We often talk about the way we think when we have depression but an equally important question is what do we do?
One of the key aspects of depression is that it reduces our levels of enjoyment in everyday things and this often pushes us to stop doing those things. The most common behaviours that occur when we experience depression are isolation and avoidance. We see less of the people we normally see and we do less of the things we normally do.
If we stop “doing”, what fills the gap? Negative thoughts, worry, catastrophic thinking, self-criticism. If our mind isn’t occupied, then it becomes filled with negative thinking. A reduction in our actions allows the negative thoughts to rule the roost but even a small increase in our actions can help keep us challenge our depression.
So what can we do?
Often we notice that when we start to feel worse we stop doing something. We don’t want to get out of bed. We don’t want to go to work. This is where we have to go. We can do it gently. We can do it compassionately but that is the direction we have to go in. We don’t have to do it perfectly. We don’t have to do it at 100% but we do have to do it. No part of this will be easy. We may feel like we can’t. Then can we do half of it? Can we do 10% of it?
What is the smallest thing we can do?
Often people say, it is to ‘send a text’. This is perfect. We mightn’t have spoken to someone in a while, so send a short text. Excellent. If we are in bed can we get our two feet out of bed? We often say that depression is caused by the mind but solved by the feet. If we can put our two feet on the floor, can we get to the shower? Don’t think about it. Don’t ask what comes next. Don’t ask about the future or the past. Just put your body in the shower. After you put your body in the shower, walk to the kitchen, put on the kettle and put a cup of tea in your body. For some people, at some times in their lives these are enormous steps. But nothing happens without them.
For other people, we are going to have to take on the four principles below and apply them to the office or to the social group or whatever it is we are avoiding.
- small steps
- focus on the behaviour
- keep the focus away from the mind
- keep it physical
After people engage in behaviours like this, people who have depression do one thing; people who do not have depression do something else and we are going to do something totally different.
People who have depression criticise themselves for only getting out of bed or going to work. They compare themselves negatively to their well selves or compare themselves negatively to people who are well at the moment.
People who don’t have depression don’t think about it at all, they just move unconsciously through the actions.
We are going to praise ourselves for the titanic effort it took to do that one thing.
People running marathons don’t have to make the effort that it sometimes takes someone with depression to send that first text. People climbing Everest don’t need the drive that someone who is severely depressed needs to get out the front door. People who have depression are titans of willpower and we are going to praise that. It mightn’t have been perfect. It mightn’t have been everything, but for today it was extraordinary and it is exactly the building block on which we can build a recovery.
We do not need to be cruel to ourselves to overcome depression. We will not do this perfectly. Monday, we may be tackling it but Tuesday we may fall back into old habits. That’s alright. This is just human nature. Every diet, every new exercise regime, everything we have ever tried has had these speed bumps and they are largely irrelevant. We don’t even have to work out why they happened. We just have to roll onto the next day and go again. What was the plan? Let’s get back to that.
Here is the worst part of depression. We don’t feel like doing it. This is why we get trapped by it. We know we should but we don’t want to. Unfortunately and paradoxically, the “wanting” comes after. We have to do something then we want to do it. We do the walk then we want to do the walk. We go to the social event, then we want to go it. And maybe not even the first time but the second or the third or the fourth time.
If we think about it neurologically, it makes perfect sense. How do we know that we like cake? We try some. Find out that the body loves sugar and the reward system in our brain kicks in. The action comes first, the reward comes second. With exercise we have to go through the pain of stiff joints, poor fitness levels, Irish weather and only then and only after a while do the endorphins kick in. We have to make ourselves exercise before we get the reward for it.
None of this comes naturally when we are feeling depressed but it is really important that we keep doing it. Aim for small pleasures. Accomplish small tasks. Reward yourself afterwards.
Something strange happens when we actually achieve that thing. We focus on the next potential negative event. We completely forget about the thing we just achieved. We dismiss the good stuff and focus on the bad stuff. We shouldn’t be surprised. That is depression. Depression affects our sleep, our energy, our brain function, our emotions, our thoughts. We wish to be transported to the end-point. We wish more than anything that this would go away. That’s not how health works. Health is gradual. But if we can accept small steps, small pleasures, gradual change, then depression will fade away.
Picture the Great Wall of China. Imagine the first step you take as you begin to walk along those ancient walls. Imagine with each step gaining strength and wisdom. Imagine with each step being able to look up from the ground and see the extraordinary splendour of China laid out in front of you. This is your journey. Breathe in. Take the first step.
By Keith Gaynor
Keith Gaynor is a Senior Clinical Psychologist in the Outpatient Department of St John of God Hospital, Stillorgan. He is the author of “Protecting Mental Health”.