Overcoming Depression One Step at at Time

By Thanos Napolias, MA

As any living being can attest, problems are unavoidable. Some problems are simple and their solutions are relatively immediate, such as figuring out an alternative route to work when there is heavy traffic and running late to work. Other problems are more distressing and complex, like dealing with an unexpected expense that throws an entire family out of budget. In both cases though, it’s essential to carefully examine the problem and then apply specific solutions to address each aspect, one at a time.

Like most mental health concerns, depression can be seen as a problem, since it causes significant distress and functional impairment for over 15,000,000 American adults each year, according to the Anxiety and Depression Association of America.  Therefore, when it comes to depression, a similar strategy of examining the problem and applying specific solutions to address each aspect can enable individuals who struggle to overcome their symptoms. Even though mental health challenges seem more complex than everyday unwelcome matters, therapy models that concretely address the various parts of depression have been showed to be very effective.

Traditional Cognitive Behavior Therapy conceptualizes depressive concerns as having four parts: (1) Negative emotions, (2) Distressing physiological responses, (3) Maladaptive cognitions (thinking), and (4) Maladaptive behaviors. As such, the first step in Cognitive Behavior Therapy for depression is to teach individuals to break down their experiences into these four parts, in order to come up with step-by-step solutions to each one.

For instance, we can think of a fictional person “Sally”, who is a college student experiencing depression. Sally feels sad all the time and is also afraid that she has fallen too far behind with her assignments (negative emotions). Sally also has no energy to attend her classes, feels tense in her neck and back, and she has a hard time falling asleep at night (distressing physiological responses). As a result, Sally starts to think of herself as a failure and wonders whether she will be able to graduate (maladaptive thinking), and she starts to spend more and more of each day in bed, avoiding classes, exercise, and social activities (maladaptive behaviors).

When Sally came to us for therapy, using the above cognitive-behavioral approach we helped her to realize that when a stressor came up she tended to feel sad, down, and somewhat anxious. On a thinking level, she tended to make unhelpful predictions about her future and for herself, such as “I am going to fail that class,” “The professor will think that I am lazy,” “Even if I try to go out with my friends, I will feel as miserable as staying in bed.” When she thought this way, it triggered Sally’s physiological sensations such as tiredness, muscle tension, as well as feeling “unreal and detached” from the world. In these difficult moments, Sally’s behaviors included staying in bed, withdrawing from friends, dropping out of her favorite workout class, and avoiding returning to her classes, which paradoxically reinforced her unhelpful thoughts and feelings.

Once Sally understood how her feelings, thoughts, sensations, and behaviors worked together to maintain her depression, she began with the help of her therapist to identify more helpful interpretations about her stressors and adopt small behavioral changes that significantly reduced her depression. With appropriate guidance, Sally made gradual shifts in her behavioral patterns, such as returning to her work out class and inviting a friend over, which had a positive impact on her mood and eliminated many emotional and physiological symptoms of sadness and fatigue. Similarly, over time she began to notice and challenge her unhelpful thoughts. At times she even tested her thoughts by approaching the professor and explaining her situation, and other times she started observing her thoughts without necessarily believing their content. Over time and with consistent practice, Sally overcame her depression, one step at a time.

Sally’s brief story is an example that mental health disorders are not permanent and that it is not overly simplistic to view them as problems to be overcome. Like Sally, individuals who struggle with depression can develop methods to live much happier and meaningful lives!


Have a Happy Summer!

Written by Peryl Agishtein

Ahh, the fresh smell of mowed grass… no school… and sun, sun, sun! Many of us remember summer as one of the most favorite and relaxing time of the year. Did anyone else count down the days until school was out? But once we grow up, and often work through the summer, and have kids out of school… and somehow summer morphs into a season marked with its own unique stressors.

Summer has a number of common stressors. Changes in routine (e.g., from school to vacation) come with the need for adjustments, which can be inherently stressful. Kids in particular may struggle to be flexible and stay even-keeled despite upended routines, which can lead to behavioral challenges and parental stress. Often there are even bigger changes that occur in the summer: Some families move houses or cities or take on new jobs, which can compound the general stress of routine changes. Another stressor that can arise in particular during the summer months relates to body image: Swimming and summer sports reveal more of our bodies, and even for those who forgo the pool, saying goodbye to sheltering coats and bulky sweaters can be cause for distress.

For parents of school-aged children, one particularly taxing stressor is the traditional cry “I’m so booooorrrredd!” Children who are used to jam-packed schedules and to-do lists can find themselves at loose ends with ample free time (as can adults), and may depend on their parents to entertain them. Another stressor for parents can arise when children compare summer plans, which often leads to jealousy. Comparison-based jealousy is most problematic in communities where people of varying SES all live side-by-side, or share schools or camps. Children in these communities are easily exposed to what others have, which can sometimes be sharply contrasting to what they own. Sleepaway camp in particular serves as a ripe context for highlighting children’s possessions that are not revealed in school, such as entire wardrobes, linens, pillows, accouterments, canteen and trip allowances. Unfavorable comparisons in any of these areas can lead to jealousy, unhappy children, and parents feeling pressure to either spend more or say no to their children.

