Teen Depression and Suicide

I am very sad to say that this post has been inspired by the two recent suicides of middle school students in Iowa. Suicide is tragic no matter who is affected by it, but there is something especially tragic about the loss of a young life. Unfortunately, it is the third-leading cause of death for people ages 15 to 24 according to the U.S. Center for Disease Control and Prevention.  Many parents in our communities are now struggling with questions about how they can recognize signs of teen depression or warning signs of suicide.

Some common signs of depression include: sadness, irritability, tearfulness, withdrawal from friends and family, loss of interest in formerly enjoyed activities, restlessness, agitation, feelings of worthlessness, guilt, lack of motivation, fatigue, sleep issues, and sudden difficulties in concentration. Some parents may say “Don’t all teens act that way?” It is true many teens are moody, tired, or withdrawn because of the challenges that come along with being a teen. It is important to let your teen know that if things ever feel overwhelming or hopeless that they can talk to you or you can help them get to someone to talk to.

Everyone expresses depression differently. Teen depression often looks different from adult depression. Some things to keep an eye out for are:

• Irritability- Teens are more likely than adults to express irritability rather than sadness when depressed. If you notice your teen is snapping at you or siblings more often than usual it could be a sign of depression.
• Physical complaints – Depressed teens will often struggle with things like headaches, stomach aches, diarrhea, or nausea.
• Changes in social patterns- Adults often isolate from everyone whereas teens may change their social group, only hang out with certain people, or pull away from friends or family only. Be aware of changes in teens’ social habits.
• Low self-esteem- Depression can trigger and intensify feelings of ugliness, shame, failure, and unworthiness. This can be evident in sensitivity to criticism.
• Academic concerns- Depression can cause fatigue, lack of motivation, and concentration difficulties. If your teen is having poor attendance, a drop in grades, or you are seeing new frustration with schoolwork it could be a sign of depression.
• Drug and alcohol abuse- Teens may use drugs or alcohol to “self-medicate” or avoid what they are feeling. Unfortunately they are many substances that teens can abuse including street drugs, prescription drugs, inhalants, cough syrup, alcohol, and synthetic cannabis. It is a good idea for teachers and parents to educate themselves about the types of substances being abused and signs of abuse.
• Changes in online behavior - Teens may try to escape from or deal with how they are feeling by going online. Changes in the amount of internet use, types of sites visited, or things that teens are posting may be indicators of depression.
• Risky or impulsive behavior – Teens may be demonstrating high risk behaviors like drugs, sex, and shoplifting, fast driving, or engaging in vandalism when dealing with depression.

If you feel like your teen may be struggling with depression talk to them.  Avoid asking many questions. Feeling interrogated often causes teens to shut down. Let them know that you are there and willing to hear whatever they may need to talk about. Try not to lecture or minimize feelings. Some things to avoid saying:

• “Do something about it”
• “Just go have some fun”
• “Stop thinking about it”
•  “There are a lot of people who are worse off than you.”
• “Don’t feel sorry for yourself”
• “You don’t have a reason to be depressed”
• “You have so much to be happy about”
• “You are just trying to get attention”
Focus on validating their feelings and letting them know that whatever they are feeling is okay.  If you feel uncomfortable or unequipped to talk to them, speak with a psychologist or other mental health professional. The national suicide prevention hotline is 1-800-273-TALK (8255). They are available 24 hours a day to help.

Barbells, Protein Powder, and Psychology

Does anyone out there have a New Year’s resolution to lose weight? Many of us do. It is hard not to think about your weight after you've gotten through two months of holiday celebrations and winter weather.  An article on Yahoo News today, “Psychology Hits the Gym” highlighted the importance of paying attention to the psychology of weight loss in addition to the usual stuff we should think about like diet and exercise. Many studies have found that combining both a physical and psychological approach to weight loss is most effective. Many weight loss programs across the nation and programs that offer bariatric surgery partner with psychologists to offer the most effective treatment.  So what are some ways that psychology can help with weight loss? Here are a few:

• Help people identify triggers to eating and reasons for eating
• Help people develop coping skills to replace emotional eating
• Teach people about the difference between “physical hunger” and “psychological hunger” or “emotional hunger”
• Teach people about effective goal setting
• Teach skills like mindful eating
• Help people to identify their emotions
• Address body image and self-esteem issues
• Address emotional trauma related to many body issues like abuse, bullying, and medical concerns
• Address the psychological implications of things like diabetes and physical disabilities
• Help people have healthier relationships that support healthy lifestyle changes

These are just a few of the ways that a psychologist can help with weight loss or other health goals. While you are in line to sign up for the gym this January you may want to think about scheduling an appointment with a psychologist to talk about ways that you can make your New Year’s resolution more successful than ever!

