Brain Science and Updates From the Field

Inventive exercises help shake off effects of trauma

Monday, February 09, 2015

The word “trauma” is rooted in a Greek word meaning injury—damage to the body that triggers a natural response that regulates conditions to remain stable and constant.

Now, an inventive method of relieving the effects of trauma has shed light on the body’s natural healing abilities that are activated when releasing stress through physical exercises.

Trauma Releasing Exercises, or TRE ®, is a series of deep muscle movements that assist in ridding the body of stress, tension and trauma. The movements help people to return to a state of balance by encouraging shaking and vibrating.

Kevin Berceli, a therapist at Stairways’ Meadville Outpatient Clinic whose uncle, Dr. David Berceli developed the exercises during his work as an international trauma expert, is a certified TRE® practitioner.

Berceli is also owner of Counterpoise Solutions, LLC, which offers TRE® instruction and trauma education services.

As a way to supplement therapy, Berceli has incorporated TRE® exercises into his work with clients and has recently given demonstrations to Stairways employees and staff.

David Berceli developed TRE® after observing the responses of different traumatized communities while working primarily in Africa and the Middle East.

During mission trips, David Berceli witnessed the reaction of eight people who hailed from six different countries during a bombing in Lebanon in the 1980s, as well as observed natives during an air raid in Africa years later.

What he found among everyone subjected to a traumatic experience, though, was one shared behavior: shaking. To his discovery, many of the people presented with a trauma balled up and began rocking back and forth.

“So it wasn’t so much of a cultural response as it was a human response,” Kevin Berceli said.

The quivering response was more evident in children, it seemed, while adults, were more reserved and restrained in their reaction. To Berceli, this suggested that adults were conditioned to repress their natural response as a way to appear more confident and in control, instead of letting the body’s built-in system trigger.

“As we get older, we often suppress our natural healing response to stress and trauma,” Kevin Berceli said. “Children actually use the natural response more than adults, who deny it out of fear and shame.”

Based on the universal reactions he observed, David Berceli theorized that stress and trauma tends to cause muscles to tighten and become tense. TRE® exercises invoke a self-controlled muscular shaking process called neurogenic muscle tremors as a way to relax muscles and promote healing.

David Berceli has conducted studies and published research on the effectiveness of TRE®, which has reported particular success with veterans suffering from post-traumatic symptoms. In 2011, TRE® gained a level 3 status from the Defense Centers of Excellence, a military organization dedicated to veterans suffering psychological and traumatic brain injuries.

In using TRE® with clients, Kevin Berceli has noticed pronounced improvements in many cases.

“(TRE®) has been wildly successful,” he said. “People with some pretty severe anxiety have responded well to it and have felt calmer after taking part.

“I always give clients an option of whether to use it, but those who use the technique consistently seem to benefit from it.”

Having begun TRE a decade ago and achieved certification in 2013, Berceli said his TRE® work with Stairways has expanded to performing exercises with staff during lunch breaks. Berceli said TRE is even being incorporated into yoga classes and corporate wellness programs.

Learning TRE® from a certified teacher is a safe and effective way to reduce stress for most people, Berceli said.

“Anyone can pick up a book and do TRE® on their own, but, as we all have various exposure to stress and trauma in our lives, the safest way is to learn from a certified TRE provider,” he said.

To learn more about TRE® and trauma treatment, visit Counterpoise Solution’s at www.resetstress.com or www.traumaprevention.com.

Tangled in the Web

Tuesday, January 20, 2015

The teen who spends hours upon hours engaged in an online role-playing game each day. The husband who can’t stop downloading pornography at home and work. The mother who neglects her kids and maxes out several credit cards surfing the web for items she doesn’t need.

While the internet has been successful in connecting people across the world, relaying information at the click of a button and even changing the way we interact, the aforementioned scenarios represent the ugly side of the web: addiction and abuse.

For Dr. Kimberly Young, Ph.D., a member of the board of directors at Beacon Light Behavioral Health, a Bradford-based outfit with whom Stairways Behavioral Health recently affiliated, these situations arise all too often. Young is also a psychologist noted for her research and treatment of internet addiction disorders and founder of the Center for Internet Addiction.

Internet addiction disorder (IAD) is a compulsive behavior in which online activity interferes with normal life functions.

“It’s not about someone who is in front of their computer at work for most of the day,” she says. “What we’re really talking about is the teen who games for 10 hours a day or the guy who looks at porn or gambles to excess.”

