Cognitive fusion is a process that involves attaching a thought to an experience. Cognitive fusion is beneficial in many ways. Through the process of cognitive fusion, people can become interested in story lines in movies and books because they attach their emotions to the events. Hobbies that elicit positive feelings can be enhanced as a result of cognitive fusion as well. Even feelings of love can be influenced by cognitive fusion. But this process can also impair behavior in individuals with certain psychological issues. People who struggle with anxiety and depression experience negative thoughts that can prevent them from taking positive actions. For instance, when someone with depression focuses on feelings of worthlessness because they have been unable to overcome their depression, they may continue to avoid seeking help because of the perceived outcome. Individuals who suffer with anxiety also find themselves trapped by cognitive fusion when for instance, they believe they will panic if they are exposed to stressful situations, and therefore avoid all situations that could induce stress, even if they are necessary for recovery.

Understanding how cognitive fusion affects mental health is a relatively new area of research. Acceptance and commitment therapy (ACT) is a mindfulness-based therapeutic approach that teaches clients how to accept negative feelings independently of perceived outcome. Therefore, ACT and other mindfulness techniques aim to teach cognitive de-fusion. Because there is little evidence exploring this, Kristen N. Herzberg of the Department of Psychology at the University at Albany of the State University of New York, recently conducted a study that employed a new tool to measure the effectiveness of ACT on cognitive fusion.

Herzberg and her colleagues developed the Believability of Anxious Feelings and Thoughts Questionnaire (BAFT) and administered it to over 900 individuals, half of whom struggle with extreme anxiety, undergoing 12 weeks of internet ACT treatment. She found that BAFT was quite accurate at identifying levels of cognitive fusion. Specifically, the BAFT was able to measure anxiety sensitivity, avoidance, and cognitive de-fusion in the participants. The results also showed that the anxious participants saw significant reductions in avoidant behaviors after completing the cognitive fusion–targeted ACT program. Herzberg added, “Taken together, these findings suggest the BAFT to be a reliable, valid, and useful measure of cognitive fusion.”

Reference:
Herzberg, K. N., Sheppard, S. C., Forsyth, J. P., Credé, M., Earleywine, M., Eifert, G. H. (2012). The Believability of Anxious Feelings and Thoughts Questionnaire (BAFT): A psychometric evaluation of cognitive fusion in a nonclinical and highly anxious community sample. Psychological Assessment. Advance online publication. doi: 10.1037/a0027782

Major depressive disorder (MDD) is more prevalent in the pediatric population than previously believed. According to some estimates, between 2% and 8% of children and adolescents have mood disorders. Depression in childhood often predicts recurrent episodes of depression later in life. This population is also at heightened risk of psychiatric disorders, substance abuse, social maladjustment, homelessness, and criminality. Clearly, depression in young people is not a problem that can be safely ignored. Early therapeutic intervention is essential and usually consists of cognitive-behavioral therapy and medication. Currently, the only antidepressant medication approved for use in children and adolescents is Prozac (fluoxetine). However, the lasting effects of Prozac exposure during youth are still not completely known. Conventional wisdom suggests that the benefits of treatment likely outweigh long-term risks, particularly in cases of MDD.

The adolescent brain, just like the adolescent body, experiences profound and rapid development. Chemicals in the brain called neurotransmitters direct cellular and structural growth throughout the brain, and this process gives rise to the adult brain: a well-regulated, stable organ that manages consciousness and the central nervous system. During the period of rapid growth, any disruptions or chemical stimuli can lead to functional changes later in life. For this reason, antidepressant use in childhood has come under great scrutiny. Prozac alters the balance of neurotransmitters in the brain. Some have argued that Prozac exposure during adolescence may result in lasting, even permanent behavioral changes. Researchers conducted a controlled experiment with adolescent rats to address some of these issues.

Rats given Prozac during adolescence displayed significant behavioral changes when tested as adults. For example, they showed less response in a forced-swim test and more response to anxiety-producing situations, such as a new environment. The increased anxiety was reduced by a second exposure to Prozac. Most disturbingly, sexual behavior in adulthood was impaired by Prozac taken during adolescence. This finding was completely unexpected. However, the researchers cautioned that the relationship between brain development and behavior is enormously complicated, and the current study only highlights this complexity. How much of these results translate to humans is also an open question. Rats are typically used in these studies because they mimic human physiology and neurobiology. Still, the underlying mechanisms of behavior are not well understood.

The adolescent rat study, among others, adds powerful evidence to the argument that Prozac initiates profound changes in the brain. These changes manifest themselves as behavioral and mood alterations. Human research is necessary to determine the scope of these alterations. As it stands, prescription of this antidepressant for children with MDD is still warranted.

References

1. PubMed Health. [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Fluoxetine. Retrieved April 11, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000885/
2. Iniguez, S. D., Warren, B. L., Bolanos-Guzman, C. (2010). Short- and long-term functional consequences of fluoxetine exposure during adolescence in male rats. Biological Psychiatry, 67(11), 1057-1066.

Women have been stereotypically defined as being more emotional than men. In popular culture, women are depicted as being more emotionally volatile, often erupting into fits of sadness, anger, despair or jealousy much more frequently than their male counterparts. But is this portrayal scientifically accurate? Research has shown that there are differences in how men and women emotionally respond to situations. However, little research has addressed the core self-conscious emotions (SCE) of men and women and how they differ. Nicole M. Else-Quest of the Department of Psychology at the University of Maryland in Baltimore sought to debunk the myth that women have less emotional regulation than men. She recently conducted a study that compared male and female levels of embarrassment, shame, guilt, and pride in data gathered from over 300 studies.

