How to Deal with Depression

Depression is more than just feeling really, really, really sad. Depression is also something that can come and go in your lifetime depending on certain human needs not being met. Think of depression as a cluster of symptoms affecting you all at once. Symptoms such as: fatigue, crying spells, lack of motivation, feelings of worthlessness or hopelessness, and low self-esteem to name a few. If you’ve been experiencing this for more than 6 months, it may be time to seek some type of treatment.

So, what do you do about depression? As mentioned earlier, depression, anxiety, and other psychological distress happens when our basic human needs are not met. As part of my assessment process, I ask clients to complete a short questionnaire stating whether or not each need is met in their lives. Needs include:

Security

Autonomy

Community

Competence and Achievement

Emotional Connectedness (friendship and intimacy)

Sense of Meaning or Purpose

Take an inventory of the above needs and ask yourself where you stand for each. Are these needs met in your life? If not, what must change in order for that to happen? What perceived barriers are in the way of meeting these needs? What negative thoughts do I keep telling myself that keeps me stagnant?

Medication can be beneficial. However, keep in mind this will only help you manage the symptoms as long as you take the medication, and will not be the solution to the cause of depression. Unless you are confronting the cause of depression head on, the feelings are sure to come up again at some point. This is where therapy can be helpful.

Cognitive Behavioral Therapy (CBT) is one helpful way to decrease or eliminate symptoms of depression. Now, there are other forms of therapy, but CBT is the most beneficial when trying to identify any negative thinking patterns or associations that may be fueling the depression.

CBT allows us to figure out how to stop the ever so popular “all or nothing” thinking. For example, you make a mistake at work and your manager approaches you about the issue. The “all of nothing” cognitive distortion will have us thinking to ourselves, “I can’t do anything right. My manager hates me. I’m going to be fired.” (This is also an example of something called “catastrophizing”). Meanwhile, back in reality, your manager simply asks you to be more mindful next time and moves on.

So the next time you find yourself thinking in “all or nothing” terms, stop yourself and ask, “What is my evidence to support this thought?” and “Where is the middle ground?”

The last point I’ll make is this: You are not you’re depression. There is more to who you are than the symptoms you’re experiencing. Instead of seeing yourself as the problem, zoom out for a second and become a participant in addressing each symptom individually.

The above is only a fraction of what you may need to know about depression and how to cope with the symptoms. If you feel like you could benefit from therapy, please advocate for yourself and seek treatment.

How Trauma Impacts Our Nervous System

In light of the recent school shooting in Parkland, Florida, I feel compelled to share information regarding how traumatic stress can impact a person’s life. Also, how one can overcome the life threatening event(s) when all hope is lost. There’s a moment when you watch an interview with one of the survivors from the school shooting soon after the event took place, and see that their hands are trembling, their thoughts are scattered, and muscles are tense. In this moment, you are seeing someone experience a dominant sympathetic nervous system. Not only do the above symptoms occur, but a person will also experience accelerated heart rate, constricted blood vessels, rise in blood pressure, and overall physical sensation amplification. Mentally, their language ability reduces, logic and reasoning shifts, and executive functioning skills shut down. Our instincts kick in when we are under threat and we choose one of three instinctual responses: fight, flight, or freeze.

Our bodies know when we are under threat and prepare us for action. Our heart rate increases in order to push blood to our limbs faster so we can be ready to fight or flight. Not only does this happen with a real life-threatening event, but also perceived threats. Think of perceived threats like this: All of our stress is the result of experiencing a perceived threat. In other words, stress does not exist without perceived threat. And guess what happens when we are stressed? Sympathetic nervous system dominance.

There is a good chance that students and survivors of the school shooting in Parkland, Florida will experience posttraumatic stress and some may develop the disorder itself (PTSD). The job many trauma therapists and other mental health professionals have to do now is help those who experienced the above symptoms and work to achieve parasympathetic dominance. The way to do this is to teach survivors how to engage in reciprocal inhibition (Wolpe, 1968). Survivors must learn how to desensitize the present day effects of trauma with a regulated autonomic nervous system and relaxed muscle body. “By maintaining relaxed muscle bodies in the context of perceived threats, normally functioning adults can quickly find physiological and psychological comfort, maximize neocortical (thinking) functions, and regain intentional, principal based behavior even while we are confronting these threats (Gentry, 2016).” In order to self-regulate and relax, one must become intentional with releasing muscle tension they hold throughout their bodies. Allow yourself to let go of the muscle constriction and feel heavy in your chair. So, here's the take home message: You cannot be stressed in a relaxed muscle body. Give it a try and feel the difference.

"Healing the Angry Brain" - Dr. Ronald Potter-Efron

I've recently read a fascinating book by Dr. Ronald Potter-Efron titled, "Healing the Angry Brain." Dr. Ronald Potter-Efron provides the reader with the ability to understand the science behind how you're brain operates when angry and the coinciding behaviors associated with the emotion. Additionally, he breaks down the Six Stages of Anger and describes what can go wrong and when.

I've outlined and summarized the Six Stages of Anger below, which I share with my clients who experience issues in controlling their own anger. This allows clients to see where they miss-step in the expression of anger and how to resolve the hurdles of expressing one's anger. You will see examples of how anger is handled well and how anger is handled poorly, according to Dr. Ronald Potter-Efron. (Note: This is my summarized version).


The Six Stages of Poorly Handled Anger:

Stage 1: Poorly-Handled Anger Activation

  • Too quick to anger; immediately feel threatened or anxious.

