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Psychodrama
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What is Psychodrama?
Psychodrama is a form of psychotherapy developed by Dr. J.L.
and Zerka Moreno that uses acting to facilitate problem
solving. The
client, called the protagonist, puts his/her truth into action with
the assistance of the therapist, called the director, and other participants,
called auxiliaries. Action Methods refer to a form of therapy
derived from psychodrama that facilitates the client’s shift
from narration (verbally telling his/her story) to motor representation
(showing through use of the body as well as the voice). Psychodrama
is an experiential and expressive arts therapy (as are drama therapy,
music therapy, art therapy, dance/movement therapy, poetry therapy),
engaging the right side of the brain as well as the left side. This
powerful modality has applications in psychotherapy,
education, business, law, and more!
What is The Therapeutic Spiral Model™?
The Therapeutic Spiral Model as a whole system of modified
psychodrama. This
is a trademarked model of experiential change for trauma survivors.
(Hudgins, Experiential Treatment for PTSD. 2002, p.
207)
What is Bibliodrama?
Bibliodrama - as developed by Peter Pitzele, author of “Our
Fathers’ Wells” and “Scripture Windows” -
is a creative and engaging way to revitalize the meanings
of Biblical texts by bringing traditional stories to
life.
Pitzele, a trainer, educator and practitioner fluent in
psychodrama and sociometry, created this form as a result
of his personal
spiritual quests.
In both small and large groups, Bibliodrama is employed
by people of all ages to make new meaningful connections
with
stories from
the New or Old Testaments. They may appreciate their
inheritance from Biblical generations and the links between
the ancient
characters’ lives
and their own lives.
The process, carefully guided by a trained group leader,
involves staying with the text while also expanding upon
the parts of
the story that are silent or not embellished in writing.
Currently, Bibliodrama is used in churches, synagogues,
retreats, faith communities and schools with people of
all levels of
familiarity with the Bible.
As people learn more about the characters and stories
of the Bible, they often make personal connections to
their
own lives.
Kept safe
by the “mask” of the character that they
play, they have the opportunity for a unique kind of
personal growth and even healing.
Natural choices of participation are respected, and each
participant’s
resources - even as a witness - are valued. No special
expertise or experience in acting or theater is needed.
Practical Psychodrama by Karen Carnabucci, MSS, LCSW, TEP
What is Axiodrama?
For anyone experiencing a dark night of the soul or any
troublesome quandary that seems to be blocking one's
way upon the spiritual
path, taking part in an axiodrama can provide a meaningful
and profound
intervention. Whatever one experiences as an obstacle
between herself or himself and God could provide the basis
for
an axiodrama. Adam
and Allee Blatner have identified various spiritual challenges
that could identify the content for an axiodrama. These
include a person's
reluctance to experience "closeness to God," a person's
perception that his or her "innate qualities" must impede
union with God, a person's "feeling angry at God," a person's
feeling "intimidated by the demands" of a spiritual path,
a person's fears about "going crazy," of dying,
of being misled or of misleading others, to name just
a few. An axiodrama
can address virtually any spiritual crisis or concern.
All that is needed are a sincere heart and willingness
to do the work. (Alma
Nugent, MA)
The Body Double:
An Advanced Clinical Action Intervention Module
in the Therapeutic Spiral ModelTM to Treat Trauma
by Kamala Burden, MA, ADTR, CP
and Linda Ciotola, M.Ed. CHES (ret.),TEP
REPORT FROM A BODY DOUBLE
"Since I am an energy worker and a trauma survivor, what I focus on first
is to get myself centered and aware of what is going on in my own body and energy
field.
Then I set an intention to join with the person whom I am being
a double for with what I can best describe as an energetic empathy. I am aware
of what is
going on in my own system and I notice once I join with the person
that I am doubling, the things that are not mine. Some of that may be sensations,
images,
thoughts, symbols, etc. I then attempt to put to words what I am
discovering that is not of my energy system." Roger Halm, CSAC, TAEDESCRIPTION
OF THE CLINICAL ACTION INTERVENTION MODULE
The body double (BD) is a clinical action intervention developed
in the Therapeutic Spiral Model to help treat trauma safely using
experiential
methods of change.
