Panic Attack 520

Practice Patience

2009-04-12T00:31:00.001-07:00

It would seem that the warm weather of summer is an inducement to slow down and live life at a more leisurely pace. Summer time and the livin’ is easy-and it’s a good thing because if things didn’t slow down for at least a few months out of the year, many of us would just fall over dead from the incessant demands of life in the 21st century.

While walking through O’Hare airport several weeks ago I looked around and saw that practically everyone was talking on a cell phone. I remembered some 10-12 years ago, all those people would have had to find a pay phone if they wanted to call someone, or wait until they got home-and that was okay then, but now expectations have changed.

It’s ironic. Faster and more efficient technological devices promise to save us time—but everyone I know feels like they have less time.

Did ancient people also feel that time was a thief? No doubt.

But this perception is undeniably compounded by an increasingly frantic pace of life in modern times. When I was a teenager my mother put up a refrigerator magnet that said, “the hurrieder I go, the behinder I get”. It seems that this modern age nudges us to hurry up. But as many of us experience, the more we hurry up, the less time we seem to have.

The less time we seem to have, the more impatient we become. When we are impatient, the world around us becomes a source of frustration. If we are feeling impatient, we are feeling self absorbed.

Last Labor Day weekend, I found myself in the airport in Atlanta. We had just celebrated my grandson Henry’s first birthday. The plane was supposed to leave at 4:00 pm. Thunderstorms put O’Hare on a ground stop. But by 6:00 pm the status had passed. A voice came over the speaker saying we would leave by 7:00, 3 hours late but we all knew it could be worse. We boarded the plane, taxied to the tarmac and sat there 30 minutes, 60 minutes, 90 minutes. The man sitting next to me struck up a conversation saying he was worried that he wouldn’t get into Chicago until after midnight and he had to be on the job by 6:00 am. Finally, by 9:00 pm, (5 hours late) we took off. An hour into the flight the pilot announced there were more storms in Chicago and rather than burn fuel in a holding pattern we’d land in Indianapolis. There was no way we were going to get into Chicago until 2 or 3 in the morning. My seatmate exploded – he hit his seat and cursed.

Fidgeting impatiently, he broke into a sweat and loosened his tie. His mantra was-I can’t deal with this-I can’t deal with this…. He kept mumbling about how tired he was going to be. It was now midnight, and we were sitting in the Indianapolis airport awaiting permission to take off. Suddenly my seatmate burst out laughing. He said, “I might as well just accept it, I’m not going to get any sleep.” “I might as well accept it,” this became his new mantra. Earlier he had told me that he was staying in a Lakefront Hotel in the loop and he had a view of the lake, so I tried to cheer him up. I said, “It’ll be great. You are going to walk into your room and the sun will be coming up over Lake Michigan. It will be a beautiful sight.” By then he was laughing about how all of that angst was a waste of energy.

We have all been in situations when our expectations about what was supposed to happen didn’t pan out. We all know what it’s like to erupt in frustration when events turn against us. We all know what it’s like for our minds to scream at us that it shouldn’t be this way. When things go haywire or we are falling behind impatience invades the mind.

When my seatmate first realized how late we were going to be, his mind began to speed up with negative thoughts. He quickly thought of at least 10 horrible things that could happen.

In the book Take Your Time Ecknath Easwaran says that when our minds are in a hurry, our thoughts are usually negative. A mind in a hurry is not a healthy mind.

Many years ago I had a full blown manic episode. It landed me in the psychiatric intensive care unit. One thing about that experience I remember was how my mind speeded up. Fast thinking is characteristic of a manic episode.

I was thinking fast and thought I was so smart because of my fast thinking mind. But now I see that when my mind was thinking so fast I wasn’t being smart, or clever — my mind was in overdrive which meant that I was so taken with my thoughts that my speedy thoughts were all that mattered to me. To have a crazy mind like that is a weird sensation. The faster the mind the more you create your own version of reality.

But when the mind slows down, there is space and spaciousness—and space and spaciousness in us is what makes room for others and other thoughts. When the mind slows down we become patient—when the mind is quiet, panic dissolves. And when we are less in a panic, less in a hurry, we see that life is not all about me. Learning patience is the process of quieting the mind.

The Sufi mystic Meher Baba put it like this: “A mind that is fast is sick. A mind that is slow is sound. A mind that is still is divine.”

Slow down the mind.

There are two ways to learn patience by slowing down the mind. The first is to become aware of what our minds are doing.

Whether driving a car, biking or walking, if we are running late, we probably started late. If there is not enough time in the day then we are probably trying to fit too much into the available time. If we are feeling irritated with our kids, frustrated with a partner or spouse or annoyed with a relative or aging parent what we need is patience. And the way to get patience is to slow down the mind. The first thing I do to practice patience is to have a little chat with my own mind. It helps me to remember that I have a mind but I am not the mind.

The second thing I do is practice patience every day. I know of no better way to practice patience every day then to practice meditation.

The purpose of meditation is to train the mind to be quiet. By the silent mental repetition of a mantra, the mind becomes absorbed in one thing rather than everything. As long as the fluttering mind is in motion, it is creating a commotion for us. As long as the fluttering mind is in motion it is pushing us to think thoughts, chatter internally, make judgments, keep things moving. Meditation teaches the mind to be patient. The more we are patient, the less we suffer.

Just think about times when you have felt impatient. Think about those times you have felt restless, irritated, anxious and intolerant. To be impatient is to suffer.

The purpose of spirituality is to give us tools that will reduce our suffering. A basic spiritual truth is that the more self absorbed I am, the more I will suffer, and the more I suffer, the more suffering I cause others.

His Holiness, the Dalai Lama once said, “The moment you think only of yourself, the focus of your whole reality narrows, and because of this narrow focus, uncomfortable things can appear huge and bring you fear and discomfort and a sense of feeling overwhelmed by misery. But the moment you think of others with a sense of caring, however, your view widens. Within that wider perspective, your own problems appear to be of little significance, and this makes a big difference.”

We practice patience because it not only reduces our suffering but it also reduces the suffering of those around us.

As I practice slowing down my mind, I learn to settle down, and when I learn to settle down I develop the capacity for compassion and love. Compassion and love are two sides of the same coin. Compassion is the wish for other beings to be free from suffering. Love wants other beings to have happiness.

Compassion and love grow naturally out of the mind that is spacious and slow. This is why practicing patience is the ground out of which compassion and love take root in our lives. And this is why lately, I’ve been repeating the mantra: practice patience – don’t hurry, be happy.

Support groups

2009-02-24T01:05:00.000-08:00

In my earlier rather depressing job description of parenthood I pointed out the lack of any form of trade union representation to argue for parental rights and needs. Of course, by its very nature, parents do their job out of love, and voluntarily sacrifice many material things to be able to care for their children. However, there is also little doubt that governments have frequently taken advantage of this absence of cohesion of parents as a group, in order to be able to dictate to them about the financial aspects of child-rearing. The health professional can begin to fight for parents and can offer a great deal of support as well as representing parental views. However, the emergence of self-help groups has to be one of the most encouraging and stimulating developments in recent years.

The majority of these groups are focused on some particular aspect of parenthood. This may be crying, hyper-activity, asthma, eczema, the disabled, and so on - but they are a very real and valuable step towards parents understanding their problems more, feeling less isolated and being much more involved with professional decisions that may affect their children.

As well as self-help groups there are many other groups and organisations that give parents a voice and can offer support, reassurance, help and guidance. It is no secret that one of the chief advantages of mother and toddler groups, and pre-school playgroups, is the support that these groups offer the parents - not just the children.

A fascinating piece of research done in the 1970s looked at some of the characteristics of American parents.1 These characteristics applied to almost every parent, irrespective of social class, ethnicity, education, or religion. Even though over 20 years have passed, the chances are that they apply to you as well. They certainly apply to me. These were a selection:

• We have no real idea as to what a 'good parent' is
• We get virtually no parenting training
• Our view of parenthood is somewhat romantic
• We expect to be able to solve problems that the professionals can't
• We have complete responsibility for our children, but only partial authority
• We expect extremely high standards of ourselves as parents
• We often have to work with incomplete or conflicting information when trying to resolve situations with our children
• The standards we set for our children are even higher than those we set ourselves. We want them to be happier, and more successful, than we ever were.

We certainly mean well. Nevertheless, we simply have to accept that many of these beliefs are incompatible. We are bound to get stressed. The function of this book is to look at some of the stresses that inevitably arise from parenthood,, to give practical guidance as to how you can lessen their impact, to show you who can help, and how you can help yourself. But -1 might as well admit it straight away - this book's title is more than a little optimistic. There is no way that parenting will ever be completely stress free. But I do believe that stresses really can be diminished to a remarkable extent, so that the pleasures of being a parent totally overwhelm them. And you will believe it too. Read on.

The attitude of society

2009-02-24T01:03:00.000-08:00

That isn't to say that society doesn't appreciate and understand the intense importance of parenthood. After all, how often have you heard the phrase 'Of course, I blame the parents' when some bad news story about a young person becomes public? During the trial of the British au pair, Louise Woodward, in Boston in 1997, countless articles in the nation's newspapers were devoted to analysis and criticism of the parents of the child that died. Their child had died, and they were criticised Everyone in their heart of hearts knows that the skills involved in being a parent are absolutely vital.

And just how does society show its appreciation of all this vital work on behalf of the next generation? You've guessed. When social scientists in the United Kingdom are grading various professionals because they need to collect statistics on patterns of disease, or educational or social needs, the job of 'housewife/mother' is placed in the same category as 'unskilled'.

There is much more to this than pure symbolism. It genuinely does reveal society's true attitude. When women are asked 'do you work?', how many reply 'no, I am just a mother1? Even today, many professionals such as doctors, and other interviewers often say such things as 'do you have a job, or are you a housewife?' Maybe no insult is intended, but the inevitable implication from such thoughtless remarks comes shining through. Society's prejudice is all too obvious.

Parents, and mothers in particular, are frequently made to feel inferior - an attitude exemplified by the development of the 'super wife and woman' ideal, whereby a really successful woman is expected not only to have a demanding job and be a perfect mother, but also to look glamorous and have all manner of fulfilling hobbies - possibly writing the odd book or two about them in her spare time. Is it any wonder that other women can feel distinctly inadequate?

There is no doubt that the sociological changes in the past two or three generations have given most women an entirely new set of options for their lives. Whereas in the past it was expected that every woman would simply settle for life as a mother and supporter of her husband, society has changed its view of a woman's potential place in the world and this means that the opportunities are very much broader. It is wonderful that the entrants to many professions are now at the very least as likely to be women as men. It is entirely healthy for society that cabinet ministers, doctors, engineers, secretaries, and chief constables should be appointed purely on the basis of merit and ability, rather than on which set of chromosomes they have. However, it is extremely unhealthy when society expects women in these jobs to do them in addition to being parents. The job description of parenthood is quite simply big enough, and it is entirely unreasonable simply to add this to someone's paid employment. There is a limit to what any one person should be expected to do.

I have little doubt that attitudes are changing but we are still an enormously long way from a genuine equality of opportunity. In my experience, when children wake at night it is still far more likely that the mother will get up than that the father will. Over and over again I have heard mothers say things like 'of course I always get up to the baby at night. It isn't fair on my husband to expect him to do it. He's got a job to go to/ If both a father and mother go out to work, it is still unusual for it to be the father who stays off work when the child is ill. There is far more Up service paid to equality than any genuine change of attitudes.

One of the most potent causes of stress in any of us is the failure of reality to live up to one's expectations. There can be no doubt at all that almost all parents have entirely unrealistic expectations of what parenthood is actually like. Even those who manage to achieve all the activities of a 'superwoman' often put themselves under intolerable stresses.

My Panic Attack (4)

2009-01-31T11:06:00.001-08:00

But there was one problem I felt unable to face. I had happily sailed through my music exams and the day came when I was told that I had to play the piano at assembly. To play in front of the whole school, knowing that many girls would be only too eager to criticise my performance, was unbearable.

Again the nights of frantic anticipation. I could imagine all the things that could go wrong. I could see all the gleeful faces as the whole school enjoyed hearing me make a fool of myself.

Why did I not just refuse to play? I could not bring myself to do it. I couldn't run away this time, so I cracked my thumb joint with a hammer. A difficult 'accident' to explain at the hospital, but I ended up with my arm in a sling and an overwhelming feeling of relief at the honourable way of escaping from my ordeal. I now suffer from chronic arthritis in my hand as a reminder.

II scrambled through my exams. There were too many gaps in my education for me to do really well, but at last I reached my final day at school... and I didn't want to leave.

Even travelling was no longer a bugbear. I attended a secretarial college, travelling into the centre of London every day. The fears were all behind me and I could look ahead to a future as a normal person. A relative in the Foreign Office got me a job in MI6. Sounds exciting, but it was basically just another secretarial post where I was very happy and made many good friends.

I was engaged to be married, although we had a five-year wait ahead of us as Michael had to get his law degree and qualify as a solicitor.

One winter's day I was just recovering from a bout of flu and waiting at a bus stop on my way to work. Disaster. Back swept the terrifying feelings that I thought had gone for good. I didn't know how to handle them and staggered into a shop, where I asked for a glass of water and telephoned for a cab to take me the ten miles home from the centre of London. Of course, as soon as I arrived home I felt perfectly all right apart from being a bit shaky. After-effects of the flu, I decided, and opted to take another week's sick leave to make sure I had completely recovered. I never dreamed that the old demon had raised its ugly head again.

I put the episode out of my mind and happily travelled back to London the following week. Back at the same bus stop, and my knees started to wobble and my breathing speeded up. It was all coming back. Luckily a bus came along and, jumping on to it, I broke the sequence of panic.
I couldn't believe I was back to square one, but I became increasingly worried abut my journey to work and organised my day around a variety of coping strategies. There was no way I could avoid the bus journey to the centre of hondon and, desperate for human contact, I would talk to anyone else standing at the bus stop. I always carried a newspaper to look at while I waited, and when the panicky feelings started to build up I would dart into the nearest telephone box. (How I would have welcomed a mobile phone.) I would telephone my mother, the only person who knew about my struggle. Having once suffered from agoraphobia in her youth she would talk me through the feelings and encourage me to keep going.

Every day was a continual fight against rising panic and feelings of unreality. Every morning I felt sick with appre¬hension but I was determined to hide my distress. I could not bear anyone to know about it and dreaded making a fool of myself in front of other people; I was determined not to draw attention to myself though I may have looked somewhat twitchy and uncomfortable to anyone who studied me care-fiilly as I stood at the bus stop. I carried a card on which I had written my name, address, date and destination.

When the real world started to slide and my memory played tricks I would read this over and over again to reassure myself that I really existed.

I would deliberately arrive at my office half an hour before anyone else so that I had time to have a cup of tea, sit down and recover my equilibrium. I loved my job and dreaded the fact that I might have to give it up, despite the misery of getting to the office each day. Sometimes when I felt really bad I would think of looking for work nearer home, but I knew instinctively that once I gave in the phobia would follow me; then I would give up the local job and retreat into my home. I had to conquer the problem before it conquered me.

I was not tackling the phobia correctly, any expert would tell you today. Face the panic, experience it and go through it, they would say - but I was trying to avoid it at all costs. Every time I experienced a severe panic attack I would become more sensitized and likely to have another one. Avoiding the panics enabled me to operate on an even level and live a normal life, but I am sure I would probably have overcome it more quickly had I known the modern way of going about it.

I combed libraries and bookshops looking for information about agoraphobia (panic disorder wasn't known to the lay person in those days). There was very little written for the sufferer, and what I could find frightened me even more.

I consulted a psychiatrist (I picked his name out of a newspaper, hoping to find an expert in his field). 'You are probably quite a nice young woman/ he told me. 'But you are obsessed with your symptoms which are caused by an anxiety state, and you will just have to learn to overcome them.' I had hoped some sort of treatment might be available but was warned off by the great man, who felt that as I did not appear to have any underlying problems and was managing to cope, any treatment might result in aggravating the condition rather than curing it. This was in 1953.

No treatment, just keep going! At least I had acquired one comforting piece of information: agoraphobia would not kill me and it would not ruin my life unless I let it.

Recovery would take me five years. It was very gradual but I tried to adopt an optimistic approach to life. Every day I would find something to enjoy. It may have been a compli¬ment - oh how vain I was! — it may just have been enjoying the music of the buskers on the way to work; I have always responded to any kind of music. One spring, Piccadilly Circus was filled with multi-coloured bubbles inviting the public to the Ideal Home Exhibition.

I talked to people - anyone who looked as though they might be responsive - so I was never alone. These tactics would do nothing for my panic attacks but they made me feel more cheerful. I learned to smile at everyone and was gratified to find that about 80 per cent of the public would smile back. Life was definitely looking up.

II still had trouble travelling around London. My office had moved to the bottom of Whitehall and I had to cross Parlia¬ment Square every morning. Sometimes I couldn't do it and would have to take a taxi, making some feeble excuse such as that I was late for an important meeting.

It was at this time that my future in-laws invited me to join them and Michael on a summer holiday to Wales. I gritted my teeth on the long journey but would not have dreamed of admitting that I felt nervous. My father-in-law to be had been my family doctor all my life — but I never consulted him about my agoraphobia!

I felt relaxed and at ease with my second family, but then Michael announced that he and I were going to walk up Snowdon. Remember I couldn't walk across Parliament Square without feeling ill. I was really stuck. No way was I going to let on that I couldn't face that mountain.
It could have been worse. I kept my head down all the way as I found the open sky too vast and overpowering. I had blisters on my feet and took off my shoes as I felt happier concentrating on my sore feet than on any panicky feelings.

I have photographs to prove we reached the summit, but I couldn't wait to get to the bottom again, pleased to find I felt a sense of achievement. Two weeks later I was back in a taxi circling Parliament Square to get to my office in Whitehall.
Gradually it all faded. I hardly realised how much I was progressing until it became obvious that my nerves were no longer dominating my life. It takes some time to appreciate that one is really free. The biggest bonus was discovering that all the other anxieties disappeared, and instead of being a permanently anxious person with many devastating fears I discovered that I had become less fearful than most of the people I knew, that having trained myself not to worry, I didn't worry. It is possible to change one's life around.

I have described how my life changed when I had overcome my fears, but my crowning success was my wedding day. Four hundred guests in a London church in the middle of Piccadilly - one of my 'panic spots' some years earlier. The service was long and I thoroughly enjoyed every moment without even a frisson of fear. My self-confidence was so high I felt like floating off the ground. I will never forget that day.

My Panic Attack III

2009-01-31T11:02:00.001-08:00

It took a term for the novelty to wear off. The feelings of anxiety which had been pushed below the surface began to trouble me once more and I felt increasingly trapped. Sleeping in a dormitory with rigid rules about not talking after lights out and no reading in bed left me with too much time alone with my thoughts and my out-of-control imagina¬tion. Mealtimes meant more rules and there were no accept¬able excuses to leave the table. Eating became a problem with so many people watching and noticing my jittery behaviour.

At first I was able to cope with services in the school chapel (two each day and three on Sundays) but, inevitably, as the panicky feelings began to recur I found it more and more difficult to sit still until the end of a service.

Lessons were becoming an ordeal too. I would watch the clock: twenty minutes until the bell goes ... ten minutes ... five minutes. Little wonder that I started to slip behind with my school work again when sitting through a forty-minute lesson was purgatory. The feeling of being trapped built up even when I was sitting near a door. There was, of course, no chance of asking to be excused; you might get away with it on one occasion if you could plead an emergency - but not a second time.

i The last straw came when I was told that I had to propose a vote of thanks to a visiting lecturer. It meant standing up in front of the whole school to speak and I knew I couldn't do it. For days - and worse, for nights — beforehand, I lived with this terror, visualising how I was going to make a fool of myself, forgetting what I had to say, breaking down in front of the whole school. My imagination was as usual running out of control and I knew I would not be able to walk on to the stage, smile sweetly and say my piece.

On the day itself I was sick several times and the terror built up and up. There was no way I could tell anyone that I couldn't go through with it, and as the time approached I felt even worse. I ran away from school.

I went back, of course, and I won't go into details of my punishment and disgrace. This was fifty years ago, and no one then would have considered that I might actually have needed help for a psychological problem.

I asked my parents to take me away and let me return to the local high school. Panic attacks and daily assembly would be preferable to a twenty-four-hour school environment. I said I was unhappy at boarding school and told some lurid stories about life in that eminently respectable establishment. Being unhappy was reason enough where my sensible parents were concerned, but I was grilled by the headmistress, house mistress and other members of the staff who insisted on being told why I wanted to leave their precious school.
Was I leaving because I was unpopular? I was indignant about that as I had many friends. Anything wrong at home? Death in the family? Bankruptcy? Divorce? I looked at them blankly and then explained that I was suffering from delayed shellshock after my - mostly imaginary - experiences during the Blitz. Did they believe me? I never found out.

It was such a relief to make yet another fresh start that I felt practically normal again. It didn't last, of course, but as the old feelings crept back, the time had come to do something about the problem. Hauled up before the head, I found out that at the age of sixteen I could at last explain why I was invariably late for school.

At last the adults were sympathetic. During assembly I was allowed to slip into one of the side rooms if I felt unwell. Better still, I was not forced to attend assembly at all but could wait in die classroom until the other girls returned. My form teacher let me sit near the door and I had permission to slip outside the class for a few moments if the tension became unbearable. Would you believe it, as soon as I ceased to feel under pressure I found many of the hitherto impossible situations I had avoided before became tolerable; now I could talk about the things that bothered me and tackle problems such as standing on my head in PE or hanging upside down on the wall bars in the gym, both of which activities invariably made me feel sick and dizzy.

I would take a packed lunch instead of eating with the crowd; but that didn't last long, as I found I was missing out on most of the news and gossip, so I was soon back lunching with my friends. The best thing was that nobody thought there was anything peculiar about me.

My Panic Attack II

2009-01-31T10:58:00.001-08:00

War was looming and we moved to the country. Sometimes at school I would experience fluttery feelings of anxiety, but being fairly stoical I put up with them. After all, my mother had assured me that they couldn't hurt me.
Unfortunately my all too vivid imagination was getting out of control, and as more and more phobias became part of my life I would go out of my way to avoid anything that might upset me. Apart from medical and dental phobias I had a horror of skeletons, people with any deformity, being blind¬folded, hanging upside down (how I hated PE lessons), tunnels, travelling any distance, sleeping away from home, nose-bleeds, abstract thoughts, infinity, cemeteries, clouds, darkness, silence, thunderstorms - and tidal waves! I knew I would never see a tidal wave but the thought was disturbing.

The list was almost endless. There seemed to be so many upsetting things to cope with that I was only really happy in the fantasy world into which I slipped at every available opportunity.

\ School was becoming a problem. Morning assembly became an ordeal which had to be faced every day, but the dread of it was with me every waking moment. Most nights were disturbed by troubled dreams, and at breakfast I would feel sick and tearful, filled with worry about the coming day. The journey to school involved a long walk, a bus ride and another walk. This itself was becoming more and more difficult as panic was always just below the surface, waiting to strike if I allowed myself to stop and think. I became addicted to daydreaming to get away from the situation, pretending to be another more glamorous person triumphing over difficult and heroic situations. In my fantasy world, I was in control.

When filing into the school hall for assembly, my first thought was always what the hymn was for that day and how many verses it ran to. Up to three was bearable but any more and the panic would well up, making me feel sick, dizzy and unsteady. My great dread was that I might faint, though I never did. As things got worse I frequently had to slip out of the hall with the excuse that I felt unwell. There was no point in trying to explain further, I'd tried that and nobody understood.

Then sitting through lessons became difficult, and I was trying to avoid assembly by arriving late to school almost every day. The atmosphere that I had once enjoyed was becoming unbearable: too many people, too much noise — my mind felt overloaded and I could not concentrate on my lessons. I withdrew from my friends, who found me odd'. I still managed to hang on, though too many days off meant my school work was affected.

Strangely enough, the adults around me never suggested I saw a doctor. In those days one was just considered to be a 'difficult* adolescent. In any case, the suggestion of a consultation with a doctor would have filled me with horror. I had to cover up my real problem.

Boarding school, my parents decided, and I went along with this idea. A new start, a different atmosphere. I had read so many books about girls' boarding schools and I knew it was all going to be jolly good fun ... new friends, midnight feasts and lots of practical jokes. Above all there would be no travelling to and from school. The daily journey to my present school was becoming a nightmare in itself. Being privately coached soon helped me to regain my educational level and my confidence was returning when I passed the entrance exam to the new school.

My Panic Attack

2009-01-31T10:56:00.001-08:00

Panic attacks and agoraphobia were part of my life from childhood until my mid-twenties. My mother was agoraphobic and at one time was housebound for two years. I didn't even notice this, mainly because my brother and I, and later our sister, were brought up by a nanny. We had a very happy childhood and a good social life, but I was a nervous child with an over-active imagination. I was happiest when retreating into a fantasy world and weaving stories to entertain my siblings and my friends.

One day I was enjoying my weekly ballet lesson. My mother sat with her friends and smiled encouragingly every time I caught her eye. As the winter afternoon was bleak and dark, someone switched on the lights, and suddenly from being a carefree child I became a nervous wreck for no apparent reason. The noise of the music was overwhelming, the lights were too bright and everything around me seemed unreal. I ran to my mother for reassurance, and after I had calmed down we went home and the family doctor was summoned. It was decided that I was suffering from a reaction to a tonsil operation I had had a few weeks earlier.

These days, I suppose this would have been diagnosed as a panic attack caused by post-traumatic stress, and certainly the experience had been particularly stressful. In the 1930s there was no such thing as a pre-operative sedative; I was wheeled straight into the operating theatre and, amid the frightening sight of surgical instruments and gowned adults, was held down while the rubber mask was placed over my face. I fought against the horrible smell of the gas, screaming with fright as the anaesthetic took effect. I can still remember vividly the sensation of falling and the blackness overcoming me while disembodied voices alternately soothed and scolded me.

Two weeks in hospital did not unduly disturb me and I didn't appear to have any after-effects. In fact, I soon forgot the ordeal and didn't worry abut it until the panic attack when I was dancing.

I never did go back to ballet lessons. I had a few mild panic attacks and felt generally jumpy but my mother reassured me and said the nerves were just something one had to put up with.

Some time later I had to visit the dentist. This was a regular occurrence and did not bother me until I saw the family doctor in the surgery and knew what that meant.. . gas. I fled from the surgery, out of the front door and along the road, pursued by several adults.

