This is an excerpt from my upcoming book, We Get Better: 48 Treatment Options for Chronic Depression.
***
Treatment option 44: Using a physical release
Many people report that their depression has an inner voice, and that voice gives reliably bad advice. It encourages them to ruminate, to avoid friends and family, to eat too much or not at all, and, of course, to stay in bed. All day.
The good news: depression’s recommendations are so reliably unreliable that taking the opposite action almost always helps. Get out of bed. Stretch. Do yoga. Vacuum. Physical activity of almost any kind can reduce depression in the short-term.
As discussed earlier, this might be in part due to the limbic system of the brain, which is responsible for emotion, memory and more. When the physical body is at rest, this system becomes more active. By moving your body, you shift your energy to the parts of the brain responsible for movement, reducing the amount of energy the limbic system receives.
Taking a walk, going for a swim, or even just cleaning the house are some examples of activities that can shift you away from mind-mode and into body-mode. For acute anxiety or panic, some experts recommend jogging around the block, doing twenty jumping jacks or using other vigorous movement to refocus the body’s energy. See When Panic Attacks by David Burns for more on how this works.
If desired, add “using a physical release” to your list of emotional coping skills. List specific activities as well.
This is an excerpt from my upcoming book, We Get Better: 48 Treatment Options for Chronic Depression.
***
Treatment option 43: Doing breathing exercises
Astronaut training might be the most expensive job training that exists. Yet NASA has invested in professional controlled breathing instruction in order to help astronauts better manage the psychological and physiological stresses of space travel.
The benefits of deep, slow breathing were understood thousands of years before the moon landing, of course. Indian gurus, for example, have been known to endure extreme weather conditions with little protection by using meditation and breathing techniques. In recent years, scientific research has demonstrated its effect on mental health–even chronic conditions like depression.
Most of us will never work at the International Space Station or hike in the Himalayas. But our lives can be stressful, too. Focusing on your breath can help you calm your mind, slow your body’s stress responses, and bring yourself into the present moment.
For me, deep breathing is an enhancement technique that I use in connection with other mental health practices, rather than a coping skill that stands alone. In moments of emotional activation, I remind myself to breathe first. Then make the next healthy choice.
If desired, add “doing breathing exercises” to your list of emotional coping skills.
Photo by Jessica Lewis 🦋 thepaintedsquare on Pexels.com
This is an excerpt from my upcoming book, We Get Better: 48 Treatment Options for Chronic Depression.
***
Treatment option 39: Journaling
One of my clients told me that she’d never had a therapist who didn’t recommend journaling to her at least once. They were right to do so, I told her. Journaling isn’t just a filler exercise; it’s an evidence-based technique for regulating emotions. Writing about difficult feelings and experiences can bring a sense of calm, and it can produce cognitive shifts as well. When thoughts are written down, they’re more clearly seen and evaluated. This is why most cognitive therapies include written exercises.
While stream-of-consciousness journaling is an option and can be helpful, I prefer more structured approaches. Write a letter you don’t send to a person who has caused you harm, or write about difficult past experiences and what you’ve learned from them. Write about your personal strengths and things and people you’re grateful for. Or brainstorm solutions to challenges you’re currently facing.
The journaling technique I find most helpful is the one I described earlier in this book. When experiencing acute distress, put all of your worst thoughts on paper. Be as uncensored and as honest as you can be. Then choose a few of these thoughts–maybe the ones that feel most distressing or persistent–and challenge them. Are they accurate, or is there another side to the story? Come up with helpful reframes that you can use if the thought arises again in the future, and write them down. Finding new stories is a learned skill that gets easier with practice.
If desired, add “journaling” to your list of emotional coping skills.Â
This is an excerpt from my upcoming book, We Get Better: 48 Treatment Options for Chronic Depression.
***
Treatment option 38: Visualizing your best self
Country singer Dolly Parton once said, “Find out who you are, and do it on purpose.” To me, that isn’t just good advice–it is a mental health strategy.
No matter what psychological or emotional concerns my clients present with, my main goal for them is always the same. I want them to discover who their best self is, and how to be that version of themselves more often.
