Depression self-evaluation – Goldberg Depression Scale

Instructions


You might reproduce this scale and use it on a weekly basis to track your moods. It also might be used to show your doctor how your symptoms have changed from one visit to the next. Changes of five or more points are significant. This scale is not designed to make a diagnosis of depression or take the place of a professional diagnosis. If you suspect that you are depressed, please consult a mental health professional as soon as possible.


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The 18 items below refer to how you have felt and behaved during the past week. For each item, indicate the extent to which it is true, by checking the appropriate response next to the item.


Responses:


  • Not at all (0)

  • A little (1)

  • Somewhat (2)

  • Moderately (3)

  • Quite a lot (4)

  • Very much (5)



Questionnaire


1. I do things slowly.
  • Not at all

  • Just a little

  • Somewhat

  • Moderately

  • Quite a lot

  • Very much



2. My future seems hopeless.
  • Not at all

  • Just a little

  • Somewhat

  • Moderately

  • Quite a lot

  • Very much



3. It is hard for me to concentrate on reading.
  • Not at all

  • Just a little

  • Somewhat

  • Moderately

  • Quite a lot

  • Very much



4. The pleasure and joy has gone out of my life.
  • Not at all

  • Just a little

  • Somewhat

  • Moderately

  • Quite a lot

  • Very much



5. I have difficulty making decisions.
  • Not at all

  • Just a little

  • Somewhat

  • Moderately

  • Quite a lot

  • Very much



6. I have lost interest in aspects of life that used to be important to me.
  • Not at all

  • Just a little

  • Somewhat

  • Moderately

  • Quite a lot

  • Very much



7. I feel sad, blue, and unhappy.
  • Not at all

  • Just a little

  • Somewhat

  • Moderately

  • Quite a lot

  • Very much



8. I am agitated and keep moving around.
  • Not at all

  • Just a little

  • Somewhat

  • Moderately

  • Quite a lot

  • Very much



9. I feel fatigued.
  • Not at all

  • Just a little

  • Somewhat

  • Moderately

  • Quite a lot

  • Very much



10. It takes great effort for me to do simple things.
  • Not at all

  • Just a little

  • Somewhat

  • Moderately

  • Quite a lot

  • Very much



11. I feel that I am a guilty person who deserves to be punished.
  • Not at all

  • Just a little

  • Somewhat

  • Moderately

  • Quite a lot

  • Very much



12. I feel like a failure.
  • Not at all

  • Just a little

  • Somewhat

  • Moderately

  • Quite a lot

  • Very much



13. I feel lifeless -- more dead than alive.
  • Not at all

  • Just a little

  • Somewhat

  • Moderately

  • Quite a lot

  • Very much



14. My sleep has been disturbed -- too little, too much, or broken sleep.
  • Not at all

  • Just a little

  • Somewhat

  • Moderately

  • Quite a lot

  • Very much









15. I spend time thinking about HOW I might kill myself.
  • Not at all

  • Just a little

  • Somewhat

  • Moderately

  • Quite a lot

  • Very much



16. I feel trapped or caught.
  • Not at all

  • Just a little

  • Somewhat

  • Moderately

  • Quite a lot

  • Very much



17. I feel depressed even when good things happen to me.
  • Not at all

  • Just a little

  • Somewhat

  • Moderately

  • Quite a lot

  • Very much



18. Without trying to diet, I have lost, or gained, weight.
  • Not at all

  • Just a little

  • Somewhat

  • Moderately

  • Quite a lot

  • Very much



Scoring


  • If you score points was less than 9 then depression is not indicated.

  • Between 10 and 17 – perhaps some slight depression.

  • Between 18 and 21 – perhaps the brink of depression.

  • Between 22 and 35 – less than indicated moderate depression.

  • Between 36 and 53 – moderate to severe depression can be.

  • Over 54 – maybe suffering from severe depression.



About Developer


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Ivan K. Goldberg, M.D specializes in the treatment of individuals with treatment-resistant depression. The founder of Depression Central , he is a psychiatrist and clinical psycho-pharmacologist in private practice in New York City. Formerly on the staff of the National Institute of Mental Health and the Departments of Psychiatry of the Columbia- Presbyterian Medical Center, and Columbia University's College of Physicians and Surgeons, he now devotes his time to evaluating and providing advanced innovative treatment for individuals whose depression or bipolar disorder has not responded to standard drug treatments.




Sources and Additional Information:






Circadian Rhythm Chronotherapy for Depression Treatment

In one of our previous post we discussed an unusual approach to the depression treatment through sleep deprivation. This method shows very encouraging results in the critical conditions, but is difficult to apply and the received positive effects are usually not sustainable. While the related research is still ongoing, there is no doubt that sleep and depression have tight links, and there is a good potential for the further remedy for the patients.


Chronotherapy is one of the new therapies, applying developed knowledge on the connection between natural biorhythms and well-being to the depression treatment. It is using the circadian rhythm-altering interventions that treat depression by adjustments of the sleep-wake cycle and daily light exposure. In a way, it is theory combining the sleep regulation and light therapy for the patients’ treatment.


