hey there everybody and welcome back to the week by week guide
to depression treatment part five i'm your host dr dawn elise snipes
remember that in-depth videos on each of the topics that we
discuss in these videos can be found at doc snipes dot com slash youtube
this set of presentations is really designed just to give you a framework
example of what i might use if i'm working with somebody who is experiencing depression
in this session like with others i start with a review i review the morning and
evening mindfulness logs for themes and sleep trends now when i say pacer themes what i mean
is physical themes for their energy for their sleep their nutrition their pain levels
etc affective trends and themes what triggered anxiety anger depression
cognitively how were they feeling about the way they were able to think um
did they feel foggy headed or did they have some more clarity in the past week environmental themes
what things in the environment what sensory stimuli were either helpful or unhelpful to them
in the past week so i'm getting in more and more information about what promotes happiness
and what contributes to depression for the person as we go through week by week
and this kind of granular information can be really helpful to
everybody can be really helpful to the patient because it provides more insight a lot of times
we're so focused on autopilot that we don't notice the little nuances we don't notice the themes
that might be contributing to our sense of hopelessness and helplessness or anxiety
or irritability i explore any meditation and distress tolerance skills that are working for
the person to help them when they feel distressed to get into their wise mind and in the past weeks
they have been learning about different meditation and distress tolerance skills
so now we're really trying to identify which ones work for you which ones are
we going to put into your toolbox and which ones are we going to put back on the shelf
i'm going to review their progress and trends in their baseline data for the top three symptoms
and i said last week and i said the week before it's important to keep this data
so we can analyze it and see granular progress we can see those baby steps forward
and if there are any baby steps backwards we can see those two and we can really
dive in and look at them more closely and say okay um you were on a forward trend and last
week you took some steps backwards i'm wondering what was different last week what changed what
do we need to do differently in order to help you get back on a forward moving trajectory
this week i review the nutrition log and success in making basic changes that the person identified
last week remember nutrition provides the building blocks for the hormones and neurotransmitters that
help you feel everything so identifying people's nutritional
effectiveness if you will is really important now i'm not a registered dietitian so i'm not
going to be making prescriptions about what they should and shouldn't be eating
but it's important if there are gaping holes that the person's aware of them and i can make a
referral to a registered dietitian should that be helpful we'll review cognitive distortions
and identify themes and schema and explore if restructuring is becoming more second nature
over the past couple of weeks people have been asked to identify their beliefs
that trigger anxiety anger depression and apply the cognitive distortions worksheet
they've also been asked to when they start feeling angry anxious or depressed to identify what their
belief is that's contributing to that feeling at that moment and apply the cognitive distortions
worksheet to help them restructure those thoughts to be less extreme in nature or to
alter any thinking errors that they may have we discuss what events these triggers are related to
and why they promote a sense of unsafeness or disempowerment so we're looking at
the cognitive distortions we're looking at what triggered their anger and anxiety
and trying to identify in the past you know what happened that is making you react
in the present with anger or anxiety to this situation
maybe it's triggering a fear of abandonment maybe it's triggering a fear of rejection or prior
traumas where they experience loss whatever it is you know it's important to understand
and help the person understand why they are having the emotional reaction to things in the present um
the way they are we'll discuss progress on completing their autobiography and any
challenges now remember it's not due this week it's next week but the first week a
lot of times i find that the first week people really don't do it now it's ideal if they do
if they get started on it but a lot of times it feels overwhelming to get started with
so this is why we discuss it now to make sure that they have gotten started and if not
do some motivational enhancement and really break it down into more granular chunks so
they can get it done because the autobiography is really really crucial to helping us understand
the way people's thought process has developed how their experiences have in
from the past are influencing them in the present and to help them identify grief and trauma issues
that are continuing to negatively impact them we'll discuss the effectiveness of
adding positive journaling which is what they started doing last week how effective is it
in your evening meditations that you're now also ending by focusing for 15 20 minutes on
only what went right that day now prior to that you were doing your mindfulness and focusing on
what went wrong as well but finishing up by focusing on the positive how effective is that
this week the objective so now we move on from review to adding a little bit more and this
i usually the objectives for this week usually end up in the last you know 25 of the session
because reviewing is so important my job as i see it is to help people take the knowledge that
they have and take the information that they've gathered over the past week and
process it and start forming it you know it's kind of like a puzzle and each week they come in
they're giving me more pieces to that puzzle and we try to put that together and then we move on to
learning a little bit more and future assignments so the first three quarters of
the session focused on review the last quarter focused on the new objectives if needed learn
about the impact of alcohol on inflammation stress and sleep by reading or watching the
video on the pharmacology of alcohol now not everybody drinks so that's not always needed
learn about the different types of losses the grief process
and strategies for grief resolution by reading various books on grief or watching the video on
complicated grief and grief and loss interventions that are on the youtube channel
additionally the person is going to finish writing their autobiography and review it for losses
making a list of the losses that they have experienced and these can be losses in any
of the pacer areas losses of physical abilities or health loss of their ability to feel happiness
loss of dreams the childhood or parents they believed that they should have had
environmental losses like losses of things if they experienced a fire and
they lost their home for example their loss of safety now that's not necessarily tangible
but their loss of a sense of safety in their skin or in the world loss of jobs you know there's a
lot of different losses that we can experience in the environment and relationship losses and this
obviously includes romantic relationships family relationships loss of pets and loss of self-esteem
we have a relationship with ourself and if somebody has experienced a loss of self-esteem
that's going to be a loss to be grieved and to be worked on but it's important to identify
all of those losses because we're going to start working on them in the upcoming week
in this week again there was a lot of
review and there was a lot of focus on really understanding and completing that
autobiography the person is going to continue the mindfulness worksheets baseline data collection
taking happiness breaks at lunch monitoring thoughts for cognitive distortions or
things that trigger their anxiety and anger and completing the cognitive distortions worksheet
positive journaling if it was helpful and working on their autobiography for at least
30 minutes per day they will also watch the videos on the grief process and techniques
to address grief and prepare them to start addressing their losses that are identified
in their autobiography so we've addressed sleep we've addressed nutrition we've addressed
pain we've started focusing on mindfulness and the autobiography and now learning about new
learning about what grief is and the grief process and skills to deal with grief so we're still
stacking that toolbox and beginning next week we're really going to start addressing
some of those losses and traumas that were identified in the autobiography