ADHD & Sleep

The links between ADHD and sleep issues are still unclear, as is the cause of ADHD in general. Both the symptoms of ADHD and some of its medications can affect sleeping patterns. Also, “sleep deprivation…can worsen ADHD symptoms.” Nearly 50% of kids with ADHD suffer from some sort of sleep problem and nearly 75% of adults with ADHD reported suffering from insomnia.

Common Sleep Problems Associated with ADHD:

  • Anxiety or resistance about bedtime (in children)
  • Difficulty falling asleep at night
  • Difficulty waking up in the morning
  • Sleep-disordered breathing and sleep apnea
  • Interrupted sleep (waking up during the night)
  • Excessive daytime sleepiness
  • Restless legs syndrome (RLS)
  • Periodic limb movement disorder (PLMD)
  • Delayed sleep-phase disorder
  • Higher rates of nightmares
  • More likely than average to experience parasomnias like sleepwalking

Treatments for these ADHD-related sleep issues include cognitive behavioral therapy (CBT) and medication management. Contact Dr. Bharagava’s office to see if these treatments may help you or your child’s ADHD symptoms.

Source: “ADHD and Sleep” by

Gabby Lundy, Exult Healthcare

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Who Can Help Treat My Depression?

Mental health treatment can be found from a variety of professionals, especially for depression. Knowing your own symptoms and needs can help you determine what type of care provider is needed to best treat your depression. You may even see more than one of these professionals at a time to get the best care possible. Let’s break down some differences between these mental health care professionals.

Primary Care Doctors

Your general doctor may be the first person you see to access care. They can:

  • Recommend a behavioral health provider such as a therapist, counselor, psychiatrist, etc.
  • Prescribe and monitor medication
  • Monitor your progress and follow up over time


Psychiatrists have medical degrees (MD) and specific training in mental health conditions. They can:

  • Assess your symptoms to make an informed diagnosis
  • Assess the need for medication
  • Prescribe and monitor medication
  • Provide psychotherapy

Licensed Counselors, Therapist, and Social Workers

All three of these providers have a master’s degree (MS), a doctorate (Ph.D.), or another type of graduate-level certification. They have completed an internship and one (or more) years of supervised practice. They can:

  • Assess your symptoms to make an informed diagnosis
  • Provide talk therapy (also known as counseling)
  • Offer specialized counseling, such as family or marriage therapy


Psychologists have a master’s degree (MS) or a doctorate (Ph.D./PsyD) in psychology. They are not medical doctors nor can they prescribe medication (in most cases). However, they can:

  • Assess your symptoms to make an informed diagnosis
  • Provide talk therapy (also known as counseling)
  • Conduct psychological testing
  • Refer you to a psychiatrist for medication

Psychiatric Nurse Practitioners

Psychiatric nurses are register nurses (RN) that also have graduate-level education in mental health. They can:

  • Assess psychiatric conditions
  • Prescribe and monitor medication
  • Follow up with medication management and coordination of care

If you feel like medication may be part of your mental health treatment, Dr. Bhargava, a board-certified psychiatrist, may be able to help. Visit our Depression Treatment page for more information.

If you are more interested in talk therapy, Exult Healthcare has licensed therapists and counselors that have a variety of specialties. They also offer transcranial magnetic stimulation (TMS) treatment if therapy and medications are not working for you.



Gabby Lundy, Exult Healthcare

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Perpetuating the Negative

Most of us have maladaptive thinking habits that lead us into anxiety, depression or substance use. It’s based on our environment and how we learned to think based on the family, social, economic, ethic, religious and political background that we grew up within. We get stuck in the unhealthy thinking habits and we get stuck in a loop.

  • What drives the old habits of thinking:
    • Living on automatic pilot instead of awareness and conscious choice
    • Relating to experiences through thought rather than direct sensing
    • Dwelling on and in the past and future rather than being fully in the present moment
    • Trying to avoid, escape, or get rid of unpleasant experiences rather than approach it with interest
    • Needing things to be different from how they are rather than allowing them to just be as they already are.
    • Seeing thoughts as true and real rather than as mental events that may or may not correspond to reality.
    • Treating oneself harshly and unkindly rather than taking care of oneself with kindness and compassion.

