CBT for Depression Treatment Week 1 of 14 | Start Addressing Depression Now

https://www.youtube.com/watch?v=XWr0AEWUY5M

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Hey there everybody and welcome to this episode  of the week by week guide to depression treatment   this is part 1 of 14 and i’m  your host dr dawn elise snipes   in this series i’m going to explore one potential  treatment path for somebody with depression  
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depression looks different for each and  every person so no one treatment path   will look exactly the same but this gives you a  general idea of what treatment might look like   this particular video explores what  the initial session will look like
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as a helpful hint over the next few  weeks i will be going over a lot of   stuff for more in-depth information  about particular techniques or issues   in-depth videos can be found on the youtube  channel at doc snipes dot com slash youtube
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the first thing that i do when people come into  treatment is you know get to know them and then   we start talking about what their symptoms are i  typically don’t get too hung up on the dsm or the   diagnostic criteria because depression may look  different for every person and there are a lot  
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of symptoms that occur with depression that are  not in the diagnostic manual so i start by asking   for each symptom the person has when it started  is it something that started a week ago or three   years ago what was different before it started  what do they think causes it what makes it worse  
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and what makes it better even if just a little bit  or for a short period of time this will give us an   idea about potential causes of the symptom about  potential things that the person already does or   skills they already have that we can build on and  about things the person knows already don’t work  
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i also encourage them to watch the video what  causes that symptom on the youtube channel   to learn more about what causes each of the  symptoms that we’re going to start talking about physically when somebody is depressed  they may experience sleep disturbances  
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likewise people who don’t sleep  well often develop depression   many of these symptoms can either cause depression  or be caused by depression and it’s important to   understand that and recognize the reciprocal  nature eating disturbances are another issue  
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that come up sometimes people have no appetite  sometimes all they want to do is eat junk food   and that kind of makes sense because when we  are under stress sometimes our body says you   know what now’s not the time to eat we need to  worry about fighting or fleeing not resting and  
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digesting other times our body is experiencing  imbalances in neurotransmitters and foods we eat   that are high fat high sugar foods tend to  cause the release of dopamine and serotonin   and endorphins which are feel-good chemicals i  always look at what is the behavior telling me  
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another symptom is gi distress some  people may experience constipation when   people get depressed it’s often a  slowing of their whole system including   their gut so we want to look at constipation and  pain pain in the gut can be made worse because of  
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changes in the gut bacteria because of the  depression or because of what they’re eating   and generally pain can be made  worse when people are depressed   because when we’re depressed our pain tolerance  actually often goes down things that may have been  
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not painful or not you know notable before they  were depressed now are are painful to them we want   to recognize that that actually is a legit symptom  of changes in in neurochemicals in the person   when people are depressed they often don’t move a  lot and they often sleep a lot more which can also  
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contribute to muscle imbalances and pain so we’re  going to talk about pain because pain also can   cause depression low energy can be caused by sleep  disturbances poor nutrition or chronic pain or a   lot of other things and we want to recognize that  when we have low energy it’s hard to get motivated  
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it’s hard to feel like you’ve got any  get up and go which can contribute to   feeling depressed you know you just you want to  sit on the sofa all the time different than low   energy which is just not having the energy not  having the gas to go is slowing and that is like  
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moving into a 60 mile an hour wind when people  are depressed it often feels like it takes 10   times more energy to move to walk to take a shower  than it did when they weren’t depressed addiction   also often comes up because when people are  depressed they often try to self-medicate in some  
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way and make it go away this can be behavioral  addictions like shopping or gaming it can gambling   it can be chemical addictions it can you know  and in there we’re also including nicotine   so addictions may get worse addictions also alter  the neuro chemical levels or the brain chemicals  
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which can contribute to mood symptoms impulsive  behaviors some people don’t have enough energy   to even think about it other people occasionally  have these little spurts of energy and they engage   in risk-taking behaviors or impulsive behaviors in  order to feel something you know that’s the brief  
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moment where they have this adrenaline rush and  they’re like oh my gosh that’s incredible and   immunity when your immune system goes haywire  it can contribute to systemic inflammation   people who have autoimmune disorders are well  aware of this but any time your immune system is  
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triggered it can trigger associated inflammation  that inflammation has also been associated   with an increase in depressive symptoms  likewise depression and stress can trigger   an increase in inflammatory cytokines in the  body and an increase in immunity in inflammation  
