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Cognitive Behaviour Therapy (CBT) has been identified as the gold standard therapy approach for managing many psychological difficulties including depressed mood. CBT focuses on improving mood through the implementation of a range of strategies including activity scheduling, problem solving, goal setting, thought challenging and mood monitoring.

Attached is a paper substantiating the benefit of CBT for managing psychological difficulties including unipolar depression.

Empirical-Status-of-CBT: a review paper on CBT.

In addition to being implemented via face to face therapy sessions, a number of International trials have substantiated psychological therapy programs delivered online, including CBT (i.e. e-therapy).

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aus-flag

With it being Australia Day yesterday I thought it timely to write a piece on community and it’s direct relationship on happiness.

International research has shown that happiness can be improved by contributing towards others and the local community. Not only does contributing to the community bring about a greater sense of belonging, it assists in the development of life purpose and meaning. Egocentrism and self preoccupation on the other hand dramatically impacts on negative mood states for the individual and everyone around them.

Many of us contribute to the life of those directly around them including family and friends by offering their services, giving them a helping hand and socially connecting and checking in about how they are going but how many of us contribute to the larger community?

You can belong to 1) yourself, 2) a family, 3) a social network, 4) a workplace or educational institution, 5) a community group, 6) a national community and 7) to the world.

While contributing to the community should not be at the detriment of your mental and physical well-being, finding a way to contribute in a meaningful way without too much consequence is important to well-being and long-term happiness and meaning.

What ways can you contribute to your community? It may be by attending and participating in a community event, it may be about contributing financially to a charity or not for profit organisation or volunteering your services to an organisation or educational institution for an event or on an ongoing basis. At the very least for those that are time or money poor, help someone across the street that needs it or take unwanted clothing to the community clothes bins for people less fortunate.

If you already contribute to your community! Well done and keep it up. The world needs more people like you.

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Prolonged loss of sleep either from anxiety or shift work is one of the prime causes of depression. Insomnia is also a major symptom of the disorder.

It is thought that all animals sleep, although some marine mammals such as the Porpoise, Bottlenose Dolphin, Beluga Whale and Pilot Whale and a variety of birds can put one side of their brain to sleep whilst the other remains active.

During sleep most animals are in an increased anabolic state with increased growth and rejuvenation of the immune, skeletal, muscle and nervous systems.

It is also thought that sleep is also a very important step in the process of allowing new memories from the day to be laid down into storage.

Another reason has been found and reported in Science in October 2013.

Researchers showed that’s during the day waste products build up in the spaces between brain cells. These include proteins such as amyloid and tau proteins which are associated with neurodegenerative diseases such as Alzheimer’s Disease

Their study showed that in mice the flow of Cerebral Spinal Fluid (CSF) through the brain is increased by 60% during sleep thus bringing about an greater reduction in these dangerous wastes.

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sad-face1

The Cognitive Model of depression states that it is not necessarily the situation that affects the way we feel and behave but our thoughts about it. Challenging our thoughts about a situation so that they are both rational and healthy has been found to significantly improve mood and better manage depressive symptoms.

Below is a list of the thinking errors that individuals tend to make when evaluating a situation. Read through the list and identify 2-3 thinking errors that you tend to make the most. Next time you are feeling depressed, anxious or angry, identify your thoughts about the situation and the types of thinking errors that you have made.

Awareness is the first step towards change!
Mental Filtering: Focusing on the negatives and filtering out the positive
Catastrophising: Over-exaggerating in a situation
Black and White Thinking: People who are black and white (all or nothing) in their thinking might see a situation as being either good or bad, positive or negative.
Can’t Standitis: Inability to tolerate situations that are either undesireable or unpleasant.
Personalising: Blaming yourself for a negative situation
Mind Reading: Thinking that you know what people are thinking
Labelling: Calling yourself negative and unhelpful names instead of focusing on the facts of the situation.
Unfair Comparisons: Comparing your own situation to someone elses that has some kind of advantage or better situation than you do.
Overgeneralising: Drawing an overall negative conclusion based on one specific situation. An overgeneraliser will often make comments in terms such as “always”, “never” when really only referring to one specific piece of evidence about one isolated situation.
Emotional Reasoning: Emotional reasoning refers to the tendency to believe that if one feels a certain way it must be true.

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art-class

A new research study has shown that developing a strong connection to a social group can help adults to reduce their depressive symptoms and to prevent them from experiencing relapse. This adds on to past research that advocates for interpersonal relationships for improved mood and managing depressive symptoms.

That is, having a sense of group identity (i.e. belonging to a group) as well as engaging in interpersonal relationships will greatly improve your recovery from depression as well as reducing the likelihood of you experiencing depressed mood again.

