Advocating for Your Child—

As a parent, you have to do what is in your child's best interest. Sometimes that can be a scary and uncertain road. Relying on what your gut instinct is telling you is usually the right road to follow.

No one knows a child as well as the parents. (When I say parents, that could also mean a child's caretaker such as grandparents or whoever is raising the child). If you think that there might be something that is not quite right, then you need to investigate it immediately. Of course, it could be nothing but what if it isn't....

DON'T be afraid of what you might find out. DO be afraid of doing nothing.

1 in 5 will experience signs and symptoms of a psychiatric disorder during the course of the year. Some nine million children have serious emotional problems at any point in tie. Yet, only 1 in 5 of these children are receiving appropriate treatment. When parents or teachers suspect that a child may have an emotional problem, they should seek a comprehensive evaluation by a mental health professional specifically trained to work with children and adolescents.

Parents are natural advocates for their children. Who is your child’s first teacher? You are. Who is your child’s most important role model? You are. Who is responsible for your child’s welfare? You are. Who has your child’s best interests at heart? You do.

You know your child better than anyone else. The school is involved with your child for a few years. You are involved with your child for life. You should play an active role in planning your child’s education.

The law gives you the power to make educational decisions for your child. Do not be afraid to use your power. Use it wisely. A good education is the most important gift you can give to your child.

As the parent of a child with a disability, you have two goals:

1. To ensure that the school provides your child with a “free appropriate public education” that includes “specially designed instruction . . . to meet the [child’s] unique needs . . .” (20 U.S.C. §1401)

2. To build a healthy working relationship with the school.

Signs and symptoms of childhood and adolescent emotional problems may include:

• Anxiety or frequent worries
• Dangerous or self destructive behavior
• Excessive weight loss or gain
• Feeling sad
• Frequent fighting
• Injuring or killing animals
• Mood swings
• Obsessive thoughts or compulsive behaviors
• School problems
• Setting fires
• Stealing or lying
• Thoughts about suicide or running away
• Trouble paying attention
• Trouble sleeping
• Troubling or disturbing thoughts
• Use of drugs or alcohol
• Withdraw or isolation

Throughout the evaluation process, parents should be directly involved and ask many questions. It's important to make sure you understand the results of the evaluation, your child's diagnosis, and the full range of treatment options. If parents are not comfortable with a particular clinician, treatment option, or are confused about specific recommendations, they should consider a second opinion.

Before a child begins treatment, parents may also want to ask the following:

• Does my child need medication?
• How long should it take before I see improvement?
• How will I be involved with my child's treatment?
• How will we know if the treatment is working?
• What are the arrangements if I need to reach you after-hours or in an emergency?
• What are the recommended treatment options for my child?
• What should I do if the problems get worse?

You may also need to advocate to have your child seen in a timely way, by the most appropriate clinician. Most insurance plans now include some form of managed care, which may utilize provider panels with few mental health professionals. However, many states now have laws concerning reasonable access to specialists. If you have problems or questions, try calling the Department of Insurance, the Patient Ombudsman/Advocate, or the Department of Consumer Affairs at your insurance company.

Your Assignment—

Plan for the Future

What are your long-term goals for your child? What do you envision for your child in the future?

If you are like most parents, you are focused on the present. You haven’t given much thought to the future.

Do you expect your child to be an independent, self-sufficient member of the community? Although some children with disabilities will require assistance as adults, most will grow up to be adults who hold jobs, get married, and live independently.

If you have a vision about what you want for your child in the future, you are more likely to achieve your goals.

If you believe others will make long-term plans for your child and provide your child with the necessary skills to be an independent, self sufficient member of society, you are likely to be disappointed.

Answer Questions

What do you want for your child? What are your goals for your child's future? Do you have a master plan for your child's education?

If you want your child to grow up to be an independent adult, what does your child need to learn before he or she leaves the public school system?

What do you want?

Develop a Master Plan

If you are like many parents, you don't have a master plan. You don't know where you are, where you need to go, or how to get there. Do not expect school personnel to make long-term plans for your child -- this is your responsibility.

Begin by thinking about your vision for your child's future. What are your long-term goals for your child? What will your child need to learn? What services and supports will your child need to meet these goals?

