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Ketamine and Depression: Science 101

How & Why Ketamine is a Breakthrough Treatment

Long standing stress from stress and anxiety takes a toll on brain function and connections. Ketamine can help restore those connections in a different way than traditional SSRIs.

Ketamine for Treating Depression and PTSD: Science 101

Depression and stress disorders are common. In this article, we will look at the research on using ketamine to treat depression and PTSD, including how it works, how well it works, and any potential side effects.


These mental health conditions can make it hard for people to enjoy their lives, and cope with stress. There are many different ways to treat depression and PTSD, including therapy, medication, and lifestyle changes. But, for some, depression and anxiety become chronic, long-standing, and resistant to traditional treatment.

 

Ketamine has become a promising treatment option for these conditions. Ketamine is a medication that was first used as an anaesthetic, and is now known widely for its use in alleviating the symptoms of hard to treat depression and stress disorders.  When standard treatments like therapy-only, SSRIs-only, or a combination of therapy and SSRIS do not work, other psychiatric interventions, like Ketamine treatment, offer new hope.  


What is ketamine?

 

For many ketamine is a familiar word, but not always for it’s medicinal use. While ketamine has reputation for being a club drug, and like other medications, has been abused in uncontrolled settings, for medical purposes and with the correct dosage and administration it is a safe and highly effective treatment. Ketamine has been used for decades as an anaesthetic. In human medicine Ketamine has historically been used as a means of sedation and for pain management. In fact Ketamine is on the WHO’s list of essential medications for pain management and anesthesia.  


While in an active phase of treatment, Ketamine makes people feel detached or dissociated from their surroundings and themselves.  However, the impact of ketamine on the brain is now believed to last after the immediate effects have worn off, and the benefits in a psychiatric setting can build overtime and with continued treatment.

 

How does ketamine work for depression and PTSD?

As is the case with many medications research is always deepening the understanding scientists and doctors have on the how & why psychological change occurs with Ketamine treatment.  What is known is that  ketamine does help with depression and PTSD especially when other treatments have failed to bring about lasting relie, and the way it works in the brain is different than how traditionally prescribed SSRIs work.

 

Ketamine targets the glutamate system in the brain, which plays an important role in healthy brain functioning. Glutamate is a highly abundant neurotransmitter, responsible for facilitating signals between nerve cells. Through the target of the glutamate system scientists theorize that Ketamine works by blocking a protein called the NMDA receptor in nerve cells and activating another protein called the AMPA receptor, which helps with forming and saving memories. This interaction between the NMDA and AMPA receptors may lead to the quick and sustained improvement in mood and behavior seen with ketamine treatment. Ketamine may also increase the production of BDNF, a protein that helps nerve cells grow and survive, and change the activity of neurotransmitters like serotonin, norepinephrine, and dopamine, which are involved in mood regulation.

 

Interestingly, the pain relief and mood improvement can last even after the drug has left the body. This might be because ketamine changes how the brain’s cells talk to each other, which can help the brain form new connections that last longer than the drug’s effects. Often this concept of being able to change and create new connections is called neuroplasticity. 

 

Evidence for using ketamine for depression and PTSD

 

There is a lot of evidence showing that ketamine can be used to treat depression and PTSD. Many studies have shown that ketamine can quickly and effectively reduce symptoms of depression and PTSD.

 

One study published in the American Journal of Psychiatry found that a single IV infusion of ketamine improved mood and suicidal thoughts in patients with treatment-resistant depression. Another study published in the Journal of Clinical Psychiatry found that a series of six IV ketamine infusions reduced symptoms of PTSD in military veterans.

 

Several studies that look at many studies together, called meta-analyses, have also shown that ketamine is a safe and effective treatment for depression and PTSD. A meta-analysis published in the Journal of Affective Disorders found that ketamine was more effective than a dummy treatment at reducing symptoms of depression, with a large effect size and a quick onset of action. A systematic review published in the Journal of Clinical Psychiatry similarly found that ketamine was effective at reducing symptoms of PTSD, with a moderate to large effect size.

 

What are the potential side effects of ketamine?

