If you have depression or another mental health condition, joining a support group can be a valuable addition to professional treatment. Support groups can help you feel less alone, find new coping skills and motivate you to stick to treatment plans. They can also be a source of hope for recovery and a more enjoyable future.
Depression and mental health support groups abound. Choosing a support group can be challenging but ultimately rewarding. Here's a look at how support groups may help you and how to find one that suits your needs.
Understanding support groups
A support group is a gathering of people who share a common condition or interest. Most mental health support groups focus on specific conditions, whether it's depression, substance abuse or eating disorders, for instance.
Members of the support group share their experiences and practical information about the way they've handled their own situation. They also offer emotional comfort and moral support.
Support groups may be formed by someone with depression or another condition or by someone interested in it, such as a family member. In some cases, they may be formed by nonprofit organizations, mental health clinics or other groups.
In-person support groups may meet in a variety of locations, such as in someone's home, in a church, in a community center or in a clinic. They can also meet electronically, with support shared over the Internet.
Support groups are not the same as group psychotherapy sessions. Group therapy is a formal type of mental health treatment that brings together several people with similar conditions under the guidance of trained mental health professionals.
Gaining benefit from support groups
Good support groups can offer a variety of benefits, from the emotional to the practical. The benefits of support groups include:
Making connections. Meeting others with depression or another mental health condition may make you feel less alone or isolated. A safe and welcoming environment, filled with compassion and understanding, can also reduce any stigma you may feel over having depression or another mental disorder.
Improving your coping skills. Support groups offer the chance to draw on collective experiences. Others who have "been there" may have tips or advice about coping with your condition that hadn't occurred to you. Brainstorming with others may inspire even more ideas. For instance, swapping information about antidepressants for depression can help you see how others handle side effects.
Getting motivated. Support groups can encourage you to seek professional treatment if you haven't yet. They also may encourage you to take a more active role in your treatment or stick to your treatment plan when you feel like giving up. And they may help you tap into community resources, such as housing or transportation assistance.
Finding hope. Sharing experiences and making connections can make you feel better about life in general. Seeing others make strides against depression or another mental illness may give you hope about your own future.
You may be nervous about sharing personal issues with people you don't know. At first, you may reap benefits simply by listening. Over time, contributing your own ideas and experiences can help you get more out of a support group.
Evaluating support groups
Support groups come in many forms. Which one is best for you depends on your needs and wishes.
For instance, perhaps you prefer a structured, moderated group, where you're more likely to find organized discussions and educational information. A moderator or facilitator can help ensure that all participants have equal time and that discussions stay on track.
Here are some questions to consider when evaluating a support group:
Is it geared toward a specific condition?
Is the location convenient for regular attendance?
What is the meeting schedule?
How long has the group existed?
Is there a facilitator or moderator?
What are the confidentiality guarantees?
Does it have established ground rules?
Is it sponsored by a reputable health care facility or organization?
Does it avoid false promises of quick cures?
Does it encourage you to continue your regular medical care and treatment?
What is the mix of participants, such as gender and age?
How many people usually attend?
What is a typical meeting like?
Does it charge reasonable fees, if any?
Plan to attend a few sessions to see how you fit in. If the group makes you uncomfortable or you don't find it useful, try another one.
Remember that even a support group you've come to cherish can change over time as participants come and go. Periodically evaluate the group to make sure it continues to meet your needs.
Finding support groups
You've decided which kind of support group characteristics sound most appealing to you. Now how do you actually find a group to join?
First, ask your doctor, therapist or mental health expert for a suggestion.
Other ways to find a support group include:
Contacting a local, state or national mental health organization
Asking your church, synagogue or other place of worship
Looking in your phone book under mental health, counseling or similar topics
Checking your newspaper for a listing of support resources
Contacting community centers or libraries
Getting recommendations from friends or family
Searching the Internet
Spotting red flags in support groups
Despite all of their benefits, support groups have the potential to interfere with your medical treatment if you're not careful.
Don't abandon treatment with your regular doctor or mental health professional when you join a support group. Support groups are not meant to replace that treatment. They may, however, be a valuable supplement to professional care.
In addition, be wary of information you receive about treatment or medications if it doesn't come from medical professionals. Remember that some information discussed in a support group may not be entirely accurate. If you have depression, for instance, don't be tempted to stop taking antidepressants without consulting your doctor simply because you may hear about a "natural" product to take instead.
Here are some red flags that may indicate the support group isn't in your best interests:
You feel worse after joining the support group
You feel pressure to try a certain kind of treatment
Other members encourage you to stop traditional treatment
Sessions are centered around complaining and negativity
Members insist that you reveal private information
It charges unreasonable fees
It requires you to buy certain products it endorses
It demands your allegiance to a cult-like leader
A few people dominate the discussions
Support groups for depression and mental illness have blossomed on the Internet. And they can be just as valuable as those that meet in person. But keep in mind that while the anonymity can be appealing, it can also be deceiving. The people you're interacting with may not be who they say they are. Also, make sure you don't let extensive Internet use lead to isolation from your in-person social network.
Be sure to talk openly with your doctor or mental health professional about your participation in support groups.
Helping yourself through support groups
Support groups for depression and other mental health conditions can offer a valuable addition to your medical care. They may teach you new coping skills and encourage you to follow through on treatment. They can also broaden your social horizons and make you feel less isolated. Although opening up to others can initially be difficult, you may get more out of a support group than you thought you could.
Monday, December 10, 2007
Depression and anxiety: Exercise eases symptoms
If you have depression or anxiety, you might find your doctor prescribing a regular dose of exercise in addition to medication or psychotherapy. Exercise isn't a cure for depression or anxiety. But its psychological and physical benefits can improve your symptoms.
"It's not a magic bullet, but increasing physical activity is a positive and active strategy to help manage depression and anxiety," says Kristin Vickers-Douglas, Ph.D., a psychologist at Mayo Clinic, Rochester, Minn.
When you have depression or anxiety, exercising may be the last thing you think you can do. But you can overcome the inertia. Here's a look at how exercise can ease symptoms of depression and anxiety. Plus, get realistic tips to get started and stick with exercising.
How exercise helps depression and anxiety
Exercise has long been touted as a way to maintain physical fitness and help prevent high blood pressure, diabetes, obesity and other diseases. A growing volume of research shows that exercise also can help improve symptoms of certain mental conditions, such as depression and anxiety. Exercise also may help prevent a relapse after treatment for depression or anxiety.
Research suggests that it may take at least 30 minutes of exercise a day for at least three to five days a week to significantly improve symptoms of depression. However, smaller amounts of activity — as little as 10 to 15 minutes at a time — have been shown to improve mood in the short term. "So, small bouts of exercise may be a great way to get started if it's initially too difficult to do more," Dr. Vickers-Douglas says.
Just how exercise reduces symptoms of depression and anxiety isn't fully understood. Researchers believe that exercise prompts changes in both mind and body.
Some evidence suggests that exercise postively affects the levels of certain mood-enhancing neurotransmitters in the brain. Exercise may also boost feel-good endorphins, release tension in muscles, help you sleep better and reduce levels of the stress hormone cortisol. It also increases body temperature, which may have calming effects. All of these changes in your mind and body can improve such symptoms as sadness, anxiety, irritability, stress, fatigue, anger, self-doubt and hopelessness.
If you exercise regularly but depression or anxiety still impairs your daily functioning, seek professional help. Exercise isn't meant to replace medical treatment of depression or anxiety.
The benefits of exercise for depression and anxiety
Exercise has numerous psychological and emotional benefits when you have depression or anxiety. These include:
Confidence. Engaging in physical activity offers a sense of accomplishment. Meeting goals or challenges, no matter how small, can boost self-confidence at times when you need it most. Exercise also can make you feel better about your appearance and your self-worth.
Distraction. When you have depression or anxiety, it's easy to dwell on how badly you feel. But dwelling interferes with your ability to problem solve and cope in a healthy way. Dwelling also can make depression more severe and longer lasting. Exercise can provide a good distraction. It shifts the focus away from unpleasant thoughts to something more pleasant, such as your surroundings or the music you enjoy listening to while you exercise.
