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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!

Explaining Flow: How “Getting in the Zone” Can Help with Mental Wellness

Have you ever been “in the zone” with a project? Or you sat down to do something you love and somehow the ideas just seemed to come to you on their own? 

There’s a word for that: “flow.” 

There’s been a lot of research about flow and “flow state,” but happiness expert Mihaly Csikszentmihalyi first coined the term 40 years ago and has been doing research on it ever since.

As a provider of behavioral health services, we’re interested in how flow and mental health are related. There are positive effects of flow aside from simply being more productive; because of that, we investigated how you can work on getting to flow state with your passion projects.

What Is Flow?

Mihaly Csikszentmihalyi
Mihaly Csikszentmihalyi, original proponent of the concept of flow

According to Csikszentmihalyi’s research in 1990, flow is “a state in which people are so involved in an activity that nothing else seems to matter; the experience is so enjoyable that people will continue to do it even at great cost, for the sheer sake of doing it.” 

While someone is in this state of flow, “There’s this focus that, once it becomes intense, leads to a sense of ecstasy, a sense of clarity: you know exactly what you want to do from one moment to the other; you get immediate feedback,” Csikszentmihalyi said in a 2004 Ted Talk.

Flow state has been called many things by many people, including artists, creatives, athletes, and musicians. They all report these same feelings of being hyper-focused and having clarity—as if the ideas and actions weren’t from their own thoughts, but some external force. 

Positive Psychology succinctly lists eight defining characteristics of flow state:

  1. Complete concentration on the task
  2. Clarity of goals and reward in mind and immediate feedback
  3. Transformation of time (speeding up/slowing down)
  4. The experience is intrinsically rewarding
  5. Effortlessness and ease
  6. There is a balance between challenge and skills
  7. Actions and awareness are merged, losing self-conscious rumination
  8. There is a feeling of control over the task

Someone doesn’t have to experience all eight characteristics to be in flow, but they will experience at least one and probably more.

What Does Flow Have to Do with Mental Health?

When people experience flow state, they are happier and more satisfied with life. The BBC reports that “flow is associated with subjective well-being, satisfaction with life and general happiness.”

People who can achieve flow state are not only more likely to be happy, but also less likely to experience the negative side effects from unmanaged mental health issues: “The thoughts and feelings that generally cloud our minds, such as stress, worry, and self-doubt, take a back seat when we achieve a flow state” (Headspace). 

These are certainly encouraging ideas, and recent neuropsychology studies have shown that the brain is actually changing during flow state. Researcher Arne Dietrich notes that the prefrontal cortex, which normally controls our complex cognitive processes like self-reflection and conscious state of mind, seems to work differently during flow state. 

His research shows, “In a state of flow, this area is believed to temporarily down-regulate in a process called transient hypofrontality. This temporary inactivation of the prefrontal area may trigger the feelings of distortion of time, loss of self-consciousness, and loss of inner critic. Moreover, the inhibition of the prefrontal lobe may enable the implicit mind to take over, allowing more brain areas to communicate freely and engage in a creative process.” 

When someone experiences flow, they might feel like time passes differently, feel less inhibited by their inner critic, and be less self-conscious. Dietrich’s scientific findings line up with Csikszentmihalyi’s eight defining characteristics of flow state. Moreover, some of the problems faced during times of mental health crisis include harsh internal criticism and extreme self-consciousness. Therefore, getting into flow state could help people become better able to handle mental health challenges and ultimately increase mental wellness.

How to Get into Flow State

While flow state seems obviously desirable, it’s not always an “easy” goal to achieve. As artists know well, “there’s a stereotype that writers and creatives can enter the zone at will—that we sit down at our laptops and the world melts away” (BBC). 

There are conditions you can create to make flow state more likely, but unlike a light switch, you can’t always turn it on and off. You must know yourself and what your optimal environment is in order to start creating the perfect conditions. 

