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Introduction to Depression: defining it, diagnosing it, & managing it

Introduction to Depression: defining it, diagnosing it, & managing it

Depression is a mental health condition that goes beyond mere feelings of sadness. It would be better described as a persistent and overwhelming sense of despair that can linger for weeks, months, and even years. Depression affects millions of people worldwide, oftentimes having a negative impact on personal well-being, relationships, work, school, and overall quality of life. 

Contrary to common misconceptions, depression isn’t a sign of weakness, nor is it a mere mood swing that one can easily snap out of. Rather, depression involves a combination of biological, psychological, and/or environmental factors. Physiologically, there can be multiple neurotransmitters involved, making it difficult to regulate mood. Genetic predispositions can also make certain individuals more susceptible to experiencing depressed mood. Additionally, life events such as trauma, loss, or chronic stress can act as triggers, exacerbating the condition.

Being able to recognize the symptoms of depression is essential, not only for those who experience it, but also for those close to them. Detecting depression at its earliest signs is optimal, as it allows for prompt initiation of treatment, which can prevent the condition from worsening. Common symptoms include persistent sadness, loss of interest in previously enjoyable activities, changes in sleep and appetite, fatigue, and difficulty concentrating. 

The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) outlines the following criterion for depression (otherwise known as major depressive disorder or MDD). In order to meet diagnostic criteria, an individual must exhibit at least five of the following symptoms during the same 2-week period, representing a change from previous functioning. Additionally, at least one of the symptoms must be either (1) depressed mood, or (2) loss of interest or pleasure.

  1. Depressed mood most of the day
  2. Significantly decreased interest or pleasure in all (or almost all) activities
  3. Major change in weight or appetite (not due to dieting) 
  4. Insomnia or hypersomnia
  5. Excessive restlessness or observable reduction in activity levels
  6. Fatigue (exhaustion) or loss of energy
  7. Feelings of worthlessness or excessive/inappropriate guilt
  8. Diminished ability to think, concentrate, or make decisions
  9. Frequent thoughts of death or attempt to end one’s life

These symptoms must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. It’s important to note that the diagnosis also considers ruling out other medical conditions or substances that could contribute to the symptoms. Diagnosis and treatment should be conducted by qualified mental health professionals.

Seeking professional help, whether through therapy, medication, or a combination of both, is a crucial step for managing depression. It is certainly not a sign of weakness, but a courageous step towards healing. By fostering awareness, understanding, and compassion, we can collectively promote mental health treatment for those in need of support. The best thing we can do for those affected by depression is (1) listen without judgment, (2) validate their experiences and emotions, (3) connect them with a professional, and (4) continue to connect with them throughout their journey toward a brighter future.

Go Like Yourself!

Go Like Yourself!

Founders of Go Like Yourself — Cindy Martin & Bruce Coffman — believe in writing one’s own unique story, regardless of outside pressures or judgment.  Their goal is to get their message into the minds and hearts of people of all ages so they simply feel better about themselves:

This isn’t about ego. It’s about choosing for yourself who you are and what you do. It’s about directing your own life – not to get noticed or get more followers. It’s about being true to yourself. Push your limits on the trail. Go for bold strokes with a paintbrush in hand. Reach for the high note that has always eluded you. Or do none of these. Do what feels good and what feels right – just for you and no one else.

Please take a moment to reflect on Bruce’s thoughts on A Good Place to Start in liking oneself…

Okay. “Go Like Yourself”—you get it.

But now what? I mean, how do you do that?

This should help!

I love to mountain bike. Have for 20 years, even led a chapter of Trips for Kids that took inner-city youth on mountain biking day trips. Beautiful sport. I mean, what could be more fun than riding your bike like a kid on dirt trails through the woods?

Technology has changed the sport in many ways. The bike itself: lighter, stronger, better designs—simply more fun. Plus how rides are tracked and recorded: GPS, smartphone apps, helmet cams—on and on.

So. What could be more fun than riding? How ‘bout this? Not just riding, but taking photos & videos along the way, then immediately afterwards uploading ride data and blasting out to your friends. Right?

Wait. I don’t allow myself anything electronic on my bike, just a cell in my pocket in case of emergency. Why not? To live (ride) in the moment. Versus thinking ahead to the posting. Then waiting and watching—who liked? who commented? who shared?

I’m not throwing stones. I still check to see who reacts to things I post. I probably check too much. But my rides are sacred. Just for me.

