Blog – Page 6 – Jeff Dwarshuis LMSW ACSW

Decreasing Workplace Anxiety through Leadership Development

By Jeff Dwarshuis LMSW ACSW

The workplace is a social system and like any group it is susceptible to changes in the social climate. For example, the workplace can be impacted by the economy, traumatic national news stories and loss issues of employees. Generally this will show itself through decreased performance, more sick days, anger and making decisions based upon feelings instead of facts. Leaders and employees can change this process by recognizing the differences between acute and chronic anxiety and recognizing how their own emotional issues and past relational patterns impact their workplace communication and behavior.

Acute and Chronic Stress

There are two types of stress that impact any social system. First, Acute Anxiety is from typical stress producing events such as being understaffed, having broken equipment or experiencing workplace accidents. Chronic Anxiety however, is a long term anxiety that is caused by past organizational events and employee reactions. It is usually hidden, very difficult to detect and contagious. Chronic Anxiety has many forms. For example, it may be initiated by a traumatic event in an organization and unknowingly spread through people and across time. Examples might be an employee death, chronic illness, the loss of a CEO, and mergers. Due to anniversaries, constant reminders, communication, perceived threats and unspoken reactions, Chronic Anxiety will spread from one generation to the next. A new employee may feel anxiety on their first day of work due to an event that occurred a decade before. Chronic Anxiety may be experienced to a higher degree if the employee’s past consists of several common themes or conflicts to the traumatic past event of the organization.

Employee reactions to Chronic Anxiety

Chronic Anxiety will grow when leaders and employees begin to react to the stressful situations at work by unconsciously repeating patterns of their own youth and family. Generally these reactions fall into one of four behaviors

A. Closeness – As an employee grows anxious he may respond with getting too close to fellow employees, managers or customers. This may be shown by private complaining, secrecy, hidden agendas and inappropriate decision making.

B. Distance – Anxiety may cause an employee to become distant from everyone else. This may be shown by a decrease in communication with colleagues, hiding behind closed doors, leaving work early and a non-participatory attitude. The extreme form of distance is a complete cutoff.

C. Over and Under Functioning – As an employee feels stressed he may bond unconsciously with another worker in a pattern of over/under functioning. This is shown by an uneven sharing of a workload. One becomes lazy while the other picks up the pieces.

D. Projection – As an employee becomes stressed he may revert to a personal defense of projection. Projection is shown by an irrational behavior shown to one person when it is actually meant for another person. It has the quality of being unfair and unreasonable.

Change workplace anxiety through a personal action Plan

The effects of Chronic Anxiety can be reversed if leaders and employees begin to evaluate self behavior and communication. This is especially important with leaders since they have a more significant impact on the organization as a whole. Follow the suggestions below.

Observe behaviors when you become stressed at work and ask yourself if these are the same behaviors done at home in adult relationships and/or when experiencing anxiety as a child.
Observe your role in emotional patterns at work. Do you over or under work or become clingy or distant? Do you involve others in your conflict or feel ostracized by others who do. Identify relationships you want to change, resolve conflicts and be sure leadership is not undermined.
Identify the hot button issues that increase anxiety among coworkers. Determine if the problem is within the reach of the organization for possible change. If so, decease anxiety by establishing a position based on facts instead of feelings and use appropriate forums for communicating these issues.

Cognitive Therapy for Performance and Mood

By Jeff Dwarshuis LMSW ACSW

Much of what a person feels is caused by what is said to themselves. Day after day, people at home and the workplace experience many situations and their perception and related self talk about these situations greatly influence outlook, mood and even health. Unfortunately, much of this self talk can be negative, irrational and incorrect. Negative self talk is automatic and starts in patterns developed during youth. As an adult, this negative talk leads to worry, perfectionism, low self esteem and panic. Socially or in the workplace it creates low mood and anger. Negative and irrational thoughts are called “distortions” and the way to end this irrational process is through what Cognitive Psychologists call – Thought Stopping, Substitution and Reframing.