Ongoing parental involvement and support are essential to the overall success of treatment. Depending on the nature of your child's problems, it may also be important to involve the school, community agencies, and/or juvenile justice system. In addition, it may be helpful to learn how to access other support services such as respite, parent skill building, or home-based programs. Local advocacy groups can also provide valuable information, experience and support for parents.

Go with your gut. You are the one that lives with the child daily. You see things that other people don't. Don't let yourself get talked out of seeking answers and help. Be your child's advocate before the problem is even identified. You don't want to look back later and regret not acting sooner.

Although serious emotional problems are common in childhood and adolescence, they are also highly treatable. By advocating for early identification, comprehensive evaluation and appropriate intervention, parents can make sure their children get the help they need, and reduce the risk of long term emotional difficulties.

Advocating for Your Child: 25 Tips for Parents (PDF)

How to Avoid the Stepfamily Holiday Blues

Even though the tales of woe are many, blended families can have joyous holidays.

One of the most difficult times for stepfamilies can be the holiday season. This time brings expectations of family togetherness that usually cannot be met.

Children often are reminded of the loss they experienced when their biological family separated. They also may experience the many feelings they had about the creation of the stepfamily. Parents also are reminded of the loss of the biological family unit and must deal with sharing the children during holiday celebrations. In other words, lots of difficult feelings could derail the expected gaiety of the season.

Here are some ways stepfamilies can produce more holiday cheer and less melancholy for the entire family. The following suggestions can be applied throughout the year and come from others who’ve discovered ways to avoid the stepfamily holiday blues:

1. Prepare for the absence of your children on those days you will most wish they could be with you. If they will be with their other parent on Christmas Day, birthday or other holiday, consider an activity for yourself and/or your household. If they will be away for an extended period of time, consider doing a couple of things on the list that follows:

• Collections — Find an interest that is unique to your child and build a collection (stamps, snowglobes, favorite animated characters). Sending little gifts that will enhance your child’s collection can create a connection for parent and child.

• Favorite TV shows — A television program that you and your child could watch together, even when you are miles apart, can provide a sense of connectedness and shared time across the miles.

• Phone cards, toll-free numbers, e-mail, faxes — Make it easy for your children to contact you. They will be more likely to pick up the phone to simply say hello. Show younger children how to use the various devices.

• Photo/video album — Send pictures or a videotape of times when your children were visiting you.

• Postcards — Little notes that simply say you are thinking of each child is one way to remind your children that you are a part of their lives, even when they are not with you. Sending your child a set of cards and envelopes that have been preaddressed and stamped also gives your child a way to respond.

• Your voice on tape — Provide a tape player your child can operate, then send stories you have read (perhaps along with the book) so that your child can listen to your voice reading the stories. For older children, articles, summaries or playbooks might be of interest.

2. Be sensitive to your children’s need to be with both of their biological parents. Also, as children age, they may want to spend some of their holiday time with friends. Providing permission to move freely between homes and enjoy all celebrations is a true gift to your children.

3. Adjust your expectations! Remember a stepfamily is different from a biological family. Your celebrations may not look like a Norman Rockwell painting. They may not even resemble those of the Brady Bunch. Create new traditions that are unique to the stepfamily and set aside a time when you know all will be able to participate — even if it’s before or after a particular holiday’s date.

The holiday season is almost here, and while for many people this time of year is joyous and hopeful, a recent poll found that 41 percent of respondents rated the holiday season as just as stressful as interviewing for a new job. For others, the holidays can trigger severe anxiety or even depression.

Many factors can contribute to the holiday blues. To begin with, there’s the time crunch. Just because there are more parties to attend and shopping trips to make doesn’t mean any of us work fewer hours or get a break from household obligations—we just try to cram more activities into the day. Then there are the financial burdens. The rewards of being generous to close friends and family may outweigh the price tag—but what about extended family, old friends from school, and coworkers? Where do you draw the line? And finally, the holidays can be truly painful when they recall the loss of those who are no longer celebrating with us because of death, distance or divorce.

The bottom line is that often many of us have unrealistic expectations of the season. We think that we should have time to do everything, buy gifts for everyone, and be happy and joyful, even if that’s not how we really feel.

The good news? It usually is possible to ward off the holiday blues by recognizing the demands we place on ourselves. This year, make the decision to enjoy the holiday season by approaching it differently. Here are some tips:

· Talk with your family and loved ones, and make a holiday plan based on what everyone agrees is important. Don’t assume you know what everyone wants out of the holidays.

