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Season Affective Disorder and What You Need to Know

Seasonal Affective Disorder (SAD) is a type of depression that comes and goes with the seasons, typically starting in the late fall and early winter and going away during the spring and summer. Depressive episodes linked to the summer can occur, but are much less common than winter episodes of SAD.

Signs and Symptoms

Seasonal Affective Disorder (SAD) is not considered as a separate disorder. It is a type of depression displaying a recurring seasonal pattern. To be diagnosed with SAD, people must meet full criteria for major depression coinciding with specific seasons (appearing in the winter or summer months) for at least 2 years. Seasonal depressions must be much more frequent than any non-seasonal depressions.

Symptoms of Major Depression

  • Feeling depressed most of the day, nearly every day

  • Feeling hopeless or worthless

  • Having low energy

  • Losing interest in activities you once enjoyed

  • Having problems with sleep

  • Experiencing changes in your appetite or weight

  • Feeling sluggish or agitated

  • Having difficulty concentrating

  • Having frequent thoughts of death or suicide.

Symptoms of the Winter Pattern of SAD include:

  • Having low energy

  • Hypersomnia

  • Overeating

  • Weight gain

  • Craving for carbohydrates

  • Social withdrawal (feel like “hibernating”)

Symptoms of the less frequently occurring summer seasonal affective disorder include:

  • Poor appetite with associated weight loss

  • Insomnia

  • Agitation

  • Restlessness

  • Anxiety

  • Episodes of violent behavior

Risk Factors

Attributes that may increase your risk of SAD include:

  • Being female. SAD is diagnosed four times more often in women than men.

  • Living far from the equator. SAD is more frequent in people who live far north or south of the equator. For example, 1 percent of those who live in Florida and 9 percent of those who live in New England or Alaska suffer from SAD.

  • Family history. People with a family history of other types of depression are more likely to develop SAD than people who do not have a family history of depression.

  • Having depression or bipolar disorder. The symptoms of depression may worsen with the seasons if you have one of these conditions (but SAD is diagnosed only if seasonal depressions are the most common).

  • Younger Age. Younger adults have a higher risk of SAD than older adults. SAD has been reported even in children and teens.

The causes of SAD are unknown, but research has found some biological clues: 

  • People with SAD may have trouble regulating one of the key neurotransmitters involved in mood, serotonin. One study found that people with SAD have 5 percent more serotonin transporter protein in winter months than summer months. Higher serotonin transporter protein leaves less serotonin available at the synapse because the function of the transporter is to recycle neurotransmitter back into the pre-synaptic neuron.

  • People with SAD may overproduce the hormone melatonin.Darkness increases production of melatonin, which regulates sleep. As winter days become shorter, melatonin production increases, leaving people with SAD to feel sleepier and more lethargic, often with delayed circadian rhythms.

  • People with SAD also may produce less Vitamin D. Vitamin D is believed to play a role in serotonin activity. Vitamin D insufficiency may be associated with clinically significant depression symptoms.

Treatments and Therapies

There are four major types of treatment for SAD:

  • Medication

  • Light therapy

  • Psychotherapy

  • Vitamin D

 These may be used alone or in combination.

Medication

Selective Serotonin Reuptake Inhibitors (SSRIs) are used to treat SAD. The FDA has also approved the use of bupropion, another type of antidepressant, for treating SAD.

As with other medications, there are side effects to SSRIs. Talk to your doctor about the possible risks of using this medication for your condition. You may need to try several different antidepressant medications before finding the one that improves your symptoms without causing problematic side effects. For basic information about SSRIs and other mental health medications, visit NIMH’s Medications webpage. Check the FDA’s website for the latest information on warnings, patient medication guides, or newly approved medications.

Light Therapy

Light therapy has been a mainstay of treatment for SAD since the 1980s. The idea behind light therapy is to replace the diminished sunshine of the fall and winter months using daily exposure to bright, artificial light. Symptoms of SAD may be relieved by sitting in front of a light box first thing in the morning, on a daily basis from the early fall until spring. Most typically, light boxes filter out the ultraviolet rays and require 20-60 minutes of exposure to 10,000 lux of cool-white fluorescent light, an amount that is about 20 times greater than ordinary indoor lighting.

Psychotherapy

Cognitive behavioral therapy (CBT) is type of psychotherapy that is effective for SAD. Traditional cognitive behavioral therapy has been adapted for use with SAD (CBT-SAD). CBT-SAD relies on basic techniques of CBT such as identifying negative thoughts and replacing them with more positive thoughts along with a technique called behavioral activation. Behavioral activation seeks to help the person identify activities that are engaging and pleasurable, whether indoors or outdoors, to improve coping with winter.

Vitamin D

At present, vitamin D supplementation by itself is not regarded as an effective SAD treatment. The reason behind its use is that low blood levels of vitamin D were found in people with SAD. The low levels are usually due to insufficient dietary intake or insufficient exposure to sunshine. However, the evidence for its use has been mixed. While some studies suggest vitamin D supplementation may be as effective as light therapy, others found vitamin D had no effect.

Join a Study

Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions, including seasonal affective disorder. During clinical trials, treatments might be new drugs or new combinations of drugs, new psychotherapies or devices, or new ways to use existing treatments. The goal of clinical trials is to determine if a new test or treatment works and is safe. Although individual participants may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future.