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Existing research has shown that women and men differ in their risks for some mental health issues such as depression, food and eating issues, anxiety, and self-worth. How men and women experience SCEs has a direct influence on their likelihood of developing these and other psychological problems. Else-Quest analyzed over 200,000 self-reports and found that for the most part, women and men had similar levels of SCEs. The results revealed slightly higher levels of guilt and shame in the women, but minimal differences in pride and embarrassment. Else-Quest also looked at age as a factor because men and women tend to exhibit the first signs of depression, anxiety, and low self-esteem at different ages. She found that although there were relatively few differences in SCEs in early childhood, women reported higher levels of SCEs, primarily shame and guilt, during adolescence.

Overall, Else-Quest discovered that women experienced the highest levels of guilt and shame when they were asked about sex, food and eating, body image, or the environment. Although the rates of SCEs in these areas were only slightly higher for women than men, these results support existing research regarding women’s emotional perceptions about sex, body image, and eating problems. Else-Quest concluded by saying that even though women had minimally elevated levels of guilt and shame, the men and women reported levels of pride and embarrassment that were virtually identical. She added, “These findings contribute to the literature demonstrating that blanket stereotypes about women’s greater emotionality are inaccurate.”

Reference:
Else-Quest, N. M., Higgins, A., Allison, C., Morton, L. C. (2012). Gender differences in self-conscious emotional experience: A meta-analysis. Psychological Bulletin. Advance online publication. doi: 10.1037/a0027930

For children, teens, and college students, summertime is associated with freedom from school and positive emotions. However, summer can also be a time where certain mental health issues need to be tended to even more than usual. Experts share information on what mental health problems can be present more often during summer and how to prevent certain issues.

Peter Zafirides, a psychiatrist in Ohio, said he has noticed a common mental health issue for children, teens, and students during the summer. Many evaluate whether they should still take their medication for attention deficit hyperactivity disorder (ADHD).

“Stimulants are often prescribed during the school year, but depending on the severity of the underlying ADHD, the summers may provide for some time off the medications,” Zafirides said. “But it may not always be smooth-going. The combination of unmedicated ADHD symptoms, along with the less structured days of summer can be very problematic for kids and their parents. Beyond the attention symptoms that worsen, kids can experience mood changes, including anxiety and irritability.”

School can provide a consistent schedule, which can be better for children with certain mental illnesses. “The potential unstructured nature of the summer can feed in to any underlying anxiety disorders and depression present in these kids,” he added.

For children who have ADHD, Zafirides has tips to make summer more bearable. “Children and parents may benefit from sitting down at the beginning of the summer and talking about shared goals and expectations,” Zafirides said. “Have a plan ahead of time to regularly check in with each other and, in an open, nondefensive forum, talk about any changes in behavior or concerns about mood.”

He also has other suggestions that can apply to children and teens with any type of mental illness or mental health issues. “Get outside and enjoy the summer. Try to limit the amount of time online, watching TV, or playing video games,” Zafirides said. “Be active, get plenty of sleep and exercise. If medications will continue over the summer, make sure kids are taking them regularly. Again, summer is less structured, so compliance may not be as consistent, resulting in a worsening of a mental health condition. Always speak to your medical professional before either discontinuing or reducing the dosages of medication.”

Communication is key for healthy relationships and lives. “I think the most important aspect between parents and children in the summer months is to establish clear and respectful lines of communication without either side getting defensive or feeling they are not being heard,” Zafirides said. “An occasional small discussion may be all that is needed to avoid big problems over the summer.”

John Duffy, a clinical psychologist and author of The Available Parent: Radical Optimism for Raising Teens and Tweens said in an email that depression can be more noticeable during the summer. “I have found that depression driven by loneliness often becomes more pronounced in the summer,” Duffy said. “This may be due in part to the fact that people are more obviously out, about, and social in the summertime. For many young people, summer is a far less-structured time of year than any other season.”

Anxiety issues can also come to the surface. “We often find that anxiety-based issues become apparent due in part to the lack of structure,” Duffy said. “Though most young people claim this is the time of year they most look forward to, many become listless and irritable because of a lack of structured activity.”

The solution to these issues is to provide somewhat consistent structure during the summer. “This might include participation in a sport, a play, a camp or other club, volunteer activity, or a job,” Duffy said. “Kids do better when they are part of something. They are happier, less restless, and more driven. Summer also presents a unique opportunity for young people to investigate strengths and interests, and opportunity that is less open to them during the very-structured school year.”

Adults can experience the same mental health issues as children during the summer, especially depression and anxiety. “Depressed adults are more aware, for example, of the degree to which others are socially connected during the summer, and this can serve to amplify the depression,” Duffy said. “Many adults also tell me that, though they want to be more active, limitations imposed by work and other obligations prevent them from doing so. This can contribute to feelings of depression and anxiety as well.”

The National Alliance on Mental Illness website suggests that some people can actually experience seasonal affective disorder (SAD) during the summer. SAD is characterized by depressive episodes that occur during certain times of the year (typically during the winter). In the case of seasonal affective disorder that is experienced during the summer, symptoms tend to be weight loss, minimal appetite, anxiety, irritability, and insomnia. Heat and humidity could worsen this “reverse SAD,” according to the website. Some adults with bipolar disorder are more likely to experience the mania part during spring and summer as well, he said.

William Oswald, the CEO and director of Summit Malibu, a behavioral and addiction treatment center in California, said in an email that all types of mental health issues can occur more often during the summer, such as agoraphobia, addictions and compulsions, as well as the more common depression and seasonal affective disorder.

