Lately I have had several conversations with people suffering depression in which the topic of shame has come up. They discuss feeling shame over not doing what they should do, want to do, and even what they need to do. Their depression is taking a big toll with its accompanying low energy that causes people to stop doing those things that would make them feel accomplished. The lethargy of depression directly induces shame as people stop living in accordance with their own values (e.g., to be reliable or productive) or their images of themselves (e.g., as people who do what needs to be done or who finish their work). It does not matter your age or your occupation. People, whether employees, homemakers, managers or students, can feel weighted down by depression. The energy necessary to get up and do something is outweighed by the inertia of the depression. The motivation to defy the pull of lethargy and move is minimal.

The lethargy of depression is like a gravitational pull to slow down and by itself is the major block to getting things done. The lawn does not get mowed, the bills are not paid, the homework is not completed, the report remains unfinished in the computer. Undone work is the hallmark of depression when lethargy is the dominant symptom. And people feel ashamed of not fulfilling their obligations. They judge themselves as weak, and try to stay under the radar about what they are not doing because when the tasks of life go undone the risk of being judged by others goes up. For students the judgment may be a bad grade. For an employee it may be the risk of a performance improvement plan being started (or failed). And for a homemaker, the knowledge that the family is living in a mess or not eating well adds to the self-disparagement so common to those with depression.

It is not just the loss of energy that interferes with accomplishment however. The low self esteem that plagues depressed individuals leads them to fear more rejection or failure. So even if they contemplate trying to do something: trying to finish the paper for school, apply to the college, put their name in for a promotion, they hold back because they fear that they won’t do it well or get what they try for. The very possibility of finishing and then being judged negatively is worse than the shame of not doing the task at all. And anticipating that if they start a task and they won’t finish it raises anxiety. Anxiety about failure just makes it that much harder to start. As one client of mine stated, “It is easier to just avoid the task, telling myself I will do it later, than to face the stress of trying knowing I might fail anyway.”

Low energy and low self-esteem are further complicated by the difficulty of finding excitement or even just satisfaction in completed tasks. “Checking off items on a to-do list should be meaningful and satisfying,” reported JK, one of my clients, “but I just don’t feel all that excited when I get something done.” He is reflecting the emotional experience of one of the neurobiological underpinnings of depression: impaired action of dopamine in the reward pathway of the brain. Many theories about the neurotransmitters connected to depression offer glimpses into causes, such as studies that indicate lower levels of serotonin impair the sensation of satisfaction. The reality is if you do not feel reward when you get a job done, it makes it darned hard to put out extra energy even for a possible good outcome.

There is even more to the story of how brain function and structure contribute to depression and lack of achievement, because most people with depression feel some degree of accomplishment. But in addition to limited feelings of reward, depression both causes and is an outcome of difficulty noticing and holding on to positive sensations. Even when work is completed, the modest degree of satisfaction can be fleeting. Depressed brains do not give enough attention to positive experiences, and that bias toward noticing negatives mires people in the muck of depression. Escaping that negativity is like trying to escape quicksand. By not noticing or remembering positives, future motivation is impaired. If you cannot recall how good it felt to get something done, then the missing sense of accomplishment impairs motivation to act when feeling depression’s downward pull. Not wanting to act becomes a shameful secret. The more shame people feel, the less likely they are to discuss their depression and get some help for it.

There is a way out of the self-reinforcing cycle of low-energy – low self esteem – loss of accomplishment – shame – low energy. How does a person deal with what seems like an inevitable failure of motivation and activity?

Here are some thoughts to help break into the cycle:

1. Depression is not your fault

Believe that depression is a medical condition (not your fault or a sign of your weakness) in which you have thoughts and feelings that are not true. Just because you don’t see positives in your life does not mean there are no positives. Not every belief you have is a truth. Try believing that depression clouds your vision of who you are and what you are worth and it impairs your ability to see what is good about you.

2. Start thinking

To enhance your ability to get moving, start with just thinking. Think about the benefits of completing a task and then think about the costs of not completing it. If you can logically decide it is important to get something done you may be more inclined to fight your low energy. You might even write down your reasons and read them several times to strengthen your resolve.

3. One step at a time

Break any task into small steps and list them out. You will see it does not take so much energy to complete one at a time, and you only need to expect yourself to complete one step at a time. And yes, cross each step off the list as you do it. Seeing movement toward your goal may be just the extra boost of reward that helps you pull up from your depression.

 

 

 

 

 

 

4. Get encouragement from others

Left to your own devices, you are probably talking yourself out of trying, discounting the importance of small steps, or telling yourself that you will only be worthwhile when you can make giant leaps of improvement. There is ample evidence that the praise and encouragement of other people can boost motivation. Getting encouragement means telling someone what your goals are. The goals should be concrete and the completion of the goal should be observable.  “I am going to go back to school and finish my degree,” is too big, too far away and too vague for another person to cheer you on. Telling a friend or family member that you are going to a) identify 3 university programs to apply to and b) gather information about the application deadlines are specific and complete-able goals so that a supporter can ask if it is done and help you feel positive about achieving a stated goal. You can then create other goals or action steps in the same way, small, measurable steps that you and others can see you have achieved them.

