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Interventions - The EFAP Journal of CMR Canada

Spring 2007

In this issue:

• Depression
• Your Mental Health
• Children and Self-Esteem
• Are You Too Anxious?
• Bumper Stickers
• EFAP Profile
• Link - AUPE Member Assistance Program

Note: These articles present only one perspective on a body of information on the subject and is not intended to be definitive. CMR Canada recommends you seek additional perspectives on the subject.

Depression:  An illness, not a weakness

In 1998, StatsCan estimated depression cost Canadian employers more than $14 billion in lost productivity.

More than three million Canadians will experience a major bout of depression at some point in their lives, according to the Canadian Mental Health Association. Most of them will be women and most will be between the ages of 22 and 44.

Follow-up research released by Statistics Canada on Jan. 12, 2007, found that half a million Canadian workers experience depression and most of them — almost 80 per cent — say the symptoms interfere with their ability to work.

The survey found that four per cent of workers between the ages of 25 and 64 had experienced depression in the 12 months before the survey. The workers most prone to depression were those who regularly worked evening or night shifts and those employed in sales or service.

Depressed workers reported an average of 32 days in the previous year when their symptoms left them either unable to carry out normal activities or totally unable to work.

A study released by Statistics Canada on Oct. 17, 2006, found that slightly more than one million adults reported a "major depressive episode" in the year before they were interviewed. Seventy per cent of those surveyed held jobs.

In 1998, StatsCan estimated depression cost Canadian employers more than $14 billion in lost productivity. The World Health Organization reported that in 2000, depression was the leading cause of short-term disability around the world.

However, depression is a highly treatable illness: 80 per cent of people who seek help can be successfully treated. But 15 per cent of those diagnosed with a severe depressive episode commit suicide.

I'm feeling down. Am I depressed?

Not necessarily.

It's normal not to be in the best of moods all day, every day. However, you may be depressed if you're experiencing:

• A major drop in your mood that lasts most of the day and is consistently low for two weeks or more.
• A loss of interest in things you normally love to do.
• Changes in sleep patterns.
• Loss — or increase — of appetite.
• Inability to concentrate or function at work.
• Irritability at home or at work.
• Grudges against people you perceive have wronged you.
• Decreased sex drive.
• A desire to avoid other people.
• Overwhelming feelings of sadness or grief.
• Unreasonable feelings of guilt.
• Thoughts of death or suicide.

Are there different types of depression?

There are three main types:

Major depression

• Interferes with work, study, sleep, eating habits and activities.
• Depressive episodes may strike some individuals once, but more commonly occur several times in a lifetime.
• Primary symptoms include sad, anxious or "empty" moods; hopeless feelings; a sense of guilt, worthlessness or helplessness and a loss of interest in activities.
• Fatigue or insomnia may be symptoms as are changes in sleep habits or appetite.
• Thoughts of death or suicide can suggest depression, as can physical symptoms that don't respond to treatment.
• Strikes women twice as often as men.

Dysthymia  

• Dysthymia lasts longer than major depression, but is less disabling.
• A dysthymia sufferer can function although depressed feelings generally prevent the individual from functioning well or feeling good. Many people with dysthymia also experience major depressive episodes at some time.
• Characterized by a lack of enjoyment in life that normally lasts at least two years.
• Over a lifetime, dysthymia can have severe effects: high rates of suicide, poor functioning at work and social isolation.
• Strikes women twice as often as men.

Bipolar disorder

•  Sometimes called manic depression.

•  Least common form of depression.

•  Dramatic mood swings are typical.

•  Symptoms include abnormal elation, decreased need for sleep, increased sexual desire, markedly increased energy, and inappropriate social behaviour.

•  Left untreated, a manic episode could worsen into a psychotic state.

•  Strikes men and women equally.

What causes depression?

There is no one cause of depression. It can be triggered by a specific traumatic event in your life, a biochemical imbalance in your brain or your outlook on life, if it's particularly negative.

There can also be other factors that make some people more prone to depression than others, such as a family history of the illness.

