Activity Patterns May Predict if Depression Responds to Ketamine

Monitoring a depressed patient’s daily activity patterns before trying the drug ketamine — being tested as a fast-acting antidepressant — may help physicians determine whether the drug will be effective or not, according to a new study published in the journal Biological Psychiatry.

During a depressive episode, many people experience reduced energy, a feeling of being slowed down and having less interest in activities. As their mood lifts, energy and activity return to their usual levels.

In the study, patients whose depressive symptoms improved in response to ketamine showed a particular level of activity before trying the drug: more activity earlier in the day and less activity later in the day. This finding suggests that activity patterns may help identify patients who would benefit from the drug.

“These findings are the first clinical results to suggest that trait-like circadian activity patterns are associated with rapid mood response to ketamine,” said first author Dr. Wallace Duncan from the Experimental Therapeutics and Pathophysiology Branch at the National Institute of Mental Health in Bethesda, Maryland.

For the study, the researchers used wristwatch activity monitors on 51 patients to examine measures of circadian timekeeping systems, including the timing and levels of activity. All of the patients had either major depressive disorder or bipolar disorder, and all had depressive symptoms that had not responded to any previous treatments.

The findings show that patients who responded to a single infusion of ketamine initially typically had more activity earlier in the day and lower activity later in the day than patients who did not respond to ketamine.

“In other words, their daily activity clock was shifted forward,” said Dr. John Krystal, editor of Biological Psychiatry.

Those patients who responded to ketamine also had advance-shifted timing of their activity on the first day after the treatment, and increased overall activity levels on the third day, consistent with the notion that activity levels are part of the clinical response to ketamine.

Altered measures of circadian timekeeping on the third day suggest that changes in circadian circuits may mediate ketamine’s continued effects on mood.

Furthermore, the differences in activity levels before and after treatment suggest biological differences in the circadian systems that regulate activity between people who respond to the drug and those who don’t. The researchers suggest that these underlying differences may help predict ketamine’s effects on mood.

“It would be nice if daily patterns of activity could be used clinically to identify people who might respond to ketamine and to monitor clinical improvement,” said Krystal.

According to Duncan, the findings are also important because they show that rapid-acting treatments such as ketamine can provide key insights into the associations between sleep and circadian rhythms, activity, and mood response.

The unique activity produced by ketamine suggests that the clock-gene mechanisms that control circadian rhythms may be linked to the type of depression that responds to ketamine.

In addition, depressive symptom scores were linked to decreased activity and increased sleep quality on the first night after the infusion, indicating that improved sleep quality may be key to ketamine’s rapid mood effects.

Source: Elsevier

If you were fortunate enough to be given instruction in the use of genograms during your graduate training, you can skip this article. If, like some of my early career supervisees, you were not taught this valuable tool, then I do urge you to learn more about them. Genograms are a powerful and sympathetic way to get an overview of your patient’s background and the early conclusions that are now giving him or her trouble.

A genogram is a formalized version of a family tree that provides a visual representation of an individual’s family over several generations. During the 1980s, Monica McGoldrick and Randy Gerson  standardized the icons used for construction so that professionals could readily share information. (See: Genograms: Assessment and Intervention; Norton Professional Books.) Constructing the genogram in session with an individual or family helps both therapist and patient take a step back and look at the patterns of interacting that have had, and continue to have, an impact on the people involved.

Most sports events provide us with a scorecard to help us know the players and their positions. A conversation about the players can help spectators (and team members) understand how different individuals typically behave as well as which players are allied with each other, which players don’t get along and where the team needs to change if it is to be successful.

A genogram can be understood as having the same function. The genogram itself is a simple drawing. The conversation while we construct it begins the process of helping individuals make sense of their history (and perhaps their present) in a new way.

Here’s a simple example: Circles stand for females. Squares stand for males. Horizontal lines between show marriage. Vertical lines show children born to the couple. Notes taken during an intake discussion are above each of the parent symbols.

Genograms: What they are and How to do them

Mary and Mike came for couples therapy. They’d been married for less than a year following a romantic whirlwind courtship of three months. They’ve been fighting about just about every practical matter involved in setting up a home together. Jointly constructing a genogram showed both individuals how much more they were influenced by their families of origin than they had understood.

Mary is the older of two siblings with a powerhouse of a mom who set the rules and kept the family ship afloat. She described her dad as her mother’ss biggest fan who pretty much left the family day to day operation to his wife. Mary was often left in charge of her younger brother. When Mom had to stay late for a meeting, it was Mary who got dinner together and saw that her brother got his homework done.

Mike is the only son following three girls. He was known as the “ittle prince” at home. The girls dressed him up and played with him. Dad set the family rules but kept his distance from all the women by spending time in his workshop or at work. He loved having a son and spent lots of time doing projects with him. Dad felt Mike could do no wrong and bailed him out of both minor and rather major scrapes.

