Spring Breakup — A Change of Seasons

[Upbeat Guitar Music]

Mike: Welcome everyone. This is Avoiding the Addiction Affliction brought to you by Westwords Consulting and the Kenosha County Substance Use Disorder Coalition. I'm Mike McGowan.

Mike: What time of year do you think people feel the most down, the most at risk for depression, perhaps suicide, increased substance use?

Mike: Well, if you're anything like me, the answer just might surprise you. We're going to talk about that today and a lot more with my guest, Joshua Arvidson. Joshua is the Chief Operating Officer for Alaska Behavioral Health. He's a licensed clinical social worker. and an expert in trauma informed care for children and established the Alaska Child Trauma Center at Alaska Behavioral Health.

Mike: He serves on the steering committee for SAMHSA's National Child Traumatic Stress Network and is the principal investigator for the Military Family Child Trauma Program. Joshua is also on the Editorial Review Board for the Journal of Child and Adolescent Trauma and has presented at over 100 conferences on childhood trauma, including the International Society for Traumatic Stress Studies.

Mike: He serves on the Board of Directors for FOCUS and has designed and taught courses on clinical practice with children and adolescents in childhood trauma for the University of Alaska Anchorage. He's also published numerous articles. Just an expert all the way around. Thanks for joining us today, Joshua.

Joshua: Thanks. Thank you, Mike. It's wonderful to be here.

Mike: I was reading an article, the reason I called ya, I was reading an article about mental health and the change of seasons, and it used a term for the change of seasons up in Alaska. They called it Spring Breakup. Is that accurate?

Joshua: Yeah, that's what we call it.

Mike: And because, I'm assuming I know, but

Joshua: Yeah, the breakup itself is a specific thing that happens, and in the wintertime, our rivers, in most of Alaska, our rivers freeze over pretty solid. It's actually kind of interesting, in some ways, the rivers in parts of rural Alaska serve as kind of like highways that people use.

Joshua: We call them snow machines here, snowmobiles in the lower 48. There's snowmobiles to get to get to and from. And then in the springtime as it warms up, when those rivers thaw, there's a strong current underneath that ice, right? All winter is still flowing. So you got this big, big ice on top and as it melts at a point when it kind of breaks up, it literally will like crumble and you'll have this huge, there's can be like ice damming and flooding and all this kind of stuff.

Joshua: So it's quite an event. It's not like a lake thawing out where the ice just slowly recedes when when a river thaws. It's a it's quite a force of nature when all that's unleashed, so that's what we mean by the breakup in a kind of literal sense and then we just use that term to talk about the spring season here which In most of alaska involves a lot of melting snow, a lot of mud (laugh), a lot of dirt. What you guys call spring, with flowers and stuff.

Joshua: We call that summer. (laugh)

Mike: Well, I'm in Wisconsin and we're at the what we would call the dirty time of the year.

Joshua: Yeah.

Mike: Where the snow is melting and whatever crud was under there now gets exposed. By the way, in case you're listening along, these are all metaphors for mental health too.

Mike: I assumed forever, and I've worked in this field for a long time, the midwinter when darkness is the deepest and longest was the height of all of the things I talked about in the introduction. But according to research, not so.

Joshua: That's really interesting and it is kind of counterintuitive, isn't it?

Joshua: You would think that, you know, depression and anxiety and the most common mental health conditions would be at their kind of peak during the dark months of winter and for us here in Wisconsin, I'm in Alaska, during the during the cold months of winter social isolation hard to get around that kind of stuff. But yeah, I started to become aware of that research about 15 years ago, that that's actually in the springtime that we see kind of the peak of people's distress.

Joshua: If you look for seasonal patterns, and I think the most important thing is scientists can ever say is we don't really know.

Mike: Yeah, right.

Joshua: I mean, we have to have humility in this, right? And so as scientists, we really need to always be asking questions. We have some ideas about why that might be but it's still a bit of a mystery.

Mike: What are the ideas?

