Written by Dr. Andrew Miki, R. Psych.
www.mentalfitness.ca
Tel: (604) 985.3939
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1. Health Canada (2009). Depression.

2. National Institute of Mental Health. (2008). Depression.

3. Cochran, S. V. & Rabinowitz, F. E. (2000) Men and depression: Clinical and Empirical Perspectives. San Diego: Academic Press.

4. Kochanek. K. D. et al. (2002). Deaths: final data for 2002. National Vital Statistics Reports; National Center for Health Statistics.

Written by Dr. Andrew Miki, R. Psych.
www.mentalfitness.ca
Tel: (604) 985.3939
Information Request Form

1. Health Canada (2009). Depression.

2. Weissman MM & Olfson M. (1995). Depression in women: implications for health care research. Science, 269, 799-801.

3. Piccinelli, M. & Wilkinson, G. (2000). Gender differences in depression. British Journal of Psychiatry, 177, 486-492.

A good analogy to memory is our eyesight. As we age, our eyes change and we need glasses to compensate and remain independent. Similarly, as we age, some types of memory decline (i.e. recent memory and remembering to do things in the future) and we need memory strategies to maintain our level of functioning.

Memory strategies have been documented in research to be helpful for individuals with a brain injury². In fact, the World Health Organization³ and the US Department of Defense⁴ have published guidelines that recommend the use of memory strategies for the rehabilitation of people with a Traumatic Brain Injury.

Written by Dr. Andrew Miki, R. Psych.
www.mentalfitness.ca
Tel: (604) 985.3939
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1. Troyer et al. (2008). Changing Everyday Memory Behaviour in Amnestic Mild Cognitive Impairment: A Randomized Control Trial. Neuropsychological Rehabilitation, 18, 65-88.

2. Gentry et al. (2008). Personal Digital Assistants as Cognitive Aids for Individuals with Severe Traumatic Brain Injury: A Community-based Trial. Brain Injury, 22, 19-24.

3. World Health Organization (2004). Rehabilitation for Persons with Traumatic Brain Injury.

4. US Department of Defense (2009). Clinical Practice Guideline for Management of Concussion/Mild Traumatic Brain Injury (mTBI).

Although the severity, frequency, and duration of symptoms are different for every individual, symptoms of depression include:

• Persistent sadness nearly every day for most of the day
• Loss of pleasure in activities/hobbies
• Significant change in appetite (i.e. increase or decrease)
• Sleep problems (i.e. insomnia, staying asleep, getting up)
• Feeling tired most of the day
• Feeling worthless and/or guilty
• Concentration problems
• Difficulties making decisions
• Thoughts of suicide and/or suicide attempts

Scientific research has demonstrated that 10 to 20 sessions of Cognitive Behavioural Therapy (CBT) can significantly reduce symptoms of depression, prevent relapse, and improve one’s quality of life^3,4.

Due to all of the evidence, CBT is endorsed as a primary form of treatment by:

• The World Health Organization¹
• The National Institute of Mental Health⁵
• The Canadian Psychological Association⁶
• The Canadian Psychiatric Association²

Dr. Miki received doctoral training in CBT for depression in the Mood Disorders Clinic at the Centre for Addiction and Mental Health (CAMH).

Written by Dr. Andrew Miki, R. Psych.
www.mentalfitness.ca
Tel: (604) 985.3939
Information Request Form

1. World Health Organization (2005). What Are The Most Effective Diagnostic and Therapeutic Strategies for the Management of Depression in Specialist Care?

2. Canadian Psychiatric Association (2001). Canadian Clinical Practice Guidelines for the Treatment of Depressive Disorders. Canadian Journal of Psychiatry, 46.

3. Keller et al. (2000). A Comparison of Nefazodone, The Cognitive Behavioral-Analysis System of Psychotherapy, and their Combination For the Treatment of Chronic Depression. The New England Journal of Medicine, 342, 1462-1470.

4. Butler et al. (2006). The Empirical Status of Cognitive-Behavioral Therapy: A Review of Meta-Analyses. Clinical Psychology Review, 26, 17-31.