Interactions. Depression and anxiety can lead to isolation. That, in turn, can worsen your condition. Exercising can create opportunities to interact with others, even if it's just exchanging a friendly smile or greeting as you walk around your neighborhood.
Healthy coping. Doing something beneficial to manage depression or anxiety is a positive coping strategy. Trying to feel better by drinking alcohol excessively, dwelling on how badly you feel, or hoping depression and anxiety will go away on their own aren't helpful coping strategies.
Tips to start exercising when you have depression or anxiety
Of course, knowing that something's good for you doesn't make it easier to actually do it. With depression or anxiety, you may have a hard enough time just doing the dishes, showering or going to work. How can you possibly consider getting in some exercise?
Here are some steps that can help you exercise when you have depression or anxiety:
Get your doctor's support. Some, but not all, mental health professionals have adopted exercise as a part of their treatment suggestions. Talk to your doctor or therapist for guidance and support. Discuss concerns about an exercise program and how it fits into your overall treatment plan.
Identify what you enjoy doing. Figure out what type of exercise or activities you're most likely to do. And think about when and how you'd be most likely to follow through. For instance, would you be more likely to do some gardening in the evening or go for a jog in the pre-dawn hours? Go for a walk in the woods or play basketball with your children after school?
Set reasonable goals. Your mission doesn't have to be walking for an hour five days a week. Think about what you may be able to do in reality. Twenty minutes? Ten minutes? Start there and build up. Custom-tailor your plan to your own needs and abilities rather than trying to meet idealistic guidelines that could just add to your pressure.
Don't think of exercise as a burden. If exercise is just another "should" in your life that you don't think you're living up to, you'll associate it with failure. Rather, look at your exercise schedule the same way you look at your therapy sessions or antidepressant medication — as one of the tools to help you get better.
Address your barriers. Identify your individual barriers to exercising. If you feel intimidated by others or are self-conscious, for instance, you may want to exercise in the privacy of your own home. If you stick to goals better with a partner, find a friend to work out with. If you don't have extra money to spend on exercise gear, do something that is virtually cost-free — walk. If you think about what's stopping you from exercising, you can probably find an alternative solution.
Prepare for setbacks and obstacles. Exercise isn't always easy or fun. And it's tempting to blame yourself for that. People with depression are especially likely to feel shame over perceived failures. Don't fall into that trap. Give yourself credit for every step in the right direction, no matter how small. If you skip exercise one day, that doesn't mean you're a failure and may as well quit entirely. Just try again the next day.
Sticking with exercise when you have depression or anxiety
Launching an exercise program is hard. Sticking with it can be even harder. One key is problem solving your way through when it seems like you can't or don't want to exercise.
"What would happen if you went out to your car and it wouldn't start?" Dr. Vickers-Douglas asks. "You'd probably be able to very quickly list several strategies for dealing with that barrier, such as calling an auto service, taking the bus, or calling your spouse or friend for help. You instantly start problem solving."
But most people don't approach exercise that way. What happens if you want to go for a walk but it's raining? Most people decide against the walk and don't even try to explore alternatives. "With exercise, we often hit a barrier and say, 'That's it. I can't do it, forget it,'" Dr. Vickers-Douglas says.
Instead, problem solve your way through the exercise barrier, just as you would other obstacles in your life. Figure out your options — walking in the rain, going to a gym, exercising indoors, for instance.
"Some people have the idea that being physically active is supposed to be easy and natural," Dr. Vickers-Douglas says. "Some think of it as just having enough willpower. But that really oversimplifies it and can make us feel like failures. You can't just rely on willpower. Identify your strengths and skills and apply those to exercise."
From MayoClinic.com
"It's not a magic bullet, but increasing physical activity is a positive and active strategy to help manage depression and anxiety," says Kristin Vickers-Douglas, Ph.D., a psychologist at Mayo Clinic, Rochester, Minn.
When you have depression or anxiety, exercising may be the last thing you think you can do. But you can overcome the inertia. Here's a look at how exercise can ease symptoms of depression and anxiety. Plus, get realistic tips to get started and stick with exercising.
How exercise helps depression and anxiety
Exercise has long been touted as a way to maintain physical fitness and help prevent high blood pressure, diabetes, obesity and other diseases. A growing volume of research shows that exercise also can help improve symptoms of certain mental conditions, such as depression and anxiety. Exercise also may help prevent a relapse after treatment for depression or anxiety.
Research suggests that it may take at least 30 minutes of exercise a day for at least three to five days a week to significantly improve symptoms of depression. However, smaller amounts of activity — as little as 10 to 15 minutes at a time — have been shown to improve mood in the short term. "So, small bouts of exercise may be a great way to get started if it's initially too difficult to do more," Dr. Vickers-Douglas says.
Just how exercise reduces symptoms of depression and anxiety isn't fully understood. Researchers believe that exercise prompts changes in both mind and body.
Some evidence suggests that exercise postively affects the levels of certain mood-enhancing neurotransmitters in the brain. Exercise may also boost feel-good endorphins, release tension in muscles, help you sleep better and reduce levels of the stress hormone cortisol. It also increases body temperature, which may have calming effects. All of these changes in your mind and body can improve such symptoms as sadness, anxiety, irritability, stress, fatigue, anger, self-doubt and hopelessness.
If you exercise regularly but depression or anxiety still impairs your daily functioning, seek professional help. Exercise isn't meant to replace medical treatment of depression or anxiety.
The benefits of exercise for depression and anxiety
Exercise has numerous psychological and emotional benefits when you have depression or anxiety. These include:
Confidence. Engaging in physical activity offers a sense of accomplishment. Meeting goals or challenges, no matter how small, can boost self-confidence at times when you need it most. Exercise also can make you feel better about your appearance and your self-worth.
Distraction. When you have depression or anxiety, it's easy to dwell on how badly you feel. But dwelling interferes with your ability to problem solve and cope in a healthy way. Dwelling also can make depression more severe and longer lasting. Exercise can provide a good distraction. It shifts the focus away from unpleasant thoughts to something more pleasant, such as your surroundings or the music you enjoy listening to while you exercise.
Interactions. Depression and anxiety can lead to isolation. That, in turn, can worsen your condition. Exercising can create opportunities to interact with others, even if it's just exchanging a friendly smile or greeting as you walk around your neighborhood.
Healthy coping. Doing something beneficial to manage depression or anxiety is a positive coping strategy. Trying to feel better by drinking alcohol excessively, dwelling on how badly you feel, or hoping depression and anxiety will go away on their own aren't helpful coping strategies.
Tips to start exercising when you have depression or anxiety
Of course, knowing that something's good for you doesn't make it easier to actually do it. With depression or anxiety, you may have a hard enough time just doing the dishes, showering or going to work. How can you possibly consider getting in some exercise?
Here are some steps that can help you exercise when you have depression or anxiety:
Get your doctor's support. Some, but not all, mental health professionals have adopted exercise as a part of their treatment suggestions. Talk to your doctor or therapist for guidance and support. Discuss concerns about an exercise program and how it fits into your overall treatment plan.
Identify what you enjoy doing. Figure out what type of exercise or activities you're most likely to do. And think about when and how you'd be most likely to follow through. For instance, would you be more likely to do some gardening in the evening or go for a jog in the pre-dawn hours? Go for a walk in the woods or play basketball with your children after school?
Set reasonable goals. Your mission doesn't have to be walking for an hour five days a week. Think about what you may be able to do in reality. Twenty minutes? Ten minutes? Start there and build up. Custom-tailor your plan to your own needs and abilities rather than trying to meet idealistic guidelines that could just add to your pressure.
Don't think of exercise as a burden. If exercise is just another "should" in your life that you don't think you're living up to, you'll associate it with failure. Rather, look at your exercise schedule the same way you look at your therapy sessions or antidepressant medication — as one of the tools to help you get better.
Address your barriers. Identify your individual barriers to exercising. If you feel intimidated by others or are self-conscious, for instance, you may want to exercise in the privacy of your own home. If you stick to goals better with a partner, find a friend to work out with. If you don't have extra money to spend on exercise gear, do something that is virtually cost-free — walk. If you think about what's stopping you from exercising, you can probably find an alternative solution.
