Ep. 8: Behavioral Health - The Healing Power of Therapy

Brian (00:08):

Welcome to the Living the Healthy Life podcast, where we bring you the latest on health and wellness from the experts here at Lee Health. Discover what's happening at Lee Health, and take away tips and inspiration to reach your ideal state of health.

Brian (00:26):

Hello and welcome once again. My name is Brian Hubbard. I am the manager for marketing and brand management of Lee Health. With me, as always is our co-host, Carrie Bloemers. She's a registered dietician as well as the Director of Education and Navigation at the Healthy Life Center at Lee Health Coconut Point. I got tongue tied saying your title because it's just so long. Hello, Carrie.

Carrie: Co-Host (00:45):

Hello everyone.

Brian (00:47):

It's a stressful world out there, anxiety, depression, mental health challenges. We're hearing about it more and more. The stigma we think, we hope, is finally wearing off, and a lot of us are admitting that we need help. So we are thrilled today to welcome Nicole Liberto, Director of Behavioral Health at Lee Health. She's here to tell us a little bit about our behavioral health programs, how they can help, how it works, and how you can get the resources and help you need. Welcome, Nicole. Good morning.

Nicole (01:14):

Hi, good morning. Thank you for having me.

Brian (01:16):

So it's a big topic. We got a lot to cover. We don't want to go too deep, but we do want to talk. We want to cover as many things as we can for the general public. There's a lot to get to, as I said. So first of all, before we start, tell us a little bit about yourself, how you found this passion for this kind of work and what led you down here to Florida?

Nicole (01:35):

So I am licensed clinical social worker. I've been in this field for about 28 years. And I want to say I first really found my passion when I was young. I'll start with a story. I had a friend who had a mom who was seemingly an amazing mom, very involved with my friend's life and would bring us to school and things of that nature. And one day I went to her house and all of a sudden everything was really dark. The house was dark. I couldn't really find her. She wasn't out and about like she normally was. And I didn't really think anything of it that day, but I knew something was off. And then the more I kept going over there, the more it seemed like she wasn't around as much anymore. And then she stopped bringing her to school and we had to. And then I kind of noticed she didn't leave the house.

Nicole (02:19):

And I just remember thinking as a young girl what happened that made this person who was seemingly out and about and seemed to just be functioning so well all of a sudden not function? And it just became such a passion of mine to figure that out and figure out what can be done to help situations like that. Because back in the seventies there wasn't a lot around that addressed that kind of thing and you didn't see it very often. So I just became absolutely fascinated with it, became such a passion of mine. And ever since then I really just fell in love with psychology and the mind and the power of the mind and what can be done to help people.

Brian (03:03):

What led you in this direction?

Nicole (03:05):

The weather's beautiful. It's sunny. I'm unfortunately from New Jersey. You have really long cold winters and loved working in hospitals, but really didn't love shoveling my car out. Six feet of snow.

Brian (03:16):

Seems to be a common story. So winters are really, seem to be the thing.

Nicole (03:20):

And really it's just weather and lifestyle. I mean, you can just go outside and take a walk.

Brian (03:25):

So we use the word behavioral health to describe a lot of things here at Lee Health. Can you tell us what does behavioral health mean both to the system and to you and what should it mean to the listeners out there? And then sort of a two parter, can you tell us what you're seeing more and more of behavioral health challenges from the community today?

Nicole (03:44):

Sure. That's a big question.

Brian (03:47):

That is big. Sorry, I should have broken into two, but we'll just go with it.

Nicole (03:49):

Okay. So when I think about just health and health overall, you think about balance. When you think about the human body in and of itself, there's multiple systems just working harmoniously to achieve wellness. You've got the respiratory system, the adrenaline, the adrenal system. All those systems work harmoniously to achieve balance and wellness. And behavioral health is really no different. Inside the brain, there's the neurochemistry of the brain and when all of the neurotransmitters are working well, you have a healthy mind. And then when you think about your thoughts and your feelings and your behaviors and when they're in balance and being managed well, you're in what's said to be a healthy state. When you look at the brain and it's not functioning as it was intended to and there's a disruption in there, you're looking at dis ease to brain functioning, which can lead to problems with your thoughts and your emotions and your behavioral regulation.

