Follow-up To; How do You Apologize and Why Should You?

By Dr. Priscilla Diffie-Couch

A while back, family member Priscilla Diffie-Couch who holds a doctorate in communication, penned a blog for Bob’s Newheart titled, “How do You Apologize and Why Should You?”  (https://bobsnewheart.wordpress.com/2014/08/18/how-do-you-apologize-and-why-should-you/) It became very popular but in its popularity generated a multitude of questions.  Dr. Diffie-Couch, who is never comfortable with loose ends provided some very thoughtful and effective answers.  Please feel free to share them and the original blog with anyone you choose.

In forwarding her response draft she said, “I am pleased that so many of you read my blog on effective apologies.  Several of your comments and questions have prompted some points of clarity.”

QUESTION

I have repeated my apology so many different times that my friends now treat it as though it is not sincere.

If you find yourself repeating the same apology for the same offense to the same people, you must question whether you have ever included all of the five dimensions of an effective apology:

 

1. RECOGNITION
2. RESPONSIBILITY
3. REMORSE
4. RESTITUTION
5. REPETITION

At the very minimum, you are evidently repeating the offensive behavior that caused the original distress.  People grow tired of hearing repeated promises when a change in your behavior is what they really expect from you.

QUESTION

I try to explain my offensive behavior very carefully before I actually say the words “I’m sorry” when I apologize.  Is that the best approach?

 

No.  You run two risks with this approach.  (1) You will add to the anger and hurt of those you have offended, the longer you put off saying the two words they want to hear:  “I’m sorry.”  (2) You will waste your lengthy explanation because the listener or reader will be so focused on hearing or seeing those two magic words that they will miss much of the rest of your message.

QUESTION

What is the best way to end an apology so that it doesn’t drag on endlessly?

Start by saying you are sorry.  Determine what the hurt party expects.  Make sure you come to a mutual understanding of the exact nature of the offense.  Work to include the five dimensions.  Is it something you said or didn’t say?  Did or didn’t do?  Then end by saying exactly what you intend to do to avoid repeating the offense.

QUESTION

How soon do I have to apologize?                 

Apologize without delay.  Undue delay adds to the offended person’s distress and allows for compounding the problem and even encourages imagined transgressions that never occurred.  Allow yourself enough time to pull your thoughts together and assess the nature of your offensive words or behavior.  It never hurts to take great pains in how you plan to phrase an apology.

 QUESTION

Is it better to apologize in person or in writing?  Can I do so on the phone?

You would think apologies should be done in person.  But that is not always the best or most practical approach.
You can express a simple “I’m sorry” immediately through any medium.  But you need to let the party know you plan to follow up with specifics.  Even when it is practical to apologize in person, a carefully-thought-out written apology can smooth the way for a more comfortable and satisfying personal interaction.  Put yourself in the reader’s place.  Reread your apology many times with a careful eye as to the “tone” of the words you have chosen.

As a person who wears top-of-the-line hearing aids, I can tell you that apologizing on the phone is fraught with potential perils.

QUESTION

Isn’t it better to keep my apology very general so that I can avoid getting into the same issues that caused the hurt feelings?

Absolutely not.  In fact, the offended party will be looking for a direct reference to the exact hurtful deed or word and will wonder if you really understand why you are giving an apology if you fail to recognize the specific nature of your offense.  It is pointless to promise to make obscure and general behavior changes when it is a particular offense that caused the hurt.  Until you address the matters of contention fully, the offended person is unlikely to view your apology as satisfying or sincere.

QUESTION

Regardless of how explicitly I apologize for my offense, the wounded party keeps bringing up some other offense I’ve committed in the same altercation?  Isn’t enough enough?

Unfortunately, it is all too common for people to “gunny sack” a lot of old grievances and then to dump them all at once in a given confrontation.  Ask yourself if you recognize your guilt in each separate issue the offended party raises.  If you do, you are obligated to make amends for each issue as a separate matter.  In healthy relationships, people avoid “gunny sacking.”  Every disagreement should be dealt with independently without delay.

QUESTION

Shouldn’t I just keep my apology very simple if that is my style?

That depends on your goal.  If you seek only satisfy your own personal standards with your apology, you can choose what to include and hope for the best.  However, if your goal is to repair and restore a damaged relationship, then you should heed the approach that works most successfully in a larger world.

QUESTION

Wouldn’t it be better in some cases just to skip the apology, let things go, and move on with your life?
That is what many people do who are left wondering why they have so much trouble maintaining close, trusting relationships.  Those same people excuse offending behavior by saying, “That’s just the way I am.”  If you are one, ask yourself, “When did the death of my growth occur”?  At age three?  Thirty-three?  Sixty-three?

CONCLUSION

Unresolved issues left to smolder can burst into flames in sudden and devastating ways. 

Valued relationships must be nurtured.  That demands taking responsibility for any role you may play in eroding a relationship.  As human beings, we will find ourselves guilty more than once of causing temporary distress in other people’s lives.  Learning how to repair the damage that distress can cause necessarily involves utilizing effective apologies.  That is a part of actively becoming a better person.  That kind of growth is possible and desirable as long as we live.

-0-

An award winning high school speech and English teacher, Priscilla Diffie-Couch went on to get her ED.D. from Oklahoma State University, where she taught speech followed by two years with the faculty of communication at the University of Tulsa.  In her consulting business later in Dallas, she designed and conducted seminars in organizational and group communication.

An avid tennis player, she has spent the last twenty years researching and reporting on health for family and friends.  She has two children, four grandchildren and lives with her husband Mickey in The Woodlands, Texas.

Bob Aronson of Bob’s Newheart is a 2007 heart transplant recipient, the founder of Facebook’s over 4,000 member Organ Transplant Initiative (OTI) and the author of most of these donation/transplantation blogs. You may comment in the space provided or email your thoughts to me at bob@baronson.org. And – please spread the word about the immediate need for more organ donors. There is nothing you can do that is of greater importance. If you convince one person to be an organ and tissue donor you may save or positively affect over 60 lives. Some of those lives may be people you know and love.

 

How do You Apologize and Why Should You?

Introduction by Bob Aronson

This blog has addressed many issues over the years, but we’ve never approached the issue of how our behavior when ill sometimes results in hurt feelings, the loss of friends and even the dissolution of marriages because so few of us know how to say, “I’m sorry,” in an effective and meaningful manner.

Anyone who has suffered a serious, life-threatening illness has at one time or another lost their temper, or become overly emotional and said and did things that are out of character.  Unfortunately we rarely know just how deeply our words and actions can hurt others and worse yet, when and if we apologize we do so ineffectively.  “I’m sorry,” are two words that are extremely difficult for most people to say and when we do use them it is often too late and without sincerity.

I’m a member of Alcoholics Anonymous.  It is a twelve step program and two of the steps are devoted to apologizing.  In AA it’s called  “Making Amends” or apologizing to those you have hurt or harmed in some manner.  Specifically step eight admonishes members to “make a list of all persons we had harmed, and became willing to make amends to them all.”  And –Step Nine says, “Make direct amends to such people wherever possible, except when to do so would injure them or others.”

Having been part of that program for 33 years I should have more than a passing acquaintance with apologizing, but I don’t. I’m not very good at it and I don’t like doing it because like most people I don’t like having to admit that I’ve made mistakes….who does?

The bottom line is that making amends or apologizing is good for one’s mental health and I was made aware of that recently by Dr. Priscilla Diffie-Couch a family member with a Doctorate in Communication.  A brilliant woman, Priscilla has for years served as a healthy living advisor to the Diffie family and her advice is always spot on.  Recently I asked her to pen a guest blog for Bob’s Newheart and she responded with this essay on apologizing.  It’s a subject to which I’ve given almost no thought and am grateful that she brought it to our attention.

I’m hoping we can talk Dr. Diffie-Couch into being a more regular contributor to our efforts.   Thanks Priscilla.

 How do You Apologize and Why Should You?

By Dr. Priscilla Diffie-Couch ED.D.

One of the most fundamental communication skills needed to maintain trusting and close relationships is found in the art of apologizing.  The most common mistake we make is to respond to someone who expresses hurt feelings by saying, “Oh, you misunderstood.  I didn’t mean to hurt you.”  That only serves to insult that person’s intelligence. Few people would say, “I meant to hurt your feelings or offend you.”

