Get to Know Our Staff: Marida Williams, Psychology

Get to Know Our Staff: Marida Williams, Psychology

What is your job title/your role at Scottish Rite?
I am a mental health navigator for the Psychology department. I assess patients’ mental health risk through consultations and interventions to provide families with resources for their children.

What is the most fulfilling part of your job?
I get to meet new patients and help them in their care journeys toward achieving mental health stability.

What makes Scottish Rite a special place to you?
I have made connections with the staff and physicians, which helps ensure that all patients receive quality care.

What made you choose a career in health care?
I have a passion for helping others, so it feels like health care naturally chose me.

What is something unique you get to do in your position?
Whenever a patient has mental health needs, I am the first person who connects with their family. Because of this, I get to set the tone for the level of care they will receive at Scottish Rite from the rest of the staff.

What’s your favorite thing to do outside of work?
I enjoy spending time with my family and friends. We create memories together that will last a lifetime.

Do you have any hidden talents?
I can sing.

Where are you from, and what brought you to DFW?
I am originally from Detroit, Michigan. The hotter weather and new experiences brought me to the DFW area.

If you could travel to anywhere in the world, where would you go and why?
I would choose to go to Ghana. I would love to experience the culture there and take my kiddos with me.

If you had to pick one meal to eat for the rest of your life, what would it be and why?
I choose salmon. I know how to prepare it a thousand different ways, and I would never get tired of eating it.

What movie do you think everyone should watch at least once?
I think people should watch “Inside Out” and “Inside Out 2” because those movies explain mental health in a great way.

What was the first concert you attended?
I saw Allen Stone in Chicago, Illinois in 2013.

Favorite DFW hidden gem?
The Peach Cobbler Factory in Richardson.

If you were to have a movie based on your life, which actress/actor would you choose to play your character?
Coco Jones

What is some advice you would give your younger self, OR what’s the best piece of advice you’ve received?
You should enjoy life to the fullest and make every moment count!

Miles of Motivation: Alice Races Ahead of AMPS

Miles of Motivation: Alice Races Ahead of AMPS

12-year-old Alice is racing towards her dreams, confidently managing each day and creating her own path! With a passion for running, she participates in cross country for her school and the Amateur Athletic Union (AAU). After securing fifth place in AAU’s 5K, Alice began experiencing knee pain, which worsened following an injury during P.E. class in 2022. Despite physical therapy and using crutches, her condition didn’t improve. Alice had moments of extreme pain that prevented her from even walking. Unable to find a solution, Alice’s mom, Lindsey, sought help from Scottish Rite for Children in May 2023.

Sports medicine physician Jacob C. Jones, M.D., RMSK diagnosed Alice with amplified musculoskeletal pain syndrome (AMPS). Defined by Psychology fellow Diana Tinsley, Ph.D., AMPS is a chronic pain condition that causes prolonged pain, even though there is no identifiable pain source. “The pain sometimes starts with an injury,” Dr. Tinsley says. “Even though the physical injury heals, the pain persists and can spread throughout the body or even worsen in severity.”

Her condition required a multidisciplinary team of experts in sports medicine, physical therapy and psychology to reintroduce her to her love for running. Lindsey says Dr. Tinsley and physical therapist Ashley Ratliff were key motivators throughout Alice’s care journey. “There were many tears and ‘What if?’ moments during Alice’s treatment,” Lindsey says. “It’s important to truly lean on your care team and follow through with the work they give you to do at home – no matter how hard it may be!”

Alice’s Scottish Rite team worked to create a comprehensive treatment approach that set her transformation into motion. Her goal was to learn how to move through the pain and get back to daily life. Dr. Tinsley provided Alice psychological support through pain management strategies and helped her set manageable goals to work into her day-to-day schedule, such as leaving her crutch at home when doing errands. Soon, Alice went from relying on crutches to walking without assistance altogether. “Her pain had taken over her life,” Dr. Tinsley says. “Pain flares can happen especially when stress increases. We try to put her immense progress into perspective and continue to encourage her.”

Physical therapy for Alice was trickier, as there was no clinical evidence of her injury. However, Ashley’s exercises focused on desensitizing Alice’s knee to decrease the pain signals to her brain and improve Alice’s knee function. Similar to Dr. Tinsley’s approach, Ashley slowly decreased Alice’s use of crutches to help her regain muscle in her knee from not bearing weight on it. “The focus was on making small goals at a time to gradually work to her overall goal of running again,” Ashley says. “This involved a lot of communication between Alice and I to ensure she was being challenged, but also that she had appropriate time to cope and work through new challenges.”

