This mindfulness practice is a good introduction to meditations and mindfulness in general, especially if you have a hard time with some of the more formal practices. It can help you get present just by focusing on one part of your body – your hand (alternatively you could use any part of your body that you can see fully, including using a mirror to do so). Mindfulness is mentioned by Dr. Richard Harris in this podcast episode as being beneficial for chronic pain and illness. For all of my meditations, subscribe to my YouTube channel. Be mindful, and keep making the most of it!
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Okay so I’m going to acknowledge that this blog post might be a little divisive. But if I look around at our society right now, most issues regarding health are. This is probably more of an opinion piece than many of my posts, which I do research (yes, I read scientific journal articles to make sure I get the facts as straight as possible for all of you). I did a post (and a podcast episode) about the guidelines that came from NICE in the UK regarding the treatment of chronic pain awhile back. These guidelines were controversial within the medical community itself because, well, they recommend against the use of pain medications due to a lack of evidence that they are effective AND that many of them can be addictive. Doctors, of course, like to prescribe medications.
The recommendations for the treatment were: (1) exercise, (2) acupuncture, (3) cognitive behavioural therapy, (4) acceptance and commitment therapy, and (5) anti-depressants. I recently saw a post on Instagram that linked a petition against these guidelines. The reasoning behind the petition was that it makes it harder for people to get the treatment (i.e., medications) that they need to manage their chronic pain. Much like doctors, most patients also feel like medications are the way to go (which is a fairly western version of pain management – check out the podcast episode with Dr. Richard Harris for an East meets West version of pain management that tends to work better). Now, I’m not saying that pain medication doesn’t work for anyone ever. And I don’t think that’s what they guidelines are saying either. They are saying that the evidence-base isn’t strong for most of those medications, but it is strong for these alternative treatments. The other argument in the petition is that the alternative treatments are expensive and not covered by insurance. I’m going to break each of these arguments down a bit further.
Me during a hike this summer.
So first, whether or not people will still be able to access pain medications. Regardless of these guidelines I find it very hard to believe that most Western doctors will stop prescribing pain medications. Like I mentioned earlier, most doctors were upset by the guidelines in the first place. Also, doctors are trained to prescribe medications, they aren’t trained (literally almost no training) on prescribing alternative treatments. It’s more than likely they’ll go with what they know. They might though be more willing to recommend alternatives as adjunct treatments. This is actually what my rheumatologist did. She recommended that in addition to the medications she prescribed, I seek out alternative treatments such as physiotherapy and naturopathy (and I did and they were helpful). I get why people are upset about the guidelines, especially if they mostly rely on medications. The guidelines do state that for some conditions (mostly CRPS) pain medications do work best (it’s best just to read all the guidelines – AND all the hyperlinks that give fuller explanations yourself – available here).
The second point that alternative treatments are expensive, is true and not true at the same time. Exercise is technically free. I exercise at home – both cardio (walking) and strength training (body weight) and have spent $0 on it since the pandemic started (I did go to the gym before that). But a lot of people with chronic pain are hesitant about exercising (check out the podcast episode with Dr. Frank Nahn). Acupuncture can be a bit pricey depending on where you live, but it is sometimes covered by insurance. I had insurance through work that covered my naturopath, who did acupuncture, for up to $500 a year. That’s about 6 sessions. I’m not saying it’s always covered, but it might be. CBT and ACT, the two psychotherapies listed are along the same lines as acupuncture. They might be covered or they might not be. In the province (Canada) that I live, it is covered up to a certain amount by provincial insurance, or short-term therapy is also covered by the provincial government. There are also self-help versions of these available at bookstores and online. Finally, anti-depressants, again may be covered by extended health insurance if you have that. Also, wouldn’t a better petition to be to try and get governments (or insurance companies) to cover these services for chronic pain and chronic illness patients? Just a suggestion…
As a therapist who went into the field to help people with chronic pain and illness (and their co-occurring mental health issues I decided to primarily use ACT with my clients due to its large evidence base).
