Aspira CE Launches New CE Website and Free Clinical Resources

Check out our new website for Mental Health, Social Work, Counseling, and Nursing Continuing Education.

Aspira Continuing Education is a board-approved and accredited online CEU provider. We offer a broad range of CE course subjects that are board-approved for many professions and states. The process is as simple as selecting an online CE course, completing and passing the online exam, and receiving & printing your certificate. Your certificate is available to view/print once payment has been processed.

Aspira is committed to excellence in the fields of Social Work, Marriage and Family Therapy and Professional Counseling providing board-approved CEUs online. We offer MFT continuing education,  Social Worker continuing education and Professional Counselor continuing education. Our online CE courses are the best you’ll find.

Family-Focused Therapy Effective in Treating Depressive Episodes of Bipolar Youth

Adolescents with bipolar disorder who received a nine-month course of family-focused therapy (FFT) recovered more quickly from depressive episodes and stayed free of depression for longer periods than a control group, according to an NIMH-funded study published September 2008 in the Archives of General Psychiatry. MFT Continuing Education
In FFT, the patient and his or her family are heavily involved in psychosocial treatment sessions. They learn to identify the symptoms of bipolar disorder, its course, and how to spot impending episodes or relapses. Patients and families also learn communication and problem-solving skills, and illness management strategies. For this trial, David Miklowitz, Ph.D., of the University of Colorado, and colleagues adapted the therapy to the needs of adolescents and their families.

The 58 participants, ages 12 to 17, were recruited from the University of Colorado and the University of Pittsburgh, and randomly assigned to either 21 50-minute sessions of FFT or to a control intervention called enhanced care (EC). EC included three 50-minute sessions with patients and their families that focused on relapse prevention planning, taking medication as directed, and dealing with conflict at home. All participants took mood-stabilizing medication such as lithium as well. Participants were evaluated every three months during the first year of the two-year study and every six months in the second year.

Although the rate of recovery was high for all participants—91.4 percent—participants in the FFT group recovered faster from depressive symptoms than the EC group. This was especially pronounced in youths who were in the midst of a major depressive episode at the beginning of the study. In the FFT group, the average time to recovery from major depression was 10 weeks, compared to 14 weeks for the EC group. The FFT group also spent less time depressed—about three weeks compared to the EC group’s five weeks—and had less severe depressive symptoms over the two years than the EC group.

The results are similar to those of the NIMH-funded Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), which found that adult participants who received up to 30 sessions of FFT, cognitive behavioral therapy, or interpersonal therapy plus mood stabilizing medications recovered more rapidly from depressive episodes than the participants who received only three psychoeducational sessions in addition to medication.

The adolescent participants in the new study eventually recovered from manic symptoms as well, but neither of the treatments showed a statistically significant advantage in treating mania, a finding also consistent with STEP-BD results. The researchers conclude that for full recovery from adolescent bipolar disorder, FFT may need to be augmented with psychoeducational interventions that are effective against mania symptoms.

Reference
Miklowitz DJ, Axelson DA, Birmaher B, George EL, Taylor DO, Schneck CD, Beresford CA, Dickinson M, Craighead WE, Brent DA. Family-focused treatment for adolescents with bipolar disorder. Archives of General Psychiatry. 2008 Sept; 65(9).

Study Identifies Three Effective Treatments for Childhood Anxiety Disorders

Treatment that combines a certain type of psychotherapy with an antidepressant medication is most likely to help children with anxiety disorders, but each of the treatments alone is also effective, according to a new study funded by the National Institutes of Health’s National Institute of Mental Health (NIMH). The study was published online Oct. 30, 2008, in the New England Journal of Medicine. MFT Continuing Education


“Anxiety disorders are among the most common mental disorders affecting children and adolescents. Untreated anxiety can undermine a child’s success in school, jeopardize his or her relationships with family, and inhibit social functioning,” said NIMH Director Thomas R. Insel, M.D. “This study provides strong evidence and reassurance to parents that a well-designed, two-pronged treatment approach is the gold standard, while a single line of treatment is still effective.”

The Child/Adolescent Anxiety Multimodal Study (CAMS) randomly assigned 488 children ages 7 years to 17 years to one of four treatment options for a 12-week period:

Cognitive behavioral therapy (CBT), a specific type of therapy that, for this study, taught children about anxiety and helped them face and master their fears by guiding them through structured tasks;
The antidepressant sertraline (Zoloft), a selective serotonin reuptake inhibitor (SSRI);
CBT combined with sertraline;
pill placebo (sugar pill).
The children, recruited from six regionally dispersed sites throughout the United States, all had moderate to severe separation anxiety disorder, generalized anxiety disorder or social phobia. Many also had coexisting disorders, including other anxiety disorders, attention deficit hyperactivity disorder, and behavior problems.

John Walkup, M.D., of Johns Hopkins Medical Institutions, and colleagues found that among those in combination treatment, 81 percent improved. Sixty percent in the CBT-only group improved, and 55 percent in the sertraline-only group improved. Among those on placebo, 24 percent improved. A second phase of the study will monitor the children for an additional six months.

“CAMS clearly showed that combination treatment is the most effective for these children. But sertraline alone or CBT alone showed a good response rate as well. This suggests that clinicians and families have three good options to consider for young people with anxiety disorders, depending on treatment availability and costs,” said Walkup.

Results also showed that the treatments were safe. Children taking sertraline alone showed no more side effects than the children taking the placebo and few children discontinued the trial due to side effects. In addition, no child attempted suicide, a rare side effect sometimes associated with antidepressant medications in children.

CAMS findings echo previous studies in which sertraline and other SSRIs were found to be effective in treating childhood anxiety disorder. The study’s results also add more evidence that high-quality CBT, with or without medication, can effectively treat anxiety disorders in children, according to the researchers.

“Further analyses of the CAMS data may help us predict who is most likely to respond to which treatment, and develop more personalized treatment approaches for children with anxiety disorders,” concluded Philip C. Kendall, Ph.D., of Temple University, a senior investigator of the study. “But in the meantime, we can be assured that we already have good treatments at our disposal.”

The six CAMS sites were Duke University; New York State Psychiatric Institute/Columbia University Medical Center; Johns Hopkins University; Temple University/University of Pennsylvania; University of California, Los Angeles; and the Western Psychiatric Institute and Clinic/University of Pittsburgh Medical Center.



Reference
Walkup JT, Albano AM, Piacentini J, Birmaher B, Compton SN, Sherrill J, Ginsburg GS, Rynn MA, McCracken J, Waslick B, Iyengar S, March JS, Kendall PC. Cognitive-behavioral therapy, sertraline and their combination for children and adolescents with anxiety disorders: acute phase efficacy and safety. New England Journal of Medicine. Online ahead of print 30 Oct 2008.

The mission of the NIMH is to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery and cure. For more information, visit the NIMH website.

The National Institutes of Health (NIH) — The Nation’s Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit the NIH website.

Just Over Half of Americans Diagnosed with Major Depression Receive Care

More Receive Psychotherapy than Medication; Study Provides New Detail on Disparities
Overall, only about half of Americans diagnosed with major depression in a given year receive treatment for it, and even fewer—about one fifth—receive treatment consistent with current practice guidelines, according to data from nationally representative surveys supported by NIMH. Among the ethnic/racial groups surveyed, African Americans and Mexican Americans had the lowest rates of use of depression care; all groups reported higher use of past-year psychotherapy vs. medication for depression. MFT Continuing Education
Background
Depression is a leading cause of disability in the United States. Past research has found that many people with depression never received treatment, and that the percentage of those receiving treatment varies with ethnicity and race. In order to provide comprehensive and up-to-date information on depression care, with a particular emphasis on minority groups, NIMH's Collaborative Psychiatric Epidemiology Surveys initiative (CPES) has combined data from three nationally representative studies: the National Survey of American Life, the National Comorbidity Survey-Replication, and the National Latino and Asian American Study.

This Study
Scientists at Wayne State University, Detroit, MI; the University of Michigan, Ann Arbor; the University of California, Los Angeles; and the Harvard School of Public Health, Boston, MA, carried out the current study, which reports on data from CPES collected between February 2001 and November 2003 from 15,762 residents 18 years and older. The size of the sample makes it possible to examine health care use in ethnic/racial groups with a new level of detail, distinguishing between groups often surveyed as one population. The investigators were able to break out types of care used, and to assess to what extent the care used was consistent with the American Psychiatric Association (APA) Practice Guidelines for the Treatment of Patients with Major Depressive Disorder. Finally, they examined how factors enabling healthcare access—insurance, education, and household income—influenced rates of care.