In many ways, Mary and Mike are a good but problematic fit. She is accustomed to being in charge and to seeing men as passive but nice. He is accustomed to being both bossed and coddled.  But Mary’s complaint about Mike is that he seems to expect her to do everything. Mike’s major complaint is that Mary seems to think it’s “Her way or the highway.” They have fallen into their accustomed roles without realizing it. They don’t know how to change their relationship to a more egalitarian one, even though they both say that is what they want and neither one grew up with an egalitarian model of marriage.

This is a very simple example as an illustration of what can come from a discussion. Treatment begins from there.

Actual genograms are much more complex than the example of Mary and Mike.

McGoldrick and Gerson provided us with useful symbols to indicate pivotal life events like births, adoptions, deaths, divorces, marriages and remarriages, etc. as well as different types of relationships. There are now even computerized templates available. To see examples of genograms of famous individuals (such as Sigmund Freud or John F. Kennedy) do a simple internet search.

Questioning about the various family members and family events can help both therapist and client develop a renewed or new appreciation for the culture and issues within each person’s family that they bring to their relationships.

The central belief is that families repeat themselves, both positively and negatively. Often, if a problem in a couple or family isn’t solved, it bumps down into the next generation. Such patterns are called the intergenerational transmission of an issue or style.

It’s fascinating to map out a family over several generations. Often discussion does reveal patterns that keep repeating. Infidelity, for example, may be present generation to generation, with the same painful behavior creating pain in each succeeding family. Another example is a family riddled with “cut offs” with various members not speaking to other members for years. Cutting people off is the only way the family knows how to resolve conflict. That dysfunctional approach to problems has been modeled for each succeeding generation.

Sometimes, we see alternating generations expressing a problem with one extreme or another (alcoholism to total abstinence from alcohol to alcoholism, etc.).  To watch Monica McGoldrick interview and treat a simulated family using the information generated by a genogram, obtain this wonderful videotape via interlibrary loan: The Legacy of Unresolved Loss. The tape shows how unresolved grief reverberates through three generations of a family.

Taking the time to develop an overview of a family like this helps us be aware of the family context when we are working to understand an individual, couple or family. It sensitizes us to family issues and helps a patient recognize that at least some of his or her beliefs and behaviors were absorbed long ago and now deserve reconsideration.

It’s true that there are some schools of therapy that reject the importance of such an investigation into a client’s family history. Behaviorists, for example, are more focused on current behavior. Cognitive-behavioral therapy is more interested in changing negative thoughts. But those of us for whom psychodynamics is central to our work can make use of the skill as both an assessment tool and as an intervention.

By being curious, empathetic, and kind while constructing a genogram, a therapist can often help a client (or couple or family) develop a more compassionate understanding of themselves and their family members. It’s an excellent place to start treatment.

From the U.S.: A few years ago, (5 or 6 years) when I was still trying to figure out who I was and what i wanted out of relationships, sex, etc etc I became very dear friends with a couple who were open-ish (wife is Bisexual and Husband is Heterosexual). The friendship started out as just a great platonic friendship. They’re both a little older than me so I would go to them with relationship struggles or just general life advisers and confidantes.

Well, the friendship was strong and when I started running into repeated relationship problems with people I tried dating I decided to take a hiatus from dating and instead just explore what I wanted. In that time I explored my sexuality a little with them. I learned a lot about myself in the safety of that arena. It did not take long. But I discovered I am in fact very heterosexual and monogamous. I also discovered other important things. A few years later the husband was lost tragically in a motorcycle accident.
I still have a beautiful friendship with the wife/widow.

Well, fast forward to this last year. I have now been dating a man exclusively for nearly a year. (she also has a new SO whom I’ve met and enjoy the company of). I moved in with my SO about two months ago. So, one evening last fall I was in a deep conversation about life experiences with him and I feel safe enough to vulnerably share the one experience I had with said friend and her late husband as I was exploring my own sexuality.

He shut down rather abruptly and proceeded to judge the late husband and his widow as having questionable characters etc…. i was irritated by this. We sort-of just walked away from that issue and haven’t gone back there.

Well, she is still my friend and I’ve insisted upon spending time with her (double dates as couples, etc.) He claims he likes her yet every time we see her within 24 hours he makes some judgmental comment about “Well, I can’t say I’m a fan of you being so close to someone you had that kind of relationship with” or “I can’t say I’m a fan of you’re little circle you have with them”.

After the husband died the friendship dynamic shifted significantly. Even before he died there was no intimate connections at all for over a year, everything slid back into respectfully platonic.

I don’t know what to do. Please help. I feel really angry and upset like I’m constantly having to choose which parts of me I can share and what I have to keep secret.

A. When people get together as adults, they each are likely to have had past relationships. While young, people are likely to have tried experiences and to have taken risks they would not take as adults. Once past 30, there is also a strong possibility of having loved and lost and loved again.

You can’t erase your past. Neither can he. While developing a new relationship, the important thing is not what we’ve done or who we’ve been with but what we have learned along the way to becoming our present self.

The current situation is difficult for you both. You don’t want to live your life always feeling like he may judge you yet again for something that is past history. If he can’t accept that your experimental stage was just that — a stage — then he will always be wondering if he will lose you to another threesome. That’s not a good way to live either.

