Can anything be done? Understanding Depression and How to Overcome - PDF document

2016‐02‐04 Can anything be done? Understanding Depression and How to Overcome It Dr. Michelle Haring, R. Psych Director, NSSAC Overview • What is depression? How do I know if I am depressed? • Why do people get depressed? • How is depression treated? • What is cognitive‐behavioural therapy (CBT) and how does it work? • What are some ways that I can apply CBT skills in my own life? • How can I help a loved one with depression? • Where can I get more information and support? Common Signs & Symptoms of Depression • Feeling depressed, low, sad or empty most of the day, nearly every day • Loss of interest or pleasure • Loss of motivation • Significant changes in weight or appetite • Sleep problems & other physical concerns • Feeling restless or feeling “slowed down” • Low energy/fatigue • Feeling worthless, guilty or like a “failure” North Shore Stress And Anxiety Clinic (2016) 1

2016‐02‐04 Common Signs & Symptoms of Depression • Social withdrawal • Irritability • Decreased sex drive • Tearfulness/crying • Problems with concentration, memory, decision‐making • Thoughts of death • These problems are upsetting or interfere with your ability to work, take care of things at home, get along with other people, etc. • People with depression often have other problems such as anxiety or health issues What is Depression? • Approx. 1 in 8 Canadians (12.2%) will experience a major depression at some point in their life • Approx 2x as many women as men will experience depression • At any given point in time, 5% of Canadians will be experiencing a major depression • Approx. 9000 people on the North Shore are currently depressed • Canada’s fastest rising diagnosis, with diagnosis rates likely to increase dramatically in next few years Risk Factors for Depression • Family or personal history of major depression and/or substance abuse • Recent loss (e.g., death of loved one or divorce) • Chronic health problems/pain • Stressful life events (interpersonal conflict, work stress) • Traumatic events • Major life changes (e.g., having a baby, moving to a new city, new job) • Domestic abuse or violence • Other chronic stressors: unemployment, low income,etc North Shore Stress And Anxiety Clinic (2016) 2

2016‐02‐04 A Model of Low Mood & Depression SITUATION Thoughts Physical Behaviours Symptoms Emotions How is depression treated? • Depression can be treated effectively • Evidence‐based treatments include: – Pharmacotherapy (medication) – Psychological treatment • Cognitive‐behavioural therapy (CBT) • Interpersonal psychotherapy (IPT) How is depression treated? • The BAD NEWS: too few people are receiving effective treatment – Stigma & secrecy – Symptoms are overlooked or misdiagnosed by health professionals – Cost • The GOOD NEWS: you can apply key skills from cognitive‐behavioural therapy (CBT) to help you to manage your mood North Shore Stress And Anxiety Clinic (2016) 3

2016‐02‐04 What is CBT & how does it work?  Short term, problem‐focused psychological treatment  Effective for approximately 75% of people who complete treatment  Offers some protection against future episodes of low mood/depression  Targets current problems instead of family/childhood history  Teaches effective coping skills so you can manage your mood  Need to use skills consistently to make lasting improvements: time & effort is required A Model of Low Mood & Depression SITUATION Thoughts Physical Behaviours Symptoms Emotions How CBT Works • Because thoughts, feelings, behaviours & physical symptoms are interconnected. . . • . . .changes in one area lead to changes in the others • Making small, planned changes to behaviours & thought patterns can gradually lead to big improvements in how we feel & function North Shore Stress And Anxiety Clinic (2016) 4

2016‐02‐04 6 Key Tips for Managing Low Mood • Learn about low mood & effective treatment approaches • Practice good self‐care • Set goals to get back to important activities • Replace unhelpful thoughts with more accurate and helpful messages • Problem‐solve the situations that are contributing to low mood • Seek support: connect with others who will encourage you to make positive changes Learning about Low Mood & Effective Treatments • … that’s what we’ve been doing tonight . . . – What is low mood/depression? – What are the risk factors? – What treatment approaches have been shown to work? – What resources can I access in my community? – From what I’ve learned, what ideas can I apply/resources can I access to make improvements in my own life? Changing Behaviours • It’s often easiest to start with changing behaviours before tackling thoughts • As people become depressed, they tend to stop doing things that are important for well‐being • Need a plan to gradually put these behaviours back into your schedule • Key areas to address include self‐care & other important “daily ingredients” North Shore Stress And Anxiety Clinic (2016) 5

