Beginning Evidenced-Based Therapy: What is it? & What can you expect?

By Laura Miller, LMSW

Most of us will face challenging and stressful situations at some point in our lives and find ourselves needing more support. This is a normal part of human experience; out of necessity, humans evolved into social beings, as dependence and cooperation with one another enhanced the ability to survive. Although survival threats may be lower today, we still see that people continue to need support from others. In fact, lack of support can actually lead to increase stress.

At times, you may be able to cope with stressful life situations on your own or with the support of a trusted loved one. However, difficult circumstances may also include emotional symptoms such as depressed mood or anxiety or cognitive symptoms such as repetitive and upsetting thoughts or uncontrollable worry. It may be that even with support, that these symptoms don’t resolve. When this happens, it makes sense to consider seeking professional mental health support. The American Psychological Association recommends seeking therapy when a problem has become distressing and it is interfering with some aspect of life. Yet, you also don’t need to have a significant stressor or problem to benefitfrom therapy. If you find yourself curious about the process and can find value in having more support, that is reason enough to begin!

Benefits of Therapy & Evidenced-Based Treatments

While therapy can be a daunting process to begin, there have been numerous advances in the treatment of psychological disorders and there are many research studies to show that therapy is helpful! Treatments known as “evidenced-based treatments” (EBTs) are treatments that have been developed through extensive research and shown to be effective in treating specific symptoms. Not all mental health treatments are equally helpful and some therapies have been shown to work better than others. Due to the extensive research that goes in to developing EBTs and the amount of data showing their effectiveness in decreasing symptoms, EBTs are listed as “best practice” and “preferred” approaches for mental health symptoms by both the American Psychiatric Association and the American Psychological Association. In fact, research has demonstrated that some EBTs actually result in larger symptom improvement than pharmacological treatments, as they teach life skills that last beyond the course of medication.  There are several EBTs, including therapies such as Cognitive Behavioral Therapy, Dialectical Behavior Therapy and  Acceptance and Commitment Therapy.

What Can You Expect?

EBTs are structured and focused, and they are meant to help improve specific problem areas. In order to best meet a client’s needs, treatment first begins with a therapist conducting a clinical interview to determine problem areas. During the interview a therapist will ask a series of questions to assess overall functioning and may also give specific checklists or questionnaires to further understand the severity of problems.

EBTs require the client to take an active role. Therapy is geared at changing thoughts and behavior, rather than just talking about problems or listening to a therapist give advice. In order to achieve this, a client and therapist will collaboratively develop a plan or agenda for every session. The agenda then acts as a guide to complete several steps that are aimed at solving the problem.

Clients will learn to practice specific skills that are aimed at helping to improve the client’s problem areas. In order for clients to learn skills and integrate them into their day to day life, clients are asked to practice skills in-between sessions. Most EBTs usually involve some form of homework as practice is key to developing new behaviors and generalizing them to outside of the therapy session. Many EBTs will also include some form of self-monitoring, so that clients can learn to observe their behaviors, keep track of interventions and skills to help, and see overall improvement.

Treatment is typically short-term, lasting anywhere from 12-20 sessions. However, many people find it useful to return to treatment after completing the EBT for “booster” sessions as needed, in which clients can continue to refine their skills.

Throughout the COVID-19 pandemic, many EBT programs started to be conducted online through tele-therapy. Check out a previous BPS blog post to learn more about how an evidenced-based treatment can also be delivered virtually!

The decision to begin therapy is personal, however, with so many evidenced-based therapies that have extensive data to show their effectiveness, there is certainly something that could benefit everyone!

The Myth of Motivation & How to Stay Productive

By: Laura Miller, LMSW

“Ugh, but I’m just not in the mood to do that right now!” Sound familiar? Perhaps you’ve heard something like it from a loved one or caught yourself thinking similarly prior to starting a difficult or unpleasant task.  It’s natural and common for our mood or opinion toward a task to impact our motivation to complete it. However, we don’t actually needmotivation to get something done! Many people believe that they need to be motivated to do something in order to begin the task (i.e. motivated to begin spring cleaning or motivated to try a new workout routine in order to start cleaning or exercising). However, if you wait until you feel motivated to begin, you might find yourself stuck waiting.

Why? Well, action actually comes first and then motivation comes as an after effect of our actions! Think about the last time that you felt like staying home and relaxing and weren’t that motivated to go to the gym. However, sometimes, there’s something that occurs that you get yourself to go anyway regardless of your motivation. Have you ever noticed that after going you not only felt better about yourself but were also more motivated to go back later? That is evidence for your action morphing into more motivation! It’s normal to not feel motivated all of the time, however, if you start acting in ways that are consistent with your long-term goals and values, your motivation will build after!

Even with the understanding that we don’t absolutely need motivation to act, it can still be challenging to start tasks and stay focused and organized throughout. Since the pandemic’s start, work and school has transitioned to virtual and hybrid models that at times, may make it challenging to feel motivated and productive. In stressful environments, your productivity may look different, and that’s okay and understandable. In fact, there is some research to suggest that employees have noticed a change in their levels of energy and productivity since remote work has increased. Below, you will find tips for staying organized and productive. Remember, once you’ve decided to act, motivation will build!

