Taking the First Step

Replying to yesterday’s post, Valory sent in a comment:

“Taking that first small step, i.e., thinking about how to do something to feel better, rather than thinking about all the reasons you don’t feel “good/OK/happy/content,” is the most important and, sometimes , the most difficult step.”

I agree!

Very often, first steps can be the most difficult and even scary. Especially when depression is involved.

When we are depressed we may even feel paralyzed, unable to do literally anything to change our situation. In fact, the feeling that “there is nothing I can do that will make me feel better” is actually one of the primary symptoms of depression.

That is often why people with depression tend to look for solutions that require almost no effort on their parts. Because well, if “nothing I can do will help,” the only help seems like it has to come from somewhere else, right?

I even think that a lot of the popularity of antidepressant meds, both with patients and doctors, comes from their shared (yeah, doctors feel  it too!) assumption that there is nothing that the patient can do on their own that will matter. Under those conditions, taking a pill often seems like the only way to get some relief.

Now, it is often true that the meds may help people. But it can be a big mistake to assume that medications are the only, or even the best approach. Many research studies have shown that this is not true. There is a lot that a person can do on their own that may help.

I have learned a lot from my clients over the years (well, ahem, decades) of being a psychologist about ways people often learn to manage their own moods. Very often, people discover that they can at least feel a bit better by doing some fairly simple things to cope with a depression.

In future posts and my book, I’m going to list a number of things that often help people manage their moods. But the first, biggest step is often deciding that one is willing to give something a try. To experiment.

Different things work better, in different amounts, for different people. What helps me might not help you, but you might find that something you do that I’d find unhelpful, for you is actually a life-changing idea.

My first suggestion, then, is to get a notebook. Or find some way to keep some notes. I’ll tell you why soon.

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The “Five Stroke Depression Cure” – update

I’ve mentioned my pending book, The Five-Stroke Depression Cure, in the past. I’d expected to have it done and published by now, but it’s been lagging. I admit that I tend to get caught up in the daily grind, especially my own psychology practice, and so it’s been a long time coming. (Particularly for what is supposed to be a “short” book of suggestions.)

Possibly people with depression can relate to that thing where you say you are going to get around to doing something and never seem to get it done. But this is not necessarily a sign of depression (which I’m not, I think)… it’s just life. (Though over time, it can actually be a bit of a depression-causing habit.)

I admit I tend to be a bit “OCD” and so tend to go over and over a bit of writing, sometimes when it’d be better to just dump something out there and settle for “good enough.” That is actually, very often, a more effective way of living — not letting your perfectionism (the belief that it’s wrong if it is less than perfect) interfere with functioning.

So I’ve decided to start sharing. I’m going to start here in the blog, bits of the book.

The basic idea of “The Five Stroke Depression Cure” is to suggest things that a person can do that will hopefully improve their mood. Mostly, these will be small, fairly easy things.

As a “starter idea” (imagine planting one tiny seed), I’d like to make a suggestion. Ask yourself this question:

If there was one small thing that you could do that, if you did it, it might improve your mood, would you do it? 

Would you try it right now?

How to do psychological first-aid on a desert island

You’ve probably never had it THIS bad. Nearly killed in a shipwreck, stranded alone on an island, no hope of rescue. The temptation to give in to despair must have been nearly overwhelming. Many would have become immobilized, maybe even considered taking a long, cold walk back into the ocean to end it all.

message in a bottle

But Robinson Crusoe didn’t. And the reason he didn’t, the psychological “first aid” that he rendered unto himself, still stands nearly 300 years later as perhaps one of the simplest, yet best example of what would later be called “cognitive behavior therapy.”

How Crusoe did it

Here’s the key passage* from Daniel Defoe’s 1719 classic:

I now began to consider seriously my condition, and the circumstances I was reduced to; and I drew up the state of my affairs in writing, not so much to leave them to any that were to come after me—for I was likely to have but few heirs—as to deliver my thoughts from daily poring over them, and afflicting my mind; and as my reason began now to master my despondency, I began to comfort myself as well as I could, and to set the good against the evil, that I might have something to distinguish my case from worse; and I stated very impartially, like debtor and creditor, the comforts I enjoyed against the miseries I suffered, thus:—

At that, Crusoe write down a list of negatives in one column, and responses in the other:

             _Evil_.                             _Good_.
I am cast upon a horrible,          But I am alive; and not drowned,
desolate island, void of all hope   as all my ship’s company were.
of recovery.

