Fear Keeps Depression in Place: Part 2

Overcome fear and you are on your way out of depression.

Fear of success is sometimes a bigger obstacle than fear of failure. In my previous blog, I was advocating asking others to help you move out of depression, drawing on their creativity, problem solving and their optimism to help you get energized. Whether you want to or not, you probably have to rely on other people to help you get out of depression. All that “pull yourself up by your own bootstraps” stuff is fine in theory, but the depressed person usually needs someone to help tug them along. That is because depression sucks the energy right out of you and robs you of the creativity to find a solution to the problem you are in.

One major reason you may not get out of the depressed spot you are in is that you are afraid: Afraid of asking for help and afraid that asking would make you look foolish. You may be afraid that trying and failing PROVES you are no good.

Another aspect of the fear that keeps depression in place, is the fear of what will happen if you succeed in your goals. Uncertainty about life after success can make the process a challenge. The willingness to succeed is necessary, but surprisingly hard. For some, succeeding may make all their previous beliefs about themselves wrong.

So if a person is certain that no love will ever come her way, then she does not have to be anxious and she can remain depressed as an unloveable person. That is better for some than knowing they are lovable and have not as yet achieved the romantic partnership they desire. (In the meantime they overlook all the other ways they can experience love – which might decrease their depression!)

Why is uncertainty such an issue? Anxiety is what we feel in the face of uncertainty: and in depression, uncertainty about how you will accomplish a success or about what it will feel like to succeed can create reluctance to try. Anticipating failure ironically diminishes anxiety if you are stuck in the depressed point of view that you are not the kind of person who gets to have love or money or success.

Keeping fear in place can keep isolation in place too. “No one cares enough,” is a typical depressed way of thinking, and sticking to the notion that no one can help maintains self-fulfilling isolation. And isolation increases depression that robs you of creative problem solving and of optimism that a new solution could work. So if you are ready to draw on another person’s aid, you still have to face the possibility of failure and the possibility of success.

Take a look at your fear specifically. Make some cognitive changes to deal with it and use the input of others to help you find better thought processes.

  1. Take a good hard look at the question, “So what?” (…if I fail?) “What would be different?” Probably nothing. But nothing will be different if you don’t try either. You can fee less fearful of failing if you know what to expect by facing the possibility head on. A new solution might NOT work, but, then “So what?” If you were going to live without love, you still don’t have it- nothing new. If you were afraid you would not succeed and did not try, then you did not succeed. Same difference.
  2. Dial down your assumptions about how bad it will be. Start by changing statements that are ‘all or nothing’. For example, “If he does not want to go out with me a second time it will prove that no one will ever love me,” could be said less extremely, “If he doesn’t want a second date, that is one less bad date I have to go on!” Or, “If I apply for that promotion, even if I do not get it, the boss knows I am interested and may think of me for another position.”
  3. Deal with your fear of success by first assessing what it might look like if something works out for you. Have your friend, colleague or family member help you make a list of the positives that could come of trying something different. You cannot guarantee success, but you can guarantee trying. “If I ask for help and get myself down to dinner, I may not get stronger, but at least I will enjoy my meal more if I eat with company.” “If I do get someone interested in a second date, that will be fun, and I can take my time to know if it is a good relationship developing.”
  4. Healthy skepticism about success may help us form realistic plans that we can achieve, but healthy optimism about success is often hard to come by. Ask someone to give you a reason why you will succeed. Write it down and read it daily.

Your courage develops from small steps, not from leaps.

Here is where courage really comes in. It can be easier to leave things as they are, and trying something new takes courage. And to get that first bit of courage you might need to be en-couraged. It takes courage to tell a friend or mentor or therapist that you are going to do something new. And when you do, their enthusiasm for you to try, and their implicit promise to respect you for trying (not for succeeding) can help you take that next courageous step into the uncertain territory where you can defeat fear and thus diminish depression.

Using that helping person you have chosen is in itself an act of courage that is like planting a seed. In a fairly short period of time it will grow into a strong enough courage to try, knowing you might succeed in changing your outcomes!

Fear Keeps Depression in Place: Part 1

Overcome fear and you are on your way out of depression

But to do it, you may need to take one little step – let someone who cares help you get moving. In this blog I am not addressing change for a person who is severely depressed or suicidal. I am writing about those who are participating in life but with little vigor or pleasure.

I  am a specialist in anxiety disorders and, as most therapists know, anxiety and depression go hand-in-glove, with anxiety most often the first of the two disorders to emerge when people have them both. I know that anxiety about disappointment, failure, or health looks a lot like depression. You will have met people that fit these descriptions:

  • “She is so afraid of being dumped again that she does not want to risk getting close to anyone.”
  •   “He is so afraid of criticism because his father was always so critical that now he cannot even hear praise when it is offered.”
  • “He is so afraid of failure that he won’t even try.”
  •    “I know she is getting older, but she is so afraid she will fall again she won’t even ask for help to walk down to the dining room for dinner with her friends.”

Such fears block full participation in life. They stop people from meeting potential romantic partners, trying for a promotion at work or cause a person to get weaker and lonelier with each passing mealtime. Facing fear is one of the great challenges in life, and not facing fear is a great cause of depression. Whenever fear wins, it gets stronger. And whenever people give in to fear they feel less able, less competent, less positive about themselves, i.e., more depressed.

There are currently several popular books out about daring – daring to be great, daring to face the past, daring to achieve – and they are popular for good reason. The idea of daring applies in every way to getting out of depression. But often a discussion of daring neglects the role of support from others who can offer encouragement to try even when you are scared and offer comfort if things do not go exactly as you wish.

Daring applies to asking for help because:

  •  First of all, it takes great courage to see oneself as one is without excuses or explanations.
  •  Next, showing how you feel about your life to someone who knows you can be so reassuring because you can see that they continue to care about you. (And often others do see us as we are already!)
  •  Also, it takes great courage to take the risk that whatever one fears will indeed happen. Others can support us to take a chance.

When people are depressed, they tend to isolate themselves, pulling back from others with whom they might otherwise have spent time. The depression makes them feel unlovable or undesirable or simply just not interested in people and activities they previously might have enjoyed. Withdrawing from others also limits their contact with encouragement and with positive interactions they might have with others.