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Indications for Chronotherapy


Chronotherapy has been found to benefit most forms of depression including:


In addition to these diagnostic indications, chronotherapy is also useful in the following circumstances:
  • When there is a need for a rapid antidepressant response; in other words, when someone needs to get better quickly

  • Inability to tolerate or preference to avoid medication.

    Most often, chronotherapy is used along with antidepressant or mood-stabilizing medication. It can, however, be used on its own, especially when several different forms of chronotherapy are used in combination.



This option allows for a fully non-pharmacologic treatment for those who are sensitive to, or need to minimize medication side-effects; for example, those with other medical illnesses, the elderly, and for antepartum and post-partum depressions.


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Contraindications to the use of Chronotherapy


  • Psychotic Depression.

    People who are experiencing hallucinations or delusions while depressed (or when manic) should not receive chronotherapy.

  • Mixed States (the simultaneous co-occurance of both manic and depressive states) or depressive states with significant anxiety or other manic symptoms (relative contraindication).

    Chronotherapy, like all other biological forms of antidepressant treatment, can cause emotional side effects. About 7% of patients treated with wake therapy will develop hypomanic symptoms. Patients experiencing manic or significant anxiety symptoms as part of their depression are at a higher risk of having this reaction. It is therefore contraindicated in this group.

  • Certain eye conditions may limit the use of bright light treatment.

    Retinal problems, macular degeneration and the use of photosensitizing medications may complicate or prevent the use of light treatment.

  • The presence of epilepsy or a seizure disorder is a relative contraindication for wake therapy.

    The use of antipsychotic drugs, sleep medications (sedatives), or certain anti-anxiety agents can interfere with the action of wake therapy and may need to be discontinued or temporarily suspended.



Chronotherapy Types


Chronotherapy is basically therapy using manipulation of sleep, wake and light. There are different types of Chronotherapy:
  1. Light therapy - this is dosed precisely and at exact times. This therapy is well-known in the treatment of seasonal affective disorder (SAD).

  2. Wake therapy – use of prolonged periods of wakefulness.

  3. Sleep phase advancement – moves the time of the sleep forward to early evening to improve antidepressant action.

  4. Triple chronotherapy – a combination of the above three.

  5. Dawn simulation – gradual light before waking.

  6. Chronobiotics – use of circadian rhythm-modifying compounds such as melatonin.

  7. Social rhythm therapy – schedules daily activities.



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How Chronotherapy Works?


As with most complicated things in life, scientists and doctors admit that the picture is far from being clear. What they are pretty sure about though is that natural circadian rhythms for different mental illnesses are often disturbed.


So, in the average person, they want to sleep at night and be awake during the day. They also want to sleep around eight hours a night and wake and sleep at about the same time each day. This rhythm can be interrupted by normal, life events, but the person will regain their rhythm once circumstances allow.


The problem with different mental illnesses is that people sleep too much, we don’t sleep enough, or they able to get sleep at the wrong times. It’s one of the reasons so many of the many of the people are hooked on the various sleeping medication.


The idea of Chronotherapy then, is to reinstate a natural sleep rhythm, or to manipulate the sleep rhythm for the positive therapeutic effect.


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Triple Chronotherapy


“Triple chronotherapy is a natural, ultra-rapid therapy that typically reduces depressive symptoms within one-to-two days,” explains Northwestern Medicine psychiatrist John Gottlieb, MD, who is an assistant clinical professor of psychiatry and behavioral science at Northwestern University Feinberg School of Medicine. “This approach doesn’t require medications, but it’s every bit as biologically active as antidepressant medications.”


Circadian rhythms are the fluctuations of certain physiological variables that occur over a 24-hour period, like sleeping, for instance. Circadian-shifting approaches, like bright-light therapy and dawn stimulation, have long been proven to effectively treat depression and other emotional disorders. Triple chronotherapy is no different, and has been used in Europe for nearly two decades in the successful treatment of unipolar and bipolar depression, as well as seasonal affective disorder. However, due to the intensiveness of the approach, patients were required to remain in the hospital during treatment. For the first time, the triple chronotherapeutic protocol is being administered on an outpatient basis, and Northwestern Medicine is one of few centers to offer this in the US.


“Chronotherapy has been demonstrated to be effective,” said Gottlieb. “However, it is not used for patients with psychotic depression or for patients who are bipolar and not on medication. Additionally, patients with eye disorders may be unable to undergo light therapy.”


As he explains, the first part involves wake therapy which requires a period of extended wakefulness over one night and the following day. This acts as an antidepressant response-inducer, jump starting an improvement in mood. Following wake therapy, patients move their sleep period earlier (sleep phase advance) and begin using bright light at prescribed times.


Chronotherapeutic treatments can also be used with antidepressant and other psychiatric medications. These combinations can both enhance and expedite treatment response. According to Gottlieb, standard, pharmacological therapy for depression takes between two to eight weeks before significant improvement occurs. Bright light therapy generally produces an antidepressant response within one to two weeks, while triple chronotherapy can induce remissions within hours.


“Triple chronotherapy provides a faster and lasting antidepressant option for many people who struggle with depression.” Gottlieb said.




Sources and Additional Information:






Quick inventory of depressive symptomatology (self-report) (QIDS-SR 16)

Instructions: Please circle the one response to each item that best describes you for the past seven days.


