OCD: Exposure Therapy and Medication

OCD stands for Obsessive Compulsive Disorder and is a chronic, long-term disorder in which a person has uncontrollable reoccurring thoughts and/or behaviors that take over and are constantly repeated. These repetitions can take over one’s life; all they can focus on are one’s obsessions and nothing else. Obsessions are defined as “repeated thoughts, urges, or mental images that cause anxiety,” while compulsions are “repetitive behaviors that a person with OCD feels the urge to do in response to their obsessions.” It’s a common disorder affecting about 1% of the U.S. on any given year, with a lifetime prevalence of OCD among U.S. adults falling at 2.3%. Symptoms can present themselves in a range of mild to serious, with about ½ of OCD cases falling under serious.

Exposure and Response Prevention, also known as ERP therapy, is a common form of treatment for individuals with OCD, but it can be very harsh and relentless. In simple terms, ERP therapy takes the OCD patient and places them at the forefront of their fears so that they confront them head on, with no protection. However, when doing this they’re guided by a trained therapist to ensure they don’t resort to their compulsive behaviors. An example of this type of therapy would be having a patient who suffers from germaphobia stick their hands in dirty water without washing their hands after. Over time they’re usually able to adapt to and overcome their fears, but it takes a lot of hard work. Unfortunately, this type of therapy doesn’t work for everyone and many individuals fighting OCD need medication instead, or a combination of both. Some common OCD medications are Zoloft, Prozac, and Luvox. These are all anti-depressants approved by the FDA to treat OCD.

If you or someone you know is struggling with obsessive compulsive disorder, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/

Sources: https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml https://www.psychologytoday.com/us/therapy-types/exposure-and-response-prevention

Anxiety, Depression, Eating Disorders, ADHD, Et al: How to Support a Friend with Mental Illness

By: Sarah Cohen

When helping a friend with a mental illness, the first step should be assessment of their symptoms. Sometimes they just might be going through a difficult time, but if certain common symptoms associated with mental health issues persist it is imperative to respond sensitively. Majority of the time, friends will just want to know they have your support and that you care about them. A good way to show your support is by talking to them. If you provide a non-judgmental space for them to speak about their issues it will help encourage them to be open with their problems. Let them lead the conversation and don’t pressure them to reveal information. It can be incredibly difficult and painful to speak about these issues and they might not be ready to share everything. If you aren’t their therapist do not diagnose them or make assumptions about how they are feeling, just listen and show you understand. If someone doesn’t want to speak with you, don’t take it personally, just continue to show them you care about their wellbeing and want to help as much as possible. Just knowing they have support can give them the strength they need to contact someone who can help them.

If a friend is having a crisis, such as a panic attack or suicidal thoughts, you must stay calm. Try not to overwhelm them by asking a lot of questions and confronting them in a public setting. Ask them gently what would be helpful to them right now or reassure them. If they hurt themselves, get first aid as soon as possible. If someone is suicidal, contact the suicide hotline at 800-237-8255 immediately.

The best way to help someone is by connecting them to professional help. By expressing your concern and support you can show them that they can get help and their mental health problems can be treated.

If you or someone you know needs support with their mental illness, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/

https://www.mentalhealth.org.uk/publications/supporting-someone-mental-health-problem

https://www.mentalhealth.gov/talk/friends-family-members

Obsessive Compulsive Disorder

Sarah Cohen


Obsessive Compulsive Disorder, commonly referred to as OCD, is a disorder that is composed of patterns of unwanted or intrusive thoughts that cause repetitive actions or compulsions that create difficulties by interfering with day to day activities. This is different than being a perfectionist because OCD thoughts are not just extra worrying about real life issues or enjoying a clean house. When most people think of OCD, they usually imagine someone who is always cleaning, and while this can be a manifestation of OCD, there are many other themes OCD might center around. For example, checking things such as light switches and locks excessively in order to get to a “good” number of times. Symptoms of OCD include obsessive and/or compulsive thoughts that take up a large amount of time and prevent normal work or school functioning. Obsessions are persistent, unwanted thoughts or urges that cause anxiety and distress usually followed by compulsions which are repeated actions meant to lessen the anxiety from the obsessions or prevent something bad from occurring. OCD is more common in women than men and usually begins during the teen or young adult years. Symptoms usually start off little by little and vary throughout the lifetime of the patient. Risk factors for OCD include a family history of OCD, physical differences in the brain, traumatic life events, or other mental health disorders. While there is no cure, if a patient can manage their symptoms well, they can lead a normal life. Treatments include psychotherapy, meditation, medication, and in rare cases when both medication and therapy are not effective, neuromodulation.