The shame of not getting things done is your judgment on yourself that does not recognize depression’s strong gravitational pull to stop moving. Shame does not help you find a way out of depression. Try putting shame away and finding the small steps that get you moving again. Just like a long, heavy train does not go from 0-60 in a matter of seconds, so in depression you can only pull away from the low energy by moving in small increments

Next: some concrete ideas to help you get that train moving.

“When I am yelling at myself, who is the real me?”

An intriguing question posed by I a very sharp woman trying to grasp the nature of self criticism and the way it rules her life.

We examined her criticisms of herself to hear how she might be damaging her own self-esteem, rather than waiting for life’s circumstances or other people to do the wounding.

When I asked what she said to herself, she replied with out a moment’s hesitation: “You are fat. You are ugly. You are stupid.” And I thought to myself that she only needed to add “You are crazy,” to hit Anne Wilson-Schaef’s 4 major targets for how people insult women. Only my client was doing it to herself.

I was interested, though, that she used the accusatory “You are..,” so i asked how she would finish the statement if she started it with ‘I.’ Again, without hesitation, she replied, “I am feeling fat.”

This shift from ‘You’ to ‘I’ spontaneously brought up a far less accusatory statement. Really, it was a description of a feeling, not an appraisal. So I wanted to know if she felt different when she said it that way. She puzzled for a moment before hitting on the idea that starting with ‘You’ was like shaking a finger at herself. It was evident the accusatory ‘You’ felt like an other voice judging her. The question was who was judging?

Well, who usually sits in judgement of any of us? Typically a parent started the judgement ball rolling, and that was true for my client in this case too. A parent’s voice is absorbed into us so thoroughly that if we do not deliberately identify and root out those parental judgements, we will repeat them to ourselves until we cannot discern the voice belongs to someone else. Now we carry out our own character assassination.

Of course you may have a voice saying wonderful, positive things as well. If we are lucky, a parent can cheer us on or an important adult in our past or present, such as a coach or mentor, can get into our heads with praise or encouragement. Those voices are not our own either, but when repeated often enough we can hear them as our own. But of course, we don’t perceive the positive voice that raises our self esteem to be a problem.

If you have that tendency to call yourself names or criticize your self or your actions, it may not be the “real you” talking. Consider that you just absorbed someone else’s negativity. How can you tell whether you really believe what you are telling yourself or not? Apply the “I/You analysis that my client did. If the statement starts with ‘You’ chances are good it is someone else’s voice doing the judging. That won’t be enough to stop you from doing it, but it is the place you have to start.

If you want to interrupt the self-esteem-lowering, negativity-promoting voice, you have to confront it.

1. Identify that it is happening (and don’t yell at yourself for doing it!!)
2. Ask yourself, “Is this true?” Remember that not everything you think is true. It might be a false belief that you are wrong, or stupid or beyond help. You may suspect it is not true even though, like my client, it is a feeling you have at the moment.
3. Ask,” How does it affect me to believe this?” Typically, a negative accusatory statement does not motivate us to do better, try harder, or change for the best. It tends to deflate our mood and make us feel bad.
4. To stop the criticism, try changing it a little.
5. If you were to start the statement with ‘I’ how would it change?
6. If you modulated the criticism to be less harsh, how would that feel to you? (For example, changing “You are so stupid,” to “You forgot that.”
7. Then every time you do notice you are doing it, make that change immediately. It will help you get out of the habit of self-criticism.

One caveat to making this change to a gentler, kinder inner voice is that sometimes you will not remember that any person said the actual words you are hearing. The may be puzzling, but think about how often you react to a tone of voice or a look on someone’s face. It does not take words to communicate a judgement. You can still take it that criticism and give words to it when your parent is not there to give you ‘the look.’

Make yourself a promise today to not believe every unkind word you say to yourself. Each time you follow through on that you will move yourself out of your negative mood toward a more positive self.

Anxiety is a normal human feeling.

Anxiety is what you feel when you are faced with uncertainty. When you do not know what is going on or what you should do about it, you react with a feeling of anxiety.

What makes anxiety pass? Resolving the ambiguity. Figuring it out. What’s happening or what to do about it. Then the feeling is gone, and you are relieved. You may still have work to do or a problem that needs to be fixed, but the anxiety about it is finished.

When people suffer from depression they often also feel anxiety and spend too much time worrying, which increases their depression. The parts of their brain that are involved in that normal reaction to ambiguity are working overtime. And the thinking brain, low on energy due to depression, cannot stop that worry train. When they worry too much and can’t exert enough control, then the feeling of anxiety persists beyond any situation that includes some uncertainty. In fact, the anxious feeling can be present before any uncertainty. Then it creates the nagging sense in your gut that something is wrong, so your helpful brain, the one that wants an explanation for every feeling you have, goes on a search to figure out what might be the source of that anxiety.

