Depression false myths

Despite the fact that depression will be the second most disabling illness by 2020 (WHO, 2012), it still causes wrong beliefs and false myths, interfering with the act of seeking and receiving appropriate treatment.

Let’s look at a few of them.

1. Depression doesn’t exist, we are all a bit depressed 

Many people think that depression is nothing but sadness and that everybody can experience it every once in a while.

Well, this is definitely false. Depression and sadness are very different in terms of intensity, duration and the impact they have on our daily lives. While sadness is a temporary feeling, as it doesn’t prevent us from experiencing positive emotions nor has it a significant impact on our daily life, depression can significantly account for changes in functioning and mood.

To be diagnosed with depression, the symptoms must be present for at least two weeks, most days and for most of the time.

Sadness and low mood are only some of the symptoms experienced by depressed people (beside lack of interest in the usual activities, diminished energy, feelings of worthlessness or guilt, change in sleep patterns and appetite, thoughts of death and difficulty concentrating).

2. Depression is all in our head and it does not have any biological root

Once again, false: nature and nurture interact to trigger and cause depression.

Genetic liability and life events play a role in this. As far as biology is concerned, a specific variation of a serotonin transporter gene seems to increase susceptibility to depression.

Besides, depression doesn’t only affect our thinking, but our body as well. Depressed people can experience different changes in their physical habits: some may experience a significantly increased or decreased appetite; some may have trouble sleeping while others may oversleep; some may go through motor retardation as opposed to agitation. This means that depression comes with a varied constellation of several different symptoms.

3. Depression is related to creativity and sensitivity

Since many gifted artists, scientists and musicians of the past suffered from mental disorders, one may tend to believe that suffering from a mental condition relates to being creative and sensitive. Well, this doesn’t apply to depression as a condition. There are so many creatives who have never suffered from depression and conversely, lots of depressed people whose nature is not particularly creative.

 4. Depression is always triggered by specific events

Specific events may sometimes trigger depression, such as the loss of a beloved one or a trauma.
As previously mentioned though, nature and nurture intimately intertwine and it’s not possible to pinpoint a single cause of depression.

5. If I start using antidepressants, I’ll be hooked forever

Taking medication for mental health treatment may be scary, because of the possible side effects as well as the fact itself of being on medication.

In the case of depression, depending on the severity of the specific case, a psychiatrist may deem clinically appropriate to prescribe medication. A combination of medication and psychotherapy is often recommended, especially in severe cases.

The length of antidepressant treatment usually depends on the case severity and the number of depressive episodes experienced.

Despite the abundance of false myths, depression is a severe and disabling condition that should never be underestimated.

If you think you are suffering from a depressive episode, consider talking to a specialist to receive appropriate treatment as soon as possible.

References:
World Health Organisation, http://www.who.int/mental_health/management/depression/wfmh_paper_depression_wmhd_2012.pdf

“False beliefs: the current treatment of patients with depression”, Lecrubier Y; Current Psychiatry Reports 2003, vol 5(6): 419-422.

Fear of flying

Despite being one of the safest means of transport, fear of flying is a common anxiety problem for many of us.

Boeing Corporation found out that 17% of Americans declare to be scared of flying and that this fear is the third most popular reason for avoiding planes (Laker M, 2012). Furthermore, it seems that around 6% of the population suffers from a diagnosed plane phobia, the so-called aviophobia.

This means that if you are afraid of flying, you are most definitely not alone.

Different shades of anxiety

Fear of flying can manifest itself in different ways and its consequences can affect us by impacting several aspects of our life. In less severe cases, it may just generate mild and unpleasant uneasiness when travelling, while for others, it may cause intense anxiety well ahead of time, making our airborne journey a very distressful and negative experience.

Anxiety can be managed using any sort of safety behaviours like choosing a specific seat or side of the plane, or having specific rituals before the flight such as checking the weather forecast, as well as self-medication (homeopathic or non-homeopathic) or a glass of wine aboard to calm the nerves. Again, for others, the idea of flying may be terrifying to the extent that setting foot on a plane is utterly inconceivable.

