Anxiety

Good Faith Estimates: What You Should Know

Good Faith Estimates: What You Should Know

As of January 1, 2022, there is a new law called the No Surprises Act that requires all health care providers to give clients who don’t have insurance or are not using insurance an estimate of the bill for medical items and services they are to receive because the provider is out-of-network for their benefits.

“Surprise billing” is when you receive a bill with an unexpected balance. This can happen when you cannot control who is involved in your care, such as when you have an emergency hospitalization and a service is provided by an out-of-network provider at an in-network facility.

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees. In the case of mental health, it refers to the number of sessions you are likely to have with your mental health professional (a licensed social worker, mental health counselor, marriage and family therapist or clinical psychologist).

Your health care provider should give you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.

If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

Make sure you save a copy or picture of your Good Faith Estimate.

If you are a client of my practice, you will have been sent a Good Faith Estimate through the client portal. To view and acknowledge receipt of your Good Faith Estimate, log into your client portal. Your Good Faith Estimate was created based on our current meeting frequency and your session rate but may likely be overestimated, in order to provide you the maximum amount of out-of-pocket expenses for treatment. If additional services are recommended, your Good Faith Estimate will be revised to reflect the change. The estimated costs are good for 12 months after the date of the Good Faith Estimate.

Remember, this is not a bill. If you do not have as many sessions this year as are listed in the estimate, then your costs will be lower than estimated. The Good Faith Estimate includes additional information about your rights and how to learn more. And as always, feel free to reach out to me with any questions you may have.

For more information about your right to a Good Faith Estimate or how to use the dispute resolution process, you can visit www.cms.gov/nosurprises or call 1-800-985-3059.

** The No Surprises Law has already seen several revisions, so it is subject to change. This document on the CMS website currently has an expiration date of 3/31/22.

Find yourself, and be that.

 

 

Licensed Clinical Social Worker
        EMDR Certified Therapist
        112 W. New York Avenue, Suite 205
        DeLand, FL 32720

 

 

Self-regulation and Mindfulness

As explored in our last blog, the ability to cope with the many challenges of life, whether big or small, and our emotional responses to them, has a relationship with something called self-regulation. Remember, self-regulation is the ability to manage one’s emotions, behavior and body movement when faced with difficult situations.

Below is a follow-up article by my colleague, Joel Bennett, M.Ed., which explores the potential for improving our self-regulation through several mindfulness-based interventions. Joel shares how you can add to your mental health toolbox and positively increase your capacity for self-regulation in several simple, easy to apply ways.

Find yourself, and be that!

 

 

Licensed Clinical Social Worker
         EMDR Certified Therapist
         112 W. New York Avenue, Suite 205
         DeLand, FL 32720

Self-regulation and Mindfulness
By Joel A. Bennett, M.Ed.

Often, through unwritten or unspoken norms, we perceive that our value and worth is tied with action and production. While it is better to think ahead, make previsions for the unknown, and get the laundry done, an often-overlooked aspect of self is quiet mindfulness.

Is mindfulness the property of Eastern thought and religions? Not according to a study that looked at the correlation between different interventions and their impact on self-regulation (Pandey et al, 2018). Remember, self-regulation includes focusing and maintaining attention, regulating emotion and stress response among many other descriptors (Blair and Raver, 2015, Pandey et al, 2018). With constant action and minimal or unintentional awareness of what “is”, our ability to control our emotions and stress responses suffers.

What is mindfulness? Mindfulness can be defined as practicing awareness of what is, internally as well as externally (Pandey et al, 2018). Okay, but what framework would support me in learning to perform mindfulness activities? I will give three examples of what mindfulness activities may look like.

Mindful Breaths

When you control your breathing, you can control many parts of how you experience life. When you sit up straight, you allow your nerves and air way to work as they were designed. Breathe in through your nose slowly. Feel the air filling your lungs and then pushing down into your belly. Sit with your belly full for 4 seconds and then let the air escape slowly out of your mouth. We will call this 4-4-4 breathing. 4 counts in, 4 counts hold, and 4 counts exhale. Go ahead, pause and practice right now. (Sit straight, with feet flat on the floor, count out loud or in your head. Think: inhale, hold and exhale.) Build up your tolerance for how long you can sustain this purposeful breathing activity. Most individuals struggle doing this for more than a minute at first. The Navy Seals do a similar activity they call squared breathing. They count to 5 and they add the empty lungs to the end of the activity just described. Pick a time during the day and practice your mindful breathing. Prevention and habit have been shown to impact emotion and stress responses (Galla & Duckworth 2015).

