Myth Busting Part 2: Recovery From Stress Anxiety & Depression

Global businessIn Part 1 of this “Myth Busting” blog I told you about a workshop I had been running on wellbeing and recovery when someone in the audience yelled out “there’s no such thing as stress – it’s all in your head!” They subsequently claimed they had never been stressed, anxious or depressed and believed anyone who had these problems was simply weak-minded and need to harden up. These misinformed comments upset the rest of the audience and I had to stop my planned session and instead refocus the remainder of the session on two important and often misunderstood issues regarding stress and recovery:

1. Is Stress A Real Condition? – The Myth – “It’s not real and it’s all in your head!”; and
2. Is Recovery Simply About Hardening Up? – The Myth – “All you need is to have a ‘tougher’ attitude to life, harden up and you will be fine.”

Having addressed the first Myth about Stress in Part 1, let us now turn our attention to the second Myth about Recovery from Stress.

Myth Busting 2:

Is recovery simply about hardening up? – The Myth – “All you need is to have a ‘tougher’ attitude to life and you will be fine.”

It still amazes me that even now after many decades of research and widely publicized health promotion campaigns on stress and wellbeing many people are still openly critical of those of us who are honest about the stress we experience and even more critical if we admit to seeking help through either self-help strategies, use of medications or natural remedies, or seeing a counselor or psychologist. The stigma of being proactive in recovery strategies from stress conditions stops many people from recovering fully and enjoying life to the fullest!

For those of us who do take steps beyond the self-reproach of “simply telling ourselves  hardening up”, we must navigate a myriad of supposed “recovery solutions” in order to find the right approach. When attempting to understand what the best recovery is, many people find themselves asking the same set of questions, namely: (1) Should we use medications or natural remedies?; (2) Should we use self-help strategies and if so, which ones?; and (3) Should we see a psychologist, counselor or coach and if so, how long and what role should they play?

Let’s address each of these three important questions one at a time:

1. Medications vs. Natural Remedies….

Question: Should we use medications or natural remedies?

As a clinical psychologist I am not authorized to prescribe medications for stress, anxiety or depression and as such I felt it best that a Psychiatrist who is authorized to prescribe such medications author this next section.

According to my colleague, Psychiatrist, Dr John Warlow:
“In the last 40-50 years, a number of medications have been developed to help people cope with stress, anxiety and depression. Commonly used medications are the Antidepressants, which are used for anxiety and depression. Over the last decade or so, a whole new range of antidepressants, particularly focusing on a brain chemical called serotonin, have been developed. These are safer, and have less side effects than the old ones, which tended to focus on serotonin and another brain chemical called noradrenaline. Around two-thirds of people with depression or anxiety disorders improve to some extent by taking them but this improvement may not last unless there are also changes in attitudes and behaviors through improved coping skills.

The types of depression which are particularly responsive to these medications include those where there are changes to sleeping and eating patterns, concentration and memory changes. The types of depression which are not so easily improved by these drugs include those which are less severe and more reactive to life events, which don’t have the ‘neurovegetative’ changes, such as sleep and eating disturbances. These types are best resolved using healthy thinking and coping skills.

If you are prescribed an antidepressant medication it is vital to take the prescribed dosage at the prescribed times (as with any medication). It is also important to note that most antidepressants have a delayed response rate – which means you need to take them consistently for approximately 1-2 weeks before expecting to feel much improvement.

As well as using antidepressants, some people with anxiety disorders may also use other specific anti-anxiety drugs. These drugs help a person reduce physical tension and stress and develop a more calm and relaxed physical state. They can be addictive, and should be used in conjunction with developing better anxiety management coping skills. Some common types of anti-anxiety drugs include the various antidepressants previously discussed, as well as the sedative and tranquilising medications (technically called benzodiazepines). There is also a range of anxiety specific medications have been used to assist people with anxiety problems.

Dr Warlow on Natural Medicines for Anxiety and Depression:

“Natural remedies are generally either herbs, vitamins or minerals. In addition, dietary interventions and the exclusion of synthetic materials (artificial colors, flavours and preservatives) has also been used, particularly where there might be allergic problems.
Some natural medicines such as St John’s Wort, Valarium and Kava have shown some benefit in assisting people coping with low-level symptoms of depression, anxiety and stress. It is important to be aware that some herbs, vitamins or minerals that are marketed for help with stress, anxiety or depression may not have been submitted to rigorous scientific research, and may be seen as helpful based on anecdotal stories of success. It is also important to understand what an effective dose of such natural medicines may be and the appropriate duration to take such a course of medicine. Whilst the effectiveness of many natural medicines is still being researched, it is likely that the researched natural medicines do have real benefit in some situations, with some people, but as with the prescribed medications above, long-term change will also require changes in attitudes and behavior through the use of improved coping skills“.

Thanks John! It is good to know there are some real benefits to prescribed medications and natural medicines for many people depending on their specific circumstances and advice from their doctor. It is also good to know that regardless of the use of medications – long-term change also requires changed attitudes and behavior through the use of improved coping skills.

2. Self help Strategies…

The Question: Should we use self-help strategies and if so – which ones?

