Beyond Blue

Beyond Blue


Mindful Monday: A Note to the Severely Depressed–Don’t Try So Hard

posted by Beyond Blue

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I don’t know about you, but when I’m severely depressed 90 percent of my negative thinking is based on the fact that I am a failure because all my cognitive-behavioral strategies and positive thinking and mindfulness attempts aren’t working. I discussed this with Dr. Smith yesterday and she reminded me, once more, that severe depression can’t be treated in a mind-over-matter way. Her compassionate logic made me review the pages of my forthcoming book, “Beyond Blue,” where I list the neurological and scientific reasons why.

 

And I breathed a much-needed sigh of relief.

You deserve one too.

Here’s my passage:

Trying too hard was precisely my problem. It was the mind over matter issue again. In my mind, I was failing because I couldn’t think myself to perfect health. I couldn’t do it all myself.

Dr. Smith salvaged the last crumb of my self-esteem with this compassionate statement: 

“Mindful meditation, yoga, and cognitive-behavioral therapy are extremely helpful for people with mild to moderate depression. But they don’t work for people such as yourself who are suicidal or severely depressed.”

Her advice was grounded in neuroscience.

One research study at the University of Wisconsin-Madison, in particular, used high-definition brain imaging to reveal a breakdown in the emotional processing that impairs the depressive’s ability to suppress negative emotions. In fact, the more effort that depressives put into reframing thoughts–the harder they tried to think positive–the more activation there was in the amygdala, regarded by neurobiologists as a person’s “fear center.” Says Tom Johnstone, Ph.D. the lead study author at the University of Wisconsin:

Healthy individuals putting more cognitive effort into [reframing the content] get a bigger payoff in terms of decreasing activity in the brain’s emotional response centers. In the depressed individuals, you find the exact opposite.

And then Dr. Smith asked me this: if I had been in a terrible automobile accident would I be so hard on myself?

“If you were in a wheelchair with casts on each of your limbs,” she said, “would you beat yourself up for not healing yourself with your thoughts? For not thinking yourself into perfect condition?”

Of course not.

When I injured my knee while training for a marathon, I didn’t expect myself to visualize my tendonitis away so that I could run. I dropped out of the race to rest my joints and muscles so I wouldn’t further damage them.

Yet I expected myself to think away my mood disorder, which involved a disease in my brain, an organ just like my heart, lungs, and kidneys.

“What’s most important is to find a medication combination that works so that you can be able to do all that other stuff to feel even better,” she said. “I will give you a list of books you should read if you want to study depression. Until you feel stronger, I suggest you stay away from the type of self-help literature you have brought it because those texts can do further damage if read in a very depressed state.”

Here, then, are my three words for the severely depressed: Distract, don’t think. And surround yourself with people who truly understand mood disorders until you can believe in yourself again. 

At least that’s what my doctor told me.

Click here to subscribe to Beyond Blue and click here to follow Therese on Twitter and click here to join Group Beyond Blue, a depression support group. Now stop clicking.



  • Weeble75

    Therese, I remember the first time I was prescribed an antidepressant. I’d previously (many years earlier) had therapy which ingrained David Burns’ cognitive therapy principles into me. I told that to my doctor (at that time a GP), and his reply was something like “now you need more than that.” And he was right. I’d passed the point where I could argue with the negative thoughts and work my way back to health. Since mental disorders do distort our perception of things (whether minor as in our self-perception or major as in psychosis), I couldn’t see that, but he did.
    At the same time, I’ve learned that cognitive therapy measures STILL have a role to play, even with medical-grade depression. Even with medication, sometimes I’ll slip down into a funk and lie in my recliner in agony. By fighting back against the “stinkin’ thinkin'” with cognitive therapy measures, I found that I could at least stabilize myself so that I wasn’t in free fall. I didn’t pop right back out of the funk–I’ve learned that it’s more of a cycling out of the funk, which takes a little while. It DOES help to an extent, though I know it’s not the kind of cure-all that it can be for someone in mild depression.
    For myself, I need proper medication to keep my brain stable. Cognitive therapy can be a supplemental helper, but I can’t depend on it as my primary tool. That’s my 2c, FWIW.

  • http://blogs.psychcentral.com/mindfulness/ Elisha Goldstein, PhD

    Hi Therese,
    What a wonderful blog post thank you so much. When in the depths of depression, striving for relief with any tool can often be a set up as the mind is vigilant in looking for relief. Any indication that relief is not forthcoming leads to a fierce onslaught of self judgment which maintains or deepens the depression.
    I really loved your post so decided to write a follow up here:
    http://blogs.psychcentral.com/mindfulness/2009/11/the-one-suffering-you-could-avoid-mondays-mindful-quote/
    Be well,
    Elisha

  • Portia

    After surviving three months of the deepest depression I have ever experienced in my entire life, I am happy to say I am finally back from the “living dead.” I owe everything to a family physician, well versed in the pharmacology of depression, who said that what the brain needs in such dire times is a medication “cocktail” to “shock and awe.” I followed his advice and increased two of the meds I was taking, and added one more. Previously, I was afraid of taking more medication and thought I should be able to talk my way out of this but, I have come to realize, the right meds at the rights doses are what really saved me!