Foghorn

Another breath activity is called the Foghorn. This is an interesting option for those that are not self-conscious or are able to have a few minutes in a location no one is able to hear you. Sit up straight or stand and correct your posture, place your fingers on your neck just below your jaw, and feel the vibrations as you exhale through your mouth, supported by your diaphragm. Make a low rumble type noise like a foghorn. This works with your mouth open or closed. This activity engages the vagus nerve and helps to calm emotions.

Planted Seed

Make your spine straight again. In this activity you will choose an external quote or phrase that you believe to be true towards you. You might think of the words of a friend sharing their appreciation for your kindness and generosity. For someone with a spiritual frame of reference an example might be a Biblical promise such as Deuteronomy 31:6 which says, “Be strong and courageous, do not be afraid. The Lord your God will never leave you nor forsake you”. Now pick one of the words or words that attracts your attention, such as kind, generous, courageous, or never leave you and imagine it is a little seed. Imagine planting that little seed inside your heart. Do the mindful breaths and imagine it growing and growing inside of you. Sit with the seed. Imagine those words seeping into your bone marrow.

Remember, the phrase you choose must be something that you truly believe.

Build the Habit

There are myriad frameworks to practice mindfulness. Don’t allow the sheer volume of options overwhelm you. Choose one or two and begin to make it a daily habit. By so doing, you will improve your body’s ability to regulate emotions and stress responses.

Joel Bennett, M.Ed.

Blair, C., & Raver, C. C. (2015). School Readiness and Self-Regulation: A Developmental Psychobiological Approach. Annual Review of Psychology, 66, 711-731.

Galla, B. M., & Duckworth, A. L. (2015). More than resisting temptation: Beneficial habits mediate the relationship between self-control and positive life outcomes. Journal of Personality and Social Psychology. 109(3), 508-525. Doi:10.1037/pspp0000026

Pandey, A., Hale, D., Das, S., Goddings, A. L., Blakemore, S. J., & Viner, R. M., (2018). Effectiveness of Universal Self-regulation – Based Interventions in Children and Adolescents: A Systematic Review and Meta-analysis. JAMA Pediatrics, 172(6), 566-575. https://doi-org.wgu.idm.oclc.org/10.1001/jamadediatrics.2018.0232

Self Regulation Introduction

In dealing with the pandemic and the plethora of problems it has brought into people’s lives over this past year, many have recognized the necessity of intentionality in the area of mental health. This new, or renewed, curiosity about how to keep oneself healthy in the face of experiencing such a variety of disruptive events, has elicited many varying responses. These high levels of emotional bombardment and our responses can often generate additional anxiety and stress, and in some instances can lead to higher incidences of depression. The ability to cope with many of these things has a relationship with something called self-regulation, which is the ability to manage one’s emotions, behavior and body movement when faced with difficult situations.

When attempting to understand this phenomenon, it is not uncommon to confuse “self-control” with “self-regulation.” Self-control is the ability to keep emotions and impulses in check, both when alone and in social situations. Many of our current situational responses to mask-wearing for example, have to do with self-control, whereas the fears or anxiety one may feel about the pandemic has more to do with self-regulation. However, both are skills that can be developed over time.

In my practice, I have found that many clients struggle with self-regulation, not knowing what it is or how to help themselves. These struggles often lead to greater difficulties in responding emotionally in certain situations where one might find conflict between the ability to self-regulate and self-control.  This mismatch often increases stress and anxiety, has implications with anger management, and communication with others.  It can cause despair and depression, relationship difficulties, or in extreme cases even violence or abuse.

In learning to practice better self-regulation, one might improve self-esteem and self-confidence, as well as find an overall reduction in some of the symptoms related to the distress and psychological turmoil they may be feeling.

Below is an article by my colleague, which explores the potential for improving our self-regulation. Several followup articles will explore the concept further, sharing examples of what self regulation really is and how to improve it through techniques such as mindfulness-based interventions, cognitive reframing (changing thoughts), and other emotional regulation strategies.

