Self-Management of Depression

What is Recovery? The dominance of the medical model in mental health often reduces recovery to merely reaching a certain score on rating scales like the Patient Health Questionnaire-9 (PHQ-9), which is commonly used to measure depression. This narrow perspective overlooks other vital aspects of recovery beyond clinical response, as shown by many studies (Andresen et al., 2003; Jorge-Monteiro & Ornelas, 2015). Some of these overlooked facets of recovery include: Hope for the future. Re-establishment of a positive identity. Establishment of personally meaningful goals. Taking responsibility for one’s life. Feeling included and connected to others. Feeling empowered. Contributing to community life. Building on this broader understanding, recovery involves managing one’s mental illness, transcending its negative impacts, and striving for a meaningful life. The concept of recovery can vary among individuals, and some common expressions people use to describe their recovery include the ...

Approximately 30% of individuals with depressed mood develop a chronic course as defined by the criteria for persistent depressive disorder (PDD) (Struck et al., 2021). Research shows that depressed individuals have difficulties in handling another person's negative state or suffering, getting overwhelmed in emotionally tense situations, a condition called empathic distress. This leads to an avoidant interpersonal style due to fear of interaction with others, which in turn deprives these individuals of positive interpersonal experiences, thus perpetuating depressive symptoms (Struck et al., 2021). Situational analysis is a technique used in the Cognitive Behavioral Analysis System of Psychotherapy (CBASP). CBASP is one of the few psychotherapies effective for chronic depression and PDD (Wiersma et al., 2014; Wiersma et al., 2021). CBASP combines behavioral and cognitive strategies with a problem-solving focus and emphasizes interpersonal issues. Its primary goals are to help indivi...

Urge surfing is a mindfulness-based technique to help individuals manage and overcome cravings and impulses. Developed by clinical psychologist Alan Marlatt, urge surfing involves observing and riding out the waves of urges without giving in to them (Marlatt et al., 2004). This technique is particularly useful for individuals dealing with substance abuse, overeating, or other compulsive behaviors (Bowen & Marlatt, 2009). Urge surfing is also a popular emotion regulation skill in Dialectical Behavior Therapy (DBT) (Linehan, 2015). Emotions prompt behaviors (e.g., fight in anger, flight in fear) and prepare the body for action. Urges are the precursor to action, and urge surfing curbs emotional triggers that lead to maladaptive actions. Urge surfing is based on the premise that cravings and urges are like waves in the ocean. They rise in intensity, reach a peak, and then gradually subside. By visualizing urges as waves, individuals can learn to "surf" rather than being over...

Cognitive Behavioral Therapy (CBT) is one of the most proven psychotherapies for depression and anxiety. It involves identifying, challenging, and replacing irrational thought patterns, also called cognitive distortions, with rational thoughts. However, not everyone is successful in doing so. A key reason for this is when one harbors deeper irrational thoughts, called core beliefs, which are harder to change as they sit at a subconscious level.   While identifying your superficial irrational negative thoughts, also called automatic thoughts, as a part of CBT, you may realize that some of these thoughts can be lumped under common themes. These underlying thinking patterns are called core beliefs or schemas. Whereas automatic thoughts are at the surface of your awareness and more straightforward to recognize, core beliefs are not that readily accessed or easily articulated. Core beliefs or schemas represent a set of attitudes, assumptions, conceptions, preferences, goals, and va...

Imagine you are invited to a friend’s house and, upon entering, you see a group of people laughing loudly. You can react to this situation in a couple of ways. You might think something is wrong with your appearance, making you feel that people are laughing at you. Alternatively, you might interpret their laughter as a sign that they are having a good time, and you feel ready to join in the fun. This situation can evoke two responses: one makes you feel embarrassed, while the other makes you happy. So, what causes people to experience various emotions in the same situation? It’s all about how you interpret the scenario. Your beliefs influence your interpretation, which is the “B” in the “ABC” framework we will explore next. Albert Ellis (1962), the founder of Rational Emotive Behavior Therapy (REBT), introduced the “ABC” framework as a cognitive model for depression. “A” represents an activating event to which an individual responds. This can include current or past events, thoughts, f...

What is loneliness? Loneliness is a fundamental aspect of life; at some point, everyone will experience it to varying degrees. Even though it is recognized as a public health concern (Office of the Surgeon General, 2023), there is still a need for more discussion about what the experience of loneliness entails and how to recognize it in oneself or others. For starters, loneliness is the distressing feeling you experience when there is a discrepancy between the interpersonal relationships you wish to have and those you currently have (Peplau & Perlman, 1982). It is not the number or frequency of social contacts but your subjective appraisal of the quality of relationships and the satisfaction with the relationships that influences loneliness (Heinrich & Gullone, 2006). Moreover, loneliness is not synonymous with social isolation, nor is it an inevitable consequence of being alone. You can be in the company of others and still experience loneliness, whereas you may not feel...