Triggers of fear of flying

Different factors may trigger this fear, such as being exposed to a traumatic event related to flying (directly or indirectly), or behaviours taught by a “model” of behaviour (the so-called social learning), or suffering from other phobias (i.e. claustrophobia or fear of heights) or other psychological disorders.
Specifically if you suffer from a panic attack disorder and you experience one of them during a flight, it is most probable that you will be very anxious in future flights; instead if you suffer from a generalised anxiety disorder, it is very likely that you will be very distressed when travelling in general.

Cognitive factors

Several psychological factors affect this problem.

Very often, flying phobia stems from the lack of control experienced while on a plane.

Avoiding to fly is a maintaining factor and will worsen fear in the long-term, as fear has to be faced to be overcome. Some cognitive biases can contribute to the fear of flying, like the tendency to catastrophise noises, turbulences and our own bodily reactions and emotional responses (as possible cues of an upcoming disaster), cognitive distortions (by perceiving a low-probability event as a highly possible one) and intolerance of uncertainty.

Fear of flying: treatment

If you feel that your fear of flying is negatively affecting your life, lifestyle, work and relations by limiting your degree of freedom, you should think about asking for help.

A Cognitive behavioural psychotherapist can help you manage anxiety by changing the negative beliefs and biases in which your fear is rooted; psychotherapy indeed can help you to start enjoying the pleasure of flying and travelling again.

References
Laker M, “Specific Phobia: flight”; Activitas Nervosa Superior 2012, 54, no 3-4.

Counselling and psychotherapy

Psychotherapy and counselling are talking therapies, based on the assumption that talking and reflecting about our own thoughts, emotions and experiences are powerful tools to feel better and change. In particular, the role of emotions is fundamental in our daily life and too often they are not considered, mistreated, denied or swallowed. Emotions on the contrary are our own individual compass that indicates how well we are dealing with our life and our goals. Paying attention and taking care of them is a way of assuring a balanced and mindful psychological life.

Emotions’ psycho-education

In cognitive behavioural psychotherapy and in counselling, if the patient happens to be confused, overwhelmed or simply not used to pay attention to emotions, one of the first steps in therapy is acknowledging them. This process is called “emotions’ psycho-education” and it implies getting to know each of our emotions, their role, aim and physiological activation in order to discover how our mind is functioning. This usually works by monitoring everyday our affective reactions and discovering which thoughts and goals are related. Therefore recognising and labelling the emotions we perceive is the prerequisite for regulating them in a healthy way. 

What scientific research is telling us?

Despite being a technique that has been used since the birth of counselling (and even earlier), it is only in recent times that scientific research has found the biological proofs of the powerful effect of labelling emotions. A research carried out by Lieberman et al. in 2007 clearly showed that affect labelling impacts the functioning of specific areas of our brain that are responsible for emotions’ processing and regulation. Specifically, translating feelings into words decreases the activation of a little region of our brain, the amygdala, that is responsible for automatic emotions activation.

On the contrary, affect labelling seems to increase the activity of a specific region of our pre-frontal cortex (the right ventrolateral area) that is responsible for a high-level processing of emotional information. A decrease of the amygdala’s activity and an increase of that specific aerea of the pre-frontal cortex help alleviating emotional distress.

If you find yourself in a period of strong emotional distress, you may consider talking it through in psychotherapy or counselling; talking therapies are an useful tool to better understand what is going on and to find different strategies to better deal with it.

References:

Lieberman M.D, et al., “Putting feelings into words: affect labelling disrupts amygdala’s activity in response to affective stimuli”; Psychol Sci. 2007 May 18(5):421-8.

Relaxation techniques and anxiety

Anxiety is an emotion that activates physical responses in our body, such as a change in heartbeat, breath frequency and muscle tension.

The main reason of these changes stems from the fact that anxiety triggers the so-called primitive fight-or-flight response, which consists of the body’s automatic reactions by either fighting or fleeing the threat when a hazard is identified, to guarantee survival.

As a consequence, our heart beats faster to pump more oxygen to the muscles, our main muscles contract for increased strength and speed and we may perceive troubles breathing due to the contraction of the muscles of the chest.