However, with the beautiful weather and time off, it’s important to seize the day and not let summery stressors take over. Each summer stressor has unique solutions, but here are some tools that can work across the board for all:

First, implement a detailed summer routine BEFORE the end of June. Routines can include unstructured free time to relax, but should be generally predictable and comfortable in order to reduce the stress of unpredictable changes and the cries of “I’m booored.” For parents, sit down with each child and help them write a list of activities and goals that they want to reach over the summer (ranging from the small, such as blowing bubbles or reading Harry Potter, to the large, such as learn to play guitar). Encourage your child to build time into their day to engage in those activities/ goals. If they do turn to you for entertainment, remind them of their list and transfer the responsibility for entertainment back to their shoulders. However, make sure that with the cessation of individual homework time, each child continues to get plenty of attention and time with their parents (including at least a bit of individual attention). This will help relieve the pressures of entertaining your child (as they won’t be seeking your attention as much) and will help foster secure children who are happier with what they have.

Second, try to experience and model contentment with your summer plans as well as positivity and enthusiasm for the small pleasures of summer (both in speech and in affect). Stay away from comparisons and gossiping in general. Why ruin a beautiful time of year? And make sure that you do take the time to relax, go swimming, barbecue, or do whatever it is that makes summer special in your family culture.

Who says grown-ups can’t look forward to summer?

Four Strategies to Get Some Zzzzzzz’s

By Ariel Campbell

Most adults have experienced symptoms of insomnia at some point in their lives. In fact, according to the National Sleep Foundation between 30-50% of adults have occasional difficulties falling or staying asleep, waking up early, or waking up not feeling rested. Lack of adequate sleep can negatively influence our daily functioning by leading to impairments in attention and concentration, increased irritability, and overall poorer mental health. However, for those of us who suffer from occasional insomnia there are a number of healthy habits we can incorporate into our daily routines to improve our quality of sleep.

In order to understand how and why these habits can be useful in promoting restful sleep, knowing some basics about sleep is helpful. Our sleep is regulated by our body’s natural circadian rhythm. This circadian rhythm is responsible for our feelings of sleepiness and wakefulness throughout the day and is controlled by light and dark signals that occur naturally in our environments. For adults, sleep proceeds in a predictable pattern that involves 4-5 repetitions of a 90-minute sleep cycle, with each sleep cycle including 5 sleep stages. During sleep, a number of changes happen in our bodies – our heart rate and breathing slow down, our blood pressure and body temperature drop, our bodies produce and regulate a number of important hormones including those that impact growth and hunger, and our brains cycle through varying levels of activity.

Now onto some of the daily habits that can promote and improve sleep…

First, developing a bedtime routine can be an effective strategy for helping our minds and bodies transition into a state of relaxation after a busy day. Having a structured pre-sleep routine that includes a relaxing activity, like reading or listening to music, can promote sleep by helping us to form habits that actually function to cue sleep. Stimulating activities and screens, on the other hand, should be avoided during the 30-60 minutes before bedtime and as a general rule of thumb the only activities that should be carried out in bed are those related to sleep and intimacy. Additionally, an essential part of any good sleep routine involves keeping regular sleep and wake times, even over the weekend, insofar as this helps to maintain a consistent circadian rhythm.

Second, attending to certain factors within our sleeping environment can help to ensure high-quality sleep. Since light is a powerful cue for our body’s internal clock, keeping the bedroom as dark as possible while sleeping and dimming the lights one hour before bedtime are helpful sleep habits. If fully avoiding screens before bedtime isn’t possible, switching your cell phone or computer screen into nighttime mode is advisable because the blue light of daytime mode (as opposed to the red light of nighttime mode) will actually delay the release of melatonin making it harder to fall asleep. Keeping the bedroom temperature between 60-70 degrees while sleeping is another useful strategy that works by helping our bodies to maintain the drop in body temperature that accompanies sleep. And lastly, since our brains are still active and responsive during sleep a final consideration when it comes to structuring our sleeping environment is to limit noise as much as possible. Noise tends to be most disruptive during the first and second stages of sleep and during the second half of the night. Additionally “peak” sounds, for example busy street noises, are more damaging to sleep than ambient background sounds. If it’s difficult to eliminate noise while sleeping, white noise can help to reduce disruptions in sleep due to sound. Today, there are many apps for white noise but a fan or air conditioner that produces a consistent sound will also do the trick.

Third, certain exercise and dietary habits have also been shown to impact sleep. Aerobic exercise, like walking, swimming, or biking, can aid in sleep by increasing the amount of time our body spends in the deeper and most restorative stages of sleep. 20 minutes or more of daily aerobic exercise engaged in 4-5 hours before bed is recommended. While your morning coffee can help energize you for the day ahead, drinking a second cup of coffee during the afternoon or evening hours can disrupt sleep. Additionally, alcohol has been shown to cause impairments in sleep – although it may initially cause drowsiness and induce sleep, consuming alcohol before bed is associated with significantly more sleep disruptions during the second half of the night.

And finally, the timing, size, and content of meals can play a role in getting a good night’s sleep. For improved sleep, it is generally recommended that your largest meals be eaten earlier in the day and that snacks consumed before bedtime include complex carbohydrates and avoid sugar. Complex carbohydrates like whole-wheat breads, vegetables, fruit, and nuts break down slowly and help to prevent sudden spikes and crashes in blood sugar that can interfere with sleep.

While occasional symptoms of insomnia are common and not a significant cause for concern, they can nonetheless be disruptive to our daily routines. By using the above strategies for managing bedtime routines and environments as well as diet and exercise, you can develop healthy sleep habits that will promote a full night’s sleep and help you to wake up feeling rested and refreshed.