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15

The Power of Mindset

By | NESCA Notes 2024

By: Carly Loureiro, MSW, LCSW
Licensed Clinical Social Worker and Executive Function Coach

Phrases like “mind over matter,” “the glass is half full,” and “making lemonade out of lemons,” are more than just popular sayings; they capture the essence of having a positive mindset. With the complexities that everyday life can bring, maintaining a positive mindset can feel overwhelming. Negative thoughts and emotions often creep in, clouding our judgment and affecting our mental health. Learning how to maintain a positive mindset can help individuals overcome these negative thoughts, leading to a decrease in anxiety and depression symptoms, higher self-esteem, as well as improved physical well-being and interpersonal relationships. Those needing assistance in gaining control of their mindset should consider Cognitive Behavioral Therapy, a therapeutic intervention that can aid in strengthening this skill, leading to desired outcomes.

Understanding Mindset

A mindset is a set of beliefs or attitudes that shape how we perceive and respond to situations. Broadly, mindset can be categorized as positive or negative:

  • Positive Mindset: Involves seeing challenges as opportunities, maintaining optimism, and focusing on potential rather than limitations.
  • Negative Mindset: Involves focusing on problems, expecting unfavorable outcomes, and feeling overwhelmed by obstacles.

Mindset shapes our internal dialogue and emotional responses, such as how we react to challenges. A positive mindset promotes constructive thoughts and emotions, leading to feelings of hope, joy, and contentment. For example, someone with a positive mindset is more likely to engage in proactive coping strategies, such as going for a walk, engaging in positive self-talk, and practicing mindfulness and gratitude. Conversely, a negative mindset can foster destructive thoughts and emotions, leading to avoidance, self-sabotage, or other harmful behaviors.

The Role of Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy (CBT) is a powerful and effective psychotherapeutic treatment that helps individuals understand how their thoughts, feelings, and behaviors are interconnected. A CBT therapist helps clients learn new skills and strategies to gain more control of their thoughts, leading to a happier and healthier approach to problem solving. CBT is widely used to treat a range of mental health disorders, including depression, anxiety, phobias, and PTSD.

See below a visual of the cognitive triangle, often used to help people better understand the concept of CBT and how it applies to their own personal experiences:

Components of CBT That Contribute to Positive Mindset:

  1. Self-awareness: Becoming aware of your thought patterns and where they originated, noticing when you tend to think negatively, and really understanding how it influences your feelings and behaviors
  2. Cognitive Reframing: Challenging negative thought patterns when you notice them and replacing them with thoughts that are more positive, leading to actions that are productive
  3. Mindfulness and Relaxation Techniques: In order to gain more control of your thoughts, incorporating mindfulness and relaxation techniques can help individuals reset and shift their thinking patterns
  4. Gratitude Practice: Regularly reflecting on things you’re grateful for can also help shift your focus from what’s lacking to what’s abundant in your life, increasing motivation and self-esteem
  5. Positive Affirmations: Reinforcing your self-worth and capabilities with positive affirmations
  6. Homework: CBT therapists may assign tasks to be completed in between sessions in order to practice newly learned skills

An Example:

Tanya, a ninth grade student, has an upcoming history final. Final exams tend to be difficult, as her slower processing speed impacts her ability to grasp a magnitude of details. With her executive function coach, Tanya has learned new ways to memorize larger quantities of information, such as making associations and using mnemonic devices and visuals. In the past, prior to a test or quiz, Tanya got stuck in negative thinking patterns, such as telling herself she will not get a passing score, or that she isn’t smart enough. These negative thoughts would make her feel hopeless, inadequate, and self-conscious. Before the test or quiz, she’d become distracted by these thoughts, not putting forth her best effort, resulting in scores that didn’t reflect her knowledge.