This isn’t lofty stuff. Being your best self is an achievable goal. This is you we’re talking about–you get to decide what actions and attitudes make you feel calm and confident. Remember, your best self isn’t just the one who made that game-winning goal or was publicly complimented by the owner of the company; it’s the everyday you, too. Best-self moments happen throughout the week, in a variety of situations: alone, at work, out with friends. Anytime you are proud of who you are and what you’re doing, you’re probably having a best-self moment.Â
People talk a lot about the elusive spiritual experience we call inner peace, but to me, there’s nothing spiritual about it. When I like myself and my choices, I am at peace–even when I don’t feel particularly happy.
Who is your best self? Can you see them in your mind? What are they saying, wearing and doing? How do they walk? When in doubt about a course of action, visualize this person and ask yourself, “What would my best self do?” If helpful, write down some of your positive attributes and accomplishments and tape the list to your wall.
Come back to yourself. Find out who you are and do it on purpose.
If desired, add “visualizing your best self” to your depression treatment plan. Then decide on next steps and write them on your to-do lists.
This is an excerpt from my upcoming book, We Get Better: 48 Treatment Options for Chronic Depression.
***
Treatment option 37: Practicing your fears
In When Things Fall Apart: Heart Advice for Difficult Times, Pema Chödrön tells the story of a young warrior who asked Fear how to defeat him. Fear replied, “My weapons are that I talk fast, and I get very close to your face. Then you get completely unnerved, and you do whatever I say. If you don’t do what I tell you, I have no power. You can listen to me, and you can have respect for me. You can even be convinced by me. But if you don’t do what I say, I have no power.”Â
Exposure therapy is the behavioral method of choice for overcoming acute and specific anxieties. It prescribes a two-step approach: first, doing what you’re afraid to do; and second, allowing yourself to feel the discomfort without running away.
Carefully and gradually, a person is exposed to the activities or situations that bring feelings of panic so that their minds and bodies can acclimate. Social anxiety, fear of failure, fear of saying the wrong thing–even fear of not checking the door lock five times before bed–all of these respond well to simply doing them anyway … then noticing the uncomfortable feelings slowly fade.
Though exposure therapy is primarily a behavioral strategy, it is a cognitive one, too. If you’re afraid to ride on a plane and you practice doing so over and over while also practicing your distressing narrative, you might never overcome your fear. Use helpful self-talk.
When in doubt, ask a therapist to guide you through this challenging process. They will help you identify which fears to tackle first and how to coach yourself through uncomfortable moments. In addition, they might suggest a systematic approach that allows you to break down your feared experience into small steps that you can practice one at a time.Â
Here is a script that can be used during exposure therapy: “I feel uncomfortable right now, and that’s okay. I am allowed to feel this way. This feeling isn’t fun, but it is temporary. I am strong enough to handle it.” Edit as desired. The key here is that you don’t fight the anxiety you experience; instead, you welcome it, knowing it’s an important part of the corrective process. Each time you feel anxious while practicing your fear, then practice it anyway, you have taken another step toward defeating it.
When I was in college, I came across this quote by Ralph Waldo Emerson: “Always do what you are afraid to do.” At the time, I didn’t have many guiding principles; this became one of my first. I’ve been following it for over twenty years.
To learn more about exposure therapy, including some novel (and in some cases, hilarious) cognitive and behavioral strategies, read When Panic Attacks: A New Drug-Free Therapy to Beat Chronic Shyness, Anxiety and Phobias by David Burns.
If desired, add “practicing your fears” to your depression treatment plan. Then decide on next steps and write them on your to-do lists.
This is an excerpt from my upcoming book, We Get Better: 48 Treatment Options for Chronic Depression.
***
Treatment option 36: Practicing gratitude
Here’s a depression treatment that you can start right now: get a notebook and begin a gratitude journal. Though some people find this often-recommended strategy a tad simplistic, listing things you’re thankful for on a daily basis is shown to improve mood to a statistically significant degree. In one study conducted by the aforementioned psychologist Martin Seligman, severely depressed people were instructed to record three good things that happened each day. Within fifteen days 94 percent experienced significant relief from their symptoms.
The idea here is simple: we see what we look for. Regularly scanning our memories for positive moments and noticing our daily blessings teaches our brains to continue this practice throughout the day. Don’t worry–doing so won’t make you a crystal-carrying, aura-sensing mystic; at most, it will help you clarify what makes you happy and maybe make you a bit more pleasant to be around. And you have to be around yourself a lot.