 

    1. Change your perspective. If you believe that you have to feel like doing something in order to do it, it might not get done. Do an action step because you can, not because you have to. Changing your inner dialogue from “Ugh, I have to…” to “I get to do this...” can have a positive impact on your ability to get things done. Positive thinking has been shown to reduce stress and overall improve health.
    1. Create Urgency. Sometimes, procrastination continues because there’s no real deadline of when something has to get done. For example, you may have an ideal time of when you would like to finish folding the laundry, but there’s not a specific “due date.” You can create a sense of urgency by scheduling to complete tasks right before something that you would like to do! For example, choose to schedule cleaning up the kitchen thirty minutes before your favorite show begins! This way, you’ll be motivated to move quickly and get the task done so that you don’t miss out on your pleasant event!
    1. Begin a calendar and task list system. Develop and commit to using a system that you can use to keep track of all of your tasks. Consolidate everything into a phone, notebook, or app. You don’t want to have any loose papers or appointment slips, instead, keep everything in the same place. When you write out your task list, break down large tasks into multiple do-able steps. Often times, when there’s a task on a to-do list that seems too large, you can become overwhelmed and avoid it. Instead, choose a complex task from the to-do list and break it down. For example, if the task is “buy a house” it will never get completed, instead, if it is “look up realtors in town”, it’s much more likely to be completed. Set yourself up for success by having a clear system with manageable goals.
    1. Cope with distractions. It’s entirely natural for your mind to wander off to different topics and get distracted from tasks. Begin, by deciding on a reasonable length of time that you can expect yourself to focus on a difficult or unpleasant task. Set a timer for this amount of time and if distractions occur during this period, write them down and then go back to the task. Check in with the distractions that come up once your timer has gone off. Second, look for distractions in your environment and eliminate them in advance to set the stage for success!
    1. Use Reminders and Alarm Devices. When distracted, you generally don’t have an accurate sense of how much time is passing by. Set an alarm on your phone or computer to go off at regularly scheduled intervals like thirty minutes. Each time the alarm goes off, you can use this as your cue to ask, “Am I doing what I’m supposed to be doing right now or did I get distracted? Alarms can also be very useful in helping to schedule your daily routine. Develop a schedule for the day, and use alarm reminders to keep you on track!
    1. Reward yourself. Keep the momentum going by rewarding yourself after you’ve completed a task. For example, for every chore completed, allow yourself to get something from the amazon shopping cart you’ve been creating! Positive reinforcement is a useful tool in increasing the chances that someone will continue to engage in a desire behavior. Throughout the task, you can imagine yourself enjoying your reward!

Neuropsychological Evaluations: What Are They? & When Should You Consider Them?

By: Laura Miller, LMSW

Over the last year learning environments have drastically changed due to COVID-19. Many students have transitioned to remote and hybrid learning models and faced virtual learning challenges. For example, students must maintain focus despite home distractions being readily available, manage technical issues, all while coping with decreased socialization. These changes require a new set of skills and it’s entirely understandable if your child has needed extra support this school year.

However, in some cases, it may be important to consider if your child is struggling with something beyond the difficult transition to remote learning. According to the National Center for Learning Disabilities, one in five children in the United States experience learning and attention issues indicative of a learning disorder. Furthermore, forty-eight percent of parents falsely believe that children will outgrow these brain-based difficulties, when a child may actually require more support and intervention.

In order to more fully understand your child’s learning profile, an assessment known as a neuropsychological evaluation can be completed to identify your child’s strengths and weaknesses as well as determine the kinds of supports that can help your child thrive. Keep reading to better understand what this type of evaluation includes as well as know when it may be helpful to consider.

What is a Neuropsychological Evaluation?

neuropsychological evaluationNeuropsychology refers to the study of the relationship between behavior, emotions and thoughts and brain function. Neuropsychological testing gathers information through several sources, including standardized tests, observations of the child during testing and questionnaires completed by both parents and teachers. By gathering this information, evaluators can determine how a child learns and processes information.

In order to further understand how someone processes information, a range of domains including verbal, spatial, attention, memory, reasoning and organizational skills are assessed. Academic skill development is also measured so that there can be a clear picture of where a student is in terms of their reading, math, spelling and writing skills. Furthermore, this in-depth assessment can help identify underlying problems that a child may be having. For example, if a child is struggling to follow directions, an evaluation can help determine if the child has difficulty concentrating when directions are given, difficulty comprehending directions received, difficulty remembering directions, or a combination of several difficulties. Once underlying causes are determined, then appropriate supports can be put into place.

neuropsychological evaluationGathering the information needed for a neuropsychological evaluation can be a lengthy process. Often times, this process usually requires several meetings and involves both the child and the parent. While lengthy, many children actually report enjoying the process because they are interacting with a supportive adult and receiving positive attention.

 After the evaluation is complete, a report will be written that explains a child’s history, their tests results, and a recommended plan of intervention. Often times, this report can be used to advocate for special services within the child’s school system so that the child’s needs are best met.

When Might My Child Benefit From More Testing?

neuropsychological evaluationOf course, when you see your child having any difficulty in school, there is the natural instinct to want to help. So, how do you determine if your child truly needs neuropsychological testing? One of the ways to make the decision is to ask; “Is there a persistent problem across contexts? For example, are multiple teachers having concerns regarding attention, behavior or academic performance? Do problems persist despite tutoring sessions? Is your child’s overall well-being being negatively impacted by their cognitive, emotional or behavioral abilities? For example, a child may do poorly on their math test and it might be a point of concern, yet not have ongoing negative impact. However, if a child is consistently doing poorly, and hasn’t gotten higher than a C- in the last six months and is now reporting a negative view of their overall ability, it may be an indicator that there are problems to further investigate. Below is a list of some behaviors that may indicate a need for neuropsychological testing:

· Inability to sustain attention

· Anxiety /fear or reluctance to engage in developmentally appropriate activities

· Slow acquisition of academic skills compared to peers

· Behavioral problems in school

· Difficulty maintaining organization and focus for sequenced (multiple-step) tasks

· Low self-esteem and anxiety about school performance

· Intellectually mature yet inconsistently performing or underperforming academically

If you’re wondering if your child may need a neuropsychological evaluation, start by reaching out to your child’s teachers and gathering information on their functioning in school. Often times, school districts will also have the ability to complete some testing within the school or can provide a recommended list of trusted evaluators. You can explain to your child that all kids learn differently and everyone has strengths and weaknesses, and that you want to help them figure out how they can learn best! Ultimately, a neuropsychological evaluation will help your child get on the path to being their most effective and productive self in school. Check out this webinar on evaluations to continue to learn more!

