Psychology Services of Alaska

Winter Resilience: How Alaska’s Harsh Weather Can Strengthen Mental Health in the New Year

Mon, 09 Feb 2026 17:12:45 GMT

February in Alaska is a season of quiet beauty and steady strength. Snow-covered landscapes, crisp air, and longer stretches of calm invite a different rhythm of life. While winter here is powerful, it is also deeply grounding, offering unique opportunities to nurture resilience, clarity, and emotional well-being as the New Year continues to unfold.

At Psychology Services of Alaska, we see winter not as something to endure, but as a season that can support growth, balance, and inner strength.

Strength Grows in Steady Seasons

Alaska’s winter naturally encourages resilience. Daily routines continue despite the cold, and that consistency builds confidence and adaptability. Each day brings small accomplishments that reinforce self-reliance, patience, and problem-solving skills. These experiences quietly strengthen mental endurance and remind us of our capacity to adjust and thrive in changing conditions.

Resilience is not about pushing through hardship. It is about recognizing your ability to meet life where it is and respond with intention.

A Season for Reflection and Renewal

February often offers a slower, more intentional pace. With fewer distractions, winter provides space to reflect and reset. This is an ideal time to reconnect with yourself, notice what feels nourishing, and gently reassess goals for the year ahead.

This season supports thoughtful reflection rather than pressure. Small adjustments made now can lead to sustainable, meaningful changes that support long-term mental wellness.

Embracing Light, Connection, and Routine

Even during winter, moments of light and warmth are plentiful. Consistent routines, movement, and social connection play an important role in emotional well-being. Simple, intentional habits can have a powerful impact on mood and energy.

Helpful winter practices may include:

Maintaining regular sleep and wake times
Enjoying time outdoors when possible, even briefly
Staying physically active in ways that feel enjoyable
Connecting with friends, family, or community
Appreciating small comforts and moments of calm

These practices help create stability and reinforce a sense of balance throughout the season.

Wellness Grows With Support

Winter also reminds us of the value of connection. Seeking support is a positive and proactive step toward mental wellness. Therapy can provide space for reflection, skill-building, and emotional growth, whether you are navigating seasonal transitions or simply seeking added support during this reflective time of year.

February is a wonderful moment to invest in your mental health and set a supportive tone for the months ahead.

Moving Forward With Confidence

Alaska’s winter is strong, steady, and beautiful, much like the resilience it helps cultivate. Each day offers opportunities to build confidence, practice self-care, and strengthen emotional well-being. By embracing the season with curiosity and compassion, winter can become a foundation for a healthier, more grounded year.

If you would like additional support this winter, Psychology Services of Alaska is here to walk alongside you. Together, we can help you move forward with clarity, resilience, and confidence—well beyond the winter months.

Healthy Mindset During the Holidays: Nurturing Your Mental Health in Alaska’s Winter

Fri, 24 Oct 2025 16:24:00 GMT

The holiday season in Alaska is a time of beauty and contrast. Snow-covered mountains, crisp air, and the sparkle of lights bring a special kind of wonder, yet for many Alaskans, this season also comes with challenges. The long, dark days, isolation from loved ones, and financial or emotional stress can weigh heavily on our mental health.

At Psychology Services of Alaska , we understand that maintaining a healthy mindset during the holidays requires care, awareness, and compassion, especially in our unique northern environment. Here are some ways to nurture your mental well-being this winter:

1. Embrace the Light — Literally and Emotionally

2. Set Realistic Expectations

The holidays often come with pressure to host, buy gifts, or to meet family expectations. Remember that it’s okay to simplify. Focus on what truly matters to you this season. Let go of perfection, and give yourself permission to rest and recharge.

3. Stay Connected — Even From Afar

Winter storms and distance can make travel difficult, but connection doesn’t have to stop. Schedule virtual calls, join local community gatherings, or volunteer in your neighborhood. Isolation can increase feelings of sadness, even a short conversation can make a difference.

4. Honor Your Emotions

Not everyone feels joyful during the holidays and that’s okay. Grief, loneliness, or stress can surface more strongly this time of year. Allow yourself to feel what you feel without judgment. Talking to a trusted friend or mental health professional can help you process those emotions in a healthy way.

5. Keep a Balanced Routine

When the days feel short, it’s easy to lose track of healthy habits. Try to maintain consistent sleep, eat nourishing meals, and get some physical activity, even gentle movement like stretching or a walk in the snow. These small actions help stabilize mood and energy.

6. Practice Gratitude and Mindfulness

Even in the coldest months, there is warmth to be found. Notice the beauty around you, a quiet snowfall, a shared laugh, the glow of the Northern Lights. Practicing mindfulness and gratitude helps ground you in the present moment and reduces stress.

You’re Not Alone

If you find the holiday season especially difficult, please know that help is available. The team at Psychology Services of Alaska offers compassionate, professional support to help you navigate seasonal stress, anxiety, or depression. You deserve to feel balanced, supported, and hopeful this holiday season and beyond.

The post Healthy Mindset During the Holidays: Nurturing Your Mental Health in Alaska’s Winter appeared first on Psychology Services of Alaska .

With limited daylight, it’s important to make the most of the sun we have. Step outside during daylight hours, even briefly, to get natural light exposure. Light therapy lamps can also be a great investment during Alaska’s darker months. Emotionally, focus on sources of light in your life like relationships, gratitude, and simple joys. Even small acts of connection can brighten your mood.

Mental health for first responders | Line One

Fri, 12 Sep 2025 15:34:00 GMT

First responders run toward danger when the rest of us run away, but the weight of those moments doesn’t just disappear. Trauma-informed therapy helps firefighters, police officers, EMTs, active military and veterans process the invisible wounds they carry. This specialized care understands the unique pressures of the job, offering safe, confidential support that respects their experiences. On this Line One, host Dr. Justin Clark and his guest discuss mental health in first responders.

HOST: Dr. Justin Clark

GUEST: Paul Gaines Jr. – Psychology Services of Alaska

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Click Play below to listen to the audio from the live show.

Transcript:

Dr. Justin Clark: Welcome to Line One, Your Health Connection. I’m your host, Dr. Justin Clark. On today’s program, we will be discussing the complexities of mental health in our first responders and healthcare personnel.

First responders run toward danger when the rest of us run away. In the field, this could include police officers, firefighters, EMTs, as well as our active military and veterans. On the hospital side, it includes doctors, nurses, and hospital staff. These professionals carry the weight of the community on their shoulders, but who carries them? The truth is, the stress, trauma, and long hours don’t just disappear when the shift ends. It follows them home, affects their health, and can weigh on their family. It can lead to unhealthy habits and self-destructive coping mechanisms. That’s why trauma-informed therapy for first responders and healthcare workers is so important.

Therapy is not about weakness. It’s about resilience. It’s about finding tools to manage stress, process trauma, and stay strong for the people who count on you.

Today, I am very grateful to have Paul Gaines, Jr. with us today from Psychology Services of Alaska. Paul is a licensed clinical social worker and a licensed professional counselor who focuses on trauma-informed therapy. Paul walks the walk. As a former EMT and firefighter, he understands firsthand the pressures and consequences of being a first responder. Paul, welcome to Line One, Your Health Connection.

Paul Gaines Jr.: Thank you, doctor. It’s good to be here.

Dr. Justin Clark: It’s fantastic to have you. I’m really excited about this show because I was thinking, I graduated from medical school in 2006. So, I’ve been a doctor for almost 20 years, and residency was the first 5 years after medical school, and that was slightly traumatic. That was a unique experience to go through. In 5 years’ worth of time, I worked the equivalent of 10 years in hours. My first year was before they instituted the 80-hour workweek rule for us, so I was working between 100 and 120 hours a week, which was personally very, very challenging for me and for my family. We experience in the health industry and the first responders too, so much difficulties related to our job, and yet we still have this calling to do it. So, I’m really interested to talk to you today about your techniques and thoughts behind treating these patients.

What I would like to start with is to give our listeners a sense of who Paul Gaines Jr. is, where you came from, how you got into this line of work, a little bit about your history.

Paul Gaines Jr.: Sure. I came from Newport, Rhode Island. I’ve been in Alaska since 2014. I took a break in 2016 to start my practice and came back up here. I think most kids want to be firefighters. The police parade would go by my house every day in Newport, Rhode Island, and you see the big engine coming through, and these giants in their firefighter uniforms, and we all kind of fantasize about being that one day. When I came to Alaska, I was wondering how I could get involved in the community, and a friend said, “Why don’t you become a volunteer firefighter?” That’s pretty much what started it, and everywhere I’ve moved I try to find a volunteer house and lended my experiences there. It’s a great career. I’ve met some of the finest people I’ve ever met in fire departments, and so I was lucky to be around some great individuals.

Dr. Justin Clark: Great. You came to Alaska in 2014. At what point did you start transitioning your career into professional counseling?

Paul Gaines Jr.: I’ve been a therapist – I earned my Master’s Degree in 2002 and then got my MSW in 2013. I’ve always wanted to be a therapist. Actually, I wanted to be a therapist in the military, but they didn’t accept LPCs, and so I had to get an MSW but by the time that I did that, I was working with veterans in the University of Connecticut. I realized I would probably be more effective on the outside than on the inside when they were telling me about maybe the lack of confidentiality that therapists have with command staff. So, I morphed away from joining the military and started my own practice, and started seeing veterans and first responders through that.

Dr. Justin Clark: Your experience as a first responder through EMT and firefighter, I’m sure, played a crucial role in your ability to work with these individuals.

Paul Gaines Jriuy.: It did. First thing I learned is that I can’t provide therapy to myself, that I need help as well, because we see things, and not only do we see things, but things happen to us as well. We get injured, we have firefighters that sustain injuries, and then there’s the emotional toll of the things that we see shift to shift, day to day, year to year, that if we don’t take care of ourselves, those things pile up. We do a really good job of locking them away and forgetting about that because once we’re off shift, we have to take care of our families, we have other things we need to do before we go back to the fire department. We are conditioned to help everyone else and putting our own needs at the bottom of that priority list. But, it has a toll. It takes a toll and then it starts to come out in ways that we don’t expect and in ways that we never thought possible. By that time, it’s not too late, but that is the time when we realize that we really need to talk to someone about this.

I want folks to get ahead of the game and talk to someone before it gets to that point. Before you cause damage either to yourself to your career or to your family and friend relationships.

Dr. Justin Clark: Yes. It’s very easy to think that you’re stronger than those feelings, that you see this on a daily basis, but it doesn’t really impact you, or it doesn’t affect you until it does. You have to sort of have a release, or you can start to develop some really bad habits.

Paul Gaines Jr.: We do develop bad habits, but we’re also adrenaline junkies. We don’t do a good job of sitting down and processing what we’ve gone through and he we are now, it’s September, it’s the moose hunt. It’s easy to avoid talking about traumatic stress when we can go off-grid and camp with our buddies and do all the things that prevent us from addressing those core issues that will affect us down the line.

Dr. Justin Clark: Trauma-informed therapy, what does that mean in the context of a first responder?

Paul Gaines Jr.: Trauma-informed therapy is essentially just a collection of evidence-based therapeutic approaches that address and reduce the impact that traumatic experiences have on our wellness. It’s reduced by having the client employ behaviors and reframing their thoughts regarding their trauma so they don’t re-traumatize themselves.

Dr. Justin Clark: Let’s take police officers, firefighters, because that’s what you are most familiar with. They see horrific things sometimes on a daily basis when they’re on their shifts. How is the trauma that someone might experience from emergency work different than other types of trauma?

Paul Gaines Jr.: There are essentially 4 categories. There is the repeated exposure to trauma. When we are on a shift, we might have several calls, all of which are a different type of traumatic event as opposed to somebody who might have one or two in their lives and I’m not here to mitigate the impact of people that have daily trauma in their lives, but first responders, we are expected to see these things and to go through the process of helping people go through the worst days of their lives.

There’s also the cumulative stress and the critical incidents. It’s not just one single traumatic event. You could have a lot of sub-threshold traumatic events that build up over time.

Then, there are the moral injuries. What’s the worst thing we can see of someone dying, and then go down the strata of what’s the next worst thing every time someone experiences that. That’s a moral injury that’s done to our psyche and that has other types of effects. We can become desensitized to the suffering of others. We can become desensitized to the suffering of people and our family. If we were in a car accident and there were tremendous injuries, then we go home and our partner or our child gets hurt. To them, that’s a serious issue; to us, by comparison, it’s nothing, and so we can run the risks without being empathetic or be sensitive to the suffering of people who aren’t in a life-threatening situation.

Then there are cultural barriers. We like to tough it out. We don’t want to give the impression that we are hurting. For one, other folks in the department might think that we are weak or that we are incapable of handling the job, so we button it down. That culture can prevent people from seeking help, and they will button it down and act like nothing is wrong until something bad happens to them.

The impact on personal relationships, when first responders come and talk to me, they won’t just talk about the shift. They talk about their family, they talk about their children. They talk about the impact the job has, their inability to do things with their children, or the need to work overtime so they can help make ends meet. When folks come in, they don’t just talk about the job. They talk about everything that impacts their wellness, and therapy can help with all of that.

Dr. Justin Clark: Yes, this is Paul Gaines from Psychology Services of Alaska. We’re talking about mental health, particularly in first responders and health care workers. So Paul, I’m a healthcare worker, I’ve oftentimes thought about – some of the stuff we’re dealing with, this is life and death on a daily basis, sometimes it’s heavy. What barriers prevent people like me, first responders and healthcare workers, and police officers from seeking therapy?

Paul Gaines Jr.: Stigma. If I work in a healthcare facility, I might be reluctant to let another healthcare peer know that I’m going into therapy or that I’ve got trauma or some major depression because of what I’ve experienced on the job. There’s also the avoidance – “I’ve got other things to do”, “I don’t have time for therapy. I got to get home and spend time with the kids. I don’t have time for therapy. We’re going fishing for the weekend.” In Alaska, it’s really easy to find things to do rather than sit in therapy. It’s a beautiful state. There are a lot of reasons to get out there.

For some people, for a lot of people, that is their therapy. If that works for you, then that’s fine, but the mountains can’t give us skills to mitigate stress. They can’t teach us how to improve our sleep hygiene. They can’t inform us how to reduce our drinking when we get stressed. It’s helpful, but it’s not the only thing that you can do.

Then there’s the lack of resources and referral programs. It would be great if we had a facility that dealt exclusively with first responders, similar to what the military and veterans have both with the Cohen Clinic, which is a phenomenal resource. The Chris Kyle Clinic, the VA, and there are lots of places where veterans can go to get support. First responders, we don’t have it.

A lot of therapists are well-trained in trauma, but first responders have a different culture, a different mindset, and we are wary of a lot of things. The most important thing for our first responders is seeing safety. Can I trust this person? If I can’t trust him, who do I go to? I’m going to go out and go hiking. I don’t really want to share this with anyone because I don’t want to look vulnerable. That avoidance and that stigma compounds our own trauma.

Dr. Justin Clark: We have a call here. Mary is calling from Wasilla. Welcome to Line One, Mary.

Mary: Hi. I was calling about my husband. He is actually was a 911 dispatcher and I think that something that’s not like super talked about is the mental health that they have to go through and a lot of times they’ll get a call about having to give instructions to someone about CPR or they’re having to help someone give birth from the back seat, but then they don’t know the outcome of what happened because once the first responder gets there, they hang up and they’re like “I hope that person’s okay, because I don’t know”. So I think that’s something that my husband really struggled with. It’s like he had to hear people go through suicidal ideation on the phone and then not really know if anything good came of it.

Dr. Justin Clark : Yes. That lack of resolution is probably a thing just all by itself, not just the trauma of hearing this sort of thing, but that lack of resolution. Thank you for your call. Paul, what are your thoughts about Mary’s comments about 911 dispatchers?

