“Cognitive Behavioral Therapy for Binge Eating Disorder” was presented at the Minnesota Psychological Association’s First Friday Forum on January 8, 2016. Drs. Koball and Grothe focused on discussing diagnostic criteria for binge eating disorder, reviewed recent research on the efficacy of CBT for binge eating disorder, and described specific CBT skills using pertinent case examples. Finally, they offered information on behavioral weight management for individuals who are in remission from binge eating disorder, but who desire further weight-related intervention.

Binge Eating Disorder (BED) is characterized by episodes of eating in a discrete period of time (e.g., within 2 hours) a larger amount of food than what most people would eat in a similar period of time under similar circumstances (e.g., 4 bowls of cereal, 1 pint of ice cream). Additionally, individuals with BED experience a sense of lack of control over eating during the episode(s) (e.g., feeling that one cannot stop eating or control what or how much one is eating). Furthermore, to meet criteria for BED, binge eating episodes must be associated with 3 or more of the following: 1) eating much more rapidly than normal, 2) eating until feeling uncomfortable full, 3) eating large amounts of food when not feeling physically hungry, 4) eating alone because of feeling embarrassed by how much one is eating, and/or 5) feeling disgusted with oneself, depressed, or very guilty afterward. Finally, marked distress regarding binge episodes must be present to meet diagnostic criteria, binge eating must occur on average at least once a week for 3 months, and binge eating is not associated with recurrent compensatory behaviors (e.g., vomiting or laxative use; APA, 2013). Today, BED is more common in the U.S. than anorexia nervosa or bulimia nervosa, occurs in approximately 3-5 % of women and 2% of men, and is commonly associated with other mental health conditions including low self-esteem, borderline personality disorder, substance abuse, and depression (ANAD, 2012). Individuals who engage in binge eating often struggle to balance eating, and may cycle between periods of significant restrictive eating, episodes of binge eating, and severe guilt and shame.

The Society of Behavioral Medicine (SBM) and American College of Sports Medicine (ACSM) recently released a position statement calling for health plan coverage for exercise interventions for serious mental illness (Pratt et al., 2015).  The position statement states that, “The Society of Behavioral Medicine and the American College of Sports Medicine encourage legislation and policies for Medicare, Medicaid, and private insurers to reimburse exercise programming for people with serious mental illness treated in community mental health programs.”  Currently, exercise programs designed to treat mental illness are not reimbursable through Medicaid, Medicare, or private insurers.

Research indicates that exercise is related to improvements in both physical and mental health (Lobelo et al., 2014).  Specifically, lack of exercise is related to several health issues including increased risk of heart disease, hypertension, and stroke (AHA, 2015).  Regarding mental health, exercise is effective for treating depression (Cooney et al., 2013).  Furthermore, studies have found that exercise is just as effective as antidepressant medication for treating depression (Blumenthal et al., 2007).  Despite these benefits, only 20% of individuals with serious mental health illness exercise at the recommended levels to obtain these health benefits and over 80% are overweight or obese (Bartels & Desilets, 2012; NIH, 2013).  The recommendation is that healthy individuals engage in five or more day of moderate intensity physical activity for at least 30 minutes each session or three or more days of vigorous intensity physical activity for at least 20 minutes per session (Haskell et al., 2007).  Behavioral interventions are efficacious for increasing exercise among individuals with severe mental illness (Rosenbaum et al., 2014); however, these types of interventions are typically not reimbursed by health insurers.

1)  What is your background in psychology (e.g., education)?

I’m currently a student at St. Mary’s University – Rochester. I am working on my bachelors in psychology and plan to obtain my Master’s degree in Organizational Psychology.

I am so delighted to be the 2015 President of the Minnesota Psychological Association (MPA).  I truly believe I am your President, representing psychologists in Minnesota during a time of significant change in the delivery of healthcare across Minnesota.  Already in my 3 weeks as your MPA President, there has been a lot of buzz about the Minnesota January 2015 mandate pertaining to Electronic Health Records (EHR) and the Executive Summary of the Minnesota Mental Health Workforce Plan.