Haslam, Cruwys and colleagues (in press Journal of Affective Disorders) from the University of Queensland had depressed and anxious patients join groups in the community that focused on activities such as sewing, yoga, sports, art and group therapy. Patients who reported that they did not identify strongly with the social group had approximately 50% likelihood of continued depression one month later. However, those who developed a stronger connection to the group reported that they felt supported by the group and that they were “in it together”. Less than one third of these connected patients continued to experience clinical symptoms of depressed mood.

Know what to do to reduce depressive symptoms? Connect in with your community! It is not only important to relate to other people on an interpersonal level but also to join a group and develop a sense of group identity.

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New-year-resolution

New Year Resolutions are commonly considered and rarely followed through. While New Year resolutions are driven by positive qualities of hope and optimism, they can also be related to a belief that the year brings a “fresh slate” to work from. Common resolutions include saving money and budgeting more effectively, losing weight and/or getting fitter, stopping smoking and attending more to meaningful relationships.

In saying this, resolutions and goals are a worthwhile concept- if considered realistically and with good levels of insight and motivation for change. Cloud Clinic provide the following recommendations for identifying New Year Resolutions that increase the likelihood of change.

 

  1. Start with reflection and insight: Before planning for the future, reflect on the past year in each important part of your life. For example, taking a “helicopter” perspective, consider your year in the key areas of physical and mental well-being, relationships with important others, work, financial stability, education, etc. Note some positives in your achievements in each of these areas and then list 1-2 areas that require attention or haven’t gone so well.
  2. List possible goals for the New Year: on a separate piece of paper write a list of possible New Year resolutions/goals to be considered from each area of your life.
  3. Consider your motivation for each goal and barriers to change: For each possible goal make notes of the advantages and disadvantages of change in these areas and also make a note about your motivation to change. There is a difference between thinking that it is important to work on this and being ready to commit yourself to action. In fact, research demonstrates that motivation to change happens in different stages that include precontemplation ( limited insight and thought about changing), contemplation (considering the importance of this), preparation (making plans for change), action (implementing the plan) and maintenance (continuing to implement behaviours post the change occurring to make it a routine and way of life). Most people reach the contemplation and preparation stage at New Years without moving it into action and then maintenance. In this section, also consider things that may get in the way (barriers) to changing. These may include finances, a long history of problematic behaviour, dependence on others for support, addiction.
  4. New Behaviours and Routines take months to make: It takes consistency over a period of approximately 3 months to form new routines. For those who do reach ‘action’ stage, most do not continue to implement these changes for long enough for the efforts to pay off. If you are motivated for change, ensure that you are motivated for change over a period of months, rather than thinking that you can take it one day at a time.
  5. Choose 2 goals from your list that a) have good benefits, b) that you are motivated to change, c) that have few barriers and that d) you believe are realistic for you to expect of yourself. Also ensure that these goals are ones that you are willing to follow through on over a period of months.
  6. It is ok to not make resolutions: if the resolution activity is too overwhelming and leaves you feeling anxious, make a more general commitment to a short-term task such as reading a self-help/happiness book, to setting up reminders in your phone to remind you to reflect and do the best that you can do in each area of your life, to calling a friend or contributing to the community for one day, to starting your year off with a clean bedroom, to telling the people that you love that you love them.
  7. Maximise each day for what it brings: the best approach to happiness and well-being is to do the best you can do on each day. Face the challenges that the day brings and approach it with curiosity and willingness to ride any negativity that comes with it. Knowing what is important to you and doing the best that you can will bring about success and well-being.
  8. Remember it doesn’t have to be New Years to set goals for yourself: successful and happy people remain insightful throughout the year and consistently work on the areas that are important to them. Reflect throughout the year and be willing to set goals for yourself as they come up if they are realistic and achievable for where you are at that time in your life.

Cloud Clinic wish you a Happy and Fulfilling New Year!

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war-veteran

The US Department of Veteran Affairs have published a study this month (Nov, 2013) that demonstrates the comparable efficacy for older veterans in the management of depression through CBT as the younger veteran population aged 18-65 years.

This study included 100 older veterans and 764 younger veterans and there were similar outcomes for both populations suggesting an approximate 40% reduction in depression symptoms and scores.

Depression in the older population is associated with reduced quality of life, increased mortality, increased risk and difficulties associated with medical illness and social and environmental difficulties.

Adults from 18 years to well above 65 years benefit from CBT therapy for the management of depressed mood, including in the Veteran population. Motivating the older adult population to seek psychological treatment of depressed mood is a worthwhile goal both for the veteran and general community.

