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Monday, December 10, 2012

Baby Steps: Recovering From Bipolar Relapse

By Courtney Rundell

Courtney Rundell

After a three-year remission from bipolar 1 disorder, I gave birth to my son and almost immediately fell into a full bipolar relapse. My baby is 15 months old now and my mental recovery has been painfully slow. I assumed that the combination of time, therapy, and meds would bring me back to stability by the baby’s first birthday.

Boy, was I wrong.

The remission blessed me with two very important traits: a low threshold for pain and an expectation for full recovery.

When I plummeted into yet another scary depressive episode while visiting family to celebrate my son’s first birthday, I finally hit bottom and got mad. That feeling used to scare me, but after seven years of therapy, I’ve learned that anger is actually a gift. It’s an emotional barometer to be paid attention to, felt, and processed.

Baby Step 1 – I made a list of recent triggers:

  1. Traveling.
  2. Out-of-town visitors.
  3. Confrontation.
  4. Over commitment.
  5. Overworking.
  6. Overspending.
  7. Overeating.
  8. Toxic relationships.
  9. Negative thinking.


Baby Step 2 – I decided to eliminate my triggers after discussing them with my therapist and husband. It seemed impossible, but the fear of the psych ward sure motivated me into complicity.

Baby Step 3 – Actually eliminate the triggers by taking contrary actions.

  1. Traveling: I say no.
  2. Out-of-town visitors: I say no.
  3. Confrontation: I turn the other cheek and try not to place my cheek in a position to be harmed in the first place.
  4. Over commitment: I let go of unnecessary commitments and say no to new ones.
  5. Overworking: Three of my four bookkeeping clients went away without me doing anything.
  6. Overspending: I’m not making emotional purchases.
  7. Overeating: I’m not engaging in emotional eating.
  8. Toxic relationships: I let go of my toxic relationships and am not starting any new ones.
  9. Negative thinking: If I don’t water it, it won’t grow, so I’ve stop watering my negative thoughts as quickly as possible.


Baby Step 4 – Nature abhors a vacuum. The first time I quit drinking I replaced it with nothing and subsequently had a nervous breakdown and relapsed. When I stopped drinking and replaced it with the 12-steps and meetings, I was given the gift of sobriety (at least for today, I make no assumptions for tomorrow).

  1. Traveling: I’m exploring my own neck of the woods.
  2. Out-of-town visitors: I’m loving my alone time at home.
  3. Confrontation: Instead of pointing the finger at you when the urge to be right comes up, I look within. If I know my truth, our disagreement is moot. I am never more wrong than when I need to be right.
  4. Over commitment: Relaxing more.
  5. Overworking: When my fear of financial insecurity comes in, I don’t act on it and I focus on ways to generate income from my writing and public speaking.
  6. Overspending: I’m finally addressing the financial mess I made in my postpartum mania and my compulsion to overspend. I’m listening to Dave Ramsey on YouTube and applying some 12-step program tools as well.
  7. Overeating: I’m using an iPhone app to count my calories and am living within a food budget. I’m going grocery shopping once a week so I won’t get caught without a meal and therefore overspend and overeat.
  8. Toxic relationships: I wrote an entire post on this process here.
  9. Negative thinking: I tend to really spin when I’m driving, which I do a lot, so I listen to spiritual teachers on YouTube (for free!). My personal favorite is Wayne Dyer just because he seems very sincere and his words really resonate with me.


These changes didn’t occur at the same time or of my own volition – they’ve been over the past three months. It’s like an allergy – once I’m balanced, I add things back in slowly; if I have an episode, that activity must be removed again.

Since eliminating these triggers, I’ve made it three weeks between episodes. This isn’t ideal, but it’s progress and therefore welcomed and celebrated.

This fight has been one of the hardest things I’ve been through in my life, but I’m grateful for my strong spirit, faith, and willingness to keep looking up. I’m quite certain that I will be balanced again – it may not be tomorrow – but it will come.