Social Phobic Case Study - Allison

2009-01-29T23:45:00.000-08:00

Allison is in her late twenties:

I am a social phobic. My panic attacks started when I was at secondary school. I was always blushing from an early age but hadn't actually experienced panic attacks until I I was directly asked questions in a classroom or had to give presentations. Simply walking into someone I knew would leave me a mess. After leaving school I chose a university course that avoided presentations and tutorials, for I knew that if I had to talk to a group of people my panic attacks would be unbearable.

However, after I arrived at university I found the course had changed and tutorials and presentations were compulsory. I managed to get away with attending the minimum of tutorials or being signed off sick, but every -presentation I had to do would end in a severe panic attack, even after four years. Sometimes the panic attacks would last up to an hour or more, and the embarrassment and shame lasted for a year afterwards. Sometimes I would get -so drunk the night before that I would still knowingly be drunk while doing the presentation the next morning ... the alcohol helped me to avoid a panic attack.

After leaving university I worked in various jobs where I could avoid any position of responsibility and confrontation with others, although tasks such as typing, writing or answering the phone in front of anybody would leave me shaking, flushed, faint, having palpitations and with a numb left arm for anything up to an hour afterwards. If anyone came to talk to me and looked me in the eye, the same things would happen. I could not even carry a cup of tea without having to sit down if I knew someone was watching.

Socially I could not eat in public without severe tremors - or even lift a glass to my mouth in front of anyone. I could not sit at a table with people looking or talking to me without blushing, which would lead to panic attacks. I could not take hold of salt or pepper pots without shaking, or even sign my cheques or Switch receipts in shops. All these things became impossible and I avoided them at all costs - unless, of course, I was drunk first, knowing that the next day the symptoms would then be much worse! If ever I walked into someone I knew, I would have a panic attack when they saw me and so I avoided going out. If anyone stared at me on the tube I would have an attack, and if I was standing up I would feel I was going to pass out, blinded with dizziness and acute panic.

This has been my life for the last five years, and each new counsellor I got I prayed would help - but to no avail. I have had cognitive behaviour therapy, hypnotherapy and done a lot of work myself to try and solve the problem. Nothing worked, much to the dismay of all my counsellors, who knew that I knew what they were going to say next!

So I ended up severely depressed whereas I had not been depressed before. I was ashamed to go to work where everyone felt sorry for me and I left my job. I was scared to go out in public places where I knew I'd meet someone I knew, and as my depression worsened I couldn't face any public place. Sometimes when I was on my own I also, suffered - if I got a piece of food stuck in my throat, if I thought I had left the gas cooker on, if I thought I might be late for something - so it was not just social situations that instigated the panic. Carrying around an enormous and unbearable weight from my throat to my stomach became my life, until I finally accepted the fact that I would have to take medication as I couldn't continue like this.

I was loath to take drugs but took my doctor's advice and am now on an antidepressant which took some weeks to work, but I persisted. This drug has had some side-effects but I am no longer suicidal. The weight has lifted; I can get out of bed, can work and not panic and I can go out in public. Although nobody believes me I would definitely not be here today if it was not for this drug.

Many social phobic young people find school life very difficult. They may be brilliant scholars but they are struggling with their fears of people and find it difficult to settle in school and make the most of their academic talents.

An adolescent social phobic is in a sorry plight, particularly if he also develops agoraphobia, which often happens, causing him to become housebound. Lack of contact with his peers exacerbates the condition and may result in a retreat into daydreams and fantasies, avoiding contact with the real world outside his home and inevitably losing touch with other people. A girl may hope for a romantic hero to arrive at her front door and sweep her off her feet, though she certainly would not be able to cope if he wanted to take her away from the safety of home.

It is especially difficult to persuade adolescents to take part in a treatment programme, as recovery would mean having to face up to the realities of normal everyday life.

Some older women who have become housebound may focus all their emotions on to a well-known celebrity - often an actor or a pop singer, and often dead (safer). Recently there was a television documentary about a woman who was in love with Elvis Presley, and her restricted life revolved around the singer, his recordings and a mountain of other memorabilia.

It is not only in the Western world that social phobia is a problem. In Japan, 1.2 million young people, 75 per cent of them boys and young men, suffer from severe social phobia known as bikikomori. They become completely isolated in their bedrooms, refusing to see or speak to anyone, including their own parents. Their families are so devastatingly embarrassed and ashamed that they keep it a secret and virtually isolate themselves. Because of their embarrassment the condition is only just becoming recognised, and at last counsellors are being trained to help the sufferers and the rest of their family.

It is suggested that the problem arises because of the huge pressures young people are under to succeed at school. They often start by developing school phobia and agoraphobia as they begin to avoid school Severe social phobia develops from there, and the sufferer retreats from the outside world altogether.
This state of affairs wouldn't arise in Great Britain as therapy is available, although the waiting lists may be long. In the meantime, the phobia organisations can offer advice and practical help.

Scial Phobic - Eating In Public

2009-01-29T23:43:00.001-08:00

Another problem the social phobic has is eating in public, particularly in a restaurant or at an important social function, though some people may find the experience of eating with just a couple of friends or even members of the family equally distressing.

Rose, aged twenty-two, had an unfortunate experience: when lunching with a group of old school friends, she had to eave the table, feeling unwell and nauseous.

I could not rejoin them because the feelings just over¬whelmed me again, and although my friends were sympath¬etic I felt ashamed and embarrassed. Since that time I have felt unable to eat in front of other people. As I am to be married in six months' time the thought of the wedding reception is with me the whole time and I live in dread of the occasion.
I make no excuses for including all these examples of social phobia. I feel it is important that people understand just how life-disrupting this problem can be for the sufferer.

Blushing is a major problem for those who feel the need to hide their fears from other people. A scarlet face is impossible to conceal and inevitably draws attention to the blusher and comments from their companions.

Martin: I have been a social phobic since I was a child of ten years old. Even before this age I had other phobias and terrible anxiety. This phobia has ruined my whole life. The main symptom is a terrible fear of blushing, which happens instantly in nearly every social situation. The way I deal with these situations may sound pitiful to others who can't possibly imagine how it feels.

At the age of eleven in school I used to sit always against a wall so that one side of my face would be covered. Nobody could see that side because of the wall. Then I would rest my elbow on the desk and cover my other cheek by resting it in my hand. 1 would literally be trying to hide my face from everyone. I would avoid any group situation and I used to spend hours walking the playing fields on my own, avoiding contact with anyone.

Other ways I would try to deal with this phobia were to pretend I had a cold or flu and whenever someone spoke to me I would take my handkerchief and blow my nose (another way of hiding my face). At other times I have burned my face on purpose with a sun lamp so that no one could see when I was blushing. I was teased and ridiculed in school, even by my so-called friends.

I can still recall the terrible anxiety that I felt from 9.00 till 3.45 every day of the week. However, it didn't end there because the phobia applied to absolutely everybody, so when I got home I couldn't eat with my parents. I would take my food on a tray to the darkest room in the house to eat it, as I was ashamed of blushing in front of my family, and unfortunately today at the age of thirty-five I still am.

Because of PAX I have been able to face up to the problem and seek help at last. Though I have a long way to go I am determined to overcome this, having tackled the first obstacle - learning that it doesn't matter.

Social Phobias and Panic Attacks

2009-01-13T13:04:00.000-08:00

Dr Alan Wade, a GP from Clydebank, became aware of the condition through his interest in phobias and panic attacks.

'Sufferers grossly underachieve/ he says. They often don't earn as much as the average person and favour solitary jobs where they can avoid scrutiny. They may even choose t& be unemployed because they can't face going out. They are prone to depression and other disorders such as agoraphobia, which has similar symptoms.

These phobias do not evoke much sympathy in those who have never experienced them. On the whole they seem trivial and sufferers do their best to hide them, feeling that they might be laughed at. Walking past a line of people standing at a bank counter, writing a cheque, speaking in front of a class - such simple actions for most of us, but agonising for many social phobia sufferers.

How can a visit to the bank be as traumatic as a visit to the dentist? It is the way that a phobic person's mind works ¬always jumping ahead, expecting the worst. One member of PAX explains his fear of his bank and the thoughts that run through his mind.

There are a lot of people waiting, I feel trapped already. I should have checked how much there is in my account. Supposing there isn't enough to cover this cheque? Why is the bank clerk looking at me in that funny way? What is the computer telling her? Why has she walked away? Everyone is looking at me.
By this time he can hardly take his money because his hand is shaking so much.

Another PAX member, this time a woman, wrote;

I cannot bear to be looked at. I am afraid I might do something silly, make a fool of myself, make a mistake or lose control in some way. More than anything I am afraid of anyone KNOWING I'm afraid.

Again, the problem is the need to escape before she commits the dreadful crime of drawing attention to herself. As we see, this is closely linked to the agoraphobic state. Avoiding social situations means that she may become housebound, but unlike the agoraphobic who can find sanctuary from her fears in her home, the social phobic finds that her problems follow her indoors.
To this person, the arrival of an unexpected caller can be a disaster. The sound of the doorbell, a knock on the door, sets off warning signals. Who is it? Why are they here? What do they want? These thoughts flash through her mind as she ducks into a corner where she cannot be seen. Her heart races, her mouth dries up as she feels the situation is getting out of hand and she won’t be able to cope. The only thing to do is to stay hidden until they go away. Unfortunately there are times when visitors must be faced,

Social Agoraphobia Sufferer - Escape to Safety

2009-01-13T13:02:00.000-08:00

The agoraphobia sufferer has a need to escape to safety. She may be in a crowd of people, she may be alone in her phobic situation, but she feels trapped by her inability to detach herself quickly from the place where she is un¬comfortable and escape to her home or somewhere where she feels safe.

The person who suffers from social phobia does not have the same need to escape from a situation; it is other people he finds threatening, He cannot bear to be looked at, to have his body space invaded, to be touched, even inadvertently. Some sufferers find it physically impossible to touch or be touched by anyone other than members of their own immediate family.

Social phobics feel they are under scrutiny all the time; they imagine that all eyes are upon them and experience symptoms of acute anxiety, displaying outward signs of distress such as blushing, sweating and hyperventilating which they are sure everyone notices and despises them for. They are afraid of drawing attention to themselves, of being embarrassed by making a mistake or making fools of themselves. At the root of their shame is a fear of losing control in some way or not being able to continue what they are doing while they are being watched.

Social phobics often find themselves unable to relate to other people on any sort of personal level. They may have difficulty in expressing their emotions and feel that they cannot get close to others physically or emotionally; often, they are children who have had an over-protected upbringing, have not developed a sense of independence and are therefore unable to function adequately in an adult social world.

Social Phobia - Other people are quite dreadful The only possible society is oneself

2009-01-13T13:00:00.000-08:00

A cure for shyness!' Newspaper headlines in the late 1990s were quickly taken up by the programme This Morning when Richard Madeley and Judy Finnegan told the nation that this new drug would transform the lives of people who suffered from devastating shyness. In fact, this drug - Seroxat (Paroxetine), an antidepressant - was not new. ?or several years it had been prescribed for depression, panic attacks and agoraphobia, and a large number of PAX members were finding it very helpful towards over¬coming their problems. Recently, though, Seroxat had been hailed as the new treatment for social phobias and acute shyness.

This Mornings presenters announced that they would hand out supplies of the drug to volunteers, who would be asked to try it out Tor a few days' and then report back to the programme, hopefully to tell viewers that their shyness had disappeared and that they were able to enjoy a full social life once more.
Fortunately, some concerned doctors and some of us involved in the phobia organisations managed to stop this irresponsible experiment before it got under way. Can you imagine the hopes raised and then dashed to the ground? Of course, the drug has been of great help to thousands with anxiety problems, but it takes a good three weeks to act and it needs to be prescribed by a doctor or psychiatrist, preferably in conjunction with further therapy.

What a fuss to make about being shy, you might think. After all, thousands and thousands of people suffer from shyness and a lack of self-confidence. Surely it is a matter of facing up to life and tackling problems, something that would automatically improve with maturity.

Social phobia is a growing problem which affects equal numbers of men and women, unlike agoraphobia, which is a condition more often attributed to women, though there is a considerable overlap between social phobia and agoraphobia.

PAX newsletters

2009-01-13T12:48:00.000-08:00

PAX newsletters are full of enthusiastic reports from recovering members.
Penny (thirty): I was never completely housebound but was heading that way. My GP prescribed Seroxat, and although it took several weeks before I noticed any effect it has been extremely helpful. I was told by my GP that I also needed to see a cognitive behavioural therapist as I could not rely on drugs for ever and must learn how to manage panic attacks if they returned. I found this a rather depressing outlook. Eventually I did see a behaviourist, by which time my GP had weaned me off Seroxat, encouraging me to try and do without it.

Unfortunately the panic attacks returned. It had been so easy to live a normal, panic-free life and I rather resented finding myself back to square one. I had to learn to tolerate the panics - though it took several attempts to get through the first occasions when I had to stand outside the super¬market. I didn't know it at the time, but my husband was hovering about, out of my sight. He wasn't convinced that wasn't going to react badly, collapse or burst into tears. The therapist wasn't too pleased when he found out and Richard was told quite firmly that he was to keep right way and let me work towards recovery on my own, without im fussing around me.

I realised how much I had depended on Richard's support in the past, but it was pointed out to both of us that his attitude was holding me back.

After four months I can now shop in the supermarket on my own. I still dread the panic attacks but am learning to tolerate them. My next step is a train journey - alone. I would feel happier if the trains were more reliable, as they are inclined to stop sometimes for fifteen minutes between stations. If this happens I shall look on this as an oppor¬tunity to put into practice all I have been taught about going through panic.

Many people have written to me who are having professional help and making progress with their recovery, and remind me about the late Dr Claire Weekes. In the 1960s her books helped thousands, and her advice is as appropriate today as it was forty years ago when Self Help for Your Nerves was the most requested book in libraries all over the world.

William wrote to the PAX newsletter:
I am a man of thirty-one and a recovered agoraphobic (note 'recovered', not 'recovering'). I have had six months of treatment - behavioural therapy at my local hospital - and I am for ever grateful to those who have helped me tackle my fears and overcome them.
I also attribute much of my present happy state to Claire Weekes, the Australian doctor whose books helped me through the worst time in my life when suffering constant panic attacks. I had to be persuaded by my mother to look at these books - I thought they were just for neurotic women.

Dr Weekes teaches four concepts of fear:
Face fear - do not run away.
Accept fear - do not fight it.
Float through fear - do not run away.
Let time pass - do not be impatient.

I would urge fellow PAX members to read Self Help for Your Nerves.

Only Way Tackle Agoraphobia

2009-01-13T12:46:00.001-08:00

Those of us who have emerged from the shadow of agoraphobia know that there is only one way to tackle it, and that is by exposure to the situations which you feel you cannot face - exposure to the situation and exposure to the unpleasant symptoms. Agoraphobics are inclined to judge their progress on their ability not to feel panic. Two or three panic-free trips to the supermarket; they are doing really well. Then on the next occasion the old frightening feelings come flooding back and it's back to square one again.

Face the fear. Enter into the phobic situation. Sounds simple and easy to do, but it can seem an insurmountable task for the agoraphobic. The most traumatic approach is known as flooding, where the patient is exposed to her most dreaded situation and encouraged to remain within it, experiencing the worst sensations that her phobia can produce, facing the panic feelings and the distress that follows until the peak is past and the symptoms gradually evaporate. This might take a few minutes, or it might take an hour or two, but the important point is that the sufferer stands her ground until the anxiety starts to lessen, and has to be prepared to remain "until it does.

The patient's fear is that her system cannot tolerate the acute phase of a panic attack, that there must be some terrible climax which will prove fatal. This is not so; when the panic feelings reach a peak there is only one way they can go -down. They will gradually subside and the sufferer will find herself sick and shaky but still in one piece ... and a step nearer recovery.

There is no doubt that such an experience is more exhaust¬ing than exhilarating, but it cannot be denied that if she is well prepared by her therapist and has the motivation and the courage to co-operate, this can be the fastest way to overcome agoraphobia.

Systematic desensitisation was popular in the 1970s as this as a more acceptable form of therapy for the patients. It involved learning to relax completely before visualising the phobic situations that the agoraphobic most feared. Learning o curb her out-of-control imagination was difficult, but the therapist would then guide her to the next stage - actually going to these places and finding that she could tolerate them without experiencing a panic attack.

This approach was very time-consuming for the therapist and unrealistic for the patient who, happily acclimatising herself to the phobic situations, was unprepared when a panic attack did materialise, didn't know how to cope with it and became disillusioned with the treatment.

These days the patient is instructed to take a different view of her phobia, changing her negative attitude towards e problem ('I know I shall have a panic attach) and telling herself instead, 'I shall probably feel panicky but I am no longer frightened by the thought of this as I understand how to over¬come it!

Instead of the flooding approach, where the agoraphobic was plunged into her worst nightmare and forced to endure the panic until it peaked then subsided, she is now instructed by her therapist to take it a step at a time.

She is told to 'construct a hierarchy' - making a list of her phobic situations ranging from the very mild to the most alarming. Listing them from one to ten, she will then proceed up the scale, learning to tolerate each one before progressing to one she finds more difficult.

The object of the exercise is not to try and avoid a panic attack but to actively encourage it to do its worst. Knowing that it is not going to damage her in any way, the agoraphobic goes through the experience, emerging at the end unscathed. Unlike the flooding technique the process is gradual, and the patient does not have to tackle her worst fears until she is well prepared.

Travelling is the agoraphobic's worst nightmare

2009-01-13T12:39:00.000-08:00

Travelling is the agoraphobic's worst nightmare, particularly if he has to use public transport. Mingling with fellow travellers, waiting interminably for a bus or train while the anxiety grows, having to stand because there are no available seats - these are all situations which the sufferer dreads, believing that he is not going to survive without making an exhibition of himself.

Jo (sixteen): I have to take two buses and walk half a mile to school each day. Several of us travel together but I couldn't manage on my own. I live in dread that my friends might be ill or not coming to school that day for some reason. It is the walk that I feel I can't face. I dream about it most nights and see myself losing control, fainting or screaming. I never have fainted but the thought hangs over me like a dark cloud.

My doctor says I have agoraphobia and has put me on a waiting list for treatment at the hospital. He was a bit vague about what sort of therapy I will need and I am now very worried because I don't know what to expect. I've read about electro-convulsive therapy: I don't think I could face that. My imagination is working overtime filling me with fear and dread.

Although Jo's agoraphobia is fairly mild it could get worse if she doesn't have some help now. She could probably get help from one of the phobia organisations but as she is on a hospital waiting list it is important for her to know what to expect. Not ECT, for a start. One of the reasons so many agoraphobics refused to seek treatment in the past was that they knew the condition was often treated by electro-convulsive therapy. Forty years ago, when it was assumed that agoraphobia was automatically linked with depression, many people underwent shock treatment for something they did not suffer from - it did nothing for their phobia. Depressed? Of course they were depressed: they were faced with the possibility of becoming permanently housebound and no one could explain to them exactly what was the matter. In the majority of cases the depression was caused by the agoraphobia, not vice versa.

There is a school of thought which feels that the cause of agoraphobia must be identified before the patient can be helped through analysis and psychotherapy, and it is obvious that if someone is seriously disturbed, psychotherapy will be a vital part of their treatment. However, most agoraphobics can pinpoint the onset of their condition to a time following a major upset in their lives.

Common Contributing Factors that Cause Teen's Depression

2009-01-13T11:07:00.001-08:00

Genes

Genes are materials in the cell that determine our physical and other characteristics such as eye color, height, and blood type and are passed on from one generation to the next. Probably several genes are involved in depression, and families with histories of alcohol or anxiety problems also carry a higher risk of depression. This does not mean that if a parent has depression (or bipolar disorder), that the child will have depression (or bipolar). In fact, when a first-degree relative of a child (parent or sibling) has depression, there is a 1.5 percent chance of the child being depressed and 16 percent chance they will have bipolar disorder. Likewise, if a first-degree relative has bipolar disorder, the child has a 4.5 percent chance of becoming bipolar and a 14 percent chance of experiencing depression. The bottom line is, most children of depressed parents do not become depressed, but they are at higher risk than the average child.

Brain Chemicals

A number of brain chemicals, or neurotransmitters, help brain cells communicate with one another. Serotonin and norepinephrine are two such chemicals, and people who are depressed tend to have lower than average levels of these chemicals in certain parts of the brain. Because medications that increase levels of either of these chemicals tend to be helpful in about 80 percent of depressed people, we conclude that many people have a biological basis for their depression. However, these brain chemicals are also influenced by environmental factors. Children who are abused, for example, can have altered brain chemistry associated with their abuse.

Kindling

Once the brain gets used to thinking in depressed ways, it becomes progressively easier to slip into these depressed thinking patterns in response to problems. This "kindling" (or tendency for commonly used thinking styles to become automatic) is one reason why early treatment of depression is so important!

Life stress

Most people respond to stress with a "fight or flight" response, to either deal with the stress or escape it. Depression occurs in reaction to stress only when the stress is either:

1)too great to deal with (for example, a major loss); or

2)repeated and perceived to be inescapable (termed "learned helplessness"). Stress often acts as a trigger for an episode of depression.

Learned Helplessness

Learned helplessness (the perception that stress is inescapable) is particularly problematic, because it interferes with the desire to help oneself. After all, what's the point in trying to change things if you can't reduce the stress anyway? Eventually, this attitude leads to hopelessness and despair. Some theorists link most or all depression to this state of mind.

In most cases, depression is due to a combination of several of these factors and not just one alone.

Agoraphobia And Driving Phobia

2009-01-11T11:37:00.001-08:00

Unfortunately, agoraphobia/driving phobia seems to be on the increase, among both men and women. On motorways in particular, nervous feelings begin to build up when surrounded by heavy trucks belting along, spraying smaller cars with water, mud and dust. It might be ten miles to the next turn-off, time to let anxiety build up until the driver finds the tension unbearable. He cannot stop, and feels as though he is whirling into space and there is no escape.

Ken: Driving along the motorway at around sixty miles an hour, I thought I must have been in an accident and died, the sensation was so weird and 'out of this world'. After the first flash of fear I managed to drive on to the hard shoulder and pull up. By that time I was shaking violently, sweat was pouring from me and I felt as though a great weight was pressing on me, stopping me from breathing. It was no accident, I realised, but by then I was convinced I was having a heart attack. There was no way I could get out of the car to get help; I just sat there trying to make sense out of the totally unreal feelings. After some five minutes things began to get back to normal and I nervously started the car, creeping along cautiously, hoping I would reach the next exit safely. Once off the motorway I felt slightly better and eventually got home.

Unfortunately this has happened a couple of times since. I am a professional man in my forties and consider myself pretty well-balanced. These episodes have shaken me badly; I now wait for the next attack to hit me and am beginning to feel that somehow I am going to have to avoid motorways altogether.

Women's Phobia

2009-01-11T11:35:00.001-08:00

Women, of course, always accepted in earlier times to have a more delicate constitution, were not so reticent about admit¬ting to nervous problems. There are many examples during the last hundred years or so of women who were quite possibly suffering from what we would now recognise as agoraphobia. Shock, anxiety, frustration and physical ill health often lie behind the development of agoraphobic symptoms. How many swooning Victorian matrons languished on their day¬beds? How many wilting maidens suffered fits of Vapours' or slipped into a decline that might today be recognised as agoraphobia?

In later life, Florence Nightingale, with no physical outlet for her tremendous nervous energy, became housebound and was a semi-invalid for many years. After the shock of Prince Albert's death, Queen Victoria retreated from public life, unable to face her subjects en masse. Elizabeth Barrett was confined to her couch with physical symptoms which miracu¬lously improved after Robert Browning whisked her off to Italy and married her. Retrospectively we can only guess, but each of these ladies displayed classic agoraphobic tendencies. Even in fiction there is Charles Dickens' Miss Havisham in Great Expectations, housebound since being jilted on her wedding day.

Not all agoraphobia sufferers experience constant panic attacks. Some people, women in particular, may become housebound for a variety of reasons, resulting in a loss of confidence and unwillingness to leave the house. The longer this lasts, the more nervous the subject becomes as the outside world appears hostile and threatening. If she is persuaded to go further than her base she may well experience rising anxiety, leading to a full-blown panic attack.

Many agoraphobics are free from their fear when driving because the family car can feel like an extension of the home; like a snail or a tortoise, these sufferers would like to carry with them a permanent shell into which they can retreat at any time.

Phobiaas History: fact and fiction

2009-01-11T11:32:00.000-08:00

Phobias are not a phenomenon of contemporary life; through the ages people have suffered from a variety of phobias, but it is interesting to find that there are few historical references to omen being affected. This does not mean that women did suffer from them, but probably reflects the sexist bias that only events happening to men were worth recording!

Apparently there was no shame attached to a man admitting to a specific phobia, but when agoraphobia, with its background of sudden panic attacks, became recognised, it quickly came to be considered a woman's problem. Described the housebound housewife's complaint or the 'empty nest syndrome', it was linked with menopausal women whose children had left home. Even more alarming, until recent years agoraphobia was known as the 'Latent Prostitute Syndrome' and still is in some Scandinavian countries. This assumes that these women are afraid that unmanageable sexual urges might cause them to attack a man in the street. Therefore it is safer for them to stay indoors away from temptation!
It is hardly surprising that agoraphobic men disliked being identified as suffering from the condition as they battled on, determined to lead as normal a life as possible. Many men have a horror of anyone knowing they are agoraphobic, as there is often a definite possibility of jobs being at risk and careers ruined if their 'weakness' is exposed. At one time there were a number of well-known men in The Open Door -television and other media personalities, an eminent lawyer, several doctors and even a Member of Parliament. The late Roy Plomley, famous for his programme Desert Island Discs, admitted (privately) that he could imagine nothing more traumatic than being stranded on an island with no possibility of escape. Roy's agoraphobia was so bad that his wife had to drive him to and from the BBC; he couldn't travel on his own by public transport, nor could he drive his car alone.

There are, of course, a few recorded incidences of male agoraphobics, including - of all people - Sigmund Freud, who for several years had a fear of travelling and became so anxious that he would arrive at a station an hour before his train was due to leave.

Men Suffer Agoraphobia Too

2009-01-11T02:06:00.001-08:00

In the early days of The Open Door (TOD) it was thought that as many as 90 per cent of agoraphobics were women. Now it is recognised as being around 75 per cent.

In the 1960s when I started TOD all our publicity was through women's magazines, with articles such as 'A prisoner in her own home', accompanied by photographs of a middle-aged woman peering anxiously through her net curtains. Programmes such as Woman's Hour featured such women, and all the agony aunts in the women's magazines reassured sufferers from panic attacks and agoraphobia, referring them to TOD and the other phobia organisations then springing up. No one seemed concerned about any men who might be experiencing the same problems until the 1970s, when the media began to acknowledge this.