I guess what I’m saying is that if you dislike the guidelines because you only rely on medication but also haven’t tried or even looked into these alternatives, then it makes sense that you’d be upset. I would be too! I started using some of these alternatives (exercise, acupuncture, CBT/ACT) long before these guidelines came out and I saw how much they improved my well-being, well over and beyond what my medication has ever done. I also find it interesting that I often see posted online people complaining that their medications aren’t really helping. It’s easy to have some cognitive dissonance here. We want to believe medications will solve all our problems even when we’re acknowledging that they’re not. I’m doubtful that I’ll change too many minds with this post, but my hope is that we at least get thinking about using both holistic approaches (like in NICE’s guidelines) and are medication together so that we can get the best results.
Okay, that is all for this week. Keep making the most of it everyone!
When you have a chronic illness, there is always something that is the matter with yourself. I have chronic pain every day, throughout the day, that ranges in intensity from a 1 to an 8 (though it rarely gets to an 8 nowadays). I can get tired easily, have the occasional brain fog. All that kind of stuff that comes with having UCTD and fibro. I also have to wear glasses or contacts, and not use cold medications when I have a cold because of my glaucoma. But I feel like I have choices. Give in to all of this stuff that is “the matter with me” or do what matters to me. I’m not saying that this is always an easy choice to make, and sometimes we do have to “give in” in the sense that we have to have balance where we take care of our needs, though I posit that doesn’t necessarily mean fully giving up on what matters to you.
Spending time with family is definitely important to me. (Vienna, Austria, 2017)
What this is called is values-based living. You’ve probably read this on this blog before, and heard about it on the podcast if you listen to that too. It really has two parts. First, values. Second, committed action, which yes, even as Spoonies we can do (it’s about allocating the spoons wisely if you like that metaphor). I read a post in a Facebook group recently about someone asking how others with autoimmune diseases manage to go on vacations. They had recently gone on a weekend trip with family and really struggled. I replied that I have gone on trips with my family (Europe), friends (NYC, Europe, Costa Rica), and 2 solo trips (LA, Vancouver), since being diagnosed. Travelling, and adventure/exploration are part of my values, so I’m not letting my illness dictate this part of my life. However, I do plan appropriately, alternate high activity days with low activity days (think going ATV-ing one day, and then lying on the beach the next), and I only go with people who are considerate about my illnesses. But let’s back up for a minute.
ATV-ing in Costa Rica (2019) aligns with my value of adventure!
We need to start by clarifying our values. “Values are words that describe how we want to behave in this moment and on an ongoing basis. In other words, values are your heart’s deepest desires for how you want to behave – how you want to treat yourself, others, and the world around you.” (Russ Harris, ACT Made Simple). I have many values including compassion/self-compassion, trust, loyalty, health (I know that may sound weird to say considering my health conditions, but taking control of them as much as I can falls into this for me), and so on. There are lots of ways to figure out your values. I often give my clients values checklists with a list of ideas. You can also think about your character strengths:
what strengths and qualities do you already have?
which ones would you like to have?
what does all of this tell you about what is important to you?
I also like the magic wand question:
Let’s say I have a magic wand and when I wave it all of your painful thoughts, feelings, memories, and sensations stop being a problem for you. What would you do with your life?
What would you start, stop, do more of or do less of?
How would you behave differently?
How would others know (i.e., what would we see and hear) that things were different for you?
Image from: http://blog.theaawa.org/3-steps-to-finding-your-orgs-core-values/ I would add authenticity, challenge, contribution, creativity, determination, friendships, growth, happiness, kindness, meaingful work, optimism, openness, resilience, and self-respect to the list I’ve already mentioned for myself.