A central finding was that overall, 51 percent of all those in the study who met criteria for major depression during the prior year received some kind of treatment for it, with only 21 percent receiving care that was consistent with the APA Guidelines.

Other key study findings addressed disparities, types and quality of care received, and factors that enable access to healthcare.

Prevalence and severity of major depression was similar among the five studied ethnic/racial groups—Mexican Americans, Puerto Ricans, Caribbean Blacks, African Americans, and non-Latino Whites. However, African Americans and Mexican Americans were least likely to receive any care or care consistent with practice guidelines. Compared with non-Latino Whites for example, of whom 54 percent with depression received care, 40 percent of African Americans and 34 percent of Mexican Americans did. The rate of care for Puerto Ricans was close to that of Whites, 50 percent.
Across these population groups, psychotherapy was used more frequently than medications (pharmacotherapy). Overall, 34 percent received pharmacotherapy; 45 percent psychotherapy. Psychotherapy was more likely to be consistent with APA guidelines than pharmacotherapy, suggesting that adherence—the extent to which patients completed the recommended therapy—was greater for psychotherapy than pharmacotherapy. The contrast between the rates of Guideline-consistent psychotherapy and pharmacotherapy use was greatest among Caribbean Blacks, African Americans, and Mexican Americans.
Puerto Ricans had rates of treatment use, and treatment that was consistent with care guidelines, that were similar to, or higher than, non-Latino Whites.
Differences in factors enabling healthcare access appeared to contribute substantially to disparities in mental healthcare use, particularly for Mexican Americans. When differences in these enabling factors were controlled for statistically—so in effect, the population groups being compared had the same rates of enabling factors—the degree of disparities in use of care by Mexican Americans was reduced. For Caribbean Blacks and African Americans, statistical control of enabling factors reduced disparities in psychotherapy use, but not use of pharmacotherapy.
Health insurance coverage was associated with a greater likelihood of depression care, but not guideline consistent care. The pattern with education was reversed: education was associated with a greater likelihood of care that was consistent with the APA Guidelines, but not with greater use of care in general.
Significance
This study, with its large sample size and emphasis on minority groups, provides a more nuanced and detailed picture of the care received for major depression among different ethnic/racial groups and of factors that contribute to disparities. Lead author Hector González at Wayne State University said that Mexican-Americans make up over two-thirds of Latinos in the U.S.: "We found in our study that there are some really distinctive differences in mental healthcare use between Mexican Americans and other Latino subgroups that have not been previously reported." Estimates suggest that Latinos will make up close to one-third of the U.S. population by mid-century; the study findings suggest that Mexican Americans should be a focus of efforts to reduce health disparities to ensure the nation's health in coming decades.

All groups were more likely to have received psychotherapy than pharmacotherapy. Caribbean Blacks and African Americans were particularly unlikely to receive pharmacotherapy consistent with APA guidelines; enabling factors such as education, health insurance, and income did not explain the lower rates of medication use. The authors note possible reasons for this, including research indicating that perceived discrimination can shape health care seeking. They speculate that the non-immigrant status of Puerto Ricans—and with that, greater predominance of English language use within this group—may be factors in their relatively high rates of health care use.

Findings from this study will inform future research on adherence to various depression therapies, and the factors that shape differences in care among racial/ethnic groups. "Future studies," say the authors, "should explore the extent to which patients' subjective experiences of racial bias may affect their access and utilization of mental healthcare."

Reference
González, H.M., Vega, W.A., Williams, D.R., Tarraf, W., West, B.T., and Neighbors, H.W. Archives of General Psychiatry 2010;67(1):37-46.

Effects on Personality May Be Mechanism of Antidepressant Effectiveness

Results of a study of antidepressant treatment for major depression suggest that changes in personality traits seen in patients taking the drug paroxetine (Paxil) may not be the result of the medication’s lifting of mood but may instead be a direct effect of this class of drugs and part of the mechanism by which they relieve depression. MFT Continuing Education
Background
People with a high level of the personality trait neuroticism—characterized by a tendency to experience negative emotions and moodiness—are more likely than others to develop depression. Neuroticism is one of five personality traits that psychologists use as an organizing scheme for understanding personality: the other four traits are extraversion, openness, conscientiousness, and agreeableness. People who take anti-depressants report lower levels of neuroticism and increased extroversion, in addition to a lifting of depression. The assumption has been that these changes in personality measures were the result, not the cause, of a lifting of depression.

Studies in twins suggest that to a large degree the same genetic factors underlie both neuroticism and depression risk. Research also suggests that the neurotransmitter serotonin plays a role in the expression of both neuroticism and extraversion. The class of anti-depressant drugs to which paroxetine belongs—the selective serotonin reuptake inhibitors (SSRIs)—increase the neurotransmitter’s availability in the brain.

This Study
To test the relationship between SSRIs and personality, investigator Tony Tang and colleagues at Northwestern University, Evanston, IL, the University of Pennsylvania in Philadelphia, and Vanderbilt University in Nashville, TN, randomly assigned patients with major depressive disorder (MDD) to receive paroxetine (120 patients), placebo (60 patients), or cognitive therapy (60 patients).

After 8 weeks, medication and cognitive therapy (CT) each proved more effective than placebo in reducing depression. In addition, measures of neuroticism (based on standard surveys) in the groups receiving medication or cognitive therapy dropped, while extraversion scores rose. The changes were striking; while patients receiving placebo also reported small changes in both traits, the changes in patients on paroxetine were four to eight times as large. Patients receiving paroxetine had much greater changes in personality traits than patients receiving placebo even when the degree of improvement in depression was the same. This suggested that the effects on personality traits were not the result of the drug’s lifting of depression. After accounting for decreases in depression in patients receiving CT, the improvement in extraversion, but not neuroticism, remained significant.

In further comparison of paroxetine with placebo, patients who had initially taken placebo were given the option after 8 weeks to take paroxetine. During the placebo phase, there were small changes in neuroticism and extraversion; much greater changes occurred after 8 weeks on paroxetine. Finally, those patients on paroxetine with the greatest degree of change in neuroticism (but not extraversion) were least likely to relapse to depression; the degree of changes in personality in those receiving CT did not affect the chances of relapse.

Significance
While the neurochemical effects of SSRIs are known, how those changes act to reduce depression is not clear. These results contradict the prevailing assumption that changes seen in personality traits in patients taking SSRIs are a result of the drugs’ effects on depression. SSRIs may alter personality directly—and thus lift depression—or may act on a third factor that underlies both. CT may alter personality by a different path. Continued research on how these treatments work can provide a clearer understanding of the mechanism of action of SSRIs and how treatment can be best used to reduce depression and minimize relapse.

Reference
Tang, T.Z., DeRubeis, R.J., Hollon, S.D., Amsterdam, J., Shelton, R., and Schalet, B. Personality change during depression treatment. Archives of General Psychiatry 2009 Dec;66(12):1322-30.

Mental Health and Mass Violence

Americans have been exposed to increased levels
of mass violence during the past decade. School
violence, shootings in the workplace, and terrorist
acts both here and abroad—all have affected
individuals, families, communities, and our
country. This report addresses the urgent need to
evaluate the various psychological interventions
that are increasingly among the first responses to
these traumatic events. MFT Continuing Education
At a workshop, 58 disaster mental health experts from
six countries were invited to address the impact of
early psychological interventions and to identify
what works, what doesn’t work, and what the
gaps are in our knowledge. Prior to the workshop,
leading mental health research clinicians from the
United States, Australia, and the United Kingdom
prepared a review of the published, peer-reviewed
literature (tables appear in Appendix G and
references appear in Appendix I).
For the purpose of this workshop and report, an
early intervention is defined as any form of
psychological intervention delivered within the
first four weeks following mass violence or
disasters. Once established, services may remain
in place for the long term. Mental health
personnel will provide some of the components of
early intervention, while other components have
mental health implications but will be provided by
non-mental health personnel.
Workshop participants examined research on
critical issues related to the following questions:
What early interventions can be recommended
in mass violence situations?
What should the key operating principles be?
What are the issues of timing of early
intervention?
What is appropriate screening?
What is appropriate follow-up, for whom,
over what period of time?
What expertise, skills, and training are
necessary for early interventions, at what
level of sophistication?
What is the role of research and evaluation?
What are the ethical issues involved in early
interventions?
What are the key questions for the field of
early intervention that have not yet been
thoroughly researched?
There was general majority consensus among
participants on many points. Where significant
differences in opinion existed, participants were
invited to provide minority opinions (see
Appendix F). Some of those issues have been
reframed as research or ethical questions that can
benefit from further scientific inquiry and
discourse (see pp. 11-12).

