When Beth took him to the counseling center, Christopher was put off by the appearance of the place and the thought of having to open up to a total stranger. When Beth introduced him to the counselor she had worked with years earlier, the counselor explained the procedure that all new clients would have to go through, including an intake interview and completing some psychological tests to explore the kind of treatment he might need.
During the intake, Christopher was able to open up about the different symptoms he was experiencing (including the wall punching), and the counselor carefully outlined the treatment options available to him. This included individual counseling to help him work through some of the anger he was still feeling about how he had been treated in the foster system as well as the maladaptive coping strategies that had helped him “keep his cool” back then but which were not working for him as an adult.
The counselor also helped him identify the goals that he would be working toward in treatment, including exploring some of the triggers that brought on his episodes of depression as well as dealing with the automatic beliefs that were sabotaging him in his daily life. This included his own fears about whether he would ever be able to have a normal life or whether his time in foster care had permanently damaged his ability to be in a relationship. This also meant exploring his relationship with Beth, someone he viewed as being “much too good for him” and his fear of losing what he regarded as the first real relationship he had ever had.
Along with the individual counseling sessions, Christopher’s counselor also suggested that he join the treatment group to gain a better perspective on how different people coped with the kind of problems he was experiencing. Since many of the others in the group were also former foster children who had faced similar abuse in the past, this allowed Christopher to understand that his problems were far from unique. Also, by sharing his experiences with the group, he was able to overcome a lot of his old anger and help defuse the automatic thoughts that led to depression.
Christopher continues to have depressive episodes, but he is functioning better at work and is almost finished with his high school upgrading. He is also more confident about his relationship with Beth and hopes that things will continue to improve between them. In the meantime, his treatment sessions are continuing, and his therapist is optimistic about the progress he has made.
Analysis
For people who experienced abuse as children, the effects of this abuse can persist well into adulthood. This is especially true when dealing with the cumulative effects of repeated abuse over many years. Even as adults, these early experiences are going to shape the way they think, feel, and interact with other people, whether they realize it or not. Along with the trauma stemming from their early abuse, there are also issues with forming poor attachments as children than can affect their relationships as adults. As a result, survivors of childhood abuse can find themselves being adversely affected by the memory of these early traumatic experiences. Research studies have shown that victims of childhood sexual, physical, or emotional abuse often develop maladaptive patterns of dealing with stress that can leave them vulnerable to new stress as it arises. According to the stress sensitization hypothesis, individuals exposed to childhood adversity tend to be much more vulnerable to later problems, including depression and generalized anxiety. Even for people like Chris whose lives appear to be good, the inevitable stress that comes with new challenges and responsibilities can lead to emotional problems that they may not be equipped to handle on their own. While counseling can be effective in helping abuse survivors learn to handle stress and emotional difficulties more effectively, it is still important that they seek treatment as soon as possible. Such counseling can help them learn to be more resilient as well as help to develop support networks, whether family or friends, that can provide them with emotional support as needed.
Glossary
Anhedonia: Defined as the inability to feel pleasure, anhedonia is a common symptom of depression that can take different forms. These include motivational anhedonia (lack of motivation to engage in formerly pleasurable activities) and social anhedonia (inability to feel pleasure from social activities). Anhedonia is often associated with the emotional numbing experienced in mood disorders and trauma.
Antidepressant medications: A class of medications used for the treatment of depressive symptoms. Most antidepressants work by changing the balance of neurotransmitters in the brain that can affect mood and emotions. Different types of antidepressants include selective serotonin uptake inhibitors (SSRIs), atypical antidepressants, tricyclic antidepressants (TCAs), and monamine oxidase inhibitors (MAOIs). Antidepressant medication needs to be closely monitored due to the possibility of side effects as well as interaction effects with other medications.
Apathy: Lack of emotion, interest, or concern. A common symptom in many depressed people, in which they believe that “nothing matters” or that they are unable to make themselves care about things that once concerned them. Often associated with learned helplessness.
Attachment theory: A well-accepted theory that views many behavioral and emotional problems as arising out of attachment difficulties occurring in the critical period between infancy and the age of five. Since a strong attachment needs to form to allow for healthy emotional development, disruptions caused by abuse or neglect can led to emotional insecurity and avoidant behavior.
Attention-deficit hyperactivity disorder (ADHD): A condition characterized by a limited attention and trouble focusing on tasks, impulsive behavior, and difficulty sitting still. While usually diagnosed in children, it can also occur in adults. ADHD can produce symptoms such as insomnia, memory and concentration problems, and mood changes in many people, which may lead to it being misdiagnosed as depression.
Automatic beliefs: Cognitive distortions or errors in thinking that can contribute to depression and other emotional disorders. Different automatic beliefs can include all or nothing thinking, (seeing situations in black or white terms), overgeneralizations (viewing any setback as a sign that change is impossible), mental filtering to focus only on the negative, or jumping to conclusions about the way they view the world.