Tanya began working with a CBT therapist to help her mitigate the impact of her performance anxiety. By incorporating mindfulness, gratitude, and thought log exercises (see examples below), she learned how to reframe unhelpful thoughts into productive ones, leading to scores that matched her knowledge and skill set. Instead of telling herself, “I won’t pass this test,” she’d tell herself, “I studied for this test, therefore I have the knowledge and my score will reflect that!” By shifting her mindset and correcting the negative thoughts, Tanya learned the impact they had on her performance. She’s now learning how to apply these strategies to all of her academic classes to normalize having a positive mindset.

Examples of Exercises:

Mindfulness exercise: Each morning while eating breakfast, Tanya listens to a quick 2-minute guided meditation, helping her become more present and ready for the day, moving away from negative thoughts that could impede her success.

Gratitude exercise: Tanya completes a prompt in her gratitude journal before bed, reflecting on daily highlights, such as something that made her smile that day, or a way she helped a friend or classmate.

Thought log exercise: Tanya’s therapist created a thought log for her to challenge her negative thoughts when she found herself experiencing them, and replacing them with an uplifting thought.

Looking for support in this area?

Negative thoughts can be difficult to overcome alone. If you are interested in CBT to receive support in gaining control of harmful thinking patterns, you can book a free introductory call with me by filling out our online intake form.

  

About the Author

Carly Loureiro is a Licensed Clinical Social Worker practicing in Massachusetts and Rhode Island. Having worked both in private practice and schools, she has extensive experience supporting students, families and educational teams to make positive changes. Mrs. Loureiro provides executive function coaching and psychotherapy to clients ranging from middle school through adulthood. She also offers consultation to schools and families in order to support her clients across home and community environments.

To schedule an appointment with one of NESCA’s counselors, coaches, or other experts, please complete our online intake form. 

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and staff in the greater Burlington, Vermont region and Brooklyn, New York, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

1

NESCA Goes to Brain Camp – Exploring the Connections among Brain Anatomy, Emotional Health, and Neuropsychology

By | Nesca Notes 2023

By Angela Currie, Ph.D.
Pediatric Neuropsychologist; NH Director, NESCA

For three days every July, students, clinicians, and researchers from around the country descend upon Milwaukee for Marquette University’s Neuroanatomical Dissection Course. This Marquette course is the only one in the world that provides a continuing education opportunity to learn about advances in neuroscience research while also engaging in hands-on brain dissection within the university’s gross anatomy lab. This past July, my NESCA colleague, Dr. Erin Gibbons, and I had the pleasure of being two of the participants.

Perhaps not unexpectedly, the lab components of the course were insightful and impactful. This included watching 3-D computer-aided brain maps within the visualization lab at the engineering school, as well as hands-on brain dissection of donor specimens, some of which presented with unique pathologies that had never been seen first-hand within the lab. Across the three days of the seminar, lectures covered a range of topics, such as neuroanatomy, how emotions function in the brain, and functional and neurological presentation of brain pathology. We also had the opportunity to select from a range of presentations that provided a “deep dive” into more specific topics. There was a host of information that directly speaks to our practice as pediatric neuropsychologists. That said, as someone who often works with clients who face depression, anxiety, and trauma, certain information stood out as most relevant to my daily practice.

First, there is an increasing amount of research indicating that early-onset (onset in childhood or adolescence), prolonged depression can significantly reduce the growth and volume of particular brain areas related to learning and memory; however, this negative impact can be ameliorated with antidepressant medication.1,2 Often times, when working with clients, families are understandably reticent about giving medication to their developing child. While individual response to treatment cannot be predicted, this research shows that, when appropriate to the client’s needs, medication can actually protect brain development, and thereby better support learning and memory over the lifespan.

