Cognitive Behavioral Therapy (CBT) Interventions for Depression Treatment and Mental Health

Cognitive Behavioral Therapy (CBT) Interventions for Depression Treatment and Mental Health



Dr. Dawn-Elise Snipes is a Licensed Professional Counselor and Qualified Clinical Supervisor. She received her PhD in Mental Health Counseling from the University of Florida in 2002. In addition to being a practicing clinician, she has provided training to counselors, social workers, nurses and case managers internationally since 2006 through AllCEUs.com #CognitiveBehavioralTherapy ( #CBT ) Interventions for #DepressionTreatment and Mental Health
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Cognitive Behavioral Therapy is a very common treatment approach to help people explore how their thoughts, feelings and behaviors interact. CBT is widely accepted as a best practice to help people with depression, anxiety, anger and addiction issues begin to change self defeating thought patterns to improve their mental health. This is a fabulous tool for addiction treatment as well since stinkin' thinkin' is a well known relapse trigger.

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CEUs are available at AllCEUs.com/CounselorToolbox this episode was pre-recorded as part of
a live continuing education webinar on demand CEUs are still available for this
presentation AllCEUs.com/counselortoolbox I'd like to welcome everybody today's
presentation on Social Work and case management issues in the management of
depression I am your host Dr. Dawn-Elise Snipes
we are going to define depression symptoms and learn how to ask strengths
based assessment questions and then we'll identify a range of potential
causes for depression and explore activities and interventions that can
help people address some of the underlying causes of depression so
depression represents a cluster of symptoms as we well know and diagnosis
with depression only requires people to have a few of those symptoms so you may
have three different clients who have three different relatively different
depressant depression presentations some may have difficulty with sleep while
others don't some may have difficulty with appetite
while others don't some may have more irritability some may have more lethargy
so we really want to be individualized when we are presenting solutions for
clients and we need to remember and remind clients that depression often
indicates the loss of something important now this is more situational
depression people who are dealing with chronic major depressive disorder there
may not be a particularly a neurochemical imbalance depression
itself just like any other emotion is not necessarily bad it can cue us that
we've lost something important that we may need to grieve it also can cue us
that there may be something wonky for lack of a clinical term going on well
that may be contributing to our body's inability to stabilize the
neurotransmitters as well as it normally does a variety of different things can
cause depression you know emotions can cause depression we talked last time
about how the fact that most emotions are not singular
we don't just feel depressed we don't just feel angry we generally have
multiple emotions in there and the emotion that we are displaying is sort
of like the tip of the iceberg anger when we are angry for too long we tend
to get in this negative mindset and it can when we keep our HPA axis activated
because of anger or anxiety we can start to feel worn down and exhausted and we
can start to suffer from the side effects of elevated HPA axis including
sleep deprivation so anger and anxiety are two things
that can contribute to depression and we don't want to forget those we don't want
to just help people try to feel happier you know that's great but it is pretty
invalidating in a lot of ways we want to look at what is contributing to the
neurochemical imbalance that is causing these symptoms grief guilt and shame are
three other feelings that can coincide with depression that we may need to take
a look at cognitive distortions can contribute to depression when we see the
world when we think of the world in terms of things are against us things
are negative we're helpless we're hopeless then guess what we're probably
going to feel depressed because one of the key features of depression is
helplessness and hopelessness when we are seeing things in all-or-nothing
terms we may feel very disempowered so we're going to talk about how to help
people adjust their cognitive thinking styles relationships including self
relationships like poor self-esteem can contribute to depression if people feel
hopeless to that they're loveable they don't think they're loveable they don't
think they can change they don't think they'll ever be lovable unhealthy and
unsupportive relationships can trigger fears of abandonment and a need for
external validation which often goes back to that low self esteem can also
contribute to depression if you don't can't look in the mirror
and say I'm good enough and you're relying on other people to do that then
when that doesn't happen cuz that's not gonna happen all the time
you may start feeling that fear of abandonment fear of rejection and
helplessness and hopelessness to be loved
physically neurochemical imbalances caused by a variety of things including
poor nutrition exhaustion insufficient sleep medication side effects traumatic
brain injury there are a lot of things that can throw our neurotransmitters for
a loop and contribute to depressive symptoms and environmentally high stress
environments that prevent relaxation and rest and increase
hopelessness and helplessness also contribute to depression one of the
things we want to do when clients come into our office and this is one of those
culturally sensitive responses as well as strengths-based
ask them what depression means to them what caused it where did it come from
what do you think is making it worse when you say you're depressed you know
some people come in and they say I'm depressed and okay you know you're
depressed I'm glad you're here tell me you know how you know you're depressed
what symptoms do you have that tell you that you're depressed which symptoms are
