Managing Depression Skillfully A blog about learning to manage depression with skill by Michael Yapko, PhD Fri, 31 Dec 2010 02:36:13 +0000 en-US hourly 1 Fare Thee Well–Some Parting Thoughts Thu, 30 Dec 2010 16:00:51 +0000 managing depressionWhen I first agreed to be a blogger for PsychCentral, it was an agreement to experiment with the blogging process. Now that I’ve blogged regularly for the three month trial period I’d committed to, I’ve discovered that blogging isn’t for me. I can offer the reasons, but the bottom line is that the relationship between blogger and reader is too distant to satisfy me.














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Anxiety in Childhood Often Precedes Depression in Adulthood- A Prevention Opportunity? Mon, 27 Dec 2010 15:23:06 +0000 A high level of anxiety in kids is a key early warning sign of emotional difficulties that can easily mushroom into eventually suffering anxiety and depression together. In fact, in the majority of adults, depression and anxiety co-exist, but they don’t have the same age of onset.

Typically, anxiety precedes depression by many years; the anxious child is much more likely to become an anxious and depressed, or “comorbid,” adult.

The most common form of anxiety, though not the only one, is social anxiety. When a child is fearful of other kids and avoids interacting with other kids (stays in the classroom at recess instead of going out and playing, for example), there is good reason to be concerned.

As children get older and the more they don’t fit in with other kids, the more they accumulate negative feedback from other kids; they are made fun of, they experience more rejection and their feelings get hurt, which further raises their anxiety about being around others. By the time they get older still, they become increasingly shy and quite likely lonely, as well. Shyness, loneliness, and depression are related.

All are associated with higher levels of anxiety, greater scanning for and detecting negative reactions in other people, and more internal focus (higher levels of rumination) on negative feelings. Shyness leads to more social avoidance, which then increases a sense of victimhood and depression.

Loneliness doesn’t just hurt emotionally, it hurts physically, too. Feeling lonely can make you more vulnerable to illness, and new research in the area of genetics suggests why. A recent study at UCLA revealed that people who described themselves as the loneliest on loneliness scales exhibited increased gene activity associated with inflammation and reduced gene activity for antibody production and antiviral responses. Chronic loneliness may actually change gene activity.

If your child is socially anxious, the psychological stress can affect him or her in both emotional and physical ways. To counter the social anxiety, the most important thing you can do is help him or her to develop coping and social skills. Every day this child doesn’t get along with others, he or she gets negative feedback that can cause bad feelings early in life, and lead those bad feelings to be an enduring way of life.

Learning how to begin and end friendly interactions, how to keep a nice conversation going, how to be easy to be around, how to “read” others, how to be smart about what to disclose and when, and many other such skills are best encouraged early on. Being trapped in a world with billions of other people with whom you don’t know how to interact skillfully assures a much more difficult life.

Helping a child to learn how to think about people, how to recognize their character strengths and talents, as well as their motivations and how to manage their manipulations, is most easily done by helping them learn about their own such patterns.

Talking with kids about important interactions they have with teachers and other students, encouraging the child to think through what was said and what the impact was or is likely to be is the kind of conversation that can start relatively early in life. Asking questions such as, “Why do you think the teacher said that to Billy?” and, “How do you think Billy was feeling when the teacher said that to him in front of the whole class?” or, “What would you have done if the teacher said that to you?” are questions that stimulate conversation and encourage the child to be observant, thoughtful, empathetic and deliberate.

Be especially careful not to make global statements about people, such as “The other kids act that way because they’re all jealous of you” or “They’re all spoiled rotten.” Global thinking discourages critical thinking.

Asking kids, “What if?” is a good technique for learning to manage anxiety. “What if something happened to me, what would you do? What if another kid did such-and-such, what do you think you would do?” Anxious children (and adults, too) tend to ask themselves “what if?” question regularly, which scares the heck out of them because they don’t have answers: What if I get lost and mom can’t find me? What if my parents divorce? What if my daddy dies?

The anxiety that comes from asking such frightening questions is normal. The key to learning to manage the anxiety and empower yourself in the process to trust your own judgment is to answer the question. It would be unpleasant to face the circumstances in the “what if?” question — unpleasant but manageable.

In dealing with your child, help him or her answer the question. Let the child learn to be a problem-solver instead of a worrier. Help your child learn to calm himself or herself with self-soothing techniques like slow, deep breathing, and relaxation or self-hypnosis techniques when facing stressful situations. These techniques will help better prepare your child for a lifetime of challenges.

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Happy Holidays! Now Watch What You Say Because it Can’t Be Unsaid Wed, 22 Dec 2010 21:26:13 +0000 The largest group of depression sufferers in the United States is currently between ages 25 and 44. That will likely change as depression continues to strike at younger and younger ages.
