Area of Consensus
Key Operating Principles of
Early Intervention
Workshop participants identified key components
of early psychological interventions as including
preparation, planning, education, training, and
service provision evaluation. It is essential that
these components be operationalized and used for
service delivery, research, education, and
consultation activities. Participants also indicated
that early mental health assessment and
intervention should focus on a hierarchy of needs,
e.g., survival, safety, food, shelter, etc. (see
Appendix A).
Conference participants agreed that:
A sensible working principle in the immediate
post-incident phase is to expect normal
recovery;
Presuming clinically significant disorder in
the early post-incident phase is inappropriate,
except when there is a preexisting condition;
Participation of survivors of mass violence in
early intervention sessions, whether
administered to a group or individually,
should be voluntary.
The term “debriefing” should be used only to
describe operational debriefings (see Appendix
D). Although operational debriefings can be
described as “early interventions,” they are
done primarily for reasons other than
preventing or reducing mental disorders.
Guidance on Best Practice Based
on Current Research Evidence
Thoughtfully designed and carefully executed
randomized controlled trials have a critical role in
establishing best practices. There are, however, few
randomized controlled trials of psychological
interventions following mass violence. Existing
randomized controlled trial data, often from studies
of other types of traumatic events, suggest that:
Early, brief, and focused psychotherapeutic
intervention can reduce distress in bereaved
spouses, parents, and children.
Selected cognitive behavioral approaches may
help reduce incidence, duration, and severity
of acute stress disorder, post-traumatic stress
disorder, and depression in survivors.
Early interventions in the form of single oneon-
one recitals of events and emotions evoked
by a traumatic event do not consistently
reduce risks of later post-traumatic stress
disorder or related adjustment difficulties.
There is no evidence that eye movement
desensitization and reprocessing (EMDR) as
an early mental health intervention, following
mass violence and disasters, is a treatment of
choice over other approaches.
Other practices that may have captured public
interest have not been proven effective, and some
may do harm.

Tips in a Time of Economic Crisis.

Tips in a Time of Economic Crisis.

Many Americans report heightened levels of stress during this time of financial crisis. Yet, few realize that this reaction to economic pressures closely resembles the psychological effects experienced after natural disasters such as hurricanes, floods, wildfires, or even the terrorist attacks of 9/11. Stress reduction and mental health promotion are as important now for people affected directly or indirectly by the financial crisis as for those who suffered from effects of natural or man-made disasters.You Should Know While we try to shield our children from financial problems and the economic crisis, they hear, see, and read about what is happening in the world, the nation, and in their own homes. Despite our best efforts as adults, our worries can become their worries. Our stress can become their stress. Part of our responsibility as parents or guardians is to help our children deal with the stress that they lack the understanding or ability to manage on their own. MFT Continuing Education

Signs of Stress in the Young
Children respond to stress in many different ways. However, because certain signs are common at particular ages, adults can recognize when children are under stress and respond appropriately. Children respond to stress based on both their developmental level and their perception of family reactions. Often, the most significant indicator of stress is a change in a child’s behavior, not the behavior itself. Ages 1 to 5: With few coping skills, very young children have a hard time adjusting to change and loss. They must depend on parents, family members, and teachers to help them through difficult times. Very young children often regress to an earlier behavioral stage when under stress. Preschoolers may resume thumb sucking or bed wetting. They may cling to a parent or become very attached to a place where they feel safe. Changes in eating or sleeping habits, hyperactivity, or unusually aggressive or withdrawn behavior may indicate the presence of stress in young children.School-age Children: Those aged 5 to 11 may react to stress in many of the same ways as their younger counterparts. Signs can include regression to behaviors from earlier ages. They also may withdraw from friends, demand more attention from parents, act aggressively, or find it hard to concentrate. Some may complain of physical problems—headache or stomachache—without obvious cause. Adolescents: When under stress, youth in the 12 to 14 age range often have vague physical complaints. They also may abandon schoolwork, chores, and other responsibilities. Many withdraw, resist authority, become disruptive, or begin to experiment with alcohol or drugs. In later adolescence, teens may experience feelings of helplessness and guilt because they are unable to assume full adult responsibilities or to contribute to solving the causes of the family stress. Older teens may also deny the extent of their emotional reactions.How To Help Reassurance is key to helping children cope with stress. To the extent possible, maintain a normal household routine; encourage children to participate in activities at home and in the neighborhood. Very young children need a lot of cuddling and verbal support. Take the cue from older children about hugs and holding hands. But whatever their age, be honest; answer questions with age-appropriate responses and understandable information, whether it’s about scaling back a birthday party or finding ways to pay for college in a year or two. Listen and respond. Talk with, not to, them. Don’t let financial or job issues take over family time. Don’t dwell on details that may frighten a child or unduly upset a teen. Be frank and encourage children and teens to express their feelings in conversation, drawing, writing, or painting. Help them understand that their emotions are healthy and normal. Gently correct any misunderstandings they may have about their situations. Don’t forget to take steps to safeguard your own health. Model healthy stress-relieving behaviors and be proactive about managing your family’s stress. Finally, if stress levels in the family become overwhelming, it’s not a sign of weakness or failure to seek outside help for one or more family members.“Reassurance is key to helping children cope with stress. To the extent possible, maintain a normal household routine; encourage children to participate in activities at home and in the neighborhood.”
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Helpful ResourcesSAMHSA’s Health Information Network Toll-free: 1-877-SAMHSA-7 (1-877-726-4727) (English and Español)Web site: http://www.samhsa.gov/shinTreatment LocatorsMental Health Services LocatorToll-free: 800-789-2647 (English and Español)Web site: http://mentalhealth.samhsa.gov/databasesSubstance Abuse Treatment Facility LocatorToll-free: 800-662-HELP (4357) (24/7 English and Español)Web site: http://www.findtreatment.samhsa.govHotlinesNational Suicide Prevention LifelineToll-free: 800-273-TALK (8255)TTY: 800-799-4TTY (4889)Web site: http://www.suicidepreventionlifeline.orgOther ResourcesNational Child Traumatic Stress NetworkWeb site: http://www.nctsn.orgNational Association of School PsychologistsPhone: (301) 657-0270Toll-free: 866-331-NASPWeb site: http://www.nasponline.org/NEATAmerican Academy of Child and Adolescent PsychiatristsPhone: (202) 966-7300Web site: http://www.aacap.orgNote: This list is not exhaustive. Inclusion does not imply endorsement by the Center for Mental Health Services, the Substance Abuse and Mental Health Services Administration, or the U.S. Department of Health and Human Services.Family Talk About Economic Stress • Become a family “team” that works together to solve problems. • Have family meetings to talk about money concerns.• Include all children in family decisions, even if they don’t really understand. Just being there is important for them.• Help children learn about budgeting and the difference between needs (“must haves” like food and housing) and wants(“nice to haves” such as DVDs or a new toy).• Talk about a team approach to saving money and identify ways that everyone can help the family cut expenses. Even young children can help and feel useful by doing such things as remembering to turn off lights. • Identify and plan no-cost activities together: take a family walk, play a board game, or go on a bike ride together.
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Volunteer: Popular New Year's Resolutions

Have an idea for a service project – like getting a group together to volunteer each week at a homeless shelter, or reading to kids at your local library? Learn how to turn your volunteer idea into a successful service project using our do-it-yourself toolkits below.

Education
Help close the achievement gap and reduce “summer learning loss” by reading with kids or organizing a book drive.

•Toolkit: Read with Children
Read with Children: The Facts
Children who are not engaged in learning between school years suffer from “summer learning loss.” Many of the achievement gaps that continue to exist for disadvantaged students today result not from students falling behind during the school year but rather losing out on chances to learn over the summer.

