Cognitive Behavioral Therapy (CBT) Interventions for Depression Treatment and Mental Health

This episode was pre-recorded as part of an on-demand continuing education webinar. CEUs are still available for this filing through the All CEU Registry at allceus.com/counselortoolbox. I welcome everyone's presentation today on social work and business management issues to address

depression

. I'm your host Dr. Dawn-Elise Snipes. We will define the symptoms of

depression

and learn how to ask strengths-based screening questions, and then identify a variety of possible causes of depression and explore activities and

interventions

that can help people address some of the underlying causes of depression. . a set of symptoms, as we well know, and that diagnosis of depression only requires that people have some of the symptoms, so you have three different clients who have three different types of depression. presentations, some have problems with sleep, while others don't have problems with appetite, some don't, some may have more irritability, some have more lethargy, so we really want to be individualized when we offer solutions to clients, and it is necessary remind clients and remind them that depression often indicates the loss of something important, it is more of a situational depression.

People dealing with chronic depressive disorder may not be a neurochemical imbalance. Depression, like any other emotion, is not necessarily bad, can we be guided? We have lost something important and we must also regret it. Can we point out that there may be something curious about the lack of clinical terms that can follow well that may contribute to our body's inability to stabilize neurotransmitters as it normally does? Different things can cause depression. You know that emotions can cause depression. We talked last time about how the fact that most emotions aren't single, we don't just feel depressed, but we don't just feel angry either, we usually have multiple emotions and the emotion we show is like the tip of the iceberg. anger, if we are angry for too long we tend to adopt this negative mindset and if we keep our HPA axis activated due to anger or anxiety we can become exhausted and depleted and we can suffer the effects of increased HPA axis including lack of sleep, so anger and anxiety are two things that can contribute to depression and we don't want to forget those who don't want to help us, just try to feel happier, you know, that's great, but it's not valid in many ways.

We want to look at what contributes to the neurochemical imbalance that causes these symptoms. three other feelings that can coincide with depression we need to look at

cognitive

distortions can contribute to depression if we see the world if we think of the world in terms of things are against us nine is negative we are helpless we are desperate so think what we will probably feel depressed because one of the main characteristics of depression is helplessness and hopelessness, when we see things as all or nothing we can feel very helpless, that is why we are going to talk about how to help people adjust their

cognitive

thinking styles.

Personal relationships, including relationships with oneself, such as low self-esteem, can contribute to depression if people feel desperate to be loved, do not believe they can change, do not believe they will ever be lovable, are un

health

y, and fear Unsupportive relationships cause abandonment and the need for external validation, which often traces back to low self-esteem, can also contribute to depression if you can't look in the mirror and say "I'm good enough" and trust other people. so they can do it if you want. If this doesn't happen because it won't happen all the time, then you may start to feel that fear of abandonment, fear of rejection and helplessness and hopelessness to love physically, neurochemical imbalances caused by a variety of things including weak nutritional depletion, side effects of insufficient sleep medications. traumatic brain injury there are many things that can alter our neurotransmitters depressive symptoms and environ

mental

stress environments that prevent relaxation and rest and increase hopelessness and helplessness also contribute to depression, one of the things we want to do when clients come to our office, and it's one of those culturally sensitive responses, as well as strengths-based responses, ask them what depression means to them, what caused it, where it came from, what they think makes it worse if they say they're depressed you know the people come and say I'm depressed and that's okay, you know you're depressed, I'm glad you're here, tell me, do you know how, do you know you're depressed, what symptoms do you have, what tells you that you're depressed, what symptoms are most common for you and why sleep disorders you may not see as very bothersome, but excessive guilt is something that causes you a lot of problems, but apathy and lack of pleasure will obviously be a problem for many people. , but many clients I have spoken to who self-diagnose depression report that the fatigue and psychomotor retardation or slowing down and difficulty they experience and sometimes pain is more problematic than simply not being able to feel happiness or joy.

Because fatigue, heaviness, and lethargy negatively affect many areas of life, it is important to understand what is most important to the client. How is life more pleasant? Wow, before you get depressed, if people have had multiple depressive episodes, we want to know when you're not depressed, what's different? What is more pleasant when they experience situations l depression due to a loss or a divorce or something that we want to look at, we also want to look at things, maybe they both say, because I got very depressed. I go for a walk five times a week or something, it's a lot of walking but you understand, they were outside and then they caught a lot of things at work and it was raining outside so they couldn't go out for a walk, well it's late now.

