Depression Therapy

Lord, make me an instrument of your peace; where there is hatred, let me sow love; where there is injury, pardon; where there is doubt, faith; where there is despair, hope; where there is darkness, light; and where there is sadness, joy

– Francis of Assisi

Let us never forget that at any given time or space, we have intrinsically embedded in us the ability to take some form of action, be it large or small, that can impact our surroundings.  Choose now to impact your surroundings in a positive manner… I mean NOW, do it!

Assumption #7: Poor nutrition, lack of sleep, and lack of exercise, can precipitate or contribute to a depressed mood.

That all of these things can contribute to a depressed mood I think is pretty clear, and most would look at such a statement and agree to the truth of it.  I’m unsure whether lack of exercise or poor nutrition can precipitate a depressed mood, yet research has clearly shown that both poor nutrition and lack of exercise can fuel or contribute to a depressed mood.  What is more clear is the impact that lack of sleep has on our minds and also on our moods.  Sleep is absolutely essential to our well-being, and with only a few nights of sleep-deprivation we begin to observe the adverse effects.  Here are some of the areas that are affected:  memory and concentration wane; mood turns irritable; judgment grows poor; reaction times slow; coordination deteriorates; energy dims; and immune function declines.  If the deprivation continues the symptoms can become even more severe.  Research has shown that sleep disturbance and depression go hand in hand.  Not only can lack of sleep precipitate periods of depression, but depression often affects the patterns of sleep (usually over sleep or under-sleep).  Studies have shown that 4 out of 5 individuals suffer from some form of sleep disturbance, prior to the onset of depression.  What does this mean?  It means that finding some tools that will help you combat sleeplessness, will also help you combat depression!  What about sleep medication… should I take it?  I’m not opposed to you taking medication, yet something in your mind has to be absolutely clear – Medication is helping me to stabilize, and I need to work on my sleeping patterns and sleeping skills, so that I can learn how to do it without it.  Once again the focus is independence not dependence, and that statement is true for all medications including anti-depressants, which is why i sometimes get so frustrated when Doctors just prescribe the meds without any additional follow up or education.

Knowing this is powerful, but only in that it allows you to also see what steps you need to take to overpower your feelings of depression.  Like we have discussed before, exercise can have a dramatic influence on your mood and confidence.  I’m not a huge nutrition guy, yet there appears to be clear research out there about supplements (Omega 3′s and Vitamin D) that seem to have a significant positive effect upon people who are struggling with depression.  Sleep, of course has a tremendous ability to assist someone in rejuvenating their system, and also in helping their mood and clarity of thought.  So go do a little research and begin to get on top of these things.

Happy Day!

Assumption #6: Significant events or traumatic incidents can trigger periods of depression.

Many individuals seem to experience significant events that end up transforming into periods of depression.  The list is probably too long to list, but here are a few examples:

• A death of a family or close friend
• An assault, car accident or painful physical event
• painful mental or emotional event
• Marriage breakup, or love lost suddenly
• Constant physical, mental or emotional pain that goes on for a length of time
• Developing a disease or illness that will not get better
• Major financial setbacks
• Substance Abuse
• Rape, sexual assault, or other kinds of abuse

Now many or maybe even all of these events can cause anxiety or even feelings of sadness, yet depression is somewhat different than just a feeling of sadness.  I would even suggest that sadness, stress, and a disruption in your emotions is perfectly normal, yet depression is much more powerful and seems to rob people of motivation, emotion and can  create a substantial amount of pain.  I also feel that depression has more to do with the interpretation or judgment about the event.  Maybe I’m being a little too extreme when I say that all events are “neutral” by nature, and that we then color them according to our values, beliefs, fears, etc…  Is that too extreme??  Think that through for a minute though, what if events (things that happen to you) were by nature really just “neutral”?  What would that mean to you?  What kind of accountability and responsibility would that mean for you and for me?  It’s a difficult idea to swallow, that somehow we have to allow or honor (choose) a certain judgment of the event, and in that choice (our ultimate choice) lies our potential for happiness or misery!  Anyhow, just something to think about, yet the most important part to get out of this small article is your potential… your ability to read your events and transform what has happened to you… what is happening to you… and what will ultimately happen to you.  One quick last word, I feel that one of our ultimate purposes in this life is to grow, and with that in mind, I can color events as growth promoting.

Happy Day!

Assumption #5: Inactivity, avoidance, and escapist behaviors are core issues that can lead and exacerbate your depressive symptoms.

