nderstanding nxiety & depression
TRANSCRIPT
UNDERSTANDING
ANXIETY & DEPRESSION
Michael DiPaolo, Ph.D.
1849 Sawtelle Blvd., Suite 540Los Angeles, CA 90025310-268-7792
DrMichaelD.com
Sponsored by :
Pacific Clinics Institute
&
NAMI San Gabriel Valley
Tonight’s Goals
1. Learn about the causes, different types and prevalence of anxiety & depression
2. Learn the criteria for generalized anxiety & major depression, and gain a holistic understanding of the experience of anxiety & depression
3. Learn about treatment for anxiety & depression, including lifestyle changes, therapy and medication.
4. Learn strategies that you can start practicing today.
Painting the broad brush stroke
A Chameleon with many different appearances… and often hidden
???
I am… hiddenUncovering the Facts about Anxiety & Depression
Anxiety Disorders
▪ The most common mental illness in the U.S.
▪ 40 million adults, or 18% of the population each year.
▪ Over 30% of the population will have an anxiety disorder at least once in their lifetime.
▪ Over 22% are severe
I am… hiddenUncovering the Facts about Anxiety & Depression
Major Depression
▪ Among the most common mental illnesses
▪ Affects 15 million U.S. adults, or 6.7 % of the population each year.
▪ Over 17% of the population will have major depression in their lifetime.
▪ 45% are severe.
I am… hiddenUncovering the Facts about Anxiety & Depression
▪ Major Depressive Disorder is the leading cause of disability in the U.S. for ages 15-44.
▪ Anxiety Disorders cost over $42 billion per year in treatment – about 1/3 of the country’s total mental health bill
▪ Both anxiety and depressive disorders are more common in women than men.
▪ Age of onset varies by specific type of anxiety and depression.
I am… hiddenUncovering the Facts about Anxiety & Depression
Over 50% of persons with Major Depression will
also have an Anxiety Disorder
+They are more likely to have physical health
problems & substance abuse
I am… hiddenUncovering the Facts about Anxiety & Depression
The majority of people suffering from anxiety &
depression will NOT receive treatment for their condition.
Primary Types of Anxiety & Depression
Anxiety Disorders
▪ Generalized Anxiety Disorder
▪ Panic Disorder
▪ Agoraphobia
▪ Social Anxiety Disorder
▪ Specific Phobia
Mood Disorders
▪ Major Depression
▪ Persistent Depressive Disorder (Dysthymia)
▪ Bipolar I Disorder
▪ Bipolar II Disorder
Mania
Hypomania
Minor Depression
Major Depression
Normal
Moods
Minor Depression
Major Depression
Normal
The BluesA look on the low
side
The DSM criteria for a Major Depressive Episode
Presence of at least 5 of the following symptoms over a 2 week period
1. Depressed mood
2. Lack of interest in pleasurable activities
3. Significant change in appetite (5% weight)
4. Significant change is sleep
5. Psychomotor agitation or retardation
The DSM criteria for a Major Depressive Episode
6. Fatigue or loss of energy
7. Feelings of worthlessness or inappropriate guilt
8. Poor concentration and indecisiveness
9. Recurrent thoughts of death or suicide
The DSM criteria for Generalized Anxiety Disorder
Excessive anxiety and worry… + at least 3 of the following
1. Restlessness or feeling keyed up or on edge
2. Irritability
3. Difficulty concentrating or mind going blank
4. Muscle tension
5. Easily fatigue
6. Sleep disturbance (difficulty falling asleep, or restless unsatisfying sleep)
Stress & vs. Anxiety & The Blues Depression
A normal reaction to a life event
Primarily affect a single domain - moods
Temporary
Rarely lead to suicidal thoughts or actions
Requires some coping, support, and time
“There’s something wrong”
A condition, disorder, or an illness
Affects multiple domains -moods, thoughts, body
Persistent
Panic Attacks (A) Suicidal thoughts (D) common
Requires professional treatment
“There’s something wrong with me”
A Holistic Model of Understanding
▪ Mental
▪Emotional
▪Physical
Spiritual Relational
DepressionA Holistic Model of Understanding
▪ MENTAL
▪EMOTIONAL
▪PHYSICAL
SPIRITUAL
Lack of Energy
Change of Appetite
Sleep Disturbance
Restlessness
or Lethargy
Poor Concentration/
Indecision
Rumination
Suicidal Thoughts
Depressed Mood
Lack of Interest in
Pleasurable Activities
Inappropriate Guilt/Shame
Hopelessness
RELATIONAL
Isolation
Tension
Despair
Abandonment by
God
AnxietyA Holistic Model of Understanding
▪ MENTAL
▪EMOTIONAL
▪PHYSICAL
SPIRITUAL
Muscle Tension
Nausea/Abdominal
Distress
Sleep Disturbance
Fatigue
Restlessness
(“on edge”)
Shaking
Sweating
Shortness of Breath
Persistent Worry
Poor Concentration/
Mind Going Blank
Hypervigilance
Anxious Mood
Irritability or Anger
Inappropriate Guilt/Shame
Fears (losing control)
RELATIONAL
Isolation
Tension
Despair
Abandonment by
God
Anxiety & Depression are caused by?