The BBC notes, “We are more likely to access the flow state when engaged in tasks we’ve already practiced.” So it helps if you are doing something you’re already familiar with. 

The wellness app Headspace notes four conditions that need to be met to achieve flow state: 

  1. You need to care about the task at hand 
  2. The activity, job or task cannot be too easy or too difficult 
  3. Optimally, the activity should be something that you are good at 
  4. Your mindset surrounding the task should be focused on the journey, not the destination

Don’t let the short list deceive you—it’s a near-perfect combination that gets you to flow state. Looking at the conditions, it makes sense why creatives are thought to be able to turn on flow state at will. It also makes sense how athletes can enter flow state even though they’re doing something completely different than creatives. 

If this list seems hard to accomplish, don’t be discouraged just yet. There are also some things you can do that will help you get to flow state: “Do something you love, create a ritual, choose your most important task, identify your peak creative and productive times, & eliminate distractions.” 

Creating an environment that’s predictable and free of distractions can really help you change your mindset and delve deeper into your passion project. 

Ultimately, flow state can greatly benefit your mental wellness through added happiness and lessened stress and anxiety. Not to mention the positive boost you will get from being so productive.

If you’re struggling with mental wellness, we would encourage you to do some self-reflection. Figuring out your passions and how to make daily or weekly time for them can be a great help in making positive mental health changes in your life. 

If you need help figuring out how to manage your mental wellness, Cummins Behavioral Health offers many types of therapy and counseling services. From individual therapy to group therapy options, our skilled professionals can help you improve your mental health. They could even help you discover your passion so you can get to flow state and take advantage of the benefits. If you’re interested in getting help, call (888) 714-1927 today. You can lead a happy and balanced life!

Interested in more wellness-related topics? Here are some other blog posts you might enjoy!

Yoga, meditation
Wellness: What It Is and How to Achieve It
overwhelmed by social media
Seize Control of Your Social Media Time with These Simple Setting Suggestions

How to Spot and Respond to Cyberbullying, a Growing Problem for Children and Teens

In a world where technology is a dominant feature in most of our lives, it would seem that bullying would be a thing of the past. Everyone’s on their phones now, especially amidst a global pandemic, so kids are minding their own business…right? 

Unfortunately, this is not the case. Cyberbullying runs rampant throughout the maze of technology kids have access to and are using on a daily basis. The bullying hasn’t stopped—it’s gone viral. 

As a provider of school-based behavioral health services, we’re worried about the negative effects of cyberbullying. We know this form of bullying is harmful, so we want to make sure caregivers can spot the signs to get help for the children in their lives. 

What Is Cyberbullying?

Much like the traditional bullying you see in movies or might have experienced growing up, cyberbullying includes name calling and mockery. It goes further, though, in the extensive number of ways kids can communicate with each other. 

According to the National Bullying Prevention Center, “Cyberbullying is the use of technology to repeatedly and intentionally harass, hurt, embarrass, humiliate, or intimidate another person.” This includes laptops, cell phones, and tablets—basically anywhere someone can access the internet. It’s particularly tricky because there is so much technology in so many places that it almost makes bullying easier. 

As to what the bullying actually includes, StopBullying.gov, a website run by the U.S. Department of Health and Human Services, says it best: Cyberbullying includes sending, posting, or sharing negative, harmful, false, or mean content about someone else. It can include sharing personal or private information about someone else causing embarrassment or humiliation.” This might mean vicious insults or hurtful comments, sharing an embarrassing photo, or even distributing a home address and phone number—a practice called doxing.

How It Differs from Traditional Forms of Bullying

There are many similarities between traditional physical bullying and cyberbullying. Bullies are notorious for being relentless and persistent. Some common reasons children are bullied include: socioeconomic status, sexual orientation, and even smaller things like what hobbies they enjoy. 

While bullying and cyberbullying are similar, there are many problematic elements of cyberbullying that make it harder to detect and deal with. For instance, with technology available 24/7, a cyberbully can harass a child not just while at school, but also on social media and video games. In some cases, it may feel hard to ever get away from cyberbullying because technology keeps everyone so connected. 

