How to Reduce Autumn Anxiety: 10 Ways to Relax

EVEN IF THE STUDY IS LONG GONE, THE END OF THE HOLIDAY SEASON and the beginning of the school year are associated with stress and increased workload. Work is added, in transport there are more people, the weather worsens-and it's time to hone the ability to relax to calmly survive the autumn and winter. We have collected ten ways, the calming effect of which is confirmed by research and which will help to recover, even when it seems that everything collapses and goes out of control.

Drawing

Art therapy has already proved its effectiveness in the treatment of depression, anxiety disorder and other mental illnesses. After all, sometimes it is easier to draw what you feel than to tell. Forget about the lessons of fine ARTS and harsh teacher: here you are not required to clear lines, “correct” composition or a certain combination of colors. Create what you want and how you want, frames (they will be except on canvas) and no estimates, the main thing — come to this lesson consciously: take a break from thoughts and focus on the process. According to the candidate of psychological Sciences and associate Professor of Brooklyn College Jennifer Drake, only fifteen minutes of drawing significantly uplifting.

Meditation

Around meditation many myths — apparently it is complex, confusing and generally only advanced yogis. In fact, for a successful meditation is not necessary to sit in the Lotus position, teach wise (special gestures and finger positions) or pronounce mantras. It is important to choose a quiet place to concentrate on your breathing and try to observe their thoughts. The first time is unlikely to succeed (from the second and third too), but the main thing here is regular practice. Start with short sessions: five to ten minutes a day is enough to form a habit. It is better to meditate in the morning or before going to bed, but even this is not considered a strict rule.

Meditation helps lower cortisol levels in the blood, reducing stress and increased anxiety, but that’s not all. Last year, the society of integrative Oncology updated its guidelines-and now recommends the use of meditation as one of the ways to improve the physical and emotional state of breast cancer. Another study found that various practices for the mind and body, including meditation, mitigate the symptoms of menopause. And neuroscientist Sarah Lazar is convinced that eight weeks of regular meditation sessions can change the physical properties of the brain. During the experiments, Sarah and her colleagues found that the size of the amygdala (the area responsible for the appearance of anxiety, fear and stress) in people practicing meditation, decreased. This was followed by a decrease in the level of stress.

Strolls

Physical activity is useful in any form, and normal walks are also considered. With friends, a partner, a dog or without anyone — it doesn’t matter, just leave the house when you want to relax or calm down, it really helps. Spend more time outdoors and those who have depression. Walking an average of two hundred minutes a week, women noted that they had more energy, they felt better physically and emotionally, and it was easier for them to socialize. And if you increase the duration of walking to seven hours a week, it will help reduce the risk of breast cancer after the onset of menopause — so say researchers from The American cancer society.

Sex

Hugs, kisses and sex are very useful for health — both physical and psychological. So, sex reduces cortisol levels and relieves stress, so that a person feels more peaceful. According to psychologist from Paisley University in the UK Stuart Brody, such a calming effect may occur due to the release of the hormone oxytocin, it is also called the hormone of love and affection. In addition, sex helps to better perceive and control their emotions, increase self-esteem and overall health. But some research does say about the positive impact of sex on memory in women.

Floating

Floating was invented and developed by neuropsychologist John Lilly. Translated from the English term means “swim on the surface” — in fact, this happens during the procedure without any effort. The patient is immersed in water with a high concentration of salt rich in magnesium, so that the density of the water is much higher than the density of the body — and it pushes the person to the surface (as in the Dead sea in Israel). This happens in the sensory deprivation chamber — from the name it is clear that the person in it is almost completely cut off from external stimuli, often-in complete darkness.

Since the procedure appeared recently, it is still poorly studied, so it is necessary to approach it cautiously: it will be useful to consult with a psychotherapist if you have it (after all, not everyone will be comfortable in a small enclosed space alone). On the basis of already conducted studies, we can say that flotation (probably due to magnesium in the salt) helps to relax muscles, accelerate recovery after training, relieve stress, normalize the nervous system and even improve sleep. On the procedure you need to try to relax, although the first time it will be difficult to do: the brain does not understand what it is, it will seem that you are drowning (in fact it is impossible, do not be afraid).

Journeys

It is not necessary to go to the other side of the world — it will be useful to go just for or to another city, provided that there you can feel like a tourist. Studies show that the holidays allow you to break away from the routine, bad weather and problems at work, which helps a person to relieve stress, reduce anxiety and find peace of mind. This effect has a very short — four-day-trip. Even at the planning stage-making a route, booking hotels, buying online tickets to museums-a person is in a good mood: a study conducted at Cornell University, confirmed that waiting for a trip gives a person more pleasure than waiting for the purchase of something tangible, such as a car.

Nurslings

If you have long been thinking about how to get a pet, then this item is for you. In February of this year, Helen Brooks, a lecturer at the Institute of psychology, health and society (Liverpool University), and her colleagues published a systematic review of the impact of Pets on people’s emotional health. After analyzing more than eight thousand articles, they came to the conclusion that Pets helped their owners to better control emotions and helped reduce the severity of symptoms of mental illness.

According to Brooks, this effect was achieved due to the fact that Pets accept people as they are (and the person understands this), and give them unconditional support, which research participants did not receive from their family or friends. According to experts of the mental health Fund, games and walks with Pets, especially with dogs, help to relax and calm the mind. And in moments of despair, caring for Pets can be the only incentive to get out of bed — it helps a person to realize their value and necessity. The main thing-approach the question responsibly: consider the option to take the animal from the shelter and do not forget that any animal should be systematically engaged.

Autogenic training

Those who do not like to do fitness, can exhale: no exercise is not necessary. Autogenous training is a method of therapy aimed at relaxing the body, relieving tension and stress. The first time to conduct sessions of auto-training is better under the supervision of a specialist. It will help to learn how to relax properly-so that it does not lead to deterioration of the patient’s condition, the appearance of anxiety or panic attacks (and this can happen).

Then you can put yourself in emotional order at home. The main thing is not to make the main mistake of all beginners-do not force yourself to relax, everything should flow naturally. The indications of the use of auto-training include not only stress or fatigue, but also anxiety and depression, sleep disorders, irritable bowel syndrome, high blood pressure caused by stress. The results of the studies show that this method of therapy is really suitable for some people.

Massage

What could be better and more pleasant than to spread out on the massage table after a day in the office? Although the benefits of massage for health (for example, that it helps to align the posture or relieve back pain) is still debated, that it helps to relax the body and mind, there is almost no doubt left. In one of the studies, participants who were given a massage, there was a decrease in the level of anxiety. There are many types of massage: hot stones (stone therapy), herbal bags, aromatic, honey, Thai, soap-choose any, but again do not expect anything from them except relaxation.

Music

Music has existed for 250 thousand years, and maybe more — psychologists, anthropologists, musicologists, neuroscientists have long studied its origin, properties, goals and effects. Scientists have made significant progress in the study of the influence of music on the emotional and physical health of a person: for example, they found that music reduces the level of stress hormone (cortisol) and is even able to relieve pain. In a 2013 study, doctors found that listening to music reduces anxiety in people before surgery.

You are certainly without any kind of research I have noticed that after listening to a favorite album becomes easier. In one study, scientists interviewed 834 people to find out what music gives them. It turned out that a lot: music helps different people to think about feelings, to better understand others, to believe in themselves, not to lose heart and to find the meaning of life.

There is a Depression in Cats?

The answer to this interesting question is positive: Yes, it happens. Of mental balance cat may knock the change in daily routine, to which she was accustomed, or the feeling of loneliness. She experiences stress, and when a stranger appears at home, as well as in any other situation, if she feels that she is in danger. The sufferer (sorry, cats going through a lot silently) walks with a missing eye, stops eating, and to wash, starts bad to navigate, even in familiar surroundings.

From time to time it is a negative mental discharge: cute fluffy creature demonstrates behavior that is unacceptable in human understanding (“Oh, what a nightmare!”), – scratch, bite and irrigates the urine that is handy, for example untouchable Persian carpet. An unexpected change in the cat’s “personality” can be a symptom of one of many diseases. However, if the veterinarian will rule out all possible physiological causes of the new state, then you can be sure: your pussy is going through a nervous crisis. What is the cause of such deviations from the norm?

