Help for Mental Health: What We’re Doing Wrong

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I was recently reading about an online treatment for depression called “Deprexis” summarized by Dr. John Grohol, over at the Psych Central site. Dr. Grohol discusses the study that was done to investigate the effectiveness of this online treatment program, that doesn’t involve any contact with a therapist.

Results of the study were very promising, suggesting that those who completed the treatment improved in terms of their scores on the Beck Depression Inventory.

Surprisingly, however, even participants who did not complete the entire 10-module program still improved. Those who only completed 4 or fewer of the 10 sessions still received a positive benefit. In addition, there was a very large dropout rate (almost half) in the study, which is consistent with most online interventions.

Dr. Grohol discusses some of the issues surrounding these findings — namely, why do people drop out of online treatment? Is it because they are depressed? Or because they have improved enough in the first half of the program that they don’t need to continue? Or that they just lost motivation, possibly due to the depression itself?

These are all fascinating issues, and relevant to those who wish to create online treatment programs for social anxiety disorder as well. I would like to return to this discussion, but first, I have a little story to tell.

I recently went to see my doctor for a physical issue that had been giving me problems for a couple of months. When I arrived at the office, I was told that there was a medical student who would be sitting in on the appointment, if that was okay with me. I don’t mind that sort of thing, so agreed that it was fine.

Prior to the doctor arriving, the medical student took my history. And by history, I mean an extensive list of questions about my medical background. As I answered the questions, in the back of my mind I was thinking, “When will I be asked about my mental health history?” I kept waiting, and waiting, and waiting. The questions never came.

I left that day bewildered. If our primary physicians are not the entry point into mental health discussions, then who is? Is it up to the person with depression, social anxiety, obsessive-compulsive habits or post-traumatic flashbacks to say, “Hey doc, I’ve been having these mental health issues. Do you think you could help with that?” Perhaps it is, but I don’t think it should have to be that way.

People shouldn’t have to jump through hoops to get mental health diagnoses and treatment. The process needs to be made as easy as possible for those struggling with mental health issues. Asking someone with social anxiety or depression to proactively bring up mental health issues during a routine doctor’s appointment is akin to asking a person who just had a heart attack to drive himself to the hospital. We have procedures like 911 and ambulances because we recognize the handicap that those in physical distress face. Why don’t we recognize the same handicap among those under extreme mental stress?

Bringing the discussion back around full circle — I would like to think that somehow the online treatment revolution might bring some relief. However, if nearly half of those who start an online program end up dropping out, then we still aren’t doing a good enough job.

How can we fix this problem? Here would be a few of my suggestions:

1. Train primary physicians to watch for and ask about mental health symptoms. And to ask about them even when it seems irrelevant.

2. To take the burden off of the patient with mental health issues to push for treatment. Once symptoms have been identified, the burden should be on the attending physician to start a course of action that leads to a resolution — that does not require the patient to be proactive or make follow-up phone calls. The simplest road block could discourage someone with depression or social anxiety from continuing to seek help. All of those road blocks need to be removed.

3. Follow through. In the case of those in the online treatment programs I described, I suspect that some form of accountability might have kept them in the program longer. For those with social anxiety, facing fears can be daunting. Having someone (anyone) to whom they are accountable for completing the program could make a huge difference.

As Dr. Grohol states, however, we still don’t know the reason for those dropout rates — so this is the next avenue that research needs to address.

In the meantime, what can you do?

1. Start an online treatment program for SAD that has been validated with some form of scientific study.

2. Try to complete the whole program, even if you feel like dropping out.

3. If your doctor isn’t good about asking about mental health symptoms, bring a written summary with you. Doctors still need to do a better job with mental health issues, but in the meantime you can help them out.

How to Overcome Social Anxiety and Reclaim Your Life

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Does it ever strike you as odd that social anxiety disorder (or SAD, as I will refer to it sometimes on this blog) is among the top three most common mental health conditions (yes, up there with depression and alcoholism), there are science-backed treatments for it that we know work, and yet around a third of people with social anxiety experience symptoms for 10 years or more before seeking help. Wait, what?

