Major Depression and Negative Mindset

A recent study has found further evidence that people suffering with Major Depression are stuck in a negative mindset, and re-live their negative experiences again and again in their mind.

In the study 26 people with depression and 27 people who had never had depression were sat in front of a computer and shown three words, one at a time. They were told to remember the words either in the order they were presented or in reverse order. The computer then presented one of the three words and they were supposed to respond as quickly as they could whether that word was first, second, or third in the list.

People with depression had trouble re-ordering the words in their head; if they were asked to remember the words in reverse order, they took longer to give the correct answer. They had a particularly hard time if the three words had negative meanings, like "death" or "sadness."

But therapy techniques such as motivational interviewing, brief solution focused therapy or positive therapy could prove to be very useful at helping clients change their mindset and thinking and allow them to move on with their lives, which they may not be able to do without guidance.

All of these psychological skills are available from the Skills Development Service:
Motivational Interviewing
Brief Solution Focused Therapy
Positive Therapy

Interested in all these courses? Then why not go for our certificate in Resource Based Therapy course.
Certificate in Resource Based Therapy

Psychotherapy DVDs are also offering an 8 Disk CBT Training Package, offering 14 CPD hours: Essential CBT Skills Series - 8 DVDs Set - 14 CPD Hours

CBT and Bipolar mood swings

Previously Bi-polar disorder (or 'Manic depression') was thought to be largely biologically or genetically based, meaning there was little that patients could do about their mood swings other than medication.

However researchers at Manchester and Lancaster Universities have found that mood swings can be predicted by patient's thoughts and behaviour. This finding is significant as it opens the door for therapy techniques such as CBT to be used effectively.

"Individuals who believed extreme things about their moods, for example that their moods were completely out of their own control or that they had to keep active all the time to prevent becoming a failure, developed more mood problems in a month's time. In contrast, people with bipolar disorder who could let their moods pass as a normal reaction to stress or knew they could manage their mood, faired well a month later." said study lead Dr Warren Mansell.

This is obviously encouraging for CBT as it aims to help patients talk about their moods and change their thinking about them. A new CBT method known as TEAMS (Think Effectively About Mood Swings) is currently under development at the University of Manchester.

Anybody interested in the SDS CBT course can find it here:
SDS 3-Day CBT

Our June course is already fully booked so make sure you book September now to avoid disappointment!

Also to be released soon is our new range of CBT Training Series! So please keep an eye out of upcoming information!

Post Stroke: Functional Capabilities and Depression

After a stroke a third of people become clinical depressed but testing and treating of depression post-strok can help improve functioning.

Research has found that individuals who remain depressed three months after a stroke are more likely to have decreased functional capabilities (e.g. dressing self and eating) than those whose depression was successfully treated!

According to a study by Arlene A. Schmid, “The relationship between post-stroke depression and recovery of function after a stroke has not been well understood. Previous researchers have looked at both depression and function after stroke but they did not investigate whether identifying and managing depression improved ability to accomplish tasks of daily living and other function related issues.”

This new research reports that successful depression management led to better functionality that might enable the individual to return to work or more thoroughly enjoy leisure functions while decreasing the caregiver burden.

In addition to improving the well being of Stroke patients, management of depression would lower health care costs associated with functional impairment and other post-stroke treatment issues.

"This study is one of the first to show not just the link between depression and worse function post-stroke, but that successfully treating depression symptoms actually improves post-stroke outcomes,” noted the researchers.

Luckily the Skills Development Service has already been delivering a course on Psychological Coping Strategies Post Stroke for some time, and has provided training to a number of Cardiac and Stroke Networks around the country! The course is available to be delivered in-house but seminars are also being run around the country throughout 2011 and BPS Learning Centre approved.

More information can be found on our website: Psychological Coping Strategies Post Stroke

(The study mentioned above is published in the March 15, 2011 issue of the journal Neurology.)

