Psychology of Chronic Illness: Making it Normal [Part 3: Depression]

Welcome everyone thank you for joining
us for our third in a series of six presentations on the psychology of
chronic illness making it normal brought to you by Bateman Horne Center and myself Timothy Wyman I’m a licensed clinical social worker providing counseling
services through teller counseling for Utah and Arizona residents I come to
this topic my main aim of this topic was that there’s quite a gap in patients
receiving information and just a normalization of what they’re going
through from both medical and psychological professionals so I wanted
to provide a brief overview of generally what the research says is really normal
with chronic illness to go through we’ve broken this up into six different parts
development and phases of chronic illness anxiety depression identity
relationships meaning making religion and spirituality and existentialism and
today I focus on this presentation is going to be depression so first of all
let’s review symptoms of depression how do you know you’re depressed officially
we all have moments of sadness but I want to break down a few common symptoms
the first theme of these symptoms being cognitive or thinking symptoms so what’s
going on in our heads when we’re depressed first off we can have
ruminations about past loss losses and difficulties ruminations are repetitive
almost intrusive memories that keep coming out where we were thinking of a
past really difficult time that we may even be currently present that might not
be completely resolved and we’re experiencing presently as well we can
have a disturbed son self-concept and a loved self-esteem a general fuzziness in
our thinking that can include slowing down in responses or memory or recall
issues now this can be kind of a crossover between some of the cognitive
issues associated with mecfs and fibromyalgia so sometimes can be hard
which is which and where this is coming from nevertheless it is a symptom of
depression as well we can have a preoccupation with so-called negative
thoughts or aspects of and challenging and aspects living difficulty creating
and accessing a sense of purpose and meaning difficulty for seeing a hopeful
feature and even at its worst we can develop suicidal ideation if we’re not
interrupting any of these processes it can lead to suicidal thoughts emotional
or feeling and sensations that you can have related to depression can be
difficulty accessing positive emotions or any emotion so you can have kind of
this flat affect or blunted where you’re just nothing really seems to affect you
positively or negatively a sadness or generally feeling blue or at its worst
some despair there can be lethargy and apathy feeling lost but also it can lead
to increased irritability or agitation and anhedonia
which is Greek for not know pleasure difficulty accessing a sense of pleasure
or difficulty feeling pleasure and things he once found pleasurable some
behavior that you could see in yourself or someone else which could indicate
depression includes reducing the frequency and intensity of activities
you once found pleasurable increase use of substances or other self soothing
behaviors examples can be binge eating excessive sexual activity out-of-control
spending escaping into social media or games or whatever frequently finding
yourself checking out or just associating during the day mentally
increased time spent house bound or bed bound not attributed to your physical
limitations engaging in reckless behavior without much care for the
consequences that can also be a warning sign of an escalating depression which
really needs attention as it can predict some suicide fidelity engaging in self
harm not performing as well as you used to at work school or in your duties at
home and general difficulty keeping pace previous levels of energy and activity
once again out of treated to your physical diagnosis relational symptoms so the way our
relationships can play out when one or more partners are depressed or not just
partners but in family and friendships we can become socially withdrawn or
isolated increased arguments with people in our lives feeling generally less in
the sitting people we care about or have previously carried about I’m feeling
generally disconnected from others physical symptoms can include stomach
disturbance appetite disturbance in which there can be a decrease or
increase disturbance in your sexual functioning a disturbance in your sleep
difficulty going asleep staying asleep going back to sleep or sleeping in
excessive amounts lethargy and fatigue slowing down of motor activity like your
speech or your general physical movements or headaches all of those can
be indicative but there’s some depression going on and could suggest
that it could be good for you to be further assess with like a medical
provider or behavioral health provider to determine if a diagnosis of
depression is appropriate so depression if we look at this before we get into
the details of this slide depression is a common co-occurring disorder across
many chronic illnesses it would not be super abnormal for you
to have depression one way that this is explained is first biologically you’re
having a lot of changes going on in your body due to the elements so there could
