Think You Might Have Seasonal Affective Disorder?

Do you have Seasonal Affective Disorder or are you simply sad? 

I often hear from clients that the winter months are hard. A common statement is, "I think I have Seasonal Affective Disorder." Seasonal Affective Disorder refers to having less energy and increased depressive symptoms at certain times of year, particularly during the Fall and Winter months. It is thought that less sunlight during the winter interrupts the body's cicadian rhythms and causes changes in Serotonin and Melatonin levels, causing mood changes and sleep issues. You can find more detailed information about the definition, causes, risk factors and treatment for Seasonal Affective Disorder by visiting the Mayo Clinic website. 

Much has been written about Seasonal Affective Disorder. I invite you to consider another possible cause for this seasonal sadness. Trauma anniversaries can cause intense feelings at certain times of the year. A trauma anniversary is the date that something traumatic happened in your life. I will explain more below.

Susan felt that her symptoms were completely unexplainable and unpredictable, but when talking in more depth about the story of her childhood and the loss of her mother, she revealed that her mother died on May 31. She also pointed out that she never had a chance to grieve her mother's death since she was too busy trying to survive in an abusive home without her only protector. Her father was not attuned to her emotional needs and he lacked the ability to cope with his own grief. 

Susan's annual experience of overwhelming depression in June makes sense when you consider that her mother died at the end of May, so that incredible pain she experienced throughout the month of June 28 years ago, when she was 12, was never processed. Trauma is held in the body, and feelings which are outside of our conscious awareness can show up seemingly at random. You can learn more about this by reading Bessel van der Kolk's book "The Body Keeps The Score," Peter Levine's "In An Unspoken Voice,"  Babette Rothschild's "The Body Remembers," and many other books on the subject of trauma and the body.

Considering whether there is any explanation which may relate to prior traumatic experiences helps us take back control of our own wellbeing.  Susan's body was reminding her every June of the deeply painful loss of her mother. She struggled all year with depression, which is common for survivors of childhood abuse, and in June it became unbearable every year. Susan was able to break this annual cycle and take back control of her emotional and physical health by working with a therapist specializing in trauma. She was able to process these traumatic experiences and she felt better than she had ever thought possible.

*Susan is not a real person. Her story is a composite of many stories clients have shared about their trauma anniversaries. 

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This is by no means a comprehensive list of traumatic experiences. If you believe you have experienced trauma, and you are ready to start the healing process, find a qualified therapist who has specialized training in trauma. As difficult as it may be to begin therapy for trauma, it is so worthwhile to find out that you can feel better than you ever thought you could. I know this is true because I have personally witnessed that transformation. 

If you don't have trauma and you really do have Seasonal Affective Disorder, the article I cited above recommends getting more sunlight, taking a vacation to a sunny place (heck yeah!) and/or trying therapy or medication. If you're not sure, talk to a helping professional, whether your primary care doctor or a therapist. 

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Susan's Story

Susan* had experienced depression throughout her adult life. Despite taking medication faithfully, she found herself being hospitalized for inpatient psychiatric treatment once a year -always in June - and she lived in fear of when her next depressive episode would cause this disruption in her life. When Susan was a little girl her father was an alcoholic. Her mother tried to protect her from his rage but when her dad was drinking, he often physically and sexually abused Susan. When Susan was twelve her mother died suddenly, and Susan was left alone with her father, who continued to abuse her until she was able to move out on her own at 18. The effects of her traumatic childhood continued to haunt Susan when I met her at age 40. She explained that she felt sad much of the time and her pain would build throughout the year, until in June she would have a breakdown and end up in the hospital because of suicidal thoughts. 

So Do I Have Seasonal Affective Disorder or Trauma? 

So before you assume that you have Seasonal Affective Disorder, ask yourself whether there is a certain date or specific month that is especially difficult for you. Is there any event you can recall which happened at that time of year which might relate to your feelings about this? Have you experienced trauma? It's not always as obvious as we think. Some situations which can cause trauma include:

• Loss of a parent or other primary caregiver during childhood
• Sudden, violent or traumatic death of a loved one or close friend
• Witnessing domestic violence in childhood or being in a physically violent relationship
• Growing up feeling that your emotional needs weren't met, that no one was there for you
• Experiencing physical abuse, including being "spanked" with a belt or other object, or being hit in any way when you were a child, even if you don't consider it abusive
• Being bullied
• Any unwanted sexual contact, from touching to intercourse without your consent or when you were incapacitated in some way

If you'd like to talk to me about working together click here or send me an e-mail at laura@laurareaganlcswc.com. You can reach me by phone at (443) 510-1048. For more from me, sign up for my newsletter! I send e-mails every so often when I have something to say, and I definitely won't overwhelm your inbox. You can also follow me on Twitter, Facebook, Pinterest and Google+. I have a weekly podcast which you can listen to here.