Depression could also follow prolonged stress on the job. Judith Berg, a Vancouver-based therapist, says workplace depression can result from stressors such as high demands over which you have little control.

She says enlightened employers are looking for ways to address those issues.

"In the last five years, they've moved away from the old health promotion model into looking at what can they do in the organization to reduce the stress."

How long does depression last?

It depends on the person, the depth of the depression and the help available to the person suffering from the depression.

If left untreated, depression may lift on its own after several weeks or months. With professional treatment, it could end much more quickly.

Depression is rarely permanent. But once a person has suffered an episode of depression, they are more likely to experience it again.

How is depression treated?

Those who realize they are suffering from depression benefit from professional counselling and — possibly — medication. There is a wide range of anti-depressants on the market that have been approved in the treatment of depression.

Medication does not normally "cure" depression. But it can help people get through their daily routines.

Your Mental Health

Mental health means striking a balance in all aspects of your life: social, physical, spiritual, economic and mental. Reaching a balance is a learning process. At times, you may tip the balance too much in one direction and have to find your footing again. Your personal balance will be unique, and your challenge will be to stay mentally healthy by keeping that balance.

This article has been prepared with some suggestions to help you strike and keep your balance.

Build a healthy self-esteem

Self-esteem is more than just seeing your good qualities. It is being able to see all your abilities and weaknesses together, accepting them, and doing your best with what you have. For example, you may not play tennis well enough to be a star, but that should not stop you from enjoying the game.

Activity - Build Confidence
Take a good look at your good points. What do you do best? Where are your skills and interest areas? How would a friend describe you? Now, look at your weak points. What do you have difficulty doing? What things make you feel frustrated? Take a look at this list. Remember that all of us have our positive and negative sides. We let our strengths shine, and we build on our weak points to help us mature and grow.

Receive as well as give

Many of us confuse having a realistic view of our good points with conceit. We have trouble accepting kindness from others. We often shrug off a compliment with a, "Yes, but..." and put ourselves down.

Activity - Accept Compliments
The next time someone compliments you, say, "Thank you! I'm glad you think so." Then think about other compliments you have had, and how good they made you feel.

Create positive parenting and family relationships

Work on building good family relationships. Learn to value each member's skills and abilities. Learn how to give and accept support.

Activity - Make Time
Make time just to be a family. Schedule time for both serious things and fun. Listen respectfully without interruption to what each person has to say. Do it frequently.

Make friends who count

Friends help you understand that you are not alone. They help you by sharing your "ups" and "downs", and you in turn help them. Together, you and your friends share life's challenges and celebrate life's joys.

Activity - Build A Friendship Tree
Keep in touch - invite a friend to lunch. Encourage new friendships - ask your friend to bring someone you have never met.

Figure out your priorities

Advertisers try very hard to convince us that we "need" their products and services. Our challenge is to know the difference between our real needs (food, shelter, clothing, transportation) and our "wants" (bigger TV, new CD player, expensive fashions, flashy car), and to find the right balance in our spending. Financial problems cause stress; so it is important to avoid over-spending.

Activity - Create A Meaningful Budget
Write out a budget for yourself. Is it realistic? Have you planned what to do with the money left over for your "wants"? Which "wants" are most important to you?

Get involved

Being involved in things that really matter to us provide a great feeling of purpose and satisfaction. You should always remember that you make a difference, no matter how big or small your efforts.

Activity - Volunteer 'Be a volunteer'.
Read to children at your local library; visit an elderly person at home or in hospital; serve on a committee or the board of your favorite charity; organize a clean-up of a local park or beach; help a neighbor clean out his/her garage.

Learn to manage stress effectively

Stress is a normal part of life. How you deal with it will depend on your attitude. You may become overwhelmed by things that other people deal with easily. Learning to keep a balance among work, family and leisure is difficult and needs skillful management of your time. Planning helps, and so does staying calm.

