10 Signs of Walking Depression

 

This is Part 1 in a series on depression in creatives.

Part 2: 10 Ways to Walk Away from Depression
Part 3: When Medication Isn’t Enough: Rethinking Depression with Eric Maisel

Note: I wrote this article to raise awareness of low-grade depression, which many people don’t recognize in themselves. I am an author and creativity coach, so I wrote it particularly for writers and artists, but these signs could apply to anyone ~ I believe we are all creative in one way or another.

There are many causes of depression; in my work I focus on people’s needs to create art and to make meaning, and on how to deal with the depression that arises when those needs go unmet for whatever reason.


Let’s play a little word association.

When I say someone is DEPRESSED, what comes to mind?

You might think of someone who:

  • Looks or acts sad most of the time
  • Cries often
  • Can’t feel any emotions (positive or negative)
  • Can’t get out of bed or leave the house
  • Can’t work
  • Can’t take care of themselves or others
  • Thinks or talks about suicide

That’s what severe depression can look like, and it’s a terrible and potentially deadly illness. Most people would notice those signs, realize something was wrong, and hopefully get some help.

But depression has many different faces and manifestations.

I was one of the walking depressed. Some of my clients are too.

We have many of the symptoms of clinical depression, but we are still functioning.

On the surface, people might not know anything is wrong. We keep working, keep going to school, keep looking after our families.

But we’re doing it all while profoundly unhappy. Depression is negatively impacting our lives and relationships and impairing our abilities.

Our depression may not be completely disabling, but it’s real.

10 Signs of Walking Depression

“I once read that succumbing to depression doesn’t mean you are weak, but that you have been trying to be strong for too long, which is maybe a form of denial. So much of life happens somewhere in between being okay and complete breakdown—that’s where many of us live, and doing so requires strength.” ~ novelist Matthew Quick

Walking depression can be hard to recognize because it doesn’t fit the more common picture of severe depression. But it can be just as dangerous to our well-being when left unacknowledged.

This list isn’t meant to be exhaustive or to diagnose anyone. But these are some of the signs I’ve observed in myself and those I’ve coached:

Nothing is fun. You root around for something to look forward to and come up empty.

You can’t find flow. Working on your creative projects feels like a grind, but you keep plodding away. There is research that shows that neuroticism (the tendency toward negative moods) is associated with lower rates of flow.

Your energy is low. Maybe you’re not getting enough rest because you’re too anxious to sleep, or you’re trying to cram too many tasks into a day, or you’re punishing yourself by staying up. Whatever the reason, you are effin’ tired.

You feel worse in the morning and better at night. I remember explaining this to a friend, who found it mystifying. In the morning I felt the crushing weight of all the things I had to do that day. In the evening I was temporarily free from expectations and could enjoy a moment’s respite.

You have simmering resentment toward others. Sure, you’re still doing what everybody asks of you, but you stew in anger the whole time. You are jealous of and bitter toward people who look happier than you feel.

Your self-talk gets caustic. You say nasty things in an effort to shock yourself into action. You use shame as a motivator.

You feel distanced from people around you. It’s hard to have genuine, intimate conversations because you have to keep up this front that you are alright.

You deprive yourself of creative work time (the artist as sadomasochist). This helps you exert some control and stirs up feelings of suffering that are perversely pleasurable. Also, taking on new projects that prevent you from writing or making art lets you prove to yourself that you’re still strong and capable.

Jen Lee has coined the term Dutiful Creatives to describe those who are inclined to take care of their responsibilities before anything else.

“If life were a meal, you’d consider your creativity as the dessert, and always strive to eat your vegetables first. Pacing and knowing how to say No are your strengths, but your creativity is more essential to your well-being than you realize.” from Jen Lee’s Quiz: What Kind of Creative Are You

You notice a significant mood change when you have caffeine or alcohol. A cup of coffee might make you feel a lot more revved-up and optimistic. A glass of wine might make you feel really mellow and even ~ gasp! ~ happy. (That’s how I finally realized that I was depressed.)

You feel like you’re wasting your life. Some people have a high sensitivity to the inherent meaning in what we do. Creativity coach Eric Maisel calls this our “existential intelligence.” If our daily activities don’t carry enough significance ~ if they don’t feel like a worthwhile use of our talents and passions ~ then soon we are asking ourselves, “What’s the point? Why should I keep going?”

