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Is it Time to Move on from Self-Help to Self-Management of Depression?




Self-Help Vs Self-Management
You probably have heard the term “self-help” and may have also read a few self-help books. When it comes to depression, most self-help books focus on acute treatment of depression based on a particular model of therapy, usually the Cognitive-Behavioral Therapy (CBT). While the self-help approach tries to address a particular condition using a focused treatment modality over a short period of time, self-management is learning new ways to manage an illness over a longer period of time. In other words, self-management is using the resources and learning the skills to “positively manage” an illness (Lorig et al., 2006). Self-management, besides treating depression, also prevents relapse of depression and helps an individual maintain good mental health on a day-to-day basis. Lorig and colleagues (2006) further elaborate on self-management: it is a “management style” wherein you are a positive self-manager who not only uses the best treatments provided by healthcare professionals but also approach your illness in a proactive manner on a daily basis, leading to a more healthy life.

Unlike self-help strategies that purport to “help” you overcome depression, self-management strategies, in addition to treating depressive symptoms per se, address life style changes, social relationships, communication, problem-solving, and also include elements of wellness and recovery. In other words, self-management teaches you skills that continue to work above and beyond the short-term relief that one may get from self-help strategies. To illustrate this, let’s take diabetes as an example. Good self-managers of diabetes, besides taking medications, educate themselves about diabetes, learn to recognize symptoms of low or high blood sugar, monitor their blood sugar levels regularly, eat healthy and avoid foods that may destabilize their diabetes, exercise to maintain their weight, and seek professional help if their blood sugar levels are staying above or below the normal range. People with diabetes, heart disease, emphysema, asthma, and other long-standing medical conditions have successfully used self-management to live a healthy life. Unfortunately, treatment of depression has lagged behind in incorporating the concept of self-management, even though one in five people with depression will have chronic depression.

What are the Components of Self-Management?
While the list below is not exhaustive, the key components of self-management include the following (Barlow et al., 2002):
1.      Information:
·         Educating self and family members/friends about depression

2.      Medication management:
·         Taking medications as recommended by your provider
·         Overcoming barriers to adherence to medications

3.      Symptom management:
·         Using various strategies (e.g., cognitive, behavioral, positive psychology interventions, mindfulness, etc.) to manage symptoms of depression
·         Self-monitoring of symptoms
·         Managing concurrent symptoms of anxiety and/or substance use
·         Using techniques to deal with frustration, fatigue, pain, and isolation
·         Managing sleep
·         Managing symptoms of medical conditions that may be associated with depression
·         Relaxation
·         Using strategies for preventing relapse of depressive symptoms

4.      Life style:
·         Exercise
·         Overcoming barriers to exercise adherence
·         Holidays
·         Leisure activities
·         Nutrition and diet

5.      Social support:
·         Family support
·         Relationships with peers and friends

6.      Communication:
·         Assertiveness
·         Communication strategies (e.g., with mental health professionals)

7.      Others:
·         Accessing support services
·         Creating action plans
·         Decision making
·         Goal setting
·         Problem-solving
·         Career planning
·         Spirituality
It goes without saying that most of the available self-help books on depression woefully fall short of covering a majority of these essential ingredients of self-management and tend to go with one paradigm of treating depression. Depression, however, cannot be treated by one-size-fits-all strategies as suggested by many of these books.

Empower Yourself with Self-Management
Healthcare is moving toward a model of client-centered care. In this model, clients are partners in decisions related to their healthcare and collaborate with their healthcare providers to prioritize and set goals and choose interventions for their illness.  In this context, self-management strategies prepare you to be an active player in your own treatment rather than being a passive recipient. With self-management, you assume the primary responsibility of your treatment, though with support from your provider and your social network. Self-management puts one in the driver’s seat with regards to making choices to treat depression. Being able to self-manage your depression enhances your confidence and gives you a sense of control in dealing with your illness. Depression can make you doubt your capability for dealing with stress or sometimes even mundane day-to-day stuff.  Self-management provides you with an antidote to counter these negative thoughts.

Robust evidence supports the use of self-management strategies in depression (Houle et al., 2013). Individuals using self-management have reduced depressive symptoms, lower relapse rates of depression, improved quality of life and psychosocial well-being, better adherence with medications, and a greater sense of self-efficacy, i.e., self-confidence in one’s abilities. Even if you are on medications or in therapy, self-management complements your ongoing treatment. 

To learn more about evidence-based self-management techniques that are proven to work for depression, check out Dr. Duggal's Author Page.




HARPREET S. DUGGAL, MD, FAPA

REFERENCES

Barlow, J., Wright, C., Sheasby, J., Turner, A., & Hainsworth, J. (2002). Self-management approaches for people with chronic conditions: a review. Patient Education and Counseling, 48, 177-187.

Houle, J., Gascon-Depatie, M., Bélanger-Dumontier, G., & Cardinal, C. (2013). Depression self-management support: a systematic review. Patient Education and Counseling, 91, 271-279.

Lorig, K., Halsted, H., Sobel, D., Laurent, D., Gonzalez, V., & Minor, M. (2006). Living a healthy life with chronic conditions (3rd ed.). Boulder, CO: Bull Publishing Company.




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