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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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Therapy Motivation: 10 Simple Ways to Stay Engaged and On-Track

Therapy Motivation: 10 Simple Ways to Stay Engaged and On-Track

January 20, 2023

Talk therapy is a powerful tool for making progress with your mental health. While it can be incredibly gratifying, finding the motivation to stick with it and apply your therapist’s tips and tools can be challenging. Mental health conditions like depression can sap your motivation, making it difficult to accomplish goals both in and outside therapy. On top of that, therapy often requires patients to confront difficult topics. In some cases, this means patients aren’t able to stick with therapy as well as they otherwise would be.

 

Here are 10 simple tips for boosting your motivation as you continue your wellness journey.

#1: Start Small

If your mental health plan is too demanding early on, you might have more trouble starting to apply all the advice you’ve been given. Instead of overwhelming yourself, start small. As you build your therapy muscles, you’ll be able to use the recommended strategies more consistently.

#2: Remember Your Goals

Because your mental health homework may not be intrinsically rewarding, it can be helpful to focus on the external benefits of the activities and specifically on why you set out to improve your mental health in the first place. Keeping these goals in mind can help you stay motivated and stick with your therapist’s recommended strategy.

#3: Normalize Feeling Stuck

Putting too much pressure on yourself to make progress and strictly adhere to treatment can be counterproductive. 


“Feeling disappointed in yourself whenever you less productive in therapy, miss an appointment or forget to apply a technique in everyday life can challenge your motivation to stay committed to therapy,” shares Andrea Marquez, LCSW, an Austin, Texas-based therapist here at Heading Health. “But, that’s a normal part of the process and of life. Rather being hard on yourself practice self-compassion instead. You’re more likely to get back on track when you practice self-forgiveness.”


Remember, even in moments when it feels like progress has stalled or you’ve gotten off track, you can begin again and it won’t be a square one. 

#4: Seek Support From Friends, Family, and Support Groups

You don’t have to tackle therapy all on your own. If you are comfortable talking to friends and family about your therapy journey, let them know you’re working on your mental health. Their loving support and helpful reminders can give you the energy you need to stick with therapy. Support groups for individuals in treatment can do the same.

#5: Set Time-Limited Goals

Therapy goals can seem unachievable when you feel like you should always be working on them. Instead, specify a limited amount of time you can dedicate to applying mental health help strategies daily. This will lower the mental hurdle you need to overcome to start your mental health workouts.

#6: Measure Your Progress

Going to therapy and sticking with your provider’s advice can be more challenging if you don’t have clear evidence of progress. Because progress often builds slowly and progressively, you might not notice it right away.   Mental health is not linear. Unlike healing a broken bone, therapy progress is not always straightforward. However, that doesn’t mean you should give up on measuring progress. Ask your therapist to provide regular evaluations to see how you’re doing. If you’re getting better, that’ll motivate you to keep going.

 

If you’re not, that’s a reason to change things up (see tips #8 and #9)

#7 Celebrate Your Wins

“Making progress, especially in therapy, is a big deal,” shares Julia Lopez, brand manager at Heading Health. “I remember the first time I told my husband about a therapy break though I had I was so nervous! He celebrated with me. So when you see yourself getting better, celebrate it – maybe its not with your partner but perhaps your best friend or another trusted person.” 

 

Do something fun with your friends, or reward yourself with a self-care day. You may even share your therapy breakthrough with someone you trust. 

 

This will help you recognize mental health progress as the achievement it really is and allow you to feel more positively about putting in the hard work. 

#8: Try a Different Form of Therapy

From cognitive-behavioral therapy (CBT) to psychoanalysis, therapists utilize various therapies to help guide their clients’ treatments. When you start therapy, your therapist will decide which strategies to use as primary tools in your mental wellness journey. However, no treatment works for everyone; sometimes, adjustments must be made. 

 

Let your provider know if you are having trouble sticking with treatment, and they can decide whether it would make sense to try a different type of therapy. Many therapists are skilled in many modalities, and draw from a range of theories to personalize their approach with clients. They will probably be really glad when you take this level of interest in your care and their approach. Therapy is intended to be collaborative. 

#9: Look for a Different Therapist

Even if you’re trying out the right therapy, it might not work as well if it’s not coming from the right therapist for you. Research has shown that patient-therapist fit matters, including when it comes to how well patients adhere to treatment. If you don’t connect with your therapist, you may be less likely to attend your appointments and listen to their advice. This can mean you need to find a new provider who you’re more likely to like and relate to.

#10: Ask if Medication Would Help

While therapy can be incredibly impactful on its own, studies have found that it often works best when combined with medication or other biological interventions, such as ketamine or transcranial magnetic stimulation (TMS). Among other things, these tools can boost your motivation, providing you with the extra energy you need to stick with therapy.

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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. 

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Cognitive Behavioral Therapy 101: What You Need To Know

Cognitive Behavioral Therapy 101: What You Need to Know

December 27, 2022

Whether searching through provider bios or hearing about your therapist’s treatment plan at your first psychotherapy appointment, you’ll likely come across a therapy called cognitive behavioral therapy (CBT). This post will cover the basics of CBT to help you make more informed decisions regarding therapists and treatment plans as you navigate your way through your mental-wellness journey. Specifically, we will answer the following questions. 

 

  • What is CBT?
  • What techniques does CBT use?
  • What is CBT used for?
  • What are some other types of CBT?
  • How effective is it?
  • What are some additional benefits or advantages of CBT?
  • What should I keep in mind during treatment?
  • What can I do if it doesn’t work?

What Is CBT?

CBT is a form of psychotherapy based on the idea that our thoughts, emotions, and behaviors are interconnected and that while we can’t directly control our feelings, we can adapt our unproductive thoughts and behaviors. In turn, these impact our emotions, which improve our mood and support more positive thoughts and actions.

What Are the Tools of CBT?

CBT utilizes a variety of techniques to help patients identify and alter their unproductive thoughts and behavioral patterns. In one of the more common techniques, therapists help patients recognize common “cognitive distortions” (i.e., unhelpful or irrational ways of thinking). 