Note that practicing gratitude isn’t the same as practicing toxic positivity, which is about ignoring or avoiding uncomfortable experiences. We can feel and honor our feelings while also moving away from unhelpful thought patterns that distort our view of reality.
If desired, add “practicing gratitude” to your depression treatment plan. Then decide on next steps and write them on your to-do lists.
This is an excerpt from my upcoming book, We Get Better: 48 Treatment Options for Chronic Depression.
***
Treatment option 35: Practicing meditation or mindfulness
Though some people use meditation as a coping skill for acute stress, for me, its true power lies in the way it trains our brains. Pema Chödrön says that meditation simulates a crisis situation (you mean I have to just sit here? for how long?) so that we can practice responding to the resulting emotions with equanimity. Put another way: meditation teaches us how not to freak out as much.
There are many types of meditation, but the main element they share is the refocusing of one’s thoughts onto a neutral object. Of course, a full discussion of the topic is outside the scope of this book, but excellent resources are widely available. In Ten Percent Happier: How I Tamed the Voice in My Head, Reduced Stress Without Losing My Edge, and Found Self-Help That Actually Works–A True Story, Dan Harris concludes that meditation increases his sense of well-being by about ten percent–an excellent return on investment. In his follow-up called Meditation for Fidgety Skeptics: A 10% Happier How-to Book, he pairs up with meditation teacher Jeffrey Warren to offer practical how-to advice on the topic.
Possibly the most well-known type of meditation is breathing meditation. However, if for any reason you find this difficult, you can also try visualization meditation, mantra meditation or another type. Visualizations can take many forms, from happy places to body scans. People who experience chronic pain often imagine healing elements like light and water with surprisingly good results.
Mindfulness is a type of meditation that involves bringing your thoughts back to your body and your immediate environment. Unlike some other forms of meditation, this can be done anytime, anywhere. If you don’t like the thought of sitting still for an extended period each day, look into mindfulness techniques that yuo can use during your usual daily activities.
Personally, I most enjoy mantra meditation. Repeating a calming phrase like “this moment” or “I am here” allows me to focus my mind and reduce distractions.
Jon Kabat-Zinn has helped develop meditation techniques for decreasing pain and improving mental health. In Wherever You Go, There You Are, he shares more about the science of meditation and success stories from his years in the field. He also coauthored a book called The Mindful Way Through Depression.
When in doubt, download a meditation app.
If you believe in a higher power–or even if you don’t–prayer can also be a helpful neural pathway shaper. Some experts believe that prayer affects the same areas of the brain as meditation and mindfulness practices do, which makes sense. The effectiveness might be comparable as well.
If desired, add “practicing meditation or mindfulness” to your depression treatment plan. Then decide on next steps and write them on your to-do lists.
This is an excerpt from my upcoming book, We Get Better: 48 Treatment Options for Chronic Depression.
***
Treatment option 34: Practicing acceptance
Finding new perspectives on your old, unhelpful stories is an important part of managing mood disorders like depression. Sometimes, though, after exploring a difficult thought, you might conclude that no accurate reframe exists. The horrible thing you’re thinking is simply … true. In these moments, you might consider a different strategy: acceptance.
Acceptance isn’t resignation. It’s an active, affirming choice. It involves finding the lessons and growth in difficult circumstances and reminding yourself gently that it won’t last forever.
Meditation teacher Tara Brach describes this process beautifully and in detail in one of the books I recommend most often to clients: Radical Acceptance: Embracing Your Life with the Heart of a Buddha. Whenever an uncomfortable feeling arises, Brach says, take a moment to accept and allow it. Rather than immediately avoiding it or distracting yourself, simply sit and feel the feeling in your body. See it for what it is: a temporary and manageable experience. Remind yourself to breathe. Notice that having this emotional experience doesn’t make you a bad person. It doesn’t define you. The feeling is just a feeling, and you are strong enough to handle it.
Radical, indeed.
Buddhist teacher Pema Chödrön has written about the practice of acceptance at great length. Actually, she’s famous for it. “We think that the point is to pass the test or overcome the problem, but the truth is that things don’t really get solved,” she writes in When Things Fall Apart: Heart Advice for Difficult Times. “They come together and they fall apart. Then they come together again and fall apart again … The healing comes from letting there be room for all of this to happen: room for grief, for relief, for misery, for joy.”
