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Depression: What is it and how to overcome it
Depression is a mood disorder. While there are various mood disorders, the one most commonly referred to when using the term "depression" is Major Depressive Disorder (MDD).
In MDD, there is a noticeable decline in mood and loss of interest in activities that were once enjoyable, persisting for more than two weeks. The primary symptoms of MDD include changes in weight, sleep disturbances, loss of energy, agitation or retardation in movements, feelings of worthlessness or guilt, difficulties in thinking, concentrating, and decision-making, and in severe cases, recurrent thoughts of death or suicidal ideation.
It's important to note that meeting all criteria is not necessary to receive a diagnosis of MDD. The focus in the psychotherapeutic process is on addressing the individual's suffering and restoring functionality and levels of happiness and interest to a desired degree.
Exploring such a complex mental phenomenon requires nuanced answers. However, for the sake of dualism and simplicity, let's consider the human being as consisting of both body and mind. By doing so, we can gain some insight into this disorder that affects more than 200 million individuals worldwide each year.
And so, biologically, individuals with depression often exhibit reduced levels of certain neurotransmitters crucial for mood regulation, such as serotonin, dopamine, and norepinephrine.
Also, psychologically, people with depression tend to adopt a pessimistic outlook on themselves, the world, and the future. They may experience feelings of helplessness, worthlessness, and powerlessness. Their thoughts become circular and self-defeating, leading to a sense of being trapped in negative cycles ("I should have gone out shopping, but I didn't because I am useless, and I am useless precisely because I didn't go shopping, just as I didn't attend class because I am useless," and so on). They believe they deserve the situation they are in because they perceive themselves as inherently "unworthy, bad, and flawed" individuals who get what they deserve. They are more prone to cognitive errors such as dichotomous thinking, over-generalization, catastrophizing, arbitrary conclusions, and rejection of the positive.
The prevalent pattern observed in individuals with depression is one characterized by loss, defectiveness, and hopelessness.
However, depression is not solely an individual matter. Environmental factors , such as the quality and nature of early relationships with significant others, childhood trauma, abusive parental behaviors, multiple stressors in the past and present, a history of loss or bereavement, and various other factors, may also contribute to the onset of depressive symptoms.
Again, for convenience, we will split the answer into two parts: those actions you can take independently and those that require assistance and collaboration.
On your own, you can adjust your sleep schedule so that you fall asleep and wake up at times that align with your circadian rhythm (otherwise known as your biological clock). Ensure you get at least 7 hours of sleep.
Additionally, incorporating exercise into your weekly routine can be beneficial, as it releases mood-improving chemicals (endorphins), enhances self-confidence, improves sleep, promotes physical health, and offers numerous other positive effects. Committing to 30 minutes of your preferred exercise three times a week can provide a potent means of combating depression.
Of course, nutrition, a major factor in mood regulation, plays a crucial role as well. A diet rich in protein, fiber, and omega-3 fats, while low in processed foods, sugar, alcohol, and saturated fats, can bolster your immune system, promote faster and more efficient brain function, and contribute to overall well-being. Aim to consume 3 liters of water daily.
Lastly, managing stress levels through relaxation techniques like diaphragmatic breathing or meditation, maintaining connections with your social network , and engaging in activities and hobbies, even when your mood and interest are low, can significantly alleviate symptoms of depression.
However, we are not superheroes, and depression can sometimes manifest with roots so deep and symptoms so painful that it feels like facing a formidable supervillain. In such challenging times, seeking help is not a sign of weakness but rather a courageous step toward healing. Even the most resilient heroes, when faced with overwhelming adversity, turn to their trusted allies for support (think Batman, Sherlock Holmes, Frodo Baggins, and others).
Psychotherapy offers several avenues to help alleviate depression. Initially, the therapeutic relationship built with the therapist serves to soothe symptoms of pessimism, hopelessness, and anhedonia. The therapist not only listens but also comprehends the issue at hand, standing alongside the individual and supporting their efforts to overcome the weight of depression. Providing emotional support and validation, the therapist offers an alternative, objective perspective on matters, which can be particularly beneficial for someone who perceives everything through a negative and bleak filter. The therapeutic setting is intentionally crafted to offer a safe and supportive space for exploring thoughts, emotions, and experiences associated with depression and mental distress.
Furthermore, within the therapeutic framework, the therapist employs a range of cognitive and behavioral techniques, tailored to alleviate depression and enhance pleasure and self-efficacy. Particularly effective methods include Dysfunctional Thought Record, cognitive restructuring, activity planning, time management, establishing a healthy routine, and behavioral activation. With the therapist's guidance, it becomes feasible to set more realistic, behaviorally measurable goals, while monitoring progress, adjusting strategies in case of setbacks, and recognizing and celebrating achievements and successes.