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How Well Do You Know Yourself…Really? Sun, 19 Dec 2010 18:59:57 +0000 do you know yourself?How well do you know yourself? Some of the most depressed people I’ve ever treated became depressed by trapping themselves in circumstances where they really just didn’t belong. With eyes wide open, yet not really seeing, they ignored their own basic nature and got absorbed in situations that violated that personal nature.

Here’s an example of what I mean. One of my clients, Joyce, is depressed, divorced, and in her mid-30s. A self-described “nester,” she claims she wants nothing more than to find the right man and settle down into a long and healthy marriage. But she has not been dating, socializing or putting herself in situations where she can meet eligible men who might be suitable to marry. Why not?

Because she has gotten herself into what I consider a bad situation with two different men who are her “friends.” Joyce calls these men “friends with privileges.” Even though they are “just friends,” with no illusion on anyone’s part that the relationship is going to turn romantic and possibly culminate in marriage, they are having sex together.

Joyce says, “It’s casual, there are no strings, it’s nice to be held, so what’s the harm?” Her level of self-deception is extremely high, keeping her depressed, feeling very bad about herself.

What is a “nester” doing in this kind of exploitative relationship? She wants marriage but is in a kind of relationship that saps her motivation to go out and meet new people. Although she claims to value depth and commitment, she engages in intimate behavior that is in direct violation of those values.

As a direct result of this “solution” to her lack of a love life, she pretty much hates herself, feels cheapened by it, yet feels stuck in it because of all the conflicting emotions involved. She is depressed because she is violating her self-awareness and sabotaging her own goals.

Knowing yourself is difficult. It requires that you think clearly about your desires and values and then you act in accordance with them. Making moral compromises, getting lost in the need for contact or approval, selling out for a raise or a promotion are pathways to unhappiness. You want to know yourself well enough to be able to stay out of situations that are attractive on one level, but violate your sense of yourself on another.

How can you assess how well someone else really knows himself? When he says, “I’m ready for a commitment,” that sounds good, but is it true? When someone says, “I can complete this for you by Friday,” should you believe her? The key point is this: Most often, but not always, people are telling you what they believe to be true about themselves.

Some people intentionally lie and know they’re lying, but for most people it’s not about lying. It’s about self-deception. It’s about wanting, even needing, to believe we’re better than we really are. Thus, no one is going to say to you, “I’m a superficial person who callously uses other people for whatever I can take from them, so will you sleep with me?”

It takes some time to determine how well someone you’re assessing knows himself because you have to talk a lot and listen to what this person says about his or her character, temperament, or nature. You don’t need to believe, nor do you need to disbelieve, what you hear. You simply note it.

Over time, you watch for how well the things people do fit with what they said they’d do. The more consistent they are, the better it speaks for their level of self-awareness. Even when they’re inconsistent, if they’re responsible about it, they’ll acknowledge and try to mend the inconsistency. If they’re not responsible, they’ll make lame excuses for it.

This is why you don’t want to rush into things with people. Until you ask a lot of questions, until you observe the relationship between what someone says and what he does, you just don’t know how much of what he tells you will be true. Until you see someone in a variety of situations and moods, you won’t really know whether he can be respectful when angry or sensitive when stressed. It’s your responsibility to know yourself accurately, including your own vulnerabilities, so you don’t get too easily swept up in other peoples’ bull*@#*.

Photo by Nathan Csonka Photography, available under a Creative Commons attribution, non-commercial license.

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What Do You Notice in Other People? Wed, 15 Dec 2010 18:21:28 +0000 When you meet someone for the first time, what do you tend to notice about him or her? Pause and think about your response. Do you tend to notice his or her appearance – manner of dress, physical attractiveness (or lack thereof), the quality of eyes, hair, teeth, skin, body size and weight?












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Self-Aware? Or Lost in Space? Sun, 12 Dec 2010 17:06:20 +0000 The tendency of people in general, and depressed people in particular, to excessively use their own frames of reference in interpreting and reacting to life experiences is called an “internal orientation” by psychologists. The term internal orientation describes someone who reflexively uses his or her internal experience, such as feelings, beliefs, and judgments, as the sole or primary basis for forming reactions and generating behaviors.

When your focus, or orientation, is an internal one, it means much of the time, perhaps too much of the time, you are either entirely or primarily engaged with whatever is going on inside of you.

Because our attention is limited –there are more things going on at any given moment than we can possibly pay conscious attention to – by having our focus over here, it means our focus isn’t over there. In practical terms, this means that when I focus intensely on how I’m feeling, I’m not focusing very much on how you’re feeling. When I focus narrowly on how I see it, it may not occur to me to consider how someone else sees it.