All of this because we know that a lack of sunlight and a lack of vitamin D disrupt circadian rhythms and are associated with seasonal affective disorder, which has symptoms of depression, and that gives us some ideas where to start looking for what you do when you're not. depressed How is it different now that you are depressed and how do you hope life will be different when your depression goes away? What things do you want to do again? What things do you hope will bring you joy? to the ultimate goal of what life is going to be, why is it worth making these changes that I have to make or doing this hard work that I have to do because of the hard work of

therapy

and we go back many times to neurotransmitters If the neurotransmitters are unbalanced, for whatever reason people are going to have different symptoms, your neurotransmitters dopamine serotonin norepinephrine acetylcholine gaba serotonin are important in helping people feel relaxed.

Sleep well to help them concentrate and learn things that help them have motivation and energy. Oh, glutamate is the other neurotransmitter. I knew I was forgetting one to help modulate your pain to prevent irritability and agitation, and you know, neurotransmitters are also very active when the HPA axis is activated, cortisol is released, which causes the release of glutamate and norepinephrine to prepare the person to fight or flee. when these neurotransmitters are out of balance for some reason, then people are going to have to struggle with some of these very basic life problems or tasks, if you remember the hyperactivity of the HPA axis now, the HPA axis is just the short term for the system Our body's stress response when overactive, causes the release of inflammatory cytokines that we have already talked about.

It's really meant to help you. You know why your inflammation is useful. The HPA axis activates when there is a threat and immediately in the acute phase of this HPA axis activation, cortisol actually works as an anti-inflammatory, which is great, and when the threat passes, the HPA axis causes the body to secrete inflammatory cytokines that are supposed to circulate throughout the body find something that was possibly damaged increase the inflammation and help it, you know, bring blood to that area to feed it and help it heal well when the HPA axis finally activated for too long, the body says, okay, we have a repair, you know, the cortisol still says hello, but I have to start repairing the body, you know, and move forward, although the stress will remain and think of a soldier in a war zone in sometime, it's not like you know they come out. , they fight a skirmish, come back and just start.

You know they're drinking coke or beer or whatever, and everything is relaxed, they're moving, but their body still needs to recover, even though during that time they can't relax because it's not safe to relax completely. relax when the body secretes those inflammatory cytokines. One of the other interesting things that happens is that it causes symptoms of depression and we know that there is a strong correlation between depression and inflammation, and one of the reasons is that the way the body breaks down tissues and everything that it still needs happen, and to create energy to repair whatever is damaged, so the body diverts energy from other things like mood to help the person repair their body, so they may feel lethargic, they may have an activity reduced movement or psychomotor delay as the DSM calls it.

This can change food intake and increase the need for sleep, now they may not sleep, but they have a greater need for sleep, and this is all because the body is trying to use energy to save. They say we have to get energy from somewhere, that we can't relax, that we have to draw on energy reserves to repair broken things. What can we help people do now? We'll talk about some cognitive

interventions

in a few minutes, but let's start with basic lifestyle medicine, now on PubMed it's called lifestyle medicine interventions to reduce activation of the HPA axis and allow the body to relax and not use energy . to stay awake and use the energy to recover so you don't have to borrow from a bank account.

That's all you know, it's blank, sleep well and you'll see all these hyperlinks in the PowerPoint. These are all the studies that you know that highlight these different points and you see that there is a lot of blue on this slide because there is a very strong connection between crazy school and crazy temperament. people need quality sleep lack of sleep increases the risk of major depression and major depression increases the risk of poor sleep it's this downward spiral that we need to help people figure out how to break that sleep disturbances contribute to inflammation and major depression and greater activation of the HPA axis changes or creates sleep deprivation, and we see that after someone is sleep deprived, they have an elevated HPA axis, which makes us think about why someone is sleep deprived.

