In today’s world, many of us have experienced events that are deeply troubling. These include car accidents, physical assault, gruesome deaths, difficult childhoods, witnessing violence, working in fields where tragic things occur, etc. None of these experiences in themselves will result in post-traumatic stress disorder. Indeed, many events in life can be extremely upsetting but may not lead to post-traumatic stress disorder. For some, however, such events stay with the individual and change their ability to cope significantly.
Let’s begin with a bit of discussion about the difference between a difficult event and a traumatic one. I like to refer to difficult events as small-t traumas. These are events that can upset us for days, weeks, and even months. They take time to adjust to and with time and social support the individual is eventually able to function as well as they did prior to the difficult event. Capital-T traumas tend to be events that impact the psyche in ways that prevent us from returning to our previous ability to function. These tend to be events that are outside of the realm of normal human experience, i.e., they are statistically unlikely. Therefore, it is difficult for the sufferer to find social support as most people cannot identify with the events that have occurred. In addition, traumatic events tend to happen quite suddenly and therefore overwhelm the brain in terms of its ability to process what has occurred. There is a great deal of science that explains this but it is beyond the scope of this blog. Capital-T traumas can result in full-blown post-traumatic stress disorder.
How do I know when I need to get help for PTSD?
How does one know if they have post-traumatic stress disorder and should, therefore, seek help? There are several factors that experts agree are consistent with a diagnosis of post-traumatic stress disorder.
The first of these is physical symptoms. Following a traumatic event, it is not uncommon for the sufferer to report extreme fatigue, dizziness, headaches, as well as a host of gastrointestinal difficulties. In addition, the event itself may have left the individual with chronic pain. For example, motor vehicle accidents often result in observable injuries that are painful. If these symptoms persist beyond the length of time in which healing should occur, this may be a symptom of PTSD.
Secondly, those with post-traumatic stress disorder typically report nightmares about the traumatic event and other flashbacks. Flashbacks sometimes called triggers, occur when something relatively small reminds the sufferer of the entire traumatic event and the sufferer experiences a very high level of distress. An example of this might be smelling alcohol following an event in which an assailant was intoxicated or smelled like alcohol. The sound of sirens can also be a common trigger.
In addition, PTSD sufferers tend to exhibit a specific form of anxiety in which they begin to avoid situations that might remind them of the traumatic experience. This is done so that the sufferer can avoid feeling the distress and pain that they felt during the initial event. For example, if the traumatic event involved harm coming to a child, the sufferer may begin to avoid settings where there are children. These avoidances can make it very hard to resume normal life as some of them are quite common settings and or objects.
The next symptom that commonly occurs with PTSD is social withdrawal. This can take the form of an otherwise friendly person who begins to decline invitations that they would normally attend. The sufferer may also begin to spend time alone and become very quiet even within their own family. Added to this, the sufferer may begin to use alcohol or drugs in an attempt to withdraw from the feelings and memories associated with the trauma. They may also begin to engage in risky and seemingly wild activities such as driving erratically, walking alone in high-risk situations, etc., as a means of distracting themselves from the traumatic memory.
Repression or trying to forget the event is another symptom of PTSD. This can take the form of the sufferer destroying anything that might remind him or her of the traumatic event. It can even go so far as to result in a memory loss wherein the sufferer does not have a conscious memory of the traumatic experience.
Folks with post-traumatic stress disorder often become emotionally numb. Their loved ones may begin to notice a difference in that the sufferer appears to have no feelings. Sufferers themselves often describe feeling numb. This is the mind’s way of protecting us from becoming overwhelmed when something horrible has occurred.
Another common symptom of PTSD is what is called hyperarousal. Basically, this means that the individual becomes very jumpy and is easily startled. They may be startled by a sound that was present during the initial event such as a loud banging sound or may as easily startled by anything that they consider sudden. Individuals with PTSD often appear to be on edge as if they are waiting for the next bad thing to happen.
With all of the triggers, nightmares, hyperarousal, attempts to avoid being reminded of the traumatic event, and physical discomfort that may be present, it is no wonder that trauma survivors are commonly irritable. Irritability is the final factor that is typically present in a person with PTSD.
Is there hope for me or my loved one if PTSD is involved?
