What is Harm OCD? This is a question asked by many people who suffer from OCD, as they wonder what could cause this type of obsessive compulsive disorder. There are many possible causes for OCD but no one knows for sure what causes Harm OCD or any of its variations. However, there are some things that scientists have learned about OCD that shed some light on what could cause this behavior disorder.
First, we need to answer what is Harm OCD first. Harm OCD is a clinical term used to define OCD when dangerous, intrusive thoughts take on the possibility of hurting others. The thoughts may take on the form of anxiety you will hurt someone, fear that you will hurt someone, a desire to harm someone, or even a fear that you will hurt yourself. This type of OCD comes with symptoms of anxiety, fear, worry, and even depression. This is usually seen in people who have been child abusers or sexual offenders and has a common cause of anxiety and stress.
Avoiding contact with these types of thoughts is one way to treat what is known as Harm OCD. It can be hard to do because it feels like the person wants to harm you or is going to hurt you. To treat this type of obsessive-compulsive disorder, avoiding contact with the feared entities is often the best way to treat it. Therapy or counseling can help with this.
When a person is exposed to these types of thoughts and images repeatedly, they are at risk for developing Harm OCD. The key to treating what is called Harm OCD is to expose the person to these thoughts and images, but not so much that they are in danger, but just enough to where the effects become manageable. This is done by avoiding the situation that is thought to bring out the behavior. The treatment for avoiding exposure to these thoughts and images is exposure to the situations that bring them on, but to a degree that are manageable.
If you are exposed to harm ocd thoughts and you can tolerate them, you may find that it helps your Anxiety Disorder. If you can tolerate them but feel anxiety when you are around them, it may help your OCD. There is also some success with using cognitive behavioral therapy. This involves changing how you think about your obsessions and compulsions and replacing them with rational thoughts. This is better for people who are not able to tolerate the anxiety that comes with exposure to harm ocd thoughts and images.
Cognitive behavioral therapy is often very effective, especially when combined with an extra (counseling therapy). An exrp is someone who will help you change the way you think and act so that you can get better control of yourself and your life. It is important to have both a exrp and a CBT (Computer Based Therapy) treatment. The benefit of both treatments is that they work together to help you gain complete control over your condition and live a better quality of life.
PTSD affects about 11-20% of veterans that have served in Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF). Symptoms can be grouped into four distinct clusters: recurrent and intrusive reminders of the event, avoidance of things that remind one of the event, negative changes in thoughts and moods, and emotional reactivity. These symptoms can affect one’s quality of life. PTSD has been found to contribute to low mental and physical quality of life (Gradus, 2017). It is necessary to improve the quality of life for veterans because they already have to adjust back into civilian life after experiencing war and dealing with additional physical and mental health challenges can cause distress. Generally, people with PTSD have 5.3 times higher rates of death from suicide (Gradus, 2017). These rates are high, and are even higher in veterans who are diagnosed with PTSD. Veterans with PTSD diagnoses have four times higher suicide rates than veterans without (Gradus, 2017). Adjusting to civilian life can add more stressors to veterans who are also struggling with PTSD.
Treatments for PTSD have been focused on two types of cognitive behavioral therapy. Cognitive Processing Therapy (CPT) has been used and shows the strongest evidence for reducing symptoms, better than any other non drug treatment (Reisman, 2016). It focuses specifically on the impact of trauma and identifies negative thoughts. Therapists then work with the patient to replace negative thoughts and work on coping skills. Prolonged Exposure (PE) focuses on repeatedly visiting the trauma in a safe setting to change emotional reaction to the event. It also teaches patients how to overcome stress and fear in situations that may induce these negative emotions. Both techniques take twelve weekly sessions to complete. This time commitment and reexposure to trauma can be potential factors that lead to patient dropout. Dropout rates are as high as 54 percent (Schottenbauer, Glass, Arnkoff, Tendick, & Gray, 2008) and are even higher for Afghanistan and Iraq veterans with dropout rates being 62 percent (Harpaz-Rotem & Rosenheck, 2011). Some other treatments include Eye Movement Desensitization and Reprocessing therapy and medications. However, these treatments are not used as the first step.
New treatment approaches have been used that focus on mindfulness cognitive behavioral and incorporating exercise. These treatments have been seen as a way to help not only with symptom reduction but also with patient dropout. Mindfulness has been brought into psychology by Langer and Kabat-Zinn (Lang et al., 2012). There has been an increase in using these techniques, which can be used in addition to treatment or as its own intervention (Lang, 2017). Some of these treatments are already being conducted at Veteran Affairs offices (Libby, Pilver, & Desai, 2012). A randomized trial of a certain type of yoga showed reduction in PTSD symptoms, and had a 90 percent rate completion of the veterans in the active group (Seppälä et al., 2014). This suggests that veterans may be interested in trying new methods to helping with PTSD symptom reduction. Mindfulness includes non judgemental acceptance which helps with avoidance and thought suppression, two symptoms that are frequently found in PTSD (Lang, 2017). These two characteristics are often the focus of mindfulness techniques and are strong predictors of outcome (Boden, Bernstein, Walser, Bui, Alvarez, & Bonn-Miller, 2012).
Exercise is also emerging as a new treatment for PTSD. Despite it being a familiar part of their day, individuals with PTSD report exercising less than those without PTSD (Goldstein, Mehling, Metzler, 2017). With being used to exercise as their routine, these treatments might have an appeal to veterans. Previous studies have looked at civilian populations, but have not been generalizable. Even though there have been studies that show there is an improvement in symptoms, they are not generalizable and have limitations. In order to address these concerns, more studies are creating methods that can be replicated. More specifically, they are examining types of exercises, determining which will be most effective in symptom reduction. In the study by Goldstein, Mehling, and Metzler, (2017) they utilized strength training, aerobic exercise, and yoga. All exercises were accessible to participants and could be conducted anywhere. This is also something that can be done whenever is convenient to the individual (Whitworth, Craft, Dunsiger, Ciccolo, 2017). Studies have found that there was a high acceptability rate, meaning that participants were willing to do the treatment as well as finding symptom reduction. Attention and exercise was another factor that was examined. In Fetzner & Asmundson (2015), they found that increasing attention to the changes in body changes made exercise less enjoyable, and that it might be better to not tell the individual to focus on these changes.