 

For example, your therapist might provide you with worksheets and exercises designed to highlight distorted thoughts that can result in stress and anxiety, which might include:

 

  • Catastrophizing: Blowing things out of proportion or assuming the worst without justification
  • Should statements: Thinking in terms of what you should do rather than what you can do
  • Black and white thinking: Thinking of things as all or nothing
  • Emotional reasoning: Assuming that because we feel a certain way, things are that way

 

Other CBT techniques include:

 

  • Cognitive restructuring: Cognitive restructuring offers methods for changing your cognitive distortions after you’ve identified them. These include techniques like Socratic questioning, guided imagery, and more. 
  • Exposure therapy: Your therapist may slowly expose you to a thought or situation that provokes anxiety while preventing any avoidant behavior in response. 
  • Interoceptive exposure: Interoceptive exposure is used to treat feelings of panic. This therapy helps reduce sensitivity to the sensations of anxiety through repeated and strategic exposure to its physical and emotional components. 
  • Journaling or thought records: Here, you’ll record negative thoughts and reactions to identify common themes.
  • Behavioral experiments: This involves making predictions before engaging in an anxiety-provoking activity to reveal errors in your thinking. 
  • Play the script until the end: This strategy asks patients to play out the worst-case scenario. This can help them realize that even if what they are worried about comes true, they can manage it. 

What Is CBT Used to Treat?

Because of its general structure and because so many mental health conditions are characterized by maladaptive cognitive, emotional, and behavioral patterns, CBT can treat many mental illnesses. While it is primarily used for anxiety and depression, it can also be helpful for:

 

  • Bipolar disorder
  • Eating disorders
  • Obsessive-compulsive disorder (OCD)
  • Panic disorder
  • Post-traumatic stress disorder (PTSD)
  • Specific phobias
  • Substance use disorders

 

It’s important to note that when used for conditions other than depression and anxiety, practitioners often deploy a specialized version of CBT. For example,  Teressa Carter LCSW, a Texas-based therapist here at Heading Health, is trained in TF-CBT, a trauma-focused form of the therapy. 

 

It’s also worth bearing in mind that CBT isn’t just for treating mental health conditions. It can also help those who haven’t been diagnosed with a mental illness as they deal with other difficulties. 

 

CBT can be helpful for:

 

  • Relationship issues
  • Divorce
  • Grief or loss
  • Insomnia
  • Fibromyalgia
  • Migraines
  • Occupational Stress

How Effective Is CBT?

The effectiveness of CBT depends on many factors, including condition type, severity, and whether it’s combined with medication. With that said, it is generally a highly effective therapy. 

 

For depression, some studies have found CBT to be as or more effective than any other form of therapy or psychiatric treatment. Findings are similar for anxiety-related disorders. CBT is often used as a first-line treatment, with over half of patients responding to the therapy

 

The effects of CBT appear to last for a significant period of time as well, with one experiment finding that the treatment’s effects can last a year or more.  CBT also works well when combined with psychiatric interventions. In addition to first-line medications such as Prozac and Zoloft, recent experiments suggest that ketamine-based therapies, which can provide rapid and robust relief from treatment-resistant depression and suicidal ideation, can enhance the effects of CBT. 

Additional Advantages of CBT

Aside from being highly effective, CBT has several notable benefits that help explain why it’s such a popular choice among mental health practitioners. 

Takes Place Over a Limited Time-Frame

Some therapies don’t have a precise end date. CBT is designed to occur over a defined period of time, leaving patients with the tools they need to continue to apply its techniques on their own without the aid of a therapist. On average, CBT training occurs over 12-20 sessions. 

Personalizable

CBT is a highly customizable therapy. Whether you’re dealing with anxiety, depression, or insomnia, its wide array of strategies and techniques can be tailored to suit your needs. 

Does Not Require Medication

Though CBT works well (and sometimes better) when combined with medications, many individuals find it highly effective on its own. For example, one study found that patients with OCD who underwent CBT both with and without medications had comparable improvements in their symptoms. 

Works in Virtual and In-Person Settings

Over the course of the COVID-19 pandemic, we saw a sharp rise in the use of CBT in virtual settings as in-person sessions became unsafe. Fortunately, we learned it’s still a highly effective treatment. This makes sense when you think about how the treatment works. Whether at home or in person, patients are thoughtfully and carefully guided through one of CBT’s many techniques, whose effectiveness doesn’t appear to depend on the proximity of the therapist and the patient. 

Some Things to Keep in Mind

You Must Be Willing to Put the Work In

CBT doesn’t work on its own. If you don’t keep up with CBT activities like journaling, restructuring your cognitive distortions, engaging in exposure therapy, or taking part in whatever other techniques your therapist has decided are likely to be most effective in your case, you won’t see results. 

Change Is Gradual

While the treatment is typically limited to 12 to 20 weekly sessions, you likely won’t experience a complete improvement in your symptoms within the first few meetings. Instead, you’ll progress gradually from one appointment to the next. “The routes of your progress will develop, grow, and strengthen over many weeks,” shares Ken Brown LPC. “This base of tools and strategies will support your mental wellness long after your initial treatments have ended.”

Change Can Be Difficult 

Though CBT is effective, applying its techniques and making the necessary changes can be difficult. For example, exposure therapy requires patients to deliberately place themselves in specific situations that stress them out. This can be pretty challenging. As you go through treatment, it’s important to be prepared for some discomfort before things get better. 

What to Do if CBT Isn’t Working

Despite the effectiveness of CBT, it’s not the right therapy for everyone. Fortunately, if you find that you aren’t getting the results you were looking for, there are several options you can try, which include:

 

  • Trying a different CBT technique
  • Combining CBT with medication
  • Switching to a different form of psychotherapy (e.g., acceptance-commitment therapy, psychodynamic therapy, etc.)
  • Switching therapists

Getting Started with CBT

CBT is a popular and evidence-based form of psychotherapy that emphasizes the interconnectedness between our thoughts, feelings, and behaviors. It deploys specialized techniques that take advantage of our ability to modify our thoughts and behaviors to improve our mood and mental well-being. The therapy is effective for many conditions, from anxiety to depression to phobias and substance use disorders. 

