Depression: Part 1

This topic, depression, will be broken into two parts. Understanding depression, treating it, managing it, etc. can be approached from so many angles. This post will be more looking at depression on a surface/practical/lifestyle level. The next post will go deeper into the realm of meaning and purpose and how the lack of, can lead to depression. But for now, let’s not go too deep, let’s keep it practical, and start by looking at our everyday choices and what they could be doing to contribute to our overall mood. 

When I’m treating someone with depression I start by exploring if what they are feeling is typical or clinical. The reason I do this is because all of us are vulnerable to the ups and downs of life. When in graduate school, I was an intern therapist at the university’s mental health clinic (may the good Lord above forgive me for the terrible therapy I provided those people). Before each appointment, the clients would be given a survey to fill out on an electronic tablet. The survey was tracking their mood and overall depression levels, comparing and tracking their progress from their 1st appointment, to each following week of therapy. In order to determine if they are actually depressed, their scores on the survey had to be compared to the general population’s scores. The general population meaning, those who are not in therapy currently but just going about their daily lives. The client’s results/scores were placed on a 0-10 scale (0 being no depression at all, 10 being severely depressed, if not suicidal). Now, if you were to guess what the average score of depression was in the general population; or in other words, the level of sadness that everyone is usually walking around with, what would you guess? The answer is 4-5. Upon seeing this, the clients wouldn’t feel so bad when they would score a 6-8 because compared to everyone else, come to find out, they’re not so bad. The next step I would do with these clients is explore with them lifestyle changes they could make, to take their score from, let’s say, a 7 down to a 6, then over the next few weeks, from a 6 down to a 5, and so on. 

Depression and pain can be lonely, because well, you are the one feeling it. We can’t literally give it to someone else or divide and share it. However, when we know that on average, we are not that far off from the general population’s scores of feeling negative emotion, it can give us hope. That maybe, just maybe, we can make some adjustments in our lives to start to feel better; because very often, if not always, you have to do better before you feel better


To “do better before feeling better” is the correct order of operations. All too frequently, we wait to feel better (motivated) before we do better (action/change). We have to be driven by discipline, devotion, and an acceptance of pain (all of which are deeper than motivation). But where do we start? What areas of our life can we begin to explore to discover how we could be doing better?

May I suggest looking at the following areas of your life (almost like an inventory) and look for any ways, no matter how small, you could be doing better. The key to this is honesty; to honestly and openly reflect on how you are living now and if there is any way you could do something differently that would benefit you. If you open your mind and soul to this, you’ll hear that small voice inside you guiding you to clarity and direction.

Sleep - What are my habits around sleeping? Do I/Should I get up at relatively the same time and go to bed at the same time every night? Do I have a nightly routine that helps my body, mind, and soul get ready for bed? (A routine that doesn’t involve screens at least 1 hour before bed). 

Nutrition/Food & Water - How much water do I drink? If I’m being honest, should I drink more? How much sugar am I ingesting each day? Is there a balance (hey, I enjoy a cookie and donut just like anyone else) that is now off? How do I feel when I eat healthier vs when I let loose? 

Exercise - Am I either lifting weights or engaging in cardiovascular type workouts at least 3-4 times a week for 45 mins each time? Where could I start? Could I at least go for 2 walks this week? What support can I ask for to get this done? 

Relationship with Screens/Entertainment - What entertainment am I taking in? Pay attention to how you feel afterwards. Have I consumed too much? What is this time on screens really doing for me in the context of my overall mood? 

Time management & Routines - How do I spend my time? Am I productive at work? What do I do with my free time? Do I live my life with a plan in mind that is fairly consistent? Is my time management too strict and organized? Too chaotic? Do I routinely set aside time to be with people? Do I spend way too much time online? 

Spirituality - Do I feel connected to something bigger than me that leads to positive growth? God? Nature? My community? 

Relationships - What is the state of the most important relationships in my life? While I may not have the types of relationships I want (ex., being single and wanting to be married), do I still take time to nurture the familial and peer relationships that I DO have? Is there a strained relationship that I am avoiding? Do I need to work things out with this person before it gets worse? 

Work/Job environment - Is the work I am doing meaningful? If so, why or why not? Am I satisfied with my work? Would I feel better if I really gave it my all? Do I have a decent relationship with my boss or co-workers?

Cleanliness of living spaces/work spaces - Think of your room, workspace, home and your mind as being reflective of one another;  how are things looking? Can I pick an organizing/beautifying task in one of my spaces and make it better? How does it feel when I do that? How might a cleaner and more beautiful space affect my mental state?  

Values - What inherently good values are important to me? Am I living up to them? For example, Do I value honesty? Do I lie frequently to others? Do I lie to myself? Telling the truth to myself - What do I need to change!? Finally acknowledging the truth-  Do I need to break up with him?  I wonder how I would feel if I really tried to tell the truth for 2 weeks. Hmmm.

Do I value kindness and compassion? I wonder if I would feel better if I made a deliberate effort to reach out and help someone that is in need of help. Or at the very least, look around and seek ways to help others in my neighborhood. Are my beliefs/perspectives/value system bearing good fruit? 