Okay, this is probably the very best picture i have ever seen describing most people’s attempts at avoiding or escaping depression.  Notice how his escape effort is about to lead to a big pile of POOP (sorry about the potty language)!  This is often what happens when we use avoidant or escapist behaviors, they only lead to more, and stinkier, problems.  No one has ever beat depression, at least long term, by laying in bed thinking about how to beat it!  Just like no one has ever ran a marathon or ironman by daydreaming about how they are going to do it.  Inactivity, avoidance, and other escapist (not sure if that’s a word or not… but i like it) behaviors almost always create additional problems, increase guilt, and like an untreated wound, they fester and sap confidence from your soul.  The challenge with depression and the symptoms of depression is that they specifically target our motivation and drive.  Like a smart-bomb, that can be laser focused on it’s target, so it is with depression.  When engaged in depression therapy I often find that individuals complain of a loss of interest in activities, lack of energy, fatigue, lack of sleep, loss of a sense of purpose.  Depression, like a thief in the night, seems to rob individuals of exactly what they need to defeat it.  I have found that medications can often be helpful in this area, yet… and this is a big YET… medication can ONLY BE AN ADDITIONAL TOOL!  This is critically important, because we are not trying to foster a dependency here, what we are looking to increase is your ability to choose and effect changes in your life.  So medication only serves its purpose as far as you are willing to work on the issues and improve the skills that in the long run will help you to overpower depression on your own.  If you remember the article that I wrote about exercise, and why it proved to be more effective than pills in the long run.  The power is in the realization that you are exacting the change, and more importantly, that you can do it again and again.  Now, back to inactivity, avoidance, and other escapist behaviors.  I find that people who are depressed are masters of avoidance.  Stay with me, these statements are not made to derail you, they are made to help you to see that some of the fog that surrounds you is man made… more specifically made-by-you!  It’s okay, don’t fret because knowledge in and of itself is powerful, yet it is not as powerful as action.  At the bottom of all my emails and business cards is one of my favorite quotes “the best way out is always through,” and that is exactly what you have to do to overpower depression and depressive symptoms in your life.  Drinking, drugs, pain pills, procrastination, excessive rumination, obsessive behaviors, irritation, anger, and lack of hope, often fuel depression.  These behaviors, at times, are only avoidance mechanisms, that perpetuate the problem of depression and feed it’s parasitic friend, anxiety.  So, what do you do?  Just like Steve MacQueen in the movie “the great escape” there is a way to escape, to successfully leave behind the behaviors that feed depression and anxiety.  First, you have to recognize that you are actually doing it, and then implement the already proven techniques to battle and eventually overpower feelings of depression.

Action Now:  Build your awareness by identifying when you are avoiding or escaping the things that you really need to do in your life.  identify the behaviors.

Happy Day!

“Worry does not empty tomorrow of its sorrow; it empties today of its strength”

“Worry is a cycle of inefficient thoughts whirling around a center of fear.”

–Corrie Ten Boom

Depression and anxiety, like a parasitic duo, usually join hands in their attempt to gain control and overrun our natural, God given gift of choice. I have found that most people who struggle with depression and symptoms of depression, also suffer from anxiety.  Often, part of depression therapy also includes treatment for anxiety.  Anxiety disorders, in my opinion, are simpler to treat, yet are just as difficult to live with. Once again we turn to the importance of your thinking habits, the time you spend ruminating, and focusing on what is inherently out of your control, instead of focusing all of your abilities and strength to what you can do and control.

Happy Day!

Assumption #4: Your thinking habits, and more specifically what you focus on, can fuel your depressive symptoms (especially ruminating excessively and obsessing).

It’s important to pay attention to the language that I use to explain this issue.  I’m not talking about thoughts, I’m talking about thinking habits and focus.  You cannot fully control all of your thoughts, though with some practice and the correct skills you can learn to master your focus and correct your thinking habits.  I find that many clients with whom I speak to are obsessive thinkers.  They may not necessarily be compulsive, yet they seem to report that they spend a lot of time ruminating or obsessing about what is going wrong in their lives.  This “habit or pattern” contributes to symptoms of depression.  Think of the implication, my thoughts can create or fuel depressive symptoms??  Do you see the significance behind this statement?  Your mind has tremendous power, and an uncanny ability to affect your mood, depressive symptoms, or anxiety.  Now for the great news… You may not become the master of your thoughts, but you can become the master of your thinking habits and focus.  Realize that there is a tremendous difference between what randomly enters your conscious or subconscious brain, and what you choose to think and focus on.  With practice and the skills that I will teach you, you will be able to enhance your ability to choose what happens to you consciously.  The theory behind it is not complicated at all, though the application of it will require awareness, compassion, and perseverance.  The key is to stop being scared of your thoughts.  Remember that you are not all of your thoughts… some of them are just thoughts… old memories… old picture albums… that you can learn to re-direct and respond appropriately to.  Aaron Beck (cognitive therapist extraordinaire) correctly indicated that most depressed individuals buy into three specific thinking distortions (thinking errors, illogical thinking):

