Demystifying Couples Therapy
There’s a stigma around couples therapy, we don’t end up having those conversations, and we can wind up feeling alone when, of course, that couldn’t be further from the truth. People associate it with divorce. However, most people who come to couples therapy are not getting divorced—they’re building a healthier relationship.
Q: What can you expect to get out of therapy as a couple? And what can’t you expect?
A lot of people come to therapy thinking that they’re going to change something about their partner. When you come to couples therapy, you have to be prepared to make changes yourself. You can’t change another person. But you can influence another person. And that’s why it’s important to know that if you make changes, you will instigate change in someone else. Meaning you can’t tell someone to change, but if you change your behavior, they will change in response to you.
We think: How can we get them to do something that we want? But really, the way we can do that is by helping them first. If you can do something in a way that helps them, you will get back something that helps you.
Q: How do you take the first step?
By the time a couple gets into an office, there’s often some resentment. And because of the resentment they don’t feel generous toward each other. They have to remember that they do love this person, and that the person isn’t acting in this way to harm them; the person is acting this way because they are also struggling. If you can look at it that way, you might have more compassion for your partner, because you’re not the only one who’s struggling in this relationship. When you have more compassion, you can carve out a place of generosity for the fact that your partner is struggling, too.
Your partner’s reality doesn’t cancel out your reality. Just because your partner sees the situation differently from how you see it, it doesn’t mean that that person is wrong or that you’re wrong. It just means there’s room for both. Sometimes people don’t want to take the first step because they think: I need you to see it this way. I need you to see it accurately. I need you to see it my way. It’s important for both people to listen to how the other person sees it, but that doesn’t mean they have to agree with it.
Q: When is going to couples therapy a good idea?
Sometimes there’s a concrete issue, like you don’t see eye to eye on something like money or how much time you spend with the other person’s family. Or you have different ideas about how you are raising the kids. You want to go before it gets to the point where you’re both backed into your corner and you can’t listen at all to the other person’s point of view. A good time to go is when you can say, “Hey, there have been a few times when we’ve gotten really agitated when we talk about this with each other. Maybe we need somebody else to help us learn how to have this conversation, because it’s a really sensitive topic for both of us, and it’s hard for us to hear each other.”
Q: How do you approach the idea of therapy if your partner is averse to it?
It’s very important not to make it sound like, “We’re going to therapy because you have problems.” Some people even say, “We’re going to therapy because I can’t handle what you’re doing.” Or “I can’t handle something about you.”
Try something along the lines of: “We’re going to therapy because I love you so much, and our relationship is so important to me, and it breaks my heart when we argue. I would really like to go talk to somebody so maybe we can get some help with that.”
Q: How do you go about finding the right therapist?
Word of mouth is a great way to find a couples therapist, but if you’re hesitant to do that, you can look on Psychology Today. Look at therapist profiles in your area and see which ones have an approach that feels comfortable to you. But really, you won’t know until you get into the room and you see what it’s like when all three of you are sitting there.
“It’s tricky, because there’s so much shame around couples therapy—even more than with individual therapy. People associate couples therapy with divorce. But in my experience, most people who come to couples therapy are not getting divorced—they’re building a healthier relationship. The people who end up getting divorced are often the people who never got help.”
It’s really important to know that couples therapy is hard work, but it’s also very rewarding. You’re very exposed in a way you aren’t in individual therapy. In individual therapy, you can present yourself the way you want to present yourself. In couples therapy, your therapist is going to see you and your partner and the way you two interact with each other. You can feel very vulnerable. And you should—that’s largely the point, to be real with each other.
After your first session, did you feel like the therapist heard both sides of what was happening? Did you feel like the therapist understood some of the ways you two interact? That’s a good way to assess initially.
(Also, take a look at my post about how to find the right therapist)
Q: What else can you expect from that first session?
You should feel that the therapist can hold both of your realities at the same time. You should also walk out knowing there’s a definite possibility that you have some flawed assumptions about your partner’s motives, and maybe some of those will come out in the first session. And that he or she has some flawed assumptions about yours. The therapist can help point out that maybe you were thinking that the reason your husband is never home for dinner on time is because he doesn’t want to be, or because his work is more important than you, or vice versa. But your assumptions are often wrong. A good therapist can help you learn something new—even in that first session—about the way your partner thinks and feels about you that isn’t as harmful or hurtful as you had imagined.