Find yourself, and be that!

 

 

 Licensed Clinical Social Worker
         EMDR Certified Therapist
         112 W. New York Avenue, Suite 205
         DeLand, FL 32720

Introduction to Self-Regulation of Youth and Adolescence
By Joel A. Bennett, M.Ed.

“Why can’t you control your meltdowns?” “Why is it so hard to focus on what you are working on?”   “Why do your emotions swing so far so fast?” As a parent and educator, with 15 years in both the classroom and the home, I have heard these questions and others like them from many other parents, as well as pondered them myself. Is it only anecdotal stories that make me think that Americans are decreasing in their ability to control themselves, their emotions, their responses?   Psychology has developed the umbrella idea of self-regulation which encompasses our ability to self-monitor, –evaluate, –react, –judge.   It includes focusing and maintaining attention as well as physiologically controlling our stress response (Cellar et al, 2011, Blair and Raver, 2015, Pandey et al, 2018).

Wow! That sounds exactly like the types of problems parents and my colleagues have been noticing! Because my personal and professional observations align with these observations, I wondered, “If this umbrella idea of self-regulation has been identified, is there evidence on how to improve these abilities?” I looked at 18 peer-reviewed articles focused on youth and adolescence (2-18-year-olds) and found clear demonstration that, YES, SELF-REGULATION CAN BE IMPROVED!  

A very helpful way of looking at improving self-regulation is to break the problem into two realms of focus: biological and cognitive (Cole, Ram, & English, 2019). Think of this scenario: You are walking from your room for your morning coffee when you step on your child’s cars that were left in the hallway. You went to bed late, woke up with a tremendous agenda that may or may not get finished before you must run your kids to appointments.   You are not biologically at your peak.   Maybe not even in your top 75%.   If you have had a moment like the one I just described, you may recall responding in a way you were regretful about later. I know I have asked for forgiveness after moments like this. Cole, Ram, and English (2019) lump exhaustion, hunger, lack of rejuvenation, and the like into the biological realm.

Our children find themselves in this predicament many times, too. Many parents instinctively pack snacks, create routines for sleeping, exercise, fresh air, and quiet time into the day-to-day rhythm. Galla and Duckworth (2015) found that building beneficial habits provides the strongest positive life outcomes. A quick snack or regular waking and sleeping schedule may address an individual’s ability to control impulses, maintain focus or self-awareness and become the least costly solution to improved self-regulation.

The second realm to consider when looking at ways to improve self-regulation is the cognitive. Do we have the neurological pathways to respond, to control, to become aware of ourselves? These neuropathways are developed in the context of our relationships rather than individually. It has been demonstrated that high doses of parent-child “attunement,” a neurologically synchronized give and take, co-creation experience, have significant impact in the youth who experienced the ongoing activities with the parents (Davis, Bilms, & Suveg, 2017). Another give and take role playing model was found in the Tools of the Mind preschool and Kindergarten curriculum. This curriculum utilizes mature, dramatic play to improve executive function (Diamond, Barnett, Thomas, & Munro, 2007). It ought not to be a surprise that traditions from the past that have been cast aside, such as family dinners where people look at one another and engage in the give and take of creating a space or Holy Days with traditions and engagement or walks in nature, were more valuable than we previously thought.   These former traditions provided regular and routine opportunities to attune to our loved ones and invest in their neurological abilities to self-regulate!

And while it is true that past traumas of rejection, attachment issues and disorders, or harms play a strong role in self-regulation, we can make progress and strengthen the positive alternatives to dysregulation by considering the push and pull relationship between the biological and the cognitive.  