Since Alice was a competitive runner, they alternated between gym sessions and aquatic therapy to improve her pain tolerance for her running return. Alice’s care journey continued at home, with her Scottish Rite care team and family collaborating to decrease her fear of movement. “Alice had such success based on her participation with Dr. Tinsley and being diligent with her physical therapy exercises at home,” Ashley says. “Patients with AMPS need support at home to encourage their progress.” Alice slowly transitioned from running in the pool to the treadmill, eventually running 6 miles without discomfort. Due to her dedication to her passion, Alice made excellent progress and was discharged from physical therapy!

Alice

Inspired by her care, Alice is now encouraging other kids with similar diagnoses. She has published a journal titled “Today is My Day!”, a mindfulness journal dedicated to those who have anxiety or depression. It encourages self-reflection with the goal of taking steps to appreciate life more. Additionally, Alice safely returned to cross country and is continuing to build her strength to achieve her dream of being a professional runner! Her success is a testimony of the support from her Scottish Rite care team and family. “From the smiles we get from the front desk to excellent care, our overall experience has been amazing,” Lindsey says. “Without Scottish Rite, Alice would not be where she is today and doing what she loves!”

Do you have a story? We want to hear it! Share your story with us.

Modern Luxury: Champions for Change

Modern Luxury: Champions for Change

Scottish Rite for Children is leading the charge to ensure that children’s mental health is top of mind.

By. Abra Garrett

In 2021, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children’s Hospital Association joined together to declare a national state of emergency in children’s mental health. Drawing on data from the National Survey of Children’s Health, 2022 showed children in the United States to be experiencing unprecedented rates of depression and anxiety. Scottish Rite for Children (scottishriteforchildren.org) has worked extensively treating kids with orthopedic conditions and researching how these disorders impact their mental health. To be seen by their in-house psychologists, a child needs to be an orthopedic patient at Scottish Rite; however, their expertise is useful for all parents, teachers and caregivers.

Dr. Jill M. West, the director of psychological services at Scottish Rite for Children and a licensed pediatric psychologist, as well as the parent of two young children, understands the importance of talking about mental and behavioral health, both personally and professionally. “The rates of mental and behavioral health needs of children and adolescents have steadily increased since 2011,” West explains. She says this change corresponds with the growing availability of smartphones and daily usage becoming a ubiquitous part of being an American youth.

“COVID-19 undoubtedly exacerbated an already building problem,” West says. “It’s not all bad, though—kids and teens appear to feel more comfortable sharing what they are experiencing and reaching out for help.” She says this helps to decrease stigma around mental and behavioral health needs and is serving as a catalyst for efforts to attempt improving access to care.

“Unfortunately, the demand for mental and behavioral health services presently has outpaced the number of clinicians available to offer support in most places, yielding long waiting lists and sometimes leaving parents feeling helpless,” West says. Tools like the Stress Management Workbook, created by the staff at Scottish Rite for Children, give families access to strategies they can begin to implement on their own.

For additional help, West had suggestions for healthy ways for parents and children to interact with digital media together. “Another one of my favorite strategies is the idea of co-using screens with your kids,” she says. “For instance, if your child loves TikTok or loves playing Minecraft, make a point to view it with them for 15 or 20 minutes per day.” She explains this gesture can take an activity that is usually done independently and make it an activity that becomes more social. “Spending time engaging with your child in something they enjoy is important, and it may naturally spark conversation or interest in what they are doing,” West says.

Parenting-related stress is an important variable to attend to as well. “You may be feeling as though every time you look at social media, there is another recommendation about how to be a ‘better’ parent,” West says. “That can be overwhelming and confusing when you know you are already doing your best.” She recommends setting aside some time each day that is screen-free, for you and your children, to give everyone a chance to reset and focus on real-life connections. “Remember that your pediatrician’s office is also a good place to bring up concerns about your child’s mental or behavioral health,” she says. “Primary care practices increasingly have access to embedded or co-located behavioral health services and can make a referral for services.”

Meanwhile, in Houston, Texas Children’s Hospital (texaschildrens.org) announced in December of 2022 the implementation of a communitybased approach to the rising pediatric behavioral crisis. One of the nation’s largest children’s hospitals, Texas Children’s raised over $11 million to launch several behavioral and mental health initiatives, which include the following priorities: training frontline pediatricians on behavioral healthcare, embedding psychiatrists and psychologists in Texas Children’s Pediatrics clinics, building an intensive outpatient program, increasing emergency center staff and safe treatment spaces, and implementing specially designed programs to help employees identify warning signs of suicide and tools for navigating these challenging situations. “These services are desperately needed, and we are committed to providing them because we believe that the behavioral and developmental health of children, adolescents and teens is just as important as their physical well-being,” says Dr. Kirti Saxena, chief of psychiatry at Texas Children’s Hospital and associate professor of psychiatry and behavioral sciences at Baylor College of Medicine.