(Eric Maisel has published a book called Rethinking Depression, which I talk to him about in this post, When Medication Isn’t Enough.)

Why is it hard to admit that you have walking depression?

You may recognize many of these signs in your life but still be slow to admit that you are depressed. Why is that?

Because it feels presumptuous to put yourself in that category when you’re still getting by. You feel like it would be insulting to those who are much worse off than you. You may feel like you have no real reason to be depressed.

Because your pride and your identity take a hit. You have to admit vulnerability and allow that you are not the all-conquering superhero you thought you were.

Because you realize that you and your life need to change, which feels like more work piled on your plate.

Because you are admitting your own responsibility for your unhappiness and that can trigger self-judgment.

Because you might uncover grief or anger at those around you for not seeing and taking better care of you.

What to do, what to do?

I’ve posted another entry about how creatives heal from walking depression, and here are the highlights:

  • Rest.
  • Make use of medication and other physical treatments.
  • Do therapy.
  • Practice gratitude.
  • Make connections.
  • Reduce your responsibilities.
  • Spend time creating.
  • Change your thoughts.
  • Develop a meaning practice.
  • Change your life.

These steps are simple to say, not easy to do, so make sure you get as much support as you can.

Important: If you are in dire straits, please contact your doctor or visit the International Suicide Prevention Wiki to find a hotline near you.

How to Connect With Your Spouse After a Long Workday

https://www.verywellmind.com/is-work-affecting-how-well-you-connect-with-your-spouse-4138231

Once you’re finally home from work, you might flop down next to your spouse and ask, “How was your day?” They’ll likely reply, “Good.” They may go into detail or they may not. You may forget that you even asked the question while zoning out.

This person that you’re building a life with is pretty important. You know that. But after a long workday, possibly getting the kids bathed and in bed, plus cleaning up the house a bit, you have little energy left to connect with your spouse. The same goes for them, too. You love each other, but you’re exhausted.

Regardless of your energy levels, you’re in this life together and failing to make time to truly connect with each other can erode your relationship. So, here are six ways you can strengthen your bond that work even when you’re feeling wiped out.1

1

Ask Open-Ended Questions to Invoke Conversation

Ask open-ended questions to jump start your conversation

Getty Images / Gary John Norman

A close-ended question will result in a one-word response like “Okay” or “Fine”. We may use it as a warm-up for an in-depth conversation we’d like to start but instead, skip it. Get straight to the point and don’t waste your time and energy.

First, get your spouse’s attention, especially if they’ve already zoned out with electronics. Look them in the eyes, say hi, and then use the language of love. Go in for the kiss! Ah, now we’re talking! Contact has been made.2

Now, hook them into the conversation and ask a question like, “What was the best part of your day today?” to get them talking about something that excited instead of what stressed them out. Another question you could as is “What was your most important encounter today?” to learn who they connected with and what that was like.

Then, the most important part, listen with all your heart. Resist the urge to pick up your phone and mute the T.V. if you must. Leave the spotlight on them for as long as possible so that you can give each other your full attention.

Use the Language of Love

Use the language of love to connect with your spouse after a long work day

Pexels / Unsplash.com

Words are not the only way to connect with your spouse after a long day. If you don’t have the energy for a love-fest there are alternatives. You could have a long hug when you first see each other. When you feel like letting go, hug for a few more seconds and feel the connection between your hearts. Feels good, doesn’t it? Or give your spouse some really good kisses all night when they least expect it! You haven’t seen each other in over eight hours. Show them some love!

If this public display of affection bothers the kids physically make contact in discreet ways. You could hold hands while watching T.V. or walk hand in hand while taking the kids out for a walk. If your spouse is doing the dishes (yippee!), go up behind them and put your arms around them. This might feel funny, but that’s part of the game of love, right? Another idea is while on your tablets or laptops, touch their feet or legs with yours.

Reminisce About the Good Old Days

Take a trip down memory lane to connect with your spouse

Getty Images / Chris Ryan

If you don’t feel like hashing out your day talk about a specific funny or loving memory you shared. 3For example, you can ask, “Do you remember that time in Hawaii when we took our first helicopter ride and saw all those amazing waterfalls?” Then, enjoy the trip down memory lane.

