Out of the Blue: Six Non-Medication Ways to Relieve Depression (Norton Professional Books) (8 page)

He followed through and started to feel better within a few days—not radically so, but enough that his parents noticed it and felt encouraged. He felt good enough to call up some friends and spend some time with them, and he felt a lot better and less like a loser after his time with them.

So we added a social component to his game system. He got his parents to contribute $100 to his video game purchase fund when he explained the system we had put in place. He earned points every time he spent thirty minutes with his friends or with his parents without arguing.

Soon he was going out more with his friends and eating more healthy dinners with his parents. He apologized for being so angry with them and yelling at them and even thanked them for letting him live in their home and caring for him.

We talked about whether playing video games was adding to his depression. He wasn’t sure and was unwilling to experiment with stopping for even a day, so we left that alone.

We also had him try wearing different clothes. This didn’t make any discernible difference, so after a few days we ended that experiment.

After some discussion, he changed his view that he couldn’t go back to college. He enlisted his mother to help him apply for some funding to attend the local community college and started there. He did much better than he had during his first college experience and began to make new friends and develop more confidence.

Now, this intervention might not work with everyone. It worked for Charles, because we took the time to assess his depression patterns and did some experiments that worked. We used some things that had worked before (spending time with friends, “gamifying” the changes) and shifted him out of his previous patterns a little at a time.

POSITIVE PSYCHOLOGY

For much of the history of experimental psychology, research was focused on how people become dysfunctional or damaged and what was wrong with them. Positive psychology is a relatively new branch of experimental psychology that studies what helps people to be happy, find meaning, and function well. There is now evidence that having people do activities that positive psychology research has shown to be correlated with increases in well-being and happiness can lift depression.

What We Can Learn From Psychotically Optimistic Dogs

One of the founders of positive psychology is a fellow named Martin Seligman. Seligman was a researcher who focused his pre–positive psychology research on depression. He used dogs for this research.

In one of the experiments, he put dogs in a wire mesh cage raised on stilts. The cage had two chambers. The dogs could go back and forth between the chambers. Once the dogs were accustomed to their living situation, Seligman turned on a mild shock on the wire mesh floor on one side of the cage. It wasn’t enough to harm the dogs, but it was irritating.

Of course, the dogs would quickly move to and spend their time in the non-shock chamber of the cage. Then, when they had become accustomed to this condition, Seligman would turn on the shock on both sides of the cage. The dogs now had nowhere to go to escape the shock. After going back and forth to both sides of the cage and discovering eventually that there was no place that was safe, most of the dogs would stop trying to escape the shock and appear depressed. They often stopped eating and slept most of the time.

Seligman called this state “learned helplessness.” The dogs had concluded that there was nothing they could do to decrease their suffering, so they gave up.

Seligman went on to study this condition in people and discovered that people with a tendency to pessimism were more prone both to learned helplessness and to depression. When bad things happened, they tended to think that (a) those things would persist, (b) there wasn’t much they could do to change those things, and (c) those bad things were an indicator of some bad quality about themselves (“I’m so useless!”).

When he began to develop and encourage positive psychology research, Seligman thought back on those dog experiments. He remembered that a few of those dogs never gave up. Those were the psychotically optimistic dogs—they seemed to hold on to the idea that things might change for the better at any moment, and every so often they would wander to the other side of the cage to find out if the shock was gone.

And here was the thing: After some time, the researchers would turn off the shock on the other side of the cage. So the optimistic dogs were the only ones to ultimately escape the shock before the experiment ended. One of the things about optimism is that it prompts people to try things to change situations they don’t like, even if they’re deluding themselves about how much influence on those situations they actually have. But in the end, if there is something that will make a difference, the optimist will eventually find it, and the pessimistic, who gave up trying, often won’t.