Surviving Winter Skillfully

By: Laura Miller, LMSW

Winter is here and for the time being also here to stay. Freezing cold temperatures and brutal winter storms have swept through the country over the past couple of months. Most recently, winter weather caused unprecedented devastation in areas throughout Texas, leaving millions without power and access to water. Alongside the destruction that winter storms may cause, the change in weather can also leave many people feeling isolated and down. This winter, given COVID-19 restrictions, many people may feel even more isolated and experience low mood. While many may long for warm summer months and day dream of walking outside without needing to bundle up in layers, others may experience Seasonal Affective Disorder (SAD), a type of depression related to changes in the season. Thus, don’t just brush off any changes in mood with a case of the “winter blues” or an “annoyance with the cold” and make sure to check out the below steps to stay in control of your emotions throughout the change in seasons.

Dialectical Behavior Therapy (DBT), is a skills-based intervention aimed at helping people gain more control over their emotions. From the category of emotion regulation skills, comes “ABC PLEASE”, a catchy mnemonic to help remember how to reduce vulnerability to unwanted negative emotions that the winter months may be more likely to prompt.

surviving winterA: Accumulate Pleasant Experiences: Depression is thought to be maintained by the dynamic that when someone is depressed they are often isolated and withdrawn, with little access to stimuli that offer any reward. While it may feel intuitive to cut back on activities and responsibilities when you don’t feel up to it, becoming less active can actually increase low energy, fatigue and worsen depression. When this happens, one can become a part of a vicious cycle of worsening depression. In order to break the cycle, one use behavioral activation, a type of depression treatment, to increase pleasant events. Increasing pleasant events can lead to positive emotions and making a concerted effort to engage in multiple pleasant activities can help to create a buffer between you and stress. It’s as if each time you engage in something pleasant, you put “money in the bank” to be later drawn on when you need it (i.e. for when stress comes along). However, not engaging in any pleasant events will leave you low on resources and create additional stress! While it can feel more challenging to find pleasant events in the winter time, spend time brainstorming a list of pleasant things; read a book, watch a new movie, connect with someone you haven’t talked to in a while, bake a cake, etc. The possibilities are endless!

B: Build Mastery: Do at least one thing each day that helps you feel competent and in control of your life. For example, practice an instrument, work on a home improvement project that you’ve been thinking about doing, learn to knit or teach yourself a new language! Turn the time spent inside this winter into time spent doing something that you’ve always wanted to accomplish. The idea here is to challenge yourself a little, get better at something, or cross something off of your “to-do” list. As you achieve your goals, you will feel productive, competent and ultimately experience a mood boost! Plan for success, and pick something that will be difficult yet also achievable. You can gradually increase the difficulty over time as you reach your goals.

C: Cope Ahead of Time with Emotional Situations: Everyone has certain situations that will likely make them more vulnerable to experiencing negative and unwanted emotions. For example, some people become more irritated when they haven’t eaten or feel sadder every time it starts to get dark out. Think ahead of time of all of the situations that may lead you to experience negative emotion and plan in advance for how you might help yourself cope. For example, can you make sure to set alarms throughout the day for a reminder to eat meals and also have snacks prepared ahead of time? Would it be helpful to make sure all of the lights are turned on prior to the sun going down and also turn on your favorite music to have on in the background as it gets dusky and turns into evening? Imagine yourself in the situation that causes you stress and rehearse in your mind ahead of time exactly what you can do to make yourself feel better. Having a plan in advance can help you cope in the long term!

PL: (Treat) PhysicaL Illness: You can take care of your mind and emotional well-being by first taking care of your physical health. Take medications as prescribed, go to the doctor when necessary and listen and respond to your body’s needs. You can also be sure to check out the Centers for Disease Control and Prevention’s (CDC) guidelines on how to prevent the spread of COVID-19 here

E: (Balanced) Eating: What you eat and drink can impact your mood. Pay attention to how you feel after eating certain foods and note the foods that make you feel more energized. Make sure to get enough nutrition so that you feel fueled to go about your daily tasks.

A: Avoid Mood Altering Drugs: Avoid any non-prescribed drugs as they may make you more vulnerable to negative emotion and also have consequences on your physical health.

S: (Balanced) Sleep: Try to get the amount of sleep that helps you feel rested throughout the day. If you feel rested, you will be better prepared to complete your daily tasks by having more energy and motivation throughout the day. When someone is sleep deprived, it can have significant consequences on their emotional well-being. However, getting the proper amount of sleep has been shown to result in significant mood boosts. Keep reading here to learn tips on improving your sleep hygiene.

E: (Get) Exercise: Do some sort of exercise every day. Don’t let the cold weather totally rule your exercise routine. It’s better to do laps around the house, or walk up and down the stairs inside, rather than avoid exercise altogether. You can start small and build up your exercise routine over time. In addition to all of the positive effects on physical health, exercise has been shown to have a significant positive impact on mood.

While it can sometimes feel like the winter months are never going to come to an end, remember that eventually, it will. Don’t wish this time in between winter and spring away, but rather, think about how you can turn this time into a period of self-care for yourself. And of course, if you feel like you need more support reach out to a mental health professional. Here at BPS we are wishing you all a safe, peaceful and healthy winter. Stay warm!

Learning to Ask Difficult Questions About a Loved One's Safety

By: Laura Miller, LMSW

The unfolding of the current coronavirus pandemic has resulted in profound mental health consequences. Individuals are facing unprecedented levels of uncertainty, managing anxiety and depression, coping with sleep disturbances, all while continuing to face incredibly difficult situations. Given the ongoing and significant number of stressors, there is concern among researchers that rates of suicide may increase throughout the pandemic. Furthermore, research trends suggest that significant predictors of suicide such as depression, suicide ideation and self-harm behaviors have already increased since the pandemic’s start.