It’s always helpful for the therapist to reframe for people: “Hey, the reason that this or that might be happening is not because your partner doesn’t care about you. The whole reason that you’re both here is because you care about each other. If you didn’t care, nobody would be sitting in this room right now.”
Q: What kind of commitment is couples therapy, emotionally and timewise?
It depends on what’s going on and how long it’s been going on. That’s why people need to come in earlier, because if something is a relatively new issue between a couple, that can be resolved pretty quickly. If something has been going on for decades, it can’t be undone in four sessions. That might take a little bit longer.
The good news is that once you start seeing the underlying patterns, it changes most of your interactions. It won’t just change the one thing that you came in to talk about; it will change the way you see each other. You’ll see each other with more generosity and more compassion. You will take what your partner is doing less personally, and you will feel less injured by the other person’s behavior. That helps globally in the relationship. You don’t have to keep coming back every time you have a problem, because now you know more about each other in a way that helps you to resolve your own problems.
Q: How does couples therapy work in conjunction with individual therapy, if one partner already has a therapist?
Lots of people do that. You get different things out of them. You learn a lot about yourself individually in couples therapy, but sometimes people need extra support, or they’d like the extra support. Or they’re working through something personally that they need an individual therapist for. A couples therapist will generally not see either member of a couple for individual therapy, because we want that relationship to be clean. We don’t want any perception of the therapist favoring one person over the other. There’s often a lot of sibling-like rivalry in couples therapy, where people feel like they want the therapist to take their side, or they want the therapist to like them better. It’s not really in their awareness. People want the therapist to validate their position, but we’re not there to do that—nor would that be helpful.
Q: What are some tools that couples can try using to resolve conflict?
A lot of people say, “You’re not listening to me. You’re not listening,” as they’re talking over somebody else. Before you say you don’t feel heard, consider how well you listen.
People don’t realize they do that. They feel so unheard that they don’t realize that they’re making the other person feel unheard. You will be heard much more expansively by the other person if you truly listen to them. A lot of people don’t realize that they’re terrible listeners; they really just want to get their point across.
One of the most important things is to realize that you’re two separate people: You’re going to have different ideas and perceptions. And you don’t have to convince the other person of the truth of your perception. It’s important only that they understand how you feel about it. But neither perception is more valid than the other.
Q: How do you know when you can pause on couples therapy?
When the couple feels like they’re relating to each other better. When they feel like whatever they came in for isn’t really happening anymore, or at least it’s not happening to the same degree. Or even if it’s happening, they are able to stop before it escalates and not go down that rabbit hole the way they used to. It’s about changing the pattern between them.
All couples do a dance. If one person changes the dance, either the other person is going to fall flat on the floor or they’re going to have to change their steps. Usually what happens is the other partner changes their steps, too. And now the couple’s doing a different dance, and if they’re doing a different dance and it’s working for them, then they don’t need to be in therapy anymore.
Sometimes people are scared to leave couples therapy because even though their problem has gotten better or is mostly resolved, they fear that if they leave therapy, they will backslide at times. But that’s to be expected. I say, “Go out there and try it, and if you backslide, come back in. You know you can come in for a tune-up.”
There’s nothing wrong with coming in for a tune-up, but I do want clients to learn to trust themselves, to trust that they can do this and that they are going to backslide. We all have longstanding reactions that are very visceral, and sometimes we screw up. But that’s okay—nobody’s perfect. It doesn’t have to be very significant. It’s kind of like when people go on a diet and they eat two pieces of cake and feel like their entire diet is ruined. It’s not—you ate an extra piece of cake, and you move on.
You can always come back to therapy. It’s a conversation that you have with the therapist and with each other. But it’s not as though everything needs to be perfect for you to stop. No couple is perfect.
Read the full article on Goop.
If you live in the Los Angeles or Westlake Village area and are interested in therapy, I invite you to contact me via email at: tanyasamuelianmft@yahoo.com . I provide a 15-minute complimentary consultation. Check out my services to see which one might fit your needs. Contact me now to see if we might be a good fit to work together! Or book your appointment here!
