Heidi R. Bruty, MD, PLLC

Adult, Child and Adolescent Psychiatry

Operating as usual

[07/29/17]   A great article that spoke to me and thought I would share for others in midlife.....

Well | Mind

How to Boost Resilience in Midlife

By TARA PARKER-POPE

JULY 25, 2017

Much of the scientific research on resilience — our ability to bounce back from adversity — has focused on how to build resilience in children. But what about the grown-ups?

While resilience is an essential skill for healthy childhood development, science shows that adults also can take steps to boost resilience in middle age, which is often the time we need it most. Midlife can bring all kinds of stressors, including divorce, the death of a parent, career setbacks and retirement worries, yet many of us don’t build the coping skills we need to meet these challenges.

The good news is that some of the qualities of middle age — a better ability to regulate emotions, perspective gained from life experiences and concern for future generations — may give older people an advantage over the young when it comes to developing resilience, said Adam Grant, a management and psychology professor at the Wharton School of the University of Pennsylvania.

“There is a naturally learnable set of behaviors that contribute to resilience,” said Dr. Grant, who, with Sheryl Sandberg, the chief operating officer of Facebook, wrote the book “Option B: Facing Adversity, Building Resilience and Finding Joy.” “Those are the behaviors that we gravitate to more and more as we age.”
Scientists who study stress and resilience say it’s important to think of resilience as an emotional muscle that can be strengthened at any time. While it’s useful to build up resilience before a big or small crisis hits, there still are active steps you can take during and after a crisis to speed your emotional recovery.

Last year Dr. Dennis Charney, a resilience researcher and dean of the Icahn School of Medicine at Mount Sinai in New York City, was leaving a deli when he was shot by a disgruntled former employee. Dr. Charney spent five days in intensive care and faced a challenging recovery.

“After 25 years of studying resilience, I had to be resilient myself,” said Dr. Charney, co-author of the book “Resilience: The Science of Mastering Life’s Greatest Challenges.” “It’s good to be prepared for it, but it’s not too late once you’ve been traumatized to build the capability to move forward in a resilient way.”
Here are some of the ways you can build your resilience in middle age.

■ Practice Optimism. Optimism is part genetic, part learned. So if you were born into a family of Eeyores, you can still find your inner Tigger.
Optimism doesn’t mean ignoring the reality of a dire situation. After a job loss, for instance, many people may feel defeated and think, “I’ll never recover from this.” An optimist would acknowledge the challenge in a more hopeful way, saying, “This is going to be difficult, but it’s a chance to rethink my life goals and find work that truly makes me happy.”

While it sounds trivial, thinking positive thoughts and surrounding yourself with positive people really does help. Dr. Steven Southwick, a psychiatry professor at Yale Medical School and Dr. Charney’s co-author, notes that optimism, like pessimism, can be infectious. His advice: “Hang out with optimistic people.”

■ Rewrite Your Story. When Dr. Charney was recovering from the shooting, he knew that his life was forever changed, but he reframed the situation, focusing on the opportunity the setback presented. “Once you are a trauma victim it stays with you,” he said. “But I knew I could be a role model. I have thousands of students watching my recovery. This gives me a chance to utilize what I’ve learned.”

Study after study has shown that we can benefit from reframing the personal narrative that shapes our view of the world and ourselves. In expressive writing studies, college students taught to reframe their college struggles as a growth opportunity got better grades and were less likely to drop out. A Harvard study found that people who viewed stress as a way to fuel better performance did better on tests and managed their stress better physiologically than those taught to ignore stress.

“It’s about learning to recognize the explanatory story you tend to use in your life,” Dr. Southwick said. “Observe what you are saying to yourself and question it. It’s not easy. It takes practice.”

■ Don’t Personalize It. We have a tendency to blame ourselves for life’s setbacks and to ruminate about what we should have done differently. In the moment, a difficult situation feels as if it will never end. To bolster your resilience, remind yourself that even if you made a mistake, a number of factors most likely contributed to the problem and shift your focus to the next steps you should take.

“Telling yourself that a situation is not personal, pervasive or permanent can be extremely useful,” Dr. Grant said. “There is almost no failure that is totally personal.”

■ Remember Your Comebacks. When times are tough, we often remind ourselves that other people — like war refugees or a friend with cancer — have it worse. While that may be true, you will get a bigger resilience boost by reminding yourself of the challenges you personally have overcome.
“It’s easier to relate to your former self than someone in another country,” said Dr. Grant. “Look back and say, ‘I’ve gone through something worse in the past. This is not the most horrible thing I have ever faced or will ever face. I know I can deal with it.’”

