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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.

 

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yaelingh Uncategorized

A Peaceful Meditation Day to All!

The physical and health benefits of meditation have been noted for years and repeatedly validated by science. You don’t have to switch to an entirely new lifestyle in order to practice meditation! There are many ways to begin practicing, a little at a time.

Many people with anxiety do very well with the structured approach taken by Headspace (Andy Puddicombe). With simple graphics that clearly explain physical, cognitive, and emotional aspects of meditation, you will find the process easy to understand and implement. Even if you do not get a subscription and only use the first sessions that are free, it is well worth a look:

Another meditation tool that many clients report being highly satisfied with is Insight Timer:

And if you’re ready to go a little deeper into the emotional aspects of meditation, I highly recommend anything at all by Tara Brach!

 

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Yoga Through the Lens of Western Science

Yoga class concept

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:

 

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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! ❤

 

 

 

 

 

 

 

yaelingh Uncategorized

Happy Spring Equinox!

In the Northern Hemisphere, we are now at the balance between length of day and night. After today, the days will be longer than the nights.

People with seasonal depression are likely to find their mood lightening. Many people will feel renewed enthusiasm and motivation for everyday activities and for future plans. Some people may have more difficulty with insomnia, though, so it’s a good time to review your sleep hygiene!

Tonight is also a full moon!

 

 

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Acceptance: Making People into Trees

Ram Dass (Dr. Richard Alpert) expresses acceptance of self and others with a beautiful metaphor:

 

“…when you go out into the woods and you look at trees, you see all these different trees. And some of them are bent, and some of them are straight, and some of them are evergreens, and some of them are whatever. And you look at the tree and you allow it. You appreciate it. You see why it is the way it is. You sort of understand that it didn’t get enough light, and so it turned that way. And you don’t get all emotional about it. You just allow it. You appreciate the tree.

The minute you get near humans, you lose all that. And you are constantly saying “You’re too this, or I’m too this.” That judging mind comes in. And so I practice turning people into trees. Which means appreciating them just the way they are.”

Remember, emotional and cognitive skills take practice just as physical skills do. Many of us have years or decades of practice in thinking destructively and judgmentally! So practice a little self-acceptance today, and then again tomorrow, and the next day…

 

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What Attending Therapy Is About: (AKA We Are Not Just Sitting Here Chatting)

Everyone’s approach to attending therapy sessions is different: people’s needs, symptoms, and circumstances vary incredibly. People want and expect different things in session.

Clearly, there are specific, well-researched interventions that are likely to be effective with most people who experience a certain symptom or pattern of behavior. Some interventions can be practiced in a therapy session, and some interventions are good for a client to take home and practice on their own. I do have plenty of handouts to work on and books to recommend that you read!

But not every intervention is on a list of tips that I’m going to print out and give you outright, or on a sheet in a manual with steps 1, 2, and 3. In fact, nearly all of what we are doing while in session is an intervention, even if I do not formally announce it as such. That is to say, we are not just sitting here chatting, even if sometimes that’s what it appears to be.

When I’m asking about your week, or how you feel, if you’ve gotten over your flu, or how things are going with your family or job, for example, I’m actually assessing your anxiety, depression, hypomania, behavior patterns, physical well-being, environmental influences, sense of hopefulness, and any changes in how you are interacting…for starters.

But I’m not just gathering data. I’m also intentionally getting you to practice certain kinds of conversing, thinking, and interacting during session.

I’m getting you to practice speaking openly about things that may have felt “unspeakable,” uncomfortable, scary, or just awkward. I’m reframing or redirecting your thoughts as you speak them from “shoulds and musts” to “preferences and wants,” so that you can begin to change your internalized messages. I am giving you the chance to practice openly experiencing and expressing feelings in the presence of someone who will not censor or scold you for how “irrational” or “unacceptable” they are. I am often taking the role of defending you from your own inner critic! I am supporting you in developing an attachment that is not based in power and control or other unhealthy dynamics. I’m also simply being a trained witness to your life; checking in with you over time to see how you are changing and making sure you are okay.

Developing different patterns of thought and interaction takes time, and it’s a great deal more powerful if done with another person. That is why sessions are “booster shots” even for those who do a lot of internal work on their own. Humans are social creatures. Everyone, even introverts (like me!) must interact with others in order to process and develop emotionally.

And you know I can tell you’ve been making real progress when you stop yourself from saying “should” in session before I can give you the “shoulds” lecture yet again! ;D

So that is why–even if I didn’t give you a handout to take home or a list of suggested solutions to your situation–you made a LOT of progress in your session today.

Remember, “talk therapy” actually changes brain structure!

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