Therapy for Depression

Everyone feels sad or “blue” on occasion. It is also perfectly normal to grieve over upsetting life experiences, such as a major illness, a death in the family, a loss of a job or a divorce. But, for most people, these feelings of grief and sadness tend to lessen with the passing of time.

However, if a person’s feelings of sadness last for two weeks or longer, and if they interfere with daily life activities, something more serious than “feeling blue” may be going on.

Depressed individuals tend to feel helpless and hopeless and to blame themselves for having these feelings. People who are depressed may become and exhausted and may stop participating in their routine activities. They may withdraw from family and friends. Some may even have thoughts of death or suicide.

There is no single answer to the cause of depression. Some depression is caused by changes in the body’s chemistry that influence mood and thought processes. Biological factors can also cause depression. In other cases, depression is a sign that certain mental and emotional aspects of a person’s life are out of balance. For example, significant life transitions and life stresses, such as the death of a loved one, can bring about a depressive episode.

Depression is highly treatable, and it is critical for people who suspect that they or a family member may be suffering from depression seek care immediately. Simply put, people with depression who do not seek help suffer needlessly. Unexpressed feelings and concerns accompanied by a sense of isolation can worsen a depression; therefore, the importance of getting appropriate help cannot be overemphasized.

Our therapists can help you recover from depression and to identify the factors that contribute to their depression and to deal effectively with the psychological, behavioral, interpersonal and situational causes. We can work with you to:

Pinpoint the life problems that contribute to their depression and help them understand which aspects of those problems they may be able to solve or improve.
Help you to identify options for the future and set realistic goals that enable them to enhance their mental and emotional well-being. Therapists also help individuals identify how they have successfully dealt with similar feelings if they have been depressed in the past.
Identify negative or distorted thinking patterns that contribute to feelings of hopelessness and helplessness that accompany depression.
Explore other learned thoughts and behaviors that create problems and contribute to depression by helping you to understand and improve patterns of interacting with other people that contribute to their depression.
Help people regain a sense of control and pleasure in life
Psychotherapy helps people see choices as well as gradually incorporate enjoyable, fulfilling activities back into their lives.

Having one episode of depression greatly increases the risk of having another episode. There is some evidence that ongoing psychotherapy may lessen the chance of future episodes or reduce their intensity. Through therapy, people can learn skills to avoid unnecessary suffering from later bouts of depression.

ADHD/ADD

Attention-deficit/hyperactivity disorder (ADHD) is a brain disorder marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.

Inattention means a person wanders off task, lacks persistence, has difficulty sustaining focus, and is disorganized; and these problems are not due to defiance or lack of comprehension.
Hyperactivity means a person seems to move about constantly, including in situations in which it is not appropriate; or excessively fidgets, taps, or talks. In adults, it may be extreme restlessness or wearing others out with constant activity.
Impulsivity means a person makes hasty actions that occur in the moment without first thinking about them and that may have high potential for harm; or a desire for immediate rewards or inability to delay gratification. An impulsive person may be socially intrusive and excessively interrupt others or make important decisions without considering the long-term consequences.

Signs and Symptoms

Inattention and hyperactivity/impulsivity are the key behaviors of ADHD. Some people with ADHD only have problems with one of the behaviors, while others have both inattention and hyperactivity-impulsivity. Most children have the combined type of ADHD.

In preschool, the most common ADHD symptom is hyperactivity. It is normal to have some inattention, unfocused motor activity and impulsivity, but for people with ADHD, these behaviors:

are more severe
occur more often
interfere with or reduce the quality of how they functions socially, at school, or in a job

Inattention

People with symptoms of inattention may often:

Overlook or miss details, make careless mistakes in schoolwork, at work, or during other activities
Have problems sustaining attention in tasks or play, including conversations, lectures, or lengthy reading
Not seem to listen when spoken to directly
Not follow through on instructions and fail to finish schoolwork, chores, or duties in the workplace or start tasks but quickly lose focus and get easily sidetracked
Have problems organizing tasks and activities, such as what to do in sequence, keeping materials and belongings in order, having messy work and poor time management, and failing to meet deadlines
Avoid or dislike tasks that require sustained mental effort, such as schoolwork or homework, or for teens and older adults, preparing reports, completing forms or reviewing lengthy papers
Lose things necessary for tasks or activities, such as school supplies, pencils, books, tools, wallets, keys, paperwork, eyeglasses, and cell phones
Be easily distracted by unrelated thoughts or stimuli
Be forgetful in daily activities, such as chores, errands, returning calls, and keeping appointments

Hyperactivity-Impulsivity

People with symptoms of hyperactivity-impulsivity may often:

Fidget and squirm in their seats
Leave their seats in situations when staying seated is expected, such as in the classroom or in the office
Run or dash around or climb in situations where it is inappropriate or, in teens and adults, often feel restless
Be unable to play or engage in hobbies quietly
Be constantly in motion or “on the go,” or act as if “driven by a motor”
Talk nonstop
Blurt out an answer before a question has been completed, finish other people’s sentences, or speak without waiting for a turn in conversation
Have trouble waiting his or her turn
Interrupt or intrude on others, for example in conversations, games, or activities

