09 Dec 2021
How to deal with the uncertainty surrounding the Omicron variant

Many of our patients are asking for advice on how to handle the anxiety and uncertainty surrounding the Omicron variant of the coronavirus. The answer we’re all hearing in the news, “It’s too early to know for sure,” while true, isn’t very helpful.

Is Omicron more or less dangerous than the variants currently in circulation? Can it evade vaccination or previous infection? How transmissible is it? Where did it come from? Will we need extra shots to combat Omicron?

While the early data is certainly heartening, it will be weeks before we have definite answers to these questions and this leaves us feeling very anxious. If we let them, thoughts like this will lead us down the rabbit hole of catastrophic thinking.

Unfortunately, we’re likely to be in this situation over and over again before the pandemic is really over so it’s time to flex our “dealing with uncertainty” muscles. Here’s what we’re advising our patients:

1) Take a deep breath

“As with every other area of uncertainty in our lives,” says WCWCW Director, Dr. Wendy Hookman, “we can’t panic every time we perceive a potential threat. Once we’re in the panic state, we can’t think clearly, process new information or act appropriately to defend ourselves so the first step, always, is to breathe.” Having a “go-to” breathing or meditation practice is the first step in calming yourself and feeling more grounded.


2) Remember that you already know how to protect yourself

“As opposed to early 2020 when we first learned of the novel coronavirus,” says Dr. Hookman, “we’re in a much better position. We already know what to do to reduce the risk of COVID-19 transmission. Get vaccinated, if you aren’t. Get kids vaccinated if they aren’t. Wear a mask in indoor public places, especially if they’re crowded. Avoid really crowded indoor events. Use tools like rapid tests to reduce your risk of carrying something into a family gathering or party. Those are the basics. If you’re already doing them, great. You don’t need to go on full lockdown just because scientists are investigating a new variant of concern. If you aren’t already doing those things, now is a good time to consider employing more of those precautions in your life.”

3) Train your brain to stop focusing on things you can’t control

“When you spend too much time worrying about what could happen in the future then it’s easy to get swept away by disastrous scenarios;” says WCWCW psychotherapist, Amy Pelletier, LCSW-C, “The wisest thing you can do is just focus your time and attention in the present where you have the power to decide what works for you and carry out what you want to do.”

One way to accomplish this is to slow down. Do whatever you are doing right now but do it slower. Move, write, eat or fold the laundry more slowly. By doing so you’ll become more aware of what is happening all around you right now.

You can also disrupt and reconnect. If you feel you are starting to worry then disrupt that thought by shouting this to yourself in your mind: STOP! Then reconnect with the present moment by taking just one or two minutes to focus to 100% on what is going on around you. Take it all in with all your senses. Feel it, see it, smell it, hear it and sense it on your skin.

4) Step away from the news

“These days, when we learn about something scary in the news, our instinct is to attempt to control our anxiety by researching it on the internet to gather more and more information,” says Amy Pelletier, “but this approach becomes counterproductive very quickly. A better approach is to believe the scientists when they say they don’t have all the facts yet and redirect your attention to something more productive.”

Make it a habit to only check the news once, or at most twice a day, and spend time doing things that decrease rather than increase your anxiety like exercising, meditating, or spending time with friends and family.

At WCWCW, we’re here to help you cope with uncertainty and anxiety of all kinds. Give us a call or request an appointment anytime.

10 Nov 2021
Helping our Teens through a Mental Health Crisis

We’ve been hearing from so many patients how tough this school year has been for teens. A new report from the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children’s Hospital Association declared the mental health crisis a national emergency. The resulting teen mental health crisis has rates of depression, eating disorders, and even suicide attempts on the rise. And, social media is in the spotlight again following a report about Instagram’s negative effects on teen girls and body image.

We know it’s a lot. We also know how painful it is to watch your kid suffer and that it’s a struggle to get teenagers to open up. So we wanted to offer some advice to help you relate to your teen during this challenging time.

Understand where your kid is coming from

Adolescence is a confusing developmental phase for kids and parents alike. Teens are experiencing strong emotions. At the same time, they’re still learning to recognize, process, and understand their feelings.

“As adults, it seems so easy to us, but what we don’t remember is that as teenagers these feelings are so strong and so new,” says WCWCW Child and Adolescent Psychiatrist, Dr. Valerie Relacion.

