CBT for Depression Treatment: Week 2 of 14 | Start Addressing Depression Now

Hey there everybody, and welcome back to this episode of the week by week guide to depression treatment. This is part two of 14. So we're just getting started. I'm your host, Dr. Donnellice Snipes. Now, as a little helpful hint, there are in depth videos on everything that we talk about on my YouTube channel@docsnipes.com YouTube so if I go through something too fast or not in depth enough for you, you can find more resources@docsnipes.com YouTube in this session, we're going to review activities from the past week, create a change plan, identify and make a list of distress tolerance skills, conduct a sleep hygiene assessment, and learn a little bit about motivation. So there's a lot to cover in session. And I like, when I work with people, I like to provide them a lot of resources that they can look at and learn about when they are between sessions, when they're on their own, and then we talk about them and apply them in session instead of me spending a lot of their time teaching them specifically about it. Because, you know, let's face it, counseling is expensive. What I like to do is start out week two. We're going to review week one. Now, in week one, you were doing your assessment, you were identifying your symptoms. You know, you were doing a lot to try to figure out, okay, where am I starting? You also started gathering baseline data on two or three things that you wanted to change. So you were trying to figure out with these things, where am I starting at? You know, whether it's how many hours you're sleeping, how many times a day you're crying, your energy level, your get, you were gathering baseline data on that. You also were asked between sessions to review what feelings look like for you. So for example, for anxiety, what are your physical symptoms? When you start feeling anxious or afraid, what is your mood like? When you're feeling anxious or afraid, what are your thoughts like? Do you tend to be pessimistic? Do you have difficulty thinking clearly? What's that like when you are anxious or afraid? The goal here was to help you start identifying your early warning signs of distressful emotions so you could notice them, be mindful of them and do what you could to intervene and improve the next moment to prevent it from getting to the point where it's a total crisis. We also discuss your mindfulness activities. Last week you were given mindfulness activities. In the morning, you were supposed to inhale energy, exhale foggy headedness, and then review your mindfulness worksheet. And then in the evening, you are supposed to inhale relaxing energy and exhale distress and do your mindfulness worksheet. So there were questions that you were supposed to answer. And that gives us more ideas about what your status was last week and what your sleep, because I put a lot of stuff about sleep in your morning mindfulness activity and this gives me a better idea of where you are right now. And you're going to keep doing those every single week and we're going to review them every single week so you can see your progress. Sometimes, you know, like when you lose weight or when your kids are growing up, if you are doing it every day, if you're immersed in it, you may not notice the little changes. So keeping baseline data and mindfulness and doing your mindfulness activities is really important. I will follow up on your physical to make sure you at least got it scheduled. Because many things that produce mood symptoms like depression and anxiety may also have a biological component. It may relate to hormones or whatever. So it's important that you get that scheduled so you can identify and address any deficiencies. Maybe you're anemic, for example, and that will maybe start helping you feel better faster than just talk therapy. Because I mean, talk therapy is great and behavioral therapy is great, but it is not going to get you across the finish line if you are struggling with physiological issues like anemia or hypothyroidism. So it's important to get that done. Then we'll discuss your financial and housing stability issues which you were supposed to assess over the last week. You know what issues related to your housing and your finances are causing you distress. And then if you're in my office, you know, if we're doing this in a one to one, then I make referrals, you know, I help you identify places that you can connect with. But if you're doing it on your own, you can call United Way Information and Referral or go to their website online and find a lot of these resources to help you with everything from paying your electric bill to food assistance, prescription assistance, etc. So once we review all that stuff, we are going to move on to identifying smart goals, specific, measurable, achievable, rewarding and time limited. And I know the R usually stands for something else, but I like rewarding because you're not going to do things that aren't rewarding. That's just a basic principle of behavior modification. You're going to identify three symptoms. You know, the ones that you were keeping baseline data on. You're going to identify those three symptoms. And answer the questions, what am I going to do? So let's take sleep for example. I am going to get to the point where I can sleep seven to nine hours straight each night. How will I know when I've succeeded? Well, because I'm sleeping seven to nine hours each night. When do I expect to have this accomplished? Well, if you look at your baseline data and you're waking up every two hours and you tend to only be able to sleep for four hours at a night, setting a goal of sleeping seven hours in two weeks is unrealistic. So you're going to want to look and say, what can I do? Maybe try to sleep 