Did you know that if a young person reads only five books over the summer, the effect “is potentially large enough to prevent a decline in reading achievement scores from the spring to the fall?” footnote 1

Did you know that if a young person is read to at least three times a week, that person is twice as likely to score in the top 25% of reading? footnote 2

Commit yourself and a team of your friends, family, and neighbors to help young people close the summer learning gap by joining United We Serve. This tool kit will give you the basics to start a reading program from scratch, recruit a team, organize your group, and make an impact.

•Toolkit: Organize a Book Drive | en Español
Starting a Book Distribution Team: The Facts
80% of preschool and after-school programs serving low-income populations have no age-appropriate books for their children. footnote 1

A recent study shows that while in middle-income neighborhoods the ratio of age-appropriate books per child is 13 to 1, in low-income neighborhoods the ratio is 1 for every 300 children. footnote 2

The most successful way to improve the reading achievement of low-income children is to increase their access to print. Communities ranking high in achievement tests have several factors in common: an abundance of books in public libraries, easy access to books in the community at large and a large number of textbooks per student. footnote 3

Commit yourself and a team of your friends and neighbors to help increase reading achievement and literacy by joining United We Serve. This tool kit will give you the basics to run a book drive, organize your group, and make an impact.

What will you do to help increase reading and literacy?


Health
Promoting healthy lifestyles in your community is key to preventing costly disease and improving our nation's health.

•Toolkit: Support Community Gardens | en Español
•Toolkit: Starting a Walking Team | en Español
•Toolkit: Promote Back to School Health | en Español
Community Renewal
At a time when many Americans are struggling with the loss of their job or their home, you can help meet some of their most basic needs by working to reduce hunger, secure donated clothing and strengthen community resources.

•Toolkit: Support Local Food Banks | en Español
•Toolkit: Organize a Clothing Drive | en Español
Energy and Environment
Join your friends and neighbors to reduce energy by auditing your home and helping maintain public lands.

•Toolkit: Audit Your Home | en Español
•Toolkit: Maintain Public Lands | en Español
•Toolkit: Let's Glean! (USDA)
Veterans and Military Families
Support military families and veterans who have served our country.

•Toolkit: Connecting Veterans to Community Services
Disaster Preparedness
Help your community prepare for disasters.

•Toolkit: Preparing Your Community for Disasters
Create Your Own Project
Work with your neighbors to identify local needs and find solutions that work. MFT Continuing Education
•Toolkit: Create Your Own Project
Disclaimer of Endorsement
Toolkit references to any specific non-profit organization, commercial product, process, or service by trade name, trademark, manufacturer, or otherwise do not necessarily constitute or imply its endorsement, recommendation, or favoring by the U.S. Government or any agency thereof.

Weight Loss: Popular New Year's Resolutions

Weight Loss for Life

■Can I benefit from weight loss?
■How can I lose weight?
■Your Plan for Healthy Eating
■Your Plan for Regular Physical Activity
■What types of weight-loss programs are available?
■Nonclinical Program
■Clinical Program
■Additional Reading
■Other Resources

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Weight Loss for Life There are many ways to lose weight, but it is not always easy to keep the weight off. The key to successful weight loss is making changes in your eating and physical activity habits that you can keep up for the rest of your life. The information presented here may help put you on the road to healthy habits. MFT Continuing Education

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Can I benefit from weight loss?
Some Weight-related Health Problems

■diabetes
■heart disease or stroke
■high blood pressure
■high cholesterol
■gallbladder disease
■some types of cancer
■osteoarthritis (wearing away of the joints)
■sleep apnea (interrupted
breathing during sleep)

Health experts agree that you may gain health benefits from even a small weight loss if:


■You are considered obese based on your body mass index (BMI) (see BMI chart below).
■You are considered overweight based on your BMI and have weight-related health problems or a family history of such problems.
■You have a waist that measures more than 40 inches if you are a man or more than 35 inches if you are a woman.
A weight loss of 5 to 7 percent of body weight may improve your health and quality of life, and it may prevent weight-related health problems, like type 2 diabetes. For a person who weighs 200 pounds, this means losing 10 to 14 pounds.

Even if you do not need to lose weight, you should still follow healthy eating and physical activity habits to help prevent weight gain and keep you healthy over the years.

Body Mass Index

BMI is a tool that is often used to determine whether a person’s health is at risk due to his or her weight. It is a ratio of your weight to your height. A BMI of 18.5 to 24.9 is considered healthy, a BMI of 25 to 29.9 is considered overweight, and a BMI of 30 or more is considered obese. You can find your BMI using the chart below, and you can also see the weight range that is healthy for your height.

BMI
19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 Weight
(Pounds)
Height (Inches)
58 91 96 100 105 110 115 119 124 129 134 138 143 148 153 158 162 167 172 177 181 186 191
59 94 99 104 109 114 119 124 128 133 138 143 148 153 158 163 168 173 178 183 188 193 198
60 97 102 107 112 118 123 128 133 138 143 148 153 158 163 168 174 179 184 189 194 199 204
61 100 106 111 116 122 127 132 137 143 148 153 158 164 169 174 180 185 190 195 201 206 211
62 104 109 115 120 126 131 136 142 147 153 158 164 169 175 180 186 191 196 202 207 213 218
63 107 113 118 124 130 135 141 146 152 158 163 169 175 180 186 191 197 203 208 214 220 225
64 110 116 122 128 134 140 145 151 157 163 169 174 180 186 192 197 204 209 215 221 227 232
65 114 120 126 132 138 144 150 156 162 168 174 180 186 192 198 204 210 216 222 228 234 240
66 118 124 130 136 142 148 155 161 167 173 179 186 192 198 204 210 216 223 229 235 241 247
67 121 127 134 140 146 153 159 166 172 178 185 191 198 204 211 217 223 230 236 242 249 255
68 125 131 138 144 151 158 164 171 177 184 190 197 204 210 216 223 230 236 243 249 256 262
69 128 135 142 149 155 162 169 176 182 189 196 203 210 216 223 230 236 243 250 257 263 270
70 132 139 146 153 160 167 174 181 188 195 202 209 216 222 229 236 243 250 257 264 271 278
71 136 143 150 157 165 172 179 186 193 200 208 215 222 229 236 243 250 257 265 272 279 286
72 140 147 154 162 169 177 184 191 199 206 213 221 228 235 242 250 258 265 272 279 287 294
73 144 151 159 166 174 182 189 197 204 212 219 227 235 242 250 257 265 272 280 288 295 302
74 148 155 163 171 179 186 194 202 210 218 225 233 241 249 256 264 272 280 287 295 303 311
75 152 160 168 176 184 192 200 208 216 224 232 240 248 256 264 272 279 287 295 303 311 319
76 156 164 172 180 189 197 205 213 221 230 238 246 254 263 271 279 287 295 304 312 320 328


Source: Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults, National Institutes of Health, National Heart, Lung, and Blood Institute, September 1998.

* Without Shoes
**Without Clothes

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How can I lose weight? To lose weight you need to take in fewer calories than you use. You can do this by creating and following a plan for healthy eating and a plan for regular physical activity.

You may also choose to follow a formal weight-loss program that can help you make lifelong changes in your eating and physical activity habits. See below for more information on weight-loss programs.
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Your Plan for Healthy Eating
The Nutrition Facts label from the U.S. Food and Drug Administration (FDA) is found on most packaged foods. It tells you how many calories and how much fat, protein, carbohydrate, and other nutrients are in one serving of the food. For more information on the Nutrition Facts, see “Other Resources” at the end of this brochure.
It may be hard to stick to a weight-loss “diet” that limits your portions to very small sizes or excludes certain foods. You may have difficulty making that work over the long term. Instead, a healthy eating plan takes into account your likes and dislikes, and includes a variety of foods that give you enough calories and nutrients for good health.


Make sure your healthy eating plan is one that:

■Emphasizes fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products.
■Includes lean meats, poultry, fish, bean, eggs, and nuts.
■Is low in saturated fats, trans fats, cholesterol, salt (sodium), and added sugars.
For more specific information about food groups and nutrition values, visit: http://www.healthierus.gov/dietaryguidelines.

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Your Plan for Regular Physical Activity Regular physical activity may help you lose weight and keep it off. It may also improve your energy level and mood, and lower your risk for developing heart disease, diabetes, and some cancers.