These treatments can help with symptom reduction and might appeal to veterans more so. It can be framed as skills to help cope with stressors and done in group settings. This could help with reduction of dropouts. However, more research would need to be done on comparing these treatments with CPT and PE before any claim can be made. It is important to study these treatments side by side because it will help determine if one yields better outcomes than the other. If one technique is proven to be helpful, then it could be used to improve veterans lives and then be researched to see if it has the same effects in civilian PTSD populations. The research will compare mindfulness cognitive behavioral therapy and Integrated Exercise side by side on the effect of symptom reduction. This research proposal hypothesizes that Mindfulness Cognitive Behavioral Therapy will have higher rates of symptom reduction than Integrated Exercise.
Sports psychology is focused upon various theoretical perspectives: psychodynamic, humanistic, behavioural and cognitive, biological, and psychosocial models. These perspectives provide an explanation and description of human behaviour and the reasoning behind behavioural changes. Furthermore, they are implicit in the practitioner’s practices and theories. Although there have been some influential theories in sports psychology, cognitive-behavioural has had an implicit impact for multiple reasons. Despite the lack of cognitive psychological studies strictly focused on sports, competitive sports enable researchers the ability to study fundamental cognitive processes, for example, memory, knowledge acquisition, attention and visual search. In addition to expert views on the performance of complicated abilities and actions for strict control of time within constantly altered environments. This review will be focusing on the critical analysis of the cognitive approach in an applied sports psychology practice.
Cognitive psychology examines an individual’s internal brain processes concentrated on understanding the environment and reviewing what the applicable action required. Eysench et al. (2015) focus on the cognitive functionalities which comprise the following: perception, attention, learning, memory, language, problem-solving and reasoning. The cognitive approach can be described as an attempt to comprehend what is human cognition through observation of people’s behaviour when participating in cognitive tasks. There are three explicit areas of cognitive sports psychology – imagery, attention and expertise- required in understanding how dysfunctional processes have progressed into a functional progression or can be progressed when studies are performed on athletes. Moran (2008) stated that motor cognition provided a model for this approach as it acknowledges the link between an athlete’s cognition and action, including the significance of knowledge of the body and awareness of an individual’s movement whilst attributed to their cognitive activity.
In the Hofmann et al. (2013) study cognitive behavioural therapy is considered as the most result-orientated procedure for numerous syndromes in various environments such as sport. Though there is a growing interest in CBT, amongst most sports psychologists, there is limited published research demonstrating the significance of key cognitive principles for applied sports practice. It is often perceived that CBT is representative of one cognitive approach, however, it is a term linked to multiple therapies which incorporate cognitive and behavioural responses. For instance, rational emotive behaviour therapy is another form of therapy. There is research in sport available in support of many of the other approaches, despite there being a lack of specific publications in direct support of cognitive behaviour. The groundwork of cognitive behaviour is considered by various key concepts such as systematic information-procession biases that are integral to the improvement and maintenance of psychological issues. Furthermore, the CBT technique insinuates the psychological difficulties originate from the involvement of a person’s experiences: distorted or prejudiced rationale, emotional and behavioural responses, and physiology. Furthermore, the interferences between the four systems are thought to be impacted by environmental elements. Moreover, another factor of CBT is cognitive development from a negative to a positive outcome. Additionally, the transformation of an athlete’s behaviour and the emotional responses also the somatic reaction could be accomplished by the resolving modification of mental processes and formats. Although the mediation work aims to accomplish positive transformations in mental processes, either directly or indirectly modifying through behaviour mediation. Conversely, this method of CB strictly requires the practitioner’s skill to encourage the client to participate in any form of verbal or visual dialogue about their issue, thus the ability to perform CB mediation. The common social ground holds unchanging central beliefs that are inaccessible to an individual’s consciousness. Beck (1995) stated that the common social belief is incorporated and valid in lifetime scenarios, such as an athlete stating they are incapable of performing better in their sport. The fundamental beliefs impact the cognitive stage of consciousness and preconsciousness. Cognitive behaviour therapy claims that the majority of instantaneous undesirable contemplations do not hold significance. The role of a sports practitioner is to construct negative opinions that are able to serve a positive purpose clearly by supported treatment and various methods.
One cognitive technique includes the use of imagery, which was used on 345 athletes, in training in competition to see if confidence was enhanced. This study discovered motivational imagery was the benefactor in building confidence during sporting events. Imagery has been discovered to be more beneficial for elite athletes in competition compared to training (Hall & Chandler, 2009). A sports practitioner has a chance to contemplate which cognitive models they utilise to inform applied sports psychology decision-making. Furthermore, Anderson’s research (2009) implies that the commonly used approach is cognitive behaviour in contrast to psychotherapy – the ‘canon’, the most prominent methods used are imagery, goal setting, self-talk and relaxation. Additionally, rational emotive behaviour therapy (REBT) is perceived to be the initial form of CBT, it differs from other approaches as it focuses on rational and irrational beliefs, as the central cognitive premises between scenarios and attitudes and behaviour responses. It is through the cognitive behavioural mediation in the sport setting formed a practical sports psychological importance, which is in conjunction with the athlete’s development and greater progression within the department. Furthermore, these mediations involve the management of stress through the usage of coping skills methods. Additionally, the use of imagery performance improvement procedures assists the practitioner in constructing positive-based imagery for the client, goal setting, ability to control focus and retention techniques, and the usage of self-efficacy mediations. Usually, the usage of cognitive behavioural methods has had a significant impact on the growth of sports psychology. Sports psychology research which has been published regarding mediation places greater importance towards the content rather than towards the development of forming a relationship between the practitioner and client, as well as their execution.