Young, who has studied and treated internet addiction since 1995, created a treatment model called Cognitive-Behavioral Therapy for Internet Addiction (CBTIA) that targets thoughts and feelings associated with IAD.

Internet addiction is a concept that has gained considerable traction in recent years as technology proliferates. As it becomes more available, the internet becomes an accessible place for diversion and refuge from life’s problems, not unlike the role drugs and alcohol play for others, Young said.

“The theme that’s common to the cases I see is escape,” she says. “Like any other addiction, people use the internet to get away from the issues in their lives and they put all their focus and absorb themselves in their computer.”

In addition to escape, those addicted to the internet have the added luxury of remaining completely anonymous to the web community with whom they’re interacting.

“Because they are able to become someone different in the character they become in games or the internet world, it becomes very enticing to take on a position of power, recognition and respect,” she says.

Indeed, many of the changes in brain chemistry that are present in substance abuse also occur in those who are abusive of the internet. For instance, the mesolimbic dopamine pathway—the pleasure center of the brain—becomes active for both drug and internet abusers.

However, unlike chemical dependence, internet use can be difficult to completely eradicate while functioning in an increasingly digital world. That’s why it’s important to assess one’s “digital diet” and establish healthy parameters for more controlled internet use, Young noted.

“I use the analogy of a food addiction,” she says. “It can be harder to treat addiction to food because we all need to eat at some point, whereas you can quit a drug or alcohol and never have the actual need for it again.”

Young stresses that “controlled and moderated” use of is key for anyone.

“For work and some things, you are going to need to use the internet, so moderating it becomes very important,” Young says. “(Internet use) becomes a problem when it is interfering with our everyday lives.”

Dr. Kimberly Young, Ph.D., is a professor at St. Bonaventure University and has been featured in numerous national media outlets including the New York Times, Good Morning America, USA Today, Newsweek and CBS News among others. She has also authored several books on the topic of internet addiction and recently gave a lecture as part of a TEDx event. You can view the lecture here https://www.youtube.com/watch?v=vOSYmLER664

For tips or more information, visit Young’s website http://www,netaddiction.com/

Treatment Court offers an alternative to offenders

Thursday, December 11, 2014

At a site where they might otherwise have been sentenced to incarceration, a group of individuals were recognized for making the most of a second chance Thursday, Dec. 18.

That’s when a handful ex-defendants stood before family, friends and support staff to mark their sobriety and advance to the next stage of recovery by graduating from Erie County Treatment Court.

“It’s usually an emotional time for therapists and families who have invested a great deal in seeing them graduate,” said Autumn McLellan, Stairways Behavioral Health Forensic clinical director.

Treatment court is a court-sponsored program that offers alternative treatment options for non-violent offenders struggling with mental health and substance abuse issues in lieu of jail time.

Treatment court is a model used in place of traditional prosecution for certain offenses in courts across the country and has gained popularity in recent years. In Erie, treatment court is broken down into drug, mental health and family dependency courts, all of which are presided over by Judge William Cunningham.

In March, Erie County President Judge Ernest J. DiSantis Jr. approved a veterans’ court—a program aimed at addressing veterans with addiction and mental health problems. DiSantis assigned Judge John Garhart to head up the court, which became the 18th such program in the state and will operate independently of the other three treatment court programs.

Since its inception in 2000, Erie County treatment court has graduated well over 200 individuals and witnessed on multiple occasions the benefits of using a more supportive and therapeutic approach in place of traditional punishments.

“The courts are more receptive to working with these offenders on issues that may arise because they recognize the mental health component,” said Wayne Sharrow, supervisor of Stairways Behavioral Health’s Drug and Alcohol Clinic.

Stairways has formed a close working partnership with the county in providing mental health services to those involved in treatment court. With the help of Stairways and other providers, treatment courts generally focus on treating the problems that cause the offenders to commit crimes.

Treatment court does have certain eligibility restrictions, Sharrow noted.

“If someone can’t be monitored that would be reason not to include them in treatment court,” he said. “The same is true for if there is a victim who is not welcome to the idea in the victim impact statement.”

Individuals who have applied for and are approved for treatment court attend weekly court hearings that track their adherence to the court’s conditions. Each defendant stands before Cunningham, who evaluates their progress and orders further discipline or treatment.

