Anti-depression habits to support your wellbeing

Are you dragging yourself round and saying to yourself, What is wrong with me? Pull it together!”.

As Christmas comes around we can think we have to feel the ’joy of the season’ if the advertising is to be believed. However, some of us do not feel joyful or even neutral. In fact we can feel blue and down in our mood and for no apparent reason.

Since beyondblue made depression better known in our community more people have a better understanding that feeling down or blue or low in your mood for extended periods is not the normal way we should.

Depression is much more common today than it was in the community 50 years ago. Even though we are more likely to talk about it today than we did 50 years ago, more people are experiencing signs of depression.

Depression is often misunderstood so let’s be clear about what it is and what it is not. A diagnosis of depression will be made if mood is low for at least two weeks, if your self-esteem is low, you are extra critical of yourself, you feel unreasonably guilty, you have feelings of being worthless, you have no energy and feel lethargic, your appetite has increased or decreased, you can’t concentrate, your sleep is poor, you have trouble getting to sleep, you wake repeatedly, and/or you wake early, you have lost weight without intending to, or you find yourself thinking about suicide.

If you more than one of these signs you should contact your GP to speak about it. Perhaps a friend may have spoken to you about changes they have noticed in you. Depression is often not recognized by ourselves but can be noticed by others around us.

Depression is not sadness. Feeling sad is a normal part of life. Depression is not normal.

Feeling like this can be very unpleasant and sometimes painful to feel so low in your mood. It is best to go to your GP and have them ask you a series of questions to establish what the possible causes may be and how life is for you right now.

It is important to remember that sometimes depression happens for no particular reason. There may be an interaction between the events in our life and the personal history or our biology that causes a change in the chemical levels that shape how we feel about ourselves, our life, future and others.

Treatment is often a combination of medication and psychotherapy. For mild depression psychotherapy alone may be sufficient to relieve the low mood and other signs.

However, when depression becomes more severe it is important to use the tools at hand that have proven effective. The evidence suggests that medication plus psychotherapy is the most effective way to treat symptoms of low mood and other signs of depression and to ensure that you do not have further problems in the future. This is called relapse prevention.

There are some strategies that can be useful for all of us in preventing depression. First, pay attention to yourself – do not neglect yourself. Be aware of your mood. How do you feel right now? Most of us do not have a clue and so become alarmed when we notice we are feeling low.

Second, exercise regularly. Exercise has been shown to have a beneficial effect on mood. Several times a week go out of your house and walk at a pace that makes your heart go a little faster. Some say “walk like you’re late”. For 20 minutes three times a week. Check it with your doctor before you walk if you have medical conditions that concern you.

Third, socialize. Have at least one conversation, however brief, each day. This keeps you connected to others. If you don’t feel like doing it, make yourself do it. Form the habit. Do it every day for six weeks and it will become a habit.

These are anti-depressive habits to support your wellbeing.

7 rules for mental health at Christmas

What is Christmas dinner like at your place? Advertisers would have us believe we need a full table, happy smiling people all the time, all decked out in the latest clothes and having a wonderful time. Unfortunately, or maybe fortunately you might say, the real family Christmas is often far from that fantasy.

Christmas is different things to each of us and there is no one right way to celebrate this time of the year. It is often when we place unrealistic expectations on ourselves that we end up creating tension, anxiety, depression and withdrawal for ourselves and difficulties between us and those we love.

Expecting it to all go smoothly and have no difficulties means we can be overwhelmed when it doesn’t go to plan.

So Rule #1 is to keep your expectations realistic. This can avoid much anxiety and depression that can occur because we don’t met these unrealistic expectations. Family dinners are often tense times and just because you have arguments around the table because someone did not bring the food they were to bring doesn’t make it all a failure.

Rule #2. Life is not black or white, it is often very colourful and mottled. At Christmas, it can be easy to think in terms of fantastic or dreadful. Keep it within reasonable bounds and remember that life is varied and it is normal for life to be complex and colourful.

Rule #3 is that just having one problem does not make Christmas a failure. Just because the turkey didn’t come out the way you wanted or you didn’t get the presents you wanted or Aunt Joan cannot come for Christmas, doesn’t make it a failure. This can help you keep it in proportion and not become catastrophic in your thinking.

