Psychology Research

I said that I would write more about our work in Israel and Gaza, but the work-and trying to find funding so that we can continue it-is taking up so much time (joyous, exciting time, to be sure) that I haven’t been able to write. Still, I thought I would send along this very brief summary that I forwarded to our US Mind-Body Medicine faculty. Hi everyone, Just a couple of words from Gaza City: overwhelming, amazing, touching. That’s three words. We (Jim, Amy, Afrim, Yusuf, Dan and Lee-Ann) had a great visit with our Israeli faculty. They are doing many interesting and exciting projects including groups that combine mind-body skills and Jewish spirituality, joint Israeli Jewish and Arab groups, and many groups for traumatized children and adults in Sderot. In fact, we made a visit to Sderot and had a chance to talk with teachers who are using mind-body skills in wonderfully creative ways with children in the SCIENCE AND RELIGION SCHOOL. The kids have experienced shelling on and off for eight years and are having all kinds of problems with concentration, bed-wetting and anger. Naftali who heads up our Israeli program, is on the track of a major initiative in the South which will build on the work that he and his team have already done. We are working together on developing cooperative relationships and future funding. Thanks to Danny Grossman, a friend to whom Aaron and Debbie Kaplan introduced us some years ago, (with able assists from Naftali and Smadar who handle the administrative work in Israel), we were all able to get into Gaza. It took a couple of extra days for Afrim and Yusuf, but Naftali and Tami and Ayelet from our Israeli faculty kept their spirits high while they waited. Once in Gaza, we began with visits with grieving families. There are whole sections of Gaza that have been completely destroyed and many thousands of people who are without homes. “I am very small,” one ten year old girl told us, “but the tent the 20 of us are staying in is even smaller.” We went on for a day of meetings with our Gaza faculty. The next day, we had more site visits including one to Dr. Izzeldin Abuelaish, whose three daughters were killed. He’s an amazing man, an OBGYN who works in Israel as well as Gaza and through some miracle of wisdom and compassion, has managed to transform his suffering into a visionary project for the education of girls in Gaza-”not just so they will think, but so they will think freely”-and a mission to promote greater Israeli-Palestinian understanding. We’re now about to start the 4th day of our PTP. Our Gaza faculty, which Jamil heads up, is doing virtually all the lectures and leading all the groups and our international team is consulting/supervising. The Gaza group is doing an absolutely wonderful job. They are so open-hearted and skillful-I’d say over the last 18 months, they’ve each lead anywhere between 6 and 20 groups and it shows. Participants (there are over 140 of them) are speaking of issues that they have never before discussed and beginning to solve problems that have troubled them for years-not to mention finding practical ways to ease their high levels of anxiety and deal with nightmares, flashbacks, etc. All of them-faculty and participants-are so eager to learn and to share what they are learning. They are an inspiration to all of us. There is much more to tell and I will when I have more time. For now, I send all of you my love as well as my gratitude for being with us on this and many other adventures. Jim    

Sigh. These friday weird science titles just keep getting worse and worse! But there’s really no other way to put this paper. And it kind of carries on the depression theme I’ve had going for the past few weeks. Well, kind of. Gallup et al. “Does semen have antidepressant properties?” Archives of Sexual Behavior, 2002. Now, I saw the title of this paper and went “you’re KIDDING. They want women to take…WHAT?!” I had this strange image of what the marketing department for “semen pills” would be like. But it turns out the title is slightly misleading. And as for the implications…we’ll get to them. Read the rest of this post… | Read the comments on this post…

If scientists ever come up with a physics of the psyche, one of its first axioms might be the above title. We humans crave stimulation, and on many different levels. To experience ourselves as fully alive, we all have various “arousal requirements”-whether physical, mental, emotional, or spiritual. And if we feel under-stimulated, we’ll generally complain of being bored, antsy, anxious, irritable, lonely, or even depressed. This post explores some of the less fortunate ramifications of our constant need for stimulation. Perhaps more than anything else, our arousal needs–and the negative emotions and states of mind we experience when these needs aren’t being met–can interfere with our better judgment. People who suffer accidents and injuries, for example, frequently do so because their personal arousal requirements compel them to take risks ranging from the not-entirely-prudent to the foolhardy or downright reckless. Others may join religious cults or fringe organizations because they’re frantically searching for a more fulfilling, spiritual life–but