Therapy and Treatment

How to Know If You Need Outpatient Depression Treatment

Jim Sugel on October 21, 2024

If you’ve been diagnosed with depression, getting treatment is very likely to be an ongoing part of your life. That’s so much true that many people benefit from inpatient stays in clinics for rehab treatment and care. That stint in full time treatment gives you a baseline to build life skills and to learn how to manage your disorder. However, over time, you might need more and ongoing support.

Outpatient treatment is ideal for that because you can stay at home, continue your daily life and responsibilities, and fit treatment into your life instead of the other way around.

Outpatient treatment is typically 5 days per week and up to three hours per day. Here, you’ll go to treatment in the evening after work or during the day, while kids are in school. You might also opt for treatment on the weekends or in the morning before the rest of your day starts. In any case, you’ll get treatment for your depression without having to give up on the rest of your life. Mental health treatment is normal and it should be. 12.7 million U.S. adults received mental health assistance for things like depression and anxiety in 2022. If you need help, it’s important to ask. Whether you need that or not should almost always be decided by a doctor. However, some signs that you will benefit from it include:

You’re Struggling

If you’re having trouble with your day-to-day life, you probably need help. That’s true whether you’re withdrawing from the things you love, you’re having trouble keeping up with routines, you’re dropping out of social life, or you feel bad. Even persistent feelings that things are off or wrong are a good sign to reach out and talk to your doctor and to potentially get help.

You should never have a hard time keeping up. You should always feel like you have the tools to manage your life and the things in it. And, while emergencies happen, the norm should be that you have a handle on things. If that doesn’t feel like it’s the case, reaching out and looking into treatment and help is an important thing.

That’s also true if the issue is that you’re “just” feeling stressed or tense all of the time. A lot of people experience expression as fatigue. Others experience it as stress or feelings of tension or that things are about to go wrong. These feelings are not normal, and you shouldn’t have to live with them all the time. You can get help and you can work on finding a solution.

You’re Not Enjoying Things

If you’re doing things you used to enjoy and are getting nothing out of it, it’s time to talk to a doctor about treatment. Depression means that your brain isn’t processing serotonin and dopamine correctly. That can mean feeling less enjoyment, less motivation, and more simple fatigue and tiredness. Either way, if you’re not doing things you love anymore, it’s a sign that things are deteriorating. And, that means things will get worse. Without positive things in your life and things you enjoy, you won’t have outlets or good things to look forward t. That will mean things will just keep getting worse. Therefore, it’s critical that you seek out depression treatment if things are that bad.

It’s okay to have a few down weeks. However, if things last more than a few weeks, you really want to make sure you’re getting help.

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Your Routines are Falling Apart

If your routines are falling apart, it’s a good sign that you’re overwhelmed. Sometimes that can be because the routines are too much. In other cases, it can be because you are not doing well and you need help keeping up. This means that the first step is to step back, reduce your workload, find workarounds, and ensure that you have tools to get things done. That might mean talking to a professional and asking for help and insight. That’s especially true if you have family responsibilities that might push you towards doing more than you feel capable of. However, if you notice:

Personal hygiene slipping, e.g., you don’t put the same effort into dressing up, you don’t brush your hair, you don’t get dressed, etc. It’s a good time to be concerned for yourself and to ask for help. Major changes in personal routine and hygiene are hugely important indicators of your mental health. Even small stuff like not being invested in dressing nicely when you used to be or feeling like tying your shoes is too much effort can be hugely important indicators of mental health.
Slipping up on home routines like cleaning the house, putting away the dishes, or cooking. If you used to have a routine you could keep up with and now things are piling up, or you don’t know how to create a routine you can keep up with, it’s a very good sign that you might want professional help. It’s normal to have some trouble keeping up with dishes and other cleaning. It’s less so to have those tasks be overwhelming, for them to fall by the wayside for weeks at a time, or for some chores like laundry to just not happen until things are extremely bad.
Dropping responsibilities at home, like childcare, cooking for yourself, spending time with your partner, etc. The more important the responsibility, the larger the red flag it is when you drop it. If you find you’re just not keeping up with things you need and want to do, it’s critical to ask for help – even if that means staying at an inpatient facility.
Being late for work or failing other major responsibilities outside the home. If you’re not keeping up when social or financial pressure are involved, it’s a sign that you are having significant trouble and you should be getting help.

Letting things slip for a few days is okay. But, if things are falling behind for the longer term, you feel overwhelmed, too tired to manage, or just don’t care, it’s a very good sign that you badly need help.

Trouble with Relationships

The worse you’re doing, the more your mood is going to go up and down, the harder of a time you’ll have handling your emotions, and the worse you’ll be at keeping up with social responsibilities. That often means your relationships with friends, family, and even partners will deteriorate. Here, it’s important to recognize that depression can actively sabotage your relationships. Having the tools to communicate that, to set expectations, and to manage your emotions will allow you to manage your relationships and to maintain them around depression. That’s important for you, your quality of life, and your ability to maintain those relationships. Often, it will mean going to treatment, getting relationship therapy, and learning skills to manage your life around depression.

Eventually, going to treatment is a normal and healthy thing. Even if you think you’re struggling, it’s a good idea to talk to your doctor, get insight from a professional, and get a handle on what your options are and how you can move forward.

Outpatient treatment for depression can be a great choice to allow you to get help and to get your depression under control without putting your life on hold – but you might also need more intensive care. It’s important to talk to a professional and ask for advice on what will work for you with your symptoms.

Redeemed Mental Health is a mental health & dual diagnosis treatment center offering PHP, IOP, and individual levels of care. Contact us today to begin your journey of recovery!

What is Insight-Oriented Therapy and What Happens?

Annie Winner on October 7, 2024

Insight-oriented therapy includes a branch of therapies very often recommended to individuals with disorders such as eating disorders, substance use disorders, personality disorders, mood disorders, and anxiety disorders. Insight-oriented therapy or IOT is sometimes known as psychodynamic therapy or insight therapy and focuses on helping the patient get to know themselves and their responses better. Here, therapy relies on intensive talks between the therapist and that patient to help the patient uncover and understand their behavior, reactions, and emotions – so that they can be more self-aware, can recognize behaviors as they happen, and can make meaningful steps to changing behavior, improving emotional regulation, and resolving internal conflicts.

If you or a loved one has been recommended insight-oriented therapy as part of mental health treatment, it means your therapist thinks you might benefit from insight into yourself and your behavior. It’s also commonly used in cases where patient motivation for treatment is getting in the way of seeing results with other forms of therapy. Let’s take a look at what insight-oriented therapy is and how it works.

What are the Goals of Insight-Oriented Therapy?

Insight-oriented therapy is a talking therapy in which you first work to build trust and a bond with your therapist and then work on exploring yourself. This means that you spend sessions of 45-60 minutes 1-3 times per week for 3-24 months with your therapist. The length and duration of therapy depends on you, your goals, and the complexity of the situation, as most IOT is delivered on a personalized and needs basis. This means you’ll get a different program depending on your initial assessment during intake and your program will be updated as you progress (or don’t) along the way.

The primary goal of insight-oriented therapy is to understand how past experiences and patterns limit and cause problems today, so that you can take steps to change those patterns.

