Healing Bridges, Inc.

Psychodrama and Related Articles

What is Psychodrama?
Psychodrama is a form of psychotherapy developed by Dr. J.L. and Zerka Moreno that uses acting to facilitate problem solving.  The client, called the protagonist, puts his/her truth into action with the assistance of the therapist, called the director, and other participants, called auxiliaries.  Action Methods refer to a form of therapy derived from psychodrama that facilitates the client’s shift from narration (verbally telling his/her story) to motor representation (showing through use of the body as well as the voice).  Psychodrama is an experiential and expressive arts therapy (as are drama therapy, music therapy, art therapy, dance/movement therapy, poetry therapy), engaging the right side of the brain as well as the left side.  This powerful modality has applications in psychotherapy, education, business, law, and more!

What is The Therapeutic Spiral Model™?
The Therapeutic Spiral Model as a whole system of modified psychodrama.  This is a trademarked model of experiential change for trauma survivors. (Hudgins, Experiential Treatment for PTSD. 2002,  p. 207)

See also, Dr. Kate Hudgins article:
A Simple Clinical Action Map to Heal PTSD

What is Bibliodrama?

Bibliodrama - as developed by Peter Pitzele, author of “Our Fathers’ Wells” and “Scripture Windows” - is a creative and engaging way to revitalize the meanings of Biblical texts by bringing traditional stories to life.

Pitzele, a trainer, educator and practitioner fluent in psychodrama and sociometry, created this form as a result of his personal spiritual quests.

In both small and large groups, Bibliodrama is employed by people of all ages to make new meaningful connections with stories from the New or Old Testaments. They may appreciate their inheritance from Biblical generations and the links between the ancient characters’ lives and their own lives.

The process, carefully guided by a trained group leader, involves staying with the text while also expanding upon the parts of the story that are silent or not embellished in writing.

Currently, Bibliodrama is used in churches, synagogues, retreats, faith communities and schools with people of all levels of familiarity with the Bible.

As people learn more about the characters and stories of the Bible, they often make personal connections to their own lives. Kept safe by the “mask” of the character that they play, they have the opportunity for a unique kind of personal growth and even healing.

Natural choices of participation are respected, and each participant’s resources - even as a witness - are valued. No special expertise or experience in acting or theater is needed.

Practical Psychodrama by Karen Carnabucci, MSS, LCSW, TEP

What is Axiodrama?
For anyone experiencing a dark night of the soul or any troublesome quandary that seems to be blocking one's way upon the spiritual path, taking part in an axiodrama can provide a meaningful and profound intervention. Whatever one experiences as an obstacle between herself or himself and God could provide the basis for an axiodrama. Adam and Allee Blatner have identified various spiritual challenges that could identify the content for an axiodrama. These include a person's reluctance to experience "closeness to God," a person's perception that his or her "innate qualities" must impede union with God, a person's "feeling angry at God," a person's feeling "intimidated by the demands" of a spiritual path, a person's fears about "going crazy," of dying, of being misled or of misleading others, to name just a few. An axiodrama can address virtually any spiritual crisis or concern. All that is needed are a sincere heart and willingness to do the work. (Alma Nugent, MA)

The Body Double:
An Advanced Clinical Action Intervention Module
in the Therapeutic Spiral ModelTM to Treat Trauma
by Kamala Burden, MA, ADTR, CP
and Linda Ciotola, M.Ed. CHES (ret.),TEP

REPORT FROM A BODY DOUBLE
"Since I am an energy worker and a trauma survivor, what I focus on first is to get myself centered and aware of what is going on in my own body and energy field. Then I set an intention to join with the person whom I am being a double for with what I can best describe as an energetic empathy. I am aware of what is going on in my own system and I notice once I join with the person that I am doubling, the things that are not mine. Some of that may be sensations, images, thoughts, symbols, etc. I then attempt to put to words what I am discovering that is not of my energy system." Roger Halm, CSAC, TAEDESCRIPTION OF THE CLINICAL ACTION INTERVENTION MODULE

The body double (BD) is a clinical action intervention developed in the Therapeutic Spiral Model to help treat trauma safely using experiential methods of change. It is a clinical role designed to constantly "keep clients focused on healthy body awareness, even when triggered by body memories, flashbacks, and ego state shifts. The body double enacts the cellular nonverbal, intuitive, and emotional communication from the person’s body to the mind. The body double is used to assist clients to develop a clearer communication relationship with their body in order to rebuild what has been termed the ‘body of trust.’" (Hudgins, 2002, p.79) The body double’s purpose is to create a sense of safety and containment within the realm of the physical body. It works to contain trauma based nonverbal behavior, such as body memories, sensory flashbacks, and ego state shifts by providing words to explain and manage unprocessed trauma material.

