Target Zero to Thrive FAQ

DBSA works hard to ensure that the voices of those living with and affected by mood disorders are heard concerning all issues related to mental health. Thank you all for the wonderful feedback you given us on Target Zero to Thrive. We thought you would appreciate more background on why the program was developed.

Why did DBSA launch the Target Zero to Thrive campaign?

Total remission, zero symptoms, is rarely the end goal today for mental health treatment as it is in other health conditions. Rather, we hear clinical terms for mental health treatment goals like “measurable improvement,” and/or “stable.” Not wellness. Not thriving lives. DBSA is partnering with you to start a dialogue within the clinical, research, and peer communities about raising expectations for the clinical treatment of mood disorders.

DBSA believes we and our peers deserve the chance to thrive, so we’re asking

  • Clinicians to dramatically raise the goals for their patients’ treatment. To work together with them to strive for complete remission of symptoms (see the costs of not doing so below); to measure how well people are as opposed to a singular focus on how sick they are by incorporating measurements like the World Health Organizations WHO-5 Well-Being Index into their practice; and to establish goals that align with their patients’ goals for wellness, not just those outlined on a symptom scale.
  • Researchers to seek out better treatment options, both pharmacological and non-pharmacological, that move beyond “measurable improvement.”  To incorporate wellness measurements in addition to symptom measurements into the evaluation of those treatments; and to look to those living with mental health conditions to drive the focus of studies based on the things that matter most to them.
  • Peers to expect more from their treatment teams. If you’re not working with practitioners that hold the belief that wellness is possible, it is unlikely that you’ll achieve it. Create a plan and share your wellness goals with your mental health providers. If they’re not on board, find others that are. And yes, we may also need to raise our personal expectations for what is possible. The journey is not easy, but wellness—however you define it—is possible! Many people living with mood disorders live extraordinary lives. DBSA is working to help make that a reality for more people—to have wellness become the norm instead of the exception.

You may also want to listen to the TZ2T podcast featuring DBSA Scientific Advisory Board members, Dr. Gregory Simon and Dr. Joseph Calabrese, discussing current treatment options for mood disorders and the need within the clinical and patient communities to shift expectations and raise treatment goals to complete remission of symptoms and sustained wellness.

Why is DBSA specifically targeting zero symptoms?

The cost of settling for reduced symptoms is simply too great—because when symptoms persist, individuals who have mood disorders are

  • at significantly greater risk of relapse
  • more likely to experience significant functional impairment, making the day‐to‐day demands of job and family challenging, and too often, debilitating.
  • more likely to have life‐threatening co‐occurring conditions, such as heart disease, hypertension, and diabetes—a huge factor in why individuals with mental health conditions die, on average, 25 years younger than those without mental health conditions
  • at a higher risk to die by suicide

Statistic citations for the above four points can be found at www.DBSAlliance.org/TargetZero.

Is DBSA saying that the only measurement of wellness is zero symptoms? That I can’t be well and have some residual symptoms? 

No. Wellness is different for each person. Many people live full lives even though they still experience some problematic symptoms. But, we do believe that the closer we get to complete remission of symptoms, the easier it will be for people to live in wellness and the less likely it will be for people to be vulnerable to relapse, functional impairment, life threatening physical conditions, and suicide.

Doesn’t DBSA think achieving zero symptoms is an unrealistic goal?

Yes. Well, a qualified yes. Today, achieving zero symptoms is unfortunately unrealistic for many, though not all, individuals living with mood disorders. If you don’t have a treatment team that believes wellness is possible; if you do but time and other limitations prevent that team from working with you towards that goal; if treatment options (of all kinds) aren’t available for you to go beyond “measurable improvement”; if you aren’t given the hope that wellness is possible—then achieving zero symptoms can be an uphill battle.

That is why DBSA has initiated this campaign. To start the conversation about how we collectively (clinicians, researchers, people living with and affected by mood disorders) can work to change this. And to discuss how we can use the tools that do exist today to get us closer while we work towards that change—because while achieving zero symptoms today might be unrealistic for many, thankfully achieving wellness, as defined by a full and extraordinary life, is not unrealistic. The journey is not easy, but wellness—however you define it—is possible! In fact, although the road is often hard and long, many, many people living with mood disorders do find treatments that work well, support to help them when they need encouragement or assistance, and personal strategies to help them lead full and extraordinary lives! We simply believe that the closer we get to zero symptoms, the easier the journey will be and the more likely wellness will be a reality for more people.

DBSA honors every person’s unique journey to wellness and looks to our peers to inspire us, to give us hope along the way that life need not be limited by a diagnosis. Looking for a little inspiration? To read stories from peers living extraordinary lives, visit our Life Unlimited page.

Is DBSA saying that I have failed if I don’t achieve zero symptoms?

