Does depression require hospitalization?

A study published in the current issue of Psychotherapy and Psychosomatics has analyzed the difference between day hospital and inpatient stay in depression. Depending on the severity of depression, patients may be treated at different levels of care with psychotherapy and/or antidepressant medication. While several previous studies compared the efficacy of different levels of care for psychotherapy of personality disorders, sufficient data is lacking for the comparison of day-clinic and inpatient psychotherapy for depression. The current pilot study evaluates the feasibility of randomization in a routine hospital setting and compares preliminary efficacy for day-clinic and inpatient psychotherapy for depression.

Of 144 incoming patients who met inclusion criteria, 44 patients agreed to participate. Of these, 97.7% had a major depressive episode, 1 patient was primarily diagnosed with dysthymia. Comorbid diagnoses included anxiety (45.5%), somatoform (13.6%), obsessive-compulsive (6.8%), and personality disorder (33.3%).
After the initial assessment, patients were randomized to either the day-clinic or inpatient setting and treated for 8 weeks with multimodal psychotherapy. The therapy unit combines inpatient and day-clinic treatment, therapeutic staff is the same for both treatment arms. Both groups received equal amounts of psychotherapeutic interventions. The psychopharmacological antidepressant treatment followed the German national treatment guidelines for depression. In order to be representative for routine clinical practice, no further specifications with regard to psychopharmacological medications were made for the study.
At admission, 22 patients (50%) were taking antidepressant medication. Within the completer sample, 11 patients (31.4%) had a change in antidepressant medication during treatment. Antidepressants were reduced or terminated for 6 patients (17.2%) and increased or started for 4 patients (11.4%). One patient had a change of drug class. At termination, 51.4% of completer patients were taking antidepressant medication. There were no differences between groups for change during therapy or medication at termination. Change of medication was not related to initial depression severity and beginning or increasing medication was not significantly related to symptom reduction.
Depression severity decreased from baseline to the 4-week follow-up. There were no differences between day-clinic and inpatient psychotherapy concerning change over time. In addition, response and remission rates are reported descriptively. Eight inpatients (50% of completers) and 6 day-clinic patients (35.3% of completers) were classified as responders. In both groups, 3 patients (16.7% of inpatients, 17.7% of day-clinic completers) reached remission.
These results may encourage the incorporation of a scientific evaluation in routine clinical settings. Also, the findings suggest that it may be beneficial to consider different levels of care for the treatment of severe depression. Finally, the results call for further research in larger samples in order to test for moderator effects. As inpatient psychotherapy is more expensive than day treatments, it will be crucial to find out who benefits more in each setting.

Source: http://www.sciencedaily.com/releases/2014/07/140706083943.htm

The kindest way to banish anxiety

melia Adams has suffered from anxiety since she was a teenager – a constant worry that can leave her light-headed, shaky and exhausted.
Now aged 22, she had her first panic attack at 17 and has spent years trying to overcome her overwhelming feelings.
Today, after two courses of cognitive behavioural therapy – the standard NHS treatment for anxiety – proved ineffective, Amelia is finally being helped by a new type of psychological intervention: compassion focused therapy (CFT).
Inspired by Buddhism, CFT was  conceived 30 years ago by Professor Paul Gilbert, a clinical psychologist for Derbyshire Health Care Foundation Trust. It is now being offered as a therapy option at a number of NHS hospitals.
Sessions can be either for individuals and last about 50 minutes, or be 90-minute group discussions.
‘It’s similar to CBT, which works by helping patients to consider their negative thoughts and come to more realistic alternative views,’ says Prof Gilbert.
‘But while CBT focuses on changing behaviour in a neutral, practical way – such as using timesheets to plan the day more productively –  in CFT the focus is more on being kind to yourself.’
Sessions have three elements: encouraging patients to do activities or make changes that are kind to themselves, such as writing to a friend; helping them focus on seeing the good in other people and their own lives rather than the negative aspects; and getting the patient  to speak out loud to themselves in a kind, warm tone.
‘Our brains naturally focus on the negative,’ says Prof Gilbert. ‘For example, if we go shopping and in nine shops the assistants are extremely helpful but in one shop the assistant is very rude, we focus on the latter and lose sight of the positive experiences.

‘Deliberately training our attention to notice kindness in others can be very helpful, which CFT does.’
Through tackling the self-criticism and replacing it with kindness, patients then judge themselves and their lives less harshly and therefore feel happier.
‘By helping people feel compassion, we believe you can create  a positive physiological change in your body – just like imagining a delicious dinner will stimulate saliva and appetite,’ continues Prof Gilbert. ‘CBT is primarily focused on thinking and behaviour change but CFT looks at the emotion behind people’s thoughts.’