Karlin, B.E., Trockel, M., Brown, G.K., Gordienko, M., Yesavage, J., & Taylor, C.B. (2013). Comparison of the effectiveness of cognitive behavioral therapy for depression among older versus younger veterans: Results of a national evaluation. Journals of Gerontology, Series B: Psychological Sciences and Social Sciences.

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Henrymarkram-300x200

Dr Keith Roberts recently attended the ENCP ( European College of Neuropsychopharmacology) Congress in Barcelona.

Researchers and clinicians from around the world gathered to hear the results of some of the most advanced research in neuroscience.

The keynote speech was given by Prof Henry Markram from the Blue Brain Project of the École Polytechnique Fédérale de Lausanne Switzerland.

his project aims to reconstruct the brain using supercomputers.

The project started in 2005 and as the first step the project succeeded in simulating a rat cortical column. These neuronal networks consist of approximately 10,000 neurons. They are around the size of a pin head. They occur repeatedly throughout the brain. A rat brain has around 100,000 columns. The human brain has many many more.

Each cortical column appears to be allotted a single simple role. For example in the rat brain one specific column is devoted to each whisker.

It takes 20,000 experiments to map a neural circuit. The human brain consists of around 86 billion neurons with 100 trillion synaptic connections. It would be impossible to map these out using routine experiments.

What the Blue Project intends to do is to understand the building blocks of the brain, the neuronal columns, and using statistical simulations predict the way the neurons combine and function, and compare these simulations against real data from biology.

Many in the field doubted whether this was possible or realistic but recently the Blue Brain project was funded by the European Union to the tune of 100 million Euros.

The aim of the research is further understanding of the brain.

This, it is hoped, will lead to better medications and treatments for brain illnesses including addictions, depression and schizophrenia.

There is also another thread of research that hopes to point in another direction. That is to change the architecture of computers to be more like a brain, with the aim of producing a computer which works much quicker than a brain but uses far less energy than today’s supercomputers.

The Blue Brain Project can be compared to the Human Genome Project, which mapped 3.3 billion base pairs making the 20,000 to 25,000 genes within our chromosomes. This too was initially thought to be overly ambitious. However the task was completed 5 years ahead of target and costs involved dropped significantly. Much basic science has been discovered about our genes but the hope for personalised medicine held out by many is still some way off in the future. Probably the benefits of the Blue Brain Project will be profound but distant.

There was recently a very informative newspaper article in “The Guardian” about Prof. Markram and the Blue Brain Project.

http://www.theguardian.com/science/2013/oct/15/human-brain-project-henry-markram

The Blue Brian project made an introductory video to explain their work.

HBP-videoverview from Human Brain Project on Vimeo.

There is also a 10 year project to make a series of documentary films on the project.

Currently the latest film is “Year Three”

http://bluebrainfilm.com

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acceptance

Trying to fix a problem isn’t always the right approach! While problem solving is a good approch based coping style for situations within your control, preoccupying your mind and efforts with a need for change in situations outside of your control is not helpful!

That is, change the situations that you can but work towards accepting the situations that you can’t! Perseverating on issues outside of your control with negative thoughts and ongoing efforts for change will only reinforce a sense of hopelessness and negativity.

Accepting a situation doesn’t mean that you are ok with it happening in the first place. It simply means that you are acknowledging that it has either happened or that it is happening outside of your control and that given that there is nothing you can do about it, there is no positive function of getting emotionally involved and enmeshed with it.

Focus your attention on the things that you can change! Remember that goals for change should follow the SMART acronym that includes the goal being achievable.

What is going on in your life that you would be best accepting rather than ruminating negatively about? Maximise the potential of your day by not involving your mind in negative situations or stressors and focusing on being calm and accepting that situations happen outside of your control.

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family-at-beach

This week I am on the Gold Coast with my family, a place I visit 3 or more times a year during school holidays. Aside from the convenience of the short 1 hour flight with two children under the age of 4, my husband and I have developed an appreciation for everything that the Gold Coast offers us- and most of it comes down to simplicity and calmness. We both live very busy lives parenting two young children and working full time hours and holidays are always a time where we need to maximise the break and our ability to refuel.

Today’s society works harder than ever before. Working hours are longer, the drive to succeed seems stronger and the juggle of career, health, family, friendships is increasingly more hectic. Stress, anxiety and depression rates have hit world record highs with more than 50% of the population experiencing emotional difficulty at some point in their life.

Substantiated in International research is the evidence that as humans we cannot be emotionally resilient and well if we are not attending to our basic primal and physiological needs. That is, without adequate nutrition, sleep and physical health we cannot survive, let alone be emotionally well.

I come home from the Gold Coast after each trip being at my peak of emotional resilience. I would like to share with you my own personal holiday formula for emotional resilience because I think it is embedded in International research and is what underpins a lot of the work that I do with my clients experiencing significant levels of stress, anxiety and/or depressed mood. It is usually the base from which deeper and effective therapy can work successfully.

