Investigators from the University of British Columbia found that body language, and specifically non-verbal signs of shame, were accurate predictors when it came to foretelling a person’s risk of falling back into addiction.

While nearly 50 drinkers were asked to complete surveys regarding their physical and emotional wellbeing, study authors observed unspoken cues given by each person’s body language. They uncovered that nonverbal language spoke much louder than the written word when it came to providing clues of relapse.

For instance, a person’s written explanation of shame did not correlate with lower instances of relapse. The positioning of his or her shoulders and chest, however, were accurate predictors and were also directly related to the quantity of alcohol the person was apt to consume. In other words, high levels of outward shame foretold future setbacks to sobriety and also predicted how much the person would consume upon relapse.

According to an article posted at Examiner.com, the study is groundbreaking in that it is potentially the first of its kind to show a link between high shame and alcohol consumption. The idea that shame perpetuates addiction, however, has been around since the 1980’s.

Study results point to the fact that social stigma can be a barrier to treatment of alcoholism; therefore, making a person feel guilty or embarrassed for his condition is not likely to inspire abstinence. The other side of the story is that dependent individuals can improve their odds of sobriety by addressing shame through treatment and support groups.

Amyloid Protein Basics

The human body makes proteins from structural building blocks called amino acids, which are produced internally or acquired from the consumption of dietary protein. The presence of healthy proteins is required for the performance of some of the body’s most essential tasks, including DNA copying, the breakdown (metabolism) of all kinds of chemical molecules, and reception of the chemical signals that power everyday communication between nervous system cells called neurons. One of the main properties of a healthy protein molecule is the ability to break apart or dissolve into its constituent amino acids under certain conditions. Amyloid proteins don’t have this ability; instead, they contain insoluble fibers that cause disruption when they enter healthy organs or tissues within the body.

Amyloidosis Basics

Amyloidosis occurs when amyloid proteins clump together in large enough numbers to seriously degrade normal function in an affected part of the body.  The main form of the disorder—called primary amyloidosis—has no known cause, the US National Library of Medicine reports. The secondary form of the disorder—called AA amyloidosis—has no single cause, but typically appears in the aftermath of some sort of chronic inflammatory disease or long-term infection. Potential health consequences of primary amyloidosis include nerve damage, kidney failure, heart failure, abnormal enlargement of the liver, carpal tunnel syndrome, and a group of kidney-related symptoms known collectively as nephrotic syndrome. Apart from the effects of drug use, conditions commonly found in association with AA amyloidosis include rheumatoid arthritis, cystic fibrosis, tuberculosis, lupus, hairy cell leukemia, multiple myeloma, Sjogren syndrome, and Hodgkin’s disease.

Lung Amyloidosis

IV drug users typically develop AA amyloidosis in the lungs when they crush and inject medications that are designed for oral use, according to the authors of a study review published in 2002 in the Radiological Society of North America journal RadioGraphics. Apparently, the underlying source of this condition is lung tissue inflammation caused by the presence of minute particles of the mineral talc. This mineral is commonly used to bind prescription medications in pill form, and injection of a solution containing one of these medications can lead to the abnormal and dangerous introduction of talc particles into the bloodstream.

These particles cause problems when they lodge within small blood vessels inside the lungs, or when they migrate into lung tissue and trigger a damaging form of lung scarring called pulmonary fibrosis. Depending on the individual, lung amyloidosis in an IV drug abuser can appear in the lung periphery near clusters of tiny oxygen-exchanging sacs called alveoli, or in a more central lung position near air passageways called bronchi.

Kidney Amyloidosis

IV drug abusers frequently develop chronic infections in soft tissues located in various parts of the body. In many cases, these infections stem from the infiltration of bacteria and other disease-causing microorganisms through a given individual’s preferred injection sites. According to a study published in 2012 in BMC Nephrology, AA amyloidosis associated with a long-term infection is the number one cause of chronic kidney disease in people who abuse IV drugs. Chronic kidney disease is a progressive disorder that produces a gradual reduction in normal kidney function over a period of time that can range from months to years. IV drug users infected with the HIV virus have especially high risks for the development of amyloidosis-related kidney disease. This is likely true because HIV typically worsens the effects of other infections that develop in the body.

