Sunday, December 27, 2009

The Mindfulness and Acceptance Workbook for Depression

I began reading this book with the cynical expectation of being brainwashed by ACT (acceptance and commitment therapy). I relaxed some when in the middle of the book I read, “The type of acceptance we encourage you to practice is best thought of as a voluntary, intentional stance of nonjudgmental awareness of thoughts, feelings, memories, and sensations in the context of a triggering event.” By the end of the review, I absolutely loved the book. But I am quite certain I wasn’t brainwashed. Instead, I think it was the large focus on mindfulness with lots of engaging exercises that won me over.

The authors use a comprehensive definition of health that includes physical, psychological, and social aspects. The text itself is interesting in that it contains elements of ignorance, intelligence, poetry, insightfulness, creativity, superiority, and flaky triviality.

In the foreword the authors claim that, “Depression is not just a feeling. Depression is an action.” I would argue that depression is much more than either or both of those things. However, depression does affect action and action can likewise affect depression so both need to be ‘treated’ (by treating actions I mean learning healthy new behaviours and coping strategies).

There is a lot of talk of avoidance (presumably in order to contrast acceptance) of issues as being a root problem for depression. It is not uncommon for people with depression to avoid certain problems, but it is also common for depressed persons to be actively seeking solutions, only their illness clouds effectiveness. People with depression do try.

The ideas, at least in the first half of the book, are quite dichotomous. The book only has two options for thinking processes – wise mind and reactive mind – whereas I am more familiar with the three option approach – emotional mind, reasonable mind, and wise mind, which is a combination of the former two. There was actually a sentence at the end of a chapter implying that if the reader wasn’t ready to commit to change, they shouldn’t read any further until they are. I encourage readers to continue regardless as there are some beneficial exercises.

Many of the exercises in the book were insightful. I particularly liked the one where you get to write your own epitaph – “I should have separated the whites.” This type of individual engagement with understanding problems and solutions is likely to be more effective than simple fill-in-the-chart exercises.

It’s refreshing to see CBT ideas translated with a different vocabulary. An example of this is the ‘phishing’ metaphor used to help the reader identify problematic thinking. In CBT these same thinking types are recognised as ‘mind reading,’ ‘all or nothing thinking,’ etc. Plus, bonus points for using a computer metaphor leaning on the geeky side.

Final Rating: Very good.

Sunday, December 13, 2009

Heat Therapy

Heat is often used to treat pain associated with muscles and bones, but there doesn’t seem to be much research as to the psychological effects of thermal treatments. Undoubtedly though, warmth engenders anxiolytic effects. (An interesting note, heat therapy is commonly advertised as a treatment for anxiety, among other things, in dogs.)

One study directly related to the measure of psychiatric symptoms, found that people with mild depression who were exposed to thermal treatment (sauna and warm blanket in a warm room) had a greater reduction in psychological and physical symptoms (including appetite) than a control group.

In a 2008 study, researchers found that, based on the hypothesis that the insula is involved in processing both physical and psychical warmth, exposure to warm objects increased interpersonal warmness (generous, caring). The study design itself is quite amusing.

Other studies (1, 2) have found warm baths before bedtime reduced insomia and improved sleep in older adults and the elderly, respectively.

Suggestions on ways to warm up: sauna, bath, pocket packs, trip to the tropics, electric or regular fireplace, electric blanket, warm drink.

Things to be cautious of: burns, overheating/hyperthermia, dehydration.

It would be curious to see if a combination of heat and light therapy, such as in a tanning booth (you can wear sunscreen) had some adjunctive effect.

Thursday, December 10, 2009

Gifts for Someone Who is Depressed

This could be for the holidays or a special occasion or just because. The best gift is your support, but presents are nice too. The following list is compiled from ideas I found on the interweb and my own ideas. There are of course many wonderful gifts you could give to any person, but I tried to make this more specific for depressed people by choosing gifts that are not only presents, but will enhance their life in a healthy and positive way.

* Ask them to do something healthy for you -bake a cake, make a cd, play a song if they play an instrument. Some people might be more willing to engage in activity if they’re not concerned about the cost/benefit to themselves. Eventually, an individual has to choose to things by and for themselves, but a little help getting started can go a long way.

* Make them some homemade food. Self-care can be difficult when depressed and appetite particularly can fluctuate. Having nutritious, wholesome, and comforting food at hand can make the difference between a person eating or not.

* Pretty paper or a nice journal. There can be a lot of CBT homework and scheduling; having some brightly coloured paper might encourage someone to fill out their 3 positive events for that day, for example.

* A day out. Ask them to go for a walk with you. Take them to a movie or concert. Bear in mind, they might not be in their best mood. So don’t necessarily expect the outing to be overly joyous, but do know that even if it seems you are only helping a small amount, that amount can be greater to your guest. In short, don’t put expectations on them to respond in a particular way.

* A plant or pet. Things like pets you need to be careful with; they might not have the energy to train a puppy. Something like a Siamese fighting fish might be more appropriate. Sometimes when a person is depressed they can be resistant to caring for another person/thing. If the gift dies, don’t be angry. Offer whatever emotional support they need to take care of this new thing; it might seem a simple skill, but even the easy stuff gets difficult in difficult times.

* Something comforting such as a blanket, stuffed animal, new socks, or hot chocolate packages.

* A picture (or pictures) of them by themselves or with someone else doing something memorable. It’s easy to forget that you were ever happy when you’re depressed.

* Money, gift cards, or offer to pay bills. That alone can alleviate a lot of stress.

* Adopt a child or endangered animal in their name. Encourage them to write letters to the child or stay updated with conservation through the newsletters that are mailed to sponsors.

* Enroll them in a class. Exercise is extremely good and an activity like yoga could help with mindfulness while they exercise. But any class (cooking, academic) that encourages social activity and skill building is good.

* A book. But a positive book, not one with a sad story and a sad ending. Self-help books are also an option, but these can be personal. Give them the opportunity to tell you it’s not quite the right book, but they would like something similar.
Garth Kroeker has a good reading list.

* Music. This can be given either as a cd/mp3 or an instrument. I recommend Glenn Gould’s 1955 recording of the Goldberg Variations.

* A light box. Very helpful for seasonal as well as chronic depression.

* A comedic dvd or cd.

It might sound cynical, but when giving a gift that involves the receiver and another person, be sure they like that other person. The thought always counts, and they will most likely appreciate the gesture, but it’s also nice to have something tangible. I don’t mean this to sound materialistic, most of the above suggestions can be done at little cost, only that concrete reminders of healthy times/relationships can last longer than thoughts which can become easily distorted or forgotten by the depression. The other option is to let them choose their companion (for example, give them two movie tickets, but don’t suggest they have to take you. Do encourage them however, to take someone. Adding a social activity to a pleasurable one can make it that much better.).

*** Avoid things like alcohol

* This site has some humourous gifts, but exercise caution when practicing irony.

Friday, December 4, 2009

Psychiatry Blog Novels

I’ve been trying to put together a collection of blog novels directly related to psychiatry. Unfortunately, my ability to use a search engine is embarrassing and so far I’ve only found two such books. But I know there must be more, so if anyone has any suggestions, please feel free to comment.

1. ‘The Goose That Laid the Golden Egg’ a Twitter novel about a psychiatrist who takes on a multibillion dollar drug co and finds his mother along the way.

2. ‘In the Absence of White Rabbits’ examines in great detail one woman's relationship with her psychosis, psychiatrist, and imaginary friends.