Joshua: Yeah, so there's, there's a lot of things, like I said, intuitively you would think it would be wintertime. I'll talk about some biological things we think are happening and some psychological and then some social. So on the biological side the farther away you get from the equator the bigger adjustment your body has to deal with in terms of the amount of light that you're exposed to throughout the year. And light is this really, I think, understudied and not well enough understood component of mental health and behavioral health. As is sleep. I think sleep and light are really big, big factors.

Joshua: And, where I live here in south central Alaska at latitude 61, in the dark of winter at the winter solstice, we're getting about five hours of sunlight a day. And it's not like the sun's going over really quick. It's actually just like dipping... actually I'm at home right now.

Joshua: It actually doesn't even come above the mountain next to my house. So it's like, it's literally like twilight. And then it's dark again. So it's, you know, it's pitch dark at 9:30 and then it's pitch dark again by, by 3:30 or 4. And so when you're living in that environment, it has a huge impact on your mental health, but I think a lot of people kind of hunker down in the winter.

Joshua: And then as the spring comes, we're close to the equinox, right? Which means everyone will be getting 12 hours of each, so we've gained, we've doubled the amount of light that we have in the here in South Central Alaska in just a couple months, and I think our bodies have a lot of trouble adjusting to that.

Joshua: So I think that's part of the biological piece in our circadian rhythms, melatonin production, all those things that our body does. We're diurnal mammals were built to be around up during the daytime. I know society gets in the way of that with night shifts and crying babies and all these other things, but we are built as daytime creatures.

Joshua: We're not owls or bats. We don't see in the dark. So I think our bodies are adjusting to have a lot of biology behind that. And then I think the other piece the psychological piece, like I said, I think people sometimes hunker down in the wintertime and as springtime comes and there's more light and people are up and moving around and excited.

Joshua: If you're really depressed or anxious or really struggling with your mental health, it can actually almost be harder as everyone's kind of like getting going for the summer. I'm going to play softball. I'm going to do all these things. And if you really feel stuck and in distress, you kind of can feel a little left behind.

Joshua: I see a lot of clients who feel that in the springtime.

Mike: And of course, as people interact more and have more interactions, that's going to affect your mental health. And we're leaving a part out, at least here in the Midwest, as you socialize a little bit more, the drinking tends to go up.

Joshua: That is true.

Joshua: That is true. There's a lot around substance use patterns that can change in the springtime that I think has a big effect. And there is some biology too, around when people are in the darkest depths of like, for example, depression, as they start to feel more energy that actually may open the door to some additional, like thoughts of self harm or other things that can happen, because what we see, what we know, is that suicide rates hit their peak in April and May in the springtime, and that's really true throughout North America.

Mike: And they're higher in northern latitudes, are they not?

Joshua: That's correct, that's correct.

Joshua: Yeah, and I think a lot of that is the biology. Your body just is really struggling to deal with major changes in light, which disrupts sleep and sleep is an emerging science in both mental health and substance use recovery. Sleep is the foundation of wellness and as sleep gets disrupted, it really can have a cascading effect.

Mike: Wow. And then crime and violence go along with that, I would think.

Joshua: Yeah, that's another piece as well. Our patterns of social interaction change a lot during the springtime and into summer. And yeah, while you would think it would be, you know, kind of coming out of the darkness and, you know, the easiest time of year, it's actually, it's actually quite the opposite.

Mike: I think there's a lot of people that say they have seasonal affective disorder without ever having it diagnosed, but my mood definitely improves with being outside and light.

Joshua: Yeah. Yeah. I think that's a big piece. Here in Alaska, a lot of folks, really try to power through the winter by leaning into it, going skiing.

Joshua: I got into fat tire biking a couple of years ago. My skiing days are probably over, but don't let the ski sweater fool you. I'm not a skier anymore, but. But I got into fat tire biking and I've been really disciplined about it the last two years. It doesn't matter what the weather is.