· Plan your time realistically, and don’t feel badly about declining invitations to events that give you more migraine than merriment.

· Give yourself time alone to refresh and recharge.

· Don’t over-schedule yourself or your family. If you try to attend every event, you may not enjoy any of them.

· Develop a budget. Stick with it.

· Avoid drinking and eating excessively.

Enlist the help of friends or family when you feel overwhelmed. If you have children, give them small jobs—their willingness to help may surprise you, and they’ll be proud of their accomplishments.

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Dr. Jantz speaking on the Holiday Blues, depression, seasonal affective disorder (SAD):



Try This Exercise-

1. Picture what your ideal holiday season would be like and write in detail what you would like to see happen - including pleasant things from past (your childhood and your adult past), what you would like to do or see, who the important people are to see and spend time with. Go wild. Express your deepest longing and wishes. Keep adding to the list over a week or two.

2. Now, underline the most important items and set priorities.

3. Enjoy.

When Your Teenager Is In Legal Trouble

Despite a parent's best efforts, some young people find themselves in trouble with the law. Peer pressure, the need to assert independence, or misjudgments can place your adolescent at risk of involvement in activities that result in arrest and processing through the local juvenile justice system.

Juvenile justice systems vary widely between communities. If your child becomes involved in the juvenile justice system, your first step is to learn how the system in your area works. This knowledge will allow you to advocate for an outcome that teaches your child about the results of inappropriate behavior without hurting his or her prospects for the future.

There are three kinds of juvenile cases:

1. Abuse/neglect cases, in which the child has been mistreated by the parents, and it is necessary for the court to take over temporary legal custody for the protection of the child. Depending on the circumstances, it may also be necessary for the court to take physical custody, removing the child from the parents' home and placing the child with relatives or in foster care.

2. Delinquencies (law violations), in which the child has committed an offense which would be charged as a crime if the child were an adult.

3. Status cases, in which a child runs away from home, or is frequently truant from school, or is otherwise beyond parental control.

Begin by asking the processing officer at the police station (usually an officer in the juvenile division) to explain the process to you:

· What happens next?
· Whom should I speak with to get assistance if my child is referred to juvenile court?
· Why was my child arrested?
· Will my child have a record simply as a result of the arrest?
· Will you have to detain my child or can he or she be released in my custody? Will we need to post bond?

In many cases, particularly for minor offenses or a first-time arrest, youth will be released into their parent's custody. They also may be diverted into a community service program where they will be expected to perform volunteer service. In exchange, the charges against them will be dropped.

If your child is referred to juvenile court, however, what happens next will depend on the structure of the local system, the actions of the prosecutor's office, and the availability of diversion or treatment programs. The prosecutor and juvenile court staff can tell you what to expect from the process. (Juvenile court staff include intake or probation department staff who often conduct preliminary investigations. These investigations provide juvenile court judges with background information they use to decide on dispositions.)

You also are well advised to seek legal counsel if your child is referred to the court system. Youth of families without financial resources can request counsel from the local public defender's office.

Even if you obtain a lawyer to represent your child, you should accompany your teen through all juvenile justice system processing: intake, meetings with juvenile court staff and diversionary or treatment program staff, and any court hearings.

Keep in mind that the main intent of most juvenile justice systems is to help young people redirect their lives, not simply to punish them. Still, your role in advocating for your child is crucial. There are several alternatives to a court hearing, court decision, or detention. Your child can be diverted, for example, into a treatment program. Further, when a court hearing and decision are required, courts usually view a parent's involvement in the case positively when making a decision.

It is often in times of crisis that bonds between parents and adolescents are reaffirmed. At those times, youth again turn to their parents for support and protection. Troubling circumstances may present parents of adolescents with opportunities to show their love and support, to help their child obtain services to deal with specific problems, and to strengthen interpersonal connections that will benefit the family for years to come.

Glossary of Terms-

Acquittal: Judgment of the court that a person is not guilty of the offense(s) for which he or she has been tried. The judgment is made by a jury or a judicial officer.

Adjudicate: To settle a case by judicial procedure.

Adjudication hearing: Stage in juvenile court proceedings in which arguments, testimony, and evidence are presented to determine whether a youth actually committed the alleged offense.

