Tag: mental health

Higher rates of post-natal depression among autistic mothers

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Autistic mothers are more likely to report post-natal depression compared to non-autistic mothers, according to a new study of mothers of autistic children carried out by researchers at the University of Cambridge

Photo by Engin Akyurt on Pexels.com

A better understanding of the experiences of autistic mothers during pregnancy and the post-natal period is critical to improving wellbeing. The results are published in Molecular Autism.

The team recruited an advisory panel of autistic mothers with whom they co-developed an anonymous, online survey. After matching, this was completed by 355 autistic and 132 non-autistic mothers, each of whom had at least one autistic child.

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Sixty percent of autistic mothers in the study reported they had experienced post-natal depression. By comparison, only 12% of women in the general population experience post-natal depression. In addition, autistic mothers had more difficulties in multi-tasking, coping with domestic responsibilities, and creating social opportunities for their child.

The study also found that when autistic mothers disclosed their autism diagnosis to a professional, they were not believed the majority of the time. Autistic women felt misunderstood by professionals more frequently during pre- and post-natal appointments and found motherhood an isolating experience. Despite these challenges, autistic mothers reported they were able to act in the best interest of their child, putting their child’s needs first and seeking opportunities to boost their child’s self-confidence.

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Dr Alexa Pohl, who led the study, said: “Autistic mothers face unique challenges during the perinatal period and parenthood. Despite these challenges, an overwhelming majority of autistic mothers reported that parenting overall was a rewarding experience. This research highlights the need for increased awareness of the experiences of motherhood for autistic women and the need for more tailored support.”

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Professor Simon Baron-Cohen, Director of the Autism Research Centre at Cambridge, and part of the team, said: “This worryingly high number of autistic mothers who experience post-natal depression means we are failing them and their infants at a critical point in their lives. We now need more research into why the rates are so much higher, whether they are seeking help and not getting it, or if they are not seeking help and for what reasons. A new research priority is to develop autism-relevant screening tools and interventions for post-natal depression in these mothers.”

Monique Blakemore, an autistic advocate and member of the team, said: “This vital study was initiated by the autistic community, who collaborated as equal partners with researchers in the design, dissemination and interpretation of the survey. This is an excellent example of what can be achieved through such partnership.”

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The study was supported by the National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC), East of England, at Cambridgeshire and Peterborough NHS Foundation Trust, the Autism Research Trust, the MRC, the NIHR Cambridge Biomedical Research Centre, and Autistica.

Reference

A comparative study of autistic and nonautistic women’s experience of motherhood by Alexa Pohl, Sarah Crockford, Monique Blakemore, Carrie Allison and Simon Baron-Cohen. Molecular Autism. DOI: 10.1186/s13229-019-0304-2

Asperger’s Syndrome

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Photo by Pixabay on Pexels.com
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Credit: Deborah Mann Lake, UTHealth
Paula Ong talks about her journey with Asperger’s syndrome, which often can escape diagnosis until adulthood. A new clinic at UTHealth is reaching out to Aspies.

Paula Ong will chat away about her childhood, dropping out of college and the 13 jobs she has held in the past two decades. But ask how she “feels” about living with Asperger’s syndrome and she will give you a lengthy pause.

“Feels” is not a concept she can verbalize clearly.

“Feeling is abstract and at times broad,” she explains. “Many people with Asperger’s syndrome have a hard time grasping and verbalizing abstractness.”

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Asperger’s syndrome is a developmental disorder on the autism spectrum that causes impairment in social and communication skills. It is sometimes thought of as being a high functioning form of autism because “Aspies,” as they call themselves, are people of average or higher intellectual level.

Symptoms include repetitive routines or rituals; peculiarities in speech and language; socially and emotionally inappropriate behavior; difficulty interacting successfully with peers; problems with non-verbal communication; and uncoordinated motor movements. They also may have limited interests or an unusual preoccupation with a particular subject to the exclusion of other activities.

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“They are high on systemizing and low on empathizing,” says Katherine Loveland, PhD, professor of psychiatry and behavioral sciences at The University of Texas Health Science Center at Houston (UTHealth) Medical School, which has just opened a new clinic for patients with Asperger’s. Changing Lives through Autism Spectrum Services (CLASS) will serve intellectually able people age 16 and older with Asperger’s or another autism spectrum disorder. “Systemizing is the kind of thinking we do when we organize things, solve concrete problems and think in terms of how things work as opposed to empathizing, where we are attuned to and concerned with the feelings of other people.”