I did not sleep enough last night. They wake up and say it's daytime, it's time to be alert and there it is. Cortisol levels are a little out of whack, the HPA axis is saying, oh, you need energy, I think I need to rev it up a bit to help you. have energy, so the HPA axis speeds up, helps people create a sleep routine, reminds or educates them about the problems of blue light, especially within two hours before bedtime, and includes no only on your digital devices, but also on your ceiling lights if you have a lot of cooling or daylight bulbs in your environment that they use up; encourage them to think about switching to at least softer white light bulbs, if not to bulbs that have a slight yellow tint, reduce stimulants, including caffeine and nicotine, before bed, encourage people to turn on pain, say we didn't sleep well, right? you're in pain or you know you have a sprain in your neck or your bed isn't comfortable my dog ​​was in bed the other night and somehow she managed to get into a king size bed little dog she's 30 pounds now but her A small dog still made me kick to the edge of the bed and I sleep in this twisted position and feel very uncomfortable.

I don't want to go to so much trouble at 2:00 in the morning or whatever, I was sleeping well at the time, not because I was uncomfortable and it was just a slight discomfort when you're talking about someone. whoever has chronic pain has fibromyalgia is something like that so it can be worse if you have an upset stomach and I think a lot of us have experienced that you know you eat something that's a little bit different at night and your stomach gets queasy before you go. to sleep and you have a small stomach pain, do you wake up or disturb your sleep during the night?

If you have a fitness tracker, you can watch your heart rate overnight and get an idea if you may have experienced pain. I know that when I'm overtrained or if I'm in pain, I feel pain. For some reason my heart rate tends to be a little higher, it tends to be 10 to 15 beats per minute all night long, and that tells me I'm probably not getting a good night's sleep.restorative, apnea is repeatedly associated only with increased activation of the HPA axis and increased cortisol levels, but also increased depression, continuous positive airway pressure or CPAP machines are very useful in reducing apnea problems, we urge people to improve their sleeping environment.

Many people don't think about the fact that their spouse snores, it can impair sleep and I recommend that everyone sleep in separate rooms, no, not necessarily, but I recommend considering earplugs if your partner snores or others snore or if your dog snores, It is helpful to encourage deep sleep if you can have a quiet environment. If you live in an area like New York City or somewhere where there is a lot of street noise, your windows cannot be opened fully with a white noise machine, it can be very useful because at least it's the constant noise, whether it's the only my daughter has crickets chirping, she goes ahead and it's her white noise and it works for her, she's used to it and she goes to sleep, we want to make sure they get rid of the allergens.

HEPA filters are very useful in hypoallergenic pillows to help keep something from waking up in the middle of the night, but they also found a connection between allergic rhinosinusitis. noses and bad sleep and depression it is important that you can breathe when you sleep, even if it is not due to apnea the light in your sleeping environment, your sleeping environment should be as dark as possible and if for some reason there is light red light something that does not have the blue colors and a yellow light even better to maintain your night vision and not make your brain think it's time to get up if people have night terrors or children who are afraid is that the dark has a tap light next to their bed, something they can easily reach and slap, you know, if you have a lamp next to your bed and you have to try to find a little gnarly thing if you're stressed if you're scared it's because I've had a nightmare that's not going to work, but if you have something that people can reach and generally overcome, it's a reasonable compromise for presentation and temperature issues.

Now that there are beds you can get, it is expensive and can help regulate temperature. I don't know how well it works. There are some that have a tube that goes up under the sheets and blows out the air. all night under the covers to prevent you from getting hot and sweating. Anything you can do to regulate your temperature is also helpful, and the temperature that's comfortable for you to sleep varies among people I like. I want to sleep on the much cooler side, while some people like 68 to 72, I think the Sleep Foundation recommends other factors that can affect shift work, it takes people at least 30 days to adjust to a change and shifts, and it can only be a change of shifts, don't you know? moving from the morning shift to the midnight shift, it is important that when people are on a shift, they maintain the shift even on their days off to stabilize their circadian rhythms, and sometimes it is not realistic for a lifetime outside of work of people and are not willing to do it and it is important to encourage them to think about what changes they can make or are willing to make while they are in the recovery process, to help them alleviate their depression. is going to change today, would you know that the first thing we can ask?

If people travel between time zones, pilots are a perfect example of this: they are at much higher risk of depression because they approach Dian rhythms if they start on the East Coast and at the end of their day in California, their rhythms circadian rhythms will go completely haywire and then they fly out the next day and land in Nashville, splitting the difference to help them understand the importance or impact of changing time zones on their circadian rhythms and prompt and encourage them to figure out how they want to deal with this, such as if I didn't say that everyone will be able to change something that a pilot can't say well, I can only fly on the east coast, but what?

