DEALING WITH DEPRESSION

UNDERSTANDING DEPRESSION
– depression is not a single condition and does not have a single cause
– anxiety and depression are closely related and frequently overlap
– physical causes of depression (drugs, alcohol, illness) should be ruled out first

FACTORS THAT CAUSE OR CONTRIBUTE TO DEPRESSION
– loss of social worth or belonging
– problems in close relationships
– unemployment
– financial distress
– social isolation
– childhood trauma
– drug and alcohol use or withdrawal
– some medical illnesses and medications

WHAT TO DO
– have a check-up for possible medical causes of depression (eg. anemia, B12, hypothyroidism)
– remember that depression after a sudden loss often resolves on its own over several months
– recognize the basic human need to be with others and to feel loved
– pay attention to sleep, diet and exercise
– limit use of drugs and alcohol
– ensure good medical care if you have a chronic illness
– develop a network of supportive relationships instead of relying on one person
stay active every day (even if you don’t feel like it)
– check yourself for perfectionism and unrealistic ideas about self-esteem
– check yourself for ineffective problem solving due to rumination
– practice mindfulness and attention-shifting techniques
– reconsider your goals and values as you begin to feel better

DRUGS FOR DEPRESSION
– anti-depressants can help in severe depression but are less effective in mild to moderate depression
– anti-depressants take 2 or more weeks to start working and should usually be stopped after 6-12 months
– when coming off anti-depressants, taper down over 2-3 months to avoid withdrawal symptoms
– see here for precautions and side effects of anti-depressants
– see here for controversies about anti-depressants

SAFETY PLAN FOR SUICIDAL THOUGHTS
– if you are having suicidal thoughts, use crisis services:
Toronto Distress Centres 416-408-4357
Gerstein Centre 416-929-5200
– if suicidal thoughts are uncontrollable, call 911 or go to an Emergency Department:
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

UNDERSTANDING ANXIETY
– anxiety symptoms include varying amounts of fear, worry and physical arousal
– physical causes of anxiety (drugs, alcohol, illness) should be ruled out first

FACTORS THAT CAUSE OR CONTRIBUTE TO ANXIETY
– physical threat
– fear of loss of social worth or belonging
– childhood deprivation or trauma
– excessive use of stimulants such as caffeine, nicotine, and energy drinks
– drug and alcohol use or withdrawal
– some medical illnesses and medications

WHAT TO DO WHEN FEELING PHYSICALLY ANXIOUS
– understand that anxiety is usually a false alarm based on misinterpretation of danger
– deep breathing (slow exhalation) will usually reduce or stop physical symptoms of anxiety
– gradually learn to accept some degree of anxiety rather than trying to avoid or suppress it

WHAT TO DO IN THE LONGER TERM
– have a medical check-up to rule out physical causes of anxiety
– limit use of drugs and alcohol as well as caffeine, nicotine and energy drinks
– pay attention to sleep, diet and exercise
– identify sources of stress and how to problem-solve them
– practice mindfulness and attention-shifting techniques
– understand negativity bias and learn to challenge negative thoughts
– take action to overcome avoidance
– understand that excessive reassurance-seeking perpetuates anxiety
– reconsider your goals and values as you begin to feel better

DRUGS FOR ANXIETY
– all drugs have side effects and should not be used before trying other methods
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

SIGNS OF STRESS
– restlessness
– irritability
– fatigue
– poor sleep
– muscle tension
– poor attention
– physical symptoms – headaches, teeth grinding, digestive problems
– frequent illnesses or worsening of existing health problems

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

WHAT NOT TO DO
– emotional numbing
– binge behaviours
– avoidance
– procrastination
– over-scheduling
– multi-tasking
– isolating yourself
– blaming others