 

  1. Focus on the Basics- a simple life: Satisfaction and positive emotion can come from the simple things in life. You don’t need a huge achievement or a new asset to be happy. The basics of the Gold Coast that I enjoy most are: moving at a slower pace, the sun, swimming in the ocean, a fresh meal, watching my children play in the sand, having time to connect with quality to the people I love
  2. Physical Health: exercise directly impacts on mood management and significantly reduces stress and anxiety and improves mood. Exercise obviously needs to be tailored to your individual ability- with the Gold Coast having nice flat paths along the ocean, I am enjoying a 25-30 minute jog along the beach each morning. While I like to jog, a walk would be just as helpful!
  3. Nutrition: I don’t believe in an all or nothing approach to health as it is unsustainable and unrealistic. A very clever woman called Teresa Cutter (The Healthy Chef) talks about an 80/20 approach to nutritional health that I adopt as being ideal. That is, 80% of the time eat the foods that fuel your body and 20% of the time allow yourself to indulge in the foods that you like that might not be so healthy. For example, my dinner last night was a fresh piece of fish with salad and chips. From my perspective the nutrition goal for emotional health is not to be strict and eat to lose weight but rather to eat the foods that will appropriately fuel your body and give you the energy to engage in activities and be well.
  4. Sleep: Sleep also directly impacts on emotional resilience and is a significant contributor to depression, anxiety and stress. I once came across a graph that suggested that the first 6 or so hours of your sleep are designed to refuel your physical health and the last 2 hours assist in emotional health and refueling. While I am away on leave I aim to get 9 hours sleep (rather than my 8 hours at home) in an attempt to rest as much as possible. It is important to add however that oversleeping can also negatively affect mood- 8-9 hours is ideal for adults.
  5. Connecting to Family and Close Friends: Research consistently demonstrates how important unconditional love is for psychological wellness. Love can come from your biological or other family, from your partner, with your children, with friends, etc. Many of my clients struggling with their mood want something more in their relationships- either with the people they are in a relationship with or that they want new relationships formed. While there will always be an ideal, maximising the relationships you have and care about is important- it might be with a niece or nephew, with a parent, a friend, your partner or a cousin. On the Gold Coast I am keen to maximise my relationship and connection with my husband, my two children and a few friends that are meeting us on our holiday. This connection doesn’t need to be out doing something exciting- so far on this trip my most successful connection moment has been sitting on the beach all digging a sand pool for the little ones to paddle around in.

Emotional resilience requires a base of physical wellness and connection with others. Start your journey of wellness by focusing on the simple things in life that are essential to life including sleep, exercise, nutrition and connecting with others. This will be the platform from which better self-esteem, life enjoyment, excitement, deep relationships and success can spring from.

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happiness-with-balloons

There is no doubt that life gets busy for many of us. Without too much question we fulfil our routine and obligations and look forward to our next holiday. Many adults reach a time where they question their satisfaction with their life and question their career, their relationships, their home environment and/or something else in their environment.

Research has clearly demonstrated that those who live life according to their values experience higher levels of happiness and satisfaction.

Have you considered your values? Is your life consistent with your values? Work through this activity to better understand your values and to set some goals to increase your value driven your life is.

Look through the below listed values and write down approximately 20 of the values that are most important to you. These should relate to times and experiences in the past that have produced feelings of happiness and satisfaction for you as well as values that would be important for you to have in your future.

Accountability Accuracy Achievement Adventurousness
Altruism Ambition Assertiveness Balance
Being the best Belonging Boldness Calmness
Carefulness Challenge Cheerfulness Clear-mindedness
Commitment Community Compassion Competitiveness
Consistency Contentment Continuous Improvement
Contribution Control Cooperation Correctness
Courtesy Creativity Curiosity Decisiveness
Democraticness Dependability Determination Devoutness
Diligence Discipline Discretion Diversity
Dynamism Economy Effectiveness Efficiency
Elegance Empathy Enjoyment Enthusiasm
Equality Excellence Excitement Expertise
Exploration Expressiveness Fairness Faith
Family-orientedness Fidelity Fitness Fluency
Focus Freedom Fun Generosity
Goodness Grace Growth Happiness
Hard Work Health Helping Society Holiness
Honesty Honor Humility Independence
Ingenuity Inner Harmony Inquisitiveness Insightfulness
Intelligence Intellectual Status Intuition Joy
Justice Leadership Legacy Love
Loyalty Making Difference Mastery
Merit Obedience Openness Order
Originality Patriotism Perfection Piety
Positivity Practicality Preparedness Professionalism
Prudence Quality orientation Reliability
Resourcefulness Restraint Results-oriented Rigor
Security Self-actualization Self-control Selflessness
Self-reliance Sensitivity Serenity Service
Shrewdness Simplicity Soundness Speed
Spontaneity Stability Strategic Strength
Structure Success Support Teamwork
Temperance Thankfulness Thoroughness Thoughtfulness
Timeliness Tolerance Traditionalism Trustworthiness
Truth-seeking Understanding Uniqueness Unity
Usefulness Vision Vitality Zeal

From your list of top values, highlight five that are most integral to you and write a short sentence about how and why that value is important to you.

