Depression Techniques (evidence for)

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Depression Techniques (evidence for)

Socratic questioning:
– What evidence do you had to support this idea?
– How’s strongly do you believe this now?
– On a scale of 0 to 10 where does your belief fall? What about other people?
– How does this thought affect how you feel and act?
– Can you describe experiences when this thought was not completely true?
– If a close friend felt this way, what would you tell them?
– If you told a close friend this thought, what would they say to you?
– When you feel differently in the past, what would you have said to this thought?
– Are there any distortions present in this thought?

1) Behaviour
– relaxation strategies
– lifestyle changing (alcohol, exercise, sleep) aka self-care [behaviour activation]
– taking responsibility for management
– recommends writing for 4 days for 15 minutes to identify thoughts & beliefs
– cannot control events but how we respond to them
– visualisations
– slow breathing and changing the focus of their attention away from worries and anxieties)
– put Structure in your day
– Make each day count (Friends, family, volunteerism)
– Take as few sleeping pills / alcohol as Possible
– Get a pet (BP goes down, exercise, behaviour activation)
– If you are a workaholic get a hobby
– Avoid stress
– bibliotherapy
– -don’t suppress, plan
– if, then… Contingency-planning
– what you will do to not act upon them
(I.e. plan ahead, in accordance with your goals)
– Checking in with yourself
– Combing your hair
– Getting in or out of bed
– Getting in or out of the car
– Cleaning your teeth
– Washing your hands
[grounding]
– behaviour activation

– Behavioural approach – psychology looks at it as a classically conditioned response (like Pavlov’s Dog) – through exposure and relaxation, you get a lesser response over time – a new habituated responses. However, the amygdala can remember – particularly in high-stress situations – and the old response can return

1A) Responses to Problematic Behaviours
– Are they effective? [OUR GOAL IS TO REDUCE PROBLEMATIC BEHAVIOURS & INCREASE EFFECTIVE BEHAVIOURS]
– clients are taught to re-enter situations they have been AVOIDING [as AVOIDANCE /WITHDRAWAL is common in clients with MDE – BEHAVIOURAL ACTIVATION IS THEREFORE RECOMMENDED]
– activities that are fun & which provide mastery/pleasure are planned (sense of accomplishment or fun)
– training in new skills (social interaction, assertiveness/less aggressive, communication)

2) Cognitive
– changing pessimistic/negative thinking styles
– cognitive Distortions / not the whole facts
– Cognitive Restructuring (re-evaluating negative thinking patterns) [so you can re-evaluate & react more effectively]
– cannot control events but how we test & interpret them
– thought challenge
– knowing thought, situational & people triggers [& planning for these]
– using problem-solving strategies
Steps in problem-solving therapy:
– identify problem
– set specific goals
– brainstorm
– pros and cons of solution
– (involve patient in solving their problem)