With A Little Help From Your Friends

"The long-term effects of being a withdrawn child are enduringly negative," says lead author William M. Bukowski, "Over time, we found that withdrawn kids showed increasing levels of sadness and higher levels of depressive feelings."

In this recent study, 130 girls and 101 boys took part in the three-year study, where they were asked to rate whether they felt shy or whether they preferred being on their own.

Compared with friendless children, those who had friends were less likely to report depressed feelings.

The researchers believe that "Friendship disrupts the negative and long-term effects of withdrawal. Friendship promotes resilience and protects at-risk kids from internalizing problems such as feeling depressed and anxious."

They concluded that the key to avoid peer rejection is to make at least one friend.

Link to full article on 'Science Daily'

Depression and it's link with Obesity

A new recent study has found that past surveys show having a body mass index (BMI) of 30 or more increases a person’s risk of depression by 50% to 150%.

Lead author said: “I expect that the relationship between depression and physical activity goes in both directions, Increased physical activity leads to improvement in depression and improvement in depression leads to increased physical activity. We see in our study that they go together, but we can’t say which causes which.”

In the study, women involved were put in two groups.
Group 1: Focused on weight loss
Group 2: Focused on weight loss and depression.

38% of the women who had at least a one-half point decrease on the Hopkins Symptom Checklist depression score lost at least 5% of their body weight.

But only 21% of the women who had no decrease in their depression score lost the same amount.

It seems that levels of depression can greatly affect your weight, perhaps suggesting that you must first help the mind before the body can be effectively helped also.


Simon GE, et al. Association between change in depression and change in weight among women enrolled in weight loss treatment. Gen Hosp Psych, 32(6), 2010.

Depression and Related Problems

The World Health Organization has predicted that depression will be the world's leading cause of disability by 2020. But what can we do about it?

Well, it may not break any records but for a start - let's try and minimise smoking!

Based on the results of a new study, researchers involved recommend quitting smoking to improve mood! In the study they tracked the symptoms of depression in people who were trying to quit and found that they were never happier than when they were being successful, for however long that was.

"The assumption has often been that people might smoke because it has antidepressant properties and that if they quit it might unmask a depressive episode," said Kahler. "What's surprising is that at the time when you measure smokers' mood, even if they've only succeeded for a little while, they are already reporting less symptoms of depression."

With smokers that only quit temporarily, their moods were clearly brightest at the checkups when they were abstinent but after going back to smoking, their became more depressed and sometimes the depression was actually worse than before. Surprisingly, participants who never quit remained the unhappiest of all.

So if you want to start feeling better, it's time to stop smoking!

And best get started quickly as another study has found that depression may be a consequence of and risk factor for Diabetes!

Research found that women with depression were about 17% more likely to develop diabetes after controlling for other risk factors, such as physical activity and body mass index (BMI). Those who were taking antidepressants had a 25% higher risk of developing diabetes than those who did not have depression.

After controlling for other risk factors for mood disorders, women with diabetes were 29% more likely to develop depression. Women who took insulin for diabetes had a further increased risk -- 53% higher than women without diabetes.

The WHO may be right, and if so - maybe we need to look at all this small things to try and curb depression in society. Maybe it seems like very small changes, but a number of small changes add up to something bigger!

Article 1


Article 2

Gambling away your health..

Although just a correlation, a recent study has found that Pathological Gamblers are at risk of Mental Health Disorders - they are 3 times more likely to commit suicisde than non-gamblers.

"..Pathological gamblers account for five percent of all suicides. These staggering statistics motivated us to study the difference between gamblers and non-gamblers," says study co-author, Richard Boyer.

The study examined 122 suicides between 2006 and 2009 and found that 49 (40%) were pathological gamblers.

Those committing suicide were found to be twice as likely to be suffering from Specific Mental Disorders than other suicide cases, suggesting that the personality disorder is a significant flag towards increased suicide risk.

