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2020 Spring Meeting - CANCELLED

In light of the current circumstances related to COVID-19, members of the executive board conferred and voted to cancel the upcoming spring GAP meeting, originally scheduled for April 2-4 in White Plains. Increasing academic travel restrictions and health concerns had already led to individual cancellations and decisions by at least four committees not to meet in White Plains – a preview of what was to come. I regret that we will miss an opportunity to get together next month, but it is the right decision.

Frances has spoken with the Renaissance, and they have been most accommodating. We are not being charged a cancellation fee, recognizing the extraordinary situation but I also feel reflecting the hotel’s longstanding relationship with GAP. Frances has agreed to cancel any room reservations made through her. If you made your own reservations through Marriott or the hotel, please contact them directly to cancel. Also, if you already sent her your registration fee, Frances can hold it and apply it to the fall meeting. If you prefer a refund or wish to donate it (e.g., to the member-funded fellowship), please let her know. Speaking of the Fellowship, with funds contributed and pledged so far, we are very close to fully endowing a GAP Member Fellowship in addition to the Adler Fellowship and a pledged Institute of Living Fellowship – some great news to offset these tense times.

Although we will not be meeting in person this spring, GAP Committees have a creative history of meeting at other venues, via Skype, and via conference calls. Frances has already set up a Zoom account, and I encourage committees to arrange a time and format to meet and continue your work until our fall meeting. It will be the final meeting for our current Fellows, who will have to prepare remotely for their November plenary presentation. Frances will be in touch with details for arranging virtual meetings –feel free to contact her for assistance.

As an organization, our in-person meetings are very special, so cancelling one - not just skipping one – is a big deal. I hope our decision not to meet in White Plains helps in some small way to increase your personal safety and societal safety during these extraordinary uncertain times. Monitor COVID-19 guidelines, and take good care of yourselves, your families, and your patients. I hope to see you in November!

Warm regards,

Larry

  • 9 Jan 2017 11:13 PM | Deb Forsten (Administrator)

    The stress of a crisis can lead to progressive “wear and tear” on the brain. Even mild stress can cause a rapid and dramatic loss of mental functioning. Left unattended, prolonged stress can impair brain structure and function, impacting not just the thinking brain, but regions that process emotions too.

    One of the major brain regions involved in flexible thinking and decision-making is the prefrontal cortex (PFC). This region, which specializes in higher order thinking processes, is ordinarily directly connected to regions that process emotions, in particular, the amygdala. Under stressful conditions, the usual connection is disrupted. This makes people much more vulnerable to many symptoms, including anxiety, emotional dysregulation, and fixed and faulty thinking as well. Understanding how to productively change one’s mindset is critical to building resilience after a crisis.

    Here we examine helpful mindset shifts that one can institute after a crisis. We also explain our growing understanding of how these shifts may cause corresponding brain changes too. Many of these interventions have been empirically shown to be useful, while the actual state of knowledge about how these interventions affect brain changes is still in its infancy.

    One such person who used these mindset shifts to recover from a crisis was Joe, who was at “Ground Zero” after the September 11 attack on the World Trade Center. He lost his best friend in the attacks. He was immensely distressed when he sought psychotherapy a year later. He had spoken to many people and therapists about this, but his anxiety persisted. He entered therapy with me and I hypothesized he had cemented those memories into his brain, making them hard to directly access and understand.. So we worked on mindset shifts to get his mind off the tragedy and trauma and back to his daily life.

    Attending to mindset shifts takes advantage of the brain’s ability to change, and in allowing one to be more adaptive, specifically enhances resilience. As a result, one may be able to decrease anxiety and restore thinking closer to one’s prior baseline. It is helpful to employ more active mindset shifts early on. Even a year later, using the mindset shifts below was helpful to Joe.

    Distraction—Look beyond the crisis: After a crisis, deliberately focusing on one’s resilience instead of the disaster is preferable. Even if one cannot muster up thoughts of one’s own resilience, replacing the anxious contents of one’s thoughts with more neutral contents can be immensely helpful. Although it is tempting to debrief after a crisis, the exact opposite (distraction) is far more helpful to the brain. Distraction decreases negative feelings, lowers blood flow to the anxiety center (amygdala) in the brain, and also increases blood flow to the thinking brain (PFC.) This allows one to have less reactivity and clearer thinking. In Joe’s case, he had to start to notice what he could look forward to in his life. When tempted to talk abut the disaster, he learned to distract himself with video games, eventually feeling less distressed. Distraction is a common technique across empirically validated psychotherapies for a variety of mental disorders.