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all of these symptoms have a back and forth   affectively well of course the person  is presenting for depression so they’re   depressed they may also experience apathy or low  motivation they just they don’t really care about  
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much of anything or what we call anhedonia and  that’s feeling numb not feeling super depressed   not feeling you know super happy super anxious  just not feeling guilt anger and anxiety are also   very prominent symptoms in people with depression  and in treatment if somebody’s experiencing these  
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things we talk about what’s triggering them  and will process some of those issues but right   now we’re just trying to get a picture of what  depression looks like for the person cognitively   or mentally people who are depressed often have  difficulty making decisions and thinking clearly  
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now this can be caused by insufficient sleep poor  nutrition depression itself a variety of things   but these things also make it harder to do  your daily activities which can contribute   to feeling hopeless helpless and depressed  pessimism can cause depression if you’ve  
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always been sort of a negative nelly then that  can contribute to feeling helpless and hopeless   a lot of times when people are depressed  though they can start feeling more pessimistic   because when they’re depressed they notice  more of the negative stuff they notice more  
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of the stuff that’s out of their control and  it can contribute to feelings of depression   ruminations a lot of times  when people are depressed   they have thoughts that bounce around in  their head and you know there’s a lot of  
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reasons for this but what’s important to  recognize is those thoughts are generally   critical negative pessimistic and they tend to  be very overwhelming and loud that negative inner   critic or that those hecklers in your gallery  tend to be a lot louder when when you’re depressed  
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environmentally i found that for a lot of people  they’re outside represents what’s going on on   their inside so if they’re disorganized or  disheveled that gives me a clue that that   that may be how they’re feeling inside because  of all the things that we’ve talked about already  
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people may be experiencing difficulty at school  or work and resulting financial difficulties   difficulty in these areas contributes to stress  and distress and often worsens depression   relationally people who are depressed often  withdraw from others they can’t take the input  
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from other people they don’t have the energy to  deal with their own stuff let alone anybody else’s   stuff they may withdraw from others because other  people may try to cheer them up which makes them   feel rejected or misunderstood or other people  may withdraw from them because they just can’t  
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take being around somebody who’s so depressed  they may experience impatience or irritability   again because they are overwhelmed when people  bring stuff to them when when life happens it   can feel overwhelming and it can trigger that  fight-or-flight response low self-esteem is very  
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common in depression a lot of times because of  the depression the person is not doing the things   they think they should or the way they used to  and it makes them feel bad about themself now   people with low self-esteem from long ago can also  develop depression partly as a result of that so  
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yin and yang toxic relationships  also tend to cause depression and may   flourish when somebody is depressed  because people who are depressed may   tolerate toxic behavior more because they  just don’t have the energy to address it
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once we’ve identified what each symptom looks  like for that person when it’s started what   makes it better what makes it worse etc then  we’re going to identify what recovery from each   symptom looks like and for a lot of things when  we talk about psychology we use what’s called  
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a likert scale and an anchored likert scale has  words that go along with each point on the scale   so for somebody’s mood one may be miserable two  may be okay three is happy four is really excited   and five is unbelievably ecstatic we don’t expect  them to get to five a whole lot but that gives  
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us an idea of where we are starting so people can  rank their moods or rank the behavior on a regular   basis so we can track its progress we will work to  define goals for people’s symptoms that are smart   specific measurable achievable rewarding and time  limited for example i will have more energy as  
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evidenced by being able to work out go to work and  do at least 90 percent of my normal adulting tasks   without getting completely worn out or feeling  weighed down now this is a goal the person is   setting for three months from now not for next  week this is ultimately where they want to be  
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i will sleep better as evidenced by getting at  least seven solid hours of quality sleep each   night i will get motivation back as evidenced  by doing the things that i need and want to do   most days it’s important with goals not to  set extreme goals that are a hundred percent  
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of the time because generally we can’t  do things a hundred percent of the time   so if you set a goal that’s like that then  you’re setting yourself up for failure the next thing i do in this first session  with the person is create a support  
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plan change causes crisis and crisis causes change  it doesn’t matter what the change is it can be a   positive change like getting healthier or bringing  a new baby to the into the family but that causes   changes which can be stressful it may not be like  an overwhelming crisis but it can be stressful  
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change takes a lot of energy and work and i  encourage the people that i work with to recognize   that they’re going to need at least 15 minutes in  the morning 15 minutes of the evening and about   30 sometimes 60 minutes some other time during  the day so when they get up at lunch time and  