What can they do and allow them to be creative? Safety and post-traumatic stress disorder. I gather people together when they go to sleep. They want to be able to relax. People who have a history of PTSD feel that they are safe, not to be safe. which negatively affects sleep quality and can contribute to co-occurring depression, helps people feel what they need now, emotional support animals are very helpful for this. There are a variety of other interventions that can be helpful, but it all comes down to asking the person what will help them feel safe when making their eyes interesting enough that antidepressants can also cause depression.

Actually yes, we know that antidepressants are not a panacea. No. You know some of the drug companies want us to think that they work for twenty or thirty percent of the population, but for the other sixty or eighty percent, seventy or eighty percent, antidepressants may not be super effective. Additionally, many antidepressants with activating effects, such as Prozac, are known for their activating effects. People suffering from depression and fatigue are supposed to have more energy, which can disrupt sleep. They found that people who take it may have less deep sleep because it hyperactivates antidepressants with some sedative properties.

Antidepressants like paxil, which tend to make people drowsy, can make sleep improve initially, which is really great, but can cause problems in the long term. deadline due to deafening conversations with clients that encourage them to defend themselves to their doctor about what works. they take this medication and it helps them sleep, but they just can't wake up for the rest of the next day and drink coffee, which defeats the purpose and probably causes more problems motivating them. Sometimes doctors start by changing the dose. The time my stepdad took Paxil at night before he went to sleep because it helped him get sleepy and then he took it early in the night and when he woke up at 12 later it wasn't as prominent in his system and it doesn't have much of an effect soothing, so sometimes it can work.

People may want to consider trying another antidepressant, as there are dozens of them, and they encourage patients not to give up if the first antidepressant doesn't work for them, but they feel that what they need is relaxation, another non-pharmacological form of reduce HPA. Axis Activation Biofeedback has been repeatedly shown to be very useful and can be as simple as getting a fitness tracker or chest strap that monitors your heart rate and encouraging people to spend some time lowering their heart rate. . You already know deep breathing and you see how if they breathe deeply and slowly their heart rate decreases, they begin to feel a sense of empowerment because they realize that they can control some of these symptoms, if they feel anxious they have a sense of personal well-being. effectiveness.

Okay, I'm hyperventilating here, I need to belly breathe and I need to focus on slowing down my breathing because that will slow my heart rate down in the personal control sense. Oh, if your body does a lot to reduce feelings of helplessness and hopelessness, it helps. Also, to reduce any activation of the HPA axis, once you know if someone gets anxious, we don't want them to stay anxious for four hours because that will contribute to depression. We want to help them know that that is good. I feel angry. I feel that feelings of anxiety are normal that the HPA axis kicks in, just like the fire alarm goes off and says, check if there is a threat, but with biofeedback that allows you to check and then progressively relax, muscle relaxation, meditation and yoga.

It has been shown to help reduce activation of the HPA axis and reduce symptoms of depression. Relaxation

therapy

offers everything from art therapy to playing ball and checkers, everything that is recreational and can be fun. People have been shown to divert their attention from a stressor to something. which can be at least mildly pleasurable, reduce activation of the HPA axis, and reduce symptoms of depression. The forest and ecotherapy are also very useful in reducing depressive symptoms in adults. I haven't seen any studies on children, but it encourages people to be exposed to nature, to get away from digital things, to get away from TV and to get out into nature, because nature tends to slow down and people tend to be slower. more relaxed when they're out in nature in the woods, you know, walking or even just through a park where there's a lot of vegetation, they've found that there's a pretty positive correlation between the amount of vegetation and nature and the mood of people.

So it's an interesting little side effect, because people can make their home environments a little bit more environ

mental

ly friendly. If you have a place in your house, most people have a place to have some plants or a window that overlooks a small area, it doesn't have to be this hug. We are also looking forward to this little garden area that you can appreciate. We also want to discuss other side effects of medications and we often forget to consider these things when dealing with people. We've already talked about psychotropics, and there are many other psychotropics available on the market, atypical antidepressants, atypical antipsychotics tend to be extremely sedating for people.

Some people will experience rebound anxiety when using benzodiazepines, which may contribute to their depression. People are the best judges of which medications work best for them and which ones make them feel worse, and we should listen, but there are other things you don't even know that are identified as mood-altering medications and have been associated with increased risk. of depression in people. . Beta blockers used for high blood pressure statins used for high cholesterol anticholinergics well, you are as we should. These are the most beautiful and ubiquitous Lee actually for bladder problems, Parkinson's disease, COPD, asthma and dizziness to name just a few, it can also be used for allergies but it is important to note that some of these physical conditions are people. getting medications because we need to understand the impact of those medications has a state of mind where they may not be able to stop taking them, but we need to help them determine if it's okay to start taking this statin.

