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Posts Tagged ‘
therapy ’
Introduction
Social workers can be instrumental in helping people control their anger problems. Over the years, in my practice many individuals have attended 10-week group therapy sessions. They each have their own stories, but they each have paid a heavy price for their anger.
The were many reasons why someone might seek anger management therapy:
- Committing violent acts.
- Verbal abuse and short temper causing problems in a marriage.
- Problems dealing with one's in-laws.
- Court mandated anger management therapy resulting from neglect or abuse of one's children.
The goal of anger management is not to eliminate the anger, but to use it as a signal that there is a problem or issue that needs to be addressed. Individuals in the group are taught how to slow down their arousal when angered, so that it can be processed and acted on in a proper way without the negative consequences when it is uncontrolled.
Often anger is secondary to other emotions like hurt, loss and disrespect. It is important to figure out what these underlying feelings are if a proper solution is to take place.
There are many triggers that can set off anger episodes. When anger is intense our ability to think is hampered. We often react immediately and worry about the consequences later. This can be dangerous and can make us feel ashamed and guilty later. Many times old immaturities from our childhood can be triggered. Reacting in anger just keeps us stuck in the past and decreases our ability to mature. Knowing what triggers anger can be useful so that we can attempt to avoid those triggers, or learn better coping skills to deal with them.
An important aspect of anger management is to replace aggressive action with assertive action. Many people in the group are very confused about what effective assertiveness is like. Many have made anger a habit and cannot understand that conflict can be dealt with in a win-win scenario that is the hallmark of being properly assertive.
The group is taught how to discuss things verbally with others, and to use "I" messages in order to express to others in a non-offensive way what is bothering them.
Members of therapy groups are often asked to complete homework assignments. There are readings that they have to do as well. Early on they are asked to complete an anger management plan for themselves so they can pinpoint what they need to work on. Plans are then revisited at the end of the group. The group members are also asked to complete an anger log of weekly events in order to increase their awareness of anger, and focus on their feelings, actions and thoughts.
There is a strong emphasis in the group on understanding the relationship between thoughts and anger. Often what we tell ourselves is what we believe to be the case. When it comes to anger we usually apply very illogical or unreasonable thinking, and often very unhelpful thoughts about the situations in which we find ourselves. We often have unreasonable expectations that may trigger our anger, and sometimes make what should only be our preferences into "shoulds" and "musts". The group is taught ways to challenge their angry thinking, and replace negative talk with positive and reasonable messages that are geared towards problem solving.
Anger can be very damaging to the body. Long episodes of stress from uncontrolled anger can have very negative effects. The group members are taught skills for relaxation as well as ways to express anger safely.
Anger that is not acted upon but rather accumulated can contribute to a passive-aggressive expression of anger, or even to depression. Parts of the lessons of the group are to find ways to improve self-esteem, and to endure what is often a very stressful and hectic life. The group discusses ways to learn greater tolerance, improve empathy, and to forgive when necessary in order to let go and move on.
Other important topics for the group include domestic violence, child abuse and road rage.
A key element to the group is the mutual support that each member provides to the other. Members often make very useful suggestions to others about what has worked for them and how others should appraise or deal with a difficult situation.
Each group is unique in many ways but I always find the experience rewarding. Many times the changes are dramatic and can be very beneficial. If families can come back together and marriages can prosper and if others can be kept out of jail than it has all been worthwhile.
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Introduction
Nineteen million (or eight percent) of Americans could benefit from treatment for “an alcohol problem.” Although 2.4 million people are diagnosed with alcoholism, only 139,000 of them receive treatment with medications.
The most common form of treatment for alcoholism consists of group and/or individual therapy, including community self-help programs. Treatment can often be time consuming. For example, individuals are often encouraged to go to 90 meetings in 90 days or they are involved in structured group therapy three to five days per week at two to three hours per day. Often, people want to know, "Isn’t there a pill that can fix the addiction to alcohol?" Unfortunately, there is not a pill that can cure the addiction, but there are medications that can perhaps make it easier to effectively participate in treatment.
The Food and Drug Administration (FDA) has approved only three drugs in the past 55 years to treat alcoholism. Each of these drugs acts differently in the body to interrupt the addiction process. They are Antabuse, ReVia, and Campral.
For those with an alcohol problem, the oldest medication thought to “cure” the disease is Antabuse (disulfiram). Wyeth-Ayerst Laboratories Division first marketed Antabuse in 1948. This drug causes many unpleasant effects when the individual consumes alcohol, even in small amounts. The effects can range from facial flushing, headache and mild nausea to severe vomiting and increased blood pressure and heart rate.
The expectation is that as a person associates these negative symptoms with drinking, the individual will be less likely to want to drink another time. Usually, the threat of becoming ill after a drink of alcohol will deter most motivated people. However, the effectiveness of the drug depends mostly on the individual’s motivation for remaining abstinent.
While Antabuse will build up in the person’s system those who choose to resume drinking will simply stop taking the medication for a few days prior to consuming alcohol.
Another problem is that people have reported experiencing very mild reactions with the use of mouthwash that has a percentage of alcohol in it, foods with vinegar like salad dressings and ketchup, and certain colognes and aftershave. Your doctor should talk to you about what is best to avoid and what to experiment with in terms of over-the-counter products and medicines.
Antabuse should not be prescribed for people with cirrhosis or other chronic medical conditions, including heart disease or diabetes. Let your doctor make this decision. This drug should also not be prescribed for people over 60 years of age. Severe reactions to Antabuse have included heart attacks, and some cases have even resulted in death.
The FDA approved the use of ReVia (naltrexone) in December 1994 for the treatment of alcoholism. It was initially marketed by DuPont Merck Pharmaceutical company for treating narcotic dependency. ReVia blocks the parts of the brain that experience pleasure from drug/alcohol use.
Studies began to show that when used to assist with treating alcoholism, the drug helped to decrease cravings and relapse when it was used over a period of three to six months. The success of the drug, however, is likely dependent on a person's simultaneous involvement in a structured treatment program that can educate them on addiction, recovery, and relapse prevention behaviors.
The studies on ReVia and alcoholism treatment all occurred in settings that combined psychotherapy and psycho-education with the medication. Therefore, the FDA approved ReVia for alcoholism only as an adjunct to traditional supportive therapy. According to the FDA, “This drug is non-addictive but can cause liver toxicity if prescribed at doses higher than recommended.
ReVia is not recommended for people with active hepatitis and other liver diseases (www.fda.gov).” Side effects include nausea, headache, dizziness, fatigue, and sometimes vomiting and insomnia. This is a daily medication to be taken orally; however, a long-acting injection is being developed.