At last, newspapers, radio and TV featured male agoraphobics and how their lives were affected by the condition. At once the phobia organisations began to hear from more and more men, many of them in their early twenties, which was a surprise to some of us. Until then, agoraphobia been assumed to be a female disorder.

Who suffers from agoraphobia?

2009-01-11T02:03:00.001-08:00

It is difficult to estimate the number of agoraphobics in the world. We really have no idea how many there are as the number of people receiving treatment is a very small proportion of the whole, put best estimates are that it varies between three and five million.

At one end of the scale are those whose phobia affects their lifestyle totally, even to the extent of them becoming house¬bound, while at the other end there is an army of women and men whose symptoms are mildly disturbing but manageable, who would never dream of admitting to such problems and would certainly not seek treatment for what they would probably describe as a 'nuisance'.

As the official number of agoraphobics is based on the number receiving treatment it is obvious that this is quite irrelevant.

Judith's Case of Agoraphobic's Dilemma

2009-01-11T02:02:00.001-08:00

Judith: Each day on my way to work I have to pass a high fence about a hundred yards long. On the other side of the road is a church with a very tall steeple, which soars into the sky. I try to avoid looking up at it as I begin to feel dizzy and slightly sick, and I walk along beside the fence which appears to go on for ever. I feel more and more disorientated. If I break into a run my heart starts to race and I begin to sweat.

How crazy to be afraid of a stretch of road! I cannot avoid it as it is the only approach to the local train station and I must get to the city centre to my office. I have seriously thought of giving up my job because I cannot face this daily ordeal for much longer.

The agoraphobic's dilemma is that if she experiences these feelings in certain places, she will avoid these places in order to avert the panic; but with sensations of anxiety always resent she then begins to worry about other situations. She expects the panic to occur - so it does, almost as though her mind has an 'on' switch which operates whenever she thinks about the dreaded spot. The trouble is that she does not know to operate the 'off switch, so she retreats to safety - only soon nowhere is safe. If she is really unlucky she will feel that the only place to avoid panic is behind her own front door; but even then, if the habit of switching on fear has become established, the security of her home may not protect her from the dreaded attacks.

Some long-term agoraphobics may not be able to recall the last time they experienced a full-blown panic attack but, trapped by the fear of fear, they are not prepared to risk facing a dreaded situation - just in case.

Agoraphobia - Nothing Is Terrible Except Fear Itself

2009-01-11T01:54:00.000-08:00

Constant panic attacks become 'panic disorder' and, as the sufferer knows, they can strike at any time and in any situation. Because they usually happen away from the safety of the home, the term agoraphobia' was used in the past to signify fear of open spaces

The Greeks had the correct definition - agora the market lace or place of assembly, and phobos, terror or flight. They understood the panic-stricken need to escape from a situation - wherever it was, indoors or outside - when the feelings of ear became overwhelming.

Those who have not experienced this problem naturally find it difficult to comprehend the extent of the Offering it causes. It is a condition that defies easy description, for these days the word 'agoraphobia' is used as a collective term for a number of unpleasant sensations which can, if allowed, wreck the life of the sufferer, but which appear to bear little relation to the original definition: fear of open spaces. Fear is there, certainly, but fear of what? Not of the great outdoors, the shopping centre, the motorway - but fear of the terrifying irrational feeling of anxiety escalating to panic which for no apparent reason can overwhelm the victim. One person may well experience these feelings in a shopping centre, another in an open field, another on a bus or in church. Yet another sufferer may be affected in each one of these situations, but what we have to understand is that it is not the 'place of assembly' - the theatre or the supermarket - that is the object of the phobia; these become places to be avoided because they are the settings associated with the fear.

When panic strikes, the overwhelming need is to escape. If you are out in the open you must get under cover; if you are in a confined space you look round for an exit. You must get away from the people milling about you, must escape from the noise, the silence, the bright lights, the darkness. There are so many things to dread and all of them contradict each other. No wonder the sufferer is confused when told that agoraphobia is the problem when she feels just as panic-stricken in a lift or hemmed in by a crowd. Isn't this claustrophobia?

The definitions of the two states may appear to be con¬tradictory, but agoraphobia and claustrophobia both apply to a state of anxiety which manifests itself in certain situations, causing feelings of terror and a need to escape from and avoid these situations.

Trapped! Inside or out, the feelings are the same. Agora¬phobia may begin when a panic attack strikes in a specific situation. The situation itself becomes the focus of the fear as the subject expects a repetition of the original panic attack and, anticipating it, involuntarily triggers it off.

What If Your Depressed Teen Won't See a Psychologist or Psychiatrist?

2009-01-11T01:49:00.000-08:00

Parents are often the first to recognize the presence of emotional or behavioral problems in their child's life. If you have identified symptoms of depression through this article or through others who know and have voiced concern about your teen, we strongly advise that you seek professional stigma. That is not to say that the decision to seek help is an easy one. With the negative stigma of depression, it can often be difficult and painful for parents and embarrassing for adolescents. But, we believe it is worth it.

The first step is to gentiy try to talk to your teen. An honest, open talk about your concern might help your teen to share his thoughts and feelings with you. He needs to know that you are concerned and would like to check things out for him with a professional.

Many teens are leery of seeing a "shrink." When they reject psychiatric help, it is often because they are familiar with media stereotypes of mental health professionals and the people who consult them, or because they fear appearing weak in front of peers.

See if your son would consider seeing a family doctor, nurse practitioner, or school nurse first. Some teens are willing to agree to a "check-up" of physical health (for example, to look at causes for the fatigue often associated with depression) but not to an appointment focused on mental health. A sensitive nurse or physician may be able to gradually explore mental health issues either as part of the check-up or during a follow-up visit. If your teen is hesitant about seeing his usual nurse or doctor, perhaps because of confidentiality concerns, provide some alternative names. In some communities, specialized "teen clinics" are available for adolescent health concerns as well. You could also ask the school counselor to chat with your teen about what is bothering him and, perhaps, about pursuing an appointment with a psychologist or psychiatrist.

If you cannot get your teen to see anybody, ask the professional you wanted your teen to consult whether he or she would be willing to speak to you, the parent, as a first step. Just getting an outside perspective on your child's difficulties may be helpful, and may give you additional ideas on how to get him to access help.

Depression On Teens - Three Rare but Possible Causes

2009-01-09T02:29:00.000-08:00

Past Experience - Depression on teens

In some forms of psychotherapy, the focus is on uncovering or exploring events in the past that may have led to the person's depressed state. This information can be helpful in better understanding the current situation, but it does not necessarily change the individual's depressed mood.

The past is relevant to the extent that it affects current thoughts, feelings, and behaviors. If repeating destructive patterns can be found, these are worth examining and changing. In depression on teens, however, such patterns are not always evident, and if they are, they often take time to change. Nevertheless, it is surprising how many people are effectively treated for depression with no need to re-examine the past or find the psychological "roots" of their depression. Many depressed people do better looking forward than looking back, focusing on changing current behaviors and thoughts (a so-called "cognitive-behavioral'' perspective) is a forward-looking approach to depression that has been shown to be helpful in adolescents and adults alike.

Hormones

Some girls and women experience depressed mood consistently at certain points in their menstrual cycle. Currently termed "premenstrual dysphoric disorder," this condition can respond to antidepressant medications. In girls with irregular cycles (common the first year or two after menstruation begins), birth control pills that regulate the cycles may regulate associated mood problems as well. Given that most girls' cycles eventually become more regular, however, our practice is to advise patience, and only provide medication when depressive symptoms are severe or do not resolve when the cycles become regular.

Sudden hormonal changes—as occur after giving birth, for example—can certainly trigger depression. Therefore, depression is particularly common in women after having a baby (so-called "postpartum depression"), especially if there has been a previous depressive episode. Because this form of depression can be particularly severe, early contact with a mental health professional is essential.

Lack of Sunlight

There is a subtype of depression on teens called Seasonal Affective Disorder (SAD) that has been linked to the lack of sun exposure people in the Northern Hemisphere experience in the winter months (and people in the Southern Hemisphere experience in the summer months). For people who consistently get depressed during seasons that lack sunshine and not at other times of the year, this diagnosis may apply. Some of these people experience improved mood when treated with photo therapy (bright lights, brighter than ordinary room lighting).

If you think your child or teen may have Seasonal Affective Disorder, talk to the doctor. However, don't leap to conclusions if your youngster is depressed in the winter. Remember: winter is associated with less sun, but also with more school. Any stress at school, whether it's academic problems, a tough teacher, or a peer problem, can contribute to depression. For this reason, talk to a professional before considering photo therapy, and only use an approved bright light device. Don't risk sunburn or eye damage by exposing your child to extra sunlight.

Anxiety described by Wordsworth's Margaret

2009-01-08T12:31:00.000-08:00

My apprehensions come in crowds; I dread the rustling of the grass; The very shadows of the clouds Have power to shake me as they pass.
William Wordsworth, The Affliction of Margaret

Wordsworth's Margaret suffered from a problem with which many of us can identify today. He describes a general anxiety disorder, a disproportionate sense of fear and apprehension induced without good reason. Millions of people in the world go through life feeling that there is something terribly wrong with them because of the constant anxiety that pervades their lives. It may be a state of galloping panic, it may be continuous feeling of uncertainty and conviction that something is not quite right.

Anxiety is the permanent companion of so many of us. The Latin word anxius means to press tightly or to strangle; the dictionary defines 'anxiety' as 'a state of chronic apprehension’. Men and women are blessed - some may say cursed with imagination; they can project their thoughts into the future and anticipate what might happen rather than what actually will happen ... and what misery this can cause. Too often anxiety develops into a chronic condition where the sufferer is afraid of the anxiety itself and is then caught in a vicious circle which is difficult to break.

Some people are naturally timid, going through life trying to avoid confrontations that they feel might upset their equili¬brium. Rude behaviour from a stranger or a family row will set them for days and they will avoid arguments at all costs, i is now accepted that many of us are born with a predispo¬sition towards anxiety; others, as we shall see later in this book, ay become oversensitised as the result of some traumatic event, psychological or physiological, and find that they not cope with the stresses of everyday life. In their highly sensitised state these people may experience chronic, nagging anxiety which can disrupt their lifestyles r, in more severe cases, become overwhelmed by sudden devastating attacks of acute anxiety, commonly called panic attacks.

Many people will experience a panic attack at some time in their lives. The after-effects of a serious illness, seeing or being involved in an accident, or experiencing some other traumatic event may result in a one-off panic attack - and that's understandable. Almost everyone at some time feels sick, weak, faint or over-anxious, but these feelings are soon shaken off and we are reassured because we know there was a reason for them. However, there are some people who can experience four or more panic attacks every month without any obvious reason, and this is when the anticipatory anxiety builds up.. the ‘what if?' syndrome. What if I have a panic attack at work? ... at school? ... in the cinema? Anywhere? Now the sufferer is faced with the most crippling phobia of them all: fear of fear itself. We know this as agoraphobia. For many years agoraphobia was understood to be a fear of open spaces, but you will see that this was a misnomer.

Though sufferers have often been unwilling to admit to being agoraphobic, the condition has been recognised for a long time. Richard Burton wrote in 1621 of:
one that durst not walk alone from home for fear he should swoon or die ... if he be in a throng, middle of a church or multitude, where he may not well go out, though he sit at ease he is so misaffected.

Understanding your nerves

2009-01-08T12:24:00.000-08:00

The old English word faer meant 'sudden danger’. Fear is what we experience when something unpleasant or dangerous is happening to us; without any conscious effort our body immediately reacts by producing sensations which are often as unpleasant as the cause. The heart beats faster, blood is shifted from other areas of the body to the limb muscles and to the brain, encouraging quick thinking and vigorous activity. Adrenalin and related chemicals which are released-into the bloodstream provide additional strength, stamina and the ability to respond rapidly. These chemicals help soldiers to survive in battle, athletes to perform better and all individuals to respond more effectively when faced with dangerous situations.

There are people who actually enjoy these sensations, finding them exciting and stimulating, and they frequently seek a career or hobby where there is an element of danger, indulging in hair-raising activities in the name of adventure, exploration or sport. (Think bungee-jumping, white-water rafting and even some of the gut-wrenching rides found in amusement parks.)

Most of us are ashamed to admit that we might be nervous or fearful, since courage has always been considered to be a superior virtue and from childhood we are told to be brave and not show our fears. There can be a backlash, though, because some children - particularly boys - are so conditioned to be 'brave’ that they become over-confident, foolhardy and accident-prone.

Many of the world's great heroes killed in battle might have lived to fight another day if they had been less fearless and more cautious. At the Battle of Trafalgar, Lord Nelson insisted on wearing all his medals and decorations so that the enemy could identify and marvel at the bold British admiral ... they made a great target for a French sniper, and the man who in his youth had remarked, Tear, what is that?' returned to his homeland pickled in a keg of brandy.

Our forebears had good reason to be fearful. In order to survive it was necessary for people to be continually on the alert for danger. Marauding tribes and dangerous animals on the prowl were a constant threat when you had only a club for a weapon and the sparse shelter of a cave to retreat into. When nger threatened, these people, their survival at risk, would e 'tensed up' and ready for action - to stand and fight or to run for their lives.

Over the centuries, as we have become more or less civilised, survival has become easier and most of the earlier dangers have disappeared. Of course, modern humanity has its problems - mainly of our own making - but apart from those people for whom danger is a normal way of life, either in their profession or for entertainment, most of us are fairly assured of our survival to a ripe old age, bar accident or illness. The danger response is not now a necessary daily part of our bodily functions, so when it does occur it is likely to have longer-lasting disturbing effects. The cave people, victorious in battle or having escaped from a woolly mammoth or a sabre-tooth tiger for the umpteenth time, would relax and sleep by the fire, forgetting their nerve-racking experience until the next time. Nowadays, the emotional consequences of a bad shock or accident will persist for much longer, and being unused to such experiences we resent the effect they have on our well-being.

A certain amount of fear is healthy and it prevents us from risking ourselves in dangerous situations. There are, however, many of us who because of our personalities are more prone to fear than others. We can all understand being terrified when onfronted with a dangerous situation, though in these days, apart from being attacked by a mugger or injured in a car accident, life isn't all that dangerous. If we are faced with a life-threatening situation, however, the 'flight or fight* response that our cave people experienced is perfectly normal. In fact, it is imperative that our automatic system goes into overdrive in order that we may tackle the emergency or retreat from the scene as quickly as possible.

But sometimes we get the wrong signals. A sudden surge of fear, even when no danger exists, causes bodily changes. Adrenalin pours into the system, the body prepares itself for action ... but no action follows. If the nervous energy could be discharged, the body would settle down. But when this does not happen there is physiological confusion. I'm sure you recognise the sensations: racing heart, dry mouth, clammy hands, overbreathing, dizziness, a 'tight band round the head', vision disturbance, a 'lump' in the throat and buzzing in the ears. The feelings build up until they seem unbearable and the sufferer, clinging to the nearest static object to support her 'jelly legs', thinks, 'I can't stand it. My system won't take any more. I'll have a heart attack, a stroke, a burst blood vessel. I'll drop down dead, I know I will….’

This is the classic description of a panic attack as experienced by Jane in the previous chapter. Unfortunately the word 'panic' suggests a loss of control resulting in the person screaming and running round in circles. The usual panic attack sufferer does not behave like this. She (or he) feels overcome by feelings of acute fear, but most shrink at the thought of drawing attention to themselves. The struggle to appear calm increases the tension and terror as they fight to conceal their distress. The feelings build up until they seem unbearable and the sufferer, clinging to the nearest static object for support, waits for some dreadful climax. There is no climax. The sensations can only reach a certain level and then they subside.

This does not mean that there are no after-effects of such an experience; a severe panic attack can leave you in a highly sensitised state, weak and exhausted, but it cannot damage you, either physically or mentally.

What is panic attack?

2009-01-08T12:23:00.000-08:00

The ambulance arrives at the A 8c E Department and a young woman is helped through the hospital doors. She is pale and shaking, and breathing erratically... a suspected heart attack. Hospital staff gently encourage her to calm down as they spend the next couple of hours putting her through a number of tests. Jane is terrified; such feelings as she has just experi¬enced have never affected her before and she is convinced there is something terribly wrong - pains in her chest, ringing in her ears, faintness and dizziness and difficulty in getting her breath. These could be symptoms of a number of serious disorders.

'You can go home now, Jane,' the doctor tells her eventually. 'You have just experienced a severe anxiety attack. Nothing else wrong, just visit your GP in the next couple of days and he will prescribe something to settle your nerves.'

Jane sits and waits for her husband to collect her and take her home. Her mind is spinning, and although she is partially comforted by the doctors assurance that there is nothing seriously wrong, surely the frightening feelings she experi¬enced can't be as harmless as the doctor said? She has always been so healthy and now in her mid-twenties she is happily married with a toddler and a young baby. She feels there was no reason for her to have gone through such an overwhelming experience and is mortified at the thought of having made such a fool of herself in public.

By the time Mike collects her, Jane is almost back to her normal self. 'What came over you?' he asks. 'I was told you fainted in the street. You’ve never fainted in your life!

'I felt faint,’ Jane admits. 'But I didn't actually pass out. I was so frightened, my legs turned to jelly and I just sat down on the pavement. That's when someone sent for an ambulance - they thought I was having a heart attack. Surely anxiety couldn't have had such a devastating effect? Why did it happen? What if it happens again?

Next day Jane visits her GP. 'Lots of people may have an anxiety or panic attack,' she is told as she is prescribed a week's supply of tranquillisers, given a pep talk and told to relax and stop worrying.

The family is reassuring, reminding her that she has recently got over a bad cold which hung around for a couple of weeks. 'You're just a bit run down,' her mother tells her. How comforting. A few days resting at home with her mother and sister helping with the children, and Jane feels she will be back to normal.

A week later Jane has almost forgotten her frightening experience in the High Street. She leaves the children with her mother while she and Mike visit the supermarket and do the weekend shopping. What a relief, she thinks ... no unpleasant symptoms, everything is back to normal. She goes with her mother to buy clothes for the children. Nothing untoward happens and Jane feels confident enough to make the next trip to the supermarket on her own.
The supermarket is warm and bright; the usual crowd of weekend shoppers bustle about. Suddenly the lights seem to flicker, Jane's eyes are playing tricks and the noise of the people around her is overwhelming. It's happening again, she thinks, as she tries to fight the rising fear which is becoming difficult to control. Oblivious of the other shoppers she abandons her shopping trolley and escapes through the nearest checkout to get to the car park, where to her relief the frightening feelings subside almost immediately.

The way to stop these feelings recurring must be to avoid the supermarket altogether for the time being. Jane feels that the constant worrying is beginning to affect her in other ways and she feels on edge and jittery all the time. Shopping locally seems to be the answer, and all goes well at first until one day as she is walking along the street the dreaded feelings start building up once again. She feels unsafe and afraid - but what is she afraid of? Not of the shops nor the street, but of the feeling of fear itself.

Time to return to the GP. This time Jane breaks down and cries in the surgery as she tells him she is afraid she is going out of her mind.

A course of antidepressant drugs will help, the doctor tells her, but he will refer her to a psychologist for therapy — unfortunately there is a long waiting list and it could be several months before she can get the help she needs to overcome her panic attacks. In the meantime she should contact one of the self-help groups and learn to manage her recovery.

Perhaps you can identify with Jane and need to know what is the next step to managing your fears. You may not be suffering from panic attacks but have other deep-seated problems such as chronic anxiety; you may suffer from one or many phobias or some other nervous problem that you are desperate to overcome.

Where do you start? First of all you have to learn to face your fears and not be frightened by them. Fear of the fear is the shadow that hangs over you, and once you have mastered that fear you can then tackle the other problems. It wont be easy, but remember: if you had a broken leg you would have to face weeks of physiotherapy, often painful, before you could walk properly again.

Many anxious people cannot bear to read descriptions of symptoms, but you do not 'catch' feelings you read about, even if your imagination makes you feel uncomfortable. Keep reading and you will be surprised at your relief at knowing you are not alone or different from everyone else.

If You Are Depressed, Your Brain and Body Stop "Talking"

2009-01-08T05:14:00.000-08:00

Why does depression affect your brain, body, moods, and behavior—everything about you? Because when you're depressed, your brain and body can't work together well enough to help you function normally. Your body depends on your brain to tell it to eat, drink, sleep, move, and feel. When your brain and body stop "talking," you're unable to process these important messages (it's like your brain is giving you the "silent treatment").

Your brain's limbic system helps regulate your emotions and your motivation. It's made up of several different areas, each responsible for certain tasks. Here are some examples:

• The thalamus screens and sorts messages from your senses (sight, smell, touch, hearing, and taste). If your thalamus doesn't receive the messages correctly, one result might be that foods don't look, smell, or taste appealing.

• The hypothalamus is the source of your feelings, including vein sexual feelings; it also controls your blood pressure and tells you when you're hungry and thirsty. If your hypothalamus is impaired, you may feel hungry a lot, lose your appetite, or have an increased (or decreased) interest in sex.

• The amygdala can activate anger and aggression, or make you feel calm, depending on the part that's stimulated. Overstimulation or under-stimulation of the amygdala may cause problems with anger and self-control.

• The hippocampus forms and stores new memories. If your hippocampus isn't working properly, you may have trouble learning new things or remembering what you've learned.

• The Reticular Activating System (RAS) alerts your brain that messages are coming from the five senses, then helps you concentrate by filtering this input. If this function fails, it may be hard for you to focus. The RAS is also responsible for regulating sleep.

• The cerebellum is responsible for posture, balance, and muscle coordination. If messages aren't transmitted properly in this area, you might have difficulty playing sports or just doing normal daily activities.

• The cerebrum, the largest part of your brain, does the "thinking" jobs like solving problems, making decisions, and receiving, storing, and retrieving memories. Your intellect, language skills, and ability to understand numbers and the alphabet are all based in your cerebrum. If the nerve cells in your cerebrum aren't functioning well, you may not be able to think clearly, use good judgment, or communicate effectively with other people.

In fact, when you're depressed, normal functions like eating, sleeping, walking, thinking, feeling, and remembering may seem like monumental tasks.

How to Deal with Normal Teen Behavior

2009-01-07T21:00:00.001-08:00

For parents, adolescent development can challenge our ability to deal with strong emotions, and even affect our perception of ourselves (especially if we had difficulty with adolescence ourselves). Furthermore, parents often feel they have less influence over the behavior of adolescents than of younger children. Handling your teen's behavior may be especially problematic if she seems to be deliberately "pushing your buttons"—that is, reacting in ways that predictably make you upset.

When you feel a "button beeing pushed"

Many times, your teen's responses are less deliberate than they first appear to be. Think about these possibilities to understand underlying reasons you feel as if your buttons are being pushed:

• Maybe the teen's behavior reminds you of someone who hurt you in the past.

• Maybe her behavior elicits reactions from you that are like those of someone who hurt you in the past.

In both situations, a negative relationship from the past seems to be "replayed" between you and your teen. Also consider the following possibilities, which are more relevant to your own identity development:

• Maybe the teen's behavior reminds you of an undeveloped part of yourself. (For example, you may pride yourself in being strong and self-reliant, but your teen is repeatedly asking for help with the smallest thing—perhaps you envy her ability to rely on others.)

• Maybe the teen's behavior reminds you of a part of yourself you dislike.

• Maybe the teen's behavior reminds you of something you missed out on in your own adolescence (For example, your teen confidently speaks her mind, even when it annoys you, while you were too considerate of others' feelings to be so bold.)

• Maybe you miss being the mother or father of a child, and are irritated by reminders of the fact that she is now an adolescent. (For example, you are upset that your adolescent now does things alone or with others that you used to do with her.)

Consider whether one of the above may be intensifying your feelings about the situation. Then, give yourself a chance to calm down, separate your own feelings from those of your teen, and try to put yourself in her shoes. An empathic parental response should be easier in this frame of mind.

Dealing With Teen Behavior

Here are some parents' ideas for handling teen behavior, regardless of whether the teen has a diagnosis.

• Don't take it personally.

• Don't expect respect, but give it.

• Don't punish endlessly.

• Support independence by letting your teen do some things for herself. (For example, don't argue about why you won't get her a Popsicle from the fridge; just don't do it.)

• If your teen won't go to her room for a time out: give her space, send her to the store, go to your own room, or have an immediate consequence.

• Give her choices, but with limits. (For example, "Do you want to do your math first or your history?"—implying that some sort of homework will be done, but you're willing to negotiate on the order of subjects. Or, "Would you like to take the bus to school or walk?"—implying that school attendance is compulsory, but mode of transportation is negotiable.)

Recipe For Panic Attack: Depression Basmati Rice with Flaked Fish and Green Peas

2008-12-29T03:14:00.000-08:00

Type: Lunch/Dinner
Equipment: Medium pan, hob
Preparation time: 5 mins
Cooking time: 20 mins

Basmati rice contains a higher proportion of the slowly-digested amylose starch. This means it has a particularly low Glycaemic Index and makes a good choice for a carbohydrate that won't create a blood sugar high to be followed by a rebound low. Oil-rich fish from a tin are an excellent, easy and economical source of the beneficial omega-3 essential fats needed to 'oil the brain'. A balance in colour is provided with something green so peas seem the ideal choice for this recipe. Frozen peas (also having a low GI) are very convenient. The freezing of vegetables retains high vitamin levels which can so easily be reduced in the not-so-fresh alternatives.

Ingredients (per person)

75g/3oz/V2 cup basmati rice
1 small tin oil-rich fish in brine/spring water or olive oil e.g. mackerel, salmon, sardines, pilchards or fresh tuna
75g/3oz/V2 cup frozen peas

Method

Rinse and cook the rice according to the instructions on the packet.
Meanwhile, drain the liquid from the tinned fish, tip into a bowl and flake with a fork. Large bones can be removed but smaller bones are soft, edible and a good source of calcium.
Cook the frozen peas in a pan of boiling water for 5 mins, then drain.
When rice is ready, drain and tip into a bowl. Add the fish and peas and fold gently together.
Serve. If liked, plain live soya yoghurt can be used as a dressing.

Good Mood Herbs For Panic Attack Relief

2008-12-29T03:08:00.000-08:00

Many common herbs which are used in cooking for their flavour and aroma can also be included in recipes for their effects on the mind. Other herbs, such as chamomile (which has a calming effect and can help with insomnia), are usually taken in the form of a tea. Herbal teas are available in many food stores and can be purchased as loose tea or tea bags. They can be used as alternatives to tea and coffee and do not contain caffeine.