According to the 2008 Physical Activity Guidelines for Americans, experts believe all adults should be physically active. Some activity is better than none, and individuals who engage in any amount of physical activity may gain some health benefits. The majority of your physical activity should be moderate to vigorous in intensity. However, adults should aim to include muscle-strengthening activities as well. For more information on the Physical Activity Guidelines, see the “Other Resources” section at the end of this brochure.

You can be physically active every day for one extended period of time, or you can break it up into shorter sessions of 20, 15, or even 10 minutes. Try some of these physical activities:


■walking (15 minutes per mile or 4 miles per hour)
■biking
■tennis
■aerobic exercise classes (step aerobics, kick boxing, dancing)
■energetic house or yard work (gardening, raking, mopping, vacuuming)
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What types of weight-loss programs are available? There are two different types of weight-loss programs—clinical and nonclinical. Knowing what a good program will offer and what to look for may help you choose a weight-loss program that will work for you.

Nonclinical Program

What it is: A nonclinical program may be commercially operated, such as a privately owned weight-loss chain. You can follow a nonclinical program on your own by using a counselor, book, website, or weight-loss product. You can also join others in a support group, worksite program, or community-based program. Nonclinical weight-loss programs may require you to use the program’s foods or supplements.

A safe and effective program will offer:

■Books, pamphlets, and websites that are written or reviewed by a licensed health professional such as a medical doctor (M.D.) or registered dietitian (R.D.).
■Balanced information about following a healthy eating plan and getting regular physical activity.
■Leaders or counselors who show you their training credentials. (Program leaders or counselors may not be licensed health professionals.)

Program cautions:

■If a program requires you to buy prepackaged meals, find out how much the meals will cost—they may be expensive. Also, eating prepackaged meals does not let you learn the food selection and cooking skills you will need to maintain weight loss over the long term.
■Avoid any diet that suggests you eat a certain formula, food, or combination of foods for easy weight loss. Some of these diets may work in the short term because they are low in calories. But they may not give you all the nutrients your body needs and they do not teach healthy eating habits.
■Avoid programs that do not include a physical activity plan.
■Talk to your health care provider before using any weight-loss product, such as a supplement, herb, or over-the-counter medication.
Clinical Program

What it is: A clinical program provides services in a health care setting, such as a hospital. One or more licensed health professionals, such as medical doctors, nurses, registered dietitians, and psychologists, provide care. A clinical program may or may not be commercially owned.

Clinical programs may offer services such as nutrition education, physical activity, and behavior change therapy. Some programs offer prescription weight-loss drugs or gastrointestinal surgery.

Prescription Weight-loss Drugs. If your BMI is 30 or more, or your BMI is 27 or more and you have weight-related health problems, you may consider using prescription weight-loss drugs. Drugs should be used as part of an overall program that includes long-term changes in eating and physical activity habits. Only a licensed health care provider can prescribe these drugs. See “Additional Reading” for more information about prescription medications for the treatment of obesity.

Bariatric Surgery. If your BMI is 40 or more, or your BMI is 35 or more and you have weight-related health problems such as diabetes or heart disease, you may consider bariatric surgery (also called gastrointestinal surgery). Most patients lose weight quickly. To keep the weight off, most will need to eat healthy and get regular physical activity over the long term. Surgery may also reduce the amount of vitamins and minerals that are absorbed by your body. The rapid weight loss as a result of bariatric surgery may also cause gallstones. See the “Additional Reading” section for more information about bariatric surgery.

What a safe and effective program will offer:

■A team of licensed health professionals.
■A plan to help you keep weight off after you have lost it.
Program cautions:

There may be side effects or health risks involved in the program that can be serious. Discuss these with your health care provider.

Regardless of the type of weight-loss program you choose, be sure you have follow-up visits with your health care provider. He or she may suggest ways to deal with setbacks or obstacles you may face along the way, as well as answer any questions you may have as you move forward.

For more detailed information about choosing a safe and successful weight-loss program, see the “Additional Reading” section at the end of this brochure.

It is not always easy to change your eating and physical activity habits. You may have setbacks along the way. But keep trying–you can do it!
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Additional Reading
From the Weight-control Information Network Active at Any Size describes the benefits of being physically active no matter what a person’s size. The brochure presents a variety of activities that large people can enjoy safely.

Bariatric Surgery for Severe Obesity describes the different types of surgery available to treat severe obesity. It explains how gastrointestinal surgery promotes weight loss and the benefits and risks of each procedure.

Changing Your Habits: Steps to Better Health guides readers through steps that can help them determine what “stage” they are in—how ready they are—to make healthy lifestyle changes. Once that stage is determined, strategies on how to make healthy eating and physical activity changes are offered.

Just Enough for You describes the difference between a portion—the amount of food a person chooses to eat—and a measured serving. It offers tips for judging portion sizes and for controlling portions at home and when eating out.

Prescription Medications for the Treatment of Obesity presents information on medications that suppress appetite or reduce the body’s ability to absorb dietary fat. The types of medications and the risks and benefits of each are described.

Walking…A Step in the Right Direction offers tips for getting started on a walking program and illustrates warm-up stretching exercises. It also includes a sample walking program.

Weight and Waist Measurement explains two simple measures—BMI and waist circumference—to help people determine if their weight and/or body fat distribution are putting their health at risk.
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Other Resources U.S. Department of Agriculture. My Pyramid Plan. April 2005.
Available at http://www.mypyramid.gov.

U.S. Food and Drug Administration Center for Food Safety and Applied Nutrition. How to Understand and Use the Nutrition Facts Label. June 2000. Available at http://www.cfsan.fda.gov/~dms/foodlab.html.

U.S. Department of Health and Human Services (DHHS). Physical Activity Guidelines for Americans. October 2008. Available at http://www.health.gov/PAGuidelines.

National Diabetes Information Clearinghouse, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health (NIH). Diabetes Prevention Program (DPP). DHHS. NIH Publication No. 09–5099. 2008.
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Weight-control Information Network
1 WIN Way
Bethesda, MD 20892–3665
Phone: (202) 828–1025
FAX: (202) 828–1028
Toll-free number: 1–877–946–4627
Email: win@info.niddk.nih.gov
Internet: http://www.win.niddk.nih.gov

The Weight-control Information Network (WIN) is a national information service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health, which is the Federal Government’s lead agency responsible for biomedical research on nutrition and obesity. Authorized by Congress (Public Law 103–43), WIN provides the general public, health professionals, the media, and Congress with up-to-date, science-based health information on weight control, obesity, physical activity, and related nutritional issues.

Publications produced by WIN are reviewed by both NIDDK scientists and outside experts. This publication was also reviewed by F. Xavier Pi-Sunyer, M.D., M.P.H., Director, New York Obesity Research Center, St. Luke’s-Roosevelt Hospital Center, and English H. Gonzalez, M.D., M.P.H., Community Medicine and Curriculum Development Coordinator, St. Vincent’s East Family Medicine Residency Program in Birmingham, AL.

This publication is not copyrighted. WIN encourages users of this brochure to duplicate and distribute as many copies as desired.

Popular New Year's Resolutions

Popular New Year's Resolutions
Check out some New Year's resolutions that are popular year after year.

•Drink Less Alcohol
•Get a Better Education
•Get a Better Job
•Get Fit
•Lose Weight
•Manage Debt
•Manage Stress
•Quit Smoking Now
•Save Money
•Take a Trip
•Volunteer to Help Others


Drink Less AlcoholSmall changes can make a big difference in reducing your chances of having alcohol-related problems. Here are some strategies to try. Check off some to try the first week, and add some others the next. MFT Continuing Education

Keeping Track
Keep track of how much you drink. Find a way that works for you, such as a 3x5” card in your wallet, check marks on a kitchen calendar, or a personal digital assistant. If you make note of each drink before you drink it, this will help you slow down when needed.

Counting and Measuring
Know the standard drink sizes so you can count your drinks accurately (see back page). One standard drink is 12 ounces of regular beer, 8 to 9 ounces of malt liquor, 5 ounces of table wine, or 1.5 ounces of 80–proof spirits. Measure drinks at home. Away from home, especially with mixed drinks, it can be hard to keep track and at times you may be getting more alcohol than you think. With wine, you may need to ask the host or server not to “top off” a partially filled glass.