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1. Falling asleep:

0 I never take longer than 30 minutes to fall asleep.

1 I take at least 30 minutes to fall asleep, less than half the time.

2 I take at least 30 minutes to fall asleep, more than half the time.

3 I take more than 60 minutes to fall asleep, more than half the time.


2. Sleep during the night:

0 I do not wake up at night.

1 I have a restless, light sleep with a few brief awakenings each night.

2 I wake up at least once a night, but I go back to sleep easily.

3 I awaken more than once a night and stay awake for 20 minutes or more, more than half the time.


3. Waking up too early:

0 Most of the time, I awaken no more than 30 minutes before I need to get up.

1 More than half the time, I awaken more than 30 minutes before I need to get up.

2 I almost always awaken at least one hour or so before I need to, but I go back to sleep eventually.

3 I awaken at least one hour before I need to, and can’t go back to sleep.


4. Sleeping too much:

0 I sleep no longer than 7–8 hours/night, without napping during the day.

1 I sleep no longer than 10 hours in a 24-hour period including naps.

2 I sleep no longer than 12 hours in a 24-hour period including naps.

3 I sleep longer than 12 hours in a 24-hour period including naps.


5. Feeling sad:

0 I do not feel sad.

1 I feel sad less than half the time.

2 I feel sad more than half the time.

3 I feel sad nearly all of the time.


6. Decreased appetite:

0 There is no change in my usual appetite.

1 I eat somewhat less often or lesser amounts of food than usual.

2 I eat much less than usual and only with personal effort.

3 I rarely eat within a 24-hour period, and only with extreme personal effort or when others persuade me to eat.


7. Increased appetite:

0 There is no change from my usual appetite.

1 I feel a need to eat more frequently than usual.

2 I regularly eat more often and/or greater amounts of food than usual.

3 I feel driven to overeat both at mealtime and between meals.



8. Decreased weight (within the last two weeks):

0 I have not had a change in my weight.

1 I feel as if I’ve had a slight weight loss.

2 I have lost 2 pounds or more.

3 I have lost 5 pounds or more.


9. Increased weight (within the last two weeks):

0 I have not had a change in my weight.

1 I feel as if I’ve had a slight weight gain.

2 I have gained 2 pounds or more.

3 I have gained 5 pounds or more.


10. Concentration/Decision making:

0 There is no change in my usual capacity to concentrate or make decisions.

1 I occasionally feel indecisive or find that my attention wanders.

2 Most of the time, I struggle to focus my attention or to make decisions.

3 I cannot concentrate well enough to read or cannot make even minor decisions.


11. View of myself:

0 I see myself as equally worthwhile and deserving as other people.

1 I am more self-blaming than usual.

2 I largely believe that I cause problems for others.

3 I think almost constantly about major and minor defects in myself.


12. Thoughts of death or suicide:

0 I do not think of suicide or death.

1 I feel that life is empty or wonder if it’s worth living.

2 I think of suicide or death several times a week for several minutes.

3 I think of suicide or death several times a day in some detail, or I have made specific plans for suicide or have actually tried to take my life.


13. General interest:

0 There is no change from usual in how interested I am in other people or activities.

1 I notice that I am less interested in people or activities.

2 I find I have interest in only one or two of my formerly pursued activities.

3 I have virtually no interest in formerly pursued activities.


14. Energy level:

0 There is no change in my usual level of energy.

1 I get tired more easily than usual.

2 I have to make a big effort to start or finish my usual daily activities (for example, shopping, homework, cooking or going to work).

3 I really cannot carry out most of my usual daily activities because I just don’t have the energy.


15. Feeling slowed down:

0 I think, speak, and move at my usual rate of speed.

1 I find that my thinking is slowed down or my voice sounds dull or flat.

2 It takes me several seconds to respond to most questions and I’m sure my thinking is slowed.

3 I am often unable to respond to questions without extreme effort.





16. Feeling restless:

0 I do not feel restless.

1 I’m often fidgety, wringing my hands, or need to shift how I am sitting.

2 I have impulses to move about and am quite restless.

3 At times, I am unable to stay seated and need to pace around.


Scoring the QID-SR-16

_____ Enter the highest score on any of the 1 of the 4 sleep items (#1, 2, 3 or 4)

_____ Item 5

_____ Enter the highest score on any ONE appetite item (#6, 7, 8 or 9)

_____ Item 10

_____ Item 11

_____ Item 12

_____ Item 13

_____ Item 14

_____ Enter the highest score on either of the psychomotor items (#15 or 16)

_____ TOTAL


Interpretation of Depression Severity Thresholds (QID-SR-16):

0 – 5 No Depression; 6 – 10 Mild; 11 – 15 Moderate; 16 – 20 Severe; 21 – 27 Very Severe


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The QIDS-C16 and the QIDS-SR16 total scores range from 0 to 27. The total score is obtained by adding the scores for each of the nine symptom domains of the DSM-IV MDD criteria: depressed mood, loss of interest or pleasure, concentration/decision making, self-outlook, suicidal ideation, energy/fatigability, sleep, weight/appetite change, and psychomotor changes. Sixteen items are used to rate the nine criterion domains of major depression: 4 items are used to rate sleep disturbance (early, middle, and late insomnia plus hypersomnia); 2 items are used to rate psychomotor disturbance (agitation and retardation); 4 items are used to rate appetite/weight disturbance (appetite increase or decrease and weight increase or decrease). Only one item is used to rate the remaining 6 domains (depressed mood, decreased interest, decreased energy, worthlessness/guilt, concentration/decision making, and suicidal ideation). Each item is rated 0-3. For symptom domains that require more than one item, the highest score of the item relevant for each domain is taken. For example, if early insomnia is 0, middle insomnia is 1, late insomnia is 3, and hypersomnia is 0, the sleep disturbance domain is rated 3. The total score ranges from 0-27.