 

Like any medication, ketamine can cause side effects. The most common side effects of ketamine are dizziness, drowsiness, nausea, and vomiting.  Ketamine will also impair your ability to drive or operate machinery which is why Heading requires patients have transportation to and from treatment. Other potential side effects include hallucinations, changes in blood pressure, and respiratory problems, which is why Heading recommends treatment be in-person and under the direct supervision of medical professionals. It is important to talk to a healthcare provider about the risks and benefits of ketamine treatment before starting treatment.

More research

There are a number of studies that discuss the use of ketamine for the treatment of depression.  Here are a few examples of scientific resources that may be of interest.

 

Zarate, C. A., Jr., Singh, J. B., Carlson, P. J., Brutsche, N. E., Ameli, R., Luckenbaugh, D. A., … Charney, D. S. (2006). A randomized trial of an N-methyl-D-aspartate antagonist in treatment-resistant major depression. Archives of General Psychiatry, 63(8), 856–864. https://doi.org/10.1001/archpsyc.63.8.856

  • This study found that a single intravenous (IV) infusion of ketamine was associated with a rapid and significant improvement in mood and suicidal thoughts in patients with treatment-resistant depression.

Feder, A., Parides, M. K., Murrough, J. W., Perez, A. M., Morgan, J. E., Saxena, S., … Charney, D. S. (2014). Efficacy of intravenous ketamine for treatment of chronic posttraumatic stress disorder: A randomized clinical trial. JAMA Psychiatry, 71(6), 681–688. https://doi.org/10.1001/jamapsychiatry.2014.30

  • This study found that a series of six IV ketamine infusions was associated with a significant reduction in symptoms of PTSD in military veterans.

Caddy, C., Giaroli, G., White, T. P., & Tracy, D. K. (2019). Ketamine as a treatment for depression: A systematic review and meta-analysis. Journal of Affective Disorders, 245, 959–973. https://doi.org/10.1016/j.jad.2019.03.053

  • This meta-analysis concluded that ketamine is a safe and effective treatment for depression, with a large effect size and a rapid onset of action.

Bremner, J. D., Vythilingam, M., Vermetten, E., Adil, J., Khan, S., Nazeer, A., … Krystal, J. H. (2008). Pilot study of repeat-dose intravenous ketamine in treatment-resistant posttraumatic stress disorder. Biological Psychiatry, 63(3), 339–341. https://doi.org/10.1016/j.biopsych.2007.05.028

  • This study found that a series of IV ketamine infusions was associated with a significant reduction in symptoms of PTSD in a small group of patients
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The Irreplaceable Benefits of In-Center Ketamine Treatments

Is it Better to Receive Ketamine in a Center or at Home?

January 9, 2023

Unlike with most antidepressants, patients considering ketamine have to consider different methods of receiving the medication as well as the location for treatment: at home or in a clinic under the supervision of a medical professional. 


While at-home treatments have the advantage of convenience and accessibility, there are aspects of the in-clinic process that cannot be duplicated at home. Some experts even argue an in-clinic treatment is essential for safety and efficacy.  From the added sense of security to access to a well-oiled integrated care team, every part of the in-clinic experience is thoughtfully designed to optimize therapeutic outcomes.


By exploring the benefits of in-clinic treatments below, you’ll be well-suited to make an educated decision on which option is right for you.

Access to Different Ways of Taking Ketamine

Ketamine is available in several forms or routes of administration, including oral tablets, nasal sprays, and IV infusions. While oral tablets are commonly prescribed for at-home use, others must be administered at a clinic. At Heading, we offer Spravato® (intranasal esketamine) and intramuscular (IM) ketamine. In both instances, you need a medical provider’s support and supervision.


“Each method of receiving ketamine treatment has its benefits and drawbacks, many of which are unique to individual patients,” shares Dr. Tyson Lippe, an Austin-Texas-based psychiatrist here at Heading Health. “However, patients taking Spravato®, which is FDA-approved to treat treatment-resistant depression, will need to come into the clinic – it’s a requirement.” 


Dr. Arif Noorbaksh highlights that cost is a key reason in favor of having access to all the ketamine forms and routes of administration.

Spravato®, which is delivered intranasally, is FDA-approved to treat treatment-resistant depression. And for the vast majority of these patients that we see at Heading, this also means that insurance will play a part in covering the expense. 