don’t really know where to turn. Their need to fit in somewhere , to fill the internal void of un-relatedness, drives them (at times, quite indiscriminately) to put their faith in an ideology, or charismatic leader, that can easily lead them astray. Since as a therapist I typically focus more on mental/emotional problems than physical or spiritual ones, I’ve become acutely aware of how experiencing an inner vacuum can lead people to make poor life choices, especially in relationships. Many people I’ve worked with who’ve gotten into bad or inappropriate relationships did so because at the time they felt alone, abandoned, or rejected. Consequently, they experienced an overwhelming need to prove to themselves they were still lovable. Perhaps they’d been having problems dating, or recently “loved and lost,” or maybe gone through a painfully one-sided divorce, which they’d strenuously sought to avert. Anxious to escape intolerable feelings of emptiness–the emptiness of loneliness or desertion–they rushed to embrace (as it were) the first person that came along. Unable to simply allow themselves to fully experience their disappointment, or grieve their loss, they propelled themselves headlong into a new relationship–one which they weren’t at all ready for. Additionally, they may have feared going within themselves (or, for that matter, eliciting professional help) to learn just why their relationship had gone sour. Feeling hollow, desolate and forsaken–and without the ability to self-soothe –they hastily paired up with the first available person they could find. It reminds me a little of the lyrics to B. J. Thomas’ song, “No Love at All,” in which he opines: “A little bit of love is better than no love/Even a bad love is better than no love/And even a sad love is better than no love at all.” In fact, in the mind of an individual unable to tolerate the emotional vacuum of dis-connectedness, it must certainly feel that almost anything is better than the unnerving void of being alone. But I myself would argue that if you can develop a secure, nurturing relationship with yourself , you’re in a much better position to “stabilize” your thoughts and feelings after a failed relationship and patiently wait for the right person. To me, such an alternative is far preferable to making any person the “right” person simply because he or she can immediately fill what is “abhorred” as an unbearable vacuum. Finally, the vacuum that some people strive so assiduously to avoid is really a “vacuum of self.” When we’re not enough for ourselves (i.e., can’t somehow fill our own vacuum), we can’t help but focus our attention on what we can import into ourselves to feel more whole and complete. Another PT blogger, Robert W. Firestone, recently made a similar point in a post entitled Emotional Hunger Vs. Love . As he put it, emotional hunger is the “pain and longing which people often act out in a desperate attempt to fill a void or emptiness.” When people precipitantly get into unhealthy relationships, it’s almost always to keep at bay some inner void they only vaguely understand. But to try to get from without what we haven’t yet learned to give ourselves from within is almost always an exercise in futility. Of course, there’s nothing wrong in striving to fulfill ourselves by pursuing people and things that might offer us what–personally–will afford us just the right degree of stimulation. As I stated earlier, although what is an optimal degree of stimulation varies with the individual, the basic need for such arousal is universal. And it’s certainly worthy of respect. But we still need to carefully monitor our behavior to ensure that our requirement for stimulation doesn’t ultimately end up jeopardizing our health or peace of mind. In instances where our best judgment is not available, we ought at least to confide in someone who cares about us as to whether we might possibly be getting ourselves into something questionable. Are we perhaps on the verge of making a decision that hasn’t really been thought out? that may be wrong-headed, or foolish? Many people I’ve worked with have told me that before they made what, ultimately, was a disastrous decision, friends and relatives had already warned them against it. So it’s not simply a matter of informing others about what you may be planning to do, but listening painstakingly to their feedback–whether it’s welcome or not. I’d caution anyone on the brink of acting impulsively to stop, reflect, and speak to people they trust before giving themselves final permission to embark on such a venture, or commit to such a relationship. Although it may be true that our need to fill a vacuum can productively direct our behaviors, it can also end up seriously threatening our welfare. To conclude, if you’re harboring some ambivalence about making a decision, most of the time it will be in your best interest not to until you’re able to resolve this ambivalence. At the very least, you might ask yourself the question, “Am I driven to do this because I’m desperate to fill a void inside me?” If the answer is “yes,” or “probably,” I’d suggest–before going any farther–that you talk to others. . . . Or, if at all possible, go within and consult your own wiser, more prudent self.