Dear Diary...
Writing down your feelings is a powerful tool for relationships because by doing it, you get to know the number-one most important person in your life: yourself. The quality of any romantic relationship is going to be directly correlated to your own self-worth. You are the person you really need to get to know, and journaling is a great ally in that process.
Writing can help you tune in to your inner voice and appreciate who you are—in other words, your journal shouldn’t just be a dumping ground for frustrations about your partner. (Although that can definitely be helpful in some situations, like if you need to have a talk with them and want to organize your thoughts.) Rather, you can also look at it as a place to dig deep into who you are and what you want.
Here are a few journal prompts that can help take a person’s relationships to the next level, whether single or attached.
Journal Prompts for Single People
The perfect day visualization: A big roadblock people come up against when dating is that they don’t really know what they want. And if you’re not clear on your endgame, you risk wasting time and energy on people who ultimately aren’t going to be the best fit for you.
To find that clarity, try this two-part journaling exercise. First, take a little time to dream about what [your ideal] partnership looks like and feels like. These prompts can help get you started, but feel free to be creative here:
Journal out a whole day spent with this person. What does it feel like when you wake up together? Where do you go? What do you do? Really dig in and get specific.
Keep coming back to how it feels physically and emotionally. Are you energized? Does it give you a sense of safety? Are you having fun?
Next, use the intel gleaned from your perfect-day visualization to make a list of qualities you want to prioritize in a partner. What are the nonnegotiables for you?
The post-date debrief: One of the ickier aspects of dating-app culture is that it can make a person feel like they’re on a job interview, and it’s easy to put too much focus on the performance aspect. We’ve all fallen down the rabbit hole of self-doubt. But this is the absolute wrong approach. We’re often so preoccupied with being chosen that it’s easy to forget that you are picking your partner, as well.
You can use your journal to flip the script. Don’t just get caught up in the ‘shiny object’ aspects of their persona or appearance, ask yourself about the qualities they exhibited and if those are in alignment with what’s most important to you. Here are some things she suggests you journal about after a date:
How did your evening make you feel?
What did you enjoy about spending time with this person (or not)?
Did they make you feel good or kick up insecurities?
It’s not about judging your date. It’s about being connected with yourself through the dating process and assessing whether you two humans are a good fit for one another. You might be surprised to realize that person you were hoping to impress isn’t actually that impressive themselves!
Journal Prompts if You’re in a Relationship
The stress-buster: Stress is a major relationship buzzkill—if you’re obsessing over your to-do list or a conflict with someone at work, it’s hard to be present with your partner. Compounding this is the fact that self-care can often take a backseat when you’re coupled up. It erodes the foundation of the relationship long-term, because you both need to be taking care of yourselves in order to have the energy and clarity to take care of each other.
Here’s how you can use your journal to calm your mind and clear mental space for your S.O.
At night in bed, jot down a list of everything you want to get out of your head. This might help you sleep better—and wake up knowing exactly what priorities you need to tackle the next day. (That way, you’re not thinking about them during quality time with your bedmate.)
In the morning, do a free-write for at least four minutes and see what comes up on the page. Think of it like a juice cleanse for your brain.
The self-love party: Let’s be honest: One of the perks of being in a relationship is having someone constantly tell you how great they think you are. But if you’re solely looking to your partner to validate you, you’re likely heading down a sketchy path. We aren’t going to get all our needs met by a significant other. That’s unreasonable and unrealistic.
If you find that your moods peak and dip based on the amount of attention you’re getting from your plus-one, try giving yourself the gratuitous praise you’re seeking. Make a list of the things that you appreciate about yourself, and not a short list! Go for at least 50: traits, body parts, habits, you name it. Like how you set the dining room table? Include it. Think you have lovely feet, claim it. Love how you are a good friend to x person? Celebrate it. It’ll take the pressure off your partner to be the president of your fan club—but, more importantly, it can help you fall a little deeper in love with you.
Read the full article on Well+Good.