Posted by: Courtney Rundell at 6:13 pm

Thursday, September 13, 2012

Trying to Balance Dollars & Sense

By Courtney Rundell

Stressed Woman with Baby

After 8-months of being a stay-at-home mom, I went back to work part-time and put the baby in full-time daycare. While grateful for the luxury of staying at home, I found it to be detrimental to my mental health. This became glaringly obvious to me when collapsing on my bed and going fetal, my body vibrating and my brain buzzing, became a nightly routine.

My brain needed structure and I needed a break.

I truly believed returning to work would fix me. I painted a rosy picture of my idyllic days: I’d drop the baby off, work all morning, break for a delicious lunch, write all afternoon, mother all evening and fall asleep feeling productive, satisfied, and ready to tackle the next day.

Boy, did I get the math wrong. And the irony is that I’m a bookkeeper.

Instead, I allowed what should’ve been a simple adjustment to completely knock me off balance. I lost my footing and rapidly descended into a fear and shame spiral. Writing took the backburner, bookkeeping took all my energy, and my nightly routine didn’t change a bit .

Work wasn’t the magic elixir I was hoping it would be. I was unstable at home. I was unstable at work. It was just a different kind of unstable.

Wherever you go, there you are and where I went was to the land of hyperfocus — an intense form of mental concentration or visualization that focuses consciousness on a narrow subject.

When I climbed into my analytical brain already unbalanced, I became obsessed with analytics, spreadsheets, answers, research, numbers, and math, math, math. I found safety in numbers. My mental problems are complex and sometimes unsolvable. I have to live with unresolved problems, but in my work, there’s always an answer in black and white. There’s always a way to find the balance.

Of course, I didn’t realize I was out of balance until I had a major meltdown. Then I did what I do best, I made a list.

Courtney’s Priority List:

1. Baby.
2. Sobriety:

    • Three 12-step meetings a week.
    • Fellowship.
    • Speaking engagements.
    • Service work.

    3. The rest of the family:

      • Husband quality time.
      • Doggie’s needs.
      • Dishes, laundry, errands, bills, mail, minutiae.

      4. Therapy twice a week/once a week.
      5. Bookkeeping.
      6. Writing.
      7. Exercise twice a week.
      8. Social commitments.
      9. Me time.

        Next I made a calendar in Excel and plugged in these commitments according to priority, like a budget, only with time instead of money.

        I stared at the packed calendar in sheer disbelief and, although it was still a spreadsheet, it started to look more like a baseball bat. My heart started to race and I caught myself holding my breath.

        But then something magical happened.

        I reminded myself that I’m a work in progress. I’m not perfect. I’ll never be perfect. And I had forgotten the most important thing on my priority list.

        My Higher Power.

        I had forgotten to tap into the source that gives me strength and wants me to be my highest self. That small, quiet voice in my heart – not my head – that reminds me that my life isn’t about me. It’s about being of service and helping others. It’s about letting my light shine so others can shine too.

        When I put that universal ebb and flow in charge and let go of my self-imposed illusion of control, my priority list is replaced by intuition. I suddenly know what the next indicated action should be throughout the day without referring to lists, spreadsheets and the like.

        When I let my heart determine my priorities and schedule, I can breathe again. My shoulders release and my jaw relaxes. I feel the endless possibilities of this life, rather than the endless reasons I should fail.

        Does this mean I’m handling my life fantastically now? Nope. I’m overwhelmed a lot of the time. The baby just turned one and I’m still unbalanced. My blog posts have been sporadic at best. I still fall into hyperfocus and have a hard time getting out. I still collapse and tingle, but not every night.

        But I’m hopeful. Some days I take two steps forward and one step backward, but I make note of the progress. I work on accepting that I’m still recovering from relapse, but am hopeful that my illness will go into remission again.

        And I’m hopeful that the less I try to find the balance, it will end up finding me.

        Courtney Rundell is a freelance blogger for the International Bipolar Foundation and the North Hollywood Patch. She speaks all over California about thriving with alcoholism, bipolar, and PTSD. When Courtney was diagnosed bipolar in 2006, a life she never knew was possible began. She’s devoted to inspiring and sparking hope in others now that she’s finally a free woman. Her personal blog can be found at

        Photo: iStockphoto

        Posted by: Courtney Rundell at 10:32 am

        Tuesday, September 4, 2012

        Riding Out the Storm

        By Marybeth Smith

        Depressed Woman

        There are many ways in which people cope with their depressive cycles. Some seek therapy. Some increase meds. Then there are the lights, the exercise, and the diet changes.

