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Purpose of the course This Online Group-Support Psychotherapy course has been developed to equip both health workers and lay people with knowledge and skills to alleviate high stress levels, mild to moderate anxiety and depression. Are you a human resource professional? Do you run a business or work with several groups of people? Are you managing a family? Do you want to learn how to effectively provide support to individuals and groups? If yes, then this course is for you. In this course, trainees will gain knowledge on stress overload and how to manage it, learn effects of stress on mental health, learn common mental health problems and how to manage them, learn group dynamics, formation and cohesion, learn about income generation, and learn how to lead therapeutic group sessions.
Origins of the course In 2012, Grand Challenges Canada supported the development and evaluation of group support psychotherapy (GSP) for depression treatment among persons living with HIV. Our successful results were published in Lancet HIV, leading to a larger trial supported by MQ involving 30 HIV clinics in northern Uganda to evaluate the effectiveness and cost-effectiveness of GSP. While we observed positive developments in the mental health, adherence to antiretroviral therapy (ART), and viral suppression among adults living with HIV, we noticed that children and adolescents faced more challenges with their HIV treatment outcomes. Specifically, at the Kitgum district hospital, which was the focal point of our work, 60% of children and adolescents living with HIV still had detectable viral loads even after six months of initiating antiretroviral therapy. In response to these findings, CRI Foundation supported the adaptation of the adult model to make it suitable for children and adolescents living with HIV.
Course objectives By the end of this course, participants should be able to demonstrate the following core competencies and sub-competencies Competency Domain Knowledge Skills Attitudes Able to initiate contact and build rapport with an adult or young person experiencing stressful problems Able to describe basic communication skills required for effective counseling Able to demonstrate active and reflective listening skills, Able to express empathy and establish rapport with stressed individuals Able to express a positive manner of relating to others by being warm and non-judgmental, and showing respect for people and their differences (e.g. ethnic, age-related, or political) Able to conduct brief assessment and triage Able to define characteristics of mild-moderate versus severe depression/anxiety Able to gives health talks on depression and performs screening to distinguish between mild-moderate versus severe depression/anxiety Able to appreciate that screening is useful to discern between mild-moderate versus severe depression/anxiety Able to deliver GSP sessions following the Intervention Manual Able to describe the importance of mitigating depression and enhancing positive coping and income generating abilities Able to demonstrate techniques for mitigating depression and enhancing positive coping and income generating abilities Able to express confidence in ability to mitigate suicidal ideation and promote positive coping, problem solving, and income generating skills. Able to practice self-awareness and self-care (a prerequisite for caring for others) Able to identify at least 5 possible signs of personal stress, and knows at least 5 self-care principles and practices such as proper nutrition, exercise and sleep hygiene Able to apply appropriate techniques for maintaining awareness of possible signs of personal stress, and for using self-care principles. Able to stay calm and confidently address strong release of emotions during group sessions. Able to manage personal stress, by using self-care principles.
1.0 Mental Health 1.1 What is mental health? The World Health Organization defines mental health as a state of well-being in which an individual is: Able to realize their potential, Able to cope with stressful life situations that come their way, Able to have meaningful relationships, Able to make meaningful decisions that lead to optimum work productivity Able to contribute to your community. Not realizing your potential means your thoughts, emotions, and behaviors are not driving you to achieve what you aspired to be. There is a mental health problem. We cannot prevent stressful situations from happening, but we can learn skills that we have to continuously use to combat stressful situations. These can include loss of a loved one, loss of a job, or loss of a relationship. No one knows that this is going to come; it just happens like that. We need to know how to positively cope with these challenges. We need to know how to nurture deep, meaningful relationships because these relationships help us prevent major shifts in our mental health, such as a mental breakdown. This is because if you have people whom you confide in, you are more likely to receive emotional support. There will be people in your life who can listen to your problems, provide you with positive encouragement, and information that you can use to solve your problems. You will not be stuck with your problem, wondering “what do I do? whom do I tell?”. We also need to pay attention to the decisions that we make. Take a moment and ask yourself, “Is it a good decision to have multiple boyfriends?” Is it a good decision to use drugs to feel good? Is it a good decision to wake up at midday every day? Your decisions should enable you to make a meaningful contribution to your community. We need to think about our mental health along these lines. We need to continuously monitor our thoughts, our feelings, and our behavior so that we can recognize and improve our weaknesses and maintain our strengths. It’s a daily struggle. Rate your mental health on a scale of 0% to 100%. 1.0 Mental Health 1.1 What is mental health? The World Health Organization defines mental health as a state of well-being in which an individual is: Able to realize their potential, Able to cope with stressful life situations that come their way, Able to have meaningful relationships, Able to make meaningful decisions that lead to optimum work productivity Able make a contribution to your community. When you are not realizing your potential, it means your thoughts, emotions and behaviors are not driving you to achieve that which you aspired to be. There is a mental health problem. We cannot prevent stressful situations from happening, but we can learn skills which we have to continuously use to combat the stressful situations. These can include loss of a loved one, loss of a job, or loss of a relationship. No one knows that this is going to come, it just happens like that. We need to know how to positively cope with these challenges. We need to know how to nurture deep, meaningful relationships because these relationships help us prevent major shifts in our mental health, such as a mental breakdown. This is because if you have people whom you confide in, you are more likely to receive emotional support. There will be people in your life who can listen to your problems, provide you with positive encouragement, and information that you can use to solve your problems. You will not be stuck with your problems, wondering “what do I do? whom do I tell?”. We also need to pay attention to the decisions that we make. Take a moment and ask yourself “Is it a good decision to have multiple boy friends?” Is it a good decision to use drugs to feel good? Is it a good decision to wake up at midday every day? Your decisions should enable you to make a meaningful contribution to your community. We need to think about our mental health along these lines. We need to continuously monitor our thoughts, our feelings and our behavior so that we can recognize and improve our weaknesses and maintain our strengths. It’s a daily struggle. On a scale of 0% to 100%, rate your mental health. 1.0 Mental Health 1.1 What is mental health? The World Health Organization defines mental health as a state of well-being in which an individual is: Able to realize their potential, Able to cope with stressful life situations that come their way, Able to have meaningful relationships, Able to make meaningful decisions that lead to optimum work productivity Able make a contribution to your community. When you are not realizing your potential, it means your thoughts, emotions and behaviors are not driving you to achieve that which you aspired to be. There is a mental health problem. We cannot prevent stressful situations from happening, but we can learn skills which we have to continuously use to combat the stressful situations. These can include loss of a loved one, loss of a job, or loss of a relationship. No one knows that this is going to come, it just happens like that. We need to know how to positively cope with these challenges. We need to know how to nurture deep meaningful relationships because these relationships help us prevent major shifts in our mental health such as a mental breakdown. This is because if you have people whom you confide in, you are more likely to receive emotional support. There will be people in your life who can listen to your problems, provide you with positive encouragement and information that you can use to solve your problems. You will not be stuck with your problems wondering “what do I do? whom do I tell?”. We also need to pay attention to the decisions that we make. Take a moment and ask yourself “Is it a good decision to have multiple boy friends?” Is it a good decision to use drugs to feel good? Is it a good decision to wake up at midday every day? Your decisions should enable you to make a meaningful contribution to your community. We need to think about our mental health along these lines. We need to continuously monitor our thoughts, our feelings and our behavior so that we can recognize and improve our weaknesses and maintain our strengths. It’s a daily struggle. On a scale of 0% to 100%, rate your mental health.