In search of an answer to this question, let’s remember who are cats and how they like to live. Some of them, as in the good old days, lead a real cat’s life: walk through the stables and gardens, explore the neighborhood, protect their territory, exposed to natural hormonal cycle. Home run only to eat and warm tired limbs. Then again go about their business, following the secret, they are a well-known trails. These lucky people, who behave in accordance with their nature, never face the problem of existence in the world. With them and in them all flows naturally.

Living conditions in the big city radically changed the old style of cat life. Fans of these animals (and their cities getting bigger) out of a desire to protect Pets from danger and the sense of responsibility for unregulated reproduction put them under house arrest. Fluffy little rascal has a guaranteed sofa for rookery and a bowl full of tidbits that do not need to produce their own, but it lacks the most important in life-freedom. What is to be surprised when the “prisoner” literally squeaks his teeth, seeing that the window glass separates him from the world. Cat falls into the clutches of unbearable boredom. People who perceive Pets in their own, human categories, make a serious mistake. For example, they do not understand what it means for a small predator to be unable to hunt.

Hunting is a fundamental need of every “domestic tiger”. Dissatisfaction in this sphere of life often leads to nervous disorders. How can you keep your mental balance if you can’t climb roofs, sit on fences and climb trees? How not to succumb to sadness when you are doomed to a monotonous life in four walls, without entertainment, without a single mouse or at least a moth for fishing? How not to die of boredom, when there is nothing to do but to meet with home appliances-incomprehensible devices and household appliances that can not be scratched, and when constantly driven away from the most interesting place – the kitchen?

Unless the cat is interesting, fun to watch with the owner of the Mexican television series or with the owner – the next match “Spartak – the champion!”? Boredom becomes a source of various incidents. Due to the lack of a real daily portion of physical and mental stress, the animal has only one goal of interest – the moving legs of the owners. “Home tiger” quietly creeps up hides, crouches to the floor, and then sudden surge rushes to “production” (master’s thigh, calf, ankle), and often with a wild cry. Then instantly disappears.

People don’t tolerate such antics, asking his players an earful. And in vain. After all, what, in their opinion, it is unacceptable for a cat is perfectly normal. Inattentive owners do not understand: this behavior is a symptom of mental illness of the animal, devoid of natural stimulating factors and so necessary physical activity.

Watch your pet. Cats usually behave with dignity, restraint. However, even the most balanced “personality” must from time to time defuse the accumulated tension. Those of them who live in freedom, carry out their “wild dance” over the caught victim – affect the excitement and joy.

He has to release the accumulated energy during his “five minutes of madness.” Calm Murka suddenly transformed into a real fury-flying around the apartment, like a witch in the broom, disguised tail rushes to the obstacles, riding on the carpet, jumps on the windowsill, one jump reaches the sofa and paused for a moment, instantly unfolds-the bullet flies out of the room. Then he calms down and from the terrible Gorgon turns into a balanced Mrs. Hutson. Let’s say you’ve already begun to understand that your four-legged is depressed. What should be done in this case? You can refer to the tablets and powders. Cats, by the way, the fit of the drugs used in the treatment of nervous system disorders in humans. But that alone is not enough. Modern therapeutic techniques recommend to accompany pharmacological treatment with dense psychological support: to surround the patient with care, to pay special attention to him, to please with tasty, fragrant, useful food, even to feed from hands. So in the case of a nervous breakdown in your pet should not immediately run to a cat shrink – with this trouble can be dealt by yourself at home. Take care of the necessary amount of entertainment; think about games with which the animal will be able to defuse emotional tension and give vent to the manifestation of hunting instinct. Remember: the game is a panacea for many cat troubles. What brings your pet the most joy? In addition to food – it is a game! All items designed for gnawing, braking, skating, shaking and grabbing satisfy not only the cat’s natural need to “hooliganism”, but also distract her attention from your carpets, furniture, shoes. Thanks to the games, the animal maintains physical shape, develops intelligence, does not yearn, does not get bored when he spends long hours alone in the daytime.

The household is filled with items suitable for hunting: toilet paper, paper bags, brushes, boxes, cabinets, Laundry baskets and so on. Every item that can roll, scratch or throw, will awaken even the most avid liebore fighting spirit and zeal. Look around you. Paper (in any case not polyethylene!) the package will certainly cause your pet great interest. The cat will enthusiastically greet the advent of cardboard boxes with cut out entrance or a cardboard tube. The desire to hunt will cause her ball of rustling wrapper, coil of thread, cork of wine, a ball of wool or a light spot, put on the wall of a flashlight – that is, everything that moves when touched (focus with a flashlight, of course, suggests an accomplice). Joint games long autumn evenings will not only rally your friendship, but also help the owner not to fall into the November melancholy.

Thus, if you want to make your pet was healthy "body and soul", should remember one thing: do not have a cat to entertain you and you cat.

How to Cope with Depression?

“I have depression” – we often hear these words. But most often people call depression the usual attacks of melancholy and bad mood, which often pass by themselves a maximum of a few days. Real depression is a disease that can poison life for many years and never goes away without treatment.

What is depression?

Depression is a serious illness characterized by clear symptoms that distinguish it from a bad mood.

The main signs of depression include:

• A joyless, oppressed state;
• Frequent and sudden mood swings;
• Anhedonia, the loss of feelings of pleasure (“Nothing pleases and is not interested»);
• Inability to concentrate, memory impairment;
• The inability to make a decision, the constant return to the same issues;
• Fear, anxiety, panic attacks, attacks of aggression;
• Chronic feeling of fatigue, lethargy (“Wake up broken”);
• Sleep Disturbance, insomnia or, conversely, constant drowsiness;
• Loss of appetite, weight loss, digestive problems;
• Depression libido;

Feeling of pressure, heaviness in the abdomen and chest, shortness of breath; various vegetative symptoms, such as excessive sweating, tremor, dry mouth and others.

If these symptoms occur simultaneously and last for several weeks, then there is every reason to suspect depression.

We used to believe that depression is always a consequence of some sad events – the loss of loved ones, divorce, loss of favorite work. But that’s not exactly true. There are three main types of depression – reactive, somatic and endogenous. Jet really is the consequence of abrupt changes in life or of trauma. Endogenous arises as if “out of the blue”, without any obvious reasons. In fact, there are reasons, they are just not so noticeable to others. Endogenous depression can be the result of hormonal imbalances (especially well-known postnatal depression), taking some drugs, alcohol or drugs. Somatic depression is one manifestation of another disease, such as Alzheimer’s disease, hypothyroidism, traumatic brain injury, or even the common flu.

In addition, residents of the Northern latitudes are often observed seasonal depression associated with a lack of sunlight.

It is very dangerous to underestimate or poetize depression. In this state there is nothing attractive or romantic, it destroys the life and personality of a person, affecting not only himself but also his loved ones. Tips “stop whining” and” pull yourself together ” are not only useless, but also very harmful – a depressed person is unable to control this condition in the same way as a patient with a broken leg can not run a hundred meters. Reproaches of friends lead only to the fact that a person is even more confident in his weakness and worthlessness and even deeper immersed in this state. It is also wrong to believe that the disease is the result of the tendency to analyze too much and”wind yourself”. Even small children who have barely learned to speak can suffer from depression.

This disease is one of the most common mental disorders – it affects more than 350 million people of all age groups. Every year, about 150 million people in the world are deprived of working capacity due to depression. At the same time, women get sick twice as often as men – although doctors explain such statistics not by the “resistance” of the stronger sex, but only by the fact that men are less likely to turn to specialists and “are treated” mainly with alcohol or other similar means. There is another disturbing fact – according to statistics, the risk of getting depression increases three times if someone in the family already suffers from this disease.

Treat, cannot be deferred!

Getting rid of depression quickly is very difficult, and without the help of doctors and psychologists – it is impossible. But the disease is successfully treated with the right approach. Complex measures are usually prescribed.

First to fight drugs – antidepressants. They should be selected by a doctor-as a rule, such tablets can not be bought without a prescription, and uncontrolled intake of funds of this group can lead not to recovery, but to deterioration. Antidepressants relieve the main symptoms. As a rule, the stage of medical treatment lasts from several weeks to several months. As a Supplement to antidepressants, sedatives are often prescribed. In some cases, a good effect is also given by physiotherapy, light treatment, acupuncture.

