I had a conversation with a friend the other day who asked me for advice on what to do when you are have fallen so deep into depression that you cannot fathom performing any action at all, let alone CBT and self-care strategies. “I do all this work on changing our psychological cognitions of myself, others, and the world, and I practice all these CBT strategies. But when it comes down to it, when I am in that state of depression, it feels like all the work was for nothing, because I feel powerless to do anything. Thinking about how much work I did to prepare for when I’m feeling depressed and how I am avoiding the strategies when I really need them…frankly, it makes me even more depressed.”
Photo by maxime caron
Let me tell you something. It is not reasonable to expect yourself to be able to force the use of a CBT strategy when you are in the thick of depression. When someone is in a depressive state, they often suffer from slowed thinking, reduced concentration and less efficient and effective decision-making skills. Not to mention, their minds linger on negative thoughts and there is a distinct feeling of emptiness and hopelessness that overwhelms them. In this state, is it sensical to expect them to take out their thought record and begin analyzing, “Hmm, so I found a marked increase in the emotions of anger and sadness after Victoria made a snide comment about me – maybe 80% and 75% respectively”? Well, personally, I would think not.
What is the point of practicing the strategies then?
I am sure you must have the question of, “Then what is the point of practicing these strategies? If we’re just going to fall back into depression and not be able to use the strategies, what use is it?”. The key is in the timing. We have just established that the wrong time (and frankly, the impossible time) to use these strategies is when one is already in a depressive state. I personally have found that the best time to use the strategies is either a) when my mood is stable and I was just pushed a bit off because of an event, or b) when I first become aware that I am rising out of the depressive state.
It is important to use the strategies as much as possible during these times because ultimately, we are trying to rewire (often) years and years of taking the same mental paths that leave us in the depressive state. This rewiring is not something that will likely occur when your symptoms are at their peak, and by definition, are following those negative spiralling paths.
Remember, just as our negative automatic thoughts can lead us to a depressive state, practicing the development of more positive, alternative thoughts as soon as possible can help reduce the impact that any potential trigger can have on us. If we practice the ability to reframe our perceptions of any situation, then it becomes less and less likely that we will fall into depression.
Then when I am depressed, what do I do? How can I get better?
I know from personal experience how meaningless and hopeless everything feels when one is in a depressive state. How empty it can feel when you reach rock bottom and do not remember how it felt to feel anything. Every rational thought is somehow twisted like a pretzel, and further feeds your chain of negative thoughts. It feels endless, and also feels like it has been that way for your entire life.
For some reason, during my last few depressive episodes, there was one rational thought that kept me going. That was that I knew from previous experiences that I always eventually rise out of the depressive state. It seems like a very simple concept. The thought that I have gone through this before, and every time I won against my negative chain of thoughts. The problem with most other rational thoughts is that it can be difficult to find concrete evidence for their validity.
Rational thought: “If I do something I enjoy doing, then I might be able to distract myself from my negative thoughts.”
My thoughts in a depressive state: “No I won’t. I don’t even enjoy anything right now. I can’t. I won’t ever enjoy anything. If it was that easy, I’d be cured already.”
Rational thought: “I’ve been in bed for 2 days straight eating very little and sleeping endlessly. Maybe if I start doing little actions like putting my feet on the ground, taking one step, and then another, and bringing myself to the restroom to wash my face, I will start slowly coming out of this state.”
My thoughts in a depressive state: “No. If I try getting out of bed, I will be too weak. There’s no point in getting out of this bed.”
But with “I know from previous experiences that I always eventually rise out of the depressive state”, there is incredibly concrete evidence for its validity. The proof is in your beating heart. Your breath. The warmth of your body. The fact that you can read this post right now. Your life. You are alive. No matter how dead you may feel, by definition you are alive. This has happened before, and you came out of it. Whether you came out of it with professional help or by waiting it out on your own or with your loved ones, you are here. You are exhausted, feel empty, hopeless, and helpless, but again, you are alive.
I believe it is flawed to try and convince someone suffering in a depressive state that they will feel better if they do x or y or z. First of all, it is never that simple for individuals with depression, and there is no formula or ’on/off switch’ to get better. However, there is no denying the statement that they have been here before, and they have always eventually come out.
But how does that help me when I am depressed?
It is hope that a person in a depressive state needs. We don’t need someone telling us to go get some exercise, or to play an instrument, or listen to music, or any other activity that typically makes someone who feels sad feel better (read: depression is not the same as sadness). We need hope – even a sliver of a thought that we might be able to get out of this state.
Do you ever hear the phrase that “people who have depression are living in the past”? First of all, that is an overgeneralization and an oversimplification rolled into one romanticized phrase. But even then, there is a bit of truth in there. Why do mental health professionals recommend their patients to practice mindfulness? What is the core tenet of mindfulness?
When I tell myself,“I know from previous experiences that I always eventually rise out of the depressive state”, I force my thoughts to look for proof. Again, the proof is in everything I perceive in the present. My heartbeat. The sensation of my body connecting with the ground or bed or chair or whatever it may be. Even the emptiness I feel. The frustration with myself. The anger at myself or others. The thoughts whirling in my head. All of it is proof I am alive.
With mindfulness practice, the focus is not in removing negative thoughts and emotions from ourselves. It is to practice remaining present, to accept every sensation, to note every sensation, and to let our transient thoughts come and go. If we experience even a small bit of hope when we are in a depressive state, then we can begin centering ourselves in the present, as opposed to the past or the future. And this is what will help us to start rising back up. But sometimes, it requires us to look to the past – which is what we tend to do anyway when we are depressed (albeit at our negative perceptions of certain events).
Actively weather the storm.
Believe it or not, a conscious thought that begins in the past but uses it to bring you more to the present is an active way to resist the depressive state. None of us who suffer from depression can definitively say that we will never fall into a depressive state again. But I hope that we can more definitively say that if it happens, we’ll be as prepared as possible. Plus, every time it happens, we will get better and better at coping and moving through it.
Always remember to love (ARTL),