C is for Cognitive Behaviour Therapy (CBT)

Cognition is so important in terms of mental health. It is the whole basis of cognitive behaviour therapy (CBT). The belief in CBT is that your life experiences consist of five components; environment (past and present), thoughts, moods, behaviours and physical reactions. These components are all interconnected and a change in one can influence the others. Although adjustments in all five areas are probably needed to improve mental health, CBT puts the emphasis on your thoughts. Thinking patterns are thought to be most important when trying to make lasting positive changes in your life. A change in thought patterns from the usual negative to more positive and constructive can cause similar changes in the other components.

must stay positive

Of course, it isn’t as easy as it sounds. Your negative thoughts are automatic. You have to actively identify them and then use a strategy to combat them. I like to use logic. What are the facts? What information do I have to support my thoughts? What is the proof? I use previous experiences too. What has happened in similar situation? How did I cope? What have I learned that will help me this time? You have to work at it before it becomes natural. CBT has really helped me manage anxiety and perfectionism.

Then, there is depression. My issue is self-loathing. I hate the way I look, I’m not successful, I am inadequate. These are my thoughts. I know they are negative and I know I need to combat them. There is nothing wrong with the way I look. I get compliments, no one calls me ugly. I am successful. I am a Ph.D. candidate, that can’t be a failure. I am adequate. I am a good person, I work hard, I try to lead a balanced life. That is adequate. I have re-framed my negative thoughts into more positive ones. I realize my self-loathing is irrational and there are no flaws in my logic, so why do I feel worse?

The whole thing creates a conflict in my head. I know my thoughts are irrational, but logic is not enough to change the way I feel. It seems like I am lying to myself. Not only that, but I am a failure because I can’t get CBT to work for me. I gave up on therapy for a while because of this. Only after doing my own research and talking to the mental health community online did I figure out there were other forms of therapy I hadn’t tried. I guess CBT is either the front line in terms of talk therapy or it was for my specific case. All the clinicians I worked with wanted to go in that direction.

Here is a list of some of the other options.

  • Psychoanalysis – This was developed by everyone’s favourite psychologist, Freud (note the sarcasm here) and is where the whole lying on the couch thing came from. It is intense, several sessions a week are required. It focuses on bring unconscious thoughts and behaviours to the surface.
  • Interpersonal Therapy (IPT) – This one examines the relationships in your life. There is a focus on communication and may involve role playing with the therapist.
  • Dialectical Behaviour Therapy (DBT) – This is centered around the discussion of opposing views and work on how to balance the two extremes. There are usually individual and group sessions. This form of therapy is often recommended for Borderline Personality Disorder.
  • Mindfulness-based Therapy – It is focused on talking and mediation. Its purpose is to reduce stress and prevent a relapse in depression
  • Eye Movement Desensitization and Reprocessing (EMDR) – This method stimulates the brain through eye movements intending to make distressing memories less intense.
  • Life Coaching – The focus is on hopes and ambitions. It uses empowering and motivational methods to reach goals and make changes in life.
  • Arts-based Therapies – Involves expression through various art forms, visual arts being the most common. The aim is to help you release emotions and understand yourself better.
  • Bibliotherapy – The use of self-help books.
  • Acceptance and Commitment Therapy (ACT) – Uses acceptance and mindfulness strategies to increase psychological flexibility.
  • Hypnotherapy – Uses hypnosis to modify behaviour, emotional content and attitude.
  • Somatic Psychology – Focuses on the link between mind and body. It teaches you to become more aware of the physical body and how the mind interacts with it.
  • Humanistic Therapy – The focus is on the person as a whole. It explores your relationship with different parts of yourself (emotions, behaviours, mind, body, etc.).
  • Existential Therapy – It is a holistic therapy that considers depression the result of how you make sense of yourself and the world around you.
  • Compassion Focused Therapy (CFT) – This is usually recommended for those that have high levels of shame and self-criticism. It has Buddhist and evolutionary elements.

My psychiatrist recommended I try DBT next. I was supposed to start in January. In the mean time I have been art journaling and I have a couple self-help books on ACT and mindfulness.

Did you know there were so many different types of talk therapy? Do you have experience with any of these therapies? What do you think is the best approach? Is medication the more important element?

help quote

B is for Biological Basis

Mental health problems are frustrating because it is hard to classify them as having a biological or psychological basis. I know there has to be some psychological component, mental illnesses are diagnosed based on behaviour after all. I am hoping for some solid research showing depression and other mental health issues have a biological basis though. If the cause is in my biology, there isn’t much I could have done to have prevented it. It is not in my control. I am not to blame. A psychological basis would imply that my behaviour is the problem. I am responsible for my behaviour and so I am to blame, or so society dictates. Calling depression a brain malfunction would minimize the shame I feel when I have to explain myself. I don’t want people to feel sorry for me, but I don’t want them to always wonder why I don’t just snap out of it either.