Similarly, there is a necessity to comprehend the functionality of the mechanisms of change and action. Even though sports psychologists attain the intellect and capabilities, there is still a lack of clarity on the deliverance of conversations with the clients for instance, the practitioner’s usage of dialogue mechanisms which have incorporated precise frameworks and devices which are applied, as well as constructing a beneficial alliance with the client, and ability to recognise the athletes willingness to participate in mediation, the framework which supports the decision the practitioner implements during each session. In addition, the practitioner’s procedures for implementing various compatible therapeutic strategies are not frequently emphasised in detail. Therefore, it becomes problematic when other practitioners attempt to duplicate publicised mediations, this also increases the difficulty when attempting to recognise the methods which achieve causes success with the mediations. The cognitive behaviour principles are perhaps the most prevailing in the world of mental health as this is the main beneficial option for the treatment of an increasing number of cases that need to deal with various forms of anguish. Notwithstanding the fact that these restrictions are pertinent towards sports psychology, this is because cognitive behavioural techniques and other related therapies are still being used with clients who are athletes. This relates to instances where it is necessary to find solutions for an athlete’s difficult situation, possibly towards the obligation of recognising and reimplantation of the client’s strengths, however, practitioners have risks of seeming overly discerning or insolent when scrutinising and analysing non-rational thinking and distorted thinking patterns. There are some instances where CBT will be unable to be effective in a third of cases, and an inclination to associate this with the client’s reduced motivation or any form of positive insight. Furthermore, if there is a mediation within CBT that is analysed and considered to not be successful, in regard to the goals of the intervention, the preliminary assessment is interrogated.
To conclude with the multiple approaches and therapies that fall under and are attributed to cognitive behavioural therapy, practitioners are more often challenged to train this discipline and work with one or more of these approaches in any given client session or research. This is problematic because of the variation within the CBTs and the lack of clarity, also there is not enough practice literature from a professional perspective, which incorporates the implicit usage of several CBTs. Overall, the fundamental cognitive principles of memory, attention, visual search and knowledge acquisition, are implicit when working with an athlete as they work in time-constrained situations and constantly changing environments.
Based on research, there are 166,000 direct deaths caused by the drug abuse in year 2017. Besides that, there are 0.9% of the global population had a drug use disorder. On the contrary, sugary drinks are responsible for 184,000 deaths each year and research found 133,000 annual deaths happen at the hand of type 2 diabetes. More than 2 billion people worldwide regularly play video games. Studies have found anywhere from 1-10% of gamers struggle with compulsive addiction issues. Example is a 23-year-old Chinese gamer died of exhaustion after continuously playing the game for 19-hours non-stop in an internet café at Shanghai.
A surprising fact about addiction is that it can change the structure of your brain. Repeated use of addictive substances has been shown to change the way the human brain is structured. Most irresistible substances cause a surge of dopamine, one of the mind’s vibe great synthetic substances, each time the substance is utilized. In the end, the reward framework will never again work appropriately, leaving the client feeling dull or lazy. Additionally, the territories of the cerebrum start to wear path as the substance keeps on being brought into the sensory system, making it harder for those effectively dependent to quit.
The main topics includes three types of addictions which are addiction to games, sugar and drugs. There are various symptoms towards the addiction to these three types of things can cause horrible side effects but at the same time there are always ways to overcome these said addictions. On the topic of game addictions, there are causes and overcoming methods while for sugar addiction, it includes the effects and ways to overcome the problem, and for the addiction of drugs it analysis the effects and overcoming ways. Firstly, we will talk about two causes of games addiction followed by the two methods of overcoming games addiction.
Addiction of games is caused by the brain chemical changes. In this case, high level of dopamine known as happy chemical is released when someone is playing video games. In this case, it is linked with the reward system and involved in regulating memory and problem solving in the brain, thus increasing the desire to play games. High level of dopamine released will make someone addicted as it is associated with the pleasurable dopamine release which will make it more difficult to stop the cycle of compulsive behavior without professional support.
Cognitive behavioral therapy (CBT) – a talking therapy that is commonly used to treat other types of addiction because it can identify the underlying reason for why someone is stuck in the addiction of playing games. In this case, the specialist therapist will teach you the way of retraining your thought process which is lead to your addiction, by helping you to curb this addictive thought about playing games with learning to focus on the ways to fill your time wisely and fighting boredom.
Addiction of games also causes by the emotional influences. Next, if someone is experiencing unhappiness and even bad emotions due to the mental health condition, then someone will prefer to use games in order to escape above feeling. In this case, a sense of increased self-esteem and glory that it is hard to achieve in the real world can be easily achieved through the achievement system in games. But, this feeling is only lasts for a short term if as soon as you stop it, then you will require more game time in order to escape the problems and negative emotions.
Those who are addicted to games should try to develop a new lifestyle that can help them to avoid excessive gaming. In this case, people should explore their skills and abilities that are related to their personal interests, setting a goal for themselves like continuously reduce the time for gaming for about 2 weeks as a small goal, and even find themselves some activities rather than gaming that keep them away from other people like going for jogging and playing basketball with friends. As a result, boredom can be filled with excitement of life gain from daily activities
Sugar addiction causes weight gain. Paces of obesity are rising worldwide and included sugar, particularly from sugar-improved refreshments, is believed to be one of the primary guilty parties. Sugar-improved beverages like soft drinks, juices and sweet teas are stacked with fructose, a kind of basic sugar. At the end of the day, sugary drinks don’t check your appetite, making it simple to rapidly expand a high number of fluid calories. This causes weight gain.
To overcome sugar addiction, you need to voluntarily carry out exercises. Day by day exercise gives your body an outlet for excess blood sugar. This doesn’t imply that you need to sign up for a gym membership and sweat till you drop. For instance, taking a walk, extending at your work area, and playing outside with your children would all be able to be included.
The addiction of sugar also increases the risk of heart disease. High-sugar diets have been related with an expanded danger of numerous illnesses, including heart illness, the main source of death around the world Proof recommends that high-sugar diets can prompt obesity, aggravation and high triglyceride, glucose and blood pressure levels — all hazard factors for heart illness.
It is important to realize that there is a difference between craving and hunger. In the event that you get a sugar craving while hungry, perhaps the best thing is to eat a balanced dinner right away. Stock your kitchen with healthy snacks or premade suppers. Foods that are rich in protein such as meat, fish and eggs are good for curbing hunger and indirectly sugar cravings as well.