I am singled out and separated,     But I am singled out, too, from
as it were, from all the world,     all the ship’s crew, to be spared
to be miserable.                    from death; and He that
                                    miraculously saved me from death
                                    can deliver me from this
                                    condition.

I am divided from mankind—a         But I am not starved, and
solitaire; one banished from        perishing on a barren place,
human society.                      affording no sustenance.

I have no clothes to cover me.      But I am in a hot climate, where,
                                    if I had clothes, I could hardly
                                    wear them.

I am without any defence, or        But I am cast on an island where
means to resist any violence of     I see no wild beasts to hurt me,
man or beast.                       as I saw on the coast of Africa;
                                    and what if I had been
                                    shipwrecked there?

I have no soul to speak to or       But God wonderfully sent the ship
relieve me.                         in near enough to the shore, that
                                    I have got out as many necessary
                                    things as will either supply my
                                    wants or enable me to supply
                                    myself, even as long as I live.

His conclusion from the exercise:

Upon the whole, here was an undoubted testimony that there was scarce any condition in the world so miserable but there was something negative or something positive to be thankful for in it; and let this stand as a direction from the experience of the most miserable of all conditions in this world: that we may always find in it something to comfort ourselves from, and to set, in the description of good and evil, on the credit side of the account.

Useful lessons from a shipwrecked man

Reading the above passage, there are a few really good examples of effective self-treatment for depression or despair.  You can probably see how effective this exercise might have been in reducing some of the despair and fear he was feeling.

Here are a few of the most notable things Crusoe does:

1. Writes his concerns down

First, Crusoe makes the point that it’s better to not let your concerns just rattle around loose in your head:

“I drew up the state of my affairs in writing…to deliver my thoughts from daily poring over them, and afflicting my mind.”

Continuously “poring over”,  ruminating about your worries, overthinking things, is a sure way to go crazy — at every turn, these things will pop up and nag at you.

“Free range terrors,” left to run amok in your mind, are the most damaging. Tweet this

You’ll often see this key principle of writing things down happening if and when you talk to a therapist. Forget your troubles for a second and just watch how they work, and how this works for you:

Generally, they start jotting down the sixteen things you rattle off that are bothering you. And at the end of their high-priced session, they look up over their spectacles, smile, and in that kindly and wise seeming way, say, “so… it seems to me that your main worries are…” and they glance down at their pad, and like a genius, they read back to you the three or four main “worry clumps” that pretty much summarize your last hour’s worth of fretting and whining. Then they sit back, let that soak in, and send you a bill.

It seems too simple. But odds are, you’ll feel like your head is a bit clearer, things seem less chaotic, just for having had your concerns summarized back to you. This kind of summary lets us get a bit of psychological distance from things, and that seems to help.

Like Crusoe, stuck on an island that has no managed care clinic nearby, you can jot down your worries and fears yourself, pick out the main “themes,” and get about $150 dollars’ worth of therapeutic help from that simple step. (Plus, write down one more in the “Good” column: you will have saved $150.) Writing your concerns down tends to give you a bit of psychological “distance” from them. Seeing  beasts on the ground from helicopter height, instead of down on the ground where the big scary rhino is breathing in your face, you tend to feel a bit more able to think clearly about things.

2. Examines his thoughts and asks critical questions

The second thing Crusoe does, is to start coming up with responses to his fears. This is almost exactly the same process that later became the hallmark of “Rational Emotive Therapy” founder Albert Ellis, and still later, the “Cognitive Therapy” of Aaron Beck.

It’s not a hard thing to master. Having written his worst fears down, Crusoe then has a bit of psychological “breathing room” in which he can think logically about these concerns. He is then able to think of a specific, focused responses to each concern, a sort of “on the other hand” response.

It’s important to notice that this is not a vague, overly general “always look on the bright side of life” cure. He is not just staring up at the blue sky and whispering “everything is peachy keen today!” Because that would not work. It would not deal with the very real, and very specific, raging fears and concerns that are tormenting him.

Rather, he gets each individual concern down on paper. He then comes up with a SPECIFIC “on the other hand” kind of response to each concern.

The standard Cognitive Therapy way to work with such a list would involve taking  each concern on your list, and asking yourself a few simple questions:

– Is this concern valid? How do I know? (Could I be misinterpreting the evidence? Am I being selective in what I am paying attention to, filtering out the good news and only paying attention to the scary clues? Was that scary bump a burglar, or just the cat…again?)

