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The Depression Cure -- The 6-Step Program to Beat Depression without Drugs
by Stephen S. Ilardi, Ph.D. 2009.
Da Capo Press: Cambridge, MA
) All rights reserved [253 pages].
[Answer 21 of 30 questions correctly to receive
10 hours of continuing education credit.]

Introduction (p. vii -x) and

Chapter 1: The Epidemic and the Cure (p. 3-24)

1. Which is NOT true?
a. The author recommends that before anyone begins the TLC program, they should first get a physical exam from a doctor.
b. The Therapeutic Lifestyle Change (TLC) program was developed by a clinical research team at the University of Kansas.
c. About 1 in 4 Americans will meet the criteria for major depression at some point in their lives.

d. Compared to other societies, Americans have a very low rate of depression.

2. Which society has the highest rate of depression?
a. The United States
b. Hunter-gatherer bands
c. Third world countries
d. The Amish

3. Which of these is NOT part of the Therapeutic Lifestyle Change program?
a. Omega-3 Fatty Acids
b. Rumination
c. Engaging activity
d. Physical Exercise
e. Sunlight Exposure
f. Social Support
g. Sleep

Chapter 2: Making Sense of Depression (p. 25-42)
4. Which of the following is NOT one of the 9 symptoms of Major Depressive Disorder?
a. Depressed mood
b. Loss of interest or pleasure in all or nearly all activities.
c. Thinking primarily negative thoughts.
d. A large increase or decrease in appetite or weight change.
e. Insomnia or hypersomnia (greatly increased sleep).
f. Slowing of physical movements, or severe agitation.
g. Intense fatigue.
h. Excessive feelings of guilt or worthlessness.
i. Difficulty concentrating or making decisions.
j. Frequent thoughts of death or suicidality.

5. Which helps to INCREASE depression?
a. When the left hemisphere of our frontal lobe shuts down (if we are right-handed).
b. An increase in cortisol.
c. A lack of slow-wave or deep sleep.
d. All of the above

6. Which is NOT true about risk factors for depression?
a. About 80% of our risk for depression is directly related to our genes
b. Children who suffer physical or sexual abuse have a greater risk for depression.
c. Research shows that having one supportive confidant, an emotionally close family member or friend, cuts the risk of depression in half following a separation, divorce, or job loss.
d. Redirecting one's thinking away from ruminating, or brooding on negative thoughts, and engaging in more rewarding activities is highly effective for keeping depression at bay.
e. Sudden drops in estrogen are linked to depression, such as during a woman's premenstral period and immediately following childbirth.
f. Maintaining regular exercise, eating lots of fish, getting plenty of sunlight, and getting adequate sleep help to reduce one's risk of depression.

Chapter 3: Treating Depression -- The State of the Art (and Science) (p. 43-61)

7. About antidepressant medications, the author concludes that
a. most people with depression must take medication to get better.
b. the majority of people taking antidepressants will be symptom-free after 1 to 3 years.
c. insurance companies would rather pay for counseling than antidepressants.
d. neither placebos nor antidepressants are very effective.

8. Which of the following was NOT mentioned as a possible side-effect of taking antidepressants?
a. Suicidality
b. Emotional numbing
c. Panic attacks
d. Sexual dysfunction
e. Weight gain
f. Insomnia

9. Which of the following treatments had the highest (56%) recovery rate with severely depressed patients? It was considered effective because it substituted rewarding activities for the toxic process of rumination.

a. Dr. Neil Jacobson's behavioral activation
b. Dr. Aaron Beck's cognitive therapy
c. Dr. Sigmund Freud's psychotherapy
d. antidepressant medication

10. There are now over four hundred distinct varieties of psychotherapy being practiced by clinicians, and the vast majority of them have never been tested scientifically.
a. True
b. False

Chapter 4: Brain Food (p. 65-88)
11. Omega-3 fats are made in the leaves of plants and grasses. Omega-6 fats are found in plant seeds, nuts, and grains. The author says that hunter-gatherer societies consisted of a 1:1 ratio of Omega-6 fats and Omega-3 fats. But the typical American diet has a ratio of 16:1 Omega-6 fats to Omega-3 fats. Why?
a. Grains (Omega-6) are a large part of Americans' food source (wheat, corn, rice, barley, sorghum, oats, rye, etc).
b. Livestock (cattle, chicken, pigs, and fish) are primarily grain-fed (Omega-6), not free-ranged (Omega-3).
c. Most Americans cook with seed oils (Omega-6) such as corn oil, canola oil, soybean oil, sunflower oil, peanut oil, palm oil, safflower oil, and derivative products such as margarine and Crisco.
d. All of the above.

