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Care Insights: Treating Severe Depression & Anxiety with Julie Isaacs, SVP of Operations & Therapy

Therapy Insights: Treating Depression & Anxiety with Julie Isaacs, LCSW

January 24, 2023

The Intersection of Depression, Anxiety, and Trauma

Depression and anxiety disorders are different mental health conditions that can have similar symptoms and can even co-occur. However, they have different causes that often require different types of treatment.

 

Julie Isaacs, SVP of Operations & Therapy at Heading, offered her insight into how depression and anxiety disorders intersect and the role of specializing a therapy practice to address long-standing and extreme stress.

Related Yet Distinct Diagnoses

“Anxiety and depression are like first cousins; they relate very well to one another and often share a lot of similarities. That said, the experience of depression, anxiety, or post-traumatic stress disorder (PTSD) is also unique to the individual person, and the therapeutic tool kit should be personalized as well,” shares Julie Isaacs

 

Diagnostic criteria for mental health disorders are helpful for research and developing treatments and support, but like other aspects of health problems often coexist. Depression is considered as a mood disorder and is often characterized by persistent feelings of sadness, hopelessness, and a lack of interest or pleasure in activities. Anxiety disorders are conditions that include excessive and persistent feelings of worry or dread, and typically comes with edginess, difficulty concentrating, fatigue, increased muscle tension and discomfort in the body, and trouble sleeping.  Trauma is a criterion of PTSD and the result is a response or set of responses to a deeply distressing or disturbing event, such as a natural disaster, a car accident, or a violent crime. People who have experienced trauma that results in PTSD experience anxiety and fear,  may have flashbacks and nightmares, and become hypervigilant to situations that remind them of the event or carry a perceived threat. Avoidance of uncontrollable situations and hypervigilance are coping mechanisms that promote personal safety. However, they often snowball into more rigid and isolated ways of being.  Over time, this increase in rigidity and isolation, along with the fear, anxiety, flashbacks, and nightmares, can leave those with PTSD at risk of developing depression as well as a substance abuse disorder. 

 

While PTSD can cause depression, depression is less likely to have been brought on by a single traumatic event. Instead, depression’s causes are more varied. It might be set off by a stressful life event that gives rise to sadness with a life of its own. Evidence suggests there may also be biological triggers that can put the condition in motion even in the absence of difficult circumstances. Often, it’s a more complicated combination of factors.

 

“Depression is sometimes experienced as ‘anger turned inward’, and this anger is also  experienced with anxiety disorders and PTSD especially if a person has gone untreated or undertreated for a long time,’” shares Julie.

 

Julie has dedicated her career to the treatment of severe depression and anxiety disorders. Through her years of experience working with individuals struggling with these mental health disorders, she has gained unique insights into the best approaches to helping people find healing and improve their quality of life. She also has vast experience mentoring therapists who want to specialize in these areas and knows firsthand how rewarding and challenging the work can be.

 

Understanding both the intersection of symptoms, and causes are important for appropriate care. However, the skill of understanding what someone is going through is not only a science but also an art as every individual’s personal experience of their mental health is expressed differently.

Naming the Unspoken Symptoms of Mental Illness

While diagnosis is essential for many aspects of treatment, it can come with strong feelings of shame due to the stigma associated with having a mental health condition. 

 

 

“Overcoming shame is a big part of developing the courage to seek treatment, and a therapist needs to know how to not only ask the right questions or identify the right symptoms but also how to build trust and rapport,” Julie points out. “Some patients might tell you right away what they’re going through. But it’s also very common to have a patient who is reluctant to use the words ‘depression’ or ‘PTSD.’ And that could be for many reasons. They may feel it will threaten their job, their standing, or their personal identity.”

 

 

As such diagnostic labels, while necessary and valuable for many medical and therapeutic reasons, carry substantial weight for the individual, which should be seriously considered. 

 

 

Julie also noted that stigma can have a different impact on men and women, especially when it comes to how they express their symptoms and whether they seek treatment. 

 

 

“Men struggling with severe depression or anxiety often seem ‘functional’ by going to work and doing their best to appear ok outside of the home, but when they come home there is often a big shift in their behavior and they might shut down. Men are also more often slow to seek treatment. Women on the other hand are more likely to pull the covers over their head and have a hard time leaving the house, but are more likely to feel comfortable seeking treatment. We have to break through gendered conditioning to really address the heart of the matter – no matter the gender expression or societal norms – all people should feel comfortable seeking help.”

