Archive for February 27, 2012

Addiction, Willpower, & Tools

 

 

 

 

 

 

 

 

 

A recent book I came across: “The Addictive Personality: Why Recovery is a Lifetime Thing” By Craig Nakken.  For a handy review, go to:   http://psychcentral.com/blog/archives/2012/02/26/the-addictive-personality-why-recovery-is-a-lifetime-thing/

This book outlines an assumption that addiction is by nature our attempt to deal with negative emotions by chasing illusions of power and of contentment.  And, although the source of this ‘gem’ escapes me, a common wisdom about addiction is that it is persisting in a behavior even when it is evident that the behavior is proving to be destructive to one’s life.

In order to achieve sobriety and true happiness, honesty, combined with hope are necessary.

 

- Molly Allen, PsyD, Licensed Psychologist

What You Need to Know About Willpower: The Science of Self-Control

When patients come to me asking for help with changing a habit, I tell them during the first appointment that if they truly want help, we have to agree that there will be no ‘laughing-off’ of things that they claim that they are powerless over.  In that vein, this is an in-depth article about how we go about harnessing the power we all have within us to make our lives better. – Molly Allen, PsyD, Licensed Psychologist

 

http://www.apa.org/helpcenter/willpower.aspx

This is Psychology: Willpower

Why Willpower Matters, and How to Get It

Life & style

Willpower is a mental muscle that you can train. Those who do so are more likely to lead happy and successful lives.

 

Roy Bauermeister

Roy Baumeister … One cake now, or two if you wait? Photograph: David Levene for the Guardian

In the smart restaurant of a very smart hotel in the West End of London, Roy F Baumeister, eminent American social psychology professor, orders a lunch of fish and chips, and then decides not to eat the chips. “I won’t eat something that’s not good for me unless it’s absolutely perfect, and it’s going to give me real pleasure,” he says. “I’m afraid … Well, it just didn’t look like these were going to do either.”

What willpower, you might say. You’d be right; the chips looked pretty good. But Baumeister is also, coincidentally, a leading authority on that very subject, and has just published a smash-hit book on it with New York Times science writer John Tierney.

Willpower: Rediscovering Our Greatest Strength distills three decades of academic research (Baumeister’s contribution) into self-control and willpower, which the Florida State University social psychologist bluntly identifies as “the key to success and a happy life”.

The result is also (Tierney’s contribution) readable, accessible and practical. It’s an unusual self-help book, in fact, in that it offers not just advice, tips and insights to help develop, conserve and boost willpower, but grounds them in some science.

Willpower is, Baumeister argues over lunch, “what separates us from the animals. It’s the capacity to restrain our impulses, resist temptation – do what’s right and good for us in the long run, not what we want to do right now. It’s central, in fact, to civilisation.”

The disciplined and dutiful Victorians, all stiff upper lip and lashings of moral fibre, had willpower in spades; as, sadly, did the Nazis, who referred to their evil adventure as the “triumph of will”. In the 60s we thought otherwise: let it all hang out; if it feels good, do it; I’m OK, you’re OK.

But without willpower, it seems, we’re actually rarely OK. In the 60s a sociologist called Walter Mischel was interested in how young children resist instant gratification; he offered them the choice of a marshmallow now, or two if they could wait 15 minutes. Years later, he tracked some of the kids down, and made a startling discovery.

Mischel’s findings have recently been confirmed by a remarkable long-term study in New Zealand, concluded in 2010. For 32 years, starting at birth, a team of international researchers tracked 1,000 people, rating their observed and reported self-control and willpower in a different ways.

What they found was that, even taking into account differences of intelligence, race and social class, those with high self-control – those who, in Mischel’s experiment, held out for two marshmallows later – grew into healthier, happier and wealthier adults.

Those with low willpower, the study discovered, fared less well academically. They were more likely to be in low-paying jobs with few savings, to be overweight, to have drug or alcohol problems, and to have difficulty maintaining stable relationships (many were single parents). They were also nearly four times more likely to have a criminal conviction. “Willpower,” concludes Baumeister, “is one of the most important predictors of success in life.”

So how can we improve ours? Baumeister’s big idea, now borne out by hundreds of ingenious experiments in his and other social psychologists’ labs, is that willpower – the force by which we control and manage our thoughts, impulses and emotions and which helps us persevere with difficult tasks – is actually rather like a kind of moral muscle.

