ART OF RETREAT

Along with the cold, winter can bring loneliness, low motivation and social withdrawal. Cass Hogan of Fontein Coaching offers advice on how to support yourself through it.

PHOTO CASEY VAN LIEFDE

There’s a particular feeling that settles in around now. The mornings are darker, the harbour is grey, the calendar is suddenly less crowded, and something in us pulls inward. We sleep a little later. We say no to things we'd usually say yes to. The text we meant to send sits idle for three days.

If that’s where you find yourself this winter, I want to start by saying it’s not a failure. The natural world slows down in winter for a reason, and we’re part of the natural world. The pull toward quiet is real, and it can be a beautiful thing if we move with it intentionally, rather than letting it carry us somewhere we didn't choose to go.

In my coaching practice, I see this distinction every winter. There’s intentional retreat, which might mean slower mornings, deeper conversations and early nights. Then there’s unintentional withdrawal, like motivation that disappears, relief sought through cancelled plans, a slow drift away from the people and practices that keep us well. The first restores us; the second costs us. The tricky part is that they can look identical from the outside, and even from the inside for a while.

The question I find most useful during the cooler months is a gentle one: Am I choosing this or am I hiding in it? If the honest answer is the latter, you don’t need a five-step plan or a burst of new-year energy, you need anchors that look like small, consistent points of contact that keep you from drifting.

Here are three I come back to again and again with my clients.

Light, every day. Even 10 minutes of natural light in the morning can help your sleep, your mood and your sense of being awake to your own life. Coffee on the deck counts. A walk to the letterbox counts.

One real conversation a week. Not a “We should catch up” text – an actual coffee, an actual phone call, an actual “How are you, really?”. Connection isn’t a luxury we earn when we feel better; it’s often what helps us feel better.

One small thing that's just yours. A book, a class, a Sunday ritual, a project underway. Winter has a way of shrinking our worlds down to work and obligation. A small claim on your own joy is an act of self-respect. Winter will do what winter does. The grey will come and go, but you get to decide whether this is a season you move through asleep, or one you move through with your eyes open, with purpose.

That’s the difference, and it’s a difference worth choosing.

FONTEINCOACHING.CO.NZ

MIND OVER MATTER

One Mount Maunganui clinic is bringing cutting-edge mental healthcare closer to home, with a groundbreaking treatment offering new hope for depression.

WORDS NICKY ADAMS

PHOTOS DEBORAH DE GRAAF

There are few who would argue with the saying “your health is your wealth”, but when UNO sits down to talk to psychiatrist Dr Darren Malone and his wife, psychiatric nurse Kate Malone, of Equilibrium Assessment and Treatment Clinic, Darren zeroes in on this even further, pointing out that in reality, “the cornerstone of your health is your mental health”.

With the World Health Organisation confirming in 2017 that depression had become the leading cause of ill health and disability (statistics showing an 18 percent increase between 2005 and 2015), it’s probably fair to say that it’s an illness that resonates with most of us. To call it ‘common’ feels reductive, because depression is so hugely impactful both to those suffering and to close whānau and friends. When you consider that up to 7 to 10 percent of adults experience depression annually, its prevalence begins to hit home.

Medication and cognitive behavioural therapy are often the first port of call; however, 30 percent of people with depression are treatment resistant. These people include those who have not achieved an adequate response to medical treatment and those who are unable to tolerate medication side effects.

Worldwide research efforts have focused on everyone in this group. One specific treatment option has gained huge ground globally: Transcranial Magnetic Stimulation. TMS has been internationally approved and FDA-cleared since 2008, and is approximately twice as effective Dr Darren Malone and Kate Malone. as antidepressant medication.

The outpatient procedure is already widely supported in the US, the UK and Australia, where it’s used as a proven plan for treating resistant depression. In Australia, TMS costs are covered by Medicare.

Darren and Kate have practiced in the public and private systems in New Zealand and the UK for more than three decades. Latterly, Darren was clinical director of Mental Health Services for Lakes DHB, before moving to Mount Maunganui and setting up Equilibrium. The clinic is light and bright, and the atmosphere is relaxed. Darren and Kate are warm and welcoming; it’s hard not to feel at ease.

They focus specifically on working within the field of depression and treatment via TMS, which works using magnetic pulses. They’re passionate about and heavily invested in providing a pathway for patients for whom medication simply doesn’t work, or for those who want to explore a treatment hitherto largely unavailable in New Zealand. The fact we have access to this private facility and level of expertise locally – and without heinous waiting lists – is remarkable.

The route to a treatment plan involving TMS is as stringent as you’d expect. Kate says most patients will be referred to Equilibrium by their GP or psychologist, who will likely have extensive notes to share. The next step will then be a comprehensive assessment with Darren. As he says, “the most important thing about TMS is that you have to confirm that the patient has depression. Then it’s about working together to try to help… We don’t want to give people medication or TMS if it’s not going to be the solution.”

Crucially, Darren continues, “you want the patient to engage in a treatment that will help them get better. You’ve got to understand their preferences and goals. If you can establish the way they want to work, you’re going to get the best outcomes, so you’ve got to adapt.”

The patient groups that really benefit are not only people with treatment-resistant depression, but also those who can’t tolerate medication, pregnant or breastfeeding mothers, and older people who are already on multiple medications. If it’s conclusive that TMS could indeed be positive, a treatment plan is put in place.

Having read about the benefits of TMS, I’m curious as to what the process actually involves. Darren explains, “People will tell us when they’re depressed that their brain doesn’t work properly. It’s been discovered that the primary depression area in your brain is your left side dorsolateral prefrontal cortex, which has been shown to be under-functioning in people with depression. We’re able to stimulate this area with the magnetic coil, and the pulse passes through your skull and into the cortex. It’s a kind of non-invasive brain stimulation.”

And the feeling while you’re having the treatment? As the practitioner who gives the treatment, Kate immediately reassures, “It's a very safe, well-tolerated treatment, with minimal or mild side effects, such as mild fatigue and mild scalp discomfort. The delivery of rapid, brief magnetic pulses through the skull into the brain results in a tapping sensation on the skull.”

Although I realise there’s no ‘one-size-fits-all’ plan, I’m interested in how many sessions are required and how often. Typically, Darren says, “the original TMS protocols consisted of a 20 to 30-minute treatment, once a day, five times a week, for four to six weeks.”

That said, both Darren and Kate are hugely excited by global progress, particularly in the US, where extensive use and research shows that accelerated TMS protocols can be even more effective. What this means is that “we’re able to offer a full course of TMS over two weeks, which is far more feasible for people to fit into their lives”.

Clinical response to TMS is monitored regularly. Ultimately, the joy of the process for Darren and Kate is being able to offer a potential solution to a problem patients may have battled for years.

“Often the people we see will tell us that they’ve tried medication and cognitive behavioural therapy, as well as diet and exercise,” says Darren. “These people are invested in their mental health and have done really well, but over time, those things have become less effective in treating their depression. They get to the stage where they can become quite desperate because they’ve tried everything. We feel quite hopeful with TMS that it’s something people can try. TMS is tolerable, proven and highly effective.”

TMS.NET.NZ