(Segal, Williams & Teasdale, 2013, p. 89)

Keeping these thinking habits can lead to worse habit forming behaviors. It becomes a coping mechanism for some and a way to stop progressing for others. Whenever you are struck into a loop of negative thinking, positive can change things around. Although thinking positively is easier said than done. Minor adjustments can help break a negative cycle such as:

  • Change and observe your body language
  • Talk it out
  • Take a walk
  • Spend one minute of meditation
  • Have a cup of tea
  • Positive affitmations


By LPC-Intern, Karen Limme

Quotes on Thoughts:

“Thoughts are not facts.”

(Segal, Williams & Teasdale, 2013, p. 164)

“A thought is a mental event containing a seed of reality surrounded by a shell of inference”

(Segal, Williams & Teasdale, 2013, p. 313)

“If we can observe in ourselves the toxicity of certain beliefs, thought patterns, and behaviors as they arise in the moment, then we can work to lessen their hold on us.”

(Kabat-Zinn, 1990, p. 217)


Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness (15th anniversary ed.): New York: Delta Trade Paperback/Bantam Dell.

Segal, Z., Williams, M., & Teasdale, J. (2013) Mindfulness-based cognitive therapy for depression. New York: Guilford Press.



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Minding Your Upkeep

“Mindfulness is the awareness that emerges through paying attention on purpose, in the present moment, and nonjudgmentally, to things as they are.”

-Williams, Tisdale, Segal and Kabat-Zinn



 Moment-to-moment awareness
 Being in the present
 Cultivate a new kind of control and wisdom
 Inner relaxation
 Knowledge of self
 Acceptance
 Directing attention
(Kabat-Zinn, 1990) & (Baer, 2006)


Strategies for Developing with Mindfulness:

 Be mindful of one thing at a time- internal or external not both.
 Be nonjudgmental- describe what you are observing without making a judgment. Enjoy the moment.
 Patience
 Beginner mind- look at thing through new eyes
 Slow down
 Stop-be still and silent in meditation
 Trust- develop a trust in yourself
 Non-striving- no goal
 Observe-participant observer by engaging with the experience
 Be mindful of the moment- observe the present without thinking of the past or future.
 Focus on your senses- use all your senses in the moment to truly appreciate the event or observation
 Return- when you wonder off return back to your focus
(Kabat-Zinn, 1990)

Major Concepts in Mindfulness:

 The only time we have to:
 Know
 Perceive
 Learn
 Act
 Change
 Heal
(Kabat-Zinn, 1990)

 Lack of a goal
 “Letting go of wanting something else to happen.” (Kabat-Zinn, 1994, p. 15)
 Being more aware of ourselves
 Present- moment-to-moment experience
 Accepting things how they are
 Allowing things to be as they are
 Thoughts are passing events in the mind
(Segal, Williams & Teasdale, 2013)

 Focus on the breath without controlling the breath.
 Watch your stomach move up and down or place your hand on it as it moves
 Attention to the feeling on your breath entering and exiting
 The focus helps avoid your mind wondering
 Calms the anxious mind
 Takes us back to now- breath is only now
(Kabat-Zinn, 2012)

Driven and Doing

 Don’t let go of a goal
 Consumed with solving the problem
 Difference in how things are and how you want them to be
 Ruminating- focus on past and future
 Affects view of self
 Ignore the present
 Driven by expectations
 Have our own way
(Segal, Williams & Teasdale, 2013)


Written by: Dr. Cynthia D’Sauza, Clinical Director


Baer, R. A.(2006). Mindfulness-based treatment approaches: Clinician’s guide to evidence base and applications. San Diego: Elsevier Academic Press.
Kabat-Zinn, J. (2012). Mindfulness for beginners. Boulder: Sounds True.
Kabat-Zinn, J. (2007). The MBCT program. Retrieved from
Kabat-Zinn, J. (1994). Wherever you go, there you are. New York: MFJ Books.
Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness (15th anniversary ed.): New York: Delta Trade Paperback/Bantam Dell.
Segal, Z., Williams, M., & Teasdale, J. (2013) Mindfulness-based cognitive therapy for depression. New York: Guilford Press.
Williams, M., Teasdale, J., Segal, Z., & Kabat-Zinn, J. (2007). The mindful way through depression: Freeing yourself from chronic unhappiness. New York: Guilford Press.


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Doing More in May

Mental Health Awareness is during May. The stigma behind mental health has hurt the growing community and kept mental health in the dark.

