Poor response to treatment is an unfortunate reality for many people with major depression (MDD). By some estimates, as few as 30% of people with MDD achieve complete and lasting remission of symptoms. Primary care physicians deal with this lack of treatment response in one of three ways: They may increase the dosage of an antidepressant medication, add a secondary medication, or switch to an alternative medication.

Dosage increases are often the first choice, assuming higher doses remain within reasonable safety parameters. Because of its unique chemistry, the selective serotonin reuptake inhibitor Lexapro (escitalopram) is an ideal candidate for dose escalation. Whereas other antidepressants reach a sort of effectiveness plateau, Lexapro’s mechanism of action becomes stronger in proportion to dose.

Lexapro is approved for daily doses of not more than 20 mg. In practice, however, doctors have prescribed up to 50 mg for patients showing no response to lower dosages. That said, little evidence exists on whether successively higher doses represent a good balance between efficacy and safety.

A recent investigation in Scotland sought to answer this question. A starting group of 60 people diagnosed with MDD was switched from Celexa (citalopram) to Lexapro for a 32-week period. At regular intervals, Lexapro dosage was increased up to a maximum of 50 mg or until remission of symptoms. Researchers employed standard psychological measures to quantify severity of depression and occurrence of side effects.

Results from the study revealed few problems with safety or tolerability of high-dose Lexapro. However, overall effectiveness was somewhat less than desirable. Of the 60 participants, 18 dropped out because of adverse effects or lack of efficacy. Most of these withdrawals happened earlier in the study, before reaching the higher dose levels.

Half of study participants experienced remission of symptoms. Thirty-eight percent of those required a dosage of 50 mg. At doses higher than 40 mg, side effects became more pronounced although not necessarily more severe. Diarrhea was the most frequent complaint for those at doses of 40-50 mg. Other common side effects included headache, nausea, fatigue, and dizziness.

Larger, more controlled studies will be useful in ascertaining whether the benefits of high-dose Lexapro outweigh the risks. The Scotland study indicated only marginal effectiveness, although participants generally tolerated the high doses of medication. It should be noted, of course, that the population in question has a history of poor response to treatment. It’s unlikely that any one avenue will prove beneficial to all.

References:

  1. PubMed Health [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Escitalopram. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000214/
  2. Wade, A., Crawford, G., Yellowlees, A. (2011). Efficacy, safety and tolerability of escitalopram doses up to 50 mg in major depressive disorder (MDD): an open-label, pilot study. BMC Psychiatry, 11, 42. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068950/?tool=pmcentrez

Man with his head down in his arms

I’ve been thinking about grief, mourning, and loss a lot lately. It shows up as a theme in my work as a psychotherapist all the time. I’ve also been studying the literature on methods of providing grief counseling and grief therapy. What I realize is that my sub-specialty in this area is not limited to working with individuals who have experienced the death of a loved one. It is more far-reaching than that. Judith Viorst wrote a wonderful book, Necessary Losses: The Loves, Illusions, Dependencies, and Impossible Expectations That All of Us Have to Give Up in Order to Grow, in the mid-1980s in which she described the losses we experience along the life cycle. It’s a must-read for people who are unfamiliar with it.

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I would venture to say that most of the work we as psychotherapists and spiritual counselors do is about coping with loss. We help our clients grieve about their losses, whether it’s loss of youth, money, job, socioeconomic status, or friends. They need to be helped to grieve the loss of hopes and dreams. They even grieve the loss of fantasies and illusions, although much of this happens unconsciously. In this case, our job as psychotherapists and counselors is to help them recognize that they are in mourning and provide tools to cope. The idea is that grief takes up a lot of psychic space in our beings, and it is only by coming to terms with our losses that we create room for the new.

The focus of this article is how many people typically grieve. The ways—which are not healthy—include:

These are just a few of the many ways people attempt to fill the space loss creates in their psyches and spirits. With methods such as these, the loss is not completely grieved or grieved at all. The feelings may even become worse, leading to a cycle of self-harming behavior.

So what predisposes someone to engage in the self-harming and ultimately unsatisfying behavior described above? There can be many factors, including low self-esteem, a history of untreated anxiety and depression, an inability to express feelings—especially difficult ones such as anger—and the lack of a support system. There are also more complex reasons involving one’s family of origin, including trauma in early childhood and the absence of a secure connection with early caregivers.