Once you figure out what’s important to you, you can move on to the committed action piece of the puzzle – doing what is important. “Committed action means taking effective action, guided and motivated by values. This includes physical action and psychological action. Committed action implies flexible action: readily adapting to the challenges of the situation and either persisting with or changing behaviour as required. In other words, doing what it takes to effectively live by your values.” (Russ Harris, ACT Made Simple). I think the last part of this – the flexible action part – is really important for Chronic Illness Warriors. There are often ways we can adapt in order to live by our values, sometimes we just have to be creative. Some of this action might actually be uncomfortable for you, at least at first. It might challenge your thoughts and feelings about your illness, perhaps even your sensations. When I was in LA on my solo trip, I decided to take a surfing lesson because I had always dreamed of doing so. Surfing is super hard! And I wasn’t very good (granted it was just one lesson) and I hit the ground under the water so many times. It was such a challenge to keep going and I was super sore after. But… it was worth it. It falls into my values (adventure, challenge) and while I may not be super keen to jump on it again (I declined taking a lesson in Costa Rica) I’m so glad I did it, and yes, it was worth being sore and tired afterwards.
Post-surfing I was sore but happy. (Los Angeles, 2018)
How will this improve your wellbeing? Feelings of accomplishment, of doing what we love to do, and keep busy with activities that engage in our values have been shown to be helpful for our mental health. And a lot of research in this area has been done with chronic illness and chronic pain. I’m not saying it’s easy, but it is worth it.
Keep making the most of it everyone!
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If you’re anything like me, you may have wondered why pain medications aren’t working well. Aren’t giving the relief we’re told they should. I’ve been taken off NSAIDs because they hurt my stomach – has this happened to you to? I’ve been offered opioids after surgery but decided against it for fear of addiction even though I’ve been in a lot of pain – do you relate? I’ve also tried lowering doses of medications and found they’ve been as effective on a lower dose as they were on a higher one, because I’ve added holistic approaches to pain control – what about you?
Some medications and supplements I’ve been on (and this isn’t even all of them).
There were some interesting recommendations out of the National Institute of Health and Care Excellence (NICE) in the UK that came out of a meta-analysis (review of scientific studies) on treatments for pain/pain management. The part of the study and recommendations that really blew my mind what was that not a single pain medication was said to have enough evidence to support its effectiveness for treating chronic primary pain. Now, I will say that they reviewed about 22 studies per type of pain management – each medication and each holistic approach – that they looked at, so not super extensive but definitely enough to be a good indicator. I’m going to do a podcast episode on the 5 suggested treatments (exercise, acupuncture, 2 types of psychotherapy, and anti-depressants) for pain so stay tuned to the podcast for that episode in a few weeks. On the blog this week, I thought we’d talk about what they said about all these pain meds that we take!
NICE didn’t comment on CBD/Medical Marijuana, other than to say they didn’t really review the research in this area.
Opioids – I know that these are commonly prescribed, and as a mental health professional, I also know that there is an opioid crisis in North America (that being said, just because you take opioids does not mean you’ll become addicted as we need to look at other biopsychosocial factors). NICE states that there is not enough evidence that shows long-term opioid use actually helps with chronic pain, plus they note the risk of addiction (for some people) in the short- and long-term. Conclusion: Maybe not a good idea.
Benzodiazapines and NSAIDs – also commonly prescribed, and as I said, I used to be on strong NSAIDs that hurt my stomach, now I have a less strong one that I’m to take “as needed.” Benzos were cautioned as not being effective for chronic pain, AND leading to poorer functioning. And NSAIDs, these were said to also not improve pain, distress, or quality of life and increase the risk of gastrointestinal bleeding. Conclusion: Maybe not a good idea either.
Antiepileptics (Gabapentinoids) and Pregablin – these are only shown to be effective for neuropathic pain and CRPS. However, NICE cautions that they can be highly dependent and are known to be addictive. Again, one needs to consider biopsychosocial factors, but if you have other risk factors for addiction, possibly not a good choice. Conclusion: Depends on your condition and your risk factors for substance misuse.
Local anaethetics – Short-term use indicates they may actually make things worse, except for CRPS. So again, this might come down to your specific diagnosis. Luckily there was nothing mentioned about them becoming addiction. Conclusion: A go for CRPS but not anything else.
