Mood

Types of Mood Disorders:

Mood
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.
Emotion Dysregulation:Dysregulation can present differently than Bipolar and depression.  It often involves acting impulsively and making the situation worse in response to an event. 

Dysregulation includes the following areas: non-accepting of emotions, unaware of emotions, unclear about emotions, lacking strategies to get through emotions, and poor impulse control when emotional.
Associated Concerns with Mood:  Life threatening urges or actions (suicide, self-harm), low self-esteem, anxiety, eating problems, substance abuse, trauma

Strategies to improve mood now:

  1. Improve self-care: Healthy and balanced eating, quality rest, and regular exercise.
  2. Get active: A highly effective way to control your mood is to control pleasant events in your life. Do more fun things (mindfully!) to build joy in the short-term. These pleasant events will also help with your mood in the long-term by maintaining a baseline of positive events and positive mood so stressors are more manageable when they arrive.
  3. Increase mindfulness: Increased awareness can lead to improved mood. Becoming aware of body sensations, emotions, thoughts, surroundings, relationships, and values allows you to know how to keep the pleasant and change the unpleasant.
  4. Have a toolbox of coping skills: There are “many roads to Rome” in changing emotions. The more skills you have, the more capable you are at improving mood. Know how to reduce and manage vulnerabilities, how to react without making it worse, how to build and change emotions, how to manage stressors so they don’t get out of control, how to have acceptance to situations, how to change thinking, how to prevent problems and to problem solve.
  5. Live in line with your values and be around others that improve your mood.

Anger

Mood and Anger

Anger is a normal emotion that anyone feels when there is an injustice or a goal is blocked. It can be also be problematic. It’s important to know when to get help.

Anger generally includes judgments, negative interpretations and intense body responses can lead to angry behavior and aggression. It can be difficult to regulate mood and increase joy if often having angry reactions, and anger has a number of negative physical side effects.

When to seek treatment for anger: Therapy can be helpful when anger or angry outbursts are interfering in areas of life – relationships, work or school performance, sleep, physical activity, legal issues, often ruminating on angry related situations, and 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.

Mood and Sleep

Insomnia is commonly associated with depression, difficulty regulating mood, and anxiety disorders.  Therapy can help resolve sleep problems.

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: 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.

Strategies to improve sleep now:

  1. Establish a routine as often as possible with the same sleep and wake times.
  2. Turn off screens- blue light is disruptive to your body’s natural rhythm.
  3. Keep your room as dark and cool as possible to ensure falling asleep and achieving a deep sleep cycle.
  4. Avoid turning on the lights if you need to get up.
  5. Appreciate the relaxation time even when not falling asleep. Don’t add the pressure of not getting sleep or counting down of hours you have left for good sleep- that generally doesn’t end well. The stress and anxiety increases.
  6. Move slowly and intentionally while resting- avoid tossing and turning as much as possible to maintain a relaxed state.
  7. Be aware of caffeine and exercise close to sleep.
  8. Practice breathing and mindfulness while trying to fall asleep.
  9. Stick to a bedtime practice that is as similar as possible each night.
  10. Get out of bed if you can’t sleep past 30 minutes. Move to a place outside of your bed that is quiet and non-stimulating until ready to fall back asleep. Return to your bed at that time.

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.

Behavioral Activation

Mood and Beahvior Activation Therapy

What is Behavior Activation Treatment (BA)?: BA is an evidence-based therapy for depression and anxiety. 

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

Mood and CAMS treatment

What is Collaborative Assessment and Management of Suicidality Treatment (CAMS)?: 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 identifying “drivers” that make one suicidal, agree to a plan to decrease life threatening concerns, and continue sessions using a variety of approaches to increase reasons for living.  Kim is a CAMS trained clinician. 

Cognitive Behavioral Therapy

Mood and CBT

What is 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).  


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