Carrie: Co-Host (04:46):

That's a great way to package that in a concise way for our listeners.

Brian (04:50):

Let's put that on a card.

Carrie: Co-Host (04:52):

Yeah. What has the disruption of COVID caused then for what Brian asked, what are we seeing in the community?

Nicole (04:58):

Sure. Well, I mean COVID brought a lot, so many things. The number one thing being stress. Stress causes the body to react. It's what it does. In the body of the human is reacting to both the physical physiological chemicals that's happening as well as the environmental situations that it's in. So it just causes so many things to be disrupted. Anxiety, it's causing depression, it's causing isolation, it's causing insomnia, it's causing lower digestive processes which is causing problems eating. I mean, it's just linked to so many things that we could talk about I'm sure here for absolute hours.

Brian (05:40):

So stress seems to be the driver of all these things or most of these things. So are you finding that that's true, not only with the pandemic, let's just say over the last couple years, you're seeing people are more stressed out, basically?

Nicole (05:54):

Absolutely. And people have a right to feel stress. I mean this is a stressful time. We've dealt with illness and death and just social issues and now other political issues. I mean, we've dealt with so much in a very short period of time. I don't think the majority of people were able to handle all of that incoming information and be able to process through that effectively given the resources that we were having at the time.

Carrie: Co-Host (06:25):

So when we talk about stress, and we mentioned the lifestyle wellness wheel prior to this, what are some of those initial things that you would have everybody kind of evaluate with stress management practices, self care?

Nicole (06:39):

Being aware that stress is normal. We all experience stress. Some of it can be positive. We have things like performance stress and goal oriented stress, which helps us achieve our goals. But then there's other stress that for prolonged periods can kind of lead to other problems. And I think that's what we've been experiencing, more chronic stress than acute stress. And I think that is really where we landed with a lot of what's been happening with COVID. And the ways to really combat chronic stress is through behavioral health services is one, managing your thoughts and how that's connecting to your emotions to manage the stress, and then managing your behaviors.

Nicole (07:22):

Also, looking at the other aspects of your life and trying to keep them balanced, and it's going to be relative to what works for you. Some people relieve stress by running. Other people relieve stress by meditation and yoga practices. So really it's going to be finding a way for you to be able to manage your stress in a healthy way, and the key there is healthy, in a healthy way that keeps you in balance so that when you're receiving more incoming stress, it doesn't throw you off.

Brian (07:55):

What's it look like then when... So like you said, we all have stress every day. What does it look like though, or what does it feel like when it's too much? Like suddenly you can't handle it anymore. At that point you know that you probably need to talk to somebody. What does that look like I guess?

Nicole (08:13):

So I think the best way I can describe it is I'll use the example of a car cutting you off in traffic. So your body responds to that acute stress, and your heart rate goes up and your blood pressure elevates and your digestive system kind of slows down. But once that threat is over your body re-regulates and kind of goes back to a normal sense of homeostasis. It goes back to its balance. And it's able to go, okay, I'm okay. I'm safe, I can keep going. I think what happens with chronic stress is you don't get back to that balance. You're activated in a way that says, you have to do something.

Carrie: Co-Host (08:49):

You have to take some action on.

Nicole (08:51):

Yeah, exactly. You're always kind of in that flight or fight mode, and it doesn't necessarily turn off as easy as it was intended to. So when you start to feel like this is too much and your body's not coming down or re-regulating, you'll see it in problems with your behavior or sleep or emotional regulation. It'll come out you might lose interest in some of the things that you used to enjoy doing. You might find yourself overly anxious and unable to calm down. You might find intermittent episodes of anxiety that you never experienced before, and you don't know where they're coming from. And they come out of the blue. So I mean, there's a lot of symptoms that your body will tell you something's wrong. It's signaling.

Brian (09:35):

You have to listen to it.

Nicole (09:35):

Something's wrong. Yeah, and you just have to listen. And

Brian (09:38):

From my experience, the anxiety causes more anxiety. So you know that something's wrong. Like you said, you're in the middle of a Saturday afternoon doing nothing, and suddenly you feel like you're going to have to fight somebody. So it's like, what is that? But then it can also go the other way where suddenly you want to sleep for four days. So whatever, again you mentioned balance. Whatever naturally in your mind, this is not right. You're way outside the parameters here. So once that becomes a chronic thing or you're not sleeping well. You go three days without sleep or you only sleep a couple hours a night and all these things. Whenever those things get out of balance, that's sort of when you know that you're facing some kind of challenge, whether it's just two or three days or whether it's a chronic thing, it could be either of those.