Joshua: I'm going every night. And so I'm out there in the dark. That was pretty warm right now, actually here at South central, but, you know, there'll be nights where it's below zero and I got my dogs with me and I'm just, it's pitch dark and but I just kind of got to lean into it cause it's the only way I can get through that 18 hours of darkness, 20 hours of darkness.

Mike: I can't do that. I bike a lot and I've tried the fat tire, but biking when it's cold and windy, what do you, I got it. We're going to take a tangent here, folks. What are you, what are you wearing?

Joshua: Well, I think this is a good metaphor for mental health. In the farther north you get, the more common the saying, there's no bad weather, there's just bad gear. And that is something I think about a lot as a mental health professional, like we're dealing with these changes in daylight or whatever the stressors are in our environment, in our life.

Joshua: But there are things we can do. There are things we can do. So, you know you can fat tire bike at zero if you've got the right gear on, half the time I'm getting sweaty halfway through because I've got a great gear on, but you really do have to prepare and kind of brace yourself and insulate yourself from all the stressors and buffers that are coming.

Joshua: So yeah, I think there's a lot to that.

Mike: What a great lead in. Talk about Alaska behavioral health. You have tons of programs across Alaska.

Joshua: Yeah, it's a really exciting place to work. We just celebrated our 50th anniversary. I've been there for almost half of that.

Joshua: We're the largest behavioral health provider in Alaska. And because we're in Alaska, you know, this huge state with a relatively small population, we do a lot of different things to try to meet all the community needs so we kind of really do everything below hospital level care. So we have day treatment, partial hospitalization, day treatment programs, which you are like high intensity treatment for people with really acute distress. You get the same level of care that you would get in a hospital in many ways. But you go home at night and so for folks who have a safe place just to sleep in a situation where they can do that.

Joshua: That's the highest level of care adult mental health residential, which is similar in some ways all the way to outpatient clinics. Psychiatry, primary care. Over the last seven years what we've been really focused on, you know, I'm a clinical nerd. I love to talk about all our different treatments, trauma focused, CBT and CBT cognitive behavioral therapy, but the most important thing that we provide is a c c e s s access. It's it's gonna get care to people when they need it. It doesn't do you any good to have the best science based care if people can't get it when they need it. And mental health conditions and substance use conditions are progressive So the earlier we can get people care, the better. So that's what we've been really focused on the last five, six years.

Joshua: We've done so from serving 2000 Alaskans a year that this year we will serve 10,000 Alaskans. It's a lot of growth, but you know, it's really good because when you can eliminate things like wait lists and people can get into treatment when they want it and when they need it and when they're ready for it.

Joshua: Treatment so much more effective. I've been a therapist for over 20 years and the most common thought I have when I'm meeting with someone for the first time is I wish you would have come in a couple months earlier before it got this. There's still stigma. There's still these barriers. We don't think of mental health care the way we think of primary care. If you're sick, go to the doctor. You know, if you call your friend who's a doctor, you think, I think I might be sick. I think I should, you know what they're going to say, go to the doctor (laugh). And they're not just, you know, doing that for liability reasons. I mean, really, they're like, you should get it checked out.

Joshua: If you think you should get it checked out, get it checked out. We need to think about mental health and behavioral health care that way. Get it checked out and get treatment as quickly as possible. And we've been doing some exciting things the last couple of years. Adding primary care into our system so people can get all their health care needs, behavioral health related needs and psychiatry and primary care kind of all through, kind of more streamlined system.

Joshua: We even have in house pharmacies in Anchorage and Fairbanks so that people can get kind of those needs met because it's not just about convenience. What we really think, what I've seen in my career is it's not just about making it convenient, but what it is about is if there's barriers to people getting care, they won't get it.

Joshua: They've got a lot going on in their life. And so going from three different places to get your therapy and your medication management and fill your prescriptions and do those things in the life of an average family, that's just too much. Not to mention when it's dark 20 hours and there's snow on the road and all that.

Mike: Well, given that, and it may be difficult sometimes, do you offer telehealth and teletherapy as well?