1.1.1 What are the components of mental health? Our thoughts, feelings and consequent behaviors 1.1.2 What is the mental health spectrum? Our mental health lies on a continuum whereby on one end of that continuum it’s excellent (no problems at all) and on the other end it is extremely poor (severe mental disorder) as shown on the figure below. The number one thing that impairs our mental health is stress. Stressful problems will lead to major negative changes in our mental health. 1.1.1 What are the components of mental health? Our thoughts, feelings and consequent behaviors 1.1.2 What is the mental health spectrum? Our mental health lies on a continuum whereby on one end of that continuum it’s excellent (no problems at all) and on the other end it is extremely poor (severe mental disorder) as shown on the figure below. The number one thing that impairs our mental health is stress. Stressful problems will lead to major negative changes in our mental health. 1.1.1 What are the components of mental health? Our thoughts, feelings and consequent behaviors 1.1.2 What is the mental health spectrum? Our mental health lies on a continuum whereby on one end of that continuum it’s excellent (no problems at all) and on the other end it is extremely poor (severe mental disorder) as shown on the figure below. The number one thing that impairs our mental health is stress. Stressful problems will lead to major negative changes in our mental health.
1.2 Stress 1.2.1 What is stress? Stress is a combination of physical, mental, and emotional reactions that you experience when the demands on you exceed the personal and social resources that you are able to mobilize to deal with those demands.
1.2.2 What is the relationship between stress and mental health? Stressful problems impair our mental health. Whenever we experience difficult situations, call them problems or challenges our mental health gradually shifts from being excellent (the green zone) to being extremely poor (the red zone). This shift is gradual over many months or years. This shift is reversible when stress symptoms are mild to moderate and when they are recognized early at the onset of problems.
1.2.3 Categories of Stress Biological issues: Genes, Chronic disease e.g., HIV, Cancer Alcohol & Drug use, Medications Social issues: Significant loss, Financial losses, Marital conflicts, works conflicts, land conflicts, unemployment Psychological issues: Uncertainty, Negative thinking styles, De-motivation, Stigma, Discrimination Fear
1.2.4 Examples of stressful situations Various stressful situations interact to cause major negative changes in our mental health. Stressful situations are automatically perceived as threats to one’s life. They automatically lead to negative thoughts. When you have a conflict with your girl friend, you may automatically think “My girl friend is going to leave me. I will never be happy”. When you have a conflict with your husband, you may automatically think “I am a bad wife, my marriage is going to fail”. When your teenage son is rude and abusive and refuses to go to school, you may automatically think “My child is addicted to drugs. I am a bad parent.” When you feel certain sensations in your body, you may automatically think, “I have cancer…..I am going to die.” When we are threatened our thoughts turn negative…In our brains, there is an in-built mechanism to help us survive these threats. It is referred to as the stress- response reaction.
1.2.5 The stress- response reaction When we are in stressful situations, there are changes in our brains and other body organs. These stressful situations lead to a secretion of a hormone called cortisol, which is also called “the stress hormone.” Cortisol will lead to the release of adrenalin, and this adrenalin will activate various body organs. So your heart will pump more blood and your heart rate increases. Your lungs will be activated to bring in more oxygen thus your respiratory rate increases. Your organs will function more to give you the energy to meet the new demands and once you meet your new demands then cortisol is shut off. This is the stress-response reaction. 1.2.5.1 Good Stress Response A good stress response comes from positive events, for example, winning a scholarship, getting married, having a new born baby, getting a promotion…etc. These events increase the demands on you but they generate positive feelings. Therefore they are not perceived as threats. When you experience positive events they led to normal secretions of cortisol which adequately activates your body organs. This increases your performance which helps you meet your new demands.
1.2.5.1 Good Stress Response A good stress response comes from positive events, for example, winning a scholarship, getting married, having a new born baby, getting a promotion…etc. These events increase the demands on you but they generate positive feelings. Therefore they are not perceived as threats. When you experience positive events they led to normal secretions of cortisol which adequately activates your body organs. This increases your performance which helps you meet your new demands.
1.2.5.1 Bad Stress response Bad stress comes from negative events, for example, uncertainty brought about by the Covid-19 pandemic, financial loss, marital conflicts, work conflicts, loss of income, and loss of a loved one, divorce or separation, sexual harassment or assault, and domestic violence. This bad stress creates negative feelings like fear, anxiety, and sadness. The brain perceives these signals as a threat. “Oh my God, this person is in danger, I must work to protect this person” so the brain secretes cortisol. However, when these problems are chronic, for example, the pandemic is not going away anytime soon, or we do not cope well with negative events, then the brain secrets excessive cortisol which leads to an excessive stress-response reaction which leads to organ damage. Consequently our performance goes down. Organ damage leads to both physical and mental disorders. The graph below demonstrates the effects of bad and good stress.
1.2.6 Signs of a bad stress response 1.2.6.1Physical signs Persistent headaches Dizziness Lack of sleep Sleeping too much; Loss of energy Easily gets tired Palpitations; Body tremors; 1.2.6.2 Emotional Signs Excessive Anger Excessive irritability Over critical(complains about everything) Hostile behavior Loss of interest(neglect physical appearance, absenteeism) A negative view of oneself, those around you and the future Lack of motivation Persistent low mood Social withdrawal 1.2.6.3 Cognitive signs Decreased ability to focus on tasks Decreased ability to remember things (Forgetfulness ) Decreased ability to concentrate on your work Decreased ability to make decisions (Indecisiveness) ;impaired judgment Loss of rational thinking( Suicide ideation / homicidal ideation) Negative thinking styles e.g. catastrophizing, labeling, Negative coping e.g. self-blame, denial and excessive use of alcohol and drugs
1.2.7 Stress Management Get knowledgeable about mental health and stress. You cannot address what you do not know. You will be able to overcome stigma when you are knowledgeable. Learn to express your pain. Open up about painful, disturbing experiences to close friends you trust. They will offer emotional, information or instrumental support that will lessen the burden you have to carry. A problem shared is half solved. Nurture deep confiding relationships. Be proactive and connect with other people. Research shows that social connections and support are the strongest buffer against depression. Close connections are important to your well-being. The best way to cultivate and maintain close relationships is to put time and energy into building your relationships with others Create positive experiences to have positive thoughts. Practice positive self-talk, visualize yourself succeeding, recall something in your life you're grateful for; (past success), practice acceptance; learn to say “No” & learn to delegate tasks. These are some of the positive coping skills that will be discussed in this training workshop Practice spiritual care. Believe in a “higher power” & have FAITH. Schedule Time for a spiritual activity. Schedule physical care activities. Schedule physical activity: go for a walk, play football, gardening, cooking, re-organize your home. Drink more water –rehydrate your- self. Eat right; increase fruit & vegetables in your diet.