REDUCING VULNERABILITY TO STRESS
– have a medical check-up if you are concerned about your health
– pay attention to diet, sleep and exercise
– cut down on caffeine, nicotine, sugar, energy drinks
– avoid drugs and alcohol
– complete one task at a time rather than multi-tasking
– try to understand what your emotions are telling you
– give yourself time for rest, socializing and pleasurable activities
– consider limiting your use of social media
– practice mindfulness and attention-shifting techniques

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

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

DEALING WITH ADDICTION

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

WANTING
– wanting/craving is a powerful motivational circuit originating in the lower parts of the brain
– the core feeling is hopeful anticipation and excited searching
– activated by brain dopamine and stimulant drugs
– triggers are can be any or all reminders of past use

LIKING
– compared to wanting, liking/satisfaction is fickle and tends to habituate
– the core feeling is physical comfort and social belonging
– activated by brain endorphins and opiate drugs

ADDICTIONS AND COMPULSIVE BEHAVIOURS
– tolerance develops with all drugs and leads to decreased satisfaction
– the wanting/craving system become over-sensitized and easily triggered
– cycles of using and withdrawal create a vicious cycle
– preoccupation with using leads to narrowing of interests and concerns about losing control

DEALING WITH CRAVINGS
– identify emotional triggers. including boredom and loneliness
– be aware of your efforts to rationalize using
– change your environment (people, places, things) to reduce exposure to reminders
– practice urge surfing rather than trying to suppress thoughts
– develop new habits to interpose between triggers and rewards
– re-learn simple satisfactions rather than pursuing shiny new objects
– keep long-term goals in mind
– see information on relapse prevention here

SEE ALSO
The Science of Craving
Why Disappointment Is So Devastating: Dopamine, Addiction, and the Hedonic Treadmill
Addiction and the Opponent Process Theory
The Dark Side of Drug Addiction

DEALING WITH ANGER

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

LEARNING TO THINK BEFORE YOU ACT
– use deep breathing to calm yourself down
– identify external triggers and learn how to avoid them
– identify inner warning signs and take a time out
– identify painful feelings that you may be covering up by getting angry
– check yourself for blaming or trying to control others
– practice effective communication in close relationships
– learn how to admit mistakes and make amends
– practice mindfulness and attention-shifting techniques
– use relapse prevention techniques to prevent repetitive behaviours

RESENTMENT IN CLOSE RELATIONSHIPS
– resentment involves holding others responsible for one’s frustrations and disappointments
– it may be expressed through sarcasm, cynicism or blowing up over small things
– facts are selectively chosen to to justify one’s mistakes and blame the other person
– resentment can become entrenched and lead to enduring stand-offs in relationships

DEALING WITH RESENTMENT IN CLOSE RELATIONSHIPS
– check yourself for caring more about winning arguments than co-operation and closeness
– learn to practice effective communication
– make an effort to validate your partner’s feelings
– acknowledge mistakes and 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
– The Anger Habit in Relationships
– Anger Management for Dummies

DEALING WITH GRIEF

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

UNDERSTANDING GRIEF
– grief often comes in waves rather than progressing through stages
– an initial period of painful preoccupation and social withdrawal is common
– dreams and visitations are common
– some grieving people may not be outwardly distressed
– grief may be prolonged out of feelings of loyalty or responsibility

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

GRIEF AFTER LOSING SOMEONE TO SUICIDE
– there is no single or comprehensive reason for someone committing suicide
– blaming oneself is common
– feeling angry at the deceased is common
– blaming others for not doing more may be an effort to relieve feelings of guilt
– survivors may feel judged or shunned by others
– survivors may identify with the deceased and question the value of living

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

PHYSICAL HEALTH & MOOD

DIET AND DEPRESSION
foods that can contribute to depression include sugars, refined grains and processed foods
nutrient deficiencies that can contribute to depression include vitamins B6, B12, D, folic acid and iron

SUPPLEMENTS FOR DEPRESSION
– a basic multi-vitamin for B vitamins
– vitamin D up to 2,000 IU/day
– omega 3 fatty acids 1,000 mg/day of EPA + DHA

