Medication or Therapy- Which is Better?

Depression- we all know the signs, right? Wrong. I have lost count of the amount of clients I have seen, who have sat in front of me saying “But, I’m not depressed though, am I?” after having reeled off a very impressive list of depressive attributes. Depression creeps up on you, slowly. At first, you’re just having a bad day. Then a bad week, and before you know it, you’ve had so many bad weeks; they’ve turned into months and possibly years.

There has been a lot of academic argument lately, within the Institute’s of Psychiatry and Psychology- an argument is being put forward that the long-term use of psychiatric medication is causing more harm than good. Professor Peter Gøtzsche, the director of the Nordic Cochrane Centre at Rigshospitalet in Copenhagen is currently arguing that the ‘minimal’ benefits of psychiatric drugs are exaggerated and the harms (including suicide) are underestimated (Gøtzsche, Young and Crace, 2015). For those people who are on medication, and find it works, I am sure that they would argue the odds with these authors, and be angry at their assertion that medication has minimal benefits. Medication, which for some people is a lifeline, seems to be being dismissed so out of hand and so easily.

There have also been articles with regards to Mindfulness – and other talking therapies, that have appeared recently, advocating the benefits of Mindfulness Based Cognitive Therapy (MBCT), which was developed as an explicit intervention to reduce relapse and recurrence in depression; the study goes on to find that there is no evidence that MBCT is better at avoiding depressive relapses than antidepressant treatment (Kessler et al, 2015). So, what does that mean for the ‘layperson’? Well, it means that talking therapies can be as effective as medication, but that it depends on the illness that is being treated and the person themselves, but also how that person responds to the medication and the talking therapy.

Let’s not forget- medication needs to be taken regularly, and may need to be adjusted to find a dose that works for the person effectively, or that the medication prescribed is not actually working for the individual and a change of medication may be needed. But also that, in terms of talking therapies, it is crucial that you find a therapist that you can get along with, that you trust and that you can open up to- creating the working alliance of the therapeutic relationship is key to ‘good’ therapy (Clarkson, 2003).

The combination of using medication and talking therapies can prove to be very useful for some people- the medication can work to combat the symptoms of the depressive illness and the talking therapy can help to support the patient to deal with any underlying issues that may have caused the depression (Hollon et al, 2014). So, as you can see, a two-pronged attack seems to work also. There was another study in 2013 that suggested that neither medication nor talking therapies worked any better than each other (Cuijpers et al, 2013) which was a meta-analysis- a meta-analysis is where all the current studies for the related field are looked at, and an overall summation of the findings is given.

So, what does that leave you with? You are not a study, cohort or focus group- all the studies I read tell me what I may find, but in reality we are all very different and we each need to find what works for us. A doctor can help you find the right medication, and a therapist can supply the therapy – the important thing is that whether its meds of therapy type, if it did not work for you, don’t give up, try something else; another therapist, go back to you doctor, go to a new doctor. Keep trying until you find the help and support you need.

Well, in my experience, medication is great- if you can find one that works, get the dosage right, then it can really help to resolve the physical manifestation of depressive illness. Sometimes, we do not know what has triggered the depressive illness, and sometimes we do- when we do know what has caused it, coming to therapy can really help gain a sense of perspective, or put old ghosts to rest. Even if you don’t know what has caused your depression, talking to a professional can really help and may even help you understand the cause. As therapists we are there to listen and be non-judgmental; we wont tell you to ‘buck up’ or ‘snap out of it’, as we know that saying that to you wont help you and it certainly wont work! If you could really just ‘snap out of it’, wouldn’t you have done that months ago?

The World Health Organization (WHO) believe that 1 in 10 of us will suffer with depression at some point in our lives, and it is the leading cause of disability in the world (yes, really!). Depression can affect anyone, at any time. We don’t know what causes depression and much, much more research needs to be done in the area. Depression does tend to run in families and it can be caused via a genetic and environmental combination. You may not realise you are depressed to start with, other people may recognise it in you first, or you may recongise that you are just not feeling as good as you used to.

It can be difficult to support someone going through a depressive illness, especially if you have no experience of depression and don’t understand what is happening to your loved one or friend. The important thing is to listen to them; be patient and encouraging, but above all, show kindness and compassion. And, you know what? The same applies to yourself, if you are suffering with depression- be kind to yourself, acknowledge that you are going through a bad period and do not beat yourself up over it. Something I like to say to my clients is “What would you say to a friend, if they were in your situation?” because, you can guarantee, you wouldn’t be harsh on a depressed friend, so why be harsh on yourself?


 

Clarkson, P. (2003) The Therapeutic Relationship, London: Whurr Publishers.

Cuijpers, P., Sijbrandij, M., Koole, S.L., Andersson, G., Beekman, A.T. and 3rd, C.F.R. (2013) ‘The Efficacy of Psychotherapy and Pharmacotherapy in Treating Depressive and Anxiety Disorders: a Meta-analysis of Direct Comparisons’, World Psychiatry, vol. 12, no. 2, pp. 137-148.