1. They view themselves negatively – refuse to accept compliments, chastise themselves, mercilessly punish themselves for past mistakes, see themselves stuck and victimized, unable to change
2. They view others negatively – just as they are critical of themselves they are often just as critical of others, unforgiving, resentful, think others are out to get them, take everything personally, assume others are always judging or watching them
3. They view the world negatively – “life is a big crap sandwich… and then you eat it”, everything is seen with a negative tint to it, negative things are amplified and positive things minimized… you get the idea.

You see the problem right?  If you are thinking this way no wonder you are suffering from depression.  Once again this is where you need to stop justifying (yeah…but… iuri, you don’t understand… my situation… these events… these people… my boss… my dog… my neighbors… my teacher… etcetera, etcetera, etcetera) these kinds of distortions and start moving in a real direction.  I’m not suggesting sweeping things under the rug or faking it until you make it, what i’m suggesting is something much better, much more efficient, that won’t leave you feeling rotten because you are smiling when you don’t feel like it.

Action Now:  Begin to recognize how you see yourself, others and the world.  See if you can catch yourself ruminating or obsessing about how much of a crap sandwich your life is, and then write me a quick comment letting me know what you found out.  good luck and may the force be with you.

Happy Day!

Assumption #3-Your history, and more importantly, the way you respond to your past, increases or decreases your chances of being depressed during your life.

This can be a very personal and powerful discussion for some.  My years in practice have placed me eyeball, to eyeball with some of the most abused people I have ever heard.  Their stories of suffering, emotional abuse, broken homes, violence, drug abuse, sexual abuse, etcetera… etcetera, have impacted me, and the way that I look at the world around me.  These survivors are often left with horrific wounds, that fester and haunt.  Often their perception of life is dimmed, and the dreams that are so real in the eyes of some, become further proof that something is wrong with them… and that they are destined to live a life filled with torment.  These precious people often suffer from severe anxiety disorders, severe depression, sleep problems, relationship problems, and a fragile existence.  Who is to blame?  I remember visiting with a young lady some time ago whose family tree was filled with 6 to 7 different fathers, drug abuse, prison, violence, and all sorts of abuse.  I remember vividly thinking to myself: “she doesn’t stand a chance.”  It was heartbreaking, because even though my sincere hands were reached out to assist, her perception was so calloused, so hardened, so distrusting that she was unable to see it for what it was.   What is to be done?  What is a child supposed to do when she is faced with such serious and severe circumstances?  If most adults don’t know how to deal with things of this magnitude, children are especially helpless, and often react in a very protective and fearful way.  Unfortunately for them, this short term “defense mechanism-like” response, can create significant long term problems.  Abuse is not the only problem.  Family deaths, accidents, and other traumatic events can create a “hair-trigger-like” stress response in individuals.  This over-sensitivity to life stressors makes people especially susceptible to depressive symptoms, anxiety, and obsessive tendencies.  Geez… I’m getting depressed just talking about it… let’s move on to what we can do about it NOW!  what can we do about it?  What if I have a hair-trigger reaction to stress, what can i do about it?  LOTS… you can do LOTS about it, and that is why we are putting together an “overpowering depression program” to assist people to do just that.  The first step would involve realizing that they are patterns, responses, habits that have turned into ruts… water drainage.  The recognition that our maladaptive responses to these unfortunate events have created some degree of dysfunction (we are all a little crazy), carries within it the ability to effect change.  Here are some typical maladaptive responses that adults and children alike use as protective mechanisms that often backfire on them:  Avoidance, procrastination, distrust, paranoia, withdrawal, isolation, secrecy, anger, resentment, bitterness, violence, self-blame, etc.  Remember responses can be changed.  Your brain can be taught.

Action Now:  You don’t have to dive back into painful situations, or relieve dark periods, just courageously become aware that somewhere along the line you have become accustomed to responding to crappy situations in crappy ways.  Listen here… there are better ways, and you can do them!

Happy Day,

Assumption #2:   Some people may be predisposed depressive symptoms organically.  For others, continued patterns of response to stress, trauma, and life events can contribute to a chemical imbalance or change in brain function.