Exploring the Unconscious Mind – Much of IOT is based on psychotherapy and the idea that unresolved conflicts from early life shape your behavior, thoughts, and feelings. That means exploring the unconscious mind as part of therapy, which can help you to understand processes that influence your actions and reactions now. This is often used to understand transference – where you project feelings, responses, and beliefs from the past onto current people. E.g., some of us feel anxious and like our loved ones may abandon us because we were emotionally neglected as children, and moving on from that means dealing with that trauma.
Understanding Patterns – Another primary goal of IOT is to help you understand your own patterns and behaviors. That means what you do, how you do it, and how you respond to things. For example, defensive mechanisms, coping mechanisms, automatic habits, and behavior patterns that are automatic responses rather than thought out and chosen. For example, if you rely on patterns of denial to avoid painful emotions, if you act defensively when people ask you for change, etc., you may be able to work past that by simply understanding those patterns and the root cause and acknowledging that at the root.

Insight-oriented therapy is a long-term program intended to deliver treatment over a period of months or even years. That’s significantly different than many approaches like cognitive behavioral therapy, which may deliver the entire therapy in as little as 10-15 sessions. Therefore, your relationship with your therapist, your long-term adaptation, and growth over time all become important.

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What Happens in Insight-Oriented Therapy?

Insight-oriented therapy is a talking therapy where you sit down and talk to your therapist over a period of months or even years. It’s the classic picture of a patient leaning back on a couch with the therapist sitting on a chair listening.

Intake – You’ll have one or more sessions with your therapist that are entirely about sharing basic details, getting to know your therapist, and allowing the therapist to figure out a good approach to start your treatment. These sessions will mean sharing your life information, relationships, current concerns, current mental health symptoms, and establishing current goals.
Exploration of Childhood Experiences – Most IOT begins with multiple sessions designed to help patients explore and share their early childhood experiences. This means sharing family dynamics, sharing emotions, sharing things that happened and notable experiences, etc. This is in part to set an easy starting point to share with your therapist and to build trust, while giving the therapist insight into why you might act, behave, and think in the ways that you do.
Exploration of the Self – Insight-Oriented therapy will then switch to sessions designed for self-reflection, exploring current behaviors, and building insight into what’s underneath current behaviors. That means reflecting on current emotional state, thoughts, and behaviors. Here, you’ll likely be asked to connect thoughts and emotions or reactions to influences from the past. This stage can be tricky, as it’s easy to make “false” breakthroughs, without truly understanding the root of a problem. Still, your therapist will work with you to help you understand what’s underneath coping mechanisms, defensive behaviors, avoidance behaviors, etc. This includes sessions and time spent on self-reflection, on interpreting dreams, fantasies, and imagery, and on building insight into the self.
Catharsis – Insight-oriented therapy has a significant focus on exploring and releasing previously repressed emotions – leaving room for emotional distress and experiencing feelings. However, this stage is normally very late in the therapy and requires significant trust and relationship with the therapist.

Depending on your progress, these sessions can take you years to work through. In addition, they won’t always be delivered in order. You might spend a few sessions focusing on childhood experiences then explore how those affect your life now – and then go back to exploring more of your childhood. Your therapist will determine how your treatment program is paced based on your needs and your responses in session.

Who Can Benefit from Insight-Oriented Therapy?

Insight-oriented therapy is one of the oldest therapies delivered to patients. It’s intended to deliver self-awareness and an understanding of the “gears” that make you tick. That means taking time to look at what’s going on underneath your problems, so you can work on resolving the root causes of issues.

That’s ideal for individuals struggling with mental health disorders like depression, anxiety, personality disorders, mood disorders, trauma, and interpersonal problems. However, it’s not intended to be a crisis intervention. It’s intended to be a long-term look into solutions that help you improve your life, your emotional understanding of yourself, your relationships, and your relationship with yourself.

It’s also ideal for individuals who show resistance to traditional behavioral therapy techniques, where you might need a deeper exploration and understanding of what’s going on to make progress with changing behavior.

Insight-Oriented Therapy is not a quick fix. It’s not ideal if you need emergency treatment right away. Instead, it provides long-term structural support and safety, where you get to explore yourself, your emotions, and how you work and then learn to apply those insights to your behavior while continuing to get therapy. That can make it extremely helpful for individuals with chronic and long-term mental health disorders where longer-term support and room to work through problems has the most benefit.

Take the first step toward recovery today! Reach out to a qualified therapist to discover how Insight-Oriented Therapy can guide you on your journey to healing and self-discovery. Your path to a healthier, more fulfilling life starts now!

What Are the Best Types of Therapy for Trauma?

Jim Sugel on September 24, 2024

An average of 50% of women and 60% of men will experience a major traumatic event in their lifetime. This means that the majority of Americans will experience a traumatic event as an adult. That trauma always leads to risks including mental and psychological side-effects with complications that can include increased anxiety, reduced quality of life, and major mental health disorders like post-traumatic-stress disorder. PTSD develops in about 30% of cases where an individual experiences severe trauma. Getting treatment early means mitigating those side-effects and preempting the risk of PTSD developing.

Trauma treatment also requires custom or personalized therapeutic approaches that address underlying or “pre-risk” factors like stress, environment, genetics, personality, coping mechanisms, and worldview. As a result, the best therapy for treating trauma is often customized to the person. However, some treatment options are relied on for trauma and PTSD treatment more than others.

Counseling May be Enough for Early Trauma Treatment

In most cases, the side-effects of trauma should go away on their own in about 2 weeks after the trauma occurs. In other cases, it can take up to about 2 months. Here, it’s often recommended to seek out counseling. For example, many police departments offer counseling to individuals who have experienced trauma. It’s also more and more common for emergency service responders to receive trauma counseling as part of response to traumatic events.

Counseling means that you have someone working with you from day one to identify any blockers to recovery, to help you talk through the traumatic event, and to recognize if things are not going well. That means you have someone on-hand to help you recover so you might not need ongoing therapy or more intensive treatment.

The Best Therapy for Trauma Treatment

Globally, CBT or cognitive behavioral therapy is the primary treatment used for therapy and for PTSD. However, other treatment types are also used.

1. Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy or CBT was first developed in the 1950s to help people understand their thoughts and feelings and to learn behaviors to control, manage, and relate to those thoughts and feelings. In trauma-treatment, it usually means bringing exposure therapy, cognitive restructuring to change behavior (E.g., to stop negative thought patterns), and to learn acceptance and coping mechanisms.

As a result, CBT is often the first choice for trauma treatment almost everywhere. For PTSD treatment, it’s also normally combined with exposure therapy, where a normal course of treatment might include 5-6 weeks of a benzodiazepine to reduce symptoms of PTSD followed by CBT with exposure therapy starting in the middle or near the end of the CBT program. In this capacity, it’s one of the most proven treatments for helping patients to recover from PTSD.

2. Trauma-Focused CBT

TF-CBT is a form of CBT developed in the 1990s to specifically treat trauma and PTSD. It’s also specifically designed for younger patients and is delivered over 8-25 sessions. Here, therapy focuses on delivering culturally adapted CBT to help children change worldview, process distress, and learn coping mechanisms.

While technically a subtype of CBT, TF-CBT is considered the strongest and most evidence-backed treatment choice for children and adolescents. As a result, most people under the age of 17 with PTSD receive this treatment.

