How Come They're Happy and I'm Not? (20 page)

• “I am not worth anything.”
  
• “I am not good at anything.”
  
• “I hate my job.”
  
• “I will not get everything done that I need to get done.”
  
• “I am not lovable.”
  
• “I have no reason to have self-esteem.”
  
• “The world is a bad place.”
  
• “What I did was a mistake.”
  

You get the idea. I am sure you could add your own list to these. In fact, if you feel bold, over the course of a day, I would like you to add to that list. What are you are telling yourself? What messages did someone teach you at a young age, or did you teach yourself?

Once you have your list, try to counter these thoughts:

So, this is probably the part of the book where you are reading this and begin to think, Okay, this guy's in la-la land now. This kind of nonsense can't possibly help me.

Well, if you are only listening to yourself, ruminating on the same negative messages day in and out, then you are right. You will not be able to change those messages and believe new thoughts.

In fact, as time goes on, the same negative messages in your brain will only get more ingrained. There is an old saying that your belief becomes your biology. For every thought we have, brain molecules are being created and others suppressed. You have spent a lot of time not allowing any positive thoughts to mix in, inhibiting the creation of your best mood chemicals. You can break this cycle. It takes practice and habit. It does work, though. I assure you.

So how do you change the negative messages? You bring in other thoughts. Also, you can start bringing in positive people as friends, working with positive counselors and therapists, and continuing to read positive books. I hope this is one of the positive books for you. You may also want to minimize time with the people around you who promote negative messages—sometimes this could even be family and close friends. It's not an easy process, but you are fighting for your health and for your life.

I often read books or listen to lectures together with my patients, or I have them take a book home to read. You can find a list of recommendations at www.drpeterbongiorno.com/positivity. Many of these books bring in Buddhist ideas, some are about relationships, some are lectures on self-esteem while others are about figuring out what makes you happy, and some are just about being positive. They all help reframe various negative messages you are telling yourself. Listen and read them all if you can—the more you bring these ideas into your life, the less room your brain has for negativity.

Reality is truly in your mind—you can create a new reality that honors the positive aspects of your heritage, upbringing, and experiences without grasping the negative messages.

The second part of positivity work is choosing new experiences. These activate the brain's reward system, flooding it with dopamine and norepinephrine. These are the same neurotransmitters that are ignited in early romantic love, a time of exhilaration and obsessive thoughts about a new partner.

Following are some experiences that I have seen particularly useful to spur patients out of depression. One patient even came in one day and said, “Okay, I thought of a new idea: skydiving!” She'd always wanted to try it, and even though it scared her, she realized that not being happy and living a dreary day-to-day life scared her more. So she went skydiving (with a qualified instructor, of course), and soon after, her antidepressant medications were history! Her brain was making those neurotransmitters on its own. No drug can compete with the influx of dopamine a good skydive will elicit.

Listen, you do not have to jump out of an airplane, but do try to be bold and open-minded about trying new things. They can be big experiences like a trip or small ones like buying yourself a new favorite flower.

• Volunteer to help those less fortunate than yourself.
  
• Purchase an MP3 player and load it with all your favorite uplifting music for exercising.
  
• Find a good hairstylist and try a new style haircut or color.
  
• Pick a new set of glasses to wear.
  
• Schedule time with a loved one to do something fun.
  
• Sign up for an acting class.
  
• Start lessons for a musical instrument or buy a self-teaching book.
  
• Try some new clothes, maybe a style you have not worn before.
  
• Travel somewhere new. Make sure you take pictures and put them up around you when you get back.
  
• Try new foods at a restaurant or even cook some at home.
  
• Buy a new flower for yourself weekly.
  
• Get a massage.
  
• Attend a musical event, concert, or play.
  
• Sign up for an online dating service and meet new people.
  
• Join a book club.
  
• Pretend you lost your job and look to see what new opportunities might be around for you.
  

I promise if you pick up a new book or lecture and start a new activity, your brain will begin switching modes and bring you greater joy in your everyday life. If you are thinking, Well, I would do these things if I wasn't depressed, you are not alone. Try your best to do them, and follow the other recommendations in the book. As we discussed last chapter, sometimes phenylalanine and tyrosine can help the motivation, as can acupuncture. A combination of these things will eventually get you up and moving—just keep doing your best.