After improving the condition, there is a period of consolidation of the results. This stage of treatment is equally important – depression is insidious and can return again in a few months or even years. In order not to leave the disease a single chance, you need a course of psychotherapy and individual work with a psychologist. To combat depression, there are many techniques-cognitive psychotherapy, which aims-to change the perception of man about himself and the world; interpersonal psychotherapy, helping to resolve conflicts with others; behavioral therapy designed to change the behavior that leads to stress and depression; psychodynamic method that resolves internal conflicts of a person with himself and many others. The duration of this stage depends on the severity of the condition and how the patient is ready for cooperation: it will take from several sessions to several months of work with a specialist.

Alternative opinion

The author of the book “The Loss of sadness: how psychiatry transformed normal sadness to a pathological depression,” Jerome Wakefield argues that depression could be the impetus for positive changes in your life, allowing you to understand the desires and to learn from mistakes.

How to beat depression, or antidepressant advice

You can overcome depression only if you really want it. And if the fight against the disease is limited only to the formal taking of pills and visiting doctors, the result will not be achieved or the path to recovery will stretch for months or even years. To get back in shape as soon as possible, “antidepressant measures” need to be actively incorporated into everyday life. There are no trifles in the treatment of depression. Of course, these tips will not help cure the disease without medication and psychotherapy, but can significantly speed up the process.

Switch attention

For depression are typified by obsessive thought, get rid of which very difficult. If you feel that for the hundredth time you are scrolling in your head the same memories and questions, switch your attention to any subject. Lift a stone from the ground, consider it, note the color, texture, weight, twist in your hands, think what it looks like. Instead of a stone, you can use any other object – a key, a leaf from a tree, anything that comes to hand. It is important to concentrate on contemplation. In a few minutes, the gloomy thoughts will recede.

Sport

This is not psychology, and pure physiology – during exercise, like them or not, the brain produces endorphins – hormones of happiness and joy, the lack of which provokes depression.

Create

Art therapy is a whole section of psychotherapy. Creativity really helps to cope with depression. Any result of creative work increases self-esteem, while the process itself is important. But the artistic value does not matter much.

Do not hold emotion in itself

The demands to “pull myself together“,”keep the blow” and “do not get unstuck“, as we have said, only drive a person into an even deeper depression. Pent-up emotions are like a bomb exploding inside. Even healthy people, who keep everything in themselves, pay for their apparent composure with neuroses and psychosomatic diseases. If you want to cry-cry, I want to scream-scream, I want to rampage-beat the sofa cushion.

Please yourself

Start to keep a diary in which you will celebrate all the pleasant moments, even if they were very fleeting and insignificant. Pay attention to what pleases you most often, and strive for it.

Endogenous depression is a mental disorder, the classic signs of which are:

• Depressed, sad mood;
• Motor and mental retardation;
• Irrational anxiety;
• Slow thinking speed;
• Depersonalization;
• Decreased appetite;
• Sleep disturbance;
• Suicidal tendencies.

The state of the persons suffering from this disorder are characterized as depressed with a hopeless, oppressive melancholy. Although patients separate their feelings from the natural sadness and sadness, they can not explain what specific differences are endowed with the emotions they experience. Symptoms of the disease-pronounced and intense in strength manifestations, it has a strong painful effect on patients, forcing a radical change in the usual way of life.

Anxiety in endogenous depression manifests itself depending on the severity of the disorder in different ways: from the sense of inevitability of a catastrophic event with vegetative symptoms to agitation-anxiety numbness, reaching a state of complete stupor. Moreover, patients often can not distinguish between the state of panic anxiety and debilitating anguish, since these feelings merge together with the disease and they are characterized by stagnant pathological affects.

Endogenous depression occurs without the presence of external circumstances and outside influence, not depending on what happened or the present events in the life of the individual. No favorable moments: positive news, pleasant events, activities that bring normal pleasure, do not affect the mood and well-being of the person. People suffering from endogenous depression are not characterized by crying, but they are completely absorbed in the painful ideas of self-criticism, self-blame and self-abasement. That is, given these facts, the experts distinguish a disease from a psychogenic disorder and are diagnosed with endogenous depression.

A feature of endogenous depression, occurring in a mild form, is the daily cycle of mood changes, when after waking up in the morning, a person feels the maximum peak of a sad mood, while in the evening the feeling is slightly softened. In severe form of the disease there is a syndrome of” perversion of the daily rhythm”, when in the afternoon there is a noticeable decrease in mood, increased anxiety.

An important indicator for the diagnosis of endogenous depression is a pronounced mental retardation: slowing down the speed of thinking, the pace of speech. Sick for a long time to comprehend the information received, they require a much longer time than normal to formulate their answers and to describe the arisen thought. Persons suffering from the disorder note that their thoughts and decisions have become illogical, inconsistent, arise slowly with a tremendous effort of will. In contrast to asthenic States, the slowdown in the rate of speech is observed throughout the dialogue with the patient. Constant and constant is the decrease in motor activity-patients describe feelings of fatigue, lack of strength and energy, fatigue, which do not disappear even after a long rest.

Even in the presence of all these manifestations, endogenous depression often remains without due attention, most patients do not consider themselves sick and, accordingly, do not apply to a psychotherapist in a timely manner. This is due to the fact that in this disorder there are no visible external causes, there are almost always no bodily ailments, somatic manifestations are rare and non – intensive.

“Dreary” depression can be both an independent mental illness, and can act as one of the phases in the course of bipolar disorder (manic-depressive psychosis).

The leading place in the formation of prerequisites for endogenous depression belongs to the internal hereditary-genetic, biochemical and organ-somatic factors, that is, the main reason for the occurrence of the disorder lies in the individual characteristics of the human body. In most patients with this diagnosis, hereditary severity of various mental disorders is recorded. Very rarely, the onset of the disease is provoked by a strong negative or positive stress factor, but quite quickly the connection of low mood with a stressful event is lost.

Endogenous depression is classified as a severe depressive disorder with no psychotic symptoms. Despite the severe course of the disease, these diseases are attributed to the predicted favorable, as amenable to successful treatment with drugs (antidepressants).

The complexity of the treatment of this disorder is the absence of a real problem, as it is not clear what to fight and what should be corrected. Endogenous depression is associated with a high risk of suicide, and thoughts of suicide do not depend on the severity of the disorder.

Causes of endogenous depression

This disease belongs to the so-called predisposition disease, since the main factor in the presence of predisposition to the occurrence of the disorder is genetic heredity. The transfer of” inherited ” adaptive resources of the body and the feature of the regulation of the level of mediators: serotonin, norepinephrine, dopamine. When genetic pathology is a shortage of these chemicals controls mood. Despite this hereditary predisposition, a person staying in a favorable psycho-emotional environment may not suffer from depressive disorders.

Also, the lack of a number of important chemicals in the body can be provoked by the peculiarities of the diet, natural age-related changes. Thus, the lack of amino acids L-Tryptophan, L-Tyrosine, L-Glycine and L-Glutamine significantly reduces the body’s resistance to stress factors and is a factor in the inevitable development of depressive disorders.

The trigger for the development of endogenous depression can be external factors such as:

• the traumatic event,
• chronic somatic diseases,
• pathology of the Central nervous system,
• taking some medications.

Subsequently, a secondary depressive episode can occur independently, without external influence.

Symptoms

A typical endogenous depression is represented by a triad of Kremelin-a classic triad of the main symptoms: depressed mood, slow thinking, motor retardation.

• The leading symptom and specific feature of this disorder is Hypo – MIA-pathological vital depression. Such a protopathic nature of longing is inseparable from the physical sensations experienced by patients and brings the strongest bodily suffering. Many people suffering from the disorder can accurately localize their feelings in a certain area (usually in the chest, head, neck). Moreover, patients clearly differentiate the sensation of pain, characteristic of somatic diseases and experiences associated with real causes.
• Typical primary symptom acts and ideational (mental) braking. Even being in an emergency, extremely responsible situation, the patient is not able to quickly make the necessary decision, willpower accelerating the thought process.
• With endogenous depression, motor retardation looks characteristic: the patient forms a kind of facial expression, the so-called “face of melancholy”, giving an expression characteristic of elderly people. Often, motor braking reaches the maximum degree of numbness, when the patient is in a depressed stupor. Occasionally, against the background of complete retardation, patients experience a sudden, unexplained and uncontrolled attack of despair, accompanied by intense motor excitation, up to the probability of self-harm.
• With a depressive episode, the phenomena of depersonalization and anhedony often appear. Many patients note the appearance of a painful sensation, in which there are no emotions and desires and there is a sense of change in their own “I”. Often there is a derealization of what is happening: patients perceive what is happening unreal, dark, faded, there is a feeling of slowing down time.

