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Dr. Z
Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 5968
Experience:  Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
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Dr. Z only:

No chat please, since I cannot see it properly on my phone

I hope you can help. I feel so stuck.

I am struggling so much with emotional overeating. The pain of my loneliness, isolation due to constant sadness and hopeless has made it so I have not been able to cope without the overuse of food to self medicate and clam, numb and lift my mood.

No other meds have worked in my over the course of 14 years of trying so they are no longer an option.

I went through a long course of DBT outpatient work and still that did not completely resonate with me.

When feelings get so overwhelming and scary and painful I feel I have to turn to food to lift the mood and take the edge off but it backfires an hour later and makes me feel more out of control and heavier.

I spend most of my weekends in bed due to lack of motivation and no energy and sadness. Just pass the time.

If I could just get a proper grip and totally transform my body with weightloss I would feel so healthy and proud.

It is just that the lack or ability to tolerate distress and good enough self soothing have not happened yet. When people just take a warm bath or go for a walk that just does not work against the explosion of sadness and pain.

I wonder how slim people handle their overwhelming pain.

I am so aware of the process of feeling powerless and turning to food that will make me feel worse after the fact but it has been the most affect coping mechanism but harms me after.

Exercise and therapy have not helped me during the times I am not engaged in them at that moment.

I feel so low and hopeless

I feel no motivation for my life - what's the point for going through like like this?

I have no friends and have not been able to make any because I do not have and upbeat energy to me.

I seem to always notice problems instead of being light and breezy.

I am a very intense female. I have intensity in my expression and verbage.

I tend to be very black in white in my thinking and too sensitive.

I assume the worse since I have been let down so much.

I worry about certain things before they happen because I feel that I will be better prepared if I start now.

I cannot seem to cope with events that trigger failure or stress for me. Ex: Ex spouse calling hearing his voice and news of all of his glory.

I am so awkward socially.

I feel so devastated by my loneliness and lack of having much to offer.

I can't seem to take much initiative. Its too hard.

I isolate be it is do hard to interact with people.

I am very meek unless I am paying for a service then I take more of a stand.

It feels that I have no backbone at times.

I have trouble setting boundries with people.

I feel truly overwhelmed by appointments and normal tasks such as washing dishes and laundry.

I do not know how to comfortably converse with people unless I am leaning on them for support or talking about myself in therapy.

I Feel the necessity to use food to feel better by calming, distracting and numbing.

I am so fatigued most of the time with no physical energy or stamina.

No more gusto like I had 10 years ago.

No more guts either

Suffer severe emotional stress on a daily basis.

It as if I do not have emotional skin I cry alot and am such a overly sensitive and fragile minded female.

I feel powerless about how to deal with my self-doubts

I feel powerless about how to get real satisfaction in life

I feel powerless to insure my own safety

I feel powerless to appropriately assert my independence

I feel powerless to fill myself up when I feel empty inside
Submitted: 1 year ago.
Category: Mental Health
Expert:  Dr. Z replied 1 year ago.
Hello,

I am so sorry that you have been struggling with this pattern of depression and emotional overeating for such a long time. You have also tried most conventional therapy and medications out there to help you and they also have not worked. This is definitely a form of resistant depression, where conventional treatment methods may not work for you. It feels that you are in a maladaptive cycle where you have feelings of depression and then emotionally overeat to combat those depressive feelings, but the overeating causes you to feel depressed and you go through the cycle again. So the goal is typically aimed at treating the depression first to lessen the incidence of emotional eating.

I do like the DBT therapy a lot, but because it has not worked for you may not be because the therapy is flawed, but because your medication regimen has not been effective for you to make the DBT successful. So I do not believe you have mentioned taking this medication, but I would encourage you to ask your doctor for an antidepressant that has had some benefit for you in the past, but also to add a stimulant medication, like Adderall for instance. Stimulant medications do have an off-label use to treat depression, and it will also give your more energy and will promote weight loss for you. This may be the medication you need to get over the hump.

