This is an excerpt from my upcoming book, We Get Better: 48 Treatment Options for Chronic Depression.
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Treatment option 7: Eating well
No judgment here, and no specific advice: when it comes to your diet, do what works for you. Consider whether or not your eating habits affect your mood, and if so, what changes might help. Undereating can cause depression, and overeating can, too. Avoid perfectionism and choose goals that are realistic and doable.
Of course, when it comes to food, it’s not just about physical health, but about mental health, too. Do your food-related thoughts, choices and plans help you feel more emotionally stable and healthy, or less? Answering this question can provide helpful information when assessing whether or not you’ve established habits that work for you.
If you suspect that you could benefit from a rigorously scientific perspective on nutrition, try How to Eat: All Your Food and Diet Questions Answered by Mark Bittman and David Katz. Everything by Michael Pollan is also great.
Finally, if you suspect that you might have an eating disorder, take a moment to fill out a confidential screening or start the search for help at nationaleatingdisorders.org. Food is a big part of life, and it’s hard not to be depressed or anxious if this area of functioning isn’t going well.
If desired, add “eating well” to your depression treatment plan. Then set specific food-related goals and write them on your ongoing to-do list.
This is an excerpt from my upcoming book, We Get Better: 48 Treatment Options for Chronic Depression.
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Treatment option 6: Improving your sleep
A complete sleep might be longer than what you’re used to, but you know when you’ve had it: you feel fully able to get out of bed and start the day’s tasks. Increased energy can increase motivation, which often increases productivity. Productivity, in turn, produces confidence and optimism. In addition, emotional energy–patience, distress tolerance, etc.–can be enhanced through proper rest. In people who are chronically tired, increased sleep might be the most effective mood booster available. It might also increase the effectiveness of other depression treatments.
Cognitive behavioral therapy for insomnia (CBT-I) is the behavioral modification therapy of choice for sleep problems. If you think you might need professional help for this issue, find a mental health counselor trained in this modality. Different people benefit from different CBT-I interventions. Briefly, CBT-I practices include:
Adjusting your sleep schedule as closely as possible to your natural circadian rhythms;
Going to bed at around the same time every night, and getting up at (as nearly as possible) the same time every morning–even on the weekends;
Using various techniques to reduce sleep anxiety;
Staying busy during the day and refraining from napping;
If needed, reducing your time in bed and/or getting out of bed during wakeful night hours to reset; and
Tracking your sleep patterns in a sleep journal.
Substance and caffeine use can significantly impact sleep, reducing the length of your phase three deep sleep and increasing the length of your less restorative REM sleep.
Finally, if you are consistently sleeping poorly even while maintaining good habits, consider setting up a consultation with a sleep specialist. You might be suffering with a sleep disorder like sleep apnea without knowing it.
If desired, add “improving my sleep” to your depression treatment plan. Then set specific sleep-related goals and write them on your ongoing to-do list.
This is an excerpt from my upcoming book, We Get Better: 48 Treatment Options for Chronic Depression.
***
Treatment option 5: Exercising regularly
When I talk with clients about exercise, I always feel a bit redundant. Most of us know that it’s one of the best non-pharmaceutical mood enhancers available. We also know that the long-term benefits–better physical health, better sleep–will likely increase our quality of life overall.
While some people report feeling a “runner’s high” after a good workout, others don’t seem to receive this benefit. If you are in the latter category, you still might notice a milder, yet significant, sense of well-being. In addition, for many people, exercise is associated with a sense of self-efficacy–even empowerment.
As discussed previously, don’t wait to feel motivated to take a long walk outside, or to follow along with a yoga YouTube video in your apartment. That feeling might never come. Unfortunately, the human mind isn’t as logical as we tend to believe: it knows the relevant facts, but it doesn’t vote for them. Instead, it votes for what’s comfortable.
Veto the vote for comfortable. If you’re not quite ready to start your new routine, consider a soft entry. Choose your days and times to exercise and put your exercise shoes or clothes on at those times every week, even if you don’t leave the house. Gradually, add small amounts of exercise (a walk around the block?) to this routine. Habit is what matters most.
From a mental health perspective, being consistent is the most important part of exercise–much more important than time spent, frequency, difficulty and other factors. Anytime you follow through with your exercise goals you have made progress–even on the days or weeks you don’t increase difficulty or see changes in your body. Your body has built or at least maintained its fitness levels that day, and more significantly, your mind has strengthened its relevant neuropathways.
After around twenty-five years of consistent exercise, it’s almost impossible for me to imagine discontinuing the habit. Over time, movement becomes more than a healthy self-care practice–it is part of your identity. You can take breaks, but it soon pulls you back; when you don’t do it, something feels missing.
That’s a good feeling.
If desired, add “exercising regularly” to your depression treatment plan. Then set specific exercise goals and add them to your ongoing to-do list.
A lot of times, when you discover something great, you overestimate its greatness just a bit. Well, okay, sometimes more than a bit.
Sometimes you get way too excited.
Every once in a while, though, your excitement proves justified. And when that happens, you cross the line. Before you were a fan, a follower, an advocate.
Now, you’re a believer.