Setting Goals
Decide how many days a week you want to drink and how many drinks you’ll have on those days. It’s a good idea to have some days when you don’t drink. Drinking within the limits below reduces the chances of having an alcohol use disorder and related health problems.


For healthy men up to age 65 —
•no more than 4 drinks in a day AND
•no more than 14 drinks in a week.
For healthy women (and healthy men over age 65) —
•no more than 3 drinks in a day AND
•no more than 7 drinks in a week.
Depending on your health status, your doctor may advise you to drink less or abstain.

Pacing and Spacing
When you do drink, pace yourself. Sip slowly. Have no more than one drink with alcohol per hour. Alternate “drink spacers” — non-alcoholic drinks such as water, soda, or juice — with drinks containing alcohol.

Including Food
Don’t drink on an empty stomach — have some food so the alcohol will be absorbed more slowly into your system.

Avoiding “Triggers”
What triggers your urge to drink? If certain people or places make you drink even when you don’t want to, try to avoid them. If certain activities, times of day, or feelings trigger the urge, plan what you’ll do instead of drinking. If drinking at home is a problem, keep little or no alcohol there.

Planning to Handle Urges
When an urge hits, consider these options: Remind yourself of your reasons for changing. Or talk it through with someone you trust. Or get involved with a healthy, distracting activity. Or “urge surf ”— instead of fighting the feeling, accept it and ride it out, knowing that it will soon crest like a wave and pass.

Knowing Your “No”
You’re likely to be offered a drink at times when you don’t want one. Have a polite, convincing “no, thanks” ready. The faster you can say no to these offers, the less likely you are to give in. If you hesitate, it allows time to think of excuses to go along.


Additional Tips for Quitting

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If you want to quit drinking altogether, the last three strategies can help. In addition, you may wish to ask for support from people who might be willing to help, such as a spouse or non-drinking friends. Joining Alcoholics Anonymous or another mutual support group is a way to acquire a network of friends who have found ways to live without alcohol. If you’re dependent on alcohol and decide to stop drinking completely, don’t go it alone. Sudden withdrawal from heavy drinking can cause dangerous side effects such as seizures. See a doctor to plan a safe recovery.



What’s a Standard Drink
In the United States, a standard drink is any drink that contains about 14 grams of pure alcohol (about 0.6 fluid ounces or 1.2 tablespoons). Below are U.S. standard drink equivalents. These are approximate, since different brands and types of beverages vary in their actual alcohol content.

beer or cooler
malt liquor
table wine
80-proof spirits
gin, vodka, whisky, etc.


˜ 5% alcohol:
12 oz.
˜ 7% alcohol:
8.5 oz.
˜ 12% alcohol:
5 oz.
˜ 40% alcohol:
1.5 oz.


Many people don’t know what counts as a standard drink and so don’t realize how many standard drinks are in the containers in which these drinks are often sold. Some examples:

For beer, the approximate number of standard drinks in
•12 oz. = 1
•22 oz. = 2
•16 oz. = 1.3
•40 oz. = 3.3
For malt liquor, the approximate number of standard drinks in
•12 oz. = 1.5
•22 oz. = 2.5
•16 oz. = 2
•40 oz. = 4.5
For table wine, the approximate number of standard drinks in
•a standard 750-mL (25-oz.) bottle = 5
For 80-proof spirits, or “hard liquor,” the approximate number of standard drinks in
•a mixed drink = 1 or more*
•a fifth (25 oz.) = 17
•a pint (16 oz.) = 11
•1.75 L (59 oz.) = 39
*Note: It can be difficult to estimate the number of standard drinks in a single mixed drink made with hard liquor. Depending on factors such as the type of spirits and the recipe, a mixed drink can contain from one to three or more standard drinks.


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Excerpted from NIH Publication No. 07–3769
Reprinted September 2008

Holiday Hints

The holiday season is a time for visiting and reconnecting with family, friends and neighbors. Sometimes this season can be sad or stressful for those caring for a loved one with Alzheimer’s disease. These hints are our gift in wishing you an enjoyable holiday season.

•Holidays can be meaningful, enriching times for both the person with AD and family. Maintaining (or adapting) old family rituals and traditions helps all family members feel a sense of belonging and family identity. For a person with AD, this link with a familiar past is reassuring and builds self-esteem, i.e. “Look at the beautiful family I created!”

•Set your own limits early, and be clear about them with others. You do not have to live up to the expectations of friends or relatives. Your situation is different now.

•Encourage family and friends to visit EVEN IF IT IS PAINFUL FOR THEM. Keep the number of persons visiting at one time to a minimum, or try a few people visiting quietly with the person with AD in a separate room. Most people with AD can pull it together for brief periods, if they have adequate private rest in between.

•Try some simple holiday preparation with the person with AD several days ahead. Just observing your preparations will familiarize him/her with the upcoming festivities; if they participate with you, they experience the pleasure of helping and giving as well as the fun of anticipation and reminiscing.

•Prepare potential quiet distractions (a family photo album or a simple repetitive chore like cracking nuts) to use if the person with AD becomes upset or over-stimulated.

•Try to avoid situations that further confuse or frustrate many people with AD:

◦crowds of people who expect the person with AD to remember them
◦noise, loud conversations or loud music
◦strange or different surroundings
◦changes in light intensity – too bright or too dark
◦over-indulgence in rich or special food or drink (especially alcohol)
◦change in regular routine and sleep patterns

•Try scheduling activities, especially some outdoor exercise, early in the day to avoid the fatigue from added activity at the end of a long day. Familiar holiday music, story-telling, singing or church services (even on TV) may be especially enjoyable.

•If you receive invitations to holiday celebrations which the person with AD cannot attend, GO YOURSELF. Enjoy the chance to be with friends and family who love you and enjoy your company, with or without your relative.

Preparing the Guests

1.Explain as clearly as possible what has happened to the person with AD. Give examples of the unusual behaviors that may take place: incontinence, eating food with fingers, wandering, hallucinations.

2.Explain that it may not be appropriate behavior but the person with AD has a memory loss and does not remember what is expected and acceptable.

3.Remind the visitor through phone calls or letters to be understanding and not to shun the person with AD.

4.If this is the first visit since the person with AD became severely impaired, tell the visitor the visit may be painful. The memory-impaired person may not remember the guest’s name or relationship.

5.Explain that memory loss is the result of the disease and it is not intentional.

6.Stress with the guests that what is important is the meaningfulness of the moment spent together and not what the person remembers.

Preparing the Memory-Impaired Person

1.Begin showing a picture of the guest to the person with AD a week before the arrival.

2.Spend more time each day explaining who the visitor is while showing the picture.

3.Arrange a phone call for the person with AD and the visitor. The conversation may help both. The call gives the visitor an idea what to expect and gives the memory-impaired person an opportunity to familiarize him/herself with the visitor.

4.Keep the memory-impaired person’s routine as close to normal as possible.

5.During the hustle and bustle of the holiday season, guard against fatigue and find time for adequate rest.

For more information see: Holiday Visiting Tips, A Message from the Faith Community and Friends of Alzheimer’s Families (PDF, 381KB), prepared by the Duke University Aging Center Family Support Program and the Education Core, Bryan Alzheimer’s Disease Research Center, Duke University Medical Center

For more information about Alzheimer’s Disease, contact:
The Alzheimer’s Disease Education and Referral (ADEAR) Center:
1-800-438-4380
www.nia.nih.gov/Alzheimers
e-mail: adear@nia.nih.gov

A Service of the National Institute on Aging, part of the National Institutes of Health
U.S. Department of Health and Human Services

MFT Continuing Education

Stress Less during the holidays

Too often, the holiday season is a very stressful time, followed by a post-holiday letdown that can take us the rest of the winter to recover from. Learn more about the causes of holiday stress and what you can do to avoid it. MFT Continuing Education
Causes of holiday stress
Many factors can contribute to holiday stress. Some of the most common include:

•Too much of a good thing: eating, drinking and spending too much. An overabundance of parties and gift-giving may lead people to eat, drink and be merry – often to excess. Overindulging in rich foods, alcohol and spending can burden many people with the additional stress of dealing with consequences (weight gain, memories of embarrassing behavior and debt) that linger after the season is over.

•Family fatigue: too much togetherness. The holidays are a time when families tend to gather. While this can be a wonderful thing, even the most close-knit families can overdose on togetherness, making it hard for family members to maintain a healthy balance between family-time and alone-time.