Paul Gaines Jr.: Absolutely, there’s a lot of survivor’s guilt that goes on where we lend our support to someone, first responders show up, and dispatch disconnects the call. The lack of closure is something else that can be traumatizing for folks. “I don’t know what happened,” and so there’s no closure, there’s no…the circle hasn’t been complete on that call, and so those are tough. Thank you so much, Mary, for calling because folks don’t recognize and realize the impact that 911 calls have on 911 dispatchers. It’s fantastic that you called. I have not worked with any dispatchers, but I would certainly be open to that as well. Without the dispatchers, we don’t get the calls, and the dispatchers not only have to help the client, they also sometimes have to help us get to where we’re going because in rural Alaska, the caller might be giving landmarks to the dispatch and then the dispatch relays it to our driver. They have a tremendous role because without the dispatchers, we don’t get there in time.

Dr. Justin Clark: That sort of stress that they are taking on seems to me to be a very difficult thing to handle.

Paul Gaines Jr.: Yes and they have to be calm and not get drawn into the energy of the event and it takes a special person to do that because I don’t know a lot of folks who could listen to this call and not want to jump out of their seat and try to do more than just help that person try to stay calm and get them through the process of administering first aid before we show up.

Dr. Justin Clark: Before we take a break, Paul, for someone like a 911 dispatcher, let’s discuss the lack of follow-up or the lack of resolution. What would be the first steps in talking to someone like this? What sort of therapeutics would you start with or recommend?

Paul Gaines Jr.: I always tell clients that therapy is doing things that are uncomfortable and unfamiliar, and if you’re doing the uncomfortable, unfamiliar thing, you’re moving away from the thing that is familiar and maybe not productive. Recognizing that we don’t have closure is difficult to identify, but that is also the most helpful aspect of my work if I were working with the dispatch. You realize you’re not going to know the outcome, and you have to find a way to be okay with that. How can I be okay with not being okay? I think that recognizing that and practicing those mindfulness exercises, when we wonder what’s going to happen, we’re putting ourselves in the future – boy, what’s going to happen? I’m nervous about what’s going to happen. If we recognize that we don’t know what’s going to happen, that’s practicing being more mindful and present in the moment. Be okay with not being okay, with what the outcome is on that call.

Sometimes in therapy, people say, “That’s okay. Things will be okay”. Well, sometimes things aren’t okay, and we have to recognize that despite all of our efforts, we aren’t going to know the outcome, and we have to be okay with that. We have to be okay with knowing that we’re not going to know what happens.

Dr. Justin Clark: With that, we’re going to take our first mid-break here. You’re listening to Line One, Your Health Connection. After the short break, we will continue our discussion on trauma-informed therapy for first responders with Paul Gaines, Jr. from Psychology Services of Alaska.

Welcome back to Line One, Your Health Connection. I’m your host, Dr. Justin Clark. I’m joined today for a discussion on trauma-informed therapy for first responders, police officers, firefighters, and health care workers with Paul Gaines Jr. from Psychology Services of Alaska.

We have a few calls coming in, and one of them looks to our next topic, which is discussing how therapy may help with common challenges such as burnout. I would like to welcome Scordino, from Anchorage, to Line One. Welcome Scordino.

Scordino: Hey, Dr. Clark, thank you so much for taking my call.

Dr. Justin Clark: You’re welcome. I see you have a question, maybe about burnout? Tell us how we can help you.

Scordino: I guess it’s more of a sort of pontificate upon because one of the things that show up repeatedly in the literature is about moral injury and moral hazard for mostly within the healthcare community, about the lack of resources that we have to provide for our patients whether it’s the lack of substance abuse options for these people – housing options, home, healthcare options more frequently sending them back out and being like, i hope for the best because we have nothing that we can offer them from a medical perspective and what they really need is wraparound support and they frequently don’t have those resources. If it comes to moral injury that many of us experience within the healthcare community, and I’m sure that’s true for obviously other first responders as well as the police, who frequently are left wondering, what can I actually do to help this individual who truly does need help, but I have limited resources that I can truly help them with. Definitive question, but I’d be interested in your thoughts on that, and how do we move forward with that, because it does remain a persistent issue that comes up repeatedly in every single burnout, say at least, within the physician and nursing community.

Dr. Justin Clark: Yes. Scordino, thank you for your call today. We’ll take the answer off air. So, Paul, in a healthcare setting, we struggle with this. When I take trauma calls and stuff, and sometimes people come in and homeless people or just other people, we have nowhere to send them after the hospital, and it’s like you push them off and hey, good luck. But man, that does weigh on you because you see these people come back and they go out and they fail because they don’t have the resources. They’re leading to that burnout feeling. What are your thoughts on what Scordino has to say?

Paul Gaines Jr.: Anyone who works in this field, either in the healthcare setting or as a responder, shares that pain, and it’s heartbreaking. We do the best we can, but we know that we are sending people back into an environment that’s going to cause a return of our service, a return of our needs. All we can do is the best we can. We know that Alaska is woefully short on resources for a lot of different populations, but as long as we know that we have done the absolute best we can, we’ve treated this person with the utmost respect and compassion, knowing that they’re going back into an environment that is neither compassionate nor supportive of them. For that brief moment, we can realize that we have given them – we’ve been humane to them. We’ve restored, even for a short time, their belief that kindness does exist. That’s a small consolation for a lot of us, but sometimes the best we can do is the only thing we can do, which is to offer compassion and support and ease their suffering in the best way we can, knowing that we’ll probably see them again.

Dr. Justin Clark: You can’t always impact the system on a system level, but what you can do is impact your own care and how you treat people. So, reframing the focus on that sounds like one aspect that you would work on.

Paul Gaines Jr.: That’s why it’s important for us to make sure that we are not becoming desensitized to the suffering of others because of the trauma that we are experiencing. That’s really where therapy comes in because it helps us restore empathy both within ourselves and the empathy that we can give to other people. But once we’ve gone to the point we are so desensitized to suffering, someone comes in, like I said before, with a minor injury, maybe we won’t be using all our resources to give them compassion and support. Maybe we’ll make a comment, “Oh really, it’s nothing, it’s just a couple of stitches. Get over it.” But for them, that could be a highly traumatizing event. Making sure that we are always empathetic for every call ,regardless of the nature of the injury.

Dr. Justin Clark: Thank you for your call, Scordino. We have another call from Paul in Fairbanks. Paul, welcome to Line One.

Paul: Hi. How are you today?

Dr. Justin Clark: Wonderful. How are you? What can we talk about for you?

Paul: Just caught me off guard hearing this broadcast this morning. I’m originally from Massachusetts and medically retired, in stable environment. It was 2003, I had an injury from fighting a fire that stopped me from doing what I love and in 2019, 22 years of being a paramedic, 30 years of being a paramedic [unclear] how to get my head straight and it’s nice to hear there’s someone else out there trying to look at first responders because mostly the culture is we don’t talk about what goes on in the job and a part of that needs to change. I just want to say thank you for having someone out there to help our first responders.

Dr. Justin Clark: Well, Paul, thank you for your comment today, and thank you for everything that you’ve done for all those years and all those people that you helped. We appreciate your call today. Let me ask you this first before we get to our next call. How do you deal with negative versus positive perception in first responders? Let me qualify that. You are a fireman; people are happy to see you show up. They call you and you show and you’re there to help, and maybe that’s in an EMT standpoint or putting out a fire, you know, you are kind of this hero for the moment. Then on the flip side, police officers, some people may be happy to see them, but a lot of people may not be happy, and this is a negative perception out there. Especially in the last few years. Defund the police and all of this. That must just weigh heavily on the actual police officer. How would you work with people on this negative versus positive perception?

Paul: Good question. My father was a police officer, and towards the end of his career, that’s when public shift reels badly into negative towards police officers. Honestly, that is why I chose to go to the fire department and just because I didn’t want to deal with that negative persona that goes along with law enforcement. Likely wrong,

Dr. Justin Clark: Thank you, Paul. Appreciate that. Paul Gaines, what are your thoughts on that negative versus positive perception?

Paul Gaines, Jr.: Police have it much harder than firefighters and first responders. Recently, we have had incidents where firefighters and EMTs are ambushed, but with police, they are often referred to as the bad guys. I don’t really like that. That’s not fair. These are folks who are putting themselves in harm’s way much more regularly than firefighters and EMTs. No one has ever written a song like F the fire department. To hear that, it’s wow, it’s a heavy toll. I had not worked with many police officers. In my experience, the police officers who work are coming in primarily for family issues and not work-related issues. I think that there are also services in police departments to deal with their stressors there.

We got to get through these stereotypes of all kinds, where they are bad and these people are good. All people are inherently good, and for police officers to be at the broken end of the bottle just because they want to serve their community and do the right thing and keep people safe, it’s tragic how people perceive the police. These are folks who want to do well, and they do do well. So the acts of the few affects the ones that I’ve seen. Even though they are coming in and talking to their families, they know that when they go to a call, is someone going to jump them, or someone going to say something to them, or try to spit on them, or do something harmful to them. Fire and a lot of first responders don’t have that, and so I think that reducing the stigma that people have against the police is something that all of us need to start doing.

I did want to say something about Paul, the firefighter. I want to thank him for his years of service. There is something else that happens when we get injured and we can no longer do our job. That loss of purpose also exacerbates trauma, as well as our depression. So, even if someone has safely navigated their career and then they have an injury and they can no longer do it, that loss of purpose also leads to a loss of sense of self. “I’ve been doing this for 30 years, now what do I do? I wasn’t ready to retire, I’ve been forced into retirement,” and that can lead to other types of depression and other coping strategies which are not helpful.

Dr. Justin Clark: That’s a great thought. Tina is calling from Anchorage. Tina, welcome to Line One.

Tina: Hi. How is it going?

Dr. Justin Clark: It’s going great. How can we help you today?

Tina: I have a role that – I work in sex crimes for seven years, but not as a police officer. I feel like my role has always been on the periphery. It’s not a job that’s ever been like, oh, thank you, law enforcement, and your EMS and your fire. Sometimes I feel like I’m a little burned out too lately, but am I allowed to be? I’m not like one of these big three, but I still like very much have work. I worked with victims for four years, and now I’m working with the perpetrators for three years. I feel like my job is kind of lost in the shuffle, and I’m like, maybe that’s affecting me a little bit more than I realize.

Dr. Justin Clark: Tina, thank you so much for your call because you are absolutely on the frontlines, and maybe you’re not one of these big three, but all of us who work with healthcare, and especially the type of stuff that you’re describing – it’s got to be very personal. Paul, any thoughts on Tina for her job?

Paul Gaines, Jr.: Tina, thank you. Sincerely, thank you. When I was an intern back in Rhode Island, I was interested in becoming a forensics counselor, and when I went to one of the in-services to listen to a man who had been working in it for 20 years, the look on his face, the burnout that he had, was profound, even though he was giving a presentation. That turned me off of that career immediately. I knew that I didn’t have the chops to handle that type of content. I had a friend who went through it, and she also burned out tremendously from that. I don’t think it’s part of the big three. I think forensic counseling for sex crimes workers is a big one. Frankly, I think if you’re feeling burned out, that’s a good place because you know that something is not working out for you. I’m always concerned about the people who don’t feel burned out, who don’t ever allow themselves to be empathetic towards the suffering of others. So, it is a big deal, and you should be feeling burned out. That’s a heavy toll. Absolutely, get yourself some help, even if it’s once a month, once every couple of weeks. I advocate for therapy, which I think everyone can benefit from, by talking to someone outside of their social circle, even if it’s once a month, just to check in to make sure that your emotional balance is still solid and that you’re still heading true north. Absolutely, get some help. You should be burned out from that position because it’s incredibly tormenting, the stories that you hear. So thank you, and definitely find someone to talk to.

Dr. Justin Clark: Thank you for your call Tina. Now we have Stu, who is calling from Eagle River. Welcome to Line One, Your Health Connection, Stu.

Stu: Thank you for taking my call. Anti-stress debriefing is a phrase that was used in the profession – I’m referring to ski patrol, both volunteer and professional. I experienced the one circle of professionals after we had a [unclear] and I found it remarkably helpful. I assume a lot did not continue in the profession after that and other events, but at other times, I wish we had the anti-stress debriefings. You know, [unclear] femur fractures, not enough people to take care of, screaming. Eventually, people threw in the towel because they don’t have a circle to discuss the issues. But, I just hope that that kind of process is available to first responders because you just see things repeatedly over and over, and you got to go home with that screaming. Anyhow, I would just hope that those circles are continued by professionals and fellow workers. I think they are really important, and unfortunately, they can’t afford it at a lot of places where people work. I think if they did, they’d probably keep more workers longer. Thanks for taking my call.

Dr. Justin Clark: You’re welcome, Stu. Paul, any thoughts on Stu’s comments?

Paul Gaines, Jr.: Yes. He’s exactly right, and a lot of the fire departments are now starting with critical incident management training and so they’ll have senior officers or captains who can do some emotional triage. It’s not therapy, but it helps them get through an immediate traumatic response due to a call that just happened. I know that at Steese, we had our chaplain and myself; we’re both available at any time if a firefighter or a first responder had a bad call and needed to speak with someone. The shift captain had our phone numbers. They could call us. Some folks would rather speak to a man of the faith, and others prefer to speak to me, and again, it’s not therapy, but it helps get them through a difficult moment. The sooner someone can have those issues addressed, the less likely they are to be retraumatized in subsequent calls. The third infantry division had mental health specialists in the field; these were soldiers who went outside the wire with their patrol, and if something happened, they were debriefing before they even got back inside the wire. That helped reduce the impact of that traumatic stress. I think the more progressive first responder facilities can be in addressing those immediate traumas, the less likely they will be traumatized again.

Dr. Justin Clark: Yes. Well, we’re going to take our second break here. You’re listening to Line One, Your Health Connection. After the short break, we will continue our discussion on trauma-informed therapy for first responders and healthcare workers with Paul Gaines Jr., from Psychology Services of Alaska.

Welcome back to Line One, Your Health Connection. I’m your host, Dr. Justin Clark. I’m joined today for a discussion on trauma-informed therapy for first responders and health care workers with Paul Gaines Jr., from Psychology Services of Alaska.

Paul, I want to give you a chance about some of the techniques that you use for therapy. Now, before we do that, I did want to piggyback on a comment that was made earlier about loss of empathy and compassion, and I see this personally in a healthcare setting. So, I sort of see that, either in myself or in colleagues, it’s kind of a late stage or burnout phase, and it’s like – it can be a red flag to me. Like, man, you’re jaded, you need a break because you just saw this horrible thing, and it like hasn’t… even when you’re talking bad stuff about this person. How do you approach someone who maybe has gotten to that stage where they have sort of lost empathy or compassion with their patients?

Paul Gaines, Jr.: Find time to check them on it as soon as the patient has left. Like, “hey, where did that come from? I’m noticing…” That’s one of the things you do, you notice attitude changes, personality changes, snide remarks. Sarcasm is a form of anger, but anger is a secondary emotion, and it’s usually a mask for sadness or other types of emotional pain. So, when I hear someone making a sarcastic remark, I’ll note it and say maybe that was just having a bad moment, but then if I start to notice a pattern, I’ll say, “Hey, what’s happening with you?” I think we owe it to ourselves to check our colleagues. I’m not saying running off to HR and getting them in trouble, but just doing a check-in. “Hey, are you okay? I’ve noticed you’re a lot quieter than you are. You are not making as many jokes, or you’re not coming in with the energy that you’ve have. I just want to make sure you’re okay.” We don’t do a good job at that because we know that the people coming in are far less fortunate than we are. We can kind of overlook the things that we notice in the workforce, in the workplace. Finding a time to just ask, “Hey, are you alright?” I think that’s helpful because in most cases, when you ask someone if they’re okay and they’re not, and they trust you, they’re going to start talking about stuff. Say, “Ah, well, I got things going on at home,” or “I don’t know. I just don’t feel right. I’m a little ticked off with management and what-have-you…” Give someone a form to talk and that’s really what therapy does. It’s just a form for people to open up and talk about things that are troublesome to them.

