What’s In A Name?

When you are first diagnosed with a mental illness, it can be very confusing regarding the number of people you are going to meet on your journey to better health. All of these people are here to help you, but what exactly are the psychologists, psychiatrists, and therapists doing to help you? Here is a short guide on the difference between all the medical professionals you will meet when you are diagnosed with a mental illness.

A psychotherapist is an umbrella term for any professional trained to treat people for their emotional issues. A psychotherapist can be a psychologist, social worker, counselor, or psychiatrist.

A psychologist is an expert in the field of psychology which is the “science of the mind or of mental states and process”. Psychologists have to attend graduate school and obtain their doctoral degree, a PhD or PsyD. The difference between a PhD and PsyD, is that PsyD psychologists are trained specifically for clinical work, while PhD often focus on research. Psychologists often have to complete years of internships to gain further training and experience. They also must be licensed by their state boards of psychology. Psychologists are not medical doctors and can not prescribe medication. Psychologists are licensed to do counseling, psychotherapy, and provide treatment for mental disorders.

A psychiatrist is a medical doctor that specializes in the diagnosis and treatment of mental illness via medication. A psychiatrist usually has 4 years of medical school, followed by an internship and residency. They have a M.D. A psychiatrist can write prescriptions for medication. Psychiatrists must be licensed as a medical doctor in their state of residency. They must also pass the American Board of Psychiatry and Neurology’s Psychiatry Certification Examination. Many psychiatrists have a special focus such as major depressive disorder, schizophrenia or bipolar disorder. They will often work together with a psychologist to provide treatment for mental illness.

A therapist is a person trained in psychological methods to help patients. Therapists can be psychoanalysts, marriage counselors, social workers and life coaches among others. A therapist provides support and guidance and helps patients make decisions and clarify feelings to solve problems. Selecting a therapist is a personal experience. You should always feel comfortable and welcomed by your therapist, but also consider their licensing and professional credentials. It may take time to find the right therapist for you, so feel free to shop around for the right fit.

A licensed mental health counselor has at least a master’s degree in psychology or counseling. They are focused solely on providing therapy to individuals, families or couples. The mental health counselor has to have 2 years of additional experience working with a mental health professional after graduate school in order to be licensed. They are qualified to evaluate and treat mental health problems, with much of the emphasis on working with problems of normal living rather than mental illness.

A clinical social worker has at least a master’s degree in social work and very specialized training. Social workers provide case management and hospital discharge planning. They can also act as an advocate for the patients. Some social workers also practice psychotherapy. There are many different types of licensure depending on the state in which they are licensed.

Psychiatric or mental health nurses have specialized training in providing mental health services. They often work with the doctors to form an individualized therapy and medication program for their patients. Some nurses can prescribe and monitor medications depending on the states where they practice.

Here is a quick cheat sheet for clarification:

Psychologist Therapists Psychiatrist
  • Advanced degree in psychology
  • Does research or therapy
  • Diagnose disorders or problems with patients
  • Determine appropriate treatments
  • Work in tandem with psychiatrist
  • Help patients make decisions & clarify feelings
  • Provide support & guidance
  • Includes psychologists, psychiatrists, counselors, life coaches & social workers
  • Any number of degrees or certifications
  • Help patients make decisions & clarify feelings
  • Provide support & guidance
  • Medical degree
  • Does research or therapy
  • Diagnose disorders or problems with patients
  • Determine appropriate treatments
  • Work in tandem with psychologist
  • Prescribes medication
  • Help patients make decisions & clarify feelings
  • Provide support & guidance

 

http://www.webmd.com/mental-health/features/psychology-vs-psychiatry-which-is-better

http://www.webmd.com/mental-health/guide-to-psychiatry-and-counseling

http://education-portal.com/articles/Psychologist_vs_Psychiatrist_Whats_the_Difference.html

http://www.allpsychologyschools.com/psychology-careers/article/differences-therapist-psychologist/

https://www.psychologytoday.com/blog/couch-meets-world/201107/psychiatrist-psychotherapist-whos-who-in-mental-health

 

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Rumination

Rumination is the continuous dwelling on issues in our past and difficulties and things that distress us in the present. It is becoming preoccupied with something and not being able to get it out of your mind. There is helpful and unhelpful rumination. The problem comes when you are focusing on what has gone wrong and this leads to negative thinking. Too much negative thinking can lead to depression and maintaining a depressive episode.

