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15 Sep 2020
Teen Depression Is Different

The symptom profile for teenagers is different than that of adults. Parents sometimes do not recognize the symptoms because depression in teenagers is not what most people think of as signs of depression. As a result, many teens unnecessarily suffer in silence.

Depression has become increasingly common among American teenagers – especially teen girls, who are now almost three times as likely as teen boys to have had recent experiences with depression. Younger children have about equal rates of depression based on gender. After puberty, however, girls become much more inclined to be diagnosed with depression.

In 2017, 13% of U.S. teens ages 12 to 17 (or 3.2 million) said they had experienced at least one major depressive episode in the past year, up from 8% (or 2 million) in 2007, according to a Pew Research Center. And during COVID19 pandemic it is on the rise again.

Adults who have experienced depression are treated at higher rates than teens. Among adults who had recent depressive episodes, about two-thirds (67%) received treatment. Among teen girls who had recent depressive episodes, only 45% received treatment for depression over the past year. By comparison, 33% of teen boys with recent depressive episodes received treatment. From these statistics we can see that more teens go untreated than treated.


Warning Signs

While depressed adults often talk about emotional pain, depressed teens tend to report physical aches and pains. They may report headaches, stomach problems, or say they just do not feel well. In the case of depression, physical exams will not reveal any findings. Also teens present more irritability than sadness during an episode of significant depression. Here are some things to look for in your teen.



Adults usually describe feeling sad when they’re depressed, but teenagers often become increasingly irritable. They may behave disrespectfully or may have less patience than usual. They also may become defiant.

While mood swings can be normal during the teenage years, an unusually high amount of irritability should be considered a warning sign of possible depression.


Academic Changes

Teens may experience a sharp decline in their grades when depression strikes. But that’s not always the case. Some teens maintain a high grade point average (GPA) even in the midst of emotional turmoil.

In fact, sometimes the pressure to maintain good grades becomes a factor in depression. A teen who feels the need to get accepted into an Ivy League college, or one who insists a disappointing SAT score could ruin their life, may remain driven to achieve despite being depressed.


Sensitivity to Criticism

Depression can lead to an intense sensitivity to criticism. Sometimes teens deal with this increased sensitivity by avoiding activities where they fear failure. A teen may refuse to try out for the soccer team or may refuse to invite a date to a school dance in an attempt to avoid rejection.

At other times, teens may deal with this fear by becoming an overachiever. A depressed teen may become a perfectionist in an attempt to avoid the risk of being rejected. It is important to monitor how your teen responds to risk, criticism, and failure as changes in your teen’s behavior could signal your teen is depressed.


Social Withdrawal

Social isolation is a common problem for someone with depression, but teens don’t necessarily withdraw from everyone when they become depressed. Sometimes they simply change peer groups.

A teen may begin to hang out with the wrong crowd or may stop talking to certain friends or family members.

At other times, teens withdraw from real-life activities and focus their attention on the online world when they are feeling depressed. A depressed teen may create an online persona and may engage in online chats or play role-playing games for hours on end to escape the realities of life. There is also a tendency to sleep through the day to avoid a regular daily lifestyle.


Four Types of Teen Depression

The word depression is used to describe a variety of conditions. Recognizing the signs and symptoms can be key to getting a teen treatment. And early intervention can often be key to successful treatment.

There are four types of depression that commonly affect teenagers. Depression can affect all teens regardless of their gender, popularity, academic success, or athletic abilities. It is important to familiarize yourself with the common symptoms of depression in teens so you can provide support and seek help when necessary.


1. Adjustment Disorder with Depressed Mood

An Adjustment Disorder occurs in response to a life event. Moving to a new school, the death of a loved one, or dealing with a parents’ divorce are examples of changes that can spur an Adjustment Disorder in teens.

Adjustment Disorders begin within a few months of the event and may last up to six months. If symptoms persist beyond six months, another diagnosis would be more appropriate.

Adjustment disorders can interfere with sleep, school work, and social functioning.

Your teen may benefit from talk therapy to teach him new skills, increase emotional functioning, and get help to cope with the stressful situation.