Prepare for setbacks and obstacles. Exercise isn't always easy or fun. And it's tempting to blame yourself for that. People with depression are especially likely to feel shame over perceived failures. Don't fall into that trap. Give yourself credit for every step in the right direction, no matter how small. If you skip exercise one day, that doesn't mean you're a failure and may as well quit entirely. Just try again the next day.
Sticking with exercise when you have depression or anxiety
Launching an exercise program is hard. Sticking with it can be even harder. One key is problem solving your way through when it seems like you can't or don't want to exercise.
"What would happen if you went out to your car and it wouldn't start?" Dr. Vickers-Douglas asks. "You'd probably be able to very quickly list several strategies for dealing with that barrier, such as calling an auto service, taking the bus, or calling your spouse or friend for help. You instantly start problem solving."
But most people don't approach exercise that way. What happens if you want to go for a walk but it's raining? Most people decide against the walk and don't even try to explore alternatives. "With exercise, we often hit a barrier and say, 'That's it. I can't do it, forget it,'" Dr. Vickers-Douglas says.
Instead, problem solve your way through the exercise barrier, just as you would other obstacles in your life. Figure out your options — walking in the rain, going to a gym, exercising indoors, for instance.
"Some people have the idea that being physically active is supposed to be easy and natural," Dr. Vickers-Douglas says. "Some think of it as just having enough willpower. But that really oversimplifies it and can make us feel like failures. You can't just rely on willpower. Identify your strengths and skills and apply those to exercise."
From MayoClinic.com
Saturday, November 10, 2007
Depression: Supporting loved ones through their battle with depression
Depression can rob your loved ones of fully enjoying life or engaging in everyday activities. Instead, they may feel sadness, despair and hopelessness. Not surprisingly, their depression affects you, too, as someone who cares about them, whether it's a family member, friend or even a co-worker facing this serious medical condition.
When a loved one has depression, you can offer support and help in a variety of ways. At the same time, remember to tend to your own physical and emotional needs, too. This way, both of you will be cared for even during the darkest days.
Recognize the symptoms of depression, even if a loved one doesn't
You might think a loved one may have depression even before he or she does. People in the throes of depression sometimes don't recognize the symptoms. Or they may be embarrassed about it or simply think that their situation is hopeless.
Two hallmarks of depression are:
Loss of interest and pleasure in normal daily activities
Feelings of sadness, hopelessness or crying spells
Other signs and symptoms include:
Sleep disturbances
Impaired thinking or concentration
Unintentional weight loss or gain
Agitation or slowing of body movements
Fatigue
Low self-esteem
Less interest in sex
Thoughts of death
If you suspect that a loved one has such symptoms, gently urging him or her to seek medical help may be the best thing you can do. You can also point out that depression is a medical condition that has several effective treatment options. You may also consider discussing how certain other medical conditions, such as thyroid disease, can mimic the symptoms of depression. This may help further persuade your loved one to seek treatment.
If your loved one refuses to seek medical treatment, remember that it may simply be out of shame or a sense that things can't get better. Try to be patient and bring up the topic again — but without being pushy or insensitive. However, if your loved one's depression is so severe that it's debilitating or life-threatening, you may need to consider intervening by contacting a doctor, hospital or emergency medical services.
Don't tell someone with depression to snap out of it
If you've never experienced depression yourself, then it's impossible to know how helpless and hopeless a person can feel in the midst of it.
Understand that depression is a serious illness that requires medical attention. It isn't the result of a character flaw or moral weakness. It may result from a chemical imbalance in the brain. When someone with depression can't get out of bed, go to work or play with their children, it's not laziness. Rather, it may be a debilitating sense of fatigue, overwhelming feelings of worthlessness or the inability to make even simple decisions.
People with depression can no more snap out of it than can people with diabetes or arthritis. If a loved one has depression, don't tell them to smile more or just get over it. People don't enjoy having depression, but they can't simply will themselves into wellness.
Try reading more about the condition and treatment to better understand what it's like to have depression.
And even if your loved one begins depression treatment, don't expect immediate results. Treatments, such as therapy and medication, take time to have an effect on depression symptoms. In the meantime, encourage your loved one to continue treatment and remind him or her that things will improve as time goes on.
Offer support and compassion to a loved one with depression
Even if you can't know what depression feels like, you can offer empathy and compassion. Simply being there for the person can make a difference in the course of his or her illness.
To help someone who has depression, you can:
Gently express concern. Acknowledge their pain but avoid using the words "I know how you feel" if you really don't. Although you may think you know what's causing the depression, avoid offering solutions. Listen if he or she wants to talk, but try not to ask too many intrusive questions. People with depression often don't have the energy or inclination to discuss their symptoms, and they may instead just stop talking altogether.
Ask how you can help. Depression may leave your loved one unable to take care of regular chores and tasks. Make yourself as available as possible to help balance the checkbook, keep the home in order, run errands and take care of children or pets, for instance. Keep in mind that your loved one may not be able to offer suggestions. If that's the case, give specific suggestions about what you're willing to do and ask if it's OK if you go ahead and do them, such as mowing the lawn.
Give positive reinforcement. Depression can make people feel worthless. They may judge themselves harshly and find fault with everything about themselves, from their appearance to their job to their thoughts and feelings. You can remind your loved one about his or her positive qualities and how much he or she means to you and others.
Encourage healthy behaviors. Depression steals away motivation, energy and interest. Ask your loved one to join you on a walk, for a movie, or to work on a hobby or other activities he or she previously enjoyed. But don't try to force him or her into doing something. If your loved one is in treatment for depression, help him or her remember to take prescribed medications and to attend therapy appointments.
Watch for depression symptoms that worsen
People with depression are at an increased risk of taking their own life. Stay alert for suicide warning signs such as:
Agitated behavior and sleeplessness
Statements about no longer living, such as "You won't have to worry about me much longer"
Giving away possessions or saying goodbye to friends
Suddenly cheering up after a period of depression, which could actually signal a renewed sense of energy to follow through on suicide plans
If you think a loved one is considering suicide, encourage him or her to call a doctor, mental health clinic or suicide hot line immediately. If your loved one's life is in imminent danger but he or she refuses to seek help, call for emergency help yourself.
Keep depression from taking a toll on you
Supporting someone with depression isn't easy. You may find yourself stressed and you may even begin to think that things won't improve. It can be even more difficult if you have others to care for as well.
Share your feelings with a caregivers' support group or discuss the situation with a therapist, relative or confidante. See your doctor if you develop any problems that you think require medical attention.
And finally, remind yourself that with appropriate treatment, most people with depression do see an improvement in their symptoms. Better days may be on the horizon — for both of you.
When a loved one has depression, you can offer support and help in a variety of ways. At the same time, remember to tend to your own physical and emotional needs, too. This way, both of you will be cared for even during the darkest days.
Recognize the symptoms of depression, even if a loved one doesn't
You might think a loved one may have depression even before he or she does. People in the throes of depression sometimes don't recognize the symptoms. Or they may be embarrassed about it or simply think that their situation is hopeless.
Two hallmarks of depression are:
Loss of interest and pleasure in normal daily activities
Feelings of sadness, hopelessness or crying spells
Other signs and symptoms include:
Sleep disturbances
Impaired thinking or concentration
Unintentional weight loss or gain
Agitation or slowing of body movements
Fatigue
Low self-esteem
Less interest in sex
Thoughts of death
If you suspect that a loved one has such symptoms, gently urging him or her to seek medical help may be the best thing you can do. You can also point out that depression is a medical condition that has several effective treatment options. You may also consider discussing how certain other medical conditions, such as thyroid disease, can mimic the symptoms of depression. This may help further persuade your loved one to seek treatment.
If your loved one refuses to seek medical treatment, remember that it may simply be out of shame or a sense that things can't get better. Try to be patient and bring up the topic again — but without being pushy or insensitive. However, if your loved one's depression is so severe that it's debilitating or life-threatening, you may need to consider intervening by contacting a doctor, hospital or emergency medical services.