Gøtzsche, P., Young, A.H. and Crace, J. (2015) ‘Does long term use of psychiatric drugs cause more harm than good?’, British Medical Journal, vol. 350, May, p. h2435.

Hollon, S., DeRubeis, R., Fawcett, J., Amsterdam, J., Shelton, R., Zajecka, J., Young, P. and Gallop, R. (2014) ‘Effect of cognitive therapy with antidepressant medications vs antidepressants alone on the rate of recovery in major depressive disorder: a randomized clinical trial.’, JAMA Psychiatry, vol. 71, no. 10, October, pp. 1157-64.

Kessler, Lewis, G., Watkins, E., Brejcha, C., Cardy, J., Causley, A., Cowderoy, S., Evans, A., Gradinger, F., Kaur, S., Lanham, P., Morant, N., Richards, J., Shah, P., Sutton, H., Vicary, R., Weaver, A., Wilks, J., Williams, M., Taylor, R.S. et al. (2015) ‘Effectiveness and cost-effectiveness of mindfulness-based cognitive therapy compared with maintenance antidepressant treatment in the prevention of depressive relapse or recurrence (PREVENT): a randomised controlled trial’, The Lancet, April, Available: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)62222-4/fulltext [20 May 2015].

 

 

Disappointed with the Result? Bear this in Mind!

Here in the UK, we have just had our General Election, which we have once every five years. Now, I know that some of you out there are going to be left feeling disappointed and disenfranchised, but others will be feeling the opposite (I will not be pledging my own Political allegiance here- I learnt at a very young age not to argue about Politics, Religion and music!). And this is where this blog is going- disappointment and how it affects our lives.

There is a general feeling of apathy and dysphoria in the Nation, at this moment in time- I am wondering, have you ever felt that in your life? Do you sometimes wonder where you are going with your life, why you are in a cycle of repeating mistakes, or just that you seem to be disappointed with your lot in life? We all do, at some point in our lives, but it can become a problem if this is our outlook for extended periods of time. In fact, for some people, even just a short period of time feeling like this can be extremely detrimental to their mental health. You know, ‘cos Mental Health Matters, don’t it?

Lots of people are sceptical about therapy- I encounter it all the time. “Oh, you’re a Psychologist? Read my mind then” or the other familiar “Oh. You’re a Psychologist.” Then nothing. They don’t want to talk because they think I will psychoanalyze them the whole time! This doesn’t happen, I just want you all to know this- even Psychologists need time off to kick off our DM’s and enjoy a party!

Saying that, there has been some articles in reputable UK publications of late, to do with something you may never have heard of; Mindfulness. “What is Mindfulness?” I hear you ask! The Dictionary definition of Therapeutic Mindfulness is;

“A mental state achieved by focusing one’s awareness on the present moment, while calmly acknowledging and accepting one’s feelings, thoughts, and bodily sensations, used as a therapeutic technique.”

 I bet you’re thinking “Mumbo Jumbo?” Well, according to a recent study published in the most ‘reputable’ of medical publications, The Lancet (Kuyken, 2015), Mindfulness-based Cognitive Therapy (MBCT) is nearly as effective as taking prescription Antidepressants alone- out of 424 participants, after two years, 44% of the MBCT patients relapsed as opposed to 47% of Medication only patients. So, what does this tell us? Well, surprisingly, MBCT is more effective than first believed.

There are a few issues here, with the Mindfulness study- the scientific description of Mindfulness changes from provider to provider. Now, because it is available on the NHS, MBCT has proven its efficacy (that it works) and so, if it can work on the NHS, then maybe, going to a reputable provider (if seeking private therapy), will also be the same.

The main critique with this study is that the Mindfulness patients had already suffered three or four bouts of depression (depression can be a right b*gger that way) and were already on a maintenance dose of medication. The common thinking has been that the combination of talking therapies, be it MBCT or CBT or Person-Centered, with medication is the best form of support for someone with recurring depression.

So, where does this fit in with disappointment? Well, disappointment and depression can both be caused by life’s tribulations. In one study, disappointment was ascribed to being the resultant causes of ‘what might have been’ or the ‘outcome of unfavourable decisions’ (Zeelenberg et al., 1998). Sound familiar to anyone? Mixed up in there is also the emotion of regret; perhaps you regret your vote yesterday? Perhaps you regret making a decision that ‘could’ of had a more favourable outcome? Whatever it is, life is full of mistakes, disappointment and regret- as well as happiness, joy, love and positivity! The problems only come when these two opposing forces are unbalanced.

So, that Mindfulness stuff, eh? How does that work then? Well, MBCT blends Mindfulness with CBT, so we learn to be in the present, instead of focusing on the future and the past. It helps us to come to terms with the decisions we have made; the disappointment, the regret, and focus on the here and now and how we can make the most of our lives as they are.

MCBT looks at what is going on for you now, and how the impact can be lessened for you- it gives you a specific set of skills, to practice for everyday life. No, it is not just meditation, it is being mindful of what is happening, your surroundings and not skipping forward to the end result.