So. To Go like Yourself (you’ll want to write this part down):

  1. Find one thing you love or want to do, just for you. Either a one-time thing or something lifestyle, longer-term
  2. Do that thing, but don’t let anyone know—or maybe only your mom or someone close to you
  3. Feel good about what you’re doing, then feel good about what you’ve done—not due to any reaction 

Smile about it and know that you’ve won!

Like when you were a kid, just riding your bike.

For more information, please visit Go Like Yourself!

By: Bruce Coffman, Go Like Yourself

3 Core Conditions for Therapeutic Change

3 Core Conditions for Therapeutic Change

The person-centered counseling approach was established in the 1940’s by humanistic psychologist, Carl Rogers. The goal of a person-centered therapy is to create the necessary conditions for clients to engage in meaningful self-exploration of their feelings, beliefs, behavior, and worldview, and to assist clients in their growth process, enabling them to cope with current and future problems.

A major concept of this approach is that people are generally trustworthy, resourceful, capable of self-understanding and self-direction, able to make constructive changes, and able to live effective and productive lives. Another key concept is that the attitudes and characteristics of the therapist, and the quality of the client-therapist relationship are prime determinants of the outcome of the therapeutic process.

Rogers maintains that therapists must have three attributes to create a growth-promoting climate in which individuals can move forward and become capable of becoming their true self: (1) congruence (genuineness or realness), (2) unconditional positive regard (acceptance and caring), and (3) accurate empathic understanding (an ability to deeply grasp the subjective world of another person).

1. CONGRUENCE (GENUINENESS)
Congruence refers to the therapist being real, authentic, and genuine with their clients. It’s called congruence because their inner experience and outward expression match. In being authentic, the therapist shows they are trustworthy, which helps in building a good therapeutic relationship with the client. It also serves as a model for clients, encouraging them to be their true selves, expressing their thoughts and feelings, without any sort of false front.

2. UNCONDITIONAL POSITIVE REGARD and ACCEPTANCE
Unconditional positive regard means the therapist genuinely cares for their clients and does not evaluate or judge their thoughts, feelings, or behaviors as good or bad. Each client is accepted and valued for who they are, as they are, without stipulation. Clients need not fear judgment or rejection from the therapist.

3. ACCURATE EMPATHIC UNDERSTANDING
Accurate empathic understanding means that the therapist understands their client’s experience and feelings in an accurate and compassionate way. The therapist recognizes that each client’s experience is subjective and therefore strives to see things from the client’s unique perspective. An important part of accurate empathic understanding is for the therapist to convey that they “get it” by reflecting the client’s experience back to them. This encourages clients to become more reflective with themselves, which allows for greater understanding of themselves.

If you’ve ever had an experience where you felt like someone just really got you…they completely understood where you were coming from, or could truly relate to the way you felt – that’s accurate empathic understanding.

Rogers asserts that empathy helps clients (1) pay attention and value their experiencing; (2) see earlier experiences in new ways; (3) modify their perceptions of themselves, others, and the world; and (4) increase their confidence in making choices and pursuing a course of action. Jeanne Watson (2002) states that 60 years of research has consistently demonstrated that empathy is the most powerful determinant of client progress in therapy. She puts it this way:

“Therapists need to be able to be responsively attuned to their clients and to understand them emotionally as well as cognitively. When empathy is operating on all three levels – interpersonal, cognitive, and affective – it is one of the most powerful tools therapists have at their disposal.”

 

References:
1. Watson, J. C. (2002). Re-visioning empathy. In D. J. Cain (Ed.), Humanistic psychotherapies: Handbook of research and practice (pp. 445-471). American Psychological Association, Washington, DC.
2. Corey, Gerald. Theory and Practice of Counseling and Psychotherapy. Belmont. Thomas Learning, Inc. 2005.

Mental Attitude

Mental Attitude

I recently came across Elbert Hubbard’s essay on “Mental Attitude” in a book I was reading, and I enjoyed it so much that I wanted to share it with others. For me, it speaks an optimistic message of how having the right combination of self-confidence, courage, and determination will lead you to success. I hope you enjoy it as much as I do!

Whenever you go out of doors, draw the chin in, carry the crown of the head high, and fill the lungs to the utmost; drink in the sunshine; greet your friends with a smile, and put soul into every hand-clasp.

Do not fear being misunderstood, and never waste a minute thinking about your enemies.  Try to fix firmly in your mind what you would like to do, and then without veering off direction, you will move straight to the goal.

Keep your mind on the great and splendid things you would like to do; and then, as the days go gliding by, you will find yourself unconsciously seizing upon the opportunities that are required for the fulfillment of your desire, just as the coral insect takes form the running tide the elements it needs.  Picture in your mind the able, earnest, useful person you desire to be, and the thought you hold is hourly transforming you into that particular individual.