Please Note: Decisions about whether to apply for a clinical trial and which ones are best suited for a given individual are best made in collaboration with your licensed health professional.

Clinical Trials at NIMH/NIH

Scientists at the NIMH campus conduct research on numerous areas of study, including cognition, genetics, epidemiology, and psychiatry. The studies take place at the NIH Clinical Center in Bethesda, Maryland and usually require regular visits. After an initial phone interview to see if any of the clinical trials recruiting subjects are a good match for you, you will come to an appointment at the clinic and meet with a clinician. Visit the NIMH Clinical Trials — Participants or Join a Study for more information.

How Do I Find a Clinical Trial Near Me?

To find a clinical trial near you, you can visit ClinicalTrials.gov. This is a searchable registry and results database of federally and privately supported clinical trials conducted in the United States and around the world. ClinicalTrials.gov gives you information about a trial's purpose, who may participate, locations, and contact information for more details. This information should be used in conjunction with advice from your health provider.

Learn More

Free Booklets and Brochures

You can download or order free copies of the following booklets and brochures in English or en Español:

  • Depression: What You Need to Know: This booklet contains information on depression (depressive disorder or clinical depression), including signs and symptoms, treatment and support options, and a listing of additional resources.

  • Depression: This brochure describes the two most common types of depression: major depression, and persistent depressive disorder. It lists symptoms, treatment options, and how the condition may look different in women, men, seniors, and children.

  • Teen Depression: This flier for teens describes depression and how it differs from regular sadness. It also describes symptoms, causes, and treatments, with information on getting help and coping.

Federal Resources

Research and Statistics

Millennials Are the Therapy Generation

People in their 20s and 30s seek mental-health help more often, and they are changing the nature of treatment

Kristina, a 27-year-old publicist living in Manhattan, has been in and out of therapy since she was 9, when her parents got divorced. Back then, she says, “I had a pretty pragmatic view of what was happening, and so did my parents—going to therapy was just something you make kids of divorce do.” During her first year of college, Kristina (who requested that only her first name be used) suffered a sexual assault. Again, she says, therapy afterward was a given. “I figured I would use therapy to get through my trauma and then be done,” she says. “I eventually learned that’s not really how it works.” She has had four or five different therapists since then. So have most of her friends.

The stigma traditionally attached to psychotherapy has largely dissolved in the new generation of patients seeking treatment. Raised by parents who openly went to therapy themselves and who sent their children as well, today’s 20- and 30-somethings turn to therapy sooner and with fewer reservations than young people did in previous eras. 

According to a 2017 report from the Center for Collegiate Mental Health at Penn State University, which compiled data from 147 colleges and universities, the number of students seeking mental-health help increased from 2011 to 2016 at five times the rate of new students starting college. A 2018 report from the Blue Cross Blue Shield Association found a 47% increase between 2013 and 2016 in depression diagnoses among 18-to-34 year-olds; the report attributed the rise largely to the fact that far more young adults are seeking help.

“Many of my clients joke that they and their co-workers often start conversations with, ‘My therapist thinks…’” says Elizabeth Cohen, a clinical psychologist in Manhattan, “The shame of needing help has been transformed to a pride in getting outside advice.”

One reason for the shift is celebrities such as Demi Lovato, Lady Gaga and Dwayne (“the Rock”) Johnson, who have publicly discussed their struggles with depression. Many therapists also credit social media—often criticized as a source of millennial distress—with helping to normalize mental illness and to remove any lingering stigma from seeking support. Vix Meldrew, 32, a London blogger, says that whenever she talks about mental health online, her response from readers skyrockets because she is “making them feel less alone.”

‘I think the therapist’s natural instinct to listen and not give advice can be challenging and threatening to millennials.’

Many younger people pursue therapy as another form of self-improvement and personal growth, not unlike yoga, meditation or “preventive Botox.” (A 2015 survey by the research firm Field Agent found that millennials spend $300 a month on such pursuits.) Some millennials also use life coaches. That includes Ali Wunderman, a 29-year-old freelance journalist in Whitefish, Mont. “My life coaching and my therapy work really well together,” she says. “It’s about forming habits and behaviors that lead to a fuller life.”

But young people are struggling to find such balance. A 2018 study of 40,000 American, Canadian and British college students published in the journal Psychological Bulletin found that millennials are suffering from “multidimensional perfectionism” in many areas of their lives, setting unrealistically high expectations and feeling hurt when they fall short. This propensity can motivate them to seek assistance when something goes wrong—but it also sometimes drives them to turn that assistance into dependence. 

Some young people think “that the therapist is going to provide an answer rather than help them discover the answer within themselves,” says Dr. Cohen, the Manhattan psychologist. Dr. Cohen recalls one recent 20-something client who was unsure about whether to stay in a relationship. “It really felt like she had gone from therapist to therapist looking for one that would tell her what to do,” says Dr. Cohen. “I think the therapist’s natural instinct to listen and not give advice can be challenging and threatening to millennials.”

Technology has contributed to the expectation of a quick fix. Apps and online services such as Talkspace and MyTherapist offer therapy by phone, chat, video and message board, making it more likely that young people will opt for superficial bromides over meaningful long-term help. Used correctly, however, tech-based therapies can fill in important gaps, especially for millennials more comfortable facing their devices than a therapist. Julia Koerwer, 28, a graduate student in social work in Queens, N.Y., uses textlines when she needs immediate help. “People tend to think crisis hotlines are for suicide only,” she says. “But just to be like, ‘OK, it’s Wednesday, I see my therapist on Sunday, and I feel like [expletive] right now. What can I do?’ That’s helpful.”