A stigma is an association of negative feelings towards something or someone. The stigma for mental health has become a barrier to people processing and seeking help for their own illness.

The National Alliance on Mental Illness has decided to spend the month of May, raising awareness about the effect predispositions cause. The campaign #curestigma or #stigmafree has spread across their social media platforms. The goal is to keep the conversation about mental health in a constant stream.

Key mental health statistics include:

  • One in five adults in the U.S. lives with a mental health condition.
  • One in 25 (10 million) adults in the United States lives with a serious mental illness.
  • Sixty million people in the United States face the day-to-day reality of living with a mental illness.
  • Half of all lifetime mental health conditions begin by age 14 and 75 percent by age 24, but early intervention programs can help.

Understanding mental health and the illness that ensues has become a critical part of our society. So many suffer from different types such as depression, bipolar, borderline, schizophrenia, etc. While, some types are beginning to be decriminalized, there are other types that need a higher level of compassion. May is a month that highlights the need for more information and understanding of mental health.


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A New Set of Paws Around Exult

Recently, Exult Healthcare did new employee training except it was a bit different. Our latest therapist is Koa, a 3 foot, 5 pound Labradoodle. He has his licensing as well in AAT (Animal-Assisted Therapy).

Koa partakes in therapy sessions from individual, adolescent, family, and couple counseling. Koa is not there just to be a cute pet to look at, he is fundamental in the therapeutic sessions that happen. Animal-assisted therapy provide a sense of calmness, comfort, safety, and become a destressor. Dogs are sensitive to the changes of human facial expression, behavior, and emotion. This is a big reason why Exult chose to begin animal-assisted therapy. The studies that support AAT help show the wide variety of mental illness’s they treat from anxiety to PTSD (

A session with Koa is dependent on you. Throughout the session he will not come to you unless called


or motioned for. He will be attuned to you and your needs throughout the session. As you have repeated sessions, you will begin to grow a closeness to Koa. You, as the client, go at your own pace of touching, looking, and interaction with Koa.

Koa’s trainer is Astrid Thomson who also provides Exult with equine therapy. He is available to be a part of your recovery team at Exult Healthcare.




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Nutrition and Mood: A Diet to Battle Depression

Depression is a global epidemic affecting the lives of millions of people worldwide. Research has delved into the, social, bio-chemical and pharmacological means of fighting depression. One novel approach suggests that a balanced nutrition rich in green leafy vegetables, nuts , fruits, seafood and low in red meats can promote a sense of well being.

Research carried out in Australia’s Deakin University showed that amongst 67 subjects who had depression and started on a healthy diet developed a significant improvement in their mood, energy, activity levels and sleep. This research was published in the January 2017 issue of BMC Medicine.

Nutrition plays a definitive role in a lot of therapeutic modalities such as those for hypertension, diabetes and other cardiac conditions, all impacting an organ- the heart. Hence, depression which stem from certain imbalances in the brain could also be assisted by nutritional therapy. These results have promoted psychiatry programs to teach their residents about the importance of diet in the management of mental illnesses.


So, what should you eat: research suggest a diet based on the Mediterranean style of eating( high on seafood, olive oil, green leafy vegetables, fruits, yogurt and cheese) and low on trans-fat rich foods like red meats.

As stated by Ms Loretta Go from Balwin, a change in her diet greatly impacted her mood, uncontrollable crying spells and insomnia- an effect which Prozac did not achieve.

So if you are at risk or suffering from depression, consult a dietitian and adopt healthier choices to experience a change!

From: Contributor, S. Mitra

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The Elements of Good Therapy

There are many models and types of therapy to choose from. We believe there are a handful of common denominators present in all forms of healthy, ethical therapy. These elements are described here:


Viewing a person as greater than his or her problems is the hallmark of nonpathologizing therapy. It does not mean problems do not exist; rather, it means one does not view the problems as the whole person. Working nonpathologically requires a shift in both the understanding and the approach to pathology.

