Addressing Depression Through Lifestyle Change

A friend recently sent me this video by Stephen Ilardi, author of The Depression Cure: The 6-Step Program to Beat Depression without Drugs. In the 20 min TED talk, He introduces an understanding of major depressive disorder (sometimes popularly referred to as clinical depression) as distinct from the narrower subjective experience of “feeling sad.” Then he outlines his approach to a lifestyle that reverses or prevents clinical depression.

I am always skeptical of something that calls itself “The Cure.” People are endlessly variable, and treatments need to reflect that. For some, medication is a vital part of a collection of treatments that help them live a sustainable fulfilling life. Nonetheless, the basic lifestyle elements that Ilardi outlines in his video are foundational for most physical and mental health. His recommendations are:

1. Physical activity

2. Omega-3 Fatty Acids

3. Sunlight

4. Healthy sleep

5. Anti-Rumination activity

6. Social connection

Most of these recommendations are not news to most people. But many of us also fail to prioritize these elements in our lives. We are surrounded by cultural structures and messages that minimize the importance of these basic building blocks for health, and then we wonder why we feel bad when these are lacking from our lives. It’s worth watching the video for his compelling descriptions of causes of major depressive disorder and his explanation of why the items on this list are so vital. Addressing these 6 aspects of life may not be the complete depression cure for everyone, but they are certainly a good place to start.

Changing the daily patterns of our lives is never easy. For those struggling with major depressive disorder, making lifestyle changes can be particularly difficult. By definition, depression saps energy, interferes with focus, makes it difficult to motivate and follow through on desires. This is where a therapist or a supportive network of peers can be vital. Setting up a structure that requires little daily thought, and engaging others to motivate you can make a big difference. One big takeaway here is that for many people, change in behavior is needed in order to feel differently, and that it is possible and worthwhile.

If anyone has read the book or worked with his program, I’d be interested in hearing your thoughts.

On Darkness and Light, Travel and Dance

I have been traveling recently, and as I do so, I have also been struggling with a complex mix of emotions in response to tragic events around the world. It seems that the past two weeks in particular have offered little respite from news of destruction. It is important to honor all the feelings that such news can evoke, including deep sadness, anger, and fear. It is also important to attend to things that give us hope and remind us of human connection. The times when life is disrupted can also be the times when we see most clearly that which is precious in each-other. So this week, in honor of balance, travel, connection and possibility, here's Matt.

Matt is a guy who really likes to travel and to dance. His dancing is not fancy, in fact, he is the first to admit that it's pretty silly. But that didn't matter. In 2005 he made a video of himself dancing all over the world.  His enthusiasm was contagious and it quickly became a (brief) internet sensation. In 2008 he did it again, and this time he was joined by laughing, smiling, dancing crowds in 42 countries:

www.wheretheheckismatt.com/ks Back my new video on Kickstarter! 14 months in the making, 42 countries, and a cast of thousands. Thanks to everyone who danced with me.

In 2012 things got more elaborate. Matt exchanged dance moves with even more people in even more countries. His video highlights the diversity of cultures and movements around the world with a palpable delight.

www.wheretheheckismatt.com/ks Back my new video on Kickstarter! Put # and then your city and country/state in your comment so I know where you're from. #Seattle, Washington Download the video to your computer/tablet/phone: http://store.wherethehellismatt.com/ Facebook: http://tinyurl.com/9h7qzss Twitter: https://twitter.com/WhereTheHIsMatt "Trip the Light" on iTunes: http://tinyurl.com/772ot8k Vocals by Alicia Lemke of Alice and the Glass Lake www.aliceandtheglasslake.com Lyrics: www.wherethehellismatt.com/about/faq#triplyrics The dancers in Syria are blurred for their safety.

In the midst of darkness, let us remember the beauty, silliness and wonder that we humans are also capable of creating.  