Rumination is normal because everyone dwells on their problems to a point. It’s when the circular thinking patterns that are rumination continue in overdrive, that it becomes a problem. Rumination is different than worry in than worry is future focused and often leads to anxiety. Rumination is past focused and leads to depression. Rumination is a learnt strategy for dealing with our problems however unhelpful rumination can lead to inactivity and avoidance of problem-solving.

Unhelpful rumination Helpful rumination
  • Ask my “why…?” questions
  • (Evaluative mode)
  • Why questions tend to focus on the problem, its causes and it consequences
  • “What did I do to deserve this?” & “Will my life ever get better?”
  • Is continuous
  • Asks more “How…?” questions
  • (Process-focused mode)
  • How questions tend to focus on solving problems
  • “How can I make my life better?”
  • Is time-limited. It stops when the problem is solved

One of the biggest strategies for unhelpful rumination is accepting the situation and being mindful in the present moment. Mindfulness is the most useful coping skill for dealing with depression and will be discussed in a future post.

There are many steps to stopping rumination. Some examples would be accepting your situation, being aware that you are ruminating, or distracting yourself. Please follow this link for a list on 11 Steps to Stop Ruminating.

Remember rumination can be helpful if it is time-limited and problem-solving. However, unhelpful rumination can cause and continue depression, so it is better to find ways to stop rumination if you want to continue your road of recovery.

http://jayuhdinger.com/chapters/chapter-3-practice-11-steps-to-stop-ruminating/

http://jayuhdinger.com/chapters/chapter-2-rumination-faulty-thinking/

Reprogramming Me: My Issues & My Struggles

According to the doctors, I have ingrained personality traits that are causing my depression. This means that I have learned certain ways of thinking and doing things that are actually part of the problem. This basically means that I have to learn how to reprogram my ways of thinking and my outlook on the world. Here are a couple of things they believe I need to work on:

  1. Mindfulness
    1. I’m not very mindful. I’m constantly reviewing the past or worrying about the future, so I have a very hard time being present. I need to learn to stay in the moment and be mindful, to pay attention to what is going on around me and to what I am doing in the moment.
  2. Quick Fix
    1. I want a quick fix to everything. I don’t want to have to struggle for answers or solutions to problems, I just want them fixed immediately.
  3. Catastrophize
    1. This is one of a couple cognitive distortions that I have. I tend to view situations in the worst possible light and look for the worst possible situation to occur. You can read about Cognitive Distortions here.
  4. Avoidance and Fixations
    1. I tend to avoid situations that I don’t want to deal with and fixate on things I shouldn’t.
  5. Negative outlook and worst case scenario
    1. I tend to have a negative outlook on life and believe that the worst possible scenario will occur.
  6. Expectation for things to go my way, or the way I plan.
    1. I have an expectation for things to go the way I plan and for everything to work out exactly as I specify. This is often not the case, and I can get extremely upset when the plans I have made go awry.
  7. Fixation on connection.
    1. Because of a lack of friendships, I have a fixation on connection. I yearn to connect with people and make friends. Oftentimes this connection causes me more harm because I form connections quickly and often believe I have a close friendship with someone who may only consider me as a passing friend.
  8. I also need to explore why group social settings are so uncomfortable
    1. Despite my need for connection, I have a hard time thriving in a group social setting. I need to explore why this is the case. I yearn for connection, but feel uncomfortable in group settings. Why?

I also have issues with my primary support group (my family) which I have discussed here and problems related to social environment which I will be discussing in a later post.

Some of the ways the doctors and therapists have suggested that I work on these issues is by focusing on and accepting myself. I’m holding onto ideals and an old relationship with myself that is only hurting me now. By focusing on myself, something I’m not very good at, I can form a new relationship and connection with myself that will make me a stronger person, and help me fight depression

All of these problems are works in progress and I will continue to update you on my progress in my journey to mental healthiness.

Cognitive Distortions: Fixes

Now that we know what cognitive distortions are and how this way of automatic thinking affects our moods, we must now find a way to counteract and change these thought processes. Here is a list of the cognitive distortions and steps that you can take to prevent  these types of thinking.

