Depression and anxiety

So I have postulated that this blog was going to address alternative, as well as mainstream (but mostly alternative) therapies. But what are we treating? Well it appears that two of the most prevalent mental health issues plaguing our society today are depression and anxiety. But what are these maladies? We throw these terms around rather freely. We worry about the slightest thing and say we are anxious, feel a bit sad and say we are depressed.. So let me start by defining these terms a bit.

Depression

Depression in it’s clinical definition, taken straight form the Diagnostic and Statistical Manual of Mental Disorders, fourth edition is:

  • Depressed mood for most of the day
  • poor appetite or overeating
  • insomnia or hypersomnia
  • low energy or fatigue
  • low self-esteem
  • poor concentration or difficulty making decisions
  • feelings of hopelessness

Of course there are many different types of Depressive disorders, with different durations and severities, but, in a nutshell, the bullet points  above sum up the criteria for a clinical diagnosis.

How do we understand depression in layman’s terms then? Simply put, depression is living in the past, not being able to let go of past hurts, past goals that were not attained, dashed hopes. If you are not able to stop constantly looking behind you, life is going to be a difficult road to travel as you are not going to get very far…

Now to address the physical aspects of depression. What is described in the DSM criteria is a constant feeling of lethargy and fatigue. Someone who is experiencing this in their body all the time isn’t going to be very motivated to do much. They may be able to get through their day in terms of the necessities, but once work is done and dinner is out of the way, that’s it, time to crash. That’s not a very fulfilling way to go about searching for happiness and isn’t that what we are all supposed to be doing? Well, if someone who feels depressed isn’t going to get very far and of course it’s vicious cycle, because if they aren’t feeling fulfilled like they are supposed to feel, and aren’t finding happiness, then they aren’t feeling very good about themselves, and this adds to the low self-esteem and the cycle continues… So we have lots of tired, unhappy people trying to right the wrongs of their past and depression is born.

Not that simple, of course! I don’t want to make it sound like all you have to do to deal with depression is to let go of the past. On the level of body chemistry, depression is caused by dips in dopamine and serotonin levels – the “happy” hormones – and an imbalance is a very real thing and can affect a person in very profound ways. BUT, there are also very real, profound ways one can increase these hormones with alternative therapies. More on treatments later, however. For now, on to anxiety..

Anxiety

So while depression is essentially living in the past, anxiety is having a future-oriented view on life. It’s constantly anticipating what is going to happen. And unless one is a psychic that is impossible. And since you don’t what’s going to happen and can’t prepare for it, you are going to be pretty anxious trying to figure out how to deal with something that may or may not, or five million other options..

So the definition of anxiety per the DSM:

  • constant and severe anxiety

All the time. Of course there are different types of anxiety, about different things, but that’s just the bottom line.. In clinical terms, an anxiety disorder is diagnosed when a person is very anxious to the point that the anxiety interferes with their functioning.. I can think of multiple people in my life that are affected.

The most prominent (and undertreated feature) of anxiety are the physical symptoms. I am not talking about panic attacks here. I think most people know that when someone is experiencing a panic attack, they have tightness in the chest, rapid heart beat, nausea, an overall sense of being unwell. So in these cases you can’t ignore the physical symptoms as they are primary and in most cases people experiencing them feeling like they are having a heart attack rather than an anxiety attack and treatment focuses on differentiating between the two. But just plain, garden variety, everyday anxiety where you aren’t thinking you might be dying.. We spend our day worrying about the bills, the kids, our jobs.. And we carry all that tension in our necks, backs, shoulders. We get headaches and feel exhausted on a daily basis but don’t connect it with all the worrying we are doing.

As I have treated patients with both of these conditions over the years and as I delved deeper into my exploration of alternative therapies, I have seen some astounding results. The holistic therapy approach, one that accounts for all aspects of the person will always be more effective in addressing the issue. Patients who gain awareness of their bodies and become mindful of this connection can then begin to gain mastery over their minds. But I will have to leave the discussion on treatment for next time. Or times as there are so many options to choose from! Thanks for reading!

