depression

So, what is it you practice anyways?

This first in a multi-part series exploring the types of therapy I practice.

I've been a big believer in Cognitive Behavioral Therapy (CBT) since studying it in graduate school. The simple premise behind CBT is that your thoughts influence your feelings, which influence your behavior. Understanding this pattern allow you to change it, right at the core.

Say you're in a meeting with your boss and she's not saying much. 'Is she annoyed with me?' you think. 'Maybe what I'm saying is totally off base.' These thoughts might make you anxious and start second guessing everything you're saying. These emotion-filled thoughts are called automatic thoughts, and they pop up based on beliefs about ourselves and the way the world works. Instead of automatically thinking your boss was annoyed, wondering if your boss was tired or preoccupied may change how you behave.

Automatic thoughts rely on perceptions about yourself and others called core beliefs. Core beliefs are developed from childhood experiences, cultural influences, your environment and more. Common core beliefs often follow themes of abandonment, un-lovability, defectiveness, helplessness, and entitlement.   

I have to be in control to be ok.

I'm unsuccessful.

If I don't succeed, I am worthless.

It's not ok to ask for help.

I'm stupid.

I'm bound to be rejected.

Challenging these automatic thoughts is the key to accessing and changing these core beliefs. Asking yourself questions like "Am I jumping to conclusions?" or "Am I condemning myself as a total person based on a single event?" or "Am I using all-or-nothing thinking?" can help challenge these thoughts. 

Noticing these automatic thoughts and changing them to a more realistic view can relieve distress. Changing the thought pattern from 'My boss is thinks I've done a terrible job; I'm worthless' to 'She's had a busy day and isn't saying much; Can I ask for feedback?' will change your behavior.

CBT is effective in treating:

  • alcohol use and abuse
  • substance abuse
  • depression
  • anxiety
  • chronic pain
  • chronic fatigue
  • eating problems
  • health problems
  • relationship problems
  • sleep problems

It's a short-term, problem-focused therapy that aims to systematically change the way you think about yourself and the world. 

Pokemon Go: Helping Players' Mental Health

It's only been out for days, but Pokemon Go is taking the world by storm. The app-based game combines the virtual world with the real world by tasking players to hunt Pokemon in the real world. 

Intended or not, players are getting out and about, what researchers have proven to be effective in treatment of depression

It's a great step in the gaming world, connecting the virtual and real worlds to encourage movement and socialization.

What is Self-Compassion?

Self-compassion, where one extends compassion to themselves in instances of struggle, failure, or inadequacy, can be a tremendous therapeutic tool. Instead of ignoring or piling on to pain, it's reminding yourself how difficult this is right now, and asking yourself what you can do to comfort yourself.

Dr. Kristin Neff, the leading researcher of self-compassion, has identified three key components to self-compassion: 

  • self-kindness - being warm and kind toward yourself in times of personal failings instead of critical and judgmental.
  • common humanity - recognizing that we all make mistakes. Suffering is part of the human experience.
  • mindfulness - a non-judgmental, receptive mind state that allows you to have a more balanced approach to emotions

The more you open your heart to disappointments, frustrations, personal failings, and imperfections, the kinder you are to yourself and others.

In the therapy room, I use self-compassion on client's who are intensely critical of themselves. I often ask questions like, "How can you be kinder to yourself?" or "What would you say to a friend who was experiencing the same thing?" I'm aiming to pull the client out of their destructive thinking cycle and introduce a more compassionate and kinder way of thinking.

Test it out for yourself. Take the quiz to see how self-compassionate you are. 

G.L.A.D. - A simple mindfulness exercise

Incorporating mindfulness into your daily life doesn't have to take much time. This simple exercise takes less than 5 minutes and provides an opportunity for reflection, something we often forget to do.

G.L.A.D.

In a journal, reflect on the following:

G: Write one thing you're grateful for. It could be basic, like the shoes on your feet or the bed you can sleep on, or it can be a meaningful relationship in your life. 

I'm grateful for my dog, as she provides me entertainment and company.

L: Write one thing you learned today. It can be something you learned about yourself, about how you relate to the world, or a new skill or piece of information you discovered.

I learned I do my best work when my office is in order.

A: Write one thing you accomplished today. This is a small accomplishment (unless you have a big one to celebrate), but is a simple reminder of the things you do every day. 

  • getting out of bed
  • getting enough sleep
  • paying all my bills on time
  • making it to work on time
  • completed all my domestic chores

D: Write one thing that delighted you today. These are things that made you smile or laugh, things that entertained you, or simply made you happy.

