Adolescent mental health was already worsening prior to the COVID-19 pandemic. A troubling pattern of suicidal thoughts and behaviors are increasing for many high school students with female and LGBTQ+ students at greater risk for persistent feelings of sadness and hopelessness.

But what about my child? Mental health is shaped by several factors: biological factors, including genes and brain chemistry; environmental and life experience factors such as poverty, losses, school stress, peer relationships/bullying, adverse child events often referred to as ACES (neglect, abuse, and other trauma-related events), parental divorce and interparental conflict.

How do I know my child is experiencing mental health struggles? Look for changes in behavior, lifestyle, friends: sleeping more/more difficulty sleeping, appetite changes, mood changes from becoming more withdrawn to more irritable, drop in grades at school, does not want to participate or enjoy activities that they used to enjoy or participate in.

What to do? Have open and honest conversations with your child/teen; listen instead of reacting, model this with your own behavior by talking about emotions and problem-solving strategies. Encourage connections with friends and family, monitor the amount of time spent on/with social media, video games, and other technologies. Provide a stable and predictable home environment, model stress management and problem solving.

How do I know my child/teen has a mental health problem or is just being a teenager? The acronym FIND can be helpful.

• F=Frequency of concerning behaviors and moods/how often are they, 1-2 times a month or
  more days than not;
• I=Intensity of emotions and behavior, are reactions to stress, rules/limits, changes out of
  proportion to the event;
• N=Number of problem behaviors observed (irritability/anger, withdrawn, appetite, sleep);
  and
• D=Duration, how long have these changes been going on?
  

Need Help? Call The Behavioral Wellness Group at 440-392-2222 to talk with one of our Intake Specialists. We will listen to your concerns, ask some questions, and help you match with one of our mental health providers.

Frank R. Ezzo, Ph.D., ABPP, LLC
The Behavioral Wellness Group
8224 Mentor Ave #208 Mentor OH 44060
P: 440 392 2222 #852 F: 440 565 2349
fezzo@behavioralwellnessgroup.com
www.behavioralwellnessgroup.com

The post Is There a Youth Mental Health Crisis? appeared first on Behavioral Wellness Group.

Behavioral Treatment for Tics

• Behavioral Treatment called Cognitive Behavioral Intervention for Tics (CBIT) is the gold standard of treatment. There are three components: 1. Learn to become more self-aware of tics and the preceding urge that sometimes arises before the tics; 2. Help learn a competing response, which makes the tic more difficult. For example, if the tic involves jerking your head back, a competing response would be to tuck your chin, straighten your neck, and hold that position; 3. Figure out what situations tend to make tics worse or to reinforce them and change the circumstances.

• TicHelper is an on-line self-help version of CBIT that walks kids and families through the intervention

• About half of kids and most adults who try CBIT do not respond or partially respond, therefore an alternative approach is Exposure and Response Prevention (ERP).  This involves learning to tolerate the urge to tic-exposing yourself to situations that may trigger tics and learning to relax with deep breathing and progressive muscle relation.

• Mindfulness exercises and distress tolerance practices are part of mindfulness. Using images such as the urge to tic as an ocean wave and let the wave crest and collapse on the shore. Tics increase with excitement and stress and improve with calm, focused activities.

• People with chronic tics have an overconnected corticostriatal sensorimotor circuit that links the cortex to deep motor structures in the brain. They also have underactive inhibitory circuits and overactive limbic circuits. Interventions like CBIT helps strengthen the prefrontal inhibitory circuits.

• Tics can appear alongside other disorders such as obsessive-compulsive disorder (OCD) or Attention Deficit Hyperactivity Disorder (ADHD).  A thorough diagnostic session is necessary to identify other coexisting diagnoses. Anxiety disorders can worsen tics, as well as depression. Life stressors can worsen tics, for example, a difficult Calculus Class, transitioning to college or a job, a divorce, being bullied.

• Lifestyle: exercise, good sleep habits, daily routines—things that you can control.

Source: Monitor on Psychology. June 2026. Stephanie Pappas. Pages: 33-37.

Another source: Nix your tics! Eliminate Unwanted tic symptoms” A how-to-guide for young people (2^nd ed.) B. Duncan McKinlay.

One last comment. We may suggest a referral for medication, but will leave specific medication recommendations to the expertise of the Prescriber.

