How To Defeat Depression

I spend my days teaching clients how to use skills … to reduce tough symptoms of depression. One day, one of those same clients taught me a valuable lesson — it’s not about the individual skills, it’s about what they can do in combination.

A mighty oak will not fall in one swing of the ax; a formidable foe will not fall after a single punch; a powerful army will not raise the white flag after one shot fired; and a chess master will not resign after the very first move. In that same regard, depression will not be quelled following a single application of a therapeutic intervention – not a fact I like very much, but a fact nonetheless.

As a therapist who specializes in treating intense and unrelenting depression and anxiety often associated with chronic mental illness and personality disorders, I spend my days teaching clients how to use skills like deep breathing, distraction, positive activity scheduling, thought restructuring, and mindfulness to reduce tough symptoms of depression. One day, one of those same clients taught me a valuable lesson — it’s not about the individual skills, it’s about what they can do in combination.

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Dysregulation in the Workplace: An HR Nightmare

Working together, we developed a plan, based largely on Dialectical Behavior Therapy (DBT) strategies we therapists use when working with self-destructive clients. DBT lends itself to the needs of HR departments because it is behaviorally based and translates well into policies and protocols.

As a therapist specializing in the treatment of patients with Borderline Personality Disorder, it is not uncommon to get phone calls from frustrated friends, perturbed partners, exhausted parents, and discouraged roommates of my clients. I even get those calls from my own friends and family who have found themselves in a confounding situation with a neighbor or co-worker who seems to be suffering from features of the disorder (i.e. big fluctuations in mood, angry outbursts, extreme evaluations of others, dangerous and impulsive behaviors, etc).

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Changing Negative Thoughts

Your thoughts are just thoughts. They have no meaning other than the meaning you give to them. You are not the sum of your thoughts. Your thoughts do not define who you are. They are fleeting, here one moment, gone the next. They are neither good nor bad.

Depression debilitates. It saps your energy, erodes your confidence and leaves you in a mental haze that makes it impossible to do the things you once took for granted.   You become a prisoner to your racing thoughts and lose interest in the people and activities that used to satisfy you.  It’s hard to pick up one foot and put it in front of the other.  Just getting out of bed can be overwhelming.  Taking a shower and going to work can become impossible.  Even mindless TV doesn’t hold your interest.  The thoughts just won’t let you go.  You beat yourself up for not being able to do the things you once did with ease.  You ruminate about conversations that happened decades ago and what you should have said.  You can’t let go of the question, “what if this never ends?”  Life just doesn’t seem worth living.

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DBT for High Conflict Couples

Mary and John have had the same predictable fight week after week for almost five years. They have it down to who says what when. They both could benefit from DBT.

Imagine — Mary and her husband, John, have the same predictable fight week after week. John cheated on Mary five years ago and she can’t let it go.  When John is late getting home from work, which happens frequently, she obsesses he’s having another affair and is going to leave her.  By the time he gets home, she is so worked up she accuses him of cheating and threatens suicide if he leaves.  He dreads walking in the door because he knows what’s coming.  By the time he pulls in the driveway, he’s just as worked up as she is.  According to script, he rages while she cries and begs and throws things. He starts drinking and she goes to the bathroom to cut away the pain with a razor blade.  The next morning, she apologizes and he goes about his business silent and hung over.  She calls him six times over the course of the day to apologize.  He refuses her calls.  In between calls, she beats herself up for what happened.  She can’t let go of the thought that he is going to leave and it will be her fault. 

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Storytelling: Changing the Narrative

Our memories of past events come from “narrative truth,” rather than “historical truth.” We remember the stories we tell ourselves about what happened, not what actually happened.

A couple of blogs ago, I talked about the five options our clients (and we) have when confronted with a problem. We can:

  • Solve the problem in whole or part
  • Change the way we think and feel about it
  • Radically accept it
  • Make ourselves miserable
  • Make the situation worse

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Mindfulness Across Spiritual Traditions

I have started explaining mindfulness and meditation to some clients in the context of their own spiritual tradition, when appropriate. The key words here are “some clients” and “when appropriate.” Careful assessment is needed ….

As therapists, whether we are using DBT, MBSR, ACT, MBCT, MBRE or another mindfulness-based approach, most often we tell clients mindfulness evolved out of Eastern spiritual traditions when we introduce it.  We take care to explain that the benefits of mindfulness are documented with hard science[i] and mindfulness will be presented based on the science stripped of its spiritual roots.

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When A Client Says – “It’s So Unfair!”

Radical acceptance is not easy. Getting hit by a drunk driver is not fair. Mental illness is not fair. Experiencing trauma is not fair. But only our clients can solve the problems that result.

Mature man with depressed look

Clients come to me with mental illness or a history of trauma. Most of my clients have both.  New clients often will say “it’s so unfair.”  What they really are saying is “I shouldn’t have to deal with this.  I don’t want to be here.  Why me?  Why now?”  My response is always the same.  “You may not have caused the problem but you are the only one who can solve it.”

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