Effective Apology—Mending Fences by John Kador is an excellent resource for understanding the skills involved in apologies that actually repair hurt feelings.  His five “R’s” explain why an effective apology is far more than simply sincere and why extracted apologies leave us feeling so unsatisfied:

1. RECOGNITION
2. RESPONSIBILITY
3. REMORSE
4. RESTITUTION
5. REPETITION

By RECOGNITION, he means acknowledging that feelings are not debatable or deniable.  You must treat that person’s declaration of being hurt as valid and true.  Denying the truth of your offense will do nothing toward healing.  Of course, confining your attacks to the issues–not the persons who raised them–will greatly reduce your need to make apologies.

By RESPONSIBILITY, he means acknowledging your real role in this hurt.  You must own the words that you said and accept that they caused hurt.  Responsibility means saying, “I’m sorry.  I see how that was offensive to you.”   You must acknowledge your guilt and convey a willingness to do something about it.  Saying “You misunderstood” not only adds insult to injury, it suggests you think the responsibility for fixing the hurt belongs with the person who is offended.

By REMORSE, he means verbally admitting that you made a mistake in the way you conveyed a message and you feel bad about causing the hurt.  Arguing with someone who has expressed that your words were hurtful exposes that you do not feel contrite; your real goal is to prove you were right.  Excuses are equally offensive.  They only widen the wounds.

By RESTITUTION, he means the willingness to invest whatever time is required to ensure that the hurt party sees that you are sincere, feels better and knows that you care.  Saying “That’s just the way I am” is tantamount to saying, “You are the problem, not me.  You are too sensitive when I express my strong opinions.  You are the one who should change, not me.”  You are not alone in having strong opinions.  It’s how and when you choose to express them that most affects your relationship with others.

When deeds and words collide, words seldom win.  Saying, “I love you” is meaningless unless you are willing to take specific actions that truly reflect that love.  Words have the power to inflict wounds that only deeds can heal.  When you hurt others, the act of making a full apology is the deed required. It is critical in repairing a relationship damaged by hurt.  Expressions of love are poor imposters of apologies.

By REPETITION, he means promising to avoid repeating the offense.  Apologies that fall short are seldom seen as “wholehearted.”  Vows to change help insure acceptance of your apology and increase the hurt party’s desire to take on responsibilities and benefits that come with forgiveness.  But that is another story.

Effective apologies restore and improve relationships and pave the pathway to personal growth.  People who have good relationships live longer and healthier lives.

This summary focuses on only part of what Kador deals with regarding effective apologies.  Maybe you have questions.  I did.

QUESTION:  Do all my apologies have to include all five dimensions?  The short answer is no.  Passing events in our lives like bumping into someone or creating a disturbing noise call for little more than “I’m sorry.”  The focus in this book, however, is repairing and improving relationships.  Achieving that goal demands consideration of each dimension in framing your apology.

QUESTION:  Isn’t it true that some people are overly sensitive and require an unusual number of apologies?  True, but you have little to gain by excusing yourself from giving an apology based on what you see as the recipient’s personality shortcomings.  Life demands dealing with all kinds of personalities.  You cannot change others.  You can control only your own behaviors.  People with the greatest number of satisfying relationships are those who recognize the value of understanding and adaptation.

QUESTION:  I am not a great communicator.  Can’t I just send the injured person flowers or some kind of gift?  No gift can convey the five dimensions that characterize a wholehearted apology.  Gifts can easily be seen as taking the easy way out of situations that are full of needs and complexities.

QUESTION:  But isn’t it possible that whatever I did or whatever I said does not warrant an apology?  That is possible. Your first objective with someone who claims to be offended is to be sure that you have a full understanding of the basis for that claim.  Use the words “Help me understand exactly what I said or did….”  When no specific examples or explanations can be provided, then an extracted apology will do nothing to promote trust.  Instead, say something like this: “I value our relationship, but giving you an empty insincere apology for something so vague will not bring us closer.”

QUESTION:  Are there specifics about what I should or should not include in my apology?  Begin with “I.”  Use active voice.  Example:  “I’m sorry I hurt you,” not “I’m sorry you were hurt.”  Do not include “if’s” or “buts.”  Don’t joke.  Don’t assume.  Ask how someone feels.  Use the person’s name.  Don’t ramble.  Don’t argue.  Listen.  Really listen.  Then apologize.

Learn to apologize effectively.  It’ll do your heart good.

 -0-

An award winning high school speech and English teacher, Priscilla Diffie-Couch went on to get her ED.D. from Oklahoma State University, where she taught speech followed by two years with the faculty of communication at the University of Tulsa.  In her consulting business later in Dallas, she designed and conducted seminars in organizational and group communication.

An avid tennis player, she has spent the last twenty years researching and reporting on health for family and friends.  She has two children, four grandchildren and lives with her husband Mickey in The Woodlands, Texas.

 Bob Aronson  has worked as a broadcast journalist, Minnesota Governor’s Communications Director and for 25 years led his own company as an international communication consultant specializing in health care.

In  2007 he had a heart transplant at the Mayo Clinic in Jacksonville, Florida.  He is the Bob of Bob’s Newheart and the author of most of the nearly 250 posts on this site.  He is also the founder of Facebook’s nearly 4,000 member Organ Transplant Initiative (OTI) support group.

You may comment in the space provided or email your thoughts to him at bob@baronson.org.  And – please spread the word about the immediate need for more organ donors. There is nothing you can do that is of greater importance. If you convince one person to be an organ and tissue donor you may save or positively affect over 60 lives. Some of those lives may be people you know and love.

Clinical Depression. You Can Defeat Your Demons!

By Bob Aronson

Depression, what is it? Why can’t you just snap out of it? Many people including family and friends who have not experienced depression have great difficulty understanding it much like people who are not addicts can’t understand addiction. In both cases we often hear advice like, “Snap out of it, you’ve got things pretty good. There’s no reason to be depressed.” Or, “You made the choice to start drinking or using drugs so choose to stop.” Oh, if it were that simple.

Here’s a cold slap in the face to bring us into reality. Depression is a mental illness, like the common cold is a physical illness. There has long been a stigma associated with mental illness held over from the days of Insane Asylums and “Crazy” people. That stigma is rapidly disappearing because so many people suffer from depression which is often a chemical imbalance that is quite treatable. Your mental health is every bit as important as your physical health and one can affect the other.

Here are some shocking statistics from the National Institutes of Mental Health (NIMH).

Major Depressive Disorder

• Major Depressive Disorder is the leading cause of disability in the U.S. for ages 15-44.³
• Major depressive disorder affects approximately 14.8 million American adults, or about 6.7 percent of the U.S. population age 18 and older in a given year.^1, 2
• While major depressive disorder can develop at any age, the median age at onset is 32.⁵
• Major depressive disorder is more prevalent in women than in men

Major or clinical depression is an awful feeling. It is a gnawing at the pit of your stomach, in your gut that makes you feel hopeless, helpless and alone. It is as though someone locked up your ability to reason, your sense of humor and your will to live in a windowless, dark, solitary confinement jail cell from which there is no escape. It is a constant feeling of impending doom combined with a profound sadness and even fear. It can steal your energy, memory, concentration, sex drive, interest in activities you used to love and…it can even destroy your will to live. Depression may not be as common as the common cold but it is much more common than ever before. Nearly 20 percent of Americans suffer from it at one time or another.

Logic says that you should be able to “Will” yourself out of this mood, but will power alone cannot give you the boost you need to get your life’s engine started again. Mental illness is not unlike physical illness. You cannot use will power to eliminate depression any more than you could use it to stop cancer. No one wants to be depressed, no one,. Think about it. If will power would work as an anti-depressant there would be no depression because again, no one wants to feel like what I described.

Let’s get to the medical description and symptoms as offered by the Mayo Clinic. http://www.mayoclinic.org/diseases-conditions/depression/expert-answers/clinical-depression/faq-20057770

“To be diagnosed with clinical depression, you must have five or more of the following symptoms over a two-week period, most of the day, nearly every day. At least one of the symptoms must be either a depressed mood or a loss of interest or pleasure. Signs and symptoms may include:
• Depressed mood, such as feeling sad, empty or tearful (in children and teens, depressed mood can appear as constant irritability)
• Significantly reduced interest or feeling no pleasure in all or most activities
• Significant weight loss when not dieting, weight gain, or decrease or increase in appetite (in children, failure to gain weight as expected)
• Insomnia or increased desire to sleep
• Either restlessness or slowed behavior that can be observed by others
• Fatigue or loss of energy
• Feelings of worthlessness, or excessive or inappropriate guilt
• Trouble making decisions, or trouble thinking or concentrating
• Recurrent thoughts of death or suicide, or a suicide attempt
Your symptoms must be severe enough to cause noticeable problems in relationships with others or in day-to-day activities, such as work, school or social activities. Symptoms may be based on your own feelings or on the observations of someone else.
Clinical depression can affect people of any age, including children. However, clinical depression symptoms, even if severe, usually improve with psychological counseling, antidepressant medications or a combination of the two.”