most bothersome for you and why because sleep disturbances they may not see that
as super bothersome but excessive guilt may be something that is causing them a
lot of problems now obviously the apathy and lack of pleasure is gonna be a an
issue for a lot of people but a lot of clients that I've talked to who come in
with self diagnose depression report that fatigue and the psychomotor
retardation or the slowing and heaviness they feel and sometimes the pain is more
problematic than just not being able to feel a sense of happiness or joy because
that fatigue and that heaviness and lethargy negatively impacts so many
areas of their life it's important to understand what's prominent for the
client how is life more pleasurable pleasurable Wow prior to you getting
depressed if people have had multiple major depressive episodes then we want
to know when you're not depressed what's different what's more pleasurable if
they are experiencing situational depression as a result of a loss or a
divorce or something we want to look at that we also want to look at things like
maybe they say both for I started getting really depressed I
was going out hiking you know five times a week or something that's a lot of
hiking but you get my points they were outside and then they got caught up with
a lot of stuff at work and it's been raining outside so they couldn't go
hiking oh well let's how long has that been going on because we know that lack
of sunshine and lack of vitamin D messes up circadian rhythms and is associated
with seasonal affective disorder which has symptoms of depression so this gives
us some ideas where we can start looking at what is it that you do when you're
not depressed how is it different now that you are depressed and how do you
expect life to be different when your depression is gone what things do you
want to start doing again what things do you have hope will bring you joy and
that really gets people looking forward to the end goal what is life going to be
like why is it worth the effort to make these changes that I need to make or do
this hard work that I need to do because therapy's hard work and we come back a
lot of times again to neurotransmitters when the neurotransmitters are out of
balance for whatever reason people are going to have a variety of different
symptoms your neurotransmitters dopamine serotonin norepinephrine acetylcholine
gaba serotonin are all important to have in order to help people feel happy to
help them feel relaxed to help them get good sleep to help them concentrate and
learn things to help them have motivation to give them energy Oh
glutamate is the other neurotransmitter I knew I was forgetting one to help
modulate their pain to help prevent irritability and agitation and you know
neurotransmitters are also really active during when that HPA axis is activated
cortisol is released which triggers the release of glutamate norepinephrine to
prepare the person to fight or flee when those neurotransmitters are out of
balance for whatever reason then people are going to have difficulty
with some of these very basic life issues or life tasks if you will
HPA axis hyperactivity now remember HPA axis is just the short
term for our body's stress response system when it is hyperactive it causes
the release of inflammatory cytokines we've talked about this before which are
really meant to help you you know you think why is inflammation ever helpful
well generally the HPA axis is activated when there's a threat and in the
immediate the acute phase of this HPA axis activation the cortisol actually
acts as an anti-inflammatory which is awesome and then when the threat is
passed the HPA axis causes the body to secrete inflammatory cytokines that are
supposed to circulate throughout the body find anything that might have been
damaged increase inflammation and help it you know get better bring blood to
that area to nourish it and help it heal well when the HPA axis is activated for
too long eventually the body says well we got a repair you know the cortisol
still saying hi but I've got to start repairing and keeping the body you know
going even if the stress is going to stay and think about again a soldier in
a war zone at a certain point it's not like you know they go out they fight a
skirmish they come back and they just start you know popping back cokes or
beers or whatever they're drinking and everything's relaxed they are on the go
but their body still has to repair despite the fact that they can't relax
during that time because it's not safe to completely relax
when those inflammatory cytokines are secreted throughout the body one of the
other interesting things that happens is that it causes symptoms of depression
and we know that there is a strong correlation between depression and
inflammation and one of the reasons is inflammation is the body's way of
breaking down tissues and whatever else needs to happen and creating energy to
repair whatever has been injured so the body is diverting an energy from other
things like mood in order to help the person repair their body so they may
feel lethargic they may have reduced locomotor activity or psychomotor
retardation as the DSM calls it they may have altered food intake and an
increased need for sleep now they may not be getting good sleep but they may
have an increased need for sleep and all of this is because the body is trying to
conserve energy they're saying you know we got to find energy somewhere even if
you can't relax we got to pull from the energy reserves in in order to repair
the things that have been broken down what can we help people do now we're
going to talk about some cognitive interventions in a few minutes but let's
start by just doing some basic lifestyle medicine is what it's now being called
in PubMed lifestyle medicine interventions to help reduce that HPA
axis activation to help the body relax so it's not using energy staying hyper
vigilant and it can use that energy for repairing so it's not having to borrow
from a bank account that's already you know empty get quality sleep and you see
all these hyperlinks in the PowerPoint these are all the studies that you know
highlight these different points and you see there's a lot of blue on this slide
