One Year On and Has There Been Any Real Change?

One year ago today, the world was rocked by the unexpected death of Robin Williams. He had been suffering from severe depression and, sadly, took his own life. What caused him to do this is unknown, and sadly, suicide remains very prevalent in our modern society.

According to The Samaritans 2015 report, Suicide Statistics 2015,

  • In 2013, 6,233 suicides were registered in the UK. This corresponds to a rate of 11.9 per 100,000 (19.0 per 100,000 for men and 5.1 per 100,000 for women).
  • The male suicide rate is the highest since 2001. The suicide rate among men aged 45-59, 25.1 per 100,000, is the highest for this group since 1981.

SuicideChart

 

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So, why is this happening and what is going on? The rates of suicide are increasing- but aren’t we more aware of our mental health now, more than ever? The Mental Health Foundation estimates that;

  • One in four people will experience a mental health problem at some point in their lives.
  • Around one in ten children experience mental health problems.
  • Depression affects around one in 12 of the whole population.
  • Rates of self-harm in the UK are the highest in Europe at 400 per 100,000.
  • 450 million people worldwide have a mental health problem.

So, mental health issues are pretty common place- so why are the suicide rates increasing? One reason that is consistently studied is the idea of stigma that is attached to admitting that one is suffering from a mental health difficulty. Different forms of stigma include personal stigma (negative attitudes towards others), perceived stigma (perceived attitudes of others) and self-stigma (self-attribution of others’ negative attitudes), so we can see the possible effects of ‘owning up’ to a mental health difficulty.

A study published this year asked 350 members of the public and university students to complete an online survey assessing their knowledge and contact with depression and anxiety, perceived stigma and self-stigma for both anxiety and depression (Grant, Bruce and Batterham, 2015). They found that (surprise, surprise!) the more contact you have with anxiety and depression- be it yourself or a friend or colleague- the less stigma you perceived from other people.

Men reported that they felt more personal stigma around depression and anxiety than women and the more the participant had personal experience of anxiety and depression, the higher their levels of self-stigma were towards mental health illnesses. So, really, there were no surprises. The more you experience mental health difficulties, the more you think other people will judge you negatively. So, now are we getting to the crux of why suicide’s are rising year on year? Despite the fact that we all think we are tolerant towards mental health illnesses, there is still a huge amount of perceived stigma, particularly from people who are suffering.

If you are feeling bad, who is going to want to risk telling people, who may then judge them and make them feel worse? Or just the idea that we have a mental health difficulty can be enough to stop you even acknowledging it, and certainly stop you getting help for it. What this study found was that we need to increase interventions aimed at increasing help-seeking behavior- we need to make it easier and less traumatic and worrying to get help.

We still assume that we are going to be penalized, personally, financially and professionally if we admit to having difficulties; but, and here is the crazy part, ONE IN FOUR PEOPLE will experience mental health problems at some point in their life. It could be you, your mum, dad, partner, children, best friends or colleagues from work. How would you feel if your loved one was feeling depressed, or, heaven forbid, suicidal, but didn’t want to tell anyone for fear of shame?

We really like to think of ourselves as sophisticated and non-judgmental, but, if this were the case, more people would seek help for their health, and surely, suicide rates would decrease? Mental health difficulties don’t discriminate; the old, young, rich, poor, male, female, cultural differences- it doesn’t matter. So, if mental health illnesses don’t discriminate, why should we?

What Robin Williams sad death highlighted for our society was the fact that no matter how rich or successful you are, if you are feeling low, depressed or anxious, money and fame and success won’t fix it- it’s time we were more open about mental health. Life is hard, sometimes, and we all need help from time to time; why should we have shame and stigma attached to that?

I wrote a blog piece earlier in the year on teenage depression, but, you know what? A lot of the symptoms are the same! The other point about this piece I am writing, is that even if you are not suffering from depression or anxiety, it’s really helpful to know what the symptoms are, so we can help and support our friends and family! Also, what’s the harm in spreading information and destigmatizing the issue of mental health? Anyway, back to the point of this particular paragraph; when it comes to mental health illnesses, please seek some help if you are experiencing three or more of these;

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

Please do go and see a Doctor. Seek out some help. Everybody goes through a rough patch at some point or another and sometimes things are just really difficult to deal with.