NUTRITION
– for information and controversies about healthy diets, see here and here
– for potential problems with herbs and supplements, see here and here

LOSING WEIGHT
– the first step in losing weight is to reduce food intake (see here and here)
– the easiest way to lose weight is to reduce sugars, starches (bread, pasta, potatoes) and processed foods
exercise along with increased protein can prevent muscle loss when dieting
– a calculator for BMI and other parameters can be found here
– a free service in Ontario that lets you to speak with a dietician is available here

METABOLIC SYNDROME
– a precursor of diabetes, heart disease and other lifestyle diseases
– includes abdominal obesity plus raised blood pressure, blood sugar and cholesterol/fats
– metabolic syndrome can be prevented by changing diet, losing weight and increasing activity

CHRONIC ILLNESS
– chronic illness and depression frequently go together and can create a vicious cycle
– educate yourself about the illness and have your medications reviewed on a regular basis
– for information on the risks of modern medicine, see here and here
– for information on the dangers of self-diagnosis, see here and here

MEDICAL SELF-MONITORING
– monitoring devices and apps can give you more control over your health
– examples include metabolic syndrome, borderline diabetes, borderline hypertension
– find a variable that can be easily measured, such as weight, blood glucose, blood pressure
– change one thing at a time using trial and error to find out what changes the variable

EXERCISE
– the benefits of exercise on mood is greater than medication in many cases
– exercise can improve energy level, sleep and mental focus in depression
– see these links for information about the health benefits of running, walking and dancing.
– an easy way to integrate exercise into your daily life is to walk – see here and here

SLEEP
– for information on sleep problems, see here

SUN EXPOSURE
– the benefits of moderate sun exposure far outweigh the risks – see here and here

DRUGS AND ALCOHOL
– alcohol and drugs give short-term relief but lead to long-term problems
– continuing to use despite negative consequences on work, relationships and health indicates a problem
– if you are not ready to quit, try using Moderation Management (see here and here)
– for information on addictions and relapse prevention, see here and here

SLEEP PROBLEMS

TO GET INTO A REGULAR SLEEP PATTERN
– get up at the same time every day – regardless of how you feel or how long you have slept

TO PUT YOURSELF TO SLEEP
– avoid heavy meals, alcohol, caffeine and nicotine in the evening
– practice relaxation and/or mindfulness meditation techniques
– write down worrying or distracting thoughts to clear your head
– get up after 20 minutes if you can’t fall asleep, but keep getting up at the same time each morning

STAYING ASLEEP
– getting up in the middle of the night is a common practice in some cultures
– waking up can occur as drugs or alcohol wear off, or as a result of a dream
– write down dreams and thoughts that keep you awake to clear your head

SLEEPING PILLS
– side effects include uninhibited behaviour, amnesia, rebound anxiety and hangover effects
– continuous use for 3-4 weeks can cause dependence
long-term health effects of sleeping pills are equivalent to smoking

MELATONIN
melatonin (3-6 mg at bedtime) can improve the quality of sleep
– melatonin is for short term use only (6-12 weeks)
– if melatonin stops being effective, stop using it for a while rather than increasing the dose

SLEEP LABS
– can identify breathing problems or other medical conditions responsible for insomnia
– often fail to come up with a definite reason for insomnia in healthy adults

SEE ALSO
– What to do about Insomnia
– How to Fall Asleep
– Sleeping with a Partner
– 10 Things the Sleep-Aid Industry Won’t Tell You

EFFECTIVE COMMUNICATION

HOW TO LISTEN
– let the other person have their say without interruption
– try to understand the central message in what is being said
– paraphrase back what was said to check your understanding
– acknowledge criticism without making excuses or blaming
– learn how 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 get along

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

ACKNOWLEDGING MISTAKES
– acknowledge the damage done without trying to minimize or make excuses
– make a commitment to not repeat the mistake
– offer a plan to remedy the mistake
– spell out the consequences of repeating the mistake
– start over without grudges 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 here for dealing with anger in close relationships
See here for a model of assertiveness training