 

Aside from being highly effective, CBT has the advantage of being relatively brief, customizable, beneficial without medication, and successful in virtual and in-person settings.

 

In essence, it can be used right away to start influencing change. So even while you are in continued therapy, the tools from a CBT therapy session can be put into practice and then discussed and refined over time with a therapist.

Despite its benefits, patients should be aware that change may still seem to be gradual.  Changing thoughts and behaviors that are well-established requires dedicated work. While it can be challenging and patients must put the work in to see results, CBT does offer hope of finding a new outlook on life.

Types of CBT

In addition to the standard CBT and its variants focused on treating specific disorders, several other related therapies are often considered forms of CBT. These CBTY spin-offs and related therapies take the theoretical essence or have similarities to CBT and expand it with additional ideas and techniques.

Cognitive Processing Theory (CPT)

Developed by Dr. Patricia Resick, this therapy is highly effective against PTSD.  Throughout the treatment, patients identify and challenge unhelpful beliefs related to the trauma.

Mindfulness-Based Cognitive Behavioral Therapy (MBCT) 

This form of therapy builds on CBT by combining it with mindfulness meditation to help patients pay attention to and learn from their thoughts and feelings in a non-judgmental way. The treatment utilizes several techniques, from meditation to body-scan exercises, to yoga.

Dialectical Behavioral Therapy (DBT)

Rather than focusing on identifying and modifying unhelpful ways of thinking, DBT teaches people how to regulate their emotions, live in the present moment, and tolerate feelings of stress.

Metacognitive Therapy (MCT)

Instead of targeting our specific worries and fears, metacognitive therapy addresses general beliefs about worrying. It proposes that anxious and depressed individuals worry as much as they do because they believe doing so will help them avoid negative outcomes. MCT aims to undermine these erroneous beliefs.

 

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New Year’s Resolutions Always Don’t Work. Here’s Why You Should Commit to Your Mental Health Instead

New Year's Resolutions Don't Work. Commit to Your Mental Health Habits Instead.

December 21, 2022

Every year an estimated 800,000 U.S. adults make New Year’s resolutions in the hopes of improving their lives and developing healthier habits.

 

Despite the popularity of New Year’s resolutions, they may not be the best use of your time and effort. For one thing, they are rarely effective. Studies suggest that 91 percent of New Year’s resolutions are not successful. For another, the pressure of sticking to these resolutions can cause heightened stress and anxiety levels. To make matters worse,  if you do fail to achieve your goal, you might experience feelings of shame and guilt. 

 

This year New Year’s, rather than making the regular resolutions, commit to your mental health instead. Here are four strategies for building and maintaining your mental health in the coming year. 

#1 Examine How You Approach Goals (Before Even Setting On!)

Even though New Year’s Resolutions are often unsuccessful and prone to cause stress and anxiety, goal setting is still critical to mental wellness. Everyone has goals they are trying to achieve regardless of whether they are setting New Year’s resolutions. Following through with them can help you feel more competent and resilient, which can have positive downstream effects on your mental health. 

 

The goals people set for their New Year’s resolutions fail for a variety of reasons. Fortunately, psychologists have identified general strategies for formulating goals in ways that help you achieve them. Victor Furtick, LCSW, an Austin-based therapist here at Heading Health, recommends the “SMART” technique.

 

I would encourage those seeking to make goal-setting more effective and less stressful to consider implementing  SMART goals–Specific, Measurable, Achievable, Realistic, and Timely. 

 

Anit Kaur, Heading’s community outreach manager, echoes Victor’s remarks and suggests making short-term goals to make goal attainment more specific, achievable, and timely. 

 

I create short-term goals in all areas of my life and work on a plan to reach them. For me, it is more realistic than making a New Year’s resolution. Don’t pressure yourself to make a change overnight. Break it up into steps with monthly goals. 

 

By following these two goal-setting tips, you’ll have an easier time sticking to your mental health plans, which will help you stay committed to your mental wellness journey. 

#2 Remember, It’s Okay to Get Off Track (and Sometimes Beneficial)

The hustle and bustle of the holiday season can throw off your mental health strategies. Whether you’re too busy for your appointments or can’t find the time to implement your therapist’s recommended tips and tools, you may find that your mental health has taken a back seat to other priorities as the new year rolls around.

 

This is a perfectly normal reaction, and it’s important not to judge yourself if you’ve gone a little off course. “Guilt and shame will only serve to keep you from making progress,” shares Helena Hernandez, PA-C. “The key is to be mindful of whether your focus on your mental health has changed and to re-orient yourself if it has without judgment or self-criticism.” 

 

Throwing in the towel when the resolution doesn’t pan may not really be a failure after all.  As life shifts and grows, priorities change, and making space for flexibility if your desires or priorities shift too can be a very positive experience. 

#3 Focus on Supportive Relationships

After so many gatherings and get-togethers, you might be all socialized out. While the New Year’s festivities can deplete your social batteries, they can also serve as a reminder of who your close connections are and who you really enjoy spending time with. “Take stock of how you felt after your holiday and New Year’s gatherings.” Andrea Marquez, LCSW, tells Heading. “Make specific, actionable plans to spend more time with those who made you feel revitalized, valued, and uplifted.”

 

You may also want to make a note of who you weren’t really looking forward to seeing. You are not obligated to stay close to people who bring you down. If the holiday gatherings shed light on who isn’t supporting your mental well-being, you may want to adjust those relationships accordingly. 

#4 Overwhelming Yourself with Change Can Backfire

Mental health advice is often about adopting habits and dispositions that will make you happier and more resilient. For example, you may be told to practice mindfulness to learn how to deal with unpleasant emotions or do some cognitive behavioral therapy  (CBT) to rid yourself of negative thinking patterns. But going overboard with self-improvement can also leave you feeling exhausted and overly critical of yourself. 

 

Your journey to mental wellness will almost certainly require you to make some internal changes. However, it’s important to practice self-acceptance and to consider how your surroundings or routines could better support your happiness.  

