Depression Fighter

Self help for depression fighters

Depression Fighters

What’s DBT? (stands for Dialectical behavior therapy)

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DBT has become one of the most popular forms of conventional therapeutic treatment methods for patients suffering from mental disorders. Here’s a brief summary of what it is and how it works so you can decide whether to continue to explore this methodology. What's DBT? (stands for Dialectical behavior therapy)

What’s DBT?  (stands for Dialectical behavior therapy):

An overview of DBT:

“DBT”, as it’s most commonly known, stands for Dialectical Behavior Therapy. It is a type of cognitive behavior therapy (see above for the definition of CBT). It involves a dual component process of:

  1. Acknowledging and accepting your current behaviors, and
  2. learning to change them.

The acceptance allows you to be present to your reality (helps you live in the “now”)  versus thinking about or referencing the past. It also allows you to recognize what’s not working so you can work on changing it.

A large component of DBT involves a skill called “mindfulness” (covered in SECTION 5). This skill teaches you how to look at emotions and situations objectively and without judgement.

The accepting component also means not being frustrated about making mistakes as you learn to create new patterns of behavior.

Core skills taught by DBT:

There are four core skills taught in DBT, each one teaches how to choose how you will behave in a specific situation.

Mindfulness: Learning how to live from the present and be conscious of your feelings, thoughts and actions without be judgmental.  Mindfulness is covered in greater depth in SECTION 5, but here is a quick example of what it means to be mindful: If you were being mindful right now your focus would be on reading the words on the page in front of you. You may also notice sounds and the temperature of your environment. You may notice your thoughts and how you are feeling about what you are reading. But, you only notice and don’t react to these various parts that make up your present experience right now at this moment.

Distress tolerance:  Learning how to be non-reactive to stressful situations.  It’s about learning how to tolerate versus change something that is uncomfortable.  Allowing yourself to deal with momentary pain may help you achieve an outcome you actually desire. For example, a marathon runner who wants to win may have to tolerate physical and mental pain all the way to the finish line.

Interpersonal effectiveness: Learning how to interact with other people so you can maintain good relationships that involve mutual respect. Learning how to make requests and say no to the requests from others if and when you need to.

Emotion regulation: Learning which emotions serve you and which ones don’t; and how to shift them. Learning how not to immediately react to emotions without thinking about the consequences or the facts.

 

DBT involves a combination of four types of treatment:

Participants of DBT learn the tactics it teaches in three ways:

  1. Group training
  2. Individual therapy
  3. Phone coaching

Group therapy sessions typically run for 24 weeks to cover the entire DBT curriculum. Participants meet for one 2.5 hour session. The group therapy is taught in a similar style to a traditional classroom. An instructor teaches DBT concepts and assigns homework.

How DBT therapists are different than other therapists

DBT therapists also participate in therapy. They meet with other DBT counsellors in a group setting where they develop skills, get help from other therapists for their own patients and stay motivated.

The therapist is allowed to empathize with the patient.  Which means, acknowledging what they are dealing with versus take on a role of being the expert and not expressing emotion (as is the case with some therapies). The alliance is based on a “tough love” type of principle. Much like a parent-child relationship, where the parent ensures that the child takes actions in line with what is good for them, even if they don’t want to.

The use of acronyms as teaching tool

DBT uses a great deal of acronyms to help participants easily learn and remember the new skills they’re taught.  Here is an example of one of the acronyms. It is used to teach good interpersonal behaviors

The “GIVE” acronym:

GIVE: These skills are to be used in communicating with others.  It helps you to be great with other people and make them feel comfortable when they speak to you.

  • Gentle: Use appropriate language always. Do not verbally attack people. Don’t put them down even in frustrating situations. Be non judgemental in your communication with others.
  • Interested: When the person you are speaking to is talking about something try your best to remain engaged. Listen to what they are saying. Show you are listening with your body’s cues. Make eye contact. Nod your head.
  • Validate: Show your understanding by nodding your head or responding.
  • Easy Manner: When you speak to people be relaxed. Smile and laugh.

 

What’s CBT? (stands for Cognitive behavior therapy)

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Many therapists today suggest CBT as a therapy for patients suffering from mental health disorders. Here’s a brief overview of how it works.

What’s CBT? (stands for Cognitive behavior therapy)

If you’ve ever listened to Dr. Laura Schlessinger on Sirius radio you’ll hear her recommend CBT to many people.  It’s one of the most effective and popular treatments for learning new behaviors.