If you or someone you know needs support managing their OCD, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/ .

https://www.webmd.com/mental-health/obsessive-compulsive-disorder#2 https://www.mayoclinic.org/diseases-conditions/obsessive-compulsive-disorder/symptoms-causes/syc-20354432

Perfectionism: Obsessive-Compulsive Personality Disorder (OCPD)

Perfectionism: Obsessive-Compulsive Personality Disorder (OCPD)
By: Isabelle Siegel

Oftentimes when people say “I’m so OCD,” what they really mean is “I’m a perfectionist.” Perfectionism is a trait characterized by a rigid need to be perfect: that is, without flaws. Although perfectionism is often thought of as being a positive trait, it can be maladaptive in many ways. Perfectionists tend to have unrealistically high standards, to take longer to complete tasks, to struggle with collaboration, and to place immense pressure on themselves. When perfectionism is extreme, it may meet criteria for Obsessive-Compulsive Personality Disorder (OCPD).

OCPD, not to be confused with OCD, is a personality disorder characterized by a pattern of inflexibility and a fixation with perfection. This fixation can interfere with one’s ability to complete tasks, one’s interpersonal relationships, and other aspects of one’s life. People with OCPD attempt to control life using details, rules, lists, order, organization, and/or schedules. According to the Diagnostic and Statistical Manual of Mental Disorders, OCPD is diagnosed when an individual demonstrates:

  • a fixation with details, rules, lists, order, organization, or schedules
  • perfectionism that interferes with task completion
  • overemphasis on work and productivity, leaving no time for leisure or relaxation
  • a fixation with morality and ethical responsibility
  • hoarding of objects and/or money
  • an inability to delegate tasks to others
  • an overall rigidity and/or stubbornness

Like other psychological disorders, OCPD can be treated with therapy and medication. Therapies for OCPD emphasize identifying and modifying maladaptive behavioral patterns, as well as targeting triggers (such as stress) for overly perfectionistic behavior.

If you or a loved one demonstrates symptoms of OCPD, the licensed psychologists, psychiatrists, psychiatric nurse practitioners, and psychotherapists at Arista Counseling & Psychotherapy can assist you. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, visit http://www.counselingpsychotherapynjny.com/

Sources:
https://www.goodtherapy.org/learn-about-therapy/issues/perfectionism
https://www.ocduk.org/related-disorders/obsessive-compulsive-personality-disorder/clinical-classification-of-obsessive-compulsive-personality-disorder/

Image Source: https://commons.wikimedia.org/wiki/File:Signs_of_OCPD_1.png

OCD: Perinatal/Maternal Obsessive Compulsive Disorder

Perinatal/Maternal Obsessive Compulsive Disorder (OCD)

By: Isabelle Siegel

Conversations about postpartum depression have recently become commonplace, leading many people to become familiar with the signs and symptoms of this condition. As a result, new mothers are much quicker to recognize and label their struggles and to seek help. However, the same attention has not been paid to a similar condition: Perinatal or Maternal Obsessive Compulsive Disorder (OCD).

What is Perinatal/Maternal OCD?

Perinatal/Maternal OCD is essentially OCD with onset during pregnancy or shortly after giving birth. In general, OCD involves the presence of obsessions (“unwelcome thoughts, images, urges, worries or doubts that repeatedly appear in your mind”) and compulsions (repetitive behaviors or thought patterns performed to relieve anxiety caused by the obsessions).

Expecting and new mothers with Perinatal/Maternal OCD commonly experience obsessive thoughts about their infant’s safety, including intrusive thoughts about:

  • Unintentionally harming the infant
  • Sexually abusing the infant
  • Contaminating the infant
  • Making wrong or harmful parenting decisions

They may then engage in compulsive behaviors or thought patterns in order to relieve the resulting anxiety, including:

  • Repetitively calling the doctor or other health professionals
  • Repetitively checking on the infant
  • Total avoidance of the infant
  • Excessive washing of anything with which the infant might come in contact

Treatments for Perinatal OCD

Mothers experiencing Perinatal/Maternal OCD are not hopeless. As with other forms of OCD, Perinatal/Maternal OCD can be addressed with therapy and/or medication. Cognitive Behavioral Therapy (CBT) and, more specifically, Exposure and Response Prevention (ERP) can be used to target obsessive thoughts and compulsive behaviors.

