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I’m Struggling With Depression.  What Can I Do?

I’m Struggling with Depression. What Can I do?

Jane is tired of being depressed.  She wants to enjoy life as her friends seem to and just stop feeling depressed and feel happy like her family tells her to.  But it isn’t quite that simple for her.  Life’s outlook just looks bleak.  She feels alone and nobody seems to understand her.  She doesn’t have the energy to accomplish what she knows she needs to during the day.  She admires people around her, but can’t find the same strengths or likable traits within herself.  Sometimes she even feels like hurting herself.  What should Jane do?  What are some different counseling options?  Therapy ideas and workbooks?  Ways to find support?

What Causes Depression?

Many people ask what is causing Jane to feel depressed in the first place in an effort to get rid of the cause.  What causes Major Depressive Disorder?  That’s the billion dollar question.  Seriously…if I knew the answer to that and could stop it from continuing I’d be an overnight billionaire, I’m sure.  Because humans are so complex and everyone’s life is unique, there is no one single right answer or solution for depression.  Do genetics play a role?  Absolutely.  Does brain chemistry?  Sure.  Do our past histories and traumas and life set-backs cause it?  That’s a no-brainer; of course they do.  What about our physical health, social and family life stressors, environmental causes, work and educational factors?  Yes, yes, and yes.  And probably dozens of other causes I didn’t mention.

Therapists like to use bio-psycho-social-environmental-spiritual assessments to help identify factors that are contributing to a person’s mental health.  All this really means is there are many, many factors that go into creating the storms of depression and other mental illnesses.

So, if we can’t succinctly define and state what causes depression, perhaps the more helpful question is what each individual can do to try to cope with, alleviate, and sometimes cure Major Depressive Disorder.  Notice I say cope with, and not 100% once-and-for-all rid ourselves of it.  Of course the goal is for Jane to no longer feel depressed or be diagnosed with Major Depressive Disorder, but sometimes it’s a long, slow and bumpy journey.  That does not mean that there is no hope, though!  Of course there’s hope.  Thousands of people can testify of how they pushed through and arrived at a happier time in their lives.  I worked with clients who practiced therapeutic skills and worked on their mental wellness to the point that they no longer felt clinically depressed and they started enjoying life again and felt better about themselves.

There are so many different research-based options out there to try to help with feelings of depression, anxiety, and other mental illnesses.  It is my hope that this blog post will provide possible options to cope with depression.  That being said, this post is not meant to provide therapeutic services, nor is it comprehensive.  It does not provide an assessment for or diagnosis of depression or other mental illnesses.  Nor is this post intended to provide help in and of itself.  Please seek the help of a licensed professional for that.  Rather, this post is only meant to provide some food for thought on different potential courses to take.

Reach Out for Support for Depression

It’s important for Jane, and everyone feeling like her, to know that they are not alone.  Thousands of other people struggle with feelings of depression and understand how you feel.  Even more than that, there is nothing wrong with someone who is depressed.  Remember, a person is so much more than their feelings; their personality and goodness should not defined by the depression.

A person is so much more than their feelings!  Their value and their contributions to society should not be defined by depression.  Depression is an illness and does not diminish worth.

I would encourage Jane to try to reach out to people who can provide empathy and support to her.  Maybe the person she reaches out to has felt depressed before and maybe not.  That doesn’t matter. What does matter is that she finds someone who can provide empathy, support, and help.  Perhaps she relies on a spouse, a parent, or a close family member.  Maybe she can talk to a close friend.  It’s possible that her support comes in the form of a co-worker or a coach.  Many people find support in online or in-person support groups.

Support can come in various shapes and sizes, as well.  Some people might find a lot of support from a yoga class, even though they don’t overtly talk about your feelings to your fellow yoga-goers.  Many people find support from a lunch club that they attend and chat with other friends.  There are countless ways and means to find support; what’s important is that individuals find a good fit for them.

I realize that this can be really difficult.  It’s 1,000 times easier said than done.  After all, feelings of isolation (meaning feeling alone) is one of the symptoms of Major Depressive Disorder.  People who struggle with depression often withdraw from social activities.  So, it may take a conscious, intentional, and difficult effort to reach out to others.

Seek Professional Help for Overwhelming Feelings of Depression

Part of seeking support can include finding help from licensed professionals.  They can provide expertise and additional support and resources if feelings of depression are feeling more than a personal can handle on their own.  For more information, check out FamilyNinja’s article on how to know when to seek counseling.

There are many different licenses that give the ability to provide therapy.  Counselors include psychiatrists, psychologists, Licensed Clinical Social Workers, Marriage and Family Therapists, and Licensed Professional Counselors.  Of course there are other options, including medical personnel that work in the field, as well as others I have not mentioned.