 

New Year’s resolutions typically require people to think about what they want to change internally. But it can be equally important to look around and see what’s currently present in your life and also what you might want to bring in that fosters a sense of pleasure, calm, or ease. 

 

Switching the focus from constantly assuming something about you needs to change and instead acknowledging what’s working for you, what you love, and what you want to see more of can positively impact your life.

 

Consider whether there are small upgrades you could make to your environment or routine that would improve your mood, as opposed to ways you need to change internally. Whether it be adding some greenery to your apartment or embarking on a new career search, setting out to change your environment can be just as powerful a tool as working on yourself.

 

Above all, be kind to yourself as you make your way through your wellness journey.

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What You Should Know About Your First Therapy Appointment​

What You Should Know About Your First Therapy Appointment

December 20, 2022

Once you’ve made the brave step of making an appointment with a therapist, you may wonder, “what am I setting myself up for?” Knowing what to expect can help alleviate any anticipatory anxiety and prepare you for your first session. 

 

Here’s what to expect at your first appointment and some quick tips to get the most out of it. 

You Might Feel Nervous

Whether it’s your first appointment or meeting your new therapist for the first time, it’s normal to be nervous. Opening up about your deepest thoughts and feelings is difficult, especially in a new environment with someone you’ve never met before. So, if these feelings come up, know that they are a normal part of the process and will likely go away with time.

 

You can also try some strategies for managing therapy anxiety, such as:

 

  • Opening up to your therapist about your anxiety
  • Setting aside your preconceptions about psychotherapy
  • Focusing on your therapist’s experience and desire to help
  • Recognizing your strength and bravery

They’ll Ask Some Tough Questions

Your therapist will spend much of your first session trying to get to know you better. Before your appointment, you’ll fill out an intake form with questions about your background, mental health history, and more. During the session, your therapist will review these questions and follow up with a few others.

 

Their goal is to assess your mental health, determine whether they’re the best provider to help you on your journey to mental wellness, and begin designing your treatment plan. Some examples of the types of questions your therapist may ask include the following:

  • What brings you to therapy?
  • Have you attended therapy before? If so, what was that experience like?
  • How do you cope with stress?
  • Do you have a family history of mental illness?
  • What do you hope to get out of therapy?
  • What are your strengths?
  • How are your relationships with others in your life?

Take Your Time

While these questions may seem simple enough, they can be difficult to answer on the spot. One way to get around this is to work on your answers before your session. Go for a walk and think carefully about why you’re going to therapy and what you hope to get out of it. Consider your stressors and focus on your strengths. The more accurate and thorough your answers, the better your therapist can help.

 

If you aren’t able to answer the questions right away, that’s okay too. Your therapist can work with you slowly over several sessions to learn more about you and how they can help. 

Remember, It’s Just a Conversation

Femi Olukoya LPC, an Austin, Texas-based therapist at Heading Health, shares a helpful tip for reframing therapy discussions in a way that makes them seem more casual and less intimidating. He says:

 

It doesn’t have to be that you’re sharing your deepest thoughts on your vulnerabilities. […] It’s more like having a conversation with a friend in a coffee shop or a bar, and the therapist is doing the work in the back end.

 

In other words, you don’t have to view your sessions as a rigid discussion with a detached profession. They are far more akin to talking with a warm, compassionate friend whose got some special therapy skills to help you address what’s bringing you down. 

Confidentiality

One reason you might be worried about talking about your mental health is privacy. While this worry is understandable, it’s important to remember that almost anything you say during a therapy session is confidential. While the exact details vary by state, generally, a therapist can only breach confidentiality if a client poses an imminent threat to themselves, the therapist, or a third party

 

Of course, you are never obligated to respond to your therapist’s questions. You are in complete control of what information you provide and withhold. 

They’ll Lay Out Your Treatment Plan

After learning a little about your background and mental health needs, your provider may discuss a tentative treatment plan. Often they will mention the psychotherapeutic technique they’ll be using, of which there are many. Some of the main therapies include:

 

  • Cognitive-behavioral therapy (CBT): This therapy helps you become aware of inaccurate or unhelpful ways of thinking and offers healthier thought patterns. 
  • Dialectical-behavioral therapy (DBT): Rather than changing the way you think, DBT aims to help people be more mindful of their emotions, cope with stress, and improve their social relationships
  • Acceptance-commitment therapy (ACT): ACT helps individuals learn how to accept and sit with challenging emotions rather than avoid, deny or struggle with them
  • Psychoanalysis and psychodynamic therapies: Based on the theories developed by Sigmund Freud, psychoanalysis tries to uncover unconscious thoughts, feelings, and desires that are at the heart of a patient’s psychological struggles. 

 

Your therapist may also discuss the treatment timeline and what it will require from you, both in and outside of your appointments. 

 

If you are uncomfortable with their chosen approach or have any follow-up questions, be sure to ask them. Often, the most effective treatment is the one the patient feels best about, so it’s important to voice your preferences and concerns if you have any.

You’ll Get to Know Your Therapist Too

“New patients should see every appointment as a conversation. This is your time to talk and allow me to know who you are,” shares Andrew Neal LPC, another one of our therapists here at Heading. 

 

Your first appointment isn’t just an opportunity for your therapist to get to know you; it’s also a chance for you to learn more about them. This can help you assess whether they are a good fit, align with your goals, and are equipped to address your concerns and mental health needs. 

 

Here are a few examples:

 

  • What got you interested in therapy?
  • How much experience do you have treating issues similar to mine?
  • How long will therapy last?
  • Is medication an option?
  • How will I know if therapy is working?
  • Are you available in case of a crisis or after business hours?

Crispin Feliciano LPC highlights how specific questions may be crucial for members of marginalized or disenfranchised communities. When discussing the LGBTQ+ community, he states:

 

Many members of the LGBTQ+ community may try to find therapists with a shared aspect of their identity to help reduce anxieties. It’s also helpful to consider other important factors […] such as the issues surrounding sexuality, gender expression, coming out, or other challenges that affect the community. It may also be important to know if the therapist is working from a sex-positive framework, as people are often seeking a space to explore their sexuality and gender without judgment or shame.

