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Do you, a loved one or someone you know suffer from depression? If so, you are aware that depression can be tough to live with – tough to understand and tough to treat.

For many people, depression is not just a single “episode”, but a long-term, chronic disorder requiring long-term management. Research tends to be more focused on resolving the first episode, rather than maintaining good health and developing positive habits of self-care after the depression has resolved. Unfortunately, relapses are very common.

Episodes of depression can become a learned habit.  Habits are developed through repetition and become deeply ingrained. Resolving depression becomes more challenging when depressive habits have become part of a person’s personality.   The depressive thinking, helplessness, body sensations, energy loss and shut down becomes part of the behavioral ritual when a stressor hits making intervention more difficult.

As an Addictions Counselor and Behavior Therapist, I see this a lot in my practice in Chestnut Hill, Philadelphia and West Chester, Pa.  Many of my clients have struggled with addiction(s), chronic medical illness, early life trauma, and unexpected life events, which have challenged their resilience and ability to cope in a helpful way. At times, stressors have compounded over time and have outstretched the person’s ability to move forward.

Some self help groups and organizations which tend positive support include:

National Alliance on Mental Illness (NAMI)

Depression and Bipolar Support Alliance (DBSA)

Each group has a local Philadelphia and Tri-state presence with regular support meetings.

It is important to identify and understand the depressive pattern and to construct a plan to dismantle the behavior chain as promptly as possible as it gets tougher as additional episodes occur, and the pattern reinforces itself. Being able to “head off” depressive episodes in their early stages is important in minimizing their impact and ceasing their progression.

Early intervention is paramount; this includes identifying the warning signs of relapse.

Some early warning signs of depression relapse include:

–    Becoming more isolated and withdrawn; not responding to emails or phone calls,

–    enduring some loss; personal or professional,

–    moving or changing jobs,

–    suffering through some disappointment, or

–    stress at work or home.

It is at this point that many people drift from their treatment providers, losing confidence in their ability to make progress. Termination of treatment is usually done unilaterally, with little or no response to outreach.

Sometimes people with a long history of depression or several relapses may have to stay on medication for several years. Developing a strong collaborative relationship with a prevention-minded primary care physician is a key part of the treatment plan.  Improving and optimizing health status is a foundational part of developing resilience.  The body must be as healthy as possible for the brain and mind to heal. Sleep, nutrition, and exercise are all part of improving one’s health.

What helps?

The conditions of our lives are directly related to our health and sense of well-being. Creating conditions for our well-being and growth enhance self-esteem and satisfaction.

A few things that can help, include:

–    Seeking pleasurable emotions and sensations each day (through healthy means, of course!),

–    pursuing goals and activities that require full engagement,

–    doing things for other people,

–    being connected to good friends and a strong social support network, and

–    having a healthy partnership or marriage, affection, and physical intimacy.

Staying focused in the “here and now” rather than past, future, or other topics and places are what it means to be “mindful.”  Study after study has demonstrated that happiness and satisfaction come from the ability to “live in the moment” and “being in the moment” – Experiencing life in the moment versus living in the fiction and anxieties associated with thoughts of past and future.

To successfully prevent depression developing strength of focus and attention is most important.  Without mindfulness, there can be no treatment or progress for there is no presence in order to receive the help that is offered.

A brand New Year can be very exciting as it offers a clean slate and new possibilities with review of priorities.

Did you include putting yourself first in 2015? Are you a priority?

Human energy is the fuel that keeps us going and moves us towards our goals in life. Human energy, however, is not infinite.

Generating and managing our energy on and off the job is critical to sustaining our movement forward and interfacing with challenges as they present themselves. Being successful at work involves making many mini-decisions that add up and make or break it in terms of our health, well-being, and productivity.

To optimize your energy consider the following:

•    Delegate and share responsibilities at work.

•    Avoid confrontation with difficult colleagues.

•    Find an outlet for frustrations.

•    Be more assertive.

•    Take control over some aspect of the job.

•    Reward yourself for accomplishments.

•    Avoid drug use (alcohol, prescription drugs, nicotine, caffeine, over the counter medications.)

•    Find humor or absurdity in stressful situations.

•    Don’t take on more than you can cope with; know your limits

•    Organize the time to accomplish tasks.

•    Find colleagues you can talk to and process things that are going on.

•    Get plenty of sleep.

•    Practice good nutrition.

•    Find something good about the job each day.