Activity - Take A Five-Minute Vacation
Each day, set aside five minutes for a mental health break. Close your office door or go into another room, and day-dream about a place, person or idea, or think about nothing at all! You will feel like you have been on a mini-vacation.

Cope with changes that affect you

It would be nice to "live happily ever after", but real life keeps "throwing monkey-wrenches" at us. Coping with these unexpected (and often unwanted) changes can be stressful. Children have accidents, parents get ill, jobs disappear -we need to be flexible and learn ways to cope.

Activity - Find Strength In Numbers
Search out a support group that deals with the issues you are facing. By teaming up with people who share your problems, you may find a fresh solution. Try starting a group of your own by using the public service announcements in your local newspaper, radio station or TV station.

Deal with your emotions

We are all challenged to find safe and constructive ways to express and share our feelings of anger, sadness, joy and fear. Your ways of experiencing and expressing emotions are unique because you are unique.

Activity - Identify And Deal With Your Moods
Find out what makes you happy, sad, joyful or angry. What calms you down? Learn ways to deal with your moods. Share joyful news with a friend; "cry on a shoulder" when you feel blue. Physical exercise can help you deal with your anger. Keep a stack of your favorite funny cartoons or a collection of humorous stories or video tapes for times when you feel the need to laugh.

Have a spirituality to call your own

Learn to be at peace with yourself. Get to know who you are: what makes you really happy, what you are really passionate about. Learn to balance what you are able to change about yourself with what you cannot change. Get to know and trust your inner self.

Activity - Build Your Own
"You" Set aside quiet, quality time to be totally alone. Do a breathing exercise- try counting your breaths from one to four, then start at one again. Or do something you love to do, like dancing, going to a baseball game, building a bird house, whatever works for you!

Do you need more information?

If you would like more information about mental health, you can contact a community organization, such as the Canadian Mental Health Association, to help you find what you need to know. The Canadian Mental Health Association is a national voluntary association that exists to promote the mental health of all people. CMHA believes that everyone should have choices so that, when they need to, they can reach out to family, friends, formal services, self-help groups or community-based organizations.  

Children and Self-Esteem

Self-esteem is the value we place on ourselves. It is the feeling we have about all the things we see ourselves to be. It is the knowledge that we are lovable, we are capable, and we are unique. Good self-esteem means:

• having a healthy view of yourself,
• having a quiet sense of self-worth,
• having a positive outlook,
• feeling satisfied with yourself most of the time,
• setting realistic goals.

Both adults and children benefit from good relationships, experiences and positive thinking. Many of the steps necessary for building a child's self-esteem will also help you in developing and maintaining your own.

As a parent, you have the greatest influence in shaping your children's sense of self-worth; you are their first and most important teacher. Their self-esteem is further influenced as they develop relationships with other family members, school teachers, friends and other adults.

Love and acceptance

Showing children that they are loved and accepted simply because they exist is the first and most important step to building a healthy self-esteem. Children need to get the message that they are worthy of love (even if they behave badly sometimes) from the most important adults in their lives - their parents, You must remember to:

• give love with no strings attached,
• show love and acceptance through your daily expressions of affection, care and concern,
• spend time together - play, work and relax together,
• show that you feel good about them by hugging them,
• tell them often, "I like what you did/said" and "I love you."

A sense of belonging

Children need to know that they are important. When they feel accepted and loved by the important people in their lives, they feel comfortable, safe and secure, and open to communication. If children feel respected and secure within a family, they will find it easier to make friendships outside the family. To help children develop that sense of belonging, you can:

• help them build valuable family and community relationships,
• encourage pride in their family's ethnic background and heritage,
• keep reminders of family events and family history around the home (photograph albums, home videos, etc.).

Security and safety

Children must have their basic needs met if they are to feel safe and comfortable. A sense of security and safety allows them to take the next step: to try new things and to learn about themselves.

When children feel safe, they are less likely to be afraid of failure and more likely to risk trying again when they fail. Through this process, they are able to experience success. As their parent, you should try to:

• provide a safe physical environment,
• set and enforce clear rules and limits,
• be realistic in your expectations,
• encourage them to say "No" to negative pressures.

