Tag Archives: depression

“Hard on yourself” can mean a hard time seeing support.

If you’ve been in a child therapist’s office, you’ve seen posters illustrating basic emotions – joy, terror, humiliation, etc. Research using photos of such broadly-expressed feelings has shown those with schizophrenia and autism struggle partly due to difficulty identifying others’ emotions. At the University of Cardiff, Kirsten McEwan and  her research team investigated people’s responses to photos of more-understated sentiments. They’ve found that highly self-critical people may have subtler difficulties recognizing a subtler emotion: compassion.  

McEwan, et al began by photographing actors they’d asked to express ‘social emotions’, such as sympathy, embarrassment or a critical attitude. They kept or discarded images for future research, based on whether their first group of study subjects could consistently agree on the emotion shown.

journal.pone.0088783.g001

A sample set of social-emotion expressions from the research study.

They asked their second group of study subjects to watch the images on a screen, and press a button whenever a dot appeared. Such “computer visual probe tests” give clues to a person’s attention: the farther their eyes are from the dot, the longer they take to press the button. McEwan, et al separated their study participants into two groups: those who were highly self-critical and those who were no tougher on themselves than average. They found that those in the average category were quicker to respond when a compassionate face was replaced by a dot. Those who were higher in self-criticism took just as long or longer  – suggesting they were less attentive to supportive expressions.

High self-criticism is a common aspect of depression. While our depressed clients tell us, “Nobody cares,” their friends and family may well be wondering, “Can’t they see how worried we are? That we’re all here for them?” McEwan, et al’s data shows the answer, to an extent, may be, “No. They can’t.”

Afterthought: 

Therapists in private practice may want to consider the researchers’ comments about beaming faces:

“Recent research suggests the ‘full-smile’ of a happy/joyful face can actually be aversive, and processed as a threat by some individuals. Schultheiss and colleagues (2005, 2007) suggest that this is because some types of smile – especially broad smiles – communicate social dominance; hence, smiles can be aversive.”

Psychology Today‘s “Find a Therapist” site is a parade of clinicians grinning like lottery winners. Our photos may draw more clients if our expressions say, “Compassionate, gently-concerned clinician,” more, and “The cat who ate the canary,” less.

Citation: 

McEwan K, Gilbert P, Dandeneau S, Lipka S, Maratos F, et al. (2014) Facial Expressions Depicting Compassionate and Critical Emotions: The Development and Validation of a New Emotional Face Stimulus Set. PLoS ONE 9(2): e88783. doi:10.1371/journal.pone.0088783

@ 2014 Jonathan Miller All Rights Reserved

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“Six Harsh Truths” and depression

David Wong‘s Six Harsh Truths That Will Make You a Better Person is a New Year’s essay for those who lack resolution – one that applies directly to treating depression.

If you want to know why society seems to shun you, or why you seem to get no respect, it’s because society is full of people who need things … the moment you came into the world, you became part of a system designed purely to see to people’s needs.

 Either you will go about the task of seeing to those needs by learning a unique set of skills, or the world will reject you, no matter how kind, giving and polite you are. You will be poor, you will be alone, you will be left out in the cold.

 Does that seem mean, or crass, or materialistic? What about love and kindness — don’t those things matter? Of course. As long as they result in you doing things for people that they can’t get elsewhere.

He’s talking to those paralyzed by the dissatisfaction they feel with their lives, and that includes those with Major Depressive Disorder. As  Marsha Linehan pointed out, the best medicine for unpleasant emotions is often the opposite of what the emotion makes us want to do.  “Opposite action” is Wong’s prescription for those who are disgruntled but inert: do something. Anything. Anything  more than what you do now, that would also be useful to others. He stands with  Roy F. Baumeister, whose research shows we don’t achieve because we have good self-esteem. Per the Florida State University researcher, if there’s a relationship between the two variables,  it’s much more likely we have good self-esteem because we achieve.

It’s a shame Wong builds his argument on Alec Baldwin’s role in Glengarry Glen Ross as a manager who shames and threatens his sales force.  Who gets motivated from abuse? Those galvanized by anxiety – the sort of highly-motivated go-getters who rarely need our help. Wong doesn’t scorn his readers for freezing in fear of rejection and failure. His point is simpler: the world values you for what you do. You can be valued more highly by doing more.

In cognitive-behavioral therapy, the most effective reframes for thoughts of, “I’m worthless,” are usually about accomplishments – grades the client earned, projects they completed, people they have helped. Once I’ve helped a client identify all of the reasons they aren’t garbage, I’m going to ask, “Now that we’ve settled that, what do you want to do that would make you even more worthwhile?”

@ 2013 Jonathan Miller All Rights Reserved

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Sleep Apnea: Depression’s subtle sidekick.

A client presents with irritability, drowsiness, lack of energy,  and hypersomnia. You’d suspect depression, possibly Bipolar Disorder, and you’d likely be correct. It might also be something more.