        I’ve tried these things; numerous times, in fact. But nothing works better for me than tuning out the world and focusing on my own reality. The reality that there is no magic way to make the depression disappear. There is no way to completely avoid it. And there is absolutely no way to ignore it.

        Recently I’ve been cut off from the world. It happened slowly. At first it was just tuning out certain responsibilities, knowing I couldn’t carry them out and fearing failure. Then it grew into avoiding friends and family. And now I find myself hidden in my room, trying to pretend I’m okay while tuning out the rest of the world.

        I want to get back in the swing of things.

        I want to smile and laugh and have energy again.

        I want to not find myself annoyed with everyone.

        I want to feel pretty again.

        I want to enjoy the taste of food once more.

        I want to crave ice cream.

        I want to care about upcoming events.

        But I don’t right now.

        I can’t.

        I won’t.

        Soon though. Soon I’ll be back and better than before. It’s only a matter of time. Then the world will be my playground once again and my house will be clean and my kids will get played with and my husband will have my affection.


        How do you cope with depression? Do you find yourself cut off from all human contact? Or do you force yourself to get out there and make the best of what feels like the worst?

        Marybeth Smith was diagnosed with Bipolar II at age 26. Marybeth created the website in hopes of helping others understand what it’s like to suffer from mental illnesses. Marybeth is the author of the Amazon Kindle Best Seller and ABNA quarter-finalist, Fall Girl, and is currently working on the sequel while pursuing a degree in Child Psychology. Additionally, Marybeth designs websites, writes for bpHope Magazine and The International Bipolar Foundation, and serves as a board member for NAMI MI.

        Photo: Goodshot

        Posted by: WebMD Blogs at 1:00 am

        Monday, June 18, 2012

        My Happy Pill

        By Courtney Rundell

        Happy Pills

        I love the Zoloft commercial with the sad ball guy who’s tragically lost his bounce. Even if he had the energy to play with the cute bluebird vying for his attention, the persistent rain cloud over his head would ruin all the fun.

        Then he takes a pill.

        Next time we see him, he’s smiling. He has his bounce back. He not only notices Mr. Bluebird, but they are downright chillin’ together. And that annoying raincloud? Totally turned into white fluffy clouds of love.

        For years, I bought the idea of a happy pill – all I’d need to get to “happily ever after” was a prescription.

        Boy was I wrong.

        While medication might be the bright orange water wings that keep me from drowning, just as with any floatation device, it only helps keep my head above water. If I don’t move my arms or kick my feet, I’ll only keep floating in the deep, wondering why I’m not getting anywhere.

        Just holding onto an inflatable isn’t good enough; I need to swim.

        Enter my lovely therapist. If my psychiatrist is Prince Charming, she’s my Fairy Godmother. It took me a few tries to find her as well, but the trial and error was well worth it. I went to therapy twice a week for 2 years and yes, it was expensive. I sold my record collection and clothes and begged my in-laws for money. In the end, my sanity was worth more than my stuff or my ego.

        It’s been a good investment. By doing the work, I’ve become aware of and subsequently eliminated many triggers and self-destructive habits that were pushing me back toward the deep waters. Toxic relationships and codependency are still big stumbling blocks for me. I’m not perfect, nor will I ever be, but I am becoming more and more aware of circumstances that can take me down, medicated or not.

        Granted, not every bipolar person spent his or her formative years with an abusive sociopathic alcoholic father. I did. I needed more therapy than the average person. And though we all come from our own set of circumstances, I’d venture to guess that most people struggling with mental illness would probably benefit from some good therapy.

        Of course, in fairness to our cartoon ball guy, I’ll admit that there’s no way I could have made the progress I’ve made in therapy without the cushion of medication. When I’m chemically balanced we dig deeper; when I start to get out of balance we pull back. It’s like dancing or walking a tightrope – under close supervision.

        The other equally important part of my recovery is keeping my addiction issues at bay. I’m a recovering alcoholic and drug addict and have been sober for 13 years. I had to stop drinking and using before I could be diagnosed properly, find the right medication, or get any benefits from therapy.

