For the last two weeks, Nancy has noticed that her mood has been very low, she’s had a much lower appetite, she’s been sleeping a lot more, she’s been feeling worthless, and she’s had a lot of trouble concentrating; these symptoms have really impacted her ability to function at work and they have been causing her a lot of distress. Could she be experiencing depression?
Depression is among the most common psychiatric disorders1. According to the Diagnostic and Statistical Manual of Mental Disorders – 5th Edition2, symptoms of depression can include: depressed mood, getting less pleasure from (or interest in) activities than we used to, gaining or losing weight (without dieting) or having lower/higher appetite, sleeping too much or too little, feeling slowed down or keyed up, feeling more tired or low energy, feeling worthless or intense guilt, having difficulty making decisions or being less able to concentrate/think, and having repeated thoughts of death or suicide (or having a suicide attempt or plan). One does not need to experience all of these symptoms to be diagnosed with depression.
How can we help reduce symptoms of depression? Both our behaviors and our cognitions (thoughts) can have a big impact on our mood. In cognitive-behavioral therapy, clients are encouraged to target both of these aspects in order to help boost their mood:
1. Behavioral activation3:
a. Sleeping: Low mood can contribute to difficulty sleeping (e.g. trouble falling or staying asleep), but difficulty sleeping can also contribute to low mood (ever feel more down when you haven’t gotten enough sleep?). These tips can help improve sleep quality, which can in turn help to improve mood: Sleep Hygiene.
b. Eating: Low mood can contribute to changes in appetite and to poorer eating habits, but poorer eating habits can also contribute to low mood (ever feel more down or irritable when you’ve skipped a meal?). Eating 3 meals and 2-3 snacks per day at regular intervals can help to reduce hunger-related declines in energy and mood.
c. Exercising: Sometimes people who feel depressed may feel slowed down or low energy and may be quite sedentary. However, being sedentary can also contribute to low mood. Exercising can help to boost mood4. If you’re currently very sedentary, consider starting with a walk around the block and gradually building from there. Choosing a physical activity that you like (or at least one that you don’t dislike) can help motivate you.
d. Socializing: Low mood can contribute to social withdrawal/isolation (we might not feel like attending a big party when we are feeling down). However, spending too much time alone with our negative thoughts can have a negative effect on our mood. Meeting a friend to talk on a regular basis can provide some much-needed social support.
Doing pleasurable activities each day can also help to improve mood. Not sure what you might like to do? Check out this Fun Activities Catalogue to get some ideas.
2. Cognitive restructuring:
Imagine that a man named John asked a woman out on a date and she declined. In the first scenario, he thought to himself “I’m such a loser. No girl will ever go out with me”. In the second scenario, he thought: “Well that’s disappointing. Maybe she’s not looking to date right now”.
John is likely to feel a lot more down following the first interpretation than the second one, even though the situation was identical in both cases. The point is that the way we interpret/think about a situation can have a big impact on how we feel as a result of the situation.
Here is how you can start to challenge your negative thoughts about a situation: When you notice yourself feeling a negative emotion (sad, mad and/or nervous), write down a brief description of the objective situation that took place before you started to feel this way, rate the intensity of your negative emotions, and identify the negative thoughts that arose in the situation.
Next, examine these thoughts to identify whether you fell into certain cognitive traps (i.e. negative thought patterns), like jumping to conclusions or black & white thinking, which can contribute to the intensity of negative emotions. Check out this handout, Unhelpful Thinking Styles, for a description of cognitive traps.
Then challenge those thoughts with examples/evidence showing that your negative thoughts are not always true. It can be difficult to challenge your negative thoughts, especially if they have gotten a lot of repetition over the years. Since we tend to be much more compassionate towards other people than we are to ourselves, it can be helpful to ask yourself: ‘if someone I love were in this same situation and had the same negative thoughts as me’…
· ‘…would I judge them as harshly as I’m judging myself?’ Often the answer is no, highlighting the harsh double-standard that we apply when it comes to ourselves. If you wouldn’t judge someone else as harshly even if they were in the same situation, then it isn’t fair and doesn’t make sense to do this to yourself.
· ‘…what would I say to them?’ You might consider extenuating circumstances that played a role, think of other times that the person has been successful, and realize that the person’s overall success/value is not defined solely by this one situation. And then apply this same reasoning to yourself.
Next, try to arrive at a more balanced interpretation of the situation. So in John’s case, it might sound something like this:
Getting turned down definitely does suck. At the same time, I don’t know any guy who has never gotten rejected at some point - it’s a normal part of dating life. Plus, I’ve gotten turned down before, so I know from experience that I’ll get over it eventually. I’ve also had some meaningful relationships in the past so I know that there are some things about me that women find appealing and that I will likely be able to have other meaningful relationships in the future.
Then re-rate the intensity of your negative emotions. Did the intensity of your negative emotions go down?
It won’t be easy, and these guidelines won’t be a quick-fix, but consistently and persistently practicing behavioral activation and cognitive restructuring can be a good start towards helping to reduce the intensity of negative emotions.
That being said, overcoming depression can be challenging. Although the tips listed above can be of some help, they may not be enough and it can be a very good idea to seek the help of a health professional. And remember, if you’re feeling hesitant about getting help, just think of what you would tell a loved one in the same situation.
Simcha Samuel is a clinical psychologist in Westmount, Montreal, Quebec, at Connecte Montreal Psychology Group. The team at Connecte loves writing about ways to boost our mental health and bring psychology into our everyday lives. For more helpful tips, check out Connecte’s blogs, podcast, follow @connectepsychology on Instagram or @ConnecteMTL on Twitter, or like us on Facebook.
Haddad, M., Menchetti, M., McKeown, E., Tylee, A., & Mann, A. (2015). The development and psychometric properties of a measure of clinicians’ attitudes to depression: The revised Depression Attitude Questionnaire (R-DAQ). BMC Psychiatry, 15: 7. DOI: 10.1186/s12888-014-0381-x
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Mazzucchelli, T., Kane, R., & Rees, C. (2009). Behavioral Activation Treatments for Depression in Adults: A Meta-analysis and Review. Clinical Psychology: Science and Practice, 16, 383–411.
Carek, P. J., Laibstain, S. E., & Carek, S. M. (2011). Exercise for the treatment of depression and anxiety. International Journal of Psychiatry in Medicine, 41, 15-28.