Seligman found that optimists, when confronted with something bad in their lives, tended to respond in ways that were much different from the way pessimists responded: (a) They considered the bad situation limited in time (“I’m just going through a bad patch at the moment”), (b) they considered the situation to be limited in scope or context (“This job sucks” or “I’m going through a depression” instead of “Everything sucks”), and (c) each of them considered himself or herself to be a good person going through a bad thing (“I’m okay at my core, but I’m overcome by what I’m going through”).

Seligman, himself a bit of a pessimist, wondered if these natural leanings toward pessimism could be turned toward the more optimistic explanatory style and discovered that, indeed, they could. They were changeable. And they were surprisingly easy to change with just a few activities over a short period of time.

He had people who scored higher on the pessimism scale do deliberate tasks to increase their happiness and well-being and reorient their attention for merely
one week
, and he found that these people were significantly happier when their happiness levels were measured six months later.

What kinds of things did he have them do? In each of four different experiments, he gave them one of these activities:

1.
Identify and write down times in the past in which you were at your best

2.
Express gratitude to someone you have never properly thanked

3.
Write down your personal strengths

4.
Write down three good things that happen each day

You might recognize that these positive psychology interventions all involve changes in The Doing or The Viewing. Doing those things for as little as one week shifted participants away from their depression (Seligman, Stern, Park, & Peterson, 2005).

Could this kind of intervention really work with people who are severely depressed? The answer turns out to be yes. Seligman and his colleague Jeff Levy did another study with people who scored as severely depressed in a depression inventory. Participants were asked to recall and write down three good things that happened every day for fifteen days. Ninety-four percent of them went from severely depressed to mildly to moderately depressed during that time (cited in Seligman, 2002). An aggregate study of positive psychology studies has shown that these interventions can relieve depression (Sin & Lyubomyski, 2009).

These positive psychology interventions are more formulaic then the individualized approach I have written about above, but they give us a sense that even severely depressed people can be moved to feel better by shifting their attention and their actions and interactions.

CHANGING BRAIN GROOVING

Depression keeps narrowing the depressed person’s thinking, perceptions, actions, foci of attention, interactions, and environment, until life becomes very small and repetitive indeed. Pushing back against this narrowing is one way to begin to take back power from depression, undoing its domination of one’s life.

We will get into this in more detail in a future chapter, but there is a rationale for why interventions to “undo depression” work. The brain gets grooved with continued repetition of the same kind of experience. That is bad news for people who are depressed, because they tend to do, think, and pay attention to the same things over and over again, and they tend to get less and less new stimuli as they get more depressed. But the good news is that, due to plasticity, the change ability of the brain, new things can happen in their experience if they do something different.

So it is important to get depressed people to stop “doing depression” and do something different and incompatible with their depression patterns. As Andrew Solomon suggests, “the surest way out of depression is to dislike it and not let yourself grow accustomed to it.” (2002, p. 29). This entire book is really a variation on this theme, with each strategy offering another way to undo depression.

In the next chapter, we’ll take up the third strategy for undoing depression: shifting the depressed person’s relationship to depression.

CHAPTER FOUR

Strategy #3: Shifting Your Client’s (or Your Own) Relationship With Depression

Depression doesn’t exist in isolation. Anyone who is depressed has a relationship with her experience, and shifting the nature and quality of that relationship can make a difference and help her experience less depression or move out of it.

This strategy for resolving depression helps people develop a new relationship to their experience and thereby shift out of the grips of depression. Just as it’s possible to be afraid of being afraid (as in Roosevelt’s “We have nothing to fear but fear itself”), people can get depressed about being depressed. They feel bad about feeling bad.

One of the first ways to shift someone’s relationship to her depression is just to help her notice it without judging it or trying to change it. This is called mindfulness. There is a growing body of research that shows that helping people become mindful of their depression rather than reacting to it or getting swept up in it can provide substantial relief. This may seem counterintuitive, but at least some of the suffering in the experience of depression comes from comparing oneself to how one used to be and how others seem to be, and from judgments that one is not supposed to feel this way. Dropping these elements can help the person shed one layer of suffering associated with depression.