The National Institutes of Health (NIH) has this to say about depression.

What causes depression?

Several factors, or a combination of factors, may contribute to depression.
• Genes—people with a family history of depression may be more likely to develop it than those whose families do not have the illness.
• Brain chemistry—people with depression have different brain chemistry than those without the illness.
• Stress—loss of a loved one, a difficult relationship, or any stressful situation may trigger depression.
Depression affects different people in different ways.
• Women experience depression more often than men. Biological, life cycle, and hormonal factors that are unique to women may be linked to women’s higher depression rate. Women with depression typically have symptoms of sadness, worthlessness, and guilt.
• Men with depression are more likely to be very tired, irritable, and sometimes even angry. They may lose interest in work or activities they once enjoyed, and have sleep problems.
• Older adults with depression may have less obvious symptoms, or they may be less likely to admit to feelings of sadness or grief. They also are more likely to have medical conditions like heart disease or stroke, which may cause or contribute to depression. Certain medications also can have side effects that contribute to depression.
• Children with depression may pretend to be sick, refuse to go to school, cling to a parent, or worry that a parent may die. Older children or teens may get into trouble at school and be irritable. Because these signs can also be part of normal mood swings associated with certain childhood stages, it may be difficult to accurately diagnose a young person with depression.

Ok we’ve defined the malady and we know how clinicians determine if patients have it so the next logical question is, “What can you do about it.” Well, the answer is simple, but it will take a major commitment on your part to make the answer work for you, we can start by identifying some hazards, potholes on the road to good mental health.

Depression: Ten Traps to Avoid

Dr. Stephen Ilardi, author of “The Depression Cure,” has identified several things that can make depression worse. First, know this. Depression is a serious medical condition and should be treated by a doctor or licensed therapist. Having said that, here”s what Dr. Ilardi suggests.

Trap 1: Being a Couch Potato

When you’re feeling down, it’s tempting to hole up in your bed or on the couch. Yet exercise – Even moderate activity like brisk walking – has been shown to be at least as effective against depression as antidepressant medication. It works by boosting the activity of the “feel-good” neurochemicals dopamine and serotonin.
For an “antidepressant dose” of exercise, try at least 40 minutes of brisk walking or other aerobic activity three times a week.

Trap 2: Not Eating “Brain Food”

Omega-3 fats are key building blocks of brain tissue. But the body can’t make omega-3s; they have to come from our diets. Unfortunately, most Americans don’t consume nearly enough Omega-3s, and a deficiency leaves the brain vulnerable to depression. Omega-3s are found in wild game, cold-water fish and other seafood, but the most convenient source is a fish oil supplement. Ask your doctor about taking a daily dose of 1,000 mg of EPA, the most anti-inflammatory form of omega-3.

Trap 3: Avoiding Sunlight

Sunlight exposure is a natural mood booster. It triggers the brain’s production of serotonin, decreasing anxiety and giving a sense of well-being. Sunlight also helps reset the body clock each day, keeping sleep and other biological rhythms in sync.

During the short, cold, cloudy days of winter, an artificial light box can substitute effectively for missing sunlight. In fact, 30 minutes in front of a bright light box each day can help drive away the winter blues.

Trap 4: Not Getting Enough Vitamin D

Most people know vitamin D is needed to build strong bones. But it’s also essential for brain health. Unfortunately, more than 80 percent of Americans are vitamin D deficient. From March through October, midday sunlight exposure stimulates vitamin D production in the skin – experts advise five to 15 minutes of daily exposure (without sunscreen). For the rest of the year, ask your doctor about taking a vitamin D supplement.

Trap 5: Having Poor Sleep Habits

Chronic sleep deprivation is a major trigger of clinical depression, and many Americans fail to get the recommended seven to eight hours a night. How can you get better sleep?

Use the bed only for sleep and sex – not for watching TV, reading, or using a laptop. Turn in for bed and get up at the same time each day. Avoid caffeine and other stimulants after midday. Finally, turn off all overhead lights

Trap 6: Avoiding Friends and Family

When life becomes stressful, people often cut themselves off from others. That’s exactly the wrong thing to do, as research has shown that contact with supportive friends and family members can dramatically cut the risk of depression. Proximity to those who care about us actually changes our brain chemistry, slamming the brakes on the brain’s runaway stress circuits.

Trap 7: Mulling Things Over

When we’re depressed or anxious, we’re prone to dwelling at length on negative thoughts – rehashing themes of rejection, loss, failure, and threat, often for hours on end. Such rumination on negative thoughts is a major trigger for depression – and taking steps to avoid rumination has proven to be highly effective against depression.

How can you avoid rumination? Redirect attention away from your thoughts and toward interaction with others, or shift your focus to an absorbing activity. Alternatively, spend 10 minutes writing down the troubling thoughts, as a prelude to walking away from them.

Trap 8: Running with the Wrong Crowd

Scientists have discovered that moods are highly contagious: we “catch” them from the people around us, the result of specialized mirror neurons in the brain. If you’re feeling blue, spending time with upbeat, optimistic people might help you “light up” your brain’s positive emotion circuits.

Trap 9: Eating Sugar and Simple Carbs

Researchers now know that a depressed brain is an inflamed brain. And what we eat largely determines our level of inflammation. Sugar and simple carbs are highly inflammatory: they’re best consumed sparingly, if at all.

In contrast, colorful fruits and veggies are chockablock with natural antioxidants. Eating them can protect the body’s omega-3s, providing yet another nice antidepressant boost.

Trap 10: Failing to Get Help

Depression can be a life-threatening illness, and it’s not one you should try to “tough out” or battle on your own. People experiencing depression can benefit from the guidance of a trained behavior therapist to help them put into action depression-fighting strategies like exercise, sunlight exposure, omega-3 supplementation, anti-ruminative activity, enhanced social connection, and healthy sleep habits.

So you think you’ve avoided all the traps, but you are still depressed, now what? According to the National Alliance on Mental Illness (NAMI) here are the options. (http://www.nami.org/Content/NavigationMenu/Mental_Illnesses/Depression/Depression_Treatment,_Services_and_Supports.htm)

Treating Major Depression

Although depression can be a devastating illness, it often responds to treatment. The key is to get a specific evaluation and a treatment plan. Today, there are a variety of treatment options available for depression. There are three well-established types of treatment: medications, psychotherapy and electroconvulsive therapy (ECT). A new treatment called transcranial magnetic stimulation (rTMS), has recently been cleared by the FDA for individuals who have not done well on one trial of an antidepressant. For some people who have a seasonal component to their depression, light therapy may be useful. In addition, many people like to manage their illness through alternative therapies or holistic approaches, such as acupuncture, meditation, and nutrition. These treatments may be used alone or in combination. However, depression does not always respond to medication. Treatment resistant depression (TRD) may require a more extensive treatment regimen involving a combination of therapies.

-0-

Bob Aronson of Bob’s Newheart is a 2007 heart transplant recipient, the founder of Facebook’s nearly 4,000 member Organ Transplant Initiative (OTI) and the author of most of these donation/transplantation blogs. You may comment in the space provided or email your thoughts to me at bob@baronson.org. And – please spread the word about the immediate need for more organ donors. There is nothing you can do that is of greater importance. If you convince one person to be an organ and tissue donor you may save or positively affect over 60 lives. Some of those lives may be people you know and love.

Mental Illness Myths Exploded — Music Therapy Can Help

“Music is a moral law. It gives soul to the universe, wings to the mind, flight to the imagination, and charm and gaiety to life and to everything.”

Plato

Mental Illness is as real as cancer — you can’t “think” your way out of it.

By Bob Aronson

Get over it!  It’s all in your head,” was and is a common utterance by those who don’t understand that just because it is in your head doesn’t make it less real.  Will power cannot dislodge demons of the mind any more effectively than it can stop cancer.   Both are real, both are serious and treatment for both is available and necessary.

The difference between the two is that while we accept illnesses of the body as real illnesses we, as a society, have not yet fully accepted mental illness as a disease and until we do greater societal problems will ensue.