I was delighted by the Youtube video I watched today, which made me laugh. 

Set yourself a reminder and practice this exercise everyday for a week. Notice how you feel during and after this exercise.

Binge-watching tied to depression, loneliness

The fourth season of House of Cards just hit Netflix yesterday and the people in my life have already asked if I've had a chance to watch it yet. 

With instant streaming and Netflix releasing seasons at once, binge-watching, watching multiple episodes of television at a time, has become a pretty standard part of the American lifestyle.

A recent study from the University of Texas at Austin found the lonelier and depressed you are, the more likely you are to binge-watch television.

"Physical fatigue and problems such as obesity and other health problems are related to binge-watching and they are a cause for concern. When binge-watching becomes rampant, viewers may start to neglect their work and their relationships with others. Even though people know they should not, they have difficulty resisting the desire to watch episodes continuously," said the researchers.

"Do I really need therapy?"

Knowing when to ask for help a brave and courageous step. How do you know when or if you need therapy?

We all experience a range of emotions, from happiness and excitement, to grief and stress, and none of this is necessarily problematic. However, if your emotions feel out of control or unmanageable, it's time to seek help from a psychotherapist.

If you struggle with regular eating, hear voices, or have difficulty sleeping through the night, it's time to seek help.

If your relationships are suffering, be it a parent/child relationship, spousal relationship, friendship, etc., it's time to seek help. 

If you find yourself using (and/or abusing) substances to cope with unwanted feelings, it's time to seek help. 

If you no longer find pleasure from activities you used to enjoy, it's time to seek help.

If a friend, family member, or loved one suggests you need help, it's time to seek help.

A trusted relationship with a mental health counselor can drastically improve your life. 

"I don't like feeling this way."

"I just don't want to feel like this anymore," I remember saying to my therapist. I was anxious and sad and didn't know what to do about it, but knew I didn't want to feel that way anymore. I was fed up. 

What I didn't know then was that I was experiencing distress intolerance. We often feel uncomfortable. There are times we're too hot, too cold, have achy or sore muscles. The type of discomfort I'm talking about is emotional discomfort - feeling sad, ashamed, disappointed, etc. Some find they're able to ride out difficult emotions, but for others, they "can't bear," or "must get rid" of these difficult feelings. This desperate need to escape emotional distress has a compounding impact, often interfering with other areas of one's life.

It makes sense to move away from things that feel unpleasant but for emotional distress, it often causes more problems than it solves. Often people intolerant of distress use the following tactics:

Avoidance. Avoiding people, places, or things that trigger an emotional response. Distracting and suppressing the emotion.

Numbing and withdrawing. Using drugs or alcohol to numb the emotional pain. Binge eating or excessive sleep to withdraw from others.

Harmful releases. Taking the distress out on ourselves, including scratching, cutting, and picking.

These tactics can provide short-term relief, but often cause more problems in one's life. From neglecting relationships to drug and alcohol abuse, the effect compounds upon itself. Now, in addition to dealing with upsetting depression or anxiety, you're struggling with an addiction that prevents you from holding down a job. Because you feel so ashamed and cut yourself, you're constantly living in fear that someone will find the scars.

The more we struggle with and fear distress, the worse it gets. In fact, the best solution is to lean in and tackle the distress head on. Since it's impossible to get rid of emotional distress, it's imperative to learn how to live with it. Working with a trusted mental health professional can help you develop a distress tolerance action plan to move through the pain and discomfort.

Are you suffering from Seasonal Affective Disorder?

Winter, especially in the Pacific Northwest, can be brutal. Days on end of limited light, the endless drizzle of rain, and a sun that sets at 4 p.m. can take it's toll on anyone. 

Seasonal Affective Disorder (SAD) is a type of mood disorder whose onset occurs with the change of the season. For most people with SAD, the transition into winter finds them moody, irritable, and sapped of energy. Researchers believe SAD may be a type of hibernation found in other animals or an imbalance of serotonin or melatonin

Treatment for SAD include light therapy, medication, and psychotherapy. In addition to recommendations from your doctor, you may find the following helpful:

  • Make your environment brighter. Open the blinds, turn on the lights, and sit closer to windows throughout the day.
  • Spend more time outside. Go for walks or spend some time in the park. 
  • Exercise. Finding a physical activity you enjoy doing will decrease depressive symptoms. 
  • Schedule social activities. Plan to do activities with friends to get yourself out of the house and engaged with the world.

