Rising Above
Depression
& Low Self-Esteem
- Do you feel sad, down, or depressed?
- Do you feel unmotivated or powerless to change your circumstances?
- Are you frequently criticizing or blaming yourself?
- Do you have trouble saying “No” to people?
As with anxiety, depression affects both mind and body. When struggling with depression, we experience changes in the way we think and view life, as well as changes in our feelings and emotions. A person may feel s/he is not good enough, that s/he is a failure at work, in relationships, or in life as a whole. The thought pattern is often unchanging and global, as if one is looking at life through a pair of gray-colored glasses. Our thoughts are often plagued by negativity and global self-criticism, and at times recurrent thoughts of death. Our minds are often focused on past events: regret and guilt for things done or said or missed opportunities. Future-oriented thought may be characterized by reluctance to pursue goals and a sense of powerlessness to change our life. Depressive feelings may include sadness, irritability, excessive guilt and hopelessness.
With respect to physical affects of depression, depression’s toll on the body is often manifested by extremes in eating, weight, sleep and energy. For example, a person’s appetite may increase or decrease significantly during episodes of depression with corresponding weight increases or decreases. Sleep duration may intensify or diminish as people experience increased somnolence or insomnia. Extreme fatigue, fidgetiness and restlessness can also occur.
Cognitive and behavioral treatments for depression address the individual’s thoughts, feelings and behaviors. One of the major tenets of cognitive therapy is that our thoughts affect how we feel and therefore influence our behavior. In CBT, the therapist and client work collaboratively to identify and correct maladaptive thoughts associated with depressed feelings. This process is called cognitive restructuring. After the client and therapist practice in session, the client is given homework activities to practice cognitive restructuring on his/her own during the week. The client learns to become a scientist so to speak, detecting when thought errors are occurring that can lead to depressive feelings and behaviors such as withdrawal. The client learns not only how to identify such thoughts, but also to reframe the thoughts to be more in line with reality and therefore help lead to more realistic responses. Behavioral activation, or the scheduling of pleasant activities, is another strategy learned during treatment to help counter the depressed client’s inclination to withdraw socially. These skills, in addition to improving problem-solving abilities form the basis for cognitive and behavioral approaches to depression.
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Mindfulness based cognitive therapy, a more recent approach to help prevent relapse of depression, incorporates a perspective that allows an increased awareness of the present moment. When mindful, we realize more quickly what we are thinking and the feelings we are experiencing. Mindfulness allows us to experience more freely our negative emotions and therefore to be more empowered to live life as we experience it, instead of being encumbered by fear of the future and regret for the past. This is accomplished by various exercises practiced in session as well as daily practice between sessions.
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