This sense of emptiness and lack of safety makes loss intolerable rather than simply painful, and it is this inability to tolerate it that leads to the behavior described above.

In addition to these internal factors, society in general and specific cultures in particular make grieving difficult. Part of this stems from our lack of recognition of the universality of loss, i.e., as something that permeates all aspects of life and isn’t just about death. In addition, we have become a culture of short-term fixes—the “just-get-over-it-and-move-on” philosophy. This puts pressure on individuals to minimize their sense of loss.

Finally, there is the over-arching reason grief is given short shrift. It makes many, if not most, people uncomfortable because it touches unhealed grief in themselves.

Next month, I will discuss some effective and healing ways to cope with grief and loss.

 

Integrating live animals into the therapeutic process has been gaining recognition as a viable and effective approach in a clinical setting. Equine-assisted therapy is a widely popular form of therapy that has shown remarkable results with clients who do not respond well to other types of treatment. Similarly, children who are resistant to traditional therapies have demonstrated improvement in animal-assisted therapies. For individuals who experience disassociation, animals represent an unconditional source of love and acceptance. For people who may have experienced early life trauma, especially trauma or abuse that undermined attachment relationships, animals can replace missing secure attachment bonds.

Although animals as therapy adjuncts, even pets, can help reduce anxiety, depression, loneliness, and isolation, owning or working with an animal may not be a viable option for everyone in need. Therefore, stuffed animals, which represent a source of comfort in times of stress for young people, may serve as a suitable replacement. Rose M. Barlow of the Department of Psychology at Boise State University in Idaho wanted to see if stuffed animals would serve clients equally as well as live animals. In a recent study, Barlow surveyed a sample of high and low dissociative female college students and those with dissociative identity disorder (DID) about attachment to live and stuffed animals. She found that the DID women had significantly stronger attachments to both live and stuffed animals than any of the other women. She also found that those with high dissociation and those with DID reported higher levels of attachment to stuffed animals than live animals when compared to the low dissociative group.

The findings of this study have several important clinical implications. Even though comorbid issues such as depression, anxiety, and bipolar were not considered in this research, the evidence suggests that stuffed animals may be particularly helpful to those with high levels of dissociation. Because symptoms of dissociation, even disorganized attachment, can begin in childhood and result from emotionally unavailable parents, divorce, or abuse, integrating stuffed animals into therapy for young children can provide a sense of security and help to rebuild impaired attachment bonds. “Animals, live or stuffed, can aid therapy for both children and adults by providing a way to experience and express emotions, a feeling of unconditional support, and grounding,” Barlow said.

Reference:
Barlow, Rose M., Lisa DeMarni Cromer, Hannah Prairie Caron, and Jennifer J. Freyd. Comparison of normative and diagnosed dissociation on attachment to companion animals and stuffed animals. Psychological Trauma: Theory, Research, Practice & Policy 4.5 (2012): 501-06. Print.

Man watching female coworkerDepression makes it difficult to function in daily life, but adding discrimination to the equation makes it even more troublesome.

A new study in the journal The Lancet stated that out of the 1,082 adult participants with major depressive disorder, 79% reported that they have experienced discrimination. People who experienced discrimination while depressed had more depressive episodes, social difficulties, and issues finding and keeping a job. They also were less likely to reveal a diagnosis of depression.

These results suggest that more works needs to be done in the area of preventing discrimination and eliminating stigma. Discrimination can prevent people with depression, who may be worried about disclosing their diagnosis, from getting the help they need. While getting a job and growing social networks can help fight depression symptoms, those pursuits become more challenging in the face of discrimination.

How, specifically, does discrimination affect people with depression? How can the general public be more understanding? And what options do people with depression have? Mental health experts and other professionals have some answers.

Dr. David Sack, CEO of Elements Behavioral Health and Promises Treatment Centers, said by email that sensitivity toward people with depression often is lacking.

“The most common example has to do with intolerance toward peers/friends/relatives that comes from not understanding that depression is a disease that the individual cannot simply will themselves out of,” he said.

Sack said a supervisor might question an employee’s motivation and commitment due to symptoms of depression, even if those symptoms don’t reflect how the employee really is.

“How often have we heard that this or that person claims that they are depressed just so they can get time off from work or won’t have to take responsibility for mistakes they’ve made?” Sack said.