OPERATIONAL DEFINITION
The body double (BD) begins with classical psychodrama doubling methods (Blatner, 2000), speaking from the first person as part of the client. It is an intrapsychic/internal role that is concretized as part of the client, an inner voice that is supportive and containing
.
The Body Double:

First establishes a baseline of safe, here-and-now nonverbal connections to the client by attuning to his/her movements and body and putting words to the action. (Attunement)

Increases awareness of what is unconscious for the protagonist; notices trauma-based defenses as demonstrated by breathing, movement, and other nonverbal cues. (Reflection)
Then, most importantly, the BD redirects the protagonist via nonverbal and verbal modeling toward increased awareness of POSITIVE body experiences in the here and now to prevent the client from being triggered by unconscious material. (Containment

Make statements to focus the client in the here and now to maintain healthy body awareness. (Anchoring)

CLINICAL GUIDELINES
The Therapeutic Spiral Model (TSM) includes a number of clinical action structures as guidelines to support the practice of experiential methods when they are driven by clinical theory and practice. The body double is a prescriptive role within the trauma survivor’s Intrapsychic role atom (Hudgins, 2002), which provides a clinical map for the enactment of all roles in TSM.

STEP ONE
: Empathic attunement with and reflection to the protagonist where they are in their bodies. Use non-interpretive language to establish a baseline with the protagonist that acknowledges their positive movement preferences and healthy body experience. Areas of focus
Breath – rise and fall of rib cage, depth and pace of breathing, breathing through mouth or nose. Slow, steady breathing is encouraged: "I can feel my breath moving deeply in through my nose; my chest rising and falling with the breath."

Body & posture - body parts from foot to head, center/periphery, rising/sinking, growing/shrinking, etc.: "I notice my head connected to my spine; I notice my arms crossed over my chest, my feet planted on the ground, etc."

Space –use of the body in space: forward/backward, up/down, orientation in room and to other participants; moving with direct or indirect effort; use of space near self or spread out. "I notice myself moving directly through the room, I feel the space above me, the floor below me, my arms moving close to my sides."

Weight – the body’s relationship to gravity and vitality; light or strong movement qualities. Be aware of using "strength" as a descriptive rather than interpretive word. "I feel my feet stepping strongly on the floor, my fingers brushing lightly together?"

Flow and muscular tension – the degree of tension or relaxation in the skeletal muscular system. "I can feel my arms hanging loosely from my shoulders."

Senses – seeing (including gaze), hearing, touch, etc. "I can see my friend across the room."

STEP TWO: Containment of negative body experiences. The focus on positive nonverbals creates containment of negative experiences via verbal and nonverbal redirecting. Puts narrative labels on traumatic experiencing and makes them manageable to the client.Breath – Watch for held, shallow, or quickened breathing. Encourage deep, slow breathing, along with reminders to keep the feet on the floor.

Example: Client’s breathing is becoming rapid. BD feels/sees client’s pace escalating and has prior knowledge of client’s panic attacks. Redirecting: "I can feel my breath moving in and out of my nose. I can put all four corners of both feet on the floor. I can slow down and take a long, slow breath through my nose, feel my lungs and ribs expand, and exhale slowly through my nose."

Dissociation – Watch for averted, glazed over or quickly darting eyes, physical shrinking. As a BD, you may begin to feel a "spaced out" feeling in yourself or feel disconnected from your body.

Example: Client is triggered by a drama with a story similar to her own. BD feels and sees client exhibiting signs of dissociation, and knows of client’s stated desire to "stay present" during the session, something the client has not been able to do in previous dramas. Redirecting: "I can feel my breath, etc. (as above), I can feel my legs, hips and back against the chair, I can begin to move my body slightly, put my feet on the floor?I can choose to look up and see my friend across the room), I feel myself staying in my body here and now."