Cyberbullying can also be anonymous and reach a much wider audience. If a cyberbully shares an embarrassing photo all over the internet and social media, it could “go viral.” This not only creates a permanent paper trail of embarrassment for the child being bullied, but also creates a situation from which the child may not be able to escape, even as they grow older and mature. 

What’s worse is that the cyberbully may create fake profiles or be completely anonymous when performing the cyberbullying. This makes it harder to track and creates an environment where it’s easier to be much more hurtful with much less remorse due to the lack of perceived consequences. 

A final key difference between traditional bullying and cyberbullying is that cyberbullying can be hard to detect. Students use technology in and for class and assignments. They also communicate with friends and family using technology. There will, at some point, be a time where parents, guardians, and teachers can’t monitor children at every moment, especially during a global pandemic when so many parents and teachers are already juggling eLearning and new work-from-home environments.

Cyberbullying does a lot more mental and emotional damage before adults begin to see the effects than traditional physical bullying. If a child is getting physically harmed at school, it probably leaves a mark. Unfortunately, in the digital world cyberbullying does long-term damage to mental health before anyone recognizes what’s going on and is able to intervene.

Long-Term Effects of Cyberbullying

With so much cyberbullying occurring, there are mental and emotional long-term effects. Researchers note, Victims of bullying are at significantly increased risk of self-harm or thinking about suicide in adolescence. Furthermore, being bullied in primary school has been found to both predict borderline personality symptoms and psychotic experiences, such as hallucinations or delusions, by adolescence. Where investigated, those who were either exposed to several forms of bullying or were bullied over long periods of time (chronic bullying) tended to show more adverse effects.” 

Victims of bullying face a higher risk of many serious consequences from bullying—from serious mental health disorders to much higher risk of suicide. In fact, suicide rates in children and adolescents have doubled since 2008.

Aside from the obvious mental and emotional strain, there can also be physical effects from cyberbullying. According to recent research, “Children who were victims of bullying have been consistently found to be at higher risk for common somatic problems such as colds, or psychosomatic problems such as headaches, stomach aches or sleeping problems, and are more likely to take up smoking. Victims have also been reported to more often develop internalising problems and anxiety disorder or depression disorder.”

If you’ve been bullied, you’ll likely recall that showing weakness to bullies seems to push them further into their habits and bring more suffering and increased bullying into your life. For this reason, many children who are being bullied are more likely to withdraw from their daily lives and internalize their fear. 

According to researchers Dieter Wolke and Suzet Tanya Lereya, “Bullying rather than other factors explains increases in internalising problems.” There are then physical consequences of this internalization, like more common colds and headaches, which can seem unrelated.

Spotting the Signs of Cyberbullying

We know that cyberbullying is a problem—a big one. And it’s not going away anytime soon. We also know that it can be hard to detect. After all, we can’t monitor every child all the time. 

So what signs can we look for that might indicate cyberbullying is occurring? The Cyberbullying Research Center has a very helpful list:

  • Unexpectedly stops using their device(s)
  • Appears nervous or jumpy when using their device(s)
  • Appears uneasy about going to school or outside in general
  • Appears to be angry, depressed, or frustrated after going online (including gaming)
  • Is oversleeping or not sleeping enough
  • Becomes abnormally withdrawn from friends and family members
  • Shows an increase or decrease in eating
  • Seems regularly depressed
  • Makes passing statements about suicide or the meaninglessness of life
  • Loses interest in the things that mattered most to them
  • Avoids discussions about what they are doing online
  • Frequently calls or texts from school requesting to go home ill
  • Desires to spend much more time with parents rather than peers
  • Becomes unusually secretive, especially when it comes to online activities

Many signs involve unusual behavior with technology. When a child who loves being connected stops wanting to be involved with activities online or games they previously loved to play, it’s odd and something might not “feel right” with how they normally act.