Although many people know the basics of depression thanks to widespread awareness initiatives, prejudice, bias, and stigma still are rampant.

Viola Drancoli, a clinical psychologist, said in an email that friends and family members of people with depression might exhibit discriminatory behavior with them because they may feel drained from being around someone who expresses sadness, pessimism, irritability, and a lack of motivation.

This could push someone with depression into isolation. A person with depression might prefer being alone so he or she doesn’t have to attempt to hide feelings from others.

“The social isolation often starts a vicious cycle in which the (client’s) negative outlook on life is reaffirmed, they feel let down by family and friends, and symptoms may worsen,” Drancoli said. “This is especially dangerous for individuals who have suicidal ideations and need support and monitoring.”

Drancoli said it’s important for family and friends to be supportive. She suggests volunteering to help out with chores that might be difficult for someone with depression to complete when he or she is struggling to function, as well as patiently listening without judgment. Loved ones can gently encourage a person with depression to exercise as well, as this has been shown to boost mood.

People with depression who believe they have been discriminated against have the law on their side. Sack said that discrimination against people with any disabilities, including mental issues such as depression, is forbidden by the Americans with Disabilities Act. The civil rights law, enacted in 1990, defines disability as “a physical or mental impairment that substantially limits a major life activity.” Some states have additional laws against discriminatory behavior.

“An individual who is concerned about discrimination at work will want to speak with their supervisor or the director of human resources first,” Sack said. “Most companies have strong policies to promote fairness and nondiscrimination.”

Justine Lisser, a senior attorney advisor in the Office of Communications & Legislative Affairs at the U.S. Equal Employment Opportunity Commission, said by email that if an employer has at least 15 employees, it must abide by the ADA. Employers need to provide “reasonable accommodations” for people with disabilities, as long as the employer isn’t deeply burdened as a result.

“For example, if a person with depression is hired for a position that requires an 8 a.m. start time, but due to the effects of (antidepressant) medication the person could not start until 10 a.m., it would be a reasonable accommodation to permit the employee with depression to start at 10 a.m., assuming that it would not cause an undue hardship for the employer,” Lisser said.

The EEOC has successfully enforced employee discrimination laws in a few cases involving people with mental health issues. In one case, a sales associate at a video retailer experienced harassment because of his social anxiety disorder and depression. His employer was ordered to pay $70,000 to settle the discrimination suit, according to an EEOC press release from March 2012.

silhouette man pushing woman in wheelchair 2

There are many parallels between living with a disability and dealing with an uninvited house guest. If you have ever had an uninvited house guest, I am sure you remember moments when things may have been uncertain and, at times, tense or uncomfortable. At the very least, having an uninvited guest requires some adjustments, much like living with a disability.

An uninvited guest may arrive unannounced, leaving no time to plan or prepare. Likewise, in many cases people living with disability have little or no time to plan for the many changes to come. While there may have been no way to prevent the disability and requisite life changes, having time to prepare—psychologically and literally—can make a huge difference in a person’s ability to adapt and cope.

A period of psychological adjustment is required for a person who has a disability, his or her spouse/partner, parents, and other family members. The adjustment process people frequently talk about resembles the grief process in many ways. Like the grief process, people often experience feelings in what seem to be stages. Similar to the grief process, this adaptation process usually begins with a period of denial.

Denial
In my work with couples and families living with multiple sclerosis, I often hear concerns that one person seems to be “stuck in denial.” To people who have moved through the initial denial stage, it may seem as if their loved one is not progressing as quickly as others. The truth is, different people work through this period of adjustment differently, and it takes as long as it takes. The denial stage usually happens at the time of diagnosis or disability, and may come up again at other times. For example, in a progressive illness, if one begins to lose mobility or other limitations arise, the initial stage of the adjustment process may be triggered again.

It may seem clear to a caregiver/partner or family member who has been helping someone walk even short distances that a mobility device is needed (cane, walker, scooter). For the person who is having mobility difficulty, admitting that it is time to talk to a doctor about a mobility device may affect his or her identity, hope for recovery, or future progress. If so, working through the denial and bargaining, and then later stages of adaptation, may be necessary. It is not unusual to see all members of the family triggered by new developments that start the process over.