Reminiscing takes you away from the stress of the daily grind. It sends you back to a happier time and thus gives you a burst of energy when you need it most, at the end of your day. You’ll feel grateful you were able to have that experience with your spouse. Your past has helped bring you both to where you are today.

Go to Bed Early – Together

Go to bed early with your spouse to connect after a long day

Getty Images / Lilly Bloom

Recoup from a tiring day by getting into bed early and at the same time. So, get ready for the next day together, like making coffee, putting out breakfast, or packing lunches together. Then, brush your teeth and get frisky or cuddle. Or, be silly—humor is a great way to bond! 3Then, jump under the covers and snuggle.

Snuggle time makes you feel secure and love. At the end of the day, a bit of affection tends to make us feel better, right? No words need, just getting warm and comfortable to prepare for a good night sleep.2

Smile at Each Other Often

Smile at each other, even if you don't feel happy, to connect with your spouse

Getty Images / SCC

Let’s say you come home in a bad mood. Although your spouse had nothing to do with that we tend to take out our frustrations on those we care about the most. With this perspective in mind, if you want to get over this bad mood and be able to connect with your spouse in a positive way, smile at them.

Psychologist and facial coding expert, Paul Ekman, discovered that if you smile with both your lips and eyes, even if it’s fake, it’ll put you in a better mood. Also, since we are wired to be social if your spouse sees you smiling, they can’t resist by smile back.4 Put this in your toolkit when you want to get your spouse out of their bad mood!

Start a Bucket List Together

Make a bucket list together to connect with yoru spouse

Getty Images / ZoneCreative

What do you want to do before you die? What does your spouse what to do before they die? After the kids are asleep start your bucket list. How many similar things do you want to accomplish?

This conversation connects you by dreaming about possibilities. These things don’t have to be done this weekend. They are goals you’d like to accomplish within your lifetime. This perspective takes the pressure off checking off the list and instead you dream together. Making plans this way can excite you both and give you another burst of energy at the end of a long day.

A Word From Verywell

At the end of the day, your marriage needs your attention. Not your undivided attention, and perhaps not every day. But making an effort, even a small one, will pay off in a closer connection and healthier marriage. Taking the time to nurture this relationship lets your partner know you care and that they (and your marriage) are a top priority—and helps keep your relationship strong.

How to do the Faster EFT Tap — The Basic Recipe

Sep 27, 2017 · 5 min read

The Faster EFT Tapping Basic Recipe is easy, quick, efficient, effective and a fun healing tool.

It is used to change the references held in the subconscious that result in problems in all areas of life.

It is this procedure that is used for every round of tapping.

This Faster EFT Tapping Basic Recipe method can be used to solve any issue — financial, personal, professional, emotional, psychological, physiological, health related.

This Faster EFT Tapping Basic Recipe has provided relief to thousands of people around the world with impressive results.

We encourage you to try and test this out for yourself.

But first, you will need to know the basics of Faster EFT Tapping, so let’s start!

With just SIX easy steps to learn, it is the Fastest EFT tapping technique out there.

The Faster EFT Tapping Basic Recipe has only FIVE steps, that takes only 30 seconds to do.

Anyone of any age can learn this simple technique and use it whenever they want, wherever they are with lasting results.

It may seem a little strange at first, but after a couple of round of using the Faster EFT Tapping Basic Recipe, you’ll feel more comfortable.

Just like with anything new you learn, it takes practice and persistence.

This will be a tool that can be used throughout your life, like brushing your teeth or taking a shower.

It’ll always be on hand for you to use, no matter the circumstances.

Why Faster EFT Works

In order for a problem to exist, there must be proof (the memory or record of an experience) and feelings.

Feelings are what make a problem a problem.

It is how you feel about something that determines whether it’s a problem or not.

If you feel good, that means you like something.

Conversely, if you feel bad, it means you don’t like something.

It’s that simple.

It is the feelings that make the problem real.

For example, Tom feels angry when he hears loud music in a parked car.

Another person, Tina, may enjoy the music.

She hears the same loud music, but she feels good.