 

In general, it’s important to consider whether your therapist has experience with and can relate to important parts of your background and identity. 

What’s Next?

After talking about your mental health, everyday stressors, treatment plans, and more, you might feel a little overwhelmed. Remind yourself that this is totally normal. Feeling anxious after an appointment is common, and it’s not a sign that you have made the wrong choice or that therapy won’t work for you. Take some time to decompress and let any post-session anxiety drift away. 

 

After you’ve come down from your first session, you may have a bit of homework to do. Therapy doesn’t just happen within the walls of your therapist’s office, and they may want to get you started before your next session. This will likely involve something light at first. You may be asked to try practicing mindfulness or write some quick journal entries when you encounter something that triggers anxiety or low mood. 

 

Subsequent appointments will look a little different. While your therapist will continue asking questions during each session, the goal will shift towards helping you get better and applying the strategies your therapist has decided will most effectively alleviate your symptoms.

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Can TMS Be Used to Treat Alzheimer’s Disease?


Can TMS Be Used to Treat Alzheimer's Disease?

December 20, 2022

Alzheimer’s disease is a complex brain disease that results in the progressive deterioration of one’s cognitive, emotional, and behavioral capacities. The condition affects nearly six million people in the United States age 65 and older.

 

Though there is no cure for AD, many treatments offer some amount of symptom reduction. While they are effective to some degree, there is much room for improvement.

 

In recent years, researchers have been exploring alternative ways of addressing the range of impairments caused by AD. In particular, they have explored whether transcranial-magnetic stimulation (TMS), a non-invasive, nonpharmacological procedure often used for psychiatric conditions such as treatment-resistant depression, may prove useful against the cognitive and emotion impairments experienced by individuals with AD.

 

If effective, this novel application of TMS could help AD patients maintain their capacities and improve their quality of life. Does the evidence support its use?

 

What is TMS?

Transcranial magnetic stimulation is a drug-free and noninvasive procedure used to treat various brain disorders, including several mental health conditions. It uses magnetic coils placed just above the scalp to send magnetic pulses into specific regions of the brain associated with symptoms of the condition it is being used to treat. For example, in the case of treatment-resistant depression, the pulses are sent toward regions of the brain associated with mood regulation.

By sending repeated pulses to these specific areas of the brain, TMS “trains” neurons in those locations to fire differently and create new, healthier connections.

 

Assessing the Efficacy of TMS for the Treatment of AD

TMS has been used to treat a wide range of issues associated with AD with varying degrees of efficacy and evidence backing its use.

TMS for Mood-Related Symptoms of AD

Though Alzheimer’s disease is mainly known for its effects on memory and cognition, it can also cause disruptions in mood and emotional regulation. For example, up to fifty percent of individuals with AD suffer from depression

 

Source: brainhope.com

Though the high prevalence of depression in AD patients is partially attributable to the stress of having the disease, it is likely also to be the direct result of the disease’s biological effects. For example, post-mortem studies have found that AD patients with depression were more likely to have lost neurons that respond to chemical messengers commonly targeted by anti-depressants, such as serotonin and norepinephrine.  

 

Several studies have found that AD patients treated with TMS experience improvements in their mood. For example, TMS has been associated with lower scores of depression and apathy among individuals with AD. This finding is supported by the fact that the treatment protocol for AD often targets the same brain area as the protocol for treatment-resistant depression, namely the left dorsolateral prefrontal cortex (L-DLPFC).

TMS for the Cognitive Symptoms of AD

Regarding cognitive symptoms, researchers are actively investigating whether and how much TMS helps. In particular, they have examined the effects of TMS on the following:

 

  • Memory (facial recognition, word recall, etc.)
  • Language function (e.g., sentence comprehension)
  • Executive function (e.g., verbal reasoning, problem-solving, planning, etc.)
  • Visuospatial skills (e.g., the ability to draw a clock)

 

While several studies have found positive results, others have failed to find a significant effect. Explaining this is difficult mainly because different researchers have utilized different protocols on different parts of the brain in patients at different disease stages. As a result, it is hard to determine whether the results are inconsistent because the treatment does not work or because some researchers are targeting the right areas in the right ways in the right patients while others are not.

 

Researchers have attempted to comb through the data to find patterns in when the treatment does and does not work. One finding that emerged most clearly is that TMS does not work in patients with more advanced AD, suggesting that if the treatment works at all, its efficacy depends on the individual’s disease stage.  

 

Even among the studies that have found positive results, patients may have improved for reasons that had nothing to do with the direct effect of TMS on AD. For example, improvements in depression are associated with gains in cognitive performance. Since TMS tends to alleviate depression in AD patients, this could explain why their cognitive symptoms improved and not that TMS treated the part of their cognitive dysfunction caused by their AD. 

 

Another issue stems from how the studies measure the subjects’ cognitive abilities. To determine whether symptoms improved over time, researchers had AD patients repeatedly take tests and perform tasks that allowed them to track how their performance changed as they continued to receive TMS. The problem with this method is that patients may get better with practice alone. This means we can’t be sure how much the positive effects are attributable to practice or to the impact of TMS on AD itself. While some studies included a control group that took the cognitive assessments while being given “sham” TMS, which does not stimulate the brain, the results were unclear.

Conclusion

So, does TMS work for Alzheimer’s disease? That depends in part on what symptoms we are concerned with. As far as depression goes, TMS appears to work just as well in AD patients. However, the results are less clear when it comes to cognitive impairments. Confounding variables and a lack of consistency in treatment protocols mean it’s too early to draw any confident conclusions.

 

If you feel you need to see a mental health professional or could use help deciding which service is right for you, please give us a call at 805-204-2502 or fill out an appointment request here. We have a wide variety of providers, including therapists, psychiatrists, nurse practitioners, and nutritional therapists, who can see you in as little as one day via teletherapy. 

