Can anything be done? Understanding Depression and How to Overcome It

Overview Can anything be done? Understanding Depression and How to Overcome It Dr. Michelle Haring, R. Psych Director, NSSAC What is depression? How do I know if I am depressed? Why do people get depressed? How is depression treated? What is cognitive-behavioural therapy (CBT) and how does it work? What are some ways that I can apply CBT skills in my own life? How can I help a loved one with depression? What is Depression? Approx. 1 in 8 Canadians (12.2%) will experience a major depression at some point in their life Approx 2x as many women as men will experience depression At any given point in time, 5% of Canadians will be experiencing a major depression Approx. 9000 people on the North Shore are currently depressed Canada s fastest rising diagnosis, with diagnosis rates likely to increase dramatically in next few years Common Signs & Symptoms of Depression Feeling depressed, low, sad or empty most of the day, nearly every day Loss of interest or pleasure Loss of motivation Significant changes in weight or appetite Sleep problems & other physical concerns Feeling restless or feeling slowed down Low energy/fatigue Feeling worthless, guilty or like a failure Common Signs & Symptoms of Depression Social withdrawal Irritability Decreased sex drive Tearfulness/crying Problems with concentration, memory, decision-making Thoughts of death These problems are upsetting or interfere with your ability to work, take care of things at home, get along with other people, etc. People with depression often have other problems such as anxiety or health issues Risk Factors for Depression Family or personal history of major depression and/or substance abuse Recent loss (e.g., death of loved one or divorce) Chronic health problems/pain Stressful life events (interpersonal conflict, work stress) Traumatic events Major life changes (e.g., having a baby, moving to a new city, new job) Domestic abuse or violence Other chronic stressors: unemployment, low income,etc Dr. Michelle Haring 2015 1

A Model of Low Mood & Depression SITUATION How is depression treated? Depression can be treated effectively Physical Symptoms Thoughts Emotions Behaviours Evidence-based treatments include: Pharmacotherapy (medication) Psychological treatment Cognitive-behavioural therapy (CBT) Interpersonal psychotherapy (IPT) How is depression treated? The BAD NEWS: too few people are receiving effective treatment Stigma & secrecy Symptoms are overlooked or misdiagnosed by health professionals Cost The GOOD NEWS: you can apply key skills from cognitive-behavioural therapy (CBT) to help you to manage your mood What is CBT & how does it work? Short term, problem-focused psychological treatment Effective for approximately 75% of people who complete treatment Offers some protection again future episodes of low mood/depression Targets current problems instead of family/childhood history Teaches effective coping skills so you can manage your mood Need to use skills consistently to make lasting improvements: time & effort is required Physical Symptoms A Model of Low Mood & Depression SITUATION Thoughts Emotions Behaviours How CBT Works Because thoughts, feelings, behaviours & physical symptoms are interconnected......changes in one area lead to changes in the others Making small, planned changes to behaviours & thought patterns can gradually lead to big improvements in how we feel & function Dr. Michelle Haring 2015 2

6 Key Tips for Managing Low Mood Learn about low mood & effective treatment approaches Practice good self-care Set goals to get back to important activities Replace unhelpful thoughts with more accurate and helpful messages Problem-solve the situations that are contributing to low mood Seek support: connect with others who will encourage you to make positive changes Learning about Low Mood & Effective Treatments that s what we ve been doing tonight... What is low mood/depression? What are the risk factors? What treatment approaches have been shown to work? What resources can I access in my community? From what I ve learned, what ideas can I apply/resources can I access to make improvements in my own life? Changing Behaviours It s often easiest to start with changing behaviours before tackling thoughts As people become depressed, they tend to stop doing things that are important for well-being Need a plan to gradually put these behaviours back into your schedule Key areas to address include self-care & other important daily ingredients Changing Behaviours: What to Target? Key areas of self-care include Diet Exercise Sleep Limiting caffeine Limiting drug & alcohol use Other important areas to target include: Enjoyable activities Activities that give you a sense of accomplishment Connecting with others Overcoming avoidance Adapted from Antidepressant Skills Workbook by Bilsker & Paterson (2005) How Do I Change My Behaviour?: Goal Setting A simple yet powerful technique to begin forward momentum Choose one or two areas to begin with (getting more exercise, seeing friends, doing something enjoyable, etc.) Goals must be: Specific Realistic (90% confident) Scheduled How Do I Change My Behaviour?: Goal Setting Examples of goals Go for a walk to & from the community mailbox (10 mins) twice a week after work on Tuesdays & Thursdays Call my sister for a 15 minute chat Sunday morning after church Try to anticipate and problem-solve around obstacles Watch out for doing too much/trying too hard! Achieving goals builds motivation & momentum Falling short of goals breeds discouragement and hopelessness Dr. Michelle Haring 2015 3

