Progress Notes

Category
  • Cupid Searching for a Full-Time Gig

    It’s over a week since Valentine’s Day 2016. By now, for most of you, the chocolate is long gone and the flowers are already wilting. For the fortunate, you may have some new jewelry; a charming reminder of your partner’s affection.

    For some of you, Valentine’s Day is nothing more than a Hallmark holiday, but for many, February 14 serves as a calendar reminder that you need to spread a little love to your partner. The typical Valentine’s Day rituals are nice and all but it’s so easy to go through the motions. The dinner out, the chocolates, the flowers? It’s all become habit. I ask you this, what about a commitment to relationship growth as a notion of love? Nothing says I love you more than a real intentional focus on growth in your partnership with a loved one.

    That sounds well and good, but how do we focus on intentional relationship growth? Books? Youtube videos? Vacation? I’m not saying no, exactly, but I am saying you could try something you may not have considered. Take a look at the tips included below. Each one of them could provide you with plenty of new ideas on how to express your desire and commitment in real tangible ways.

    • According to relationship expert John Gottman PhD, couples should avoid, at all costs, some specific kinds of negative interactions he calls The Four Horsemen of the Apocalypse: Criticism, Contempt, Defensiveness, and Stonewalling are all examples of your relationship weakening. Gottman’s research has identified when these Horsemen run rampant they leave a relationship in a state of emergency.
    • Sue Johnson, developer of Emotionally Focused Couple Therapy, urges partners to nurture the adult attachment bond or, in lay-terms, the rock that is your partner. The degree of your partner’s commitment and presence in the relationship holds influence on your life in most every other way. Those partners who take the opportunity to remind their partners of their willingness to stick it out will stand the test of time.
    • Couples who have a strong sense of each others’ world are far better prepared to deal with stressful events and conflict. What does this mean? It’s like a buffer. It smooths out the bumps in the road. Ask yourself right now, how well do you know what your partner finds most important? Can you name their major aspirations and hopes in life? Are you able to recite in detail your first impressions of each other? Do you know your partner’s basic life philosophy?

    If you want to show your adoration and commitment for the next 358 days, set intentional time to work together with a therapist to help you get to your ideal relationship with less confusion. Imagine how you might be celebrating Valentine’s Day next year.

    Until then, be well.

    Ryan

  • The secret to goal achievement in the New Year, no resolution required.

    It’s already 12 days into 2016. This is about the time that our well-meaning resolutions are abandoned for reasons that often include overly ambitious goals, unforeseen difficulty related to strategy, or just plain unsupportive environments.  When we succumb to defeat we are often overwhelmed by feelings of inadequacy, shame, even hopelessness. It’s tragic really, but there’s good news. It doesn’t have to be this way. I’m suggesting an alternative strategy. Keep your resolution for the New Year in mind as you read on.

    A resolution is a firm declaration to do or not do something. A New Year’s resolution is generally an all or nothing affair. There’s no room for grey. Life simply does not work this way but this is a good thing. An intention requires directed attention to the stages of the pursuit of a goal. An intention is more flexible than a resolution. Someone who has the intention to achieve a goal possesses a sort of agility while traveling the path leading to their desired outcomes. Each obstacle along the path can be negotiated by evoking your original intention. There is a popular quote that captures the essence here, “Be stubborn with your goals and flexible with your methods.” In other words, it’s ok to have aggressive goals, knock yourself out. However, if you intend to achieve those goals by a rigid strategy, odds are you’re leaving a lot of opportunity on the table.

    Intention allows for course correction during your pursuit. Engaging in intentional actions during each phase of the pursuit produces unforeseen opportunity that so often provides that extra motivation we need to persevere. 

    So, how does one go about pursuing goals with intention? Here’s a few of the key concepts to keep in mind as you work towards achieving your goal for the New Year:

    • Have compassion for yourself. Lofty goals aren’t achieved in a day, a month, or even a year. Go easy on yourself if, and when, you lose focus on your goal. A well placed physical reminder of your goal and why it’s important provides precious reinforcement.
    • What about slip ups and setbacks? Thinking, feeling, and acting with intention does not require self- criticism only observation. Take note of what you’re thinking and feeling. Reflect on your actions. If you observe a slip up simply resume your intentional pursuit where you left off. Self-judgment is not part of the equation.  
    • Make an effort to avoid the needless all or nothing thinking. If you find yourself using “must” or “should” chances are that you’re missing the point. Progress towards your goal is just that, it’s a progression. In almost every situation progress occurs in subtle increments. Incremental growth tends to be more meaningful and longer lasting when your intention is to grow at a sustainable pace. Diet and exercise for the purpose of weight-loss is a good example of this concept.
    • Evaluate the supportiveness of your environment. Ask yourself on a regular basis, “Is this a helpful situation?”  If you identify parts of your environment that are not helpful, this is your cue for your next intentional act. Set an intention to avoid or change unhelpful obstacles in your environment. Your future self will thank you for your intentional effort today.