In each of those cases, the subconscious is referencing a record that connects loud music in parked cars with either a negative meaning or a positive meaning; and then the brain signals the organs to produce the matching chemicals for those emotions.

How Faster EFT Tapping Basic Recipe works

FasterEFT is an energy based system as well, founded on Neurology and Biology.

Emotions affect both our physical and mental wellbeing.

So it follows that once your turbulent emotions are healed and cleaned up, you’ll have overall wellbeing.

The foundation belief in Faster EFT is that there is no disruption of energy, unlike traditional EFT.

In fact everything in your life and body is functioning as it should.

According to the way the brain has developed in order to survive in the environment, depending on your life’s experiences.

In Faster EFT, the tapping is used to disrupt the signal between the brain and the major organs of the body that trigger the fight or flight response while changing neural pathways in the neocortex of the brain.

The Faster EFT Tapping Basic Recipe doesn’t just deal with energy disruptions, which only fixes the outer issue of the problem.

It deals with the root cause of the problems, eliminating them completely.

Faster EFT recognizes that experiences are recorded in the subconscious for future reference.

This is how we learn to walk, drive, take a shower, eat, wash the dishes, type etc. without needing to consciously concentrate on every movement and decision.

Regular EFT specifically believes that negative emotions have nothing to do with memories, and are caused only by a disruption in the body’s energy system.

The Faster EFT Tapping Basic Recipe interrupts that signal between the brain and the organs by focusing on the meridian points connected to those organs.

This rewrites the reference or memory associated with that trigger.

For example, if Tom feels angered by the loud music and wanted to change that automatic response, he could use the Faster EFT Tapping Basic Recipe to disrupt the production of the chemicals that cause the feeling of anger when he hears the loud music.

And change the meaning of the loud music in his subconscious from “rude” or “disruptive” (or whatever they learned it means) to fun and enjoyment.

This will then result in an automatic feeling of enjoyment and fun when Tom hears that loud music in the future.

The Faster EFT Tapping Points

The following illustration is pretty straightforward and we’ll give a brief explanation with it as well.

For now, just identify each of these Faster EFT Tapping points on your body and follow along!

Step #1: Aim

Notice how you know you have the problem.

You don’t need to know what the emotions or feelings are, just notice how you know they’re there.

What do you feel?

Where in your body do you feel it?

What do you see or hear?

How do you know it’s a problem?

Step #2: Tap

Use two fingers to tap the following points, while focusing on the feeling of your fingers on your skin:

  • between your eyebrows
  • beside your eye
  • under your eye
  • just below your collarbone

While you are tapping, say “Let it go”. You can also add “It’s safe to let it go”.

Note: It doesn’t matter which side you tap — you can do either side, or both if you like.

Step #3: Peace

Grab your wrist, take a deep breath, blow it out, and say “peace” — and go to a peaceful memory for a moment.

Step #4: Check

Go back to your problem and take notice of how it’s changed.

Do you feel different?

Is the intensity of the feeling different?

Does the memory look or sound different?

Just notice.

Step #5: Repeat

Repeat steps two to four until the feeling or memory has “flipped” — in other words, the negative memory has been replaced by a positive memory.

Read: Why do We “ Reimprint or Flip” Memories in Faster EFT?

Watch the Faster EFT Tapping Basic Recipe

The Key to Success in using Faster EFT Tapping Basic Recipe:

Persistence is essential.

Don’t stop until it’s changed — even if it doesn’t feel like it’s going to change — it will, as long as you keep going until it does.

Good luck and let us know how it goes!

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Robert Smith

Written by

Creator of FasterEFT and CEO of Skills to Change Institute

Top 50 health apps: Body&Soul

Top 50 health apps – body+soul.

These are pretty good start .  .  . good ratings.

for PMS, meditation, relaxation, exercise, and more.

Rory

**************************************************

By Charmaine Yabsley & Maureen Shelley

Maintaining your health, fitness and happiness goals is only a click away…

We review 50 of the best health and fitness apps you need to download, for a healthier and happier you
.

Accommodations: Illness or Excuse?

A Serious Illness or an Excuse? – WSJ.com.

[COLLEGE11] Sally McCay

At University of Vermont, above, staff role play with students with mental health issues to prepare them to negotiate with professors.

