Depression Part 4: Just do the little bit that you can.

Part 1: Is It Depression?  Part 2: When Depressed   Part 3: Nurture Yourself Back to Life

Part 4:

Exercise: We’ve been told so often that we must exercise, that now we may hear it as a burden. Who can carry any more burdens when severely depressed? Who can go lift weights when it’s a struggle to get the bathroom and brush their teeth? But exercise is not supposed to be horrible. You can’t go wrong if you focus on exercise primarily as a way to make your body feel a bit better. It’s not some kind of punishment for resting, or for eating, or for existing in a body of any shape or size. It does not have to be within a contest. It is not a “cure” for mental illness, though it can help to improve your mood. It is an activity your body can like if done in a pleasant, kind way!

I often suggest to clients that if they are too exhausted to go to the gym or whatever their preferred exercise may be, just walk around the block. If that is still too much for right now, then just go outside and walk around the house and back in! Just do the little bit that you can.

There are very few texts that “get” how to approach exercise when you’re experiencing severe depression, but this excellent article really helps when you need to ramp up from zero: “Depression-Busting Exercise Tips For People Too Depressed To Exercise” (Sarah Kurchak)

Social Interaction: Maintaining social interaction can be a tricky aspect of depression. You need some level of social interaction to help stabilize your emotions and keep you woven into reality. If you are in a marginalized group, it is especially important to have supportive others to validate your experiences and keep you feeling sane, cared for, and safe. However, there is a HUGE difference between how much social interaction you need if you are more extroverted versus the amount you need if you are more introverted.

Extroverts can more easily harness the power of friends and family to help recover from a depressive episode: being around others will energize you and give you a bit of motivation. It’s straightforward. Seek out others to talk to daily and if possible, to see in person. It may be hard to ask for help, but see if you can ask for help with something simple. This could be something like dishes, child care, or taking you to the grocery store. You can also just ask someone to watch a movie with you or go for a walk. Ask several different people to do several different things. Being able to be in supportive company will be very useful in your recovery.

Introverts, however, may have a harder time with this. Since interacting with others can drain you of energy, you may need to be choosy about whom you contact and how you interact with them. It’s still a good goal to speak with another human at least once a day. But it’s okay if this is just talking to a friend on the phone, getting your change from the clerk at the corner store, or even calling a help line. If you have the energy to tolerate having someone in your space, it’s good to ask a friend for a little help. But make sure it’s someone who understands your limits and does not expect you to be entertaining or emotionally fulfilling to them. You can offer that later when you are not in a depressive episode! If it is still very hard to see people or even to just talk on the phone, you can start with just texting or emailing with someone(s) daily. But try not to let a day go by without communicating with others. And keep doing it.

Furthermore, you may also be considering medication.

Medications: There are a lot of non-medical things you can do to manage your depression, and medication is certainly not mandatory. However, medications can be a useful part of managing depression. They will not make you immune to sadness, but if you are especially low or “flat” or suicidal they may pull you up enough to get to your self-management.

Other people in your life may have a lot of strong opinions about medications, but this is your decision, not someone else’s. If someone tells you that you should take medication but you don’t want to, you do not have to. If someone tells you that you should not take medication but you want to try it, you may try it. That decision is between you and your physician, and you need to do what will help YOU to recover.

Most antidepressants and anti-anxiety medications are prescribed by people’s primary care physicians, though often your PCP will require that you are also seeing a therapist if they are to prescribe psychoactive medications. A psychiatrist can address more complex psychoactive medication issues than your primary care physician. A psychiatrist may be necessary if you have resistant depression or other mental health issues, such as hypomania or psychosis. It may take up to three months to get an appointment with a psychiatrist, since they are in short supply everywhere. So if you think you may want a psychiatrist, don’t wait to start looking.

Now you have stabilized yourself as best you can! You have examined the four crucial life aspects influencing mental health (sleep, nutrition, exercise, and social interaction), you have considered whether you’re interested in medication, and you have begun doing what you can to develop a healthy rhythm in those areas.

For today, you are doing the little bit that you can. And you will keep doing it. It’s very hard to manage your mood at all when even one of these aspects is disrupted, so stabilizing them all is the basis of recovery.

Next part: Emotional Aspects: Mood Management

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Just do the little bit that you can. And keep doing it.