IV drug users with amyloidosis usually have poor outcomes from advancing kidney disease, even when they undergo kidney transplants, the authors of a study published in 2006 in QJM: An International Journal of Medicine report. People in these circumstances also die much more rapidly than people with AA amyloidosis who don’t have kidney problems.

The Basics

Roughly 35 to 45 percent of all alcoholics and other alcohol abusers smoke, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) reports. Smoking rates among participants in alcohol treatment programs range from 60 percent to as high as 80 percent and approximately half of the smokers in this category qualify as heavy smokers. In many cases, program directors consider smoking a minor problem when compared to the damaging effects of alcoholism. Other reasons for avoiding addressing smoking in alcohol treatment include the belief that program participants have no interest in quitting smoking while also trying to quit drinking, and fear that anti-smoking efforts reduce the chances for successful alcoholism treatment outcomes.

According to study results published in 2006 in the NIAAA’s Alcohol Research & Health, these common assumptions and beliefs are largely false. For example, while alcoholism itself does indeed produce a range of highly negative social and personal consequences, more alcoholics ultimately die from smoking-related health issues than from issues related directly to alcohol use. When asked about quitting smoking during alcohol recovery, fully 75 percent of people in treatment for alcoholism respond positively to the idea. Finally, several studies conducted from the 1990s through the 2000s show that quitting smoking during alcoholism treatment doesn’t reduce the motivation of program participants or reduce the numbers of people who successfully complete treatment.

Timing of Smoking Cessation

The timing of smoking cessation efforts can alter recovering alcoholics’ willingness to participate, as well as the real-world chances for maintaining long-term sobriety. Rather than going through smoking cessation during the heart of their initial treatment program, most alcoholics willing to quit smoking prefer to complete their treatment and then deal with their nicotine habit. While this might seem like an attempt to avoid the issue, there’s considerable scientific evidence to support this approach. For instance, both small experiments and larger random trials done in the 2000s indicate that anti-smoking efforts undertaken during active alcoholism treatment can decrease the chances of maintaining sobriety after treatment, in addition to decreasing the chances of successfully quitting smoking.

However, not all evidence supports this conclusion, and a well-regarded 2004 study on the issue found that people who quit smoking during active alcoholism treatment have roughly a 25 percent greater chance of maintaining sobriety than people who don’t quit smoking during active treatment. According to this study, quitting smoking during alcoholism treatment also reduces risks for future use of many common drugs of abuse.

Disagreements of this type are common in the scientific community. Potential reasons for them include differences between the ways in which individual studies are designed, differences in interpretation of complex information collected during research, and incomplete information on the issue at hand. Over time, mounting evidence typically decreases disagreement among researchers and points to a more solid, generally accepted conclusion.

The Effects of Varenicline

Doctors and other treatment specialists commonly try to curb smoking through a combined approach that includes psychotherapy, additional forms of counseling, and anti-smoking medications. One of the newer medications used for this purpose is called varenicline (Chantix). According to studies conducted in the 2000s at the University of Chicago and the University of California San Francisco, use of varenicline for smoking cessation may have a secondary effect of reducing the urge to drink in active alcoholics, as well as reducing drinking urges during alcoholism treatment.

However, use of varenicline is fairly controversial even in smoking treatment, and potential side effects of the drug include increased risks for suicidal thinking, active suicide attempts, depression and other serious mental health problems. Populations especially at risk for these outcomes while using varenicline include anyone with a history of schizophrenia, bipolar disorder, depression, or any other diagnosed psychiatric disorder. Unfortunately, alcoholism commonly occurs in people with serious mental illnesses, and varenicline may not be a suitable option for significant numbers of smokers undergoing treatment for drinking dependence.

Bacteremia Basics

Bacteria occur naturally in or on various parts of the human body, including the skin, mucous membranes, mouth, eyes, nose, gastrointestinal (GI) tract and vagina. In most cases, these microorganisms are harmless or actually contribute positively to human health (by doing such things as helping the body break down dietary carbohydrates). However, problems can occur when the bacterial population in a certain area rises above normal levels, or when bacteria enter parts of the body where they don’t belong. As noted previously, bacteremia occurs when bacteria enter the bloodstream, an environment that does not usually host a bacterial population.