In the area of Electronic Health Records (EHR), MPA established an Electronic Health Records task force that has been very active in seeking to understand the demands of e-health so as to educate and make recommendations to our members and other mental health professionals.  MPA sponsored two education and training sessions on Health Reform and Electronic Records, in February of 2014 and in January of 2015, and psychologists continue to have many questions and concerns regarding privacy and security, as well as the information that needs to be included in an electronic health record.  This Minnesota Department of Health link provides some guidance for understanding this mandate and includes some recommendations for the adoption and effective use of EHRs.  This can be found at: Guidance for Understanding the Minnesota 2015 Interoperable EHR Mandate.

"Assessment and Treatment of Mood Disorders in Children and Adolescents” was presented at the Minnesota Psychological Association Friday Forum series on November 6, 2015.  Dr. Leffler focused on the following three areas: enhancing diagnostic skills related to mood disorders in youth, utilizing assessment strategies for identifying mood disorders in youth, and applying treatment techniques for youth with mood disorders.

Pediatric mood disorders, which include depression and bipolar spectrum disorder, are among the more severe childhood disorders. These disorders have been found to result in significant impairments in numerous areas including interpersonal interactions, communication patterns, academic and employment functioning, family engagement, and suicide.

It is hard to believe that 2015 is coming to a close.  My niece once reasoned about why time seems to fly by as we get older, “For a 5-year-old, one year is 1/5^th of your life; for a 45-year-old, one year is 1/45^th of your life!”  Time is definitely relative, and it seems to be speeding by.  Do you think we can extend the same relativity of time to the changes that the practice of psychology is seeing?

As graduate students, it seemed as if we were entering a profession that was well-established with time-honored and well-researched skills and practices to learn.  With each passing year, new discoveries in the connections between the human brain and behavior are found.  Over time the God-words of psychology transform from “eclectic” to “integrative;” CBT moves over for DBT; and, mindfulness and evidence-based practice seem to be dominant buzzwords.  Simultaneously, technology in our world is advancing at a rapid pace, and disruptive innovation is a term I believe we all need to understand.

1)  What is your background in psychology (e.g., education)?

I became interested in psychology as an undergraduate at UW-Eau Claire. I had the opportunity to be involved in research related to stimulant abuse in high school and college students and animal models of hunger. I went on to complete my MA at Bethel University and then my Psy.D. in Counseling Psychology at the University of St. Thomas. I conducted research related to child and adolescent mood and psychotic disorders and maternal depression at the University of Minnesota Department of Psychiatry during graduate school. I completed my pre-doctoral internship at the University of St. Thomas Counseling and Psychological Services, and went on to complete a 2-year post-doctoral fellowship in the Department of Child and Adolescent Psychiatry at the University of Minnesota Mood and Anxiety Disorders Clinic specializing in providing evidence-based treatments for child and adolescent mood and anxiety disorders.

The media commonly uses the term “psychopath” to refer to persons, generally criminals, who act outside of the moral sphere. They may be real, like Ted Bundy or Charles Manson, or characters such as Hannibal Lector or Dexter Morgan – the lines between the fanciful and the factual can become blurred in our imagination. However, psychopathy is an important concept in forensics, and is increasingly prominent in mental health studies, and thus deserving of measured consideration.

Characteristically, a psychopath is defined as having such traits as charming, manipulative, deceitful, emotionally shallow, callous, impulsive, irresponsible, blasé, extravagant, and directionless (Hare, 2003). While the prevalence of psychopathy among the general population is estimated to be around 1-2% (Newman & Hare, 2008), it is thought to exist in around 30% of prison populations (Hart & Hare, 1997). Mental health professionals must be aware of several key points when dealing with the label of psychopathy.

A recent development in information technology is the advent of Google glasses.  These are smart goggles that allow streaming of data via the internet onto a sector of the lens and linked to a GPS embedded in the frame.  Imagine walking by any place of business and with a glance at the storefront accessing the company website (restaurant menu, movie marquee with IMDB reviews) or being able to encounter a bird in the wild and with instant photo with feature recognition see all the information you want about that bird displayed in your field of vision.  Pretty cool!   Without waiting for this next best thing to emerge, we already have instant access to more information than was available in the great library of Alexandria (or any historical repository of human knowledge).  If we wish, we can allow the information to roll over us in a continuous flow.  But is there a cost to wading through this incessant stream?