30 more minutes each week until you're up to seven hours. So if you're sleeping four hours now, then by next week, hopefully you're sleeping four and a half hours. If you exceed that, great. If you don't, then we're going to kind of look at some of the other things that might be causing that. If you're talking about your mood or your. Let's state your energy level. What am I going to do? I want to improve my energy level. So I have on a scale of 1 to 4, an energy level of a 3, which is very good most days. Well, that's your ultimate goal. So what are we going to do between now and next week? When you are starting counseling, a lot of times you are experiencing a lot of distress. That's what brought you here. It's important to understand that when you are experiencing distress, especially anger or anxiety or any cousin of anger and anxiety, you are in fight or flight mode. Your brain is bathed, if you will, in adrenaline and cortisol and other things to help you fight or flee. It is not the time that you are able to think clearly, think logically about what's going on. So distress tolerance skills don't solve the problem. Distress tolerance skills are designed to help you cool down so you can think clearly and solve the problem. I use the mnemonic tags for distress tolerance. T stands for tolerant thoughts, A stands for activities, G is guided imagery and S is sights, smells and sounds. And this will take you about 30 minutes to do between sessions. And I try to give people time parameters so they can gauge how much they need to be doing. I found if I didn't give them time parameters, sometimes they'd spend three hours doing something that I only expected them to take 30 minutes. When you make your tags, five distress tolerant thoughts. So five things that you are going to tell yourself that can encourage you to keep going that Help you know that you can get through this distress. That help you know that you can tolerate it. One of those thoughts is going to include unhooking. Unhooking means saying, I am having the feeling that I'm helpless, or I am having the thought that this is hopeless. When I say I am helpless or I am hopeless, then I have to change me. That's harder than having to change a thought or a feeling. So if you unhook it and you say, okay, there's this feeling here, I need to change it. I need to figure out how to address feels a lot less onerous. For many people, another technique is called living in the and when people experience distress, it's important to allow them allow yourself, if it's you, to experience that distress, but to also recognize that they can experience that and have a rich and meaningful life. So if they are experiencing difficulty with pain, a lot of people with depression also have concurrent autoimmune or pain issues. Living in the and would be saying, I can experience pain. I can have some pain in my life and have a rich and meaningful life, recognizing, you know, there are things that I can do to mitigate my pain as much as possible. And. And there are things that are important to me that I can still enjoy despite the fact that I've got pain. And you're going to identify other ways. Three ways to stop your thoughts and as kids, we used to put our fingers in our ears and say la la la la la when we didn't want to hear what our parents were saying. But we can kind of do that for ourselves as adults to stop our internal monologue. You can count, you can sing, you can la la if you want to. Your brain cannot focus on the words involved in the distressful thoughts and focus on whatever you're forcing it to focus on at the same time. It can't juggle two simultaneous word tracks, if you will. So that's one thing. Now you're going to identify three activities that you like to do, and they can be activities that help just distract you. Like for me, gardening. If I go out and I start weeding, takes just enough mental focus that I end up just kind of having a blank mind. Or you can identify activities that you like to do that make you happy, like going on a run or crocheting or playing with the dog. You'll identify three guided imagery activities. And we're going to talk more about those in just a minute. But guided imagery, again, uses your words as well as visual images to create this state in Your mind, if you will. And when your mind is focused on that, it can't focus on the distressful stuff. It's not good. Believe it or not, your mind is not really all that good at multitasking. This is kind of akin if you think back to when you were a kid and your parents told you to count sheep. Same sort of thing. You were envisioning the sheep, you were seeing them jump over the fence. So you were using words, you were using images. In this activity, I encourage you to think of your favorite place and identify five things that you see, five things that you hear, and at least three, maybe five things that you can smell. So really try to integrate all of your senses to make it as real as possible when you're doing that. A lot of people, especially if they're using this to try to help themselves get back to sleep, a lot of people find that they drift off in the midst of doing this because it focuses their attention so much. And then identify three sights, three smells and three sounds that make you happy. They can be pictures, they can be videos, whatever you want to have. And remember, have them available on your mobile device. Have them available next to your bed if you need to, where you can access them wherever you're likely to experience distress. Smells don't have to be essential oils or aromatherapy. It can be any smell that makes you happy and that's really what you want to focus on. What do I smell and think that smells really good? And sounds. A lot of times the white noise machines that