If the above describes yourself or someone you love, there is much reason for hope. PTSD is not a lifelong condition. However, it can be life-threatening if it is not addressed because the suffering is so intense. Ways of addressing PTSD include talking about it with someone trusted and who can really listen. Formal help in the form of counselling is recommended. It is important to identify and work with a therapist who has expertise in the assessment and treatment of PTSD. Such a therapist is likely to use methods such as progressive relaxation, Eye Movement Desensitization and Reprocessing (EMDR), talk therapy, art therapy, or neurofeedback, and may work in concert with the sufferer’s physician or other members of a healing team.
It is possible to return to living a full and happy life just like before the trauma. While the traumatic event cannot be forgotten, it does not have to define or debilitate a person who has survived a terrible experience. With the right help, it is possible to learn from even life’s most terrible experiences rather than be controlled by them.
Kathryn Priest-Peries is our newest Associate at Alongside You, starting in January. She has lived experience with, and a high level of expertise in working with Post-Traumatic Stress Disorder. If you identify with this article and would like to meet with her, please contact the office and we would love to set up an appointment for you.
Winter is coming, and so too are shorter days and longer periods of darkness. For a sizable percentage of people (~3% of the Canadian population1), this change to our environment can bring about a seasonal form of depression called Seasonal Affective Disorder, SAD. Those who experience SAD experience an onset of clinical depression in the fall season, which spontaneously improves in the summer, a cycle that usually repeats for at least two calendar years in succession. Interestingly, the symptoms of SAD are not typical of non-seasonal depression.2 Depressed mood, loss of interest in activities, and withdrawal from social interaction is common to both, but where typical depression usually includes insomnia, anxiety and reduced food intake, SAD is characterized by hypersomnia, carbohydrate craving and increased body weight. The symptoms look superficially like seasonal rhythms in animals as they prepare to hibernate.
In fact, many of the same biological mechanisms which prompt the onset of hibernation in animals like bears are similar to the processes which give rise to SAD in humans. This is because most organisms have internal body clocks which track daily and annual cycles in the external world. Our body clocks, for example, are capable of tracking how long the sun is present each day. While we don’t yet fully understand why this process affects mood, we know that SAD is associated with day length because data from different American states reveal that the incidence of SAD are higher in more northern states.3 This is also true of the ‘winter blues’, or sub-clinical SAD. We also know that the issue is in terms of day length and not the amount of sunshine a location gets because Calgary (~51° N) has much more winter sunshine than Vancouver (~49° N) but similar daylengths and population rates of SAD. This is particularly important information for us Canadians who live north of the 49th parallel. We may get plenty of sun, but we still experience shorter days.
So, as we get less daytime during these seasons, is it possible to trick our body clocks into thinking the days are longer?
Remarkably, one of the most effective remedies for SAD is bright light treatment. Introducing bright light in the Fall and Winter can prevent or reverse SAD, with roughly 2/3rd of SAD patients responding to the treatment4. The research indicates that it is as effective an antidepressant as any pharmaceutical used to treat SAD and when used correctly is accompanied by relatively few possible side effects. Importantly, however, bright light therapy may trigger mania in individuals with bipolar disorder5, so please consult with your doctor before considering the treatment. The minimum effective dose is approximately 2500 lux, which is about the intensity of sunrise outdoors.6 Bright light treatments, however, will often exceed 10,000 lux. Indoor, room lighting typically emits 500 lux and is thus an ineffective treatment. Those susceptible to SAD can purchase bright light-emitting visors or, alternatively, there are bright light lamps which allow one to sit or work in an environment containing ambient day-time levels of light. These devices can also be used strategically to ease certain sleep disorders and help realign one’s body clocks during jet lag.7
Because many of the symptoms of Major Depression and SAD are shared and the two disorders are often comorbid, traditional psychotherapy is also a highly effective treatment for seasonal depression.2 Research using group-based cognitive-behavioural therapy (CBT), for example, has demonstrated antidepressant effects which nearly mimic 30 minutes of 10,000 lux bright light treatment.8 Health professionals who utilize CBT teach skills to those suffering from various forms of depression which help to change their perceptions of the world.9 Cultivating emotional regulation, developing personal coping strategies, and learning to disrupt patterns of negative thoughts and actions are key constructs of CBT. Bright light treatment and psychotherapies like CBT may be used alongside one another, as well as in conjunction with other therapies like medication or mindfulness practices. Research also suggests that people whose depressive symptoms look more like the ‘winter blues’ than seasonal depression should improve their diets by limiting starches and sugars, exercise frequently, manage stress (especially around the holidays), increase social contact and connection, and spend more time outdoors.10
Finally, vitamin D, an essential building block for our bones and muscles, is in short supply in the Canadian Fall and Winter months. A deficiency of vitamin D has been associated with depressive symptoms and some research suggests that taking vitamin D before winter darkness sets in may help prevent symptoms of SAD.11 During the winter months, those living roughly 33 degrees north or 30 degrees south of the equator synthesize very little, if any, vitamin D.12 People beyond these latitudes rely primarily on eating fish and egg yolk or taking nutritional supplements to get the vitamin D needed.13 It is important that most of us, and perhaps especially people experiencing SAD, ensure that we have sufficient levels of vitamin D during these darker months. Thankfully, the Canadian government acknowledges this problem and mandatorily requires that products like cow’s milk, margarine, and calcium-fortified beverages have vitamin D added to them.14 Planning a mid-winter vacation may be valuable for its increased light exposure and onset of vitamin D synthesis, and who doesn’t like taking a vacation as a form of treatment?15
Thankfully, there are multiple options for Seasonal Affective Disorder which allow for more personalized treatment plans. If you’re feeling blue this Fall and Winter, Alongside You offers an abundance of counselling and well-being services that can help you if you identify with any of the discussion above regarding SAD.
