Soda Bottles, Volcanoes, and Neuroanataomy: How Emotional Distress Causes Physical Symptoms in Kids, and What To Do About It.

Transcription:

Greg Fritz, MD (Host): Spotting the signs of emotional distress in young people is often no easy task. For some parents and caregivers, finding out how their kids are coping or maybe not coping, is as difficult as getting them away from YouTube. Evidence shows that there is a prevalence of emotions causing physical symptoms in both children and adults. Today we're gonna be talking with Dr. Matt Willis, who will help us understand this very real phenomen. Matt is the co-director of the Hasbro Partial Program at Hasbro Children's Hospital. This program is part of the Integrated Medical Psychiatric program, a unique program of Hasbro Children's Hospital that addresses the needs of children and adolescents who are struggling with both physical and emotional problems. Welcome Dr. Willis.

Matt Willis, MD: Great to be here.

Greg Fritz, MD (Host): This is Mind Cast, Healthy Mind, Healthy Child. A podcast from the mental health experts at Bradley Hospital. Leaders in Mental health care for children. I am Dr. Greg Fritz with my colleague Dr. Ann Walters.

Anne Walters, MD (Host): Hi Matt. So great to have you here. This is such an interesting topic and I think it's one that can show up in almost everyone's life from time to time. One often encountered example in our partial program for younger children is the link between stomach aches or other somatic complaints and anxiety. Sometime parents are at their wits end trying to figure out what's an illness and what is something else.

Matt Willis, MD: Yeah. Thanks so much for that introduction on this topic. I think one of the reasons I'm so passionate about this is I want to help families understand the very real phenomenon that exists between emotional distress, the very real connection that exists between emotional distress and physical symptoms. And you're right, these symptoms can be experienced in a number of different ways. And you mentioned abdominal distress is one way that something that's emotional, emotionally based can come out physically. But there's a host of other examples, really in adults and children in our everyday lives.

All of us are familiar with words like butterflies in my stomach, for example, is a way to describe anxiety. Not uncommon for those of us that have to do public speaking to suddenly feel our heart racing a bit like mine is at the moment. And not only that, but sort of have phenomena like headaches, a little bit of even a faintness or a dizziness that can go with emotional distress. So certainly it's actually fairly common for us to actually experience this connection between emotions, anxiety in particular, and physical symptoms.

And yet, we don't really talk about it all that much, and when it shows up in clinical situations, I think we scratch our heads to try to understand it. So I, one of my passions here is to try to really normalize this for all families as something that we actually experience very prevalently in society. And then help kids understand that because this is the case they don't have to be ashamed of the concept of their own body experiencing these symptoms physically either, and that we can do something about it.

Greg Fritz, MD (Host): That's really interesting and I agree. It's super important. everybody needs to understand this phenomenon and recognize it, but it's equally important to be able to describe this accurately to the kids. I don't think most of them understand it right from the get go. And sometimes they know their stomach hurts, but they don't really have a words to explain it. how do you help them with that?

Matt Willis, MD: Yeah, and the language that we use Dr. Fritz is really based in, the age of the kid that we're working with. There are gonna be some kids that we're gonna get kind of scientific in describing what's going on in their body. And there are other kids that were gonna use analogies for this to have them understand this. So, one analogy that don't know if I've patented or not, b causee I, can't really remember what I've taken from someone else and what's my own material? Probably like most of us, but one of the analogies that I frequently will rely on anyway is the soda bottle analogy. So, picture your body as a soda bottle, right?

And stuff happens to it over the course of the day, The course of your weeks or months. Carbonation or fizz builds up in the soda bottle. And if you don't do anything to let that fizz out of the soda bottle, physical stuff happens to the body. So usually when I ask a kid if I'm using this analogy, I'll say, what happens if the. If the fizz builds up in the bottle? And of course younger kids want to tell me right away, well, it'll explode. But the key here is to actually describe what happens before it explodes. Because what happens before it explodes is the tension builds up in the bottle. If we feel that plastic, it starts to feel like hard rock instead of plastic.