Open any page of any of Chödrön’s books for more.
Remember the Serenity Prayer (there’s a reason it’s so popular): change what you can and accept the rest. Behavioral modification is important. Perspective change is vital. But acceptance is a pretty good backup plan.
If desired, add “practicing acceptance” to your depression treatment plan. Then decide on next steps and write them on your to-do lists.
Catch it. Check it. Change it. This is a succinct description of the cognitive behavioral therapy (CBT) process. Catch unhelpful thoughts as they come. Check them for accuracy. Then find a helpful, balanced replacement. This can be done anytime, anywhere, but it seems to work best (especially at first) when you do it in written form.
Cognitive therapy guides recommend a variety of ways to identify inaccuracies in your thinking. Many make use of detailed worksheets for recording negative thoughts, feelings arising from the thoughts, cognitive distortions within those thoughts, replacement thoughts and more. Though these processes are shown to be effective, they’re also rather time-consuming. The method I prefer is a bit simpler.
Here is that method: Grab a pen and paper and make a list of all of the negative thoughts that are currently bothering you. Distressing experiences, personal shortcomings, difficult people, challenging situations, core fears–these are all great candidates for reframing. When you can’t think of any more, reread the list. Circle the ones that are most harmful to you or that feel the most stuck.
For each thought that you have circled, ask yourself some of the relevant questions in the list below. If needed, you can also notice if your distressing thought contains any cognitive distortions–common logical fallacies that sometimes creep into our thinking, especially in moments of acute depression or anxiety. These include: exaggerating, using all-or-nothing thinking, overgeneralizing, mind reading, jumping to conclusions, catastrophizing, personalizing, using “should” statements, disqualifying the positive, using emotional reasoning, minimizing, labeling, blaming and more. When you notice one of these distortions in your thoughts, that’s a sign that it might not be true, or fully true. Knowing this can help you find its weakness.
Once you’ve challenged your distressing thought, find at least one helpful reframe and write it down. For example, the thought “I am sad all the time” can be rewritten as, “I am sad some of the time, but not all of the time. I have many good moments and even hours throughout my week and I am learning how to expand those good times.”
If you prefer not to use the list of questions provided, no problem–just use the last one: “What is a more balanced, more realistic and more helpful perspective of this problem–a new story that I can remind myself of as needed?” That should do the trick.
Many people benefit greatly from a daily or weekly cognitive therapy ritual, but if that idea doesn’t appeal to you, use this process during times of higher-than-usual anxiety, depression or stress. Cognitive therapy can be difficult at times. It forces you to think in ways that might be unfamiliar or uncomfortable. But it is also one of the most evidence-supported depression treatments available, and I can’t imagine willingly passing it up.
If desired, add “challenging unhelpful thoughts” to your depression treatment plan. Then add it to your ongoing to-do list as well.
Questions for Reframing
Is this story true?
What percentage of this story is true, and what percentage is not true?
What aspects of this story are true, and what aspects are not true?
If I were to put this story on trial, what evidence would there be both for and against it? Would the judge find enough evidence to declare it true?
Is the opposite story also true? Is it more true than the original story?
Does this story include all-or-nothing thinking?
Does this story include exaggeration?
Does this story include catastrophizing?
Does this story minimize positive aspects of the problem?
Does this story overgeneralize or include words like always, never, nothing, and everything? Does this story include words like should or must?
Does this story include labels like stupid or bad? Do those labels always apply?
Does this story include jumping to conclusions, worst-case assumptions or guessing the thoughts or motives of others?
Does this story imply a need for perfectionism?
Does this story feel true partly or mostly because it’s familiar?
Does this story relate to any of my triggers or past experiences?
Does this story relate to any of my fears?
Does this story include self-blame for things I’m not responsible for?
Is the voice who is telling me this story the real me, or is it someone else that I know or used to know, such as a parent or authority figure?
Does all of me believe this story, or does only a small part of me believe it, such as the wounded child in me or the rejected lover in me?
Does this story bring up underlying desires or needs? What are other, more effective ways I can meet those needs?