Social media and psychology: A marriage made in heaven?

In a study published this month in “The Lancet”, a medical journal, researchers found that combining psychological principals and social media lead to more than double the amount of participants getting tested for HIV. Seven of the study participants tested positive and were linked with medical care. People in the control group were linked to social media without the psychological intervention and were about 50% less likely to get tested. This study suggests that combining psychology and social media may be an effective way to increase healthy behaviors and get health interventions to many people in need.

This has not been the first study that has found that social media could be a new forum for health promotion. A meta analysis published last month in the journal of Sexually Transmitted Infections looked at multiple studies that examined the effect of social media on condom use and STD testing. The results showed that the interventions lead to significant increases in both of these health behaviors. Social media is also being used to contact difficult to reach populations like veterans about things like mental health treatment.

An important thing to take away from the research is that the psychology is an important part of why this works. Just putting information out on blogs, Twitter, Facebook, or other social media outlets is not effective by itself. Using psychological principals to inform the ways in which you engage people about health information is important. As with any marriage, each partner contributes something important. Social media and psychology work best together to engage people in thinking about their health.

Social media combined with psychology can empower it’s users to be healthier and be more active in their own healthcare. As with any medium there are things to be aware of when looking to social media for information and guidance about health. Here are some tips to help you be a savy social media user:

• Evaluate the source and the quality of the information that you are reading. Just because it appears online doesn't make it reliable or true.
• Understand that there are implications for privacy when you use online mediums. If you are concerned about privacy be sure to read the user and privacy agreements for the services you use.
• Monitor your social media use and ensure that it is having a positive impact on your daily life. It should be a tool to help you stay connected to others and information. If it becomes something that causes you stress, anxiety, or impacts your ability to pursue offline interests you may need to evaluate your use.
• Try to remember to take technology breaks. It is important to be present in your life and unplugging can be a really good way to do that.

A Christmas Story

So you made it through Thanksgiving. Congratulations! Whether you survived a second helping of Aunt Stella’s green bean casserole or made it through a day filled with a cacophony of clanking dishes, screaming children, and interrogations from distant relatives – you made it through. For many though, that is just the first hurdle in a daunting holiday season. While the holidays are wonderful for some people, (I admit I am one of those star eyed holiday junkies who loves everything from fudge to trees) they aren’t for everyone. The holidays are often part of a larger seasonal depression or a reminder of things lost. The holidays also fall on a time of year when many families are doing struggling with loss of seasonal work, high heating bills, and healthcare expenses.

A recent article in the Providence Journal by psychologist Ben Johnson, PhD “Mental Edge: 10 Ways to Keep the Blues atBay this Holiday Season” might give you some insight into ways you can beat the blues if they are a problem for you this season. All of these are good suggestions but one of them caught my eye, “Let go of limiting life stories.”  The way we tell our stories can have a profound impact on our lives. 

There have been many research studies that have investigated and found that how we tell our stories is directly related to things like mood, longevity, and self-concept. David Snowdon and colleagues (2001) examined handwritten autobiographies from 180 Catholic nuns, composed when participants were in their 20’s.  They found that those narratives that had more positive emotional content were associated with longevity over six decades later.  In another study, Libby and colleagues (2005) found that the way people described an embarrassing incident from high school impacted their views on their change and development since that time. It also affected the way that they were able to sustain self-improvement.   

As a psychologist working in a clinical setting I see examples of this nearly every day. Those clients who describe difficulties as challenges and not as things that are inherently wrong with themselves are much more easily able to overcome their difficulties.  In the last Psyowa blog post, one of the tips for practicing gratitude was to look at situations in a different way. This is very similar, but now you are looking at your life story in a different way.