Aftercare: Control, supervision, and care exercised over youth after they leave community-based programs or are released from juvenile facilities. Aftercare may include probation, counseling, enrollment in a community program, or other forms of treatment. Aftercare services are designed to support young people's return to their families and communities and to lessen the chance that they will get in trouble again.

CHINS or CIN: Commonly used abbreviation for "child in need of supervision." Also referred to as PINS ("person in need of supervision").

Commitment: Action of a judicial officer ordering that a young person who has been alleged or judged to have committed an offense be placed in a particular kind of confinement or community residential program.

Correctional facility: Facility for the confinement of individuals accused or convicted of criminal or delinquent activity.

Delinquent offense: An act committed by a youth that would be a crime if committed by an adult. Examples include assault, burglary, or possession of illegal drugs.

Dependency case: A case in which neglect or physical, sexual, or emotional abuse of a young person by a parent is alleged.

Dependent: A legal term denoting a young person who is alleged to have been neglected or physically, sexually, or emotionally abused by a parent and has come to the attention of the court.

Detention: Temporary confinement of a youth alleged to be delinquent pending pretrial release, juvenile court proceedings, or disposition.

Disposition: The decision reached concerning a young person's case. Examples include, but are not limited to, a juvenile court judge's decision to dismiss the case or to order a young person to participate in a drug treatment program or perform community service. Juvenile court case dispositions fall into the following categories:

· Dismissal: An order of the court disposing of a case without conducting a trial of the issues. Dismissal may occur when there is a finding of insufficient evidence to bring the matter to trial, when no more decisions or actions are anticipated, or when the case is already being handled by another court.

· Placement: Removing a youth found to have committed an offense from the home and placing him or her elsewhere for a specified period of time, such as in a juvenile or other facility.

· Probation: Placing a youth found to have committed an offense under the supervision of the court. During probation, the young person must maintain good behavior, not commit another offense, and meet any other conditions the court may deem appropriate to impose.
· Probation before judgment: Placing a youth found to have committed an offense on probation before the judge makes a final decision. Successful completion of the probation period results in a complete dismissal of the charges without any finding of involvement by the young person in the offense.

· Transfer or waiver to adult criminal court: Transfer of a young person's case to a court normally used to try adults for violations of criminal law, such as murder, rape, robbery, burglary, or distribution of illegal drugs. A juvenile's case usually is transferred to adult criminal court because of the serious nature of the alleged offense.

· Other: A youth found to have committed an offense may be given a disposition other than a commitment or probation, such as requiring participation in a drug abuse treatment system, payment of fines, or performance of community service.

Disposition hearing: Hearing held after the adjudication hearing in which the judge determines the disposition of a young person's case.

Diversion: Channeling young people into programs as an alternative to processing their cases through the juvenile court. A youth, for example, might be referred to a community service program to perform volunteer work to "repay" the community.

Group home: A non-secure program in which a group of young people live and receive services at the program facility under the supervision of adult staff. Group homes emphasize family-style living in a homelike atmosphere. Although many youth living in group homes are ordered there by the court, group homes may also house abused or neglected youth who are placed there by social service agencies.

Hearing: A court proceeding to decide on a course of action or to determine a young person's involvement or noninvolvement in an offense. Arguments, witnesses, and evidence are heard by a judicial officer or administrative body in making the decision.

Holistic or wraparound services: In the wraparound service approach, a team of professionals from different disciplines works with a young person and his or her family to offer services that meet their specific needs. The team also may work with the family in a location that is comfortable for the family, for example, at their home or at the young person's school.

Intake/arrest: Action of taking a youth into police custody for the purpose of charging him or her with a delinquent act. The juvenile justice process often begins with an investigation by a police officer, either because he or she observes a delinquent act being committed or because such an act is reported. The police officer will generally take one of three actions at intake or arrest: (1) release the youth to his or her parents with a warning or reprimand, (2) release the youth to the parents under the condition that the youth enroll in a community diversion program, or (3) keep the youth in custody and refer the matter to the juvenile court's intake officer for further processing.

Intake decision: Recommendation made by the juvenile court's intake officer to either handle the case informally or schedule the case for a hearing in juvenile court.

Intake hearing: Early stage in juvenile court proceedings in which an intake officer decides to either handle the case informally or schedule the case for a juvenile court hearing.