Paracetamol, ketamine, corticosteroids, anaesthetic/corticosteroid combinations and antipsychotics – again there is insufficient evidence for all of these, and NICE cautions that harm could actually come from taking these, though they don’t specify what the harm is. Conclusion: Maybe not a good idea.
I find it best when I combine holistic approaches, like exercise, with Western medicine, like pain meds.
So, what have I done to supplement lowering my pain medications (which may not be that effective anyway) so that I can continue to have better quality of life and well-being? A lot of the recommendations made by NICE and some others. I exercise daily (any movement is good movement if you’re starting out), I eat healthy, I use approaches such as acupuncture, chiropractor, physiotherapy, mindfulness, etc., and I have been to psychotherapy (and I currently use psychotherapy to help others). You can check out NICE’s study here. ALWAYS, check with your physician and healthcare team before changing medications or doses or adding holistic care to your plan. I started by adding holistic approaches first, and then cut back on meds. We are each unique individuals and this information is for psychoeducation/health education purposes only.
This week’s podcast episode is on nutrition for chronic illness – check it out: Apple, Spotify, Web. Everyone, keep making the most of it!
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This month I read the book, Man’s Search for Meaning by Viktor Frankl. The book is actually one of the top selling “self-help” books of all time. I put self-help in quotations because I’m not sure if that was the original intention behind Frankl writing it, but it seems that he might have recognized what it became between the years it was first published in 1946 and his death in the late 1990s. The first half of the book chronicles his experiences as a prisoner in concentration camps during the second World War, including Auschwitz. While this could be just read as an intense, heart-breaking story (and it is), the way that Frankl writes about his life experiences doesn’t come off that way. Instead, you can see his reflection and growth in his writing. It’s kind of hard to explain how that works, unless you read it for yourself. The story is also not chronological but instead jumps back and forth across his timeline in the camps to highlight pieces of the story that are connected to each other in some way.
While I don’t want to give away too much from the story, because I highly recommend that everyone read it, there were two main takeaways that I had from the first half of the book. First, is that if we believe our lives have no meaning, then we are more likely to give up when faced with difficult circumstances – and that meaning doesn’t have to be grand or anything, as the beauty of a sunset or holding the hand of a sick friend can bring some meaning for that day. Of course, as Frankl admits, in the concentration camps there was a huge element of dumb luck that you ended up in this line instead of that line (whereas that line led you to the gas chambers and this one didn’t), but for those with that luck, meaning became important. The other takeaway I had is that meaning is created by each other us, and is different for each person. It is solely up to us what that meaning is.
The second half of the book is about Logotherapy, which is a psychotherapy modality that Frankl (who was a psychiatrist) invented. It was kind of based on psychoanalysis, but with a heavy emphasis on existential philosophy, particularly meaning-making. During the second half of the book, Frankl does tell more stories from his time in the camps, integrating it with his theories about human existence and how helping people find meaning can aid with the treatment of many mental health problems. Frankl is considered one of the leaders of existential psychotherapy. Though logotherapy isn’t really used anymore, as there isn’t a huge amount of empirical evidence supporting it, it has influenced many other existentially-based therapies, including Acceptance and Commitment Therapy, which I practice. My personal beliefs are that life meaning is incredibly important, as are other existential concepts, which all humans ultimately deal with, and our ability to deal with contributes, at least partially, to our overall well-being.
Even if you aren’t interested in psychotherapy or existentialism, I highly recommend giving this book a read. There’s a reason that this is a best-selling self-help book. Many people struggle with finding meaning in their lives, especially at transitional periods, and this book can really open your eyes on how to find meaning, even in incredibly difficult circumstances. There are so many amazing quotes from this book, but I’m going to leave you with this one: “The helpless victim of a hopeless situation, facing a fate he cannot change, may rise above himself, may grow beyond himself, and by doing so change himself – he may turn personal tragedy into a triumph.”