While our team at Heading has worked hard to ensure we can also provide coverage for IM ketamine, we are unique in this respect. At other clinics, Spravato® may be a patient’s best bet for getting their treatment covered.

Optimal Set and Setting for Mental Health Improvement

With any intervention that has the potential to produce psychoactive effects, the set and setting (i.e., the patient’s mindset and treatment environment) are vital. Most immediately, how you feel going into the treatment can impact how you feel during it. If you go in confident and calm, you’ll be more likely to have a pleasant experience.


Aside from being valuable in its own right, positive ketamine experiences can result in other good outcomes. For example, studies have found that pleasant ketamine experiences are associated with better treatment outcomes, while scary ones can undermine ketamine’s antidepressant effects. Knowing that a care team is steps away can help ease nerves about treatment, and may put patients at ease knowing help is available should they experience any adverse side effects.


While everyone has their own unique preferences regarding set and setting, an environment that supports feelings of safety and security is essential. Ketamine treatment centers are well-equipped to provide this. 


With physicians and therapists on-site, patients can feel confident that a competent professional is there to help. As Dr. Noorbaskh shares:

Patients receiving ketamine in a clinic or medical center receive an entire team of people who are supporting the best possible outcomes. Safety is, of course, paramount. Patients also take comfort in knowing that they have a medical team who can immediately make them more comfortable and answer any questions or concerns they may have in real-time. And these are also the same people you will see time and time again. Developing therapeutic relationships requires trust, and building trust over time with your care team enhances the experience. 


Being in the hands of a team of professionals isn’t the only way clinics can support a positive mindset. Clinics often take great care to design the treatment rooms so they are conducive to feelings of calmness and relaxation. For example, they may include soft ambient and natural lighting, cozy chairs, fresh greenery, and ample space to help you settle in and focus on your journey.

Improved Patient-Provider Relationship

At-home ketamine therapies are sometimes paired with telehealth tools to help guide patients through their treatments. However, while telehealth increases access and flexibility, there are situations where in-person treatments offer irreplaceable benefits, especially for individuals experiencing loneliness and isolation. 


As Dr. Tyson Lippe shares:

I see patients through telehealth, and I also see patients in person. Telehealth certainly increases accessibility, which is incredibly valuable. That said, loneliness and isolation are significant mental health concerns. Anytime we are able to connect directly with people who truly care about our health and well-being, there is a benefit. Offering care in a more hybrid fashion with telepsychiatry and in-clinic treatment administration opens up accessibility while also maintaining great care.

Behavioral Activation

Aside from helping patients combat loneliness and isolation, in-person treatment centers can lead to better outcomes simply by providing patients with a regularly scheduled outing and a chance to interact with friendly staff. In fact, in one evidence-backed form of psychotherapy called behavioral activation, practitioners help patients engage in pleasurable activities that get them moving and socializing to alleviate symptoms of their depression. 


By offering patients a reason to go out, enjoy the company of physicians they’ve grown close to, and undergo a relaxing treatment on a consistent basis, ketamine clinics are able to supplement the therapeutic effects of ketamine itself with the benefits of behavioral activation. 

Comprehensive, Integrated Care

Ketamine often works best when combined with other interventions. For example, Janssen Pharmaceuticals, the maker of Spravato®, recommends combining the treatment with an oral antidepressant. Similarly, researchers have found that psychotherapy can extend the therapeutic effects of ketamine. 



Dr. Noorbaksh highlights how, for a holistic approach to work seamlessly, providers from different disciplines and areas of expertise must develop close working relationships that facilitate the delivery of comprehensive, integrated care:

An important aspect of medicine is developing relationships with other healthcare professionals. At Heading, our approach is hybrid with telehealth for psychiatry and therapy services and in-person visits for interventional treatments like TMS and ketamine. When it comes to combining services, I don’t have to go far to help my patients find great therapists. I’m able to directly communicate with my patients’ therapists, nurses, and care coordinators. Direct communication means there’s less time that my patients and I are waiting for treatment notes to be reviewed or changes in care to take place.

Accountability

Though ketamine can alleviate symptoms far more rapidly and with less frequent maintenance than other interventions, repeated visits are often necessary to sustain the full benefits of the treatment. However, the mental health conditions that ketamine can be used to treat can make it more difficult for patients to stay on schedule.