Blair, C., & Raver, C. C. (2015). School Readiness and Self-Regulation: A Developmental Psychobiological Approach. Annual Review of Psychology, 66, 711-731.
         Cellar, D., Stuhlmacher, A., Young, S., Fisher, D., Adair, C., Haynes, S., …Riester, D. (2011). Trait Goal Orientation, Self-regulation, and Performance: A Meta-Analysis. Journal of Business and Psychology, 26(4), 467-483. https://doi-org.wgu.idm.oclc.org/10.1007/s10869-010-9201-6
         Cole, P.M., Ram, N., & English, M.S. (2019).   Toward a Unifying Model of Self-regulation: A Developmental Approach. Child Development Perspectives, 13(2), 91-96. https://doi-org.wgu.idm.oclc.org/10.1007/s10802-010-9418-x
         Davis, M., Bilms, J., & Suveg, C. (2017). In Sync and in Control: A Meta-Analysis of Parent-Child Positive Behavioral Synchrony and Youth Self-Regulation. Family Proces, 56(4), 962-980. https://doi-org.wgu.idm.oclc.org/10.1111/famp.12259
         Diamond, A., Barnett, W.S., Thomas, J., & Munro, S. (2007). Preschool Program Improves Cognitive Control. Science, November 30; 318(5855): 1387-1388.
         Galla, B. M., & Duckworth, A. L. (2015). More than resisting temptation: Beneficial habits mediate the relationship between self-control and positive life outcomes. Journal of Personality and Social Psychology. 109(3), 508-525. Doi:10.1037/pspp0000026
         Pandey, A., Hale, D., Das, S., Goddings, A. L., Blakemore, S. J., & Viner, R. M., (2018). Effectiveness of Universal Self-regulation – Based Interventions in Children and Adolescents: A Systematic Review and Meta-analysis. JAMA Pediatrics, 172(6), 566-575. https://doi-org.wgu.idm.oclc.org/10.1001/jamadediatrics.2018.0232

How Well Do You Bounce? Part 2: Adapting a Growth Mindset

How Well Do You Bounce?

Part 2: Adapting a Growth Mindset

Kristine Proctor, MSW, LCSW

In part 1 of this series, we affirmed the fact that while we all approach life with great expectations – And we should! – There are times we need to deepen our understanding of ourselves in order to be successful personally and relationally. In other words, we need emotional wellbeing to thrive.

We learned the importance of knowing how to identify stress in our lives, some of the indicators that we are stressed and that tracking our emotional responses is a healthy way to enable us to respond with intention.

One of the ways to increase our coping capacity is to develop our resilience, defined as the ability to recover quickly from difficulty. We looked at characteristics of individuals who have the ability to bounce back from adversity in order to give ourselves a benchmark for our own level of resilience. We asked ourselves, “How well do I bounce?”

One strength we can develop or improve to be more resilient is to…

  • Adapt a growth mindset.

In this context this means thinking of yourself and your coping skills as something that can be developed rather than fixed.

Teach yourself to expect that your journey will have twists and turns. Expect that life will not be a linear process. Expect that there will be hard things and you’ll need to dig in and apply tenacity, sometimes a little and sometimes a whole lot! Expect that you will handle what comes the best that you can and that you will grow from the experience.

Self-talk is a powerful tool in shifting into a growth mindset. This does not mean that you need to start having conversations with yourself! What it does mean is that you can develop your ability to be your own coach or cheerleader when it comes to reframing the experiences you have from negative to positive. Pay attention to your thoughts and beliefs. You can tell yourself, either quietly in your head or aloud, what you need to hear. One example might be, “This is a really tough situation. I am doing the best I can, and that is good enough.” Or, “I really wasn’t expecting that! I’ll know to watch for that the next time.”

Additionally, acknowledge and embrace your imperfections. Be real and attempt to value authenticity and growth more than being right. Commit to developing your strengths further and improving the weaker areas over time. You are unique and there is no one like you! That includes the lessons you’re learning and the way you handle life, not just your successes.

One way to help shift into a growth mindset is to partialize. This means to break down what you see or feel into smaller chunks and deal with them one at a time. This decreases your level of frustration and overwhelm and makes what needs to happen manageable. 

Another piece of the resilience puzzle is to set realistic goals. Work to accept what you cannot change. Set your own expectations and seek to fulfill them rather than using your emotional energy on whether or not you are pleasing someone else.

As you know yourself better, you will be more equipped to find your sense of purpose. Remember, resilient people have a sense of independence and self-worth and intentionally form and maintain positive, mutually respectful relationships. These support what they know to be true about themselves. And overall, because they know their sense of purpose, they can live out of that.

Paying attention to what your passions and strengths are and what gives you life, will guide you in knowing where you prefer to focus your energy.

Eleanor Roosevelt said, “People grow through experience if they meet life honestly and courageously. This is how character is built.” Knowing yourself better helps you to recognize where your strengths are. It enables you to recognize that you do have it in you to lean into life’s challenges and to bounce back. Let’s go grow!