It wasn’t until 1992 that Asperger’s was recognized as a distinct disorder by the World Health Organization and not until 1994 that it was included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the American Psychiatric Association’s diagnostic reference book.

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So like many people who have Asperger’s syndrome, Ong’s ability to put a name to her idiosyncrasies didn’t come until she was well into adulthood. Ong, 41, was diagnosed with Asperger’s in 2006 during treatment for a mood disorder and attention deficit hyperactivity disorder (ADHD). Although current DSM criteria do not permit the diagnosis of ADHD together with an autism spectrum disorder, recent research including a major study at UTHealth has revealed that a majority of people with autism spectrum disorders have some form of ADHD as well.

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“We’re only now getting good at detecting Asperger’s in young people and there is a cohort of adults from when we were not so good at detecting it,” says Loveland, director of the CLASS Clinic.

“Either it’s never been diagnosed or it’s been misdiagnosed,” Loveland says. “One of the reasons it might be missed is because they are intellectually able. They are bright and verbal and good at school work, but they have continuing social problems, such as forming relationships with peers, being accepted, and dealing with emotions.”

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Ong is a good example. She is sharp with a keen sense of humor. She made As and Bs in school and excelled in history and science, the subjects that most interested her. She admits she wasn’t as good in math, which led to her decision to drop out of college, a decision her parents weren’t happy about. Her mother has degrees in journalism and business; her father is an aerospace engineer.

“My mom always suspected that I had something like autism despite what the schools told her when I was growing up,” says Ong, whose good grades disguised the severity of her disorder.

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As she grew older, Asperger’s syndrome affected Ong’s ability to sustain a career. The longest job she held was from 1997 to 2006. She began the position working in a parking booth and the limited contact with customers played to her advantage. But when parking tickets went electronic and the booths went away, she had to interact more with customers and sometimes it didn’t go well. She was written up after chasing down a car and banging on its rear window because the driver followed another car through the gate arm without paying.

“Some Asperger’s people don’t think and feel at the same time,” she says. “With some Aspies, you think and then you feel or you feel and then you think. My thinking is visual. I’m impulsive. Customer service is not my thing despite the fact I’ve been doing it for more than 20 years. The only time my experience in customer relations comes in handy is when I’m ‘translating’ for other people with Asperger’s. I have to know body language and stuff and I think I have a good idea of what others are expressing.”

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Ong has been under a doctor’s care since she was in her mid-20s for stress management and mood disorders, which includes depression.

“There are emotional issues… if people think you are odd, it affects how they treat you, and so you have a lot of stress,” Loveland says. “People on the autism spectrum have more trouble regulating their emotions. Their resources for coping with stress are less developed and they can become upset very easily. Over time, the stress and the emotional upset can lead to anxiety and depression. That’s not good for the developing brain and as a result, they often develop secondary psychopathologies.”

Specialists such as those at the UTHealth psychiatry CLASS Clinic can determine whether the problems an individual is experiencing are related to Asperger’s syndrome. Co-existing conditions such as depression and anxiety can be treated with medication or psychotherapy.

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“I really feel there is an unmet need in the community. There are people out there who are struggling and need a place to go. We want people to access the support they need,” Loveland says. “They will be able to meet people on a similar journey and know they are not alone. Group and individual training will help them develop skills that they need to feel successful in stressful situations.”

Ong has learned many skills, including using her favorite stuffed animal, Boo, to help her through stressful situations.

“I had to make presentations about Asperger’s in Corpus Christi and Fort Worth and Boo came. I didn’t know any of these people or what they would think of us. Boo takes away my fears. He handles my emotional burden,” Ong says.

Taking Antidepressants During Pregnancy Increases Risk of Autism by 87%

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Ground breaking study published in JAMA Pediatrics looks at outcomes of 145,456 pregnancies after antidepressant use

Credit: Hepingting, CC BY SA 2.0, https://flic.kr/p/95h8gu
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Using antidepressants during pregnancy greatly increases the risk of autism, Professor Anick Bérard of the University of Montreal and its affiliated CHU Sainte-Justine children’s hospital revealed today. Prof. Bérard, an internationally renowned expert in the fields of pharmaceutical safety during pregnancy, came to her conclusions after reviewing data covering 145,456 pregnancies. “The variety of causes of autism remain unclear, but studies have shown that both genetics and environment can play a role,” she explained. “Our study has established that taking antidepressants during the second or third trimester of pregnancy almost doubles the risk that the child will be diagnosed with autism by age 7, especially if the mother takes selective serotonin reuptake inhibitors, often known by its acronym SSRIs.” Her findings were published today in JAMA Pediatrics.