Although expressed depressed mood may be accompanied by secondary (affectogenimap) symptoms – delusions, depression, in patients suffering from endogenous depression, there is a prevailing belief in his guilt, insignificance, hopelessness of the future. This disorder brings to public attention the most important human fears: concerns about the healing of the body, salvation of the soul, material goods. These primary fears form the typical delusional symptoms: hypochondriacal ideas, ideas of sin, ideas of self-accusation and self-abasement.

In severe involutional melancholia is clearly manifested stereotypical anxiety-delusional syndrome: depressed mood, morose state of alarming agitation, fear, verbal illusions, delusions conviction. Without adequate treatment is the formation of irrational phobic anxiety with continuing anxiety, constant agitated state and manifest a variety of manifestations of delusional experiences in the form of inevitability of punishment and death, hypochondriac moods, ideas of suicide. Typical hypochondriacal delusions stands particularly imaginative whimsicality, absurdity and irrationality of the content.

As a rule, having reached its peak, endogenous depression provokes the formation of a mental defect called “depressive weakness“, which is characterized by a decrease in mental and motor activity, constant depression of mood, decrease in emotional and sensitive resonance, a variety of violations in the intellectual sphere.

Melancholy depression affects the supply of human vitality and energy, and awareness of this fact causes the person the most concern. The vital symptoms include:

• Excessive fatigue;
• Severe apathy;
• Inability to carry out volitional efforts in the usual volume;
• Sleep disorders: too early awakening, alternating with problems falling asleep;
• Appetite disorders and disorders of the digestive system: lack of appetite or, conversely, excessive appetite, constipation, nausea, weight loss or weight gain;
• Problems with concentration;
• Pain of somatovegetative nature: “pressing” or “squeezing” pain in the chest, neck, head;
• Lack of sex drive, loss of libido, inability to reach orgasm;
• A sense of irrational fear, panic attacks;
• Mood swings depending on the time of day.

For this disorder is characterized by a decrease in response to events, detachment from the surrounding reality, the immunity of information from the outside. In the physiological aspect, the decrease in reactivity is manifested in the absence of appropriate reactions after taking standard doses of drugs.

Treatment of endogenous depression

The basis of treatment of endogenous depression is the use of drug therapy. In this disease, antidepressants are usually used. The choice and dosage of the drug occurs on an individual basis, taking into account the personal characteristics of the patient and based on the presence and severity of symptoms.

Against the background of drug therapy, there is a gradual disappearance of symptoms. After 2-3 weeks from the start of taking antidepressants, motor and mental retardation decreases, while depressed mood, delusional formations and suicidal thoughts/attempts are still preserved. Therefore, the use of antidepressants should be carried out until the complete disappearance of all manifestations of the disease, since the sudden cessation of treatment is fraught with deterioration of the patient’s condition and a return to a deeper depressive state.

Along with antidepressants for the treatment and prevention of endogenous depression is used that group of drug. Long, continuous use of these drugs helps to stabilize mood and prevents the emergence of new depressive episodes.

Psychotherapy is carried out only as a secondary addition to drug therapy. Modern psychotherapeutic techniques help to identify and eliminate the true cause of the disorder, to form a new model of response to stressful situations, to correct personal assessment. However, without the help of antidepressants, it is impossible to restore the metabolism and concentration of neurotransmitters impaired in endogenous depression.

Persons predisposed to this mental disorder, it is necessary to periodically carry out preventive measures, to avoid excessive mental stress, to observe the regime of work and rest, not to abuse alcoholic beverages, to adhere to a healthy diet.

Many use the word “depression” to describe bad mood, sadness, or simply to say that they are not in the spirit. When a specialist uses the word “depression” – he means clinical depression – major depressive disorder (BDR).

Major depressive disorder (BDR): a condition in which the feeling of sadness is much stronger than usual and lasts longer than usual. In addition, there is a loss of interest and pleasure.

People suffering from depression experience difficulties in daily functioning. Difficulties also arise at work. Very often they are not interested in the proximity of family and friends. They feel desperate and useless.

There are different types of depression of varying severity: postpartum depression, seasonal depression, mild depression, and clinical depression (BDR).

Depression can be expressed as symptoms on both psychological and physical levels.

Symptom of Depression

Symptoms of depression are individual and manifest in each person differently. Not all of the following symptoms should be present in depression. There are also additional symptoms, not listed below, that may be present in depression.

• • Reduced mood.
  • Loss of pleasure.
  • Obsessive occupation of guilt and self-abasement.
  • Feeling helpless and desperate and self-loathing.
  • Deterioration of memory and ability to concentrate.
  • Removal from social activity.
  • Problems in the sexual sphere.
  • Disturbed sleep.
  • Low or increased appetite.
  • Thoughts of death or suicide.
  • Various physical symptoms such as fatigue, apathy, headaches and digestive problems.
  • In certain cases, delusions and/or hallucinations (usually auditory hallucinations) may be present.

  Risk Factors for Depression

  In most cases, it is not about one single cause leading to depression, but a combination of several causes.

  The following are causes that increase the risk of depression:

  • Heredity.
  • Early trauma, such as abuse, separation, or neglect.
  • Deterioration of physical condition.
  • Chronic pain due to injury, accident or illness.
  • Separation and loss.
  • Post-traumatic stress disorder or its complications.
  • Old age or widowhood, especially among men.
  • Previous mental disorders.
  • Adaptive response to changes in status, place of residence, especially in people with dependent personality.
  • Various physical ailments such as Parkinson’s and fibromyalgia.

  The thoughts of a depressed person can be dark and unpleasant, accompanied by a sense of failure, low self-esteem, and despair. These thoughts and feelings are accompanied by anxiety and reduced functioning – relative to the expectations of others, or his own.

  And yet, there is good news – there is what to do and who to turn to.

  Professional Help

  Psychological treatment from an independent practitioner: private treatment (psychotherapeutic treatment, psychiatric treatment, etc.) from an independent practitioner, through a health insurance Fund or in private.

  Psychological treatment in a polyclinic: includes psychiatric consultation, psychiatric treatment, recommendations to family members, etc.Treatment is carried out in psychiatric clinics of hospital offices, in public clinics of the Ministry of Health, in clinics at hospitals or in private clinics.

  Day hospital: a day hospital is a “transit point” between living in the community and hospitalization in the hospital and Vice versa. The treatment is very intensive: about 6 hours a day are different types of treatment-psychotherapy, group therapy, occupational therapy, etc.

  Hospitalization in a psychiatric hospital: designed for severe cases in which staying at home is impossible because of the risk (both for the patient and for others), because of reckless behavior or the need for continuous care.

  Selfhelp

  A person who is depressed is very difficult to find the strength to take care of himself. But if a person takes an active role in the treatment and goes to concrete actions, it will help to improve his condition.

  Care and self-care

  Quality sleep: most people with depression sleep either very little or very much. Quality sleep can significantly improve mood and increase the amount of energy during the day.
  Balanced diet: a varied and enriched diet will help to improve health, add clarity of thinking and increase the amount of energy in the body.

  Medication: taking medication on time and in the doses recommended by your doctor may help to improve mood and will be a palliative, complementary treatment to psychotherapeutic and/or group treatment.

  Sports: simple sports such as yoga, walking and swimming will help to improve your mood.
  Hygiene: when people suffer from depression, hygiene can become an impossible task. Regular bathing and comfortable, neat clothes can greatly improve the inner feeling.

  Introduce good habits

  Focus on positive things: make a list of actions, people and places that cause a feeling of happiness and well-being. You can choose from a list of things that are already being done, or you can do them every day. Most likely, it is impossible to do everything that is written in the list every day, but you can try to enter those things that can be done daily in the daily routine. At this point, this list may look pointless, but in the future it can become a source of ideas and lead to the understanding that all situations are transient and there is nothing that would remain unchanged.

  Be sensitive to yourself: no need for criticism or self-flagellation, if something did not work, or plans are not implemented. In addition, you can try to apply to yourself all that you would advise a friend, whether he is in your situation.

  Show Activity

  To join any group: the group in Matnas (community center), a community group with those closest to you in spirit and interests, sign up for a program or club. It’s important to find something you like to do to increase motivation.

  Trying new things: Hobbies, course, studies and new experiences can improve mood and prevent negative thoughts and actions.