There is support for both the biological and psychological sides. Since mental processes are carried out by the brain, all disorders of mental function are biological. Just like the lungs are the organs for breathing, the brain is the organ for the mind. Where else could mental illness be if not the brain? Not so long ago, we didn’t know that much about how the lungs worked. All doctors could do for respiratory disease were observe physiological presentation and listen to patient complaints. Today, there are all sorts of tests to measure lung function. The same principles apply to the brain, we just don’t know enough about it yet.

On the flip side, some go to extremes, arguing that everything from mental illness, to criminality and sexual orientation are seen less as a matter of choice than a genetic destiny. Mental health problems could be the result of normal personality traits coming together in such a way to make functioning in today’s world difficult. One scientist compared the brain to a computer and mental processing to the software. There can be a bug in the software that prevents things from running smoothly, but the hardware is still fine.

What do you think? Do mental illnesses fall into one of two distinct categories (psychological vs. biological), or do they exist on a continuum having different percentages of biological and psychological contributions?

Recent research posed similar questions to clinicians (psychiatrists, psychologists and social workers) to determine their beliefs on the causes of mental illness. I would like to know what my psychiatrist thinks. After all, his beliefs would probably have an effect on my therapy and may determine whether or not he prescribes medication and which medication it would be. The study showed that clinicians tend to look at mental health problems across a spectrum of biological to psychological rather than categorical. They believe disorders with a larger biological component would respond best to medication, while those with a larger psychological component would respond better to therapy.

They didn’t show all 445 identified mental illnesses on this spectrum, but they did show 9 familiar ones. I looked up my primary diagnosis, depression, on the graph and it was right smack in the middle. Clinicians viewed depression as having biological and psychological contributions that were almost even. Darn. Other diagnoses like bipolar and bulimia were more clear cut in clinician minds, showing larger biological and psychological components respectively.

It turns out the biological basis I was hoping would explain my depression is a double-edged sword. Although the average person would probably be more compassionate about a brain malfunction, clinicians would be less so. This study showed clinicians felt more compassion towards those with mental health problems thought to be caused by psychological factors. Researchers thought perhaps the emphasis on biology was dehumanizing, causing the patient to be viewed as more of a biological mechanism than a person.

Regardless of the beliefs of clinicians or those of society in general, I think we can all agree, the more we understand about all components of mental illness, the better.

2015-04-01 18.09.42

Resources: Ahn, Proctor and Flanagan, 2009

A is for Anger

Happy April Fool’s Day! Today kicks off the A to Z Challenge and the first of my posts on mental health. I’m no good with introductions, so let’s just jump right in.

A is for…

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Anger is a basic, healthy human emotion. It is a signal telling you there is a situation that needs your attention. It is meant to motivate you into action. As with any emotion, there is an element of perception, but generally anger is a response to being treated unfairly, hurt or not having our expectations met. Anger exists on a spectrum from irritation all the way to rage. Frustration is probably the most common point people experience on the spectrum. A lot of people deal with their anger by talking about it, writing about it or exercising it out. These are all healthy ways to deal with anger. Other ways to discharge anger that are also common, but more destructive include shouting, fighting, breaking things or dumping on whoever is near by.

How do you express your anger?

When I am angry, I don’t do any of the things I just mentioned. I wouldn’t describe myself as an angry person. “Angry” is probably the last word most would use to describe me. I just recently discovered that I do in fact, have a lot of anger. So how do I express it? I don’t. Most of the time, I don’t even know I am angry. I suppress my anger and I have been doing it for so long that I no longer recognize the emotion.

Depression and anger have a long history together. Studies have shown that the degree of anger correlates with the severity of depression. Those suffering from depression often have trouble experiencing and expressing anger. It creates inner conflict, triggering guilt, self-criticism and fear of disrupting relationships. Freud even described depression as anger towards the self. I agree with Freud, that is definitely part of it.