Some people have found medications to be helpful in coping with depression.  I am not a medical professional, so I won’t say much more about that.  Several of my clients found medications lessened their depression.  Some went to family doctors, while others went to doctors or nurse practitioners that specialized in mental health field.

Suicide and Crisis Hotline

If you are struggling with suicidal thoughts or intents of self-harm, please seek the help of a professional!   (This post is not intended to provide therapeutic services assessment.). There are also several local suicide and crisis hotlines that are available 24/7.  You can call or chat the National Suicide Prevention Lifeline a 1-800-273-8255.  Similar hotlines exist for other challenges and feelings.

For more information about helping a loved one who is struggling with suicidal thoughts, check our our podcast about the topic with Dr. Gregory Hudnall.

Identify Personal Contributors to Depression

Curing depression generally may be a million dollar question, but perhaps Jane can find some answers for herself.  What I mean by that comment is this: with some introspection people may be able to figure out some of the factors that are contributing to their feelings of depression.  Then, they may (or may not) be able to do something about it.  Let’s look back at our bio-psycho-social-environmental-spiritual model for examples:

For example, maybe before the story opened Jane was abused and that trauma from it is definitely contributing to feelings of depression.  This doesn’t mean that she now has an easy or fast answer.  Rather, she can intentionally seek help that addresses the trauma and learn how to adapt, cope and recover from it.

Maybe Jane’s spouse died.  If so, she can deliberately and intentionally work through her grief.  She can understand that grieving is normal and healthy, but there are also unhealthy ways to grieve.  Maybe she attends a grief group or starts creating memory books.  If she has closed herself off, maybe she starts talking to friends and family about it.  Again, this isn’t easy or simple, but it can provide Jane with some direction in the right way.

Identifying what can be impacting a person’s feelings of depression can also be more subtle than these two examples.  Maybe Jane is fighting with her spouse, struggling with her current work assignments, does not enjoy her responsibilities or her co-workers, is not eating the nutrients her body needs, and is barely surviving the harsh winter.  To top it all off, her family has a history of depression.  What are her options?

If this is the case, Jane might seek more education or perhaps even search for a new job (although she should ensure that it’d really be helpful and it’s not the depression telling her that her job stinks.  Does Jane have a pattern of leaving jobs?)  She could talk to her family and/or a nutritionist and work out a system to eat healthier and get better nutrients.  She could make a greater effort to do things that makes her happier, such as going on long runs, because she knows that winter always hits her hard.  Maybe she takes a trip to a sunnier portion of the world.  She decides to go to marriage counseling with her husband.  Lastly, she decides to visit the doctor and talk about getting medication.

The list could go on and on.  I hope it goes without saying that none of these solutions are quick and easy.  They’re probably really difficult.  But, hopefully you can identify one step in the right direction.  Remember, a journey of a thousand miles begins with one step.

Find Therapy or Solutions that are the Right Fit for You

In therapy, counselors use different theories that hypothesize how to help lessen depression.  I found that some of my clients really clicked with one way of working on depression while others weren’t very interested in that specific way.  Again, there is no one “right” way, as long as it’s backed by science.  There are several theories that are research-backed and have been shown scientifically to be helpful.  So, the next step is for each individual to find the right fit for them.  There are many more theories, but I will list just a few here.

Please recognize that they are overly-simplified since I am only dedicating a couple paragraphs to each of them. Also recognize that the therapy modality isn’t as important to improvement as motivation to change and relationship with the therapist, according to research.

Cognitive-Behavioral Therapy (CBT)

Jane is feeling especially low today because she noticed on Instagram that several friends went out to lunch without her.  She’s been fighting with her husband and it’s been a while since they had a nice evening together.  She starts thinking, “Nobody loves me.  What’s there to like about me, anyway?”  Her correction from his boss on her report further reinforces this in Jane’s mind.  She sees a reminder on her phone to work out, but she doesn’t have the energy to finish work, let alone go for a jog.

Jane is interpreting events in a negative light.  She jumps to negative and depressing conclusions and thinks sad thoughts (the cognitive piece) and this contributes to her feeling of depression.  She is at home lounging on the couch alone and does not reach out to her friends, exercise, or plan a nice evening with her husband (the behavioral piece).  All of these actions contribute to depression, where the opposite could be helpful.  Obviously, this is a grossly exaggerated story of depression that I tell simply to try to make a point.