Rule #4 is be prepared to let others help you. Do not try to do it all yourself. Being a martyr for the cause is not going to make Christmas any more enjoyable and probably will make it tense for those around you as you try to cope and possibly unpleasant as they deal with your tension. Engage others to do things to help you prepare so it is a team effort.

Rule #5 is make a list of what needs to be done so you can be organized and plan ahead. This makes for a calmer environment for everyone and those around you can be involved in doing what needs to be done in a timely way.

Or offer to help the hosts. This can give you a sense of inclusion and no doubt your hosts will be very grateful.

Rule #6 stay in the present. Avoid flying off into the future in your thoughts about Christmas and worrying about details and events that have not yet happened. Stay in the present. If it has not yet happened it needn’t take up your mind.

Rule #7 think about what you can control and avoid worrying about what you cannot. If you cannot control the outcome of something don’t worry about it. Other people are responsible. If you take over it makes other people less responsible and in the end, less accountable. You doing it all, only makes others more childlike around you, instead of more adult and equals. If you want cooperation you must give people responsibility.

In the end remember, there are no rules!!

Anxiety gets you three ways

Anxiety is often assumed to be palpitations, dry mouth and shortness of breath. But your anxiety may not look like this. It can also be experienced in a range of other ways that may not look like the anxiety we know from the movies or scaremongering 6.30pm TV shows.

Anxiety affects us in three ways. The first of these ways is physically in the superficial muscles of our body including the chest muscles, arms and legs, neck, shoulders and back, and of course head. When adrenaline floods the system in response to perceptions of threat, these large superficial muscles contract in readiness for action. If we live with chronic anxiety it can cause us to develop lower back problems, neck, jaw, teeth and head aches, and sometimes migraines associated with stress. Many people presenting to physiotherapy practices have anxiety induced physical pain.

The chest pain we experience can often cause us to think we are having a heart attack. It is extremely important that you check this out with your GP or specialist so you eliminate this possibility. If after you have explored this and there is no medical explanation it may be worth considering if you have strong chest pain because of stress.

A common problem when anxiety affects people in this way is Chronic Fatigue Syndrome (CFS). It is by no means the only reason but it can make us extremely tired and lethargic. Effectively we become too tired to function and the anxiety causes us to withdraw and in some cases curl up on the couch. Rest becomes a priority and in time the symptoms can become the main aspect we build our life around

The second way anxiety can show itself in our bodies is in our smooth muscles of our gastrointestinal tract. . These are the intestinal muscles that move food down and around our oesophagus stomach and bowel.. Have you noticed that when you get nervous you can sometimes hear your stomach gurgling, or even feel nauseous? Some people do vomit and have trouble keeping food down when they are very anxious.

In the stomach and oesophagus the anxiety causes the release of stomach acid which in large quantities can pass up into the oesophagus causing a burning commonly known as ‘heartburn’, which is very painful.

A common bowel problem that is affected by anxiety is Irritable Bowel Syndrome (IBS). Stress makes the symptoms worse and can compound the physical difficulties by making people uncomfortable about socializing where they may not be close enough to a toilet. Often there has never been any toilet accident in the past but the fear of it is enough to make people avoid social situations altogether.

Other bowel issues include pain and discomfort, gas, diarrhoea and constipation.

The third way anxiety can cause us discomfort is not as obvious as the first two ways. It is known as Cognitive Perceptual Disturbance (CPD).

This type of anxiety can affect your memory, thinking and perception. Memory problems are fairly common at all ages, not just as you get older.

Stress causes some of us to forget, to have difficulty concentrating, and in some extreme cases to simply blank out. Some clients have moments of not being able to remember where they are or to have forgotten what we spent the session talking about if stress was too high for them during the session. Some people will report being dizzy and unable to stand without assistance when highly stressed.

Thinking can also be affected. Some will report having ‘cloudy’, confused thinking. Others will report being unable to concentrate on the voice of a person who is making them anxious.

Disturbances of perception can also occur when anxiety becomes very high. This can take the form of visual blurring, or visual snow. Hearing can be impaired for brief periods making the person unable to hear clearly. Tinnitus is also made worse by stress.

