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Self-Care for Depression
As a clinical psychologist, Mary Pipher, PhD, designed “healing packages” for her patients: activities, resources, and comforts to help them recover from trauma. Then, after Dr. Pipher’s book Reviving Ophelia became a runaway best-seller, she herself suffered from an episode of major depression and designed a healing package of her own. “The essence of my personal healing package,” she describes in her book Seeking Peace, “was to keep my life as simple and quiet as possible and to allow myself sensual and small pleasures.” She created a mini-retreat center in her home and modified the ancient ways of calming troubled nerves to fit her lifestyle. Pipher’s healing package looked like this:
She accessed the healing power of water by walking at Holmes Lake Dam, swimming at the university’s indoor pool, and reading The New Yorker magazine in the bathtub every morning.
She cooked familiar foods, dishes that reminded her of home: jaternice, sweetbreads, and perch; and cornbread and pinto beans with ham hocks.
She unpacked her childhood teacup collection and displayed it near her computer desk to remind her of happy times and of people who loved her.
She reconnected with the natural world by walking many miles every week on the frozen prairie, watching the yellow aconites blossom in February and the daffodils and jonquils in March, following the cycles of the moon, and witnessing sunrises and sunsets.
She read biographies of heroes like Abe Lincoln, and read the poetry of Billy Collins, Robert Frost, Mary Oliver, and Ted Kooser.
She found role models for coping with adversity.
She limited her encounters with people and gave herself permission to skip holiday gatherings and postpone social obligations. She erased calendar engagements until she had three months of “white space” in her future.
She embraced her body through yoga and massage. She started to pay attention to tension in her neck and other cues from her body and let those signals teach her about herself.
She meditated every day.
These activities were exactly what she needed to emerge from the other side of depression. She writes:
“After taking care of my body for several months, it began to take good care of me. My blood pressure improved and my heart problems disappeared. After a few months of my simple, relatively stress-free life and my healing package of activities, I felt my depression lifting. I enjoyed the return of positive emotions: contentment, joy, calmness and new sparks of curiosity and energy. I again felt a great tenderness toward others.”
Psychiatrist James Gordon, MD, discusses similar healing packages in his best-selling book Unstuck. At the end of his first meetings with all of his patients, he will write out a “prescription of self-care,” which includes instructions on changing diet, advice about specific recommended meditations or exercises, and a list of supplements and herbs. “Among my recommendations, there are always actions, techniques, approaches, and attitudes that each person has told me — which she already knows — are helpful,” he explains. At the end of his introduction, he suggests each reader take some time to write out his or her own prescription. He supplies a form and everything.
Each person’s healing package is unique. Many people have benefited from more meditation and mindfulness exercises, psychotherapy sessions, and therapies like Eye Movement Desensitization and Reprocessing (EMDR) that help unclog the brain of painful memories. Some people do better with more physical exercise and nutritional changes. While mindfulness and meditation have certainly helped many become aware of my rumination patterns, the most profound changes in others recovery have come from the bags of dark, green leafy vegetables, yoga, and breathing exercises.
It’s empowering to know that we don’t need a doctor or any mental health professional to design a healing package for us. We are perfectly capable of writing this prescription ourselves. Sometimes (not always), all it takes are a few simple tweaks to our lifestyle over a period to pull us out of a crippling depression or unrelenting anxiety.
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Anxiety Handout
We all know the uncomfortable feeling of anxiety. Our hearts race, our fingers sweat, and our breathing gets shallow and labored. We experience racing thoughts about a perceived threat we fear will be too much to handle. That’s because our “fight or flight” response has kicked in, resulting in sympathetic arousal and a narrowing of attention and focus on avoiding the threat. We seem to be locked in that state, unable to focus on our daily chores or longer-term goals. Below are six strategies that you can use to help relieve your everyday anxiety:
- Reevaluate the probability of the threatening event actually happening.
Anxiety makes us feel that a threat is imminent, yet most of the time what we worry most about never happens. By recording our worries—and how few actually came true—we can notice how much we overestimate the prospect of negative events.
- De-catastrophize.
Even if a bad event happened, we may still be able to handle it by using coping skills and problem-solving abilities or by enlisting others to help. Although not pleasant, we could still survive encountering a spider, having a panic attack, or losing money. It’s important to realize that very few things are the end of the world.
- Use deep breathing and relaxation.