Is your life at the moment fulfilling your top 5 values?

If it does, congratulations! You are living a value driven life. When your mood is low or you are preoccupied by a sense of satisfaction, try to acknowledge that your life is successful in its ability to meet your values.

If your top values aren’t being met write down some ideas to help you make some changes in your day to day life to help you achieve a value directed life.

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suicide

It is World Suicide Prevention Day (Tuesday 10 September) and R U Ok Day (Thursday 12 September) this week. These two days aim to reduce stigma and get people talking about depression and suicide.

We have written this blog to contribute to a better understanding of depression and suicide and to reduce the stigma associated with it. Taking responsibility in knowing the warning signs of depression and learning to speak about it (rather than hiding from it) will help reduce the overwhelming incidence of suicide in Australia and Worldwide.

The Statistics

Almost one million people worldwide commit suicide each year. This equates to 1 death by suicide every 40 seconds! Suicide is one of the leading causes of death in the world (particularly young people)and is expected to account for 25% of the total disease burden in the world over the next two decades, beating cancer and heart disease in percentage accountability. For every person who commits suicide, there are 20 or more who make an attempt on their life.

Suicide is often the result of depression. At least 350 million people in the world live with depression. It impacts not only the sufferer but their loved ones too. Unfortunately depression and suicide remains hidden and many people don’t receive professional treatment or support.

How to Recognise Depression in Others (and yourself)

Depression is characterised by low mood, a reduced pleasure and interest in activities, poor sleep, appetite disturbance, social withdrawal, feelings of worthlessness, irritability, poor concentration and suicidal thinking and planning.

Ask Your Friend or Loved One: R U OK?

These details can be found in greater detail on the R U OK website.

  1. Ask R U OK?
  2. Listen without judgement
  3. Encourage action
  4. Follow up

What if you think the person is considering suicide?

While the awkwardness and difficulty of asking someone if they are having suicidal thoughts is completely understandable, I do urge that you ask the person you are worried about directly about suicidal thoughts and plans.

Take communicated thoughts of suicide seriously. Try not to become too upset, agitated or anxious- reassure him/her that suicidal thoughts are common in depressed mood and don’t have to be acted on. Also reassure him/her that there is help available and if they have been receiving help in the past that other options might be available.

Try and find out if the thoughts are fleeting or if they have been formulating a plan to take their life. This can be asked by questioning whether they have thought and/or decided on how they would take their life and if they have taken steps in preparation for it.

If you are concerned about his/her risk of suicide do not leave them alone (or ensure that when you do that someone else is aware and is committed to monitoring his/her safety) and get immediate professional help (Australian services listed below).

Treating Depressed Mood and Reducing Risk of Suicide

Depression does respond to treatment and reduces risk of suicide for many worldwide.

Treatment of moderate to severe depression typically involves a combination of medication and cognitive behavioural therapy (CBT).

CBT focuses on the implementation of some key strategies including:

Behavioural Activation/Activity Scheduling:

The lethargy circuit theory of depressed mood clearly states that depressed mood often results in reduced motivation and desire to engage in previously enjoyed activities. The concern is that engaging in fewer activities also then reinforces and worsens your mood. Scheduling regular activities into your diary and forcing yourself to do the things that you don’t feel like doing, has been shown to have significant positive impacts on mood.

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It is not the situation that causes us to feel the way we do. Rather, it is the way in which we interpret and think about the situation that influences our emotions and behavioural responses. Challenging the way that you think about a situation in a realistic and positive way will help you to feel more positive and to cope with the situation. Thought challenging is about developing a rational and positive perspective of a situation that will assist you in reducing your experience of negative moods. We can often not change what has happened in a situation but do have some control with the way in which we think about it.

Links to more information and to a CBT program for depression

(note: Australian Sites)

Lifeline: http://www.lifeline.org.au/

Beyond Blue http://www.beyondblue.org.au/

Black Dog Institute: http://www.blackdoginstitute.org.au/

Cloud Clinic: http://www.cloudclinic.net.au

R U Ok Day: https://www.ruokday.com/

Suicide Prevention Australia: http://suicidepreventionaust.org/

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sad

There is nothing to feel ashamed about when you still feel sad despite recognising the more rational and positive perspective in a situation- we all have times in which we do!