5. The National Institute of Mental Health, (2008). Depression.

6. The Canadian Psychological Association, (2002). The Cost-Effectiveness of Psychological Interventions.

Some of the key features of GAD include:

• Worry about many everyday issues. People with GAD often comment, “What don’t I worry about.”
• The worry topics are the same as everyone else but are more frequent and more severe.
• It is difficult to stop or control the worry
• Many worry thoughts begin with, “What if….. (e.g. my child is hurt, my boss is upset with me, that feeling in my chest is cancer)?”
• A low tolerance for uncertainty
• Sleep difficulties (i.e. falling asleep, staying asleep, or waking early)
• Irritability
• Muscle tension
• Concentration problems
• Feelings of restlessness, keyed up, or on edge

There is scientific evidence that 10 to 20 sessions of Cognitive Behavioural Therapy (CBT) can significantly reduce symptoms of GAD and improve one’s quality of life². Dr. Miki was one of the research therapists in a recent scientific study that demonstrated the effectiveness of CBT for GAD³.

Written by Dr. Andrew Miki, R. Psych.
www.mentalfitness.ca
Tel: (604) 985.3939
Information Request Form

¹ Wittchen et al. (2002) Generalized Anxiety and Depression in Primary Care: Prevalence, Recognition, and Management. Journal of Clinical Psychiatry, 63, 24-34.

² Dugas et al. (2003). Group Cognitive-Behavioural Therapy for Generalized Anxiety Disorder: Treatment Outcome and Long-term Follow-up. Journal of Consulting and Clinical Psychology, 71, 821-825.

³ Westra et al. (2009). Adding a Motivational Interviewing Pretrement to Cognitive Behavioural Therapy for Generalized Anxiety Disorder. Journal of Anxiety Disorders, 23, 1106-1117.

Instead of misplaced positivity, it is optimal for people to be more objective. Fortunately, Cognitive Behavioural Therapy (CBT) has developed a set of specific skills that can help people think more realistically by balancing their thoughts.

The first step in balancing one’s thoughts is to identify mood shifts. This term refers to increases in one’s mood (i.e. stress, anxiety, etc.) and the accompanying thoughts. For example, if you are sitting at your desk late one evening and find yourself upset and overwhelmed, you may have the thought, “My boss isn’t supportive of me anymore.” Although there may be some truth to this statement, it is not helpful because it can make you feel more distressed, less motivated, and may interfere with your work.

People often ruminate over the “evidence” that support their thoughts (e.g. “My boss doesn’t appreciate how hard I work. She forgets that there used to be two people doing this job”). Since these thoughts are emotionally charged, people often don’t realize that their thoughts aren’t based on factual evidence. For example, the thought “My boss gave me a strange look today” is based on an interpretation rather than a fact.

Thought Records are a very effective CBT technique that provide structure to people’s thoughts so that they can balance them in a systematic way. After outlining the evidence in favor of your thoughts, it is important to think of facts that do not support the thoughts (e.g. “My last performance review was positive. My boss is overworked herself. She told me that she is glad to have me on her team”).

Finally, you want to consider all of the evidence and develop an alternative or balanced thought (e.g. “Although this was once a two person job, my performance review indicated that the company has a lot of confidence in me” or “I will have to speak to my boss because two people used to do this job and I cannot keep up this pace”). A more objective thought has the potential to completely change the way you feel or, at a minimum, reduce the intensity of negative moods so that you can continue your work.

Like any other skill, balancing your thoughts can be learned, practiced, and mastered. Most individuals that I have worked with need to write their thoughts down on a worksheet for several weeks. There is scientific evidence that using CBT tools like the Thought Record can rewire your brain[2]. This change is most likely to occur when individuals become so proficient with this skill that they can summarize the Thought Record in their head. Overall, this tool, along with other CBT strategies, has helped many depressed, anxious, and stressed people find greater control over their lives.

Written by Dr. Andrew Miki, R. Psych.
www.mentalfitness.ca
Tel: (604) 985.3939
Information Request Form

[1] Wood, J. et al. (2009). Positive Self-Statements: Power for Some, Peril for Others. Psychological Science, 20, 860-866.