Both pre and post transplant patients suffer from depression.  Some suffer from other mental illnesses as well.  Just because we need or have had an organ or tissue transplants doesn’t mean we aren’t subject to all the ills that befall everyone else.  In reality we may be more susceptible because we have come face to face with death.  Many of us live with it for years.  You can’t get on the transplant list unless you have an end stage disease. That’s fancy doctor talk for, “You are dying.”

This blog is about one approach to helping people with emotional or other problems involving the brain…music.  Before we get into solutions, though, it is important to understand the problem.

The U.S. Centers for Disease Control (CDC) says that although mental health and mental illness are related, they represent different psychological states.

Mental health is “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.”¹ It is estimated that only about 17% of U.S adults are considered to be in a state of optimal mental health.² There is emerging evidence that positive mental health is associated with improved outcomes.

Mental illness is defined as “collectively all diagnosable mental disorders” or “health conditions that are characterized by alterations in thinking, mood, or behavior (or some combination thereof) associated with distress and/or impaired functioning.”² Depression is the most common type of mental illness, affecting more than 26% of the U.S. adult population.³ It has been estimated that by the year 2020, depression will be the second leading cause of disability throughout the world, trailing only ischemic heart disease.⁴

Evidence has shown that mental disorders, especially depressive disorders, are strongly related to the occurrence, successful treatment, and course of many chronic diseases including diabetes, cancer, cardiovascular disease, asthma, and obesity⁵ and many risk behaviors for chronic disease; such as, physical inactivity, smoking, excessive drinking, and insufficient sleep.

Unfortunately public acceptance of mental illness treatment has been slow in coming despite the fact that many effective treatments have existed for a long time.  Often people who are affected don’t seek help because of the embarrassment of being labeled “mentally ill”

Mental Health America (MHA) is trying to dispel the myths surrounding mental illness.  The five most common are: (http://www.mentalhealthamerica.net/go/workplacewellness/5myths )

Myth #1: Mental illness is the same as mental retardation.

The Facts: Mental illness and mental retardation are entirely different disorders. Mental retardation is primarily characterized by limitations in intellectual functioning, while intellectual functioning varies among persons with persistent mental illness just as it does across the general population.

Myth #2: Recovery from mental illness is impossible.

The Facts: While these illnesses are persistent, research has shown that with treatment, the majority of people with mental illnesses achieve genuine improvement in their symptoms over time and lead stable, productive lives. As the treatment of mental illness has advanced, the focus of treatment has shifted from simply minimizing symptoms to true recovery-that is, the reintegration into mainstream society, including (and perhaps most importantly) the world of work.

Myth #3: Mentally ill and mentally restored employees (that is, those in whom mental illness is effectively treated) tend to be second-rate workers.

The Facts: Far from being inferior workers, individuals with mental illnesses may in fact be superior in many ways to their co-workers without mental illness. Employers who have hired these individuals report that their attendance and punctuality exceed the norm, and that their motivation, work quality, and job tenure is as good as — or better than — that of other employees. Research has shown that there is no difference between the productivity of workers with and without mental illness.

Myth #4: People with psychotic disabilities cannot tolerate stress on the job.

The Facts: The response to job-related stress, and precisely which factors will be perceived as stressful, vary among individuals with psychiatric disabilities just as they do among people without such disabilities. For all workers — with or without psychiatric disabilities — productivity is optimized when there is a close match between the employee’s needs and his or her working conditions.

Myth #5: Mentally ill and mentally restored individuals are unpredictable, potentially violent, and dangerous.

The Facts: This myth is reinforced by media portrayals of people with mental illnesses as frequently and randomly violent. However, a research literature review conducted at Cornell University found absolutely no evidence to support such portrayals. The fact is that the vast majority of individuals with psychiatric disabilities are neither dangerous nor violent.

So, Given that we understand the myths and can deal with them let’s look at one form of therapy that can be and has been very effective in some cases.

While mental illness was not an issue, a serious brain injury was in the case of former congresswoman Gabby Gifford  who was seriously wounded when shot in the head in an attempted assassination.   Her therapists have used music to help her learn to walk and speak again, as well as give her an emotional boost along her stunningly difficult path.  If you want to learn more about the Gifford story click on this link from ABC TV news.

http://tinyurl.com/n3cuapy

The power of music

Music can help rewire the brain after a traumatic injury, stroke or accident. In all of us, Our own playlist of personal favorites can help to:

• Trigger memories. Think of jingles that remind you of a company’s name, or that song that always takes you back to your senior year of high school.
• Promote learning. Next time you have a phone number or list of terms to remember, try putting it to music. Elicit emotions. The movie industry has long known how to use background music to heighten terrifying, tragic or exhilarating moments.
• Provide motivation. Chores can become an entirely different experience when set to an energetic beat. Improve coordination. If you hear music while you’re walking, you can’t help but to walk to the beat. That’s a biological process called “entraining,” in which a rhythm and melody pull us into synchrony with them.
• Reduce stress and pain. Calming music can entrain you to breathe deeply and the memories music elicits can remind you of happier, more peaceful times and places.Source: Concetta Tomaino, executive director of the Institute for Music and Neurologic Function at the Beth Abraham Family of Health Services in New York.

Music holds a unique role in human life. Its rhythms help organize movements — almost no one can resist a good beat. Music brings up memories. And music, it seems, can help retrain the speech centers of the brain.

I could go on here and offer quote after quote about what music therapy is and does but the best way to for readers to know how it works is to listen to what patients have to say.  The American Music Therapy Association (AMTA) http://www.musictherapy.org/ has a section on its web site where patients relate their experience with music therapy.  Here are just a few, you can read more by going to the AMTA site.

Parent testimonial, written by Tamera Norris

Music has the power to enrich the mind of a child with autism. Many people with autism have limited verbal expression. They live a life of involuntary silence. “After silence, that which comes nearest to expressing the inexpressible is music.” (Aldous Huxley) That is the reason why “music (became) the shorthand of (William’s) emotions.” (Leo Tolstoy) It gave him opportunities for speech, emotional contact and mental focus.

From the age of four through his current age of 16, William has taken a music bath once or twice a week at The Music Settlement. As Oliver Wendell Holmes once said, “…a music bath… is to the soul what the water bath is to the body.” Music has flown out, immersing restless feelings, calming William, minimizing his hesitation. Then it ebbed and he met the eyes of the therapist. With the guidance of Ronna Kaplan and other music therapists, William has developed, encouraged to tune his fine and gross motor skills. The therapy program made use of live and recorded music, pre-planned dialogues for the clients and sound effects. While learning to play instruments, William also learned life skills. “Music (became the soundtrack of (his) life.” (Dick Clark)

Being born with autism makes it difficult to interact with others or communicate verbally. It causes the affected person to be unaware of reacting in ways that others do not commonly react in society. Music therapy provided William a non-threatening environment in which to build relationships with peers, express himself verbally and nonverbally and learn to participate in socially acceptable ways. This was achieved through group therapy, as well as individualized sessions. Both forms were ideal for William, because individual lessons allowed him to learn at his own pace. These lessons were tailored to meet his needs. They helped him to learn to read music, follow a rhythm, and to respect the need to display the proper behavior in the proper situation. Small group therapy required him to learn to take turns and to be a focused member of a team. He had to use proper questions and verbal responses. He had to learn to be both leader and supportive member. This even carried over to life outside of The Music Settlement, as William auditioned for and earned a position on a regular team of drummers for his school. He was able to perform at the House of Blues in front of a large, noisy audience, with no problem. This was not something that he would have been able to withstand before his experiences in music therapy.

We are very pleased and thankful for the progress that William has made over the years and we foresee him continuing to flourish with additional music therapy. The combination of an excellent music therapy curriculum and an enthusiastic, care-giving staff, has enabled William not to just, “…go where a path might lead, but instead to go where there is no path and leave (his) trail.”  (Ralph Waldo Emerson)

I am closing with a short poem, expressing my feelings about The Music Settlement and its staff. It is simply entitled, Thank You.

Thank You

Music therapy teaches
Social skills.
It’s about communication.
It’s about what William’s taught,
In nurturing situations.
He’s learned patience
And tolerance,
Growing in many ways.
His social skills developed,
Made him what he is today.
So, thank you for your guidance,
As only music can touch.
Thank you for reaching our William,
Because it means so much.

A physician/patient  talks about his recovery.

