It remains a topic few health professionals want to discuss openly with their patients. It remains a topic avoided even by many mental health professionals. Policy makers see it as a black hole without an obvious solution.

And now grim new statistics confirm a disturbing trend — more people are taking their own lives than ever before in the U.S.

The U.S. Centers for Disease Control and Prevention released statistics yesterday showing that 33,687 people died in motor vehicle accidents, while nearly 5,000 more — 38,364 — died by suicide. Middle-aged Americans are making up the biggest leap in the suicide rate.

It’s data that should make us sit up and think.

The New York Times has the story:

From 1999 to 2010, the suicide rate among Americans ages 35 to 64 rose by nearly 30 percent, to 17.6 deaths per 100,000 people, up from 13.7. Although suicide rates are growing among both middle-aged men and women, far more men take their own lives. The suicide rate for middle-aged men was 27.3 deaths per 100,000, while for women it was 8.1 deaths per 100,000.

The most pronounced increases were seen among men in their 50s, a group in which suicide rates jumped by nearly 50 percent, to about 30 per 100,000. For women, the largest increase was seen in those ages 60 to 64, among whom rates increased by nearly 60 percent, to 7.0 per 100,000.

What’s the cause of the rise in suicides in this country? Nobody can say for sure, but the CDC officials have some ideas:

But C.D.C. officials cited a number of possible explanations, including that as adolescents people in this generation also posted higher rates of suicide compared with other cohorts.

“It is the baby boomer group where we see the highest rates of suicide,” said the C.D.C.’s deputy director, Ileana Arias. “There may be something about that group, and how they think about life issues and their life choices that may make a difference.”

The rise in suicides may also stem from the economic downturn over the past decade. Historically, suicide rates rise during times of financial stress and economic setbacks. “The increase does coincide with a decrease in financial standing for a lot of families over the same time period,” Dr. Arias said.

Another factor may be the widespread availability of opioid drugs like OxyContin and oxycodone, which can be particularly deadly in large doses.

Men continue to prefer using a firearm to kill themselves at a rate far higher than all other methods combined (suffocation comes in a far second). Women prefer, instead, to poison themselves, followed by the use of a firearm. Suffocation (predominantly hanging) has risen as the new preferred method for committing suicide, rising 75 percent among men and 115 percent among women in the ten years studied.

Because the reasons for most people’s suicides are fairly complex, targeting new prevention methods and public educational campaigns to this problem is difficult. While suicide is most often the result of untreated or undertreated depression, getting more people who are suicidal to seek out treatment (or enhanced treatment) remains a challenge.

That does not mean we shouldn’t try, however. If anything, such reports point to the need of a redoubled effort to helping those in desperate need of intervention. Suicide is preventable, if only society put forward more effort to care and reach out to those in need. And not through the use of bandaid suicide crisis hotlines, but through the greater access of compassionate mental health treatment.

Read the article: Suicide Rate Rises Sharply in U.S.

Read the CDC Report: Suicide Among Adults Aged 35–64 Years — United States, 1999–2010

How then later did I come to embrace cognitive behavioral and related therapies that spell out that we are, essentially, just a mess of behaviors (good and bad)?

If you dig into your family dynamic, and maybe establishing relationships with others from equally dysfunctional backgrounds, you are bound to have a change of heart about old Skinner. Maybe there is something to behaviorism after all, and it can jibe with the deeper therapies that ask you to reflect on early places of pain and identity-molding.

Dialectical Behavior Therapy (DBT) is particularly of interest not just to me, but folks trying to come to grasp with certain subsets of mental illness — borderline personality disorder, bipolar and other depressive disorders. But its principles can be significantly farther-reaching than mental illness circles alone.

There are 4 critical components to the DBT methodology. The categorical names alone should conjure hope for those suffering from mental illness symptoms and individuals afflicted with interpersonal issues at home and in workplace: mindfulness, interpersonal effectiveness, distress tolerance and emotion regulation.

Any reader of Daniel Goleman’s Emotional Intelligence, with an introduction by the Dalai Lama, knows that mindfulness is at the core of human attempts to find balance and centeredness in our own body, as well as connection to others. Nothing is more key for individuals with beginner-level trust in family or therapists or slowly-developing insight into dysfunctional ways of relating to colleagues.

Interpersonal effectiveness involves “strategies” — practical, effective means of dealing with thought, mood and behavioral maladjustments. Yes, actual skills are taught, driven by goals for different situations. (Sound like business counsel?) This is invaluable to those with borderline personality disorder, who “possess good interpersonal skills in a general sense” but are unable to have self-insight to get past “problematic situations” when stress hits.

Now, what better need do we have as humans than to develop distress tolerance? It can help us in our workplace, for ill loved ones, and for ourselves when debilitated by depression, addictive thoughts, or the surfacing of manic traits. This is integral to DBT’s beauty. As in Alcoholics Anonymous, where people are encouraged to discern between what can be changed and what can not, distress tolerance skills involve “the ability to accept, in a non-evaluative and non-judgmental fashion, both oneself and the current situation.”

The heart of helping ill individuals and ourselves lies, I believe, in letting this mindset seep in, allowing for gentle, passive strength. (Not to mention that this simple maxim is a behavioral powerhouse when artfully practiced and applied, and can profoundly affect our professional, family and social life.) “Self-soothing” and “pros and cons” work are two tactics in the distress tolerance strategy, one whose benefits to mentally ill family systems can certainly be equally applied to the needy masses of a larger society.

The last outlined DBT component is emotion regulation, so critical to disorders such as bipolar, where emotional intensity and stress make for frequent anxiety. But we all have encountered situations with bosses and friends that contain these elements. How do we identify obstacles and triggers, and then work on changing emotional patterns? And can we increase positive emotional experiences? Like the mouse after his cheese, is it not possible to stack the deck a certain way in families, in the workplace and within the mental health system so that the satisfaction of getting a little more of that nibble — stability, harmony, collaboration — can happen more effectively and more often?

Want to learn more about dialectical behavior therapy?
Follow our blog, Dialectical Behavior Therapy Understood or read the article, An Overview of Dialectical Behavior Therapy.

