummins, because so many individuals within our communities who are trying to manage a mental illness do not have access to support groups,” Christina says. “Since we’ve started this group, many of our consumers have found it helpful for their recovery to share their experiences in a safe and confidential setting, which allows them to gain hope and develop supportive relationships with one another.”

What Happens During a Typical MHIOT Session

We’ve explained the underlying principles of mental health IOT, but what exactly do these principles look like in practice? How do group members work toward their mental health goals, and what does Christina do to guide each session? What should someone expect the first time they attend a group?

Like many group therapy sessions, every MHIOT meeting begins with introductions. “We have five basic questions that everyone answers,” Christina explains. “They tell us their name, how they’re feeling that day, any court issues they’re willing to discuss, what skills they’ve used since the last session, and whether they’re having any suicidal ideation, homicidal ideation, or thoughts of self-harm.” The group works through each member’s answers one by one, providing emotional support and guidance as needed.

After introductions, Christina leads the group in a discussion of their recovery values, including a daily reading to help members understand and apply each value. Once this is done, the group typically moves on to a lesson on mindfulness. “We teach the ‘wise mind,’ which is about not getting stuck in our emotional mind or our rational mind, but mixing the two together,” Christina says. “A lot of our members had no idea whether they tended to react with their emotional mind or their rational mind, nor did they know how to identify what feelings they’re feeling in the moment. It’s really a process that we have to teach ourselves.”

Finally, each session ends with training and discussion on a life skill that can help group members achieve their mental health goals. These skills are taken from dialectical behavior therapy (or DBT), a type of psychological therapy that emphasizes validation and acceptance. According to Christina,

“We chose dialectical behavior therapy because it’s the basis for skills training, and it’s been shown to help an array of diagnoses—especially serious mental illnesses like depression, anxiety, and personality disorders. There are three bases that I teach from: on Monday, we focus on distress tolerance skills; on Wednesday, we focus on interpersonal effectiveness skills; and on Friday, we focus on emotional regulation skills. So the group is learning how to recognize and identify their emotions, how to interact with other people, and how to use these skills to improve their mental health and wellness.”

We are excited to now be offering Mental Health Intensive Outpatient Treatment to consumers who need additional support with non-addiction-related behavioral health problems! If you are a Cummins consumer and you believe MHIOT could be a good fit for your needs, we encourage you to discuss it with your care provider.

We would like to extend a special thanks to Sarah Gunther and KEY Consumer Organization for helping us continue to provide the best behavioral health care possible for our consumers. If you would like to learn more about KEY, you can visit their website at KEYConsumer.org, or call their mental health “warmline” at 800-933-5397 if you need a sympathetic ear to discuss your mental health challenges with.