  Volunteering: being able to do something for others directly affects the inner feeling and the feeling of loneliness. There are organizations and various structures such as medical facilities, matney, nonprofit organizations, educational institutions, factories and museums, looking for people who want to help.

  Set real goals: it is important to set real and independent goals: dress up in the morning, swim, walk around the neighborhood on your own or prepare food. Achieving these goals improves mood, gives confidence and encourages the establishment of the following goals.

  Effect not mood

  Mood observation: for some time, mood observation provides an opportunity to see a picture of changes in feelings and shows that the number of good days is greater than it may seem. This review will show the real picture that not everything is permanent and that there are activities, people and places that improve mood.

  Use imagination: imagination gives you the opportunity to plunge into the memories of good emotions and pleasant places. You can even imagine a future experience or a place you would like to visit. This method helps to understand that there are things that improve our health.

  Development of social relations and interpersonal relations

  Stay in touch: if you feel like you do not want to see anyone, you can send a message or contact by e-mail with family, friends or acquaintances.

  Communication: it is difficult to start talking about your feelings and feelings, but many people say that they feel better after they share their impressions and experiences.

  Join a support group: participating in support group meetings is a great opportunity to listen to people who are or have been in a similar situation and get information from them. Information on support groups on the topic of depression can be obtained through Internet searches, access to health insurance Fund or mental health stations.

  Getting support via the Internet: professional support via the Internet can help in cases where a person cannot or cannot ask for help. Professional forums or chat rooms, such as ERAN (Rishon Ezra navset – psychological first aid) or MOTHER – Kehilat briut hanefesh – society for mental health can provide first aid.

  Advice to family and friends of a depressed person

  Talk about bad mood and depression: it is difficult for most people to talk about their health and what is happening to them. It is necessary to remain open, talk about depression or about mixed feelings. This way, your friend or close relative who is depressed will feel more comfortable telling you what is happening to him.

  Advise to apply and send for professional assistance: a close friend or relative can be those who will provide assistance and support – both in everyday life and in applying for professional help. Talking over a Cup of coffee or a slow walk around the house can improve your mood, help to trust a friend or relative and lead to a decision, finding a way out of the situation and strength. It is impossible to force a person to ask for help if he is not interested in it, but it is possible to listen, calm, encourage to ask for help and remind that this opportunity always exists.

  Staying in touch: it is sometimes difficult for a depressed person to stay in touch and keep in touch, so his friends and family should try to stay in touch with him. Text messages or phone conversations can mean a lot to him and remind him what they think about him.

  Take care of yourself: caring for another person affects our feelings. Close family and friends can also receive support and guidance and participate in suitable support groups.

When in quite recent times I consulted in 33 hospitals (figuratively speaking, in fact, there were only 4 of them), I was always in some confrontation with somatic doctors for mental disorders. I wrote about it more than once. The fact is that when a person is “fooled”, all immediately begin to claim that he has schizophrenia and he urgently needs to be transferred to a mental hospital. This is the easiest solution and the existence of symptomatic (due to somatic diseases) and pharmacogenic psychoses do not want to believe. It’s not that the doctors are wrong (although they are also wrong). The development of psychosis or any mental side effects of the plan largely depends on the person – from it’s genetics, comorbidities, status of the brain, and the fact that he’s Chiharu takes (or relatives give him) for a speedy recovery. This was one such episode in my life when I consulted Granny with long-term current psychosis and prescribed her a course of Seroquel in a small dose. Two days she was very much nothing, and the third daughter, remembering my colorful stories about the impact of high pressure on the brain, decided to “treat” the pressure. You don’t think of your daughters as anything, just for the best of reasons. They gave her 3 full clonidine pills for 12 hours. Granny dropped the pressure from her working systolic (upper) 180 to 70. Against the background of such a deafening effect, the phenomena of psychosis not only returned, but also intensified. Relatives were to understand about the “poisonous” medicine, which “not only does not help, but also does worse.” In their understanding of clonidine-generally mint tablet, from which no harm, but only benefit.

So that’s what I’m saying. I’m talking about the fact that there are a whole bunch of somatic drugs that can cause psychiatric side effects. Note that it is not disease, and the effects. That is, when a person stops taking them or goes to another group of drugs then everything becomes normal with him. So if a person started taking a new drug and” screwed up ” do not hurry to write it in schizophrenics.

In fact, drugs, the list of side effects which include mental disorders, is large enough. Their 65%. All list it for a long time, but we can identify individual groups that are most often the cause of mental side effects.

Beta-blockers

– Affect the nervous system. Some of them also cause mental disorders. Depends on what? All drugs can be divided into 2 groups of water-soluble and fat-soluble. Water-soluble excreted by the kidneys and hardly penetrate the brain. The brain loves fat-soluble drugs, they penetrate well through the blood-brain barrier. Therefore, less water soluble atenolol penetrates into brain tissue than fat-soluble metoprolol and propranolol. If you compare the concentration of water and fat-soluble drugs in the brain, the latter will be there 20 times more. Therefore, in terms of side effects metoprolol and propranolol are the most likely candidates. They can cause drug delirium and psychosis. In addition, their side effects are associated with sedation, nightmares, depression. In 1967, it was reported that more than 50% of patients taking propranolol may experience dysphoria ( a maliciously dreary mood) and depression, with symptoms that may occur and become acute and increase gradually. However, the question of depression caused by drugs in this group remains open. There are studies confirming this plunging position, as well as refuting it.

ACE inhibitors

– This group also affects the Central nervous system. From 4 to 8% of patients experience a state of some activation or excitation. 2% of patients stop taking the drug due to side effects of the mental plan. They include anxiety, mania (high spirits), insomnia, weakness, paresthesia (crawling), and hallucinations. Sedation occurs in 5% of patients. Although in General the drug itself slightly improves mood, there were cases of depression caused by drugs in this group. Also described are cases of psychosis that occurred during the administration of ACE inhibitors.

Clonidine

– Is a Central alpha agonist, i.e. it acts on the alpha-adrenergic system of the brain, exciting it. This system is responsible for the regulation of awakening, as well as plays a role in the development of depression and anxiety. More than 1/3 of patients (35%) taking clonidine experience drowsiness and sedation, 3% anxiety, 1% depression and the same amount of insomnia. States of confusion, delirium, hypomania or psychosis occur in less than 1% of cases.

Nitrates

– Cause delirium, psychosis with delirium, anxiety, motor anxiety, hypomania.

Digoxin

– Can cause hillside-induced encephalopathy, which is characterized by sedation, apathy, depression and psychosis. In this case, patients can develop psychosis, even if the level of the drug in the blood is within normal limits.

Statins (Cholesterol-reducing drugs)

– Can cause depression and increase the risk of suicide, although opinions on this are not clear.

Corticosteroid hormones

– Most often affect mood, to a lesser extent they develop delirium. Among other side effects include drowsiness, insomnia, euphoria, depression, psychosis, personality changes, anxiety, motor anxiety. Overall, more than 18% of patients undergoing therapy drugs in a dose of 80 mg per day develop mental symptoms. Among those who received prednisone for the treatment of asthma, many found signs of mania (painfully high mood). However, among those who were depressed before the start of therapy, the condition did not deteriorate. On the contrary, persons with previous treatment of post-traumatic stress disorder have noted such deterioration in themselves. In General, it was noted that during short courses of therapy with corticosteroids, mania occurs, with prolonged depression. Side effects occur during the first 2 weeks from the start of therapy. In severe cases, when hormones can’t be reversed patients assigned to concomitant therapy with psychotropic drugs. It is assumed that women have a higher risk of developing mental complications, but not all studies confirm this.

Anabolic steroids

– Have limited medical use, but are actively used by bodybuilders and similar citizens to increase muscle mass. These drugs are dangerous in terms of the development of acute delirium (paranoid), delirium, mania, euphoria, attacks of rage, aggression, significant mood swings and irritability. The effects depend on the dose. The higher it is, the greater the risk of such complications.

Gonadotropins

– According to some uncertain data cause depression, but the data are not accurate.

Hormonal contraceptives

– In addition, there is evidence that estrogens on the contrary cause mood enhancement. But there are several works on this account, which contradict each other.