Find yourself, and be that!

How Well Do You Bounce? Part 1: Resilience & Self-Care

How Well Do You Bounce?

Part 1: Resilience & Self-Care

Kristine Proctor, MSW, LCSW

We all approach life with great expectations. And we should! Yet at times we need to deepen our understanding of ourselves in order to be successful personally and relationally. In other words, we need emotional wellbeing to thrive.

Emotional wellbeing is coping effectively with life and creating satisfying relationships. This means having an understanding of what it takes to handle stress well is essential to creating management techniques that work best for you.

How do we recognize stress?

We all experience stress but we need to dig a little deeper in our understanding of stress so that we can recognize when we are experiencing it and determine how we choose to respond. By definition, stress is a state of mental or emotional strain or tension resulting from adverse or very demanding circumstances. (1)

Stress occurs when one’s tension level exceeds their energy level, resulting in an overloaded feeling. As long as our available energy exceeds our tension level then we’re in an okay state. But if energy is low and tensions are higher, then that can lead to a state of anxiety, depression and feeling overwhelmed.

 

Experientially stress is:

  • Low energy.
  • Headaches.
  • Upset stomach, including diarrhea, constipation, and nausea.
  • Aches, pains, and tense muscles.
  • Chest pain and rapid heartbeat.
  • Insomnia.
  • Frequent colds and infections.
  • Loss of sexual desire and/or ability.
  • Depression or general unhappiness.
  • Anxiety and agitation.
  • Moodiness, irritability, or anger.
  • Feeling overwhelmed.
  • Loneliness and isolation.
  • Other mental or emotional health problems

Do you recognize any of these in your experience? Being able to identify symptoms of stress when they are happening gives us the opportunity to intentionally respond rather than just react in the moment. Practice tracking your reactions to become aware of their occurrence. By tracking I mean, when you have these various emotional and physical reactions,notice without judging yourself. These are signals from your body and self-blame is not helpful. It is destructive and can create more stress.

Culturally, we tend to accept the idea that it is a good thing to judge ourselves when we experience negative emotions. But feelings are not to be judged. Feelings are signals from our bodies that we need to respond to. When we have a sprained ankle or broken bone, do we judge ourselves because we are experiencing pain? Typically, no. We know it is a signal from our body that we need to respond to in order to recover and be healthy. Feelings can serve a similar purpose.

Being able to recover quickly from difficulty is essential to managing our stress levels. In other words, we want to be able to bounce back. We want to be resilient.

Resilient people tend to have several characteristics in common. They are consistently able to meet the demands of their life successfully, take action to deal with challenges and setbacks and to seek support when needed.

They know when to take a break and rest and allow themselves to do so. Resilient people have a sense of independence and self-worth and intentionally form and maintain positive, mutually respectful relationships. And overall, they have a sense of purpose.

So, how well do you bounce?

Well, we can all develop our resilience! Here are a few ideas:

  • Adapt a growth mindset.
  • Assess how vulnerable you are to stress.
  • Develop self-knowledge.
  • Challenge negative thoughts and put things in perspective.
  • Develop additional coping skills
  • Develop body-based skills, such as deep breathing
  • Develop a self-care plan
  • Work to change our emotional responses

One of the keys to successful change is to ‘choose your battles.’ In other words, don’t try to change everything at once or you will quickly become overwhelmed and give up. And that means more, not less, stress!

Choose an area that seems like it would be one that you could benefit from most at this present time in your life and then explore how you might start to implement it in your life. In upcoming blogs we will explore the ideas listed above to further facilitate your resilience.

 

Find yourself, and be that!

 

References:

(1) Oxford Dictionary

 

 

Welcome to Kristine’s Mental Health Blog

Hello,

This blog includes my professional reflections and comments, as well as hyperlinks to articles and videos that can be beneficial to your mental health. Visit this page to find up-to-date information to support your journey.

Find yourself, and be that!

 

Contact Kristine



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    Kristine has an innate ability to meet her clients wherever they are at. She simplifies complicated issues by identifying the root causes and makes applying mental health principles to real life — like healthy boundaries — manageable.  — P.L., Deland, FL

    March 26, 2020

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