Free online computerized cognitive-behavioral therapy for depression



Free? Then can it be worth much? Ah, that might depend on how hard you work. This is working with a computer, not a human.


Mind you, this may not work as well as seeing a real live therapist who knows the CBT approach well. But lots of people can't get real live CBT, because they:
  • Can't afford it

  • Can't find it

  • Don't like the whole idea of telling someone their problems (guys?)

  • Think they've already had it (but haven't)



So, if there was a way to get cognitive therapy for free, that would be pretty nifty. Well, there is.


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What is MoodGYM?


MoodGYM is an innovative, interactive web program designed to prevent depression. It consists of five modules, an interactive game, anxiety and depression assessments, downloadable relaxation audio, a workbook and feedback assessment.


Using flashed diagrams and online exercises, MoodGYM teaches the principles of cognitive behavior therapy – a proven treatment for depression. It also demonstrates the relationship between thoughts and emotions, and works through dealing with stress and relationship break-ups, as well as teaching relaxation and meditation techniques.


MoodGYM was designed and developed by staff at the Centre for Mental Health Research at the Australian National University, in collaboration with other researchers, mental health experts, web and graphic designers, and software engineers.


Each module explores issues such as:
  • why someone feels the way they do,

  • changing ‘warped’ thoughts,

  • changing the way they think, 

  • knowing what makes an individual upset,

  • assertiveness and interpersonal skills training.



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History


This idea originated, in a way, not with the internet but with another technology: telephone-based "interactive voice response" (IVR). Trying to make CBT more widely available, a team of researchers created an IVR system of therapy. I never got to try it, but apparently it worked as well as a live therapist.  Then, an intermediate form of computer-assisted therapy was tested at Harvard, in which a computer program was used to deliver some of the basic explanations and planning of CBT.  Therapist time was reduced accordingly. This worked as well as standard, "live" therapy. Now, there is a program in which all of your interaction is with your computer, none with a human.


Warning


Here are several ways in which this free program could harm you:
  • You try it, it doesn't work, and you conclude cognitive behavioral therapy doesn't work for you. Don't do that.

  • You try it, raise your hopes, it doesn't seem to help, you feel disappointed (especially if you tried hard)

  • You try this instead of a good, live therapist whom you could go see, within a few weeks, when you could afford it.

  • You stay up too late at night on your computer doing this homework instead of sleeping!

There is no evidence that this computer approach is better than a live therapist.  So since we know that good live CBT really works; and since we don't have a head-to-head comparison of computer versus live therapist yet; for now, you should only use this approach if for some reason it's clear: you need additional antidepressant help, and you are not going to be able to see a good, live therapist.


Why should you try it? If you really, for any reason, can't get CBT some other way; and if you need to add an additional antidepressant element into your treatment, and you want with all your hurt to make it work, the program might be quite useful for you and will help your recovery.  


Technical Requirements


Before using MoodGYM, please make sure that:
  • You have the flash 4.0 plug in (so that you can view graphics)

  • JavaScript is enabled (so that you can view extra content)

  • 'Cookies' are enabled (so that you can log in). If necessary, you can enable cookies using your browser's Help utility. Cookies are temporary and are deleted when you close your browser.

MoodGYM makes frequent use of multimedia presentations and graphics. If you are visually impaired, you may be using browser software that is unable to display some of this material.


Interface Languages


English and Norwegian


Cost


The program MoodGym is free and anonymous for all users. And there are no ads!








Power of the Human Touch for Depression Treatment

Human Touch Secrets


The skin is the largest organ in the body and touch is human’s natural way of reacting to pain and stress and conveying love and compassion. When something painful happens to you like when you accidentally bump your head on the wall, your natural reaction would be to rub the affected area to ease the pain. Kisses, hugs, and holding hands, meanwhile, are people’s way of expressing emotions toward another person.


The warmth of a hand held, the sensation of a soft cheek against ours, arms wrapped around shoulders in embrace... they can all go a long way toward expressing our affection for someone. But touch can actually give more than a momentary tingle or a second of solace; touch can comfort and heal.


The effect of a touch depends, of course, upon the situation. A touch from someone can be relaxing or reassuring, off-putting or gentle, soothing or stimulating. Touch can also bond us together in ways that transcend words or in situations in which words may not help.


The latest researches have shown that the people who are touch deprived are prone to diseases and emotional dysfunction. In nursing homes, tactile stimulation and caring touch are utilized to give patients a sense of security. In infants, those who are caressed by their parents often develop more properly than those who are not nurtured by their mothers. In one study it was found that fathers who gave their infants daily bedtime massages displayed more enjoyment and warmth with their child. In another, babies given a blood test were either swaddled in blankets or held, skin-to-skin, by their mothers. The babies being hugged had lower heart rates and cried 82% less than those left wrapped and lying in their cribs.