Denial is believed to be a protective measure that prevents us from becoming emotionally overwhelmed. Denial slows down the process of coping with traumatic events, giving us more time to psychologically prepare ourselves for the onslaught of feelings. The process of denial, known as a defense mechanism, should not be rushed or sabotaged by well-meaning loved ones who are at a different place in the adaptation process. Doing so can cause the person who needs more time to become emotionally overwhelmed without the necessary skills to cope effectively.

Coping skills: A person with disability and his or her family members should try to be empathetic and understand things from the perspective of others. Be honest, but gentle, about your perceptions. Choose the time to discuss these issues carefully—not when either of you are tired, frustrated, or angry. Always talk to your loved one(s) before bringing up concerns with doctors or other professionals.  Caregivers and family members should keep in mind that their needs are important, too. Take care of yourself and make sure you have plenty of support. When children are involved, be very careful what and how you share information with them. Children need to hear things based on what is appropriate for their age and stage of development. Ask for guidance from a professional if you are unsure how much to tell children or how to talk to them about disability.

Bargaining
The stage that usually follows denial is bargaining. During this time, people often are looking for second opinions, alternative therapies, and other remedies. It can also be a time when we promise the gods that we will turn our lives around if given a second chance without the disability or diagnosis.

It is true that finding the best medical providers, keeping a positive outlook, and staying informed of new research and possibilities is important. However, this can also be a time when people are vulnerable to scams and false promises. Unfortunately, there are a lot of companies and people who offer products and services that guarantee outcomes without doing the necessary research required to back up those assurances.

It is a good idea to check out any new or experimental treatments carefully before trying them—particularly if there is a large commitment of money, resources, or time involved. Check with local and national nonprofit organizations that provide services to people with your specific issue or health challenge. Agencies such as the National MS Society, American Cancer Society, and others often have information about ancillary and alternative therapies. They may be able to send you information or answer your questions.

Coping skills: Make decisions together based on facts. Find local and national organizations that you trust to support you and provide well-researched information. Be sure that any second opinions or ancillary providers have access to all the information you have from other providers. In some cases, taking medications or treatment without being fully aware of how they interact with your other treatment can be life-threatening. Make a commitment to fully investigate any new or experimental treatments before deciding to try it. Ask for and check references when appropriate. Verify the credentials of all providers before visiting them. At some point, you may have to accept a new reality that you had not planned for and do not welcome. If you have prolonged difficulty coping with the diagnosis or prognosis, find support from a professional or support group to help you with the transition.

Over the next few months, I will explore additional aspects of disability, how it affects the lives and relationships of the people involved, and ways of coping with these situations. If you have ideas to share about how you have effectively coped with any of the situations presented, please join the discussion by leaving comments below. Likewise, if you have questions, feel free to ask for input from others who read the blog.

Cyber bullying has become more common with advances in technology. Messages can be posted on social networking websites, and pictures can be downloaded, altered, and made available to the world in seconds. Although there has been abundant research into the consequences of cyber bullying and traditional bullying, little has been done to determine which type may cause more psychological damage. It is well established that bullying itself—the act of terrorizing, intimidating, and ridiculing another through verbal or physical acts—can have numerous deleterious effects.

Those who endure bullying are at increased risk for internalizing problems such as anxiety, depression, and suicide ideation. Understanding how each type of bullying impacts young people is of critical importance in order to target those most vulnerable and help them deal with the ramifications. To get a better idea of the effects of cyber bullying in comparison to traditional bullying, Sheri Bauman of the University of Arizona’s College of Education recently conducted a study asking college students to rate their levels of distress based on hypothetical cyber and traditional bullying scenarios. The scenarios were similar in nature and differed only in delivery.

Bauman discovered that three main bullying themes emerged, including generalized bullying, name calling, and sexual victimization through explicit sexual images. Although the female participants reported higher levels of distress for all three types of bullying, the method of delivery did not impact emotional response. Specifically, although their responses varied by bullying scenario, all participants reported similar distress levels whether the bullying event was traditional in nature or cyber bullying.

However, Bauman found that one type of bullying was the most distressing. “We … found that bullying with sexual material, whether conventionally or by technological methods, is the most upsetting kind of incident to targets,” she said. This was especially true for female participants. Those with a history of victimization had higher distress than those without. In sum, Bauman believes that these findings demonstrate that it may not be the delivery method of bullying behavior that is most detrimental to young people, but rather the content of the message conveyed.