Does this story include blame of others? Does it focus on what another should do differently, even though I cannot change their actions? How helpful is that strategy? What is a better strategy?
Does this story include anger? If so, is this because an important boundary of mine has been crossed (for example, a boundary regarding how people should treat me)? How can I reestablish that boundary for the future?
For any aspects of the story that are true, what are the real effects of the problem, and are they manageable?
How distressing is this problem on a scale of 1 through 10, with 10 being extremely distressing?
Is this problem always a problem, or is it only sometimes a problem? How often and to what degree is it actually a problem?
If I were to ask myself three times per day if the belief was true right then, how often would it be true? For example, if my belief is that I am not smart enough, would this be true when I am in the shower? Eating lunch? Writing an email? Having a work-related conversation? Performing a work duty? Relaxing with friends?
Is this a true problem (ongoing unfixable issue) or is it merely a challenge? Will this problem still exist one year from now?
How much of my emotional energy do I want to devote to this problem?
What is the worst case scenario that could arise as a result of this problem? On a scale of 1 to 100, how likely is that scenario to come to pass?
If the worst case scenario were to happen, how would I respond? How would I handle it and what would I learn from it? After I fully went through it, what would the outcome be and would it be as terrible as this story implies?
For any aspects of the story that are true, what can I do to fix or lessen these difficulties, even in part? Am I willing to do these things?
For any aspects of the story that are true but unfixable, can I accept these challenges?
Is this problem a normal part of life that many people manage well?
What image can I bring to mind when thinking of this situation that would help me feel more calm?
Can I find a place of acceptance inside of me in which to put this problem?
What acceptance self-reminder can I use when the unfixable aspects of this problem come to mind?
If I were to ask a friend for their perspective of this problem, what would they say? If a friend of mine had this problem, what would I tell them?
And finally, and most important: What is a more balanced, more realistic and more helpful perspective of this problem–a new story that I can remind myself of as needed?
This is an excerpt from my upcoming book, We Get Better: 48 Treatment Options for Chronic Depression.
***
Treatment option 32: Going to counseling and/or entering a treatment program
Self-help books are great, but many people find that lack of knowledge about mental health isn’t their biggest barrier to self-improvement. When major life changes like many of those discussed in this book feel too difficult, counseling is often extremely helpful. A good therapist will guide you to explore the mental and emotional roadblocks that keep you from following through on your goals.
Counseling can be expensive and time-consuming. Still, for many people, the investment is worth it as it can greatly improve your quality of life. If you choose this mode of treatment, find a counselor who specializes in depression and who you can be completely honest with. Have clear goals and commit to the process. Prepare to hear feedback that might make you a bit uncomfortable, and, possibly most important, choose a counselor you respect and feel respected by.
Group therapy classes are another option and can be more cost effective than one-on-one counseling.
In On Becoming a Better Therapist: Evidence-based Practice One Client at a Time, Barry Duncan reviews studies showing that more often than not, counseling is an effective way to manage mental health disorders like depression. Most counseling failures result from client dropout, client noncompliance, or the lack of a strong client-counselor bond. This is good news, because all three of these factors are within your control.
Mild to moderate depression can often be treated with weekly one-on-one therapy sessions. People currently experiencing severe depression, though, might need significantly more support. If you are in crisis or having persistent thoughts of suicide or self-harm, seek a higher level of care. Intensive day treatment programs and inpatient treatment programs save lives.
If you are currently in crisis or have complex mental health needs, and you need help finding counseling or other treatment, the U.S. Department of Health & Human Services has a national helpline that offers referrals at samhsa.gov/find-help/national-helpline.
If you have persistent thoughts of suicide, please call the 24-hour National Suicide Prevention Lifeline at 800-273-8255.
If desired, add “going to counseling” and/or “entering a treatment program” to your depression treatment plan. Then decide on next steps and write them on your short-term and/or long-term to-do list.
This is an excerpt from my upcoming book, We Get Better: 48 Treatment Options for Chronic Depression.
***
Treatment option 31: Improving your sex life
Sex is a powerful emotional and physical experience: a natural, healthy high that can significantly improve your mood. It offers a peak experience and can also increase partner intimacy. Though improving your sex life isn’t a traditional depression treatment, people with mood disorders might greatly benefit from investing in this area of life.