Is it possible to focus too much on your feelings? The research strongly indicates the answer is yes. People can get so wrapped up in their feelings, especially their depressed ones, that they can disconnect from others and withdraw into their own unhappy worlds – becoming lost in space.

It is important to have a balance between being self-aware but not too heavily focused on oneself at the expense of engaging well with others. Logically, you would think that these are not “either –or” distinctions, that I can be aware of my feelings and sensitive to your feelings, too. And, while that’s true, too often it isn’t how many people respond.

Instead, they get wrapped up in their own feelings, focused on themselves and their depression, and they miss partially or completely what’s going on with others around them. They may even justify it by believing that because they’re miserable, they don’t need to be engaged with or responsive to others. Others can see this as insensitive, or worse, and it creates the vicious cycle of generating negative feedback, which leads to more withdrawal over and over again.

An internal orientation can become so pervasive that it leads directly to an inability to relate well to other people. It is difficult to have empathy or concern for others when what matters most to you is how bad you feel.

Besides setting up the vicious cycle just described, it can also lead to an “It’s either them or me” kind of competition. When people view the world in this “us or them” way, other people can seem like the enemy, the people who can harm you, either in word or deed. It takes a lot when you’re depressed to strive to see what’s right with other people. The typical reflex is to see what’s wrong, what makes the other person seem insensitive, lacking understanding, or even just plain stupid. By comparison, our suffering can seem noble, beyond other’s comprehension.

This “you’re either with me or against me” mindset fueled by an internal orientation is evident in “hot spots” all over the world. Even in our own political elections, we rarely see a respectful exchange of viewpoints about what might be best for the country. Instead, we engage in accusation, innuendo and character assassination.

There isn’t nearly enough of an external orientation that would lead people outside their own thinking to examine what might be as good as or even better about a position professed to be held by “them.” If it’s the position of “them,” it is, by definition, a bad one. It’s why people will support mediocre candidates in their own party rather than someone more qualified in another party. Party loyalty prevents thinking clearly or objectively.

So, what is the “us” and “them” in regards to depression? If I met you at a cocktail party and we began to casually discuss depression, how would you define your position on the subject? Would you use only your own experience as the reference point? Would you acknowledge that depression is different for different people and accept a variety of viewpoints and experiences quite different than your own? Would you try to learn anything from someone else’s experience or would you simply conclude, “they just don’t get it?”

In these blogs, I make a point of stating regularly that each viewpoint about depression has some merit, and each person’s experience is valid (though not necessarily effective). However, I also say how important it is to evaluate what any one person’s viewpoint allows him or her to do and what it also prevents him or her from doing.

Consider this point carefully: What does your view of your depression encourage in you – and does it help keep you stuck or is it what’s going to help you eventually overcome depression?

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Better Relationships? Why Bother? Wed, 08 Dec 2010 13:16:44 +0000 importance of good relationshipsIn my posts, I regularly focus on the importance of good relationships with others as a core ingredient of feeling good. Why? Because many studies from a variety of fields have all shown that people who are connected to other people in positive relationships have significantly lower rates of depression than those people who are not.

People in happy marriages, for example, have a much lower risk of developing depression than people who are unhappily single. People who have a network of positive and supportive friends have much less chance of becoming depressed than those who have no such network.

Good relationships can provide us with the basic needs we all have for love, intimacy and support. When you’re depressed, though, it sometimes seems too huge a task to engage with other people. When you’re hurting, you want to be left alone, and for those who try to support you, they often end up getting less than your best. So, why bother to try?

Most people sense intuitively how important it is to have positive and healthy connections to other people. Yet good relationships don’t “just happen.” People who don’t fit in well with others for any number of reasons, often become accustomed to being socially isolated from others. They may erroneously believe that others will never accept them, will always reject them, will never find them even marginally worthwhile, and will always consider them essentially useless.

Or, they believe that about others – no one can understand my pain, no one is worth confiding in, no one can help. Such damaging beliefs make developing good relationships impossible, and so the social skills necessary to make positive contact with others and build satisfying relationships never have occasion to develop.

The general health and mood benefits of good relationships now duly noted, let’s get a little more personal. Why should you bother to try to build relationships with anyone? Why should you expend any effort in the direction of getting connected to other people, especially if other people have been a source of hurt and pain in your life?

If you’re depressed, socially isolated, feeling emotionally scarred by what’s happened in your relationships, afraid to trust anyone again, yet also long for friendships or a caring, loving relationship with someone, you are in a dilemma. It’s what psychologists call an “approach-avoidance” conflict. It’s when you want something (“approach”) yet are afraid of it (“avoidance”), and the usual consequence is behavioral paralysis, or “freezing,” i.e., doing nothing at all.