Physical effect is one of the effects of the drug addiction which includes heart attack, irregular heartbeat, respiratory problems, lung cancer, kidney damage, brain damage, liver problem and stroke. The effect of drug addiction can be far-reaching as almost every organ of the human body can be affected by excessive usage of drugs. Immune system of drug addicts will be weakened and this could lead to an increase in risk of infection and illness.
Detoxification is usually the first step in treatment to overcome drug addiction. Detoxification is the process of clearing the drugs from the body and manages the withdrawal symptoms. In most of the cases, there are three steps involved in detoxification which are evaluation, stabilization and preparing entry into treatment.
Drug abuse not only causes negative impact on your physical health but also may have legal consequences. The drug addicts may have to deal with the rest of their life with the legal consequences. In Malaysia, drug abuse is seen as a serious offence that is governed by the Dangerous Drugs Act 1952. The highest punishment for the offence is capital punishment which is the mandatory sentence of death by hanging. Punishments for lighter offences include imprisonment, rehabilitation to fines.
Inpatient Rehab Program is also a choice of treatment for drug addiction. Inpatient Rehab is a residential treatment centre for the patient to get their intensive treatment that usually last for 30 days. Most of the inpatient centre offer family programs that give opportunities to the patients to rebuild trust with their family members and family members can always help to encourage and motivate the patient to involve actively in their recovery.
Conclusion
We have discussed three types of addiction which are addictions to games, sugar and drugs and the two main points we discuss on addiction to games are causes and ways to overcome while on the topic of addiction to sugar and drugs we have discussed about the effect and ways to overcome.
Don’t worry about hard times because some of the most beautiful things we have in life come from changes or mistakes. It’s never too late for a new beginning in your life. Life is too short to waste, so appreciate your life. Lasty, think before you act.
A mental health disorder characterised by persistently depressed mood or loss of interest in activities, causing significant impairment in daily life. Possible causes include a combination of biological, psychological and social sources of distress. Increasingly, research suggests that these factors may cause changes in brain function, including altered activity of certain neural circuits in the brain. The persistent feeling of sadness or loss of interest that characterises major depression can lead to a range of behavioural and physical symptoms. It is generally treatable by a medical professional usually by medication, talk therapy, or a combination of the two.
According to the DSM-5 Manual, published in the May of 2013, there are 8 specific disorders described, including Disruptive Mood Dysregulation Disorder (DMDD), Major Depressive Disorder (MDD) – included Major Depressive Episode (MDE), Persistent Depressive Disorder (PDD), Premenstrual Dysphoric Disorder (PMDD), Substance/Medication-Induced Depressive Disorder, Depressive Disorder due to another medical condition, Other Specified Depressive Disorder, and Unspecified Depressive Disorder:
Disruptive Mood Dysregulation Disorder (DMDD). Disruptive mood dysregulation disorder (DMDD) is a mental disorder in children and adolescents characterized by a persistently irritable or angry mood and frequent temper outbursts that are disproportionate to the situation and significantly more severe than the typical reaction of same-aged peers. DMDD symptoms typically begin before the age of 10, but the diagnosis is not given to children under 6 or adolescents over 18. To be diagnosed with DMDD, a child must have these symptoms steadily for 12 or more months. A child with DMDD experiences: Irritable or angry mood most of the day (nearly every day), Severe temper outbursts (verbal or behavioural) at an average of three or more times per week that are out of keeping with the situation and the child’s developmental level, Trouble functioning due to irritability in more than one place (e.g., home, school, with peers).
Major Depressive Disorder (MDD). Clinical depression is marked by a depressed mood most of the day, sometimes particularly in the morning, and a loss of interest in normal activities and relationships — symptoms that are present every day for at least 2 weeks. In addition, according to the DSM-5 there are other symptoms with major depression. Those symptoms might include: fatigue or loss of energy almost every day, feelings of worthlessness or guilt almost every day, Impaired concentration, indecisiveness, insomnia or hypersomnia (excessive sleeping) almost every day, markedly diminished interest or pleasure in almost all activities nearly every day (called anhedonia, this symptom can be indicated by reports from significant others), restlessness or feeling slowed down, recurring thoughts of death or suicide, significant weight loss or gain (a change of more than 5% of body weight in a month). Major depression affects about 6.7% of the U.S. population over age 18, according to the National Institute of Mental Health. Overall, between 20% and 25% of adults may suffer an episode of major depression at some point during their lifetime. Major depression also affects older adults, teens, and children, but frequently goes undiagnosed and untreated in these populations. Almost twice as many women as men have major or clinical depression; hormonal changes during puberty, menstruation, pregnancy, miscarriage, and menopause, may increase the risk.
Persistent Depressive Disorder (PDD). The essential feature of dysthymia is a depressed mood that occurs for most of the day, for more days than not, for at least two years for adults or one year for children and adolescents. Symptoms of dysthymia can come and go over time, and the intensity of the symptoms can change, but symptoms generally don’t disappear for more than two months at a time. Symptoms include: poor appetite or overeating, loss of interest in daily activities, insomnia or hypersomnia, low energy or fatigue, low self-esteem, self-criticism, or feeling incapable, poor concentration or difficulty making decisions, feelings of hopelessness, decreased activity and/or productivity, social isolation, irritability or anger, sadness or feeling down, feelings of guilt. In children, depressed mood and irritability are often primary symptoms.
Premenstrual dysphoric disorder (PMDD). Premenstrual dysphoric disorder (PMDD) is a much more severe form of premenstrual syndrome (PMS). It may affect women of childbearing age. It’s a severe and chronic medical condition that needs attention and treatment. Symptoms of PMDD appear during the week before menstruation and end within a few days after your period starts. Over the course of a year, during most menstrual cycles, 5 or more of the following symptoms must be present: depressed mood, anger or irritability, trouble concentrating, lack of interest in activities once enjoyed, moodiness, increased appetite, insomnia or the need for more sleep, feeling overwhelmed or out of control, other physical symptoms, the most common being belly bloating, breast tenderness, and headache.
