Depression can be experienced by any of us or by someone we know. We can access help through our doctor or counselling or psychotherapy services. Depending on where you are, you may need to wait to be seen or start treatment. Or it may be that the treatment is not 100% effective, and you are thinking about other treatment strategies. Even if you take antidepressants, it helps to find different techniques that can help you to recover quicker and prevent relapses as much as possible. The advice below is meant as an addition to your treatment, not instead of it. I am not advocating stopping antidepressants without a discussion with your doctor, but you may find some of the strategies helpful.
what can we do to help ourselves?
First, it depends on severity. If you are feeling extremely low and you have strong suicidal thoughts with imminent plans to end your life, you need to access emergency help to ensure your safety.
The guide below applies more for mild-moderate depression or if the suicidal risk is otherwise manageable.
It is essential to think that depression has bio-psycho-social determinants and is not only a biological illness that can be treated by medication only. In recent years, there have been more studies and theories about the role of the microbiome, inflammation and physical exercise in improving mental health. Depression (and many other chronic conditions) can be tackled from many angles.
a few strategies that can improve your mood
psychotherapy
Of course, finding a psychotherapist would help, but if you are stuck on a waiting list or can’t afford a private therapist, there are a few self-help strategies that you could try. I gave a short overview but if the techniques sound helpful, look up that particular therapy as there are many free online resources.
CBT strategies
CBT stands for cognitive behavioural therapy and, as the name suggests, includes techniques aimed at changing behaviour and challenging unhelpful thoughts.
The main CBT techniques aimed at depression are behavioural activation and thought challenging.
how to do "Behavioural activation"?
The first step is to understand why it is important. We have low energy, motivation and desire to do anything when we are depressed. It is very likely that we become less active and withdraw from things we used to enjoy, which in turn has a further negative impact on mood. Movement improves well-being and mood. Also, by withdrawing from life, we are perpetuating the idea that we cannot do things and, in more severe cases, that we are no good, useless…
Therefore, although it sounds counterintuitive, we must challenge ourselves to be more active. It is essential to balance the challenge with the current ability, to do more than we currently do, but without setting a goal so out of reach that it’s impossible, making us feel even more incompetent.
Which tasks to pick?
what is "thought challenge"?
When we are depressed, we tend to see the world through dark lenses. Everything seems worse than it is, and even good memories are distorted. For example, if you felt good about yourself about something you did well, if depressed, you re-evaluate the whole situation negatively, seeing it as “not so good”, “actually I didn’t do so well”, “it was other people’s merit”…
Some unhelpful ways of thinking are:
1. Selective abstraction: you disregard the positives and only notice the negatives. For example, 3 out of 4 friends ask how you are and are interested in you, and the 4th keeps quiet. You feel that nobody cares about you and that your friends are not interested in how you feel.
2. Black and white thinking: things are either good or bad. There is no middle way. For example, you are either the best at something or a failure.
3. Personalisation: you take fault when the situation is not about you. For example, your partner says that they are tired, and you feel it’s about you, that you didn’t do your share of house chores, and he is having a go at you.
4. Labelling: you are your own bully, naming yourself in unhelpful ways. For example, “I am so stupid”, “I am such a failure”, “I am a horrible parent”…
5. Should and must: putting too much pressure when it is unnecessary. For example, “I must always prioritise my family’s needs”, “I should diet to lose weight”.
6. Mind reading: assuming that we know what others are thinking. For example, a thought that someone looked in a certain way must mean that they are avoiding us, when it may mean that they were distracted or having a bad day.
7. Emotional reasoning: I feel in a certain way, so it must mean something. It is prevalent in anxiety. Anxiety symptoms in the body are misinterpreted as “something bad is about to happen.”
8. Catastrophising: thinking that the worst is about to happen and not being able to see the most likely outcomes.
How can we challenge these thoughts?
The first step is to notice them and to reflect on how these unhelpful thoughts impact on the way we feel and the consecutive behaviour. Below is an example, the idea is to notice how the thoughts, feelings and behaviour influence each other. A wrong assumption can spiral into further negative thoughts, feelings and behaviours.
There are a few ways to challenge unhelpful thoughts
1. Is there any evidence for this thought?
2. Is there another way to interpret the situation?
3. What would you tell a friend if they recounted a similar situation?
4. What are the pros and cons of having this thought?
5. Can you problem solve?
Other strategies used in psychotherapy approaches
Journal
Write down about your day, your thoughts, and anything that comes to mind in an unstructured way. It helps to process your thoughts and worries, and if you write freely, thoughts you were unaware of may come to light, helping you make sense of the experience.
Reflect on your values and priorities
What is important for you? Is your life at the moment aligned to your values or is there anything you need to change or adjust?
What really matters to you? for example, if you say that family is the most important for you but spend 95% of your time awake working, maybe you need to change the balance.
strategies inspired from 3rd and 4th wave CBT
Apart from thought challenging, there are other ways to tackle unhelpful thoughts and consecutive negative feelings
1. Using mindfulness
The idea is to notice the thoughts for what they are: just thoughts, not reality. We have thousands of thoughts. Some are true, some are opinions, and some are just products of our minds without connection to reality. By noticing the thoughts as only thoughts, not reality, we can distance ourselves from them.