2. Persistent Depressive Disorder (Dysthymia)

Persistent Depressive Disorder (dysthymia) is a low grade, chronic depression that lasts for more than a year. Teens with dysthymia are often irritable and they may have low energy, low self-esteem, and feelings of hopelessness.

Their eating habits and sleeping patterns may also be disturbed. Frequently, dysthymia interferes with concentration and decision making. It’s estimated that roughly 11 percent of teens, ages 13 to 18, experience dysthymia, according to the National Institute of Mental Health.

Although dysthymia is not as severe as major depression, the long duration can take a serious toll on a teen’s life. It can interfere with learning, socialization, and overall functioning. Cognitive Behavioral Therapy or Dialectical Behavior Therapy along with medication are often effective in treating dysthymia.


3. Bipolar Disorder

Bipolar Disorder is characterized by episodes of depression followed by periods of mania or hypomania (a less severe form of mania). Both the depressive and manic states will last anywhere from a couple of weeks to many months. Symptoms of mania include a reduced need for sleep, difficulty focusing, engaging in risky behaviors and a tendency for anger outbursts.

During a manic episode, a teen is likely to talk fast, feel animated or silly, and be willing to engage in risky behavior. Many teens engage in high-risk sexual behavior during a manic episode.

Teens with bipolar disorder will likely experience significant impairment in their daily functioning. Their severe mood changes interfere with their education and friendships. Bipolar is treatable but not curable. Bipolar is usually best treated with a combination of medication and therapy.


4. Major Depression

Major depression is the most serious form of depression. Symptoms of major depression include persistent sadness and irritability, talk about suicide, a lack of interest in enjoyable activities, and frequent reports of physical aches and pains. Teens will typically decline in their grooming and isolate socially.

Major depression can cause severe impairments at home and at school. Treatment usually involves weekly therapy and supervised medication treatment.


If you or your teen are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

05 Aug 2020
Radical Acceptance

Radical Acceptance is the acceptance of life, on life’s terms. While pain is part of life, radical acceptance allows us to keep that pain from becoming suffering. It is about accepting the facts of reality, no matter how painful, without avoidance, overthinking, or dangerous behaviors. When a person does not accept the realities of life issues, they often remain stuck in that pain and fail to move forward and lose the chance to heal. In other words, unresolved pain can continue to hurt you even when it is not happening anymore. If you simply do not accept the facts, it does not change the facts, and this can lead to unnecessary and prolonged suffering.

Resistance to reality may be a defense mechanism that helps to numb the pain in the short-run but in the long-run creates more problems. If you ignore a past due electric bill long enough, the lights will be turned off. Avoidance is not an effective problem-solving strategy.

During the course of your life, you can’t avoid pain and painful situations, but you can learn to cope with something you can’t change. When you practice Radical Acceptance, it does not mean that you approve of the issue or agree with it. It means that life happened, it was painful or hurtful, or unfair, and I can accept that it sucked. But now it is over, and I hope to learn from this, and hopefully not repeat it. I can accept that even though it was bad, I can live through it.

Some people hold on to unresolved issues with pain and anger. It’s exhausting to fight reality, and it doesn’t work. Refusing to accept that you were blamed for something you didn’t do, that your friend lied to you, or that you weren’t called back for a second interview for a job you wanted, doesn’t change the situation, and it adds to the pain you may experience. Until that pain is accepted and realized, the wound stays active.

This can also happen with false hope. Making excuses and minimizing toxic situations, pursuing abusive and toxic people in the face of negative evidence. Repeating patterns of violence and abuse; over and over again. Radical Acceptance is giving up the notion that you can control other people’s thoughts or behaviors. It is acknowledging that it is what it is, nothing more and nothing less. By holding on to a false hope, you may simply be fooling yourself and staying in a pain producing situation. The false hope that things will get better, that someone else will change, maybe this time, is keeping you and perhaps your other family members and children, in the grip of abuse and pain.

Working with trauma cases, one of the main things we do as therapists is to get to the acceptance of the trauma. We help a client look at negative thinking patterns that may be reinforcing an inaccurate self-story about a trauma event. And it is always a part of our treatment to confront the trauma and get away from denial and avoidance patterns. Again, you really can’t move forward if you are stuck in your past and in your pain.

