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What is the Blues All About?


Summer days are gone. Autumn has begun.  For many, this time of the year signals the launch of fall festivities, savory treats to indulge along with deliciously comforting fragrances that are sure to cozy you into the change in season with grace and poise – caramel apples, pumpkin spice donuts, mint hot chocolate, spearmint, eucalyptus. While this time of the year is indicative of shorter days, longer nights, and the arrival of winter. It is, for others, the start of an accompanying risk of seasonal affective disorder, or SAD. 

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Seasonal Affective Disorder is a type of depressive disorder that strikes at the shifting of the seasons and is marked by changes in mood that vary from mild to severe (DSM-V., NAMI). Some may refer to it as winter depression, very different from the winter blues, as it can be debilitating and very overwhelming, shaping daily functioning, productivity, and overall wellness. Approximately five percent of adults in the U.S. experience SAD (APA) during predictable months of the year.  While people commonly experience depression symptoms during the cold fall and winter months, some people experience symptoms of SAD during the warm summer months (Melrose, S).

What are the symptoms of SAD?

It is important to note that symptoms of SAD may vary across several different factors, however common symptoms of SAD include alterations in mood – such as sadness, hopelessness, numbness, irritability – furthermore, changes in sleep, appetite, energy, loss of pleasure and interest in activities once enjoyed, or in cases that are severe, suicidal ideation (APA).

Although the primary differentiating element concerning SAD symptoms is that it occurs seasonally, individuals experiencing SAD might also present with sustained depressed mood for periods greater than two weeks where there lies a propensity to develop lethargic depression versus irritability , which is why people experiencing this condition are prone to behaviors such as overeating and oversleeping.

How is it caused?

The evidence for SAD is related to the hormone, melatonin, which is discharged by the pineal gland that controls the sleep-wake cycle (Melrose, 2015). Lack of light stimulates the discharge of melatonin, grooming the body for sleep (Melrose, 2015). Simply put, as the fall and winter cold settles in, melatonin production in the body rises and people tend to be affected by this in ways that lead to increased feelings of lethargy, exhaustion, and sluggishness. 

Alternatively, researchers have found that individuals with SAD may have difficulty regulating their levels chemically, where the neurotransmitter, serotonin, is influential on mood (NAMI., Melrose, 2015). In conclusion, research also suggests the role of Vitamin D in serotonin activity where less sunlight contributes to the body’s response of less Vitamin D (Melrose, 2015).  Other factors found to increase a person’s chance of developing SAD include biological, environmental, and geographical influences. 

How is SAD treated?

SAD can be successfully treated in many ways, including counseling or talk therapy,  antidepressant medications, light therapy, Vitamin D supplementation or a combination of these.  Self-care is also an important component of treatment (APA., Melrose, 2015).  For those who experience SAD, it is important to: 

  1. Take advantage of available sunlight and monitor your body’s internal clock
  2. Get creative by tapping into your inner artist
  3. Develop healthy eating and sleep habits
  4. Exercise in the morning 
  5. Approach the cooler season with a positive attitude and reinforce it with self-affirmations
  6. Plan pleasurable, physical activities (outdoors if safe to do so) 
  7. Seek out a healthy support network through relationships
  8. Learn and practice relaxation techniques such as progressive muscle relaxation, mindfulness, imagery, and deep breathing

References

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition

American Psychiatric Association 

National Alliance on Mental Illness

Melrose, S. (2015). Seasonal affective disorder: an overview of assessment and treatment approaches. Depression research and treatment, 2015.

Perinatal Depression


Changes in emotions and mood swings may be expected during and for a period after childbirth. What may not be unexpected are symptoms of depression. Perinatal depression is depression experienced during pregnancy (antenatal) and up to one year after childbirth (post-partum). World-wide, the occurrence of perinatal depression is estimated to be between 10 and 13%, with slightly higher rates reported in the United States (U.S.). In 2018, one in five and one in eight women in the U.S. reported experiencing antenatal and post-partum depression, respectively. Women from all social economic, racial/ethnic backgrounds, and geographic locations in the U.S. reported experiencing perinatal depression. However, there are several factors that increase the risk of experiencing perinatal depression including a pre-pregnancy episode of depression, being younger than 19 years old at the time of the pregnancy, intimate partner violence, and limited physical support. In addition, having antenatal depression increases the risk for post-partum depression. Risks associated with perinatal include elevated potential for pre-term delivery, decreased mother-child bonding, and delayed cognitive/emotional development.  Identifying and addressing the symptoms of perinatal depression are important steps to ensure the current and future welfare of the mother and the child. 