This next two modalities can help with resistant depression, like you have described and it may translate in you not overeating anymore in response to the depressive feelings. The first is called Transcranial Magnetic Stimulation (TMS). This is very similar to the Electroconvulsive Therapy that you mentioned you have tried, except this used magnetic stimulation instead of electrical and is considered safer with less side effects. Also this modality is relatively new (FDA approved since 2008) and has been considered a last resort for patients when other conventional treatments of depression/guilt have been unsuccessful. This novel method for treatment of depression has been very successful for resistant depression and I think it is something that you should consider based on your symptoms and the other unsuccessful treatment approaches. Here is one links describing it in more detail for you and another link of a study in praising its effectiveness and minimal side effects.

http://www.mayoclinic.com/health/transcranial-magnetic-stimulation/MY00185

http://depression.wustl.edu/O'Reardon%20Pivital%20trial.pdf

Now the other treatment modality can be used if all antidepressant medications have been used with no success. Ketamine is a strong medication that has been recently studied in resistant depression, which a symptom of guilt is a part of. According to a few studies patients that have resistant depression were treated with Ketamine and saw drastic improvements in their symptoms. Here a couple links to describe the benefits of Ketamine use for treatment resistant depression.

http://www.psychiatrictimes.com/bipolar-disorder/ketamine-induced-optimism-new-hope-development-rapid-acting-antidepressants

http://www.smw.ch/docs/pdf200x/2007/15/smw-11852.pdf

I was also wondering if you have considered going to an inpatient eating disorder clinic? They have many experts at these clinics that can treat your depressive feelings and how it relates to overeating. If anything these clinics may be effective for you to stop the cycle of emotional overeating and make your depressive symptoms less resistant to treatment.

Now these treatment modalities may not resolve you completely of your resistant repression, but they can lessen your symptoms substantially to a point where you may respond better to therapy and conventional medications. And in doing so, your emotional overeating may lessen as result of your lessening depressive symptoms.

My goal is to provide you with excellent service, so if you have any questions or concerns at all, please feel free to contact me at anytime.

Customer: replied 1 year ago.

Hello,


 


Thank you for trying to help.


 


I stated that I have tried 14 years of medicines for this and nothing ever worked. I am not able to tolerate the meds.


 


The TMS is $550 per session every day for 6 weeks straight. I in no way could afford that and insurance does not cover that. Insurance also does not cover eating disorder treatment either.


 


Can you give me something I can work with for distress tolerance and self soothing? That would be most helpful now.


 


I have not been able to work due to this.


 


 

Expert:  Dr. Z replied 1 year ago.
Hello,

I understand that you have used 14 years of medications, but I did not think that you would have tried the stimulant medication or ketamine treatment since those are outside the box types of treatment for your resistant depression.

I understand that you want something that can be effective for distress tolerance, but that is DBT and you said DBT did not work for you. You can try focused Mindfulness therapy instead of just DBT. This can help provide you with that distress tolerance and soothing feeling you are looking for. This type of modality will go into more detail and depth of mindfulness that can be beneficial for you. Here are a couple good books on the subject matter.

http://www.amazon.com/Mindfulness-Beginners-Reclaiming-Present-Moment--/ dp/1604076585/ref=sr_1_3?ie=UTF8&qid=1379308507&sr=8-3&keywords=mindfulness

http://www.amazon.com/A-Mindfulness-Based-Stress-Reduction-Workbook/dp/1572247088/ref=sr_1_6?ie=UTF8&qid=1379308643&sr=8-6&keywords=mindfulness

http://www.amazon.com/The-Mindful-Way-Through-Depression/dp/1593851286/ref=sr_1_1?ie=UTF8&qid=1379308678&sr=8-1&keywords=mindfulness+depression

You can try something called Progressive Muscle Relaxation that can help you create a long term calm by using muscle tension and release techniques. This can be used now, but make take some practice for it be effective for you.

http://prtl.uhcl.edu/portal/page/portal/COS/Self_Help_and_Handouts/Files_and_Documents/Progressive%20Muscle%20Relaxation.pdf

You may also want to try to hypnotherapy, this can help self-soothe yourself and produce distress tolerance for yourself. In addition, Eye Movement Desensitization and Reprocessing (EMDR) uses a certain technique that has been shown to help treat PTSD in many individuals in the past, but may also be effective in treating resistant depression. Hypnotherapy and EMDR is typically not as effective as DBT or CBT, but since you have tried nearly everything else like you said I think these are modalities that you may want to consider.

I think you definitely have a resistant depression that has not responded to anything and I am sorry that your insurance will not cover TMS because I think that is the next step to take for your treatment. If these techniques do not work for you, I can opt out and allow for other experts to weigh in on possible treatments that I have not thought of that may be effective for you.
Customer: replied 1 year ago.