In that isolation, the world does not present as many challenges, and it is possible for people to feel safe in depression, avoiding the hurts and disappointments that weighed them down. But that is risky. If you stay safely isolated in depression you can miss the confidence-building that can come with moving out of your comfort zone to meet new people, put yourself forward at work or ask for assistance to participate with others, even though your physical abilities are in decline.

Getting less depressed is an act of courage – without en-courage-ment, it might not happen.

A depressed brain over-focuses on the negative. A person who is going to try once again to achieve a personal or relationship goal needs to borrow the optimism of a not-depressed brain. Choose people whom you respect, who have been encouraging in the past and, even if they are not the closest friends you have ever had, who appear to be positive. Borrowing the vision that person has of your success can help you literally see yourself in a different way. Borrowing their courage by accepting their support can be the thing that helps you try one more time to get what you want. Life does not come with guarantees, except perhaps this one: If you never try, you will never succeed. Trying takes courage, so borrow someone else’s for a while, and see what can happen.

The following actions take place over time, they are not a quick fix:

  1. Recognize you cannot do it alone. The word ‘encouragement’ is quite literal: gain courage from those in your life who would like to support you. The “pull yourself up by your own bootstraps” is a slogan that is at best unhelpful, and at worst, defeating. Of course, you will need to put in some effort, but that is what depression blocks you from doing. You need to borrow some energy from another person, whether mental energy for problem solving, hopeful energy for motivation or physical energy to literally move yourself. Find a therapist, a friend, a mentor, or a family member to help you figure out a good approach to your problem.
  2.  To do that, you might have to take a small step to connect to a person you already have a relationship with. Text, email, call – whatever is comfortable- to see if that person is free for a coffee, a movie, a meal or just a chat. In the case of the woman who won’t leave her independent living apartment to go dine with friends, she needs someone to come with a wheelchair and literally move her, but there are those who will do exactly that once they are asked. Reconnecting with a familiar person can start you on your way out of a slump.
  3.  Ask others how your situation could be better if you succeed. The negativity of depression might prevent you from forming a clear view of how you will benefit if another try works out, and borrowing the vision of another person can improve motivation.
  4.  Explore what you will lose if you succeed: Many people avoid forming friendships, romantic relationships or seeking new jobs or education because if they succeed, it might prove their depressed attitudes were wrong. If you think that you will never have a romantic partner because you are unlovable, if you found love you might have to change that belief. Ironically, you might lose your excuse to be depressed. But then, worse things could happen!
  5. Be realistic about what others can do. They cannot do it for you, but they can help you decide how to proceed, look with you at whether your goals are realistic, and they can check on whether you are progressing in your goals.They can share their confidence in you so that you can feel more confident about trying. And you shift too: you typically don’t want to disappoint those who are encouraging you, so you may feel more energy to try.

Using others for en-couragement is the first part of a process that can grow into real change. Next we will take on fear of succeeding!

Forming Categories of Experience: A Balancing Act for a Depressed Brain

The natural antidepressant impact of using the depressed tendency to ruminate to strengthen networks of positive experience

I was recently out with my 6-year-old grandson (I know, how lucky can a person be?), and as we returned to our car, a family in the parking lot was clearly trying to start a very dead car. They were international visitors with a rental car and without a phone for domestic calls. We offered use of our phone and made a suggestion about finding jumper cables from the parking lot security office, which turned out to work well. Problem solved. Handshakes and smiles. Everyone happy.

As we drove away, my grandson was doing the 6 year old version of integrating the experience. “We would never, ever walk away from someone who needed help. Except bullies. Or robbers.” That made me smile for many reasons. He learned about how good it feels to help just for doing of it. He saw us as a family with a code of honor to help people in need. His exceptions to the code were so typical of a boy in elementary school: bullies and robbers.

But then I thought about how our brains process experiences. We try to find similarities and differences between one experience and another. It helps us be brain-efficient to have categories in which to put things: good/bad, tasty/icky, fun/not fun, worth it/not worth it, likely to succeed/likely to fail. I know phrasing it in that binary way is simplistic compared to how our complex brains form networks of similarities and differences. But it demonstrates how we begin the sorting out of experience. We start down a path and branch immediately into complex networks of related information.

Our brains connect information in networks. And those networks hold vast amounts of interconnected data. When a person branches into a network of “not good,” then other “not good” data is brought to attention. So if you think about a failure that just occurred, other times of failure will be brought to awareness, even if nothing in the situations were similar beyond the fact of failing, or perhaps the emotion of failing.

What does all this have to do with depression? Because, when a person is depressed, there is a tendency of the brain to get stuck or ruminative. When we are depressed, it is too easy to enter into a network related to a thought or an event and then find it really hard to get out of that network. And that original network is, not surprisingly, often about negative issues.

Why does a depressed brain go to the negative? A really important aspect of processing experiences includes noting exceptions, or unexpected outcomes. I think about my grandson, processing what had been a positive experience. In forming categories for it, it occurred to him that sometimes helping people you do not know could also have negative consequences. What if they were bullies? Or robbers? Our brains need to know what is different as well as similar. In depression, the noting of exceptions typically ranges to the negative outcomes: why something won’t work the next time or why it won’t be good (or fun, or worthwhile or even just “for the best”). In depression, there is a brain quality of being stuck. In a way, you could view this as being in a type of protective mode of looking out for risk, threat, or failure. The low mood of depression is, in some respects, a mental preparation to handle an upcoming problem.

The problem with depression is that the brain gets stuck there. Unable to generate much in the way of positives and unable to shift off the ‘potential’ in ‘potential problem’. The longer focus stays on potential negatives, the more real they seem, and the more that negative is ruminated upon, the stronger it gets. The network has time to form and connect strongly to similar negative expectations. If my grandson stayed focused too long on whether people in need could be bullies or robbers, he would develop a longer and longer list of people whom he would not want to help or situations that could turn dangerous. Now, you might be saying, “Well, that is protective,” and I would agree. However, it could lead him away from the other part of processing the experience: we help people in need.

