Self-Management of Depression

Have you ever been so engaged in an activity that you lost touch with your surroundings and felt intense joy and satisfaction after the activity was over? Psychologist Mihaly Csikszentmihalyi describes this experience of highest satisfaction as being in a state of “flow” (Csikszentmihalyi, 1990; Csikszentmihalyi, 1999). According to him, an individual in a state of flow- Exactly knows what they have to do moment by moment, either because the activity requires it, or because clear goals are set at every step of the way. Gets immediate feedback on their performance either from the activity itself or from their internalized standards. Feels that the activity matches with their skill set, it being neither too hard and nor too easy so as not to lead to anxiety or boredom, respectively. Athletes, painters, and other creative people have described this state as an ecstatic feeling or a feeling of contentment. The person in a state of flow pays undivided attention to the task at hand to the ex...

If you are human, you will have problems. Having problems means that you are normal, and solving them means you are a happy normal! While the traditional therapy approaches focus on the “why” of a problem, Solution-Focused Brief Therapy (SFBT) moves the focus from the “why” of a problem to “how it can be solved.” Evidence suggests that SFBT is effective for treating mild or moderate depression and has also been widely used as a life-coaching strategy (Gingerich & Eisengart, 2000; Kramer et al., 2014). Here are five questions used in SFBT that you can ask yourself to find solutions for problems that impede your goals (Grant & Greene, 2001; Simon & Berg, 1997). 1. The miracle question: The miracle question goes like this: “Suppose one night, while I am asleep, there is a miracle and the problem that I am facing is solved. However, because I am asleep, I don’t know that the miracle has already happened. When I wake up in the morning, what will be different that will tel...

What is Measurement-based Care? Measurement-based care is extensively used in medical conditions and involves matching treatment interventions with the outcomes for those treatments. For example, a provider would periodically measure fasting blood glucose or glycosylated hemoglobin in an individual with diabetes to make adjustments to the treatment plan, including medication and lifestyle changes. Measurement-based care fosters self-management by making the individual aware if they are on the right treatment plan or if they need to modify it in collaboration with their provider. While measurement-based care has been proven to improve outcomes for medical conditions, mental health, unfortunately, has lagged behind in adopting it as a regular practice. Measurement-based care in depression is an algorithmic application of published, accepted, clinical guidelines and consists of four steps (Morris et al., 2012): Step 1: Screening: Your provider may use one of the several available tools ...

Anxiety tends to be pervasive and it can interfere with your daily life. A helpful technique to prevent worry from distracting you from the task at hand is to create a fixed daily “worry time” and postpone your worries to that time (Lewinsohn et al., 1986). The purpose of this activity is not to avoid thinking about the things that worry you, but to let you decide when the best time is to focus on the worries. Individuals with anxiety, especially generalized anxiety disorder, have excessive worry about many different aspects of their daily life and this lack of a specific trigger for anxiety makes it harder for these individuals to gain control over their worries. Worry time offers a way for these individuals to gain more control over their anxiety through a psychological process called stimulus control. When people with generalized anxiety disorder worry throughout the day, the worry becomes associated with many places, times, and/or situations. Over a period of time these places, tim...

What is Mindfulness? If your notion of mindfulness is a practice starting with a phrase like, "Take a deep breath and close your eyes," then you have mostly bought into the myth that the only effective way of practicing mindfulness is guided meditation .  However, if you know what mindfulness entails, you can incorporate it in your daily routine in an informal way without relying on popular apps that have commercialized a practice known to humans for thousands of years.  Mindfulness-based interventions are well-validated treatment approaches that not only promote well-being and resilience but also have been found to be effective in anxiety, depression, chronic pain, and substance use disorders (Wielgosz et al., 2019). Mindfulness has two components: (a) orienting one’s attention purposefully to the present moment, and (b) approaching one’s experience in the present moment with curiosity, openness, and acceptance (Bishop et al., 2004). The state of mindfulness is described as ...

Through the ages, philosophers, poets, and scientists have tried to make sense of the concept of meaning in life. In simplistic terms, people experience the presence of meaning in life when they (Steger et al., 2008): Comprehend themselves and the world Understand their unique fit in the world Identify what they are trying to accomplish in their lives Although there are objective ways to measure one's level of meaningfulness in life, the concept remains riddled with misconceptions. This article discusses common myths and their corresponding facts (Duggal, 2018).  1. Myth: Meaning in life is a long-term pursuit that may take years. Fact: Meaning in life differs from man to man, day to day, and hour to hour, and what matters more is not the meaning in life in general but the specific meaning of an individual’s life at a given moment . Meaning in life can be a vocation or mission to carry out a concrete assignment that demands fulfillment (Frankl, 2006). 2. Myth: One has to find m...

Conflicts and arguments are an inevitable part of any relationship. However, there are strategies that will help you either avoid conflicts or handle them more constructively. The article discusses three such techniques.  1. Don’t do the “ABCDE” behaviors during communication The acronym “ABCDE” refers to certain types of communication behaviors that increase conflict in a relationship and include the following (Duggal, 2016): Accusation: Accusations usually are “You always …” or “You never…” statements. Accusations may have some kernel of truth in them, but that gets exaggerated and dramatized by the heat of the argument. Accusations lead to counteraccusations and defensiveness, and take the focus away from one’s own shortcomings and from resolving the conflict at hand. Blame: Individuals may blame their partner’s actions for a problem or blame their mental illness, moral weakness, or personal inadequacies for the problems the couple is facing. For example, “If you had taken tho...

What is Behavioral Activation? When it comes to treating depression, most mental health professionals talk about either medications or therapies such as cognitive therapy. These are, no doubt, clinically relevant treatments for depression. However, with the recent emphasis on treating the "chemical imbalance," simple treatments for depression such as behavioral activation have been sidelined. Behavioral activation is an evidenced-based treatment for depression and complements other treatments of depression (American Psychiatric Association, 2010). In fact, research demonstrates that in individuals with severe depression, behavioral activation is comparable to antidepressant medication and better than Cognitive Behavioral Therapy (Dimidjian et al., 2006). Avoidance is a key target for change in behavioral activation. The lack of energy and motivation in depression can result in people with depression either cutting back on pleasurable activities or not enjoying them as they ...