Antibiotics

– Often cause side effects on the mental plane. Penicillins can cause depression, anxiety and hallucinations. Cephalosporins cause delirium, especially in patients with concomitant kidney disease. Jainology such as ciprofloxacin and ofloxacin, less than 1% of cases cause anxiety, irritability, drowsiness, tremors, insomnia, mania, psychosis, depression, seizures and catatonia. Also, mental disorders can occur during the reception of sulfonamides, tetracycline, etc. However, the most well-known in terms of the development of mental disorders anti-tuberculosis drug isoniazid. During therapy with this drug, delirium, mania, depression and psychosis occur.

Antiviral drugs

– Especially when administered intravenously can cause drowsiness, anxiety, hallucinations and delirium. The same disorder can cause another drug for the treatment of herpetic infection-foscarnet. Didanosine, a drug for the treatment of HIV causes drowsiness in 5-7% of patients, 2% depression, delirium and anxiety, 25% mood instability, 1% delusional disorders.

Tablets “from a cold”

– As a rule, contain a number of drugs of various kinds and can provoke atropine-like psychoses with confusion, disorientation, hallucinations of a frightening character. The data is particularly dangerous in patients receiving antidepressant group of MAO inhibitors.

Stomach pills.

– The most common are proton pump inhibitors (omez) and H2 – antagonists (famotidine, ranitidine, etc.) Although the side effects ( confusion, depression, motor anxiety, hallucinations) from these drugs are widely known, especially in elderly patients with liver and kidney failure, they occur only in 0,2%. However, it is necessary to know that these effects may occur not immediately, but after a time. So when taking ranitidine, they can occur for 4-8 weeks of treatment, cimetidine 2-3 weeks ( excluding delirium, which can occur after 24-48 hours). All symptoms are usually resolved self after 3 days after discontinuation of the drug. In addition it should be borne in mind that discontinuation of ranitidine cimetidine may experience a withdrawal syndrome characterized by anxiety, insomnia and irritability. You should also know. That cimetidine increases the concentration of tricyclic antidepressants in the blood, and increases their toxicity.

Tablets “analgesics”

– Perhaps, the most popular group of drugs in the masses, which are taken without a doctor’s prescription. They can cause quite serious side effects, such as mania, psychosis, depression and delirium in the elderly. The last complication occurs frequently on ketorol.

Well, that’s the list. The list is not for you to throw out all the pills that are included in it and not for you to give up the treatment that was prescribed to you. Taking many drugs is vital, and a person can not live without them. And to if you or your family something happens in terms of you need to pay attention to what drugs a person takes at the moment. Canceling the drug or replacing it with another leads to a significant improvement in a short period of time. If such a replacement is not possible, then additional treatment with psychotropic drugs is prescribed. And most importantly. Be careful with self-medication. Some tablets can aboutits. I’m talking about the abuse of non-addictive drugs.

The collection of articles by the outstanding psychotherapist A. Langle is devoted to one of the most topical issues of practical psychology, psychotherapy and psychiatry – depression. At the heart of existential-analytical work with depressed people lies the phenomenological understanding of depression as a loss of experience of the value of life. The process of therapy includes a series of successive steps that lead to work with the deep roots of depression – with a violation of the fundamental relationship with life.

At the heart of existential-analytical work with depressed people lies the phenomenological understanding of depression as a loss of experience of the value of life. The process of therapy includes a series of successive steps that lead to work with the deep roots of depression – with a violation of the fundamental relationship with life.

In the process of treatment, patients must find new ground by recreating the ability to feel the fundamental value of life and the formation of a new attitude (mainly in the process of therapeutic relationships and experiencing sadness). This goal involves a number of preparatory and accompanying actions aimed at softening, “melting” the blocking structures of the psyche that have solidified in depressive suffering and opening the Person for the process of change.

Existential Understanding of Depression

From the point of view of existential analysis, depression is a mental disorder whose severity is determined by the degree of disruption of the experience of the value of life. Depression as a mental disorder has a more or less pronounced (primary or secondary) somatic part. In addition, it harms the personal dimension, influencing attitudes and attitudes towards both the external world and the internal, as well as the ability to make decisions, the spiritual experience of the world and of oneself. Thus, depression affects all dimensions of a person: physical, mental and personal.

Specific in a depressive disorder is that the correlation with the realities of the world and with itself (primarily with the body) as such remains virtually intact. The main disorder concerns a personal measurement. The ability to perceive the value of everything that previously filled the life of a person with joy and gave meaning to it is lost. What usually pleased a person, that he experienced as a pleasant, provocative interest, fades, loses the paint. This phenomenon is known in psychotherapy as “negative affizierbarkeit”. Its existential analogue is the depletion of “spiritual food” and the loss of the ability to experience values. It’s about the content that makes our life full, causing a sense of fulfillment. These contents make our relations attractive to us, creating a desire to preserve them as long as possible. Values ​​have an animating, reinforcing and nutritional impact on both the Person and the human psyche in general. Through the experience of value, relationships are established with a deep structure of existence – with life itself. At its core, depression is a failure that a person has suffered in comprehending the value of life.

So, we can say that with depression, relations with the fundamental value of life, the ability to feel and experience it are violated.

Therapy of Depression

Existential-analytical therapy for depression should begin at all levels: at the level of relationships, on the cognitive, emotional, somatic, biographical and social levels, and this is being done today in many psychotherapeutic approaches. We are most interested in the existential nucleus.

A) In existential analysis in the treatment of depression, special attention is paid to therapeutic relationships. They must be imbued with a warm, understanding and accepting feeling. Active appeal to the patient and his trouble, empathic feeling is important because communication with the therapist represents a new contact with life, through which the patient can keep warm, and the frozen regulatory structures can “thaw”. Thus, next to the therapist, the patient acquires the opportunity to resume relationships with life. The therapist becomes like the representative of life itself, while, due to active treatment in the process of therapy, he is more likely to meet the patient than the real life in the situation of depressive retreat is capable of.

B) Address to the present and division of tasks. The depressed patient largely lives in the past. He has little actual relationship, which allows him to establish intimacy with life, all his relationships are mostly distant. To judge what life is, he can only observe others, and not on the basis of his own experience. Such a distance in relation to life disrupts its formation under specific conditions of daily life. The structure of the day, rest periods, sleep deserve special attention on the part of the therapist, since all these moments facilitate the unloading of patients. It is especially important to find out whether the patient is referring emotionally to what he is doing. Supporting the patient’s intentions to retain the ability to perform even small tasks gives him the opportunity to establish relationships with life.

C) Work on cognitive structures and misidentification. This step is not specific to existential analysis. We are talking about the disclosure and realization of “closed circles of thinking” – generalizations, generalizations of the type “always”, “never”, “all”, etc., leading to exhaustion.

D) Mobilization of personal resources and exercise in determining their position. Specific existential-analytical methods are used here, in particular, work with the central personal ability – to find and occupy one’s own position.

Self-distancing

• in relation to feelings (for example, “feelings are now frozen, but I will not allow this state to determine my behavior”);
• in relation to expectations (for example, expecting a feeling of indispensable joy from the fact that a person does something).

We are trying to develop with patients personal ways of dealing with negative feelings and such painful conditions as lack of joy. This is important, because under normal conditions, joy helps us, denoting the areas where we are closest to life. A depressed person who, when performing an activity, can not be more happy, will also perceive this fact as his own failure. As a result, there can be a gradual increase, an escalation of the negative: a person will begin to feel sad that he can not rejoice, he can not find joy for himself in anything. In therapy, one should take into account the possibility of such an injection of a negative. It is possible to alleviate the patient’s condition, if one draws his attention to the fact that during the period of “black and white cinema” (the metaphor of depression) the expectation that the feeling of joy will come to life, as soon as the conditions appear, is hardly justified. He should focus more on cognitive knowledge (the first fundamental motivation), on the intuitive sense of what is right and what is not (the third fundamental motivation), but not on the deficit feeling (the second fundamental motivation). Thus, the patient releases himself from the expectations of positive emotions and at the same time from the destructive feeling that he should rejoice, but he can not. The rupture of the vicious circle “Depression through depression” is an important element of depression therapy (work on the position).

Self-acceptance

Here it is a matter of seriously considering what you are doing, or being out of the case. It is important to establish that the action itself, too, has value, which, most likely, is more significant than it seems. Depressive patients tend to depreciate all their own (deeds, the results of their actions, dignities, etc.) or either perceive as the norm (“it should be so”), while they lose their openness to the value they really possess.