Campral (acamprosate) is the newest drug approved by the FDA to assist with alcohol abstinence. It was approved in July 2004 for marketing and distribution by Forest Pharmaceuticals, Inc. Though the exact workings of the drug are not understood, it is believed that Campral can restore imbalanced brain chemicals to a normal balance, thereby reducing cravings and thus relapses.
Campral is prescribed once someone has made the decision to remain abstinent and he/she is currently alcohol-free. The medication is most effective when combined with a structured treatment program that can teach relapse prevention skills, or provides social support, such as community self-help groups.
Campral has been used in Europe for over 10 years and has been shown to be useful for individuals with mild to moderate liver problems. Side effects have been reported as diarrhea, fatigue, nausea, gas, and itching. The most common side effect, diarrhea, usually resolves with time.
In all cases, a primary care physician or psychiatrist can prescribe and monitor the medications. Also, in all cases the recommendation is to use medication as a part of a comprehensive plan for treating addiction. The person with an alcohol problem should be willing to participate in some sort of supportive treatment program, ranging from community self-help groups like Alcoholics Anonymous / Narcotics Anonymous, Rational Recovery, etc, to a structured treatment program involving a combination of group and individual therapy and education. Recovering from addiction involves a lifestyle change. The medications can only assist in making the changes easier by reducing cravings and/or drinking behaviors so that you can focus on recovery.
Sources and Recommended Websites:
www.addictionrecoveryguide.org
www.fda.gov
www.medscape.com
www.niaaa.nih.gov
www.nida.nih.gov
Forest Pharmaceuticals, Inc. Campral Brochure. 2005.
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| Knight Ridder Photo |
Charles Ryder tosses a bean bag from
hand to hand as part of his non-drug
ADD therapy at a Schaumburg,
Ill., treatment center.
|
Introduction
When Charles Ryder was finally diagnosed with adult attention-deficit disorder at age 25, his doctor immediately started him on the medication Strattera. For the first time since childhood, Ryder's focus partially improved.
But Ryder didn't feel like himself when he took the drug. He also hated putting a chemical into his body, especially one that now comes with federal warnings about increased suicide risk in younger populations.
In his quest for a holistic alternative, Ryder tapped into the burgeoning market on the Internet of largely unproven non-drug treatments for ADD, therapies that range from special diets and supplements to biofeedback and spending time in nature. Now, every six weeks, the father of two girls drives seven hours from his home in Traverse City, Mich., to a Dore Achievement Center in Schaumburg, Ill., where he learns simple balance and coordination exercises designed to stimulate part of his brain.
‘‘I definitely notice a difference,'' said Ryder, who sees too much of himself in his easily distracted 4-year-old daughter and will likely start her on the Dore program. ‘‘I used to feel like I was always in my own world. My mind was always in so many other places. I didn't know if I was stupid or what the problem was, because I could excel in other things.''
Symptoms of ADD
Untreated, ADD's hallmark symptoms of hyperactivity, impulsivity and inattention can have serious consequences. Studies have shown it doubles the chances of being arrested, divorced and to have held six jobs or more in any 10-year span. Untreated ADD also has been shown to affect self-image and hurt on-the-job performance.
Psychostimulant medications, in conjunction with behavioral therapy, are considered the most effective way to treat ADHD, largely because drug companies have the money to fund clinical trials. However, not only are the long-term effects of medication unknown, but the most common one, methylphenidate (Ritalin), is in the same class as cocaine, morphine and amphetamines, all drugs that carry the potential for abuse.
But now there's no shortage of complimentary or alternative treatment methods that can be used either in conjunction with drugs or on their own.
Alternative Therapies
Most alternative ADD therapies offer only anecdotal, rather than scientific, evidence of success. But experts say a good rule of thumb is if it's safe, you believe in it and it's good for you anyway, it's worth exploring.
‘‘Just because it hasn't been in a (rigorously controlled) study doesn't mean it's worthless,'' said Edward Hallowell, who discusses alternative treatments for adults in ‘‘Delivered From Distraction'' (Ballantine Books, $25.95). ‘‘On the other hand, you have to watch out for inflated claims. People have turned ADD into a little industry.''
Enduring controversies such as the effect of sugar on behavior in children, the use of electroencephalography (EEG) biofeedback and the efficacy of eliminating artificial food additives, colors and/or preservatives have been well studied. But they lack support as effective sole treatments for ADD, according to a published study by researchers Neal Rojas and Eugenia Chan at Children's Hospital in Boston.
But the researchers also found that early evidence for therapies such as essential fatty acid supplementation, yoga, massage, homeopathy and green outdoor spaces ‘‘suggests potential benefits as part of an overall ADHD treatment plan.''
Chicago social worker Laurie Walsh believes the best core treatment is ‘‘individual and group support, diet, exercise, medication and counseling. If one falls down you have four other areas to hold you up,'' she said.
Do You Have ADD?
Everyone fidgets, lacks concentration and has impulsive outbursts at some point in life. So how do you know whether you're suffering from a case of modern life or attention-deficit disorder? There is no definitive test. But the Adult Self-Report Scale, or ASRS, is a screening tool that was developed in conjunction with the World Health Organization. Experts have found that 80 percent of the people who score positive on the ASRS will have ADD when a full evaluation is done.
These six questions will not tell you whether you have ADD, and beware of any written test that promises a diagnosis. But if you find yourself answering ‘‘sometimes'' or ‘‘often'' to at least four questions, it's a sign to consult your health-care provider.
- How often do you have trouble wrapping up the final detail of a project, once the challenging parts have been done?
- How often do you have difficulty getting things in order when you have to do a task that requires organization?
- How often do you have problems remembering appointments or obligations?
- When you have a task that requires a lot of thought, how often do you avoid or delay getting started?
- How often do you fidget or squirm with your hands and feet when you have to sit down for a long time?
- How often do you feel overly active and compelled to do things, as if you were driven by a motor?
Assessing Alternative Treatment Options
Whether you're on medication or not, support groups are a key, but often overlooked, part of ADD treatment.
‘‘We've gone through life feeling misunderstood and all alone,'' said a 44-year-old father from Naperville, Ill., who withheld his name to protect his 14-year-old son, who also has ADD. ‘‘When you go to these support groups, you feel like you belong. It allows us to embrace the positives.''
Here's a look at some other non-drug treatments that can be used as part of a multifaceted plan that may or may not include medication.
ADD Coaches
A life coach with special training (but not a therapist) who can come to your home or work with you by phone on quality-of-life issues.
Pros: Many coaches recast ADD as a gift, rather than a disorder, and help clients identify their positive characteristics and strengths. Coaches can focus on improving executive functioning skills, such as planning, organizing and prioritizing.