By deliberately relaxing our muscles we begin to calm down so we can think clearly. If you practice this at first without a threat present, it can start to become automatic and will be easier to use in the moment when you face a threat. Deep breathing engages the parasympathetic nervous system to put the brakes on sympathetic arousal.
- Become mindful of your own physical and mental reactions.
The skill of mindfulness involves calmly observing our own reactions, including fear, without panic or feeling compelled to act. It can be taught in therapy and improves with practice.
- Accept fear and commit to living a life based on core values.
Acceptance and Commitment Therapy (ACT) is an approach that encourages people to accept the inevitability of negative thoughts and feelings and not try to repress or control them. By directing attention away from the fear and back onto life tasks and valued goals, we can live a full life despite the fear.
- Exposure.
Exposure is the most powerful technique for anxiety and it involves facing what we fear and staying in the situation long enough for the fear to habituate or go down, as it naturally does. Fear makes us avoid or run away, so our minds and bodies never learn that much of what we fear is not truly dangerous.
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Some health benefits of yoga
Yoga is considered a mind-body type of complementary and alternative medicine practice. Yoga brings together physical and mental disciplines to achieve peacefulness of body and mind, helping you relax and manage stress and anxiety. Traditional yoga philosophy requires that students adhere to this mission through behavior, diet and meditation. But if you’re just looking for better stress management — whether because of life’s daily hassles or a health problem you’re facing — and not an entire lifestyle change or way of life, yoga can still help.
Yoga has many styles, forms and intensities. Hatha yoga, in particular, may be a good choice for stress management. Hatha is one of the most common styles of yoga, and some beginners find it easier to practice because of its slower pace and easier movements. But most people can benefit from any style of yoga — it’s all about your personal preferences.
The core components of hatha yoga and most general yoga classes are:
- Poses. Yoga poses, also called postures, are a series of movements designed to increase strength and flexibility. Poses range from lying on the floor while completely relaxed to difficult postures that may have you stretching your physical limits.
- Breathing. Controlling your breathing is an important part of yoga. In yoga, breath signifies your vital energy. Yoga teaches that controlling your breathing can help you control your body and quiet your mind.
The potential health benefits of yoga are numerous and may include:
- Stress reduction. With its quiet, precise movements, yoga draws your focus away from your busy, chaotic day and toward calm as you move your body through poses that require balance and concentration.
- Increased fitness. As you learn and refine new poses, you may enjoy improved balance, flexibility, range of motion and strength. And this means you’re less likely to injure yourself in other physical endeavors or in your daily activities.
- Management of chronic health conditions. Yoga might help with a variety of health conditions, such as cancer, depression, pain, anxiety and insomnia, by helping with sleep problems, fatigue and mood. Yoga also can help reduce heart rate and blood pressure.
- Weight loss. If you’re overweight or have binge-eating disorder, yoga may help you make the healthy lifestyle changes necessary to gain control of your eating and drop those extra pounds.
While you shouldn’t expect yoga to cure you or offer 100 percent relief, it can help some health conditions when combined with standard treatment. And if you already enjoy good health, yoga can be an enjoyable supplement to your regular fitness routine.
Yoga is generally considered safe for people of all abilities, even if you use a wheelchair or you’re severely overweight. But there are some situations in which yoga might pose a risk. You may need to find an alternative to yoga or scale back your yoga poses.
See your health care provider before you begin yoga if you have any of the following conditions or situations, since complications can arise:
- Balance problems
- Uncontrolled high blood pressure
- Certain eye conditions, including glaucoma
- Severe osteoporosis
- Pregnancy
- Artificial joints
You may be able to practice yoga in these situations if you take certain precautions, such as avoiding certain poses or stretches. Regardless of your health status, start slowly and gently. If you develop symptoms or concerns, see your doctor to make sure you’re getting benefit and not harm from yoga.
Finding a yoga class
If you’ve decided to try yoga, whether for stress management or other health benefits, look for classes in your area. Although you can learn yoga from books and videos, beginners usually find it helpful to learn with an instructor. Classes also offer camaraderie and friendship, which are also important to overall well-being.
When you find a class that sounds interesting, talk with the instructor so that you know what to expect. Questions to ask include:
- What are the instructor’s qualifications? Where did he or she learn yoga, and how long has he or she been teaching?
- Does the instructor have experience working with students with your needs or health concerns? If you have a sore knee or an aching shoulder, can the instructor help you find poses that won’t aggravate your condition?
- Is the class suitable for beginners? Will it be easy enough to follow along if it’s your first time? Can you observe a class before signing up?