For example, if someone says that he likes to draw, but does not practice drawing, but constantly sits in front of the TV, then this may mean that watching TV for a person at this stage is more important than drawing, but he does not realize it himself. If the intrinsic value is determined for a person by the perfectionist ideas about himself as an artist, then this kind of pastime will inevitably lead to a fiasco (“I did not take place as an artist …”). In such cases, in the treatment of depression, it should be about promoting self-acceptance of the person and putting an end to attacks of daily self-depreciation. A depressed person believes that he is not engaged in important things, but is wasting his time on something insignificant: in fact, from the point of view of culture, it is more important to draw and do art, and what he is doing now does not cost anything at all. However, does not television represent a particular value for a depressed person? Perhaps, due to this source of information, he has a growing sense of closeness to real life, as a result of which the sense of loneliness loses its former acuteness? And is not this value existentially more significant than the universally recognized, but not capable of warming the soul?

If any value is a real reason for preferring a particular action, then a real evaluation will occur daily, which makes it preferable. Meanwhile, the occupation of a position in relation to this real assessment in a depressed person is usually absent or the evaluation does not correlate with the possible value that “wrong action” has, because rigid normative thinking does not allow anything like this. When a person openly admits the possible value of a rejected action, a reconciliation with oneself takes place, and the stress associated with devaluation goes away.

Personal position finding (Personale Positionsfindung – PP)

The purpose of this method is to translate the depressive “primary emotion” into an “integrated emotion”. This attempt is carried out using three steps, each of which is briefly described below by typical questions:

PP1 – position in relation to the outside world (“position outside”): What really happens? Is this really so? How do I know about this?

PP2 – position in relation to the inner world (“position inside”): If it is really so that I will lose? Could I have stood it at least once?

PP3 – position in relation to the positive: What is it for me in this situation? What for me personally is important, valuable in a broader life context?

E) Recycling the feeling that you have failed. It is necessary to find out the inability to do something and, starting from here, go through depressive feelings right up to the positive core, due to which the negative turns into a positive one: “Is there a strong side in what I consider to be weakness?” – “Is it really that I I consider incapacity, is that, or is there also an opportunity to Stand for Myself? “. Thanks to such work, an understanding of the intentions of behavior occurs and relationships with one’s own life are established.

For example, a patient with a depressive disorder comes to the reception. The reason for the visit was that she recently again found herself on something “incapable”. She accepted the invitation of her friends to sit over a cup of coffee, reached the house of one of them, where they decided to meet, was about to press the bell button, but at the last moment suddenly changed her mind and returned home. There she closed herself from everyone and indulged in depressive feelings and thoughts. She felt like she was not a capable loser. This feeling was further enhanced by the fact that she did not even call her friends to apologize.

“The inability to do something” we worked through using a phenomenological approach: what moved it when she decided to accept the invitation and go to her friend? For what reason did she not press the bell button? Why did not I call my friends when I got home? We sought to discover the hidden value of her actions. As a result of the search, it turned out that at the moment when she had to press the bell button, she was overwhelmed by the feeling that she could not meet her friends because she was depressed. She thought that would deprive them of joy if she came with such a mood. Now it became clear to her that she turned and left her for good reason – she wanted to protect her friends. In other words, she returned home because of her love for her close people. By understanding their own intentions, a sense of inability, failure, disappeared. And in relation to her depressive feelings she was now in a personal position. With her seemingly ridiculous act, she followed the values ​​that were extremely important for her: to give her friends a friendly service, not to spoil the joy of meeting them, not to burden them with the burden of their problems. The patient left the session with a feeling of relief and in her own way moved. In the wilds of depressive feelings she was able to meet and accept herself.

F) Conversion of feelings of guilt and concretization of responsibility. Depressive feelings of guilt are determined, on the one hand, by a diffuse sense of responsibility in which to clarify the real content, the true responsibility or the actual guilt. On the other hand, it comes from an overestimation of value, which also requires a critical attitude and revision.

In addition, a depressed person is inclined to fill in “emptiness”, so he makes excessive demands on himself and thereby contributes to the emergence of frustration. No one can be responsible for the feelings of others, for example, whether the mother or father is happy or unhappy. However, a depressed person feels responsible and at the same time incapable of doing anything and guilty, thereby burdening and draining himself.

G) Work on relationships. Exercise in the receiving unit in relation to values. Motto: “Doing something good for yourself every day!”. Rejecting, devaluating attitude towards oneself and the associated loss of relations with one’s own life should be reviewed and revised. Thanks to the daily exercise, concrete, decisive actions, a new life-affirming experience is acquired.

To implement this program in practice, the patient is offered the following thesis: “Nothing can be good if it is not good for me, either.” At this stage, work is carried out with blockades of value, with a perception of value, with traumatizations or losses. Lack of vitality in endogenous depression requires a special approach to treatment, for which specific steps have been developed in the existential analysis. The ability to notice and prevent depletion is also important, so the patient learns to take preventive measures.

H) Deep therapy aimed at restoring the ability to experience a fundamental value, the process of experiencing sadness as the main condition for the therapy of depression. Preparatory work at the level of values ​​precedes a deep level of existential-analytical therapy. At this level, working with the patient is to uncover and make tangible what led to the construction of a negative attitude toward life. It is divided into phases of anger, sadness and resource mobilization by further working out the attitudes and values ​​of patients.

It is obvious that if a patient is asked about whether it is good that he is and how he feels about the question “Do you like to live?”, This will affect the painful aspects of his life. The deepest point of existential-analytic therapy of depressions is seen in laying the foundation for a new patient’s attitude toward life. At the same time, it is very important to help him realize that this new attitude follows from the source of personal life, which is born in the premonition and feeling of Being here.

We can assume that the goal is achieved if we come to “Yes” in relation to life – a position that is not taken on a rational, but on a deeply felt emotional basis. Such an acquisition of a personal position occurs after an understanding of the value of life, to which the patient can reopen. He gets access to it thanks to new installations and experience. And then on the basis of a new solution, he can rise above depressive feelings, for depression in our understanding is a loss of existential fundamental motivation and an active component of personal action. The most important thing is that painful experiences make one forget how important and necessary is the appeal to life and life values. To regain this ability is helped by experiencing sadness, and sometimes – anger. Thanks to these feelings, a person again begins to feel the power of life within him: a power of tears that brings relief, or a strengthening and defending force of aggression.

Therapy of Suicidality

Suicidality is a common phenomenon in depression. If one imagines that for a long time a person has to live under the unbearable burden of depression, losing strength, suffering from an inability to act, from feeling deficient, lacking something, from feeling guilty, having lost desire and joy of life, prospects and hope, then suicidal trends can be understood. From the existential-analytical point of view, we consider the desire to deprive ourselves of life as a symptom that corresponds to an internal attitude toward life. If you consider that a depressed person values ​​his life, as if not worth it, as a burden to others, and therefore – as a source of insuperable guilt, then suicidal seems a logical consequence and even an honest expression of the experience. This negative assessment of one’s own life (in the existential analysis we call it “negative fundamental value”) leads not only to negative feelings, but also to a personal attitude that contains a solution against life. Therefore, suicidality in itself is not a disease, but a person’s decision taken in connection with a disease. The decision to realize what he thinks and feels, that is, to follow his psychic reality and his conviction. It is an act that appears to him to be truly moral within the framework of his relationship.

There are three grounds that can deter a depressed person from a self-destructive intention: a positive inner attitude toward life, fear and lack of power. The latter is especially characteristic for the middle of severe depressive phases. Therefore suicidality in the acute form is most often manifested at the beginning and at the end of the depressive phase, when the patient has enough strength to realize his intention. At the end of the phase, the risk is particularly high, because no one is waiting for suicide at this time – after all, the patient externally feels better: the negative feelings have largely receded, activity and enterprise have become more noticeable. And yet there is no basic – the reinforcement of the affirming attitude towards life. Retreat visible externally depressive feelings and lack of activity, but in the depths still remains and operates a gloomy, life rejecting life.

Let’s consider briefly the positive internal attitude towards life as the most powerful defense against suicide. It can stem from a deep belief in the value of life and rational knowledge that it is just a temporary shortage of neurotransmitters in the brain or in a mental state that corresponds to the loss of existential value and has not been personally developed, etc. Knowing the causes of a depressed state is important in order to maintain the conviction that life still has value. Persuasion is an attitude, a general solution to the fundamental value of life. Usually such a conviction is accompanied by memories of the former life, about the time when it had a positive value, which means that life has other sides that can not be seen at the moment.