Dr. Justin Clark: Yes. So, some of the techniques that you utilize based on the website, which is psychak.com , talk about some of the techniques you use, such as CBT, EMDR, and DBT. That’s a lot of acronyms there, so I will ask you to explain what these are and how they’re potentially useful in your therapy for anybody, but particularly for first responders. I guess let’s start with CBT.

Paul Gaines, Jr.: CBT stands for Cognitive Behavioral Therapy. If you imagine a triangle, at one point of the triangle, you put an F for feeling, and at one a B for behavior. If I ask you what’s the creepiest animal you know, and you say it’s a spider, okay, a spider walks, and what do you do? Oh, I get up and I smash it. I kill it. Okay. So you had a big feeling and a big behavior. At the top of the triangle, there’s a T for thought. Did you think, was this really a spider, or was it me pulling a rubber spider towards you or was it a dust bunny coming up underneath the floor? If we can think through a big feeling, it might lead to a different behavioral outcome. It might be the same outcome, but chances are it’s going to be different because the part of our brain that deals with hypervigilance and states of consciousness gets activated. That part of our brain does not care about do I have Tex-Mex or Italian for dinner, it’s in a survival mode. I either have to kill that thing or have to run away from it. The moment that we engage thought, even if for a nanosecond, that shuts off that part of our brain and allows our executive functions to take over, to make a different decision. Let’s say it’s a real spider and it is poisonous or venomous and it’s coming at you, then your killing it would be the correct decision, but more often than not, we don’t want that part of our brain to make choices for us because 90% of the time, it’s going to be the wrong decision.

Dr. Justin Clark: So, someone’s been in a car accident or some sort of trauma that involved a loud noise, a gunshot, or like military, and then maybe every time they hear a loud noise or a clap or a door slam, it can activate that same pathway.

Paul Gaines, Jr.: That’s right. CBT, the hallmark of this is challenging these irrational beliefs that we have, so that we can change it to a rational belief, which leads to a more rational behavioral pattern.

Dr. Justin Clark: Okay. So that’s one of the techniques utilized?

Paul Gaines, Jr.: Yes. Folks, a lot of first responders and veterans are comfortable with it because we don’t get into the weeds of sharing our emotional experiences. It’s about – this is the problem, this is the thinking error, and this is how you can change a thinking error so you can make a better decision. A lot of folks who are adverse to therapy prefer CBT because they don’t have to talk about their feelings; they’re talking about their thoughts and their behaviors.

Dr. Justin Clark: So it may be better for somebody who is a little bit less inclined to seek help or that sort of stereotypical therapy of lying on the couch and bearing your soul.

Paul Gaines, Jr.: Yes. There’s no couch in my office.

Dr. Justin Clark: Just chairs. What is EMDR?

Paul Gaines, Jr.: EMDR is Eye Movement Desensitization and Reprocessing. I actually have a lot of experience with that because I had to deal with my own trauma as a first responder. I had nightmares about this one particular call for years, and I had maladaptive ways of coping with that, and so I went to EMDR training. In order to become an EMDR therapist, you would have to go through the training yourself. I went through two 90-minute sessions with another therapist who was training, and I can talk about that scene now, but for years, that call gave me nightmares. Nightmares. Waking nightmares and sleeping nightmares, and so I understand how powerful a tool EMDR is. I can attest to that one. That was the most helpful modality that I’ve had, and I’ve had a lot of therapy. EMDR is a powerful tool. There is some screening that is required, and it’s a long process, but I’m a fan of EMDR. It’s the most helpful for me.

Dr. Justin Clark: I guess more in a basic description, I mean, how does eye movement and desensitization sort of – what is the technique necessarily?

Paul Gaines, Jr.: You’re basically activating the left and right hemispheres of your brain alternatively. It used to be eye movement; it can also be sensory inputs on your hands, anything that activates the left and right hemispheres back and forth, back and forth, back and forth. As you’re doing that, you’re also thinking of a specific target image and an associative negative thought. We call that negative cognition associated with that. As your right hemisphere is firing off, that subconscious brings that target image into play, and you can actually relive and reexperience everything that happened in that target image. I would like to think of it as the hemispheres are the parents and the subconscious as the kid. When the parents are busy, the kid runs out the back door and plays in the yard. With EMDR, we want that kid to go out into the yard because it creates a structured dissociative event. The client is safe in the room, but they are locked into their target image, and they can see and feel and experience everything that happened in that event, and it’s a therapist’s job to remind them that they are safe. Our memories cannot hurt you. They can scare you, they can terrify you, but they cannot hurt you. You are not in any physical danger. That type of window of tolerance where 50% of that client’s existence is in the room and 50% is in that target image. Through that, they can develop a path of cognition about that event and not have that subjective unit of disturbance, which is that feeling that we get in our bodies when we are feeling traumatized or depressed. We can minimize that feeling and then replace the negative cognition with a positive cognition. So, the next time they see that image, it doesn’t affect them the way that it had in the past.

Dr. Justin Clark: Wow. Sounds really interesting. For me, it sounds incredibly complicated and complex, but I imagine with practice and time, people can utilize this technique to reframe some of their trauma.

Paul Gaines, Jr.: Yes. One thing that I also need to point out is that television shows and movies have done no service to the healthcare profession. People don’t get their trauma resolved in a 15-minute conversation in front of a studio audience, or your favorite character has a traumatic event, and then the next episode, they’re completely fine. Therapy is a lifestyle change, not just a behavioral change. We might have to say goodbye to things that we are accustomed to and that are familiar in our lives. It takes months and years to get through some of these things, especially if we’ve installed them and had them in our minds set for years and decades. It’s not a one-stop shop. It’s not a get-healthy-quick scheme. It’s a lot of work. Sometimes you may feel worse before you feel better. But just trust the process. The goal of therapy is not to feel better at the end of the session; it’s to feel better a year from now, 10 years from now, for the rest of your lives, and that takes a lot of work.

Dr. Justin Clark: Yes. Debra. Debra is calling from Anchorage. Welcome to Line One, Debra.

Dr. Deborah: Hello. This is Dr. Deborah.

Dr. Justin Clark: Oh, I’m sorry.

Dr. Deborah: No, it’s fine. It’s not about the name. That’s why I had to come on, and I said Dr. Deborah. I needed to share because what I heard right now, this hurts my spirit very much because that’s the thing that we’re… I listened and excellent information, I just heard about some of the things that we can do to facilitate maybe this. But, what’s so difficult is the simplicity that we couldn’t get there. I understand the 15 minutes doesn’t work, but what I know, and it’s probably not well-known enough, I worked with helping those who help others and working within facilities into military bases in Fort Louis – McChord for years. Here in Anchorage, even, we offer this within the bases, the military bases. Because the people who are doing the work, if they are raggedy, they can only deal raggedy. If they are in the facility and we would have sessions that they would come to and he’s right, it’s not a one size fits all first thing, and it’s not a you can just snap your fingers and do it or all of that, but if you are able to get some assistance and it’s right there for you within those facilities and it is promoted, they come and they get to work and they realize what they’ve missed. They find out, and they don’t know that they might be missing anything, because with everything that they can do, working is as hard as it can be, but this is exactly what they are doing: they are working. They are unable to give what is needed because they don’t even have it within them. So, helping others who are helping others is how it was working, and it worked well from the top up. The top is the one that says, Yes, we need this because we want to help people who are whole. Wholeness. We want them to have everything. We want them to have some vitality. We want them to have clarity. We want them to have those things within, and if we can promote that and provide it, then it doesn’t cost. It doesn’t cost.

Dr. Justin Clark: It pays dividends. Well, thank you so much for your call, Dr. Deborah. I appreciate it, and Paul raises an interesting thought about mental health care for mental health care providers.

Paul Gaines, Jr. : Yes. I’ve always told my staff we can’t provide therapy effectively if we are not in therapy ourselves because we will hear things in session that might sound eerily similar to our own experience, and then we are providing advice, and therapists don’t provide advice, we provide recommendations, and we listen. I’d like to point out, as the caller, Dr. Deborah said, raggedy. If we aren’t buttoning it down and taking care of ourselves, our practice and our service delivery will become ragged,y and we will start to do things that are not in line with core ethical principles. So I’ve always told my staff, I don’t need to know what they talk about in therapy, I don’t need to know who their therapist is, but they better be in therapy because it will show up in their work, and I have seen it. You see it in there – people becoming a little less neat in their writing, a little more jaded, a little more sarcastic in team meetings because this job is supposed to affect you. I don’t want someone in my staff who can experience all this and not be affected, at least on some level. I want some level of empathy with my staff. We also have our own personal challenges. There isn’t a person listening today who isn’t going through their own little hell or big hell. Find someone to talk to, even if it’s once a month, and for my staff, a little more regularly would be helpful. At least once every two weeks because even as a supervisor, I’m not their therapist. Even my friends, my partner, I’m not their therapist. I tell her, go talk to someone. I love you, but I’m not your therapist. Find a therapist, and I don’t need to know what you’re talking about. So, we need to be especially focused on our wellness if we’re in this field.

Dr. Justin Clark: Yes. That would go under self-care care and I think we just have 2 more minutes here, Paul. What are your thoughts on getting therapy for yourself in these situations of self-care? Any recommendations on self-care for people before we have to close up here?

Paul Gaines, Jr.: For me, self-care is woven into the fabric of my day. It’s not something I do once a week. “Oh, my self-care, I’ll go yoga or I’ll go for a run…” I try to incorporate self-care in between sessions. I have some stress relievers in my office. I’ll work out or go for a walk around the office or around the building. It’s something that we have to do perpetually every day as often as we can. If we’re not caring for ourselves, how can we honestly care for other people? This might sound selfish, but we need to be the most important person in our lives so that we can then be there for everyone else in their lives. If we’re not squared away, then we can be ineffective in lending support to the people we love and especially to our clients and to our fellow first responders.

Dr. Justin Clark: Absolutely. Thank you, Paul. We have about 1 minute left. I want to give you an opportunity to make any closing remarks to our listeners, any thoughts that you would like to get across to people, and also, what are the resources we could use if someone wants to talk with you?

Paul Gaines, Jr.: I’m available at Psychology Services of Alaska, and for first responders, there’s a great book out there called Fit For Off-Duty by Peter Salerno. He is the son of a firefighter. He is a therapist in California, and it’s a short read, it’s an easy read, but I found it to be one of the most helpful books that I can refer out to other people. It’s called Fit For Off-Duty because we need to be sure that we are fit when we go home to be with our families, not just fitness for duty, but fit for off-duty, so I think the title is remarkably appropriate, and I just want to thank all the first responders out there. There is help for you. Don’t wait until it’s too late to ask for help.

Dr. Justin Clark: All right. With that, special thanks to our guest for being with us today, Paul Gaines, Jr., from Psychology Services of Alaska. That’s psychak.com 907-531-8149. Thanks to our audio engineer, Chris Hyde, and our Producer, Madeleine Rose. You can find more information on this in previous programs on our website at alaskapublic.org . This program will also be available on-demand through Apple Podcasts, Spotify and Amazon Music. Let us know your thoughts or suggestions by emailing us at lineone@alaskapublic.org .

This has been Line One, Your Health Connection. I’m your host, Dr. Justin Clark. Stay healthy, Alaska.

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How to escape learned helplessness and find your motivation | Line One

Fri, 04 Apr 2025 17:07:00 GMT

Feeling stuck in life, whether in work, relationships, or personal growth, is more common than you think. It’s not about laziness or lack of effort, but a mental loop where past setbacks train the brain to stop trying. But just as the mind creates barriers, it also holds the key to breaking free. On this Line One, Dr. Jillian Woodruff and her guest discuss how to re-frame your thinking and create lasting change.

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The post How to escape learned helplessness and find your motivation | Line One appeared first on Psychology Services of Alaska .

Suicide Warning Signs and Prevention | Line One

Thu, 31 Oct 2024 18:39:00 GMT

CDC data shows that in 2022, there was one death by suicide for every 11 minutes. While the stigma around mental health has begun to fade, this is a reminder that many struggles are still hidden. The signs of suicidal thoughts are not always obvious and recognizing them in yourself and loved ones is vitally important. On this Line One, host Dr. Jillian Woodruff and her guest discuss those signs and share resources for suicide prevention.

HOST: Dr. Jillian Woodruff

GUEST: Dr. Seth Bricklin of Psychology Services of Alaska

Click Play below to listen to the audio from the live show. Please continue below for a transcript.

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Transcript:

Dr. Jillian Woodruff: Hello and welcome to Line One, Your Health Connection. I’m your host, Dr. Jillian Woodruff.

Introduction: Suicide is a profound and complex issue that affects individuals, families, communities across the world. In fact, in the US, suicide ranks as the 11th leading cause of death across all age groups. What’s even more alarming is that among individuals age 10 to 34, suicide is the second leading cause of death. A heartbreaking reality that underscores the need for greater understanding and awareness. For many, the warning signs of suicidal thoughts and intentions are not always obvious. They can manifest as changes in mood or behavior like withdrawing from loved ones, sudden irritability or even a sense of calm after a long period of deep distress.

These are often misunderstood or overlooked making it crucial for all of us to be vigilant and informed. Today, we’ll be talking about recognizing the red flags if someone you care about might be considering taking their own life, how to support a loved one in crisis, and understanding the reasons that may drive someone to feel like death is their only option. We’ll also address how people dealing with depression can recognize these signs in themselves and seek help before reaching a crisis point. Most importantly, if you or someone you know is experiencing thoughts of suicide, resources are available.

Call 988, this is the Suicide and Crisis Lifeline. It’s a national confidential 24/7, support line that anyone can call or text to connect with a trained counselor. Help is just a call away.

Joining us today is Dr. Seth Bricklin, a highly respected licensed clinical psychologist. Dr. Bricklin brings a wealth of expertise in mental health care with a focus on depression, anxiety, post traumatic stress disorder and suicide prevention, making him an invaluable voice in today’s conversation on suicide awareness and intervention. Dr. Bricklin provides care here in Anchorage at Psychology Services of Alaska, and can be reached at 907-290-7250 or by visiting www.psychak.com.

Dr. Jillian Woodruff: Welcome. Dr Bricklin.

Dr. Seth Bricklin: Thank you so much for having me.

Dr. Jillian Woodruff: Well, thank you again. Dr Bricklin, and I think before we dive into this immense topic today, let’s just learn a little bit more about you and what led you to this field.

Dr. Seth Bricklin: Sure. Well, how I got into psychology probably started when I was in middle school. My mom went back to school to get her Masters in Counseling, and I just became interested in hearing her talk about what she was learning, and that got me interested in psychology. And then when I was in high school, I actually had the opportunity to take a psychology class. Then it just started to make sense. I just really felt like I understood it well – helping understand people and it really seemed very interesting. And then, we actually saw a movie in that class called Ordinary People. It’s an old movie. It’s like 1980. It’s like Timothy Hutton’s first movie. He actually won an Oscar. He’s like one of the youngest people to win an Oscar, and that’s about him. So he survives a boating accident where his brother died, and then he struggles with depression, PTSD. The movie starts as he’s coming out of a residential facility after attempting suicide. So, the movie is all about his recovery, and a lot of the movie scenes are with his therapist. I just remember watching it saying, that’s what I want to do. Yeah. I really wanted to do that. And, you know, I remember talking to my folks, and they reminded me, you know, your aunt and uncle are both psychologists. So I had a lot of support also, as I got into the field. I went to college and just started in psychology and it took off from there. So a lot of people are supporting me, helping me, which is something that I have always been interested in.

Dr. Jillian Woodruff: Do you think psychologists are masters of communication? Do you think that’s something that we all struggle with, communication, whether that’s at work or with colleagues, with our family members, we’re all trying to, like, reach the other person, are these just strategies that you learn from training?

