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Rewire Your Burned-out Brain

Burnout often results from extended periods enduring the emotional stress precipitated by unaccomplished expectations or failure to fulfill unreasonable demands. The symptoms can include intensified emotional exhaustion, physical fatigue, lowered self-worth, changes in eating and exercising habits, social withdrawal, sleep disorders, anxiety, and depression.

If You’re Burned Out, Your Brain Has Rewired to Survival Mode

There are specific and reproducible patterns of changing neural activity and brain connectivity associated with the stress buildup that leads to burnout. In the high-stress state subjects’ neuroimaging scans reveal less activity in the higher, reflective brain (Prefrontal cortex/PFC) and more activity in the lower, reactive brain that controls involuntary behaviors and emotional responses. Prolonged stress correlates with structural increases in the density and speed of the neuron-to-neuron connections in the emotion-driven reactive networks of the lower brain and corresponding decreases connections in prefrontal cortex conscious and reflective control centers.

The explanation of these changes is attributed to the brain’s neuroplasticity defined by the phrase: “neurons that fire together, wire together.” The brain literally rewires to be more efficient in conducting information through the circuits that are most frequently activated.

When stress is frequent, the more frequent activation of the neural pathways to the lower, stress-reactive brain results in their strengthening from enhanced wiring (dendrites, synapses, myelinated axons). These pathways can become so strong that they become your brain’s fast route to its lower, reactive control centers. The stressful, burned out state when the lower, reactive brain is in charge overcomes the calm, reflective, and productive higher neural processing in the (PFC) – the preferred brain locale for control of behavior and emotional self-management.

As your efforts to achieve unreasonable goals are thwarted or increasing demands recur, and the lower brain dominates more frequently, you lose touch with your reflective brain. With less management coming from your reflective PFC, it becomes harder and harder to logically see these challenges in realistic perspective or to solve problems creatively.

Disappointments take on more emotional power and without your higher brain’s perspective, they are interpreted as personal failures. Your self-doubt and stress further activate and strengthen your brain’s involuntary, reactive neural networks. The spiral down to burnout accelerates as these circuits become the automatic go-to networks. Your brain achieves less success in problem-solving and emotional control and ultimately reacts by withholding efforts to escape the burnout state.

Reset Your Brain’s Default Neural Network from Retreat to IGNITE!

The good news is you can apply what we’ve learned from neuroscience about your brain’s survival mode to take actions to retrieve voluntary control of your choices and emotional wellbeing.

You can activate the same neuroplasticity, that gave dominance to the lower brain networks in the burnout state, to construct a new, stronger positive default response. With increasing successful experiences in achieving goals, you can reset the circuits to redirect your brain to access its highest cognitive resources. You can build up newly improved circuitry switching your responses from retreat to IGNITE for mindful awareness and creative problem-solving!

Since an effort-failure pattern sets up the brain’s survival response to withhold effort, you’ll need to strengthen your brain’s recognition that effort toward your goals can result in success. Your weapon of mass reconstruction can come from your brain’s very powerful drive for its own intrinsic neurochemical reward— dopamine and the deeply satisfying and motivating pleasure it brings. When the brain releases dopamine in rewarding bursts, you experience a deep intrinsic satisfaction along with increased motivation, curiosity, perseverance, and memory. Dopamine is particularly released when your brain recognizes that you’ve achieved a challenge (from the “I get it” of figuring out a joke to the satisfaction of completing a marathon).

To get the dopamine-pleasure response from challenges achieved, you’ll need to plan for your brain to experience frequent recognition (feedback awareness) of incremental progress. The choices of what you set as a goal should be guided by their desirability and the goal’s suitability to be broken down into clear segments. You want to set goals, the progress of which, you can chart or easily recognize with each stepwise challenge and success. The pleasure burst of dopamine’s intrinsic motivation accompanying your brain’s recognition of each progressive increment achieved in the goal pathway will keep you motivated to persevere.

Goal Buy-In for Your Brain’s Neural REWIRING

Buy-in and relevance are important in choosing your rewiring goal. Since your goal is to rewire your brain’s expectations that your goal efforts do yield progress, despite increasing challenge, you need to really want the goal. This is not the time to challenge yourself with something you feel you should do, but won’t really look forward to, such as dieting, climbing stadium stairs, or flossing after every meal.

The idea of planning and achieving goals as a burnout intervention is probably not new to you. These are likely to be activities you’ve considered but didn’t do for the obvious reason. They take time. when it comes to adding another activity to your schedule, past experiences have left you with the expectation that there is not enough time.

These first goals that can provide ongoing awareness of your progress are often tangible (visible, such as planting a garden or making pottery on a wheel, or auditory such as playing an instrument, or physical such as learning tai chi), but your goal can also be spending more time at something you already do, but want to do more frequently or successfully, such as journaling, practicing yoga, or sketching.

You’ll Find Your Own Goal for Buy-In, but Here are Some Examples of Planning

Physical goals: Notice I didn’t say exercise. That’s not as motivating as “training” for a physical goal you want to achieve, even though they often overlap. If you want to run a 10K, and you enjoy running, the goal for an achievable challenge could first be building up to the distance starting with your baseline distance you comfortably run now. Then, plot out the increments that you’ll consider progressive successes, such as adding 100M each day or a week (with increments based on what you consider both challenging and achievable). Once you reach 10K goal, speed can become the next goal again plotted out in segments of incremental progress before you start.

Hobbies: From woodworking to shooting wooden arrows, hobbies really are opportunities for brain rewiring. Again, plan your stepwise achievable challenge increments. If you select darts, start with a home dartboard—low initial investment and throw from a close, but challenging distance at first. As you get better in accuracy move back further. Record your results with the notations of the distance of each improvement you set as an achievable challenge. If you get so good that you are no longer challenged by the dartboard, try that archery!

Mindfulness and meditation are certainly positive interventions for burnout and will be topics of a subsequent blog.

Your Rewired Brain’s Default Changes from Defeat to Ignite

With your understanding of what happened in your brain to create the hopeless frustration of burnout, you’ll hopefully have more positive expectations to help you put in the effort to try (or retry) suggested interventions. Your own natural dopamine-reward system will then be at work deconstructing the resistance network built by your burnout as you reset your circuits of motivation.