There are lots of different ways to tackle depression- medication is not the only thing available! I work in the NHS with clients who are referred from their Doctors surgeries. Sometimes, just talking to someone can help. Knowing that you are not the only one who feels that way can help to normalise what is going on for you. The NHS offers CBT therapy and courses to help deal with depression, anxiety and other issues. Please believe me when I say that you are not alone, many, many others feel this way too.

It might sounds ridiculous, when you are feeling so rough that you don’t want to get out of bed, but try and see your friends and family- research shows that getting out there and talking to people really does make you feel better. It is hard work, I know, but the more you see your friends and family, the easier it gets to go out and see them and the less you isolate yourself from the people who care.

Get some exercise! Go for a walk, run, swim- whatever it is that makes you feel better! Exercise releases endorphins, which are the feel good hormones in our body, so after we exercise, we get a hit of endorphins that makes us feel good. Even If it is just a walk- it will still do the same!

Concentrate on ‘me’ time- whether that’s a face pack, a bath, and meeting friends, going to the cinema. Whatever it is that will relax you. I know, I know, there are far too many things that need to be done before you can have some relaxation. But, the dishes will still be there when you have spent some ‘me’ time, and you know what? Doing those dishes might not be such a big deal when you have had time to relax.

As adults, especially if we have families to look after, we don’t feel like we deserve to have ‘me’ time, but realistically, having some ‘me’ time can help you so much more than you think it will! Spending a small amount of time de-stressing yourself will make all those things you need to deal with easier. Go on, try it- what have you got to lose?

Are you worrying too much? Do you find yourself spending all your time worrying? One thing that can really help is to have a ‘worry book’ on hand. Every time you have a worry, write it in your worry book. Then allocate yourself a period of time during the day to acknowledge your worries- make sure its not bedtime though, as those thoughts will just swim around your head! Take 30 minutes (no more- it’s worry time, not worry hours!), perhaps after dinner, or when you’ve put the kids to bed, and get your worry book out. Have a look at your worries. Can you do something about it? If so, it’s a problem, not a worry- and problems we can do something about!

If it is something in the past, or something that we physically cant do anything about, it is a worry. Write it in your worry book, acknowledge it in your worry time, and whenever it pops back in to your head during the day, say to yourself ‘Yep, that’s a worry for me- but, it’s in my worry book/I’ll put it in my worry book, and I will look at it later in worry time!’ distinguishing between what is a worry and what is a problem can be very helpful and give us some perspective about things we can do and things we cant.

Finally, seek out help- if you are feeling low, call a friend, call the Samaritans, CALM or SANE to talk to someone. Don’t suffer alone! If you don’t feel like your GP is taking you seriously, talk to another one. Just like some people specialise in holiday insurance and others in pet insurance, GP’s have specialisms too! Some are just better dealing with mental health difficulties than others!

If you do decide to go for counselling, it is really important that you find a counsellor who fits with the way you think and feel. If you don’t feel safe and listened to by one counsellor, go to another- as counsellors, we really want you to feel confortable with us; we wont take offense if you don’t! You cant like everyone in this life!

So, don’t let your mental health get to the point that you feel there is no hope. There is help out there, if only you can find it. And, you know what? People are a lot less judgemental than you think, and that stigma you perceived from your colleague? Well, maybe they just don’t really know what to say, but they do want to help!

 


Grant, J.B., Bruce,  .P. and Batterham, P.J. (2015) ‘Predictors of personal, perceived and self-stigma towards anxiety and depression’, Epidemiology and Psychiatric Sciences, vol. 1, August, pp. 1-8.

Samaritans 08457 90 90 90

SANE 0845 767 8000

CALM 0800 58 58 58 or by text on 07537 404717

 

 

 

When is a Therapy not a Therapy?