Thought Stopping

Thought Stopping is the processes of recognizing, interrupting and ending a negative thought. Read the examples below to help identify any thought distortions you may have.

1. “I fell behind on the company expectation. I am such a loser.”

2. “I should have done a better presentation. I will never make it to management.”

3. “This equipment doesn’t work well. It is going to be an awful week.”

4. “Although my department has been successful, it doesn’t matter. We will always be behind.”

5. “My team hates me. Every time I do something wrong they give me the evil eye and wish I would quit.”

Keep in mind that thought distortions are not behaviors but are thoughts. Some people have a great deal of distorted thinking while others have little. In any case, they are automatic by nature and consistent across time. When recognizing a negative thought, write it down and then watch for patterns. People tend to think in patterns. Then, each time you catch yourself, either sit in silence not letting it happen or create a negative association like slapping a rubber band on your wrist.

Substitution

After recognizing and stopping the negative thought, create a replacement. This is called substitution. Replace the negative thought with a more realistic and positive description of the situation. This is also called “the rebuttal”. Substitution statements may sound like this –

“I fell behind on the company expectation but I have learned a great deal and did better then last month.”
“My presentation was acceptable. I got my point across and many people are better because of it.”
“The equipment does not work well. This is a perfect opportunity to talk to the salesman and negotiate some changes.”
“My department is successful and will continue to grow and be the best.”
“My team likes me most of the time. This is a good fit.”

Reframing

Thought stopping and substitution can change how we think, feel and respond. Reframing is an exercise in changing how you think and what you do related to a situational interpretation. It is an active process in considering the positive. Reframing is used well with the automatic thoughts that begin with the words “always” and “never”

These are three steps in Reframing and changing the interpretation of events.

1. Identify several situations that typically produce uncomfortable or distressing feelings.

2. List your automatic thoughts and feelings in each situation.

3. List a more useful way to perceive each situation which offers choices and potential for growth.

Thought Stopping, Substitution and Reframing is a process. Begin by creating a plan. Use a notebook to list negative thoughts, substitutions and reframes. Set aside specific times to address these. After a good beginning effort of 3-6 weeks, the process will become more automatic.

Adjustment Disorders and Symptoms

By Jeff Dwarshuis LMSW ACSW

Adjustment Disorders are a common problem caused by experiencing a larger than usual life stressor. Examples of these stressors are relational breakups, a move to another city, job loss, divorce or extended family conflict. Everyone is subject to the possibility of an Adjustment Disorder; however the disorder is more likely if the change is unexpected. Also, individuals may not make the connection between the adjustment issue and the experienced symptoms it creates. Often times being able to make the connection is a cause for relief.

Types of Adjustment Disorders

The diagnosis of a specific Adjustment Disorder (AD) depends on the types of symptoms the individual presents following the stressor. The possible symptoms fall into the three broad categories of mood, anxiety and behavior. An Adjustment Disorder is given one of the specific diagnoses listed below.

AD with depressed mood: Symptoms are that of a minor depression.

AD with anxious mood: Symptoms of anxiety dominate the clinical picture.

AD with mixed anxiety and depressed mood: Symptoms are a combination of depression and anxiety.

AD with disturbance of conduct: Symptoms are demonstrated in behaviors that break societal norms or violate the rights of others.

AD with mixed disturbance of emotions and conduct: Symptoms include combined mood, anxiety and behavior symptoms.

AD NOS: This residual diagnosis is used when a maladaptive reaction that is not classified under other ADs occurs in response to stress.

Emotional Symptoms of Adjustment Disorders

The signs and symptoms of an Adjustment Disorder may affect how you feel and think about yourself or life. The list below represents symptoms of depression and anxiety. These are important signs to watch for in yourself, family or coworkers.

Depression – Sadness, hopelessness, lack of enjoyment, crying spells, thoughts of suicide, trouble sleeping or difficulty concentrating.