Earlier this semester, college senior Leah Nelson emailed one of her instructors to ask for extra time to complete a paper. “I have been going through a rough patch lately and am making the decision to take care of myself this week,” Ms. Nelson wrote. Her mental health, she continued, would “take priority over everything else.”

Ms. Nelson, a 21-year-old student at the University of Connecticut in Storrs, struggles with depression. Her symptoms often flare when exams and papers pile up. She says the timing of a suicide attempt in March of 2010, when she took an overdose of Tylenol, was influenced by the pressure of the three exams and paper due she had that week.

As mental health problems become less stigmatizing, more college students are comfortable asking their professors for test extensions and excused absences due to bouts of depression and panic attacks. Andrea Petersen has details on Lunch Break.

Ms. Nelson is one of a growing number of college students asking for wiggle room with their academic workloads due to mental health issues.

In some cases, students make direct pleas to professors. In others, students work through their university’s disability office to receive official academic “accommodations.” These can include extra time for exams, the opportunity to take tests in a quiet room, or flexibility with class attendance and assignment deadlines.

Schools are required to extend “reasonable accommodations” for students with documented disabilities—including psychological ones—to comply with the federal Americans with Disabilities Act.

Brian Harkin for The Wall Street Journal

A student group devoted to reducing stigma around mental illness is on 325 campuses. A backpack, pictured, reads ‘1,100 students die by suicide each year.’

The Other College Application Process

To qualify for academic accommodations, most schools require students with mental health issues to go through a fairly extensive application process. It generally includes:

•A recent evaluation from a psychiatrist, psychologist or social worker.

•A disorder included in the DSM-IV, the primary handbook for diagnosing mental illnesses.

•A professional assessment of how the disorder affects the student academically and why specific accommodations are needed.

•There is often a deadline for applying: Some schools require applications at the beginning of the semester. Some require students to apply a certain number of days before the accommodations are necessary, say, two weeks before an exam where they’ll need more time.

But there’s hand-wringing among university administrators and faculty about how to support college students with mental health issues while making sure young adults progress academically. One of the goals of college, after all, is to prepare students for the working world. And not every boss may be OK with a blown deadline for a critical client report, no matter the reason. Professors also want to make sure they’re being fair to all students.

“There’s the danger that we take too much care and when they hit the real world that same kind of support isn’t there,” says David Cozzens, dean of students and associate vice president of student affairs at the University of Wyoming in Laramie.

Some formal accommodations, like additional test time, are fairly standard across universities and apply to students with physical and learning disabilities, too. But, schools diverge widely on formal accommodations for flexibility with assignment deadlines, class attendance and participation. Some schools leave it up to individual instructors. Others intervene more directly on students’ behalf.

Schools say they are seeing a rise in the number of students registering with their disability offices due to psychological problems. At Pace University in New York, the number of requests for accommodations from students with disabilities related to psychological disorders tripled in the last three years.

Brian Harkin for The Wall Street Journal

Leah Nelson, right, a University of Connecticut student, walks on campus with friend Kylie Angell. Ms. Nelson struggles with depression and works with professors to manage her workload.

At the University of Texas at Austin, 33% of the 1,687 students that registered with the disability services office during the spring 2011 semester listed psychological problems as their “primary” concern. In the spring of 2008, only 23% out of 1,175 did. (The increase was due, in part, to a procedural change that routed more students to the disability office.)

Colleges say they’re seeing more students on campus with psychiatric illnesses. About 11.6% of college students were diagnosed or treated for anxiety in the last year, and 10.7% were diagnosed or treated for depression, according to a survey of more than 100,000 students at 129 schools conducted by the American College Health Association. Many mental illnesses, particularly depression, bipolar disorder and schizophrenia, emerge during late adolescence.

Psychiatric disorders like depression and anxiety can have serious academic consequences because they affect concentration, sleep and cognitive processing, say mental health professionals.

Associated Press

The health center at Cornell University in Ithaca, N.Y., recently stopped issuing notes students gave to professors to be excused from class.