Proper treatment doesn’t suppress emotions or dull a person’s ability to feel things deeply. It builds a protective layer — an emotional resilience — to safeguard a depressive from becoming overwhelmed and disabled by the difficulties of daily life.

However, the tools found in happiness research are those I practice in my recovery from depression and anxiety, even though, theoretically, I can be happy and depressed at the same time. I came up with my own recovery program that coincides with the steps toward happiness published in positive psychology studies.

1. Sleep

Sleep is crucial to sanity because sleep disturbances can contribute to, aggravate, and even cause mood disorders and a host of other illnesses. The link between sleep deprivation and psychosis was documented in a 2007 study at Harvard Medical School and the University of California at Berkeley. Using MRI scans, they found that sleep deprivation causes a person to become irrational because the brain can’t put an emotional event in proper prospective and is incapable of making an appropriate response. Chronic sleep deprivation, especially, is bad news. It often affects memory and concentration. And, according to one recent study, it can cause a decline in cognitive performance similar to the intoxicated brain.

2. Diet

My mouth and brain are in constant negotiation with each other because while one loves white bread, pasta, and chocolate, the other throws a hissy fit whenever they enter my blood stream. My diet has always been an important part of my recovery from depression, but two years ago — after working with the naturopath and reading Kathleen DesMaison’s “Potatoes Not Prozac” — I could more competently trace the path from my stomach to my limbic system. Moreover, I recognized with new clarity how directly everything that I put in my mouth affects my mood.

Here are the bad boys: nicotine, caffeine, alcohol, sugar, white flour, and processed food — you know, what you live on. Here are the good guys: protein; complex starches (whole grains, beans, potatoes); vegetables; vitamins (vitamin B-complex, vitamins C, D, and E, and a multivitamin); minerals (magnesium, calcium, and zinc); and omega-3 fatty acids. I’m religious about stocking up on omega-3 capsules because leading physicians at Harvard Medical School confirmed the positive effects of this natural, anti-inflammatory molecule on emotional health.

3. Exercise

Dr. James A. Blumenthal, a professor of medical psychology at Duke University, led a recent study in which he and his team discovered that, among the 202 depressed people randomly assigned to various treatments, three sessions of vigorous aerobic exercise were approximately as effective at treating depression as daily doses of Zoloft, when the treatment effects were measured after four months. A separate study showed that the depressives who improved with exercise were less likely to relapse after 10 months than those treated successfully with antidepressants, and the participants who continued to exercise beyond four months were half as likely to relapse months later compared to those who did not exercise.

Even as little as 20 minutes a week of physical activity can boost mental health. In a new Scottish study, reported in the British Journal of Sports Medicine, 20,000 people were asked about their state of mind and how much physical activity they do in a week. The results showed that the more physical activity a person engaged in — including housework, gardening, walking, and sports — the lower their risk of distress and anxiety.

Exercise relieves depression in several ways. First, cardiovascular workouts stimulate brain chemicals that foster growth of nerve cells. Second, exercise increases the activity of serotonin and/or norepinephrine. Third, a raised heart rate releases endorphins and a hormone known as ANP, which reduces pain, induces euphoria, and helps control the brain’s response to stress and anxiety. Other added benefits include improved sleep patterns, exposure to natural daylight (if you’re exercising outside), weight loss or maintenance, and psychological aids.

4. Relationships and Community

We are social creatures and are happiest when we are in relationship. One of the clearest findings in happiness research is that we need each other in order to thrive and be happy, that loving relationships are crucial to our well-being. Relationships create a space of safety where we can learn and explore. Belonging to a group or a community gives people a sense of identity. Studies indicate that social involvement can promote health, contribute toward faster recovery from trauma and illness, and lower the risk of stress-related health problems and mental illness.

Plenty of evidence indicates that support groups aid the recovery of persons struggling with depression and decrease rates of relapse. The New England Journal of Medicine published a study in December 2001 in which 158 women with metastatic breast cancer were assigned to a supportive-expressive therapy. These women showed greater improvement in psychological symptoms and reported less pain than the women with breast cancer who were assigned to the control group with no supportive therapy.

Another study in 2002, published in the American Journal of Psychiatry, followed a group of more than 100 persons with severe depression who joined online depression support groups. More than 95 percent of them said that their participation in the online support groups helped their symptoms. The online groups here on Psych Central are a great resource where you can find support from people going through similar struggles.

5. Purpose

The father of positive psychology, Martin Seligman, explains in his book, “Authentic Happiness,” that a critical element to happiness exists in using your signature strengths in the service of something you believe is larger than you. After collecting exhaustive questionnaires he found that the most satisfied people were those that had found a way to use their unique combination of strengths and talents to make a difference. Dan Baker, Ph.D., director of the Life Enhancement Program at Canyon Ranch, believes that a sense of purpose — committing oneself to a noble mission — and acts of altruism are strong antidotes to depression. And then there’s Gandhi, who wrote: “the best way to find yourself is to lose yourself in the service of others.”

6. Gratitude

Gratitude doesn’t come easily to me. When my girlfriend sees a half-full glass of fresh milk, I see a half-empty glass of cholesterol-rising, cardiac-arresting agents. And when the kids’ school is called off because some road somewhere in our county apparently accumulated a half of an inch of snow, she thanks God for an opportunity to build snowmen with she kids. I have a conversation with God, too, but it’s much different.

However, I train myself to say thank you more often than is natural for me because I know that gratitude is like broccoli — good for your health in more than one way. According to psychologists like Sonja Lyubomirsky at the University of California Riverside, keeping a gratitude journal — where you record once a week all the things you have to be grateful for — and other gratitude exercises can increase your energy, and relieve pain and fatigue.

Shameless plug! Join me at one of three private screenings of “Happy,” a film that explores what makes us happy, followed by a discussion on depression and happiness and a book signing. Click the following links for more information:

When we function in a healthy manner, we don’t just experience joy and happiness, prancing around without a care in the world. We actually still experience a range of emotions, some of which can be very difficult to live with.