Cons: No quality control. Anyone can claim to be an ADD coach. Even ‘‘licensed'' coaches can be self-licensed. Try to get a referral from someone who had a good experience. Also, be wary of the prices. Most coaches should be around $60 a session. Beware of coaches charging $150 to $200 a session, but pay something so you take it seriously and don't blow it off. One resource is the ADD Coach Academy (www.addca.com ).
Biofeedback
Used for decades, biofeedback allows people to increase brain-wave activity through training. One company, Play Attention ( www.playattention.com ), uses an EEG biofeedback-based system (the patented name is ‘‘Edufeedback'') that attempts to form new neural networks.
During each session, the user wears a helmet equipped with sensors that record theta (daydreaming) and beta (focused) brain-wave activity.
The video-game-like interface coaches ADD subjects through tasks designed to maintain concentration for a certain period. For example, the screen might show a bird flying through the sky. A loss of concentration would cause the poor bird to fall. A live ‘‘coach'' could be present to give instruction encouragement and verbal feedback.
Pros: Biofeedback has been used for conditions including seizure disorders, mood disorders and ADD for the last 30 years. The evidence shows biofeedback is ‘‘probably efficacious,'' according to a June study in the journal Applied Psychophysiology and Biofeedback.
Cons: The knock against biofeedback has always been that the benefits likely vanish once you unhook yourself from the machine. It's also expensive and time-consuming. Hourly fees at freestanding Play Attention ‘‘learning'' centers can range from $35 to $250, and about 40 hours of training (two hourlong sessions per week) is recommended.
Brain Exercise and Movement
The Dore Achievement Centers (www.dorecenters.com ) use what they call ‘‘cerebellar stimulation.'' The cerebellum, a clump of neurons in the back of the brain, has long been associated with balance and coordination. The Dore theory, which is still being researched, asserts that the cerebellum is underdeveloped in those with ADD. Dore clients might balance on a wobble board, toss a bean bag from one hand to another while sitting on a Swiss ball, or move the eyes from side to side to stimulate the cerebellum.
The idea is that the exercises will help build correct neural pathways and improve frontal lobe performance.
A similar technique, used by The Brain Gym (www.braingym.org ), works to ‘‘develop the brain's neural pathways through movement.''
Pros: Though skeptical at first, psychiatrist Dr. Edward Hallowell, director of the Hallowell Center for Cognitive and Emotional Health, put his son Jack through the Dore program and says the founders deserve credit for ‘‘developing an innovative method of tapping into the untapped power of the cerebellum.'' Both methods are enjoying anecdotal reports of success.
Cons: More research is needed. The Dore method is ‘‘essentially a combination of physical therapy and occupational therapy,'' said psychology professor Robert Resnik, author of ‘‘The Hidden Disorder: A Clinician's Guide to Attention Deficit Disorder in Adults.'' ‘‘You wonder about the placebo effect,'' he said. ‘‘I think it's a gimmick.''
Fatty Acid Supplementation
Fatty acids, which are essential for brain development, maintenance and function, are mainly found in fish oils. Omega-3 fatty acids suppress inflammation and have been shown to be useful in treating adults with depression and bipolar disorder. Studies also show fatty acids promote the body's production of dopamine, which could be good for those with ADD.
Pros: Excellent safety profile. In this age of fast and processed foods, they should be part of your diet anyway. Humans can't make fatty acids; they must be consumed through diet.
Cons: Evidence on its success with ADD is mixed. Also, not all fish oil is created equal. Fresh fish oil capsules should taste fresh; if you're experiencing unpleasant burping and foul taste, look for a brand with quality control, like Nordic Naturals.
Green Outdoor Spaces
Some studies have shown that children were more able to concentrate, complete tasks and follow directions after spending time in natural, especially green, settings, according to psychologist Lara Honos-Webb in ‘‘The Gift of ADHD'' (New Harbinger Publications, $14.95). Camping, fishing or playing soccer outside were all considered green activities.
Activity alone couldn't explain the findings, because ‘‘playing basketball in paved surroundings didn't result in the improvements in concentration that even passive activities in green settings did,'' Honos-Webb wrote. Still, other studies contradict this to some extent.
Pros: Getting some outside exercise is good for you anyway, whether you're trying to treat attention deficit or another modern malady: obesity.
Cons: Not enough research to prove whether it works as a sole treatment.
Nutrition
Three primary dietary inventions are used to treat ADD: the Feingold (additive free) diet, the oligoallergenic/oligoantigenic (few foods) diet and sugar restriction.
Feingold asserted quite controversially in 1975 that the increase in learning disabilities and hyperactivity was related to an increase in the use of artificial flavors and colors. Overall, the science is still lacking, but recent studies focusing on behavior effects of artificial colors and preservatives suggest that some children (not necessarily those with ADD) might have sensitivities, according to Neal Rojas and Eugenia Chan of Children's Hospital Boston.
Others have taken Feingold's theory and eliminated not only additives and dyes but also sugars, dairy products, wheat, corn, yeast, soy, citrus, egg, chocolate and nuts.
Pros: Diet modification can offer a sense of control and help promote a healthy lifestyle. Some foods do exacerbate the condition, and food allergies are underdiagnosed. Anecdotal evidence is strong, especially among families who removed gluten and dairy products. It never hurts to eliminate refined sugar from the diet.
Cons: Elimination diets are notoriously hard to stick to, especially if other family members aren't in the same boat.
Quality-of-Life Improvements
Get daily physical exercise, join support groups, avoid foods with trans-fatty acids (often hidden on labels as partially hydrogenated oils) and get some sleep. Israeli researchers found that treating sleep disorders in children can lead to a significant reduction of ADD symptoms and improved cognitive performance levels.
Yoga and meditation have also been shown to be excellent adjunct therapies.
Pros: ‘‘Exercise can't hurt, but if you have ADD you need it tenfold,'' said social worker Laurie Walsh of Insight Employee Assistance Provider. ‘‘Even if it's just 10 minutes to help you release chemicals. You can regain focus without needing medication.'' We should all be doing these things anyway.
Cons: None.
©1996-2006 The Pueblo Chieftain Online
Reprinted with permission of The Pueblo Chieftain
Tags: ADHD, adult, alternative, attention-deficit disorder, chieftan, medication, pueblo, therapy
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Introduction
It is never too late to stop using tobacco. Quitting tobacco has several benefits, including psychological, health, and financial benefits.
For example, psychologically, quitting tobacco can boost a person's sense of self-esteem, self-confidence, and self-control. This can result from learning more effective ways of coping with stress and negative moods, and from knowing that you are able to live without tobacco. In addition, quitting tobacco also provides immediate and long-term improvements in health. The following is a timeline list of some benefits to look forward to when quitting tobacco.