 

 

Unlike a broken bone there’s no x-ray for depression or anxiety. Through experience and training therapists build the skills to hear what’s going on even if a patient has a hard time talking about it. While people may not come right out and say, ‘I have major depression’ or ‘I have PTSD’, they might say other things that indicate they are struggling. For example, they might say  ‘I’m not sleeping,’ ‘I’m having trouble thinking’ ‘No matter what I do, I just don’t feel like myself,’ or ‘I experienced X and just can’t stop thinking about it.’  While it’s gotten better, there’s still certainly shame and stigma around getting help, especially among men, in certain cultures and social circles, and among those with jobs where they need to be perceived as extremely competent or feel a diagnosis could jeopardize their employment.  

 

 

According to one study, 29 percent of male participants said the reason they haven’t spoken to anyone about their mental health is because they are too embarrassed to speak about it.

 

 

Forty percent of men in the study said it would take thoughts of self-harm or suicide to get them to seek help. 

 

Shame will take many different forms depending on the individual, their background, and their lived experience. Shame often comes with feelings of isolation, failure, and embarrassment.  In a traumatic event, or repeated traumatic events, there can be significant fear and shame associated with it as well and which can spur negative thoughts about one’s self. Similarly, with major depression, one might feel guilt or disappointment for not being able to deal with the symptoms ‘on their own’ are common. Trained therapists and psychiatrists are able to help their patients identify these thought patterns in themselves, and dismantle their strong grip.

Addressing the Whole Person in Therapy

Over years of treating patients, Julie notes that, in addition to common mental symptoms, there are also common physical symptoms of both depression and anxiety disorders.

 

“To be honest, no one is sleeping,” notes Julie.  “When we’re dealing with a major mental illness, we’re either sleeping too much with low-quality sleep, or we’re not sleeping enough. But, in truth, no one is rested. And there’s only so much you can do when your body is exhausted. Therapists need to be curious about what’s going on in someone’s body and not just their mind and emotions; depression and anxiety don’t simply exist from the neck up.”

 

The conversation about mental health is becoming less and less siloed from other aspects of health. Mental illness has a strong physical component.   Both anxiety and depression can involve changes in appetite, sleep, and energy levels, as well as difficulty concentrating. Studies show that mental illness can even impact our immune systems and cause or exacerbate other physical conditions such as heart failure, high blood pressure, and cancer

As such, many people benefit from a holistic approach to healing that includes biological and lifestyle interventions, mindfulness practices, and regular exercise. Additionally, more and more the field of psychiatry is also turning towards interventional treatments like ketamine, and psychedelic research, to address the neural pathways within the brain in ways that traditionally prescribed medications do not.

 

Comprehensive treatment is often needed when depression, anxiety, and PTSD become severe or recurrent. When this happens, it’s particularly helpful to have a team that is highly trained in these specific disorders to deliver personalized treatment.

Improving Therapy & Mental Health Outcomes

The shortage of mental health care providers in the U.S. is a known problem, with a recent survey indicating that 60% of psychologists are unable to take on new clients. Many states, such as Texas,  are also short on psychiatric staff in hospitals and centers.

 

What is less talked about is what this means to mental health of providers, especially those treating patients with severe depression and anxiety. “The stakes are high. And among therapists, burnout is real,” shares Julie. “While it can be an issue for all therapists and providers, those focusing on more severe cases of depression and anxiety may be more likely to experience it.” 

 

Her remarks are well-backed up by recent studies. One report found that 50 percent of behavioral health providers reported feeling burnout out, and that a lack of training was a common source of stress. The consequences for those with severe mental health conditions can be devastating.  

 

“Undertreated mental health struggles can absolutely be lethal,” shares Julie, underscoring the importance of proper staff and adequate training. To address the issue, Julie says we should focus on education. “Providers dealing with more severe cases need access to continued education as well as personal support through supervisors, mentors, and peer groups.”

 

Other mental health professionals feel the same. When discussing the problem of mental health care in rural Texas, Dr. Steve Bain, founding director of the Institute for Rural Mental Health Initiatives, also highlighted the importance of training. 

 

“Knowing the patterns among diagnoses certainly helps a therapist connect the dots within their patient’s experience, but it’s also important not to jump to conclusions. This is where peer support, continued education, and mentorship relationships within the field can be incredibly helpful. We can’t practice in a vacuum. Making the effort to continue our own education and develop a network of peers and mentors who challenge our thinking improves the quality of care,” notes Julie.

 

“And like in any profession there may be a time when it is helpful to niche ourselves diving deeply into a few disorders to develop the level of quality and experience a patient with severe struggles needs. That can be challenging and it takes time. But I do know that therapists who are willing to go the distance in their education and experience to support severe mental illness can truly save lives.”