The repeated experiences of dopamine-reward you’ll experience as you monitor your goal progress will literally change your brain’s circuitry. Repeated effort-reward experiences promote the neuroplasticity creating neural networks that expect positive outcomes in your new default network. This is because your brain will build stronger connections into the memory pattern. The expectation in achieving this challenge will bring pleasure. As with other less used networks, the previous lower brain stress-activated go-to response network you developed in burn-out, that caused you to react negatively to stressors, will be pruned away from disuse.

You’ll be rewired with optimism and renew positive expectations about your self-efficacy. With your higher, reflective brain back in control, as you access your perseverance, innovation, and creative problem-solving when you need them.

Just be sure to take the time to break down big challenges into opportunities to recognize incremental progress as you achieve each small step en route to your goals. With that positive recharge, your well-deserved dopamine reward will sustain your brain’s motivated perseverance on to the next step of the path to your goals.

Dr. Judy Willis is a board-certified neurologist and middle school teacher, specializing in brain research regarding learning and the brain. With a unique background as both a neurologist and classroom teacher, she writes extensively for professional educational and parenting journals and has written six books about applying the mind, brain, and education research to classroom teaching and parenting strategies. The Association of Educational Publishers honored Dr. Willis as a finalist for the Distinguished Achievement Award for her educational writing. Check out her website.

Depression and Loss of Energy: A Waiting Game

Reversing the downward spiral of depression takes less energy than you think.

Depression and loss of energy — it is the beginning of a waiting game that does not end well.

Sometimes depression is born from loss of achievement, loss of goals, and loss of positive feelings about oneself. When low energy plays a role, a person who is not blessed with high drive and physical energy can see a spiral into depression start quickly. But even people with more energy lose it while bearing the weight of the losses. And, without a lot of energy, people begin to wait for things to get better around them rather than take action to make a change.

The Downward Spiral

Spiraling — the word makes it seem like a gentle way to go down, but when it comes to depression, going down is hard to stop, and once at the bottom, reversing the spiral takes intention and support. I hear about this often from my younger depressed clients — those adults who started out of high school or college ready to be successful but who found the world did not fulfill the vision they had.

Jeremy (not his real name) was one such young man. He never had to work too hard to get a passable grade point and was popular enough to have a solid romantic relationship. He was ready happy with his life. But, as commonly happens, the college romance did not last, which made him feel down in the dumps. Then the company he worked for, facing hard times, cut his hours. He now did not earn enough to live on but he expected the company, not himself, to change and he took no action. He waited for work to increase his hours, but in the meantime, he felt like a failure, and the waiting sapped him. His self-esteem, already suffering from being single again, took another hit as he saw his money dwindle to nothing. He started to isolate himself from friends without funds for fun and without a date to go along. Waiting was his enemy. Without meaningful activity beyond limited work hours, that isolation increased his depressed mood.

Waiting also intensified the mental and physical fatigue, so he slept later in the morning since he did not have to get to work early. He began to think he had a lot of time every day to work on his situation, so he did not start on possible job hunting and, as the day melted away, it was too easy to let himself decide that tomorrow was a good day to start fresh. But that waiting also increased his fear that nothing could change and his mood became very depressed. That depression and his situation robbed him of the very things he needed to reverse the spiral: meaningful work (purpose, as well as money), positive interactions with others, pride in his achievements, sense of competency, and a feeling of being loved.

This spiral is one I have seen repeatedly in young adults who have not met with easy success out of high school or college. They often did not have to work at jobs during those years to obtain phones or cars or clothes or do costly activities, such as attend concerts or sporting events. One young man I worked with as he finished high school, Casen (again, a pseudonym), felt literally terrified of applying for a part time job so that he could begin developing job skills and a resume and have some spare cash. Without classroom demands, he moved into waiting mode: waiting to apply to community college, waiting for a job that might fall into his lap. (The job that a friend would provide not that Casen would go search for since the friend said he could get his boss to hire Casen). Waiting did not bring him the job or the college acceptance letter, and he felt even more scared and more depressed. And he judged himself rather mercilessly: believing he would never succeed. That negative mindset robbed him of even more energy, and the more time he spent watching shows on his laptop, the less energy he had to reverse the downward spiral to depression.

What can be done about this? It is typical that an outside force will help. If you are reading this you might be saying to yourself phrases like, “Yeah — the outside force of getting evicted or starving! That would work!” If so, you would be correctly identifying motivators! At times, though, a person in a downward spiral ends up living with family or friends who are being helpful to them in averting disaster, but the pattern of waiting on something outside themselves does not change until motivation can pick up.

Reversing the Downward Spiral

How is it possible to reverse the spiral? Raising energy is a primary initial goal — with or without motivation. To start the spiral on an upward trend, simply:

Stop telling yourself negative things: you only reinforce the belief they are true. Interfere with negativity, saying, “Stop! I choose to believe I will solve this!”

Stop isolating. Get in contact with people, any interaction with others will help you also get outside of your own negative thoughts or mood.

Stop talking about your own life for a short while. When you only ruminate on your troubles, they seem larger. Ask someone else about his or her life. Hearing about another’s life, you can look at your reactions. I love the saying that troubles shared are cut in half and joys shared are doubled.

Then start the upward spiral with attention to developing a sense of purpose. Don’t assume this is a deep spiritual quest. In fact, it can be initially as simple as scheduling your day and meeting some regular commitments. An important brain change toward a less depressed mood occurs results from intentional activity. You get a blip of glutamate, an activating neurochemical, and one of dopamine, the feel-good neurochemical, and the combination is energizing. The bigger the step you take, the more you get. And any action will supply enough energy to do a little more.

My Tips

If you are underemployed — set a daily schedule that begins with a reasonable wake-up time.

Have a pattern to the day what news show you listen to or watch when you have your coffee when you feed a pet or meet a friend for tea.

Leave the house — you might have to start with leaving your room and interacting with others in your home- but forcing yourself toward less isolation is important.

At work, be sure to talk to your colleagues and ask them how they are; It improves the chance of a positive social exchange that can increase your self-esteem a bit and moves the spiral upward a fraction.

Set small goals — like walking the dog an extra 5 minutes — and notice you achieved them. There’s a bit more glutamate and dopamine!

Do something physical. When you move your depressed body you gain energy rather than lose it, so even a few minutes of tidying up can raise enough energy to do a bit more.

The above ideas tend to work best when you are working with another person who supports you, such as a therapist, a 12-Step sponsor, or a good friend who knows your goals and will help you keep track of them.