Each of these tips offers an opportunity to formulate new healthy habits boosting attitude, motivation, productivity, and the self-esteem and confidence that most of us want.

Rule of thumb; the better we feel, the more we will want to do – Energy begets energy.

Successful people formulate a daily structure and habits within it supporting their personal and professional needs.  Their carefully crafted structure and habits serve as their winning formula sustaining them and continues to impact positive results.

Self-discipline is a valued friend supporting everything that they do keeping their goals front and center in work and life.

And, remember, no one gets to where they are going alone.

Today’s 24/7 almost, 365-day business world of increased demands; appears to have become the “new normal.” Changes one on top of the other often compound and go unnoticed in the name of getting what needs to be done, completed. Maintaining a competitive edge, secured employment and financial solvency is of primary importance for most professionals. There are risks associated with both keeping up and not keeping up with the high pace.

Human energy is not, however, without limits. Social Psychologist, Roy Baumeister  author of the book Willpower, likens behavioral control to a muscle that can fatigue if overused. He posits that exercising willpower, but also making decisions and choices and taking initiative takes energy – physical and mental. He notes that these active processes all seem to draw on the same well of energy. Our health status and strength of our immune system has significant bearing on our ability to exercise control of our behavior.

Bauermeister indicates that when willpower becomes depleted – glucose can revive it. Getting a good night’s sleep and eating healthy – protein- rich nutrient dense foods as fuel is important in preserving the constraint and focus needed to maintain willpower. Balance in lifestyle is paramount in maintaining and replenishing energy.

When the work environment becomes overwhelming with unmanageable workloads, absence of support and direction, lack of role clarity, ongoing job insecurity, and unpleasant  or poor working conditions, it is only a matter of time until a professional will become burned out and less effective. There will be a higher likelihood of a behavioral or health crisis.

Consider this hypothetical situation as an example:

Your Vice President of Information Technology who has a flawless track record of enterprise management begins to demonstrate angry outbursts and explosive behavior – While he has always been highly organized and focused, he becomes overly critical and controlling. His direct reports fear him and avoid interacting with him on projects and deliverables. He makes reactive, unilateral decisions, over -communicates and overworks.

His direct reports receive demanding emails in the late hours of the night and weekends – Some decide to leave. Recently, a key implementation was delayed due to miscommunication of time sensitive information and the loss of a key staff member. You consult with him, and he is defensive and deflects all accountability.

High functioning – high performing professionals often minimize their stress levels and the impact of their distress and or impairments on others in the work environment.   Their intelligence, focus, and determination while beneficial as high performers can in turn serve as liabilities, because their strengths can work against them. When it comes time to put on the brakes and downshift in order to regroup and get clear about how to move forward more productively, it becomes more difficult. Determination and drive can become obstacles as exhaustion sets in and health and behavioral control deteriorates.

The high performing IT executive that all of the sudden turns intense, controlling and angry is more than likely suffering from burn-out and moving into exhaustion. His work life balance is more than likely nonexistent, impacting his marriage and home life. Marital stress and constant fears about losing his job and having kids in college weigh on him heavily. Caught in a cycle of control, silently and unknowingly suffering underlying depression, he has become depleted of energy, exhausted and too afraid to stop because he may not be able to restart. He becomes highly impulsive and compulsive.

Chronic compounded stress over the long-term can result in vital exhaustion. Vital exhaustion (VE) is real and very serious. It is a syndrome of chronic psychological stress and burnout resulting from a breakdown in adaptation with:

–   Feelings of excessive fatigue and low energy

–   Increased irritability

–   Feelings of demoralization

Vital exhaustion is often due to ongoing overwork or problems at work that have not been able to be solved – And or the employee experiences a real or symbolic loss of his or her  life – control over one’s life and is completely overwhelmed and hopeless.

According to the American Heart Association, vital exhaustion can be an extreme threat to a person’s health because of a very high increase in the chance for sudden cardiac death. For these reasons, it has been suggested that VE is a state of mind that people arrive at when their resources for adapting to stress have broken down – Adaptation is key to survival.

By the time a person reaches the point of exhaustion; the situation has often taken on the velocity of a runaway train. A crisis will require stronger efforts to put the brakes on, and the stakes are higher – damages can result.