Intake officer: An official who receives, reviews, and processes cases in which a young person is alleged to have committed an offense. The intake officer can recommend either handling the case informally or scheduling the case for a hearing in juvenile court. The intake officer may also provide referrals for juveniles and their families to other community agencies.

Juvenile: A young person at or below the upper age of juvenile court authority, as defined in the local jurisdiction. In most States, young people age 18 or younger fall under the jurisdiction of the juvenile court.

Juvenile court: A court with authority over cases involving individuals under a specified age, usually 18 years.

Mandatory release: Release from an institution required by law when an individual has been confined for a period equal to his or her full sentence minus time for good behavior, if any.

Mediation: An alternative to a court proceeding in which a neutral person assists two or more people to resolve a conflict and reach a solution acceptable to all sides.

Nonpetitioned (informally handled) case: A case decided by juvenile court intake officers rather than through a hearing in juvenile court.

Nonresidential program: Program that provides services to youth who live at home and report to the program on a daily basis or as scheduled. Young people in such a program require more attention than that provided by probation and aftercare services. Often the program operates its own education program through the local school district.

Petition: The formal charging document filed in juvenile court alleging that a youth has committed a status or delinquent offense or is a dependent. A petition asks that the court hear the young person's case or, in certain delinquency cases, that the court transfer the case to adult criminal court so that the young person can be prosecuted as an adult.

Placement: Removing a youth found to have committed an offense from the home and placing him or her elsewhere for a period, such as in a juvenile facility or group home.

Predisposition investigation: Investigation into the background and character of a young person who has been determined to have committed a delinquent offense. The investigation collects information that will assist the court in determining the most appropriate disposition.

Probation: Placing a youth found to have committed an offense under the supervision of the court. During probation, the young person must maintain good behavior, not commit another offense, and meet any other conditions the court may deem appropriate to impose.

Probation before judgment: Placing a youth found to have committed an offense on probation before the judge makes a final decision. Successful completion of the probation period results in a complete dismissal of the charges without any finding of involvement by the young person in the offense.

Recidivism: Repetition of criminal behavior.

Residential program: Program in which youth live on site in program housing. Residential programs do not have the security fences and security hardware typically associated with correctional or detention facilities. A residential program, for example, could be located in a converted apartment building or a single-family home.

Runaway or emergency shelter: A center that provides services to address the immediate needs of runaway youth for food, clothing, and shelter.

Shelter care: Any non-secure public or private facility that provides either (1) temporary placement for alleged or adjudicated status offenders prior to the issuance of a disposition order or (2) longer term care under a juvenile court disposition order.

Status offenses: Behavior that is considered an offense only if carried out by a young person. Status offenses are handled only by the juvenile court and include the following:

· Curfew violation: Breaking a regulation requiring young people to leave the streets or be at home at a prescribed hour

· Running away: Leaving the home of parents, guardians, or custodians without permission for an extended period

· Status liquor law violations: Violating laws restricting the possession, purchase, or consumption of liquor by minors

· Truancy: Failing to attend school

Training schools, camps, and ranches: Non-secure residential programs providing services to youth. Training schools also are known as youth development centers, youth villages, youth treatment centers, youth service centers, or schools or homes for boys or girls. Camps and ranches generally are located in relatively remote or rural areas. Camps have structured programs that emphasize outdoor work, including conservation and related activities. On ranches, youth usually participate in a structured program of education, recreation, and facility maintenance, including responsibility for the physical plant, its equipment, and livestock.

Transfer or waiver to adult criminal court: Transfer of a young person's case to a court normally used to try adults for violations of criminal law, such as murder, rape, robbery, burglary, or distribution of illegal drugs. A juvenile's case is transferred to adult criminal court usually because of the serious nature of the alleged offense.

Valid court order: Order of a juvenile court judge. A juvenile court hearing, for example, might result in a young person receiving a valid court order to receive counseling.

Violation of a valid court order: Failure of a status offender to comply with an order of the court, such as to receive counseling. In such cases, the court may place the child in custody.

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Johnny is caught by a high school teacher returning a playground punch in a fight William started. But it’s the second fight this month for Johnny and the school’s principal calls the police. Johnny ends up as another case in Chicago’s infamous juvenile justice system, which some experts see as just another incubator for crime.