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

BUILDING SELF-CONFIDENCE

LOW SELF-CONFIDENCE IS PERPETUATED BY
– staying within a narrow comfort zone
– believing that others know better
– sacrificing your interests in the hope of gaining approval and security

OVERCOMING SOCIAL ANXIETY
– identify patterns of avoidance and safety behaviours
– challenge your negative thoughts
– check yourself for perfectionism
– check yourself for excessive reassurance-seeking
– understand the reasons for the brain’s negativity bias
– practice self-compassion and reward yourself for taking steps forward

CHANGING HABITS
– it is easier to replace a habit than eliminate it
– try to understand the cues and rewards that drive the habit
– use trial and error to find a new routine that can give similar rewards
– start simple and change only one habit at a time
– practice the new routine consistently for the first 30 days

OVERCOMING INDECISIVENESS
– try working 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 even if there is no obvious right decision
– leave room for course corrections and have a back-up plan
– doing things for the right reason is more important than doing them the right way

OVERCOMING PROCRASTINATION
– try to clarify your motives for going forward and what is stopping you
– start even if you are not in the right mood or do not have all the materials
– build momentum by starting on the edges or with the easy parts
– focus on one step at a time rather than thinking about the end result
– learn to procrastinate productively by using breaks to perform other tasks

CHANGING JOBS
– try to be clear with yourself about why you want to leave your current job
– look at whether the problems with your current job are fixable
– list what you want from a new job in concrete terms
– spend time doing research and consider all options
– assess your financial options and supports
– consider vocational assessment or further education
– sign up for job alerts to find out what jobs are actually available
– test your readiness by doing preliminary job interviews
– consider a trial run before committing yourself to a new position
– beware of recruiters who pressure you to close the deal
– organize a plan by making a time-line and work backwards by setting deadlines for each step
– 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
– The Dangers Of Being Dutiful
– Misemployment
– How to Find Fulfilling Work
– What is ‘Success’?

EMOTION REGULATION

PRACTICING EMOTIONAL AWARENESS
– observe your reactions without judgement
– identify trigger situations and why they are important to you
– identify situations or thoughts that cause your emotions to escalate
– understand emotion as information about your wishes and beliefs
– use emotion as a sign that you need to change your expectations or actions

INEFFECTIVE METHODS OF EMOTION REGULATION
– numbing
– binge behaviours
avoidance
thought suppression
worry/rumination
reassurance-seeking
– over-scheduling and multi-tasking
– isolating yourself
– blaming others

EFFECTIVE METHODS OF EMOTION REGULATION
– understand the purposes of negative emotions
– identify and challenge negative beliefs
– develop methods for problem-solving
– take action to overcome avoidance
– practice acceptance of uncertainty and painful feelings
– try using 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
– humour

SEE ALSO
– On Being Out of Touch With One’s Feelings
– How We Lie to Ourselves
– The Faulty Walnut
– Why Are People So Nasty?
– Why We’re Fated to be Lonely
– The Dangers Of Being Dutiful

WORRY & RUMINATION

Worry and rumination are forms of repetitive thinking.
Worry usually involves apprehension about the future.
Rumination usually invovles disappointment or regret about the past.

UNDERSTANDING WORRY
– worry is a way of trying to anticipate future problems or dangers
– worry often leads to over-monitoring, checking and excessive reassurance-seeking
– people who worry may mistakenly believe it makes them safer or more prepared

DEALING WITH WORRY
challenge your thoughts to see if they are realistic or likely to happen
– write down worrying thoughts and deal with them during a set period later in the day
– practice mindfulness and attention-shifting techniques

UNDERSTANDING RUMINATION
– rumination can involve self-criticism or internal arguments with others
– cycles of rumination can intensify feelings of shame, guilt, and anger
– people who ruminate may mistakenly believe it helps them find answers or solve problems