Thought is supreme.  Preserve a right mental attitude – the attitude of courage, frankness, and good cheer.  To think rightly is to create.  All things come through desire, and every sincere prayer is answered.  We become like that on which our hearts are fixed.  Carry your chin in and the crown of your head high. 

 

Works Cited:
Knox, George.  Thoughts That Inspire.  Des Moines.  Personal Help Publishing Co. 1906.
Carnegie, Dale. How to Win Friends & Influence People. New York. Simon and Schuster, Inc. 1981.

A Young Woman’s Personal Experience with Anxiety

A Young Woman’s Personal Experience with Anxiety

Anxiety is something that everyone deals with, to some extent, during their life. For some people it’s a passing experience of feeling stressed and overwhelmed. For others, though, anxiety can be crippling. I mean truly, intolerably, despairingly crippling.

You can’t sleep, you can’t eat, you can’t focus. Your work suffers; your relationships suffer.  You question everything you do, and everything you say. Your mind never stops churning things over. You’re filled with feelings of self-doubt and never being good enough. It’s pure agony.

The term “anxiety” gets thrown around for everything, ranging from feeling nervous to experiencing unrelenting, incapacitating panic attacks. Because of this, there are people who equate “feeling stressed” to knowing what having an anxiety disorder feels like. Unfortunately, this attitude feels discrediting and invalidating to the person who truly experiences the wrath and magnitude of anxiety.

Anxiety can manifest itself as a condition, such as a phobia, social, or generalized anxiety; or on a greater level, it can present comorbidly with other conditions, such as Depression, ADHD, Schizophrenia, and so forth. Anxiety is not a character flaw. I repeat: ANXIETY IS NOT A CHARACTER FLAW. Anxiety is a neurological imbalance. It is the result of obtaining some unfortunate genetics and/or exposure to certain life experiences. None of those things are your fault in any way.

I am the youngest child of two girls. Some people believe that being the youngest child makes you “selfish.” I would say that I do, in fact, have a tendency towards selfishness. But my selfishness isn’t due to being the youngest child; rather, it’s a result of having to manage my anxiety.

For instance, I can’t be the person who goes and offers comfort to a friend in the middle of the night because of a break-up, or some other challenging situation. I have to be selfish; I need to sleep. Because altering my routine and extending myself could offset my own mental stability. I need to rest. I need to relax. I need time to myself.

I have to “be selfish” in order to operate in a fast-paced, high-producing, performance-based society. I’m at a disadvantage to others, who function at a higher level, and with more ease. Because of my anxiety, my mental and emotional reserves are easily and quickly depleted.

I want to be there for my friends in the middle of the night, when they are hurting, but the fact of the matter is that I can’t. I have to take care of myself. This doesn’t mean that I don’t care. It doesn’t discredit me as a kind-hearted person. I absolutely want what is best for the people around me. I simply need my time, time when I am off limits, time to recuperate.

I’ve learned from past mistakes of over-extending myself. There have been times when I’ve tried to be everything to everyone. I went out of my way, above and beyond, to be there for people. Even when I did all that I could, I still felt this hankering guilt that it wasn’t enough; that I wasn’t enough.

I have since learned that the care and support I am able and willing to offer others is enough. I have since learned that I am enough. I realize that I owe it to myself (and others) to take care of me. I have to care for myself at least as well as I care for others. Self-care is a requirement for others-care. And when you think about it, there’s really nothing selfish about that.

 

* Special thanks to my considerate, generous, hard-working, and capable niece for sharing her story, in hopes of providing understanding and validation for those who face their own struggles, and in hopes of providing insight for others to develop empathy for such challenges. 

6 Principles for Meaningful Living

6 Principles for Meaningful Living

The Happiness Trap: How to Stop Struggling and Start Living [A guide to ACT: the mindfulness-based program for reducing stress, overcoming fear, and creating a rich and meaningful life] by Russ Harris

Acceptance and Commitment Therapy is based upon six core principles that work together to help a person develop a mind-set known as “psychological flexibility.” Psychological flexibility is the ability to adapt to a situation with awareness, openness, and focus, and to take effective action, guided by your values. For short, psychological flexibility can be thought of as Mindfulness + Values + Action.