With concern, must come preventative action; it’s incredibly important to remain alert to risk factors that may increase the likelihood someone considers suicide. Equally important is knowing how to approach conversations around this topic.

learning to ask difficult questionsFirst, one of the greatest myths of suicide is that you shouldn’t talk about it with someone else because by doing so you may somehow “implant” the idea of harming oneself into someone else’s head. Although often accepted as true in mainstream culture, this has been debunked several times in research settings. In fact, there is actually evidence to support the opposite; talking about suicide may reduce, rather than increase suicide ideation and actually lead to mental health improvements. It’s important for people to know that they can discuss these topics, and that it’s okay to both ask for and offer help.

Even with the understanding that talking about suicide isn’t going to encourage someone to think about doing it, it’s still not grounds to talk about the subject cavalierly. Below are some tips and ideas on how you may start a conversation.

  • “Did you hear that since the start of the coronavirus pandemic more people have been experiencing depression and suicide ideation? It was really difficult for me to learn that so many people are struggling at the same time. This has been a very difficult time period. What do you think about it?” (By using this prompt, you are modeling appropriate sharing of your reactions to the topic while also promoting open disclosure of someone else’s reactions.)

  • “How do you feel when talking about coronavirus’s impact on mental health? Do you ever talk about this in school or with friends? Have any of your peers shared that they are having a difficult time with you?” (Sometimes, people are often more comfortable talking about other people’s reactions and might prefer to start the conversation discussing someone else’s feelings or reactions prior to speaking about themselves.)

  • Many people are feeling anxious, overwhelmed and have experienced significant mood changes throughout the pandemic. Have these ever been challenges for you? (This prompt allows you to broaden the conversation from suicide to its underlying risk factors).

  • “I want you to know that I am always here for you if you want to talk. I may not know exactly how to make the problem go away, but I can always listen and work to understand how you’re feeling. Is there anything that I can do to make myself more available to you?” (With this conversation starter, you are conveying that you are present and will be receptive to someone’s needs).

  • “Sometimes, when people are experiencing significant stressors and hopelessness about the future they may experience thoughts of suicide. Have you ever had thoughts like this? I’d love to talk about it with you so that I can provide you with any support that you may need.” (Using this prompt, you are asking directly to show that you are not afraid of this topic and that you’re available to talk).

If the individual you’re talking to expresses some thoughts about suicide, it’s important to gently find out more information. You can generally ask when they started having these thoughts and what stressors they are currently experiencing. Next, it’s important to ask the person whether they have made any plans or thought about how they might attempt suicide. Next, you can ask if the person has any intention of acting on their plans and how often they think about completing their plan. It is important not to over-react or under-react, and instead be an understanding an empathetic listener.

Additionally, take some time to assess if the person your speaking to has experienced any risk factors or warning signs. For example, have they experienced a recent job or financial loss, death of a loved one, or have a history of engaging in impulsive behavior?

learning to ask difficult questionsHave you noticed a recent shift in mood, a change in sleep pattern, or do they appear to be more withdrawn? (For more information on assessing risk factors during COVID-19, click here.) Make your goal to gather as much information as possible so that you can make an informed decision about what to do next.

 

If the person you are speaking with is currently experiencing risk factors and warning signs and also expresses thoughts of suicide, citing that they think about it often, and have also thought about a method or made a plan, these are significant concerns. If you are worried, call a mental health professional and or recommend that someone seek emergency services. You can also provide resources such as the National Suicide Prevention Hotline. Talking to individuals about suicide and assessing risk can be an incredibly stressful. If you have any concerns, contact a mental health professional immediately.

Understanding Trauma

By: Laura Miller, LMSW

Previous blog posts, Understanding Anxiety and Understanding Depression, both discussed the significant impact that the coronavirus pandemic has had on mental health. For months, society has been faced with unparalleled levels of uncertainty, significant loss and oftentimes, inadequate resources to cope. Now, research suggests that the ongoing stress from the coronavirus pandemic may lead to the development of trauma responses. Research also shows that receiving support as early as possible, is critical for minimizing the long-term effects of trauma. Keep reading to better understand trauma, recognize signs and symptoms and learn ways to cope.

What is Trauma?

Trauma results from exposure to an incident or series of events that is emotionally-disturbing or life-threatening. Traumatizing events can be directly experienced, witnessed or learned about from others. When an individual is exposed to a traumatic event, a person’s coping capabilities can become overwhelmed and one’s sense of safety and security can become entirely disrupted.

Effects of Trauma

understanding traumaWhen an individual experiences danger, the body’s “fight-flight-freeze” response is triggered to help the body prepare to defend itself against the threat. However, an individual who has experienced a traumatic event(s) may continue to experience this defense response in non-threatening situations. This is an entirely normative response; the “fight-flight-freeze” response can get “stuck” and not function as properly when it doesn’t know how to process disturbing information. Furthermore, out of care, the body and brain can stay in “defense mode” making every effort to protect against future risk. However, developing hypersensitivity and vigilance to potential risk can leave individuals feeling disconnected from the present moment and inadvertently lead to more suffering.

In addition to developing a hypersensitive “fight-flight-freeze” response, individuals may also experience intrusive memories of the event, actively try to avoid thinking or talking about the event or avoid the people or places associated with the trauma, experience negative changes in thinking and mood, as well as changes in physical and emotional reactions. Click here to review a list of common symptoms.

Research also demonstrates that traumatic experiences can change the brain and alter certain phsyiological responses. For example, prolonged trauma exposure can decrease the volume of areas of the brain responsible for cognitive functions such as short-term memory and emotion regulation. There is also a growing body of research to suggest that trauma exposure can increase one’s risk of developing physical health problems such as chronic lung, heart and autoimmune diseases.