And an investment it is. In Come Together: The Science (and Art!) of Creating Lasting Sexual Connections, sex educator Emily Nagoski discusses some of the relational improvements, planning skills and perspective changes that might be needed to build a fulfilling, satisfying sex life. “Center pleasure,” she emphasizes, over and over again. Sounds like a depression treatment to me.
Nagoski’s first book on the subject, Come as You Are: The Surprising New Science that Will Transform Your Sex Life, is equally enlightening. It discusses sexual desire, sexual functioning and sexual myths. If sex is important to you, read this one, too.
Depression can reduce sexual desire, and so can some depression medications. In either case, consult with your medical provider and find out what options are available.
If desired, add “improving my sex life” to your depression treatment plan. Then decide on next steps and write them on your to-do lists.
This is an excerpt from my upcoming book, We Get Better: 48 Treatment Options for Chronic Depression.
***
Treatment option 30: Caring for a pet
It’s easy to love an animal. And it’s easy to be loved by them. For many people, pets are a primary source of joy, affection and emotional reassurance. And according to the Anxiety and Depression Association of America, pet ownership can reduce or prevent depression in some people. Pets provide companionship, and they also encourage healthy routines. Additionally, they enhance a person’s sense of personal significance. When you care for another living being (kids and plants count, too), you often increase your feelings of self-worth, and this feeling can be highly protective during tough times.
Of course, pets come with a financial and lifestyle commitment that you might not be ready to make. Carefully consider the sacrifices before adopting. Pet ownership is a great pleasure and a great responsibility, and as with other major life commitments, timing is important.
If desired, add “caring for a pet” to your depression treatment plan. Then decide on next steps and write them on your short-term and/or long-term to-do list.
This is an excerpt from my upcoming book, We Get Better: 48 Treatment Options for Chronic Depression.
***
Treatment option 29: Attending a community group
Positive psychology researcher Sonja Lyubomirsky reports in The How of Happiness: A New Approach to Getting the Life You Want that people who actively participate in spiritual communities are physically healthier, live longer, enjoy better marriages and experience less stress overall. The 2000 classic Bowling Alone: The Collapse and Revival of American Community by Robert Putnam covers the topic in more detail, arguing for the importance of community to mental health.
If your life isn’t quite peopled enough, consider joining a group. The choices are many: spiritual groups, religious groups, crafting groups, therapy groups, volunteer groups, writing groups, hiking groups, book clubs and more. If you can’t find one in your area that interests you, consider starting your own. Just keep in mind that the benefits of doing so might not come right away; it takes time to build community.
If desired, add “attending a community group” to your depression treatment plan. Then decide on next steps and write them on your to-do lists.
This is an excerpt from my upcoming book, We Get Better: 48 Treatment Options for Chronic Depression.
***
Treatment option 28: Practicing healthy assertiveness and boundaries
When your sense of well-being is consistently and significantly affected by someone else’s behaviors, choices or moods, depression can sometimes result. Neglecting to create proper boundaries, even in healthy relationships, reduces your felt power over your activities, environments, time, energy and needs.
Boundaries aren’t just for extreme situations, like toxic relationships and demanding bosses. They’re everyday tools for everyday needs. Increased self-advocacy, for example, and reduced emotional exertion spent on someone else’s problem–these might not seem like boundaries, but they are.
A cautionary note: even slight changes in the dynamics of your relationships can lead to destabilization and conflict. A capable therapist can assist you in determining healthy and appropriate boundaries and in communicating them effectively.
Like boundaries, assertiveness can be tricky at times. Located at the halfway point between passivity and aggression, it can be hard to detect at first (the middle ground often is). Early attempts at this skill might be less than graceful, but practice helps. As confidence grows, communication is smoother. Much of the time, people respond less to what you say and more to how you say it, and standing up for yourself or for someone else isn’t always as difficult as your primal brain fears it will be.
One of my most frequently recommended therapy homework assignments is keeping a list of occasions on which the client practices assertiveness and confidence. Taking the time to note down these moments of growth not only encourages you to find more opportunities to build this skill, but serves as proof that you can do it. Don’t forget to give yourself credit for the small stuff: paying your way, choosing the restaurant and limiting phone calls with a difficult family member all count.