WHAT IS DEPRESSION? Depression is a brain condition in which one’s way of thinking; feelings and behavior change such that the affected person develops a constant feeling of sadness that is present all the time, everyday for more than two weeks. In addition, the affected person no longer enjoys the things that they used to enjoy; for example, they no longer enjoy working in their home, garden, shop, office or socializing with friends.
2.1.1 How does depression present? The affected person may lose their energy and they feel weak all the time, and also they cannot think clearly, consequently they fail to do their daily work or job, The affected person may have difficulty in sleeping especially waking up in the middle of the night (3.00am) and failing to go back to sleep. . The affected person may experience a change in appetite or weight Some people affected by depression may eat too much and put on a lot of weight. Others may lose appetite and lose weight. The affected person may feel worthless, hopeless, and useless all the time. The affected person may have difficulty thinking clearly or thinking too much, thus unable to make decisions. The affected person may resort to drinking alcohol excessively or using drugs to counteract the feeling of sadness. As the disease becomes severe, the affected person may feel that they have no future and that they are better off dead.
2.1.2 Who gets depression? Anyone can get depression. It can occur in children, adolescents, adults, and the elderly. It affects both males and females, but it is more common in females than in males.
2.1.3 Is depression the same as sadness? Depression is different from sadness. Sadness is a normal emotion (feeling) that occurs especially after a negative event. Depression is an abnormal, sad feeling and may be present in the absence of negative events. Sadness is not persistent for weeks or months. However, in depression, the feeling of sadness is present all day, every day, for more than two weeks. Sadness does not produce significant weight changes or prolonged periods of sleep changes. Sadness may usher in negative thoughts, but it does not lead to suicidal. Sadness is interrupted by periods of laughter, but depression often cannot be lifted by any form of laughter. Sadness may reduce our ability to enjoy life, but depression destroys our ability to enjoy life and is associated with a complete lack of interest in things that we used to enjoy.
2.1.4 How common is depression? Depression affects one in four individuals worldwide. The majority of the cases are people with mild or moderate severity of depression which is amenable to talk therapy.
2.1.5 What are the misperceptions about depression? In our culture, traditional explanations about the causes of depression include the following Depression is caused by evil spirits and demons Depression is a normal response to problems in life. Depression is caused by turning away from God. Depression is caused by being lazy and weak.
2.1.7 How is depression treated? Treatment should aim at biological, social and psychological factors that may combine to precipitate the depression. First line treatment includes psychotherapy or counseling through which the affected person provided with knowledge and a variety of skills to overcome depression. Below are some activities that take place in therapy Teaching the affected person how to remove or modify the stressful situations in our social environment that lead to depression. For example, we can learn income generating skills and reduce poverty We can learn helpful ways of thinking and helpful coping skills that will reduce our depression. We can learn new skills like gardening, a sport, music or dance that can give us positive experiences to enhance our sense of purpose. We can learn to connect with other people who can help us when we are in overwhelming difficult situations We can engage in activities which give us positive feelings like hope. These activities include things like positive creative visualization, expressing gratitude, helping acts, positive self talk, practicing spirituality, maintaining good nutrition, and general physical health. If there is no improvement with the above, psychotherapy sessions can be combined with medications that help reduce depression.
2.1.8 How to identify someone with depression An individual with depression may be identified by assessing him or her with a screening tool called the self-reporting questionnaire. We recommend that you follow the following five steps. Step 1: Introduce yourself to the people in the waiting area of your health center and give a health talk on depression. Step 2: Invite those who have experienced any of the signs and symptoms of depression that you mentioned to be screened for depression using the self-reporting questionnaire. Step 3: For those who endorse 6 or more symptoms in the self-reporting questionnaire, there is a high chance that they have depression. Next, conduct a suicide risk assessment. Step 4: If the suicide risk is low to moderate invite individual to attend group support psychotherapy. Step 5: If suicide risk is high, or the affected person is hearing voices of people they cannot see (auditory hallucinations) or seeing things that other people cannot see (visual hallucinations) or firmly holds beliefs such as believing that other people want to harm them (paranoid delusions), make referral to a mental health worker at closest health center.
2.1.9 How to conduct a suicide risk assessment Prediction of suicide is never easy. However, there are known risk factors, which may help us to predict suicidal risk. One method goes under the acronym SAD PERSONS. S: Sex. Men are more likely to commit suicide than women. Males kill themselves about four times more often, although females make far more attempts. A: Age. The ages which are most dangerous for suicide include 15-24 years especially males and above age 65. D: Depression. The suicide rate for those with depression is about 20 times greater than for the general population. Hopelessness is one aspect of depression that has a close tie to suicide. P: Previous suicide attempt. Roughly 80% of completed suicides were preceded by a prior attempt. E: Ethanol abuse. Alcohol and/or drug abuse increase risk for suicide. R: Rational thinking loss. Psychosis (I heard a voice saying I should kill myself‘) increases risk for suicide S: Social support: loss lack of social support. O: Organized plan: This speaks for itself. Having a method in mind creates more risk. N: No Significant Other. Especially the lack of a spouse or other close relations S: Sickness. Terminal illness, such as cancer and AIDS, also carries with it a 20 fold increase in risk of suicide compared to the general population. Scoring System: 1 point for each positive answer on the above. 0-4: low suicide risk, No real problems, treat with group support psychotherapy 5-7: moderate suicide risks; treat with group support psychotherapy, but check for suicidal thoughts in every group session. 8-10 high suicide risk, refer to mental health worker
2.1.10 Complications of untreated depression Health Problems: Depression can lead to different physical health problems. This can include issues with sleep (like having trouble falling asleep or staying asleep), headaches, and even more serious issues like heart disease. Trouble at Work or School: Depression can make it hard to concentrate or make decisions, which can affect performance at work or in school. It can lead to a lack of motivation, decreased productivity, or even job loss. Social Issues: When someone is depressed, they might withdraw from friends and family. They might not enjoy activities they used to, which can lead to isolation and loneliness. Alcohol or Drug Use: Some people might try to cope with their depression by using alcohol or drugs, but this can make things worse. It can lead to addiction and other health problems. Self-Harm and Suicide: In severe cases, depression can lead to thoughts of death or suicide. Some people might harm themselves. This is a serious issue and requires immediate medical attention. General Quality of Life: Overall, untreated depression can affect a person's quality of life. It can make it harder to do everyday things or take care of yourself. Other Mental Health Disorders: Sometimes, depression can come with other mental health problems. This might include anxiety disorders, panic disorders, or eating disorders.
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2.2 Anxiety 2.2.1 A Story about Anxiety Monica, a happy woman from a small, quiet town, often had scary episodes where her heart would beat fast, she'd feel prickly all over, sweat a lot, feel dizzy, and have trouble breathing. These signs made her think she had a serious heart problem. Scared, she went to a nearby hospital for check-ups. But after a lot of tests, the doctors told her she was physically okay, which surprised her. When she told her family about these scary episodes, they thought they might be due to stress or even some kind of ghostly problem. Monica's experience shows how tricky understanding health can be because it's not just about the body, but also about the mind. Her story tells us that dealing with health issues isn't easy and it's not just about physical health. It reminds us that we need to think about mental and traditional health too.