Dr. Seth Bricklin: I think it sort of depends – what kind of communication, but hopefully, I think as a psychologist, the thing you have to be really good at is listening, hearing what other people are really saying, and being able to communicate with them. But a lot of times it’s listening, letting the person know that you’re listening to them, how to reflect back to them. It’s really the best tool is what we call active listening. Somebody says something, you reflect back what they’re saying. Let them know that you’ve heard them ask open-ended questions, continue to help them talk and really doing things to let the person know that you’re really interested and hearing what they’re saying.

Dr. Jillian Woodruff: That’s a great point you bring up. I think in my research and studying for this program, I did come across that a lot – listening. I think we want to share our point and get our point across, we all want to be understood. And so I guess showing that you’re understanding that other person by listening is very important and critical.

Dr. Seth Bricklin: The term we love to use as psychologists and therapists is validation. You want to really validate what the other person is saying that often gets confused with agreeing. Validating somebody doesn’t mean you agree with them. It really just means that you’re saying to them, hey, I hear what you’re saying. Your feelings make sense to me. They’re reasonable or understandable, and they matter to me. Even if I disagree with you, I can still validate and that’s really what it comes down to. I think that is really important.

And that’s really what I would say is sort of the underlying theme for this is you have loved ones, children, other people in your lives that are struggling. The main thing is, you know, all the recommendations and things I might suggest you say to people, the underlying theme is you want to validate them. That you care about them, you hear what they have to say. Their feelings matter to you, you’re not trying to talk them out of those feelings, you’re not trying to minimize them, but you’re giving them the time and consideration and telling them that it’s valuable, it matters to you.

Dr. Jillian Woodruff: So if they’re saying to you that their life is difficult or that they’re struggling or they feel bad about themselves, they’re coming from a difficult situation, our job is not to tell them, No, your situation is good, better than others.

Dr. Seth Bricklin: Correct. In fact, that would be one of the don’ts. Often, people say what are the dos and don’ts if somebody’s expressing to you suicidal thoughts or concerning kinds of thoughts? We don’t want to do pep talks or try to cheer them up, necessarily. The reason being is that it feels invalidating. Imagine, think of times you’ve come home or you talk to somebody “I’m so upset that this person did this to me, can you believe what they said?” and I’m like, “Oh, calm down, it’s no big deal. Just relax.” Most of us don’t like to be told to relax when we’re upset because it’s invalidating.

Dr. Jillian Woodruff: Or saying others have it worse than you.

Dr. Seth Bricklin: That’s another one. “Look, there was a hurricane the other day in Florida, at least you don’t have that happening.” Because then what the person feels is you don’t understand. They feel patronized. They’re not feeling heard or understood, and then they’re just going to say, well, this person just doesn’t get it and they’ll just shut down.

Dr. Jillian Woodruff: Given the range of mental health issues that you address, how frequently do you encounter concerns about suicide?

Dr. Seth Bricklin: It’s such a broad topic, right, because people can talk about suicide or say things sort of even “ugh, I’m so mad I could kill myself.” Often, they may not really be suicidal and not necessarily a concern in terms of, hey, this person needs immediate intervention.

So, I would say the majority of patients I see don’t struggle with suicidal thoughts on a regular basis. I think many people have them from time to time and it’s certainly a normal occurrence in my practice helping people deal with struggles. It’s a common thing where people may have what we call fleeting thoughts where they think about suicide, but it’s not something they dwell on or actually consider doing. You may have somebody who is having more serious thoughts. I think people who are having more serious thoughts or more persistent kinds of thoughts, I probably see that in a given month a few times. Usually, the way I work is I will have a case load of patients that I’m working with, so at any given time I may have 2 or 3 or 4 that are struggling with this as an ongoing issue.

Dr. Jillian Woodruff: Maybe you can give us an overview of suicide in general and the many facets of it.

Dr. Seth Bricklin: It’s a broad topic. There’s different ways to talk about sort of like we already but I said this like it ranges from people who are actively suicidal, so we say were they really seriously considering it. But I guess we’ve looked at it like the CDC, let’s say, would define suicide as death caused by injuring oneself with the intent to die. It’s the intent. When we talk about suicide, one thing we want to distinguish are – there’s suicidal thoughts, which might be actual thoughts of killing oneself. There might be thoughts about death, where it might be, something might be thinking, “Gee, I’m just tired of living. I wish I just wouldn’t wake up tomorrow. That might be what we call more passive, so somebody’s not actively thinking about taking action to harm themselves, but feels like they would rather be dead.

Dr. Jillian Woodruff: So it’s suicidal thoughts without the intent?

Dr. Seth Bricklin: Correct.

Dr. Jillian Woodruff: So people can have that? Think maybe this would be a better way to go, but do not have any intention of…

Dr. Seth Bricklin: Correct. That is probably the most common form/type of suicidal thoughts that I see in practice. People who are thinking about it, who are feeling very depressed or distressed about some type of crisis but may not actually be actively suicidal. That’s something that we assess, as a professional.

For folks who have people in their lives that they’re concerned about, the bottom line is, if you’re not sure, try to get them help so they get them somewhere. Call that hotline, take them to their primary care doctor. If it’s your child, go to a pediatrician and let them do that assessment to try to distinguish what might be going on. The majority of people I see will have those kinds of thoughts without any act of intention.

Dr. Jillian Woodruff: I think that some people may be a little concerned even to bring this to their primary care doctor, maybe thinking “are they going to call the police on me because I’m actively trying to die.” So maybe that could leave people to not want care.

Dr. Seth Bricklin: That’s true. People are very concerned about that, and I will say to patients frequently…They say, I don’t want to be taken away. I don’t want to be put in a hospital. I tell them, the only reason people are put in hospitals is because they’re a danger to themselves or others and have some kind of mental illness perhaps. But if somebody says they’re having thoughts of suicide, but they have no intention of doing it, they’re not going to get put into a hospital. Now, that might be recommended as a form treatment long term, because if somebody’s chronically having that kind of thought, that’s obviously not a good place to
be. If you’re feeling that way long enough, then those thoughts may become suicidal. But there is that distinction and the other important distinction to make especially with teenagers because it’s becoming more common is the topic of self harm.

So we often talk about self harm like cutting behaviors and it’s important to distinguish that most often, people who are engaged in those behaviors are not suicidal. Things like self harm and cutting generally is a way to cope. It’s a coping mechanism.

Dr. Jillian Woodruff: So they’re not trying to die by suicide? Just dealing with intense emotions?

Dr. Seth Bricklin: Yes, but that’s often very shameful, and so they cover it up and they don’t talk about it because they’re afraid that people will think that they’re suicidal. But very often, if you ask them, were you trying to kill yourself? Very often they will say no. I was feeling so stressed that doing that is a stress relief. They feel empty and it’s a way to feel something.

Dr. Jillian Woodruff: So they definitely need help, but a different sort of help for that situation?

Dr. Seth Bricklin: Yes a different help, and also again sometimes people can be seriously injured or die accidentally. People will be engaging in those behaviors, but their intention is not to kill themselves, but things can happen so obviously these are things you might want to take seriously.

Dr. Jillian Woodruff: So is there a way to distinguish between self harm and somebody who is trying to die by suicide? Is it basically just what you mentioned, just asking them?

Dr. Seth Bricklin: Yes. Certainly as a parent, you may feel more comfortable to just ask that direct question, but in all honesty, asking directly cuts through all of the stigma and actually help somebody talk about it and it takes a lot of the pressure off. Sometimes you can just say, are you thinking about killing yourself? I saw that you cut yourself. What’s going on? Tell me about that. Tell me what happened. Were you trying to kill yourself? Sometimes asking a direct question can be the best. What I would say to family members, people who have loved ones, people in their lives who are struggling, you want to make sure you get help from a professional. You don’t want to feel like it’s up to you to decide – is this serious? What do I need to do? The bottom line is encourage them to get into treatment, talk to their pediatrician, have them see a counselor or call a hotline. You don’t want to feel like it’s up to you to decide it. Having said that, it is okay to ask those questions.

Dr. Jillian Woodruff: I hear you with these questions that are open-ended questions which is exactly what you said to do so that would encourage the person to listen to that response. I think when we talked previously we were talking about that by asking these questions, you’re not putting thoughts into someone’s head.

Dr. Seth Bricklin: Right. That’s another myth about about suicide. That if you mention suicide, you’re going to give them the idea. It’s not like it’s a new concept. It’s not like they haven’t heard of that before. Think of it yourself. If you’re having such a bad day and somebody said “are you thinking about killing yourself?” You would say no, I’m not. It’s not as if that plants the seed. There are some things like certain media coverage and there’s really good work now being done with the media in covering suicide in a way that doesn’t encourage other people. You know, sensationalizing it, things like that can lead to suicide clusters and things of that notion. But when you’re talking about just talking to an individual or asking them that question is not going to put them more at risk of suicide.

Dr. Jillian Woodruff: Dr. Bricklin, I want to make sure were using correct terms when we’re talking about suicide. There’s been this shift in language and they’ve eliminated “commit suicide” and now discuss “death by suicide” or they’re utilizing that term. Are there other terms and are these to reduce stigma around it at all?

Dr. Seth Bricklin: Yes. The reason the language is so important is because we would encourage people struggling with suicidal thoughts to talk about it. So, language that stigmatizes or shames suicidal thoughts and behaviors is going to discourage people from seeking help. So the bottom line is we want to change that language to encourage people to talk about it and the term “committed suicide” goes back to when suicide was illegal, so you were committing a crime. That’s one of the reasons why we changed that language. If somebody dies from cancer, you don’t say they committed cancer. They die from cancer. So now we’re saying, the person died from suicide or died of suicide, because you want to equate it more with other kinds of medical conditions that could be fatal.

Dr. Jillian Woodruff: Now, I was also somewhat surprised to hear that death by suicide is not necessarily associated with mental illness.

Dr. Seth Bricklin: Well, it frequently is, but it’s not a guarantee that the person may not always be mentally ill. More importantly, they may not have any history of it. So the question of, well, were they mentally ill at the time they actually committed suicide? That’s a little bit maybe more of a difficult question to answer with any certainty, but it is true that people can die by suicide may have no history of mental illness. People may think about suicide or attempt suicide for other reasons. It could be an acute crisis. They could have a devastating diagnosis, a death of a loved one, somebody close to them committed suicide. They’re struggling with addiction, which that, in of itself, could be considered a mental illness, but, you know, it’s a little bit different than what we’re thinking of like somebody who is depressed.

People make mistakes, they’re about to get arrested, they know they’ve done something, and they really have a lot of shame. They could also be the victim of violence or abuse, and maybe again, you know that’s like, well, if they’re struggling with abuse, they must have PTSD. I mean, maybe. We don’t know. But they may not have any history of mental illness.

Dr. Jillian Woodruff: I think you just shared some of the risk factors. Are there other risk factors for dying by suicide that predispose someone to be more likely to have suicidal thoughts?

Dr. Seth Bricklin: There are certainly risk factors. When you’re dealing with an individual person, those aren’t really as important, but things that you would think about are what we would call… The CDC sort of identifies different categories of risks. So, one would be individual characteristics, and that would be things like previous suicide attempts, history of depression, mental illness. I mean, it is a risk factor, but serious illness, chronic pain, is a big one. People struggling with chronic pain, especially idiopathic pain, like they don’t know where it’s coming from, they just have this pain, but it could be a specific injury, criminal justice, legal problems, financial problems, impulsive aggressive tendencies, substance use, history of trauma. They’re feeling a sense of hopelessness, violence, victim of violence, or even perpetrators of violence.

So these are sort of, you know, they’re all risk factors. None of those are guarantees, but if you see that…Then we also talk about relationship risk factors, bullying, someone struggling with that. A family or loved one has a history of suicide, loss of relationships. They’re in high conflict or violent relationships.

Dr. Jillian Woodruff: So a suicide in your family can increase your risk?

Dr. Seth Bricklin: Statistically speaking. People who have a history of suicide – parents, if someone has a parent or a close relative or a loved one who has committed suicide, it just statistically puts them at greater risk.

Dr. Jillian Woodruff: Well, in Alaska, we have a lot of people who participate in high risk activities or even sports that have increased risk of concussions or brain injuries. How do these injuries affect suicide risk? Just seeing a lot more about that, especially in the professional sports world, what are the signs or what should family members or those who have had concussions, are there things they should look out for or do?

Dr. Seth Bricklin: The best advice is always get help. You know, if somebody has a concussion, especially in Alaska, we’re kind of rough and tumble folks up here, if they get a concussion, they bump their head, they rub some dirt on it, they go home. When it comes to head injuries, you really want to make sure you’re getting assessed. If they tell you, oh, you had a mild concussion, you should go see your doctor, you should go see your doctor. Very often patients will “Oh, yeah, I went home and I felt fine.” So anytime you’re dealing with head injuries, you really do want to get assessed. You want to be mindful. Most people with a concussion, usually one to two weeks, their symptoms are going to get better, and they usually recover. You know, 99% of people who suffer a concussion do not have any kind of suicide related behavior after that. So, it’s not a common thing, but your risk does increase after a concussion.

Dr. Jillian Woodruff: Is that for everyone, or for people that have had a history of suicidal thoughts?

Dr. Seth Bricklin: That would just add to it, you know, so somebody with a history of it and then has a concussion, yes, they would certainly be at a higher risk. You want to look for signs of post-concussion syndrome – headaches, dizziness, nausea, fatigue, loss of balance, light and noise sensitivity, ringing in the ears, confusion, concentration, memory problems, and then anxiety, irritability, and depression. Irritability is a big one with post-concussion syndrome. You often will see a lot of irritability, and it often gets missed a lot in kids.

Dr. Jillian Woodruff: Because kids are irritable.

Dr. Seth Bricklin: Yes. Kids can be moody, kids can be irritable, but they fall. They have a fall on their skateboard or their bike, they hit their head. You know, they’re at school, they don’t really tell anybody, they get up, they shake it off and meanwhile nobody knows.

Dr. Jillian Woodruff: And you may just think it’s kids being kids.

Dr. Seth Bricklin: Yes, I mean that is part of my assessment. I will always ask my patients, have you ever had any head injury, any seizures? Things like that, we always want to know.

Dr. Jillian Woodruff: Do you know how long after you’ve had an event where you would start to have these changes in your mood?

Dr. Seth Bricklin: It’s not something I would say specifically, when you would see that. Like I said, if the symptoms go on more than a couple weeks after the concussion, you would want to get that looked at. And then, from my experience, it can come up months later, a year later
and oftentimes people don’t realize that. If you really start to ask them more specifically, they’ll realize, hey, this has been going on for a few years. Oh, and you know, a few years ago I had that head injury. I bumped my head and had that concussion. It’s a little bit hard to gauge, because sometimes people don’t recognize it. You may not see it until 2 or 3 years later, but when you ask them, they’re like, the signs have actually been there that whole time, just nobody picked up on it.

Dr. Jillian Woodruff: So then when you’ve had a head injury, being proactive and making sure you’re following up, but then afterwards, now you’ve helped a lot of people to maybe connect things that they’ve been seeing looking back. “Oh, this happened to me” and this could be really good.

Dr. Bricklin, we’re going to take our first break. You are listening to Line One, Your Health Connection. After this short break, we will continue our discussion of how loved ones can help someone with suicidal thoughts with Dr. Seth Bricklin as Line One continues statewide.

Welcome back to Line One, Your Health Connection on Alaska Public Media. I’m your host, Dr. Jillian Woodruff. I’m joined by guest, Dr. Seth Bricklin, who holds a doctorate in clinical psychology and a master’s in business administration from Widener University. Dr. Bricklin has experience treating a wide range of mental health issues and integrate science-based practices, including cognitive behavioral therapy, psychodynamic, mindfulness and client-based therapies to treat anxiety, depression and post-traumatic stress disorder.

