‘Healing from the inside out’
An Upstate psychiatrist’s mission: to help prevent suicide
BY AMBER SMITH
Record numbers of suicides among young people prompted the creation of Upstate’s Psychiatry High Risk Program in 2017.
“Our mission is very simply to save and transform lives,” says Robert Gregory, MD, a professor of psychiatry and behavioral sciences.
This program offers comprehensive outpatient care that includes weekly individual psychotherapy. It may also include medications, and family and group psychotherapy, if appropriate.
“It’s a 12-month program, since it takes a while for transformative healing to occur, enough time for individuals to change lifelong coping patterns and ways of perceiving themselves and others,” Gregory says. The goal is for the person to be well enough to continue their recovery without needing to be in the mental health system.
The weekly individual psychotherapy is a particular style of treatment called “dynamic deconstructive psychotherapy,” which Gregory developed. He describes it as helping someone heal from the inside out.
“It works through a different mechanism than most psychotherapies and feels very different to the patients undergoing it as compared to previous experiences they may have had in counseling,” he says.
Gregory explains that people who are suicidal have an impaired emotion processing system in the brain that renders them unable to process emotionally painful experiences through their prefrontal cortex. So more primitive subcortical areas of the brain are activated, causing them to experience a high state of arousal and distress and a sense of emptiness and disconnection.
Instead of focusing on symptoms or giving advice on how to cope with each crisis that arises, DDP helps patients practice how to connect with and process emotionally laden experiences. This helps activate and remediate the emotion processing system in the prefrontal cortex, much like the way physical therapy remediates functioning after a stroke.
“As their emotion processing system begins to strengthen and heal, symptoms of anxiety and depression markedly improve, and patients feel more connected with themselves and others, no longer obsessed with thoughts of suicide,” Gregory says. “It’s a different way of thinking about treatment, but it really works.”
About two-thirds of the patients in the Psychiatry High Risk Program take psychiatric medication. Gregory says medication may provide symptom relief before the effects of psychotherapy kick in. “What we have found is that the need for medications decreases over time, such that most of our patients are on fewer medications when they leave the program than when they started.”
When the program began in 2017, Gregory and one other therapist handled all of the patients. Today, a dozen staff members are dedicated to the Psychiatry High Risk Program. They’ve treated almost 600 patients between the ages of 14 and 40.
About half of the patients are referred to the Psychiatry High Risk Program through emergency physicians. Self-referrals are also accepted. Call 315-464-3117.
Higher-level regions of the brain (shown by green arrows) either atrophy or underreact to highly emotional situations; lower regions (yellow arrows) become hyperreactive -- leading to a high state of arousal and impulsive pleasure-seeking.
How to recognize that someone is suicidal
Psychiatrist Robert Gregory, MD, says a common indicator of depression is withdrawal from people and difficulty functioning at work or school.
There may be a lot of expressions of pessimism and negativity.
Be aware that many people who are struggling do not share their pain, and many are very good at hiding depression, he says.
Do not be afraid to ask, “Have you been feeling depressed lately?” and “Have you been having thoughts of suicide?” If the answer is anything other than a definitive “no,” Gregory says, please refer them to the National Suicide Prevention Lifeline, which now has a national three-digit number: 988; or to a hospital emergency room.
The Psychiatry High Risk Program in Syracuse can be reached at 315-464-3117.
To hear an interview with Gregory where he discusses this suicide prevention program, including how it has been expanded to include teens, click here.
This article appears in the spring 2023 issue of Upstate Health magazine.