Here is the understanding: Most of the issues people go to therapy for are not organic disorders—they are not hardware problems, they are software problems. These issues are the result of the person’s psyche doing the best it can to deal with life experiences—to adapt, survive, and prevent the person from ever getting hurt again. Certainly, there are some “disorders” that are purely organic in etiology (meaning a hardware problem that is genetic, biochemical, or neurological), such as some forms and instances of psychotic and mood disorders. However, the nonorganic problems people bring to therapy, which are often labeled as disorders, are actually very organized, orderly, and systemic psychological reactions. Thus, the word disorder is simply inadequate and misleading. Adding insult to injury, being labeled with a disorder can provoke shame and inadequacy and make some people feel worse. Read more about the position on the concept of disorder, here.

Here is the approach: Treatment of a software problem requires curiosity and compassion in order to undo the orderly and organized response to suffering. Treatment of a software problem does NOT warrant psychological amputation—this is what the medical model does to pathology. When a therapist joins a client in getting rid of a symptom instead of exploring its depths, the therapist is overlooking the client’s opportunity to heal. We do justice to a person’s true nature when we remember that behind the layers of protection, no matter how self-destructive or hurtful to others an individual has been, there is a loveable and vulnerable person at the very core. What about sociopathy?


Therapists who empower the people they work with in therapy maintain the belief that people have the capacity for change and are equipped with the inner resources to change, even if they never do. Therapy is based on the belief that people can heal if they want to and if they are able to contribute to their own growth what is sufficient and necessary.

Unfortunately, there is a tendency, especially in medical model treatment environments, to view people as fundamentally flawed. When a therapist views a person as flawed or incapable of change, the person is more likely to feel and become flawed. When the therapist is able to see beyond a person’s wounds and defenses, he or she is more likely to discover his or her true nature. Some people may not be able to overcome their obstacles and heal in this lifetime, but the therapist should not become an additional barrier.


The spirit of collaborative therapy is summarized in the words of Albert Schweitzer who wrote, “Each patient carries his own doctor inside him… We are at our best when we give the doctor who resides within each patient a chance to go to work.”

Collaborative therapy can be established when a therapist encourages the person they are treating to become the co-therapist. Therapists who work collaboratively trust people to know themselves (or have the potential to know themselves) better than anyone else, to access their own wisdom, and to attend to their wounds. This orientation puts the person in therapy in the driver’s seat of therapy. Collaboration is not directionless, nor does it put a person at risk of further trauma.


Therapists generally love working with people and tend to be empathic and big-hearted. There is no doubt that providing psychotherapy is gratifying and rewarding for most therapists. Although therapists witness the damage caused by the worst life has to offer–such as emotional abuse, trauma, or violence–they can be rewarded by being present with people during some of their greatest aha-moments, unburdenings, and transformations.

Addressing the person in therapy’s needs–not the therapist’s–is the focus of good therapy.Indeed, therapists get some emotional needs met as a part of the therapy process, sometimes even experiencing secondary healing. However, there are some therapists who unintentionally use the therapy process and the people they work with to soothe their own psychological wounds. These needs vary, but come from the same issues that many of us, therapist or not, have struggled with: to feel powerful, smart, appreciated, good, loved, seen, in control, etc. When a therapist’s psychological needs are met in therapy at the expense of a client, it damages the therapy process and has a high potential of harm for the person in treatment. Those therapists who have done their own therapy; have identified their psychological reasons for entering the helping profession; and are aware of, have tended to, and continue to tend to their own wounds and needs outside of their therapy practice are less likely to depend on their clients to feel good about themselves and are less likely to cause harm. Addressing the person in therapy’s needs–not the therapist’s–is the focus of good therapy.


Self is a state of being that a therapist can embody when working with people in therapy. Self is defined by Richard Schwartz as a state of calm, curiosity, compassion, creativity, confidence, courage, connectedness, and clarity. Self is considered a requisite of good therapy because it is this state that allows a therapist to work collaboratively without pushing, without pathologizing, and without retraumatizing.


Beyond technique and theory is the realm of the relationship: the ongoing human-to-human connection that provides the foundation for change. The therapeutic relationship is the safe container that allows one to more fully and completely feel the presence of Self while in the presence of another. A therapist who embodies Self and feels unconditional positive regard in the face of whatever the person in treatment may be experiencing nurtures the therapeutic relationship. Without a therapeutic relationship, there is no therapy.


Therapy often times needs to “go deep.” There seems to be a split in the mental health field between types of therapy that emphasize cognitive solutions and those that emphasize emotional or body-oriented healing. Both are important. Healing takes more than just insight about a problem, cognitive countering, and surface behavior change. To heal, we must explore the depth of the wounds that fuel extreme beliefs, feelings, and behaviors rather than turn away from, counter, or compensate for our suffering. When we counter and turn away from our deeper suffering, we experience “more of the same,” which often leads to more suffering.

