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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.

A Look at Test Anxiety

A Look at Test Anxiety

Interview with Kansas City Blogger Local

High school and college students are no strangers to the effects of anxiety and depression.  This segment of the population however, faces a unique type of anxiety and depression that the general population rarely comes in contact with.  Test anxiety is a major issue for students the Kansas City metro area.  We met up with one local counselor to discuss test anxiety and how to deal with it.

Ben: Hello there.  This is Ben Hartman from Blogger Local Kansas City.  We’re out in Leawood with Molly Pierce, a Kansas licensed professional counselor  and owner of True Self Counseling.  We’re meeting with her today to discuss some of the upcoming anxiety that is related to the school season being in full swing.  There are a lot of tests coming up.  We met with Linden at Get Smarter Prep the other day, and she was actually talking about the ACTs coming up on September 21st.  Molly, if you can just tell us a little bit about yourself and True Self Counseling, that would be awesome.

Molly: Aright.  I started True Self Counseling in 2010.  I really have a passion to help people deal with common everyday problems, such as anxiety, depression, and communication/relationship problems.

Ben: Okay, so you deal with individuals, and then you deal with people in relationships, and then some group counseling as well?

Molly: Yes, absolutely.

Ben: You have a test anxiety clinic going on over at Get Smarter Prep.  Tell us about it.

Molly: It’s a one hour clinic in the evening to help students prepare to manage their anxiety, to get the best score that they can on their ACT or SAT.  With the ACT test coming up, we actually just did a test anxiety clinic last week.

Ben: Is it open to only people that go to Get Smarter Prep already or is it open to the general public?

Molly: This was the first one we did, and it was just Get Smarter Prep students, but I’m sure that outside people would be welcome to come.  There’s just a $25 fee.

Ben: Okay, so this is something that you guys are developing and working on, and it seemed successful this time?  There was a good turnout?

Molly: It did seem successful.  It seemed like the students really benefited from it.

Ben: There’s kind of two sides to being anxious about tests, the side where it’s impending and you’re stressed and you’re trying to learn as much you can before it comes.  Then for some people, afterwards there’s the anxiety of not having gotten the goal they strived for and being let down by or disappointed by their performance.  Can you maybe talk a little bit about the difference in the problems face on either side of the test?

Molly: Sure.  A lot of the students are getting the help they need in learning how to solve the problems on the exams and they feel confident in that aspect, but they really get freaked out about being timed and running out of time, and then there’s just this train of negative thoughts of like, what if I run out of time?  What if I fail?  Then I’m not going to get into the school I want to get into, and into my preferred profession.

Ben: It’s a compounding cycle?

Molly: Yes, it can go down this compounding hole of anxiety.  Same thing for after the test if they don’t get the score they were hoping for.  It’s almost like this sense of impending doom that now they can’t pursue the career that they want.

Ben: Yes, that their life is over.

Molly: Their life is over, even though they can really just go retake the test and go on with life.

Ben: Yes.  For some people, they feel like it speaks about them and tells people outwardly something they don’t want to convey.

Molly: That is absolutely true.  A lot of people equate their self-worth with how well they perform whether it’s on the test, or in sports, or relationships, or jobs, or whatever, so not getting a good score can actually make people feel pretty bad about themselves.

Ben: Yes.  There’s that misconception that the test score you get is a reflection of your worth, and those things are really completely exclusive.

Molly: Exactly, and that type of thinking really leads into depression and just feeling bad about yourself.

Ben: For some people that didn’t come to the clinic what could you recommend?  What are some tips that people can follow to get in their habitual nature that will help them avoid getting test anxiety or help them in reducing test anxiety?

Molly:  Anxiety is really a twofold issue.  There are the physical symptoms of anxiety, so when you feel like your breathing is getting short and shallow, and you might feel tingly.  You might feel butterflies in your stomach.  One thing you can do is deep abdominal breathing, which really calms your body and soothes the physical symptoms of anxiety. 

The other aspect of anxiety is the mental part of it.  It’s the thoughts, so if you’re thinking, oh my gosh, I’m so nervous.  I’m going to do horrible. I’m going to fail. That thinking is not going to be helpful, so you need to identify that negative thinking and change it into more positive and accurate thinking, such as I’ve prepared for this test.  I know what I’m doing.  It’s going to work out, and so forth.

Ben: Okay.  Do you have any recommended reading for people that need some encouragement, that need to help to and reinforce a better positive mental frame of mind before a test?  

Molly: Sure.  There’s lots of good reading out there on anxiety and changing negative thinking.  One book is the Anxiety and Phobia Workbook  by Edmund J. Bourne. Another good one is When Panic Attacks, which is written by David Burns, and he really does a lot in the treatment of anxiety and depression.  He’s pretty big in that world.

Ben: Okay, so that would be some good recommended reading?

Molly: Absolutely.

Ben: We will check back in with you soon so we can learn about some of the group work you’ve been doing over at the  Leawood Church of The Resurrection on the topics of depression and anxiety.  Thanks for your time, and we encourage our readers to check out your test anxiety clinic over at Get Smarter Prep as well as many of the services you offer.

Molly: Absolutely, and really, anyone struggling with anxiety, depression, marital issues can feel free to check out True Self Counseling to see if we might have services that are helpful for them.

Ben: Definitely. Thanks for your time, Molly.

Molly: Thank you.

People-Pleasing: Is it really such a good thing?

People-Pleasing: Is it really such a good thing?