Liberated Love: Release Codependent Patterns and Create the Love You Desire by husband and wife team Mark Groves and Kylie McBeath emphasizes the deliciousness that boundaries create between romantic partners. Mutual respect, affection and sexual desire increase as partners advocate for their needs. Opportunities for resentment decrease, and couples no longer feel the need (or are allowed) to “fix” each other’s feelings or behaviors. Personal growth and fulfillment is each person’s own business.
In other words: boundaries are sexy.
Flexibility is important. Some boundaries are negotiable. But they exist in some form in every healthy relationship. Anytime you start to feel responsible for another person’s choices, or act against your inner wisdom due to fear of another person’s reaction, consider ways to take back your power. People with chronic mental health concerns like depression might have an even greater need to protect their emotional energy and maintain healthy levels of independence.
If desired, add “practice assertiveness and boundaries” and/or related strategies to your depression treatment plan. Then decide on next steps and write them on your to-do lists.
This is an excerpt from my upcoming book, We Get Better: 48 Treatment Options for Chronic Depression.
***
Treatment option 27: Learning communication and conflict management skills
A good day can go bad very, very fast when a conflict arises, especially one that isn’t managed well. Seeing the improvements that the skills of listening, deescalation, finding agreement and the like bring to an uncomfortable conversation will make you a believer in corny couples counseling exercises forever.
If you haven’t read anything by John Gottman, one of the most well-known relationship researchers, skim (or pour over) one of his many books. Online summaries are also available, and his sound bytes are widely shared in every format.
Some of my favorite communication tips are as follows. First, aim for a 7-to-1 (or higher) ratio of positive-to-negative interactions–the ratio Gottman found that happy couples maintain. Second, during an argument or difficult conversation, find something you can agree on–anything at all. Most of the time, doing so significantly reduces defensiveness and tension. When in conflict, stick to one topic; otherwise, fights become unfocused and unhelpful. Also, keep the discussion either solution-focused or feelings-focused–don’t switch back and forth between the two. When in doubt, validate, then validate some more. Finally, when anger or frustration levels mount to an unhealthy level, take space and try the conversation again after a good night’s rest.
Of course, the process of learning communication and conflict management skills is a highly complex and individual one, and will likely continue throughout your life. If needed, make use of professional resources, such as couples counseling. Early intervention works best.
If desired, add “learning communication and conflict management skills” or a related strategy to your depression treatment plan. Then decide on next steps and write them on your to-do lists.
This is an excerpt from my upcoming book, We Get Better: 48 Treatment Options for Chronic Depression.
***
Treatment option 26: Establishing and maintaining strong relationships
Psychologist Daniel Gilbert writes in Stumbling on Happiness that if he were to guess at a person’s level of felt well-being based on only one fact of their life, he would choose to know not about how healthy they were or how successful, but about the quality of their relationships. One of our most basic human needs is secure attachment, and if you don’t have enough of it, it might be time to increase your social efforts. Go on dates with your partner. Reach out to a friend at least once a week. Plan a standing walk or coffee date with a friend. The alternatives to secure attachment are anxious attachment, disorganized attachment and avoidant attachment, and if you notice a pattern of insecurity in your relationships, it’s worth learning more about these concepts.
It can be challenging to find your people. If you’re feeling discouraged by the process, know that the difficulty is more common than many people suppose. Commit to the effort. Follow through with your social efforts on a regular basis. Open up to others in a genuine way and allow them to do the same.
In Love Warrior: A Memoir, best-selling memoirist Glennon Doyle puts it well: “We can choose to be perfect and admired or to be real and loved. We must decide. If we choose to be perfect and admired, we must send our representatives out to live our lives. If we choose to be real and loved, we must send out our true, tender selves.”
If desired, add “find more friends,” “regularly reach out to friends,” “try new social activities” and/or related strategies to your depression treatment plan. Then decide on next steps and write them on your to-do lists.
This is an excerpt from my upcoming book, We Get Better: 48 Treatment Options for Chronic Depression.