Okay, now that you have a roadmap for a lifestyle inventory, give it a try. There are various ways to look at and treat depression, but this is always a good place to start. It will take effort, lots of reflecting and sometimes some bravery, but I encourage anyone to do this. Yes, it may reveal some failures in our everyday choices. Yes, it may leave us feeling down about ourselves, but that feeling is due to a choice of perspective. You can look at this inventory as a sign of your failures (which, okay, it could be) and/or you can look at it as a roadmap to feeling better. 

In a world where immediacy and quick fixes abound, getting back to patiently improving ourselves a little bit at a time can be hard but trust me, it’s worth it. I’ve seen this approach effectively help people not only make positive change but sustainable change! Except for some comfort and perhaps pride, what do you have to lose? We can accept the pain of making necessary changes now, or experience the suffering from not making these changes later. 

“The conquest of the soul is in reality a work of patience, self sacrifice, and devotion.” - Carl Jung

“Straight, not straightened.” - M Aurelius


Part 1 of The Big 3:

Anxiety

by Ron Squire

In my experience as a therapist I have treated a lot of what is sometimes referred to as the “big 3”. The big 3 are Anxiety, Depression, and Trauma. Today’s thoughts will focus on Anxiety (although at times, not always, but at times - all 3 can become connected, interwoven, and start to feed off one another). 

Anxiety can be seen as an alarm system. Anxiety comes from a very ancient and old part of our brain. Its main purpose is to keep us protected and alive. Anxiety is actually what has contributed to us as a species surviving this long. Anxiety overestimates threats and underestimates our abilities to deal with the threats (whether real or imaginary). Think about it, if we perceive a threat, and we don't feel we can handle it, then we run. Running away from something leads to a higher chance we’ll stay alive versus confronting it.

Another perspective on anxiety is that it’s a form of time traveling.Those suffering from anxiety or consistent worry live in “what if land” (future mindset) and not in “what is land” (present mindset). Constantly wondering about the “what ifs” in life can lead us down an endless maze of possibilities with danger and harm lying behind every turn. Thinking about the future is not always bad though. Future based thinking is necessary at times. There is, however, a difference between healthy future thought vs unhealthy future thought. William James in his book The Varieties of Religious Experience discusses this difference as “Fear Thought vs Forethought”. Forethought is good - “What do I pack for my trip?  How much will I need to save up for a new car? How many string cheeses will we need to bring to make sure our children don’t turn on us and lead a rebellion of violence and aggression?” Fear thought is bad. What differentiates fear thought from forethought you ask? Fear thought is thinking about something coming up that may be challenging and feeling incapable. There is something coming up and I AM INCAPABLE of meeting the challenge (remember, anxiety is an overestimation of a threat and an underestimation of our ability to deal with it).   

One well-intentioned goal of many clients is to “get rid of” their anxiety. While I understand their desire, that is something that will never happen. Anxiety is a part of our story, however, it does not have to be the entirety of our existence. Anxiety is not going away, but to what degree we feel anxiety (clinical or typical) we can maybe do something about.

Here are some general things I myself have tried as well as my clients that have been successful in keeping anxiety in check; at least enough to be able to more effectively navigate the challenge ahead:

1)Deep breath, step back - oxygen is fed to our frontal cortex, the analytical part of the brain responsible for taking perspective and navigating our way through the challenge in front of us. Oxygen intake will bring back online this part of the brain that can help keep the anxiety in check. 

2)Ground yourself in the present - check in with what IS, not what if. Then, really take stock of your capabilities to deal with what IS. Talk to your anxiety, thank your anxiety for doing its job. But then you can discard it by gently steering that anxiety in the right direction. Just by slowing down your breath and turning back on the analytical part of the brain (prefrontal cortex), you give yourself time and a chance to make the next best decision/move.

3) Choose your Move - 

But what is the move I should choose? 

To conquer your anxiety it takes voluntary, incremental steps towards the thing you’re afraid of. 

Do you over involve yourself? Are you a control freak? Does the loss of control bring up anxiety? If so, then the conquering of your fear would be taking voluntary incremental steps towards letting go; to remove yourself and just be. It’s not about inaction but rather disciplined inaction. 

Do you isolate yourself? Hide out? Avoid? If so, then the conquering of your fear would be taking voluntary steps towards the very thing that scares you. 

To engage or disengage? That is the question when it comes to anxiety. Which do I do? Well, it depends on what is more scary to you. If stepping forward and engaging is what terrifies you, then that is what you must do. If stepping back and letting go is what terrifies you, then that is what you must do. 

Anxiety is real but not real like a pen or an external object we can touch, taste, smell, etc. Anxiety is experienced within and once we recognize it for what it is (an alarm system that is just trying to protect us), take a deep breath, ground ourselves in the present, and start to bring back online the analytical part of our brain (introduce other perceptions or perspectives), we can choose what we do with it. 

To close I can’t say it better than Marcus Aurelius, in Meditations, when he says this about anxiety:

“External things are not the problem. It’s your assessment of them. Which you can erase right now.” (110)

Today I escaped from my anxiety. Or no, I discarded it, because it was within me, in my own perceptions - not outside.” (121)

Citations:

M. Aurelius - Meditations

William James - The Varieties of Religious Experience