•Not enough togetherness. For those who don’t have family, loneliness can be just as difficult. When everyone else seems to be getting together with family, those who rely more on friends for support can feel left out and alone.

•SAD can make you sad. As daylight diminishes and the weather causes many of us to spend more time indoors, many people are affected to some degree by a type of depression known as seasonal affective disorder (SAD). It’s a subtle, but very real condition that can be a source of stress and unhappiness during a time when people expect to feel just the opposite.

Minimizing holiday stress

Unlike many other types of stress, holiday stress is predictable. We can make plans to reduce the amount of stress we experience and the impact it has on us. Here are some tips to help you reduce holiday stress:

•Set your priorities. The flurry of baking, shopping, sending cards, visiting relatives and other activities can leave you exhausted by January. Pick a few favorite activities and really enjoy them. Skip the rest.

•Cut corners. If you can’t imagine the idea of skipping all some of the activities that usually run you ragged, find ways to simplify. For example, only send cards to those you’re in regular contact with or don’t include a personal note in each one.

•Watch your finances. Before you go shopping, plan a reasonable budget for holiday spending. Then, stick to your budget. King County’s Making Life Easier Program can help. The program offers financial consultation on issues such as budgeting and financial planning and 8 free counseling sessions with a licensed professional per problem per year.

•Change your expectations for togetherness. Think back to previous years and try to pinpoint the amount of togetherness with family and friends you can handle before feeling stressed out. Then, look for ways to minimize the stress. Try limiting the number of parties you attend or the time you spend at each. Or, reduce the time you spend with family to an amount that will feel special without leaving you exhausted.

•Nurture your heart. If holidays tend to make you feel lonely or depressed, make plans to meet with a friend, spiritual leader or counselor to get the support you need. If virtually everyone you know is with family during the holidays, consider volunteering to help others. Helping others can be rewarding and help fill the void you may be feeling.

•Take care of yourself. Your holiday plans should include steps to take care of your physical and emotional health. Remember to get enough sleep and eat nutritiously. Also, be sure to exercise daily if possible. Exercise and exposure to daylight can help reduce or even eliminate the symptoms of SAD.

Winter Wellness Planner

Developed by CSP-NJ Institute for Wellness 2
and Recovery Initiatives – John Garafano, BS, CPRP, CFT , Jay Yudof, MS, CPRP & Peggy Swarbrick, PhD, OT,CPRP -December 2010

Winter Memories

Many of us may have good memories of winter/holiday gatherings, and/or outdoor winter recreation. Some people face challenges including isolation, limited ability to exercise, memories of losses, overeating, and overspending. This wellness planner is designed to help you plan ahead so you can maintain a sense of wellness during the winter season.

Describe a positive winter memory.
______________________________________________________________________________
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______________________________________________________________________________
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What do you see as the benefits of the winter season?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Holidays

The holiday season, (the holidays) is an annual festive period. Various studies have shown that the winter holiday season can have some impacts on health (social, emotional, physical etc).

What do you like to do during the Holiday Season?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

How do you celebrate the Holiday season?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Winter Challenges

Winter is the coldest season of the year in temperate climate, between autumn and spring. At the winter solstice, the days are shortest and the nights are longest, with days lengthening as the season progresses after the solstice.
Challenges during the holidays Many holidays occur during the winter months when people are already more susceptible to the common cold, flu, and depressed mood Holidays usually involve the obligation of spending money on gifts or food Alcohol is typically served during holiday functions which can be a trigger for some Holiday travel can be a major source of contention and stress. Dealing with traffic and the short-tempers of other travelers can also be quite challenging Social anxiety may be heightened when we are invited to parties with large gatherings of people.

General Stressors and Triggers

Physical
o Diet and nutrition, physical activity, sleep, Emotional
o Losses may impact harder during winter time Social
o Too much stimuli or may not have a support network so sense of loneliness becomes overwhelming
o Drinking can be a trigger for some people Financial
o Spending can become out of control Spiritual
o Sense of purpose and meaning can be impacted Occupational
o Work routines are altered which can impact rhythm and – over or under productive

What triggers do you face during the holidays?
(Examples include large groups of people, overspending, and alcohol at parties)
1.
2.
3.
4.
5.

List supporters and how you can connect with them during the holidays?
Supporter Methods to Connect
1.
2.
3.
4.
5.

Diet and Nutrition Eat several small meals so that you are not starving when it comes time to eat a holiday feast. Drink water before your meal so that you get full faster. Watch portions. Aim to eat mostly vegetables and fruit on your plate and opt out of breads and biscuits. Opt for water instead of soda, alcoholic beverages, or caffeinated drinks. Be aware that many of us get less fresh fruit and vegetables during winter months – look for healthy ways to replace these vital nutrients.
Physical Activity and Environment: Walk around a mall with friends Join an exercise class or fitness group in the community Clean your living area Enjoy outdoor winter activities Exercise extra care to prevent slips and other winter injuries, and make sure that kids and elders do the same Health Care Practice good prevention for colds and flu such as frequent hand washing If you follow self-management for a chronic health condition, don’t let holiday events, meals. Travel, etc. let you get derailed
Family, Friends, and Supporters: Consider who in your support network is a positive supporter and who might be unhealthy for you Decide on how much socialization time you need in order to feel well Make holiday get-togethers a positive opportunity to renew acquaintances with family and friends you may not see or speak with very often Make attempts to “give back” whenever possible

Finances: Plan ahead in terms of spending and know your limits Consider ways to give gifts other than spending money

Rest/Relaxation: Know your limits and plan ahead for proper balance of sleep, relaxation, and activity. Try to get enough sleep/rest each night, and avoid oversleeping during the winter months

Spiritual: Attend spiritual gatherings and celebrate in the holiday season Find ways to express gratitude each day

Expressive Art: Art can be a great way to express yourself during the holidays Consider attending a museum or holiday light show Attend a play with a holiday theme Think about combining friends/family and expressive arts – do a project or go to a show with some of the kids (young and old) in your life. MFT Continuing Education
When considering our holiday/winter wellness, it is a good idea to think of the self-care practices that we need in order to feel well and maintain/improve our overall health status. Activities like exercise, spiritual connection, social contact, and reading can all be tools that help us to stay well during the winter season. List your top five strategies for staying well this season:

Wellness Strategy How often I will do it When I will start
1.
2.
3.
4.
5.

Coping with Grief During the Holidays

For many people who have experienced a loss, holidays can be a very difficult time. "If only I can get through the holidays" is often a continued refrain during this season. In the roller coaster of grief, holidays are, for many people, a low point.

According to the Hospice Foundation of America, there are many reasons why the holidays can be so difficult. Kenneth Doka says the holidays are full of memories. We often pause to reflect on all the holiday experiences we've had, both good and bad. We remember all the people who have been part of our lives.

Second, holidays are not only times for past memories, but for fantasies of the present and future, as well. As we shop, we may see things that would be perfect gifts for the person who has died. We envision how that person would be so delighted when the gift is opened.

Third, holidays are stressful. There are so many things to do and so much to accomplish. In a time when one is already experiencing low energy, this can be overwhelming.

Finally, we can feel out of sorts with the season. Everyone seems so happy and cheerful; it is easy to feel alone. Recognizing that the holidays can be painful often helps ease that sense of isolation. We can acknowledge that this is a normal reaction to grief.

There are strategies to make holidays easier. They won't take your grief away, but they may help.

1. Be kind to yourself. Only do as much as you can comfortably manage. Honor your own feeling and needs.

2. Express your feelings. According to Judy Tatelbaum, the surest road through grief is to feel it, not deny it. When you are hurting, the best advice is cry if you need to cry.

3. Ask for what you need. If you want privacy or companionship or a shoulder to cry on, say so. Other people don't know how you feel unless you tell them. Helping you can be satisfying for someone else.

4. Don't overwhelm or over commit yourself. Give yourself a reprieve. Take time for yourself and take care of yourself. Take it slow and easy.
MFT Continuing Education

Easy Ways to Reduce Holiday Stress

For many families, the holiday season can feel more stressful than joyful. Stress comes from many directions at this time of year: too much rich food and drink, not enough exercise or sleep and all the rushing around to find the perfect gifts at the lowest prices.