  1. All or nothing thinking
    1. Instead of categorizing things in black and white, try rating them on a scale from 1-10. By rating the situation, you are considering all sides instead of instantly picking a side.
  2. Overgeneralization
    1. Instead of making a judgment and reacting on that, view the evidence. Examine how others are behaving to the situation and why. Is there another perspective?
  3. Mental filter
    1. Am I only noticing the bad stuff? Am I filtering out the positives? What would be more realistic?
  4. Disqualifying the positive
    1. Am I exaggerating my negatives and minimizing the positives? How would someone else see it? What’s the bigger picture? It can also be helpful to minimize social media usage, where we compare our worst to other people’s best.
  5. Jumping to conclusions
    1. Mind reading
      1. Am I assuming I know what others are thinking? What’s the evidence? Those are my own thoughts, not theirs. Is there another, more balanced way of looking at it?
    2. Fortune teller error
      1. Am I thinking that I can predict the future? How likely is it that that might really happen?
  6. Magnification
    1. Thinking that the worst possible thing will definitely happen isn’t helpful right now. Ask yourself, “ what’s most likely to happen?”
  7. Emotional reasoning
    1. Just because it feels bad, doesn’t necessarily mean it is bad. My feelings are just a reaction to my thoughts – and thoughts are just automatic brain reflexes.
  8. Absolute Statements
    1. Am I putting more pressure on myself, setting up expectations of myself that are almost impossible? What would be more realistic? Avoid using words that have no meaning. Please see the list at the end of this article which shows what words are more helpful than others.
  9. Labeling & Mislabeling
    1. Instead of labeling the situation, look at the evidence. Also avoid double standards, these will only make a situation worse.
  10. Personalization
    1. Would most people who really know me say that about me? Is this something that I am totally responsible for? Instead of blaming yourself or another person, consider the circumstances. Look at the situation and view the evidence.
  11. Memories
    1. This is just a reminder of the past. That was then, and this is now. Even though this memory makes me feel upset, it’s not actually happening again right now.

 

Replace… with…
Should Like or Want
Should not Do not Like or Want
Have to Would Like
Must Wish
Must not Wish would not
Deserve Desire
Always Usually/Frequently
Forever Until/Unless
Never Rarely
Awful Disagreeable
Horrible Unfortunate
Terrible Unfavorable
Perfect Successful

http://jayuhdinger.com/chapters/faulty-thinking/

http://getselfhelp.co.uk/docs/FindingAlternativeThoughts.pdf

 

Cognitive Disorders

Cognitive Distortions are thoughts that cause reality to be inaccurately perceived. These inaccurate thoughts are usually reinforcing negative thoughts or emotions. This can lead to an anxious or depressive mental state when they combine to give an individual a negative outlook on their world. Cognitive distortions are also known as automatic thoughts. These thoughts are ingrained in individuals and affect the way they think. It takes time and patience to overcome these automatic distortions.

Here is a list of just a few of these distortions.