There are also signs involving relationships with the people they care about. Sometimes children who are being bullied push away from their peers and closer to parents and siblings. But sometimes they begin to pull away from everyone and lose interest in relationships, as well as passions they used to love. 

The bottom line is that cyberbullying is serious, and although it’s harder to detect than more traditional physical bullying, there are signs parents and guardians can and should watch for. Knowledge is power, especially in the digital age where so much information is readily available to learn. 

We would encourage you to check on the children closest to you—whether your own children, nieces and nephews, grandchildren, or children of friends. The kids need you more now than ever before, although they might not say it out loud. Regular and open communication about bullying and its negative effects can really help children not just for their own sake, but also so they know what to look for when they see it happening to others. Help them help themselves.

If you find that a child close to you is being bullied, therapy can help.  Cummins behavioral health partners with many school districts throughout central Indiana to provide quality mental health therapy for children in the school-based environment. If you have questions or are worried your child might be experiencing cyberbullying, call (888) 714-1927 today. Early intervention can save lives!

If you’re concerned about other challenges to children’s mental health especially during the COVID-19 pandemic, we recommend also reading our blog on child abuse prevention below!

girl-jeans-kid-loneliness-236215
National Child Abuse Prevention Month 2020: Keeping Children Safe in the Age of “Social Distancing”

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.

Conscious Discipline: A Constructive Approach to Behavior Modification for Children

“Discipline is not something you do to children; it is something you develop within them.” — Dr. Becky Bailey

As many parents would attest, few things about raising children are easy. On top of the substantial commitments of time and resources that children require, parents must also determine how best to guide their children as they learn, grow and develop as individuals. Providing discipline can be a significant part of this process, which leaves parents with the additional task of deciding how they ought to do it.

The old adage “spare the rod, spoil the child” suggests that punishment (and in this case, corporal punishment) is a necessary component of discipline for children. However, modern psychologists have discovered that punishment is not as effective at changing behavior as once thought. For example, studies presented by the American Psychological Association have found that punishments like “time-outs” can be effective at reducing defiant and violent behavior, but reasoning with children is most effective for milder forms of misbehavior. In addition, reasoning proved more effective at reducing violent and defiant behavior in the long-term than punishment.

It’s with this knowledge that Dr. Becky Bailey, at the time a professor of early childhood education at the University of Central Florida, created “Conscious Discipline” in 1996. Conscious Discipline is a social-emotional learning program for parents, educators and mental health professionals that emphasizes behavior modeling and problem solving rather than punishment for misbehavior. According to a report by the The Harvard Graduate School of Education, Conscious Discipline has been shown to reduce aggression, hyperactivity and conduct problems among children.

Anna Harmless and Melissa Lawson, two school-based providers at our Putnam County office, have begun utilizing components of Conscious Discipline in their work with youth, parents and educators. In this blog post, they explain the basic science underlying Conscious Discipline and why it can be an effective, constructive alternative to punishment-based discipline.

Brain States and Behavior: The Science Behind Conscious Discipline

Anna Harmless and Melissa Lawson of Cummins Behavioral Health
Anna Harmless, LCSW, Team Lead and school-based therapist (left) and Melissa Lawson, LSS, OBHP, school-based life skills specialist (right)

According to the Conscious Discipline model, anyone who wants to modify a child’s behavior must first understand a few things about the way the human brain functions.

The tenets of Conscious Discipline are based upon a simplified neuropsychological model of the brain. This model does not tell us everything about the way our brains work, but it can help us predict how a person will feel and behave in certain situations. “Dr. Becky Bailey did a lot of research on the human brain, and she found that we have three different ‘brain states,’ “ Melissa explains. These states are:

  1. The Survival State: This is the most basic or “primal” of our brain states, which is activated when we perceive a threat to our well-being. When our brain is in the Survival State, we look for ways to fight or flee from the perceived threat, and we are incapable of thinking clearly and rationally.
  2. The Emotional State: This state is typically triggered when something upsets us and causes us to feel anger, fear, sadness, or another negative emotion. In this state, we tend to revert to ingrained patterns of behavior and are not good at thinking critically or considering other people’s opinions.
  3. The Executive State: This state makes full use of our prefrontal cortex, allowing us to think through conflicts and find logical, constructive solutions. It is the optimal brain state for problem-solving and learning, but it is only accessible when we are in a state of emotional calm.