CBT, as it’s most commonly known, stands for Cognitive Behavior Therapy. And the nature of the method is as it’s named. It involves reprogramming thought and behavior patterns you’ve learned overtime, that have helped prevent you from dealing with fears, or pain, and allow you to ensure your survival.

CBT acknowledges that what you think about a external situation influences your emotional experience. And, what you think and believe is also related to what you’ve learned.

For example, a person that almost drowned as kid may see a body of water and think “I need to stay far away from the water”. They will feel fear and the action they will take will be to avoid  the water. Whereas, a person who spent summers at the beach, took swimming lessons and never had an accident, may see the same body of water and think, “wow, I’d love to hop in there right now.” They will feel happy when they see water and will take an action like going for a swim.

When your behavior does not serve what you would like to do – for example, the adult that had the swim accident is embarrassed of their inability to swim on a vacation with friends – it becomes a distressing problem. The good news, is this thought – emotion – behavior pattern can be disrupted and changed through CBT.

CBT as a diagram looks like this:

What's CBT? (stands for Cognitive behavior therapy)

The diagram above presents a triangle to show how thoughts, behaviors and emotion are connected and continue to reinforce one another overtime.

CBT acknowledges that individuals learn automatic behaviors that become difficult to control through rational thought. It appears as if they act spontaneously to situations, without any reasoning. That’s because the past has conditioned them to react automatically.

 

Why CBT is effective and how it’s different from other therapies

 

CBT targets the problem in behavior, which makes it a problem-focused type of treatment. It teaches you new actions that stop you from taking unwanted actions you have taught yourself to take. It replaces them with healthy behaviors that lead to more favorable outcomes. Therefore, it is more “action-oriented” than earlier therapies and leads to fast results.

 

Earlier therapy techniques (which are still in practice today) focus on understanding the past to learn why you have a tendency to behave a certain way. This introspection can be helpful, though it does not address present issues.  It looks directly at the problems the individual is suffering from and treats them. The goal is not to diagnose, but to fix.

Six phases of CBT treatment:

  1. Assessment
  2. Reconceptualization;
  3. Skills training;
  4. Application of skills
  5. Maintenance;
  6. Post-treatment and follow-up.

A typical CBT program consists of in-person sessions with a therapist.  A minimum of six to 10 sessions with one to three weeks in between. There are often homework assignments to do that help you learn and use various skills.

 

How ECT works for depression

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If you’ve tried antidepressants, you are making healthy lifestyle choices,  you are involved in therapy, and none of it works, your physician may consider you a good candidate for electroconvulsive therapy (ECT).

How ECT works for depression:how ECT works for depression

During an ECT treatment you’ll receive a stream of electric currents to the head that go into the brain and induce a short seizure. The result is changes in your brain chemistry that may reignite lagging or malfunctioning communication  processes.

An ECT treatment is like rebooting a computer that’s not working properly. When you restart the system the system reboots (restarts) and in many cases the problem goes away when you turn the computer back on.

Does ECT hurt?

It sounds seems like crude treatment – zapping your brain with electrical currents – but it is highly effective for some people. And the newer treatments use better equipment and technology so it’s much safer than it used to be. Early treatments involved extremely high doses of electricity that were given without pain medications or anesthetics.  This resulted in major issues such as fractured bones and neurological problems like memory loss.

Today, patients are given multiple treatments instead of one giant one.  They receive the treatment under general anesthesia, so it is painless. The patient is asleep for most of the treatment. When they wake up they may experience some side effects – like brief memory loss and confusions. Most side effects are short term and will go away within one or two weeks.

In general, ECT treatments are administered two to three times per week for three to four weeks. Most patients receive somewhere in the range of  six to 12 treatments. The number of treatments depends on the severity of your symptoms.

 

Why you should always get a second opinion

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When you are sick, especially when you have a mental health conditions, one of the most important things to remembers is: ALWAYS get a second opinion.why you should always get a second opinion

Or a third. Or forth. Really. Get as many as you can. The more you get, the more expert evidence you can collect as to what is the real issue.  

As a patient it’s important to always remain aware. In the end, it is your body. You’ve been living with so often you have the best understand of your symptoms. And, you have to live with it and take care of it the way you see fit. That means, deciding what you feel is the best treatment option and weighing that with what professionals suggest.

Don’t believe what your family doctor says because they have the “almighty powers” that come with the allowance to put the letters M.D. after their name. While they are more knowledgeable than you on the topic of medicine, they are still human.

And humans make mistakes. Even doctors. They have bad days and can miss important aspects of your diagnosis.

They also have different life experiences, which may make give them different ideas about your diagnosis. A doctor who just treated a patient with the rare condition, may consider that as possible condition for you. While a doctor who learned about it once in med school, won’t even think about it.

