Category: Mental

Dialectical Behavior Therapy

I would like to highlight another type of therapy that may not be familiar to people – dialectical behavior therapy, also known as DBT.

According to a page on the Psychology Today website, (https://www.psychologytoday.com/us/therapy-types/dialectical-behavior-therapy), DBT is a way to provide individuals with new ways to manage painful emotions and decrease conflict in relationships.  DBT focuses on four specific areas: 1. mindfulness to focus on improving an individual’s ability to accept and be present in the moment 2. distress tolerance to help individuals increase their tolerance of negative emotions instead of trying to escape from them 3. emotion regulation strategies to manage and change intense emotions that are causing issues in a person’s life 4. interpersonal effectiveness techniques that allow a person to communicate with others in a way that is assertive, maintains self-respect, and strengthens relationships.

DBT was originally created to help patients with borderline personality disorder.  However, the use of DBT has expanded to include eating disorders, bipolar disorder, post-traumatic stress disorder, substance abuse, and depression.  DBT typically includes both individual sessions and group sessions, both of which are used to help individuals learn and practice the skills used in DBT. 

Although I have heard of DBT a few times in passing, this type of therapy is fairly new to me.  I am glad that its use has expanded to several areas of mental health, including depression, and it appears to be yet another tool that can be used to help those affected with depression.

How about you?  Are you familiar with DBT?  If so, how has it worked for you?  If you are just hearing about DBT for the first time, is this a therapy that you might consider?  To me, the more options available for the treatment of depression can be a beneficial thing, and I encourage people to learn more about DBT.

Adverse Childhood Experiences

One of the hopeful pieces about depression today is the recognition that there are many, many theories about what may lead to it.  And, while in some ways it makes the story more complicated, in other ways it gives us more information as to how we might treat or prevent depression in the future.  One of the theories is that depression can result from trauma, which is another huge topic.  However, today I want to discuss a subset of trauma that is known as adverse childhood experiences, or ACEs.

According to SAMHSA (Substance Abuse and Mental Health Services Administration), adverse childhood experiences, or ACEs, are stressful or traumatic events.  According to their website page, (https://www.samhsa.gov/capt/practicing-effective-prevention/prevention-behavioral-health/adverse-childhood-experiences), ACEs can include a wide array of experiences, including physical, sexual, or emotional abuse, physical or emotional neglect, intimate partner violence or abuse, substance use in the household, mental illness in the household, a household member in jail, and parental separation or divorce.  These events can lead to an increase in depressive episodes and suicide attempts later in life.  In general, ACEs can also lead to an increase in other issues with substance abuse and issues with physical and mental health.  Sadly, ACEs are very common and touch many of our lives.

Despite the unpleasant reality of ACEs, there is hope.  Recognition of ACEs is growing, and more and more people are beginning to understand the possible relationships between ACEs and future health implications.  Work is also being done to figure out how we might better prevent ACEs from occurring in the first place.  Clearly, there is a long way to go, but I am so glad we are starting to look at a bigger picture of what health and wellness truly means for all of us.  Every little piece matters and can make a difference when our overall health is on the line.

Transcranial Magnetic Stimulation

Today I want to touch on another therapy that people may not have heard much about – transcranial magnetic stimulation, also known as TMS.

According to the Mayo Clinic’s webpage on the topic (https://www.mayoclinic.org/tests-procedures/transcranial-magnetic-stimulation/about/pac-20384625), TMS is a noninvasive procedure that involves magnetic fields to stimulate nerve cells in the brain.  This in turn can help improve symptoms of depression.  TMS involves repetitive magnetic pulses, and during a session an electromagnetic coil is placed on your scalp near your forehead.  The idea is that the pulses can help to activate regions of the brain that have decreased activity in depression.

TMS has shown promise for depression, and has some advantages over ECT (electroconvulsive therapy, also known as “shock” therapy).  ECT involves anesthesia, whereas TMS does not.  ECT also causes seizures as a part of treatment, but this is not intended in TMS (although seizures are an uncommon possible side effect of TMS).  Common side effects with TMS include headaches, scalp discomfort at the site of stimulation, lightheadedness, and tingling, twitching, or spasms of facial muscles, so TMS is not completely free of possible issues.  However, for many with depression TMS appears to be a better alternative to ECT.