Many know the benefits of some drugs with an anti-depressant effect in the treatment of the chronic pain of fibromyalgia.  Well, now it would seem that there is no overwhelming evidence supporting the use of anti-depressants in the treatment of chronic low back pain.  Although, the authors of a recent review (in the “Cochrane Database of Systematic Reviews”) of the subject are quick to point out that this does not mean that depressed patients with back pain should not receive medical treatment for their depression. The hypotheses for even considering anti-depressant drugs for chronic low back pain does, nonetheless, make sense:  First, patients with chronic low back pain often also suffer from depression, and improving the mood with medication may improve in turn pain tolerance.  Second, many anti-depressant drugs have actual pain-relieving activity which often occurs at lower doses than those utilized for the treatment of depression.  Finally, many anti-depressant drugs have a sedating effect, and perhaps the improvement of sleep in those who experience insomnia may improve pain tolerance. Well, the conclusion of the Cochrane review included the finding that there was no difference in pain relief between different types of anti-depressants and placebo.  And, it appears that patients with chronic low back pain do not experience a reduction in depression with the use of anti-depressants. However, many pain experts are wondering how this can be.  Because there are fairly good studies which show that Effexor or Cymbalta have an effect on pain reduction. The divergent conclusions could result from different measures of improvement in different types of patients—–in different studies. And primary care doctors continue to prescribe anti-depressants to their chronic low back pain patients; some studies showing at a rate of about 25%. I use a variety of anti-depressants for the treatment of chronic pain, whether it be due to low back pain or neuropathy or fibromyalgia.  Sometimes there is no rhyme or reason as to why one drugs works for a particular patient with chronic pain; and so it is the duty of the doctor to be patient and use different drugs in succession if need be until the “winner” is stumbled upon.  This becomes the art of medicine, as opposed to the sometimes quirky science of medicine. I have too many patients with chronic pain who obtain at least some relief with an anti-depressant drug, no matter that the scientific conclusions today might be against me.  Tomorrow will likely bring another study and a different conclusion. A toast to art!        

On the question of new antidepressants and suicide, the evidence we have has been synthesized, and the results are in : the medications prevent suicides in adults, and especially in the elderly. For children and adolescents, we simply don’t know – and the gap in our knowledge has had dangerous effects. World Health Organization scientists based in Italy and Canada have re-analyzed data on over 200,000 patients with depression treated with serotonergic antidepressants, or SSRIs. With a pool this large, the researchers were able to look past ideation to actual attempts or completed suicides. The study found a strong protective effect for adults, including young adults, aged 18 to 25, and the elderly, over age 65. The medications decreased the risk of suicide by over 40 per cent in adults aged 18 to 64, and by over 50 per cent in older patients. These results are striking, especially in the light of earlier FDA summaries that found a neutral effect for non-elderly adults and a negative effect for young adults. But the FDA reports were based on research not designed to investigate suicidality, and the data were skewed conservatively, that is, in ways that might over-identify suicidal behavior. The new analysis is more clear-cut; it moves the line of high risk down from age 25 to age 18. What happens below age 18 is uncertain. Both the FDA summary and yesterday’s analysis found a marked increase in suicidality in depressed adolescents treated with SSRIs. (Unless I’m reading the data wrong, the risk for youth looks to be almost double on medication.) But as an accompanying editorial indicates, a large body of research points in the opposite direction. For instance, examining all youth suicides (42 deaths) over a five-year period, Danish pathologists found that none of the adolescents had been on SSRIs. In many countries, studies have found that low SSRI prescribing levels correlate with high youth suicide rates. Decreased SSRI prescribing since the FDA issued its "black box" warning has been associated with increased rates of suicide in adolescents. And some of the studies (including ones in the current WHO analysis) that have demonstrated an increase in suicidality are poorly controlled, so that the young people on SSRIs may be more seriously ill than those in the comparison group. We need to settle this issue: As regards risk of suicide, do SSRIs help or harm depressed adolescents? The editorial assessing the WHO study contains these disturbing sentences: "Alarmingly, concerns about the risk of suicide in youth have led not only to fewer SSRI prescriptions without substitution of alternative medications or psychotherapies, but also to a decrease in predicted rates of diagnosis of mood disorders. Since a decrease in the rate of true depression is improbable, clinicians may be avoiding making this diagnosis to avoid the dilemma of whether to prescribe antidepressants to children or adolescents." This worry was one that experts raised when the FDA was considering its action – that a warning, however carefully worded, might cost lives. (I should note that on balance I favored the black box warning.) As the editorial indicates, "in youth, suicide appears to occur most commonly among those with untreated mood disorders." My own impression – I discuss it in Against Depression – is that antidepressants simply work less well in children, and for reasons that accord well with the prevailing neurobiological theories of mood disorder. But when the medications do appear to help, are they dangerous? The new study again raises special worries about Paxil and also Effexor in young patients. Incidentally, two of the WHO researchers on the new study, Andrea Cipriani and Corrado Barbui, were also authors of the widely publicized recent summary analysis that rated the relative merits of antidepressants. As in the prior report, in the new one Zoloft looks especially safe, at least in adults. © 2009 Psychology Today. This RSS Feed is for personal non-commercial use only. If you are not reading this material in your news aggregator, the site you are looking at is guilty of copyright infringement. Please contact blogs@psychologytoday.com so we can take legal action immediately.