Don't tell someone with depression to snap out of it
If you've never experienced depression yourself, then it's impossible to know how helpless and hopeless a person can feel in the midst of it.
Understand that depression is a serious illness that requires medical attention. It isn't the result of a character flaw or moral weakness. It may result from a chemical imbalance in the brain. When someone with depression can't get out of bed, go to work or play with their children, it's not laziness. Rather, it may be a debilitating sense of fatigue, overwhelming feelings of worthlessness or the inability to make even simple decisions.
People with depression can no more snap out of it than can people with diabetes or arthritis. If a loved one has depression, don't tell them to smile more or just get over it. People don't enjoy having depression, but they can't simply will themselves into wellness.
Try reading more about the condition and treatment to better understand what it's like to have depression.
And even if your loved one begins depression treatment, don't expect immediate results. Treatments, such as therapy and medication, take time to have an effect on depression symptoms. In the meantime, encourage your loved one to continue treatment and remind him or her that things will improve as time goes on.
Offer support and compassion to a loved one with depression
Even if you can't know what depression feels like, you can offer empathy and compassion. Simply being there for the person can make a difference in the course of his or her illness.
To help someone who has depression, you can:
Gently express concern. Acknowledge their pain but avoid using the words "I know how you feel" if you really don't. Although you may think you know what's causing the depression, avoid offering solutions. Listen if he or she wants to talk, but try not to ask too many intrusive questions. People with depression often don't have the energy or inclination to discuss their symptoms, and they may instead just stop talking altogether.
Ask how you can help. Depression may leave your loved one unable to take care of regular chores and tasks. Make yourself as available as possible to help balance the checkbook, keep the home in order, run errands and take care of children or pets, for instance. Keep in mind that your loved one may not be able to offer suggestions. If that's the case, give specific suggestions about what you're willing to do and ask if it's OK if you go ahead and do them, such as mowing the lawn.
Give positive reinforcement. Depression can make people feel worthless. They may judge themselves harshly and find fault with everything about themselves, from their appearance to their job to their thoughts and feelings. You can remind your loved one about his or her positive qualities and how much he or she means to you and others.
Encourage healthy behaviors. Depression steals away motivation, energy and interest. Ask your loved one to join you on a walk, for a movie, or to work on a hobby or other activities he or she previously enjoyed. But don't try to force him or her into doing something. If your loved one is in treatment for depression, help him or her remember to take prescribed medications and to attend therapy appointments.
Watch for depression symptoms that worsen
People with depression are at an increased risk of taking their own life. Stay alert for suicide warning signs such as:
Agitated behavior and sleeplessness
Statements about no longer living, such as "You won't have to worry about me much longer"
Giving away possessions or saying goodbye to friends
Suddenly cheering up after a period of depression, which could actually signal a renewed sense of energy to follow through on suicide plans
If you think a loved one is considering suicide, encourage him or her to call a doctor, mental health clinic or suicide hot line immediately. If your loved one's life is in imminent danger but he or she refuses to seek help, call for emergency help yourself.
Keep depression from taking a toll on you
Supporting someone with depression isn't easy. You may find yourself stressed and you may even begin to think that things won't improve. It can be even more difficult if you have others to care for as well.
Share your feelings with a caregivers' support group or discuss the situation with a therapist, relative or confidante. See your doctor if you develop any problems that you think require medical attention.
And finally, remind yourself that with appropriate treatment, most people with depression do see an improvement in their symptoms. Better days may be on the horizon — for both of you.
Wednesday, November 7, 2007
Deep brain stimulation: An experimental depression treatment
Depression is usually a very treatable condition. Often, standard treatment with antidepressant medications, psychotherapy or electroconvulsive therapy can help improve even severe cases of depression.
But if standard depression treatment doesn't work, you might wonder if experimental treatment can help. One potential option is deep brain stimulation. This procedure hasn't been approved by the Food and Drug Administration (FDA) to treat depression, but it may be available to you through a clinical trial.
How deep brain stimulation works
Deep brain stimulation is a highly experimental treatment for depression in which the brain is stimulated with electrical impulses in an attempt to change mood. The procedure hasn't been FDA approved for depression and is in only the early stages of research. However, deep brain stimulation has become a standard treatment for people with Parkinson's disease.
Deep brain stimulation requires two surgical procedures — surgery on your brain to implant electrodes and surgery on your chest to implant a neurostimulator device. Because the procedure is new and experimental for depression, it may not be performed exactly the same way everywhere.
In general, here's how surgery for deep brain stimulation works. For the brain surgery portion, you're given local anesthetics to numb the area being operated on. You remain awake and alert, however, so that the surgeon can talk to you to make sure the proper areas of your brain are being stimulated. Your head is placed in a special frame to keep it still during surgery. Two holes are drilled in your skull. Guided by imaging techniques, the surgeon implants electrodes on both sides of your brain.
During the second portion of surgery, the surgeon implants the neurostimulator in your chest. Wires from the brain electrodes are placed under your skin and guided down to the battery-operated neurostimulator. The neurostimulator sends electrical signals along the wires to the electrodes, stimulating the brain.
The neurostimulator can be easily programmed from outside your body. Dosage of the electrical impulses is customized to the individual. Stimulation is generally continuous, 24 hours a day.
How deep brain stimulation affects depression
Exactly how deep brain stimulation can affect depression isn't clear. Researchers theorize that certain regions deep within the brain influence mood and depression. They believe that the areas associated with depression may be overactive in certain people. Sending electrical impulses to these areas may "reset" them to normal functioning, researchers speculate.
Little research has been done using deep brain stimulation in people with depression. One clinical trial included just six people, for instance. Follow-up of these people has been short, which means it's not known if any improvements in depression symptoms will last long term. Additional research is needed to learn more about how deep brain stimulation works and how safe and effective it is for depression.
Who may benefit from deep brain stimulation
Because deep brain stimulation is experimental, it's available only through participation in clinical trials. In addition, because of the risks involved, its use is limited to people who have severe, debilitating depression that has not improved with other treatments. Talk to your doctor to see if it may be an option for you.
Side effects of deep brain stimulation
Any surgical procedure carries risks. Because deep brain stimulation involves brain surgery, the procedure may be especially risky. In addition, the neurostimulation itself may cause side effects.
Common side effects and adverse health problems associated with deep brain stimulation include:
Bleeding in the brain
Infection
Delirium
Unwanted mood changes
Movement disorders
Lightheadedness
Insomnia
In addition, people who have undergone deep brain stimulation to treat Parkinson's disease have reported such side effects and adverse events as panic attack, speech difficulty, movement problems and even suicide.
The long-term risks of deep brain stimulation for depression aren't known.
There also are possible inconveniences associated with deep brain stimulation. For instance, the hardware may malfunction, and batteries must be replaced every one to three years.
Weighing the pros and cons of deep brain stimulation
Deep brain stimulation is a serious and potentially risky procedure. Even if you are a candidate for a clinical trial to test deep brain stimulation, you and your doctors must carefully weigh the pros and cons of the procedure. If your depression is incapacitating or life-threatening, you may be more willing to face the risks involved with deep brain stimulation.
But if standard depression treatment doesn't work, you might wonder if experimental treatment can help. One potential option is deep brain stimulation. This procedure hasn't been approved by the Food and Drug Administration (FDA) to treat depression, but it may be available to you through a clinical trial.
How deep brain stimulation works
Deep brain stimulation is a highly experimental treatment for depression in which the brain is stimulated with electrical impulses in an attempt to change mood. The procedure hasn't been FDA approved for depression and is in only the early stages of research. However, deep brain stimulation has become a standard treatment for people with Parkinson's disease.
Deep brain stimulation requires two surgical procedures — surgery on your brain to implant electrodes and surgery on your chest to implant a neurostimulator device. Because the procedure is new and experimental for depression, it may not be performed exactly the same way everywhere.
In general, here's how surgery for deep brain stimulation works. For the brain surgery portion, you're given local anesthetics to numb the area being operated on. You remain awake and alert, however, so that the surgeon can talk to you to make sure the proper areas of your brain are being stimulated. Your head is placed in a special frame to keep it still during surgery. Two holes are drilled in your skull. Guided by imaging techniques, the surgeon implants electrodes on both sides of your brain.