Body Memories – client may show signs nonverbally or verbally of physical illness: nausea, belching, difficulty swallowing, headaches, sudden unexplained muscular pain, or extreme body temperatures.

Example: During a drama in which he has contracted to confront a perpetrator, a client who was severely physically abused begins to feel sharp pains in his shoulder and has no injury. Redirecting: "I feel intense pain in my shoulder, I can breathe and feel my feet, legs, hips, and back supporting me. I can touch my shoulder, rub my shoulder ?my shoulder has information for me. I can tell someone my shoulder hurts and ask for help.

Flashbacks – Client’s gaze may shift, breathing will change, the face may become distorted, and s/he may make startled noises or cry, or may shrink into self and rock or shake. Client will experience self as currently in a former trauma & needs to be redirected to the here & now.

Example: Client witnessed his brother shot and killed in a gang-related riot. During a drama with loud noises, client had a flashback and began to see the scene again. Redirecting: "I feel my breath moving fast & my heart beating hard, I can choose to breathe slowly, I hear loud noises around me, I am remembering the scene with my brother, I feel my heart beating a bit slower?now I can feel my feet on the floor, I can look up at friend, I can reach out and touch her hand, I can see that it is her, I see it is not my brother, I can hug my friend, I can see the room I am in, I can walk slowly with my friend to the side of the room, I can move away from the noises, I can choose to have distance and be here, now in this room with my friend and myself."

Self Harm – Watch for picking, scratching, hitting, digging fingernails into hands, twitching, pulling hair, etc. See "Clinical Example" below.

Ego State Shifts – Watch/feel for shivering motions, twitching, eye focus, postural and vocal tone shifts.

Shame – Often accompanies or is a precursor to other negative experiences listed here. Watch for shrinking body posture, drawing in of limbs, rocking, lowering the head, draping hair over face, covering face with hands, shallow breath, and lack of eye contact. See "Clinical Example" below.


STEP THREE
: Anchoring into the here and now. After redirecting the client into safe experiences of the body, it is important to make a "here & now" statement such as "I can feel my breath, my feet on the floor, etc. and here and now I can make a choice to stay in my body, stay in the room, and not harm myself." This is the third, crucial step, wherein the BD, having redirected the client away from trauma based responses into a positive body experience, anchors the experience into the here and now through new words and narrative labels. This is vital to the client being able to carry the healthy body choice into his or her every day life

CLINICAL EXAMPLE

ILLUSTRATING ALL THREE STEPS OF THE BD INTERVENTION
The protagonist, TJ, was a 25 year old female african-american sexual abuse survivor with a history of bulimia and self-harm. She contracted for a drama of transformation in which she would reclaim her right to fully inhabit her body and make a conscious choice not to hurt herself during an extended workshop. This example includes three roles: the client, her body double, and a Wise Grandmother (WG). The therapist made a choice at the beginning of the drama to give the protagonist a body double and this scene is a conversation with WG to further anchor in this positive internal roleTherapist – So you have your body double with you?.can you look up and hear what WG has to say to you?

TJ – I think so (begins to tense up and curl fists)
BD – I can take a deep breath, uncurl my fists a bit, look up and see my WG
TJ – Yes, I can do that, I see you, and I am ready
WG – You are a beautiful being, you deserve to have a healthy body, and to be fully in it, I love you and I want this for you
TJ – I can’t believe this, I just feel so bad, I want to love my body, but I can’t (begins to shrink inward, turn away, and pick at skin)
BD – (notices what she sees as shame and possible self harm) "I can feel my body curling in and turning away?.AND I can feel my breath?.I can use my breath to expand a bit, I can feel my fingers on my arm and here and now I can choose to gently rub my arm, I can begin to open my body with my breath, and I can slowly turn and see my WG and hear what she has to say. (BD role models turning to look at WG)
TJ – (slowly turns to see WG and hear her speak.)
WG – I love you and I won’t let you hurt yourself. I am with you always and I know you are ready to take this step to love your body and yourself (opens arms to TJ)
TJ – (Hesitates, beginning to cry)
BD – I can hear those words and see her eyes and her arms opening to embrace me. I can choose to listen, to be held, to keep my body safe and not hurt it in any way
TJ – I can, I want to connect (goes to WG and is embraced and held). I know you love me. I love you and I want to be safe. I don’t have to stay stuck in the shame. I want to choose to not hurt myself and to stay connected to my WG and to my healthy body.
BD – I can feel the strong body of WG, I can allow myself to be held, I can feel my body breathe that in, and I can feel my body is my own
TJ – Yes, my body is my own. My body is strong like WG’s body?I can be held and I can love and hold myself, I can love my body and keep it safe. TJ was able to complete her drama of transformation and to report back to the group the next day that she had not harmed herself or had a bulimic episode. She was able to stay present and safe for the remainder of the workshop.