Like a muscle, it can get tired if you overuse it. Exercising willpower, but also making decisions and choices and taking initiatives, all seem to draw on the same well of energy, Baumeister has established. In experiments, he found that straight after accomplishing a task that required them to restrain their impulses (saying no to chocolate biscuits, suppressing their emotions while watching a three-tissue weepy), students were far more likely to underperform at other willpower-related jobs such as squeezing a handgrip or solving a difficult puzzle.

“The immune system also dips into the same pot, which is big, but finite,” says Baumeister, “and, we are pretty sure, so does women’s premenstrual syndrome. Having a cold tends to reduce your self-control, and PMS does the same. We get cranky and irritable, but it’s not that we have nastier impulses – it’s that our usual restraints have become weakened.”

So best avoid trying to do too many things involving mental effort at the same time, or if you’re ill. As with a muscle, though, you can train your willpower. Even small, day-to-day acts of willpower such as maintaining good posture, speaking in complete sentences or using a computer mouse with the other hand, can pay off by reinforcing longer-term self-control in completely unrelated activities, Baumeister has found. People previously told to sit or stand up straight whenever they remembered later performed much better in lab willpower tests.

The final way in which willpower resembles a mental “muscle” is that when its strength is depleted, it can be revived with glucose. Getting a decent night’s sleep and eating well – good, slow-burning fuel – is important in the exercise of willpower, but in times of dire need a quick shot of sugar can, according to Baumeister’s lab tests, make all the difference.

(This is, of course, something of a problem for crash dieters, who basically need to eat in order to summon up the willpower not to eat. Indeed some very strong impulses, such as the behaviour often exhibited by males in possession of an erect penis, can sometimes prove completely resistant to willpower, even after the ingestion of a can of Coca-Cola.)

Baumeister cites a “very impressive demonstration” of the glucose argument: in a study published last year, researchers found that Israeli judges making the difficult and sensitive decision of whether or not to grant parole opted to do so in roughly 65% of cases after lunch, and hardly ever just before.

Baumeister’s top willpower tips: Build up your self-control by exercising it regularly in small ways. Learn to recognise signs that your willpower may be waning. Don’t crash diet. Don’t try to do too much at once. Establish good habits and routines that will take the strain off your willpower. Learn how to draw up an effective to-do list.

Don’t put yourself in temptation’s way, or if you can’t avoid it, make it harder for yourself to succumb. Use your willpower actively: plan, commit, and do so (like members of religious communities) publicly. “People with low willpower,” Baumeister says, “use it to get themselves out of crises. People with high willpower use it not to get themselves into crises.”

Much of this, of course, is in the book. You may even learn how to say no to chips.

The Science Behind the Serenity Prayer

When addicts reject the first step in a 12-step program, it is usually a cop-out.  The addict wants a way around that terrifying prospect of giving up the very substance that has caused them misery.  Finding the courage to face up to the reality that we cannot have the reality we would prefer is really the first step to getting healthy. – Molly Allen, PsyD

 

Wray Herbert

Author, ‘On Second Thought: Outsmarting Your Mind’s Hard-Wired Habits’

The Science Behind the Serenity Prayer
Posted: 02/ 8/2012  8:35 am

 

 

“God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.”

These are the first lines of what’s known as the Serenity Prayer, which is well-known to many recovering alcoholics. It’s often recited in the rooms of AA as a reminder of the core principle of successful sobriety: Acceptance of the reality that for addicts, nothing but absolute, lifelong abstinence will lead to healthy and lasting recovery.

As simple as that message is, it’s very difficult for many alcoholics to embrace, at least at first. Most resist the finality of an absolute prohibition, hoping and looking instead for half measures and temporary fixes to the problem — or putting off abstinence for another day. These lukewarm efforts often end in relapse.

So what’s actually going on in the mind of an alcoholic as he or she goes through the process of recovery? What are the cognitive mechanics underlying the initial, angry rebelliousness and, later, the genuine commitment to a sober life?

Duke University psychological scientist Aaron Kay has some ideas that may clarify this mysterious transformation. The human mind, he and his colleagues say, sees all restrictions, prohibitions and bans as fundamental limits on personal freedom. Personal freedom is so highly valued and so important to our sense of identity that we will go to great lengths to protect it. On the most basic level, when the mind processes “no drinking ever again,” this prohibition is perceived as nothing less than a totalitarian clamp-down on personal liberty and processed in the same way as any such edict. It’s the cognitive equivalent of “no travel allowed” or “all political speech prohibited.”