As experienced evaluators, we at Integrated Treatment Solutions know how delicate such situations can be. We know that the presenting issue is often only “the tip of the iceberg” and that no matter how thorough and productive an assessment may be it is only as good as what follows. Providing feedback, collaborating on treatment planning and focused implementation must happen to gain optimum results.

Debriefing and educating evaluation participants and the referring organization on findings and what they mean is essential to the process. Everyone involved needs help.

Where there is communication and commitment, there is always hope, possibilities and new choices.

A solutions – focused approach is necessary. Both the professional and his or her organization can benefit from the assessment process with each party’s best interest in mind.

Going back to our IT executive; he can receive the help he needs, including stress management, financial and or marital counseling and his depression treated. He can be offered career planning and establish short and long-term goals for himself – A sense of control and optimism restored.

A mutually accountable win-win can happen with a renewed sense of confidence and future plan of action.

Identifying risk factors and difficulties that can lead to problems in professional careers is important. Prevention always saves time, energy and resources. Being able to identify behavior changes in one’s self, staff, and colleagues helps prevent more serious problems from developing in the future, which can leave individuals, consumers and organizations vulnerable to risk and liability.

There are many factors that contribute to work stress. Some are adjustable and some not. However, problems don’t generally, “go-away” or change without intervention.

When feeling stressed and worn down, it can be confusing as to why. It is always important to step back and look at what might be going on a daily basis to identify contributing factors.  Tracking health habits, food, exercise and sleep, recreation, etc., for a short period can be helpful to be able to see what may be impacting stress levels, behavior and overall health.

Changing the perception of  stressors and releasing the need for control or reevaluating expectations of one’s self can also be helpful. This is a cognitive- behavioral skill which can make a big difference in perceiving an issue and dealing with it more constructively giving the person back control.

Looking at habits and mindset is a way of taking care of the internal conditions impacting health, well-being and behavior.

The outside environment, meaning the conditions under which we operate and function is of critical importance – People, physical space, processes, demands/ requirements, etc. We are deeply affected by the environmental conditions whether or not we are aware of it – They impact our thinking, emotions and behavior as we are wired to naturally adapt to meet environmental demands.

When outer conditions overwhelm a person’s ability to sustain the demands of the environment over a period of time, there is likely to be a crisis.

Professionals are usually smart, goal oriented, and skilled people and tend to push themselves. They may be more vulnerable to over-functioning and feeling highly responsible in the work they do.  This can put them at additional risk for stress and burnout potentially leading to health and behavioral problems as their ability to self- manage becomes more difficult.

Personal control is important for human beings to feel stable, focused and safe.

Less flexible personal traits and behavioral tendencies in combination with challenging workplace conditions can give rise to the development of misconduct and unprofessional behavior.

Over many years of counseling professionals dealing with occupational conflicts, behavioral challenges and impairments our clients have voiced some common workplace difficulties which have been tough for them to manage over the long term. However, with some willingness on part of the professional and his or her employer, concerns can be addressed and in many cases improvements can be made in the benefit of both parties. Much of the time improvements may include the fine-tuning of communication, revisiting expectations, guidelines and other accommodations without too much disturbance to work processes. The importance of boundaries is highlighted.

Something else we have learned is that many professionals have a hard time saying “no.”

This can be especially true of people in human service oriented roles, including healthcare, law and areas of consulting, where there is a focus on being helpful to others. Setting limits and boundaries becomes paramount in making healthy changes.

Professionals have also achieved their success through working hard and can be competitive (often self-competitive). It takes commitment to excellence to get to the top. After years of diligence and drive it can often be hard for professionals to establish the balance needed to maintain their health, energy and positive mindset. You can see how the inner and outer conditions start to inter-weave and make for difficulties as tension grows.

Neither the employer nor the professional employee is wrong or at fault. Macro and micro changes shape situations over time.  Changes can go unnoticed until crisis hits and there is an incident of sorts.

At the end of the day, everyone is just trying to move forward in the best way possible.

In working with professionals the effort to resolve problem issues, we have noted some themes concerning what they have found difficult in their respective work environments.

• Lack of communication between professional and his or her direct report.
• Responsibility without authority.
• Lack of control or input over pace of work.
• Frequent distractions (including too many meetings) – Not being able to finish work.
• Excessive workload demands – Never being able to be “caught up.”
• Ongoing difficulty with work – life balance.
• Combination of high-demands and decreased rewards.
• Unrealistic work expectations-Especially in light of a change in work processes.
• Inequitable work environments- Including oversight of a team member’s under-performance or misconduct.
• Rusting out – Low workload, lack of challenge or opportunities for growth, lack of intellectual engagement (opposite of “excessive”) – Underemployment.
• Negative mindset from “spinning one’s wheels” and lack of support and above noted issues.