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Reintroduction

This blog has been in the works in my mind for a while and an actual blog in existence for the very short time. Now it’s back and I would like to present it’s mission and purpose, as well as to re-introduce myself as it were.. I started this blog several years ago. At that time I have been a therapist with many years experience in the field of mental health and had started to realize that the field had something lacking. Traditional therapy approaches were addressing the issues that people were struggling with, but were leaving many gaps in treatment as there is a huge disconnect between the mind and the body in a society where people are preoccupied with the pursuit of happiness but many neglect their health engaging in this pursuit and do not realize just how much this impacts their lives both physically and emotionally. In a fast-paced, non-stop world we do not stop to take care of ourselves and look for a fast easy fix.
So when I started the blog several years ago I was just starting to explore other ways to approach mental health and what alternative therapies can be helpful. But what I knew then didn’t even begin to scratch the surface..  Then I took a break from the blog and through some self-exploration and other life-changing experiences came across several discoveries. First, the mind-body connection is profound and is essential to health, both mental and physical. And, there are countless ways to obtain this connection and exploring these and bringing them to you will be the goal of this blog. The most important thing that I have learned so far is that I have so much to discover about what can help one to be healthy in mind and body and how the two are intertwined..  So stay tuned and let’s explore this together. I would love to hear from you – your thoughts, experiences, anything you would like to learn more about.

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Biofeedback

Biofeedback has been talked about quiet a bit lately. It’s talked about as a form of pain management, a way to address stress, ADHD in children, anxiety and trauma, a cure-all really. But what is biofeedback? And does it work?

Biofeedback uses instruments to measure the body’s responses to stress so that these responses can be modified to improve functioning. The stress in question can be physical pain, which the body can express by muscle tension, for example. Stress can also be psychological and be manifested by a rapid heartbeat or sweaty palms when someone is anxious. Biofeeback can measure all of these bodily responses immediately and demonstrate changes as a client learns to control or modify these.

What makes biofeedback so wonderful is that the results are not only fast, they are also demonstrated right there on the screen for the client. If a client is experiencing pain the their lower back, for example, their muscles in that region will be tense and this tension can be measured with the instruments that the treatment utilizes. As the client is able to see how much muscle tension he/she has in the region where they are experiencing pain and are able to relax their muscles, they will immediately feel relief from the pain. This type of treatment usually takes 10-20 session as a client learns the treatment and practices to generalize what they learned at home, between sessions.

Treatment for psychological maladies works similarly, with the client learning to train their body using the feedback they get from baseline readings since we know that psychological stress causes muscle tension in certain areas such as the head and neck, decreases in temperature in the extremities, rapid breathing and hearbeat, and and increase in bloodpressure. This type of treatment can also take a anywhere from 10-20 sessions, with booster sessions as needed.

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What makes a good therapist or how to deal with burnout

When someone is considering entering therapy, what is the hardest part of the process? I would venture to say that it’s choosing a therapist. After all, how does one decide who they can entrust their inermost secrets, struggles, and life’s tribulations to? What if you get the wrong advice? In a lot of ways, it’s like starting a relationship. How do you know that the person you decide to open your heart to will not hurt you? How do you know this person is a good therapist?

So what makes a good therapist? Of course you want to know that the therapist you choose is well-educated and state licensed to practice. Those are the basics. But beyond that you want to have a therapist who will hear you and your needs and goals, rather than push their own agenda. A big red flag should be when a therapist begins to prescribe interventions before really understanding and exploring your presenting problem. Another reg flag should be when a therapist who gives advice rather than helping the client to explore their issues and come up with a solution on their own, a solution that would work for them.