2.2.2 What is Anxiety? Anxiety is a normal emotional response characterized by feelings of tension, worried thoughts, and physical changes like sweating, rapid heartbeat, and rapid shallow breathing. It's normal to experience anxiety in response to stressful events. Such instances might include pre-exam jitters, feeling uneasy while travelling on a dark road, or encountering a potentially dangerous creature like a snake. But when these feelings become excessive, last for longer than six months, and interfere with daily life, they could signify an anxiety disorder. Anxiety disorders are a group of mental health conditions that include Generalized anxiety disorder, Panic disorder Specific phobias Social anxiety disorder Those struggling with anxiety disorders can experience the aforementioned symptoms excessively and persistently for more than four weeks, to the point where it hampers their ability to function normally in their daily life - be it at work, school, home, or within their social circles. They find it challenging to maintain a state of calm and are constantly tense. This condition can even hinder their ability to focus on routine tasks and social activities.
2.2.3 Who gets Anxiety? Anyone can get anxiety. For example, the fear of getting Covid19 has caused anxiety in many people. But, if you follow the standard operating procedures (SOPs), your anxiety will reduce or even go away. Many young people have very high levels of anxiety about their studies and their future which is uncertain and threatened by factors they cannot control. Factors such as school closure because of Covid19, rising tuition costs and high levels of un- employment in those who have already successfully completed their studies.
2.2.4 How common is it? Anxiety disorders affect one in four individuals worldwide. Majority of the cases are people with mild or moderate severity of anxiety which is amenable to talk therapy.
2.2.5 What causes anxiety? Anxiety does not have a single cause. Instead, it is believed that many factors come together to cause an anxiety disorder. Some of these factors include;
2.2.6 How does Anxiety present? Anxiety can present itself in numerous ways, and it varies greatly among individuals. The symptoms can be physical, emotional, or behavioral. Here are some common ways anxiety may present: 2.2.6.1 Emotional Symptoms: Feelings of intense worry or fear. Feeling nervous, restless, or tense. A sense of impending doom, panic, or danger. Feelings of irritability or unease. Physical Symptoms: Increased heart rate or palpitations. Sweating excessively, trembling, or feeling weak. Breathing rapidly (hyperventilation) or shortness of breath. Feeling tired easily or fatigue. Trouble sleeping, including difficulties falling asleep and staying asleep. Gastrointestinal problems like nausea or diarrhea. Frequent urination or diarrhea. 2.2.6.3 Behavioral Symptoms: Difficulty concentrating or mind going blank. Avoiding situations or places that trigger anxiety. Difficulty carrying out daily tasks and responsibilities. 2.2.6.4 Cognitive Symptoms: Excessive worry about past or future events. Catastrophizing or expecting the worst in situations. Trouble making decisions due to fear of making the wrong choice. Fear of interacting with others, often due to fear of judgment or embarrassment.
2.2.7.1 Mild to moderate anxiety symptoms These are treated through a combination of psychotherapy and lifestyle changes. Psychotherapy (Counseling): In psychotherapy, the affected person learns different ways of thinking, behaving, and reacting to anxiety-producing and fearful situations. They learn positive ways of coping with stress, they learn to regulate their emotions, and improve relationships with others. Lifestyle Changes: A healthy lifestyle can significantly help manage anxiety. This can include regular physical exercise, a balanced diet, avoiding caffeine and alcohol, and ensuring adequate sleep. Relaxation Techniques: These can help reduce symptoms of anxiety and include methods such as meditation, deep breathing exercises, long baths, yoga, and tai chi. Self-Care Practices: These can involve regular physical activity, adequate rest, maintaining a regular eating schedule, and taking time each day to relax or engage in activities you enjoy. Support Groups: Joining a group of people with similar problems can provide emotional support and shared coping strategies.
2.2.7.2 Anxiety disorders These are managed with both psychotherapy and medications. It's important to consult a healthcare professional to discuss treatment options if you're experiencing severe symptoms of anxiety. Several types of medications may be used to treat anxiety disorders, including: Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) are commonly used to treat anxiety. Benzodiazepines: These are anti-anxiety drugs used for short-term relief of acute symptoms. Beta-Blockers: These drugs can help manage certain physical symptoms of anxiety, such as rapid heart rate.
2.2.8 What complications arise in case anxiety is not treated? If left untreated, anxiety can lead to several complications that affect both physical health and quality of life. Some of these complications include: Mental Health Disorders: Anxiety often coexists with other mental health disorders, like depression, eating disorders, or substance abuse. Untreated anxiety can worsen these conditions or even trigger their onset. Physical Health Problems: Chronic anxiety can contribute to physical health issues like heart disease, gastrointestinal problems, and respiratory disorders. It can also lead to chronic headaches, sleep disorders, and general unwellness. Social Isolation: People with untreated anxiety may withdraw from social situations and activities they once enjoyed, leading to feelings of isolation and loneliness. Poor Quality of Life: Living with persistent worry or fear can make it difficult to enjoy life, perform at work or school, maintain relationships, or carry out everyday activities. Suicidal Thoughts or Behavior: In severe cases, untreated anxiety can lead to feelings of hopelessness, suicidal thoughts, or suicide attempts. Substance Abuse: Some people may turn to alcohol, drugs, or other substances to self-medicate their anxiety symptoms, leading to substance abuse and addiction issues. Impaired Cognitive Function: Anxiety can lead to difficulties in concentration, decision-making, and memory. It's important to note that effective treatments for anxiety are available. If you're experiencing symptoms of anxiety, reach out to a healthcare professional who can guide you towards the right treatment plan for you. The earlier anxiety is addressed, the more likely it is to prevent these complications.
2.3 Alcohol and Substance Use 2.3.1 What is alcohol and substance use? 2.3.2 Who gets alcohol and substance use disorder? 2.3.3 Who is likely to develop alcohol and substance use disorder? 2.3.4 How does Alcohol and substance use disorder present?
2.3.2 Who gets alcohol and substance use disorder? Alcohol and substance use disorder can affect people from all walks of life. It does not discriminate based on age, gender, race, or socioeconomic status.
2.3.3 Who is likely to develop alcohol and substance use disorder? However, certain factors can increase the risk of developing these disorders. Some of these risk factors include: Genetic and biological factors: Having a family history of alcohol or substance use disorders can increase the likelihood of developing the condition. Additionally, certain individuals may have a biological predisposition that makes them more susceptible to addiction. Environmental factors: The environment in which a person grows up and lives can contribute to the development of alcohol and substance use disorders. Factors such as peer pressure, exposure to substance abuse, a history of trauma or abuse, and lack of parental guidance can increase the risk. Mental health conditions: Individuals with mental health disorders, such as depression, anxiety, or post-traumatic stress disorder (PTSD), are more susceptible to developing alcohol and substance use disorders. Substance abuse may be used as a form of self-medication to cope with underlying psychological issues. Social and cultural factors: Societal and cultural norms, as well as the availability and acceptability of substances, can influence the likelihood of developing alcohol and substance use disorders. For example, environments where substance use is prevalent or socially acceptable may increase the risk. It's important to note that while these factors can contribute to the development of alcohol and substance use disorders, they do not guarantee that someone will develop these conditions.