R.B.Fratianne, MD.  Prof. of Surgery, CWRU Dir. Emeritus, Burn Center Metrohealth Med. Center.  I was deeply honored by the gracious invitation to attend this year’s annual meeting of The AMTA and receive the Advocate of the Year Award. At the meeting, I was impressed by the level of enthusiasm and dedication to excellence shown by the highly trained professionals I met. They radiated pride in their work coupled with an intense sense of fellowship which made me feel welcome and respected – even though I was a rookie. For this I am very grateful.

I learned the value of music therapy first-hand when I had a brain tumor diagnosed several years ago. Fortunately it was not a cancer, but my recovery from major cranial surgery was slow and difficult. I was given physical/occupational and speech therapy. The music therapist working with me on the burn unit knew I played piano by ear and she suggested I work out on the piano as part of my therapy. At first everything seemed strange and “nothing” worked. Molly wouldn’t let me quit. I wanted to – it was frustrating! Slowly I began the feel at home at the keyboard and all my other therapies started to become more effective. I could “think” better.

Music therapy forced my brain to respond to the complex patterns of pitch, tempo and melody, and forced me to integrate motor function with the psycho-acoustic properties of what I was trying to express. I promptly regained my surgical skills at my pre-operative level and returned to practice on the burn unit. This response is known as neuro-plasticity; the unique ability of the brain to bypass injured areas and to re-teach the damaged brain how to regain more normal function.

I believe music therapists play an important, but often overlooked, role in helping patients cope with the effects of illness, pain, loneliness and fearful apprehension about the future of their health. Unfortunately all too often, music therapy is not reimbursed by insurance companies and many hospitals, therefore, do not use this modality of patient care. Other traditional forms of therapy, i.e. physical/occupational/speech etc., have demonstrated they are a cost effective addition to patient recovery. Insurance companies are therefore willing to compensate hospitals for these services and they generate income for the medical facility.

Music therapy professionals MUST produce evidence that their services provide a cost effective addition to other forms of care. THAT MEANS GOOD SCIENTIFIC RESEARCH must be carried out to demonstrate what we all believe. It is not enough to show a reduction in pain and anxiety with music therapy. Research must show a reduction in length of stay or improved patient outcomes for patients such as those sustaining head trauma/post traumatic stress disorder etc. Only then will insurance companies agree to reimburse hospitals/nursing homes for music therapy services; and more medical facilities will be able to incorporate music therapy as a standard of care. Then patients will receive the services we all know will benefit them. May God Speed your efforts on behalf of the patients you serve.

 

The Knot at the End of the Rope

Submitted by Florence Cohen

 

My father lived life with strength and determination.  As complications associated with diabetes diminished his physical capabilities, his indomitable will to combat the disease fervently hammered away.  A WW II Navy Seal, Joe Altman lived by a simple rule; when you get to the end of your rope, tie a knot and hang on.

When dementia struck hard and violently broke through Dad’s spirit, music therapist Alessandro Ricciarelli entered his life.  Armed with six strings attached to a wooden guitar, Alessandro surpassed the capabilities of the most sophisticated medical technology.

Each time Alessandro walked through the door, an invisible wall formed around them, creating a comfortable space in which a trusting bond of friendship would quickly form.  Alessandro brought with him happiness, encouragement, added a sense of meaning and purpose to Dad’s life, and, in doing so, resuscitated his spirit.  In a most gentle way, Alessandro treated Joe with the utmost dignity and respect.

Alessandro’s dedication was not limited to actual hospital visits; he took personal time to learn songs that were relevant to Dad and made recordings of their sessions together to be enjoyed at any given time.  Alessandro appreciated the power of positive thoughts, and with his kind words, a smile, compassion, and a true desire to make Dad happy, he encouraged Dad’s participation, leaving us with cherished memories of my father having one last chance to express himself through music, smiling and enjoying life.

In a very real sense, Alessandro was that knot at the end of the rope on to which Dad grabbed.  I am forever grateful to the Music Therapy Program at NYU Medical Center, more specifically, to Mr. Alessandro Ricciarelli.

Obviously music therapy works..at least in some cases with some people but then not all therapy works all the time in all cases.

I will be posting other blogs on the subject of mental illness and the therapies available to those afflicted.  Just know there is help available.  It may take some time to find it and it may turn out to be a combination of therapy or therapies and/or medication.  There is help but you have to find it. It is up to you to seek it out because it is very unlikely a miracle will knock on your door and say, “May I come in?  I’m the cure for all that ails you.”  If that does happen, don’t let them in.  It won’t be real.

Bob Aronson of Bob’s Newheart is a 2007 heart transplant recipient, the founder of Facebook’s nearly 3,000 member Organ Transplant Initiative and the author of most of these donation/transplantation blogs.

You may comment in the space provided or email your thoughts to me at bob@baronson.org. And – please spread the word about the immediate need for more organ donors. There is nothing you can do that is of greater importance. If you convince one person to be an organ and tissue donor you may save or positively affect over 60 lives. Some of those lives may be people you know and love.

Please view our music video “Dawn Anita The Gift of Life” on YouTube https://www.youtube.com/watch?v=eYFFJoHJwHs.  This video is free to anyone who wants to use it and no permission is needed.

If you want to spread the word personally about organ donation, we have another PowerPoint slide show for your use free and without permission. JAgain, write to me and ask for “Life Pass It On.”  I will email it to you immediately.  This is NOT a stand-alone show; it needs a presenter but is professionally produced and factually sound.  If you decide to use the show I will  also send you a free copy of my e-book, “How to Get a Standing “O” that will help you with presentation skills. Just write to bob@baronson.org and I will send the show and book ASAP.

Also…there is more information on this blog site about other donation/transplantation issues. Additionally we would love to have you join our Facebook group, Organ Transplant Initiative  (OTI).  The more members we get the greater our clout with decision makers.

En Espanol

Bob Aronson de Newheart de Bob es un centro receptor de trasplante 2007, el fundador de la Iniciativa de Facebook cerca de 3.000 miembros de trasplantes de órganos y el autor de la mayoría de estos blogs de donación / trasplante.

Usted puede dejar un comentario en el espacio proporcionado o por correo electrónico a sus pensamientos a mí en bob@baronson.org. Y – por favor difundir la palabra acerca de la necesidad inmediata de más donantes de órganos. No hay nada que puedas hacer lo que es de mayor importancia. Si se convence a una persona para ser un donante de órganos y tejidos puede salvar o positivamente afectará a más de 60 vidas. Algunas de esas vidas puede haber gente que conoces y amas.

Por favor, vea nuestro video musical “Dawn Anita The Gift of Life” en YouTube https://www.youtube.com/watch?v=eYFFJoHJwHs. Este video es libre para cualquier persona que quiera usarlo y no se necesita permiso.

Si quieres correr la voz personal sobre la donación de órganos, tenemos otra presentación de PowerPoint para su uso gratuito y sin permiso. JAgain, escribir a mí y pedir “Life Pass It On.” Voy a enviar por correo electrónico a usted inmediatamente Esto no es un espectáculo independiente,. Necesita un presentador, pero es producido profesionalmente y objetivamente sonido Si usted decide utilizar el archivo. demuestro que también le enviará una copia gratuita de mi libro electrónico, “Cómo obtener un Standing” O “que le ayudará con habilidades de presentación. Sólo escribo bob@baronson.org y enviaré el programa y el libro lo antes posible.

Además … hay más información sobre este sitio de blogs de otros temas de donación / trasplante. Además, nos encantaría que te unas a nuestro grupo de Facebook, la Iniciativa de Trasplante de Órganos (OTI). Cuantos más miembros que tienen la mayor influencia en nuestra toma de decisiones.

Post Transplant Depression. You Don’t Have To Feel That Way!

By Bob Aronson

The very first thing you should know is that depression is common after an organ transplant – very common and no one is immune.  You should also know that there is help available.  You don’t have to feel that way!   I know because I suffer from it.  As of this writing I am six years post transplant and my depression is under control because I found help but it still rears its ugly head from time to time.

For two years following my 2007 heart transplant I wallowed in emotional pain, I felt useless, worthless, without value, guilty and empty.  I looked at myself as one might look at a car you’ve owned for many years.  It was useful and desirable once but now it is old and things keep going wrong and need fixing.   To keep it running just costs too much and sad as it is we are probably better off without it.  It is costing more than it is worth.   That’s pretty much how I felt about myself.

Depression, I think, is compounded by the patient’s inner battle between the armies of logical thought and those of emotion.  Your logical mind asks, “How can you be depressed when you just got a new heart that saved your life?”   But, your emotions say, “I don’t know but I feel awful and sometimes I wish I was dead.”  That is a horrible battle to have to fight alone…but you don’t have to, there’s help and you can win.