In most cases, psychotherapy is important and useful to treat depression. Emotional processing is useful for low mood, especially when there's a past traumatic or depressing life event. During psychotherapy, you can identify and work through the factors that may be causing depression. This section will briefly survey common forms of psychotherapy.

Psychodynamic therapy is based on the assumption that a person is depressed because of unresolved, generally unconscious conflicts, often stemming from childhood. The goal of this type of therapy is for the patient to understand and cope better with these feelings by talking about the experiences. It is administered over a period ranging from weeks to years.

Interpersonal therapy (IPT) generally focuses on improving communication skills and increasing self-confidence and esteem. It is often used when depression onset stems from the loss of a loved one, life transition (such as becoming a parent or changing careers), feelings of isolation, or relationship conflicts. In a study of 233 women with a history of recurrent depression receiving IPT, half
the subjects improved with IPT alone. Interestingly, researchers concluded that frequency of counseling was not a factor—monthly treatments appeared to be as effective as weekly in preventing the recurrence of depressive symptoms. However, they noted that twice-monthly therapy yielded the lowest quitting, suggesting that there may be a best frequency of treatment. If you try IPT, talk about it with your therapist to determine the best visit frequency for you. For the subjects that didn't improve with IPT alone, antidepressant therapy was recommended. I wonder, if other natural remedies from this book had been used in conjunction with IPT, perhaps the success rate would have been even higher.

Cognitive behavioral therapy (CBT) helps people with depression to identify and change inaccurate perceptions that they may have of themselves and the world around them. The therapist helps patients establish new ways of thinking by directing attention to both the “wrong” and “right” assumptions they make about themselves and others.

Some high-quality studies have suggested that online CBT may hold great value and promise as a therapy. Results based on a data review of 1,746 patients with depression, social phobia, panic disorders, and anxiety showed that about one in two people improved with online CBT alone, which is a pretty good result for a single medical therapy. I was most struck by what Dr. Gavin Andrews, a conventional medicine psychiatry professor from Australia who headed the study, said:

[T]here was no hint of relapse reported in any study, which is just foreign to my experience. Depression is supposed to be a relapsing and recurring disorder. What on earth is it doing just disappearing after someone does CBT over the Web? This is not what any of us were trained for.

Another study of twenty-six patients hospitalized for severe depression found that mood states improved significantly after one sixty-minute computer-assisted CBT session—let me repeat,
that was only one session. This is impressive, for severely depressed patients from an in-patient ward may be the toughest to treat. This study used a commercial DVD-ROM program called Good Days Ahead which costs much less than you would pay for a single session with a psychiatrist or psychologist in most cases. There are also free websites and inexpensive phone applications too. Please see the resources section of this book for CBT resources that you might find helpful.

A note about psychotherapy: The famous medicine intuitive Dr. Caroline Myss has a cautionary saying in her self-esteem lecture series that goes something like this: “Be careful with psychotherapy. It's great at keeping people feeling good in their dysfunction.” Remember, when you are working with a psychotherapist, naturopathic physician, acupuncturist, medical doctor, or anyone else, you need to ask them to explain exactly what you are doing together so you understand it. The word
doctor
comes from the Latin
docere
, which means “to teach.” So if your doctors are not teaching you—they are not doing the job correctly. Then ask, “How long do you expect to work at this before you start to see changes, and what kinds of changes do you expect to see?”

To be fair to practitioners, sometimes it takes time to see results and the approach will change as you go—and they may need to explain that to you. But if you feel like you are really not making any progress after a reasonable amount of time, you may want to consider working with someone else for a different approach. Sometimes I suggest patients I have been working with start to work with another practitioner if I believe I am not moving them in the right direction within a reasonable time. It's not that I do not believe in my ability, but sometimes the practitioner-patient chemistry is not as healing as it may be with another—and that is okay. We are all different, and we do not completely understand what makes a healing relationship successful. You may need to try a few or more practitioners to find the right healing therapy and chemistry.