Substance/medication-induced Depressive Disorder. Substance/medication-induced depressive disorder is characterised by a prominent and persistent change in mood, exhibiting clear signs of depression or a marked decrease in interest or pleasure in daily activities and hobbies, and these symptoms start during or soon after a certain substance/medication has been taken, or during withdrawal from the substance/medication. The individual’s mental health history, as well as the nature of the substance/medication taken must be taken into account, to ensure that the depressive symptoms cannot be better explained by a different diagnosis. The symptoms of the depressive disorder must also be severe enough to cause impairment in the day to day functionality of the individual. Withdrawal times for various substances from the body vary, and so the depressive symptoms may continue for some time after the individual has ceased taking the substance/medication.
Symptoms of Depression (DSM-5):
The DSM-5 outlines the following criterion to make a diagnosis of depression. The individual must be experiencing five or more symptoms during the same 2-week period and at least one of the symptoms should be either (1) depressed mood or (2) loss of interest or pleasure:
Depressed mood most of the day, nearly every day.
Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.
A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down).
Fatigue or loss of energy nearly every day.
Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
Diminished ability to think or concentrate, or indecisiveness, nearly every day.
Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
To receive a diagnosis of depression, these symptoms must cause the individual clinically significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms must also not be a result of substance abuse or another medical condition.
Aaron Beck’s Theory of Depression
Different cognitive behavioural theorists have developed their own unique twist on the cognitive way of thinking. According to Dr. Aaron Beck, negative thoughts, generated by dysfunctional beliefs, are typically the primary cause of depressive symptoms. A direct relationship occurs between the amount and severity of someone’s negative thoughts and the severity of their depressive symptoms. In other words, the more negative thoughts they experience, the more depressed they will become. Beck also believes that there are three main dysfunctional belief themes (or ‘schemas’) that dominate a person with depression’s thinking: 1) I am defective or inadequate; 2) All of my experiences result in defeats or failures; 3) The future is hopeless. Together, these three themes are described as the negative Cognitive Triad. When these beliefs are present in someone’s thoughts, depression is very likely to occur (if it has not already occurred).
An example of the themes will help illustrate how the process of becoming depressed works. For example, a person has just been laid off from their work. If they are not in the grip of the negative cognitive triad, they might think that this event, while unfortunate, has more to do with the economic position of their employer than their own work performance. It might not occur to them at all to doubt themselves, or to think that this event means that they are washed up and might as well throw themselves down a well. But, if the person’s thinking process was dominated by the Negative Cognitive Triad, however, they would very likely conclude that their layoff was due to a personal failure. They would also believe that they will always lose any job they might manage to get and that their situation is hopeless. On the basis of these judgments, they will begin to feel depressed. In contrast, if they were not influenced by negative triad beliefs, they would not question their self-worth too much, and might respond to the lay off by dusting off their resume and starting a job search.
Beyond the negative content of dysfunctional thoughts, these beliefs can also warp and shape the attention a person focuses on certain events or thoughts. Beck stated that people with depression pay selective attention to aspects of their environments that confirm what they already know. They do so even when evidence to the contrary is right in front of them. This failure to pay attention properly is known as Faulty Information Processing.
Particular failures of information processing are very characteristic of the depressed mind. For example, people with depression will tend to pay attention to information which matches their negative expectations and ignore information that goes against those expectations. Faced with a mostly positive performance review, people with depression will manage to find and focus in on the one negative comment that keeps the review from being perfect. They tend to magnify the importance and meaning placed on negative events, and minimize the importance and meaning of positive events. All of these issues, which happen quite unconsciously, function to help maintain core negative themes in the face of evidence that goes against them. This allows them to remain feeling hopeless about the future even when the evidence suggests that things will get better.
Research on Depression
Depression and Sleep
Of all the psychiatric disorders associated with insomnia, depression is the most common. It has been estimated that 90% of patients with depression complain about sleep quality. Since the first reports of short rapid eye movement (REM) latency in depressed patients and of the effect of sleep deprivation on depression in the 1970s, numerous sleep studies have provided extensive observations and theoretical hypotheses concerning the etiology and pathophysiology of depression.
Depression and Type 2 Diabetes Over the Lifespan
A meta-analysis Depression is associated with a 60% increased risk of type 2 diabetes. Type 2 diabetes is associated with only modest increased risk of depression.
Social Media Use and Depression
Social Media use was significantly associated with increased depression among a population of young adults. Given the proliferation of Social Media, identifying the mechanisms and direction of this association is critical for informing interventions that address Social Media use and depression.
Depression and cooking with Biomass:
Cooking with biomass fuel, a common practice in rural India, is associated with a high level of indoor air pollution (IAP). Women who cook with biomass had higher prevalence of depression than users of cleaner fuel LPG. Platelets of biomass users expressed more P-selectin and released more serotonin, implying platelet activation. Depression in biomass users was intimately associated with indoor levels of PM10 and PM2.5 and platelet hyperactivity. Indoor air pollution due to cooking with biomass is a potential risk for depression in women in their child-bearing age.
Depression in Adolescents
Unipolar depressive disorder in adolescence is common worldwide but often unrecognised. The incidence, notably in girls, rises sharply after puberty and, by the end of adolescence, the 1year prevalence rate exceeds 4%. The burden is highest in low-income and middle-income countries. Depression is associated with substantial present and future morbidity, and heightens suicide risk. The strongest risk factors for depression in adolescents are a family history of depression and exposure to psychosocial stress.
Depression and HIV
Depression is one of the most prevalent psychiatric diagnoses seen in HIV-positive individuals. Women with HIV are about four times more likely to be depressed than those who are not infected. Among 137 HIV-positive women, 51.1% were depressed. Around 16% were having moderate to high risk for isolation. Depression was statistically significant in rural women, widowed women, and lower socioeconomic class women. Conclusion. Depression is highly prevalent among women living with HIV which is still underdiagnosed and undertreated, and there is a need to incorporate mental health services as an integral component of HIV care.