DBT or Dialectical Behavior Therapy has offered the following ways that you can begin the process of Radical Acceptance. This is a part of strengthening your coping skills and ability to increase Distress Tolerance:

  • Observe that you are questioning or fighting reality (“it shouldn’t be this way”)
  • Remind yourself that the unpleasant reality is just as it is and cannot be changed (“this is what happened”)
  • Remind yourself that there are causes for the reality (“this is how things happened”)
  • Practice accepting with your whole self (mind, body, spirit) – Use accepting self-talk, relaxation techniques, mindfulness and/or imagery
  • List all of the behaviors you would engage in if you did accept the facts and then engage in those behaviors as if you have already accepted the facts
  • Imagine, in your mind’s eye, believing what you do not want to accept and rehearse in your mind what you would do if you accepted what seems unacceptable
  • Attend to body sensations as you think about what you need to accept
  • Allow disappointment, sadness, or grief to arise within you
  • Acknowledge that life can be worth living even when there is pain
  • Do pros and cons if you find yourself resisting practicing acceptance



15 Jul 2020
Benefits Of Gratitude Journaling

Modern psychologists suggest that our overall personality is relatively fixed and stable throughout life. But the brain possesses the remarkable capacity to reorganize pathways and create new connections. This is called neuroplasticity, or brain plasticity.


Modern research has demonstrated that the brain continues to create new neural pathways and can alter existing ones in order to adapt to new experiences, learn new information, and create new memories. So, we may not change our core personality but researchers do believe that there are things you can do to change certain parts of your personality that can result in real changes to the way you act, think, and function in your day-to-day life. Our beliefs shape so much of our lives, from how we view ourselves and others, how we function in daily life, how we react to life’s challenges, and how we connect and relate to others. If we can create real change in our beliefs, it is something that might have a resounding effect on our behaviors and possibly on certain aspects of our personality.


So how does therapy help to create change? You only spend 1 hour a week with a counselor but have 168 hours between sessions to reinforce the changes you define in your session. This kind of directed therapeutic work outside the therapy office is vital to making the new neural pathways of sustainable change. Turning knee-jerk negativity into increased positivity, both in thought and action.


One of the most basic and reliable concepts towards positivity is gratitude. Gratitude is defined as the quality of being thankful; a readiness to show an appreciation for and to return kindness.


  • When we express gratitude and receive the same, our brain releases dopamine and serotonin, the two crucial neurotransmitters responsible for our emotions, and they make us feel ‘good’. They enhance our mood immediately, making us feel happy from the inside.
  • By consciously practicing gratitude daily, we can help these neural pathways to strengthen themselves and ultimately create a permanent grateful and positive nature within ourselves.


Gratitude Improves Health


  • Gratitude impacts on mental and physical well-being. Positive psychology and mental health researchers in the past few decades have established an overwhelming connection between gratitude and good health. Keeping a gratitude journal causes less stress, improves the quality of sleep, and builds emotional awareness.
  • Gratitude is positively correlated to more vitality, energy, and enthusiasm to work harder.


Gratitude Improves Relationships


Simple practices like:


  • maintaining a Gratitude Journal
  • complimenting the self, daily affirmations
  • sending small tokens and thank you notes


Can make us feel a lot better and enhance our mood immediately. Couple studies have also indicated that partners who expressed their thankfulness to each other often, could sustain their relationships with mutual trust, loyalty, and had long-lasting happy relationships.



What is a Gratitude Journal


  • A tool to keep track of the good things in life. No matter how difficult and defeating life can sometimes feel, there is always something to feel grateful for.
  • Regularly journaling about the good things in your life can help prepare and strengthen you to deal with the rough patches when they pop up.
  • Regular use over time can encourage positive neural pathways.