12. To maximize the reduction in depressive symptoms, the author recommends which of the following for taking a daily supplement of Fish Oil (Omega-3)?
a. Take fish oil that has a 2:1 ratio of EPA to DHA.
b. Begin with a dose of 1000 mg of EPA and 500 mg of DHA. Then, if depressive symptoms are not reduced within four weeks, increase dosage to 2000 mg of EPA and 1000 mg of DHA.
c. Use fish oil that says "molecularly distilled" on the label.
d. Use fish oil that says "pharmaceutical grade" on the label.
e. All of the above.

13. Besides taking daily supplements of fish oil, the author also recommends taking
a. a daily dose of 500 mg of Vitamin C, because this antioxidant prevents free radicals from damaging Omega-3 in our bloodstream.
b. a weekly dose of 5 to 10 mg of GLA (gamma linolenic acid) which combats the inflammatory effects of too many Omega-6 fatty acids. Sources of GLA include oatmeal and evening primrose oil.
c. a daily multivitamin.
d. All of the above.

Chapter 5: Don't Think, Do (p. 89 - 112)
14. Which is NOT true about rumination?
a. It amplifies negative emotions. It makes you fell worse or more anxious.
b. The more you ruminate, the more helpful information you discover
c. It makes us less active, locked inside our own heads, and socially withdrawn.
d. It increases our brain's stress response. It can trigger a full-blown episode of depression.

15. Which is NOT true about our brains and rumination?
a. Most of us are quickly aware of when we are ruminating.
b. Our brains tag every one of our memories according to the emotional state we are in when the event happens. Then, when we experience that same emotional state again, let's say sadness, we remember previous sad experiences of failure, loneliness, or rejection.
c. When people are sad, they find it difficult to recall any time in the past when things were going well.
d. When people are sad, they tend to conclude that horrible outcomes are the norm, which increases their despondency, which primes even more negative thoughts.

16. Which is NOT true about rumination?
a. When two depressed people get together, like two depressed adolescent girls, they tend to encourage one another.
b. The best way to monitor your own rumination is to keep an hour by hour log of your day.
c. People typically ruminate and feel the worst when they have nothing else to occupy their attention. The single greatest risk factor for rumination is simply spending time alone.
d. People tend to ruminate while watching television because most programs do not engage their minds.
e. Other activities which promote rumination include sitting in traffic, listening to sad music, driving, doing routine chores, daydreaming, and lying around the house.

17. Which is NOT true?
a. Activity stimulates the left frontal cortex of our brain, which slightly reduces our depressive symptoms.
b. Often what makes rumination hard to stop is the mistaken conclusion that if I keep ruminating I will eventually gain insights which will make me feel better.
c. If someone is having difficulty stopping rumination, it is helpful to tell that person to set a limit of ruminating for no more than 30 minutes
d. Writing down ruminating thoughts can help some people stop thinking about them.

18. It is up to individuals to decide which activities will help stop them from rumination.
Of the following, which activity was NOT mentioned by the author?

a. Engaging in conversation with a close friend.
b. Reading a well-written book.
c. Playing a game indoors or outdoors.
d. Listening to music.

Chapter 6: Antidepressant Exercise (p. 113-132)
19. What was NOT mentioned as a benefit of exercise for our brains?
a. It increase our serotonin and dopamine.
b. It helps us to use technology more efficiently
c. It stimulates the brain's release of a key hormone (BDNF), which helps to reverse the toxic, brain-damaging effects of depression.
d. It sharpens our memory, our concentration, and helps us to think more clearly.

20. Assuming someone who does not exercise is not sick or injured and can perform all of the following, which activity does the author recommend a person start doing three times each week?
a. Walking three times each week.
b. Lifting light hand weights.
c. Swimming
d. Biking

21. Of the following, which did the author NOT recommend as part of one's regular exercise program?
a. Do three 35-minute aerobic activities each week, where the first 5 minutes gets you into aerobic range. (124)
b. Shoot for 75% of your maximum heart rate for your age. Even though an activity is aerobic when it gets your pulse to 60% of your maximum heart rate, the best research studies have asked people to work out in the middle to high-end of their aerobic range.
c. The harder the exercise is for you to do, the better it is for you.
d. Only engage in exercise that is meaningful, purposeful, and enjoyable to you.
e. When possible, work out with someone.
f. Listen to audio books or your favorite music while working out.
g. Whenever possible, exercise at the same times on the same days of the week. Space out these days to give your body time to recover.
h. Finish exercising at least two hours before bedtime.
i. If you just cannot get started, hire a personal trainer who will provide the initial motivation.