you can get have different tracks like birds chirping and rain falling and babbling brooks. Whatever sounds you like, you can probably find a track for it either in a white noise machine or as an MP3 or, or even on YouTube. I will also ask people to begin reading about meditation and I can give book suggestions or watching my video on meditation techniques, which is about an hour. But it walks you through a bunch of different types of meditation and guided imagery that you can start using. Meditation and guided imagery can be helpful to help you tolerate distress and down regulate, but it can also be helpful in helping you just relax and recharge. Depending on what you're meditating on, it can actually give you a burst of energy. You will identify three types of meditation and begin practicing them to help you relax each day. I encourage you to start doing 10 minutes a day. You're going to start with two minutes and you're going to work up, but ultimately you want to get to where you're able to meditate for 10 minutes a day. Some forms of meditation include using a thermometer and imagining cooling down the temperature. So if your emotions, if you're angry, that means you're really hot, so maybe you see it at all the way at the top and than breathing and imagining that thermometer going down or imagining a knob on a music on a radio turning down the volume, turning down the volume of those noisy distressful thoughts so you can't hear them anymore. You can envision color. If you envision when you're feeling distressed, maybe you are just bathed in the color red. You can envision that color turning to blue or yellow or whatever color you want. If you're experiencing pain, a lot of people associate with pain either with red or black and envisioning that turning to a cooling blue or a warming gold can as they feel their pain, relax and release. You can practice something called a loving kindness meditation that I talk about in that video. You can practice progressive muscular relaxation, which I actually have a video that walks you through that. And you can practice open awareness. So these are just some of the types of meditation that can help you relax and garner positive energy in yourself. The next thing we're going to talk about is the importance of sleep and circadian rhythms. And again, I don't spend a lot of time teaching stuff that you can watch a video on between sessions. So there is a video circadian rhythm regulation Quick Start guide on the YouTube channel that walks you through why circadian rhythms are important. And I'll give you a hint, it's because they regulate everything from your hormones to your appetite to your sleep. So if your circadian rhythms get out of whack, there's a problem. You're also going to complete a sleep hygiene evaluation and we're going to talk about that in a second and work on addressing deficiencies. So you're going to take this sleep hygiene evaluation home with you and you're going to identify the things that you already do. And that's wonderful. And then you're going to identify the things that you may need to work on as you make those changes. You're going to monitor the effects in your morning mindfulness logs because I have in your morning mindfulness worksheet or log questions about your sleep. In terms of sleep hygiene. We all need a wind down ritual that cues our body in that, hey, it's getting ready to be sleep time. If you like run in the door from somewhere and plop down on your bed, your body doesn't get the message to start secreting melatonin so you can get sleepy. Reduce or eliminate exposure to blue light one hour before bed. So that includes blue light from your tv, your computer, your phone, and even fluorescent light bulbs. Go to bed at roughly the same time each night. Eliminate as much light as possible, and that includes from the moon. So I suggest for a lot of people, if they feel comfortable wearing a sleep mask and there are a lot of different ones out there, you can get the ones that don't crunch your eyelashes and stuff. Eliminate as much noise as possible. And that can mean not having the dog next to you in bed who snores or barks in her sleep. Have one of those. It can mean wearing earplugs if you have a significant other who snores louder than a freight train. Sound Even if you think you're used to it, sound does tend to wake you up throughout the night. Don't exercise or take a hot bath within two hours of bed. Now, some people say they feel like they get really sleepy right after they work out, and so this may not apply to them. But in general, people, when they get their body temperature up, have a harder time getting to sleep. Your body wants to be cool when you sleep. Keep the room cool. According to the sleep foundation, 72 degrees is ideal. I disagree. I like something closer to 64, but we'd go broke in the summer if we always had that in our house. So trying to find a moderate temperature where you're not waking up Sweating. Consider a cooling pillow and mattress topper if you tend to get hot during the night. Avoid anything that might get you upset before bed. So at least an hour before bed, so stay off social media if you tend to get triggered by it. Don't watch television programs that may upset you. Don't be doing your bills right before bed. Try to make sure that that hour before bed is a time where you can wind down, relax, do something you enjoy, or spend time with people that you enjoy spending time with. Reduce or eliminate caffeine at least six, preferably 12 hours before bed. And a lot of people are never going to make 12, but six is often doable. Caffeine impairs your ability to get good quality sleep the first part of the night. Drink your majority of fluids during the day so you're not getting up every couple of hours to go