The tricky facet of the matter lies in the fact that this activation can maintain a high level of anxiety, giving rise to a vicious cycle. Anxious people are very sensitive to these physical changes and may interpret these responses in a negative way, as evidence of something bad about to happen or afoot. These individuals might feel like they are losing control or getting crazy or are affected by a serious disease.

Another component contributing to the vicious cycle is an increase in respiratory rate, which can be regarded to as a maintaining factor, as well. When we are anxious, we are easily prone to hyperventilating, meaning a higher number of breath cycles per minute and breathing using the chest and not the diaphragm. As a consequence, we take in too much oxygen and that may lead to typical anxiety symptoms such as dizziness, confusion, air hunger and so on.

As these psychical changes maintain or enhance pre-existent anxiety, aiming to reach a state of calmness is a useful tool to relieve and prevent anxiety.

Cognitive behavioural psychotherapy tackles anxiety on different levels, either the cognitive, physical and behavioural one.

Relaxation techniques are an effective ally that can be used in therapy while working on the causes and interpretations that create and perpetuate anxiety disorders.

The patient is taught different types of techniques by their therapist and is encouraged to practice as much as possible in their daily life to master stress and anxiety and keep them under control in stressful situations.

Among the most common relaxation techniques, you may find slow breathing, progressive muscle relaxation, isometric relaxation and relaxation through guided imagery.

Slow breathing, as the name itself suggests, helps you thwart hyperventilation through constant breathing at a particular frequency.

On the other hand, progressive muscle relaxation and isometric relaxation focus on relaxing the muscles of our body, alternating contraction and relaxation of specific muscles.

Guided imaginary allows you to relax through imagination, visualising yourself in a peaceful state and place instead.

Relaxation techniques are an effective range of simple and easy-to-learn tools to help you manage anxiety and reach a state of relaxation.

If you are currently going through a bad patch and find it difficult to cope with stress on your own, or if you think that you might suffer from an anxiety disorder, seeking the help of a counsellor or a psychotherapist is warm-heartedly recommended.

Therapy can help you address the issue on different levels and reach a new balance.

First session in psychotherapy

Deciding to start psychotherapy or counselling can bring forth questions and doubts. Above all, most questions permeate in the first session, which is always laden with great expectancy.

Questions like ‘What should I say?’, ‘Should I open up to my therapist straight away?’, ‘Will I feel comfortable speaking to my therapist?’, ‘How can I tell if my counsellor is the right one for me?’, ‘What should I expect from my first session of therapy?’ and so on may arise.

Let’s examine these questions.

Questions and doubts

What should I say? 

Usually the first session is a preliminary consultation that helps both therapist and client introduce each other and see if common ground is found for further collaboration. As the therapeutical process begins during the first interactions in the initial session, the therapist will gather information about the client and the specific reasons that brought them to ask for help. The first session is crucial to the patient too, as they will eventually decide whether the counsellor is a good fit for them.

The therapist will usually guide the client through a series open-ended questions to assess their situation.

Should I open up to my therapist straight away?

There is no straightforward answer to this question as we all tend to follow our own instinct. For example, some try out therapy with a clear idea of their issues while others may feel confused and overwhelmed at the idea of pinpointing their case. Others may have mixed feelings about it and may experience troubles connecting all the dots when outlining their complex inner picture.

Some aspects of our suffering can elicit intense shame or guilt and therefore, building and establishing trust with a therapist has to be an essential prerequisite for opening up.

Some people find it quite easy to open up and talk comfortably from the beginning whereas others may find it tricky as they require more time and trust.

Will I feel comfortable speaking to the therapist? 

Therapists and counsellors are trained to work and help people with psychological issues. They are able to create a comfortable and non-judgmental setting showing an active-listening attitude.

Obviously, each therapist differs from another in personality and type of training, so each counsellor will adopt a slightly different approach to the client. Also, we all have personal preferences when it comes to people.

Some clients prefer a straightforward and direct attitude, others may opt for a female therapist as opposed to a male therapist or vice-versa, or look for a therapist from a specific country or of a specific age.