Sallie Krawcheck, a former Wall Street executive, said that after a very public firing, she reminded herself how fortunate she still was to have a healthy family and a financial cushion. While she has never studied resilience, she believes early challenges — like being bullied in middle school (“It was brutal,” she said) and going through a painful divorce — helped her bounce back in her career as well. “I just believe in comebacks,” said Ms. Krawcheck, who recently founded Ellevest, an online investment platform for women. “I see these setbacks as part of a journey and not a career-ending failure. There was nothing they could do to me on Wall Street that was as bad as seventh grade.”

■ Support Others. Resilience studies show that people are more resilient when they have strong support networks of friends and family to help them cope with a crisis. But you can get an even bigger resilience boost by giving support.

In a 2017 study of psychological resilience among American military veterans, higher levels of gratitude, altruism and a sense of purpose predicted resiliency.
“Any way you can reach out and help other people is a way of moving outside of yourself, and this is an important way to enhance your own strength,” said Dr. Southwick. “Part of resilience is taking responsibility for your life, and for creating a life that you consider meaningful and purposeful. It doesn’t have to be a big mission — it could be your family. As long as what you’re involved in has meaning to you, that can push you through all sorts of adversity.”

■ Take Stress Breaks. Times of manageable stress present an opportunity to build your resilience. “You have to change the way you look at stress,” said Jack Groppel, co-founder of the Johnson & Johnson Human Performance Institute, which recently began offering a course on resilience. “You have to invite stress into your life. A human being needs stress; the body and the mind want stress.”

The key, Dr. Groppel said, is to recognize that you will never eliminate stress from your life. Instead create regular opportunities for the body to recover from stress — just as you would rest your muscles between weight lifting repetitions. Taking a walk break, spending five minutes to meditate or having lunch with a good friend are ways to give your mind and body a break from stress.

“Stress is the stimulus for growth, and recovery is when the growth occurs,” said Dr. Groppel. “That’s how we build the resilience muscle.”

■ Go Out of Your Comfort Zone. Resilience doesn’t just come from negative experience. You can build your resilience by putting yourself in challenging situations. Dr. Groppel is planning to climb Mount Kilimanjaro with his son. Take an adventure vacation. Run a triathlon. Share your secret poetry skills with strangers at a poetry slam.

“There is a biology to this,” said Dr. Charney. “Your stress hormone systems will become less responsive to stress so you can handle stress better. Live your life in a way that you get the skills that enable you to handle stress.”

[11/07/16]   This is concerning data and we need to be vigilant parents for our young adolescents!

Young Adolescents as Likely to Die From Su***de as From Traffic Accident
By SABRINA TAVERNISE•NOV. 3, 2016

WASHINGTON — It is now just as likely for middle school students to die from su***de as from traffic accidents.

That grim fact was published on Thursday by the Centers for Disease Control and Prevention. They found that in 2014, the most recent year for which data is available, the su***de rate for children ages 10 to 14 had caught up to their death rate for traffic accidents.

The number is an extreme data point in an accumulating body of evidence that young adolescents are suffering from a range of health problems associated with the country’s rapidly changing culture. The pervasiveness of social networking means that entire schools can witness someone’s shame, instead of a gaggle of girls on a school bus. And with continual access to such networks, those pressures do not end when a child comes home in the afternoon.

“It’s clear to me that the question of suicidal thoughts and behavior in this age group has certainly come up far more frequently in the last decade than it had in the previous decade,” said Dr. Marsha Levy-Warren, a clinical psychologist in New York who works with adolescents. “Cultural norms have changed tremendously from 20 years ago.”

Death is a rare event for adolescents. But the unprecedented rise in su***de among children at such young ages, however small the number, was troubling and federal researchers decided to track it. In all, 425 children ages 10 to 14 killed themselves in 2014. In contrast, 384 children of that age died in car accidents.

“This graph is really surprising,” said Sally Curtin, an expert at the National Center for Health Statistics who analyzed the data. “We think of traffic accidents as so commonplace.”

Adolescent Su***des
Among children aged 10 to 14, death by su***de is now more common than death from traffic accidents.

4 deaths

per 100,000

Traffic

accidents

The crossing-over point was reached in part because su***de had spiked, but also because fatal traffic accidents had declined.

In 1999, the death rate for children ages 10 to 14 from traffic accidents — about 4.5 deaths per 100,000 — was quadruple the rate for su***de. But by 2014, the death rate from car crashes had been cut in half, part of a broader trend across the entire population. The su***de rate, however, had nearly doubled, with most of the increase happening since 2007. In 2014, the su***de death rate was 2.1 per 100,000.