I have been on a lot of training lately- some I have loved, and some I have found less impressive-  the techniques just don’t resonate with me, so I have decided not to adopt them in my therapeutic work. That isn’t to say that the types of therapy do not work, I just don’t see them fitting in to my practice, be it because of a lack of a rigorous scientific background, or I just didn’t like the form of therapy! This got me to thinking- who is to say what works and why? Whilst pondering this (eternal) question, I found a study in the Psychological Bulletin that really intrigued me.

The study is called The Effects of Cognitive Behavioural Therapy as an Anti-Depressive Treatment is Falling: A Meta-Analysis, so perhaps from this, you can see why my interest was piqued! The study is a meta-analysis, which means that they have taken all the studies (between 1977 and 2014) that are about CBT (Cognitive Behavioural Therapy) (Johnsen and Friborg, 2015) and have analysed them to produce an overall investigation in to the efficacy (how it is working) of CBT. The results are, interesting, to say the least!

The study tracked the fluctuations in the effectiveness of CBT over time, and what the study found was that CBT appears to becoming less effective over time. This is not good news for the NHS, as this is the main type of therapy that they advocate. So, why does it appear to be falling out of grace, and why?

The study shows that over a period of time, 1977 to 2014, CBT has become roughly half as effective in treating depression as it used to be. I have to say, that from my clinical practice, I am finding that clients are becoming more and more resistant to CBT- in my (limited!) opinion, it is because we are becoming more self aware, and the more self aware we become, the less we can justify it to ourselves. But then, I am just one psychologist and that is my opinion!

One theory that is being bandied around is the idea of the placebo effect, which I am sure you have all heard of. The placebo effect is the idea that if you take a pill for your headache, and you believe it is paracetamol, but it is actually just a sugar pill, that the power of your mind is so strong that you will believe that this ‘tablet’ has made you better and your headache disappears, even though there was no ‘active ingredient’ in the pill you took.

Perhaps, like a popular friend in your network of friends, CBT’s reputation precedes it; the fact that CBT was hailed as a miracle cure, could mean that people really thought it worked (the placebo effect) when in actual fact, it didn’t work as well as was expected.

Part of this theory is about our expectations, which kind of ties in with my theory on the efficacy of CBT- in comparison to when CBT came about, when it was developed by Dr Aaron Beck in the 1960’s, our expectations of life have changed greatly. We are more realistic about life, in general. So, perhaps we do not expect a ‘miracle cure’ anymore? Perhaps we accept that we are who we are, and we can only change things if we want to? Who knows? That, my friends, is another study waiting to happen!

Another theory is that, as any therapy develops and becomes more popular (which is inevitable!), that the number of incompetent or inexperienced therapists applying these techniques increases. This means that the efficacy of the therapy decreases- if you are not attending CBT therapy with an experienced practitioner, it is not going to work as well. It’s like taking your Porsche to the Skoda garage- it’s similar, but not quite the same, and a Porsche has a specialist management system, so a Skoda garage wont be able to give you as good service as the Porsche garage will; although your car may be fixed to a certain extent, there is still work left to do.

Whatever the reason, life has changed and therapy changes with it. Who is to say that the placebo effect can’t actually help? I mean, if CBT works for you, who cares if it is the placebo effect at work? As long as it works, right? The problem though, lies in if it doesn’t work for you because you have been to an inexperienced therapist, or perhaps, as in my experience, you are actually self-aware and you know what is happening for you. Either way, if the only therapy available to you is CBT, and it doesn’t work, what do you do?

Well, the current therapy du jour happens to be mindfulness. Now, I have been using mindfulness for a few years, and just attended a course to brush up on my techniques, learn any new theories and to make sure I am not an inexperienced practitioner! But, is mindfulness just the next buzz word- in 40 years time, will the studies be there to show us that, just like CBT, mindfulness has become less effective also?