So you can see that stress can affect us in many different ways. Psychotherapy is designed to assist you to recognise the signs of anxiety/stress for what they are. Too many times we hear of people attending Emergency Rooms (ER) with chest pain or crippling stomach pain only to find they have no physical reason for the experience. Canadian figures suggest 50% of presentations to ER with gastrointestinal pain are due to anxiety/stress. This is high cost to the person and to the medical and hospital system.

Psychotherapy can help!

Appreciative Inquiry as a new method of response to behavioural and emotional difficulties in dementia

What could we do in dementia care if we were not focused on problems and deficits, but focused on what the person can still do and wants to? Have we become so focused on what is wrong with the person that we forget who they are, who they can be?

I don’t know about you but if I am surrounded by people who love me and appreciate me for who I am I am a better person than if I am surrounded by people who are not interested in me or have misconceptions of me. What is it like for the person with dementia who maybe can’t use words to understand and communicate their own feelings and experience anymore?

Most ‘behavior management’ (don’t like that term anymore) is focused on what is wrong, the problem caused to others. Usually the person themselves is regarded as the problem by the time a professional is called in to ‘solve’ the problem for them. This loses sight of the person and who they are disappears under the weight of negativity, frustration and judgments about the person.

I suggest we may  be better to go in a different direction. Let’s look to Appreciative Inquiry.

Appreciative Inquiry focuses on approaching  organizational change from a standpoint that the organization is a “solution designed in its own time to meet a challenge or satisfy a need of society” (Cooperrider and Whitney, 2005). This approach focuses on what is working well and effective in organizations rather than on seeing the organization as a problem to be solved. In this way I think we can approach the individual person as a solution designed in its own time to meet a challenge or satisfy a need. This is indeed what the human brain is constantly trying to do. It is trying to work out how to survive, how to make sense of the massive inputs it receives from the world around it so that it can keep the person alive long enough to pass its genes onto another human being. The desire to stay alive is phenomenally strong in the human being.

As the human being faces the threat of diminishment by a condition that destroys the very organ that is designed to keep it alive, the human being goes into survival and responds to this by seeking out attachments, by fighting or fleeing, by behaving in ways that make perfect sense as efforts to ‘make sense’ of the confusing world and to simply survive.

Traditionally in modern dementia care we take a psychiatric approach in response to this range of actions that people engage in when threatened with annihilation. We call it a symptom of an illness (Behavioural and Psychological Symptoms of Dementia – BPSD) and medicalise the normal reaction into an abnormal sign of illness; and ‘disturbed’, or challenging’ or disruptive’ all of which says more about its effect on us and our perceptions of it than anything about the behaviour itself. We gather evidence of this problem and label it aggressive, wandering, repetitive, vocalising, mood swings, agitation, or attention seeking, or manipulative, or clinging. And then we medicate it away because if it is a symptom then medical solutions are called for. So we use psychotropics to modify the person so they don’t do these behaviours. The unfortunate side effects that we tolerate are sedation and confusion, dull emotions and slowness. But its a small price to pay for peace and quite, isn’t it?

Appreciative Inquiry uses 4Ds as a process: Discovery, Dream, Design, and Destiny. Lets look at each a little as they might be applied to an individual ‘behaviour management’ issue.

Discovery:We seek to understand the situation by engaging all stakeholders to articulate the strengths and best approaches to responding to this person. In this way the person can begin to come alive in our minds and the ‘problem” can diminish in our perceptions. What works? What is the best of what is and what has been in this person and our time with them? Let’s ask what is working in this person’s life right now that we want to maintain? What is going well? What are the threads or aspects of this person’s life that they and we want to maintain? What does the person say is going on for them, from their point of view? Rather than focus on  the ‘problem behaviour’ let’s focus on the success this person has in functioning in the face of a condition that undermines their very confidence in their own perceptions and memory for reality.

Dream: What is it we want? What is the result we want here if this is what is working for the person and for us? What is this person calling us to do and be with them? What do they need from us?

Design: Create ‘possibility propositions’ of the ideal relationship with this person, articulating an ideal arrangement of people, routines, relationships that we think this person is capable of engaging in and drawing upon  and magnifying the positives about the person to realise thsi ideal relationship and situation with them.

Destiny: Strengthen the affirmative capability of the situation, organisation, family, enabling it to build a hopeful and sustainable momentum for positive change and high performance of excellent human relationship.

