However, if you have been feeling down for an extended period of time, with a persistent feeling of sadness and a loss of interest in daily living, you might be suffering from depression. Depression need to not be linked to an event and may include suicidal tendencies. A study suggested that if we eliminate depression, suicide rates would go down by as much as 80 per cent. In some cases, the mental health condition may be caused by one or more reasons.

If you are feeling depressed or suicidal, my first advice is to talk to someone who is kind, compassionate and empathetic and is willing to listen without judging you. Talking to a friend or a well-wisher often puts things in the appropriate perspective. If possible, see a trained counsellor. Seeking treatments for your condition may help alleviate it and prevent it from getting worse.

Next, I would suggest you kickstart your yoga practice right away. Participating in various activities may help you manage your condition better. Don’t underestimate the efficacy of yoga in managing mental health issues such as anxiety and depression. Indeed, my own journey is a testimony to its powerful benefits on one’s mental health, for had it not been for yoga [and my friends], I too may have been part of the terrible statistics.

Yoga and mental health

Various researches including the one by Journal of Affective Disorders have concluded that yoga-based interventions are “an attractive option for treatment of depression”. According to Harvard Medical School, a new research on yoga has yielded promising evidence that yoga could complement traditional treatment for depression. It was seen that a regular practice of yoga helped modulate stress response which, in turn, was beneficial for those with depression and anxiety.

My own journey into wellbeing started when I was on medication for depression and anxiety. Interestingly, one of the side-effects of the medication was suicidal feelings. [Yes, your anti-depressant could make you suicidal.]

For me, a few rounds of Surya Namaskar (sun-salutations), headstand and kapalbhati played a big role in dissolving the suicidal thoughts. While Ayurveda believes this has to do with yoga’s ability to balance and energise chakras in a therapeutic manner, we are yet to understand the intricacies from a modern research perspective. This is not due to lack of evidence but rather because we do not have methodologies to study the shift in suicidal tendencies.

4 ways yoga benefits your mental health

1. Regulates good and bad hormones

At the most basic level, any physical activity helps improve muscle tone and circulation and causes a surge in endorphins—the feel-good hormones. Yoga goes a few steps further. A well-designed yoga session not just works at a physical level but also helps increase the energy field by removing mental and emotional blocks and not just muscle knots. Ideally, after finishing a traditional yoga session, you would feel like you received an Abhyangam. Yoga helps reduce the levels of the stress hormone cortisol while increasing happy hormones like GABA, serotonin and dopamine, all critical neurotransmitters related to mood.

If you want to include a workout session into your daily routine to help your mood, it may be an excellent idea to consider enrolling in yoga classes.

2. Encourages slow, deep breathing

Gymnasts perform many postures that look similar to yoga asanas, but they do not get all the benefits of an asana. This is because yoga practice involves slow, deep diaphragmatic breathing which, in turn, helps the body and mind to relax. The yogic style of breathing is known to stimulate the parasympathetic nervous system and the vagal tone, both extremely important to help us move away from stress and towards relaxation. Learning proper breathing may help you outside your yoga sessions. For instance, you may try to calm your thoughts whenever you feel low by breathing slowly and practicing mindfulness.

3. Promotes mindfulness

Depression often leads us to replay our past whereas anxiety is related to the thoughts of the future. In yoga, you are encouraged to keep your attention on the breath and not let your mind wander. Some forms of yoga utilise the benefits of mindfulness to help improve a person’s overall well-being and health. An authentic yoga teacher reminds her students to keep bringing their attention back to the now. With regular practice, being centered and mindful comes easily.

4. Builds resilience

Yoga helps us face failure and build resilience by bringing us face to face with our vulnerabilities and strengths. On the mat we learn that we can’t always do a pose that looks easy for another person. We learn also that after months of practice, we are nowhere closer to touching our toes. But the principles of Abhyasa and Vairagya—practice incessantly, practice without expectation of results—keep us grounded and committed. Your improvements may also boost your mood and, therefore, may help alleviate your mental condition. We show up and try again, until we begin to surprise ourselves. When we are in a difficult pose on the mat, the teacher encourages us to observe, to breathe, embrace our limits and to know within that “this too shall pass”—an excellent learning for a difficult phase off the mat. This is how yoga builds our adversity quotient while teaching us to be kind to ourselves.

Final Thoughts

Practicing yoga can provide various benefits to your overall health. For one, it’s an effective workout to keep your body fit and healthy. It can also help improve your flexibility and mobility. In some cases, yoga may also help your mental well-being. Some people who suffer from mental health problems can take advantage of yoga to improve their mental state. So, if you’re looking for an activity to help your health condition, don’t hesitate to try yoga.