We have two ways of dealing with such unwanted restrictions on liberty. The first is what scientists call “reactance,” which really just means shouting “no!” People get annoyed, indignant, outraged, defiant; they bridle at the new restriction and inflate the value of what’s being taken away — in the case of an alcoholic, the freedom to drink without censure. Or — quite differently — people sometimes rationalize the new prohibition. They go through whatever cognitive gymnastics are needed to make this unwelcome restriction okay, to cast a positive light on the prospect of never drinking again.

These two processes are incompatible, so why does one win out over the other? Why do we jealously guard our liberty some times and other times go through mental contortions to rationalize bans. Kay and his colleagues believe it is a single factor — the absoluteness — that shapes our thinking. When prohibitions are the least bit tentative or vague, if they allow any loopholes, then we plot to get around them and preserve what’s ours. But when restrictions have no shades of gray and no prospect of bending, we search out ways to make them palatable. The scientists tested this theory in a couple simple experiments.

In the first one, volunteers read about how a hypothetical new city speed limit would improve public safety. Then some of these volunteers read that lawmakers had already acted to lower the speed limit; according to this news story, the law would go into effect on a prescribed date. Others read that it was likely the new law would go into effect, but that it had not been enacted yet. In other words, some were presented with a fait accompli, while others were left thinking about a likely — but not signed and sealed — restriction on their driving rights.

Afterward, all of the volunteers — including a control group — rated their level of annoyance regarding the lower speed limit. They also reported how often they drove in the city, assuming that regular drivers would be more annoyed than infrequent drivers, who might see the restriction as irrelevant.

The results, reported online in the journal Psychological Science, supported the scientists’ theory. Those presented with an absolute, written-in-concrete restriction were much more likely to rationalize the change. They had more positive attitudes toward the new speed limit than did controls. By contrast, those who read about a likely new limitation expressed much more annoyance; it was not yet a certainty, so they wanted nothing of it. As expected, the frequent drivers were more likely to rationalize the infringement on their liberties; they were more motivated to make the infringement acceptable.

The second experiment was similar, but with some important differences. In this case, the volunteers read about the dangers of using a cell phone while driving — and a government plan to ban the practice. But the scientists introduced a new twist as well: Some read that it was a done deal, others that there was a small chance it would not be passed, and still others that there was reasonable chance it would be voted down. In other words, they introduced two different degrees of uncertainty.

Again, the volunteers rated how bothersome the new restriction would be, and they also rated how important this particular liberty — driving while talking on a cell — was to them. And again, volunteers facing the absolute certainty of a new ban were more likely to rationalize: They played down the importance of this right. Those who faced the likelihood of a new restriction had a harsher reaction. They claimed that this restricted right was very important to them, and this was the case even if there was only a miniscule chance of the new ban not being approved. These findings boil down to this: We are very reluctant to give up any bit of personal liberty, and will clutch any shred of it before we do.

Kay and his colleagues concede that life is more nuanced than these studies suggest. Some restrictions on liberty, even when they are absolute, may be too sudden or too abhorrent to be rationalized easily. That may be the case with the alcoholic, who certainly faces a horrifying prospect. The alcoholic must also dictate his or her own prohibition and with time come to the realization — or rationalization — that freedom isn’t always liberating, and restriction isn’t always oppressive.

On Second Thought: Outsmarting Your Mind's Hard-Wired Habits

 

 

 

 

 

 

 

9 Tips for Building Loving Relationships

9 Tips For Building a Loving RelationshipThis guest article from YourTango was written by Dr. Lynda Klau.

How many of us have learned how to build loving relationships? Where did we learn? At home? At school? There is an art and science to building strong relationships. These indispensable tips were written with romantic relationships in mind, but with a little modification you can apply them to your friendships, family and even work relationships.

1. Create a safe environment where you can trust and share openly without being afraid.

Don’t interrupt, even if you need to put your hand over your mouth to stop yourself. Learn to fight fairly. No name calling. Don’t make threats. Apologize when you know you should. If you’re too angry to really listen, stop! Go into another room, take space for yourself, breathe and “calm down.”