The physical world we have created and within which the incidence of depression is most rapidly rising is the densely populated Western city. It is made of concrete, steel, glass and asphalt. Most of us breathe hydrocarbon polluted air, eat nutritionally harmful or vacuous food (see your local fast food menu or supermarket tomato or strawberry for details), and drink plasticized bottled water. The National Institute of Health is studying over 900 new-to-nature chemicals, thought of as hormone interrupters, to see what effect they have on us. If we are fortunate, we may have an ocean retreat from the man-made. If we are less affluent we may make special trips to connect to nature, be it at the zoo, or the botanical gardens. But for most of us in most of Western civilization, nature is absent from our daily life. We and nature are strangers, distant relatives, and therefore we have become estranged from an important and deep aspect of our own natures. We do not, in a personal sense, understand nature as Thoreau came to, when he was at Walden Pond. I experienced this for several years as an avid mountain biker. Year after year I would bike the same trails. I was foolishly surprised when, after a winter away, the forest had changed. Year after year, bit by bit, storm by storm. I began to notice the death and new growth, the re-working of the bike trails around natures events. Most of us do not know, in our bones, the slowly changing rhythms of the forest, through the seasons, and year after year. We can only see time passing in the faces of our loved ones, or the mirror, but we do not experience the naturalness of the passage of time via a changing, slowly morphing landscape around us. We have lost the mirroring experience which the natural world provides us around the experience of time, the naturalness of it, as we might experience, if we lived connected to nature. And so we are left with an experiential void which is filled by a tremendous existential aloneness and anxiety about the strangeness of death, which seems quite disconnected from our lives, and therefore fails to inform our lives with meaning and value. We are no longer chaperoned through the stages of our lives by nature. And so we cling to youth, attempting to freeze time. In the purely physical universe, where there is no inherent meaning, and no dialogue with nature, we seek solace in the physical. We buy what we don’t need, because it is supposed to make us feel good. We work harder to buy more, because it may make us feel better. Safer. In the process, we become alienated from our families (too much time at the office, too much pressure on performance which translates into money and purchasing power and ultimately, safety from financial anxiety), our coworkers (who are generally viewed as competition). Furthermore, as a culture, western society seems to have lost its center, and seems disoriented, and without a higher purpose. The capitalistic ethos seems to have replaced a constitutional, higher purpose or imperative. And finally, we, as a society remain largely unconscious of the issues I have raised above, about our effect on other cultures, and on our planet. In the last 90 years, two world wars, multiple holocausts, threatened nuclear annihilation, and now a massive global imbalance are in the consciousness of each person on the planet. It is all very real, yet we, as individuals, as political parties, as families, communities and as a culture, are quite willing to be unconscious of the clear evidence that our current approach to human existence is failing. What is often said to alcoholics-the definition of insanity is doing the same thing over and over again and expecting a different result-can certainly be applied to Western civilization. Perhaps, with the current economic crisis, we have ‘hit bottom’. And so, to circle around to the point at hand-if one is living in a fundamentally imbalanced and insane culture, is it surprising that greater and greater numbers of individuals are presenting with depression? Should we be so myopically focused on the individual? Is that individual focus not part of the reductionsitic thinking that has limited the effectiveness of the current treatment approach? Can and should the individual carry the full burden for recovery from depression? It seems that on a collective level, higher numbers of depressed non-functioning individuals are already causing a braking, or a negative feedback loop to the growth of the culture, via excessive health care costs, comorbid conditions such as diabetes and heart disease, and reduced viability of the individual, the family unit and therefore the community-all known sequelae of depression. If we can learn about and understand the links between the brain and the immune system, and between diet and mood, must we not wonder about the links between the culture and individual behavior, between the stresses of Western psychology and the craving for something to satisfy the inner emptiness? Is there not then a link between this craving, and the purchase of material goods (and the attendant stresses of paying for them), just as there is between the intake of sweets and the subsequent inflammatory response? Ultimately, reduction of the incidence and prevalence of depression on the public health scale will not come from anti-depressants, individual psychotherapy, or from fish oil. It will come from a re-connection of the individual with the larger whole of the family, the community, a purposeful culture, and a dialogue with nature and meaning. This will require a rebalancing of the male-dominated, individualistic, domination oriented culture (in which reason and logic are the only way of knowing) with the feminine, wholistic, interactive and participatory approach to life. We, as human beings need a balance of both to thrive. Socioeconomic and political efforts to incorporate such an integrated view of ourselves, the world and our futures are the therapy which this culture requires, if we are to stem the rising tide of depression. In the many older cultures (e.g., Jewish, Indian), the collective community is responsible for the well-being and good behavior of the individual. So too, must the larger Western society and culture be held accountable for its role in the mental health and wellbeing of individuals. © 2009 Psychology Today. This RSS Feed is for personal non-commercial use only. If you are not reading this material in your news aggregator, the site you are looking at is guilty of copyright infringement. Please contact blogs@psychologytoday.com so we can take legal action immediately.