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Using antidepressants during pregnancy greatly increases the risk of autism, Professor Anick Bérard of the University of Montreal and its affiliated CHU Sainte-Justine children’s hospital revealed today. Prof. Bérard, an internationally renowned expert in the fields of pharmaceutical safety during pregnancy, came to her conclusions after reviewing data covering 145,456 pregnancies. “The variety of causes of autism remain unclear, but studies have shown that both genetics and environment can play a role,” she explained. “Our study has established that taking antidepressants during the second or third trimester of pregnancy almost doubles the risk that the child will be diagnosed with autism by age 7, especially if the mother takes selective serotonin reuptake inhibitors, often known by its acronym SSRIs.” Her findings were published today in JAMA Pediatrics.

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Bérard and her colleagues worked with data from the Quebec Pregnancy Cohort and studied 145,456 children between the time of their conception up to age ten. In addition to information about the mother’s use of antidepressants and the child’s eventual diagnosis of autism, the data included a wealth of details that enabled the team to tease out the specific impact of the antidepressant drugs. For example, some people are genetically predisposed to autism (i.e., a family history of it.) Maternal age, and depression are known to be associated with the development of autism, as are certain socio-economic factors such as being exposed to poverty, and the team was able to take all of these into consideration. “We defined exposure to antidepressants as the mother having had one or more prescription for antidepressants filled during the second or third trimester of the pregnancy. This period was chosen as the infant’s critical brain development occurs during this time,” Prof. Bérard said. “Amongst all the children in the study, we then identified which children had been diagnosed with a form of autism by looking at hospital records indicating diagnosed childhood autism, atypical autism, Asperger’s syndrome, or a pervasive developmental disorder. Finally, we looked for a statistical association between the two groups, and found a very significant one: an 87% increased risk.” The results remained unchanged when only considering children who had been diagnosed by specialists such as psychiatrists and neurologists.

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The findings are hugely important as six to ten percent of pregnant women are currently being treated for depression with antidepressants. In the current study, 1,054 children were diagnosed with autism (0.72% of the children in the study), on average at 4.5 years of age. Moreover, the prevalence of autism amongst children has increased from 4 in 10,000 children in 1966 to 100 in 10,000 today. While that increase can be attributed to both better detection and widening criteria for diagnosis, researchers believe that environmental factors are also playing a part. “It is biologically plausible that anti-depressants are causing autism if used at the time of brain development in the womb, as serotonin is involved in numerous pre- and postnatal developmental processes, including cell division, the migration of neuros, cell differentiation and synaptogenesis – the creation of links between brain cells,” Prof. Bérard explained. “Some classes of anti-depressants work by inhibiting serotonin (SSRIs and some other antidepressant classes), which will have a negative impact on the ability of the brain to fully develop and adapt in-utero”

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The World Health Organization indicates that depression will be the second leading cause of death by 2020, which leads the researchers to believe that antidepressants will likely to remain widely prescribed, including during pregnancy. “Our work contributes to a better understanding of the long-term neurodevelopmental effects of anti-depressants on children when they are used during gestation. Uncovering the outcomes of these drugs is a public health priority, given their widespread use,” Prof. Bérard said.

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About this study:Takoua Boukhris, Odile Sheehy, Laurent Mottron, MD, PhD, and Anick Bérard, PhD, published “Antidepressant use during pregnancy and the risk of autism spectrum disorder in children” in JAMA Pediatrics on December 14, 2015.

Anick Bérard, PhD, is a professor at the University of Montreal’s Faculty of Pharmacy and a researcher at the CHU Sainte-Justine Research Centre.

This study was supported by the Canadian Institutes of Health Reseach (CIHR) “Quebec Training Network in Perinatal Research”, and the Fonds de la recherche du Québec – Santé (FRQ-S).,

Dr. Bérard is the recipient of a FRQ-S research Chair on Medications and Pregnancy. Dr Bérard is a consultant for plaintiffs in litigations involving antidepressants and birth defects.

The University of Montreal is officially known as Université de Montréal.

Can artificial intelligence help prevent suicides?

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New tool from the Center for Artificial Intelligence in Society at USC aims to prevent suicide among youth

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According to the CDC, the suicide rate for individuals 10-24 years old has increased 56% between 2007 and 2017. In comparison to the general population, more than half of people experiencing homelessness have had thoughts of suicide or have attempted suicide, the National Health Care for the Homeless Council reported.

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Phebe Vayanos, assistant professor of Industrial and Systems Engineering and Computer Science at the USC Viterbi School of Engineering has been enlisting the help of a powerful ally -artificial intelligence- to help mitigate the risk of suicide.