As you stop the waiting game — that passive waiting for life to change without you doing something to change it — the spiral reverses. You will be surprised that you will slowly feel your energy rise so you will be more able to take the next steps toward success.

By Dr. Margaret Wehrenberg, Psy.D.

This article first appeared in Psychology Today website.

Dr. Wehrenberg is the author of 5 books published by W.W. Norton, including The 10 Best Ever Anxiety Management Techniques, The 10 Best Ever Depression Management Techniques and her most recent 10 Best Anxiety Busters, an ideal book for the general public. She earned her M.A. studying psychodrama and bioenergetics, and had years of experience as a certified drug and alcoholism counselor, before earning her Psy.D. She now specializes in treating anxiety and depression and has a private practice in Naperville, IL. She is a frequent contributor of articles to The Psychotherapy Networker magazine, has contributed a chapter to Clinical Pearls of Wisdom (Ed. M. Kerman), and has produced CD for breathing, muscle relaxation and imagery for anxiety management. Check out her website at www.margaretwehrenberg.com.

My Struggle With Bipolar Depression and Dream to Go to Law School

I’ve struggled to write this blog, just like I’ve struggled to do most things for what amounts to a very long time now-so long that it feels like a lifetime and what came before only fragments of a not well remembered dream. In actual temporal time, it’s only a few years of melancholy and moderately severe major depression. But in the life of the mind, there is an unbridgeable chasm between the person I am now, who I once was, and who I want to become. I am so lost in my isolation that my only refuge is in turning inward; a strategy which offers no solace at all-only shame and regret.

I feel so isolated. I suppose that is one of the hallmarks of mental illness – detachment – that it seems impossible to relate to anyone. Furthermore, I’m not an attorney, just someone who has lived the hells and wonderful peaks of manic depression. My exposure to the law is through my father, my uncles, my cousins, and Dan Lukasik. I hope to go to law school one day, but I need to retake the LSAT first. So why write a blog? What good could it possibly do? Hopefully, some of the sentiments I describe will resonate with you. But hope is fickle; a thinly stitched veneer stretched tautly over an ever-widening mire of unfulfilled promise. When I look back at what I hoped for, most of it has faded into the mists of time with barely even the trace of memory or, worse yet, has been completely buried beneath the scars of regret.

In the face of my futility, my stupidity, my selfishness, my demons, hope that I can one day return the love and support that has been given me has allowed me to trudge on, kept me from giving up. Even if it flies in the face of all rational thinking, experience, and who you believe you are the sole advice I would deign to give is to no never give up hope that you can bring yourself to a better place and can make yourself into the person you wish to become. Though there be no reason to believe, allow belief to inspire you all the same.

“I can only stand apart and sympathize/ For we are always what our situations hand us/ It’s either sadness or euphoria.”

The above is a stanza from Billy Joel’s song “Summer, Highland Falls” that has always resonated with me. The song itself captures the sense of helplessness, at times even ironic apathy, I have felt towards a disease (or mental illness or whatever I should call it) that has allowed me to leap through the heights of “euphoria”, and to spiral down into the depths of suicidal depression, seemingly completely independent of any of the external aspects of my life.

I once told a friend that in the past three months I had had at least 45 “perfect days” (i.e., days that I could not imagine being any happier in), but that 45 was a conservative estimate and it was probably more. I’ve also spent weeks on end consumed by vivid images of ways in which I could gruesomely kill myself. And both of these emotions, which at the time feel so pervasive and all encompassing, occurred while living on the same college campus and surrounded by many of the same people. So it’s hard not to “stand apart and sympathize” with the fact that regardless of daily accomplishments or minor setbacks, or even in the face of significant change, it doesn’t matter what you do. That because of who you are, in a very intimate and fundamental sense, you are going to experience “either sadness or euphoria,” and you have little say in how intensely you are going to experience that emotion, or for how long (so let’s hope its euphoria, and it lasts forever).

This complete lack of control has always weighed on me as a moral failure because I’ve recognized what I consider the best version of myself-productive, engaged, intelligent, charming and yet, due to an inherent weakness, have been unable to maintain that persona consistently.

Instead I, and I would like to emphasize the contradiction and confusion surrounding a feeling at once of helplessness and simultaneously of complete responsibility for being who I am, have eventually always succumbed to periodic bouts of anxiety, negativity, and self-doubt. These periods have always been characterized by an intense sense of isolation in which almost palpable barriers are restricting me from coming into touch with the people and events surrounding me while at the same time engaging/suppressing the most endearing aspects of who I would hope to be as a person.

There are two types of sadness which result from this frustration and alienation.

Painful Sadness

There is a horrible, painful sadness. For me, this type of sadness is expressed through intense suicidal ideation-constant mental images meant to shock the senses into an acknowledgment of how base you are. Brutal beatings, stabbings, gouging’s, hangings. It consumes you until the idea is all there is and it takes every ounce of energy you have to beat it back. And it breaks your heart to see someone you love not to be able to say that this is how you feel, and it’s not their fault, but you are worlds away and mired in a sadness/loathing that is impossible to understand for those who have not yet experienced it. And they love you, so they are trying to understand, but, how could they? And this breaks your heart even more.

Cleansing Sadness

And there is also a beautiful, cleansing sadness. For me, this beautiful sadness feels more real than anything in the world. When I have been at the height of mania-during the happiest times of my life, I have still felt intimately in tune with songs that deal with regret-juxtaposing the inadequacy of the self with the intrinsic sublimity of some other-which you have failed.

There is a powerlessness to this beautiful sadness, an inevitability. It is real because it exists at the core of our most vulnerable selves, and therefore its expression comes out at a time when we are “most alive” and most in tune with our emotional intuition-when we are most ready to admit to and grasp on to that which we truly hope for and believe in. This sadness is not manifested in horrifying suicidal ideations but rather in the awe-inspiring idea that we are not worthy of the wonderful phenomena we call life. That we are ashamed of our ugliness amidst so much beauty and yet, in spite of our baseness, we have the opportunity to exist within as well as work towards some greater good.

Mania

In many senses, for me, the mania of bipolar has been synonymous with stripping away the debilitating fear and anxiety which were so constricting for so long, and a constant struggle has been not to glorify it. My Mom is taking a wonderful self-help course entitled “Fearless Living” and those two words, again from my experience, imbibe what it means to be manic or hypo manic; imbued with amazing amounts of self-confidence and gratitude, it’s unbelievably easy to live a carefree, upbeat, happy-go-lucky lifestyle, all the while being extraordinarily productive. Thus thinking in the binary can be dangerous-there is a natural tendency to see every aspect of the mania as better than every aspect of the depression.