Hope For The Future of Mental Health Care

Despite the prevalence of depression, anxiety, and PTSD the diagnoses themselves can come with a strong degree of stigma. But as the conversation around mental health continues to make its way out of the shadows and into the mainstream, more people will feel ready to seek help.

 

Julie notes that things are moving in the right direction, “I’ve witnessed a huge shift in the conversation around mental health since I first started as a therapist. Big picture, the fact that more people are talking about mental health is promising. Insurance plans, and employers are also starting to take mental health more seriously which is absolutely needed.”

 

“But, we also have a shortage of mental health care providers nationwide. Caring for people who have severe or longstanding mental illness is a demanding job. Providers need training, support, and resources that allow them to their job effectively, and their patients need access to a dynamic tool kit for care for better outcomes. The future of Mental Health will require tearing down silos around treatment modalities, continuing to embrace technology for improved access and education, and for the medical system to take mental health as seriously as physical health. Change has started and I’m hopeful we’ll get there” Julie concludes. 

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Yes, It Matters if You Like Your Therapist. Here’s Why

Yes, It Matters if You Like Your Therapist. Here's Why

January 17, 2023

When searching for the right therapist, you might focus on things like how much experience they have, what conditions they specialize in, and the types of therapy they are trained to provide. 

 

What you may be less likely to prioritize are features that might impact how much you’ll like or connect with them. In some sense, this is perfectly reasonable. Much like seeing a doctor for your physical health, it may seem that all that matters is that they know what treatment to give and how to deliver it. 

 

While this may be true when it comes to your physical health (though it’s questionable even then), there are reasons for thinking that therapy is different. Above and beyond being able to deliver the proper treatment, it matters that patients like, connect, and relate with their therapists. Often talked about in terms like ‘therapeutic rapport’ or ‘therapeutic alliance,’ studies have found the quality of patient-provider relationships to be a significant predictor of how well they respond to treatment. 

 

Explore why this matters, learn some common factors that impact whether patients and providers connect, and check out what you can do if you and your therapist aren’t vibing.

Why It’s Good if You Connect with Your Therapist

There are a variety of reasons why it’s good to relate to and connect with your therapist. Here are some of the most significant ones. 

#1 You’ll Be More Likely To Share Important Information

Therapy often requires patients to bring up and share personal details at the heart of their anxiety and depression. This is an understandably difficult process. Therapy requires a deep sense of trust and psychological safety. If you feel your therapist will understand where you’re coming from and won’t judge you for your experiences and reactions, you’ll have an easier time opening up and delving into what’s bothering you.

#2 You’ll Be More Open to Their Suggestions

While therapists are not typically ‘advice-givers’ they will offer insights and suggestions.  It’s natural to wonder if it will really work for you, and we’re more inclined to seriously consider the suggestions of people that we admire and respect. 

 

Not connecting with your therapist can undermine your sense that they understand how to address your problems or effectively personalize your treatments.

#3 You’ll Be More Likely to Stick with Treatment

While therapy can be rewarding, finding the motivation to stick with it can also be challenging. When you’re on the same page as your therapist, this becomes less of an obstacle. Studies have found that the stronger the therapeutic alliance, the more likely the patient is to adhere to the treatment. 

 

Additionally, if you aren’t taking your therapist’s advice because you don’t connect with them, you may not be seeing the results you were looking for, which can make you wonder whether therapy is right for you.

How to Find a Therapist You’ll Connect With

While the list of factors supporting a solid connection is endless, several common traits are particularly important to look out for. Here are a few.

Style

Remember why you are seeking therapy. It’s not always best to simply find someone that is exactly like you. However, there may be aspects of your life that you may be more comfortable opening up about if the person in front of you seems to have a level of personal understanding. Consider your willingness to be challenged, or your learning style. Do you want someone who is more directive and straight to the point? Or would you like someone who is conversational, and funny? Typically during an intake session you will be asked about your preferences for therapy and that would be a good time to bring up any aspects of therapy that might be important to you.

 

Cultural or Ethnic Background

A shared cultural or ethnic background can help for several reasons. For one thing, different groups are more likely to deal with specific stressors due to their lived experience with issues like racism and oppression. To best help patients develop effective coping mechanisms, it can be important for their therapists to have similar cultural or ethnic backgrounds.

Gender

Gender plays an important role in our experience of mental health and our mental health outcomes. For example, men are more likely to be diagnosed with substance abuse disorders. They are also less likely to seek treatment and more concerned with mental health stigma. A therapist of the same gender may be better equipped to address these and other gender-specific issues.