My mood is in the bathroom. I know with motion sickness medication. In my state of mind I can tell you what I can't take because I'd rather get motion sick than feel the way I feel after taking everything. Dramamine, not everyone may be as sensitive, but it is important for people to understand what is causing it and talk to their doctor about how to treat it. Opioids depress the system, which tends to slow breathing. They make the pain go away, but have many other side effects. If we don't breathe enough, if we breathe shallowly, we tend to feel slower and more tired.

One of the symptoms of depression is that corticosteroids such as prednisone increase people's risk of developing depression. , as well as certain antibiotics that are also new levofloxacin and ciprofloxacin ciprofloxacin since cipro most of us have taken or are familiar with both, is unique in relation to depression, which can mostly cause or worsen depression, are there other alternatives to antibiotics if your clients are sensitive to them and then contraceptive or hormone replacement therapy and this is specifically for women who have not encountered depressive side effects of testosterone therapy, but people with low testosterone have experienced symptoms of depression, but people taking contraceptives, including implanted progesterone contraceptives, have greater depression.

Some people are more sensitive than others to improving their nutrition, remember that the neurotransmitters that help us feel happy, focused and energized are made from the foods we eat if you don't eat your brain or your body doesn't get what it needs. make neurotransmitters good. warn clients, beyond apathy, they may not have good access to nutrition if they do not know how to drive, because they have lost their license, because the nearest store is about 20 km away, because they are older and for any This is why they are afraid to drive and move because they cannot consume.

There are many places that deliver fresh food, as well as places like Mobile Meals that can deliver food to CONDO people. Affordability is another thing that prevents access to good nutrition. Their

health

iest foods tend to be the most expensive, unfortunately we need to help people figure out where I go, my money for nutrition, where I can spend my grocery budget and ENCO encourages them to learn how to grow their own vegetables; We can grow many hydroponically using the key crack method is the KR 81452 sprout, so that's something else you can consider. I don't really like the taste of thesprouted, they tend to taste like te tate a te rata, for me she is, but some people like them, and if they are willing to germinate and eat them, someone can do it, take one. scoop every day and a little time.

Some people don't have access to good nutrition because they don't know how to cook and yes you can buy some frozen meals and things like that, it's a little knowing what they have, they're colorful, but people can get bored with what and frozen meals tend to be. masks; we can help them learn to cook rice and beans; we can help them cook affordable healthy meals there; It's not that hard to encourage people, and yes, planning ahead also helps you eat more economically and healthily. is hungry, we tend to want something that is real; We can do it quickly and rice and beans is not something that can be cooked quickly unless you have precooked the rice and precooked the beans.

That's what I do on Sundays, I pre-cook pasta, rice, beans and lentils. I'm a meatless vegetarian, and during the rest of the week I can throw things together to make different kinds of dishes and stews and stuff, so planning ahead definitely helps get people excited. It is also useful to cook and do group activities. This is a great activity for recreational therapists to help people learn different dishes, so they can prepare different barbecue bowls, you know, if you want to eat on one plate, so there is less to clean up, it encourages people To do it.

Know the nutritional basics, your macros, your proteins, carbs, fats, you know these are the most important things to consider since most of our neurotransmitters are made from proteins. Hey, it breaks down different proteins, but to break down proteins, they need vitamins and minerals like calcium, iron, zinc and selenium from other foods, but you can't eat proteins alone, people have to eat colorful foods. I have three colors on my plate during every meal, hydration with just 2 percent dehydration, and you don't even feel very thirsty if you're 2 percent dehydrated. 2% dehydration has a negative effect on your feeling of energy, your mood, your short-term memory and attention span drink water, preferably clear water with a little lemon, if you want to encourage people to Think about ways they can start drinking more fluids, especially unsweetened, caffeine-free, and ideally non-carbonated fluids, aspartame has been associated with. and we know that since NutraSweet has been associated with increases in headaches and irritability in certain aspects of marijuana, certain segments of the population are not all going to experience it, but some can, so if people have been eating a lot of aspartame , It is important. so they are aware and if you look at the side of drinks like Crystal Light and things like that, a lot of them unfortunately still contain Nutrasweet and it will be important for customers to recognize how NutraSweet affects their mood. your energy and if it gives them headaches the people who stopped drinking it were drinking it, you know, they had a weekend where they were with their in-laws or whatever, they drank a lot and then they came home and went back to take it. a different zero-calorie sweetener, they may also start to get headaches and feel lethargic.