Ways to Cope

1. Be non-judgmental. Everyone responds to trauma differently and there is no “right” or “wrong” way to think, feel or respond after one has experienced a traumatic event. Develop a non-judgmental attitude toward your own reactions, remembering that your response is a normal reaction to an entirely abnormal event. Additionally, let go of any preconceived notions that you shouldn’t ask for help. Reaching out for help is a sign of strength and it’s never too late to ask for help when you need it.

2. Allow yourself to grieve. Whether or not a traumatic event involves loss of a loved one, as a survivor of trauma, one must learn to grieve with the loss (at least temporarily) of one’s sense of safety. A natural reaction to this loss can be grief! Allow yourself to experience sadness and acknowledge that it makes perfect sense to be feeling this way.

3. Get your body moving. Trauma disrupts the body’s nervous system and can paralyze individuals in fear and arousal. Give your body the opportunity to reset its nervous system and release physical arousal through movement. You can start small with stretching or going on a short walk and then increase from there. You can also self-regulate your nervous systems through relaxation techniques such as progressive muscle relaxation. Taking care of your physical health is critical, as having a healthy body can help support your ability to cope with stress.

4. Stay connected to others. Oftentimes, if you’re experiencing symptoms of trauma

there can be a tendency to withdraw and isolate from others. You may feel too exhausted to talk and spend time with others, however staying alone can make things worse by not providing any distraction from thoughts and memories about the trauma. While you don’t have to share any details of the trauma with others if you don’t want to, it’s important to turn to trusted individuals and feel like you can share your emotions without judgment.

understanding trauma5. Engage in pleasant activities. You might not feel up to doing anything, but begin by making a list of pleasant activities that you might enjoy. If you need help brainstorming, begin by thinking about the past; what did you like to do before you experienced the traumatic event? Try to pick a few things to do even when you don’t feel like it. It’s important to develop distractions and engage in activity entirely unrelated to the traumatic event.

Healing from trauma is possible. Human beings are incredibly resilient and with the proper support can learn to cope with even the most unimaginable and horrific events. However, recovery from trauma takes time and if months have passed and you’re continuing to experience symptoms, you may need professional help. There is a wealth of research to support the effectiveness of evidence-based-treatments for trauma that you can read about here. Do not hesitate to reach out for more support when you need it.

Understanding Depression

By Laura Miller, LMSW

In a recent blog, Understanding Anxiety, we discussed the impact of the coronavirus pandemic on mental health. In fact, since the pandemic began, the number of adults who reported symptoms of anxiety more than tripled in comparison to the number of adults who reported symptoms prior to the pandemic’s start. Sadly, this is only one statistic among many, which testifies to the unrelenting crises of an incredibly challenging year.

understanding depressionAs 2021 begins, it’s natural to reflect on the typical feelings that occur related to the start of a new year; renewals of hope, commitment to change and optimistic views of new beginnings. However unfortunately, the start of this year has already been met with significant political unrest and continued coronavirus related challenges. At some level, the continuation of hardship is to be expected; there is little evidence to suggest that difficult times respect arbitrary calendar perimeters. However, at the same time, people need separation from difficulty. So, how do you continue to move forward and hold on to hope for the future and new beginnings?

Well, first, recognize that it’s totally understandable and okay, to not be okay. In addition to anxiety, symptoms of depression have also increased significantly since the pandemics start. In comparison to typical new years, often offering "new beginnings" and "fresh starts," the rocky beginning to 2021 may lead to experiencing a more (or continued) pessimistic outlook, and worsening in mood. Keep reading for more information on depression as well as learn ways to cope.

What is Depression?

understanding depressionEveryone experiences times of “bad” mood. For example, feeling sad, unhappy, irritable, cranky or even very bored. However, typically, one is able to “bounce back” pretty quickly with their mood changing in a couple of hours or a couple of days. However, sometimes, these moods last a long time; two weeks or even more. This longer length of time is indicative of depression and one cannot just “snap out of it.” Depression is a mood disorder that affects the way one feels, thinks, behaves and relates to others. See below for a list of common symptoms and click here for more information on how depression may present in different age groups.
 

Emotions:

● Sad or irritable

● Hopeless about the future

● Guilty

 

Thoughts:

● Difficulty concentrating, remembering information, making decisions

● Self-blame or criticism

● Loss of interest in activities once enjoyed

● Thoughts of death or suicide

 

Behavior:

● Crying

● Change in appetite, weight loss/weight gain

● Avoiding people/isolating

● Difficulty sleeping /Loss of energy

● Self-harm behaviors

 

What Happens?

Sometimes, depression can be prompted by recent experiences, such as death of a loved one, loss of a job or relationship difficulties. Other times, depression can occur without an identifiable prompt. Yet in both cases, the way one thinks about their circumstances often contributes to depression. When someone is depressed the brain focuses more on negative experiences and has negative beliefs about the world, other people or the future. With this understanding, one can then learn strategies to reframe their negative thoughts. Depression is also thought to be maintained by the dynamic that when someone is depressed they are often isolated and withdrawn, with little access to stimuli that offer any reward. While it may feel intuitive to cut back on activities and responsibilities when you don’t feel up to it, becoming less active can actually increase low energy, fatigue and worsen depression. When this happens, one can become a part of a vicious cycle of worsening depression. In order to break the cycle, one must work to increase activity.

 

How to Cope:

Depression is among the most treatable of mental disorders. Almost all individuals who experience depression experience some relief from their symptoms with proper intervention.

1. Talk to your doctor or mental health provider. If you are experiencing symptoms of depression talk about your concerns with a professional who can help. Cognitive Behavioral Therapy (CBT) is one of the most effective treatments for depression. This treatment can help you learn how your thoughts and your behavior influence the way you feel. You will learn ways to change your thoughts and your behaviors so that you can overcome depression.