2.3.4 How does Alcohol and substance use disorder present? Alcohol and substance use disorder can present in various ways, and the specific symptoms and behaviors may differ depending on the substance involved. However, there are common signs and symptoms that are associated with these disorders. Loss of control: Individuals with a substance use disorder often find it difficult to control or limit their substance use. They may repeatedly consume larger amounts or use substances for longer periods than intended. Cravings: Strong and persistent cravings for the substance are common in individuals with substance use disorder. These cravings can be intense and difficult to resist, leading to continued substance use despite negative consequences. Tolerance: Over time, people with substance use disorder may develop tolerance, meaning they need increasing amounts of the substance to achieve the desired effect. This can contribute to a cycle of escalating substance use. Withdrawal symptoms: When substance use is abruptly stopped or reduced, individuals with a substance use disorder may experience a range of withdrawal symptoms. These symptoms can vary depending on the substance but may include physical discomfort, cravings, mood swings, irritability, insomnia, anxiety, or depression. Neglecting responsibilities: Substance use disorder can lead to a significant decline in functioning and neglect of personal, occupational, or social responsibilities. Individuals may start neglecting work, school, or family obligations, and their personal relationships may suffer as a result. Continued use despite negative consequences: Despite experiencing adverse consequences related to their substance use, such as health problems, relationship issues, legal troubles, or financial difficulties, individuals with a substance use disorder often persist in their substance use. Loss of interest in other activities: As substance use becomes more central in a person's life, they may lose interest in activities they previously enjoyed. Hobbies, socializing, and fulfilling responsibilities may take a backseat to substance use. Physical and psychological health issues: Substance use disorder can contribute to a range of physical and psychological health problems. These may include liver damage, cardiovascular issues, respiratory problems, memory impairments, mood disorders, anxiety, and depression.
2.3.5 How alcohol and substance is use disorder treated? Alcohol abuse and substance use can be treated through psychotherapy. Group support psychotherapy has helped affected individuals recognize and change unhealthy behaviors and develop coping skills to prevent relapse. Alcohol and substance use dependence (addiction) These conditions have to be referred to a mental health professional who will do the following Detoxification: In cases of severe substance dependence, the first step is often a medically supervised detoxification process. This helps manage withdrawal symptoms and ensures the individual's safety during the withdrawal phase. Medications: Medications may be prescribed to assist in the treatment of alcohol and substance use disorder. For example, medications can help manage withdrawal symptoms, reduce cravings, or block the effects of certain substances. Medication-assisted treatment (MAT) is commonly used for opioid and alcohol use disorders. Support groups: Participation in support groups, such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA), can provide a valuable source of peer support and guidance. These groups offer a platform for individuals to share their experiences, receive encouragement, and learn from others in recovery. Residential or outpatient treatment programs: Depending on the severity of the addiction, individuals may benefit from residential (inpatient) or outpatient treatment programs. Residential programs provide a structured and supportive environment away from triggers and temptations, while outpatient programs allow individuals to receive treatment while living at home.
2.3.6 What complications arise if alcohol and substance use disorders are not treated? If alcohol and substance use disorder are not treated, several complications can arise, affecting various aspects of a person's life. Here are some potential complications: Physical health problems: Substance abuse can lead to a range of physical health issues, depending on the substance involved. These can include liver damage, cardiovascular problems, respiratory disorders, compromised immune function, increased risk of infectious diseases (such as HIV or hepatitis), neurological damage, and an increased likelihood of accidents or injuries. Mental health disorders: Substance abuse and addiction are closely linked to mental health disorders. Persistent substance abuse can contribute to or worsen conditions such as depression, anxiety disorders, bipolar disorder, or schizophrenia. Conversely, untreated mental health issues can also drive substance abuse as a form of self-medication. Relationship difficulties: Alcohol and substance use disorder can strain relationships with family, friends, and romantic partners. It can lead to broken trust, communication breakdowns, conflicts, and emotional distancing. Legal issues: Substance abuse can result in legal complications, such as arrests, fines, or imprisonment. Individuals may engage in illegal activities to obtain drugs or alcohol, driving under the influence (DUI), or other substance-related offenses, which can have serious legal consequences. Occupational and educational problems: Substance abuse can significantly impact a person's work or academic performance. It may lead to absenteeism, decreased productivity, poor job performance, loss of employment, academic failure, or dropping out of school. Financial hardships: Maintaining a substance abuse habit can be costly. Individuals may spend a significant portion of their income on drugs or alcohol, leading to financial strain, debt, and an inability to meet basic needs or financial responsibilities. Social isolation: Substance abuse can lead to social isolation and withdrawal from friends, family, and social activities. Individuals may prioritize substance use over social interactions, leading to a loss of social support and connection. Increased risk of overdose and mortality: Untreated substance abuse carries a higher risk of overdose and death.
A story about Anger Once, Kwame was the best storyteller and musician in his village in Ghana. During a big party, a string on his special instrument, the kora, broke. He got very angry and broke his kora into pieces. Because of his anger, people stopped respecting him, and he lost his job. Now, he plays music at the busy market for little money, feeling very sorry. His music doesn't sound happy anymore, reminding him of the mistake he made because of his anger. Kwame learned the hard way that getting too angry can cause big problems. He understood that staying calm and thinking before reacting is better.
3.1.1 What is Anger? Anger is a normal emotion that a person feels when they have been insulted, disrespected, neglected or treated unfairly. The person experiencing anger feels an uncomfortable sensation of annoyance in their mind, throat or chest. When a person is experiencing anger, they may become hostile and may want to say something, do something or behave in such a way as to communicate that they are not happy or to cause the other person to feel how they are feeling. Anger may also occur when something has gone wrong or gone in a way that a person was not expecting. In this case the affected person directs their anger towards the cause. For example, the weather.
3.1.2 Who gets excessive Anger? Anger is a normal emotion that is experienced in all human beings. What is not normal is when a person gets too much anger and behaves in a negative way. Sometimes people use anger to hide the other feelings they may be experiencing such as shame, loneliness, frustration, sadness, helplessness or fear.
3.1.3 How common excessive Anger? Scientists have found that about 7 in 100 people have poorly controlled anger. It is more common in males with other traits like aggression, competitiveness and violence but it also occurs in females. In some societies, highly expressed emotions like anger are common while in others it is not common. These cultural factors mean that what maybe abnormal in one society may be normal in another society as people have different ways of expressing their feelings. Anger problems are also more common in people who consume too much alcohol.