Given the challenges of this year — readjusting to in-person schooling after last year’s remote experience, pivoting when classrooms or schools shut down in response to COVID-19 outbreaks and catching up academically—it’s important to acknowledge and validate the stress your kids may be going through.

Listen actively

When our kids are struggling, we instinctively want to make the problem go away. It’s completely understandable, but we can alienate our children when we jump in with a solution.

“What teens want is for parents to just listen, hear them out, and be present with them, not judgmental,” says Dr. Relacion.

Instead of trying to fix his or her problem, ask your teen open-ended questions about how they’re feeling, and let them talk. Getting those feelings out is part of healing. After they’ve told you what’s going on, you can ask them: “What do you think is bringing this up right now?” or “Can you think of a time when this has happened before?” Using language like “Tell me more,” or starting sentences with reflective listening phrases like, “Could it be that …?” can make them feel safe and more willing to share.

Avoid making light of what they tell you, dismissing or telling them not to think or worry about it, or saying the problem “will get better.”

Once your teen has had a chance to tell you what’s wrong, you can repeat to them your understanding of what they have told you in their own words. You can say something like: “It sounds like this has been your experience. I can see you’re feeling overwhelmed,” or “It sounds like this has been really hard for you, tell me more about it.”

“Teens will do the right thing given the opportunity but you have to give them the opportunity;” says WCWCW Child and Adolescent Psychiatrist Dr. Alexis Wesley, “parents supporting their children in processing their emotions helps promote autonomy and bolster problem-solving skills.

Model self-care

When we’re feeling overwhelmed, anxious, or upset, being active or doing something restorative, like playing with a pet, can help. Model self-care by suggesting that the two of you go for a walk with the dog, cook, shoot hoops, or whatever you do to unwind. This is also a great way to connect with your teen. “Talking casually while doing something you both enjoy is a great way to connect,” Dr. Wesley says.

Have family dinners together

Eating meals together regularly is one of the most consequential practices you can do as a family. Research links family dinners to positive self-esteem and reduced risk of disordered eating, alcohol and substance use, violent behavior, and feelings of depression or thoughts of suicide.

“Even if you can’t do it every day, sitting down at least once or twice a week as a family for dinner brings so many benefits,” Dr. Wesley says.

Balance screen time with green time

Balance out the heavy screen time that your teen may have adapted this past year by encouraging them to get outside — whether it’s reading a book in the backyard or going on a hike. If social media is particularly damaging to your kid, you can help reduce the time they spend on these apps by asking them questions to help them understand if it is playing a negative role in their lives and encouraging more in-person meetups with their friends.

Practice constructive reinforcement on social media

With the heavy emphasis on looks, body image, and popularity, social media can be toxic, especially for teen girls. If you’re friends with your kids’ friends on Instagram or Facebook, avoid focusing on looks or materialistic things when commenting on photos. Instead, focus on the experience in a photo. For instance: “What a fantastic trip that must have been,” rather than “You are gorgeous!”

Get help

If you are noticing changes in your teen’s eating or sleeping habits, if they’re saying particularly harsh things about themselves, or if anything else feels off, consider having them see a professional. Contact us at WCWCW to learn more about our adolescent mental health specialists and to make an appointment.

05 Oct 2021
Finding the Light at the End of the Tunnel

With COVID-19 cases rising and uncertainty surrounding its variants, many patients have told us recently that it feels like there’s not a light at the end of the tunnel right now and are reporting poor sleep, fatigue or less productivity at work.

“At the beginning of the summer, we expected we were over the hardest part of the pandemic, and that the return to school might look a little more normal,” says WCWCW psychiatrist Dr. Valerie Relacion. “With the rise of the delta variant and differing opinions about vaccines and masking as our kids return to school, there’s this sense of dread that we’ll have to endure another difficult winter.”

Having our hopes dashed is incredibly dispiriting, especially after expecting that things would get better. Here’s how you can cope if you’re struggling.

Validate your feelings

The feeling there’s nothing to look forward to can be powerful enough to bring on depressive symptoms like sadness, tearfulness, insomnia and anhedonia (not being able to enjoy the things you usually enjoy). If the symptoms go on for more than two weeks and are interfering with your ability to function in one or more areas of your life, that’s when it’s time to get help. However, if the symptoms are just beginning, there are things you can do to prevent yourself from sinking lower. Recognizing you’re feeling this way, and that the feelings result from a thought pattern, is the first action to take. Then, start to validate your feelings. Affirming rather than suppressing difficult emotions helps mediate depression. Maybe you feel anger toward people who won’t get vaccinated or sadness that your children will miss out on aspects of a normal school year. Make space for all of it by writing it down or reflecting on it in a safe personal space.

