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Depression Assistance and Education

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Depression Assistance and Education

looking out window Audio that helps you understand clinical depression better. Focuses on changing some of the negative self-talk that occurs from not understanding what clinical depression is. For instance, helps you to understand it as an illness not a weakness so as to reduce the self-blame type of thinking that frequently occurs with clinical depression. By changing this thinking, you will be able to cope with your depression better.

Depression Assistance and Education

This audio is to help coach you to think differently about depression so that you can gain greater control over your depression. It is meant to be listened to repeatedly until you automatically think in this new way about depression.

First, it is easier to learn when you are relaxed and focused. So take a few moments to concentrate on your breathing and relaxing your muscles. Especially focus on letting the muscles in your neck and shoulders relax each time you exhale. Just let the tension go and the shoulders droop as you inhale and exhale slowly. Allow yourself to focus on each breath you take. Notice the air coming into your body as you inhale. Notice your chest muscles as your lungs expand with each breath and notice the relaxation in your muscles as you exhale slowly. Just allow yourself to focus completely on your breath. As you do so you can begin to let other thoughts go and focus on what I am saying to you.

This mindful breathing process that we just did is a very important part of learning to manage depression and I will explain why in just a bit. Right now though, the most important thing to understand about depression is that it is a physical condition. Depression is not an inability to cope with life problems. It is a genetic condition that you were born with just as someone with diabetes is born with that genetic condition. This is very important to understand because so many people with depression blame themselves for feeling bad. Unfortunately, the more you blame yourself and criticize yourself, the worse the depression can be. So, it is important to understand that you are not to blame for this physical condition.

However, just as a person with diabetes may need to do certain things to manage the diabetes, there are things you can do to manage the depression. And we will discuss those things. Right now, though, I want you to understand a little more how depression works and why people have believed that it is a psychological problem when it is actually a physical illness. To understand this, it is necessary to understand how psychological problems and stress affect depression.

When I say that depression is a physical illness, I am referring to the cause and the symptoms. The basic core symptoms of depression are all physical which include sleep problems, fatigue, lethargy, focus and concentration problems. The secondary symptoms are a result of these. So, because someone doesn't feel well, they may lack interest or desire in things, it may be hard to motivate, they may overeat as a way to feel better or get energy, they might not eat due to lack of desire, they might find it difficult to do most things, they may feel sad, worthless and discouraged.

But the core symptoms are physical! The reason there is so much confusion about depression and the tendency to believe that it is psychological is because psychological stress worsens depression. Think of it this way. Imagine a person who had no psychological stress but had depression and rated their symptoms as a 5 on a 10 point scale meaning that the symptoms were uncomfortable but manageable. Now that person has a disagreement with a friend. If they didn't have depression that disagreement might be rated a 1 on the same scale but since they have depression, their rating may now be a 6. Now imagine they just discovered some unpaid bills and are having a budget problem. Under normal conditions that might rate a 2 on the scale but with the depression and the disagreement with the friend this person may now be at an 8 on that 10 point scale which would indicate now that the symptoms are intolerable and unmanageable.

My point is that these psychological factors add to the depressive symptoms but are not the cause. Without the depression, the psychological stress may have been very manageable. However, the combination creates an intolerable situation. As you can see, it is not that you can't manage the normal stressors of life, it is that you have to deal with the normal stressors of life in addition to the symptoms of the depression!

Understanding this process, though, gives you a way to manage depression. You may not have control over the core depressive symptoms but you may have some degree of control over other stress in your life. The idea is that the more you control the other stress, the more you are able to tolerate the depression because you don't have to deal with the combined effect. The same concepts I'm sharing with you work for other physical illnesses such as heart disease. If the psychological impact can be reduced, many physical illnesses are better controlled.

So, I want to share with you some methods to help you begin to manage the depression. Let's return back to your breathing for a moment. I'd like you to again focus on your breath. Allow yourself to relax your neck and shoulders and completely focus on your breath as you slowly inhale and exhale. Notice the air as it comes into your body. Notice the change in your chest muscles and your shoulders as you inhale. Notice the air as it leaves your body. Pay particular attention to the relaxation of your muscles as you exhale. Let your shoulders drop and notice those muscles relax. Let your facial muscles relax. Imagine the muscles in your forehead becoming very smooth and relaxed. Let that relaxation continue down into your cheeks and your jaw—just let all those muscles relax as you continue to focus on each breath you take. Now as you continue to breathe slowly, we will discuss this mindfulness method that you are using now.