Remember: your partner is not the enemy.

 

2. Separate the facts from the feelings.

What beliefs and feelings get triggered in you during conflicts? Ask yourself: Is there something from my past that is influencing how I’m seeing the situation now? The critical question you want to ask: Is this about him or her, or is it really about me? What’s the real truth? Once you’re able to differentiate facts from feelings, you’ll see your partner more clearly and be able to resolve conflicts from clarity.

3. Connect with the different parts of yourself.

Each of us is not a solo instrument. We’re more like a choir or an orchestra with several voices. What is your mind saying? What is your heart saying? What is your body saying? What is your ‘gut’ saying? For example: My mind is saying ‘definitely leave her,’ but my heart says ‘I really love her.’ Let these different voices or parts of you co-exist and speak to one another. In this way, you will find an answer that comes from your whole self.

4. Develop and cultivate compassion.

Practice observing yourself and your partner without judging. Part of you might judge, but you don’t have to identify with it. Judging closes a door. The opposite of judging is compassion. When you are compassionate, you are open, connected, and more available to dialoging respectfully with your partner. As you increasingly learn to see your partner compassionately, you will have more power to choose your response rather than just reacting.

5. Create a “we” that can house two “I’s”.

The foundation for a thriving, growing, mutually-supportive relationship is to be separate and connected. In co-dependent relationships, each person sacrifices part of him or her self, compromising the relationship as a whole. When you are separate and connected, each individual “I” contributes to the creation of a “we” that is stronger than the sum of its parts.

The differences between you and your partner are not negatives. You don’t need to be with someone who shares all of your interests and views. We may sometimes fear that these differences are incompatibilities, but in fact, they’re often what keeps a relationship exciting and full of good fire.

6. Partner, heal thyself.

Don’t expect your partner to fill your emotional holes, and don’t try to fill theirs. Ultimately, each of us can only heal ourselves. Your partner, however, can be supportive as you work with yourself, and vice versa. In fact, living in a loving relationship is healing in and of itself.

7. Ask questions when you’re unsure or are making assumptions.

All too often, we make up our own stories or interpretations about what our partners’ behavior means. For example: “She doesn’t want to cuddle; she must not really love me anymore.” We can never err on the side of asking too many questions, and then listen to the answers from your whole self — heart, gut, mind and body. Equally important is to hear what’s not being said — the facts and feeling that you sense might be unspoken.

8. Make time for your relationship.

No matter who you are or what your work is, you need to nurture your relationship. Make sure you schedule time for the well-being of your relationship. That includes making “playdates” and also taking downtime together. Frequently create a sacred space together by shutting off all things technological and digital. Like a garden, the more you tend to your relationship, the more it will grow.

9. Say the “hard things” from love.

Become aware of the hard things that you’re not talking about. How does that feel? No matter what you’re feeling in a situation, channel the energy of your emotions so that you say what you need to say in a constructive manner.

 

There you have it. Be kind to yourselves. Remember: change takes time and every step counts.

Panic Attacks: Symptoms and Therapy

If you get panic attacks, you’re not alone. Research has found that more than three million Americans will experience panic disorder during their lifetime. According to the American Academy of Child and Adolescent Psychiatry, panic disorder can begin during childhood or before age 25. And  research suggests that panic disorder is more prevalent in women than in men.

While it is not clear what causes the disorder, researchers believe it is inherited and runs in families. At one time, researchers believed panic disorder was caused by psychological problems, but experts now believe genetic factors or changes in body chemistry, combined with stressful circumstances, play a pivotal role. According to the American Psychological Association, even though each panic attack peaks within about 10 minutes, sometimes attacks repeat in clusters for up to an hour after the initial attack, with associated fear over the possibility of another attack. Subsequent attacks may occur days and even weeks later.

This element of fearfulness is called anticipatory anxiety. People fear having another attack while performing the same activity or being in the same situation as when a panic attack occurred before. Anticipatory anxiety can be so extreme that people turn away from the outside world, fearing that contact will brook  new attacks. For example, if an attack occurred while driving on the freeway, a person may be so afraid of driving on the highway that he’ll only drive on secondary roads. Also, if someone experienced a panic attack while walking through the mall, they’ll avoid this activity for fear of another attack. According to the National Institute of Mental Health (NIMH), panic disorder can also occur in conjunction with other disorders, particularly depression and substance abuse. About 30 percent of people with panic disorder abuse alcohol and 17 percent abuse drugs. However, substance abuse can also be an attempt to alleviate the anguish and distress caused by panic attacks. NIMH-funded research has resulted in effective treatments to help people with panic disorder, which includes medication and cognitive-behavioral psychotherapy. This type of therapy can reduce or prevent attacks in 70 to 90 percent of people with panic disorder.