References
Depression Strikes: Symptoms and Treatments of Depression Strikes. (2016, March 17). Retrieved November 03, 2020, from https://www.apollohospitals.com/patient-care/health-and-lifestyle/diseases-and-conditions/depression-strikes
Nemade, R. (n.d.). Gulf Bend MHMR Center. Retrieved November 03, 2020, from https://www.gulfbend.org/poc/view_doc.php?type=doc
Kupfer, D. J. (2016, November 10). Depression and the new DSM-5 classification. Retrieved November 04, 2020, from https://www.medicographia.com/2015/06/depression-and-the-new-dsm-5-classification/
Premenstrual Dysphoric Disorder (PMDD). (n.d.). Retrieved November 04, 2020, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/premenstrual-dysphoric-disorder-pmdd
Truschel, J. (2020, September 25). Depression Definition and DSM-5 Diagnostic Criteria. Retrieved November 03, 2020, from https://www.psycom.net/depression-definition-dsm-5-diagnostic-criteria/
Bhandari, S. (2020, September 13). Major Depression (Clinical Depression) Symptoms, Treatments, and More. Retrieved November 05, 2020, from https://www.webmd.com/depression/guide/major-depression
Disruptive Mood Dysregulation Disorder. (2013). Retrieved November 05, 2020, from https://www.nimh.nih.gov/health/topics/disruptive-mood-dysregulation-disorder-dmdd/disruptive-mood-dysregulation-disorder.shtml
Hurley Katie Hurley, K. (2020, September 25). Persistent Depressive Disorder (Dysthymia) Symptoms Guide. Retrieved November 03, 2020, from https://www.psycom.net/depression.central.dysthymia.html
Depressive Disorders: Substance/medication-induced depressive disorder. (n.d.). Retrieved November 03, 2020, from http://www.safmh.org/wp-content/uploads/2020/09/Depressive-disorders-Substance-medication-induced-depressive-disorder.pdf
Tsuno, N., Besset, A., & Ritchie, K. (2005, October 14). Sleep and Depression. Retrieved November 05, 2020, from https://www.psychiatrist.com/JCP/article/Pages/sleep-depression.aspx
Mezuk, B., Eaton, W., Albrecht, S., & Golden, S. (2008, December 01). Depression and Type 2 Diabetes Over the Lifespan. Retrieved November 05, 2020, from https://care.diabetesjournals.org/content/31/12/2383
Lin, L., Sidani, J., Shensa, A., Radovic, A., Miller, E., Colditz, J., . . . Primack, B. (2016, January 19). ASSOCIATION BETWEEN SOCIAL MEDIA USE AND DEPRESSION AMONG U.S. YOUNG ADULTS. Retrieved November 05, 2020, from https://onlinelibrary.wiley.com/doi/abs/10.1002/da.22466
Banerjee, M., Siddique, S., Dutta, A., Mukherjee, B., & Ray, M. (2012, April 19). Cooking with biomass increases the risk of depression in pre-menopausal women in India. Retrieved November 05, 2020, from https://www.sciencedirect.com/science/article/abs/pii/S0277953612002869
Thapar, A., Collishaw, S., Pine, D., & Thapar, A. (2012, March 17). Depression in adolescence. Retrieved November 05, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3488279/
Unnikrishnan, B., Jagannath, V., Ramapuram, J., Achappa, B., & Madi, D. (2012, June 21). Study of Depression and Its Associated Factors among Women Living with HIV/AIDS in Coastal South India. Retrieved November 05, 2020, from https://www.hindawi.com/journals/isrn/2012/684972/
Analysis of behavioural response to substance is a critical point of discussion when formulating a assertion around addiction/substance use disorders. The diagnosis manual, referred to in psychiatry is used to define the different psychiatric diagnoses that are presented within societal groups which is commonly known as the DSM. Advances in neuroscience identified addiction as a chronic brain disease alluding to strong genetic, neurodevelopmental and social components that offer a debate towards classification of a personal lifestyle choice or a biological vulnerability. This discussion will explore the history of drug abuse and addiction, societal’s response, epidemiology, neuroplasticity of dopamine circuits, brain-behaviour relationships and new approached to treatment and prevention.
Substance abuse or substance dependance are terms previously used in the DSM-4 to define a diagnosis of substance use disorder, however numerous iteration have been made to redefine and clarify a diagnosis between the DSM-4 and DSM-5. The key differential feature between these two diagnoses are physiological symptoms of tolerance and withdrawals. The change from DSM-4 to DSM-5 was significant as the DSM-5 deemphasised the physiologic pieces attached to this disorder allowing the DSM-5 to define and incorporate behavioural components as its core attribute. Through reconceptualising addiction as a chronically relapsing mental illness, it allows for a deeper analysis of potential heritability rates, compliance of treatments and treatment response for patients suffering with a substance abuse diagnosis. This triggers a response to the relegated stigmas attached to this disorder.
Neuroplasticity is heavily classified in relation to defining addiction as a disease. Results of extensive research into addiction it has draw conclusions towards substances that the brain hold traumatic memories that manifest itself by reflex activation brain circuits primarily involving the reward system. This manifestation results in motivation to return to a substance consumption behaviours when triggers or cues are encountered. Using a substance that activates the reward system produces the potential for the development of addiction while vulnerability to a substance use disorder is influenced by complex genetic and environmental factors.
Neuroplasticity can be seen in tolerance to the substance, manifesting through reduced effects from exposed dosage and the physical dependance presented through withdrawal symptoms. Another significant form for neuroplasticity can be seen in compulsive substance seeking behaviour. Brain imaging studies has provided clear evidence of the rapid activation through the increase of blood flow to the reward pathways when patients who are involved in remission are exposed to substance related stimuli. This is a result of the brain interpreting a craving and the reward system is activated. The level of craving of the substance is directly related to the level of endogenous dopamine released in the reward structures.
Individuals who are vulnerable to addiction and experience repetitive exposure to substance agents, can induce long-lasting neuroadaptive changes to the nervous system that promote drug seeking behaviours and can lead to persistent and uncontrollable patters of use that constitute addiction. The neuroadaptive changes form the foundation to tolerance, craving, withdrawal and can lead to a motivational shift which is driven by impulsivity and positive reward signals. Extensive research has been undertaken to assess the functionality of the orbitofrontal cortex within the brain in people with substance use disorder to understand the involvement in the inhibitory decision making process related to reward value and environmental stimuli. Dopamine plays a key role in the processing of reward-related stimuli with a strong association to drug use which allows for a further understanding of addiction and certain vulnerabilities to addiction. Traditionally, dopamine increases in response to natural rewards to food, water and sex in comparison to an artificial serve of dopamine which triggers an exaggerated reward.