For example, rather than thinking “I am useless” and believing that, we can notice that “I had an unhelpful thought that I am stupid”; this places some distance between us and the thought and the intensity of the belief decreases.
2. Using Compassion focussed strategies
The below is an oversimplification, but the primary purpose is to develop a more compassionate self towards ourselves and others. It is beneficial, especially for people who are self-critical and prone to shame.
Some exercises we can try:
1. Building a compassionate image for ourselves
For this exercise, find a comfortable position and practise slow breathing, aiming for a calm state of mind. Think about the attributes of compassion: wise, strong, warm, understanding, and non-judgemental. Slowly create an image in your mind, someone or something wise, non-judgemental, who has an accepting attitude towards you, who you feel can accept you for who you are, even if they knew your darkest secrets.
If you are unfamiliar with using imagery, creating this image may take a few attempts. Try to have a complete picture, seeing the shape, expression, size, colours, and tone of voice. You may use the memory of someone you know who was compassionate towards you but it needs to be someone fully accepting and non-judgemental.
Play around with creating this image. After you build it, you can use it whenever you need it, when you are harsh towards yourself or feel down, unaccepted, or unloved.
2. Build a safe place
This exercise is similar in the sense that it also involves imagery. Find a comfortable position and practise slow, deep breathing. When you are relaxed, imagine a safe place where you can feel safe, calm and peaceful. Imagine the place in great detail: what does it look like? What colours can you see? What sounds can you hear? Is there anyone else around? Focus on how you feel, on sensations associated with the place, such as the sun on your face or the air breeze. Allow any body tension to melt and continue to breathe slowly. You may associate this place with a gesture or a smell to help take you back to the safe place in the future (for example, using aromatherapy while you do the practice of touching your fingers together when you reach a safe feeling)
You can recreate this imagery to bring back the feelings of safety; in consequent practices, it will be quicker.
3. Practice “maitre” (loving-kindness) – this is a Buddhist practice borrowed by CFT practitioners and in many other therapies (I also came across it in DBT)
It starts with the same breathing exercises and finding a calm inner self. When calm and safe in ourselves, we imagine a close friend or family member and repeat this in our mind or aloud: “May you be happy, may you be healthy, may you be safe, may you live with ease”. This step should be relatively straightforward as we start with someone we are close to. The next step is to practice thinking about people we are indifferent toward or the world at large. In the next step (it may be in a different session), the practice involves bringing someone we dislike or hate to mind. It helps soften strong negative feelings and brings more feelings of acceptance and commonality with the human experience.
These are just a few examples but if you want to delve more into CFT, the theoretical explanation and further exercises, here is a good resource:
Lifestyle strategies
Work on improving your sleep
I will write another post on sleep and self help for sleep, but for now, my advice is to start with following “sleep hygiene” advice.
Here is a leaflet that summarises the advice
Look after your gut
There are studies about the link between gut flora and mood; in depression, the variety of the gut flora is lower. From my search on the topic, it is not sure what came first: depression or less than optimal gut flora.
The field is growing, but the evidence suggests that better gut flora correlates with better overall health, reduced inflammation and improved immune response.
It is one of those things that, even if the effect on mood is not direct, will lead to an improvement in health, improving the way we feel.
The specialist in this field is Prof Tim Spector. I recommend you read his books or hear him talk on podcasts if you want to learn more about this.
A few suggestions to improve your gut microbiome:
-according to Prof Tim Spector, we need to aim to eat 30 different plant foods per week (it includes fruits, veggies, nuts, seeds, grains)
-there are certain foods that contain a higher quantity of useful live microbes, which are good to include in our diets: kefir, kombucha, kimchi, miso paste, sauerkraut, yogurts, cheeses (the more artisanal and less sterile the better)
-avoid antibiotics as much as possible
-aim for foods that are as natural as possible and non processed. It is very hard if not impossible to avoid processed food completely but the aim should be to eat food that your grandmother would recognise as food
-reduce sugar and fizzy drinks
-give your gut time to rest by having at least 12 hours of fast between dinner and first meal of the day
-movement, good sleep and lowering the stress levels also help the gut (and the mood and health in general; everything is interconnected in the end)
Try to keep active
I wrote about moving more as a CBT strategy above but including it here too as there are several components of physical activity that can help.
It is the movement in itself but extra benefits can be added if we join with friends or people with similar interests. Also, movement in nature is proven as more beneficial, especially in green spaces.
practice self care
Try to do something that gives you pleasure every day. This can be: a nice bath, listening to music, having a massage, or watching a good movie.
Find something that you enjoy, and it’s relatively easy to organise so that you don’t add stress to your life.
The activity can increase the sense of well-being, and it can also distract you from negative thoughts.
Find yourself a "therapy group"
Ideally, it would be part of a treatment programme but if you can’t access that yet, try to find one online.
If you are UK based, look at the Mind website, there are links to online communities. Ideally, it should be a supportive group, moderated, with a mix of people going through the same difficulties and some who managed to get better and are sharing their experience.
There are also groups online on social platforms; try it, stay only if the community is supportive and sharing useful strategies.
Summary
There are many things we can do to improve our mood. Above are a few strategies to use for self-help. The whole list may seem overwhelming, but you can start with one thing at a time, adding another one no earlier than 1-2 weeks later. Small changes add up to massive benefits in time.
references in links