Trust

A stable environment they can depend on provides children with a sense of security. It is important for children to learn that their actions have consequences. Knowing that you can be relied upon to be consistent and to give help when necessary helps children to think, "I can trust you, and I can trust myself." To build this kind of trust, you should:

• be consistent so they know what to expect,
• be sure your verbal and non-verbal messages agree,
• be honest about your feelings to yourself and to the children,
• treat each child fairly.

Respect

Children will develop respect for themselves and for others if they learn that what they think, feel and do is important. If you put them down or call them demeaning names, your children will feel unworthy. Criticism or punishment which is too harsh will prevent children from developing self-confidence. By accepting your children's right to have feelings, you can help them learn to respect the feelings of others. If you teach your children healthy ways to express their feelings, they will learn to develop positive relationships. When dealing with your children, you should remember to:

• accept what they are feeling even if it is different from your own feelings,
• show respect for their feelings, beliefs, actions and individuality by listening with sincere interest,
• make "I feel" or "I believe", rather than "You are", statements when you do have to tell children what they are doing is wrong.

Feeling special

We are all special. It is important for you to help your children discover their own special talents and qualities. Once they do identify what makes them special, they need to learn to value their own strengths. Remember to teach your children that feeling special does not mean feeling better than others; rather, it is a positive understanding of their own uniqueness. You should encourage children to:

• value their uniqueness,
• be optimistic,
• have a cheerful attitude (remember to set a good example),
• try things their own way,
• understand that trying your best is more important than winning.

Confidence

It is extremely important to give children support and approval. Children who have faith and confidence in themselves and their abilities will be more likely to lead happy and productive adult lives. Teach your children to learn from their mistakes, to work towards a goal, and to have pride in their successes. You should:

• encourage them to face challenges and take risks,
• teach them to make decisions and to set goals,
• express faith and confidence in them and their capabilities,
• provide opportunities for them to take responsibility for their actions,
• help them recognize that there are things they must accept and things they can choose to change,
• give them an opportunity to succeed.

Do you need more information?

There are many books written for teachers, health professionals and parents, that provide information and ideas on helping to build children's self-esteem. You can also contact a local community organization, such as the Canadian Mental Health Association, to find out about workshops and other programs available in your community.

Are You Too Anxious?

Everybody feels a bit of anxiety from time to time, but a clinical anxiety disorder is a different matter. If you suspect you may be suffering from one, you should consult a professional for a diagnosis. The psychological diagnostic manual lists 12 anxiety conditions. Here are the signs of five of the most common ones:

Panic Disorder
What it is: Recurrent, unexpected attacks of acute anxiety, peaking within 10 minutes. Such panic may occur in a familiar situation, such as a crowded elevator  

What it isn't: Occasional episodes of extreme anxiety in response to a real threat

What to look for: Palpitations; chest pains; sweating, chills or hot flushes; trembling; shortness of breath or choking; nausea; light-headedness or feeling of unreality; fear of losing control or dying

Bottom line: Four or more of these symptoms in at least two discrete episodes could spell trouble

Specific Phobia
What it is: Consuming fear of a specific object or situation, often accompanied by extreme anxiety symptoms

What it isn't: Powerful aversion to certain places or things

What to look for:
• Do you come up with elaborate ways to avoid the object or situation?
• Do you dread the next possible encounter?
• Are you aware that the fear is excessive but you are unable to control it?
• Does merely thinking about the thing you fear make you anxious?

Bottom line: Don't worry if you just plain hate, say, snakes or crowds or heights. The key is how powerful your feelings are — and how you handle them

Obsessive-Compulsive Disorder
What it is: A preoccupation with specific thoughts, images or impulses, accompanied by elaborate and sometimes bizarre rituals

What it isn't: Fastidious — even idiosyncratic — behavior that does not significantly interfere with your quality of life

What to look for:
• Are the obsessive thoughts persistent and intrusive?
• Do you expend a lot of energy suppressing the thoughts, usually unsuccessfully?
• Are you generally aware that the thoughts are irrational?
• Is the anxiety temporarily eased by a repetitive ritual such as hand washing or a thought ritual such as praying?
• Are the rituals time consuming?