“When people have a purpose, or curriculum in this case, their minds stay occupied, and boredom is not as prevalent of an issue,” Oswald said. “When they go from being extremely busy to having nothing to do, oftentimes this boredom results in mild, or in some cases severe, forms of depression. Once untreated, depression sets in, people (teens and college students especially) end up self-medicating with drugs or alcohol as a means to simply feel better. This is true of seasonal affective disorder as well—some may not want to be outside, and in turn isolate, resulting in isolative behaviors and a depressive state.”

Oswald has specific preventative tips for each age group during the summer:

Children: “Setting play dates with other kids or sending them to a day-care program where they do outside activities can keep their minds occupied and also help with socialization. This is key to preventing isolating behaviors later on in life.”

Teens: “Having a part-time summer job is the most important thing they can do to protect their mental health. They will learn the importance of a work ethic, earn money (which they can then spend on fun activities), and [prevent] boredom—the number one offender during summer breaks.”

College students: “Having an internship or continuing to work on their educational goals will keep them focused and driven, preventing depression and other detrimental behaviors associated with the disorder.”

Unfortunately, these suggestions will not always work, and in that case it’s best to seek a mental health professional to keep any mental health issues from worsening.

For adults, it can be unfortunate to be stuck inside working when the weather is gorgeous (at least in some places). This can be just another trigger for depression and other mental illnesses like substance-related disorders. “Adults need to utilize their vacation days properly so they have something to look forward to and get to experience summertime weather on days other than the weekend,” Oswald said. “Making time for outdoor activities on the weekend and starting an exercise program will keep one’s mood elevated.”

Despite decades of research and several new classes of antidepressant medications, successful treatment of depression is still an elusive goal. In particular, people with major depressive disorder (MDD) often fail to respond to the first line of treatment or relapse after a short period of recovery. The search for new therapies and combinations of therapies is ongoing. Recently, the antipsychotic medication Abilify (aripiprazole) has been prescribed as a secondary treatment for MDD patients, often with positive outcomes.

Originally designed as a treatment for symptoms of schizophrenia and other psychotic disorders, Abilify’s usage has expanded widely in just a few years. Now, doctors are prescribing this medication for conditions ranging from bipolar disorder to certain forms of autism. Like all psychotropic medications, Abilify works by altering the balance of chemicals in the brain called neurotransmitters. Several of these neurotransmitters, including serotonin and dopamine, are largely responsible for a person’s emotional state. Abilify has demonstrated great potential to stabilize emotional states for a wide variety of patients. This includes the capacity to reduce anger and aggressive outbursts, which is why its original usage was for psychotic patients.

In 2007, the Food and Drug Administration approved Abilify as a supplementary treatment option for patients with MDD who were already following a course of traditional antidepressants. Several clinical trials and controlled experiments have demonstrated that Abilify may offer a “boost” to the mood stabilizing attributes of antidepressants. At the same time, Abilify may work to offset some of the more unpleasant side effects of these drugs, such as sexual dysfunction.

In addition to its effectiveness as a supplementary therapy, clinical trials and tests indicated that Abilify is a relatively safe and well-tolerated medication in depressed patients. The most commonly reported side effect associated with the medication was restlessness. Rarely was this side effect bothersome enough to cause the patient to discontinue taking Abilify.

Millions of people experience the debilitating symptoms of depression every day. Nevertheless, a reliable cure or even a more effective treatment for depression is likely still many years away. Because the brain is the body’s most sophisticated organ, understanding how best to restore the proper neurochemical balance is difficult. Discovering the most successful early treatment options is therefore important in reducing relapse and improving long-term outcomes.

References

1. PubMed Health [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Major depression. Retrieved February 20, 2012. Available from: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001941/
2. Pae, C., Forbes, A., & Patkar, A. A. (2011). Aripiprazole as adjunctive therapy for patients with major depressive disorder. CNS Drugs, 25(2), 109-127.

Dressing up can take extra effort, but it also feels good, especially if you receive extra compliments. A new study suggests what many women have experienced: dressing in nicer clothes makes you feel better.

According to a recent news release, one study has shown that women who are depressed or sad are more likely to wear baggy tops, jeans, and a sweatshirt or jumper. Women who are happy or positive are more likely to wear a favorite dress, jewelry, and jeans. These clothing choices seem to mean that women who are feeling down put less effort into what they’re wearing, and women who are in a good mood tend to try and look nicer to match their mood.

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There were 100 women interviewed for the study, and their ages ranged from 21 to 64 years, according to the news release. The researchers also found that 73% of women in the study “shopped for clothes at least every few months.” The majority of women, or 96%, “believed that what they wear affects how confident they feel,” according to the news release.

Researchers determined from the results that there is a possibility that wearing certain clothes can affect emotional states. “The strong link between clothing and mood state suggests we should put on clothes that we associate with happiness, even when feeling low,” according to the news release. The author of the study, Karen Pine, who is the coauthor of Flex: Do Something Different and a professor in the School of Psychology at University of Hertfordshire, added in the news release that jeans are more associated with a depressed mood state and that women should consider abandoning them for a different clothing choice in order to feel better.

“Jeans don’t look great on everyone. They are often poorly cut and badly fitting,” Pine said in the news release. “Jeans can signal that the wearer hasn’t bothered with their appearance. People who are depressed often lose interest in how they look and don’t wish to stand out, so the correlation between depression and wearing jeans is understandable. Most importantly, this research suggests that we can dress for happiness, but that might mean ditching the jeans.”

In the study, 51% of women would wear jeans when they felt sad or depressed, and only 33% of women would wear jeans when they felt happy or positive, according to the news release. So if people still wear jeans when they are happy, just to a lesser degree, why are they such a bad choice? Why are baggy clothes associated with a sad or depressed emotional state and dresses and jewelry associated with a happy or positive emotional state? Pine addressed these issues in an email.