Another topic that was covered was the impact of trauma on brain development and later self-regulation challenges and treatment response. As a clinician who often sees children with developmental, complex trauma, I am often in the position of explaining to families how trauma affects brain development. There is research to suggest that ongoing adversity early in childhood inhibits development in areas of the brain that manage inhibition, emotions, and processing, and this may contribute to later difficulties understanding emotion and modulating stress.3 While trauma may affect brain development in any child, there are also some children who appear to persist through adversity with lesser effect. There is research to suggest that this “resiliency” may not just be a personality characteristic, but may be a result of a larger, better-developed area of the brain that is thought to integrate emotional and cognitive information, allowing them to better manage emotional responses.4 Stronger development in this area can also predict better response to cognitive behavior therapy in older individuals with PTSD. 5 While it is not always clear what allowed those individuals to have stronger brain development, research shows that early treatment and access to social supports results in improved emotion processing and brain function in children with trauma, emphasizing neuroplasticity within the brain.6,7

The message that can be extracted from the above research is that the brain is highly vulnerable, but it can also be very resilient and adaptable. While our experiences and genetic vulnerabilities may present their challenges to neurological development, proper therapies, social supports, and medications can change a person’s developmental course and support long-term gains. Actually measuring brain volume and conducting imaging is not necessary for understanding how these factors present within an individual person. Instead, comprehensive assessment of their neurocognitive functioning, processing, learning, and social/emotional functioning can elucidate their resiliency factors, as well as targets for intervention. This is what we have always strived to do at NESCA, and now with the advantage of the Marquette Neuroanatomical Dissection Course, we can demonstrate how our clinical process, values, and goals are supported by current brain research.

 

References

  1. Schmaal, L., Veltman, D., van Erp, T. et al.(2016). Subcortical brain alterations in major depressive disorder: findings from the ENIGMA Major Depressive Disorder working group. Molecular Psychiatry, 21: 806–812. https://doi.org/10.1038/mp.2015.69
  2. Sheline YI, Gado MH, Kraemer HC. (2003). Untreated depression and hippocampal volume loss. American Journal of Psychiatry,160(8):1516-1518. doi: 10.1176/appi.ajp.160.8.1516.
  3. Zhai ZW, Yip SW, Lacadie CM, Sinha R, Mayes LC, Potenza MN. (2019). Childhood trauma moderates inhibitory control and anterior cingulate cortex activation during stress. Neuroimage, 185:111-118. doi: 10.1016/j.neuroimage.2018.10.049.
  4. Stevens, JS, Ely, E.D., Sawamura, T., et al. (2013). Childhood maltreatment predicts inhibition-related activity in the rostral anterior cingulate in PTSD, but not trauma-exposed control. Depression and Anxiety, 33(7): 614-622. https://doi.org/10.1002/da.22506
  5. Bryant RA, Felmingham K, Whitford TJ, et al. (2008). Rostral anterior cingulate volume predicts treatment response to cognitive-behavioural therapy for posttraumatic stress disorder. Journal of Psychiatry and Neuroscience, 2008, 33(2):142-6. PMID: 18330460.
  6. Wymbs, NF, Orr, C, Albaugh, MD, et al. (2020). Social supports moderate the effects of child adversity on neural correlates of threat processing. Child Abuse & Neglect, 102: 104413. https://doi.org/10.1016/j.chiabu.2020.104413.
  7. Garrett A, Cohen JA, Zack S, C, et al. (2019). Longitudinal changes in brain function associated with symptom improvement in youth with PTSD. Journal of Psychiatric Research,114:161-169. doi: 10.1016/j.jpsychires.2019.04.021.

 

About the Author

Dr. Currie specializes in evaluating children, teens, and young adults with complex profiles, working to tease apart the various factors lending to their challenges, such as underlying learning, attentional, social, or emotional difficulties. She particularly enjoys working with the seemingly “unmotivated” child, as well as children who have “flown under the radar” for years due to their desire to succeed.

 

To book an evaluation with Dr. Currie or one of our many other expert neuropsychologists, complete NESCA’s online intake form. Indicate whether you are seeking an “evaluation” or “consultation” and your preferred clinician in the referral line.

 

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham (coming soon), Massachusetts; Londonderry, New Hampshire; and the greater Burlington, Vermont region, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

39

So, You Are Taking a Leave of Absence from College—Now What?

