hey there everybody and welcome back to the week by week guide to depression treatment
this is part six and i'm your host dr dawn elise snipes
helpful hint in-depth videos on each of the topics that we talk about can be found at doc
snipes dot com slash youtube so as we go through talking about grief and trauma and loss and
mindfulness and all that other stuff if you want to learn more about those particular
topics you can find those videos at doc snipes dot com slash youtube
in session six i start out as usual by reviewing we review morning and evening mindfulness logs for
themes related to how people are feeling physically affectively cognitively themes in
their environment and their relationships you know what's going on or do things seem to be improving
is there physical health improving have we had some setbacks somewhere what themes am i seeing
and how do they correlate with what's going on in terms of what the person is working on
are they sleeping better and as they sleep better how's that impacting the other areas
explore any meditation and distress tolerance skills that are working for the person to help
them get into to their wise mind and i generally touch on this every week because i want to remind
people to be practicing their meditation into stress tolerance skills and i want them to be
able to quickly come up with those when i ask them what distress tolerance skills are working for you
i want somebody to be able to rattle those off right away because that means when they're in
distress it'll be easier for them to access those tools it'll be easier for them to recall the
tools that are helpful if they are basically right on the tip of their tongue so to speak
review progress and trends in baseline data for the person's top three symptoms i know
we do this every week but it's important because we're looking for those incremental improvements
in the issues or in the symptoms that brought the person into treatment to begin with
the top three symptoms of their depression are they improving and or not and if not you know
what's what's changed if so great the person can see that what they're doing is working
review the nutrition log and success in making basic changes that have been identified i talk
regularly about how sleep and nutrition are fundamental aspects to recovery from anything
whether it's depression or addiction or physical illness they are so crucial
so this is something else that i touch on pretty much every week review the cognitive
distortions remember the cognitive distortions worksheet you started doing a couple weeks ago
we're going to go back through those each week you're supposed to be identifying or using these
worksheets when you start feeling anxious or angry or depressed to identify thinking errors that
might be contributing to it and to addressing it ultimately the hope is that restructuring
becomes more second nature so eventually you won't need to do the worksheets you're going to
be able to kind of do it in your own head and identify as soon as you have a thought that's
unhelpful or a distortion you're able to quickly identify that and reframe it without having
to go through the rigmarole of the worksheet then we move on to discussing what events the
person's triggers were related to and why they promote a sense of unsafeness or disempowerment
anxiety anger and depression remember are triggered when we feel a threat
when we feel unsafe or disempowered so we're going to look at when you started feeling anxious
there something happened you know when we go back to basic cognitive behavioral something happened
that was the activating event the consequence was that you got angry anxious depressed
you started feeling an unpleasant feeling we're gonna look at those beliefs that contributed to
you feeling unsafe or disempowered and we're going to start trying to figure
out what's that related to why is it every time you experience this particular situation
it triggers anger in you and what what what is that related to from the past because clearly you
learned that this situation uh can be threatening from something that happened in the past
so we're going to start trying to connect the dots we'll review the grief process remember last week
you were supposed to watch the videos on the grief process this week finally week six we moved from
learning tools and developing skills to deal with the stress into processing the first five weeks
it was so important to start helping you feel empowered start helping you feel like
you have the tools to deal with the stress before we start ripping off the band-aid
so now we're going to start exploring the losses identified from your autobiography and what
stage you're at in the grief process at this moment remember the grief process isn't linear
you don't go denial anger bargaining depression acceptance and done and it's just not that way you
know you bounce back and forth between stages or phases of the grief process which is why i say at
this moment you know based on you know whatever you identify how are you feeling about that at
this moment are you depressed about it angry do you feel kind of at peace with it where are you at
so in week six we're gonna start processing the autobiography
we're going to read through the autobiography highlight traumatic events
and make notes of themes whether they're related to loss rejection abandonment
whatever and we're going to try to start grouping some of these traumatic events so we can see
undercurrents if you will that are that often are contributing to your anxiety depression
or anger in the present we'll apply the cognitive distortions worksheet to any cognitive distortions
so as we're going through the autobiography i may notice or you may notice themes such
as i'm not lovable no matter what i do i was a bad child my parent just didn't care about me
or people can't be trusted so these are very um common themes that may emerge out of
autobiographies but they are also all laden with cognitive distortions thinking errors
i as a person am not lovable and never lovable no matter what i do so that's a pretty hopeless
helpless disempowered place so we're going to look at distortions like overgeneralization
and personalization to examine you know where did that thought come from why do you have why do you
have this belief who taught you that what taught you that and let's examine it with fresh eyes
i was a bad child well and and we've talked in in other sessions about how it's important to
separate behaviors from the person number one so you may have been a child who made bad choices but
you were a lovable child and then we want to start looking at why did you make those bad choices
remember behavior is communication what were those choices communicating were they communicating