- What is the focus of the class? Is it aimed at your needs, such as stress management or relaxation, or is it geared for people who want to reap other benefits?
- What do you need to take along to class? Some classes require you to bring a mat or towel to sit or stand on while doing poses. Other classes will provide a mat.
Remember, regardless of which type of yoga you practice, you don’t have to do every pose your instructor demonstrates. If a pose is uncomfortable or you can’t hold it as long as the instructor requests, don’t do it. Good instructors will understand and encourage you not to exceed your personal limits. Spend time sitting quietly, breathing deeply until your instructor moves the class on to another pose that’s more comfortable for you.
At the end of a yoga session, you should feel invigorated, yet relaxed and calm. If this isn’t the case, talk to your instructor. He or she might have suggestions for you. Otherwise, there may be another yoga class better suited to your needs for stress management and relaxation.
- Yoga for health: An introduction. National Center for Complementary and Alternative Medicine. http://nccam.nih.gov/health/yoga/introduction.htm.
- Smith C, et al. A randomized comparative trial of yoga and relaxation to reduce stress and anxiety. Complementary Therapies in Medicine. 2007;15:77.
- Massey PB. Prescribing movement therapies. In: Rakel D. Integrative Medicine. 2nd ed. Philadelphia, Pa.: Saunders Elsevier; 2007.
- DiStasio SA. Integrating yoga into cancer care. Clinical Journal of Oncology Nursing. 2008;12:125.
- McIver S, et al. Yoga as a treatment for binge eating disorder: A preliminary study. Complementary Therapies in Medicine. 2009;17:196.
- Javnbakht M, et al. Effects of yoga on depression and anxiety of women. Complementary Therapies in Clinical Practice. 2009;15:102.
- Bertisch SM, et al. Alternative mind-body therapies used by adults with medical conditions. Journal of Psychosomatic Research. 2009;66:511.
- Bauer BA (expert opinion). Mayo Clinic, Rochester, Minn. Dec. 11, 2009.
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Anger Handout
Once a week I facilitated an anger management group. I used a variety of handouts and activities to have a process oriented group interaction. One of the handouts I use is below. I use it in 1 of 2 ways. I have folks fill it out first and then we discuss or we go through it together and discuss. We explore as a group, learning from each other.
ANGER WORDS
anger disgust grumpiness rage aggravation dislike hate resentment agitation envy hostility revulsion annoyance exasperation irritation scorn bitterness ferocity jealousy spite contempt frustration loathing torment cruelty fury mean-spiritedness vengefulness destructiveness grouchiness outrage wrath
Other:_________________________
Prompting Events for Feeling Anger
Losing power.
Losing status.
Losing respect.
Being insulted.
Not having things turn out the way you expected.
Experiencing physical pain.
Experiencing emotional pain.
Being threatened with physical or emotional pain by someone or something.
Having an important or pleasurable activity interrupted, postponed, or stopped.
Not obtaining something you want (which another person has).
Other:_______________________________
Interpretations That Prompt Feelings of Anger
Expecting pain.
Feeling that you have been treated unfairly.
Believing that things should be different.
Rigidly thinking “I’m right.”
Judging that the situation is illegitimate, wrong, or unfair.
Ruminating about the event that set off the anger in the first place, or in the past.
Other:____________________________
Experiencing the Emotion of Anger
Feeling incoherent.
Feeling out of control.
Feeling extremely emotional.
Feeling tightness or rigidity in your body.
Feeling your face flush or get hot.
Feeling nervous tension, anxiety or discomfort.
Feeling like you are going to explode.
Muscles tightening. .
Teeth clamping together, mouth tightening.
Crying; being unable to stop tears.
Wanting to hit, bang the wall, throw something, blow up.
Other:__________________________
Expressing and Acting on Anger
Frowning or not smiling; mean or unpleasant facial expression.
Gritting or showing your teeth in an unfriendly manner.
Grinning.
A red or flushed face.
Verbally attacking the cause of your anger; criticizing.
Physically attacking the cause of your anger.
Using obscenities or cursing.
U sing a loud voice, yelling, screaming, or shouting.
Complaining or bitching; talking about how lousy things are.
Clenching your hands or fists.
Making aggressive or threatening gestures.
Pounding on something, throwing things, breaking things.
Walking heavily or stomping; slamming doors, walking out.
Brooding or withdrawing from contract with others.
Other:_____________________
After effects of Anger
Narrowing of attention.
Attending only to the situation making you angry.