Anxiety – Excessive worry, feeling on edge, headaches, tightness in the chest, stomach pain, dizziness, nausea, flashes or chills, pacing or irritation.

Behavioral Symptoms of Adjustment Disorders
Signs and symptoms of an Adjustment Disorder may affect actions or behavior. Again, these are the things to watch for in others.

Fighting, reckless driving, ignoring bills, avoiding family or friends, poor school or work performance, skipping school or vandalism.

Treating Adjustment Disorders

Adjustment Disorders are generally easy to recognize in a clinical setting because the symptoms begin with a specific event. Adjustment Disorders are usually treated with a combination of medication, problem solving and behavioral empowerment strategies. Also, Adjustment Disorders may diminish alone with time. Psychotherapy is suggested however because the Adjustment Disorder may last longer than six months and if it does the diagnosis changes to a more severe mood or anxiety disorder.

Techniques to Increase Quality Communication

By Jeff Dwarshuis LMSW ACSW

The Use of Self to Increase Communication

The quality of communication within a relationship can be increased by the listener’s behavior. Generally this involves the alteration of things in the relational context that already exist but may be unclear, normalized, taken for granted or ignored. The three listening techniques for increasing quality communication are – The Art of Being Quiet, Boundaries and Self Disclosure.

A. The Art of Being Quiet – Both listeners and presenters maintain an unspoken time limit on the accepted length of silence between the exchange of language between each person. Altering the length of silence when responding to a presenter will increase the level of the listener’s attention to what is being said. The alteration of silence is taken from the discipline of Ericksonian Hypnotherapy. It is based on the recognition that communication is rhythmic and altering the timing sequence disrupts the unconscious timing pattern. Disrupting unconscious patterns creates an internal crisis and leaves the conscious mind working to make sense of the change. The result is a heightened level of attention to what is happening. Consider following these suggestions.

Wait longer before responding to a speaker. This causes the speaker to turn inward and have a heightened recognition of their thoughts and feelings.

Respond more quickly than expected after hearing a speaker. This creates a state of listener confusion which initiates an internal crisis response and a heightened attention state. This response causes an increase in attention to what is being said to them.

B. Boundaries – Boundaries are the spoken and unspoken rules, roles and limitations relevant to a relationship and its context. Boundaries involve issues of time, authority, submission, involvement, distance and resources. Boundary management is a universal human challenge which was shaped by instinctual responses to the joys and disappointments of childhood attachment. The quality of communication is greatly increased when boundaries are clear and verbalized. Boundaries are determined usually by the person in authority. When boundaries are clear, it allows for safety, freedom and self development. Here are examples of clear boundaries.

Job descriptions and work roles are clearly understood and well managed.

When a listener is clear and consistent regarding how long he or she can listen, what topics can be heard and how much he or she is willing to do.

When someone is willing to say “no” to tasks that are too big, inappropriate or out of line with expectations or personal decisions.

When a manager listens to an employee or colleague in the same location each time they talk.

C. Self Disclosure – Self disclosure is sharing information about one’s self that is personal. When a listener self discloses he or she is giving an unspoken suggestion that the speaker self disclose as well. Consider using these ideas:

Think about what you would like for the speaker to say that would move the discussion in a direction you would like. Based on this topic, pick something from your life that is personal and share it. The speaker will hear this and most likely respond with a personal example on the same topic. (If you want someone to talk about their mother than start by talking about your own mother.)

Self disclosure allows the listener to control the discussion by setting the parameters of what is acceptable. In other words, the level and detail of personal disclosure is determined by the listener.

The listener should be sure to only share as much as he or she can manage emotionally.

Keep Valued Employees through Performance Enhancement Counseling

By Jeff Dwarshuis LMSW, ACSW

All people have difficult times and employees at all levels of leadership will carry stress to the workplace. The result can be a less than optimal performance. Employees can be stressed by financial hardship, marital discord, parenting or past issues of divorce, family loss, bereavement or child abuse. All can dramatically impact an employee’s work performance.