[2] Kennedy, S. et al. (2007). Differences in Brain Glucose Metabolism Between Responders to CBT and Venlafaxine in a 16-Week Randomized Controlled Trial. American Journal of Psychiatry, 164, 778-788.

Imagine for a moment how you feel after a single stressful event. Perhaps you had a tough day at the office or had an argument with your partner. Let’s consider how stress impacts you in four basic ways.

First, you may notice that the stress makes you feel slightly irritable, sad, or anxious. Second, think about how your thoughts will be coloured by your negative mood (i.e. “No one will talk to me,” or “What if I can’t get the project done in time?”). Third, feeling stressed may make it a little more difficult for you to do things that you usually enjoy (i.e. getting out of the house to go for a walk) or things that you need to do (i.e. making yourself dinner). Finally, stress has a negative impact on your body. You may feel tense in some areas (chest or back) or notice a change in body temperature (feel hot or sweaty) throughout the day. These feelings should sound familiar as we have all experienced stressful days. However we can usually cope and the feelings of stress don’t last for a long time.

Instead of a single event that causes you stress, let’s now consider if you feel intense stress for weeks, months, or years. One way to cope in the short term is to avoid the stressor. However, avoidance often causes the stressors to multiply or worsen. Alternatively, we may have no choice but to endure the stress. In these situations, the level of stress may be very high and the duration can be uncertain. For example, when an aging parent becomes sick, family members often experience significant stress and are at risk for caregiver burnout. If you put yourself in this type of situation, how long do you think you could cope?

When people experience heightened stress for a prolonged period of time, they often develop bad habits in the way that they behave and think. For example, people may develop even more negative or anxious thoughts over time and this way of thinking becomes ingrained. Also, we can become socially isolated and stop participating in our hobbies. Both of these habits have a detrimental effect on our wellbeing, and once formed these habits can be very difficult to break.

The combination of an individual’s genetic makeup and the bad habits they acquire due to stress are believed to trigger depression and anxiety disorders. The greater the genetic vulnerability, the less stress required to cause a disorder. Alternatively, with enough stress, we are all at risk for symptoms of depression, anger, and anxiety. Consequently, it is important for all of us to be aware of the stressors in our lives and to learn tools and strategies to manage them.

Written by Dr. Andrew Miki, R. Psych.
www.mentalfitness.ca
Tel: (604) 985.3939
Information Request Form

The figure in the logo represents an individual who is standing on one leg balancing four balls above his head. Each ball represent a major component of CBT (i.e. thoughts, behaviours, physiology, and mood).

This figure resonates with me because I believe that one of the goals of CBT is to help people become more aware of these 4 components and to develop skills/tools to keep them in balance. So, the ability to maintain this balance while living a busy/fulfilling life is optimal mental fitness.

I like the concept of mental fitness because it is a great analogy for improving one’s mental health. As a person becomes more physically fit, their participation in a number of activities (i.e. cardiovascular exercise, weight training, healthy eating) increases and becomes part of their lifestyle. Much like physical fitness, individuals can learn and practice exercises to improve their mental fitness.

For example, one can learn to think more objectively using a series of cognitive exercises. With practice and active use, more objective thinking can help reduce negative thoughts and improve one’s confidence.

It is so common for people with depression to view themselves, others, or the world in a negative way. Consequently, their thoughts are negative (i.e. “I’m a failure” or “Nobody likes me”) and they tend to ruminate. What this means is that they think of evidence that supports these thoughts and review it over and over in their heads, much like a broken record.

One of the most powerful tools in CBT is the “Thought Record” that teaches people to think in a more balanced way. I often tell my patients that thinking 100% positively can get you into just as much trouble as thinking 100% negatively. So, I want to help people think more objectively and more realistically. We can do this by writing down the evidence/facts of one’s thoughts in a systematic and organized way (i.e. times in one’s life when they failed vs. times when they succeeded). Reviewing all of the evidence and creating a balanced or alternative thought generally helps improve one’s mood. However, it is a skill to think this way and an individual must practice this for several weeks to improve their mental fitness.

I have observed significant changes in many people using this technique. Often, with practice, patients report that they are able to balance their thoughts on their own, very quickly, and in their head.