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                    Acacia Counseling
 
           Gene Douglas, M.Ed. LPC LMFT

TAPAS ACCUPRESSURE TECHNIQUE (TAT) 

To treat a problem using TAT, follow these instructions:
1.) Rate the strength of your feeling you are experiencing right now, on a scale of 1-10, when you think of the problem.
That number is the SUD (Subjective Units of Discomfort.)
2.) Put your thumb against the inside corner of one eye. Place the ring finger against the inside corner of the other eye.
3.) Place the middle two fingers against your forehead, about a quarter inch above a line between the eyebrows so the
two fingers are lined up with the upper part of the eyebrow.
4.) Cup the other hand, and place it behind your head, with the thumb against your neck, right where it meets the base of the skull.
The little finger will be pressed against your head where it rests. Don't lay your hand flat against your head.
5.) Close your eyes and think of the feeling or event or person that bothers you. Continue for one minute, or until you feel a "shift"
in your body before that. This may be a reflexive sigh.
6.) Keep your pose, and repeat a statement reminding you of the problem in your mind. It may be a person's name,
a phrase about what happened, or the name of the feeling. Continue repeating for one minute, or until you feel a shift.
7.) Keep the pose, and repeat in your mind a statement which is opposite of the problem -- even if you don't believe it.
This might be "I will feel comfortable when I do that," or "I will feel calm and relaxed," whatever is opposite to what has been the case.
Continue repeating for one minute, or until a shift occurs.
8.) Keep the pose, and concentrate your attention on the part of your body where you feel your feelings. That will be different for different people.
Continue for one minute, or until a shift occurs.
9.) Rate your SUD again.

TAT Links:
Learning and Using TAT
https://www.youtube.com/watch?v=YcNlj2SdzmM
How To Do TAT
https://www.youtube.com/watch?v=-rDF_qUntDg
https://www.youtube.com/watch?v=AcxaZW57ymY















    
Recommended Reading

Acacia Counseling
Gene Douglas, M.Ed. LPC LMFT


Do You
Have -- Seasonal Affective Disorder? (Winter Depression -- S.A.D.) 

Personal Inventory for Depression and SAD 

Self-Assessment Version 

This questionnaire may help you decide whether to consult a clinician about depression, whether Seasonal Affective Disorder (SAD) may be your problem, and whether treatment with light, medication or psychotherapy should be considered. This is not a method for self-diagnosis, but it can help you assess the severity and timing of certain symptoms of depression. 


You should answer these questions privately for your personal use.  Check your responses, and then follow the scoring instructions.


PART 1. SOME QUESTIONS ABOUT DEPRESSION.


In the last year, have you had any single period of time (in the winter time) lasting at least two weeks in which any of the following problems was present nearly every day? (Of course, you may also have had several such periods.)


Were there two weeks or more . . . 


when you had trouble falling asleep or staying asleep, or sleeping too much?
when you were feeling tired or had little energy?
when you experienced poor appetite or overeating? 


Or significant weight gain or loss, although you were not dieting?
when you found little interest or little pleasure in doing things?
when you were feeling down, depressed, or hopeless?
when you were feeling bad about yourself


or that you were a failure or that you were letting yourself or your family down?
when you had trouble concentrating on things, like reading the newspaper or watching television?
when you were so fidgety or restless that you were moving around a lot more than usual? 


Or the opposite-- moving or speaking so slowly that other people could have noticed?
when you were thinking a lot about death or that you would be better off dead, or even thinking of hurting yourself? 


How many questions above did you score "yes"? ____ 


PART 2. HOW 'SEASONAL' A PERSON ARE YOU? 


Circle one number on each line to indicate how much each of the following behaviors or feelings changes with the seasons. (For instance, you may find you sleep different hours in the winter than in the summer.) 


(0 = no change, 1 = slight change, 2 = moderate change, 3 = marked change, 4 = extreme change.)


Change in your total sleep length (including nighttime sleep and naps)
Change in your level of social activity (including friends, family and co-workers)
Change in your general mood, or overall feeling of well-being Change in your weight


Change in your appetite (both food cravings and the amount you eat)
Change in your energy level
What's the sum total of the numbers you selected above? ____ 


PART 3. WHICH MONTHS STAND OUT AS 'EXTREME' FOR YOU?


For each of the following behaviors or feelings, draw a circle around all applicable months. If no particular month stands out for any item, circle "none". You should circle a month only if you recollect a distinct change in comparison to other months, occurring for several years. You may circle several months for each item. 

 
COLUMN A-- I tend to feel worst in 

Jan Feb Mar Apr May Jun July Aug Sep Oct Nov Dec none 


I tend to eat most in
Jan Feb Mar Apr May Jun July Aug Sep Oct Nov Dec none 


I tend to gain most weight in
Jan Feb Mar Apr May Jun July Aug Sep Oct Nov Dec none 


I tend to sleep most in
Jan Feb Mar Apr May Jun July Aug Sep Oct Nov Dec none 


I tend to have the least energy in
Jan Feb Mar Apr May Jun July Aug Sep Oct Nov Dec none 


I tend to have the lowest level of social activity in
Jan Feb Mar Apr May Jun July Aug Sep Oct Nov Dec none 


COLUMN B
I tend to feel best in
Jan Feb Mar Apr May Jun July Aug Sep Oct Nov Dec none
I tend to eat least in
Jan Feb Mar Apr May Jun July Aug Sep Oct Nov Dec none
I tend to lose most weight in
Jan Feb Mar Apr May Jun July Aug Sep Oct Nov Dec none
I tend to sleep least in
Jan Feb Mar Apr May Jun July Aug Sep Oct Nov Dec none

 I tend to have the most energy in
Jan Feb Mar Apr May Jun July Aug Sep Oct Nov Dec none

 
I tend to have the highest level of social activity in 

Jan Feb Mar Apr May Jun July Aug Sep Oct Nov Dec none


For Column A and Column B above, how many times did you circle each month?


Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec NONE


COLUMN A ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
COLUMN B ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___


PART 4. MORE ABOUT POSSIBLE WINTER SYMPTOMS . . . 


In comparison to other times of the year, during the winter months, which if any of the following symptoms tend to be present? 


I tend to sleep longer hours (napping included).
YES NO 


I tend to have trouble waking up in the morning.
YES NO 


I tend to have low daytime energy, feeling tired most of the time.
YES NO 


I tend to feel worse, overall, in the late evening than in the morning.
YES NO 


I tend to have a distinct temporary slump in mood or energy in the afternoon.
YES NO 


I tend to crave more sweets and starches.
YES NO 


I tend to eat more sweets and starches, whether or not I crave them.
YES NO 


I tend to crave sweets, but mostly in the afternoon and evening.
YES NO


I tend to gain more weight than in the summer.

YES NO


How many questions above did you score "yes"? ____

-3-

INTERPRETATION


PART 1. If you circled 5 or more problems, it is possible that you have had a major depressive disorder for which you should consider seeking help. Even if you circled only one or two problems you may want to consult with a psychiatrist, psychologist, social worker or other mental health professional if the problems worry you or interfere with your daily activities.


You may have experienced some of these problems for less than two weeks if so, your problem is probably not a classic 'major' depressive disorder, but still may be serious enough to merit consultation with a therapist and possibly treatment. To determine whether the problem might be seasonal, consider Parts 2 and 3 below.


PART 2. If your total score on Part 2 is less than 6, you fall within the 'nonseasonal' range. You probably do not have seasonal affective disorder (SAD). It is still possible, however, that you have experienced a chronic or intermittent depression that merits clinical attention.


If your score falls between 7 and 11, you may have a mild version of SAD for which seasonal changes are noticeable and possibly even quite bothersome but are probably not overwhelmingly difficult. If your score is 12 or more, SAD that is clinically significant is increasingly likely. But you still need to consider which months pose most problems, as shown in Part 3.


PART 3. People with fall or winter depression tend to score 4 or more per month in a series of 3-5 months beginning anywhere from September to January, as would be noted in Column A. For months outside that grouping the score tends to be zero, or nearly zero. In Column B, the same people will usually score 4 or more points per month over a series of 3-5 months beginning anywhere from March to June.


Some people show a different pattern, with scores split between Columns A and B during both winter and summer months. For example, they may feel worst and socialize least during the summer, especially July and August; during the same time period, they may eat least, lose most weight, and sleep least. 


In winter, they may feel best and socialize most, yet still tend to eat most, gain most weight, and sleep most. Such people may experience seasonal depression of the summer type, and treatment recommendations may well differ from those for winter depression.


Some people show relatively high scores in the fall and winter months in Column A (winter depression), but there is still a remaining scatter of good and bad months throughout the year. 


Such a pattern may indicate a 'winter worsening' of symptoms, rather than clear-cut SAD. Recommendations for winter treatment might be similar to those for winter-SAD, although there may be a need for multiple treatment approaches.


Some people experience depression in the winter as well as in the summer, but they feel fine in the spring and the fall. Their summer depression is usually not accompanied by oversleeping and overeating, in contrast with the winter. 


This is a special case of SAD, for which different treatments might be appropriate in the opposite seasons. Even people who experience only winter depression sometimes feel summertime slumps in mood and energy when the weather is rainy or dark for several days. They often find relief by brief use of their winter treatment during these periods.

It may even be possible that their summertime SAD could be brought on by staying indoors a lot due to the air conditioning, or at least the shade indoors.


PART 4. If you reported any of these tendencies, you have experienced winter symptoms that may respond to light therapy and various medications, regardless of whether or not you have depressed mood. The higher your score in Part 4, the more likely you are to have 'classic' winter-SAD. 


It is possible, however, to be depressed in winter without these symptoms or even with opposite symptoms such as reduced sleep and appetite if so, a therapist might recommend a different treatment from that for 'classic' SAD.


SO WHAT CAN YOU DO ABOUT IT?


For winter SAD, the treatment is sunshine.  Either get out in the sun for 30 minutes in the morning and 30 minutes in the afternoon, or sit in a window and let the sun shine in your face. (No need to stare at the sun, though.)  If you do not have a south window in your house, go to a restaurant and sit by the window where you can see the sun.


Full-spectrum lights are useful, too.  They can be found on the internet at prices ranging from $10 to $100.


See if your mood, or your scores above, improve as a result of this experiment.   Also, try doing this at different times of day.   It may be that sunlight in the morning helps more than in the afternoon, or vise-versa.   Both might be even better.


NOTES


Developed by Michael Terman, Ph.D., and Janet B.W. Williams, D.S.W., New York State Psychiatric Institute and Department of Psychiatry, Columbia University. Part 1 was adapted from the Prime-MD Clinician Evaluation Guide (CEG), developed by Robert L. Spitzer, M.D., and Janet B.W. Williams, D.S.W., New York State Psychiatric Institute and Department of Psychiatry, Columbia University. Parts 2 and 3 were adapted from the Seasonal Pattern Assessment Questionnaire developed by Norman E. Rosenthal, M.D., Gary J. Bradt, and Thomas A. Wehr, M.D., National Institute of Mental Health. Preparation of the PIDS was sponsored in part by Grant MH42930 from the National Institute of Mental Health. This questionnaire is under development and is subject to further revision.