| Persistent Depressive Disorder: | An ongoing low level of depression and can include major depressive disorder lasting longer than two years. Symptoms include hopelessness, worthlessness, negative thoughts, low energy, loss of interest, isolation, and changes in sleep or appetite. |
| Major Depressive Disorder: | More extreme depressive symptoms that occur most of a day for at least two weeks. |
| Bipolar I (manic) and Bipolar II (hypomanic – less severe than manic): | Characterized by mood swings that have impairment in functioning (more severely in Bipolar I). Can include changes energy, reduced need for sleep, increased self-esteem, and goal directed behavior. |
| Disruptive Mood Dysregulation Disorder: | For children up to 18 years old who experience extreme irritability, anger, and frequent outbursts. |
Anger
When to seek treatment for anger: Anger is a normal emotion that everyone feels and commonly when there is an injustice or a goal is blocked. It is important to know when anger is interfering in life and when to get help. Therapy can be helpful when it is difficult to reduce judgements and extreme interpretations, angry outbursts are frequent and/or intense evidenced by damaging relationships, work or school performance, disrupting sleep, reducing physical activity, creating legal issues, frequent rumination, and no longer achieving overall goals.
How to treat anger: CBT and Mindfulness skills can effectively reduce anger. The goal in treatment is to gain control so that anger is not so destructive. One learns thinking skills to decrease the extreme interpretations that can occur with anger, as well as problem solving (including avoidance and removal strategies) to both prevent and change angry responses if they have started. Mindfulness helps to increase awareness and relaxation strategies.
Insomnia
Insomnia is commonly associated with depression, difficulty regulating mood, and anxiety disorders. Sleep is significantly important in one’s physical and mental well-being, and research has now evolved to focus equally on depression causes sleep problems AND sleep problems cause depression. Moving adequately through sleep cycles is restorative for physical, cognitive, and emotional well-being.
When to seek treatment for insomnia: Therapy can help resolve sleep problems. It is helpful to find a therapist when one is having difficulty falling asleep, staying asleep, and waking for more than a month long.
How to treat Insomnia: CBT for Insomnia (CBT-I) is very effective to improve sleep and can occur in a short period of time if people are responsive to the interventions. CBT-I teaches people stimulus control, as people with sleep problems often have a weak association between sleep and their bed. A person can learn to strengthen the bed as a cue for sleep and weaken it as a cue for wakefulness . CBT-I individualizes sleep and wake times to each person, sets schedules and limits on the time spent in bed, and helps establish healthy sleep protocol to maintain that routine. Relaxation and thinking skills are taught to aid sleep.
Treating Mood Disorder Symptoms
Dialectical Behavior Therapy (DBT) is a treatment that can be offered as a full, comprehensive package or as a stand alone skills training. It is commonly used for emotion dysregulation, depression, and ongoing life threatening behavior concerns. It successfully treats side effects of mood disorders: impulsive behaviors, relationship concerns, anxiety, stress and burnout.
Cognitive Behavior Therapy (CBT) is an evidence-based therapy that focuses more on the current situation, ways of living, and individual goals. CBT teaches people how to change ways of thinking (increase alternative or flexible thinking), feeling (increase positive emotions, more regulated emotions), and acting (how to replace previously ineffective behaviors with more effective behaviors).
Behavior Activation Treatment (BA) is an evidence-based therapy for depression and anxiety and considered a type of CBT.
How does BA work?: When people are depressed, there is an urge to isolate, withdraw, and avoid. The therapist and client create a collaborative schedule of pleasant events, including behaviors that are in line with ones’ values and that build competency and joy. The therapist offers ongoing support and troubleshooting to implement these behavioral changes, create a new way of living, and to ultimately decrease depression.
Collaborative Assessment and Management of Suicidality Treatment (CAMS) is one of a handful of evidence-based therapies for suicide. It is a framework that uses collaborative assessment and treatment planning between the therapist and client to reduce suicide risk, in particular when suicidal urges are newer and there aren’t other multi-diagnostic concerns (DBT would be recommended with more persistent symptoms).
How does CAMS work? Initial suicide assessment is completed to identify “drivers” that make one suicidal and client and therapist agree on a plan to reduce the drivers. Any evidence based treatment approaches can be used to treat the specific drivers and increase reasons for living. Kim is a CAMS trained clinician.