New studies also show that young couples are using therapy before moving in together or in the early years of marriage—something virtually unheard-of in earlier generations. Kristina and her partner started couples counseling in 2017 when they got their first apartment together. “If my mom and stepdad weren’t communicating well, they’d be like, ‘Oh, let’s just talk about it over dinner,’” she says. “But we work late, and then at home we’re answering emails on our phones, and talking it out over dinner just doesn’t work that way anymore.” 

For many, such “self-care” doesn’t feel like a chore. “I just enjoy therapy,” says Ms. Koerwer. “I don’t enjoy getting blood drawn—I’d be looking for ways to stop having to do something like that. But I like my therapist, I have a good relationship with him. It’s not like I’m trying to figure out, at what point can I stop doing this?”

Check Out Change Counseling’s Updated Services

Check out our updated services page with new and innovative interventions to help you in your healing process!

SPECIALIZED INTERVENTIONS

  • ACCELERATED RESOLUTION THERAPY

    • ART incorporates a combination of techniques used in many other traditional psychotherapies. ARTworks directly to reprogram the way in which distressing memories and images are stored in the brain so that they no longer trigger strong physical and emotional reactions. ART accomplishes this through the use of rapid eye movements similar to eye movements that occur during dreaming. Although techniques similar to these are used in other types of therapies. ART’s very specific and directive approach can achieve rapid recovery from symptoms and reactions that may have been present for many years. ART combines long respected, sound treatment practices with safe and effective methods validated by current scientific research studies conducted by the University of South Florida. Find out more here.

  • EQUINE THERAPY

    • Equine Therapy (also referred to as Horse Therapy, Equine-Assisted Therapy, and Equine-Assisted Psychotherapy) is a form of experiential therapy that involves interactions between patients and horse. It involves activities (such as grooming, feeding, haltering and leading a horse) that are supervised by a mental health professional, often with the support of a horse professional. The goal of equine therapy is to help the patient develop needed skills and attributes, such as accountability, responsibility, self-confidence, problem-solving skills, and self-control. Equine therapy also provides an innovative milieu in which the therapist and the client can identify and address a range of emotional and behavioral improvements. Check out an informational article here.

  • CANINE THERAPY

    • Canine-assisted therapy uses dogs to promote health and healing. Like other animals, dogs are accepting, comforting and non-judgmental, making them ideal therapy companions. In canine therapy, patients may: learn to give a dog commands, walk and play with a dog, or pet and care for a dog. Canine therapy can be immensely healing. Children and teens respond particularly well to canine therapy, developing trust and strong bonds with the animals. Many find it easier to open up and talk when the focus is on the dog. The therapist working with the patient can gain valuable insights by observing the interactions between patients and their canine companions. More info here.

  • ECO THERAPY

    • Ecotherapy is based on the idea that people are connected to and impacted by the natural environment. It can consist of walking, hiking, cycling or meditating in nature. Ecotherapy can be especially beneficial for those with depression, anxiety, stress or other emotional issues. Read more about its benefits here.

  • TELE-COUNSELING

    • Video counseling provides behavioral health therapy in the privacy of your own home. It allows greater flexibility for clients who travel for work, have changing schedules not always allowing for consistent in-person sessions, identify transportation as a barrier to care, and more! It is 100% HIPPA compliant and in many cases provides more privacy than traditional in-person therapy. More about virtual therapy here.

Social Media Use Linked To Anxiety, Depression Among Teens, New Study Finds

A new study found social media use, television viewing and computer use over a four-year period predicted more severe symptoms of anxiety and depression among adolescents. 

Social media use and screen time can lead to an increase in depression and anxiety among teens and adolescents, a new study finds.According to a study published in the Canadian Journal of Psychiatry, researchers observed more than 3,000 seventh to 10th graders in the greater Montreal area over a period of four years.

Researchers measured how much time students spent in front of social media, television and computers. The data revealed the more time kids spent engrossed in digital screens, their symptoms of anxiety and depression became more severe.

Not all forms of screen use yielded the same impact on their mental health, says Patricia Conrod, one of the study’s researchers.

“In terms of the relationship between screen time and depression, what we found was that social media was very robustly related to increases in depressive symptoms, as was television,” she says. “And there was no relationship between video gaming and depressive symptoms.”

When watching TV, kids often consume idealized lives that are different from their own experiences, she says. But social media is unique because adolescents are seeing pictures, videos and status updates from their own network of friends and peers.

“In some way, you're being exposed to a slightly biased perspective on what young people's lives are like and you compare yourself to that,” she says.

Most adults experienced their childhood and teenage years without social media. Conrod says many adults developed a “more balanced perspective on what everyday life is like” since they did not have digital access as kids.

But digital technology is more accessible than ever, and adolescents tend to spend a good chunk of their day using it — teens average around seven hours per day on social media, while tweens clock in around five hours per day. In 2018, roughly half of U.S. teens said they spend too much time on their cellphones, according to the Pew Research Center.

This consistent use can blur the lines of reality for adolescents whose brains are still developing, Conrod says.

“Adolescents today spend a lot more of their time interacting with others through social media and therefore exposed to a reality that is biased,” she says.