It’s absolutely healthy to feel anxiety, depression, anger, jealousy, envy, guilt, hurt or shame. But what makes experiencing these emotions healthy is that we don’t linger in them for longer than is good for us. We don’t demand that they ‘go away.’ We accept the appropriateness of how we feel, and do something about our situation.

Let me give you an example of how a person’s thinking can perpetuate depression.

Imagine that your favorite dog was very sick and you took her to the vet, who tells you she’s in a lot of pain and it’s best to euthanize her. How do you think you might feel? Very sad (most likely), guilty (perhaps), happy (to some degree if you know you can stop her suffering). So, do those emotions seem healthy and appropriate to you? Of course they do, and to experience them is human.

Given the choice, you may not have wanted to face that situation in the first place, but we can’t always pick and choose what happens to us in life. We can only choose how we deal with those situations when they arise.

So how could a person drive themselves into depression after such an event? It’s easy. When a person feels sad about a loss or death, if they start taking far too much responsibility for what happened and judging themselves negatively, then depression will be only a short taxi ride away. The kind of thinking that perpetuates depression will be thoughts such as “I’m such a bad person for killing her,” “I should have done more to make her life happy,” “I should have taken her to the vet sooner and I would have saved her.”

None of those statements is wholly true, yet when you repeat them, you start to believe it and you feel depressed. You’ll even start acting depressed. Instead of going out for a walk, which you used to enjoy, you might stay at home watching TV, because ‘there’s no point in going out without your dog.’ You might even stop socializing with other dog walkers and so you’ll become more isolated, which perpetuates the problem.

So from a healthy sadness about the loss of a loved pet, with unhealthy thinking and behavior, your mood sinks into depression. And once there, it is a lot harder to get out of than when you’re healthily sad.

Anxiety, on the other hand, is depression’s opposite. Rather than dwelling on the past, people with anxiety tend to focus on the possible threat in the future, and employ defensive mechanisms against that perceived threat or problem. Let me give you another example.

Frank gives a presentation at work that doesn’t go down well with his boss. Frank gets shouted at and bawled out for not doing a good enough job. His boss also tells him that he must improve before the next presentation or else! How do you think you might feel? Disappointed (sure). Frustrated (maybe). Concerned (oh yeah).

So how does Frank perpetuate his anxiety? The first thing he does is to fly into the future and use ‘what if’ and ‘if…then’ type thinking. “If I deliver another bad presentation, then my boss will fire me.” “What if I can’t do it the way he wants?” “What if I’m terrible?”

These ‘what if’ thoughts are the precursors to the unhealthy demands that lead to anxiety: “I must know that the presentation will go well.” “I must not screw up the presentation or my boss will fire me.” “I must be perfect.”

The trouble with these irrational demands is that they lead to anxious behaviors: spending hours on the presentation; not sleeping; seeking others’ opinions; asking for reassurance; feeling nauseous beforehand; sweating; feeling ill at ease.

Clearly, Frank is not in a good state to be giving a presentation. He’ll most likely deliver a sub-par presentation. What do you think will happen next time he needs to give a presentation? He’ll feel worse.

To end these destructive cycles, we need to understand that emotions — even the difficult ones — are healthy. Emotions should be used as a guide to let us know that something is off-balance and might need changing. When we demand unreasonable things from ourselves, we’re destined to feel strong, unhealthy emotions.

It’s a thin line between healthy and unhealthy emotions, but by understanding how our thinking perpetuates our emotional disturbance, we can become a healthier version of ourselves.

It then shows the man sitting in the cabin, waiting to die.

A few frames later, the garage lights come back on, and the man opens the garage door. The tag line is, “The New ix35 with 100% water emissions.”

Yes, very tasteful. Maybe if you were brain and dead and haven’t been alive for the past three decades. Nothing like making fun of people with mental illness, clinical depression, or a disability, is there Hyundai (and Innocean)??

Warning, we’ve included a copy of the video below. Do not continue on if you don’t wish to watch it.

I can imagine some of the other ideas that Hyundai and Innocean are also discussing right now:

• A cancer patient is shown dying in a hospital bed, and asks for one last drink of water. They wheel her out to the ix35′s exhaust pipe and instruct her to drink away.

• Lawn need watering? Just start up the ix35 and continually drive it around the yard, letting the water from the tailpipe drip onto the grass.
• A poor family is shown holding their cupped hands under the ix35′s tailpipe, dying for a drink of water.

Here’s the offensive video. You’ve been warned, so don’t view it if someone you know has died by suicide in this manner:

This ad has particular poignancy for me — and I suspect tens of thousands of other people around the world — as I knew someone who took their life via this method. Rob was my childhood best friend, and one of the primary motivations for me going into public education and advocacy as my career rather than providing individual psychotherapy to patients. He died November 8, 1990, and his death is a memory that I’m reminded of nearly every week as I work on the resources that go to make up this site.

Seeing such a vivid depiction of the end of a man’s life — to sell cars no less — is not just in poor taste. It is thoughtless, and even mean-spirited. As though human life is worth so little, we can demonstrate someone failing at taking their own life to help promote the attributes of this stupid pile of metal. A Hyundai.

Criticism of the Hyundai Video

The Hyundai ad is incomprehensible in an age where we are finally making inroads in the public understanding of mental illness… Of reducing the discrimination and prejudice against those who have one. A depiction of suicide in the media — even when reporting on a news item — can up the rate of suicides temporarily, referred to as suicide contagion. Did the ad agency who produced this ad even know that? Did they care?

Does it make a point? If one can get past the gruesome darkness of the ad, I suppose the point that you can’t kill yourself in this particular Hyundai is noted. But really? Out of all the options you have to demonstrate a car’s eco-friendliness, this is the one you go with?

Hyundai North America is distancing itself from its European counterparts with this statement:

We at Hyundai Motor America are shocked and saddened by the depiction of a suicide attempt in an inappropriate UK video featuring a Hyundai. Suicide merits thoughtful discussion, not this type of treatment.