However, beyond the fact that I have never been able to sustain mania, there is also a depth of feeling engendered by the sincere melancholy of depression that I have never encountered in the euphoric whirlwinds of mania. And I think the small silver lining to what is a dark cloud is the depth of meaning such great sorrow can expose you to-in a way an almost redemptive suffering. At the very least, though depression has taught me to hate myself many times over, it has also taught me to love life. The sad beauty of such a self-effacing distinction, to hate your being while loving your existence, is something to be thankful for and, hopefully in time, something to build off of for the future.

I would like to close this blog with what have for me been some solid building blocks for sheltering myself from, coping with, and eventually recovering from depression.

Exercise

When there seems to be nowhere to turn and the prospect of getting through the day seems unbearable, working out and (especially) yoga exercises are blocks of time where you don’t have to interact with other people, can be totally in your head, and when you’re done you feel a little better physically, even if not mentally. Really any small thing that you can do consistently and through which you can mark progress-I’m getting stronger, better endurance, or greater flexibility-is a wonderful way to establish extrinsic markers of success-I’m better at this than I was a few weeks ago, which, in turn, can catalyze good feelings about yourself as a person.

Think of something you’ve always wanted to do or be good at, and then identify manageable steps that you can take on a consistent basis that gradually takes you towards your goal. Don’t say I need to be as good as someone else or make an arbitrary benchmark-rather say I want to get in better shape relative to how I am right now, so I’m going to run or go to yoga more often. Or I’ve always wanted to know how to tie my flies, shuffle a deck of cards, play an instrument, or speak a foreign language, so I’m going to work on this task a few minutes each day as opposed to watching TV or surfing the web.

Taking little steps like these that are working towards longer goals, even if you are not aware of any specific professional or extrinsic benefits to achieving those goals, can be inherently rewarding in and of themselves. If you’re better at an activity, any activity, then you were a few weeks ago, that can be one small thing that you feel good about, even as the rest of your world remains shrouded in darkness. It can help motivate you to get through the day, can serve as a spring towards other “productive” behavior, and eventually be something you can hang your hat on. However, it’s important not to beat yourself up after a day in which you failed to take your positive “step”-rather have a little self compassion and say tomorrow is a new day, and it’s not the end of the world, indeed its completely ok, that I wasn’t able to do anything “productive” today.

Finally, reading and writing can be extremely cathartic. Reading great literature can give you an emotional connection to characters, ideas, and feelings during a time when you felt completely isolated and estranged from the outside world. Fiction and non-fiction distract you from the constant stream of negative and self-critical thinking that can paralyze you. And, in a way similar to the steps discussed above, finishing a book you’ve always wanted to read or one on a subject that you’ve wanted to know more about, can generate a (no matter how small) sense of accomplishment that, no matter how insidiously it attempts to, the depression cannot take away.

On the other hand, for me, writing is more of a risk. I can be very critical of myself as a writer-a case in point is this blog which has been taxing at times-and sometimes end up feeling worse after sitting down to write. At other times, writing has been akin to therapy in that it has helped me to sincerely articulate-in the best way I know how the complex matrix of emotions enmeshed within me. Even if journaling or poetry don’t make sense to a single other person, the fact that they make sense to you can temporarily relieve part of the burden imposed by self-guilt and personal shame. It can be an outlet for your anguish, space where you can be authentically yourself. Sometimes, you can be so overwhelmed by your depressive thinking that you need some way to release that thinking-writing can be an effective way to do this.

In any case, don’t immediately sit down and assume that because of your depth of feeling you’re going to write the next great American novel. Rather start with a paragraph or a poem. It might end up being useless junk that you never look at again, and that’s ok, because part of what depression is, is a needless anguish and self-doubt that is inhibiting you in your quest to live a full life and should be discarded as soon as possible. But amidst the uselessness you may stumble upon small snippets of truth-a rhyming couplet here, a few sentences there-that satisfactorily express for you one of the tragic and meaningful aspects of your condition (or symbolically the human condition more generally). These small snippets are worth holding onto as they reflect the deeper truths embedded within a malaise that so often brings us to our knees and which, on sublimely rare occasions, reveals insights that one (I believe) can only obtain through suffering.

Anonymous

SHUTDOWN: WHY PEOPLE WITH DEPRESSION FEEL SO NEGATIVE

Depression is a state of shutdown in which an individual’s psychological system shifts toward negative feeling states and diminishes the positive feeling states. The hallmark features of a depressive episode is a high negative mood state (characterized primarily in terms of depressed/demoralized/defeated/despairing feelings and secondarily in terms of anxiety, irritability/defensive hostility, and guilt/shame) and a diminished positive mood state (loss of interest, pleasure, energy, desire, and excitement).

Why do people get depressed? The primary reason people enter depressive shutdowns because they cannot obtain the necessary psychological nourishment needed to energize their behavioral investment system. Think of it as being akin to a state of starvation, only instead of physiological nutrition, the individual is lacking psychological nutrition. What is psychological nutrition? The fundamental principle that underlies psychological organization is that of behavioral investment. The psychological system is organized to direct mental energy and action toward investments that offer a return on those expenditures. When one is a getting a good return on one’s investments, then one feels fulfilled, energized and engaged. However, when one is not getting a good return, one begins to feel frustrated, anxious, irritable, or disappointed. If one cannot find an effective pathway for getting one’s needs met, one begins to enter into a state of psychological shutdown called depression.

So what are the core psychological needs that people have that need to be nourished? There are many different possible classification systems of needs (and motives and goals that people seek fulfillment around, see, e.g., here). I offer five categories here that overlap loosely with Maslow’s classic hierarchy of needs.

Safety and Security Needs. First and foremost, the psychological investment system is concerned with basic safety and survival. If one’s physical safety is chronically threatened, if one is in constant pain, if one is chronically hungry, and so forth, the attention of the system will largely be focused here.

The Base Pleasures. Good sex, tasty food, relaxing on a warm summer day on the beach after working hard. The “hedonic” pleasures serve as a fundamental reward and signal positive investments (at least in the short term). Good investment systems are generally characterized by meaningful effort and hard work toward a productive goal, followed by short periods of relaxing and enjoying the base pleasures.