Source: 

Author Unknown. (2015) Retrieved on November 10, 2015 from: http://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/basics/definition/con-20021047

Wholeheartedly,

Laura Reagan, LCSW-C

Somatic Therapies: Eye Movement Desensitization & Reprocessing (EMDR)

In the latest edition of my blog series on holistic and alternative methods to complement traditional talk therapy, I am excited to interview Cathy Canfield, MSW, LCSW, LICSW. Cathy practices in Northern Virginia and Washington, D.C. where she offers Eye Movement Desensitization and Reprocessing, which is commonly called EMDR. 

If you've been following the series, you know that a couple of weeks ago I interviewed Kara Falck, MSW, LCSW-C, LICSW, who offers another somatic, or body-based therapy technique: Sensorimotor Psychotherapy - in her Baltimore area practice. You may be wondering about the differences between these interventions. I plan to cover that subject in a future blog post. 

EMDR is one of the somatic therapy interventions which has been studied quite a bit and research indicates that it is an effective treatment for trauma. This article from the EMDR International Association ("EMDRIA")  explains the phases of EMDR treatment to help potential clients understand what to expect and how the process works.  The National Center for PTSD (Post-traumatic Stress Disorder), which is a program of the VA, states that EMDR is effective to help veterans and others with PTSD heal on this page from their website.  

Read on after the image for my interview with Cathy! 

Tell me about your work. What is EMDR?  

During an EMDR Therapy session, we use a standardized process to access the brain’s information processing system.   This may include the use of eye movements or other forms of bilateral  (left-right) stimulation. Through EMDR, negative memories are re-processed by the brain in order to form a new emotion associated with the memory.  It's like reorganizing the filing system in your brain to be more effective.  

What benefits does EMDR have? Are there any risks? Who is a good candidate for EMDR? Who should not participate in EMDR?

Eye Movement Desensitization and Reprocessing (EMDR) Therapy is used by specially trained psychotherapists to treat anxiety, panic, fear and depression. EMDR has been extensively researched and proven effective for the treatment of traumatic or stressful experiences. It has more recently been used for treating depression, chronic pain and poor relationships.

Many people who come to me for therapy services are affected by trauma, anxiety and depression. How does EMDR help people with these issues?

EMDR Therapy helps people not be driven by the past and past memories in the present. It eliminates past triggers in our daily lives by processing memories cognitively, emotionally and through the body. 

What else do you want people to know about yourself and the services you offer?

My passion is to provide people routes to healing that include both verbal and non-verbal methods. That is why I love play therapy, sandtray, have an art therapist on staff and practice EMDR Therapy. 

Cathy Canfield, MSW, LCSW, LICSW, is a psychotherapist with a background working with individuals, children and teens, specializing in EMDR (Eye Movement Desensitization and Reprocessing) Therapy, Child-Centered Play Therapy, anxiety, depression, relationship issues, transitions and trauma. She believes that within all of us is the way to healing, we just have to sometimes work hard to uncover the path.  You can find Cathy online at www.counselingofalexandria.com. Visit her site if you are considering therapy or give her a call at  703.650.9195! You can also send an e-mail to cathy@counselingofalexandria.com.  

I love the fact that Cathy offers her clients at Counseling of Alexandria the opportunity to use non-verbal methods as well as talk therapy to process their feelings. Children, in particular may lack the words to describe their experiences and/or to name their feelings. As mentioned in my last post of this series, art therapy is a great option for helping us connect with and express our emotions.  I want to learn more about sandtray so look for a future blog post on that subject!  

If you'd like to read more of my blog posts and other articles I share, follow me on Twitter, Facebook and Pinterest to read more of my blogs and other articles I share. You can also sign up for my e-mail newsletter to receive occasional updates on blog posts and articles of interest as well as upcoming groups, intensives and workshops. My women's group begins April 2, 2015. I will also be offering one intensive women's weekend in July this year using The Daring Way™ method, based on the research of Dr. Brené Brown. I'm working on lots of fun stuff so I hope you will check back to see what's new! And drop me a line in the comments below to tell me what you think about EMDR! 