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Prolonged Exposure Therapy (PE)

Prolonged Exposure Therapy or PE is a form of CBT that switches the focus away from reframing emotions and emotional processing and towards confronting and processing events and trauma. The treatment program typically consists of 8-15 90-minute sessions with weekly exposure to trauma in a safe environment, mixed with tactics to process emotions, keep the body calm, and reduce negative reinforcement. This line of treatment is ideal in situations where the individual may have low risk factors relating to the traumatic event and may be good at emotional processing, but still needs help with a specific traumatic event. The idea is to specifically target and focus on the specific trauma rather than on emotional and trauma processing as a whole. That means confronting, processing, and desensitizing to specific trauma and environments, resulting in decreased fear response, decreased avoidance, and increased ability to cope and apply other coping mechanisms to the event.

Cognitive Processing Therapy

Cognitive Processing Therapy is based on CBT but is specifically designed for individuals with PTSD or trauma complications. The idea is that persons with PTSD are unable to recover on their own, which means that the focus is on identifying and removing the blockers to recovery. That’s typically delivered across 12 sessions focused on helping individuals to understand worldview, though processes, automatic responses, and to identify and correct negative thoughts and behavior patterns that contribute to symptoms. The idea is to build the beliefs, skills, and coping mechanisms that contribute to the ability to recover – essentially delivering building blocks for recovery. CPT is considered a first line treatment for PTSD.

Eye Movement Desensitization and Reprocessing (EMDR)

EMDR was designed in the 1980s as a therapy specifically for treating trauma. Here, the therapy primarily focuses on exposure therapy, where the individual is asked to consider specific distressing memories or thoughts at the same time as sensory stimulation with either a moving object to focus on, tapping, or other body stimulus. The idea is that patients with trauma typically experience impaired memory processing, and the body may respond as though it is experiencing the trauma. Exposure therapy with EMDR forces the body to be physically present in the present, allowing the patient to process the memory as what it is – a memory. EMDR sessions are typically once or twice per week for 6-12 weeks depending on patient responsiveness. The results are almost always reduced distress in response to the traumatic event.

Narrative Exposure Therapy (NET)

Narrative Exposure Therapy or NET is a type of trauma therapy normally applied after the fact and for cases of complex PTSD. Here, the therapy helps the individual to organize and write out their trauma in a chronological order – stopping to understand and acknowledge the impact and emotions behind events at every stage. Narrative Exposure Therapy is one of the most important therapies in treating longer-term trauma exposure such as refugees and for cases of domestic and child abuse. However, it’s also most-often combined with CBT or followed up with CBT in order to also deliver reframing, coping skills, and emotional processing strategies that enable recovery.

Dialectical Behavioral Therapy (DBT)

Dialectal behavioral therapy or DBT is a branch of CBT. It was originally designed to help individuals with personality disorders such as schizophrenia or borderline personality disorder by focusing on acceptance of things as they are, minimizing symptoms that are there, and improving emotional regulation. The focus of the therapy is not “recovery” but improved quality of life. As a result, it’s not a primary treatment for PTSD. However, it’s a line 2 treatment for individuals who have complex PTSD that has been shown as resistant to other treatments. Here, you work to learn to understand symptoms, to learn tactics to reduce symptoms, and to learn tactics to manage and prevent symptoms where you can. Together, these can have a powerful impact on quality of life.

Conclusion

There are more therapies used to treat trauma and PTSD. In addition, there’s no one best option. For many people, choosing the right therapy means going to a doctor, getting advice, and being referred to a specialist in trauma and PTSD. From there, you’ll be given a program that tackles your unique experiences, personality, and trauma, so you may receive a mix of treatments. However, CBT is the most common treatment for PTSD, so chances are very high that if you have trauma, PTSD, or complex PTSD, treatment will start there. Good luck getting help.

Emerging Technologies in Mental Health Treatment

Annie Winner on August 15, 2024

Technology has driven mental health treatment since the early days of treatment – with some early devices like EEG readings still in use in some treatments. Today, technology drives our culture and how society functions, with internet, video calling, and artificial intelligence all driving change. That also impacts mental healthcare and treatment, including how treatment is delivered, types of treatment, diagnosis, and much more.

Many of those interventions make treatment more accessible, more affordable, and more accurate. They also range from mobile apps to predictive analytics, with many steps in between. In this article, we’ll review some of the emerging technologies in mental health treatment and how they impact treatment.

Teletherapy and Telepsychiatry

Telehealth or virtual health typically means delivering mental healthcare via a phone or video call. That can also mean chat with mental healthcare sessions via video calls, phone, and even on messenger apps. This delivery method makes healthcare more accessible, reduces concerns surrounding mobility and affordability, and means that even very busy people with responsibilities can access mental healthcare. Telehealth has increased in prominence, especially following the Covid19 pandemic, when video calls and platforms enabled many people to continue receiving treatment. Today, it’s considered a good second-line treatment or follow-up to in-person treatment and may be used as primary care for individuals with lighter needs.

This can include software-based interventions for behavioral treatment. Here, telehealth is delivered as part of an app that delivers diverse treatment including behavioral health programs.

Mobile Health (mHealth) Apps

Mental health apps are increasingly popular because they allow cost-effective and accessible care to a large number of people. Here, people use apps for self-care, routine tracking, behavioral therapy, mood tracking, stress management, anger management, and more. Apps have pros in that they are accessible and offer a low level of care and support to a large number of people. They can also monitor symptoms and progression and, with a mental health expert on call for monitoring patients, can help keep patients on track. However, they don’t offer a high level of care and without monitoring and follow-up, are easy to drop.

These digital therapeutics are also increasingly FDA approved, with some digital or software interventions being approved as primary treatment. Here, you typically receive a behavioral health program with homework which you follow through the app – with monitoring by a therapist and potentially sessions with the therapist as well.

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Machine Learning

Machine learning, commonly referred to as artificial intelligence, is more and more often integrated into mental healthcare. Here, algorithms are used as chatbots, with the option to provide 24/7 support at a low level and to escalate cases to people as needed. AI also provides predictive analytics, which enable monitoring patients after graduating from programs, monitoring app usage, and implementing early intervention programs. For example, Facebook has an algorithm that detects users who are potentially at risk of suicide and flags them for contact and engagement. These kinds of AI are increasingly trained in workplaces, hospitals, and aftercare scenarios, where they allow medical professionals to better process data and respond to it, because data is analyzed, and risks are flagged for manual review.

Machine learning can also be used to deliver targeted and personalized treatment plans because AI can more easily compare individual symptoms and test results to previous patients to look at what performed well. That can help to improve the efficacy of treatment – although many providers don’t yet have the data on record to provide this kind of care.

Virtual Reality (VR) and Augmented Reality (AR)

Virtual reality and augmented reality are two technologies which are increasingly being used in therapy sessions. Here, users wear devices like Meta Quest to experience environments and visuals without having to be present in them. This is used to create controlled environments for exposure therapy so patients can confront fear and anxiety in a safe space. It’s also used for relaxation, mindfulness, guided therapy sessions, etc., which users can undergo from their own home.

Wearable Devices

Wearable devices like smartwatches, heart and sleep trackers, and activity trackers are increasingly popular in mental health. However, they are for the most part aligned with mental health apps and tracking. Here, biometric tracking and monitoring means that therapists don’t have to rely on patients inputting data. Instead, the tracker automatically inputs it for them – reducing chances of avoidance and faking data. Trackers can also share alerts about stress and anxiety levels, giving therapists better insight into their patient’s wellbeing.