Eye Movement Desensitization and Reprocessing (EMDR) is a treatment that can quickly and effectively assist with workplace stress. EMDR has its beginnings as a treatment for Posttraumatic Stress Disorder and has been very effective with performance, depression and anxiety as well. Created by psychologist Francine Shapiro PhD, EMDR uses a blend of cognitive, emotive and client centered therapies in combination with neurobiological interventions. Since its beginning in 1995, EMDR has dramatically changed the lives of thousands of people.

EMDR, REM and Memory Reprocessing

To understand EMDR it is helpful to first know about the impact of Rapid Eye Movement (REM). After 30-60 minutes of sleep an individual begins REM sleep. During REM, one involuntarily moves their eyes back and forth. The eye movements cause a neurobiological reaction which stimulates a reprocessing of the day’s memories and makes recent memories into old memories. If someone has a negative memory in their day, the REM process facilities making this recent bad memory no longer bothersome.

REM and Posttraumatic Stress Disorder

Traumatic memories occur when one is overwhelmed by either witnessing or enduring something that is horrific beyond the typical human experience. This might include combat, child abuse, domestic violence, personal assault, traffic accidents or traumatic medical procedures. Because of the severity of these memories, the REM mechanism described does not work. In these cases, the individual remains aware of the memory and continues to experience its negative impacts. The memory is not reprocessed and the individual could go on for decades terrorized by their own memory. This is called Posttraumatic Stress Disorder.

Negative Memories and the “Three Point Power Supply”

All negative memories create three things which exist interdependently and make a memory seem unpleasant. These three things are a negative emotion, an unpleasant body sensation and a negative self belief. Say for example someone went to a social gathering and said something foolish in front of a group of people. When thinking about this memory, the person would experience embarrassment, flushing and a self belief of “I am so stupid!” During REM, eye movements create an even stimulation of the right and left hemispheres of the brain and cause a tremendous and fixated calm in the body. Since the body is so relaxed, it does not react during the subconscious reprocessing of daily negative memories. The body reaction is separated from the two other interdependent “power supplies’ and the negative impacts of the memory fade. The individual can recall the event but no longer experiences embarrassment, flushing or a negative self belief.

EMDR Procedure as REM Simulation

EMDR is a simulation of REM used in a therapeutic setting and applied to a traumatic memory. During an EMDR session, a client visualizes a trauma while recognizing the negative emotion, body sensation and self belief. The therapist measures the negative response levels and leads the client through sets of eye movements by use of a light bar or “eye scan”. After 45-60 minutes, the negative impacts of the trauma are gone…permanently.

EMDR, Performance Enhancement and the Workplace

All individuals are functioning below their potential because of a history of mistakes, criticisms, self questioning or relational abuse. A therapist can uncover these performance interferences by asking someone a detailed list of questions to help the person visualize an ideal state. The ideal state may have to do with performance in school, the performing arts, sports, relationships or in the workplace. The therapist asks what memories or experiences get in the way of the individual being able to live up to their ideal. Those memories are then treated as EMDR memory targets, the EMDR procedure is done in the office and the client is free to return to their goals without the interference of negative memories.

For example, imagine an employee who is highly skilled and committed and his boss wants to promote him to a manager position. The employee, however, has a number of problems relating to employees including having a temper and not listening. The CEO very much wants to promote him but without the necessary relational skills, the CEO would have to hire from outside the company.