Ever feel frustrated because others are telling you not to worry about a situation or that you should focus on the positives and what you have when really you just want a few minutes to feel sad?

While challenging negative and irrational thoughts is one of the most successful techniques in managing depressed mood- it doesn’t take away all of your sadness. You can be rational and sad at the same time!

Many of my clients ask me when they are thought challenging whether it is ok if there level of emotion doesn’t change significantly shortly following a thought challenging activity. My response is YES- it’s healthy and appropriate. The goal of thought challenging is to adopt a more rational perspective and to help yourself to cope with situations from the most healthy headspace- it doesn’t however change the fact that the situation happened in the first place and that this situation has triggered sadness for you.

Whether your sadness is due to an argument with your partner, some negative feedback from an employer, not getting a grade you were working towards, losing control with your children or another month of falling to fall pregnant unsuccessfully, if you didn’t experience some negative emotion around these things (at some level) you would be abnormal and possibly unhealthy!

I caught up with a girlfriend of mine this week and when I mentioned to her that I was going to blog about this over the weekend she said to me “feeling sad is ok- but wallowing isn’t”.

It is so accurate! There is a difference between allowing yourself the space to experience emotion (including sadness) and “wallowing” in it. It is important that you are kind and compassionate to yourself and that you give yourself some space to experience emotion, even when it is upsetting. Allowing yourself to be preoccupied by it and to invest ongoing periods of time ruminating about what happened and refusing to engage in life as usual because of it isn’t healthy however.

As a psychologist I would recommend that you allow yourself time to experience the sadness and emotion but keep it contained enough that it doesn’t impact negatively on your mood or ability to function in the medium term. Crying all night and allowing yourself to be preoccupied with a situation for days doesn’t provide positive function. Contain the negative emotion where possible and focus on a positive way forward- but don’t forget to leave a little room for being sad if it is warranted!

The right amount of time differs between individuals and situations and may range from 5-10 minutes to 24 hours or so. More than a few consecutive days of preoccupation however is usually not helpful (other than in situations similar to below). That doesn’t mean that the sadness doesn’t return a few days later- rather it then provides yourself with an opportunity to once again rationalise the situation, allow a further short period of sadness and then to push forward again. The ‘sad’ expressions and times should become shorter however over time.

Please note: this post is written for people challenging day to day negative situations, not people who have experienced significant trauma. If you have experienced a trauma that has been life changing including the death of someone very close to you, a diagnosis of a chronic illness, etc, it is appropriate and healthy to experience more significant and longer amounts of sadness. While moving forward will likely involve a similar process to the above, this needs to happen at a time that is right for you.

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stressed-out-300x290

There has been a growing amount of research to indicate that how you respond to small irritants or stresses can affect whether you later develop depression or anxiety.

Life’s small problems may be small but they are common if not daily occurrences.

In my clinical practice it striking how often people reach their limit not through one major problem, such as death or divorce, but more often through lots of smaller problems coming along at the same time, like buses.

If the stresses had been more spread out the person would probably have coped with each problem but by coming together their coping skills were overwhelmed.

How we deal with small matters may be more important that how we deal with the bigger problems of life in whether we develop depression.

In 2013 Susan Charles and her team [1] asked their 711 research participants to record their level of stress and the effect it had on their mood over eight consecutive days.

Those with increased levels of negative emotion on days which were not massively stressful, but contained life’s smaller irritants, suffered from greater levels of mood problems when they were reviewed 10 years later.

Susan Wenze and her team [2] asked her subjects to rate their mood using a PDA regarding the events of everyday life. Those who showed a stronger momentary negative mood and negative thoughts to these events were more likely to be depressed 6 months later.

This aligns with earlier research from Suzanne O’Neill and others [3] who in 2004 studied college students and found that mood reactivity to daily interpersonal stress predicted later depressive symptoms .

These and other research papers show the benefit of learning to cope with a variety of events that occur in life.

One needs to learn how to deal with them effectively, efficiently and without due distress. This can come about through CBT, ACT and or meditation.

[1] Susan T Charles et al
Psychological Science May 2013 vol. 24 no. 5 733-741

[2] Susan J Wenze et al Dec 2010
Cognitive Therapy and Research Vol. 34, no. 6, pp 554-562

[3] Suzanne C. O’Neill et al April 2004.Journal of Social and Clinical Psychology: Vol. 23, no. 2, pp. 172-194

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emotions
The revolution in neuroscience is providing us with more and more information about how the brain and mind are interrelated

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padclinic-300x80

Managing Antenatal and Postnatal Depression and Anxiety

If you have been experiencing depression or anxiety during pregnancy or following the birth of your baby, you are not alone. Approximately 15-20% of women experience depressed mood and/or anxiety in the perinatal period. Research suggests that both medication and psychological therapy can greatly improve mood and stress and also suggests that the earlier you receive treatment and support, the easier it will be to get things back on track.