Bottom line: Some researchers question whether OCD is a genuine anxiety disorder. Whatever it is, it does respond to treatment — provided you seek help

Post­Traumatic Stress Disorder

What it is: Repeated, anxious reliving of a horrifying event over an extended period of time

What it isn't:: Anxiety following a trauma that fades steadily over the course of a month or so

What to look for: After witnessing, experiencing or hearing about an event that caused or threatened to cause serious injury, do you:
• Have recurrent recollections or dreams about the experience?
• Feel emotionally or physically as if the event were still occurring?
• Experience intense anxiety when something reminds you of the event?
• Try to avoid thoughts, feelings, activities or places associated with the event?
• Have difficulty recalling details of the event?
• Experience anxiety symptoms such as irritability, jumpiness, difficulty sleeping, feelings of detachment from others, diminished interest in things, feelings that your future is in some way limited?

Bottom line: Sometimes, PTSD will not appear until six months after the event. Seek help whenever symptoms occur

Generalized Anxiety Disorder
What it is: Excessive anxiety or worry, occurring more days than not for six months

What it isn't:  Occasional serious worry that doesn't markedly diminish quality of life

What to look for: Restlessness; difficulty concentrating or sleeping; irritability; fatigue; muscle tension

Bottom line: If you have three or more symptoms for the required six months, the diagnosis may fit

What You Can Do

There are as many ways to relieve anxiety as there are things that make us anxious. The key is to find the way that works for you — and use it 

Behavioral Therapy
When the brain sets anxiety alarms ringing, our first inclination is to find the off switch. Behavioral scientists take the opposite approach. They want you to get so accustomed to the noise that you don't hear it anymore. The standard behavioral treatment for such anxiety conditions as phobias, obsessive-compulsive disorder and panic disorder is to expose patients to a tiny bit of the very thing that causes them anxiety, ratcheting up the exposure over a number of sessions until the brain habituates to the fear. A patient suffering from a blood phobia, for example, might first be shown a picture of a scalpel or syringe, then a real syringe, then a vial of blood and so on up the anxiety ladder until there are no more rungs to climb. There is a risk that if treatment is cut short (before the patient has become inured to the anxiety triggers), the anxious feelings could be exacerbated. But done right, behavioral therapy can bring relief from specific phobias in as little as two or three sessions. Social anxiety takes somewhat longer, and OCD may take a good deal longer still.

Cognitive Therapy
Rather than expect patients to embrace anxiety, cognitive therapists encourage them to use the power of the mind to reason through it. First popularized in the 1980s, cognitive therapy teaches people who are anxious or depressed to reconfigure their view of the world and develop a more realistic perspective on the risks or obstacles they face. Patients suffering from social-anxiety disorder, for example, might see a group of people whispering at a party and assume the gossip is about them. A cognitive therapist would teach them to rethink that assumption. Some behavioral therapists question cognitive techniques, arguing — not without some justification — that a brain that was so receptive to reason wouldn't be all that anxious in the first place. Cognitive therapists dispute that idea, though some have begun incorporating behavior-modification techniques into their treatment.

Antidepressants
When talk therapy doesn't work — or needs a boost — drugs can help, especially the class of antidepressants called selective serotonin reuptake inhibitors. Prozac is the best known of these drugs, which work by preventing the brain from reabsorbing too much of the neurotransmitter serotonin, leaving more in nerve synapses and thus helping to improve mood. Another SSRI, Paxil, was recently approved by the Food and Drug Administration specifically for the treatment of social-anxiety disorder, though the others seem to work as well. A third, Zoloft, has been approved for OCD and panic disorder. Each formulation of SSRI is subtly different — targeting specific subclasses of serotonin. And side effects — which can include dry mouth, fatigue and sexual dysfunction — will vary from person to person. A new group of antidepressants, known as serotonin-norepinephrine reuptake inhibitors, may be even more effective in treating anxiety disorders than the SSRIs are. As the name implies, the SNRIs target a second neurotransmitter called norepinephrine, which is secreted by the adrenal gland and plays a role in triggering the fight-or-flight response — thus actually increasing anxiety symptoms in many situations. However, norepinephrine also helps control emotion and stabilize mood, and, properly manipulated along with serotonin, may be able to do just that for the anxious person.