Through the establishment of a secure bond grounded in mutual acceptance and understanding, therapist and client collaborate in utilizing diverse strategies and therapeutic tools to effectively combat depression and enhance levels of personal happiness, meaning, and satisfaction. No individual deserves to endure the burden of depression when solutions, support, and hope are available.
Stress, Anxiety and Fear: Similarities, differences and how to combat them
Firstly, stress is a normal bodily process that occurs in response to a perceived threat, challenge, or demand that we believe surpasses our ability to manage and cope effectively. It is accompanied by a cascade of physiological, emotional, and behavioral responses aimed at helping us cope with this perceived threat or danger. Stress is a broad concept that includes the body's response to any threat, danger, demand, or pressure, whether real or imagined (such as stress related to work, marriage, household expenses, etc.).
On the other hand, fear is an emotional response that emerges in reaction to an external, tangible threat that is consciously perceived. It serves as an innate survival mechanism, activating our body's fight or flight response (sympathetic nervous system) through the release of hormones like adrenaline and cortisol. This leads to heightened heart rate, increased blood pressure, enhanced alertness, and other physical changes aimed at rapidly preparing the body to confront or evade imminent danger. Fear typically manifests as a transient reaction to a specific stimulus or situation. Consequently, once the threat diminishes or dissipates, the fear response diminishes as well (for instance, fear triggered by an animal attack or a near-collision with a vehicle).
Finally, anxiety is characterized by persistent and excessive worry about future events, situations, or scenarios. Unlike fear, which is a response to an immediate threat, anxiety involves anticipation and an unspecified fear of potential threats or negative future outcomes. While fear and stress are frequently triggered by specific stimuli or stressors, anxiety can arise in the absence of an identifiable threat or in anticipation of future stressors (for example, anxiety about one's professional future or health). Often, it is accompanied by physical symptoms such as rapid heartbeat, muscle tension, sweating, and stomach discomfort.
If we were to conduct a quick analysis of these three phenomena, we would classify stress as primarily a physiological response to real or perceived threats or pressures in life. Fear, on the other hand, is an emotional response triggered by an immediate, real threat. Anxiety, meanwhile, is a cognitive process characterized by persistent worry about future, as-yet-nonexistent threats or scenarios.
While stress, fear, and anxiety share some similarities in their physiological and psychological responses, each experience has its own unique characteristics and nuances. The main symptoms of stress stem from the activation of the sympathetic nervous system, which is part of the autonomic nervous system responsible for the fight or flight mechanism. Let's explore how these symptoms manifest across the four axes of psychological experience.
Physical symptoms:
- headaches or migraines
- muscles tension
- chest or neck pain
- fatigue or exhaustion
- digestive problems
- disturbed sleep
- increased heart rate
- sweating
- shallow breathing or hyperventilation
- flushing of the face
- dizziness or nausea
- skin issues
- decreased sexual desire
Emotional symptoms:
- agitated mood
- irritability
- nervousness
- sadness or depression
- feeling emotionally overwhelmed
- frustration
- disappointment
- reduced self-confidence
- difficulty relaxing
Cognitive symptoms:
- anxious thoughts
- chained destructive scenarios
- overestimation of risk
- negative/pessimistic thoughts
- underestimation of individual abilities and external help
- "running thoughts"
- difficulty in concentrating
- fear that the mind "goes blank"
- memory problems and forgetfulness
- difficulty in making decisions
- mental fog
Behavioral symptoms::
- avoidance of stressful stimuli
- alcohol and drug consumption (legal or illegal)
- excessive or reduced appetite for food
- social withdrawal
- procrastination and avoidance of responsibility
- difficulty with time management or organization
- impulsive behavior
- difficulty in communicating or expressing thoughts and feelings
The term "Anxiety Disorders" is used by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to encompass those mental disorders that share characteristics of excessive fear, anxiety, and corresponding behavioral disorders.
Here are the five most common ones:
Generalized Anxiety Disorder (GAD)
When we think of anxiety disorders, more often than not we think of Generalized Anxiety Disorder and that is because GAD is characterized by persistent and excessive worry about various aspects of life, such as work, health, finances, or relationships. Individuals with GAD often struggle to control their anxiety, significantly impacting their daily functioning. Symptoms of GAD typically include feelings of anxiety and agitation, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbances.