Sources:

EMDR International Association. (n.d.). What is the actual EMDR session like? Retrieved from:  https://emdria.site-ym.com/?120 

National Center for PTSD. (n.d.). Treatment of PTSD.  Retrieved from: http://www.ptsd.va.gov/public/treatment/therapy-med/treatment-ptsd.asp 

Art Therapy: A Creative Method to Express Emotion

This edition of the blog series on alternative and holistic methods to complement traditional talk therapy comes to you during National Eating Disorders Awareness Week. Although many of my clients (and I, too) struggle with body image and feeling body positive, I do not have specialized training in helping clients with eating disorders. 

However, my guest today, Elizabeth Hlavek, LCPAT, ATR-BC, does have that specialized training and experience. She is a Licensed Clinical Professional Art Therapist and a Board Certified Art Therapist practicing in Annapolis. I asked Elizabeth if she would agree to be interviewed about how art therapy can help people who are struggling with eating disorders and she graciously agreed. Art therapy is a "natural fit" for eating disorders work, as this blog post from Pershing-Turner Centers explains. 

Personally, I'm fascinated with art therapy. My mother is an artist (the images in this post are her work), so art has always been a part of my life and I enjoy cultivating my creativity - though I don't focus on this as much as I would like to. I use some creative techniques in my work with clients and plan to incorporate more as time goes by. In fact, next week I will begin attending a series of three trainings in using expressive arts techniques in work with survivors of trauma, and I'm elated to be able to bring the new methods I will learn back to my work with clients!

Read on below the image for my interview with Elizabeth. I found her responses to be very interesting and I hope you will too! 

Original art by Beverly Furman, copyright Laura Reagan LCSW-C Psychotherapy Services, LLC 

Tell me about your work. What is Art Therapy? How do you use it in helping people with Eating Disorders?
 

Art Therapy is a mental health profession in which clients, facilitated by the Art Therapist, use art media, the creative process, and the resulting artwork to explore their feelings, reconcile emotional conflicts, foster self-awareness, manage behavior and addictions, develop social skills, improve reality orientation, reduce anxiety, and increase self-esteem. 

Often times, individuals struggling with eating disorders are rather guarded. Art therapy can allow these individuals to express themselves creatively, in a non-verbal format. Discussing artwork in session often brings up parallels between the work and the client's internal experience, and we can talk about their struggles through the metaphor of the artwork.

I also use the process of body tracing to challenge a client's distorted body image. I first have the client draw an outline of themselves on a life sized sheet of paper taped to the wall. Then, I trace them against it to get an accurate depiction of how much space they actually take up. Comparing the two can be a very intense experience, but is a concrete way for the client to see their body objectively. They have the option to further develop the tracing, identifying feelings, experiences and memories that are attached to their body, which is a way to bridge the gap between emotion and body image. 

What benefits does Art Therapy have? Are there any risks? Who is a good candidate for Art Therapy? Who should not participate in Art Therapy?
 

Art therapy is practiced in a variety of clinical, educational and community settings with diverse client populations in individual, couples, family and group therapy formats. Art therapy is an effective treatment for people experiencing developmental, medical, educational and social or psychological impairment. Trauma survivors, individuals with development disabilities and anyone experiencing extreme stress or emotional distress can benefit from art therapy. Art therapy helps people resolve conflicts, improve interpersonal skills, manage problematic behaviors, reduce negative stress, and achieve personal insight. And it can also be a lot of fun! 

Many people who come to me for therapy services are affected by trauma, anxiety and depression. How does Art Therapy help people with these issues?

Art therapy has become a staple in the treatment of a wide array of traumas, from child abuse to combat PTSD [WARNING: TRIGGER ALERT. THIS ARTICLE DESCRIBES COMBAT-RELATED TRAUMATIC EXPERIENCES]. Art making can help individuals express dark emotions or memories that they may not be able to verbalize or even comprehend. Exploring intense emotion through art making can help the client process the feeling and heal. When trauma is experienced, it tends to be stored in the nonverbal part of the brain. Recent neuroscience research recognizes that the creative process involves both sides of the brain bridging cognitive and emotional functions leading to enhanced insight and behavioral changes. Art therapy also creates a feeling of well being, offers healthier coping skills and builds resiliency. I find that the process of art making helps to discharge anxiety, allowing the client to help relax and feel more calm. For depression, art therapy can allow for self expression and help to build self esteem. Making artwork, seeing your own creation, offers a sense of autonomy, which can be very empowering.  

What else do you want people to know about yourself and the services you offer?

I'm passionate about my work. Art has always been a huge part of my identity, and so using it as a means of healing is very comfortable for me. I see clients both as a primary therapist and in collaboration with talk therapists. 

Most of my clients prefer a mix of art therapy and traditional psychotherapy. I specialize in eating disorders and PTSD, and am an in network provider with BCBS. I am a huge advocate for Art Therapy and helped develop the first clinical license for art therapists in Maryland. I currently sit on the MD Board of Professional Counselors and Therapists. 