- a chemical imbalance
- genetics
- spiritual despair
- Identity crisis
- a situational reaction
- a response to loss
- the sequelae to childhood issues
- trauma
All of them
can lead
to depression
Depression reduces activity in the frontal lobe
A Dysregulating Combination
The Executive is less active when we need more
The Emotional Regulator is overactive when we need less
The Impact of TraumaA Short Circuit sets off a “False Alarm”
▪ Increased cortisol secretion▪ Decreased immune system
functioning
▪ Decreased autonomic system functioning (“fight or flight” performance)
▪ Decreased frontal cortex processing
▪ Smaller hippocampus (memory center)
▪ → Chronic Anxiety & Depression
Advice from People with Anxiety & Depression
Treatment to address all aspects of the person
Mental
Emotional
Physical
Spiritual Relational
Responsibility = Embracing our Vulnerability
“Vulnerability is the core of shame, fear, our struggle for worthiness, but it is also
the birthplace of joy, creativity, belongingness and love.”
Brene Brown
How do we deal with our vulnerability?
“We are the most in debt, obese, addicted, and medicated cohort
in U.S. history.”
- Brene Brown
Treatments to restore brain functioningWhich of the following can positively influence your brain chemistry?
- Medication
- Herbs (e.g., St. John’s Wort, Kava Kava)
- Psychotherapy
- Exercise
- Yoga
- Meditation
- Breathing
- Sudoku
Answer:
Treatment for Anxiety & Depression
Lifestyle
Psychotherapy
Medication
Treatment for Anxiety & Depression
Lifestyle Adjustments
Exercise
Sleep
Mindfulness
Social Support
•Reduce stress
•Reduce anxiety & depression
•Improve self-esteem
•Improve sleep
•Increase energy levels
Exercise has been proven to:
THE THERAPEUTIC BALANCE
Activating
Grounding
A Game Plan for Sound Sleep
1. Honor the Golden Hour
2. Get into the Routine
3. No Screens
4. Avoid Eating (but a cup of chamomile tea is ok)
5. Exercise, exercise
6. Ground Body, Mind & Spirit
7. Reading & Writing
8. “My soul is restless until it rests in thee.”
Mindfulness Practices
▪ Ancient practices that science is now catching up with through brain imaging
▪ Examples: Yoga, meditation, tai-chi, contemplative prayer, deep breathing
▪ Teach to observe the experience of body, thoughts and feelings without being swept away by them
See the surface storms of the ocean from the depths of tranquility
Start simple… Breathe
New book by James Nestor
Free breathwork class on Zoom
By Chuck McGee
- Sunday – 11:00 am
- Monday – 9:00 pm
https://zoom.us/j/750599401
Compassion
▪ Compassion = com (with) + pati (to suffer) = to suffer with
▪ Respond with compassion vs. self-criticism (the anxiety & depression is already hard enough on you!)
▪ What is needed is a new response of understanding and empathy
▪ See the work/videos of Brene Brown
The Mindful Life -Empty Well or Wellspring
▪ The opposite of depression is expression - a key to coping is finding outlets to express oneself - talking to others or other creative outlets such as prayer, journaling or artwork
“Pain is inevitable. Suffering is optional.”
- M. Kathleen Casey
Stuck in
the
cycle of
isolation
Social Support
▪ We are the loneliest at any time in history →
39% of Americans said that they are no longer close to anyone
▪ Social support is consistently shown to decrease both anxiety and depression.
▪ 75 years of happiness at Harvard
▪ Cancer Patients live longer
Treatment for Anxiety & Depression
Psychotherapy
Cognitive-Behavioral (CBT)
Somatic Therapies
Internal Family Systems (IFS)
Therapy comes in all shapes & sizes
▪ Who’s in the room?
▪ What theory is it based on?
▪ How long does it last?
The bottom line:
The most important factor in predicting good outcome is your relationship to the
therapist.
