Psych-Mat

How to make your treatment for depression more effective and successful

Today’s post is directed at those who are depressed and are contemplating or already receiving treatment from a mental health professional such as a psychologist. I want to share with you some suggestions about how you can optimize the effectiveness of treatment for depression.  These suggestions are based on both published research and from my experience as a psychotherapist and as someone who has had personal experience with depression.  Most of these suggestions hold true not only for the treatment of depression but for the treatment of any psychological problem.

Depression is complex in its origin and no one therapeutic strategy works for everyone

My first suggestion is that you understand that there is no single way to treat depression.  As discussed in a previous post, depression is very complex in its causation and manifestations: one must consider genes, environment, and the interactions between these factors.  Since each one of these factors is unique for each individual, each person’s depression is different in its causation, in the way it manifests itself, and correspondingly in the way or ways it can be alleviated.  Hence there is no single miracle “cure” for depression that works for everyone. 

 

Treatment of clinical depression.

In a previous post I described the various ways depression can manifest itself and in today’s post I wish 
to focus on ways to cope with or treat clinical depression.

If you think you might be depressed, I have described in this post the steps to take to alleviate this very treatable condition.  To summarize they are:

• consult a mental health professional to obtain a qualified assessment of the degree of seriousness of your mood disturbance

• obtain from this professional a recommendation of what steps you can take to alleviate whatever degree of depression you have
• get actively involved in your recovery program
• develop a “Maintenance program” to maintain your recovery.

Are you experiencing normal sadness or clinical depression?

In the previous post I discussed the ways that ordinary sadness and clinical depression are distinguished.  However this is not always easy.  For example if you have experienced depression over a long period of time, perhaps from childhood, it may seem “normal” to you but it most definitely is not.  Therefore I recommend that you have a “depression check up” from a competent mental health professional such as a psychologist, psychiatrist or social worker. 

What causes depression?

Why it is important to understand the causes of clinical depression?

Probably the most important reason for having an understanding of what causes depression is that it enables one to design the optimal treatment plan. For example, if you moved from the tropics to Canada and did not see the sun for days at a time then, your psychotherapist might point out that there is scientific evidence that lack of sunlight is correlated with depression and suggest that light therapy might be the treatment of choice.  Another reason for knowing the cause of our depression is that many of us are curious to know what happened to us.  Furthermore if we don’t know why we are depressed, our depression can talk us into believing that we brought it upon ourselves because we are bad or stupid people or that we should feel guilty even for being depressed. Understanding the cause of depression can stop us from this kind of self blaming.

The causes of clinical depression are usually extremely complex.  Recent research has shown that the cause of clinical depression can be surprisingly complex:

What you should know about depression and how to manage it

How does clinical depression differ from normal sadness?

There are three important questions about depression which I often get asked in my clinical practice:

• How does clinical depression differ from normal sadness?
• What causes depression?
• What cures depression?

 
In today’s post I will answer the first question concerning how depression is defined. In following posts I will answer the other two.

We all experience te occasional few hours or even a few days in which we feel sad, or have the “blues”.  But how is this different from what a mental health professional would diagnose as clinical depression?   The answer is not simple; clinical experience suggests that three factors must be considered: the severity, duration, and context of the mood of sadness.

How you can use natural beauty to restore yourself mentally, physically, and spiritually.

Over 200 years ago, William Wordsworth alluded to the idea that nature has the power to restore our weary hearts and minds.  In his poem “Lines Composed a Few Miles above Tintern Abbey, On Revisiting the Banks of the Wye during a Tour, July 13, 1798”, he eloquently describes how the beauty of nature can provides us with “tranquil restoration”. 

 

These beauteous forms,

Through a long absence, have not been to me

As is a landscape to a blind man's eye:

But oft, in lonely rooms, and 'mid the din

Of towns and cities, I have owed to them,

In hours of weariness, sensations sweet,

Felt in the blood, and felt along the heart;

And passing even into my purer mind

With tranquil restoration.

                                      

These sublime words of Wordsworth also point out that city living, whether in the 18th or 21^st centuries, often causes us to feel depleted, disconnected, and isolated, with a vague free-floating anxiety, or the painful thought that nothing makes sense including our own stressful lives.  As a result of these thoughts and feelings, we work at low efficiency with little creativity and no sense of fulfilment.  We often are irritable being barely able to tolerate the many minor difficulties of living in a complex society. 

 

The good news is that recent psychological research clearly supports the very solution that Wordsworth proposed so eloquently 212 years ago, specifically the solution of taking time to experience natural beauty in order to bring about “tranquil restoration” of our minds and souls. 

 

Our innate bias to focus on the negative and how to compensate for its effects.

Have you ever obsessed about the one critical comment someone made to you despite the fact that they also made quite a few positive remarks?  For some reason you keep ruminating about that one negative remark.  You think about it over and over, perhaps looking for a way to argue better against it or at least to forget about it, but the painful memory just keeps playing back in your mind like a broken record.  Is there a scientific explanation for this tendency to focus, sometimes obsessively, on the negative aspects of our lives?  Are we really powerless to control our bias to pay more attention to the negative than to the positive in our lives?