“In this research, we wanted to find ways to mitigate suicidal ideation and death among youth. Our idea was to leverage real-life social network information to build a support network of strategically positioned individuals that can ‘watch-out’ for their friends and refer them to help as needed,” Vayanos said.

Vayanos, an associate director at USC’s Center for Artificial Intelligence in Society (CAIS), and her team have been working over the last couple of years to design an algorithm capable of identifying who in a given real-life social group would be the best persons to be trained as “gatekeepers” capable of identifying warning signs of suicide and how to respond.

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Vayanos and Ph.D. candidate Aida Rahmattalabi, the lead author of the study “Exploring Algorithmic Fairness in Robust Graph Covering Problems,” investigated the potential of social connections such as friends, relatives, and acquaintances to help mitigate the risk of suicide. Their paper will be presented at the Thirty-third Conference on Neural Information Processing Systems (NeurIPS) this week.

“We want to ensure that a maximum number of people are being watched out for, taking into account resource limitations and uncertainties of open world deployment. For example, if some of the people in the network are not able to make it to the gatekeeper training, we still want to have a robust support network,” Vayanos said.

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For this study, Vayanos and Rahmattalabi looked at the web of social relationships of young people experiencing homelessness in Los Angeles, given that 1 in 2 youth who are homeless have considered suicide.

“Our algorithm can improve the efficiency of suicide prevention trainings for this particularly vulnerable population,” Vayanos said.

For Vayanos, efficiency translates into developing a model and algorithm that can stretch limited resources as far as they can go. In this scenario, the limited resources are the human gatekeepers. This algorithm tries to plan how these individuals can be best positioned and trained in a network to watch out for others.

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“If you are strategic,” says Vayanos, “you can cover more people and you can have a more robust network of support.”

“Through this study, we can also help inform policymakers who are making decisions regarding funding on suicide prevention initiatives; for example, by sharing with them the minimum number of people who need to receive the gatekeeper training to ensure that all youth have at least one trained friend who can watch out for them,” Vayanos said.

“Our aim is to protect as many youth as possible,” said lead author, Rahmattalabi.

An important goal when deploying this A.I. system is to ensure fairness and transparency.

“We often work in environments that have limited resources, and this tends to disproportionately affect historically marginalized and vulnerable populations,” said co-author on the study Anthony Fulginiti, an assistant professor of social work at the University of Denver who received his Ph.D. from USC, having begun his research with Eric Rice, founding director of USC CAIS.

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“This algorithm can help us find a subset of people in a social network that gives us the best chance that youth will be connected to someone who has been trained when dealing with resource constraints and other uncertainties,” said Fulginiti.

This work is particularly important for vulnerable populations, say the researchers, particularly for youth who are experiencing homelessness.

“One of the surprising things we discovered in our experiments based on social networks of homeless youth is that existing A.I. algorithms, if deployed without customization, result in discriminatory outcomes by up to 68% difference in protection rate across races. The goal is to make this algorithm as fair as possible and adjust the algorithm to protect those groups that are worse off,” Rahmattalabi said.

The USC CAIS researchers want to ensure that “gatekeeper” coverage of the more vulnerable groups is as high as possible. Their algorithm reduced the bias in coverage in real-life social networks of homeless youth by as much as 20%.

Said Rahmattalabi: “Not only does our solution advance the field of computer science by addressing a computationally hard problem, but also it pushes the boundaries of social work and risk management science by bringing in computational methods into design and deployment of prevention programs.”

6 ways to overcome the holiday blues

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Charlie Brown might have said it best as he opined to his pal, Linus: “Christmas is coming, but I’m not happy. I don’t feel the way I’m supposed to feel.”

Yes, the holiday season can foster moments of great joy, but it can also at times be a source of distress.

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Whether you’re worried about purchasing the right mix of decorations to create the perfect atmosphere for a Thanksgiving meal, or finding a way to connect with family members who live on the opposite coast, the holidays can be tricky to navigate.

It’s easy, especially in our increasingly social media-driven world, to “compare and despair,” says Dr. Michelle Paul, psychologist and director of The PRACTICE Mental Health Clinic at UNLV.

“It’s difficult to tear ourselves away from constant messages of what they’re doing and what we’re, in turn, not doing,” Paul said. 

As pumpkin pies bake, and grocery stores line their shelves with peppermint-flavored treats, Paul explained the sources of holiday blues that can sometimes affect us, and shared some practical ways to greet this time of year.