LGBTQ+ Allyship

Members of the LGBTQ+ community are disproportionately likely to experience mental health problems. According to The Trevor Project, 45 percent of LGBTQ+ youth considered suicide in 2022. Of those who did not receive mental health care, 43 percent said they did not see a therapist because they feared their concerns would not be taken seriously. Therapists with clear LGBTQ+allyship are desperately needed to help this community.

What Should I Do if I Don’t Like my Therapist?

Let’s say you find yourself in therapy, and despite all your research, you just don’t gel with your therapist. What should you do?

 

There are a few options.

 

Depending on where the disconnect is, you can discuss it with your therapist. Sometimes, you can try resolving disagreements. Speaking up and voicing your opinions may also allow your therapist to demonstrate empathy, compassion, and a willingness to adopt new strategies to better suit your needs. 

 

It’s not always possible to close the gap between you and your therapist with some quick conflict resolution. When this happens, it’s time to break up with your therapist. If you are going to end the relationship, it’s best not to ghost them. Instead, open up a conversation where you explain why you want to look for a different provider. Not only does this give the therapist the fix the issues, but it also helps them learn for future clients so that they may avoid whatever mistakes they made in your case. 

 

While this can seem scary, it’s really an easy process. Mental health professionals generally understand the importance of fit and won’t judge you for wanting to find the therapist that works best for you. “Remember, you are under no obligation to stick with a particular therapist,” shares Patricia Hernandez, LPC.  “Whatever your reasons for wanting to find a new one are, they are valid.”

Takeaway

There’s nothing unreasonable about wanting to like your therapist. In fact, feeling connected to your mental health provider may be one of the more vital ingredients in a successful mental wellness journey. From helping you feel comfortable discussing challenging and personal topics to strengthening your ability to stick with therapy, a close patient-provider connection can have a significant impact on treatment outcomes. 

 

When looking for a therapist, check for things that might impact how well you’ll connect. This may include a shared culture or ethnicity, gender, LGBTQ+ allyship, and more. If you find you don’t like your current therapist, that’s no problem. You may not get it right on the first try, but fortunately, switching is no big deal. 

Take the first step

Want to find out if Heading is right for you? 

Complete our consultation form and an intake specialist will get in touch.


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Mental Health(care) is for Everyone

Mental Health(care) is for Everyone

February 24, 2022

With the onset of the COVID-19 pandemic, uncertainty, stress, discomfort and periods of isolation has increased across the world. This increased stress has resulted in amplified waves of anxiety, exacerbated depression, and even increased OCD. What many individuals may not realize is that almost everyone struggles with their mental health at some points, not just those who have been diagnosed with mental illnesses. This means that even those without a diagnosable mental illness can benefit from comprehensive mental healthcare and implementing positive coping strategies.


When we find ourselves in these moments of uncertainty, here are a few basic concepts to keep in mind:

 

  • Sharing really is caring: Talking about how we feel is powerful. In many circumstances, speaking to someone who cares about you or a mental health professional can help you to feel supported and less alone. If you don’t know where to start when it comes to sharing your emotions and thoughts, a good place to start is using simple statements such as, “today I feel…” or “when this happens it causes me to feel..”
  • Sleep is your friend: Prioritize a good night’s rest. It’s no secret we aren’t at our best cognitively when we haven’t made time for quality rest. Sleep and mental health are closely linked and frequently affect one another. While it may seem challenging to relax and fall asleep when we have a lot on our mind, things like sticking to a schedule for sleep and ensuring that at least 30 minutes prior you are reducing or eliminating distractions such as TV, phone time, or working on projects can help prepare your body for a much needed rest.
  • Move: Stay active. Physical activity is not only good for your body, it’s also great for your mind. With the increase of online activities over the last few years, it has become increasingly easy to lose sight of the importance of moving our bodies. Staying active can mean anything from taking part in a HIIT (high intensity interval training) workout to doing some stretching or taking a quick 10-15 minute walk. As you consistently engage in even just a few minutes of physical activity per day, you will provide increased support to your mental well-being, effectively helping to combat stress, anxiety, depression, or anything else you may be struggling with.
  • Get help when you need: Talking to friends and family, sleeping well, eating well, and physical activity are strong steps that we can take to promote mental wellness. It is important to recognize however, that sometimes we need additional. Mental illness, just like any illness, sometimes requires the care of someone specially trained to treat it. Remember, asking for help is a sign of strength and a way to show yourself compassion and self-love. Professionals such as therapists and psychiatrists are trained to help you find and implement the best strategies for your unique circumstances and will support you on your journey to recapture your highest quality of life.

To learn more or request an appointment with one of our providers, give us a call at 512-777-2591 or visit us at headinghealth.com.

Take the first step

Want to find out if Heading is right for you? 

Complete our consultation form and an intake specialist will get in touch.


Schedule your consultation