Joshua: We do. About 10 percent of our appointments are telehealth. And so that's been a good access strategy for us. A lot of clients prefer in person when they can do it, but we do do telehealth to provide access out into our hub communities and rural areas. And then for some of our folks, they may live like an hour away from one of our clinics.

Joshua: And so they're able to come in person sometimes and then do sessions in between those in person sessions via telehealth. Kind of like a hybrid model that actually has become pretty common in our South Central and Fairbanks clinics and our Mat Su clinic.

Mike: There's a pretty big emphasis in your website and even in your introduction on the military.

Mike: They present some unique issues along the way.

Joshua: Yeah, Alaska has the highest portion of veterans in our population of any state. If you look at a globe, it makes sense. There's a lot of military installations in Alaska for really important strategic reasons. And so we have a lot of service members here.

Joshua: Two miles that way is joint bear base air Elmendorf Richardson, which is a joint air force and army base. And F 22 is fly over my house every day. So it's just a reminder. We live in a state where there's a big military presence and they're part of our community.

Joshua: And so as a community provider serving the folks who serve our country is really important to us and serving the veterans. So we have some specialty clinics. specifically for service members and veterans. And then we serve family members and military service members and veterans across all of our 12 locations.

Mike: Awesome. When I was reading your bio I've worked my entire life with youth, adolescents. And you're an expert in childhood trauma. This is not an easy time for youth. We're seeing mental health issues through the roof is probably a little bit over, but they're dramatically risen in the last dozen years.

Joshua: Yeah, I think there's so many likely factors driving that. But we have seen that. I mean, as I said, we've grown from being able to serve about 2000 Alaskans a year to almost 10,000. And what we've seen is we've needed to do that. The demand and the need for for mental health services is has increased in our state.

Joshua: And I think that's that's true nationwide.

Mike: So how do adolescents present in a more unique way than working with adults?

Joshua: Adolescence, there's a lot going on. Adolescence is such an amazing again, thinking about start with biology, think about what it is like to be a sixth grader and in 10 years, you might be raising your own children. (laugh)

Joshua: So think if you have a sixth grader at home, think about the fact that she might be a mom or he might be a dad or you know, I mean, that's, that's in a decade. I'm not going to go through that kind of change in the next decade of my life, for sure. So that's incredible. The social kind of development that's going on, the biological development that a child is becoming an adult.

Joshua: And so there's so much going on. And then if you experience as emotional and mental distress as you're going through that, all those rapid changes, I think it can present some unique challenges. The flip side though is adolescence. Because they're growing so quickly.

Joshua: And their biology is wired for growth and development and learning. Treatment with adolescents also can be really fast. I mean, they're ready for change. I often think like my third session with an adolescent who's experiencing generalized anxiety disorder feels like my 15th session with them.

Mike: (laugh)

Joshua: They are ready. They're ready. They're growing. They're changing. They're open to new experiences in ways that people in our age cohort maybe have more challenges with so yeah, I really enjoy working with adolescents and they're a big part of the population that we serve at Alaska Behavioral Health.

Joshua: We have done some innovative things to try to reach them because sometimes adolescents are a little bit of a missing population when you look at your demographics. We really saw that actually. When you're 10 and you really struggling your parents bring you in for treatment when you're 35 you bring yourself in.

Joshua: When you're 17, how do you get there? So we've had to do some strategies to make sure that adolescents have good access. Part of that's partnering with schools and other systems that are already working with adolescents, so that they can get into treatment. But you know, one thing that's changed in my career, I've been doing this for a while is adolescents are leading the way on stigma reduction.

Mike: Yes, they are. It's awesome. Isn't it?

Joshua: It's so cool. 20 years ago, the typical, my first meeting with an adolescent, they'd have their arms crossed. I was told I have to be here. I don't want to be here. That's not how most adolescents are today. They're leading the way. They've really flipped the switch.

Joshua: Mental health care is just health care. Mental wellness is just wellness. It's just a type of health care. And they actually, you know, it's flipped 180 degrees. The adolescents coming into our clinics often have a lot less stigma and presumptions about mental health treatment than other generations.