For a quarter of a century I had been a communications consultant with a stable of highly respected internationally known clients many of which were based in Minnesota where I lived.  I needed a heart transplant and discovered that I stood a better chance of getting one if I moved to Jacksonville, Florida.  I learned that the Mayo Clinic there had an excellent record of obtaining and transplanting organs and data indicated I stood a better chance of getting a heart there than in Minnesota.  Furthermore, Jacksonville was my wife Robin’s home town and her son, parents and extended family lived there.  It made sense to move…but it also meant giving up a lion’s share of my business.

To shorten a long story we moved to Jacksonville and I got my new heart after only a 13 day wait but recovery took longer than expected.  There were complications…many of them. I got pneumonia, suffered two torn rotator cuffs which resulted in an extended period of excruciating pain and I became very, very depressed.  I could hardly function day to day never mind think of working again.  But, because I could not work I felt guilty and my depression got worse.

I sat in a dark corner of our family room every day watching the TV’s flickering light change the shadows in the room.  The set was on but rarely was I involved in what was playing…my mind was somewhere else.  I felt totally and utterly useless and guilty that I had taken an organ but couldn’t do anything to show that I was worthy of it. I felt that way for two years.  Each day I went through the motions of living, trying to be useful, trying to help my wife with her fledgling business but feeling totally inadequate and unnecessary.

You’ve seen the Roadrunner TV cartoon I’m sure where the poor coyote just can’t win against his fleet footed foe.  Often the canine victim is seen hanging by one hand from a branch on the side of a mountain…then the branch gives way and he falls the 5,000 feet  to the ground below which flattens him.  I felt like Wylie, like I was hanging from that branch waiting to fall and sometimes I wished the branch would break.

Two things kept me from giving up,  Robin’s constant encouragement and this blog along with my Facebook Group Organ Transplant Initiative (OTI).  Both were started two months after my transplant at the urging of my friends at Mayo.  These social media activities weren’t meant to be anti depressants but they turned out to be just that.   Thank God for both of them.

Then, one day, it occurred to me that maybe, just maybe I could get help and for the first time I mentioned depression as a problem to my Mayo Clinic transplant coordinator.  With virtually no delay I was seen by a physician who determined that anti depressants might help.  There were several false starts before we found one that worked but we did

At about the same time Robin asked me if I could make some wood fixtures for her art show booth; shelving, pedestals and other display items.  I soon found I loved woodwork and a new hobby was born, one that ensured my not returning to that dark corner in which I used to reside.

As I did the research for this blog I found a good deal of information about depression,  most of it clinical in nature and not real helpful.  From personal experience I know that fighting depression isn’t easy.  I know that it can last a long time, it can take even more time to find the right solution and sometime the solutions have a short life and the depression returns which forces you to find another solution.   It is a never ending battle but oh so worth it.

In a document titled “Issues for Today’s transplant Patients….A guide” published by the National Kidney Foundation (NKF) http://www.kidney.org/transplantation/transAction/pdf/UnderstandingDepression.pdf   there is an excellent section on post transplant depression, “Understanding Depression” I won’t re-print all of it but here’s some of it.

Depression is extremely common in the United States, and it can have a unique impact on transplant recipients. Practically every transplant recipient has likely felt—or fought off—depression at some time or another.

 Living with a new organ has daily challenges. These include medical bills and getting used to a new body. Some transplant recipients may also feel they are burdening their loved ones with constant doctors’ visits and a general need for extra help. All of this comes on top of the trials and tribulations that arise for everyone, transplant recipient or not.

It’s normal to have a range of feelings after a transplant.  We at the NKF believe that depression is one of the biggest issues people face, and something a lot of health care workers ignore.  Research shows that, in any given year, almost 10 percent of theU.S. population is depressed. That’s 19 million adults, with and without transplants.  And in people with chronic illness, the incidence of depression is much higher . Some research suggests that up to 25 percent of people with illnesses become depressed at some point in their lives. So, if you are a transplant recipient and you feel depressed, you are definitely not alone. 

Depression is different. It’s not just a bad mood, which is something everybody feels. Being depressed means that people feel at least five symptoms of depression for two weeks or longer. A bad mood should only last a couple of days. Depression is also more intense than a bad mood, even how the body feels.

 Nine symptoms of depression:

1. Feeling depressed for most of the day, almost every day
2. Lack of enjoyment of activities you once enjoyed, such as going to work or visiting friends.
3. Weight changes (gaining or losing).
4. Sleep problems (too much or too little).
5. Feeling restless.
6. Lacking energy, feeling easily fatigued.
7. Feeling worthless or guilty.
8. Trouble concentrating.
9. Frequent thoughts of suicide.

 Remember that people have to have at least five of these nine symptoms for at least two weeks before doctors will diagnose depression. This is to make sure that people who have bad days here and there are not misdiagnosed.

The stress of having a transplant can trigger depression.  Having a transplant is a life-altering experience. The range of emotions people feel as a result of the procedure can definitely trigger depression in those who are susceptible to it.   It can be incredibly difficult for people to accept that one of the organs they were born with no longer works. For many, organ failure can feel like a profound loss. Some really grieve over it, which is totally under-standable. Unfortunately, this grief can also lead to depression.

 Having a transplant can create another loss, by changing recipients’ lives in an irreversible way. They may grieve that they can no longer lead the same life as before, now having to rely on doctors and medications to stay well. That can be hard to accept.

 Some recipients may also find it hard to accept that they are more dependent on their families. They may feel like their illness disrupts their families’ lives, and they are dependent on them emotionally and sometimes financially.

For recipients who are used to being the sole providers for their families, that can be really tough.  Financially, many transplant recipients also worry about their futures and how to afford the medicines they’ll need for the rest of their lives.  People with kidney transplants often worry about their health insurance,   knowing that they lose Medicare after three years.   

 Ok, all of that explanation makes a lot of sense but if you are depressed what can you do about it?  There’s much that can be done and you can start by talking to your transplant coordinator.  You can be sure they’ll have some resources for you to investigate or they can arrange for you for appointments.

While treatments abound there are two that are most common.  They are talk therapy and medication.  The most common type of therapy cognitive behavior therapy,  or CBT.  A highly skilled therapist can help you correct the negative thought patterns behind your depression. For instance, if people are constantly feeling hopeless, or that there’s no point in living, There is also a behavioral aspect to cognitive behavior therapy.  It focuses on how helping you avoid behaviors that cause or invite depression…behaviors like staying in bed all day or avoiding activities that had been enjoyable.  This kind of therapy can be done in a one on one or group setting, whichever makes you more comfortable and is most effective.

Another form of therapy is medication.  Sometimes both therapies are applied simultaneously but experts in depression can advise you best on when that is appropriate.

In my case it was medication that worked.  But it took time, there were months of trial and error.  It usually takes four to six weeks for an anti depression medication to work.  Sometimes it did but only for a short while and on other occasions there was no effect at all and we’d have to start all over again.  Different people react differently to the same medication.  What may work for your neighbor may not work for you at all but withy patience and the aid of a professional it is likely you will find the right one.

A word of caution: AVOID ST. JOHN’S WORT

A lot of people use herbal medicines to treat a variety of conditions. One very popular herbal medicine is St. John’s Wort which has achieved some popularity in treating depression.  Transplant patients should avoid using it because medical evidence clearly indicates that St. John’s Wort interferes with other drugs like Cyclosporin, which people take to prevent transplant rejection.  There is documented evidence that some transplant recipients have lost their organs after taking St. John’s Wort.

Still another way to address depression is activity, a hobby, a business, a project.  The combination of medication and activity is what got me out of depression and keeps me there.  I rarely sit still and when I do it’s because I’m exhausted from all the activity.   I will be writing more about activities but woodwork, music, art, nature studies or astronomy can be of immense help in chasing away your demons.  There’s one for you…you just have to find it.

One way of beating depression is…not to get it.  Not long ago CBS TV news did an interesting story on the subject called, “Depression: Ten Traps to Avoid”  You can watch it on this link…or read it below.

http://www.cbsnews.com/2300-204_162-10004447.html

Clinical depression is a devastating illness, and profound sadness is just the beginning. Depression can rob people of their energy, memory, concentration, sex drive, interest in usual activities – and in severe cases, even the will to live. Seventy million Americans will be afflicted at some point.

Dr. Stephen Ilardi, author of “The Depression Cure,” has identified several things that can make depression worse.