Staff from Stairways, the Erie County Probation and Parole Department, the district attorney’s office, Erie Office of Children and Youth, Erie County Care Management, Erie County Office of Drug and Alcohol, the Public Defender’s office, other service providers and Cunningham meet prior to the weekly hearings to review offenders’ progress and decide on the proper course of action. Should offenders violate the conditions of their treatment-court sentences, they can be sentenced to traditional penalties, such as jail time.

Offenders are monitored by probations and are subject to random drug testing. Additionally, they must comply with the conditions set forth by the court at the weekly hearings, including those relating to work and personal matters.

“If there is a bad living situation, we try to make arrangements to get them in better situations,” McLellan said. “And if the judge says you have to leave (your current living situation), then you have to leave.”

Treatment court’s pragmatic approach to justice has yielded positive results for courts utilizing the program, as national recidivism rates for graduates are regularly lower than offenders who don’t participate.

On Dec. 18, Erie County residents who completed the program’s three requisite phases and appeared before the court for graduation were the latest group to represent the efficiency of treatment court— a means of reintegration and rehabilitation McLellan endorses.

“I’d recommend (treatment court) to anyone because the need to be held accountable is so great and treatment court offers that,” she said. 

New gene mapping tool used for medication selection

Thursday, November 13, 2014

Stairways doctors are now using cutting-edge genetic testing for a personalized approach to prescribing medicine for appropriate clients.

Pharmacogenomic testing identifies individual genetic differences and how they relate to medication response. Because genes influence the way a person’s body responds to specific medications, they may not work the same for everyone.

While not standard procedure for all clients of Stairways’ prescribers, this simple cheek swab has helped doctors determine the next best step for clients who have tried multiple psychotropic medications without success, or for whom side-effect risks are too high with certain medicines.

Genetic testing is a welcomed new instrument for solving a traditionally difficult situation. According to Lisa Hillman, co-director and nursing manager of Stairways’ Erie Outpatient Clinic, some clients express frustration while enduring repeated introduction phases for new medications.

The following scenario is common, said Hillman.

“A client will try one prescription, wait the required time for that medication to take effect, feel no improvement in symptoms and work with their doctor to try dosage adjustments – but ultimately that drug can fail, simply based on the person’s body chemistry.”

Often, the failure of one medication helps a doctor to know exactly which to try next. But some cases are more difficult. When repeated attempts with new medicines fail, turning weeks into months without successful symptom management, a new method is in order.

The genetic testing process is simple, and the results are clear. Under the supervision of a medical assistant, “Clients perform the cheek swab themselves; their doctor fills out the order, FedEx picks up the package same-day and five days later we’ve got the findings,” said Hillman.

Test findings provide results according to three categories: GREEN under the heading “Use as Directed,” YELLOW drugs are to be “Used With Caution,” and RED medications are suggested only for “Use With Increased Caution and With More Frequent Monitoring.” Both cautionary levels include notes specific to the chemistry as indicated by an individual’s DNA, e.g. “genotype may impact drug mechanism of action and result in reduced efficacy.”

GeneSight, the name of the test used in Stairways’ clinic, was developed in the Assurex Health clinical laboratory of Mason, Ohio and is based on patented technology licensed from the Mayo Clinic and Cincinnati Children’s Hospital Medical Center, who continue to be research collaborators. In August, 2014, the laboratory celebrated their 100,000th North American patient test.

More recently, Assurex Health and Canada’s Centre for Addiction and Mental Health (CAMH) today announced they have received a $6 million grant from Genome Canada, an agency of the Canadian government, to study the benefits of genetic testing to guide specific medication decisions for patients with depression or schizophrenia.

Stairways began limited GeneSight testing in April, 2014, and its use is slowly growing in frequency. “Some places jump right into this, testing every client,” said Hillman, “whereas we see tests ordered for about three to five individuals per week.”

This growth may increase more rapidly, due to favorable results, the growing body of research and educational information available to doctors – and one important fact for Stairways clients: the test is covered under both Medicare and Medicaid insurance.

This is important to Hillman as well, who has watched GeneSight provide a new opportunity through an historical stumbling block. “Many of the people we serve could not afford the out-of-pocket fees associated with DNA testing or genome mapping. But this is right in the reach of people who need it; the benefits of these tests are designed specifically to address the symptoms and risk profile of our clients.”