    Does this method of achieving goals resonate with you? I welcome your comments. 

    Until then, be well.

    Ryan

  • SAD ending.

    Welcome to our final installment focusing on the topic of Seasonal Affective Disorder (SAD). Over the past two weeks we’ve explored the symptoms and causes of SAD. If last week’s discussion of the risks to us here in Portland left you feeling a bit doomed to a fate of enduring SAD every year, fear not. Research over the past 30 years has offered some valuable information regarding the effectiveness of treatments specifically targeted to reduce symptoms and, at times, preventing an episode entirely. Know that others have sought treatment with positive results. Lastly, use this information to encourage yourself and loved-ones to pursue treatment. You’ll thank yourself later.

    To fully understand any mental health disorder scientists and practitioners use models or frameworks that help explain the circumstances that cause a disorder in the first place. The most useful of these models is called the BioPsychoSocial model. The thought is, none of these areas are really isolated; each area of function has an effect on the other in some way. Addressing SAD by considering each of these areas goes a long way to developing effective treatment. So we’ve used the BioPsychoSocial model to explain the current treatments for SAD. As you’ll see, many treatment methods can affect more than one area of function.

    THE BIOLOGICAL

    If you recall from the previous week’s post we discussed the Circadian Rhythm, a biological process affecting the body’s regulation of brain chemicals. Some treatments are specifically for assisting the body in restoring normal sleep/wake cycles.

    Sunlight: What does one do when this ingredient is in short supply? We imitate it. Phototherapy, more commonly referred to as Light Therapy, utilizes light provided by a special lamp or fixture. Research tells us that approximately 30 minutes, give or take, of light exposure, specifically aimed at your eyes, can ease depressive symptoms in as little as 4 days. Many people use a light therapy lamp at their desk or dining table positioned about 16”-24” away from their face. This is best done during the morning hours. When browsing for light therapy products be aware that some of the higher intensity lamps bring risk of damaging the eye. Make sure to look at the product offering by Phillips, who places more emphasis on the spectrum of light rather than the intensity of the light.  

    Movement: Moving your body for as little as 30 minutes a day has shown to be helpful in regulating mood as well as numerous other health benefits. Moving the body promotes healthy brain function. Fortunately, this is becoming common knowledge. For best results make sure to pursue additional forms of treatment too. 

    Medication: Not entirely unlike light therapy, anti-depressant drugs can be useful in helping the brain to regulate chemicals that affect mood. More than this, the medication can help provide relief from the physical symptoms like fatigue or aches and pains. Some people only take meds during the winter months, others take them year round to prevent a seasonal episode. You have many options here and a little research on your part will go a long way. One major caveat -- side effects are a reality. To what degree they cause disturbance depends on the individual. You must stay in contact with your prescriber regarding these side effects. No doubt you will be advised to do so by your doctor.  

    Chinese Medicine: This type of treatment has continued to demonstrate effectiveness in treating as many types of ailments as western medicine. Chinese medicine is widely available here in Portland resulting in a reasonable cost. Another unique benefit is that acupuncture carries very little risk of side-effects. Whether its acupuncture or the use of Chinese herbal medicine the practice is shown to be helpful in treating SAD.

    THE PSYCHOLOGICAL

    Psychotherapy: Psychotherapy has proven to be at least as effective as any other treatment for depression. Seeing a therapist to discuss your troubling emotions and intrusive thoughts will often provide relief from the depressive and hopeless symptoms. The most proven critical aspect in therapy is feeling a connection with your therapist. You should feel  safe and free of judgment. Some people find “their therapist” after meeting with other therapists that didn’t quite click. The most important thing to remember is that you need to keep looking if you haven’t found your match. Most therapists will talk with you over the phone free of charge to determine if they are a good fit. If not, ask them about therapists they believe may be a better fit for you. So what exactly is a good fit? Here’s a place to start. Remember, some treatments are helpful in more than one area of function. Some medications can help restore psychological function. Depending on the severity of symptoms, seeing a therapist in conjunction with the use of medication has shown to result in best outcomes. 

    THE SOCIAL

    Spend time with good people: Visiting friends and loved-ones is not only restorative for the soul it also has a biological underpinning; brain chemicals are involved. Spending time with your favorite people, especially when sharing personal feelings or providing and receiving loving support, can really work wonders in soothing depressive symptoms. Those people in your life who have a history of providing this type of support are the people who are likely capable of doing it again. Time spent with others can also have another positive effect. When we help others we benefit as well by feeling connection and usefulness. 