Addicts and patients that surfer from substance use disorder have clinically shown to have reduced ability to inhibit impulses. This directly correlates with decreased activity in the frontal lobe of the brain. Patient who don’t suffer from this disorder can activate normal frontal lobe control mechanisms when triggered by a stimuli like sexual arousal however patients that struggle with SUD are unable to inhibit cravings when exposed to substance related stimuli. Frontal lobe activation is a intervention is used to condition patients to learn to activate inhibitory structures and inhibit specific substance cravings. This therapeutic cognitively introduces new learning to addictive behaviour. The continual study of neuroplasticity markers and mechanisms active in patients will correspond directly with new pharmacological and behaviour treatments towards prevention and subduing the growth of substance use disorders.
In the persecute to developing a comprehensive understand of addiction, debates have been conducted that conceptualise drug addiction as a chronic disease while others provide evidence of the role that choice has in addiction. A strong advocate of choice operating as the foundational block to the substance use disorder is Gene Heyman. Heyman’s “A disorder of choice (2009)” focuses on a range of relationships and descriptions that provide a central point for depicting normality and rational choice processes that lead to long-term outcomes like addiction. While Heyman acknowledges the genetic contributions he argues that genetic influence lacks a sound basis for concluding that drug abuse is a disease process which can be further challenged through related twin studies. A defining perspective discussed is the evidence showing that brain activity and neuronal functions appear differently in drug abusers and non-abusers which draws the conclusion that addiction is tied to changes in brains structure and function which defines it as a disease. This statement is challenged by Heyman as any persistent change in behaviour is directly associated with change in the central nervous system.
A complex theory was developed by Gary Becker and Kevin Murphy to categorise choice theory and define addiction as a rational economic choice. Becker and Murphy’s applied economic theory to the psychology of addiction and developed a model that hinged on the rationality of addictive behaviour and its similarity to consumers and the commodity of the consumption. This commodity is a representative of a substance for addicts and implies a cost/benefit analysis when consuming the substance. The rational theory invokes the significants of distress acting as a superficial trigger and pathway to using a substance as a benefit to reducing the emotional stress being felt by the user. Therefore, the user is balancing the complexities of the cost/benefit analysis and the considerations towards seeking treatment. As a result of the distress it can become a triggering event of the addiction but also the key component in maintaining the addiction. Becker and Murphy conceptualised the theory of addicts self medicating conditions like depression or anxiety and shaping a conscious choice to use a substance as a benefit of medicating to cope with feelings indicative of depression or other disorders. Both theories operate under the principle that addicts and people suffering with addictive disorders are making rational and logical choices towards their own addiction and using a cost/benefit analysis to determine an imbalance that may lead to prevention and treatment.
Treatments that attempt to reverse learnt behaviours exhibited in addiction can involve a variety of different interventions including Cognitive-Behavioural therapy (CBT). CBT in relation to substance use disorder has become progressively more relevant as a effective tool to combat and improve the mental health for the patient though behavioural and cognitive behavioural intervention. Strategies developed in CBT address both the association and operant consequence conditioning methods.
Traumatic experiences are a terrible thing for anyone experience. But they do happen to people. When these events transpire, it is possible that the victim of the incident will start showing symptoms of posttraumatic stress disorder (PTSD). The DSM-5 lets us know that some of the people who are most likely to be affected by PTSD are the “survivors of rape, military combat and captivity, and ethnically or politically motivated internment and genocide” (American Psychiatric Association, 2013). We hope that such horrible events would never happen to any of the students that we will work with. But we don’t live in a perfect world. These events, as well as an increasing amount of school shootings make knowing how the treatments for PSTD work are useful for us as school counselors.
The article ‘Embodied Simulation in Exposure-Based Therapies for Posttraumatic Stress Disorder – a Possible Integration of Cognitive Behavioral Theories, Neuroscience, and Psychoanalysis’ by Peri, Gofman, Shahar and Tuval-Mashiach (2015), that I read, was looking at how psychoanalytic concepts are currently being used in the cognitive behavioral therapy (CBT) interventions used in treating PTSD, and how CBT interventions could potentially be improved by embracing psychoanalytic concepts. The authors inform us that a common treatment of PTSD is the use of exposure-based therapies, but these therapies do not reflect upon how the interaction of the client and the therapist influences the therapy received. Two recently found concepts, the theory of embodied simulation (ES) and mirror-neuron system, are used to form the authors hypothesis “that during exposure to trauma memories, emotional responses of the patient are transferred to the therapist through ES and then mirrored back to the patient in a modulated way” (Peri et al., 2015).
I found this article to be very interesting. The authors are using recently discovered ideas to try and explain how the patient-therapist relationship has an effect CBT and how this relationship could potentially be used to better our current methods of PTSD interventions. I find it fascinating to learn about the possible reasoning that psychoanalytic theories work the way that they do. I also feel that it is important to not just understand how to do something, but why it works as well. This article seems to present reasoning for why psychoanalysis works as well as it does and how it can help improve other currently used therapies.
Another reason that I find the material in this article important is because learning how these therapies work can help you explain what a student who is going to get treatment will experience. A child who is suffering from PTSD might be scared before going to treatment. As a counselor, you should be able to help explain what it is and hopefully make it less scary for them to go to the first time. As school counsellors we will not be able to help treat every disorder that our students develop. That is why it is key for us to know what resources are available for them, and a broad idea of what the treatment is. The knowledge that we have can help our students understand what they are going to go do.
One part of the article that I was not fond of is that they state their hypothesis but they did not try to test it. The authors learned about embodied simulations and mirror-system neurons. They made their hypothesis about the potential relation between those two ideas and psychoanalytic therapy. And then brought their hypothesis about how these concepts relate in PTSD interventions to the scientific community. But they did not test their hypothesis in this article. They did bring up a potential way to test the hypothesis and I hope that they are able to test it so we can see how accurate their hypothesis is.
The authors of this article use recent discoveries in neuroscience to attempt to explain how psychoanalysis therapy works using the context of PTSD. I feel that they are on to something that is important to understand. But as of the time of the writing of the article, they had not been able to test their hypothesis. This is connected to our students because our students may potentially be diagnosed with PTSD and if they are, it is important to have a basis of what the treatments are so we can help inform the students and help alleviate some of the fear that they might face before starting the treatments.