How can I tell if the therapist is the right one for me? 

The impression you will get from the first consultation will determine whether you want to embark upon the therapeutic journey with that specific therapist.

Beyond the therapist’s qualifications and specialism, the match for you will make you feel comfortable enough to open up by giving you food for thought.

What should I expect? 

From a first session you may expect to start thinking about the reasons that brought you to counselling in the first place, as well as the causes and consequences related to what you regard to as an issue, along with your expectations and ultimately, motivation. Will may expect a welcoming, non-judgemental and confidential setting where you will feel comfortable about expressing your troubles.

But above all, the first consultation will give you interesting insight into the world of psychotherapy as a tool to provide you with a new perspective on and solutions to a particular issue.

Young adults and mental health

Several psychological disorders tend to manifest and strengthen between the end of adolescence and the beginning of adulthood.

In particular, mood disorders have an average age of onset of 25. Conversely, anxiety disorders have a more variable onset: some of them appear fairly early in life, as separation anxiety or specific phobias that tend to manifest during childhood, while others, such as social phobia, obsessive compulsive disorder and panic disorder tend to appear slightly afterwards, during adolescence and early adulthood.

Scientific research has shown that people suffering from a mental disorder usually tend to wait for a long time before seeking help. Sometimes months or even years may elapse without asking for help or a professional like a psychologist, a psychotherapist or a psychiatrist for assistance.

Why does this happen? 

Many reasons may contribute to the avoidance of counselling and the delay of seeking help. Hesitancy and uncertainty about asking for help are often attributable to feelings of guilt and shame. Seeking assistance is not easy for most people as the society we live in today expects us to always be at our best. The act of acknowledging a problem may be perceived as a sign of weakness and vulnerability, hence the fear of exposure and loss of social standing.

We may also think that what we are experiencing is but fleeting symptoms of a transient condition that might well disappear in time. Luckily enough, sometimes this is actually the case and the symptoms will simply and naturally dissolve, whereas some other times, signs and symptoms may lead to an actual mental disorder. In the latter case, it is very likely that the chronicity and severity of symptoms, as well as the consequences that they may cause in our daily life, may be affected and worsened by lack of treatment in individuals with strong help-seeking barriers.

If you experience psychological symptoms that make you feel as something were off, talking to a professional therapist is strongly recommended as a counsellor may help you understand the cause and the severity of the situation and, if necessary, point you in the right direction and towards the best psychological approach to tackle the issue.

If the onset of a mental health condition manifests during adolescence and early adulthood, hesitancy in seeking help may be particularly counterproductive for young adults as in this case it implies an even more delicate scenario.

Why is it important for young adults to seek help? 

The first years of adulthood are a window to our future dotted by several remarkable decisions and events such as diplomas and university degrees, our first job, stable relationships with friends and a partner. Some of us will also start a new family.

While we are young adults, we strive to envision the direction our life will take. Our very attitude towards life and the choices we make will inevitably influence it in the long term, much more than we can imagine.

At such an important and delicate moment, suffering from an untreated disorder may dramatically impact on our future. Mental health clearly can affect how we relate to other people and the social environment we build around us, as well as how we focus on and effectively engage ourselves in study or work-related goals and achievements.

This is why it is so important for young adults not to be afraid to acknowledge any psychological difficulties and not to lock the door to their inner world, but instead open up and ask for help to better understand what’s going on and finally allow a change.

Social anxiety

Anxiety triggered by social situations is quite a common issue. I guess everyone has felt very anxious at least once in a lifetime with regard to speaking in public, taking exams, a job interview, attending a party with strangers or starting a conversation with an unknown person.

Instances implying potential social judgments can undoubtedly represent a source of anxiety.

A certain amount of anxiety is acknowledged as useful in order to improve our performance (both socially and professionally), by making us more focused on the task, for example. If the level of intensity related to anxiety raises excessively though, the risk of a counterproductive response may arise too, worsening our performance.