If you live in the Los Angeles or Westlake Village area and are interested in therapy, I invite you to contact me via email at: tanyasamuelianmft@yahoo.com . I provide a complimentary consultation. Check out my services to see which one might fit your needs. Contact me now to see if we might be a good fit to work together! Or book your appointment here!
Cultivating true happiness? Here's how!
Many people find themselves struggling against external ideas about what should make them happy. What’s the one thing you’re pining for in your life that would make you happier, if only it would happen? A new job? Romance? More Instagram followers? There’s always something, that’s for sure.
There are so many conceptions out there that you have to have something by a certain age, you have to have everything in place. Research shows external factors have the power to make us happier in the moment, but cultivating a deep sense of happiness is a much different project that spans far beyond any promotion or number of likes.
Here are a few things, proven through research, to help you cultivate true happiness.
Get more sleep Getting enough sleep is so important for our overall well-being, on so many levels! The vast majority of us need somewhere between seven and eight hours of sleep a night.
In addition, more than a decade ago, Harvard Women’s Health Watch reported chronic lack of sleep can weaken the immune system, make maintaining a healthy weight more difficult, contribute to high blood pressure, and interfere with learning and memory. It’s hard to believe something free has so many amazing benefits—or that we’re not all getting enough of it every night.
Exercise Exercise, like sleep, is a quick ticket to happiness, with even more immediate effects on mood. A recent study by the Black Dog Institute in Australia found even just one to two hours a week of exercise, defined as an activity that raises the heart rate and gets you warm and slightly out of breath, has a whole host of physical and mental benefits.
Spend time outdoors This may make you tweak your exercise routine to do double duty. While that candlelit spin experience is sure to boost your endorphins, a lower intensity jog or even a brisk walk outside gets you closer to something researchers are finding makes humans very happy: nature.
Find meaning Here’s where things get a little trickier. Getting enough sleep, exercising, and spending time outdoors are all pretty much guaranteed to quickly improve your mood. They’re also simple to plan and execute. But what about your internal monologue and your overall satisfaction with your life and what it all means?
A growing body of research is differentiating between two different types of happiness: hedonic and eudaimonic. Hedonic well-being is instant-gratification stuff like getting a present, collecting a record number of likes on your latest Instagram masterpiece, or going out on Friday night. Eudaimonic well-being stems from an overall sense of building a meaningful life. The two can dovetail—maybe you’re headed out on Friday night with an old and dear friend, for instance. The relationship is eudaimonic, while the activity itself may be hedonic.
We all find meaning in different places: work, relationships, family, and volunteering. This kind of happiness can also be described as a sense of purpose—and cultivating these elements in your life can take years and a good amount of self-knowledge.
Maintain relationships The Harvard Study of Adult Development is the longest running longitudinal study on happiness, and its main takeaways all have to do with relationships. The qualities that showed up time and time again in the happiest lives? Spending time with others regularly; long-term relationships; investing in the future by having children or establishing strong mentor-like bonds with younger people; and having social support systems. (There’s that eudaimonic well-being again!) Maybe call a friend you’ve been meaning to catch up with and look into some volunteer opportunities, like spending time at a nursing home.
Listen to yourself This one may require some self-examination and soul searching to figure out. I regularly work with clients to help them find clarity in terms of what they actually want to do with their lives versus external pressures telling them what they “should” be doing. I also advocate for self-compassion. Many patients who come to see me are very hard on themselves.
A recent study published in the Journal of Experimental Psychology found that when we repress emotions we don’t perceive as correct—say, ambivalence over motherhood, or being angry when we think we should be happy—we end up less happy than if we would simply express our inconvenient emotions. Cultivating respect for your inner voice—whether it’s a fleeting weird emotion that you need to just sit with, or a change in career paths to something more meaningful to you—is a lot harder than going to bed earlier. But it may be the ultimate key to deep happiness.
Spend money on experiences not things Whenever you go shopping, whether it’s in person or simply hitting the “place your order” button on Amazon, it’s not uncommon to feel an instant thrill and get excited about your new purchase. It happens to all of us. Unfortunately, that happiness doesn’t last. Past research published in the Journal of Positive Psychology found the only way spending money is going to make you happy is if it’s on life-benefiting experiences—not more material objects that are only going to add clutter to your life.