Further criticism and commentary can be found over on this article by Matthew Herper, Update: Hyundai North America Disavows ‘Particularly Graphic And Dangerous’ Car Ad.

I just have to shake my head that this ad got through multiple levels of management review and approval in two different companies. Everybody probably was congratulating themselves on producing an “edgy” or “thought provoking” ad — while trying to sell pieces of steel on wheels.

There’s something strangely comforting in looking at these lists and hoping that our life problems can be boiled down into five simple steps. I read them hoping for the answers, because I too want the secret to life, the universe, and everything.

However, I think the reality is this: As much as some lists offer interesting ideas, the majority mislead people about change. They offer false hope instead of facts. They generally encourage people to think their lives can be simpler if only they do those five secret things that may have worked for another person.

Come on, really? Life is so complex and the reasons why we feel and do what we do also are complex.

Take depression, for example. The reality is nobody really knows why people feel depressed; and nobody really knows what will cure each individual’s depression. When talking about cause and effect, there are so many factors to take into account: cognitive, environmental, social, biological.

What we do have is good empirical evidence that some therapies can help some people overcome depression. But that doesn’t mean everyone will overcome it through therapy. I’ve worked with many people and, for whatever reason, they remain depressed and sometimes become even more depressed. When that happens, the focus of therapy changes to learning to live with being depressed. No list is going to change that.

We know that medication can help. But it doesn’t help everyone. More often than not, medication is guesswork — an art more than a science. What works for one person can make another person sick. I’ve seen some people recover in a matter of weeks, and others poisoned to the point of hospitalization. Where’s the five-point list on that one?

Advances in neuroscience are helping us understand the brain and how it works. Yet, even super-intelligent scientists with the most sophisticated technology don’t fully understand what is causing depression. So, can a five-point list really tell us how to overcome it?

It’s clearly frustrating not knowing the secret to being well. As a therapist and coach, it’s my job to help somebody get well, so it’s easy to hope a list will provide me with the secrets that’ll help me and the person I’m working with.

But many lists just don’t cut it. I was reading a list on procrastination the other week and the first thing on the list was something like ‘just do it.’ I can imagine all the people who procrastinate reading that and thinking, “Wow, that’s amazing. Why didn’t I think of that?”

OK, I’m knocking these lists, so I must know all the answers, right? Nope. I wish I did but unfortunately I don’t (please don’t tell my wife I said that). With that being said, I will now counter everything I’ve just written and offer you my own secret five-point list to life, the universe and everything.

1. You are personally responsible for all that you think, do, and (mostly) feel.
2. Accept reality: Life doesn’t owe you a thing.
3. You are you. Nobody can ever know what it means to be you, so be kind to yourself and others.
4. Life is meaningless, except for the meaning that you give it — so use that power wisely.
5. Nobody has all the answers. We’re all just making stuff up as we go along, hoping for the best.

One of those things was eat ice cream. A lot. So I gained a few pounds. It was time to buy new pants anyway. The only important thing was that my medicine was working and I was feeling good. I felt like participating in my life again. Feeling good and eating ice cream were natural.

But then I broke the couch.

Maybe it was a coincidence that I was the one whose bottom touched the couch and made it go POP and collapse. But it had occurred to me, in that moment I felt the couch break underneath me, that I had gained a lot of weight. And that was enough to tell me that all this weight gain was starting to bother me.

I finally realized that as my mood had gone up, so had my weight; maybe my medicine came with a trade-off. I’d never had a medicine that made me gain weight before or gave me cravings that led to weight gain. But here I was.

I’d always told people in the same situation that it didn’t matter if they gained weight. Obviously mental health is more important than gaining a few pounds.

But is there a line that can get crossed, where weight gain can make the scales tip in favor of switching meds? What’s the number? 15 pounds? 25 pounds? 30 pounds? 50 pounds? In what span of time? One month, three months, a year? What is OK and not OK?

Mental health is most important, but at what point does weight gain also affect health? It affects physical health, like blood pressure and risk factors that come with obesity (I am now technically obese), but I’m not even talking about the physical drawbacks of weight gain. What I’m irrationally worried about is the emotional toll that weight gain can cause.

I’m not satisfied with what the medicine is doing with my body. I don’t feel like myself. I feel like myself when I was pregnant, only without a baby, meaning I feel too big and tired and slow. That is affecting my mental health. Not in a serious, clinical way. But in a way that is still real.

Still, I would never stop a drug that’s working in favor of nothing, or one that didn’t work, to be able to lose weight. I’ve been in the dark hole that depression is, and there’s no way I would jeopardize my own quality of life or my family’s with my vanity. But it’s a little tempting, when I’m still on my meds and they’re working well, but there’s just this one side effect…. And I think, maybe I could stop. But I wouldn’t just stop; I would switch to something else, after talking with my doctor like I should. I’m more vain than I realized, but I’m also even more terrified of falling into depression again.

One of the most disconcerting things is the feeling that I don’t have power over my body. Even when I eat well, and exercise, and sweat off what feels like pounds of water, it turns out I have actually gained weight. I haven’t lost a single pound since I started my medicine several months ago. That unsettles me and makes me feel a tiny bit like I do in a depressed state: I am not in control of my body.

This doesn’t cause me to lose hope in general, to think that there won’t be a better time. But it does cause me to lose confidence in myself. I’m already on shaky ground, living with mental illness. Will I feel good today or bad? How am I feeling? But now, I add, How do I look? How much have I gained? to the daily evaluations. I can’t always depend on my mind; now I can’t depend on my body.

Having a mental illness throws new challenges at me at every turn. Even when I feel well, it still reminds me of its presence, in this case, through these extra pounds clinging to me. I believe that there might be side effects and trade-offs to medication, but I also believe they saved my life, or at least saved the quality of my life, and that it’s worth it. And I believe the perfect medication might be out there, waiting to still be discovered for me.

Maybe I’ll always have to make the decision between effective medicine and side effects like weight gain. But I have hope that someday I won’t have to.

In my 20 years living in the Boston area, I cheered on the runners on many occasions and now, even from far way, these events feel close to home.