because there is a really strong correlation between crappy school
and crappy mood people need quality sleep sleep deprivation increases the
risk for major depression and major depression increases the risk for bad
sleep is this downward spiral we need to help people figure out how to break that
sleep disturbances contribute to inflammation and major depression
additionally increased HPA axis activation alters or creates sleep
deprivation and we we see that after somebody is sleep deprived they have an
elevated HPA axis let's think about why this is somebody sleep-deprived they
didn't get enough sleep last night they wake up their body says it's daytime
it's time to be alert and there their cortisol levels are kind of out of whack
the HPA axis says oh you need energy I guess I need to ramp up a little bit to
help you have energy so that HPA axis goes into overdrive help people create a
sleep routine remind them or educate them about the problems with blue light
especially within two hours of bedtime and that includes not only their digital
devices but their overhead lights if they've got a lot of the cool or
daylight bulbs in their area that they spent that they spend their evening
hours in encourage them to think about switching those out to at least softer
white bulbs if not some bulbs that have a slightly yellow tint to them reduce
stimulants including caffeine and nicotine before bed include encourage
people to address pain we don't sleep well when we're in pain whether it is
you know a kink in your neck or your bed's not comfortable my puppy was up on
the bed the other night and somehow she managed in king-size bed little puppy
well she's like 30 pounds now but she's still a puppy managed to scoot me over
to the very very edge of the bed and I am sleeping in this contorted position
and I am very uncomfortable I don't want to go through all the
trouble of moving at 2:00 in the morning or whatever it was so was I getting good
quality sleep at that point no because I was uncomfortable and that was just mild
discomfort if you're talking about somebody who has chronic pain
fibromyalgia is something like that then it may be worse when you have an upset
stomach and I think a lot of us have experienced that you know you eat
something that's a little different at night and your tummy gets all rumbly
tumbly before you go to bed and you have a little bit of a stomach ache that
actually can keep you awake or impair your sleep throughout the night if you
have a fitness tracker you can look at your heart rate throughout the night and
you can get an idea about whether you might have been experiencing pain I know
when I'm over trained or if I'm experiencing pain for some reason my
heart rate tends to be a fair bit higher it tends to be about 10 to 15 beats
higher per minute throughout the night and that tells me that I probably wasn't
getting good restful sleep sleep apnea is repeatedly associated with not only
increased activation of the HPA axis and increased cortisol levels but also
increases in depression continuous positive airway pressure or CPAP
machines have been found to be very helpful with reducing apnea problems
encourage people to improve their sleep environment a lot of people don't think
about the fact that they're snoring spouse may be impairing their sleep and
am i advocating for everybody to sleep in separate bedrooms no not necessarily
but I am advocating for considering earplugs if your if your spouse snores
or significant other snores or your dog snores it is helpful to encourage deep
sleep if you can have a quiet environment if you live in an area like
New York City or somewhere where there's a lot of street noise that your windows
can't quite walk out using a white noise machine can
be extremely helpful because at least that's that constant noise whether it's
the my daughter has chirping crickets that she has going on constantly and
that's her white noise and that works for her she habituates to it and goes to
sleep we want to make sure that they get rid of allergens HEPA filters really
helpful hypoallergenic pillows anything to help them not wake up in the middle
of night coughing but they've also found an association between alergic rhinosinusitis you know stuffy
noses and poor sleep and depression it's important that you can breathe when
you're sleeping even if it's not because of apnea the light in your sleep
environment your sleep environment should be as dark as possible and if
there has to be light for some reason a red light something that doesn't have
the blue colors and a yellow light even better in order to preserve your night
vision and not make your brain think that it's time to get up if people have
night terrors or for children who are afraid of the dark having a tap light by
their bed something that they can easily just reach over and smack you know when
you have a lamp by your bed and you have to try to reach up and find a little
knobby thing if you're stressed out if you're freaked out because you had a
nightmare that ain't gonna work but if you have something that people can just
reach over and smack generally that is a reasonable compromise to the presenting
issues and temperature there are beds now that you can get they're expensive
that can help regulate temperature I don't know how well they work there are
some that have a tube that goes up under your sheets and blows air you know
basically circulating air underneath your sheets all night long to keep you
from getting hot and sweaty whatever you can do to regulate your temperature is
also helpful and what temperature is comfortable for you to sleep is it's
variable between people I tend to like to sleep on the much cooler side whereas
some people like 68 to 72 is I think what the Sleep Foundation recommends
other factors that can impact sleep shift work it takes people at least 30
days to adjust to a switch and shifts and this can only be a switch in shifts
of about three hours is not you know going from morning shift a midnight
shift it's important that when people are on a shift
that they maintain that shift even on their days off in order to help
stabilize their circadian rhythms and that is sometimes not realistic for life