What about therapist burnout? How does this affect treatment for a client? Therapist burnout has to do with a therapist who is having difficulty addressing client issues effectively because they are under too much stress, either for personal reasons or because of not having an effective outlet to destress from the stress of taking on the issues of the clients they work with. When a client is working with a therapist who is suffering from burnout, treatment is affected because the client’s issues may no longer be the primary focus in treatment and transference/contertransference issues may come into play for both the client and the therapist. If a client feels that they are not the main focus during sessions in treatment, they need to immediately address this with their therapist as burnout may be the issue.

In summary, finding a good therapist is a difficult process and once treatment starts the client has to be on the lookout to make sure that therapist burnout doesn’t occur. Of course this is always the therapist’s responsibility to ensure that ethical treatment practices are always used, but the client is always their own best advocate as well and should know what to look for to avoid unnecessary issues and ensure a positive treatment experience.

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The process for change

What is the process for change? Change is an uncomfortable thing, after all, and takes a while to get used to. A person first has to get used to the idea that this is going to happen (motivation) and start the process (action), and then the change actually has to become permanent through repetition and practice. This is then a lengthy process and doesn’t happen overnight and is true for both psychological and behavioral change that a person may wish to undertake, as well as any change a person may want to make to their circumstances.

So how does one start this difficult process? One has to first identify what they are looking to change, of course, and how they would like things to be different. Setting goals is very important in therapy as figuring out exactly what a client would like to address will help to focus the treatment and make sure that the interventions are targeting what the client is struggling with.  Once the client has set a goal for treatment, the therapist can now create a treatment plan with the client and establish what steps that client is willing and able to take to effect the change and what tools they have to have them do this – what strengths the client has on their own, as well as what supports they have at their disposal (family, community, etc.) This is the main part of treatment.

The last step in this process is to help the client practice the changes that they have made and the new skills they have learned in treatment. The clients need to be reminded that there will be setbacks and they will lose some of the gains they have made in treatment as they implement the changes. As the client becomes more and more proficient in using their newly gained skills, they can slowly begin to transition out of treatment and begin to practice the changes they made independently, utilizing their strengths and supports.

That is, of course, the ideal way that treatment should go and it goes that way very rarely. More often there are setbacks having to do with a client’s difficulty with setting goals, lacking resources, or having difficulty with practicing their newly learned skills. Clients also sometimes return to treatment after terminating if a destabilizing event occurs in their lives. Change is a very complex and individual process and understanding the stages is just the first step in being able to help a client facilitate this change.

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Motivation for change

In my work with clients I often wonder what motivates someone to effect change in their lives. I work with clients who are mandated into treatment, either by courts, probation, or family circumstances that would not otherwise allow them to return home. But despite this, some clients find the internal motivation within themselves to make changes, while others continue on the same path they were on prior to entering therapy. You can’t save people from themselves, right? You can, however, understand what drives people to the point of catharsis, the point when they gain insight, when they realize that they have to do something differently, not for the systems involved but for themselves.

Some clients arrive at this point on their own, even prior to deciding to enter therapy, when they realize that something in their lives is not going well and interfering with their desired level of functioning. This is the optimal scenario – a client who comes into treatment ready for change and motivated to work to achieve that change. Other clients are motivated by external factors, such as pressure from family, other systems such as the courts, DYFS, probation or parole, etc. What drives them is getting rid of the negative consequences to not changing – e.i. if I continue this negative behavior, then the external systems that are putting pressure on me will put in some consequence that I would really like to avoid - my husband or wife will leave, DYFS will take my children, my probation or parole will be violated. The goal with these clients is to get to a point where they can find something of intrinsic value for themselves in change – feeling happy that they are not having so many problems with their family members, being better parents, or having a sense of accomplishment at successfully completing probation and being able to function successfully in socially acceptable ways.