Using the EMDR performance protocol, that potential manager would be asked a series of questions to assist him in seeing his ideal work state. For example…”In the ideal state what are you doing that you are not doing now?” “What personal characteristics or qualities are improved?” “What are you feeling in the ideal picture?” “What do you believe about yourself?” After the potential manager sees this ideal picture of himself interacting with his employees he then is asked to identify a memory that interferes with his being able to live the ideal picture. Most of the time the employee will describe negative memories related to their relationship with their parents. This may be in the form of criticism, neglect or abuse. Most all stated and volunteered answers regarding interfering memories are from childhood. Then the employee would be asked to visualize the bothersome memory and do the set up for the EMDR procedure. The person follows the EMDR procedure described above, eliminates the negativity of the old memory and visualizes himself in the ideal state. Simply doing this one procedure, the employee returns to work that day and begins to improve and act differently.

The employee may have a series of memories that interfere with the ideal performance picture and each memory is reprocessed using the EMDR procedure. Each one hour session will cover 1-2 memories. The treatment processes is brief and intense lasting 8-12 sessions. Unlike traditional therapy that requires time between sessions, EMDR can be completed as quickly as one would like.

What are some typical work performance problems addressed by EMDR?

1. Public speaking

2. Managing difficult people

3. Increased effectiveness in sales

4. Increased believably in short and long-term success goals

5. Increased ability to communicate with potential business partners

6. Increased success in working on a team

7. Increased ability to manage time

8. Increased ability to manage workplace crisis

9. Increased ability to manage job stress

10. Increased physical health due to fewer symptoms of stress

The EMDR performance enhancement procedure has allowed employees to get past personal issues, better use their skills and knowledge and be promoted. Also, employers have been able to retain valued employees who otherwise would have been terminated because of ongoing behavioral and emotional problems carried to the workplace.

Active Listening

By Jeff Dwarshuis LMSW ACSW

What is Active Listening?

Active listening is a communication technique that requires a listener in a relationship to use specific language to show an understanding of a speaker’s expression. The language, which consists of suggested phrases combined with the listener’s response, is designed to create psychological safety for the speaker. This structured process is highlights the importance of the speaker’s words and meaning and leaves no room for advice giving. Active listening is a developed skill which can be learned by most anyone to improve understanding and relational closeness between two people. Active Listening has four main parts; they are paraphrasing, clarifying, giving feedback and listening with your body.

A. Paraphrasing – Paraphrasing is the first step in the active listening process. After hearing what the speaker initially says, the listener provides what is called a mirroring statement. A mirroring statement is a set of words that are nearly identical to the words said by the speaker and are preceded by one of the phrases below. The use of these phrases followed by a mirroring statement creates a paraphrase and an atmosphere that is centered on the speaker. Following this structure keeps the attention off of the listener by eliminating the possibility of advice giving, question asking or interpretation. With this combination of a heightened focus on the speaker and the diminished importance of the listener’s thoughts, a sense of communicative predictability allows the speaker to feel emotionally safe. Generally when people feel safe they will express more. Consider using one of the phrases below to start the mirroring statement.

So you are saying…In other words…If I understand you correctly…What I hearing you saying is that…Let me get this straight…

After paraphrasing is complete the speaker should have the sense that they were heard and are understood. The listener, however, does not have to agree with what was said.

B. Clarifying – After giving feedback, the listener should clarify to the speaker what they heard. This is done by asking questions about the presented topic and making sure there are no misunderstandings. Since the listener is actively seeking understanding, clarifying should make the speaker feel important and that their concerns have value. The listener also should be sure to have a goal of understanding the meaning of what the person said rather than being preoccupied with the factual information the person provides. Too much attention to facts will cause the speaker to feel interrogated.

To establish language that leads to clarification ask the “who, what, when, where” questions to make sure the speaker is understood.

C. Feedback – After paraphrasing and clarifying the listener should give feedback. Feedback is a supportive yet honest expression of the listener’s opinion regarding the topic. Feedback should be given at the same time as the discussion because the speaker is then more likely to hear the feedback. Feedback gives the speaker an understanding of the impact of their language and it can provide a fresh point of view.

Feedback should be honest but supportive. For example to say “I think you may have made a mistake” rather than “You blew it!”

