Treating Depression with Inpatient Therapy

Major depression, not just periodic moments of feeling blue, is considered one of the most common mental disorders, according to the National Institute of Mental Health (NIMH). The agency refers to the Diagnostic and Statistical Manual of Mental Disorders definition of this level of depression, which is: "A period of two weeks or longer during which there is either depressed mood or loss of interest or pleasure, and at least four other symptoms that reflect a change in functioning, such as problems with sleep, eating, energy, concentration, self-image, or recurrent thoughts of death or suicide."

Depression creates a dysregulation, or impairment, of neurotransmitters—brain chemicals that affect emotions and moods. There are a number of causes for depression, including genetic predisposition, trauma, stress, hormone imbalance, or mood-altering substances. It's not uncommon for depression to be a co-occurring disorder to alcohol and drug addiction.

When presenting statistics, NIMH doesn't exclude a major depressive episode caused by "medical illness, bereavement, or substance use disorders." Data from 2016 indicates:

• Approximately 10.3 million adults over 18 in the U.S. had "at least one major depressive episode with severe impairment." Roughly 64 percent of all depressive episodes were severe. Roughly 3 million adolescents under 17 in the U.S. had "at least one major depressive episode with severe impairment." An estimated 70 percent of all depressive episodes were severe.
• Adult females suffer major depressive episodes nearly twice as much as adult men. Adolescent females have three times more episodes than their male counterparts.
• The prevalence for major depression in adults aged 18-24 is 10.9 percent; 25-49 is 7.4 percent; and people 50 and older at 4.8 percent. For adolescents aged 12-17, the prevalence is 12.8 percent.
• Both adults and adolescents experiencing major depressive episodes are higher among those identifying with two or more races.

What continues to be a problem is nearly 40 percent of adults and 60 percent of adolescents who experience major depression don't receive treatment for it.

Symptoms of depression include, but aren't limited to:

• Agitation, irritability, or anger
• An inability to function optimally in daily life
• Changes in appetite and sleep patterns
• Concentration difficulties
• Excessive guilt or self-hate
• Extreme sadness, including feelings of helplessness or hopelessness
• Insomnia
• Isolation or increasing withdrawal from people and activities
• Lethargy or fatigue
• Thoughts of suicide

Mental Health America offers a screening to help identify symptoms.

Major depression isn't the only type of this disorder. You or someone you love may also experience other serious conditions such as:

• Dysthymia causes a low mood over an extended amount of time—sometimes a year or more. An individual can function, but barely. This condition includes many of the symptoms listed above.
• Postpartum depression, commonly associated with low moods after giving birth, is also revealed by many of the symptoms above. Roughly 85 percent of mothers experience it within weeks or months after having a baby, but 16 percent develop more serious symptoms, such as disconnection from children or worse, thoughts of harming them.
• Seasonal Affective Disorder, or SAD, is often referred to as seasonal or winter depression. If you're struggling with substance abuse or in recovery, this condition may affect you more if you have a biological relative with a depressive disorder but you have yet to be diagnosed. Symptoms are more severe during winter, but ebb slightly with the onset of spring.
• Atypical depression, which some researchers consider to be frequently undiagnosed, often presents with overeating and sleeping too much, as well as irritability and relationship issues.
• Psychotic depression, in extreme cases, results in someone's inability to communicate, rise from bed, and distinguish reality from false beliefs. Some major depressive episodes when left untreated may become this severe—the National Alliance on Mental Illness reports this happens for about 20 percent of depression sufferers.

How Inpatient Therapy May Help Depression

When it comes to depression, it's easy to think someone can simply "snap out of it" or that he or she is lazy, craving attention, or being manipulative. This isn't true.

