Depression is different from other illnesses in that, in addition to the physiological symptoms (loss of appetite, nervousness, sleeplessness, fatigue), there are the accompanying thoughts that can be so incredibly painful. For example, when my Raynaud’s flares up, the numbness in my fingers can be uncomfortable, but it doesn’t tell me that I am worthless, pathetic, and that things will never ever get better. During severe depressive episodes, however, these thoughts can be life-threatening: They insist that the only way out of the pain is to leave this world.
Being able to manage our thought stream will direct us toward health, as our thoughts are constantly communicating with the various systems of our body, either sending certain glands or organs an SOS in distress, or a note that everything is fine, resulting in calm. But being able to harness this craziness in the midst of depression and anxiety is so very difficult.
Here are some of the ways I try to let go of the thoughts that cause depression and anxiety. Some days I am much more successful than others.
Identify the Distortions
I have benefited immensely from David Burns’ book Feeling Good: The New Mood Therapy — from doing the cognitive behavioral therapy exercises he prescribes to identifying the various distortions in my own thinking that he presents in his book and his workbook. They include:
All-or-nothing thinking You look at things in absolute, black-and-white categories.
Overgeneralization You view a negative event as a never-ending pattern of defeat.
Mental filter You dwell on the negatives and ignore the positives.
Discounting the positives You insist that your accomplishments or positive qualities don’t count (my college diploma was a stroke of luck … really, it was).
Jumping to conclusions You conclude things are bad without any definite evidence. These include mind reading (assuming that people are reacting negatively to you) and fortune telling (predicting that things will turn out badly).
Magnification or minimization You blow things way out of proportion or you shrink their importance.
Emotional reasoning You reason from how you feel: “I feel like an idiot, so I must be one.”
“Should” statements You criticize yourself or other people with “shoulds,” “shouldn’ts,” “musts,” “oughts,” and “have-tos.”
Labeling Instead of saying, “I made a mistake,” you tell yourself, “I’m a jerk” or “I’m a loser.”
Blame You blame yourself for something you weren’t entirely responsible for, or you blame other people and overlook ways that you contributed to a problem.
It doesn’t take long to identify one or more of these in your thinking. Just recognizing these traps can be helpful. You might then try one of the methods listed in Burns’ 15 Ways to Untwist Your Thinking. A warning, though: I’d wait until you have emerged from a severe depressive episode before you attempt some of these exercises. I’ve made the mistake of trying too hard to “fix” my thinking during severe depression, which has made it worse. It’s better to focus on the other ways listed below.
Focus on the Present
Although every self-help book I read touches on this, I am just beginning to really learn what it means to focus on the present and to appreciate the healing power of mindfulness, which, according to meditation teacher and bestselling author Jon Kabat-Zinn, is “paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally.” If we continue to practice this, he explains, “this kind of attention nurtures greater awareness, clarity, and acceptance of the present-moment reality.” It’s not that we don’t feel the hurt, rage, and sadness that lives at the surface of our minds. It’s not an attempt to escape all the suffering that is there. But if we can observe all of our projections into the past and future — and all of the judgments that are part of our thought stream — and simply get back to what is happening right now, right here, we can allow a little room between our thoughts and our reality. With some awareness, we can begin to detach from the stories that we spin and from the commentaries that are so often feeding our pain.
One of the best ways we stay present is by keeping our attention on our breath. Vietnamese Zen Buddhist Thich Nhat Hanh instructs us that with each in-breath, we might say, “Breathing in, I know that I am breathing in.” And with each out-breath, “Breathing out, I know I am breathing out.” In his book You Are Here, he explains that mindful breathing is a kind of bridge that brings the body and the mind together. We start by this simple gesture of watching our breath, and then by this mindfulness of breath we begin to stich the body and mind together and generate a calm that will penetrate both.
“Self-compassion doesn’t eradicate pain or negative experiences,” Kristin Neff, PhD, explains in her book Self-Compassion. “It just embraces them with kindness and gives them space to transform on their own.” It gives us the “calm courage needed to face our unwanted emotions head-on.” When I’m in the most pain — especially during a severe depressive episode — it is self-compassion more than anything else (cognitive behavioral therapy techniques, mindful breathing, etc.) that saves me and restores me to sanity. Nhat Hanh says that we should treat our depression tenderly, as we would treat a child. He writes:
If you feel irritation or depression or despair, recognize their presence and practice this mantra: “Dear one, I am here for you.” You should talk to your depression or your anger just as you would to a child. You embrace it tenderly with the energy of mindfulness and say, “Dear one, I know you are there, and I am going to take care of you,” just as you would with your crying baby.
It is so easy to be so cruel to ourselves without even realizing it. The ruminations that are part of depression beat us down and shred us until there is practically nothing there. That’s why it is so critical to apply self-compassion from the start, and treat ourselves, as well as our depression, as the scared little child that needs comforting, not scorn.
Acknowledge the Transience of Things
One of my favorite prayers is St. Teresa of Avila’s “Bookmark” that says:
Let nothing disturb you,
Let nothing frighten you,
All things are passing;
God only is changeless.