Depression is a common experience among most people who must put up with the demands placed on them by work, family and the society. However, unlike mild depression which many people overcome without seeking medical intervention, Bream et al. (2) define severe depression as a potentially fatal condition, which is characterised by hopelessness, suicidal thoughts, negative ruminations, poor concentration, irritability and feelings of guilt. A person suffering severe depression hence loses the ability or willingness to enjoy life, and as a result, he or she may experience disruption in sexual functioning, appetite and sleeping patterns (2).
While there are other treatment methods used in the treatment of severe depression, Cognitive Behavioural Therapy (CBT) is one of the common approaches used in managing the condition. According to Bream et al. (2), CBT has not only demonstrated its equivalence or superiority to other depression treatments, it has also established its effectiveness in preventing depression relapse. To understand the role that CBT plays in managing severely depressed patients however, one must have a clear understanding of what exactly CBT is.
Bream et al. (2) state that CBT can be simply defined as a guide that helps the patient think positively. More comprehensively however, CBT is defined as a “therapeutic style, which includes the psychological formulation of a problem, a collaborative relationship between the patient and the therapist, and use of aids and techniques to help the patient attain positive thoughts”.
This form of goal-oriented therapy is used on the assumption that clinicians possess ideas and skills that enable them to intervene in the patient’s condition, hence helping the patient overcome the emotional difficulties accountable for his severely depressed state (2). Overall, according to Branch and Willson (1), CBT works on the idea that people’s thoughts affect their feelings and actions.
According to Bream et al. (2), the role of CBT in the management of depression is contained in the cognitive aspect of the therapy. The cognitive aspect works on the premise that a clinician can foster behaviour change in a patient through self-instructional training. The self-instructional training is meant to equip the patient with ways and means of pushing away negative thoughts, and reinforcing his or her emotions through helpful self-talk.
Through CBT, a severely depressed patient learns how to access the negative thoughts that occur automatically in his or her mind when faced by a specific situation. For example, a depressed patient suffering from albinism may always associate his skin colour with what other people think of him. However, he may not recognise his thoughts about albinism as the trigger for his negative thoughts until a clinician helps him to be aware of the same.
According to Bream et al. (2), severely depressed patients undergoing CBT also acquire cognitive skills, which enable them to become aware of, and differentiate various emotions that they may have at different situations. Some of the emotions prevalent in depressed patients include anger, sadness, anxiety and guilt. Becoming aware and differentiating the diverse emotions allow the clinician and patient to establish the cause of such emotions, and hence devise effective thought processes to counter the same.
Shannon (3) further notes that CBT makes room for clinician-patient interaction, whereby, the two get to discuss what leads to the emotions that the patient experiences, and how long those emotions last. This is done in order to establish the exact link between the patient’s thoughts, feelings and behaviours (2).
Branch and Willson (1) hold the opinion that often times, people (and in this case patients), know the practical and sensible approach to handle their emotional crisis. Notably however, these approaches are not always easy to enforce hence the need for CBT intervention. According to Branch and Willson (1), CBT maximises on a person’s common sense and helps him or her to deliberately adopt healthy, self-enhancing thoughts on a regular basis.
Defining the role that CBT plays in the management of severe depression cannot be comprehensive without acknowledging its educational nature. Unlike other treatment options available for severely depressed patients, CBT provides patients with a great deal of information, which is intended to help them “become their own therapists”.
According to Branch and Willson (1), CBT combines behavioural, scientific and philosophical aspects, which collectively provide patients with a comprehensive approach to overcoming their psychological problems. Using a scientific approach, the clinician educates the patient about treating their thoughts as theories or hypotheses rather than truths or facts. This enhances the patient’s ability to critically analyse his or her thoughts and rationally choosing how to behave.
The philosophical approach on the other hand, starts by educating patients on how to identify and recognise personal beliefs and values that shape the way they think and act. Through philosophical teachings contained in CBT, a patient learns how to develop flexible, non-extreme and self-helping beliefs (1).
This means that a patient who has undergone CBT is able to adapt to the reality more easily. In addition to emphasising the role that thoughts have on a patient’s behaviours, CBT also acknowledges that environmental factors have an effect on the feelings, thoughts and actions of a person.
Notably however, CBT clinicians are encouraged to take into consideration that a patient is not always in a position to change his or her environment (1). In such a case, the therapist should maintain that patients can still change their feelings and emotions in a specific environment (even though they may not be able to change the environment), by replacing unhelpful thoughts with positive ones.
The behavioural aspect of CBT is emphasised through teaching severely depressed patients of the need to change their behaviours. This is an active process that requires the patient to start by modifying his thoughts, then feelings, and finally his behaviours (1). If one is lethargic and anxious for example, the clinician using CBT will encourage him to take a step-by-step approach that will lead eventually enable him confront his worries.
CBT also train patients on effective ways of shifting their attention from events, people or situations that produce undesirable emotions. As such, Branch and Willson (1) posit that underlying motive for every clinician using CBT to manage severe depression should be informing patients that healthy thinking can enable them live happier and more productive lives.
Overall, the role of CBT in managing severely depressed patients can be summed up as the provision of a focused approach, which equips patients with the knowledge necessary to solve their behavioural and emotional problems.
For cognitive behavioural therapy to succeed however, the clinician and the patient need to work together in order to establish specific goals regarding the feelings and behaviours that the patient would like to have. This gives both the patient and the therapist specific targets to work towards. Ideally, CBT use should provide the patient with a lasting solution to the defeatist attitude that underpins depressive tendencies.
References
Branch R, Willson R. Cognitive behavioural therapy for dummies. 2nd ed. Chichester, UK: John Wiley & Sons; 2012. 344 p.
Bream V, Challacombe F, Palmer A, Salkovskis P. Cognitive behaviour therapy for obsessive-compulsive disorder. Oxford, UK: Oxford University Press; 2017. 285 p.
Shannon J. Anxiety survival guide for teens: CBT skills to overcome fear, worry, and panic (instant help solutions). Oakland, CA: New Harbinger; 2015. 208 p.