In some cases, bacteremia doesn’t produce any significant health concerns. For instance, when you brush your teeth, certain amounts of bacteria can enter your bloodstream through your gum line. If these bacteria remained in circulation, they might cause problems; however, in a healthy person, the immune system quickly tracks down these invaders and destroys them. A similar process happens during defecation, when bacteria enter the bloodstream through tiny breaks in the wall of the large intestine. However, if bacteria remain in the bloodstream too long, and/or large numbers of bacteria enter the bloodstream at one time, bacteremia can lead to the onset of a serious infection in almost any part of the body through which (or to which) blood flows.

If bacteria lodge in the lining of the heart’s chambers—or the valves that sit between those chambers—they can produce endocarditis, an infection that can seriously degrade normal heart function and trigger a potentially fatal condition called heart failure. If bacteria lodge in the tissues covering the brain (known as the meninges), they can produce meningitis, an infection that can lead to severe problems that include seizures and brain damage. Bacteria circulating in the bloodstream can also trigger the onset of sepsis, a system-wide inflammation that results from the body’s attempts to fight off the bacterial invaders. At its worst, sepsis can produce septic shock, a severe drop in blood pressure that can shut down organs throughout the body and kill the affected individual.

The Role of IV Drug Abuse

People who abuse IV (intravenous) drugs can inadvertently grant bloodstream access to a number of dangerous bacteria. As a rule, this inadvertent access occurs when an IV drug abuser shares needles with other users, or engages in any other practice that results in nonsterile vein injection. According to researchers at Tufts University, the bacteria most typically found in the bloodstreams of IV drug abusers include Staphylococcus A (Staph A) and other members of the Staphylococcus family, various members of the Streptococcus family, various members of the Enterococcus family, and bacteria known as gram-negative rods.

The most common serious consequence of bacteremia in IV drug abusers is endocarditis that affects a valve in the heart called the tricuspid valve, the authors of a study published in 2002 in the medical journal RadioGraphics report. This valve sits between two heart chambers called the right atrium and right ventricle, and helps control the flow of oxygen-depleted blood from the heart to the lungs. Endocarditis-related degradation of the tricuspid valve can contribute to heart failure by making it significantly more difficult for the right ventricle to send blood to the lungs through a major blood vessel called the pulmonary artery. Tricuspid valve damage can also lead to a condition called tricuspid regurgitation, which occurs when blood flows upward abnormally from the right ventricle back into the right atrium.

Once endocarditis forms on the surface of the tricuspid valve, clumps of tissue and bacteria can break off from the infection site and form a dangerous mass called a septic embolism. After it’s created, a septic embolism travels through the bloodstream; if it lodges inside a blood vessel in the lungs or elsewhere in the body, it can block the normal flow of blood and produce potentially fatal forms of tissue death and organ disruption. In some cases, tricuspid valve endocarditis in IV drug abusers produces even greater risks by triggering the formation of multiple septic emboli over time.

Each problem reinforces the other, creating a self-perpetuating cycle. There are a couple typical scenarios. For some, addiction leads to financial instability, the combination of which leads to depression. For others, depression leads to self-medication with drugs or over-spending. Still others first struggle with debt, which leads to depression and then drug use becomes a destructive coping strategy.

Suicide Rates Increase

A recent report from the Centers for Disease Control and Prevention shows that suicide deaths rose sharply from 1999 to 2010, particularly among middle-aged Americans. Although many variables play a role, including the aging population of baby boomers, rising rates of prescription drug abuse and increasing rates of mental illness in general, it’s likely that financial woes are contributing to the rise in suicide rates.

We need money to live. If we don’t have enough of it, every aspect of life, including work, family, health, can begin to feel hopeless. For some, money problems carry an unbearable sense of shame and a profound sense of hopelessness. The stress caused by financial hardship can increase activity in areas of the brain responsible for learning, memory and thinking. In this state of mind, people think they are failures, that their families would be better off without them and that there is no way to improve their situation, even though this is never the case.