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Kind words: In compassion focused therapy (CFT) the focus is on being kind to yourself and encouraging positivity

CFT therapist Chris Irons adds: ‘It is a relatively new therapy but we are working hard to show that this approach has something important to offer.
‘So far there has been one successful randomised control trial of CFT which found a reduction in symptoms in patients with depression.’ Up to 30 per cent of the population suffers anxiety at any one time.  Last month a report from the  Office for National Statistics said young women are more anxious than young men, while growing numbers of middle-aged women  are suffering chronic anxiety – females aged over 60 are the most likely group to need hospital treatment for the condition.
‘My anxiety started on a night  out with friends when we were on holiday in Greece,’ says Amelia, a personal assistant from Surrey.
‘I felt suddenly overwhelmed by panic and I ended up walking back to our apartment alone and then  was up all night in absolute bits trying to calm myself down.
‘I ended up getting in the shower every hour to cool down and I had no one to speak to, which made it ten times worse.
‘It was so terrifying I flew home early from the holiday, and afterwards I was always really nervous that I’d have another panic attack somewhere far from home with nobody there to comfort me.’
Following that trip, Amelia’s attacks became regular, happening once or twice a month. They lasted about ten minutes each time and left her upset and exhausted. Her GP referred her for two courses of CBT, but the anxiety persisted.
‘It sounds silly, but I couldn’t stop worrying about my cat during the day – thoughts about her getting run over. Whatever the trigger, I feel light-headed and shaky, my stomach churns and for a moment it’s a bit like I’m having a panic attack. It’s really upsetting.’
Amelia heard about CFT through her volunteer work at a mental health charity and, hoping to eliminate her anxiety, she booked a course of six sessions with a private therapist.
Amelia says: ‘CBT had helped with my generalised anxiety but I preferred CFT because it involved more talking and delving into things like my childhood. I’m usually quite hard on myself so it’s taught me to be kinder, which has really helped.
‘Now when I’m on my own and start to feel panic, I am more gentle on myself, so instead of panicking  I sort of talk myself round with comfort. I now know that the anxiety I feel is not my fault. For the first time in years I have found a way to calm down rather than wind myself up still further.’

Source: http://www.dailymail.co.uk/health/article-2619470/The-kindest-way-banish-anxiety-Compassion-Focused-Therapy-help-conquer-crippling-worries-teaching-sufferers-nice-themselves.html

Do I have an anxiety or depression disorder?

So just to start, I'm generally a fairly happy person, or at least try to be. I'm a full time college student and have a handful of good friends. Almost everyone I really know thinks of me as someone with a lot of confidence and a positive attitude. They see me as very strong and together, but I don't really feel that way about myself. Though I try, in a lot of ways I'm just very terrified of everything. I always feel like I'm going to be rejected.. like I'm never going to be successful at the things I really want in life.. like a career or a relationship.

Even though I'm good at hiding it, I'm often very nervous when talking to people I'm unfamiliar with. Half of the time I don't even know what to say and just feel awkward. I can do one on ones.. but talking in front of a group or something, even just to introduce myself is terrifying. It's like I'm constantly nervous or worried.. and it's been getting worse. I feel like I'm always going to say or do something stupid..

On top of that, I have all these things I want to do in life.. all this passion.. I love art and creating things, and writing.. but have absolutely no self confidence about any of it even when my work is praised. For instance.. last quarter our class had to write and send an article to the editor of our newspaper. I wrote something on a current political issue that was going on at the time, and it was the only one to be published. I honestly thought it sucked and was embarrassed to even send it in. That's just an example, but I'm ALWAYS very harsh on myself to the point where I almost see no reason to proceed with the things I'm supposedly good at.

I have good days and bad days.. but sometimes my motivation level is so low and I feel so empty that I'd like to just isolate myself from everyone and everything. I don't know if I have a mental illness or something.. but I wanted to get someones take on this...

I grew up in a very bad household with an abusive drunken father who beat my mother in front of me for the first 6 or 7 years of my life. and then grew up with an alcoholic and completely unstable mother who blamed me for all of her problems. On top of it I'm physically "disabled".. so that doesn't exactly help matters. I can't help but wonder if that has a lot to do with my issues..

These days I just feel lonely most of the time.. yet in some ways I almost feel like that's the way I prefer to be, if that makes sense at all.

Anyway, I'm not sure if I described my feelings well enough or not. I guess if I had to break it down into a few sentences.. it feels like I always have this sinking feeling in the pit of my stomach. I almost never feel comfortable in my surroundings.. almost like a paranoia.. and it makes it so I feel like I can never really be happy.
Source: http://answers.yahoo.com/question/index?qid=20140206000640AAuyzaI

Therapy for Anxiety

 Therapy for Anxiety

Anxiety is one of the most common reasons people seek therapy. Anxiety is defined as nervousness and an inability to relax. Some level of anxiety is normal in human beings; however, excessive anxiety can interfere with relationships, sleeping patterns, eating habits, work, school, and all areas of life. Anxiety can take several forms, including phobias, obsessive-compulsions, and panic attacks, and it is often associated with depression. Anxiety is often found in people with psychotic symptoms, especially those who are paranoid. Excessive anxiety can also be a symptom of posttraumatic stress.