Symptoms of perinatal depression include:

  • Persistent sadness, anxiousness, or feeling empty
  • Feelings of guilt, worthlessness, hopelessness, or helplessness 
  • Loss of interest or pleasure in hobbies and activities 
  • Fatigue or abnormal decrease in energy 
  • Difficulty concentrating, remembering, or making decisions 
  • Difficulty sleeping (even when the baby is sleeping), awakening early in the morning, or oversleeping 
  •  Abnormal appetite, weight changes, or both 
  • Trouble bonding or forming an emotional attachment with the new baby 
  •  Persistent doubts about the ability to care for the new baby 
  • Thoughts about death, suicide, or harming oneself or the baby 

If you believe you or someone you know is experiencing perinatal depression, it is important to have the symptoms assessed by a qualified medical and/or a mental health professional to ensure the appropriate diagnosis and course of treatment. Once perinatal depression is confirmed, there are several options available to help alleviate the symptoms.

Treatment Options

Medication and psychotherapy are effective methods to address the symptoms of perinatal depression. Health care providers can assess your symptoms and coordinate appropriate treatment which may include medication and/or psychotherapy. Antidepressant medications may be prescribed by a medical provider after consideration of the medical history, the physical condition of mother and child, as well as the potential risks to their future health. Cognitive Behavior Therapy (CBT) and Interpersonal Therapy (IPT) are mental health strategies that have been effective in helping to address the symptoms.

Taking care of yourself helps to decrease the depressive symptoms. Components of self-care include eating nutritious food throughout the day, getting regular exercise to reduce stress, getting an appropriate amount of sleep, having time for yourself each day, and creating a support network. 

Joining a support group may be beneficial. Support groups offer the opportunity to discuss concerns with people familiar with and who have experienced like symptoms while decreasing the sense of isolation. There are support groups specifically for perinatal depression. Your health care provider can direct you to local groups, groups may be found by searching the Psychology Today database, and the Post-partum Support International organization has information on local chapters.

Perinatal Depression in the time of COVID-19

Limited information indicates there has been a substantial increase in women experiencing symptoms of perinatal depression during the pandemic. A Canadian study reported rates in excess of 40%. Stay at home mandates, worries about contracting and transmitting the virus to the baby, limits or bans on birth support, contracting the virus during the hospital stay, and having other young children to care for so there’s limited time for rest or relief are factors cited by women reporting depressive symptoms. In addition to the strategies listed above limiting exposure to media is suggested to reduce symptoms. 

Perinatal depression is estimated to affect more than 10% of women in the U.S. Recognizing the symptoms and seeking treatment are important first steps. There are effective treatment options to reduce the severity of the symptoms and the potential for future health risks for the mother and child.


References

Alessandra Biaggi a,n , Susan Conroy b , Susan Pawlby b , Carmine M. Pariante bJournal of Affective Disorders 191 (2016) 62–77 Identifying the women at risk of antenatal anxiety and depression: A systematic review

Rebecca M. Pearson, PhD; Jonathan Evans, MD; Daphne Kounali, PhD; Glyn Lewis, PhD; Jon Heron, PhD; Paul G. Ramchandani, DPhil; Tom G. O’Connor, PhD; Alan Stein, FRCPsych Maternal Depression During Pregnancy and the Postnatal Period Risks and Possible Mechanisms for Offspring Depression at Age 18 Years Original Investigation jamapsychiatry.com

Brenda L. Bauman, MSPH1; Jean Y. Ko, PhD1; Shanna Cox, MSPH1; Denise V. D’Angelo, MPH1; Lee Warner, PhD1; Suzanne Folger, PhD1; Heather D. Tevendale, PhD1; Kelsey C. Coy, MPH1; Leslie Harrison, MPH1; Wanda D. Barfield, MD1 Vital Signs: Postpartum Depressive Symptoms and Provider Discussions About Perinatal Depression — United States, 2018 US Department of Health and Human Services/Centers for Disease Control and Prevention MMWR / May 15, 2020 / Vol. 69 / No. 19

National Institute of Mental Health. Perinatal Depression. Retrieved from Maternal%20depression/20-MH-8116.

Pregnancy Anxiety and Postpartum Depression During COVID-19. The uncertainties of the situation have presented challenges for our families. Dr. Dawn. Psychology Today.

Perinatal Depression Treatment Options BC Reproductive Mental Health Program. BC mental health and addition services. August 2011.