  1. 2. Tell someone that you trust that you are struggling. Oftentimes, if you’re experiencing symptoms of depression there can be a tendency to withdraw and isolate from others or you may feel too exhausted to talk or too ashamed or guilty to ask for help. Remember, that this is the depression talking. Be nonjudgmental toward yourself and let go of any preconceived notions that you shouldn’t ask for help. Reaching out for help is a sign of strength and it’s never too late to ask for help when you need it.

    3. Challenge negative thoughts. Put your thoughts on a witness stand as if they’re on trial. Ask yourself, what’s the evidence that these negative thoughts are true? Cross examine your thoughts to determine if they are the most accurate. It’s not that you are only allowed to think about positive things all the time (this probably wouldn’t be realistic anyways!), yet you do want to learn to think more accurately and not always assume the worst. Check out this list of common unrealistic thoughts.

    4. Engage in pleasurable activities. You might not feel up to doing anything, but begin by making a list of pleasant activities that you might enjoy. If you need help brainstorming, begin by thinking about the past; what did you like to do before you were feeling this way? Try to pick a few things to do even when you don’t feel like it. Gradually, as you engage in pleasant events you’ll feel more upbeat and energetic. Keep reading about behavioral activation; a treatment that emphasizes engagement in pleasant activities in order to overcome depression here.

    understanding depression5. Take care of your physical health. Your physical health has a huge impact on your mental health, and when depressed, your physical health can be altered and may need more focused attention. Make sure you're eating balanced meals with plenty of nutrition and don’t skip out on meal times, as lack of nutrition can increase irritability. Furthermore, focus on getting some exercise. While getting out of bed can seem daunting, let alone going outside for a walk, research shows that exercise can be as effective as medication for some people. Additionally, developing a new sleep routine may be helpful. Check out this list of sleep hygiene tips.

6. Monitor stress and use relaxation techniques. Oftentimes, individuals experiencing depression will also experience anxiety. Monitor your stress level and use relaxation techniques to reduce the physical arousal associated with stress. You may also want to develop a “wellness toolbox;” a prepared kit of items to help you self-soothe and relax when you need it.

Depression can be very isolating and a difficult disorder to manage. Remember, you are not alone and there are people who want to help. Do not hesitate to reach out for support when you need it. If you are ever in need of immediate assistance and support, you can call the 24-7 National Suicide Prevention Hotline at 1-800-273-8255.

Learning to Practice Acceptance Amongst Significant Change

By: Laura Miller, LMSW

In a recent blog, mindfulness, a practice of purposefully bringing your attention to the present moment and being aware of thoughts, emotions and physical sensations without judgment was discussed. This practice can be used toreduce stress and improve mood. Mindfulness benefits may be especially important throughout the holiday season, as the advertised most “wonderful time of the year,” can also be incredibly stressful. This year has likely included even more stressors than past years and perhaps significant unwelcomed change due to the ongoing coronavirus pandemic. Many holiday traditions might look entirely different this year; perhaps you’re gathering in much smaller groups, celebrating alone or unable to travel. With so much change, this holiday season might require a larger skill set, including both mindfulness and ways to tolerate and accept the unwanted change that has occurred.

At times, change can be exciting, for example, when one chooses to move to a new city or start a new job, however when change comes unexpectedly or without any desire, (i.e. losing a job or being unable to travel for the holidays due to COVID-19 restrictions) change can be painful. Depending on the circumstances, your reaction to change may vary from excitement to sadness. Yet in all cases, your attitude toward the change affects your experience of it. The good news? You can improve how to cope with change by recognizing (or being mindful!) of your reaction as the change occurs.

In most cases, reacting to change with “willfulness” can often make the situation worse. Willfulness is ignoring reality; or rejecting the unwanted change or other painful event that has occurred. For example, you may find yourself saying, “Why me!? This isn’t fair! I’m not going to deal with this! It shouldn’t be this way!”. While this attitude is understandable (of course it makes sense to not want to tolerate and cope with a painful situation), rejecting what is happening in the moment often makes the situation worse. Rejection of pain keeps someone stuck in bitterness, anger, unhappiness and

other painful emotions. So much so, that Marsha Linehan, Ph.D., the treatment developer of Dialectical Behavior Therapy, writes that “pain plus nonacceptance equals suffering”. Linehan coined the term, “radical acceptance”, meaning that one must accept rather than fight painful situations with mind, heart, and body and accept something “all the way” in order to cope. (Clickhere to watch Marsha Linehan further discuss acceptance.) Yet, acceptance of a painful situation is often not a desirable option either... keep reading to better understand how and why acceptance might help!

Why Bother Accepting Unwanted Change or Painful Situations?

  1. Rejecting or denying reality doesn’t actually change reality. Although avoiding a painful situation or denying what is happening might make you feel better in the moment, it doesn’t actually change what is happening. Resistance and or the willpower to ignore pain won’t actually help change the painful situation.
  2. Changing reality requires first accepting reality. Fighting reality often interferes with one’s ability to be able to see the painful situation clearly. For example, if one refuses to accept that COVID-19 may interfere with their holiday traditions and that they will need to take safety precautions over the holidays, one might not properly prepare or take the necessary precautions, potentially resulting in even more difficult to manage and painful situations. Accepting the facts of a situation can be helpful for future coping and problem solving.
  3. Acceptance May Lead to Sadness (at first) but deep calmness and freedom follows. Coming to terms with the reality of the situation can result in sadness, it’s hard to acknowledge painful events as true. Allow disappointment and/or sadness to arise and be kind to yourself by using self soothe skills. Although incredibly difficult, once one accepts what’s happening and stops fighting reality, the amount of effort and mental energy that was going into fighting the situation no longer has to work so hard. At times, no longer fighting the situation can result in a calmness. Ultimately, accepting what is happening and living in reality offers a sense of freedom where you don’t have to feel controlled by willful thoughts like “why me?” and “this isn’t fair!”.
  4. Acceptance decreases psychological suffering. Acceptance has been found to havesignificant psychological benefits and as Marsha Linehan, PhD indicates “reduce suffering.” Accepting experiences as they occur has been linked to improved psychological well-being, life satisfaction and decreased depressive and anxiety symptoms.