Conrod says she is concerned that the filtered lives of others that many young people see while scrolling on their phones could influence how they critically examine information.

Multi-screening, the act of being exposed to more than one screen at a time, also contributes to whether young people can effectively parse out what’s biased and what’s not, she says. When you’re in front of multiple screens, “you become less critical of the information you're being exposed to because your attention is divided,” she says.

“If you're spending a lot of your time being exposed to biased information, there's a risk that you're going to develop a somewhat biased perspective of the world,” she says. “And that's concerning to me.”

How to Find the Best Mental Health Professional for You

Do you need a psychiatrist, psychologist, counselor or someone else?

You work out for your physical fitness. You get your checkups, brush your teeth, get enough sleep and wash your face. You take so many steps to maintain your health, but they'll only take you so far if you feel depressed or struggle with alcohol or can't stop fighting with your spouse. "Mental health is essential to overall health," says Paolo del Vecchio, director of the Substance Abuse and Mental Health Services Administration’s Center for Mental Health Services. Most of us (hopefully) wouldn't think twice about seeing a doctor if we had, say, strep throat, and we'd gladly take the antibiotics prescribed. So if you're feeling sick in other ways – you're anxious, you don't want to eat – why wait to get help from a professional? Here are the different people who can help:

Psychiatrists

Psychiatrists are physicians specialized in mental health and sometimes more specific areas, such as psychiatry for addiction recovery or for children. They can diagnose and treat mental health disorders and hold either a Doctor of Medicine or a Doctor of Osteopathy degree, often shortened to M.D. and D.O., respectively. Because they’re medical doctors – unlike most other professionals on this list – they can prescribe medications. Del Vecchio says medication management is one of psychiatrists’ primary roles, and they are less likely (but certainly qualified) to provide counsel.

Psychologist

The two “psych-” professions can be easy to mix up. Here’s a basic distinction: While a psychiatrist holds a medical degree, a psychologist has a doctoral degree, either in clinical, educational, counseling or research psychology. Psychologists can diagnose mental health disorders and provide counseling in either an individual or group setting. While most psychologists cannot prescribe medications, they may work with a physician to coordinate a medical treatment plan, if necessary.

Counselor

The training and academic requirements for licensed counselors vary by state, but they typically have a graduate degree in a mental health field, along with clinical experience. Most counselors don’t diagnose conditions, and none prescribe medications. According to "8 Things You Didn’t Know About Counseling," they’re more likely to help with life transitions, which may include issues with family members, spouses or a changing work environment. 

So wait, what’s a therapist?

Here’s the thing: A “therapist” can be a number of mental health professionals, including a psychiatrist, psychologist or counselor. A therapist is simply someone who provides therapy, and it’s more so a general term than an official title. That’s why knowing the difference between the specific professions is key in figuring out who will work best with you.

And there are other folks who can help.

Depending on your needs, certain social workers, specialized nurses and physician assistants can also provide guidance. The range of their abilities and qualifications is wide and can include diagnosing conditions, counseling, and in some cases, prescribing medications.  

Don’t forget about your primary care physician.

Del Vecchio says more than 50 percent of mental health-related medications are prescribed through primary care physicians, who can diagnose many mental health issues, such as depression and anxiety. Your doctor’s office is a great place to start if you want to feel better. Tell her your concerns – whether you’ve been super stressed about the divorce or feeling very lonely – and she can help you determine your next step. Your primary care physician may prescribe medication or refer you to one of the professionals previously mentioned. 

So how do you know which kind of doctor you need?

Your primary care doctor may help you determine what kind of professional you should see, based partially on your needs for, say, medications. She will likely refer you to someone in the network of your health insurance, too. Another tip for finding the right professional: Consider your situation. Generally, the more severe your symptoms – you’re so depressed you’ve been skipping work – the more training you should look for in a professional. And if you’re looking to solve a specific issue, such as work stress or marital conflicts, seek providers specialized in those areas. 

Other considerations

Whoever you choose, comfort with that person is key, del Vecchio says. He encourages folks to ask the mental health professional plenty of questions about his or her specialty, approach and philosophy. And don’t be shy about discussing the cost of appointments, he says.

Don’t settle.

Given the important role your therapist may play in your life, del Vecchio says you ought to “shop around a little bit.” In addition to your primary care doctor’s referral and your insurance company’s network, ask friends and family for their suggestions. There are also online locator tools for mental health resources, like the one on the Substance Abuse and Mental Health Services Administration website.

What Parents Should Know About Teen Depression

Look for these signs and be proactive in addressing the mood disorder.

According to the Substance Abuse and Mental Health Services Administration, in 2015 an estimated 3 million teens in America between the ages of 12 and 17 experienced at least one major depressive episode in the past 12 months; that’s 12.5 percent of the U.S. adolescent population. An MDE is experiencing symptoms of depression, such as loss of interest in usual activities, lack of energy and hopelessness, accompanied by depressed mood for a period of two weeks or more. According to a study published in the journal Pediatrics, the prevalence of adolescents who reported they had an MDE in the previous year jumped from 8.7 percent in 2005 to 11.5 percent in 2014 – a 37 percent increase. Sadly, adolescent depression continues to rise.