In summary, the BD is a role of containment that helps trauma survivors experience and anchor in a positive sense of the self-in-body. The BD role requires complete focus, presence, and steady pacing. Body messages tend to come slower than mental ones, so make a statement, leave some space, and then continue. Do NOT flood the client with additional sensory stimulus! DO NOT get caught in the seductive pull of the trauma-based non-verbals.

DO INTERRUPT?DO INTERRUPT?DO INTERRUPT the cycle of traumatic experience when the client is nonverbally triggered, provide labels for what is happening in the here and now to discriminate between past trauma based experiences and the present. It is a large part of the job as a BD to interrupt & redirect – you ARE the intervention to bring a person to positive body awareness. This is NOT the time to be timid!!


The Body Dialogue, An Action Structure To Build Body Empathy
by Linda Ciotola, M. Ed., CHES,(ret.), T.E.P.

Abstract
     “The Body Dialogue” is an action structure using role reversal to build a bridge of empathy between the body and the self.  The director facilitates a conversation between the body and the self in an attempt to repair the bridge of broken trust and to re-establish the bond that was disrupted by the trauma of physical, sexual and/or emotional abuse; medical trauma; illness; aging.  The goal is to facilitate the self’s acceptance of the body and the self’s willingness to listen to the body; to hear the body’s needs and for the self to make a commitment for the body’s care.

Introduction
     “The Body Dialogue” evolved in the 1990’s from work which I was doing in my private practice, mainly with clients suffering with eating disorders.  Regardless of weight, size, or shape, clients often talked about their bodies as something separate from the self, and labeled the body names such as “blubber”, “jelly roll”, “pot bellied pig”, and “beached whale”.  Clients engaged in a struggle to control and dominate the body often through dieting, food restricting, purging, laxative and/or diuretic abuse, excessive exercise, use of stimulants, etc.  The body rebelled by reactively binging, over-sleeping or insomnia, constipation, and lethargy.  Thus ensued an embattled struggle between the self and the body for power and control.

     Later in my work, I found “The Body Dialogue” to be useful in the work I was doing with trauma survivors during my training with The Therapeutic Spiral™ and sometimes included use of  The Body Double™ with the Body Dialogue in working with clients who struggled with dissociation (see www.Therapeuticspiral.org).  Trauma Survivors often used words like “disgusting”, and “gross” to address the body, which had been the holder of the trauma and pain.  “The Body Dialogue” frequently resulted in the client’s expression of sorrow and gratitude to the body for all it had suffered and survived.

     The next application of “The Body Dialogue” came during an in-service, which I facilitated for colleagues who work with eating disorder clients, but who themselves were facing declining physical capacities due to aging.  The conversation between the body and the self again resulted in a new acceptance of the body’s limitations and allowed the body to make specific requests of the self about the kind of care it now needed.

     “The Body Dialogue” may be used with clients in private practice using an empty chair as well as in groups when another group member may take the role of the body.  “The Body Dialogue” may be done seated or standing, with protagonist (self) facing the auxiliary (body).

     The Six Steps of “The Body Dialogue” are:
     The protagonist and body are in role with chairs facing one another; or, may be standing, facing one another.
     Step 1:  The director says, “Here is your body.  How long have you had this relationship with your body?”  (Protagonist says how many years).  “Tell your body how you feel about your body now.”  Protagonist makes a statement to the body.
     Step 2:  Role Reverse with body to see what body says, wants, needs.
     Step 3:  Role Reverse to see if protagonist can do what body is asking for and make a commitment.  Director:  “Look into the eyes of your body and make the commitment to do what you said.”
     Step 4:  Continue role reversing between self and body until there is some agreement and new relationship between body and self.
     Step 5:  Director looks for non-verbals to get information about what the new relationship could be.  Body positions can be changed to facilitate the new connection, e.g. from face to face to side by side.  Encourage physical connection between body and self if it doesn’t occur spontaneously, e.g. holding hands, hugging, etc.
     Step 6:  Director:  “Make a final statement to your body to close out the scene.”
 
