Watch this video with Dr. Dawn-Elise Snipes to learn a bit more about depression.
Note: If you are feeling suicidal or your depression is severe, contact a health professional immediately or dial 911 to be taken to your nearest emergency room. Online videos are not a substitute for the assessment and advice of a licensed healthcare professional.
Watch this video with Dr. Dawn-Elise Snipes to learn a bit more about depression.
So often we get stuck in the shoulda, coulda, woulda trap without even knowing why. Who said you should have been a lawyer instead of a teacher? Who said you could have been a millionaire, but instead you chose to be a cop. What makes you thing that you would have done anything differently? Shoulda, coulda, woulda, but didn’t. Through listening to our parents, teachers, friends and the media, we develop a litany of “Shoulds” in our head. Most of the time we take these things at face value without even asking ourselves if we believe it is something we should do, or if it is just something others are trying to convince us we should do. When we start to get depressed or stressed out, often it is because of all of the things we are telling ourselves we should be doing, but are not. For example, there used to be a commercial in which a very pretty woman sang about being able to bring home the bacon, fry it up in the pan and never let you forget you’re a man. In reality, how many women can work a full time job, do all of the house chores, errands and cooking and handle the bedroom as well without getting stressed out? Very few. Unfortunately, many women in the 70s and 80s grew up believing that they “should” be superwomen, able to be everything to everyone all of the time.
There are times when we are unable to do things and we wish we could have. However, many times these things we “should” have done are simply overly high standards or goals someone else has tried to convince us that we care about. If you are going to beat yourself up over something you “shouda” done, then at least make sure you are the one that believes that and why. Try filling in the following statements: “I believe I should have done this because ______. The fact that I did not do it means that I am _________.” If you can fill in that statement with something that is reasonable and true, then move to the next step. If you cannot complete the exercise with reasonable answers, then you have to ask yourself why you are beating yourself up for something that really does not make that much difference anyway.
There is a basic principle that we do the things that are most rewarding (and least painful). Sometimes there is something that you truly believe you “should” do, like going on a walk instead of eating another piece of chocolate cake. If it is something that you really want (as opposed to something someone else tells you to do), then the challenge becomes figuring out how to make the desired activity(exercise) more rewarding than what you currently are doing (eating cake).
The first step is to do what we call a decisional balance exercise. Identify the pros and cons of eating a second piece of cake and the pros and cons of exercise. It is important to make the pros of exercise and the cons of eating cake strong arguments for exercise. If you need to, add incentives. For example, under the pros of exercise, say that you will get to go buy a new outfit every time you successfully complete 20 miles of walking (over multiple days of course).
So, to sum it all up. Identify what is important in your mind to do and why. Those are the goals you focus on. The rest of it can be delegated, ignored or compromised.
The quantity and quality of sleep people get each day significantly impacts their mood. Think about the last time you were exhausted (maybe the last time the time changed?) Did everything take a lot longer to get done? Did you lack motivation to do much of anything? Were you all but mainlining caffeine to stay awake? Was it difficult to make decisions or remember anything? Okay, point made. Despite the fact that it forms the foundation of our mental and physical health, all too often, the first things people forego are sleep, exercise and nutrition. When people are awake, their energy is diverted across a wide spectrum of activities. When they sleep it is a time for their bodies to focus all of the energy on rejuvenation and repair. Not only repair of things that are broken, but also restocking the supply of neurotransmitters that produce feelings of relaxation and happiness.
When people sleep it is also the time for the body to focus on building immunity. When I was in college I used to stay up cramming for exams the entire week of finals. As soon as finals were done, it seemed inevitable that I would be sick. Coincidence? I think not. I don’t know about other people, but when I am sick, I am not so pleasant to be around, I lack motivation and feel like I am in a fog. Sound familiar? Yup, being sick and sleep deprived have a lot of things in common.
What about nutrition. Did you know that the symptoms of dehydration and depression are very similar—fatigue, confusion, constipation, loss of appetite… Similar things happen when blood sugar levels drop. My husband is hypoglycemic, and I can tell when he has not been eating right. He gets irritable, sluggish, has difficulty hearing and processing what I say and tends to seek caffeine and processed sugar to keep him going.