According to the London School of Economics, 1 in 6 adults will be affected by depression during their lifetimes. That is a significant number; really, a lot. So, if you are feeling that way, please know that you are not alone and there is help available.

If you are interested in Mindfulness based therapy, have a look at the NHS website for more information. Many of your local GP surgeries, in the UK, will also offer free courses in Mindfulness. So, what are you waiting for?


 

 

Effectiveness and cost-effectiveness of mindfulness-based cognitive therapy compared with maintenance antidepressant treatment in the prevention of depressive relapse or recurrence (PREVENT): a randomised controlled trial; Dr Willem Kuyken, Rachel Hayes, PhD, Barbara Barrett, PhD, Richard Byng, PhD, Tim Dalgleish, PhD, David Kessler, PhD, Glyn Lewis, PhD, Edward Watkins, PhD, Claire Brejcha, BSc, Jessica Cardy, BSc, Aaron Causley, BSc, Suzanne Cowderoy, MSc, Alison Evans, MSc, Felix Gradinger, PhD, Surinder Kaur, BSc, Paul Lanham, Nicola Morant, PhD, Jonathan Richards, BSc, Pooja Shah, Harry Sutton, Rachael Vicary, PhD, Alice Weaver, BSc, Jenny Wilks, MSc, Matthew Williams, MSc, Rod S Taylor, PhD, Sarah Byford, PhD The Lancet, April 2015.

Zeelenberg, M., Dijk, W.W.v., S.R.Manstead, A. and Pligt, J.d. (1998) ‘The Experience of Regret and Disappointment’, Cognition and Emotion, vol. 12, no. 2, pp. 221-230.

 

 

Laughter- the friendly medicine.

So, tonight is going to be a really quick blog post- I have been training all day and am shattered (remember back to a previous blog where I said it was ‘ok’ to give yourself a break? Well, this is it!). I will be writing about my training today in next week’s blog though- so look forward to a long in depth article then!

I was working this week with a new client- new client’s are always interesting, as you don’t know their story and it is a ‘process’ to develop a rapport with your client, into what we called the ‘working alliance’ (Clarkson, 2003). The Working Alliance is basically a term for the way in which we work with our clients- in order for you to tell me about yourself, we have to get on, you have to engage with me enough to feel comfortable enough to talk about issues that can be very challenging.

Now, notice how I didn’t say ‘we’ need to engage with each other? As a therapist, my work is all about engaging with you, as the client. I am ready from the moment you walk through that door- you could tell me the very worst thing in the world, and I will openly accept, listen and empathise with you. You don’t even have to know me. That is my job. As a therapist, I am a keen listener and what a therapist does do, is to afford you Unconditional positive regard (Rogers, 1951)- that whatever you say to me, whatever your experience is, even though I many have never experienced it myself, I can listen to you without judgement. Accepting all that you tell me and actually caring about it, too.

As a therapist, I am ethically bound to be empathetic and congruent to you, as a client. What this means, is that I am open to what you say, and am listening- I can understand and imagine, or empathise with you about how that must feel and how difficult/challenging/funny/scary it is. After all, it is about being genuine and if I am not genuine with you and honest, how could you hope to gain anything from our meeting?

These are the core conditions of my training- I hope it is what makes me an understanding and empathetic therapist. But, sometimes, for some clients, this isn’t enough. They still experience difficulty in the therapy room and it can take some time to get to know each other well enough, for you to feel like you can open up to me. And you know what? That is fine. It is ok to take your time!

I was reading a study about how, after laughing, we are more inclined to open up and tell others personal details about ourselves (Gray, Parkinson and & Dunbar, 2015)- the study used groups of participants, who were each shown a different video, prior to writing down five pieces of personal information about themselves, which they were prepared to share with their companions. They were shown either a comedy clip, an uplifting but sobering clip or a neutral clip from an instructional golf video.

The only difference in their reactions was laughter. I remember doing a similar experiment during my Psychology degree, except we were measuring our heart rate. Laughing, for obvious reasons raised our heart rate. I remember thinking, well, how can this be linked to anything interestingly Psychological? But here it is- the laughter made that group of participants share more intimate details about themselves than the other clips.

So, I guess you will be wondering, what does that have to do with being in the therapy room and talking about yourself? Well, as therapists, we are only human, you know. We smile, we joke and we are guilty of laughing at the wrong thing, sometimes. So, perhaps, when sharing our information, a more light-hearted approach could be used? Maybe we should share a joke or two, before we start our sessions? I know that, the longer I see you for, the more we talk about, the more we exchange pleasantries and the more we will laugh or smile at the beginning, middle and end of a session. So, I guess, laughter does actually bring us closer together- it helps us to feel comfortable with the person we are with. I imagine, that laughter is a great leveller for all people.

It has been found that when we disclose information about ourselves, it increases liking of us in the other person, and increased liking increases the likelihood of laughter. Increased liking leads to further self-disclosure and before you know it, you are part of a disclosure liking cycle! (Collins and Milner, 1994) So you can see how talking about ourselves, liking and laughter all go together hand in hand.