“All the findings apply, but because jeans are so ubiquitous (everyone seems to have a pair, women on average have eight pairs each) we chose to ‘lead’ on this finding. It is interesting that many women wear them a lot but there’s still a variation according to mood. I think the finding that women will only wear their favourite dress when happy or will likely wear a baggy top when depressed is just as compelling.”

She said that the research didn’t go into certain details, like the fact that some women are more into a “jeans and T-shirt” type of fashion, and other women wear skirts and dresses every day as part of their style. It’s also uncertain whether results would’ve changed if researchers took into consideration the emphasis some women put on fashion and beauty and if women who shopped less were interviewed. “Of course there will always be individual differences, but nonetheless recent research into enclothed cognition … confirms there is a strong association between what we wear and our psychological processes,” Pine said.

Results would also possibly look different if men were included in the study. “A lot of my research concerns women’s issues .. and I think the emotional link is probably stronger for women than for men, although there is research that shows men’s clothes affect how they behave (e.g. sports teams that wear all black act more aggressively),” Pine said.

Overall, Pine believes the research provides a look into how we can improve our moods. “It shows that clothes impact strongly on how we feel and may also influence how we think (as the above research also suggests), which we’ll be exploring further in our research,” Pine said. “It suggests we should give more thought to what we wear and even dress for happiness, irrespective of how we are feeling. If we knew more about which clothes could lift a person’s mood perhaps there’d be less need for anti-depressant medication.”

Shauna Mackenzie Heathman, a certified image consultant and owner of Mackenzie Image Consulting in South Carolina, said in an email that the results of the study are expected. “When we are feeling depressed or unhappy, looking our best is not on our minds,” Pine said. “In fact, it becomes a hassle and waste of time. Mental energy is turned inwards towards emotional thoughts. Dressing simply becomes function versus adornment or fun.”

She said that people shouldn’t necessarily make assumptions about the feelings and emotions of another person based on their clothing though. “We have the power to wear items that represent our personalities and feelings,” Heathman said. “With that being said, who knows how other people will interpret it. We make [judgments]/assumptions based on our own experiences. Bottom line: I would be careful to assume one’s feelings based on what they wear. To a certain extent, you can read whether someone is feeling insecure based on their clothing, but body language and nonverbal communication is much more representative of one’s feelings.”

She thinks there could also be a separate study on men that explores their clothing choices and emotional states. “I think it was okay for this study to be focused around women,” Heathman said. “A separate study on men should be considered. However, first you would need to discover the underlying differences between men and women and how they interpret clothes. Men are much more focused on functionality in their wardrobe than women, regardless of emotional state. So I do think there may be some general similarities, but overall women’s results would probably be more dramatic.”

One of the main parts of the study Pine focused on was jeans and their association with a depressed or sad mood state, and Heathman thinks this could be because jeans are an easy choice that doesn’t require a lot of thought. “I don’t think it’s the fact of wearing jeans that suggests sadness or depression as it is just wanting effortlessness and functionality,” Heathman said. “As I mentioned before, when we are depressed or sad, we’re not focused on how we look. We stop caring. We turn to what’s easy and comfortable. Prolonged long enough, you then fall in ‘the rut.’ Often, altering one’s mood by enhancing wardrobe can be done. However, it generally only has short-term results if working on one’s emotional and mental state is not at play as well.”

“The study mentions that happy clothes include well-cut, figure-enhancing items made from bright and beautiful fabrics,” Heathman said. “To this, I ponder, isn’t this obvious? If something makes our figure look poor, we generally don’t like this and thus are unhappy about it. When we don’t like what we wear, we focus on it throughout the day. It takes away the focus from the daily tasks that are important—work, relationships, family. A woman should walk out of the door and not have to think about what she’s wearing for the rest of the day. You’d be amazed at how much mental energy is exhausted pondering about how we look.”

Overall she thinks the study could have gone more in-depth to provide more useful information. “I think the study lacks depth. What is revealed seems fairly obvious,” Heathman said. “I would be curious to hear why women choose to wear a hat more often when they are happy. Is it because it’s fun? Is it because it draws attention towards them? Also, the psychology of color comes into play much more than the study presents. I think it’s informative more than it is useful.”

Donna Stellhorn, a Feng Shui expert and author of 2012 Year of the Water Dragon, interprets the study from a unique perspective involving her experience with Feng Shui. For those who are unfamiliar with Feng Shui, it is “the study of how the environment affects those who dwell in it,” according to the American Feng Shui Institute website. The “science” of Feng Shui suggests that there are “different energies” in our planet, and learning how to balance these energies can help improve various aspects of life.

“In Feng Shui we understand how you dress is associated with the five elements. Each element has an energy, and we’ll gravitate to the energy that’s in harmony with how we feel at the moment,” Stellhorn said. “The study says when we’re feeling down we’re more likely to reach for jeans and loose-fitting tops. These boxy shapes relate to the Earth element, a desire for stillness and stability. There are five elements (Earth, Wood, Fire, Water, and Metal), each with an energy, feeling, and a related style. Besides the shape of clothes, also the color and material indicates the element. For instance, animal prints are associated with the Fire element and a desire to be noticed and feel alive.”

She said for men, color would probably be more of an indicator of emotional states. “Because men tend to stick to a limited wardrobe, emotional states can be read in the choices of colors and the slight changes in what they normally wear,” Stellhorn said. “Men who usually sport a T-Shirt and suddenly start wearing a button-down shirt in greens or browns has moved from the Earth element to Wood, showing a desire to grow, to add to their life financially and socially, they’ve become curious about the world.”