And it gives kids a way to understand that there really are physical things that can happen to my body, and also that if I really can't figure out some way to let that fizz out, it's gonna be things more dramatic than just tension building up in my body are gonna happen. I actually might have some sort of physical explosion as well. So that's one analogy. Another kind of similar one is the volcano. If kids don't like soda bottles or their families are against soda you can use the volcano analogy too to describe the same phenomenon. And then with kids that. are still doubters at that phenomenon or sort of are more into what the science could be.

We do have some nomenclature, some punitive science I guess you'd say to describe that as well. So what we'll talk about with some kids and families that might not buy into the idea of the reality of this, is this concept that, the limbic system is the emotional center of the brain. It's what the movie Inside Out is based on. If you wanna get a good education about the limbic system, watch Inside Out. I have no stock in Disney. But watch that movie because it'll do a really nice job describing kind of how the limbic system works. The limbic system sits around a structure called the Thalamus.

And the thalamus functions both as kind of like a motor relay system and a pain or sensory relay system. It's part of those systems in the brain. So when you have kind of excessive charge, if you will, in one area, like the limbic system, you can start to understand how it might affect other systems in the brain that pass through the thalamus. And that's a kind of a more scientific way for some families that are inclined to say, This is real. When emotions build up and you can't figure out what to do with them, they really do have, like at the anatomic level, they really do have some impact on what your body's doing motor wise or what your body's doing, sensory or pain-wise.

So there will be some families maybe more scientifically inclined that might rely more on that description, understand this, rather than the analogies. I just mentioned .

Anne Walters, MD (Host): So one big takeaway for us to Mark really is that physical symptoms can be signs of emotional distress. And can you talk a little bit about what a diagnosis might look like or what those might be?

Matt Willis, MD: Yeah. Initially what we've talked about so far is how commonplace these symptoms are. But when they rise to a level of a diagnosis, it's usually around, as is the case in the rest of our field of psychiatry, when something becomes functionally impairing, when it blocks you from doing the stuff as a kid that you need to or the stuff as a kid that you wanna do. So couple diagnostic terms that we have. one is called, Functional Neurological Disorder. And Functional neurological Disorder tends to be applied when the symptoms that you're expressing are coming out sort of more neurologically, more with like a motor or a sensory, problem in your body.

An analogous term for that, or a synonym for that is something called conversion disorder, which is an older term, but actually one that I prefer to use because it's actually describing what's going on. Emotional symptoms are converting into physical symptoms in the body, so conversion disorder or functional neurological disorder are two terms to describe the same entity. And they apply when what's happening physically has more of a neurological appearance to it. And also when it blocks you from doing something you need to do or you wanna do, go to school, socialize with friends, do those types of things.

The other term we'll use diagnostically is something called somatic symptom disorder. And Somatic symptom disorder is a more general term for when whatever is going on with your. Is something that you really become quite preoccupied with. You start spinning on, if you will, so you have abdominal upset, for example, you can't do anything except kind of spin on that abdominal upset and really focus on how concerned you are about that in your body. That term applies when your brain starts spinning on the physical symptom. And the rumination that you have about that physical symptom is actually what's blocking you from doing this stuff you need to d o .

Greg Fritz, MD (Host): Good .That encapsulates a lot . So once the conclusion is made that these emotional distress signs are significantly impairing the child's ability to function as normal, what's the course of treatment? What can we do to help the kid get out of that pickle ?

Matt Willis, MD: Yeah. I'm gonna go back to the soda bottle analogy as the best way to kind of root ourselves in some of the things we do. If your soda bottle is over carbonated, you gotta decarbonate it, right? You have to let the fizz out. And the way that you let the fizz out, first and foremost, is through learning how to recognize your own emotions. Some kids don't recognize their own emotions and also communicate those emotions to another person. So emotional expression is first and foremost the mainstay. Teaching kids how to communicate what's going on emotionally is gonna let that fizz outta that soda bottle. There are different ways you can do that.