Reference:
Bauman, S., Newman, M. L. (2012). Testing assumptions about cyber bullying: Perceived distress associated with acts of conventional and cyber bullying. Psychology of Violence. Advance online publication. doi: 10.1037/a0029867

The term “hook up” is one modern way individuals, especially young people, refer to casual-sex encounters. Teenagers who are sexually active, but not in romantic relationships, may “hook up” with other teens. But are these encounters damaging to adolescents’ sense of well-being? Research has suggested that teens who date are more likely to experience stress, depression, and emotional conflict than those who do not. However, the level of depression and stress teens experience in committed relationships has not been compared to the depression and stress in teens who “hook up.”

To address this void in research, Jane Mendle, of the Department of Human Development at Cornell University in New York, conducted a study that compared the emotional and psychological well-being of more than 1,500 pairs of siblings ranging in age from 13 to 18. She gauged whether the siblings were romantically involved with another person, engaging in sexual activity with that person, or whether they were sexually active with nonromantic partners. She found that although the teens in committed relationships did have moderately higher levels of depression than those who were single, the teens who participated in “hook-ups” had the highest levels of emotional distress and depression. This was especially pronounced in teens under the age of 15.

Mendle believes that one of the reasons for this finding could be the fact “hook-ups” often involve partners who used to date, or who may want to date each other in the future. In this sense, one of the participants may be more emotionally invested in the encounter than the other. The subsequent dismissal of a romantic relationship may bring on feelings of sadness, disappointment, and even jealousy. The findings in this study are rather robust because they are based on sibling pairs. However, this dynamic can also limit the results, and further family history should be gathered in future work. Additionally, romantic relationships, as defined by the participants, may not necessarily involve sexual intercourse but may include other intimate acts. This should also be explored in future research. “Continued exploration of how the transition to sexual maturity may be moderated by contextual factors can help clarify the particular developmental challenges and stressors of adolescence,” Mendle said.

Reference:

Mendle, J., Ferrero, J., Moore, S. R., Harden, K. P. (2012). Depression and adolescent sexual activity in romantic and nonromantic relational contexts: A genetically-informative sibling comparison. Journal of Abnormal Psychology. Advance online publication. doi: 10.1037/a0029816

One of the most common methods for assessing the behavioral and emotional state of a child is a parental report. This type of evaluation usually comprises a parent’s observation and evaluation of the child’s feelings, mood states, and behaviors over a period of time. But just how accurately do parents gauge the emotional temperature of their children? That was the question at the center of a recent study conducted by C. Emily Durbin of the Department of Psychology at Michigan State University. Because parental reports can vary quite dramatically from reports obtained by other observers, such as teachers, counselors, and classmates, Durbin wanted to determine what factors, if any, skewed parents’ perceptions.

Durbin chose to focus on the effects of maternal depression on parental reports. She based her decision on the fact that other conditions, such as alcoholism, parental anxiety, and family distress, have been shown to influence maternal reports. Durbin extended the existing research and compared mothers’ reports with those of unbiased observers on a sample of 190 children ranging from 3 to 6 years old. Participants were instructed to rate levels of sadness, fear, happiness, surprise, and anger in the children after they completed 10 emotion-inducing tasks. Durbin found that the mothers with a history of depression or anxiety tended to rate their children as less happy than mothers with no such history. Additionally, these same mothers viewed their children as overly fearful, and rated girls as sadder than boys. This could be a result of maternal sensitivity to emotions such as fear and sadness. However, the outcome showed a significant disparity between observers’ ratings and those of the mothers with a psychological history. “These mothers may have greater difficulty setting aside their perceptions of the child’s typical emotional adjustment to focus solely on rating the behavior the child is currently exhibiting,” Durbin said. Although the sample size was limited to young children and did not contain a large number of mothers currently exhibiting depressive symptoms, the results warrant further investigation. Durbin believes it is essential to expand this research to include older children, comparison to other assessment tools, and evaluation of other aspects of childhood development.

Reference:
Durbin, C. Emily, and Sylvia Wilson. Convergent validity of and bias in maternal reports of child emotion. Psychological Assessment 24.3 (2012): 647-60. Print.