Nicole (10:27):

Yeah, absolutely.

Carrie: Co-Host (10:28):

Yeah. And I think physiologically, it's worth mentioning that when we're experiencing maybe that underlying chronic stress, you didn't do anything wrong. Your body is having some physiological hormones that are produced or raised cortisol, things that are just happening that make you feel that way.

Nicole (10:48):

Absolutely. The good news for that, Carrie, is that there are things that you can do to help train your body to calm down. And that really, that's where therapy comes in because although you might not be responsible for it actually happening in that moment or the depression that you're feeling or the sadness, there are things that you can do to manage those symptoms so that they're not as intense for so long and so painful.

Carrie: Co-Host (11:17):

Can you give an example of that? Are you talking about the thought that you mentioned or what would you say that might look like for people?

Nicole (11:24):

Sure. A perfect example is what Brian said. It's the middle of a Saturday, and all of a sudden you're just kind of activated for no reason, and you don't know why. And your heart starts racing, and you start experiencing those same symptoms that you know did when the car cut you off. It's the same kind of response. Things that you can do is you can A, you can ground yourself and let yourself know it's okay. Let yourself know that the feeling will pass. You're safe. And you can find things to tell yourself in the moment of that panic that will help deescalate the panic rather than make it worse because your response to the panic can either do one of two things.

Brian (12:03):

This is exactly right

Nicole (12:04):

It will make it better or it will make it worse. And that's some of the point of therapy is to help learn those skills so that you're able to, when you have panic or depression or any type of illness really, how you manage yourself through it. Because anybody, we're all humans, we all have emotions. Those emotions will regulate at certain point and fluctuate at certain point in time. It's just how you manage yourself through them that determines whether or not they get better or they get worse.

Brian (12:37):

So that brings up a good point then about what you mentioned therapy, how therapy works. Like I said in the introduction, more people, at least publicly, it seems like, more people are opening up lately about they're facing some sort of mental health challenge or they've been struggling with it their whole life and didn't feel like they could talk about it, that kind of thing. So the stigma seems to be wearing off. People seem to be having more open conversations about it. I'm assuming that's been your experience. Has that been your experience and how does that then work? How does therapy work at behavioral health? I keep giving you two part questions. Sorry, I'm just so excited. I'm sorry. Go ahead.

Nicole (13:14):

Yes. I think the pandemic gave people a reason, gave them a reason to open up. It gave them a reason to admit that they were struggling. It gave them a reason. It allowed people to tie their feelings to something. And it was, in all of its horror, it did do some things for mental health by allowing people to be more open and to tie it to, I have stress related to this. Oh, by the way, for the past 10 years, I've been experiencing this, this, and that. And we're getting a lot of that, which it kind of opened the door for the awareness of mental health issues that may have been going on for years that people just ready to get help for. That's okay when everyone's ready, they're ready.

Brian (14:03):

It's a good point because it's like what positive should come from the pandemic?

Carrie: Co-Host (14:06):

Silver lining maybe.

Brian (14:09):

Exactly. So can you take us through what happens next? They come to see you. Do they go to the office? How does that work?

Nicole (14:17):

We're reserved for patients typically that need both. They need medication management because their brain, like I talked about earlier, isn't kind of in balance, and it might need some medication or some help from our doctors or APRNs to help rebalance the brain structure. And then we also address the thoughts, feelings, and behaviors that people may be experiencing to help them re-regulate themselves. And that's really what therapy is. Therapy is, it's the relationship where you're given models and interventions, and you're educated on systems that help you achieve your best quality of life through self-awareness. And that's really the goal of therapy is helping you live your best life.

Carrie: Co-Host (15:02):

And you mentioned earlier that the wellness wheel has some of those tools whether it's sleep, nutrition, exercise. Can you give some examples about how those are tied in there? It includes nutrition, sleep, stress management, your mental and behavioral health, finding your purpose or living your why, where's your passion in life? And then that physical activity. Nicole and I were just chatting and bantering how those are some of the things that you might be equipped with to help what you've been calling balance. And I love that and how you've been tying that into this conversation.