Boyer reported that there are three elements generally recognised: depression, alcohol or drug consumption and a personality disorder. They believed that it was the interaction between these problems that led ultimately to suicide.

But they didn't stop there. The study also found that gamblers who committed suicide were three times less likely to have seen the doctor the year preceding their death.

Boyer believes this is because they see their financial or alcohol/drug problems as a result of their gambling addiciton and seek help for that rather than get help for their other issues.

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Do you know anybody in your life with a gambling problem? It could affect anybody! Just keep an eye out for the warning signs and remember that gambling may not be their only problem!

Link to Article

Get Rhythm When You Get The Blues

Genes that regulate circadian rhythm were examined in people with and without a history of depression and found that those with a history of depression had a higher level of activity in this gene.

Higher expression levels of this gene could affect sleep patterns and other physiological functions governed by circadian rhythm - this is highly interesting as Sleep disturbance is a common symptom of depression.

This is only a link, it cannot be inferred either way whether the gene difference is the cause or the effect of depression but it does advance what we know about depression and brain structures that seem to indicate it.

In terms of advances in treatment, those with depressions and this genetic profile may benefit most from sleep-related treatments: Light therapy or a antidepressants that act on melatonin (a sleep regulatory hormone.)

Link to Article

Depression and the Percentage of Relapse

"A study of adolescents who had a major depressive disorder found that nearly all recovered from their episode after treatment. But within five years, nearly half of them had relapsed, and females were at much higher risk of another major episode, researchers at Duke University Medical Center found."

"After the initial 12-week treatment, the subjects were then followed for five years. They found that 96.4% of the participants had recovered for at least 8 weeks after short-term treatment. Those who responded to the short-term treatment rather than partially or not at all were significantly more likely to recover by the two-year follow-up mark. The most effective treatment was a combination of the antidepressant fluoxetine (Prozac) with CBT."

"Reaching recovery within two years was not significantly related to being in the group that received the combination therapy. Instead, it mattered whether the patients responded to treatment, as opposed to being partial responders or nonresponders."

"Of the 189 patients who recovered, 88 of them had a recurrence of major depression. Recurrence couldn't be predicted by the child's full short-term treatment response or by original treatment. Gender played a significant role in recurrence, with a majority of females (57.6 percent) having another major depression versus just 32.9% of males."

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This study may be confirming what we already know, that those who recover from depression are likely to relapse, but what is interesting about it is the overwhelming percentage of relapse and the gender difference as well. Transtheoretical models such as John Norcross' stages of change wouldn't see relapse as a problem however, more of an expected, and possibly necessary part of change. More study in this area in the future may prove even more fruitful and maybe go on to explain even further the reasons behind the relapse and gender differences.

Link to article

Patient Personality Can Hinder Detection of Depression

"Friends and family members of a person who is highly outgoing and fun-loving and who is likely to experience happiness and excitement often miss the signs that indicate the person is depressed."

"When a person who has enjoyed socializing and whose mood normally is positive becomes depressed, friends and family often don't recognize it. Depression is inconsistent with the expectations that people have," said Paul R. Duberstein.

When the research began, researchers hypothesized that friends and family would miss depression in a person who is introverted.

"But our research showed the opposite to be true," Duberstein said. "We found the signs of depression were more likely to be missed in people with an outgoing, extraverted personality."

The researchers also found that friends and family missed signs of depression in a person characterized as "agreeable," someone who is more trusting and more altruistic or who might be considered a conformist.

"It is important for people to understand that people who are highly extraverted and highly agreeable can become depressed and that the signs of depression for these people are more likely to be missed or detected by friends and family," Duberstein said "Don't assume that because someone is outgoing or agreeable that they are not vulnerable to becoming depressed."

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But surely you'd think we'd be more likely to notice if our usually outgoing friend was depressed? Apparently not! But why is this? Perhaps because we're not looking for it, we're just refusing to see it. If somebody is very happy and outgoing, this is the image we have of them in our head, even if they have not been acting this way recently. Perhaps it is just our selective attention that is the problem!

