Major Depression - New Findings For Therapy

A study conducted by Lewis Judd, M.D., chairman of the Department of Psychiatry at the University of California, found that major depressive disorder (MDD) is best seen as a long-term illness that is prone to recurrences. He studied 367 people who were diagnosed with MDD and followed them for up to 31 years after diagnosis. He found that 55% of the time, MDD patients had some depressive symptoms (sadness, crying, loss of interest in enjoyable activities, avoidance of friends and family, low self-esteem, low energy, sleeping/eating problems) whether they were mild, moderate or severe. During the course of illness, the experience of even mild symptoms not meeting the full criteria of the diagnosis were associated with difficulty in functioning – particularly in the areas of social and work functioning. Further, for patients who are recovering from a first major depressive episode, even the presence of non-clinical (mild) levels of depressive symptoms that were not addressed significantly increases the risk of a faster, more severe relapse. What does this mean if you have MDD? It means that you and your family need to know that MDD is a long-term illness that typically waxes and wanes. Long-term care is needed and early signs of even mild depressive symptoms need to be addressed. If you have been diagnosed with MDD, the experience of any depressive symptoms should instigate a consultation with a qualified mental health practitioner. Finally, it is important to follow through with the recommended treatment and medication for as long as necessary. Holly Houston, Ph.D. Licensed Clinical Psychologist

7 Ways to Reduce the Stress of Grieving

One of life’s most challenging tasks is dealing with the death of a loved one. Whether the loss is a sudden event or one that is anticipated for some time, the feelings of sadness and grief can be overwhelming. There is no one right way to grieve nor is there a specific time frame within which grieving should conclude. However, it is important to allow grieving to occur in order to heal, integrate the loss and live fully. In order for successful grieving to occur, one must experience the sadness and loss and work toward acceptance. The stages of grief, which are outlined in the following website http://www.recover-from-grief.com/7-stages-of-grief.html , are helpful in explaining what the grief experience is likely to entail. Here are other helpful techniques to promote a healthy grieving process. 1. Talk about your thoughts and feelings with others; it helps to get them out. 2. Share memories and mementos of your loved one and celebrate your loved one’s life. 3. Refer to books written by professionals and reputable websites for information on grief. 4. Let go of your loved one’s belongings gradually, over time. 5. Go to a grief support group. 6. Stay connected to friends. 7. Partake in hobbies and projects. Holly Houston, PH.D. Licensed Clinical Psychologist

What do I do when I think a friend or family member has an eating disorder?

If you are worried about the body image, weight, and/or eating patterns of someone you care about, this can be a very overwhelming and challenging time. We are glad you found this blog, as researching eating disorders is often one of the first steps in helping someone who is struggling with eating concerns. Below, find some effective guidelines on how to help. For additional information, please contact The Anxiety and Stress Center.

Learn
Continue to research as much information as possible regarding eating disorders and body image. We strongly recommend that you limit your information gathering to reputable sources such as the National Eating Disorder Association, books, scholarly articles, and treatment center brochures. Pay special attention to the difference between facts and fiction about weight, exercise, and food intake. Knowing these facts will help you inform your friend against any myths he or she might be using to reinforce the disordered eating.

Be Honest, Caring, and Firm
Ignoring the disordered eating patterns and body image concerns of your family member will not make it go away. Set a private time to talk to your loved one, away from other distractions. Being open and honest about your concerns will let your loved one know you care. However, it is important to be firm in helping your friend recognize they are responsible for their actions. Do not set unfair rules or expectations on your friend, i.e., “Eat or I won’t talk to you again.” Do not make promises that will only help your friend continue the disorder eating, i.e., “I won’t tell anyone.”

Be a Role Model
Demonstrate self-acceptance as well as healthy eating patterns and exercise habits. Compliment your friend on their personality and efforts and do not focus simply on appearance.

Tell Someone
If you are concerned about a friend, reach out to a trusted parent, teacher or coach. If you are a parent of a child who may struggle with disordered eating, it is important to seek professional help. Addressing body image and eating concerns during the initial stages of the disorder provides the best chance for recovery.

Avoid Shame, Control, or Guilt
When someone is struggling with disordered eating, avoid focusing immediately on food. Eating disorders involve complex emotional struggles, and cannot simply be “fixed” by forcing someone to eat. Statements like, “just eat” or “look what you’re doing to this family” only add to the guilt and shame surrounding disordered eating. Express continued support and understanding.


Source:
National Eating Disorder Association,
www.nationaleatingdisorders.org

Sara M. Gruzlewski, Psy.D.
The Anxiety & Stress Center, P.C.