Even with the understanding that acceptance has benefits, it is still incredibly difficult. Remember, that acceptance is not the same as approval nor is it minimizing the emotional difficulty that may be associated with the painful event. Furthermore, accepting reality is not giving up nor giving in, in fact, it’s quite the opposite; it’s accepting what is happening so that you can then choose how you want to cope rather than resigning to the pain of the unwanted situation.

How to Accept Unwanted Change:

  1. Observe willfulness. Notice when you are having difficulty accepting change and painful situations and describe what you are having difficulty accepting without judgment. At times, it can be easy to fight reality without even realizing that you are doing it. Acknowledging that you are not accepting, is the first step to later acceptance.
  2. Remind yourself that you can’t fight reality and consider what you need to accept. Remind yourself that fighting what’s happening in reality doesn’t change reality and begin to consider what it is that you are actually having difficulty accepting.
  3. Practice Accepting. Practice letting go of the tension in your body (check out these relaxation techniques) so that you become more open to acceptance. By relaxing your body, you can also relax your mind and become more open to acceptance. Begin to think about what you are accepting and imagine yourself accepting the situation entirely. Practice saying out loud “yes, I can handle this!”.

You can also check out this step by step guide to radical acceptance .

Similar to mindfulness, acceptance is also an ongoing practice. At times, acceptance can last a moment or two, and then willfulness can pop back up (i.e. Ugh, but do I really have to cope with this?!”). Continue to observe when you’re willful, and be willing to “turn the mind” to acceptance and make an inner commitment to continue to accept reality as it is. You may find yourself turning the mind over and over again back to acceptance, and this is okay. Acceptance is a difficult process, yet it comes with high reward when suffering can be reduced.

Remember, be kind to yourself this holiday season. You are not alone in facing these unprecedented challenges. Make an effort to spend extra time taking care of yourself and don’t hesitate to ask for support when you need it.

From all of us at Behavioral Psych Studio, Happy Holidays!

Understanding Anxiety

By: Laura Miller, LMSW

There’s no question that 2020 has been a year of significant and unrelenting challenges. Across the globe, individuals have been tasked with managing financial crises, flexibly adapting to virtual learning and or employment, monitoring and coping with on-going health risks and tragically, over 280,000 families are grieving the loss of loved one due to COVID-19. In addition to these challenges, one of the most difficult things of 2020, has been the invisible yet fiercely felt unprecedented levels of uncertainty that we are confronted with daily. Humans find comfort in routine, yet 2020 has been a year of ongoing disruption. For many, this may have contributed to a significant decline in overall well-being and mental health. More than one in three adults in the U.S. have reported symptoms of anxiety during the pandemic which is more than triple the number of adults that reported symptoms prior to the pandemic’s start. Continue reading to better understand anxiety as well as learn ways to cope.

What is Anxiety?

Anxiety is the body’s natural response to stress. It is a feeling of fear or apprehension about what’s to come or at times, preoccupation and worry about something that has already occurred. Although anxiety can be uncomfortable, anxiety is actually a very normal and helpful emotion. Anxiety helps individuals respond to real danger (i.e. prompts you to move quickly out of the way of a speeding car) as well as prompts individuals to perform at their best (i.e. motivates you to prepare for a test/job presentation).

What Happens?

When anxiety is experienced, the body’s “fight-flight-freeze” response is triggered, which helps the body prepare to defend itself. This is a very helpful response when someone is in danger; for example, when a bear is coming at you while hiking in the woods! In this dangerous moment, anxiety will help you “fight” (i.e. yell and wave your arms to appear big and scary to the bear), flee (i.e. sprint away from the bear to safety) or freeze (stay quiet and still until the bear passes).

anxiety cycleHowever,“fight-flight-freeze” can also be triggered in non-threatening moments. Emotions are blind to what is actually happening, resulting in this response being triggered when something feels dangerous but really isn’t, such as beginning your first day of work or school entirely remotely or thinking about when you will be able to gather with a large group of friends. Although these moments are certainly challenging, they are not dangerous per-se. Yet, the feeling of danger can be so strong that you may snap at people (fight), have a hard time thinking clearly (freeze) or become overwhelmed enough that you entirely avoid your work or school responsibilities (flight). Anxiety becomes a problem when our “fight-flight-freeze” response continues to react when there is no danger present. It’s similar to having an overly sensitive smoke alarm system in your body; you certainly want to make sure it’s functioning properly for when there is danger present, but don’t want it alerting you to false alarms.

How to Cope:

Differentiate between “real” and “false” alarms. Check the facts of the situation, is there real danger present? Is there a threat to your life or health or a threat to someone that you care about? If not, begin to wonder if this may be a “false alarm.” Try describing the facts of the situation that you can observe through your five senses and challenge any judgments that might come up. Ask yourself, “Am I assuming a threat to come true?”. If so, label the threat, and assess the probability of your assumption coming true. Try to think of as many other possible outcomes as you can. You can even imagine yourself coping well with “worst case scneario” too!

Get to Know Your Anxiety. Learning the warning signs of anxiety can help you become less afraid of it when it occurs. (Oftentimes we experience anxiety, about our anxiety!) Get to know your anxiety by noticing what happens when you're anxious. You can ask yourself; “What happens when I’m anxious?” or “Where do I feel anxiety in my body?”. Many people experience physical sensations such as an increased heart beat, sweating, stomach upset, feeling dizzy or numbness. Also be on the lookout for anxious thoughts. Are you only thinking about worst case scenarios and “what ifs”? Label these thoughts as “anxiety mind” and indicators of a “false alarm.” Then, try to replace your anxious thoughts with positive coping statements like; “this may be hard and I can ask for help if I need it.”