Some researchers also suggest that people who are deprived of touch early in life may have a tendency toward violent or aggressive behavior later, and research in rats has found that rats with a strong mothering instinct (measured by licking and grooming their babies) were more likely have babies that showed a strong mothering instinct.


Touch's comfort can extend to older kids, too. After receiving massage sessions, adolescents with ADHD expressed feelings of happiness, and their teachers noted a decrease in the adolescents' fidgeting and off-task activities. Even self-massage has benefits, as proven by a study of people trying to deal with the cravings and anxiety associated with quitting smoking. When they felt the urge to smoke, test subjects were advised to rub their hands together or stroke their ear lobes. Rubbed away with the tension was the urge to light up.


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Human Touch Therapies


Having a massage is one of the best ways to enjoy the wonderful benefits of physical touch. This therapy, which is known primarily for being able to relax both the mind and body, can bring a host of physiological and psychological effects in your health such as improvement of circulation, strengthening of the immune system, relaxation of tense muscles, reduction of spasms and pain, and improvement of range of motion, among many others.


Human-touch therapy includes modern, traditional and alternative methods known by a variety of names. The University of Maryland Medical Center states there are more than 100 different human-touch therapies. Physical therapy and chiropractic are examples of modern methods. Massage and acupuncture are traditional methods that have existed for centuries. Alternative methods, such as Rolfing and Touch for Health, combine modern and traditional therapies. These categories are flexible as evidenced by insurance companies using different labels for the same method. No matter the category or name, human-touch therapy can help with a variety of health and well being issues.


Touch therapy can help reduce negative influences of stress--physical and emotional. Pain, lowered mood and anxiety are all symptoms of stress. The University of Maryland Medical Center found that human touch therapies reduce certain stress-inducing hormones, such as cortisol, and release natural substances called endorphins in the body to reduce pain and elevate mood. Further, the touch therapies of spinal manipulation, acupuncture, and massage can and do ease pain and reduce depression--sometimes alone, sometimes in conjunction with other therapies.


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Not only Massage


However, it is important to note that massage is not the only way to experience the power of human touch. Even a simple kiss, hug, or a handshake can have positive psychological effects that can enhance overall health and facilitate healing and recovery.


On the physical level, human touch has the ability to lower blood pressure and reduce stress and tension. This is because a soothing touch can trigger the increase of oxytocin levels in the body, which gives a calming effect. When there is pain, a comforting human touch can alleviate the feeling and act as a numbing agent.


When it comes to emotional benefits, human touch like a comforting hand squeeze, a gentle tap on the back, or a reassuring hug can help intensely in stress management by calming and easing a person’s nerves. It is no wonder people feel good about themselves when they give or receive a hug. It is a sign that someone cares for them. Some studies have shown that people who receive sufficient physical affection (especially the non-sexual type) are less prone to depression and unhealthy habits such as drinking and smoking.


Aside from the two mentioned above, nourishment and comfort are also primary benefits of the human touch. Babies have instinctive craving for this. When a mother comforts a baby, rocks him or touches him lovingly, she may not be aware but this can greatly affect the growth and behavior of the child. Those who are held more often grow up to be more confident and less clingy children to those who are not.


For centuries, the human touch has been known to have positive healing effects on people. Even before medical technologies and medications were invented, people made use of the therapeutic effect of the human touch to improve a wide variety of health problems. Today, many still rely on the power of human touch.


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Human hand


The human hand possesses a particularly refined sense of touch. Researchers discovered that our hands can detect a dot just three microns high - a micron being a unit of linear measurement equal to 1 millionth of a meter (10 to the minus 6m) or 1/125000th of an inch (a human hair has a diameter of 50 to 100 microns).
However, by "using a texture rather than a dot, the researchers found the hand can detect roughness just 75 nanometers high" - a nanometer being one thousandth of a micron! This quite remarkable sensitivity is attributed to about 2,000 touch receptors in each individual fingertip!


In addition to such sensitivity, scientist have also discovered that we as humans are endowed with a special nervous system that senses love and tenderness - our senses of pleasure being evoked by a second nerve network in the skin, consisting of slow-conducting fibers called tactile C fibers.


Surprisingly, this network responds only to a gentle touch and activates those areas of the brain dealing with emotions.


A “Touch Phobic” Society


In today’s world, technology has reduced the amount of physical contact that people have with each other on a daily basis. With automatic bank machines, online shopping, internet, email and voice mail people can make appointments, dates or decisions without ever actually talking to or seeing another person. Those subtle contacts with others, once common on a daily basis are gone.


In addition, it is more common to hear about situations where touch has been used negatively or inappropriately. The news reports on child abuse cases, sexual harassment suits and rapes. Parents are teaching children to be wary of strangers, and to be selective in how and what to touch. Though this is beneficial to keep children safe, it has created a society that has become “touch phobic” where the simplest and most innocent touch can be easily misconstrued as sexual, or inappropriate.