(Additionally research and information about GeneSight and pharmacogenomic testing can be found here: www.genesight.com)

New study finds schizophrenia is eight different disorders

Tuesday, October 14, 2014

New research indicates that schizophrenia is not a single disease, but a group of eight separate disorders.

In a study published in mid-September by the Washington University School of Medicine in The American Journal of Psychiatry, researchers found that schizophrenia, a mental disorder often characterized by delusional interpretations of reality, has identified gene variations that contribute to eight different classes of the disease.

In a study of more than 4,000 people with schizophrenia, researchers at Washington University at St. Louis revealed that certain disorders correspond with specific genetic makeups. For instance, while an individual with one genetic cluster may have auditory hallucinations, someone afflicted with disorganized speech will have different genetic features.

The discovery could have implications with how the disease is diagnosed, treated and understood, according to Dr. C. Robert Cloninger, co-author of the study.

“Genes don’t operate by themselves,” Cloninger said in a press release published by Washington University. “They function in concert much like an orchestra, and to understand how they’re working, you have to know not just who the members of the orchestra are but how they interact.”

The study analyzed the DNA of 4,200 people with schizophrenia as well as 3,800 without the affliction, finding that people with certain gene clusters are more predisposed to schizophrenia. Researchers grouped patients based on their symptoms—including hallucinations and delusions— and severity before examining their genetic profile. What researchers found were certain genetic features that made people more susceptible to developing schizophrenia.

For example, one genetic group carries a 95 percent of developing schizophrenia.

While genes are weak and unreliable associations of schizophrenia by themselves, interacting clusters of genes can be highly strong and credible indicators. This underlies the strong genetic component of schizophrenia, a reality that is illustrated by the fact that 80 percent of the risk for schizophrenia is known to be inherited.

In total, less than one percent of people develop schizophrenia.

In addition to the study, investigators also replicated their findings when analyzing two DNA databases of people with schizophrenia—indicating that identifying the gene variations that contribute to the illness could provide insight as to how best to diagnose and treat it.

The hope, Cloninger said, is that by recognizing the gene variations and the corresponding symptoms that may become present, doctors might be able to give more specific diagnoses and identify the most appropriate form of treatment at an early stage.

“People have been looking at genes to get a better handle on heart disease, hypertension and diabetes, and it’s been a real disappointment,” he said. “Most of the variability in the severity of disease has not been explained, but we were able to find that different sets of genetic variations were leading to distinct clinical syndromes. So I think this really could change the way people approach understanding the causes of complex diseases.”

A Different Look at Addiction Recovery

Monday, September 08, 2014

Innovative Injectable treats addiction by target brain's receptors

There is no magic pill for addiction, but an innovative treatment method that can eliminate the effects of alcohol and opiates has been an effective tool in the box for those struggling with substance abuse.

Wendy McCullough, director of Stairways Behavioral Health’s Forensic Clinic has witnessed first-hand the positive outcomes Vivitrol, a monthly injectable, can yield in recovering addicts.

“We’ve had good results with it,” McCullough. “The big thing is that it is not a narcotic, so it’s not addictive and it can be given by anyone who can write prescriptions.”

Vivitrol, the trade name for Naltrexone, is an extended-release injection given each month that acts as a blocker by attaching to receptors in the brain, blocking the euphoric feelings associated with opiates and alcohol.

Vivitrol blocks receptors in the brain associated with opioids (above) and alcohol.

In contrast to methadone and buprenorphine (Suboxone), which have been the standard agonist treatments used during recovery, Vivotrol is an antagonist, meaning it blocks the brain’s neurotransmitters. Methadone and buprenorphine, which are opiates, meanwhile, activate the effects of neurotransmitters naturally found in the brain.

Stairways has used Vivitrol with clients for more than two years and has seen its effectiveness on multiple occasions.

Part of the drug’s appeal, noted McCullough, lay in its practicality. Vivitrol gives substance abuse treatment providers and those in treatment an alternative to methadone and buprenorphine, which must be taken daily under the supervision at certified clinics or, in the case of buprenorphine, at home, which can lead to street sales.

Another attractive quality of Vivitrol is its extended-release feature, which can reduce the urge to get high by eliminating the need to take a daily pill. If a dosage of one of the daily drugs is missed, McCullough noted, addicts are susceptible to relapse because they would then be able to feel the effects of the substance they abuse.

“If I wanted to go use heroin tonight, I could stop using Suboxone two days in advance and get high,” McCullough said. “You can’t do that with Vivitrol.”