Talk to a trusted person

There are very few people who aren’t struggling in some way right now, whether it’s medical, financial, emotional, or all of it. Getting confirmation you’re not alone helps you feel less isolated. Talk to a trusted loved one or friend about how you’re feeling. Find someone with whom you feel comfortable sharing negative feelings and who will validate how you’re feeling rather than try to fix the problem.

Practice finding gratitude

Spend some time each day noting what you’re grateful for. You can write this down, talk about it with a friend or family member, or simply think about it. Individuals who write a “gratitude letter” reported significantly improved mental health after several weeks, compared to those who didn’t, according to one University of California Berkeley study.

Unlike toxic positivity, which means suppressing negative emotions, gratitude is about recognizing the good, not erasing the bad.

Remember, you’ve already done this

As psychiatrist Dr. Jena Lee said recently, change is “one of the most taxing and stressful thing(s) for any of us because it requires adjustment and flexibility.” Appreciate that you and your family have already made many big changes adapting to a world with COVID-19, and are, in a sense, “over the learning curve.” We’re now used to wearing masks. We know that the virus is much less transmissible outside. We have vaccines. We’ve come a long way, even if we’re still struggling. Reminding ourselves of the wins, even if they’re small, can go a long way.

It won’t always be like this

It may feel like things are always going to be this bad. But the “light at the end of the tunnel” mindset has a cognitive flaw: things are always changing. We’ve already experienced so many changes since the start of the pandemic. Although the vaccine’s authorization for children can’t come soon enough, it’s only expected to be approved by the end of this year or early next year. Scientific knowledge about the virus and how to treat it continues to expand. And we’ve already been able to resume many of the activities that were once restricted.

Accept what you can’t control, and focus on what you can

Anticipatory anxiety occurs when you fear future events that haven’t happened. One of the most effective ways to deal with this is to try to focus on the present. This can be developed through meditation. It’s also important to accept what you can’t control, and focus on what you can. For instance, you may not be able to control the course of the pandemic, but you can control the measures you take to keep your family safe. Additionally, WCWCW psychologist Dr. Susan Felzer recommends starting to deal with decisions you put off earlier in the pandemic and making changes that make sense now.

“You don’t need to solve everything right away, but it will increase your sense of agency to start to break down an issue and address it,” says Dr. Felzer. “This can reduce feelings of helplessness that are common with depression.”

If you’re feeling hopeless, alone, or like things will never get better, visit our website or call Washington Center for Women’s and Children’s Wellness to learn more about our counseling services for addressing depression, anxiety and other common conditions.

14 Sep 2021
Tips for Returning to School in a Difficult Time

In the best of years, going back to school is one of the most stressful times for families. This back-to-school period brings with it a number of unprecedented challenges: a return to in-person learning after last year’s exhausting remote or hybrid learning experiment, a rise in cases of COVID-19 among kids and teens because of the highly transmissible delta variant, the lack of vaccine authorization for kids under 12, and the polarizing debates over mask and vaccine mandates.


“Kids and parents were already dealing with the fall-out from the past year, like falling behind in learning and social development, because of remote school. In the last few weeks, everyone has had to face the health concerns about young kids and rising cases just as schools reopen,” says Alexis Wesley, M.D., child, adolescent, and adult psychiatrist at WCWCW. “Parents are overwhelmed and disappointed that this year isn’t turning out to be the return to school we’d hoped at the start of the summer.”


It’s impossible not to be stressed right now, and we’re not going to tell you otherwise. But we can provide some strategies to help you and your kids get through this trying period.


Talk to your kids about what to expect

Remote learning was challenging for many kids and teens, but transitioning back to in-person learning has its own set of challenges. Take time to calmly talk to your kids about what to expect for this school year, to the best of your knowledge, including information about what to expect in terms of masking and vaccination. It’s okay to acknowledge that things remain uncertain. Let your kids share what they’re nervous about. With things still changing, it’s important to check in regularly and continue to validate their feelings.


Help children with socializing

Returning to school after a year of remote learning is bound to create social anxiety for many kids. Things like bullying and cliques haven’t gone away, and now there’s also uncertainty about whether kids will have their normal social outlets, like sports and other extracurriculars. 