Feeling a bit anxious or stressed in social situations is no big deal per se. It usually occurs quite often as a matter of fact. But for some of us, social anxiety can quickly escalate to overwhelming levels, with the person experiencing unbearable unease or even a panic attack to the extent that they would rather avoid exposure to said social situations in the first place. If this condition significantly impacts our daily routine and brings forth intense discomfort, it might relate to a Social Anxiety Disorder.

Social anxiety can be generalised or specific, depending on how many social situations are intensely feared. Usually the most feared situations relate to speaking in public, eating, drinking or writing in public, engaging in a conversation, participating in group activities, speaking with a person of authority, taking exams.

Social anxiety and shyness

Social anxiety, if generalised, can be confused with shyness at times. The main difference here lies in shyness being a personality trait occurring at a very early developmental stage as well as being a normal part within the process of growing up. Although shyness as a trait can significantly change throughout a person’s lifetime, it tends to be stable and continuous. On the contrary, people suffering from social anxiety usually experience a sudden onset, which crucially marks the difference between pre-onset and post-onset functioning.

Why does this happen?

Anxiety is an emotion that we can experience when a potential danger is perceived. When this happens, our archaic reptilian brain activates several bodily reactions connected to the fight or flight response. The fight or flight response prepares our body to react to a potential danger promptly in order to survive. We may experience tachicardia due to the increased heart rate as our body aims to provide contracted and ready-to-react muscles with oxygen. The body can also interrupt digestion to save energy so that we may experience stomach or abdominal pain. We may feel dizzy and mentally confused too, because of the sudden blood concentration in the main muscles and, for the same reason, we may experience a tingling or torpidity in our body extremities.

Social situations as a threat

The reason why we feel anxious in a social situation is the threat we perceive in it.

If this happens, it is important to ask yourself: What is the threat? What could possibly happen that I fear? What’s the worst that can happen?

Trying to get an answer to these questions really depends on the person. The tricky aspect of anxiety is that most of the times we are not even aware of the specific reason that triggered such a response.

In the case of social anxiety, the perceived threat is often the fear of acting in an embarrassing or shameful way, or making a display of our anxiety-related symptoms in front of other people with the risk of incurring negative judgment.

When a social situation is perceived as a threat, several other processes take place and worsen the anxious state.

We might try our very best in an attempt not to show any anxiety, using tricks to hide the symptoms with the result of focusing even more on how we could appear to others rather than on our performance (that can eventually be affected).

If you recognise yourself in the dynamics described above, you may think about seeking help.
cognitive behavioural psychotherapy can help you recognise the process that takes place in these situations and break the vicious cycles. Cognitive behavioural psychotherapy can also help you handle anxiety effectively and make you feel more confident about yourself.

Caregiver

No one is born as a caregiver, although it is a role that life obliges us to fulfil.

Being a caregiver means being a family member (or a paid helper) who regularly looks after a sick, elderly or disabled person (Oxford Dictionaries).

It seems that on average caregivers are women, in their mid 40s, who spend about 20 hours per week (or more) taking care of another person, usually their mother or a young family member or their own partner.

Being a caregiver implies a direct contact with different types of diseases, from dementia to physical illnesses and mental problems. Another responsibility is usually helping the person carrying out different daily tasks: from assuring the compliance to pharmacological and non-pharmacological treatments to monitoring the general health of the assisted person and helping in daily routines…

The list is potentially very long, depending on the severity and type of disability.

The sure thing is that being a caregiver can become a full-time job and it can involve great responsibilities, a considerable amount of stress and very often putting the other person’s needs first with the consequent risk of disregarding our own personal needs.

Caregivers and mental health

In particular, if the assisted person suffers from a mental health condition the scenario may get even more distressful and complexed.

Mental health problems are unfortunately still marked by stigma and prejudice and the general information about them is still not sufficient. As a consequence the emotional burden of the caregivers may be even heavier and it is not uncommon for caregivers to experience anxiety and/or depressive symptoms. Scientific research shows that family members of schizophrenic and bipolar patients are particularly affected by the issue, with between 30 to 60% experiencing depressive symptoms (NAC, 1997; Heru et al, 2005).