Though sounding simple, learning to accept and change are powerful strategies that keep relationships intact. “Accepting” your partner means that you are tolerating your partner’s unpleasant or offensive behavior while at the same time trying to understand the deeper meaning of that behavior and putting it in the larger context of your relationship with your partner (Christensen et al., 2014). For example, an individual may become more accepting of their partner’s introverted nature or tendency to criticize. Do not confuse acceptance with submission. Submission is enduring offensive behavior from a position of weakness as one has no alternative. In contrast, acceptance is tolerating offensive behavior from a position of strength as you choose to do so while seeing the offensive behavior in the larger context of your relationship with your partner. Acceptance also doesn’t mean one cannot assertively differ from one's partner, resist one's aversive behavior, or try to limit it....

Clarifying one’s values and having value-based actions is one of the core tenets of Acceptance and Commitment Therapy (ACT), an evidence-based treatment for depression. Values are our heart’s deepest desires for the way we want to interact with the world, other people, and ourselves. They are what we want to stand for in life, how we want to behave, what sort of person we want to be, and what sort of strengths and qualities we want to develop (Harris, 2009). Values are subjective; what one may consider as a value (e.g., being famous) may be considered as being cocky by another person. Compared to thoughts and behaviors, values provide a far more stable compass to motivate you to achieve your goals, even when faced with personal adversity (Hayes et al., 2012). An exercise that may help you clarify your values and find meaning in life is to imagine that you are eighty years old, and you are looking back on your life. Then finish the following sentences (Harris, 2008): I spent too much ti...

What are Self-affirmations? When going through a rough patch, we have all been reminded by our well-wishers to use positive self-statements such as, “I am okay" or “I can do this.” Known as self-affirmations, these statements demonstrate one’s adequacy usually through writing positive statements about one’s core personal values (Cohen & Sherman, 2014). When things don’t happen as planned or when you have setbacks, self-affirmation statements provide you with a tool to defend your positive self-image by bolstering your self-image (Critcher & Dunning, 2015). Self-affirmations work by enhancing your self-integrity – an image of oneself being able to control important adaptive and moral outcomes in one’s life. Self-affirmations broaden your perspective beyond a particular stressful situation by reminding you of your other strengths and resources that are not limited by the situation at hand (Cohen & Sherman, 2014). This in turn helps you put things in perspective, disengag...

Problem-solving is a popular modality of psychotherapy and is also conceptualized as a brief skills-oriented training program. A problem is a real or perceived imbalance or discrepancy between the demands of a situation and one’s coping ability and reactions (Nezu et al., 1989). Problem-solving skills are not personality traits but social skills that can be learned. Successful problem-solving involves not only the right kind of orientation but also an adaptive style (Nezu et al., 2013). Problem-Solving Orientation Problem-solving orientation refers to an individual’s beliefs, attitudes, and emotional reactions to problems, as well as one’s ability to cope with them. Research has shown that there are two types of problem-solving orientation – positive and negative. 1. Positive problem-solving orientation View a problem as a challenge rather than a threat Be realistically optimistic in believing that problems are solvable Have the self-confidence in one’s ability to cope with problems Un...

Burnout has become a common term in our modern lexicon, with people using it in a broad sense to describe their general experience of stress at work. Although not classified as a medical condition with diagnostic criteria like other mental health conditions, burnout does have a specific definition based on extensive research. The World Health Organization (WHO) describes burnout as an “occupational phenomenon” resulting from chronic workplace stress that has not been successfully managed. Burnout is more than just feeling bummed out or having a bad day at work; it doesn’t happen overnight. It slowly creeps up on us, albeit with some warning signs. Burnout most commonly results when there is an imbalance between the demands and resources at work, or a conflict between personal and organizational values. In particular, burnout is conceptualized as the final stage of breakdown in one’s ability to adapt to the demand/resource mismatch or values conflict. Symptoms of burnout represent not o...

What is Reminiscence? According to the Oxford Dictionary, to reminiscence is to “indulge in the enjoyable recollection of past events.” Interestingly, embedded in the definition of reminiscence is the positive emotion of joy. Reminiscing is more than just flipping through an old photograph album; it also involves reflection and reconstructing your memories. It is a process of discovering and re-discovering who you are today by making linkages between disparate aspects of your life, your families, and your communities (Gibson, 2011). You can reminiscence in various forms – mental image, speech, writing, poetry, drawing, painting, drama, mime, music, dance, or some other medium of communication. Literature on reminiscence identifies two types of positive reminiscence that lead to well-being and decrease in depressive symptoms (Watt & Cappeliez, 2000; Wong & Watt, 1991): 1. Integrative reminiscence: This involves accepting one’s past as worthwhile, reconciling the discrepancy...