We are here speaking on the important topic of how to support a friend or loved one who may be thinking about taking their own life and the red flags that they may display. If you, yourself are personally struggling with suicidal thoughts or recognizing that you may be on a path leading to suicidal behaviors, please know there’s help. Call 988, a national helpline where trained counselors are ready to connect you to the support and the resources that you need.

Dr. Bricklin, I think we should get into beginning that conversation with a loved one that we may suspect is having suicidal thoughts and what are some ways to start that conversation effectively?

Dr. Seth Bricklin: Great question. Again, one of the things I learned in graduate school is you can answer every question in this field with an “it depends.” So it depends on your relationship to the person. I think some general tips, you really just want to let the person know that you’re there and that you’re listening. And so you might say something, you might just look at them and say, “hey…” I guess I’d say it depends on what’s causing your concern. If it’s like this person doesn’t seem themselves, they seem down, they seem depressed. They haven’t really said anything specific, but something in your gut is telling you something is wrong. You know, something that just says you care and you’re listening. So you might say something like, “You know, I’m really grateful for your friendship, and I’m so glad you’re my friend. I noticed you haven’t been yourself lately, and I’m worried about you. Is there anything going that you need to talk about?” It could be just that simple. Just letting them know that you’re there.

Dr. Jillian Woodruff: Just being there.

Dr. Seth Bricklin: I think, as parents, you know your kids, I mean, so some of that is, you know, depends to some degree on your relationship with them.

Dr. Jillian Woodruff: So they’re a little different when you’re talking to an adult versus a child or adolescent?

Dr. Seth Bricklin: Yeah. I mean, it can be, in all honesty, a lot of the interventions are pretty similar. You might see some differences in how they manifest to some degree, like some of the warning signs you might see. From peers, they tend to be isolated from their friends. They’re having a lot of peer conflicts.

Dr. Jillian Woodruff: So younger people?

Dr. Seth Bricklin: So, younger people. Like a lot of adults were dealing with stress at work and there’s office politics or gossip. Most adults manage that okay. For younger folks, if they’re dealing with a lot of gossip at school or that sort of thing at their level, that might be a little bit more of a concern. So, if they’re struggling with their peer group, that could be a big risk factor. So it’s something to be aware of. Those are times when you might say something, “How’s it going with your friends? Are you struggling? What’s been happening?”

And so then, if somebody actually starts to say things that cause you more concern, that are more direct, more specific – “I feel like I’m a burden to everybody.” “I’d rather not be here.” The first thing you want to do is make that validating statement – “Wow, I hear what you’re saying. I’m so sorry you’re struggling with that. I can’t imagine how you might be feeling, but I’d like to try to understand.”

Dr. Jillian Woodruff: I think that’s very difficult, Dr. Bricklin because instinctively, we’re going to want to negate that feeling. Of course, you’re not a burden. Of course, we want you to be here. So I think that is something that definitely takes practice.

Dr. Seth Bricklin: Yeah, it does. The other thing I would say is, if you’re not sure, you yourself can seek help. Talk to a counselor, talk to a therapist, you know, reach out. I very often work with patients on this very thing. How do I talk to my son, my daughter? They’re really struggling. I’m not sure what to say, so I will talk to them about ways to do it.

Dr. Jillian Woodruff: So they can contact you as well. So let’s say they’re struggling with their family member and they want to get help and that family member may not be at that place, do you have people that are seeing you and talking to you as patients, in that situation, to help other people?

Dr. Seth Bricklin: Yes. What I will help them with is their own anxiety, and that’s really what I’m technically treating in a sense. But often, in order to help them, I’m teaching them communication skills, tools and how to express their feelings and then talk to their loved one. So if somebody does share more suicidal statements, you can say something like, “I’m so glad that you’re able to share that with me. I’m here for you. I would be devastated if something happened to you.” Letting them know that you care about them.

One question that people are often surprised when I tell them, especially if I’m training interns, is that you can ask people this question, or if I tell somebody this question, they’re sort of surprised. But sometimes I will say, Well, what’s kept you going? What’s kept you from hurting yourself or killing yourself until now?

The reason you do that is you want to get people thinking about what are the reasons for living? They often will say, “Well, it’s my parents I wouldn’t want to do that to them.” “I really want to graduate high school.” “I really want to finish this project. So, you want to get them thinking about the things that they have to live for. So, asking that question directly, it’s again another example of “just ask them”. Sometimes I might say, well what stopped you from killing yourself until now? What stopped you? It’s something that I would say sometimes to patients. What that does is, because it’s validating, I’m not telling them not to do it, but they’re actually feeling “Okay, I can open up to this person…”

Dr. Jillian Woodruff: Because you’re listening.

Dr. Seth Bricklin: I’m listening and I’m saying that – I’m not trying to say that their pain is not important. It’s letting them know that I hear what they’re saying. I’m understanding how they’re feeling. There’s a saying we have in the field, “Don’t just do something, sit there.”

Dr. Jillian Woodruff: Interesting. That’s powerful.

Dr. Seth Bricklin: That really is important, and especially as a parent, your immediate reaction is – I got to do something. “No, no, you’re fine. No, it’s okay.” And really, just resist that impulse and just sit there, just listen. Nothing’s going to happen in the next 20 minutes. If you take that 20 minutes to just listen, let them talk about it, it’s going to be hard sometimes to hear what they have to say. That’s often the best thing we can do.

Dr. Jillian Woodruff: Tell us some more about the warning signs that we may see. So in an adult, what are some of the warning signs and how do those warning signs differ between I have depression or major depression, versus I’m having suicidal thoughts with intention?

Dr. Seth Bricklin: Well, some of that’s based on what they say. And as I said, if you have somebody who’s really struggling with depression, the main thing is that they’re getting treatment. You know, if they have depression, they’ve been diagnosed with it, are they keeping up with their treatment? If they have prescribed medication, are they keeping up with their medication?

Dr. Jillian Woodruff: So start there, the warning sign. What’s the warning sign for depression because we know they could be at risk or they’re more at risk?

Dr. Seth Bricklin: The warning signs for depression – there is some overlap here. There’s changes in mood. Then the symptoms of depression that are observable might be the person is having trouble sleeping, they’re certainly expressing those kinds of suicidal thoughts, trouble concentrating, trouble focusing. But the risk factors we see when someone may be really more at risk for suicide are things like preoccupied with death, dying or violence. They seem to talk about it a lot. They watch a lot of movies about it.

Dr. Jillian Woodruff: This is adult?

Dr. Seth Bricklin: And kids. I mean, these are the same for adults and teens. I’ll talk about some of the things you may be more likely to see in teens, personality changes, severe anxiety or agitation, risky self-destructive things – they start using drugs or they’re driving faster, they’re engaging in just kind of more risky sorts of behaviors.

An individual, you know, you mentioned at the top of the show, what are some warning signs you might see within yourself – feeling trapped, feeling hopeless… So, somebody expressing feelings of hopelessness, you know that their situation is bad and doesn’t think it can be changed. Acquiring the means to take your life – somebody suddenly buys a gun, you find out they’re stockpiling medications. Things like that are certainly a warning sign – giving away belongings, getting their affairs in order for no apparent reason. If you say goodbye to them, and it’s like they’re saying goodbye to you for the last time. As I say, trust your gut. Increased alcohol, drug use, mood swings, talking about suicide, and then withdrawal, isolation. Those are all certainly signs of depression and if you know somebody who’s already depressed, and then these start to happen, those would all be risk factors. They’re the same in teens. It may manifest slightly differently and so you have to sort of know your teen a little bit to understand it. But as I said, romantic breakups are much more traumatic for teenagers. We often think, “Oh, they’re young. This is no big deal. But to them, this is supremely important. It’s very important when you’re talking to teens not to be dismissive of their problems and go, “oh, you’re young, it’s fine, you have plenty of time,” because they don’t see it that way. They don’t have that perspective. So certain things like that, I think, you might be more concerned about a teen going through a breakup than you might be, like an adult or somebody in their 20s or 30s. Now, if somebody is going through a divorce and custody battle, those kinds of things, that certainly could be an issue.

The other risk factor for somebody to actually be dying by suicide would be things like firearms in the house. I think we live up here in Alaska, and you know, a lot of firearms. The most important thing is making sure they’re safe and secure if they are in the home. But if you have somebody in the home who has expressed suicidal thoughts, and you know is suicidal, the best recommendation is to at least temporarily get them out of the house. Store them elsewhere in a storage unit, with a friend, with a neighbor.

Dr. Jillian Woodruff: So it’s safer. The home, it’s not ever secure.

Dr. Seth Bricklin: It’s safer. I mean the lowest risk is in homes where there are no firearms, and then in homes where there are firearms, the risk is much more reduced obviously if they are stored unloaded and locked. One of the myths is, “Well, what’s the difference? They’ll find a way to do it if they want to do it.” That’s actually not true.

Dr. Jillian Woodruff: Interesting.

Dr. Seth Bricklin: I mean, sometimes it is, but there are many suicides that can be prevented if we remove or put barriers between the person and the means.

Dr. Jillian Woodruff: Make it more difficult.

Dr. Seth Bricklin: Make it more difficult, because a lot of times people who are depressed and maybe feeling suicidal, they lack volition, they don’t have the energy. So, taking that extra step like, gosh, I don’t know. I don’t want to get in the car and go to the storage unit where the gun safe is and get them out there. I can’t manage that.

Dr. Jillian Woodruff: Lack of volition, okay.

Dr. Seth Bricklin: There’s good research to say that these methods work. I mean, the statistics are pretty clear. One thing that is striking is a lot of parents who own guns, and they feel like, oh, yeah, my child has never handled a firearm that’s in our house. Well, they did some research, and in those cases, about 22% of kids who were then interviewed separately said that they actually had. So even when parents think that their kids have not accessed the firearms, there’s about a quarter of them that actually can access them. They know the code to the safe. They figured something out. So all I would say is, if you have somebody who you’re concerned about just kind of double, triple check that everything in the home is safe.

Dr. Jillian Woodruff: Kids are smart. They’re intuitive. They’re always listening.

Dr. Seth Bricklin: So they know more than we think. That is one thing I would say that really does help.

Dr. Jillian Woodruff: Before we go to a caller, you did mention teens having conflict with others, and so this could be a warning sign. What about adults who suddenly enter into having conflict with multiple people who would typically be getting along?

Dr. Seth Bricklin: One of the things that we say typically is like a behavior change. So something that seems to be a pretty significant, noticeable change in the person’s behavior. This used to be the calmest, nicest person, and all of a sudden they’re fighting with everybody. That would certainly be something I would be concerned about.

Dr. Jillian Woodruff: It’s a warning of something. It’s a change.

Dr. Seth Bricklin: It’s a warning of something. It’s a change. Especially with parents and their kids, but even with friends, if you see a sudden behavior change, they’re not themselves, you know, if you see something, say something. The other thing too is, if you’re worried about somebody, you’re not sure what to say, you’re not sure how to talk to them, talk to somebody. If it’s a friend, maybe try to talk to their family or talk to your own doctor – like I said, talk to your own therapist.

Dr. Jillian Woodruff: If you have concerns that there are suicidal thoughts, or intentions, you can call that national hotline 988.

Before we actually go to that caller, we have to take another break. Let’s take this short break for the stations down the line. We’ll continue our discussion of providing support to loved ones at a time of mental health crisis when we return. You’re listening to Line One, Your Health Connection on Alaska Public Media.

Welcome back to Line One. I’m your host, Dr. Jillian Woodruff. Our guest today is Dr. Seth Bricklin, who provides specialized psychology services to address mental health concerns and life challenges here in Anchorage.

Dr. Bricklin, we’ve got a caller. We have Deborah from Eagle River who is going to ask us some questions or tell us something about concussions. Deborah, welcome to Line One. You’re on air, Deborah? Okay, we’ll come back to her. We have some difficulties, so let me go through an email that came in please. They are asking for some clarification.

We have a Judy that has emailed us about preteens. Preteens that may become friendless and may shut down. So if they are depressed, do you ask directly about suicide with a validation statement if they express suicidal tendencies? If they express maybe that they want to
hurt themselves or die, what is that? What does that question look like that comes from you and how do you make that validating?

Dr. Seth Bricklin: Well, I think the first thing is, whatever their statement is, make a reflective statement. So what is that? You can repeat back what they said to you. “My life is so bad I just want to kill myself.” “Gosh, you’re feeling so bad that you’re actually thinking of killing yourself?” That reflective statement – I hear what you’re saying. I can help. What can I do? What is it that you need? That would be a validating, reflective statement.

Again, as I would say, if you have a preteen who is saying things like that, the most important thing is trying to get them help. Now, that doesn’t happen overnight. So in the meantime, how do you help them stay safe? Again, I would ask directly, were you thinking about hurting yourself or killing yourself? And there’s one thing I would say, it’s really important to actually say “killing yourself” and not just “hurting yourself” because to somebody who is suicidal, in their mind, suicide may not be harming themselves. They might be ending their pain. So they might see it very differently – “hurting myself? No.” So I will usually say, are you really thinking about hurting yourself or killing yourself? It’s important to say both.

I think I would just say that directly. “You know, I’ve been hearing what you’re saying and it sounds like you’re really struggling and you’re in a lot of pain. Are you thinking about hurting yourself or killing yourself? And then if they say, “well, yeah, I don’t know….”

One way that we assess it as professionals and as a parent, you can do this too. There’s an acronym, and it’s actually SLAP.

SERIOUSNESS – What’s the seriousness of their thoughts? Do you have intention or is it like “I thought about it, but I would never do it” or “I’m actually thinking about doing it.”

LETHALITY – What’s your plan? How would you do it?

Dr. Jillian Woodruff: And you’d ask them?

Dr. Seth Bricklin: Yes. Are you having thoughts? Do you want to hurt yourself or kill yourself? “Well, yeah I think about it” Ask, well have you thought about how you would do it?

[LETHALITY] – How lethal? “Well, I don’t know. I would just take some aspirin. I have my Prozac and I would just take that.” Well, that’s not as lethal as “I would shoot myself.” The next question now is access to means.

ACCESS – Do you have access? You would shoot yourself, but do you have a gun? “Well no, I don’t know where I would get one.”

PROXIMITY OF SUPPORT – Loved ones, do you have friends, family? I think in the email it said the person suddenly doesn’t have a lot of friends. Do they have other support? So as a parent or even as a friend, that is something you can do. You can try to assess how serious is this right now. If it’s a friend who is an adult where I can’t just go to their house and take them somewhere, maybe I can ask them those questions and then what I’m thinking is am I calling 911 or not? If I’m really concerned that somebody’s in immediate danger, then it’s not 988, it’s 911.

Dr. Jillian Woodruff: I think that’s scary too, especially if you’re thinking about doing that for an adult, that can be very scary. Add to the trauma for that person. It would be very difficult to determine, like, this person’s going to be mad at me, but at least they will be alive. But then, if you think about minority communities and calling 911, the police coming, that could certainly…

Dr. Seth Bricklin: It might be while you’re thinking about hurting yourself or killing yourself, yes, I’m going to do it. Well, I would be devastated. I don’t want you to do that. What can we do to get you help? “I don’t know”, say, “look, if you’re telling me that you’re gonna go and do it, then what kind of friend would I be if I just let that happen? I would have to call 911, or have to call somebody. How about I come and pick you up and we go to the hospital together?” But I think the response is often, you know, people might be concerned but I would generally say, “Well, what kind of friend would I be if I just let you do that? What kind of dad? What kind of mom would I be if I just let that happen? I can’t just let that happen.” Sure, they might be angry at you, but in my experience, having had to hospitalize patients and having had parents do that, in the end, oftentimes the person understands it. They understand.

Dr. Jillian Woodruff: They understand why it was done.

Dr. Seth Bricklin: They understand why it was done.