Depression is a serious medical condition and should be treated by a doctor or licensed therapist.

Trap 1: Being a Couch Potato

When you’re feeling down, it’s tempting to hole up in your bed or on the couch. Yet exercise –

Even moderate activity like brisk walking – has been shown to be at least as effective against depression as antidepressant medication. It works by boosting the activity of the “feel-good” neurochemicals dopamine and serotonin.

For an “antidepressant dose” of exercise, try at least 40 minutes of brisk walking or other aerobic activity three times a week.

Trap 2: Not Eating “Brain Food”

Omega-3 fats are key building blocks of brain tissue. But the body can’t make omega-3s; they have to come from our diets. Unfortunately, most Americans don’t consume nearly enough Omega-3s, and a deficiency leaves the brain vulnerable to depression. Omega-3s are found in wild game, cold-water fish and other seafood, but the most convenient source is a fish oil supplement. Ask your doctor about taking a daily dose of 1,000 mg of EPA, the most anti-inflammatory form of omega-3.

Trap 3: Avoiding Sunlight

Sunlight exposure is a natural mood booster. It triggers the brain’s production of serotonin, decreasing anxiety and giving a sense of well-being. Sunlight also helps reset the body clock each day, keeping sleep and other biological rhythms in sync.

During the short, cold, cloudy days of winter, an artificial light box can substitute effectively for missing sunlight. In fact, 30 minutes in front of a bright light box each day can help drive away the winter blues.

Trap 4: Not Getting Enough Vitamin D

Most people know vitamin D is needed to build strong bones. But it’s also essential for brain health. Unfortunately, more than 80 percent of Americans are vitamin D deficient. From March through October, midday sunlight exposure stimulates vitamin D production in the skin – experts advise five to 15 minutes of daily exposure (without sunscreen). For the rest of the year, ask your doctor about taking a vitamin D supplement.

Trap 5: Having Poor Sleep Habits

Chronic sleep deprivation is a major trigger of clinical depression, and many Americans fail to get the recommended seven to eight hours a night. How can you get better sleep?

Use the bed only for sleep and sex – not for watching TV, reading, or using a laptop. Turn in for bed and get up at the same time each day. Avoid caffeine and other stimulants after midday. Finally, turn off all overhead lights

Trap 6: Avoiding Friends and Family

When life becomes stressful, people often cut themselves off from others. That’s exactly the wrong thing to do, as research has shown that contact with supportive friends and family members can dramatically cut the risk of depression. Proximity to those who care about us actually changes our brain chemistry, slamming the brakes on the brain’s runaway stress circuits.

Trap 7: Mulling Things Over

When we’re depressed or anxious, we’re prone to dwelling at length on negative thoughts – rehashing themes of rejection, loss, failure, and threat, often for hours on end. Such rumination on negative thoughts is a major trigger for depression – and taking steps to avoid rumination has proven to be highly effective against depression.

How can you avoid rumination? Redirect attention away from your thoughts and toward interaction with others, or shift your focus to an absorbing activity. Alternatively, spend 10 minutes writing down the troubling thoughts, as a prelude to walking away from them.

Trap 8: Running with the Wrong Crowd

Scientists have discovered that moods are highly contagious: we “catch” them from the people around us, the result of specialized mirror neurons in the brain. If you’re feeling blue, spending time with upbeat, optimistic people might help you “light up” your brain’s positive emotion circuits.

Trap 9: Eating Sugar and Simple Carbs

Researchers now know that a depressed brain is an inflamed brain. And what we eat largely determines our level of inflammation. Sugar and simple carbs are highly inflammatory: they’re best consumed sparingly, if at all.

In contrast, colorful fruits and veggies are chockablock with natural antioxidants. Eating them can protect the body’s omega-3s, providing yet another nice antidepressant boost.

Trap 10: Failing to Get Help

Depression can be a life-threatening illness, and it’s not one you should try to “tough out” or battle on your own. People experiencing depression can benefit from the guidance of a trained behavior therapist to help them put into action depression-fighting strategies like exercise, sunlight exposure, omega-3 supplementation, anti-ruminative activity, enhanced social connection, and healthy sleep habits.

We hope this blog has helped.  If you feel depressed or even if you are not sure talk to your transplant coordinator or any mental health professional. There is help. You don’t have to feel the way you do.

                                                                    

Bob Aronson of Bob’s Newheart is a 2007 heart transplant recipient, the founder of Facebook’s nearly 3,000 member Organ Transplant Initiative and the author of most of these donation/transplantation blogs.

You may comment in the space provided or email your thoughts to me at bob@baronson.org. And – please spread the word about the immediate need for more organ donors. There is nothing you can do that is of greater importance. If you convince one person to be an organ and tissue donor you may save or positively affect over 60 lives. Some of those lives may be people you know and love.

Please view our music video “Dawn Anita The Gift of Life” on YouTube https://www.youtube.com/watch?v=eYFFJoHJwHs.  This video is free to anyone who wants to use it and no permission is needed.

If you want to spread the word personally about organ donation, we have another PowerPoint slide show for your use free and without permission. JAgain, write to me and ask for “Life Pass It On.”  I will email it to you immediately.  This is NOT a stand-alone show; it needs a presenter but is professionally produced and factually sound.  If you decide to use the show I will  also send you a free copy of my e-book, “How to Get a Standing “O” that will help you with presentation skills. Just write to bob@baronson.org and I will send the show and book ASAP.

Also…there is more information on this blog site about other donation/transplantation issues. Additionally we would love to have you join our Facebook group, Organ Transplant Initiative  (OTI).  The more members we get the greater our clout with decision makers.

En Espanol

Bob Aronson de Newheart de Bob es un centro receptor de trasplante 2007, el fundador de la Iniciativa de Facebook cerca de 3.000 miembros de trasplantes de órganos y el autor de la mayoría de estos blogs de donación / trasplante.

Usted puede dejar un comentario en el espacio proporcionado o por correo electrónico a sus pensamientos a mí en bob@baronson.org. Y – por favor difundir la palabra acerca de la necesidad inmediata de más donantes de órganos. No hay nada que puedas hacer lo que es de mayor importancia. Si se convence a una persona para ser un donante de órganos y tejidos puede salvar o positivamente afectará a más de 60 vidas. Algunas de esas vidas puede haber gente que conoces y amas.

Por favor, vea nuestro video musical “Dawn Anita The Gift of Life” en YouTube https://www.youtube.com/watch?v=eYFFJoHJwHs. Este video es libre para cualquier persona que quiera usarlo y no se necesita permiso.

Si quieres correr la voz personal sobre la donación de órganos, tenemos otra presentación de PowerPoint para su uso gratuito y sin permiso. JAgain, escribir a mí y pedir “Life Pass It On.” Voy a enviar por correo electrónico a usted inmediatamente Esto no es un espectáculo independiente,. Necesita un presentador, pero es producido profesionalmente y objetivamente sonido Si usted decide utilizar el archivo. demuestro que también le enviará una copia gratuita de mi libro electrónico, “Cómo obtener un Standing” O “que le ayudará con habilidades de presentación. Sólo escribo bob@baronson.org y enviaré el programa y el libro lo antes posible.

Además … hay más información sobre este sitio de blogs de otros temas de donación / trasplante. Además, nos encantaría que te unas a nuestro grupo de Facebook, la Iniciativa de Trasplante de Órganos (OTI). Cuantos más miembros que tienen la mayor influencia en nuestra toma de decisiones.

Post-Transplant Depression — What It Is and What To Do.

This is a compilation of information from various sources.  It does not constitute medical advice.  Please consult your physician about your condition and base your treatment decision on his or her advice, not on what you read here.

Post-transplant depression is real.  There are no statistics of which I am aware that indicate the percentage of organ recipients that suffer from the malady but there are enough reports of the problem to suggest it is no small number.

The extent to which your emotional health is affected by a transplant depends on a complex interplay of your health status and personality, genetic factors, social support, financial situation, and other concerns.

For most people, emotions about their experience change and evolve over time. Typically, feelings of sadness or anxiety are transient. For some, however, these feelings may persist and interfere with daily life.