If you or a loved one experiences bouts with serious depression, it might be time to consider inpatient therapy to manage the condition effectively. Residential treatment often fosters a comforting atmosphere to start addressing the type of condition and what therapies might be necessary to reach stability. Methods might include:

• Non-habit forming medication to help recalibrate and regulate neurotransmitters
• Individual and group talk therapy to address attitudinal and behavioral aspects of clinical depression and develop coping strategies for managing emotions and thoughts
• Cognitive behavioral therapy, which helps people identify and process irrational or unhealthy patterns that prompt continual pain
• Applications such as Eye Movement Desensitization and Reprocessing (EMDR), grief groups, and trauma-specific therapy for conditions like grief, trauma, and post-traumatic stress that contribute to depression
• Brain and physical exercises to restore new cerebral tissue and release positive chemicals
• Nutritional plans that eliminate toxins and help restore a balance of vitamins, minerals, and amino acids

During an inpatient stay, residents can rely on 24/7 support and a structure that allows for the only focus to be on healing. This approach often clears the way for establishing regular mechanisms for managing the condition, developing a continuum of care plan, and finding professionals and other groups for assistance after treatment.

After an inpatient stay, individuals can work with their care providers to determine what other coping measures can be part of daily life that help keep the phantom of depression at bay.

Everyday Health provides a comprehensive checklist to review when considering inpatient depression facilities.

Depression Care at Cottonwood Tucson

The professionals at Cottonwood Tucson have a multi-faceted individual approach to residential depression treatment that includes everything from cognitive behavioral therapy to proper nutrition plans. Find out how we can help you.

If you or someone you love is in need of immediate support because of the potential for self-harm, please call the National Suicide Prevention Lifeline at 1-800-273-8255. This help is free and confidential.

By Tracey L. Kelley

Mindfulness for Better Meditation

Although there are numerous techniques for meditation, many people are still uncertain about how to do it. However, the practice is often easy to incorporate into your recovery.

One way to meditate is to pause in a quiet space, close your eyes, and focus on your breath for a minute or two. The concept of meditation is to rest the mind and have a state of consciousness that differs from your normal wakefulness. Learning how to be still is actually one of the principle aspects of meditation. It's too common in our always on, always connected modern world to lose relatability to this stillness and recognize what happens to our sense of self when we stop, breathe, and let go. So, we often don't.

When we choose to focus on cultivating stillness in everyday moments, we begin to learn how simple meditation really is. It's all about mindfulness. As an example, while you're reading this article, you could take a moment right now to explore this concept. After this sentence, close your eyes and slowly count to 30 in your mind. When you're finished, open your eyes again.  

What happened?

How did the sounds around you change? Did you feel as though there was more space behind your eyes? Were there colors? What areas of the body seemed to soften a little? Could you hear your breath?

These and other micro-moments of observation help ground you in the present. While it's possible you still had a to-do list unfurling in your mind, or the random thought of "Well, this is kind of dumb…" nevertheless in just 30 seconds, your sense of being changed:

• Systolic blood pressure slowed. This measurement records how blood moves in your arteries.
• Respiration became easier. This is why when people are upset, they're told to take "10 deep breaths"—a focus on breath naturally prompts the parasympathetic nervous system to respond.

The combination of relaxed blood pressure and easier respiration created by our 30-second exercise is one reason why the parasympathetic nervous system—the "rest and digest" response—can send calming signals throughout your mind and body. Through mindfulness and meditation, you have the ability to evoke this sense of peace more frequently and with greater duration, for more effective results.

Practice Mindfulness

Are meditation and mindfulness the same thing? Yes—and no. Mindfulness is most certainly the first step to creating a more healthful meditation practice. And the more you meditate, the more mindful you'll be.

Mindfulness is something we're all capable of at any time. Just like the exercise you did a moment ago (You didn't do it? Well maybe now you'd like to try it!), being mindful is the choice to be present. Any person can dwell in the past or be worried about the future. Stillness—and therefore, peace—is easier to achieve when the present moment is explored more completely.

Noted peace activist, Buddhist monk, and author Thích Nhất Hạnh offers one of his many observations about mindfulness: "While washing the dishes, you might be thinking about the tea afterwards, and so you try to get them out of the way as quickly as possible in order to sit and drink tea. But that means you are incapable of living during the time you are washing the dishes.”