Detoxifying your body is the aspartame leaving your system again, not everyone will experience this but it is one of those triggers worth noting because it affects a large portion of the population. addictive behaviors alter dopamine, serotonin and norepinephrine levels, and different addictions alter different neurotransmitters, stimulants will increase that dopamine, your norepinephrine and your glutamate, they will get you excited and then you will crash, depressants tend to increase gaba levels. and dopamine in our systems, alcohol is an interesting thing because initially it serves as a depressant and relaxant, but then when it leaves the body it actually causes anxiety, the body can't keep up, it leaves faster than the body can secrete gaba. to balance it out, so we see people experiencing anxiety in this detox, at the extreme of sobriety drinking alcohol, gambling and gambling produces pleasure, produces excitement, excitement means increased HPA, activation of activation, increased cortisol levels, you know you're trying to win that game whatever it is, which can also result in a bit of a dopamine hangover the next day if you want to think about it that way.

The same goes for sex and pornography in an addictive way when used in an addictive way when used too. It can greatly alter the levels of neurochemicals in the brain, which can contribute to mood disorders. The thyroid also affects mood, libido, and energy levels, as well as estrogen and testosterone. It is not difficult for people to go to the doctor and get tested for sex hormones. and your thyroid hormones to see if they are in balance, even if they are in balance and trading in the normal range, not everyone feels good when their hormones, whatever hormone it is, are in the normal range, especially if they are in the lower end of the normal range.

The lower end of normal may be fine for some people, but may be too low for others. Having clients learn the numbers and know where they feel good and where they don't feel good can be important and working with an endocrinologist who understands that. You know that the normal range is just a guide and not everyone feels good. Many of their newer doctors are beginning to understand that those ranges are simply guidelines. Cortisol is that hormone that is released by the adrenal glands and during fight or flight. Situation in which the HPA axis is activated, it helps the body adapt to stress by increasing heart rate, breathing and blood pressure and by affecting serotonin and norepinephrine levels.

Cortisol alters norepinephrine levels. It alters our serotonin levels. Norepinephrine and serotonin are two of the main neurochemicals involved. In depression, what are our antidepressants, SSRIs, selective serotonin reuptake inhibitors, and SNRIs, selective norepinephrine reuptake inhibitors? So for monkeys, and with any of them, we are likely to affect our mood. Normally, cortisol levels rise early in the morning to prepare us to meet requirements. demands of the day and they gradually decrease throughout the day this is our circadian rhythm not only does cortisol do this but our circadian rhythms influence are feeding hormones are sleep hormones are stress hormones everything we want to make sure that We pay attention that DHEA can also impact our mood DHEA naturally decreases in people as they age, it does not mean that everyone should take a DHEA supplement and over-the-counter supplements are between one hundred and five hundred times stronger of what your body really needs.

In 99.99% of cases, this is another one. I wouldn't recommend people try to self-medicate, they really need to see an endocrinologist, but other than that, if DHEA levels are low, then their libido and sexual arousal may be low, they may have low motivation. They may not have a great sense of well-being, they may experience more pain, they may not sleep as well, and they may have difficulties with memory and immune system function, so there are many symptoms of depression that are related to levels of DHEA, so we're seeing how depression itself is not such an easy thing to treat.

Have people have a physical exam to address what may be causing any imbalances. Encourage them to talk to their doctor about eating a low-glycemic diet so that their blood sugar doesn't go up and down all the time, which can make them feel fatigued, and remember that the less sleep they get, the more your cortisol will be, the more you sleep within reason, the lower your cortisol will be. Deep sleep tends to reduce cortisol levels, rapid eye movements, sleep not as much, so we want to make sure people get a good night's sleep. Hormonal imbalances affect millions of people and the symptoms of hormonal imbalances are very similar to depression and include feeling anxious tired irritable weight changes not sleeping well changes in sexual desire focus and appetite causes of hormonal imbalances include poor gut health inflammation high amounts of genetic susceptibility to stress, you know, we know that exists and toxicity from heavy metals and other chemicals, if people try to eat relatively healthy and drink enough water, they can minimize some of those things.