It's normal to feel sadness occasionally. If you're finding your not enjoying activities you once did, if you feel overwhelmed or hopeless, you might be depressed. Seek the guidance of a professional for an evaluation.

Managing Holiday Stress

'Tis the season! What's the most wonderful time of the year for some is a complete nightmare for others. The holiday season, stretching from Thanksgiving through New Year's, can often be long, stress-inducing, and painful for people.

Learning how to manage your stress level, especially around the holidays, is a great skill to develop. 

Plan. Start thinking about your holiday plans before they sneak up on you. Who are you celebrating with? Are you traveling? What will you need to do in anticipation of the holidays? Spending time considering the impact your plans have on your life may reduce your stress level.

Set aside differences. Beyond the actual holiday (are you celebrating Christmas? Hanukkah? Kwanzaa?), learning to set aside differences to enjoy time with family and friends is key to reducing stress level. If your Aunt Anne thinks Donald Trump is the best thing to happen to America, just let her. Your brother's kids driving you up the wall and you wish he'd step in to discipline them? Let go of your parenting ideas. Setting your ideas of "how the world should be" aside and allowing everyone to experience it themselves, no matter how frustrating, will reduce your stress level!

Act intentionally. The holidays come with a lot of obligation. You have to make Christmas cookies for the gift exchange party. You always go to your grandmother's house for Christmas Eve, even though you hate it. And if you don't: disaster. Instead of acting out of obligation this year, focus on acting out of intention. What will happen if you don't go to your grandmother's house for Christmas? Could you take her to brunch a week later instead? What will happen if you purchase cookies for the office exchange instead of spending five hours in the kitchen making from scratch? Look beyond your initial reaction to consider what will actually happen. And from there, choose to act intentionally. 

Make a budget. Holidays are expensive! Travel cost, gifts, parties, etc ... it adds up quickly. Spending a few minutes planning your holiday budget will help you feel in control of your finances and live within your means. 

Honor yourself. Above all else, choosing what's best for you is most important! Be reflective. Take inventory of what you're willing to do and what you'd rather not. Stick to your healthy habits. Be mindful of how you feel. If you'd rather stay in with a good book on Saturday night than attend the company holiday party, it's ok to do so. It's ok to take 30 minutes on Christmas morning for a jog. It's also ok to feel occasional sadness, despite the holiday season!

Seek professional help. If your anxiety or depression isn't going anywhere, don't hesitate to see a counselor. Bouncing what's happening off a trained professional may help reduce your symptoms and help you navigate this stressful time.

Navigating Life Transitions

Transitions are a natural part of life, and even the most positive life changes can be stressful. Moving to a new city, losing a loved one, accepting a new job, becoming a parent, settling a divorce - all bring a mix of emotions. Navigating these life transitions can be aided with a few simple tools.

Expect the emotional roller coaster. Some days will be easier than others. You may feel a range of emotions, from angst and worry, to excitement and anticipation. This is normal! Curbing your expectations (and removing should's from your vocabulary) will help you adjust to the new normal.

View situations as opportunities. Just a minor tweak in viewpoint can make a tremendous change. Instead of viewing unexpected transitions as setbacks, challenge yourself to make a positive re-frame. This situation is a forced opportunity for you to learn and grow as a person.

Develop a self-care ritual. There's no time like the present to develop a practice that makes you feel happy. From painting, to bubble baths, to yoga, there are a billion things you can carve into your life to take care of yourself. Setting aside intentional time to nurture your body/mind/soul can ease the pain of a growth period and help gain perspective.

Get support. Talk to family and friends. Seek support from a licensed mental health practitioner. Attend a church or religious organization. Do what makes you feel understood and supported. Chances are, you aren't the first person in the world to go through this experience. 

Seize the moment -- a new chapter of your life is here!

 

Mindfulness Apps

meditation

Over the last few years Mindfulness, the process of active, nonjudgmental awareness, has exploded in the mental health field. It's a practice that's been proven to reduce anxiety, help with emotional regulation, and improve overall well-being. The goal is to become aware of what's true, moment by moment.

There are a variety of ways to practice mindfulness, including yoga and martial arts. The majority of research has focused on mindfulness meditation. 

If you've never tried meditation, it can be an incredibly difficult practice. I've found the Stop, Breathe, Think iPhone app to be a great tool for developing a practice. The app allows you to "check-in," with questions regarding your mood and physical state. Depending on your responses, the app generates guided meditations that vary in length to focus on specific topics. Best of all, the app is free.