Problems and Disorders Treated
Depression
Major depression is a leading cause of disability worldwide. In the United
States alone, it has been estimated that over 19 million suffer from depression
in any given one-year period.
Depression is a serious medical condition that affects the individual’s mood,
thinking, physiology and behavior. Individuals who suffer from untreated
depression are at higher risk of suicide. Depression often has global effects on
appetite, sleep, and energy level. It also affects one’s view of self, others
and the world; and, may significantly affect an individual’s way of thinking.
People suffering from depression can become negative, pessimistic,
self-critical, gloomy and irritable. They are likely to experience loss of
interest and pleasure in things normally enjoyed, sometimes accompanied a by a
general loss of energy or extreme fatigue. The typical “joie de vivre’, the
spirit that keeps us engaged and interested in our everyday lives, in our loved
ones and in the people around us is suddenly absent. Life may even appear drab,
dull and gray. Seriously depressed individuals suffer an enormous sense of
internal psychic pain and may feel hopeless, helpless and even suicidal at
times.
Depression is not the same as a temporary “blue mood”. We all experience low
moods due to everyday events- disappointments, stresses, and losses being a part
of the human condition. These temporary “ups and downs” are a normal part of
life and not a warning sign that professional help is needed. In order to be
considered a clinically significant depression, the person’s low mood must be
present nearly every day, last for two weeks and significantly impair daily
functioning at home, work or school.
At times, our culture takes the view that depression is merely a sign of
personal weakness or a condition that can be wished away. People with depression
cannot merely “pull themselves together” and get better by sheer will power or
force of will. Without treatment, symptoms can last for months, or even years.
Appropriate treatment, involving specialized types of structured psychotherapy
(including Cognitive Behavioral Therapy, behavioral therapy and interpersonal
therapy and/or medication) can help most people who suffer from depression. In
fact, psychological treatment for depression is remarkably effective in most
cases.
TYPES OF DEPRESSION
There are several common types of depression that are distinctly different.
Major Depression (or major depressive disorder) is characterized by a
low mood and loss of interest almost every day over a period of two weeks as
well as a combination of symptoms that interferes with ability to function on a
day to day basis including affecting working, school work, sleeping, eating, and
self-care (dress and grooming). A major depressive episode may occur only once;
but more commonly individuals may experience repeated episodes over a lifetime.
Common Symptoms of Depression
- Persistent sadness or low mood
- Feelings of hopelessness, pessimism
- Feelings of guilt, worthlessness, helplessness
- Loss of interest or pleasure in hobbies and activities that were once
enjoyed, including sex
- Decreased energy, fatigue, being “slowed down”
- Difficulty concentrating, remembering, making decisions
- Trouble sleeping, early-morning awakening, or oversleeping
- Appetite and/or weight changes
- Recurrent thoughts of death or suicide, or suicide attempts
- Restlessness, irritability
- Persistent physical symptoms, such as headaches, digestive disorders, and
chronic pain, which do not respond to medical treatment.
Dysthymia (or dysthymic disorder) is a less severe form of depression
involving long-lasting symptoms (over two years duration) that keep one from
functioning well or feeling good but may not seriously impair everyday
performance, schoolwork, parenting, etc., Many people with dysthymia may also
experience major depressive episodes at some time in their lives.
Symptoms of Dysthymia
- Appetite and/or weight changes
- Trouble sleeping, early-morning awakening, or oversleeping
- Decreased energy, fatigue
- Low self-esteem
- Poor concentration or difficulty making decisions
- Feelings of hopelessness
Bipolar Depression is experienced by individuals with Bipolar Disorder
(or manic-depressive illness) who are in a depressed phase of their illness.
Bipolar disorder is characterized by extreme and highly impairing mood cycling:
severe highs (mania) and lows (depression), often with periods of normal mood in
between. Sometimes mood shifts are dramatic and rapid, but they may also be
gradual. When in the depressed phase, an individual can have any or all of the
symptoms of depression. When in the manic cycle, the individual may be highly
energized, overactive, over-talkative, and be engaged in numerous projects and
activities simultaneously. Mania affects thinking, judgment, and social behavior
in ways that may cause serious problems. Often individuals later feel very
remorseful and embarrassed over their behavior. Mania, left untreated, may
worsen to a psychotic state. It is very important that individuals with Bipolar
Depression get a comprehensive diagnostic assessment before being tried on an
antidepressant medication because antidepressants may induce mania in certain
individuals.
Common Symptoms of Mania
- Abnormal or excessive elation
- Unusual irritability
- Decreased need for sleep
- Grandiose notions
- Increased talking
- Racing thoughts
- Increased sexual desire
- Markedly increased energy
- Poor judgment
- Inappropriate social behavior
Depression, Medications and Medical Illnesses
Symptoms of depression may also be associated with certain medical illnesses or
medications. Therefore it is important to get a physical exam to rule out
medical causes before seeking psychological treatment.
Anxiety
Stress
Shyness & Social Anxiety
What is shyness/social anxiety?
Shyness is in part simply a temperamental quality--something we are more or
less born with. There are strengths associated with shyness; for instance, we
often find increased empathy, concern for others, altruism, and
conscientiousness among shy persons. However, chronic shyness can involve
excessive concern about negative evaluation and/or an avoidance of participation
in social situations that would otherwise be pleasurable or important to one's
professional or personal growth. Discomfort and non-participation can become
severe enough to interfere with the pursuit of one's goals. A person may become
isolated, dissatisfied, and sometimes depressed.
How does treatment for shyness/social anxiety work?