Excerpts from The Disease to Please (Harriet B. Braiker)
Additional annotations by Molly Pierce, MA, LPC, NCC

Has anyone ever told you that you’re a people-pleaser?  Don’t be so flattered…it’s not really a compliment.  It feels better to view people-pleasing as an admirable attribute, rather than look at it for what it truly is: a serious psychological problem. 

In actuality, the “disease to please” is a compulsive — even addictive — behavior pattern in which you feel controlled by your need to please others, and addicted to their approval.  At the same time, you feel out of control over the pressures and demands on your life that these needs have created. 

The Disease to Please is comprised of three components: (1) People-Pleasing Mindsets, or distorted ways of thinking; (2) People-Pleasing Habits, or compulsive behaviors; and (3) People-Pleasing Feelings, or fearful emotions

People-Pleasing Mindset
If you fall into this category, your behavior is driven by a fixed thought that you need and must strive for everyone to like you.  You measure your self-esteem and define your identity by how much you do for others whose needs, you insist, must come before your own.  You believe that being nice will protect you from rejection and other hurtful treatment from others.  You impose demanding rules, harsh criticism, and perfectionist expectations on yourself in an attempt to gain universal acceptance from others.

People-Pleasing Habits
If you fall into this group, you are driven to take care of others’ needs at the expense of your own.  You do too much, too often for others, almost never say “no,” rarely delegate, and inevitably become overcommitted and spread too thin.  And, while these self-defeating, stress-producing patterns take their toll on your health and closest relationships, they maintain a firm grip on your behavior because they are driven by your excessive, even addictive, need for everyone’s approval.

People-Pleasing Feelings
Under this category, your behavior is primarily caused by the avoidance of frightening and uncomfortable feelings. You will recognize the high anxiety that merely the anticipation or possibility of any angry confrontation with others evokes.  (All you conflict avoiders out there — this is you!)  Your people-pleasing behaviors are primarily an avoidance tactic intended to protect you from your fears of anger, conflict, and confrontation.  These fears don’t actually diminish; they intensify as long as the avoidance pattern persists!  (Long story short: you have to face your fears in order to overcome them).  Because you avoid difficult emotions, you never allow yourself to learn how to effectively manage conflict or how to appropriately deal with anger.  As a consequence, you relinquish control too easily to those who would dominate you through intimidation and manipulation.

Living a life of people-pleasing is not the way to go.  Your self-esteem takes a massive toll.  Your identity and sense of self-worth is all tied up in how much you do for others and how successful you are at pleasing them.   It causes your relationships to lose their authenticity; If your niceness prevents you from telling others what is making you unhappy, angry, upset, or disappointed — or from hearing their complaints — there is little chance of fixing what has gone wrong.

Under the surface of your selfless niceness, resentment and frustration will begin to boil and churn, threatening to eventually erupt in open hostility and uncontrolled anger.  It takes a physical toll, as well.  It may come out in the form of migraine or tension headaches, back pain, stomach pain, high blood pressure, or any of a host of other stress-related symptoms.  You will eventually hit the proverbial wall with your energy exhausted and you’ll want to give up, not knowing what else to do.  In the end, your trusty habits of people-pleasing will fail you. So save yourself the trouble, and don’t spend your whole life living hostage to its ways.

Take Control of Your Anxiety

Take Control of Your Anxiety

Everybody deals with stress and anxiety at different points in their life. It’s normal to feel anxious or nervous before taking an exam, having a performance review at work, or when faced with a difficult decision. But when worry and fear consume your life or cause so much distress that it interferes with normal functioning, it begins to become a problem. More than 40 million American adults struggle with some form of an anxiety disorder, which is about 18% of the population in a given year.

There are many different types of anxiety disorders, including panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, social anxiety, phobias, and generalized anxiety.

Panic Disorder consists of sudden attacks of fear or nervousness, which are accompanied by physical symptoms, such as sweating and a racing heart. Most people with panic disorder develop a constant fear of having another panic attack, which impacts daily functioning and quality of life.

Obsessive-Compulsive Disorder consists of recurring and distressing thoughts, fears, or images (obsessions) which create anxiety, causing the person to perform certain rituals or routines (compulsions) in an attempt to make the obsessive thoughts go away. People with OCD often realize that their obsession-compulsion cycle is irrational, but they can’t seem to control it.

Post-Traumatic Stress Disorder develops after a person has witnessed or experienced a traumatic event in which harm occurred or was threatened. It causes intense feelings of fear, helplessness, shock, anger, nervousness, horror, and sometimes guilt. For people with PTSD, these feelings last for more than one month and cannot return to normal functioning as it was prior to the traumatic event.

Social Anxiety (also known as social phobia) is an intense, irrational, and persistent fear of being negatively evaluated by other people. Some people are just shy, but those with social anxiety can become completely overwhelmed in the context of a simple social situation. People with social phobia tend to be sensitive to criticism, have difficulty being assertive, and suffer from low self-esteem.

Phobia Disorder involves a persistent, excessive fear of a specific situation or object. Phobias are one of the most common types of anxiety disorder. The difference between a fear and a phobia is that people with a phobia are actually physically and/or psychologically impaired by it.

Generalized Anxiety is characterized by excessive worry about everyday life events – such as health, money, family, work, or school – with no obvious reason for it. People with generalized anxiety can’t seem to stop worrying and they live in a near constant state of worry, fear, or dread.

For people suffering from anxiety disorders, worry and fear are constant, overwhelming, and sometimes crippling. At True Self Counseling, we teach relaxation exercises and coping techniques so that you can effectively manage the stress in your life, rather than let it consume you. The choice is yours: you can let your anxiety control you, or you can take control of it.