If you or a loved one is experiencing symptoms of Perinatal or Maternal OCD, the licensed psychologists, psychiatrists, psychiatric nurse practitioners, and psychotherapists at Arista Counseling & Psychotherapy can assist you. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, visit http://www.counselingpsychotherapynjny.com/

Sources:

Image Source: https://www.mothersclub.sg/mum-confessions-1/

The Less Talked-About Side of OCD: Obsessive Compulsive Disorder

By: Isabelle Siegel

When thinking about OCD (Obsessive Compulsive Disorder), most people instinctively think of those who care about cleanliness and tidiness. In fact, it is not uncommon to use the phrase “I’m so OCD” to imply that one agonizes over neatness and order. This perception of OCD is not without reason, as many people with OCD do obsess over germs, contamination, and order and engage in excessive hand washing, cleaning, and ordering.

However, it is important to note that this is not the reality for many other sufferers of OCD. OCD is a wide-ranging disorder involving the presence of obsessions—“repeated thoughts, urges, or mental images that cause anxiety”—and compulsions—repetitive behaviors performed to relieve the anxiety. These obsessions can take nearly any form, with contamination and order being only two of them. Some other common obsessions include thoughts about: losing control or going insane, harming oneself or others, unwanted sexual ideas or images, and/or religion. For example, it is well-documented that people with OCD may experience intrusive thoughts about homosexuality, pedophilia, violence and aggression, and/or suicide.

Many people with these less talked-about OCD “themes” take longer to realize that they have OCD because their symptoms are not in line with the stereotypical hand washing and tidying. These individuals often engage in different compulsive behaviors to alleviate anxiety. These behaviors may include mental compulsions such as repeated checking and rumination (that is, repetitively reviewing and evaluating one’s thoughts and their meanings). For example, the individual who obsesses about violence and aggression may repeatedly check that he/she has not unintentionally harmed those around him/her.

It is ultimately important to acknowledge this less talked-about side of OCD in order to encourage sufferers to acknowledge their symptoms and to guide them to get the treatment and help that they need. 

If you or a loved one appears to be suffering from OCD, the licensed psychologists, psychiatrists, psychiatric nurse practitioners, and psychotherapists at Arista Counseling & Psychotherapy can assist you. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, visit http://www.counselingpsychotherapynjny.com/

Sources:
https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml
https://iocdf.org/about-ocd/
https://www.psychologytoday.com/us/blog/overcoming-self-sabotage/201002/rumination-problem-solving-gone-wrong
Image Source:
https://www.helpguide.org/articles/anxiety/obssessive-compulsive-disorder-ocd.htm

Depression: Have a Case of the Winter Blues? Understanding Seasonal Affective Disorder

 

By: Keely Fell

Can’t seem to shake the winter blues? Nearly five percent of adults are experiencing symptoms that align with major depressive disorder with recurring seasonal pattern, which is more commonly known as Seasonal Affective Disorder. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), an individual who is experiencing “two major depressive episodes in the last two years” that show relations to the time of year, and experience full remissions at other times they may be experiencing Seasonal Affective Disorder (SAD).

It is also important to understand what is happening in the body and why an individual is experiencing such symptoms. When an individual is experiencing these symptoms, often it can be as a result of the lack of natural light due to the shorter periods of daylight during the winter season. With the lack of light, the human brain slows down the production of serotonin, and increases the production of melatonin which leaves individuals feeling drowsy. Melatonin production increase is caused by darkness, which is why we get sleepy when the sun goes down. The regulation of these chemicals is what helps create your body’s specific circadian rhythm. When this system is affected it can cause a feeling of lethargy and or restlessness.

Here are some tips and tricks to shaking those winter blues:

  1. Take a few minutes during your day to get outside Whether that’s during your lunch break or walking to pick up the mail, going outside during daylight will increase the serotonin production in your brain.
  2. Light Therapy During the dark winter months, if these symptoms are taking over you can try light therapy. Light therapy allows for the brain to think it’s being exposed to sunlight. People who use light therapy typically invest in a light box (if interested Harvard Health has many they recommend) which delivers around 10,000 lux, compared to a standard sunny day that ranges 50,000 lux or above. They recommend that, you sit in front of the light box for no more than 30 minutes a day. This allows for the brain to regulate its circadian rhythms by allowing the retinas to be stimulated. Light therapy does not work for everyone.
  3. Talk Therapy If these symptoms persist and are affecting your day talk therapy is also affective. Reaching out to a psychologist, psychiatrist, psychiatric nurse practitioner, or psychotherapist to come up with symptom relief is another big way to combat these symptoms. Symptom relief may include the use of antidepressants, or various therapeutic methods.