That doesn't have to be in a face-to-face conversation with a therapist or even a parent. That could be through journaling. That could be through artwork, that could be through musical expression. There's a lot of different ways kids can get to the other side of getting their emotions into some form for somebody else to hear about. Beyond that, the other mainstays of treatment that kind of form the, core of our skill building curriculum in our program are, in addition to emotional expression, are relaxation training, which is as it sounds, it's a few, things we introduce kids to that can help their bodies to become more relaxed.

And essentially just a couple examples would be like deep breathing progressive muscle relaxation guided imagery, those types of things. There's also mindfulness, and mindfulness is a word out there in the, in society that's kind of used in a lot of different contexts. But what we mean here in, in mindfulness is awareness of what you are thinking and feeling right now. So as I'm doing this podcast, I need to be thinking about this content, right? My brain cannot go to what happened earlier today that I'm second guessing, it can't go to something later today that I need to do back at the hospital. I have to be zoned into what's going on right now.

And we teach kids that if we can get their brain focused on the here and now with all five of their senses, it'll actually screen out some of the distress that they're having and they'll be able to absorb the moment more. So that's mindfulness. And then the last main skill set that we're. For kind of addressing these symptoms is it's like thought restructuring that, that sounds fancy. It's really just noticing automatic thoughts that come up in your head that aren't particularly helpful. As I was driving over here, I was started thinking if there's an accident, I might be late.

And if I'm late, maybe Ann and Greg will be really upset with me and they'll never let me do another podcast again. And as I'm thinking about that, right, that's an automatic popup thought that's in my head. That's not helpful. So what I need to do is I need to restructure that if I'm late by a little bit from what I've, from what I know of them, they're kind people and reasonable doctors. And they'll probably let me start the podcast late. So I have to restructure that thought into something that's a little bit more reasonable. And we're doing that with kids too. So those are the mainstay emotional expression, relaxation training, mindfulness, and then thought restructuring.

Greg Fritz, MD (Host): So just one other question about those specific things. Do you teach them to the parents as well?

Matt Willis, MD: That's a great question. Yes. I will say that I don't know that there's any work here that we do with this population of patients that should be done without parent involvement. So the way we teach this to the parents is we run a parent support group on Tuesdays and Thursdays from 8: 30 to nine o'clock. And we're reviewing these same strategies over that time interval with the parents in a slightly different form. Of course, different parameters, but we're letting them know what we're teaching their kids so that they can employ it at home too.

Anne Walters, MD (Host): Matt, in our program, you know that I work with mostly younger children and we call those automatic thoughts, ANTS, automatic negative thoughts. And so we teach kids to squash the ANT. So if I were in the car with you, I would've said, Matt, you gotta squash that. That's a mind reading ANT.

Matt Willis, MD: Well, if I give you my soda bottle analogy for use, may I use your ANT's phrase?

Anne Walters, MD (Host): You might. You may. Very well. So those are great strategies. The hope would be that once a child is introduced to these strategies and coping mechanisms, there are obstacles to emotional expression would lessen. What do you think are the barriers to doing this work?

Matt Willis, MD: Yeah, great, question. just as a segue from what Greg just mentioned, the barriers are largely within the family structure itself, right? Within the family structure itself, and not to blame a family. We all have certain patterns of doing things that unfortunately over time can get in the way of emotional expression, which as I just said, is a mainstay of this kind of treatment. So what are those? Well, one is accidental modeling. So I'm a psychiatrist, I have a pediatrician.

I have four daughters. But when I go get home at night and I have like a kind of forlorn look on my face what do you think I'm most likely to say? When one of my daughters says, Hey dad, are you okay? Even though I should know better, right? I'm most likely to say I'm fine. Right, And what I just did when I say I'm fine, is I accidentally modeled what I don't want my kids to be doing, which is when somebody asks you a question about how you're feeling, just pretend you're feeling fine and answer the question and move on.