When you save up for a trip rather than spending your entire paycheck on new workout clothes, you’ll be able to go on an adventure that will leave you with memories to last a lifetime. Ones that are so meaningful and profound you won’t even feel the need to share all of them on your Instagram Stories.
Unplug often Technology undoubtedly makes your life easier. You can buy your latte with a flash of your phone and tell Alexa to order your groceries. But with as many perks as it adds to your life, happiness isn’t always one of them. According to the World Happiness Report, activities related to smartphones and digital media, including the endless scrolling on your social media platforms, have been linked time and time again to decreased happiness. In fact, those who unplug often are typically happier overall. So, post your cute dog pics to Instagram, then take a break from the screen for the rest of the night and play with your pup without social media.
Grab a good book Speaking of unplugging, one of the best ways to do so is to grab a good book. In an online survey of 4,164 adults, researchers found regular readers not only had less feelings of stress and depression, but also felt happier about themselves and their lives overall. The best part is you only need 30 minutes a week to see improvements in your happiness levels, and there are so many options to choose from, whether you want to pick up one of the buzziest wellness reads of the year, hit up your local library, or download some free classics online.
Find the full article at Well+Good.
If you live in the Los Angeles/Westlake Village area and are interested in therapy, I invite you to contact me via email at: tanyasamuelianmft@yahoo.com . I provide a complimentary consultation. Check out my services to see which one might fit your needs. Contact me now to see if we might be a good fit to work together! Or book your appointment here!
Growth Mindset
Our minds have such an ability to influence our lives. It's amazing how powerful our minds and our thoughts can be; how we look at the world shapes our own world.
"Growth mindset" (a term coined by Carol Dweck of Stanford University) is marked by a self-belief that your intelligence is malleable and never set in stone. As Ellen DeGeneres once said, "It's failure that gives you the proper perspective on success. When you take risks, you learn that there will be times when you succeed and there will be times when you fail. Both are equally important." Researchers have found that children who are encouraged to view failure as an opportunity for growth faired much better than children who had parents who reinforced the notion that failure is always 'bad.'
People with a growth mindset believe that intelligence is malleable, expandable, and never fixed. They also believe that you can learn and grow from mistakes or setbacks.
Failure and success are two sides of the same coin. Previous research has found that growth mindset also boosts resilience, positive emotions, and someone's ability to bounce back quickly from the agony of defeat. With practice, a growth mindset helps you let go of failure's disappointment and move on to new challenges.
On the flip side, those with a "fixed mindset"—who believe that their intelligence and abilities are less fluid—tend to beat themselves up and get stuck by dwelling on failures. A fixed mindset is also linked to a lack of self-compassion, in which failure can create a demotivating downward spiral of hopelessness and low self-esteem.
This is especially important for parents of younger children when teaching kids how to respond to setbacks in ways that are encouraging rather than discouraging. Nourishing a growth mindset can give youngsters a set of coping skills that could last a lifetime. I encourage teachers and parents to help children learn to pay more attention to their mistakes in a way that opens up growth mindset opportunities. Glossing over mistakes or shying away from a constructive dialogue about the importance of short-term failure as a pathway to long-term success can undermine someone's potential growth.
If you live in the Los Angeles/Westlake Village area and are interested in therapy, I invite you to contact me via email at: tanyasamuelianmft@yahoo.com . I provide a complimentary consultation. Contact me now to see if we might be a good fit to work together! Or book your appointment here!
This article is for informational purposes only, even if and to the extent that it features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and should never be relied upon for specific medical advice. Full article on Psychology Today.
Feeling Blue? It could be Seasonal Affective Disorder...
Seasonal affective disorder (SAD) is one of the few ailments that is on a clock: It usually begins in October, and people who suffer from it usually feel the full effects in January and February. We also know that it’s more common for people living in places that get less sunlight during the winter and it’s more common in women than men, according to psychologists and researchers.
Traditionally, SAD is treated with antidepressant medication or light therapy, but there has been recent piloting towards a new approach using cognitive behavioral therapy (CBT), looking at the effects of CBT method on reducing negative thought patterns for people with SAD, using the Socratic method to interrupt negative thought patterns and make way for more mood-neutral thoughts, while simultaneously focusing on behavior and helping people to make slight shifts in their habits.