During the second portion of surgery, the surgeon implants the neurostimulator in your chest. Wires from the brain electrodes are placed under your skin and guided down to the battery-operated neurostimulator. The neurostimulator sends electrical signals along the wires to the electrodes, stimulating the brain.
The neurostimulator can be easily programmed from outside your body. Dosage of the electrical impulses is customized to the individual. Stimulation is generally continuous, 24 hours a day.
How deep brain stimulation affects depression
Exactly how deep brain stimulation can affect depression isn't clear. Researchers theorize that certain regions deep within the brain influence mood and depression. They believe that the areas associated with depression may be overactive in certain people. Sending electrical impulses to these areas may "reset" them to normal functioning, researchers speculate.
Little research has been done using deep brain stimulation in people with depression. One clinical trial included just six people, for instance. Follow-up of these people has been short, which means it's not known if any improvements in depression symptoms will last long term. Additional research is needed to learn more about how deep brain stimulation works and how safe and effective it is for depression.
Who may benefit from deep brain stimulation
Because deep brain stimulation is experimental, it's available only through participation in clinical trials. In addition, because of the risks involved, its use is limited to people who have severe, debilitating depression that has not improved with other treatments. Talk to your doctor to see if it may be an option for you.
Side effects of deep brain stimulation
Any surgical procedure carries risks. Because deep brain stimulation involves brain surgery, the procedure may be especially risky. In addition, the neurostimulation itself may cause side effects.
Common side effects and adverse health problems associated with deep brain stimulation include:
Bleeding in the brain
Infection
Delirium
Unwanted mood changes
Movement disorders
Lightheadedness
Insomnia
In addition, people who have undergone deep brain stimulation to treat Parkinson's disease have reported such side effects and adverse events as panic attack, speech difficulty, movement problems and even suicide.
The long-term risks of deep brain stimulation for depression aren't known.
There also are possible inconveniences associated with deep brain stimulation. For instance, the hardware may malfunction, and batteries must be replaced every one to three years.
Weighing the pros and cons of deep brain stimulation
Deep brain stimulation is a serious and potentially risky procedure. Even if you are a candidate for a clinical trial to test deep brain stimulation, you and your doctors must carefully weigh the pros and cons of the procedure. If your depression is incapacitating or life-threatening, you may be more willing to face the risks involved with deep brain stimulation.
Friday, November 2, 2007
Combined reuptake inhibitors and receptor blockers
Certain brain chemicals called neurotransmitters are associated with depression, including the neurotransmitters serotonin (ser-oh-TOE-nin) and norepinephrine (nor-ep-ih-NEF-rin). Research suggests that abnormalities in neurotransmitter activity can affect mood and behavior.
Combined reuptake inhibitors and receptor blockers are dual-action antidepressants that act on brain cells both by inhibiting the reabsorption (reuptake) of neurotransmitters into nerve cells and by blocking nerve cell receptors. This leaves more of these neurotransmitters available in the brain, thereby boosting mood.
Here are the combined inhibitors and blockers that have been approved by the Food and Drug Administration specifically to treat depression, with their generic names followed by available brand names in parentheses:
Trazodone (Desyrel)
Nefazodone (Serzone)
Maprotiline
Side effects and safety concerns
Side effects of combined inhibitors and blockers include:
Dry mouth
Dizziness
Drowsiness
Lightheadedness
Nervousness
Nausea
Constipation
Weakness
Vision problems
Confusion
Headache
Trazodone has been associated with priapism — persistent, usually painful erections not associated with sexual arousal. If this occurs, seek medical treatment immediately. Many of those cases have required surgical correction, resulting in permanent impairment of erectile function or impotence.
In rare cases, nefazodone (nef-AY-zoe-done) can cause life-threatening liver failure. Don't take it if you already have liver problems. Know the signs and symptoms of possible liver dysfunction, such as yellowing of your skin or the whites of your eyes, unusually dark urine, loss of appetite, nausea or abdominal pain. Contact your doctor immediately if you experience any of these problems.
Maprotiline has been associated with seizures, so people with a history of seizures usually shouldn't take this medication.
In some cases, antidepressants may be associated with worsening symptoms of depression or suicidal thoughts or behavior, particularly early in treatment or when you change your dosage. Be sure to talk to your doctor about any changes in your symptoms. You may need more careful monitoring at the beginning of treatment or upon a change in treatment, or you may need to stop the medication if your symptoms worsen.
From MayoClinic.com
Combined reuptake inhibitors and receptor blockers are dual-action antidepressants that act on brain cells both by inhibiting the reabsorption (reuptake) of neurotransmitters into nerve cells and by blocking nerve cell receptors. This leaves more of these neurotransmitters available in the brain, thereby boosting mood.
Here are the combined inhibitors and blockers that have been approved by the Food and Drug Administration specifically to treat depression, with their generic names followed by available brand names in parentheses:
Trazodone (Desyrel)
Nefazodone (Serzone)
Maprotiline
Side effects and safety concerns
Side effects of combined inhibitors and blockers include:
Dry mouth
Dizziness
Drowsiness
Lightheadedness
Nervousness
Nausea
Constipation
Weakness
Vision problems
Confusion
Headache
Trazodone has been associated with priapism — persistent, usually painful erections not associated with sexual arousal. If this occurs, seek medical treatment immediately. Many of those cases have required surgical correction, resulting in permanent impairment of erectile function or impotence.
In rare cases, nefazodone (nef-AY-zoe-done) can cause life-threatening liver failure. Don't take it if you already have liver problems. Know the signs and symptoms of possible liver dysfunction, such as yellowing of your skin or the whites of your eyes, unusually dark urine, loss of appetite, nausea or abdominal pain. Contact your doctor immediately if you experience any of these problems.
Maprotiline has been associated with seizures, so people with a history of seizures usually shouldn't take this medication.
In some cases, antidepressants may be associated with worsening symptoms of depression or suicidal thoughts or behavior, particularly early in treatment or when you change your dosage. Be sure to talk to your doctor about any changes in your symptoms. You may need more careful monitoring at the beginning of treatment or upon a change in treatment, or you may need to stop the medication if your symptoms worsen.
From MayoClinic.com
Tuesday, October 30, 2007
Anger management: Tips to control your temper
If you find that your angry outbursts are negatively affecting your relationships with family, friends, co-workers and even complete strangers, it's probably time to change the way you express your anger.
Here are some tips to get your anger under control:
Take a "time out." Count to 10 before reacting or leave the situation altogether.
Do something physically exerting. Physical activity can provide an outlet for your emotions, especially if you're about to erupt. Go for a walk or a run, swim, lift weights or shoot baskets, for example.
Find ways to calm and soothe yourself. Practice deep-breathing exercises, visualize a relaxing scene, or repeat a calming word or phrase to yourself, such as "take it easy." You can also listen to music, paint, journal or do yoga.
Express your anger as soon as possible so that you aren't left stewing. If you can't express your anger in a controlled manner to the person who angered you, try talking to a family member, friend, counselor or another trusted person.
Think carefully before you say anything so that you don't end up saying something you'll regret.
Work with the person who angered you to identify solutions to the situation.
Use "I" statements when describing the problem to avoid criticizing or placing blame. For instance, say "I'm upset you didn't help with the housework this evening," instead of, "You should have helped with the housework." To do otherwise will likely upset the other person and escalate tensions.
Don't hold a grudge. Forgive the other person. It's unrealistic to expect everyone to behave exactly as you want.
Use humor to defuse your anger, such as imagining yourself or the other person in silly situations. Don't use sarcasm, though — it's just another form of unhealthy expression.
Keep an anger log to identify the kinds of situations that set you off and to monitor your reactions.
You can practice many of these strategies on your own. But if your anger seems out of control, is hurting your relationships or has escalated into violence, you may benefit from seeing a psychotherapist or an anger management professional. Role playing in controlled situations, such as anger management classes, can help you practice your techniques.
Keep at it
It may take some time and intense effort to put these tips into practice when you're facing situations that typically send you into a rage. In the heat of the moment, it can be hard to remember your coping strategies.