Frank R. Ezzo, Ph.D., ABPP, LLC
The Behavioral Wellness Group
8224 Mentor Ave #208 Mentor OH 44060
P: 440 392 2222 #852 F: 440 565 2349
fezzo@behavioralwellnessgroup.com
www.behavioralwellnessgroup.com

The post TOURETTE’S DISORDER AND TICS appeared first on Behavioral Wellness Group.

Signs Your Mental Health May Need More Attention During a Transition

Sometimes we become so focused on adjusting that we ignore the early warning signs that we’re struggling. If you are experiencing any of the following symptoms, it may be a sign that you need to slow down and prioritize your mental health.

• Constant feelings of stressed or overwhelmed
• Difficulty managing emotions
• Isolation from others
• Losing motivation or interest in things you enjoy
• Persistent self-criticism
• Trouble sleeping or relaxing
• Feeling emotionally numb or “stuck”
• Increased burnout or exhaustion

Healthy Ways to Cope During Transitions

Give Yourself Permission to Adjust Slowly: Not every transition will feel natural immediately. Many people expect themselves to “have it together” quickly, which often creates additional stress. It is common to miss your old routine, feel both excite and anxious at the same time or even need more rest and support. Adjustment takes time and it is important to be patient with yourself.

Maintain small routines: During times of uncertainty, simple routines can help to create a sense of stability. Take some time to focus on more manageable habits such as waking up around the same time every day, eating regular meals, practicing mindfulness daily, spending time outside, etc.

Lean on your support system: Transitions can sometimes feel isolating, especially if you are someone who does not like to ask for help and values your independence. Reach out to your trusted family/friends, therapist, or join a support group.

Let go of perfectionism: Transitions are difficult and there may be setbacks or uncertainty, and this does not mean you are failing. Try to reduce verbiage such as “I should _____” or “I should have _____”.

Practical Ways to Prioritize Mental Health During Change

• Set aside for yourself to rest
• Set realistic expectations for yourself
• Practice self-care
• Eat regular meals
• Take breaks without guilt
• Limit comparison to others
• Practice self-compassion
• Ask for help when needed
• Celebrate small wins and progress
• Create boundaries around your time and energy

Transitions can challenge your confidence, routines, and emotional balance, however, they can also become opportunities for growth, resilience, and deeper self-awareness. You do not need to navigate change perfectly to move through it successfully. Prioritizing your mental health during transitions means giving yourself permission to slow down, seek support, and care for yourself while adapting to something new. Change is hard—but you don’t have to lose yourself in the process!

Madeline McDowell Rabah, LPCC
Therapist and College Mental Wellness IOP Director
The Behavioral Wellness Group
8224 Mentor Ave #208     Mentor OH  44060
P:  440 392 2222 #412    F:  440 565 2349
mmcdowell@behavioralwellnessgroup.com
www.behavioralwellnessgroup.com

The post Navigating Transitions: Protecting Your Mental Health Through Change appeared first on Behavioral Wellness Group.

• “Coach might cut my playing time now.”

• “I’m letting my teammates down.”

• “I have to make the next shot, otherwise we could lose this game and not make playoffs”

• “This ref hates me!”

• “He calls everything on me and completely misses the same calls on the other end!”

This is an example that demonstrates an athlete’s stream of consciousness while
struggling with negative thinking and performance pressure. As an athlete there is a large
focus on physical factors, and understandably so. However, mental and emotional
processes play a critical role in performance, influencing the likelihood of either success
or failure.

Sport and performance psychology could help this athlete navigate stressors more
effectively with three of the following strategies inspired by Cognitive Behavioral
Therapy (CBT):

Positive Reframing:
This is not to be confused with toxic positivity (“That didn’t matter. You’re fine.”) which
ignores life’s challenges. There are two important parts of positive reframing, first,
validating your challenges (frustration with missing shots). Second, is applying a ‘glass
half full’ perspective. How to use positive reframing to address one of the automatic
negative thoughts from the example above: “I am frustrated about that missed shot and I
got the next one! Nice and smooth”.

Process Focused versus Outcome Focused:
Being process oriented helps athletes to be mindful and truly focused on the task at hand
(shooting a shot or running a play). Being focused on the outcome is thinking about a
made or missed shot or winning or losing a game. Being process oriented is helping pull
an individual’s focus to the here and now and building small actions or tasks towards an
outcome. If an athlete is worried about winning or losing they are distracted from what is
happening right in front of them.