Ruminating about the situation making you angry and not being able to think of anything else.
Remembering and ruminating about other situations that have made you angry in the past.
Imagining future situations that will make you angry.
Depersonalization, dissociative experience, numbness.
Intense shame, fear, or other negative emotions.
Other:______________________
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Manage stress handout
If your methods of coping with stress aren’t contributing to your greater emotional and physical health, it’s time to find healthier ones. There are many healthy ways to manage and cope with stress, but they all require change. You can either change the situation or change your reaction. When deciding which option to choose, it’s helpful to think of the four As: avoid, alter, adapt, or accept.
Since everyone has a unique response to stress, there is no “one size fits all” solution to managing it. No single method works for everyone or in every situation, so experiment with different techniques and strategies. Focus on what makes you feel calm and in control.
Dealing with Stressful Situations: The Four A’s
Change the situation: Avoid the stressor. Alter the stressor. Change your reaction: Adapt to the stressor. Accept the stressor. 1. Avoid unnecessary stress
Not all stress can be avoided, and it’s not healthy to avoid a situation that needs to be addressed.
Learn how to say “no” – Know your limits and stick to them.
Avoid people who stress you out –Limit the amount of time you spend with people that cause you stress.
Take control of your environment – If the evening news makes you anxious, turn the TV off.
Avoid hot-button topics –If you repeatedly argue about the same subject with the same people, stop bringing it up or excuse yourself when it’s the topic of discussion.
Pare down your to-do list –If you’ve got too much on your plate, distinguish between the “shoulds” and the “musts.”
2. Alter the situation
If you can’t avoid a stressful situation, try to alter it. Figure out what you can do to change things so the problem doesn’t present itself in the future.
Express your feelings instead of bottling them up. If something or someone is bothering you, communicate your concerns in an open and respectful way.
Be willing to compromise. When you ask someone to change their behavior, be willing to do the same.
Be more assertive. Deal with problems head on, doing your best to anticipate and prevent them.
Manage your time better. Plan ahead and make sure you don’t overextend yourself.
3. Adapt to the stressor
If you can’t change the stressor, change yourself. You can adapt to stressful situations and regain your sense of control by changing your expectations and attitude.
Reframe problems. Try to view stressful situations from a more positive perspective.
Look at the big picture. Will it matter in a month, or a year?
Adjust your standards. Set reasonable standards for yourself and others, and learn to be okay with “good enough.”
Focus on the positive. When stress is getting you down, take a moment to reflect on all the things you appreciate in your life, including your own positive qualities and gifts.
4. Accept what you can’t change
Some sources of stress are unavoidable, in such cases; the best way to cope with stress is to accept things as they are. Acceptance may be difficult, but in the long run, it’s easier than railing against a situation you can’t change.
Don’t try to control the uncontrollable. Focus on the things you can control such as the way you choose to react to problems.
Look for the upside. As the saying goes, “What doesn’t kill us makes us stronger.” When facing major challenges, try to look at them as opportunities for personal growth.
Share your feelings. Talk to a trusted friend or make an appointment with a therapist.
Learn to forgive. Accept the fact that we live in an imperfect world and that people make mistakes.
5. Make time for fun & relaxation
You can reduce stress in your life by nurturing yourself. If you regularly make time for healthy fun and relaxation, you’ll be in a better place to handle life’s stressors.
Healthy ways to relax and recharge
Go for a walk. Spend time in nature. Call a good friend. Exercise. Write in your journal. Take a long bath. Light scented candles Play with a pet. Work in your garden. Get a massage. Curl up with a good book. Listen to music. Watch a comedy Nurturing yourself is a necessity, not a luxury.
Set aside relaxation time. Include rest and relaxation in your daily schedule..
Connect with others. Spend time with positive people who enhance your life.
Do something you enjoy every day. Make time for leisure activities that bring you joy, whether it be stargazing, playing the piano, or working on your bike.
Keep your sense of humor. This includes the ability to laugh at yourself.
6. Adopt a healthy lifestyle
You can increase your resistance to stress by strengthening your physical health.
Exercise regularly. Physical activity plays a key role in reducing and preventing the effects of stress.
Eat a healthy diet. Well-nourished bodies are better prepared to cope with stress, so be mindful of what you eat.
Reduce caffeine and sugar. The temporary “highs” caffeine and sugar provide often end in with a crash in mood and energy. By reducing the amount of coffee, soft drinks, chocolate, and sugar snacks in your diet, you’ll feel more relaxed and you’ll sleep better.