outside of people's work and they're not willing to do that and it is important
to encourage them to consider what alterations that they can make or are
willing to make while they are in the recovery process in order to help them
alleviate their depression can they go today shift would be you know the first
thing that we might ask if people travel between time zones pilots are a perfect
example of this they are at much higher risk for depression because their
circadian rhythms if they start over on the East Coast and the end their day
over in California their circadian rhythms are going to be completely out
of whack and then they fly the next day and they land in Nashville which is
splitting the difference helping them understand the importance
or the impact of regularly switching times time zones on their circadian
rhythms and advocating and encouraging them to figure out how they want to
handle it not ever like I said not everybody is going to be able to change
something a pilot's not going to be able to say well I can only fly on the East
Coast but what can they do and empower them to be creative safety and PTSD I
kind of put those together when people go to sleep they want to be able to
relax in order to relax they need to feel safe people who have a history of
PTSD often have difficulty feeling safe difficulty not being hyper-vigilant
which negatively impacts their sleep quality and can contribute to concurrent
depression helping people figure out what they need now emotional support
animals are super helpful with this there are a variety of other
interventions that can be helpful but it comes down to asking the person what
would help you feel safe when you close your eyes interestingly enough
antidepressants can also cause depression really yes we know that
antidepressants are not the panacea that you know some of the pharmaceutical
companies might want us to think they are they work for twenty to thirty
percent of the population but for the other sixty to eighty percent seventy to
eighty percent the antidepressants may not be super effective additionally many
antidepressants with activating effects like Prozac is one that is known for its
activating effects it's supposed to help people who have depression and fatigue
have some more energy that can disrupt sleep they found that people who take
those may have less deep sleep because they are hyper activated the
antidepressants that have sedative properties some of those antidepressants
like paxil that tend to make people sleep
may cause may improve sleep initially which is really awesome but it may cause
problems in the long term due to over sedation talking with clients
encouraging them to advocate for themselves with their doctor about
what's working what's not if they're taking this drug and it helps them sleep
but they just can't wake up throughout the rest of the next day and they're
pounding back coffee that's defeating the purpose they're
actually probably causing more problems encouraging them to advocate for
themselves sometimes doctors will start with changing the dosing time
my stepfather used to take paxil in the evening before he would go to bed
because it would help him get sleepy and then but he would take it early in the
evening so when he woke up 12 hours later it wasn't still as prominent in
his system and didn't have overly sedating effects so sometimes that can
work other times people may have to consider trying a different
antidepressant there are dozens of them out there and encouraging patients not
to give up if the first antidepressant doesn't work for them but they really
feel like they need one relaxation is another non pharmacological way to
reduce HPA axis activation biofeedback has been shown repeatedly to be really
helpful and it can be as simple as getting a fitness tracker or a chest
strap that monitors your heart rate and encouraging people to spend a little bit
of time each day focusing on trying to reduce their heart rate you know deep
breathing and seeing how when they breathe deeply and slowly it actually
slows their heart rate they start feeling a sense of empowerment because
they realize that they can control some of these symptoms then when they start
feeling anxious they have this sense of personal efficacy that okay I'm
hyperventilating here I need to belly breathe and I need to focus on
slowing my breathing down because that will make my heart rate go down that
sense of personal control over your body goes a long way towards reducing
feelings of helplessness and hopelessness
it also helps reduce any HPA axis activation sooner you know if somebody
gets anxious we don't want them to stay anxious for four hours because that's
gonna contribute to depression we want to help them you know recognize that
okay I feel angry I feel anxious feelings are normal that HPA axis kicked
off just like the fire alarm goes off and says check to see if there's a
threat but with biofeedback that allows them to check and then relax
afterwards progressive muscular relaxation meditation and yoga have all
been shown to help with reducing HPA axis activation and reducing symptoms of
depression recreation therapy and that is brought everything from art therapy
to you know playing ball to checkers anything that's recreation oriented that
can be kind of fun that helps people divert their attention from a stressor
to something that might be at least mildly enjoyable has been shown to
reduce HPA axis activation and reduce symptoms of depression forest and eco
therapy have also both been shown to be very helpful at reducing depressive
symptoms in adults I didn't see any Studies on children but basically this
is encouraging people to be exposed to nature to get away from the you know
digital things to get away from the TV to get out in nature because nature
tends to go more slowly and people tend to be more relaxed when they are out in
out in nature out in the forest hiking you know or even just going through a
park where there's a lot of greenery they found that there's a pretty
positive correlation between the amount of greenery and nature
and people's moods so it's kind of an interesting little side effect with that