Given this delicate and complex background, being a caregiver or living with a person suffering from a psychiatric disorder, is doubtless a tough job that implies many challenges and that can sometimes make us feel isolated and not supported enough.

If you are a caregiver

If you find yourself in a similar situation, keep in mind that your health (also your mental health) should come first, as it allows you to better take care of the other person. Plus, a very important tool is information: getting to know the specific illness that the person you are taking care of is suffering from may give you better tools to deal with it as well as foresee any possible complication.

If you feel too burdened don’t be ashamed to ask for help and cooperation to your close family and your closest friends and use the services provided by your community; very often hospitals and clinics organise support or self-help groups specifically for caregivers. Even if often we may feel lonely and not fully understood by the people who surround us, reality is different: there are many caregivers who experience the same feelings and sharing can bring a powerful relief.

On the contrary, if you are experiencing intense symptoms of anxiety or prolonged sadness you may start thinking about seeking a more specialised help and perhaps beginning psychotherapy to better deal with the whole situation.

Remember that it is not possible to take care of everything on your own; sometimes a little help could really bring much more relief than you may think.

Intimacy

Creating intimacy with a person, either a partner, a friend or even our therapist, is not always a smooth and easy process for everyone. In this instance, the word intimacy means not only a relationship characterised by physical closeness, as we may spend a lot of time with a person without being intimate with them. For an intimate relationship is meant as an emotional relationship connoted by affection, familiarity, mutual support and sharing of our thoughts and emotions. Being intimate with someone entails revealing our deepest secrets, weaknesses and vulnerabilities: this is the reason why it is sometimes hard to get so intimately close to someone.

Seasonal Sadness

The temperature goes down, days get shorter, you wake up in the morning and outside it is already dark … you get out from work and outside it is still dark. You hope that the day will pass as fast as possible so that you can go directly back home, sleep and wait for spring to come back. You have the feeling of having become like a bear in hibernation: you have interest in doing nothing, you are only very tired, irritable and maybe more hungry than usual.

Why is this happening?

The change of season, in particular the shift from summer to autumn/winter in northern Europe, can be tough especially in countries situated far from the equator, where the amount of light is significantly different among the seasons.

Researchers have found that light has a significant impact on our circadian rhythms and on the production of some hormones; in particular, the most affected hormones seem to be melatonin, responsible for sleep patterns, and serotonin, a hormone linked to mood.

Therefore it seems normal to experience a slight effect of the lack of light on our mood, the so-called seasonal sadness, but usually this effect doesn’t have a significant impact on our daily life and it doesn’t prevent us to efficiently carry out our daily duties and activities.

On the contrary, for around the 2-3% of the adult european population autumn blues take the form of a real psychiatric disorder: the Seasonal Affective Disorder (SAD). Very often SAD symptoms show up in autumn, they worsen in January – February and tend to disappear with the arrival of spring.

SAD implies severe depressive symptoms such as a persistent low mood, loss of interest/pleasure in everyday activities, lack of energy, sleeping and eating more than usual, feelings of guilt or despair.

To diagnose SAD these symptoms must begin and end always in the same seasons and must be experienced for at least two consecutive years. Interestingly women are six times more at risk to developing SAD then men.

What to do

In general if you are experiencing a slight seasonal sadness, then taking care of yourself, your habits and your relationships can be a good start in dealing with it and feeling better.

Taking care of ourselves implies caring for our body as well: having a good and healthy diet and physical exercise are recommended. At the same time taking care of our relationships is important: researchers showed that perceiving a good social support is a protective factor for many psychological difficulties.

Another good way of taking care of our seasonal sadness is stimulating emotions that are opposite to the problematic ones; if you feel down you may try to work on your everyday life to improve the amount of positive events that can foster a better mood. A way of tracking this exercise is keeping a diary of pleasurable activities so that you can monitor your progress and the impact that these activities have on your mood.

If you think that you may be suffering from SAD then seeking help to your GP is recommended. Psychotherapy can help you out as well in dealing with these seasonal sadness. Cognitive behavioural psychotherapy is indeed very recommended by NICE for the treatment of mild and moderate depressive states.