While the statistics can be daunting, if not downright discouraging, it is vital to note that some of the most celebrated experts in the state have made it their mission to address head-on the issues that our children, teens and young adults are facing today. With their commitment to normalize the conversation and proactively address the challenges that have accompanied the last decade plus, parents and caregivers will have access to guidance and expertise to help navigate these unprecedented times.

Read the full issue.

Ten Ways To Manage Pain Without Medication

Ten Ways To Manage Pain Without Medication

Whether following an injury or a surgery, pain management is an important factor in many orthopedic conditions. Our psychology experts provide our patients with the necessary techniques and skills to manage their pain, preventing the need for extensive medications. Much of pain management is based on mental perception. Pediatric psychologists Emily Gale, Ph.D., L.P., ABPP, and Emily Stapleton, Psy.D., explain how to manage pain using psychology.
 
Importance of Pain Management
 
Nobody wants to be in pain, and ongoing or chronic pain can lead to mental health issues, such as anxiety and depression. Pain management is important to prevent increased stress levels and improve comfort in daily life. “Non-pharmacological pain management interventions are important because they allow patients to increase comfort for continued function, therefore supporting overall quality of life and allowing them to stay involved in the activities and sports they love,” Stapleton says. “Individuals who use these strategies also tend to rely on medications less, thus experiencing fewer side effects, decreased drug dependency and have reduced health care costs.”

Emotions and Pain Management
 
Our emotions and behaviors can directly impact our perception of pain. “The experience of pain is a multifactorial experience in our brains — multiple centers, including the limbic system, which is involved in emotional processing, help us understand pain,” Gale says. “In fact, the International Association for the Study of Pain defines pain as ‘an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.’ Therefore, emotion management is a critical part of managing pain. Specifically, negative emotions often amplify the intensity of pain while positive coping skills can mediate the experience of pain.” Different psychology methods can allow patients to regulate their emotions and work through painful situations.
 
Pain Management Techniques
 
Our team of experts have many tips to help patients cope with pain. The following techniques can help manage pain:
 

  • Eat healthy meals at regular times throughout the day.
  • Be sure to get plenty of sleep to refuel your body.
  • Stay active and exercise regularly.
  • Address any concerns with mood (i.e. poor mood, irritability).
  • Use skills such as:
    • diaphragmatic breathing
    • progressive muscle relaxation
    • guided imagery
    • positive self-talk
    • stress management

 
Diaphragmatic Breathing
Diaphragmatic (belly) breathing is a technique that strengthens the diaphragm while deeply breathing.

  • Use the diaphragm and expand your belly instead of the upper chest muscles.
  • Diaphragmatic breathing can help you relax, breathe more easily and strengthen your diaphragm.

Diaphragmatic breathing does not take the place of medicines or other treatments, but it can help you breathe more easily in certain situations. Learn how to use diaphragmatic breathing in our Pain Management Workbook.
 
Progressive Muscle Relaxation
Progressive muscle relaxation (PMR) or “Tense and Relax” is the simple practice of tensing, or tightening, one muscle group at a time followed by a relaxation and release of tension in that muscle group. Practicing this skill helps you get better at recognizing and reducing tension in your body and decreasing stress, anxiety and discomfort. PMR practice allows the muscles to relax more thoroughly after releasing, which makes letting go of physical tension more effective and increases relaxation.
 
Guided Imagery
Imagining a relaxing place or thinking relaxing thoughts can reduce pain and decrease stress. You can use imagery to imagine you’re somewhere else as a distraction from your pain and to feel more relaxed.
 
Positive Self-Talk
Self-talk is the inner voice or internal conversation that we have with ourselves. The way you talk to yourself can have a big influence on how you feel and act. Negative thoughts or self-talk increases stress, so with practice, you can learn to shift negative thoughts to positive ones and decrease stress using this cognitive-behavioral technique.
 
Learn more about the skills and psychology approaches used to manage pain in our Pain Management Workbook to assist patients and others with managing their pain. Download it now to get started. Learn more about our Psychology services.

Fear-Avoidance in Athletes

Fear-Avoidance in Athletes

What is Fear-Avoidance?