people can arrange their home environments to be a little bit more eco
friendly if you will have a place in your house most people have a place
where they can have a couple of plants or a window that looks out onto a
landscape little area it doesn't have to be this huge landscape but looks out
onto this little garden area that they can appreciate we also want to look at
other medications side effects and we often forget to consider these things
when we are doing our assessments with people we already talked about
psychotropics and there's a lot of other psychotropics out there the atypical
anti-depression atypical antipsychotics tend to be
extremely sedating to people some people will experience rebound anxiety when
they take benzodiazepines which can contribute to their depression people
are the best judge of what medications are working best for them and which ones
make them feel worse and we need to listen however other things that are not
even you know identified as mood altering drugs have been associated with
increasing people's risk of depression beta blockers which are used for high
blood pressure statins which are used for high cholesterol anticholinergic
drugs well you are like we should what are those those are the ones they're
used pretty ubiquitous Lee actually for bladder problems Parkinson's disease
COPD asthma and motion sickness to name a few
they can also be used some for allergies but it's important to recognize that
some of these physical conditions people may be getting medicated for we need to
understand the impact that those medications are having on their mood
they may not be able to stop taking that medication but we need to help them
identify if okay when I started taking this statin my mood went into the into
the toilet I know with motion sickness medication oh that's a doozy on my mood
I can tell you what I can't take it because it's just I would rather be
motion sick than feel the way I feel after I take the whatever it is
Dramamine not everybody may be as sensitive but it's important for people
to understand what causes it and talk with their doctor about how to address
it opioids depress the system they tend to slow respiration they make pain go
away but they have a lot of other side effects when we are not breathing enough
when we have shallow breathing we tend to feel more lethargic and tired which
you know is one of those symptoms of depression corticosteroids like
prednisone are increased people's risk for depression as well as certain
antibiotics who new levofloxacin and ciprofloxacin ciprofloxacin is also
known as cipro most of us have taken it or are familiar with it both of those
are uniquely associated with potentially triggering or exacerbating depression
most of the time there are other antibiotic alternatives if your clients
are sensitive to that and then birth control or hormone replacement therapy
and this is specifically for women they haven't found depressive side effects of
testosterone therapy they do have seen people with low testosterone
experiencing symptoms of depression but people who take birth control including
the implanted progesterone birth control do have higher rates of depression some
people are more sensitive than others increased encourage people to improve
their nutrition remember the neurotransmitters that help us feel
happy and focused and energetic are made from the foods that we eat if you're not
eating your brains not getting or your body's not getting
what it needs to make those neurotransmitters well what might be
preventing clients except for just apathy they may not have good access to
nutrition if they can't drive because they've lost their license because the
nearest store is 15 miles away because they are elderly and are afraid to drive
for whatever reason if they can't get to it
they can't ingest it there are a lot of places that will deliver fresh groceries
as well as places like Meals on Wheels that can deliver to homebound people
affordability is another thing that prevents access to good nutrition your
healthiest foods tend to be the most expensive unfortunately we need to help
people figure out you know where am I going to spend my my nutrition dollars
where I'm going to I can spend my grocery budget and encourage them to
learn about growing their own vegetables we can grow a lot of things
hydroponically now using the crack key method is KR 81452 sprout then that is something else they
can consider I don't really like the taste of sprouts myself they tend to
Tate to taste too rata she to me but some people love them and if they're
willing to sprout and eat them anybody can do
that it takes one ball jar and a little bit of time every day some people don't
have access to good nutrition because they don't know how to cook and yes you
can buy some frozen frozen dinners and things like that that are somewhat you
know they have they're colorful but people may get bored with that and
frozen dinners tend to be more expensive we can help them learn how to cook rice
and beans we can help them learn how to cook affordable healthy meals there
they're not that hard to do encourage people to be and yes planning ahead also
helps with eating more economically and healthier great point Barrett when we're
hungry we tend to want something that is really
we can do fast and rice and beans is not something you can cook quickly unless
you already precooked the rice and precooked the beans which is what I do
on Sunday on Sundays i precooked pasta rice beans and lentils I'm vegetarian so
I don't have any meats in there and then throughout the rest of the week I can
put things together in to make different types of dishes and casseroles and and
things like that so pre-planning definitely helps getting people excited
about cooking is is also helpful and group activities this is a great
activity for recreation therapists to help people learn different dishes that
they can make different casseroles you know focus on one dish meals if you want
to so there's less to clean up encourage people to be aware of nutritional
principles their macros your your proteins carbohydrates fats you know
those are the big things that you're considered considering most of our
neurotransmitters are made from proteins they break down different proteins but