It’s unclear why the incidence of psychiatric disorders appears to be rising among college students. Better medications and treatments are likely making it possible for more young adults with even serious mental illnesses to attend college. Many schools have launched programs to identify students with psychological problems and get them into counseling. Student-advocacy groups like Active Minds Inc., an organization with chapters on 325 campuses, are trying to reduce the stigma around having a mental illness.

Cornell University in Ithaca, N.Y., has developed an extensive suicide-prevention program and a comprehensive disability services office. But it is pulling back on how involved it gets in student-faculty negotiations not covered by the office.

Over the last several years, the counseling center has stopped issuing dated “verification of visit” notes. Too many students were making appointments just to get the notes to provide proof of why they missed class or failed to turn in an assignment, says Greg Eells, director of counseling and psychological services. (The school’s health center stopped giving notes for medical appointments, too.)

“It was just not a good use of the university’s resources,” says Mr. Eells. But professors pushed back. “The faculty wants us to be a detective to see if the student is telling the truth. That’s not our job,” he says.

If students complain of psychological problems, some faculty members will send them to the disability services office to avoid having to determine what’s a serious issue versus what’s a gloomy day. Then, “the instructor isn’t having to make decisions on something they’re not equipped to assess,” says Steven Barrett, a professor of electrical and computer engineering at the University of Wyoming.

In the fall of 2010, Amy Goodnough, now a senior at the University of Vermont, started experiencing severe insomnia and excess energy. Some mornings, she couldn’t get out of bed. Eventually diagnosed with bipolar disorder, Ms. Goodnough withdrew from one class, took an incomplete in another and appealed directly to other professors to turn in some assignments late. “It was difficult to know day to day what my energy would be like,” Ms. Goodnough, 21, says. “I kind of crawled through the end of the semester.”

Before the spring term, she registered with the university’s disability services office and received letters to take to her professors stating that she be allowed “limited” flexibility with attendance and deadlines. Without those accommodations, “I don’t think I could have stayed in school,” that semester, she says. Now getting effective treatment, Ms. Goodnough has not needed the flexibility this term and has a 3.9 grade-point average.

Schools say they can’t require faculty to adjust deadlines or attendance policies. And in some courses, like science labs and speech classes, participation is critical, but schools can push instructors to compromise with students.

Students with mental illnesses “don’t know when the symptoms will happen, when they might be incapacitated,” says Laurel Cameron, the director of ACCESS, the University of Vermont’s disability services office. Even with a letter giving a student flexibility with deadlines and attendance, students are required to negotiate with each instructor at the beginning of the semester. They need to devise a plan, for example, of when to notify faculty of an absence and a timetable for making up work.

To help students prepare for those discussions, Ms. Cameron says she and her staff will role-play with students, taking on the tone of a skeptical professor.

Kim Larrabee, a faculty member at UConn and the instructor Ms. Nelson emailed for an extension, says she has a “sense of intuition of sincerity,” when students approach her for flexibility with academic work. And she considers how committed the student has been so far to the course. She gave Ms. Nelson an extra 10 days to finish her paper.

“I think your decision to take care of your needs shows maturity and commitment,” Ms. Larrabee wrote in an email replying to Ms. Nelson’s request. Ms. Nelson got an A on the paper.

 

Myths of Psychotherapy: Mental Health

Myths of Psychotherapy: #2 « Mental Health.

By Thomas L. Schwartz, MD

Psychotherapy, talk therapy, and counseling are all terms used when treatment revolves around a patient talking to a therapist every week. This series of blogs aims to evaluate some common myths about getting therapy for one’s mental or emotional symptoms. The first post in this series addressed the purpose of psychotherapy.

Myth: Talking about your issues is a psychological-only treatment in that it does not affect biological brain functioning.

Reality: This may be partially true. Talking about things often calms one down and lets one see several points of view and options for corrective actions in the future.

But psychotherapy is also a brain process. Talking things through likely strengthens the front part of the brain, making it stronger and better able to control the parts of the brain involved in drives and impulses (such as anger and sadness).

Imagine a depression study in which half of the patients only get psychotherapy, and the other half only get an antidepressant medication. Both groups of patients would get their brains scanned. (Such a study was published in the Archives of General Psychiatry in 2001.) Guess what? Those whose depression got better had the same changes in brain functioning, regardless of whether they took the medication or just talked in therapy. So talking in psychotherapy does create biological changes, just like some medications do.