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Businesses are Prioritizing Employee Mental Health. Here’s Why

Employers are Prioritizing Employee Mental Health. Here's Why

December 16, 2022

Unfortunately, our mental health problems don’t wait at home while we work. Whatever stressors we are dealing with can latch on to us and linger in the background, exacerbated by various work-related stressors that pop up throughout the day. 

 

Over a quarter of adults experience mental health problems each year. Since employees can’t set down their mental health conditions before they clock in,  many struggle with mental illness at work. Aside from the immediate stress this puts on employees, it is also bad news for the companies that employ them. Mental illness and work-related stress are associated with a variety of adverse organizational outcomes including lower productivity and engagement, higher rates of burnout, decreased employee retention,  a decline in creativity, high turnover, and more. 

 

Despite the prevalence of mental illness and its harmful effect on employees and the companies they work for, mental health has typically not been a priority for most businesses. Until recently, employees were often left without adequate resources to quickly and affordably take care of their mental health needs. 

 

Fortunately, many companies now grasp the significance of maintaining a mentally healthy workforce. According to a 2022 report, 90 percent of employers are investing more in mental health programs. This marks a significant shift in the importance organizations are placing on mental health and their willingness to act as stewards of their employees’ mental well-being. 

 

Here’s why organizations are shifting gears to focus on helping their employees achieve and maintain mental wellness. 

Work-Related Stress is Common

One reason employers are offering comprehensive and holistic mental health care services is that work itself is stressful. In one survey, eighty-three percent of U.S. workers said they suffer from work-related stress, and 25 percent reported that their job is the number one stressor in their lives.

 

In some cases, work-related stress can become so severe that it results in an “occupation syndrome” called burnout.” According to the World Health Organization (WHO), this condition is characterized by

 

  • Feelings of energy depletion or exhaustion
  • Increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job
  • Reduced professional efficacy

Given the impact of burnout and the fact that work can be stressful by its very nature, employers now recognize they should provide workers with the tools they need to establish a healthy relationship with work and build the skills required to cope with work-related challenges.

Therapy Can Help

Burnout and other forms of work-related stress can be managed with psychotherapy. Therapy can combat work-related stress by helping employees become more mindful of what triggers workplace stress and how they react to it, build emotional resilience, and develop and maintain a healthier work-life balance.

 

Julia Lopez, Brand Manager at Heading Health, shares her experience of how therapy helped her navigate stress, including work stress:

 

Working with my therapist helped me understand aspects of work-related burnout that were and were not in my control. Through therapy, I learned how to practice better boundaries, acknowledge when I was putting too much pressure on myself, and on a larger scale, evaluate the relationship between my work and my identity.” She also noted, “Work is an incredibly important part of my life, but it’s not the totality of my life. Having a more appropriately-sized relationship with work actually helped me become more clear about my career goals and ultimately feel more effective in my job.

 

Julia is far from alone in her experience. Studies have shown that a variety of mental health techniques, from cognitive behavioral therapy to mindfulness-based stress reduction, are effective at helping employees combat burnout and other types of workplace stress.

 

Of course, employers shouldn’t just throw more mental health services on top of work-related stress and call it a day. Burnout is complicated and may require internal and external solutions. However, easily accessible and affordable mental health solutions can play an important role.

Good Mental Health is Good for Organizations

Employers generally understand the value of helping employees maintain their physical health. From mild colds to severe medical conditions, employees who aren’t physically well simply can’t perform at their best, if at all. 

 

Though it may not be as readily apparent, mental health is just as critical to a well-functioning organization. 

Happier Employees are More Productive and Creative

There is a well-established link between depression and motivation. Low motivation is so frequently experienced by individuals with depression that it’s listed as one of the condition’s main symptoms in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). 

 

With that said, you’d expect employees who don’t feel their best to get less done, given that their low mood is taking their productive energy away from them. Recent research has verified this intuition.  One study found that happier employees are 13% more productive on average. 

Better Mental Health Leads to Stronger Engagement

Depression and anxiety can make it more difficult for individuals to be engaged at work, meaning they may struggle to approach their tasks, jobs, and colleagues with a positive, focused, and energized state of mind. Unsurprisingly, researchers have consistently found that burnout and other sources of work-related stress are associated with decreased levels of engagement.

Mental Wellness Can Boost Recruitment and Retention

Employees are increasingly evaluating potential employers’ ability to provide adequate mental health resources when applying for jobs. According to one report, 81 percent of respondents stated that how employers support mental health will be an important consideration when looking for future work.

 

Mental health has also become a more significant consideration for employees deciding whether to leave their current employer. A recent study found that one in four workers who left their jobs in the past two years did so because of its impact on mental health.

Investing in Mental Health Saves Companies Money

Mental illnesses such as depression cost companies an estimated $51 billion annually. From lower productivity to a lack of engagement to the loss of valuable talent, poor mental health dramatically affects companies’ bottom lines. 

 

Fortunately, employers can effectively combat this by investing in accessible, comprehensive mental health services. According to the World Economic Forum, employers see a $4 ROI for every dollar they spend on mental health care.

Takeaway

Mental health must continue to play a critical role in employers’ overall wellness strategies. From its impact on organizational outcomes, to its effects on the company’s bottom line, to the fact that workplaces are often a significant source of stress, organizations have strong altruistic and self-interested reasons to take care of their employees’ mental health. Investing in a flexible, accessible, and affordable option that provides employees with quick access to a range of services is a great place to start.

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How Ketamine Works Quickly When Other Treatments Have Failed

How Ketamine Works Quickly When Other Treatments Have Failed

December 7, 2022

Ketamine (and its cousin, Spravato®) are novel antidepressants that have been gaining recognition for their ability to provide rapid relief from the most severe forms of depression, including treatment-resistant depression (TRD) and depression with suicidal ideation. In addition to their quick effects, ketamine-based therapies can work even after several other treatments have failed to produce an adequate response. All of this raises the question, how does ketamine work, and what is it doing differently?

 

Researchers are continually increasing their understanding of how Ketamine works differently for depression and anxiety, and they have identified several promising mechanisms of action.