It is unhealthy for you to feel that you have to withhold parts of yourself in order for your boyfriend to feel secure. You may have to take a step back in this relationship while your boyfriend thinks this over. Another option is to see a couples therapist to help you both get past this.

I wish you well.
Dr. Marie

“Chaos is a ladder.” Petyr “Littlefinger” Baelish One of the more perplexing and complicated characters in George R. R. Martin’s Game of Thrones (2015)  is Petyr “Littlefinger” Baelish. Littlefinger is […]

Are you a mental health professional or caregiver? Would you like to know how to avoid burnout or compassion fatigue?

Many of us know that we need to watch out for compassion fatigue (Figley, 1995) but are at a loss on how to do this. Compassion fatigue is “a state experienced by those helping people or animals in distress; it is an extreme state of tension and preoccupation with the suffering of those being helped to the degree that it can create a secondary traumatic stress for the helper.”

Contrary to Figley, Kristin Neff, Ph.D argues in her “Art of Self-Compassion: Accepting your Imperfections,” workshop  that there is no such thing as compassion fatigue. You cannot feel too much compassion for yourself or others. There is only empathy fatigue. This post will provide you with some of Neff’s simple techniques for preventing empathy fatigue as you care for patients, clients or loved ones.

Empathy refers to the ability to feel others’ feelings. It is thanks to mirror neurons that our brains can read others’ emotions and create empathetic resonance. Without taking sufficient precautions, as you are caring for people who are in pain, over time, you can suffer and experience burnout.

Matthieu Ricard explains empathy in the two minute video below.

Traditionally, self-care consists of: good nutrition, sufficient rest, exercise, play, setting boundaries, getting supervision, socializing, massage and yoga. While it is beneficial to include as many of these components as possible in your routine/life, there is a limitation to these methods. They are off-the-job and can not be done while actually caregiving.

Neff recommends employing self-compassion as an oxygen mask in the moment, during the actual presence of suffering. This on-the-job approach is a sustainable method of self-care. Self-kindness entails giving ourselves the same kindness and care we’d give a good friend.

As a caregiver and/or mental health professional, this means giving yourself some soothing words of support at the very moment you’re feeling stressed or overwhelmed with another person’s suffering such as:

It’s so hard for me to hear this right now. It’s so painful.

You may also include part, all (or an adaptation) of the serenity prayer: “May I have the serenity to accept the things I cannot change, the courage to change the things I can and the wisdom to know the difference.”

Another alternative is to employ the Soothing Touch/Self-Compassion Break, or the Coping with Difficult Emotion Exercise.

Using one of the above-mentioned self-compassion practices will enable you to nurture yourself while you’re nurturing others.

If you only experience empathy for others’ suffering with no loving compassion for yourself, you resonate with the pain of others and have nothing to balance yourself and therefore develop empathy fatigue. However, when you give yourself loving-kindness, you have a protective buffer from the negative effects of feeling the suffering.

Self-compassion provides you with the emotional resources to care for others. As you start practicing self-compassion for yourself when you come into contact with someone else’s suffering, you will be further helping your client, patient or loved one.

Wondering how self-compassionate you are? Take this quiz to find out!

Additional Practices to Boost Your Well-Being

Celebrate what’s good!

For survival reasons, our brains have a strong negativity bias. This means that we’re more likely to note and remember negative things to positive things at a seven to one ratio.

Fortunately, our brains are also trainable (plastic); therefore, we can train ourselves to focus more on the positive by taking the time to savor the good and positive things and feelings we see and experience. In addition, a gratitude practice increases one’s happiness and well-being.

Appreciate what’s good about ourselves

Take the time to become a good friend to yourself. Acknowledge when you’re doing something nice and/or when things are going well.

Recognize and be grateful for your own good qualities. Every human being has good qualities; part of being human means having good qualities.

Lastly, playing small does not serve the world or yourself. Marianne Williamson addresses this beautifully below:

Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure. It is our light, not our darkness that most frightens us. We ask ourselves, ‘Who am I to be brilliant, gorgeous, talented, fabulous?’ Actually, who are you not to be? You are a child of God. Your playing small does not serve the world. There is nothing enlightened about shrinking so that other people won’t feel insecure around you. We are all meant to shine, as children do. We were born to make manifest the glory of God that is within us. It’s not just in some of us; it’s in everyone. And as we let our own light shine, we unconsciously give other people permission to do the same. As we are liberated from our own fear, our presence automatically liberates others.

How to Use Self-Compassion to Avoid Burnout


Figley, C.R. (1995). Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. Brunner-Routledge; New York.

Neff, K. (2017, May 20). The Art of Mindfulness and Self-Compassion:  Accepting your Imperfections. Eileen Fisher Learning Lab. NYC.

Neff, K. (2017). Self-Compassion

Williamson, M. (2009). A Return To Love: Reflections on the Principles of A Course in Miracles. HarperCollins Publishers; New York.

The Fix Q&A with Christopher M. Finan, author of Drunks: An American History, on our nation’s history of alcoholism, recovery and AA.