Link to Article

The Pain of Discrimination

"In a new study, researchers found that adolescents from Latin American and Asian backgrounds experienced more discrimination than their peers from European backgrounds and that the discrimination came not only from other adolescents but from adults as well. The level of discrimination also impacted these teens' grade-point averages and their health and was associated with depression, distress and lower levels of self-esteem.

601 Teens (equal males and females) kept a daily diary for 2 weeks to record any discriminatory events or comments they experienced. They were also asked to separately record on a four-point scale any physical symptoms, such as headaches, stomach-aches or general pain.

Among the teens in the study, nearly 60% reported experiencing discrimination from other teens, and 63% reported discrimination from adults; 12% reported experiencing discrimination on a daily basis.

The researchers found that teens who reported higher levels of peer or adult discrimination also reported more aches, pains and other symptoms, as well as a lower overall grade-point average. Thus, discrimination may not only tax adolescents' physical and psychological resources but may also affect their ability to achieve in school, the researchers said.

"Discrimination significantly predicted lower GPAs, higher levels of depression, higher levels of distress, lower self-esteem and more physical complaints," Fuligni said. "So the bottom line? Discrimination is harmful."

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This interesting study highlights the link between the personal world, i.e. one's own wellbeing and health, and the social world. This link can be good, in terms of positive interactions and suppport, but, as this study shows, negativity in the social world can create bad results in the personal world.

Although people may think the discrimination is only small, it can mount up on a single individual, much like in the story 'An Inspector Calls' by J.B Preistley, and can manifest itself in a number of physical and psychological problems.

The modern world already seems to be accelerating the number of people that are being diagnosed with depression and ADHD and personality disorders etc, and people are quick to blame the fast paced life and music and videogames. This study is an interesting wake-up call that shows how our interactions with each other, although seemingly harmless, may be commiting more pain than we realise.

Link to article

More casualties of the BP oil spill!

Anger, depression, and helplessness are the main psychological responses being seen in response to the catastrophic Deepwater Horizon oil spill in the Gulf of Mexico, and they are likely to have long-lasting effects, according to an interview in Ecopsychology, a peer-reviewed, online journal published by Mary Ann Liebert, Inc.

In an interview published in Ecopsychology and conducted by Editorial Board member Susan Koger, PhD, Professor of Psychology at Willamette University in Salem, OR, Winter predicts a great deal of chronic depression, withdrawal, and lack of functioning among not only people directly affected by the events in the Gulf, but also people nationwide and globally who identify or empathize with their circumstances.

Describing the oil spill as "the absolutely worst 'environmental' disaster" in the history of the United States, Winter discusses her own personal attempts to deal with the negative emotions she is experiencing by focusing at times on hopeful, positive feelings related to the "tremendous self-sacrifice and generosity of spirit" among those affected by the spill and those helping to contain it and clean up the oil.

With the hope that the BP spill, with all the damage and suffering it is causing, will stimulate renewed environmental activism and changes in attitudes and behaviors, Winter says, "this disaster is probably just the kick in the pants that the environmental movement has needed."
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Maybe it's stronger in the US, being a little closer to home, but how do you feel about the oil spill? Has it made you feek angry or depressed? Why do you think others feel like this?

Link to Article

Most still depressed despite treatment

An Australian study has shown how anti-depressant treatments often do not work fully, leaving sufferers to battle a condition known to "shorten people's lives".

The Perth-based study assessed the effectiveness of anti-depressant drugs or psychotherapy used by depressed men aged over 68 and, alarmingly, it was shown to work in less than half of the cases.

"This is a big issue," said Professor Osvaldo Almeida, research director of the Western Australian Centre for Health and Ageing at The University of Western Australia.