Another form of inner positive attitude toward life is rooted in faith. This is an understanding of the value of life, which is based not only on a special subjective experience, but also on revelation, divine knowledge. And yet in this case the therapist should be careful: a belief that does not rest on its own experience and is not connected with memories of the positive value of life, can not always withstand the pressure and weight of depression.

Finally, the hidden form of a positive inner attitude is the rejection of suicide due to lack of courage. In this sense of “cowardice”, as patients call their setting in a typical self-deprecating and self-aggressive manner, phenomenology reveals uncertainty, doubt, hidden hope, an unrecognized impulse towards the fact that in the end life could be something good, or, that it is inherently inviolable. For such a definite and categorical solution, one often encounters the content of an experience whose meaning exceeds any logic and argumentation. It is important for therapists to see and take into account what is hidden behind such words, because then they can better help the patient in revealing his personality.

In suicide therapy, the following is important:

a) propose and work with the patient to understand the situation;

b) take from the patient a promise that he will not commit suicide;

c) if the patient refuses such a promise, it is mandatory to ensure a constant presence next to the patient of other people.

A) The therapist invites the patient to talk about his desire to commit suicide, his intentions or plans. Since here we can talk about concealed intentions, an empathic formulation is needed that will help the patient either to hear and accept the question, or to circumvent the intention concealed by him. For example: “I understand the situation in which you are now. You carry a huge load … And I admit that in such a situation the desire to live can disappear, up to the point that there is a thought … to put an end to life … Do you have such a feeling? “- Thus, the patient may feel understood and, if agreed, react with relief. Among other things, this understanding strengthens the relationship with the therapist.

If the patient does not experience similar impulses and feelings, then this request in any case will not cause harm. Some therapists are afraid that such a question will negatively affect the patient or even bring him closer to suicide. A person who does not have suicidal intentions, even if he is in a state of depression, can perceive this issue more likely as a challenge to his positive attitude towards the life situation and will respond with something like: “My situation is not so heavy!”

The one who is visited by suicidal thoughts will react differently. Either he will agree with relief, feeling that he is being understood, or for various reasons will try to hide his intentions. This may be a desire to avoid hospitalization and drug treatment; or the patient does not trust the therapist so much that he can talk to him on such a difficult subject, finally, he happens to be already determined and would not want someone to interfere with the execution of his plan. Then we should expect that the patient will indignantly reject this assumption.

How can we recognize the danger of dissimulation? To this end, V. Frankl already in the 1920s proposed a method that is widely used today. At that time, he headed the department where the suicidal patients were. On the eve of their discharge, he had to assess the risk that they could commit suicide. He developed a short survey technique, with which it was possible to estimate the danger of dissimulation with the necessary accuracy. The questions were indirectly centered around how the patient relates to the meaning. The author of the method relied on the following observation: if the patient sees the meaning in his life, this reduces the risk of suicide, if he does not see such a meaning, then nothing can keep him. Meaning – an important auxiliary tool (hilfsmittel), a resource that allows you to overcome suicidal.

The detection of latent suicide begins, as already noted, with the questioning of possible suicidal tendencies. If the patient intends to dissimulate, he will try to dispel the therapist’s doubts: “No, I have no such thoughts … It would never have occurred to me … Do not worry!”, Etc. With such an answer, the possible dissimulation will help uncover the question, at first glance, unexpected: “Why would you not do this? What gives you such confidence? “In the case of dissimulation, the patient usually surprises, begins to stutter:” No, rather no, I will not do it, do not worry, rest assured, I will not do it …! “Dissimulation is recognized on the basis of, that a person can not relate to the meaning and ask for a specific content. If the patient does not dissimulate, he calmly gives his arguments, for example, says: “I have a family … there is this or that task … I would not want to do this, knowing how my wife will suffer … out of fear before God … “, etc.

B) Patients with suicidal intentions are asked if they can promise that they will not do anything to themselves. It is not recommended to ask a general question: “Can you promise that you will not kill yourself?” Most people will not be able to give such a promise. The question should be more specific and designed for a certain time interval: “Can you promise me that this month (or this week) do you no harm yourself?” In severe cases, the question should be even narrower: “Can you promise me, that tomorrow we’ll see each other again? “

In acute and particularly acute cases, the only content that a promise can relate to is the relationship between the therapist and the patient, and not the possible act. “Can you promise me that in any case, contact me if your thoughts revolve around suicide? Can you promise that you will call me if you understand that you can not guarantee that you will not do anything with yourself? Promise me that in that case, you will most likely call, be it a night or a day before you decide on this act. ” It is necessary to consolidate this promise with a handshake, while openly looking into each other’s eyes. If the patient tries to avoid a handshake (or if it is not strong), if he avoids the look, then he should insist that the binding of the arrangement is normal. If the patient chooses to do this, then it can be guaranteed with a high probability that he will not break his promise. Such a promise has great weight, for it is hard to die with a broken promise!

C) If a promise is not obtained from the patient, then the situation should be regarded as critical, as an immanent suicide. In this case, you can not leave the patient alone. Recommended hospitalization. If this is not possible, then a social network should be established from credible individuals who are able to take responsibility and ensure that they are vigilant. It will be a fatal mistake to send the patient home without making sure that he is there to be provided with reliable supervision (while one can not rely solely on the patient’s assurances!).

Prevention of Depression

Let us consider a few more points concerning the prevention of depression and psycho-hygiene.

Savings and restoration of forces (care of forces). Prevention is to closely monitor the areas of depletion and be sensitive to areas where there is a loss of strength. This often happens where a person acts out of a sense of duty or exerts too much effort on something, for example, at work, while driving a car, even in the process of washing dishes late at night after a work day. Such stress factors should be realized, because they take a lot of energy, and often it leads to irritability, to the appearance of muscle tension (especially in the shoulder region and back). Proper organization of rest, attentive attitude to the duration of sleep, to breaks, to sports, the regime of the day, the planning of the week can prevent loss of strength and exhaustion. Rhythmicity and regularity make life easier. there is no need to make decisions. It is important to live according to your pace, for, as experience shows, there is a depletion share in any depression.

Medicines. To the care of the forces and, thus, to the area of the first fundamental condition of the fulfilled existence, the use of medicines also applies. Long-term use of antidepressants, as well as lithium, is a proven means of preventing depression.

Care of valuables. To preserve the joy of life and vitality, it is important to pay attention to what you like. The fundamental feeling – it’s good that you live, that you are in the world – should be preserved and, if possible, strengthened. For this, the experience that leads a person to relationships with values is important. This means the following:

• To look after pleasant experiences, knowing that where there is joy, there is life. It is not enough to know what would be useful, you must also experience it and do it.
• Enjoy the values of experience, give them time, turn to them.
• To look after the relationship.
• With things that are important to a person, treating as a value is a culture of life.
• To take care of the body, to move more, to go in for sports. Pay attention to good physical well-being. For the senses, the body is like a wax for a candle flame.

Appeal to life’s obstacles, to what takes a person’s life:

• Ask yourself questions about the cause of loading feelings (Belastende Gefühle) and discuss them with others.
  Start to feel sad if there is no sadness.
• To turn to disappointments and losses, to accept a feeling connected with failure or failure. If there is no appeal to these vital obstacles, the soul holds on to what is denied by reason, and this inevitably leads to depression.

Careful use of time. Time is always a time of life. Thanks to careful use of time, people pay attention to the love of their own lives. Specifically, this means: if possible, do only what is important to you, and avoid wasting time on the secondary. For a depressed person, compliance with this rule is particularly significant. Do not set yourself apart again and again, do not give up yourself for others.

Special work on installations. A depressed person is prone to subordination, especially at the onset of depression. It is peculiar to him to adapt to “deserve” a valuable closeness, to submit to fate or authority. It is necessary to work on the fact that it is important to fight for oneself, to live their desires, needs, requests. It is necessary to critically examine and change the depressive “ideal” picture: it is by no means always good to be modest and “push” yourself. Working with desires: desires conceal the danger of latent passivity. A person is given to desires if he expects others to fulfill them. Because of fixation on desire to possess something that he does not have, a person experiences a scarce side of life much more strongly. The basic rule is: desires are good as long as the opportunity remains to abandon them. Work on the installation of self-esteem: to maintain or increase self-esteem, it is important to feel disrespect from others, do not tolerate disrespect. If it is, it is important to talk about it as prevention.