Focused on that part of the ‘Family Code’ that is positive, he can enter the network of times when helping is good and the outcome is worthwhile. Strengthening the recall of those prior experiences and practicing in his mind the potential positive outcome of a future chance to lend a helping hand is as necessary to forming his identity as rehearsing when it is not a good idea to help. And if he does not make that positive network strong by repetition, he will miss the smiles, the handshakes and the really good feeling he will get for being helpful to someone. Those lovely outcomes make a positive network that can be entered into and deliberately ruminated upon, getting stronger and stronger; thus, leading to optimism, positive self-esteem and genuine reward from being helpful.

So, one natural anti-depressant is to find and deliberately rehearse all the positive potential of a recent-past or near-future experience. As best as possible, delay the negative and strengthen the depressed brain’s positive network on purpose. The stronger it gets, the easier it is to get into and stay on the positive side.

A New Medication on the Horizon for Depression

But what do we do while we wait?

I don’t typically write about medications because I do not prescribe them. I am a psychologist and treat people with psychotherapy methods. Research consistently shows that psychotherapy is incredibly helpful to people with depression, but it is not all that people may need when they suffer severe and chronic depression. Then medication is necessary. Current medication options are not sufficient for all the types of depression people experience, and it is with interest that I have followed news about the potential of ketamine since a study in 2008 suggested it as promising for rapid reduction of severe depression.

This is a compelling issue because ketamine is an animal anesthetic, abused by some people as a club drug, referred to as Special K or K (and many other names). It has dangerous side effects. When ingested it causes hallucinations, dissociative experiences, distorted perceptions and in excess it can be lethal. Yet it has garnered interest in the mental health community for a surprising impact on severe, suicidal depression episodes. In the last several years, a few studies have shown a rapid relief of suicidal depression that lasted briefly — a week or so — before the relief faded. It is exciting to think there is a drug with such rapid and effective relief from refractory (hard-to-treat) depression. But no one has known why it has that effect, speculating it has something to do with blocking glutamate (NMDA) receptors. Glutamate is an excitatory neurotransmitter.

But holding promise does not mean it is the next right thing to use. In fact, I recently read in Medscape Medical News (April 25, 2016) Charles Nemeroff’s, M.D., PhD., wise comments on the troubling trend of physicians prescribing ketamine ‘off-label’ for relief of severe or suicidal depression. (Off-label use means that physicians prescribe it for uses other than it was approved for.) People are impatient for answers to the epidemic of depression and, reasonably, want answers to help with this devastating condition. But using it off label means making a guess about dose and hoping for a good outcome while not knowing much about it, either why it works or about potential damaging side-effects — not really a good plan for safe use of a medication.

Until two weeks ago, there was promise without clear knowledge about why it helped, but on May 4, 2016, a press release from the National Institute of Mental Health reported that a team of scientists, working on related studies, found the anti-depressant action of ketamine occurs not from ketamine, but from the action of a metabolite of ketamine, hydroxynorketamine, created as the body breaks down ketamine. It activates the AMPA receptor, a different receptor than the NMDA glutamate receptor that ketamine blockades. That metabolite can reverse depression without triggering any of the negative side effects of ketamine. The combined efforts of the team or researchers made this discovery, and involved researchers Carlos Zarate, Todd Gould, Irving Wainer, Ruin Moaddel.

The action now is much better understood, but we are still a long way from having a drug safe for human use. The good news/bad news scenario for anyone with severe depression that has not responded to treatment is that researchers believe they have a new drug to develop for fast relief of depression. The bad news is how long it takes to get it to market safely. That’s where the National Center for Advancing Translational Sciences (NCATS) comes in. Their website states “NCATS is all about getting more treatments to more patients more quickly. Several thousand genetic diseases affect humans, of which only about 500 have any treatment. A novel drug, device or other intervention can take about 14 years and $2 billion to develop, with a failure rate exceeding 95 percent. NCATS is directly addressing this problem by discovering new technologies and other approaches that could greatly accelerate the process of developing and deploying solutions that can be used by all translational researchers. […] NCATS studies translation on a system-wide level as a scientific and operational problem.” Using government research funds to move projects along when they hold as much promise as this one makes sense, and the research outcomes of this team, working separately but in concert, reflects how well this can work.

In the meantime, we in the mental health field working with people who suffer depression are not without options. Many people with significant depression do respond to the selective serotonin reuptake inhibitors (SSRIs) and other medications can be used to augment the impact of those medications. But I want to put in a word for encouraging clients who suffer to carry out the self-care that genuinely holds promise for relief, if not full remission of depression. So as a reminder, and even if you are holding steady, waiting for the next beneficial medication, check out these options:

  • David Burns new T.E.A.M. method for rapid relief of depression. He is very optimistic about this method and is currently training therapists to use this approach.
  • Mindfulness: the research fully supports mindfulness as a way to immediately loosen the grip of neurobiologically based cognitive over-focus on negative aspects of a situation that seems to be a hallmark of depressive cognition. Learning mindfulness is easy, safe and has no negative side effects.
  • Exercise: almost daily, there is more science about the profound mental benefits of vigorous physical exercise. For example, recent studies indicate it is one of the most effective means of increasing galanin and neuropeptide Y, two peptides that are protective against the neurobiological impact of stress and its consequent depression. Also, subsequent to exercise, the brain’s ability to increase production of serotonin is improved, as is the attitude of the person who exercised. People with depression are unlikely to want to exercise this way, but knowing the possibilities for improvement may make a difference, moving them in the direction of trying. This is the perfect scenario for a trainer or a friend to encourage a depressed person to move more often and more energetically.
  • Eat right: You are what you eat. So make sure you are getting nutrients, not just calories. But even more, research about gut microbes and their connection to producing enough serotonin (a neurochemical involved in mood regulation) is pouring in. It is possible that the use of probiotics helps depression, especially if there is a reason to believe the gut is not full of healthy microbes due to digestive disorders, significant stress, or extensive use of antibiotics. While this is still new science, taking a probiotic is not a treatment with great potential for harm.
  • Sleep: U.S. Citizens are typically under-sleeping and there is no question that sleep is restorative at every level, including brain-mind health.

While science searches for medications that can turn around serious and refractory depression, there are things any of us can do that will promote brain health. RemeMber that one feature of depression is lethargy of mind and will, so any person suffering this disorder may need help fm those family and friends who can encourage them in the daily habits that might create the best brain health possible without medication.