"More than half of older men with depression who use antidepressants or psychotherapy fail to respond fully to the treatment.

"We need to do something urgently to improve the efficacy of our treatments for depression."

Professor Almeida and his team assessed the health and lifestyle of almost 5300 men aged 68 to 88 years who had been living in Perth for more than a decade.

Almost 300 of the men were receiving treatments for depression.

Where the men were found to not respond fully to their treatment, Prof Almeida said their overall risk of death during the 10-year study window increased.

Where they were found to respond well to their treatment, with an significant easing or resolution of their depressive symptoms, these men had the same life expectancy as a person without depression.

"We found that older men who were using antidepressants but remained depressed had a substantially higher mortality risk," Prof Almeida said.

"The increased mortality risk associated with antidepressant use is not due to the medication itself ... it is the depression that is contributing to shorten people's lives."

Prof Almeida said research was under way in a bid to improve conventional treatments for depression, the disabling condition that affects one in ten people over the age of 60.

Results of the study were published recently in the medical journal PLoS-One.

Link to Article

The end of face-to-face CBT?

Web psychotherapy 'just as good'

Therapy delivered via the internet is just as good as face-to-face sessions for treating depression, say Swedish researchers.

In the study, 117 volunteers with mild to moderate depression participated in either a web-based self-help CBT programme plus an internet discussion group, or an internet discussion group alone. The do-it-yourself CBT programme consisted of 89 pages of text divided into five modules that were estimated to take eight weeks to complete.

Overall, 37% of the patients withdrew from the programme - the main reason given was that it was "too demanding".

However, those that continued with the programme reported significant improvements to their psychological wellbeing.

The success of the web-based self-help programme was the same as that seen in past studies of face-to-face therapy, and was much more effective than the internet group therapy on its own.

The self-help programme resulted in decreased depressive symptoms immediately after treatment and at the six-month follow-up, the researchers found.

Richard Brook, chief executive of Mind, said: "Computer-delivered CBT is an important addition to the range of treatment options available for people experiencing depression.

"This method of delivery is useful for people who might not be able to access CBT easily because of their remote location, or for people who find it difficult to speak 'one-to-one' about their depression.

"However, online CBT will not suit everyone. It should not be used as a reason to evade training enough therapists so that people experiencing mental health problems can access the treatments they need when they need them."

Link to News Article

What makes a nation suicidal ?

A list of the top nations in the world for suicide rates doesn't make for pleasant bedtime reading. However, as a source of ideas for explaining why people kill themselves (and thus what can be done to prevent it), it is an interesting source of data.

So....what do you think are the factors that are most likely to lead a country to be vulnerable to high suicide rates? Poor social welfare systems ? A poor sense of community or togetherness, maybe its poor mental health services ?

In the industrialised world who do you think scores highest ? The USA ? Many of you may think this is a trick question and answer "the Scandanavian countries". Maybe you think its the UK ?
Well...you would all be wrong and infact, as far as the UK is concerned, it has the lowest suicide rate of all the countries in Western Europe...

The latest edition of The Economist (10 Ocober 2009) has just published OECD data on this question, that begs more questions than it answers. Infact the country with the highest rate is Japan ( a country defined by its sense of community and public services, though arguably with a social tradition of suicide). However, most striking (in position number 3) is France - which has a suicide rate that is TWICE that of the UK and 40% higher than Germany.

The Economist offers explanations which I personally do not find credible - such as a restrictive employment policy that creates meaningless jobs. However, it is a fascinating question as to why a country that prides iteself on quality of life and the value of community should have so may people who want to kill themselves ?

I would like to explore this further at my next block of workshops on Suicide and Self Harm ( http://www.skillsdevelopment.co.uk/seminars.php?courseid=6 ) . Id be fascinated by your tho0ughts and theories on this (whether at the workshop or here on this blog). Let me know what you think.