Symptoms of Panic Disorder

While there are more than a dozen physical or emotional sensations a person can experience during a panic attack, not everyone experiences all of them. And even though it is not technically life-threatening, left untreated, panic disorder can interfere with relationships, schoolwork, employment and normal development.

It is not uncommon for a person with panic disorder to experience an anxious feeling even between attacks. People with panic disorder will begin to avoid situations where they fear an attack may occur or situations where help might not be available. The Anxiety Disorders Association of America has formulated questions to help an individual determine whether he’s experiencing panic disorder. These include:

1.  Are you troubled by repeated and unexpected “attacks” of intense fear or discomfort for no apparent reason?

2.  During such attacks, do you experience at least four of the following symptoms?

  • pounding heart
  • sweating
  • trembling or shaking
  • shortness of breath
  • choking
  • chest pain
  • nausea or abdominal discomfort
  • “jelly” legs
  • dizziness
  • a feeling of unreality or being detached from yourself
  • fear of losing control
  • going crazy
  • fear of dying
  • numbness or tingling sensations or chills or hot flashes

3.  Do you have a fear of places or situations where escape or getting help might be difficult, such as a crowded room or traffic jam?

4.  Do you have a fear of being unable to travel without a companion?

5.  For at least one month following an attack, have you felt persistent?

  • Concern about having another attack?
  • Worry about going crazy?
  • Need to change your behavior to accommodate the attack?

While anxiety, worry, and stress are all a part of most people’s life today, anxiety becomes a disorder when the symptoms become chronic and interfere with our daily lives and our ability to function.

 

Source: Psych Central

What You Need to Know About Treatment-Resistant Depression

This article deals mainly with use of medication and other physcian-administered treatments for Depression.  I am concerned with the number of patients I see for intakes/evaluations who have never been referred for psychotherapy/counseling.  ‘Talk therapy’ has been shown to be quite beneficial for many patients with depression.  The key is finding the right combination of treatments to help each patient.  – Molly Allen, PsyD, Licensed Psychologist

What You Need to Know About Treatment-Resistant Depression Depression can be effectively treated with psychotherapy and medication. But it takes time to find the correct medication and dose. Still, for about one million patients with depression, even several trials of medication don’t seem to be enough, and their symptoms linger.

These individuals may have treatment-resistant depression or refractory depression. While there’s some debate over the precise definition, treatment-resistant depression is typically thought of as failing to achieve remission after two treatments or two antidepressants, according to George Papakostas, M.D., director of Treatment-Resistant Depression Studies in the Department of Psychiatry at Massachusetts General Hospital.

Why Some People Have Treatment-Resistant Depression

People develop treatment-resistant depression for many reasons. Some struggle with severe depression, which is difficult to treat. Medical illness and comorbid psychological disorders — such as drug or alcohol abuse or eating disorders — also complicate treatment response, according to Dr. Papakostas and Yvette Sheline, M.D., professor of psychiatry and the director for the Center for Depression Stress & Neuroimaging
 at the Washington University in St. Louis. Severe stress also can impact improvement, Dr. Sheline said.

A variety of genetic, neuroimaging and electrophysiological studies have investigated the underlying causes of treatment-resistant depression. And researchers know one thing for sure: Refractory depression is not the result of one brain region or neurotransmitter system.

Preliminary research suggests that individuals with depression may have abnormalities in the frontal and temporal regions in the brain and dysfunction in serotonin modulation. Also, the subgenual cingulate (Cg25), which is located under the cortex along the midline of the brain, may play a role. Cg25 is activated when an individual experiences sadness. It also connects to other regions involved in mood, motivation and sleep. When antidepressants are effective, this area is less active. Some researchers have hypothesized that in refractory depression, Cg25 doesn’t turn off. In general, according to Papakostas, there isn’t enough evidence to show a consistent or unifying theory.