Anxiety and Bullying

What is bullying?
Bullying is a repeated act that can be physically, verbally or socially aggressive and is intended to cause harm.
Types of Bullying:
a. Physical
• Hitting,
• Pushing,
• Kicking,
• Taking others personal belongings.
b. Verbal
• Threats,
• Putdowns
• Name-calling, nick names.
c. Relational Aggression-Behavior that is intended to harm someone by damaging or manipulating his or her relationships with others (Crick, N.R., & Nelson, DA, 2002)
• Indirect, hidden acts of aggression
• Social Isolation, exclusion
• Ignoring
• Spreading Rumors/Gossiping
• Cyber-Bullying-IM, E-mail, Web Pages/Blogs
• 18% of students in grades 6-8 said they had been cyber-bullied at least once in the last couple months (Kowalski et al., 2005).

Even if your child is not the target of bullying, they are still affected by the exposure of seeing others being bullied. Children often know who the bullies and their targets are. This can cause a child to feel worried about what might happen if they socialize or stick up for the target. They may not want to upset the bully in any way that could in turn; cause them to become a new target. This in itself can be anxiety provoking for your child simply by being in the presence of bullying.

Signs your child may be affected by bullying:

• Abrupt changes in mood/behavior
• Changes in school performance

• Changes in friend groups
• Frequent complaints of illness or wanting to leave school/Not attend school
• Lowered self-esteem



What can parents do to help their child if they are a victim of bullying?
Be proactive. Even if you are not sure your child has been a victim of bullying, talk with your child about bullying. Explain what bullying is and ask them what their school is doing to work with the issue. Discuss ways of handling situations where your child may be bullied and how to handle it. For instance, it is not uncommon for children to keep their worries about bullying to themselves, often due to fears of the bullying increasing and not wanting to look bad for “telling”. This shows the importance of finding your child supports they know they can trust. Your child should always tell an adult if he feels unsafe in any way and should have an adult in the school they are able to speak to about their issues with bullying, without having to fear their name would be used. Try to stay in pairs or groups and stick up for one another. Bullies tend to look for easy targets.
Role Playing. Another way to prepare your child is by running different scenarios and discussing the importance of trying to stand up to the person who is bullying you in a responsible manner. It is OK to let someone know they are making us uncomfortable. It is OK to let someone know they are being a bully. If he is being bullied on-line, let him know not to reply or stand up to the person doing the bullying. Instead, show an adult.

If your child is showing signs of distress from dealing with bullying, contact your child’s school to make sure they are aware of the situation and to discuss what actions are taken to deal with situations regarding bullying in the school. Because bullying can lead to issues such as low self-esteem, depression and anxiety, it may also be a good time to consider contacting a child therapist to discuss ways to help your child to cope and build skills to deal with the issues they are experiencing. Help for school refusal and social skills building can be attained through working with a Clinical Therapist.

Deanna Kozlowski, MSW, LCSW

The Impact of Job Loss on Families

Losing a job certainly takes a toll on the person who lost the job. However, when a parent looses a job, everyone in the family is significantly affected.

One of the more obvious changes for families is the reduced income. When a parent looses a job, lifestyle changes are often required. Decisions have to be made about how to spend what money there is. Relied upon extras, such as childcare, extracurricular activities, and various forms of entertainment, often have to be cutoff.

Other, more drastic family changes may result from unemployment. The other family members may have to find employment or increase their hours at work. This change may lead to less family time together. Finding employment may necessitate relocating to a new city. The children may have difficulty and resentment leaving their schools, friends and routine.

Emotional responses from household family members may result from both the reactions to the unemployed parent as well as to the job loss itself. The unemployed parent may withdraw from family members and show signs of depression. There may be more conflict between the parents due to the increased stressors. These challenges increase the discomfort during this period of time, especially for the children. Job loss is frightening for children. They rely on their parents for emotional support. When parents are in distress, the children feel a loss of security.

There are several ways to reduce the negative emotional impact of job loss:
1. Inform the children of the job loss. It is scarier for them to be aware of negative changes and not know what they are. Their imaginations take over.
2. Maintain household routines and keep change to a minimum, as much as possible.
3. Help the children by helping yourself: eat balanced meals, recognize and address signs of stress such as headaches, sleeplessness, digestive problems, angry outbursts and appetite changes.
4. Be on the look out for these signs of stress in the children, too.
5. Have the family discuss their feelings, thoughts and concerns about the job loss situation.
6. Find low or no cost ways to spend family time together.
7. Focus on the positives like having good friends, a loving family, good health, etc.
8. Assure the kids (and yourself) that the job loss is a temporary condition that affects many other people.
9. Use this situation to role-model for the children how to handle a life-crises and use problem-solving skills. Children who see their parents handle stressful situations well are more likely to handle stressful situations successfully as adults.

Holly Houston, Ph.D.

Childhood Sexual Abuse

Childhood sexual abuse is a commonly occurring negative life event.  One in four girls and one in six boys experience some form of sexual abuse before the age of 18.  Many time children don't tell their parents that they are being sexually abused.  There are many reasons why children don't tell.  Some children are afraid to tell because they think they are to blame for the abuse or they fear they won't be believed.  Other children are afraid to tell because they fear the perpetrator of the abuse may be punished.  Many times, the perpetrator of sexual abuse is someone the child knows and thus also has caring feelings towards.  Finally, children don't tell out of fear that their loved one will be harmed (many times they have been told this by their pepetrator). 