Relational Needs. Our core psychosocial need is to be known and valued by important others. Most notably, this includes being known and valued by members of our family of origin, friends/peers, romantic partners, and community. Needs for relational value are reflective of one’s degree of social influence. And folks go about achieving social influence and relational value in different ways. For example, see here for power and achievement needs relative to belonging and intimacy needs.

Developmental Growth Needs. We can think about an individual’s psychological system as being akin to an investor’s portfolio. An investor has resources that have the potential for growth and loss. An investor with a diverse portfolio whose investments are growing in a way that is exceeding expectation is flourishing. The same is true for an individual. Each individual will have “personal projects” that are engagements they are involved in that afford opportunities for growth (hobbies, interests, creative and playful endeavors, meaningful work projects, etc.). If an individual is chronically stuck and not growing or is largely cutoff from their growth pathways, or is frequently failing to meet expectations, or is deeply investing in pathways based on extrinsic reasons that are not consistent with their underlying emotional/motivational needs (or intuitive sense of potential), then the investment system is vulnerable.

Existential/Transcendental/Virtuous Needs. Adult humans are meaning-making creatures that need to have a narrative for how their lives and personal projects make sense. As Victor Frankl notes in his timeless classic Man’s Search for Meaning, if they cannot place their suffering, personal projects, virtues and relationships in the context of a larger narrative that provides meaning, then they will be vulnerable to developing a nihilistic attitude, which is the belief that their lives or actions really don’t matter, because really nothing matters. A nihilistic narrative can undercut the emotional value that folks get from engaging in such projects, leading to existential crises or depressions.

Why do people have trouble getting their psychological needs met? Sometimes the answer is obvious. For example, consider the city of Aleppo in Syria. The people of that city have been completely brutalized and many folks there undoubtedly feel depressed. (As an interesting aside, it is worth noting that the field of psychiatry/clinical psychology is divided as to whether such individuals should be considered “clinically depressed”). In other obvious cases, folks get depressed because of chronic pain or illness, or death of a loved one or because they get addicted so substances that ruin their lives or because they are abused or isolated.

Other times the issue is much more complicated. Consider that there are many people that live in nice houses and seem to be surrounded by caring people and are achieving in their lives, yet they also get depressed. Indeed, despite the fact that we have more and more technology and more and more resources and control over our environment, we seem to be struggling more than ever with feelings of depression and anxiety. What is going on in these cases?

The short answer is that I think the modern, fast-paced society is placing many new, unusual stressors on our emotional system. And I don’t think people have been well-educated about how to appropriately process negative feelings. People have been given much more freedom to acknowledge negative feelings than in past generations (read this story to see what I mean), but there has not been good education on how to learn and grow from such feelings (see here or here). What I see in my clinic is that individuals try to avoid negative feelings, and wish everything would just be fine. They often try to act publicly like everything is fine, but they have no idea how to maturely process and learn from their negative feelings. Instead, they enter into an intra-psychic battle with their negative feelings, often working to banish them, or criticize themselves out of their feelings or try to “stay positive”. This creates a powerful “split” in their psychological systems. Namely, their feeling system is sending one signal, their internal narrator is in conflict with that signal, and they are trying to publicly present a totally different image than their inner conflict. All of this sets the stage for a “neurotic breakdown”.

In addition, I see many parents who value their kids, but who do not know how to guide their children in processing negative feelings. Instead, too many have been caught up in “self-esteem nation” and act in an overprotective way, essentially communicating both that their kids are fragile and that others are responsible for keeping you happy. Another group teaches their kids to repress and minimize their feelings. I am not blaming parents here. The modern world is complicated and psychologists and psychiatrists have generally not done a great job being clear about the nature of emotions and relational needs.

At the societal level, we need to recognize both the dramatic changes the information technological revolution has brought to our world and how many of the institutions that provided guidance for the good life are breaking down. Religious systems have lost much of their authority. The political system has broken down into a polarized way. I think our educational system is broken in the way it assesses performance and fails to teach character values. Science often seems to characterize the world as an amoral, meaningless physical system. In other words, in terms of our existential/transcendental understanding, there seems little that supports the deep-seated need that many people have for true meaning making. So, we live in a fast-paced, high-stress world in which we are overloaded with choice, we regularly observe massive amounts of inequity in power and resources, we give lip service to negative feelings but often characterize them as disease states and provide very little real education about human emotions and needs, and institutions that provided deep meaning making systems have lost their authority.

The bottom line is that depression arises, in most cases, when people do not receive the necessary psychological nourishment from their investments. This arises because of brutal environments and injury from traumas, diminished capacities to meet growth expectations, intrapsychic and interpersonal conflict with important others. Unable to find a path forward folks shutdown and, unfortunately, getting depressed in modern society likely creates more problems than it solves. So folks get trapped in neurotic depressive cycles.

There is clearly no easy fix, as depression is a massive health problem. But I do believe there is much that can be done. We need (and can achieve) a much better shared understanding of human psychological needs and nourishment. We also need a clear recognition from institutions like the World Health Organization that depression emerges as a function of psychological malnourishment, rather than being brain disease stemming from neurological malfunctions.

My ultimate vision is for the development of a holistic meaning-making system that harmonizes the natural sciences, the social sciences, and the humanities in a way that affords an understanding of our human natures such that we can have a more effective guide toward fulfillment during these rapidly changing times.

Gregg Henriques, Ph.D., author of A New Unified Theory of Psychology, directs the Combined Clinical and School Psychology Doctoral Program at James Madison University. He is a licensed clinical psychologist with expertise in depression, suicide, and the personality disorders. He has developed a new meta-theoretical system for psychology articulated in many professional journals and is now applying that system to researching well-being, personality, and social motivation, and he and his students are working on the development of a general system of psychotherapy. Henriques received his M.A. in Clinical/Community Psychology from UNC-Charlotte and his Ph.D. in clinical psychology from the University of Vermont. He also completed several years of post-doctoral training at the University of Pennsylvania under Aaron T. Beck exploring the effectiveness of various cognitive psychotherapy interventions for suicide and psychosis. Henriques teaches courses in personality theory, personality assessment, social psychology and integrative adult psychotherapy.