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before they go to bed possibly that’s not a huge  time commitment but people who are depressed have   very little energy so this still feels like a  lot we talk about what things can you eliminate   or simplify to free up time and energy for  this change and that may mean things like  
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preparing meals ahead of time or getting  pre-prepared meals for a little while   so you don’t have the dishes and you  don’t have the prep time and all that   stuff so you have more time you can  focus on working your recovery plan  
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how can you alter your environment to stay  motivated and remind you to use your new skills   for change there are a lot of new behaviors  and habits that i ask people to do and those   behaviors and habits can be programmed into your  your mobile device you can get an app that people  
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often use for medication and get push  notifications for things like meditation   then i ask them to think about who in in your  life is supportive and how can they help you and   how will you let them know about plans and what  you need from them don’t expect them to read  
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your mind and know that you need them to do extra  work around the house or help you watch the kids   or something else it’s important to articulate  to other people what they can do to help   it’s also important for the people to identify  what they can do to help themselves feel safe  
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in general feel safe when they’re triggered and  feel safe so they can work on their assignments   so they’re not afraid of becoming overwhelmed or  spiraling and then they’re asked to identify three   strategies they can use to cope when they begin  to spiral when people are experiencing depression  
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you don’t expect them to start treatment and never  have another spiraling episode and i believe it’s   important to create this safety support plan ahead  of time to help people feel empowered so they have   tools at their disposal that can help them endure  what’s going on it’s not going to necessarily make  
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them feel wonderful but it helps them endure it  so they feel safe they don’t feel like they’re   going to be completely overwhelmed the next thing  we do is talk about which two or three symptoms do   you want to focus on changing first because when  you make positive changes in any area of your life  
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it often makes reciprocal positive changes in  other areas and you can really only effectively   focus on two or three things at a time we will  talk about how we’re going to measure that whether   we’re going to measure the frequency how often  each occurs how long particular episodes last or  
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the intensity or quality of each again on one  of those like likert scales and each time the   behavior or or symptom occurs the person  is also going to know what triggered it   what helped stop it if anything and what did  not help so we continue to get information about  
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what is helping what doesn’t work what  triggers it so we can address those in session another thing i ask them to do  is a feelings awareness worksheet   now this is something they’re going to do  between sessions in order to start identifying  
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early warning signs of distress so they may be  able to take action sooner than waiting until   it’s a big crisis you know waiting till  it hits them from quote out of the blue   i ask people to identify what particular feelings  look like for them and what triggers that feeling  
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what thoughts what activities what people  and even what sensations like what sounds   my the ceiling fan over my bed makes an awful  humming sound and it annoys the crap out of me   and that can trigger my irritation so i know that  that’s a sound that will trigger irritability  
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in me and i encourage them to look  at and identify what anger anxiety   depression and happiness look like for  them and what triggers those emotions another thing they’re going to start doing  beginning tomorrow you know beginning the  
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day after this session is morning and evening  mindfulness and this is the 15 minutes in the   morning and 15 minutes in the evening in the  morning they’re asked to inhale for a count of   four envisioning energy and light filling their  body hold it for a count of four and feel that  
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energy spread and then exhale for a count of  four and envision fatigue darkness and brain fog   leaving their body on their breath you know they  can even envision their breath coming out a color   that represents fatigue repeat this four times  in the morning this deep breathing helps increase  
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oxygen and get people get people going  so to speak after they do this they will   do their mindfulness inventory and it seems long  on these slides but it really only takes about 10   minutes they’ll think how do i feel physically  what are my needs physically right now  
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what things might make me more vulnerable to  emotional distress today what physical things do   i have going on that might make me cranky or more  prone to be irritable and how can i cope with them   was it easier hard to fall  asleep how well did i sleep  
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how many hours did i sleep do i feel rested if i  woke up a lot why what will i do beginning today   to address anything that is waking me up  in the night if i did not sleep well how   does that impact my energy concentration  productivity mood and patience with others  
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affectively or emotionally and cognitively or  mentally how do i feel am i happy and clear-headed   or depressed and foggy-headed or something in  between what are my needs what might make me more   vulnerable to distress today if you wake up in the  morning and you’re just in a you know awful mood  
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you know that you know that you’re already kind of  at your precipice and it’s not going to take much   to trigger irritability so what can you do to cope  during your day so when life happens it doesn’t   bring on extra distress and you don’t spiral  environmentally what are three positive things  