Woman looking out train window

Dialectical behavior therapy (DBT) is a comprehensive, evidence-based treatment approach used to treat individuals with a wide variety of issues, including relationship conflict, anxiety, depression, bipolar, self-injury, eating issues, and substance abuse. Developed in the 1980s by psychologist Marsha M. Linehan for the treatment of borderline personality disorder and chronic suicidality, this method has since been adapted and utilized to help clients with much less severe issues. The therapy can help clients who exhibit extreme emotional reactions, helping them develop self-acceptance while also learning coping skills to better regulate their emotions and handle distress. DBT uses both individual therapy sessions and group skills training, as well as telephone coaching between sessions.

The DBT model combines a behavioral therapy approach with eastern mindfulness practices. In one sense, the term dialectical refers to the goal of synthesizing the extreme opposites inherent in the rigid “black and white” thinking of many clients who have trouble regulating their emotions. “Dialectical” also applies to the core DBT principle of practicing acceptance strategies while implementing change strategies, in the process of reducing and modifying self-destructive behaviors.

This type of therapy is very support-oriented; it helps clients identify their strengths, build new skills, and increase their self-esteem. DBT focuses on cognitive issues by indentifying destructive thought patterns and replacing them with more neutral and accepting internal dialogues. It is designed to be a nonjudgmental collaboration, with the therapist and client working together to increase emotional awareness and understanding, minimize negative thought patterns and behaviors, and develop new coping and problem-solving skills.

The four modules of dialectical behavior therapy:

In the case of adolescent treatment, Dr. Alec Miller has adapted Dr. Linehan’s model to incorporate parents attending skills training groups with their teens. There is an additional module, “walking the middle path,” which focuses on helping parents and their children understand each other’s viewpoints and reduce conflict and invalidation.

The five functions:

Dialectical behavioral therapy was designed to fulfill five primary functions:

Stages of treatment:

The course of DBT generally flows through three stages:

Who can benefit:

Though DBT originally was developed to treat more severe issues, such as borderline personality disorder, suicidal behaviors, and self-harm, the treatment has become a widely respected method for treating clients who exhibit the following, much milder traits and issues:

Dialectical behavior therapy has proven to be a very effective tool to help people manage intense emotions, change negative thought patterns, and decrease self-destructive behaviors. Individual therapy sessions focus on current detrimental behaviors in the client’s life, while group sessions involve learning skills from the four modules: mindfulness, interpersonal effectiveness, distress tolerance, and emotion regulation.

Major depressive disorder (MDD) is a mental health problem with both psychological and physical effects. Someone diagnosed with depression may have strong feelings of sadness or a loss of interest in normal activities; physical symptoms may include lethargy, body pains, insomnia, and headaches. Despite decades of research and study, fast and effective treatment for depression remains an unfulfilled goal. Currently, the preferred approach for depression treatment begins with cognitive behavioral therapy and may include one or more psychotropic medications. 

Suicide risk is a serious complicating factor in the treatment of major depressive disorder, and choosing the appropriate drug intervention remains a haphazard procedure. Because many antidepressants are potentially linked with a heightened risk of suicidal behavior, doctors must exercise caution. Response to psychotropic drugs, particularly antidepressants, is highly individual. A period of trial and error is often necessary before doctors can identify the optimum drug or drug combination. In cases of possible suicidal thoughts and behavior, the best course of action is often observation, possibly in an inpatient facility.

A recently completed study at the New York State Psychiatric Institute promises to offer some guidance in the selection of treatment for severely depressed individuals with suicidal tendencies. The study consisted of two groups, one receiving Paxil (paroxetine) and the other receiving Wellbutrin (bupropion). The choice of these specific drugs was deliberate: Paxil belongs to the selective serotonin reuptake inhibitors (SSRI) category and is among the most frequently prescribed antidepressants; Wellbutrin is a non-SSRI medication with a different mechanism of action. However, both medications still carry the “black box” warning to notify doctors and pharmacists of potentially dangerous side effects, namely the increased suicide risk. A second aspect of the study included functional MRI scanning of each participant’s brain—once at the beginning of the 8-week trial and once more at the conclusion. Participants were given a cognitive task during the scan to assess how each of them processed sensations of reward.

The initial phase of the study is complete. Data on the 125 participants is currently being compiled and analyzed. Researchers hope that one of the drugs will reveal itself as a more effective remedy for major depression, although they may find that one of the drugs leads to a higher rate of side effects. In any event, the data from this study will help attending physicians and therapists make better choices when treating their most severely depressed patients.