Gratitude Journaling

Journaling is a popular way to organize your thoughts, get to know yourself better, and often gain new perspectives on personal dilemmas,

Journals don't have to be the classic "Dear Diary" account of your day and thoughts. There are many techniques for journaling, from careful prose to simply making lists of words or ideas associated with something on your mind.

Gratitude journaling is a quick and, often surprisingly, effective technique to help improve mood. Simply list 3-5 things you appreciate each day. This can be very basic, for example:

• My cup of coffee this morning
• The bus was on time at the end of the day
• I saw a pretty bird outside my window

Or the even more streamlined version:

• 6-26-16: Coffee, Bus, Bird.

It might seem awkward at first, but practice creates a habit of attending to moments of positive experience, regardless of what is happening in the bigger picture of life. In difficult times, this is especially important as it can break through the monolithic dark lens that distorts our perspectives. This is not about denying or repressing things that are troubling us. Rather it is a  way to actively balance out the pull that our troubles can have on our attentions. It is a way to bring nuance to our experience of life.

Make sure to pick things you really do appreciate. I may think that I should be grateful to have two working legs, but if I can't access a real feeling of appreciation about that, then it doesn't help to try to manufacture it now. Keep it simple and real.

And to make things more interesting, journals don't have to use words at all. Draw your own emoji faces, or stick figure sketches, or use abstract images and color. No technical artistic skill is required to externalize something of what you're feeling. Any journal style gives you a way to look at your thoughts and feelings in a new light, and offers a record of yourself over time.

If writing daily seems daunting, start with the commitment to write 5 things per week. All in one day, or spaced out, it doesn't matter. Just pick a concrete number of items/days to write and stick with it. If you leave the plan open-ended ("I'll just write as much as I can") then a simple meditation moment can feel like an endless chore.  By limiting your list, you also get the small and regular satisfaction of meeting a goal each week. These little moments add up to support a sense of self-efficacy and confidence.

For more thoughts on the value of cultivating gratitude, check out: https://positivepsychologyprogram.com/thanks-beneficial-effects-expressing-gratitude/

A week later

Sometimes mourning can take time to form itself into words. Click through the picture below for art created around the world in response to the Orlando Pulse nightclub shooting. From formal gallery shows to informal candles in the street, may these images of solidarity bring a measure of solace to all who grieve.

A man touches the ground next to rainbow flags during a candlelight vigil for the victims of the Pulse Nightclub shooting in Orlando, Florida, at Newtown Neighbourhood Centre on June 13, 2016 in Sydney, Australia. Photo by Daniel Munoz/Getty Images.

Caption text from The Art World Responds to the Devastating Orlando Nightclub Shooting by Sarah Cascone, Monday, June 13, 2016.

https://news.artnet.com/art-world/world-responds-to-orlando-shooting-517154

It Will Never Happen To Me: Book Review

In the past few months, I've been working with this book quite a bit. To borrow a description from the book jacket, this is a “classic on the experience and legacy of being raised in an addictive household.” As with many good resources on human psychology and health, the ideas here have resonance for more people than just the population they were originally written for and about.

Without blame or stigma, it looks at the rigid roles that kids take on to survive in many highly disrupted households, and how those roles become both strengths and vulnerabilities in adulthood. The four major roles that this book identifies are:

• The Responsible Child: The parentified child who takes care of a myriad of adult tasks and logistics. This person often learns how to work hard in many arenas at once and is frequently well organized and praised as an overachiever. Later in life they can find themselves struggling with an inability to relax, a severe need to be in control, and so much trouble listening to others that it disrupts professional and personal relationships.
• The Adjustor: The one who learns to go with the flow, no matter how outlandish it might seem. This person learns to be incredibly flexible and easygoing, often at the expense of being able to identify their own feelings and notice opportunities for agency later in life.
• The Placater: This is the family social worker who makes peace between siblings or parents when they are fighting. They might also be the person who friends turn to for emotional support in times of need. As adults they are caring and empathic, often described as warm by people they meet. They might also be the compulsive giver, who structures their life and self around the needs of others. They might be highly tolerant of inappropriate, even coercive or abusive behavior, fearing anger and valuing relational peace even over their own needs for safety, and often feeling guilty that they can never do enough.
• The Acting-Out Child: This child tells the world that something is very wrong here by breaking rules and causing disruptions in their lives and the lives of others. This person often has less denial and greater honesty about the emotional truths of the world around them. They challenge authority and can have the ability to “lead without questioning.” This person is often the most likely to get in trouble with the system in which they live, to be identified as a “problem” and to struggle with low self-esteem.