 

If you or someone you know has Seasonal Affective Disorder or seems to have the symptoms of SAD, and needs help, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/ .

Sources:

https://www.nimh.nih.gov/health/topics/seasonal-affective-disorder/index.shtml

https://www.health.harvard.edu/blog/seasonal-affective-disorder-bring-on-the-light-201212215663

https://www.psychiatry.org/patients-families/depression/seasonal-affective-disorder

 

Anxiety: Social Media Anxiety Disorder

Anxiety: Social Media Anxiety Disorder

Tatyana A. Reed

Social media is very prominent in today’s society and nearly everyone has a social media account; whether it be Facebook, Instagram, Twitter, Tumblr, etc. Although social media can be great for promoting things, it is also negatively promoting an Anxiety Disorder which is also known as Social Media Anxiety Disorder. According to ePainassist.com, “Social Media Anxiety Disorder is a mental illness that is related to generalized social anxiety, which is acquired when social media interferes with the mental and physical health of a human being.” This can mean that the idea of not being able to check your social media can cause you extreme anxiety. Your anxiety may rise because of the number of likes you’re receiving on a picture, the number of repost on your tweet, or just not getting as many views on your story. Since this new form of anxiety is now increasing, ever climbing with more technology, most people have never heard of the disorder. In this article we will delve more deeply into the topic.

According to The Anxiety and Depression Association of America (ADAA), below are some symptoms of Social Media Anxiety Disorder:

  • Lying to others about how much time you spend on social media
  • Unsuccessfully trying to stop or reduce your use of social media
  • Loss of interest in other activities
  • Neglecting work or school to comment on Facebook or Twitter
  • Experiencing withdrawal symptoms when you are unable to access social media
  • Overwhelming need to share things with others on social media sites
  • Having your phone with you 24 hours a day to check your social media sites
  • Severe nervousness or anxiety when you are not able to check your notifications
  • Negative impacts in your personal or professional life due to social media usage

At first glance, the symptoms probably seem like they would have no physical or mental effects on a person. That’s a false assumption. For starters, being on a phone constantly will affect your eyes by drying them out which then leads to headaches and vision issues. Furthermore, sitting on your phone all day, instead of being active, can cause issues with weight, lower back problems, and neck strain. Using social media constantly can also feed into OCD, depression, and feelings of loneliness, according to ADAA. We think social media is all about being able to connect and share happy things with others but many people subconsciously begin to compare their lives or physical selves to others.

 

If you or a loved one appears to be suffering from SMAD, the licensed psychologists, psychiatrists, psychiatric nurse practitioners, and psychotherapists at Arista Counseling & Psychotherapy can assist you. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, visit http://www.counselingpsychotherapynjny.com/

References:

ePainAssist, Team. “Social Media Anxiety Disorder: Causes: Symptoms: Treatment: Recovery Tips.” EPainAssist, 15 Apr. 2019, http://www.epainassist.com/mental-health/social-media-anxiety-disorder.

Fadar, Sarah. “Social Media Obsession and Anxiety.” Anxiety and Depression Association of America, ADAA, Nov. 2018, adaa.org/social-media-obsession.

n/a, n/a. “Social Media Anxiety Disorder All Occasion.” Zazzle.com, 2009, rlv.zcache.co.uk/social_media_anxiety_disorder_all_occasion-re4d11e0809ba45fbbbf7a966b6e2f527_xvuak_

Obsessive Compulsive Disorder

Obsessive Compulsive Disorder

Obsessive Compulsive Disorder

By: Julia Keys

Obsessive Compulsive Disorder (OCD) has been normalized and trivialized in society as a need for everything to be meticulously clean and organized when in reality it is a serious psychological disorder that can cause significant distress for those who have it. Obsessive Compulsive Disorder is characterized by a pattern of uncontrollable reoccurring thoughts, known as obsessions, which can only be remedied by certain behaviors, known as compulsions. People with OCD are commonly depicted as being ultra-neat or afraid of germs, which is true for some people, but the way OCD expresses itself is unique to the individual.

There are several common themes that psychologists have determined when treating patients with Obsessive Compulsive Disorder. One common theme is contamination. This may take on the literal meaning in which an object or place can be perceived as dirty, but it can also mean that contact with a person, place, or object will cause great harm. Checking is another typical behavior. One may check if something is safe or turned off over and over again. Checking can also express itself in the need for constant verbal reassurance, so a person with OCD may ask the same question over and over. People with OCD may be worried that they will suddenly lose control and hurt themselves or someone else. In efforts to qualm these obsessions, one may avoid certain places or people or have plans set in place that could prevent them from acting out these thoughts.