Also available are concentrated herbal preparations which are used specifically for their therapeutic benefits for emotional and mental health. For example, herbs such as St John's Wort (Hypericum perforatum) or Kava Kava (Piper methysticum) can be used to help symptoms of depression and anxiety respectively. However, if you are already taking any medication, it is essential that you first consult your doctor for guidance prior to trying these herbal remedies. It is very unwise to suddenly stop taking any medication, and if you continue with some drugs whilst also taking herbal remedies, the combination can create unpleasant side-effects. It is also recommended that you consult a medical herbalist about using these herbs, which don't necessarily suit everyone.

Knowledge of the benefits of herbs for the mind comes from their use down the ages in traditional folk medicine as well as in the modern-day practices of herbalism and aromatherapy (which uses essential oils extracted from herbs). The herbs listed here are some that can be used in cooking or to make a tea for drinking.

basil
Can have a clarifying effect on the mind, sharpen the senses and improve concentration. Used in cooking, it works particularly well with tomatoes or to make pesto sauce.

chamomile
A soothing herb that helps to ease anxiety and tension and promotes relaxation. Can be of benefit for insomnia. The dried herb is usually used loose or in bags to make a tea.

cinnamon
A spice that can help counteract exhaustion, fatigue and weakness. May help with depression. It also appears to have an insulin-enhancing effect and may help regulate blood sugar levels. Used in baking and with cooked fruit such as apples and pears.

coriander/ cilantro
Reputed to have a refreshing, stimulating and uplifting effect on the mind and may help with lethargy and tension. The leaves or seeds may be used in a variety of cooked dishes.

Panic Attack Tips: The Value of Water

2008-12-29T03:05:00.000-08:00

If you change only one thing in your diet you could do a lot worse than simply increasing the amount of plain water you drink

If you change only one thing in your diet you could do a lot worse than simply increasing the amount of plain water you drink, for water can have a profound effect on the way we feel. Symptoms of 'fuzzy thinking' and poor concentration, for example, can simply be a matter of dehydration which is soon improved by having a glass of water. Water is also the solvent for many of the toxins that are flushed out of the body in the urine via the kidneys. When reducing the amount of caffeine you consume, withdrawal symptoms such as headaches can be helped by increasing the amount of water that is drunk throughout the day.

The body is approximately three-quarters water. About two litres, or approximately eight tumblers, of water are needed every day to replace fluids excreted in waste products, sweat and even in the air we exhale. More than this amount is needed in warmer weather and when undertaking physical exercise. If your urine is darker in colour with a strong smell, then dehydration is the likely cause. Counting the water which is used in cups of tea or coffee towards your total water intake doesn't work, as the caffeine contained in these drinks has a diuretic effect, causing you to get rid of yet more water. Diluted fruit juices, for example, are better than no water-containing liquids at all, but drinking plain water is the most effective solution for dehydration.

Although many people do not actually feel thirsty, most of us appear to be suffering from chronic dehydration to some degree and feel better if we drink more water. Beginning a regime of drinking more water may take a certain amount of discipline -even willpower. Nevertheless, the benefits to the way you think and feel can appear within a week or two of making a concerted effort to drink more water. Eventually, your thirst sensation will be reawakened and plain water will become the thirst-quenching drink you enjoy.

Good Mood Nutrients

2008-12-29T03:00:00.000-08:00

Taking some nutritional supplements may be the only way to obtain what is needed to feel well.

To attribute how we think and feel as being entirely due to the effect of specific nutrients would obviously ignore the wide range of influences that affect emotional and mental health. Yet much of the (often confusing and contradictory) nutritional advice in the media arises from scientific research which has been conducted by focusing on individual nutrients and testing them to learn their specific effects in particular situations. The scientific testing of individual nutrients may not always reflect how the whole mind-and-body responds to food or functions in everyday circumstances outside of the laboratory. Further, this process tends to highlight certain individual nutrients which then become better known for their beneficial effects, whilst giving less attention to other nutrients which may be just as important.

All nutrients function together in an extremely complex network of supportive and antagonistic relationships. It is likely that the nutrients most compatible with the human mind-and-body are those found in food, rather than the substances that can be obtained from nutritional supplements. Although not all foods in nature are harmless to humans, our bodies have evolved over millions of years because we have been able to adapt to what we experience in our environment. Whole foods (rather than refined or overly processed products) which have been grown with the minimum artificial fertilizers, pesticides and herbicides, are going to be closest to what the human body is designed to deal with.

Yet, because the amount of nutrients within foods varies enormously, and the soil on which food is grown can be lacking in minerals, taking some nutritional supplements may be the only way to obtain what is needed to feel well.

How Do We Know when Our Teen Has Major Depression

2008-12-29T02:46:00.001-08:00

About 5 percent of children and adolescents in the general population suffer from major depression at any given point in time (American Academy of Child and Adolescent psychiatry www.aacap.org). Major depression, also known as a clinical depression, is not a single symptom but rather a cluster of symptoms. Major depression is most likely to be present if there has been a change in the teen's patterns of thoughts, feelings, and/or behaviors which are manifested with the following symptoms:

• Frequent sadness or "down" mood

• Increased irritability, anger, or hostility (sometimes children exhibit more irritability than sadness with depression)

• Lack of enjoyment (also called "anhedonia") or inability to enjoy activities that the teen previously showed interest in

• Appetite change (either an increase or decrease in appetite)

• Sleep change (difficulty falling asleep, restless sleep, sleeping more or less than usual)

• Low energy

• Low concentration

• Motor agitation (such as restlessness, fidgeting or pacing, or reporting feeling "revved up") or slowing down (such as feeling as if daily activities are hard to get through or to physically complete)

• Guilt or worthlessness (such as feeling or expressing guilt or feeling worthless or "like a loser")

• Suicidally (ranging from questioning the value of life, to actual thoughts, expressions, or gestures of self-harm.

• Depressed adolescents may also abuse drugs or alcohol as a way to make themselves feel better.

A diagnosis of major depression will be made if the teen's feelings of sadness and lack of enjoyment have gone on for at least two weeks and if four or more of the other listed symptoms have occurred almost every day. Suicidal thoughts and - may not occur as frequently as daily. However, if they exist at all, they need to be explored immediately.

There can be a genetic component to depression. One study (Kovacs, 1997) showed that families of depressed teens were five times as likely as those of non-depressed teens to have a person in the family who also suffered from depression. The closer the relative is, the higher the risk.

Depressed children and teens have most of these symptoms for at least a couple of weeks. Briefer mood disturbances sometimes occur in response to stress, but this is not considered true "clinical depression" (i.e., a depression requiring treatment). Everyone has these symptoms sometimes (for example, normal grief), but if they persist and interfere with day-to-day functioning, they constitute a disorder.

Once a disorder is diagnosed, it can happen once (a so-called "single episode" of depression), or several times (called "recurrent depression"). A single episode can last anywhere from a few months to a year. Therefore, it is important that professional involvement continues for at least this length of time. A substantial number of depressed teens (30 to 40 percent) have recurrent depression, so it is important to watch for further mood problems once an episode of depression resolves. Early intervention can minimize the impact of recurrent episodes of depression. Without intervention, a teen's self-esteem and ability to function (in the family, socially academically) can be severely affected.

A teen who experiences a major mood disorder with hallucinations (such as hearing voices) or delusions (such as having unrealistic ideas about a TV show containing a special message for her), but does not have schizophrenia, may be experiencing psychotic depression.

Common Side Effects of Selective Serotonin Reuptake Inhibitors

2008-12-29T02:45:00.002-08:00

Like all medications, Selective Serotonin Reuptake Inhibitors can have potential side effects. Common ones include:

• Nausea or upset stomach, especially during the first week or so after starting medication or after a dosage increase.

• Sedation (tiredness or sleepiness) or activation (having more energy) can also occur with these medications. Of the five currently prescribed, fluvoxamine (Luvox) is more often sedating, fluoxetine (Prozac) and paroxetine (Paxil) are more often activating, and sertraline (Zoloft) and citalopram (Celexa) are in between. We use the term "more often" because children and teens vary greatly in their responses, and the same medication may sedate one child and activate another. By having either morning (for activating medication) or evening (for sedating medication) dosing, these problems can often be avoided. Youngsters appear to be somewhat more sensitive to the activating effects of SSRIs than adults are, so the more sedating and "in between" medications have increased in popularity with children recently.

• Headaches are less common side effects, but can occur in children who are predisposed.

• Loss of sexual interest can occur.

• Flu-like symptoms can occur if they are stopped suddenly (except for Prozac, which leaves the body very gradually). Note, however, that none of these medications are addictive, in the sense that they do not induce a "high," and the body does not develop a need for ever-increasing doses over time (termed "tolerance"). Dosage adjustments are made according to your child's response to the medication, and sometimes in response to physical growth. Teens who grow quickly or gain substantial weight quickly may need more medication.

• Weight change can occur. Weight gain is more common than weight loss, but some of these medications (for example, Prozac) can also curb appetite in some people. With good eating habits, medication-related weight change is usually not great. Remember, though, that appetite changes often accompany depression and remit as depression improves. Thus, a teen whose appetite has been suppressed by depression for several months may appear to gain substantial weight when the depression is medically treated.

Overall, SSRIs are remarkably well tolerated compared to other psychiatric medications. The one exception occurs in people predisposed to bipolar disorder, a condition where elated or irritable mood episodes occur alternating with depressive ones. In these people, SSRIs (or any other antidepressant medications) can sometimes trigger manic episodes. People with close relatives who have bipolar disorder may also be at risk for this reaction.

Depression Tips: How to Benefit from Exercise and Acupuncture

2008-12-29T02:45:00.001-08:00

Exercise

Exercise is the most effective way of physically changing how we feel, and it requires the most amount of effort. When we exercise, endorphins are released into the body and this boosts the mind and spirit.

'Exercise' is a huge subject and is personal to each individual. We need to give our heart a work-out to produce the 'feel good' endorphins that will occur as a result. If you are doing no exercise at the moment, then a fast walk three times a week may be what you need to feel better. However, if you are already fit, then a game of squash or an exercise class three times a week may be what you need. Many leisure centers now have well-equipped, reasonably priced gyms with qualified staff to help plan an exercise routine for you. If you're worried about how much exercise to start with, consult a doctor or a personal trainer.

Yoga

If you aren't keen on the idea of jumping around in a gym, then yoga can be the perfect answer to getting a total mind/ body outing without having to sweat for it. It is calming, non-competitive and gentle. It is also perfect for relieving the symptoms of stress. Even the smallest towns have a yoga class somewhere as part of the local adult education program. There are many forms of yoga being taught these days, brought to prominence by celebrity endorsement, but the basic Hatha yoga is the one to aim for if you have never tried it before.

After a period of time, usually a couple of weeks, the benefit of exercise for those who are unused to it can be astonishing. Not only do the right chemicals get released, but stamina and strength increase. In turn, we carry ourselves a little taller, we feel fitter and our mood will lift.

Exercise may be just what you need to help you absorb the extra energy you will feel from changing your eating plan. However, if you find you only have the energy for one or the other, just take each task a day at a time.

Acupuncture

A survey conducted by The Daily Telegraph found that scientists in fields ranging from molecular biology to neuroscience were twice as likely to use complementary medicine as the general public. Three quarters of scientific users believed they were effective, with acupuncture topping the list. The method of acupuncture -seems strange to us in the Western world, but it is really worth checking out. Personally I have found acupuncture to have an 'unblocking' effect, both physically and emotionally. I simply feel as if everything is flowing more freely.

There are ways to receive acupuncture for a minimum cost or for no charge. You can contact an acupuncture college through the British Acupuncture Council and receive treatment from the students under supervision. Otherwise, as with a counselor, get a good recommendation.

When Suffering from Depression, Develop Your Faith

2008-12-29T02:44:00.001-08:00

Developing a faith in something will help you get better quicker by developing your trust. No matter how cynical we are, we are all better off with more trust and less control in our lives.

What does letting go entail? It means letting go of trying to hold on for dear life to things in spite of knowing that it is killing us!

What do we hold on to? We may try to hold on to another person, unwilling to let them go because we are scared of being alone. We may be trying to hang on to a lifestyle that we can no longer afford or keep up because we are frightened what others might say. We hold on to what is familiar for fear of facing change.

But what is the alternative? For many of us, self-control and control of others has got us nowhere except up a dark alley. We have been taught to be self-sufficient at any cost and to trust that only we can help ourselves.

It is when our backs are against the wall that we are perhaps at the point where we are most open to change. Putting in place an idea that we can rely on something other than ourselves will help us to free ourselves of the burden of depression. Relying only on ourselves keeps us stuck in the pain of depression, but reaching out in the belief that some-thing other than our self-control can help us will enable us to liberate ourselves.

FAITH IN A GOD

If you have a belief in a God then this should be an easy step for you. Using your confidence, start to turn to God and allow yourself to be guided by Him. Start your day with the following prayer:

"I turn my will and my life over to you.

Show what is your wish for me

And how to deliver it in my life, just for today."

With these thoughts uppermost in your mind, you can start to let go a little. Instead of getting frustrated about something you cannot manage, take a deep breath and 'hand it over'. Instead of trying to push the boulder uphill, stand aside and let nature take its course, allowing it to roll down the hill. Allow the love of God to enter you, nourish and heal you.

Letting go of control and letting a God take over doesn't mean we abdicate our responsibilities. It doesn't mean we don't bother to work any more or wait for God to hand us Saturday night's lottery numbers. It means we 'plan but don't project'; we have aims with objectives but we don't force the result; we ask for what we need but we don't demand that someone else does it. We become clear about what we want and then hand it over to our God.

If we allow our faith to develop and grow we will begin to create an inner home to which we will be able to turn when we need warmth and comfort. We will gradually feel the need to control others and outcomes less. We will start to feel more secure in the knowledge that there is a bigger picture than we realize; one over which we have very little influence. We begin to need less control over things, as our faith grows stronger. We become less needy and therefore less frightening to others because we have created a little haven into which we can dive for nourishment. People will come towards us and offer gifts that we may choose or not choose to accept. In time, they will want to know what it is we have and want some for themselves. No one can violate this sanctuary and our trust will manifest itself as an aid to recovering from depression.

Good Ways To Improve Sugar-Sensitivty

2008-12-29T02:39:00.000-08:00

Cut Down on the Sugar You Add To Food
You have probably gathered that too much sugar, particularly the refined sort added to food, is not going to be good for your emotional and mental health, especially if eaten in large amounts on a daily basis. A reduction in the amount you are eating is likely to be needed. But a word of warning: sugar can be experienced as a highly addictive substance.

Eating large amounts of sugar on a regular basis may create an addictive-type relationship with sugar that can be difficult to change.

Eating sugar-rich foods is thought to trigger the release of pleasure-giving brain chemicals called endorphins which 'reward' us for eating these foods. Eating large amounts of sugar on a regular basis may create an addictive-type relationship with sugar that can be difficult to change. We have no doubt evolved to find the taste of sugar extremely enjoyable because it guarantees an instant energy fix that in the past may have been essential for our survival. Sugar (mostly in the form of honey or sweet fruits) would have been harder for our cave-dwelling ancestors to obtain compared with the availability of sugar today. Concentrated sugar (for our ancestors) would have been an extremely valuable food compared with what is needed for the survival of modern man.

You may find that if you suddenly exclude all concentrated sugars from your diet you experience unpleasant withdrawal symptoms and feel worse before you feel better, as your body and brain adjust to the change. For this reason it is often easier if you reduce your sugar intake slowly and re-train your taste buds gradually. Your first step could be to cut down on the quantity of concentrated sugars in your daily diet. Start by reducing the amount of table sugar you add to tea or coffee and sprinkle over breakfast cereal, or indeed over any other foods you eat. Try setting yourself the target to re-educate your taste buds to enjoy less sugar within a few weeks or months - whatever feels comfortable to you.

Panic Attack Recipe: Grilled Sardines on Corn/Maize Bread

2008-12-29T02:34:00.000-08:00

Type: Quick lunch or supper
Equipment: Small bread tin, oven, grill/broiler, grinder for linseeds (optional)
Preparation time: 10 mins (bread), 1 min (grilled sardines)
Cooking time: 45 mins (bread), 5 mins (grilled sardines)

Corn/maize bread can make a good alternative for those sensitive to wheat and rye-based bread which both contain gluten. If you don't wish to make your own then corn/maize bread can be purchased from most health-food stores. This recipe is for sourdough bread which does not use yeast. It is therefore suitable for those avoiding yeast and its texture is closer to that of cake than traditional leavened breads. There is also the option to add linseeds which are the main vegetarian source of omega-3 oils an also provide useful fibre or 'roughage'. Tinned sardines, which are readily available and inexpensive to buy, can be used for this recipe. They are also an excellent source of omega-3 oils, the essential good mood nutrient.

Ingredients (per person)

For the grilled sardines:

1 small tin sardines in olive oil, spring water or brine
For the com/maize bread (serves 4):
150g/6oz/l 1/2 cups corn/maize meal or corn/maize flour
150g/6oz/l 1/2 cups rice flour
50g/2oz/V2 cup ground/whole linseeds (optional)
1 tbsp mixed dried herbs (optional)
pinch (sea) salt
1 tsp sodium or potassium bicarbonate 300ml/V2 pint/1 cup rice milk

Method

To make the corn/maize bread:
Preheat the oven to 180°C/350°F/Gas Mark 4. i 2 Mix together the dry ingredients.
Make a 'well' in the middle and pour in half the rice milk.
Stir together and keep adding the remainder of the milk until the ingredients stick together to form a single lump (you may want to use your hands for this). You may need slightly less or more milk than given in the ingredients list.
Bake for 45 mins approx.
When ready, remove from oven. If necessary, loosen edges with spatula or fish slice and tip out of tin to cool, preferably on a wire rack.

Mood And Food: Acidic and Alkaline Foods

2008-12-29T02:17:00.001-08:00

Foods can also be classified as either acid-forming or alkalizing according to the effect they have on the body. This effect may be different to whether or not the food actually tastes acidic. For example, the acids of most fruits are metabolized to leave an alkaline 'ash' in the body and so are classed as alkaline foods. Both types of food are needed for balance, depending on individual metabolism, amount of physical activity and breathing pattern. It is generally easier to become over-acidic than over-alkaline so most people benefit from including a greater proportion of alkaline foods in their diet.

Cravings for alkalizing foods or drinks can indicate a need to redress an acid overload, which can be signalled by a range of symptoms which include poor concentration, insomnia, irritability and low libido. This imbalance may result from eating too many acid-forming sweets, cakes, fatty foods and meat. Fruit and vegetables and their juices can be eaten to redress the balance. An excess of alkalizing fruit or vegetables is less likely but it could create a need for acid-forming foods such as meat, fish, eggs or cheese.

Five Phases of Foods and Feelings

2008-12-29T02:14:00.000-08:00

One way to avoid an imbalance is to eat as varied a diet as possible.

A different and more complicated way of thinking about balance is the Oriental Theory of the Five 'Elements' or Five 'Phases'. It is based on the idea that life energy moves in specific predictable cycles. Each phase in the cycle influences the others and has traditional associations such as body organ, flavour sensation, type of food and mood. Energy imbalances in this system can show up as cravings for unusual combinations of foods. One way to avoid an imbalance, according to this theory, is to eat as varied a diet as possible. Use the diagram below to find out if any imbalances in your diet can be linked with any of the associated feelings.

Oriental medicine also lists foods that are found to cause water retention or mucus formation. These foods are known as 'damp'-forming foods. The 'damp' foods correspond with many of the common culprit foods associated with emotional and mental symptoms. Particularly 'damp' foods include bananas, beer, milk and dairy products, oranges, peanuts, pork, saturated fats, sugar, tomatoes, wheat and yeast.

The Need for Balance

2008-12-29T02:06:00.000-08:00

The idea of health as being a matter of balance is central to many systems of medicine. The term 'homeostasis' is used by orthodox and complementary practitioners alike to describe the body's in-built checks and balances that aim to keep things running smoothly. Whether or not we fully comprehend the mechanisms involved, it is becoming clearer how food has an important part to play in maintaining, or undermining, the functioning of mind and body.

Different medical systems use different models to describe and explain the idea of balance. When applied to the food we eat, each system offers an insight into what we could eat more of, and what we may need to eat less of, in order to feel well. All approaches to nutrition appear to start by grouping foods in one way or another. Problems are then associated with either too much, or not enough, of one or other category of food. Solutions are suggested which require a change in the balance of foods eaten. Ideally, individual characteristics are also recognized and accommodated by adjusting the combination of foods suggested.

Most of us are familiar with the idea of eating a 'balanced diet' and of the need to eat a variety of different foods to help us become - or remain - healthy. This idea of balance can vary between cultures but, whichever way we choose to view foods, all approaches have something to offer our understanding of the relationship between food and mood.

In the west we are used to thinking of foods as being divided up into protein foods (such as meat, fish, beans, cheese, eggs), carbohydrates (such as bread, pasta, potatoes, cakes, biscuits) and fatty foods (such as butter, cream and oils). In practice, a complete and largely unrefined food is likely to contain some protein, carbohydrate and fat, although one of these substances probably predominates. The protein, carbohydrate and fat groupings relate to how these food components are used by the body.

Eastern systems of medicine and philosophy divide foods according to the subtle effects they have on mind and body.

More common to eastern systems of medicine and philosophy are ideas of dividing foods according to the range of subtle effects they can have on mind and body. These approaches to food may use terms in pairs of opposites, such as the 'yin' and 'yang' of rnacrobiotics, or have groupings such as the three 'doshas' of Ayurvedic medicine or the fve 'phases' of Oriental medicine.

Good Mood Food Recipe - Sweet Potato Cakes

2008-12-29T02:04:00.001-08:00

Type: Snack
Equipment: Oven
Preparation time: 10 mins
Cooking time: 30 mins

The natural sweetness of these savoury foods combine with the apple to produce a tasty and filling sweet snack. Sweet potatoes belong to a different food family from the more familiar white-fleshed potato (which is a member of the nightshade family). They contain antioxidant nutrients and have a lower Glycaemic Index than regular potatoes. Despite the name, buckwheat is no relation to wheat; instead it is in the same food family as rhubarb. It does not contain gluten and so makes a safe alternative for those sensitive to gluten-containing grains. Buckwheat is also rich in antioxidant bioflavonoids and minerals and has a low GI. The combination of sweet potato and buckwheat makes for a very slow energy-releasing snack.

Ingredients (serves 4)

200g/8oz/2 cups sweet potato, cooked with skin removed
100g/4oz/l cup buckwheat flour
100g/4oz/l cup milk-/dairy-free margarine
1 apple, chopped small
1 tsp chopped ginger
pinch cinnamon (optional)

Method

Preheat the oven to 200°C/375°F/Gas Mark 5.
Combine the ingredients in a bowl.
Form into four medium-sized or eight small balls, place onto a greased baking sheet and flatten slightly.
Bake for 30 mins.
Delicious eaten whilst still warm.

How Does Major Depression Relate to Bipolar Depression and Dysthymic Disorder

2008-12-23T02:19:00.003-08:00

Bipolar Disorder

Mania is having the opposite picture to depression for at least a week (for example, high energy, fast speech, elated mood, involvement in reckless activities), sometimes accompanied by feelings of grandiosity (being better than everyone else). It occurs in a subgroup of depressed teens, and is also known as "bipolar illness" or "bipolar affective disorder." In bipolar illness, episodes of depression and episodes of mania both occur at different times. Between episodes, the teen may appear normal and function well. It is important to tell your child's doctor if there is a family history of mania as well as depression, as this may affect the treatment plan. (For example, the choice of medication is sometimes different with this information.)

There is a genetic predisposition to bipolar disorder. If the teen has an immediate family member diagnosed with bipolar, there is about a 4.5 percent chance of the child getting bipolar disorder and about a 14 percent chance of getting major depression.

In teens and children, bipolar disorder is sometimes difficult to distinguish from AD/HD and other childhood disorders. Therefore, it requires a thorough diagnostic assessment, and sometimes further assessment of mood patterns over time, before the diagnosis is clear.

Because teens who are manic can engage in dangerous activities and/or lose their perspective on reality, have your teen see a doctor immediately if you think she has this problem. The approach described in this book is not suitable for helping teens overcome manic states. The approach can still be used, however, to help these teens with their depressed states.

Dysthymic Disorder

Dysthymic disorder or dysthymia (pronounced "dis-THI-me-uh) is a type of depression that is less severe than major depression. It is characterized by long-term chronic symptoms that keep individuals from functioning with usual energy levels and from feeling good. There are fewer physical symptoms than with major depression, but more emotional symptoms such as gloomy thoughts and low mood (Kaufman, 2000). Sometimes people with dysthymia also experience major depressive episodes, so it is worth watching for signs that this is happening. If a major depressive episode is occurring, the teen's moods will be clearly worse than usual and she will experience more physical symptoms than usual.

Major Causes of Teen's Depression

2008-12-23T02:19:00.001-08:00

As in most mental illnesses, we can't really talk about a single "cause" in depression. There are usually both constitutional (inborn) and environmental factors that contribute to the condition, and often there are one or more environmental stresses (such as school demands and frustrations, death of a loved one, a move, or separation or divorce of parents) that act as triggers for a particular depressive episode. As a parent, blaming yourself or your spouse for your son's or daughter's condition is unlikely to be helpful. It is worthwhile having a thorough assessment by a mental health professional, however, as this may clarify the diagnosis and uncover contributing factors that could be changed.

Some teens are initially thought to be depressed but are later found to be suffering from a medical condition that is producing mood changes. Thyroid problems and aheinia (low iron in the blood) commonly cause mood changes, but so too may other medical conditions. Use of certain medications (for example, birth control pills) or street drugs can also affect mood. If your teen hasn't had a recent physical examination, it is well worth pursuing one. Remember to tell the doctor about the mood changes so he or she knows what to look for.

Parents often inquire about blood tests or other examinations that could reveal whether or not their child's brain chemistry is abnormal. Unfortunately, measuring brain chemicals in the bloodstream is not reliable, as there is a cellular barrier or wall between the bloodstream and the brain. Thus, levels of brain chemicals in the bloodstream do not necessarily reflect similar levels in the brain. Brain structure is rarely abnormal in depression, so computerized tomography (CT scan) or magnetic resonance imaging (MRI scan) usually do not help. Brain functioning, as measured by positron emission tomography (PET scan), can be abnormal, but such scans are very expensive, and are usually only available as part of research protocols.