The book goes on to talk about some of rules-for-living that are taught within the family, often without ever being explicitly spoken. These include “don’t talk, don’t trust, and don’t feel.” These ideas can be so fundamental that people continue to act on them without realizing there’s any choice there. It can be freeing to see that these are really learned constructions, and that other ideas might serve you better now.

Towards the end of the book there are a series of exercises to help readers identify their learned assumptions about people and relationships, consider new perspectives, and integrate those perspectives into their daily lives.

The book is filled with anecdotes and written in easy day-to-day language. Those anecdotes can be intense! At times, I found it overstimulating. I would find my eyes glazing over and my mind wandering- not because I was bored, but because what I just read was giving me so much to think about, and to feel. I found it best to read about a half chapter to a chapter at a time, in the afternoon rather than before bed. Pay attention to your own energy and attention while reading, and pace yourself accordingly. It’s also good to have people to talk with if this brings up intense thoughts, feelings, or memories.

Headspace

This is a glossy mindfulness tool with a catchy sales pitch.  It's available as an app and website, mostly accessible only with a paid subscription. If you sign up, the app has a lot of features such as timers, reminders, ways to connect with other subscribers, and animated videos about different concepts relating to the practice of mindfulness.

While the subscription costs less than a video service like Netflix, I am interested in resources that have no financial barrier, so I focus on the free portions of the site here. The app includes a free 10 day intro course for people who have never tried any mindfulness meditation, and the website offers prodigious blog entries about developing a regular practice, integrating mindfulness into your life, and conquering common challenges.

I really liked the the 10 day course. Andy Puddicomb, the Headspace designer and teacher, has a soothing voice and good pace. The first video gently offers recommendations for setting the stage if you're new to meditation. This includes starting in a quiet space and suggesting a consistent morning practice.  At the same time it encourages flexibility and persistence. Andy was encouraging after the first day and I definitely wanted to come back for more on day 2. 

I enjoyed the course throughout. Since then, I've returned to listen to several chapters again. For new meditators or experienced ones who just want a sitting companion for 10 days, I recommend the free portion of this service. If you do try it, with or without the subscription, I'd love to hear your take.

Memorial Day

Photo by Tim Pierce

Arts are one of the most ancient and powerful resources we have for healing. Around the world, stories and poetry, images and music, provide the frameworks through which we make meaning out of loss and come to understand the day-to-day of our lives. So in honor of Memorial Day, I offer one of my favorite poems, about losing, living, and remembering:

WHAT THE LIVING DO
by Marie Howe

Johnny, the kitchen sink has been clogged for days, some utensil probably fell down there.
And the Drano won't work but smells dangerous, and the crusty dishes have piled up

 waiting for the plumber I still haven't called. This is the everyday we spoke of.
It's winter again: the sky's a deep, headstrong blue, and the sunlight pours through

the open living-room windows because the heat's on too high in here and I can't turn it off.
For weeks now, driving, or dropping a bag of groceries in the street, the bag breaking,

I've been thinking: This is what the living do. And yesterday, hurrying along those
wobbly bricks in the Cambridge sidewalk, spilling my coffee down my wrist and sleeve,

I thought it again, and again later, when buying a hairbrush: This is it.
Parking. Slamming the car door shut in the cold. What you called that yearning.

What you finally gave up. We want the spring to come and the winter to pass. We want
whoever to call or not call, a letter, a kiss--we want more and more and then more of it.

