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.
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8 Comments to
“A Note to the Severely Depressed: Don’t Try So Hard”
Many people seem to forget the Behavioural component (which incidentally has the most effect) when applying Cognitive Behavioural techniques to treat depression. No amount of thinking/meditating will improve symptoms unless some form of positive reinforcers are regularly experienced – hence activity scheduling & graded task assignment in the early mid stages of therapy(coupled with thought stopping and plenty of distraction tasks!)
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I have suffered from anxiety/ severe depression for most of my life, and can attest to the view that trying to think oneself out of it is impossible.
I have read so many self-help books, and gone deeper and deeper inside myself, all to no avail.
There is definitely a place for distraction/ keeping busy, and talking to other people.
I find this helps.
I really appreciated this post. I’m grappling with whether to continue to take anti-depressants while trying to conceive. I’m in the highly recurrent severe depression category. When I’m better (thanks to meds…) I feel like I *should* be able to go off. And yet, my psychiatrist is always saying, yes, it’s great you are feeling better, great to exercise, great you’ve learned so much in therapy, great that you have more social support, etc. etc…. but those things wouldn’t be possible without the effective meds, and wouldn’t be enough to fight off a recurrence without the meds. I know she’s right, that when I was severely depressed last time, I was simply unable to implement my therapist’s admonitions to stop “negative self talk”… it was only when the meds had helped first that suddenly what she was talking about became possible.
This was such a relief to read. Absolutely great advice. Thank you so much!
great one..thanks!
Good perspective to treat it as it is illness of the brain…so true would we beat ourselves up for our cancer not healing? But in society that’s what happens with those with mental health issues because it’s associated with weak will, not illness. This permeates even after years having a DSM that helps diagnose it as illness…so much stigma even though everyone knows someone with this illness.
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Last reviewed: By John M. Grohol, Psy.D. on 23 Nov 2009