Example
 
     Step 1:  Kelly chooses Missy for role of Body.   Director to Kelly (Self):  “What do you want to say to your body?”
     Step 2:  Kelly moves in, holds body’s hands and is crying.  “You are sick right now and I feel really sad that I haven’t been taking good care of you somehow.  I know I’ve gotten better, but I’m still not good at letting you rest, rest for no reason, not just when I am sick.”
     Step 3:  Role Reverse.  Director to Kelly in role of Body, “What do you want Kelly to do before you get sick?”  She answers, “I need to go slow sometimes and it’s hard for you, for your mind to go slow.  You forget it’s important to go slow with me and when we rest we have time to be together.  I need more rest than you.  Sometimes you try to make my needs match yours and we aren’t always in tune.”
     Step 4:  Role Reverse – Kelly (Self) admits to body that she doesn’t pay attention to body’s needs.  Body (Missy in Role) repeats, “We are together when we rest, that’s our time together.”  Kelly (Self) says, “I have heard the teenage part, but I forget about the baby – that’s the part that needs to rest.  That’s the part I forget because I didn’t even know you were there for a long time.”
     Step 5:  Role Reverse:  Kelly speaks in role of body, “I’m really cute and I need to rest.  Babies need to go slow and to rest.  I’m good at the later years, but I need more rest.”  Self (Missy in role) says, “You are cute!”  Role Reverse:  Kelly (Self), “I will let you rest more, hear your needs and be attuned.  I’m not gonna wait til you cry.  I’m just gonna know what you need.  Role Reverse (lines repeated).  Body says, “I do trust you.”
     Step 6:  Final Statement to Body.  “You are a gift from God and I am grateful you didn’t die despite my hard efforts.”  Body says, “I stuck with you and I’m still here.”  Self says, “I don’t feel like you’re holding it against me and I’m grateful for that as well.  I’m gonna listen to the baby better.  I can do that.”  They hug.

Director gently facilitates rocking motion and labels it “Rock the baby”.
End of scene.

When used in a group setting, “The Body Dialogue” may be used as a warm-up, or may be used as vignettes giving several group members an opportunity to have the conversation between the body and the self.  Sharing, of course, follows.

I welcome questions, comments, and the shared experiences of other directors who use “The Body Dialogue” at linda.healingbridges@gmail.com.
Copyright, 2005.

References
Caldwell, C. (1996).  Getting Our Bodies Back.  Boston:  Shambala   Publications, Inc.
Ciotola, L. (2004).  The Body Dialogue.  unpublished article www.fitness-movement.com
Dayton, T. (1997).  Heartwounds.  Deerfield Beach, FL:  Healt Communications, Inc.
Farhi, D. (1996).  The Breathing Book.  New York:  Henry Holt and Company, LLC.
Hudgins, M. K. & Kellerman, P.F. (2001).  Psychodrama with Trauma:  Acting Out Your Pain.  London:  Jessica Kingsley publishers, RRP 

Hudgins, M. Katherine (2002).  Experiential Treatment for PTSD:  The Therapeutic Spiral Model.  New York, NY:  Spring Publishing Company.

Hudgins, M.K., Burden, K.B., Ciotola, L., and Halm, R. (2002).  The Body Double:  An Advanced Clinical Action Intervention Module in the Therapeutic Spiral Model™ to Treat Trauma.  Unpublished article. www.therapeuticspiral.org

Lewis, T., Amini, F., Lannon, R. (2000).  A General Theory of Love.  New York: 
   Vintage Books, a Division of Random House, Inc.

