Depression Self - Management

I. Coping Skills:

Coping skills are to be used when faced with a stressful or difficult situation, not only during a depressive or anxious state but also in the day to day living. Coping skills when used correctly, can reduce the symptoms of depression or anxiety, and gives a sense of clarity in the situation.

There are two types of coping skills: healthy and unhealthy. It is important to identify unhealthy coping skills which have a short-term benefit and a feel-better moment, but is harmful to yourself and others and has long-term consequences. Healthy coping skills on the other hand also have a feel-better moment, but it does not have long-term consequences and it does not harm yourself and others.

Unhealthy Coping Skills:

Drugs and alcohol use
Procrastination
Self-harm
Social withdrawal
Being passive aggressive
Working till burnout
Sleeping less or more
Binge eating or food avoidance
Maintaining poor hygiene

Healthy Coping Skills:

Physical exercise
Talking to loved ones
Seeking professional help
Community service
Playing a sport
Yoga or meditation
Taking a bath/ shower
Maintaining a journal
Listening music or playing an instrument

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II. Psychotherapy:

One of the most commonly used therapy methods for depression control is Cognitive behavioral therapy (CBT). American Psychological Association defines CBT as a form of psychological treatment that has been demonstrated to be effective for a range of problems including depression, anxiety disorders, alcohol, and drug use problems, marital problems, eating disorders, and severe mental illness. Many studies have proven that CBT is as effective as psychiatric medications. Although, both psychiatric medications and psychotherapy have a synergistic effect when provided together and have a better and quicker outcome than any of them alone.

CBT usually involves efforts to change thinking and behavioral patterns. It is based on several core principles, including:

Psychological problems are based, in part, on faulty or unhelpful ways of thinking.
Psychological problems are based, in part, on learned patterns of unhelpful behavior.
People suffering from psychological problems can learn better ways of coping, relieving their symptoms and becoming more effective in their lives.

CBT is usually provided by a certified psychotherapist or a psychiatrist. The number of follow-up visits and the need for CBT are decided by the providing therapist based on the severity of the condition.

III. Physical Exercise:

People suffering from anxiety benefit more from relaxation exercises such as meditation, and people suffering from depression benefit more from physical exercises such as walking or running. Both exercises are healthy coping skills to practice when the patient is off medications.

Patients diagnosed with Major depressive disorder often have a decreased motivation to carry out their daily tasks, have decreased concentration, and have low energy. Such symptoms can be managed by regular physical exercise. I often speak to my patients about the importance of physical exercise for curing depression. I guide them to start with a 15-minute brisk walk every morning, and many patients increase the duration, frequency, and type of exercise once they notice the changes in their mood.

Benefits:

Better and quicker recovery from the depressive stage
prevent the recurrence of depressive symptoms
Release of feel-good hormones (endorphins)
Better control over negative thoughts
Increase in the level of confidence
Social interaction increases
Prevents lifestyle diseases such as diabetes and hypertension

IV. The 3 blessings:

Positive Psychology is the scientific study of the strengths that enable individuals and communities to thrive. The field is founded on the belief that people want to lead meaningful and fulfilling lives, cultivate what is best within themselves, and enhance their experiences of love, work, and play. The founder of positive psychology is an American psychologist Dr. Martin Seligman, also known as the “Father of positive psychology.” “The three good things,” also known as “the three blessings,” is a part of positive psychology. It is an exercise intended to increase happiness and a sense of well-being.

Our mind subconsciously focuses more on the negative events of the day and tends to overanalyze and overthink them. This creates a sense of self-doubt and low self-esteem. By redirecting our thoughts from the negative occurrences of the day to the positive. We can do a lot to correct this negative bias.

Method:

Each night before going to sleep:

Think of three good things that happened today. It can be anything but should be positive to you. Eg. I had a good and healthy breakfast, I completed all my tasks.
Write them down.
Reflect on why they happened. This is perhaps the most important step. To think why the listed events are positive to you.

When to practice it:

To be done every day before bedtime for at least six months.

V. Sleep Hygiene:

Many patients with a depressive disorder have trouble falling or staying asleep. People with insomnia , for example, may have a tenfold higher risk of developing depression than people who get a good night’s sleep. American Academy of Sleep Medicine defines sleep hygiene as a series of healthy sleep habits that can. improve your ability to fall asleep and stay asleep. For people with insomnia and chronic sleep disturbances, it is an important part of the treatment.