When asked how in-person treatment centers are well-equipped to address this issue, Dr. Noorbaksh emphasized the value of the interpersonal connections and support patients receive from their care team:

The human interaction and support patients receive from the clinical team during treatment are tremendously valuable. Psychiatric care nurses, medical assistants, and the psychiatrist providing care all get to know their patients and facilitate touch points that simply can’t be replicated in the same way remotely.


In other words, providers at in-person treatment centers can draw on their close connections with and deep understanding of their patients to help mitigate any motivational barriers to receiving treatment. 


Aside from interpersonal connections, clinics are well-equipped to take over the logistical obstacles that might otherwise make scheduling and receiving treatment overwhelming for individuals suffering from anxiety and depression. Dr. Lippe shares that:

Mental health conditions like anxiety and depression can make it hard to keep engaging in activities that are beneficial to health and well-being. But having a clinical team that schedules appointments, offers reminders, and conducts follow-up visits helps keep patients on track. This is vital as we know that staying on track with treatment and in therapy can lead to faster and more durable outcomes. 

Finding the Best Option for You

Ketamine is a powerful psychiatric intervention that can alleviate symptoms of the most severe cases of depression. Specialized clinics designed to optimize each part of the treatment process are likely the best place to undergo ketamine therapy and maximize its therapeutic potential. Some of the most important benefits treatment centers are better suited to provide include:

  • The ability to choose the most effective and affordable type of ketamine and route of administration
  • A tailored environment carefully crafted to support feelings of confidence, safety, and security
  • Close patient-provider relationships that use the power of social connection to build on ketamine’s effects
  • Behavioral activation through consistent appointments, which provide individuals with depression with a regularly scheduled relaxing outing and the opportunity to socialize
  • Comprehensive, integrated care supported by efficient communication among healthcare professionals
  • Added accountability due to interpersonal connections with staff and a competent team ready to take care of all the logistics of planning appointments.
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Mental Health Care Lags in Rural Texas. Can Teletherapy Help Now?

Mental Health Care Lags in Rural Texas. Can Teletherapy Help Now?

January 6, 2023

According to Mental Health Texas, more than three million adults in Texas have a mental health condition. For those in rural areas, adequate mental health care is hard to come by. For example, there isn’t a single hospital in 28 percent of the state’s counties. Even when those in need can make the trek crisis center, hospitals often lack the resources to treat them. 

 

This overall lack of access can have serious consequences as Texans wait to receive or completely forgo treatment. When it comes to mental health care, time is of the essence. Delayed treatment is associated with a wide range of adverse outcomes, from a lower likelihood of remission to cognitive impairments to an increased risk of suicide.

Advocates Propose Solutions to Lawmakers

Mental health advocates have been discussing potential solutions with Texas lawmakers. One of the more glaring issues with the mental health system for rural Texans is the lack of crisis centers. “As I’ve traveled around the state, I have seen the need,” shares Lt. Gov. Dan Patrick. “We don’t have a mental health facility in the Panhandle, so I’m proposing we build one there. This is something we have to do for our communities.” Lt. Patrick is also asking for more hospital beds in several locations, including 300 more in Wichita Falls and Terrell and 140 more in the Rio Grande Valley.

 

“While some hospitals need more beds, others have more than they can fill.” Lt. Patrick suggests this is mainly due to nursing staff shortages. 

 

“There simply aren’t enough mental health professionals to care for a full house of patients.” He says,  “That’s why, in addition to more beds, advocates are calling for tuition assistance to get more students into nursing school and pay raises to incentivize them to take the jobs that are out there.” 

 

Getting more students into nursing programs is a big step in the right direction. Still, according to Dr. Steve Bain, founding director of the Institute for Rural Mental Health Initiatives, we also need to focus on the nursing curriculum. For example, he suggests that there should be more opportunities for nursing students to finish their fieldwork in rural communities.

 

“We’ve got to be constantly connected with these communities,” shares Dan. “It’s going to take research and research funding. And it’s going to take putting our graduate students who need their practicum and internships into these rural communities.”

The Role of Teletherapy

New buildings, beds, and updated nursing programs are a critical part of a comprehensive mental health care system in rural Texas, but what can you do if you need help now?