However, despite the increase in adolescent depression, there hasn’t been a proportionate increase in mental health treatment. These teens are not receiving the professional services they need to help them cope and relieve their symptoms. Teen depression goes beyond sadness and can often manifest in anger, moodiness and isolation. Whether your teen is being moody or suffering from clinical depression can be difficult to determine, since depression can be easily mistaken for typical teen behavior.

It’s easy to dismiss adolescent behavior as a snarky attitude or being disrespectful, but perhaps there’s more to the story. What if behind the defiance, your teen is miserable, can’t remember the last time she felt happy, or worse yet, questioned whether she’d be better off dead? With these troublesome and dismal thoughts looming, your teen may know that something is wrong but not know how to talk with you about how she feels. Though it may be difficult to distinguish from teen angst, adolescent depression is real, it’s painful and it can take an emotional, mental and physical toll. The only way you can combat teen depression is to take a proactive approach.

How Do Adolescents Experience Depression?

To begin to understand depression, you have to know what it is and how to differentiate it from normal teen behavior. Depression can be described as the persistent feeling of deep sadness. Most of us have felt depressed at some point in our lives. Usually these feelings come and go, but sometimes they linger for days, weeks or even months.

Depressed adults and teens may experience similar symptoms. However, those symptoms may manifest in different ways, making it hard to separate normal adolescent behavior from the behavioral changes associated with depression. For example, depressed teens may show signs of anxiety, refuse to go to school, stop talking with friends, become extremely argumentative and stay awake most of the night, but sleep all day. Many teens who aren’t depressed may exhibit some these behaviors at one time or another. The difference between typical behavior and depression is the duration, frequency and intensity as well as the implications it has on personal, social and academic functioning. Unlike adult depression, teen depression may go unnoticed and get brushed off as rebellious adolescent behavior.

How Do I know If My Teen Is Depressed?

There are some tell-tale indicators of depression. The following are some common signs and symptoms of adolescent depression:

  • pulls away from family and friends

  • seems depressed or irritable more days than not

  • disengages in things that were once fun and enjoyable

  • sleeps too much or not enough

  • eats too much or not enough resulting in weight loss or gain

  • appears lethargic and is unmotivated

  • expresses feelings of worthlessness and hopelessness

  • pays little attention to personal hygiene

  • expresses feelings of emptiness and being emotionally numb

  • lacks the ability to focus and concentrate

  • appears more argumentative and agitated than usual

  • experiences bouts of crying without reason

  • uses drugs to cope with problems

  • engages in self-injurious behavior

  • complains of stomach aches, headaches and other pains that don’t respond to treatment

  • expresses thoughts about death or suicide

  • some of these symptoms persist for two weeks or more

If you feel your teen is suffering from depression, please seek professional help immediately. Untreated depression is serious and can, in some instances, put an adolescent at risk for suicide.

How Can I Help My Teen Manage Depression?

If your teen is depressed, here are five things you can do right now to help him or her cope:

1. Stop and listen. Don't worry about what to say; be understanding and encouraging and let your teen know that you’re right there every step of the way. Set aside some face-to-face time each day to speak with your teen. Make sure there are no distractions during your time together, such as a vibrating cell phone or having to take dinner out of the oven. Your teen needs your undivided attention. There is nothing that can be more healing than the power of your presence.

2. Stay the course. Separate depression from your teen, and don’t let the illness push you away. Even if your teen refuses to talk, there is comfort in just sitting on the sofa together and watching Netflix. Small steps can lead to great strides.

3. Do something together. Go for a walk, play a game of one-on-one basketball or take up a new hobby, such as cooking or woodworking. Slowly reintroduce your teen to fun social activities. Keep in mind that depression may lead your teen to disengage, but with time, your teen may come around to doing the things he or she once found enjoyable.

4. Go there. Don’t steer clear of difficult topics, such as suicide or drugs. Too often parents avoid the tough conversations; but these are the exchanges that can have the most positive impact. For example, if you find your teen self-medicating with pot, discuss how marijuana is a depressant and can intensify depression. Likewise, ask your teen about thoughts of self-harm or suicide. Don’t worry about planting a seed, if the thought is there, you aren’t reinforcing it by saying it out loud. By bringing up the difficult topics, you make it clear that any subject can be discussed – and that can be comforting to a depressed teen.

5. Get help. Take your teen to see a mental health professional and stick with the treatment plan. Depression doesn’t develop overnight, and it won’t go away overnight either. Work closely with your child’s doctor and therapist, and sign a release for both to communicate with one another. These professionals will form your teen’s treatment team.

With modern advancements in medication and therapy, depression can be effectively treated in 70 to 90 percent of cases. So, your teen doesn’t have to suffer in silence. There is hope, there is treatment, and there are brighter days ahead.

How Adult Bullying Impacts Your Mental and Physical Health

How this kind of harassment can have harmful ripple effects on your body and mind.

UNTIL THE last presidential election and the rise of the #MeToo movement, people often thought of bullying almost exclusively as kid stuff, not something mature adults engage in. How wrong we were! It turns out that adults are being bullied at rates that rival what kids experience: In an online survey of more than 2,000 adults across the U.S., conducted on behalf of the American Osteopathic Association in October, 31 percent of respondents said they’ve been bullied as adults, and 43 percent believe that bullying behavior has become more accepted in the past year.