Nicole (15:38):

And the beauty of the wellness wheels is it's a lot of things that you can do. You can make sure that you are doing the best that you can to get appropriate sleep or get resources to help you sleep if you're having difficulty. You can work on how you talk to yourself and how you manage yourself through stressful situations. A lot of that wheel is things that you can do because in that wheel you are kind of arming yourself with the necessary skills and nutrition and all of the equipment that you need to fight off stress. It's beautiful.

Brian (16:10):

There's a lot that plays into it. You were talking about in many previous podcasts we talked about food and how you eat a certain type of food like pasta or pizza, and you just feel done for the day.

Carrie: Co-Host (16:23):

Weighted down.

Brian (16:24):

So Carrie, from your perspective then, there are certain foods that we know I'm guessing, obviously that make us feel better but are better for our mental health to making us feel more lively and all those kinds of things.

Carrie: Co-Host (16:38):

From that registered dietician perspective, I think we talk more about the meal patterns and following that regular eating times and not skipping meals, not becoming too hungry or skipping breakfast and then feeling angry by 11:00 AM or anxious, whatever it is. So it's fueling your body so it's maybe not so stressed or strained because when we are calorie deficit or not including enough, we might have increased feelings of anxiety or be more volatile with our emotions. So just that baseline foundation of regular meals, hydration, water, and managing your chronic disease. Because of course if your blood sugar's through the roof, you're going to feel sick and awful and not motivated to do things because your diabetes is out of control. And Nicole, like you were saying, the sleep on there. So it's like you're telling us rhetorical question, if I'm not getting that good seven to eight hours of sleep, that's going to impact how I feel.

Nicole (17:36):

Oh absolutely. I mean your body repairs itself in its sleep. So it's kind of like a race car. If the race car just went 100 miles an hour until the end of the race, at some point the wheels would fall off. And the car wouldn't be able to run anymore. So sleep is actually the pit stop of a race car. So you got to give yourself good sleep, good sleep hygiene routines, sleep journals, whatever it is you need to help you get a good night's sleep because your mind, your cells, everything repairs itself while you're sleeping the same way it does with nutrition. The food you eat, you're either helping your body with it, or you're hurting your body with it.

Carrie: Co-Host (18:13):

Absolutely.

Brian (18:14):

Nicole, what do you think about what's next? Because like I said, I feel like we were talking about the stigma and people are more open to talking about things nowadays maybe than they used to be back in seventies. Where do we go from here though? What have we learned from all of this? Obviously it's still ongoing, the pandemic, but where does the mental health landscape go?

Nicole (18:35):

I mean I think we were given some really good modeling by more and more people are coming out talking about struggles that they're having with mental health issues. It's on the news, it's in our athletes, it's in our Olympians. And people are just not as bothered by talking about it anymore. And I think that that just speaks volumes for the modeling that's being done about being open about mental health and behavioral health struggles because I think it's a great start where we're at. But I think we have a long way to go. I think the stigma is still there unfortunately. But I think as time goes on, people will feel more comfortable and realize, like Carrie made a great point. You're not seeking therapy because there's something wrong with you. You're seeking therapy because you want to learn skills to optimize your quality of life and inspire hope.

Brian (19:29):

That's a beautiful way to put it.

Carrie: Co-Host (19:32):

And to your example, I'll share. I started working with a therapist in January. And it was my boss who was encouraging the journey, like, hey, take this next step because you've been through a lot, couple surgeries, changes the way you function. And that journey just starting in January, giving tools to adapt, manage new anxieties, just kind of creating a new future for myself because it's been life altering. So I mean it's all started because my boss kept asking me like, "Hey, who are you talking to? Have you started talking to anybody?" And besides your friends and family, those are people who are in our lives and it's great to share with, but there's that extra of course trained benefit to a therapist.

Nicole (20:21):

Yeah, absolutely. I mean they know the skills that they're able to offer. They've been trained. We've got the best that our therapists are specifically trauma trained. So any traumas that are coming out through just coming to see treatment for anxiety, they're able to manage and work with. So absolutely.