Two men rescued at sea last week in the Torres Strait by an Australian helicopter crew claimed to have drifted helplessly for 25 days in a large plastic cooler. Ko Ko Oo, 22, and Haung Htaik, 24, told rescuers that they were Burmese fishermen who had climbed into the five-by-four-foot box after their rickety boat broke up in rough waters some 200 nautical miles north of Australia; the boat’s eighteen other fishermen and crew were thrown overboard and presumably drowned. The men told reporters that they drank rainwater and ate nothing for the first ten days of their ordeal. "Then two big seabirds came and vomited some small fish — about six or seven little fish," Oo said. Bit by bit, these became the men’s meals. Seldom has anyone ever been so grateful for anything upchucked. A man rescued from the Indian Ocean two weeks after the 2004 tsunami that devastated parts of South Asia reported that he had survived by clinging to pieces of wood, snatching coconuts as they floated past and eating them after prying them open with his teeth. According to the Guardian , Indonesian construction worker Ari Afrizal said that as he watched corpses and debris swirling in the water, he "prayed and prayed. I told God I didn’t want to die… I worried about my elderly parents and asked for a chance to take care of them." In 2001, the San Francisco Chronicle ran a story about a boatload of Dominicans who lost their way while trying to reach Puerto Rico and survived by drinking the breast milk of a new mother on board: Soon after setting sail on the handmade boat, the passengers realized its compass was broken. Six days later, "’there was nothing more than prayer and my sister’s breast,’ said Elena Mercedes, 24." We are duly told that the waters in which all three incidents took place were shark-infested.  Why do we so love survival-at-sea stories? It’s partly because they hark back to adventure tales of old — to those days when human beings were frequently and brutally thrust into the jaws of nature without layer upon layer of technology and infrastructure to protect them. But we also love such stories because they’re about situations in which typical day-to-day mental processes are abruptly displaced by arguably stronger stuff: extremist thinking, survival strategies, prayer and panic and instinct. We spend the bulk of our complex yet cosseted lives pondering. Analyzing. Processing. And even though some of us ponder/analyze/process ourselves into chronic anxiety, for better or worse this is a luxury that comes with living in a free and safe society. When you’re suddenly adrift in an icebox or atop flotsam or lost and starving, that luxury vanishes as if it never existed. Sheer necessity encompasses all as body and mind face hard cold facts entirely on their own. Fears of anything besides death fade. Humiliation loses all meaning. And questions about how on earth one can resist another Ecstasy pill or another cigarette or another shopping spree simply cease to be questions. Priorities shift because they must. Reading survival-at-sea stories, we project ourselves into them, and wonder: What if I had to give up this … and this … and this? What if I absolutely had to?   © 2009 Psychology Today. This RSS Feed is for personal non-commercial use only. If you are not reading this material in your news aggregator, the site you are looking at is guilty of copyright infringement. Please contact blogs@psychologytoday.com so we can take legal action immediately.