Just over a year ago, Texas governor Rick Perry was hailed as the Republican party’s best choice to win the White House in 2012.   Poor debate performances sank his candidacy, most notably when he couldn’t remember a third government department he planned to eliminate.  In his new book “Oops“,  Texas Tribune correspondent Jay Root claims Perry’s lapses were due to a sleep disorder:

“…by early October, days after the Florida fiasco, (Perry) had urgently consulted sleep specialists. After conducting overnight tests on Perry, they produced a rather startling diagnosis: He had sleep apnea, and it had gone undetected for years, probably decades.”

Rick Perry’s doctors: “Oops.”

Sleep apnea causes sleepers to stop breathing. These pauses can last several minutes and occur  thirty times or more per hour. Unknowingly, sufferers’ wake dozens of times per night. This sleep disruption can slip past diagnosticians because it shares so many symptoms with depression. When a client presents with  fatigue, forgetfulness and lack of motivation, a family doctor might refer them to counseling instead of a sleep study.  The assessing therapist might ask the person if they ever wake up gasping for air. More likely, they’ll focus on all of the mental health questions we have to squeeze into an assessment session.

Along with serious physical risks, sleep apnea can cause depression and memory troubles, via sleep deprivation.With depressed clients who report fatigue, but no trouble sleeping, it’s smart to ask about the following:

  • Morning headaches
  • Memory or learning problems and not being able to concentrate
  • Waking up frequently to urinate
  • Dry mouth or sore throat when you wake up
  • Snoring
  • Reports from bedmates that you stop breathing in the night.

Two years ago, I started to encourage clients to report such symptoms to their family doctors. An impressive percentage have returned with a positive diagnosis for sleep apnea. So far, each who pursued treatment have reported improved mood and energy. Each was genuinely depressed; disrupted sleep made each’s depression significantly worse. With sleep apnea, sleep deprivation can hamper therapy even when a client believes they sleep all too well.

 

@ 2012 Jonathan Miller All Rights Reserved

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Bad for your heart, bad for your mood

It’s a therapist’s job to help people find their own answers. When it comes to healthy living,  we spend a lot of time telling them what they should do. By the time you’ve explained how one’s mood and stress level benefit from exercise, regular hours, spiritual practice and skipping drugs and alcohol,  your index finger can be exhausted from the waggling.

Luscious, hot, salty yummy-nummies, just dripping with despair

This paradox will only grow worse, with the University of Montreal Hospital Research Center’s new study on diet and mice’s behavior.  Stephanie Fulton, Ph.D and her team found that after twelve weeks of high-fat, high sugar meals, their subjects froze under stress. They were less likely to explore new environments, and more likely to scurry for safety. Compared to a control group of mice fed the pelletized equivalent of grilled quinoa and kale, they gave up faster in tests of  ‘behavioral despair’.  In short,  they looked anxious and depressed.

Behavior can have lots of explanations, of course. It’s  been assumed that anxiety and unhealthy eating correlate, because we seek solace in ‘comfort food’ when we feel stressed.  Sadly, Fulton’s study suggests the reverse. Brain scans indicated the mice on high-fat diets had elevated levels of corticosterone, a hormone conclusively linked to anxiety and CREB, a molecule implicated in the fear response. Saturated fat appears to be the enemy here – the mice who were fed “good fats” like olive oil didn’t show as much anxiety.

Dopamine depletion in T-minus 100… 99… 98…

In interviews, Fulton theorized there’s also a neurological link between scrumptiously unhealthy food and depression. She surmises  that because high-fat, high-sugar eats are so ineffably delicious, they trigger releases of dopamine. That’s a neurotransmitter associated with pleasure, particularly with reward-driven learning. Life being unfair, the rush of dopamine leads to a corresponding crash, which causes symptoms of depression. Over time, per Fulton, this can reshape the brain’s reward circuits. Instead of easing life’s suffering, steady consumption of greasy, sugary treats may create an addictive pattern of short-term highs and long-term gloom.

… told you so.

David C.W. Lau MD PhD, editor of Canadian Journal of Diabetes emphasized this study only shows association, not causation.  The researchers freely admit it is hard to square their findings with other studies where mice on similar diets became more docile. Given that, two points come to mind:

1. The clash between offering health advice and helping people find their own answers? It’s an irony, but not a conflict. We’d be remiss if we didn’t tell people there are quick steps to improve one’s mood. “You have worse problems than lack of exercise,” I’ll say. “But exercise would help.”

2. Occasional indulgences are not a high-sugar, high-fat diet. Vegetarians’ organic, easy-going good humor is enviable, but not every client will be pried away wholly from sugar and fats. Good food is one of life’s great pleasures, and life has to be worth living. As  clients often ponder when they’re offered MAOIs: if you give up chocolate, cheese and wine entirely in trade for an effective antidepressant, has your life actually improved?