3.1.4 What causes excessive Anger? Excessive or poorly controlled anger can stem from various sources: Psychological factors: Certain mental health conditions, such as depression, bipolar disorder, attention deficit hyperactivity disorder (ADHD), substance use or intermittent explosive disorder (IED), are associated with problems in anger management. Stress: High levels of stress can exacerbate feelings of anger or make it harder to control. Family history: Patterns of anger and other behaviors can be learned or inherited. Children often learn how to express anger by observing their parents or caregivers. Environmental influences: Chaotic or disruptive environments, as well as negative experiences, can contribute to anger issues. This can include things like experiencing or witnessing violence, having traumatic experiences, or being chronically exposed to stressful situations. Physical conditions: Some medical conditions can trigger anger. For instance, traumatic brain injuries or neurological disorders can lead to changes in behavior, including increased anger and aggression. Unresolved issues or past trauma: Sometimes, people carry anger from past traumatic experiences or unresolved issues. This could involve unresolved grief, experiences of abuse, or other significant life events that have not been fully dealt with. Poor coping skills: Some people might not have learned healthy ways to handle frustration, stress, or upsetting situations, leading them to express their feelings through excessive anger.
3.1.6 How is poorly controlled anger managed? Anger management refers to the process where the person experiencing the excessive anger uses a set of skills to act in certain ways that help them control their anger and prevent drastic reactions that may occur as a result of the anger. Managing your anger (Anger management) is a skill that is learnt and eventually mastered. Different situations starting from childhood present an opportunity for a person to practice their anger management skills. By adulthood, most people have learnt how to manage their anger. During the learning process, young people need guidance and assistance from parents, guardians and other carers on how to manage anger. Good anger management should be encouraged and rewarded. Poor anger management should be discouraged and not rewarded. Young people also need role models to demonstrate a proper way to deal with anger. If a person grew up witnessing parents dealing with their anger in a wrong way for example by destroying items, he/she may also start to behave in the same way.
3.1.6.1Steps in Anger Management 3.1.6.1.1 Step 1: Create a list of your triggers. Recognise situations that are likely to cause anger. Avoid them, if they cannot be avoided, go into those situations with the knowledge of how they may affect you. Have a plan of how to control your anger. For example, avoid touch conversations when you are tired, upset or angry. 3.1.6.1.2 Step 2: Recognise feelings of increasing anger and calm yourself down during the situation, if it is too much then it is advised to walk away and go to a calm place. Practice deep breathing Inhale: Breath in slowly through your nose for 4 seconds Pause: Hold the air in your lungs for 4 seconds Exhale: Breath out slowly through your mouth for 6 seconds Repeat: Practice for at least 2-10 minutes 3.1.6.1.3Step 3: Express your anger verbally and not physically. Use words to calmly express how you feel and what has caused you to feel that way. Avoid expressing your anger physically. 3.1.6.1.4Step 4: Use diversions. When you feel your anger rising, it is advisable to take off time to cool down. You could use the following diversions: meditation, engaging in exercise, listening to music, cleaning or organizing your room or kitchen or house, talking to friends and family. The goal of diversions is to buy yourself some time. If you can distract yourself for just 30 minutes, there is a higher chance that you will deal with your anger in a healthy way. 3.1.6.1.5 Step 5: Keep an anger log. Following an episode of anger, take a few moments to record your experience. This practice will help you identify patterns, warning signs, and triggers.
3.1.7 What complications arise in case poorly controlled anger is not managed? Uncontrolled or poorly managed anger can lead to a number of complications, affecting various aspects of life including health, relationships, work, and legal status. Here are some potential complications: Physical health issues: Chronic anger can lead to a variety of health issues, including heart disease, high blood pressure, digestive issues, headaches, insomnia, and a weakened immune system. buse. Mental health problems: Uncontrolled anger can contribute to or exacerbate mental health problems, including anxiety, depression, and other mood disorders. It can also lead to higher levels of general stress and decreased overall well-being. Interpersonal issues: Poorly managed anger can strain or damage relationships, leading to conflict with family members, friends, and colleagues. It can make it difficult to build and maintain meaningful, trusting relationships, and can lead to social isolation. Work or academic difficulties: Unmanaged anger can create problems in work or academic settings. It can impair concentration, decision-making abilities, and cooperation with others. This can lead to poor performance, conflicts with colleagues or classmates, and even job loss or expulsion. Legal consequences: If uncontrolled anger leads to aggressive or violent behavior, it can result in legal consequences, such as charges of assault, domestic violence, or other crimes. Impacts on personal growth: Constant anger can take a toll on your personal life and limit your ability to grow, explore new opportunities, or enjoy life fully.
3.2Acute Stress Disorder 3.2.1 A story on Acute Stress Lily, a dedicated emergency room nurse, was known for her efficiency and poise. However, when the pandemic struck, the flood of patients pushed her to her limits. She found herself working grueling hours in a high-stress environment. As weeks turned into months, she began experiencing symptoms of acute stress – anxiety, irritability, and insomnia. Her job, once a source of pride, became a daunting task. Recognizing her struggle, her supervisor intervened, insisting she take a break. Lily spent her leave focusing on self-care and therapy. With time, she learned healthy stress management strategies. The rest gave her renewed energy and resilience, enabling her to return to the ER stronger, ready to face the challenges ahead.
3.2.3Who gets acute stress disorder? Anyone can get acute stress disorder. Women are more likely than men to develop ASD after a traumatic event. Additionally, people with a history of previous trauma, mental health conditions, or inadequate social support are also more likely to develop ASD.
3.2.4 How common is acute stress disorder? According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the prevalence of ASD among people who have experienced trauma is estimated to be around 14-33%. The rates can be higher in certain populations, such as victims of assault or severe accidents.
3.2.5 What causes acute stress disorder? Acute Stress Disorder (ASD) is typically triggered by exposure to a traumatic event. This might include: Directly experiencing a traumatic event, such as a car accident, a natural disaster, an act of violence, a severe injury, or sudden loss of a loved one. Witnessing, in person, a traumatic event happening to others. Learning about a violent or accidental traumatic event happening to a close family member or friend. Repeated or extreme exposure to aversive details of traumatic events (for example, first responders collecting human remains or police officers repeatedly exposed to details of child abuse).
3.2.5.1 Examples of trauma Physical violence (being beaten, robbed, tortured or punished), Sexual violence (e.g., Defilement, incest, rape), Accidents (e.g., house fires, accidents), Civil disruption like riots and war, natural catastrophes (e.g., floods, draught)
3.2.6 How does acute stress disorder present? Acute Stress Disorder (ASD) can present with a range of symptoms that typically begin within days of a traumatic event and last for a minimum of 3 days and up to a month. Symptoms of ASD are usually grouped into several categories: Intrusion symptoms: These involve re-experiencing the traumatic event. This might be in the form of recurrent, involuntary, and intrusive distressing memories; distressing dreams; dissociative reactions (e.g., flashbacks) during which the individual feels or acts as if the traumatic event were recurring. Negative mood: Persistent inability to experience positive emotions such as happiness, satisfaction, or loving feelings. Dissociative symptoms: These are changes in a person's sense of reality, including not feeling connected to oneself (depersonalization), feeling as though things around you aren't real (derealization), or significant gaps in memory about the event or yourself (dissociative amnesia). Avoidance symptoms: These involve efforts to avoid distressing memories, thoughts, feelings, or external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings related to the traumatic event. Arousal symptoms: These include sleep disturbance, irritable behavior and angry outbursts, hypervigilance, problems with concentration, and an exaggerated startle response.