Granted, when I discovered Cognitive Behavioral Therapy, my hopes were high for good reason. According to articles by the National Institute for Mental Health, the National Center for Biotechnology Information and, of course, Wikipedia, CBT is the most-practiced evidence-based therapy for tons of emotional and personality disorders.
More important, when I tried it, it worked.
Unfortunately, I was late to the party; I’ve had depression my whole life, but didn’t learn about CBT till age thirty-eight. Yikes, right? I often wonder what I was thinking, not looking up popular depression therapies sooner. Then I remember exactly what I was thinking.
I was thinking spirituality was the answer.
Ouch.
I mean, spirituality is great. Spirituality works. But sometimes, other stuff works better. And every once in a while, you hit the proverbial jackpot, and you find a regular therapy that’s spiritual, too.
Which is where Byron Katie comes in.
Soon after discovering CBT, I found this teacher, and when I did, the above process repeated itself. Excitement. Enthusiasm. Fandom. Advocacy.
Then, full-on belief.
Here’s how that happened.
***
It was one of Those Moments. You know the kind. They feel normal at first, then later earn an unexpected spot on your greatest-hits playlist. It was evening, and I was depressed—much more so than usual. Worse, earlier that day I’d taken a three-mile walk and even that, my go-to strategy, hadn’t helped. I didn’t get an endorphin high. I didn’t clear my mind.
I felt just as bad after as before.
If you struggle with a mood disorder I don’t have to tell you what a frightening realization this was. Will I have to starting walk more than three miles now? I wondered. Has my body acclimated to this level of exercise? Heavily pregnant, with two other children in tow, I couldn’t imagine putting more time and effort into walking than I already did. And so, after dinner, after my husband had taken our two boys to the mall, I decided to try something different. Desperate, I went to my office to scan the titles on my bookshelf, looking for anything that might help.
I didn’t actually believe I’d find something.
But I did. I found The Feeling Good Handbook by David Burns.
One year prior, I’d bought the Handbook on the advice of my doctor and then, after a brief review, dismissed it. Platitudes, I thought. Nothing new here. Nothing I haven’t heard a million times before. I had no idea it was a psychotherapy classic. (Why hadn’t the doctor told me that? Sheesh.)
That day, though—that greatest-hits day—I sat on the couch and for the first time, gave the method a chance. After reading a few chapters, I took its suggestion and started writing down every negative thought in my head. When I couldn’t think of any more, I stopped writing and counted the pages.
I’d filled seven pieces of paper on both sides.
Okay, I thought. Maybe the book is right. Maybe my depression really is caused by my thoughts.
Prior to that time, I knew negativity played a role in depression. But I had no idea how big that role was. I’m a positive person, I thought. I’m hopeful about the future. It’s a chemical imbalance that’s to blame.
And I still believe that. I’ve been moody my whole life—never lighthearted, even as a kid. But maybe, just maybe, there’s more to the story. Maybe part of the problem is solvable.
Because, it turned out, I wasn’t the optimist I thought I was. I was actually sort of the opposite, but in a different way. The kind of thoughts I wrote down that day had nothing to do with my faith in God or my many dreams of success. They weren’t about my overall health, or my financial or familial satisfaction.
They were about the little annoyances of life.
They were about the way my clothes fit, the kids’ morning moods, the tyranny of my family’s need to eat. Only a few of my troubles even mattered long-term. And yet, when I emptied the contents of my head, these silly little details were what I found. Obviously, my pessimism wasn’t as much about the significance of my negative thoughts as it was about the sheer number of them.
I had accumulated a bunch of mental crap.
And so, that night I began the process of excavation. And I haven’t stopped since.
Even after that first writing session, I noticed a change—a lifting, even a slight high. I felt the way I feel after a thirty-minute jog, or a long talk with a friend, or an especially enjoyable night out.
Holy crap, I realized. It worked.
And it did so when I was at my very worst.
And so, like I said before, after discovering CBT, my hopes were ridiculously high. Somehow, I knew that this was my game-changer, my next major level up.
Somehow, I knew it would be epic.
The cool thing is that I was right. During the month that followed the discovery, I was the most hopeful I’d been in my life regarding my ability to deal effectively with—maybe even overcome—my depression. Then, a shocking twist: I found another strategy, a variation of CBT. And for me, it was even more powerful. You probably already know what that method was. It was Byron Katie’s process of self-inquiry called The Work.
Byron Katie is a spiritual teacher, someone you may have heard of before. I had, too; the previous fall I’d even read her free ebook, The Work of Byron Katie: An Introduction. At that time, though, her ideas didn’t particularly appeal to me.
Truth be told, I wasn’t desperate enough to try it.
But after practicing CBT for a while, her name came up again, and I thought back on what I’d read. Wait a sec, I realized, Now that I think about it, The Work is a lot like CBT.
I decided to look into it again.
More about Byron Katie’s method later, and how it compares with CBT. Suffice it to say here that it’s a way to look objectively at your favorite (or not-so-favorite) thoughts. It gives you four questions to ask yourself that help you realize, deep down, what is true and what is, well, a bit crazy.
And as with CBT, my first experience with The Work didn’t disappoint.