One cannot fully assess the nature of depression without addressing the context (cultural, communal, familial) within which it occurs, any more than one could fully understand the growth of a bacterium without understanding the medium within which it grows. To focus the analogy even further, we might say that we cannot fully understand the growth of the phenomenon of depression, the rising incidence and prevalence, without understanding the medium within which this phenomenon is growing. That medium is the western culture, the community one lives in, the schools and groups one belongs to, and the family. Much has been written about the influence of marital status, marital satisfaction, early parental loss, and early developmental trauma on the vulnerability to depression. However, much less information has found its way into the mainstream psychosocial literature in regards to the influences of both the community and the larger western culture on the growing incidence of depression. What is this culture of depression? Families, communities, and farms have been broken apart as a result of the industrial revolution, economic swings, technology, and the pursuit of work. Two income families have become much more prevalent as personal income in the US became flat in 1973, and then has been declining since 1980. With both parents working, and grandparents in another city, most children are spending their critical attachment years in pre-school or a series of day care centers. Western culture, according to Richard Tarnas, author of: The Passion of the Western Mind & Cosmos and Psyche , has evolved over the last few millennia in such a manner that modern humankind is now alienated, disoriented, and unconscious. Despite the very significant advances afforded by the current world view, we are seeing the darker aspects of that world view come to the fore in the form of world wars, holocausts, the threat of nuclear annihilation, and now global warming and ecologic disequilibrium. Furthermore, the western world-view is that we live in an inanimate universe, with other life forms, which are essentially unconscious. We consider ourselves to be unique in the universe, and as a corollary to that, we are superior, and we are, by definition, alone. Additionally, we believe that science is the only valid way of knowing. In a neuroanatomical sense, we have over-privileged the functions of the prefrontal cortex and left hemisphere, over the rest of our brain. Logic rules, and instinct and tradition have become stepchildren. More and more, if we think about it, we grapple with what seems to be an inescapable conclusion: we live in an essentially meaningless, purely physical, random world, in which we are essentially alone, separate from others, separate from nature, and separate from (if we even believe in) a creator. We wonder if we may be nothing more than meaning-seeking specks of dust in an infinite, uncaring, and unconscious universe. We are here. The creator, if there is one, is out/up there. This then, is the world-view and the culture, within which depression (not to mention greed and corruption) has grown in incidence and prevalence. If world-views create worlds, as the leading psychotherapy of depression, cognitive therapy, asserts, then we must wonder what it is about the assumptions of the western world view that have created a new reality in which depression is rapidly becoming the second leading cause of disability in the world. Could the assumptions (outlined above) be mistaken, or harmful? Adapted from Depression: Advancing the Treatment Paradigm. © 2009 Psychology Today. This RSS Feed is for personal non-commercial use only. If you are not reading this material in your news aggregator, the site you are looking at is guilty of copyright infringement. Please contact blogs@psychologytoday.com so we can take legal action immediately.

Depression stinks. No doubt about it. Having treated dozens of individuals with depression over the years, while reading countless books on the treatment, I still believe that the number one factor that really enables me to get to the heart of this malady is my firsthand experience with it. Depression started tugging at my heels by the time I was 8 years old. By 16, the dean of my high school would call me each morning to make sure I got out of bed and showed up at school, instead of sleeping all day. By 30, I had two boyfriends; Ben and Jerry. Today, I still have low moments, but they are far less often, and last far less long. Imagine if we had a scribe in our heads, even for a day. I know I would be ashamed to think of what mine might write. Having done a great deal of research on depression, I have heard many expert opinions regarding its etymology. We are still unsure if is is environmental, historical, genetic, energetic, past-life, DNA-related, trauma-based, kharmic law. One thing is for sure; when we got it, we got it, and it can be crippling. What folks may not know is that there are very useful tricks we can use to alleviate a sour mood. The brain is plastic. It is the last part of our body to really know something. When we tell our brain that life is awful and we are doomed, our brain tends to agree. In fact, I have noticed that when I experience a bout of depression, it is often triggered by events where I feel exposed as a failure. My way out usually begins with a decision. A decision to feel better. So, I decided to compile this list. Write these down, stick em on your wall, and put them in motion. Trick 1: Get out of your head and into your feet The body craves movement. Exercise really works. Let’s not think of it as exercise though. Nothing is gnarlier to the depressed person than imagining him/herself at the gym in ill fitting sweats, panting on the stair master while svelte athletes are bopping around in all directions. As Woody Allen says, 90% of success is showing up. Once we’ve got our walking shoes on, once we get endorphins cooking, the doldrums have less power to penetrate. Christine