Right. So accidental modeling in families is really, really, really, real phenomenon. It's something we deal with. Shame anybody for it. I acknowledge I do it myself, but we want to help parents to actually model something a little bit different. So what I want to model is, instead being able to share a little something, my child already knows that I'm in some distress. I might as well not deny that. I don't wanna necessarily say, I thought we were gonna get a tax refund and instead we owe money and I'm not sure what that's gonna mean for the next tax season and, etcetera, etcetera.

But I am gonna give something that could be, at least somewhat genuine and real, like it was a harder day at work than I expected, and I have a couple kids that I'm working with that are still struggling and it, weighs on me a little bit, but thank you for asking, right? So I'm gonna try to model something that's a little bit different because my kid, my child already knows I'm in distress. So that's where kind of accidental modeling or kind of families of origin that over contain sort of come in. This phrase that I'm gonna use next, I stole from Dr. Michelle Ricker be who was one of the co-directors of our partial program before me, and that is called the Family Protection Fallacy.

So what the Family Protection Fallacy is, the belief that it's better for me to protect you from my distress. If you ask me how I'm feeling. I'm better off telling you I feel fine because that'll unburden you, you won't be burdened with my distress. What we of course know as parents is that if my child's just trying to protect me by saying they're fine, I'm much worse off not knowing, than knowing whatever it is that they have to tell me. That question mark on that box that's closed, that I don't know the answer to is worse than anything they could tell me they're going through.

So we try to demystify or demythize, I guess you would, the family protection fallacy, so that we were in a position where we actually let folks know, that's actually not doing you any good in your family. The last two I would comment on are denial, which as we say is more than just a river in Egypt. It's a real phenomenon. And related to that com compartmentalization, which is the concept that I just have to put some of my stressors away in a box somewhere in my head and pretend they don't. In order to deal with him, that is useful, that is helpful.

We all have to do that from time to time. And I would want a pilot flying a plane that's taking me somewhere to be able to do that with his or her own stressors. But we can't do it all time if we rely on denial and com compartmentalization at all times. The carbonation builds back up and the last, obstacle is kids will ask us or parents will ask us, why bother sharing something, with you that you can't change anyway? So the comment that we often make about that is, you're right, I might not be able to change what's going on, but there was this kind of equation that I learned in med school that's still stuck with me.

That is that it's, it goes that emotional or physical pain is not the same as suffering. It's actually emotional or physical pain plus isolation that equals suffering. So if I can impact that second variable, that isolation, I might still have something that's emotionally or physically painful that I'm going through, but if I'm not experiencing it in isolation from mother, I may not suffer with it. So a parent once described this to me really well, as much more succinctly than I just spent the last three minutes describing it as a problem, shared as a problem cut in half.

And I really think that when I think about it that way, that helps me to understand, to explain to families why you should bother sharing something that actually can't be changed. But again, those are probably the main obstacles we see for why families are not engaging in this kind of work.

Greg Fritz, MD (Host): Wow. Well, no doubt that we could talk in length about all this like days. I think we've just covered the tip of the iceberg when it comes to emotional distress and it's relationship to physical symptoms, but if you could talk to parents out there whose child is experiencing stomach aches or headaches or other physical symptoms, and there's seemingly no explanation, what would you tell them first to do?

Matt Willis, MD: I would tell them first to communicate to their child that their symptoms are real. The physical symptoms the child is experiencing are really happening in the body. and that's that important dialect, that and word, and that real physical symptoms can be caused by emotional distress. Not that those two things are mutually exclusive from each other.

Anne Walters, MD (Host): Thanks so much for being here with us, Matt, and if you found this podcast helpful, please share it on your social channels and check out our entire podcast library at bradleyhospital.org/podcast. For topics of interest to you. This is Mind Cast. Healthy Mind, Healthy Child. A podcast from the experts at Bradley Hospital, and today Hasbro Children's Hospital. I'm Ann Walters with my colleague, Dr. Greg Fritz. Thanks for listening.