Although our brains are quite adaptable and resilient, they require the full cycle of a night’s sleep to prune unnecessary synaptic connections and consolidate and strengthen the connections of new knowledge.  They also require stillness and silence to find the depth and meaning in what we absorb.  For us (and our children) these moments of stillness are disappearing as rapidly as ice sheets in the polar regions.  I found a New York Times article by Pico Ayer to be a compelling reminder of the deep value of cultivating silence and stillness.  http://www.nytimes.com/2012/01/01/opinion/sunday/the-joy-of-quiet.html?pagewanted=all

In Minnesota, 2015 will go down in history as a good year for mental health.  The 2015 legislative session provided $51 million in new funding for a number of mental health initiatives.  An excellent summary of the 2015 Minnesota Legislative session can be found on the following link from the Minnesota Chapter of the National Alliance on Mental Illness:

http://www.namihelps.org/2015-NAMI-Minnesota-Legislative-Summary.pdf

Jerrod Brown, Adam L. Piccolino, Anthony Wartnik, Anne Russell & Tina Andrews

Fetal Alcohol Spectrum Disorder (FASD) affects the lives of millions of individuals in North America and is associated with a vast array of physiological, psychiatric, and neurological consequences that can significantly impair behavioral, emotional, developmental, and social functioning.  Our experience tells us that individuals with suspected or confirmed FASD are likely to come in contact with mental health inpatient and outpatient providers on a regular basis. As such, mental health professionals are strongly recommended to participate in continuing education on FASD. A more comprehensive understanding of FASD among mental health professionals should lead to improvements in identification, intervention, and treatment strategies, as well as an informed perspective when making recommendations on child welfare, custody assessments, competency to stand trial evaluations, and diagnostic and treatment planning. The overall goal of this article is to provide a review of FASD for mental health professionals.

1)   What is your background in psychology (e.g., education)?

I obtained a bachelors of science, majoring in psychology at Winona State University and my doctorate of clinical psychology from the Minnesota School of Professional Psychology (MSPP).

MPA at APA:  Photos from the Front

The first time I attended the American Psychological Association convention was when I was still a graduate student, and I was presenting a poster session of research I had done with my academic advisor.  That was far too many years ago.  Fast forward to 2015, and with many years of life behind me, I attended the APA convention for the second time this past August.

Like 12,000 other psychologists, I boarded a plane to Canada, anticipating that I would experience the APA convention a little differently after so many years in private practice.

1)      What is your background in psychology (e.g., education)?  

As an undergraduate student at Marquette University I majored in Psychology and English, and I went on for my M.A. and Ph.D. in Counseling Psychology at the University of Akron in Akron, Ohio.

2)      Describe your current occupation and any involvement in the Minnesota Psychological Association if applicable.  

Professor Pat Frazier has been selected to receive the Charlotte Striebel Equity Award from the University of Minnesota. The award  “… annually recognizes a University of Minnesota faculty or staff member of any gender who goes above and beyond daily responsibilities to promote access for the common good, to undo bias and discrimination, or to build capacity for diverse and equitable campus communities” (this description is from the University Women’s Center website). Congratulations to Pat on this well-deserved honor!

Huntington’s disease (HD) is a terminal neurodegenerative disorder, which affects cognitive, motor and behavioral functioning (Abel & Zukin, 2008; Lin & Beal, 2006). The disorder has long been suspected to be heritable and in 1993, after decades of research, scientists identified the causal gene.  The genetic mutation is transferred to offspring by a single gene from one parent.  Carriers of the Huntington gene mutation have a 50% chance of passing on the mutation to every child (Andersson, Juth, Petersén, Graff, & Edberg, 2013).  A laboratory blood test verifies a positive diagnosis.  Additionally, research suggests that the onset and severity of Huntington’s disease are indicated by the number of repeated CAG counts on chromosome 4 (Vassos, Panas, Kladi, & Vassilopoulos, 2008).  Higher numbers of repeats indicate the possibility of earlier onset and more severe declines in functioning.  The aim of the current article is to provide brief educational material regarding this disorder, to present accessible information for professionals working with individuals who are affected by Huntington’s, and to encourage additional consultation regarding this topic.