Experiencing trauma can have a dramatic effect on our bodies and our minds.  And although it’s a different experience to witness a trauma on television, it still can affect us.

When you perceive a threat, the body activates the stress response. The stress response occurs in both your body and brain.

The body’s response to acute stress is a preparation for emergency.  Adrenaline and other hormones are released.  The body shuts down processes associated with long-term care.  When under immediate threat, digestion, reproduction, cell repair and other body tasks related to long-term functioning are unimportant.

Of immediate importance is survival.  Increased blood sugar can provide extra energy for muscles. Increases in cortisol counter pain and inflammation. Blood pressure increases. Blood is diverted from our extremities to our major muscles to provide us with extra strength. Increased endorphins can help us ignore physical pain.

You can see the effects of these changes to the body in many of the symptoms of stress, such as racing heart, dizziness, nausea, shortness of breath, shaking, feeling hot and flushed, and sweating.

But it is the impact of trauma on the mind that is often the most disturbing.  Traumatic events can leave us feeling unsafe.  They can disrupt our beliefs and assumptions about the world. Your sense of your ability to control your life may be shattered. You may question how much influence you have over your life and your life choices.

A trauma, such as the one the occurred at the Boston Marathon, can leave us distrustful of other people.  You may question your basic trust of other people in the world.  Trauma can affect your ability to be intimate with others and may impact your feelings of self-worth.  Those who survive the trauma often feel guilt and wonder why they lived when others were less fortunate.

As we grow, change and have varied experiences throughout life, our beliefs and assumptions typically evolve over time.  With trauma, those beliefs and assumptions that we use to make sense of the world around us change nearly instantaneously.

It’s common to experience a wide range of psychological symptoms, including intrusive thoughts, worry, difficulty sleeping, trouble focusing, bouts of crying, blame or self-judgment and lack of satisfaction.

The effects of trauma also can cause intense emotion, including extreme emotional fluctuations, unhappiness, anxiety, loneliness, anger, and irritability.

Multiple traumas or repeatedly being exposed to life-threatening events can have a further impact on your body and mind. Parts of the brain can become sensitized, causing you to be on high alert and to perceive threats all around, leaving you jumpy and anxious.

Other parts of the brain associated with memory can actually shrink, making it difficult to consolidate and form new memories.  Prolonged stress can effect the development of a number of health issues, including diabetes, obesity and hypertension. And repetitive stress affects our moods, brings on anxiety disorders, and affects our experience of chronic pain and our ability to control food intake.

But when horrible events occur, such as those that occurred at the 2013 Boston Marathon, we also see the generosity and caring that is a large part of human nature.

Countless individuals ran to help without a second thought.  First responders, medics, EMTs and even bystanders jumped into action to do what they could to save lives.  Runners crossed the finish line and kept on running straight to give blood.

As we deal with the impact of violence, we can also keep in our minds the heroes and the strength of the human spirit that brings us together when we are faced with senseless tragedy.

Image: Wikimedia Commons: Aaron “tango” Tang

And while you’re getting treatment — whether through medication, psychotherapy or both — there are many ways you can manage your symptoms in the meantime.

In his valuable book Depression: A Guide for the Newly Diagnosed, clinical psychologist Lee H. Coleman, Ph.D, ABPP, provides tips on minimizing symptoms and getting better while you’re receiving professional help.

Here are five of his suggestions.

1. Chart your symptoms.

A chart that documents your symptoms is incredibly informative. For instance, a chart of your energy levels will let you know the time of day you have the most and least energy. A chart with your activities will let you know how each action affects your symptoms (for better or worse.)

Coleman suggests recording your energy, sleep, mood and activities every day. Specifically, rate your energy and mood from 1 to 10; record the number of hours you slept; and jot down the type of activities you did that day. Bring this chart to your provider so they can see your progress.

2. Keep a consistent schedule.

According to Coleman, “When you’re depressed is never a good time to ‘wing it’ or leave your days completely unstructured, because you run the risk of drifting aimlessly.” Be consistent about when you eat, go to bed and wake up, along with other routines.

3. Stay active.

Depression drains your energy, enthusiasm and motivation. That’s why it’s important not to wait until you feel like it to engage in activities. (It’s like Therese Borchard said in this piece on exercise: “I think sometimes we have to lead with the body, and the mind will follow.”) In fact, mood and motivation often improve by continuing to participate in activities. Coleman suggests creating a list of activities you’d like to do or did in the past.

For instance, your list might include inviting a friend over for coffee, walking around the block, preparing a meal for yourself, picking up a few things at the grocery store, and meditating. Consider how these activities affect your mood. Also, if some activities seem overwhelming, break them down into bite-sized steps. Encourage yourself to accomplish one step at a time.

4. Practice self-compassion.

Self-compassion is especially important when you’re depressed. Unfortunately, the very nature of depression makes it difficult to be kind and understanding with ourselves. Depression shrinks your self-image and self-esteem. It makes you feel worthless and guilty.

But think of it this way: “We don’t get mad at ourselves for having the flu or a kidney infection, because we know that we didn’t cause the problem and that our job is to get better, not to feel bad about ourselves. It’s no different with depression,” Coleman writes.

Some people still worry that if they’re kind, they’ll just become even more unmotivated. But, as Coleman notes, these types of beliefs only exacerbate depression. Plus, “drill sergeants rarely make effective therapists!” Remember you can’t shame or hate yourself to health.

(It also helps to consider how you’d treat a friend who was going through the same thing. It’s likely you’d lead with kindness and compassion. What does that look like for you?)

5. Adjust your expectations.

Depression tends to affect all areas of your life. It might be tougher to work, study, socialize and participate in any other activity, Coleman says. So it’s key to adjust your expectations. “It simply doesn’t make sense to expect yourself to be at 100 percent with the hundred-pound weight of depression on your back.” Coleman encourages people to ask for help and advocate for themselves. “Remember people won’t know what you need unless you let them know — so tell them!”

Depression is a serious illness. But with effective professional help, you can get better. And while you’re receiving treatment, the above strategies may help enhance your improvement.

