“Double depression” – What is it and how is it treated?

Double depression, as the name implies, is a complex interplay between two distinct forms of depression: Major Depressive Disorder (MDD) and Persistent Depressive Disorder (Dysthymia). It represents a challenging clinical scenario where the acute symptoms of MDD are superimposed on the enduring low-grade depressive state of Dysthymia.

Identifying Double Depression:
One of the key challenges in addressing double depression is recognizing it. The chronic nature of Dysthymia may lead individuals to believe that their low mood is “normal” for them, making it difficult to discern the acute exacerbation of MDD. Therefore, a comprehensive evaluation is essential for an accurate diagnosis.

Impact on Daily Life and Functioning:
Double depression can significantly impair an individual’s daily functioning and overall quality of life. The persistent low-grade symptoms of Dysthymia can create a baseline of dissatisfaction and hinder the individual’s ability to experience joy or motivation. When the acute symptoms of MDD emerge, they compound the distress and dysfunction.

Challenges in Diagnosis and Treatment:
Diagnosing double depression requires a keen understanding of both MDD and Dysthymia, as well as the ability to differentiate them from other mood disorders. The treatment approach must be equally sophisticated, addressing the acute symptoms of MDD while also targeting the underlying dysthymic features.

Treatment for Double Depression

Effectively managing double depression necessitates a comprehensive and integrated approach:

1. Comprehensive Evaluation and Diagnosis:
Accurate diagnosis is the foundation of effective treatment. A mental health professional will conduct a thorough assessment to determine the severity of both MDD and dysthymic symptoms. This evaluation enables the development of a tailored treatment plan.

2. Combining Treatments for MDD and Dysthymia:
Double depression demands a multifaceted treatment strategy. To address the acute symptoms of MDD, antidepressant medications may be prescribed. These medications aim to provide relief from intense sadness, hopelessness, and other acute symptoms.

Simultaneously, psychotherapy plays a pivotal role in managing both components of double depression. Cognitive-Behavioral Therapy (CBT) can help individuals reframe negative thought patterns and behaviors associated with MDD. It also equips them with practical tools to navigate the enduring low mood of Dysthymia.

3. Long-Term Management and Relapse Prevention:
Managing double depression is not a short-term endeavor. Even when the acute symptoms of MDD improve, ongoing therapy and medication management may be necessary to prevent relapse. Maintenance treatment can help individuals sustain their progress and lead fulfilling lives despite the challenges posed by double depression.

In conclusion, the landscape of depressive disorders is diverse, with each type requiring its unique approach to assessment and treatment. Understanding the nuances of these conditions empowers mental health professionals to offer personalized care that maximizes the chances of recovery and improved well-being. Double depression, while complex, can be effectively managed through a comprehensive strategy that addresses both acute and chronic aspects, offering individuals hope and a path toward a brighter future.

-Claudia Coxx, LMSW

Claudia Coxx is a clinical therapist at Marsh Psychology Group specializing in mood and anxiety disorders.  She can be reached at 248-860-2024 or ccoxx@marshpsychologygroup.com.

Dialectical Behavior Therapy (DBT) is a form of cognitive-behavioral treatment developed by Marsha M. Linehan, initially aimed at treating individuals with borderline personality disorder. It has, however, proven effective for treating a range of other conditions, notably depression and anxiety.

DBT incorporates the standard cognitive-behavioral techniques for emotion regulation and reality testing while integrating new strategies like mindfulness, acceptance, and focusing on dialectics – the process of finding balance, avoiding extremes, and synthesizing opposite concepts. These components collectively make DBT an innovative and comprehensive approach towards managing depression and anxiety.

Acceptance:

In terms of depression, DBT focuses on the acceptance and change dialectic. The goal is to help patients accept their experiences and feelings while working to change their negative thought patterns and behaviors. By doing so, they can break free from the cycle of depression. DBT provides tools to manage painful emotions and decrease conflict in relationships, elements often associated with depressive disorders.

Emotional Regulation:

DBT’s emphasis on emotional regulation is particularly useful in dealing with anxiety. Techniques such as mindfulness help patients focus on the present, alleviating worries about the future. Anxiety often stems from an overactive fight-or-flight response, and DBT aids in calming this response, allowing individuals to better manage their reactions to stressors.

Treatment:

A typical DBT treatment for depression and anxiety involves individual therapy, group skills training, phone coaching, and therapist consultation. The group skills training is essential as it teaches behavioral skills in four modules: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.