So what is the point? Simple changes in people’s lifestyles can have a huge impact on their mood, motivation and ability to be on their game. When they are rested and nourished, they will have more energy to be motivated, sociable and focus on the positive, and will need less energy to concentrate, make decisions and get things done. All that combined can be a great stress relief.
TIPS for GOOD SLEEPING
- Don’t eat right before bed. Drink a small glass of milk or water if necessary
- Keep a note pad, pencil and small lamp next to the bed. When something pops into your mind, write it down
- Keep the bedroom a comfortable temperature
- Try to make it as dark as possible
- Make a wind-down routine each day to cue your body to start releasing melatonin. We do it for children, why not for ourselves.
- Minimize annoyances. One of our dogs licks the sheets incessantly. She cannot sleep on the bed anymore.
- Reduce (or eliminate) caffeine 12 hours before you want to sleep. Yup. It stays in your system that long.
- Try stretching, meditation or partner massage to relax your muscles and work out the tension knots from the day.
- Drink plenty of water, but not right before bed.
- Cammomile and lavender essential oils can help calm you.
- Try creative visualization. When I am trying to get to sleep, I plan my garden or some other interior or exterior decorating project. It diverts my mind from stressful thoughts, and before I know it, I am asleep.
TIPS for GOOD EATING
- Keep a water bottle with you
- Eat small meals every 3-5 hours
- Drink 4-8 oz of water before each meal. It will help you get your water intake as well as fill you up a bit
- Eat colorfully–at least 3 colors on every plate.
- Fiber, protein and fats help slow down sugar absorption. Try to combine foods to prevent a spike (and crash) in blood sugar.
- Use a salad plate instead of a dinner plate
- Put back half. Only serve yourself 1/2 of what you would normally. Often you will find that is just as satisfying, and it saves a bunch a of calories.
Executive Order 12968, Access to Classified Information, states that “no negative inference concerning eligibility for access to classified information may be made solely on the basis of mental health counseling.” Further, seeking professional care for mental health issues is a positive course of action that, by itself, will not jeopardize security clearance.
PTSD impacts the lives of people directly and indirectly on a daily basis. It causes great physical, emotional and mental distress in the person who has it, and it also takes its toll on the people around them. I want to start by emphasizing that PTSD is a normal reaction to an abnormal situation. Let’s take a look at what PTSD really is and what you can do to deal with it. In the simplest sense, PTSD or Post Traumatic Stress Disorder can result when a person experiences or witnesses a horrific event over which they have little or no control . While it is important to remember that not everyone who experiences such an event develops PTSD, some people will. Further, if the event is repetitive such as may occur in war, child abuse or law enforcement, then the chances for PTSD to develop increase dramatically. People are just not meant to experience that level of horror on a regular basis.
But what IS PTSD? It is a cluster of symptoms which is thought to result from changes in the traumatized brain. Why is this important? Because it is vital for those with PTSD and their loved ones to realize it is not just something they can “snap” out of. It is not “just” a nightmare, and they are not “crazy.” It is somewhat interesting though to consider the symptoms of PTSD and assess how they represent the mind’s best attempt at coping and protecting the body and itself.
- Re-Experiencing the traumatic event, intrusive memories, flashbacks, night terrors
- Okay, this part really sucks, but why does it happen? It is possible that the brain is trying to assimilate something that it does not know how to deal with. It is also possible that these memories are coming back as the mind’s way of saying “Okay, that was awful. Make sure we don’t do that again.” When faced with a traumatic event, our natural response is to fight or flee. When you can do nothing, your mind cannot figure out what to do with that…which brings us to…
- Avoidance of Reminders of the Trauma
- Like reminders of pleasant things bring back pleasant memories, reminders of the trauma bring back memories of the horror and helplessness. So, yeah, it is natural to avoid reminders of the trauma. Unfortunately, reminders come in sights, smells, places, people, dates, noises etc. Eventually avoiding these things can lead the person to avoid leaving the house or sobering up.
- Subjective Numbing.