That extends to neurofeedback and brain stimulation, where neurofeedback wearables are used in sessions to offer self-regulation of brain function. In neurofeedback sessions, individuals often see representations of brainwaves on screen and are able to learn how reaction, behavior, and thought patterns impact that. Other therapies like Transcranial Magnetic Stimulation or TMS use similar approaches but with magnetic pulses to actively impact brain function. The difference is that the latter two therapies are only delivered in clinics and biometric devices are typically worn 24/7.

Genetic Testing and Personalized Medicine

Modern medicine increasingly points out that everything from behavioral responses to addiction are partially determined by genetics. This means that genetic testing is increasingly viable as part of treatment, where it is used to inform treatment plans. That includes identifying and managing vulnerabilities, identifying potential reactions to specific interventions and medications, and creating more effective individual treatment strategies.

Genetic testing is not yet widespread but as our understanding of the impact of genetics on medication and behavioral responses grows, it will be more and more common in mental health treatment.

Genetic testing is currently being used to inform patients about what genetic mental health conditions may impact them – which allows them to invest in proactive treatment and mitigation measures. For example, patients with a family history of depression can implement lifestyle interventions proactively while people with a history of schizophrenia can ensure that they have check-ins and safety measures in case they experience episodes, so they get treatment and medication as soon as they start to show symptoms.

Backend Technologies

While most patients will never see it, technologies like blockchain and IOT are increasingly used in mental healthcare. For example, blockchain integrates to offer increased security and privacy for data records, enabling more secure sharing, and giving patients better control over their data. IOT means devices automatically share data, so, for example, trackers automatically upload data, saving you the hassle of doing it yourself. In each case, you get a smoother and more informed approach to mental healthcare, even if you rarely see the actual technology at work.

Conclusion

New technologies will continue to arise and change the mental healthcare market. Today, most changes involve digitization, in which the availability and delivery of healthcare is increasingly moved online. This enhances accessibility. Other innovations improve personalization and hopefully effectiveness, such as genetic analysis and using AI to diagnose and predict better potential treatments.

Eventually, technology will always revolutionize mental healthcare. Whether that’s by enabling online therapy sessions, ensuring you can access behavioral therapy programs with an app, or giving you tools to talk to a chatbot and ask for help 24/7 doesn’t matter. Hopefully, these innovations make it easier, more accessible, and more affordable to reach out for help and to get the care you need.

How Long Does Untreated Trauma Last?

Jim Sugel on August 7, 2024

Most people will eventually struggle with trauma. An estimated 70% of all Americans experience significant or major traumatic events at some point during their lives. And, everyone experiences traumatic events like the death of parents and grandparents. Often, that means taking time to heal and that means giving yourself time to recover from trauma.

At the same time, that trauma should heal. If your trauma doesn’t start to naturally go away on its own, it’s a sign that something deeper is wrong. For example, if you’re not seeing even slow improvement after a month, you might want to look into treatment. Left untreated, trauma that isn’t resolving on its own can turn into PTSD (post-traumatic stress disorder) which is a much more serious disorder that requires more significant treatment.

However, the path to trauma recovery varies per person. It’s important that you understand the path to trauma recovery, how untreated trauma works, and the steps you can take to get help if you don’t see improvement.

Talk to Your Doctor

If you’ve experienced a traumatic event, it’s important to talk to your doctor. That means discussing your health and mental health with someone who is both qualified to talk to you about it and who can set up next steps for you. Doing so right away means you’ll understand the options available to you and your doctor will know they might have to make next steps for you in the future. That will simplify the process if you end up needing help later.

Here, you want to discuss:

What happened
What the expected timeline should be
How you feel now and what your doctor thinks about that
What side-effects or long-term affects you might experience and what to do about them
How you feel on a daily basis

If it’s already been some time since you experienced trauma, you’ll also want to discuss whether you’ve made any progress, any actual symptoms, and if things are getting worse.

Trauma means you’re at increased risk of stress, stomach and digestion issues, sleeping issues (sleeping too much or too little), cardiovascular problems, and complications like PTSD. Sitting down with your doctor to discuss those risks, your recovery, and your options will allow you to decide what the next steps for your health should be and what you can do to support recovery.

What is the Normal Recovery Timeline for Untreated Trauma?

If you’ve experienced a traumatic event, recovery can take months. In fact, if a loved one dies, recovery times for that trauma are typically 6-12 months. For other events, you’re generally looking at a shorter recovery period.

The first two weeks are usually the worst in terms of symptoms such as anxiety, flashbacks, and fear
For some people, this initial peak can last as long as 2 months
Improvement starts gradually and can look like accepting things, feeling less discomfort, and being more capable or willing to push boundaries around trauma.

In most cases, the rule of thumb is that if someone isn’t showing gradual improvement after about 2 months, they aren’t going to recover on their own. That means you’ll need a mental health intervention such as counseling or therapy to help you step out of trauma and get back to your life.

For most people, that means giving it about a month to get back to feeling like yourself after a traumatic event like assault, robbery, a car accident, or a natural disaster. For others, that might look like 2 months. And for some people, it can take longer. Still, if you’re not showing gradual improvement after 2 months, you definitely want to talk to a professional.

Still, that can be further complicated by the fact that not everyone is aware they have to make steps to recover from trauma. That can mean you need counseling to even start processing trauma which can further complicate the process.

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Risks of PTSD

PTSD or Post-traumatic stress disorder is a complication of trauma in which your brain and your body do not heal from trauma. Instead, you become mentally stuck in the experience of trauma with a heightened adrenal response. That can mean you experience severe anxiety, avoidance, uncontrollable thoughts, nightmares, and flashbacks about the traumatic event(s) for even decades after the event. Normally, PTSD is diagnosable after about a month from a traumatic event.

Here, diagnosing PTSD depends on severity of the symptoms with severe anxiety, guilt or shame, guarded behavior, fear or anxiety, memory problems, negative thoughts, depression, flashbacks, and nightmares being key symptoms looked for. However, PTSD may also be diagnosed purely on the basis of duration of symptoms. Even mild symptoms are PTSD if you continue to experience them for a year after the traumatic event.

If you’re diagnosed with PTSD, you will need treatment. That typically means behavioral therapy like CBT and counseling to help you overcome the impacts of trauma on the brain. At the same time, that treatment can help you prevent complications of trauma to begin with.

Should You Get Treatment for Trauma?

In most cases, if you’ve experienced a traumatic event, it’s a good idea to talk to your doctor. From there, you can make decisions about getting treatment or not based on your history of mental health and potential complications. You can also make sure your doctor is aware of what’s going on, so if things don’t improve, they can help you take the next steps. If you have a history of trauma, it’s probably best to immediately look into treatment. In addition, if you have a mental health problem such as depression or anxiety, that can make recovering from trauma harder. Individuals who have experienced violent crimes are also more likely to experience complications, which means you should typically take advantage of counseling offered by emergency care services.