Mindfulness:

Mindfulness, the core skill, teaches individuals to be fully present in the moment, thereby helping to manage depressive rumination and anxious preoccupation. Distress tolerance equips individuals with crisis survival strategies and the ability to accept and tolerate distress. Emotion regulation focuses on identifying and managing emotional reactions – an essential skill for anyone battling depression or anxiety. Interpersonal effectiveness helps patients navigate relationships and social situations, which can often be a source of stress and trigger for depressive or anxious episodes.

DBT’s effectiveness for treating depression and anxiety is backed by multiple scientific studies. In these studies, DBT has consistently shown to reduce symptoms of depression and anxiety, improve emotional regulation, and enhance overall quality of life.

While the journey to recovery can be challenging, DBT equips individuals with the tools and strategies to navigate their path. It’s a comprehensive, evidence-based therapy that brings hope to those struggling with depression and anxiety. This therapeutic approach helps individuals find balance, improve emotional resilience, and ultimately lead a life worth living.

Sincerely,
Claudia Coxx, MSW, LMSW
248-860-2024 Ext. 505
Office Hours: Tu 3p-6p, W-Th 11a-7p; Fri 11a-5p; Sat 10a-1p

EMDR Phases 5-8

Eye movement desensitization and reprocessing therapy, commonly known as EMDR, is a mental health therapy approach that works to reduce distressing emotions which are linked to traumatic memories. EMDR treats mental health conditions, often anxiety, depression or other symptoms, which occur because of those memories we have stored from traumaticevents.

In my first and second articles on the phases of EMDR we looked at Phases 1&2-Client History/Treatment Planning and Preparation and then we explored phases 3&4-Assessment and Desensitization.

If you would like to read the articles on phases 1&2 and 3&4, please find them on the Marsh Psychology Group website, https://marshpsychologygroup.com/blog/

We will now look at Phases 5-8.

Phase 5: Installation.  Once the desensitization therapy sessions are complete, the client will likely feel more positive about the memory. Clients often report they feel the memory is farther away or it just isn’t upsetting anymore.  In theinstallation phase these positive emotions and thoughts are “installed.”

In this phase, the client connects and strengthens a positive belief with the target event until it feels completely true. This is done by having the client focus on the positive belief or thought while continuing with bilateral stimulation. The primary objective is to create positive cognitions and associations with the memory.

Phase 6: Body Scan: During the body scan, the client is asked to hold in mind the target event and the positive belief while scanning the body from head to toe. If there are any lingering negative emotions or thoughts, the therapist will ask the client to focus on those sensations while continuing with bilateral stimulation. The goal is to help the client become more aware of their body and any emotions or thoughts affecting them.

The next and last two phases ensure safety for the client both at the end of the current session and at the beginning of the next session.

Phase 7: Closure: Every session of reprocessing ends with the seventh phase, closure, in which the client is assisted to return to a state of calm in the present moment. This phase occurs whether the reprocessing is complete or not. Reprocessing of an event is complete when the client feels neutral about it andreports a disturbance level of zero, and the positive belief feels completely true. The body is also completely clear of disturbance.

Phase 8: Reevaluation: Reevaluation is how each new session begins after reprocessing. The client and therapist discuss recently processed memories to ensure that distress is still low, and that the positive cognition is still strong. If that is true, the client and therapist will move back to the assessment phase to begin working on the next memory.

If you have experienced trauma of any kind and feel you could benefit from EMDR to reduce symptoms and to improve quality of life, feel free to reach out to me at Marsh Psychology Group.

Carol Van Kampen, LMSW is an individual private practice psychotherapist who specializes in anxiety, depression, grief, and trauma treatment at Marsh Psychology Group. Carol is EMDR trained. Contact her at marshpsychologygroup.com

cvankampen@marshpsychologygroup.com

 

” https://marshpsychologygroup.com/carol-van-kampen-lmsw/

Resources: https://www.emdria.org/public-resources/the-eight-phases-of-emdr-therapy/

Postpartum Depression 

 

 

Symptoms of postpartum depression can include:

•   Persistent feelings of sadness, hopelessness, or emptiness
•   Loss of interest in activities that used to be enjoyable
•   Difficulty bonding with or caring for the baby
•   Changes in appetite or sleep patterns
•   Difficulty concentrating or making decisions
•   Fatigue or low energy
•   Feelings of worthlessness or guilt
•   Thoughts of death or suicide

It is important to note that these symptoms can also occur as a normal part of the “baby blues,” which is a temporary and milder form of depression that affects many women after giving birth. However, if these symptoms persist or worsen, it is important to seek help from a healthcare provider or mental health professional to determine the best treatment plan.