Behavior modification: Also known as contingency management, this mode of treatment focuses on making positive changes in how a client behaves on a daily basis. Based on principles of operant conditioning, behavioral modification works by using specific rewards to reinforce positive behavior (such as avoiding brooding behavior or isolation).
Behavioral shutdown hypothesis: A recent hypothesis suggesting depression can actually be a healthy coping mechanism under some circumstances since it helps us adapt to extreme situations by reducing activity as much as possible. This kind of shutdown causes people with depression to take time out of their lives to allow for recovery.
Bipolar disorder: A mood disorder similar to depression although symptoms often swing from feeling extremely depressed to feeling manic (i.e., superenergized or on top of the world). A less severe equivalent is cyclothymic disorder.
Chronic fatigue syndrome (CFS): Also known as myalgic encephalomyelitis, this condition can be characterized by symptoms such as concentration and sleep problems, extreme fatigue, and muscle pain. Until fairly recently, CFS was routinely misdiagnosed as depression by medical doctors. Diagnostic testing for this sufferers can prescribe antidepressant medications.
Cognitive behavior therapy for chronic pain (CBT-CP): Developed by therapists at the Veterans Administration for treating injured veterans, CBT-CP teaches patients to manage their chronic pain as part of a comprehensive pain treatment program. They are taught valuable coping techniques including relaxation training, cognitive restructuring, and ways to prevent the kind of catastrophizing and rumination that can make chronic pain worse.
Cognitive behavioral psychotherapy (CBT): a short-term form of psychotherapy focusing on teaching skills and strategies for managing stress and defusing dysfunctional thought patterns that might trigger emotional problems suc
h as depression or anxiety. There are many different types of CBT that can be applied to a wide variety of settings and populations including dialectic behavior therapy, rational living therapy, rational emotive behavior therapy, cognitive therapy, and rational behavior therapy.
Cognitive restructuring (CR): Therapeutic process used to identify and change irrational or maladaptive thought patterns. A key component for cognitive behavioral psychotherapy and rational emotive behavior therapy. Studies have confirmed the effectiveness of CR in the treatment of problems such as addiction and depression.
Collective trauma: Traumatic distress that can strike entire populations after a wide-scale event such as 9/11 or Hurricane Katrina.
Complex posttraumatic stress disorder (C-PTSD): A more complex form of PTSD that arises due to prolonged exposure to traumatic stimuli or situations. Often seen in victims of long-term physical or sexual abuse, refugees, or people dealing with long-standing conflict or violence.
Complicated grief: Prolonged grief with symptoms much more severe and long-lasting than normal grief. These symptoms often include an inability to focus on anything other than the death of a loved one, emotional numbness, a sense that life has lost its purpose, and a sense of personal blame (such as believing that they could have prevented the death somehow). Often identical to major depressive disorder.
Cyberbullying: Bullying or harassment relying on electronic means such as social media. Just like emotional bullying, cyberbullying often involves undermining a victim’s social reputation by spreading rumors as well as posting graphic images taken without the victim’s consent. Along with harassment, victims can also be stalked by anonymous abusers as a prelude to physical or sexual violence later.
Cyclothymia: A milder form of bipolar disorder in which emotional cycling doesn’t quite reach the highs and lows associated with full bipolar disorder but which can still have a serious impact on a person’s life.
Depression: One of the most common mood disorders, depression can be identified by symptoms such as sadness, fatigue, concentration problems, suicidal thoughts and behaviors, sleep and appetite problems, and inability to experience pleasure. Though often confused with sadness or grief, episodes of depression can last for weeks and often require intensive treatment involving medication and/or supportive counseling. There are numerous subtypes of depression depending on the nature of the depressive symptoms that occur. Since many medical conditions can mimic depression, it should only be diagnosed by a qualified professional.
Diabetes (type 2): A medical condition resulting from the body’s failure to produce enough insulin. Can produce develop depression-like symptoms such as weight loss, fatigue, and increased irritability, which may be misdiagnosed as depression.
Dysthymic disorder: Less severe than major depressive disorder, dysthymic disorder can still be serious, with symptoms lasting for years before finally being recognized. These depressive symptoms can also cycle with periods of hypomanic moods (a condition referred to as cyclothymic disorder) or else lead to more severe depressive episodes (also known as double depression).
Electroconvulsive therapy (ECT): A controversial treatment of depression and other mental disorders that works by the running of small electric currents through the brain. While it is still unclear why this treatment works, ECT is frequently effective in treating people with severe depression who don’t respond to other forms of treatment. Rarely used today due to the notoriety resulting from its misuse during the 1940s and 1950s.
Emo culture: A music genre that is usually identified by the emotional expression, hardcore (and often confessional) lyrics, and the distinctive fashion styles preferred by fans. Similar to goth styles in many ways, emo fans have a preference for studded belts, black wristbands, flat hair, and long bangs that often cover the face. In the same way that goth fans are called “goths,” emo fans tend to be referred to as “emo kids” or, simply, “emos.” Both goth and emo fans have been linked to increased risk of depression and suicide.
Emotional bullying: Also known as relational bullying. This type of bullying involves undermining a victim’s social reputation, often by spreading rumors about sexual or deviant behavior.