Unfortunately there is also an opposite cycle where by fear of rejection in the face of disclosing prevents disclosure – leading to increased isolation, loneliness and depression. (Wei, Russell and Zakalik, 2005). The thing is, in therapy, I won’t reject you. I won’t laugh if it’s not funny and I won’t make you feel bad about a decision you regret.

So if you are feeling low, and someone invites you out somewhere, and you don’t really feel up to it, you need to ask yourself a question. Which cycle do you want to ride? The fun bike to town? Or the same one you have been riding in the rut you have been stuck in?

The flip side to this, I would assume, is when we are out and about socialising. Perhaps if we are giggling too much, we relax too much and allow ourselves to say things we didn’t mean to? Perhaps it isn’t just ‘all the alcohol talking’. The study described how laughing could be a ‘social lubricant’. By the very nature of therapy, this seems to go against the grain; after all, I am supposed to be empathic and congruent towards you. But, perhaps you would like to see me laugh or smile? Maybe that makes me more real to you? Whatever it is, and however we are in the therapy room, I am there for you and we can talk and develop a rapport; even if we don’t laugh!


 

 

Clarkson, P. (2003) The Therapeutic Relationship, London: Whurr Publishers.

Collins, N.L. and Milner, L.C. (1994) ‘Self Disclosure and liking; A Meta-analytic review’, Psychological Bulletin, vol. 116, no. 3, pp. 457-475.

Gray, A., Parkinson, B. and & Dunbar, R. (2015) ‘Laughter’s Influence on the Intimacy of Self-Disclosure’, Human Nature, vol. 26, no. 1, March, pp. 28-43.

Rogers, C. (1951) Client Centered Therapy, London: Constable.

Wei, M., Russell, D. and Zakalik, R. (2005) ‘Adult Attachment, Social Self Efficacy, Self disclosure, Loneliness, and subsequent Depression for Freshman College Students; A Longditudinal Study’, Journal of Counselling Psychology, vol. 52, no. 4, pp. 602-614.

 

 

 

The Issue Behind The Headlines.

The murder suicide of Andreas Lubitz last week, with Germanwings flight 9525 was a terrible tragedy, for all concerned- the 149 victims and their families must be devastated by what the Co-Pilot chose to do. In all the news reports, there has not been any sympathy garnered for Andreas, or his family. Some may say that he does not deserve it, but I would be one of the first to disagree with this perspective. I am not saying that Andreas is absorbed from any responsibility for his actions; I am saying we need to learn and grow from them.

This kind of murder-suicide has happened before- from my research, at least 9 times before. That is a lot. Too many times, if we are being honest. From the news reports, it would appear that there have been failings at many levels- both from the Co-pilot himself, and the process of risk and safety and security from the airlines. One can only hope that these processes have all been re-evaluated in the light of 24th March’s events, and that the situation of one person being alone in the cockpit will not happen again.

I am no aviation expert; I do not know the rules and regulations of air flight. What I do know, are people. Although not an expert in people, I have dedicated the last 10 years of my life towards learning about the ‘human condition’ and what makes us ‘tick’. Over the years, the stigma of depression has decreased, but as demonstrated in the last week; we are still not over the fact that 1 in 6 people suffer depression in their lifetime, and that this is a completely normal illness.

The failing here, I believe, was in company policy- had Germanwings had a policy that there was always to be two people in the cockpit at any given time, as in the US, Andreas would not have had the opportunity to do what he did. So, this then begs the question- was it premeditated or a spontaneous act?

When people suffer with depression, usually, the only people that they are willing to hurt are themselves. Suicide is a form of self-harm; an extreme form of self-harm, but self-harm none the less. The problem with screening for this type of event, is that it would bring up too many false positive’s (Eliason, 2009); making it unfeasible both ecologically and financially.

Most murder-suicides are actually between couples, or estranged couples (Eliason, 2009) and premeditating factors are; substance abuse; divorce and separation; 88% of the time, the victims are female; depression was a risk factor, but in most of the cases of murder-suicide, this was between a couple who had broken up- not an aircraft full of men, women and children. The supposition that Andreas had recently split from his partner is there, but as yet there is no proof to determine this, or indeed if it was a cause or effect of his mental state. But aren’t we getting away from the point here, just a little?

Murder-suicide is rare, especially of this magnitude. Not everyone who is depressed is going to kill themselves, let alone anybody else; so, surely the question here, is why is someone who was mentally ill being demonised for actually being… well, mentally ill? We do not know the factors involved, but what we do know is that the resulting chaos in the press has served to stigmatise mental illness even further. Headline such as ‘Crazed Pilot’ from the Daily Mail; web articles with titles such as ‘Mad, Sad or Bad’ are screaming out the prejudice that society still serves towards mentally ill people.

Dr Paul Keedwell, a Psychiatrist at Cardiff University, was quoted in the Independent newspaper as saying “Among cases of murder suicide in general, the rate of previously diagnosed depression varies from 40 to 60 per cent, depending on the context. Of those who are depressed, very few are being treated for it..” (Connor, S 2015). But most crucially, amongst professionals, the consensus is that murder-suicide is not explainable by depression. Therefore, something more is going on in play here, but, because most of the people who are involved in murder-suicide, who know the perpetrator, are actually the victims of the crime, we cannot get a real psychological pathology of what was going on for the perpetrator at the time (Eliason, 2009).