Moms Are Not OK: COVID-19 and Maternal Mental Health. Margie H. Davenport1*, Sarah Meyer1Victoria L. Meah1Morgan C. Strynadka1 and Rshmi Khurana2   Front. Glob. Womens Health, 19 June 2020  https://doi.org/10.3389/fgwh.2020.00001

Better Than Before


We all want another chance to get something right, or to be granted a do-over.  The one question that continues to be paramount is: How do we get through this time?  A time that appears to have no set end.  Every report, conference, appointment has been completely refocused to include the impact of COVID-19 on our society, bodies, business, finances, families, churches, communities, race, culture and emotions.  Most Americans have experienced heightened anxiety, low mood, loneliness and isolation.

When I first started learning therapy skills, I learned the power of reframing.  I took a workshop that was about interventions. We had to describe the picture we saw as the presenter placed a different frame over each picture.  I started thinking about this exercise a couple of days ago and thought, in order to make this better, we have to think about this time differently.  We need to REFRAME this.  How can we not only survive this, but thrive through this so that at the end we are better than before?  I struggled to this of this differently.  This is only a reset, so that we can rest, so that we can recommit.  Let me explain what I mean.

Reset – Reset can be viewed as a re-entry to the state of zero, or to start over, or to be given another chance.  To start afresh.  I thought, the year has already started, that was our reset.  We made commitments to ourselves, we started new schedules, started a new journal and thought through the old.  We said farewell to Auid Lang Syne (Scottish for days gone by).  We let go so that we can enter in.  We embraced what could be and set our hearts to engage in new possibilities with great anticipation.  Our goals were set, our schedules were set, we were engaged and then all of a sudden it all came to a halt.  In Using a different frame:  We have been given the gift to reset again.  What a treasure and what a wonderful opportunity.  In resetting, we can clear out the last three months and try one more time.  What was not there prior, we can now add.  We can start anew and embrace the beginning once again.

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Rest –  During this period of time we have also been given the gift of rest.  I think about this more in terms of respite.  Although we were only in the 3rd month of the year, some of us were deeply engaged in completing our goals and well-set to move through to the summer with great anticipation of warmth and beauty.  We were running hard and moving fast. All of a sudden it all stopped.  In Using a different frame:  I picture respite as a little slice of joy.  I see myself resting near a pond with my toes in the warm water, the warmth of the sun on my back and the sound of beautiful birds chirping in the background. I lean back to get the full warmth of the sun as I listen to the most beautiful sound that only God can create – Birds chirping, the warm wind blowing and the thought that I’m in the best place ever.  This is what the scripture means in Hebrew about entering into His rest — His rest.  Everything about respite was created by Him. Even this small slice of time in which we are resting, and becoming comfortable with what is so odd, with what we cannot control.  Take a deep breath and enter into His rest. Hebrew 4:10 – For whoever enters into His rest, he also ceases from his own works, as God did from His.

Recommitment – The commitment we made at the beginning of the year, a couple of months ago seem so far away.  In Using a different frame:  This is an opportunity for a recommitment to self.  One of the promises that we don’t want to break is a promise we made to the self.  The promise of want to do better, be better and live better.  Some of us had already picked up bad habits.  We had fallen back into the late arrivals, the bad eating, the loss of sleep, the loss of connection with others.  In the 3rd month, this started to look like the old schedule we wanted nothing to do with.  This period of time gives us the opportunity to recommit to self.  To do what we said.  It also gives us the opportunity to recommit to family.  What a wonderful word.  It is always and has been complex but yet deep.  It has been layered, but yet beautiful.  Family is this amazing group of people that we all have been gifted with who teach us so much.  Family teaches us about how deeply we can love, and how often we can forgive.  This is a recommitment to our faith, as well.  The very essence of who we are and why we are.  It is a reassurance of what we stand for and who we are.

Yes, we will get through this.  What appears to be suffering, fear and sadness, we will get through it.  We will come out of this and we will be better than before as we use this time to reset, rest and recommit!

COVID-19 – The Worry of Violence From An Economic Crisis: Just Another Day For The Poor


  • “The opposite of poverty is justice.” Bryan Stevenson, lawyer and social justice advocate
  • “Like slavery and apartheid, poverty is not natural. It is man-made and it can be overcome and eradicated by the actions of human beings.” Nelson Mandela
  • “He that oppresseth the poor, reproacheth his Maker; but he that honoureth Him hath mercy on the poor.” Proverbs 14:31

As the federal and state sanctions unfold, in response to the Coronavirus, I find myself grateful that our nation and city are taking steps to flatten the curve of the outbreak. In so doing, it can prevent widespread panic, economic crisis, and subsequently, thoughtless violence. However, while I feel grateful, I realize I also feel afraid. And while I am sure I am not alone, rather I am joined by many Americans across the country, I also realize that my fear of unchecked panic turning violent feels eerily familiar. I think, “When have I felt this before? This fear of leaving my house, and coming in contact with people?” Then I remember, “Oh. My childhood.”