Depression Is a Drag

When people want to move forward, depression holds them back.

Change is hard. Even when you want the change. You may be choosing a path that has all the hallmarks of the right thing and yet putting your foot on that path brings fear and an urge to turn around.

Manny has been depressed since high school. Smoking marijuana has brought him some fun, but he wants to quit because it makes him lethargic. He has goals to succeed in college. But he is conflicted. “It’s only with those friends smoking weed that I have any fun.” But he goes on to say, “This is the first time I have a real shot to finish college with decent grades and a chance to get a job. I could show myself I am worth something.” Without that, he thinks he will be worthless. A choice between fun and self esteem seems clear even to him, but he is scared that future of work won’t include friends. That future is not at all clear.

Callie wants to divorce. Her husband is verbally abusive and the stress is exhausting. But they have been married 20 years. “How can I give up now? What if he would finally change?” She is stuck. “But what if he never changes and I remain this depressed and hopeless for my life? If I leave now I have a chance to create a peaceful life.” Choosing between hopelessness and possibility of peace seems easy if you are outside looking in, but to her the future is unknown. What she does know is how to live with this man.

Charles wants to leave his job. His boss treats Charles like a slave, screaming and blaming him whenever something goes wrong. The stress has made him sick and he imagines working in a place that appreciates his work. His ability at work is the one thing that he feels proud of. Leaving makes him nervous and he says, “I know I could do this somewhere else, but I don’t know if anyone will hire me to do it.” He is dragged back by fear of knowing how to job search and fear of more rejection if he applies somewhere.

I see people confused about why they cannot make changes even when the choice should be clear and easy. One asks, “Why should I want to stay here, when going forward looks like the best chance I have to be happier?” The simple answer is because ‘here’ is familiar. Because ‘here’ is where you know what to do. Because ‘here’ has no surprises. And, because ‘there’ could mean you will face the possibility of embarrassment, failure, and continued unhappiness. ‘There’ there are no guarantees.

What does your depressed brain have to do with it?

That old expression “What a drag!” Perfectly describes depression.

  1. Depression drags on your physical energy. If you have been chronically in a tough situation and getting depressed, your stressed brain wears your body out. Stress is physical, even if you think it is only mental. Your brain generates all the necessary physical preparation to take action, and if you do not take action, you suffer: Tension and aches, exhaustion, sicknesses, and even weight gain.
  2. Depression drags you back. Change activates brain circuits that scan new situations for threat and reward. All new situations come with the energizing impact of noticing new things, but in depression, that may not be interpreted as excitement but as fear. Possibility is just that – it has more than one way to turn out. Depressed brains over-focus on what is negative, so they see the possibility of failure where others see the possibility of success.
  3. Depression drags your mental energy down. It makes it hard to go forward because it lowers energy, both mental and physical. Under-supplied with energizing neurotransmitters, the person with depression feels less mental “oomph”. That makes it harder to overcome lethargy with self-statements like, “Come on, we can do this!” that people give themselves to get through a tough time.
  4. Depression drags on your creativity. It makes it hard to see new solutions to old situations. Due to the impact of low supplies of serotonin, dopamine and norepinephrine, the parts of the brain that shift gears, that think “outside the box”, that can suddenly see a new idea, are very slow to move.
  5. Depression drags your mood down. In a low mood, remembering that your current situation is a drag, it is too easy to believe that new things will also be a drag. That neural network of failure draw you into other moods when it was hard to go forward because of low self-esteem, the outcome of too many times when you felt like a failure. That pessimistic mood drags optimism down to the ground.

How can you overcome this drag?

Counteract the impact of depression with small steps that will energize you mentally or physically. Taking one step in the right direction is not as hard as waiting for the energy to make a big switch. These ideas are low energy output methods to gently pull against the drag of depression and strengthen yourself for action.

  1.  Start with a simple appraisal to get clarity about your choice. Make a list with two columns labeled:
    A. What is wrong with “Here?”
    B. What is better about “There?”
  2. Then do nothing more but imagine “There.” Create a vivid image of the new situation. Is there anything in it that gives you a spark of energy? Just like as park to start a fire, that spark needs some oxygen and some fuel to burn.
  3. Now create a literal image that will fuel that spark. Make a collage or just find a picture you can look at that symbolizes what you want. Then look at it every day.
  4. Use the energy of others to fuel your own. Who is already in your life who will strengthen your resolve? Who in your life can root for you? Tell that person or people what your goal is and what kind of encouraging you need. For example, tell them you have a goal to not smoke weed during the semester. Ask if they will go out with you, even just for a beverage, without it. Or tell someone you want to explore how to make a job search. Ask if they have ideas of how to do it.
  5. Use the drag. This is like swimming with the current to gradually pull out of it. Knowing what is potentially bad in your new possibility might be the best information you have. Ask yourself, “What is the worst that could happen in the new situation?” But then also ask,”Could I deal with that?” More often than not, the answer is ‘yes’. So write that down. If it is ‘no’ follow up by noticing if the problem is a.) the worst outcome too awful to tolerate or b) you would need skills to handle it if it occurs. Now at least you have more information to swim with the current and look for new options to pull away.

When depression is a drag, do not expect to move all at once. These kinds of slow and steady steps will strengthen your mood, your body and your mental energy to move forward.

Rumination: A Problem in Anxiety and Depression

Springboard out of negative networks into new solutions.

Rumination is one of the similarities between an anxiety and depression. Ruminating is simply repetitively going over a thought or a problem without completion. When people are depressed, the themes of rumination are typically about being inadequate or worthless. The repetition and the feelings of inadequacy raise anxiety and anxiety interferes with solving the problem. Then depression deepens.

Brain function plays a role in rumination in several ways, but one significant aspect of brain function relates to memory. People remember things that are related to each other in neural networks. And when people enter a ‘woe is me’ network the brain lights up connections to other times they felt that way. Ruminating is worsened by the another difficulty of the depressed and anxious brain: challenges to flexibly generate solutions. Brain chemistry makes it hard to switch to another perspective to find the way out of problems, so rumination intensifies. Both anxiety and depression are then reinforced.

Rumination can be switched off by two good methods: get out of the negative neural networks and tackle one problem at a time with planning.