Over the past few years, as safety precautions made many in-person services infeasible, we saw a dramatic and sustained rise in the use of telehealth services, including teletherapy and telepsychiatry. According to a Zocdoc report, 87 percent of mental health visits were virtual in May 2022.

 

Virtual mental health services have remained popular for reasons which suggest they can help improve mental health care in rural Texas. Telemental health makes mental health care more accessible. But it does in many different ways that remove the obstacles to care for those in need outside of the urban areas of Texas.

Eliminates the Need to Travel Far

Given that in rural Texas, mental health centers are few and far between, distance and travel times are likely significant factors preventing many from seeking care. With teletherapy, there’s no need to travel anywhere.

Patients Don’t Have to Take Time Off

As travel time increases, so does the amount of time one needs to take off work for an appointment. According to the report, 56 percent enjoyed not having to take time off work or responsibilities to travel to appointments. 

More Affordable

Not having to take time, or as much time, away from work to attend appointments is not only convenient it is also addressing cost concerns of hourly and shift workers. 1 in 4 Americans already cite cost concerns as a significant reason for avoiding medical appointments. Missing work for an appointment compounds the financial strain.

 

Telehealth options make it easier for appointments to occur outside of standard work hours which is a more convincing proposition for those who don’t work a traditional 9 to 5.

 

Without the need to pay for transportation or take time off, it’s not surprising that telemental health is easier on the wallet.

Provides Patients with a Better Selection of Mental Health Professionals

Because you can pick providers from a larger area, you typically have a much bigger selection of professionals when booking a virtual appointment. This makes it easier to find the right therapist. For example, it can help find a provider who works with your insurance, specializes in your mental health needs, matches up with your cultural background, speaks your language, or simply vibes with you in a way that enhances your therapy journey. 

Gets Rid of Physical Barriers

Teletherapy allows those who otherwise could not make it to an in-person appointment due to physical disabilities. For example, mental health professionals working out of their own homes may not set up the proper accommodations to make their practice equally accessible for individuals of all abilities. With some estimates suggesting that nearly one in five farmers has a disability that interferes with their ability to perform their job, this barrier may be causing many Texans to avoid receiving care. 

Reduces the Problem of Stigma

Though the public perception of mental health has improved significantly, there is still a considerable amount of stigma associated with having a mental health condition and seeing a therapist. This can be a bigger obstacle in rural areas. 

 

“Stigma, cultural norms, the power of the grapevine in rural communities where folks don’t want other people to know when they’re accessing services…all these factors contribute to a large portion of rural residents not getting help when they need it,” shares Dr. Carly McCord, director of Telebehavioral Health and clinical assistant professor at Texas A&M University College of Medicine

 

Virtual mental health care makes this less of an obstacle, as patients don’t have to go out in public or risk being identified. Telemental health offers them greater privacy and shields them from some of the effects of stigma.

Can Teletherapy Help With Crisis Situations?

Many of the updates that mental have advocates are lobbying for are designed to help those in crisis situations. While teletherapy can help increase access to mental health care in general, one may wonder whether it can do much to help those in the middle of a mental health crisis.

 

One straightforward way teletherapy may help is by preventing the circumstances that require a mental health facility from arising in the first place. Access to regular visits with a mental health professional makes it less likely that one’s mental health condition or circumstances worsen to the extent that crisis intervention is necessary. Since teletherapy allows more patients to see therapists and may increase the odds that they continue to see their provider regularly, it can serve as a preventative measure.

 

With that said, many crisis-specific interventions aren’t available through teletherapy, meaning mental health centers with in-person treatments will remain a crucial component of Texas’s comprehensive rural mental health system. 

Takeaway

For many Texans in rural areas, there are limited mental health resources. From distant crisis centers to understaffed hospitals, finding care when you need it can be challenging, if not impossible. 