In his book, The Miracle of Mindfulness: An Introduction to the Practice of Meditation, he carries the concept further: "Be yourself. Life is precious as it is. All the elements for your happiness are already here. There is no need to run, strive, search, or struggle. Just be. Just being in the moment in this place is the deepest practice of meditation. Most people cannot believe that just walking as though you have nowhere to go is enough. They think that striving and competing are normal and necessary. Try practicing aimlessness for just five minutes, and you will see how happy you are during those five minutes.”

This approach doesn't come naturally to many of us. But by practicing various aspects of mindfulness in daily activities, you begin to expand your ability to recognize stillness. From here, it's much easier to consider how meditation may help you achieve a greater sense of calm and connection with inner self, and why it's often helpful for people overcoming substance abuse.

Mindfulness for Better Meditation

Here's another mindfulness-to-meditation exercise for you, compliments of Mindful.org:

1. Sit comfortably with your back supported.
2. If you're on a cushion, cross your legs. If you're in a chair, touch your feet to the floor.
3. Straighten your upper body and adjust your head above your shoulders. Do this naturally, without creating stiffness.
4. Move your arms to the sides of your body, then rest your hands on your thighs.
5. Lower your chin toward your chest just slightly. You can leave your eyes open or close them—whatever is best for you.
6. Rest here and breathe. It's possible your mind will wander—don't worry about, judge, or fret this. When you have a thought, simply return attention to your inhale and exhale. This may happen multiple times, depending on how long you choose to sit.
7. When the time feels right, get up and move on with your day.

Notice there aren't a lot of rules for this exercise. You're simply placing the body in a particular position and breathing. You're not trying to stop thought, chant, or expand upon anything. This is one of many examples of how easy meditation can be through the concept of mindfulness.

And when you're ready to expand your meditation practice, there are literally hundreds of resources available to you. For example, here's a five-minute guided breathing meditation to try. Be curious and look into other styles and approaches to see what works for you.

Cottonwood Tucson's Holistic Practices

Exploring meditation is one component of Cottonwood Tucson's integrated mind-body therapy approach to addiction recovery. Our experts believe disorders often cause someone to disconnect from self-care. Through mind-body therapy, they reveal their best selves.  

By Tracey L. Kelley

Understanding Stress and How to Cope

Stress is a dirty word for many people, and with good reason. We often don't feel its full effects until it's wreaked havoc on our emotions, thoughts, and physical well-being.

But did you know that stress isn't always a bad thing? Or that there multiple types of negative stress? Understanding the various forms of stress helps you recognize when you can apply certain coping techniques to feel better.

Eustress vs. Distress: What's the Difference?

Surprise! There's actually a form of positive stress called eustress. In the past 50 years, mental health professionals identified that stress "shouldn't always be linked to negative scenarios," according to Positive Psychology.
Eustress, as identified by endocrinologist and author Hans Selye, is the difference between the stress stimulus and your response. Good stress, or eustress, includes excitement, focus, and improved performance. It's a short-term burst that motivates and energizes, and we don't feel it taxes our coping skills. You may notice eustress when starting a project that intrigues you, taking a new class, or following through on an idea. This boost helps you progress well and feel good about what you accomplish.

Distress, on the other hand, is the negative condition most of us try to avoid. It's often associated with anxiety, depression, and other unpleasant emotions. It can last for a little while or an extended period of time—which often compounds its unfortunate effects.

With distress, no matter how you try to apply the usual coping mechanisms, nothing seems to make it go away. It starts to affect your performance and concentration in many areas of life, and eventually causes a host of physical and mental complications.

The Multiple Facets of Distress

Before you can work out different ways of managing stress, you first need to understand the different types. The American Psychological Association identifies these three categories:

• Acute
• Episodic acute
• Chronic

Acute stress is what many people experience. Dealing with addiction cravings. A pressing deadline. A child's discipline problems. These and hundreds of other personal and universal issues momentarily crop up in our daily lives, and we have to find a way to acknowledge what's happening in the short term and how to deal with it effectively.

This form of stress contributes to numerous health challenges, including:

• Stomach, digestive, and bowel issues
• Muscular restrictions, including backaches, jaw pain, and tension headaches
• Over-arousal, resulting in dizziness, chest pain, heart palpitations, and high blood pressure
• Emotional issues such as anxiety, depression, and irritability

Episodic acute stress is a little more problematic. If your everyday life is perpetually disorganized, rushed, chaotic, and pressured, it's possible you're suffering from this stress manifestation. It's harder to break patterns of behavior that contribute to episodic acute stress.