By | Nesca Notes 2023

By: Kelley Challen, Ed.M., CAS
Director of Transition Services; Transition Specialist, NESCA

Over three-quarters of college students (76%) reported moderate to severe psychological distress during the 2022-2023 school year (National College Health Assessment, American College Health Association, Spring 2023). College students across the country are continuing to struggle with depression, anxiety, self-harm, and suicidal thoughts this school year. My appointment calendar is often made up of meetings with college students or parents of college students beginning the process of taking a leave of absence and wondering what to do next. Here are some tips that I shared with many of these students and families.

Get Treatment

Many students need to participate in skill-based therapies (cognitive behavioral therapy, dialectical behavioral therapy, exposure and response prevention, acceptance and commitment therapy, etc.) in order to build up coping skills that may not have been developed in high school. Depending on the severity of current mental health issues, a student may need to participate in an intensive inpatient or outpatient treatment. Ultimately, many students need to find a supportive outpatient therapist—ideally someone who will be able to continue treating the student if they plan to make a future college attempt.

Psychopharmacological intervention (i.e., medication) can be important to consider. Sometimes students have not been taking medications as prescribed or they are taking medications exactly as prescribed but not gaining the intended benefits. Consulting with a prescriber can be an important treatment step for determining whether medication, or medication changes, are necessary.

Get Exercise

For any student, having a regular routine for exercise, sleep, and healthy diet has an impact. However, this is even more critical for students who are vulnerable to anxiety and/or depression. Exercise does not have to start big. Walking (with or without the dog), hiking, or just moving along to a YouTube fitness video for 10 minutes a day will make a difference. It’s critical to schedule the exercise in and often easiest if this is part of a morning or evening routine. For some students, working with a personal trainer or attending scheduled classes helps with accountability. Using a wearable exercise tracker like a Fitbit, Garmin Watch, or Apple Watch can also help with motivation and consistency.

Get a Job

Over the past 25 years, we have seen a notable decrease in the number of high school students who have participated in paid employment. Many students went off to college without taking time to connect college participation with future career interests. Using time off from school to explore work preferences and build transferrable skills (and a resume) can help students experience efficacy and improve mood. As a college student, no one is particularly excited when you show up to class, and the professor certainly doesn’t depend on you in order to get their job done. However, as an employee, students can experience tangible success through accomplishing work activities, receiving gratitude from coworkers and supervisors, and earning money. Work can also provide an important social experience. This is also an historic time to be looking for a first or early career position in the American workforce. Entry-level workers can make good wages. and there are plenty of part-time job openings across industries. Moreover, it’s difficult to get fired right now because good help is truly hard to find.

For students who are not ready to commit to paid work, and need time to recover and build energies up, volunteer jobs are also good opportunities. Some students will do better with brief drop-in volunteer activities while others my want to schedule more routine work hours.

Consider Taking Classes

When students take a leave of absence from college, the assumption is that the student will want to return to a college experience. But many students take a leave of absence and determine that they do not want to go back to college or that they do not want to go back to the same college. If a student wants to keep up academic skills, they can audit or take one or more college courses during the spring semester (depending on their college’s policies and whether they are planning to return). Community colleges, state colleges, and part-time or online college programs (like Harvard Extension School) are good options to explore for classes of interest as a non-degree seeking student. Starting back with a class that is high interest or a low degree of difficulty can be helpful for students who need to rebuild confidence. Additionally, when students are unsure if they are going to return to college or uncertain of a potential future major, it can be good to try classes that are likely to transfer and generally meet basic liberal arts requirements.

Get a Coach

Some students with mental health issues have other underlying challenges that contributed to their struggles in college. There could be a learning disability that wasn’t appropriately being addressed with accommodations, executive function challenges that impacted keeping up with pace, or volume of academics, social challenges that were exacerbated by the highly social dorm environment, or other issues. It is important to consider whether there are skill deficits that may have contributed to a student experiencing anxiety or depression. Some students will benefit from life skills, executive function, or social coaching in order to build up areas that are weaker before heading back to college (or may want to continue with that coaching when they head back).