Anyone who is a carrier of HD will eventually exhibit symptoms of the disorder (Brouwer‐DudokdeWit, Savenije, Zoeteweij, Maat‐Kievit & Tibben, 2002).  Most individuals with Huntington’s disease are diagnosed in their 30s-50s, although rapidly progressing juvenile forms of the disease can be diagnosed during the early adolescent years (Scerri, & Cassar, 2013). In each of these versions, cognitive changes may begin up to 15 years early (Nance, Paulsen, Rosenblatt, Wheelock, 2001).  Those suffering from juvenile onset HD tend to have a larger range of clinical symptoms than those suffering from adult onset HD.  These clinical symptoms can include an increased likelihood of seizures, oral motor dysfunction, and increased behavioral disturbance (Gonzalez-Alegre & Afifi, 2006; Nance & Meyers, 2001).  The expected lifespan for individuals suffering from HD is generally 15-20 years post-diagnosis (Krobitsch & Kazantsev, 2010).

Huntington’s disease is typically first indicated by the declines in the ability to emotionally regulate, organize thoughts or spaces, and navigate complex decisions.  These symptoms make early diagnoses difficult.  The first visual symptoms characteristic to HD is chorea. Chorea is an uncontrollable, jerky “dance like” movement (Nance & Meyers, 2011). Individuals displaying chorea movement may appear to have a tic, twitch or appear intoxicated due to progressive loss of voluntary movements.  Eventually chorea becomes constant and has a significant effect on an individual’s metabolic rate such that weight loss becomes common during the later stages (Krobitsch & Kazantsev, 2010).

“Managing Difficult Patients in an Era of Interprofessionalism” was presented at the Minnesota Psychological Association First Friday Forum series on June 5, 2015, by William Robiner, Ph.D., A.B.P.P., L.P.

Who are difficult patients and why should health professionals be concerned about managing them?  Like beauty, difficulty lies in the eye of the beholder.  Patients might be labeled “difficult” when health professionalshave difficulty working with them (Wessler, Hankin & Stern, 2001).  In health care, patients may be considered challenging if they are “interpersonally ‘difficult,’ psychiatrically ill, chronically medically ill, or lacking in social support (Adams & Murray, 1998).”  Difficult patients are those with whom health professionals feel frustrated, uncomfortable, ineffective, or threatened (Duxbury, 2000) or whose disorders do not respond to treatment (Pollack, Otto, & Rosenblum, 1996). Because health professionals invariably will encounter difficult patients they need to be prepared to manage them so as to provide quality health care and to cushion their impact on individual clinicians and the system.

Behavioral aspects that lead a patient to be seen as difficult include being demanding, blaming, unappreciative, defensive or angry.  Other factors are perceived risk of abuse, violence, suicide, litigiousness, or making reports to regulatory boards. Various pejorative terms have been used with reference to difficult patients, including “train wreck,” “crock,” “frequent flyer,” and “heart sink” (i.e., patients who cause clinicians’ hearts to sink when they encounter them).

Over the past year or so, there have been times when I felt overwhelmed by all of the changes to the practice of psychology that we are experiencing with our evolving health care system.  Frankly, occasionally I can find myself dropping into what I call “an Eeyore frame of mind.” Remember Eeyore from Winnie the Pooh?  He was the doomsday donkey who could turn any joyful moment into something about which to feel sad or gloomy.  So, when I first learned that psychologists, like other health care professionals, were going to be required to use electronic health records, I did not see this as something that was making me leap for joy.  When I learned that Medicare was going to be incentivizing my work only if I began to report PQRS measures to somehow prove that my work was effective, I balked.  And, when I learned that there was a monumental shift on the horizon toward population-based, value-driven payment models, I could hear my inner Eeyore groan!