As upsetting as being bullied is at any given moment, what’s worse is it can have a significant impact on your physical and emotional health, leading to sleep loss, headaches, muscle pain, anxiety and depression, or frequent sick days, according to the AOA poll. “There can be significant, long-term detrimental effects,” notes Dr. Charles Sophy, an osteopathic psychiatrist in private practice and medical director for the Los Angeles County Department of Children and Family Services. Over time, “the stress from bullying can trickle into thyroid problems, gastrointestinal problems, elevated blood pressure, mood disorders, self-harming behavior and eating disorders,” among other health conditions. In fact, a study in the November 2015 issue of the American Journal of Public Health found that victims of workplace bullying have double the risk of experiencing suicidal ideation over the subsequent five years.

Whether it occurs at work, at the gym, sporting venues, in the community or elsewhere, bullying – defined by the American Psychological Association as “aggressive behavior in which someone intentionally and repeatedly causes another person injury or discomfort” – typically involves a real or perceived power imbalance. Among adults, bullying can take more subtle forms than it does with kids: Rather than threatening to beat someone up or calling someone nasty names, the adult brand of bullying can include political backstabbing, the silent treatment, publicly belittling or humiliating someone, social ostracism or undermining him or her.

In 2011, Tracy Lamourie and her husband experienced an onslaught of social bullying after they stood up for a lesbian couple’s right to publicly display affection; the couple had been asked to leave a coffee shop in a small conservative town in Canada after a pastor complained about their kiss. The personal moment mushroomed into a community-wide controversy after the couple requested an apology from the shop’s owner and didn’t get one. A “Kiss In” demonstration was organized, and Lamourie, a publicist, wrote a press release that attracted local and national attention from TV stations and newspapers.

When the demonstration sparked community uproar, Lamourie and her husband became targets of bullying. “It was suddenly not only cool to hate us in person and on Facebook, but people turned on us in a giant way and it got to the point where we started to expect a rock [to be hurled] through our front window,” says Lamourie, now 48. “I was depressed and angry – it was so overwhelming [that] we literally made the decision to pack up our family and walk away from the home we loved.” The couple moved with their son to a Toronto suburb.

A Climate of Fear and Loathing

When it happens at work, being bullied also can affect your ability to focus and function effectively. “It can lead to a toxic environment where the victims are unable to concentrate because they are focused on self-preservation,” says psychologist Kenneth Yeager, director of the Stress Trauma and Resilience program at The Ohio State University Wexner Medical Center in Columbus. “Bullies target people who pose a threat to them in the workplace. They will frequently target someone who is smart, competent and well-liked. After the bullying is done, the target will be less confident and may feel inadequate.”

Jon Salas once worked for a manager who was a master at belittling people – “she made just about everyone in the office cry at some point, and she fostered a sense of paranoia,” recalls Salas, 29, a publicist in Boston. Feeling constantly anxious and on edge, Salas often woke up at 2 a.m., “thinking about work and how I would handle my confrontation when it was my turn,” he recalls. “I would fall asleep after an hour or two and wake up exhausted when my alarm went off. The effects of workplace abuse wear on you physically and emotionally.”

Bullying can even have harmful ripple effects among bystanders who aren’t on the receiving end because “watching it is a vicarious trauma,” Sophy says. Research in a 2013 issue of the International Archives of Occupational and Environmental Health found that even witnessing workplace bullying is associated with an increased risk of developing depressive symptomsover the subsequent 18 months.

Coping Cues

Since dealing with a bully can take a toll on various levels, it’s smart to take care of yourself in multiple ways, too. For starters, it’s important to call it what it is – to acknowledge that you’re being bullied, in other words. Some people might not immediately admit they're being bullied because they're reluctant to see themselves as victims or they question their perception of what's going on. Recognizing bullying as it’s happening can provide some comfort by validating your feelings and assuring you that the negative dynamic isn’t imagined.

“Don’t think that bullying isn’t affecting you because it is unconsciously, especially if you have underlying health problems,” Sophy says. You may want to see a therapist to help you cope with the fallout and get checked out by your primary care physician if you have symptoms – such as sleep problems or pain conditions – that are triggered by the stress of bullying, Sophy says. It’s also important to practice good self-care – by eating well, exercising regularly, getting enough sleep and engaging in stress-relieving activities such as meditation, yoga or journal writing.

At work, try to limit your exposure to a bully, Sophy suggests. As they occur, keep an inventory of the bullying behaviors to help you develop a plan for confronting the perpetrator or formalizing a complaint if you decide to go that route. When a bully does come after you, “don't react to the attack – bullies live for the reaction,” Yeager says. “It’s reinforcing and enables the bully. Instead, listen carefully and respond as the voice of reason.”

Between outbursts, do your best to stay focused on getting your work done and maintaining your productivity. Engage in positive self-talk to try to bolster your spirits and self-confidence – “don’t give the bully free rent in your head,” Yeager warns – and turn to trusted co-workers for mutual support. “We all have a part in stopping bullies, so if a peer is being bullied, be their support,” Yeager advises. “If you are being bullied, find support” from co-workers. Sometimes the best way to buffer a bully’s impact is to try to get by with a little help from your friends and colleagues.

Accelerated Resolution Therapy (ART)

Accelerated resolution therapy, or ART, is a type of therapy that combines principles from several traditional forms of psychotherapy to reduce the effect of trauma and other psychological stressors. Using techniques such as rapid eye movement and image rescripting, this approach works to recondition stressful memories, changing how they are stored in the brain to improve overall mental health.