Dr. Jillian Woodruff: An interesting thing that you taught me about are the different reasons why somebody may have suicidal thoughts. If somebody has not had that, it may be very difficult to understand somebody, but you were saying that some people may think that this is not a bad thing to do. It may be in line with their beliefs. Can you tell us a little more about that?

Dr. Seth Bricklin: Yes, if somebody is really struggling and in a lot of pain, let’s say, in their mind, suicide may be something that’s reasonable and that it makes sense. There’s a term: Ego-syntonic. It means it fits my view of myself, and it seems a reasonable to me versus, you know, I’ve had patients come to me and say, “I’ve been depressed, but I felt like it was okay and then all of a sudden, I started having these thoughts of killing myself, and it really scared me. It freaked me out.” That’s what we would call Ego-dystonic. It’s upsetting to them. It doesn’t fit with their view of things.

And so when they get concerned, that’s a good thing because they’re more likely to bring themselves in for treatment. But sometimes, people won’t say anything because they don’t think of it as a problem. You’ve got to remember too, a lot of times when people are severely psychologically distressed, or if they are mentally ill, they may not be thinking very clearly. Their thinking is kind of clouded, or might be irrational. They’ll struggle with all-or-nothing thinking. They will believe that everybody hates them. There’s plenty of evidence to the contrary, but you know, there’s something called the confirmation bias, which is we tend to focus on evidence that supports our beliefs. So if I believe that nobody loves me, then I’m going to only look for evidence to support that belief, and I’m going to ignore all of the things that are clearly demonstrating that that’s not true.

Dr. Jillian Woodruff: It’s like that in scientific literature. You can always find things to support what you believe and ignore the rest. So when they’re having these thoughts, we may think that these are irrational thoughts too, but we cannot counteract those thoughts with what we think is our logic.

Dr. Seth Bricklin: Yes, you don’t want to try to get into that debate with them. It’s really more what you can at least acknowledge and try to validate the pain. “Gosh, I can’t imagine how that must feel.” And very often, what people will say, and I’ve asked patients this question, you know, it sounds to me, I might say something like, it sounds to me that it’s not so much that you really want to die or want to kill yourself. You just want your pain to stop. And very often, most patients, “Yeah, that’s what it is.” Not always, but very often, that’s what they’re saying. They’re just in a lot of pain and they just want that to stop.

Dr. Jillian Woodruff: They could try to get help for that.

Dr. Seth Bricklin: One of the things that we say as a therapist, one of our primary jobs is instilling hope, which is not always easy. You can say things like, “I know this won’t be easy, this would be difficult, but I’m going to be here with you and I will do what I can to help you. I know what help is available and I will make sure that we will get that for you.”

Dr. Jillian Woodruff: Thank you for that. I think that’s going to speak to a lot of people.

We have an email from Susan, and Susan says that in a class, and in her experience, one of the signs of suicide is the person’s mood seems to be lighter, and they are clear on what they need to do. Can you speak to that?

Dr. Seth Bricklin: It’s what I said a little while ago, because they feel like they have come to the solution of their problem. So they feel like, “Ah, I’ve got it. I’ve solved the problem. I know what I’m going to do.” So, it’s not uncommon that once they have made that decision to end their life, they might suddenly seem better. It’s like, gosh, they seem so down and now suddenly, out of nowhere, they seem better. That actually can be a cause for concern. “I don’t need therapy anymore. I quit therapy. Everything’s great.” I see that as a therapist and I get concerned.

Dr. Jillian Woodruff: Right. Because they’ve figured it out. The way to end that suffering.

Dr. Seth Bricklin: Right. That’s why you sometimes will see that.

Dr. Jillian Woodruff: We have another email. This one is from Doug, and Doug says that this is, of course, a very important topic, and that this tracks with his experience many years ago. His depression reached the stage that if he had had access to a gun, he would have been dead. He lacked the energy to actually figure out a plan to take his life, and he did mention that the 988, national suicide prevention hotline is great and will save thousands of lives.

Dr. Seth Bricklin: Okay, well, thank you for that, Doug. I appreciate you sharing that. It really is true, and I’m glad that he was able to share that with us. You know, it does tell you – very often people have told me that. I’ve heard that from several patients, “If I had had…” Sometimes what I’ll do as a therapist is, I’ll call their family “I’m with your son, I’m with your daughter, they’re telling me they’re suicidal. I know they have a gun in their house” – and this could be an adult.

Dr. Jillian Woodruff: Because they need that support.

Dr. Seth Bricklin: This could be an adult and I say, would you be willing to go over and get their firearm and hold that temporarily? And I’ve had patients tell me that, yeah, if we hadn’t done that, they were pretty sure they would have gone and used it.

Dr. Jillian Woodruff: Here’s another email that has to do with that. This one. This Judy, she wants to know, how do you speak to a person that has a gun in hand?

Dr. Seth Bricklin: We have people who train for years for that kind of work when you’re talking about somebody who is really in imminent danger. That’s a really, sort of a different expertise, you’re talking about, like, hostage negotiators. If you’re really talking about somebody that seriously, but really, like, I’d be on the other line to 911. I’m on the phone, I’m getting help and I’m calling 911. I’m not going to try to talk somebody down just by myself. I mean, I think in general.

Dr. Jillian Woodruff: It would take a professional. It’s scary too because if you have a gun and….

Dr. Seth Bricklin: If you’re in that situation, the guidance I would give is just tell them “I’m here for you. I want to talk to you. Please tell me what’s going on.” Just try to keep the person talking. Don’t try to cheer them up. Just “I hear what you’re saying. I know that you’re hurting.”

Dr. Jillian Woodruff: And you’re calling for help.

Dr. Seth Bricklin: Yes.

Dr. Jillian Woodruff: We have one final email because we’ve run out of time. This is very interesting and I think we probably need to do a whole different show about this, because we didn’t get to this part. But Lindsay from Matsu knows someone who works in mental health, and the stress of this position has led this person to self harm and contemplate suicide. So this is a mental health provider. The person doesn’t have any plans of leaving the behavioral health field, and they don’t reach out to family or friends for help. How do you suggest they combat the stress of the career? But I think you know this is a big one, and our music’s coming up.

Dr. Seth Bricklin: I could do a whole show on caring for caretakers. Yes, that’s the next one.

Dr. Jillian Woodruff: I think we should definitely do that. We will email Lindsay back.

Well, thank you so much for your time with us today. I really appreciate your willingness to share your expertise.

Thanks to our expert, Dr Seth Bricklin, thanks to our audio engineer, Chris Hyde and our producer, Madeline Rose. You can find more information on this and our previous programs on our website at alaskapublic.org. Let us know your thoughts and suggestions by emailing us at LineOne@alaskapublic.org.

This has been Line One, Your Health Connection. I’m your host. Dr Jillian Woodruff.

Line One is a production of Alaska Public Media which is solely responsible for its content. News expressed are those of the host and participants, and not necessarily those of Alaska Public Media, this station or its underwriters, learn more about Line One and listen online at AlaskaPublic.org. This is Alaska Public Media.

The post Suicide Warning Signs and Prevention | Line One appeared first on Psychology Services of Alaska .

The Underlying Effects of Trauma | Line One

Wed, 26 Jun 2024 20:00:00 GMT

April 10, 2024

Traumatic experiences can come in many forms: emotional, physical, sexual, and even witnessing trauma in others can affect you. Whether in childhood or as an adult, the way this changes your brain can impact your mental health and underlying trauma can be mistaken for, or worsen, anxiety, depression and even ADHD. Finding the right mental health provider can also be challenging in Alaska. Join host Dr. Justin Clark as he discusses how trauma impacts mental health and how to navigate mental health services to find the right provider for you.

HOST: Dr. Justin Clark

GUEST: Dr. Seth Bricklin of Psychology Services of Alaska

Click Play below to listen to the audio from the live show. Please continue below for a transcript.

Dr. Justin Clark: Hello, good morning and welcome to Line One, Your Health Connection. I’m your host, Dr. Justin Clark. Today on Line One, we will be discussing the underlying role of trauma on mental health and also access to the right care.

Traumatic experiences can come in many different forms. It can be emotional, physical, sexual, natural disasters, and even witnessing trauma and others can affect mental health. Whether in childhood or as an adult, the way this changes your brain can impact your mental health and underlying trauma can often be mistaken for or worsen anxiety, depression, and even ADHD.

There are both immediate and delayed reactions to trauma and these can be emotional like numbness, detachment, and anxiety, or physical like sweating, nausea, rapid heartbeat cognitive like memory problems or difficulty concentrating and behavioral like sleep disturbances or substance use. In addition, the need for mental health services has greatly increased in the last few years, perhaps as a result of the pandemic but also because of increased awareness and acceptance as well as less stigma surrounding seeking care. However, the supply of providers has not kept up with the demand for services and this is particularly true in Alaska. Not only can it be challenging to find a mental health provider, but it can be challenging to find the right provider for you, which is just as important.

To discuss these important topics, I am pleased to be joined by psychologist Dr. Seth Bricklin, from Psychology Services of Alaska.

You can also be part of our conversation. If you have a question or a comment please call us toll free statewide at 1888-353-5752. In Anchorage, 907-550-8433 or email us at lineone@alaskapublic.org.

Dr. Bricklin, it is a pleasure to have you in the studio today. Thank you for joining us.

Dr. Seth Bricklin: Thank you for having me.

Dr. Justin Clark: I want to give you an opportunity first to introduce yourself to our listeners. Let them know a little bit about yourself, how you got to Alaska, what kind of therapy you do, your training whatnot. So please introduce yourself.

Dr. Seth Bricklin: My name is Seth Bricklin. I’m originally from Los Angeles and I spent most of my life there. I started in psychology in 1996, and actually went back east to do grad school in Philadelphia. While I was in graduate school, I actually started specializing in industrial organizational psychology and executive coaching and then when I got out of graduate school, moved into substance abuse, so I spent a lot of years early in my career working in substance abuse.

After that, in about 2005, I became the director of a mental health program that was on a campus of a school for kids with special needs and we contract with LA County Department of Mental Health. So, I worked in that sector for quite a while for about 10 years, mostly doing administrative but also a lot of clinical work and working a lot with kids with developmental delays as well as severe emotional issues. Then after that, I got a little burned out dealing with the Department of Mental Health and moved into private practice. I did that for quite a while. Then about two and a half years ago, my wife and I decided we wanted to move out of LA and she’s from up here originally, so we came up to Alaska. When we first got here, I started working at Providence. I was working in primary care doing integrated behavioral health. I did that for a couple years and then a couple months ago, came over to Psychology Services of Alaska, and so doing evaluations for bariatric surgery, Department of Labor work comp cases and then also a lot of individual therapy.

Dr. Justin Clark: That’s great. We’re happy to have you here in Alaska. When we were talking, before we get into trauma, because I think it helps underlie, you know, our trauma discussion and all therapy discussions. We talked a little bit about your approach and your philosophy to therapy. I wonder if you could share that with our listeners.

Dr. Seth Bricklin: Sure. As far as my approach with therapy and how I like to work with patients, I always like to think of therapy as a joint venture and different from a lot of medical treatments, especially like surgeries, therapy is something we do with the patient, not to the patient. They are very actively involved in that entire process. I sometimes think of my role as almost like a personal trainer. A patient client comes in, here’s my goals, here’s what I want to achieve – and I will work with them and give recommendations and suggestions and help map out a plan for how we’re going to get there. The patient has to still do the heavy lifting. They’re the ones that are doing a lot of the work and I feel I’m more of a guide. I really like to let them lead.

In terms of my philosophy in what I think people often come and need help for, there’s an old Buddhist saying, which I think really encapsulates it very well, which is, “pain is inevitable, suffering is optional”. It basically means that painful things are going to happen to all of us in life and if we’re suffering because of them, it’s often because of our own processes, whether we’re thinking too much or have a hard time letting go or feeling stuck. But often, there’s a lot of things that we’re doing to contribute to that. The good news is if we’re contributing to it, then it’s also in our power to fix it and to change it.

Dr. Justin Clark: Yeah, that’s a great philosophy. I think “suffering is optional” is a great idea. Life is hard – it’s hard and things are definitely going to happen. It’s just how we deal with them that makes a big difference. What’s your thoughts on mindfulness? How does mindfulness play into your philosophy?

Dr. Seth Bricklin: I think that the same “pain is inevitable, suffering is optional”, has become kind of adopted by the mindfulness folks and people who believe in that. The idea there is, one of the other principles in mindfulness is this idea of radical acceptance. Acceptance doesn’t mean we have to like something, it just means we accept that it’s happening. I believe suffering comes really from two places – It’s either when we refuse to accept that something is what it is, or when we believe that something is what it is, when it isn’t. Meaning, we do have the power to change a situation. People will say, well, I have this job and I’m stuck and I can’t leave and it’s like, well, you could leave. It might be difficult and maybe challenging, but you could do it. So it’s either we refuse to accept something that we cannot change, or we believe that we can’t change something that we actually could.

Dr. Justin Clark: Fair enough. Fair enough. Looks like we have our first caller coming in. We’re gonna take Amelia calling from Eagle River. Welcome to Line One.

Caller Amelia: Hey, thank you for taking my call, Doctor. I wanted to address something. I suffer from PTSD. I had my best friend roofie me, rape me and tried to kill me and then he ended up committing suicide himself.

Dr. Justin Clark: Oh, my goodness.

Caller Amelia: So it was a really traumatic experience and I went to talk therapy, medicated therapy and nothing was really helping. I ended up having to travel out of state for inpatient PTSD treatment. There’s nothing like that here in the state for inpatient for adults. We have Ernie Turner for substance abuse, you know, juveniles but they’re really up to anybody who wants inpatient or wants that level of care, has to travel out of state. I just wanted to bring that point up.

Dr. Justin Clark: Thank you, Amelia. That’s a good point. We’ll chat about that here. I’m really sorry for your experience and hopefully, now that you’ve returned to Alaska, you’re with someone that can help you work through this process and encourage you. Make sure you listen to the rest of the show as well as we talk more about trauma. Dr. Bricklin, I know you’re strictly outpatient and outpatient therapy. I know Alaska does have a lack of services for the inpatient side. Any thoughts on what Amelia had to say?

Dr. Seth Bricklin: It’s actually unfortunately common throughout the country. There are many places I worked and I lived in LA for a couple of decades and there are very few really good accessible programs for just mental health. So many of the residential programs down there will say we treat mental health issues, depression, anxiety and they end up being very much substance abuse. There’s always a strong component. They will advertise to try to draw inpatients but that’s really not their specialty, so it really is true what Amelia is saying and it’s not unique to Alaska. I’m glad that you were able to find that program. It does take some work to find the right place. You know, when patients need a higher level of care and they feel like outpatient isn’t doing it, I really encourage them to call places and make sure they’re asking them what’s your programming like, how many of your patients are struggling with trauma versus substance abuse? So you get a feel to make sure that the program really is geared towards what you need.

Dr. Justin Clark: Then once they return to their community, further outpatient therapy, it’s beneficial.

Dr. Seth Bricklin: Yes. Usually patients coming out of a residential program are going to do what we call step down, so they’ll go from residential, maybe to an outpatient program where they would go a few days a week, and then ultimately into just regular outpatient therapy where they might see the therapist once or twice a week for an hour. Unfortunately too, these programs, some do a really good job with aftercare and some don’t do the best job so a lot of times as is the case nowadays with a lot of healthcare is, you really have to be an advocate. You really have to keep asking questions and keep searching until you find the right care.

Dr. Justin Clark: I want to give our listeners the call-in numbers again here as we transition into talking more about trauma. Toll free statewide 1-888-353-5752, in Anchorage 907-550-8433 or email us at lineone@alaskapublic.org.

Dr. Bricklin, let’s go into a little bit of trauma. There’s a lot of different types of trauma that can happen to people. Some people think when they say trauma, it’s necessarily, “Oh, like I was attacked or I had a physical trauma”, but there are many different types of trauma that affect people. Even seeing somebody or knowing about trauma, like these wars that are going on on the other side of the world, thinking about it can have an impact on you. So, what are some of the examples of trauma?