But what about clients who do not subscribe to social normals, who hold moral values that are conflicting with the expectations of what is socially acceptable. If a client is mandated into treatment due to being on probation for an ssault charge, for example, but is not able to identify any other acceptable way of handling conflict other than fighting, how can this be addressed successfully in treatment? Working with the client to identify what their treatment goals are is always important, as well as letting them know through establishing confidentiality and rapport in the therapeutic relationship that no matter what moral beliefs or social norms they subscribe to, you as the therapist will hold a supportive, non-judgemental attitude. I often challenge my clients in sessions, but not without first establishing this trusting and supportive treatment atmosphere. I also let my clients know that it’s OK to hold the beliefs that they hold and they are not in treatment to change their beliefs but they do have to live and function in a soceity that may not and often does not support those beliefs and attitudes and we work together in treatment to find ways to help the client adjust and improve their functioning.

 

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Music as therapy

My current job involves working with teenagers and work with teenagers often involves working on identifying and utilizing coping strategies. The coping strategies focus on any number of things – anger management, impulse control – all things that often elude the growing and developing mind and body. One of the most often identified coping strategies that I hear with adolescents is listening to music. Analyzing why this would work so well with adolescents (and adults for that matter), it makes complete sense. After all, when we are talking about impulse control, we are talking about the brain being focused, preoccupied even, on a thought or an object and when the thought is replaced with something else – music – the focus shifts and the person is able to consider other alternatives. Same goes for anger management, except here the person is focused on an emotion and cannot move past it and listening to music allows the person to shift their focus away from their anger and be able to consider other feelings and alternative ways to address the situation that caused the anger in the first place.

Sometimes clinicians use music in treatment if clients have identified it as a useful coping strategy to get their clients to learn to focus and develop impulse control or anger management strategies. The mistake that is often made is recommending the type of music a client should listen to because it is identified as “soothing” or “calming”. So a clinician may recommend classical music, for example, to get a client to cope with stressful situations. However the problem occurs when a client does not find that type of music appealing and is not able to focus on it. The basic pillar of social work practice, starting where the client is, is always a good thing to remember. So if a client has identified that hard rock is their music of choice, for example, that would be what would be most therapeutic for them and should be recommended as a coping strategy if the client feels that it may help.

 

 

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Mind-Body Connection

When someone experiences stress in their lives, feels depressed or anxious, what are some of the first symptoms that we experience? We usually feel tired, run-down. With anxiety, some of the symptoms we may feel in the body are rapid heart beat, shortness of breath, headaches. With depression, it’s fatique, difficulties with sleep (either too much or too little), restlessness. And just as these symptoms are manifested by the mind in the body, they need to be treated by treating the mind, or so the mental health field has always believed. But what about the body? What about the interconnectedness between the two? Neglecting the body and it’s symptoms can lead to neglecting a crucial aspect of treatment. In trauma treatment, for example, one crucial element is to make sure that the client undergoing treatment feels safe prior to being able to talk about their trauma. Several of the techniques used for this are grounding and relaxation techinques. In grounding the client needs to develop a certain level of body awareness so that when they enter a state of anxiety when talking about their trauma, they can ground literally, physically ground their body, touching the floor, feeling the chair they are sitting on, to remind themselves that they are in a safe environment. Likewise, relaxation exercises help the client to be mindful of their body reactions like their breathing, the tension in their muscles, to help them know when it’s becoming too difficult speaking about their trauma and they need to take a brake and regroup. In these ways trauma treatment is very mindful of the mind-body connection and clients benefit.

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Thoughts on integrating alternative therapies with mainstream approaches

I have been considering this topic for quite some time and this is really the reason this blog came into existance. Although mainstream treatment approaches are incredibly useful in addressing all the maladies of the mind and the heart, I can’t help but think that some alternative approaches have validity as well. After all, before evidence-based practice became a corner stone in the mental health field, we as treatment providers knew to use clinical judgment and clinical judgement tells us that relaxation exercises make clients less stressed, as would meditation. I doubt there are any formal studies on that, but maybe I am mistaken… This is partly the purpose for the blog after all – to find out of anything that is not yet a mainstream therapy treatment approach can be considered evidence based practice. So the other purpose of this blog is considering how alternative therapies such as reiki, meditation, the Trager method, Native American or African healing rituals, etc. can be integrated with traditional therapy approaches to successfully be used in mental health practice.

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