The origin story of America is typically told as a fight for freedom. But a new book, Drunks: An American History, by Christopher M. Finan, recounts a struggle that predates our wrestle for independence: a three century long battle to sober up.

Drunks begins in 1799 with the story of Handsome Lake, a member of the Seneca Nation whose drinking reduced him to “yellow skin and dried bones.” Stripped of their land and decimated by poverty, Natives sought solace in yet another empty gift offered by Americans: booze.

In a weakened, depressed state, Handsome Lake had a vision in which the Creator told him that alcohol was for the white man. “No, the Creator did not make it for you.” Inspired by his spiritual awakening, Handsome Lake eventually went on to help his fellow Iroquois sober up in what turned out to be one of the first bona fide recovery movements in North America.

Finan also chronicles the evolution of temperance movements that ultimately led to America’s failed flirtation with prohibition. The history is full of passionate characters, like Carry Nation, the radical prohibitionist known for wielding a hatchet used to break saloon windows. You’ll discover a whole other reason to dig Abraham Lincoln. While stigma punished alcoholics, he had something of a soft spot. “There seems ever to have been a proneness in the brilliant, and the warm-blooded, to fall into this vice,” he says fondly of local drunkards.

A theme of warmth and empathy toward those who’ve walked through the gauntlet of alcoholism is carefully threaded throughout Drunks. Probably because Finan himself comes from a long line of people who drank too much. He, his mom and his dad all came down with alcoholism. But the interview below, which was lightly edited for length and clarity, shows Finan as an optimist. Reading his book, you’ll understand why. While many of us are still drunk and will stay drunk, history shows we’ve come a long way from gold cures and cruel sanatoriums. Drunks is a history of lost causes finding redemption.

Your book is chock-full of fascinating historical nuggets about alcohol’s place in America’s political and social history. Which person or story that you dug up stands out as a favorite?

The story of Handsome Lake. He’s the Seneca leader of the first recovery movement. Partly because it’s such a heartbreaking story, of how hard alcoholism hit the Indians. They were experiencing nightmare after nightmare: military defeat, dispossession, poverty and alcoholism. But his religious awakening, founded on sobriety, is so encouraging. He was very successful in sobering up other members of the Iroquois Confederacy. Of course he didn’t sober up everybody but the Indians had no idea that recovery was even possible until Handsome Lake began his crusade. One of my favorite quotes is from an unidentified member of his tribe. Someone asked why did it take you guys so long to get sober. He responded, “Until Handsome lake. our prophet, said the great ruler wants us to get sober, we didn’t have the power. But now we know it’s possible.” In many ways that is every alcoholics’ experience. When we’re trending down to the bottom, we wonder: is there anything we can do to stop this? Those people become powers of example to us; that’s what Handsome Lake was to his people. He was proof that not only you can get sober but that your welfare and happiness depended on it.

“Drunks” is an exhaustive history. And addiction and alcoholism are deeply personal, complex topics to explore. What motivated you to research this history?

I studied history in grad school and toward the end of my dissertation, I told my advisor I was in recovery. I had known him quite a long time and I don’t know why I decided to tell him but I did. He was a very warm and gracious guy. He became very excited and told me I ought to write a history of alcoholism. He said it would gain from the fact that you’re sober and provide some of that perspective that another historian might not be able to do.

I really liked the idea, but my dissertation took a very long time. That book took even longer. Then I wrote my second book as a history of free speech. When that was done, and I began to think about this book,I only knew my own experience in recovery. But when I looked at the broader picture I found that this was an untold story. There are certainly many historians of recovery and I depended heavily on their work, particularly William White. But there wasn’t a compact version of this story.

The more I researched the more I realized that I identified with these people. When I researched the Indians and read them describe their first experience with inebriation, I thought wow I felt that. I got that excitement, that thrill. It was like reading something that had been written yesterday instead of three centuries ago. I got very excited about these people.

Read more of Zachary Siegel’s interview with Christopher M. Finan about Finan’s take on a three-year century long battle for American’s to sober up in the original article A Sober Historian Chronicles America’s Drunk History at The Fix.

Quieting the Voice of the Devil on Your ShoulderSee no evil, hear no evil, and speak no evil.

And in case you were wondering, the proverbial “evil” would be my dormant mental health issues.  

Growing up in an upper-class family in Des Moines, Iowa, mental health was an afterthought — sandwiched in between tennis matches, gawky Homecoming dance photos, and college football Saturdays. While I struggled with perfectionism (presaging a later struggle with OCD), my mother glossed over my mental rigidity.  

“You just have high standards, Matthew,” she soothingly reassured to me and — perhaps — herself.

See no evil, hear no evil, and speak no evil. And, honestly, I understand and empathize with my beloved mother.

You see — talking about mental health is uncomfortable. I finally disclosed my mental health struggles — the tormenting thoughts, the depressive malaise — to my parents while in college. Stammering and stumbling, the conversation resembled Rick Perry during his ill-fated 2011 debate. And just like the esteemed Perry, it was tempting to mutter “oops” after my fumbling self-disclosure.