It is a clinical role designed to constantly "keep clients focused on healthy
body awareness, even when triggered by body memories, flashbacks, and ego state
shifts. The body double enacts the cellular nonverbal, intuitive, and emotional
communication from the person’s body to the mind. The body double is used
to assist clients to develop a clearer communication relationship with their
body in order to rebuild what has been termed the ‘body of trust.’" (Hudgins,
2002, p.79) The body double’s purpose is to create a sense
of safety and containment within the realm of the physical body.
It works to contain trauma
based nonverbal behavior, such as body memories, sensory flashbacks,
and ego state shifts by providing words to explain and manage unprocessed
trauma material.
OPERATIONAL DEFINITION
The body double (BD) begins with classical psychodrama doubling methods
(Blatner, 2000), speaking from the first person as part of the client.
It is an intrapsychic/internal
role that is concretized as part of the client, an inner voice that
is supportive and containing
.
The Body Double:
- First establishes a baseline of safe, here-and-now
nonverbal connections to the client by attuning to his/her
movements and body and putting
words to the action.
(Attunement)
- Increases awareness of what is unconscious
for the protagonist; notices trauma-based defenses as demonstrated
by breathing, movement, and other
nonverbal cues. (Reflection)
Then, most importantly,
the BD redirects the protagonist via nonverbal and verbal
modeling toward increased
awareness of POSITIVE body experiences
in the here
and now to prevent the client from being triggered
by unconscious material. (Containment
- Make statements to focus the client in
the here and now to maintain healthy body awareness. (Anchoring)
CLINICAL
GUIDELINES
The Therapeutic Spiral Model (TSM) includes a number of
clinical action structures as guidelines to support the
practice of
experiential methods
when they are driven
by clinical theory and practice. The body double is a
prescriptive role within the trauma survivor’s Intrapsychic role
atom (Hudgins, 2002), which provides a clinical map for the
enactment
of all roles
in TSM.
STEP ONE: Empathic attunement with and reflection to
the protagonist where they are in their bodies. Use non-interpretive
language
to establish a
baseline with
the protagonist that acknowledges their positive movement
preferences and healthy body experience. Areas of focus
Breath – rise and fall of rib cage, depth and pace of breathing, breathing
through mouth or nose. Slow, steady breathing is encouraged: "I
can feel my breath moving deeply in through my nose; my chest
rising and falling with
the breath."
- Body & posture - body parts from foot to head, center/periphery,
rising/sinking, growing/shrinking, etc.: "I notice my head
connected to my spine; I notice my arms crossed over my chest,
my feet
planted
on the ground,
etc."
- Space –use of the body in space:
forward/backward, up/down, orientation in room and to other
participants; moving with direct
or indirect effort; use
of space near self or spread out. "I
notice myself moving directly through
the room, I feel
the space above me, the
floor below me,
my arms moving close
to my sides."
- Weight – the
body’s relationship to gravity
and vitality; light or strong movement
qualities. Be aware of using "strength" as
a descriptive rather than interpretive word. "I
feel my feet stepping strongly on
the floor, my fingers
brushing lightly together?"
- Flow
and muscular tension – the
degree of tension or relaxation
in the skeletal muscular system. "I
can feel my arms hanging loosely
from
my shoulders."
- Senses – seeing (including gaze),
hearing, touch, etc. "I
can see my friend across the room."
STEP
TWO: Containment of negative body
experiences. The focus on positive nonverbals
creates containment
of negative
experiences
via
verbal and
nonverbal redirecting.
Puts narrative labels on traumatic experiencing
and makes them manageable to the client.Breath – Watch
for held, shallow, or quickened breathing.
Encourage deep, slow breathing,
along
with reminders to
keep the feet on the floor.
- Example: Client’s
breathing is becoming rapid. BD
feels/sees client’s
pace escalating and has prior knowledge
of client’s panic attacks. Redirecting: "I
can feel my breath moving in and
out of my nose. I can put all four corners of both feet on
the
floor. I can slow down
and take
a long,
slow breath through
my nose, feel my lungs and ribs
expand, and exhale slowly through my nose."
- Dissociation – Watch
for averted, glazed over or quickly darting eyes, physical
shrinking. As a BD, you may begin to feel
a "spaced out" feeling
in yourself or feel disconnected
from your body.