But again, surely there is something wrong here? Yes, a crime has been committed, and the person who committed it, who we are calling the perpetrator, well, surely they, too, could be considered a victim? I don’t know about you, but the above statistic is actually quite frightening- up to 60% of people among murder suicide cases are not being treated for depression- what we have to ask, is why? If they are not being treated for depression, and the consensus is that murder-suicide is more than just depression- where are the health care system, and employers, letting us down?

Professor Michael Anestis, director of the Suicide and Emotional Dysregulation Lab at the University of Southern Mississippi states that ‘we are not particularly good at detecting risk; who’s going to do it and when’ (Bruenig, E. 2015). Reasons cited for not disclosing mental illness are fear or repercussions professionally and personally. And there in lies the problem. Mental illness, of any form, is still so radically stigmatized that the people who genuinely need the help, are not seeking it. Suffering a mental illness does not have to mean that your life is over; it does not have to mean that you lose your job. What it does mean, is that if you look for, and get support for your illness, there is help available.

In the UK, we are not used to paying for healthcare; we expect everything to be free, as we are lucky enough to have our NHS (National Health Service). However, with budget cuts and a rapidly expanding population, more prone to mental illness (or is it just the fact that we are more likely to report it? That, my friends, is an issue for another blog post!), it means that we are having to look to private healthcare to gain the mental health support we need, and perhaps that is where the model falls down? By having private therapy, individuals who are worried about their professional or private lives, can try to mitigate some of the fall out. Not all, but some. We think nothing of paying £45 for a pair of shoes or a console game, but when it comes to our mental health, we just don’t want to part with the money. So, herein lies the trap- individuals in need do not want to go to their Doctors, but they also deem private care too expensive. Where is the middle ground?

Well, it revolves around reducing the stigma attached to depression and mental illness. The more we can remove this stigma, the more people will seek help for their difficulties. This wont stop every murder-suicide- it would be impossible to catch everyone with one net- but it could help to change peoples lives.

Why are we still stigmatizing mental health, in this day and age? We know that there can be genetic factors involved; we know that stressful events can trigger depression and we know that sometimes, due to our brains physiology, depression can just happen. So, if it could happen to you, then surely it could happen to me? And you. And you. And you. See? If we keep the stigma of mental health, at some point it may affect you or someone you love.

From the headlines I have seen, it is fairly true to say that there is still a huge stigma towards mental illness in the media- an Australian Mental Health Charity, Sane, found ‘that SANE research from 2007 found that inaccurate and prejudiced assumptions about people with a mental illness could be reduced through increased accurate and helpful reporting in the media.’ So, have the headlines of the last few weeks really been helpful? Or have they just served to increase our societal prejudice towards mental health issues?

We need more empathy, more concern and more understanding towards mental health; if we do this, people will not be so afraid to come forwards to get the help they really need. It isn’t fair to all those families out there, suffering because of a silent illness. After all, how do you know that your family isn’t suffering because of a loved one’s health? Or if you do, are you too scared to open up about it, because of what others will think?

Either way, more tolerance is needed. I am not saying this would of stopped Andreas from his horrendous actions, but perhaps, just perhaps, openness, understanding and awareness of mental health issues could stop people feeling like they have no other option, by reaching them before they get to this point. It’s your choice- choose to reduce the stigma.


Bruenig, E.S. (2015) The Germanwings Mass Murder–Suicide Shows the Importance of Depression Intervention, 30 March, [Online], Available: http://www.newrepublic.com/article/121405/germanwings-pilot-andreas-lubitz-struggled-severe-depression [01 April 2015].

Connor, S. (2015) Germanwings Plane Crash: ‘Murder-suicide’ cannot be explained as depression, say experts, 27 March, [Online], Available: http://www.independent.co.uk/news/world/europe/germanwings-plane-crash-murdersuicide-cannot-be-explained-as-depression-say-experts-10140104.html [02 April 2015].

Eliason, S. (2009) ‘Murder-Suicide: A Review of the Recent Literature’, Journal of the American Academy of Psychiatry and Law Online, vol. 39, no. 3, September, pp. 371-376.

Why didn’t you like my Selfie?

Social media is really on my mind this week- I have several online presences; both personally and professionally. I find it hard to maintain them, but in this day and age, when most of our interactions with our friends seem to come from social media, what choice do we have? If you have your own business, then you will know as well as I, that it is essential to have a presence in the online world. But, how is this impacting us in our lives, and what impact is it having for our children?

Bare with me on this, and you will see where I am coming from- there is a psychological platform that is commonly used to study the psychological implications of social interaction called the Ultimatum game. The Ultimatum game relies on two people, one of which is in charge of dividing ‘resources’ between themselves and the other person who is the recipient (these resources can be anything- sweets, money, pencils, but it is usually money).