She agrees that jeans are less effort when people are already preoccupied with other areas of life. “It’s not that jeans specifically suggest sadness, but that the desire to throw on a pair of jeans can indicate that life’s been too chaotic, there are too many choices and we want some quiet stillness to contemplate what’s ahead,” Stellhorn said. “When we reach for jeans we want something familiar because things around us are stressful.”

Accessories can also affect mood, like the study suggests. “Women’s hats bring attention (from others and our own) to our heads and indicate a person with power,” Stellhorn said. “A man in a ball cap might be covering thinning hair, but by wearing the hat he feels more powerful and better able to interact in the world. Jewelry and handbags also bring an energy, and therefore an emotion, to the person.”

Linda Froiland, an image consultant and personal shopper, said in an email that jeans don’t need to always be associated with depression, although sometimes it can be difficult to find the perfect fit. “Jeans are not just for tennis shoes. If you have a great fitting pair in a dark wash they can be quite sexy with an elevated heel, high heel, or wedge shoes,” Froiland said. “I wear mine out dancing, dinners at friends or restaurants, shopping, everywhere really, but they fit like a glove and have attitude. I can honestly say I am not depressed when wearing jeans, nor are my clients once they know how they should fit, what they should look like, and what to pair them with.”

Rosa Mae Neel, a stylist for professionals and the founder of Prune, agrees with Froiland that jeans don’t necessarily mean depression. “In a place like New York, where women commonly spend up to $300 for a pair of jeans and wear them with heels and a sexy top to go out at night, jeans do not necessarily equal depressive state,” Neel said. “Perhaps in other parts of the country or for older generations, jeans that are not designer jeans and that are more comfortable than flattering are a go-to for depressive states. Again, blousy tops can be trendy and hip if expensive or worn with gusto, or they can be a medium through which to hide extra pounds or negative feelings.”

Froiland said that clothing can be important in not only affecting mood but also in making impressions on other people. “Whenever I talk to a group, large or small, I always start out my presentation with telling everyone that ‘It’s in less than 3 minutes someone has already decided who and what you are. First by your appearance (87%), second your body language (8%), and then your verbal communication (5%). It takes another 20 times meeting that person to change that original perception,’” Froiland said. “So the value in our clothing is profound.”

Caroline Adams Miller, a professional coach, author of “Creating Your Best Life” and a graduate of University of Pennsylvania’s Master’s in Applied Positive Psychology program, said in an email that baggy clothes in general can indicate more of a lackluster mood. “Baggy jeans that could be perceived as asexual probably don’t correlate with happiness unless paired with more individualistic shirts or accessories,” Miller said. “The baggy tops reference doesn’t surprise me because they would ‘hide’ someone, and unhappy people don’t want to interact with people—they want to ruminate and be alone, and these clothing choices are perfect indicators of not feeling worthy of being ‘seen.’”

She believes that men could be affected by clothing choices as well, although they might put more effort into choosing a car to express their personality and mood. “I do believe that many men use clothing to express and change their moods, though, so I think a future study would find similar results,” Miller said.

Overall she believes the study makes sense and that there is a real connection between clothing and mood. “The science of happiness has found that we have ‘positive interventions’ that can change our mood, and when we deliberately intervene on our happiness by wearing things that evoke positive feelings, positive reactions from others, or that remind you of positive experiences, you will be happier,” Miller said.

Related articles:
Are You Your Own Worst Enemy?
Seven Mistakes People Often Make When They Get Depressed
Depression as Trickster and Communicator

Major depression continues to be one of the most common and debilitating chronic mood problems afflicting adults. According to the Mayo Clinic, there is no quick fix for those who have this disease. Appropriate treatment includes a long process of psychotherapy, lifestyle changes, and medication. Recently, several studies have indicated that the antidepressant drug Paxil (paroxetine) may increase the risk of suicidal thoughts or even attempted suicide in certain patients. As a member of the class of drugs known as selective serotonin reuptake inhibitors (SSRIs), Paxil is one of the most frequently prescribed treatments for depression on the market. The concern over suicide has led researchers to look back at previous studies in an attempt to reassess both the effectiveness and the safety of this particular medication.

Researchers studied the results of 40 double-blind, placebo-controlled clinical trials of Paxil. As a whole, the trials included nearly 7,000 adult participants, most of whom were diagnosed with either moderate or major depression. In a typical clinical trial of a medication, participants who leave the trial early are not taken into account; their data are incomplete and inconclusive. For the present review, however, researchers considered early withdrawal to be an indicator of either ineffective treatment or adverse effects. Surprisingly, the same proportion of trial participants left their respective studies early, regardless of whether they were taking placebo or Paxil. One would expect that more of those taking Paxil would remain in the study, but the numbers tell a different story. The researchers point out another flaw in depression research in general—the dependence on rating scales rather than overt and empirical evidence. Because depression is a psychological illness with few, if any, quantifiable symptoms, gauging its severity becomes very subjective.

When researchers pooled the results from all 40 trials together, the beneficial effects of Paxil were significant but only marginally more significant than placebo. If 100 patients are treated with Paxil, then an average of 53 of them will have a positive response, compared with 42 for placebo. In essence, this medication performs only 11% better than a sugar pill. When researchers considered the potential adverse effects of Paxil, including suicidal tendencies and attempted suicides, the picture became even murkier. Of all the SSRIs, Paxil has been shown to produce the greatest spike in suicidal thoughts, especially in young adults and adolescents.