The Creativity Cure for Depression: An Interview with Dr. Carrie Barron

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Today’s guest is Dr. Carrie Barron, a board-certified psychiatrist/psychoanalyst on the clinical faculty of the Columbia College of Physicians and Surgeons who also has a private practice in New York City. She has published in peer-reviewed journals, won several academic awards, and presented original works related to creativity and self-expression at national meetings of the American Psychoanalytic Association. Along with her husband, Alton Barron, M.D., a hand and shoulder surgeon, she co-authored the book, The Creativity Cure: How to Build Happiness with Your Own Two Hands.

Dan:

Why is depression such a problem in our culture?

Carrie:

I think the level of stress has gone up enormously because we have so much to do and we’re on twenty-four hours a day. So I think because of technology, which offers us so many great things, but gives us much to do. I think that’s part of it. I also think, especially for children, we’re in a striving, ambitious, be productive all the time mentality – for children and adults. We need to play, we need to hangout, we need to have spontaneous time. I think spontaneous thought does a lot for alleviating depression and anxiety.

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Depression Undercover: A Trial Lawyer’s Secret

Once upon a time, I was a trial attorney at a personal injury defense firm. I was good at it. I always pushed hard; always did the best job possible. I won a good share of cases, and, of course, lost a few as well. I was valued highly enough to be made a partner shortly after joining the firm.

But I had a dirty little secret. I had bipolar disorder, which was well-controlled through a close partnership with a good psychiatrist. Still, in my mind, if word ever got out, my employers would see me as weak, a liability. To a degree, I understood. If the insurance companies that paid the bills learned that one of the firm’s trial attorneys had such a condition, their mandate would be clear: if you want our business, get rid of him. That is what I assumed.

Throughout my career, colleagues would make offhanded remarks about someone “not taking his medication.” I would grit my teeth and ignore it.

Instead, I was able to construct an alter-ego, the “happy warrior.” I had a smile on my face and a sardonic remark ready on cue. But I went about my daily business feeling like a secret agent in a Cold War spy movie. If my cover was ever blown, I was certain that my career would be at an end.

Over time, maintaining this secret identity while dealing with the usual strains of trial practice gave rise to a growing depression. Yet I still performed at a high level and still got results.

Although I had a close friend at the firm, another partner, he would deflect when I tried to talk to him about my depression, so I stopped. I began to worry that others at the firm might know about me.

Fear and the sense of isolation only fed upon themselves in a continuous cycle. I finally experienced a severe episode of depression that led to a period of disability. When I told my boss what was going on, he expressed genuine surprise that I was suffering from depression at all.

When I returned to work, I felt better, but I remained wary. Instead of engaging in a conversation about what had happened, we all acted as though nothing had occurred. The computer was rebooted, and business continued on as usual. I went back undercover, and no one seemed to mind.

Simply due to scheduling conflicts and adjournments, it was some time before I tried another case. I admit that I was a little nervous, but I was having no trouble handling my case load. I was puzzled when my boss came into my office one afternoon as I was preparing for the trial. He asked me if I felt good to go. He had never done that before. I said, “yes,” because I felt perfectly up to the task. I never asked myself, “If he is worried about my performance, why is he even letting me try the case?”

At trial, the insurance company sent an adjuster to audit the proceedings, a routine procedure. I knew him well, and he had an excellent grasp of the case, even though he had not been involved before trial. We had constant discussions about what was going on, and we seemed to be in sync. Suddenly, the insurance company pulled my old friend off the case and replaced him with a mid-level manager who consistently praised my performance.

The case went to verdict, and the jury awarded somewhat less than what the insurance company had offered settle for. To preclude the possibility of an appeal, the insurance company threw in a few more dollars. Case closed, on to the next one. To me, that was a pretty good result.

Was I in for a big surprise.

Shortly after the trial, year-end reviews were scheduled. I was getting ready for another trial, and I was very excited about it, so I wasn’t really paying attention to what was going on in the office. Other attorneys were getting their reviews – important because raises would be discussed – but I was never called in.

Ultimately, my case settled after much hard work on all sides, and the usual time for reviews was long past. I did start to worry then. I even made a remark to my secretary about it.

The call finally came. When I stepped into the conference room and saw every equity partner in the firm waiting for me, I knew. The spy had been caught, but what would happen?

My boss said that they waited to speak with me because they did not want to put pressure on me while I was preparing for another trial. He asked me if I felt capable of trying cases. I paused and then broke under the years of strain. I wept, and answered, “No.” Whether that “No” was true then or true now or was ever true, it was the most humiliating moment of a 20-year career.

My boss started to dissect my prior trial, telling me that the insurance company’s representative was reporting that I was doing a bad job. He even told me that the supervisor at the insurance company knew that I had depression. After the expected awkward silence, another partner suggested that “we find a creative solution” to keep me at the firm. I made some suggestions over the next few months. No replies were forthcoming. I was quietly being swept out the door. It wasn’t hard to get the message. I found another job and moved on.

The whole experience seemed to confirm everything I feared about being a lawyer with depression. Currently, I am not practicing, and am seeking other opportunities.

But if the story ends there, what is the point? Can I offer my account as a teaching opportunity? At the very heart of the tale lies the sad truth that we, as lawyers, trained to be superlative communicators, can utterly fail to make each other understood when it comes to depression. Should I have been more candid about my condition? My employers never told me what concerns they had or what they knew. Could all of us have been proactive for our mutual benefit, especially after I returned to work? I believe that there had been an opportunity to open a constructive dialogue, but my fear told me to keep my mouth shut. I cannot speak for my former employers, although I highly doubt that they held any malice. I doubt that they thought much about it at all until some critical pressure was brought to bear, whether from within or outside of the firm. Unfortunately, by the time everyone was talking, my job at a firm I loved was gone.

I miss working there. I still have close friends there. I see them when I can, which is not often enough. Just recently, I ran into my secretary, and we briefly chatted about my plans for the future. And then she said something that cut me to the quick: “You were a good lawyer.”

— Anonymous guest blog

The Neuroscience of Depression: Creating an Upward Spiral with Dr. Alex Korb

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The following is an edited transcript of the podcast recorded interview with Dr. Alex Korb. This transcript has not been reviewed and is not a word-by-word rendering of the entire interview.

