DEALING WITH DEPRESSION

FACTORS THAT CAUSE OR CONTRIBUTE TO DEPRESSION
– loss of relationships or social standing
– social isolation
– unemployment or financial problems
– childhood deprivation or trauma
– drug and alcohol use
– some physical illnesses and medication

WHAT TO DO
– remember that depression after a sudden loss often resolves on its own over several months
– develop a network of supportive relationships rather than relying on one person
– stay active every day even when you don’t feel like it
– have a check-up to rule out physical causes of depression (eg. anemia, B12, hypothyroidism)
– decrease use of drugs and alcohol
– make sure you are getting good medical care if you have a chronic illness

DIET AND EXERCISE
– the benefits of exercise on mood is greater than medication in many cases
– foods that can contribute to mood problems include sugars and processed foods
– supplements useful in depression are B vitamins, vitamin D and omega 3 fatty acids

ANTI-DEPRESSANT DRUGS
– anti-depressants can help in severe depression but are less effective in other forms of depression
– anti-depressants take 2 or more weeks to start working
– if there is no improvement after 8 weeks, switching to a different anti-depressant sometimes works
– in most cases, a plan should be in place for coming off anti-depressants after 6-12 months
– when coming off anti-depressants, taper down gradually over 2-3 months to avoid withdrawal effects
– see here for more information about anti-depressants

IN CASE OF EMERGENCY
In case of risk to life or physical safety, call 911 or go to the emergency department of your nearest hospital.
Crisis services are available at:
Toronto Distress Centres 416-408-4357
Gerstein Centre 416-929-5200
CAMH Emergency Department 416-535-8501

SEE ALSO
On Feeling Depressed
– Overcoming Bad Inner Voices
– The Wisdom of Pessimism
– Losers and Tragic Heroes
– How to Get Over Someone
– How To Get Over Rejection


DEALING WITH ANXIETY

Anxiety tends to manifest as a mixture of:
– physical symptoms related to fear and panic
– mental symptoms related to worry and rumination

FACTORS THAT CAUSE OR CONTRIBUTE TO ANXIETY
– physical threats
– fear of losing relationships or social standing
– childhood deprivation or trauma
– stimulants such as caffeine and nicotine
– drug and alcohol use
– some physical illnesses and medication

WHAT TO DO WHEN FEELING ANXIOUS
– understand that anxiety is often a false alarm based on misinterpretation of danger
– deep breathing (slow exhalation) will usually reduce or stop physical symptoms of anxiety

WHAT TO DO IN THE LONGER TERM
– have a check-up to rule out physical causes of anxiety
– pay attention to sleep, diet and exercise
– identify sources of stress and how to problem-solve them
– challenge your negative thoughts
– take action to overcome avoidance
– practice mindfulness and attention-shifting techniques
– learn to accept some degree of anxiety rather than trying to entirely eliminate it

DRUGS FOR ANXIETY
– all drugs have side effects, so other methods of dealing with anxiety should be tried first
– benzodiazepines relieve anxiety quickly but cause physical dependence if used daily for more than a few weeks
anti-depressants are not habit-forming but take 2 weeks to start reducing levels of anxiety
– when coming off anti-depressants, taper down over 2-3 months to avoid withdrawal symptoms

SEE ALSO
– Why It Is So Hard to Live in the Present
– Why We’re All So Anxious
– The Impostor Syndrome
– How to Deal With a Panic Attack

 

 

DEALING WITH STRESS

REDUCING VULNERABILITY TO STRESS
– have a medical check-up if you are concerned about your health
– pay attention to diet, sleep and exercise
– complete one task at a time rather than multi-tasking
– practice mindfulness and attention-shifting techniques

PROBLEM-SOLVING TECHNIQUES
– decide what aspects of your situation are within your control and can be changed
– break down problems into small steps that are concrete and attainable
– reduce commitments or ask for help in sharing the load
– be assertive when negotiating new commitments
– take regular breaks and reward yourself for each step forward

LOOK AT THE BIGGER PICTURE
– examine your priorities and whether you are getting satisfaction
– challenge beliefs about having little control over your life
– live according to your values rather than focusing on success

SEE ALSO
– Diathesis–Stress Model
– Understand Your Stress
– How to Deal with Stress

 

 

DEALING WITH ANGER

THINGS THAT CONTRIBUTE TO ANGER
– over-sensitivity to shame and humiliation
– ineffective communication skills
– early experiences of abuse or neglect
– drug and alcohol use

LEARNING TO THINK BEFORE YOU ACT
– use deep breathing to calm yourself down
– identify internal triggers and warning signs and take a time out
– identify external triggers and learn ways of avoiding them
– check yourself for blaming others

RESENTMENT IN CLOSE RELATIONSHIPS
– resentment involves making others responsible for one’s frustrations and disappointments
– facts are selectively chosen to to justify one’s mistakes
– resentment can become entrenched and lead to stand-offs in relationships

DEALING WITH RESENTMENT IN CLOSE RELATIONSHIPS
– learn to practice effective communication
– make an effort to validate your partner’s feelings
– acknowledge your mistakes and find ways to make amends