The researchers conclude that the fields of psychology and pharmacology are in need of better experimental design. They argue that current designs overstate the effectiveness of antidepressant medications while simultaneously downplaying adverse effects. For Paxil at least, a closer look at a large cross-section of data reveals that it may not be quite as effective as once thought. As always, doctors should carefully screen their patients before prescribing any antidepressant medications. Any hint of suicidal tendencies argues against its prescription.

References

1. Barbui, C., Furukawa, T.A., Cipriani, A. (2008). Effectiveness of paroxetine in the treatment of acute major depression in adults: a systematic re-examination of published and unpublished data from randomized trials. Canadian Medical Association Journal, 178(3), 296-305.
2. MayoClinic.com. (n.d.). Depression (major depression). Retrieved March 8, 2012, from http://www.mayoclinic.com/health/depression/DS00175

Grief arises as a product of a loss that we have experienced. It is associated with losses that may include a person’s health, job, relationship, pet, or loved one. We may not be able to describe the roller coaster of emotions, yet we do know that we are not ourselves. When we feel out of sorts, sensations surface such as low self-esteem, illness, depression, and confusion, which can manifest into thoughts that our feelings are out of our control. As a result, this full-body experience may be difficult to process or verbalize. To mend this sorrow, the expressive arts can create a doorway to the unspeakable by opening all channels to the grieving body.

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Opening Up to Grief

Expressive arts therapy encourages movement of the imagination that we may struggle with during our grieving process. Our art influences how we look at, unblock, wrestle with, and shed light on the need to distance and detach from our pain. When we dodge grief to avoid, deny, or block the inevitable pain, the arts invite the imagination of these stuck places to come to the surface in images, movement, color, and sound. Our art process releases the tension of grief, allowing it to expand and contract, while providing a safe container in which this process can take place. When we create, we give ourselves permission to examine all that is happening within our grieving bodies.

“Art shows how the difficulty can contain its cure if channeled into life-affirming expression.”
-Shaun NcNiff

Understanding the Experience of Grief

There are five to seven stages often associated with the grieving process. They may be experienced as denial, pain, anger, bargaining, depression, upward turn, reconstruction, and acceptance. The experience can feel like a roller coaster ride of ups and downs, mood swings, and erratic behavior. When we drop in to our art-making, the grief is given containment—a place to be held. This containment permits the pain to speak and encourages our healing. Making sense of what is happening comes to light. We may notice this in a color that strikes a mood, or a picture that recalls a memory, or an emotion to be felt. It is an opportunity for the most vulnerable parts of a grieving body to speak, feel safe, be heard, and be externalized. Once the art is created, we can then dialogue with it further and support our need to metabolize all that is going on within us.

“The reward for attention is always healing.”
-Julia Cameron

Facing Grief and Piecing Life Together

Fragments of memories, like bits of broken glass, can be difficult to hold emotionally around anniversary dates, picture books, and mementos. They can feel like a jab to the heart, invite an unwanted memory, or open a floodgate of emotion. These fragments seek meaning and solace, yet can wander in and out, tugging and vying for attention at awkward moments. As we seek to piece our lives together after a loss, the expressive arts can heal us by giving these bits and pieces the attention they deserve and need. For a moment, we can sink into ourselves and allow our memories, thoughts, and feelings—those we desperately struggle with—an opportunity to speak, to be heard, and to be felt. Each time that we engage the process using the arts, we give ourselves a break, a breath, and a reprieve from the pain that seeks expression beyond talk therapy.

References:

1. Cameron, J. (1992). The Artist’s Way. New York: Tarcher/Putnam Publishing.
2. McNiff, S. (2004). Art Heals. Boston, MA: Shambhala Publications.

For combat veterans, posttraumatic stress disorder (PTSD) is an all too common psychiatric condition. The symptoms of PTSD include high anxiety, a heightened state of arousal, aggression, and sleep disturbances. Many with PTSD report feelings similar to combat situations, as if they never really left the battlefield. When it is accompanied by moderate or major depression, those with PTSD are notoriously unresponsive to traditional therapies and medications. Self-injurious and self-destructive behaviors, even psychotic behaviors, are not uncommon events for the most severely affected veterans. Finding new and better treatment protocols is therefore essential.

Recent research indicates that Abilify (aripiprazole), a relatively new antipsychotic medication, may represent a moderately more successful approach for treating PTSD and major depressive disorder in veterans. Study authors performed a retrospective review of veterans’ charts to determine what effect, if any, the introduction of Abilify had on these patients’ PTSD and depression scores. A total of 27 charts were analyzed. Many of these patients were also receiving traditional antidepressants, anti-anxiety medications, or psychotherapy. All consented to participate in research on the use of Abilify to manage their symptoms. Most had shown very little or no response to their prior courses of treatment.

The study consisted of a 12-week trial of Abilify, with regular monitoring for side effects or improvements in mood. The overall positive response rate, both in terms of PTSD and depression, were rather low. At the end of 12 weeks, about 20% of these veterans showed significant improvement in their depression. Likewise, 37% showed improvement in their PTSD symptoms. These are not excellent results, but historically this population has been very resistant to most clinical approaches. Any improvement over failed techniques is worthwhile, and even small improvements to quality of life are deemed worth pursuing. Furthermore, Abilify has no potential for abuse and relatively few side effects. It is much better tolerated than many of the traditional antidepressants and anti-anxiety medications.

PTSD makes readjustment to civilian life an uphill battle for many veterans. Too many find themselves in a cycle of fear, self-loathing, anger, depression, and substance abuse. Abilify, originally developed as a first-line treatment for schizophrenic patients, has shown the potential to ease the symptoms of PTSD in at least some of these veterans. More research is needed, but the outlook is promising.