Reactions to traumatic events (so-called "post-traumatic stress disorder") can also mimic depression. Although we all try to protect our children as best we can, it's impossible to monitor teens twenty-four hours a day, so the possibility of a traumatic event should not be dismissed too quickly. Children with pre-existing mental health problems such as anxiety disorders or attention-deficit/hyperactivity disorder are also more vulnerable to developing depression in adolescence.

Note that some things that used to be considered causes of depression are now recognized as part of the illness (for example, pessimistic thinking, social withdrawal, or a tendency to ruminate on past mistakes). Depressed people typically withdraw and see the "glass half empty." Most brief, focused psychotherapies address these symptoms early, by encouraging constructive action and realistically positive thinking. Feelings often take longer to change.

What Professionals Can Determine Whether a Teen is Depressed?

2008-12-23T02:18:00.001-08:00

There are many mental health professionals - psychiatrists, psychologists, nurses, nurse practitioners, social workers, child and youth workers, child care workers, child care associates, counselors, and others - who work with depressed teens. It is sometimes overwhelming to know who to seek help from!

First, we advise you to rule out any medical conditions that may be causing the depression. It is also important to clarify from the outset whether your teen is experiencing a clinical depression. In order to get a diagnosis for your teen and rule out medical factors that may be contributing to the depressed mood, it is necessary to see a child and adolescent psychiatrist. The psychiatrist is a medical doctor who will rule out medical conditions by conducting a simple physical exam and order blood tests, if indicated. He or she also has the qualifications to prescribe and monitor medications if this becomes a recommended part of treatment for your child.

If a medical doctor has already ruled out physical conditions and you want a mental health diagnosis, you could consult a registered child psychologist instead of a psychiatrist. A psychologist cannot prescribe medications in most states or Canada but can assess, diagnose, and treat the teen for depression.

Other mental health professionals listed may conduct clinical assessments using validated questionnaires to help guide their assessments. They use knowledge of biological, psychological, and social factors in working with teens and their parents. However, they do not provide a formal diagnosis. They may, however, treat a child who has already been diagnosed.

If your child will need ongoing treatment, we recommend finding a mental health professional (like those listed above) who:

• specializes in child and family mental health,

• is qualified to provide cognitive-behavioral therapy

• is someone your teen will feel comfortable with and can relate to,

• is flexible, and

• is able to see your teen as an individual.

How to Locate a Professional to Help Your Depressed Child

2008-12-23T02:17:00.000-08:00

There are different ways to locate a professional to help your child. Probably the best way is by word of mouth through family and friends or others such as teachers or members of church or community organizations. If you are comfortable asking those you know for some names, it can never hurt to give them a call and check out their recommendations. You may also wish to consult your phone book or use the Internet as long as the Internet sites are reputable and affiliated with recognized professional groups. I recommend the website of the American Medical Association (www.assn.org) to help you locate a child and adolescent psychiatrist and the website of the American fcychological Association (www.apa.org) to find a child and adolescent psychologist.

You may also wish to contact your family doctor or a public health nurse who could recommend a mental health professional. Additionally, a crisis line, especially one for teens, or any major mental health center in your area, should be able to provide names of individuals and services to meet your teen's and family's needs.

You may personally know a child and adolescent mental health professional who could give you ideas about services for you and/or your teen. You may be tempted to ask this professional to see your child. We strongly advise against this for several reasons. First, it often becomes awkward for you, your teen, and the professional to respect the need for privacy and confidentiality. You may want to get more details about your teen's therapy, and, because you know the professional, feel more comfortable asking for it. The professional may want to share more details than she might otherwise do since she knows you. As a result, your teen may hesitate to share his feelings with the professional because he fears she may tell you or judge him. Maintaining professional boundaries is important to the success of any therapy, and in these cases, there is more opportunity to break those rules, ending in dissatisfaction for all.

How Can You Prepare For The Assessment?

When you make the first call to the professional/agency don't be shy about asking qestions. You have every right to know the professional's qualifications, as well as the type of therapy that she provides. Ask her what the research says about her therapy approach. Ask if she provides both assessment and treatment. You may wish to know how long therapy typically lasts. You should feel comfortable that your questions are answered. If you ask about wait lists, don't be surprised if the wait list is over six months for a first-time assessment. Wait lists can be long, and if you ever feel that your teen is deteriorating or needs immediate assistance, don't hesitate to take him to the Emergency Room of your local hospital.

Often parents worry that they will be judged by professionals when they seek help for mental health issues. Mental health care professionals are there to support families, not judge and blame them. They are there to help design a treatment plan that takes all the pieces into consideration. Teens and parents should feel comfortable asking questions. We hear many kinds of questions from parents and teens, such as those listed in the sidebar at left.

Likely Page Break

No question is silly. If your mental health professional does not ask you if you have questions, don't be shy about sharing your list with her! If the therapist tells you that she does a "different type" of therapy, or that it takes a long time before you will see progress, or that it is a new therapy that no one in the area offers, get more information! These are red flags! And always ask for explanations if you do not understand something.

Common Questions Parents Ask

• Can you help us?

• Is my child's problem treatable?

• What is the diagnosis?

• Do we need more testing?

• Should my child get treatment?

• Is it my fault?

• Should I get treatment?

• What are your recommendations?

• How long is treatment and how much will it cost?

• Can you recommend some books to read?

• What happens next?

• What is your cancellation policy?

What Does a Psychiatric Health Assessment Consist Of?

2008-12-23T00:49:00.001-08:00

A psychiatric or mental health assessment is essentially a conversation or interview taking place between the professional, the parent (s), the teenager, and possibly other family members. It usually consists of a set of questions aimed to help the professional better understand the problem so that a diagnosis and recommendations for treatment can be made.

Each assessment varies according to the professional's style and preference. Sometimes, it consists of an interview with the child, an interview with the parent(s), and sometimes a family interview as well. A comprehensive assessment will last on average for two to three hours and may take place over one or more office visits. Sometimes information is collected with parent(s) and teen together. Depending on the age and level of maturity of your teen, more may be collected from you than from the adolescent himself. However, professionals often will interview teens on their own.

An individual interview with the child provides the opportunity for him to freely share thoughts and feelings about his life, his relationships at home and at school, and any other issues in a confidential manner. We encourage individual time with teens, as it helps them express concerns that they may feel uncomfortable sharing with their parent(s) present. In addition, it gives the teen a message that his individual perspective is valued and respected. It may promote a positive therapeutic alliance between the teen and the professional. When the presenting concern is related to depression, it is also likely that the professional will ask questions about suicidal thoughts and suicidal behavior. Asking about suicide does not "put ideas into child's head," but rather provides assurance to him that people care for him. It gives the child the opportunity to talk about it, if in fact he has contemplated it.

In general, during the interview with the parent and teen, or with each alone, the professional will get a detailed picture about:

• the current concerns and stresses at home, at school, and in the community,

• the history of the problem,

• the child's development, health, illness and treatments, and medication,

• family relationships,

• school and friends,

• parent and family medical/psychiatric history.

If needed, laboratory studies such as blood tests, x-rays, or special assessments (for example, psychological, educational, speech and language evaluation) will be obtained during the assessment.

You and your teen may also be asked to complete questionnaires that further contribute to the assessment. We use a set of questionnaires that have proven to be accurate in determining the intensity and severity of the depression. Some examples include: the Children's Depression Inventory (CDI) (Kovacs, 1983) and the Beck Depression Inventory (BDI) (Beck, 1961), which has been revised and updated over the years. Questionnaires designed to determine whether another condition such as AD/HD or anxiety is present may also be used.

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In addition, it is not uncommon for the professional to ask parents (and the teen) for permission to obtain information from significant others (school teachers, "counselors, specialists, other relatives). Any consent requesting information is signed by the parent and also the teen, if he is of legal age to give his own informed medical consent. (In most states, this age is eighteen, but it is younger in a few states and older in a few states; in Canada it is sixteen.) Even if your teen is not of legal age, it is a good idea to include him in signing consents, as it demonstrates respect for him and may help to engage him in the assessment and treatment process.

Following the interviews, the professional arrives at a diagnosis and recommendations, which are shared with the teen and family. A treatment plan, which considers all information from the interviews and questionnaires, is developed and shared with you. If you are not comfortable with the recommendations, feel free to ask questions and raise your concerns. It is important to discuss any hesitations you have about the recommendations. It is more important to identify obstacles in the treatment plan at the outset than to go along with something that you don't believe will work.

What Are Normal Physical and Mental Changes in Adolescence?

2008-12-23T00:48:00.002-08:00

In the past, people thought that adolescence was a time of dramatic emotional turmoil. Recent studies, however, have shown that this is not the case, as 80 percent of teens get through adolescence with minimal or no psychiatric problems. Nevertheless, 20 percent of teens do experience some form of psychiatric disturbance during their adolescent years. Thus, your depressed teen is certainly not alone in her suffering. Besides depression, other symptoms considered "abnormal" include:

• antisocial behavior (for example, illegal activities),

• suicidal statements (including groups of teens who may jointly make suicide "pacts"),

• significant deterioration of school performance, or

• significant anxiety that interferes with day-to-day activities.

These behaviors are considered out of the range of normal and are red flags that need psychiatric attention. If your child falls into this category, get help.

Although adolescence is not necessarily a time of great turmoil, it is a time of great changes—physically, emotionally, mentally, and behaviorally. The changes most adolescents must cope with are discussed below.

Physical Changes

Pubertal development occurs in early adolescence, and with it comes increased self-consciousness in many teens, and some increased need for self-care (for example, using deodorants). There are some gender-specific advantages and disadvantages for adolescents whose bodies mature earlier. Boys who mature earlier have an advantage socially, as their greater size and strength are respected by peers. Girls who mature later have an advantage academically, as they are less distracted by male attention than their early-maturing peers. Whatever the rate of maturation in your teen, try to be sensitive to his or her increased need for privacy and potential embarrassment about physical development. Be positive about growing up and becoming a young man or young woman.

Mental Changes

Until the age of eleven or twelve, children are concrete thinkers. They see things in black and white and have less ability to see the "gray" areas. For example, a concrete thinker who receives a desired phone call from a friend may assume she is liked and popular. Likewise, if she does not receive a desired call from a friend, she assumes the friend does not like her. Hypothetical and futuristic thinking is not a part of concrete thinking.

Abstract reasoning (beginning around age thirteen in most children) allows for speculations and hypotheses about different possibilities, and some increased ability to plan ahead and "look before you leap." Unfortunately, it also allows for more worries and existential concerns (for example, questions about the purpose of one's life, or the nature of the universe or God). In depressed teens, this type of reasoning can lead to unhealthy, prolonged rumination (reviewing the same thought or worry or scenario repeatedly). A depressed teen may think, "I am totally unpopular. No one will ever like me." All teens reflect on their place in the world occasionally, but such negative thinking, especially when left untreated, can become habitual and actually perpetuate further depression.

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It's not unusual for teens to challenge familiar and family beliefs at this age. Another "side effect" of abstract reasoning is the ability to argue more effectively. As they come to realize that you are not perfect, teens will identify your faults more readily. Don't take it personally. Set limits when needed. For example, you may wish to say to your teen, "It is OK to express your feelings but it is not OK to yell or scream or swear at me." Remember, for some teens arguing is just a way of exercising the brain.

Another notable change in thinking is that most teens become more able to be organized and goal directed as their brain matures. This may be more evident at school, where they are required to organize their thoughts in essays and open-ended questions. Essentially, their brains are becoming more sophisticated as they prepare for adulthood.

Emotional and Behavioral Changes in Adolescence

2008-12-23T00:48:00.001-08:00

Emotional Changes

Beginning in the 1950s, psychologist Erik Erikson described a series of stages and challenges that each individual passes through in their emotional development. In teens, he termed the main challenge "Identity versus Role Diffusion." This is the time when the teen is challenged to ask, "Who am I?" By exploring this question, the teen is establishing an identity that is clear and distinct from the expectations of others. This process includes gradually developing independence from one's family of origin. A teen who successfully meets this challenge will come out of it with a strong sense of identity and clear goals for the future.

Erikson termed the main challenge of the pre-teen years (ages six to twelve) "Industry versus Inferiority," reflecting the need for recognition for one's accomplishments at this age. In the late teen and early adult years, he termed the main emotional challenge "Intimacy versus Isolation," reflecting the struggle to establish and maintain healthy, close relationships.

Erikson referred to these challenges as "stages," but we now know that there is a great deal of overlap among them, and people who do not resolve a particular challenge at one age may return to it later. Thus, adolescents who are still working on "industry" haven't necessarily missed the boat on "identity" and vice versa. For example, a teen who is focused on "industry" may be struggling with feelings of competency. She may be investing more energy into academic activities and expending less energy on self-reflection. Her thinking may be more noticeably concrete as she works to acquire a sense of achievement in school or to master other intellectual activities. A teen focused on "identity" may be less focused on school and more on finding a peer group that shares her values. However, all adolescents face these challenges to a greater or lesser degree.

Behavioral Changes

Identity progresses from establishing yourself as separate from your parents, to finding a group, special activity, or mentor to identify with or idealize, to then finding and accepting your individual identity, warts and all. Because this process takes years, young adolescents often get stuck between wanting to do things independentiy versus wanting their parents' support. (For example, "My mother won't let me go there" is often used to resist peer pressure, even if it's the teen herself who doesn't want to go there!)

The desire for independence also waxes and wanes depending on circumstances. A teen may look very independent one day, and need a great deal of support the next. Try to accept a certain amount of inconsistency with humor, but be clear what the rules are about important behaviors (for example, attending school, coming home by a certain time, and issues related to safety). Teens need to have a say, but parents must still do what's in their best interest. Freedoms should depend on the level of responsibility the teen has demonstrated. Don't expect teens to acknowledge your advice, though. They often appear not to listen even though they are (it's not cool to admit your parents are right).

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Heightened self-consciousness means "all the world's a stage" for teenagers, and the audience of their peers becomes very (sometimes overly) important. Young adolescents also tend to form highly exclusive groups or cliques, leaving some feeling alienated. Older adolescents become gradually more accepting of individual differences, usually forming more inclusive social groups toward the end of high school. Until then, kids who are not part of the "popular group" often have to focus on a few peers with a common interest (difficult for some).

Encourage your teen to treasure the friends she does have, rather than yearning for those who won't accept her. Also, foster tolerance by encouraging your teen to be respectful, interested, and open to learning from a variety of people with different appearances attitudes, and orientations - whether your child is part of the "in" group or not. This attitude makes for healthier high school environments, and probably wouldn't be a bad thing for the rest of society either.

How to Deal with Your Teen's Suicidal Risk

2008-12-23T00:47:00.002-08:00

Good rules of thumb for dealing with suicidal risk include:

• If you think your child is at risk, go to the nearest emergency department.

• If your child is sent home from the emergency room, remember that you can return there if the situation deteriorates before your next scheduled visit with the doctor.

• It doesn't hurt to lock up medications, sharp objects, or weapons if your child is or has recently been suicidal.

• Safety concerns always take priority over privacy concerns (i.e., this is the one situation where it's OK to search your teen's room).

• Children or teens with suicidal tendencies usually stabilize more readily if they learn to trust one therapist or one group of professionals. This is not the time to "shop around" for new treatments or additional assessments if you and your teen are already working with competent professionals. (Trust takes time to develop, so don't necessarily leave it to your teen's judgment as to whether or not a therapist is competent.)

• Hospitalization can provide a temporary safe haven for the suicidal child or teen, but it doesn't really solve the problem. If prolonged, it can result in your child becoming overly dependent on staff (a detrimental result). Most hospitals these days insist on family involvement from the start, and begin planning for the child's return home starting on the day of arrival.

• Teens who are uncooperative with hospitalization (for example, they refuse to go into the hospital or threaten to run away from it) may have to be admitted to the hospital on an involuntary basis. In Canada, this may require transfer to a so-called "Schedule 1" facility, which is equipped to prevent patients from leaving. They do have a right to legal advice, however, and can challenge their involuntary status. In most states in the U.S., parents can have children who are not of legal age admitted to the hospital without their consent. Check with your child's doctor if considering this option.

As children and teens recover from their crises, it is also important to allow for a gradual increase in freedoms and responsibilities. Teens who are struggling with autonomy can find a "hovering" parent very difficult to live with, sometimes exacerbating their mood. The same principles apply as in a younger child: when the teen behaves responsibly, demonstrating the ability to handle more independence, greater freedom is granted, a little bit at a time.

Finally, let us cite the old adage "an ounce of prevention is worth a pound of cure." If you see your child or teen deteriorating, call the doctor or mental health professional who usually sees her. Scheduling an earlier appointment with a familiar mental health professional is often far more helpful than ending up with an unfamiliar professional in the emergency department.

Types of Anxiety and Depression Medication for Teenagers

2008-12-23T00:47:00.001-08:00

Older antidepressants (so-called "tricyclics") targeted both serotonin and noradrenaline, but also affected other nemotransmrtters, unrelated to depression. The most troublesome effects were on the neurotransmitter acetylcholine, resulting in so-called "anticholinergic" side effects (acetylcholine was reduced). These effects included dry mouth, constipation, sedation, and (less commonly) flushing, blurred vision, or urinary retention. In children, there were also several reports of irregular heartbeat with these medications. Therefore, they are currently only used if other medications fail, and always with monitoring of your child's electrocardiogram (a test that monitors the electrical activity of the heart).

Newer medications called "SSRIs" (selective serotonin reuptake inhibitors) do not have these problems, and there is some evidence that they are more effective in teens than the older tricyclics. SSRIs increase only the brain chemical serotonin, and are so-called because they prevent the "reuptake" (removal and breakdown) of this brain chemical. They all work in 70 to 80 percent of depressed children and teens (no one drug stands out), but it is impossible to predict which child will respond to which medication, so some children must try more than one. If another member of the immediate family has done well with a particular drug, however, it is usually worth trying this one in the affected child.

Effective doses in children are highly variable, so most doctors start at a low dose and increase it every couple of weeks as long as the child does not have significant side effects. All these medications take from two to eight weeks to become fully effective after the last dosage increase. Effectiveness usually is evident from improvements in eating and sleeping patterns (early changes), with improvements in mood becoming evident later. Increasing the dose every couple of weeks may result in "overshooting" the optimum dose a bit, given that full benefits may not occur until eight weeks after the last increase. On the other hand, waiting eight weeks between dosage changes would prolong the process unreasonably, so two-week intervals are generally considered good practice. In the hospital (where there is additional monitoring), dosage can be increased more quickly.

Are Specific and Social Phobia Normal?

2008-12-18T20:35:00.001-08:00

A phobia is a persistent, irrational fear of an object, activity, or situation. Fear is a normal response to danger. It can be helpful in preparing to escape from or confront a threat. Because fear causes the heart and the lungs to work faster, you are better able to fight or flee, whichever makes sense under the circumstances.

Fear becomes a phobia only when a person alters his or her lifestyle in order to manage that fear. A phobia is a fear that is out of control—far beyond what is reasonable under the circumstances. The fear is no longer an aid to survival and it can hinder leading a normal, healthy life.

There are two general categories of phobia: specific and social. When people are afraid of particular things, they are said to be suffering from specific phobia. Objects or situations that may act as a trigger for phobia include contact with snakes or insects, being in a storm or an airplane, or being on a bridge or in a small space.

Social phobia is marked by a persistent fear of being in a situation where one may be embarrassed. For example, a person with social phobia might imagine standing in front of a room full of classmates and suddenly discovering an obvious stain on his or her shirt. A person with social phobia might panic at the idea of eating in a restaurant for fear of spilling food or stumbling into a table. If the phobic condition is severe enough, the situation may set off a panic attack.

The fear of social situations experienced by those with a social phobia is not simply a result of low self-esteem. Increasing one's self-confidence does not rid a person of a social phobia. He or she is also unlikely to "grow out of if The fears associated with social phobia are irrational and uncontrollable, but knowing they are irrational does not make them go away. In fact, the inability to get rid of the fears may lead to low self-esteem. Some people who suffer from the disorder may be overly critical of themselves if they are unable to rid themselves of fears they know are unwarranted.

A social phobia can be thought of as a false alarm. Despite logic and even a recognition that a situation isn't dangerous or life-threatening, the body reacts as if there is a serious threat and prepares for a fight or flight Recent research indicates that specific chemical systems in the brain may be responsible for the signs and symptoms of social phobia.

Treating Depression by Feeding Your Spirit

2008-12-18T20:27:00.001-08:00

Overcoming depression is a matter of healing your physical and emotional self, but another part of you may be damaged, too— your personal spirit. When you're depressed, a place inside you feels empty. This place, that holds your personal spirit, needs attention.

Feeding your spirit is like having your own personal pep rally—where you shout out "Hurray for me!" You need to feel proud of who you are and what you're trying to do. You need to want yourself to win.

Instead of yelling at yourself, yell for yourself. Show compassion for yourself when you make a mistake. Pat yourself on the back when you succeed at something. Realize that you may have a bad day once in a while, but you can get through it and move on.

Ways to feed your personal spirit:

• Write your thoughts and feelings in a journal. Don't edit what you write—you don't have to show it to anyone.

• If you play a musical instrument or sing, make up a song.

• Write a poem, short story, or any other creative piece.

• Walk on the beach and listen to the waves and birds, or take a long walk through a forest or park. Hug a tree. (Come on, try it!)

• Volunteer your time at your local Red Cross, senior center, or another organization. Helping others is a great way to help yourself.

• Collect something you love. Think of a unique way to display your collection.

• Go to an art gallery and spend time looking at the paintings and sculptures.

• Paint, draw, or sketch a picture.

• Be creative in any way you like. Use a needle and thread, paper, ink, flowers, music, cloth, words, glue, or wood. Borrow ideas from magazines, other people, art books, hobby shops, or nature. See what's inside you, waiting to come out.

Spend time with an animal friend. Petting your dog or watching your fish swim around can make you feel very peaceful. If you don't have a pet, visit a humane society or help out at one.

Buy a plant that's easy to care for, put it in your room, and watch it grow.

If you're comfortable with praying, say a prayer.

Because you want good friends, be a good friend.

Make cookies or a meal for someone who has been kind to you.

Join a support group and go at least once a week. Learn everything you can about depression and your treatment. Become an expert about your own depression so you know how to get better.

Set a goal to do something you've always wanted to do. Plan it out in simple steps, write them down, and do step #1. After you've completed one step, you'll have the confidence to tackle the next step.

Two Problems that Are Associated with Depressed Moods

2008-12-18T20:21:00.001-08:00

Sometimes teens experience depressed moods that are associated with other problems such as medical problems or psychological problems. It does not mean that their symptoms are not serious or concerning, it means that they are caused by different factors. In order to treat the problem accurately and effectively, it is important for it to be properly diagnosed.

Drepressed Mood Related to Medical Problems

Several specific medical conditions can result in depression. In addition, struggling with any chronic illness can become discouraging and depressing over time.

Recognizing medical conditions that cause depression is important because treating them appropriately may avoid long, ineffective courses of psychotherapy or antidepressant therapy. Most can be ruled out by a family doctor doing a history physical examination, and (in some cases) blood tests.

There is no physical test for depression itself, however. There are literally hundreds of diseases and medications that can affect mood, so only some of the more common ones found in teens will be listed here:

• Hypothyroidism (low function of the thyroid gland) can mimic depression. Weight gain, sluggishness, sensitivity to the cold, and dry skin often accompany this condition.

• Infectious mononucleosis (the so-called "kissing disease," caused by a virus) is another common cause of fatigue and low mood in teens.

• Poor eating habits can result in anemia (not enough red blood cells), with associated fatigue and low mood.

• A variety of drugs (whether prescription, over-the-counter, or street drugs) can affect mood. Teens who are drinking alcohol regularly, for example, often go through cycles of intoxication and withdrawal that disturb their moods.

• Starting the birth control pill can result in hormonal changes that induce depressed moods in some girls. For similar reasons, premenstrual depressed mood occurs in others.

• Chronically ill teens taking corticosteroids (for example, for rheumatic diseases or chronic kidney or liver conditions) can experience mood disturbance, with either elation or depression.

• Finally, medical conditions resulting in disability can be depressing. Accidents that result in sudden disability (for example, diving accidents resulting in paralysis) can be especially devastating because they rob the teen of previously cherished hopes and dreams.

Depression Mood Related to Other Psychological Problems

Certain problems cluster together in families, suggesting that children vulnerable to one may be more vulnerable to the others. Depression, anxiety, and alcoholism have all been linked in this way Therefore, teens with anxiety or alcohol problems often manifest depression as well. Other psychological problems can also overlap, when they are chronic and untreated. Children with undiagnosed attention problems or learning disabilities, for example, can become increasingly discouraged over me as they are unable to succeed academically. Children with behavioral problems often receive negative feedback, until they come to see themselves as "nothing but trouble." This negative identity certainly predisposes teens to depression.

Two Types of Chronic Depressive Conditions

2008-12-18T20:20:00.001-08:00

"Chronic depressive conditions" is a term for conditions that involve longstanding depressed mood not directly related to a specific incident or set of circumstances. Two examples of chronic depressive conditions will now be described in the following.

Difficult Temperament

Some children seem to be born with the proverbial "cloud over their heads." They rarely smile, have trouble controlling themselves emotionally and physiologically (for example, sleeping and eating irregularly), and seem to be constantly making demands on others. Perhaps in response to their poor internal control, they try too hard to control their environments, resulting in inflexibility and difficulty dealing with change. This so-called difficult temperament can persist, to a degree, for most of their lives unless they learn alternative ways of coping. Children with difficult temperament can do very well in certain circumstances. For example, stubbornness that is appropriately channeled can contribute to success. Consequently, these children are not considered to have a disorder. Nevertheless, they suffer from their own difficulty adapting, and sometimes become depressed when faced with the challenges of adolescence.

Low Self-Esteem

Self-esteem may be defined as confidence in and satisfaction with oneself (Merriam Webster online dictionary). Self-esteem is an odd concept: those who have it, rarely think about it; those who don't, are preoccupied with their lack of it. Adolescence predisposes teens to self-esteem problems because teens are often self-conscious. They feel that others are watching them and evaluating them more than is realistic. This self-consciousness is part of the healthy adolescent quest for individual identity. For some teens, however, it can result in unfavorable comparisons with others. These teens suffer low moods related to their constant focus on self-worth or their perceived lack of it. Family problems or rejection by others can compound the problem.

What these teens need to develop is a sense of being valuable and loveable just as they are (regardless of the latest comparison or competition). Thus, finding an activity they excel at is only part of the answer. Accepting them, laughing with them (never at them), and normalizing some of the self-absorption of youth are equally important. Taking the focus off comparisons with others, and instead emphasizing "being the best you can be" is helpful. Also, parents can show by example that it is possible to have fun regardless of whether you are "winning" or "losing" in a given activity. Teens can learn that life is much more enjoyable when we focus on the moment, rather than ourselves.