According to the Mayo Clinic Depression is more than just a bout of the blues.  It isn’t a weakness, nor is it something that you can simply “snap out” of. Depression is a chronic illness that usually requires long-term treatment, like diabetes or high blood pressure. http://www.mayoclinic.com/health/depression/DS00175

Depression is a complex disease and sometimes it is difficult if not impossible to find a reason for the problem.  One that I hear most often is guilt.  Some recipients feel guilt because, they say, someone had to die in order for them to live. Others feel guilt because they are doing well while other transplant recipients may not be so fortunate.  Those feelings sometimes proves to be a very heavy burden for many transplant recipients but it may be only one potential cause of their feelings. There are some other factors that may contribute to post transplant depression as well:

• Anger or depression, because they don’t feel better as soon as they expected.
• Frustration, because of chronic or lingering fatigue that keeps them from things they want to do or accomplish.
• Mood changes caused by the drugs that must be taken following a transplant.
• Dissatisfaction with old plans and goals. Identifying new priorities and making lifestyle changes may feel good, but can also be stressful.
• Fear that the old illness might return and affect the new organ

Symptoms of depression include:

• Persistent sad, anxious, or “empty” feelings
• Feelings of hopelessness or pessimism
• Feelings of guilt, worthlessness, or helplessness
• Irritability, restlessness
• Loss of interest in activities or hobbies once pleasurable, including sex
• Fatigue and decreased energy
• Difficulty concentrating, remembering details, and making decisions
• Insomnia, early-morning wakefulness, or excessive sleeping
• Overeating, or appetite loss
• Thoughts of suicide, suicide attempts
• Aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment.

Despite the feelings of gloom and doom, though, there is reason to be optimistic because most people with depression will eventually  feel better with medication, psychological counseling or other treatment.

Still another reason for post-transplant depression is Post Traumatic Stress Disorder (PTSD).  Post-traumatic stress disorder is a type of anxiety disorder. It can occur after you’ve seen or experienced a traumatic event that involved the threat of injury or death.  Obviously getting an organ transplant falls into that definition. http://health.nytimes.com/health/guides/disease/post-traumatic-stress-disorder/overview.html

Symptoms of PTSD fall into three main categories:

1. “Reliving” the event, which upsets day-to-day activity

• Flashback episodes, where you re-live the event so it seems to be happening again and again
• Repeated traumatic memories of the event
• Frequent nightmares of the event
• Strong, uncomfortable reactions to reminders of the situation

2. Avoidance

• Emotional “numbing,” or feeling as though you don’t care about anything
• Feeling detached
• Being unable to remember important aspects of the trauma
• Lack of interest in normal activities
• Hiding your moods
• Avoiding places, people, thoughts or things that remind you of the trauma
• Feeling as though you have no future

3. Arousal

• Difficulty concentrating
• Startling easily
• An exaggerated response to things that startle you
• Feeling more aware of negative things
• Irritability and angry outbursts
• Difficulty falling or staying asleep

If you have severe depression, a doctor, loved one or guardian may need to guide your care until you’re well enough to participate in decision making. You may need a hospital stay, or you may need to participate in an outpatient treatment program until your symptoms improve. http://www.mayoclinic.com/health/depression/DS00175/DSECTION=treatments-and-drugs

Here’s a closer look at your depression treatment options.

Medications
A number of antidepressant medications are available to treat depression. There are several different types of antidepressants. Antidepressants are generally categorized by how they affect the naturally occurring chemicals in your brain to change your mood. You can view the entire section on medications by following the above link to the Mayo clinic.

Types of antidepressants include:

• Selective serotonin reuptake inhibitors (SSRIs). These medications are safer and generally cause fewer bothersome side effects than do other types of antidepressants. SSRIs include fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa) and escitalopram (Lexapro). The most common side effects include decreased sexual desire and delayed orgasm.
• Serotonin and norepinephrine reuptake inhibitors (SNRIs). These medications include duloxetine (Cymbalta), venlafaxine (Effexor XR) and desvenlafaxine (Pristiq). Side effects are similar to those caused by SSRIs.
• Norepinephrine and dopamine reuptake inhibitors (NDRIs). Bupropion (Wellbutrin) falls into this category. It’s one of the few antidepressants that doesn’t cause sexual side effects.
• Atypical antidepressants. These medications are called atypical because they don’t fit neatly into another antidepressant category. They include trazodone (Oleptro) and mirtazapine (Remeron). Both of these antidepressants are sedating and are usually taken in the evening. In some cases, one of these medications is added to other antidepressants to help with sleep. The newest medication in this class of drugs is vilazodone (Viibryd).
• Tricyclic antidepressants. These antidepressants have been used for years and are generally as effective as newer medications. But because they tend to have more numerous and more-severe side effects, a tricyclic antidepressant generally isn’t prescribed unless you’ve tried an SSRI first without an improvement in your depression.
• Monoamine oxidase inhibitors (MAOIs). MAOIs — such as tranylcypromine (Parnate) and phenelzine (Nardil) — are usually prescribed as a last resort, when other medications haven’t worked. That’s because MAOIs can have serious harmful side effects. They require a strict diet because of dangerous (or even deadly) interactions with foods, such as certain cheeses, pickles and wines, and some medications including decongestants. Selegiline (Emsam) is a newer MAOI that you stick on your skin as a patch rather than swallowing. It may cause fewer side effects than other MAOIs.
• Other medication strategies. Your doctor may suggest other medications to treat your depression. These may include stimulants, mood-stabilizing medications, anti-anxiety medications or antipsychotic medications. In some cases, your doctor may recommend combining two or more antidepressants or other medications for better effect. This strategy is known as augmentation.

Finding the right medication
everyone’s different, so finding the right medication or medications for you will likely take some trial and error. This requires patience, as some medications need eight weeks or longer to take full effect and for side effects to ease as your body adjusts. If you have bothersome side effects, don’t stop taking an antidepressant without talking to your doctor first.

Antidepressants and pregnancy
If you’re pregnant or breast-feeding, some antidepressants may pose an increased health risk to your unborn child or nursing child. Talk to your doctor if you become pregnant or are planning on becoming pregnant.

Antidepressants and increased suicide risk
Although most antidepressants are generally safe, be careful when taking them. The Food and Drug Administration (FDA) now requires that all antidepressant medications carry black box warnings. These are the strictest warnings that the FDA can issue for prescription medications.

The antidepressant warnings note that in some cases, children, adolescents and young adults under 25 may have an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting an antidepressant or when the dose is changed. Because of this risk, people in these age groups must be closely monitored by loved ones, caregivers and health care providers while taking antidepressants. If you — or someone you know — have suicidal thoughts when taking an antidepressant, immediately contact your doctor or get emergency help.

Psychotherapy
Psychological counseling is another key depression treatment. Psychotherapy is a general term for a way of treating depression by talking about your condition and related issues with a mental health provider.

Through these talk sessions, you learn about the causes of depression so that you can better understand it. You also learn how to identify and make changes in unhealthy behavior or thoughts, explore relationships and experiences, find better ways to cope and solve problems, and set realistic goals for your life.

Hospitalization and residential treatment programs
In some people, depression is so severe that a hospital stay is needed. Inpatient hospitalization may be necessary if you aren’t able to care for yourself properly or when you’re in immediate danger of harming yourself or someone else. Getting psychiatric treatment at a hospital can help keep you calm and safe until your mood improves.

In this blog we have attempted to give you an overview of depression and its causes along with known effective treatment options.  Please remember, this is only a blog, it is not medical advice and we strongly suggest that you take no action based on what you read here.  See a qualified physician, ask a lot of questions and then make a decision.

Bob Aronson of Bob’s Newheart is a 2007 heart transplant recipient, the founder of Facebook’s nearly 2,500 member Organ Transplant Initiative and the author of most of these donation/transplantation blogs.

You may comment in the space provided or email your thoughts to me at bob@baronson.org. And – please spread the word about the immediate need for more organ donors. There is nothing you can do that is of greater importance. If you convince one person to be an organ and tissue donor you may save or positively affect over 60 lives. Some of those lives may be people you know and love.

Please view our video “Thank You From the Bottom of my Donor’s heart” on http://www.organti.org This video was produced to promote organ donation so it is free and no permission is needed for its use.

If you want to spread the word personally about organ donation, we have another PowerPoint slide show for your use free and without permission. Just go to http://www.organti.org and click on “Life Pass It On” on the left side of the screen and then just follow the directions. This is NOT a stand-alone show; it needs a presenter but is professionally produced and factually sound. If you decide to use the show I will send you a free copy of my e-book, “How to Get a Standing “O” that will help you with presentation skills. Just write to bob@baronson.org and usually you will get a copy the same day.

Also…there is more information on this blog site about other donation/transplantation issues. Additionally we would love to have you join our Facebook group, Organ Transplant Initiative The more members we get the greater our clout with decision makers.