Brian (20:44):

Carrie, you brought up a great point about you sound like you have a support system. Obviously that's important. People around you who are concerned about you notice maybe they notice something is off or something like that. But it's important. And we know this, but therapy works. It works. I've had therapists off and on for years here and there. And sometimes you find one that clicks, and sometimes you don't. It's not necessarily a one size fits all type thing, but that's part of how you figure it out. You go, and you talk to someone and you feel comfortable with them. I guess my point being behavioral health does a lot of making patients feel comfortable. It's something that differentiates us. It's compassion, it's empathy, it's connection. It's all those things that I know that you guys probably stress about. And speaking of that, what makes therapy easier is virtual appointments, if I'm correct about that because we... Again, silver lining maybe of the COVID thing. So tell us about virtual appointments and how that works.

Nicole (21:51):

Yeah, so in our clinic, all initial appointments are in person just because we want to get to know you face to face. But then anything after that we can do medical management appointments via telehealth, therapeutic appointments via telehealth. It helps people that might have transportation issues or just...

Carrie: Co-Host (22:11):

More accessible, more convenient. You can shove it in a day. Real easily that way.

Nicole (22:16):

Yes. Just please make sure you're somewhere that's confidential.

Brian (22:19):

Also tell me about Lee Health is adding therapy to some primary care offices as well. How does that work?

Nicole (22:26):

Yeah, so this is a beautiful thing. There's an initiative with primary care where they have embedded psychologists in primary care offices because primary care is really treating the whole person. And once we stabilize them in psychiatry, in therapy, they can go back to primary care, which is where they're managed. And if the primary care doctor sees anything or has any inclination that the person might need some therapy, they have embedded psychologists in primary care to make referrals to that are right there. So they don't have to go anywhere else. They don't have to do anything. It's just another beauty in the access to care model.

Carrie: Co-Host (23:04):

Yeah. No, that's just a great model. And that's so exciting to hear and that it's becoming more accessible to patients, and that the primary care team is on board. They're almost the drivers opening that door and getting patients then the help, the support that they really need at this really stressful, crazy time of the world.

Brian (23:21):

Yeah, primary care is, like I said, that's the point, that's the access point. So if you have any questions about how you feel physically or you've got something wrong with you, but you maybe think there's something else going on that's more of an internal stress anxiety, your primary care doctor is there to talk to about those things. And in some locations you have extra therapy behavioral health person there to help, which is great. Like Carrie said, it's all about normalizing the behavior, normalizing the treatment.

Nicole (23:50):

People access care with kind of medical complaints. My head hurts, my stomach hurts, and there's nothing really medically necessarily wrong. And these may be more of stress related, unresolved stress.

Brian (24:04):

My heart's racing. The first thing I'm going to think of is EKG or something. And you can go to the doctor and he says, "Well, actually your heart's just fine, you're probably a little stressed out." So Nicole, this has been great. As you said earlier we can talk about this... There's obviously a lot of specific things to dive into, anxiety, depression, and it goes way beyond that I realize. We'd love to have you back or someone from your team back in a future episode because we know this is an important thing. It's an essential thing to make sure that we're having these discussions. So is there anything else that you'd want to add for anybody out there to know today before we wrap it up?

Nicole (24:41):

No, I just thank you. Thank you for having me. I think we are at a good point. I do, like I said, think we have a little ways to go, but I'm just very grateful for the opportunity to talk about behavioral health and mental health. And please, if you find yourself in need of wanting to talk to someone or wanting services, start with a doctor, start with the primary care doctor, give us a call. And we'll be happy to navigate through your journey with you and determine what your needs are.

Brian (25:18):

Thank you so much. Absolutely. And to that point, you can go to Leehealth.org to find, obviously, primary care doctors if you don't already have one, or you can speak to your primary care doctor about it. You can also reach out to behavioral health at 343-9180. I believe that is correct. 343-9180. You can also go to the leehealth.org and search for behavioral health, and we have a whole page there with various resources and how to get in contact with them as well.

Brian (25:46):

So thank you everyone for listening. We hope you'll tune back in for upcoming episodes. We'll be interviewing experts from Lee Health so you can know more about what we do and how we strive every day to fulfill our mission to provide the best care close to home. Thanks for listening, and have a great day.