Joshua: It's really cool to see.

Mike: I do a lot of presentations at schools, and I have for a long time. And you're right, 20 years ago, they would be receptive, but then afterwards they would say, can I talk to you for a minute? And now it's not unusual to see a hand go up and say, Well, I was talking to my therapist about my depression, in front of everyone, and it's awesome because it leads the way.

Mike: Right, Joshua. It's it says to everybody. It's just what I got. It's like having asthma and having an inhaler. It's not that big a deal.

Mike: Yeah. It's incredible. Young people have really kind of led the charge on that. And it's an awesome thing to see.

What should people do?

Mike: I did this deliberately right now because we're right in that change of seasons, right? So what should people do if they're starting to experience that sensation? Because I know what people get, right? When spring comes like this, they're going to get poo pooed a little bit more. It's like, well, what are you complaining about?

Mike: The weather's starting to get nice. And so what can we do to take care of ourselves if we start to feel ourselves doing that dip?

Joshua: Again, if we think about it kind of biological, psychological, social, then I think we can break it down a little bit. There's some concrete things we could do.

Joshua: So on the biology side, sleep. Sleep is the most important thing that we can really pay attention to all year round, but especially when the seasons are changing and if you're in northern latitudes where you're dealing with really dramatic changes in light, it can throw off your circadian rhythms. And there's some concrete things that are really helpful.

Joshua: And some of these things I use myself because I live in a really northern climate. So one thing that can be helpful is light therapy or light boxes. You know, you talk to your doctor to kind of make sure you get the right one, that it's healthy for you. But those are commonly used in the morning to help people, especially during the darkest months to kind of help people reset their clocks.

Joshua: What it does is basically tells your body it's daytime, which gets your melatonin production and other things kind of in line. Again, something to talk with your physician about. Is it's really common to for Alaskans to experience vitamin D deficiencies and other things related to you're just not getting any sunlight on your skin for six months of the year.

Joshua: I'm not a physician, but I talked to my physician about that. I encourage my patients to. So those are some of the biological things you can attend to making sure your eating patterns are good. You really managing your use of alcohol or other substances in addition to the challenges that addiction can layer on to someone's life, there's a lot of emerging science around the harmfulness of alcohol when it comes to sleep patterns and restorative sleep, too, because how you sleep is as important as how much sleep you get. So there's a lot of data that depressants like alcohol and some sleep aids that are used may help people go to sleep, but that sleep itself isn't as restorative as it would be without those substances on board. So those are some of the things you can do concretely. I think exercise is a big piece. And sometimes people think about exercise in terms of like calories and this and that, but it really just.

Joshua: It has so many cascading benefits beyond those commonly thought of cardiovascular benefits, like in terms of your just hormones and sleep patterns. So those are some things I think in the social realm. Yeah, it can be hard. It's like kind of everyone's getting going in the spring.

Joshua: And, you know, here in Alaska, people are out and about more is to really pay attention to your social connections and try to build a lot of, as much meaningful interaction with other people as you can into your life. Those social connections are really big. And then on the treatment side, if someone's really struggling there are especially, for example, for with sleep CBTI, cognitive behavioral therapy for insomnia, the science on it's really good.

Joshua: It outperforms medications over the longterm. And it doesn't have any of the side effects that medications can have. So I got trained a couple of years ago in CBTI, I find it to really be almost like magic for people to experience. And there's a lot you could go into in that, but stimulus control around your sleep, which is like.

Joshua: You don't want blue light hitting your eyeballs. Basically, after about 5 p. m. if you want to be in bed by 9 or 10. And so there's things you can do around that, limiting your screen time that kind of stuff. Even using blue light blocker glasses. I actually have a pair of those I use if I'm if I'm working late at night.

Joshua: So I think all those things can be really helpful in buffering folks and building in resilience as you go through this transition. And then I encourage people, like I said, if you feel like you need help, I encourage you to get it. As someone who's been a therapist for 23 years.