Linden, P. (2001).  Winning is Healing. Columbus, OH:  CCMS Publications
A downloadable book, www.bring-in-movement.com


Walk Around the Clock

(an Action Structure created by Linda Ciotola, M. Ed., CHES (ret.), T.E.P.)
Create an imaginary clock by setting chairs or “Furry Auxiliaries” (puppets, or stuffed animals) at 12, 3, 6, and 9.  Another option is to place the numbers on sheets of paper, and place them on the floor.  Client walks around clock while doing a soliloquy about what has transpired in previous 24 hours.  Therapist “doubles”.  Particularly useful in helping to identify triggers and consequences for addictions, eating disorders, etc., and for assessment purposes.  (This can be adapted to groups by having members take roles of time).  This exercise can be repeated several times if more days need to be included.
**Soliloquy with “double” ~ Walk Around the Clock:

•  Allows Therapist to get sense of where client has been in last 24 hours
•  Behavioral analysis of impulsive behavior – back up to see trigger (engaging body)
•  “Typical day” – feelings, thoughts, behaviors
•  Elicits events which prompt therapist’s follow-up
•  Clock – different times represent past, present, future . . . move to where you need to be
•  Helps person focus on history as a way to then move to more quickly to what the goal is
•  In residential setting, investigate how nights were . . .
•  Grief work – time when loss happened / or before, related to death, serious medical treatment,  
     etc.
•  Ways to adapt to individual therapy are up to Therapist’s imagination


Example:

12
9
3
6

 
If client’s appointment is at 3 PM, begin soliloquy with walk at 3 PM the day before and have client walk and talk around the clock.

**  Soliloquy:
  The protagonist shares with the audience the feelings and thoughts that would normally be kept hidden or suppressed.  The protagonist may be engaged in a solitary activity, such as walking home, winding down after an eventful day, or getting ready for an event in the near future.  It might involve advice giving, words to bolster courage, or reproachful criticism.  Variations include having the protagonist soliloquize with a double as the two of them walk around, having the protagonist talk to a pet, or converting the inner dialogue into an encounter with an empty chair or auxiliary playing a wiser, future self or another part of the personality.  (Z. Moreno, 1959 in Blatner, Foundations of Psychodrama. 1988, p. 176-177).

In the “Walk Around the Clock”, the client’s soliloquy can be given focus by the Therapist, and the Therapist can function in the “double” role to help deepen and clarify.

** Double (Classical):  The Protagonist is joined by an auxiliary, either a trained co-therapist or a group member, whose role is to function as a support in presenting the protagonist’s position or feelings.  Doubles should first work toward establishing an empathic bond with the protagonist.  In general, they stand to the side of and at a slight angle to the protagonist so that they can replicate the nonverbal communications and present a kind of “united front”.  The double is one of the most important and basic techniques in psychodrama. (Leveton in Blatner, Foundations of Psychodrama. 1988,  p.164)

Recognizing & Treating Depression ~ Linda Ciotola, M. Ed.,CHES, TEP

Sources:  National Institutes of Mental Health; Blue Cross/Blue Shield (Vitality); American Counseling Association; Wellness Networking Group

According to the National Institutes of Mental Health, depression affects about 19 million Americans.  The effects are far-reaching, impacting not only personal well-being, but family interactions, work place performance, and even  financial security.
The following symptom check-list is provided by Blue Cross/Blue Shield:

Depressive mood:  do you suffer from feelings of gloom, helplessness or pessimism for days at a time?

Sleep disturbance:  do you have trouble falling asleep at night or trouble staying asleep - waking up in the middle of the night or too early in the morning?  Are you sleeping too much?

Chronic fatigue:  Do you frequently feel tired or lack energy?

Isolation:  Have you stopped meeting friends for lunch?  Increasing isolation and diminished interest or pleasure in activities are major signs of depression.

Change in appetite:  Are you eating far less than usual - or far more?  Severe and continuing appetite disturbance is often an indication of depression.

Inability to concentrate:  If you can’t seem to focus on even routine tasks, it’s probably time to get some help.

Dependence on mood-altering substances:  If you depend on alcohol or other drugs to make it through the day, you may be   suffering from depression.  Often the substance abuse causes symptoms like those of clinical depression, but are in fact due wholly to the drug use.

Feelings of guilt or worthlessness
Frequent thoughts of death or suicide
A number of treatment options are available and needs may differ depending upon severity.  For mild depression, exercise is a first line treatment because of its neurotransmitter elevation effect.  Outdoor exercise with sun exposure can be particularly helpful for those suffering with Seasonal Affective Disorder (SAD).  Full spectrum lighting at home and work may also help.  Avoidance of alcohol is essential for anyone prone to depression because it is a chemical depressant.  Optimal nutrition is also key.  Keep blood sugar stable with well-balanced, evenly spaced meals containing lean protein, whole grains, fruits and vegetables and healthy fats like nuts, seeds, olive oil.  Supplementation with amino acids, essential fatty acids, vitamins, minerals, and/or herbs may also help.  Contact a health practitioner familiar with these rather than trying to self-medicate.