2016‐02‐04 Changing Behaviours: What to Target? • Key areas of self‐care include – Diet – Exercise – Sleep – Limiting caffeine – Limiting drug & alcohol use • Other important areas to target include: – Enjoyable activities – Activities that give you a sense of accomplishment – Connecting with others – Overcoming avoidance Adapted from Antidepressant Skills Workbook by Bilsker & Paterson (2005) How Do I Change My Behaviour?: Goal Setting • A simple yet powerful technique to begin forward momentum • Choose one or two areas to begin with (getting more exercise, seeing friends, doing something enjoyable, etc.) • Goals must be: – Specific – Realistic (90% confident) – Scheduled How Do I Change My Behaviour?: Goal Setting • Examples of goals – Go for a walk to & from the community mailbox (10 mins) twice a week after work on Tuesdays & Thursdays – Call my sister for a 15 minute chat Sunday morning after church • Try to anticipate and problem‐solve around obstacles • Watch out for doing too much/trying too hard! – Achieving goals builds motivation & momentum – Falling short of goals breeds discouragement and hopelessness North Shore Stress And Anxiety Clinic (2016) 6

2016‐02‐04 The “trying too hard” problem Expectations/Goals Try harder Motivation/Energy Try even harder, pick your self up by the bootstraps! Just do it, already! What’s the point? I always fail Thinking Patterns Related to Low Mood & Depression  Unhelpful, unrealistic thinking is very common when we are experiencing low mood or depression  This can be part of the reason why depression starts & can keep it going  Characteristics of Depressive Thinking: – Negative view of the self: self‐criticism – Negative view of the world/situation: focus on the negative/threatening parts – Negative view of the future: expect that things will not get better or that more bad things will happen • Everyone is prone to falling into “thinking traps” when we are stressed, depressed or very tired Does this sound familiar? • I’m a failure • People at work think I’m incompetent • I’m never going to find a partner • This pain is not going to get better • My family hates me • I always mess things up • The world is a harsh place • People are generally selfish & unkind North Shore Stress And Anxiety Clinic (2016) 7

2016‐02‐04 Examples of Thinking Traps in Low Mood & Depression THINKING TRAP EXAMPLE All or Nothing Thinking Seeing things or people as right or wrong, good or bad, perfect or terrible. A small mistake is a total failure Catastrophizing Telling yourself that a minor negative event is/would be a complete disaster. Often accompanied by fears of not being able to cope Fortune Telling/Jumping Making predictions about what is going to to Conclusions happen, with little or no evidence Mindreading Thinking that you know what others are thinking, without any evidence Examples of Thinking Traps in Low Mood & Depression THINKING TRAP EXAMPLE Negative Mental Filter Focusing on the negative parts of a situation and ignoring the positive parts of a situation Overgeneralization Making up a “rule” about how things are or will be based on one experience or event: “always” “never” “everybody” “Should” statements Telling yourself how you “should” or “must” act or feel Labelling Saying something very negative (and often unfair) about yourself or other people Examples of Thinking Traps in Low Mood & Depression THINKING TRAP EXAMPLE Emotional Reasoning Thinking that bad feelings say something about how a situation actually is. Believing that your thoughts must be true or accurate because you “feel” strongly that they are, even if there is little or no evidence to support them Perfectionism Thinking that things or people are only right or worthwhile if they are perfect Personalization & Self‐ Feeling overly responsible for other people’s Blame behaviours and negative events, without considering other factors or people who may have influenced the situation North Shore Stress And Anxiety Clinic (2016) 8