D. Listening With Your Body – Listening with your body is an unspoken gesture that is done while listening to someone. These gestures make it easier for the speaker to talk. This can be done in many ways. For example,

Maintain eye contact, move closer or lean forward, nod as positive reinforcement, smile or frown in sympathy, keep posture open, remove distraction and remove objects between self and presenter.

Active listening is a developed skill. Begin by practicing each part separately and memorizing the suggested phrases before listening. Active listening can be used with family, employees, colleagues and friends. You will discover that this tool increases understanding and closeness in relationships.

The NLP Performance Technique of Surveying Cause and Effect

By Jeff Dwarshuis LMSW ACSW

Neuro–linguistic Programming (NLP) is a branch of psychotherapy that is based on the idea that people experience the world through their senses and translate sensory information into both conscious and unconscious thought processes. These thought processes activate the neurological system that affects physiology, emotions and behavior. The linguistic aspect in NLP refers to the idea that language helps us to capture, conceptualize and communicate our experiences. Programming has to do with the idea that we have patterned internal processes that help us learn, act and get results.

Cause and Effect

How we make personal decisions and act behaviorally has a great deal to do with our perception of personal control. We all maintain the assumption that every effect has an underlying cause. Because of internal dialogue and past history, individuals can be programmed to unrealistically view themselves as victims of their circumstances. In NLP the concept of “cause and effect” attempts to create a method of understanding one’s thoughts to recognize if they are thinking as if they are in or out of control of their circumstances. In NLP terms people are said to be “at cause” or “at effect” as follows:

At Cause – When an individual has the thoughts and behavior that reflect the idea of “I am not making excuses.” or “I am in control of my destiny.” or “What lessons do I need to learn from this situation.”

At Effect – When an individual has the thoughts and behavior that reflect the idea of “I am out of control”. The “at effect” person blames others, makes excuses and passively watches his or her experiences pass through time.

Where are you at right now in your perception of cause and effect both at work and in the family? Understanding one’s own patterns can impact mood, productivity and attitude.

Tuning Into Language

NLP maintains that our internal world of conscious and unconscious thinking is reflected in our words and body language. Someone’s perception of their own level of control over their circumstances is reflected in their language. Notice the differences in the examples below –

“At Effect” language –

“He made me do it.”
“I have to stay late and work because my manager makes me feel guilty.”

“At Cause” language –

“I don’t want to talk now. I am giving myself time to respond.”
“I took time off last week and I have enough energy to complete the project.”

Notice the differences. The “at effect” responses represent an unconscious thought of not being in control. The “at cause” responses represent an attitude of self responsibility and taking control of one’s circumstances.

Examining Internal Dialogue

Individuals live in a private world of internal dialogue and have the capacity for what is called the “What if reasoning processes” or the ability to mentally rehearse different scenarios. People have the tendency to repeat the same thought patterns and if this is with the internal dialogue of being “at effect’ self management will take a great deal of unnecessary energy and will limit productivity and natural capacity.

To change this, first recognize internal dialogue that reflects an “at effect” perspective. Then interrupt this unconscious process by adjusting physical sensations through deep breathing or meditation and alter negative thought process by writing affirmations of positive self beliefs. Then list the “at effect” statement and then respond to it with an “at cause” statement.

For example “My colleagues are in my way” would be replaced by “I can create space to work freely when I want.” Another example might be “My boss’s suggestions make me stressed.” This would be replaced by “I have been chosen for this job and I am the best qualified to understand suggestions.”

Interrupting the negative patterns though recognition, altering thoughts and body sensations allows one to change negative unconscious patterns and instead think more creatively about one’s own abilities and accomplishments.

The Anger Checklist

By Jeff Dwarshuis LMSW ACSW

People who have quick or extreme levels of anger may also have difficulty recognizing the signs of anger. Fortunately people can increase their recognition of anger by learning the physical, emotional and behavioral signs of anger.