Like many self-conscious teenagers, I sought parental affirmation. How would they react? Would they openly acknowledge my mental health struggles or distance themselves in stony silence?

The answer: a steely acceptance. While my mother could not understand my mind’s tumult, she — the ever-pragmatic matriarch — discussed testing accommodations and counseling appointments. My father, more laconic than loquacious, acknowledged OCD’s biological component. More than expecting my parents to fully understand OCD’s stranglehold on my synapses, however, I appreciated their acknowledgement.

Although my parents will never be confidantes in chief, their (relatively) non-judgmental response strengthened my resolve. Instead of lamenting my mental health misfortune, I now chalk up OCD/depression to a biological oddity. And believe it.

I am lucky. Some mental health consumers suffer in tortured silence for years — even decades. Fearing derision or ostracization, they swallow the tongues — and their self-worth.

While somewhat understandable (who really wants to acknowledge depression’s vice-grip?), silence is deadly. It isolates, fueling additional avoidance strategies. You hope — even beseeching to a merciful God– for a reprieve from the all-consuming thoughts and feelings. The sad irony: By seeking an escape, you further confine yourself, shackling yourself to an invisible, unbearable tormentor.

When depression’s blue wave crests or OCD’s compulsions batter, it is critical to have a support system in place. And it starts with your parents — but it doesn’t end there. If you are apprehensive about disclosing mental health struggles to the parentals, there are other resources: school counselors, help lines, NAMI (National Alliance on Mental Illness) staffers.   

The temptation to retreat into a self-indulgent cocoon is real. I have been there, staring helplessly at the bedroom ceiling. At 11:30 AM. And, truthfully, crawling under the covers continues to tempt (see yesterday). But, in reality, the covers are a figurative metaphor, blanketing you from self-help.

Regarding your mental health, you can run (even to your bedroom), but you cannot hide. And unlike you, the depressive/obsessive thoughts don’t have a curfew; they can and do appear at any times. And, sadly, they don’t care if you aced your latest homework assignment, mowed the lawn, or helped Granny Smith with her groceries.

You know who does care? Your support system. Even if that conversation is more uncomfortable than those dated Homecoming photos.

Hi. This is a complex issue. But essentially my husband’s family recently learned that his younger brother suffered sexual abuse from a family member 10 years ago. I was in this family 10 years ago (though not married yet), but when they met to discuss the issue, they excluded me. My husband flew across the country to learn the bad news in person, and I had to stay here waiting to hear over the phone…

I care about these people, but I feel as though my feelings are being completely invalidated. I have known this brother since this incident happened. At minimum, I’d have liked to have been there to support my husband when he heard this news. Maybe I don’t understand my place? I am a firm believer that survivors of sexual abuse should only tell whomever they want, on their own terms, when they want, etc. But I definitely feel a little bit down about not being included when the ENTIRE family heard. And they basically told my husband “you can tell her…if you want”. We are going on a family trip next month, and I honestly don’t even know how to act. Of course my husband told me, which I guess they were ok with, but now what? Am I supposed to act like I really don’t care? Did I not get included because they think it doesn’t effect me? Even if it didn’t, it effects my husband, and I don’t even know how to be supportive at this point. And its his mother that said I shouldn’t come, not even the brother. Feeling very lost. (From the USA)

A: My best guess is that the family was deeply embarrassed. During these times people make decisions that grow out of shame and insecurity rather than out of good judgment.

I believe the correction is reaching out to your brother-in-law. As long as your brother-in-law knows that your husband has told you, and that it wasn’t meant to be kept from you by him, then you reaching out directly to lend your support short-circuits the dynamic of feeling left out.

I would also encourage you and your husband to talk about this. The main dilemma here is that your husband honored his family over you. I believe it is you when your husband that need to talk more about you not being included. As his wife, the separation from this process should’ve been something the two of you discussed prior to his going. But now it will be essential as an effort to heal your exclusion from the process — and work toward integration in the future.

Wishing you patience and peace,
Dr. Dan
Proof Positive Blog @ PsychCentral

In this video, Gabe Howard answers the question “is depression physically painful?” He also invites you to share your thoughts in the comments sections below.

General Transcript “Is Depression Physically Painful?” Video

4 Things That Hurt Your Thinking & Keep You StuckMy name is Gabe Howard and I’m here today to talk about the physical symptoms of depression.

People are surprised to learn – and in fairness I often forget – that depression is physically painful. I’m not speaking in analogies, either. Depression literally hurts.

Anyone who has experienced depression already understands this, but for the rest of you, I will explain.

Emotions – all emotions – have physical sensations. Folks experiencing joy often laugh and the term “belly laugh” isn’t just something people say; it’s a literal description. People experiencing extreme sadness often cry. Finally, being nervous can lead to butterflies taking up residence in your stomach.

Depression is serious and, unlike the common mythology, it’s far from all in someone’s head. During a depressive episode, a person’s body becomes heavy and movement very difficult. I’ve described it as running in concrete shoes, except no one can see the shoes.