Otherwise, the best option for deciding on treatment is to wait. Talk to your doctor about what you can do to improve things in the meantime. Then, give your brain and your body time to heal. If you’re not seeing improvements after about a month, it’s a good idea to go back to your doctor, discuss next steps, and to start looking into treatment. Everyone recovers at their own pace, but staying on top of how you’re doing, looking for improvement, and taking action if it’s not there is critical no matter what your recovery process looks like. Starting out by talking to your doctor or your therapist is always a good step. In addition, if you have the option, getting preventive care for trauma is often a good way to ensure you have the tools to prevent complications and recover as quickly as possible.

Eventually, most of us experience trauma. Recovering from that takes time. Depending on you and your mental health, recovering from trauma can take months. For some of us, that won’t happen without therapeutic interventions and counseling. There’s no single path through trauma or trauma recovery. However, it’s important to be able to reach out and get help when you need it and that means talking to medical professionals, understanding what recovery should look like, and taking steps when nothing is changing. Hopefully, this helps you create a strategy so you have that support available to you and you can get help if you need it.

The Benefits of an IOP Program for Managing Bipolar Disorder

Jim Sugel on July 19, 2024

Today, an estimated 2.6% of the adult population struggle with bipolar disorder. For many of us, that diagnosis means a lifelong disorder of symptoms that come and go. It also means medication, ongoing treatment, and inevitable relapses into poor mental health that will require treatment.

For most people, a bipolar spiral that results in a diagnosis means getting inpatient or residential treatment. You’ll stay in a clinic or facility for 30 or more days where you’ll be able to focus on treatment, recovery, and learning the skills that allow you to live a happy and healthy life.

Once you get out of treatment, most people assume they are finished, that’s the end of it. But, increasingly, we’re aware that the key to long-term management of bipolar disorder is offering long-term treatment and long-term support. Here, an intensive outpatient program or IOP can be a valuable way to transition from residential treatment into everyday life.

What is Outpatient Treatment for Bipolar Disorder?

An intensive outpatient treatment program means that you attend a treatment program at a clinic for part of your day while having the freedom to go to work, to go home, or to attend responsibilities like childcare or school in between. Programs vary considerably; however, you can expect:

9-12 hours of treatment per week, broken into 3–4-hour sessions.
Treatment happens at a hospital, clinic, or community center
Multiple timing options are available. E.g., morning (6 AM-9AM), afternoon (12:00-3:00 PM) or evening (7 PM-10 PM). These allow you to choose a schedule that works with your life. E.g., afternoon schedules are ideal if you drop kids off at school and pick them up just after 3.
Programs include both group therapy and one-on-one counseling and therapy
You always go home and live in your own home or a social living accommodation after instead of staying at the clinic.

Outpatient treatment essentially means you get to continue going to treatment and therapy – while having the space to pick your life back up.

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What are the Benefits of IOP for Bipolar Disorder?

There are plenty of benefits to going to an intensive outpatient treatment program. For example, you can get ongoing care that’s delivered in the environment where you’re likely to be triggered. You can also get ongoing accountability and support, with structure to ensure you’re taking care of yourself.

Ongoing Treatment – Systemic or long-term care is significantly more effective at improving bipolar disorder management than one-touch treatment. Here, you can plan to receive treatment regularly for the long-term, which means for the foreseeable future. Typically that starts out with a heavy program such as inpatient care and then switches to intensive outpatient and may eventually switch to weekly treatment or even virtual sessions. In one study, 700 people getting long-term treatment over a 2-year period were significantly less likely to have severe episodes of mania, significantly less likely to require hospitalization and treatment, and significantly less likely to require follow-up residential treatment than a control group that did not attend ongoing outpatient care.

Accessibility – Outpatient treatment allows you to seek out ongoing help without having to rely on putting your life on hold to do it. Instead, you go to a clinic for a few hours a week and typically spend about 9 hours of your week there every week. That makes ongoing care much more accessible than taking 30 days out to go to residential treatment. IOP are also often designed around work, school, and childcare obligations, which means you can more easily fit them into your daily schedule – so you can start to get your life back while continuing to take care of yourself.

Structure – People with bipolar disorder often struggle with structure. Having an IOP program ongoing as you reintegrate into life means you’ll have structure forced on you. You’ll have to show up every week to treatment. You’ll have ongoing reminders to take care of yourself, to take medication, to invest in routines. You’ll have the structure you need to support good bipolar disorder management. In addition, IOP can recommend you into social housing if you end up needing more structure than you’re getting.

Accountability – Going into treatment 2-4 times per week means you’ll have accountability to take care of yourself, accountability to do your homework, and accountability to work on managing yourself and your disorder. That means people will check on you, you’ll have to share what you’ve done with your week, and you’ll get ongoing recommendations and support as you move forward. That can be valuable, because you’ll get help working support and structure as you run into issues with it, which means you can get specific tips and help with things you struggle with.

Integrating Treatment into Your Life – It’s one thing to get treatment in an environment where you’re not facing triggers. It’s another to be able to take things you’re struggling with, emotions and interactions you’re struggling with, instances where you reacted badly, feelings like you’re going out of control again into therapy and getting immediate help. Having treatment while living your life means you’ll be able to learn more about yourself, more about how you respond to the world around you, what starting mania feels like, what steps you can take to manage that. Integrating that into your normal life will be a powerful step towards managing your bipolar disorder for the long-term. It also means you’ll have someone else checking on you, noticing when your behavior is changing, and helping you manage that from an outside perspective.

Aftercare – Getting ongoing care is always going to ensure you can reach out and ask for help if you start slipping. It also means you’ll have help reintegrating into work. It means you’ll have help when things go wrong, when you face old triggers, when you go into depression or mania. That will always help with long-term management.

Are There Downsides?

Intensive outpatient treatment takes 9+ hours of your life every single week for as long as you go. That’s a lot. For many people, it means giving up a lot of your free time. In addition, that means you’ll have to stay motivated to stay in the program. On the other hand, if you start to lose motivation, it’s probably a good sign that you should be talking to your therapist or counselor about it, because it may mean you need additional help.

Getting Help

Moving into an IOP program is often a relatively simple step of talking to your doctor, getting approval from your insurance, and going to a local clinic. The intensity and duration of your program should also vary depending on your diagnosis, your history of treatment, and where your mental health is at when you start going. For example, if you’re mostly fine but want to manage and maintain your progress, you might have relatively light program based around building life skills and improving on what you have. If you’re struggling with symptoms, you might end up in a program that’s 12+ hours per week where you work to reduce the impact of bipolar disorder on your life. In either case, good luck getting treatment and with managing bipolar disorder over the long-term.

What is Anosognosia in Mental Illness?

Jim Sugel on July 10, 2024

Today, millions of Americans struggle with mental health problems ranging from substance abuse to anxiety or depression to bipolar disorder or schizophrenia. With almost 1 in 4 Americans qualifying for a mental health diagnosis of some kind, it’s incredibly normal to have a mental illness or mental health problem. But, for some of us, realizing that we have those problems is part of the mental illness. Instead, a percentage of people suffer from a condition known as Anosognosia, in which they are unable to realize or recognize that they have a mental health problem.

While this can be linked to denial, anosognosia is an illness of its own and is characterized by damage to the brain, which can result from bipolar disorder, schizophrenia, Alzheimer’s, dementia, some kinds of trauma, and traumatic brain injury.

What is Anosognosia?