Simply speaking, mindfulness is focusing on your immediate experience. Right now that experience is your breathing and listening to what I am saying. Most often, people are not in a mindful state. When you are caught up in thoughts about worries or negative thoughts or demand thoughts, you are not being mindful. Because usually those things are not your immediate experience. For instance, if you have a demand thought of “I should be doing something”, that demand is not your immediate experience. You can either be doing something or not doing something which can both be mindful states but being critical of yourself is not a mindful state—it is a stressor. And as I said earlier, you want to reduce stress so as to make your depression more manageable.

Mindfulness is not a stressful state. Even when we are being mindful about a crisis, we are usually less stressed. I have had many anxious clients who have told me “When I have to deal with a real crisis, I am calm.” Maybe you have had that experience. The reason a person, even an anxious person, can be calm in a crisis is because they are focused on the immediate moment of resolving the problem! Which is being mindful. However, if instead of focusing on resolving the problem, they were catastrophizing or thinking “I can't handle this” then they are more likely to feel the stress of the situation.

Mindfulness is not a state you can be in constantly, but it is one you can learn to access more frequently. Throughout the day just try to bring your attention to your immediate experience. Notice what you see around you. Notice what you hear, smell, taste. For instance, if you are eating something, don't just mindlessly put it in your mouth. Instead, notice the texture, the smell, the flavor. Notice your muscles as you chew and swallow. Notice the experience of each bite you take. Or, if you are washing dishes, instead of thinking about other things, notice the sound and feel of the water, notice your muscles as you wipe the dishes. Pay attention to the experience.

You can practice mindfulness with anything you do. If you are in a conversation with someone, focus on that person instead of what you are going to say or what that person may think of you. Try to understand the other person and your experience of that person as fully as possible.

The more that you practice mindfulness, the more you are able to get outside of the thoughts in your head. The more you do that, the more you reduce one aspect of your stress which helps you to manage your depression more. (Learn more about mindfulness by listening to mindfulness training audios.)

I also want to mention relaxation here. When you do deep relaxation such as listening to guided imagery, you actually change the chemicals in your system. Many people are familiar with how exercise releases endorphins which is a chemical that reduces pain and makes us feel good. However, most people don't realize that relaxation increases a chemical called Norepinephrine in your system. And this is a chemical that is low for most people with depression. So deep relaxation is a natural method of changing the chemical process in your system!

Another stressor over which we have some control is how we think about things that happen. Certainly, it is normal when people are feeling bad (whether it is due to the flu, chronic pain, or depression) to think more negatively. That is due to the way memories are stored in our brains—experiences with similar emotions tend to be stored together. And because they are associated, it is easier to recall events or thoughts related to your current state of mind. For example, you may have had the experience of being angry with someone you love but at the time of your anger you seem to only be able to think of every thing that person has done to make you angry and it is hard to think of the positive memories.

That is the natural way our brains function. However, we can overcome that natural way by deliberately choosing to think differently. As we make this choice repeatedly, the new thoughts become associated with our emotional states. For example, if I'm dealing with a difficult situation and I keep telling myself “I can handle this” rather than “I can't handle this” eventually the new thought is present when I have to deal with difficult situations. It is a matter of repetition to create the association. At first that repetition has to be deliberate because it has to overcome the natural negativity, but eventually it can become the more natural way to think.

A good way to deliberately change this thinking is to use the cognitive diary method in which you write down your negative thoughts, examine why they are irrational, and write new thoughts to challenge the old ones. For example, many people with depression have thoughts such as “I'll never feel better.” The irrational distortion in this thought is generalization which is the idea that because something is true now you assume that it will always be true. The way to challenge this is by telling yourself “I may feel bad now, but there are some things I can do to help myself feel better so I don't always have to feel this way.” By challenging the irrational thinking frequently, you will begin to change your thinking which will help reduce the stress caused by the thinking.