Aside from extreme lethargy, other side effects of depression can include insomnia or excess sleeping. Both are equally disruptive to a person’s physical health. Depression’s primary symptom slows down peoples’ thinking and makes them believe they are worthless. Those in this state often make poor decisions when it comes to eating, hygiene, and general self-care.

While not technically a symptom of depression, attempting to exist on a diet of cupcakes, chips, and soda isn’t a healthy choice and carries with it unpleasant physical consequences.

For a moment, ignore all the examples above and consider this: Depression makes a person feel alone and worthless. In many cases it, causes someone to consider that suicide is a reasonable decision.

That kind of emotional turmoil doesn’t just exist inside a person’s mind. It radiates through the entire body. I, personally, have been awake for over 48 hours crying, lying in my own sweat and drool, and literally dripping snot all over myself.

With my throat sore, my head pounding, and my vision blurry, I’ve cried out for people who never answered and have experienced emotional trauma so devastating that it can no longer be described as a feeling, but as a lack of feeling altogether.

To think that kind of mental anguish doesn’t have a physical consequence isn’t reasonable. Depression is an entire body disorder and it’s far from all in someone’s head.

Disclaimer: Mr. Howard is the host of The Psych Central Show podcast but not a medical professional. Any information provided is for informational purposes only and is not intended to treat, diagnose, cure or prevent any disease. The Psych Central Show can be found at

For Many Couples, Coke vs Pepsi Can Impact Relationship

New research suggests that when partners prefer different consumer brands — say you prefer Diet Coke and your partner likes Diet Pepsi — relationship quality may be impacted.

In fact, Duke University investigators believe preferring different brands can affect our happiness in relationships more than shared interests or personality traits.

“People think compatibility in relationships comes from having similar backgrounds, religion, or education,” said Dr. Gavan Fitzsimons, a marketing professor at Duke University’s Fuqua School of Business. “But we find those things don’t explain how happy you are in life nearly as much as this notion of brand compatibility.”

The findings appear in the Journal of Consumer Research.

Fitzsimons worked with Fuqua colleagues Drs. Tanya Chartrand and Grainne Fitzsimons, plus lead author and former Fuqua Ph.D. student Danielle Brick, now at the University of New Hampshire.

The researchers found that partners who had low power in their relationships — those who don’t feel they can shape their partner’s behavior — tend to find themselves stuck with their partner’s preferred brands.

“If you are lower in relationship power and have different brand preferences than your partner, you’re probably going to find yourself stuck with your partner’s favorite brands, over and over again. This could lead to a death-by-a-thousand-cuts feeling,” Brick said.

“Most couples won’t break up over brand incompatibility, but it leads to the low power partner becoming less and less happy.”

The investigators discovered different settings and products produced the same result. For example, researchers used brand preferences in soda, coffee, chocolate, beer, and automobiles to study individuals and couples, some of whom were tracked over two years.

These results were combined with findings on relationship power and happiness. “It’s an extremely robust effect, we found it over and over and over again,” Fitzsimons said.

Brick said it’s likely these brand compatibility effects have steadily gained strength as brands have evolved to play a bigger role in the daily lives of consumers. However, in the past, agreement on brands were not given the same weight as other relationship-influencing factors because they’re not seen as significant.

“If you are a different religion than your romantic partner, you know that if this is an issue you can’t work through, then the relationship isn’t going to last,” Brick said.

“Conversely, if you like Coke and your partner likes Pepsi, you’re probably not going to break up over it — but 11 years into a relationship, when he or she keeps coming home with Pepsi, day in and day out, it might start to cause a little conflict. And if you’re the low-power person in the relationship, who continually loses out on brands and is stuck with your partner’s preferences, you are going to be less happy.”

The results have implications for individuals and firms.

“People who are looking for love should maybe consider including brand preferences on their dating profiles,” Fitzsimons said.

“There’s also an opportunity for marketers to seek to be the family brand. Even if two partners have slightly different brand preferences, if they can adopt a joint brand that both are happy about, that might increase happiness for a partner who would otherwise feel unsatisfied.”

Fitzsimons said that family branding isn’t currently commonplace.

“Some brands are marketed as family-oriented, but that’s not the same as reaching out to everyone in the family,” he said.

“It’s tricky, but firms that get it right can have their brand associated with happiness and harmony — and there’s nothing better than that.”

Source: Duke University

If DBT hasn’t helped like it was supposed to, is it because I have done something wrong or is it just not for me? I have really tried to put all I learned into practice and I don’t find it helpful. I feel like I have failed? Is it possible that it doesn’t work for everyone?

A. Not all treatments, even evidence-based ones, work for everyone. I do not know why DBT did not work for you. Many factors are involved in whether or not a treatment works. For instance, how long have you tried it? Maybe the therapist is not implementing the treatment correctly or it might not be the right treatment for you. You feel that it has “failed” but you could be misinterpreting the results.

I could list 10 or 20 more possibilities, but they would all be guesses because I do not have enough information to answer your question.

Discuss this with your therapist. Get their opinion. Maybe there are easy corrections that would help.