How you resolve this dilemma (or don’t), will determine what happens next. If you could filter the fear out of the dilemma, the “avoidance” part of the “approach-avoidance” conflict, what would be different for you? Would you be less afraid of or even less hostile towards others? Wouldn’t it make a huge difference to focus on what you want, the “approach” part of the equation?

In the realm of relationships, when people put their fear of hurt or rejection ahead of their desire to be connected, withdrawing for self-protection seems to make sense. But, it’s a formula for keeping things the same, not for changing or improving things. It’s how time passes, but not depression. It’s a mindset that keeps you afraid, believing something bad will happen to you that you won’t be able to handle. Caving in to the imagined future hurts instead of learning how to prevent or manage them keeps depression the only constant companion in your life.

No one wants to take the time to develop skills without good reason. Well, you have good reason: When people get out of themselves, connect to others in a way that directly says there’s something about “us” that’s more important than just “me,” they feel better, get better, and truly are better. When you care and are cared about, you’ll feel better. That, in a nutshell, is the answer to the question, “why bother?”

Photo by Linh Ngan, available under a Creative Commons attribution, non-commercial license.

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Form Over Substance Sun, 05 Dec 2010 18:07:29 +0000 form over substanceThe emphasis in our culture, unfortunately, has increasingly become one of form over substance: too often image matters more than truth. People are so wrapped up in their solitary pursuits of personal interests and satisfaction that other people have merely become tools for achieving it.

Truth and integrity end up taking a back seat to winning. Here’s an example: Parents emphasize the importance of getting into the “right” college, which becomes their child’s goal. School systems across the country now report huge increases in academic cheating. This is form over substance: the child would rather get an “A” however he or she gets it than an honest “B” or “C” that won’t get him or her entry into the “right” school.

One of my colleagues who teaches at a local university gave a student an “A-“ in a class, and this student, who felt fully entitled to an “A,” became so hostile and vindictive that she filed complaints with the university about the instructor and made harassing phone calls to her at all hours of the day and night.

Many other colleagues who teach in universities have told me similar stories of students behaving in threatening, intimidating ways in order to get a better grade than they deserve. One who teaches at Yale University, characterized the shift this way: “Students used to come in feeling it was their responsibility to learn. Now, too many come in feeling it is your responsibility to teach.”

Too many people today have a strong sense of entitlement, which is a basis for simmering anger, poor relationships, and subsequent depression.

Psychologist and researcher Jean Twenge of San Diego State University has captured this trend empirically in her studies of the attitudes of young people about themselves in relationship to others. She documents a growing narcissism in her superb book, Generation Me: Why Today’s Young Americans Are More Confident, Assertive, Entitled – and More Miserable than Ever Before.

Young people expect the world to be as programmable as their ipods, Twenge suggests, and consequently many don’t develop tolerance for others’ views, empathy for their feelings or needs, or an ability to build and maintain genuine relationships with others that can withstand inevitable conflicts and growing spasms.

Form over substance; it’s how we choose our political leaders, it’s how we choose the products whose advertising we know best, it’s how we justify misguided efforts that help keep us painfully the same, it’s how we raise our expectations of others (and ourselves, too) ever unrealistically higher, it’s how we fool ourselves into thinking we can do things we really can’t, and it’s how we become vulnerable to depression when we’re disappointed the substance didn’t match the form.

Depression doesn’t arise in a social vacuum. It arises in response to world conditions, family conditions, marriage conditions, social conditions. It is essential for each person to get past the often misleading superficial image of how things seem (advanced by people who benefit from people buying into it) in order to get closer to how things really are.

If you really want to challenge yourself in the best of ways, explore well thought out opinions that challenge yours rather than those that simply reinforce what you already believe, especially when what you believe is working against you in some way. Only when you have many different viewpoints about some issue can you evolve a better sense of how to generate more realistic solutions to the challenges you face.

Photo by California Cthulhu (Will Hart), available under a Creative Commons attribution, non-commercial license.

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What You Focus on You Amplify: Clinical Hypnosis Enhances Treatment Wed, 01 Dec 2010 17:30:58 +0000 clinical hypnosis and therapyThis post is all about developing the kind of focus that can not only help you feel better, but be better. I have much more than a casual interest in the topic of how your focus influences your life experience: For more than three decades, I have focused on two primary domains of professional interest: Applying clinical hypnosis in short term psychotherapies, and treating depression strategically in individuals, couples and families.















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Can Too Much Reliance on Technology Become a Depressant? Sun, 28 Nov 2010 15:55:33 +0000 technology and depressionLife in the United States and around the world has grown incredibly complicated, driven by many different forces, of course, but none more significant than technology. Before the internet, the mass media (television, radio, newspapers, magazines) was how we got entertainment, news, inspirations, and first direct insights into how others lived, even if they were just characters in a TV show.







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