While oral naltrexone has been a trusted method used to treat substance abuse for nearly 30 years, intramuscular injections of Vivotrol are a relatively new development, having been approved by the Food and Drug Administration in 2010.

An ongoing concern since its introduction has been its steep price tag. Monthly injections sit in the $800-1,200 range, but unlike other treatment options, Vivitrol is now eligible to be covered by insurance.

 “Some people say it is expensive, McCullough said. “But when you factor in that most insurance pays for it, whereas it does not Suboxone, it really isn’t that much more than the other methods of treatment.”

McCullough recalled an instance several years ago when the drug was not yet covered by insurance, when a clients’ parents paid out of pocket for the monthly injections.

Stairways clients undergo a comprehensive process prior to being put on Vivitrol: blood tests are collected to detect the possible presence of liver enzymes and a chart is kept to monitor triggers and urges. McCullough said that the 20 to 25 clients taking Vivitrol at any given time who also undergo treatment in the form of stress and medication management in coordination with their monthly regimen have generally responded well.

“The people we have on it like it,” she said. “They seem more apt to stay on it. They seem not to be using.”

Though Vivitrol has produced positive results in many, McCullough did acknowledge that monthly injectables are not necessarily a fit for all in recovery.

“We realize it isn’t for everybody and not everyone wants to use it.”


Finding A Better Balance

Wednesday, July 30, 2014

Stairways program on cutting edge of biofeedback technology

An ACT team staff member uses an interactive computer game associated with the HeartMath InnerBalance application.


Math has long been the source of aggravation for countless individuals. However, thanks to an innovative and interactive biofeedback smartphone application, Stairways’ Assertive Community Treatment team (ACT) is using math to reduce stress.

Since February, the ACT team has been utilizing HeartMath Inner Balance, an iPhone app that seeks to reduce tension by improving one’s heart rate and breathing.

ACT has integrated the tool’s use in its work with clients as well as staff members, ACT physician Jennifer Pasternack, Ph.D, said.

“We’re using it for ourselves for stress,” she said. “Our clients are also using them for stress but it’s good for many of them who have had trauma as well.”

InnerBalance works by using an earlobe-clip that monitors one’s heart rate variability (HRV) — the changes in one’s heart rhythm that often reflect their present emotions. The HRV is then visually represented onscreen as a flowing wave, while the user is encouraged to breath in a slower, calmer manner by following along with a breath-pacing tool.

Sam Trychin, Ph.D., an Erie psychologist and consultant to Stairways Behavioral Health, introduced InnerBalance to Stairways after he had used the tool for more than five years, he said.

“Psychology influences physiology,” Trychin said. “And the inverse is true. Changing your breathing along with greater thoughts of appreciation can have a direct impact on your heart rate that you are able to see on the spot.”

Calmer, deeper breathing along with more appreciative feelings, Trychin says, results in fewer drastic fluctuations on the HRV meter. As this improved balance is achieved, “coherence”— the relationship between your HRV and a relaxed emotional state — increases as well, which, in turn, reduces the psychological and physiological symptoms of stress.

InnerBalance has yielded positive results for people suffering from mental illness as well as physical pain. For example, Veterans Affairs medical centers across the country have introduced the tool to veterans suffering from post-traumatic stress disorder.

At Stairways, Bernadette Valentinetti, a mental health professional in ACT, said she likes to incorporate the app into therapy as a way to visually show clients how their stress and heart rate directly correlate. With some clients, Valentinetti makes use of InnerBalance computer games that sync with breathing and heart rate variability to simulate adventure settings, such as being in a tropical garden or on a rainbow.

“I have a client that has a lot of anxiety and this is one way for her to regulate that,” Valentinetti said. “It’s a way for them to increase coherence without having to think of it as a deep-breathing exercise.”

ACT’s use of InnerBalance hasn’t been just limited to therapy with clients, however. The team’s staff also uses it immediately before meetings as a means to increase coherence and mitigate stress.

“It fits in well with our philosophy in that there’s not much of a difference between us and our clients,” she said. “Coping mechanisms are coping mechanisms and we all have stress whether we have a mental disorder or not.”

Pasternack, who initiated the app’s use after beginning to use it herself in December, said she has seen a difference in her own life.

“I feel I’m much calmer and more able to handle stress when it does arise,” she said.



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