  • Gen

    Thanks once again Therese! As far as I’m concerned yours is the best depression/mental illness blog on the net. It’s so nice to find someone who is going through it and understands. Don’t ever retire!

  • http://www.vitabits.co.uk/womens-health collagen

    need proper medication to keep my brain stable. Cognitive therapy can be a supplemental helper, but I can’t depend on it as my primary tool. I followed his advice and increased two of the meds I was taking, and added one more.I found this post very much as it contains very informative knowledge.

  • Linda

    Thank you SO much, Therese. Your website is a true God-send for me. You understand because you’ve been there. Priceless! God bless your ministry to us readers. God bless YOU!

  • susan

    This information was very informative thank you all

  • shut-eye doll

    While it is great that you have clarified this much needed point, it is indeed unfortunate that most of the readers will be Bipolar “Sufferers,Victims, Consumers,…” The rest of the world will be blissfully unaware of what we go through and will continue to see it as a “weakness, ” or “lack of will power.”
    When I hear those indictments, I don’t know whether to feel pain or anger. I used to either believe it and be hard on myself, or feel pain. Now I feel anger, which is definitely more healthy. I am striving to be able to laugh at such ignorance. Most of the time I can, but as you pointed out, when one is severely depressed it is difficult to do so!

  • Marsha !!!

    been there done that so many times, depression indeed does hurt, not just you, but your loved ones as well. So glad I went through therepy, phyciatric treatment, even though I do not really go for all that type of treatmnt. Like I always say to people, it is hard to explain how it feels. I was not suicidal, but did not care to face the next day, stayed in bed for 8 weeks before anti-depressent kicked in. With my Heavenly Father;s help and reading his word and deep breths everyday, I am fine now. still going to therapist (counselor) and the phyco for a few more times. Can’t do but one thing at the time. Just like smoking, let me take care I tell people that want to ride my b— one day and one thing at a time. AMEN (So Be IT ) :)

  • Poison

    What do you do then when medication and ECT don’t work and your depression is complicated by so many other disorders?
    I’m realising that working on my mind through spirituality and in therapy is the only way I’m going to get better. So in my case, mind over matter and acceptance ARE the only things that are going to work for me.
    Just goes to show we are all different.

  • Lori

    Thank you. I print out many of your blogs and read them over and over and share them with my therapist. Your words help me explain my feelings and also help me feel not so alone. Thank you for sharing.

  • Donna

    And, along the same lines as accepting “your” depression as a disease that you did not ask for, it just came along (whether heriditary, induced by environment, or whatever the reasons – each is different), our creator, who made us, does not make junk, he makes us unique. And especially, accepts us exactly WHERE WE ARE. If the Creator of all can accept each and every one of us and love us anyway, shouldn’t we do the same, and accept ourselves as he does? My daughter developed Type 1 Diabetes Onset – the one where her body destroys all its insulin forever, so that she has no choice but to take shots for every carb she ever eats. Its cause is unknown, just like our depression is unknown, so she cannot change that she has it, can only take the shots to live, and so we need to accept our sadness and look at the gift of another day, of the wonderful things in our lives that we are blessed with (be it our loving dog, a warm home, a beautiful child, a pretty sunset, and rejoice that we have something special to be part of in this life. God doesn’t make junk, and He is still molding us to what he wants us to be. Today is another step toward that perfection he sees in us, that WE cannot yet see as well. BUT HE KNOWS ITS THERE, so we should trust Him and accept that we are His diamond in the rough. And he loves us right now, where we sit today, knowing us better than we know ourselves. (Thanks, God!)

  • Luz

    OH Please, pardon my English, but I need to say this.I hurt my self deeply when, after finish a task, i found myself evaluating me so hard. Everybody expect to feel better after a task has been done, but in my case is the opposite. I only feel relieve when I stop thinking on myself and begin to to put myself in the others feet. In this state of “extroversion” i feel safe, i don’t feel pain. Introversion hurts very badly. But today, our culture push us to be in a constant state of auto-evaluation, auto-criticism. To me is so hard. I have to navigate counter-current, and put myself in the others feet to feel relieve.

  • SandyVC

    What do you do when you are told “you have tried all the medications and do not respond to therapy?” This after over 20 years of constant care by a variety of doctors and 20 off and on before that. I was taught mindfulness in an out-patient program and had it reinforced as a means to deal with depression in a DBT program when I was out of my mind. I became hysterical and had to be hospitalized partly because it did not work as promised. As a Buddhist who meditated this is a disaster. I feel like I have been a guinea pig for meds and theories and have now been thrown out for not responding correctly.
    What can be done when the mental health community throws their hands in the air and blames you?
    Sandy

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