This is a difficult assumption to address, because in a way we are attempting to explain what came first, the chicken or the egg.  The answer to that question is… (drum roll) YES… both are true!  It’s possible that some people are more at risk for experiencing depressive symptoms.  Much attention has been given to genes and the role they play in predisposing individuals to depression.  Research shows that genes can account for about 40% of the reason why some people suffer from symptoms of depression.  I won’t pretend to know and write about all the medical reasons why this is so, I will simply mention one area that has received particular attention -The serotonin transporter gene.

As the name explains, this gene affects the function of serotonin in the brain.  Serotonin is the chemical messenger that plays an important role in shutting down the stress response circuits and reducing anxiety.  Some people who suffer from depression appears to have a specific kind of this gene (short transporter gene), which affects the delivery of this chemical to the synapses.  In effect, people who have this gene, appear to receive deficient doses of this “I feel good” chemical.  This is why anti-depressants have become so popular, in that they attempt to address and fix this anomaly, by keeping the serotonin that’s produced in the synapse, there for a longer time.  This is what people refer to as a chemical imbalance, the good news for people who seem to have this gene is this.  There is medication and cognitive, behavioral, nutrition, exercise, and spiritual actions that you can take to affect the way you feel.  Let’s turn to this part now.

I suggested at the top that, “continued patterns of response to stress, trauma, and life events can contribute to a chemical imbalance or change in brain function.”  This, unfortunately, appears to be true.  Researchers have found and clearly shown that individuals who experience and respond to stress and depressive symptoms in negative ways (avoidance, drinking, drugs, secrecy, shame, guilt, isolation, withdrawal), actually affect how their brain function.  Much like an imprint, or rut.  I suppose that sounds like bad news!  but here is the good news.  The same research has also yielded the opposite results.  Positive response to symptoms (exercise, activity, social connections, sharing, therapy, cognitive restructuring, positive behaviors, good nutrition), also creates long lasting changes in the brain, or a positive imprint on the brain.  The reality here is this… our brains are constantly changing while we are busy behaving on a day to day basis.  Remember that our brain is in the business of creating patterns, good or bad.  The brain is not the judge of whether a  pattern is good or not… you are.  If patterns continue to lead to negative long term consequences, it means they are maladaptive, which means that we should get busy trying to change them to more positive habits.  Let me share a quick analogy to summarize what I’m talking about:  Your brain is like a jungle (that’s fun in and of itself).  You, armed with a sharp machete, go to work clearing up forest to make a path.  So you chop and walk through the vegetation, over and over and over and over, until a clear path through the forest can be seen.  This is symbolic of a pattern.  If this is a negative pattern, then it’s time for you to put a “no entrance” sign at the entrance of it, and start chopping away at a better path.  Depressive symptoms are often caused and fueled by negative responses, time to go to work recognizing them, and changing them to better ones.

Action Now:  Which patterns of behavior, paths through the forest, have you created that are maladaptive for you?  Well, what are you waiting for, put a “no trespassing” sign in front and determine which path you will take instead.

Happy Day,

Assumption #1:  Depression is a symptom that your life is “out balance.”  A red flag or a warning signal that needs to be addressed.