Money problems can spark the same reaction in the mind and body as threats of bodily harm. Humans are programmed with an automatic fight or flight mechanism that is essential for our survival. Our palms sweat, our hearts race, our faces flush in the presence of actual or perceived danger. This reaction can be triggered not only by immediate physical dangers but also emotional ones, including a personal debt crisis. When these feelings can’t be turned off, chronic over-arousal can lead to a number of physical and mental health problems.

Debt-Related Depression

Debt has become a normal part of American culture. So many people are grappling with money problems that society often overlooks how serious this issue can be. Shame compels many to keep the problem a secret, even from their spouses and partners, which only compounds the problem.

Debt is a stressor that can trigger depression. Although we know debt and depression are linked, it can be difficult to determine whether depression led to debt or debt led to depression. People who are in financial crisis can develop depression, and people who are already struggling with depression may spend compulsively in an attempt to cope with their depression symptoms.

The signs of debt-related depression include feelings of worthlessness or guilt, difficulty concentrating, unexplained muscle aches or pain, thoughts of suicide, weight loss or gain, and coping behaviors such as substance abuse. It can be difficult to turn off the constant money worries, leading to sleep problems, irritability and persistent fatigue. Since money is a leading source of stress, individuals with debt-related depression may also struggle with stress-related illnesses such as ulcers, migraines, heart attack and back pain.

Help for Depression

There are a number of resources available for those struggling with debt-related depression, including therapists, treatment centers, debt counseling services, and suicide prevention hotlines and crisis centers. Even speaking with a trusted friend or going to a support group like Debtors’ Anonymous can provide the glimmer of hope the person needs.

The problem is that, in a depressed state, people aren’t always able to take care of themselves or make logical decisions about their future. Often, it comes down to a loved one recognizing the signs of a problem and helping them through it.

The Basics

The placenta contains a network of very small blood vessels known as the placental barrier. This barrier acts as an indirect connection and filtration point between the bloodstream of an expectant mother and the bloodstream of her developing fetus. Blood that flows to the barrier from the mother passes on a variety of substances—including oxygen, nutrients, and certain medications and drugs—that end up in the bloodstream of the fetus. Blood that flows to the barrier from the fetus passes on carbon dioxide and other forms of waste that end up in the bloodstream of the mother. Along with a number of other licit and illicit drugs and medications, PCP can penetrate the placental barrier and pass from the maternal bloodstream into the fetal bloodstream.

Low Birth Weight

Once inside the fetus, PCP can potentially slow the process of fetal weight gain and thereby contribute to an abnormally low birth weight, according to the American Pregnancy Association. The underlying mechanism of this effect may be a reduced delivery of oxygen and/or required nutrients through the placental barrier. The March of Dimes lists potential consequences of low birth weight in a newborn that include long-term increases in the risks for chronic health problems such as high blood pressure, type 2 (acquired) diabetes, and a variety of declines in normal heart health. A newborn child has low birth weight if he or she weighs less than five pounds, eight ounces at birth.

Accidental Traumatic Injury

PCP is a dissociative anesthetic; drugs in this class numb the perception of pain by loosening or disconnecting the perceptual cues that link a person to his or her internal physical state or external physical surroundings. Under the influence of the drug, any given individual can display a greatly reduced susceptibility to pain, as well as a significant increase in unpredictable or overtly aggressive behavior. In combination, these changes in perception and behavior can greatly elevate the risks for physical injury in a PCP user, as well as an inability to accurately perceive that pain or understand its negative impact on health and well-being. In a pregnant women, these factors can contribute to traumatic injury of a developing fetus, as well as lack of awareness that such an injury has occurred.

Withdrawal Symptoms

People who use PCP repeatedly can develop an addiction to the drug, especially when they take it in high doses (10 mg or more) and/or for extended periods of time. Like other forms of drug addiction, an addiction to PCP will result in withdrawal symptoms when the drug is unavailable at accustomed dosages. Potential examples of these symptoms in an adult PCP user include depression and a decline in normal memory function. In some cases, a newborn child of a PCP-addicted mother may exhibit symptoms of drug withdrawal that include the alternating appearance of uncontrolled shaking (tremors) and abnormal sluggishness (lethargy), the American Pregnancy Association reports.

