Friends

In my last entry, I mentioned that I had gotten to see some old friends on a road trip.  After seeing these friends I felt recharged in a way, but I also realized how much I missed them.  It is yet another instance where I have been thinking a lot about friendships lately, and I am starting to feel like I have been taking my friendships for granted.

When I look at my life today, I have realized that friendships are pretty low on the list.  Some of it might be understandable when looking at all of our other responsibilities, but I truly believe that friendships are still very important no matter what age you are.  Friendships can provide a lot of positive benefits and meaning to our lives, and it can help protect us against the isolation that so many people experience. 

For people living with depression, friendships can be a vital part of support and the road to recovery.  Friendships connect us with people who care about your health and path to wellness, and friends accept you and understand that you are not your depression.  Sometimes, friends may also be more helpful than family when it comes to facing a depression.

As I think back to my story, I know I want to work harder to maintain the friendships that are important to me.  How am I going to do that?  Well, that is the part I am not really sure about right now.  I envision scheduling check-ins with friends on my calendar, but we will see if I have any other ideas come up.  Regardless of how I do it, I’m excited to realize that this is an area of my life that needs more attention, and I look forward to enriching and improving my life with deeper friendships.

Connecting to the Past

As I write this entry, I have just returned from a long weekend to celebrate Christmas with some of my family.  During the road trip I also got to see a few of my oldest and dearest friends, and it felt so good to see some of my favorite people in the world all in one trip.  And, while it was great to catch up a little bit, it always seems inevitable that seeing old friends and family gets me to thinking about the past.

What could I say about the past that hasn’t already been said?  Of course, my own past is unique to me, and that is honestly mostly what I will touch on today.  What is it about the past that makes me so pensive?  Why does it seem to make me sad sometimes?  Do I ever believe that the past signifies better times in my life?  Is my past better than my present?  Is it better than my future?  I typically like to think that life just keeps getting better, but sometimes I wonder…

However, I think that is where I stop.  I wonder, but I don’t try to relive my past.  What I do try think about are the fun things and the good things that have happened, and I see if I can incorporate some of that into my present life.  For example, I love 80s music, so that is constantly in my life.  I also loved rainbows growing up, and I continue to surround myself with those.

If you are struggling with depression, maybe looking at the past does not help your situation, especially if it might have in some way led to the depression.  However, if this is the case, it might be helpful to think about what you would love to look back on in the future that makes you smile and enjoy some memories.  It may sound simplistic, but connecting with the good things in your past (or your anticipated past) may be a helpful technique for thinking about depression.

Intersectionality

The words in our language can evolve and change over time.  New words also become a part of conversations, and there is a newer word that I want to discuss today.  The word is intersectionality.  What exactly does it mean?  Where did it come from?  And, for this blog, does is apply to depression?

According to Merriam Webster’s webpage (https://www.merriam-webster.com/words-at-play/intersectionality-meaning), which added the word in 2017, intersectionality is “the complex, cumulative manner in which the effects of different forms of discrimination combine, overlap, or intersect”.  The word has been around since 1989, when it was coined by legal scholar Kimberlé Crenshaw in an essay that asserts that antidiscrimination law, feminist theory, and antiracist politics all fail to address the experiences of black women because of how they each focus on only one factor.

Since its beginnings intersectionality has taken on a broader meaning, and can refer to more than just sexism and racism.  It can include other forms of discrimination as well, such as those based on class, sexuality, and ability.  So, intersectionality looks at the person as a whole and sees where they may face one or more categories of discrimination.  For example, intersectionality would imply that a black female lesbian is going to face more discrimination than a straight white female. 

How does intersectionality apply to mental health and depression?  It can possibly affect things such as access to care and the quality of care that is received.  Intersectionality can also affect the stigma some people experience and some groups may not have their depression symptoms taken as seriously as other groups.  Overall, I think intersectionality is something to consider when looking at someone with depression, as it may play in to how they are being treated.  We need to continue to demand that all patients with depression are treated with respect and compassion, regardless of what categories they may belong to.

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.