Citation: Diet-induced obesity promotes depressive-like behaviour that is associated with neural adaptations in brain reward circuitry. Sharma S, Fulton S. Int J Obes (Lond). 2012 Apr 17. doi: 10.1038/ijo.2012.48. PMID: 22508336 [PubMed – as supplied by publisher]

@ 2012 Jonathan Miller All Rights Reserved

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Filed under anxiety, depression

Napoleon Bonaparte on Depression

At age sixteen, 2nd lieut. Napoleon Bonaparte despaired. Always having dreamed of military greatness, he was enlisted in a military run by incompetent French nobility – one that offered Corsicans little chance of advancement.

“Always alone among men, I come home to dream by myself and to give myself over to all the forces of my melancholy, ” he wrote.  “My thoughts dwell on death… What fury drives me to wish for my own destruction? No doubt because I see no place for myself in this world.”

Eventually, he would rule much of Europe.

@ 2012 Jonathan Miller All Rights Reserved

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Filed under depression, The Client's Side

Why mindfulness works – The behavioral view

Photo @2005-2011 Juanita de Paola - http://www.juanita.it/

Experts have known since 500 BCE that mindfulness practice can lead to greater feelings of equanimity and contentment.  Mindfulness- based therapies have been part of western psychology at least since 1979, when Jon Kabat-Zinn opened the Center for Mindfulness in Medicine, Health Care, and Society at the University of Massachusetts Medical School. Unlike many other “eastern” treatments, empirical studies have accumulated to support claims of effectiveness against depression[i] and anxiety disorders such as generalized anxiety disorder[ii], obsessive-compulsive disorder[iii], and even irritable bowel syndrome[iv].

What has been less well understood is how it works. Michael Treanor, of the University of Massachusetts published a meta-analysis[v] this February that suggests exposure is key. Since Joseph Wolpe’s time (and before), we’ve known if you expose yourself long enough to something that causes anxiety, your amygdala and sympathetic nervous system will (eventually) realize it’s not so dangerous. The difficulty has always been how to stay with the phobic object when every part of you wants to run. Treanor’s meta-analysis finds empirical support for the idea that mindfulness works as a conditioned inhibitor – meaning, in this case, it eases the urge to flee.

Treanor’s findings were anticipated in a 2005 article[vi] by Shapiro, Carlson et al. They defined mindfulness as choosing to focus one’s attention on the present moment, with an open, accepting attitude, and the intention of calming, exploring, or regulating oneself.  Marsha Linehan made it part of Dialectical Behavioral Therapy because it helped her chronically suicidal clients stay present with their emotions long enough to recognize and tolerate them.  For those overwhelmed by dysphoria, mindfulness can be like the difference between watching a football game from the 50-yard line, and being  tackled and trampled by players on the field.

Exposure, naturally, is the key intervention in Edna Foa’s prolonged exposure therapy, which is the U.S. military’s treatment of choice for Post-Traumatic Stress Disorder. This article tells how Sgt. Richard Low, a veteran of 280 combat missions in Iraq, recovered from PTSD symptoms with help from Sudarshan Kriya yoga:

When he came back from the service, he didn’t think his experience affected him in any major way. He had nightmares, and he startled easily, but he chalked that up to just something veterans live with.

Then he enrolled in a study he initially wrote off as “just some hippie thing,” where he learned about yoga breathing and meditation. A year later, Low, 30, sums up his experience with two words: “It works.”

Heads-up to tough guys of the world: Mindfulness is not just a hippie thing. It’s also a Shaolin Monk thing.

 

@ 2011 Jonathan Miller All Rights Reserved


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Why vodka is like depression

Photo by Rob Nova - robnova.wordpress.comEvery week, in some major city,  a bar, distillery or festival holds a vodka tasting.  This sparks skepticism among non-aficionados, because vodka is tasteless – literally. The USA’s code of federal regulations title 27, volume 1 defines “vodka” as “neutral spirits so distilled, or so treated after distillation with charcoal or other materials, as to be without distinctive character, aroma, taste, or color.”

Which makes it a lot like depression. Sip a screwdriver and it tastes just like orange juice, except for the ethanol kick. Depression can feel just like everyday life, only with a deadening lack of pleasure or motivation.

When a client says, “I didn’t really feel anything this week,” it helps to ask, “What has your appetite been like? How about your temper? How many hours have you slept? What all did you do this week?” Too often, the answers are, “Terrible,” “Terrible,” “Who knows,” and, “I got the kids off to school, then I went back to bed.”  Emotional numbness isn’t one of the DSM-IV-TR’s criteria, but it notes, “(with) individuals who complain of feeling ‘blah’, having no feelings or feeling anxious, the depressed mood can be inferred from the person’s facial expression and demeanor.”

Clients often assume depression always means sadness. They can know the dishes have piled up in the sink, or that formerly-reasonable family members are suddenly impossible, without recognizing these are signs that their mood has declined. They’re more alert to such shifts when they know depression can creep up in the form of a slow, steady, subtraction – the loss of energy, appetite,  interest, or hope.

Vodka is like ‘nothing’, with a kick. Depression can be a ‘nothing’ that hurts.

@ 2011 Jonathan Miller All Rights Reserved

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