I have been in private practice since the beginning of my professional life as a psychologist.  With few exceptions, I have been my own boss, owning a small business like the vast majority of members of the Minnesota Psychological Association.  So to look toward the future of private practice as the Affordable Care Act and HIPAA rules seemed to be taking over, and to hear Eeyore’s voice saying, “Oh, well, I guess it’s all for naught,” was not a joyful moment for me.  And then, thankfully, my inner Tigger kicked in:  “Life is not about how fast you run or how high you climb but how well you bounce,” I heard him say!  I want to share with you one of the books that has helped me to discover the “bounce” I needed to feel hopeful and joyful about the future of private practice and about the future of the business of psychology.

Dave Verhaagen and Frank Gaskill, two doctoral-level psychologists living, working and thriving professionally in North Carolina, founded a psychology practice that is riding the waves of disruptive innovation in remarkable ways.  Disruptive innovation is a term that is used to describe what happens when traditional ways of doing things in an industry become obsolete because of technological advances.  Think cell phones replacing land lines, iPods and mp3 players replacing record albums, or the Kindle replacing hardcover books.  The health care industry is experiencing an explosion of potentially disruptive new technologies, and traditional models of private practice are likely to experience this as well.  Are you ready?  Is your inner Tigger bouncing?  If your answer to these questions is “No!” then I strongly encourage you to read Verhaagen’s and Gaskill’s book, How We Built Our Dream Practice: Innovative Ideas for Building Yours (2014).  If your answer is “Yes!” also read the book and be inspired and excited.

The MPA Membership Committee hosted a reception in June for newly licensed psychologists who earned their license within the past two years. The reception took place at the home of Dr. Trisha Stark, and was a huge success! The goal of this reception was to invite newly licensed psychologists to become familiar with how MPA advocates for psychologists in our state, and hopefully convince them of how important it is for psychologists to support their professional association by becoming members.

The program included brief talks from Dr. Scott Fischer, chair of the Minnesota Board of Psychology, Dr. Robin McLeod, president-elect of MPA, Dr. Ken Solberg, co-chair of MPA’s Membership Committee, and Dr. Trisha Stark, chair of MPA’s Legislative Committee. New licensees were able to hear about how MPA’s primary purpose is to serve the interests of psychologists in Minnesota, and does so via advocacy, ethics consultations, continuing education opportunities, career growth, and networking, amongst many other benefits of membership.

This reception of 50 attendees drew new licensees locally, as well as from the Iron Range, Duluth, and some who even had moved to Minnesota recently from the east coast. Our guests enjoyed networking with each other, MPA Membership Committee members, Division chairs and co-chairs, and MN Board of Psychology representatives.  Newly licensed psychologists are important members of our professional community.  It is important for MPA to understand their needs, so that we can support their growth and get them involved in MPA. We look forward to making this an important annual event. Thanks very much to the always generous Trisha Stark for allowing us to host this event in her home!

Do you know your blood pressure or your cholesterol score?  Do you know your own ACE score?  Adverse childhood experiences (ACEs) are stressful or traumatic experiences, including abuse, neglect, and a range of household dysfunction such as witnessing domestic violence, or growing up with substance abuse, mental illness, parental discord, or crime in the home. ACEs are strongly related to disruptions in development and have been linked to a range of adverse health outcomes in adulthood.  The ACEs questionnaire is available in 7 languages and can be found here.

So why should psychologists measure ACEs across the age span and why is something that happened in childhood important in my work with adults? 

The Center for Disease Control’s Adverse Childhood Experience Study – The ACE Study – suggests that adverse childhood experiences (ACEs) are associated with a number of long-term negative health outcomes and risky behaviors.  ACEs are associated with cancer, diabetes, depression, suicide, ischemic heart disease, smoking, drug abuse, obesity, sexually transmitted infections, and adolescent pregnancy.  In a time where treating the health of our population is getting a lot of emphasis, the recognition that a higher ACEs score is associated with a higher risk of negative health consequences is likely to improve efforts towards prevention and recovery.