For a podcast episode on meaning making with chronic illness, check out this one. Everyone, thank you as always for reading my posts. If you end up reading this book, let me know what your takeaways were. For now, keep making the most of it!
Today I want to talk about some of the work of Dr. Gabor Mate, because, well, I find it quite interesting. Dr. Mate is an addictions specialist, who has also worked as a family physician and in palliative care. Much of his work and research has been on that body-mind connection between mental health and chronic illness and substance use. He has a lot to say about stress, trauma, and coping and their relationship to chronic illnesses ranging from autoimmune diseases to neurological conditions to skin disorders to cancer. While I’m not sure that I necessarily agree with everything he says, a lot of it does make sense.
The work of Dr. Mate I had heard of before but never looked much into. At my practicum, the other student at my site brought it up. She was interested in his work as someone who wants to work with people who use substances, and she thought I might also be interested as someone who is specializing in working with people with chronic illness (which is currently 40% of my case load!). She was correct that this would be interesting and helpful for my work as a psychotherapist. So let’s talk about some of this work. Dr. Mate asserts that there is a “pathway from stressful emotions, often unconscious, to physical disease” or to break it down slightly differently, “emotional stress if a major cause of physical illness.” Again, he’s talking about a wide range of illnesses, including autoimmune diseases and cancer. There are two parts of this that I found interesting doing some research (and there’s a lot more I want to do yet – there’s a whole book of his that’s on my to read list).
The first part is emotions themselves. For instance, Dr. Mate connects repressed anger to the development of autoimmune diseases. Basically, if you’re not letting your anger out (in an appropriate way of course) and instead, you’re holding it in, it bursts out, not in a fit of rage, but in a chronic illness such as RA or lupus and so on. Tied into this is emotional repression in general. So if you’re disregarding your emotions, whatever they may be, and holding them in, this can lead to illness as well. On his website Dr. Mate gives the example of Lou Gehrig and ALS (and according to Mate, every patient he has seen with ALS), who often disregarded both emotional and physical pain he was in throughout his life.
The second part is trauma and trauma response. It is pretty well documented that people who endure trauma, especially early in life, will make adaptive changes either physically or psychologically, in order to survive. Childhood abuse is one often cited with this. It is also well documented that childhood trauma has a huge impact on adult physical and mental health. Dr. Mate states that trauma in another cause of the range of chronic conditions I’ve mentioned.
So wait, does this mean that every person with pretty much any chronic conditions has either a history of trauma and/or a history of emotional repression? Not necessarily. I watched an interview with Dr. Mate, where the interviewer asked just that (because it’s a rather big claim). The response was that of course, this doesn’t apply to everyone, but it does apply to a large portion of this population. Interesting. So my thoughts on it are this: I have an autoimmune disease. I did not have any kind of significant childhood trauma (I have maybe what I’d call minor trauma) and I have usually been good at expressing my emotions (though I have gone through periods where I’ve been less likely to, those are usually short-lived). Basically, I’m not sure I fall into this category. I also know many other Spoonies who would not fall into this category. That being said, especially through my work as a therapist, there are many people who this does make sense for.
It’s not necessarily the case for everyone. Circa 1988/89.
My main takeaway from this is that to help heal from chronic illness (and I’m not saying cure), one really has to take care of their emotional health. See a therapist. If there’s trauma in your background, that likely needs to be worked through (also just in general for your mental health). If it’s emotional repression, then you need to start to learn to open up (part of my work as an acceptance and commitment therapist is to get people to allow their emotions to be there). The body and mind are connected so we need to treat them as such.
There is such a delicate balance between the body and mind and how they interact with each other. At the core, our mind… or more specifically our brain, controls everything from our thoughts and feelings to our pain levels to basic functions such as breathing. It sends the signals to all the body parts. Our bodies can also let our brains know when we’ve been injured for example. But what happens when there is too strong an influence of one over the other? This often happens in chronic pain, when the pain signals are amplified much more than they should be. Another common problem is the influence of our mental health on our chronic pain. For example, if you have higher anxiety or depression, you might notice that you have higher chronic pain as well. This is part of why I’m specializing in chronic illness as a psychotherapist. The balance is delicate and all parts of health need to be looked after in order for us all to live our best lives.