It doesn’t matter that I wake up most mornings to swim 160 laps, am borderline obsessed with eating salads and whole grains, and that I haven’t drank a drop of alcohol in 24 years; that I do yoga twice a week, keep a mood journal, engage in cognitive behavioral therapy, and have a rich spiritual life; that I take omega-3 fish oil capsules, vitamin D, calcium, and other supplements with my extra-pulp juice in the morning; or that I work really hard at communicating anger, frustration, and disappointment so that the repression of feelings doesn’t end up as a tumor somewhere inside my body.

I can’t get an individual or family plan short of signing up for a $10,000 deductible.

Because I have a history of depression.

My illness falls under the ABCs of the non-insurable, the “preventable” illnesses that solicit the red flag of “no way in hell” she’s getting coverage:

A – Asthma (and, hell, let’s throw in Arthritis)
B – High Blood Pressure
C – Cardiovascular Disease (and Cancer, sometimes classified – I know – “preventable,” but which is surely a insurance-killer)
Double D (think bra size) – Diabetes and OF COURSE Depression

Now I’m not so naïve that I dismiss the economic toll these illnesses take on an already fragile economy. Here’s the chronic disease price tag, estimated annual direct medical expenditure, according to the Center for Disease Control, which used different methodologies in calculating costs:

Cardiovascular disease and stroke: $313.8 billion in 2009
Cancer: $89 billion in 2007
Smoking: $96 billion in 2004
Diabetes: $116 billion in 2007
Arthritis: $80.8 billion in 2003
Obesity: $61 billion in 2000

Not mentioned here is clinical depression, which, left untreated, is as costly as heart disease or AIDS to the U.S. economy, according to Mental Health America. It costs over $51 billion in absenteeism from work and lost productivity and $26 billion in direct treatment costs.

Depression tends to affect people in their prime working years and may last a lifetime if untreated. According the MHA:

• Depression ranks among the top three workplace problems for employee assistance professionals, following only family crisis and stress.
• Three percent of total short-term disability days are due to depressive disorders and in 76 percent of those cases, the employee was female.
• In a study of First Chicago Corporations, depressive disorders accounted for more than half of all medical plan dollars paid for mental health problems. The amount for treatment of these claims was close to the amount spent on treatment for heart disease.
• The annual economic cost of depression in 1995 was $600 per depressed worker. Nearly one-third of these costs are for treatment and 72 percent are costs related to absenteeism and lost productivity at work.

That’s not to mention the human toll: seven out of ten deaths among Americans each year are from chronic diseases. Heart disease, cancer and stroke account for more than 50 percent of all deaths each year. Almost 15 percent of those suffering from severe depression will die by suicide.

And there is much we can do to prevent it. Four culprits are responsible for much of the illness, the suffering, the costs, and the early death associated with chronic diseases:

• Lack of physical activity
• Poor nutrition
• Tobacco use
• Excessive alcohol consumption

But allow me to climb back onto my soapbox. It’s still not fair. It’s not fair to those of us who go to great lengths to pursue healthy living and do everything in our day in the name of recovery – those of us who get up every morning with a pair of boxing gloves on, ready to fight for our health. It’s just not fair and it’s wrong.

I look forward to my meetings with health insurance brokers less than I do my yearly Pap. As much as I try to mentally prepare myself for the blow – “Repeat to yourself: You’re not going to like what you hear. It’s going to be unfair. You need to stay calm” – I still leave infuriated, which then, of course, has me checking off two of the ABCs: depression AND high blood pressure. That would probably bring my deductible up to $12,000, God forbid.

Originally published on PsychCentral.com

So what is alternative treatment? You may already have some experience with the most popular, according to the Monitor on Psychology. Meditation, biofeedback, hypnosis and progressive muscle relaxation are all popular complementary or alternative psychological treatments. 

Although you may be familiar with the most popular, there are dozens of alternative and complementary treatments, which typically fall into four categories:  mind-body medicine, biologically-based practices, manipulative and body-based practices and energy medicine.

The Monitor article reports that, although these, and many other, alternative and complementary treatments have been around for thousands of years, the National Institute of Health (NIH) has been studying their usefulness, safety and role in improving health and health care for only a little more than a decade.

But many people embrace these treatments and are visiting alternative medicine practitioners more frequently than they visit their primary care doctors.  And these treatments are big business. A 2007 study found that $34 billion is spent each year on products and services for alternative and complementary medicines.

Continued research on the effectiveness of these treatments is ongoing and crucial.  However, current research suggests that many are effective for treating a wide range of problems, ailments and disorders.

There are too many to document in one post, but the following are the top 4 according to frequency of use, as reported in the Monitor.

1. Dietary Supplements.

Dietary supplements are used to promote general health, as well as to improve depression and anxiety and to decrease pain.  Common supplements reported in the Monitor include ginkgo biloba, St. John’s wort and vitamin supplements.  Although regulated by the FDA, they are held to very different quality standards than more conventional medicines.

• Caution: The FDA does not review the safety and effectiveness of any supplement before it is sold to consumers.  Supplements can vary widely from brand to brand and may interact with other medications. They should not be used without the knowledge of a physician.

2. Meditation.

Meditation is a process in which people learn to focus their attention in a particular way and on purpose.  It is used to treat a variety of symptoms, including high blood pressure, chronic pain, anxiety, depression, stress and insomnia.  It is also used to promote general health and well-being.

Meditation is integrated into many psychological treatments and practices with positive results; however, there are no formal qualifications necessary to practice it.  It is important that those who use this method receive appropriate training.

3. Chiropractic.

Chiropractic physicians use noninvasive treatments, such as spinal manipulations or chiropractic adjustments, with the aim of improving nerve and organ functioning by aligning spinal vertebrae.  These treatments are used to treat an array of ailments, from pain and headaches to stress and ADHD, among others.

Becoming a chiropractic physician requires several years of graduate work.  Most psychologists are unlikely to hold a chiropractic degree and, if they did, it would not be appropriate to serve as both a psychologist and chiropractor for the same client.