Learn How to Take Care of Yourself

For people dealing with substance abuse disorder, they may require more comprehensive methods of coping skills to not only address but also remedy episodic stress.
Physical and emotional results of acute stress are magnified in this category, including:

• Endless worry and projections of "awfulness" or fears
• Migraines
• Heart disease, heart muscle damage, and hypertension
• Combative behavior and anger management issues
• Ongoing physical ailments, such as muscle tension, joint pain, and a weakened immune system
• Inability to relax and/or sleep

Chronic stress can be caused by deep-rooted trauma, constant and unreasonable demands, or troubling environmental factors such as war, conflict, or poverty. It's also the stress of despair, when someone simply doesn't have any hope that a miserable situation will ever get better. Sometimes people also feel this way due to an abusive situation, grief, illness, or the complications of addiction.
The medical consequences of chronic stress are dire. They include:

• Violence
• Severe depression
• Heart attack
• Stroke
• Cancer

Often, symptoms of chronic stress are difficult to treat, because of the impact is compounded by many bouts with acute stress.

There are numerous ways to minimize the impact stress has on you, but they require concerted effort and often professional help.
1. Recognize when old habits aren't serving you. Seek the assistance of a cognitive behavioral therapist to help you identify key issues that contribute to distress and how to handle them.

2. Exercise and eat healthfully. Regular movement is a reliable stress reliever. A consistent yoga practice, for example, is proven to reduce the hyperactivity of the sympathetic nervous system, or the "fight or flight" response that often accompanies stress. A whole foods diet rich in vitamins, minerals, and antioxidants counteracts the negative physical effects of the condition.

3. Adopt breathing techniques. When you take deep, deliberate breaths, you stimulate the vagus nerve, which is the command center for your parasympathetic nervous system, or the "rest and digest" response.

4. Try meditation or mindfulness techniques. The reset these applications provide is integral to understanding what level of stress you're experiencing, and how you can pass through it with awareness.

5. Learn the difference between recharging and isolation. When we're stressed, it's easy to hide away and suffer alone. If you're trying to maintain sobriety, separating yourself from your support network and other helpful resources may weaken your resolve. To remember the importance of relying on a community that understands you and moments of joy that sustain you, leave contact numbers and affirmations in plain sight for easy access.

Learning to manage variables of stress takes time. Trust that you'll condition your mind and body to be more responsive with each method.

The Cottonwood Whole Person Experience

The philosophy of care at Cottonwood Tucson presumes that emotional, mental, physical, and spiritual factors of life are interconnected. Often, the root of stress is due to an imbalance of these aspects. Our caring staff wants to provide people with complete wellness, whether they're struggling with:

• Substance abuse
• Co-occurring disorders such as depression or PTSD
• Mood disorders like complicated grief or bipolar disorder
• Process disorders such as food addiction, binge eating, or sex addiction

For more information about our whole body holistic care approach, click here.

By Tracey L. Kelley

What Is SMART Recovery?

A primary aspect of a continuum of care plan involves techniques that enable you to not only maintain sobriety, but also uncover your best self. This isn't simply social media affirmation. Through exposure to positive influences and new ways of thinking, you're more likely to evolve—not because you were "bad" and need to be "good," but because the "good" exists in you already, and you have more ways to reveal it.

Many rehabilitation programs include some type of 12-Step program to help people recognize aspects of recovery, stay accountable to the effort, and receive support from dedicated people who understand the joys and challenges of choosing to be sober. However, some individuals want a little more than what these programs offer.

The SMART Recovery organization, established in 1994, is one that a number of people are exploring as a different—or additional—option. It uses guidelines informed by cognitive-behavioral therapy (CBT) methods. According to the American Psychological Association, CBT follows principles such as:

• Understanding that "faulty or unhelpful ways of thinking" contribute to psychological problems.
• Also contributing to psychological issues are "learned patterns of unhelpful behavior." 
• Individuals who have psychological challenges "can learn better ways of coping with them, thereby relieving their symptoms and becoming more effective in their lives."  