In retrospect, I have come up with two reasons for why I started repressing my anger in the first place. One being I am a “people pleaser”. I want to be a good person and I want others to see me that way too. “Good” and “anger” aren’t usually thought of together. That leaves little room for getting angry, let alone expressing it. The second reason is my need for control. If I am in control of my emotions, I am safe. No one can hurt me because they don’t know what affects me. This probably had something to do with those stereotypical mean girls while growing up. Being older and wiser, I know this is unhealthy thinking and it was only a means of self-preservation, but the damage is already done. Suppressing my anger has become a reflex that needs to be undone.

If I don’t get angry, what happens when I am being treated unfairly or my expectations are not met? I blame myself. If I am being treated unfairly it is because I must have done something to make people think they can treat me that way. If my expectations are not met, it is because of my own inadequacy. I don’t go through this reasoning like this in my head. It is automatic. This anger towards myself is turned into hatred. I think What is wrong with you? Everyone else can manage that, why can’t you?

When angry with other people, there is a fear of compromising the relationship or guilt of hurting their feelings. This is enough reason for many to hold back. There is nothing to keep my attacks on myself in check. There are no parallel restraints. Anger turned inwards is vicious. Self-loathing can get so intense that it becomes paralyzing. This paralysis makes you more angry at yourself causing more self-loathing, perpetuating depression. It’s a cycle…… Lovely.

The first step towards breaking a cycle is being aware of it. I can check that off my list.

A to Z Theme Reveal

It’s that time of year again!! A to Z is just over a week away and today is theme reveal day. I found out about A to Z the day it started last year. I was a new blogger and thought it was a good way to meet people, so I jumped in. It was a lot of fun and I met wonderful people who are still my bloggy friends today. I did make it to the end, but not without some struggle.

survivor-atoz [2014]

Writing a post every day is not easy and some letters are really hard to write about! This year, I decided to plan ahead. I would research topics and write posts ahead of time. Have I done that? No. Life has inevitably gotten in the way. I will be flying by the seat of pants through A to Z for another year. My theme this year is….

Mental Health

I know, I know, I did the same theme last year. I’m giving myself a real challenge though. I’m not going to reuse anything I did last year. Eeek!! My stomach is doing flips just trying to imagine what I’m going to write about for Q, X and Y!

Why write about mental health? Well, because it is important, duh!! Everyone at some point in life experiences problems with mental health. It can be anything from stress or low self-esteem to psychosis or suicide. The more we talk about it, the more we all understand and the better we relate to each other. The best way to eradicate mental health stigma is through education.

Now, I am not a mental health professional, or a doctor of any sort. Well, maybe that’s not true. I am an almost doctor…a Ph.D. candidate, but I study eyes, not mental health. That is beside the point though. I have experience with mental health. I have a variety of diagnoses, but to make a long story short, I have depression or Major Depressive Disorder (MDD), if you want to be formal. I have had signs and symptoms since childhood and have been getting treatment for the last 9 years. The plan for A to Z is to share my experience with mental health and what I have learned. You may laugh, you may cry, but you’ll be entertained and you’ll learn something. I think that is the most important part. 🙂

A to Z Reflections

survivor-atoz [2014] A-to-Z Reflection [2014]

I survived! It’s a bittersweet end. It was a lot of fun, but wow, posting every day is hard! My goal was to have a post and a drawing for each day. I started off with lots of ideas for my mental health theme but started running out of steam towards the end. X, Y and Z were brutal, but I came up with something and linked it to mental health…sort of, lol. 🙂 I think I’m going to miss having the prompts in the end. What am I going to post now? lol.

It was a last minute decision to join the challenge, but I am so glad I did. Overall, it was a great experience. The best part? Meeting new people and discovering new blogs to follow. I think I’ve met a few kindred spirits and look forward to having some real friendships develop. Thank you to everyone organizing this event, brilliant idea! I also want to thank everyone who stopped by to read any of my posts and especially those that commented! I really enjoy getting to know you through your comments.

Here’s a recap of A to Z in case there was one you missed. Looking forward to next year!

A is for Antidepressants
B is for Blog for Mental Health 2014 Pledge
C is for Cognitive
D is for Depressed of Dehydrated?
E is for Emotional Regulation
F is for The F word (Feelings, in case you were wondering, lol.)
G is for Giving
H is for Horrid Headaches
I is for Insomnia
J is for Juggling
K is for Kata
L is for Love
M is for The Monster in my Head
N is for Natural Remedies for Depression
O is for Overwhelmed
P is for Plasticity
Q is for Quotes
R is for Recent Research
S is for Self
T is for Talk Therapy
U is for Underrated Awesomeness
V is for Visceral Voices
W is for Worth
X is for Xenoestrogens
Y is for Yonderly
Z is for Zentangles

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