– cognitive change – what does the stress mean – being aware of it

2A) mindfulness techniques
– to help give clients some distance from negative thinking [TO NOT JUST ACCEPT OUR THOUGHTS BUT TO BECOME AN OBSERVER OF OUR THOUGHTS SO THAT WE CAN LET THEM GO BY & THIS GIVES US TIME TO EVALUATE THEM AND NOT JUST GO WITH THEM]
MBSR: Mindfulness-based Stress Reduction – Focus on reducing stress and increasing well-being [Kabat-Zinn]
– eat a sultana slowly & notice everything about it.
– coping effectiveness training
– determine if a general stressor
– determine if a specific stressor
– determine whether there are changeable aspects – if so, the do:
– Problem-solving
– Negotiation
– Communication
– determine whether there are unchangeable aspects – if not, the do:
– eMotion focused strategies
– Guided imagery (Favourite place to go to any time you want – see, Smell , sense, feel the place)(pictures/postcards may aid this)
– Physical activity
– humour
– Strategies to enhance well-being
– Mindfulness
Acronym: BREATHE
B for Breathe: Take a deep breath & Be present With yourself in the Moment [Close your eyes, breathe in, and exhale when you want to – Just be wherever you are & push away unwanted thoughts; Notice your feet touching the floor; open your eyes – practice being still and not worrying about things][do in traffic – no one will notice]
R for Realistic goals: Set realistic goals for this moment, this hour, this day & Celebrate meeting them [people with stressful lives often do too much, underestimating the time needed for particular tasks – setting them up for Constantly failing and getting angry with themselves]
E For every day events: Notice the positives in every day life. For example: Sunset, Flowers, Nature more generally (Share These events with others)[They are around us all the time][Recognise when things go right – Nice room, Good meal etc., – This requires changing how we do things]
A For acts of kindness: Create positive events for others;
T for Turn negatives around (Look for the positive) & Find the silver lining (For example write your mum a thank you note)
H For honour strengths: Acknowledge your personal strengths (Stay close to what you value in yourself)
E For End each day with gratitude: Note the good/positive things that have happened & be grateful (for e.g. You came to therapy, you laughed, you thought about something, changed something that needed changing; I did more than I did yesterday) – Like positive accounting at the end of the day – also aids sleep [Source: Beck CBT – keep a gratitude diary]

3) Behaviour & Cognitive
– assess the situation realistically)(seeing things in the day time/making decisions then rather than at night)
– assertiveness skills
– Push thoughts of the future into the future & instead focus on the present
– What if thoughts generate fears/problems without problem-solving to work out solutions

4) – lifestyle
– sleep: try to keep sleep window regular and no more than 2 hrs different per night;
– exercise: for brain & metabolism three times per week;
– alcohol and drugs – it is a myth that you can self-medicate;
– sunshine: 15 minutes in he morning;
– food: 3 meals per day, folic acid (green vegetables), omega-3 fatty acids (fish, flaxseed);
– social: be with people or 20 minutes a day if possible]

5) Medication
– all have side-effects
– side-effects are least with the anti-depressants and greatest with anti-psychotics

6) AOD
– alcohol is a depressant – longer-term will lead to mood problems (DIRECTIONS ACT – abstinence and/or controlled consumption)
– drinking alcohol or taking Benzodiazepine while on opiates is a deadly mix

7) Responses to Painful Feelings
– clients learn how to accept or tolerate painful emotions, and are sometimes taught how to change those emotions in the moment [ALLOW IT; TOLERATE IT – WORK THROUGH THE PAINFUL FEELING]
– relaxation exercises [TO DECREASE OVERALL STRESS]
– strategies to manage extreme emotional reactions are taught [DISTRESS TOLERANCE SKILLS]
COGNITIVE APPROACH TO ADDRESSING OUR EMOTIONS
What Can You Do?
“Less is more”
– focus on doing a few things
– take time to rest
[Our mind and body needs time to rest just like other machines in our lives]
[helps you to Be more efficient]
– do grounding activities
“Get organised”
– write own task
– prioritise & set deadlines
– break it into mini-tasks
– go & do it
“Practice being nice”
– be nice to yourself – less judgmental & self-critical
– watch your thoughts & actions
– consciously have a plan for imperfection
“Slow down”
– take time to relax – it is crucial to your well-being
– learn to do nothing
– delegate work to others
“Surrender control”
– accept people & situations as they are (not giving in – just being realistic)
– accept imperfection
– lower your expectations of the world

[Sometimes we feel really stuck with our emotions – How can we tell?
– stubborn/immobile
– Overly emotional/Internal
– speaks extra slowly
– overly controlling to prevent change
– depressed/Melancholy
– sluggish
– Slow to make decisions
– overly attached

What can you do?
“Learn to detach”
– address grief
– prayer/hymns
– knowledge life is temporary
– everyone will be ok
“Just do it”
– small steps & small goals
– get moving
– get out if the couch or house [ok, if doing this for a few hours/days, but not every day]
“Take on a project”
– Choose a project or task that needs to be done
– Plan and focus on this task
– When unpleasant thoughts arise, focus on the present and what you can do