As Cooperrider and Whitney state a crucial step in this process and centre of the process is affirmative topic choice. this is what will define and direct the process. If we remain focused on the topic as a problem for everyone we will ultimately see the person as a problem and not just what they are doing. However, if we can reframe the topic in an affirmative way the topic can become an agenda for relationship with that person, for improving their quality of life and an agenda for care actions and care planning.

Lets have a look at an example: Monique is refusing to come away from the door to the aged care home stating that she needs to go home to her mother who said she has to be home by dark or she will be in big trouble. She is packed and is not prepared to back away. Staff have been approaching her and trying to cajole, to persuade to lie to her, to bully her and most recently to threaten her and physically manhandle her in order to get her away from the door. She is not letting anyone get through the door until she gets through the door first. She doesn’t believe anyone and is firmly convinced that her view of things is correct and others are liars.

If we take an AI approach we begin with Discovery by asking what is going well in Monique’s life. What is working in her care? You might think that not much is working in her life right now and she may say the same thing. However, it is clear that she has a strong attachment if fearful to her mother. This is a positive. A child wants to please their mother by doing the right thing and right now she sees herself as a child needing to go home to satisfy her mother and so avoid trouble. Also a positive is that she has enough ego strength to resist the efforts of numerous cognitively intact people to maintain her stance. This is a positive. Her brain has not yet relinquished its ability to protect its own interests. What might be construed traditionally as resistiveness may be reframed as ego strength and capacity for relationship. We want to assist her to sustain these abilities.

Dream: We ask what we want. What is the desirable future state we want? We want the door way to be open and we want Monique to be contented and peaceful. Happy is too transient a state. Contentment may be more achievable and desirable. The other thing to do is ask what Monique wants. She clearly wants to leave in the short term. She also wants to see and be with her mother, to be attached or connected to her mother. She wants to be a good daughter, an obedient daughter with a satisfied mother who is not angry.

Design: We want to be able to create strong attachment relationships in which Monique feels safe to be angry and afraid and sad, where her emotions are acceptable and it is OK for her to be wanting her mother. We want to have people in our staff group who have the capacity to be unafraid of Monique’s rage and sadness at not being able to get what she wants and who are not overcome with fear at her rage and sadness, who can stand with her at the door and remain in relationship with her rather than pull her away. This may not heal the wound in Monique but it may contribute to a more peaceful life for her.  This is a possibility proposition. It is an ideal and it is what we work toward achieving for Monique and for us.

Destiny: We work to select and training staff who have the personal capacities and motivation to achieve our goal of an emotionally robust staff group who can stand with people in their distress and empathise and be in relationships that are equal with enough peace and enough contentment.

Appreciative Inquiry can be a useful way to reframe the current medical model of ‘behaviour management’ and the symptomology of BPSD into a more humane and affirmative, healing and hopeful approach to life with dementia.


Check out this trailer for the new Pixar film on emotions – ‘Inside out’

The new Pixar film ‘Inside out’ is due for release on June 19th. Check out this trailer It takes a marvelous look into the emotional life inside our heads and bodies that usually dumbfounds us, scares us, makes us defensive, simply overwhelmed. These same emotions can allow us to come close to others, live satisfying lives and understand the inner life of each other.

Check out this fantastic effort to make our emotional life understandable. I imagine this gem of a film might be enjoyed by the adults as much as the children.


Power – love – justice

Just saw this quote from Dr Martin Luther King Jr

“Power at its best is love implementing the demands of justice, and justice at its best is power correcting everything that stands in the way of love.” 
Dr. Martin Luther King Jr
What does justice demand in your life? Is it to remedy the excess disability  of a person with dementia so they can feel their own mind again?

Behaviour is not a disease

Behaviour is not a disease. It is a way of communicating our inner experience when we interact with the world around us. In dementia care behaviour is often treated as though it is a disease. “She’s got behaviour” as if she has some terrible disease. We pathologise normal behaviour and make it into some form of illness. We also ignore some problem situations that we should take more seriously such as withdrawal, anxiety, repetitive questioning or people intruding into other people’s space.

Wellbeing is the goal and respectful, warm relationship is the means to that end. Treat people as human beings – not as some ill object to be washed, pumped, fed, wiped and kept seated.

People with dementia are no different to you and me. When was the last time your brain let you down?