Therapy for Anxiety
Anxiety is a normal response to human experience and survival. Not unlike the fight, flight, or hide response, humans need anxiety in order to act and to protect themselves from suffering. Because anxiety is normal, most people experience anxiety at some points in their life, however limited or mild. Yet, many people experience a heightened and uncomfortable level of anxiety causing one to seek treatment. Rather than medicating the anxiety away as a permanent solution, the psychotherapy process approaches a person's anxiety with intense curiosity in an effort to help the person to understand and heal the source of the anxiety. Through the process of focusing internally a person can understand, unravel, and transform their anxiety.

Sometimes anxiety is the result of an inner polarization. Sometimes anxiety is the result of unresolved trauma leaving the individual in a heightened physiological state of arousal in which certain experiences have the potential to reactivate the old trauma, as is often the case with Post-Traumatic Stress. Sometimes anxiety results from a lack of, or inexperience at, knowing how to self-sooth. And there are other psychological and emotional reasons for anxiety. Whatever the cause, anxiety can be reduced if not resolved completely with therapy. Indeed, anxiety may be hereditary to some degree, in that some people may be more predisposed than others to develop anxiety in response to life events. Whether one is predisposed to anxiety or not, there is nonetheless a great benefit in addressing anxiety with therapy.

Anxiety and the Body
People with anxiety may experience physical symptoms including:

• Psychomotor agitation
• Pacing
• Shaking
• Trembling
• Quivering
• Sweaty palms
• Racing heartbeat
• Insomnia
• Tension
• Headaches
• Nausea
• Difficulty breathing

A panic attack occurs when these somatic symptoms are severe and acute, sometimes mimicking the symptoms of a heart attack (though there is no record of panic attacks leading to actual coronary arrest).

Anxiety and the Mind
Anxiety can include racing thoughts, worries, excessive guilt, excessively fearful thoughts, obsessions, and magical thinking. Anxiety is a dysphoric excitement or “apprehensive expectation” (DSM-IV), and may entail feelings of fear, confusion, frustration, and possibly shame and despair. Affect is worried and tense.

Anxiety and Social Life
People who are anxious may display social avoidance, nervousness, neediness, blaming, and an inability to maintain relations or employment. Some people with anxiety can develop social phobia and agoraphobia, in which they experience intense anxiety in public and isolate from others in order to maintain a stable mood.

Medication for Anxiety
The medical model approach to the understanding and treatment of anxiety views anxiety as a disease or disorder of the nervous system. The most popular medical treatment for anxiety is psychotropic medication, such as Celexa, Lexapro, Luvox, Paxil, Prozac, and Zoloft. These medications are helpful, and sometimes absolutely lifesaving for those who are paralyzed with anxiety or suffering intense panic. However useful these medications may be at symptom reduction, they fail to address the emotional and psychological causes of anxiety, which more often than not, play a powerful role in the formation and maintenance of anxiety.

Using Alcohol to Numb Anxiety - Case Example
Hillary, 23, experiences severe panic attacks whenever she is afraid she has failed or done something to anger a family member or coworker. Whenever she receives criticism, she begins to have trouble breathing, becomes sweaty, and may break out in hives. Her mind becomes completely focused on the offense she has committed, and she may cry, though she suppresses the tears and prevents catharsis. She drinks large quantities of alcohol to help numb herself to these feelings, and may miss work for days, which furthers her anxiety, as she has little income.

Social Anxiety – Case Example
Benji, 45, is popular at work and very competent, feels highly anxious whenever he is out in public, especially around crowds. He races home each night, locks his door, and reads in bed, feeling fine once he is alone with the apartment secure. He cannot identify the cause of his anxiety, but in therapy discovers a great deal of repressed anger, which may explain his fear of being in public--people trigger his rage, which he has avoided for years.

“People Pleasing” Anxiety – Case Example
Anna, 26, comes to therapy because of intense anxiety. Anna has not experienced a panic attack, but is often on edge, worried, stressed, and has a difficult time sleeping through the night. In therapy, Anna discovers that although a part of her wants to marry her fiancé, Jeff, another part of herself, which she has suppressed, is not in love with him. Identifying this internal conflict temporarily intensifies Anna's anxiety because now she has to face something she hasn't wanted face. Historically Anna has been a people pleaser. It's difficult for her to say "no" for fear of hurting other's feelings and then feeling her own guilt. Anna gains awareness about this and, through the process of unburdening her long-harbored guilt, Anna feels less anxiety others to feel pain. Although Anna hasn't yet decided what she's going to do about getting married, she feels less anxiety now that she is no longer suppressing her ambivalence and feels greater confidence about communicating how she really feels.

Share Your Story About Anxiety
Would you like to share your personal story about anxiety with others who may have had similar experiences? You are invited to write about your experiences with anxiety and submit your story to GoodTherapy.org's Share Your Story. Selected stories will be published live on The Good Therapy Blog.

Resource:  http://www.goodtherapy.org/therapy-for-anxiety.html#Therapy%20for%20Anxiety