Growing up in a moderate- to high-crime neighborhood, fear was a common feeling. Not to mention, being a female and a child/youth meant I was part of a population that was vulnerable to certain crimes. I would not have admitted it then, because the fear was masked by its defensive cousin: anger. However, no matter how the fear was presented, it was a sort of oppression–“mental pressure of distress” (Oxford Dictionary). In this state of fear, I learned from various sources that “I can’t cross the front gate”, “I shouldn’t look at people when I’m walking down the street”, and “even if I feel like someone is going to touch me [perversely or violently], I should hit them”: this way, I would be aware of the real dangers I faced, and the damage to me would be minimal.

Then, things changed.  As I journeyed from the inner city via CTA to a better high school and college education, I noticed a different type of oppression: one centered around race, ethnicity, and socioeconomic status (SES). It was no longer a physical issue, it was a mental one. I did not have the words to describe it then, so I initially tolerated the microaggressions silently: my peers turning away dismissively when I would begin to speak in group discussion, and chuckling comments like, “I’m sorry, can you say that in English?” when I was clearly speaking English. Seemingly unprompted, I became more aware of my Latina-ness, and the “inequitable distribution of power” (Wyatt & Hardy, 2008) I experienced as a person of lower SES and of color.  I was unaware and unprepared for this kind of danger.

This experience of loss of power–“the capacity or ability to direct or influence the behavior of others or the course of events” (Oxford Dictionary)–subsequently exposed me to feelings of inferiority. Dr. Kenneth V. Hardy describes the positions in this struggle as 1) the privileged and 2) the subjugated (Hardy, 2016). And, let me tell you, feeling inferior: MADE. ME. ANGRY. I played reels of violent responses in my mind. But over time, I built a thickness of skin and learned to speak, and write, and hold my ground relentlessly. Psychotherapy and the prayers of persistent parents shaped my perseverance. Yet my anger did not resolve. To cope, I often shamed myself, believing that this aggressive predisposition did not fit my childhood experience. I would tell myself, “I came from an intact family, my parents were involved and supportive, and Christian values were a high priority in my education”. My mind would circle back to the question, “So, where did the aggression come from?” After wrestling with this for years, I have since been able to ask a more telling question: “when (or, in what instances) was anger experienced? And from where did I learn how to respond?”

As an adult, I have gained life-changing insights from my training in patterns of behavior and Life Styles–“This expression does not refer to a particular way of life, but to how different aspects of the personality [emotional and cognitive organization] work together” (Oberst & Stewart, 2005, p. 19). I have come to understand that in my early years of anger and fighting, it was often for the purpose of 1) protecting others, or 2) exerting my own physical/mental power in response to others’ imposition of power over me (i.e. self-defense, or perceived unjust use of power by peers or authority). I can now argue that my aggression was the start of a passion for social justice. So instead of shame, I receive empowerment, and invite wisdom to guide me to healthier responses. Therefore, as I currently fear the outbreak of violence, introspect my own history with anger and violence, and study patterns of behavior, the question begs, “what will make people violent in a time like this?”

And the answer is the same: Poverty. Inferiority. Loss of power.

Poverty is not merely the absence of money, it is a psychological state of powerlessness. The Institute for Research on Poverty (IRP) posits that “scarcity experienced as a result of economic instability and poverty reduces already limited cognitive resources, resulting in detrimental behaviors and ineffective decision-making ” (2011). IRP additionally exposes that poverty has also been linked to higher risk of illness (2013). This means that unhealthy decision-making and risk of illness in the poor or under-resourced is not based on biological inferiorities, rather, it is based on the psychological oppression of the experience of powerlessness. Further, people of color and the underrepresented (to varying degrees, and despite income status) encounter a similar psychological experience of powerlessness. And finally, I would argue that this reveals that ANYONE, despite privilege or skin color, is capable of violence if they experience loss of power, increased panic, and extreme financial distress.