You may need to keep something with you that serves as a reminder to step back from the situation and get your anger under control. For instance, you may want to keep a small, smooth stone in your pocket or a scrap of paper with your tips written down. With due diligence, these anger management techniques will come more naturally and you'll no longer need such reminders.
Here are some tips to get your anger under control:
Take a "time out." Count to 10 before reacting or leave the situation altogether.
Do something physically exerting. Physical activity can provide an outlet for your emotions, especially if you're about to erupt. Go for a walk or a run, swim, lift weights or shoot baskets, for example.
Find ways to calm and soothe yourself. Practice deep-breathing exercises, visualize a relaxing scene, or repeat a calming word or phrase to yourself, such as "take it easy." You can also listen to music, paint, journal or do yoga.
Express your anger as soon as possible so that you aren't left stewing. If you can't express your anger in a controlled manner to the person who angered you, try talking to a family member, friend, counselor or another trusted person.
Think carefully before you say anything so that you don't end up saying something you'll regret.
Work with the person who angered you to identify solutions to the situation.
Use "I" statements when describing the problem to avoid criticizing or placing blame. For instance, say "I'm upset you didn't help with the housework this evening," instead of, "You should have helped with the housework." To do otherwise will likely upset the other person and escalate tensions.
Don't hold a grudge. Forgive the other person. It's unrealistic to expect everyone to behave exactly as you want.
Use humor to defuse your anger, such as imagining yourself or the other person in silly situations. Don't use sarcasm, though — it's just another form of unhealthy expression.
Keep an anger log to identify the kinds of situations that set you off and to monitor your reactions.
You can practice many of these strategies on your own. But if your anger seems out of control, is hurting your relationships or has escalated into violence, you may benefit from seeing a psychotherapist or an anger management professional. Role playing in controlled situations, such as anger management classes, can help you practice your techniques.
Keep at it
It may take some time and intense effort to put these tips into practice when you're facing situations that typically send you into a rage. In the heat of the moment, it can be hard to remember your coping strategies.
You may need to keep something with you that serves as a reminder to step back from the situation and get your anger under control. For instance, you may want to keep a small, smooth stone in your pocket or a scrap of paper with your tips written down. With due diligence, these anger management techniques will come more naturally and you'll no longer need such reminders.
Saturday, October 20, 2007
Anger management: Recognize and understand unhealthy behaviors
You've probably heard the joke: "I went to a fight and a hockey game broke out." Certainly, it seems like there are more brawls than ever at sporting events these days, that you're lucky if you've never been subjected to road rage, and that you may have to tip-toe around coworkers who seem constantly ready to explode.
But it's not anger itself that's a problem — it's how you handle it. Robert T. Zackery is a licensed independent clinical social worker at Mayo Clinic, Rochester, Minn., who provides counseling and runs anger management classes. Here, he offers insights into the nature of anger, when it can be helpful, how to manage it, and what to do when you're confronted by someone whose anger is out of control.
What is anger?
Anger is a feeling of displeasure or hostility. It's a normal, healthy emotion, just like any other feeling you have.
Anger has several components:
Psychological. This is the emotional component of anger, how you feel, such as sadness, disappointment or frustration.
Physiological. This is how your body responds to anger, such as muscle tension or an increase in heart rate and blood pressure as your body releases adrenaline — the fight-or-flight hormone.
Cognitive. This is what you think as you experience anger, such as acknowledging that it's OK to be frustrated, or, on the other end, thinking that the world is out to get you or that your spouse "never" does what you ask.
In essence, anger is a warning bell that tells you something is wrong in a situation. It's a natural response to perceived threats.
So it's not "bad" to feel angry?
No, being angry isn't a bad or negative thing. Being angry can motivate people to listen to your concerns. It can prevent others from walking all over you. And it can motivate people to change larger societal issues. It's how you handle your anger that can be a problem.
Why, then, do some people think that being angry is unacceptable?
Some people are uncomfortable with the expression of anger. A lot of it depends on their own personal experiences with anger. For instance, if they were in abusive situations or if they grew up in a household where anger was used to control their family, any sign of anger can make them anxious. They can feel intimidated by anger, even if it's expressed in an appropriate manner. They may think "nice" people don't get angry.
What causes people to become angry?
There's usually an activating event — something in particular that sets you off, such as a disagreement at work, being stuck in traffic or not being able to get through to an actual person on the phone. Some people may be angry about their own personal circumstances, such as financial problems.
Most people don't just walk around feeling mad all the time, though, unless it was a learned behavior. People aren't born angry.
You said it's how people handle their anger that's important. What are the ways of handling anger, and what's the healthiest way?
There are two basic ways to handle anger:
Expression. This is conveying your anger. Expression occurs along a continuum, from having a reasonable, rational discussion to erupting into out-of-control violence. It's the difference between talking to someone or picking up a baseball bat and hitting them.
Suppression. This is trying to hold in or ignore your anger. You may think you shouldn't be angry or that you'll lose control if you let yourself feel any anger. The danger in this passive approach is that you may not protect yourself when the need arises. On the other hand, you may become passive-aggressive, where you don't express your anger assertively or directly but scheme to retaliate because you haven't learned how to express anger constructively. Trying to suppress your anger can lead to such health problems as headaches, stress, depression or high blood pressure.
Expressing yourself in an assertive — not an aggressive — manner is the healthiest approach to handling anger. You state your concerns and needs clearly and directly, without hurting others or trying to exert power over them.
Why do some people snap, exploding into rages even over seemingly minor irritations?
Reactions to anger really aren't instantaneous, even if it may appear that someone suddenly "snaps." When someone explodes with anger, there are actually a lot of feelings behind that prior to reaching that boiling point. What happens, though, is that people don't stop to examine their feelings before they explode.
Your personal history feeds your reactions to anger. That's why some people react so angrily to certain situations, like losing a parking space, while others take it in stride. You may have built up years of feeling unheard, ignored, sad, frustrated or disrespected. From the activating event that initially triggers your anger, you move along a continuum where you feel a number of things, such as intensifying agitation or irritation, and then your personal history comes into play and you may explode, especially if you don't step back to think about where your anger is heading. Also, if you were taught that being angry was negative, you may never have learned how to express anger appropriately.
How can you stop your anger from turning into a violent outburst?
Out-of-control anger is a learned behavior, so you have to unlearn it. Consider, for instance, someone who was in the military and basically taught to kill. Then he leaves the military, but with every confrontation or challenge, he goes back into that military role and responds aggressively — not assertively, but with aggression or hostility. He has to realize that no one is trying to fight with him, and that his reaction is out of proportion to the situation.
Some anger management techniques he can practice include:
Self-talk to remind himself he's not in the military anymore and to keep himself aware of his reactions.
Walking away from the situation until he calms down.
Remembering to treat other people like he'd want to be treated.
Agreeing to disagree, and leaving it at that.
He may also need professional help or a qualified anger management class to help him unlearn these behaviors.
What is an anger management class, and how does it work?
An anger management class is a way to teach people how to express their anger in a controlled, healthy way. We teach people about what anger is, how to recognize their anger triggers, how to become aware of their own feelings of anger, and how to keep their anger under control. We also discuss what other feelings they may have going on, such as depression. We can do this individually, with spouses or families, or in groups.
So, for the person who was in the military, for example, we would work with him on realizing that he doesn't need to yell and scream and get aggressive when he's angry. We'd also work with him on issues he may have with his upbringing, such as being in an abusive household.
How do you know if you might benefit from an anger management class?
Not everyone who gets angry needs an anger management class. You may get ticked that your television remote control doesn't work and throw it across the room. Do you have an anger management issue if you do that? Probably not.
But if you have run-ins with the police, you physically harm someone or you try to intimidate someone with your anger, you could probably benefit from an anger management class.
Some people blame their reactions on others, saying things like, 'You bring out the worst in me.' Is that a valid excuse?
Someone can make you angry, but how you express that anger is your responsibility. In a marriage or family, does your spouse or your kids know which buttons to push that will set you off? Sure they do. They know your vulnerable spots.