There are several methods of recovery from postpartum depression, including:

1.   Therapy: Therapy, such as cognitive behavioral therapy (CBT) or interpersonal therapy (IPT), can help individuals understand and change negative thought patterns and behaviors that contribute to their depression.
2.   Medication: Antidepressant medication can be effective in reducing symptoms of depression. It is important to work with a healthcare provider to determine the most appropriate medication and dosage.
3.   Support: Receiving support from family, friends, and other new mothers can be helpful in coping with the challenges of motherhood and managing postpartum depression. Joining a support group can also be beneficial.
4.   Self-care: Taking care of oneself is important for recovery from postpartum depression. This may include getting enough rest, eating a healthy diet, exercising regularly, and finding time for activities that bring joy and relaxation.

Postpartum depression is a common and treatable condition, and that with proper treatment, it is possible to fully recover and enjoy motherhood.  Do not hesitate to reach out for help if you or someone you know is experiencing postpartum depression.

Claudia Coxx, MSW, LMSW

248-860-2024 ext 505

 Ccoxx@marshpsychologygroup.com

How To Feel Your Feelings

One of the basic foundations of most therapy work is to have awareness of one’s emotions as they come up. But this awareness can often be focused on our thoughts about the emotion instead of feeling it. For example, if someone has anxiety about an upcoming social event, they might have the thought ‘I am anxious about this event.’ 

They might even be able to observe the specific thoughts they are having about the event: picturing the worst that could happen, anticipating discomfort, thinking of ways to avoid the event, etc.

While this is important awareness to have, it enforces the idea that our feelings are something we THINK and ignores the physical experience of feeling them. 

Feelings and the Body

Our emotions do not just exist in our brains, they are experienced in our bodies. 

While this person is focused on thoughts about their anxiety, they will likely have less awareness of the physical sensations their body is experiencing. For example, anxiety could cause faster breathing, sweating, fluttering in the stomach, heart racing, or shaking.

Even if we know these are physical symptoms of anxiety, we usually do not take the time to fully experience the sensations in the moment. In fact, many of us avoid attuning to our physical experience of emotions because we want to avoid discomfort. But avoiding the physical feelings works against us because it does not allow the emotions to be processed fully, and they will last longer as a result. 

By developing the skill of experiencing and connecting with how our emotions feel in the body, we can become better able to allow them to come and go as they are meant to.

A Step by Step Guide to Feeling Your Feelings

1. Find a quiet place to sit or lay with your eyes closed. Take some deep breaths to start to get more in touch with your physical awareness.
2. Think of an event that triggered an emotion for you. Start with something small that is not too intense or uncomfortable. 
3. Allow the feeling to come up and focus your attention on the physical sensations, where you feel this emotion in your body. 
4. Describe the sensations (‘my heart is racing, there is a heavy pressure in my gut, etc.’)
5. Your brain will want to start thinking thoughts about the event – keep bringing your awareness back to your physical experience. 
6. Keep breathing into the sensations and allow them to be.
7. Observe how things shift and the sensations change – and trust they will leave. 
8. Notice that you got through this process and tolerated the feeling!

 

Developing this awareness through practice will allow you to be able to eventually tune in to your physical sensations in the moment when you are triggered. This will help in processing and releasing your emotions, as well as better informing you in how to communicate your feelings and needs to others.

Sometimes previous experiences, such as trauma, cause one to become even more disconnected from the awareness of their body, which will make it difficult to access physical sensations. If for any reason you find this practice too challenging to do on your own, working with a mental health professional can help guide you in becoming more attuned to your body in a safe way.

 

-Laura Gross, LMSW

Laura Gross is a Clinical Therapist with Marsh Psychology Group

You can contact her at:

(248)860-2024

lgross@marshpsychologygroup.com

 

Source: Emily McDowell, @emilyonlife

Women and Depression: Ways to Feel Better

Reach out for social support:

Getting support from people who care about you plays an essential role in overcoming depression

Ask for the help and support you need and share what you’re going through with the people you love and trust. You may have neglected your most important relationships, but they can get you through this rough time.

How to reach out for support:

Look for support from people who make you feel safe and cared for. The person you talk to doesn’t have to be able to fix you; they just need to be a good listener—someone who’ll listen attentively and compassionately without judging you.

Make facetime a priority. Phone calls, social media, and texting are great ways to stay in touch, but they don’t replace in-person quality time. The simple act of talking to someone face to face about how you feel can play a big role in relieving depression and keeping it away.

Try to keep up with social activities even if you don’t feel like it. Often when you’re depressed it feels more comfortable to retreat into your shell- but being around other people will make you feel less depressed.