It’s important to support your kids during this time by helping them safely socialize and creating some sort of consistency in their communal environment. For example, if your kids’ activities are canceled, or if they’re doing virtual or hybrid learning, you could help them maintain connections with friends by organizing small group meet-ups outdoors.


Look for signs your child is behaving differently

Because of the challenges of the past year, your child may display behavior changes that are a clue to deeper issues. In younger children, look for shifts in appetite — either acting hungrier or saying that they are not hungry — or changes in sleeping patterns, whether sleeping less or sleeping in more. Young children may also complain about tummy aches and headaches. Older children and teens may display distress by withdrawing from friends and family and pulling away from activities or things that they previously enjoyed, engaging in risky behavior or self-harming, or being agitated or more irritable than usual.


Your child may benefit from mental health support such as talk therapy, play therapy, WCWCW’s social and emotional skills groups for children and adolescents. We also recommend our colleagues who run the Parent Child Journey program, which offers low-cost education for parents to help find effective strategies to address their child’s difficulties.


Develop routines

Developing healthy routines is key to navigating difficult times. Set a consistent sleep schedule, where you and your family go to bed and wake up at the same time. Exercise regularly, and encourage that for your kids. Eat first thing in the morning, eat regular meals, and make mealtime a family event, at least for dinner, as often as possible. Make sure to get your kids’ input when helping them develop their schedules. 


Minimize screen time

Parents are really struggling with weaning their kids from screens after last year’s virtual-heavy time. We’ll get into this more in a future post, but now is the time to start cutting down on unnecessary screen time. Here are some ways to start:

  1. Make bedrooms tech-free zones.
  2. Use parental controls on devices.
  3. Reward kids for doing things that are not tech-related.
  4. Remove yourself from tech devices when your child is present.


Here are some additional suggestions from the Mayo Clinic.


Practice self-care and model this for your kids

Let’s face it, caring for others, especially your children, is exhausting, and it’s easy to neglect and even forget yourself. Build self-care, such as meditation, self-healing, baths, or any simple practice you find restorative, into your routine. Talk about the things you do that help you feel calm and grounded, and encourage your kids to try some for themselves. 


Embrace ‘good enough parenting’

Psychiatrist D.W. Winnicott coined the term “good enough parenting,” which means not expecting perfection from yourself or your children. It’s okay to lower your expectations and let go of the need to be a “Super Parent” in exchange for sanity and self-care.


“Understand that everyone has fallen behind in the past year in certain areas, and be compassionate,” says Dr. Wesley.“In bumpy times, the best you can do is be honest about what you know, as well as what you don’t know, and provide love and support for yourself and your family.”


Get in touch with WCWCW to learn more about how our excellent and compassionate clinicians, mental health services and groups can help you and your children get through this difficult transition period

26 Aug 2021
Preserve the Good Changes You Made During the Pandemic

With the rise in delta variant cases as kids return to school and fights over mask mandates, the current period is in certain ways more stressful than lockdown. With everything in flux, it may be more difficult to have any kind of routine. But if you made positive changes during the lockdown period, like exercising, meditating, or spending more time with family, they are worth hanging on to. “With the stress of returning to work and sending kids back to school in an uncertain environment, you need the good habits that helped you get through the past 18 months more than ever,” says WCWCW psychologist, Dr. Susan Felzer


Read on for guidance on how to maintain healthy changes and why doing so matters.


Set priorities and adjust your routines


Lockdown gave many of us time and space to rethink priorities. Use this transitional time to solidify those priorities—in the areas of relationships, work opportunities, and activities. Once you’ve set your priorities, identify the behaviors and practices that will help you stick to them. For example, if a priority is mental health, a behavior could be a meditation practice. If you want to keep a meditation practice you began in lockdown, work on transitioning it to your post-quarantine routine. If while homebound you meditated during the time you would have normally commuted to work, and now you’re going back to the office for part of the week, you could wake up earlier to meditate. 


Even better, see if there’s a behavior that’s not serving you for which meditation could substitute. For example, if you habitually check your phone first thing in the morning, try meditating during the 10 minutes you might normally spend scrolling. Start small. If it’s hard substituting this every day, try three times each week. 


“Don’t feel like you need to stick with every habit you developed during the pandemic, just the ones that best serve you,” says Dr. Felzer.