References:

  1. Bupropion, t. c. (n.d.). WELLBUTRIN XL® (bupropionhydrochloride extended-release tablets). DailyMed. Retrieved July 18, 2012, from http://dailymed.nlm.nih.gov/dailymed/archives/fdaDrugInfo.cfm?archiveid=14812
  2. Depression (major depression). (n.d.). Mayo Clinic. Retrieved July 18, 2012, from http://www.mayoclinic.com/health/depression/DS00175
  3. Paroxetine/Bupropion in Suicide Attempters/Ideators With Major Depression. (n.d.). ClinicalTrials.gov. Retrieved July 18, 2012, from http://clinicaltrials.gov/ct2/show/NCT00429169?recr=Open&intr=%22Bupropion%22&rank=16

Woman meditating in open roomI almost always suggest to clients that they learn focused abdominal breathing and practice a minimum of 5 minutes every day; for the best results, I recommend they practice 20 or more minutes per day. Sometimes they look at me funny and ask “You mean all I have to do is just breathe and everything will be better?” I tell them that no, everything is not going to magically change to exactly what you want in life, but learning and practicing focused abdominal breathing every day WILL do this for you:

1) Special breathing techniques can help reduce physical pain. Often when people are in pain, they breathe in a very shallow, disordered pattern. They also may frequently hold their breath without even realizing it. These are mostly unconscious protective reactions to pain, but they can actually increase the level of pain. Several recent scientific studies have shown that breathing at a slower rate from the diaphragm can significantly reduce sensations of pain.

2) Breathing helps to properly balance oxygen and carbon dioxide levels in the body.  Breathing properly from the diaphragm will:
•    Fuel energy production
•    Improve focus and concentration
•    Increase relaxation and calmness
•    Reduce tension and anxiety
•    Eliminate toxins
•    Strengthen the immune system
•    Improve bowel function
•    Lower blood pressure
•    Increase metabolism, aiding in digestion and weight loss

On the other hand, not breathing correctly can cause problems for a number of systems in the body, including the immune, circulatory, endocrine, and nervous systems. Improper breathing can produce various symptoms including:
•    Difficulty focusing attention
•    Dizziness
•    Numbness
•    Anxiety
•    Chest pain
•    Digestive problems
•    Irritable bowel
•    Neck and shoulder pain

3) Breathing releases emotional energy that is trapped in the body. People with anxiety and/or depression are almost always (and I mean 99.9% of the time) either breathing very shallowly or frequently holding their breath. Holding the breath is one of the most common ways that people stop emotions from coming up (think about the last time you tried not to cry, feel afraid, or get angry). Once you hold in an emotion it stays trapped in your body, until you release it. Breathing allows stifled, buried emotions to finally start to surface and be released.

4) Breathing keeps you in the present moment, instead of the past or the future. People with depression are often stuck in thoughts about the past, and people with anxiety are stuck in thoughts about the future. When you’re concentrating on your breathing, you are paying attention to your body sensations, the sound of your breath, and the process of breathing, all of which are happening RIGHT NOW. When you’re paying full attention to RIGHT NOW, you take AWAY energy and attention from the thoughts about the past or future. When you bring your attention to NOW, you automatically feel calmer.

Using the breath is a way to learn how the body and mind are connected. This is why I teach proper breathing to clients. Thoughts are directly related to feelings in the body and likewise, body sensations give rise to thought patterns in the mind. Mind and body are in a constant dance of influence, and it is important for people to learn that they have more choice and control in the matter than they thought.

Basic Instructions for Focused Abdominal Breathing
More than likely, if you are experiencing depression, anxiety, or pain, you are breathing shallowly from your upper chest. You want to train yourself to breath from your diaphragm/abdomen. Although it’s most effective to have someone teach you the process in person, here are the basic steps:

1) Sit in a comfortable upright position with your back against your chair and your feet on the ground. Keep your back straight, but let your shoulders and the rest or your body be very relaxed.