Avoid alcohol, cigarettes, and drugs. Self-medicating with alcohol or drugs may provide an easy escape from stress, but the relief is only temporary.
Get enough sleep. Adequate sleep fuels your mind, as well as your body. Feeling tired will increase your stress because it may cause you to think irrationally.
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Setting boundaries
Setting boundaries is an essential skill in life, especially for people in recovery. Addicts often grow up in dysfunctional homes, where boundaries were either too rigid (leading to suppressed emotions or distant relationships) or too enmeshed (depriving them of a sense of personal identity). Later in life, their interpersonal relationships may continue to be defined by old roles and patterns, increasing the risk of depression, anxiety and addictive or compulsive behaviors.
As part of recovery, addicts learn how to set boundaries and to respect other people’s boundaries in return. In the addiction field, treatment providers often refer to this process as embracing the authentic self. While it may sound like psychobabble, it is really a process of discovering who you want to be, how you want to interact with other people, and taking responsibility for the consequences of your choices.
Why are boundaries important? They keep you safe from being manipulated, abused or taken advantage of, while also protecting other people from harm you may consciously or unconsciously inflict. They prevent both parties in a relationship from blurring the lines between self and others, which can lead to enmeshment and codependency. With healthy boundaries in place, you can begin to tune in to your inner voice and trust your own thoughts and feelings, and then communicate those to other people.
Distinguishing Healthy and Unhealthy Boundaries
Without a healthy role model, it can be difficult to know what healthy boundaries look like. First, let’s cover what healthy boundaries are not. They are not threats or attempts to control or manipulate others into doing what you want. They are not rigid rules or “walls” designed to keep people out or shield you from expressing your emotions.
Healthy boundaries are simply a delineation of what type of treatment is acceptable to you, and what consequences will result from violating a boundary. People with healthy boundaries share their thoughts and feelings, take care of their own needs, and are able to say no when necessary.
By contrast, people with weak boundaries often:
• Sacrifice their personal values, plans or goals to please others
• Allow others to define who they are and make decisions for them
• Expect others to fulfill all their needs
• Feel guilty when they say no
• Hesitate to share their opinions or assert themselves if they are being treated unfairly
• Frequently feel used, threatened, victimized or mistreated by others
• Frequently offer unsolicited advice, or feel pressured to follow someone else’s advice
• Take responsibility for other people’s feelings
• Tell others how to think, feel or act
A Boundary-Setting Roadmap
Every individual is called upon to set their own boundaries. What works for some may seem either too intrusive or too distant to others. When laying out your boundaries, work through the following steps:
Create a Personal Bill of Rights. Before you can start setting boundaries, you have to recognize your right to have your own feelings, values and beliefs and to express to others how you want to be treated. For some, this requires a colossal leap in self-worth.
Identify Your Emotions. Our parents always admonish us to “think before you act.” When you have a strong response, take a time-out to identify the underlying emotion and figure out what you want to convey. Doing so allows you to interact with other people in an honest, direct way rather than blaming or lashing out.
Set Limits. Once you have a few guidelines in place for how you expect to be treated, practice setting limits with people in a clear, direct way. Examples of healthy boundaries are: “I choose to be around sober people” or “I’ll be happy to talk with you when your voice is calm.”
Assert Your Needs. If you feel that your boundaries are being violated, speak up. This doesn’t mean lashing out or blaming others, but rather assertively communicating your needs. Ask for what you want and say no, politely yet firmly, if something isn’t right for you.
Listen to Your Instincts. If a situation feels uncomfortable or inappropriate, chances are a boundary is being pushed. By tuning into your instincts, you’re more likely to respond in ways that are true to your authentic self.
Defend Your Boundaries. Once you set boundaries, expect that they will be tested. Before this happens, set consequences that you are willing and able to enforce (e.g., “If you continue this behavior, I will…”). Know that by setting limits, you may disappoint the other person, especially if they have weak boundaries themselves. While you should always act with dignity and respect, you can’t control other people’s feelings and behaviors.
If someone continually violates your boundaries, you may need to minimize contact with them, or if they are toxic to your recovery, cut ties altogether. By choosing not to let people violate your boundaries, you stop being the victim, stop blaming others and start reclaiming responsibility for your own life.
Respect Other People’s Boundaries. Just as important as honoring your own boundaries is respecting other people’s, even if they are different from yours. If they don’t have defined boundaries, show them the respect you know they deserve anyway.
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