 

Here are six effects of ketamine that experts believe might explain why it can have such a rapid and significant impact on depression even when other treatments have failed.

#1: It Increases Glutamate and BDNF

Most antidepressants work on a set of chemical messengers in the brain called monoamines, which include serotonin, norepinephrine, and dopamine. Though effective, these medications can take over a month to start working, and some find they don’t provide adequate relief no matter how long they take them.

 

Dr. Steve Levine explains that targeting the glutamate system is markedly different than the way that traditional SSRIs work.

 

 

Ketamine-based therapies differ from these interventions by impacting glutamate, an excitatory neurotransmitter that research has continued to suggest plays a critical role in depression. When ketamine enters the brain, it binds to the N-methyl-D-aspartate receptor (NMDA) receptors, ultimately causing a surge of glutamate.

Credit: Yang H. Ku/C&EN

The rise in glutamate brings about other important changes. In particular, it leads to an increase in brain-derived neurotrophic factor (BDNF), which supports the survival of existing neurons and encourages the growth of new ones (more on this below).

#2: It Helps Neurons Grow and Connect

In order to adjust our thoughts and feelings to the world around us, our brains must be malleable and adaptable.

 

Ultimately, this means that our neurons (i.e., tiny nerve cells in the brain that send and receive information) must be able to grow, form, and modify connections with other neurons, in a phenomenon known as neuroplasticity. 

 

 Research has repeatedly found that neuroplasticity is impaired in depressed individuals. These processes are often deficient in parts of the brain that are important for mood regulation, including the prefrontal cortex, amygdala, and hippocampus.

 

Ketamine has clear links with neuroplasticity. For example, ketamine studies on rats with depression-like symptoms have found that symptom relief was associated with increases in neuroplasticity. Importantly, this happens rapidly. One study found that a single dose of ketamine began to reverse deficiencies in neuroplasticity within 12 hours.

#3: It Might Reduce Inflammation 

Inflammation is heavily associated with depression, with some estimates suggesting that approximately one-third of depressed patients have elevated inflammatory markers.

 

Some research findings indicate that, in addition to all of its other mechanisms, ketamine may improve depression by reducing inflammation.

 

Animal studies have found that ketamine may have anti-inflammatory effects. Some human studies have found similar results, but the findings have not been inconsistent.

#4: It Can Improve Sleep 

Consistently poor sleep is harmful to mental health. Researchers have found that ketamine might improve sleep in several ways and that these changes are associated with better therapeutic outcomes. For example, ketamine appears to improve slow-wave sleepdecrease early night awakenings, and strengthen circadian rhythms, sometimes after a single treatment. 

 

As is often the case, it is hard to determine which way the causal arrow goes. It could be that those who experience a robust antidepressant response sleep better because they are less depressed, or it could be that those who sleep better end up feeling better. Future studies will need to verify the connection between ketamine, sleep, and depression.

#5: It Can Make People More Optimistic

Optimism has an obvious connection with depression. The more you can focus on the positives or be confident that good things are coming your way, the better you’ll feel. These optimistic tendencies and outlooks can be more challenging for individuals suffering from depression.

 

A recent study explored whether one of the ways ketamine reduces the symptoms of depression is by increasing optimism. The research team found that within four hours of a ketamine infusion, individuals with TRD were more optimistic when judging the likelihood of experiencing adverse events in the future. Importantly, this optimistic reorientation was correlated with lower depression scores one week after treatment, suggesting that ketamine’s effect on optimistic beliefs may help explain ketamine’s rapid impact on depression.

 

#6: It Creates Profound Altered States of Consciousness

Ketamine is well-known for its psychoactive effects (i.e., changes in mood, feeling, thoughts, and perception). For example, when given at the doses used for depression, ketamine can cause dissociative states, where one feels disconnected from their body and thoughts

Given that ketamine consistently produces altered states of consciousness which begin to occur around 15 minutes after administration, it’s natural to wonder whether they play an active role in rapidly alleviating symptoms of depression. 

 

Because ketamine is a dissociative anesthetic, most research in this area has focused on whether ketamine’s dissociative effects may be connected with therapeutic outcomes. Findings have been inconsistent. While some studies have found that dissociative experiences are associated with better responses, others have not.

 

Ketamine can occasionally produce psychotomimetic effects (i.e., delusions, delirium, perceived distortions of space and time, etc.) and mystical experiences. A recent meta-analysis (i.e., a review of many studies) found that neither effect appears to be strongly associated with improvements in depression.

 

It is important to note that this area of research is still in its infancy, and few studies have been conducted with the explicit goal of assessing the antidepressant effects of the altered states of consciousness produced by ketamine. Much more research will need to be done before we can draw any confident conclusions. 

 

Key Takeaways

Ketamine-based therapies are rapid-acting interventions that work in unique ways to produce their therapeutic effects. Though there is much left to discover, experts have identified several mechanisms which might explain why ketamine can offer rapid relief from depression when other treatments have failed. In particular, ketamine-based therapies may work by:

 

  • Impacting different chemicals in the brain, like glutamate and BDNF
  • Helping neurons grow and form new connections in a process known as neuroplasticity
  • Reducing inflammation
  • Improving sleep
  • Increasing Optimism
  • Causing profound subjective experiences through its psychoactive effects
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Sugar, Mood, and Mental Health: Interview with a Nutritional Therapist

Sugar, Mood, and Mental Health: Interview with a Nutritional Therapist

December 2, 2022

The holiday season is a time of gatherings, gifts, and of course, a gluttonous indulgence in sweet treats.

 

While some sugar consumption is perfectly normal and healthy, a high-sugar diet, even temporarily, can negatively impact one’s mood and mental health. As a result, it’s important to be mindful of your sugar intake during the holidays and as you carry on afterward with your regular diet.

 

To learn about sugar’s connection with mood and mental health and how to adopt healthier habits, we sat down with Austin, Texas-based Registered Dietician Nutritionist Sally Twellman. She is our in-house nutritional therapist here at Heading Health, and she shared experience supporting mental health treatments with dietary and lifestyle changes.