“Although stress is common at this time of year, it is not inevitable,” says registered dietitian Crystelle Fogle of the Cardiovascular Health Program for the Montana Department of Public Health and Human Services. “Virtually every mental health expert agrees that lifestyle habits can help with stress reduction. This is the perfect time to step back from the holiday hustle and find ways to insure that your family is getting daily physical activity, plenty of nutrient-rich foods, and enough sleep every night.”

The typical holiday pattern of overindulgence and sleep deprivation combined with low activity actually adds stress in multiple layers. First, there is the actual physical stress from your body not getting what it needs for optimal health and energy. On top of that stress is layers of guilt and frustration brought on because you’re doing things that are unhealthy. Then, these feelings often lead back to more overeating or additional alcohol consumption.

Fogle points out that stopping this vicious cycle is easier than you may think. “It starts with setting priorities for your family – like fitness, nutrition, and sleep – and then saying ‘no’ to some of the holiday events that interfere with these healthy habits,” Fogle said. “The simple act of taking more control over your daily life can lower stress levels almost immediately.”

Here are a few real easy ways to have your holiday fun and reduce your stress too:

•Eat well. Family meals and nutrient-rich foods are even more important at this time of year. Enjoy simple meals, like steaming soup with salad and rolls, together as often as possible. Take time to establish new family traditions, like making bread from scratch.
•Play well. Being active together creates special memories and improves moods at the same time. Holiday fitness fun is as easy as a family game of Twister® or a stroll around the neighborhood to sing some holiday songs or carols for friends.
•Sleep well. Most adults do best with seven to eight hours sleep a night, while young children need significantly more. Develop family routines that promote healthy sleep habits, like reading holiday stories or listening to calming music together before bedtime.
“The ‘togetherness’ of these stress reduction tips is an important aspect of healthy, happy holidays,” Fogle notes. Connections to family and friends are much more important to holiday comfort and joy than lots of new stuff or plates of high-calorie treats. Starting new family traditions that reduce stress, such as cooking a meal or playing active games together, are gifts that will truly keep on giving for years to come.

Five Easy Ways to Enjoy More Tasty Holiday Nutrition
Although calorie-rich treats and overflowing tables can be the norm during holidays, you can get the nutrition that your body needs. The key is to concentrate on nutrient-rich foods. With bright colors and delicious flavors, nutrient-rich foods are a gift on any holiday table.

Calorie for calorie, these stars of the nutrition world offer more of the vitamins, minerals, protein and fiber that your whole family needs to maintain weight, enhance health, and reduce stress during this hectic time of year. Here are five easy ways to add nutrient-rich foods to all your seasonal feasts and treats.

•Start every day (and holiday) with breakfast. For a high-energy day, always include protein in your morning meal. Enjoy an egg or two, a serving of low-fat yogurt, a handful of nuts on whole grain cereal, or some lean meat, like a sliced turkey and Swiss on whole wheat wrap or bread.
•Snack smart throughout the holidays. Nutrient-rich snacks provide energy, while reducing the tendency to overeat at your next meal. Start with a piece of fresh fruit or some sliced veggies. Add a serving of protein, like a string cheese, a glass of low-fat milk, or leftover meats.
•Feature festive holiday salads at every meal. Fruit salads (any combo of canned, dried, frozen, or fresh fruit) are delicious any time of day. Green salads, bean salads, and veggie salads add color and crunch to lunch and dinner (and they make tasty leftovers for super smart snack times).
•Pack your holiday breadbasket with nutrition. The nutrient-rich goodness of whole grains, nuts, seeds, and dried fruits makes for tasty breads, rolls, and muffins. Bake some at home or check grocery shelves for sunflower whole wheat bread or bran muffins with raisins and walnuts.
•Warm up the holiday with winter vegetables. Root veggies (sweet potatoes, beets, and carrots) and hard winter squashes, like acorn, butternut, pumpkin, and spaghetti, are some the least expensive and most nutritious produce options. Enjoy them roasted, mashed, and made into soup!
Five Ways to Enjoy 10 Minutes of Holiday Fitness Fun
Physical activity is even more important during the holidays than other times of the year. Being active helps relieve holiday stress – and helps balance out the usual increase in holiday calories. To maintain fitness levels and emotional well-being, enjoy at least three 10-minute activity breaks a day – preferably with family or friends.

•Take a brisk 10-minute stroll with a loved one. Something as simple as a 10-minute walk can make all the difference in your physical and mental state. A brisk walk around the block at work or around your neighborhood can improve your mood and kick-start your metabolism in just a few simple steps. For extra holiday fun, invite someone you’ve been missing!
•Play a child’s favorite active game for 10 minutes. It’s often said that holidays are “all about the children.” What better way to be active than to have festive fun with one or more young people! Children often have extra energy to burn during the holidays and even serious adults can enjoy some sledding, get tied up in game of Twister®, or toss around a Koosh® ball.
•Dance for 10 minutes to your favorite holiday tunes. You could “Rock around the Christmas Tree” and just go “Walkin’ in a Winter Wonderland.” Use music to pick up the pace when you are walking or working outside with headphones – or cleaning up the house for a holiday gathering. For the best holiday break of all, take a spin on the dance floor with your sweetie.
•Walk for 10 minutes between stores. You can even fit fitness into a busy shopping day. Take a 10-minute ‘breather’ between each store on your list. Enjoy a quick lap around the perimeter of the mall or a walk around a couple of downtown blocks. You’ll have more energy – and you just might make more reasonable spending decisions too!
•Take a 10-minute stretch break at home or work. Holiday tension can take a toll on backs, shoulders, and jaws. A quick break can relieve physical and mental stress. Check these sites for gentle moves that can be done anywhere you need a stretch: www.lib.msu.edu/ergomsu/stretch.htm and www.will-harris.com/yoga/everyday_yoga.html
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Freeing Yourself from Holiday Debt

'Twas the day after New Year's, when all through the house
Not a creature was stirring, just me and my spouse;
We mused at the holiday cheer we had brought
To all of our dear ones, with gifts we had bought:
From ties, scarves and sweaters to books and CDs,
All manner of lip-smacking delicacies,
The latest high-tech, packed with features and frills,
But now how do we pay off our credit card bills?
If this sounds strangely familiar (and not just because of a brazen similarity to Clement Clark Moore's The Night Before Christmas), then you may be suffering the financial effects of your holiday generosity. You are not alone. Here are some tips that can help you overcome your holiday debt and be better prepared for next year's holiday spending:
• Face the facts; avoid denial – Delaying or avoiding the issue will cost you dearly in late fees and interest charges. It will also worsen your credit score - making your credit cards even more of a burden in the future.
• Make a payment plan and stick to it – Plan to make timely payments on every single card, and follow through on your plan no matter what. Even a single late payment can have disastrous results. For each card, define a fixed monthly payment (preferably more – even a little more – than the minimum due) and stick to it. Do not reduce this fixed amount as the minimum due gets smaller. When you have paid off one card, re-budget by dividing its monthly payment among the other cards.
• Consider a balance transfer – Try to transfer your debt from a high-interest card to a lowerinterest one. Ask your cards' customer service representative for an attractive deal. But pay attention to the terms! If the low interest rate expires before the debt is paid off, you could end
up worse off.
• Negotiate – Many credit cards will lower your interest rate if they fear you are about to transfer your balance and leave them. Cards will also frequently cooperate if you come to them with a payment plan.
• Consider a second job – Extra income can help you pay off more at a time and eliminate your debt faster.
• Give up one habit – Sweeping lifestyle changes may be hard to maintain, but it's easier to forgo a single habit, such as cable TV, high-speed Internet, a manicure, even a gym membership (you can exercise free). Use the extra money to pay off your debt.
• Free up cash to pay down high-interest debt – If you have money in your savings account, it is almost definitely earning less interest than you are paying on your credit card debit. Cash out the savings to pay your debt. If you have a 401(k) plan, you can suspend your contributions, but be careful not to jeopardize your employer's level of matching.
• Make a spending plan – Write down your income, monthly expenses and debts. Budget
realistically, and keep an eye on where you need to cut back. Consider setting aside money for next year's holiday expenses: divide this year's expenditure by 52 and set aside that amount each week.
• Seek help – You can get free or low-cost credit counseling through an agency affiliated with the National Foundation for Credit Counseling (NFCC). Call (800) 388-2227 or log on to www.nfcc.org. Your EAP can also provide you with telephonic financial counseling, delivered by certified professional counselors.
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