- Example: Client is triggered by a drama
with a story similar to her
own. BD feels and sees
client exhibiting
signs of
dissociation, and
knows
of client’s
stated desire to "stay
present" during
the session, something the
client has not been able to
do in previous
dramas. Redirecting: "I
can feel my breath, etc. (as
above), I can feel my legs,
hips and back against the chair,
I can begin to move my body
slightly,
put my feet on the floor?I
can choose to look up and
see my friend across the
room), I feel
myself staying in my body
here and now."
- Body Memories – client
may show signs nonverbally
or verbally of physical illness:
nausea, belching, difficulty
swallowing,
headaches, sudden unexplained
muscular pain, or extreme
body temperatures.
- Example: During a drama in
which he has contracted
to confront
a perpetrator, a
client who was
severely physically
abused
begins to
feel sharp pains
in his shoulder and has
no injury. Redirecting: "I
feel intense pain in my
shoulder, I can breathe and feel my
feet,
legs, hips,
and back supporting me.
I can touch my shoulder, rub
my shoulder ?my shoulder
has
information for me. I can
tell someone my shoulder
hurts and ask for
help.
- Flashbacks – Client’s
gaze may shift, breathing
will change, the face
may become distorted, and s/he
may make startled
noises or cry, or may shrink
into self and rock or
shake. Client will experience self as currently in a former
trauma & needs
to be redirected to the here & now.
- Example: Client witnessed
his brother shot and
killed in
a gang-related riot.
During a drama
with loud noises,
client
had a flashback
and began to see the
scene again. Redirecting: "I
feel my breath moving
fast & my
heart beating hard,
I can choose to breathe
slowly, I hear loud
noises
around me, I am remembering
the scene with my brother,
I feel my heart beating
a bit
slower?now I can feel
my feet on the floor,
I
can look up at friend,
I can reach out and
touch her
hand, I can see that
it is her, I see it
is not my brother,
I can
hug my friend, I can
see the
room I am in, I can
walk slowly
with
my friend to the side
of the room, I can
move away from the
noises,
I can
choose to have distance
and be here, now in
this room with my friend
and
myself."
- Self Harm – Watch
for picking, scratching,
hitting, digging
fingernails into hands, twitching,
pulling hair, etc.
See "Clinical
Example" below.
- Ego State Shifts – Watch/feel for
shivering motions, twitching,
eye focus, postural and vocal tone shifts.
- Shame – Often
accompanies or is a precursor to other negative experiences
listed here. Watch for shrinking body posture, drawing
in of limbs, rocking,
lowering the head,
draping hair over face, covering face with hands, shallow breath,
and lack of eye contact. See "Clinical Example" below.
STEP THREE: Anchoring into the here and now.
After redirecting the client into safe
experiences of the body, it is important
to make
a "here & now" statement
such as "I can feel my breath, my feet on the floor, etc. and here and now
I can make a choice to stay in my body, stay in the room, and not harm myself." This
is the third, crucial step, wherein the BD, having
redirected the client away from trauma based
responses into a positive
body experience,
anchors the experience
into the here and now through new words and narrative
labels. This is vital to the client being able
to carry the healthy
body choice
into his or her every
day life
CLINICAL EXAMPLE
ILLUSTRATING ALL THREE STEPS OF THE BD
INTERVENTION
The protagonist, TJ, was a 25 year old
female african-american sexual abuse survivor
with
a history of bulimia
and self-harm. She contracted
for a
drama of transformation
in which she would reclaim her right to
fully inhabit her body and make a conscious
choice not to hurt herself
during an
extended
workshop.
This
example includes
three roles: the client, her body double,
and a Wise
Grandmother (WG). The therapist made a
choice at the beginning of the
drama to give the
protagonist a body double
and this scene is a conversation with WG
to further anchor in this positive internal
roleTherapist – So you
have your body double with you?.can you look up and hear what
WG has to
say to you?
TJ – I think so (begins to tense up and
curl fists)
BD – I can take a deep breath, uncurl my
fists a bit, look up and see my WG
TJ – Yes, I can do that, I see you, and
I am ready
WG – You are a beautiful being, you deserve
to have a healthy body, and to be fully in it,
I love you and I want
this for you
TJ – I can’t believe this, I just feel so bad, I want to love my
body, but I can’t (begins to shrink inward,
turn away, and pick at skin)
BD – (notices what she sees as shame and possible self harm) "I
can feel my body curling in and turning away?.AND
I can feel my breath?.I can use
my breath to expand a bit, I can feel my fingers
on my arm and here and now I can choose to gently
rub my arm, I can
begin to
open my
body with my breath,
and I can slowly turn and see my WG and hear
what she has to say. (BD role models turning
to look at WG)
TJ – (slowly turns to see WG and hear her
speak.)