Here are a few questions to consider.
Q
What is seasonal affective disorder?
A
Seasonal affective disorder is a type of clinical depression that commonly occurs in the fall and winter months and typically resolves in the spring and summer. While it can take any seasonal pattern, the fall/winter type is overwhelmingly the most common. The only thing that makes it different from garden-variety depression is the seasonal pattern that it follows.
Because of their similarities, SAD is often misdiagnosed as depression. It sometimes takes a few years for people who have this pattern to recognize that it’s a pattern, and that it’s tied to the seasons.
Q
What are the most common symptoms?
A
Because we’re diagnosing depression when diagnosing SAD, we look for at least five of the nine diagnostic symptoms of depression. We’re diagnosing a depression that follows a seasonal pattern, meaning we’re looking for depressive symptoms that are present much of the day, almost every day, for at least two weeks. The hallmark symptoms of depression are:
Feeling consistently down for most of the day or nearly every day.
A loss of interest in the things that would have otherwise been enjoyable, such as social activities that previously would have brought a sense of enjoyment or pleasure.
Feeling overwhelmingly tired or experiencing low energy.
Inability to hold attention and focus or experiencing difficulty in concentrating.
Feeling worthless or hopeless.
Issues with sleep. Either too little or too much. In winter depression, we tend to see hypersomnia or sleeping too much. In most cases, the individual sleeps for at least an extra hour a day compared to the spring or summer. Some patients may sleep ten to even fourteen hours a day and are still tired. It’s not restorative sleep that we’re seeing. A minority of patients, on the other hand, experience insomnia.
Changes in appetite or weight. This could be either wanting to eat a lot more or a lot less than usual. In winter depression, it’s usually wanting to eat more, and it’s usually carbohydrate-rich foods. Either sugars, starches, or both. With this, we typically see weight gain with an increased appetite or weight loss with a decreased appetite.
Agitation often accompanied by feelings of guilt and shame.
In extreme cases, thoughts of death or suicide.
Individuals can be diagnosed with SAD when they’re experiencing five of these symptoms, which need to include the first and/or second symptom.
These are not momentary symptoms; rather, they are pervasive for at least a couple of weeks. On average, it’s estimated to be five months of the year in a major depressive episode. It’s a lot of time to spend in depression, in terms of the cumulative toll that it could take on a person’s life.
Q
Whom does it affect most?
A
Similar to depression, there is a pronounced gender difference for those affected by SAD. Depression in general is two times more common in women than in men, and data suggests seasonal depression is even more common in women than in men. When we look at its prevalence, we’re looking at a single snapshot in time. And we’ve found that most cases occur in young adults, typically in their twenties to thirties. We’re not entirely sure why it occurs in this age range, though, since these studies don’t follow people over time. One theory is that SAD becomes less prevalent as people age, because they learn how to cope with it or possibly move to places that don’t have winters that are as harsh.
Q
How does SAD differ from depression? For individuals who have been previously diagnosed with depression, does that put them at an increased risk of developing SAD?
A
It’s estimated that up to 10 to 20 percent of recurrent depression cases follow a seasonal pattern. This is generally the course of depression, in which a depressive episode tends to return over time, with periods of time without depression between the episodes.
For SAD patients, there are unfortunately very few studies that have tried to look at the long-term trajectory of the disorder. So we don’t have a coherent idea of its outlook. We’ve tried contacting people we knew who had SAD in the past to learn about their experience and see where they’re at today, and we’ve found mixed long-term courses. A lot of them continue to experience SAD episodes every winter. Others become more subclinical, where they used to have full-threshold SAD, and now they may just have the winter blues. Some develop a completely nonseasonal course where they still have depressive episodes but it’s not tied to the seasons. And others fully remit, where they don’t have depression, seasonal or otherwise, moving forward.