in order to break those proteins down they need vitamins and minerals like
calcium and iron and zinc and selenium from the other foods you can't just eat
protein alone people need to eat colorfully
I have three colors on their plate at every meal hydration with as little as
2% dehydration and you're not even really feeling super thirsty when you're
2 percent dehydrated 2% dehydration has negative effects on your feelings of
vigor your mood your short-term memory and your attention span drink water
preferably clear water with a little bit of lemon if you want to encourage people
to brainstorm ways they can start ingesting more fluid especially non non
sugared non-caffeinated and ideally non-carbonated fluids aspartame has been
associated and we know that as NutraSweet has been associated with
increases in headaches and irritability in certain aspects of the pot certain
segments of the population not everybody is going to experience it but some may
so if people are have been eating drinking a lot of aspartame it's
important for them to be aware and if you look on the side of the drinks like
Crystal Light and things like that a lot of them unfortunately still do have
nutrasweet in it and it's going to be important for clients to recognize how
that NutraSweet impacts them their mood their energy and whether it gives them
headaches people who quit drinking it they were drinking it you know they had
a weekend that they were out at their in-laws or whatever they drank a bunch
of it and then they came home and switched back over to a different no
calorie sweetener they also may start having headaches and
feeling lethargic wow their body detox is that aspartame out of their system
again not everybody's gonna experience this but it is one of those triggers
that is worth noting because it does affect enough of the population
addictive behaviors alter dopamine serotonin and norepinephrine levels and
different addictions alter different neuro
transmitters stimulants are going to ramp up that dopamine and your
norepinephrine and your glutamate it's going to get you excited and then you're
gonna crash depressants tend to increase levels of gaba and dopamine in in our
systems alcohol is kind of interesting because initially it serves as a
depressant and a relaxant but then as it exits the body it actually causes
anxiety the body can't keep up it leaves the body faster then the body can
secrete gaba to balance it out so we do see people
experiencing anxiety on this detox end on the on the sobering-up end of
drinking alcohol gaming and gambling produces pleasure it produces excitement
excitement means increased HPA activate activation increased cortisol levels you
know you're trying to win that game whatever it is which can also result in
a sort of a dopamine hangover the next day if you want to think about it that
way same thing with sex and pornography it in in an addictive fashion when it's
used addictively when it's used too much it can alter the levels of neuro
chemicals in the brain which can contribute to mood disorders thyroids
also impact mood libido and energy levels as well as estrogen and
testosterone it's not hard for people to go to the doctor and get a test for
their sex hormones and their thyroid hormones to see if they are in balance
even if they are in balance and quote in normal range
not everybody feels great when their hormones whatever hormone it is is in
normal range especially if it's like at the low end of the normal range well low
end of normal may be fine for some people but that may be too low for
others having clients learn the numbers and learn where they feel good and where
they don't feel good can be important and having them work with an
endocrinology that understands that you know those
that normal range is just a guideline and not everybody feels great they're a
lot of your newer physicians are starting to understand that those ranges
are simply guidelines cortisol is that hormone that's released by the adrenal
glands and during the fight or flight situation when the HPA axis is activated
it helps the body adapt to stress by increasing heart rate respiration and
blood pressure and by impacting serotonin and norepinephrine levels
cortisol alters the norepinephrine levels it alters our serotonin levels
norepinephrine and serotonin are two of the primary neuro chemicals involved in
depression what are our antidepressants SSRIs selective serotonin reuptake
inhibitors and SNRIs selective norepinephrine reuptake
inhibitors so for monkey and with either one of those it's likely that we are
going to affect our mood normally cortisol levels increase early in the
morning to prepare us to meet the demands of the day and gradually
decrease throughout the day this is our circadian rhythm not only does cortisol
do this but our circadian rhythms influence are feeding hormones are
sleeping hormones are stress hormones everything we want to make sure that we
pay attention to that DHEA can also impact our mood DHEA naturally declines
in people as they age it doesn't mean that everybody needs to take a DHEA
supplement and the supplements that they sell over-the-counter are like a hundred
to five hundred times stronger than what your body actually needs in 99.99% of
the cases this is another one I would not recommend people trying to
self-medicate they really need to see an endocrinologist but that aside if DHEA
levels are low then their libido and sexual arousal may
be low they may be low in motivation they may not have a great sense of
well-being they may experience more pain not sleep as well and have difficulty
with memory and immune system functioning so there's a lot of symptoms
of depression that are related to DHEA levels so we're seeing how depression
itself is not something that is so simple to treat have people get a
physical to address what may be causing any imbalances encourage them to talk
with their doctor about eating a low glycemic diet so their blood sugar is
not going up and down all the time which can make you feel fatigued and remember
the less sleep you get the higher your cortisol will be the more sleep you get
within reason the lower your cortisol will be deep sleep tends to reduce