Unfortunately, TMS is not available everywhere, and there are also potential issues with cost.  And, while some insurance covers TMS, others have been slow to cover it.  But, my hope is that these access and cost issues will start to be addressed more efficiently in the future.

What do you think?  Does TMS sound like a promising therapy for depression?  So far, the data appears to be positive, but TMS is fairly new, and more information is being researched.  Regardless, for depression patients TMS can be yet another tool that can help patients enter recovery.  My hope is that this treatment continues to expand and help more people affected by depression.

Cognitive Enhancement Therapy

In my last post, I talked about cognitive behavioral therapy (CBT) and how it can be used in depression.  A lot of people have heard about or experienced CBT, so it may be a topic that people are very familiar with.  Today, I want to touch on a different type of therapy that I had never heard about until a few weeks ago, and I would like to introduce it to you today.

Instead of CBT, this therapy is CET, which stands for cognitive enhancement therapy.  According to the website, http://www.cognitiveenhancementtherapy.com/, CET is a performance based, comprehensive, and developmental approach to the rehabilitation of social cognitive and neurocognitive deficits.  CET is designed as a recovery phase intervention for persons with schizophrenia or schizoaffective disorder who are symptomatically stable, but who nonetheless remain socially and vocationally disabled.  Participants work at recovery through structured group and computer exercises.   Overall, CET attempts to increase mental stamina, active information processing, and the spontaneous negotiation of unrehearsed social challenges.  It does so with a focus on enhancing perspective taking, social context appraisal, and other components of social cognition.  CET is evidence based, and can also be a cost effective strategy involved in treating schizophrenia or schizoaffective disorder.

Needless to say, I do not know much about CET, but since it is evidence based, that can lend more credit to the effectiveness of this therapy.  And, while I spend most of my time focusing on depression, I think this therapy is definitely something to consider in the area of schizophrenia.  My goal for this post was to at least make everyone aware that there is CET and that it can help.

How about you?  Have you ever heard of cognitive enhancement therapy?  Is this a topic you want to learn more about?  Are you touched by schizophrenia in any way and could see a benefit in trying this therapy? 

Cognitive Behavioral Therapy

Perhaps you have heard of cognitive behavioral therapy, also known as CBT.  Maybe you have not heard about it, but you have experienced it without it being called CBT.  Today I want to touch on what CBT is and how it is used.

According to the Mayo Clinic website (https://www.mayoclinic.org/tests-procedures/cognitive-behavioral-therapy/about/pac-20384610), CBT is a common type of talk therapy.  You work with a mental health counselor in a structured way, attending a certain number of sessions.  CBT helps you become aware of inaccurate or negative thinking so you can view challenging situations more clearly and respond to them in a more effective way.  CBT can be a very helpful tool in treating depression, post-traumatic stress disorder (PTSD), or an eating disorder.  But not everyone who benefits from CBT has a mental health condition.  It can be an effective tool to help anyone learn how to better manage stressful life situations.

Also, according to the Mayo Clinic website CBT is often the preferred type of psychotherapy because it can quickly help you identify and cope with specific challenges.  CBT is a useful tool to address emotional challenges.  For example, it may help you: manage a mental illness, prevent a mental illness relapse, learn coping techniques, identify and manage emotions, cope with grief, resolve relationship issues, and overcome emotional trauma.

As you can see, CBT can have many benefits and can be very helpful for depression.  Does this sound like anything you have ever experienced before?  Was it helpful or beneficial in any way?  What did you learn from receiving CBT?  If it doesn’t sound familiar, I would encourage anyone touched by depression to look into this as a part of the treatment plan for depression.  It may not cause every depression symptom to go away, but CBT can be very useful when combined with other treatments for depression.