Anosognosia is a condition in which you cannot recognize another or other health conditions that you have. For most people, it means you simply are not aware of a deficit or illness that you have and instead see yourself as normally functioning and not in need of medication or help. In mental illness, it most often crops up in bipolar disorder and schizophrenia, where affected individuals may think they are normally functioning and not in need of any help at all. However, the illness is from a family of agnosia’s, all of which relate to inability to recognize sensory input. For example, the inability to see visual motion, inability to recognize body parts, inability to recognize partial paralysis, inability to differentiate visual objects, etc.

In mental illness, anosognosia is most-often linked to bipolar disorder and schizophrenia. Here, individuals can suffer significant trauma to the brain, resulting in their inability to see that they are functioning any differently than the people around them. They may also not notice or not realize that episodes happen and may therefore feel that any attempts to get them help are trying to harm them or asking them to do something for no reason.

What’s the Difference Between Anosognosia and Denial?

There are significant overlaps between anosognosia and denial. People who are in denial of having a mental health condition can delude themselves to the point of very significantly believing that they don’t have a problem.

Denial can also be a significant mental health problem in which a person can delude themselves into a condition that can be diagnosed as anosognosia. If you are incapable of acknowledging that you have a deficit, whether because of brain injury or because of a mental health problem, it likely qualifies as anosognosia.

Anosognosia is normally linked to the mechanism by which people make a mental image of themselves. Here, you have to change that mental image as you move through your life. You get a haircut, now you have to think of yourself with short hair. You learn a new skill, your mental image of yourself updates to include being able to achieve tasks with that skill. But when you lose skills, it can be difficult for your brain to adapt. You see this with people who lose limbs who very often react and try to use those limbs for decades after losing them. For example, patients with amputated limbs show brain activity for those amputated limbs decades after amputation, because the brain never gets rid of the portion of the brain dedicated to moving that limb.

Mental illness is thought to have a similar mechanism, where persons who lose functionality, such as by going into a bipolar manic episode, are unable to recognize the episode because their brain isn’t updating their mental image. The brain is inflexible. Whether that’s caused by brain chemistry, denial, or traumatic injury to the brain is less relevant than the fact that the problem exists.

Anosognosia can be a form of denial. It might also be something forced on the individual by a brain injury. You can’t just talk someone with anosognosia out of it. If that were the case, they would just have denial and not anosognosia.

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Who Develops Anosognosia?

Anosognosia is extremely rare on a population level but extremely common when you start to look at the specific groups that it affects. For example, one study shows that it impacts an estimated 40% of people with bipolar disorder, 40-98% of persons with schizophrenia, and 20-80% of persons with Alzheimer’s.

Often, anosognosia follows significant trauma to the brain, which can occur as a result of a mental health disorder like schizophrenia.

Signs & Symptoms of Anosognosia

Anosognosia is characterized by an inability to recognize that something is wrong. That can mean:

The individual stops taking their meds
The individual goes from understanding they have a diagnosis to claiming they are completely healthy and potentially back again (Anosognosia can come and go)
The individual is paranoid about why people want them to get treatment or take medications
The individual deteriorates and starts having worse symptoms of mental health problems becuase they stop taking care of themselves and going to treatment (after all, nothing is wrong).

Diagnosing anosognosia normally starts with a questionnaire to assess whether someone is aware of having problems. The Scale to Assess Unawareness of Mental Disorder (SUMD) is the standard used here. After this, you may receive a CT, EEG, or MRI scan to check for physical damage to the brain. Often, there are no physical signs, especially in patients with schizophrenia and bipolar disorder.

How Do You Treat Anosognosia?

Anosognosia can be extremely difficult to treat because people receiving treatment are often resistant to treatment. For this reason, it’s best to take a mixed approach of switching away from getting someone to acknowledge illness and towards getting someone to acknowledge goals.

For example, in patients with schizophrenia, getting them to take medication is often the primary goal. About a third of persons with schizophrenia-related anosognosia are able to recognize that they have mental health problems when they take their medication long enough for it to have an effect.

Motivational enhancement therapy is also often used to help people meet goals like going to treatment and taking medication. Again, the goal is not to convince the person that they are ill or that they have a diagnosis. Instead, it’s to convince them that there are benefits to fixing a specific behavior or making a change and then getting them to do it – to improve their overall wellbeing. In patients with “denial” MET is used to convince people that they have a mental illness and need treatment, but this approach does not work with anosognosia.

Getting Help

People with anosognosia are unable to acknowledge that they have a mental health problem. This may be total (they never realize they have a mental health problem) or it may come and go (they take meds for months and then suddenly believe they are well and are taking medication for no reason). In every case, the best approach is to get that person to a doctor where they can be diagnosed and given treatment. Often, the challenge is keeping that person in treatment because they won’t normally see anything wrong with themselves. That means talking to them about goals like work, living alone, taking care of themselves, etc., and then working out reasons that mental health professionals can help with that. You won’t get anywhere trying to talk someone with anosognosia into believing they are sick. However, you can talk them into getting help for other reasons by normalizing mental healthcare for normal life. Good luck getting treatment.

What Happens if You Leave Co-Occurring Disorders Untreated?

Jim Sugel on July 3, 2024

If you or a loved one has been diagnosed with a co-occurring disorder, you’re not alone. Today, 21.5 million Americans have both a substance use disorder and a mental health disorder. This means that you have a substance use disorder or addiction and a behavioral or mental health disorder like bipolar disorder, depression, anxiety, or schizophrenia.

This overlap in diagnosis happens for a wide variety of reasons. For example, mental health disorders make you more vulnerable to dependence on substances and to addiction.

Addiction also triggers mental health disorders and can make them worse. For that reason, it’s important to treat both at the same time, with a treatment program designed around the needs of your co-occurring disorder.

If that doesn’t happen, you could find yourself relapsing.

Co-Occurring Disorders Get in the Way of Treatment

If you go to an addiction treatment program built around the needs of a dual diagnosis patient, the treatment is designed to treat the most pressing issues first. That means it will tackle physical reliance on the substance, and behaviors that present a risk to mental and physical health, and then start on treating behaviors and attitudes that get in the way of treatment.

That means:

Treating mental health problems that delay or prevent treatment
Tackling behavior and mindset
Working on improving motivation for treatment
Creating the mental health to allow the individual to adapt and respond to treatment

How does that work? If you’re completely overwhelmed by anxiety or depression, or in the middle of a manic episode because of bipolar disorder, you don’t have the resources to concentrate on therapy or to make meaningful steps to change. This means that it will be crucial to recognize where you’re at and what your capabilities are and then use treatment to bring you to a point where you can benefit from addiction treatment and therapy.

Co-Occurring Disorders Increase Risk of Relapse

Mental health disorders increase your risk of drug abuse and addiction. They also increase your risk of relapse. Why? You’ll still be dealing with stress and anxiety caused by the mental health disorder. In addition, it’s highly likely that you won’t have had the same benefit from therapy and treatment that you would have if you didn’t have the co-occurring disorder.

Persons with mental health disorders are significantly more likely to use drugs and alcohol. That tracks to self-medication, where you use drugs and alcohol to feel better or to reduce stress. It also tracks to impulsivity, poor risk assessment for decision-making, and increased chemical reliance on drugs and alcohol. That’s especially true if you have a mental health disorder that reduces serotonin production in the brain, because drinking or using drugs can temporarily make you feel much better than you do normally, so you’re much more likely to continue using.