DEALING WITH RUMINATION
– check yourself for whether rumination has actually helped you find answers or solve problems
– learn lessons from the past and resolve not to repeat them
– practice self-compassion
– start taking action towards new goals
– practice mindfulness and attention-shifting techniques

DEALING WITH INTRUSIVE THOUGHTS
– cycles of worry and rumination often start with intrusive thoughts
– everyone experiences intrusive or distressing thoughts on a daily basis
– consider intrusive thoughts as mental noise and focus on the immediate present
– if you feel you must worry or ruminate, set aside a 20 minute period once a day

SEE ALSO
– Are You Confusing Rumination with Problem-Solving?
– Probing the Depression-Rumination Cycle
Excessive Reassurance-Seeking
Why Thought Suppression is Counter-Productive
Metacognitive Therapy for Anxiety and Depression

 

USING ATTENTION

ACTIVE ATTENTION
– involves focussing on specific tasks while limiting distractions
– focussed attention has limited capacity and is easily fatigued
– take breaks (eg 10-15 minutes per hour) to restore attention
– do a different activity during the break (eg walking or working with your hands)

PASSIVE ATTENTION
– attention is grabbed by whatever sticks out, especially novelty or danger
– occurs when active attention is fatigued or during activities such as watching TV or internet surfing

MIND-WANDERING
– involves self-focussed thinking when attention is not engaged with a specific task
– 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
– some people find it hard to be alone with their thoughts because of worry and rumination

USING ATTENTION
– each form of attention has helpful uses and drawbacks
– allow time for passive attention and mind wandering
– to focus on a difficult task, limit background distractions and multi-tasking
– 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
– use mindfulness techniques to counter worry and rumination

SEE ALSO
– How to Focus a Wandering Mind
– Soft Fascination
– Confronting the Negativity Bias
– How to Build a Happier Brain
Making It Up as You Go Along: How Your Brain Improvises
Against Flow

RELAPSE PREVENTION

CAUSES OF RELAPSE
– stress or anxiety
– sadness or loneliness
– over-confidence
– leading a double life

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
– identify your high risk situations – people, places, things
– make a plan for avoiding or leaving high risk situations
– structure your free time and access to money, especially on weekends
– check yourself for making excuses or blaming others
– learn new ways of problem-solving
– practice attention-shifting and urge surfing
– build new habits to replace the addiction cycle
– examine your priorities and set new goals
– check yourself for misconceptions about 12 step programs (see here and here)
– consider using relaxation and mindfulness techniques

BENEFITS OF 12 STEP PROGRAMS
– meet people with similar experiences
– see the consequences 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 out a number of groups until you find the right one for you
– check the schedules for meetings in your area:
Alcoholics Anonymous
Narcotics Anonymous

POST-ACUTE WITHDRAWAL
– periods of difficulty with mood, sleep, energy and mental focus after physical withdrawal is complete
– symptoms come in waves lasting up to several days and can be a trigger for relapse
ride out the waves with good support and self-care
– see here for more information about craving

Recovery involves nothing shorter than a complete change in your life, but relapse prevention is a matter of paying attention to warning signs and avoiding triggers. Rather than trying to bargain with yourself, the best way to resist a craving is to not open the question.

SEE ALSO:
– An ACT Workbook For Overcoming Substance Abuse
– Ageing Out of Drugs
– How Big Pharma Is Cashing in on Addiction to Alcohol and Illicit Drugs

ANTI-DEPRESSANTS

I see many people in my practice who have taken anti-depressants for long periods of time, sometimes starting in adolescence and continuing for much of their adult life. Many of these people have never had a psychiatric assessment. It is sometimes difficult to determine why anti-depressants were started in the first place because details of memory have become vague or records are hard to get, but in many cases it can be established that the person has never had an episode of severe (melancholic) depression.