Find ways to support others. It’s nice to receive support, but research shows you get an even bigger mood boost from providing support yourself. So, find ways to help others: volunteer, or  help a friend.

Join a support group for depression. Being with others dealing with depression can go a long way in reducing your sense of isolation.

Support your health

In order to overcome depression, you must do things that relax and energize you. This includes following a healthy lifestyle, learning how to better manage stress, setting boundaries on what you’re able to do, and scheduling fun activities into your day.

Aim for eight hours of sleep. Depression often involves sleep problems, whether you’re sleeping too little or too much, your mood suffers.

Keep stress in check. Not only does stress prolong and worsen depression, but it can also trigger it. Figure out all the things in your life that stress you out, such as work overload, money problems, or unsupportive relationships, and find ways to manage the stress so you feel more in control. 

Practice relaxation techniques. A daily relaxation practice can help relieve symptoms of depression, reduce stress, and boost feelings of well-being. Try yoga, deep breathing, progressive muscle relaxation, or meditation.

Do things you enjoy (or used to). While you can’t force yourself to have fun or experience pleasure, you can push yourself to do things, even when you don’t feel like it. Pick up a former hobby or a sport you used to like. Express yourself creatively through music, art, or writing. Go out with friends. Take a day trip to, the park, the beach, or the ballpark.

Come up with a list of things that you can do for a quick mood boost. The more “tools” for coping with depression, the better. Try and implement a few of these ideas each day, even if you’re feeling well.

1. Spend some time in nature.
2. List what you like about yourself.
3. Read a good book.
4. Watch a funny movie or TV show.
5. Take a long, hot bath.
6. Take care of a few small tasks.
7. Play with a pet.
8. Talk to friends or family face-to-face.
9. Listen to music.

Get up and get moving

When you’re depressed, just getting out of bed can seem overwhelming, let alone working out! But exercise is a powerful depression fighter—and one of the most important tools for depression recovery.

Studies show that regular exercise can be as effective as antidepressant medication at increasing energy levels and decreasing feelings of fatigue. A 30-minute walk each day will give you a much-needed boost. And if you can’t manage 30 minutes, three 10-minute bursts of movement throughout the day are just as effective.

Your fatigue will improve if you stick with it. Starting to exercise can be difficult when you’re depressed and feeling exhausted. But research shows that your energy levels will improve if you keep with it. Exercise will help you to feel energized and less fatigued.

Find exercises that are continuous and rhythmic. The most benefits for depression come from rhythmic exercise—such as walking, weight training, swimming, martial arts, or dancing—where you move both your arms and legs.

Add a mindfulness element, especially if your depression is rooted in unresolved trauma or fed by obsessive, negative thoughts.

Eat a healthy, depression-fighting diet

What you eat has a direct impact on the way you feel. Some women find dietary modifications, nutritional supplements and herbal remedies can help aid in the relief of depression symptoms. These include:

Cutting back on salt, unhealthy fats, caffeine, sugar/refined carbs, and alcohol.

Not skipping meals. Going too long between meals can make you feel irritable and tired, so aim to eat something at least every three to four hours.

Boosting your B vitamins. Deficiencies in B vitamins such as folic acid and B-12 can trigger depression. To increase your intake, eat more citrus fruit, leafy greens, beans, chicken, and eggs. Vitamin B-6 along with calcium, magnesium, Vitamin E, and tryptophan have all been shown to benefit women suffering from PMDD.

Eating foods with Omega-3 fatty acids. Omega-3 fatty acids play an essential role in stabilizing mood. The best sources are fatty fish such as salmon, herring, mackerel, anchovies, sardines, and tuna, or vegetarian options such as seaweed, flaxseed, and walnuts.

Making sure you’re getting enough iron. Low iron levels can produce common depression symptoms like irritability, fatigue, and difficulty concentrating. Iron rich foods to add to your diet include red meat, beans, leafy greens and dried fruit.

Get a daily dose of sunlight

Sunlight can help boost serotonin levels and improve your mood. Aim for at least 15 minutes of sunlight a day. 

Take a walk on your lunch break, have your coffee outside, enjoy an al fresco meal, people-watch on a park bench, or spend time gardening.

• Increase the amount of natural light in your home and workplace by opening blinds and drapes and sitting near windows.
• If you live somewhere with little winter sunshine, try using a light therapy box.

Challenge negative thinking

Depression puts a negative spin on everything, including the way you see yourself and your expectations for the future. When these types of thoughts overwhelm you, it’s important to remember that this is a symptom of your depression and these irrational, pessimistic attitudes—known as cognitive distortions—aren’t realistic.