Common obsessions may include, but are not limited to:

  • Fear of germs or contamination
  • Unwanted forbidden or taboo thoughts involving sex, religion, and harm
  • Aggressive thoughts towards others or self
  • Having things symmetrical or in a perfect order

Common compulsions may include, but are not limited to:

  • Excessive cleaning and/or handwashing
  • Ordering and arranging things in a particular, precise way
  • Repeatedly checking on things, such as repeatedly checking to see if the door is locked or that the oven is off
  • Compulsive counting

When reading these lists one might think that these behaviors are relatively typical, however people with OCD spend an excessive amount of time and effort thinking about obsessive thoughts and preforming rituals to control them. A person with OCD may feel brief relief after preforming a compulsion, but they do not feel pleasure from such acts. Obsessions and compulsions are very difficult to control and may result in significant problems in one’s daily life or relationships.

If you or someone you know is struggling OCD, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/ .

Sources:

https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml

https://www.psychologytoday.com/us/blog/living-ocd/201107/the-many-flavors-ocd

Source for Picture:

https://www.bing.com/images/search?view=detailV2&id=47C5DD3F1D65AD247FE6091E7A61190FA00E0683&thid=OIP.X50wPNnUfEvJHrY8IH6VyQHaFj&mediaurl=http%3A%2F%2Fwww.belmarrahealth.com%2Fwp-content%2Fuploads%2F2016%2F01%2FObsessive-compulsive-disorder-OCD-questionnaire-can-also-help-determine-the-risk-of-depression-and-anxiety.jpg&exph=2475&expw=3300&q=ocd&selectedindex=57&ajaxhist=0&vt=0&eim=1,2,6

 

 

 

Bullying: Impact of Bullying on Children’s Mental Health

Bullying: Impact of Bullying on Children’s Mental Health

By Lauren Hernandez

            National media has created a frenzy of coverage surrounding Wisconsin’s controversial ordinances which fine parents if their children are bullies in school. Some may disagree with this new policy; however, others believe this harsh measure will help to eliminate bullying among school children.

Bullying can be physical, emotional, or verbal, and is a pattern of harmful, humiliating behaviors directed towards people who seem vulnerable to the bully. Oftentimes bullying happens in school, but with the rise of technology, cyberbullying is also becoming a problem. Children who are victims of bullying are typically vulnerable to mistreatment because they may be smaller, weaker, younger, and fearful of the bully; however, this description is general and does not apply to everyone. Bullies use their power, whether that is physical strength, popularity, or intimidation to harm others. Bullies tend to demonstrate signs of aggression or hostility beginning around 2 years old. It has been found that bullies have mental health issues such as lack of emotional understanding, lack of prosocial behavior, and increased rates of hostility as well as insecurity. Additionally, bullies typically have difficult relationships with their parents, teachers, and peers.

Victims of bullying not only suffer from physical consequences, but being bullied negatively impacts their mental health and overall well-being.  These detrimental social and emotional abuses can foster the development of mental health disorders such as anxiety or depression.  Victims of bullying often experience feelings of low self-esteem, isolation and loneliness. Some children create somatic symptoms such as headaches, stomachaches and other complaints which might not be valid, in order to prevent attending school. Victims of bullying generally stop liking school because they associate it with the threat of a bully. Incidents of bullying should immediately be reported to a school official, parent, or other adult that can help the victim and resolve the situation.

It is important to recognize that in most cases both the bully and the victim are suffering from mental health issues and they would benefit from treatment by a school counselor, psychologist or psychiatric nurse practitioner.

If you or someone you know who may be suffering from bullying, depression, or anxiety, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit http://www.counselingpsychotherapynjny.com/ .

 

Sources:

https://www.psychologytoday.com/us/basics/bullying

https://www.psychologytoday.com/us/blog/resilience-bullying/201906/can-wisconsin-get-rid-bullies-fining-their-parents

https://www.psychologytoday.com/us/articles/199509/big-bad-bully

Image Source:

https://www.bing.com/images/search?view=detailV2&id=E96397A385D68EA2836ABF172145323D4ACC382E&thid=OIP.yGetJrSKLf9RfOX94w0QPwHaFj&mediaurl=http%3A%2F%2Fwww.scholastic.com%2Fcontent%2Fdam%2Fteachers%2Fcollections%2F17-18%2Fbullying-prevention-collections-4-3.jpg&exph=1125&expw=1500&q=bullying&selectedindex=10&ajaxhist=0&vt=0&eim=1,2,6