Elizabeth is a Licensed Clinical Professional Art Therapist and Board Certified Art Therapist in Annapolis, Maryland. She spent four years working in an eating disorders hospital program, working with individuals in inpatient, partial outpatient and intensive outpatient (IOP) levels of care. For more information, or to contact her, please visit www.hlavekarttherapy.com.

Thanks so much to Elizabeth! I hope you learned something new about art therapy, eating disorders, or both - I did! If you want more information about National Eating Disorders Awareness Week or Eating Disorders in general, visit the National Eating Disorders Association website. If you're in the Annapolis area and you think Elizabeth might be a good fit for you, check out her website!

Also, follow me on Twitter, Facebook and Pinterest to read more of my blogs and other articles I share. You can also sign up for my e-mail newsletter to receive occasional updates on blog posts and articles of interest as well as upcoming groups, intensives and workshops. 

Thanks for reading. Did you learn anything? Please share your thoughts in the comments below! 

Sources:

Alexander, C. (n.d.) Behind the mask: Revealing the trauma of war. Retrieved from:  http://www.nationalgeographic.com/healing-soldiers/

Bechtel, A. (2012, February 22). Retrieved from:  http://pershingturnercenters.com/2012/02/art-therapy-a-natural-fit-for-eating-disorders/ 

Burgard, D. (n.d.). A body positive approach. Retrieved from:  http://www.bodypositive.com/whatisit.htm

National Eating Disorders Association. (n.d.) About #NED Awareness Week. Retrieved from:  http://nedawareness.org/about-nedawareness 

Schwartz, D. (2014, March 21). Expressive arts therapy and eating disorders. Retrieved from: http://www.nationaleatingdisorders.org/blog/expressive-arts-therapy-and-eating-disorders

Kids Are Resilient, Right?

Conventional wisdom holds that children are resilient, and they bounce back easily from childhood experiences by the time they reach adulthood. This is considered to be even more true if the child doesn't remember the events. A large study has de-bunked that myth. Read on! 

There's an epidemic in the United States which is causing increased risk of suicide, chronic disease – including heart and lung disease and cancer – as well as addiction, violence and divorce. It costs the U.S. healthcare system over $103 billion annually. The good news is that there is a cure, and we can prevent new cases. This short TED Talk explains:

Dr. Nadine Burke Harris’s TED Talk explains that Adverse Childhood Experiences, also known as ACEs, correlate highly with poor health outcomes in adulthood.  

ACEs include the following experiences during childhood:

• ·      Abuse, whether emotional, physical or sexual – or emotional or physical neglect
• ·      Witnessing one’s mother being abused (domestic violence)
• ·      Losing a parent to separation or divorce, or another reason
• ·      Having a family member who is depressed, has addiction or is incarcerated

How Was This Epidemic Discovered?

As explained in this article, when a physician conducting research on obesity noticed higher than expected numbers of dropouts in his study, he began asking questions and discovered that most of the patients reported history of childhood sexual abuse. 

Until then, he did not realize how common sexual abuse is. We now know that one in four girls and one in six boys will experience sexual victimization at some point before his/her eighteenth birthday. The study also found that 64% of Americans have experienced at least one ACE, and of those people, 87% had 2 or more.

Image copyright Laura Reagan, LCSW-C Psychotherapy Services, LLC

The higher the score, the worse the respondents’ health outcomes. In other words, those who had more ACEs were more likely to have cancers, heart disease, autoimmune disorders, addiction, depression, divorce, and overall their lifespans were shortened by as much as 20 years compared with people who had no ACEs.

Adverse Childhood Experiences Study

This information was gained from the Adverse Childhood Experiences Study, a longitudinal study conducted by Kaiser Permanente on a huge sample of insured patients – 17,000 mostly white, educated, middle- to upper- class, employed people – in other words, some of the most high-functioning members of society who should have the best access to healthcare. This makes me wonder how much higher the stats on the incidence of childhood adversity and poor health would be if the sample had included people who live in poverty, those who are incarcerated, and others of less means and access to healthcare.

All of This Sounds Pretty Scary, but Here’s the Good News!

For one thing, if you have experienced childhood trauma, you now know that you aren’t alone. Traumatic experiences in childhood are quite common in the United States. The most important thing is to recognize that traumatic experiences can affect us years later, even if we think we should be over it by the time we reach adulthood.  

How Do I Find Out My ACE score? 

You can take the quiz at this link. As I’ve mentioned - and you may have read in the linked articles - the higher your ACE score, the more likely you are to be affected by mental and physical health issues.  It’s scary to hear that having an ACE score of 6 or higher is correlated with lifespans as much as 20 years shorter than the average.