Other students may want to take time to work with a career or transition coach to do some self-exploration. Taking a step back to participate in self-assessment related to one’s preferences and interests and to determine how those align with potential college major and future career interests can be helpful. I have worked with several students on leave to go through a career planning process. For some, they discover that they chose exactly the right college and major, and that can increase motivation when they get back to school, with proper supports in place. For others, this process sets a student on a completely new path.

Let us know, in our online Intake Form, if your student needs support during their time off from school and/or coaching to assist during their time off or when they return to college.

 

About the Author
Kelley Challen, Ed.M., CAS, is NESCA’s Director of Transition Services, overseeing planning, consultation, evaluation, coaching, case management, training and program development services. Ms. Challen also provides expert witness testimony in legal proceedings related to special education. She is also the Assistant Director of NESCA, working under Dr. Ann Helmus to support day-to-day operations of the practice. Ms. Challen began facilitating programs for children and adolescents with special needs in 2004. After receiving her Master’s Degree and Certificate of Advanced Study in Risk and Prevention Counseling from Harvard Graduate School of Education, Ms. Challen spent several years at the MGH Aspire Program where she founded an array of social, life and career skill development programs for teens and young adults with Asperger’s Syndrome and related profiles. She additionally worked at the Northeast Arc as Program Director for the Spotlight Program, a drama-based social pragmatics program, serving youth with a wide range of diagnoses and collaborating with several school districts to design in-house social skills and transition programs. Ms. Challen is co-author of the chapter “Technologies to Support Interventions for Social- Emotional Intelligence, Self-Awareness, Personality Style, and Self-Regulation” for the book Technology Tools for Students with Autism. She is also a proud mother of two energetic boys, ages six and three. While Ms. Challen has special expertise in supporting students with Autism Spectrum Disorders, she provides support to individuals with a wide range of developmental and learning abilities, including students with complex medical needs.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com, call 617-658-9800 or complete our online Intake Form.

39

So, You Are Taking a Leave of Absence from College—Now What?

By | NESCA Notes 2022

By: Kelley Challen, Ed.M., CAS
Director of Transition Services; Transition Specialist, NESCA

Almost 75% of college students reported moderate to severe psychological distress during the 2020-2021 school year (National College Health Assessment, American College Health Association, 2021). College students across the country are continuing to struggle with depression, anxiety, self-harm, and suicidal thoughts this school year. In the weeks leading up to Thanksgiving, my appointment calendar consisted primarily of meetings with college students or parents of college students beginning the process of taking a leave of absence and wondering what to do next. Here are some tips that I shared with many of these students and families.

Get Treatment

Many students need to participate in skill-based therapies (cognitive behavioral therapy, dialectical behavioral therapy, exposure and response prevention, acceptance and commitment therapy, etc.) in order to build up coping skills that may not have been developed in high school. Depending on the severity of current mental health issues, a student may need to participate in an intensive inpatient or outpatient treatment. Ultimately, many students need to find a supportive outpatient therapist—ideally someone who will be able to continue treating the student if they plan to make a future college attempt.

Psychopharmacological intervention (i.e., medication) can be important to consider. Sometimes students have not been taking medications as prescribed or they are taking medications exactly as prescribed but not gaining the intended benefits. Consulting with a prescriber can be an important treatment step for determining whether medication, or medication changes, are necessary.

Get Exercise

For any student, having a regular routine for exercise, sleep, and healthy diet has an impact. However, this is even more critical for students who are vulnerable to anxiety and/or depression. Exercise does not have to start big. Walking (with or without the dog), hiking, or just moving along to a YouTube fitness video for 10 minutes a day will make a difference. It’s critical to schedule the exercise in and often easiest if this is part of a morning or evening routine. For some students, working with a personal trainer or attending scheduled classes helps with accountability. Using a wearable exercise tracker like a Fitbit, Garmin Watch, or Apple Watch can also help with motivation and consistency.