Q & A with Sally Twellman RDN, LD

Are Sugar Rushes and Crashes Real? If So, What Causes Them?

Yes, for sure, and this goes for carbohydrates in general. When we have a large amount of carbohydrates, our blood sugar rises rapidly, which causes an equally sharp increase in insulin. This increase in insulin causes a rapid drop in blood sugar, and that’s when you get that slump, which can make you feel tired, lethargic, and even a little bit irritable. In turn, this can cause sugar cravings and, ultimately, a vicious feedback loop of sugar consumption followed by a crash followed by more sugar consumption, and so on. 

Are There Long-Term Mental Health Consequences of a High-Sugar Diet?

Very much so.

 

For example, a high-sugar diet is correlated with depression. One of the many ways it might contribute to depression is through frequent and erratic fluctuations in blood sugar levels. Some fluctuations are normal, but when the peaks become too large and too frequent, it is very stressful for the body and can contribute to chronic inflammation, which is associated with adverse mental health outcomes.

 

Another way that having a lot of sugar in your diet can impact mental health is through its connection with diabetes. Over time, people who eat a carbohydrate-heavy diet are disproportionately more likely to develop insulin resistance, predisposing them to depression.

The third way having lots of very sugary foods can impact mood is that it changes the gut microbiome. Your body adapts to whatever you eat, and if you mostly eat high carbohydrates and low-fiber foods, the bacteria you will grow more of will be the kind that thrives in that environment. And those bacteria are typically not the ones that are beneficial for maintaining good neurotransmitter production, which your brain needs to send messages chemical messages and, ultimately, to produce good feelings.

Is the Damage Reversible?

Yes. Even a dietary change of two weeks to a Mediterranean-based diet, for example, can have a profoundly positive impact on your gut microbiome. This means that if you’re experiencing a low mood resulting from a high-sugar diet, it’s possible to undo the damage and experience benefits after just a few weeks on a low-sugar, high-nutrient diet.

Does the Sugar Source Matter?

Absolutely. The source matters for a variety of reasons. For one thing, some sources make it much easier to consume lots of sugar than others, which is why I highly recommend people avoid sugar-sweetened beverages. We don’t really get that fullness factor like we do when we eat the same amount of sugar or calories in, say, a cookie. So, we can consume a lot of sugar just by drinking regular amounts of liquid without realizing it.

Also, some sugar sources contain ingredients that help to balance out the sugar and help our bodies break it down. Protein, fiber, and fat are good examples. When sugar comes from a source with sufficient amounts of fat or protein, it’s released incrementally into your bloodstream, which helps to avoid the kind of spikes and dips that are particularly unhealthy. So, if you want a cookie, try having it alongside some yogurt with protein and fat to help balance out your blood sugar.

Does the Type of Sugar Matter (e.g., Glucose vs. Fructose)?

In theory, it should matter because our liver is what’s primarily responsible for breaking down fructose. So, part of why food and drinks containing high fructose corn syrup are dangerous is because they can cause the liver to overwork, resulting in all sorts of problems. For example, nonalcoholic fatty liver disease can be caused by a high carbohydrate diet and insulin resistance. Over time, a fatty liver becomes inflamed, which can cause inflammation throughout the body, which, again, is associated with adverse mental health outcomes.

Is Fruit Okay?

You might think, “well, I shouldn’t eat fruit because fruit is high in sugar fruit and it’s high in fructose, which is harder to process,” but naturally occurring fructose isn’t the same as high fructose corn syrup. It’s also coupled with fiber and many other nutrients your body needs to break it down. So, for example, your body can break down the amount of sugar and carbohydrates in an apple in a healthy way because it also comes with things like magnesium and fiber, which it needs to support the good bacteria that help process sugar. So, fruit is not bad. It’s separate from things like gummy bears and other high-fructose snacks.

What About Artificial Sweeteners?

I’m not a fan of artificial sweeteners. They have been linked to things like migraines and changes in the microbiome, and they have to be detoxified by our overworked livers.

 

Also, even though artificial sweeteners have zero calories, they can still cause an increase in insulin. This is because part of what causes your body to release insulin is the sweet taste of sugar on your tongue.

 

Whenever you have something sweet, your brain will send signals down to your pancreas saying, “something sweet’s coming down. You better start pumping up insulin.” As a result, your insulin levels will increase, and these spikes can be just as significant as they would be with natural sugar.

So, if you feel like you need to add some sweetness to your beverages, try more natural sweeteners like honey and maple syrup. These may not taste as sweet as table sugar, but over time your taste preferences will adjust to the lower sweetness levels. Another option is to add natural sugar alternatives, like monk fruit or stevia if you like those.

 

You might think, “well, I shouldn’t eat fruit because fruit is high in sugar fruit and it’s high in fructose, which is harder to process,” but naturally occurring fructose isn’t the same as high fructose corn syrup. It’s also coupled with fiber and many other nutrients your body needs to break it down. So, for example, your body can break down the amount of sugar and carbohydrates in an apple in a healthy way because it also comes with things like magnesium and fiber, which it needs to support the good bacteria that help process sugar. So, fruit is not bad. It’s separate from things like gummy bears and other high-fructose snacks.

What’s a Good Tip for Managing Our Sugar Intake During the Holidays?

My basic recommendation is to be picky about the added sugar you take into your diet. As the holidays continue, it’s important to choose things that you thoroughly enjoy, like really delicious cookies or a great pie. Don’t waste it on sweethearts (unless you really like those, of course). It’s also best to choose something with nutritional value, like dark chocolate, which has antioxidants.

What’s the Best Way to Get Off of a High-Sugar Diet?

The best way is just to go cold turkey. Weaning yourself off incrementally by decreasing the amount of sugar you add to your coffee is generally less effective. Because you get such a robust physiological reward when you have sugar, your body will want more, and you’ll have to endure intense sugar cravings every time. So, it’s best to tough it out for a little while, and you will begin to crave it less.

 

People in Austin, Texas as well as Texans across the state connect with Sally to supplement their mental health care with nutritional support. Those interested in working with Sally are encouraged to reach out to Heading to set up a consultation.

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