Chapter 7: Let There Be Light (p. 133-162)
22. Which is NOT true about exposure to bright light and depression?
a. Exposure to bright light increases our brain's serotonin.
b. People usually feel some mood elevation within an hour or two of exposure to bright light.
c. About thirty minutes each day of exposure to bright light provides an antidepressive effect.
d. People who lack exposure to sunlight can make up for it by keeping the lights on in their homes all day.

23. When resetting your body-clock, which would NOT be helpful?
a. If you are a late shift person, where you have trouble falling asleep at night, and are sluggish in the morning, you should get 30 minutes of bright light within the first hour of waking, and not past 8:30am.
b. If you are en early shift person, where you fall asleep at night, but wake up too early and can't go back to sleep, you should begin getting 30 minutes of bright light 5 hours before bedtime.
c. If you get fragmented sleep, where you are waking up frequently throughout the night, try to get 30 minutes of exposure to bright light in the evening.
d. The best light box to use is one that will provide 10,000 lux of white light, also known as broad-spectrum light.

24. Which is NOT true about Vitamin D?
a. Those of us who drink milk get an adequate supply of Vitamin D3.
b. The author recommends taking 2000 IU of Vitamin D3 each day, after checking with one's doctor.
c. According to the best research, our blood level of Vitamin D should be as high as 30 ng/mL (or 75 nmol/L) for optimal health.
d. In the continental United States, most of our bodies would make enough Vitamin D if we received 10 to 15 minutes each day of sunlight between 11:00am and 3:00pm.

Chapter 8: Get Connected (p. 163-191)

25. To improve social connections, the author recommended you do all of the following EXCEPT
a. schedule 3 activities to do each week with someone rather than alone, such as walking, working out, and eating lunch.
b. ask your friends to read an educational book about depression.
c. ask your friends to call you if they haven't heard from you in awhile.
d. put yourself down in front of your friends so they will give you reassurance and encouragement.

26. Toxic relationships _______.
a. make you feel worse about yourself.
b. won't allow you to redirect rumination to something positive.
c. seem to offer love and acceptance without giving either.
d. All of the above.

27. Which is NOT true?
a. Research has proven that people are happier when they give to others than when they do something pleasurable for themselves.
b. Caring for animals increases our sense of well-being through affectionate physical contact, which lowers stress hormones and increases our dopamine and serotonin.
c. Sociologists say that the most likely place for us to make meaningful connections is at our jobs with our co-workers.
d. Churches that have a clear sense of mission and whose members meet in small groups can provide an excellent source of connections.

Chapter 9: Habits of Healthy Sleep (p. 193-212)

28. Of the following, which is NOT consistent with good sleep habits?
a. After going to bed, don't lie awake in bed for more than 15 minutes. Otherwise, your body will associate your bed with staying awake. Get up and do something relaxing until you become drowsy. Then go back to bed.
b. Only use your bed for sleep and sex.
c. Don't sleep anywhere else in your home other than in your own bed.
d. Reading in bed or watching TV in bed can help promote good sleep.
e. Go to bed at the same time every night, and get up at the same time every day, including weekends.
f. Don't take naps if you have trouble sleeping at night.
g. Darken the lights in your home one hour before bedtime.
h. Avoid caffeine after your morning coffee or tea.
i. Avoid alcohol at night.
j. Turn your thermostat down by 5 degrees every night.
k. Redirect your mind from rumination, using progressive muscle relaxation, deep breathing, or by thinking positively.
l. Don't TRY to go to sleep. TRYING requires effort, and effort is counter to relaxation, which is when sleep occurs. Don't keep looking at your clock.
m. If the advice above fails to produce 8 hours of sleep each night, consult your doctor to see what might be interfering with your sleep, such as a side-effect of your medication, sleep apnea, periodic limb movement disorder, chronic pain, allergies, colds, hyperthyroidism, pheochromocytoma (adrenal tumor), etc.

Chapter 10: Putting It All Together (p. 215-230)
29. When beginning the Therapeutic Lifestyle Change (TLC) program, the best way to monitor your progress is by
a. completing the Depression Scale in Appendix A and totaling your score for each week. Decreasing scores show improvement.
b. the amount of sleep you are getting. The ideal is 8 hours each night.
c. the amount of weight you are losing as a result of increased exercise.
d. the increase in your stamina, motivation, and energy level.

30. By the end of week 12 (3 months) of beginning the TLC program, the author expects participants to experience a ___ decrease in depressive symptoms.
a. 10%
b. 25%
c. 40%
d. 50%