        I use the 12 steps to stay sober, but there are many other ways to arrest addiction. It doesn’t matter which path I take, I just need to remember that I can’t recover from my mental illness if I’m drinking or using drugs. The 12 steps and meetings have given me a fellowship, a spiritual set of principles to live by and a higher power that gives me strength when times are tough.

        With my situation, regular therapy sessions and my 12-step program continue to be as important as medication. For others, it may be church, support groups, exercise, diet, writing, singing, dancing or any other healthy, self-esteem building outlet.

        I’d like to make my own Zoloft commercial. The beginning would be the same, but after he takes the pill, he has night sweats and binges on carbohydrates. He may have lost the rain cloud, but he’s gained fifteen pounds. The chubby ball then trudges to therapy, noticing the happy birds but not yet singing with them, sleeps for 12 hours, downs a cup of coffee and bounces off to his support group. He keeps up this routine for several months, after which he turns to the camera and slowly smiles.

        Somehow I don’t think my version would fit into a one-minute time slot.

        Courtney Rundell is a freelance blogger for the International Bipolar Foundation and the North Hollywood Patch. She speaks all over California about thriving with alcoholism, bipolar, and PTSD. When Courtney was diagnosed bipolar in 2006, a life she never knew was possible began. She’s devoted to inspiring and sparking hope in others now that she’s finally a free woman. Her personal blog can be found at

        Photo: Creatas

        Posted by: WebMD Blogs at 10:13 am

        Thursday, May 17, 2012

        Frog-hopping: My Journey to the Right Psychiatrist

        By Courtney Rundell

        Frog Prince

        We’ve been together for a little over 6 years – the best years of my life. He’s intelligent, kind and compassionate. He’s a great listener. He knows me, my past, my dreams, my strengths, my weaknesses. He’s always there for me.

        No, he’s not my boyfriend. He’s my psychiatrist.

        Our relationship is one of the most important in my life. He’s saved my life countless times – I actually don’t think I’d be on this planet if it weren’t for him.

        Finding the Prince Charming of psychiatrists wasn’t an easy task. It took 6 years, three frogs and two misdiagnoses, but I finally was lucky enough to stumble upon him.

        Once upon a time…

        Frog #1 diagnosed me with panic disorder and prescribed Celexa. After 6 weeks, my already intolerable anxiety was worse. So, he directed me to stop taking Celexa and to start taking tranquilizers every day, knowing full well I’d been sober over 2 years.

        He didn’t offer another antidepressant, therapy or any other solution beside tranquilizers.

        I left his office convinced that they were all the same. They’d all just want me to shut up and take whatever they threw my way. They were the boss, not me. I had no say in our relationship – it was patriarchal. I was just another girl.

        Frog #2 diagnosed me with panic disorder and prescribed Lexipro which made my mouth taste like metal, so she switched me to Paxil which wrecked me, so she switched me to Zoloft which worked.

        I saw her for 2 years. She was extremely cold, rarely spoke and took copious notes. The only phone number I was given was the appointment line, so we only spoke in sessions.

        I left that relationship thinking that was as good as it gets – icy, clinical, lacking any new insights into my internal life. I would never feel warmth or compassion. I would never be understood.

        The One Who Got Away was the staff psychiatrist at Northern Nevada Adult Mental Health Services. I was visiting my mother in Reno – 500 miles from home – when I was hospitalized.

        He diagnosed me with bipolar 2 disorder and PTSD. Ends up, contrary to the beliefs of Frogs 1 and 2, I never even had panic disorder.

        After a long talk, he handed me two prescriptions – one for Lithium and Zoloft and the second for “therapy and 12-step meetings once I got back to LA.” He wrote the second as a prescription to emphasize the importance of not only medication, but treatment as well.

        I finally met the perfect match and I couldn’t have him. He was already taken and long distance relationships never worked. What a cruel trick the universe played on me!

        Frog #3 did his own scheduling. He didn’t have a waiting room so I sat in the hallway outside his office. When he managed to remember our appointments, I was in his office no more than five minutes – just to get my refills. I spent more time outside his office than I did inside.