Emotional Labor

Today I want to talk about another topic that I have heard about only recently.  I am guessing that most of us have heard about physical labor, but are you familiar with the term “emotional labor”?  Although you may not have heard the term before, my guess is that you will be familiar with the concept.

So, what is emotional labor?  As usual, the term can have different definitions, but I take a very broad approach to it.  Emotional labor can be done anywhere and anytime, and it can involve regulating emotions and performing mental activities related to nurturing and caring.  Here are some examples: making appointments for yourself or others, buying and sending gifts or cards, delegating tasks to others, planning outings and trips, arranging care for children or other dependents, and working around the emotions of others.  Some examples of jobs that include a lot of emotional labor are flight attendants, hotel desk clerks, secretaries, and child care workers, who are typically expected to put on a smile every day and make sure everyone around them is happy and comfortable.

When it comes to depression and mental illness, you can imagine there is a lot of emotional labor that happens in these settings.  Mental illness can disrupt a person’s typical emotions, and caregivers also face a range of emotions.  And, while emotional labor has some plusses and can play an important role in caregiving, it is also important to note that just like any other types of labor, it can take a toll on those who perform it.  In my mind, a good first step is that no matter the setting, we recognize what emotional labor is and who is doing it.  Then we can begin to see how and when this labor can be redistributed or improved for everyone.

The Mind Body Connection

When it comes to the mind and the body, I think a lot of us think about them as two separate things.    It’s possible to partially blame it on some long standing historical perspectives.  As a result, we believe that one does not influence the other.  However, many people have started to talk about how the mind can affect the body, and those ideas seem to be gaining more acceptance and are receiving more attention.  But, what about the body affecting the mind?  Is that even possible?  What does that look like?

In my general quest for knowledge I have heard about interesting research that the body can indeed affect the mind.  One example involves using Botox.  Botox has been used cosmetically for many years as a way to smooth lines and wrinkles on the face.  However, it has been found that people who have had Botox for frown lines have also shown improvements in mood.  There is an argument that a person may feel better because they think they look better, but there seems to be more to it.  Another example comes from exercise, where it has been shown that it can improve mood as well.

So, Botox and exercise for depression?  Of course, these are only a few examples from a larger world of possibilities, but there is growing evidence that the body can and does affect the mind.  Using this idea as a framework, my hope is that this will give us even more possible treatment options for depression.  So, if possible, why not consider Botox?  Why not consider exercise?  Overall, I like the idea that the mind and body work together and should not be treated separately.  Once we think about everything as being connected, I believe we can find even more ways to treat the whole individual.

Happy ALL of the Time?

While I can’t speak about the rest of the world, here in the United States it seems like we are obsessed with “being happy”.  We want to be happy, and we want those that we care about to be happy too.  What exactly does “being happy” mean?  I think you can find many different answers for a definition, but part of that definition seems to include the idea that we should be happy all of the time.  Today, I want to share that I think being happy all of the time is not realistic, nor is it healthy.

In the recent history of my life, I have been bothered by the idea that I am not happy all of the time.  Why shouldn’t I be happy I ask myself – I really do have it all in most respects.  But, try as I might, I get sad or angry or mad, and it happens more than once a week.  Then, when I haven’t “been happy”, I have felt bad about not being all sunshiny all of the time!  And so the downward spiral goes.  However, I am starting to recover from this.

It’s time to get real.  Being happy all of the time is not ideal.  We are all humans, and we all have a wide array of feelings.  As long as we are not hurting others or ourselves, it is ok to feel what we feel and roll with it.  We all need to lose the pressure to be happy all of the time, because life is simply not built that way.  So, give yourself the permission to feel what you need to, and be happy when it makes sense to you.

If you are dealing with depression in any way, no doubt the pressure to “be happy” is way larger than what the rest of us face.  But, the same goes for you as well.  You will be happy when you can.  It can take time to get into recovery and feel some joy again, and that is ok.  No one should pressure you to just “be happy and get over it”.  Let’s all give ourselves a break, and let’s just feel the variety of emotions that humans were meant to feel.