SEE ALSO
– How to Get Angry a Lot
– How Not to be Angry all the Time
– How to Remain Calm with People
– How We Lie to Ourselves

 


DEALING WITH GRIEF

UNDERSTANDING GRIEF
– a period of painful preoccupation and social withdrawal is common
– feeling the presence of the deceased person is common
– outwards signs of distress are not necessary in order to grieve
– grief often returns in waves rather than progressing through stages
– grief may be prolonged out of feelings of loyalty or responsibility

DEALING WITH GRIEF
– postpone major decisions
– dealing with the funeral and estate can help by giving structure
– expect feelings of guilt and anger about the loss
– do not force yourself to find ‘closure’
– expect further waves of grief at anniversaries, holidays and other reminders
– seek support from others
– find ways of making the qualities you admired in the deceased live on in the world

Grief involves not just the loss of someone you care about but also loss of parts of one’s own self and world.  Close relationships create a shared identity with shared routines, social networks, memories and plans for the future.  Ceremonies and other forms of memorialization can be helpful in acknowledging the loss and re-locating the deceased person.

SEE ALSO
– Bereaved Families of Ontario
– Coping with Grief and Loss
– Suicide Survivors Face Grief, Questions, Challenges

 

 

DEALING WITH ADDICTION

WANTING VERSUS LIKING
– wanting (craving) and liking (satisfaction) are separate aspects of pleasure
– in addictions, satisfaction decreases and craving takes on a life of its own

WANTING
– wanting (craving) is a powerful motivational circuit
– the core feeling is hopeful anticipation and excited searching
– craving is activated by brain dopamine and stimulant drugs

LIKING
– liking (satisfaction) is fickle and tends to habituate
– the core feeling is physical comfort and social belonging
– satisfaction is activated by brain endorphins and opiate drugs

ADDICTIONS AND COMPULSIVE BEHAVIOURS
– tolerance develops with all drugs and leads to decreased satisfaction
– the craving system becomes over-sensitized and easily triggered
– cycles of withdrawal and shame/blame create a vicious cycle
– excessive craving leads to a loss of other interests

DEALING WITH CRAVINGS
– change your environment (people, places, things) to reduce exposure
– identify emotional triggers such as boredom and loneliness
– be aware of your efforts to rationalize or bargain with yourself
– re-learn simple satisfactions rather than pursuing shiny new objects
– learn relapse prevention techniques here

SEE ALSO
The Science of Craving

 

DEALING WITH RELAPSE

STAGES OF RELAPSE
– feeling stressed, anxious or sad
– entering high risk situations
– giving yourself permission for a lapse
– allowing a lapse to become a full relapse

PREVENTION OF RELAPSE
– identify your inner warning signs
– make a plan for avoiding or leaving high risk situations
– structure your free time and access to money
– practice attention-shifting and urge surfing
– check yourself for making excuses or blaming others
– build new habits to replace the addiction cycle
– check yourself for misconceptions about 12 step programs

BENEFITS OF 12 STEP PROGRAMS
– meet people with similar experiences
– see examples of the problem in others
– see examples of recovery
– get a sponsor for 1-1 help
– review your life by working the steps

FINDING A 12 STEP GROUP
– try different meetings until you find the one that is right for you
– Alcoholics Anonymous
– Narcotics Anonymous

POST-ACUTE WITHDRAWAL
– symptoms can return in waves lasting up to several days and can trigger a relapse
– learn to ride out the waves with good support and self-care

SEE ALSO:
– Ageing Out of Drugs
– How Big Pharma Is Cashing in on Addiction to Alcohol and Illicit Drugs

 

PHYSICAL HEALTH

NUTRITION
– Eat food. Not too much. Mostly plants.
To lose weight, eating less is far more important than exercising more
– What we do and don’t know about dietary science

EXERCISE
– The mental health benefits of exercise
– Why walking helps us think
How to start running

SLEEP
– How to fall asleep
– How to wake up at the same time every day
Understanding sleep

LIVING WITH CHRONIC ILLNESS
Why chronic illness and depression go hand in hand
– Why are medical mistakes our third leading cause of death?
The perils of being your own doctor


 

 

 

 

EMOTION REGULATION

PRACTICING EMOTIONAL AWARENESS
– observe your reactions without judgement
– identify situations or thoughts that cause your emotions to escalate
– use emotion as information about your wishes and expectations

INEFFECTIVE METHODS OF EMOTION REGULATION
– binge behaviours
– numbing
– isolating yourself
– worry/rumination
– over-scheduling
– reassurance-seeking
– blaming others

EFFECTIVE METHODS OF EMOTION REGULATION
– understand the purposes of negative emotions
– challenge your negative beliefs
– develop methods for problem-solving
– take action to overcome avoidance
– practice acceptance of uncertainty and painful feelings
– use opposite action to counter painful or overwhelming emotions
– practice mindfulness and attention-shifting techniques
– seek validation from others
– imagine what advice you would give to a friend in a similar situation
– change the situation

SEE ALSO
– On Being Out of Touch With One’s Feelings
– How We Lie to Ourselves
– The Faulty Walnut
– The Dangers Of Being Dutiful


 

WORRY & RUMINATION

Worry and rumination are types of repetitive thinking where thinking circles around a problem without coming to solutions.  Worry is usually focused on future dangers while rumination is concerned with past mistakes or losses.  Trying to suppress unwanted thoughts may make them stronger.