WG – I love you and I won’t let you
hurt yourself. I am with you always and I know
you are ready to take this
step to
love your body and yourself
(opens arms to TJ)
TJ – (Hesitates, beginning to cry)
BD – I can hear those words and see her
eyes and her arms opening to embrace me. I can
choose to listen, to be
held, to
keep my body
safe and not hurt it
in any way
TJ – I can, I want to connect (goes to WG and is embraced and held). I
know you love me. I love you and I want to be safe. I don’t
have to stay stuck in the shame. I want to choose
to not hurt myself and to stay connected
to my WG and to my healthy body.
BD – I can feel the strong body of WG,
I can allow myself to be held, I can feel my
body breathe that in, and
I can feel
my body
is my own
TJ – Yes, my body is my own. My body is strong like WG’s
body?I can be held and I can love and hold myself,
I can love my body and keep it safe.
TJ was able to complete her drama of transformation
and to report back to the group the next day
that she had not harmed
herself
or had a bulimic episode.
She was able to stay present and safe for the
remainder of the workshop.
In summary, the BD is a role of containment
that helps trauma survivors experience
and anchor in a positive
sense of the
self-in-body. The
BD role requires complete
focus, presence, and steady pacing. Body
messages tend to come slower than mental
ones, so make
a statement,
leave some space,
and then continue.
Do NOT flood
the client with additional sensory stimulus!
DO NOT get caught in the seductive
pull of the trauma-based non-verbals.
DO INTERRUPT?DO INTERRUPT?DO INTERRUPT the cycle of traumatic experience when
the client
is nonverbally
triggered,
provide labels for what
is happening in
the here and now to discriminate between
past trauma based experiences and the present.
It
is a large part
of the job
as a BD to interrupt & redirect – you
ARE the intervention to bring a person
to positive body awareness. This is NOT
the time to be timid!!
The Body Dialogue,
An Action Structure To Build Body Empathy
by Linda Ciotola, M. Ed., CHES,(ret.), T.E.P.
Abstract
“The Body Dialogue” is an action structure using role reversal to
build a bridge of empathy between the body and the self. The director facilitates
a conversation between the body and the self in an attempt to repair the bridge
of broken trust and to re-establish the bond that was disrupted by the trauma
of physical, sexual and/or emotional abuse; medical trauma; illness; aging. The
goal is to facilitate the self’s acceptance of the body and the self’s
willingness to listen to the body; to hear the body’s needs and for the
self to make a commitment for the body’s
care.
Introduction
“The Body Dialogue” evolved in the 1990’s from work which I
was doing in my private practice, mainly with clients suffering with eating disorders. Regardless
of weight, size, or shape, clients often talked about their bodies as something
separate from the self, and labeled the body names such as “blubber”, “jelly
roll”, “pot bellied pig”, and “beached whale”. Clients
engaged in a struggle to control and dominate the body often through dieting,
food restricting, purging, laxative and/or diuretic abuse, excessive exercise,
use of stimulants, etc. The body rebelled by reactively binging, over-sleeping
or insomnia, constipation, and lethargy. Thus
ensued an embattled struggle between the self
and the body for power
and
control.
Later in my work, I found “The Body Dialogue” to be useful in the
work I was doing with trauma survivors during my training with The Therapeutic
Spiral™ and sometimes included use of The Body Double™ with
the Body Dialogue in working with clients who struggled with dissociation (see
www.Therapeuticspiral.org). Trauma Survivors often used words like “disgusting”,
and “gross” to address the body, which had been the holder of the
trauma and pain. “The Body Dialogue” frequently resulted in
the client’s expression of sorrow and gratitude
to the body for all it had suffered and survived.
The next application of “The Body Dialogue” came during an in-service,
which I facilitated for colleagues who work with eating disorder clients, but
who themselves were facing declining physical capacities due to aging. The
conversation between the body and the self again resulted in a new acceptance
of the body’s limitations and allowed the
body to make specific requests of the self about
the kind of care it now
needed.
“The Body Dialogue” may be used with clients in private practice
using an empty chair as well as in groups when another group member may take
the role of the body. “The Body Dialogue” may
be done seated or standing, with protagonist
(self) facing the auxiliary
(body).