So, what is the connection between this and the state of the world regarding COVID-19? To name a few: the mental-emotional state of uncertainty, desperation, hopelessness, and fear. If you are not currently in poverty (in terms of wealth, health, or privilege) but fear it, count yourself blessed. You are ahead of the curve and you still have power. But if this is just another day of fear, violence, high risk of illness, and inequitable power for you, and/or you are in poverty, know that your mind does not have to be. There is hope and power lying inside each of us, even if it is inequitable. Faith and early experiences have taught me of resilience: ultimately, that WE. WILL. SURVIVE. Therefore, I urge you to use your influence to inspire peace (versus violence), understanding (versus power-struggle), conscientiousness (of the poor, and of privilege), and solidarity in our collective struggle.

Stay connected and wash your hands.

“Peace I leave with you; my peace I give you. I do not give to you as the world gives. Do not let your hearts be troubled and do not be afraid.” John 14:27

“Stop your fighting — [Be still] and know that I am God…” Psalm 46:11

References

Hardy, K. V. (2016). Anti-racist approaches for shaping theoretical and practice paradigms. In M. Pender-Greene & A. Siskin (Eds.), Anti-racist strategies for the health and human services. Oxford, UK: Oxford University Press.

Institute for Research on Poverty (2011). The Psychology of Poverty. Fast, Vol. 28 (1), 19-22. Retrieved from https://www.irp.wisc.edu/publications/focus/pdfs/foc281e.pdf

Institute for Research on Poverty (2013). [Fact Sheet] Poverty Fact Sheet: Poor and In Poor Health. Retrieved from https://www.irp.wisc.edu/publications/factsheets/pdfs/PoorInPoorHealth.pdf

Oberst, U.E., & Stewart, A.E. (2005). Adlerian Psychotherapy: An Advanced Approach to Individual Psychotherapy. New York, NY: Routledge.

Oppression. (n.d.). In Lexipro Powered by Oxford.  Retrieved from https://www.lexico.com/en/definition/oppression

Power. (n.d.). In Lexipro Powered by Oxford. Retrieved from  https://www.lexico.com/en/definition/power

Violence.  (n.d.). In Lexipro Powered by Oxford. Retrieved from https://www.lexico.com/en/definition/violence Wyatt, R.C. (Interviewer) & Hardy, K.V. (Interviewee). (2008).  Kenneth V. Hardy on Multiculturalism and Psychotherapy [Interview transcript]. Retrieved from Psychotherapy.net website: https://www.psychotherapy.net/interview/kenneth-hardy

Come As You Are: Examining Our Own Narratives Around Food, Health, and Body Image


Common assumptions around eating disorders often narrowly focus on an individual’s food intake and exercise. It’s time to examine how cultural norms directly impact all of us. A leading factor in the development of disordered eating is a cultural emphasis on being thin (Culbert, Racine, & Klump, 2015). When thinness is celebrated and equated with health, anyone outside of thinness is subjected to weight stigma and bias. One’s “discipline” and even morality is questioned. Weight stigma is a subsequent threat in and of itself as a risk factor for depression and anxiety (Andreyeva, Puhl, & Brownell, 2008). Rather than investing our time, money, and energy into a narrow and often impossible standard, what if our focus is to work against weight stigma and the idealization of thinness? 

This work begins with ourselves, in identifying the ways we have internalized messages of shame for our bodies, or perhaps in how we have pursued and been devoted to this standard of thinness. For parents and caregivers there is a compelling obligation to consider one’s own beliefs and actions around health, wellness, and eating patterns for the sake of their children. All children are currently composing their own narrative of what it means to “be healthy” and are modeling behaviors from those around them, for better or for worse. (Andreyeva, Puhl, & Brownell, 2008). 

This work is individual and collective. National Eating Disorders Awareness Week is from February 24th-March 1st. The National Eating Disorders Association (NEDA) theme for this year is “Come As You Are, Hindsight is 2020.” Let us take time, be it in conversations, prayer, or in counseling to reflect about our own narratives around food, health, and body image. Let us work toward a culture in our families and communities that speaks to each and every one: “Come as you are.”

References

Andreyeva, T., Puhl, R. M. and Brownell, K. D. (2008), Changes in Perceived Weight Discrimination Among Americans, 1995–1996 Through 2004–2006. Obesity, 16: 1129–1134. doi:10.1038/oby.2008.35

Culbert, K. M., Racine, S. E., & Klump, K. L. (2015). Research Review: What we have learned about the causes of eating disorders – a synthesis of sociocultural, psychological, and biological research. J Child Psychol Psychiatry, 56(11), 1141-1164. 

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