Focus on What is in Your Control:
During games, matches, or competitions there are many factors outside of an athlete’s
control that can easily influence their thoughts and emotions (missed calls by referees,
rude fans, or inclement weather). By focusing on things in an athlete’s control can assist
with regulating emotions, building confidence, and letting go of uncontrollables.
Overall, sport psychology views athletes as multidimensional people. Athletic
performance not only requires physical training (they are not just a body), but also
intentional development of mental and emotional skills. While these strategies take time,
effort, and consistency to implement initially, they can be beneficial towards an athlete’s
performance in the long-term.
Please feel free to reach out if you believe you would benefit from the expertise of a
psychologist that specializes in sports and performance to assist you in enhancing your
mental and physical capabilities.

Kayla Kovach, Ph.D.
Post-doctoral Psychology Fellow
8224 Mentor Ave #208 Mentor OH 44060
P: 440 392 2222 #302 F: 440 565 2349
kkovach@behavioralwellnessgroup.com
www.behavioralwellnessgroup.com

Supervisor: John A. Glovan, Psy.D.
Phone: 440-392-2222 #302 Fax: 440-565-2349
jglovan@behavioralwellnessgroup.com

The post Sport Psychology on Negative Thinking and Performance Pressure appeared first on Behavioral Wellness Group.

• Take breaks from the hospital when you can. If you have support from a partner, friend or family member, it can be beneficial to step out of your child’s room to walk around the hospital, get a cup of tea and get some natural sunlight to reset so you can show up as your best for your child.
• Eat regular meals and healthy snacks to have energy to maintain understanding of your child’s procedure and continued care. It can be easy to eat convenient food items that may not be the healthiest, so if possible, pack snacks and have a reusable water bottle to fill up with water to stay hydrated.
• Reach out for support to friends and family to discuss what is going on, your thoughts and feelings or to have them stop by the hospital to provide a break for you and to provide connection to your child while they are away from home. It can be helpful to identify 1-2 close support people to connect with regularly who can disseminate information to other loved ones so you are not inundated with text messages and phone calls for updates.
• Reach out to hospital support staff to assist you or your child to manage their hospital stay. Hospitals have chaplain services to provide a safe space to explore emotions or child life specialists who can provide toy rooms or developmentally appropriate toys for your child to allow them to have options to pass the time during an in-patient hospital stay.
• Pack comfortable clothes, blankets, and pillows to have while you are staying over at the hospital. Most rooms will have a pull out sofa bed but it can be helpful to bring some comforts of home to help your stay overnight be more relaxing and recharging to get a good night’s sleep.
• Pack items that can help you pass the time and be relaxing activities to assist – in managing your stress. These items can include: books, crafts, ear buds, magazines, puzzles, sudoku/word searches, knitting or crocheting, coloring books, and a tablet or kindle with downloaded content like your favorite movies or TV shows.
• Pack toiletries that can help to refresh yourself while you are staying away from home. These can include: toothpaste, toothbrush, mouth wash, soap, moisturizer and skin care routine, wash cloth, hand towel, soap, lip balm, and hair care items.

If you recognize that you are needing additional support due to the stress that you are experiencing because of your child’s medical condition, it could be helpful to reach out to a licensed therapist to meet with regularly to discuss this with. To set up an appointment with a licensed therapist you can contact our front office staff at 440-392-2222.

Stephanie Cerula, LPCC
Clinical Counselor, The Behavioral Wellness Group
8224 Mentor Ave #208 Mentor OH 44060
P: 440 392 2222 #404 F: 440 565 2349
scerula@behavioralwellnessgroup.com
www.behavioralwellnessgroup.com

The post Managing Stress During a Child’s Hospital Stay appeared first on Behavioral Wellness Group.

Depression can affect anyone, and watching a loved one struggle with it can be challenging, concerning and at times, maybe even scary. While you can’t “fix” their depression, your support can make a significant difference in their journey to recovery.

Educate Yourself About Depression
Self-Knowledge is one of the most crucial things you can do to help your loved one who is struggling with depression. Even having just a basic understanding of depression can make a difference. Mental health still has a lot of stigma attached to it, even in 2026. Depression is a condition, not a weakness or something people can just “snap out of.” If it were that easy, wouldn’t they have done it already?

Active Listening and Empathy
In addition to learning about depression, practice listening to your loved one without judgement. Actively listen to them. That means giving them the time to speak without you trying to fix it or make things better. Let your loved one share their feelings without fear of criticism or dismissal. Sometimes, just having someone listen is a powerful support.

What about well-intended advice? We’ve all been there. Someone trying to help us gives unsolicited advice and we may get upset about it because that isn’t what we currently need. Phrases like “just think positive” or “cheer up” can feel invalidating. Instead, express empathy and understanding and always practice active listening.