In terms of how SAD differs from depression, there is a strong correlation of SAD with latitude in the United States. The farther you are from the equator, the more cases you’ll find. It is estimated that 9 percent of those people who live in Alaska suffer from SAD, compared with 1 percent of those who live in Florida. For most people—at least in the northern United States—SAD slowly begins in October. People often report an increase in their symptoms after the end of daylight saving time and experience their symptoms in full effect in January and February. It is in these two months that we find the largest proportion of SAD patients in a full major depressive episode.
Another strong link is photo period, or length of daylight. Photo period is the strongest predictor of when symptoms start in any given year for someone who has seasonal affective disorder, as well as how severe the symptoms are on a given day. The number of hours from dawn to dusk determines your photo period. We believe that photo period is what explains the onset of this disorder and can determine how bad symptoms may be on any particular day.
Q
What is the traditional approach to treating SAD?
A
Light therapy was the first line of treatment developed specifically for SAD patients. It was developed at the National Institute of Mental Health under Norman Rosenthal. He was a psychiatrist who moved from South Africa to Bethesda, Maryland, to work at the National Institute of Mental Health, and he experienced SAD symptoms. He was interested in learning more about it, and seeing if others experienced similar symptoms. He put an ad in The Washington Post, asking whether anyone experienced depression in the fall and the winter, and the lab phone rang constantly for weeks at a time. They had a huge response from people who thought they had the symptoms. They brought them they seemed to follow. From this, they developed light therapy as a form of treatment.
With light therapy, the goal is to give people a very bright dose of light, first thing in the morning, to simulate an early dawn. In theory, we’re trying to jump-start a sluggish biological clock, so that circadian rhythms go back to a normal phase as if they’re in the summer, when these people are feeling good. The devices tested in clinical trials are 10,000 LUX, which is the same intensity of light from the sky at sunrise. We block out the UV rays since they’re not necessary for an antidepressant response. We’ve found that prescribing patients to sit in front of 10,000 LUX for at least thirty minutes a day is what it takes for the treatment to be effective in people who have SAD. That said, similar to finding the right antidepressant, it can be a bit of a trial-and-error process. We try to find that sweet spot of exactly how many minutes a day and at what time or times of the day it’s most effective for the patient. The optimal benefit from light therapy must be determined on an individual basis so we can balance any side effects they may experience in response to the light.
The same drugs that are effective in treating nonseasonal depression—particularly SSRIs like fluoxetine/Prozac—have been tested for SAD with a good outcome in placebo-controlled studies. There is one drug that’s FDA-approved specifically to prevent SAD, which is Wellbutrin Extended Release. There was a large multisite study—with the GlaxoSmithKlein drug—completed a few years ago with over 1,000 SAD patients. The study compared putting people on the Wellbutrin Extended Release versus a placebo, and the participants started the treatment early in the fall when they weren’t yet having their symptoms, and the study followed them into the winter. The researchers found fewer relapses on the drug than with the placebo, which led to the FDA approval of the medication. Either bright-light therapy or antidepressant medication are typically used in treating SAD.
Q
How can cognitive behavioral therapy be used to treat SAD?
A
There is an extensive body of research demonstrating that CBT is an effective talk therapy for people with depression. There have also been a lot of clinical trials showing that it worked as well as antidepressant medications for improving depression. Additionally, when you follow people over time, after they’re treated to remission using CBT versus treated to remission using antidepressant medications, there are fewer relapses and recurrences among those treated with CBT than those treated with antidepressant medication.
Q
Recommendations?
A
Resist the urge to self-diagnose and self-treat. Seek evaluation from a qualified person who can figure out once and for all if it’s SAD or if it might be something else, including a depression that’s not following a seasonal course. And know that there are treatment options out there that are effective, including light therapy, antidepressant medications, and cognitive behavioral therapy. So there are reasons to be optimistic that one of these interventions will be helpful in terms of improving your experience.
This article is for informational purposes only, even if and to the extent that it features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and should never be relied upon for specific medical advice. View the full article here: https://goop.com/wellness/how-to-treat-seasonal-affective-disorder/
If you live in the Los Angeles/Westlake Village area and are interested in therapy, I invite you to contact me via email at: tanyasamuelianmft@yahoo.com . I provide a complimentary consultation. Contact me now to see if we might be a good fit to work together! Or book your appointment here!