Cognitive-Behavioral Therapy is all about exercises to help you 1) identify unhelpful thoughts, 2) challenge their rationality and probability, and 3) slowly but surely replace them with helpful and true thoughts.  4) It is also all about finding baby steps to behave in ways that increase happiness.  So, Jane would challenge the notion that since she wasn’t invited to lunch that means her friends don’t like her anymore.   She could remind himself of some of the positive interactions she has had with her husband this last week.  She can find positive outcomes she had at work and challenge the assertion that she’s an idiot and incompetent at her job.  Better yet, she could practice assertiveness and talk to her boss about the report and what she is seeking.  Although a 5k run every day seems overwhelming, she can start by taking a walk around the block a couple times a week.

There are several Cognitive-Behavioral Therapy Workbooks available.  I have not personally reviewed too many of them, so I would suggest simply reading reviews from other readers.  I will say that David Burns is very well-known in the Cognitive Therapy world.  Family Ninjas has a post about working on improving self-esteem with cognitive behavioral exercises.  It might help provide ideas about what CBT is.

I'm feeling depressed. What should I do? Don't believe everything you think.

Dialectical-Behavioral Therapy (DBT)

Jane is at home on the couch, feeling upset, because her boss really dug into her about the report.  She didn’t receive help from her co-workers; they left her high and dry.  She feels like she doesn’t have friends to talk to and her boss is out to get her.  Jane’s thoughts and emotions start spiraling out of control.  She feels like she’s in a dark whole that she has no idea how she can climb out if.

Dialectical Behavioral Therapy (DBT) is pretty difficult to explain succinctly and whole websites can be and are dedicated to it.  Some of the most important premises of DBT are learning to accept what is going on instead of fighting it and getting more worked up.  This is called radical acceptance.  If something is outside of your control then accept it and move on.  For example, when Jane is stuck in rush-hour traffic she practices taking a deep breath and accepting that it will take her a while to get home instead of tapping the steering wheel impatiently and muttering under her breath about drivers who cut her off while her blood pressure rises.  This is one baby step in the right direction, and this eventually leads her to practicing this acceptance when her boss criticizes her in a meeting with the whole company in attendance.

DBT also focuses a lot on being mindful and present in the moment instead of getting swept up into the whirlwind of hurtful past events and anxiety-provoking future events.  With dialectical behavioral therapy, Jane learns to accept that her report could have been better and that her co-workers did not prioritize that particular report like she wished they had (radical acceptance).  She takes a deep breath and lets the emotions of anger, shame, and hurt wash over her like a wave.  She tries not to fight the feelings and become more and more upset about the day and hence escalate feelings of worthlessness and loneliness that she feels.  She reminds herself to not wallow in the feelings and metaphorically drown.  Instead, practice what the mental health field calls mindfulness.

Mindfulness is about staying in the moment.  Practice being in the present instead of thinking depressing thoughts about the past (the work report) or the future (how the co-workers will act tomorrow).  Jane uses her 5 senses to stay grounded to the here-and-now.  For example, she takes a hot bath.  She thinks about what the water sounds like splashing against the side of tub.  She smells the lavender in the bubble bath.  She touches the warm water.

Radical acceptance does NOT mean that she accepts inappropriate behavior and lets a boss walk all over her, nor does it mean that she accepts mistakes she makes because it’s just who she is and she’ll never do better.  Indeed, DBT emphasizes the question: can I do something about it now?  If the answer is yes, then do it.  Jane can talk to her boss or work on learning what she needs to in order to create a better report.  If the answer is no, that’s when mindfulness and radical acceptance can help, such as during rush hour traffic.

Again, this is a grossly exaggerated view of both depression and what DBT is, and there is much more to it than radical acceptance and mindfulness.  If you’re interested in learning more, there are again numerous workbooks about Dialectical Behavioral Therapy.  Although it’s geared toward teen agers, I really like Don’t Let Your Emotions Run Your Life for Teens by Sheri Van Dijk.  The author has other DBT workbooks that are not geared toward teens.  I bet they’re great.  I just haven’t read them yet…

Stay tuned for more future posts about DBT.

Acceptance and Commitment Therapy (ACT)

Contrary to Cognitive Therapy, Acceptance and Commitment Therapy (ACT) doesn’t try to discover the rationality of thoughts and change them.  With ACT, a person decides whether a thought is helpful or unhelpful and if it gets him or her to where he/she wants to be.  So, Jane decides that dwelling on work injustices and thinking that friends hate her is unhelpful.

So often we become fused with our thoughts.  Instead, take a step back and recognize that a thought is just thought: a thought.  It doesn’t have to be more than that.  Thoughts don’t have to rule us.  Jane might think, “Hmm…I just had a thought that Robin doesn’t like me.  But that’s just a thought.”  ACT workbooks provide several awesome ways to “defuse” from your thoughts.  The purpose of ACT is not to get rid of unwanted thoughts, but to provide some prospective so you can see outside of the thoughts.