Technology can be stressful, too. The expectation of immediate access of 24/7 devices can take its’ toll on the personal boundaries needed to be effective. Being constantly “plugged – in” can be like always being on alert and “on call” with little to no opportunity for release.

The bottom line is that most professionals need increased awareness and skills to be effective in today’s work world. Change is constant and rapid fire. Professionals need to reflect and reconsider how to navigate the new work landscape and to perhaps make new choices.

A thorough assessment of all the dimensions of functioning can help in planning for improvement.

At Integrated Treatment Solutions we help professionals focus on getting back to the basics of self –care, including moving away from over-functioning and operating out of fear.  We help professionals form a structured routine supporting their needs and performance requirements, along with training on skills to self- manage in order to navigate the work setting more effectively.

Self- management skills help professionals advocate for themselves, their teams and to collaborate with other colleagues in their organizations’ more effectively. They also help with coping with emotions and stress.

The ultimate goal is to provide greater awareness, confidence, balance and personal control in work and life.

The world of work has changed dramatically over the years due to macro shifts in the way business is conducted as well as micro shifts in terms of structure and process.  According to the National Institute for Occupational Safety and Health (NIOSH), problems at work are more strongly associated with health problems and complaints than any other life stressor – Even more so than financial difficulties and-or family problems. 25% of employees perceive their jobs as being the #1 stressor in their lives – 75% of employees believe that workers now have more on-the-job stresses and demands than they did a generation ago.

These statistics may come as no surprise to any of us in light of the challenges of today’s economy and business climate.  It is more important to be extra mindful of self-care and to attend to personal health as stressful job conditions and or lack of coping and self-management skills can lead to increased risk of injury and illness.

Flexibility and adaptation have become requisite skills for professionals to successfully navigate this new work terrain all while maintaining optimal performance. Just as in nature, “Adaptation is key to survival ” – Always.  Such requirements can be very challenging for most as change often happens so rapidly that there is not often ample time to understand and integrate.

Rapid – fire change has become the new normal.

The professional who is not as flexible with change or who does not have the behavioral skills to accommodate major shifts is at most risk for negative consequences. We often see professionals who are struggling (often unknowingly) with significant changes in their respective industries and or work processes.  Another group we see includes high performing “turn-around” or start-up executives and entrepreneurs who have been operating on over-drive for extended periods of time  and hit crisis when there is no longer an outlet for such energies. The stress can pile up and compound over the course of time leading to problems with health and or behavior.  Unmanaged  energy and behavior can escalate in the form of misplaced attempts at control in and outside of the workplace.

As a Behavior Therapist, I see this repeatedly in my counseling work with professionals (in my offices in Chestnut Hill, Philadelphia and West Chester, PA). Stress, fear and rigidity compounds over the course of time leading to confusion and negative consequences.

It is not uncommon for professionals to get into “behavioral ruts” and spiral downward with negative thinking, non-collaborative behavior, impulse control problems with alcohol, food and other self-defeating behaviors.   Problems tend to then migrate to relationships with spouses and children – The boundaries become blurred.  That’s how most professionals end up in my office.  Counseling is often mandated by the spouse in order to stay married.

In order to approach unprofessional behavior in a comprehensive, preventative and solutions focused manner it is critical to understand that accommodating change takes mental, emotional and physical energy.

People have different capacities when it comes to flexibility, skill and energy – Perhaps this is another form of diversity.

Professionals often need help in identifying the issues at hand, understanding them and developing new skills in order to make new choices. Life can get so busy that personal reflection and the possibility of new choices and creativity become less apparent.

In a nutshell, constant change often pulls on less flexible personality traits, taking energy, challenging tolerance and individual capacities. Understanding this behavioral equation and how the pieces come together is necessary to accurately appraise people and situations.  This is another conversation which we will have in future blog posts.

Occupational facts to consider about what constitutes a highly stressful job and what may become difficult for professionals as they move through constant change is the topic of the next Living Well Weekly Blog entry.

Tips and tools in the interest of remaining stress hardy in navigating the new occupational landscape will follow.

If you found this information helpful, feel free to forward it to a colleague or friend.

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