Thank you for that. Can you share the multi page worksheet that I have seen you use before with others that shows different tasks or something like that and the different choices and consequences or the choices and then alternative choices that would be better options.


 


I hope you can recall what I am talking about because I cannot find it online anymore on this site.


 


 

Expert:  Dr. Z replied 1 year ago.
Hello, sure I can give you those worksheets that can be beneficial for you. They are very similar to DBT, but this is called cognitive behavioral therapy (cbt). I am actually away from my computer right now, I am doing this from my phone, so in about 1-2 hours I will send some worksheets and book ideas over to you. Thank you for your patience.
Customer: replied 1 year ago.

You are most helpful. Thank you.....

Expert:  Dr. Z replied 1 year ago.
Okay, I am back at my office now.

CBT has a premise that your symptoms are caused by negative thoughts, so if we change your thought process to be more positive and objective as well, then your symptoms will lessen

So this link may help you, it contains a technique I use with patients called a thought record. It will help you keep track of any negative thoughts you have. You put the negative thought on paper, the emotion accompanying, the evidence to support it, and the evidence against it. Then I want you to come up with an alternative thought for the situation (more objective and plausible). This will help you change your way of thinking to be able to think more positive and not automatically go to a negative type of thinking.

http://www.psychologytools.org/assets/files/Worksheets/CBT_Thought_Record.pdf

This worksheet is called a positive belief record that can help you replace your negative self-critical thoughts with more positive self-beliefs.

http://media.psychologytools.org/Worksheets/English/Positive_Belief_Record.pdf

In addition, these two worksheets are very good at helping lessen symptoms of depression/anxiety and helping you focus on the big picture and the objective/positive thoughts and outcomes.

http://media.psychologytools.org/Worksheets/English/Decatastrophising.pdf

http://media.psychologytools.org/Worksheets/English/What_If.pdf


Also individuals with severe resistant depression have a poor coping mechanism, so this worksheet will help you develop a better coping strategy to manage your symptoms of depression better.

http://media.psychologytools.org/Worksheets/English/TRAP_TRAC.pdf


These two books also have more CBT techniques that can be effective for you and help you to treat your depression more effectively.

http://www.amazon.com/Mind-Over-Mood-Change-Changing/dp/0898621283/ref=sr_1_2?ie=UTF8&qid=1379 354129&sr=8-2&keywords=cbt+workbook

http://www.amazon.com/Cognitive-Behavioral-Workbook-Depression-Step-/dp/1608823806/ref=sr_1_1?ie=UTF8&qid=1379354140&sr=8-1&keywords=cbt+depression

In addition this website has CBT techniques specifically used to treat eating disorders, so you may find it very helpful for you

http://www.cci.health.wa.gov.au/docs/5%200910%20%20Low%20self-esteem.pdf

I want to wish you the best of luck with everything. Using CBT is journey that can be very effective for you, but it does take time and patience, so if you have any questions or concerns about this process please feel free to contact me at anytime.
Customer: replied 1 year ago.

Tap and Trac was the one I was remembering.


http://media.psychologytools.org/Worksheets/English/TRAP_TRAC.pdf


 


Thank you for your amazing and incredibly helpful service.


 


I really need this stuff. The DBT did not work because the group leader kept starting from the beginning every time a new student would joining in and I had so many unanswered questions. It was a matter of back peddling.


 


I will now dive right in to your resources.


 


By the way, in future posts would you be able to explain any specific questions on certain things in DBT that I do not quite get or have trouble conceptualizing in regards XXXXX XXXXX skills and definitions?


 


My appreciation for your kindness.

Expert:  Dr. Z replied 1 year ago.
You are most welcome and I would be happy to help with any specific questions you have regarding DBT or CBT that may have. I am sorry that your DBT group leader would always start from the beginning and not move forward because new patients would enter the group. Here is also a really good book on DBT skills that I use with patients, so you may find it helpful also.

http://www.amazon.com/Dialectical-Behavior-Therapy-Skills-Workbook/dp/1572245131/ref=sr_1_1?ie=UTF8&qid=1379356624&sr=8-1&keywords=DBT

Good luck and I hope you have a great rest of your week :)
Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 5968
Experience: Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
Dr. Z and other Mental Health Specialists are ready to help you
Expert:  Dr. Z replied 1 year ago.
Thank you for the positive review, I truly appreciate it. Best of luck to you and if you need anything please feel free to contact me at anytime.

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Dr. Z
Dr. Z
Psychologist
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Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.