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in my environment right now what things might come  into my environment today that cause me distress   and how can i best deal with them planning ahead  for any obstacles that you might have encounter   relationally how do i feel about myself what  relationships do i have that enhance my life  
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and this can include your pets what can  i do to nurture them what relationships   might trigger or make me more vulnerable to  distress today and how can i best cope with them   so if you know you’ve got to interact with  a person at work that typically gets on  
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your very last nerve how can you best cope  with this so it doesn’t cause extra distress   in the evening you’re going to do deep breathing  again but this time inhale for a count of four   envisioning cool blue entering  your body and helping you relax  
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hold for a count of four and feel that soothing  feeling spread then exhale for a count of four   envisioning stress darkness and irritability  leaving your body on your breath if you’ve   got kids in the house this can be a fun activity  to do with them and everybody gets bubble stuff  
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and you try try to see who  can blow the biggest bubble   in order to blow a single big bubble you have  to exhale a lot of breath very very slowly in the evening the questions are a little bit  different again physically how do i feel and  
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what are my needs what things made me more  vulnerable to distress today so you’re doing   a look back how well did i cope with them is  there something i will do differently next time   affectively and cognitively how do i feel you  know emotionally and mentally what are my needs  
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what would make me happy right now how well did  i cope with my feelings today how good was my   concentration and is there something different  i will do tomorrow to improve the moment environmentally what are three positive  things in my environment right now  
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what things came into my environment today that  caused me distress how well did i cope with them   is there something different i will do next time  and finally relationally what are three things   i did well today this plays on your relationship  with self or your self-esteem what relationships  
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do i have that enhance my life remember those  pets again and what can i do to nurture them i also ask people to get a physical because  there are a lot of physiological things   like low testosterone estrogen imbalances  hypothyroid anemia low vitamin d you know there  
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are a lot of things that have relatively simple  fixes that can contribute to depressive symptoms   and no amount of talk therapy is going to address  those things i ask people to schedule their   physical as soon as possible so that we will have  the results including the blood work back by week  
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six i encourage them to make sure that they get  their blood pressure and their oxygen saturation   evaluated vitamin d and b12 levels liver  and kidney functioning their sex hormones   gonadal hormones and thyroid hormones so like  testosterone estrogen and thyroid hormones  
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assess for anemia and if there might be a chance  that they have an undiagnosed autoimmune disorder   to also ask the doctor if it would be  appropriate to look for those autoimmune markers finally i ask people to think about their  housing and their finances when you don’t  
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feel like you’ve got house safe stable housing it  adds stress it adds distress which makes it harder   to recover and con contributes to feeling helpless  and hopeless i encourage people over the next 12   weeks to start thinking about what they need to  do in order to make sure that they feel as safe  
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as possible in their own four walls so they can  relax and what do they need to do if anything to   ensure the stability of their housing so they know  that they’ve got a home i ask them to do the same   thing with their finances because we need to have  enough money to pay the rent to keep the lights on  
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to get medication to get food all those things  and without those things we are at much greater   risk of experiencing distress and depression  so i encourage people over the week to evaluate   their housing and their finances to identify  if there’s anything that needs to be addressed
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in this first session people have identified  their symptoms and the causes they’ve defined   the overall overall what recovery looks like for  them we’ve worked together in session to develop   a support and safety plan now throughout the week  they’re going to use worksheets to gather baseline  
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data on their two or three symptoms that they’re  going to start addressing they’re going to do the   feelings worksheet to identify what feelings look  like for them begin practicing morning and evening   mindfulness and bring those mindfulness worksheets  to session because we’ll process them in session  
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we’ll look for themes we’ll look for trends we’ll  look for triggers and we’ll look for improvement   as you start keeping these mindfulness journals  it will provide a whole lot of information   and then they’re going to schedule a physical  and assess their financial and housing stability  
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so that’s a lot to do in the first  week but when you really look at it   there is the feelings activity assessing  finances and housing and scheduling that physical   so none of those should take too terribly  long beginning practicing morning and evening  
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mindfulness so that’s your 15 minutes in  the morning and 15 minutes in the evening this show was produced by mr charles snipes and  presented by dr donnelly snipes you can learn   more about depression treatment boundaries and  mental health at doc snipes dot com slash youtube  
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