be a biological component to it outside of that because of the biological
changes people experience a significant amount of loss related to chronic
illness for example in a 2000 study of 30 people who were out working age and
had a chronic illness with an average disease duration of 18 years had shown
that all individuals had experienced repeated physical emotional and social
losses the most common were the loss of bodily function in relationships
autonomous life and life imagined so we have your loss of hope you know people
maybe you had hopes that things will go differently than they are going because
of your illness a loss of control over your body and bodily function
loss of integrity and dignity it can be very humiliating Tufted maybe it hope
you need four basic tasks or things of that nature loss of the healthy identity
seeing yourself as this kind of a person I know before I eat guts the guy was a
runner and I loved it and I have not been able to do that again um a loss of
faith that life is just a loss of social relations it’s not uncommon for you to
lose friends because you perhaps cannot relate to them anymore if they’re not
chronically ill or they can’t relate to you and more than that sometimes the
social isolation that’s necessary because of not being housed about or
bed-bound people can slowly stop maybe calming or
inviting and things of that nature loss of freedom and autonomy if you have
functional disability can become dependent on different people for
different things and generally loss of life imagined you know most people who
acquire a chronic illness later in life more born with it do you have different
plans for their lives so as you can see this is a significant amount of loss
hopefully it’s not surprising when you look at this list I think yeah like it
makes sense that it would lead to depression and because researchers were
have documented all of this multiple times um they come up with this curve in
this last point consequently the research indicates that many with
chronic illness experience what is called chronic sorrow and depression is
a common co-occurring disorder with many diseases so
the bad news what’s the good news and how do we face this we see this here in
the Select pression coping strategies so these are specific to to depression and
chronic illness you’re gonna see a lot of crossover here from the treatment
from anxiety the anxiety presentation anxiety and depression are essentially
known as sisters and the mental health community meaning they often come
together and so a lot of treatments that are effective for anxiety are effective
for depression and vice versa um one of the main treatments can be at the top
increasing self-efficacy we learned in our last presentation that self-efficacy
is our belief to manage difficult things and our capabilities increase
self-esteem and increase optimism all three of those if we work on increasing
those from a cognitive behavioral perspective what we think and behave
it can Native it can positively improve our depression cognitive behavioral
therapy is effective of anxiety and depression we come back to our
appraisals how we’re making sense of things do we are we engaging what’s
called presage any thinking which is like see you have one you have a symptom
that’s a resort resulted in a disability do you keep your grief to that
disability or do you take that grief to mean that life isn’t worth living if you
don’t have that ability or that possibility that’s what’s called
depressogenic thinking and the mental health bill so we’re taking really real
negative things that we have to learn to cope with but we’re making them bigger
than they are in the way that we’re thinking about that often we do that
when there is a lack of self-efficacy we don’t believe that we could adopt enough
to make a more meaningful purposeful life so doubling down from our anxiety
prett presentation we really want to deal with these threat appraisal about
how harmful things are and how much we can deal with them as well as adjusting
our our life goals or the way we meet our life
often was chronically chronic illness or disability we could still preserve what
was behind our goal maybe you can’t climb Mount Everest but if the goal was
adventure or exploration maybe you can find many ways to explore and be
adventurous that you haven’t thought of before related to depression is working
on our unfavorable social comparisons you know stop comparing yourself to
healthy people like the sooner you can stop that the better off you’ll be
compared if you have to compare compare yourself to maybe uriel self or ill
others who have similar challenges as you if you do the other you don’t take
the strain I’ll take you down a dark path this was an interesting study
related to coping with depression as it relates to CBT and self-efficacy
self-esteem and optimism now this was on caregivers who were caring for someone
who had dementia I don’t know showed that well-being was positively
correlated with self-efficacy self-esteem and optimism well-being was
basically defined how we feel inside of ourselves the nursing aspect of this
study is that those three things weren’t necessarily associated with improved
quality of life so what that says is that these caregivers of people with