Why is this important?  Some patients think psychotherapy is just talking and they want a more “biological” treatment that is studied and scientific.  Psychotherapy is both of these.

Posted by: Thomas L. Schwartz, MD at 2:42 pm

Comments
Audrey

I have been on anti-depressants and anxiety medications for several years; I have also seen a couple of different psychotherapists as well. I feel that the combination for me has been tremendously healthy for my emotional well-being. Quite frankly I feel that for me the combination has been enormously helpful because talking with a trained professional in addition to taking medication is crucial at getting to the root of my mental health issues. I feel that talking with a psychotherapist “validates” and guides me through very strong mental issues that I have had over the years. For example, I have learned to be more assertive as a result of seeking psychotherapy as I am the type of person who can admit to needing more than just medication….I need validation of my feelings by a trained pr

Social Anxiety: Cognitive or Interpersonal Therapy?

 

World of Psychology

Social Anxiety Disorder: Cognitive Therapy or Interpersonal Therapy?

By John M. Grohol, PsyD
Founder & Editor-in-Chief

Social Anxiety Disorder: Cognitive Therapy or Interpersonal Therapy?If all you did was watch TV, you might think social anxiety disorder was as prevalent as depression — or as big a problem. Also called social phobia, social anxiety disorder is often treated first with medications, such as an SSRI antidepressant (you know, regulars like Paxil or Prozac). Psychotherapy is also an option — it’s just not as popular as medication.

In a randomized controlled research study published recently, two psychological interventions were put head to head to see which one would come out on top.

Cognitive therapy (CT) focuses on the modification of biased information processing and dysfunctional beliefs of social anxiety disorder. Interpersonal psychotherapy (IPT) aims to change problematic interpersonal behavior patterns that may have an important role in the maintenance of the problem.

According to the researchers, no previous direct comparison of these two treatment options exists.

 

In psychotherapy research, often researchers use a condition called a “waiting-list control” group. This group is told they will get treatment in a short time, but they have to be placed on a waiting list because no therapists are readily available. This allows the researchers to test to see if it’s time alone that will result in a person’s condition improving (rather than the therapy treatment).

A total of 117 subjects were gathered from two outpatient treatment centers, and out of those, 106 completed the study.

How was the study conducted?

Treatment comprised 16 individual sessions of either cognitive therapy or interpersonal therapy and one booster session. Twenty weeks after randomization, posttreatment assessment was conducted and participants in the control group received one of the treatments.

The primary outcome was treatment response on the Clinical Global Impression Improvement Scale, as assessed by independent evaluators [blinded to treatment conditions].

The secondary outcome measures were independent assessor ratings using the Liebowitz Social Anxiety Scale, the Hamilton Rating Scale for Depression, and patient self-ratings of SAD symptoms.

What were the results? At the end of the study, the cognitive therapy group have a nearly 66 percent response rate while the interpersonal therapy group had a 42 percent response rate. The control group, in comparison, had only a 7 percent response rate — meaning that just waiting for the problem to resolve on its own is significantly less effective than getting treatment for it.

In the specific measurement of social anxiety disorder, cognitive therapy significantly outperformed interpersonal therapy. Both treatment conditions significantly improved social anxiety symptoms in comparison to the control group.

This study also did something special a lot of studies don’t do — a one year followup. It’s all well and good to measure the effects of a treatment immediately when the study ends. But a one-year followup tells us whether the treatment “sticks” or not.

At the follow-up, the differences between CT and IPT were largely maintained, according to the researchers. The cognitive therapy group again came out on top with significantly higher response rates (68 percent) versus the interpersonal therapy group (32 percent)

The cognitive therapy group also had better outcomes on the Liebowitz Social Anxiety Scale at the one year followup.

So there you have it. For social anxiety disorder, cognitive therapy is the therapy of choice — it’ll give you great results in just 16 weeks. And not results dependent upon taking a medication for a year or two — results that are long-lasting and permanent.

Reference

Stangier U, Schramm E, Heidenreich T, Berger M, Clark DM. (2011). Cognitive therapy vs interpersonal psychotherapy in social anxiety disorder: a randomized controlled trial. Arch Gen Psychiatry, 68, 692-700.