Minor Tranquilizers
If the antidepressants have a flaw, it's that they sometimes don't start working for weeks — a lifetime for the acutely anxious. For this reason, many doctors recommend judicious doses of fast-acting relaxants such as the benzodiazepines Xanax, Valium or Klonopin to serve as a temporary bridge until the SSRIs have a chance to kick in. The downside of such drugs is that they can be highly addictive and may merely mask symptoms. For this reason, doctors will prescribe them very carefully and strictly limit refills.

Exercise
Before turning to drugs or talk therapy, many people prefer to try to bring their anxiety under control on their own. Unlike most emotional or physical conditions, anxiety disorders respond well to such self-medication — provided you know how to administer the treatment. One of the most effective techniques is simple exercise. It's no secret that a good workout or a brisk walk can take the edge off even the most acute anxiety. Scientists once believed the effect to be due to the release of natural opiates known as endorphins, but new research has called this into question. Regardless, working out regularly — most days of the week, if possible for at least 30 minutes or so — may well help recalibrate the anxious brain.

Alternative Treatments
One of the most popular self-treatments is yoga, which is both a form of exercise and a way to quiet the mind by focusing attention on breathing. Indeed, even without yoga, breathing exercises can help quell an anxiety episode, if only by slowing a racing heart and lengthening the short, shallow breaths of a panic attack. Many anxiety sufferers have found relief through meditation or massage — even just a 10-min. foot treatment. For those willing to travel a little farther from the mainstream, there's aromatherapy (enthusiasts recommend rose and lavender scents), guided imagery (a form of directed meditation used with some success by people recovering from cancer and open-heart surgery) and acupuncture.

Lifestyle Changes
If all else fails, go back to basics and try cleaning up your lifestyle. For starters, you can cut back or eliminate the use of sugar, caffeine, nicotine, alcohol and any recreational drugs you may be taking. Are you eating right and getting enough sleep and leisure time? Finally, if your job or the place you live is making you anxious, you might consider moving to a less stressful environment or finding a different line of work.

References:  CBC, Canadian Mental Health Association

 Spring is on the way!

Boss Prepared 

A salesman was assigned to secure an important client but failed in his mission.

He faxed his secretary and asked her to break the news indirectly to his boss. His note read, "Failed in securing client, prepare the boss."

He received the following fax from his secretary:

"The boss is prepared ... prepare yourself."

An Irish Toast  

A guy raises his glass and toasts his blonde girlfriend. "May you be in Heaven a half-hour before the devil knows you're dead!"


"That is an authentic Irish toast."

"Oh. In that case, here's to bread, eggs and cinnamon."

"Bread, eggs and cinnamon? What's that?"

"That's French toast."

 Get Better Soon

A retired man who volunteers to entertain patients in nursing homes and hospitals went to one local hospital in Calgary and took his portable keyboard along. He told some jokes and sang some funny songs at patients' bedsides.

When he finished he said, in farewell, "I hope you get better."

One elderly gentleman replied, "I hope you get better, too."

Getting the Message

Our young daughter had adopted a stray cat. To my distress, he began to use the back of our new sofa as a scratching post. "Don't worry," my husband reassured me. "I'll have him trained in no time."

I watched for several days as my husband patiently "trained" our new pet. Whenever the cat scratched, my husband deposited him outdoors to teach him a lesson.

The cat learned quickly. For the next 16 years, whenever he wanted to go outside, he scratched the back of the sofa!!

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