  1. DEFUSION is creating distance and separating from unhelpful thoughts. It entails recognizing that most of our thoughts are neither true nor false; rather, most of our thoughts are actually opinions, judgments, beliefs, and morals and related plans, goals, wishes, and values. The idea is not to determine whether a thought is true or false, but whether it is helpful. One way to create distance from an unhelpful thought is to simply insert the following phrase in front of the thought: “I’m having the thought that…” or “I notice I’m having the thought that…” DEFUSION recognizes that thoughts may or may not be true; therefore, we mustn’t automatically believe them. It also recognizes that thoughts may or may not be important; therefore, we only pay attention if they’re helpful.

Thought Defusion PICTURE for blog post

  1. ACCEPTANCE (EXPANSION) literally means “taking what is offered.” It is fully opening yourself to your present reality – acknowledging what is, right here and now, and letting go of the struggle with life as it is in this moment. This philosophy is encapsulated in Russ Harris’s “Serenity Challenge” (his version of the Serenity Prayer): Develop the courage to solve those problems that can be solved, the serenity to accept those problems that can’t be solved, and the wisdom to know the difference.

In practicing EXPANSION, the aim is to observe your emotions, not think about them. The four steps of EXPANSION are (1) Observe, (2) Breathe, (3) Create Space, and (4) Allow.

  • Observe the sensations in your body (i.e. a lump in your throat or a knot in your stomach) and focus your attention on that sensation with curiosity.
  • Breathe into and around the sensation with a few deep, slow breaths co provide a center of calm within you, like an anchor in the midst of a storm to hold you steady.
  • Create Space with your breath flowing in and around the feeling, giving it plenty of room to move around.
  • Allow the sensation to be there (even if you don’t like it or want it); simply let it be. Acknowledge any urges to fight with the feeling or push it away, and bring your attention back to the sensation.

Expansion PICTURE for blog post

  1. CONTACT WITH THE PRESENT MOMENT (CONNECTION) means being fully aware of you’re here-and-now experience, fully in touch with what is happening at this moment. The goal is to pull yourself out of the past or the future and bring yourself back to the present – right here, right now.

Why practice Connection?

  • so you can appreciate the richness and fullness of life
  • because the only moment we have is NOW
  • so that you can take effective, mindful, value-driven action (which requires being aware of what’s happening, how you’re reacting, and how you wish to respond).

CONNECTION happens through the OBSERVING SELF; it involves bringing full attention to what is happening here and now without getting distracted or influenced by the thinking self.

  1. THE OBSERVING SELF (as opposed to the THINKING SELF) is a viewpoint from which you can observe thoughts and feelings. It’s essentially pure awareness; without the observing self, you would have no capacity for self-awareness. Your thoughts, feelings, and sensations change continuously; sometimes they’re pleasant, sometimes painful, helpful, happy, calm, angry, etc. The observing self can’t be judged as good or bad, right or wrong, because all it does is observe, nor does it judge or criticize you (because judgments are thoughts, which come from the THINKING SELF); it simply sees things as they are. You can think of the observing self as being like the sky, while thoughts and feelings are like the weather – constantly changing.
  1. VALUES are (1) Our heart’s deepest desires: how we want to be, what we want to stand for, and how we want to relate to the world around us, and (2) Leading principles that can guide us and motivate us as we move through life.

To identify what your values are, here are some questions to ask yourself:

  • Deep down inside, what is important to you?
  • What do you want your life to be about?
  • What sort of person do you want to be?
  • What sort of relationships do you want to build?
  • If you weren’t struggling with your feelings, or avoiding your fears, what would you channel your time and energy into doing?

Values are not the same thing as goals; a value is a direction we desire to keep moving in, and ongoing process that never reaches an end, while a goal is a desired outcome that can be achieved or completed. For example, getting married is a goal, whereas being a loving and caring partner is a value. One can think about their values in relation to different domains of life, such as Family, Marriage/Intimate Relationships, Friendships, Employment, Education/Personal Development, Recreation/Fun/Leisure, Spirituality, Community Life, Environment/Nature, and Health.

Values PICTURE for blog post

  1. COMMITTED ACTION entails setting meaningful goals for your identified values. Use the following steps to create a Committed Action Plan for yourself:
    • Summarize Your Values for each domain. For example, “In the domain of Family, I value being honest, respectful, authentic, and supportive.”
    • Set an Immediate Goal – something that can be accomplished right away. For example: “During my lunch break, I’ll call my husband and encourage him because I know he’s having a stressful day.”
    • Set Short-Term Goals: ask yourself what small things you can do over the next few days and weeks that are consistent with your identified values.
    • Set Medium-Range Goals: think of larger challenges you can set for the next few weeks and months that are consistent with valued living.
    • Set Long-Term Goals: decide upon major challenges you can set for the next few years that will continue to take you in your valued direction. A good question to ask yourself is, “Where do I want to be five years from now?”