Out of the Blue: Six Non-Medication Ways to Relieve Depression (Norton Professional Books) (6 page)

So, what we’re up to in this chapter is finding any repeating patterns associated with depression and, one way or another, getting the depressed person to do anything that changes things up.

THE “DOING” OF DEPRESSION

In the previous chapter, we discussed exploring times when the person is or has not been depressed as well as times when she is or has been depressed. This is a good foundation for the strategy of undoing depression.

I sometimes joke with my clients that I know how to do a good depression, since I used to be depressed and have worked with countless clients who have been depressed.

If I were to do a good depression, I would:

•
Stay still and not do anything that would make me breathe fast or hard

•
Stay in bed if I could; if not, sit in the same chair or lie on the couch

•
Isolate; avoid other people

•
If I couldn’t avoid other people, try to talk to the same person or few people

•
Talk to them about the same topic—usually how depressed/unhappy I/they are

•
Sleep during the day and have insomnia at night

•
Brood on my past, my fears, my faults, and my resentments

•
Imagine the future will be the same or worse than the past or present

•
Eat terribly; overeat or undereat (whichever one I specialize in); eat junk foods, sugar, fat

•
Watch a lot of TV, usually of the mindless variety

•
Not pursue hobbies, passions, or spiritual interests

•
Drink alcohol, smoke cigarettes, and/or use other drugs

•
Not ask for help

Clients often nod in recognition of some of these elements.

Then I ask them how they do
their
depression, and they can often detail some of the patterns and elements typically involved.

This is not a way to blame them for being depressed or to imply that they choose to be depressed or get some sort of gain from it. It is instead a way to help them find some “moments of choice” in relation to their depression—to help them find some points of leverage where they might be able to do something different and shift themselves out of their depression or at least get some traction so they can start feeling better. It’s a way of helping them find their own power to influence what has been an overpowering and disempowering experience.

What we’re searching for here are
the patterns
, that is, the recurring activities, thoughts, attentional directions and foci, interactions, body behaviors, and other regularities that happen before, during, after, and around the episodes or experiences of depression. Things that happen only once or not very often aren’t so helpful. What will have the most impact is identifying the usual things that happen or that the person does that are associated with her depression. We then further search those patterns for moments of choice. We look for any action, focus of attention, interaction, body behavior, clothing choice, eating decision, or other pattern that the person could change.

If you cast your mind back to the previous chapter (marbling), in which I showed you a map of Cindy’s depression patterns, one of them was that she would stay in bed until about noon when she was depressed. We decided together that she would experiment with getting herself up and getting showered and out of the house by 9
A.M.
every day for the next week. She made an appointment to meet someone that helped her keep that commitment, and she discovered that she was almost totally out of her depression within the week.

But what if Cindy had said, during our discussion, that she just knew she couldn’t get herself up and out of bed; she was just too depressed to do that? Then that is not one of her moments of choice, and it wouldn’t be good to suggest that experiment for her just now. Instead we could search her maps of depression and non-depression to discover another possible moment of choice.

One might be her focus of attention. She had said that when she was depressed, she would focus on how her future might become even worse than her present, but when she felt more confident and competent, she would focus instead on giving herself credit for some small or large accomplishment from the recent past. So, a better experiment might be for Cindy to agree to spend a few minutes each morning (while she is in bed) thinking about things she has accomplished in the recent past. Doing so might help her feel better enough to find the energy to get out of bed more quickly.

Or perhaps we could focus on the fact that when Cindy is depressed, she tends to eat breakfast cereal all day. We could get Cindy to ask a friend to bring in some different, healthier food, cook it up, and freeze or refrigerate it so Cindy can just heat it up and eat it. She could get rid of all the breakfast cereals for a week as an experiment.

Or she could get dressed in different clothes instead of staying in her night clothes much of the day.

We wouldn’t really know which of these pattern changes would yield results without trying them, but each one offers a bit of new stimulation for the brain, so even if these changes didn’t have radically helpful outcomes, we would be doing a bit to combat brain atrophy—which, as you will discover in Chapter 7, can be very important in depression.

Most people who are depressed have these moments of choice, and it is our task to help them find them and arrange for them (or to help the people around the depressed person facilitate them, if she is so incapacitated that she is not available to do much herself) and thereby do “undoing depression” experiments to discover if they make a difference. And the word
experiment
really does capture the spirit of what this strategy is about. There is no set formula for this and no guarantee of success (that’s why there are six strategies—nothing works for everyone). There is no failure here, just experimental results. No blame, just possibility.

Each depressed person has an individualized pattern of how she “does” depression and how she might undo it. But there are some general guidelines for where to search and where to suggest experiments. I typically search in three places for the patterns of doing depression and undoing depression.

THE DOING, THE VIEWING, AND THE CONTEXT

My idea is that doing any kind of change work involves working with four areas of human life: The Being, The Doing, The Viewing, and The Context.

The Being involves the inner self: feelings, the core nature of the person, and so on. It is who he is.

My suggestion is never to try to change that aspect of people. If people get the sense that you don’t accept them as they are and are trying to change them at their core, they often feel shamed or blamed or just not heard, understood, and accepted. If that happens, they are often defensive, wary, and suspicious and aren’t available for change.

So, in regard to The Being aspect of things, just acknowledge, validate, and accept people as they are. Most therapists have good skills in this area. This is one of the first things we learn in connecting with people—listen deeply and respectfully and communicate deep acceptance and no judgment. Be empathic and respectful. Notice when you have said or done something that the person experiences or perceives as off-putting, disrespectful, or invalidating, and make amends and adjustments to ensure you don’t lose connection and influence with him.