Motivation/Energy 02/06/2015 The trying too hard problem Try harder Try even harder, pick your self up by the bootstraps! Just do it, already! What s the point? I always fail Expectations/Goals Thinking Patterns Related to Low Mood & Depression Unhelpful, unrealistic thinking is very common when we are experiencing low mood or depression This can be part of the reason why depression starts & can keep it going Characteristics of Depressive Thinking: Negative view of the self: self-criticism Negative view of the world/situation: focus on the negative/threatening parts Negative view of the future: expect that things will not get better or that more bad things will happen Everyone is prone to falling into thinking traps when we are stressed, depressed or very tired Does this sound familiar? I m a failure People at work think I m incompetent I m never going to find a partner This pain is not going to get better My family hates me I always mess things up The world is a harsh place People are generally selfish & unkind THINKING TRAP All or Nothing Thinking Catastrophizing Fortune Telling/Jumping to Conclusions Mindreading Examples of Thinking Traps in Low Mood & Depression EXAMPLE Seeing things or people as right or wrong, good or bad, perfect or terrible. A small mistake is a total failure Telling yourself that a minor negative event is/would be a complete disaster. Often accompanied by fears of not being able to cope Making predictions about what is going to happen, with little or no evidence Thinking that you know what others are thinking, without any evidence THINKING TRAP Negative Mental Filter Overgeneralization Should statements Labelling Examples of Thinking Traps in Low Mood & Depression EXAMPLE Focusing on the negative parts of a situation and ignoring the positive parts of a situation Making up a rule about how things are or will be based on one experience or event: always never everybody Telling yourself how you should or must act or feel Saying something very negative (and often unfair) about yourself or other people THINKING TRAP Emotional Reasoning Perfectionism Personalization & Self- Blame Examples of Thinking Traps in Low Mood & Depression EXAMPLE Thinking that bad feelings say something about how a situation actually is. Believing that your thoughts must be true or accurate because you feel strongly that they are, even if there is little or no evidence to support them Thinking that things or people are only right or worthwhile if they are perfect Feeling overly responsible for other people s behaviours and negative events, without considering other factors or people who may have influenced the situation Dr. Michelle Haring 2015 4

Challenging Unhelpful Thinking Patterns: 4 Steps STEP ONE: Recognize your unhelpful thinking When you notice your mood has dropped, pay attention to the thoughts that were going through your head when that happened If you can, make a note of the thought and the situation that triggered it STEP TWO: Identify your thinking traps Look at the thinking traps and see whether your thinking falls into any of these categories. It is common to fall into more than one thinking trap. 4 Steps adapted from Coping with Depression During Pregnancy and After the Birth: A cognitive-behaviour therapy-based self-management guide for women by Haring & al., 2011 Challenging Unhelpful Thinking Patterns: 4 Steps STEP THREE: Challenge the unhelpful thinking and replace it with more healthy thinking Use challenging questions to help you to come up with an alternative thought that is more realistic & helpful If someone I really care about knew I was thinking this thought, what would they say to me? If someone I really care about was in this situation and had this thought, what would I tell them? Is this thought helpful right now? Is there another way of thinking about this situation that would have better results? Have I confused a thought or feeling with a fact? What evidence do I have that supports this thought? What evidence do I have that does not support this thought? Questions adapted from Greenberger & Padesky (1995), Burns (1999), Bilsker & Paterson (2005) Challenging Unhelpful Thinking Patterns: 4 Steps Challenging questions continued Am I blaming myself for something over which I do not have complete control? What s a less extreme/more fair way of looking at the situation? Are there shades of grey that I am ignoring? When I have felt this way in the past, what did I think about or do that helped me feel better? Five years from now, if look back at this situation, will I look at it any differently? Are there any small things that contradict my thoughts that I might be discounting as not important? Questions adapted from Greenberger & Padesky (1995), Burns (1999), Bilsker & Paterson (2005) Situation After I tell my mom that it takes my baby 30 minutes to settle down, my mom calms my baby down in about 5 minutes Techniques for Challenging Unhelpful Thoughts Unhelpful Thoughts Why can t settle her down that fast? I should know how to do that she s my baby. She probably thinks I m a terrible mother Thinking Trap or Questions to Challenge this Thought Should statement Overgeneralizing Labelling Healthier Thoughts My baby takes different amounts of time to settle on different days. Sometimes she settles fast for me. It isn t fair to call myself a terrible mother I have learned a lot since she was born and I do a lot to care for her which takes effort and love. Challenging Unhelpful Thinking Patterns: 4 Steps STEP FOUR: Make healthier thinking a habit Learning to catch and challenge your unhelpful thoughts and replace them with more helpful thoughts is a SKILL It takes time & practice to become confident and comfortable with this new skill PRACTICE as much as you can it will come easier to quickly recognize and let go of unhelpful thinking when it happens Sometimes coping cards can be helpful For more information about Healthy Thinking, see the Healthy Thinking Wellness module at www.heretohelp.bc.ca Problem Solving Low mood and problems go hand-in-hand Sometimes problems are what trigger the low mood in the first place (e.g., financial problems, conflict with a coworker) Other times, problems have begun as a consequence of the symptoms of low mood - low motivation & energy, concentration & decision making difficulties (e.g., mounting debt because not opening & paying bills, poor social support because new to the community, etc.) Learning and applying problem-solving skills can help you to manage the situations that are contributing to your low mood/depression Dr. Michelle Haring 2015 5