With increased student deaths in the headlines and gang turf disputes always lurking in the background, locking up juvenile offenders and throwing away the key might seem the safe thing to do. Even schools have adopted zero tolerance policies in an effort to create safe havens. But do traditional forms of juvenile justice really reduce crime and violence? And what happens to youth exposed to the system?

The Community Justice for Youth Institute suggests there is another way to end the violence in our communities. The Institute grew out of efforts to reform the juvenile court system through a process called restorative justice. And as it works to de-escalate violence in schools and communities, the Institute has also had a tremendous impact on Chicago Public School policies.

In this episode of Community, Media & You, Cheryl Graves, director of the Community Justice for Youth Institute and board member Ryan Hollin join host Thom Clark.

Children & Anxiety

Anxiety is a natural part of life, and most of us experience it from time to time. The word "anxiety" usually refers to worry, concern, stress, or nervousness. For most teens, anxiety is limited to particular situations such as tests, important dates (like the prom), or driving lessons.

For some teens, anxiety is a constant factor in their lives. When a person has an anxiety disorder, it interferes with their ability to function normally on a daily basis. Anxiety disorders can cause teens to suffer from intense, long-lasting fear or worry, in addition to other symptoms.

Anxious children are often overly tense or uptight. Some may seek a lot of reassurance, and their worries may interfere with activities. Parents should not discount a child’s fears. Because anxious children may also be quiet, compliant and eager to please, their difficulties may be missed. Parents should be alert to the signs of severe anxiety so they can intervene early to prevent complications. There are different types of anxiety in children.

All children experience anxiety. Anxiety in children is expected and normal at specific times in development. For example, from approximately age 8 months through the preschool years, healthy youngsters may show intense distress (anxiety) at times of separation from their parents or other persons with whom they are close. Young children may have short-lived fears, (such as fear of the dark, storms, animals, or strangers).

Symptoms of separation anxiety include:

·being overly clingy
·constant thoughts and intense fears about the safety of parents and caretakers
·extreme worries about sleeping away from home
·frequent stomachaches and other physical complaints
·panic or tantrums at times of separation from parents
·refusing to go to school
·trouble sleeping or nightmares
Symptoms of phobia include:
·the fears cause significant distress and interfere with usual activities
·extreme fear about a specific thing or situation (ex. dogs, insects, or needles)

Symptoms of social anxiety include:

·avoidance of social situations
·fears of meeting or talking to people
·few friends outside the family

Other symptoms of anxious children include:

·constant worries or concerns about family, school, friends, or activities
·fears of embarrassment or making mistakes
·low self esteem and lack of self-confidence
·many worries about things before they happen
·repetitive, unwanted thoughts (obsessions) or actions (compulsions)

If anxieties become severe and begin to interfere with the child’s usual activities, (for example separating from parents, attending school and making friends) parents should consider seeking an evaluation from a qualified mental health professional or a child and adolescent psychiatrist.

Severe anxiety problems in children can be treated. Early treatment can prevent future difficulties, such as loss of friendships, failure to reach social and academic potential, and feelings of low self-esteem. Treatments may include a combination of the following: individual psychotherapy, family therapy, medications, behavioral treatments, and consultation to the school.

There is no one cause for anxiety disorders. Several factors can play a role, including genetics, brain biochemistry, an overactive "fight or flight" response, life circumstances, and learned behavior.

Anxiety disorders tend to run in families, suggesting that there is a hereditary, or genetic, component to many of these conditions. A person who has a family member with an anxiety disorder has a greater chance of developing an anxiety disorder, though not necessarily the same type.

Certain things that happen in a person's life can also set the stage for anxiety disorders. Frightening traumatic events that can lead to PTSD are a good example.

Early learning also plays a role. Growing up in a family where others are fearful or anxious can "teach" a child to view the world as a scary place. Likewise, if a child grows up in an environment that is actually scary or dangerous (if there is violence in the child's family or community, for example), the child may learn to be fearful or expect the worst.

Some teens with anxiety try to medicate or relax themselves by using alcohol and drugs (even things like sleeping pills), which may seem to make the anxiety or stress go away temporarily. This is not a good solution for several reasons. Drugs and alcohol create only a false sense of relaxation, can be dangerous, and can lead to lots of other problems, which can make it that much harder to function.

Treatment for anxiety may include medication, cognitive-behavioral therapy or other types of talk therapy, and relaxation or biofeedback to control tense muscles. A combination of treatments may be prescribed.