Caldwell, Body-Centered Psychotherapist and author of "Getting our Bodies Back" tells us: Our bodies love to move and must move. Movement is the way we define life–when our hear beats, lungs pulse, brain waves, we are alive; in the absence of movement we become inanimate or dead. When movement is held back, energy/life flow is impeded and we become sick. Trick 2: Turn on the music Keep an arsenal of inspiring and fun music. When we’re depressed, the smallest task feels overwhelming. If I can kick-start someone’s joy, then I am thrilled. Turn on the sound. Trick 3: Sit in the sun Many of us work in windowless cubicles or offices, and wonder why we feel blue. This time of year, when the sun sets earlier, we lose vitamin D. Do anything you can to take in more light. Sit in the sun for 5 minutes. And if there is no sun in your world, then buy a full-spectrum light. Get one cheap on E-bay. Trick 4: Hang out with 4-leggeds (Unless you’re allergic) Having an animal companion near can instantly release oxytocin, that delicious hormone that we secrete when we fall in love, give birth, or are nursing. It releases a feeling of goodwill, or trust in the world. OK, so not all of all are blessed to be in love all the time, or be breast feeding, so find other ways to bring on the joy chemical. Read on. Trick 5: Change your thoughts We have around 60,000.00 thoughts per day. Some 87% of them are negative and are the same thoughts we had yesterday. Experiencing joy is a deliberate choice. Joy takes practice. Joy is hardcore. In Natural Intelligence, Psychotherapist Susan Aposhyan states; "On a muscular level, any thought also results in at least minute muscular responses, evidencing the body’s compulsion to somehow do the thought. Having an affirmation, allows the mind to want to do the thing that we are hoping for. We must remember that affirmations don’t make something happen, they make something welcome. People tell me, "I put an affirmation up on my bedroom wall, saying: "I am ready to meet a gorgeous, successful, fabulous man who will adore and worship me." It’s been 3 months. Where is he?" I tell them; "You have made yourself more open to meeting this human. Finding him is another story. Sorry." Trick 6: Follow a joyous lifestyle. Find a class, a workout, anything that gets you in your body, preferably sweating a bit. Just getting out of the house and being with other people, say, in a yoga class, or dance class, or knitting group, offers us a distraction from the mind chatter. It works. Trick 7: Affirm joy with words Rudyard Kipling said "I am by calling a dealer in words. And words are by far the most powerful drug in the world". It may seem trite, but changing the way we speak can be extremely influential in changing our moods. Trick 8: Grab hold of a goal Make it a do-able one. Psychologist Martin Selegman tells us: Happiness and joy come from goals. We mustn’t put off our lives. Trick 9: A smidgen of faith Christiane Northrup, bestselling author of Womens’ Bodies, Womens Wisdom, and expert on mood disorders, shared this pearl of wisdom in a talk that she gave last summer at the Omega Institute. She says; "We are whom our higher self wanted to experience." There is some truth to the pithy phrase: There’s no aetheists in foxholes. Have a smidgen of faith and the world can be a gentler space. Trick 10: Choose joyous companions When we are depressed, we take our bored, sluggish selves wherever we go. We need distractions. We need company. We need intimacy. It is very important to be around upbeat people. We need someone who believes in us. No nay-sayers welcome. *Guest blogger Rachel Fleischman, MSW, LCSW, is a San Francisco-based therapist. Her profile can be found on Psychology Today’s therapy directory . © 2009 Psychology Today. This RSS Feed is for personal non-commercial use only. If you are not reading this material in your news aggregator, the site you are looking at is guilty of copyright infringement. Please contact blogs@psychologytoday.com so we can take legal action immediately.

The phrase "There’s a war on…" has been so overused by some sensationalist news coverage in recent years that I loathe to even go there in looking at an alarming new research finding. Yet, there is nothing else to call it. It’s inescapable. The common teachings in my training program years said that single men were in a more precarious health position as compared with their married peers, and that women generally were more protected against completed suicide than men, especially those married and with children. Well, I couldn’t believe my eyes when I saw the recent article finding a massive rise in suicide among middle-aged women (Source: MSNBC )  Having seen thousands of women both in clinical mental health treatment and in the live coaching programs I put on for both men and women out on the town – to show them the latest techniques and tactics in effective dating – many at first view their dating lives as a mere hobby, a casual thing in the face of more important career strivings in the recent economic environment. Meanwhile they also express significant discontent about the state of love and dating today – even going so far as to suspect most of their troubles are due to the strange and annoying habits and instincts of the other gender. "Men can’t commit, and all they want is the sex," I hear. Are they really an enemy of committed love? "Women don’t seem to appreciate me, and they nag me," I hear. Are they really an enemy of male contentedness? Well, one quote I sometimes paraphrase from DH Lawrence in these trainings is that "the future of the world will not be determined by nations, but in the relations between men and women." WASHINGTON – U.S. suicide rates appear to be on the rise, driven mostly by middle-aged white women, researchers reported on Tuesday. They found a disturbing increase in suicides between 1999 and 2005 and said the pattern had changed in an unmistakable way – although the reasons behind the change are not clear. The overall