Birth Defects

Several different animal studies have indicated that PCP can produce birth defects when used repeatedly in unusually high doses, according to a study review produced in the early 2000s by the Illinois Teratogen Information Service. Examples of these defects include a cleft palate and various forms of dwarfism (known medically as skeletal dysplasias). Some human studies also indicate that repeated exposure to extremely high doses of PCP can produce a range of birth defects, including abnormal fluid accumulation in the brain (hydrocephalus), underdevelopment of the optic nerves, and the absence of an important membrane in the brain called the septum pellucidum. However, according to the review undertaken by the Illinois Teratogen Information Service, not all studies support the connection between PCP use and birth defects, even in women who take unusually large doses of the drug.

Considerations

As previously stated, pregnancy-related problems associated with PCP use are typically the result of repeated or high-level exposure. However, there is relatively little information available on the effects that single, short-term or low-dose use of the drug may have on fetal development. For this reason, the American Pregnancy Association recommends that all pregnant women strictly avoid PCP use.

The Difficulty in Determining Success Rates

Working out how effective rehab is for drug (or alcohol) addiction is extremely difficult, and this has led to substantial variation in reported figures. With some AA and NA groups suggesting success rates of 50 percent to 75 percent, many others have suggested that this isn’t the case, claiming that it’s actually only as effective as no treatment at all. This uncertainty is related to the fact that finding out if the treatment is successful generally involves checking up on those who’ve left treatment at various intervals, and doing that on a large scale isn’t easy.

This also opens the door for several other issues, including the definition of success. Some may argue that success for someone attending rehab can only be measured by complete abstinence from drugs or alcohol, but many people who don’t suffer from addiction aren’t entirely abstinent. This can lead to some variation in results, and the definition of success still isn’t really clear. There are also other factors which could influence the results, such as people lying in the responses to surveys (perhaps neglecting to mention a recent relapse) and other things such as the length of time between the completion of treatment and the survey being taken.

The Actual Success Rates

The Substance Abuse and Mental Health Services Administration reports each year on the number of people discharged from facilities from all across the country after having successfully completed treatment. In the most up-to-date report, from 2009 data, the rate of completion of programs is 47 percent. This means that around half of the people who go into a drug rehab won’t even complete the course of treatment. This is one of the only fairly comprehensive reports on the topic, so this figure is extremely important.

Many of the other studies vary considerably in their findings, so precise figures are only really possible when individual pieces of research are considered. One piece of research looking at AA, for example, found that 67 percent of those who attended 27 sessions or more during their first year were abstinent after 16 years. If you combine this information with the SAMSHA data, this puts the overall success rate at around 30 percent, when AA is considered. A more widely quoted figure from addiction specialists stands at around 10 percent across the board when one year abstinence is compared to the number of people who decide to attend rehab.

Research looking into the overall effectiveness of 12-step treatments and others such as cognitive behavioral therapy has generally shown that any form of treatment is roughly as effective as any other. The important point is that both types of treatment are superior to no treatment at all.

Making Sense of the Data

Although the success rates appear to be very low, virtually all of the studies taken into account are in some way flawed. For example, although only one in two people will actually complete the full course of rehab, that doesn’t necessarily mean that those who are impossible to contact for follow-up definitely relapsed. Things like this (and the lack of comparative, no-treatment groups in some of the studies) mean that the rate can be thought of as variable.

So what does that mean for somebody thinking about rehab? An important and consistent finding is that people who engage in treatment more thoroughly are more likely to have a positive outcome. This means that on the whole, the effectiveness of treatment depends on the individual.

The only way the government and rehabilitation centers can maximize this figure is to continually use evidence-based practices. In Oregon, any rehabilitation center that receives state funding must base its treatments on evidence, and this legislation seems like the best approach for ensuring high-quality treatment for everybody in need.