Don’t Avoid Situations That Make You Anxious (Yes, really!!). It’s entirely natural to want to avoid the situations that make you anxious. However, if you continue to avoid situations that are non-threatening, you and your brain will never get the opportunity to learn that 1) your feared worst case scenario might not have actually come true and 2) you might actually have been able to cope even if your feared outcome did occur! Avoidance actually contributes to anxiety increasing creating a vicious cycle. In order to break the cycle, practice “opposite action” and approach the situations that make you anxious!

Practice Relaxation Techniques.

understanding anxietyAs discussed, anxiety can prompt physical sensations and physiological arousal that is uncomfortable. In order to combat these changes, practice relaxation techniques. Check out this list of relaxation techniques to try when anxious. Additionally, develop a kit of items that you can use to self-soothe when anxious; perhaps a good smelling candle or favorite blanket to cuddle with!

 Most importantly, let go of any judgment that you have or yourself for being anxious. This has been an extremely challenging year and it makes perfect sense to be on high alert. Make a conscious effort to schedule time to engage in pleasant activities and take care of yourself. And of course, don’t hesitate to ask for help when you need it.

A Mindful Holiday Season

By: Laura Miller, LMSW

With the start of the holiday season among us, you may be experiencing an increased sense of excitement and energy. However, you may also be feeling the pressure to make it “the most wonderful time of the year” and have a growing to-do list of holiday preparations while still managing the unique stressors of the coronavirus pandemic. With so much to accomplish, it makes sense to be pulled to tackle all of it at once. For example, completing a work report while searching for the best holiday recipes or folding the laundry while watching the news and planning your gift giving.

However, while multitasking may feel helpful, you may ultimately find that you’re losing connection with what is actually happening in the present moment; missing out on how you’re feeling or what you’re actually doing. Furthermore, with so much focus on the upcoming holidays, we become so future-focused, that we sometimes miss out on the small yet enjoyable things that are occurring in the present moment. This disconnect from the present moment can leave someone feeling even more stressed and may contribute to a worsening mood. Keep reading to learn more about mindfulness, a way to stay connected to the present moment and manage stress this holiday season.

What is Mindfulness?

mindfulness  Mindfulness has emerged as a new buzz word; the answer to all things stressful. However, beyond the buzz...what actually is it? Mindfulness is the practice of purposefully focusing your attention on the present moment, being aware of thoughts, emotions and physical sensations without judgment and without trying to change them. Click here, to listen to Jon-Kabat Zinn, a prolific mindfulness writer and treatment developer of Mindfulness-Based Stress Reduction, elaborate on his definition of mindfulness. You may also enjoy watching this animated clip on mindfulness.

A key component of mindfulness is acknowledging that it is a practice. One does not achieve mindfulness, yet practices it! It’s entirely natural and normal for your mind to wander off to different topics. Mindfulness is the act of noticing when the mind has wandered off to thoughts of the past or future and bringing it back to whatever is going on in the current moment. As you think about mindfulness this holiday season, recognize that bringing your mind back to the present moment is like building a muscle and that practicing mindfulness over time will help to grow that muscle.

Why Practice Mindfulness?

Research has demonstrated that practicing mindfulness is associated with several improvements. For example, practicing mindfulness has been shown to have a positive impact on overall well-being, mental health, relationship satisfaction,ability to sustain attention, job burnout and creativity. Furthermore, mindfulness has been shown to have physical health benefits such as improving cardiovascular health and immune response as well as decreasing cognitive decline, chronic pain, cell aging and other physical ailments exacerbated by stress such as eczema, asthma and psoriasis.

mindfulnessMindfulness can also help individuals make decisions. For example, think about what happens when you respond to a text that makes you angry immediately versus what happens if you wait a little while. Oftentimes, the non-mindful response (having no awareness of anger) has unwanted consequences. Mindfulness can also increase your compassion for yourself and others. Remember, mindfulness is the practice of noticing what is happening in the present moment without judgment. Let go of those judgments toward yourself this holiday season. For example, change, “I’m so slow I’ll never finish everything I need to go done!” to “I’m doing the best I can in this given moment.” Mindfulness is all about being kind to your mind. In addition, the holidays often bring a layer of expectation; “We should be spending “x” time with family” or “we should be so happy this time of year.” Remember that these “should” statements are also judgments about how you think the present moment “should” be happening. Use mindfulness to bring awareness to your judgments and then let those go to…as if they’re items flowing down a conveyer belt.

How Can I Practice Mindfulness?

1. Observe what is going on inside your body and mind

Find a quiet place and get into a comfortable seated position with your feet flat against the floor. Allow your eyes to close or take a soft gaze down to the floor. Listen to the sound of your breath and notice how your body feels; noticing how your inhale fills your nose and how the exhale of air feels leaving your lips. Acknowledge the thoughts that come into your mind and then watch them go as if they are clouds in the sky. Then, refocus your attention back to your breath.

2. Observe and describe using all five senses.

Notice and describe five things that you can see, four things that you can hear, three things that you can touch, two things you can smell, and one thing you can taste. As you describe, make an effort to be nonjudgmental and only describe the things that you can observe.

 

3. Participate in one activity

mindfulnessPick one activity and then fully throw yourself into that one task. Really allow yourself to get involved in the moment, letting go of any thoughts or self-consciousness. Have a dance party, go for a run, sing in the shower- whatever it is, just throw yourself in and allow yourself to do one thing wholly!

 

While exciting, the holidays can also be very stress inducing. Practicing mindfulness will help to slow your mind and body down as you navigate the hustle and bustle of the holiday season. Additionally, you may want to check out a past blog post for more ways to cope ahead of a potentially stressful holiday season. Wishing you all a healthy and mindful holiday season!