Managing Your Depression (15 page)

• Be assertive.

• Listen to your needs.

• Say “no” when necessary.

• Get organized.

• Control what you can.

• Set realistic and specific goals.

• Balance and prioritize.

• Pace yourself.

• Don’t overcommit.

• Structure your day.

• Take good care of your body (sleep, diet, exercise).

• Treat yourself with compassion and respect.

• Focus on the present moment.

• Use self-soothing.

• Give yourself credit.

• Reward yourself.

• Stay safe. Avoid situations that could worsen your symptoms.

• Consider the consequences of your actions and decisions.

• Watch for your Triggers and Warning Signs. Activate your Action Plan for Relapse Prevention as needed.

• Develop some Distress Tolerance (using distraction, self-soothing, improving the moment; see
page 113
).

6. Try relaxation techniques (work with your therapist to learn these skills).

• Progressive muscle relaxation—relax each muscle in your body from head to toe, one muscle group at a time (start with your jaw, then move to your neck, shoulders, arms, fingers, etc.).

• Visualization—sit and focus on a calm, serene image or a place where you feel relaxed.

• Biofeedback—discuss with your therapist how to learn this technique.

• Meditation—Dr. Herbert Benson’s book
The Relaxation Response
gives detailed information on getting started.

• Deep breathing exercise—sit quietly and focus only on your breathing, taking slow deep breaths. Do this for 3 to 5 minutes. If your mind wanders, refocus on each breath.

7. Use humor: watch a funny movie or DVD, read a funny book, read the comics. Being able to appreciate humor is a healthy coping strategy.

8. Use self-soothing strategies: comfort and nurture yourself with gentleness and kindness, using the five senses:

•
Vision:
enjoy looking at flowers, art, or other objects of beauty; visit museums; get out in nature; see a play, musical, or dance production.

•
Taste:
have a favorite food or beverage; take it slow and savor the experience.

•
Smell:
use a favorite fragrance or lotion; buy flowers or walk through a flower garden or shop; bake cinnamon rolls or cookies.

•
Touch:
take a bubble bath, get a massage, wear comfortable fabrics, hug someone.

•
Hearing:
listen to beautiful, soothing music or sounds of nature; sing; play an instrument.

9. Use Mindfulness techniques (see below)

• Focus on the present moment, on purpose, nonjudgmentally.

• Focus on doing one thing at a time, in just this moment.

• Avoid ruminating about the past or worrying about the future.

Mindfulness

Mindfulness is a way of living your life by focusing on the present moment. It is a way of “being” in the world, adopted from Eastern meditation practices. The skills learned in Mindfulness practice have been found helpful in managing mood disorders.

As described by Jon Kabat-Zinn, Mindfulness means being in the present moment in a particular way, by

• paying attention

• on purpose

• nonjudgmentally

Being in the present moment
means that instead of being preoccupied
with the past or future, you are focused on and attentive to the present. This is not easy to do. It is common for the mind to wander, particularly to thoughts of past events or future worries. The key is to notice when your thoughts drift and then bring your mind back to the present. Becoming so deeply involved in doing something that you lose track of time is an example of being in the present moment.

Mindfulness requires that you
pay attention
to what is going on around you. It means that you live with awareness instead of going through life on autopilot. Paying attention also involves observing your own thoughts and feelings, your body’s response to emotion (such as rapid heart rate, sweating, etc.), your urges, and your behavior just as they are.

Being
nonjudgmental
means that you avoid making any judgment about your thoughts, actions, or experiences and let each moment be as it is. Allow yourself to think or feel what you are feeling, without putting labels or judgment on it. This is also not easy to do. Part of your mind is constantly evaluating your experiences, comparing them to past experiences or expectations you may have. Instead, work on developing a neutral attitude toward what comes into your mind without judging it. Acknowledge your thoughts as thoughts and then let them go. For each experience, emotion, or thought you have, try to feel it without reacting to it.

Why Practice Mindfulness?

• Living mindfully allows you to engage in what you are doing. Emotions will interfere less often. This will improve the quality of your life.

• Mindfulness helps you to live in the present moment instead of experiencing the painful emotions related to the past or future. Dwelling on past experiences or future worries tends to trigger painful emotions. This happens often in depression. Mindfulness practice helps you to decrease these ruminations and the emotions and distress they produce.

• Mindfulness practice can help you manage your mood disorder. When you have an increased awareness of the present moment, you are able to notice when symptoms of your mood disorder arise. Recognizing your depression or bipolar symptoms enables you to respond effectively with your Relapse Prevention plan.

• Mindfulness can improve your ability to tolerate and respond to painful events. When you are overwhelmed by emotions, your mind clutters up quickly. So you have to focus first on the thought or moment and try to clear your mind, to calm it down. To do this you must step back, observe your own thought, and try to get a handle on it. Mindfulness practice can help you do this. When you are focused on and attentive to the present moment, without attaching judgment or value to it, you can make the best use of your thoughts, take action, and work on your problem.