Joshua: The best thing you can do is seek help as soon as you think you need it. And sometimes people have these thoughts like, oh, someone needs it more than me. I encourage you not to have those thoughts. They're not really, you know, as a therapist, I say one, probably not true to definitely not helpful. And the other thing is, you know, access is a virtuous cycle.

Joshua: So people get into treatment when they need it, the treatment's more effective and it's faster. And if your treatment's faster, that benefits the next client who comes to my clinic, because you're going to be off living your life and potentially not need as long or as intensive treatment actually creates room for the next client who walks through the door.

Joshua: So I actually flip it around a little bit. If you're like, well, you know, someone else needs it more than me, the quicker you get treatment. The quicker it works, the better it works, and that creates more access for the next person to walk through the door. So I encourage people to kind of flip that thinking around.

Mike: Places across the country are stretched thin. Even though we deal with mental health, you deal with mental health. Do you have to remind your staff to practice what we preach?

Joshua: Oh, yeah. Oh, yeah. I have to remind myself (laugh). To really pay attention. As a healthcare provider, we do talk about this, when you get in the airplane and you're traveling with a child and they say if the oxygen mask dropped down, you got to put on yours first.

Joshua: Because if you pass out, you're not helping anybody else. So yeah, we do have to pay attention to that a lot as mental health practitioners. And as healthcare providers in general, attend to our own stress and wellness. Yeah, and engage in this work in a sustainable way.

Mike: In the article that I was referencing earlier, I read that Alaskans have a term for the footwear that they wear during the spring.

Joshua: Yeah. Break up boots.

Mike: Break up boots.

Joshua: Yeah. Yeah.

Mike: Meaning?

Joshua: Yeah. So it's really common. I'm not trying to sell a particular brand here, but in most Alaskans wear Xtratufs. Somewhere bogs. There's a little debate about that.

Mike: (laugh)

Joshua: But some version of Xtratufs or like that you'd call them galoshes if you were in Britain.

Joshua: But these rubber boots that are almost knee length, they make different lengths, but and, you know, it is an interesting metaphor because it's like, like I said, there's, you know, we have this thing, there's no bad weather, there's just bad gear. It is kind of this attitude in the spring where it's like, yeah, it's muddy out.

Joshua: Yeah, there's like even right now it's late February here in Anchorage. Normally, we would have eight feet of snow on the ground. But we didn't have very snowy winter and it's been pretty warm. So it's been off and on muddy the last couple weeks here. And you just put on your boots and you keep going. Like in some ways you get outside as much as you can and it's muddy and it's sandy and there's puddles And you put on these knee high waterproof boots and you just go out and do it. And you'll see Alaskans walking around in the store and the grocery store and the health care clinic with their Xtratufs on and they just keep them on all day. And yeah, it's kind of a cool little anomaly in this wet, cold, slushy environment that we have. But to me, it is kind of a powerful metaphor of like, do the best you can to prepare yourself and get outside and do what you can.

Joshua: In therapy, we always like to come up with complicated terms for simple concepts. So, we call that behavioral activation. Which means what you do changes how you feel and you think. If you're feeling really sad or anxious and I just tell you, Hey Mike, don't feel so sad, don't feel so anxious.

Joshua: That's not helpful! It's not going to do anything. So what we do is we think about your thoughts because you can change your thoughts. Thoughts are really, they are changeable. And you can definitely change your behavior. And what you do if you put on your your breakup boots and you get out there and you walk your dogs and you go to the store and get what you need for food and cook good meal and all those things.

Joshua: That's going to change your feelings more than me talking about your feelings and you and I talking about your feelings, right? So we call that behavioral activation because we like to come up with fancy terms. But it's a really important concept.

Mike: What a great place to leave it. Joshua, thank you so much for being with us today.

Mike: This is so instructive and it's such a great reminder for all of us.

Mike: I'm going to put links, as you all know, who listen to Alaska Behavioral Health and Joshua's contact information on the podcast. We invite you to listen in whenever you're able to until we talk to you next time. Stay safe and lace up your breakup boots.