Growing up in the beautiful southern coast of Portugal, I got to experience incredible storms that would roll in every time there was a southwest wind.  These storms were wonderful for two reasons:  One, the water always became a few degrees warmer, and two,  it was time to grab the body board and hit the waves.  Without fail, we would arrive at the beach and see the Red Flag flapping in the wind, letting us know that swimming was restricted due to wave size and the difficult currents that were created.  Of course nobody listened and within a few minutes my friends and I were carving up waves and having the time of our lives.  This small story is meant to suggest a different approach to your depressive thoughts, feelings and symptoms.  Instead of continually avoiding or running from depression (the stormy ocean and difficult currents), I would like to help you dive in and “carve” through these periods of turmoil and unrest.   In addition to the intro, I would like to once again throw out a quick preface to this entry; this assumption is not meant to minimize the symptoms of depression and the tremendous chaos that they can cause to an individual, or a family.  My purpose in addressing this assumption is to suggest a different way of looking at depressive symptoms.  This is a common technique in Dialectical Behavior Therapy (DBT) or Acceptance & Commitment Therapy (ACT), where a trained professional attempts to guide a client toward viewing his thoughts, feelings, or other symptoms in a healthier, less threatening way.  They often refer to this as “mindfulness” or “radical acceptance.”  Let me explain how this would apply in your current circumstance.  Often people who suffer from depression do much of what the sign at the right suggests, they “run like hell.”  They are constantly in a state of reaction, often emotionally reacting to whatever stimulus just presents itself.   Stimulus happens (criticism, negative event, argument, rejection, lack of integrity or follow through), and immediately there is an emotional response, usually driven by fear, insecurity, or old patterns.  This, somewhat, subconscious, hypnotic suggestion-like type of response is almost like a blind spot, and often times, cannot be perceived by the individual itself.  Aaron Beck (Cognitive Therapy Powerhouse) described it as someone attempting to look at the back of his head… it just doesn’t work.  Well, the time has come for you to look over your shoulder, or grab two mirrors to finally get a look at the back of your head, and realize that these symptoms, feelings, and thoughts are attempting to tell you something.  Could this be true?  What if instead of running “like hell,” you moved toward the feelings?  Mindfulness based theories suggest that as you come to accept, or move toward the feelings you are experiencing  (like a scientist looking for clues, patterns, solutions), that over time, the feelings lose some of it’s power… some of it’s control over you.  Taking the “run like hell” example, this pattern of avoidant behavior has more likely than not created much grief, misery, and continued states of depression.   Although “run like hell” behavior often provides short-term relief, it often guarantees that future bouts of depression will return with renewed guilt, and shame.  In addition, they often serve to perpetuate the state of darkness (blind spots) in which persons who are suffering from symptoms of depression, find themselves in.   The solution begins with the realization (mindfulness) that your state of depression is a message to you that something is wrong.   Next you must move toward depression inquisitively in an effort to find answers.  Once aware of negative thinking habits, behaviors, and patterns, you must acquire new skills and tools that will help you address the issues at hand.  Lastly, you must take action with the understanding that the wonderful process of change is exactly that… a strengthening process.  Begin today to look at depression differently.  Stop the running and begin to move confidently towards it.

Action Now:  Next time you begin to feel sad, or happy, or angry, or humble, or grateful, take some time to indulge in that moment.  Become aware of the thoughts, feelings and circumstances that surround you.  Ask yourself whether the behavior (your response) assists you in the long run or not.  Learn new skills and move forward.  Oh yeah, never give up!

Happy Day!

According to the DSM IV-TR(Diagnostic and Statistical Manual of Mental Disorders) depression is described as a disorder with at least five of the following symptoms.  At least one of them must be symptom 1 or 2:

1. Sadness or depressed mood
2. Loss of interest or pleasure in all or most things that you usually enjoy
3. Significant weight loss or gain
4. Difficulty sleeping (too much or too little sleep)
5. Feeling very restless (unable to sit still) or feeling very slowed down
6. Being tired all the time
7. Having feelings of worthlessness or guilt
8. Difficulty thinking or concentrating
9. Having repeated thoughts of death or dying

These symptoms need to be present for a period of at least two weeks and occur most of the day nearly every day.  Furthermore you must rule out other factors such as medical illness or the effects of drugs, alcohol, or certain medications, which could cause these symptoms.

Often this set of beliefs and feelings, lead us to withdraw; to isolate; to become hypersensitive; to become resentful of others; to procrastinate; to avoid (a key element in depression) situations or individuals;and to lose a sense of purpose and direction.  Of course these behaviors or actions in turn create more depression (behavior-mood links, more on this later).  This is a very important cycle that you need to be aware of immediately.  It is a negative feedback loop, that won’t stop or alleviate, unless you snap out of that muddy rut.  This is why we suggest that depression is more than just feelings or symptoms, it is a way of responding to the thoughts and feelings you are having at any given point.  I often tell friends that “the problem with people who are depressed, is that they always do what they feel like doing!”  For example they’ll say: “I don’t feel like getting out of bed… so they don’t;” “I don’t feel like exercising… so they don’t;” “I don’t feel like going to work… so they don’t;” the problem of course is that they are living their life in a state of reaction, not action.  It is time for you to stop allowing fear, sadness, and insecurity to drive your daily actions.  It is time for you to live deliberately, and to make choices that coincide with a higher purpose or meaning.  Henry David Thoreau spoke eloquently and powerfully when he stated the reason for why he went to live in the woods - “I went to the woods because I wanted to live deliberately, I wanted to live deep and suck out all the marrow of life, To put to rout all that was not life and not when I had come to die Discover that I had not lived.” Yes, let us live deeply, and suck out all the marrow of life.

Action Now:  Ponder and consider which behaviors and thinking habits maintain your symptoms (or worsen) of depression.  Determine to learn new ways to respond, and “bust out” of the muddy ruts that you find yourself in.

Happy Day!