Similar to DBT, ACT also talks about the need to accept some of the hard realities instead of living in denial or fighting it.  I’m not saying we shouldn’t work to change what is changeable or stop fighting against the unjust.  Rather, let go of (accept) the situations and thoughts that are depressing so that they will stop having that control over you.  Just like I mentioned above, this does not mean you passively stand by and let bad things happen.  It simply means that you don’t make hard situations harder by living in denial or getting too worked up about it.

Jane also decides what is valuable in her life, using ACT.  Happiness and fulfillment comes from living by values.  Jane googles ACT values so she is better able to articulate her values.  She might decide, for example, that championing the cause of children is what brings meaning into her life.  She then acts on that value, and her other values, in order to increase happiness.  Maybe she makes changes in work or home life in order to act in more accordance with her values.

Again, this is a grossly oversimplified version of ACT.  It’s a pretty cool theory, in my opinion.  I really like the workbook Get Out of Your Mind and Into Your Life: The New Acceptance and Commitment Therapy by Steven Hayes.  There are also great books to read such as The Happiness Trap: How to Stop Struggling and Start Living: A Guide to ACT by Russ Harris.

I'm struggling with depression. What can I do?

Family Therapy

There are several different theories about family therapy, one of the most common being systems theory.  Systems theory can help identify how family dynamics and family problems are contributing to the depression.  Maybe fights with her spouse and various stressors with her children are really taking a toll on Jane.  A counselor can help her sort out these issues.

Jane decides to see a marriage counselor with her husband.  They work on learning how to communicate better and identify what is at the root of several of their arguments as systems theory goes beyond simple communication techniques.  Jane and her husband are able to work through and change some of the issues they are struggling with.   Jane and her husband work on everything from working through finances, jealousy, speaking more assertively, and in-law problems.

There are Many Other Therapies.  There are Many More Solutions.

There are many other therapies.  These are just a few options.  Again, individuals can find a fit that is right for them.  And, like mentioned above, traditional talk therapy might not be the first choice for some people.  This is by no means a comprehensive list of therapies.  Nor is it a comprehensive list of solutions.  I’m a social worker, so obviously this post is biased toward explaining more therapy solutions than others.

Look to the Opposite of Depression: Find Ways to Increase Happiness

Positive Psychology took a step back and wondered why we are focused on depression and anxiety and anger.  Instead, positive psychologists wanted to know what happy people do.  Isn’t that what we really want anyway?

Before I write a little about what some positive psychologists have studied about people’s well-being in general, ask yourself these questions about your personal well-being:

What makes a good life for me, personally?

When am I happiest?  Most fulfilled?  Doing well?  The pleasantest?  

What do I imagine I am doing and being if I were to wake up tomorrow and the depression was magically gone?

They have researched a multitude of various things that contribute to happiness.   (Again, this list is by no means comprehensive or a well-rounded summary of positive psychology.)  Christopher Peterson and Dr. Martin Seligman, founders of positive psychology, describe how happy people:¹ ²

  • Live in the moment, savor positive experiences and emotions and find reasons to view themselves as worthy of happiness
  • Recognize and use their strengths, talents, and virtues.
  • Have friends/family/positive relationships and social support and are a friend to others
  • Are engaged in what they are doing and have “flow” or are fully immersed.  They have confidence in their tasks and their ability matches it.
  • Find meaning outside themselves- something bigger like faith in God or serving a common good for humanity
  • Accomplishing goals or tasks and gaining achievements
  • Find happiness not just within themselves, but also do things in the home or workplace to promote happiness.
  • Exhibit growth and resilience through adversity and have grit and self-control

Look for Hope

If there’s one thing I’ve learned in life, it’s that people can find sources of hope in the very darkest of times.  It’s my hope that people feeling depressed, overwhelmed, and like they just can’t take another step on this hard journey can remember their strengths, their goodness, and their purposes in life.  I hope that they can find what gives them hope.

Disclaimer: This post is not meant to provide therapeutic services.  It does not offer a diagnosis of or counseling for depression.  If you are struggling with feelings of depression that is more than you can handle, or suicidal thoughts, please seek the help of a professional.  If you have suicidal thoughts, please seek the help of a professional.

References

¹Seligman, M. (2011, April). Flourish: A new theory of positive psychology. Authentic Happiness. University of Pennsylvania. Retrieved from https://www.authentichappiness.sas.upenn.edu/node/2333

²Peterson, C. (2013). Pursuing the good life: 100 reflections on positive psychology. New York: Oxford University Press.

 

Tanya Lindquist

Tanya is a licensed clinical social worker who worked for several years at various therapy clinics before becoming a stay at home mom. She loves helping families find tools and methods they can apply to helping children overcome any challenge.

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