Should we help ourselves in recovery? YES! Self-help is a ‘no brainer’ when it comes to recovering form stress, anxiety and depression.

Research has shown that self-help is very effective in promoting recovery either as a stand-alone approach or in conjunction with medical and psychological treatments. Whilst self-help is essential and there are hundreds of thousands of books, videos, podcasts and programs on self-help and recovery, not all of these self-help strategies are beneficial – some are even bad and/or harmful.

The only self help materials worth reading, watching or listening to are those which include a ‘cognitive behavioral’ approach as part of their self-help formula of recovery. That is, they teach you practical techniques on how to reframe negative thinking, use behavioral skills to manage negative emotions and help you make positive changes to your lifestyle and improve your sense of purpose.

There are quite a number of authors in the self-help space who define themselves in different ways such as a ‘relationship expert’, ‘recovery expert’, ‘success guru’, ‘spiritual awareness guide’ etc. and it can be easy to get confused about whether or not their message is based on proven recovery strategies according to their book titles and promotional material. However, a quick read of the contents page or first few chapters should easily alert you to the inclusion or absence of practical cognitive behavioral strategies and lead you to disregard or read on accordingly.

Needless to say I write all my recovery focused books and blogs from a cognitive behavioral approach linking the “Four Elements of Wellbeing” (Mindsets, Emotions, Lifestyle & Purpose) to the “Four Elements of Nature” (Wind, Water, Earth & Fire) when it comes to overcoming stress and “Riding The Waves of Life”. These simple links to the concepts of nature and waves make things easy to understand, fun to read and easy to put into practice in every day life.

3. Counselor or Coach…

The Question: Should we see a counselor or coach and if so, how long and what role should they play?

Life coaching is for people that are mentally healthy, highly functional, and capable of achieving their goals. Coaching clients are typically goal-oriented people that are in need of guidance, motivation, and accountability. They are looking forward to where they want to be, not back to where they’ve been. Life coaching is focused on ‘future’ goals, overcoming obstacles in the ‘present’.

Coaching is not appropriate for clients who suffer severe depression, anxiety, posttraumatic stress disorder, or unresolved issues requiring a counselor to help them analyse the (recent) ‘past’ for causes of emotional pain and unhealthy behaviour patterns in the ‘present’.

When is comes to Counselors there are a number of therapists available ranging from people with no qualifications or formal training through to specialist clinical psychologists and mental health professionals with post-graduate degrees and advanced clinical training. I would recommend getting counselling from a health professional such as a registered psychologist who has formal qualifications and training in evidenced based treatment for depression, anxiety and stress should you have one of these more severe conditions.

How long you see a counselor is an important question. Generally, people will get the most value by having 5-7 sessions of therapy during which time the therapist should play a very active and direct role in guiding recovery and providing homework tasks and monitoring activities between sessions. After the initial period of therapy the counselor should change their role from active and directive to a more reflective and supportive role in any follow-up sessions to prevent relapse and promote resiliency.

NOTE: Active vs. Passive & Enduring Results…

I feel compelled to include a comment about Active vs. Passive approaches to recovery. Whilst I know it may seem obvious that an active approach is essential to enduring recovery, and indeed as Dr John Warlow pointed out using coping skills to make long-term changes to attitudes and behavior are essential even when medications are used, this topic nonetheless deserves a special mention.

During my clinical training many years ago I was told about some early research using antidepressants, therapy and exercise in depressed hospital patients. The patients were divided into different groups to receive different combinations of treatment. The results showed that after several weeks the group receiving medication alone was no better than the group also receiving therapy including exercise. However, after several months when all the patients were discharged and followed-up in the community, the group which included therapy and exercise had recovered significantly further whilst many people in the medication only group had relapsed or failed to improve beyond the levels achieved in the first few weeks. This latent additional recovery was termed the ‘sleeper effect’ where additional benefits emerged after the fact.

This highlighted how long it took to get to full recovery as well as how important being ‘active’ was in recovery – in other words we need to ‘use it or lose it’. This ‘use it or lose it’ phenomena is also true of recovery and disease prevention in other areas of our lives such as in preventing some forms of dementia (continuing intellectual stimulation) and arthritis (continuing exercise and resistance training). So when you’re recovering from stress, anxiety and depression, take an ‘active’ approach and commit to a long-term view of recovery so you can stay focused and motivated during the initial stages while the longer term benefits (sleeper effects) begin to develop.

Myth 2 is Busted: “Harden Up” Is Not the Cure All for Stress

So I think it is fair to say that simply telling yourself to “Harden Up” will not get you very far on the road to recovery from Stress, Anxiety or Depression. As such this Myth is officially BUSTED!

However, as we have seen, changing your Mindset or Attitude to be more resilient is an important part of a much bigger puzzle of recovery where you also need to change how you manage your emotions, lifestyle and purpose. Using effective self-help strategies will be essential for your recovery. You may also need to use medications or natural medicines depending on your condition as well as see an appropriately qualified counselor.

Also remember the importance of being Active in your recovery and taking a long-term view of the process so that after the initial improvement is made you stay on track with your wellbeing goals to prevent relapse and further improve your wellbeing!

Ride the Waves of Life!

Dr Pete

The Stress Surfer

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