The most effective forms of psychological therapy for women in the perinatal period are cognitive behavioural therapy (CBT) and acceptance and commitment therapy (ACT). These two types of therapy aim to teach a number of different strategies to improve mood and reduce anxiety and may include activity scheduling, problem solving, thought challenging, improving mindfulness, relaxation, sleep hygiene, communication training and challenging unhelpful beliefs about yourself (self-esteem related).

Some initial recommendations for better managing your mood and anxiety if pregnant or are a parent to a young infant

  • Maximise sleep where possible. Both pregnancy and being a parent to an infant can significantly impact on sleep quality and quantity. Sleep directly impacts on both mood and anxiety management. Maximise number of hours of sleep where possible including napping, going to bed early, getting your partner to assist with night feeds.
  • Exercise: Research has clearly substantiated the benefit of exercise for mood and anxiety. Engage in at least 30 minutes of exercise regularly with that exercise matching where you are at both physically and in your energy. A walk is a great start!
  • Seek Social Support: While you might feel too tired or low to socialise and engage with others it is important that you seek support wherever possible. This might be through family, friendships, mother’s group and community health staff and groups.
  • Communicate with your partner: Relationship difficulties are more common in the perinatal period. Try to communicate with your partner about where things are at for you and to express any concerns that you might have. Remember that many are defensive to criticism so communicate gently and approach it as positively as possible. It might not change behaviour or outcomes but will be good for them to know where you are at and what you need.
  • Challenge negative and irrational thoughts: we all have a tendency to consider situations with negativity and/or irrationality. Make efforts to keep your thoughts in perspective and as functional as possible.
  • Mindfulness: Rather than focusing your attention and thoughts on past or future events or concerns, try to engage in the moment (here and now). You can do this by focusing on your breath, by noticing something in your environment or in being present during your morning or afternoon routine.
  • See professional assistance: Perinatal depression and anxiety often requires professional support and treatment. If you are really finding it difficult to manage your mood and/or anxiety, speak to your doctor or specialist.
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This week I have spoken with a few people regarding their decision to engage in University study and it has inspired me to write this article. It is an area which interests me a lot, although I have to admit that the interest is based on my personal experience and the wonderful outcome it has provided to my husband and my family.

In short, my husband was working in the city in finance and often came home from work feeling flat and uninspired. This continued for about 6 months before he began discussing the possibility of changing careers. I was pregnant expecting our first baby and running a business where an income wasn’t reliable. I have to admit that the idea of a career change was a little concerning especially as I was about to be taking leave and I would not be generating much of an income for some time. Despite the anxiety around the endeavour, my husband made a well informed decision to enrol in a postgraduate secondary teaching course that would provide him with the qualification of being a secondary school teacher in his area of expertise after 12 months. He then went on to juggle part-time work and full-time study for a year and was soon employed as a teacher. It is without doubt one of the best decisions that he has made in the time that I have known him and I absolutely encourage others to have the courage to make decisions that are in their longer-term best interests both emotionally and environmentally.

So let me get on to my recommendations as both a clinical psychologist and as a wife of someone who has had the pleasure of personally experiencing the benefits of a change in career and study. To those of you looking at a career change or more study I recommend that you consider the following:

  1. Be clear in identifying why you may not be feeling satisfied with where you are at with your career or study. What is missing for you in the here and now?
  2. Compile a list of possibilities both with career thoughts and study possibilities
  3. Brainstorm the positives of each of these careers and/or study options
  4. Brainstorm the negatives of each of these career or study options
  5. In weighing up the positives and negatives of each course or career, consider how each of these benefits and consequences relate to what you value. For example, if a positive of a career is that you will be home earlier to be with the family but the negative is a pay reduction, compare within yourself the values of family and financial stability and prioritise options that focus on positives in line with your values and negatives that will not be too consequential on what you value.
  6. Believe in yourself! Everyone experiences doubt when they are making major life decisions. If you have considered the strengths and weaknesses of each option and your top options are consistent with your values, there is enough in this to consider change.
  7. Check the logistics of this option. While it is good to take some risks and to believe in yourself, following through with an option needs to be realistic and achievable. For example, can you afford financially to follow this goal (e.g. can you pay your bills- it might be helpful to run a budget on this to check its viability)? Are you able to continue to attend to your other important commitments and responsibilities including your relationships with family and friends? Do you have the academic grades or background to gain entry into the course? If not, have you identified a way to get into this course or career that is reasonable?
  8. Communicate your thoughts and goals to people who know you well and be open to their feedback and recommendations.
  9. Speak to people who specialise in the career or course to discuss the relevance and appropriateness for you
  10. It is ok to dip your toe in the water! Consider engaging in a short related course or elect to study 1-2 subjects in the first semester to assess whether it is right for you.
  11. Be willing to face your fears. We all experience concerns when changing a career or enrolling in a new course. If you have considered all the above, challenge yourself to give it a go.
  12. There is time! Both the people that I have spoken to this week are in their 30’s. Careers usually run into one’s 60’s and some people work until the end of their lifespan. Changing careers in your 30’s and 40s (and even 50s and 60s) is ok! If you are in your mid 30s for example, you still have at least half your career ahead of you.