It’s not like we can quantify the amount of loving touch that’s needed as a prescription to heal touch deprivation. But, one study sheds some light on the particular lack of touch in the American culture. Sets of American, French and Puerto Rican friends were observed in a coffee shop over the course of an hour to determine how frequently physical contact occurs. U.S. friends tend to touch each other an average of only twice an hour, whereas French friends touch 110 times, and Puerto Rican friends touch 180 times. There are significant cultural differences between these nations, but the new technology and artificial “personal space” establishment caused a noticeable signs of touch deprivation among Americans.


Dr. Barnaby Barratt from Santa Barbara Consulting and Healing highlights in his article on Nurturing Touch that "affectional touch is highly beneficial so long as it is experienced as 'appropriate' to the situation, and does not impose greater intimacy than is desired, or is not part of some interpersonal 'power play.' Touching should neither be coercive nor manipulative. It should be purely giving, and never used as a means to an ends, for example, as a maneuver to get someone into unwanted sexual relations.”


Due to the overload of negative touch, society has become very guarded. When people are touched in any form it is often perceived as bad or inappropriate. Unfortunately, this change in perspective has denied people the simple opportunities to enhance their development and one of the key elements needed to thrive and grow.


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Healthy Touch Tips


In general, hugs, handshakes, a hand on the shoulder or a comforting rub on the back are examples of appropriate touch.



~ Make sure the person you desire to touch consents before you proceed.



~ You may verbally ask to touch and receive a verbal consent.



~ You may extend your arms to hug a loved one and they may extend their arms to receive.



~ You may extend a hand to offer a hand shake and the person reciprocates.



~ You may move toward a person who appears in need of a comforting hand on the shoulder -  Look in their eyes and watch their body language for consent.



~ If your touch is rejected, don't take it personally!


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Sources and Additional Information:






Hakomi Therapy for Depression

Body Centered Therapies


Body centered psychotherapy is psychotherapeutic work that uses the body as a resource. The body is intimately connected with the mind, spirit, and emotions of a person and it acts as a vehicle to resolve relevant issues.


Body centered psychotherapists believe that the patient is a whole person and much of what is helpful to them can be accessed in other areas beyond the conscious mind. The body holds emotional information and this information can be accessed and processed through the body.


They believe that trauma and negative events create blocks in our experience of our “full self” by binding energy in our bodies. The therapy helps us release negative emotions, which results in satisfaction, joy, and even character changes in the patient.


What is Hakomi Therapy?


Hakomi Therapy is one of the newly developed mindfulness-based, body-centered forms of psychotherapy, which became popular around the World. The Hakomi Method of Experiential Psychotherapy was first created in the late 1970's by the internationally renowned therapist and author, Ron Kurtz. In 1981, to fully develop the method and promote the teaching of Hakomi, Ron and a core group of therapists and educators founded the Hakomi Institute. Today, Hakomi Trainings and workshops are presented throughout the world, in North America, Europe, Japan, Latin America, Australia and New Zealand.   


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Integrating scientific, psychological, and spiritual sources, Hakomi has evolved into a complex and elegant form of psychotherapy that is highly effective with a wide range of populations. The method draws from general systems theory and modern body-centered therapies including Gestalt, Psychomotor, Feldenkrais, Focusing, Ericksonian Hypnosis, Neurolinguistic Programming, and the work of Wilhelm Reich and Alexander Lowen. Core concepts of gentleness, nonviolence, compassion, and mindfulness evolved from Buddhism and Taoism.


Basic Principles


These are five basic principles Hakomi Therapy is based on:
1. Unity
- We are all interconnected within the universe.
2. Body/mind/spirit holism
- The mind, body, and spirit are interconnected and influence each other.
3. Organicity
- What contributes to our breakdowns in healing is the limiting beliefs that block us from our full authentic selves.
4. Mindfulness
- It is a state of consciousness where the patient’s awareness is directed inward on their experience in the present moment. When we focus mindfully on our experience, we can deepen our understanding of our inner relationships, which gives us an alternative to acting habitually to our limiting beliefs.
5. Nonviolence
- The therapeutic process unfolds without force and with the cooperation of the unconscious.
6. Loving kindness
- This is based on studies that indicate that a therapist’s attitude is more healing than the method they use.


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Hakomi therapists believe that a person’s behavior, thoughts, feelings, attitudes, and relationships are determined by unconscious core beliefs. These beliefs organize the person’s experience of the world and are set early (usually) in life by early relationships and experiences. Hakomi therapists work with limiting, problematic beliefs. They allow the patient to release negative emotions and beliefs and reorganize into a healthier self.


Body centered psychotherapy incorporates the whole self (mental, physical, and spiritual) into a system of healing that traditional psychotherapies often overlook. They more quickly access deeper levels of unconscious material, which can facilitate more significant changes in core beliefs and attitudes.
BCPs are mainly applied to growth and human potential, not treating specific disorders. However, they can be very useful in treating common mental disorders like depression, anxiety, and ADHD. It can also help to deal with trauma.


The Method


Hakomi helps people change “core material.”  Core material is composed of memories, images, beliefs, neural patterns and deeply held emotional dispositions. It shapes the styles, habits, behaviors, perceptions and attitudes that define us as individuals. Typically, it exerts its influence unconsciously, by organizing our responses to the major themes of life: safety, belonging, support, power, freedom, control, responsibility, love, appreciation, sexuality, spirituality, etc. Some of this material supports our being who we wish to be, while some of it, learned in response to acute and chronic stress, continues to limit us. Hakomi allows the client to distinguish between the two, and to willingly change material that restricts his or her wholeness.