No. Target Zero to Thrive is about raising the expectation of clinicians, researchers, and peers for the treatment goals of mood disorder. In other words, to say let's not consider treatment "done" when a person is no longer suicidal, or stable. Let's continue to work together to help a person reach as full a life as possible. That ultimately may indeed mean that symptoms persist—and that would not be a personal failure. As DBSA President Allen Doederlein shares, "If a person doesn't achieve zero symptoms, they haven't failed, but if they are never given the opportunity to achieve that goal, the system has failed them."

How can I even consider thriving when I’m still struggling to survive?

DBSA President Allen Doederlein shared his perspective on this in his note in DBSA’s March eUpdate newsletter as copied below.

NOTE FROM ALLEN (as published in DBSA’s March, 2014, eUpdate)

After the introduction of DBSA’s 2014: The Year of Thriving, a friend and colleague from one of DBSA’s chapters called to congratulate us on a campaign that looks at those of us who live with mood disorders not as amalgams of symptoms, but as a diverse and talented group with much to contribute, and potential not just to survive, but to thrive. Yet he went on to share that, when he described the initiative to participants in one of the chapter’s support groups, their reaction was dubious. “Thriving” as a concept seemed difficult to grasp among a group of people that had experienced recent hospitalizations, suicide attempts, or unemployment. Indeed, when shared with people for whom surviving didn’t seem a given, but rather a hard-won battle, “thriving” felt like almost an impossible dream—a destination so far away that even to think of it could be perceived as setting oneself up for failure.

This sentiment truly resonated with me, and all the more so as, over the past several months, I’ve personally dealt with much more acute symptoms of depression than I have had in a very long time. There were days, even weeks, when thriving seemed so very far away; indeed, I don't think thriving was on my mind at all. During those stretches, just for tears to stop, for anxiety and self-loathing to lessen, for racing thoughts to slow down were all I could muster hope.

I guess what I’m saying is that I get it. I know from real, and recent, personal experience that sometimes, just making it through to the next day may actually be a very lofty goal. When I assured my friend that I understood and validated the support group members’ concern about thriving, he shared that maybe a better verb would be “striving.” And I like that. What DBSA’s Year of Thriving is all about is not a notion that, if we’re not personally in a place of thriving, we’re somehow failing. Rather, we feel that we, as a community of peers, must take the lead on a fundamental paradigm shift: that, although surviving is where we sometimes must start, we owe it to ourselves and our peers to promise ourselves that this is not where we will settle. And “thriving” is our word for that transformation—from symptoms to resiliencies, from illness to wellness, from settling to striving. When we as a community can demand and achieve a higher standard of what “successful treatment” is, we will as a group and as individuals thrive.

Higher standards require new targets, and so in April we launch Target Zero to Thrive: a challenge to our community to raise expectations from fewer or less severe symptoms to zero symptoms, from better to well. The reasons for this are not just that we deserve better (although we do). Targeting zero symptoms will mean our likelihood of relapsing is lower and the courses of our conditions will not be as severe. Join DBSA in spreading the word that we’re setting a new standard for research, for treatment, and for our own expectations and demands!

Believe me, I know—I know—that thriving can seem so elusive, even impossible, at times. But we can’t get there if it’s not even part of the conversation, and that’s why DBSA is targeting zero…we must strive for a new endpoint if we’re truly committed to wellness.

How do I Target Zero to Thrive after April?

After April the hard work begins! We’re asking

  • Clinicians to dramatically raise the goals for their patients’ treatment. To work together with them to strive for complete remission of symptoms (see the costs of not doing so below); to measure how well people are as opposed to a singular focus on how sick they are by incorporating well-being measurements like the World Health Organizations WHO-5 Index into their practice; and to establish goals that align with their patients’ goals for wellness, not just those outlined on a symptom scale.
  • Researchers to seek out better treatment options, both pharmacological and non-pharmacological, that move beyond “measurable improvement.”  To incorporate wellness measurements in addition to symptom measurements into the evaluation of those treatments; and to look to those living with mental health conditions to drive the focus of studies based on the things that matter most to them.
  • Peers to expect more from their treatment teams. If you’re not working with practitioners that hold the belief that wellness is possible, it is unlikely that you’ll achieve it. Create a plan and share your wellness goals with your mental health providers. If they’re not on board, find others that are. And yes, we may also need to raise our personal expectations for what is possible. The journey is not easy, but wellness—however you define it—is possible! Many people living with mood disorders live extraordinary lives. DBSA is working to help make that a reality for more people—to have wellness become the norm instead of the exception.

What’s next?

It is DBSA’s sincere hope that starting this dialogue about raising expectations for clinical treatment goals as highlighted by Target Zero to Thrive is just that—a start.

  • A start to more and more in-depth conversations within and between the clinical, research, and peer communities about how we can raise the bar for treatment.
  • A start to create fundamental change not only in perception but in practice.
  • A start to open the door to new standards of care and treatment options so that someday the goal of zero symptoms is no longer viewed as impossible, but as probable.

So let’s keep the conversation going. Let’s try to get this topic on the agenda of major mental health conferences where clinicians, researchers, and those living with and affected by mood disorders can explore this further—and work together to find opportunities for meaningful change.