UNDERSTANDING WORRY
– worry is an attempt to anticipate future problems in order to feel safe or prepared
– worry can worsen the problem through over-monitoring and searching for reassurance from others

DEALING WITH WORRY
challenge your worrying thoughts to see if they are realistic or likely to happen
– distract yourself from worry by taking action or using attention-shifting techniques

UNDERSTANDING RUMINATION
– rumination about the past can involve self-criticism or internal arguments with others
– cycles of rumination can intensify feelings of shame, guilt, and anger

DEALING WITH RUMINATION
– check yourself for whether rumination has actually helped you find answers or solve problems
– practice self-compassion and resolve not to repeat past mistakes

DEALING WITH INTRUSIVE THOUGHTS
– cycles of worry and rumination often start with intrusive thoughts
– consider intrusive thoughts as mental noise and focus on the immediate present

SEE ALSO
– Are You Confusing Rumination with Problem-Solving?
– Why Thought Suppression is Counter-Productive
Excessive Reassurance-Seeking

 

USING ATTENTION

The goal is to use each form of attention effectively and learn how to shift between them.

ACTIVE ATTENTION (eg. studying)
– focussed attention has limited capacity and is easily fatigued

PASSIVE ATTENTION (eg. TV or internet surfing)
– occurs when attention is grabbed by whatever sticks out, especially novelty or danger

MIND-WANDERING (eg. day-dreaming)
– mind-wandering is the brain’s default mode and occurs about 50% of the time
– the stream of consciousness is a jumble of fantasies, memories, arguments and rehearsals

USING ATTENTION EFFECTIVELY
– to cope with distracting thoughts, write them down and deal with them later
– to get a new perspective, return to a task after taking a break or a night’s sleep
– to refocus wandering attention, focus on immediate perceptions and sensations
– to restore fatigued attention, take regular breaks and vary activities
– allow time for passive attention and mind wandering
– use mindfulness techniques to counter worry and rumination

SEE ALSO
– How to Focus a Wandering Mind
– Soft Fascination
– How to Build a Happier Brain

 

BUILDING SELF-CONFIDENCE

LOW SELF-CONFIDENCE IS PERPETUATED BY
– staying within a narrow comfort zone
– sacrificing your interests in the hope of gaining security

OVERCOMING SOCIAL ANXIETY
– challenge negative thoughts
– take action to overcome avoidance
– practice self-compassion

MAKING DECISIONS
– work backwards from what you know you don’t want
– brainstorm all possible options and make a list of pros and cons
– choose the best possible option
– leave room for course corrections
– have a back-up plan

DEALING WITH PROCRASTINATION
– start now even if you are not in the mood or do not have all the materials
– focus on one step at a time rather than thinking about the end result
– build momentum by starting with the easier parts
procrastinate productively by using breaks to perform other tasks

CHANGING HABITS
– try to understand the cues and rewards that drive the habit
– use trial and error to find a new routines
– start simple and change only one habit at a time
– practice the new routine consistently for 30 days

CHANGING JOBS
– be honest with yourself about why you want to leave your current job
– look at whether the problems with your current job are fixable
– organize a plan with a time-line and work backwards by setting deadlines for each step
– list what you want from a new job in concrete terms
– spend time doing research and consider all options
– assess your financial situation
– consider further education or retraining
– test your readiness by doing preliminary job interviews
– beware of recruiters
– leave your old job on good terms
– see here for information on dealing with problems in the workplace

SEE ALSO
– Confidence
– The Impostor Syndrome
– Status Anxiety
– Procrastination
– The Perfectionist Trap
– Misemployment
– How to Find Fulfilling Work
– What is ‘Success’?

 

EFFECTIVE COMMUNICATION

HOW TO LISTEN
– let the other person have their say without interruption
– paraphrase back what was said to check your understanding
– acknowledge criticism without making excuses or blaming
– learn to validate feelings

HOW TO GIVE FEEDBACK
– adjust your message to the other person’s understanding and perspective
– talk about specific behaviours rather than presumed motives or character defects
– suggest changes along with any criticism
– respect differences of opinion – you can disagree and still be close

BEING ASSERTIVE
– find the middle ground between caving in or blowing up
– talk about how you feel rather than attacking or making accusations
– ask for concrete changes rather than changes in attitudes
– repeat the message in different ways if you are not getting through

ACKNOWLEDGING MISTAKES
– acknowledge the damage done without minimizing or making excuses
– make a commitment to not repeat the mistake
– offer a plan to remedy the mistake and spell out the consequences of repeating the mistake
– start over and maintain an intention to keep improving

CONFIRMATION BIAS
– selective use of information that confirms one’s beliefs
– leads to over-generalization and polarization of opinions
– used in close relationships to blame the other person
– used in social groups to discriminate against people who are different

SEE ALSO
– Being A Good Listener
– Honest Communication
– The Challenge of Being Close
– How to Help Those We Love
– Emotional Translation