Hi, I’m Dan Lukasik from lawyerswithdepression.com. Today’s guest is Dr. Alex Korb. Dr. Korb is a neuroscientist, writer, and coach. He’s studied the brain for over fifteen years, attending Brown University as an undergraduate and earning his Ph.D. in neuroscience from UCLA. He has over a dozen peer-reviewed journal articles on depression and is also the author of the book, The Upward Spiral: Using Neuroscience to Reverse the Course of Depression One Small Change at a Time. Interesting, he’s also coached the UCLA Women’s Ultimate Freesbie team for twelve seasons and is a three-time winner for Ultimate Coach of the Year. His expertise extends into leadership and motivation, stress and anxiety, mindfulness, physical fitness, and even standup comedy. Welcome to the show.

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Depression and Suicide: A Catholic Perspective

As a psychiatrist, I had been aware, prior to his death, that Robin Williams struggled with a severe mood disorder – major depression and bipolar disorder, depending on the source of the reporting – along with related problems and drug dependence.

The vast majority of suicides are associated with some form of clinical depression, which in its more serious forms can be a sort of madness that drives people to despair – leading to a profound and painful sense of hopelessness and even delusional thinking about oneself, the world and the future.

I knew all of this, and yet this death still shocked and surprised me, as it shocked and surprised so many others. Williams seemed to be the consummate humorist, the funny man who would be just so much fun to be around. Unlike some comedians who trade only on irony and cutting humor, Williams appeared to us as a warm, big-hearted, endlessly fun, brilliantly quick, incredibly talented man. Though he was a celebrity, he was the kind of person that people felt like they knew – like the cousin, everyone just adores and hopes will show up at the family reunion. Williams was the kind of guy that people wanted to be friends with, the kind of person that one wanted to invite to the party.

This is not the typical stereotype of mental illness, which why the typical stereotype must be relinquished: Quite simply, it is false.

Mental illness can afflict anyone, of any temperament and personality. In the wake of his death, the strange truth gradually began to sink in: In spite of outward appearances, Williams’ mind was afflicted by a devastating disorder that proved every bit as deadly as a heart attack or cancer. He suffered in ways that are difficult for most people to imagine.

Why couldn’t Williams see himself as other saw him – as a person of immense gifts and talents, a man who stood at the pinnacle of achievement in the world of comedy and entertainment?

Why couldn’t he see himself as God saw him – as a beloved child, a human soul of immense worth, a person for whom Christ died?

This is the tragedy of depression, which is so often misunderstood by those who have not suffered its effects.

Novelist William Styron – whose memoir Darkness Visible represents one of the best first-person attempts to describe the experience of depression – complains that the very word “depression” is a pale and inadequate term for such a terrible affliction. It is a pedestrian noun that typically represents a dip in the road or an economic downtown. Styron prefers the older term “melancholia,” which conjures images of a thick, black fog that descends on the mind and saps the body of all vitality.

Indeed, the title of his book – Darkness Visible – comes from John Milton’s description of hell in Paradise Lost. We’re not talking about hitting a rough patch in life or the everyday blues that we all experience from time to time. We are talking about a serious, potentially fatal, disorder of mind and brain.

Fortunately, in most cases, depression is amenable to treatment. Because the illness is complex – involving biological, psychological, social, relational and, in some cases, behavioral and spiritual factors – the treatment likewise can be complex. Medications may have a very important role, but so do psychotherapy, behavioral approaches, social support and spiritual direction.

In some cases, hospitalization may be necessary, especially when an afflicted individual is in the throes of suicidal thinking or when one’s functioning is so impaired from the illness that he or she has difficulty getting out of bed or engaging in daily activities. For the severely depressed, even brushing one’s teeth can seem like an almost impossibly difficult chore.

This level of impairment is often puzzling to outsiders – to the spouse or parent who is trying to help the loved one. Unlike cancer or a broken bone, the illness here is hidden from sight. But the functional impairments can be every bit as severe.

I recall one patient, a married Catholic woman with several children and grandchildren, who had suffered from both life-threatening breast cancer and from severe depression. She once told me that, if given the choice, she would choose cancer over the depression, since the depression caused her far more intense suffering. Though she had been cured of cancer, she tragically died by suicide a few years after she stopped seeing me for treatment.

Depression is neither laziness nor weakness of will, nor a manifestation of a character defect. It needs to be distinguished from spiritual states, such as what St. Ignatius described as spiritual desolation and what St. John of the Cross called the dark night of the soul.

Tragically, even with good efforts aimed at treatment, some cases of depression still lead to suicide – leaving devastated family members who struggle with loss, guilt, and confusion.

The Church teaches that suicide is a sin against love of God, love of oneself and love of neighbor. On the other hand, the Church recognizes that an individual’s moral culpability for the act of suicide can be diminished by mental illness, as described in the Catechism: “Grave psychological disturbances, anguish or grave fear of hardship, suffering or torture can diminish the responsibility of the one committing suicide.”

The Catechism goes on to say: “We should not despair of the eternal salvation of persons who have taken their lives. By ways known to him alone, God can provide the opportunity for salutary repentance. The Church prays for persons who have taken their own lives.”

Robin Williams’ death – like the death of so many others by suicide who have suffered from severe mental illness – issued from an unsound mind afflicted by a devastating disorder. Depression affects not just a person’s moods and emotions; it also constricts a person’s thinking – often to the point where the person feels entirely trapped and cannot see any way out of his mental suffering. Depression can destroy a person’s capacity to reason clearly; it can severely impair his sound judgment, such that a person suffering in this way is liable to do things, which, when not depressed, he would never consider. Our Lord’s ministry was a ministry of healing, in imitation of Christ, we are called to be healers as well. Those who suffer from mental-health problems should not bear this cross alone. As Christians, we need to encounter them, to understand them and to bear their burdens with them.

We should begin with the premise that science and religion, reason and faith are in harmony. Our task is to integrate insights from all these sources – medicine, psychology, the Bible, and theology – in order to understand mental illness and to help others to recover from it. In cases where recovery proves difficult or impossible, we pray for the departed and never abandon those who still struggle.

Aaron Kheriaty, M.D., is associate professor of psychiatry and human behavior at the University of California-Irvine School of Medicine. He is the co-author with Msgr. John Cihak of The Catholic Guide to Depression.

Interview with Dr. John Greden, Director of the U. of Michigan Depression Center

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Today’s podcast interview is with Dr. John Greden, Professor of Psychiatry and Clinical Neurosciences in the Department of Psychiatry, Founder and Executive Director of the University of Michigan Depression Center, Founding Chair, National Network of Depression Centers. His research over the past 30 years has focused on studying biomarkers and developing treatment strategies to prevent recurrences of depression and bipolar disorders.