cortisol levels your rapid eye movement sleep not so much so we want to make
sure people are getting quality sleep hormone imbalances affect millions of
people and symptoms of hormone imbalances are very similar to
depression and include feeling anxious tired irritable weight changes not
sleeping well changes in sex drive focus and appetite causes for hormonal
imbalances include poor gut health inflammation high amounts of stress
genetic susceptibility you know we know that that exists and toxicity from heavy
metals and other chemicals if people are trying to eat relatively healthfully and
if they're drinking enough water they can minimize some of those things
natural treatments include eating an anti-inflammatory diet consuming enough
omega-3s getting good sleep exercising and controlling stress so these are some
of our lifestyle factors that may help people who experience pain need to help
control that and they can do that with exercise guided imagery progressive
muscular relaxation we already talked about that one alternate focus when
we're in pain if we focus on what hurts we're just going to
exacerbate that if we try to focus on something else then it can help divert
our attention I always grab towards my ear when I when I do this demonstration
because when I get an earache that is like one of the worst pains I think that
exists in the world and if I can focus on something else
it helps me tolerate the pain a little bit more tense therapy physical therapy
hydrotherapy which is you know water baths or hot tubs ice or heat and
hypnosis and and EMDR have also been effectively used with pain we may not be
able to help our clients eliminate their pain but we can help them identify
problem solving strategies to mitigate their pain and help them address their
cognitions surrounding pain if they're having cognitive distortions like I will
always be in pain I can never feel pain free or you know any of the
all-or-nothing or exaggeration things I can't tolerate this we can help them
work on their distress tolerance skills and their distress distress tolerance
verbage and change what they're telling themself you know this is agonizing I'm
going to die that's not gonna help you feel any better thinking of it on a
scale of one to five and how much better it feels today then it felt yesterday
can help you get through it that's what I do a lot of times when I when I've had
surgeries I had foot surgery one time and instead of focusing on how much it
hurt that day I was just focusing on how much better I felt each successive day
and you know I rapidly actually did feel a lot better but I had a good surgeon –
anger resentment jealousy and B guilt that whole family of anger emotions
pushes people away and asserts dominance or control but excessive anger can
exhaust our stress response system contribute to negative thoughts we start
seeing everybody as against us impair our relationships
which could help buffer our depression and it can even actually cause physical
harm like hypertension and metabolic disorder we want to help people identify
what is causing their depression if they are feeling depressed my grandfather I
would say had concurrent depression and anger issues you know he just he was
angry at the world and he felt hopeless and helpless and he was in pain all the
time bless his heart you know if we would
have known then what we know now but he just he had a hard time seeing the good
in anything because he was in so much pain and he was so he felt so powerless
helping people change their cognitions and focus on what they do have control
over in order to address their anger anger is a natural emotion and if there
is a threat people need to figure out what am I going to do to address it to
improve the next moment if there's something worthy of being angry about in
in terms of something that may prevent you from achieving your rich and
meaningful life then what are you gonna do about it I'm not saying suppress the
anger I'm saying accept it embrace it say okay I feel like there's a threat
right now I'm angry what do I need to do that's going to help me achieve my goals
and is staying angry going to do anything to help me achieve my goals encourage people to pay attention when
they're angry what do they notice you know and and a lot of we have angry days
when you have an angry day think about you know what did you notice that day
did you notice the clouds did you notice the birds chirping did you notice
whatever for me I noticed the best on the baseboards I
noticed the dishes in the sink I noticed the fingerprints on the window
I can be a little bit obsessive-compulsive sometimes but I
notice the things that irritate me when I'm in a bad mood unless I make a
conscious choice to say you know what I I'm going to spend 10 or 20 minutes
focusing on the good you know and trying to get myself out of that negativity
spiral help people identify what their anger triggers are so they can prevent
them or minimize them and develop a plan to address triggers to feel safer and
more empowered for example if being on Facebook and
having somebody put something nasty or on Instagram put something nasty on your
on your wall or on your whatever they call it on Instagram if that triggers
your anger what one of the things you can do is make your profile private and
only allow people you know your trusted people to post on those because
generally your friends are not going to be hateful and if they are you can block
them but there are strategies that you can use to keep yourself feeling safer
since you can't control other people you've got to control yourself and
you've got to control your environment so your space online so your space at
home so your space at work feels safe and you feel empowered in those areas
anxiety is the other half of flight or fight or flight chronic anxiety worry or
just good old fashioned stress will exhaust the stress response system
causing neurochemical hormonal imbalances and increasing muscle tension
and pain when our HPA axis is elevated our body's going now's not the time to
reproduce when it says that because you know it's time to fight or flee then it
alters our levels of sex hormones and we already saw that altered levels of sex