Physical signs of anger

Clenching of the jaw or grinding of the teeth

Headache or stomach ache

Rapid heart rate, sweating and feeling hot in the face

Shaking, trembling and/or dizziness

Emotional signs or triggers for anger

A feeling of flight or wanting to get away

Sadness, irritation, or feelings of resentment

Feelings of guilt or a sense of contempt for another or others

Aggression and the desire to strike out verbally or physically

Behavioral signs of anger

Rubbing of one’s head or cupping fists

Pacing, raising one’s voice or beginning to yell, scream or cry

Aggressive behaviors of throwing, name calling or crossing into someone else’s personal space

Craving a drink, a smoke or other substances that relax oneself

Getting Anger under Control

If you think that you often or occasionally have these warning signs then see the list below for seven steps to manage anger.

1. Take a Timeout – Before reacting in anger count to 10, take deep breaths and allow yourself to leave the situation. Slowing oneself down helps to defuse anger.

2. Express your anger – Use assertive language to express frustration. Keep from being aggressive, controlling or confrontational. Also, think first before speaking to avoid saying something you might regret.

3. Identify solutions for changing what causes anger – Instead of getting angry identify what is causing the anger and create solutions for change.

4. Use “I” statements – Avoid criticizing or blaming others by expressing your anger using “I” statements. For example instead of saying “You never spend time with me.” say “I feel upset because you came home late.”

5. Don’t hold a grudge – It is unreasonable to expect that others will always behave as you want. Forgiveness allows you to not become crowded by your own anger and sense of injustice and makes it easier to see the positive qualities in others.

6. Use relaxation techniques and physical exercise to decease anger – Physical exercise releases chemicals in the brain that can leave one feeling more happy. Relaxation, such as deep breathing, reading, or positive self talk can allow control over anger.

7. Know when to seek help – It can be difficult to manage anger. Consider getting help if you find your anger is out of control, hurts others or causes you to do things you regret. Help can be found through anger management classes or anger management counseling.

The Depression Checklist

By Jeff Dwarshuis LMSW ACSW

Depression is a common problem with a specific course and set of symptoms. It is not uncommon for people to feel depressed from time to time but the severity and length of symptoms determine if outside help is needed. The causes for depression might involve stress reactions and biochemical and hormonal complications. Other causes involve negative thinking patterns, poor emotive processing, traumatic memory and delayed emotional development from child abuse. Although depression can be a serious problem, it also is very treatable.

Symptoms of Depression

1. The individual has a depressed mood most of the day, nearly every day, and feels sad, empty or tearful. In children and adolescents, depressed mood can appear as constant irritability.

2. The person has a diminished interest in things that used to give pleasure.

3. The person has significant weight loss when not dieting, weight gain, or a decrease or increase in appetite. In children, failure to gain weight as expected can be a sign of depression.

4. The person sleeps very little or has a desire to sleep most all of the time.

5. The person is either restlessness or has slowed behavior that can be observed by others.

6. The person feels fatigue or loss of energy nearly every day.

7. The person has feelings of worthlessness, or excessive or inappropriate guilt nearly every day.

8. The person has trouble making decisions and concentrating.

9. Recurrent thoughts of death or suicide, or a suicide attempt.

Treatment for Depression

The treatment for depression usually involves several interventions. Treatment is generally done in psychotherapy sessions, group therapy or in a hospital setting.

1. Medication – Medication is generally used in moderate and severe cases of depression. In moderate cases, medication is used temporarily to decrease symptoms. Medication use is slowly deceased as other interventions are learned and used. In severe cases the timeline to decease medications may not be as clear. Antidepressants should be taken in conjunction with psychotherapy as this is statistically the best way to end depression.

2. Cognitive Therapy – It is recognized that depression causes people think in a very specific way about themselves, others and the future. Cognitive Therapy is used to recognize unhealthy thinking patterns that contribute to depression and provides exercises to change these patterns.