The person, who is dividing the money, is free to divide the resources in any manner they wish; the recipient can then accept or reject the first person’s offer. If the offer is accepted, say for example a 50/50 split, and then each party gets 50% of the resources. If there is a 70/30 spilt, and it is agreed, then the split is 70% to the divider and 30% to the recipient. If the recipient rejects the offer, then both parties get nothing.

The brain processes involved in the Ultimatum game were analysed (the most cited study of this is (Wout et al., 2006) ) and the results found that ‘unfair’ offers (offers 30% or less), when made by a human partner were rejected at a significantly higher rate than offers made by a computer. Thus suggesting that the participants involved had a much stronger emotional reaction to unfair offers from humans, than they did to the same offers from a computer.

So, what does that actually mean, and what does it have to do with Social media, I hear you ask! Well, this study shows that interacting with humans takes much more emotional involvement, and by default, more cognitive effort (the effort involved in making our brains work) than interacting with a computer.

So, again, I hear you ask, what does this have to do with Social media? Well, this generally means that interaction with a computer is easier for us, as it requires less emotional involvement and cognitive energy than talking to a human- when we talk to humans, 55% of our communication is through body language, 38% through tone and speed of your voice, and only 7% is actually through what we say (Aron, 1997). So when we interact with people, we are constantly paying attention to what is being said, but also the body movements, gestures, the tone of voice, the words that are being said and eye contact that is, or is not, being made.

This enables us to see and hear how people are feeling when they are speaking to us- that is not available to us when we are ‘talking’ from behind our keyboards! This means, to speak online, we need to use a lot less effort than we do when we are face to face- it is easier to hide our emotions online than it is to hide them in a face to face conversation.

By utilising Social media, the user is able to project a personality, expression, opinion, and a persona if you will, that may not be the same as the person that they ‘actually’ are. We all say things out of anger, or hurt, sometimes, but when we say it to the person themselves, we see the effect and reaction we get from being cruel- you do not get that when you are behind a screen.

When we are talking to someone who is in a particular emotional state, we are primed to enter that state ourselves (Dimberg, Thunberg and Elmehed, 2000)- meaning that when we are talking to each other, if our friend is sad, we are likely to become sad ourselves. This is sadly lost when interacting via a computer. Social media is a virtual form of interaction- meaning that the interaction takes on some of the qualities of being real, but is not in fact ‘real’. Therefore, how do we know what we are being presented with is in actual fact, real?

What’s so bad about that, then? Well, for most people, using social media is a form of remaining in contact, whether because there is a distance involved or you just want to let people know how you are doing- ever noticed how most people only really post when good things happen? As adults, we can generally regulate our use of Social media much easier than young teenagers or pre-teens can. Most children have access to the Internet now, and in particular Social Media apps such as Facebook, Instagram, Oovoo and other messaging platforms. Whilst they are happily posting away about how good there day was, how much they love their Bae, the ‘banter’ at school, or the fact that Zayn Malik has left One Direction (see, I really am ‘down’ with the kids!), these young people are posting their hearts and lives and loves out in the open, for all to see. It is amazing to me, how many young people’s online accounts are open access; enabling anyone to read them. Or the fact that parents do not seem to be checking what their children are posting to these platforms.

So, here in lies the problem- if a young person is posting on Social media that they are depressed, sad, excited or happy, how do we know that this is really happening? Haven’t you ever just sent a text saying ‘I’m good’ when in actual fact, you have a headache, feel poorly or tired, or are feeling a little depressed, stressed or anxious?

Social media can be a disingenuous way of communicating- the persona we are projecting may not be the persona we actually have, and so who is regulating this? As adults, we would like to the think that we would think twice before we posted something that could be, potentially, offensive. But, young people live in the moment, they speak from their heart and not necessarily their heads- if they are posting offensive comments, perhaps it is down to peer group pressure, and not the actual person they are; who actually does have a very different set of beliefs.

So, where do we go from here? Should parents check their childrens Social Media accounts? Do we need to teach, or remind, our children about self-regulation? We assume that schools are doing the job, but isn’t it also the caregivers responsibility? As shown by the Ultimatum game, we don’t respond to computers in the same way that we respond to people- although there is a person at the end of the Social media platform, perhaps it is easier to say things we don’t necessarily mean on a computer, and then have regrets after?

And what about us as adults? Who regulates us, when we are incapable of regulating ourselves? What we need to remember is that what we put out there on Social Media is there forever, even if we do delete it. Recipients or viewers can take screenshots and keep the information. Whatever you are preparing to say, be it to your audience, a friend or possible romantic interest, ask yourself these questions- would I say it to their faces, if I were stood in front of them? And if you would, how would it make them feel?

 


Aron, A. (1997) ‘The Experimental Generation of Interpersonal Closeness: A Procedure and Some Preliminary Findings’, Personality and Social Psychology, vol. 23, no. 4, April, pp. 363-377.

Dimberg, U., Thunberg, M. and Elmehed, K. (2000) ‘Unconcious Facial Reactions To Emotional Facial Expressions’, Psychological Science, vol. 11, no. 1, January, pp. 86 – 89.