suicide rate rose 0.7 percent during this time, but the rate for white men aged 40 to 64 rose 2.7 percent and for middle-aged women 3.9 percent, the team at Johns Hopkins University in Baltimore found. "The biggest increase that we have seen between 1999 and 2005 was the increase in poisoning suicide in women – that went up by 57 percent," said Susan Baker, a professor in injury prevention with a special expertise in suicide. If we compare this alarming change in danger to women to some of the observations from Lancet, 2000 . We see that suicide by poisoning among women was still high, but the demographic more at risk was women under 30, with unemployment previously offset my more women entering the workforce, and protected against by having offspring to care for: These possibilities are not mutually exclusive, and examples of each are apparent in the links between suicide and unemployment, divorce, and misuse of alcohol and drugs. Increases in the prevalence of these factors may have contributed to the rise in suicide rates among men in recent years and the widening gap between the sexes.5 Alcohol and drug misuse has also risen among women, although rates remain lower than among men. By definition divorce happens as commonly among men as among women, but the experience is often different. In particular, women are more likely to retain responsibility for the care of young children, a factor that seems to be protective against suicide.6 Although population unemployment rates may be associated with suicide in both sexes, the effect of rising unemployment rates among men in the 1980s on the socioeconomic circumstances of women, and therefore their risk of suicide, may have been offset by the increasing entry of women into the job market, another possible protective factor. Today, we are not only under excessive economic strain, but as compared to years and decades past, there are also far less middle-aged women with children – that protective factor against suicide. In fact, in the age groups 40-44, double the rate of childlessness from thirty years ago. (Source: USA Today ) Meanwhile, that protective effect of marriage on men they taught us about in medical school years ago has begun to deteriorate . New research by Hui Liu and Debra Umberson published in the Journal of Health and Social Behavior, suggests this story may be changing. Liu and Umberson looked at self-reported health data obtained as part of a huge US survey from over 1 million participants. They were interested in seeing how the relationship between marital status and health had changed between 1972 and 2003. What they found was that the health gap between married men and men who had never been married narrowed in this 30-year period. By 2003 there was very little difference in health status between unmarried and married men. It seems that marriage no longer confers the same health benefits on men that it once did. If we scan these four articles, they don’t directly, irrefutably prove that a lack of love, a "War on Love" is directly killing more women than ever – ironically the most likely gender to actually seek out mental healthcare, be motivated to get treatment, and yet possibly still the greatest current "casualties of war." However, they really do open up a lot of questions that we need to be very concerned about – to view dating and the mate selection process not just as a pastime, hobby, or casual "add-on" to our career strivings in an economic downturn, but a major educational need and a major public health crisis. Are men leaving commitments to marriage and children, or forgoing them entirely in part because the institution no longer benefits not only their mental well-being, but even their physical health? Are middle-aged women depressed and even dying because of a lack of mutual understanding between the genders, effectiveness at dating and mate selection, and a decrease in childbirth? With a wealth of formal studies on committed relationships and marriage, and a relative lack of them on early dating and the details of mate selection placed in educational formats for practical application, is our lack of knowledge on this subject not only causing a loveless discontent, but literally killing women? The articles don’t directly address this, but clearly we, as a society, need to know. If there is a "War on Love", then the enemy is not men or women as genders, but our lack of effective dating strategies for men and women individually, with a practical application of the findings. "On the street," thousands of men have told me face to face that they really, truly desire a commitment, but just have not found a person they are both attracted to, yet also feel a real, true commitment back from. Many say that they don’t feel valued and appreciated by women in general. Just as many women tell me that they haven’t had a real, proper date in a long time, and feel adrift in the sea of popularity of "hook-ups" and "hang-outs." Undefined, no-rules dating, rather than a true, thoughtful effort on the part of men to get to know them slowly, over time, and at a level that is more than just feeling the "sexual chemistry." All of which to my mind sounds like a desperate societal need for what was once, long ago, called "courtship" – a slow, thoughtful, wise process of getting to know another person intimately, before diving in headlong into a lifetime commitment. Friends, family, and entire villages were once involved in assisting it… …and while courtships ended in disappointment due to incompatibility at times, there wasn’t a "War on Love" itself, or so many potentially true and permanent casualties. We need to act. The cost of letting this study become a forgotten headline is far too great. © 2008 Psychology Today. This RSS Feed is for personal non-commercial use only. If you are not reading this material in your news aggregator, the site you are looking at is guilty of copyright infringement. Please contact blogs@psychologytoday.com so we can take legal action immediately.