        The second time he stood me up, I was done. I’d met a prince before, so I had a little spark of faith that he was out there, but it was most certainly not this one. I had enough self-respect to know that we both needed to show up for the relationship.

        … and then I found my Prince.

        He’s never been late or canceled an appointment. He has a waiting area and an assistant who does his scheduling. He changed my diagnosis from bipolar 1 to 2 after learning more about my cycles and affirmed that PTSD was causing my panic attacks. We did therapy for the first few years. I graduated to med checks, but I’m still in his office at least 20 minutes.

        We have conversations. I never feel like I’m being observed. He takes notes after our session is over.

        He’s always up on new research and treatment options. He never overmedicates and respects my sobriety. He’s open minded, experienced and human.

        He’s walked me through a miscarriage, a pregnancy, suicidal depressions, postpartum OCD and mania and everywhere in between.

        …and we lived happily ever after. The End.

        The moral of my story can be best expressed with clichés:

        1.      If at first you don’t succeed, try and try again.

        2.      You have to kiss a lot of frogs before you find your prince.

        3.      Rome wasn’t built in a day.

        Courtney Rundell is a freelance blogger for the International Bipolar Foundation and the North Hollywood Patch. She speaks all over California about thriving with alcoholism, bipolar, and PTSD. When Courtney was diagnosed bipolar in 2006, a life she never knew was possible began. She’s devoted to inspiring and sparking hope in others now that she’s finally a free woman. Her personal blog can be found at

        Photo: iStockphoto

        Posted by: WebMD Blogs at 12:26 pm

        Friday, May 11, 2012

        Mood Swings of a Bipolar Friendship

        By Marybeth Smith

        Marybeth Smith

        Marybeth Smith was diagnosed with Bipolar II at age 26. Marybeth created the website in hopes of helping others understand what it’s like to suffer from mental illnesses. Marybeth is the author of the Amazon Kindle Best Seller and ABNA quarter-finalist, Fall Girl, and is currently working on the sequel while pursuing a degree in Child Psychology. Additionally, Marybeth designs websites, writes for bpHope Magazine and The International Bipolar Foundation, and serves as a board member for NAMI MI.

        There are people in this world who meet their best friend in Kindergarten and are friends forever. Others meet in high school. Some in college. They meet, they click, and the friendship grows, making the term ‘BFF’ an actual thing.

        Best Friends Forever.

        They exist.

        Not so much in my life.

        I met my best friend in Kindergarten. Then I switched schools. The same happened in first grade, and then I went best friendless until the seventh grade. We went to different high schools, and then she went to college. We stayed in touch, but grew apart.

        And then … there were the high school BFF’s.

        The symptoms of my illness really came to life in high school. Thus my friendships began to take a bit of a bipolar curve of their own. I’d get depressed and suddenly I was like a magnet with the opposite charge … everyone cleared the area and kept clear until I surfaced. Then I’d switch to a little hypomania and suddenly everyone was my friend. I was funny, I was entertaining, I was friendly, I was fun.

        Until I’d fall again.

        I’d crash.

        I’d turn into an irritable, depressing monster.

        Friends were lost, friends were made, and friends were lost again. Then new friends were made again. I was and am great at making friends … still, they pretty much all ended the same way. I’d get depressed and say or do stupid things and it’s goodbye friendship.

        I’d like to say this changed as I got older. I’d like to say it became easier to maintain friendships after my diagnosis. Unfortunately, it actually got a bit worse. There were friends I would stop being friends with and then start being friends with again about a year later only to go through the entire ordeal again.

        Now maybe these things happen to everyone. And then again, maybe it’s just a problem I have. But sometimes I wonder if it’s a problem that everyone who struggles with bipolar disorder experiences. Do you have a difficult time maintaining friendships? Do you think it has anything to do with your illness?

        Posted by: WebMD Blogs at 6:40 pm

        Friday, April 27, 2012

        A Standing Ovation for Sinead

        By Courtney Rundell

        Courtney Rundell

        Courtney Rundell is a freelance blogger for the International Bipolar Foundation and the North Hollywood Patch. She speaks all over California about thriving with alcoholism, bipolar, and PTSD.

