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Self-Care for Depression 2
Everyone gets the blues from time to time. In fact, according to the National Institute of Mental Health, major depressive disorder (also known as depression) affects 7 percent of adult Americans every year, and chronic, mild depression affects 2 percent.
The good news is you may not have to turn to drugs to combat the blues. Of course, if bouts of depression continue for weeks at a time, you need to see a health-care professional and work out a treatment plan. But for occasional down days, adopting some simple lifestyle and diet changes and making them part of your daily routine can naturally boost your mood.
A regular dose of exercise may be just what you need to ease the first signs of depression or anxiety. A study by a team of researchers including Michael Babyak, professor of medical psychology at the Duke University Medical Center, showed that engaging in mild aerobic exercise three times a week was as effective as undergoing a standard treatment with antidepressant medications. While researchers aren’t sure why exercise helps, some speculate being active may affect brain chemicals or improve blood flow to the brain. Babyak says you don’t necessarily have to do extremely vigorous activity — even fast walking (try for 30 minutes at least three times a week) may help improve your mood.
The foods you choose can also affect your mood. “Low levels or actual deficiency of such nutrients as omega-3 fatty acids, zinc, selenium, chromium, vitamin D, and the B vitamins folic acid and B12 are all associated with human depressive symptoms,” says Alan C. Logan, naturopathic physician and author of The Brain Diet (Cumberland House, 2007). However, Ronald Pies, M.D., clinical professor of psychiatry at Tufts University School of Medicine and professor of psychiatry at SUNY Upstate Medical University, Syracuse, adds that there’s no solid evidence to date that specific foods or nutrients can boost a person’s mood under normal circumstances. The key, he notes, is moderation. “A nutritious, well-balanced diet is very important for maintaining a normal mood.”
Omega-3 fatty acids, found in fish, fish oils, and flaxseed, are being studied for their mood-boosting properties. Specifically, research suggests that eicosapentaenoic acid (EPA), an omega-3 found in oily fish, may be especially effective against depression. Though the jury is still out on all of the potential benefits of omega-3s, many experts say it’s worth giving them a try. “Consider adding more omega-3 fatty acids to your diet, if not to boost mood, then to improve your overall cardiovascular fitness,” says Ronald Pies, M.D., clinical professor of psychiatry at Tufts University School of Medicine and professor of psychiatry at SUNY Upstate Medical University, Syracuse. “This can be easily done by increasing your dietary consumption of certain fish, such as salmon or herring.” You can also get fish oil in supplement form.
When your body relaxes, it can help you see the world from a rosier perspective. One way to achieve effective relaxation is through the increasingly popular practice of yoga. Studies by India’s National Institute of Mental Health and Neurosciences have shown that certain yoga-linked breathing exercises can lower levels of cortisol, an adrenal hormone linked to stress. Another study found that immediately after a one-hour session, yoga practitioners had a healthy boost in levels of the mood-related neurotransmitter gamma-aminobutyric acid (GABA). Low brain levels of GABA have been associated with anxiety and depression. Yoga has many other health benefits as well.
Some people report that taking the herbal supplement St. John’s wort helps their depressive symptoms, while others find no benefit. Naturopathic physician and author Alan C. Logan says research has shown that it’s worth trying St. John’s wort if you have mild to moderate depression. He warns, however, that this herb shouldn’t be used if you’re already taking antidepressant medications. In addition, St. John’s wort can interact with many other prescription drugs, such as birth control pills, making them less effective. As a general rule, it’s always advisable to consult a health-care practitioner before using any nutritional supplement.
Getting your feelings out, be it in a letter or journal entry, or through creative writing, can provide insight into your feelings and give you perspective on how to let go of destructive emotions. James W. Pennebaker, Ph.D., professor and chair of the department of psychology at the University of Texas, says that although research about the value of expressive writing is still preliminary, regularly recording your emotional upheavals can improve both your physical and mental health. He recommends a writing session that lasts for a minimum of 15 minutes a day, on paper or the computer, for at least three or four consecutive days. Try to write continuously without worrying about spelling or grammar.
Research shows that a lack of sunlight during the dark winter months can cause a verifiable condition called seasonal affective disorder (SAD), or the winter blues. Alan C. Logan, naturopathic physician and author, says that even adults who don’t have SAD often report a decline in mood during this time. Greater exposure to natural sunlight can help combat this problem, as can the regular use of a full-spectrum light box. “The value of a light box has also been demonstrated even in healthy adults without SAD,” says Logan. Using the light box early in the morning (7 a.m. or earlier) may be most effective, he adds.
A massage by a skilled practitioner is not only rejuvenating for your muscles, it can also be a great stress and anxiety buster. A 2005 review of many research studies showed that massage therapy consistently lowered levels of the stress hormone cortisol in patients with various physical and psychological conditions. At the same time, it increased the activity of pleasure-related chemicals in the brain. Even if it’s not for therapeutic purposes, a massage can be enjoyable and decrease muscle and mental tension.
Trying to think positively, even during down times, can also affect your mood. Start by making a list of all the things in your life that you appreciate — the results may surprise you. Alan C. Logan, naturopathic physician and author, adds that being mindful (staying in the moment) can also help. He suggests you can do this by paying attention to your thoughts, emotions, and bodily sensations. “Taking stock of these mental events in a nonjudgmental way allows for the identification of negative patterns that can lead to depressive symptoms,” he says. “Research suggests that mindfulness may lead to resilience against stress and positively alter brain activity in the areas governing emotions.”
Though your tendency may be to avoid people when you’re feeling down, often this can just add to feelings of isolation and depression. Reaching out to people, whether you discuss how you’re feeling or not, can help. Studies show that positive social ties can significantly protect a person’s health and well-being. So try to strengthen your relationships with people around you: Propose social dates, keep in touch with friends, explore volunteer opportunities, or take a new class. If your depression makes it too difficult to do these things, you should begin by reaching out to a doctor or therapist for some help.
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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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