But there are moments, walking, when I catch a glimpse of myself in the window glass,
say, the window of the corner video store, and I'm gripped by a cherishing so deep

for my own blowing hair, chapped face, and unbuttoned coat that I'm speechless:
I am living. I remember you.

Herbs for Psychological First Aid- and Onward

This friendly presentation by Katja Swift goes beyond its title. It provides a rich perspective on how traumatic events can stick with people in particularly disruptive ways, and how we can prevent and heal those disruptions. The extensive list of herbs are good for people struggling with traumatic events, and for those who are in the role of helping with that recovery. Even if you’re not planning to try any of the recommended herbs, her introduction and descriptions provide food for thought about how we understand both trauma and recovery.

In particular, I love Katja’s introduction about the role of stories in our lives. She situates the notion of healing in the idea that our narratives about our lives are vitally important.  It’s hard to overstate the power of the ways that we describe our experiences to ourselves and others.

Then she’s got great info on the brain, including an accessible description of the role of the hippocampus and cortisol in people’s responses to traumatic events.

This video comes from the Commonwealth Center for Holistic Herbalism, which is a great resource for more info on herbalism and health generally, including videos, blog posts, workshops and periodic free clinics.

The vimeo stream got stuck occasionally when I was watching. If that happens to you, just skip ahead a second and it will continue from there.

Calm

Like the sounds and sights of the natural world? check out  https://www.calm.com/  There's also an app version you can download and carry with you.

Simple and pretty. The app has about 5 videos of nature, such as the ocean, or leaves in the rain, where a still camera sits much like a window to look out of onto the calm world of your choosing.  There's also a longer collection of free soundtracks without videos (such as crickets chirping). The website has more videos than the app, and it can play in the background while you do things in other tabs.

These resources can be a great way to take a 5 minute breather before a stressful phone call, or provide a soothing background before sleep. If you are using it at night, stick with just the sound and skip the screen. Computers and phones give off a blue-tinged light that wakes your body up, no matter what's happening on the screen.

If you want to be more active with it, the app has meditation timers and trackers too. There features are more robust with a subscription, and then you get access to a variety of guided meditations. I didn't subscribe so I can't tell you about those. I'd love to hear your thoughts if you are using that service. 

Recordings are no replacement for actual nature! A 5 minute walk can work wonders for your day and, on a regular basis, for overall mental health. But the best resources are the ones you'll really use. So consider this an additional way of finding a moment's peace and focusing, (or gently un-focusing) the mind, not a substitute for what's outside your door.

Grounding

Diagram from www.socialwork.career

Today's resource is a classic grounding exercise. It's a short-term, in-the-moment, I-need-something-NOW tool that can be incredibly empowering for people suffering from panic attacks and flashbacks.

Use this when you start to feel your anxiety rising, when your thoughts are starting to spin, when you're getting overwhelmed and need to get a break from your own head.  It works, if you practice regularly so it's easy to remember when you need it. I recommend trying it at random moments throughout the day when you are relaxed so you associate the practice with relaxation. Build it into your routine so it's familiar.

This version uses 4 senses, and encourages people to breathe 3 times. Find out if this feels good for you, and adjust. Maybe you want to breathe deeply between each sense. Maybe you want to breathe 2 times to start, then add more as you begin to relax.

Some people use just one sense, such as sight. When focusing on vision, try noticing color as a way to focus. For example, I see: a purple wall (breathe), green tree (breathe), grey sidewalk(breathe...) etc.

Another version is "5, 4, 3, 2, 1." This uses the senses in order of what's easiest for most people. In this variation, name 5 things you can see, 4 things you can hear, 3 things you can touch (even as simple as noticing your shirt sleeve against your arm), 2 things you can smell (if any), and lastly, notice if there is one thing you can taste- even if it is the aftertaste of coffee from this morning. Breathe deeply once or twice between each sense.  

This is a simple way to pull yourself out of racing thoughts, to give your nervous system a moment to calm down and give yourself a chance to redirect your attention or activities, or take yourself someplace else that is less overwhelming for a break.