The Six Steps of “The Body Dialogue” are:
The protagonist and body are in role with chairs facing
one another; or, may
be standing, facing one another.
Step 1: The director says, “Here is your body. How long have
you had this relationship with your body?” (Protagonist says how
many years). “Tell your body how you feel about your body now.” Protagonist
makes a statement to the body.
Step 2: Role Reverse with body to see what body says, wants,
needs.
Step 3: Role Reverse to see if protagonist can do what body is asking for
and make a commitment. Director: “Look
into the eyes of your body and make the commitment
to do what you
said.”
Step 4: Continue role reversing between self and body until
there is some agreement and new relationship
between body and self.
Step 5: Director looks for non-verbals to get information about what the
new relationship could be. Body positions can be changed to facilitate
the new connection, e.g. from face to face to side by side. Encourage physical
connection between body and self if it doesn’t
occur spontaneously, e.g. holding hands, hugging,
etc.
Step 6: Director: “Make a final statement to
your body to close out the scene.”
Example
Step 1: Kelly chooses Missy for role of Body. Director to Kelly
(Self): “What do you want to say
to your body?”
Step 2: Kelly moves in, holds body’s hands and is crying. “You
are sick right now and I feel really sad that I haven’t been taking good
care of you somehow. I know I’ve gotten better, but I’m
still not good at letting you rest, rest for
no reason, not just when I am sick.”
Step 3: Role Reverse. Director to Kelly in role of Body, “What
do you want Kelly to do before you get sick?” She answers, “I
need to go slow sometimes and it’s hard for you, for your mind to go slow. You
forget it’s important to go slow with me and when we rest we have time
to be together. I need more rest than you. Sometimes you try to make
my needs match yours and we aren’t always
in tune.”
Step 4: Role Reverse – Kelly (Self) admits to body that she doesn’t
pay attention to body’s needs. Body (Missy in Role) repeats, “We
are together when we rest, that’s our time together.” Kelly
(Self) says, “I have heard the teenage part, but I forget about the baby – that’s
the part that needs to rest. That’s the part I forget because I didn’t
even know you were there for a long time.”
Step 5: Role Reverse: Kelly speaks in role of body, “I’m
really cute and I need to rest. Babies need to go slow and to rest. I’m
good at the later years, but I need more rest.” Self (Missy in role)
says, “You are cute!” Role Reverse: Kelly (Self), “I
will let you rest more, hear your needs and be attuned. I’m not gonna
wait til you cry. I’m just gonna know what you need. Role Reverse
(lines repeated). Body says, “I do
trust you.”
Step 6: Final Statement to Body. “You are a gift from God and
I am grateful you didn’t die despite my hard efforts.” Body
says, “I stuck with you and I’m still here.” Self says, “I
don’t feel like you’re holding it against me and I’m grateful
for that as well. I’m gonna listen to the baby better. I can
do that.” They hug.
Director gently facilitates rocking motion and labels it “Rock the baby”.
End of scene.
When used in a group setting, “The Body Dialogue” may be used as
a warm-up, or may be used as vignettes giving several group members an opportunity
to have the conversation between the body and the self. Sharing,
of course, follows.
I welcome questions, comments, and the shared experiences of other directors
who use “The Body Dialogue” at linda.healingbridges@gmail.com.
Copyright, 2005.
References
Caldwell, C. (1996). Getting Our Bodies Back. Boston: Shambala Publications,
Inc.
Ciotola, L. (2004). The Body Dialogue. unpublished article
www.fitness-movement.com
Dayton, T. (1997). Heartwounds. Deerfield Beach, FL: Healt
Communications, Inc.
Farhi, D. (1996). The Breathing Book. New York: Henry
Holt and Company, LLC.
Hudgins, M. K. & Kellerman, P.F. (2001). Psychodrama with Trauma: Acting
Out Your Pain. London: Jessica Kingsley publishers, RRP
Hudgins, M. Katherine (2002). Experiential Treatment for PTSD: The
Therapeutic Spiral Model. New York, NY: Spring Publishing
Company.
Hudgins, M.K., Burden, K.B., Ciotola, L., and Halm, R. (2002). The Body
Double: An Advanced Clinical Action Intervention Module in the Therapeutic
Spiral Model™ to Treat Trauma. Unpublished article. www.therapeuticspiral.org
Lewis, T., Amini, F., Lannon, R. (2000). A General Theory of Love. New
York:
Vintage Books, a Division of Random House, Inc.