Last week I attended training on a course called Havening Techniques®. Yes, yet another new form of therapy. I have not had enough experience with Havening to fully make my mind up about it, which is why I need volunteers to work with. But, this brings in to question, again, the efficacy of a therapy and the placebo effect- who is to say what is right and what is wrong? If a therapy works for you, and a competent therapist is treating you, then does it really matter what the modality of therapy is? Perhaps, in our ever-changing world in which we live in, the changing modality of therapies is actually useful. Perhaps therapy is adjusting to our different lifestyles and expectations in life?

Back when Freud was just at the beginning of his Psychodynamic theory, life was very different. People did not understand how their emotions effected, and affected their lives. The ‘new therapy’ gave us an understanding of what was happening in our lives. But now we understand, we want to solve our problems. And, in true modern fashion, we don’t want to wait; we want to fix them NOW.

Perhaps this is where Havening® could fit in? Dealing with trauma and emotions in a focused way, whilst, at the same time, giving you techniques to practice at home, where you do not have to be an expert? I don’t know, but I do know one thing- I am looking forward to finding out!


 

★ if you have contacted me with regards Havening therapy; I am in the process of writing contracts etc. to begin the therapy. I hope to be in contact with you in the next week or so to book appointments!


Johnsen, T.J. and Friborg, O. (2015) ‘The Effects of Cognitive Behavioral Therapy as an Anti-Depressive Treatment is Falling: A Meta-Analysis’, Psychological Bulletin, May.

Being Mindful of Mindfulness!

I was on a Mindfulness course last week- Mindfulness is a really hot topic with Mental Health workers at the moment. I have been working with Mindfulness for around 4 years, so I thought I would scrub up on my techniques and ideas and get back into my Mindful practice for myself!

Did you know that in 2012 there were 40 new papers on mindfulness published every month according to Google Scholar? Guardian journalist Barney Ronay noted that 37 new books had been released that week alone! I think that this demonstrates just how popular mindfulness has become.

Mindfulness, the act of paying attention, in a non-judgmental way, to ones own experiences of the here and now. So, what exactly does that mean? Well, exactly what it says- paying attention to what is happening to you, around you, in the moment that you notice them.

Whenever anyone is going on a mindfulness course, the first thing people who are experienced in mindfulness will say to him or her is “Wait until you do the raisin exercise!” What? What on earth is that? Well, a good way to explain mindfulness is to take a raisin. Don’t eat it- you are jumping the gun there! Hold it in your hand. Have you ever really looked at a raisin? Have you noticed the colours? Have you held it up to the light and looked at the brown and amber hues that are in front of you? Have you ever looked at the creases, the ridges, and the folds? The size of the raisin or the shape of it? Have you felt it between your fingers? Is it squishy? Hard? Smooth? Textured?

No? I am sure you haven’t. Not really. Not closely.

Well, let’s not stop there! Pick up the raisin. Put it to your ear. Do you hear anything? No, of course you don’t, but then roll the raisin between your fingers. Can you hear the squeakiness of the raisin now? The slight grinding as you roll the raisin between your fingers?

Take the raisin and hold it up to your nose. Take a deep breathe in- can you smell it? What does it remind you of? Christmas cake? Cinnamon rolls? Is it a slight smell, or pungent?

Now, put the raisin in your mouth- but don’t chew it or swallow it! Roll it around in your mouth and really feel it. Put it between your teeth, give it a little squeeze. Can you feel the textures and the taste starting to spread? Gently chew the raisin, experience the flavour. Is it sweet? Bitter? Finally, swallow.

Now. I bet you haven’t experienced a raisin like that before, have you? You could do the same with making a cup of tea or brushing your teeth- any activity that you do during the day, that you can break down and really pay attention too!

So, what on earth has fiddling with a raisin for the last 10 minutes done for you, eh? Well, by exercising all of your five senses, your cortisol level has decreased (stress hormone) and you will feel calmer than you did before you started. By looking at things from a visual, auditory, kinaesthetic, gustatory and olfactory sense (see, hear, touch, taste, smell!) you have brought yourself into the present moment. You are not thinking of that annoying colleague today at work and you are not thinking of all the work you need to do tonight to prepare for tomorrow. You are in the moment, and that moment is peaceful and calm.