End rumination by exiting the negative memory network

Stop ruminating on negatives and activate a neural network of times when everything worked out okay. These might be hard to remember. Neural networks are triggered by mood, and your mood might have connected to other moods when you were afraid of bad outcomes.You can deliberately decide to recall the times when things worked out even though you had been afraid. Those networks of anxiety can lead into remembering positive outcomes. However, ruminating may get you too negative to shift into a network of positive thoughts without a memory jogger. What can shift you into a different network?

  1. Use family or friends to help you remember. Ask them to help you think of times when things turned out fine. Conversation with encouraging others can shift your attention to a different memory network, and when others point out positive outcomes at your request, you start down a different neural path.
  2. Interfering with rumination may be helped with a memory jogger for times you were feeling good by going over pictures of happy memories. As you look them over, try to recall not just what you were thinking then but what your body felt like. You might be surprised that joy and happiness are physical sensations. To get in touch with a body memory, scan your senses. What you see? Taste? Touch? Smell? Hear?
  3. Music holds the power to put us directly back into to a place when we listened to it, usually entering into the mood we were in when we listened and then the pieces of memory fill in with people and situations. As one rather depressed person I know put it, “I like to listen to songs from high school and college, from before things started getting complicated. Maybe life was not perfect, but the music makes me feel good when I hear it.” I there a timeframe or type of music that puts your memory back into a good place?
  4. Another rumination interrupter is to put yourself literally into a place you connect with things turning out for you – taking a walk in a location that helps you enter a positive frame of mind can only be helpful.

The idea of going into another network is not to get lost in old memories but to find a way into a positive neural network from which you may spring board into a solution to your problem.

Separate the problems and make plans

Rumination might prevent you from solving the problem or from moving on if you do not have a solution at the moment. Try to unhook problems from each other to see if you have an actual problem you can solve or just a worry to eliminate.

One example of this is a man who was decidedly depressed and anxious about his worklife that was fraught with debt, angry colleagues, and overwhelming reports for expenses and hours put in. He actually knew what to do about the debt, but rather than saying to himself, “I know what I will do,” and setting that problem aside, he tangled it up with a different problem. “I know what to do about the debt, but everyone will find ways to tell me they are angry about it.” Now he was ruminating on what to say to make them be less angry. Then he thought, “I wish I could walk away from them. If I can get caught up with my expenses and reports, I could consider looking for another job,” and he began ruminating about whether he could find a different job. The debt problem had nothing to do with how he wanted everyone happy, and neither affected finding the time to do his paperwork and none connected to how hard it is to find new work. But he connected unrelated problems and now could not let go of any of them. If this kind of rumination sounds like the way you go from one problem to another:

  1. Make a list of problems on your mind and put them in columns, side by side so you can see if there are any connected parts.
  2. Identify: Can you make a plan for the first one? If so, write it down, with action steps.
  3. Do the same thing for each problem.
  4. Look across the columns. Are any action steps connected to each other? If so, which step comes first? That is where you will direct your first effort. If they are not connected, then pick which action plan you will attend to first.
  5. See if any one problem in any one column has NO solution. Then write down a date when you might have more information to make it useful to think about it again. This is now jut a worry, and until it is possible to find a solution you do not need to think about it in the meantime.
  6. When any of these problems comes up, say to yourself, “Stop! I have a plan.” Refusing yourself the permission to re-think a plan is hard, but worth the effort.

The better you get at interrupting rumination, the lighter your depression will become. is possible to stop brain patterns that contribute to anxiety and depression by stopping rumination. It gets easier the more you practice, so stick with it and you will soon be able to do it automatically.

Depression and the Power of Influence

The critical distinction between influence and control makes all the difference to positive self esteem.

Life is not often in our own control. We bemoan this in various ways as we go throughout our day. “Why do I always get the red lights when I leave the house late in the morning?” “I wish I did not have to work such a mundane job.” “I want her to love me the way I love her.” “I want a baby so much. Why can’t I get pregnant?” “I don’t know what I will do if the tests show I have cancer.” From the trivial to the passionately desired wishes we have, it seems so much of our lives are not in our control.

This is truth: No person controls much in life. Yet, we create a great deal of misery in our own lives by the desire to be in control. The very idea that we should be able to control a situation leads to feeling helpless. And if a person has depression, this ‘should’ intensifies a common problematic thought process of this disorder. Depressed thinking is typically ruminative: repetitive, unresolved thoughts. And, when people are depressed, helplessness is a primary theme of their ruminative thinking. “There’s nothing I can do about it,” their brooding brains repeat and repeat until they believe it entirely.

Your brain believes what you tell it. Okay, that is very simplistically stated. But brain science demonstrates that when you repeat a thought, the brain recognizes the repetition and supports it by strengthening the structure of the neural pathway you are lighting up. The brain builds more blood supply (increased vascularization) and provides faster processing (more glial cell support). With such increased speed, that pathway of thought regarding how helpless you are becomes a superhighway of helplessness. It gets easier and easier to fall into the path of “There’s nothing I can do.”

When that is a default thought process, depression gets stronger too. It becomes harder for a person with depression to shake off the sense that they are not effective and will not be effective. Low self-efficacy is a hallmark of this disorder. When you want to climb out of depression, you do have some control, but it is important to be absolutely clear about what control is and what it is not.

12 Step Self-Help provides insight into this and I have learned from the program about the use of the word ‘powerless’ when I think about control vs. influence. The first step of this program is to acknowledge that one is powerless over the addictive substance. It is important that the step does not say helpless because that would be the first step to giving in to addiction. The powerlessness of addiction is that once you use the substance, the substance wins the battle. But an addict is not helpless. Addicts can help themselves by not using. Power is in the choice to refrain, not in controlling how much they use. Much of the 12 Step Self-Help model is focused on living a life of contented sobriety—there is a lot more to that than learning ways to not take the first drink or drug—but from the first step onward, people working a program pay attention to what they can influence as well as what they cannot control in life.

