“I don’t feel like doing anything, nothing is working out in my life, I can’t sleep, or eat, why is god doing this to me? “ It is just a phase…”
The other day, on a moonlit promenade after a heavy meal, I initiated a seemingly ‘never getting to a conclusion’ discussion with an old friend. At that moment, a realisation dawned; actually, more of a reinforcing confirmation entered my mind. Humans by nature do not easily accept. Period.
Mental health in our country is often not included in our everyday life’s discussions. A family member sneezes and it becomes at least a 5-minute table or bedroom conversation. We are told not to get out in the cold winter months, not eat ice creams or drink juices lest we catch a cold and flu. An anxious mother even calls the family doctor for what we call the ‘common cold’.
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A teenage daughter closes herself in the room for hours, thinking about how she looks and is not thin enough, leading her to avoid all social situations; is casually taken as ‘normal behaviour’ of children. Educated parents too resist consulting mental health professionals. They tell themselves their children are fine and don’t need psychologists. Stigma about mental illness persists and they are more about what others will think. They don’t realise that by avoiding intervention when required they are making it worse.
We all experience different states of moods and emotions in our daily lives. It is our state of mind at that time; nervousness before an exam or being cross with a friend, a parent and so on and so forth. Feeling sad, having a low mood, and worrying about the day’s events would subside or cease to exist as soon as the situation or event passes and we move on. We also know that being in a constant state of happiness is not statically wired in our brains.
Let’s take a small example. You partied the night before a presentation in college. You get up early but are cranky and try to calm yourself by listening to some music. Minutes later, your mom starts her regular lecture about your life. You get irritated and take off your headphones. You step in 15 minutes late and worry about the look on your friends and the teacher’s faces. The presentation and the following Q & A round go on smoothly. However, the grade you will receive on it keeps you further worried. This scenario portrays a ‘normal’ range of emotions a person goes through on any given day.
Sadness however does not involve distortion of thoughts or perception. So, after a loved one’s death, you will miss their physical presence and miss them. These are realistic thoughts. If on the other hand, you feel you will not be able to live without them, life has become hopeless, and you stop engaging in daily activities and are not taking care of yourself, this can lead to negative distorted thoughts. If these persist for a long time you could be going through depression. In such a case, seeking professional help is ideal.
What is Psychotherapy?
People also call it ‘talk therapy’. Talking to a friend to express self, however, is not psychotherapy. Professionals authorised to conduct psychotherapy are psychiatrists, psychologists, mental health social workers and other trained mental health providers. Children, adolescents, adults and the elderly with psychological and neuropsychological problems can be helped using individual, family, couple, marriage, and group therapy sessions.
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Generally treatment resorts to three approaches namely psychodynamic, cognitive –behaviour and humanistic perspectives. The myriad number of mental health problems and disorders can be treated and or helped through therapy be it using any approach. Depending on the severity of the disorder after being assessed and diagnosed, either medication or medication in conjunction with therapy is advised for patients.
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Medication is the first thing people resort to falsely thinking that popping a pill can magically cure whatever they are going through. Yes, it helps the neurotransmitters that are playing truant to get back to their normal levels thus making us feel fine. So, it takes control of our mood for a few hours till u pop another one. What will you do about your thought process? A patient suffering from depression with negative distorted thoughts is on medication to alleviate their low mood but the constant “ I am not good enough and no one likes me” persists. What can be done to make them think differently so that they no more negatively perceive things?
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Psychotherapy assists in first understanding moods, thoughts, behaviours and its effects on our physiology. The therapist helps the patient to challenge these unwanted negative thought patterns to gain some control and be able to handle life’s situations. Research to evaluate therapy outcomes has proven that patients who undergo therapy fare substantially better than those who haven’t. However, there is no ‘one answer’ to whether psychotherapy is effective or not. It differs from person to person and there are many factors one needs to keep in mind to understand what works and what doesn’t.
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The first one is the patient going into therapy. Each person who wants to seek help has a varied history of his illness, family background, social support or the lack of it, thought perceptions, personality and self-concept, past experiences and physiological complaints. Let us imagine this patient undergoing medical treatment, diagnosed with severe depression has just begun therapy. What are the challenges that a therapist can face? The chances are many. There’s a possibility they would have been forced by family or friends to begin with therapy, as they would not be in a state to do so.
Attention and concentration would be difficult as cognitive impairment is seen as a main feature in depression patients. The level of motivation of the patient will also matter whether they continue or withdraw. If there is a high level of motivation, they will be totally in it and follow what they have been told to do and therefore show improvements in symptoms of depression. The premorbid personality of the individual can determine how positively or negatively they go through the process. A great deal has been written about the patient’s perspective in therapy. Those with challenging symptoms, problems and co-morbidities have shown low improvements.
Let me cite an example from my practice as a clinical psychologist with a patient suffering from borderline personality and suicidal tendencies. He has come into treatment for the first session with the assumption that the problem lies in his marriage and that the spouse is equally to be blamed. After the first consultation and assessments, it is seen he has many comorbidities including self-harm suicidal tendencies and depression.
He then starts making excuses and withdraws from therapy right after an assessment and diagnosis has been made. Let’s compare this patient with a 25-year-old depressive patient who has willingly entered into therapy because of his motivation to be the person he was before this mental illness led to a change in his life. Such a person is likely to make all the efforts to help himself and be there in the sessions.
Therapy and the therapist
The kind of therapy or combination of therapies used by a professional makes a huge difference in the outcome of the treatment. Even though many psychologists and therapists use an eclectic approach, specific approaches used in some mental health disorders have been more successful than others. For example, it is well known that patients with anxiety disorders fare well with a behaviour therapy approach. Two universally known and practically followed treatments; systematic desensitization and progressive relaxation techniques have shown great efficacy.
Of course, depending on the severity these are either used in isolation or with medication. Cognitive behaviour therapy has been proven to be effective in mood disorders. This is assisted with cognitive training for those with moderate to high depression levels to help alleviate cognitive dysfunction, a primary feature of depression usually not paid heed to.
Also, if there are deep-rooted causes of depression then psycho-analytical therapy strategies come in handy. Eating and sleeping patterns take a toll on most mental health and neurological issues. Thus the professional should deem it necessary to educate the individual about the same. However, care should be taken in what suggestions are given.
That has to be based on appropriate knowledge and not their own choices and tastes. Eating disorders are also helped with CBT and interpersonal therapy approaches. Along with treating the patient individually, it is important to psycho-educate families and take family and group therapy sessions as and when required for a holistic outcome.
There can be harmful effects of psychotherapy as well. If the therapist is not well trained in certain approaches and takes it upon themselves instead of referring, this can harm the patient instead of help. In such a case the professional should immediately suggest another psychologist /therapist who has the expertise in the approach required. Some people have a personal bias towards certain approaches or a particular school of thought and because of that are not entirely able to do justice to the problems faced by patients.
A lack of a therapeutic relationship also becomes a major concern as far as any treatment is to follow. A therapist’s state of mind and their personal opinion on some life situations can spoil this relationship and hamper the actual purpose of treatment. For instance, if the therapist is irritable and frustrated on a particular day instead of cancelling the day’s session they go ahead with it, the patient may not feel comfortable at all. Being empathetic is in itself a predictor of the effectiveness of therapy outcomes.
Early detection of any causes leading to deterioration of a patient’s state will help rectify the mistakes made in the process whether coming from the intervention strategies or the relationship in its entirety. Regular feedback and follow-up sessions are a way to benefit patients.
Do we say to people with diabetes or any physical illness “You’ll get over it” without any treatment and care? Then why does this happen with mental health problems? Think about it! Go for timely intervention
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