Take care

Paul

Paul Grantham
Consultant Clinical Psychologist

BACP issues warning that new depression guidelines may harm patients

The British Association for Counselling and Psychotherapy (BACP) has today issued a warning that the new depression guidelines published by the National Institute for Health and Clinical Excellence (NICE) could mean a narrowing of the options available to those being treated for depression, Britain's number one mental health concern.

Dr Lynne Gabriel Chair of BACP said: "BACP welcomes NICE's recommendations to support counselling and psychotherapy in general to treat depression. But we are worried that the narrow focus of the new guidelines could be used to promote one form of talking treatment - Cognitive Behavioural Therapy (CBT) - at the expense of the full range of psychological therapies. The evidence is clear that CBT can only be of benefit to some 50 per cent of depressed patients rising to just over 70 per cent when symptoms specially lend themselves to a CBT approach".

All patients with long-term illnesses will be assessed for mental health problems under new guidelines issued by the National Institute for Clinical Excellence (NICE).

Depression can be up to three times more common in those suffering from chronic illnesses such as cancer, diabetes and heart disease but because of the focus on primary physical symptoms the mental distress can often go undiagnosed. The new guidelines will tell GPs to do routine screens for depression in all cases of serious illness.

NICE also released updated guidelines on treatment of general depression, suggesting that psycho-social or talking therapies should be the first treatment option for people with mild or moderate depression rather than medication

For further details please go to:
http://www.bacp.co.uk/media/index.php?newsId=1610

We would be grateful if you could share your views on this issue with us.

Is the "depression epidemic" really as bad as it appears?

The World Health Organisation has stated that by 2020 depression will create the second largest "health burden" in the world after heart disease. This is a prediction made made on the basis of data analysed by Harvard University Faculty of Public Health. At first sight, this appears to match up with our perception of the society we live in and the clients we work with - more stress, greater unhappiness, increased social and family breakdown. But hold on a minute. Is it really that clear cut or does the WHO position hide a more worrying trend which a brief history tour should illuminate.

Since the marketing of diazepam (Valium) in 1963 for "anxiety disorders" in 1963, their prescription (along with other prescription of other benzodiazepine anxiolytics reached a peak of 24.5 million prescriptions in the UK 1982. In the late 1970s pharmaceutical companies decided that they wanted to replicate Valium's success with other psychiatric drugs. They knew that despite the drug's success, past experience indicated it would be self limiting and that criticism's of valium's "addictive qualities" were already arising in the literature. As a result, they lobbied the American Psychiatric Association, who were reconsidering diagnostic categorisation for DSM III. As a result the APA radically changed their definition of "depression", with the primary effect being to broaden it substantially in 1980. Valium prescriptions peeked in 1982. However the new definition of depression opened up a new huge market for antidepressants and the arrival of Prozac in 1988 cemented the new broader definition of depression into place. In other words, the broadening of the definition of depression has been largely driven by the need to market new drugs.

In practice, most psychologically distressed clients still present with a mixture of anxiety and depression, as they were in 1970s, except that medication driven diagnosis classifies it as "depression". Secondly, the relative lack of addictive properties of SSRIs has meant that their prescription has escalated beyond that that existed for the benzodiazepines. 31 million were prescribed in 2006. Many have seen this is an acceptable price to pay in order to destigmatise requesting help for psychological problems. The price has been a high one however. The medicalisation of psychological distress and unhappiness for large sections of the community has meant that it has disabled and disempowered such individuals and has often legitimised victim roles. It ultimately makes people less (rather than more) psychologically minded about their problems and averts our gaze from the more fundamental question of why are more of us feeling unhappy and stressed, and feel life lacks meaning. Using a medical diagnosis is inappropriate and unhelpful.

Our seminars on 'Working with Depression: New Thinking & Effective Interventions' give us an opportunity to discuss these and many other issues. I am sure they will be stimulating training days for all of us. However, I welcome any of your thoughts on the topic here.

Best Wishes
Paul Grantham