It is so important to make this distinction when the depressed brain is feeling helpless. We are indeed helpless when we want people, life, God or the universe to give us what we want and wait to see if we get it. Taking no action to influence is as unlikely to get us what we want as trying to control others to get it. I talk with people every day in therapy who say things like, “I do everything for her. Why won’t she just do this (thing I want from her)?” Meaning, “I should be in control of what she gives. The more I give to her the more she should give to me.” Or “How can I convince him/her to (stay in school, stop using our credit cards, eat better, stop drinking/gaming/gambling, pay attention to me, etc.) Meaning, “If I just find the right words, I will get what I want. S/he will do what I want.” The fallacy is you can control the other person’s behavior by finding the right words or motivation.

If any of us were indeed that powerful, it would mean we could find a way to be less depressed by exerting our control over others. We would really be effective! But we stay depressed, feeling helpless if others do not comply. Well, we are helpless to control others! So by that definition, we are ineffective, indeed.

This is where the understanding of influence comes to the rescue. You may not have control but you do have influence. I use the analogy of trying to force a baby to sleep. If you have ever been wishing a restless infant would sleep, you know the helpless feeling. That tiny person can keep you up all night and you cannot control the child’s sleeping. However you can influence whether the child sleeps. You can make sure the child is fed, dry and warm and make the environment peaceful, dark and quiet. Rocking and singing might help influence drowsiness.

What Situations Can You Influence Even if You Cannot Control Them?

There are many arenas in life where your actions make a difference.

  • You cannot force your boss to give you a good evaluation, but you can influence it by the way you do your work.
  • You may be powerless over whether you develop cancer, but you have influence over it by managing diet, stress, exposure to chemicals and so on.
  • You cannot force a spouse to want intimacy with you, but you influence intimacy by the kindness, caring or sexual interest you display.
  • You cannot guarantee an ‘A’ in a class, but you can influence it by the amount you study or put work into an essay.
  • You cannot make someone show up for your birthday party, but you can send an invitation that makes it sound like fun and send a reminder.
  • You cannot force another person to give you the statistics you need to complete your report, but you can send a memo reminding that person you need their work on deadline.

Influence Success: Have a Plan B

You can influence getting what you want in any situation involving another person by making plans for how to handle the situation if that person does not come through.

When you are depressed, rigid thinking may cause the failure to see influence as actual power. That rigidity might insist that you must make things go your way or you have failed. But once you see that you do not have power to control and only power to influence, you will feel much better about yourself. It is in your power to exert influence over the consequences in your life and, once you do, you may get more of what you want. And if you do not get what you want, you can evaluate if it was in your control (probably not) and if there are other ways to influence the situation in the future. Start on the path to self-efficacy today: Do the DEEDs that can help you get what you want

  • Decide what you can influence about a current situation.
  • Evaluate the actions you are able to take that can make a difference.
  • Exert that influence: e.g., make that phone call, have that conversation, put in the effort.
  • Do not assume failing to get what you want means that your influence was ineffective. It means you did not have complete control of the outcome.
  • State your intention for the next time you are in this situation.

You will increase your sense of effectiveness and, thus, your self esteem, banishing the helplessness of depression.

Minimize Your Response to Disaster and Terrorism

Preventing Terrorism from Terrorizing You


Once again tragedy has struck. This time over 130 dead and hundreds more injured physically and mentally in Brussels, targets of hate that neither they nor their families deserved. Needless grief has been heaped upon them. And the world community is outraged. We are as helpless to assuage the grief the Belgians and those related to the victims are feeling as we are to predict and prevent every act of terrorism.

These events leave anxiety and also depression in their wake, even in those of us who live thousands of miles away. The inability to predict a terrorist attack raises levels of vigilance, especially among those who monitor internet and phone communications for signs of plots. Most of us ordinary citizens are not daily vigilant for attacks; however, our anxiety can be even more intense because we do not know if we might be the victim of an attack, and we do not have any means to participate in the actions that could be helpful.

Inability to do anything helpful can increase depression over the state of the world. The depressed brain has trouble getting out of negativity. It is already set up to notice more negativity by structure (circuits that prefer to notice negatives by their size), lack of chemistry that balances emotion with logical thought and insufficient neurotransmitters that prompt positive or optimistic feelings. When a disaster strikes falling into depression can be mitigated by having a useful role to play in recovery from the disaster. A scene such as the airport bombing in Brussels leaves us in a negative mood but without recourse to handle the event in any practical manner.

When a person is depressed, the negative brain broods on themes of being helpless and situations being hopeless. The brooding has a problematic function. There is some research suggesting that rumination on a problem could be the brain’s effort to come up with a solution. That is, “If I think about this long enough I will solve it.” And that evolutionarily-determined repetitive thought process could lead to becoming more effective. In such a situation as we face now, with a tragedy too far away to help, the rumination actually creates a problem. Brooding without solution creates an increasingly distorted picture of what is going on and about one’s own condition in relation to the problem. Thoughts may go from “This is sad, frightening and I wish I could help,” (fairly logical) to “This is the end of the world and we are all going to be bombed, probably soon!” (Distorted logic that causes emotions to spiral downward.)

The alarm inherent in such distorted thoughts changes the stress level in the mind/body, further exacerbating depression. High chronic stress is felt in proportion to the perception of control. When we simply do not have control, our stress increases both anxiety and depression.

What can you do to avoid becoming anxious and depressed in the face of tragedy? Minimize and maximize our responses.

Three things to appropriately minimize the circumstances immediately help;