Let’s look at fibromyalgia as an example, because it is a fairly common chronic pain condition. According to medical research, depression and pain share receptors in the brain. So it’s common for people with fibromyalgia to develop depression (less common the other way around but still possible).Dr. Ananya Mandel (news-medical.net) So treating depression and chronic pain at the same time can be beneficial. A number of antidepressants have found to be in treating both. If you think you’re already on a lot of medication and don’t want to take anymore, then therapy for depression, may also impact chronic pain, especially if you’re clear with the therapist that you’re looking to treat both simultaneously. An even more interesting example is anxiety, which often feeds chronic pain, making it feel worse. Anxiety can increase how sensitive we are to pain, and therefore make the pain worse than it would be without anxiety. Dr. Ananya Mandel (news-medical.net) That being said, having pain can lead to anxiety, and so it is a vicious cycle. In this case, it might be more beneficial to treat the anxiety rather than the pain. As anxiety decreases, pain should decrease as well. Whether it’s pharmacological interventions, or psychotherapeutic ones (though for anxiety best results are always a combination of the two), if you have a lot of anxiety and a lot of chronic pain, it might be time to get a referral to a mental health professional!
I have a diagnosis of fibromyalgia (along with UCTD) and I used to have anxiety. While I do still have chronic pain, it is much less intense than when my anxiety was bad.
Let’s quickly talk about stigma, because while it’s decreasing, I want to recognize that some people still struggle with it. You are not crazy if you seek out mental health help. You’re not abnormal. A lot of things people tell me are normal, or do make sense given their circumstances. Mental health help is not just for the severely ill, it’s for everyone, because everyone struggles. If it’s a family member that is playing into the stigmatization for you, get them to read this post, or heck the millions of other posts and articles out there on mental health and stigma, and who is seeking services for what. And if that doesn’t help, remember that you have to do what’s best for you, not for other people.
If you have more questions about the body-mind connection, I am going to be doing a podcast episode on it in the near future, so feel free to email or DM me (on Instagram) some questions and I’ll answer them on air! Until then, keep making the most of it!
Chronically Living and how to make the most of it – new episodes every Monday!
The concept of the half smile is part of two things I’m passionate about: psychology/psychotherapy and mindfulness. But how can this help people with chronic illness? Surely smiling will make no difference on my health, so why force myself to do this half smile thing? If this is not your first time reading this blog then you know that I don’t write about finding cures, I write about ways to improve the overall quality of our lives. Health and mental health are so intrinsically tied together. If our physical health is poor, our mental health tends to suffer. If our mental health is poor, we are more susceptible to physical health problems. And so, I present to you a small way to improve your mental health, as part of this overall, holistic way of viewing health.
The Half Smile.
In psychology, we look at the half smile as a way to regulate emotions and improve mood. For one, it’s almost impossible to be angry if you’re smiling. Try it. Very unlikely that you can stay mad while having a half smile on. Same goes with many other emotions. Most people have a difficult time at some point in their lives, or just consistently, regulating their emotions. It can be difficult when you’re in the heat of the moment. And there are many, many aspects to learning how to regulate them if you’re currently struggling in that area (and these vary slightly depending on which form of psychotherapy you subscribe to). The half smile is one technique you can try out. It is probably most helpful with anger and frustration, but can work with other intense emotions. I want to caution you and mention that it is not meant to be a way to get rid of your emotions. Emotions are good! It is a way to help get them to be more appropriate in intensity to the situation you are experiencing. The byproduct of this is often mood improvement. Plus, as I’m sure many of you have heard before – it takes more muscles to frown than to smile.