    Reappraisal—Find productive ways to understand what has just happened: Lowered reactivity can also be achieved by reappraisal—a way of looking at what happened that is less anxiety-provoking. Like distraction, reappraisal can also lower negative feelings (although distraction is more effective in this particular way it can lower negative feelings much more). It also lowers activation of the amygdala and increases activation in the PFC regions. In addition to these shared effects with distraction, reappraisal also uniquely activates brain networks that process the emotional meaning of the crisis, allowing one to make more sense of a traumatic event. For example, rather than focusing on the devastation that occurred, it helps to look for the opportunity after the devastation, and to celebrate one’s survival and resilience rather than mourning the losses one has incurred. In Joe’s case, seeing his survival as an opportunity to do something great with his life helped steer him toward a career change that made him happier. In the field of trauma study, this is an important clinical goal known as traumatic growth.

    Expressive Suppression—Wait out your first reactions: Expressive suppression is another strategy to regulate emotions in which one suppresses an instinctual and reactive behavior or expression in exchange for a more well thought-out one. Although this is helpful too, it is less effective than reappraisal in reducing negative feeling states, and less effective in re-establishing helpful thinking patterns and social relationships. This technique probably works by enhancing one’s attention to subtle physiologic changes and helping the brain manage the conflicts after a crisis as well. Joe rarely used this method, but when he did, he would simply pause before reacting if anyone spoke about 9/11.

    Enhanced self-esteem—Do things that help your self-esteem: Self-esteem is defined as an evaluation of one’s own goodness or worth. When one’s life is threatened, it helps to have good self-esteem. Good self-esteem helps by restoring the “thinking-feeling” connections in the brain. As a result, one avoids unnecessary defensiveness (which can deplete brain resources needed for proactive decisions.) Higher self-esteem helps people become more self-reflective and less reactive under situations of stress. This ability to regulate one’s emotions also enhances one’s willpower to thrive. Joe reflected on the strength of his past friendship and what made him special to his friend, in the process appreciating himself more.

    Practice mindfulness-based stress reduction(MBSR): MBSR includes multiple forms of mindfulness practice, including formal and informal meditation practice. The formal practice consists of various approaches in which one ignores mental chatter. This includes focusing one’s attention on one’s breath or body while noticing the fleeting nature of sensory experience, or shifting one’s attention across multiple sensory modalities. It may also include open monitoring of moment-to-moment experience, or walking meditation too. It is very effective in reducing the impact of stress and anxiety on the brain. Mindfulness may increase the density of gray matter on the brain, and in addition to enhancing one’s attention, it is also helpful in regulating the brain’s emotional centers as well. It changes the brain to become more aware of subtle physiologic changes too. Just eight weeks of mindfulness practice may induce brain changes similar to the changes seen with long-term meditation. Joe simply practiced 20 minutes of mindfulness on most days, and his anxiety was significantly reduced.

    Crises can have shocking and devastating effects on our brains, but we are fortunate to be able to change our brains with mindset shifts that facilitate emotion and thought control.


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From: Harold Kudler, M.D. Chair of the Military and Veterans Committee

Date: Tue, Mar 24, 2020

Subject: Sharing Valuable Resources Specific to COVID-19 Responses on the Part of Psychiatrists and other Mental Health Professionals and Systems of Care through GAP

Our colleagues need reliable, well-articulated information which we can share across our practices, health systems and communities, I offer the following authoritative fact sheets from the Department of Defense and VA along with other materials which we feel may be helpful to our colleagues. What is distinctive about these materials is that they were specifically developed to address the needs of Psychiatrists, other Mental Health professionals and Mental Health systems.

Click here for more.

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The Psychiatry and Religion Committee and the LGBT Committee of GAP have collaborated in producing a publication for faith communities to educate their members about the heightened risks for serious mental health consequences faced by LGBT youth and ways to mitigate those risks; both of these messages are based on research findings.   Click here for more.

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Special Section: Current Challenges and Opportunities in Psychiatric Administration and Leadership

By Sy Atezaz Saeed



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