Category: Depression

Staying Cool in Summer Heat

By Yoni Sobin, PsyD

In the winter, we face an increased risk of flu and seasonal depression, so we stay vigilant for contagions, stay warm, and keep engaged in activities with others (see my previous article on loneliness – http://www.centerforanxiety.org/2016/12/20/loneliest-time-year/). We typically overlook seasonal risks in the summer, but here are two concerns to be mindful of as the temperatures rise:

Dehydration

Almost everyone knows the value of protecting our skin against the sun, but protection against dehydration is equally important and often neglected. During the summer, the average adult loses over two liters of water daily through sweat (we have over two million sweat glands!) and other bodily functions. And this can impact our mental health – dehydration is associated with mood lability, poor concentration, depression, and anxiety.

A key strategy to combatting dehydration is using mindfulness to observe our body sensations and noticing early signs when we are running low on water. Low-grade headaches or muscle cramps, fatigue, lightheadedness, difficulty concentrating, and reduced urination or darker/yellower urine are some indications.

Behaviorally speaking, drink eight to ten glasses of water daily throughout the summer to facilitate an optimally focused and healthy mind. Eating foods like cucumber and watermelon are also excellent ways to stay hydrated. Sports drinks help restore electrolytes and body salts such as sodium and potassium. And if you’re exercising outdoors, drink at least 6 ounces of additional fluids each 30-minutes, and try to schedule activities in the mornings or afternoons when it is cooler outside. For beachcombers, while catching the sea breeze is a great way to cool down, remember to bring at least two liters of water per person since the sun’s reflection on the water surface significantly increases dehydration risk and ultraviolet ray exposure.

Lethargy

While seasonal depression tends to decrease during warmer months, many individuals still experience depressive episodes in the summer. One reason is that is easy to stay indoors and watch television or read a book in an air-conditioned room, and by contrast, the most effective tools for staving off depression are remaining active and maintaining interpersonal connections.

If you’re feeling blue during the days of sun, try to attend events or concerts outdoors. Go to a beach or find a water-based activity. Attend or even host a barbeque. Take a weekend vacation getaway with a friend or on your own. Google “free things near me today” and do one or two things that pop up. Try one new activity each week. Spend time in nature (while remaining hydrated, of course) and give yourself time to decompress your mind. Whatever you do, engage with your activities mindfully. Take note of sounds, sights, smells, sensations, and tastes.

If the weather is too hot to comfortably enjoy the outdoors and you find yourself binge-watching the West Wing or Big Bang Theory while sitting on the sofa, be sure to take at least a 10-minute break after each episode to walk around the block or call a friend. Research shows that sedentary activities increase depression risk, and punctuating the day with active blocks can make a big difference.

On the whole: While summer is a great time to relax, it’s important to remain mindful and never relax attitudes towards protecting our physical and mental health!

The Science of Acceptance (and How to Get “Unstuck”)

By Aliza Dinerstein, LMSW

Throughout life, many of us experience periods of time when we find ourselves feeling stuck. We may feel stuck in an unfulfilling job, stuck in a conflict with a good friend, or even stuck in our own feelings of depression, panic, or fear. Understandably, our instinctual response is to try everything in our power to fight the reality as it is, in the hopes of rewriting the past and present according to the script of what we feel reality should be. Although on the surface this approach appears to be constructive, it is often the very act of not accepting the facts of reality which can cause us to become even more fastened to the problems that we are trying to rid ourselves of.

What is Acceptance?

Acceptance, the willingness to fully experience reality as it is, is a fundamental aspect of evidence-based psychotherapy. Acceptance and Commitment Therapy (ACT) is a behaviorally oriented approach to psychotherapy that places emphasis on the combination of acceptance and behavioral change. Within the ACT framework, acceptance is considered the impetus of change in regards to our actions, thoughts, and feelings. Similarly, Dialectical Behavior Therapy (DBT) also focuses heavily on “radical acceptance” as a primary intervention for tolerating, decreasing suffering, and increasing our capacity for change.

Why is accepting reality so important?

When we reject reality we focus our energies on trying to change things that are beyond our control, which then causes us to feel stuck and helpless. Non-acceptance leads us to getting tangled up in our distressing thoughts and feelings, and we may notice ourselves trying to undo the past and control the future. Furthermore, refusal to accept our challenges causes us to avoid experiences of pain or fear, and before we know it we are no longer able to do the things that matter to us most. This concept is illustrated with the following metaphor (adapted from ACT): Imagine that you were blindfolded and placed in a large field, and you were given a small bag with some items to help you in the darkness. Unbeknownst to you, this very field was full of large holes, and soon after you began walking around the land you fall into a deep pit. You don’t know how to get out, so you take out your bag and find a shovel. You feel a sense of relief knowing that you have found the “perfect” tool, and you began to dig. However, as time passes, you realize that not only are you still in the hole, but it is actually much bigger. You continue to dig, even more fervently, but somehow the hole just continues to grow… Non-acceptance of reality may seem like the only tool we have, but it only creates the illusion that we are working towards solving our problem while we are actually just digging ourselves deeper into a hole.