— This article was last updated on 7^th December 2021

The post How yoga can help strengthen your mental health appeared first on Complete Wellbeing.

I have counseled a number of people who have come to me with feelings of guilt because their close friend has died by suicide. They feel as if they have failed their departed friend by not doing enough to save them. They mull over whether they could have done something.

If you have a severely depressed or suicidal friend, you may find yourself in a very precarious position where you want to urgently do something but see yourself as helpless in the face of severe clinical depression.

So is there any kind of intervention that you can offer to a suicidal friend, to stop their downward spiral? And what are the limitations you must accept in such a scenario?

There are several factors that contribute to the tendency of an individual feeling suicidal. Let’s look at each of them.

Factors That Contribute to Suicidal Feelings

Psychological factors

Flexibility

This is the first principle of emotional health. It is a ‘demanding’ philosophy which is at the core of all emotional disturbances. If we did not hold on to rigid demands that things must only be a certain way, life would not be hard. It is perfectly okay to have desires and preferences of how you would like your life to be. It is only when these desires are escalated to ‘absolute must haves’ that they become a problem.

Perspective

If a person thinks that every moment of their life is a catastrophe instead of keeping things in perspective, they come down a lot harder on themselves. For instance, if I view every unpleasant situation as ‘awful’, or every disappointment as a ‘disaster’, I would find it untenable to continue to live. So taking the disappointments, inconveniences and discomforts of life into context is the next requirement for emotional health.

You need to accept your shortcomings and realize that neither you nor anyone else is perfect.

Objectivity

Most youth today have very low frustration tolerance and quickly label any discomfort or something that they don’t like as intolerable or unbearable. But we all survive so many discomforts and disappointments and live to tell the story. It’s when we do not realize our capabilities of handling difficulties and frustrations that we tend to engage in self-defeating self-talk. We begin to feel hopeless and resigned and start to behave in ways that are anti-life.

As a mental health professional I feel it is imperative that everyone understands that human beings can both construct and destroy. We have the ability to resolve problems as well as to self-sabotage, and therefore you must know that it is one’s conscious choice as to the kind of self-talk one chooses to engage in, because that is what determines how you face the many challenges life throws your way.

External factors and internal factors

There is often a debate about whether people become suicidal because of their circumstances, or because of internal factors [their psychological state or their genetic makeup]. The truth is that both factors play a role. Environmental factors like social isolation, poor family support, sudden loss or abusive relationships increase the risk of suicide. However, not everyone exposed to such situations wishes to die. Therefore internal factors clearly play a part. If one is genetically predisposed to depression, is clinically depressed, has high expectations from oneself, or has a tendency to suppress emotions, the risk of suicide definitely increases.

Bio-Psycho-Socio factors

When a person is identified as being at risk of self-harm, an intervention is needed to tackle both the internal and external factors, i.e. at a biological, psychological, and sociological.

Biological

A psychiatric assessment is required to give a person suffering from depression anti-depressant medication. This should be done by a psychiatrist in a hospital along with the support of a parent/partner/friend/volunteer at home. Resources like a suicide helpline, psychiatric emergency team and family doctor should be available on call to prevent a suicide attempt. Never leave the suicidal or depressed person alone and keep weapons and dangerous substances away.

Psychological

Teach the depressed individual the principles of flexibility, keeping things in perspective and objectivity to change their self-defeating self-talk, and help them to consciously choose pro-life beliefs irrespective of their circumstances.

Sociological

Help to negotiate changes in the environment e.g. relationship counseling in the case of poor family relationships or empowering them to get out of abusive relationships, cajoling the individual to create a support system by associating with a group of friends, a religious group, or any forum, and engaging in activities on a regular basis to reduce the social isolation.

In case of some kind of loss [whether the death of a loved one or the ending of a relationship, loss of reputation or finances, or a loss of a dream/life envisioned for oneself], facilitate the grieving process and then discuss the fact that there is life beyond that event, and encourage the individual to act against his/her withdrawal impulses.