Health Benefits
- 20 minutes: Blood pressure and heart rate drop
- 8 hours: Carbon monoxide levels drop to normal
- 24 hours: Decreased risk of heart attack
- 48 hours: Improved ability to smell and taste
- 72 hours: Lung capacity improves
- 3 weeks to 3 months: Circulation and lung function improves
- 1 year: Risk for sudden heart attack cut in half
- 5 years: Risk of stroke begins to reduce to level of non-smoker
- 10 years: Decreased risk of cancers including lung, mouth, throat, esophagus, bladder, kidney and pancreas
Financial Benefit
Tobacco has become increasingly costly due increased prices from tobacco companies and the raising of taxes by government agencies. Quitting saves money also by avoiding the financial burden from treating tobacco related illnesses. Insurance rates for coverage are often lower for former and non-smokers.
The Difficulty of Quitting
Most tobacco users make multiple attempts to quit. Many are surprised at just how difficult it is to stop using tobacco. In fact, for most people, quitting will involve a strong level of commitment and determination. Even with smoking cessation medications and counseling, quitting is hard work. The good news, however, is that today there are resources that provide a picture of the road ahead, help in identifying possible obstacles, and suggestions on coping with setbacks
To begin, it may help to understand that there are two important sides to quitting tobacco: 1) the physiological addiction to nicotine and 2) the behaviors associated with tobacco use. Tobacco users can prepare for and increase their success in quitting by learning more specifically what to expect and how to cope with withdrawal from nicotine and how to identify and change the behaviors associated with tobacco use.
The use of smoking cessation medications (described below) in combination with tobacco cessation counseling can be helpful in the first months to reduce withdrawal symptoms and the chances of relapse. In fact, the combination of pharmacotherapy (using medications) and counseling is considered the most effective approach for tobacco cessation.
Withdrawal
Initially, the most difficult aspect of quitting is coping with the immediate withdrawal symptoms of negative moods, urges to smoke or use, and difficulty concentrating. After a few weeks, the immediate symptoms associated with the depletion of nicotine in the blood decrease. After a longer period of abstinence, withdrawal symptoms can be triggered by the behaviors associated with tobacco use. The potential symptoms of withdrawal can be described as falling into physical, psychological/emotional, behavioral, and social categories.
- Physical withdrawal from nicotine typically peaks 1-3 weeks after quitting and symptoms include sleep disturbance, cravings, increased appetite, fatigue, tenseness, decreased heart rate, coughing (clearing lungs), stomach disturbance, throat irritations, dizziness, light-headedness.
- Psychological and emotional symptoms include poor concentration, drowsiness, mental confusion, depression, irritability, aggression, restlessness, distraction, anxiety/fear, pining, longing, lower stress tolerance, pain of separation, negative mood, anger, anxiety, and depression.
- Social symptoms include possible loss of confidence, loss of self-esteem, sense of vulnerability, and loss of control over discomfort in social situations.
- Behavioral symptoms include disorganization, preoccupation with thoughts of tobacco, tobacco, a compulsion to talk about tobacco, unconsciously reaching for tobacco when it isn’t there, and a feeling of restlessness.
Recognizing, understanding, and learning to cope with withdrawal symptoms are all important strategies for maintaining long-term abstinence and avoiding relapse.
Chemical Dependency, Psychiatric Disorders, and Tobacco Addiction
The majority of tobacco users who have already quit, have quit without seeking outside or professional help. This fact often leads to the false notion that quitting is only a matter of will power. There are important factors that can determine the success rate of quitting tobacco and a person's chance of relapse without professional or outside help.
A history of psychiatric disorders, history of chemical dependency, and limited access to resources in the community can affect the strength of tobacco addiction. The more tobacco plays a vital role in coping with mood and daily functioning, the more difficult it will be to learn to live without it.
Because nicotine increases positive mood and decreases negative affect like anger, tobacco is often a form of self-medication for individuals suffering from depression. And it is not uncommon for tobacco users to recover from alcohol dependence, only to suffer from poor and deteriorating health from smoking.
By finding the right combination of support, an addiction to tobacco can also, if needed, be effectively treated simultaneously with psychiatric and other chemical dependency disorders. The use of smoking cessation medications, counseling to identify and change behaviors, and social support are all important components in the treatment of tobacco addiction for individuals with a history of mental disorders and substance use problems.
Pharmacotherapy for Tobacco Cessation
Medications for tobacco cessation include Bupropion and Nicotine Replacement Therapy (or NRT). It is important to consider taking medications as an aid to quitting tobacco. Nicotine Replacement Therapy is not safe for everyone. There are exceptions, such as having a history of health concerns or conditions. Therefore, it is important to see your physician for evaluation for prescription drugs and to discuss the safety of available over-the-counter medications.
With those cautions in mind, for most people treating tobacco addiction with medication is safe and effective, and increases the chances for long-term abstinence. The following is a list of "first-line" medications approved by the U.S. Food and Drug Administration (FDA) for use in smoking cessation.
Non-nicotine Medications: These medications help reduce the urge to smoke.
- Bupropion SR (also known as Wellbutrin) is a non-nicotine drug that has been approved since 1997 as an aid to smoking cessation. Bupropion SR is also used as an anti-depressant and is available by prescription.
Nicotine Replacement Therapy: These medications help relieve withdrawal symptoms.
- Nicotine gum is available over-the-counter. The gum is chewed and then "parked" in the side of the mouth between the cheek and gum. Nicotine passes through gum tissue into blood vessels.
- Nicotine inhaler is available by prescription. The nicotine is inhaled into the mouth, not the lungs.
- Nicotine nasal spray is available only by prescription. Nicotine is delivered by pumping the spray into the nostrils where it is absorbed through the nasal membranes.
- Nicotine Patches are available over-the-counter and by prescription. Patches are worn and replaced daily or are removed at night.
- Lozenges are available over-the-counter and are the most recent NRT product to be approved by the FDA. Nicotine is absorbed through the mouth.
Keep in mind that the effectiveness of smoking cessation medications increases when used in combination with a tobacco cessation program that addresses changes in behavior.
References:
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Introduction
There are more and better treatments than ever before for schizophrenia, even though it has historically been one of the most difficult mental illnesses to treat. The result is that more and more individuals are recovering with the help of treatments that focus on the biological, psychological, and social aspects of their illnesses. Most individuals with schizophrenia today are able to live in and participate in the community. Helping them figure out what they need to do to accomplish this is something with which social workers can help.