 

~You may qualify for our new sliding-scale fee discount.~
~Please contact us for an application.~

Yoga Through the Lens of Western Science

Our physical, emotional, and cognitive aspects are interconnected and interdependent. This is the case whether we use a psychodynamic approach or a cognitive-behavioral psychological approach. If we are experiencing (noticing) dysfunction in one area, the whole system is actually affected. The good news about this is that by changing things in one aspect, we can affect other aspects as well.

This does not mean that we can simply “think away illness” or that if we can exercise “perfectly” (whatever that would be!) then our thoughts and feelings will just “snap out of it” into rationality and/or bliss. What it does mean, however, is that when we gradually move our habits towards health and balance in one aspect, the other aspects will also move more towards health and balance.

That means when behaviors become healthier, thoughts and feelings become healthier. When thoughts become healthier, feelings and behaviors become healthier. When feelings become healthier, behaviors and thoughts become healthier. A change in any one of them changes all of them!

When we consider the interconnected areas of behavior, cognition, and emotion, the most easily and directly influenced aspect is behavior. We can change what we do, which can help to change what we think and how we feel.

Remember, with any behavior change, the idea is not instant change, but rather successive approximation: doing things a bit more like the goal behavior, and then when that sticks, we do it a bit more like the goal behavior. Attempting drastic changes is less likely to create long-term change than creating and conditioning gradual habit change.

This really interesting clip discusses some ways in which developing–for example–a yoga practice can influence not only thoughts and feelings but also our bodies down to the cellular and chemical level:

 

ILC&P Hiking Sessions Begin Next Week

 

Trail through the forest at Lancaster County Central Park, Penns
Lancaster County Park

Beginning next week, ILC&P is expanding services to include hiking sessions for adult clients in the Lancaster area!

Hiking (or strolling!) sessions will be conducted in a public hiking area during limited daylight hours. You may walk at whatever pace is comfortable for you; athleticism not required! Prospective new clients must attend a standard in-office intake assessment before scheduling hiking sessions.

I am an all-weather walker! Hiking sessions are rain or shine unless conditions are bad enough to qualify for school cancellation.

Clinical service fees and discounts are the same for hiking sessions as for in-office sessions. (For example, if someone qualifies for Open Path sessions in person, they would qualify for Open Path hiking sessions).

Further details will be posted, but clients need not wait to contact us regarding scheduling or with any questions.

 

~Compare therapy session options~

 

Race Against Racism

Good morning! It’s time to run the Race Against Racism. I’ll be making fellow runners feel better about themselves by being the one everyone can pass!

So far this year I have personally provided 101 cost-discounted sessions to 11 separate clients. This included 15 sessions at an 87% discount and 86 sessions at a 55% discount. Donors have generously covered $670 so far this year–nearly 10%! Thank you!! For the balance of session costs I have donated my time ($6545 so far this year).

Minority statuses occupied by this year’s session discount recipients have included homelessness, disability, LGBTQ identity, immigrant/nationality, religious minority, and racial statuses, as well as low income.

If you would like to sponsor* me by contributing to our Therapy Scholarship, click the paisley icon 👇👇👇👇! (Read more about the scholarship below the link). Any amount helps! If you cannot donate, shares and RTs are also great. Thank you!!

 

YOUR DONATIONS ARE KEEPING US RUNNING — THANK YOU!

Donate to Therapy Scholarship for Low-Income Marginalized Individuals

Often, members of minority and marginalized groups have the greatest need for therapy to help recover from injurious life experiences and environments. However, for the same reason, they are also the most likely to be unable to afford treatment.

This Therapy Scholarship has been helping to fund discounted, low-cost, and no-cost therapy in 2019 for low-income individuals with a qualified professional therapist. Your donations are helping keep the bills paid at ILC&P while we see clients!

 

 

*I plan to run regardless so it may not technically be a “sponsorship” but we do really appreciate any and all donations!

If you are a fellow runner with chronic illness or mental illness, read about my approach to running with PTSD.

YWCA Lancaster Race Against Racism 2019

My injured knee from the fall I took last fall is about as healed as it is going to get! I’ll be participating in this Saturday’s Race Against Racism again though probably at my traditional slow pace. 😁

If you would like to sponsor* me by contributing to our Therapy Scholarship, click the paisley icon 👇👇👇👇! (Read more about the scholarship below the link). Any amount helps! If you cannot donate, shares and RTs are also great. Thank you!!

 

YOUR DONATIONS ARE KEEPING US RUNNING — THANK YOU!