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Hakomi is an experiential psychotherapy: Present, felt experience is used as an access route to core material; this unconscious material is elicited and surfaces experientially; and changes are integrated into the client's immediate experience. 


Hakomi is a body-centered, somatic psychotherapy: the body serves as a resource that reflects and stores formative memories and the core beliefs they have generated, and also provides significant access routes to core material.


The Hakomi Method follows a general outline: First, we establish an ever-present, attitude of gentle acceptance and care known as loving presence. This maximizes safety, respect and the cooperation of the unconscious. With a good working relationship established, we then help the client focus on and learn how core material shapes his or her experience. To permit this study, we establish and use a distinct state of consciousness called Mindfulness.  Mindfulness is characterized by relaxed volition, a gentle and sustained inward focus of attention, heightened sensitivity, and the ability to notice and name the contents of consciousness. Its roots derive from Eastern meditation practice. Hakomi has pioneered the use of active, or dynamic mindfulness in psychotherapy: instead of using mindfulness meditation as simply an adjunct to therapy, virtually the entire Hakomi process in conducted in mindfulness. This facilitates Hakomi techniques in accessing unconscious material quite rapidly, but safely.


The heart of the Method works with the client’s present, felt experience, as it is presented spontaneously, or deliberately and gently evoked by having them experiment with habitual tension or movement patterns known as “indicators.” These emotional/cognitive patterns automatically keep deeper experience out of present awareness. The results are processed through different state-specific methods, including:
  • We work with strong emotions and bound energy, safely releasing them, and finding nourishment in that release

  • We work with the inner child and other specific self-states, often in the context of vividly re-experienced memories, frequently providing the “missing experience” for the child.

  • We process core beliefs in mindfulness, not as intellectual problem-solving, but as direct dialogue with the unconscious.



The basic method, then, is this: 
  • To establish a relationship in which it is safe for the client to become self-aware

  • To use the Hakomi methodology to evoke experiences that lead to the discovery of organizing core material

  • To seek healing changes in the core material. 



All is in support of this primary process. Once discovered in this experiential manner, core material can be examined, processed, and transformed. Transformation begins when awareness is turned mindfully toward felt, present experience; unconscious material unfolds into consciousness; barriers are attended to; and new experiences are integrated that allow for the reorganization of core beliefs. These, in turn, allow for a greater range of mental, physical, and emotional coherence and behavior.


Finally, we help the client to integrate these new beliefs, modes and choices into everyday life.  It is here - in the ability to transform new possibilities discovered in the office into on-going actualities of daily living - that real change happens.


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Hakomi is effective and appropriate in many therapeutic situations, with individuals, couples, families, and groups. It integrates well with a variety of psychotherapeutic, counseling and healing modalities, and is successfully used by counselors, psychotherapists, social workers, pastoral counselors, expressive therapists, bodyworkers, group therapists, crisis counselors, and many other practitioners. It is effective for both brief and long-term therapy.


How it Works


In mindfulness, one can notice things that normally go unnoticed. So we can do simple collaborative experiments to find these unconscious reactions. Here is one example: Therapist might say a nourishing statement to you (one he senses you need to hear, like "You are safe.") and have you sense the changes that come over you as you hear it. You may be conditioned to disregard it, i.e.: a voice in your head says: "No, I'm not!" or you may tighten up your shoulders or stomach when you hear this statement. What good information to have! Next, we can explore what may be needed for you to drop these old adaptations that are no longer needed, and begin really taking in the good that the world has to offer you.






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Male Suicide - Gender Factor in Suicide

Statistics
  • More men than women die by suicide. The gender ratio is 4:1.

  • 72% of all suicides are committed by white men.

  • 80% of all firearm suicides are committed by white men.

  • Among the highest rates (when categorized by gender and race) are suicide deaths for white men over 85, who had a rate of 59/100,000.

Suicide and men


Suicide accounts for 1 in 100 deaths. The majority of those who die in this way are men.


A worrying recent trend is the increasing rate of suicide among younger men (a trend not seen among young women). The majority of these men have not asked for help before their deaths.


The suicide rate in men also increases in those aged between 65 and 75 years. In contrast, the suicide rate in women varies less with age.


The higher suicide rate among men is a worldwide phenomenon. A few exceptions to the general rule exist, for example, among elderly women in Hungary and in some Asian countries. The reasons why men are more likely to kill themselves than women are complex and ill-understood. However, several pointers help our understanding.


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Risk factors for suicide


As well as being male, several other risk factors for suicide have been identified.


  • Age: suicide in men peaks in the 20s and again in the 60s and 70s.

  • Unemployment: the suicide rate has been shown to rise and fall with the unemployment rate in a number of countries – half of the record 33,000 people who committed suicide in Japan in 1999 were unemployed.

  • Social isolation: those who kill themselves often live alone and have little contact with others. They may have been recently widowed or have never married. They usually are not being able to form or sustain meaningful relationships.

  • Chronic illness: any chronic illness increases the risk of suicide.