Getting Started

Writing can sometimes flow very easily and sometimes not. If you get blocked and are finding it difficult to get the creativity flowing here are some prompts to get things going:


  • List five small ways that you can share your gratitude today.
  • Write about a person in your life that you are especially grateful for and why.
  • What skills or abilities are you thankful to have?
  • What foods or meals are you most thankful for?
  • What elements of nature are you grateful for and why?
  • What part of your daily routine are you most thankful for?
  • Write a letter to someone who has positively impacted your life, however big or small.
  • What is something you are grateful to have learned this week?
  • List five parts of your body that you are grateful for and why.


Gratitude Journaling Formats

People can get pretty creative with how they format their journal. Here are some examples:


  • Write an essay
  • Use a Gratitude Worksheet
  • Use an APP
  • Do a photo journal
  • Use Bullet Point journaling technique



A gratitude essay is a more detailed account of your life and requires more involved writing. It is a declaration, a reflection, and an acknowledgment of what you have to be grateful for and, indirectly, who you are. As you choose your gratitude memory, you really put it through some reflective filters and eventually learn a lot about yourself in the process.

If you reflect back on a moment where someone went above and beyond for you, you may come to realize that you value people that are unselfish, kind and generous. And may be inspired to do the same for others.

The point is that writing a gratitude essay is not just a great way to acknowledge and reflect on some of the most important or defining moments of gratitude in your life, it is also a way to learn about yourself.



There are many templates online for us to download on this topic. (Google Gratitude Worksheets). It is worth your time to check out some of the formats and try a few out to see which ones work best for you.

Some that I have found are basic calendar-type worksheets that list each day of the week, with 3-5 spots to list what I am grateful for. If that sounds too plain for you, there are some that have designs and more prompts within the worksheet.


There is a fun worksheet that is has 3 areas:


  1. What I learned today.
  2. My favorite part of the day.
  3. Three things I am grateful for.


Gratitude Apps

This has a variety of options in the APP STORE. Just type in the search: Gratitude Journal and many APPS will pop us. The good news is that many are free, and some are at least offering a free trial. Try a few out and use the one that works best for you. Here are some common features:


  • Able to take this journal everywhere you go with your smartphone in your pocket.
  • You can set notifications for reminders to journal on the app.
  • You can track your progress and gain insight on your feelings.
  • Motivational quotes.
  • Click up to ten emoji images of topics you are grateful for or can type it in. You can also click emojis about how you feel about the things you are grateful for.
  • Write about your day up to 100 words.
  • Add pictures from your phone onto your daily journal entries.
  • Send gratitude messages to others.


Bullet Journal

If you aren’t keen on writing or find yourself short on time, you can still get the benefits of journaling by using the gratitude bullet journal format where you basically list at least one thing you are grateful for each day, which may make it easier to start if you are struggling to come up with five items each day. The whole idea is to still scan your day and pop into the positive zone on a regular basis.


Abalance Counseling_CBT-Anxiety 03 Jun 2020
Cognitive Behavioral Therapy (CBT)

(CBT) Cognitive Behavioral Therapy


We have all been through a certain rough patch in our life that has had a severe impact on our mental health. Most of the time we get over such incidents on our own but sometimes we need professional help. An evidence-based technique that has proven to be very helpful with treating mental health issues is Cognitive Behavioral Therapy, also known as CBT.


Cognitive Behavioral Therapy or CBT is a communication approach that will help you improve your functioning by improving the way you feel and react to stress. It is more widely used to relieve anxiety and depression, but can be effective for many emotional and physical health conditions.


CBT can help you cope with your issues in a more constructive manner. It is based on the idea that your emotions, beliefs, thoughts and actions are interlinked, and that negative emotions can cage you in a destructive spiral.


The objective of CBT is to help you interrupt this loop by disintegrating daunting issues into smaller bits, analyzing your emotions and bad habits more closely, and teaching you how to alter such emotional trends and make you feel better.


By participating in CBT counseling you will focus on your emotions, thoughts and behaviors, and challenge your own dysfunctional patterns to create newer and more healthier ways of living. To further familiarize you about this effective treatment, we have gathered important details that should give you a good sense of how CBT works and what you may expect during your sessions.


What is (CBT) Cognitive Behavioral Therapy?


Cognitive behavioral therapy (CBT) is a type of behavioral counseling that has been proven to be successful with a number of issues including stress, personality disorders, concerns with alcohol and drug usage, relationship issues, anorexia, binge eating and serious mental issues.