Make an informed decision by considering all the options, the strengths and weaknesses of each and assess these in accordance with what you value. If everything matches up- it might be worth giving it a go!

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Know someone experiencing depressed mood? Unfortunately most of us do- The World Health Organisation (WHO) suggests that approximately 350 million people are experiencing depression.

Characterised by low mood, sadness, reduced pleasure and interest in previously enjoyed activities, sleep and appetite disturbance, low motivation and suicidal ideation, it is no wonder that individuals experiencing depression also report feelings of worthlessness and helplessness. While some people report that their depression has been triggered by a traumatic event or by difficult circumstances in their environment, others have experienced quite chronic low mood and cannot recall a time in which they felt happy or ok.

Depression not only affects the sufferer- it also affects the people around them. This is why treatment for depressed mood should not only provide the individual with strategies to best manage their mood but also provide recommendations to family and friends who need to look after themselves whilst support the needs of the person that they care about.

Below are a short list of recommendations for family and friends who are close to someone experiencing depression.

Looking After Yourself

Know that saying- you can’t love someone else fully if you don’t love yourself? Well the same applies for mood. That is, it is difficult to support the needs of someone else if you are not ok yourself. Protecting and managing your own mood is just as important as helping the person that you care about.

  • Physical Health: Ensure that you are looking after your own physical health by eating nutritious meals, exercising and practicing good sleep hygiene. Not only will this be good for your own health but is good role modelling for your friend or family member who is depressed (exercise, nutrition and sleep have a direct impact on quality of mood).
  • Support in Moderation: It can often take someone months to work through their depressed mood and get better. It is important that you balance supporting their needs with ensuring that you have time to engage in your own activities and commitments. Work on quality of support rather than quantity.
  • Engage in Pleasurable Activities: Research has shown that depressed mood can impact negatively on the mood of others. Following the provision of supporting someone with depressed mood, go and do something pleasurable for yourself to stimulate positive mood.
  • Challenge your Negative Thoughts: One of the things that we know in the treatment of depressed mood is that the individual experiencing depressed mood needs to have their own internal motivation for change to get better. That is, you cannot fix your friend’s or family member’s depression- you can only support them though it and provide suggestions. If you have negative thoughts about what you may have done to trigger the depressed mood or your responsibility to shift the depression for them, remind yourself that it is something that you have no direct control of. (Responsibility can apply however if someone has engaged in a behaviour that seeks to make the depressed person’s life difficult or traumatic).

Supporting your Depressed Family Member or Friend

There are a number of recommendations for supporting someone through depression

  • Be willing to engage in dialogue about the person’s mood. That is, if you notice symptoms consistent with depressed mood, ask them about it and let them know that you are concerned for them.
  • Let him/her know that you care and are there for him/her.
  • Encourage them to seek help by speaking to their GP or an appropriate health provider such as a psychologist, psychiatrist, counsellor or therapist.
  • Encourage him/her to exercise including going for a walk or going to the gym. Offer to go with them.
  • Suggest enjoyable activities to leave and house and engage in such as going to the beach, the movies, a museum, the park.
  • Gently discuss the factors contributing to the depressed mood (eg work stress, family issues, friendship difficulties, finances, poor sleep, low self-esteem) and encourage them to problem solve through these to see if they can find some relief from symptoms
  • Encourage hopeful  and positive thoughts. Depressed individuals can also be quite catastrophic and extreme in the extent of their thoughts- try to help them see the situation in perspective.
  • In circumstances where you are concerned for someone’s safety- you may need to alert the person’s close family or doctor and encourage them to seek formal help. Offer to attend the appointment with them if you think they are more likely to attend this way.
  • Become familiar with Cognitive Behaviour Therapy (CBT) basic principles and encourage him/her to engage in these strategies (note: the Cloud Clinic App is an easy to use CBT program with videos on the Cloud Psychology website providing instructions on how to use).
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