Many people have had horrible things happen in their lives, but how you tell that story can make a huge difference. Let’s look at a story and see how viewing it differently might impact someone.  

When John was a small child he was the victim of physical and emotional abuse in his home. His parents were both alcoholics and were poor parents to John. He often would come home to an empty house and his parents would return late in the night waking him to violent outbursts. The family had little money and John often wore ragged clothes to school. Many of the other children picked on him and he had few friends.

Looking back at that story John could tell himself that all of those things happened because he was a looser and didn’t deserve better. He could tell himself that he had no choice in life and his life will always be terrible because it is his destiny. Alternatively, he could tell himself that the things that happened to him in childhood had little to do with him. They were unfortunate things that happened and now that he is an adult he can choose differently. He can applaud himself for surviving such difficult times and see himself as a strong man for doing so. There are stark differences in how each of those stories might affect John, even though they are based on the same set of life events.

One of the most popular holiday movies, “It’s a Wonderful Life”, operates on the same concept. The main character tells himself that he isn't very valuable and that his life didn't impact others. As a result, he doesn't feel his life is worth living. After he is shown a different story, based on the same events, he realizes how valuable his life is.

This holiday season when you start to feel blue about your situation think about the story you are telling yourself about your own life. If you find that it’s a story of sorrow, difficulty, and hopelessness it may be time to rewrite your story. Instead of focusing on the things that are wrong in your life, focus on what is right. Think about the ways in which your story weaves in with others’ stories. Just like in the movie the main character finds that his time on earth deeply impacted others and changed their stories. Whether its smiling at a man on the bus on your way to work or saving your brother from drowning in a freezing pond, your story matters. It is the season for a new kind of Christmas story.

Danner, D.D., Snowdon,D.A., and Friesen, W.V. (2001) Positive emotions in early life and longevity: Findings from the nun study. Journal of Personality and Social Psychology, Vol 80(5), May 2001, 804-813.

Johnson, B. (2014, November 30). Mental Edge: 10 ways to keep blues at bay and enjoy the holiday season. Retrieved December 2, 2014.

Libby , L. K. , Eibach , R. P. , & Gilovich , T . ( 2005 ). Here’s looking at me: the eff ect of memory perspective on assessments of personal change. Journal of Personality and Social Psychology ,88 , 50 – 62.

Being Thankful Might Be as Important as Eating Your Veggies This Thanksgiving

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On the eve of everyone getting ready to fill their plates with turkey and all the trimmings it is good to have a reminder of what Thanksgiving stands for. Of course many of us have already been reminded by the “28 days of thankfulness” circulating on social networks or the school projects children bring home. One thing you might not know about gratitude is that it can have health benefits. That’s right, something that is totally free, doesn't require you to cut down on your pumpkin pie intake, or get on a treadmill this holiday season has health benefits.

Research has shown that gratitude, or being thankful can have mental and physical health benefits.  (Emmons & McCullough, 2003) Those who practice being thankful have been shown to:

• Practice better self-care
• Have better quality of sleep
• Exercise and eat healthy more
• Be more alert
• Practice more proactive health behaviors
• Cope with stress
• Have stronger immunity
• Be more optimistic 

Most of us know how to say “thank you”, but how do we adopt it as a practice? There are several ways including:

• Focus on what you do have instead of what you don’t. We all could make long lists of the things we wish we did have; a better job, a bigger house, or those new tennis shoes. Focusing on the things we do have like our health, a place to live, loved ones, etc. helps us to be grateful.
• Make a list of the things you are thankful for. Our elementary school teachers were doing even more than they thought with this assignment.  Keeping notes, sending thank you notes,  journaling about what you are thankful for, or just making a list of the things you are thankful for can be a good reminder of what we are thankful for.
• Try to notice negativity and re-frame it in a positive way. Any situation can be seen from many viewpoints. For example, let’s say Jane is driving to work today and gets in a fender bender. She could be very negative and focus on feeling awful that she got into an accident or she could focus on the fact that no one was hurt. Trying to catch your automatic tendency to evaluate things negatively and replacing it with something positive can help you to notice things that you are grateful for.
• Try to be thankful for even the things that are difficult in your life. This one is a tricky one, but often there are lessons to be learned in even the difficult and painful things. If we pull a muscle running too much our body might be telling us to slow down. If a relationship ends it may have been unhealthy. A friend of mine often asks, "what information did that give you?" Sometimes it takes time and a step back to see the reasons to be thankful but often they are hidden in the most unlikely of places. What would it be like if we were thankful for everything?  