– Are there other ways of thinking about this that might be more helpful, or calming? (e.g., the response to “God must hate me to have stranded me” can be countered with, “Well, but he DROWNED all the other guys and kept me alive! Maybe I’m the favorite!”)

– So what? So what if this is true? What’s the worst that can happen? How, specifically, can I manage if this fear is true? What, for instance, might be the realistic, long term results of this situation? (e.g.: “I’ll just live and learn.” “Pay the fine and move on.” “I’ll make sure my next brownies aren’t burned.” “I’ll make sure my next husband isn’t such a jerk.”)

This kind of thing takes a bit of practice, and I would imagine that Defoe had to struggle a bit, tapping his head with his inky quill, to get this nifty example down on parchment. It will take you a bit of time to learn, as well. But we know from decades of psychological research in treatments such as cognitive-behavior therapy, that when you learn this technique, it practically becomes your superpower. Your mind, and your life, will thank you for learning it.

3. He gets busy

Crusoe finishes the exercise thus:

Having now brought my mind a little to relish my condition, and given over looking out to sea, to see if I could spy a ship—I say, giving over these things, I began to apply myself to arrange my way of living, and to make things as easy to me as I could.

When we are depressed and scared, we tend to be paralyzed. We may be agitated, tired, unable to get moving. Breaking out of the worried, ruminative state tends to release a great deal of physical and mental energy. Crusoe felt better and so his energy was freed up to get busy, building his island home.

Another advantage of getting going, doing things, is that you can start to deal with the “real world” situations that have been triggering all that worry. After Crusoe spends some time and effort getting his situation organized, he’s going to be in a much better position to cope with the disaster that has occurred. He may still be stuck on an island, but he will at least have managed to find safety, food, water, shelter, and protection for himself. The only way he could have done all that, was by shaking off the paralyzing depression and fear that threatened to overwhelm him.

Practice exercise

Sit down and write out three of your current concerns or worries. Do a Robinson Crusoe on them: next to each one, try to come up with a different, less catastrophic way of thinking about the situation. If it’s not easy at first, remember that you will get better at this kind of thing with practice. Devoting a bit of time to mastering this skill will change your life.

___

* Excerpt from Robinson Crusoe, a public domain book, courtesy of Project Gutenberg. You can find the whole book here.

Don’t Let the Depression Industry Make You Sick

I’m finishing the first draft of my self-help manual for treating depression. One of the main points of the book is that it’s often helpful to see depression as a condition that can be dramatically improved, or even cured, by doing things on your own. Such as the kinds of things you can find in any book or good website dealing with behavioral or cognitive behavioral treatments. Because it’s a well-established fact (established by real researchers, not pharma company stooges) that these techniques can work.

But right now, just a few words about the importance of not being brainwashed, so to speak, about what depression actually is. Simply put, do you see it as something you “have” (like a case of the hives, or diarrhea)? Or something that, at least in part, you DO. (Such as by adopting unhealthy habits of thought: seeing things as more dismal than they are, say)?

Here’s the problem: nowadays, despite all we know about the essential role of skill-focused treatments such as cognitive-behavior therapy in treating depression, most physicians never even mention those kind of approaches to their patients. Since most people get their mental health treatment from primary physicians, they don’t even hear about these powerful approaches.

What they do hear about, from doctors and from websites, is the old singsong: “depression is a chemical imbalance.” This is partly because people pick these things up and share them with each other, and the “chemical imbalance” thing has become a popular cliché.

The pharmaceutical industry spends millions and millions of dollars every year to market antidepressants. We are surrounded by ads which all convey the same message:  you need a pill for this. This message is so much out there that it affects what people blog about and put on their Facebook pages: everybody agrees that every and any kind of down mood is a so-called “chemical imbalance” and the treatment is medication.

This is at best a half-truth. It may be bit more true if your condition is bipolar disorder, which does seem to have more of a genetic component, and which can be more difficult to manage with psychological treatments alone. But for most other forms of depression, it’s by no means so clear, or useful to blame your poor brain for everything.

(It is also not so clear that antidepressants are as powerful and effective as the drug companies want us to believe — particularly since we’ve learned that they tend to fund “research studies” on their own drugs, but have been systematically burying any results that don’t show the drugs to be super effective.)