 

Mental health advocates aim to change this. They have proposed a variety several changes to lawmakers, including:

 

  • Adding more mental health facilities
  • Increasing the number of beds
  • Covering nursing tuition and offering pay raises
  • Updating nursing programs to include more practicums in rural areas

 

Telehealth is also an essential part of the solution to creating a comprehensive mental health system for rural texas. Its popularity has risen significantly over the past few years for good reasons. Specifically, teletherapy can help Texans in rural areas with unmet mental health needs access adequate care because it:

 

  • Eliminates the need to travel
  • Helps patients get care without taking time off
  • Makes care more affordable
  • Provides a larger selection of mental health professionals
  • Gets rid of physical barriers
  • Reduces the problem of mental health stigma
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Stress Can Be Good for You: Here’s How

Stress Can Be Good for You. Here's How

December 30, 2022

Stress is generally seen as an undesirable state to be avoided whenever possible. It feels bad, can interfere with attention and productivity, and, when experienced chronically, may harm the body and lead to mental illnesses, including depression and generalized anxiety. 

 

Despite stress’s bad reputation, its effects aren’t universally harmful, and there may be some downsides to a completely stress-free life. Learning when stress is good and why can help you identify when it might be working in your favor and when to get rid of it.

What Is Stress?

Before it’s possible to see how and why stress can be good, it’s important to understand what stress is. 

 

Generally, when discussing mental health, we are referring to what’s called psychological stress, which is an ordinarily unpleasant feeling of arousal or tension you experience in response to a negative or challenging circumstance. For example, you may feel stressed about your looming work deadline or financial pressures. 

 

Sometimes, when experts discuss the effects of stress, they are talking about physiological or biological stress, which refers to the physical changes that occur in the body in response to actual or perceived danger, such as an increased heart rate, dilated pupils, or the release of stress hormones. 

 

‘Stress’ can also refer to circumstances or situations that cause or warrant stress. For example, we may say of someone, “They are dealing with a lot of stress right now,” when we mean they are in a stressful situation. Here, ‘stress’ is more synonymous with ‘pressure.’

 

Experts aren’t always clear about which type of stress they are referring to, though they often have psychological stress in mind. 

What is Stress Good for?

There is a reason our bodies evolved a stress response, and it’s not because feeling stressed is always bad for us. When experienced in moderate amounts for short periods. 

Stress Serves as a Wellness Threat Detector

Perhaps one of the most obvious benefits of stress is that it can direct our attention toward and make us care about threats to our well-being. If your ancestors didn’t feel stressed when encountering a dangerous animal in the wild, they might not have known or felt compelled to avoid or attack it.

While the nature of the threats may have changed, our danger detection system lives alive and well in our feelings of psychological stress. They remain an important signal from our bodies that a situation or something about it might be bad for us.

Stress Can Improve Performance

Having no stress at all isn’t always a good thing when it comes to skills and tasks. According to the Yerkes-Dodson Law, optimal performance occurs between no pressure and high pressure in a goldilocks zone, where attention, motivation, and alertness are increased. For example, while a next-day deadline might result in crippling anxiety that prevents you from making progress, no deadline at all might mean you never complete the project. Stress Can Enhance Your Memory

In some instances, our brains appear to respond to stressful experiences by growing or reorganizing in a phenomenon known as neuroplasticity to better respond to similar situations in the future.

 

Memory is a good example of this. Animal studies show the brains of mice that underwent a stress test grew new neurons and performed better on learning and memory tests. Dr. Daniele Kaufer, an associate professor at UC Berkeley who studies the biology of stress, shares:

 

“[This] makes sense from an adaptive point of view.[…] If an animal encounters a predator and manages to escape, it’s important to remember where and when that encounter happened to avoid it in the future. If you’re walking down an alley and somebody threatens you, it’s important to remember exactly where you were in order to avoid that alley in the future.” 

Stress Can Build Your Stress-Resilience Muscles

Stress is often a challenging, unpleasant experience. While we’d all like to avoid it as much as possible, the reality is that no life is stress-free. So how do we learn to manage it better?

 

As with any skill, practice is essential. In the case of stress, repeated exposure to a particular stressor can reduce how stressed it makes you feel over time. This response pattern forms the basis of one of the most commonly utilized psychological therapies, called exposure therapy, which encourages individuals to confront a fear or obsession until it becomes more tolerable. 

 

“Stressful experiences can help you learn how to better cope with stress in the future,” shares Andrea Marquez LCSW, an Austin-Texas-based therapist here at Heading Heading. “They can show you what you’re capable of managing on your own so that the next time you encounter the same stressor, you’re better able to respond to it calmly and effectively.”