Techniques like this are not a cure-all, but they are a handy addition to one's tool box. Realizing that we can have some control over experiences that seem to just take us over can profoundly change our relationship with those experiences. This can offer freedom from the secondary anxiety that arises about the possibility of becoming anxious. If you struggle with anxiety, remember you don't have to do it alone. Talk to a therapist, reach out to friends, even check out online forums. Wherever you feel comfortable starting, I encourage you to share your experience with others, and explore. In the meantime, pick a sense or a couple senses that you can notice. Pick a number of deep breaths to combine with that noticing, and practice.

On Errors & Compassion

I missed a week! Family was visiting, things got hectic. So I'm seizing this opportunity to use the blog as an example of bringing compassion to ourselves when we stumble in the pursuit of goal.

We inevitably have setbacks when practicing things we are not already good at, or when building new habits. One of the hardest parts of change is being willing to show ourselves compassion while continuing to strive. How do we respond when we feel that we've let ourselves down, on small things or big ones? These moments are good opportunities to observe our own habits.

Notice the way you talk to yourself when you feel you've made a mistake. Do you fly into a flurry of self-recrimination? Do you over-achieve to make up for errors, setting unattainable tasks that end up that pushing you further from your original plans? Do you distract yourself to avoid the feelings? Do you start apologizing to everyone, letting down healthy boundaries? Or do you become more critical of others, turning ill-feeling outward? Do you hide? 

Every time we observe our own habits, we can gain insight into our deepest values, fears, and motivations. We can also see if our behaviors are helping us reach our goals.

For example, when I realized I'd missed my weekly entry, first I thought, I'll make two entries to make up for it. Then I started procrastinating, avoiding the feeling of failure, and the resulting challenge I'd given myself. Then I took a moment to reflect and realized that my actions were coming from a place of shame, which didn't leave me feeling good about the project or myself. 

What happens when I remember that this project is about connecting compassionately with myself and others? My perspective shifts, and I see new opportunities for action that I hadn't considered before. Instead of hiding from what felt like an error, I realize that talking about mistakes is a wonderful opportunity for real connection. We all stumble. These are precisely the moments when we lean into resources (the general theme of this blog), internal and external, to keep going on the paths we want to walk. When we pause to take a breath, to talk with a friend, or meditate, or take a walk, we can make a little space for compassion. What felt like a loss becomes a part of the process.  

When we allow ourselves to make mistakes, we are freed from fear of failure.  Instead we find moments of great learning, even in the most unlikely corners. The more we practice this process, the better we get at it.

Along these lines, I offer one of my favorite poems, by Mary Oliver. For me, this is a reminder to let go of perfectionism and invite compassion in its place. And so I offer that to you. You are enough. Keep going.

"WILD GEESE"
by Mary Oliver

You do not have to be good.
You do not have to walk on your knees
For a hundred miles through the desert, repenting.
You only have to let the soft animal of your body
love what it loves.
Tell me about your despair, yours, and I will tell you mine.
Meanwhile the world goes on.
Meanwhile the sun and the clear pebbles of the rain
are moving across the landscapes,
over the prairies and the deep trees,
the mountains and the rivers.
Meanwhile the wild geese, high in the clean blue air,
are heading home again.
Whoever you are, no matter how lonely,
the world offers itself to your imagination,
calls to you like the wild geese, harsh and exciting --
over and over announcing your place
in the family of things.

Stressballs!

Photo and tutorial (click through for link) by Chastity at Pearls and Mason Jars

Not just a good exclamation when you're angry, these are a simple fidget toys you can make yourself. Click on the pic above to go to a great tutorial on the blog Pearls and Mason Jars.