Another option is to get a second opinion. You could try a new therapist or another type of treatment. Success in psychotherapy often depends upon the quality of the therapist and their ability to effectively reach their clients. Not all therapists are created equal. Some are better than others.

More exploration is needed to determine what the problem might be. You need to gather more information before determining your next move. A new therapist or a new treatment might be the answer but currently you do not have enough information to know. Start with your therapist, gather more information about the potential problem and then decide your next steps. Good luck.

Dr. Kristina Randle

As summer winds down and returning to school becomes an unavoidable reality, many teenagers are experiencing a rush of varied emotions. Some teens enjoy school and are eager to trade their dull summer jobs for daily intellectual enrichment. Others find school intolerable and wish that the steamy summer months would carry on forever. A third set sees the first day of school as a landmark of dread and anxiety and spend most of August worrying about whether they’ll get along with their new teachers, whether they’ll be able to keep their grades up, and whether they’ll be able to continue navigating the at times treacherous waters of adolescent sociality.

When Butterflies Turn into Something More

A certain amount of school-related trepidation is normal — especially if a teenager has recently moved or is starting middle or high school — but where is the line between “a case of the butterflies” and serious clinical anxiety? The National Institute of Mental Health reports that 25% of 13- to 18-year-olds struggle with some sort of anxiety disorder at some point during their adolescence.

Not all of these cases are directly related to school, but educational environments play such a dominant role in young people’s intellectual, emotional, and social development that incidents at or related to school often underlie many adolescents’ mental health struggles. In the initial weeks of the school year, teens’ most imposing anxieties tend to be social. The average teenager’s self-image is substantially influenced by how she is perceived by her peers, and concerns about one’s place in social hierarchies tend to rise to the surface each fall. Once school gets underway in earnest, the pressure of this outward-looking self-definition is compounded by academic stressors, as teens must juggle the expectations not only of their peers but of their parents and teachers as well.

In extreme cases — occurring in roughly 2% to 5% of school-aged children — parents may encounter anxiety-based school refusal, wherein their child has an extraordinarily difficult time going to or remaining at school. School refusal is often characterized by psychosomatic symptoms including headaches, stomachaches, nausea, or diarrhea that dissipate once a student is allowed to skip school for the day or return home from school early. Though these issues can, on occasion, be fabricated, they are typically legitimate physical manifestations of severe psychological stress. In many cases, children who engage in school refusal will benefit from a small dosage of non-addictive anti-anxiety medication, something that their pediatrician should be able to prescribe.

The more proactive parents — and cooperative teens themselves — are about investigating and getting treatment for anxiety issues, the better, as school avoidance often becomes something of a self-fulfilling prophecy. When a teen feels panicked about school, her instinct is to avoid attending school, but while this may ease short-term anxieties, it also inculcates an ever-increasing fear of school by lending credence to the idea that school should be feared in the first place. Ultimately, the longer a teen is left to struggle with her anxiety alone, the harder it is to achieve a quick and durable recovery.

Even if a teenager’s issues don’t manifest as a full-on refusal to attend school, she may still be dealing with an anxiety disorder that would benefit from formal intervention. If a teen’s school-related anxiety becomes increasingly frequent and intense, if it doesn’t subside a month or so into the school year, or if it begins to interfere with her eating and sleeping, her parents should strongly consider soliciting professional help.

How to Help Your Teen Cope with Anxiety

There are a number of things that parents and teens can work on that help stabilize teens’ school-related anxieties. For one, taking care of daily “essentials” is absolutely critical. It’s difficult to cope — with anything, much less anxiety — when one is tired or hungry, so parents need to make sure that their children are getting enough sleep and eating regularly and healthily. Though most teens have probably outgrown a formal bedtime, it doesn’t hurt for parents to emphasize the importance of a consistent routine — both with respect to sleeping and eating — in maintaining one’s health, both physical and mental.

Further, parents should take steps to acclimate their anxiety-prone teen prior to the start of the school year. Pre-exposure to new environments and situations can go a long way toward helping teens establish a baseline amount of comfort with and control of their daily lives. This might entail walking the halls of a teen’s school before the academic year begins, arranging meetings with their teachers in order to get a head start on relationship-building, or anything else that amounts to a pre-orientation, of sorts. Though it may seem unusual — and is probably more appropriate among the younger set — this acclimatization can even extend to a parent riding the bus or accompanying a student to school during the first week in order to facilitate as smooth a transition as possible.

In short, parents with struggling teens should make every effort to make themselves available to their children in whatever capacity possible. As mentioned above, general nervousness at the start of the school year is normal, and parents should feel free to say as much to their children. Talking with a teen about their worries and fears is a great way to assess whether what they’re experiencing is just the normal ups-and-downs of adolescence or something more serious.

If monitoring your child closely or talking candidly with her leads you to believe that she is struggling with a serious anxiety disorder, it’s time to bring a professional into the picture. Fortunately, if you believe that your child is dealing with anxiety, you’re not alone. There are as many treatment options available as there are sources of school-related anxiety, and an initial consultation with a mental health professional will help you and your child figure out what’s best for your family.