Functional analysis: Functional analysis involves having the client and the therapist work together to explore the client’s own thoughts and beliefs and how they can shape the way they behave. Clients are encouraged to talk openly and honestly about their depression and explore the way that their mood issues have impacted their lives.
Generalized anxiety disorder (GAD): Prone to episodes of extreme worry, often without any apparent cause. The persistent anxiety seen in GAD can often be so severe that it becomes almost impossible to hold down a normal life. They are also much more easily startled, have trouble sleeping, and have various physical symptoms including headaches, sweating, and hot flashes.
Geriatric depression: Occurring in adults over the age of sixty-five, for example, symptoms can often be triggered by a growing sense of loneliness and be confused with other medical problems such as dementia.
Goth culture: Inspired by the “gothic rock” of bands such as The Doors as well as gothic horror movies, art, and literature, “goths” could usually be identified by their conspicuously gloomy attitude, black hair, black eyeliner, dark fingernail polish, and other styles intended to imitate the “cultured decadence” found in classic horror novels as written by Anne Rice and other authors. Often confused with emo culture.
Heritability estimate: A statistical estimate of the extent to which the variability of a specific trait can be accounted for by genetic influences. Commonly used in studies of the genetics of depression.
Hypothyroidism: A medical condition occurring when the thyroid gland isn’t producing enough thyroid hormones. This can lead to significant health problems as well as symptoms such as fatigue, poor concentration, and a depressed mood. Commonly misdiagnosed as depression.
Internet-based cognitive behavioral psychotherapy (iCBT): A completely online form of therapy that research suggests is as effective as traditional in-person treatment programs in treating depression. Still, much of this research is in the very early stage, and many more studies need to be done to determine whether this kind of online help can become more widely used.
Interpersonal psychotherapy (IPT): Partly based on attachment theory, IPT focuses on relieving symptoms by improving the way people interact with family, friends, and peers. One of the central concepts of IPT is that psychological issues such as depression and anxiety occur due to problems in everyday relationships.
Learned helplessness: A popular theory of depression first proposed by Martin Seligman. Learned helplessness is behavior that occurs when the subject endures repeatedly painful or otherwise aversive stimuli that it is unable to escape from or avoid.
Major depressive disorder: The most common diagnosis for people suffering from depression. Usually identified through episodes of depression that last for two weeks or longer and, depending on how much this depression is disrupting normal life, can be classified as severe, moderate, or mild.
Melancholia (also known as melancholy): An early name for depression often seen in classic literature. Symptoms typically correspond to modern diagnoses of depressive disorders.
Melatonin: Specialized hormone produced by the pineal gland, which cues the body to prepare for sleep. Can play an important role in seasonal affective disorder.
Mindfulness: The process of focusing attention on the present moment through the use of meditation and mental visualization exercises. Originally a part of Buddhist teachings, mindfulness training exercises are now widely used in the treatment of a range of mental health issues such as depression, stress, and social anxiety. Specific forms of therapy based on mindfulness training include dialectical behavior therapy, mode deactivation therapy, and mindfulness relaxation.
Mindfulness therapy: Involving the use of meditation, guided imagery, or mental visualization exercises, mindfulness therapy focuses on teaching peo
ple to identify those specific thoughts, physical sensations, and desires that might be undermining their mental or physical health. This means that participants can learn how to take in and accept all incoming thoughts and feelings without resorting to automatic thoughts and beliefs that might be destructive.
Monamine oxidase inhibitors (MAOIs): A class of antidepressant medications that act on the brain by inhibiting the monoamine oxidase enzyme that breaks down serotonin, norepinephrine, and dopamine to make them inactive. Popular MAOIs include isocarboxazid, phenelzine, selegiline, and tranylcypromine. These drugs are also known to cause many of the same side effects seen in tricyclic antidepressants and can also lead to serotonin syndrome, depending on drug interactions. Not commonly used today due to the availability of safer alternatives.
Mood disorders: A broad category of psychiatric conditions that include different forms of depression as well as bipolar disorder. Characterized by disturbances in mood and formerly known as affective disorders.
Omega-3 fatty acids: An active ingredient in certain types of food such as fish, nuts, and seeds, omega-3 fatty acids have become popular as a natural treatment for depression in recent years. Though the exact mechanism linking omega-3 fatty acids to reduced depression hasn’t been identified, researchers have found a link between its use and reduced plasma norepinephrine and cortisol.
Panic disorder: Being prone to severe panic attacks, often without warning. Panic attack symptoms can include shortness of breath, shaking, tremors, and a sense that something terrible is about to happen.
Pena: A culture-based syndrome found in parts of Ecuador that resembles depression. Symptoms include crying episodes, poor concentration, sleep and appetite problems, stomach and heart pains, and poor hygiene in severe cases.
Phototherapy: Also known as light therapy, phototherapy involves the use of a bright light to simulate natural outdoor light during the first hour of waking up each day. For people suffering from fall-onset SAD, regular use of light therapy can relieve symptoms after just a few days in many cases.
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