Medications are almost always called for as a part of treatment, but for a full recovery it is equally important for most individuals to also participate in other types of treatments. Individuals with schizophrenia should see a psychiatrist so that they can decide together what medications are appropriate and at what doses, but medications are only one part of a comprehensive treatment program. A counselor or therapist should also be consulted to help decide what types of psychosocial treatments could be helpful. Depending on each individual's different challenges with his or her illness, different treatments may be more appropriate at different times. A person, for example, may want to begin treatment with individual and group therapy, gradually transitioning to more of one than the other. Once he or she has the most pressing symptoms under control, vocational rehabilitation may also become useful.
Some treatments that have been consistently shown to be effective for people with schizophrenia include:
Individual therapy is an important opportunity for an individual to talk about struggles dealt with as a result of having schizophrenia—or struggles with life in general. Social workers are trained to take a broad perspective of what different factors might be contributing to a person's struggles. He or she can help problem-solve, and help teach coping mechanisms for dealing with the various challenges involved in going through life. An important note though, is that psychoanalytic therapy, which explores problems and experiences a person may have had as a child, is most often not recommended for individuals with schizophrenia. Rather, individual therapy should focus on issues and concerns that an individual has experienced since first developing signs of schizophrenia, and how to address those problems. Having a non-judgmental individual, with whom one can confidentially share private concerns and problems, can be quite helpful when working towards recovery.
Family therapy can be very important for individuals who have contact with their families. This is usually not done in private therapeutic sessions in which the consumer and their family member(s) sit and talk with a therapist. Rather it is most often done in group settings, where family members talk with family members of other consumers. The consumers themselves may or may not also be a part of the group, depending on how a specific group is designed. Participants are educated about the illness, what to expect from a family member who has the illness, and how they can best help. There is also a strong focus on how to take care of oneself when caring for an individual with a chronic mental illness. This is because having a family member with schizophrenia can at times be very challenging, due to the need to cope with symptoms. Learning to care for oneself while helping someone else can reduce possible stresses created by being a caregiver, and can help foster better and healthier relationships between those involved. This in turn can help the individual with schizophrenia reduce the stress in his or her life, enabling him or her to focus time and attention on other aspects of life.
Vocational rehabilitation and/or educational assistance are often very important for an individual with schizophrenia. In most cases, the onset of an individual's schizophrenia happens at such a time as to disrupt their high school or college education, or it disrupts their entrance into the workforce. Once they have become stabilized, they have often missed one or more years in which they would otherwise have been furthering their education and/or their work resumes. Furthermore the illness, and sometimes the medication side-effects, make it more difficult for an individual with schizophrenia to learn or complete tasks than other non-afflicted individuals. Vocational rehabilitation and/or educational assistance can help an individual learn to compensate for these challenges. This can help individuals with schizophrenia to complete their educational objectives, and to hold a job in which they want to work. Having a job that one wants to do and enjoys is important for everyone, but having such a job can be particularly rewarding for someone who struggles with the problems associated with having schizophrenia.
Group therapy has been shown to be effective for many different problems that a person might experience in life, and there is no exception for individuals with schizophrenia. This therapy may not even focus specifically on schizophrenia, but rather on whatever concerns group members feel are important. Topics can include most anything, so long as they are respectful and appropriate. An important benefit of group therapy is that it helps individuals to not feel alone in their struggles. Hearing how others have struggled and coped with problems similar to one's own can be much more meaningful than discussing problems and struggles with people who have not had similar experiences. Sharing experiences can also be therapeutic and even cathartic for individuals who share. Not each group is appropriate for each person, however. Depending on the facility and resources available, there will usually be more than one group in which a person may participate. For example, one person may feel more comfortable in a group of younger adults, who might discuss concerns about growing up. Another individual, however, might feel more comfortable in a group with a slightly more mature age-range, where people might be talking about issues of working and living independently. Still other groups may have more specific foci, such as women's and men's groups. Each person should talk to a counselor about what group(s) and how often he or she may be interested in joining.
Assertive Community Treatment is a treatment model recommended for individuals who have repeated hospitalizations, or who have a particularly difficult time functioning in the community on their own. A team of providers is created to serve a group of consumers. The team should have at least one psychiatrist, social workers, and other mental health professionals. These professionals, including case-managers, work as a team instead of each person only having responsibility for their specific consumers. This team should also be able to go into the community and reach out to consumers, if needed, instead of waiting for consumers to come to a clinic. Such programs are expensive, however, and so usually only modified versions are available.
For most individuals, a case manager can help them learn to handle most of the day-to-day challenges associated with having schizophrenia. The case manager can act as a counselor with whom one can talk regularly, they can help a person learn how to access services through public/private systems, and they can help communicate with other providers to ensure that everyone works together. Most mental health centers that provide case management services offer different levels of service intensity that a person may obtain, depending on their need. Some consumers may only need a check-in once per month, whereas others may need some contact several times per week.
Each individual is unique, and has unique needs. Different cultural, spiritual, and other considerations are always important when deciding what types of treatments are right for an individual. Having an individual care plan can provide a framework for how best to obtain and provide for an individual's unique needs, and developing this plan with a knowledgeable professional can help ensure that it is comprehensive. Too often individual needs and differences are left out of consideration in our country's mental health systems, and doing so can hinder an individual's path to recovery. Make sure that your needs, or the needs of someone you care about who has schizophrenia, are heard and addressed in an individualized treatment plan.
It is critical to get diagnosed and to obtain treatment as early as possible. The earlier an individual is treated, the better their chance will be of having a complete recovery. Some researchers have even suggested that an early enough intervention may keep a person from ever having to experience a full-blown psychotic episode. If you suspect that you or someone you care about may have or be developing schizophrenia, seek help from a professional, who can help determine what treatments and services may be helpful.
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NOTE: This essay from the book The Power of Story was written by social worker Bonnie Collins, EdM, CSW-R.
Introduction
Therapy with this couple began in an ordinary way. I made certain assumptions right away. It was the wife (as usual) who called for couples therapy, and (as usual) she wanted to bring her husband in since “he is the one with the problem.” I’d been doing couples therapy for a long time, and I took pride in my ability to predict the needs of people even during their first phone call. This case, however, was designed to keep me humble. The woman seemed no different from many who had called. She wanted better communication between herself and her husband. She said he was withdrawing from her; they never talked anymore; or when they did, it was an argument. Their sex life was nonexistent, and there was no joy in their life together.
As usual, I invited them to an initial session and asked them to bring a definition of the problem as both of them saw it along with a list of the strengths in their relationship that might help them deal with the problem.
They arrived at the appointed time, and I found them in the waiting room where they had been silently staring into their coffee cups with an intensity that allowed them to avoid seeing each other or any one else in the room.
Ann was in her early 30s with short curly hair and sunglasses perched on the top of her head. She had big eyes and tanned skin, which, in combination with her high cheekbones and white teeth, gave her a healthy, pretty look. She sat with her long legs crossed under a flower print skirt and looked up with an open smile as I entered the room.