Also, healing requires feeling. As it is said, “If we can feel it, we can heal it.” Many of our extreme beliefs, feelings, and behaviors are maintained because we have, in an effort to survive, avoided the painful wounds and burdens that lurk beneath. Good therapy helps people to process and complete whatever wounds they have harbored. Treating a person in therapy without going deep can be like stitching up a wound without taking the bullet out; the wound is more likely to remain sore, become infected, and require ongoing attention.

Addressing the source of pain is not always easy. As Carl Jung wrote, “Enlightenment consists not merely in the seeing of luminous shapes and visions, but in making the darkness visible. The latter procedure is more difficult and therefore, unpopular.”

Good Therapy Is Imperfect

The phrase “good therapy” encourages a misconception: the idea that there is such a thing as pure good therapy, a process exempt of any problems or issues. In the same way that a good marriage or relationship is not one without problems, but rather one that works through problems, good therapy will not always be free of difficulties. No therapist is perfect, and no therapy can be provided perfectly, no matter how ideal a therapy may be in theory. Even those therapists who do the best they can to be conscious of their inner world and attuned to the therapeutic process have aspects of themselves that they are unaware of, pieces of themselves that are unhealed, and mistakes they make.

Good therapy is the sum of all the experiences, internal and external, occurring as a result of the imperfect psychotherapy process. It leads toward self-awareness, growth, and the release of extreme feelings, energies, and beliefs. And what a blessing it is that even the best therapy can be lined with areas of unawareness, mistakes, and challenges to the therapeutic relationship and yet still turn out to be positive. Think of the beautiful repairs you may have made in therapy with the people you work with. A solid repair improves the connection and deepens the trust. So, cheers to road bumps in therapy, within all relationships, and within ourselves! Read our article, Good Therapy, Bad Therapy, and Everything in Between, for more on this.

Sometimes We Can’t Help

As therapists, we are limited. We greet the people we work with with great hope. We have spent countless hours studying our trade, doing our own inner work, mastering our technique, and learning to “be” with the people who seek our services. We have parts of ourselves that want to do good work. We are compelled to help others release burdens and cope with suffering because we know how good it feels to do so. Yet, there are times we cannot help.

We believe a good therapist never gives up hope that a person can heal in this lifetime, but we also recognize that he or she may not be the one to help, that the time may not be right, or that this person may not be ready and, for whatever reason, may never do the work we envision them doing. Good therapy means letting go of expectations and outcomes for ourselves and the people we work with without giving up hope.

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“C-ing A New Way”

On March 24th, Exult Healthcare put on a fantastic workshop for parenting workshop lead by licensed professional, Astrid Thomsen. It focused on learning new techniques to understand and communicate with their children. The seminar was three hours long and was filled with interactions, lectures, and of course snacks and water.

The workshop’s theme was to give parents, who still use traditional parenting styles, the skills to understand how kid’s think today.

Astrid broke it down with, “We have parents who are still used to the old-school type of parenting. The idea that when the parent says jump, the kid says how high. Parents have to understand that children just do not work the same way. It has come to the point that when parent’s say jump, the children say why. Many adults have trouble with this and there needs to be an understanding of today’s society and just how different it is.”

She went on to point out the “wall of resilience” that comes from the inability to understand the differences. A parent can use ‘because I told you so’ but children today are not responding to a blanket statement. When you take the resilience down then the child can not only better understand the parent but the parent communicates better to reach an affective boundary with their child.

Some other highlighted points from the seminar came from the importance of letting your child fail. We are not talking, major failures that you could have prevented. But parents learning not to rescue their child every single time. This allows the child to have a better transition into later years of emerging adult and adulthood.

Taking a look at the therapist leading the seminar was Exult’s own Astrid Thomsen. Astrid has been a therapist for almost thirty years and is LPC-S certified, dual-certified as an Equine Specialist in PATH and EAGALA, and certified in Chemical Dependence specializing in Addiction. She owns a farm in East Texas, where Astrid practices her “farmacy”. It is an integrated approach to using therapy, nature, and animal rescues to benefit your mental health.


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Group therapy

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