Multiple study results suggest the CBT contributes to major changes in working and quality of life. In several trials, CBT has been found to be equally successful or more efficient than other types of clinical treatment or behavioral medication.


This is worth noting that CBT advancements have been achieved on the basis of both study and clinical experience. In reality, CBT is a technique for which there is sufficient evidence that it has significant and sustainable positive results.


What does Cognitive Behavioral Therapy Involve?


CBT incorporates a variety of strategies and methods that tackle feelings, attitudes and behaviors. This can vary from formal psychotherapy to self-help resources.


CBT usually involves these steps:


  • Recognize the troublesome scenarios or circumstances of your life. These can involve problems such as a breakup, sadness, rage, or signs of a mental health illness. You and your therapist can spend some time discussing what concerns and priorities you want to work on.
  • Be mindful of your feelings, sentiments and opinions on these things. When you have established the things, you intend to focus through, the therapist may allow you to express your feelings on them. This could include witnessing what you tell yourself about an observation, your understanding of a scenario, and your faith in yourself, others, and events.
  • Identify misleading or imprecise thought. In order to help you understand trends of thought and behavior that can lead to your question, your therapist can ask you to pay attention to your physical, mental and behavioral reactions in various circumstances.
  • Reshape pessimistic or wrong thoughts. Your therapist is likely to allow you to question yourself if your interpretation of the scenario is founded on reality or an erroneous understanding of what is going on. This move may be difficult. You may have a long-standing mindset about your experience and yourself. Through practice, constructive thoughts and action habits can become a routine, so they won’t require too much of an effort.


Examples of Cognitive Behavioral Therapy


In cognitive therapy we learn to assess negative thoughts when they arise, rather than taking them for granted as being true, and considering if there might be other ways of looking at a situation. Asking yourself some of the following questions, grouped below into three categories, can help you to reframe a distressing situation and see it in a different light.

By taking the time to ask these questions, you can disrupt the thinking-in-circles pattern that typically occurs when we allow negative thinking to go unchallenged. Asking these questions gives you the opportunity to step back from your thoughts a little, slow down your mind, and consider things from a fresher and calmer perspective.


What are the facts?


  • How do I know that my thought is true? What is the evidence (or proof) that my thought is true?
  •  Is there any evidence that disproves my thought? What’s the evidence that this thought might not be true, or not completely true?
  •  Are there facts that I’m ignoring or I’ve overlooked?
  •  Am I using any words or phrases that are extreme or exaggerated such as always, never, forever, should, must, can’t, etc.?
  • Are there any small things that contradict my thought that I might be discounting as unimportant?


Are there any other possible explanations?


  • Can I see any other way of viewing this?
  •  If my best friend or someone I loved had this thought, what would I tell them?
  •  If my best friend or someone who loves me knew I was thinking this thought, what would they say to me?
  •  What evidence would my friend point out to me that would suggest that my thought is not 100% true?
  •  When I am not feeling this way, do I think about this type of situation any differently? How?
  •  Five years from now, if I look back at this situation, might I look at it any differently?
  •  Am I blaming myself for something over which I do not have complete control?
  •  Have I had experiences that show that this thought is not true all the time?
  •  Are there any strengths in me that I’m ignoring?
  •  Are there any positives to the situation that I’m ignoring?


What can I do to help me deal with the situation?


  • Have I been in this type of situation before? What have I learned from prior experiences that could help me now?
  •  When I have felt this way in the past, what did I think about that helped me feel better?
  •  What is the worst that could happen?
  •  What is the most likely thing that will happen?
  •  If the worst did happen, what would I be able to do to cope?
  •  What is the effect of thinking this way?
  •  Will this view help me to deal with the problem? Would another view be more helpful?


Once you’re able to gain a broader perspective, things tend not to be as overwhelming, your mind quiets down, and you can start to see things more clearly. Once you have some clarity, then you can find concrete ways to deal with whatever is troubling you.