How to Help a Friend Who is Feeling Suicidal

Coping with depression and suicidal thoughts is about remaining in the driver’s seat at all times, and not being a slave to your genes, your thoughts, or even your circumstances. Here are suggestions to follow if you have a depressed and/or suicidal friend:

• Communicate your concern about their emotional wellbeing
• Suggest professional help in the form of a psychiatrist [who would medicate if necessary] and a psychotherapist [who would help to reverse depressive thought patterns]
  • Fix an appointment for your friend and accompany them for the first few appointments
  • Talk to the family of the friend, expressing your concern and ask them to be involved in the process by monitoring the medication and therapy sessions
• Keep in touch with your suicidal friend; encourage and invite them to socialize with a few close friends so that isolation is prevented
• Encourage your friend to be involved in a creative pursuit, some fulfilling work or a social/religious group to keep them constructively occupied
• Help create a support system with a combination of family, friends, volunteers, and helpline numbers that the suicidal friend can turn to whenever they are feeling particularly down
• Listen to your suicidal friend patiently whenever they call and motivate them to remain engaged in therapy and to take the prescribed medication sincerely
• Help with accessing a psychiatric team or with hospitalization procedures if ever necessary in an emergency.

If you have dared to care for your depressed or suicidal friend, extended your help and support in all the ways mentioned above, then know that you have done your best.

And if, in spite of your best efforts, your friend decides to end it all, simply pray for them and make peace with the fact that we are ultimately responsible for all our own choices, and that no one can or should assume responsibility for others.

Real Case: How Rohan helped her suicidal friend

Seema was an ad-film director in a production house. She had a breakdown on the sets on more than one occasion. Her producer Rohan expressed his concern about her emotional wellbeing and told Seema to use him as a sounding board if she ever needed someone to talk to. Seema started sharing some of her troubles regularly while he listened with empathy. One night she called to say she thought she was having a heart attack. He rushed over and took her to a nearby hospital, but all medical investigations were normal, it was diagnosed as a panic attack.

These attacks started happening frequently and he would help to calm her over the phone, but kept insisting that she should urgently see a professional counselor to resolve the deeper issues that were troubling her. She refused and said she preferred to talk only to him. One day she called hysterically crying and said that she didn’t want to live any more and planned to end her life. He rushed to her home where she lived alone and found her in a very distraught state. She had overdosed on anti-histamine medication. He called an ambulance and took her to a hospital. Her stomach was pumped and he stayed with her overnight.

The hospital psychiatrist paid her a visit and asked her to take some anti-depressant medication; through all this drama Rohan stuck around. When she was discharged, Rohan insisted that she see a psychotherapist along with continuing to take the medication. So he made an appointment for her to see me and even accompanied her for the session. He came in first to brief me about her reluctance to visit me. We then had several sessions and he would continue to accompany her, sitting in the waiting room during the session. He called her mother in Pune and informed her about the gravity of the situation and suggested that she live with Seema for a while to ensure that she took the medication and also to ensure that she did not make another suicide attempt.

Soon the medication and therapy empowered Seema with better coping skills. Rohan now no longer accompanied her to the sessions with me but kept in touch via email to check whether she was keeping her appointments.

Rohan had correctly recognized the need for professional intervention and had stretched himself to ensure that she got the right kind of help and family support. He also recognized his own limitations, which could not go beyond being an empathic listener. His timely intervention averted a possible successful suicide attempt.

— Names have been changed to protect identities

Last updated on 17^th June 2020

The post How to Help a Friend Who is Feeling Suicidal appeared first on Complete Wellbeing.

What is the impact of such media reports on young minds?

In India, the I&B Ministry hasn’t laid down laws regarding responsible media portrayal of sensitive issues. Unfortunately this encourages the media and uninformed viewers to promote and share shocking content in the guise of “spreading awareness”. But the effect is unfortunately the opposite; it creates a suicide contagion. The teen population is particularly vulnerable. A 2017 WHO report titled “Mental Health Status of Adolescents in South-East Asia” found that 25 per cent of Indian students admit to feeling depressed. This is further backed by reports from the Global Burden of Disease Study 2013 where suicide was reported as the biggest killer of 15- to 24-year-olds in India. And most recently, a report released by the Health Ministry titled “India: Health of the Nation’s States 2017” found that the leading reasons for injury burden among the youth is suicide and self-harm. This makes teens and young adults a high-risk population for suicide.

To recognise why we need to be responsible reporters of shocking news, especially for the youth, let’s understand the teenage brain. Nicola Morgan, the author of Blame My Brain, says that in teenagers, the part of the brain which seems to be working overtime is the amygdala, a tiny almond shaped structure in our emotional [limbic] brain, linked to gut reaction and raw emotion. At the same time, the pre-frontal cortex—the part of our brain that allows us to calm ourselves down, make rational decisions, and think logically—has not yet fully developed.