Exercise: Promoting Healthy Peer Influences

2008-12-17T10:27:00.000-08:00

Is your child or teen on medication? What type of medication (s)? What has your experience been with medication (s) so far? What problems have you encountered? Is it difficult to address your concerns with the prescribing physician? How could this be handled? (You may be surprised to know that even professionals sometimes respond remarkably well to a thoughtful L.E.A.P. Approach.)

Have you run into problems having the medication administered to your child or teen at school (if needed) or at camp? Are there other members of the family or extended family who question your teen's need for medication? How is this handled best?

Is your child insisting that others not know about the medication? Is this reasonable? Is it difficult to get your child or teen to take medication? What helps?

If your teen is not on medication and you think it might help, discuss this option with him objectively, including possible advantages and disadvantages. Make it clear that you respect his opinion on the subject, but would like to explore it further with a professional.

Then, see if he will go to the family doctor with you. Sometimes a check-up that addresses psychological as well as physical concerns is more acceptable to a teen initially than being sent to a "shrink." If your teen is agreeable, the family doctor can then prescribe antidepressant medication, or refer to a psychiatrist if this is preferred. If not, at least the doctor is aware of your teen's problems and can intervene quickly if he changes his mind.

In this week's L.E.A.R plan, focus on the most challenging situation you have encountered in relation to your teen's medication. If he's not on medication and you would like to pursue this option, check with the doctor to see if this is indicated. If so, do a L.E.A.R plan aimed at introducing the idea to your teen.

Dealing with different opinions on medication

2008-12-17T10:26:00.001-08:00

Teens are not the only ones who sometimes have concerns about taking medication for depression. Adults in the teen's life can influence his attitude as well. Many parents who recognize the benefits of antidepressant medication for their teen struggle with the conflicting opinions of school personnel, grandparents, and even spouses. Interestingly, when dealing with these adults, a problem-solving approach that includes some empathy often works well. It reduces the tendency for people to argue or to blame each other, by keeping the focus on the problem, and empathic comments invariably increase the level of trust in the relationship. Thus, you can do a L.E.A.R plan for these people, as well as for your teen.

In Izz/s case, for example, his mother was initially quite concerned about the risks of antidepressant medication. Her own mother had been hospitalized for psychiatric reasons many years ago, and she still remembered the horrible effects of insulin shock, large doses of antipsychotic drugs, and other pharmaceutical treatments of that era. Explanations of how much more specific, better studied, and less toxic current treatments are did little to reduce her fears. Fortunately, Izzy's father was able to discuss the situation with his wife. Here is his L.E.A.R plan:

Label thoughts and feelings: I'm so worried about Izzy. He's thin, he's not doing any school work, he's in his room with his music all day, and he doesn't sleep. We've tried counseling, but he just can't get his life back on track. Medication might make the difference, but Helen (wife) refuses to consider it. It's so frustrating!

Empathize with your teen: Maybe if I'd gone through what Helen went through with her mom I'd be skeptical of medication too. Whenever I try to convince her the newer treatments are better, she just feels pressured to give in, and gets more scared for Izzy. She must be really scared of reliving the past.

Explore ways to respond: Maybe I can get her to agree to a little bit of medication for a short period of time, just to make sure that Izzy is OK on it. Then, if she sees that he doesn't have horrible side effects, she may be willing to consider giving him a therapeutic amount. I could invite her to join us at the doctor's too, so she can ask about what happened to her mother, as well as what might happen to Izzy. She could get her mother's records from the hospital, and the doctor could help her make sense of them and explain exactly how things are different now.

Apply alternative ideas/plan: I'll make these suggestions to Helen, and see if she'd consider even one of them. (Helen agreed to see the doctor and maybe try Izzy on a small amount of medication with close supervision by herself, but declined to pursue her mother's medical record.)

Pick a follow up time and plan ahead: After a week on the smallest amount of medication, I'll talk to Helen again to see if she'll agree to another step.

What About Natural Options

2008-12-17T10:22:00.000-08:00

Some people are averse to medications because they believe them to be "unnatural," as most have been manufactured in laboratories. They would prefer something derived from a plant or other natural substance. I usually advise evaluating the risks and benefits of both options. In terms of risks, the "naturals" are often touted as having fewer side effects, but it is also more difficult to determine their purity (important in deciding about dosage). There is often a great deal of variability from one brand to another, and the inactive ingredients (apart from the active substance itself) are often not spelled out. With a medication developed in a laboratory, you know more precisely what you are taking.

In terms of benefit, there are some individuals (including some in our practice) who have responded to herbal remedies and many who have responded to prescribed medication. One criterion for approval of prescribed medication, however, is that efficacy has been demonstrated above and beyond the efficacy of a placebo (sugar pill) in large numbers of people. Over-the-counter herbal remedies do not have to meet this standard.

The most commonly used herbal remedy for depression is St. John's Wort. Unlike many such remedies, St. John's Wort has been subjected to a number of studies in adults, both in Europe and North America. Results from Europe appeared very promising, but a large North American study recently could not demonstrate efficacy above and beyond the efficacy of a placebo. Still, if you or your teen is very concerned about the risk of side effects with pharmaceuticals and/or has failed to respond to one or more standard antidepressant medications, it may be worth considering. Studies tell you how hundreds of people respond on the average, but they cannot predict how a particular individual will respond. No studies to date have examined St. John's Wort in adolescents or children. St. John's Wort can interact with some prescription drugs, particularly other antidepressants, so check with your doctor or pharmacist first if your teen is already taking another medication.

Newer Medications

2008-12-17T04:20:00.000-08:00

The "third generation" of antidepressants (so-called because they are the newest, and were developed after the tricyclics and the SSRI's) include venlafaxine (Effexor), bupropion (Wellbutrin or Zyban), nefazedone (Serzone), and reboxitine (Remiron). These are usually reserved for children and teens who don't respond to SSRIs or cannot tolerate them. Bupropion targets mainly noradrenaline, while the others target noradrenaline and serotonin, but with fewer side effects than the old tricyclics. Experience with these medications in children and adolescents is limited.

Serzone was recently taken off the market in Canada because it was linked to liver damage in some people, and concerns about Effexor and suicidal ideation have been raised, as discussed above. Activation is sometimes a problem with bupropion. For bupropion, also note that it is used in smoking cessation under the name Zyban. It is important that people do not mix Zyban with other antidepressants unless this occurs under a doctor's supervision. Remiron is the newest of the group, and experience in young people is very limited. New antidepressants come on the market quickly, however, and some of the information in this paragraph may change within a year or two.

All antidepressants can be sedating in combination with other sedating drugs (such as certain antihistamines), so check with a doctor on these combinations. Another popular combination to avoid is antidepressant + alcohol (both sedating). If it's difficult to monitor this with your teen, at least stress the importance of having one drink only and someone sober to drive him home.

How Long Should Teens Remain On Medication

2008-12-17T04:18:00.000-08:00

Once your child is on the right dose and some benefit is observed, it is usually worth continuing the medication for at least six months to one year. There is some evidence that a year may be preferable, to reduce the risk of relapse if your child is still in a depressive episode at six months. Then, an attempt to taper the medication (decreasing the dose very gradually) can be made, especially if your child has developed coping skills from a cognitive-behavioral psychotherapy program. The goal is to have your child on the minimum dose needed. In some children, the medication can be discontinued at this point, while others require medication longer term. Tapering is usually best done at a time of average life stress, to minimize the risk of relapse. If your child grows or encounters a greater-than-average degree of life stress, a dosage increase may be needed.

Long-term effects of SSRIs in children and teens are not well studied. These medications have not yet been used in children long enough for such studies to have been done. Adults sometimes develop an apathetic state termed "amotivational syndrome" and there are case reports of this syndrome in adolescents, but it tends to resolve with dosage reduction. Several children and teens at our centre have required SSPds for more than a couple of years, and "so far so good." They seem to grow and develop normally. There is even some animal evidence that SSRIs may increase the body's ability to produce serotonin in the brain, but this has not yet been studied in humans.

Why Do Some Teens Repeatedly Harm Themselves

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A variation on suicidal behavior (sometimes termed "parasuicidal behavior" or "suicidal gestures") occurs in teens who harm themselves repeatedly in ways unlikely to cause death. Common examples include superficial cutting of the forearms or other areas of the body, self-inflicted cigarette burns, hitting oneself with a fist or an object, or hitting one's head against a wall or hard object. It used to be thought that these displays represented part of an emerging personality disorder, but recent studies have shown that this is not always the case. Other reasons for such behavior can include:
• The teen has feelings of guilt or worthlessness that are part of depression.
• The teen is trying to regulate unpleasant feelings (see below).
• The teen is expressing anger or desire for someone's attention (for example, from a parent or a boyfriend).

Some teens engage in these behaviors only in the midst of a depressive episode, as in the example below.

Brian: Brian was deeply depressed, but determined to continue attending school. He was suspended after repeatedly gouging his face with scissors. The teachers felt they could not monitor him closely enough to ensure his safety, and other students were very disturbed by witnessing his self-mutilation. Interestingly, Brian engaged in no self-harm at all after his mood improved with antidepressant medication. He went back to his fellow students and explained the nature of depression and how it affected him in a class presentation. He explained his previous self-harm behavior by saying, "At the time, I felt I deserved to be punished. I felt less guilty after I punished myself." The following year, he graduated as class valedictorian.

For other teens, self-harm behavior represents a way of regulating unpleasant feelings. When the body is physically injured, endorphins are released. These are brain chemicals that are natural pain-killers, but they also have a mood-elevating effect. Thus, by inflicting physical pain on themselves, these teens numb their emotional pain. Some claim to eventually not feel the physical pain at all. For these teens, self-harm behavior can be decreased by helping them use alternative mood regulation strategies, such as those described earlier. Incidentally, regular physical exercise releases endorphins too, so encouraging a sports activity can also be helpful.

Finally, some teens harm themselves to demonstrate anger or gain attention. This is especially likely in those who engage in self-harm in front of other people (usually family most often during or after an argument). These teens often benefit from all of the strategies discussed in the chapter on anger. They usually need more consistent limits and a parent who can remain calm and not be drawn into arguments. It is important not to allow threats of self-harm to change your parenting decisions. This would simply reinforce your teen's negative behaviors. The exception would be if your teen was threatening serious self-harm in front of you (for example, brandishing a knife or firearm), in which case a call to emergency services would be indicated.

Teen's Suicidal Threats

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Threats of suicide or attempts at suicide are usually the most difficult crises for families of depressed children. It's important to remember, however, that although thoughts of self-harm are almost universal among depressed children, attempts are far fewer. About 20 to 25 percent of teens with major depression attempt suicide at some point before age 20. Children or teens who actually die by suicide are rare (less than 4 percent of teens with major depression, most of these in the late teens). These figures are still much higher than in the general population, though, so threats of suicide must be taken seriously. Depressed girls are more likely to attempt suicide, but depressed boys more often complete suicide (they often use more lethal methods).

Some books have long lists of "signs" to look for in assessing children's suicidality. Unfortunately, these create the false impression that you can evaluate this risk yourself. This is simply not true. Even experienced professionals have difficulty predicting who will attempt suicide and who will not, and even the correct predictions are rarely accurate for more than the next 24 to 48 hours. Trust your instincts. Go to the nearest hospital emergency department if you believe your child is at risk. Be extra suspicious if:

Your child has a friend who talks about suicide or has recently engaged in suicidal behavior (in this case, there is potential for a suicide "pact" among peers);
Your child starts to give away her possessions; or
There has been a recent loss of a close relationship or a source of pride (for example, losing a major competition or failing an examination).

Conversely, if your child has a habit of threatening "I'll kill myself if you don't give me what I want," recognize this for what it is: an expression of anger. On its own, this means little. If there are other recent changes in your child's behavior, however, it may be worth checking with a professional.

Also, beware of the impulsive child who takes a handful of pills in front of you to "make a statement." Depending on the pills, they could result in an inadvertent fatality (for example, Tylenol can destroy the liver). Following up with an emergency visit is often a good idea. The experience of being made to swallow charcoal (to neutralize stomach contents) or having a tube inserted down the throat can also be noxious enough to deter children and teens from repeating this behavior.

What Can The Non-Depressed Parent Do?

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Having a depressed spouse, and perhaps a depressed teen as well, can be a tremendous burden on the "healthy" parent. Supporting the family may have to take precedence over career and other priorities for the time being, if everyone is to get through their depression without long-term problems. Beyond supporting your spouse and children as described above, consider obtaining some extra support for yourself. Even if it's just the occasional conversation with a good friend or individual or family counseling, it can make a dramatic difference at such a trying time. If you are religious, members of your faith community may also be supportive. As your spouse's depression begins to lift, resuming family activities may be both therapeutic for the depressed family member(s), and a source of hope and recreation for yourself.

Occasionally, you may also be in a position to recognize and address unhealthy interaction patterns occurring around the depressed individual (s) in your family. Returning to the example of Amanda, let's look at a L.E.A.P. plan her father could develop at the time when both Amanda and her mother were depressed.

Label thoughts and feelings: I'm getting really frustrated with Amanda. She used to do so well in school, but now she seems to be just average. How does she expect to make anything of herself at this rate? To be honest, I also miss being proud of her and being able to brag a bit to the neighbors about her. I'm irritated with my wife too. She doesn't seem to realize how important an education is. All she wants is for our daughter to sit around and listen to her complaints
Empathize with your teen: What the neighbors think isn't that important. It's Amanda's happiness and her future that matter. I wonder if Amanda is getting discouraged. After all, high school is harder than elementary school. Those constant talks with her mother may be draining her energy as well. Both of them seem rather unhappy.

Explore ways to respond: I wonder if Amanda could use some time away from her mother. She needs something enjoyable to focus on. Maybe I could get her back into the choir she used to enjoy. Maybe she'd like to go skating with me on the weekends, or play some tennis in the summer. If her schoolwork is too hard, maybe a tutor for the subjects she's finding difficult would help. Her teacher might also be able to tell me more about what she should be doing in this grade. If she still struggles and looks unhappy, maybe I should arrange a check-up with the doctor. My wife's problems go way back, and I don't understand them completely. She should probably see a therapist, if I could just get her to go! On the other hand, maybe she'll be more agreeable to seeing someone if Amanda is occupied with other things after school and stops listening to her so much. Alternatively, maybe if I offered to see someone with her, she would agree.

Apply alternative ideas/plan: I'll talk to Amanda's teachers and get her the best academic support I can. Then, I'll insist on at least one nonaca-demic after-school activity, and offer to take her out skating on weekends. I'll ask the doctor if she can recommend a therapist who could see my wife, or see my wife and me together
Pick a follow up time and plan ahead: I'll stay in touch with the teacher regularly, and keep my eyes open at home. If Amanda is still unhappy and struggling at school in a month, I'll have her see the doctor as well. I'll see if the therapist has any other suggestions.

What Should A Parent Who Is Depressed Do?

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• Talk about the illness and its effect on your family. Just having a name for the problem can be very helpful to some families.
• Pay extra attention to adolescent emotional development and your teenager's need for stronger connections to peers and increasing autonomy from your family.
• Don't assume that because your child says nothing, he doesn't have concerns.
• Help children learn self-soothing strategies when upset (especially if your child was young when his parent was depressed), and model non-depressed ways of coping. Relaxation techniques, writing down your feelings, taking a bath, going for a walk, listening to (or playing) a favorite piece of music, spending time with a pet, or working on a favorite hobby or artistic pursuit can all be helpful in soothing yourself.
• Take care of yourself. Avoiding relapse is the most therapeutic thing you can do for your family. Involve yourself in activities, as recommended for your teen, and maintain mental health follow-up if necessary.
• Be honest with your family about how you feel, but emphasize what you are doing to overcome depression. This will reduce the chances that your children will worry about you.
• Resist the temptation to use a child or teen as a confidante. Youngsters have enough to do dealing with their own problems; they don't need to be burdened with yours.
• Talk to your spouse or a trusted friend. He or she may be able to better handle some aspects of childrearing while you are depressed. Setting appropriate limits with children, for example, can be very difficult when you are depressed. Don't be afraid to modify "traditional" roles, if needed.
• Focus on recovering from depression and gradually resume your usual responsibilities as you are able to. Just like academic expectations have to be modified for depressed teens, your expectations of yourself in the work and family environments may have to be modified as well.
• Ask for help outside the immediate family, if needed. Sometimes it can feel as if having a depressed child can add to your own depression or make you feel responsible and guilty. Talk about these feelings with someone you can trust so they don't become burdensome and overwhelming.
• Be prepared for times of crisis. Create action plans with your family about how to handle "down" times or hospitalizations.

Panic Attack And Worried Teenagers

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Depressed children have distorted ways of seeing the future, themselves, and others. Do you remember the depressive triad (worthless self, uncaring world, hopeless future) ? Now, how would you see the future, yourself, and the world if you were anxious? Probably, you would see a weak self, a dangerous world, and an uncertain future. Now, imagine how you would see things if you were both depressed and anxious. This would be quite a load on your mind! In Tammy's case, her view that she risked attack just by leaving the house was an anxious distortion. The danger outside her home was overestimated in this case.

All of the same ideas we discussed for depressive distortions apply to anxious ones too:
• Help your child examine the evidence for or against the worry.
(Usually, things aren't nearly as dangerous as what we anticipate.)
• Because worries often concern uncertain future events, you may have to look at probabilities as well. (What are the chances this will happen? What else could happen? What are the chances of that?)
• Try to emphasize personal competence. (Can you do anything to reduce the risk? If not, can you do anything to limit the worry time so worries don't control your life?)
• See if your teen can identify the worried state (for example, before bed is a common time when worries take hold). If so, encourage "catching yourself worrying" and then either doing something distracting or writing down the worry. Although it's not easy, some teens can learn to write down bedtime worries and then let them go until the morning. Also, if every worry must be written down, the activity becomes fatiguing and eventually induces sleep.
• At a calm time, you may want to discuss the pros and cons of worrying. (For example, occasionally, people can find new solutions to a problem after worrying about it, but more often worrying just causes distress and wastes time, so on balance it's not worth it.)
• Some teens will agree to a "worry time," which is usually a few minutes to half an hour where they can worry as much as they want. The deal is, however, that you must postpone worries to your "worry time" the rest of the day.
• Remember to also model good coping with anxiety-provoking situations. This is particularly helpful if your teen doesn't voice his worries to you. For example, if you are driving in snowy conditions, you could say, "This is not good. It's really starting to come down heavily, but then I've driven in this kind of weather before. I can slow down and still get to where I'm going. I can always pull over if it gets worse." Interestingly, you are not modeling fearlessness, but coping well despite your fears. Thus, you are modeling both acknowledging worry and good coping, thereby encouraging your teen to discuss worried feelings.

Avoidance

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Avoidance of feared situations reduces anxiety initially, but makes it worse in the long run. For example, a child with social phobia may avoid making telephone calls, fearing that he will become embarrassed or "tongue-tied" during the call. For similar reasons, he may also avoid picking up the telephone when it rings. The more the telephone is avoided, however, the more frightening the prospect of making a call becomes. As avoidance continues, conversation skills are lost, making it even harder to change. Without intervention, the problem becomes self-perpetuating.

For younger children, one of us (KM) has written a parenting book on helping with anxiety symptoms and overcoming avoidance. It is called Keys to Parenting Your Anxious Child (see Bibliography). The same principles used with young children can be adapted to teens. Basically, the teen must face each feared situation, starting with the easiest and working up to the most difficult, in order to desensitize to the fear.

Just like younger children, teens benefit from encouragement, praise, and positive reinforcement when trying to face a fear. Unlike younger children, however, teens' reinforcements for progress tend to be different. (Money or a special privilege may motivate teens, whereas stickers, prizes, or special time with a parent motivates younger children; praise is appropriate for all age groups.) You probably know better than anyone else what motivates your child or teen! To encourage desensitization:

• Help your teen approach the situation in gradual steps with positive reinforcement for every little step. In Tammy's case, several "levels" could be developed to overcome her avoidance. The first level would consist of spending time on her front porch, the second of venturing into the garden, the third of standing on the sidewalk, and so on. She should spend at least half an hour a day practicing leaving the house (a minimum for desensitization), with graduated rewards for progressing to higher "levels." For the socially anxious child mentioned above who won't talk on the telephone, a different system of levels would apply. In this case, having someone else place the call (to a familiar, non-threatening person previously informed of the exercise) and then asking the child to provide a whispered, one-word response to a specific question on the telephone may be the first step. You need to use the same principle: gradual approximations. Setting up appropriate desensitization systems is a whole course (or book) in itself.

• Gradually withdrawing support in a situation can also be a step. For example, one mother of a young teen encouraged her daughter to travel on the public transit system to her appointments by accompanying her at gradually increasing distances until they were essentially traveling independently. She praised this "grown up" behavior throughout the process (no other reward was needed).
• Relaxation and coping self-talk (see below) can also help children go into avoided situations with less fear.
• Because going into a feared situation is an activity, you may also wish to review the earlier chapter on motivating teens to engage in activities.

Anterior Cingulate Gyrus Functions

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• allows shifting of attention
• cognitive flexibility
• adaptability
• helps the mind move from idea to idea
• gives the ability to see options
• helps you "go with the flow"
• cooperation
Problems Associated with the Anterior Cingulate Gyrus
• worrying
• holds on to hurts from the past
• stuck on thoughts (obsessions)
• stuck on behaviors (compulsions)
• oppositional behavior
• argumentative
• uncooperative, automatic tendency to say no
• addictive behaviors (alcohol or drug abuse, eating disorders, chronic pain)
• cognitive inflexibility
• Obsessive-Compulsive Spectrum Disorders

Running lengthwise through the deep aspects of the frontal lobes is the anterior cingulate gyrus. It is a major switching area in the brain, with many fibers traveling through it to other destinations in the brain.

The deep limbic system

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The deep limbic system is also intimately involved in bonding and social connectedness. It influences how you connect with other people on a social level; your ability to do this successfully in turn influences your moods. When we are bonded to people in a positive way, we feel better about our lives and ourselves. This capacity to bond then plays a significant role in the tone and quality of our moods.

The deep limbic system, especially the hypothalamus at the base of the brain, is responsible for translating our emotional state into physical feelings of relaxation or tension. The front half of the hypothalamus sends calming signals to the body through the parasympathetic nervous system. The back half of the hypothalamus sends stimulating or fear signals to the body through the sympathetic nervous system. The back half of the hypothalamus, when stimulated, is responsible for the fight-or-flight response. This "hardwired response" happens immediately upon activation, such as seeing or experiencing an emotional or physical threat. The heart beats faster, breathing rate and blood pressure increase, the hands and feet become cooler to divert blood from the extremities to the big muscles (to fight or run away), and the pupils dilate (to see better). This "deep limbic" translation of emotion is powerful and immediate. It happens with overt physical threats as well as with more covert emotional threats. This part of the brain is intimately connected with the prefrontal cortex and seems to act as a switching station between running on emotion (the deep limbic system) and rational thought and problem solving with our cortex. When the limbic system is turned on, emotions tend to take over. When it is cooled down, more activation is possible in the cortex. Current research on depression indicates increased deep limbic system activity and shutdown in the prefrontal cortex, especially on the left side.
Do you know people who see every situation in a bad light? That actually can be a deep limbic system problem because, as mentioned, this system tends to set our emotional filter, and when it is working too hard the filter is colored with negativity. One person can walk away from an interaction that ten others would label positive, but which he or she considers negative. Because the deep limbic system affects motivation, people sometimes develop an "I don't care" attitude about life and work. They feel hopeless ibout the outcome, don't have the energy to care, and have little willpower in fellow through with tasks.

Problems Associated with the Basal Ganglia

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• anxiety, nervousness
• panic attacks
• physical sensation of anxiety tendency to predict the worst Let avoidance
• muscle tension
• tremors
Lie motor problems headaches
low/excessive motivation
The basal ganglia are a set of large structures located near the center of the brain. They help integrate feelings, thoughts, and movement, which is why you jump when you're excited, tremble when you're nervous, freeze when you're facilitate the integration of emotions, thoughts, and physical movement

The Basal Ganglia—The Brain's Idle
They take in sensations from (he body (emotions and thought!*), assist with putting feelings together with the correct body movements, and then help coordinate smooth outflow of motor (or body) movement. When they are working correctly, they keep input and output flowing smoothly, and emotions and body movements match each other. What happens when they don't work correctly? Panic disorder patients have basal ganglia that react correctly but to the wrong situations. Their basal ganglia incorrectly activate fight-or-flight body movements and a host of other body responses in response to the wrong sorts of emotional and environmental input. The fight-or-flight response is a primitive state that gets us ready to fight or flee when we are threatened or scared.

When a person has too much baseline tension or their i too high, we see too much activity in the basal ganglia ana orten enrome anxiety, tension, fear, and the tendency to have a negative or pessimistic outlook on life. Chronic states of anxiety and tension can increase the level of stress hormone production, and this in turn can lead to physical problems such as tension headaches, upset stomach, nausea, diarrhea, ulcer disease, and muscle soreness.

The basal ganglia have a range of optimal performance. You won't feel your best when they are performing above their optimal range or if they are underactive. People with under active basal ganglia frequently have problems with energy, motivation, and decision making.

Of note, some of the most highly motivated individuals that we have scanned, such as CEOs of companies, have had significantly increased activity in their basal ganglia. One of our theories is that excessive basal ganglia activity may be associated with heightened anxiety or, alternatively, with increased motivation. If you do not use increased basal ganglia activity to get things done, you are more likely to feel anxiety and tension. Some people can harness this increased energy and channel it productively to become the "movers" in our society, but they may also suffer from strong inner turmoil.

Anxiety Relaxation Techniques - Tips To Encourage Relaxation

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Although anxiety relaxation techniques were originally developed for those with anxiety disorders, teens with depression can also benefit from them. The most basic technique is called "diaphragmatic breathing," to indicate that the muscle at the base of the lungs (diaphragm) is involved. Because this muscle is connected to nerves that are part of the body's autonomic (involuntary) nervous system, stretching this muscle triggers a natural relaxation response.

To do this technique, start by breathing slowly: allow the air to go in through the nose and out through the mouth, either while lying or sitting straight with shoulders down. Put a hand on your belly. If the air is going to the diaphragm, your hand should move out a little on the in-breath, and fall back on the out-breath. Count to four on every in-breath if it's hard to slow down. If you feel dizzy or get a pins-and-needles sensation, you're breathing too fast. When you've practiced this technique yourself, see if your teen is willing to do it with you.