Diagnosis of ADHD requires a comprehensive evaluation by a licensed clinician, such as a pediatrician, psychologist, or psychiatrist with expertise in ADHD. For a person to receive a diagnosis of ADHD, the symptoms of inattention and/or hyperactivity-impulsivity must be chronic or long-lasting, impair the person’s functioning, and cause the person to fall behind normal development for his or her age. The doctor will also ensure that any ADHD symptoms are not due to another medical or psychiatric condition. Most children with ADHD receive a diagnosis during the elementary school years. For an adolescent or adult to receive a diagnosis of ADHD, the symptoms need to have been present prior to age 12.

ADHD symptoms can appear as early as between the ages of 3 and 6 and can continue through adolescence and adulthood. Symptoms of ADHD can be mistaken for emotional or disciplinary problems or missed entirely in quiet, well-behaved children, leading to a delay in diagnosis. Adults with undiagnosed ADHD may have a history of poor academic performance, problems at work, or difficult or failed relationships.

ADHD symptoms can change over time as a person ages. In young children with ADHD, hyperactivity-impulsivity is the most predominant symptom. As a child reaches elementary school, the symptom of inattention may become more prominent and cause the child to struggle academically. In adolescence, hyperactivity seems to lessen and may show more often as feelings of restlessness or fidgeting, but inattention and impulsivity may remain. Many adolescents with ADHD also struggle with relationships and antisocial behaviors. Inattention, restlessness, and impulsivity tend to persist into adulthood.

Risk Factors

Scientists are not sure what causes ADHD. Like many other illnesses, a number of factors can contribute to ADHD, such as:

Genes
Cigarette smoking, alcohol use, or drug
Exposure to environmental toxins during pregnancy
Exposure to environmental toxins, such as high levels of lead, at a young age
Low birth weight
Brain injuries

ADHD is more common in males than females, and females with ADHD are more likely to have problems primarily with inattention. Other conditions, such as learning disabilities, anxiety disorder, conduct disorder, depression, and substance abuse, are common in people with ADHD.

Treatment and Therapies

While there is no cure for ADHD, currently available treatments can help reduce symptoms and improve functioning. Treatments include medication, psychotherapy, education or training, or a combination of treatments.

Medication

For many people, ADHD medications reduce hyperactivity and impulsivity and improve their ability to focus, work, and learn. Medication also may improve physical coordination. Sometimes several different medications or dosages must be tried before finding the right one that works for a particular person. Anyone taking medications must be monitored closely and carefully by their prescribing doctor.

Psychotherapy/ Neurofeedback combined

Psychotherapy to treat ADHD can help patients and their families to better cope with everyday problems.

Behavioral therapy is a type of psychotherapy that aims to help a person change his or her behavior. It might involve practical assistance, such as help organizing tasks or completing schoolwork, or working through emotionally difficult events. Behavioral therapy also teaches a person how to:

monitor his or her own behavior
give oneself praise or rewards for acting in a desired way, such as controlling anger or thinking before acting

Parents, teachers, and family members also can give positive or negative feedback for certain behaviors and help establish clear rules, chore lists, and other structured routines to help a person control his or her behavior. Therapists may also teach children social skills, such as how to wait their turn, share toys, ask for help, or respond to teasing. Learning to read facial expressions and the tone of voice in others, and how to respond appropriately can also be part of social skills training.

Cognitive behavioral therapy can also teach a person mindfulness techniques, or meditation. A person learns how to be aware and accepting of one’s own thoughts and feelings to improve focus and concentration. The therapist also encourages the person with ADHD to adjust to the life changes that come with treatment, such as thinking before acting, or resisting the urge to take unnecessary risks.

Family and marital therapy can help family members and spouses find better ways to handle disruptive behaviors, to encourage behavior changes, and improve interactions with the patient.

Education and Training

Children and adults with ADHD need guidance and understanding from their parents, families, and teachers to reach their full potential and to succeed. For school-age children, frustration, blame, and anger may have built up within a family before a child is diagnosed. Parents and children may need special help to overcome negative feelings. Mental health professionals can educate parents about ADHD and how it affects a family. They also will help the child and his or her parents develop new skills, attitudes, and ways of relating to each other.

Parenting skills training (behavioral parent management training) teaches parents the skills they need to encourage and reward positive behaviors in their children. It helps parents learn how to use a system of rewards and consequences to change a child’s behavior. Parents are taught to give immediate and positive feedback for behaviors they want to encourage, and ignore or redirect behaviors that they want to discourage. They may also learn to structure situations in ways that support desired behavior.

Stress management techniques can benefit parents of children with ADHD by increasing their ability to deal with frustration so that they can respond calmly to their child’s behavior.

Support groups can help parents and families connect with others who have similar problems and concerns. Groups often meet regularly to share frustrations and successes, to exchange information about recommended specialists and strategies, and to talk with experts.