dementia their quality of their life had a lot of limitations because of their
responsibilities but given that they were still able to access a sense of
well-being by increasing self-efficacy self-esteem and optimism and ensure it
makes it there if not bearable positive there could be some positivity access
with the detection and quality of life I found that to be a very helpful study
related to if you’re gonna go the therapy or counseling around there is a
subtype of therapy called interpersonal therapy that was developed in a medical
center setting and it’s based on depression and chronic illness and it’s
slowly based essentially on improving the quality of your relationships to
improve improve your your depression and that’s shown to be a
to treatment if you’re wanting to learn more about that that’s a term you can
look up in addition without their behavioral adjustments that we can make
again this we’re gonna double down here from our anxiety presentation approach
orienting coping becomes paramount approach orienting coping is accepting
the reality of the situation and actively working to adjust to it this
includes information seeking problem-solving seeking social support
creating and maintaining outlets for emotional expression you gotta share
your feelings one way or another – for that catharsis in connection to let it
all out and then it eventually identifying benefits in one experience
mindfulness practice is shown to have a positive impact particularly related to
those with cancer and then limiting or eliminating toxic relationships or
dynamics so because of the stress of chronic illness you may have to put up
more barriers or boundaries with certain people in your life and it may even go
to the extreme to actually ending certain relationships that you just
probably won’t be able to manage anymore due to your illness depending on how
toxic the dynamics are now what subjects toxicity is do these people criticize
you do you feel safe to express what you’re feeling are they a consistent
presence in your life while positive indicators that these are healthy
relationships are people that are judgment free they promote and accept
open and honest and direct communication expression you can trust that they’re
going to have continued contact and support in your life these all are very
positive and so we want to increase the presence of those kinds of relationships
and people are strengthening double down on if we already have relationships that
include those kind of characteristics we want to double down on those
relationships to the degree that we can so general in terms of general coping
strategies independent of chronic illness these have been shown to be
effective for depression and something to think of natural adjustments can
include exposure to sunlight seasonal affective disorder as a form of
depression and we find it people who are limited to light the sunlight decreases
with the seasons in most places if you’re chronically ill you’re probably
house gonna bed down more often you’re not getting enough sunlight that can
help rigorous exercise if you’re physically capable and you don’t have
functional capacity limitations which prohibit it that is one of the most
low-cost robust findings is the natural effects positive effects of exercise on
depression are also some evidence of natural supplements like for example
fish oil as shown to have an effect on depression and improved sleep hygiene
and sleep schedule making sure that you’re going better at the same time
going getting up at the same time maintaining restful sleep not disturbing
it with you know getting on your phone or whatever those are all natural
adjustments we can make to decrease the effect of our depression
whereas medical interventions this is beyond the scope of my license but I’ll
list them here in case you’re interested so we have psycho pharmaceuticals which
are antidepressants such as SSRIs these are like paxil prozac luvox
things of that nature as well as ketamine treatment has become a new
up-and-coming treatment alpha-stim is one people who do alpha-stim they’ll
these electrodes on your ears and it’s shown to benefit anxiety and depression
there’s also what’s known as transcranial magnetic stimulation
stimulating your brain and in more severe cases
electroconvulsive therapy typically you wouldn’t go that route until it’s been
very severe and perhaps maybe even you had depression which pre-existed your
chronic situation but those are all things you
could discuss with the medical provider who treats depression that’s a brief overview if you’re
depressed you’re not alone again it’s very common related to depression there
is hope these treatments listed are effective often there’s not a magic
silver bullet it’s can be a combination of these different treatments trying
them out and seeing what works best for you if you’re interested in many more of
these information here’s a list of reference those that you can dive deeper
into any of them as well we’re happy to hear it how do you continue as we finish
our third installment we’d love to have you for the rest of our installments
related to the psychology of chronic illness making it normal you can find
them through the Bateman Horne Center website and we thank you for your time
and attention

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