If we can be of help to you, please don’t hesitate to ask. This is why Alongside You exists – because we believe that everyone is worth it. Feel free to contact us to see how we can help!
Adam Manz recently graduated from Simon Fraser University with a Bachelor of Arts majoring in Psychology. He is currently pursuing a master’s degree in clinical psychology while maintaining a love for meditation, podcasts, and hiking. Adam is volunteering with us here at Alongside You and we’re glad to have him on board!
1Body and Health Canada. (2019). Seasonal affective disorder. Retrieved from https://bodyandhealth.canada.com/healthfeature/gethealthfeature/seasonal-affective-disorder.
7Burgess, H. J., Crowley, S. J., Gazda, C. J., Fogg, L. F., & Eastman, C. I. (2003). Preflight adjustment to eastward travel: 3 days of advancing sleep with and without morning bright light. Journal of Biological Rhythms, 18(4), 318–328. doi: 10.1177/0748730403253585
9Canadian Mental Health Association. (2013). Seasonal affective disorder. Retrieved from https://cmha.bc.ca/documents/seasonal-affective-disorder-2/.
5Chan, P. K., Lam, R. W., Perry, K. F. (1994). Mania precipitated by light therapy for patients with SAD (letter). Journal of Clinical Psychiatry 55:454
4Golden, R. N., Gaynes, B. N., Ekstrom, R. D., Hamer, R. M., Jacobsen, F. M., Suppes, T., … Nemeroff, C. B. (2005). The efficacy of light therapy in the treatment of mood disorders: A review and meta-analysis of the evidence. American Journal of Psychiatry, 162(4), 656–662. doi: 10.1176/appi.ajp.162.4.656
13Health Link BC. (2019). Food sources of calcium and vitamin D. Retrieved from https://www.healthlinkbc.ca/healthlinkbc-files/sources-calcium-vitamin-d.
3Horowitz, S. (2008). Shedding light on seasonal affective disorder. Alternative and Complementary Therapies, 14(6), 282–287. doi: 10.1089/act.2008.14608
14Janz, T., & Pearson, C. (2015). Health at a glance: Vitamin D blood levels of Canadians. Retrieved from https://www150.statcan.gc.ca/n1/pub/82-624-x/2013001/article/11727-eng.htm#n2.
11Kerr, D. C., Zava, D. T., Piper, W. T., Saturn, S. R., Frei, B., & Gombart, A. F. (2015). Associations between vitamin D levels and depressive symptoms in healthy young adult women. Psychiatry Research, 227(1), 46–51. doi: 10.1016/j.psychres.2015.02.016
10National Health Services. (2018). Treatment of seasonal affective disorder (SAD). Retrieved from https://www.nhs.uk/conditions/seasonal-affective-disorder-sad/treatment/.
8Rohan, K. J., Mahon, J. N., Evans, M., Ho, S.-Y., Meyerhoff, J., Postolache, T. T., & Vacek, P. M. (2015). Randomized trial of cognitive-behavioral therapy versus light therapy for seasonal affective disorder: Acute outcomes. American Journal of Psychiatry, 172(9), 862–869. doi: 10.1176/appi.ajp.2015.14101293
12Stewart, A. E., Roecklein, K. A., Tanner, S., & Kimlin, M. G. (2014). Possible contributions of skin pigmentation and vitamin D in a polyfactorial model of seasonal affective disorder. Medical Hypotheses, 83(5), 517–525. doi: 10.1016/j.mehy.2014.09.010
6Tam, E. M., Lam, R. W., & Levitt, A. J. (1995). Treatment of seasonal affective disorder: A review. The Canadian Journal of Psychiatry, 40(8), 457–466. doi:10.1177/070674379504000806
15Targum, S. D., & Rosenthal, N. (2008). Seasonal affective disorder. Psychiatry (Edgmont), 5(5), 31–33.