8) GOALS OF CBT FOR THE MANAGEMENT OF MOOD DISORDERS
– improve functioning (positive well-being)
– recognise early warning signs (physiological signs; situational triggers/vulnerabilities)
– prevent relapse
– psychoeducation (awareness raising; boost personalise insight; normalise]
– medication: understanding & adherence (role in management; side-effects)
– mood tracking

9) WHAT HAPPENS IN A THERAPY SESSION?
– structured with an agenda [ASK: WHAT WILL W E PUT ON THE AGENDA? WHAT IS YOUR MOOD CURRENTLY?]
– homework is a key component [Review]
– assessment and tracking are common & guide treatment
– mood monitoring systems (mood diary)
– thought records [TO AID IN THE CHALLENGE OF NEGATIVE THOUGHTS]
– activity logs
– tracking of behaviours for change [practice of new skills]
[WE MEASURE DEPRESSION THROUGHOUT THERAPY]

[TOOLS – PENCIL & PAPER; APPS]

10) TOOLS:
– mood chart (daily tracking of mood, medication, sleep, significant life events) [CAN TAKE TO PSYCHIATRIST, PSYCHOLOGIST OR GP – PROVIDES MORE ACCURATE DATA]
– thought records (assist person in becoming aware of their thoughts, evaluating their thoughts, identifying NATs, correcting and replacing those NATS)
– Psychology research shows that journalling reduces the intensity of negative information, Helps us to solve problems, and clarifies confusing feelings;

11) Online Therapies
Online therapies or self-help courses:
– “This way up” (a collaboration between University of New South Wales and St Vincent’s Hospital) – Provides online courses for people with generalised anxiety disorder, panic disorder and agoraphobia, social phobia, OCD, PTSD, major depression and mixed anxiety and depression

– research has shown 80% of people who complete these courses report benefits
– “My compass” (Blackdog Institute) is a self-help tool promoting resilience and well-being & it contains modules that help you manage mild to moderate stress, anxiety and depression
[Mycompass.org.Au]
– “E-couch” (Australian National University) is a self-help interactive program Aimed at younger adults – It has modules on depression, generalised anxiety, worry, social anxiety, relationship breakdown and loss and grief
[ecouch.anu.edu.au]
– eCentre clinic (Centre for emotional health, McQuarrie University) develops and test state-of-the-art, free online treatment courses for people with symptoms of worry, anxiety including OCD and PTSD, stress, depression, low mood and other health conditions including chronic pain
[eCentreclinic.org]
– Australian government’s “mind health connect” website
[mindhealthconnect.org.au]

12) Meditation
– I exhale worry & inhale peace
– I release tension & accept tranquility
– I breathe out fear & breathe in courage
– I let go of all anger & welcome love
– I release my sadness & receive joy

13) Acceptance
– frustration intolerance [FI] or low frustration tolerance [LFT] – Metacognitive process where you feel you cannot stand something, leading to anger, depression & anxiety. There are 4 types of FI or LFT
1. Entitlement [demand for fairness; insist desires must be met; “I must get what I want” – leads to anger]
2. Emotional Intolerance [negative emotions are unhealthy & therefore intolerable; “I can’t bear to feel this way” – avoid emotional distress, thereby leading to anxiety]
3. Discomfort Intolerance [life should be easy & free if complications; “I can’t stand to be inconvenienced” – leads to depression & giving up on tasks]
4. Achievement Perfectionism [demands, not preferences, for high standards; linked to self-evaluation & sense of diminished self-worth]

Treatment of all 4 requires acceptance of reality – I.e not resisting an emotion, problem or particular situation, but acceptance does not equal resignation. Accept reality, act logically & problem-solve to effect the change you desire. Increasing FT (frustration tolerance) in one domain is likely to spill over into other life domains.

note: CBT program gives people long-term skills

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