AASM has provided the mentioned tips to establish healthy sleep habits:

Keep a consistent sleep schedule. Get up at the same time every day, even on weekends or during vacations.
Set a bedtime that is early enough for you to get at least 7-8 hours of sleep.
Don’t go to bed unless you are sleepy.
If you don’t fall asleep after 20 minutes, get out of bed. Go do a quiet activity without a lot of light exposure. It is especially important to not get on electronics.
Establish a relaxing bedtime routine.
Use your bed only for sleep and sex.
Make your bedroom quiet and relaxing. Keep the room at a comfortable, cool temperature.
Limit exposure to bright light in the evenings.
Turn off electronic devices at least 30 minutes before bedtime.
Don’t eat a large meal before bedtime. If you are hungry at night, eat a light, healthy snack.
Exercise regularly and maintain a healthy diet.
Avoid consuming caffeine in the afternoon or evening.
Avoid consuming alcohol before bedtime.
Reduce your fluid intake before bedtime.

VI. Mindfulness of Breathing (Anapana Sati):

Anapana Sati aka mindfulness of breathing means the mindfulness established on an object all the time with each in and out breath. Ana = incoming breath; Apana = outgoing breath; Sati = awareness. (Awareness of incoming and outgoing breath).

Benefits:

Concentration, awareness, and alertness of mind improve.
Decision-making power improves.
Self-confidence improves.
Agitation, nervousness, stress, tension, and fear decreases.
Better performance in studies, sports, and extra-curricular activities.
The mind becomes healthy, wholesome, and strong.
One becomes full of good wishes for others.

Practice method:

Sit comfortably keeping your waist, back, and neck straight.
Keep your eyes and mouth gently closed.
Remove your spectacles (for those who wear them).
Focus your entire attention on the entrance of your nostrils.
Remain aware of the natural breath as it comes in, as it goes out.
Don't try to control the count or regulate the breath.
Don't add any word or mantra - verbalization, or imagination of any kind.
When the mind wanders away, bring it back to awareness of respiration.
Try to remain aware of each and every breath that comes in and goes out.

When to Practice:

For getting full benefits, it is necessary to practice anapana for 10 - 15 minutes twice a day (morning and evening).

VII. Lifestyle modifications:

1. Stay away from substance abuse:

The use of illegal drugs or the use of prescription or over-the-counter drugs or alcohol for purposes other than those for which they are meant to be used, or in excessive amounts. Substance abuse may lead to social, physical, emotional, and job-related problems. Such substances are often consumed to get a quick fix for underlying psychological problems.

The vicious cycle of alcohol and other illegal substances in different scenarios:

Sleep disturbance: many people who are unaware of the harmful effects of alcohol or other substances consume them for a quick fix for falling asleep.
Depression and sadness: many patients who feel depressed and sad consume substances for a quick fix to elevate and elate their mood.
Anxiety and stress: Many people with anxiety and stress consume such substances for a quick fix to calm themselves and reduce the sympathetic hyperactivity of their bodies.
There is a tolerance that develops to such substances and the person requires more and more amount of such substances to achieve the same effect, which later leads to dependence.

There are healthy ways to handle stress, sadness, and sleep disturbances. Evaluate yourself and the people surrounding you for addiction and seek professional help.

2. Limit smartphone use:

Smartphone addiction sometimes referred to as problematic mobile phone use, is a behavioral addiction thought to be similar to that of internet, gambling, shopping, or, video game addiction and leads to severe impairment or distress in one’s life. Problematic smartphone use can lead to credit card misuse and compulsive shopping online. Moreover, there is a risk of developing social media addiction, leading to poor self-esteem, poor performance at work, and interpersonal conflicts. The commonest habit of scrolling through social media before going to bed also leads to interrupted and poor quality of sleep leading to daytime sleepiness and fatigue.

It is important to identify this behavior and limit smartphone use to less than 2 hours per day.

3. Practice your religion:

Having and practicing religion provides a person with a sense of faith and something to believe in. Some of the psychological benefits of practicing religion are: Helps a person to stay calm, decreases craving and addiction tendencies, reduces suicidal tendencies, and develops a sense of well-being.