10 or more years? Like, were they locked in their homes or something?

Well, kind of.

Not locked in a house like Paul Sheldon was in Misery.

No, these people with social anxiety are living with some kind of virtual shackle, that stops them from waving at the neighbor, going to work, raising their hand in class, leaving the house, speaking—

You get the picture. And if this is you, that picture confronts you every morning.

So, it’s no wonder that these people don’t, imagine that, pick up the telephone and call their doctor

How would that go anyway?

“Good morning, Dr. X’s office, can you hold for a moment?”

“Uh.” . Click.

You know what? It’s really not their fault. And it’s not your fault. Because, you see, the world is not set up to help people with social anxiety get help. In fact, it’s pretty much stacked against you.

But still, 10 years? Surely you can do better than that. Let’s think about what contributes to that 10 year gap.

#1. You’re not motivated to change.

Okay, okay. Hear me out.

I don’t mean not motivated in the sense that you lay about in your pyjamas all day, eat bon bons, and binge-watch Netflix. Well if you do, kudos. You’ve found a way to earn a living that doesn’t require working, so good on you. Unless, of course, you’re living with people who are supporting you. Not good. Very bad.

No, I mean the type of lack of motivation that stems from fear of making a major life change.

Maybe you’ve settled into your way of life and somehow made it work for you.

Maybe your family doesn’t support you changing.

Maybe you have other mental health issues that make life a struggle in general.

Maybe you think the cost of getting help is out of reach.

Maybe you think there is no help for you, that you were born defective.

Maybe, maybe, maybe.

I don’t know you or what reason you might have for not wanting to change.

I do know that if you ever want to get motivated to change there are 3 things you need to do:

  1. Become aware that you have a problem. Most people with social anxiety realize they have a problem, but they might think it is something they have to live with.
  2. Think about making a change sometime in the future. It doesn’t have to be tomorrow. In fact, it probably shouldn’t be.
  3. Start planning to work on your issue in the near future. Something like within the next month.

But what about the why? Why are you doing this if things are ho-hum now. If your family doesn’t support you. If you can’t afford therapy. If you can’t be helped.

Are you happy?

How could your life be better?

The answers to those two key questions will tell you if you can dig deep to find that motivation. Because it will always feel more comfortable to stay the same. And people will often be unsupportive. And you may run into roadblocks getting help (but there are ways around this—a topic for another post). And YOU CAN BE HELPED.

You all can be helped. Don’t believe otherwise.

#2. You don’t have the information to change.

So, if you’ve got the motivation that’s all you need, right? Yeah right. You need tools and information. You can’t do this alone (well, maybe you can—again, another post). But if you think you know it all already, you’re done before you start.

You need expert help to get through this and live well. Whether that comes in the form of medication, therapy, self-help books, online treatment modules, your cat telling you what to do (not advised, cats don’t know social anxiety)—it doesn’t matter. And you know, combining different methods might actually work the best, kind of like the shotgun approach.

#3. You are not putting what you have learned into practice.

Medication aside, overcoming social anxiety involves a lot of mental work. It’s very easy to slip up and return to old ways of thinking.

Perhaps you got better for a while and then went through a stressful time in your life and regressed. We’ve all been there.

Maybe you’ve read all the self-help books, but that’s all you’ve done is read.

Guess

what?

It’s not going to work if you don’t put in the work. Kind of like you can’t spend 4 months exercising like a madman and expect to then keep six-pack abs for the rest of your life.

Why do people expect that from the brain?

“Well geez, I got treatment shouldn’t I be fine now?”

“Well geez, did you dump your gym membership because you saw you were getting in shape?

What I am getting at here is that medication, therapy, and even self-help approaches are often time-limited.

We treat this as a mental health disorder that needs a short term fix. And I do understand that this is partly because it’s just not feasible to continue in therapy or on medication for an extended period.

But. Still.

We need to start envisioning mental wellness instead of focusing on mental illness. Especially for issues like social anxiety.

And we need to focus on maintenance of mental wellness among the healthy.

You can do this. You’ve got this. I believe in you.