Here are some anxiety relaxation techniques:

• Eli Bay has excellent relaxation tapes to listen to, if your teen is willing to try these.
• Activities that include relaxed breathing (martial arts, yoga, singing) are great too.
• Doing relaxation techniques with your child or teen makes it less of a chore, and may be helpful to you, too!
• A few minutes a day of regular practice is needed for two to three weeks to master the technique. Bedtime is usually the best time to practice, as it can improve quality and quantity of sleep in some teens as well.
• Once this type of breathing comes naturally to you and your teen, encourage breathing this way during the day whenever she is starting to feel tense. It doesn't work when very "worked up," but is good for anticipatory anxiety (i.e., worrying about something ahead of time) or mild irritability.

The Basic of Menopause and How to Diagnose It

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Menopause is defined as the absence of menses for one year and most American women enter menopause at 51.4 years of age. Menopause is caused by the rather abrupt withdrawal from a woman's system of the very potent estrogen estradiol, as ovarian function ceases. There are many bothersome symptoms that herald the withdrawal of estrogen, including hot flashes, mood disturbance, weight gain, night sweats, fatigue, and sleep disturbance. These are not simply annoying symptoms, nor are they peripheral effects of hormone loss; they are warning signals that brain function is disturbed by the absence of estrogen. Sleep is regulated by the brain, and in the absence of estrogen a woman in menopause may have her sleep disturbed every fifteen seconds to eighteen minutes. The hypothalamus reacts to a lack of estrogen by causing engorgement or dilation of blood vessels, which results in hot flashes.

Evidence is mounting that lack of estrogen is bad for the brain. This discovery began with rat studies. Rats that have their ovaries removed have a huge estrogen deficit just like menopausal women. Estrogen-deficit rats have trouble learning, and they have deterioration of their temporal lobes, the area of the brain that is responsible for learning and memory. When rats were given estrogen replacement, the number of connections between cells in their temporal lobes improved, and so did their ability to learn new tasks. There have since been many studies showing the same pattern in human females. Women who have undergone surgical removal of their ovaries or who have gone through natural menopause often have difficulty with memory, concentration, and attention span. They have more trouble learning skills, they have more word-finding difficulty, and they feel overwhelmed by complex tasks that were previously easily mastered. These same women have marked and rapid reversal of these symptoms with estrogen replacement.

SPECT and PET scans of postmenopausal women who have not taken estrogen replacement show deactivation of the prefrontal cortex and temporal lobes. Neuropsychological testing of these women indicates impaired cognitive functioning in the areas of attention span, concentration, and learning. When these women are treated with estrogen replacement therapy or Evista, a selective estrogen receptor modulator, their performance on testing markedly improved. Of great interest, the SPECT and PET scans of the treated women also showed greatly improved brain function.

Factors Linked To Resilience In Teens

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Recently in attempts to better understand mental illness, mental health professionals have identified certain factors that help protect individuals from illness such as depression. Resilience factors, or things that help people stay healthy in the presence of risk factors (Kaufman, 2000), may prevent a depressive episode from occurring or prevent depression from getting worse. Resilience has been defined as the "ability to persevere and adapt when things go awry" (Reivich, K. & Shatte, A., 2002). However, if resilience is offset by substantial risk factors (for example, a strong family history of depression), your teen may still get depressed. On the positive side, though, resilience factors can improve coping and recovery from the illness. They may even reduce the risk of recurrence. Therefore, they are still important to keep in mind, and to enhance if possible. Research has identified the following as resilient factors for depression

• Feeling cared for by at least one other person;
• Parents get along reasonably well and are relatively consistent in relation to how they deal with the teen (expectations and limits set by each parent are similar);
• Adults model a positive perspective on situations;
• Social connections (i.e., the teen has friends);
• The opportunity to learn from life sometimes;
• A coherent system of values/meaning;
• Temperamental "fit" with the family is reasonable (for example, a highly athletic teen may feel out of place in a family of sedentary academics, and vice versa);
• Routines and clear rules at home;
• Authoritative parenting (basically, setting clear limits but in a thoughtful way that takes the child's feelings and developmental needs into account, providing explanations when needed, and allowing more input from the child with greater maturity).

What Does A Psychiatric Health Assessment Consist of?

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There are other conditions besides depression that sometimes produce symptoms such as grief, adjustment reactions, and trauma. As they occur in response to specific events your teen reports, these conditions can generally be ruled out by a physician examining your teen. However, there are other psychiatric disorders that can show symptoms similar to depression which need to be considered by the mental health professional you consult. For example, anxiety disorders can be associated with depressed mood, particularly if they have persisted untreated for several years. The social isolation resulting from social phobia, for example, can look like social withdrawal associated with depression. Similarly, Oppositional Defiant Disorder (a condition in which the child or teen consistently refuses to cooperate with authority, to the point where it interferes with important daily activities) can mimic the negativity and irritability characteristic of teen depression. Unlike major depression, however, both of these conditions tend to persist for years, and do not change dramatically from month to month.

Teens who consume alcohol or illicit drugs can also appear depressed or withdrawn, either from drug withdrawal or from attempts to hide their habit. If you suspect this possibility, look into it, even if it means breeching your teen's privacy. The risks associated with drugs are often even greater than those associated with depression. When in doubt, check with a professional. Many teens suffer from more than one problem, and it can't hurt to have a thorough diagnostic assessment.

Things to keep in mind to help you help your depressed child

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Listed below is a "snapshot" of things to keep in mind to help you help your child. We will be discussing these ideas throughout the blog in more detail but provide some highlights here to provide an introduction to what helps.

• Focusing on realistic positives—This week, use the table provided at the end of the chapter to record some areas in which your child is already showing some positive abilities, even if they are small positives (for example, getting dressed in the morning).
• Getting active—Activity counteracts the tendency for depressed people to withdraw and ruminate, and physical activity can actually prevent relapse in some people.
• Taking medication (if needed)—Medications can normalize the levels of the brain chemicals mentioned above.
• Reducing unnecessary stress—For example, if your teen is feeling overwhelmed by three after-school activities in addition to regular courses, see if even one can be eliminated until she is feeling better. Family conflict can also constitute "unnecessary stress." Chapters 12 and 13 are devoted to addressing family interactions.
• Increasing perceived support—Perceived support (that is, the child actually feels supported) ameliorates the effect of stress, reduces learned helplessness, and offers hope. Empathy is perceived as particularly supportive, but it's one of the most difficult things to give a depressed teen. Depression constricts the range of emotional expression, making depressed teens "hard to read." Teens' tendency to shut down and withdraw while depressed adds to the problem.

Sometimes, you will have to take an educated guess about what is going on, based on the circumstances. Then, put it into words for your teen. For example, "If that happened to me, I would feel terribly angry. Is that how you're feeling?" The expression on her face will give you the answer. Expressing confidence in your teen is another aspect of perceived support. Many children and teens do better when those close to them expect that they can. Siblings may need a little extra attention too, to reduce the chances of increased sibling rivalry as you focus on helping the depressed teen.
• Mourning major losses (if any)—Several books on helping children and teens with grief are listed in the Bibliography.
• Having a chance to make a difference—Making a difference (no matter how small) helps to overcome feelings of learned helplessness. For example, something as simple as being able to continue looking after a pet can provide a sense of "making a difference."

Defining Depression

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Compare Janice (in the Introduction) and Timothy for a moment. Although both suffer from low moods and are about the same age, there are significant differences between them (apart from gender). Janice functioned very well, until a relatively sudden decline in her mood occurred over a couple of months. Timothy, on the other hand, had always struggled to a degree, but developed increasing difficulties over a year or so. Once depressed mood set in, however, Janice had many more symptoms than Timothy. Her appetite, sleep, energy level, and ability to concentrate were all affected by depression. She expressed feelings of worthlessness and no longer enjoyed her previous activities. Timothy's sleep was disturbed and he made some self-deprecating remarks, but the change in his mood and behavior was far less dramatic than that of Janice.

Janice exemplifies major depression, a diagnosis made when people become dramatically impaired by depressed moods over a relatively short period of time. Timothy, on the other hand, exemplifies dysthymic disorder, a diagnosis given when people have some impairment, but to a lesser degree than in major depression. They typically experience a chronically low mood and their problems occur over a longer time period (usually a year or more). A third consideration in teens is whether changes in mood or behavior are part of a disorder or part of normal adolescence.

Cause And Treatments of Depression - An Overview

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Timothy: Timothy, age thirteen, had always been more difficult to raise than his siblings. He was very demanding of his parents and often picky about the foods he would eat and the clothes he would wear. He was easily irritated by minor changes in routine. He had temper "blow-ups" on a regular basis, despite his parents' administration of calm, consistent time-outs. He made friends without difficulty, but had trouble keeping them because his peers perceived him as being too bossy.

Timothy had never been a good student, but lately his grades had been worse than usual. Last year's teacher suggested an assessment for Attention-Deficit/'Hyperactivity Disorder (AD/HD) or a learning disability. The psychologist who saw Timothy clearly did not think either of these diagnoses explained his difficulties. Timothy was not particularly distractible or impulsive, and his academic ability was above average in all areas. He did, however, become frustrated very easily when he was unable to master a task on the first try, responding with "I'm no good at anything!" and slamming the book shut. Timothy's difficulty was thought to be due to an emerging mood disorder.

Timothy's main risk factor for mood problems was his very difficult temperament. His parents were sympathetic, but they found his behavior frustrating at times. "The parenting courses helped, but they're not enough for dealing with this one!" reported his mother. As Timothy's temperament began to affect his functioning at school and with peers, his mood declined.
Interestingly, there was no major stress that seemed to prompt his deterioration in the previous year. More likely, he was simply struggling with society's increased expectations of more "mature" behavior with increasing age. For most people, maturity is seen as the ability to persevere despite adversity, and show a certain amount of flexibility and consideration for others. These behaviors would be difficult for Timothy to develop, given his rigid temperament and low frustration tolerance.

What if your teen appears to be deteriorating?

2008-12-14T12:10:00.000-08:00

Importantly none of the conditions described above are permanent states. Any one of them can change over time and progress toward more serious depression or toward emotional health. If you think your child may be more depressed than the teens profiled in this chapter, or if you think your child is deteriorating in that direction, see the next chapter for a fuller discussion about assessing teens for depression. If your teen is experiencing depression, you will need to seek professional help. Start by checking with your family doctor to determine whether a medical condition might account for your teen's mood. If not, ask the doctor to refer your teen to a mental health professional in your area.

Depressed mood related to difficult life curcumstances

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Benny: Benny's family lived on social assistance. His father had left the family years ago because of alcohol problems. His mother had not been able to find work, and had three young boys to raise. They didn't have medical insurance, so he and his siblings often suffered through ear infections or sore throats without antibiotics. Their sneakers were often falling apart by the time their mother could replace them. Benny was embarrassed by all this, and lied to his friends about his home life. His mother was upset that he was ashamed of his family, and smacked him roughly when she heard. Unlike his two younger brothers, he always seemed to be in some sort of trouble. When there was a fight among the boys, Benny usually got blamed. He often thought he should run away from home, but there was nowhere safe to go. He didn't want to end up in a gang like some of the other boys in his neighborhood, but he often wondered how else to find a place to fit in.

Benny's life has been difficult from the start. He is not faced with adjusting to a sudden change, but rather coping and trying to make a good life for himself despite the odds. His environment poses a combination of several risk factors for maladjustment. Poverty, a rough neighborhood, a stressed single-parent household, limited access to medical care, less than optimal parenting, and being made the scapegoat in the family can all contribute to emotional problems. Benny does not necessarily need counseling. Benny needs a source of hope for the future. The ability to excel in some area that would allow him to escape his circumstances would strengthen this. A successful male role model that took an interest in him (for example, a big brother) could also be helpful. Emotional support for his mother could also, indirectly, benefit Benny and his brothers. Although helpful interventions in this case are more social than psychiatric, they are no less important if Benny is to have a chance to make it.

Difficult Temperament And Low self-esteem

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Difficult Temperament
Lexy: Lexy had always been considered a "high maintenance" child. She made frequent, loud demands for attention as an infant, and had continued to do so for much of her life. She ate irregularly and slept irregularly, despite numerous attempts by her family to establish routines. She pouted miserably when things were the slightest bit different from what she expected. She insisted on being in charge when playing with her friends. She had difficulty adjusting to high school, where she had to rotate from class to class and had a different teacher in each subject. She became preoccupied with her teachers' different teaching styles, insisting that some were simply wrong. Similarly, her peers could never measure up to her exacting standards, and she soon had a very small circle of friends. If anyone commented on how she was making herself miserable, she blamed that person for the problem.

Low self-esteem,
Carlos: Carlos always seemed to live in the shadow of his older brother, Joe. Joe was an excellent basketball player, top student, and popular among his peers. Carlos was none of these. He was constantly trying to impress his friends with feats of daring, often injuring himself in the process. They merely laughed. Carlos bragged about his computer game system. The other boys thought he was showing off. Their families couldn't afford the latest systems. Inside, Carlos was miserable: constantly comparing himself to others and feeling that he didn't measure up. His stunts and bragging were ineffective ways of looking for praise.

Grief Reaction

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Tyler: Tyler's parents had divorced when he was a toddler, and his mother remarried when he was ten. Now fourteen, Tyler had never gotten along with his stepfather, and his older sisters tended to pick on him. He always looked forward to Sundays, though. On Sundays, he visited his grandfather, Bill. Grandpa Bill knew more about baseball than anyone Tyler had ever met, and could describe key moments of every World Series going back to the '40s. Tyler shared his passion. Sometimes, they'd get to watch a game together. Other times, they just went through Grandpa's baseball cards, autographed balls, and other memorabilia and the stories they brought to mind. Grandpa Bill was determined to live alone, even though his health was failing.

One day, Tyler's mother looked very serious. Gently, she tried to break the shocking news to him: his grandfather had had a stroke. He wasn't expected to recover. Three days later, he passed away and Tyler was inconsolable. He had nothing to look forward to anymore. He pined in his room for days. Eventually, his mother suggested he write a tribute to his grandfather for the local newspaper. He was proud to do it. With more encouragement, he began to volunteer to pass out programs when his town's team played a home game. He had never been a great player, but his knowledge of the game soon made him a fixture behind the bench. He set a goal of becoming a sportscaster one day.

Like Nadine, Tyler had to adjust to a major life change. Loss of a key person in a is life can be devastating, especially if unexpected. For Tyler, his grandfather's was doubly important because of the more strained relationships he had with ?r family members. It was not going to be possible to replace his grandfather, as it ly is when the lost person is significant. Instead, he had to find a way to honor his memory, maintain an important aspect of the relationship in his life (in this case, the love of baseball), and go on. Fortunately, his mother was sensitive to these issues and helped him grieve appropriately

As adults, we should never assume that a loss is insignificant to a teen. Apparently distant friends or relatives, even pets, can be missed terribly. Even a famous person the teen admires (for example, a famous musician or actor) can be mourned, especially if that person symbolizes an important aspect of the teen's emerging identity. Don't be shy about asking how your teen's life is different, now that the person is gone. The answer may surprise you. If a grief reaction is prolonged or accompanied by symptoms suggestive of more serious depression, counseling should be sought.

Acute Depressive Conditions

2008-12-14T11:45:00.000-08:00

Sometimes depressed mood starts suddenly, in response to a stressful event. There are two such "acute" depressive conditions recognized by mental health professionals. These are: Adjustment Disorder with Depressed Mood and Grief Reaction(s).

In this case, a teen is experiencing a very distressing event that is not extreme enough to be considered a trauma, but nevertheless profoundly affects her mood. School changes or breaking up with a boyfriend or girlfriend, for example, are common triggers of depressed moods. When the depressed mood persists for a month or more, this is called an adjustment disorder. Although unpleasant, adjustment disorders are usually not accompanied by the disturbances of sleep, appetite, energy and concentration, nor by the extreme hopelessness or extremely low self-worth characteristic of major depression. In an adjustment disorder, the change in mood is entirely related to the distressing event, and tends to resolve as the teen adjusts to the new reality (usually, a few days to a few weeks at the most) and finds new sources of enjoyment.

In Nadine's case, for example, she contacted some of her old friends and found out about the struggles they faced at their new school. Her predicament didn't seem so uniquely difficult, and she found comfort in commiserating with them. Eventually, she found a sympathetic teacher at the new school who encouraged her to write for the yearbook, and the peers involved in this activity became her friends. In some cases, supportive counseling is needed to help teens adapt.

If your son or daughter experiences mood changes related to a distressing event, try to provide comfort while maintaining normal routines. If the mood change persists for several months, or you think there might be a risk of self-harm, have him seen by a doctor to clarify the diagnosis and assess whether or not treatment is needed.

Adjustment disorder with depressed mood

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Nadine: Nadine had a gift for music. Everyone encouraged her to nurture this talent. When the opportunity came along to attend a special high school for the performing arts, there was no doubt that this was where Nadine belonged. Unfortunately, none of Nadine's friends were able to join her at the new school. They all were enrolled in the college preparatory program at the local high school. She missed them terribly, and found it harder than she expected to fit in with her new, artistic peers. Furthermore, at her old school, she was praised regularly for her exceptional talent. At the new school, she actually lagged behind her peers in some areas. Many of them had performed in recitals for years and were already entering professional competitions. Rather than feeling privileged to attend the school, Nadine felt like a fish out of water. She regretted deciding to go there. She became sullen and discouraged as she dragged herself to school every morning. By October, she was skipping classes and withdrawing from peers and family.

The spectrum of teen depression

2008-12-14T10:10:00.000-08:00

Feeling sad from time to time is normal for people of all ages. Feeling depressed is not. What's the difference? Sadness is an unpleasant emotion in response to certain events in our lives. Loss of a loved one or close friend, disappointment at missing a hoped-for opportunity, or struggling to adapt to sudden unwelcome changes, all result in sadness for most of us. Even seeing someone else experience these events in a movie can bring us to tears. Often, the tears, the grieving, the process of getting through the sadness bring relief. V,"e take some time to stop our daily routine, reflect on what has happened, cry, and gradually replenish our energy so we can carry on. This is a healthy process.

Depression is not healthy. Depressed mood, a major symptom of depression, occurs when sadness is partnered with a change in how we perceive ourselves and others. We tend to think less of ourselves than usual. We can't forgive ourselves the slightest mistake. We see others as cold and uncaring. We can't appreciate partial success, or see the silver lining in the cloud. We feel helpless and defeated. We can't imagine facing life's challenges and going on. In short, sadness repairs while depression impairs.

We shouldn't expect our children to be free from sadness. In fact, denying sadness or grief in ourselves or others can cause emotional problems. We should, however, expect our children to be free from depression. The occasional down mood occurs in most teens. Ongoing depression does not. How, as a parent, can you tell the difference? In truth, there is no single test that will tell you. In part, this is because teens don't tell you everything that goes on in their minds. They shouldn't be expected to. A certain amount of privacy is part of growing up and becoming your own person. In part, this is because there is a whole range or "spectrum" of experiences between uncomplicated sadness and clinical depression.

This blog discusses teens all the way along that spectrum. The approach described applies to any teen whose sadness is complicated by feelings of low self-worth, overly negative appraisals of events, helplessness, or hopelessness. In more severe cases, it serves as an adjunct to clinical treatments. In milder depressive states, it may allow you to get your teen back to a more average frame of mind, appropriate to his or her stage of development. Before discussing how to do this, however, let's examine some of the depressive states along the spectrum. Think about which one (or ones) might apply to your teen. In this chapter, we illustrate some of the more common, milder depressive conditions. In the next chapter, conditions on the more severe end of the spectrum (Dysthymic Disorder, Major Depression, Bipolar Disorder) are discussed.

The Brain Systems: Anxiety and Depression (2)

2008-12-13T20:59:00.000-08:00

Although the brain is complex and interconnected, neuroscientists have learned that certain brain systems are specialized and involved in controlling certain functions. This chapter gives you a basic understanding of brail anatomy and the latest information on brain function as it applies to anxiety and depression. It is estimated that the brain has more than 2,000 individual structures. To make things more manageable and easier to understand, neuroscientists divide the brain into lobes, or larger systems. The brain is typically divided into cortical (outside surface of the brain) and subcortical (deep brain areas) structures. The cortex is divided into four lobes: the frontal lobes, temporal lobes, parietal lobes, and occipital lobes. A useful, broad generalization is that the back half of the brain takes in and perceives the world, while the front half of the brain integrates incoming information with past experience and plans and executes behavior.

Through our imaging work we have seen that there are five major systems involved with behavior. As much as we have discovered, it is clear to us that we are only at the very beginning stages of understanding brain function and behavior. The information we present here is based on our own experience and what we have learned through the study and application of what other scientists have discovered. What is thought to be true now is likely to be revised time and time again as neuroscientists continue to learn about the brain. The treatment protocols and diagnostic equipment that we consider state of the art today will seem primitive as technology continues to progress.

Basal Ganglia Functions
sets the body's idle or anxiety level integrates feeling and movement shifts and smoothes fine-motor behavior suppresses unwanted motor behaviors enhances motivation

The Brain Systems: Anxiety and Depression

2008-12-13T20:57:00.000-08:00

The brain is the organ that ultimately experiences anxiety and depression because it is the organ of our personality. In fact, the brain controls mood, personality, intelligence, and adaptability. It exp our hopes and dreams, sorrows and pain. Sometimes the brain is the sole cause of anxiety and depression; sometimes it is simply the organ that experiences the results of too much life stress. Usually anxiety and depressive illnesses are the result of a combination of brain vulnerability and life stresses. In order to understand the seven types of anxiety and depressive illnesses as fully as possible, it is important to understand the underlying brain systems involved in feelings and behavior.

The brain is involved in everything you do. The actual physical function ing of your brain heavily influences how well you get along with others, how you think, how you feel, and how you act. When your brain works right you tend to work right; when your brain doesn't work right it is very hard for you to be your best self. The brain is the most complex and powerful organ on earth. It is estimated that the brain contains 100 billion nerve cells, and each of these cells is connected to other cells through hundreds or, in some cases, thousands, of individual connections. It is estimated that the brain has more than 1,000,000,000,000,000 connections within it—more connections than there are stars in the universe. Each part of the brain is vastly interconnected with other parts of the brain. The brain is also very soft, about the consistency of soft butter. It is housed in a very hard skull with many bony ridges, which means it can easily be damaged. The adult human brain weighs about 3 pounds, or about 2 percent of the body's weight, yet it is the body's major energy consumer, using approximately 20 percent of the body's energy.

Brain patterns that would clearly define the two illnesses

2008-12-13T20:56:00.000-08:00

When we first started studying anxiety and depression we thought we would discover evidence of brain patterns that would clearly define the two illnesses. We thought we would see signature patterns for each illness. We were wrong. There was not one brain pattern for anxiety and one for depression; there were many different patterns. Of course, once we thought through the problem it was foolish to think that one pattern would fit all people with depression or anxiety. After all, everyone who is anxious or depressed does not respond to the same medication or the same form of psychotherapy.

As we studied the different patterns we made some other exciting discoveries. We noticed that certain brain patterns responded to specific treatments, while other brain patterns were made worse by traditional treatments. We started to use the scan information like radar to guide us in our treatment choices, and in doing so we saw our patients improve from the more precise treatment. Over time, we grouped the patterns for anxiety and depression into seven different categories and developed treatment protocols tor each one.

Brain SPECT studies

2008-12-12T00:30:00.000-08:00

Brain SPECT studies were initially used in the late 1960s and early to mid-1970s. CT and the more sophisticated MRI anatomical studies replaced SPECT studies in the late 1970s and 1980s. At the time, the resolution (image clarity) of those studies was superior to SPECT for seeing tumors, cysts, and blood clots. Yet, despite their clarity, CT scans and MRIs could offer images of only a static brain and its anatomy; they gave no information about the activity of a working brain. In the last decade it has become increasingly recognized that many neurological and psychiatric disorders are not disorders of the brain's anatomy, but are problems of brain function.

Two technological advancements have once again encouraged the use of SPECT studies. The early SPECT cameras were called single-headed.

They used only one imaging device and took as long as one lour to rotate around a person's brain. People had trouble holding still for that long, the images were fuzzy and hard to read (earning nuclear medicine the nickname "unclear medicine"), and they did not give much information about the activity levels of the deep brain structures. Then multi-headed Cameras were developed with special filters that imaged the brain faster with enhanced resolution. Advancements in computer technology allowed for Improved data acquisition. The brain SPECT studies of today, with their markedly improved resolution, can see deeper into the inner workings of the brain with far greater clarity.

We typically do two scans when we evaluate a patient's brain. We do a baseline scan during which the patient is asked to let his mind wander, and 0 concentration scan during which we challenge the brain with a computerized test that measures attention span and impulse control. We have found it most helpful to have both scans to see how the brain activates with or without concentration and to have a baseline scan for comparison.

We look for three things when we evaluate a SPECT study: areas of the brain that work well, areas of the brain that work too hard, and areas of the brain that do not work hard enough.
The images in this book represent two kinds of three-dimensional (3D) images of the brain. The first is a 3D surface image, which captures the top 45 percent of brain activity. It shows blood flow of the brain s cortical, or outside, surface. These images are helpful for visualizing areas of healthy blood flow and activity as well as seeing areas with diminished perfusion and activity. They are helpful in looking at strokes, brain trauma, and the effects from drug abuse. A healthy 3D surface scan shows good, full, symmetrical activity across the brain's cortical surface.

The second type of SPECT images we look at are 3D active brain images comparing average brain activity to the hottest 15 percent of activity. These images are helpful in visualizing overactive brain areas, as seen in active seizures, and many types of anxiety and depression, among other irregularities. A healthy 3D active scan shows increased activity, seen by the light color in the active scans below, in the back of the brain, the cerebellum, and visual, or occipital, cortex, and average activity everywhere else.

It is important to note that everyone's brain looks different. Brains are like faces and there is variation among them. From an aesthetic standpoint, on scans some brains are beautiful, while others are a bit misshapen and symmetrical activity. A healthy brain has all of its major parts intact and they work together in a relatively harmonious fashion. While there are normal age variations, the brain scans of children and teenagers reveal more activity than the brain scans of adults; even an elderly brain, if properly cared for during life, looks full, symmetrical, and healthy.