With this CBT foundation combined with the concept of abstinence, the SMART Recovery program—an acronym for Self-Management and Recovery Training—utilizes Rational Emotive Behavior Therapy (REBT), a system created by psychologist Albert Ellis in the 1950s. REBT enables people to adjust belief systems and emotional reactions. This helps them change actions and reactions to avoid being triggered and prompt regression into self-destructive behaviors.

It's a type of self-empowerment: thinking creates emotions and emotions lead you to act. Once you comprehend the role your perception of circumstances or events plays in actions or reactions, you have the ability to process thinking and feelings more effectively—and you're less likely to default to escapism behavior as a coping mechanism.  

The SMART Recovery program methods are approved by the National Institute on Drug Abuse, the National Institute on Alcohol Abuse and Alcoholism, and the American Academy of Family Physicians.

The Principles of SMART Recovery

The SMART REBT method is a four-part system:

1. Establish and maintain the motivation to abstain
2. Learn how to handle urges
3. Manage thoughts and emotions through effective action
4. Create a balanced approach to all aspects of life

Part of the REBT approach is to use the past as a learning tool, not a continual point of reference or blame for addictive behavior.  This helps participants take ownership of present feelings and actions in order to change them for the better and have a healthier life.

Instead of requiring someone to acknowledge addiction "powerlessness," SMART utilizes the concept of "locus of control." In psychology, this phrase refers to what extent an individual believes he or she has control over what happens in life.

Another aspect of SMART involves incorporating six phases of change. This concept is from Changing for Good, a book by James Prochaska, professor of clinical and health psychology at the University of Rhode Island. His philosophy is, "change doesn't depend on luck or willpower. It's a process that can be successfully managed by anyone who understands how it works."

The concept of "staging" is the foundation of SMART. It works something like this:

1. Pre-contemplation: Individuals currently aren't interested in change or are unaware of behavioral issues.
2. Contemplation: They are aware of possible problems and want change, but may not be committed to the act or confident about how to go about it. 
3. Preparation: They acknowledge responsibility for behavioral modifications and create a plan to make adjustments. 
4. Action: They are more aware and in control of self-directed change and unwanted behavior.
5. Maintenance: They use new aspects of thinking, feeling, and control but are aware of high-risk scenarios.  
6. Graduation/Exit: They are more confident, have a greater understanding of thoughts and emotions, and use this control and new behaviors to move forward with a healthier outlook and way of life. 

Choosing Between a 12-Step Program and SMART

Technically, you don't have to choose between a 12-Step group such as AA and SMART Recovery. It all depends on what works for you. There are some core differences, including that one is secular and another often incorporates spiritual inspiration in its core principles. The SMART position is "The use of religious or spiritual beliefs and practices in recovery is a personal choice and not part of our program."

However, the organization also states that "while our approach differs from Alcoholics Anonymous and Narcotics Anonymous [for example], it does not exclude them." It goes on to say that many people will use 12-Step programs in conjunction with the skills they learn from SMART Recovery. "At SMART, we believe that each individual finds his own path to recovery…and that the power to change addictive behavior resides within each individual."

SMART also differs from most 12-Step programs regarding the philosophy of recovery. Much of the 12-Step structure focuses on maintaining sobriety "one day at a time," settling someone "in recovery" for life. SMART designs its principles to enable individuals to consider life after comprehensive addiction treatment as "recovered."  

While many 12-Step programs have a sponsor mentorship as part of fellowship and support, SMART does not. This is part of the organization's purpose of helping individuals define accountability.

Like 12-Step programs, SMART Recovery routine meetings are in a variety of communities. But they follow more of a crosstalk format, allowing participants to engage with each other. Meetings are open to anyone and free, but people have the option to donate if they wish. Each meeting lasts about an hour or slightly longer. There's an online group available as well.

Learn more about SMART Recovery.

Cottonwood Provides You with Many Resources

Our behavioral health clinicians provide you with comprehensive tools to help with relapse prevention. Contact us to learn more about what may be best for your continuum of care plan.