Jack looked older than his wife, perhaps in his 40s. He, too, was good-looking and athletic. He was neatly dressed in khakis and sneakers topped by a black tee shirt. He did not look up as openly as his wife did but instead scanned me quickly as if he were looking for trouble.
First Impressions
My first impressions of new couples are an important part of the therapeutic process for me, and I always make note of them. Intuitively, I felt their lack of connection to each other as well as her eagerness to give this process a try and his resistance, which I’ve learned over the years, is really self-protection.
This impression was confirmed further as she stood, introduced herself, and reached to shake my hand. He remained seated and simply nodded his head in my general direction as she introduced him to me. I smiled at each of them and extended my hand to him. He shook it reluctantly and rather weakly. I offered them more coffee, which she declined and which he took readily, almost as though he wanted to delay the beginning of a process for which he wasn’t quite ready.
I then ushered them into the therapy room and suggested that they sit wherever looked most comfortable to them. They chose to sit in chairs opposite each other rather than on the couch, where they might be physically closer.
At this point I always offer my clients a moment of silence to let them get settled and adapt to a new environment. I busy myself with paperwork but watch what each of them might do with his moment. In this case, Ann used it to settle in a chair and then to fuss with her skirt, her hair, and her position in the chair. Jack, on the other hand, continued the behavior he began in the waiting room, which was to study me further and scan the environment. I watched him survey the room, appearing to take in all the details as if he here checking for defects or looking for danger.
As I took my seat I went to work trying to make them feel as comfortable as possible in a setting that often provokes anxiety. Ann warmed to my attempts immediately by sharing with me how much she loved her husband though he was not himself these days. She explained that he was tense, short-tempered, and withdrawn when he was not jumping down her throat. As she spoke of these worries, Jack braced himself as though he was being attacked.
The Breakthrough
When I turned to him to draw him into the conversation and get an idea of how he saw the marriage problem, my paperwork fell out of my lap. As Jack described the problem, stating that his wife was making mountains out of molehills, I reached down to pick it up and glancing at it briefly, saw that I had written during the intake that he was a Vietnam veteran. I began to study this man more intensely and saw a much younger face than the one actually looking at me.
In its place, I saw a young soldier in an awful war. And then I thought of my two sons, twelve and fourteen years old at the time, who had no idea what war might be like. It occurred to me that it was because of this man and men like him that maybe, just maybe, my sons would not have to go to a strange place and fight with little understanding of what they were fighting for.
This thought was so powerful my eyes filled with tears. I felt such deep gratitude for what this man had done that I stopped him in his defense of his role in his marriage and said, “I know what I am about to say has nothing to do with why you are here today; or maybe it has everything to do with why you are here today; but I just want to thank you for going to war in defense of us, your fellow citizens. I hope that because of you and those like you that my sons will not have to be soldiers. Thank you for trying to make this world a better place in which to live.”
He stared at me and burst into tears, sobbing as I have never heard anyone sob except in moments of deep grief. I waited with tears in my own eyes; looking at Ann, I realized she was quietly crying too. We all sat in our individual sadness for a long time. Finally, Jack spoke up. With softened features, he gazed directly into my eyes with a look that touched my soul and said, ‘No one has ever expressed a ‘thank you’ for what I went through over there. All I came home with was nightmares, flashbacks, guilt and an addiction to any substance that would numb the pain and help me avoid what I did to survive a war I didn’t understand. To even begin to contemplate that I might have done something worthwhile over there seems impossible, but to think I may have prevented the next generation of boys from having to experience war helps give meaning to what I had to do. I thank you from the bottom of my heart.”
He reached over and grabbed my hand with a touch that communicated his gratitude even more than his words.
How to go on? He took care of that too. He reached for his wife, and they stood and hugged each other with such intimacy that I left the room. I waited in my own waiting room for them to leave the privacy of their connection to each other. They greeted me with smiles and thanked me for such a healing session. They scheduled their next session for the following week and left holding hands.
I went home and hugged my boys with tears in my eyes. At twelve and fourteen, they were naturally a bit resistant to this emotional demonstration of affection.
A Happy Ending
The following week I got a phone call from Jack canceling their next session. He said, “I really wanted to come back because you helped me feel so much better about myself, but it is because I feel so empowered that I have no more nightmares. My wife and I have renewed our sex life and are talking so much our kids can’t get a word in edgewise. I will always remember your honoring of me, and I will try to live the rest of my life as though I earned that honor.”
So much for “therapy as usual!”
“A Mother’s Thanks” is chapter from the book The Power of Story: A Process for Renewal for Therapists who Treat Trauma, by Bonnie J. Collins, EdM, CSW-R, and Trina M. Laughlin, CSW.
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Introduction
Putting on make-up. Looking in the mirror. Brushing teeth. Combing hair. Billions of people worldwide perform such mundane tasks everyday without experiencing any significant distress. Suppose, however, you see your reflection in the mirror and feel a sense of disgust about your appearance. You feel you look so awful that to go out in public seems too overwhelming, too frightening. Having a relationship feels nearly impossible, and being able to concentrate well enough to perform on the job or at school is a daily challenge. As a result you become nearly housebound, depressed, and have thoughts of suicide. It is at that point that you may feel like millions of others who have body dysmorphic disorder, also called BDD.
Sarah is a 23-year-old woman who believes she has had BDD for the past eight years. When she was 15-years old she began obsessing over the shape of her nose. She had plastic surgery at 18. Two other reconstructive nose surgeries followed because she was unhappy with the results. Although many men her age feel she is attractive and often express interest in her, Sarah has stopped dating, and now rarely even goes out with her girlfriends. Obsessions over her skin and her cheekbones have also surfaced, and she has also sought consultation to have those perceived "flaws" corrected with surgery. She continues to use multiple skin care products to cover minor acne scaring, and is exploring the possibility of a cheek implant to correct what she believes to be an asymmetric appearance of her cheekbones. She has had several bouts of major depression, and has admitted herself on two occasions to a psychiatric hospital because she was seriously considering committing suicide, and she suffered one overdose of her anti-depressant medications.
As many as three to five million people in this country are believed to have BDD. It is known to affect men and women equally, and the most likely age of onset is during the early teen years. If BDD is believed to be so common then why aren't more people familiar with it?
First, since many BDD sufferers experience tremendous shame over their appearance, they may choose not to reveal their concerns to anyone, including their therapist. Second, they may first pursue dermatologic treatment or plastic surgery, not recognizing that what may be wrong is more psychological than physical. And even when they do seek psychiatric care, they may pursue treatment for the depression, anxiety, and functional impairments which have resulted from the disorder, rather than treatment for the disorder itself. Lastly, many psychotherapists and physicians remain unskilled in assessing for the presence of BDD.