Why you should always get a second opinion

The problem with mental health diagnosis and perception:

If you break your leg your doctor will take an x ray, show you the evidence, and put your leg in a cast. That’s not like mental health diagnosis. The evidence medical professionals have to go on is a set of behaviors that can’t be represented physically. Their evaluations are based on symptoms that you tell them you have, and personal accounts. Sometimes the accounts involve your family members and friends but those stories have different people with different experience different life and different perceptions.

Some doctors will be smart enough to take that into account. Some won’t. It can be a problem. So, what you need to do is be aware of the humans frame stories. This includes yourself.

 

How do doctors diagnose depression?

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The most common diagnostic tool used by doctors to help him decide if a patient with symptoms of depression is actually suffering from the full on illness (and not just a passing state of feeling sad that’s caused by a life event) is a questionnaire.

How do doctors diagnose depression? Here are the common tests they use:How do doctors diagnose depression?

Currently the most common ones are:

  1. Hamilton Depression Rating Scale (HAMD)
  2. Montgomery-Asberg Depression Rating Scale (MADRS)
  3. Beck Depression Inventory
  4. Patient Health Questionnaire (PHQ-9)

Your doctor will likely used one of these tests to assess you. Questions are similar in nature for each.  They ask you about symptoms your experiencing – such as: Sleep disturbances, issues with fatigue, suicidal thoughts, feeling uninspired or hopeless, loss of motivation, loss of pleasure.  They will also ask you questions to help them understand the severity of your symptoms.

Here are some examples of the types of questions you may be asked:

  • Have you lost interest in activities you used to find pleasurable?
  • Ae you experiencing changes in appetite such as eating too much or not feeling like you want to eat?
  • Are you having difficulty concentrating?
  • Having you been experiencing thoughts of suicide, death, or wanting to die?

In most cases, if you have felt hopeless for a least two weeks or more and it’s so bad it’s affecting your life – you’re having trouble going to work, socializing, enjoying activities you once thought were pleasurable etc. – these are high indications you have depression.

The diagnostic criteria for depression appears in a medical text for mental illness called the DSM-IV.  (Read the diagnostic criteria here).

Your doctor will also likely run some basic biological tests to rule out other potential issues that cause depression. The most common ones are the:

  1. Physical exam. Your doctor will likely examine your body to ensure there is nothing notable wrong with your physiology that could be causing depression symptoms.
  2. Blood tests : A blood sample may be taken and a complete blood count (CBC) will be performed. This helps the doctor find out if you have any hormonal issues or a vitamin deficiency.

How doctors “fix depression”: Antidepressants

If your doctor rules out all other medical issues that could be causing your depressed mood and suggests a diagnosis of major depression they’ll likely treat you by prescribing an antidepressant medication. Doctors are trained to fix medical problems and this is how they do cure depression. It’s the only tool available to them, aside from referring you to a different type of specialist.

You need to be aware that the problem with this route is that they may skip identifying other potential causes for your depression. They will treat the symptoms without curing them. So, you need to investigate therapeutic forms of treatment that teach you how to proactively deal with negative and uncomfortable emotions.

What you need to understand about antidepressant medications:

Finding the right antidepressant for you is like finding the perfect wedding dress. You have to “try on” many to find what works for you.  This is because the current diagnostic criteria that doctors use is based on asking you a line of questions, ruling out other illnesses with basic physical tests, and then making an educated assumption.

They don’t do a brain scan to see what’s really going on and here’s why:

  1. It would put too much pressure on the medical system to do these tests for the number of people who end up in their office with symptoms of depression. There are too many people that treating everyone would cause a dramatic back up. This would lead to longer treatment wait times, and possibly more deaths.  So, prescribing an antidepressant is the fastest way to treat depression.
  2. Even if they could see what brain regions were affected it still wouldn’t tell them anything about how the condition was caused and thus what treatment to use. So, brain scans would help to identify the problem but hast nothing to do with treating it. Therefore, it’s a lot of fuss for no reason.

So, they test you on a medication for 4-6 weeks and if it doesn’t work, they try something else.  If you get worse, well, the sad truth is, sometimes that’s part of the process.

As you can see, this is hardly an effective treatment. But for now, it’s all doctors have. A questionnaire, some basic tests and a lot of trial and error with antidepressants.

But, don’t blame the doctor, it’s the system that’s flawed. We don’t know enough. And because we don’t know our treatment options are unfortunately somewhat limited right now. That is why it’s important to do what you can to help speed up your recovery process.