  • Minimize exposure to images: First turn off the TV. I was so aware that what I watched on TV Tuesday morning was a small number of video clips that played over and over and over. The same blue suitcase, the same finger over part of the lens, the same woman with her ankle propped up, and so on. The scene of people running in terror also played over and over, which raised sympathetic fear feelings in my body. By yesterday the carnage shots were more available, but still they were repeated. This repetition creates a distorted brain. Repetition makes the scenes and the thoughts that go with seeing them more imbedded in memory. As in real estate where “location, location, location” is the mantra, so in memory process, in which “repetition, repetition, repetition” is the brain’s mantra.
  • Minimize your thoughts of hate. Decide what to think early on. I don’t mean decide what to say about the perpetrators and I don’t mean decide who is responsible until you can have access to accurate information. I mean decide NOT to think of hate and rather to think about sending thoughts of grace and peace to those affected. So when you see or hear yet another reminder of the evil that you pair that information with deliberate sending out a thought of blessing to those in grief. The day of the bombing I communicated with a friend who had lived in Brussels and she said she was spending her day praying for those Americans who live there still and for relief of their fear and sadness.
  • Minimize the fear to a manageable level. Human beings like drama. Our brains are stimulated by big ideas. Of course they do. But when you create a big idea in response to the stimulation, you may make your own depressed or anxious feelings worse. My daughter was at a European airport at the time of the bombing, flying home from a visit to a brother who lives there. I could have done what many of us do when we have any kind of proximity to an exciting event by focusing on the thought, “What if she had been flying out of Brussels instead? She would have been in the bombing.” I could have told this to friends and worked up my emotional arousal. I chose to think instead, “Thank goodness she is well. I have been blessed by that.” All of us tend to place ourselves near to the drama with comments such as “I was there just before the fire started,” or “If I had not got off the road for a coffee, I would have been in that accident,” or “We were in the same hotel the Rolling Stones stayed in the day after they left!” Whether it is pleasurable excitement or terrifying excitement, our brains thrive on stimulation and we will create that by noting our proximity to big events. To do that about terrifying incidents does not help a depressed and anxious brain, because it makes it seem that we are more at risk.

Then, maximize your impact.

  • Maximize gratitude and support. We live in a world that is full of awfulness, most of which we cannot predict or prevent. We must of course decide how to respond with appropriate laws and support of those whose work is to apprehend perpetrators and to heal victims by our participation in the election and legal processes of government. We can contribute to long-term support of helpers. Fred Rogers was quoted as saying that when we see news reports of things that are deemed scary we should look for the helpers. He points out “There are always helpers.” We can support their work. And we can maximize our gratitude they are there.
  • Maximize our contributions. We could become helpers. If we live near a disaster we may be able to volunteer: to repair a home, or bring in food or water after a natural disaster. We may be able to make a financial donation to assist relief efforts.
  • Maximize our contribution to what is positive. Let us not victimize our own selves, even as a way to show solidarity. Let us not let evil take even more from us by letting our own minds and our day-to-day lives be consumed by our emotional reactions to the awful. For the sake of our health and the wellbeing of everyone we encounter, make the effort to minimize the awful, to put it into perspective and create balance in our brains and in our lives.

Once we have taken whatever action we can helpfully take in any circumstance, we can fill the space around us with beauty, with the energy of thoughts that are peaceful. That is something we can be in charge of. When you choose to starve depression and anxiety of the negative thoughts that strengthen them, you have gone along way to maximize your own health in a risky world.

When Is Depression Not Depression? Part 4

You feel sad and the world seems without color or flavor. You do not see the point of getting out of bed, but you have felt like this for several days and there are things that need to be done, so you get moving. This feels a lot like a depression, but there is a good reason to feel this way: you are grieving.

When depression is grief, the feelings can be very similar, and can last for some time. Traci was only 23 when her mother rapidly died from a late stage ovarian cancer. Traci welled with unpredictable tears and found it hard to go to work after her 2 days off for the funeral. After a couple of weeks her doctor wanted to put her on antidepressants. Paul, on the other hand, was ready to jump into marriage with the love of his life when she said she could not do it, she took a job in another city and left home with no notice. He could not eat or sleep, lost 15 pounds in 2 weeks and alarmed his daughter who wanted him to get on medication that would ease his depressed mood. Kimberly went to work and went home and did nothing but sit on the couch, watching some TV, ordering pizza for dinner and spent hours looking at pictures and videos she had taken of her dog who had disappeared from the yard one recent morning.

The biggest, and most common cause of deep grief is losing a loved one: a parent, a spouse or worse, a child. But grieving at the loss of a pet who was part of family life and even grieving the loss through divorce of a relationship or a way of life that was valued, can throw a person into a depression-like state. These behaviors and moods all make sense when put into the context of loss, but in our culture there is tremendous impatience with grieving. It is too often labeled as depression, and too often medicated, thereby blunting the normal process of grieving that allows people to move forward.
There are important differences between depression and grief.

  • One obvious one is that the cause of the grief is a distinct and important loss, where depression may not have a distinct beginning.
  • Another is that even in grief people’s sadness can be interrupted by joyful moments. Just think of funerals or wakes you may have experienced when people vacillated between tears and laughter as they remembered stories and events from the life of the person who died.
  • We know that even when we are in grief, we can think of the future being less sad. We may not feel energy to move toward it at the moment, but we believe we will eventually feel less sad, less alone, less overwhelmed.
  • We also know that we can remember a loved person, pet or even life situation with joy once we are done grieving the loss.

Sometimes grief becomes complicated, and it looks even more like depression when the grieving person cannot get out of the pit of sadness, low motivation, and tearfulness. It seems that in this grieving, the person gets stuck in process of moving forward. Among the reasons for getting stuck is the idea that leaving behind the sadness is a betrayal of the relationship that ended. I recall working with Consuela, whose daughter died in a car accident. It became apparent that she did not want to give up her grief because she felt it meant she would no longer love her daughter if she did not feel sad every day. Her grieving in some ways kept her close to her daughter. She warded off every attempt family and friends made to get her to move on, and it seemed as if she was in a deep depression, barely getting herself to work. She was refusing to eat meals with her husband, have a coffee date with a friend and she even got angry when told she would benefit if she got outside for a bike ride, saying, “How can I ride a bike when my daughter cannot?” No one understood she was using her grief to hold on to memory of her daughter or staying actively sad and tearful to demonstrate love. When she began to explain her fear of losing the close connection, we could then talk about other, less debilitating ways to remember and honor the daughter she lost.