Other sources:

http://www.drugrehab.us/drug-rehab/success-rates/

• Overcome or learn to manage a mental health disorder
• Work through emotional issues and psychological “blocks”
• Gain clarity and perspective when life throws you a curve ball
• Improve relationship skills and overcome negative relationship patterns
• Develop healthy coping skills
• Recover from an addiction
• Manage stress more effectively
• Identify and change maladaptive thought patterns and behaviors
• Work through family or marital conflicts
• Heal from past trauma

When therapy works well, it can be truly life-changing.  But sometimes therapy isn’t helpful.  Perhaps you’ve been seeing a therapist for a few months now and feel as if you’re getting nowhere, wasting precious time and money on what seems to be a futile endeavor.  You may be wondering if the problem is with you, your therapist, or therapy in general.  “Maybe it’s just not all it’s cracked up to be,” you tell yourself, discouraged.  You may even be one step away from writing off your doctor / friend / close relative (or whoever was so misguided as to suggest you “get into therapy”) as an idiot.

Before you resort to that and ditch the idea of therapy altogether, it’s important to consider why that therapy may not be helping.  Following are some of the most common reasons:

You’re not doing your part.  Many people think therapy involves nothing more than spending an hour each week talking about their problems, and that by doing so, life magically starts to get better.  It would be great if it was that simple, but it’s not.  You see, there is nothing “magical” about therapy.

Most types of therapy require a collaborative effort between the therapist and the client in order to be effective.  The therapist’s role includes things like asking appropriate, thought-provoking questions, skillfully guiding the sessions, clarifying treatment goals, and (depending on the type of therapy) assigning homework to help facilitate the process, and giving feedback.  Your role includes actively participating in the therapy process, applying what you’ve learned in between sessions, trying out new skills and behaviors discussed in therapy, and doing homework when assigned.

You’re not showing up – literally or figuratively.  It should go without saying that if you’re frequently missing or cancelling therapy sessions, it’s going to hinder the process. Granted, things like a sick child or a flat tire are bound to occur once in a while, but if you’re often missing sessions then it’s going to be very difficult to make progress.  At the very least, progress will be slowed down.  The bigger issue, of course, is why you’re missing sessions.  That’s something that should be discussed in therapy.

It may be that you’re going to every therapy session, but you’re not “showing up” emotionally.  This is a more subtle, but not uncommon, reason that therapy doesn’t work.  Some people don’t engage because they don’t want to be in therapy; they’re there only because someone else (often a spouse, employer, or parent) told them they had to go.  Others keep their guard up because they are too afraid or embarrassed to discuss the “real” issues.  They use the time to discuss superficial or “surface” problems (e.g. binge eating or irritability) but avoid revealing the underlying issue that’s driving the behavior (e.g. past sexual abuse or other trauma).

Therapists aren’t mind readers, and even the most skilled can’t force a horse to drink once it’s been led to the water.  Therapy requires a fair degree of emotional vulnerability and openness on the part of the client.  If you’re unwilling to let your guard down at some point, therapy’s effectiveness will be very limited.

You’re not being honest with your therapist.  Therapists aren’t mind readers.  Granted, a skilled therapist can often detect dishonesty, but not always.  If you aren’t willing to be honest with your therapist, then you’re sabotaging the therapy process.  The therapy-client relationship, like all relationships, relies on honesty and trust in order for the relationship to work.

You need a different type of therapy.  Some types of therapy are best suited for certain diagnoses or certain types of individuals.  In other words, “one size fits all” often doesn’t work when it comes to therapy.  For example, brief solution-focused therapy works well for some presenting problems, but would not be a good fit for the person seeking therapy to help resolve deeply painful issues stemming from a history of childhood sexual abuse.

You don’t feel comfortable with your therapist.  This is a tricky issue because therapy, by its very nature, is often uncomfortable – at least at first.  After all, it involves opening up about deeply personal and sometimes very painful issues with a total stranger.  So some degree of discomfort is normal when you’re first starting out.  But if you continue to feel uncomfortable with your therapist after several sessions, then maybe you would be better off working with a different therapist.

It’s always a good idea to discuss your feelings of discomfort before changing therapists, as doing so may provide valuable insight and may even help resolve whatever has been causing them.  For example, there may be underlying “transference” issues that haven’t been identified and addressed.  Transference is a phenomenon that often occurs in therapy at some point.  It involves unconsciously “transferring” feelings and attitudes from a significant relationship (e.g., a parent or former spouse) onto the therapist.