People seeking therapy to reduce the impact of symptoms related to traumatic or stress-inducing memories or increase their capacity for resilience within a relatively short timeframe may find ART beneficial.

HISTORY AND DEVELOPMENT

Accelerated resolution therapy was developed in 2008 by licensed marriage and family therapist, Laney Rosenzweig. ART was born from Laney’s experience with several treatment modalities, including eye movement desensitization and reprocessing (EMDR). Through her training and practice using EMDR, Laney found rapid eye movement beneficial in treatment but determined that modifying it could enhance the process. Rosenzweig created a set of standardized and directive guidelines based on multiple therapeutic frameworks, establishing ART as a treatment method.

In 2015, the National Registry of Evidence-based Programs and Practices (NREPP) officially recognized ART as an evidence-basedpractice, and the Substance Abuse and Mental Health Services Administration (SAMHSA) named ART an effective psychotherapy for posttraumatic stress (PTSD), depression, and personal resilience. 

THEORY AND PRINCIPLES

ART incorporates elements of several treatment modalities, including EMDR, Gestalt, cognitive behavioral therapy (CBT), and brief psychodynamic therapy (BPP). From these therapeutic frameworks, ART employs techniques like rapid eye movement, exposure, imagery rescripting, and guided imagery. Using these methods, ART practitioners can help change the way stress-inducing images are stored in the brain, reducing their negative physical and emotional effects. 

To grasp the fundamentals of ART, it may help to understand how it is implemented. ART interventions can be used concurrently with other treatments, including pharmacotherapy. Individuals in therapy set the pace of ART sessions, choosing which memories are shared and when. Although the use of rapid eye movement mimics the eye movements that occur during dreams, ART does not involve hypnotherapy. Additionally, therapists do not assign homework, and ART does not require people to recall or process traumatic memories between sessions.

Although ART bears some resemblance to treatment modalities like EMDR and CBT, there are several aspects of ART that make it unique, including the following:

  • Specific and Efficient: The methods applied in ART have been shown to produce a faster recovery. Accelerated resolution therapy is designed to be delivered in one to five sessions, each around 60 to 75 minutes long, over the course of a 2-week period. Research has indicated that many people experience positive results within this time frame. The techniques incorporated during sessions are structured to provide quick relief of symptoms as they arise. There are also specific, tailored interventions that target certain issues like trauma, abuse, or smoking cessation.

  • Directive and Interactive: As therapists encourage people in therapy to recall traumatic memories, they use CBT techniques like in vivo exposure to guide the triggered response. The therapist works to reduce any physiological distress accompanying traumatic memories by instructing the person to pause the recall processing. Individuals are encouraged to develop solutions to their traumatic experience during interactive portions of ART. As a memory is recalled, the therapist helps them shift the memory to something more positive, often by employing imagery rescripting. 

  • Voluntary Memory Replacement: ART helps people change feelings associated with traumatic memories, but not the facts. In ART, this type of image rescripting is called voluntary memory/image replacement. Individuals in therapy are encouraged to replace the traumatic memory with a more positive one of their own imagining. They may recall the details of the trauma but no longer feel the same physical, emotional, or visceral response.

A TYPICAL ART SESSION

A person who begins accelerated resolution therapy is often informed that they are in control of what happens. To begin a typical ART session, a therapist may start by asking the person to do a full body scan. After establishing a baseline for their physical status, the therapist could ask them to recall the distressing memory or image. Individuals are told to visualize the traumatic event in its entirety, not worrying about any gaps in memory. Rapid eye movement can be utilized at this stage, not only to facilitate visualizing the event, but also to help with any strong emotional or physical sensations that occur during this part of the process. The memory recall segment of the session can last anywhere from 30 seconds to 10 minutes.

As the physical and emotional stressors emerge, ART therapists may use a desensitization procedure to reduce the physical and emotional impact of the memories. They may pause the visualization and ask the individual they are working with to do another body scan to slow the stress response. For example, if a woman reports shortness of breath and chest tightness while visualizing an experience of childhood sexual abuse, the therapist may instruct her to forget the scene and focus on her breathing until she is relaxed again. Bringing attention to bodily sensation can provide relief from any intense emotional responses that occur during visualization. Once the person is calm, the process will continue and may repeat, alternating between memory processing and bodily awareness. In this way, the stress response can be reduced gradually.

Throughout the visualization process, the therapist can also encourage the person they are working with to think of solutions for their targeted images or memories. This process, referred to in ART as voluntary image replacement, happens through rapid eye movement, use of metaphors, gestalt techniques, and other interventions that can promote positive sensation. The image rescripting process is similar to EMDR and other methods that treat issues like depression, nightmares, or insomnia and is an element of the ART session crucial to the treatment’s effectiveness. Research indicates that when trauma-related memories are integrated with positive experiences, distressing memories become less intrusive. 

HOW CAN ART HELP?

Several studies show that in even a few sessions, ART can significantly reduce the symptoms of trauma-related issues. ART can be used to treat a variety of presenting issues, including the following:

TRAINING FOR ART

According to the official ART website, therapists who receive training in accelerated resolution therapy are promoting their own professional resilience by preventing therapist burnout. ART can allow therapists to see rapid results for those they work with while preventing themselves from absorbing painful details about the trauma, a dynamic beneficial to both therapist and the person in therapy.