Dr. Seth Bricklin: Well, you gave several of them. But that is true – trauma is one of those words that has become a very broad term. You’re right and when I meet patients, I’ve learned you don’t simply say, “Have you ever experienced any trauma?” because that definition means so many things to different people. Often, it’s associated with victims of violence. Usually, abuse is what people think of. Many times patients will tell me “no, I’ve never had any trauma” and then when we ask about their childhood or upbringing, you know, “my parent yelled a lot, they scream, they were physically abusive.” Even though they’ve said they have no trauma.

One thing to point out is that trauma is very much in the eye of the beholder. It’s how the person perceives the event or the situation that really determines whether it’s traumatic. So, it can be an actual victim of violence or abuse, sexual abuse, physical abuse, ongoing verbal abuse. It can be an acute incident, something that happened one time, involved in a car accident or witnessing some kind of event or ongoing abuse where somebody grows up in an abusive household or is in an abusive relationship – all of those things can be considered traumatic and affect us in similar ways.

Dr. Justin Clark: One interesting thing is that okay, I think there’s a lot of different types of trauma. We can all agree that certain types of trauma occur – there are like, being attacked or raped or something like that. It is a traumatic experience. We can all agree on that, but everyone is affected differently by the same trauma. So, when you’re talking to a patient, how do you determine if something is traumatic to them, but it might not be traumatic to somebody else?

Dr. Seth Bricklin: Well, it’s again, their perception. How did they feel? The key element really is a person experiencing an intense sense of fear. They were in fear for their life or their safety or the life or safety of somebody else. That would certainly qualify. That’s an element of it, which is, how was it for you? What were you feeling and experiencing during that time? But, many many people, in fact most people might experience something that could be considered objectively traumatic, and not have PTSD. It can still have an effect on us and affects our brain in certain ways.

As far as why some people will go on to develop PTSD and others don’t, I’m not sure that the evidence is really clear on why that is exactly. We do know there are certain risk factors, you know, prior trauma, co-occurring substance abuse, depression, anxiety. If somebody already has some of these issues, and then experiences trauma, they tend to be more susceptible to that developing into PTSD.

When I was in LA practicing, there was a train derailment nearby where my office was and I had somebody come in and he was having a lot of PTSD symptoms. He was on the train with friends and family and none of them had the same symptoms. So, people in the same exact event, some people go on to develop symptoms, some don’t. The other thing with trauma of course is you can have a delayed onset. So, sometimes people will have immediate symptoms related to the trauma and other times, they may not get PTSD symptoms for months or years, so they don’t think of it and they don’t make the connection. For example, there was a study done after 9/11 where people witnessed it, but didn’t really have a traumatic PTSD-like response. And then a couple years later, they got fired from their job and all of a sudden have these flashbacks and started to develop these PTSD symptoms. So, stressors later in life can bring forth trauma from earlier.

Dr. Justin Clark: That’s very interesting. We have another call coming from Mary in Anchorage, Mary, welcome to Line One. What can we answer for you today?

Caller Mary: Thank you. I was hoping that the doctor could help me understand the difference between something called Complex PTSD and traditional PTSD.

Dr. Seth Bricklin: It’s a good question. Complex PTSD. You’re seeing more and more of it in the literature these days. It’s kind of a little bit newer in terms of how it’s being discussed. It is still not an official differential diagnosis from PTSD, but you tend to see more of the complex PTSD in patients who have had ongoing, sort of longer, chronic abuse. So, verbal abuse involved in abusive relationships, grew up in a very abusive household.

The difference, you see more in the complex PTSD is a lot more of that turning inward of anger, so self loathing, depression. Those things tend to get a lot more challenging for folks with complex PTSD.

For example, somebody is involved in a car accident, that’s not their fault. Somebody ran a red light and hit them. There’s no part of them that thinks they are to blame. It’s very clear that it’s not their fault. They don’t feel bad about themselves and it doesn’t really affect their esteem, but if somebody is in a long term abusive relationship or as a child was abused, that affects their sense of self, their self esteem, they may start to ask themselves why is this happening to me? What am I doing wrong? And so because of that, PTSD in patients who have that kind of history can be more complex and more difficult to treat.

Dr. Justin Clark: Thank you, Doctor.That’s interesting. We’re going to answer an email here. Dr. Bricklin, this one’s a little bit vague, but is it possible to tell when repressed traumatic memories may be affecting someone’s mental health without the patient actively knowing or bringing it up?

Dr. Seth Bricklin: That is an interesting question. I’m not sure. In other words, a patient doesn’t know about the trauma, but I think what the person is asking is, are there certain kinds of symptoms or things a person might be doing or saying or problems they could be having that is sort of an indication that they have some repressed trauma? That’s how I’m understanding the question.

It’s a good one. I’m not sure that I would say hey, if I see this pattern of symptoms, that’s a cue that there is some kind of repressed trauma. You know, I might expect that, if somebody presents having all of these symptoms and are having these intrusive thoughts, they’re hyper vigilant, which means they’re always on the lookout for danger, they get startled very easily, like they’re having all of the PTSD symptoms, but they can’t identify any kind of trauma, maybe that would be some indication of it. So I guess if somebody’s having PTSD symptoms, and they’re not identifying a trauma, that might be an indication that something like that could be occurring. But I honestly haven’t run into that situation where I’ve had that experience with a patient where they have been presenting all the symptoms, but no, they’ve never had any trauma. I haven’t seen that. So that would be, I think, unusual, at least in my experience.

Dr. Justin Clark: Dr. Bricklin, there’s some established but also emerging evidence of how trauma actually affects the biology in the brain. I want to talk a little bit about that, because it does seem like it’s not just something that happens and it affects your mood. It actually changes the way your brain works. Let’s talk a little bit about the effects of trauma on the brain.

Dr. Seth Bricklin: Research has really helped us evolve the treatments and how we approach the treatment. So trauma affects the brain in various ways and there’s five different areas that primarily are impacted by trauma. Essentially, what happens is some parts of the brain will become overactivated, overstimulated, while other parts will become understimulated. When you do treatment, the goal of treatment is to correct that.

So, for example, the amygdala’s job is basically determining whether something is dangerous, or safe, and it’s really responsible for that fight or flight mechanism in our brain. When somebody is traumatized, that part of the brain is overactivated. They’re always in this heightened state of arousal after they’ve been traumatized.

The hippocampus which is responsible for memory, and really explicit memories, so things like what you had for breakfast, how to drive a car, the names of state capitals – importantly, it also gives memories context. So who, what, where and when, and that’s an important piece in trauma we’ll talk about and that becomes underactivated.

Those two structures in the brain are important. Example on how this happens in trauma: So during a trauma or some kind of life threatening experience, the amygdala starts firing. That floods the brain with cortisol and adrenaline. At the same time, the hippocampus starts to shut down. Think of it like the amygdala sort of drawing energy, because what your brain is saying is hey, this is a fight or flight situation we need all the energy we can for survival. What happens is the amygdala will take over memory during those circumstances, but the amygdala really only stores emotional memories.

Those are intense emotions during the trauma right? Fear, anger, rage, and so traumatic memories because of that, they lack context – the Who, what, where when. So let’s say for a combat veteran, for example, rather than understanding that angry people waving guns during Desert Storm in Iraq equals danger, the brain simply remembers that angry people and loud noises equal danger. So, something as mundane as somebody aggravated in line at the DMV and raising their voice might trigger that trauma response because all the brain remembers is loud people and angry people is danger. That’s why you can see how the structures sort of interact with each other so each time that person gets triggered, the brain is flooded with more adrenaline and more cortisol and the more this happens the more easily they can get triggered. So eventually, people can become stuck in this hyper-aroused state.

What I say about people with trauma is they have a short fuse, they get very quickly triggered and a longer recovery period. So normally, if you’re at home and your partner comes in and startles you, it might only take 20 to 30 seconds and pretty soon you’re like okay, everything’s fine and you calm yourself down. People with trauma might startle much more easily so just not a very loud noise or tap on the shoulder, but it might take them 20 or 30 minutes to recover from that.

Dr. Justin Clark: Interesting.

Dr. Seth Bricklin: So other parts of the brain, the insula, is responsible for what we call interoception and proprioception. So proprioception is like how you know where your body is in space. Like how you can touch your finger to your nose with your eyes closed. That’s proprioception. Interoception is how you feel into your body. How do you know when you’re hungry, you feel butterflies in your stomach, you feel warm, you feel cold. This part of the brain becomes dysregulated during trauma.

Very often during a traumatic experience, we disconnect. People go numb, especially in times of abuse, they just dissociate or disconnect. So with this part of the brain, you can see both where they are, sometimes it’s under activated, but once it’s triggered, it becomes very overactivated.

People with trauma could also be very sensitive. They feel one little twinge in their body and they become very reactive. Then you start to move up the brain and I say up so the amygdala is kind of the base of the brain – this is like parts of the brain that are responsible for survival. When you move up in the brain, you get to more consciousness, cognition, and these types of things. So when we move up here, we’re talking about the prefrontal cortex and this is the thinking center of the brain responsible for executive functioning, so decision making, concentration, impulse control, self control, and with trauma, this is underactivated.

So people who have trauma can struggle making decisions, they have trouble concentrating, trouble focusing, they can be impulsive, and it makes it difficult to deal with day to day stressors, because the reasoning is, particularly about interpersonal conflicts, that is compromised.

The last part of the brain that we’ll touch on is called the cingulate and this is responsible for self regulation. So when you’re angry or scared, this is what helps calm the amygdala. That’s because the amygdala is firing and is responsible for anger and fear. And when you say to yourself, “Okay, that person just bumped into me, it was an accident, take a breath, let’s calm down” – that’s your self regulation part of the brain. That becomes underactivated, so it also becomes difficult to manage conflicting emotions. I’m really frustrated with somebody who I love deeply – our cingulate allows us to make sense out of that.

These are all the parts of the brain that get affected with trauma.

Dr. Justin Clark: It’s a full brain response really. It’s pretty fascinating, complicated. Well, let me ask this question. We have an email question here because you kind of mentioned dissociation there. Now this is from Elsa. How do you treat adults that continue to dissociate as a coping mechanism? Previously considered, maybe multiple personality disorder?

Dr. Seth Bricklin: So, what used to be called Multiple Personality Disorder is now called Dissociative Identity Disorder. However, dissociation is actually a common defense and we all will dissociate at certain times.

A good example of this kind of dissociation that is sort of benign, not very, and actually sometimes helpful would be, you’re driving home from work and your mind is sort of occupied. You’re thinking through a problem or chewing on some issue from work, and all of a sudden you get home and in your driveway, you’re like, how did I get here? You know, you’re almost – you stopped at all the lights, you were paying attention – but this part of you is kind of disconnected and dissociated.

Dissociation can come in all forms. So to the person’s question, first, you really have to assess what level of dissociation is occurring. Are they really experiencing a dissociative identity disorder, which means they have really distinct personalities that will come out under times of stress? It’s fairly rare. I have treated a couple patients who had that issue and generally it stems from really severe, severe abuse, long-term severe abuse that is usually seen as a precursor of something like that. Many people with trauma that’s maybe not as severe will have some dissociation. And in that regard, you see people, they go numb, they just disconnect, they withdraw. The treatment for that, we’ll talk about, but the part of the brain that is responsible for that, the insula is a part of that right? So we disconnected our body so there are some things and even things like yoga, breathing exercises, ways to try to begin to reconnect with your body. These are obviously done very carefully with the therapist because you don’t want to overwhelm the system and get too connected, because that could then just be retriggering.

Dr. Justin Clark: Is it different? Different parts of the brain get changed or altered with different types of trauma or can it be anything?

Dr. Seth Bricklin: That’s a good question. I don’t know for sure if there’s, the research has kind of parsed it out that clearly where like physical trauma tends to lead to more problems in the amygdala versus this part of the brain. I think it really has more to do with a person’s perception. So, in the state that they’re in, if somebody is already in a weakened state, for some reason, they’re compromised in some way when the trauma is happening, they might be more prone to developing those symptoms.

Dr. Justin Clark: What about age? I imagined that a developing brain may change differently than an adult or developed brain.

Dr. Seth Bricklin: Absolutely. Sometimes when I would do assessments and you would hear people say, ”Well, you know, we had a lot of arguing and fighting and screaming and yelling in our house, but she was only six months, so she doesn’t remember any of that. There was this belief that if you were so young, that you couldn’t remember, that you wouldn’t be as affected by it. The research has shown it’s actually the opposite. The younger children are actually more affected by that. The reason is they lack the language to understand what’s going on. There’s no filter. So, if I’m at home and in my room, and my parents are downstairs yelling, I can understand that. That’s not about me. If I’m six months old, and I’m in my crib and there’s yelling and screaming right next to me, I have no filter. I’m just feeling that anger, that fear, that rage and so without that filter, younger brains can be much more effectively impacted by trauma.

As children get older, they do develop the language that they’re able to then say, “Oh, mom is mad at dad. That’s why there’s yelling.” But kids at that age developmentally, are still somewhat egocentric and that they believe things are about them. Well, mom’s mad, what did I do? And so that can have a greater effect. That’s where that complex PTSD can come into play. They tend to blame themselves and take responsibility for what’s going on around them, just because developmentally they haven’t figured it out and that’s not exactly how things work. So the younger you are, for sure, the more impacted you can be partly because your brain is developing, it’s not fully developed.

I have this experience with my kids who are still three and five. Well, they will say something, and they’ll talk to you about it like it just happened yesterday and my wife and I look at each other and say that happened two years ago, how do you remember that? You think it’s like that timestamp. That context isn’t fully there. So they will really feel things, they get all mixed up about when stuff happened. So it’s a good example of how the brain sort of develops and you learn that ability to kind of have context for your memories.

Dr. Justin Clark: Is there a way, this is maybe a strange question, but can someone get stuck at a certain age developmentally or emotionally when a traumatic event happens to them?

Dr. Seth Bricklin: Well, that’s often how we talk about trauma and what people are struggling with is they will get stuck. But usually we’re thinking like they’re reliving the memory over and over again. They have trouble letting go of something. I mentioned I worked a lot in substance abuse, and we used to say, hey, this person stopped developing when they started using drugs, because it does sort of stall their emotional development because if you’re using a substance you’re numb to things and so you just kind of are in your own world and you’re not engaging with the rest of the world and you’re not allowing your brain to develop. I think with trauma, there is an element of that where you can get stuck to some degree. I think what happens more often is rather than necessarily being stuck in the sense that you’re talking about, they might get triggered and the amygdala fires and that traumatic memory comes back and then the person might regress. So it’s more of what I would consider to be sort of a regression where I’m at work and my boss is mad at me and she’s yelling at me and all of a sudden I feel like a seven-year-old whose mom is yelling and screaming. I don’t know if that answers your question. It’s more along with that type of process, I would think.

Dr. Justin Clark: So we’ve mentioned throughout the show some of the emotional reactions, physical, cognitive, behavioral stuff, and we can touch more on that. Maybe you can mention some of the reactions to trauma that we talked about. And then I really want to understand how those can be confused for other diagnoses because a lot of people will say yes, and especially self diagnosis. Oh, well, I’m, you know, my friends told me I’m bipolar. Yeah. Like that’s not a medical diagnosis. It might be being confused for something else. So let’s list off a few of the reactions to trauma and then let’s talk maybe about how that confuses other diagnoses.

Dr. Seth Bricklin: Well, we talked about some of the reactions in terms of how it affects the brain, but what you see, oftentimes, people might be numb, that they have severe anxiety or fear, anger, guilt – helplessness is a big one. That’s a big piece of the work that I do, which I won’t go into more detail now. But, I do think that feeling of helplessness plays a huge factor. You can also get things like depression, mood swings, anxiety, angry outbursts which are very common.