The important thing is to sustain your gratitude and make it a way of life rather than a once a year occasion. Recently, in celebration of the month of November a colleague shared a list of quotes about thankfulness with me and one quote by Sarah Ban Breathnach stuck with me “Real life isn’t always going to be perfect or go your way, but the recurring acknowledgement of what is working in our lives can help us not only to survive but to surmount our difficulties.”

Emmons, R. A., & McCullough, M. E. (2003). Counting blessings versus burdens: Experimental studies of gratitude and subjective well-being in daily life. Journal of Personality and Social Psychology, 84, 377–389.

A special thank you to Vanessa Shileny, MSW for sharing her thankfulness resources. 

The Brain: The Last Frontier

The brain is a pretty amazing thing. It is one of the true "last frontiers." We know many things about the brain but not everything. It is kind of like America in pre-colonial days. We know the brain exists but we haven't fully explored it or been able to fully utilize it's resources. 

New and exciting things are being discovered all the time.  Recently, doctors discovered a woman in China who was born without a cerebellum. The cerebellum is a part of your brain that sits just above the top of your brain stem. Cerebellum is Latin for "little brain" and this part of the brain contains nearly half of the brains total neurons. This part of the brain is responsible for controlling fine movements and balance. It helps us do things like writing, riding a bike, and jumping. It also may be involved in some of the mechanics of speaking and communicating to others. The woman in China is a miracle because there are very few cases in history of humans surviving without this part of their brain. The picture below is an image of what her brain looks like without the cerebellum. The black area is filled with cerebral spinal fluid, a liquid that provides cushioning for our brains. 

You may be wondering about how she survived without an important part of her brain. Believe it or not, there are people all over the world that survive and live reasonably well without parts of their brain. Some people have an operation at a young age called a hemispherectomy in which half of their brain tissue is removed.  This is often done to control seizures. When this operation is done early enough in a person's life the brain can begin to "rewire" itself. The brain, especially when we are younger has plasticity and can change to recover from injury or to learn new things. Scientists are finding out that this plasticity lasts well into adulthood and in some parts of our brain throughout life. The Youtube video below details the journey of a little boy who had a hemispherectomy named Josiah:

In the case of the woman in China and those who have had this operation, other parts of the brain have had to assume some of the roles of the missing areas. The woman in China did have some delays in walking and talking and never has been able to jump, Considering she is missing a crucial part of her brain she functions well and has a child of her own. I have had the opportunity to work with some patients who have had this or a similar procedure and it is amazing to watch them learn and grow. From one month to the next they learn new things and regain functioning. 

An important lesson in all this is that we need to take care of our brains and make sure to provide them with stimulation and activity so they continue to grow and get stronger throughout our lives. Some ways you can take of your brain are: 

• Get enough exercise; Research has shown that regular exercise can increase our brains ability to process information, problem solve, and maintain attention. 
• Meditation- Research in this field is in it's early stages but early findings suggest that meditation and things like mindfulness can improve brain function at any age. 
• Manage your stress: Stress and anxiety can increase harmful things in our body and impact our ability to think and remain calm. 
• Learn and learn some more: Learning new things stimulates the brain. Become a life long learner; read books, take a dance class, or find a new hobby. 
• Eat a healthy diet that includes a wide variety of vegetables, fruits, and proteins. All of these things are important for your mind. 
• Control your weight- Fat, bad cholesterol, blood pressure, and  blood sugar levels can all have a negative impact on your brain. It is much easier to control these things when you are at a healthy weight. 
• Drink alcohol in moderation- Excess alcohol and other drugs can be very harmful to your brain. 
• Tease your brain-Brain teasers and brain games can be fun and useful ways to maintain or improve your brains skills in attention, focus, and problem solving.