- The trauma and its effects have overwhelmed your coping skills and permeate most areas of your life. Even if you had enough energy to be happy, it just hurts too much to feel anymore. Some people just turn it all off and simply exist. Others use substances or other activities to forget or numb the pain. This numbing prevents husbands from “connecting” with their wives, parents from being emotionally available to their children and often is one of the biggest culprits for relationship problems. “He’s just going through the motions.” “He does not seem to care about anything anymore.”
- Hypervigilance, feeling jumpy and easily startled
- Many of us know people who seem to be like robots with extra sensitive sensors. They do not seem to feel anything, but they always seem to be aware of everything that is going on. For people with PTSD, they cannot relax. They are always on guard—even when they are sleeping. If you have ever taken care of a group of toddlers, you might begin to grasp how exhausting it can be to always have to be “on.” This exhaustion can negatively impact relationships that can be supportive, can increase the flashbacks and can lead to a greater sense of helplessness and irritability. In extreme cases, people can become paranoid, reclusive and overprotective. I see this a lot in law enforcement officers. One deputy once told me, “After a while, I just assumed the worst out of every black male between the ages of 18 and 25. I could be out with my family and see someone matching that description and suddenly be in cop mode. Heck, I cannot go to Home Depot without bringing my gun. ”
- Increased anxiety and emotional arousal, difficulty sleeping, concentrating, irritability and anger outbursts
- Think back to the last time you were sick or exhausted—maybe right after you brought junior home from the hospital? Were you more emotional? Did seemingly silly things stress you out? Did you get Mommy-Brain—The inability to remember more than 1 thing at a time for more than 5 minutes? All of these things can happen when you are tired. The mind itself is mounting a fight or flee campaign. It is trying to force you to get some rest. It is telling you it cannot handle one more thing (hence the Mommy-brain). When we feel this way and try to fight it, we get irritable. We often feel like we “should” be doing _____. However, we just cannot seem to get it together enough to do so. We get frustrated with ourselves and often lash out at others. (We also might be inadvertently pushing people away to stop them from putting any demands on us).
Okay, so we can see how these symptoms may be the mind’s way of protecting us, but how do we fix it. People with PTSD cannot live in a state of exhaustion and hyperarousal forever. The first step for many people is finding a way to reduce their anxiety and hypervigilance enough that they can get some sleep. Although I have known some people to push through the early stages of recovery without medications, a short course of something like Zoloft and/or BuSpar may be in order. I try to encourage people to stay away from super intense benzodiazepines like Valium or Xanax because they are highly addictive, and people with PTSD are at high risk for developing substance use issues. Other things that help are limiting caffeine or alcoholic beverages after 2pm, drinking plenty of water, exercising and setting a routine so your body knows when it is time to sleep and when it is time to be awake.
The second thing we work on is developing a strategy for handling reminders of events and flashbacks. I encourage people to know what situations are likely to trigger flashbacks and prepare before the storm. For example, one person I worked with was a trooper who watched a trucker burn alive, trapped in the cab of his truck. We talked about how hearing the tones for a priority call, driving on the interstate, smelling gasoline fumes and seeing semis could all trigger flashbacks for him. Likewise we practiced something called systematic desensitization in the office, so encountering these things would not be so overwhelming.
Systematic desensitization involves gradual exposure to a stimulus until the point people are feeling anxious or agitated. Then they are coached through a calming sequence. For many the calming sequence is a phrase or set of phrases to help them get control back. Over time, the stimulus arouses much less of a reaction. Think about the first time you asked someone out on a date. It was terrifying, but you told yourself that you could do it. Each time after that it got a little easier. Or, remember the first time you hear the tones for a hot call when you were a rookie—tunnel vision right? But after your 5th year on the force, tones aroused no more of a reaction than your morning alarm clock. Same principle here. Once people have practiced talking themselves down a few times, then when it happens in real life, they can more easily identify what is triggering them and talk themselves down.
Now this is not the end of treatment by any means. It is only the beginning. The above suggestions are simply those steps that can be taken to help you get on level ground so you can start dealing with the trauma. Oh, and for any counselor types reading this…some people prefer the word “reaction” to “feelings.” If you find that your patient is not responding well when you ask about how he felt in a situation, ask what his reaction was.
Good luck and stay tuned for more mental health tips.