The theory goes that our neurons [brain cells] are insulated by a fatty substance called myelin, which is essential for controlled and healthy functioning of our nervous system. The process of insulation starts from the lowest parts of our brain and the last area to be myelinated, well into adulthood, is our pre-frontal cortex. Since the process of myelination has not been completed in teen brains, this explains the knee-jerk reactions and “motor-mouth” talk we associate so well with teenagers. Therefore, we need to be extra careful around young minds as they are unable to think completely logically; they can’t differentiate reality from their inner world nor judge consequences well. More importantly, the underdeveloped teenage brain makes this age group most vulnerable to depression and impulsive acts. That’s why when people argue that they share videos to make teens aware of such cases, my response is that this is counter-productive and can, in fact, add to the problem. The evidence is that in the days following this suicide case and the sharing of that video, the average number of calls I receive from troubled teens multiplied; many of them expressed that they were having suicidal thoughts.

The same “suicide contagion effect” was observed just after the Netflix series 13 Reasons Why was released. Soon after the series was released, there was an increase in Google searches for ‘how to commit suicide’ and ‘teen suicide’.

Here are some things we can do as a society to prevent teen suicides

Post responsibly

Any information received about suicide, self-harm, depression needs to be verified before being posted on social media or broadcasted on WhatsApp. Avoid forwarding videos and images about graphic portrayals of celebrity suicides or other types of deaths. There is no need to view or share those details.

Establish safety

If you teen shows signs of depression then take measures to keep the environment safe. Remove sharp objects and dangerous ingestible substances. Keep a watch on your teen’s outings and store contacts details of their friends. Request them that you will periodically check their phones [in their presence]. Install content-control software to ensure your teen is not being exposed to age-inappropriate content on the web. Educate them about general safety and cyber safety.

Be a moderator, not a helicopter

Despite the safety you may try to establish, reality is that your child may be exposed to graphic portrays of self-harm and suicide [the blue whale challenge, TV series such as “13 reasons why”, social media material]. Out of anxiety, parents end up helicoptering teens which causes more resentment and secretiveness. A balanced approach is to communicate about their feelings regarding these experiences. Ask how it impacts them and assure them you are with them no matter what.

Monitor physical health

Take your teen for regular health check-ups to test for deficiencies in vitamins D3 and B12 as low levels of these usually masquerade as depression. Ensure that the child is not eating too many sugary foods as these can cause a sugar-rush followed by a sudden drop in energy, creating a cycle of “high-low” moods. Studies show that morning hunger is strongly linked to depression so ensure that your teen does not leave home on an empty stomach. Physical exercise is a must to reduce low moods. As per the WHO, even 10 minutes of aerobic exercise is sufficient for good health.

Insist on good sleep

One major study has shown that sleep-deprived people are 40 times more likely to suffer from clinical depression. Research shows that teens need more than nine hours of sleep. Lesser sleep builds up a sleep debt and makes the teen lose out on REM [Rapid Eye Movement] sleep, which is important for memory and learning.

Be informed and communicate

Read up on teenage years [those that talk about the teen brain are often very informative]. It will help create a sense of empathy about what teens are going through and reduce your frustration as a parent. Keep your communication channels open and encourage your teen to share. Don’t judge their secrecy; it’s a part of growing up and creating their space. When teens feel comfortable, they share what is on their mind. Demonstrate rational thinking and controlled behaviour, as these will be models for your teen to replicate as they step into adulthood.

Seek professional help

Often only a mental health professional [psychiatrist/psychologist] can correctly diagnose if the teenager is depressed. Such professionals will run tests and interview the child to differentiate transient mood swings from depression. Trust the expert to provide professional help and work with them to help your child attain good mental health. 

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Is it vanity or a serious disease?

What Sachin has is called Body Image Disorder or Body Dysmorphic Disorder [BDD], a mental illness involving obsessive focus on a perceived flaw in appearance. Individuals with BDD worry that their ears are very big, nose is blunt or very sharp or large, head is huge, face has lot of acne and so on.

Body Image Disorder involves behaviours like staring at one’s appearance in the mirror for long periods of time, excessive grooming such as wearing trendy clothes all the time, having fashionable hairstyles, changing one’s style to keep up with the current trends, applying a lot of make-up, constantly comparing one’s appearance to others, trying very hard to hide a defect by wearing loose clothes, make-up and accessories like cap, glares, long boots, scarf, etc.

Such people also try to adjust their body positions so as to keep their ‘defect’ from showing to others. They engage in skin picking, repeated checking of the flawed part, are preoccupied with it during conversations and seek reassurance from others. Emotionally, the person feels hopeless that ‘nothing can be done to improve the situation’, embarrassment and shame, as they believe that they look ugly. Cognitively, they remain preoccupied with thoughts of poor body image and continue to think that this is the worst thing that could happen. They are usually delusional or have poor insight, which means that they are completely or almost convinced that their defects are repulsive or deformed. Individuals with distorted body image tend to have ideas or delusions of reference, that others are looking at, talking about, looking down upon or uncomfortable with their defect.