Here are a couple of examples of “validation talk” in therapy:

Therapist:
It sounds as if you have the sense that somehow you are to blame for being depressed or as if you haven’t tried hard enough. Having sat with a lot of people who are depressed, I can tell you that my guess is you have been trying quite a bit and that you aren’t to blame for what is happening with you.

Or:

Therapist:
When I said we could do some things that could help you feel better, you seemed to have a reaction to that. Maybe I’ve touched a sore spot there. I remember you saying that your boyfriend told you you could make yourself feel better if you really wanted to, and I don’t really mean it like that. I mean I think there is some hope we can work together to get you feeling better.

Assuming that you have connected, listened, accepted, and validated, the areas to focus on for change are the other three: The Doing, The Viewing, and The Context.

The Doing of Depression

The Doing involves actions, interactions, body behavior, and language. Anything in the realm of The Doing could be seen or heard on a video or audio recording. There is no need to speculate on this area; you, the person who is depressed, and others can all agree on what happened if you watch a video or listen to an audio recording of the situation.

Often we can observe some aspects of this when we see our clients and they are depressed. We can notice what words or phrases they use, how they dress, how they sit, how they move (or don’t), and how they interact with us in the treatment room and other people in the waiting room.

Of course, sometimes we as therapists can’t directly observe the situation, but can only hear descriptions of it provided by our clients or others in their lives. At those times, I suggest using “Videotalk” to help get clear descriptions that don’t require speculation or interpretation. Videotalk involves going beyond labels, theories, and general or vague words and phrases and limiting the description of the situation to what one can see, hear, or touch.

Thus, descriptions such as, “Then I got really discouraged,” would not fit this Videotalk criteria. Instead, the person might say something like, “Then I went into my bedroom, closed the door, turned off the light, laid on the bed, and turned toward the wall.” Or, “I looked at the floor even when my wife was asking me to look at her.”

Instead of accepting the description “I just stop trying,” I want to get an action version of what “stop trying” looks like and sounds like when the person is doing it. Is he lying in bed? Is he watching TV? Is he saying he wants to give up? Is he eating too much? Until you could play in a movie the part of a person who gives up the same way this person does, you don’t fully understand what he means by his statement. Get specific, because specific, sensory-based descriptions will give you places to intervene in The Doing.

Here are some questions that may elicit descriptions to assess The Doing associated with depression:

“What are you typically doing when you’re depressed?”

“How do you describe your depression? What words and phrases do you usually use to talk about it?”

“Who is usually around when you’re depressed, if anyone? How do you interact with them, or how do they interact with you, when you’re depressed?”

“What is your posture or body position when you’re depressed?”

“What are you doing just before you start to get depressed?”

“What kinds of clothing do you typically wear when you’re depressed?”

“What kinds of foods do you eat when you’re depressed or are getting depressed?”

Here is a sample dialogue that show how to elicit “Doing” descriptions when talking with someone experiencing depression.

Client:
I’m just so down.

Therapist:
Since I don’t know you that well yet, I’d like to have a better sense of what happens for you when you’re down. If I were a fly on the wall and could watch you when you were down, what would I see different between the times you’re feeling better and the times you’re more up?

Client:
Oh, I don’t know. I’m just listless. You know, low energy.

Therapist:
And how would I be able to tell that you were low energy, since I don’t know you well? Some people are just low key, but for you I’m sure there is some way I could tell.

Client:
Well, you would see me sitting down more. I’m usually up and doing little chores. I generally like to get things done, and when I’m down, it takes a major effort to do things, so I find myself sitting and just spacing out in a chair or lying on the couch.

Therapist:
Okay, I’m starting to get the picture.

Client:
I’m just more negative when I’m depressed.

Therapist:
How do you show that negativity? How would your wife or your brother or your best friend be able to tell you were more negative?

Client:
Oh, they know. I just shoot down every suggestion they make.

Therapist:
Like how?

Client:
Oh, like, “Hey, let’s go to a movie tonight.” And I’d say, “There’s nothing good on. All the movies suck.” Or they’d be talking about some political thing and I would say, “They’re all liars and crooks,” which I know isn’t true. It just seems like all I can see is the dark side of things when I’m depressed.

The Viewing of Depression

The Viewing involves two things: what we attend to or focus on, and our ideas about things.

Clients develop patterns and biases about what they attend to. Some attend more to auditory stimuli; some attend more visually. Some people notice what’s wrong; others notice what’s right. Some attend to details, other to the big picture. Some focus on the past, others on the future or the present.

And clients make meanings and interpretations of things in their lives. They develop notions about why they get depressed or what it means about them. They develop stories about the future and their prognoses. They compare themselves to others. These are all reflections of their views and the meanings they assign. They have judgments, assessments, evaluations, and opinions. Statements such as “I’ll never get over this,” “There is something fundamentally wrong with me,” “I’m a bad person,” “Taking medications means I’m weak,” “I’ll have to be on medications the rest of my life,” “Nothing means anything,” and “No one really cares about me” are all part of the Viewing aspect of depression for our clients.

Likewise, their attention tends to get riveted on certain things, usually negative things, when they’re depressed.

I remember teaching a workshop in 1982 and reading 125 feedback forms from the participants in the workshop after it was done. One hundred twenty-two of them were highly positive, rating me well on a rating scale and saying nice things about what they had gotten from my presentation. A few people rated me low on the scales, and one person got a bit personal: “Bill O’Hanlon is glib and articulate but shallow.” That hurt.