Maintain a sustainable schedule


In order to stick with a routine, it needs to be easy enough to do so. It’s why people live close to their gyms or stock their fridge with healthy foods. Overscheduling is one of the biggest killers of routine. It’s easy for your calendar to fill up when children’s activities, playdates, volunteering, and social activities are ramping up. 


“It’s important to preserve time in your schedule for rest and self-care,” says WCWCW psychotherapist, Joy Paul. “When deciding whether to add something to your schedule, take a few moments to think about it. Do you genuinely want to participate, or are you feeling FOMO?”  You can return to your priorities, commit to activities in your priority buckets, and decline those that don’t make the cut. Block out free and unscheduled time for yourself each week, such as family time Saturday afternoon, no meetings on Fridays, or a movie or self-care night one night a week.


Ask to continue flexible work


The majority of those who worked remotely in the pandemic period want the option to continue. However, some organizations are eager to bring everyone back into the office. 


If you discovered working from home is a big post-pandemic priority but your company isn’t planning to support it, consider speaking to your manager about how you can work together to accommodate your needs. If your company refuses to budge, you may want to look into finding a more accommodating job.


Make quality time with family 


With the tempo of work, school, and activities building back up again, it’s likely not possible to spend as much time with your family as you did during the lockdown period. And for many, it is a relief to have kids back in school and activities. But you can still make family time a part of your schedule. 


A good way to maximize family time when you don’t have a lot of it is to focus your attention on it fully, instead of multi-tasking between work emails or social media. “When you get rid of distractions, not only are you more in the moment, but you remember that moment better later,” says Joy Paul, LCSW-C.


When change is out of your immediate control


Let’s face it: change is hard, especially when it requires the support or approval of others, such as a workplace that needs to okay a hybrid work situation, or a partner who needs to agree to watch the children while you take some self-care time.


“Change doesn’t need to come right away, but if you are able to maintain beneficial routines, it can help you deal with larger challenges in uncertain times,” says Dr. Felzer

Our mental health professionals can help you tease out what came out of your pandemic transformation and navigate uncomfortable or challenging conversations. For more information on how WCWCW can help you meet your needs for healing and personal growth, make an appointment with one of our clinicians today. 

04 Aug 2021
How to cope when so much is in flux

As the world has started to reopen over the last few months, many patients are finding themselves overwhelmed and confused. On the one hand, we can gather with family and friends again and return to the activities the pandemic forced us to stop. On the other, we’re quickly realizing that it feels unimaginable to return to the way things were after a year of such immense change. We’re not only reawakening to a world that’s very different from the one we knew, but one that’s still changing, and we’re different from who we used to be. Many of us have already made significant shifts, like moving, changing jobs, and spending more time with our families.

 Further complicating our decision-making is the most recent evidence that the pandemic isn’t over yet. COVID-19 is still a threat, particularly for the unvaccinated, which includes kids. While the CDC guidelines continue to evolve (and even give us a bit of emotional whiplash) because of variants and vaccinations, it means our normal routines remain unsettled, and we’re once again left with the stress of making important health and safety decisions for our families and our children. So, how do we get through this time when so much remains in flux?

At WCWCW, we’re here to help.


Don’t minimize what you’re experiencing 

 First, it’s important not to minimize what you’re experiencing. We’ve all survived and continue to brave an overwhelming amount of change. Recognizing and naming this as collective trauma, defined as a shared psychological response to a stressful or threatening event that impacts an entire society, is an important first step. 

 If you worked from home and were spared from family illness or death, you may feel lucky. Yet, the reality is we’ve all been uniquely scarred in some way. We’ve endured not just the virus but the polarizing political response to it. Add to this the events this year surrounding the election, as well as the brutalities against people of color, and the compounded emotional weight of the last several months has been a lot for even the most stable of us to carry.

 “Understanding the event as a trauma can help you become aware of and process your more challenging actions and emotions during this time,” says Dr. Wendy Hookman, WCWCW’s founder and medical director. “A lot of my patients are saying that they don’t understand why they are more irritable or less motivated right now, but once they actually start thinking and talking about the major stressors they’ve endured — and the way their lives have changed in such a short time — they have an ‘aha’ moment of insight and can start planning how they can pivot.”