The other effect of becoming mindful is that one may notice slight or more dramatic variations in one’s experience of depression or the intensity of the depression throughout the day or the course of depression. As we discussed in the last chapter, any shift in The Viewing of depression may create some traction for getting out of it.

MINDFULNESS

Let me tell you a story. It involves anxiety rather than depression, but it handily makes the point about mindfulness.

A man had been overweight for years. He had tried many diets and, to a certain extent, they all worked. But as soon as he stopped the strict diet, he, like many dieters, gradually regained all the weight he had lost and often ended up gaining even more.

Finally, having read everything he could get his hands on, consulted experts, and tried almost every diet out there, he decided that the diet approach didn’t work and became determined to figure out what was behind his weight problem. He decided that he would study himself almost as if he were an anthropologist, doing research on this strange creature that was himself.

He began his inquiry on a Saturday morning, all alone at home. He ate a healthy breakfast with an appropriate amount of calories for his body size. He felt fine for a little while, but then, within thirty minutes or so, he noticed that he was hungry again. He knew he wasn’t likely to be physiologically hungry so soon after eating, so he didn’t seek out food, but sat on his couch to pay attention to what was driving his hunger.

The first thing he noticed was some anxiety. He didn’t know what he was anxious about, but he felt anxious anyway. As he sat, he noticed he felt a pang of hunger and the urge to eat, but again he ignored it and noticed that this free-floating anxiety increased. He started to feel quite bad. But still he resisted doing anything except observing.

Within a few minutes, the anxiety grew and started to become outright fear, and then escalated into terror. He was sweating and shaking but determined not to give in to the impulse to eat to quell the fear.

He said later that it was one of the worst experiences of his life. At times he feared he would have a heart attack or just fly apart because the feelings were so intense. But after about an hour of intense fear, sweating, and shaking, it all began to subside. He was okay again.

A few hours later, he ate lunch and noticed the same impulse to eat soon after lunch. Again he sat down to observe and again experienced the intense fear, but this time it didn’t frighten him quite so much, since he had lived through the previous episode. Again it lasted about an hour and subsided. He still didn’t know exactly what he feared. It seemed pure terror, unattached to any specific thing.

He continued this over the weekend, and by Sunday the intense fear was lasting only about fifteen minutes. When he returned to work the next day, it would still happen occasionally, but he would excuse himself, find a private place, and sweat it out for the ten to fifteen minutes it lasted and then return to work. Over time, the anxiety episodes just faded. He was finally able to maintain his weight loss.

This points to a similar tack for shifting clients’ relationship to depression. The task is to invite them to observe their depression very carefully without trying to get rid of it or compare it to other experiences. Just have them sit and do nothing about it but be with it, staying aware of whatever sensations or thoughts occur (Kaplan & Berman, 2010; Kross & Ayduk, 2011).

This may be harder than you imagine. We humans tend to be “doers.” We want to do something, problem-solve, fix it. Not doing is challenging for most of us.

And yet that may be a way out. The old saying goes “The only way out is through.”

There is research with depressed people showing that this approach works. It has entered the field under the rubric of “mindfulness-based cognitive therapy,” or MBCT. MBCT has been studied and compared to other interventions, such as antidepressant medications. Mindfulness meditation is an ancient approach rooted in Buddhism. Buddhist teacher Joseph Goldstein describes it this way: “The skill of mindfulness creates a condition of bare attention in which the meditator observes things as they are in order to notice what is just there, without grasping or aversion.” Like the man who observed his patterns of hunger in the example above, but did nothing to get rid of them, mindfulness involves merely observing, noticing, and not getting swept away by the experiences that are happening in any moment. It turns out that at least some of the suffering associated with depression arises from trying to get rid of it, to avoid it, to judge it, or to react to it.