    Exercise: Ugh again? Yep. Physical activity, especially an enjoyable physical activity including friends delivers a one-two punch to symptoms of SAD. Pleasant and shared engagement is what you’re looking for. Portlanders pay attention! Winter weather can prove a worthy adversary when trying to soak up outdoor light and get your body moving. May we suggest a few things? A waterproof jacket, layers, gloves, and waterproof footwear all provide relief against the rain and wind. You may be surprised at how well this works. With mountains and beaches an hour away you have options for staying physically engaged in a wonderfully restorative environment. Leverage this one with everything you’ve got. Even if you don’t leave the city just bundle up and get out there. You’ll notice that others are out there trying to do the same. There’s an element of comradery that serves as a reminder that you’re not alone.    

    All of these treatments have proven helpful and are readily available in Portland. We suggest accommodating as many of these as you can to get the best results. 

    If you’d like to know more about SAD or you’d like a printable resource, check out these links:

    NAMI SAD Fact Sheet

    National Institute of Health

    Mayo Clinic

    Do you have a favorite method you use to fight off symptoms? If so, feel free to share below and we’ll continue the discussion.

    Until then, be well.

  • S.A.D. in PDX.

    It’s not always sunny in Portland! If you caught yourself uttering this phrase to visitors in the past nine months, join the crowd. Our unseasonably warm and dry weather, like we experienced much earlier than typical this year, can cause even seasoned residents (pun intended) to overlook the inevitable fact that we still have long periods of rain. As if this isn’t enough to endure, consider the days when it doesn’t rain but cloud cover lingers. In part two of our three part series exploring symptoms, causes, and treatments of Seasonal Affective Disorder (SAD) we narrow the focus to causes relative to us in the Portland area. The reality is, it’s not always sunny in Portland.  So, grab a hot beverage and put on a sweater as we explain some of the nuanced challenges we all face during a Portland winter.

    In an effort to not bore you with facts and figures about average rainfall and temperatures or the days of sun versus cloud cover, we’ll keep the weather talk brief. In Portland, most of our rainfall comes during the period of October through May and more than half of the days in a year we can expect cloud cover. Here lies the culprit. It’s not so much the cooler temperatures or the inches of rainfall, it’s the significant loss of exposure to direct sunlight. Earth’s orbit is slightly oval in shape and this means that during its orbit the sun’s intensity changes resulting in our beloved seasons. Fun fact: when we’re having our winter we are closest to the sun and our summers come while we’re furthest away from the sun. This is life in the northern hemisphere.

    Daylight and twilight is at the heart of the matter. It is primarily in response to the 24 hour period it takes for earth to spin around once that our bodies maintain its Circadian Rhythm. When a disturbance to this rhythm occurs symptoms of insomnia, depression, reduced physical activity, and changes in appetite often result. As this disruption continues one becomes more and more at risk of negative changes in mental health. So, to review, when we have diminished exposure to sun for an extended period of time (winter), our biological rhythm experiences disruptions that result in negative changes in mood and physical energy (See the first part of the series for the symptoms of SAD). Our colder temperature adds some adversity too. During cold and wet weather we tend to stay indoors resulting in even less light exposure. It’s a tough haul for certain but not for everybody. Genetic variation plays a role in one’s risk for SAD as do unique cultural differences and we all know Portland has a culture.

    Portlanders love their coffee, there’s no doubt about it. Many people find that the consumption of coffee and espresso is a reliable go-to that helps improve motivation and momentum in the face of another cloudy day. This makes sense. It’s unfortunate that this coping mechanism carries some risk too. In general, a greater consumption of caffeine results in a greater risk of  “the crash,” insomnia, and disruption in the regulation of critical brain chemicals. Remember, when we disrupt the circadian rhythm we become vulnerable to mood changes, fatigue, and changes in appetite which can reduce our physical activity. Disruption of the circadian rhythm in combination with the extended cloudy periods results in a “perfect storm” for SAD.

    While Portlanders may have a taste for coffee and a distaste for the umbrella there are many effective ways in which we do cope. In typical fashion we manage to make the most of it. In our final part of the series on SAD we’ll take a look at the way that people find relief from their symptoms. We provide a more encouraging forecast for sufferers and as per usual the situation is uniquely Portland. 

    Until then, be well.

  • Are you S.A.D.?