Listen to my interview with him on Itunes or Google Play.

Please note that it takes Apple and Google Play time to upload podcasts interviews. If this interview is not available, check back a little bit later.

How to Prevent Stress From Shrinking Your Brain

Have you ever felt so stressed out and overwhelmed that you can’t think straight? We now know that prolonged stress or trauma is associated with decreased volume in areas of the human brain responsible for regulating thoughts and feelings, enhancing self-control, and creating new memories. A new research study, published in today’s issue of Nature Medicine, is a first step in uncovering the genetic mechanism underlying these brain changes.

Depressed People’s Brains are More FragmentedIn this study, conducted by Professor Richard Dumin and colleagues from Yale University, scientists compared the genetic makeup of donated brain tissue from deceased humans with and without major depression. Only the depressed patients’ brain tissues showed activation of a particular genetic transcription factor, or “switch.” While each human cell contains more than 20,000 genes, only a tiny fraction of them are expressed at a given time. Transcription factors, when activated, act like light switches, causing genes to be turned on or off. This transcription factor, known as GATA1, switches off the activity of five genes necessary for forming synaptic connections between brain neurons. Brain neurons or nerve cells contain branches or dendrites that send and receive signals from other cells, leading to interconnected networks of emotion and cognition. The scientists hypothesized that in the depressed patients’ brains, prolonged stress exposure led to a disruption of brain systems involved in thinking and feeling. Depressed brains appeared to have more limited and fragmented information processing abilities. This finding may explain the pattern of repetitive negative thinking that depressed people exhibit. It is as if their brains get stuck in a negative groove of self-criticism and pessimism. They are unable to envision more positive outcomes or more compassionate interpretations of their actions.

Glucocorticoids Damage Brain Neurons

The stress response involves activation of a brain region known as the amygdala, which sends a signal alerting the organism to the threat. This results in activation of the HPA (hypothalamic-pituitary-adrenal) axis and release of a cascade of hormones, including cortisol, widely regarded as the quintessential “stress hormone.” While short-term cortisol release prepares the organism to sustain “fight or flight” and fend off an attacker, long-term exposure appears to cause brain neurons to shrink and interferes with their ability to send and receive information via branches called dendrites. In animal studies, under chronically stressful conditions, glucocorticoids such as cortisol can remain elevated for long periods.

Traumatic Experiences Can Shrink the Hippocampus in Those Who Don’t Recover

This finding is another piece of the puzzle regarding how stress and prolonged distress may impair our ability to think in creative and flexible ways. Research in both mice and humans has demonstrated an association between stress exposure (foot shock in mice, life events in humans) and shrinking of the hippocampus – the brain center responsible for forming new, time-sequenced memories. Studies in women with PTSD resulting from childhood sexual abuse and Vietnam veterans with PTSD have shown 12-26 percent decreases in hippocampal volume, relative to those without PTSD. In another study, patients recovered from long-term major depression showed a 15 percent decrease in volume of the hippocampus, compared to non-depressed patients.

Major Life Stress Damages the Prefrontal Cortex

In addition to hippocampal shrinkage, major life stress may shrink brain neurons in the Prefrontal Cortex (PFC), the brain area responsible for problem-solving, adaptation to challenge, emotional processing and regulation, impulse control, and regulation of glucose and insulin metabolism. In a study of 100 healthy participants conducted by Dr. Rajita Sinha and colleagues at Yale University, and published in the journal Biological Psychiatry, those with more adverse life events had greater shrinkage of gray matter in the PFC, compared to their less-stressed peers. Recent major life events, such as a job loss, make people less emotionally aware while life traumas, such as sexual abuse, seem to go further, in damaging mood centers that regulate pleasure and reward, increasing vulnerability to addiction and decreasing the brain’s ability to bounce back.

Summary

While the evidence is not yet conclusive, these studies suggest that prolonged exposure to stress can shrink the brain, both via the damaging effects of cortisol on brain neurons and by disrupting expression of genes that facilitate neuronal connections. This raises the question of whether there is anything we can do to prevent such damage. Since we can’t always control how much we are exposed to financial, relationship, or illness stress, are there preventive activities we can do to maintain cognitive resilience so we can continue to deal effectively with the stressors? It is not known if we can reverse the damage by these methods, but we may lessen it and make our brains more resilient to stress.

Brain-Enhancing Activities to Combat Stress

While the below list is not exhaustive, the three activities below have enhanced brain functioning in controlled studies.

Take a Daily DHA Supplement – DHA or Docosahexaenoic acid is an Omega-3 fatty acid that is a central building block of brain tissue. DHA is thought to combat the inflammatory effects of cortisol and the plaque buildup associated with vulnerability to Alzheimer’s disease. According to Dr. Mehmet Oz, in one study, a dose of 600mg of DHA taken daily for 6 months led the brain to perform as if it were three years younger.

Exercise Most Days – In studies with mice exercise led to a more improved performance on cognitive tasks than exposure to enriched environments with lots of activities and stimulation. Exercise leads to increases in BDNF or brain-derived neurotropic factor, a substance that strengthens brain cells and neuronal connections. BDNF is also thought to promote neurogenesis or the creation of new brain cells from existing stem cells in the hippocampus. Although these effects can’t be studied in living human brains, researchers have found increases in BDNF in the bloodstream of humans following workouts.

Do Yoga, Meditate, or Pray – These activities can activate what scientist Herb Benson at Massachusetts General Hospital calls “the relaxation response,” which lowers blood pressure and heart rate and lowers subjective anxiety. Benson and scientists from a genetics institute showed, in a recent study, that inducing the relaxation response can beneficially alter the expression of genes involved in inflammation, programmed cell death and how the body handles free radicals. The effects shown were in the same genes implicated in PTSD and depression. According to Jeffery Dusek, Ph.D., co-lead author of the study, “Changes in the activation of these same genes have previously been seen in conditions such as post-traumatic stress disorder; but the relaxation-response-associated changes were the opposite of stress-associated changes and were much more pronounced in the long-term practitioners.”

About the Author

Melanie Greenberg, Ph.D. is a licensed Clinical Psychologist and expert on Mindfulness and Positive Psychology. Dr. Greenberg provides workshops and speaking engagements for organizations, life, weight loss, or career coaching, and psychotherapy for individuals and couples. Visit her website: http://www.drmelaniegreenberg.biz

This article originally appeared in Psychology Today.

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