  • Fight or flight response has been activated and you’re ready to argue.

  • This occurs at the preconscious level and you’re already in a fight without even realizing it.

  • If you continuously have issues with anger, your anger will become triggered automatically. Again, without you even knowing.

  • You are now primed to only gather negative information that will justify your anger and aggression.

Stage 2: Poorly-Handled Anger Modulation

  • Too strong a response.

  • Your brain is telling you, “Danger, danger danger! ”You’re intense emotional reaction is accompanied by an old automatic thought: “She/he’s doing this to hurt me.”

  • Your hippocampus (learning/memory) is doing a biased job of sorting through your memories of scenes that resemble this one. It’s as if your hippocampus is scanning through old pictures, but pausing to look only at the bad ones.

Stage 3: Poorly-Handled Anger Preparation

  • Jumping at the first option without planning ahead.

  • You can say goodbye to objective reasoning, keeping things in perspective, and impulse control.

Stage 4: Poorly-Handled Anger Action

  • Impulsive or excessive behavior.

  • You’re cutting people off mid-sentence and not allowing them to finish their thoughts.

  • You may shout, swear, and make demands.

  • You are now treating that person as if they are your enemy and not your partner, friend, family member, etc.

  • You are responding to your anger and not the actual issue at hand.

Stage 5: Poorly-Handled Anger Feedback

  • Inaccurate feedback.

  • Whoever your’e angry with is now trying to isolate self and get out of the interaction. You perceive this as negative feedback and follow them to “resolve” the issue.

  • You’re internal feedback system is saying, “I’m right. I just have to keep yelling and make them listen.”

  • Not responding with empathy or putting yourself in that person’s shoes. It’s not that you don’t care about their feelings, you are unable to experience them (especially when angry).

  • Hours later, it’s possible you will feel like a fool for what you said and regret how you acted. Unfortunately, the damage has already been done.

Stage 6: Poorly-Handled Anger Deactivation

  • Too quick to withdraw or unable to let go.

  • You think about the altercation repeatedly, and ever time you do it makes you angry all over again.

  • Days later, you may think, “How can they do this to me?”

  • If the other person chooses not to discuss this again, you will complain elsewhere without seeing the real problem.


The Six Stages of Well Handled Anger

Stage 1: Well-Handled Anger Activation

  • Becoming aware something negative is going to happen to your body. For example, you jaw has clamped down, your fists ball up, and you become warm. You are now aware that your physical cues are telling you anger is coming.

  • Anger develops instantaneously and at the preconscious level.

Stage 2: Well-Handled Anger Modulation

  • Take a brief time-out from what triggered you.

  • The break will allow you to think about the situation and prevent you from blurting out something you’ll later regret.

  • Take an intensity reading: Am I just a little angry, moderately, or irate?

Stage 3: Well-Handled Anger Preparation

  • Think, think, think! Consider your options for how to respond.

  • How can you share your anger without getting into an argument that will ruin the whole day?

  • De-emphasize your anger so the other person is less likely to become defensive. For example, “I’m happy for you, but do have one concern.”

Stage 4: Well-Handled Anger Action

  • Time to assertively verbalize what you’re thinking and feeling. (Note: Not aggressive, passive, or passive-aggressive)

  • Allow the other person to explain themselves.

Stage 5: Well-Handled Anger Feedback

  • Time to ask yourself, “Am I still angry or upset?” If not, move to the next stage.

  • If you’re still angry/upset, it’s time to deal with those feelings. Do an overall scan of your body and mind. Do you notice any other feelings or any light bulbs going off?

Stage 6: Well-Handled Anger Deactivation

  • You are now calm and no longer angry/upset.

  • Your frontal cortex (ability to control impulses, prioritize behavior, and understand how your actions will be perceived by others) and hippocampus (learning and memory) turn off the defensive aggression response.

  • Soon, your blood pressure will return to normal and entire body relaxes.

The Silent Stigma Behind Mental Health

"Just suck it up," "Move on already," "Get over it!" I'm sure many of you are familiar with these phrases. We heard these messages growing up from our parents and continue to hear these phrases from some of our peers today. It would be nice if simply saying these comments to ourselves would solve whatever is causing our distress. Unfortunately, telling yourself, "Get over it," doesn't quite make things any better.

The phrases above are only part of the problem when it comes to the stigma behind mental health. These phrases imply that you "shouldn't" be vulnerable and fixing your problems is as simple as "out of sight, out of mind." What many don't realize is the individuals who tend to say these messages to others are the same ones who struggle with being vulnerable and become uncomfortable with the expression of their own emotions.

Which brings me to my next point. Our society tells us that if you talk about your issues, express your feelings, or even verbalize you have a mental health disorder, you must be "weak." Men struggle specifically with this and are expected to have a strong, powerful, and almost robot like persona. For women, the stigma quickly becomes, "She must be emotionally unstable." Try a social experiment. The next time you have an opportunity to be vulnerable by expressing how you feel, take it. If someone in the room responds with a remark to shut down the conversation rather quickly, there is a good chance you don't know much about that person's true feelings since they rarely express them out of discomfort. 

If we want to eventually end the stigma behind mental health issues, we have to do the exact opposite of what the above messages are telling us to do. We must talk about it, Tweet about it, normalize it, and most importantly, not fear it! There is a tremendous amount of power in a secret. The power in this case keeps mental health discussions silenced. The more we shine light on the prevalence of mental health issues, the more power we take away from the secret.