Offer Helpful Assistance
Depression often leads to intense feelings of being overwhelmed, and your loved one might not have the energy to do the everyday tasks they normally do when they are not in a depressive state. Preparing meals, running errands or helping with chores can go a long way in assisting your loved ones at this difficult time.

Encouraging Professional Help
If they are not currently seeking professional help, you can gently suggest this but please know that this is up to them. Everyone operates on their own timeline. Some people may not be ready to have professional help, possibly due to stigma and or their own beliefs. Some cultures are not receptive to seeking mental heath help and this is something to also consider.

Supporting a loved one with depression isn’t always easy, but your compassion and understanding can be a lifeline. Small gestures, like checking in regularly or simply listening, can make a meaningful difference in their recovery. Remember, your support can help them feel less alone as they navigate their mental health journey.

If you or your loved one need additional professional support, please feel free to reach out to the National Alliance for the Mentally Ill or call us at The Behavioral Wellness Group. We would
be glad to help.

Erin Pawlak, MS, LPCC-S
Therapist and Adolescent IOP Director
The Behavioral Wellness Group
55A Sheridan Park Circle   Bluffton SC 29910
8224 Mentor Ave #208     Mentor OH  44060
P: 843 278 0008 #307 F: 440 565 2349
P:  440 392 2222 #307    F:  440 565 2349
epawlak@behavioralwellnessgroup.com
www.behavioralwellnessgroup.comup.com

The post How to Support a Loved One with Depression appeared first on Behavioral Wellness Group.

• Skills training works very well online– With DBTs structured approach-mindfulness, interpersonal effectiveness, emotion regulation and distress tolerance skill sets- all fit naturally into a video format.
• Group participation is often stronger– Many clients feel more comfortable speaking from their homes; this can help people open up sooner.
• Fewer missed sessions– No commute, fewer barriers to attending, easier scheduling that leads to better attendance, one of the strongest predictors of success.
• Privacy- For some people logging in from home reduces the anxiety of walking into a new building and sitting in a new waiting room.
• VIRTUAL DBT IOPs ARE NOT A ‘LIGHTER’ VERSION OF THE REAL THING. THEY ARE THE SAME TREATMENT DELIVERD IN A MORE ACCESSIBLE WAY.

Virtual IOPs Are Just as Effective as In-Person Care: What BWG Research Shows:

The research compared patient outcomes from BWG’s pre-COVID, in-person DBT-based IOP (2019) with outcomes from the rapidly adapted virtual IOP provided in 2021. The programs used the same core curriculum, facilitators, and interventions—only the delivery format changed. This research was conducted by Licensed Psychologist, Dr. Barbara Ballash, who specializes in CBT and DBT.  

• Key Finding: Virtual IOPs Are Equally Effective
• Using validated screening tools for depression and anxiety, the study found no significant differences in symptom improvement between the in-person and virtual groups. In other words:
• BWG’s virtual IOP produced the same clinical gains as the traditional in-person IOP, even among individuals with serious mental illness.

How This Study Fits into the Larger Evidence Base

                  –Recent research aligns strongly with BWG’s findings   

• Telehealth IOPs show comparable outcomes to in-person programs, including similar reductions in depression, anxiety, and substance-use symptoms (Contreras-Schwartz et al., 2024; Bulkes et al., 2021).
• Attendance and completion rates are often higher for virtual IOPs, likely due to fewer logistical barriers (Waite et al., 2022)
• Virtual IOPs show equal improvements in depression, anxiety, and emotion dysregulation compared to in-person programs.
• Studies report high retention and satisfaction with telehealth DBT groups.
• Telehealth DBT is effective for individuals with complex needs, including SMI and chronic emotion dysregulation.

Bottom line:
Virtual DBT IOPs deliver the same outcomes as in-person care — with added flexibility that helps more people stay engaged and get better.

Please contact me with any questions about the virtual DBT IOP.

Cathryn E. Knezevich, M.Ed., PCC
Therapist and DBT IOP Director
The Behavioral Wellness Group
8224 Mentor Ave #208     Mentor OH  44060
P:  440 392 2222 #304    F:  440 565 2349
cknezevich@behavioralwellnessgroup.com
www.behavioralwellnessgroup.com

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Email: scerula@behavioralwellnessgroup.com
Phone: 440-392-2222 opt. 1
Facebook: https://www.facebook.com/thebehavioralwellnessgroup
Instagram: @thebehavioralwellness

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