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Beating The Winter Blues: Cold, snowy and icy conditions this time of year can really bring you down, but there are ways to combat those dreary feelings and lift your spirits.

Depressed, dark, just downright downtrodden and stuck in a funk. Do those words describe your mood during these cold and bleak winter months?

The winter can be especially hard if you have spinal-cord injury or disease (SCI/D), since snow, ice and cold can make it tough to get out of the house. The reduced sunlight this time of year may also disrupt your body's circadian rhythms, can lead to depression and drain you of energy.

In fact, there's an official clinical name for those "winter blues." It's called seasonal affective disorder (SAD), with 10 million Americans diagnosed, according to the American Psychiatric Association. SAD is a type of depression that's related to changes in the seasons, and it begins and ends about the same time every year.

The symptoms, which include fatigue, loss of motivation and energy, wanting to sleep more, carbohydrate cravings, weight gain and blase mood start in the late fall and go through the winter before turning around in the spring.

However, there are some ways to combat that winter depression and get out of hibernation. SAD can't be cured, but you can manage it.

Schedule Activity

Ann Landes, a SCI/D and rehab psychologist at the Syracuse VA (Department of Veterans Affairs) Medical Center in Syracuse, N.Y., has worked with hundreds of veterans.

She says one key in dealing with SAD is to set a routine or a schedule. And you can do it around your bowel and bladder care.

Since it's a scheduled event, Landes suggests trying to schedule your day around bowel and bladder care and have an activity planned after it each day to get connected with other people. That activity could be anything from spending time with a loved one to meeting a friend for breakfast or lunch to getting some exercise with a small group.

"I think what tends to happen is people hibernate, especially persons with mobility issues. They have a hard time getting out of bed. They don't want to get out of bed. It's cold. It hurts to get out of bed," Landes says. "We always encourage them to keep moving as much as they can. And movement doesn't necessarily mean physical movement but just a routine. I think that part really resonates more with veterans."

SAD can throw sleep patterns and circadian rhythms off, so going to bed and getting up at the same time every day is key. And even though days may be cold, dark or dreary, social connectedness and physical activity are still important.

At the very least, those battling SAD could try to schedule a social date every week or every two weeks with someone or a group of people.

"I think what that does is it gives you a reason to get out of bed instead of staying in bed," Landes says. "There are a lot of reasons to stay in bed when it's cold and rainy and dark."

If you're struggling with anxiety or depression, Landes also suggests reaching out to friends or trying group therapy sessions, whether in person or through clinical video teleconferencing (CVT), which the VA offers. She knows it's challenging to get to therapy or group therapy sessions in the winter, but the VA has video sessions people can attend, including for amyotrophic lateral sclerosis (ALS), spinal-cord injury and limb loss.

There are various organizations, such as the Multiple Sclerorsis (MS) Society, and support groups that offer video teleconferencing, as well. Landes says the Syracuse VA has had success with an ALS/MS group that's completely CVT, with 12 people meeting once a month on video screens.

"I can see them. They can see me. They can see each other. They can talk to each other. So, it's been a really popular group," Landes says. "We have one for spinal-cord injury. Half the class is in-person and the other half is on the screen. So that's worked out really well, too."

Light Things Up

Sunlight is a powerful tool when it comes to your health and well-being, and while the sun may not be out as much in the winter months, there are other ways to shed some light on things.

Scheduling time in front of a light box, otherwise known as light box therapy, can boost your mood. According to the Mayo Clinic's website, light therapy is thought to affect brain chemicals linked to mood and sleep, easing SAD symptoms.

So what is a light box? It's a noninvasive box that gives off a bright light that mimics natural outdoor light and is about five to 25 times the amount of normal indoor lighting. Light boxes come in different sizes and emit different lux, a unit of light measurement defined as lumens per square meter.

Craig Sawchuk, a professor of psychology at the Mayo Clinic in Rochester, Minn., says light boxes can help those with SAD. He recommends those interested find one with at least 10,000 lux intensity and use it within the first hour of waking up in the morning. With a 10,000 lux light box, you'd only need to use it for 20 minutes instead of 40 minutes with one that's 5,000 lux.

"From a time-efficiency standpoint, you'd want to go with a higher-powered light box. You want the light box to be usually an arm's length away, anywhere from 2 to 5 feet away from you. You do want to have your eyes open. You don't have to be staring at the light box, but you need to have your eyes open so your brain is registering excess light," Sawchuk says. "You can watch TV, eat breakfast, do stuff on your iPad. Just keep using it till that time of year when your mood starts to reliably improve. That's clinically how we recommend the use of it."

It's best to talk with your health care provider about choosing and using a light therapy box, and some medical plans cover the cost of one.

If it's not covered, you can purchase a light box at stores such as Walgreens, Costco, Target or Walmart, and the better ones typically run from $40-$100, according to Sawchuk. Light boxes aren't approved or regulated by the Food and Drug Administration for SAD treatment, though.

There's An App For That

If the weather has you feeling really down and you're stuck in your head, there's another idea you could try. And all it involves is your smartphone.

Sawchuk recommends a handful of Department of Veterans Affairs (VA) phone applications (apps) that you can download for free.