The idea of the half smile originates from Buddhism. Now, I’m not religious, but more spiritual. So if the idea of this coming from Buddhism throws you, I get it. I personally practice mindfulness from secular approach. However, if you look at statues of Buddha, he does have a half smile. And actually, if you look at the Mona Lisa, she also has a half smile, which is interesting. When we are mindful of our emotions, body sensations, facial expression, thoughts, and all other cognitions, we have the ability to control our behaviour. When we are aware, we can be present. When we are present, we can find some peace. When we are peaceful, half smiling comes much more naturally. Sometimes when doing guided meditations, the person delivering them might even suggest a half smile. Notice how that changes the practice for you. For me, I find it helps me become a lot lighter. I also want to point out that there is a lot of research supporting mindfulness being helpful in lessening the intensity of chronic pain and other physical ailments. Here’s the podcast episode about it that goes into some of the research.
She’s half smiling too.
My suggestion here is to just try it out. Whether you’re struggling with mood, emotional regulation, chronic illness, or all of the above. There might be even a small improvement in your life, and we should celebrate all wins, including the little ones.
Don’t forget that I’ve got a self-care challenge coming up in a few weeks. It’s only $5 to subscribe to that content and will contain support, information, action planning, and overall upping your self care game!
Depression is one of the most common mental health problems (right up there with anxiety). It also commonly co-occurs with chronic illnesses. If you’re feeling depressed, or have been diagnosed with Major Depressive Disorder, it’s really important you are treating it in some form. As a therapist-in-training, I see many clients with depression – some with both depression and anxiety, some with perinatal depression, some with depression and chronic illness – and there are a lot of evidence-based treatments out there. It’s really important to know that you don’t have to suffer alone. So I thought this week, we’d talk about some common treatments, and some up-and-coming ones for depression. I also have an entire podcast episode dedicated to depression and chronic illness this week, which you can access here.
This week’s podcast.
For chronic illness, depression most frequently occurs in people with Alzheimer’s, autoimmune diseases of all sorts, cancer, coronary heart disease, diabetes, epilepsy, HIV/AIDS, hypothyroidism, and Parkinson’s. I got into the criteria for major depressive disorder in the podcast episode, so definitely check that out for more information. When it comes to treating depression, the two most common routes are anti-depressant medications and psychotherapy. Anti-depressants most commonly come in the form of SSRIs (selective serotonin reuptake inhibitors) that alter our brain chemistry because it is implicated in depression (our brains are not the only thing that is implicated though). There is a lot of research that supports anti-depressants in treating depression, though research also shows that it works as well as a placebo. In other words, if you believe it will help it will. Now don’t get me wrong, I fully support someone taking medication (unless you’re pregnant or breast-feeding and can’t – thus why I see many perinatal moms in my practice), however what a lot of people find is that just taking medication isn’t enough to see significant improvements in their symptoms, and many people don’t want to rely on medication forever.
Depression affects about 20% of the population in their lifetime.
That’s where option 2 comes in: psychotherapy. As a student, I see about 10 clients a week plus I co-facilitate a group for 2 hours a week. There is a lot of research that supports the use of psychotherapy. My podcast episode on anxiety, which you can access here, breaks down how much your therapist and you each contribute to your outcomes in therapy, which is important to know. As for what type of therapy, there are many to choose from and they all have good outcomes. CBT (cognitive-behavioural therapy) and it’s third-wave counterparts (DBT, ACT, SFT, etc) are the most common. Typically this involves a combination of talk therapy, where you tell your therapist about your thoughts and feelings, and then the therapist giving you some things to try out in session that you can also practice between sessions (some people call it “homework” but I don’t like that term). Another option for therapy is psychodynamic, which involves talk therapy plus the therapist often makes interpretations. And then there are the therapies that rely mostly on talk, utilizing the therapeutic relationship, such as person-centred, existential, etc. All of these can help and are something I highly recommend. There is also evidence that different lengths of therapy are beneficial as well, from one session of drop-in counselling to short-term (10-20 sessions) of CBT or long-term (more than 20 sessions) of person-centred therapy.