Childhood sexual abuse is a very frightening and shameful experience and as a result, parents or those close to the chid victim of sexual abuse many notice changes that should serve as "red flags."  Some "red flags" are changes in behaviors, appearance and functioning such as:

• Not wanting to be left alone with a particular person
• Sleep difficulties
• Nightmares
• Becoming more isolated/withdrawn
• Disturbances in mood (i.e., depression, anxiety)
• Disturbances in behaviors (i.e, oppositional and defiant behaviors, "angry outbursts")
• Sexually reactive behaviors (i.e., excessive masturbation, acting out sexually with other children)
• Decrease in grades
• Loss in previously acquired developmental milestones (i.e., toilet trained but now having frequent toileting accidents)
• Covering up (i.e., wearing baggy clothing)

It is normal for parents to have many feelings when their child begins to tell about their abuse.  However, regardless of their feelings, it is most important for parents to exhibit support to their child.  Parents should:

• Try their best to remain calm
• Don't interrogate their child
• Never blame their child
• Reassure their child
• Call for help right away

A responsive and supportive parent is the best indicator for recovery in a child who has been the victim of abuse. 

Nicole A. Tefera, Psy.D.
Anxiety & Stress Center, P.C.

The Stress of Job Loss and Stages of Grief

Our jobs not only give us a way to earn a living, but they also define part of who we are and how others see us. When meeting someone for the first time, a typical question is "What do you do?" Our jobs are valuable. They provide: status, an entity that facilitates a sense of belonginess and opportunities for socialization. So, when a job is lost, many feel as if a part of themselves has been lost. Often, people report that loosing a job is like going through a divorce.

Job loss, like other forms of loss, brings about a variety of emotions. These emotional reactions are affected by many factors including age, personality, coping skills, financial condition, employment outlook, family situation and the length of job tenure. The longer the job was held, the more difficult the loss.  Concurrent financial stress, deep attachment to the job, unrelated emotional difficulties and other losses can make coping with job loss more difficult. The most common emotional reactions to job loss include: shock and disbelief, anxiety, depression, embarrassment, loss of control, distrust of employers, self-blame, loss of confidence and anger.

Job loss often brings about grief defined as the emotional, mental and behavioral reaction to the loss of something closely tied to one's identity.  Birkel and Miller (1998), Australian therapists, liken the emotional response to loosing a job to the Kubler-Ross stages of death and dying. Birkel and Miller refer to this process as the e wave or emotional wave.

The first stage of the e wave is shock and denial. "This can't be true ?","How can this be happening to me?" are common thoughts in the initial phases if job loss. This may be accompanied by an emotional numbing. Encouraging the person to talk about their experience and providing a listening ear is helpful. It is important to inform others about job loss and not hold this information in as it adds to the overall burden.

The second e wave stage is fear and panic. "I'll have to file bankruptcy", "My career is over" are typical responses. Here, anxiety-reduction coping techniques can be quite beneficial.  Relaxation techniques, calming self-talk and thought reframing exercises are recommended interventions.

The third e wave stage is the anger stage.  In this situation, anger is a natural response to the loss of power and influence.  It is essential to express the anger in positive and constructive ways.  Rather than responding to the boss in an angry or hostile fashion, anger may be channeled through physical means (exercise, punching bag), talking it out or through creative outlets (writing/journaling, art).

The fourth e wave stage is bargaining.  "If you give me another chance, I'll be the best employee this company has ever had", "I'll work harder and longer for the same pay and correct all my mistakes" are thoughts typical of this stage.  These thoughts represent an attempt to try to regain some control. However, this approach is not constructive or realistic. Looking for constructive ways to approach unemployment can help create a greater sense of control and direction. Examples include taking classes, seeking training opportunities and revising the resume.

The fifth e wave stage is depression which is characterized by guilt, feelings of worthlessness, lack of energy and motivation. Other physical symptoms may include insomnia and appetite disturbance.  Helpful interventions include tasks that provide structure and goal achievement. Unemployed individuals should get up and get dressed, exercise (studies have shown exercise reduces depression and anxiety) and make their daily job the process of looking for a job. Seeking help from a mental health professional can also be quite helpful, even necessary if the depression is severe or prolonged.

The sixth and final e wave stage is temporary acceptance. It is called "temporary" because most people continue to have sadness, disbelief, etc., originating from the other stages, that vacillates throughout the job loss experience. This stage is characterized by greater acceptance and integration of the job loss. Individuals are able to job seek more effectively by reflecting on where they have been and where they are going career-wise. This greater level of job loss acceptance is facilitated by the ability to create emotional distance from the job loss experience itself.

The emotional wave of job loss is not experienced by everyone in the same way. Some people may not go through all the stages and others may go through them in a different order. The presentation of the e wave is meant to help with the understanding of the significant emotional experiences associated with loss of employment and to provide some general guidelines for management.

Holly Houston, Ph.D.