Story of two wolves

There is a wise old North American Indian story about two wolves that I think helps us understand this bias to focus on the angry, painful, or fearful things in life.  Although I told another version of the two wolf story in my previous post, I think it deserves retelling because it illustrates vividly how this bias can influence our thoughts, emotions, and actions in very negative and maladaptive ways.  Here is the alternative version as provided by the website: http://www.firstpeople.us/FP-Html-Legends/TwoWolves-Cherokee.html).

 

An old Grandfather said to his grandson, who came to him with anger at a friend who had done him an injustice, "Let me tell you a story.

I too, at times, have felt a great hate for those that have taken so much, with no sorrow for what they do.

But hate wears you down, and does not hurt your enemy. It is like taking poison and wishing your enemy would die. I have struggled with these feelings many times."

How to better manage your thoughts, feelings and actions: The story of the two wolves.

Did you every hate yourself for thinking, feeling or acting in ways that were not acceptable to yourself but that you felt powerless to control? The purpose of this post is to help you find ways to manage your mind so that you can live your life more in accordance with what your judgment tells you is best for you.

 As we grow up, we gradually become aware that there are many things in the external world which we are largely unable to control including people in general and most events in our lives.   Initially this is difficult to accept but an even more shocking realization is that there are many things about ourselves that we seem powerless to control.  Some of these things are our own thoughts, feelings, and actions which unfortunately can be the source of much pain.  It may be a thought such as “I cannot stop hating my boss for passing me over for a promotion.”  It may involve an emotion e.g. “My girl friend left me and I cannot stop feeling sad, lonely and unloved because of that.”  Or our complaint may involve a behavior e.g. I cannot stop eating this delicious chocolate ice cream. “

But are we really powerless to control maladaptive thoughts, feelings and actions?  What follows is an old Cherokee Indian story which I hope you will find helpful if you want to more effectively control your mind and behaviour.  This story was sent to me by a dear old friend in Canada who despite medical difficulties routinely sends me positive messages.  The Cherokee are an aboriginal native group found in the Southeastern United States.  As is common with oral historical narratives, there are various versions of this story (See: http://www.firstpeople.us/FP-Html-Legends/TwoWolves-Cherokee.html).

Online help resources in Singapore if you are in an intimate relationship with someone who has a psychological disorder.

The problem

In this post I will provide some suggestions and resources to help someone undergoing distress due primarily to their intimate other having a psychological disorder.  I quite frequently receive heartbreaking requests from individuals who are in a painful relationship or marriage in which their mate is suffering from some kind of serious psychological problem such as alcoholism, gambling addiction etc.  Often these  individuals are isolated and confused about what to do.  The purpose of this post is to provide some general information to help them get better informed and started on the path to a better relationship.

Let me describe briefly an example which although hypothetical is based on cases I see very frequently.  A 35 year old married woman with three children (a boy aged 13, and a girl aged 11, and a younger son aged 8 with ADHD) bitterly complains at the first consultation with me of the many problems she has experienced due to her husband drinking excessively for the past ten years.  She also states that the older son is doing poorly in school and has been associating with a “bad crowd”.  The girl is doing OK except that she has become the caretaker of her younger brother because the mother has frequent periods of debilitating depression.  The mother has recently tried to cope with her husband’s drinking by drinking with him but that has made their arguments become more intense to the point where the husband has began to slap her.  Despite the husband’s well paying job there never seems to be enough money to cover the family’s expenses and debts are accumulating. On top of this the father’s drinking is affecting his job and he has been warned about this.

 

How to improve your knowledge and understanding of yourself.

  “Oh wad some power the giftie gie us To see oursel's as others see us! It wad frae monie a blunder free us, And foolish notion”

 Although these lines were written by Robert Burns, Scotland’s most famous and honored poet, over two hundred years ago, they continue to have important psychological significance.  The purpose of this post is to explicate the psychological implications of his words and provide some practical ways for you to obtain accurate new information about yourself.

 Having grown up with a great aunt who quoted Burns on a daily basis, I can still only lay claim to a “wee” bit of understanding of his dialect.  My interpretation is that he wishes, somehow, we were gifted with the ability to see ourselves the way that others see us, because it would save us from many mistaken actions and erroneous ideas, particularly wrong beliefs about ourselves.

 

How to recover from the self-esteem problems of co-dependency

A useful approach to recovering from the self-esteem problems often found in co-dependency is to understand the link between these self-esteem problems of adulthood and how they developed during early childhood. To do this, I will describe first the traditional co-dependency view of self-esteem development and then a  more recently proposed epigenetic model which I hope will deepen your understanding of how such problems develop and how to recover from them.

The co-dependency model and problems in self-esteem.

Pia Mellody, one of the founders of the co-dependency movement, cites problems with self-esteem as being one of the five primary symptoms of co-dependency (Mellody, Pia, 1989; see previous post for a general description of co-dependency).  In an amazing example of prescience, Pia did not propose that every person who is co-dependent suffers from low self-esteem but instead describes three kinds of problems in self-esteem. It was prescient because recently the traditional view of self-esteem has been strongly criticized based on research indicating that low self-esteem is not necessarily problematical and that in fact high esteem can be associated with various problem behaviours  as can instability in self-esteem (Baumeister et al, 2003).  However it must be noted that Brandon (1997) has presented counter-arguments to these criticisms based mainly on his much more complex definition of self-esteem.