This happens to me with my teenage daughter sometimes. She may repeatedly ask to go out with friends I don't want her to be with, and I get mad at her. But what I'm really feeling is afraid for my child. Is her behavior making me angry? Yes, sometimes it is. But you have to remember that we're responsible for our own feelings and reactions to what other people do. Recognize that you have a conflict and see how you can handle it appropriately.
Can anger harm your health?
There is evidence that shows inappropriately expressing anger can be harmful. Whether you're overly passive and keep your anger pent up, whether you're prone to violent outbursts or whether you're quietly seething with rage, you may have headaches, sleep difficulties, high blood pressure or digestive problems. There's even some evidence that stress and hostility related to anger can lead to heart attacks. That's another reason it's important to learn how to express anger constructively and appropriately — it's good for your health.
It seems as if so many people are on edge these days, ready to explode or actually launching into violent rages, like at sporting events. Is society becoming angrier?
Many people today are faced with multiple stressors — bills, drugs, peer pressure, racial conflicts, health care issues, war. There's a lot of stress in society in general. There are so many things to feel threatened about, and some people respond in a negative way. Or maybe they're just not satisfied with life; they're not content. And they haven't learned how to handle their anger constructively.
But it's not entirely unique to modern-day society. I experienced a road-rage situation 25 years ago. I pulled up to a stop sign and so did another person. I felt I was there first so went ahead. Well, she followed me around the block several times, and when I went and parked, she pulled up next to me so close that I couldn't even open my car door. And then she started screaming at me that I'd cut her off. I finally said I'd call the police and she drove away.
What can you do if you're confronted by someone whose anger is out of control?
Usually the most rational thing to do, if possible, is to just walk away. If you stay, you risk it escalating into violence. It's important to take reasonable precautions to protect yourself if leaving the situation is difficult or impossible, and to not engage the other person in a manner that's likely to provoke an escalation in their angry behavior.
That's not to say you should never confront someone. If someone is doing something you don't want them to do, and you confront them about it, you now have a conflict. You have to know how you're going to handle that conflict, though. Size up the person you're confronting, and be ready to protect yourself, especially if it's a stranger.
But it's not anger itself that's a problem — it's how you handle it. Robert T. Zackery is a licensed independent clinical social worker at Mayo Clinic, Rochester, Minn., who provides counseling and runs anger management classes. Here, he offers insights into the nature of anger, when it can be helpful, how to manage it, and what to do when you're confronted by someone whose anger is out of control.
What is anger?
Anger is a feeling of displeasure or hostility. It's a normal, healthy emotion, just like any other feeling you have.
Anger has several components:
Psychological. This is the emotional component of anger, how you feel, such as sadness, disappointment or frustration.
Physiological. This is how your body responds to anger, such as muscle tension or an increase in heart rate and blood pressure as your body releases adrenaline — the fight-or-flight hormone.
Cognitive. This is what you think as you experience anger, such as acknowledging that it's OK to be frustrated, or, on the other end, thinking that the world is out to get you or that your spouse "never" does what you ask.
In essence, anger is a warning bell that tells you something is wrong in a situation. It's a natural response to perceived threats.
So it's not "bad" to feel angry?
No, being angry isn't a bad or negative thing. Being angry can motivate people to listen to your concerns. It can prevent others from walking all over you. And it can motivate people to change larger societal issues. It's how you handle your anger that can be a problem.
Why, then, do some people think that being angry is unacceptable?
Some people are uncomfortable with the expression of anger. A lot of it depends on their own personal experiences with anger. For instance, if they were in abusive situations or if they grew up in a household where anger was used to control their family, any sign of anger can make them anxious. They can feel intimidated by anger, even if it's expressed in an appropriate manner. They may think "nice" people don't get angry.
What causes people to become angry?
There's usually an activating event — something in particular that sets you off, such as a disagreement at work, being stuck in traffic or not being able to get through to an actual person on the phone. Some people may be angry about their own personal circumstances, such as financial problems.
Most people don't just walk around feeling mad all the time, though, unless it was a learned behavior. People aren't born angry.
You said it's how people handle their anger that's important. What are the ways of handling anger, and what's the healthiest way?
There are two basic ways to handle anger:
Expression. This is conveying your anger. Expression occurs along a continuum, from having a reasonable, rational discussion to erupting into out-of-control violence. It's the difference between talking to someone or picking up a baseball bat and hitting them.
Suppression. This is trying to hold in or ignore your anger. You may think you shouldn't be angry or that you'll lose control if you let yourself feel any anger. The danger in this passive approach is that you may not protect yourself when the need arises. On the other hand, you may become passive-aggressive, where you don't express your anger assertively or directly but scheme to retaliate because you haven't learned how to express anger constructively. Trying to suppress your anger can lead to such health problems as headaches, stress, depression or high blood pressure.
Expressing yourself in an assertive — not an aggressive — manner is the healthiest approach to handling anger. You state your concerns and needs clearly and directly, without hurting others or trying to exert power over them.
Why do some people snap, exploding into rages even over seemingly minor irritations?
Reactions to anger really aren't instantaneous, even if it may appear that someone suddenly "snaps." When someone explodes with anger, there are actually a lot of feelings behind that prior to reaching that boiling point. What happens, though, is that people don't stop to examine their feelings before they explode.
Your personal history feeds your reactions to anger. That's why some people react so angrily to certain situations, like losing a parking space, while others take it in stride. You may have built up years of feeling unheard, ignored, sad, frustrated or disrespected. From the activating event that initially triggers your anger, you move along a continuum where you feel a number of things, such as intensifying agitation or irritation, and then your personal history comes into play and you may explode, especially if you don't step back to think about where your anger is heading. Also, if you were taught that being angry was negative, you may never have learned how to express anger appropriately.
How can you stop your anger from turning into a violent outburst?
Out-of-control anger is a learned behavior, so you have to unlearn it. Consider, for instance, someone who was in the military and basically taught to kill. Then he leaves the military, but with every confrontation or challenge, he goes back into that military role and responds aggressively — not assertively, but with aggression or hostility. He has to realize that no one is trying to fight with him, and that his reaction is out of proportion to the situation.
Some anger management techniques he can practice include:
Self-talk to remind himself he's not in the military anymore and to keep himself aware of his reactions.
Walking away from the situation until he calms down.
Remembering to treat other people like he'd want to be treated.
Agreeing to disagree, and leaving it at that.
He may also need professional help or a qualified anger management class to help him unlearn these behaviors.
What is an anger management class, and how does it work?
An anger management class is a way to teach people how to express their anger in a controlled, healthy way. We teach people about what anger is, how to recognize their anger triggers, how to become aware of their own feelings of anger, and how to keep their anger under control. We also discuss what other feelings they may have going on, such as depression. We can do this individually, with spouses or families, or in groups.
So, for the person who was in the military, for example, we would work with him on realizing that he doesn't need to yell and scream and get aggressive when he's angry. We'd also work with him on issues he may have with his upbringing, such as being in an abusive household.
How do you know if you might benefit from an anger management class?
Not everyone who gets angry needs an anger management class. You may get ticked that your television remote control doesn't work and throw it across the room. Do you have an anger management issue if you do that? Probably not.
But if you have run-ins with the police, you physically harm someone or you try to intimidate someone with your anger, you could probably benefit from an anger management class.
Some people blame their reactions on others, saying things like, 'You bring out the worst in me.' Is that a valid excuse?
Someone can make you angry, but how you express that anger is your responsibility. In a marriage or family, does your spouse or your kids know which buttons to push that will set you off? Sure they do. They know your vulnerable spots.
This happens to me with my teenage daughter sometimes. She may repeatedly ask to go out with friends I don't want her to be with, and I get mad at her. But what I'm really feeling is afraid for my child. Is her behavior making me angry? Yes, sometimes it is. But you have to remember that we're responsible for our own feelings and reactions to what other people do. Recognize that you have a conflict and see how you can handle it appropriately.
Can anger harm your health?