What causes holiday stress?

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There are a number of things about the holidays that can potentially be sources of distress. For each person it’s going to be different, but there are some general themes that we can reliably predict.

  • Loss of a loved one: If someone has lost a loved one, that loss can be made all the more poignant, and experienced more deeply, around the holidays. The holidays generally represent a time where family and friends get together, and enjoy each other’s company, so having lost someone can create distress.
  • Materialism: In our culture, the holidays represent a focus on having gifts and possessions. There is marketing around how the Thanksgiving table ‘should’ be set, and how the holiday decorations inside and outside of our homes ‘should’ appear. However, not everyone has the means to make extra purchases, setting the stage for comparing and judging others or ourselves negatively for ‘failing’ to keep up.
  • Hustle and bustle: Rushing to make sure I have the right groceries, the perfect gift for that someone special, and the best decorations, is magnified during the holidays. It’s difficult to find a balance around celebrating in a way that’s meaningful, and not getting caught up in a long to-do list.
  • Unrealistic Expectations: If your circumstances don’t match the cultural ideal of a Norman Rockwell painting, your mind tends to go to a place of judgment. And with judgment comes shame. You start thinking, ‘What’s wrong with me that I can’t have it the way they do?’

How does social media contribute to holiday stress?

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Social media is supposed to help us connect. But the unintended consequences of social media include increased stress, isolation, and a decreased sense of belonging. It’s had this weird, paradoxical effect of giving us this ongoing, never-ending opportunity to look in the mirror and compare ourselves to others. We’re constantly bombarded through our phones, with young people being particularly vulnerable to the pressures of social media. 

As an adolescent, you’re figuring out who you are and where you fit in. It’s a time when friendships are very important and meaningful, and you begin to build relationships outside of your family. Today, teens are also being asked to manage these social media messages about what is cool and not cool, and you can’t get away from it. You could escape it 40 years ago. You could go home and take a break from whatever drama was going on at school, or what a classmate wore to class and what you didn’t. 

As human beings, we naturally want to find where we feel in, instead of out, where we belong and feel connected. The holidays add another layer of that, with strong messages that circulate around us for months in advance.

What are some tips that can help people cope with these and other holiday stressors?

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  • Determine your values: Step back and think intentionally about what you want the holidays to represent. Who do you want to be in relation to the holidays? What kind of values do you want to connect to? Once you make that determination, you can behave in accordance with those values. 
  • Act on your values: Behaving in ways that are consistent with your values is more important than making comparisons or judgments. Thanksgiving, for example, is all about being thankful for what you have. And there are lots of activities around Thanksgiving that wouldn’t require spending a ton of money. Maybe on that day, you can take a walk in nature in order to contemplate or spend time appreciating what you have. If you’re missing family members, why not do a Friendsgiving? Enjoy food and company and embrace the fact that you’re a ragtag team of people spending time together. Or, go out and volunteer. If you’re feeling that you’re not receiving, why not do the opposite and do some giving?
  • Avoid compare and despair: Have self-compassion. You can compare, but you don’t have to add in the layer of judgment. If someone’s reality is different than yours, that’s OK! Stop “shoulding” all over yourself, and stop using damaging or punishing language. Instead of saying, ‘I should do this,’ or ‘I must do that,’ you could try, ‘I preferably should.’ Be mindful of your own mental chatter and the automatic tendency to go toward punishing language.
  • Make connections: Focus on creating space for belonging or acceptance. Find places where you can receive support, but also give support in return. Reach out to others. Think about worth, value, and appreciation versus the enemies of comparison, judgment, shaming, blaming, and pushing people away.
  • Take stock: Take an inventory of what your individual sources of stress are because it’s different for everybody. Ask yourself: If I could change one or two things to feel better, what would they be? Do some active problem solving. If you lost a loved one, for example, celebrate that person’s life, or change up what might have been a holiday routine with that person. Make room for it to not be a happy time — it’s OK if it’s not a happy time. 
  • Seek help: If you’re really feeling that you can’t cope with the stressors around you, it’s perfectly reasonable to reach out to others, or even a mental health professional. Sometimes we get muddled in our own brains, and an outside perspective from a trusted mental health practitioner can help provide you with clarity and relief. 
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About The PRACTICE

The PRACTICE is a UNLV mental health clinic that offers counseling and other services to campus and community members. Faculty experts in clinical and school psychology and mental health counseling train and supervise advanced graduate students in high-quality mental and behavioral health care. Faculty and student clinicians work together to provide evidence-based care, drawing upon the most up-to-date research and knowledge available.