Failing to treat these issues mean you remain vulnerable to relapse because you:

Are still under a high amount of stress
Haven’t actually changed your behavior, only quit drinking or using
Haven’t benefited from treatment because mental health disorders were in the way

This often means that as soon as something goes wrong or stress levels get too high, you’re very likely to relapse and start using again. That’s worse with disorders like bipolar disorder, where you’re very likely to relapse as soon as mania strikes again.

What’s worse, relapsing often increases your chances of negative outcomes. For example, if you use drugs, your tolerance to the drug will have decreased, meaning that the same dose that was safe for you before may be dangerous now. Relapsing also means massive setbacks in progress and needing treatment again, but first you have to make it through it and choose to go back to treatment.

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Co-Occurring Disorders Decrease Quality of Life

Untreated mental health disorders can significantly impact quality of life. That often means you’ll be dealing with mental health problems like anxiety, depression, feeling down, and low energy – all while being asked to work on high-maintenance self-care and self-improvement routines.

For example, people with mental health disorders often experience symptoms like:

Social isolation
Engaging in risky behaviors
Poor personal hygiene and self-care
Poor nutritional habits
Sleeping too much / too little
Excessive stress or anxiety in response to situations

At the same time, you’ll be asked to:

Maintain a consistent social schedule
Create consistent routines to clean your home
Exercise most days
Eat healthy food most days
Sleep in consistent and routine blocks

If those sound like they might be contradictory, you’re not wrong. Mental health problems actively get in the way of the routines and habits you need to live a healthy life that supports recovery. Of course, if you can maintain those habits, they will also help with mental health problems. However, doing so often means getting treatment for the mental health problems that are getting in the way.

You’ll Still Be Dealing with the Same Stuff

Chances are that you started drinking or using for a reason. Chances are also very high that your mental health disorder was a large part of that. For many people, substance abuse is about self-medication, dealing with problems, and escaping from problems. If your mental health disorder actively interferes with your relationships, makes you feel bad, causes anxiety, or prevents you from doing the things you want to do in the ways you want to do them, then your mental health disorder is likely at least partially behind why you started drinking or using in the first place.

If you don’t actively treat your mental health disorder as part of dual diagnosis treatment, you’ll go back to your life, dealing with the same problems that sent you to rehab in the first place. That probably sounds like setting yourself up for failure, because it is. If you want to recover, you need to be able to change the underlying causes behind relying on drugs and alcohol, and that means treating mental health disorders, getting help with symptom management, and getting a prescription for medication where you need it. All of that means looking into a co-occurring disorder program where you can get help with both at the same time.

Getting Help for a Dual Diagnosis

Treating a mental health disorder means having space to change your behavior and your life outlook. Sometimes it means getting medication and treatment. At the same time, you’ll have to treat a substance use disorder at the same time, because aspects of a substance use disorder can get in the way of treatment. However, once you get over the initial barrier of needing to be clean and sober and motivated, you’ll often find that many of the tools for mental health treatment help with recovery and vice-versa. That means you’ll have treatment for mental health that contributes to your recovery and structure for recovery that contributes to mental health. So, while co-occurring disorders can get in the way of recovery, once you get started, treating both at the same time just makes sense.

If you need help, it’s important to talk to your doctor, be upfront about any mental health disorders or diagnoses, and get the full help you need – for both mental health problems and substance use disorder, even if you don’t yet have a diagnosis for both.

What is Neuroplasticity in Mental Health?

Jim Sugel on May 17, 2024

For many people, depression, anxiety, and other mental health disorders are chronic, meaning that they are permanent or near permanent. For most of us, this means that mental health disorders will come and go throughout our lives, and episodes and peaks can be triggered by lapses in self-care, traumatic events, and stress. For others, mental health problems are a one-off problem that can be treated and overcome and essentially vanish much like a broken bone, leaving some scars, but otherwise gone forever.

At the same time, many people believe that once you’re an adult, your brain stops growing. In fact, many people believe that the brain only has a certain number of cells, that you can only learn things to a certain age (you can’t each an old dog new tricks), etc. None of that is true. Instead, the brain loses some plasticity or ability to change as you grow older but is capable of changing and adapting to every circumstance as you age. This means that chances are very high that your brain can heal from whatever mental health problems you have – although it is true that some issues will remain chronic.

What is Neuroplasticity?

Neuroplasticity represents the brain’s ability to change. This often means capacity for learning, for memory, for changing behavior, and for mental flexibility. Often, what looks like simple behavioral change on the outside is a complex process of the brain changing its physical shape to achieve new things. The human brain adapts to its environment, which is why taxi drivers who memorize city streets see actual changes in the brain, as do jugglers, and medical students. The brain adapts to its environment, especially to structural information, which forces the brain to reorganize and adapt to new input as well as to providing new output.

People who don’t frequently do new things or who routinely do exactly the same thing with no changes will have difficulty changing. This doesn’t mean their brain is no longer plastic, it means they need more time to adapt. At its basis, one of the things that makes the human brain so very “human” is its ability to adapt and to change and to retain that neuroplasticity over time. Factors like life experiences, stress, genes, behavior (including thought patterns) and environment will all limit or enable that change but that change is always available.

Does Mental Illness Change the Brain?

Mental illnesses, including behavioral disorders, depression, anxiety, bipolar disorder, and most other mental health problems directly change the brain. Often, this is a two-part change of changes in hormones and neurotransmitters and changes in behavior building different habits or pathways in the brain.

This might look like:

Depression reduces the production of serotonin. Reduced serotonin means that the brain is less able to regulate mood and emotion. So, the brain feels more depressed, worsening the issue. Eventually, the brain might adapt to seek out serotonin-producing experiences (e.g., food, TV, drugs or alcohol, etc.).
Behavior builds new neural pathways that reinforce the habit. So, if you stop challenging yourself, stop taking care of yourself, and stop doing things that require those neural pathways, your brain will dismantle those neural pathways because they require energy. So the less you use behavior patterns for self-care and for maintaining health and mental health, the less you’ll have the ability to.
Mental health disorders often come with negative spiraling, negative thought patterns, and getting stuck in cycles of worry. Those are also often self-reinforcing, as the brain will adapt and you’ll build new neural pathways to make that behavior easier.

That all sounds counterproductive of your brain doesn’t it? The truth is, the brain adapts to the environment it’s given. That means that the more you indulge feeling bad and the more you give yourself leeway to not engage with behaviors that improve mental health, the harder it will be to pick that back up. At the same time, neuroplasticity works in reverse:

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Does Neuroplasticity Mean the Brain Can Heal Itself?

The common perception of the brain is that it doesn’t heal. At the same time, medical science has know that isn’t true for decades. When faced with physical trauma to the brain, patients show a remarkable ability to regenerate tissue and recover. People who have impairment to the hippocampus following significant substance abuse typically recover, so you can’t tell their brain from a healthy brain after about 3 years. Healing takes time, but it does happen.

It’s also important to note that not all mental health disorders require or will result in healing. In some cases, depression, anxiety, or schizophrenia are just how your brain works. You can take medication to supply some of what your brain isn’t, just like you’d wear glasses if your eyes weren’t meeting your needs for driving or reading, but you won’t expect your brain to heal, beyond recovering from any trauma that being untreated has resulted in.