  • Certain occupations: people with certain occupations are more likely to die by suicide, for example farmers (who usually work alone, may be unmarried and have access to the means of suicide, such as a shotgun or poisonous weedkiller).

  • Drug abuse: using drugs and/or alcohol to help cope with emotions, relationships, pressure of work etc.

  • A history of physical and sexual abuse.

  • Imprisonment.

  • Subject of bullying: being bullied at school/college/work.

Many of the above risk factors affect men more than women. It is important to remember that many people are subject to these factors, but only a tiny minority of them will end their own lives.


Other factors are also significant. The most important risk factor is the presence of a mental illness. The most important protective factor is the presence of good support from family or friends.


Mental illness


Research has shown that the vast majority of those who kill themselves are mentally ill at the time of their death. Two thirds are troubled by a depressive illness and 20 per cent by alcoholism.


Of people with severe depressive illnesses, 10 to 15 per cent will commit suicide.


Paradoxically, as mentioned above, depressive illnesses are more common in women, but suicide is more common in men.


Several possible explanations exist for this apparent discrepancy.
  • The more severe the depression is, the more likely it is to lead to suicide. So one possibility is that more severe forms of depressive illness are equally common in men and women. In addition, once men are depressed, they are more likely to end their lives. They are also more likely to choose especially lethal methods when they attempt suicide, for example, hanging or shooting. Depressive illness among people under 25 years of age is probably much more common now than it was 50 years ago, which may be one reason why the suicide rate is increasing in young men.

  • Alcoholism leads to suicide in 10 per cent of affected people. Alcoholism is much more common in men (though it is increasing rapidly among women).

  • Schizophrenia (a relatively uncommon condition affecting 1 in 100 of the population) leads to suicide in 10 per cent of affected people.

 Why is the male suicide rate rising?


The reasons why the number of men taking their own lives has risen in recent years are far from clear. All of the proposed explanations share a common feature – the changing role of men in society.
  • Adolescence has been prolonged, with adulthood and independence reached at a much later age than previously. Two generations ago, work began at the age of 14; one generation ago at 16 years for most; now many men only achieve financial independence in their mid 20s.

  • Men have a more stressful time in achieving educational goals than in the past and are now less successful in this regard than women.

  • Work is much less secure now and periods of unemployment are the norm for many (psychologically the threat of unemployment is at least as harmful as unemployment itself).

  • Alcohol use, and abuse, has increase markedly since the Second World War. Such use is often an attempt to cope with stress and to self-medicate symptoms.

  • Illegal drug abuse has become much more common (a correlation between the youth suicide rate and the rate of convictions for drug offences has been demonstrated in some countries).

  • Changes that are assumed to be symptoms of the 'breakdown of society' are associated with a rising suicide rate (examples include the rising divorce rate and falling church attendances).



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Boys don't cry


In many societies, expressing emotions, for example sadness, fear, disappointment or regret, is seen as being less acceptable for boys than girls.


This cultural stereotype is very difficult to shake off, though the advent of 'new men' in the 1990s, and 'metrosexual' men in this century, have made it more acceptable for men to open up to others.


If a man, particularly an older man, does cry openly, this is often a sign of severe depression and is taken very seriously indeed by health professionals.


Deliberate self-harm


Some of those who 'attempt' suicide, do not actually intend to kill themselves. They mimic the act of suicide by taking an overdose or cutting themselves.


They do so in an attempt to change an intolerable situation or gain attention from significant other people in their lives. This process is known as deliberate self-harm or parasuicide.


Such people can get considerable relief of tension and anxiety from these acts.


Deliberate self-harm is more common in women, though the proportion of men who self-harm is increasing.


Some 10 to 15 per cent of those who attempt suicide go on to complete suicide. Of course this means that 85 to 90 per cent do not.


Is Suicide Preventable?


Not all suicide attempts succeed and many people who set out with the clear intention of ending their own lives find that with good emotional and practical support they are able to adjust their circumstances to live a complete and fruitful life. The warning signs listed above do not inevitably lead to suicide attempts although where suicide is attempted and fails that person is much more likely to try again and be successful. People who feel suicidal often report a certain kind of tunnel vision, of being unable to see the broader picture and thinking only in terms of black and white. In such circumstances that individual may not be motivated to seek out help for themselves and it falls on others to offer support by listening, offering encouragement and sometimes even challenging the preconceptions that people hold about themselves such as their abilities and their worth to society.


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How does suicide affect others?


It's not true that suicide hurts no one except the person who takes his or her life.


Those who are left behind will typically go through a number of stages as they grieve – denial, anger, guilt, confusion, a protective wish to prove death was accidental, and, perhaps, depression and anxiety.


Barriers to effective treatment of depression in men


  • Men are less likely to recognize that they are under stress or unhappy, let alone ill.

  • Men are less likely to consult their doctor when distressed.

  • If they do consult their doctor, they are more likely to complain of physical symptoms (for example, stomach ache) or vague ill-health.

  • Health professionals are often less likely to consider a diagnosis of mental illness in men.

  • Some of the young men who kill themselves without ever seeking help seem to not have an identifiable mental illness. Rather, they are troubled by a philosophical dilemma, a disease of the soul, for which suicide seems the solution.



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