Often it helps to actually write out your answers to these questions, as writing thoughts down helps get them out of your head and slow down your mind. And seeing the answers written out in front of you can make them sink in and seem more real than if they are just more thoughts added to whatever is going on in your mind already.



Journaling about your feelings with the intent of identifying the irrational, negative or distorted thoughts and perceptions that accompany them is called cognitive journaling. Cognitive journaling helps you identify and revise your distorted perceptions and irrational thoughts.


  1. You open up to a broader perspective. When you sit down and write about your experiences and feelings, you choose to dedicate a special time window to reflecting on your own life. By putting your emotions and thoughts on paper, you gain some momentum in the process of working through them. They stop being absolute, and you feel less overwhelmed. You imply that they do not reflect the whole of reality, as it may often feel when you’re deep into them. You become, in a sense, an observer of your own thinking.
  2. You can change your views. You get more perspective on your thinking because you force yourself to slow it down. By acting as an observer of yourself, you have a chance to reorganize your thinking, spot patterns in it, and choose to change your mind with the fresh information you discover.
  3. You begin to externalize. Part of the process of healing is to identify your feelings and to externalize bottled-up or repressed emotions.  Unresolved issues can be stuck points to your growth as a person.


Who is a Good Candidate for (CBT) Cognitive Behavioral Therapy?


Cognitive behavioral treatment has been used to combat depression, and there is strong support that it performs as effective as psychiatric drugs for mild to severe depression.

Mental illnesses that respond well to CBT include:


  • Posttraumatic stress disorder (PTSD)
  • Disorders of Depression
  • Anxiety
  • Phobias
  • Obsessive Compulsive Disorder (OCD)


Cognitive behavioral treatment can also be used to combat issues such as binge-eating and other food habits, hypertension, alcohol, sleep disturbances, physical discomfort, attention deficit disorder (ADD), panic attacks, and attitude. If a person is dealing with any of the above mentioned complications then they are suitable enough to opt for CBT.


CBT Strategies

Individuals also have ideas or emotions that perpetuate or exacerbate flawed views. Such beliefs can lead to disruptive behavior that can impact many areas of life, which include relatives, intimate relationships, work, and educational experience.


  • Address Negative Thinking 

It is necessary to learn how thoughts, feelings, and circumstances can make contributions to pessimistic behaviors. The process can be complicated, particularly for people struggling with self-reflection, but it can inevitably result in self-discovery and perspectives that are a vital part of the healing process.


  • Practicing New Techniques 

It is vital to begin pursuing valuable skills that can then be used in real-life situations. For example, a person with drug abuse disorder may begin to practice healthy coping strategies and rehearsals to prevent or response to social situations that could likely cause a recurrence.


  • Progressive Improvement 

In most instances, CBT is a steady method that enables a person to take gradual steps towards behavior interventions. For example, somebody with social anxiety could begin by simply imagining anxiety-provoking social situations. After that, they may start talking to colleagues, relatives, and associates. By steadily working towards a greater goal, the procedure seems to be less difficult.


Bottom Line 

Mental issues are a serious concern and they should be dealt with a hands-on approach. Unlike several other talking therapies, CBT involves coping with your present concerns, instead of dwelling on things from the experience. It assists you to particularly analyze and challenge thoughts and feelings to enable you to achieve a healthier mind. One of the greatest benefits of cognitive behavioral therapy is that it helps clients develop coping skills that can be useful both now and in the future.

15 Dec 2019
Seasonal Depression

The Holidays can be a time of friends and family. It can be a time of giving and sharing joy. But for many it is a time of depression and like the weather, it feels kind of gloomy. For some people it may be a reminder of a lost loved one; all the festivities can re-activate grief and loss. You may be experiencing Seasonal Affective Disorder or Seasonal Depression. Over 10 million Americans get this every winter.


It hits young women the most, as they are 4 times as likely to feel depressed and hopeless during the holidays. You do not have to go through this alone. Our Therapists are here to help you by providing validation, support and using a variety of techniques to assert yourself into new patterns of more positive thinking, feeling, and being. Light therapy is often recommended as there is a correlation between depressed mood and lack of sunlight. We focus on DBT and CBT therapy and use a version of these techniques in an integrated play therapy for kids.