Our thoughts and feelings can be like quicksand. Our natural tendency is to struggle, but that only makes us sink deeper in. The actual way to get out of real quick sand: be a still and flat as possible and let yourself float to the surface.
If you are in immediate crisis because of self-harm, abuse, trauma, and suicidal thoughts/plans, then please contact your local help line. I’ve put some numbers in the show notes for my podcast on depression. A quick Google search can help you find them in your country. If you don’t like talking on the phone, there are some organization that offer texting services. I volunteered for Kids Help Phone in Canada which had switched to primarily a texting hotline since many young people prefer to text. You are strong for reaching out because it is not easy to.
Canada.
In terms of other treatments, a few are available for treatment-resistant and severe depression. Electroconvulsive therapy (ECT), which used to be called “shock therapy” can be helpful for people with severe depression, though there are some potential harmful side effects, and psychiatrists don’t commonly use this unless necessary. Transcranial Magnetic Stimulation (TMS) is another option for treatment-resistant depression where magnetic pulses stimulate the nerves in your brain. Newly approved in Canada (and how I got the idea for this post) is the use of Ketamine for treatment-resistant depression. Ketamine is a dissociative drug that has a lot of research supporting its use for depression. It activates your glutamate, dopamine and serotonin receptors in your brain. It takes effect much quicker than anti-depressants and has shown to decrease suicidal ideation. So far research shows no long-term side-effects, though because it is a psychedelic drug, there is the chance of substance dependency.
Great video for anxiety and depression.
Whether or not you have chronic illness, if you have depression there is hope for recovery, and lots of options available. Talk to your GP, your psychiatrist, a psychotherapist or whomever else is or could be part of your mental health care team. That way, you can keep making the most of it.
Recently I read an article in a psychotherapy magazine put out by the BCACC (British Columbia Association of Accredited Counsellors) about how therapists can and perhaps should integrate health promotion into their clinical practice. Being interested in health psychology anyway, and wanting to work with people with chronic illness as well as mental health problems, I devoured the article. Then I did a quick google search to see what others are saying. And while there are not a ton of journal articles on the subject, there are a few, all pointing to the same thought – this is something therapists should do. What makes it difficult is that psychotherapists, whether they hold a Masters or PhD (or not, depending on where you live they may not need either), typically don’t have a lot of training in health outside of mental health (always a little bit as it relates but rarely a large amount). This makes me curious as to what everything thinks about therapists encouraging health promotion, in some way, during counselling.
Article from Insights magazine (Spring 2017 issue)
What this article really looks at is not just physical health or mental health but all components of health. A holistic approach. Sometimes people go to therapy for things like weight loss, which in that case, health promotion and education seems necessary. Other times someone might bring it up as a secondary concern. There’s also, of course, the interrelation between things like exercise and nutrition and mental health. As well as sleep and mental health. See where I’m going with this? It actually might be almost impossible for therapists to not integrate health into counselling. So, while I usually save this kind of stuff for my premium blog, I thought I would share some health behaviours I’m going to put extra effort into this week, and I hope everyone reading thinks about some that they can as well! Body-mind connection week indeed!
nutrition: I’m going to go with making sure I eat fruit everyday (which I typically do but sometimes stumble on the weekends)
exercise: putting yoga back back into my routine at least 2x/week
sleep: ensuring I don’t have anything to drink after 8pm (part of sleep hygiene!)
other (social, hobbies, gratitude, mindfulness): playing the piano daily (I haven’t been playing as much as I would like)
As you can see, integrating health is rather inclusive and definitely extends beyond just physical aspects. Medication adherence can be another really important one for chronic illness warriors. The article I read speaks about Maslow’s hierarchy of needs, which I’ve mentioned in previous posts. We need to take care of our basic needs in order to take care of our higher needs. The three basic components of physical health I mentioned above are so important. So here’s my question (and I’d love answers in the comments), would you want your therapist to help you with aspects of health promotion that you are neglecting? Why or why not?
Chronically Living 