Across the spectrum, mental health problems seem to be on the rise. One-quarter of Americans reported moderate to severe depression this summer and another quarter said they suffered from mild depression, a recent study reported. These findings are similar to surveys done by the Census Bureau and the Centers for Disease Control and Prevention.
A third of Americans now show signs of clinical anxiety or depression, the Census Bureau finds.
Former first lady Michelle Obama highlighted the problem for many when she said in August that she has been dealing with “low-grade depression.”
As a psychologist, I hear almost daily how the combination of coronavirus, racial unrest, economic uncertainty and political crisis are leading many people to feel a lot worse than usual.
“It is not at all surprising that we are seeing the significant increase in distress. It’s a normal reaction to an abnormal situation,” said Judy Beck, president of the Beck Institute for Cognitive Behavior Therapy in Philadelphia and author of the widely used mental health textbook “Cognitive Behavior Therapy: Basics and Beyond.”
But an important difference exists between having depressive symptoms – such as sadness, fatigue and loss of motivation – and a full-blown major depressive episode that can affect your ability to function at work and home for weeks or months. The amount and duration of the symptoms, as well as the degree to which they impair one’s life all play a role in diagnosing clinical depression. Extensive research suggests that certain ways of thinking and behaving can hasten the plunge into clinical depression, while others can prevent it.
As we head into winter, which can stress the coping skills of many people, here are some strategies that can help you resist the depressive downward spiral.
1. Reduce overthinking.
When we feel down, we tend to think about the bad things repeatedly, often trying to figure out why they’ve happened. Research shows that some people are especially prone to this kind of “depressive rumination.” They overanalyze everything, hoping to think their way out of feeling bad, and fret about consequences of their sadness.
“Unfortunately, the rumination only magnifies the depressed mood. It takes normal feelings of sadness and turbocharges them,” said Edward Watkins, professor of experimental and applied clinical psychology at the University of Exeter in England. When we ruminate, we tend to think again and again about a negative past in general, global terms. To decrease rumination, Watkins suggests focusing on discrete and concrete details of troublesome events, answering, “How did this happen?” and “What exactly can I do about it?”
It can also be useful to identify common rumination triggers – such as being tired or tense – and come up in advance with engaging alternatives such as videoconferencing a friend or reading a page turner.
Finally, “it always helps to focus on someone else instead of yourself,” Beck said. Helping a relative or volunteering for a cause might do the trick.
2. Move around and socialize, even if you don’t feel like it.
Often, the last thing people want to do when they’re feeling down is to get active. My patients often describe a strong pull to stay in bed with the covers over their head. But restricting movement and engagement with others worsens mood and potentially spurs more severe depression. Conversely, action, especially focused on something that’s important to you, can reduce depression. If, for instance, your spirituality includes connecting with nature, planting some flower bulbs or taking a hike is bound to have a significant impact.
But how do we jolt ourselves out of inaction? “Don’t wait to feel like going for a walk or to be in the right mind-set to call a friend. Do it just because you deemed it important enough to put it on a calendar,” said Zindel Segal, distinguished professor of psychology in mood disorders at the University of Toronto.
If that seems like too much, break down an action into smaller parts and do just the first step, such as dressing up to go out (but staying home).
A patient of mine once remarked that this sounded “pathetic.” But for many people, taking that first small step works, as Christopher Martell, a director of Psychological Services Center and a lecturer at the University of Massachusetts at Amherst, put it: “Applaud yourself for engaging in one meaningful behavior at a time, however small.”
3. Increase self-compassion.
Depressed feelings are often intertwined with self-judgment. Studies find that self-criticism and perfectionism provide strong fuel for depression.
Self-compassion is an alternative.
Kristin Neff, an associate professor of educational psychology at the University of Texas and author of “Self-Compassion: The Proven Power of Being Kind to Yourself,” defines it as treating yourself with the same kindness, warmth and support as you would treat people you care about. “You need to first acknowledge your [sad] feelings and be open to them, then direct understanding and care toward yourself, and finally realize suffering is a part of shared human experience,” she said. So being a part of, for example, a support group or an Internet mailing list where people struggle with similar problems can be validating and helpful.
Notice when you start slipping into a self-critical mode and replace it with a self-compassionate voice by channeling what you would say to someone who is dear to you.
“Even the tone of your silent or spoken voice matters – the gentler the better,” Watkins said.
You also can write a self-compassionate letter to yourself – as you might to a friend – and read it whenever you are feeling down. Putting your hand on your heart, cradling your face with both hands or gently stroking your arms can be powerfully comforting, too.
4. Sideline thoughts of helplessness and hopelessness.
It’s common to feel frustrated and sad when we can’t control bad things.
This is especially true in the middle of a frightening pandemic that is both medically and economically threatening. A client recently told me, “I can see our country hurtling toward destruction, and I am completely powerless to stop it.” This sense of helplessness is often accompanied by a loss of hope for a better future. Psychologist Lauren Alloy’s decades-long research at Temple University has shown that hopelessness is a strong contributor to worsening depression.
Beck recommended asking yourself what you can do despite the situation, and then creating a plan to put it into action. Even small accomplishments – such as making phone calls for an hour on behalf of a political candidate – can reduce your sense of pervasive helplessness.
To counter hopeless thinking, try vividly imagining positive actions you could take or good things happening. Practice creating scenes in your mind that include all your senses. Such mental imagery has shown promise in lifting depressed mood.
Another way to disarm these thoughts is watch them pass by in your mind’s eye, as if they were leaves in a stream or drifting clouds. You may realize that this allows you to distance yourself from the thoughts and focus on something more helpful in the present moment.
5. Notice when you feel well, and build on that.
Even during low times, people occasionally experience moments of positive mood. It can be as fleeting as the first bite of a crisp apple or more substantial, such as the feeling of awe at a valley awash in golden foliage.
Savoring these positive moments – by slowing down, focusing on the experience of our five senses, taking a mental or phone photo, sharing your emotions with others – leads to the activation of brain regions known to reduce depression, studies have found.
Later, “you can reminisce with others, reviewing in detail the positive moments and cherishing uplifting photos,” Beck said. “That way, the good mood can be recalled in a deliberate fashion.”
These strategies have been shown to help people keep their low moods from overwhelming them or turning into a major depression. But if your depression worsens and interferes with your life, you should seek professional help that might include psychotherapy, medication or both.
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Kecmanovic is a founding director of the Arlington/DC Behavior Therapy Institute and an adjunct professor of psychology at Georgetown University.