While the focus of a person's BDD can be any part of the body, the most common areas of focus are the head and facial features. Skin, hair, and the nose are the body parts most often of concern. Other areas, however, can also be the focus, such as weight, stomach, breasts, eyes, thighs, and teeth. If the concern is skin, the fear may pertain to skin tone and wrinkles, with hair it may pertain to thinning, and with the nose the concern may pertain to it being misshapen.
BDD involves much obsessional thinking over the body part, to the point where someone may obsess over it for hours each day. There are also numerous behaviors which may suggest the presence of BDD, such as mirror checking or mirror avoidance. Checking of one's reflection, however, doesn't have to stop with mirrors, as many other objects have reflective surfaces. These may include glass picture frames, store windows, and even watch faces.
In addition, people with BDD often engage in "camouflaging," which refers to attempts to try and mask the body part, such as with the excessive use of make-up if the concern pertains to the skin, or wearing a hat if the fear is associated with hair.
Many people with BDD also will compare their body part(s) to those of others, such as friends, family members, or people in the public eye.
Excessive grooming can be another problematic behavior, whether it pertains to combing hair, shaving, or putting on make-up. Touching the body part, and skin picking are also fairly common as well. In an attempt to correct the supposed "flaw" someone may pick at their skin to try and remove a blemish, for example. Unfortunately, this often may result in exacerbating the situation instead of improving it. Reassurance seeking is also a frequent behavior, though typically this results in only temporary relief at best.
As indicated above, seeking unnecessary medical appointments and procedures can be another troubling behavior. Dermabrasions, breast surgery, and rhinoplasties are among the most frequently sought procedures.
Muscle dysmorphia is a form of BDD believed to affect mostly men who believe that their body build is too small. As a result, they may engage in excessive exercise, and in the use of supplements and steroids at potentially dangerous levels.
It is critically important to recognize that BDD rarely exists without the existence of other psychiatric disorders. Major depression and social phobia are quite common, as are suicidal thoughts. In fact, it is believed that as many as 25 percent of those with BDD have made suicide attempts. Given this figure, the risk of suicide may be greater in BDD than in any other psychiatric patient population.
A combination of medication and cognitive-behavioral therapy (CBT) is widely regarded as the best treatment approach for the vast majority of patients with BDD. When medications are prescribed, the first line approach is usually with the anti-depressants in the class known as serotonin reuptake inhibitors, such as Celexa, Lexapro, Luvox, Paxil, Prozac and Zoloft. (The drug Anafranil, a tricyclic antidepressant, also acts on serotonin and is effective in treating BDD.) The use of cognitive-behavioral therapy to confront maladaptive thought patterns, and the many problematic behaviors is equally as important.
Cognitive Behavioral Therapy is used to encourage clients to recognize the irrational nature of the thoughts about their appearance, and to engage in a behavioral modification technique known as exposure and response prevention. Highly trained clinical social workers can provide this therapy.
Cognitive Behavior Therapy involves having the person confront the behaviors, such as mirror checking and camouflaging, and then having the person resist the urge to engage in them. This may include, for example, going out in public wearing less make-up or perhaps none at all. The essence of this treatment is for the patient to learn that their concerns about appearance are excessive and beyond what is normal. Also, learning that life can be meaningful without having to alter one's appearance is a necessary goal of treatment.
While BDD patients may appear to be overly vain, most are in fact desperate to appear to look normal. They want nothing more than just to fit in, and not to look grotesque, as many will refer to themselves as appearing. Given this, it is perhaps understandable that they may go to great lengths to improve upon their appearance, especially if they believe that their well-being depends on it. Although there is a shortage of mental health clinicians skilled in the treatment of BDD, considerable relief can be found with proper medication and CBT, as well as from the compassion and support of the medical professionals and therapists involved in their care.
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The opinions expressed in this article are those of the writer, and do not necessarily reflect those of the National Association of Social Workers or its members.
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How many times have you walked out of the house only to immediately return, convinced that you left the iron on, or forgot to lock all the doors?
It's only normal to occasionally forget something or to worry that you neglected to do something. If, however, these worries begin to overwhelm you, or cause you to repeatedly perform certain "rituals" to help keep your anxieties at bay, you may be suffering from Obsessive Compulsive disorder (OCD).
It is an anxiety disorder characterized by recurrent, unwanted thoughts (obsessions) and repetitive behaviors to help rid yourself of these thoughts (compulsions). The behaviors may include constant hand washing to eradicate "germs," counting certain objects over and over to make sure you have not lost any, keeping everyday items in precise order. Unfortunately, performing these rituals brings about only temporary relief from the crippling fear and anxiety. Likewise, not performing these rituals usually spells an increase in anxiety.
With OCD, it's as if your brain gets stuck on a specific image, thought, or urge, and can't move on, like a needle on a broken LP record. Among the more common obsessions: excessive worries about dirt and germs, a fear of having harmed someone else (perhaps while pulling the car out of the driveway) even though it's unrealistic, or a fear of yielding to violent urges.
People with OCD may recognize that their repetitive thoughts and behaviors are utterly senseless, but cannot free themselves from them. Often, they feel helpless and embarrassed and question their sanity. Others may not realize something is wrong. Actor Jack Nicholson was nominated for an Academy Award for his role as a New York writer and OCD sufferer in the 1997 film "As Good as it gets."
Experts once thought that OCD was rare, but it's now known to be more common than other mental illnesses such as schizophrenia and bipolar disorder. More than three million Americans from all walks of life have OCD.
If your parents or other relatives had OCD, the odds of you suffering are slightly higher. However, scientists have not identified any genes responsible for it. They are also divided on its origins, with some theorizing that its cause is biological, and others saying it springs from a learned behavior. Yet other experts believe it's a combination of both environmental and genetic factors.
Inadequate levels of serotonin, a chemical messenger in your brain, may also be to blame. OCD sufferers who take medicines that enhance the action of serotonin often improve greatly.
Some people who strive for perfection in all they do – maintaining an impossibly clean home, always finishing a work projects well ahead of schedule – may be considered compulsive. This is not the same as having OCD. Behaviors associated with OCD begin to interfere with everyday functioning, taking up time, and creating anxiety.
This is where a social worker can help you.. Often people plagued by recurrent thoughts and behaviors are ashamed to admit them. They fear being judged or labeled crazy if they confide, for example, that they are stuck on the same senseless thought or feel as though they must constantly scrub "germs" off a doorknob.
In a caring, non-judgmental environment, a social worker can assist you with determining whether it is indeed OCD and help you to formulate a treatment plan, possibly even referring you to a mental health professional who specializes in the disorder. While there is no specific laboratory test to confirm the disorder, a social worker can ask a series of key diagnostic questions about your obsessions.