• Many people find that Mindfulness-based cognitive behavioral therapy is an effective treatment for depression.

How Do You Practice Mindfulness?

Mindfulness is a skill that you can develop with practice. Begin by trying to make yourself more aware of the present moment without judging it as good or bad. Focus your full attention on what you are doing, on one thing at a time. Get fully involved in that moment. Notice when your mind wanders and bring your attention back to the moment. You can begin to practice this by setting aside five minutes a day to do a Mindfulness meditation (see below).

You can also try to exercise Mindfulness as you go about your day. For example, when you brush your teeth, focus your mind on doing only that one task. Pay attention to your actions, to the taste, sensations, sounds, and so on. As your mind wanders, bring it back to the task of brushing your teeth in this moment. Try it again when you drive, wash the dishes, have a conversation, or during other
moments of your life. Live with awareness of what you are doing instead of going through life automatically.

Exercise to Practice Being Mindful

1. Sit in a comfortable chair, in a comfortable position.

2. Close your eyes if you like.

3. Become aware of your breathing, and focus on each breath.

4. Anchor your attention to the present moment: pay attention to your breathing, the sounds around you, the physical sensations you have.

5. Observe what you feel, see, and hear without placing a value or judgment on it.

6. Continue to focus on each breath, in and out.

7. When intrusive thoughts come into your mind, let them go without judging them or yourself. Return your focus to your breathing. Over time it will become easier to focus your mind in this way.

Distress Tolerance

Sometimes the intensity of depression is so deep, it feels like a crisis situation. You may feel a sense of urgency or a desire to act impulsively. You may feel there is no way out. These feelings can interfere with your efforts to manage depression and maintain stability. Learning to tolerate distress for a short time can help you get through a difficult moment, when you cannot change the situation. Distress Tolerance strategies help you do this by using skills to distract yourself, soothe yourself, provide solace, and improve the difficult moment.

These strategies are not a cure for the problems of life. They are not meant to dismiss the seriousness of your problems. Practicing Distress Tolerance is more like taking a break from your situation for a short while. Use these skills when you feel overwhelmed by your depression. Eventually the intensity of the moment will fade away.

Strategies to Achieve Distress Tolerance

Distraction

Decrease your contact with events that trigger distress using:

• Activities, such as hobbies, sports, or gardening, to distract your attention

• Other thoughts or sensations to distract your mind (such as by doing puzzles, reading)

• Contribution—reach out, volunteer, find a sense of meaning

• Comparison—with those less fortunate

• Emotions—replace a current emotion with another one (such as by watching a funny or scary movie)

Note:
Keep in mind that short-term distraction is not the same as avoiding a problem. Don’t push away—avoidance is not helpful as a regular strategy.

Self-Soothing

Be kind to yourself and provide comfort and nurturing by engaging the five senses:

•
Vision:
enjoy looking at flowers, art, or other objects of beauty; visit museums; get out in nature; see a play, musical, or dance production.

•
Taste:
have a favorite food or beverage; take it slow and savor the experience.

•
Smell:
use a favorite fragrance or lotion; buy flowers or walk through a flower garden or shop; bake cinnamon rolls or cookies.

•
Touch:
take a bubble bath, get a massage, wear comfortable fabrics, hug someone.

•
Hearing:
listen to beautiful, soothing music or sounds of nature; sing; play an instrument.

Note:
Some people feel they are not deserving, or they feel guilt or shame when using self-soothing strategies. If these are problems for you, work on them with your therapist or treatment team.

Improve the Moment

To replace the immediate negative event with a positive experience or image, try the following:

• Visualization—sit and focus on a calm, serene image or a place where you feel relaxed

• Meditation—Dr. Herbert Benson’s book
The Relaxation Response
gives detailed information on getting started

• Focusing on one thing in the moment (see the Mindfulness section of this chapter, on
page 110
, and the following exercise)

• Breathing exercise—sit quietly and focus only on your breathing, taking slow deep breaths, for 3 to 5 minutes; if your mind wanders, refocus on each breath

• Prayer

• Relaxation techniques

• Encouraging self-talk (be your own cheerleader)

• Thinking of pros and cons—the positive and negative aspects of tolerating distress

Basic Principles of Distress Tolerance

• Tolerating distress requires the ability to accept yourself and the current situation.

• Acceptance does not mean you approve of the distressing situation. It is not the same as judging it good.

• Acceptance is a skill for tolerating and surviving the crisis in the moment, until the intensity fades. It will fade.

Communication Skills

With depression, speaking up and advocating for yourself can be hard to do. You may feel that your needs, feelings, or opinions are not important or deserving. However, symptoms of depression can worsen if you hold things inside when you are upset and don’t talk about what you want and need. This can also lower your self-esteem. It is important to communicate clearly and effectively so that the other person really
hears
you. Your style of communication determines whether and how your message is received. Communication styles can be described as aggressive, assertive, passive, or a combination (passive-aggressive).