    How appropriate that we kick off our series on Seasonal Affective Disorder after a weekend of record rainfall and grey skies. Would you be surprised to hear that Seasonal Affective Disorder isn’t technically a diagnosis? That’s right, Seasonal Affective Disorder, or SAD as it’s primarily known, is not a diagnosis listed in the diagnostic manual used in the U.S. This doesn’t mean it’s not a “thing” people suffer from. This “thing” affects a considerable number of people (over 8 ½ million North Americans) with most of these people living in the more northerly latitudes as well as some evidence suggesting that women and adolescents are at higher risk. There are also millions more who suffer from symptoms that fall short of a formal diagnosis due to the intensity or duration of the symptoms. The technical term for SAD is Major Depressive Disorder (MDD). MDD has two main ingredients: symptoms must be present for a two week period of time and the symptoms must result in a marked change from the more usual functioning.

    So, let’s take a look at the symptoms. The most important indicator is that someone has either a stereotypical depressed mood or is experiencing an obvious loss of interest or pleasure in things that used to do the trick. These are the hallmark symptoms of MDD.  There are nine other symptoms to take a look at, and of these nine, five must be present.

    1. Feeling sad or depressed for most of the day, almost every day.
    2. That diminished interest or pleasure we touched on above? Well, that’s going on almost every day too.
    3. A 5% change in body weight over the last month.
    4. Sleep difficulty -- whether that’s sleeping too much or too little nearly every day.
    5. The body is restless or lethargic.
    6. Feeling tired or weak on most days.
    7. Feeling worthless or being consumed with worry and guilt that rarely subsides.
    8. Difficulty thinking or making decisions with almost no relief.
    9. Overwhelming thoughts about death and suicide. 

    And lastly, none of these symptoms can be caused by any sort of substances or by a medical or mental health condition. For someone to have MDD they must have a particular set of symptoms. If that is the case, more information is helpful in distinguishing the many forms of MDD. The seasonal pattern type of MDD occurs every year around the same time (like our seasons). At times these symptoms occur as early as the fall but they disappear in the spring months. This seasonal depression must have occurred for the last two years. So, if you have SAD you actually have a recurrent form of MDD that occurs in a seasonal pattern.  The symptoms can range from mild to severe depending on the number of the symptoms present during the episode.

    There are a few factors at play for the cause of SAD. First, most evidence points to the quantity and quality of natural light. Consider what this means -- someone can literally develop a disorder because of light deficiency. This isn’t hard to grasp when thinking of plant life but the presence of light affects people and animals too. The Circadian Rhythm affects hormones that regulate our sleep/wake cycle. A chemical called melatonin plays a big role in promoting sleep. As a result, we don’t need melatonin during the day. We only need enough of the stuff to help with our sleep cycles and that’s where light comes into play. Exposure to light during the day decreases melatonin production and promotes activity. Light entering the eye creates a signal to the brain that ultimately results in the suppression of melatonin. This reduction in melatonin during the waking hours is essential for mood regulation. Generally, the more light, the less mood disruption. For example, studies have shown that people in Florida suffer less depression caused by seasonal light levels than those in northern states. Makes sense, right? The dominant theory holds that in northern climates during the winter months food is scarce and light levels low. It may have been advantageous for our northerly ancestors to reduce activity and food consumption in order to survive the harsh winters, not unlike hibernation. Melatonin is not the only chemical with a role in depressive symptoms. The brain chemical serotonin also plays a major role in mood regulation and movement and its levels are indirectly affected by light levels. We’ll talk more about serotonin’s role in mood regulation in part three of this series. 

    So now that we have a good grasp on what makes SAD so sad, it would be helpful to know more about the implications for life in Portland. We’ll explore that in part two of this series. Comment below with your specific questions related to SAD and Portland to guide discussion in our next post.

    Until then, be well.

  • This is progress...

    This is progress...

    Hello and welcome to Progress Notes, a blog devoted to the discussion of topics relevant to peoples' experience in living. We will apply the current theories and practices to everyday life in plain explanations and practical terms. We hope to provide clarity and insight regarding issues of psychology and mental health. We will keep it timely and relevant too! 

    In upcoming posts, we will tackle the subject of Seasonal Affective Disorder (or SAD, as it is commonly referred to). In part one of the three-part series, we will explain what current studies tell us about the disorder with a focus on how it affects people in general. Later in the series we’ll talk about the unique challenges we face here in the Pacific Northwest. We will finish up with an in-depth explanation of the many treatment methods offering empirical evidence of their effectiveness. We hope that breaking down the nuts and bolts of Seasonal Affective Disorder will empower you to take action in your own life or help you to encourage a loved one. 

    Lastly, as part of our goal to bring new perspective to mental health issues we invite your input. Have something you would like to see discussed in more depth on Progress Notes? Comment your ideas below!

    Until then, be well.