hormones can contribute to depression the body under chronic anxiety adapts to
his excessive stress by often shutting down a lot of the receptors for the
cortisol because it says I cannot be this revved up all the time I can't run
this hot all the time or I'm just I'm gonna break and that causes
glucocorticoid Riz distance or hypercortisolism which is a
bad thing anxiety also makes it harder to sleep
which contributes to exhaustion hormonal imbalances and ultimately depression
grief is another one of those feelings that doesn't fall nicely anywhere it is
sadness and depression experienced as a result of loss I'm not saying that grief
is bad people grieve you know that's okay
we want to help them grieve in a healthy way and move through that process
towards acceptance happiness you can't be happy and depressed in exactly the
same moment you can have things going on in your life that make you happy and
things that are going on in your life that make you depressed but at one exact
moment I don't think it's possible to be happy and depressed at the exact same
time so if we want to increase those happy chemicals and increase our
feelings of happiness and increase the serotonin and the norepinephrine and do
things that make you happy listen to comedians watch your kids watch stupid
cat videos I do that you know it's it's whatever will help you feel happier
negative thinking Styles contribute to exhaustion and highlight what's out of
your control which heightens a sense of helplessness and hopelessness encourage
people to try to look put on those rose-colored glasses and try to look at
the positive try to see the silver lining in whatever's happening and it
will feel fake at first sometimes but if you if we can encourage them to embrace
the good with the bad they will be able to notice more than
just the negative in life poor self-esteem contributes to self-loathing
shame and a feeling of unloved ability it negatively impacts relationships
which creates that self-fulfilling prophecy of loneliness and rejection and
it often causes a person to seek external validation we want to there are
tons of books out there on improving self-esteem encouraging people to
examine their self-esteem one of my favorite activities is to have people
write down all the characteristics that they look for in a best friend and then
when they're finished doing that have them examine that list and figure out
which characteristics they have in themselves you know that's an easy way
to do it where people don't feel like they're boasting because they're talking
about a best friend and then all of a sudden I turn it back on them negative
relationships can also take a toll on self-esteem contributing to fears of
abandonment which maintains high levels of stress and feelings of helplessness
if you feel like you have no control in your relationship and you never know if
this person is just gonna leave you know that contributes to a lot of anxiety
when we are unable to develop supportive healthy relationships then we don't have
that social buffer and we know from adult attachment theory that while we
don't have the same type of attachment that we do to our primary caregiver when
we're a child in adult attachment we do form attachment bonds with multiple
other adults who fulfill similar functions they help us feel safe they
help us rejuvenate in our life high stress environments prevent relaxation
and rest increase hopelessness and increase stress hormones and decreased
relaxation hormones encourage people to design a low stress area in their home
and at their workplace or at school is not the easiest to do at work or at
school but if they can it's great there may be a park bench somewhere that they
can go sit on or something identify ways to reduce the stress in the environment
in both places in by adding positive sounds reducing negative noise avoiding
interruptions having good lighting that's positive uplifting and
eliminating anything that might trigger thoughts or feelings of a negativity and
adding things that will add positivity whether it's pictures or smells or
colors or a favorite soft fluffy blanket whatever it depression is the cluster of symptoms
created when there is a neuro chemical imbalance in the brain that's what it is
what causes the imbalance can be emotional it can be cognitive it can be
physical interpersonal environmental or some combination of the above and we
want to help people recognize that depression is a symptom of an underlying
problem with their neurotransmitter balance and we need to figure out what's
causing those neurotransmitters to be out of whack
part of the strengths based approach means helping people see what they're
already doing to prevent or deal with the symptoms and examining all of the
causative factors recognizing the reciprocal nature between things like
sleep and environment and mood are there any questions all righty everybody that gives you a
fair number of probably unique ways to think about approaching depression
treatment plans with clients and I will see you now remember next week we're
doing Monday and Tuesday again because I've got to go to Chicago again I'm
almost finished with that contract but so Monday and Tuesday for next week
everybody have a great weekend and try to stay warm it's supposed to get to 16
here tonight you between writing notes filing insurance
claims and scheduling with clients it can be hard to stay organized that's why
I recommend therapy notes they're easy to use platform lets you manage your
practice securely and efficiently visit therapy notes com2 get two free months
of therapy notes by just using the promo codes CEU when you sign up for a free
trial at therapy notes com if this podcast helps you help your
clients or yourself please support us by purchasing your CEUs at all CEUs calm or
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CEUs for this podcast is it all CEUs dot-com / podcast CEUs
that's all CEUs calm / podcast CEUs to sponsor an episode of counselor tool box
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#Cognitive #Behavioral #Therapy #CBT #Interventions #Depression #Treatment #Mental #Health

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