Wout, M.v.’., Kahn, R.́.S., Sanfey, A.G. and Aleman, A.́. (2006) ‘Affective state and decision-making in the Ultimatum Game’, Experimental Brain Research, vol. 169, Jan, pp. 564-568.

 

 

Is My Teenager Depressed, Or Just Hormonal and Moody?

I don’t know if you have read the recent news about children’s mental health care and cuts over the last 5 years (the cuts equate to 5% or £50 million) (Buchanon, 2015), but children’s mental health is a big issue, and it appears to be affecting more children now then before. I guess this means, that as parents, we need to be more observant than ever before. It is unknown if instances of teenage depression are actually on the increase, or it is just that through education and the fact that depression is no longer such a taboo, we are reporting cases of it more.

Children nowadays are under so much pressure- with the Internet and Social Media- the pressure is actually 24 hours a day, 7 days a week. It’s amazing how resilient teenagers are, given the constant pressure. But how do we know whether what they are going through is normal, hormonal teenage behaviour or an actual depressive illness? However, the average onset of depression is about 14 years old. By the end of the teenage years, 20% of teens will have had depression; of those, 70% will improve through treatment and 80% of these teens don’t ever receive help for their depression. Between 1 in every 12 children and 1 in every 15 young people self harm deliberately (Green, 2013).

So, as you can see, depression is actually a lot more prevalent than you might believe, with around 1 in 5 teens suffering. Depression can often run in families and can be preceded by a traumatic event, such as a divorce, death, a break-up or an abusive situation.

Firstly, it is really important to note that each person experiences depression in a different way from the next- our experience’s are unique to ourselves, and, although we can empathise (put ourselves in the other persons shoes) to a certain extent, we can never fully know what they are going through.

Yes, hormones are raging for teenagers, and it is a turbulent time to live through, but most teens manage their angsts with normal, sociable activities- meeting up with friends, sports, arts, music, and pride about success in school or outside activities. All of this helps to balance out the negative feelings and increase the teen’s sense of self. Bad moods, moodiness, grumpiness or ‘acting out’ (arguing, using their defence mechanisms to protect themselves from what is going on) and it is all part of the teenage years and the need to find your sense of self- if you are a parent, remember back to your teenage years? Perhaps they were difficult; perhaps you acted out? Remember that it is not an easy time; have some patience and try and listen to what your teen is telling you.

Although these moods are to be expected, there is a very big difference between moodiness and depression. Depression can challenge, and even destroy, a teens very idea of themselves or who they want to be. Depression causes overwhelming sadness and despair, which cannot be resolved by being told to ‘man up’ or ‘buck up your ideas’.

One of the most important things to recognise about depression is that your teen may not always appear sad; they could be putting on a front to hide their sadness. Teenagers are trying to assert their own independence over their parents, so the arguments and moodiness could just be that. However, for some depressed teens, symptoms can be rage, irritability and aggression, making it quite difficult to actually ascertain what is going on for them.


 

Signs and Symptoms of Teenage Depression


 

Some of the main signs and symptoms of depression (NHS, 2014) in teens can be easy to spot- others not quite so.

  • Does your teen feel a sense of hopelessness or sadness? It can be for no reason at all.
  • Does your teen have thoughts of death or suicide? ‘Everyone would be better off if I wasn’t here’ can sometimes be a common thought.
  • Do they suffer from a lack of energy? Are they fatigued more than normal?
  • Are there any changes in their eating habits? Eating more, or less?
  • Are there any changes in their sleeping habits? Sleeping more, sleeping less, night waking and being unable to return to sleep, waking up early?
  • Have they withdrawn from the family and their friends?
  • Are they tearful? Do they cry easily? Are they crying frequently?
  • Have they lost interest in their usual activities? Is there a sense of apathy that wasn’t there before?
  • Are they agitated? Restless? Unable to sit still?
  • Are they suffering from feelings of worthlessness and guilt?
  • Have they developed a difficulty in concentrating? Have their grades at school dropped?
  • Have they lost their usual enthusiasm? Have they developed a lack of motivation?
  • Are they feeling irritable? Angry? Hostile?
  • Have they increased feelings of anxiety?
  • Have they become extremely sensitive to criticism?
  • Do they have unexplained aches and pains? Headaches or stomach aches, for example?

Headaches, stomach aches, withdrawing from people or hanging out with a new crowd, anger, irritability and sensitivity to criticism are more common in teenage depression than they are in adult depression.


 

What is the effect of Depression on Teenagers?


 

So, what is the actual effect of depression on your teen (Medlar, 2014)? Again, this is a very unique perspective- what happens for one teen may not be what happens for another, so it is important to go by your own experiences and not others!