Linden, P. (2001). Winning is Healing. Columbus, OH: CCMS Publications
A downloadable book, www.bring-in-movement.com
Walk Around the Clock
(an Action Structure created by Linda Ciotola, M. Ed., CHES
(ret.), T.E.P.)
Create an imaginary clock by setting chairs or “Furry Auxiliaries” (puppets,
or stuffed animals) at 12, 3, 6, and 9. Another option is to place the
numbers on sheets of paper, and place them on the floor. Client walks around
clock while doing a soliloquy about what has transpired in previous 24 hours. Therapist “doubles”. Particularly
useful in helping to identify triggers and consequences for addictions, eating
disorders, etc., and for assessment purposes. (This can be adapted to groups
by having members take roles of time). This exercise can be
repeated several times if more days need to be included.
**Soliloquy with “double” ~ Walk Around the Clock:
• Allows Therapist to get sense of where client has been in last
24 hours
•
Behavioral analysis of impulsive behavior – back up to see
trigger (engaging body)
• “Typical day” – feelings, thoughts, behaviors
• Elicits events which prompt therapist’s follow-up
• Clock – different times represent past, present, future .
. . move to where you need to be
• Helps person focus on history as a way to then move to more quickly
to what the goal is
• In residential setting, investigate how nights were . . .
• Grief work – time when loss happened / or before, related to death,
serious medical treatment,
etc.
•
Ways to adapt to individual therapy are up to Therapist’s imagination
Example:
If client’s appointment is at 3 PM, begin soliloquy with walk
at 3 PM the day before and have client walk and talk
around the clock.
** Soliloquy: The protagonist shares with the audience the feelings
and thoughts that would normally be kept hidden or suppressed. The protagonist
may be engaged in a solitary activity, such as walking home, winding down after
an eventful day, or getting ready for an event in the near future. It might
involve advice giving, words to bolster courage, or reproachful criticism. Variations
include having the protagonist soliloquize with a double as the two of them walk
around, having the protagonist talk to a pet, or converting the inner dialogue
into an encounter with an empty chair or auxiliary playing a wiser, future self
or another part of the personality. (Z. Moreno,
1959 in Blatner, Foundations of Psychodrama. 1988,
p. 176-177).
In the “Walk Around the Clock”, the client’s soliloquy can
be given focus by the Therapist, and the Therapist can function in the “double” role
to help deepen and clarify.
** Double (Classical): The Protagonist is joined by an auxiliary, either
a trained co-therapist or a group member, whose role is to function as a support
in presenting the protagonist’s position or feelings. Doubles should
first work toward establishing an empathic bond with the protagonist. In
general, they stand to the side of and at a slight angle to the protagonist so
that they can replicate the nonverbal communications and present a kind of “united
front”. The double is one of the most important and basic techniques
in psychodrama. (Leveton in Blatner, Foundations of Psychodrama. 1988, p.164)
Recognizing & Treating Depression ~ Linda Ciotola, M. Ed.,CHES, TEP
Sources: National Institutes of Mental Health; Blue Cross/Blue Shield (Vitality); American Counseling Association; Wellness Networking Group
According to the National Institutes of Mental Health, depression affects about 19 million Americans. The effects are far-reaching, impacting not only personal well-being, but family interactions, work place performance, and even financial security.
The following symptom check-list is provided by Blue Cross/Blue Shield:
Depressive mood: do you suffer from feelings of gloom, helplessness or pessimism for days at a time?
Sleep disturbance: do you have trouble falling asleep at night or trouble staying asleep - waking up in the middle of the night or too early in the morning? Are you sleeping too much?
Chronic fatigue: Do you frequently feel tired or lack energy?
Isolation: Have you stopped meeting friends for lunch? Increasing isolation and diminished interest or pleasure in activities are major signs of depression.
Change in appetite: Are you eating far less than usual - or far more? Severe and continuing appetite disturbance is often an indication of depression.
Inability to concentrate: If you can’t seem to focus on even routine tasks, it’s probably time to get some help.
Dependence on mood-altering substances: If you depend on alcohol or other drugs to make it through the day, you may be suffering from depression. Often the substance abuse causes symptoms like those of clinical depression, but are in fact due wholly to the drug use.