3.2.7 How is acute stress disorder treated? Acute Stress Disorder (ASD) can be effectively treated with a combination of psychotherapy and medication if needed. The main goal of treatment is to reduce symptoms, improve coping and function, and prevent the potential onset of Posttraumatic Stress Disorder (PTSD). Group support psychotherapy: The affected individual will receive psycho-education, have the opportunity to share their stressful problem, receive emotional support and feedback as well as learn positive coping skills. Medication: While medication isn't typically the first line of treatment for ASD, it may be used in certain situations. For example, short-term use of sedatives or sleep aids may also be considered if the person is having severe problems with sleep or anxiety. Treatment should be individualized to the needs of the person with ASD. Some people might benefit most from individual therapy, while others might find group therapy or family therapy to be the most helpful.
3.2.8 What complications arise in case Acute Stress Disorder is not treated? If Acute Stress Disorder (ASD) is not treated, it can lead to several potential complications: Development of Post-Traumatic Stress Disorder (PTSD): This is one of the most significant risks. If the symptoms of ASD persist beyond a month and continue to cause significant distress or impairment in functioning, the individual may be diagnosed with PTSD. Other Mental Health Disorders: Untreated ASD can also increase the risk of other mental health conditions, including depression, anxiety disorders, substance abuse, and suicidal thoughts or behaviors. Impaired Quality of Life: ASD can lead to significant difficulties in social, occupational, or other important areas of functioning. It can interfere with an individual's ability to work, attend school, maintain relationships, or engage in everyday activities. Physical Health Problems: Chronic stress is associated with various physical health problems, including heart disease, high blood pressure, and a weakened immune system. Sleep Disturbances: Many people with ASD have trouble sleeping, including problems falling asleep, staying asleep, or experiencing restful sleep. Over time, sleep disturbances can contribute to both physical and mental health problems.
3.3 Domestic Violence 3.3.1 What is domestic violence? The term ‘domestic violence’ is used to refer to partner violence but the term can also encompass child or elder abuse, or abuse of any member of a household. In this training, we will focus on intimate partner violence which is the most common form of domestic violence.
3.3.2 What is intimate partner violence? It includes physical, sexual, and emotional abuse and controlling behaviours by an intimate partner.
3.3.3 Who is affected by intimate partner violence? Intimate partner violence (IPV) occurs in all settings and among all socioeconomic, religious and cultural groups. The overwhelming global burden of IPV is borne by women. Although women can be violent in relationships with men, often in self-defence, and violence also occurs in same-sex partnerships, the most common perpetrators of violence against women are male intimate partners or ex-partners. By contrast, men are far more likely to experience violent acts by strangers or acquaintances than by someone close to them.
3.3.4 Forms of intimate partner violence Acts of physical violence, such as slapping, hitting, kicking and beating. Sexual violence, including forced sexual intercourse and other forms of sexual coercion. Emotional (psychological) abuse, such as insults, belittling, constant humiliation, intimidation (e.g. destroying things), threats of harm, threats to take away children. Controlling behaviours, including isolating a person from family and friends; monitoring their movements; and restricting access to financial resources, employment, education or medical care.
3.3.5 How common is intimate partner violence? Domestic violence is a very common problem in our society. Among women who had ever been in an intimate partnership: up to 60% reported ever having experienced physical violence or sexual violence by a partner Up to 50% reported having experienced severe physical violence by a partner Up to 75% reported experiencing one emotionally abusive act, or more, from a partner in their lifetime.
3.3.6 Why don’t women leave violent partners? Evidence suggests that most abused women are not passive victims – they often adopt strategies to maximize their safety and that of their children. Some researchers have reported that what might be interpreted as a woman’s inaction may in fact be the result of a calculated assessment about how to protect herself and her children. Some reasons why women may stay in violent relationships, including: Fear of retaliation; Lack of alternative means of economic support; Concern for their children; Lack of support from family and friends; stigma or fear of losing custody of children associated with divorce; Love and the hope that the partner will change.
3.3.7 What are the causes of and risk factors for domestic violence? Domestic violence is a result of factors operating at four levels: individual, relationship, community and societal. 3.3.7.1 Individual factors Young age; Low level of education; Witnessing or experiencing violence as a child; Harmful use of alcohol and drugs; Personality disorders; Acceptance of violence (e.g. feeling it is acceptable for a man to beat his partner); Past history of abusing partners. 3.3.7.2 Relationship factors Conflict or dissatisfaction in the relationship; Male dominance in the family; Economic stress; Man having multiple partners; Disparity in educational attainment, i.e. where a woman has a higher level of education than her male partner 3.3.7.3 Community and societal factors Gender-inequitable social norms (especially those that link notions of manhood to dominance and aggression); Poverty; Low social and economic status of women; Weak legal sanctions against IPV within marriage; Lack of women’s civil rights, including restrictive or inequitable divorce and marriage laws; Weak community sanctions against IPV; Broad social acceptance of violence as a way to resolve conflict; Armed conflict and high levels of general violence in society
3.3.8 Norms and beliefs that support violence against women A man has a right to assert power over a woman and is considered socially superior A man has a right to physically discipline a woman for ‘incorrect’ behavior Physical violence is an acceptable way to resolve conflict in a relationship Sexual intercourse is a man’s right in marriage A woman should tolerate violence in order to keep her family together There are times when a woman deserves to be beaten Sexual activity (including rape) is a marker of masculinity Girls are responsible for controlling a man’s sexual urges
3.3.9 What are the consequences of intimate partner violence? Domestic violence affects one’s physical and mental health. A history of experiencing violence is therefore a risk factor for many diseases including depression. Physical injuries including bruises, lacerations, abdominal or thoracic injuries; fractures and broken bones or teeth; sight and hearing damage; head injury; attempted strangulation; and back and neck injury. Injuries may lead to various chronic pain syndromes. Mental health problems such as higher levels of depression, anxiety and phobias, suicide, alcohol and drug abuse; eating and sleep disorders; physical inactivity; poor self-esteem; Post-traumatic stress disorder; smoking; self-harm; and unsafe sexual behavior Poor sexual and reproductive health consequences for women, including unintended and unwanted pregnancy, abortion and unsafe abortion, sexually transmitted infections including HIV, pregnancy complications, pelvic inflammatory disease, urinary tract infections and sexual dysfunction. Violence during pregnancy may lead to miscarriage; late entry into prenatal care; stillbirth; premature labour and birth; and fetal injury Homicide and other mortality arising from various injuries such as head trauma Domestic violence has negative consequences on children. Many studies have found an association between IPV against women and negative social and health consequences for children, including anxiety, depression, poor school performance and negative health outcomes such as children less likely to receive immunization, and higher rates of infection.
3.3.10 How can we support clients facing intimate partner violence? The problem of IPV requires comprehensive, multi-sectoral, long-term collaboration between governments and civil society at all levels of society. As counsellors we can intervene at the individual level to provide knowledge and skills to prevent the violence and to alleviate the physical and mental health consequences. The earlier we intervene the better the recovery outcomes.