What I generally will say to folks is, generally speaking, they feel that their emotional reactions are often out of proportion. So it makes sense that they might be angry but it doesn’t make sense that they’re that angry. There’s a saying a therapist I worked with years ago, and I don’t know who actually I could credit for this saying, but “if it’s hysterical, it’s probably historical.” By hysterical meaning, if it’s an overreaction, it’s probably not about your boss getting mad. There’s probably more to it than that. These are some of the immediate responses cognitively – you have trouble concentrating, ruminating thoughts, that distortion in time and space is common. We talked about that, like you don’t know when things happen. This is why witness testimonies that…and I went and heard somebody give a lecture and she was a neuropsychologist who would go and testify, she’d have to explain to juries, this victim of this rape, their timeline is off because their memory wasn’t working right.

So, prosecutors will try to or, you know, defense attorneys will try to stump them like what you said, this happened to, you know, at two o’clock, but it’s really four o’clock and it’s not because they’re lying, it’s because their memory wasn’t working properly. You see some of these effects, sleep problems, very common, or the two main senses we often see are what we call hypervigilance. You’re always on edge, you’re looking for danger, loud noises. When you have to go to a room, you sit with your back to the wall, you’re always looking, you’re always on the lookout. And this exaggerated startle response, and many people with PTSD will tell me oh, yeah, you know, my partner touched me on the shoulder and I jumped up to the ceiling, the real overreactions.

Dr. Justin Clark: So there’s a lot of different symptoms and different parts of emotional, physical, cognitive, behavioral, and a lot of what you listed, I would say, well, that sounds like someone’s depressed right? They’re numb or they’re withdrawing, or it sounds like they have ADHD because they can’t concentrate and everything, so I can see where people might think, oh, they have these other diagnoses. As a therapist, how do you tease this out and say, oh, this patient is coming to me because they’re anxious, but when I work with them, it’s clear that they are reacting to trauma.

Dr. Seth Bricklin: It’s a good question. So the first part of whenever I meet with the patient is a really good thorough assessment. Sometimes it’s an hour, sometimes it takes several sessions to really get the full assessment, but it’s really trying to understand their whole history and a whole background. One thing I get a lot is, the two most common, self doubt… Well, now it’s sort of three that I get a lot. People come to me, just like you said, “I think I’m bipolar…I think I have ADHD…I think I might be autistic.” We hear that a lot. Now that’s becoming much more understood now that we see on a spectrum.

With bipolar disorder, 70% of the patients who tell me they have Bipolar, do not. They’ve never been diagnosed. They think they have it, but they do not. But you know, the one example of ADHD is a really good one where that can often be a result of trauma. In fact, when I do ADHD assessments, the first thing I’m thinking about is, has there been a history of trauma? Because of that effect on the prefrontal cortex – you’re not concentrating, you’re not able to focus if you’re always in this hyperaroused state, you can’t remember anything if you’re anxious. If there’s a fire alarm going off and I say here’s my phone number, you’re not gonna remember my phone number when there’s a crisis.

So, people who have trauma and are in this state will present with many symptoms of ADHD. A lot of it is just getting a history. When did it start? ADHD, you have to have had symptoms as a child. People tell me they have all these symptoms but oh no, I did great in school, no problems, got good grades. I was a good student. Then I’m thinking well, it’s probably not ADHD, it might be trauma. And you know, lack of concentration is a symptom of every one of those disorders. So teasing it out, really it’s other symptoms. So you’ve got to ask about past trauma and ask about all of those things.

Dr. Justin Clark: We have a call. Mike, calling from Palmer. Mike, welcome to Line One. Mike, are you there? Hi, Mike. What can we talk about for you?

Caller Mike: Just curious about the types of services available out here in Alaska for therapy. I have a family member who shares as an adult that he had a traumatic experience in childhood and has some other issues going on. He’s been involved in a couple of car accidents, but sometimes we see some changes in him emotionally and I was just thinking about what kind of resources are out there for adults? He might need some kind of therapy or to see somebody?

Dr. Justin Clark: Thanks, Mike. Thanks for the call. Dr Bricklin, we’re going to talk in our next section here a little bit about how to choose the right therapist and options but it’s a good transition with Mike’s question. What’s your experience with services in Alaska for this sort of thing?

Dr. Seth Bricklin: As I said, surprisingly, it’s limited. There’s waiting lists. People will tell me they’re waiting three or four or five months to get in to see somebody. So the person that Mike is talking about, usually in a case like that, the best thing I can recommend is you can start with your primary care physician. Some are very good at understanding and helping to at least get the ball rolling for mental health issues. Most of the ones that I know and I worked in primary care for a couple of years up here, you know, they’re pretty at least open about whether it’s in their wheelhouse or not. If it’s not, they’ll tell you, so you can start there and try to get a referral. But the key, as I said before, is a good assessment.

You mentioned he had had some car accidents and that’s another thing to keep in mind – head injuries. We always ask if this person had seizures, concussions. Post concussion syndrome can mimic a lot of symptoms. There’s all of these things when you do a good thorough assessment. That’s how you really tease out what’s going on and very often somebody will come to me and they’ll be diagnosed. Oh, I was diagnosed with PTSD, panic disorder, depression and bipolar disorder. Usually, it’s not gonna be all of those things. Because very often it’s just PTSD. PTSD is what could account for all of those symptoms.

So, in finding services, sometimes it’s starting with an outpatient therapist. What you want to make sure when you’re seeing an outpatient therapist – What is his or her experience? Their degree is not as important, in my opinion, as is their experience. Do they have experience with the issues that you’re having? If they have that level of experience and are going to get a good assessment, then let them help guide you into what the right treatment modality might be.

Dr. Justin Clark: Dr. Bricklin, before we unfortunately have to wrap up, I do want to talk a little bit about traditional therapy versus new therapies for trauma. But we did start the discussion on sort of the different types of providers out there and I know there are a lot of different types of therapists and credentials. There are licensed clinical social workers, there are nurse practitioners, SDs, PhDs, MDs, a lot of different initials. So if you could maybe tell our listeners what these are and more specifically, does it matter?

Dr. Seth Bricklin: One of my professors used to say you can answer every question in this field with “It depends.” It depends, to some degree, what the issue is. If you’re looking for medication, you’re already seeing a therapist and want medications, you’re going to want an MD, a psychiatrist or a psychiatric nurse practitioner can also be licensed and able to prescribe medication.

If you’re looking for a really good diagnosis, you’ve been given three or four different diagnoses by different therapists, you’re not really sure what’s going on. Well, you probably want a clinical psychologist, which is what my background is. We get a lot more training in differential diagnosis, diagnosing more severe persistent mental illness, training and psychological testing, which is not always necessary. In fact, most of the time it is not necessary to diagnose a lot of these issues. But a psychologist would know when it would be necessary, they can help guide you into that, and psychologists are going to be doctorate level PhD or my degree is in society. So it’s just a more clinically focused degree, whereas PhD typically traditionally, it was more research-based.

And then you’re going to have master level clinicians and master level clinicians would include marriage and family therapists, licensed clinical social workers. LPC is licensed professional counselors, I believe they’re now licensing up here. Each of those disciplines has a slightly different focus in their training, but all of them can be psychotherapists. And as I said before, if you’re just looking for therapy, the main thing is, do you feel like it’s a good connection? And do they have experience treating the issues that you’re struggling with? That’s the primary question.

And so that should be on the person’s website. When you’re looking for a therapist, people ask me all the time what should I do? Should I go therapist shopping? You know, usually what I say is, you might want to pick, you know, go through. Nowadays, it’s so hard like it’s hard to shop, right? Because nobody has any openings. You might not have that opportunity.

But what I often will tell people is anytime you meet with a new therapist, try to give it two or three sessions. The first session is always going to be a bit of an anomaly because they’re usually going to be doing a little bit more of an assessment, unless there’s something that really just made you completely uncomfortable. Usually I encourage, you know, friends or family, give it two or three sessions, maybe four. If you really aren’t feeling like it’s helpful, try talking to the therapist letting them know and if that still doesn’t work, yeah, then go look for somebody else.

I don’t recommend having like six appointments and going to six first appointments with therapists in a few weeks, you’re gonna get burned out. Imagine having to tell your story over and over again to new therapists. It generally can be sort of overwhelming, actually. So I usually say pick one, try it for a month or two and if that’s really not working, try talking to that therapist. We’re really trained to want to hear that kind feedback. I really appreciate feedback from patients. If something I’m doing isn’t working, let me know. As I said, this is something we do together. And if you’ve tried that, and that’s still not working, then yeah, find somebody else.

Dr. Justin Clark: We have a call from Tiffany in Anchorage, Tiffany, welcome to Line One.

Caller Tiffany: Hi, thank you.

Dr. Justin Clark: Hi. What can we talk about for you today?

Caller Tiffany: Well, thank you for taking my call. I have a question about racialized trauma. I’m Alaska native and so there was an incredible amount of trauma that was experienced. Like all that was and how that gets passed down inter-generationally. It’s really interesting. I feel like it’s a little bit different and individually impacts people a little bit differently and it also impacts families a little bit differently because of the severity of it, I guess. And then, the social dynamics are really complex and like the experiences that we have outside of that trauma kind of reinforced, I guess a feeling of being less but I was wondering if you know anybody who specializes in trauma…

Justin Clark: Trauma and intergenerational trauma. That’s a great question. Thank you. Dr. Bricklin, any thoughts on this?

Dr. Seth Bricklin: I don’t know anybody out here who would advertise that as an expertise, but I’m still new to the area to some degree, but I do think that’s a really good point. Cultural influences play a big part in that generational trauma. How people view mental health, how people view the system with a capital S, you know, all of these things are important. Generally, things that I will talk about in my assessment. So I think, one, you can certainly look and when you’re interviewing for a therapist, ask, you know, have you worked with many Native Alaskans? What’s your experience of PTSD with this population? Is that something they really consider themselves an expert in? And then if you’re struggling to find somebody who’s an expert in that, you still might find somebody who’s an expert in trauma, and then just meet with them and see how it goes.

My belief is there are so many ways in which I’m going to be different than all of my patients. I can’t possibly have shared experiences with every patient. So, I always look to my patients to educate me about their experience. I don’t know what it’s like to grow up as a native Alaskan, so I will ask them to share what their experience was. On that same note, just because I’ve done research about Native Alaskan culture, let’s say, and I have one patient who grew up that way, I don’t know that my next patient who’s native Alaskan is going to have the same experience. So it’s always about – what is your experience? What was your experience with that? I think it’s something I’m always going to be asking my patient.

Dr. Justin Clark: That’s a tough one. It would be very interesting to talk about that in a different show and get some experience off of that.

Dr. Seth Bricklin: There is good research on that. It’s not my expertise, but there certainly is research about how different cultures are affected by those types of things. And so there’s good literature out there and there definitely are people out there who have that expertise.

Dr. Justin Clark: We have about five, six minutes before we have to roll up here. I did want to ask you a little bit, since the show is mainly about trauma. You had mentioned in our conversation before that traditional therapy or talk-type therapy doesn’t always work for trauma, or it doesn’t work initially for trauma. There’s some other types of treatments that have been developed. So, I wondered if you could talk a little bit about newer versus traditional therapies for trauma.

Dr. Seth Bricklin: When we say traditional therapies, I think we still do all those traditional therapies for trauma, but what we talked about now is trauma-informed therapy, so I might do talk therapy or cognitive behavioral therapy, but it’s trauma-informed, meaning I understand how trauma affects the brain. Traditional cognitive behavioral therapy deals just with that prefrontal cortex, right? How do you think about the problem? What are the thoughts you have about that situation? Let’s identify the irrational thoughts and let’s change them. Self regulation – do some deep breathing, do some meditation. These are things that we use.

That’s also the cingulate. That’s the self regulation part of the brain. But traditionally, we haven’t really focused on the other parts of the brain, the amygdala, the hippocampus, the insula, so the newer therapies will incorporate that.

The other thing we recognize on the brain, it has two hemispheres. Each one of those structures I talked about has a left and a right side. And so a therapy like EMDR, which is eye movement, desensitization and reprocessing involves bilateral stimulation. What that is, is you might move your eyes from one direction to another, left or right. What I’m doing is, I’m stimulating both sides of the brain. The left side of the brain controls the right side of the body, the right side of the brain controls the left side. So you might alternate flashing lights on different sides, I might hold something in my both hands that vibrates alternately. And by doing this bilateral stimulation, you help process your memories more effectively and it helps the brain communicate more efficiently.

Also when you do this bilateral stimulation it actually helps inhibit the amygdala. So it doesn’t get as activated when you’re processing memories. And then the key to the new therapies is eventually what you want to do and something like EMDR and other therapies as you are reprocessing those traumatic memories. Well, why are we doing that? To give them that context. So now I’m going to teach you how to relax, disinhibit your amygdala so it’s not reacting as much and allow you to talk through the trauma in more of a relaxed state so that now I know if I’m enlightened, if somebody’s yelling at the DMV, it’s 2024, I’m in the DMV. I’m saying, you know, your brain starts to make that connection. And then when you talk about the trauma, and traumatic memories, your brain knows this was 30 years ago. My father is no longer here. I’m no longer in danger. And that’s how we reprocess the memories. So the newer therapies and the trauma informed therapies really focus on that aspect of it.

Dr. Justin Clark: Excellent. Looks like we have a final call we’re going to try to get to. Marvin in Fairbanks, welcome to Line One.

Caller Marvin: Thank you. I just have a comment. I used to be an emergency responder and for years, we would be on scene called out to help people. Sometimes, in many cases there would be some people that didn’t survive. One of the things that we initially were not trained, but eventually we got to look at the situation is that trauma occurs in a place and at a time and it affects everybody in that place at that time. Those that haven’t had any experience previously, would sometimes take that trauma and I almost want to say hide that from themselves and go away and think, Oh, thank God it wasn’t me, but it was them. And sooner or later, their brain is gonna remember that and they’ll start having problems. So what we started doing in our unit was we looked at people that were bystanders and we gave them cards and have them call us individuals in our unit if they started having problems, and we could refer them to professional help. We also asked them to discuss it with their pastor, with their spouse. At least to talk about it. The earlier you start, the better off you’re gonna end up being, as far as I’m concerned.

Dr. Seth Bricklin: I appreciate what a really wonderfully insightful and progressive idea and so simple, but you can see just how a simple thing like giving somebody a card and saying call me makes a big difference.

Dr. Justin Clark: Well, Dr. Bricklin, we have about a minute left. I do want to give you the opportunity to let our listeners know how to get a hold of you if they have any further questions or they’re looking to maybe have an evaluation or seek therapy, and any closing thoughts you might have?

Dr. Seth Bricklin: Sure, you can reach me at Psychology Services of Alaska. Our website is psychak.com. Our phone number is 907-290-7250. So any questions, I hope people will reach out if you do have questions or need some assistance with anything. In closing I just really appreciate the opportunity to be here and to share some of these things with some folks. It’s an important topic really and the best advice I give people is, if you’re not sure, to get assessed. That self diagnosis piece we didn’t cover quite as much but be very careful with self diagnosis because some primary care docs might just say “Oh, you have ADHD, here’s the medication.” If you don’t get the right medication, the right treatment, you can make things worse. If somebody doesn’t know there’s trauma and they start doing this, you can get really aggravated. So, really get that diagnosis and assessment.

Dr. Justin Clark: Well, special thanks to our guest for being with us today, Psychologist Dr. Bricklin from Psychology Services of Alaska. Thanks to our audio engineer Chris Hyde and our producer Madeline Rose. You can find more information on this and previous programs on our website at alaskapublic.org. Let us know your thoughts or suggestions by emailing us at lineone@alaskapublic.org This has been Line One, your health connection. I’m your host Dr. Justin Clark. Stay healthy Alaska.

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