2The National Institute of Mental Health. (2016). Seasonal Affective Disorder. Retrieved from https://www.nimh.nih.gov/health/topics/seasonal-affective-disorder/index.shtml.
“I love that it gets dark at 3 pm, that it’s pouring rain constantly, and that I haven’t seen the sun in 4 months!” said no one ever. Although some people may prefer the cold winter weather, there are a lot of us who are counting down the hours until patio season starts up again (okay, maybe that’s just me). So, until then, we are binge-watching TV, sleeping in, indulging in comfort foods, and pretty much avoiding the outdoors unless we absolutely have to go outside. The different seasons and the weather impact what we do and how we feel, which is why many of us prefer indoor activities during this time of year and for the next few months to come. However, on a rare day that the sunlight does shine through or when summer finally rolls around, we are quick to get outside and enjoy the sun. We may notice that our mood improves when the sun comes out and it can be a bit easier to get things done. Other times, we notice that when it’s dark and rainy, it’s a little harder to get out of bed, be alert, or even feel happy.
If you’re relating to this post right now, you’re not alone! Approximately, 17% of Canadians are also feeling pretty low during the winter months (CMHA, 2013). You can thank Seasonal Affective Disorder (SAD) for these mood changes, which is a form of depression that occurs at certain times of the year, specifically between September/October and April/May. It affects anyone and everyone but is more common amongst women, individuals between 15-55, people who live further up north or farther down south away from the equator, or individuals with a family history of SAD or other types of depression (HealthLinkBC, 2017).
How Do I Know If Seasonal Affective Disorder is affecting me?
You may be experiencing Seasonal Affective Disorder if you identify with these statements:
I feel sad, moody, or anxious
I feel tired or slowed down all the time
I’ve lost of interest in work, friends, or interests
I’m gaining weight
I’m craving carbohydrates such as “comfort foods” like bread or pasta
I’m having trouble concentrating
I’ve been experiencing changes in my sleep, such as sleeping too much or not enough
(CMHA, 2013; HealthLinkBC, 2017)
Why Do We Struggle With SAD?
But why is SAD even an issue to begin with? It is thought that the lack of sunlight creates a change in the chemicals in our brain, specifically serotonin, which is responsible for regulating our mood. Additionally, because it is darker, it can signal to our brain that it’s time to sleep which can cause an increase of melatonin in our brain, which is responsible for regulating our sleep/wake rhythm. The truth is that we’re not completely sure why it happens, just that it does, and to many people in our community.
What Can I Do About SAD?
It’s great to identify if we have SAD. One of the main ways to help yourself if you’re struggling with SAD is to increase your exposure to the right wavelength of light. This can include:
Spending more time outside during daylight hours
Opening the curtains or blinds during the day
Rearranging the space that you are in to allow more sunlight to enter
Arranging office/household furniture so you can sit close to a window
Adding lamps into your space
Using a SAD Lamp
Counselling can help with the symptoms of Seasonal Affective Disorder by giving us a better understanding of how SAD affects us as individuals and helping us to cope with the effects that come about during this time of year. It can also be useful in helping us to look at our thoughts, feelings, and behaviours and how they influence our mood and can aid us in creating strategies for making changes in these areas. In addition to this, being able to talk to someone who is able to empathize and listen to us can be very beneficial.
If you’re struggling with Seasonal Affective Disorder, you’re not alone and you don’t have to go it alone. Seeing a Registered Clinical Counsellor or one of us counselling interns can be a great help!
If you’re not sure if what you’re struggling with is Seasonal Affective Disorder (SAD), please go to your family doctor who can help you determine if this is what you’re dealing with, and can refer you to a specialist if needed.
In the meantime, we’re here and we’d love to support you until the sun comes back! Feel free to contact us!
We were talking around the office this week about how there seems to be a week for everything. Admittedly, when we plan our calendar it’s sometimes difficult to keep up. Sometimes I wonder why we need a week for everything – and even, why we need a mental health week. To help us understand why we need a mental health week, I want to tell you a story.