Cognitive-Behavioral Therapy- Psychoeducation
Learning the
essential features
of anxiety and
depression & their
treatment
Mental
Emotional
Physical
Cognitive-Behavioral Therapy –A Top-Down Approach
▪ Based on the ABC Model
• A – Activating Event
• B – Belief about the Event
• C – Consequence (Feeling or Behavior)
▪ Goal is to identify negative, maladaptive thoughts and replace them with positive, realistic, more adaptive thoughts
“Men are not disturbed by things, but by the view which they take of them.”
– Epictetus (1st century B.C.)
Patterns of Limited Thinking
• Polarized (“All or Nothing”) Thinking
• Overgeneralization
• Discounting the Positives
• Personalization
• Mind Reading
• Jumping to Conclusions
• “Should” statements
Three Steps to Transformation“It’s hard to fight an enemy who has outposts in your head”
1. Identify the Negative Thought
2. Identify the Distortions inherent in these thoughts
3. Substitute a more accurate, positive and realistic thought which directly challenges the negative thought.
Somatic TherapiesA Bottom-Up Approach
▪ Somatic Experiencing (Peter Levine)
▪ Sensorimotor Psychotherapy (Janina Fisher)
▪ EMDR – Eye Movement Desensitization and Reprocessing (Francine Shapiro)
Somatic TherapiesA Bottom-Up Approach
▪ Believe strongly in the mind-body connection for all physical and mental disorders.
▪ The body is the starting point for the therapy.
▪ Identify sensations in the body
▪ Give a voice to the sensations to explore thoughts, feelings and memories.
▪ Use the body actively in coping – mindfulness exercises, weighted blanket, tapping, bilateral stimulation
Somatic Therapies –Further Reading
Bessel Van der Kolk –
The Body Keep the Score
Peter Levine –
Waking the Tiger
YouTube
Internal Family Systems Map of the Soul
Exiles
SELF
Our many parts…
The essence of who you are, often experienced as energy, being in flow
8 Core Characteristics
Self
The “Parts” of our Soul
1. Calm2. Curious3. Compassionate4. Clarity
5. Confident6. Creative7. Courageous8. Connectedness
Young, vulnerable parts that carry emotional burdens, holding onto painful memories
Exiles
The “Parts” of our Soul
Parts that run daily life, working to prevent feeling the pain of exiles
Managers
The “Parts” of our Soul –Two Protector Parts
Parts that react after a painful event to extinguish overwhelming thoughts and feelings
Firefighters
The “Parts” of our Soul –Two Protector Parts
Curiosity Compassion
Exiles
SelfHealing
inside
The
Internal
Sacred
Space
Treatment for Anxiety & Depression
Medication
Antidepressants
Anti-Anxiety Medication
Do I need to take antidepressant medication to treat depression?
- For mild to moderate depression, research has shown that treatment can be effective without medication.
- For moderate to severe depression, medication is generally recommended
Answer:
This is not what they said on TV or in Newsweek…
Pathways of Recovery
Medication to restore
chemical imbalance
improves thought process
increases healthy
behaviors
Reduced
Depression
increases healthy
behaviors
Therapy to improve thought process
restores chemical
imbalance
Reduced
Depression
How do I know if I need medication?
Consider medication if your anxiety or depression is causing any of the following, and are not able to be managed by the lifestyle adjustments
Interference in completing activities of daily living, including work, school, relationships, self-care
Energy level significantly affected
Sleep disturbance
Acute symptoms – Suicidal thoughts, Panic Attacks
Medication
The good… The not so good…
Stabilizes some of the
symptoms of anxiety &
depression
Doesn’t address the issues
which led to the anxiety or
depression
Helps restore brain
chemistry (biology)Brings side effects (biology)
Regulates mood and
anxietyDoesn’t cure
It’s a tradeoff
Antidepressant Medication
➢Antidepressants are the 2nd most popular medication prescribed in the U.S.
➢Usage increased 29% in the decade of 2000 – 2010, and has continued to increase since.
➢Percent on Antidepressants in the past month:
➢Women: 16.5%
➢Men: 8.6%
➢1 out of 4 people on Antidepressants have been on them for over 10 years.
Multiple Chemical Messengers Implicated
DEPRESSION
Serotonin
Norepinephrine
Dopamine
What about Supplements?
▪ Supplements can be helpful – consult a practitioner before starting
Example: St. John’s Wort
▪ Herbal remedy from a yellow flowering plant indigenous to Europe
▪ Used more frequently in Europe than US –most common treatment in Germany
▪ May be effective for milder levels of depression
Medication – Anti-Anxiety
▪ Benzodiazepines
Alprazolam (Xanax)
Clonazepam (Klonopin)
Lorazepam (Ativan)
Diazepam (Valium)
▪ Fast acting agents
▪ Affect GABA receptors
▪ Potentially addictive
▪ Used by 11% of middle-age women & 5.7% of middle-age men
Thank You!