The process of resolving grief includes knowing and acting on the following:

  1. You cannot get over grief without feeling it. This is not depression.
  2. Allow for the fact that grief comes in waves—a person may be knocked flat by a wave of grief after a day or several of feeling less sad. If you are grieving, expect that you will have moments, then hours, then days, then even weeks when you do not actively feel sad. You are not ‘relapsing’ to feel keenly what you thought was past. Grief can be triggered by so many things that cross your attention – a song, a picture, a sweet smell in the air, even a specific time of year (first holidays without your loved one are especially evocative of grief) but it also passes quickly.
  3. Try to keep self care in place as much as possible so grief does not negatively affect your health. Lots of people lose weight or have trouble sleeping for a few weeks, but that should subside gradually and without professional help. It is quite common to need a sleep aid for a few or several nights, but once you get back in rhythm of sleep, sleep comes without help and it can become healing.
  4. Take on the changes in your living environment carefully and attentively. This means removing possessions with attention to what and how. A widow may find it fairly easy to clean out a closet of suits and donate them, but almost a impossible to remove the stack of magazines from the floor next to ‘his’ chair. Being attentive to how it feels to clean a room, sell a car, clean out desk drawers when someone you love is not in the house anymore can help you remember what is good and what is lost in a way that helps you hold on to the good memories.
  5. Plan how to remember the lost love, appropriate to the relationship, and plan when to remember them. For example, Consuela eventually decided she needed to write her daughter a letter, expressing all of her feelings about how she died, and then she went to the gravesite to read it. After that she decided she would visit the grave on her daughter’s birthday and on New Year’s day but no longer would she stop every day she drove past the cemetery. Traci bought new hymnals for her church and inscribed them, donated in memory of her mother. People can find many opportunities to memorialize a loved person, such as donating bricks in a walk or benches in a park or like many organizations, put up a picture and plaque honoring the founder of their group.
  6. Find a productive effort you can make to respond to the loss. Consuela founded a cheerleading camp scholarship in her daughter’s name at her high school. Marie decided to walk dogs for the humane society after the death of her beloved pet. Many fund-raising and awareness-raising organizations have started from using productive work to move beyond grief, such as cancer support walks, mothers against drunk driving, efforts to locate missing children, and even new legislation.

Grief is a lot like depression, and while the loss is permanent, the deflated feeling is not. Moving on can be the best way to remember what is lost with joy.


When Is Depression Not Depression? Part 3

“Of all sad words of tongue or pen, the saddest are these, ‘It might have been.'” John Greenleaf Whittier

Depression is often described as a feeling of sadness, but sometimes people mistake other feelings for depression. Depression is not depression when it’s disappointment.

Disappointment is loss and grief and sadness all at once. You may be disappointed to lose something you have, but it may well be loss over something you never had. When you lose something that was not in your grasp, it may be hard to acknowledge how deep and sharp the pain is. It may be even harder to describe to others how upsetting it is.

How can you put into words all that you have lost when it is what you hoped for but did not have in your grasp? When people are looking forward to having something, they feel excitement, anticipation, and even euphoria. If you are anticipating something good, you are jazzed that you are about to win, gain, come into some wonderful experience. Maybe you may be on a team with a winning streak and about to win a tournament. Maybe you are one of two people about to get hired or promoted into a dream job. That special someone you just met really could be ‘the one’. Maybe you are waiting for the test that says your pregnancy is really happening this time. And then it doesn’t happen. The let-down can be dramatic when you lose something that never happened.

Disappointment also causes pain because it could have been the best thing ever. Something waiting to happen is shiny and untarnished by reality. It is the perfect job in which we shine with success. It is the love that is forever full of attraction and admiration. It is the beautiful baby without the colic or middle-of-the-night crying. What you did not get was not just good, it was perfect.

But since you had not had a chance to have it, live it, experience it, the loss is also intangible. And as such, it is harder to let go. And disappointment feels especially bad when you lose hope along with it. If you follow the disappointment about the job, the love, the baby with losing hope that you will ever have it, that’s a lot like depression. And it is pretty typical to feel that way right after a disappointment. Pessimism thrives in the wake of disappointment.

This is when it seems as if disappointment is depression. It hangs on for a time and others cannot see why you are so sad. I cannot count how many times I hear people say, “What are you so disappointed about?” with a tone that suggests you should immediately stop being disappointed. In that a case, you can feel judged as well as sad and perhaps add some self-blame to the heap. “Maybe I should not have been so hopeful, and maybe I should never expect to have something good happen again.” Disappointment can feed a depression when you lose hope: hopeless feelings are a central feature of depression.

How is it possible to avoid triggering depression and come out of the disappointment? Here are some things to try:

1) Listen to self talk. Avoid the common pitfall of listening to or saying to yourself minimizing statements like “Close only counts in horseshoes.” “Get over it.” “You will have another chance.” “There’s always tomorrow.”

2) Acknowledge the loss, because there is no way around it: “I wanted this and I did not get it!” “I am sad! I am mad!” Sit with the loss as if you are mourning: Do not expect to get over it quickly. By tolerating and acknowledging, you move more quickly through the disappointment. A surprising thing happens when you feel something: the feeling passes. (When it is depression, this is not a true statement, but disappointment will pass.)

3) Assess what you still have. “I have lost the possibility of loving that a person, but I have 2 really close friends and my sister who really love me. That is worth a lot!” “I will have other options for a good job, and I still have a job that pays.” “I still may have a chance to have a baby, and if I don’t, I can find a way to handle that.”

4) Renew hope. Start out with something much smaller than what you lost, just so that hope is not scary. Ask yourself, ‘What would I hope for if I knew it would be possible?” And then try it out: hope for something and see how it feels to get it. E.g., “I hope that dinner with my friends will have a few laughs.” “I hope that when I see the kids for the weekend we will talk about fun things to do on summer vacation.” “I hope that I will get a better grade on the next exam.” Getting a small hope fulfilled may take a little bit of effort from you but pick things you know you can influence.

5) When you are ready, evaluate whether what you were striving for was realistic. Was it within your power to achieve it? If so, you can go for it again. If you can see it might have been beyond your ability, then you can realistically revise your plan. I worked with a young woman who wanted to become a professional make up artist, but she was 25 and had not worked in the field, nor did she have any certifications or degrees. Her disappointment not to get hired at a theater to do the make up was keen, but it was also a wake-up that her goal was unrealistic. She needed to make a plan that would fit her abilities or lead her to get more training.

As time passes, and fairly quickly, you will notice that you do not feel the sharp pang of disappointment constantly and that it diminishes like the wake of a boat washes over you – big at first, but in smaller and smaller waves, until soon you remember it but do not feel it. As the expression goes, you may be “sadder but wiser,” so perhaps more realistic. And if you have been renewing hope, your mood may once again be full of eagerness, excitement and even euphoria as you anticipate some new good thing coming into your life.