Far more boys than girls killed themselves in 2014 — 275 boys to 150 girls — in line with adults in the general population. American men kill themselves at far higher rates than women. But the increase for girls was much sharper — a tripling, compared with a rise of about a third for boys.

The reasons for su***de are complex. No single factor causes it. But social media tends to exacerbate the challenges and insecurities girls are already wrestling with at that age, possibly heightening risks, adolescent health experts said. (The data published Thursday did not include methods, but an earlier report gave those details.)

“Social media is girl town,” said Rachel Simmons, the author of “Odd Girl Out: The Hidden Culture of Aggression in Girls.” “They are all over it in ways that boys are not.”

Statistically, girls dominate visual platforms like Facebook and Instagram where they receive instant validation from their peers, she said. It also is a way to quantify popularity, and take things that used to be private and intangible and make them public and tangible, Ms. Simmons added.

“It used to be that you didn’t know how many friends someone had, or what they were doing after school,” she said. “Social media assigns numbers to those things. For the most vulnerable girls, that can be very destabilizing.”

What to Do If You Need Help
The National Institute of Mental Health recommends this site. It also warns that reporting on su***de can lead to so-called su***de contagion, in which exposure to the mention of su***de within a person’s family, peer group or in the media can lead to an increase in su***des.
There are many groups that help people having suicidal thoughts. One, Crisis Text Line, inspired by teenagers’ attachment to texting but open to people of all ages, provides free assistance to anyone who texts “help” to 741-741.
If you prefer to talk on the phone, N.I.H. recommends the National Su***de Prevention Lifeline: 1-800-273-TALK (8255).
The public aspect can be particularly painful, Dr. Levy-Warren said. Social media exponentially amplifies humiliation, and an unformed, vulnerable child who is humiliated is at much higher risk of su***de than she would otherwise have been.

“If something gets said that’s hurtful or humiliating, it’s not just the kid who said it who knows, it’s the entire school or class,” she said. “In the past, if you made a misstep, it was a limited number of people who would know about it.”

Another profound change has been that girls are going through puberty at earlier ages. Today girls get their first period at age 12 and a half on average, compared with about 16 at the turn of the 20th century, according to “The New Puberty,” a 2014 book that describes the phenomenon. That means girls are becoming young women at an age when they are less equipped to deal with the issues that raises — s*x and gender identity, peer relationships, more independence from family. Girls experience depression at twice the rate of boys in adolescence, Ms. Simmons said, a pattern that continues into adulthood.

What is more, they live in a culture of fast answers and immediate change. That compounds the pressure.

“For a young girl who starts to develop breasts, hips, body hair — it’s a long haul before you land,” Dr. Levy-Warren said. “You don’t really know how you’re going to look for a number of years, and a lot of kids don’t know how to wait anymore. It’s just so painful.”

She added, “There’s this collision of emotional need, social circumstances and a sense of needing an immediate answer.”

Depression is being diagnosed more often these days, and adolescents are taking more medication than ever before, but Dr. Levy-Warren cautioned that it was not clear whether that is because more people are actually depressed, or because it is simply being identified more than before.

Su***de is just the tip of a broader iceberg of emotional trouble, experts warn. One recent study of millions of injuries in American emergency departments found that rates of self-harm, including cutting, had more than tripled among 10- to 14-year-olds. “This is particularly concerning as this type of injury often heralds suicidal behavior,” the researchers wrote.

[10/23/16]   New screen time rules for kids, by doctors

By Hailey Middlebrook, CNN

October 21, 2016

Story highlights

Two hours of TV a day may be too much for kids, says the American Academy of Pediatrics
Infants 18 months and younger should not be exposed to screens

(CNN)Digital media exposure for children of all ages should be limited, according to new guidelines from the American Academy of Pediatrics.
This week, the AAP hosted a national conference in San Francisco, where an estimated 10,000 pediatricians met to discuss new children's health recommendations for 2017. Children's screen time, social media and cyberbullying were key points of interest.

Previously the Academy set a general screen time limit: no more than two hours in front of the TV for kids over age 2. Today, in a world surrounded by digital media 24/7, defining screen time is difficult.

"It doesn't make sense to make a blanket statement [of two hours] of screen time anymore," said Dr. Yolanda Reid Chassiakos, lead author of the "Children and Adolescents and Digital Media Technical Report" and assistant professor at UCLA. "For some children, two hours may be too much."
For the new guidelines, the AAP identifies screen time as time spent using digital media for entertainment purposes. Other uses of media, such as online homework, don't count as screen time.

The academy recommends that for children 2 to 5 years of age, screen time should be limited to one hour per day. For kids ages 6 and older, parents can determine the restrictions for time spent using screen, as well as monitor the types of digital media their children use.
Babies are most vulnerable to screens. Infants aged 18 months and younger should not be exposed to any digital media, the academy says.