By Tracey L. Kelley

Alcohol-Related Deaths for Women Are Rising

One reason why women are so susceptible to chronic illness and death due to alcohol abuse is due to how their bodies metabolize it. Research provided by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) suggests it's because women have less water in their bodies compared to men of similar weight, so alcohol concentrates in the blood more quickly. This means women feel the immediate effects of alcohol more rapidly than men for longer periods of time. Even moderate, regular amounts of alcohol are a catalyst to compromising health effects.

Other critical health factors for women and alcohol abuse include:

• Greater risk for liver damage, potentially due to estrogen; as well as hepatitis and cirrhosis
• Different types of cancer for individuals with heavy consumption, especially in the breast, colon, esophagus, liver, mouth, and throat
• Alcohol-related brain damage, which creates long-term memory decline, shrinks tissue, and affects cognitive ability
• Immune suppression, a particular concern for people over 40
• Heart disease, specifically damage to the heart muscle
• Increased anxiety, depression, and other potentially-damaging co-occurring disorders; mental health challenges often heighten the risk of suicidal thoughts

And while binge drinking is often associated with teens and college students, USA Today cited an additional study that analyzed data from ER visits. For the period of 2006–2014, it showed an increase among middle-aged women admitted for complications due to excessive alcohol consumption either from accidental binging or intentional long-term use.

The Centers for Disease Control (CDC) report 90 percent of people who "binge drink aren't alcoholics or alcohol-dependent." The CDC also notes that "approximately 12 percent of adult women report binge drinking three times per month, averaging five drinks per binge."

In addition, there are many other alcohol-related threats to women, including violence, traffic accidents, and sexual health concerns, including unwanted pregnancies or HIV.

The CDC provides a detailed outline of alcohol consumption and related health risks.

Social Acceptability Contributes to the Problem

It's not that having a celebratory cocktail every so often or a glass of wine with dinner is cause for concern. In fact, numerous medical studies suggest that 5 oz. of red wine, in particular, may improve heart health if enjoyed a couple of times a week.

But how much is 5 oz.? The typical wide-bottomed wine glass holds 15–21 oz., which is the equivalent of three-to-four drinks in a serving. WebMD defines heavy drinking for women as more than three drinks daily or seven weekly. So, the concept of a woman having a glass of wine—or two—after yoga class with friends or once her kids are asleep for the night demonstrates how difficult it is to distinguish between having the occasional beverage and quickly becoming a moderate-to-heavy drinker, with all the associated health risks.

There are many myths surrounding the stigma of high-functioning alcoholism, including tragic circumstances, homelessness, and poverty. While these components may be contributing factors for some people, the National Institutes of Health has facts stating that other social/economic aspects make it easier to hide a drinking problem, especially in certain social settings where drinking is considered normal behavior.

High-functioning alcoholic traits are often found in middle-aged people with:

• Advanced educational degrees
• Stable jobs
• A supportive, loving family
• The possibility of genetic history of addiction
• An individual history of anxiety or depression

The social expectation to drink is often hard to resist—anyone who's gone through recovery can share many stories about this. IHME researchers cite the social acceptance of drinking compared to the scourge of illicit substance abuse. This is one reason why the opioid epidemic continues to dominate the news—yet as stated above, rising deaths from both substances is cause to be alarmed.

Pause and Consider What's Really Happening

According to 2016 statistics from NIAAA, "an estimated 5.4 million women over 18 could be considered as having an alcohol use disorder and needing treatment." But less than one in 10, or nearly 7 percent, gets specialized help.

Take a moment to consider your public and private drinking habits:

• Do you look forward to two or three drinks each evening?
• Are your post-work activities often centered on joining friends in a bar, wine club, or beer hall?
• Does every dinner party include an ample list of corresponding drinks by course?
• Is it hard to imagine not having a drink every day, for whatever reason?
• Do you enjoy drinking alone, especially when feeling emotionally or mentally taxed?

The Cottonwood Assessment Program may be of help. It allows you or someone you love to have a thorough evaluation to determine if formal treatment is the next course of action. Call us today to learn more.

By Tracey L. Kelley