You may feel uncomfortable with your therapist for other reasons as well.  Women who were sexually abused by a male perpetrator often feel more comfortable working with a female therapist, for example.  Some individuals work better with a therapist who is “all business,” while others feel more at ease with a therapist who is readily “warm and fuzzy.”  Sometimes changing to a therapist who’s a better “fit” can be all it takes to finally make progress in therapy.

Your therapist lacks the necessary experience or expertise.  Just as you wouldn’t see an oncologist for your diabetes, you wouldn’t go to a therapist who specializes in couple’s therapy if you have severe OCD.  Not all therapists specialize in treating certain disorders (or certain groups of clients such as children or geriatric clients), but many do.  If possible, it’s always best to see a therapist who specializes in (or has a lot of experience) treating whatever it is that ails you, if one is available.

Most therapists have the skills to treat common disorders like depression and generalized anxiety, for example.  However, some disorders and situations require more experience and expertise.  This is especially true for disorders that are severe, chronic, or less common.  Sometimes therapy isn’t helping because a therapist simply lacks the necessary skills, knowledge, or experience to provide effective treatment.

If you suspect this is the case, then it may be a good idea to get a second opinion from someone more “seasoned” or specialized. Many therapists have the insight to recognize early on (if not right upfront) that they are not the right person for the job, and will refer a potential client to someone who is.  However, therapists are human, too, and may get in over their head at times.  While lack of insight or ego may play a role, this situation often occurs because the client’s real problem isn’t evident (or hasn’t yet been identified) until therapy is well under way.  Only then can your therapist refer you to someone who is better suited to treat you if he or she lacks the necessary expertise to do so.

Therapy doesn’t work for everyone.  These are just a few of the reasons why it may not be helping.  Identifying the reason isn’t about placing blame; rather, it’s essential to remedying the situation if possible – by discussing the issue that’s getting in the way, changing course, changing therapists, or recognizing that you’re unable or unwilling to fully engage in therapy at this time.  But most importantly, don’t assume that therapy can never work just because it isn’t working right now.  That’s often an erroneous assumption, and one that can hinder you from getting the help you need and deserve.

Although no one is yet suggesting that people with depression go out and get a course of Botox, the early data is promising. The general idea is that outward appearance and the body’s expression of emotions can profoundly affect how you feel. This can mean that reducing your signs of aging, losing weight, or just smiling and laughing may improve your mood, and if you have depression, relieve your symptoms.

Botox

Much of the research that indicates there is a connection between outward expressions and inward emotions has involved Botox. The brand name for this cosmetic treatment comes from the scientific name of a toxin produced by a bacterium called Clostridium botulinum. The toxin it produces is called botulinum toxin and is one of the deadliest substances on earth. It produces a dangerous sickness called botulism in humans and other animals.

In the past, botulism was often caused by eating improperly prepared or handled meat products. The toxin affects the central nervous system and causes paralysis and death in large enough doses. Although there are many medical applications for botulinum toxin, treating wrinkles with an injection is the most common and well-known. The toxin paralyzes facial muscles at the injection site. This results in a smooth appearance of the skin, but the effect is not permanent.

Outward Expressions, Internal Feelings

A connection between your facial expressions and your mood is not a newly discovered one. Even Charles Darwin, after studying people and animals, came to the conclusion that expressing certain emotions outwardly led to the actual feeling. For instance, just by smiling, you can temporarily improve your mood. By frowning, you make yourself feel bad. The truth is that it goes both ways. When you feel sad, you respond by crying. In turn, crying makes you feel sad.

Plenty of real, scientific research has backed up these ideas. Studies have shown that frowning can initiate a depressed mood, while forcing a smile or a laugh can improve one’s mood. This has led to the idea that smiling and laughing can make you happy. The concept is not quite that simple, but it does have some merit.

The Botox Study

The most recent study that discovered a link between Botox and elevated moods adds to the body of knowledge about the cosmetic procedure. Combined with a couple of other small trials, the information has still not seen enough peer review for publication in journals, but it is very promising and should lead to more research. For the study, 84 patients with severe depression that lasted for about two years participated. These patients also failed to respond to treatment with prescription antidepressants.