However, you don’t have to fall into those statistics, even if your score is high! I have worked for years helping people who have experienced childhood trauma and what I know is that having traumatic experiences is very painful, but the most damage comes from ignoring how you have been affected by these experiences – and the healing begins when you allow yourself to feel the emotions you’ve been avoiding. 

When the emotional effects of childhood trauma are not addressed, they don’t go away on their own. Often we develop methods of coping with trauma symptoms - like avoiding developing close relationships so we don’t get hurt - and numb the emotional pain with drugs, alcohol, the internet, being busy, sex, shopping, perfectionism, eating disorders, work, school, and/or gambling. 

Image copyright Laura Reagan LCSW-C Psychotherapy Services, LLC

Knowledge is power – what do you do with the information once you learn about it? You can ask yourself honestly whether you have healed from the Adverse Childhood Experiences referenced in your score. If not, what are the steps you can take to begin the healing process?  

You can heal from childhood trauma.  There's a therapist out there for you!

Psychotherapy for trauma can include, among other techniques:

• ·      Cognitive-Behavioral Therapy techniques
• ·      Creative methods such as art, music, yoga and dance therapy
• ·      Mindfulness approaches
• ·      Body-based (also known as somatic) methods including Somatic Experiencing and     Sensorimotor Psychotherapy
• ·      Eye-Movement Desensitization and Reprocessing (EMDR)

There are many useful methods therapists use to help you heal from trauma – I don’t mean for this to be a comprehensive list. In fact, I’d love to hear what you have tried in the comments below! 

It’s important to speak to a potential therapist about his or her training in trauma treatment. Make sure you feel comfortable that this is the right person for you, and if you don’t, it’s okay to tell the therapist that and find someone else who can help you. Trust is an important part of the therapy process, and without developing a trusting therapeutic relationship with your therapist it will be extremely difficult to work through the trauma.   

Childhood trauma is preventable! I will write about that in a future blog post. By the same token, the health outcomes the ACE Study identified are not a matter of fate. Rather, they are the body's expression of unresolved trauma, and by addressing the underlying cause you can potentially limit future illness.  I’m so glad the ACE Study has provided so much information which is now being used to help spread the word about this major public health issue affecting our children and so many adults in the United States. I hope more people will understand the effects of their own ACEs and address them as needed.

If this has made you think about finding help to work through your own childhood trauma, call me at (443) 510-1048 or visit my website. 

Sources:

Burke, N.B. (2015, February 17). How childhood trauma affects health across a lifetime. Retrieved from: https://www.youtube.com/watch?v=95ovIJ3dsNk

Center for Nonviolence & Social Justice. (2014). What is trauma? Retrieved from: http://www.nonviolenceandsocialjustice.org/FAQs/What-is-Trauma/41/

Maryland Coalition Against Sexual Assault. (2013). Sexual assault in the U.S. Retrieved from: http://www.mcasa.org/_mcasaWeb/wp-content/uploads/2014/02/Sexual-Assault-in-the-US-updated-2013.pdf

National Child Traumatic Stress Network. (n.d.). Effects of complex trauma. Retrieved from: http://www.nctsn.org/trauma-types/complex-trauma/effects-of-complex-trauma

Reagan, L. (2015, February 21). Why can’t I just get over it? Retrieved from: http://www.yourtango.com/experts/laura-reagan/why-cant-i-just-get-over-it-0

Stevens, J.E. (2012, October 3). The Adverse Childhood Experiences Study – the largest, most important public health study you never heard of – began in an obesity clinic. Retrieved from:  http://acestoohigh.com/2012/10/03/the-adverse-childhood-experiences-study-the-largest-most-important-public-health-study-you-never-heard-of-began-in-an-obesity-clinic/

Stevens, J.E. (2015, February 17). Nadine Burke Harris: How childhood trauma affects health across a lifetime. Retrieved from: http://acestoohigh.com/2015/02/17/nadine-burke-harris-how-childhood-trauma-affects-health-across-a-lifetime/

Stevens, J.E. (n.d.). ACES 101. Retrieved from: http://acestoohigh.com/aces-101/

Stevens, J.E. (n.d.). Got your ACE score? Retrieved from: http://acestoohigh.com/got-your-ace-score/

United States Centers for Disease Control. (2014, May 13). Injury prevention and control: Division of violence prevention. Retrieved from: http://www.cdc.gov/violenceprevention/acestudy/

What do you think? I'd love to hear your thoughts in the comments below! And if someone you know needs to read this, please share!