I have a courageous young friend who has battled mental health for many years. This has involved many different treatments, counsellors, psychiatrists, medications, trips to the hospital, and more. This friend has an incredible family, many supportive friends, and others in the community who have been there to help and encourage. When things first began at a very young age, it was tough. For many years things were not stable, and treatments didn’t seem to help. Then, things changed. Life got better, treatments started helping, and things became stable for a number of years. Lately, things have been more difficult again, and life has come to a bit of a standstill. It’s discouraging. It’s disconcerting. It’s heartbreaking. On the upside, the family, friends, and community are still here, but it’s back to square one with treatment planning.
As I reflect on this, it occurs to me that this is exactly why we need a Mental Health Week. It further occurs to me that the things I feel my friend may need to hear right now may also be what others struggling with the mental health need to hear. This may also be true in terms of what we all need to hear about mental health.
Mental health issues are physiological issues that are no less physiological than cancer, diabetes, heart disease, or any other physical illness.
Often, we hear that mental health is “just in our heads.” This is neither biologically accurate, nor helpful. Mental health is in our head, in our bodies, and in our spirits. Mental health difficulties may involve imbalances in neurotransmitters, physical changes in the structures in the brain, changes in our central and autonomic nervous system, and even changes in function in just about every organ in our body; in addition, it may involve changes in our view of ourselves, our identity, our spirituality, and our belief systems.
What mental health is not, is a result of an individual being a categorical failure as a human being, because they’re not strong enough, because they aren’t trying hard enough, or because they don’t measure up. We don’t say these things of someone with heart disease, cancer, diabetes, or otherwise; we need to stop saying these things to ourselves, and others who struggle with mental health.
We are not defined by our illness.
There is a strange phenomenon, it seems, that when someone struggles with mental illness they become defined by it, both in their own minds and especially in the minds of the public. It’s not uncommon to hear someone say in conversation, “Oh, they’re a schizophrenic,” or, “he’s just an addict,” or similar. Sometimes, however, it’s us saying the same things about ourselves. The problem is that in both cases, it can become a self-fulfilling prophecy, and the struggle becomes perpetuated.
See, if we’re reduced to being a schizophrenic, an addict, or simply someone who is mentally ill, we lose our true identity. We are no longer a brother, a mother, a father, a sister, a CEO, a firefighter, or an accountant. We are no longer the beloved child of our parents, the one who wears his or her heart on their sleeve, or the one who uses art to enliven the lives of ourselves and others.
If we’re reduced to our illness, we have no identity other than that – the illness. This causes us to lose our perspective on ourselves, our loved ones, and those around us who are in the midst of some of the most difficult times in our lives. If we are reduced to our illness, then there is no hope, we are simply sick, or weak, or worse.
There is always hope.
I don’t believe in hopeless cases. There, I said it. If I did, quite frankly, I’d have the worst job in the world. Now, this doesn’t mean that everyone will recover fully and not have to deal with whatever mental health issue it is that plagues them; it doesn’t mean that we’re going to have the grand life that we see everyone around us having on Instagram (which isn’t true anyway, but that’s another article); and it doesn’t mean we’re going to be happy all the time.
What it means, is that although we struggle with mental health, we have not lost our identity; rather, both we and those around us may have lost sight of who it is that we are, and now our job is to get back to our core. It is time to get back to having lived a life worth living and to get back to the essence of what makes us unique.
We are born with natural gifts and abilities, and usually, they are the first things to go when we struggle with mental health or other issues. A little-known fact about me is that I’m a classically trained pianist. I played piano for many years, training with the Royal Conservatory of Music and then training in jazz and blues. Now I play a number of different instruments when I make the time. I love music, it’s one of the few things that no matter what place I’m in, brings me joy. This is true whether I’m playing it myself or listening to one of the greats on a recording.
Music is what has kept me balanced throughout my life when I’ve let it. When I was at my worst, struggling with depression and anxiety, I didn’t pay nearly enough attention to music. It was too much effort, it didn’t seem worth it, I just couldn’t. See, music is a double-edged sword for me – I also have had very high expectations of myself, and historically, I expected to be the best, to never make mistakes, etc., etc., etc. My identity at times became my ability to perform. I’d lost my way.
The truth, however, is that music ispart of the core of who I am. When I was trained in The Birkman Method, this came out in spades – right at the top of my interests and passions. I knew this already, however, because when I was able to play music in my recovery, for the joy of it, and the emotional processing of it, and not for the expectation to perform, it helped my recovery more than anything else.