There are no objective tests for conditions like anxiety and depression.  Diagnosis in psychiatry is based solely on clusters of symptoms. During the 1980s, the definitions of depression were expanded to include less severe forms and, as a result, rates of anti-depressant use sky-rocketed to roughly 10% of the adult population. This resulted in an apparent decline in effectiveness of anti-depressants because the majority of users have less severe (ie. non-melancholic) types of depression in which anti-depressants are often not particularly effective.

But anti-depressants such as SSRIs are not simply placebos with side effects. They affect arousal in the brain in a general way and have been tried in virtually all psychiatric disorders. As with any drug, tolerance occurs with anti-depressants because the body produces counteracting effects. With anti-depressants, the counteracting effects can be easily confused with a worsening of the original problem. This may explain why many people may stay on anti-depressants for years without substantial improvement.

Part of the reason for the high rates of use of anti-depressants has been the way these drugs have been marketed. Some psychiatrists have tried to distance themselves from the ‘chemical imbalance’ theory by saying it was always just a myth or an urban legend. Drug companies were able to turn profits on these drugs despite huge fines imposed for false claims, but some of the larger companies have implicitly acknowledged the poor science behind these drugs by stopping further research in this area.

N.B. Severe depression almost always requires treatment with an anti-depressant, but mild to moderate depression can be treated with psychotherapy and lifestyle changes such as exercise and decreased use of drugs and alcohol. The average length of an untreated episode of depression is 6 months. Anti-depressants usually take 2-4 weeks to start working. If there is no improvement after 6-8 weeks, switching to a drug in a different class of anti-depressants may be helpful. Continue taking anti-depressants after you start to feel better but, in most cases, a plan should be in place for coming off after 6-12 months. When coming off anti-depressants, taper down over 2-3 months to avoid withdrawal symptoms.

SEE ALSO
The Silence of Prozac
– Medicating Women’s Feelings
– Mental Disorders As Networks
– The Illusions of Psychiatry

MINDFULNESS MEDITATION

ARTICLES
Getting Started with Mindfulness
How to Practice Mindfulness
Benefits of Mindfulness
What Meditation Can Do for Us, and What It Can’t

GUIDED MEDITATION AND RELAXATION
– Breathing for Anxiety
– Guided Meditations
– Deep Breathing & Guided Relaxation Exercises
– Diaphragmatic Breathing Technique

BOOKS
Mindfulness-Based Stress Reduction Workbook
Wherever You Go, There You Are
Calming Your Anxious Mind
The Mindful Way Through Depression
– Acceptance and Commitment Therapy
– The Happiness Trap

CLINICS/TEACHING CENTRES
– The Centre for Mindfulness Studies
– Meditation for Health
– The Mindfulness Clinic

STOIC PHILOSOPHY

Many modern therapies have roots in older traditions such as Stoic philosophy and Buddhism. Stoics believed that problems arise from trying to control things outside oneself rather than accepting them. The first question for a Stoic is to know what is in one’s control and what is not.

THINGS THAT ARE IN OUR CONTROL
– our wishes and fears
– our capacity to direct attention
– our capacity to observe ourselves from other perspectives

THINGS THAT ARE NOT IN OUR CONTROL
– the actions of others
– the natural world (including our bodies)
– the impermanence of things

OBSERVING SELF
– stand back and observe your thoughts and feelings rather than struggling to control them
– differentiate looking-from (‘I’ experiences) and looked-at (‘me’ experiences) – see here
– check yourself for cultivating an image for others rather than living life from the inside

DIRECTED ATTENTION
– learn how to shift attention between focused, distracted and wandering mind
– focus on your immediate sensations and environment to regain attention

COMMITTED ACTION
– excessive focus on achieving goals can prevent people from living according to their values
– problems with motivation often come from values that are adopted rather than freely chosen
– action in accordance with freely-chosen values is intrinsically motivating

SEE ALSO:
– The Philosophy of Cognitive Behavioral Therapy
– examples of Stoic exercises here and here
– Acceptance and Commitment Therapy
– The Happiness Trap