Process and recognize underlying trauma and begin to heal

Compounding this upheaval is that our suffering is drawn out and uncertain. When humans experience a traumatic event, we react with a fight, flight, or freeze response. Because this trauma is drawn out, the fight-flight-freeze mode can be prolonged. Although it is an evolutionarily beneficial response, if we’re in this mode for too long, an overproduction of stress hormones can lead to anxiety, depression, sleep problems, memory impairment, and physical symptoms like headaches. Moreover, some responses to trauma can be unhealthy, such as picking fights if you’re in fight mode or overworking to stay busy in flight mode, as well as other obsessive-compulsive behaviors, such as substance abuse, or even physical responses like panic attacks.

 A mental health professional can help you process traumatic events first by encouraging you to identify and recognize the trauma and your response to it and next by helping you work through each stage of healing. He or she can work with you on a variety of therapeutic techniques that enable you to turn unhealthy responses into positive ones, ultimately helping you to build resilience, emerging stronger and more equipped to deal with future challenges. At WCWCW, we offer adult psychiatry, child and adolescent psychiatry, individual psychotherapy and group therapy — all aimed at helping you not only overcome but grow and thrive.

 “The truth is, everyone is figuring this period out in their own way. And no one has been unchanged by the past 18 months,” says Dr. Hookman. “It’s going to take time, distance, and thoughtfulness before we can begin talking about reversing the hidden trauma. The important thing to remember is you’re not alone.”


21 Jul 2021
How (and why) to protect yourself and your family from tick bites

Ah! The joys of summer – sun, vacation, bike riding, swimming, and hiking. All good things for our mental health. Generally. The thing is that lots of animals love this time of year, including ticks.

And where there are ticks, there is Lyme Disease. The black-legged tick is the only organism that can transmit Borrelia burgdorferi between animals or between animals and humans. Carried by a range of hosts, the black-legged tick is about the size of a poppy seed. If it is infected with Borrelia burgdorferi, its bite can have profound health implications.

Covid-19 has dominated our attention for so long that none of us, doctors included, have been thinking all that much about tickborne infections but it’s important to remember that we are now at the height of the 2021 season for tickborne infections. In 2019, Maryland recorded over 1,400 cases of the most frequently diagnosed tickborne infection, Lyme Disease, but other tickborne infections like babesiosis, anaplasmosis, ehrlichiosis and Rocky montan spotted fever (RMSF) are also reported here every year. 

What is Lyme Disease?

With more than 300,000 cases diagnosed each year, Lyme Disease is the most common tick-borne illness in the United States. Caused by the bacteria, Borrelia burgdorferi, the early signs and symptoms of Lyme Disease include fever, chills, headache, fatigue, muscle and joint pain, and swollen lymph nodes. People often think they have the flu. One of the best indicators that the problem is Lyme Disease is the distinctive rash that is caused by the tick bite. Sometimes the rash looks like a “bull’s eye” but most of the time, the rash is simply a red circle. Left untreated, or in its chronic state, Lyme Disease includes symptoms of fatigue, restless sleep, aching joints or muscles, pain or swelling in joints, decreased short-term memory or ability to concentrate, and speech problems.

What does this have to do with mental health?

More than you might think. While the media and the public health community focus on many of the health consequences of Lyme Disease, less attention has been paid to the mental health consequences that can coincide with Lyme Disease. It is also often the case that mental health symptoms are overlooked. Both are true for Lyme Disease, but increasingly significant cognitive and psychological symptoms are being recognized as part of the symptom pattern associated with untreated and/or chronic Lyme Disease.

I’m depressed because a tick bit me?

Depression has been reported in 8-45% of patients with post-treatment Lyme symptoms. But these numbers don’t tell the whole story. Many researchers believe that Lyme disease is vastly underdiagnosed. Diagnostic tests lack sensitivity and the symptoms of Lyme disease often overlap with other disorders. Thus, the true prevalence of depression in those affected by untreated or undiagnosed Lyme disease may be much higher. And although better statistics are needed, Lyme Disease may be so debilitating in some cases that it is associated with increased risk for suicidality. The mental health implications may extend beyond depression and even suicide. Case studies suggest that Lyme Disease can be associated with symptoms common to schizophrenia and bipolar disorder, including paranoia, delusions, olfactory, auditory and visual hallucinations, catatonia, and mania.

Tick Bite Prevention Tips:

Wear insect repellent that contains DEET (≥20%) or another EPA-approved repellent and reapply as directed. Wearing clothing and gear that have been treated with permethrin will also help to repel ticks. 

Walk in the center of trails and stay away from wooded or brushy areas with high grass and leaf litter. 