  1. All or nothing thinking:
    1. Also known as black and white thinking, it is ignoring all forms of in between or the ‘shades of grey’. This thinking also involves using absolute terms like ‘always’, ‘every’ or ‘never’. The thing to remember is that there is usually some grey in a situation and all or nothing thinking leads an individual to ignoring that.
  2. Overgeneralization
    1. Also known as categorizing, it is placing judgements or evaluations on an event, person or thing rather than describing the item or person. This thinking usually involves absolute terms such as ‘always’ or ‘never’. Overgeneralization causes individuals to ignore the facts and evidence in favor of their distorted vision.
  3. Mental filter
    1. This filter allows an individual to focus on a single detail (usually negative), about an event or person so that they overlook any positive. This thinking blocks out what doesn’t ‘fit’ with our ‘filter’ and is also known as looking through dark blinkers or ‘gloomy specs’. A mental filter causes individuals to ignore the positive or anything outside of what that filter provides.
  4. Disqualifying the positive
    1. This distortion causes individuals to overlook their positive experiences in favor of negative ones. It is also known as compare and despair, seeing only the good and positive aspects in others and comparing ourselves negatively against them. This can often be seen via Facebook, where people compare their everyday life to their friend’s ‘highlights reel’.
  5. Jumping to conclusions
    1. Mind reading
      1. Mind reading is assuming we know what other people are thinking, usually about ourselves. This distortion causes people to believe they can predict a person’s reaction or attitude.
    2. Fortune teller error
      1. Fortune teller error is assuming that a situation is going to end negatively despite lack of evidence. This can also be known as a self-fulfilling prophecy; because you assume a situation won’t end well, oftentimes it doesn’t because of that mindset.
  6. Magnification
    1. Also known as exaggeration or catastrophizing, this distortion causes individuals to overlook the one side in favor of the other. For example, overlooking the negative in a person by exaggerating the positive. It’s also known as making mountains out of molehills or imagining and believing that the worst possible thing will happen.
  7. Emotional reasoning
    1. This distortion causes individuals to take feelings as fact and base your decisions and actions on them. An example would be ‘I feel bad so it must be bad’. Individuals use this distortion to often put off doing something because they don’t ‘feel’ like doing it.
  8. Absolute Statements
    1. Absolute statements are words such as ‘should’, ‘must’, or ‘ought’. These statements raise expectations, and if these expectations are not met anger, frustration and disappointment occur. Absolute statements set up unrealistic expectations and can make people feel guilty.
  9. Labeling & Mislabeling
    1. Labeling is another form of black and white thinking. This is done by assigning either good or bad labels to yourself or other people. Again, there are no shades of grey and outside circumstances are not taken into consideration.
  10. Personalization
    1. Personalization is blaming yourself or taking responsibility for something that wasn’t your fault. Blaming others for something that is your fault, also falls under this category. This distortion is taking things personally when perhaps they didn’t involve you in the first place.
  11. Memories
    1. This distortion is when current situations or events trigger upsetting memories and lead you to believe that the danger is in the present rather than in the past. This causes distress in the present when the situation isn’t in the present, but in the past.

Perhaps after reading through these cognitive distortions, you realize that your way of thinking tends to lean towards these distortions. The first step to fixing these distortions is to realize that you have them. Please read the following article, Cognitive Distortions: Fixing the Problems for information on how to retrain your thinking away from distorted thoughts.

 

Cognitive Distortions

From: The Feeling Good Handbook

By: Dr. David Burns

 

http://jayuhdinger.com/chapters/faulty-thinking/

http://getselfhelp.co.uk/docs/AutomaticThoughts.pdf

http://getselfhelp.co.uk/docs/UnhelpfulThinkingHabits.pdf

http://getselfhelp.co.uk/docs/FindingAlternativeThoughts.pdf

 

How to Deal With Being Mentally Ill Part II

So you’ve just been diagnosed with a mental illness. You’re scared, you don’t know what to do and you don’t know what other people are going to think of you now. You feel like you’ve been labeled and this label only makes you feel worse. Don’t worry, I’m here to help. Here are some things you should know.

I’d like to first describe depression for you. Depression is like your high school bully. Except, unlike that bully who is taking stabs in the dark trying to find what to say to hurt you the most, the depression is in our mind and knows exactly what to say. It pulls out everything we don’t like or that we think is not good enough about ourselves and shouts it at us just like that high school bully would. The depression knows exactly which nerve to strike. And while you can walk away from your high school bully, you can’t walk away from your mind and the depression that preys on it.

So you’re probably going to need medication and therapy. This doesn’t make you a bad person. In fact, this makes you a better person. You are doing what you need to do to be healthy. Medication will help fix the chemical imbalance in your brain. It’s necessary just like the treatment needed for cancer and you shouldn’t be ashamed to have a little help. This fight is just as important as fighting cancer, or any other sickness.

Your next step would be to find a therapist. Make sure you find someone that you like and whom you feel comfortable talking to. They are there to help you. Don’t be ashamed of asking for a little help. These are trained professionals who deal with mental illness on a daily basis. They want to help you and they want to help you help yourself. Learn what works best for you. Everyone’s struggle is different. You’ll have to learn of your triggers and warning signs and figure out what coping skills work best for you.

Mental illness isn’t easy. It is a disease of the mind. It is something you might have to work against for the rest of your life, but you are not alone. I urge you to seek out groups in your area for people with mental illness. Depression often makes you feel isolated, so hearing of other people’s struggles will remind you that you are not alone.

And I am here for you. If you need to talk, please don’t hesitate to message me. I understand the struggle you’re facing and how much of an upward battle it can seem like. I am facing it myself, every day. Just remember, you are not alone and you can do this. Win your fight!