Women also tend to ruminate when we’re depressed, perhaps spending hours trying to figure out why we’re feeling this way. However, rumination can maintain depression or even make it worse.

     Once you identify the destructive thought patterns that contribute to your depression, you can start to challenge them with questions such as:

• “What’s the evidence that this thought is true? Not true?”
• “What would I tell a friend who had this thought?”
• “Is there another way of looking at the situation or an alternate explanation?”
• “How might I look at this situation if I didn’t have depression?”

Get professional help if needed

If you don’t benefit sufficiently from behavioral tools, seek help from a mental health professional.

Therapy. Talk therapy is an extremely effective treatment for depression. It can provide you with the skills and insight to relieve depression symptoms and help prevent depression from coming back. One of the most important things to consider when choosing a therapist is your connection with this person. The right therapist will be a caring and supportive partner in your depression treatment and recovery.

Medication. Antidepressant medication may help relieve some symptoms of depression in women, but it won’t cure the root cause of depression. 

If you feel you could benefit from further support and counseling consider finding a qualified therapist you trust who can help you manage your mental health.

Carol Van Kampen, LMSW

Carol Van Kampen, LMSW is an individual private practice psychotherapist who specializes in anxiety, depression, grief, and trauma treatment at Marsh Psychology Group. Carol is EMDR trained. Contact her at marshpsychologygroup.com

cvankampen@marshpsychologygroup.com

https://marshpsychologygroup.com/carol-van-kampen-lmsw/

The Amygdala Answer: How understanding the origin of your anxiety will lead to the best solution

We usually assume all anxiety has a similar biological process, but anxiety can come from two different places in the brain. 

The Cortex

If anxiety is caused by our thoughts, it originates in the cortex. For example, if you are preparing for a big presentation and you start to think about all the things that could go wrong, you will likely begin to feel anxious about it. Those thoughts come from the cortex, which activates the amygdala, and then the amygdala responds by releasing an anxious response in the body.

The Amygdala

However, when anxious feelings come on suddenly before we are cognitively aware of the cause, that anxiety originates in the amygdala (without the cortex being involved). This type of response is the body’s way of protecting itself from perceived danger when there is no time to wait for our thoughts to recognize there is a problem. For example, if you heard a car horn just before being in a car accident, your amygdala might have learned to associate the sound of a horn with danger. If this happens, the amygdala will initiate an immediate anxiety response every time it hears a car horn. Only after the body has responded in this way will your thoughts catch up to apply reason and determine if the horn is a sign of danger or not. The amygdala has activated a response aimed at protecting the body, without you having cognitive awareness until after it happens. 

Responding to Amygdala Anxiety

Knowing what area of the brain is causing our anxiety is the key to understanding how to best address it. If our anxiety is coming directly from the amygdala, then the cortex (and conscious thought), are not involved. So, it would not be effective to try to use our thoughts to change this type of response. With amygdala-based anxiety, the best thing we can do is work on exposure. Finding ways to expose ourselves to the trigger that causes this type of anxiety will over time teach our bodies that the situation is safe. The amygdala learns from experience, so the more we experience a perceived threat without a negative outcome, the less likely it will continue to cause an anxiety response.

Responding to Cortex Anxiety

With cortex-based anxiety, the most effective approaches address our thoughts directly. Cognitive restructuring refers to the process of identifying thoughts that cause anxiety and replacing them with helpful thoughts. Thanks to neuroplasticity, each time we do this we are creating new pathways in the brain that will help to prevent an anxious response in the future. Different problematic thought patterns contribute to anxiety, such as expecting the worst, jumping to conclusions, judging yourself unfairly, making ‘should’ statements, and perfectionism. Using these thought patterns as a guide, you can identify specific thoughts you have that lead to anxiety, and then develop coping thoughts to replace the unhelpful thoughts. For example, if you frequently think ‘I need to do this without making any mistakes’ (perfectionism) it might lead to feeling anxiety about completing the task, and possibly prevent you from doing it. A more helpful coping thought to use in its place could be ‘I am learning, it is safe for me to make mistakes.’

Anxiety is a complex issue, and this is a very brief overview of how understanding where it originates in the brain can help inform the proper intervention. These processes would best be navigated with the help of a mental health professional trained in the treatment of anxiety. 

–Laura Gross, LMSW

Laura Gross is a Clinical Therapist with Marsh Psychology Group

You can contact her at:

(248)860-2024

lgross@marshpsychologygroup.com

Pittman, Catherine M., and Elizabeth M. Karle. Rewire Your Anxious Brain: How to Use the Neuroscience of Fear to End Anxiety, Panic, & Worry. Echo Point Books & Media, 2019.