hey i feel anxious i i need somebody to prove to me that you're going to be there to help me feel
safe i need somebody to give me some structure so i don't feel out of control or i need i'm acting
this way because i need somebody to pay attention you know kids need guidance and structure and
love and proactive attention from their caregivers and if they don't get it they will act out
in order to get those needs met my parents didn't care about me you know we can look back
and looking with fresh eyes a lot of times it's not that the parent didn't care about the child
is that the parent was so overwhelmed with their own crap that they couldn't even
cope with or notice the child it's not that they didn't care they just couldn't get out
of their own head and then people can't be trusted this is a pretty global statement so we're gonna
look at you know what taught you that and yes some people are not trustworthy this is true
so how can you differentiate trustworthy from non-trustworthy basically and and we're going to
apply that cognitive distortions worksheet to all of these we're going to examine how you developed
this particular belief and then we will address it using facts control and probability
as we're processing the autobiography we're also going to identify triggers
for current distress related to past experiences
there have been a lot of times that i've worked with clients for this first five weeks
and we've made a lot of progress working on addressing cognitive distortions and things
but sometimes some of the triggers for their distress seemed sort of elusive you know it's like
they couldn't identify exactly what was causing them to feel anxious or angry in this particular
situation or have an ongoing undercurrent of depress depression and when we start going through
the autobiography some of those triggers that they didn't even connect before start becoming
more apparent and again we start connecting the dots
we'll also begin processing grief and loss identified in the autobiography
remember the last week you were supposed to make a list of losses that you identified from
writing your autobiography and this week we're going to start processing those
it's important to process at least one loss each week now you may be like well i've got a laundry
list of losses that's like three pages okay you know one at a time and the goal of therapy here's
a hint here the goal of therapy is not to make you dependent on the therapist to process these things
it's to help you develop the tools working with the therapist practicing with the therapist
so then you can continue to do it on your own a lot of times when we start
processing grief and loss and those sorts of things i will do it for three maybe four
or five weeks depending on the intensity of the losses and you know the individual
but my goal is to help people develop the skills so they can continue processing the losses on
their list one at a time as they have the energy on their own they don't need to be in therapy for
months or years you know the whole goal is to help people develop tools so they can live happier
and healthier so process at least one loss each week sometimes the loss there's losses that are
minor if you will and you can do one a day and then some of the major losses may take it may be
really intense and it takes an entire week to you know really process it and
digest it and recover from processing it and it's important using your mindfulness to be aware of
am i ready am i recharged enough to start addressing another loss or do i still need to
do more with this one you can group some losses together if they have similar themes for example
lost friendships or deaths sometimes you need to process each one individually but you can do
similar ones you know back to back so for example my grandmother my grandfather
my dad and my mom all died of cancer those were all pretty traumatic devastating losses
and i learned a little bit from each one they didn't happen all at the same time
so i might process the cancer deaths oh and my uncle sorry i forgot my uncle in there too um i
might process all my cancer deaths in one week or one two week span and then move on to other things
so questions to help you start processing your loss what was the loss yeah what happened
we'll use the death of a parent so that was the loss what secondary losses did you have as
a result of this loss so you may not have only just lost a parent but you lost a best friend
you may have lost a a mentor you may have
maybe if you were young when this happened you had to move because you couldn't stay in the
same house after that parent died because the surviving parent couldn't couldn't afford to
maintain that house you know there there can be a lot of losses secondary losses associated with
any change any primary loss what are your thoughts and feelings about this loss and remember a
lot of times are easy most easily identify and identifiable feelings and thoughts that's the tip
of the iceberg the majority of it is underneath the water so really think very rarely do we have
simple emotions like i'm just angry about this i may be angry depressed guilty grief stricken
you know all of those things so really explore how you feel about this particular situation and why
use the cognitive processing worksheets to process these feelings and thoughts
you're going to go back through and look at the cognitive distortions associated with it you're
going to look at you know the facts control and probability based on what you know how
does that change how you feel about it how is this loss continuing to impact me today
now sometimes we can experience losses and they can be learning moments for us and it can have
continue to have a positive impact for example my parents um and my family when they passed away
from from cancer it caused me to become more aware of the risk factors for cancer learn more about it
and as a result of that i make healthier choices in order to protect myself from cancer henceforth
and finally what do i need to do to integrate this into my storyline and we've talked before in and
especially in the videos on grief about thinking about your life like a television series or a
book and whenever we experience a loss is kind of like the end of a chapter or the end of a season
the character in that season or in that in that chapter continues to influence the
rest of the characters henceforth but how does that work into the narrative
you will continue to work on your mindfulness worksheets your baseline data collection
doing your happiness breaks at lunch monitoring your thoughts for cognitive distortions and
completing the worksheets and positive journaling and processing at least one loss this week