Training is regularly offered through the Rosenzweig Center for Rapid Recovery at various locations around the United States and Canada. Brief but intensive 2 to 3 day trainings include basic, advanced, and enhancement levels. Training format includes lecture, video, practicum, and live demonstrations. 

CONCERNS AND LIMITATIONS

Due to the nature of trauma work, methods of treatment that target distressing memories are often capable of eliciting intense emotional and physical reactions. Although ART is specifically designed to help people manage these reactions safely, it is important to consider the potential for further trauma. Additionally, because of the likelihood that strong sensations will be experienced during sessions, people with serious physical or psychological conditions should consult their doctor before engaging in this kind of treatment. Any concerns about eyesight should especially be taken into consideration prior to treatment. 

Mental health professionals who choose to employ ART as part of their practice should be thoroughly trained in how to use it, conduct comprehensive assessment, develop solid relationships with the individuals they treat, and ensure they are able to maintain the safety and well-being of those they work with.

Why We Really Celebrate New Year’s Day

Our celebration of what's ahead is rooted in our most ancient instincts.

At one second past midnight on January 1, the day will changed from Tuesday to Wednesday, usually a transition of no special significance. But somehow we've decided that this change, which will end one year and begin the next, is different. This unique tick of the clock has always prompted us both to celebrate and to step outside the day-to-day activity we’re always busy with to reflect, look back, take stock, assess how we did, and resolve to do better. Save perhaps for our birthdays, no other moment in our year gets this sort of attention.

Why does the start of the new year carry such special symbolism? And why is its celebration so common around the world, as it has been for at least as long as there have been calendars? Behavior this ubiquitous must surely be tied to something intrinsic in the human animal, something profoundly meaningful and important, given all the energy and resources we invest not just in the celebration but also in our efforts to make good on a fresh set of resolutions, even though we mostly fail to keep them. It may be that the symbolism we attach to this moment is rooted in one of the most powerful motivations of all: our motivation to survive.

The celebration part is obvious. As our birthdays do, New Year’s Day provides us the chance to celebrate having made it through another 365 days, the unit of time by which we keep chronological score of our lives. Phew! Another year over, and here we still are! Time to raise our glasses and toast our survival. (The flip side of this is represented by the year-end obituary summaries of those who didn’t make it, reassuring those of us who did.)

But what about those resolutions? Aren’t they about survival, too—living healthier, better, longer? New Year’s resolutions are examples of the universal human desire to have some control over what lies ahead, because the future is unsettlingly unknowable. Not knowing what’s to come means we don’t know what we need to know to keep ourselves safe. To counter that worrisome powerlessness, we do things to take control. We resolve to diet and exercise, to quit smoking, and to start saving. It doesn’t even matter whether we hold our resolve and make good on these promises. Committing to them, at least for a moment, gives us a feeling of more control over the uncertain days to come.

A 2007 study by British psychologist Richard Wiseman found that for many of us, what U2 sang is true: "Nothing changes on New Year's Day.” Of 3,000 people followed for a year, 88% failed to achieve the goals of their resolutions, although 52% had been confident they would when they made them. Here’s a summary of that research, which includes some suggestions for how to make good on yours.

Interestingly, New Years resolutions also commonly include things like treating people better, making new friends, and paying off debts. It's been so throughout history. The Babylonians would return borrowed objects. Jews seek, and offer, forgiveness. The Scots go "first footing," visiting neighbors to wish them well. How does all this social "resolving" connect to survival? Simple: We are social animals. We have evolved to depend on others, literally, for our health and safety. Treating people well is a good way to be treated well. “Do unto others as you would have them do unto you," it turns out, is a great survival strategy.

And many people resolve to pray more. That makes sense in terms of survival, too: Pray more and an omnipotent force is more likely to keep you safe. Jews pray at the start of their new year to be inscribed in "the Book of Life" for one more year. And though death is inescapable, throughout history humans have dealt with the fear of mortality by affiliating with religions that promise happy endings. Pray more, and death is less scary.

There are hundreds of good-luck rituals woven among New Year celebrations, also practiced in the name of exercising a little control over fate. The Dutch, for whom the circle is a symbol of success, eat donuts. Greeks bake special Vassilopitta cake with a coin inside, bestowing good luck in the coming year on whoever finds it in his or her slice. Fireworks on New Year's Eve started in China millennia ago as a way to chase off evil spirits. The Japanese hold New Year’s Bonenkai, or "forget-the-year parties," to bid farewell to the problems and concerns of the past year and prepare for a better new one. Disagreements and misunderstandings between people are supposed to be resolved, and grudges set aside. In a New Year’s ritual for many cultures, houses are scrubbed to sweep out the bad vibes and make room for better ones.

It’s fascinating, really, to see how common so much of this is: Fireworks. Good-luck rituals. Resolutions to give us the pretense of control over the future. Everywhere, New Year's is a moment to consider our weaknesses and how we might reduce the vulnerabilities they pose—and to do something about the scary powerlessness that comes from thinking about the unsettling unknown of what lies ahead. As common as these shared behaviors are across both history and culture, it’s fascinating to realize that the special ways that people note this unique passage of one day into the next are probably all manifestations of the human animal’s fundamental imperative for survival.

So, how do you reassure yourself against the scariest thing the future holds, the only sure thing that lies ahead, the inescapable reality that you will someday die? Pass the donuts, the Vassilopitta and the grapes, light the fireworks, and raise a glass to toast: "To survival!"