The fourth episode in KET’s You Are Not Alone series, Depression and Anxiety, takes an in-depth look at the two most common mental health problems that young people face. We hear a personal story from a young woman who has benefited from therapy and medication and now counsels others, and learn about the ways depression and anxiety can manifest from Dr. Christopher Peters from the University of Louisville. We also visit an organization in Georgetown that uses equine therapy to help youth, and learn how virtual reality can help people overcome anxiety from Dr. Kevin Chapman, PhD.
This program is part of KET’s Inside Youth Mental Health initiative, funded in part by grants from the Foundation for a Healthy Kentucky and the Kentucky Department of Education.
A Personal Story
According to a federal health study, about 32,000 Kentucky adolescents ages 12-17 had at least one major depressive episode sometime during the year before they were surveyed, and more than half of them did not receive treatment. Skylar is one teenager who experienced severe and constant depression that started in fourth grade, affecting her relationships and making her feel isolated.
“In fourth grade, I remember crying myself to sleep every single night,” she recalls, “and asking my mom why I was ugly. Through the years, it got worse.”
Through constant family support, Skylar eventually found the resolve to get therapy. The therapy sessions, along with anti-depression medication, have helped Skylar take a more positive outlook on the future, even though she acknowledges that she still has moments of self-doubt. She helps other young people by working as a counselor one of the TAYLRD drop-in centers profiled in KET’s first episode from You Are Not Alone.
“Someone will tell me something, tell me one of their darkest secrets. A lot of people have opened up to me, and they’ll tell me these things, and they’re so worried about what I think, and I’m like – ‘Me too. I’ve been there,’” she says.
Diagnosing and Treating Depression
Dr. Christopher Peters, a child and adolescent psychiatrist at the University of Louisville School of Medicine, says that in recent years more adolescents have been diagnosed as meeting the criteria for depression, with an increase of around 3-4 percent over the past ten years.
A clinical diagnosis of depression in a patient identifies a depressed mood that lasts for two weeks or longer, Peters says. That results in biological changes such as sleep disruption, energy changes, self-negative thoughts, poor concentration, and even suicidal thoughts.
Treatment for depression comes in two tiers, Peters explains. “Obviously, the least invasive would be starting with some psychotherapy, of which there are several types, cognitive behavioral therapy, interpersonal therapy, family therapy – all of which have shown to be effective,” he says. “If you’re not getting improvement with therapy, or there’s a safety risk, or the patient presents as moderate or severe, then you may look at using medication to address symptoms.” Peters says that combining medication with therapy has proven to be the most effective treatment protocol, according to several studies.
Harmony Farm – Creative Therapy for Anxiety
Dr. Peters says that out of every 100 young people diagnosed with depression, about half of them will also be diagnosed with an anxiety disorder. There are several types of anxiety, including generalized anxiety (worrying about grades, relationships, sports, etc.), separation anxiety (removal from loved ones), and social anxiety (fear of performance situations).
In Georgetown, Ky., the mission of Harmony Farm Creative Therapy is to help children and their families resolve anxiety issues in a playful, relaxed atmosphere that involves art and horses.
According to Karen Zamora, a therapist at Harmony Farm, the organization’s program uses a narrative therapy approach, where children externalize their worries and separate them from their normal routines. The counselors also encourage kids to play and make art for self-expression.
A licensed mental health professional and an equine specialist lead equine-assisted psychotherapy sessions at Harmony Farm. “Horses are used for this model because they are a prey animal,” says Nicole Hatfield, an equine specialist with Harmony Farm, “and being a prey animal they react consciously and unconsciously to non-verbal messages, so they provide non-judgmental, honest feedback.”
Treating Social Anxiety Through New Technologies
Licensed clinical psychologist Dr. Kevin Chapman, PhD., is also using innovative methods to help young people heal from anxiety and gain balance in their lives. Chapman, recently a guest on KET’s Connections, prescribes exposure therapy, which requires patients to confront their anxieties by placing them in settings that may actually trigger them.
“I define anxiety as a future-oriented emotion that involves thoughts of uncontrollability and unpredictability of future events,” says Chapman. “We also call anxiety preparatory coping, because anxiety at the core is meant to help you prepare for a potential threat that might happen in the future.”
A certain amount of anxiety may be helpful for a person in that it enables them to focus their attention on upcoming tasks, but when anxiety becomes chronic and leads to constant distress over what might happen in the future, it can impair function and lead to depression.
Chapman says that medication can be used to treat social anxiety disorder, which affects approximately 15 million Americans, but that the “gold standard” is cognitive behavioral therapy, or CBT. Cognitive behavioral therapy works by teaching patients to recognize that their emotions have three parts: thoughts, feelings, and behavior.
At his Louisville practice, Chapman uses virtual reality as an innovative way to infuse the cognitive behavioral therapy model into a real-time treatment modality. The patient wears a virtual reality headset, views a scenario or situation that prompts anxiety, and then uses cognitive behavioral therapy steps to alter their response. “You gradually expose someone to the feared situation or event,” Chapman says. “What you are teaching them through the process of exposure is that you can learn a new non-threatening association through your brain. Virtual reality is a way to facilitate that.”