Music is a proven mood stabilizer.  Combining movement with music in a manner synchronizing the movement with the beats per minute of the music (entrainment)     elevates   mood-enhancing brain waves.  Try walking to your favorite upbeat music; take an exercise class choreographed to music, or just dance.  Listen to upbeat music often.

For moderate depression, counseling is a proven treatment, especially when added to the interventions mentioned above.  A number of treatment modalities are available as well as specialists in categories such as marriage and family.  Options beyond traditional “talk therapy” include experiential and expressive arts therapies, EMDR (see October issue), and dialectical behavior therapy (DBT) which combines psychoeducation with mindfulness training.  If your thinking patterns are making you depressed, cognitive behavioral therapy may be the treatment of choice.  Interview practitioners to determine a good match.

For more severe depression, medication may be essential in addition to psychotherapy and all the aforementioned treatments.  A psychiatrist familiar with mood disorders can prescribe medication best matched to your symptoms.  In very severe cases, hospitalization may be necessary.  Never stop   taking medication without medical supervision.

Like addictions, mood disorders like depression do tend to run in families.  So, there may be a genetic pre-disposition to depression which can be triggered by environmental factors such as stress, loss, or trauma.  Recent research has shown that acupuncture, regular yoga practice, and meditation help raise the genetic set-point for mood.

If you know that you have a dip in mood during the holiday season, speaking with a professional counselor can help you through this difficult time.  In addition, life coach and counselor Sue Waldman, MA, LPC, CEC makes the following suggestions:
The DO’s of managing holiday blues:

Do follow these basics for good health:

    • Do eat right
    • Do exercise regularly
    • Do get plenty of rest
    • Do pray and meditate
    • Do set realistic goals:
    • Do organize your time
    • Do make lists
    • Do prioritize
    • Do make a budget and follow it
    • Do rethink how you view and approach the holidays
    • Do write down everything that you are grateful for
    • Do focus on the present and think positively
    • Do forget about what is suppose to happen and adjust your expectations
    • Do let go of the past and create new or different ways to celebrate
    • Do allow yourself to feel sad, lonely or melancholy - these are normal feelings, particularly at holiday times
    • Do something for someone else
    • Do volunteer your time to a good cause
    • Do enjoy activities that are free
    • Do spend time with people who care about you
    • Do spend time with new people or a different set of friends or family
    • Do contact someone with whom you have lost touch
    • Do give yourself a break - plan to prepare (or buy) one special meal, purchase one special gift, and take in one special event.  The rest can be ordinary, but will seem special because of the time of year and the people you’re with.
    • Do treat yourself as a special holiday guest

The DON’TS of managing holiday blues

    • Don’t drink alcohol
    • Don’t overindulge in holiday foods, especially those that are high in sugar and fat
    • Don’t have unrealistic expectations of yourself or others
    • Don’t dwell on the past
    • Don’t focus on what you don’t have
    • Don’t spend money you don’t have
    • Don’t ignore your health
    • Don’t accept the role of victim
    • Don’t long for what once was
    • Don’t convince yourself that there is no hope

    Please pass this on to anyone who you believe needs some extra support during the holidays.

    Special Note
    :
      Since 54% of Hispanic men with depression do not recognize they have it or fear treatment, the NIMH has launched a public education campaign to encourage Hispanic men who are depressed to seek help.  Spanish-language materials are available through the Real Men, Real Depression campaign.  For information and materials, visit www.menanddepression.nimh.nih.gov.  Often, men’s depressive symptoms reveal themselves through anger and/or irritability. Treatment is essential to help them and to protect those close to them.

    Editor’s Note
    :  If you or someone you know is suffering with depression, please seek help.      

    * Linda Ciotola and her colleague Karen Carnabucci have co-authored the book Healing Eating Disorders with Psychodrama and Other Action Methods - Beyond the Silence and the Fury Click here to order.

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