This business-based attempt to “define  reality” for you (because that’s what it is) is pretty typical in our society. We are often told that we need this or that thing to solve some problem we didn’t even know we had. Do you really need a car that will drive down rocky streams? How often have you used it for that, instead of for driving to Wal-mart? In fact, why would anyone “need” a sixty thousand dollar car when a twelve-thousand dollar car drives just as far and just as fast?  Exactly.

It’s the same with the depression industry.

So here is my first bit of advice: in understanding depression, try to be aware that you are being surrounded by messages that have as their purpose, sometimes, nothing more than making a lot of money for a drug company.  Money which you (either directly, or through your insurance) must pay out. As if becoming poorer should somehow make you happier.

Give your poor brain a bit of benefit of the doubt here. Put blaming your brain (which you are doing every time you repeat the mantra, “chemical imbalance”) on hold for a minute, and consider a completely different way of viewing depression: that at least in part, depression is something you do, not something you “have.”

And that any quick Google search for “cognitive behavioral techniques for treating depression” may yield as many simple, effective ideas, ideas that if tried, may give you the same 2% boost in mood that a single dose of a pill will, on average, if it is an “effective” medication. (I’ll talk more about this “2% improvement” number in later posts.)

Excerpted from the forthcoming The Five Stroke Depression Cure, by Greg Korgeski, Ph.D.,  copyright 2012

The “Prime Directive” of High Performance Self-help

In the Star Trek universe, the officers and crew had a “prime directive,” or rule that they had to follow above all else, which was never to interfere in the development of beings on other worlds who did not know of their existence. Many of the classic episodes were organized around the struggle to adhere to such a rule.

In self-help, if you want to do it right, if you want to get the benefits, your prime directive has to be more or less the opposite. Letting things take their course is often another word for being passive until you die. The prime directive in high-performance self-help, whether this is for your psychological care or medical care or to improve your performance on the playing field or boardroom, is to be active in taking control of your situation.

You cannot underestimate the importance of developing an “active attitude.”  Of routinely seeking ways to fix or change your situation.  Yet, one of the most common problems I see in clients is that they don’t do it.  If they have a life problem, they hope for it to go away, or ignore it.  Or they wait for someone else to fix it for them, to tell them what to do or to show up with the barrel of money or the magical medicine that will cure it.  Passive, dependent responses which more often than not don’t solve the problems, but allow them to fester.  Over time, things get worse instead of better.

A better solution:  Instead of just waiting around for something to get better, you make a plan. Instead of passively following your doctor’s or your spouse’s or  your boss’s orders, you take charge! Instead of waiting for the fantasy medicine or cure, you may need to design your own treatment or cure.

“Getting active” means different things, depending on your particular situation. A financial emergency is entirely different than being told you have diabetes, or that your adolescent daughter has developed a drug addiction. But there are some fairly consistent things that high functioning individuals do in these situations.

First, you have to admit that this is, indeed, a serious situation. That you cannot keep on doing what you’ve been doing and expect things to improve on their own. Or that at the very least, you have to decide whether this is something that will “sort itself out,” or whether you really need to decide on a course of action. High-functioning people generally don’t wait for things to deteriorate. And what they tend to do is to project a bit into the future: “If this keeps up… what happens in a day.. a week… a year?” Often, that’s all you have to do to start making a decision about whether to act.

Next, of course, is you look at your options. This may take finding out a whole lot of stuff, whether it’s the facts about the family situation, or making a spreadsheet or list of your bills and debts and income and expenses, or talking to friends or family. Sometimes you need to call in the experts: everything from doing some internet research on a health condition to talking to a teacher, lawyer, or plumber (or all of them sometimes!)

Finally, you make a list of steps to take. A budget. A new diet. A bit of counseling. Sometimes these steps mean making direct changes in something in a big way. But many life problems are really a matter of creating a plan for small changes, for chipping away at a problem consistently over time (diet, health, relationship struggles), or making yourself a bit different (more patient, more frugal, more physically active, more sensitive to others) so that you can gradually turn things around.

There are life crises, and there are chronic, low-grade problems. We must often work on several “emergencies” at once. But over time, people whose lives seem to “work out so well” are really just benefitting from having made a bunch of decisions to be active in small, daily ways: to nurture connections, to floss, to pay bills on time. This, over time, tends to shape a more crisis-free life. Because good lives seldom “just happen.”