Get a Job

Over the past 25 years, we have seen a notable decrease in the number of high school students who have participated in paid employment. Many students went off to college without taking time to connect college participation with future career interests. Using time off from school to explore work preferences and build transferrable skills (and a resume) can help students experience efficacy and improve mood. As a college student, no one is particularly excited when you show up to class, and the professor certainly doesn’t depend on you in order to get their job done. However, as an employee, students can experience tangible success through accomplishing work activities, receiving gratitude from coworkers and supervisors, and earning money. Work can also provide an important social experience. This is also an historic time to be looking for a first or early career position in the American workforce. Entry-level workers can make good wages. and there are plenty of part-time job openings across industries. Moreover, it’s difficult to get fired right now because good help is truly hard to find.

For students who are not ready to commit to paid work, and need time to recover and build energies up, volunteer jobs are also good opportunities. Some students will do better with brief drop-in volunteer activities while others my want to schedule more routine work hours.

Consider Taking Classes

When students take a leave of absence from college, the assumption is that the student will want to return to a college experience. But many students take a leave of absence and determine that they do not want to go back to college or that they do not want to go back to the same college. If a student wants to keep up academic skills, they can audit or take one or more college courses during the spring semester (depending on their college’s policies and whether they are planning to return). Community colleges, state colleges, and part-time or online college programs (like Harvard Extension School) are good options to explore for classes of interest as a non-degree seeking student. Starting back with a class that is high interest or a low degree of difficulty can be helpful for students who need to rebuild confidence. Additionally, when students are unsure if they are going to return to college or uncertain of a potential future major, it can be good to try classes that are likely to transfer and generally meet basic liberal arts requirements.

Get a Coach

Some students with mental health issues have other underlying challenges that contributed to their struggles in college. There could be a learning disability that wasn’t appropriately being addressed with accommodations, executive function challenges that impacted keeping up with pace, or volume of academics, social challenges that were exacerbated by the highly social dorm environment, or other issues. It is important to consider whether there are skill deficits that may have contributed to a student experiencing anxiety or depression. Some students will benefit from life skills, executive function, or social coaching in order to build up areas that are weaker before heading back to college (or may want to continue with that coaching when they head back).

Other students may want to take time to work with a career or transition coach to do some self-exploration. Taking a step back to participate in self-assessment related to one’s preferences and interests and to determine how those align with potential college major and future career interests can be helpful. I have worked with several students on leave to go through a career planning process. For some, they discover that they chose exactly the right college and major, and that can increase motivation when they get back to school, with proper supports in place. For others, this process sets a student on a completely new path.

Let us know, in our online Intake Form, if your student needs support during their time off from school and/or coaching to assist during their time off or when they return to college.

 

About the Author
Kelley Challen, Ed.M., CAS, is NESCA’s Director of Transition Services, overseeing planning, consultation, evaluation, coaching, case management, training and program development services. Ms. Challen also provides expert witness testimony in legal proceedings related to special education. She is also the Assistant Director of NESCA, working under Dr. Ann Helmus to support day-to-day operations of the practice. Ms. Challen began facilitating programs for children and adolescents with special needs in 2004. After receiving her Master’s Degree and Certificate of Advanced Study in Risk and Prevention Counseling from Harvard Graduate School of Education, Ms. Challen spent several years at the MGH Aspire Program where she founded an array of social, life and career skill development programs for teens and young adults with Asperger’s Syndrome and related profiles. She additionally worked at the Northeast Arc as Program Director for the Spotlight Program, a drama-based social pragmatics program, serving youth with a wide range of diagnoses and collaborating with several school districts to design in-house social skills and transition programs. Ms. Challen is co-author of the chapter “Technologies to Support Interventions for Social- Emotional Intelligence, Self-Awareness, Personality Style, and Self-Regulation” for the book Technology Tools for Students with Autism. She is also a proud mother of two energetic boys, ages six and three. While Ms. Challen has special expertise in supporting students with Autism Spectrum Disorders, she provides support to individuals with a wide range of developmental and learning abilities, including students with complex medical needs.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com, call 617-658-9800 or complete our online Intake Form.

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