Natural

treatment

s include eating an anti-inflammatory diet consuming enough omega-3s sleeping well exercising and managing stress, so these are some of our lifestyle factors that can help people experiencing pain need help. control that and you can do it with exercise guided imagery progressive muscle relaxation which I already talked about that alternative approach when we have pain, if we focus on what hurts, we're only going to exacerbate that if we try to focus on something else, then it can help divert our attention. I always go close to my ear when I do this demonstration because when my ear hurts, which is like one of the worst pains I think exists in the world and if I can concentrate on something else it helps me tolerate the pain a little more therapy physiotherapy hydrotherapy that It's you know, water baths or hot tubs, ice or heat, hypnosis and EMDR have also been used effectively for pain.

We may not be able to help our clients eliminate their pain, but we can help them identify problem-solving strategies to mitigate their pain and help them. address their cognitions around pain if they have cognitive distortions such as: I will always be in pain. I will never be able to feel free of pain or you know any of the all or nothing or exaggeration things that I can't tolerate. This we can help them work. in their distress tolerance skills and their distress tolerance language and changing what they tell themselves you know this is agonizing I'm going to die that's not going to help you feel better thinking about it on a scale of one to five and how much better he feels today than yesterday.

It can help you get over it. That's what I do a lot of times when I've had surgeries. I had foot surgery once and instead of focusing on how much it hurt that day. I just focused on how much better I felt each successive day and you know I quickly felt much better, but I had a good surgeon: Anger, Resentment, Jealousy and Guilt B, a whole family of angry emotions pushes people away and asserts dominance or control, but Excessive anger can deplete our stress response system. Contribute to negative thoughts. We begin to see everyone against us. your depression, if you feel depressed, my grandfather, I would say, had simultaneous depression and anger issues, you know, he was just angry at the world and felt hopeless and helpless and was in pain all the time, bless his heart, Do you know if we would do it?

He knew then what we know now, but he just had a hard time seeing the good in anything because he was in so much pain and felt so powerless to help people change their cognitions and focus on what they do have control over. To address your anger, anger is a natural emotion and if there is a threat, people need to figure out what am I going to do to add to it and make it better in the next moment, if there is something worth being angry about in terms of something that It can prevent you from achieving a rich and meaningful life, so what are you going to do about it?

I'm not saying to suppress anger. I'm saying accept it, accept it and say: okay. I feel like there is a threat right now. I'm angry. What are you doing? I need to do that will help me achieve my goals and stay angry. I will do anything to help me achieve my goals. Encourage people to pay attention when they are angry. What do you notice? You know, and a lot of us are angry. days when you have an angry day think about you know what you noticed that day you noticed the clouds you noticed the birds singing you noticed whatever for me I noticed the best on the baseboards I noticed the dishes in the sink I noticed the fingerprints on the window I can be a little obsessive-compulsive at times but I notice things that irritate me when I'm in a bad mood unless I make a conscious decision to say you know what I'm going to spend 10 or 20 minutes focusing on the good things you know and trying to get out from that spiral of negativity helps people identify what the triggers for their anger are so they can prevent or minimize them and develop a plan to address the triggers and feel more confident and empowered, for example.

If you're on Facebook and someone puts something nasty on Instagram, puts something nasty on your wall or your whatever they call it on Instagram, if that triggers your anger, one of the things you can do is make your profile private and only allow that thepeople you know, your trusted people, post on them because generally your friends won't be hateful and if they are, you can block them, but there are strategies you can use to feel safer since you can't control other people. you have to control yourself and you have to control your environment so that your online space so that your space at home so that your space at work feels safe and you feel empowered in those areas anxiety is the other half of running away or fight or flight Chronic anxiety, worry, or just plain old stress will deplete the stress response system, causing neurochemical hormonal imbalances and increasing muscle tension and pain.

When our HPA axis is elevated, our body now is not the time to reproduce when it says that, because you know it's time to reproduce. Fight or flight then alters our sex hormone levels and we already saw that altered sex hormone levels can contribute to depression. The body under chronic anxiety adapts to its excessive stress by often turning off many of the cortisol receptors because it says I can't be this fast all the time I can't be this hot all the time or I'm just going to break down and that causes distance. Riz glucocorticoids or hypercortisolism, which is bad, anxiety also makes it difficult to sleep, which contributes to exhaustion, hormonal imbalances, and ultimately depression, grief is another one of those feelings that doesn't fit right anywhere, It is the sadness and depression experienced as a result of a loss.