If you need further information or have concerns about how your brain is working contact a psychologist in your area. They can provide information about ways to help your brain function its best, help you cope with changes, and provide testing to find out if their might be a problem. 

Stigma Can Be Deadly

Many people were touched by the death of Robin Williams in many ways. I myself was moved to tears when I heard about it in a text from a family member. The movie "Patch Adams" is my favorite movie of all time and a source for inspiration about the type of doctor I want to be. His comedy and talent has touched my own life in many ways. Many of the clients walking through my door recently have been deeply affected by the loss or affected by the coverage of his death.There was a flurry of articles on other blogs, in the news, and social media exploded. The details of the death were detailed, gruesome, and some might argue insensitive to the family's privacy. I considered when the right time might be for posting about this on the PSYowa blog and what the post might say. The issue of suicide is a sensitive topic, however many issues in psychology and concerning mental health are sensitive. This doesn't mean that we shouldn't talk about them or give voice to their importance.

As a friend reminded me when I was struggling with what to say in this blog, Robin Williams death should be kept private. As we would want the death of any of our own loved ones to be. There have been many discussions throughout all of this about the selfishness of suicide and the character of those who choose to complete suicide. I am not going to address that. The situations involved in each individual's choice to take their own lives are different and there is not enough time or space to give light to their stories in a respectful or meaningful way. The important thing that we should take from this tragedy is the very public fact that mental illness can affect anyone. Rather than shaming and stigmatizing mental illness we can make a choice to embrace that it is a part of humanity and address how to get help to so many who need it.

For some people who commit suicide we may never know why. For others it may be an apparent journey with the struggles of depression. By lessening the stigma and having conversations about mental illness we can create a safe environment where people do not feel afraid or ashamed to ask for help.

One way to decrease stigma is to be vigilant for people in your own lives who may be struggling and to reach out to them in a compassionate way. For those of you who are not familiar with the signs of depression they can include:

• A sad mood 
• Irritability 
• A change in sleeping patterns (either too much or too little)
• Significant changes in weight or appetite 
• Loss of interest in things they usually enjoy
• Increased anxiety
• Withdrawal from family or friends
• Loss of energy
• Difficulty concentrating 
• Feelings of guilt or worthlessness
• Thoughts or comments about death
• Hopelessness 
• Inability to see positive aspects of situations 

Depression can look very different in different people. While there are a set of symptoms that are common, the ways in which people show them can depend on their personality, environment, and culture. If you are unsure don't be afraid to ask a friend or family member how they are feeling. When you ask, listen without judging. This can be very hard when it is someone you love but remember this is about them, not you. Be ready to hear things that you might not like or that you may not want to hear. Just listening and creating a safe environment for them to talk can make a lot of difference. It is important that you allow them to feel what they are feeling without telling them they are wrong. You may want to say affirming things like "you're right, that's difficult." Arguing with them that they are wrong may only make it more difficult for them to talk. Being affirming is important when you are talking to someone that is going through depression. Point out whatever you can to help them to see that they aren't broken or defective and that there is hope. They may need your help to see that depression is just a part of human life and whatever the situation may be it isn't permanent.

Another important thing is to not fear asking questions about their safety. Asking about suicide will not cause someone to kill themselves. Let them know you are asking about suicide because you care about them. It can be hard but the best way is just to ask someone about their safety is to be direct.  It is important to ask things like "Have you been thinking about killing yourself?" Being tentative or saying things like "You haven't thought of doing something stupid like killing yourself have you?" can make a person feel unsafe telling you or can make it easier for them to say "no."

Having this conversation with a friend, co-worker, or loved one may be hard. It also may save their life. It may be one step towards making the world a safe place to share our difficulties and get the support we need.

If you are immediately concerned about someone in your life you can call the police and ask for a health and welfare check or call 911. If you are considering suicide or need to talk to someone you can call the National Suicide Hotline at 1-800-273-TALK. You can also utilize the American Psychological Association's Psychologist Locator here: http://locator.apa.org/ to find a psychologist near you.

Thank you to Lori Schoh, TMHC from Capstone Behavioral Healthcare for volunteering to serve as guest reviewer/editor on this post.