Other individuals may not have refractory depression after all. For instance, according to Sheline, a thyroid problem may mimic depression. Individuals may have bipolar disorder — though there’s recent evidence that bipolar disorder may be overdiagnosed in patients who appear to have treatment-resistant depression — or a long-term low-grade depression called dysthymia. If a treatment isn’t working, it’s critical that your physician re-evaluate your diagnosis.

Treatment Options for Refractory Depression

According to Sheline, there’s disagreement about the number of medication trials a person needs to try before moving onto more invasive interventions. While physicians determine this on an individual basis, it’s important for patients to have an adequate dose of medication for an adequate amount of time, Sheline said. “Each antidepressant has different therapeutic dose ranges, and these also vary according to individual factors, such as age,” she said.  An adequate duration of treatment is usually six weeks. If there’s partial improvement, doctors may recommend patients stay on the medication for six to 12 weeks, Papakostas said.

This is why it’s especially important to take medication as prescribed. Many patients stop taking their medication after a week if they don’t get better, Sheline said. But this isn’t enough time to see improvement. Skipping or forgetting a dose can decrease a medication’s efficacy and make it look like it’s not the right medication for you. Also critical is practicing healthy habits, such as engaging in physical activities and getting enough sleep, and managing stress. Exercise boosts mood, while stress and lack of sleep exacerbate depression.

If one antidepressant truly doesn’t work, physicians will typically prescribe an antidepressant from a different drug class. Or they’ll prescribe an augmenting agent, such as lithium or an atypical antipsychotic medication to boost the effectiveness of the antidepressant.

If medication and psychotherapy are unsuccessful, these are other options:

Electroconvulsive therapy (ECT). ECT involves placing electrodes on a patient’s scalp, which sends a specific current that induces a short seizure in the brain. In the 1950s, ECT developed a bad reputation because it was administered without anesthesia and with a high voltage, Sheline said. But today, it’s a completely different treatment, she said.

ECT is administered with general anesthesia and the voltage is carefully controlled. In fact, Sheline noted that there is ongoing work to decrease the pulses to minimize side effects. There’s also been concern that ECT is involuntary, Papakostas said. He clarified that ECT is voluntary and requires a patient’s informed consent.

ECT does have various bothersome side effects, including memory loss and headaches. It’s understandable why patients would hesitate to try it, Papakostas said. However, both Papakostas and Sheline agree that a large body of research substantiates ECT’s efficacy. When compared with medication and psychotherapy, ECT appears to work faster and has a higher chance of success, according to Papakostas. It also has the most efficacy data of all the more invasive interventions.

Transcranial magnetic stimulation (rTMS). According to Papakostas, this treatment is second to ECT in quality of data. Transcranial magnetic stimulation doesn’t require anesthesia or induce a seizure like ECT. Instead it creates a magnetic field that produces an electric current in a specific area of the brain. It’s typically used for mild to moderate depression. The Food and Drug Administration has approved one device called the NeuroStar TMS to treat depression, which may be used after one antidepressant has failed.

Vagus nerve stimulation (VNS). In 2005, the FDA approved vagus nerve stimulation for treating treatment-resistant depression. The device is surgically implanted onto the vagus nerve on the left side of the neck and delivers mild electrical impulses. Think of it as a cardiac pacemaker. According to the University of Maryland Medical Center, it sends 30-second impulses to the vagus nerve every five minutes.

For over a decade, VNS has been used to treat patients with epilepsy. Researchers began studying VNS for refractory depression when they noticed that some patients’ moods improved. Whether VNS is an effective treatment for refractory depression is unclear. It appears to help some people tremendously but not others. To date, “the data [on VNS] just isn’t on par with ECT or rTMS,” Papakostas said.

Not finding a treatment that lifts your depression can be utterly frustrating and make you feel hopeless. But while it may take more time and effort, together with your physician, you can find a treatment that works for you. Remaining optimistic is important. “Being able to maintain a positive, hopeful attitude is as critical as [getting the right treatment], Papakostas said.

Margarita Tartakovsky, M.S. is an Associate Editor at Psych Central and blogs regularly about eating and self-image issues on her own blog, Weightless.
APA Reference Tartakovsky, M.  (2012). What You Need to Know About Treatment-Resistant Depression. Psych Central.  Retrieved on February 8, 2012, from http://psychcentral.com/lib/2012/what-you-need-to-know-about-treatment-resistant-depression/