3.3.10.1 Psychotherapy or counselling Through counselling, counsellors can Build the knowledge base and raise awareness Promote social and economic empowerment of women and girls; Build comprehensive service responses to IPV survivors in communities; Design life-skills and school-based programmes; Engage men and boys to promote nonviolence and gender equality; and Provide early-intervention services to at-risk families. Build the evidence base for advocacy and awareness; Use behaviour change communication to achieve social change; Advocate integrating counseling services for domestic violence into reproductive health services;
WHAT IS DEPRESSION? Depression is a brain condition in which one’s way of thinking; feelings and behavior change such that the affected person develops a constant feeling of sadness that is present all the time, everyday for more than two weeks. In addition, the affected person no longer enjoys the things that they used to enjoy; for example, they no longer enjoy working in their home, garden, shop, office or socializing with friends.
2.1.1 How does depression present? The affected person may lose their energy and they feel weak all the time, and also they cannot think clearly, consequently they fail to do their daily work or job, The affected person may have difficulty in sleeping especially waking up in the middle of the night (3.00am) and failing to go back to sleep. . The affected person may experience a change in appetite or weight Some people affected by depression may eat too much and put on a lot of weight. Others may lose appetite and lose weight. The affected person may feel worthless, hopeless and useless all the time. The affected person may have difficulty in thinking clearly or thinking too much thus unable to make decisions. The affected person may resort to drinking alcohol excessively or use drugs to counteract the feeling of sadness. As the disease becomes severe, the affected person may feel that they have no future and that they are better off dead.
2.1.2 Who gets depression? Anyone can get depression. It can occur in children, adolescents, adults and the elderly. It affects both males and females but it is more common in females than males.
2.1.3 Is depression the same as sadness? Depression is different from sadness. Sadness is a normal emotion (feeling) that occurs especially after a negative event. Depression is an abnormal sad feeling and maybe present in absence of negative events. Sadness is not persistent for weeks or months. However, in depression the feeling of sadness is present all day, every day for more than two weeks. Sadness does not produce significant weight changes or prolonged periods of sleep changes. Sadness may usher in negative thoughts but it does not lead to suicidal. Sadness is interrupted by periods of laughter but depression often cannot be lifted by any form of laughter. Sadness may reduce our ability to enjoy life but depression completely destroys your ability to enjoy life and is associated with a complete lack of interest in things that you used to enjoy.
2.1.4 How common is depression? Depression affects one in four individuals worldwide. Majority of the cases are people with mild or moderate severity of depression which is amenable to talk therapy.
2.1.5 What are the misperceptions about depression? In our culture, traditional explanations about the causes of depression include the following Depression is caused by evil spirits and demons Depression is a normal response to problems in life. Depression is caused by turning away from God. Depression is caused by being lazy and weak.
2.1.7 How is depression treated? Treatment should aim at biological, social and psychological factors that may combine to precipitate the depression. First line treatment includes psychotherapy or counseling through which the affected person provided with knowledge and a variety of skills to overcome depression. Below are some activities that take place in therapy Teaching the affected person how to remove or modify the stressful situations in our social environment that lead to depression. For example, we can learn income generating skills and reduce poverty We can learn helpful ways of thinking and helpful coping skills that will reduce our depression. We can learn new skills like gardening, a sport, music or dance that can give us positive experiences to enhance our sense of purpose. We can learn to connect with other people who can help us when we are in overwhelming difficult situations We can engage in activities which give us positive feelings like hope. These activities include things like positive creative visualization, expressing gratitude, helping acts, positive self talk, practicing spirituality, maintaining good nutrition, and general physical health. If there is no improvement with the above, psychotherapy sessions can be combined with medications that help reduce depression.
2.1.8 How to identify someone with depression An individual with depression may be identified by assessing him or her with a screening tool called the self-reporting questionnaire. We recommend that you follow the following five steps. Step 1: Introduce yourself to the people in the waiting area of your health center and give a health talk on depression. Step 2: Invite those who have experienced any of the signs and symptoms of depression that you mentioned to be screened for depression using the self-reporting questionnaire. Step 3: For those who endorse 6 or more symptoms in the self-reporting questionnaire, there is a high chance that they have depression. Next, conduct a suicide risk assessment. Step 4: If the suicide risk is low to moderate invite individual to attend group support psychotherapy. Step 5: If suicide risk is high, or the affected person is hearing voices of people they cannot see (auditory hallucinations) or seeing things that other people cannot see (visual hallucinations) or firmly holds beliefs such as believing that other people want to harm them (paranoid delusions), make referral to a mental health worker at closest health center.
2.1.9 How to conduct a suicide risk assessment Prediction of suicide is never easy. However, there are known risk factors, which may help us to predict suicidal risk. One method goes under the acronym SAD PERSONS. S: Sex. Men are more likely to commit suicide than women. Males kill themselves about four times more often, although females make far more attempts. A: Age. The ages which are most dangerous for suicide include 15-24 years especially males and above age 65. D: Depression. The suicide rate for those with depression is about 20 times greater than for the general population. Hopelessness is one aspect of depression that has a close tie to suicide. P: Previous suicide attempt. Roughly 80% of completed suicides were preceded by a prior attempt. E: Ethanol abuse. Alcohol and/or drug abuse increase risk for suicide. R: Rational thinking loss. Psychosis (I heard a voice saying I should kill myself‘) increases risk for suicide S: Social support: loss lack of social support. O: Organized plan: This speaks for itself. Having a method in mind creates more risk. N: No Significant Other. Especially the lack of a spouse or other close relations S: Sickness. Terminal illness, such as cancer and AIDS, also carries with it a 20 fold increase in risk of suicide compared to the general population. Scoring System: 1 point for each positive answer on the above. 0-4: low suicide risk, No real problems, treat with group support psychotherapy 5-7: moderate suicide risks; treat with group support psychotherapy, but check for suicidal thoughts in every group session. 8-10 high suicide risk, refer to mental health worker
2.1.10 Complications of untreated depression Health Problems: Depression can lead to different physical health problems. This can include issues with sleep (like having trouble falling asleep or staying asleep), headaches, and even more serious issues like heart disease. Trouble at Work or School: Depression can make it hard to concentrate or make decisions, which can affect performance at work or in school. It can lead to a lack of motivation, decreased productivity, or even job loss. Social Issues: When someone is depressed, they might withdraw from friends and family. They might not enjoy activities they used to, which can lead to isolation and loneliness. Alcohol or Drug Use: Some people might try to cope with their depression by using alcohol or drugs, but this can make things worse. It can lead to addiction and other health problems. Self-Harm and Suicide: In severe cases, depression can lead to thoughts of death or suicide. Some people might harm themselves. This is a serious issue and requires immediate medical attention. General Quality of Life: Overall, untreated depression can affect a person's quality of life. It can make it harder to do everyday things or take care of yourself. Other Mental Health Disorders: Sometimes, depression can come with other mental health problems. This might include anxiety disorders, panic disorders, or eating disorders.
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