Athletes who experience an injury often struggle with fear-avoidance once they are physically cleared to return to sports. Out of fear of pain or injury, fear-avoidance is when a person develops and maintains chronic pain due to avoiding certain motions or behaviors. “Fear-avoidance is a model that describes how movement and pain-related fear can impact the development and maintenance of chronic pain and increased sensitivity to pain,” pediatric psychologist Emily Stapleton, Psy.D., says. To avoid perceived pain or injury, athletes may believe they cannot complete some rehabilitation exercises and as a result, the athlete may:

  • hesitate when completing exercises
  • not put in effort
  • hold back in training or competition
  • increase their dependency on family, coaches or medical team

The more the athlete does these things, the greater the anxiety becomes about pain, movement and reinjury. This fear-avoidance cycle is shown below:

What Does Fear-Avoidance Look Like in the Athlete?

“In athletes, fear-avoidance may look like hesitation when completing necessary exercises for recovery or decreased effort in rehabilitation exercises,” Stapleton says. “You may also see athletes skipping certain physical therapy exercises, discontinuing exercises early, or not completing the number of reps or recommended time due to pain or pain-related fear. Outside of rehabilitation, athletes may avoid social activities or sports where they anticipate the need to engage in increased physical activity, or actions they perceive as unsafe or as likely to increase pain, such as walking long distances or standing for extended periods of time.”

Part of the fear-avoidance cycle includes catastrophizing, or assuming that the worst possible outcome or event will happen. “This pattern of thinking increases distress and is linked to both anxiety and depression,” Stapleton says. In athletes, catastrophizing can manifest in many ways:

  • Constant or invasive thoughts about the pain of injury.
  • The athlete might think their injury is the worst possible injury and that they will never get back to their pre-injury performance level.
  • Believe nothing can be done about their pain or injury, and they will never recover.

This negative thinking can lead to fear of pain, movement, further injury and result in avoidance of anything that might cause pain, make the injury worse or result in another injury. As a result of increased anxiety and avoidance, one can become fixated on monitoring physical sensations in their body and very sensitive toward anything that increases discomfort, even physical therapy exercises that are needed for recovery. This often leads to sedentary behavior and will stop or greatly reduce physical activity levels. “Avoidant behavior is expected and healthy in the immediate acute phase post-injury, as following injury rest is often needed for recovery,” Stapleton says. “However, when returning to activities is appropriate or engagement in physical therapy exercises is necessary to recovery and rehabilitation, avoidance of these activities can actually be harmful, leading to increased pain, chronic pain, and/or declines in mood.”

In athletes, deconditioning often triggers more negative thoughts about their abilities, which can lead to depression and disability. Concerning signs and symptoms of depression include:

  • changes in appetite
  • changes in sleep
  • irritability
  • anger
  • sadness
  • frequent crying or emotional outbursts
  • lack of motivation, a decline in academic performance
  • disengagement and/or social withdrawal
  • substance abuse

It is important to learn strategies to cope with the anxiety so that rehabilitation and recovery are not significantly impacted.

How to Provide Support
There are ways that you can help support your child and work through their range of emotions and fears:

  • Help them to identify exercises or activities that increase negative emotions, or triggers. Look for when an athlete becomes distressed, avoids or hesitates prior to certain exercises for clues of triggering activities/exercises.
  • Create a hierarchy of the identified triggers and rate them from least to most fearful.
  • Start with the least feared exercise and have the athlete perform the task in a controlled and safe environment. Challenge the athlete to increase speed, repetitions and/or difficulty until they are performing without worry.
  • Use goal-setting techniques, such as setting SMART goals (specific, measurable, attainable, relevant and timely), to create daily, weekly and monthly goals for building tools to manage anxiety and stress, as well as to do the identified fear exercises.
  • Build coping skills to handle fear and worry triggered by pain and movement. Diaphragmatic breathing, positive self-talk and imagery techniques have all been shown to help reduce levels of distress, increase comfort and build confidence during rehabilitation and return to sport.
  • Provide education about how fear and decreased confidence can increase their pain and get in the way of their ability to return to their sport.

Learn more and download tips for helping young athletes manage stress.

Psychology Services at Scottish Rite for Children
Our Psychology department has teams of pediatric psychologists at both our Dallas and Frisco campuses. Pediatric psychologists are embedded in the care of each patient, providing support to our sports medicine patients throughout their care and treatment. Learn more about our psychology services.

Emily Stapleton, Psy.D., is a pediatric psychologist at the Frisco campus of Scottish Rite for Children. She specializes in pain management, rehabilitation, coping with acute and chronic illness/injury and sports medicine. She has a particular interest in supporting young athletes following a sport-related injury.