Stress Can Strengthen Your Immune System

Perhaps more surprising than the beneficial effects of stress on the mind are its healing effects on the body. While we can get an intuitive sense of how stress might help us prepare for danger or feel extra motivated to complete tasks, it’s a little harder to see how it might benefit us at a biological level.

 

Despite this, researchers argue that stress can be good for the body. For example, experiments have revealed that acute, short-term stress can improve immune responses to vaccinations, woundings, and infections. 

How Do I Know When Stress is Good or Bad?

While stress can improve memory, attention, immune function, stress tolerance, and more, it can do just the opposite. Whether or not a particular stressful feeling or circumstance is beneficial will ultimately depend on several individual factors, meaning there’s no one-size-fits-all test for separating the good stress from the bad. However, there are a few good rules of thumb. 

It Didn’t Last For A While

The benefits of stress are limited to brief exposures to it. If the stress you are feeling is sustained, it may be doing more harm than good. 

It Stops When the Stressor is Gone

Stress that sticks around after the danger or threat is gone is typically bad news.

It Feels Good

While stress usually feels bad, it isn’t always an unpleasant experience. For example, the stress of a workout may feel pleasurable. So, if the pressure you are experiencing feels good, that’s a sign that it might be good for your mind and body. 

You Feel Competent, Capable, and In Control

Stress tends to be less pronounced, shorter, and more beneficial when we have positive beliefs about our ability to problem solve in general or for the specific situation that is causing us stress.

You Feel Motivated But Not Overwhelmed

As we learned from the Yerkes-Dodson Law, some stress is necessary for optimal performance. But how much is suitable for any person depends on various factors from skill level to personality to confidence. So how much is enough for you? 

 

“A good rule of thumb is that you feel motivated but not overwhelmed,” shares Patricia Hernandez LCSW. “That way, you’ll have the energy to complete your tasks without the harmful effects of rumination and anxiety.”  

You Have a Strong Social Support Network

Social support can help ensure stress has a positive impact in various ways. For one thing, a solid social group can help you feel in control of your circumstances and better able to handle whatever stressors come your way. On top of that, social interactions can cause the release of oxytocin, which research suggests protects against the adverse effects of stress. 

You’re in a Stressful Situation

Feelings and emotions can be warranted or appropriate. For example, it “makes sense” to feel happy when something is good for you. We can evaluate stress in the same way. If you are stressed about genuinely stressful situations, then it’s more likely to be of the helpful variety. However, if your stress seems out of line with your circumstances, it’s probably not doing you any favors. 

Takeaway

While stress is often an uncomfortable, harmful feeling, we experience it for a reason. As a result, it’s no surprise that there’s a positive side to stress. For example, it can:

 

  • Alert you to threats to your well-being
  • Improve your alertness, motivation, and overall performance
  • Enhance your memory
  • Increase your stress resilience
  • Improve your immune function

 

The problem with stress is that it can hurt the same things it helps, raising the question, how do you know when stress is good? Stress is more likely to be beneficial when:

 

  • It doesn’t last for long
  • It goes away when the stressor is gone
  • It feels good
  • You feel competent and capable
  • You feel motivated but not overwhelmed
  • You have a solid social support system
  • You’re in a genuinely stressful situation
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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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Blog business mental health Ketamine spravato

How to Prepare for Your First Ketamine Session

Embarking on Your First Ketamine or Spravato® Treatment

December 15, 2022

 

If you’ve been prescribed ketamine or Spravato® for treatment-resistant depression, major anxiety disorder, PTSD, or another mental health challenge it’s normal to have a mixture of feelings and questions. Perhaps you are asking yourself

  • “Do I need to have something in mind when I take the medication?”
  • “What happens to my brain and body during treatment?”
  • “Is there anything I should or shouldn’t do prior or after treatment?”
  • “Are there safety concerns that I should consider?”
  • “Am I going to ‘trip’?”

In this guide we will walk you through the first treatment process, and how this medication can support your health and healing.

We Assure Care and Safety.