Because the natural response to anxiety is to try and figure out what to do, you may start to think over all the possible reasons you could feel worried, and you will inevitably find one. When you are depressed your brain generates too many negative thoughts and cannot effectively shove them aside. You can get stuck in a loop of worrying one worry after another. However, because real problems are not the reason you have the sensation of anxiety, you either think and rethink in an effort to get relief or you move on to yet another worry. Thus rumination and ‘serial worrying’, hallmarks of anxiety fuel depression.

There is a lot you can do about this. You can use your brain to change your brain. Here are two ideas to start out:

1. If it is a real problem you will not fail to notice it: In your ‘thinking brain’ you can assess if the problem you are worrying about is a real problem. If it is not a real problem (perhaps just a potential problem) you can decide ‘not to believe everything you think’. This is a conscious, determined choice to disbelieve the sensation of anxiety that feels so real. In its place you put an intentional more positive thought: you are competent to know when you have problems that need attention. Then you move your thoughts along to something more positive.

2. Stop and Interrupt: You will also have to use your thinking brain to stop and interrupt the worrying. As they say in the 12 Step programs, this process is simple, but it isn’t easy. You must plan what you prefer to think about on a daily basis and then when the unnecessary worry pipes up, you stop, interrupt yourself, and replace it with the preferred thought. The hard part is doing this every time an anxious feeling creeps in or a worry pops into your head.

There are many ways to use your brain to change the brain. Learning various methods and putting them into place starts a process that is the first step to lifelong change. You might need some outside help to achieve this persistence in the face of such distress, but controlling anxiety is doable over time. As you get more control of anxiety, your depression will diminish too.

Margaret Wehrenberg
Author of The 10 Best-Ever Anxiety Management Techniques

“Dummy!” “Idiot!” “Screw-up!” “Bitch!”

The labels you may give yourself when depressed often emerge from a shame-based self image and are not surprisingly the names you have been called in the home you grew up in. But what happens when you believe those labels are accurate? Your self image can direct many of your choices and relationships without you even being aware that you are in cahoots with the persons who shamed you as a child.

I recently talked with a woman who told me she wanted to improve her self esteem because she knew that she held herself back from some achievements by not believing she could succeed. I thought her self-image was also a problem, because she viewed herself as the dumb screw-up that her family had labeled her. Yet when I asked if she was willing to give up the labels she had for herself, she looked surprised. “How can I give them  up,” she asked,”when they are true?” She went on to say she wanted to give up the belief that she was ‘dumb’ and a ‘screw-up’ but she had never thought of herself in any other way.

“What about making mistakes?” I asked. “Are you allowed to just make a mistake like every other person?” On reflection, she said she certainly did make mistakes but those merely proved she was dumb; yet other, smarter people, could just make a mistake and it did not determine their quality or abilities. When you look at other people, you can see their qualities through their words and actions without hearing the labels they give themselves, while you may not be able to see yourself so objectively.

My client was curious, “What can I do about this when I just find it very hard to see myself in any other way?” When your self image is rooted in shame, you fear being exposed as flawed, insufficient or just plain bad. You are not likely to believe your successes are anything other than accidents but that your failures are the logical outcome of who you “really are.” This belief system has likely been around for w while and it is self-reinforcing. You are not allowing positive feedback to get into your self-image and change it, while you allow negative experiences to reinforce the shaming labels you apply to yourself.

I believe one way to walk out of the negative labeling is to actively develop self-compassion. Researcher/author Kristin Neff has found that becoming more objective about your abilities and actions is possible through the practice of self-compassion. This mindfulness-based approach allows you observe your own actions and the responses of others to you without any judgment. Observing without judgment can move you to see yourself in new, objective terms and can lead to greater understanding and acceptance of yourself without the negative labels. A consequence will be greater compassion toward others and more positive relationships.

Barbara Fredrickson, a brilliant researcher about positive emotions and their roll in long-term health, wellbeing, and resilience suggests a similar approach. In her book Love 2.0 she explores all the benefits of positive connections with others, and nurturing those can be a way of nurturing one’s own self-esteem. Loving self and others becomes over time the way to greater health and happiness. You can nurture positive emotions deliberately and these will help lift you out of your shame-based labeling of yourself.

But self-compassion and loving oneself (and others) take practice. In my next blog I will share some ideas for ridding yourself of negative labels and developing self-compassion.

In the meantime, you might be interested to measure your own self compassion. Visit my website at margaretwehrenberg.com where I have a link to Kristin Neff’s quick assessment of your level of self-compassion.

http://www.huffingtonpost.com/smartertravel/10-tips-for-nervous-flyer_b_3989344.html

The following articles were published in the Psychotherapy Networker.These, along with various audio products of Margaret’s speaking for the Networker Symposium and her online seminars are available at: http://www.psychotherapynetworker.org

“Deconstructing Depression” Psychotherapy Networker Nov/Dec 2010.

“Technotrap” Psychotherapy Networker. Mar/Ap 2008.

“The Ten Best-Ever Anxiety Treatment Techniques” Psychotherapy Networker. Sep/Oct. 2005.

“Turning I Can’t Into I Will” Psychotherapy Networker. Mar/April 2004

“Is Relief Just a Swallow Away?” Psychotherapy Networker. Nov/Dec 2003.