4. Aromatherapy.

Aromatherapy uses smells and aromas naturally extracted from plants to balance, harmonize and promote health of mind, body and spirit.  It is used clinically to relieve symptoms typically addressed in psychotherapy; holistically, to improve overall well-being; and aesthetically, in various oils and skin care products.

The Monitor cites recent research that indicates that aromatherapy can help treat pain, anxiety and agitation specific to dementia.  However, while certification is not required, it is recommended.  There are also risks related to toxicity, skin irritation and dosing regulations that require a competent professional to oversee, the article states.

Reference

Barnett, J.E., Shale, A.J.,(2013). Alternative Techniques.  Monitor on Psychology, 44(4).

Even the word “survivor” uncovers stigma in the world of suicide prevention. Traditionally it’s been used by those bereaved by the suicide death of someone else, and does not refer to those who have survived suicide attempts.

A few savvy agencies, including the AAS and the American Foundation for Suicide Prevention, are careful to distinguish between “loss survivors” and “attempt survivors,” but more often organizations will simply refer to “survivors,” and they always mean the bereaved when they do.

This might seem like a quibble with language, but in fact illustrates structural stigma among suicide prevention agencies. Attempt survivors simply don’t exist in their language, or in their activities.

For many reasons suicide attempt survivors have been left out of suicide prevention efforts, beginning with stigma, but there are also clashes with the bereaved who can be angry at attempt survivors. This unfortunate situation means that those who have literally survived suicide are rarely able to contribute knowledge from lived experience to the field. Channels are closed.

In my hometown of Vancouver, BC, for example, not only are suicide attempt survivors explicitly banned from volunteering (for two years post-attempt), those with active mental illness are excluded from Crisis Centre BC. (As of the publication date, Crisis Centre BC hadn’t responded to a request to explain their rationale for this policy. I received an email later explaining that people with mental illness are welcome once they have a year of recovery, and the reason for not having attempt survivors volunteer for two years is to avoid triggering and give time for healing.)

As a suicide attempt survivor, I’ve used the knowledge I gained from my lived experience of pain and recovery to help others, through blogging, by creating the Unsuicide Online Suicide Help Wiki, and sharing links to resources and supports on @unsuicide. I have bipolar disorder, which is cyclical in nature, so I’ve fought many battles with suicidal thoughts. I’ve learned what works and what doesn’t, not only for me, but by talking with peers I’ve learned what works for them as well. Books (and apps) like Kate Bornstein’s “Hello Cruel World: 101 Alternatives to Suicide for Teens, Freaks, and Other Outlaws” and Susan Blauner’s “How I Stayed Alive When My Brain Was Trying To Kill Me” are two examples of peer knowledge that have helped many people.

Peers know that bombarding us with trite “inspirational” aphorisms doesn’t help, and can have the opposite effect because it demonstrates a profound lack of understanding and empathy. We know that intentionally guilting us about loved ones makes us feel worse about ourselves (this is one example of how loss survivors and attempt survivors can be at odds). We know all the clichés and why they’re unhelpful. And we know what does help. Not every tip helps every person, but by compiling knowledge we have a lot of powerful wisdom to share.

Why don’t suicide prevention professionals want this knowledge, then? Wouldn’t it provide a tremendous amount of insight, and useful feedback on services? Couldn’t it help save lives? Why are we being overlooked? Are we considered incompetent? Failures? Traitors to life? Contagious?

What Happens Now is a groundbreaking work that explores these themes and more. If you want to keep up with the cutting edge of suicide prevention, this is truly it.

If you are experiencing suicidal thoughts, read this first. Find help near you through the International Suicide Prevention Wiki, or the Unsuicide Online Suicide Help Wiki if you’re not comfortable using a phone. Also check out the Suicide Project, a place to share your suicide story with others.

In the book, Borchard lists the many things she feels guilty for, everything from not cleaning the house to letting her kids eat more candy to worrying too much to being overly candid with her writing to overeating. And that’s just a snippet she jotted down while penning that page.

If you also have depression, you, too, probably have a list. And you, too, probably can relate to the gnawing, stubborn and heavy weight of guilt.

It’s guilt that can lead to self-doubt or even self-harm. For Borchard, guilt sparks insecurity, indecision and even poor decisions. “It colors my decisions and my conversations and I’m always second-guessing myself.”

Some research may explain why people with depression feel especially guilty. A 2012 study found that individuals with depression respond differently to guilt than people without depression. According to the news article about the study:

Investigators used fMRI to scan the brains of a group of people after remission from major depression for more than a year, and a control group who have never had depression. Both groups were asked to imagine acting badly, for example being “stingy” or “bossy” towards their best friends. They then reported their feelings to the research team.

“The scans revealed that the people with a history of depression did not ‘couple’ the brain regions associated with guilt and knowledge of appropriate behavior together as strongly as the never depressed control group do,” said Zahn, a MRC Clinician Scientist Fellow.

“Interestingly, this ‘decoupling’ only occurs when people prone to depression feel guilty or blame themselves, but not when they feel angry or blame others. This could reflect a lack of access to details about what exactly was inappropriate about their behavior when feeling guilty, thereby extending guilt to things they are not responsible for and feeling guilty for everything.”

Depression dampens a person’s reasoning and problem-solving functions, said Deborah Serani, PsyD, a psychologist and author of the book Living with Depression.  “This is why a person can feel unrealistically negative about himself, feel guilty or responsible for things that he might not truly believe if the depression wasn’t active.”

5 Tips to Help Chip Away at Your Guilt

Of course, guilt isn’t something that simply dissolves with several quick fixes. But you can slowly chip away at your guilt. The below tips may help.

1. Move your body.

According to Serani, “Getting physical will lower cortisol, increase endorphin flow and awaken your senses.” It also helps people with depression think more clearly and feel better overall, she said.

2. Shift your thoughts.

“Feelings of guilt can set a depressed individual into a cycle of negative thinking; each thought worsening into a deeper, more hopeless frame of thinking,” Serani said. That’s why working on your thoughts is key. Serani suggested revising negative thoughts into positive thoughts or using positive imagery. She gave examples such as “I can do this,” or “I’m light and floating on blue beautiful water.”