Mental diseases often co-exist with BDD

Body Dysmorphic Disorder often co-exists with other clinical disorders such as anxiety, other OCDs, eating disorders, substance use disorder and depression. The onset of these symptoms is in adolescence and it causes lifetime impairment if left untreated. It is more commonly diagnosed in females than males; however, it occurs equally in both genders. The symptomatology may be different in both genders. For example, men may obsess over their fitness or being too small or insufficiently muscular while women may focus on their skin and facial appearance. Sometimes, individuals have actual flaws in physical appearance which are apparent to others as well. However, their obsession about it is excessive and causes significant impairment in daily functioning.

Individuals with BDD are highly self-critical, apprehensive, withdrawn, feel unacceptable to themselves and others and have low mood. Thus, they are severely distressed which could lead to increased risk of attempting and committing suicide. Sometimes, individuals who are suffering from BDD come to me at a stage when they have already attempted suicide at least once.

The suicidal ideations reported by them are higher than that in general population and sometimes, even higher than those diagnosed with depression or other mood disorders. Thus, those diagnosed with BDD are likely to have higher rate of suicidal ideation.

Body Image Disorder  is one of the least diagnosed disorders in the clinical setting and it often goes undiagnosed as individuals feel ashamed and like to keep it a secret. They also fear that nobody will understand them. Another reason may be poor insight into their problem. This may again lead to an increased risk of suicide due to untimely intervention. Ideally, treating BDD is easier when diagnosed early, before the thoughts and insecurities become deep-rooted.

Signs and symptoms of Body Dysmorphic Disorder

The following signs and symptoms need to be recognised when dealing with individuals suffering from BDD:

1. BDD is diagnosed if the person is markedly worried about slight physical flaws which can be observed with the individual obsessing about them for at least an hour every day and are very difficult to resist or control. This preoccupation may lead to stress and hamper their everyday functioning.
2. An eating disorder shouldn’t be the precursor for the concerns related to one’s appearance to be diagnosed with Body Dysmorphic Disorder .But, BDD and an eating disorder may occur together. Both diagnoses should be avoided and differences analysed.
3. There are subtle signs such as desire to avoid daylight, finding comfort in dark settings, avoiding social outings altogether and being unusually self-conscious around others.
4. The person with BDD may have keen interest in cosmetic surgeries.

Sometimes, individuals opt for cosmetic surgeries as they believe that their problems will disappear once they correct their flaw(s). However, cases of multiple surgeries are not unheard of and surgeries are not the most effective treatment for Body Dysmorphic Disorder. It may benefit some to improve their confidence and make them feel better about their bodies, thereby leading a routine life. However, more often than not, the individuals still remain unhappy with their appearance after the initial phase of satisfaction and may desire more procedures to improve it further, till the time they believe that they have become perfect. Also, their obsession might move onto another body part, once their previously defected part is treated.

How to treat Body Dysmorphic Disorder

The most effective treatment for Body Dysmorphic Disorder primarily includes pharmacotherapy and cognitive behavioural therapy (CBT).

Medications such as Selective Serotonin Reuptake Inhibitors (SSRIS) are very effective to elevate the mood and reduce the anxiety symptoms. If the individual is delusional, antipsychotics may be recommended.

The component factor in Cognitive Behavioural Therapy for individuals with Body Dysmorphic Disorder involves mirror training where a client learns to observe their entire body and see it in a holistic way which involves focusing on the areas of the body disliked by the individual. Further, the individual may be refrained from excessive mirror checking, mindfulness and habit reversal for skin picking or hair pulling or plucking. They are also taught relaxation exercises to help them deal with their anxiety. Another goal of CBT is to change the irrational ideas/beliefs to rational ones.

Individuals with BDD often have ‘all or none’ thinking, they magnify their perceived flaws, discount the positive attributes and often use ‘labelling’ and ‘emotional reasoning’. During therapy sessions, they learn to identify their irrational thoughts and change them through techniques of cognitive re-structuring and affirmations. Clients with Body Dysmorphic Disorder generally have poor insight, so I recommend not asking them direct questions that involve their views on their appearance because for them, their flaws are realistic and not imaginary.

The treatment plan includes a disciplined regime regulating sleep and eating patterns, and physical activity. The family is educated to help them understand the nature and severity of the problem and to help them cope with the same. The other co-morbid disorders are also treated with medication and therapy. Thus, with a holistic approach, BDD is treatable and the person can recover from it completely. An individual, however, may take time to overcome this problem.

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