3. Emotive and Communicative Therapy – Deceasing depression also comes from increased recognition of individual thoughts and feelings and the ability to clearly express them. Communication exercises can assist someone in knowing and sharing emotions that otherwise had been repressed or forgotten.

4. Eye Movement Desensitization and Reprocessing (EMDR) – EMDR is a type of treatment that eliminates the negative thoughts, feelings and body sensations that come from negative memory. Some negative memories such as child abuse contribute to negative self beliefs that contribute to depression.

5. Problem Solving Therapy – Depression can have a negative impact on decisions, self perception and relationships. Problem Solving Therapy consists of problem identification, goal setting and solutions that lead to more productive and rational behavior. Problem Solving Therapy is done in the therapeutic setting and involves therapeutic questions, confrontation and directives.

6. Life style Changes – Treatment for depression might also involve changes in self care and health. Examples include diet, exercise, healthy family time and interaction.

Recognizing and Managing Stress

By Jeff Dwarshuis LMSW ACSW

The work environment can be very stressful and without proper management of stress the negative impacts on an employee can be surprisingly harmful. Stress, also called anxiety, creates symptoms that are physical, psychological and emotional. Left unmanaged, anxiety can leaving the employee with mild behavioral symptoms to chronic anxiety requiring medical leave and long-term follow-up treatment.

Symptoms and Types of Anxiety

The most common form of anxiety is called Generalized Anxiety Disorder and it has a number of symptoms. First there are physical symptoms of headaches, muscle tension, tightness in the chest, stomach pain, difficulty swallowing, restlessness, being easily tired and tingling in the hands or feet. There are psychological symptoms of excessive worry, feeling on edge, poor concentration and then behavioral symptoms of irritation, having a hard time getting to sleep and pacing. People who are stressed often appear angry, keyed up, directionless, over paced, argumentative, flushed and unhappy.

There are several types of anxiety in addition to Generalized Anxiety Disorder. For example, there are Phobias, Posttraumatic Stress Disorder, Obsessive Compulsive Disorder and Panic Attacks. These have more specific behavioral patterns and are much less common than Generalized Anxiety.

Managing Stress

The most important thing to do is to recognize stress symptoms early and treat them quickly. Anxiety, especially if it has continued for a long time, can be unpredictable with symptoms emerging in a way that seems to be ”for no good reason”. Unmanaged Generalized Anxiety can lead to Panic Attacks and Major Depression. At this level the person generally requires inpatient psychiatric hospitalization. Early treatment of anxiety ranges from homecare to medication and psychotherapy. Most intensive treatment can be avoided by following the suggestions below. Remember also that managing stress is both a conscious process and a life style.

Recognize the Symptoms – Read and memorize the symptoms listed above. If you have more than a few of these symptoms you should make changes.
Critical Problem Solving – Unsettled problems create stress and completed projects decrease stress. Clearly define unfinished projects, create a list of brainstormed options and come up with the best solution quickly.
Assertiveness – Recognizing and saying or writing one’s feelings will dramatically decrease stress. When self expression is used with people it leads to problem solving and increased quality in the workplace environment.
Time Management – Develop time management skills. Be organized by mapping out tasks and allow a proper amount of time for each task. Stay away from perfectionism while also spending enough time to do a good job. Also, keep clear boundaries between work and home.
Self Care – Maintain a balanced and healthy diet. Avoid excessive caffeine, get proper sleep and keep from substance abuse. Exercise is critical because it has an effect on the body that decreases stress. Also, body relaxation is important and can be done by stretching, breathing exercises, reading, laughing and having fun.
Social Support – A fulfilling family and social life is enjoyable and allows a healthy distraction from routine stress. Social fulfillment helps to keep values in perspective and gives a sense of purpose and belonging. Distraction, perspective and purpose are central to a calm attitude.

Take some time to evaluate if stress is a problem for you. Addressing and decreasing stress will lead to a happy, healthy and more productive life.