So, by practising this every day (for those of you in the know, it is VAKGO. Yep, snazzy, eh?) we can just stop what is happening, take a few minutes out of life to relax and calm down, before we go on to the next busy period of the day.

So, how exactly does being mindful, which can actually be a personality trait anyway, actually be beneficial? A study in 2011 suggests that

Evidence suggests that mindfulness practice is associated with neuroplastic changes in the anterior cingulate cortex, insula, temporo-parietal junction, fronto-limbic network, and default mode network structures” (Hölzel et al., 2011)

Say, what?! Well, what this means is that by practicing mindfulness, area’s of the brain, associated with neuroplastic changes (referring to changes in neural pathways and synapses that occur due to changes in behavior, environment, neural processes, thinking, and emotions – as well as to changes resulting from bodily injury) in areas of the brain that are responsible for attention, focus and regulation. Simply put, by utilizing mindfulness you can actually change the structure of your brain (the area’s that are ‘plastic’) for your benefit; to increase your sense of personal perspective awareness, your attention and focus, your emotional regulation and your body awareness.

Nah, that’s not real. Once your born, your brain doesn’t change. Well, actually it does- as we grow so does our brain. Our neural pathways and synapses develop and change, according to our environment, what we learn, what we don’t learn and genetics. So, if we train our brain to be present in the moment, really present, we can grow the area that we use to focus and pay attention. What magic is this, I hear you ask? Well, it is simply the wonder of the human mind- although science has come along way over the last 100 years, we still do not really know how the brain functions; we are learning more every week.

So, if mindfulness is so magic, why isn’t everyone doing it? Well, I cannot answer that one, I am afraid! What I can say is that mindfulness is NOT a cure all. It is a technique you can use to develop and enhance your day-to-day life. In fact, there are studies available that say certain people should not practice mindfulness; a study in 2012 concluded that there was not enough data available to fully analyse who should or should not partake in mindfulness meditation or therapy, but that people for whom there are deep-seated mental health difficulties or long term psychological affects, mindfulness meditation may not be appropriate (Dobkin, Irving and Amar, 2012).

The reason that mindfulness may not be appropriate for some people is that the act of mindfulness takes us deep in to meditation- by doing so, we are relaxing and allowing ourselves to be in the moment. If you have any traumatic experiences that you perhaps haven’t dealt with, or that still trouble you, the by going in to the mindful state can reduce your inhibitions, and the safety mechanisms, the defence mechanisms you have in place, to protect you from your difficult thoughts, are suddenly lowered, which can leave you in a very troubled place.

So, this blog then becomes a cautionary tale! Mindfulness, to some, seems like it is a waste of time, however, this is not what we are seeing from the studies that are coming out. Mindfulness has been shown to reduce anxiety and depression and to help with many other issues people have. However, it is not a one size fits all therapeutic achievement. In fact, if you are not in the right place in your life, in the right state of mind, mindfulness could in fact be quite dangerous for you- raising traumatic memories that you have repressed, hidden deep down or simply memories that you actually don’t want to, or can’t, deal with. Mindfulness is not the be all and end all that we originally thought it to be, the studies are showing this, but. That said, it could really work for some people.

So, if you are having difficulty sleeping, or are feeling stressed from your busy life, why not take 10 minutes out of your busy day to practice some mindfulness meditation (as long as you are not in the group of people discussed above, for whom mindfulness is contradictive!)? It doesn’t have to be the raisin, although, why not? Perhaps you are just going to use the VAKGO to notice what is going on around you, or you are just going to close your eyes and concentrate on your breath. In and out, slowly, clearly, purposefully. You never know. After 10 minutes of it, you may feel like a whole new person!


 

Dobkin, P.L., Irving, J.A. and Amar, S. (2012) ‘For Whom May Participation in a Mindfulness-Based Stress Reduction Program be Contraindicated?’, Mindfulness, vol. 3, no. 1, March, pp. 44-50.