“Music gives me hope.”
Sometimes I work with clients who have lost hope, and I can understand why they have. Their depression is unrelenting, they’ve just discovered their partner has had an affair for the past 10 years, their teenage son is addicted to heroin, or otherwise. Life can be incredibly painful.
Sometimes my job as a counsellor is to hold hope for my clients and to hold hope for those who are struggling until they can hold it themselves.
One thing that I have learned in over a decade of doing this work is that there are no hopeless cases – there is always hope. If you’re reading this and you’re the one struggling, hold on. If you don’t have hope, find someone who can hold it for you. If you’re the one who cares for someone in the struggle, hold hope for them. Encourage them daily. Don’t give up, life can get better for them, and for you.
This is why we need a Mental Health Week. We need a reminder that mental illness is real, and it is physiological, and it is not because we’re weak. We need a reminder that we are no more defined by our illness than we are the size of our shoes. We need a reminder that there is always hope for us and always hope for those we love.
We need a reminder that life can be worth living once again if we keep going.
Anxiety and Depression account for the majority of mental health diagnoses in Canada. At any given time, at least 11.6% of Canadians aged 18 and over are dealing with a mood or anxiety disorder based on a survey in 2013. My experience suggests that this number is low, both because the statistics are now 5 years old, and because it’s based on self-report and we know that many people don’t report their struggles even when asked on anonymous surveys. One of the common questions we get here at Alongside You is how to support a friend or family member who is struggling with depression. In fact, we were asked again yesterday and that’s what instigated this article.
If you run a Google search on the subject, there are many articles on this topic, such as this one from the Mayo Clinic, or this one from HereToHelp. There are many great resources out there with many suggestions around educating yourself on depression, helping friends get exercise and eat healthy food, and similar tactics. These are all great suggestions and ideas and I encourage you to spend some time looking through the articles that are available.
In this piece, I want to take a slightly different road and look at how we can help a friend, family member, or other loved one who is struggling with depression in terms of how we need to be with them. This might sound a little strange because many of us (myself included) are practical, hands-on types who like practical strategies. The thing is, being who we need to be with people is a practical strategy, and it is very effective.
The Importance of Not Knowing
When we’re struggling with something, and certainly when that something is depression, we often feel misunderstood. We say things like, “They just don’t get it,” or, “Nobody understands how I feel,” and quite frankly, it’s usually true. Even for those of us who have struggled with depression in our lifetime, the experience of someone else may be very different. How it felt for us and how we responded may not line up with this person’s experience. If we assume we know how the other person is feeling, we run the risk of alienating them and making them feel even less understood than they already do.
So, our first job then is to listen and to listen to understand versus listening to respond. Often, especially when we’re under stress, we do the latter; we listen and feel the need to respond in the hope that it will help someone feel better or feel connected. Often, we’ll respond with something along the lines of, “Oh yeah, I totally know how you feel, I went through the exact same thing!” No, we didn’t. We may have been depressed, we even may have been through similar circumstances and reacted similarly, but we don’t know how they are feeling unless we ask and listen, and we most certainly didn’t go through the exact same thing. If we want to be helpful and fight against the alienation and isolation our loved one is likely experiencing, we need to listen to understand.
The Importance of Empathy
One of the greatest challenges we face in trying to support a loved one with depression is the fact that we don’t understand. In fact, this very thing often places a great deal of stress on us because we want to understand, we feel we need to understand. The fact of the matter is, we don’t need to understand to be helpful. If we build on this stance of not knowing, we can work toward understanding on a deeper level, understanding the emotional level, and by strengthening the connection between us. This, in a nutshell, is empathy.
Empathy is not our naturally occurring, number one go to strategy – our go-to natural strategy is usually sympathy. If you haven’t seen it already, I would encourage you to watch this short video of Brené Brown talking about the difference. When people are depressed, one of the most significant things that help is the connection with others. This is why empathy is so important – we can show empathy without understanding yet. It can be as simple as saying, “Wow, I don’t even know what to say right now but I’m glad you told me, and I’m here.” And yes, I totally stole that line from Brené Brown. I stole it because it’s that good. See, if we can admit our limitations and be vulnerable with our loved one that is struggling, not only do we encourage connection, but we model the vulnerability that they need in order to connect with us. If they can do this in return, it will directly combat those voices in their heads telling them that nobody cares, nobody listens, nobody understands, and they are not good enough.