2) Place your left hand on your abdomen. Imagine that the entire area from your lower abdomen up to your chest is one large, rectangular balloon. Now, start by exhaling as completely as possible. Empty out as much air as possible. Your left hand will move inwards as the “balloon” area deflates. Now, slowly and gently, inhale, imagining that you are filling the balloon starting from the bottom, all the way up to the top. When you are breathing correctly from your abdomen, your lower abdomen will inflate, followed by your chest expanding, and your left hand will be pushed outward. Your shoulders will not go up, they will stay in place. When you inhaled did your hand move? Or did your shoulders go up instead? If your shoulders rise up when you inhale, you are breathing from your upper chest. Exhale and try again. This type of breathing may take a little practice to get the flow going. Work on this step until you can fill and empty the “balloon” completely. Then add the next steps.

3) Now that you are breathing abdominally, relax into a natural breathing rate. Your body will take over the breathing and settle into its own rate and depth. Your job is to just observe your breathing. Focus your attention on the tip of your nose and intently notice the pressure, temperature, and sensations of the air passing in and out of your nose. If it helps you to focus, you may also silently say “breathing in” on your inhalation and “breathing out” on your exhalation. Do this focusing for 5 minutes a day to start with, and work up to 20 minutes or more per day.

4) During your focused breathing session, especially when you first start practicing, you will more than likely notice that you are thinking about something else other than breathing. Thoughts have intruded into your mind and distracted your attention. When this happens, try not to react with any emotion (such as frustration). Just gently and silently allow the thoughts to drift upwards far away in to the sky like a soap bubble and then turn your attention back to your breath. At first you will find yourself re-directing your attention many, many times each session. Over time you’ll be able to maintain focus on your breathing for longer and longer periods of time and it will get easier to let go of intruding thoughts. It will even become easier to let go of unhelpful thoughts you have during the rest of the day (such as disturbing thoughts of the past or worrisome thoughts of the future). The most important thing is to keep doing the focused breathing every day, no matter what.

Open, full, unrestricted, unobstructed breathing is very important for your physical, mental and emotional health. It is something simple that can make a very big difference in your life. There are many things in life that we have no control of, so doesn’t it make sense to do the things we can have some control over? You can actively affect your own physiology and mental/emotional state just by mastering the art of breathing, focusing, and being present.

Related articles:
Deep Breathing and Guided Imagery
Alcohol and Anxiety: Not As Helpful As You Think
Managing Your Moods Through Mindfulness

Adolescent girls are among the most vulnerable for issues that relate to body image. They are assaulted with unrealistic images and unachievable ideals from virtually every media outlet. Teen girls struggle to find their identity at a time when appearance often determines their social circle and affects their self-esteem. In fact, research shows that teen girls worry more about their bodies than they do about academics, family life, or any other stressors. Young women who develop unhealthy eating behaviors can find themselves in a lifelong battle of physical and mental distress. Eating and food issues can lead to other negative psychological problems such as depression, anxiety, or even suicidal ideation.

Kathryn E. Rayner of the Centre for Emotional Health of the Department of Psychology at Macquarie University in Australia recently led a study to explore how peer relationships affect eating and body image issues in young women. Social acceptance is critical to teens, so Rayner theorized that perhaps young women select their friends based on eating and body image similarities, or perhaps they shape their own perceptions and behaviors based on the friends in their social circle. Rayner examined selection versus socialization in a sample of 1,197 teen girls from nine separate high schools in Australia. The adolescents were assessed for bulimic and dieting patterns, body satisfaction, and peer relations over a period of three years.

The results of the study revealed some interesting trends. First, the participants tended to choose friends with similar body satisfaction/dissatisfaction levels and bulimic behaviors. However, they did not choose girls with similar dieting and eating patterns. The girls also chose to engage in friendships that were bidirectional and avoided one-sided friendships. Rayner discovered that the girls who dieted the least had more people who wanted to befriend them, while those with more depressed mood and overt dieting behaviors had fewer peers soliciting their friendship. Additionally, the girls in the study, although they selected girls with dissimilar behaviors from their own, did not change their own actions to model those of their friends. Rayner believes the results of her study shed new light on some of the factors that influence eating, dieting, and body image in girls at risk. She added, “These findings represent important building blocks in facilitating the formation of more effective prevention and intervention strategies.”

Reference:
Rayner, K. E., Schniering, C. A., Rapee, R. M., Taylor, A., Hutchinson, D. M. (2012). Adolescent girls’ friendship networks, body dissatisfaction, and disordered eating: Examining selection and socialization processes. Journal of Abnormal Psychology. Advance online publication. doi: 10.1037/a0029304

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