Tuck pants into socks and shirts into pants. 

Wear light-colored long pants and long sleeves to help keep ticks off of skin.

Conduct a full-body tick check and shower or bathe within two hours of returning indoors. After removal, place clothes in a dryer on high heat for 10 minutes to kill any hidden ticks. • Remove any attached ticks with fine-tipped tweezers. 

Check yourself, your kids, and your pets daily for ticks, especially after spending time outdoors.

And if you do find a tick, consider sending it for diagnostics. Most states have labs where ticks can be tested to find out if they are infected.

19 Jul 2021
How to stay safe while having fun this summer

During this reopening period, many of our patients are enjoying summer, yet still feeling anxious about navigating the specifics. These feelings can be further complicated by the fact that, although many adults are vaccinated, kids under 12 remain ineligible to receive the vaccine and, though case rates are dropping in many areas of the country, other parts of the world continue to struggle with the virus.

“It is possible to balance having a fun and relaxing summer and keeping everyone safe,” says Dr. Valerie Relacion, child, adolescent and adult psychiatrist at the Washington Center for Women and Children’s Wellness. “If you or your kids are feeling anxiety, that’s normal. It will help to identify and even write down the questions you have and do a little extra research and planning, but the good news is so many summer activities take place outdoors and the risk of infection has been minimized greatly since last year.”

Read on for some tips to help you navigate your emotions while planning for fun activities , playdates, and vacations, as well as strategies you can use to help kids who are nervous about their safety or anxious about socializing.

If you’re anxious about allowing your children to engage in organized activities or summer camp this year (not to mention burned out from this past difficult school year), assuage your concerns by looking into the organization’s or camp’s masking, testing, and infection protocols, as well as staff vaccination requirements. The CDC has issued guidelines around summer camp practices, although each camp’s policies will be determined by the state, locality, and the camp itself. Camps that followed safety protocols last summer had an incredibly low transmission rate even as cases were rising in the country, according to studies from Maine and North Carolina.

It has been heartening to see our kids with their friends again. However, it can be stressful planning playdates if you are concerned about the vaccination status of parents and teens in another household but are wary of an uncomfortable conversation.

“The pandemic pushed us to talk more openly about what we’re comfortable with and set boundaries in terms of health and our families, and that’s something we can hang on to,” says Dr. Relacion. She suggests asking about vaccination status in a straight-forward and diplomatic manner, from a place of concern for your children as well as respect for the other parent, who is likely also thinking of their kids’ safety. “In the end, you’ll feel less anxiety if you know you’re doing what you can to protect your children,” says Dr. Relacion.
You can always share your family’s vaccination status first, which often encourages people to say whether they’re vaccinated, too.

Similar to navigating playdates, if you’re hosting a backyard barbecue or picnic this summer, being clear about boundaries upfront can help you feel more at ease, such as setting masking and distancing expectations in your invitation. For example “We’re asking everyone who’s not vaccinated to wear masks indoors, and choose what you’re comfortable with outdoors.” Have extra masks on hand in case anyone forgets to bring one. Check out Johns Hopkins’ guide on what’s safe after the vaccine, if you’re trying to figure out ground rules.
If you’re invited to an event, check with the hosts to see what they’re expecting. It may help you feel safer to stick to outdoor events, like patio dining and outdoor concerts if you have unvaccinated kids at home.

Planning a trip
Taking a vacation is a great idea, for the memories and your mental health, and there are ways to do it safely. Again, planning ahead will ease anxieties and keep everyone safe. This can include checking about the masking practices of your accommodation and mode of travel; researching activities and dining options ahead of time; checking on vaccination and infection rates in your destination; and finding out if adults and teens of families you’re vacationing with are vaccinated. And remember— you don’t need to add the pressure of an overloaded schedule. After the past year, some R&R is definitely in order!

If your child is nervous about re-entry
What if your child is more fearful than you are? Some kids are understandably frustrated that their parents are vaccinated and they’re not. Address their concerns directly. Sit down with your kids and a calendar and discuss what they can expect over the next several months. You could sign them up for fewer activities than they might normally do and build up to more, as they get comfortable. You can also update them about the vaccine timeline. As of now, a vaccine for kids is expected later this year, possibly as early as fall.