pee. Hydration really important, but you don't want to get most of your hydration at dinner time and then go to bed a couple hours later and then have to get up a couple hours after that. Keep an air purifier in the room. If you have allergies, that can help with some of the coughing, the sneezing and post nasal drip. This is one I break all the time. But ideally, keep your animals off the bed and if you can, out of the bedroom so you have a dander free or relatively dander free environment and they're not snuggling up next to you in the middle of the night or, you know, moving or barking or whatever they do. Make the bedroom a place of relaxation and sleep. It's not where you do your homework, it's not where you do your bills. It's not where you argue with your spouse. It is a place of relaxation and sleep. Keep a red light, and you can get those at, you know, the hardware store instead of a white light, which destroys your night vision and tells your brain it's time to wake up. A red light doesn't do that. So keep a red light that you can turn on and a notepad by your bed to write down anything that pops into your head so you're not laying there going, I gotta remember to get dog food tomorrow. I gotta remember to get dog food tomorrow. If you're doing that, if you're trying to remember something, then your brain is not going to go fully back to sleep. Weighted blankets help some people get to sleep easier. Weighted blankets can increase the release of a hormone called oxytocin, which is our bonding hormone. But it also helps with feeling calm and feeling relaxed. Not everybody likes weighted blankets. Some people love them. Keep daytime naps under 45 minutes so you don't get into REM sleep. Consider diffusing essential oils like lavender, chamomile, patchouli, or even catnip in your room. And I know catnip wires cats, but it has the opposite effect on humans. It's actually a sedative in humans. I encourage you to go to, to a health food store or somewhere where you can smell a tester of the different essential oils. You will find one that you, you smell and it feels relaxing. You know, some of them you'll smell like peppermint is energizing, but some of them, for me, lavender is not relaxing. I like something that's a little, a little woodier, if you will, but find that. And you can get a diffuser if, if you want to try that. And use the right pillow. Keeping your neck supported keeps pain down. It improves your oxygenation because you're less likely to snore if your head's not cocked in all kinds of weird positions. And you're more likely to wake up in, you know, not feeling pain. In terms of motivation, we'll talk about why it's important to enhance motivation. You're not going to do things if you're not motivated. We choose the most rewarding thing at any given time. So for example, maybe you're going to start trying this week to keep Remember to keep your mindfulness logs. Meditate one time a day for at least two minutes and start a sleep routine. So those are your three behaviors this week. You're going to complete a motivational worksheet for each one of those behaviors for your mindfulness logs. Physically, how will keeping this log improve your health or help you feel less pain or have more energy? Well, the log itself is giving us clues about how well you're sleeping and what your mood is like and what your triggers are so we can help identify things that are increasing your stress and increasing your physical distress. Affectively, it may help you improve your mood because it encourages you to focus on everything in your life, not just your distress. Cognitively, it makes sense that if you're keeping track of these things, you are going to be able to make more informed decisions. Environmentally, what can you put in the environment to remind yourself to do it? And and I am a big fan of push notifications. You can download the apps that are designed to remind people to take their medication and you can program in different things that you need to do and you will get a very prominent alarm on your digital device. And then socially, who can encourage you to do this thing? Your mindfulness log for example. And how will doing this improve your relationships? So how will being more mindful of yourself and how you feel improve your relationships with other people and enable you to be more open and more relaxed? You've reviewed your activities and progress from last week. In session we created a change plan so we went through your three goals identified smart goals, specific, measurable, achievable, rewarding and time limited goals in order to help you achieve recovery. You've learned about and we'll make a list of distress tolerance skills. We talked briefly about different types of meditation in general and you've got a video to watch to explore them more in the upcoming week and you're going to start trying to practice it for two minutes a day. You learned about motivational enhancement a little bit and will complete the motivational enhancement worksheet that we just talked about on each of your three behavior targets. In the coming week. You will learn the importance of circadian rhythms by watching the video. It's only less than half an hour and do a sleep hygiene evaluation. Once you've done that, you'll identify at least three ways to to improve your sleep hygiene in the coming week. And finally, continue to do the morning and evening mindfulness activities so you can continue to track and see your progress as we go through this series. This show was produced by Mr. Charles Snipes and presented by Dr. Donald East Snipes. You can learn more about addressing depression@docsnipes.com YouTube they can be reached at 1633 West Main Street, Suite 902, Lebanon, Tennessee 37087 or by email at supportocsnipes.com.