Feelings of guilt or worthlessness
Frequent thoughts of death or suicide
A number of treatment options are available and needs may differ depending upon severity. For mild depression, exercise is a first line treatment because of its neurotransmitter elevation effect. Outdoor exercise with sun exposure can be particularly helpful for those suffering with Seasonal Affective Disorder (SAD). Full spectrum lighting at home and work may also help. Avoidance of alcohol is essential for anyone prone to depression because it is a chemical depressant. Optimal nutrition is also key. Keep blood sugar stable with well-balanced, evenly spaced meals containing lean protein, whole grains, fruits and vegetables and healthy fats like nuts, seeds, olive oil. Supplementation with amino acids, essential fatty acids, vitamins, minerals, and/or herbs may also help. Contact a health practitioner familiar with these rather than trying to self-medicate.
Music is a proven mood stabilizer. Combining movement with music in a manner synchronizing the movement with the beats per minute of the music (entrainment) elevates mood-enhancing brain waves. Try walking to your favorite upbeat music; take an exercise class choreographed to music, or just dance. Listen to upbeat music often.
For moderate depression, counseling is a proven treatment, especially when added to the interventions mentioned above. A number of treatment modalities are available as well as specialists in categories such as marriage and family. Options beyond traditional “talk therapy” include experiential and expressive arts therapies, EMDR (see October issue), and dialectical behavior therapy (DBT) which combines psychoeducation with mindfulness training. If your thinking patterns are making you depressed, cognitive behavioral therapy may be the treatment of choice. Interview practitioners to determine a good match.
For more severe depression, medication may be essential in addition to psychotherapy and all the aforementioned treatments. A psychiatrist familiar with mood disorders can prescribe medication best matched to your symptoms. In very severe cases, hospitalization may be necessary. Never stop taking medication without medical supervision.
Like addictions, mood disorders like depression do tend to run in families. So, there may be a genetic pre-disposition to depression which can be triggered by environmental factors such as stress, loss, or trauma. Recent research has shown that acupuncture, regular yoga practice, and meditation help raise the genetic set-point for mood.
If you know that you have a dip in mood during the holiday season, speaking with a professional counselor can help you through this difficult time. In addition, life coach and counselor Sue Waldman, MA, LPC, CEC makes the following suggestions:
The DO’s of managing holiday blues:
Do follow these basics for good health:
- eat right
- exercise regularly
- get plenty of rest
- pray and meditate
Do set realistic goals:
- organize your time
- make lists
- prioritize
- make a budget and follow it
- Do rethink how you view and approach the holidays
- Do write down everything that you are grateful for
- Do focus on the present and think positively
- Do forget about what is suppose to happen and adjust your expectations
- Do let go of the past and create new or different ways to celebrate
- Do allow yourself to feel sad, lonely or melancholy - these are normal feelings, particularly at holiday times
- Do something for someone else
- Do volunteer your time to a good cause
- Do enjoy activities that are free
- Do spend time with people who care about you
- Do spend time with new people or a different set of friends or family
- Do contact someone with whom you have lost touch
- Do give yourself a break - plan to prepare (or buy) one special meal, purchase one special gift, and take in one special event. The rest can be ordinary, but will seem special because of the time of year and the people you’re with.
- Do treat yourself as a special holiday guest
The DON’TS of managing holiday blues:
- Don’t drink alcohol
- Don’t overindulge in holiday foods, especially those that are high in sugar and fat
- Don’t have unrealistic expectations of yourself or others
- Don’t dwell on the past
- Don’t focus on what you don’t have
- Don’t spend money you don’t have
- Don’t ignore your health
- Don’t accept the role of victim
- Don’t long for what once was
- Don’t convince yourself that there is no hope
Please pass this on to anyone who you believe needs some extra support during the holidays.
Special Note: Since 54% of Hispanic men with depression do not recognize they have it or fear treatment, the NIMH has launched a public education campaign to encourage Hispanic men who are depressed to seek help. Spanish-language materials are available through the Real Men, Real Depression campaign. For information and materials, visit www.menanddepression.nimh.nih.gov. Often, men’s depressive symptoms reveal themselves through anger and/or irritability. Treatment is essential to help them and to protect those close to them.
Editor’s Note: If you or someone you know is suffering with depression, please seek help.
Copyright 2009
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