Transcript HIV & DEPRESSION

HIV & DEPRESSION
Jordan Lewis, MSW RSW
St. Michael’s Hospital, Toronto
Judy Gould, PhD
Canadian Working Group for HIV and Rehabilitation
Mar. 11, 2009
What is Depression?
More than ‘feeling bummed’
Mild, Moderate, Severe
Biological vs. Psychosocial
Why Depressed?
Loss
Dependency
Change
Identity
So what can you do?
Be Genuine.
Consideration
Confidence
Transparent
Theoretical Foundations
Solution Focused Therapy
Narrative Therapy
Cognitive Therapy
Solution Focused Therapy
Looking for the solutions, not the
problems.
Focus on the present and future, not the
past.
Solution Focused Therapy
The Miracle Question:
“This evening you get tired and go to sleep. In the middle
of the night, when you are asleep, a miracle happens
and all your problems have disappeared. But because it
happened over night, nobody is telling you that the
miracle happened. When you wake up the next morning,
how are you going to discover that the miracle
happened? What else are you going to notice?”
NARRATIVE THERAPY
RESPECTFUL
NON-BLAMING
PEOPLE AS EXPERTS
PROBLEMS SEPARATE
PEOPLE HAVE MANY INTERNAL
RESOURCES THAT REDUCE THE
INFLUENCE OF PROBLEMS
NARRATIVE THERAPY
THERAPIST IS:
1) ALWAYS CURIOUS
2) ASKS QUESTIONS
ALWAYS IN COLLABORATION
NARRATIVE THERAPY
ALTERNATE STORIES
HOW THE CLIENT WANTS TO LIVE
THEIR LIFE.
EXTERNALIZATION – LANGUAGE
CONTEXT OF THE PERSON’S LIFE
EXPLORE RELATIONSHIP BETWEEN
THE CLIENT AND THEIR PROBLEM
NARRATIVE THERAPY
UNIQUE OUTCOMES
ANTHING THAT THE PROBLEM WOULD
NOT LIKE
UP TO THE CLIENT TO DETERMINE
UTILIZE OTHER OPINIONS TO VERIFY
UNIQUE OUTCOMES
COGNITIVE THERAPY
DIFFERENT ANGLES OF A PROBLEM
POSITIVE, NEGATIVE AND NEUTRAL
CLIENT FEELS THOUGHTS BEYOND
THEIR CONTROL
CONTROL OVER THOUGHTS
COGNITIVE THERAPY
NOT JUST THOUGHTS NEED TO
CHANGE
NEGATIVE VIEW OF: SELF, WORLD,
FUTURE
IDENTIFY MOOD – ONE WORD
HELP TO SET GOALS
COGNITIVE THERAPY
GATHERING EVIDENCE THAT
SUPPORTS AND NOT SUPPORTS
NEGATIVE THOUGHTS
CONSIDER EVIDENCE THAT
CONTRADICTS NEGATIVE THOUGHTS
COGNITIVE THERAPY
REFRAMING
Transference/Counter-transference
Definition
Own your feelings
Dealing with the ‘difficult client’
Black Hole
Dealing with ‘Difficult Client’
Don’t mean to be ‘difficult’
Threaten/push your buttons
Shift your thinking
Survival – They do it well
Dealing with the ‘Difficult Client’
Redirect
Set firm limits
Try to remain professional
Trust yourself
Talk to others
Self-Care
Compassion Fatigue
The stress resulting from helping
or wanting to help a traumatized
or suffering person (Figley, 1995).
Signs of Compassion Fatigue
Sadness, depression, sleeplessness,
generalized anxiety
– I have wished I could avoid working with
some therapy clients
– I have felt that my clients dislike me
personally
– I am unsuccessful at separating work from
personal life
Meditation
Meditation: the self regulation of attention,
in the service of self-inquiry, in the here
and now.
The techniques of meditation are
categorized by focus such as
“mindfulness” (field) or "concentrative“
(object) meditation as well as techniques
that shift between the field and the object.
Mindfulness Meditation
Jon Kabat Zinn defines mindfulness as:
“the awareness that emerges through
paying attention, on purpose, in the
present moment, and non-judgmentally to
the unfolding of experience moment by
moment.”
Mindfulness-Based Stress
Reduction (MBSR) Program
8-10 weeks
2.5 hour group meeting per week
Day of silent meditation
Home practice including daily meditation
and yoga (45 minutes) as well as written
reflections
MBSR Effect on Health Status
A meta-analysis revealed:
– 64 empirical reports, 20 studies, 1605 participants
– Examined data on short-term effects of MBSR on mental and physical
health
– across populations e.g., fibromyalgia, cancer, depression, anxiety
– Significant medium strength effect size for both mental (quality of life,
depression, anxiety) and physical health (sensory pain, physical
impairment, functional quality of life) parameters across populations
Research still needed to investigate long-term
benefits of MBSR
Grossman, Neimann, Schmidt & Walach (2004). Mindfulness-based stress reduction and health benefits: A metaanalysis. Journal of Psychosomatic Research, 57, 35-43.
MBSR and HIV
MSBR group showed significant increases
mood, functional health, and natural killer (NK)
cell activity persisting at 3-months (Robinson,
Mathews, Witek-Janusek, 2003).
Indication that mindfulness meditation training
can buffer CD4+ T lymphocyte declines in HIV-1
infected adults (Cresswell, Myers, Cole, Irwin,
2008).
Improvements in perceived stress and fatigue
and also depression, tension, anger, confusion,
and natural killer cell number (Robinson, 2002).
MBSR for Health Professionals
A self-care strategy for health
professionals and as a way to improve
client/practitioner communication
The goals of mindful practice are to be
aware of one’s own mental processes as
well as what is occurring around oneself
and thereby be able to act with
compassion (italics mine).
Irving, Dobkin, Park (2009). Cultivating mindfulness in health care professionals: A review of empirical studies of
mindfulness-based stress reduction. Complementary Therapies in Clinical Practice, 15, 61-66.
Benefits for Health Professionals
Decreased stress and distress, negative
affect, rumination, anxiety, emotional
exhaustion, burnout, health-related
complaints
Increased positive affect, life-satisfaction
and self-compassion, mood, empathy
No changes in empathy
No changes in salivary cortisol