Donate to Therapy Scholarship for Low-Income Marginalized Individuals

Often, members of minority and marginalized groups have the greatest need for therapy to help recover from injurious life experiences and environments. However, for the same reason, they are also the most likely to be unable to afford treatment.

This Therapy Scholarship has been helping to fund discounted, low-cost, and no-cost therapy in 2019 for low-income individuals with a qualified professional therapist. Your donations are helping keep the bills paid at ILC&P while we see clients!

So far this year I have personally provided 101 cost-discounted sessions to 11 separate clients. This included 15 sessions at an 87% discount and 86 sessions at a 55% discount. Donors have generously covered $670 so far this year–nearly 10%! Thank you!! For the balance of session costs I have donated my time ($6545 so far this year).

Minority statuses occupied by this year’s session discount recipients have included homelessness, disability, LGBTQ identity, immigrant/nationality, religious minority, and racial statuses, as well as low income.

 

 

 

*I plan to run regardless so it may not technically be a “sponsorship” but we do really appreciate any and all donations!

Read about my approach to running with PTSD.

Happy Earth Day!

We hope you are out enjoying the wonderful sunshine in our environment on this beautiful Earth Day. It’s one of the best self-care interventions around!

Sierra Club has more suggestions for taking care of the earth AND yourself:

 

Learning Boundaries as a Self-Parenting Skill

 

I recently saw this tweet from writer Jacinda Townsend:

Jacinda, you are definitely not alone!

For those who grew up in a family of origin with appropriate boundaries, learning how to set boundaries probably happened as invisibly as learning to walk, write their name, or sing songs. Interpersonal interactions were healthy and just “happened that way.” Those people often don’t even realize that’s how they are living. (See: fish, water!)

But for those of us from families with more dysfunction, we may have just as invisibly learned unhealthy boundaries, and it will greatly affect our daily lives. Like much of self-parenting, this is harder to learn in adulthood, but necessary and definitely worth the work.

Since I am also a therapist who hands out materials on boundaries to my clients, here are links to two articles I frequently use with clients. Others may also find them useful:

Like any skill, boundary setting takes repeated practice over time. We may see how we’re “supposed to” do it right away, but that doesn’t mean we will be able to implement it right away. Throw away that perfectionistic expectation. But you can start experiencing relief right away from even small changes! Read the articles and see what parts apply to your experience. Start small, keep working on it, and develop the habit of treating your boundaries as being important! ❤

 

 

 

 

 

 

 

Checking In With Yourself

When you’re feeling really depressed, upset, or anxious, it can be hard to come up with ways to understand what is happening with yourself, let alone what to do about it. Even the most basic self-care can be hard to remember when your executive functioning is down.

This is a very helpful list to have handy for those times when you are unable to generate the energy to remember how to support yourself:

 

Mindfully Running a Half-Marathon

Having PTSD and asthma means that there are many times I can’t run or my training is derailed for short or long periods.

I began running because it was an activity I remembered enjoying in childhood, and I really wanted to reclaim it. I also wanted to improve my cardiopulmonary health. I never thought I would make it up to even a single mile! But that wasn’t the important part. I wanted to develop a habit and create new, positive mental associations.

My training method was this: I would run only as far as it felt good and enjoyable, and then stop or walk. If I felt like it, I could start again. When I felt done, I was done!

Because I took the performance pressure (“shoulds”) off myself and made the activity 100% about enjoyment and health, it ended up being something I have stuck with, and I progressed far more than I imagined possible.

Not only do I only run as much as feels okay, I likewise never pressure myself to run when I’m not feeling well, or I’m too tired from missing sleep, or something hurts.

In this way I am mindful of not being a punitive taskmaster towards myself, which would activate PTSD symptoms and also put me at increased risk for injury or illness. Exercising punitively is a form of perfectionism that can be injurious very quickly.

I accept my current level of ability as it is, knowing it does not make me superior or inferior to anyone else. I also know my ability is temporary, fluctuates, and includes a large component of sheer luck.

I pay caring attention to my body’s needs, which sometimes (often!) means I have to re-start my training all over again from mile 1. But it also means I am more likely to be able to continue running further into my lifespan.

I hope that whatever kind of exercise you prefer, you remember that the point of exercise is to improve your physical and mental health, rather than to punish your body (for eating, for example!) If you are exercising in a self-punitive way, it will not be healthy for you for very long.

And I want you to experience as much physical and mental health as you can, for as long as you can!