Using Mental Health Treatment to Provide the Grounds for Change

The goal of psychotherapy such as Cognitive Behavioral Therapy is to help you create new patterns and new behaviors. This means addressing the existing behaviors and recognizing them, figuring out what’s behind them, and then trying to redirect them into new skills and patterns. Behavioral therapy often starts with stopping downward spirals, redirecting negative thoughts, and building basic skills to prevent negativity. At the same time, you’ll create the start of patterns o build positivity, to find positivity, and to build functional patterns. Just like with negative patterns, these patterns will also change your brain and you’ll have the neural pathways to support them – often in as little as 3-6 months after starting therapy.

The more you practice a skill, such as stopping a downward spiral, the easier it will get, as your brain adapts and builds neural pathways to enable it
The more you engage in activities that produce serotonin, the more your brain will make that easier, by building neural pathways to enable it. You can get stuck in a neural rut of thinking negative thoughts, but you can get out of it and create a neural rut about finding good in things.
Building new skills to foster neuroplasticity allows you to better adapt to change over time, so you pick up new things more quickly and adapt more quickly. That means the more you push forward, the easier adding on new things will get.

Neuroplasticity means your brain adapts to the environment it’s in, trying to maximize energy usage and output to what it’s doing and the environment it is in. This means you can always change your brain by changing your patterns, changing your behavior, and changing your environment. That change will often take time and recovering from trauma and physical damage can take years. But, you have the capacity to recover, to build new neural pathways, and to heal. That might not mean leaving your mental health disorder behind, but it will mean leaving the trauma caused by that mental health disorder behind and building healthy patterns that support quality of life and happiness around your mental health disorder.

Getting Help

If you or a loved one is struggling with mental health, it’s important to recognize that there is help. Reaching out to talk to your doctor, working your way towards behavioral therapy, and getting mental health interventions can set you on the path to permanent change and permanent improvement in your quality of life. Eventually, that will mean you have the patterns and the skills to better navigate mental health so you can be happier.

Passive Suicidal Ideation: Signs and When to Seek Help

Jim Sugel on March 15, 2024

If you or a loved one is struggling with thoughts of self-harm, suicide, and dying, it’s important to reach out and talk to a professional. That’s even true if that ideation is passive, because even if it’s not pressing, suicidal ideation is never a good sign. It’s a warning that you need help, and you need to get it before the problem becomes worse.

Passive suicidal ideation is, in short, the desire to die without having a plan to achieve that. That means you face a feeling of wanting to die, intrusive thoughts of self-harm or killing yourself, or feelings of not wanting to live. If you’re experiencing that, that is enough warning sign to seek help and to talk about it with a mental health professional. However, we’ll go more into detail on that in the rest of this article.

What is Passive Suicidal Ideation

Passive suicidal ideation is the desire to die, to kill yourself, or a lack of desire to keep living. However, it’s called “passive” because the person experiencing it hasn’t made an active or concrete plan to make these thoughts a reality. In fact, they might never do so. For many people, passive suicidal ideation is unwelcome and unpleasant. For others it’s an early warning sign of actually wanting to die and will eventually solidify into an active want to die. That change can be triggered by bad things happening, mental health getting worse, or by trauma. However, it can happen.

In either case, passive suicidal ideation is not something to just live with. It reduces your quality of life, it harms your mental health, and it can turn into active suicidal ideation over time. That means you should always look for and get help if you are experiencing it. Even talking about it with a professional can give you insight into what your coping mechanisms are, how you can redirect thoughts, and how you can work towards overcoming those thoughts.

What are the Signs of Passive Suicidal Ideation in Others

Passive suicidal ideation can take a lot of different forms. For many people, it means expressing or showing thoughts of wanting to die. Others will never voice those thoughts aloud. That can mean you’ll never notice or see suicidal ideation until it’s too late. However, you can look for signs like:

Expressing a desire to die. Even if it’s said as a joke, it is something you should take seriously, talk about, and try to figure out how real the sentiment is.
Researching or looking into how suicide works and what types of suicide methods work. Even things like knowing suicide statistics and what kinds of suicide attempts work can be a red flag. For example, if someone knows why a suicide method is the most effective, that means they’ve looked it up, and that means they had motivation to do so.

You can also look for statements like:

“I want to die”
“life just doesn’t feel worth living”
“I hope this car crashes”
“I could step in front of this bus”
“My loved ones would be better off if I were never born”
“I don’t want to be alive anymore”
“Everything is too hard to cope with”
“I just want to sleep and not have to deal with life”

These statements, and others like them, all express passive suicidal ideation.

You can also look for signs of poor mental health like:

Increased reliance on substances
Depression
Self-isolation or avoiding friends and family
Expressions of or feelings of loneliness
Changes in behavior such as self-care
Changes in sleeping patterns
Self-harm
Feelings of hopelessness

These latter symptoms can map to a very large number of mental health problems. However, they all point to the fact that this person is not doing well and probably needs help.

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Are Suicidal Thoughts Normal?

In 2021, an estimated 12.3 million Americans seriously thought about Suicide. This means that for almost 4% of the population, suicide is a normal thing to think about. At the same time, normal does not mean healthy, good for you, or something you have to live with.

People think about dying all the time. Today, someone dies by suicide almost every 11 minutes in the United States. The fact that something is normal does not mean that you should leave it alone. Instead, it means that it’s normal to need help and it should be normal to ask for that help.

Coping with Passive Suicidal Ideation

Therapy and mental health support is the best way to cope with suicidal ideation. Professional help can allow you to understand what’s underneath suicidal ideation, to find and change behavior and patterns in your life that contribute to feeling that way, and to build habits and change that improve your life so you can move past suicidal ideation and get back to enjoying your life. And, when therapy isn’t enough, a mental health professional can help you to get treatment and medication to help balance your mood so you can improve quality of life that way.

Managing suicidal ideation also means managing your life and the people in it. That means:

Managing your routines so you have structure and support
Manage energy by going to bed and getting up at the same time every day, making sure you get plenty of rest, and taking steps to ensure your quality of sleep is good
Keep your space clean by spending 15-20 minutes per day cleaning up
Take time to socialize and spend time with people who are fun and doing fun things. Consider what things you like to do and make sure you do them, even if you’re not experiencing joy in doing them right then
Make sure you have what you need to feel good. That means exercising 30-60 minutes per day most days and eating nutritious food about 80% of the time.
Minimize caffeine and alcohol intake and try to stick to recommended daily limits or less for both

Essentially, if you take steps to give yourself structure and routine, put effort into taking care of yourself, and keep your space clean, you’re giving yourself a good basis for mental health. On top of that, you should add things you like to do like hobbies (crafting, sports, games) and spending time with friends and family so that you get to enjoy things as well. That won’t make you feel “not depressed”, but it will give you a good baseline for feeling good about yourself and your life.

When Should You Seek Help?

In any case where you’re experiencing suicidal ideation, you should be seeking help. If you have recurring thoughts of death, wanting to die, not wanting to live, self-harm, or suicide, you should be talking to a mental health professional. Often, that starts with talking to your doctor who can recommend you to a therapist or to other treatment. However, you can also reach out and ask for treatment directly from a mental health clinic or center.

Suicidal ideation is always a warning that something is wrong, and it is always a good sign to reach out and ask for help. If you or a loved one is experiencing even passive suicidal ideation, the time to seek out help is now.