  • They may become violent, or more violent than usual. Usually, this is boys, but girls can become violent too. Sometimes they have been the victim of bullying, and are ‘acting out’ in the only way that they know how.
  • Some teens develop problems at school; and some excel, as they throw themselves in to their work, rather than deal with what is going on. Depression can make you feel tired, give you difficulties in concentrating and with the added aches and pains, it can lead to low attendance at school or an apathy to not engage in the way they used too.
  • Low self esteem- being depressed, your teen will already be in a low mood cycle. This can then intensify their feelings of guilt, shame, worthlessness, failure and even ugliness. They may even start to see problems where there are not problems.
  • Some teens turn to drug and alcohol abuse- substances are a common way of dealing with feelings. Whilst we are drinking or on drugs, it can make us feel temporarily better and focus us away from the problems. The only problem is that substance abuse actually makes things worse for the depressed teen.
  • High- risk behaviours, such as unprotected sex, sleeping around, out of control behaviours become common, as the teen is searching for a way to alleviate their pain.
  • Some depressed teens may start to talk about running away; some may even run away. These are usually cries for help, so if this happens, it is important to listen to your teen.
  • Self-harm can also be a way of expressing their depression. Keep an eye out for teens that appear to be hiding parts of their body with long tops, or a refusal to wear shorts in warm weather. It might be a fashion statement, but it could be a sign of something else.

 

What about Suicidal Tendencies?


 

Teens that are seriously depressed may make statements expressing suicidal tendencies. Although some of these statements may well be a way of getting attention, or a cry for help, some of these statements are real and the seriously depressed teen could act on their threats. So, when should you worry? What is a warning that your teen may well attempt suicide?

Firstly, is your teen expressing thoughts that they would be ‘better off dead’ or ‘there’s no point’ ‘things will never get better’? Negative statements that are really quite dark in thought and deed? Are they joking about committing suicide? This too can often be a cry for help, as can writing stories or poems about death, suicide and dying. Are they storing medications? Asking for pills or hiding pocketknives or razor blades in their rooms? More obvious signs would be saying goodbye to friends and family, as if this is the last time they will see them. And of course, reckless behaviour- are they getting hurt a lot because they are putting themselves in dangerous positions?


What Can I do If I Suspect My Teenager Is Suffering With Depression?


 

So, what do you do if you suspect your teen is suffering from depression? Well, the first thing to know is you are not alone! There is probably nothing you have done wrong or could of done differently to stop this happening. Even if you don’t know if it is depression, talk to your teen. Find out how they are doing. Perhaps knowing that someone is interested and there for them will help them to open up about what they are finding difficult.

Try and be empathic and non-judgemental; keeping your temper with them is tricky, but the more you can appear open to discussion, the more your teen will feel they can open up. Don’t over question your teen- this could stop them from trying to reach out; teenagers do not like to be pushed into doing things they don’t want too! Try not to patronize, or say things like ‘when I was your age’- imagine someone saying that to you, when you’re feeling down? It isn’t helpful, is it?

Do listen without lecturing- try not to pass judgement or criticize- it takes a lot of guts to open up, when feeling very depressed. The most important thing here is that your teen is trying to communicate with you! You cannot talk your teen into feeling better- listen and acknowledge how bad they are feeling; their pain and sadness. Let them know that you are taking what they say seriously and that it is of importance to you.

Your teen might be too scared too talk to you, or feel that they cannot open up about what is going on. If this is the case, get in touch with your G.P who can refer your child on to the Children and Adolescent Mental Health Team (CAMHS) or there may even be a Psychology Practitioner in your surgery who your teen can talk too. It is really important that your teen, if prescribed medication, does not rely on this alone. Evidence suggests that a combination of drug therapy and talking therapy or CBT (Cognitive Behavioural Therapy) has been shown to be the most effective way to deal with depression.

It is also important to note that some medications can increase the suicidal thoughts; if this is the case, get in touch with your GP. Particularly if there are new suicidal thoughts, failed suicide attempts, difficulty sleeping, panic attacks, restlessness or agitations, new/worse irritability, hyperactive or any other unusual changes in your teen’s behaviour.

Finally, be kind to yourself and your teen- try to factor in some ‘me’ time, where you do something important to you; be it reading, a bath, socialising or going out for a coffee or swim. The more positive experiences we have, the better we feel, especially if we can remain connected to other people. This isn’t an easy task to do, and perhaps your teen really isn’t feeling like doing any of it. Try to respect their space, but gently encourage positive activities.

Remember, your teen may not understand their feelings or how to verbalise them, so trying to get them to talk to you could be really difficult- if you don’t understand it yourself, how can you explain it to someone else?


References:

Buchanon, M. (2015) Childrens Mental Health Services Cut by £50 million, 9th January, [Online], Available: http://www.bbc.co.uk/news/education-30735370 [26 February 2015].

Green, H. (2013) Mental Health Statistics, 8 June, [Online], Available: http://www.youngminds.org.uk/training_services/policy/mental_health_statistics [26 February 2015].

Medlar, F. (2014) Signs of Depression, 8 June, [Online], Available: http://psychcentral.com/blog/archives/2012/07/21/a-few-signs-your-teenager-may-be-depressed/ [27 February 2015].

NHS (2014) Depression, 5 June, [Online], Available: http://www.nhs.uk/Conditions/Depression/Pages/Symptoms.aspx [20 February 2015].