Problem-Solving Steps Identify and Define Problem Select and Formulate Goal Brainstorm potential solutions Consider pros and cons Choose best solution Implement and Evaluate Problem-Solving Tips Be specific about the problem/chunk it down I have financial problems vs. I can t pay the minimum balance on my credit card For more information about problem solving, see the Problem Solving Wellness module at www.heretohelp.bc.ca Seek Support Speak Up: many people who are experiencing depression pull back from others & don t seek support Connect with others who will encourage your efforts to make positive changes Seek professional support from your family physician or other health care professional Be persistent in asking for the support you need: emotional support, social network support, practical support, informational support For more information about social support, see the Social Support Wellness module at www.heretohelp.bc.ca How can I support a loved one with depression? It can be really difficult to watch a loved one struggle with low mood or depression, fortunately, many excellent resources are available Here s what isn t helpful... Just change your behaviour! Try harder Pick yourself up by the bootstraps You know it will make you feel better Keep pushing, you can do it Give it your all, 110% If you loved us, you would do this Stop feeling sorry for yourself and make a change So what can I do to help? Depression is bigger than you; you can help, but you can t make it go away Treat your loved one like an adult Encourage, but know when to back off; do not apply pressure Your loved one did not choose to have this problem and cannot just stop being depressed Be positive & reinforce their efforts Treatment takes time & tremendous effort by your loved one Do not ignore problems for fear that it may upset your loved one Dr. Michelle Haring 2015 6

So what can I do to help? Educate yourself about depression & help your loved one find resources Let your loved one know that effective treatments are available & support his or her efforts to find a treatment that works Consider having a joint session with your loved one s mental health professional to find out what you can do to support his or her efforts to make progress Make sure to care for yourself! Look after yourself, keep up with self-care, recreational & social activities Take pressures off of yourself Seek your own support from friends/family Consider joining a family support group Find ways of getting away from the situation Keep Going! Learning to better manage your mood and to improve your life takes time & effort Remember that all of us feel low and/or depressed from time to time In many cases, applying the skills we ve reviewed so far will help you begin to feel better Books Available at this Library Mind Over Mood: Change How You Feel By Changing the Way You Think Greenberger & Padesky (1995) Overcoming Depression and Low Mood: A Five Areas Approach: 4 th Edition Williams (2014) For more information about depression & its treatment, consider the following excellent resources Books Available at this Library, cont d Overcoming Depression: A Self-Help Guide Using Cognitive-Behavioural Techniques Gilbert (2009) Free Online Resources: Antidepressant Skills Workbook by Bilsker & Paterson: http://www.comh.ca/antidepressant-skills/adult, available in multiple languages & as an audiobook Coping with Depression During Pregnancy & Following the Birth: A Cognitive-Behavior Therapy-Based Self-Management Guide for Women by Haring et al: www.bcmhsus.ca/resources/adultresources Dr. Michelle Haring 2015 7

Free Online Resources, cont d Wellness Modules at www.heretohelp.bc.ca: covers topics such as social support, problem-solving, getting a good night s sleep, eating and living well, health thinking and more Mood Disorders Association of BC: www.mdabc.net BounceBack: Reclaim Your Health CBT-based guided self-help for people with mild to moderate depression (with or without anxiety) Funded by the BC Ministry of Health Services to be accessible throughout the province Family physician referral required See www.bouncebackbc.ca for more information BounceBack: Reclaim Your Health 2 components: Living Life to the Full DVD Telephone-delivered Coaching to help participants complete a structured CBT workbook-based mood improvement program Workbooks cover topics such as: practical problemsolving, challenging extreme & unhelpful thinking, overcoming reduced activity and avoidance See www.bouncebackbc.ca for more information Final Thoughts Remember that effective treatments for low mood & depression are available, so don t give up! Encourage others to be understanding and supportive of people with low mood & depression Thank-you! Dr. Michelle Haring 2015 8