Before Treatment

When you are receiving IM Ketamine or Spravato® at Heading you are in the care of doctors, nurses, and medical assistants trained in understanding the intention, usage, dosage, side effects, and safety considerations of these medications. Your safety, comfort, and care are their priorities.

 

 

Your care team will connect with you prior to your appointment, consultation, and administering the medication. Areas of care that you will discuss include your mental health history, what to expect from Ketamine treatment, billing, and insurance.

Then, you’ll also be scheduled for a consultation with a psychiatrist to determine diagnosis,  eligibility, and prepare for your treatment program.

 

Just before treatment the medical team from the clinic will call you to ensure you know what to expect, discuss the dos & don’ts before & after treatment, and discuss having transportation to and from treatment. 

During & After Treatment

During treatment you will meet with a medical assistant, nurse, and your doctor. Your treatment will be administered, and your medical team will check on you periodically before, during, and after to assess how you are feeling physically and emotionally. Ketamine has psychological effects, and physiological effects. Once your treatment is done your care team will ensure you’re feeling well enough to leave the clinic, and will advise you to take it easy for the rest of the day and avoid driving until you’ve had a full night sleep.

 

Then, if you are also participating in therapy along with Ketamine, you will attend an appointment with your therapist typically within 24-72 hours after treatment.

Consider Your Intention for Treatment

Ketamine is a dissociative anesthetic, and even in dosages aligned for mental health rather than for physical anesthesia, it can produce powerful psychedelic experiences. Psychedelic treatments, including ketamine, induce thoughts and feeling that can be outside of typical daily thinking and processing. For that reason it’s helpful to consider the intention you have going into treatment, and support processing the emotions and experiences post treatment as well. 

 

The psychedelic affect of Ketamine is not only part of the appeal of these medications, but also an aspect of treatment that can have a profound impact. A 2006 John Hopkins study on psychedelic treatments – in the case of this study psilocybin was used – the experience of treatment was marked as one of the most significant experiences of their lives. Additionally studies have shown that ketamine treatment can be particularly effective in treating patients who have both PTSD and treatment-resistant depression concurrently. Given the influence a traumatic experience or experiences have on the persistence nature of challenging mental health conditions, understanding what you want to gain through treatment, and what you wish you heal may be helpful going into treatment. 

Pursue a Team Approach with Ketamine Treatment and Therapy

Feelings of overwhelm, and isolation often come with depression, anxiety, and PTSD. It’s important to not only know that you are not alone in your treatment. Therapist who are uniquely qualified to support patients receiving ketamine treatment may be able to support you best.  

 

Intention setting and experience processing can be supported through therapy, and it can be particularly helpful to have someone supporting you in digesting the experience of ketamine therapy after treatment. Perhaps you’re thinking, “Whoa, won’t I be too ‘out of it’ to navigate therapy during or immediately after treatment?”

 

The answer to that question, for you, might be yes.

 

We have found that not everyone feels up to the task of in-depth conversation during or immediately after treatment. However, this isn’t necessarily an issue. You’re still receiving benefit of ketamine treatment after the dissociative and psychedelic affects have worn off.

 

Ketamine is thought to support a brain change concept called neuroplasticity. This refers to the brain’s ability to reorganize synaptic connections – sort of like a software update on your computer. Studies have shown that there may be optimal windows of time, after the dissociative effects of ketamine are gone, to take advantage of the change-making aspects of the treatment. Therapists who are well-versed in ketamine’s ability to treat mental health and specialize in supporting individuals who have experienced trauma, or have hard to treat or treatment-resistant disorders can offer relevant can offer guidance that positively impacts healing.

Bottom line – mental health healing can be a team-effort, and a Therapist is an important member of the team who will continually help you focus your needs, experiences, and healing at the center of care. 

 

“My advice to anyone anxious when starting therapy is to approach it with an open mind,” Ken shares, a therapist at Heading.

In other words, it’s important to adopt a more flexible attitude towards your own general beliefs about therapy and mental health, and even ketamine treatment. 

 

If you are receiving Ketamine and also attending therapy your therapist will continue to guide you with warmth and compassion, and they’ll be able to do so more effectively if you are open about what treatments you are seeking, and if they are specialized in supporting patients who are attending both psychedelic therapy and talk therapy concurrently.

 

Learn More About Ketamine
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