Grab a pack of balloons, some sandwich bags, scissors, and filler- I like sweet rice, lentils, or playdough to fill mine. A lot of people use flour which can work well but can also get messy to make, or if they break later. There are a million tutorials online for different versions of these. Here's a good video for a slightly more complicated flour version. I like this because it shows how you can make polka dot patterns by cutting up the outside balloon:

This video shows you how to use plastic bottles funnels to fill a balloon with flour, then put other balloons around it to keep the flour in and make it stronger. This will make your squishiest, most moldable version of the ball. However, it's simpler to fill a sandwich bag with the flour and twist it closed first, before dealing with the balloons. Pulling a balloon around that is easier to manipulate and also less messy if you screw up. The blog that's linked in the first pic shows this version.

I've made them this way with groups and individuals. People have taken the idea home and made them with the whole family. They're good to squeeze and mold if you're anxious, bored, or irritated. They're fun for juggling practice too.

Insight Timer

It's a timer! And it's my favorite! Simple and easy to use. These are big priorities for me. This one has beautiful recordings of  singing bowls to start and end your meditations. It's much gentler than your phone alarm or kitchen timer.

Timers are oft-unmentioned yet important tools for meditation, especially for beginners. The app has grown to be more than just a timer though. It has a collection of guided meditations and mindfulness instruction. There is a meditation log for tracking sittings and a journal option to jot notes. There is a message board for questions and a robust international community interacting there. The newest version also offers soothing ambient background sounds such as rain falling.

I  frequently recommended this beginners and established meditators, and have heard great feedback from people enjoying it and then passing it along to friends. If you're new, try starting with a simple 5 min per day. If you're struggling to stay motivated, try switching between different guided meditations and your own quiet sitting.

Check it out at https://insighttimer.com/

iChill

www.ichillapp.com

Don't let appearances fool you, the content is strong with this one! ichillapp.com could be so easy to overlook. It's just a few pages of white text on a black background, organized behind big green buttons. It's developed by the Trauma Research Institute, and offers core concepts for getting in touch with your own natural rhythms and staying resilient in the face of life's ups and downs. It's written in plain English and is easy to use.  

There's an app and a web version, virtually identical although the app has optional audio so you don't have to read it yourself. This simple feature makes it much more useful for people really trying to work on these skills at home. Make sure all other audio apps are completely closed for the audio to play. The app version also has a mood/anxiety assessment tool that's not on the web, but is easy to recreate with pen and paper.

To expand it's usefulness, I copied the text off the web into a word document that I could print out and give to clients who don't use tech at all. I also helped a client download the app during session to use at home. We're using it as a way to structure our work for a few weeks, going through one section at a time. I really love how simple it is, and even find its 1990's graphics charming. It's free and easy, bite-sized education. 

Welcome to the Blog!

Welcome to my new endeavor! Each week for the rest of 2016 I'll be posting one resource for therapists and people on their own paths of change. This might include apps, websites, books, art activities, and even images and poems that I or my clients find inspiring. I'll try to write a few brief thoughts with each post. My first resource is an inspiring collection of photos-- mostly landscapes and travel:  http://travelcoffeebook.com/ *

Take a mental mini-vacation by flipping through the site. Download your favorites, or screen-cap them to your phone to look at when you're stressed. Try taking a couple of deep breaths with your favorite scenery before that tough phone call or meeting. I posted one I like above. Post a link to your own favorite image, or comment and let us know how you use these. Enjoy!

*Thanks go to graphic designer Tessa Magnusun for this link!

*** Edit on 3/29/16 As I work on my second post, it occurs to me to add a more personal note here about this project. Blogging is something I was once convincedI'd never do. I generally find writing intimidating. I edit every word over and over while I'm trying to complete each sentence. I angst over possible misinterpretations. But I realized that there are a bunch of cool little tools and fun pieces of art that I'd like to share, and so I'm taking on the challenge of facing the critical voices in my head. At the moment, with some coffee and an almost bright day outside, I'm excited about the chance to declare something complete each week, regardless of how done I think it is. I'm hoping this will be a chance to not only share resources, but also change the conversations I have with myself, and perhaps inspire others to do the same.