Panic Disorder
Individuals with Panic Disorder experience frequent and sudden panic attacks characterized by a sudden onset of intense fear or discomfort. During these attacks, individuals may experience four or more of the following symptoms: palpitations, sweating, trembling, shortness of breath or choking sensation, chest pain or discomfort, nausea or abdominal discomfort, dizziness, feeling faint, hot or cold sensations, numbness or tingling, paresthesia, feelings of derealization (disconnection from reality) or depersonalization (detachment from the self), fear of losing control or going "crazy," and fear of dying. Despite the distressing nature of panic attacks, they do not pose a threat to physical health. To receive a diagnosis of Panic Disorder, individuals must experience multiple such attacks for more than a month.
Agoraphobia
Agoraphobia is characterized by intense fear and avoidance of situations or places where escape may be difficult, or help may not be readily available in the event of a panic attack or other anxiety symptoms. Common triggers for individuals with agoraphobia include crowded places, public transportation, queues, open spaces, or situations where they feel trapped or unable to escape. To manage their fear and anxiety, individuals with agoraphobia may avoid leaving their home altogether, or if they do venture out, they often do so accompanied by a trusted person.
Specific Phobias
Phobia refers to the irrational and excessive fear of specific objects, situations, or activities. Individuals experiencing phobias recognize that their fear is not based on realistic or direct threats, yet they are unable to control their anxiety levels. Specific phobias are classified into five categories, which include fear of animals (e.g., arachnophobia, cynophobia), fear of the natural environment (e.g., acrophobia, hydrophobia), fear of blood-injection-injury, fear of specific situations (amaxophobia, claustrophobia), and a miscellaneous category (emetophobia, coulrophobia). These phobias often lead the individual to adopt avoidance behaviors and experience significant distress when confronted with the phobic stimulus.
Social Anxiety Disorder (Social Phobia)
In Social Anxiety Disorder, individuals experience intense fear or anxiety in one or more social situations where they may be subject to scrutiny or judgment by others. They fear that their actions or visible signs of anxiety will lead to negative evaluation and criticism from others. Such situations may include socializing with others, public speaking, performing tasks in public, or being the center of attention. Social Anxiety Disorder can be understood as a specific phobia of social circumstances, hence it is also referred to as Social Phobia.
Managing stress levels and anxiety is fundamental for maintaining good mental health. You can start by implementing the same strategies that help reduce depression levels, as anxiety and depression share similar biological, cognitive, and behavioral background, often associated with high levels of neuroticism. You can find these tips here.
Additionally, in cases of persistent and intense stress or anxiety, stress reduction and stress management exercises, although difficult for some at first, can be massively beneficial. While no single technique is universally more effective than others, certain methods may be more suitable for addressing individual needs. For example, scientifically documented techniques include diaphragmatic breathing, progressive muscle relaxation, mindfulness meditation, yoga, distraction techniques, mental imagery, grounding exercises in the present moment, or even book reading, drinking a hot tea, etc.
Certainly, when aiming to reduce stress and enhance relaxation, it's sensible to steer clear of stimulants such as coffee and certain drugs.
Psychotherapy offers a secure and supportive environment, offering relief to those grappling with anxiety disorders or intense anxiety. Alongside fostering a therapeutic alliance and genuine acceptance, therapists can customize treatment to suit individual needs and preferences, considering factors like severity, goals, and underlying factors that contribute to the emergence and maintenance of your anxiety.
Furthermore, a therapist proficient in Cognitive Behavioral Therapy can be particularly beneficial in addressing the symptoms of your anxiety. This approach offers a plethora cognitive and behavioral techniques, specifically tailored for this purpose. Among the most effective are psychoeducation on the nature of anxiety and stress disorders, learning relaxation techniques, practicing stress management skills, practice in assertiveness, the “worry time” technique, systematic desensitization, exposure therapy (exposure to feared stimuli), cognitive restructuring, problem-solving, and enhancing self-confidence and self-image.
Lastly, as part of Cognitive Behavioral Therapy, you will be trained in the technique of exposure. Exposure involves direct contact with the feared stimulus and can be conducted in a flooded, graded, or imaginal manner. Your therapist will lead you through exposure exercises in a safe and supportive environment, offering guidance and assistance in confronting fearful situations and anxiety triggers. The goal is to build resilience to stress without resorting to avoidance behaviors.
Having established a secure and supportive relationship, the client and therapist can employ a variety of practices and therapeutic tools aimed at significantly improving relaxation levels, well-being, and mental calm. With numerous scientifically validated methods available to combat intense anxiety, there is no compelling reason to endure its deleterious effects by yourself.
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