        When Courtney was diagnosed bipolar in 2006, a life she never knew was possible began. She’s devoted to inspiring and sparking hope in others now that she’s finally a free woman.

        Her personal blog can be found at

        Sinead O’Connor’s recent decision to cancel her upcoming tour “due to bipolar disorder” took courage few know. While putting one’s career on hold due to cancer or Parkinson’s evokes worldwide sympathy, doing so because of mental illness shines a light on how much stigma still surrounds mental health issues.

        I know all too well the vulnerability it takes to admit defeat to mental illness. Six years ago, I was placed on a 72-hour hold in a locked down psychiatric unit and diagnosed with bipolar disorder.

        I was committed because I was overcommitted.

        Shortly after getting my Master’s Degree, I landed my first paying directing gig when I was in the darkest depression I’d ever experienced. I felt like my career was finally taking off so I took the job, banking on the hope that my old frenetic energy would return like Mighty Mouse and save the day.

        Normally, I could summon the energy. When I was a stage actress, I used it to memorize lines. When I was a student, I employed it to stay up all night studying for an exam. After my tasks were achieved, I hibernated. I’d literally sleep around the clock until I was able to function again. That was simply how I operated, so it didn’t seem peculiar to me.

        But this time was different – that energy was nowhere to be found. My depression grew darker and heavier until I was finally buried and crushed by my rapidly piling responsibilities. My only answer was suicide.

        Then I was in an ambulance and the gig was up.

        Being diagnosed bipolar was shocking, yet it made sense. I often felt like I had two different personalities – one manic, one depressive. My manic self would run around making promises that my depressive self couldn’t possibly fulfill. Then the shame of not coming through on the promises I’d made only pushed me deeper into depression, creating a vicious circle of darkness and disgrace.

        Knowing that I let down many people was beyond humiliating. A deep sense of vulnerability and rawness came with admitting that I was too sick to follow through with my commitments and my sickness only magnified the already negative situation.

        My world fell apart, and while I felt like everyone was pointing and laughing at me, I was by no means in the public eye. I can’t begin to imagine what Sinead’s feeling right now.

        Sinead O’Connor has lived a life that most people can’t imagine. She’s toured the world. She’s the first-ever priestess to be ordained. She’s given of herself and her celebrity to fight hunger and poverty. She’s a human rights advocate and has spoken out against AIDS/HIV stigma.

        And she’s mother to four children. That in itself is a feat unimaginable to me.

        Therefore, in lieu of judgment, might I suggest we applaud Sinead’s bravery? Applaud her immeasurable courage. Applaud her honesty. Applaud her humanness.

        We are not our accomplishments. Tours can be rescheduled, life cannot.

        Brava, Sinead. Brava.

        Posted by: Courtney Rundell at 2:59 pm

        Friday, February 3, 2012

        Ketamine: A New Treatment for Depression?

        By Sunny Aslam, MD

        Sunny Aslam, MD, is assistant professor of psychiatry at SUNY Upstate Medical University and Director of Education and Training at Hutchings Psychiatric Center, a recovery-oriented psychiatric hospital in Syracuse, NY. When he is not playing with his young daughter, he can be found at the Carrier Dome cheering on the Syracuse Orange.


        You may have heard recently that ketamine, an anesthetic medication, may be a promising treatment for depression. There have been no new drugs that treat depression in a unique way in decades, but ketamine works in a different way in the brain than traditional antidepressants.

        Ketamine blocks a chemical called glutamate in the brain, which is different from the action of many antidepressants. Most antidepressants work on the neurotransmitters, of which serotonin is the most well known. Ketamine can help put a patient to sleep for surgery or relieve a patient who is in pain by placing them in a kind of trance called ‘dissociative anesthesia’. For this reason, the drug can also be abused, helping those who wish to leave reality; the drug can also cause hallucinations similar to PCP.

        Small studies of 6-33 patients receiving low-dose ketamine have shown impressive results in reducing depression and suicidal thinking. One study showed improvements in depression within 40 minutes! Others showed improvement within hours to days, which is much shorter than the weeks to months traditional antidepressants or psychotherapy can take to have an effect. The effect lasted 7-10 days in some trials.