References
Richardson, J.D., Fikretoglu, D., Liu, A., McIntosh, D. (2011). Aripiprazole augmentation in the treatment of military-related PTSD with major depression: a retrospective chart review. BMC Psychiatry, 11, 86.

Without the tools to manage it, recurring and intense depression often breaks up relationships. The truth is, depression is hard to handle. One way to help make it through depressive episodes is by preparing a depression plan when the partner who experiences depression is not depressed. The aim of the plan should be to create a shared understanding about the changes in thoughts and behavior that depression causes, as well as a commitment to “stretch” to get through the difficult period of depression.

Separating the Person from the Depression
It takes a great deal of effort, on the part of both the depressed person and their partner, to separate the person from the depression. Yet doing this can be very important to maintaining the relationship. Try thinking of “Depression” as a third party in the relationship: an entity with its own unique thoughts and actions that it expresses through your loved one’s body. One way to do this is to establish the difference between how the depressed person acts when they are depressed and how they act when they aren’t.

For example, during an episode of depression, the depressed person may get much more sensitive to criticism. If both people know that, it can help them to remember that that behavior is the depression, not the person. The partner may want to be more careful not to be critical, or to not react to the depressed person’s overly sensitive reaction to criticism. “That is Depression speaking (yelling, crying, acting insecure, calling me names), not my loved one,” can be a useful mantra.

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This doesn’t mean the partner should take abuse. Partners still need to set limits—calmly, firmly and before accumulating resentment—about anything the depressed person does that doesn’t feel respectful. This may sound something like, “I know you’re in a lot of pain right now, but I won’t allow you to call me names under any circumstances. I’m going out now; let me know when you are confident you can treat me respectfully and I’ll come back.”

For the depressed person, it can also be helpful to remember that no matter what terrible things the depression is telling them (she doesn’t love me, she thinks I’m disgusting…), those thoughts are the depression interpreting what the partner says and does through a filter that turns everything to the worst possible scenario. If the depressed person can identify that this is the way Depression causes them to think before the depression happens, it can help them to remember that those feelings are likely distortions of reality, even though they may continue to seem real in the moment.

The depressed person can also prevent damage to the relationship by attempting to translate what they want to say (“You’re a skank”) into their own fears and sad thoughts (“I’m scared you’re going to leave me”) before saying it out loud.

Identifying Depressed Belief Patterns
Try making a list of messages that Depression gives, in general and/or for the specific person, in order to be able to look at it when depression hits. If every time the depressed person gets depressed, they become certain that their partner is having an affair, put that on the list. A list can be written from the point of view of the depressed person or the partner, or each can have their own. An example from the depressed person’s point of view could look like this:

“When depression hits, I see things differently and characteristically believe:

• My partner is having an affair
• I am ugly and undesirable
• I will never feel better
• I am a burden to everyone and would be better off dead
• I am inadequate in any number of ways
• I fail at everything I do
• My life is cursed
• Nobody loves me, or even likes me

“When I’m not depressed, all of this looks different. When I am depressed, I believe the depressed point of view is reality and the nondepressed point of view was distorted. This is not true and not helpful to my desire to feel good.”

Setting Boundaries for Caretaking
While it can be helpful for the depressed person and loved ones to define reality, loved ones can get burned out on reassuring the depressed person. They should do it only as much as it is possible to do so without resentment. They may need to pace themselves—can they do it once a day? Once a week? Give what support is possible without getting burned out or resentful, or starting to agree with the distortions (maybe I don’t love him, maybe he is disgusting). The rest of the time, the depressed person needs to do their own work: some alone, some in therapy, and some with other friends and people they feel comfortable talking to in order to soften the distortions.

Many years ago, a mentor of mine talked about how she coped with taking care of her partner who was dying of cancer. She wanted to be there, but not to feel resentful and burned out. She told her partner that she expected her to do everything she could possibly do on her own, and then my mentor would do the rest. So if her partner could get up and get a magazine for herself but didn’t feel like it, my mentor wouldn’t get it for her. This left her available for the kind of caretaking that her partner absolutely needed and allowed her to sustain her energy over a long period of time even as her partner’s needs increased. I thought this was a brilliant way of thinking about caretaking for loved ones. It’s so easy to want to rush in and do everything in the beginning and then burn out. Pacing oneself and seeing the other person take as much responsibility as they can helps the caretaker so much.

It is important for the depressed person to commit to “stretch” as far and do as much as they possibly can—as much as they would be able to do if they were alone. Then, if the partner is willing to act in a caretaking role, they can do what the depressed person absolutely can’t do. With depression, this can be tricky to identify. Only the depressed person knows where that line is, and it can be difficult for even them to establish. It also may change from day to day or minute to minute. A depressed person may have to spend a whole day psyching themselves up to get up and take a shower or to make a phone call—but then they may be able to do it, whereas earlier in the day they absolutely couldn’t.

It is also important for the depressed partner to “stretch” by giving expressions of love and gratitude to the caretaking partner. It may be very difficult for the depressed person to do this, but it is usually possible if the depressed person commits ahead of time and the caretaker reminds them that the relationship needs it.

Caretakers need to consciously keep their own life going as much as possible. If they can’t expect to be emotionally nourished by their partner when they’re depressed, they need to be sure to be “fed” by other family and friends, activities they enjoy, work, or whatever is available. They might consider going to Co-Dependents Anonymous for support with keeping boundaries and not giving too much. This can, ironically, free people up to be more available to the person who needs their care.