Regardless of the treatment plan you choose, what’s most important is that you remain supportive of your teen, especially during challenging times like the start of the school year. Nobody expects parents to precisely diagnose what is wrong when their child suffers a lapse in mental health, only to notice that something is wrong. Doing so is not always easy, but with a bit of vigilance and a serious effort to maintain open and frank communication with your child, it’s certainly possible.

Study Finds Work is Intense and Emotionally Exhausting for Most US Workers

New research confirms what many Americans already know – that their jobs are hard and draining, and it is difficult to separate work from home.

The new study finds that workers frequently face unstable work schedules, unpleasant and potentially hazardous working conditions, and an often hostile social environment.

The findings stem from research conducted by investigators at the RAND Corporation, Harvard Medical School and UCLA. Investigators analyzed responses from the American Working Conditions Survey, one of the most in-depth surveys ever done to examine conditions in the American workplace.

Remarkably, more than one in four American workers say they have too little time to do their job, with the complaint being most common among white-collar workers.

In addition, workers say the intensity of work frequently spills over into their personal lives, with about one-half of people reporting that they perform some work in their free time in order to meet workplace demands.

Despite these challenges, American workers appear to have a certain degree of autonomy on the job, most feel confident about their skill set and many do report that they receive social support while on the job.

“I was surprised how taxing the workplace appears to be, both for less-educated and for more-educated workers,” said lead author Dr. Nicole Maestas, an associate professor at Harvard Medical School and an adjunct economist at RAND.

“Work is taxing at the office and it’s taxing when it spills out of the workplace into people’s family lives.”

Researchers say that while 8 in 10 American workers report having steady and predictable work throughout the year, just 54 percent report working the same number of hours on a day-to-day basis.

One in three workers say they have no control over their schedule. Despite much public attention focused on the growth of telecommuting, 78 percent of workers report they must be present at their workplace during regular business hours.

Nearly three-fourths of American workers report either intense or repetitive physical exertion on the job at least a quarter of the time. While workers without a college education report greater physical demands, many college-educated and older workers are affected as well.

Emotional stress and challenges to mental health are a relatively common experience at the worksite. Researchers discovered more than half of Americans report exposure to unpleasant and potentially hazardous social environments.

Nearly one in five workers — a “disturbingly high” fraction, researchers said — say they face a hostile or threatening social environment at work. Younger and prime-aged women are the workers most likely to experience unwanted sexual attention, while younger men are more likely to experience verbal abuse.

The findings are from a survey of 3,066 adults who participate in the RAND American Life Panel, a nationally representative, computer-based sample of people from across the United States. The workplace survey was fielded in 2015 to collect detailed information across a broad range of working conditions in the American workplace, as well as details about workers and job characteristics.

Despite the importance of the workplace to most Americans, researchers say there is relatively little publicly available information about the characteristics of American jobs today.

The American Working Conditions survey is designed to be harmonious with the European Working Conditions Survey, which has been conducted periodically over the last 25 years among workers from a broad range of European nations.

The American Working Conditions Survey found that while many American workers adjust their personal lives to accommodate work matters, about one-third of workers say they are unable to adjust their work schedules to accommodate personal matters.

In general, women are more likely than men to report difficulty arranging for time off during work hours to take care of personal or family matters.

Jobs interfere with family and social commitments outside of work, particularly for younger workers who don’t have a college degree. More than one in four reports a poor fit between their work hours and their social and family commitments.

The report also provides insights about how preferences change among workers as they become older.

Older workers are more likely to value the ability to control how they do their work and setting the pace of their work, as well as less physically demanding jobs. Older workers are also generally less likely than younger workers to have some degree of mismatch between their desired and actual working conditions.

The survey also confirms that retirement is often a fluid concept. Many older workers say they have previously retired before rejoining the workforce, and many people aged 50 and older who are not employed say they would consider rejoining the workforce if conditions were right.

Other highlights from the report include:

• The intensity of work such as pace, deadlines and time constraints differ across occupation groups, with white-collar workers experiencing greater work intensity than blue-collar workers.
• Jobs in the U.S. feature a mix of monotonous tasks and autonomous problem solving. While 62 percent of workers say they face monotonous tasks, more than 80 percent report that their jobs involve “solving unforeseen problems” and “applying own ideas.”
• The workplace is an important source of professional and social support, with more than one half of American workers describing their boss as supportive and that they have very good friends at work.
• Only 38 percent of workers say their job offers good prospects for advancement. All workers — regardless of education — become less optimistic about career advancement as they become older.
• Four out of five American workers report that their job provides “meaning” always or most of the time. Older college-educated men were those most likely to report at least one dimension of meaningful work.
• Nearly two-thirds of workers experience some degree of mismatch between their desired and actual working conditions, with the number rising to nearly three-quarters when job benefits are taken into account. Nearly half of workers report working more than their preferred number of hours per week, while some 20 percent report working fewer than their preferred number of hours.

Future reports will explore how conditions of the American workplace compare to those in Europe and in other parts of the world and selected findings from follow-up surveys using the same panel of participants.

Source: RAND Corporation