I'm not saying grief is bad, people grieve, you know, it's okay, we want to. to help them grieve in a healthy way and move forward in that process towards acceptance, happiness, you can't be happy and depressed at exactly the same time, you can have things happening in your life that make you happy and things that happen in your life that make you depressed, but at any given moment I don't think it's possible to be happy and depressed at the same time, so if we want to increase those happy chemicals and increase our feelings of happiness and increase serotonin and norepinephrine and do things that make you happy listening to comedians watching your kids watching stupid cat videos I do that you know what will help you feel happier negative thoughts Styles contribute to burnout and highlight what is out of your control, increasing a feeling of helplessness and hopelessness, it encourages people to try to put on those rose-colored glasses and try to see the positive, try to see the positive side of what's happening and sometimes at first it will feel false.

But if we can encourage them to accept the good and the bad, they will be able to notice more than just the negative in life. Low self-esteem contributes to self-hatred, shame, and a feeling of unloved worthiness. It negatively impacts relationships, creating that self-fulfilling prophecy of loneliness and rejection and often causing a person to seek external validation. There are tons of books on how to improve self-esteem by encouraging people to examine their self-esteem, one of my favorite things to do. is having People write down all the characteristics they look for in a best friend and then when they're done doing that, they are asked to look through that list and find out what characteristics they have in themselves.

You know it's an easy way to do it where people don't. I don't feel like they're bragging because they're talking about a best friend and then all of a sudden I throw it back at them. Negative relationships can also affect self-esteem, contributing to fears of abandonment, maintaining high levels of stress and feelings of helplessness. If you feel like you have no control in your relationship and you never know if this person will just leave, you know that. that contributes to a lot of anxiety when we can't develop healthy supportive relationships, so we don't have that social buffer and we know from adult attachment theory that while we don't have the same type of attachment that we have with our primary caregiver as children. , in adult attachment we do form attachment bonds with many other adults who fulfill similar functions they help us feel safe they help us rejuvenate in our lives high-stress environments prevent relaxation and rest they increase hopelessness and increase stress hormones and decrease relaxation hormones encourage people to design a low-stress area in their home, workplace, or school It's not the easiest thing to do at work or school, but if you can, it's cool, maybe there's a park bench somewhere they can sit on or something.

Identify ways to reduce stress in the environment in both places by adding positive sounds. negative noise avoid interruptions have good lighting that is positive uplift and remove anything that might trigger negativity thoughts or feelings and add things that add positivity, whether it be pictures, smells or colors or a favorite fluffy blanket, whatever the depression may be , the set of symptoms created when there is a neurochemical imbalance in the brain, that is what causes the imbalance, it can be emotional, it can be cognitive, it can be physical, interpersonal, environmental or some combination of the above, and we want to help people to recognize that depression is a symptom.

Part of the strengths-based approach means helping people see what they are already doing to prevent or treat symptoms and examining all the causal factors that recognize the reciprocal nature between things like sleep, environment, and mood. Is there any question? Okay, everyone, giving you quite a few probably unique ways to think about how to approach depression

treatment

plans with clients. And see you now, remember next week. We're going to do it Monday and Tuesday again because I have to go to Chicago again. I'm almost done with that contract, but on Monday and Tuesday of next week everyone have a great weekend and try to stay warm.

We're supposed to arrive at 4. Here tonight, between writing notes, filing insurance claims, and scheduling with clients, it can be difficult to stay organized, which is why I recommend therapy notes. The easy-to-use platform allows you to manage your practice securely and efficiently. Visit com2 therapy notes and get two months free. of therapy notes by simply using CEU promo codes when you sign up for a free trial at Therapy Notes com. If this podcast helps you help your clients or yourself, please support us by purchasing your CEUs at all CEUs at Calm or by having your agency sponsor an episode a direct link to CEUs on demand for this podcast it's all CEU dot com/podcast CEU that's it CEU quiet / podcast CEU to sponsor an episode of the counselor's toolbox and reach over 50,000 doctors per week go to all CEU dot-com / sponsor thank you