One is called CBT-i (Cognitive Behavorial Therapy for Insomnia) Coach, which focuses on ways to help people with overall wellness, insomnia and improving their sleep habits. The app (mobile.va.gov/app/cbt-i-coach) guides users through the process of learning about sleep, developing positive sleep routines and improving their sleep environments. It's a collaborative effort between the VA's National Center for Post-Traumatic Stress Disorder (PTSD), Stanford University School of Medicine in California and the Department of Defense's (DoD) National Center for Telehealth and Technology.

If your PTSD worsens during the winter months, the PTSD Coach app (mobile.va.gov/app/ ptsd-coach) could be helpful. It has tools, including relaxation skills, positive self-talk affirmations and anger management strategies, that can help manage the stresses of daily life with PTSD. You can also customize tools based on your preferences and integrate your own contacts, photos and music. It was created by the VA's National Center for PTSD and the DoD's National Center for Telehealth and Technology.

Could some meditation help relax your mind? If that's the case, there's the Mindfulness Coach app created by the VA's National Center for PTSD. It focuses on skills around mindfulness and building resilience and has a gradual, self-guided training program designed to help users understand and adopt a simple mindfulness practice. The app offers a mindfulness information library, 12 audio-guided mindfulness exercises and additional ones for free download, goal-setting, a mindfulness mastery assessment to help you track your progress over time, daily reminders and access to other support and crisis resources.

If your anxiety levels heighten during this time, there's the Mindshift CBT (Cognitive Behavioral Therapy) app created by Anxiety Canada (apps.apple.com/ us/app/mindshift-cbt-anxietycanada/id634684825). It helps users learn to relax and be mindful, develop more effective ways of thinking and use active steps to take charge of their anxiety. It offers CBT tools to help reorient thinking, a thought journal, coping cards, belief experiments, audio recordings of guided relaxation and mindfulness meditations, a daily check-in and healthy habit and goal-setting ideas.

There's also IntelliCare, which comes out of Northwestern University in Evanston, Ill., and focuses on helping those with anxiety and depression (intellicare.cbits.northwestern.edu). It's a suite of apps that work together to target common causes of depression and anxiety, such as sleep problems, social isolation, lack of activity and obsessive thinking.

There are 13 separate apps in the suite, including Worry Knot; Boost Me; Day to Day; IntelliCare Hub; Social Force; My Mantra; Aspire; Daily Feats; Thought Challenger; iCope; Purple Chill; MoveMe; and Slumber Time. The apps are part of a nationwide research study funded by the National Institutes of Health.

"Again, none of these apps are specific to seasonal depression, but they do do a nice job of portable things that can be helpful for either overall wellness or teach some of the skills that we work on that are evidence-based and relevant to treating anxiety or depressive disorders," Sawchuk says.

Go Dancing

If you're looking for an endorphin boost with some good vibes, have a dance party--either by yourself or with others. That's what VA Long Beach Healthcare System occupational therapist Janice Kim, OTR/L, ATP, ROT, suggests.

Kim hosts a weekly dance party from 11 a.m. to noon on Fridays at the VA Long Beach Healthcare System in Long Beach, Calif. She started it nine years ago.

The dance party usually lasts 40-50 minutes. It starts with a warmup for SCI/D veterans to get adjusted to moving around. Then, they dance, and movement is gradually increased in pace to deliver an appropriate level of challenge. Veterans pick their own songs, ranging from Top 40 pop hits to music from the 1950s, 1960s and 1970s, and each patient is encouraged to do his or her own dance moves.

Patients are also encouraged to remember each other's dance moves, as well as each other's names, as they increase their physical movement and dancing. Respiratory rates are monitored, and rest breaks from five to 10 minutes occur during the session. The dance party closes with a cool-down series of stretches to slow down the heart rate and increase range of motion. Those with limited mobility are assisted.

Triceps, biceps, wrists, forearms, shoulders, knees, ankles and calf muscles are all worked out.

"Whatever movement that they can do on their own actively that doesn't result in too much, I always try to encourage them, but I don't want them to hurt themselves," Kim says. "Being that it's adaptive, in a safe position, I'm only encouraging to them movement that they feel most comfortable doing."

Kim has found research that shows dance can be a promising treatment intervention used in rehabilitation in individuals with disabilities to address physical, psychological and cognitive impairment. She also says dance therapy supports cognitive, physical, emotional and social integration.

"Dance can be therapeutic, although more rigorous research is needed," Kim says. "Dance therapy should be considered as a potentially relevant complementary therapy for all different conditions, especially for those who don't respond well to conventional medical treatment."

Caption: Seasonal affective disorder affects 10 million Americans, according to the American Psychiatric Association.

Caption: Try to arrange an activity, like playing video games with others, to help combat seasonal affective disorder during the winter months.

Caption: Connection and talking with a friend can be helpful for people with spinal-cord injuries, especially in winter.

Caption: Light box therapy can help boost one's mood during the dreary winter months.

Caption: A light box is a noninvasive box that gives off a bright light that mimics natural outdoor light and is about five to 25 times the amount of normal indoor lighting.

Caption: These free smartphone applications can help with overall wellness, according to Craig Sawchuk, a professor of psychology at the Mayo Clinic in Rochester, Minn.

Caption: If you need an activity to boost yourself out of a winter funk, adaptive dancing and moving to music can help.

Caption: Adaptive dance can boost endorphins and be therapeutic.
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Author:Groth, John
Publication:PN - Paraplegia News
Date:Jan 1, 2020
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