A form of psychotherapy called cognitive behavioral therapy and antidepressant medications, often used together, are effective in treating OCD. Cognitive behavioral therapy involves retraining your thought patterns and routines so that your compulsions are no longer necessary.
Two types of antidepressants are used to treat OCD. These are: Selective Serotonin reuptake inhibitors (SSRIs) which enhance the brain's ability to use serotonin, a brain chemical that sends and receives messages and plays a crucial role in mood.
Yes. In fact, OCD usually begins in adolescence or young adulthood and is seen in as many as 1 in 200 children and adolescents.
A young child with OCD, for example, may be terrified someone will enter his home at night through an unlocked door or window. While his parents sleep, the child may tiptoe around the house, checking all the doors and windows, a way of alleviating the anxiety. Fearing that he may have mistakenly unlocked a door or window in the process, he then begins checking all over again.
An older child or teenager with OCD may often worry that they will become sick with AIDS, germs, or contaminated food. To cope with these unsettling feelings, the child may develop "rituals" or behaviors or activities that they repeat, such as frequent hand washing, checking something again and again or keeping items or possessions in absolute order.
The rituals can also consist of mental acts like counting aloud, repeating words silently or avoiding certain things, like cracks on a sidewalk, or climbing over every other step in a staircase.
If your child's compulsions or obsessions interfere with her normal routine, for example, keep her from focusing in school, alienating her from her peers or hindering her from joining in on social activities, a consultation with a mental health professional is definitely in order .
Again, seeking the services of a social worker possibly even within the child's school system, is an excellent place to begin.. She will help in the diagnosis and possibly in the creation of an effective treatment plan.
Cognitive behavior therapy is considered to be especially helpful in for children and adolescents with OCD
Cognitive behavior therapy with a trained mental health professional is especially helpful, more so than antidepressant medication, which is also prescribed for children and adolescents.
Remember only a licensed physician can prescribe medication for your child's OCD.
For additional information, visit these sites:
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Introduction – The Many Faces of Depression
Depression wears many faces. Some of these faces are masked with smiles, some may be buried under anger, some frozen and emotionally empty, others drowned in tears. All are sad. The faces may be that of a child or that of an octogenarian, that of a Native American, African American, Asian American, Latino/Hispanic or Caucasian. The face is most likely to be female and adult. If you live in the United States, the face has a one in sixteen chance of being your own.
Would you know if it were your own face? You are at special risk if you have experienced a significant loss–of a loved one, a marriage, a reputation, or an income. Unemployed, divorced, young adults who use drugs or alcohol excessively are at significant risk. Your risk also increases if your family has a history of mood disorders. The onset is usually gradual and only occasionally sudden, related to a traumatic event. The symptoms diminish the quality of life and interfere with functioning in most areas of our lives–work, relationships, play, pleasure.
Most people with depression feel miserable or "down." They experience:
- Episodes of crying
- Disrupted sleep (insomnia for portions of the night or excessive sleep)
- Change in appetite
- Impaired concentration
- Low energy and motivation, fatigue
- Feelings of hopelessness, helplessness, worthlessness, excessive guilt
- Loss of interest in formerly pleasurable activities
- Decreased libido
- Irritability
- Problems with decision making
- Feelings that life is not worth living
- If you have five or more of these symptoms and these last at least two weeks, you may be experiencing an episode of Major Depression.
- If you have several of the above symptoms for a two-year period of time, you may have a diagnosis of Dysthymia.
- If you develop several intense symptoms in response to a disruptive life situation, Adjustment Disorder with Depressed Mood may be occurring.
- If you have periods of depression followed by periods of euphoria or normal mood, Bi-Polar Disorder may be a problem.
All of these conditions are treatable. While some situational depressive symptoms resolve when the situation improves, most do not. Remember that the implications of untreated depression can be death by suicide.
Depression is reportedly under diagnosed in this country, especially because it masquerades in a variety of forms. Easily dismissed as just "the blues," depression can hide in chronic pain, physical symptoms that have no medical findings, alcoholism or drug abuse, and dementia. In youth it can hide in the angry acting out of a teen. Other atypical forms include post-partum depression. The media has made us more aware of the risk that illness poses for a mother and her family. Also receiving more publicity is Seasonal Affective Disorder, a depression that occurs in response to changing light conditions in fall and winter. Regardless of the masquerade, depression responds to treatment best when it is identified and treated early.
Treatment for depression involves talk therapy and may also require medication. Treatment outcome studies find that a combination of the two works best for Major Depression. Most often the type of talk therapy or psychotherapy that is most helpful is called Cognitive Behavioral Therapy (CBT), a form of therapy that teaches skills to help the depressed person engage the logical part of the brain in calming the emotional part of the brain. CBT helps to interrupt thinking patterns associated with depression, such as black and white thinking, catastrophic thinking and over-generalization. Another mode of treatment effective with depression is called Interpersonal Therapy, a treatment method that is helpful when significant relationships are missing or in trouble.
Clinical Social Workers who have a master's degree in social work and the prescribed post-masters years of clinical practice (differs from state to state, but two to five years are standard) are the largest group of mental health professionals providing talk therapy for depression. Clinical social workers who diagnose and treat depression practice in family service agencies, community mental health centers, private practice mental health groups and in outpatient clinics attached to general or psychiatric hospitals. You can identify a clinical social worker by the credentialing initials, such as LCSW (Licensed Clinical Social Worker), after a name. Social workers who qualify for advanced credentials from NASW will be certified as follows: ACSW (Academy of Certified Social Workers), QCSW (Qualified Clinical Social Worker), or DCSW (Diplomate in Clinical Social Work).
Medication, which can be prescribed by a primary care physician or by a psychiatrist, is often needed to interrupt the progression of a Major Depression episode. It can be prescribed for Dysthymia, Atypical Depression or an Adjustment Disorder, especially those that do not respond to talk therapy alone. The kind of antidepressant medication that is usually prescribed is an SSRI (serotonin reuptake inhibitor) such as Prozac, Zoloft, or Lexapro, although other medications may be equally appropriate and helpful. Successful treatment depends upon close contact with the prescribing doctor until an effective medication and dose has been achieved. Remaining on the medication until your doctor feels you can stop taking it is also important. Most treatment guidelines specify six months of medication treatment as a minimum.
Source:
"Mood Disorders," Lee W. Badger and Elizabeth H. Rand, Mental Health Research, Implications for Practice, Janet B.W. Williams, DSW, and Kathleen Ell, DSW, editors, NASW Press, Washington, DC, 1998.
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The opinions expressed in this article are those of the writer, and do not necessarily reflect those of the National Association of Social Workers or its members.
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