If your child is more introverted and feeling anxious about socializing, it’s a good idea to talk to them about it. “Understand who your child is. If they love to read and want to be home all the time, maybe you could sign them up for an activity where they’re getting some exercise but they don’t have to be at camp all day,” says Dr. Alexis Wesley, child, adolescent and adult psychiatrist at the Washington Center for Women and Children’s Wellness. If they’re still experiencing significant anxiety around this, consider having them see a professional.

As we’ve said before, you don’t need to go from zero to 100 overnight. In fact, being patient with yourself and your family will lead to a more successful transition. Says Dr. Wesley: “After this past year, it’s important to take the pressure off yourself, and focus on making this summer one of quality time and creating memories.”

05 Jul 2021
Telehealth: Online video sessions

Updated July 5, 2021


Telehealth: Online video sessions continue to be the most convenient method of meeting for our patients so we are seeing patients in person upon request only. While Montgomery County has lifted the mandate on wearing masks indoors, we care for many children, who are not yet eligible for the vaccine, in-person. For this reason, we’ll continue with the precautions instituted during the COVID-19 pandemic. If you are coming to the office for an appointment, please expect to wear a mask, fill out a questionnaire, have a temperature, and maintain social distance in the waiting room and public areas of the office. We will continue to post updates here with future plans.

01 Jul 2021
Collective Trauma: What is it and what can I do about it?

As we start to emerge from the isolation of the pandemic, the term collective trauma is being used quite a bit to describe what we’ve all been going through. The is the first time in my memory that the term is being used so widely outside of psychotherapeutic circles and we’re being asked what it means and what it can tell us.

Collective trauma refers to the psychological reactions to a traumatic event that affect an entire society; it does not merely reflect an historical fact, the recollection of a terrible event that happened to a group of people. It suggests that the tragedy is represented in the collective memory of the group, and like all forms of memory it comprises not only a reproduction of the events, but also an ongoing reconstruction of the trauma in an attempt to make sense of it.

Collective trauma differs from individual trauma as it is recollected in the memory of the group and creates a process of on-going reconstruction and reproduction of the memory in order to make sense of it.

Well known collective traumas include: The HolocaustSlavery in the United States, the Atomic bombings of Hiroshima and Nagasaki, Genocide of Indigenous Communities, the Attack on Pearl Harbor, the September 11, 2001 attacks in the United States, and too many others.

The COVID-19 global pandemic is not the first event to be shared by the entire world, but in this age of technology and social connection when information travels the earth at lightning speed, we are all living the full impact of this collective experience, in real time. The daily “losses” we’ve all experienced and the countless individual tragedies of the virus come together in a cumulative and mutual loss to which few of us are immune.

The whole truth is that some of us will be more affected than others by the stressors covid-19 has placed on our daily lives and that of our communities. We won’t really know for years to come the totality of the physical and psychological effects we’ve endured. That said, we can take notes from survivors of previous events to get a sense of what we can do to mitigate any negative effects. 

Aspects of the COVID-19 pandemic can contribute to both individual and collective trauma. In a rapid review published in a 2020 issue of The Lancet, researchers found that isolation and quarantine contributed to a number of negative psychological effects including panic, depression, hopelessness, anxiety, stress, grief, confusion, anger, and even PTSD.

Research on past pandemics including earlier SARS and Ebola outbreaks provides some clues into the potential long-term collective impact of the COVID-19 pandemic. Commonly observed reactions include panic, depression, hopelessness, anxiety, stress, grief, and PTSD.

Some steps that you can take that may help manage collective trauma include:

Limit Media Exposure

Research on the aftereffects of 9/11 found that people who reported watching more television coverage of the attack experienced greater negative psychological effects. People who watched four to seven hours a day of news coverage of the attack were four times as likely to report PTSD-like symptoms.

Stay Connected with Others

Even if working from home requires limiting your face-to-face contact with other people, it is important to maintain your social connections. Thanks to technology, it’s possible to get creative and continue meeting friends, family, co-workers, and others virtually.

Rely on Trustworthy Information

People experience greater stress and panic if they are not able to accurately and realistically gauge the risk of a threat. While emotions can sometimes cloud judgment, particularly in stressful situations, research suggests that people are pretty good at making accurate assessments of the potential danger if they are provided with trustworthy, reliable information. Helping people make good choices by providing honest, transparent facts is imperative.

Utilize Mental Health Resources

Consider visiting a mental health professional either in person or via telehealth. One benefit of the pandemic is that there are many more online options than there were previously. Please reach out to us at WCWCW or another trusted healthcare provider if you need help.

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