Another stressor that can add to the depression, is the tendency for depressed people to suppress emotions. I think this is for a couple of reasons. One is due to what I mentioned earlier—the self-blame. Depressed people often feel they are at fault for allowing their negative emotions to get out of control. Therefore, they feel that those emotions are not okay. The other reason to suppress emotions is that you already feel bad enough and so you don't want to feel the negative emotions.

The suppression of emotions is a problem for a couple of reasons. One is that it is almost impossible to suppress negative emotions without suppressing positive emotions. Therefore, people with depression are often emotionally numb. The second problem with suppressing emotions is that our emotions have a purpose—they provide us with information and help us to cope. So, if you are suppressing emotions, instead of coping with the problems related to those emotions, you are adding stress to what you already deal with.

Let me give you an example. The emotion of grief has a very natural course of healing if we allow it to occur. And when I'm talking about grief, I mean any type of loss, not just due to death of a loved one. For instance, anyone who is listening to this is dealing with the grief of having depression. You have lost so much because of the depression. You may have lost your energy or vitality. You may have lost relationships. You may have lost interest in things you enjoy. You may have lost dreams and hopes. But you have lost something. Now, most likely, just me mentioning these things has made you aware of your grief. The tendency for most people is that they don't want to feel sadness of the grief. So they may get stuck in the denial stage of grief which may be something like “I don't have anything to feel bad about. Other people have it worse.” Or they may get stuck in the anger. In fact, some of you may be angry with me right now and are thinking “Why is she making me feel worse? This is supposed to help me!”

Well, allowing the natural process of grief does help but it may feel worse before it feels better. The numbness of the depression is dangerous because it is ever-lasting. But grief doesn't last when we allow it to be expressed. Grief actually has a very predictable course when you allow yourself to fully experience the emotions. The grief process is a healing process. You have every right to be angry and sad about what depression has cost you! Other people without depression don't understand. They don't understand the loss you have experienced due to the depression. This certainly isn't something you would do to yourself. It is not your fault. You didn't ask for it. But you do have to deal with it. And you are dealing with it. You are doing something right now by listening to me and learning about your depression.

So instead of suppressing your emotions allow them to be expressed. However, there are ways that are helpful and ways that are not. For instance, allowing your anger to come out as irritability with people close to you is not helpful. One way I have found that has worked for many of my clients is to write a grief letter. In the case of depression, the grief letter may not be to a person but may be to the depression itself. You might start with something like “Dear Depression, I'm so mad at you because of what you have done to me.” And then just express whatever you feel. This helps to release the emotions. However, it is very intense so it is important to have a plan to take care of yourself afterwards. Also, you may need to do this with the guidance of a therapist. The important thing right now, however, is to validate your emotions to allow you to feel them. It may not feel like it immediately, but as you release your emotions, it will help reduce your stress.

Finally, I want to mention another group of stressors involving problem-solving and goal-setting. If we have an unsolved problem, it just adds to our level of stress. Therefore, it is important for you to try to do something about any problem that has a solution or partial solution. However, if you are like most people with depression, you are feeling so bad that trying to do anything just seems over-whelming. I have found with my clients, though, that if we can set small goals that are manageable, eventually they add up. The key is to develop a goal that is simple enough that it is hard not to do it. For example, if your room is a mess instead of saying “I need to get this room clean” which may be too over-whelming and then doesn't get done, say “Whenever I get up, I'm just going to put one thing away.” You would be surprised at how much gets accomplished with simple goals.

Activity of any sort is helpful for depression. I think this is true because activity is more mindful. You are focused on your immediate experience. So especially, doing things that you would normally enjoy is a good idea even if it seems like you wouldn't enjoy them. The more you do those things depression becomes less of a central focus of your life.

I hope that by listening to this you have some ideas about how you can address your depression. The more you listen to this, the more it will help change your thinking about the obstacles to dealing with your depression. Also, people often focus on different aspects of what I'm saying when they are ready to hear it. Keep in mind that you are taking steps to deal with your depression by listening to this. As you change your thinking and learn to be more mindful, you will reduce the additional stress that makes your depression worse. You will be able to focus more on how to care for yourself with the depression rather than being self-critical. As you care for yourself, it will help make your depression more manageable.

Kindle Books by
Dr. Monica Frank

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