We primarily work from Dr. Henderson's “Social Fitness” model, which is based
on a cognitive-behavioral (CBT) and an interpersonal model at the Shyness
Clinic. This CBT model has been shown to be an effective treatment for social
anxiety in a number of controlled research trials. Dr. Henderson's approach
developed at Stanford is one of the oldest and the most comprehensive treatments
for shyness and social anxiety in that it also incorporates an interpersonal
model of treatment. Interpersonal therapy has been shown to be effective for
countering maladaptive behavior patterns learned in childhood to cope with
anxiety and for developing trust and intimacy in relationships. Both of these
models have been shown to be effective in clinical trials for anxiety and
depression.
CBT modifies both negative thinking patterns and unwanted behaviors in order
to break the cycle of chronic shyness. Shy people often have negative thoughts
about themselves and others in social interactions (e.g., "I will sound stupid"
or "So-and-so does not really want to talk to me"). These thoughts can become
very powerful and can make one become reluctant to engage socially and to
specifically avoid anxiety provoking social situations. The CBT model encourages
challenging such self-defeating thoughts by identifying possible distortions and
by gathering evidence for and against thoughts. In addition, the CBT model
encourages approach rather than avoidance. Once coping skills have been
developed, practice in social situations both in and out of the clinic is
considered to be a major component of treatment.
Treatment for Shyness Clinic clients is based on the current research on the
development and maintenance of social skills. Clients are encouraged to develop
their own interpersonal styles that honor their temperaments and build on their
already considerable strengths.
Shyness Clinic group clients have been studied rigorously in terms of
treatment effectiveness. These individuals have shown (on average) clinically
significant reductions in: depression, concern over negative evaluation,
self-blame, negative thoughts about others, and subjective anxiety. At the same
time they report an increase in assertiveness. Shyness Clinic clients have been
followed for as many as five years post-treatment, and gains appear to be
maintained, particularly for clients who have remained committed to continued
practice.
PTSD Trauma
What is trauma?
According to mental health professionals, a trauma is an event or experience
that confronts a person with actual or threatened death or loss of physical
well-being and that the person responds to by feeling extremely scared,
helpless, or horrified. Such events or experiences may include combat, physical
or sexual abuse, physical or sexual assault, severe accidents or fires, natural
disasters, terrorist attacks, diagnosis with a life-threatening illness, or
other stressors.
How common is trauma?
According to community-based survey studies, approximately 60% of men and 50% of
women will experience at least 1 trauma in their life.
What is the emotional impact of trauma?
Although many people who experience a trauma recover physically and emotionally
without professional assistance, many others experience adjustment problems,
including depression, anxiety, and increased drug or alcohol use. Some people
who have experienced a trauma develop a set of symptoms called Posttraumatic
Stress Disorder or PTSD. Approximately 8% of Americans (10% of women and 5% of
men) will experience PTSD at some point in their lives.
What is PTSD?
PTSD is a set of symptoms that can develop after a person experiences a trauma.
This set of symptoms can be extremely distressing and can disrupt virtually all
areas of life. One subset of symptoms has to do with reexperiencing the event.
These symptoms include nightmares, intrusive thoughts, flashbacks, and having
strong emotional and physical reactions when reminded of the trauma. A second
subset of symptoms has to do with avoiding reminders of the trauma and feeling
numb. These symptoms include avoiding thoughts or feelings related to the
trauma, avoiding activities, places or people that are reminders of the trauma,
difficulty remembering parts of the event, feeling disinterested in things that
used to be important, feeling detached from others, feeling numb or unable to
have loving feelings, and having a sense of a shortened future. A third subset
of symptoms has to do with physical hyperarousal. These symptoms include sleep
difficulties, irritability, concentration problems, hypervigilance or feeling
“on guard” all the time, and feeling jumpy or easily startled.
What kinds of problems are associated with PTSD?
Individuals with PTSD often experience a number of associated problems. As noted
above, depression, anxiety, and increased drug, alcohol, or prescription
medication use are common. Those with PTSD may feel guilty, angry, and isolated
from others. They may have difficulties with work, family and social
relationships, and accomplishing basic daily tasks. Some people with PTSD have
panic attacks or feel extremely fearful. A subset of those with PTSD consider or
attempt suicide.
Are there empirically supported treatments for PTSD?
Yes. Cognitive-behavioral therapy (CBT) has shown to be effective in treating
PTSD, as well as depression and anxiety. There are several components of CBT for
PTSD. The first step involves education about PTSD, including common symptoms
and associated problems. Next, treatment involves learning some basic skills to
cope with anxiety and strong emotions – this can include relaxation exercises
based on breathing and tensing and releasing muscles. Another important part of
treatment is referred to as cognitive restructuring, and entails learning to
identify, challenge, and replace negative thoughts about the trauma with
thoughts that are more accurate and realistic. One of the central components of
treatment for PTSD is called exposure. Exposure entails carefully, repeatedly
imagining the details of the trauma while in a safe and controlled setting until
the strong emotions associated with these memories subside. Other components of
CBT for PTSD can entail preparing for stress reactions, anger management, and
communication skills training.
Grief
Bereavement
Anger
Relationship Problems
Bipolar
Disorders
Bipolar Disorder (previously known as Manic Depressive Reaction (DSM-I) and
Manic Depressive Illness (DSM-II)) is a mood disorder characterized by a
long-term episodic cyclical course of extreme fluctuations in mood resulting in
significant impairment in social, interpersonal and occupational functioning.
The results of repeated extreme unstable fluctuations in mood can be devastating
to the individual and family members over time. Bipolar Disorder is a serious
illness that requires psychiatric and psychological treatment. Untreated
individuals with bipolar disorder have a significantly higher lifetime rate of
attempted and completed suicide. Read more about Bipolar Disorder.
Schizophrenia and Psychotic Disorder
Parenting Problems/Teenage Problems
Children w/ Emotional & Behavioral Problems
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