        Studies in animals have shown increases in hormones and neurotransmitters that promote growth of brain cells. This is similar to how traditional antidepressants are thought to work, but it appears to happen much more quickly with ketamine. Ketamine may activate areas of the brain that are slowed in depression by increasing blood flow and consumption of blood sugar.

        Larger, more rigorous studies are needed and are currently being conducted. One study hopes to compare ketamine with another anesthetic in 72 persons and should be completed later this year. Patients will be followed for up to 8 weeks.

        Although the research is preliminary, and abuse concerns are real, ketamine appears to have a bright future.

        Photo: Photodisc

        Posted by: WebMD Blogs at 2:34 pm

        Friday, October 14, 2011

        Myths of Psychotherapy: #2

        By Thomas L. Schwartz, MD

        Psychotherapy, talk therapy, and counseling are all terms used when treatment revolves around a patient talking to a therapist every week. This series of blogs aims to evaluate some common myths about getting therapy for one’s mental or emotional symptoms. The first post in this series addressed the purpose of psychotherapy.

        Myth: Talking about your issues is a psychological-only treatment in that it does not affect biological brain functioning.

        Reality: This may be partially true. Talking about things often calms one down and lets one see several points of view and options for corrective actions in the future.

        But psychotherapy is also a brain process. Talking things through likely strengthens the front part of the brain, making it stronger and better able to control the parts of the brain involved in drives and impulses (such as anger and sadness).

        Imagine a depression study in which half of the patients only get psychotherapy, and the other half only get an antidepressant medication. Both groups of patients would get their brains scanned. (Such a study was published in the Archives of General Psychiatry in 2001.) Guess what? Those whose depression got better had the same changes in brain functioning, regardless of whether they took the medication or just talked in therapy. So talking in psychotherapy does create biological changes, just like some medications do.

        Why is this important?  Some patients think psychotherapy is just talking and they want a more “biological” treatment that is studied and scientific.  Psychotherapy is both of these.

        Posted by: Thomas L. Schwartz, MD at 2:42 pm

        Monday, September 12, 2011

        How Does Psychotherapy Work, Part 1

        Most patients think that they sign up for psychotherapy and they go in and talk in order to “vent” their feelings. Others think they are going it to see a counselor (like a lawyer or financial advisor) who will tell them what to do and how to behave.

        Some of this is true. Venting your feelings or “getting it all out” in a safe environment may be helpful in cases of grief where a loved one has died, but I have also met patients who have had therapists where they have been venting every week for seven years… and they still aren’t better. So venting is part of the process in some cases. Some therapists will tell you what to do and how to behave, but this may not be a hallmark of a good therapist. Good therapists work with you in hopes that you see better ways to behave, interact, and function and act on those in your own way.

        Below are some concepts that govern certain types of psychotherapy. Yes, just like there are several types of medications that work in several different ways, there are different types and styles of psychotherapy:

        Analytical or psychodynamic therapy suggests that your past (your parents, your upbringing, your environment, your friends, and all of the good and bad things that ever happened to you) shapes who you are and dictates how you behave in the present. If you learn about yourself and your past then gain insight into your patterns and behaviors, you can learn to react differently in the future and your symptoms will gradually improve.

        Cognitive-behavioral psychotherapy (CBT) suggests that patients have developed automatic negative and self-defeating thoughts. CBT does not care if problems came from your parents or elsewhere but cares that in the ‘here and now’ that you are suffering as your automatic thoughts (for example: I always fail, I am never any good, everyone always abandons me) trigger negative emotions (sadness, anger, despondency) which you get stuck in and become depressed or anxious. CBT therapists teach skills and resiliency in regards to fighting through and counteracting these negative, automatic thoughts.

        There are likely 20 other forms of psychotherapy, each with their own underlying theory and process of reducing psychiatric symptoms.

        Finally, biologically-minded therapists think that psychotherapy may activate certain brain areas and deactivate others, thus lowering symptoms. Yes – talking to a therapist actually changes brain patterns and activity. My future blogs will look at some of these more closely.

        Posted by: Thomas L. Schwartz, MD at 1:58 pm