If we can do the two things above, we stand a greater chance of success in this third thing I’m going to talk about: getting help. Most of us are proud people – we think we can do it all on our own and further, we think we should. I remember when I was dealing with major depression I thought it was because I was doing something wrong, that I just wasn’t working hard enough, and that I was a failure. Part of the reason that I believed this is because to my knowledge at the time, nobody I knew, and none of my family had ever struggled with depression, and certainly not the suicidal thoughts that were commonplace for me. This is where vulnerability and even some self-disclosure on our part can be helpful, particularly if we’ve struggled with depression ourselves. Some careful self-disclosure can normalize the struggle, and fight against the negative self-beliefs.
If we can listen to understand, and show empathy, we send the message to the one struggling that it’s ok that they’re struggling, it’s ok that they don’t have it all figured out, and it’s okay to ask for help. Now, when I say it’s ok I don’t mean it’s pleasant, or that we should like being depressed, or anything along these lines. What I mean is that it’s not because of some inherent flaw in who they are that they are struggling, and it certainly isn’t because they’re not worth it.
See, by spending time listening and understanding, spending time in empathy and connection, we are sending a strong message. That message is, “You’re worth it.” In my opinion, this is the single most important message for anyone to receive when they are dealing with depression because if their belief about themselves is that they aren’t worth it, then why would they tell anyone how they feel? Why would they open up to someone? Finally, why would they bother asking for help, because they don’t deserve it?
If we can help our loved ones come to a place of even beginning to understand that they are worth it, they are loved, and they are valuable then we stand a much better chance of succeeding at getting them the help they need. This is where we can again show vulnerability and explain that we love them, but we don’t possess the skills necessary to help them recover fully, the skills that a mental health professional does. This is also where we can reinforce that we’d like to help them get the help they need and that we will be there alongside them as they go through this. In fact, we can emphasize that we will go through this together with them.
How We Are With People Is Most Important
The reality is that helping a loved one who is struggling with depression is usually a start and stop, back and forth, messy process. Most of the time, emphasizing the practical strategies doesn’t work very well. Why is this? Because we don’t have the connection needed where the person will believe they are worth it, that they are loveable, and that recovery is possible. If we can be with the person on a deeper, empathic level, we give them the best chance possible to buy into the recovery process and we show them that they’re not alone.
If you’re reading this because you have a loved one struggling, or because you are that loved one struggling, I encourage you to take the first step toward recovery. If we can be of help to you, please don’t hesitate to ask. This is why Alongside You exists – because we believe that everyone is worth it. Feel free to contact us!
One of the most common questions I get from people when I give talks on Borderline Personality Disorder (BPD) and Dialectical Behaviour Therapy (DBT) is the question of how to support someone with BPD? So many individuals, couples, and families are struggling with how to love, care for, and support someone in the midst of what often feels like total chaos and painful experiences.
Shari Y. Manning, former President and CEO of Behavioral Tech and Behavioral Tech Research, the research organizations founded by Marsha Linehan to provide training in BPD, wrote a book on just this, titled “Loving Someone with Borderline Personality Disorder” and in it she focuses on how to keep the out of control emotions from destroying relationships between individuals with BPD and their families and other supports. She highlights the difficulty of balancing compassion for the person, while still wanting to help them find ways to change their behaviour and managing their emotions.
I’ll admit that it’s not easy to help someone struggling with BPD. It may seem that they are manipulative, egocentric, and focused on their own needs exclusively. The reality is that it’s not actually too far from the truth. The key to supporting someone with BPD without losing our own sanity, in my mind, is in our approach and how we frame what we’re observing. This is where Dialectical Behaviour Therapy (DBT) skills come in handy for us as well.
Interpersonal Effectiveness and Manipulation
Let’s talk for a minute about the idea that people with BPD are manipulative. It’s common to hear, both amongst clients with BPD, support systems, and yes, even professionals. I remember years ago that I used to get very angry when I heard this because I felt very compassionate toward clients with the borderline personality disorder and their need for help. Then it dawned on me – that is, they are being manipulative. And so are we.
See, manipulation is nothing new in relationships. We do it all the time – in fact, as I said to my intern John this week in supervision, we’re all in relationships to get what we need from the other person. None of us would be in relationships if this weren’t true. The difference is, we do it in a mutually beneficial way that serves everyone involved. The fact remains, however, that we’re all trying to get what we need from others, we just have more ability to do so effectively. This is what interpersonal effectiveness skills in DBT do for clients and for members of support systems; they teach us how to get what we need from others in an effective way.