Hölzel, B.K., Lazar, S.W., Gard, T., Zev, S.O., Vago, D.R. and Ott, U. (2011) ‘How Does Mindfulness Meditation Work? Proposing Mechanisms of Action From a Conceptual and Neural Perspective’, Perspectives on Psychological Science, vol. 6, no. 6, November, pp. 537-559.

 

 

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.

 

 

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].

 

 

Cognitive Behavioural Therapy didn’t work for my friends; why should it work for me?

In response to a question that I have been asked on the Facebook group, here is a piece I have written on CBT (Cognitive Behavioural Therapy) and how it works, or may not work for you!

CBT, or Cognitive Behavioural Therapy is a kind of therapy that is popular within the NHS. The reason that it is so popular is that it is an evidence-based practice; meaning that there have been scientific studies which prove that the therapy works (Whitfield and Williams, 2003). That isn’t to say that Cognitive Behavioural Therapy (CBT) works for everyone, just that it works quite often! We are all incredibly individual- just as you and your friend have very different needs when it comes to relationships; so do we all have very different needs when it comes to therapy!

Cognitive Behavioural Therapy works by looking at how our thoughts affect our feelings, which affect our behaviours, which in turn, affect our physical feelings- it’s sometimes called the CBT donut, as all of these behaviours and emotions affect each other! An outside situation happens, which in turn, makes us think and feel an interaction- sometimes these are good, and sometimes these are bad. When the interactions are negative, this is where Cognitive Behavioural Therapy can work.

CBTDonut

CBT can be very helpful for certain conditions; Panic Attacks, Anger, Depression, Phobia’s, OCD (Obsessive Compulsive Disorder), PTSD (Post Traumatic Stress Disorder), Sexual problems and Health problems. In simple terms, if your issue is quite specific, (for example a phobia of spiders) the more likely it is that CBT could help you. That is not to say that Cognitive Behavioural Therapy will work for you, if you have one of these issues!

During the Cognitive Behavioural Therapy sessions, you will set goals with the Therapist; specific goals, that you will work towards each week. The techniques that you learn to achieve your goals during your Cognitive Behavioural Therapy, can be utilised in other areas of your life, and are tools in your toolbox for dealing with issues as you go through life, and let’s be honest, we could all do with learning tips that might make the journey of life a little easier!

CBT tends to deal with the present, the here and now, which is where Cognitive Behavioural Therapy differs from other talking therapies. With CBT, we do not go in to the past and deal with issues you may have had since childhood; and for some issues, this is ok, as you only seek to change how you make sense of, and react to, certain situations.

However, for some people, Cognitive Behavioural Therapy is not enough- they need to go back into their past and to deal with the issues that they have experienced during their lives. Talking therapies are non-directive, and deal with support and empathy. Although your CBT Therapist may well be empathic and supportive, it is within the remit of Cognitive Behavioural Therapy to be directive- this means that the Therapist will give you advice, ideas and techniques as to how to help your issues. This, though, is very different from being told what to do- and I am sure you will agree, nobody likes being told what to do!

My practice is considered to be Integrative- this means that I utilise different types of therapeutic techniques. My main modality is to be Person-Centered; which, to you and me, just means that I am empathic, supportive and offer a non-judgemental listening ear, whilst we work together to get to a therapeutic ending. Sometimes, this does mean that I use Cognitive Behavioural Therapy; but I am not limited to just that. Perhaps a mix of therapies is what you’re after? After all, sometimes we just don’t know what the issues are, or that the issue is grounded in our experience from a long time ago. Either way, perhaps CBT may not be for you, but it could be worth a try!


 

Links to read:

NHS CBT (Cognitive Behavioural Therapy) Website

Royal College of Psychiatry Information on CBT

Patient.co.uk Website CBT


Whitfield, G. and Williams, C. (2003) ‘The evidence base for cognitive–behavioural therapy in depression: delivery in busy clinical settings’, Advances in Psychiatric Treatment, vol. 9, no. 1, Jan, pp. 21-30.