Infants 18 months and younger: No screen time

For parents with infants, cutting off technology completely can be challenging. But banning screen time for babies is hugely important for brain development and healthy parent-child connections, Chassiakos said.

"The noise and activity of a screen are distracting for a child," she said. Even if the baby isn't directly looking at the screen -- for example, if a mother is nursing her child on the couch while watching TV -- the baby can be overstimulated by the lights and sounds, which may cause distress and sleep problems.
Perhaps most negatively, screen time causes a disconnect between parents and children.

"When a mother is breast-feeding, that is a crucial bonding time," said Chassiakos. The more face-to-face interaction children have with mothers and other adults, especially eye contact, the better for the brain development of infants, she explained.

If parents' attention is fixed on a TV or phone screen, babies are deprived of that attention; and if they are repeatedly neglected in favor of digital media, children may develop behavioral issues in the future, Chassaiakos said.

"The TV should not be a babysitter," she said. "It's much better to talk to a child or read from a book."

Children 2 to 5 years: One hour per day

The AAP recommends that "parents prioritize creative, unplugged playtime for infants and toddlers," according to its press release. Children this age can be introduced to screens, but only for one hour a day. The type of media they are exposed to is critical: only high-quality programs, such as "Sesame Street" and other PBS shows should be viewed.

"Shows like 'Sesame Street' are much better than standard TV, because they don't have advertisements, which tend to overstimulate children," said Chassiakos.

Toddler-aged kids haven't developed the cognitive skills to understand advertisements or animations, she explained. Children at this age "can't interpret images like an older kid," meaning they can't decipher between real-world people and fictional cartoons.

While cartoons get a thumbs-down, the academy supports toddlers using face-to-face interactive media, such as Skype or Facetime. Including children in Skype video conversations with grandma, for example, can promote healthy development in kids, Chassiakos says. After the conversation ends, parents can supplement children's learning by repeating what grandma said on the screen.

Children 6 years and older: Limit digital media

Parents are in charge of setting limits on digital media for kids and teens six and older, the academy says. The amount of daily screen time depends on the child and family, but children should prioritize productive time over entertainment time.

For healthy kids, an average day includes "school, homework time, at least one hour of physical activity, social contact and sleep -- which is anywhere from eight to 12 hours for kids," said Chassiakos. "Whatever's left over can be screen time."

The academy agrees that digital media should never replace healthy activities, particularly sleep, social interaction and physical activity. In the press release, Dr. Jenny Radesky stated, "What's most important is that parents be their child's 'media mentor.' That means teaching them how to use it as a tool to create, connect and learn."

Kids and teens have access to thousands of apps, film streaming sites, video games and social media on multiple devices, from personal smartphones to public school-issued tablets.

"The environment of media has changed today," Chassiakos said. Many aspects of digital media are positive: it can be interactive; it facilitates communication; it allows people to create. Kids often view class lecture notes and do homework through a screen, she said.

However, parents have to talk to kids, especially teens, about the risks of digital media -- including "cyberbullying, engaging in s*xting, and being accessible to advertisements and online predators," Chassiakos said.

For smaller children, discussing advertisements on TV is important, the academy reports. Many products, such as sugary cereals and fast-food restaurants, are marketed to children, and parents should help kids understand that these foods aren't healthy choices.

"Even though the media landscape is constantly changing, some of the same parenting rules apply," Chassiakos wrote in the academy's press release. "Parents play an important role in helping children and teens navigate the media environment, just as they help them learn how to behave off-line."

Parents are children's main role models, so it's important for moms and dads to have healthy digital media habits. This means being conscious of setting down cellphones, turning off the TV and shutting laptops at night.

"Young children can tell when their parents' heads are always in their cells," Chassiakos said. The lack of attention from a parent can make "kids' levels of irritable behavior worse."

The academy recommends that families designate "media-free times together, such as dinner or driving, as well as media-free locations at home, such as bedrooms," according to the release.

With phones off the dinner table, families can have in-person conversations, which are very important for children's development. Parents benefit from media-free practices, too. Face-to-face interactions with family creates more intimate bonds, and tech-free bedrooms can promote better sleep, Chassiakos explained.

Keeping tech devices out of bedrooms is also a good way to monitor kids' digital media activity. Chassiakos recommends having children use computers in the living room, for example, to ensure they finish any online homework assignments before using entertainment media.

"This doesn't mean you can't play video games with your kids," she said. "What's most important is that families have media-free time, and when digital media is used, it's used mainly for communication rather than entertainment."

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