Maintaining Balance
Most depressive episodes do pass, and the person who experiences depression returns to their nondepressed personality and functioning. Both depressed people and loved ones have to try to remember this fact as they do everything possible to get through and resolve periods of depression. The most important thing to remember is that neither person should make big decisions about their relationship, or judgments about how things will be, until the episode is over.

Did you know that your imagination is a powerful tool for positive change? Or that, without your intentional guidance, it can be your greatest enemy? Many people neglect their imagination, allowing outside influences to guide and direct this powerful engine and then wonder why their lives are less than satisfying. Your imagination is yours to develop as you will, but ignored and neglected it can become a liability—the very source of depression, anxiety, interpersonal problems, and unconscious self-sabotage. Unless you take the initiative to choose your goals and begin to exercise discretion in what messages you allow your brain to receive and process, all the forces of marketing that bombard us on a daily basis—television, email, pop–ups, and Facebook—will shape your choices (and therefore your destiny) without your input, and often without your awareness.

When we don’t exercise careful choice over what we feed our imagination, we can end up developing habits of thought that impede success. Habits of thought are things like catastrophizing—thinking about worst-case scenarios—a habit of thought guaranteed to generate anxiety and/or depression; or habits of thought like filling in the blanks when you really don’t know—a habit of thought that can lead to all kinds of interpersonal problems if you make the mistake of believing that your imagination knows what is unknowable.

The first step to taking charge of your life is to take charge of your imagination. You can begin with a few simple exercises. Imagine a very unpleasant scene from a horror movie. If you allow this scene to fill up your whole imagination your feelings will follow—heart racing, palms sweating, a ball in your stomach, the whole nine yards. You see, your imagination cannot tell the difference between what is real and what is not. Now imagine that you are seeing the same unpleasant scene on a small flat-screen TV. Notice that you still have some of the same reactions you did before, but not as intensely. Now shrink the screen down to a very small size. Remember, this is your imagination, so you can do whatever you want with the image. Now turn the TV off.

Ok, that was interesting. But it was an unpleasant image. Now try it with a pleasant one. Bring up one of your all-time favorite memories. Perhaps recall a time when you really felt loved, or maybe a time when you had just accomplished something very hard and fairly important. Allow that image to fill your imagination and keep it on the screen in your mind. If it fades or slips, bring it back, and focus in on some random detail. The more you focus on some detail of this experience, the more vivid it will likely become and the more practiced you will get at using your imagination for your own good. While you’re focusing on this image in your mind, notice the warm feelings that result. Notice where in your body you feel these warm feelings of love, happiness, joy, and delight—usually right in the middle of your chest.

This is the power of your imagination to influence your emotions. All your thoughts and all your emotions are neurochemical events in your brain and in your body. So when you choose to develop your imagination and your ability to focus and direct your imagination, you gain the ability to guide and shift and direct your emotions as well. And when you have the ability to direct your imagination and modulate your emotions, then you also have the ability to influence the neurochemicals in your brain and in your body, too. Like all things mental, this ability is learned, and, like all things learned, this ability is made proficient through repetition. You do not learn to read overnight. You learn to read through repetition. Repetition makes proficiency.

Once you become proficient at managing your own imagination, you can do all kinds of other things—like set goals and define all the small steps that make up progress toward that goal. You can anticipate problems and anticipate solutions. You can try out various solutions and develop the confidence you need to translate goals into actions. You can step back from emotional triggers. You can pull yourself out of funks and you can stave off anxiety. You can even improve your sex life. But we’ll talk more about that later.

Related articles:
Changing Brain Chemistry, Changing Paradigms
Help! My Brain is Betraying Me!: Intrusive Thoughts in Motherhood

Any caregiver is likely to be vulnerable to stress. However, parents who care for a child with a serious mental illness (SMI) are at increased risk for adverse physical symptoms resulting from stress. Those who care for an adult child with SMI are even more likely to experience the negative effects of stress because of the length of time that they have had to cope with the difficult task of caring for a loved one with mental health issues. Although there is a vast amount of evidence showing how caring for a child with SMI can negatively impact a parent’s psychological health, there is scant clinical evidence highlighting the deleterious physiological effects to the caregiver. Erin T. Barker of the Waisman Center at the University of Wisconsin-Madison addressed this specific dynamic in a recent study by examining the cortisol levels in individuals charged with the care of adult children with SMI.

For her study, Barker asked 61 parents of adults with depression, schizophrenia, or bipolar to complete a stress diary and submit daily saliva samples over a period of several days. The cortisol levels of the participants were compared to the levels of 321 parents of adult children who had no mental health concerns. Barker discovered that the cortisol awakening response (CAR) of the parents of adult children with SMI increased less significantly half an hour after they arose in the morning than the control group. This suggests that the caregivers had a higher stress level upon waking than did the control group. Additionally, Barker found that the cortisol levels of the caregivers declined less throughout the day than did the cortisol levels found in the parents of adult children who did not have SMI.

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“The fact that a similar pattern of hypoactivated daily cortisol in response to stress has been found across studies of parents of individuals with different diagnoses (i.e., schizophrenia, autism, developmental disabilities, and in the present analysis, SMI) and that used different measures of stress (i.e., behavioral problems of the adult child with the diagnosis, time spent with the adult child, and in the present analysis, daily stress not necessarily associated with the adult child) provides strong converging evidence for this effect,” Barker said. She added that these findings underscore the importance of addressing the mental health, physiological health, and coping needs of aging parents who care for adult children with serious mental health issues.

Reference:
Barker, E. T., Greenberg, J. S., Seltzer, M. M., Almeida, D. M. Daily Stress and Cortisol Patterns in Parents of Adult Children with a Serious Mental Illness. Health Psychology 31.1 (2012): 130-34. Print.