 

How to Deal With Being Mentally Ill Part I

Being diagnosed with a mental illness can seem overwhelming at first. Here are some simple tips for dealing with your mental illness.

  • Take care of yourself. Eat a healthy diet, be physically active and get plenty of sleep.
  • Get exercise. Physical activity reduces depression symptoms. Consider walking, jogging, swimming, gardening or taking up another activity that you enjoy.
  • Get plenty of sleep. Sleeping well is important for both your physical and mental well-being. If you’re having trouble sleeping, talk to your doctor about what you can do.
  • Simplify your life. Cut back on obligations when possible, and set reasonable goals for yourself. Give yourself permission to do less when you feel down.
  • Structure your time. Plan your day. You may find it helps to make a list of daily tasks, use sticky notes as reminders or use a planner to stay organized.
  • Stick to your treatment plan. Don’t skip psychotherapy sessions or appointments. Even if you’re feeling well, don’t skip your medications. If you stop, depression symptoms may come back, and you could also experience withdrawal-like symptoms.
  • Learn about depression. Education about your condition can empower you and motivate you to stick to your treatment plan. Encourage your family to learn about depression to help them understand and be more supportive of you.
  • Learn ways to relax and manage your stress. Examples include meditation, progressive muscle relaxation, yoga and tai chi.
  • Pay attention to warning signs and learn your triggers. Work with your doctor or therapist to learn what might trigger your depression symptoms. Make a plan so you know what to do if your symptoms get worse. Contact your doctor or therapist if you notice any changes in symptoms or how you feel. Ask family members or friends to help watch for warning signs.
  • Write in a journal. Journaling may improve mood by allowing you to express pain, anger, fear or other emotions.
  • Avoid alcohol and illegal drugs. It may seem like alcohol or drugs lessen depression symptoms, but in the long run they generally worsen symptoms and make depression harder to treat. Talk with your doctor or therapist if you need help with alcohol or substance abuse.
  • Locate helpful organizations. Many organizations, such as the National Alliance on Mental Illness (NAMI) and the Depression and Bipolar Support Alliance (DBSA), offer education, support groups, counseling and other resources to help with depression.
  • Don’t become isolated. Try to participate in social activities, and get together with family or friends regularly.
  • Don’t make important decisions when you’re down. Avoid decision-making when you’re feeling depressed, since you may not be thinking clearly.

http://www.mayoclinic.org/diseases-conditions/depression/basics/treatment/con-20032977

My Life In Outpatient Treatment: Week 5

This is a continuation, part 5, of my daily journal while in outpatient treatment for depression, anxiety and avoidant personality disorder. Please click for Week 1, Week 2, Week 3 and Week 4.

Week 5, Day 23:
They don’t think I’m ready to change. That I’m holding myself back but I don’t know what is holding me back.
I have a whole list of things I need to work on with my outside therapist. I will be discussing this in more detail in “Reprogramming Myself”.
I’m supposed to focus on myself. Focus on accepting myself, 24/7.
I’m holding onto ideals that I need to let go of. I have to let go of the old relationship with myself.
But I don’t want or like to put effort into something, unless I know the results.

Day 24:
How do you keep your mind occupied and/or disengaged from negative thinking? Especially when you’re doing something that doesn’t require much thought and your mind begins to wander.
Use games, distractions, ask myself what, and why; be logical about it, and breath.
“Rumination is like fire. You feed it fuel and it grows.”

Day 25:
I decided that I would like to write a letter to myself saying goodbye to the negative me and to the expectations that I had for myself before I became depressed. See letter.
How can I forgive myself for not meeting the expectations I set for myself? Or the expectations I feel are coming from other sources, namely my family? Is that what is holding me back from being able to change?
“He who angers you, controls you.”
We also talked about acceptance today. Acceptance is: “It is what it is”; making space; and letting yourself off the hook (from suffering).
Acceptance is not: denial, forgiveness, forgetting, letting it go, being ok, agreeing with it, allowing it or understanding it.

Day 26:
Today is my final day. I thought it would be more difficult than it was.
I discovered that May in mental health month and the ribbon is a dark green. One of my fellow patients is helping me create a logo for ADAPT. I’m so excited about that!!
After talking with my therapist, I realized I need to write down my goals. I need to have short term and long term goals. During session today, I felt very much in control of myself, my thoughts & my emotions. Let’s hope this continues!!!!
“Wake up from your thoughts and experience life!”