3. Remember guilty thoughts are not facts.

Borchard finds it helpful to remind herself that her guilt is just a voice. “Once I say, ‘Oh, there’s the guilt,’ I can put some distance between me and the guilt.”

4. Try humor.

Borchard also finds that humor can lighten the heaviness. For instance, she refers to guilt as “my ‘mini-Vatican’ or something like that. I always laugh when my doctor reminds me that, of all the depressive symptoms I have, guilt will probably be the last to leave me.”

5. Try visualization.

In Beyond Blue, Borchard describes a visualization technique her therapist recommended. Borchard writes:

“She told me to imagine myself driving a car along the highway. Whenever I get one of those guilty thoughts, my car is out of alignment…it’s dragging right. So I pull over and assess the problem. I check to see if I need to make any adjustments. If I stole something, I should give it back. If I wronged someone, I need to make amends. Then I merge back on to the highway.

Each time my car wants to rear off the main drive, I should ask myself, Is there something I need to do? If not, I need to get my car back on the road.

For many people with depression, guilt is a real and stubborn symptom. It manipulates the facts and exacerbates your mood. But while guilt can be persistent and overwhelming, it also can be managed and minimized.

What does this have to do with mental health?

Well, it’s interesting listening to sports analysts talking about this as a ‘dirty play’ and debating whether Jones is a ‘dirty player.’ Similarly, people often begin to depress themselves by rating their whole self negatively for making mistakes in their lives.

This self-rating doesn’t make any sense, and is totally illogical. What these TV reports do, though, is reinforce the idea that if we do something wrong, our whole being is now judged as wrong. And because this type of reporting is on so many TV channels, repeated over and over again, it is easy to understand why we, as people, have bought into this illogical nonsense of self-rating.

It’s easy to depress ourselves if we keep telling ourselves over and over, day after day, that we are ‘not good enough’ or ‘a failure.’ These statements about ourselves usually come from an irrational belief that our behavior was bad and therefore, we are bad. We fall into the totality-rating trap with our irrational thinking — usually something like “I must not make a mistake, or I’m a worthless failure.”

Once we create such a belief, it becomes a part of our blueprint for living, and it’s from then on accessed automatically when we do anything we deem as a mistake. But what makes this irrational belief so destructive is that it sits quietly in the background, waiting to pounce when we make the slightest of mistakes.

So think about that. Every time you make a mistake, this hidden belief comes flying out of nowhere and smashes you in the face. You then just follow your automatic thinking and beat yourself up for not being good enough, or a failure.

How many things can one person conclude they get wrong in a day? One? Two? With that kind of belief it’s more like hundreds, even thousands! Soon enough, you’re destined to make a mistake, and down, down, down your mood will go, as you constantly activate this irrational belief.

To beat depression, we need to understand that one mistake doesn’t define us. We need to change our irrational belief and become more realistic and rational. We need to learn to accept ourselves and our humanity and be robust enough to know that we cannot be perfect and please everybody.

We also need to learn to be responsible for our mistakes, and to stand up and admit when we do something wrong, while being strong enough to accept we may be criticized for those mistakes.

I’m sure Dahntay Jones knew what he was doing, and maybe he did make a mistake (intentional or not), but the fact still remains: the whole of him cannot be a ‘dirty player.’ It means he’s a player that can make plays that are good, bad, dirty, fantastic, and everything that falls in between.

It’s been hard to sit at all, let alone for the 30 minutes I meditate each day. I find myself agitated and fidgety. My thoughts are all over the place.

This is not unusual during meditation, but in taking note of the subjects of my thoughts, I can see hypomania creeping in. I’m thinking of buying stuff. I’m thinking of trading stocks. I’m thinking of another career change, discarding good ideas for more exciting, if undoable, ones.

All of my thoughts are about getting and doing. Anything. Right now I feel smarter, more creative, and more energetic than I usually do. That might be dangerous, but that’s what I’m feeling, and that’s what I encounter during meditation.

And here’s where mindfulness meditation really helps.

I’ve picked up these early signs of hypomania, so I can work to avoid myself going full-blown manic. During meditation, which I now have to force myself to do, I become calm for a time and clearly see the maelstrom I’ve entered. I give my wife my credit cards. I walk past the corner pub without going inside.

I also implement the two-week rule for purchases, investments, changing my LinkedIn profile, and publicly flouting new ideas. The two-week rule allows me to note what I want, or want to do, and set it aside. If, two weeks later, it still seems like a good idea, I can act on it. Meditation sessions keep me honest. I note if I’m breaking the rules, or planning anything big and stupid.

This is when meditation becomes a little different. In quieter times, while focusing on the breath I note thoughts and release them, always returning to the present moment.

But when I recognize the signs of creeping mania (or depression), I incrementally change my relationship to my thoughts. As they arise, I pay a little more attention to them as I note them. I investigate what my thoughts are about.

Are they fantasies? Is there anger? Am I subconsciously planning? What thoughts keep returning? Are there consistencies, or even deep inconsistencies? As I note repeating and defeating thoughts, I can see how they are affecting my behavior when I’m not meditating. Then I can make what changes I need to make in my day, my plans, and my expectations, and avoid trouble.

So here’s hypomania. Although it can lead to very bad things, it has its benefits. As I stated, I think it does make me more creative and energetic. By meditating, staying present and responsible, and noting my thoughts, I can both stay focused and harness some of that energy and creativity. Meditation helps me hold on to the good ideas and keeps me away from acting out the bad ones.

Anyone who’s experienced hypomania and felt the energy, charisma, and flush of ideas it often brings, knows that if we could bottle this stuff we’d make millions. But we can’t bottle it. If left to ramble it often becomes grandiosity, poor judgment, and hurtfulness.

Through the focused attention of mindfulness meditation, I can harness the positive and avoid the negative. This episode will pass, and I hope to leave it with my life intact — and a few good ideas.