***
Treatment option 25: Resting and taking time off
When former National Chess Champion Josh Waitzkin drew close to an important competition, he did something surprising: he rested. Unlike many of his competitors, Waitzkin took several weeks away from the board during the crucial pre-game months to sail with his family–a mental rest that counter-intuitively sharpened his game once he returned. The Art of Learning: An Inner Journey to Optimal Performance follows this author’s road to mastery of two very different pursuits: chess and Tai Chi. A key insight: sometimes, extended breaks allow the subconscious to process and integrate previously learned strategies and other relevant data in a way that the conscious mind is incapable of doing.
Screen-based entertainment might not provide the kind of rest that Waitzkin’s game, and our brains, need most. While screens can offer a welcome distraction and even some relaxation, we also benefit from creating mental gaps in our days. Quiet walks. Long baths. A cup of coffee on the front porch. Find a few minutes of true rest every day.Â
Of course, taking time off work, including personal days and vacations, can also provide much-needed time to recharge.
If you are experiencing chronic stress or are frequently overwhelmed, you might like Burnout: The Secret to Unlocking the Stress Cycle by Emily and Amelia Nagoski.
If desired, add “taking time off work,” “adding rest breaks into my days” and/or related strategies to your depression treatment plan. Then decide on next steps and and write them on your to-do lists.
This is an excerpt from my upcoming book, We Get Better: 48 Treatment Options for Chronic Depression.
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Treatment option 24: Staying busy
Though relaxation and self-care are undeniably important, sometimes, staying busy helps, too. Some psychologists assert that people often overestimate the amount of enjoyment they will derive from an increase in free time and underestimate the amount of pleasure that challenging, competitive and creative pursuits provide. Many video games even include work-like tasks.
At times, staying busy can distract you from overthinking and allow you to put some space between your more contemplative, emotionally heavy moments. Of course, the benefit of staying busy largely depends on the activities you choose to fill your time. Consider engaging in a variety of healthy work and personal tasks–some of which are mentioned in this book–during a given week in order to reduce monotony, increase your sense of accomplishment and find balance.Â
If desired, add “staying busy” or “creating a balanced weekly schedule” to your depression treatment plan. Then decide on next steps and write them on your to-do lists.
A rather obvious treatment option, but one that is highly deserving of inclusion in this book, is exploring high quality self-help resources. There is no shortage of excellent self-improvement books, podcasts, channels and the like that seek to encourage, inspire and educate. I love research-backed how-tos as well as memoirs of people who have learned from their challenges. Book by book, my life has been unalterably changed.
Read everything that interests you, and some stuff that doesn’t. Keep in mind, though, that self-help materials are not a replacement for professional treatment for depression, and the other treatments listed in this book aren’t, either. If you have depression, please seek the help of a mental health professional, and use other resources in a supplemental and informational fashion.
Finally, note that many self-help resources contain inaccuracies and can cause harm. Use caution.
If desired, add “explore self-help resources” to your depression treatment plan. Then decide on next steps and write them on your to-do lists.
This is an excerpt from my upcoming book, We Get Better: 48 Treatment Options for Chronic Depression.
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Treatment option 22: Traveling
A surprising treatment option, one that I include in this book with some qualifications, is travel. For some people, adventuring to a new place (even one that’s just a car ride away) can be an effective way to get out of a mental rut and improve mental health. By stepping outside of our familiar routines and environments, we’re able to gain fresh perspectives, break free from negative thought patterns, and experience new and stimulating activities.
In Self-compassion: The Proven Power of Being Kind to Yourself, author Kristin Neff recounts a physically and emotionally taxing journey through Mongolia that she took with her young son, who has a severe form of autism, and the benefits he received. It might have been the religious rituals that did the trick, but my guess is that the fresh air and the complete change in his environment altered certain neural pathways that had developed over the course of his short life.
I’ve always loved to travel, but not because it’s easy or comfortable. I love it because when I’m somewhere else, I’m more present. I have much greater appreciation for a hot bath, a cold drink and a soft bed, and I pay close attention to interesting details in my surroundings.
Travel isn’t for everyone. It can be costly and physically and emotionally challenging. If you think travel might have a positive effect on you, and you feel emotionally stable enough to take on the challenge, consider planning a trip in the near future. When you return from your trip, continue bringing more gratitude and awareness home with you.
If desired, add “traveling” to your depression treatment plan. Then decide on specifics and next steps and write them on your short-term and/or long-term to-do list.