The main problem with “traditional” or punishment-based discipline is that it keeps children in the Emotional or Survival Brain States—neither of which are conducive to learning. “I’ve been doing therapy at Cummins for seven years now, and I have seen traditional discipline fail so many times,” Anna explains. “The child is already thinking, ‘I’m bad. I’m sad. I feel bad.’ So if we punish them by taking something away, that just reinforces the child’s inner voice. We want to help the child calm themselves and express themselves instead.”

Melissa adds, “Ideally, we want children to develop their executive functioning skills so they can problem-solve and learn to cope with their emotions in a healthy way.” Therefore, the primary goal of Conscious Discipline is to teach children how to work through problems using their Executive Brain State.

Behavior Modeling and Problem Solving: Conscious Discipline in Action

As we’ve said, Conscious Discipline teaches that children must be engaged in their Executive Brain State in order to truly learn from disciplinary action. This is all well and good if the child is calm and collected at the moment discipline is required—but what if they are misbehaving due to emotional turmoil? How can we help move the child out of the Emotional or Survival Brain States so they will be receptive to instruction?

This brings us to another important concept of Conscious Discipline: behavior modeling. Humans, and especially human children, intuitively imitate the behavior of other humans. It’s one of the primary ways we learn how to think, act and socialize with others. With this in mind, Conscious Discipline teaches that adults can help shift children into their Executive Brain State by modeling calm, thoughtful, non-aggressive responses to problems and conflicts. Melissa explains further,

“Dr. Bailey calls this ‘downloading your calm’ onto the child. If you’re approaching the child in a calm state, you can help them get to that calm state with you, whether it’s through affection or just recognizing how they’re feeling and reflecting it back to them. You can say, ‘You seem upset. Is this why? OK, we’re going to breathe, and I’m going to teach you how you can calm down and help yourself feel better.’ Once they’re calm, that’s when you can solve the problem together and teach them a skill they can use for the rest of their life.”

Of course, if the adult is upset by the child’s misbehavior, then it may be difficult for them to respond to it constructively. As a result, Conscious Discipline also requires adults to monitor their own brain states and regulate themselves appropriately. “There’s a lot of mindfulness work that the adult has to do,” Anna says. “Overall, it’s a self-regulation program to help adults first so the adults can help the children.”

For adults and children both, this means breaking free from any maladaptive disciplinary practices they may have learned in the past. “Family culture is huge in the way the world works and the way our children learn, but a lot of people don’t even think about the concept of family culture,” Anna continues. “We want people to understand how they learned what they learned about parenting and being a part of a family. We’ve been able to help some parents realize, ‘Wow, I didn’t like how it felt when I was punished as a kid. Maybe I don’t want to cause my own child to feel that same negativity.’ “

When exercised appropriately, Conscious Discipline inverts the focus of child discipline by teaching the child what to do instead of what not to do. According to Melissa, the most difficult part of the whole process is not getting carried away with our emotions: “The hardest part for kids and adults is noticing the reaction they’re having, calming down, and getting out of that Emotional or Survival State. then they’ll be able to process and work through the problem in their Executive State.”

If you’d like to learn more about Conscious Discipline, we encourage you to visit ConsciousDiscipline.com, where you can learn even more about how the program works and access free resources for working on discipline with children!

If you’d like to learn more about behavioral health challenges that children may face, we recommend watching our video on trauma and student mental health below, which we recorded last year with Cummins’ Michelle Freeman and Jessica Hynson!