Patience gains all things.
Who has God wants nothing.
God alone suffices.
If the religious language bothers you, Eckhart Tolle says much the same when he writes in A New Earth:
Once you see and accept the transience of all things and the inevitability of change, you can enjoy the pleasures of the world while they last without fear of loss or anxiety about the future. When you are detached, you gain a higher vantage point from which to view the event in your life instead of being trapped inside them.
Absolutely everything, especially our feelings and emotions, is impermanent. By simply remembering that nothing ever stays, I am freed from the suffocating thoughts of my depression — the formidable fear that this sadness will always be with me, as well as the circumstances that are causing it. By acknowledging the transience of life, I am again called to pay attention to the present moment, where there is more peace and calm than I think.
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Published originally on Sanity Break.
Beautiful, Therese, just beautiful. As always you have an uncanny knack for writing exactly what I need to hear exactly when I need to hear it. Thank you.
Therese, thank you for your beautiful words and sharing what I need to hear. Some of the things you quoted will become my daily readings. Thank you.
You are so much appreciated. I have suffered with this illness for years. Finally went for some therapy. I now know why I am having these terrible thoughts. You are helping a lot.
I am embracing the transience of depression as it helps me to let it go more and realize it won’t last forever even though it feels that way sometimes.
Thank you for acknowledging that not all of live life on religious terms, but we can find comfort in non-spiritual ways and words.
I love your blog and your help with depression. I have had situational depression episodes all my life and am having a big one this year and have been struggling. This post really hit home!!! Thank you!!!
Therese, I do love your writing and am rooting for you on your journey, and thank you for sharing your experiences. Your level of insight, reflection, and desire to intellectually devour all the materials at hand resonate with me. I’m sorry you have been treatment resistant for so long. I once had a friend from one of the big yoga/healing retreat centers listen to my story of depression, mid life crisis, and therapy. “My therapist is ok” I told her. She said “ok isn’t good enough … you should be blown away and utterly amazed after therapy sessions. When will you stop the self denial and get rid of treatment that isn’t absolutely working for you?” And she added “you already are so much in your head … why don’t you consider somatic experience therapy?” And this was the suggestion that changed my life. Every session I was blown away. I can feel my brain healing and rewiring itself. I haven’t seen you mention Peter Levine, Diana Fosha, or Bessel Van Der Kolk. I’m curious if you have an opinion on the trauma model of adverse childhood experiences and the belief that somatic work can heal the brain? I don’t mean to be presumptuous to suggest yet another modality to you when you have tried so much. But I’d be curious to hear your reaction to it if it is something you have tried. Some of this work on the autonomic nervous system is accessed through mindfulness and meditation, but the belief is that somatic therapy doesn’t just calm the brain, it rewires the brain. I personally believe it!
Nice post. The one thing I never understood was the whole “stay in the present” stuff that is always mentioned everywhere and by therapists. My mind tends to project into the future as a result of the horrible way I feel in the present moment. Like if I felt totally normal like myself before getting this–I wouldn’t even be thinking about the future in the first place!
Also never understood the cbt feeling good method either. Mainly because often times it seems like the way I feel creates the negative thinking and not the other way around. And then the thought itself will be about the the mood itself and how long it is going to last.
Though my depression started out with an adverse reaction to a medication that seemed to have change my body chemistry in ways that are currently unknown. So maybe that makes a difference when it comes to these techniques. Or stress management even–my first thought when a therapist tells me to manage stress is that at one point in my life I didn’t have to since my body worked! So I start getting depressed because I am depressed, etc…
Therese you are truly an angel and a gift to me. I only just discovered you and your writing thirty minutes ago and for the first time in two weeks, I feel somewhat at ease. I have struggled with depression for years and it was recently triggered. I will continue to read your articles to help me through this very difficult time. Thank you.
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Feels good to read the full article, but it would be great if you can quote some thoughts and impressions of real life victim of a depressed person who can share their own thoughts and real life experience.
I just discovered you last night while looking for the effects of nutrition on depression. I bought all the 10 foods on your list today and threw out my bread and cookies. Even though it is day one for changing what I eat, I already feel much better. Thank you for sharing so many helpful things about depression. I have had many bouts of depression over the last 10 years and one bout lasted for a year and a half. It was the most awful experience of my life and I truly thought I would never get well.
The ECT therapy brought me out of for which I am so thankful to God. For me, the worst part of depression is not being able to sense the presence of God and the peace that His presence brings. I feel like my prayers hit the ceiling and I can not read the Bible because it makes me feel worse. I have had to cognitively believe that God is with me as He promises even though I feel abandoned. I think that is a type of faith that God appreciates greatly. That comforts me in the really bad times. Every article of yours that I read tonight is so helpful and encouraging. I thank you with all my heart for the time and effort you put into sharing. God bless you richly! By the way we added prickly pear cactus to your greens list. I live in Mexico and we put that in our green juice and it is delicious and full of fiber and nutrients and we eat papaya as well.