There is evidence that shows inappropriately expressing anger can be harmful. Whether you're overly passive and keep your anger pent up, whether you're prone to violent outbursts or whether you're quietly seething with rage, you may have headaches, sleep difficulties, high blood pressure or digestive problems. There's even some evidence that stress and hostility related to anger can lead to heart attacks. That's another reason it's important to learn how to express anger constructively and appropriately — it's good for your health.
It seems as if so many people are on edge these days, ready to explode or actually launching into violent rages, like at sporting events. Is society becoming angrier?
Many people today are faced with multiple stressors — bills, drugs, peer pressure, racial conflicts, health care issues, war. There's a lot of stress in society in general. There are so many things to feel threatened about, and some people respond in a negative way. Or maybe they're just not satisfied with life; they're not content. And they haven't learned how to handle their anger constructively.
But it's not entirely unique to modern-day society. I experienced a road-rage situation 25 years ago. I pulled up to a stop sign and so did another person. I felt I was there first so went ahead. Well, she followed me around the block several times, and when I went and parked, she pulled up next to me so close that I couldn't even open my car door. And then she started screaming at me that I'd cut her off. I finally said I'd call the police and she drove away.
What can you do if you're confronted by someone whose anger is out of control?
Usually the most rational thing to do, if possible, is to just walk away. If you stay, you risk it escalating into violence. It's important to take reasonable precautions to protect yourself if leaving the situation is difficult or impossible, and to not engage the other person in a manner that's likely to provoke an escalation in their angry behavior.
That's not to say you should never confront someone. If someone is doing something you don't want them to do, and you confront them about it, you now have a conflict. You have to know how you're going to handle that conflict, though. Size up the person you're confronting, and be ready to protect yourself, especially if it's a stranger.
Thursday, October 11, 2007
Anger management: How angry are you?
Do you slam down the phone when faced with endless computerized voice prompts? Have you gotten into a shouting match with a stranger over a parking space at the mall? Ever put your fist through the wall after an argument with your spouse?
Although anger is a natural emotion, it may be getting the best of you. Instead of expressing your anger in a healthy and assertive way, you may be expressing it in a hostile, aggressive manner — a manner that could lead to violence.
Here are some points to consider when assessing whether you express your anger in a healthy or unhealthy manner.
Determine your level of anger
Anger itself isn't bad. Expressed appropriately, anger can be healthy. It can help protect you from dangerous situations, energize you to resolve problems or lead to sociocultural reforms, for instance.
Sure, everyday frustrations, impatience and resentment can all cause your temper to flare. For many people, these are fleeting moments. They're able to take these moments in stride and quickly return to a sense of calm without exploding.
But if your blood boils after minor irritations — such as losing that coveted parking space — or you're constantly seething, you may need to get your anger under control. Anger that's out of control can be destructive, leading to problems in your relationships, at work, in your general enjoyment of life and with your health. You may even be arrested or face other legal problems.
Just how angry are you? Study this chart to determine a barometer of your anger. See if the words describe your behavior or thoughts over the past week. Then rate each word on this scale:
0 = Not at all accurate
1 = Somewhat accurate
2 = Moderately accurate
3 = Very accurate
4 = Extremely accurate
Determining your level of anger
Words Your rating
Angry
Bitter
Rebellious
Spiteful
Deceived
Annoyed
Furious
Resentful
Bad-tempered
Ready to fight
Yelling
Frustrated
Disappointed
If you have several 2, 3 and 4 ratings, you may need professional help in learning to handle anger in a healthier way. Talk to your health care providers about resources, such as counseling or anger management classes.
Examine your anger patterns
Anger responses can become habitual. That is, you may respond automatically to a situation that makes you angry, with little pause to think about your reactions. You may even surprise yourself by the intensity of your reactions.
How do you express your anger? Consider these questions to assess your anger responses:
Do you express anger in a way that overwhelms you and others?
Do you get angry more often than most people you know?
Do you get angrier than is necessary?
Do you use threatening language or gestures?
Do you get angry enough to hit, throw or kick things or living beings?
Do you stay angry for hours?
Do you hide angry feelings from others or try to suppress your feelings?
Do you use alcohol or drugs to calm your rage?
Do you experience physical reactions such as muscle tension or a racing heart when you get angry?
Does expressing your anger usually leave you feeling better about yourself and the person who angered you?
Identify the ways you express anger to help you determine if you need to change the ways you respond to upsetting situations. You may react too aggressively or even too passively. In either case, you can learn new anger patterns to replace old, unhealthy habits.
Tips to control your anger
If your level of anger is high or you tend to express anger in an unhealthy way, make plans to deal with your anger.
Aim for constructive expressions of your anger
Anger management is not about stopping you from expressing your anger entirely. It's OK to feel angry. In fact, trying to suppress or deny your anger can lead to a host of physical complaints, such as headaches, depression, stress, and sleeping or eating difficulties. It can also lead you to erupt into violent behavior if your anger has been simmering without an outlet.
The key, though, is to express your anger in an assertive, controlled way. Managing anger effectively can benefit you and those around you. Your health may improve, you'll feel better about yourself, and your relationships with others may improve. So get your anger under control, before it controls you.
Although anger is a natural emotion, it may be getting the best of you. Instead of expressing your anger in a healthy and assertive way, you may be expressing it in a hostile, aggressive manner — a manner that could lead to violence.
Here are some points to consider when assessing whether you express your anger in a healthy or unhealthy manner.
Determine your level of anger
Anger itself isn't bad. Expressed appropriately, anger can be healthy. It can help protect you from dangerous situations, energize you to resolve problems or lead to sociocultural reforms, for instance.
Sure, everyday frustrations, impatience and resentment can all cause your temper to flare. For many people, these are fleeting moments. They're able to take these moments in stride and quickly return to a sense of calm without exploding.
But if your blood boils after minor irritations — such as losing that coveted parking space — or you're constantly seething, you may need to get your anger under control. Anger that's out of control can be destructive, leading to problems in your relationships, at work, in your general enjoyment of life and with your health. You may even be arrested or face other legal problems.
Just how angry are you? Study this chart to determine a barometer of your anger. See if the words describe your behavior or thoughts over the past week. Then rate each word on this scale:
0 = Not at all accurate
1 = Somewhat accurate
2 = Moderately accurate
3 = Very accurate
4 = Extremely accurate
Determining your level of anger
Words Your rating
Angry
Bitter
Rebellious
Spiteful
Deceived
Annoyed
Furious
Resentful
Bad-tempered
Ready to fight
Yelling
Frustrated
Disappointed
If you have several 2, 3 and 4 ratings, you may need professional help in learning to handle anger in a healthier way. Talk to your health care providers about resources, such as counseling or anger management classes.
Examine your anger patterns
Anger responses can become habitual. That is, you may respond automatically to a situation that makes you angry, with little pause to think about your reactions. You may even surprise yourself by the intensity of your reactions.
How do you express your anger? Consider these questions to assess your anger responses:
Do you express anger in a way that overwhelms you and others?
Do you get angry more often than most people you know?
Do you get angrier than is necessary?
Do you use threatening language or gestures?
Do you get angry enough to hit, throw or kick things or living beings?
Do you stay angry for hours?
Do you hide angry feelings from others or try to suppress your feelings?
Do you use alcohol or drugs to calm your rage?
Do you experience physical reactions such as muscle tension or a racing heart when you get angry?
Does expressing your anger usually leave you feeling better about yourself and the person who angered you?
Identify the ways you express anger to help you determine if you need to change the ways you respond to upsetting situations. You may react too aggressively or even too passively. In either case, you can learn new anger patterns to replace old, unhealthy habits.
Tips to control your anger
If your level of anger is high or you tend to express anger in an unhealthy way, make plans to deal with your anger.
Aim for constructive expressions of your anger
Anger management is not about stopping you from expressing your anger entirely. It's OK to feel angry. In fact, trying to suppress or deny your anger can lead to a host of physical complaints, such as headaches, depression, stress, and sleeping or eating difficulties. It can also lead you to erupt into violent behavior if your anger has been simmering without an outlet.
The key, though, is to express your anger in an assertive, controlled way. Managing anger effectively can benefit you and those around you. Your health may improve, you'll feel better about yourself, and your relationships with others may improve. So get your anger under control, before it controls you.
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