This is the end of journaling while during the outpatient treatment program. I’m interested to hear your thoughts and comments on my journey and I hope that my journey will help yours! Believe me, that it isn’t an easy fight. Sometimes you have to slog through mud, blizzards, ice and treacherous terrain, but I know that any fight is worth my chance of becoming a better and healthier person. You can view Week 1, Week 2, Week 3, and Week 4 at each link.

Music

I’ve always loved music. Since I was little, I was involved with music and I was learning how to play the piano by the time I was six. I remember a time, I was about 4 or 5, and I was singing along with the radio. My mom turned around, looked at me and asked how I knew the lyrics to the songs. I couldn’t really give her an answer besides saying that I’d heard the songs before.

Music can be very much a universal language. Musicians can often find the music or lyrics to describe a situation that you couldn’t otherwise find words for. I can’t even count the number of times that I’ve played a song for someone rather than trying to explain exactly how I felt. The music explained it better than I ever could.

I often use music as my inspiration. Music can make you feel a variety of emotion and as a depressive, I use it to motivate myself, to tell myself that I’m not the only one feeling this way and that I can get through it. I have a specific playlist on youtube that I can pull up at anytime when I need that inspiration and motivation. This playlist contains songs from Skillet, Breaking Benjamin, Three Days Grace and P!nk, as well as the specifics songs ‘Dare You To Move’ by Switchfoot and ‘Demons’ by Imagine Dragons.

Find what helps you, whether it’s listening to music or painting; playing video games or watching movies. Find an outlet for what you have inside, because you do have something self-destructive inside of you. And depression’s only goal is to destroy who you are. So don’t let it.

Here is one of my favorite songs to listen to when I feel down:

http://getselfhelp.co.uk/docs/Music.pdf

My Life In Outpatient Treatment: Week 4

This is a continuation, Week 4, of my daily journal while in outpatient treatment for depression, anxiety and avoident personality disorder. Please click for Week 1, Week 2 and Week 3.

Week 4, Day 19:
My doctor informed me today that they believe my depression is caused by ingrained personality traits which are linked with my avoidant personality disorder tendencies. Supposedly I can fix this by thinking positive things and making positive situations and decisions. I consider this ‘Reprogramming Talia’.
We also discussed change in group therapy today and the therapist had each person write down their top 5 necessities for change. Here are mine:

  1. You have to want to change (willingness)
  2. You have to have help to make change occur (therapist, doctors, etc)
  3. You have to have a solid support system
  4. You have to have the ability to be flexible
  5. You have to allow the change to happen (don’t fight it)

Everyone came up with different answers and it was interesting to see how other people view change and how much needs to happen for change to occur.
Change wouldn’t be worth it, if it was easy.

Day 20:
After yesterday and the realization about the ingrained personality traits, my thoughts have become increasingly negative about myself.
How did I become like is? Is it my fault that these personality traits evolved? Did I make myself like this (unconsciously, of course)? “I am wrong. I am messed up. I made this.”
I want to know why I’m like this. I want to know why I developed in this way.
I want to blame someone, anyone for me turning out this way. Maybe because then I would be the victim and not the perpetrator. And in a way, aren’t I still a victim? A victim of circumstances, situations and environments? Something had to have happened for me to turn out this way.

Day 21:
I feel like I can’t talk. I just get looked over. My issues aren’t important enough. I asked to see my therapist today, but I doubt he’s going to pull me out.
I feel like I’m not getting any better. I’ve been here for a month. I just don’t matter.

Day 22:
Today I talked about how I felt. The group therapist gave me the suggestion to look at situations in my life that have caused me pain and hurt. I am supposed to pick situations that still bother me; situations I still need to process. I am supposed to journal it and hopefully reprocess the situation. I should look at it as a learning experience rather than allowing it to hurt me.
I have a very ‘all or nothing’ attitude. I don’t want to invest time and energy into something if it isn’t going to work out.
My therapist also discussed my discharge from the program today. We decided that I would discharge in a week. I don’t know how I feel about this.

Please stay tuned for Week 5. Here are the links for Week 1, Week 2 and Week 3.