SPECT A Window into Anxiety and Depression

2008-12-12T00:29:00.001-08:00

Before we go further, it is important to understand SPECT technology. SPECT stands for single photon emission computer tomography. It is a sophisticated nuclear medicine study that allows us to visualize brain blood flow and metabolism. In this study, a radioactive isotope is attached to a substance (Ceretec) that is easily taken up by the cells in the brain. A small amount of this compound is injected into a patient's vein, travels through the bloodstream, and locks into brain cells. As the isotope breaks down it releases energy in the form of gamma rays. The gamma rays are like beacons of light that signal where the compound is in the brain. People do not have allergic reactions to SPECT studies. Special crystals in the SPECT "gamma" camera detect these beacons of light as the camera rotates around the patient's head for about fifteen minutes. About 10 million gamma rays strike the crystals during a typical scan, and a supercomputer then translates this information into sophisticated blood flow/metabolism maps and three-dimensional images of the brain. Physicians and researchers use these maps to identify patterns of brain activity that correlate to healthy brain function and those that are associated with psychiatric and neurological illnesses.

SPECT imaging belongs to a branch of medicine called nuclear medicine. Nuclear medicine studies measure the physiological functioning of the body. They are used to diagnose a multitude of medical conditions: heart disease, certain forms of infection, the spread of cancer, and bone and thyroid diseases. Brain SPECT studies help in the diagnosis of brain trauma, dementia, atypical or unresponsive mood disorders, strokes, seizures, the impact of drug abuse on brain function, complex forms of Attention Deficit Disorder, and atypical or aggressive behaviors.

14-Days Plan Introduction

2008-12-11T23:54:00.001-08:00

Sometimes we need another person to tell us where to go, what to do and what to say. We can become confused and disorientated when we suffer from depression. There is no obvious route to recovery. If we contract a major illness, for example, cancer, we are aware that there is a medical route for treatment and we probably know that there are various complementary therapies that are approved by the medical profession to help alongside traditional treatment. But if we are depressed it is hard to know where to go to receive help. There is little publicity about treating depression and the very nature of this state of mind renders us unable to think clearly, become assertive and demand assistance. When all we want to do is curl up in a ball and hide, it is very hard to force a sense of clarity out of ourselves.

This is a plan to help you find that clarity and meaning in your current state of mind and offer ways to sharpen your focus on moving out of depression. Whether you simply feel low or you are negotiating a way out of years of depression, this 14-day plan is adaptable to you. Each day offers tasks that will help you to feel better. You can move on to the following day when you feel you have had enough of the previous day's tasks. Conversely, you can jump ahead and try something that shines out at you.

If you are simply feeling a little low, you may want to skip through the 14 days in as many hours. If you undertake the tasks, you will find you feel more confident, your depression will have lifted and you will have a bounce in your step. If you have suffered from depression for a number of years, you may want to take each day's tasks on for some weeks at a time. Stay with each task until you feel saturated and you have had enough. You will be moving yourself in the right direction rather than floundering in a hopeless vacuum. If you decide to follow the plan through in 14 days, just like a 14-day did, at the end of it you may not have lost all your 'weight' but you will have the tools you need to get to your goal. The whole of the 14 days is designed as a sequence of tasks that can help to lift you up to the next step. They are written as a way to place the Ten Suggestions from Part 1 in a manage-able order that will create a sense of moving forward. They are designed to encompass everything you need to recover from depression.

Identify what triggers our depressed feelings

2008-12-11T23:47:00.001-08:00

While staying with the momentum of recovery from depression, it is a good time for us to identify what triggers our depressed feelings. As we start to move away from feeling chronically depressed, we can become aware of what situations hook us back into that sinking, hopeless feeling that we are so used to. Our recovery is fragile to start with, but we build strength day by day.

If we take our journal and write out what scenarios push us backward, we can then be aware of them, and either avoid those situations or arm ourselves so we are prepared. Simply knowing what our triggers are will help us halfway towards conquering difficult circumstances.

EXAMPLES OF OTHER PEOPLE'S TRIGGERS ARE:
• Returning to the parental home
• Work appraisals
• Eating junk food
• Christmas
• Receiving an 'overdue for payment' letter
• Being rejected when asking someone on a date
• Husband/wife refusing sex
• Bingeing on drink and/or drugs
• A 'look' from an authority
• Self-recrimination
• Lack of exercise

When we are aware of our triggers we have choices. Choices offer us a new power and a new road to reclaiming our life.

A Word To The Parents Which Has Depressed Children

2008-12-11T06:47:00.001-08:00

As we shoulder the responsibilities of adult life, many of us look back at adolescence as a carefree time—somehow forget¬ting the difficult struggles the teen years held. Some idealize this period as the "best years of your life," while others mini¬mize adolescent concerns with a "what do you have to worry about?" attitude. This book serves as an important reminder that teens struggle with very real and serious issues.

It's important for parents of teens to try to understand what it's like to walk in their shoes. As Bev Cobain states in this book, "Being a teen is a hard job." Teens face changes and chal¬lenges in every aspect of their lives—as their bodies change so do the expectations of parents, teachers, and even friends. Adolescents must invent and reinvent themselves in their quest to fit in and find acceptance, while also working to figure out who they are and how to express their individuality.

Teens have a unique cognitive style—they see the world through fresh eyes. What they feel and experience may be age-old, but each adolescent feels at times like he or she is the first to experience feeling so intensely happy, sad, or alone, or to be so full of ideas. This intensity of feeling is frequently coupled with a tendency to view the world, and themselves, through an all-or-nothing lens: They are "popular" or "unpopular," things are "good" or "bad," life looks "wonderful" or "hopeless." This worldview modulates over the course of normal adoles¬cent development, but in its most active phase, it places young people at particular risk for depression.

Depression and Suicide

2008-12-11T06:10:00.000-08:00

Brian was one of the neighborhood kids who hung out at my house when my sons were growing up. His handsome face and sunny smile masked the sadness he felt about his parents' divorce. When Brian was in seventh grade, he left our neighborhood to live with his father, and I saw him only occasionally after that.

During his teen years, Brian was depressed, and he isolated himself, flew into rages, and abused drugs and alcohol to cope with his painful feelings. His family tried to help, but they couldn’t get through to him. In September of 1987, when Brian was eighteen, he drove his car into the loading dock of a build¬ing a few miles away and died. His death was a complete shock to everyone who knew him, including me.

At the time, no one had understood the clues that Brian left about his suicide. No one realized how much he needed—and wanted—help. Some of Brian's behaviors prior to his suicide were typical of someone planning to die—he listened to sad music, drew morbid pictures, and made cryptic statements like "You won't have to worry about me anymore. ..." In retro¬spect, the people who loved Brian realized that the clues were messages about what he planned to do.

Why Would Anyone Want to Die?
There aren't any easy answers to this question. Experts esti¬mate that, each year, about 500,000 young people try to kill themselves; about 6,000 of them actually die. So, on average, eighteen teens complete suicide each day. According to the National Institute of Mental Health, suicide is the second lead¬ing cause of death (after motor vehicle accidents) in young peo¬ple ages fifteen to twenty-four. Suicide is a frightening, confusing issue—one that most people don't want to talk about.

It's important to understand that:
1. Most suicidal teens aren't really trying to die.
2. Talking about suicide is a way to help a suicidal person.

Teens who want to kill themselves are trying to escape problems that seem too overwhelming to solve. The tragedy is that they choose a permanent solution to temporary problems. This is why it's so important to talk about suicide, not sweep it under the rug. When teens get their feelings out in the open and ask for help, suddenly the problems don't seem so big and so awful. Having a concerned and caring person say "I will help you" can play a big role in reversing suicidal thoughts.
Suicide is a response to feeling hopeless, helpless, alone, and worthless—all these feelings are linked to depression. In fact, people with depression are thirty times more likely to complete suicide than other people. Even someone who is mildly depressed may be thinking about suicide.

If you have considered suicide or are thinking about it now, GET HELP. Please do it immediately! Tell an adult you trust—a parent, relative, teacher, school counselor, clergy member, doc¬tor, or a mental health professional.

You can also call 911 or go to a hospital emergency room (take a taxi or ask a friend to drive you). If you're by yourself and you don't want to talk to someone face-to-face, find your Yellow Pages and look for a Suicide Hotline or Crisis Hotline. On pages 97-98, you'll find a list of national resources you can con¬tact, too. Take care of yourself right now. Trust that the person you talk to won't judge you.

Believe that you don't need to act on suicidal thoughts at this time. Suicidal thoughts will pass, but you need to get help.

What Are the Symptoms and Effects of Anxiety and Depression?

2008-12-10T22:22:00.001-08:00

Although anxiety and depression are not the same, depression and anxiety disorders have similar symptoms. Both people who are depressed and those who suffer from anxiety disorders may be subject to mood swings. Both may withdraw from their usual activities. They may not be able to talk with their friends, family, coworkers, or fellow students as they did before suffering from these disorders. They may not be able to tell friends or loved ones how they are feeling, and they may even lie about how they feel in order to be left alone.

Almost half of all people diagnosed with an anxiety disorder also suffer from depression. Two out of three people diagnosed with depression exhibit symptoms of anxiety. Despite similarities in symptoms such as social isolation, sleep problems, and loss of energy, depression and anxiety disorders are not the same. Anxiety disorders can develop without signs of depression, and people living with depression may not experience anxiety symptoms.

Symptoms of depression

Those who suffer from depression may feel hopeless, overwhelmed, or angry. Their energy level may be low, making simple day-to-day tasks seem difficult. They may not be able to maintain relationships that are important to them. If their feelings of hopelessness last for a long period of time and interfere with their ability to function, they may be diagnosed with depression. Almost 19 million American adults suffer from depression at some time during their lifetimes. Women are about twice as likely as men to develop depression. Although depression can occur at any age, including the teen years, the average age of onset is the mid-20s.

Anxiety disorders

Those who suffer from an anxiety disorder experience fear, panic, or anxiety in situations where most people don't feel anxious or threatened. Panic is an intense feeling of fear or anxiety that comes on suddenly; the feeling may be overwhelming and seem to be unfounded. Some people experience sudden panic attacks without knowing what the trigger was. A trigger is an event, feeling, or situation that prompts a panic or anxiety attack. Other people feel constantly worried or anxious. Without treatment, such disorders can make it difficult to go to school, be with friends, or even leave one's house.

Anxiety disorders are common in the United States. Typically, the sufferer fears panic symptoms in a place where escape may prove either difficult or embarrassing. Agoraphobia can keep sufferers from ordinary responsibilities and tasks such as going to school or work, doing the grocery shopping, or visiting a doctor.

Seeing Anxiety and Depression: Brain SPECT Imaging

2008-12-10T00:31:00.000-08:00

Sean was one of the cutest, brightest ten-year-old boys with blond hair and big blue eyes we had ever seen. He came into our clinic clutching Dr. Amen's book ChangeYour Brain, ChangeYcur Life, which his mother had given to him and which he had actually read from cover to cover. Based on what he had read in the book he predicted that he would have problems in his deep limbic system and left temporal lobe. When we asked him how he knew this, he said that he had periods of really bad depression, a very bad temper, and that he had tried to kill himself the year before when he was feeling really sad. He also said that sometimes he saw shadows and bugs crawling on walls when there were none. As part of Sean's evaluation we did a brain SPECT series. When we reviewed the scans with Sean it became clear that he had perfectly predicted his own SPECT results. He had excessive activity in the brain's emotional center (the deep limbic system) and decreased activity in the left temporal lobe. As he and his parents looked at the images on the computer screen, tears rolled down Sean's and his mother's cheeks. "I never wanted to feel bad or be so mad," he said. "I always wanted to be good. I guess I know why I had those problems" On the right treatment, guided by the scans, his history, and our clinical observations, Sean's mood and temper stabilized and he thrived in school and at home.
A picture can be invaluable. Once we started our imaging work we could clearly see that these diseases were in fact brain problems. From the first month performing scans^ more than twelve years ago, imaging has changed the way we look at patients. Before we were able to perform brain scans, our approach to diagnosis and treatment was based on patient interviews and symptom checklists, such as those found in the DSM (Diagnostic and Statistical Manual) published by the American Psychiatric Association.
The DSM, now in its fifth version, is considered by many to be the bible for diagnosing psychiatric illness. Unfortunately, psychiatric diagnoses in the DSM are still based on symptom clusters and have little or nothing to do with underlying brain dysfunction.

Shortly after starting the imaging work, we learned to use the scan images like radar to help us target treatment toward the specific brain regions that were abnormal. The greatest aspect or our work was observing that effective treatment causes a patient's brain to actually start healing. We could change brain patterns, see it on a follow-up scan, optimize brain function, and subsequently help people heal from the inside out.

Using brain imaging to help diagnose psychiatric illness was not part of our training, even though we trained at some of the most respected institutions in the country. Dr. Amen trained at the Walter Reed Army Medical Center in Washington, D.C., and Dr. Routh at the Mayo Clinic in Rochester, Minnesota, and Timberlawn Hospital in Dallas, Texas. Brain imaging is usually not a significant part of the curriculum in most psychiatric training programs. Although most psychiatric illnesses are strongly brain-based, psychiatrists don't look at brain function because:
• imaging is usually not a part of psychiatric training programs;
• imaging is not a part of psychiatric tradition;
• most psychiatrists do not know how to read brain scans or what the results mean;
• most psychiatrists are not sure how to use information from brain scans to help with diagnosis and guide treatment;
• many psychiatrists believe it is hard to get brain imaging studies approved by insurance companies in the age of managed care;
• most psychiatrists still perceive brain imaging tools as experimental;
• many psychiatrists are uncomfortable with technology.
We have argued for more than twelve years that it is crucial for psychiatrists to look at the brain on a day-to-day clinical basis. The field is changing, although much more slowly than we would like. We are actively involved in teaching the imaging techniques in this book to psychiatric residents and other physicians around the country.

Helpful Hints in Releasing Our Present Anger

2008-12-10T00:13:00.004-08:00

As we lessen the burden of historic anger, we will find it easier to express our anger at something that happens today. Some of us take a long time to get to the point where we can deal with something we don't like as it happens. One of the reasons for this is that we are frightened that we may go out of control. But big anger starts with an irritation and works its way into a large ball. Once we have a handle on the historic anger, expressing present anger will become second nature.

The first thing we must do if we are frightened of expressing ourselves is to take time out when we feel angry. This will give us an opportunity to get a perspective on how angry it is appropriate to feel. We can ask another person to listen to us and help us divide up what is historic anger and what is present anger.

It is best to express our anger as close to the moment as is possible. The sooner we let it out, the easier it is to discharge and the better we feel for it. Anger can mean slight irritation; it doesn't have to mean 'all out war'. However we feel, we are entitled to our feelings. No matter how unreasonable it may sound, if that's how we feel then that's how we feel.

HERE ARE SOME HINTS TO APPROACH EXPRESSING PRESENT ANGER:

• Use plenty of words to express anger that will seem gentler than the word 'angry'. For example: irritated, frustrated, bothered, perturbed, etc.

• Start by expressing anger over trivial things. For example, 'I am frustrated when you don't call when you say you will.'

• Be open to others' responses as they explain their position. For example, they might say, 'I didn't realize that my phone call meant so much to you. 'This offers a chance of building a bridge.

• Try to explain what is beneath your anger. For example,"I am frustrated when you don't call when you say you will because I worry about your wellbeing."

• Don't express your anger when you are in a state of rage; no one wins at this point.

• As long as you are not in a state of rage, express your anger as soon as you can after the feelings arise.

Practice the words you need to express how you feel when you are alone, or with someone who is neutral and supportive, before you take it to the person for whom the anger is intended.

In terms of expressing anger, practice really does make perfect. At the beginning we find ourselves shaking like a leaf, screaming our heads off or bursting into tears. When we effectively practice expressing our anger, we will feel magnificent because we have found a way to assert ourselves that we can apply to any situation and get good results. We therefore feel that less and less can intimidate us and we feel free to live life with a permanent feeling of lightness.

Sometimes, however, we feel unclear and muddled about a situation and we need to take stock before we respond. A tip for delaying our response is to have to hand a couple of routine phrases that will help us get through those tricky moments when we are flummoxed for what to say. My favorite ones are:

• Thank you for that information, I'll take that away and think about it

• Oh, that's interesting, I didn't know that you saw it that way

This will give us time to evaluate what the other person is saying and to calm ourselves down if we are presented with a situation that renders us incapable of a clear reply. We can then come back to the person and continue where we left off with clarity and good judgment.

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The more we practice releasing present anger, the more liberated we feel. As we become more used to expressing anger on the spur of the moment, the less it will burden us and the safer we will feel because we know that we no longer need to run from a situation where we think we can't cope. We can cope, we can say what we need to say, and we can face what-ever used to terrify us.

This will play a very big part in beating depression and reclaiming our life.

The "Who" Thinking when Treating Our Depression

2008-12-10T00:13:00.003-08:00

When we are becoming more confident in our ability to release our anger, we can comfortably use it to empower ourselves. This is because we are less afraid of our own anger and have learned to trust ourselves fully when we feel angry. We can use this new-found confidence to restore faith in ourselves that we are not mad, out of control or bad for having these feelings. We can begin to say to ourselves, 'Yes, I do have rights and I will exercise them to help myself feel better about what I am doing and feeling.'

As our honesty grows, we can feel our alliance between our Child and Adult selves growing stronger and more able to deal with situations that previously rendered us helpless and depressed. Our victim stance will diminish as we think about what depresses us and find new ways of undertaking difficult issues. We will find a congruency between how we are inside and how we present ourselves on the outside.

WRITE IT OUT (AN ACTION PLAN)

Enough is enough. We have sat with our depression for long enough that we have worked through the main reasons for feeling so depressed. We have an understanding of how we got here and we have a picture of what we need to do to move ourselves on to reclaim our lives.

If you feel that you are not yet at this point, then don't continue until you do.

For those of us who feel bored with the previous exercise, we are ready to tackle the practicalities of our life in order to shake out what we no longer require. Like panning for gold, we wash away the unnecessary debris from our life. We start by writing an action plan for change.

Look back to your initial responses when you wrote about your depression. This will give you the key to your action plan.

At this point you are simply writing out the action plan and not undertaking it. This will give you the freedom to write the perfect plan without fear or favor. Write out the perfect scenario, the ideal result and the faultless way it is carried out. Assume you are 100% right and let your imagination flow and liberate itself.

THE WHO

The Who is a plan to take up any issues with others who need to be confronted. Who do we confront? We need to confront anyone who we think is behaving in a way that is holding us back from beating depression. We need to be cautious when we establish this list because we must take into account how much of the 'exploitation' we feel is down to us remaining as the 'victim' and how much really is because the other person is exploiting us. We need to do all we can to purge ourselves of the victim culture until we can do no more, and then assess who needs to be confronted.

Write out the following:

Who needs to be confronted?

This can be as simple as asking the neighbor if they can park a little to the left to help you get out of the drive more easily. It can be as big as facing your parents and explaining that as a child you were sexually abused by a relative and you feel hugely let down and angry that they kept sending you to the relative's house in spite of your protestations. It can be as tricky as having an immediate boss who you think might try to fire you if you apply for a promotion within your company. How do they need to be confronted?

We must choose our method carefully because we want to get the right result so that we can beat our depression. We must be aware of what doesn't work for us. Stand-up rows often leave everyone exhausted. Calm discussion can be the best way. Sometimes having another person there helps. On occasions, mediation is the best way. When are they to be confronted?

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Choose your timing with care. We want to get the best from ourselves and the other person. We need to be clear of our rights and sure of what our limits are - this is when we confront them.

What result do you want from confronting them?

Envisage the perfect result before you start. Write it down if necessary. Plan it in your head. If you want to hurt someone, that will not help you beat depression. Instead it will leave you with a guilty conscience once the initial euphoria has gone. Imagine the outcome as an adult, not a child. Think about how a great diplomat would approach the issue. The perfect result is leaving the table with our heads held high, a skip in our walk and the satisfaction that we have taken care of ourselves.

Sometimes we need to confront someone without actually 'taking the problem to them. We do it this way because it's not always good for us to directly face someone we want to confront if it denies us our integrity. For instance, confronting an abusive person and receiving a verbal backlash is not always in our best interest, especially if we are depressed. We may not have enough clarity to respond in a way that protects us.

The four questions of the action plan are simply a guide to help us home in on the main cause of our pain and frustration. Not dealing with a chronic situation renders us depressed, so the questions will help us to get to the bottom of the 'cause and effect' scenario.

When we are depressed, we need to be clear and firm to ourselves who we want to confront and why. We must decide if we need to confront another or identify the historic anger and hurt. The more we can go inside ourselves and repair past damage, the clearer and stronger we feel about confronting others.

By confront, we don't mean shout and bawl our heads off. Confront means to face facts, to tackle or deal with. It means to come out from behind the sofa and sort out something we have been trying to avoid. Avoidance leads to depression. If we aren't ready to confront, then we must go back and look at why we are depressed and find our anger.

We must confront ourselves

When we try to establish who is to blame for our depression, we find that the bottom line usually sits with us. No matter how much we want to blame another person for the way we feel, we can't, except for cases of serious abuse, because we have reduced our own choices.

Lola is depressed because James 'holds her back' by not allowing her to continue with her career. Justin is depressed because his mother is still criticizing him even though he is in his mid-3os. Rachael is depressed because David won't stop drinking. We have to confront ourselves by asking what it is that we are frightened to lose if we tackle these problems. Lola is afraid of losing James's financial support; Justin is afraid of losing his mother's approval; Rachael is frightened of being on her own.

We compromise ourselves for a so-called easy life. If we do this through choice then we are living with integrity. If we do this as a victim, we are blackmailing ourselves. If we are depressed, we have usually allowed another to get away with behavior that we shouldn't tolerate. But it is our responsibility to change it by taking control of a situation or removing ourselves from it. This is our choice, our freedom and our path to reclaiming our life.

Why We Cannot Take Action when Wanting to Cure Depression

2008-12-10T00:13:00.001-08:00

It's time to take action. It's easy to put it off when we are depressed. But we must urge ourselves to move forward. We must find the courage to challenge what is holding us back. If we have done the work thoroughly, we will be ready, because we will have moved out of isolation and the 'stuck-ness' that depression fills us with.

If we can't make the move yet, we must examine our fears. We can work through the 'First Step First' plan again and take our time in simply shifting ourselves one step at a time.

WHAT IF WE CAN'T TAKE ACTION?

If we can't take action, or can't be bothered to take action, we have to look at why not. There are several reasons why this is and they are as follows.

'It's not that bad'

We have read the book and weighed up the ideas and decided that our depression is not that bad and these ideas are for someone else. If we are at this point, we are not really suffering. Or we are too afraid to do what we know is necessary to conquer it. If this is the case, we need to comfort our child and form a plan that makes the necessary action challenging but manageable. We must step back until we are prepared.

We want a 'quick fix'

We want immediate relief and these ideas are too long and cumbersome. Depending on how long we have been depressed, we may find that we have tried quick fixes and they simply haven't worked. The most common fix I use is to tell myself that I'm overreacting when it comes to responding to another person in a way that feels horrible inside. I don't want to have to look at why I feel like that; I don't want to have to take responsibility for myself; I don't want to have to say something to someone in order to set my limits and tell them what I need. It's hard work, so the fix is to tell myself that I've got it wrong and they are acting OK. The trouble is, I compromise myself by avoiding the nitty-gritty of communicating with someone else. It's hard work for me and I don't find it easy. So I say nothing and 'grin and bear' it. This works for a short time, then I find myself becoming irritated with them and wanting to be sarcastic or shaming. I must then swallow those utterances if we are to remain friends. In turn I swallow the problem, and I feel bad about myself and eventually get depressed.

Why We Must Stop Our Black and White Thinking

2008-12-10T00:12:00.000-08:00

Black-and-white thinking is common for some of us who have become very depressed. It's the 'all or nothing' scenario voicing the extremity of our feelings. For example, 'I will never get out of this mess'; 'I will never feel good again'; 'This is how my life is going to be forever'; this is the manner in which we think in our depressed moments. The struggle to beat depression just feels too hard.

The consequences of thinking like this can spiral us downwards as our thoughts tell us that the world is a bad place and that we are victims. Black-and-white thinking keeps us stuck, as we see life as a series of crises to be 'got through'. We are acting as a child with no defense and no rights. We must remain aware that we have rights and we have the power to assert them.

This mode of thinking will begin to lessen as we put right what has dented us and we feel less like a victim. There are ways to lessen black-and-white thinking.

Thinking Neutral

Thinking Neutral can enable us to feel more balanced and at ease with the world. It is about learning to accept events with a more impartial approach. With black-and-white thinking we can often feel that every event has happened just to try and get at us. But this is not reality. Events happen and people say and do things that really have no impact on us except for the way we view them.

Thinking Neutral can help us to start seeing events as clouds moving across the sky while we watch them go by. We don't get upset about what we can't change as we accept our powerlessness over events and other people. We don't raise our hopes to dizzy heights. We feel less sad as we realize that most of our gloom is about a perceived or threatened loss and rarely about something we have actually lost.

Through Neutral Thinking we can start to live with a certain detachment that enables us to watch and feel the reaction we have to life's events without getting caught up in them. In terms of the Adult/Parent/Child split, it is like an adult watching a child carefully as she plays in the park with others; the adult is attuned to the variety of emotions, reactions and tussles the child goes through without actually getting involved, making judgments or having any reaction. Unless the child is in danger, the adult watches life go on without any worry, knowing that it's just life happening.

One of the hardest but most profound feats to accomplish is letting go of our 'highs'. Viewing 'highs' as being as disruptive as 'lows' is a complex task. We are constantly bombarded with images, sounds and ideas of what will give us the 'nirvana' we all crave and it seems to arrive in money, cars, property, clothes etc. The distraction that we nurture and celebrate takes us far away from Neutral Thinking and can result in depression, because we do not receive the comfort and love that the Child part of us needs to feel warm and secure. We are too busy relying on external things to give us a temporary high. Having 'things' clutters us up and, if we are on that circuit, someone else will always have more. So we are constantly striving to succeed in material gain.

Many people say, yes, but you have to pay the bills. Yes, we have to pay the bills but if we are trying to beat our depression

by working ourselves into the ground so we can buy 'highs' or constantly looking for others' approval, we have lost our own power and control. This is beyond working to pay the bills, this is obsessive working and will bring us further away from 'neutral thinking'.

Just Say STOP

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A simple start to lessening black-and-white thinking is to say to ourselves, when we find our minds racing along at a hundred miles an hour, 'STOP!' We can calm our thoughts instantly with this simple technique. We may only stop the mind racing for one or two seconds to begin with, but as we practice this technique the seconds will grow. Put a big STOP! Sign on your wall and just do it every time you walk by. It's an extraordinarily simple thing but it works.