Why Individuals with BPD Behave the Way That They Do
I remember back many years ago when I began working with individuals with developmental disabilities, we often repeated the phrase with staff and caregivers, “All behaviour is communication.” This is a very important concept and applies just as much to kids and adults alike, as well as individuals with BPD. When we can’t use words to communicate, we use actions. Further, when we see the often extreme behaviours of individuals with BPD, it’s important we remember what is happening to them at that moment, and how it got that way.
What we also know from brain science, and certainly I’ve observed this in my clinical work, is that individuals who have histories of abuse, neglect, invalidating emotional environments, and other traumas, have brains that are more sensitive to danger. The limbic system is designed to keep us safe and also regulate our emotions. At its’ best, it keeps us safe when we’re in danger, and regulates our emotions to keep us at an even keel. At its’ worst, it’s being triggered in situations that aren’t dangerous and causing us to react in ways that would make sense if we’re in danger but make no sense when we’re not. It’s also important to remember that when this system is acutely active, it shuts down our frontal cortex, which is where our rational thought mechanisms are housed. So, when we’re in danger, as I often say to clients, we can’t think to save our lives. This is the brain state that individuals with BPD are in when they react in extreme ways. Their brains are in full-blown fight or flight mode and simply reacting, trying to do anything they can to be safe. Most often, they turn to their closest relationships.
Relationships as Safety
Ever heard the idea that we hurt the ones we love the most? This is often the case with individuals with BPD when they react in extreme ways. But why is this? Many people with BPD have a very externalized locus of control, meaning, they don’t believe they can contain their own emotions, especially when they’re overwhelmed. You know what? They’re right. When they’re in fight or flight the mechanisms in their brain responsible for regulating emotions and behaviour are not rational, and are just reacting and they can’t contain it. This is simply a more extreme version of what happens to all of us. So then, what’s the difference?
I believe the difference is the level of fear experienced in these moments. The idea of not being able to contain extreme emotions would be, I imagine, quite terrifying. Coupled with the fear of being left by the people they are closest to, the proverbial pot boils over and they have to do something extreme to get attention. I often hear, “Oh they’re just attention-seeking,” to which I reply with an emphatic, “Yes, of course, they are!”
Remember the idea that all behaviour is communication? When people with BPD are at this heightened state they are unable to communicate effectively and are doing their darndest to communicate their pain and fear to us, asking us to help them contain it. What may look to us like someone simply showing out of control behaviour, I believe, is a desperate attempt at seeking safety and containment.
Can you imagine what it would be like to be in this position? Having BPD, feeling so unsafe and so in pain that you have to go to such extreme lengths to try to get help? I can’t. The idea of being there is far too terrifying to me. Quite frankly, I don’t want to know what it feels like to be in that place, but it gives me a great deal of compassion for those who are.
What Do We Do To Help?
One of the best ways to be supportive is to help those struggling with BPD to get the help they need. Dialectical Behaviour Therapy (DBT), on an individual basis as well as in skills groups, is very effective in helping those with BPD manage their symptoms. With the right help, individuals with BPD can learn the skills they need to manage their emotions and relationships and ultimately, have a life worth living! This was Marsha Linehan’s goal in developing DBT, to help those struggling with suicidal thoughts have a life worth living. We’re proud to say that our DBT programs have been effective at doing just that for our clients, and we’d love to help even more people this way.
We have often been asked if we run groups for family members and other supports who are trying to help someone with BPD. Unfortunately, we don’t at the moment but it’s on our radar. We are looking into doing exactly this in the future. What we can do, however, is teach DBT skills on an individual or family basis for those supporting someone with BPD. We have a number of counsellors available for this, and you can talk to Doug, Share, or Kellyabout this if it would be helpful.
Education is also very important as once we understand what is happening, it gets less scary. There are many books that can be very helpful. Here are a few ideas to get you started:
Finally, self-care is absolutely paramount to your survival for yourself and the person struggling with BPD. As the airlines often remind us, we need to put our mask on before we can help anyone else! If we don’t take care of ourselves, we will flip our lids and react in much the same way as those we’re trying to help.
I hope this has been helpful – if our team can be of any help to you as you support someone with BPD please feel free to give us a shout. Our Dialectical Behaviour Therapy program is comprehensive, and we would love to teach you the skills needed to be a solid support, for yourself and your loved ones with BPD!