The participants were randomly given either a Botox injection or a placebo injection in the same area of the face. The researchers assessed them all at three weeks after the injection and again at six weeks. They found that 27 percent of those receiving Botox injections felt almost a complete remission of their depressive symptoms, while only 7 percent from the placebo group experienced the same results. The conclusion is that by inhibiting frowning and by reducing signs of aging, depression can be at least partly treated.

“We feel sorry because we cry; we feel angry because we strike [out], and not vice versa,” Dr. Eric Finzi, medical director of the Chevy Chase Cosmetic Center in Maryland, said as he presented the latest study on Botox’s influence on depression at the annual meeting of the American College of Neuropsychopharmacology in December.

The results are relatively new and it is possible that there is another explanation for the effects seen in the depressed participants. For instance, the Botox could be affecting the body in a biological way. The immune system is altered during depressive episodes and it is possible that the Botox affects it. However, because of the similar results seen in other small studies, the researchers believe that the primary effect is that Botox helps patients to see themselves as happier. The connection between the body and the mind will undoubtedly continue to be explored with Botox and with other types of treatments.

Rumination

The study linking brooding behaviors with depression was published in Clinical Psychological Science and was conducted by researchers at the University of Wisconsin at Madison. That there is some connection between depression and focusing relentlessly on negative things is no surprise. In fact, there is evidence that some types of therapy actually worsen depression because it involves talking about negatives rather than focusing on positive change.

This new study, however, sought to deepen the understanding between rumination and if it could be a cause of depression. The researchers looked at close to 800 twins between the ages of 12 and 14. Some of the pairs were identical, meaning they have the same DNA, while others were fraternal twins, with different, unique sets of genetic material. The adolescents filled out questionnaires that helped researchers distinguish between negative, focused brooding over problems, and reflection with the intent to find solutions and positive outcomes to problems. The former is believed to be counterproductive, while the latter may be a good coping mechanism.

What the researchers discovered was that brooding in these young people was caused by environmental factors: parents, peers, school, and so on. Whether that brooding led to depression seemed to be a result of genetic factors. The findings are new and must be corroborated, but it indicates that negative ruminations can lead to depression in people with a certain genetic predisposition.

This new research has applications for therapy. Cognitive behavioral therapists have techniques for changing the behavior of negative rumination. Now that a strong link has been found between this behavior and depression, therapists may be able to intervene and prevent depression from taking root in young people who are susceptible.

Rashness

Another recent study published in Psychological Science investigated links between impulsivity, or rash behaviors, and depression in young people. Previous research has linked rashness and acting before thinking to a range of destructive behaviors like smoking, drinking, experimenting with drugs, gambling, risky sex, and even binge eating. Impulsivity, or the urge to act and respond to a need or craving without thinking of the consequences, drives these negative behaviors.

Researchers studied nearly 2,000 fifth-grade students who were transitioning from elementary to middle school. They found that the greatest predictor of whether those students would suffer from depression in the sixth grade was if they were depressed in the fifth grade, which was no surprise. The surprising result was that the second-greatest predictor was impulsivity in the fifth grade. In determining these predictors, the researchers did control for such factors as gender, family issues, addictive behaviors and early-onset puberty, all things that could cause depression.

The results suggest that rashness, impulsive behaviors, and acting in the face of emotions can possibly lead to both depression and addictive behaviors. It is important to understand that impulsiveness refers both to action and inaction. Not acting when one should can be just as impulsive as acting and doing something risky.

As with the connection between rumination and depression, understanding this link between rashness and depression could lead to treatments for preventing depression. If therapists and other caregivers can attempt to modify impulsivity, it may be possible to prevent the onset of depression in those who are susceptible to it.

What is especially important in both of these studies is that the researchers investigated children and adolescents. By rooting out causes of and connections to depression in young people, the researchers are getting to the heart of the problem. If mental health professionals have a clearer understanding of causes and risk factors for depression, they can use effective strategies to prevent it in children, who can then use the skills they have learned later in life.