How can I start to work on Acceptance?

Here are four steps you can take today:

  1. Accept with your whole self. Instead of just thinking, practice acceptance by engaging your heart and your body, as well as your mind. Use relaxation techniques (such as mindfully counting your breath), prayer, or go to a place that makes you feel calm while you think about the challenge of fully accepting reality for what it is.
  2. Use an acceptance (or self-acceptance) statement. Choose a phrase that helps you feel closer to accepting reality such as “this is what it is”  or “I accept myself as I am.”
  3. Fake it until you make it. List the things you would actually do if you were more accepting, and then act as if you have already accepted the unpleasant realities in your life. Choose one thing on the list and do it each day, even if you don’t feel motivated in the moment.
  4. Ride the wave. Allow sadness, disappointment, and/or grief to rise within you, while acknowledging that life can be worth living, even with pain. Often, after the emotions heighten they will naturally fall again, just like a wave.

Accepting reality is both a choice and a skill. The more we engage in the practices of acceptance we can build resilience to handle life’s challenges without getting “stuck,” and increase our capacity to not only tolerate difficulty but to grow through it as well.

Teen Mental Health: What Dialectical Behavior Therapy (DBT) Can Offer

By Thanos Nioplias, MA

Anxiety and depression are clearly on the rise among teenagers. And it’s not only psychologists and educators who are concerned. Everyday conversations among teens focus on how stressed and anxious they feel, and the press has recently written extensively about mental health struggles that young people face. Time magazine, citing compelling clinical research and personal accounts, recently described the modern teenager as “fragile, less resilient and overwhelmed”.

What is wrong with our teens?

The modern teenager has been impacted by technological advances unlike any previous generations. At any given time, our teenagers are glued to their screens. As a result, they are exposed to plenty of negative information, some of which is genuinely terrifying and even horrifying. They are also constantly comparing themselves to others on social media where they are exposed to images of idealized bodies and lifestyles, which leave them feeling excluded, lonely, and dissatisfied with their own abilities and accomplishments. But perhaps the most insidious negative impact of screen-time is that teens are less focused and less present-minded than ever. As a result, they are less likely to naturally recognize and regulate their basic needs and emotions. All the bright lights and limitless scrolling are so distracting that many have no clue what they need themselves to maintain emotional wellness. The worst part about the above is that it has become completely normal for kids to use technology for hours on end each day.

As a result, we have a serious crisis. It is almost expected that teens today are moody, lacking in confidence, insecure about their appearance, filled with worry and concern about their future, and that they have been exposed one way or another to alcohol and illicit substances when interacting with peers. It is also very common for teenagers today to experience significant depressive symptoms including pervasive sadness, apathy, complaining about life being “hard and overwhelming” and even thoughts about suicide. Equally common are bouts of anger, which are frequently followed by apathy and seclusion, as well as failure to complete academic work and/or maintaining meaningful hobbies and interests (aside from scrolling on their phones). Also common are possession and frequent use of alcohol and drugs, and frequenting places where these substances can pose a threat to wellbeing. Worse, a staggering number of teenagers engage in self-injury and have significant, active suicidal ideation. The majority of the above symptoms – while common – are clear red flags that warrant professional intervention and care.

Can therapy help our teenagers become more resilient?

Dialectical behavior therapy (DBT) is a comprehensive, evidence-based psychotherapy originally developed to treat self-injury, suicidality and other high-risk behaviors among individuals with Borderline Personality Disorder. More recently, DBT skills groups have been modified to help troubled teenagers reduce depression, irritability, anger, impulsivity, self esteem issues and overall social adjustment, in addition to self harm and suicidal ideation. A DBT skills group is like a classroom. Teenagers (or adults) come to a 90-minute session each week for approximately six months to learn and practice skills in four core areas.

First, DBT participants learn how to practice Mindfulness, which helps them to slow down, be present in the moment, and simply identify and be aware of their thoughts, emotions, and urges.

Second, they focus on Emotion Regulation, which involves learning how to change their feelings such as anxiety, depression, anger, etc.

Third, they learn Distress Tolerance skills to manage impulsive and other problematic behaviors that can be damaging to themselves and others.

And finally, they learn strategies to build and maintain Interpersonal Effectiveness in order to improve and enhance social relationships through assertiveness and reducing hostility.

For teens, a fifth component of treatment focuses on Middle Path skills to let go of “black-and-white” thinking and embrace a balanced perspective in their relationships and in their life.

Among other therapies that have been showed to effectively improve teenagers’ mental health, DBT is especially promising in keeping teenagers safe and helping them build a life worth living. Even in our fast-paced and uncertain times, we have evidence to believe that our troubled teenagers can learn life skills, get better, and thrive in their lives.