I once heard someone describe depression as having a monkey on your back, the more you try to shake it loose, the tighter it grips. This very colourful way of depicting the “cancer of mental health” goes a long way to help us understand what sufferers go through. Whether it is a lesser “dark cloud” day or a full-blown depressive episode that lasts several weeks, depression affects a vast majority of the planet’s population and statistics state that the problem is likely to dramatically increase in the future.
Coming back to the monkey, depression sufferers generally suffer from typical symptoms but it is often dysfunctional thought patterns that make the problem worse and ensure that the monkey stays strong. Let’s first look at some facts:
- Around 20% of people will suffer from some form of depression during their lives.
- Most people will experience depression for the first time in their twenties.
- 15-40% of all cases will persist for one year and of these 22% will still have depression two years later.
- Each depressive episode dramatically increases the chance that another episode will be experienced.
- Those whose parents were depressed are at greater risk of also being depressed.
For many sufferers, the first port of call is the local GP who is likely to use medication as a first line of attack. I know from experience that after the right dosage is found, symptoms can quickly disappear temporarily but this is not a long-term solution and sufferers are then either left to their own devices or pushed on to a therapist who has to justify every session to the managed care systems.
As a depression sufferer myself, I know that the thought patterns that surface when we are low not only complicate matters but go a long way to sustaining the depression. Our minds have been trained to look for solutions and find answers to problems, trying to close the gap between where we are and where we want to be, the so-called ‘doing’ mode. When we are depressed, the mind tries frantically to find a reason why we are down. This leads to over-thinking, rumination and daydreaming leaving us on autopilot as we go through our daily activities. Worse still, old thought patterns from the past can take over leading to a lack of self-esteem, putting us firmly on the spiral of exhaustion.
Many psychologists and therapists are increasingly guiding sufferers towards a technique that has been used in Eastern religions for centuries, that is Mindfulness. Mindfulness is the art of being totally aware of the present moment. It is a state of active, open attention on the present. When you’re mindful, you observe your thoughts and feelings from a distance, without judging them as good or bad. Instead of letting your life pass you by, mindfulness means living in the moment and awakening to experience, the so-called ‘being’ mode.
Many depression sufferers are now being offered Mindfulness in association with Cognitive Behavioral Therapy (MBCT) as a coping strategy when negative thought patterns take over. I have been using this technique personally for years and can vouch for its effectiveness. Dr. Zindel V. Segal, a co-developer of mindfulness teaches it to groups of patients in eight sessions. He leads them through a series of exercises that include sitting meditation, yoga-type stretching, deep breathing and walking, the American Psychological Association reports on its website. The exercises, conducted in a supportive environment, take patients’ minds off what’s bothering them and encourages them to live in the moment. They can use this technique as a coping and self-control mechanism to subdue or interrupt feelings of hopelessness and helplessness when they first emerge. Patients do homework in between sessions that reinforces what they’ve learned and should continue practicing these exercises on their own after the sessions end. Depression rates improved in patients who underwent MBCT, during, immediately after and a month after treatment, according to a 2007 article in the journal Psychology and Psychotherapy: Theory, Research and Practice. They also reported that the patients happily continued to practice the techniques they learned when their sessions ended.
A December 2, 2008 article on the Science Daily website described a 15-month study by University of Exeter researcher William Kuyker who reported that, over 15 months, the depression relapse rate was 13 percent higher among a group of people who used antidepressants than among those who underwent MBCT. “In addition, the group on the MBCT program reported a higher quality of life, in terms of their overall enjoyment of daily living and physical well-being,” the article added. Because one therapist teaches MBCT to groups of 10 to 12 patients over just eight weeks, it could become a cost-effective alternative to holding a higher number of one-on-one counseling sessions in some cases, Science Daily noted.
Disarm your Inner Critic
It often seems that when we get into situations when our self-esteem and confidence are at their lowest point, there appears to be an inner voice telling us how bad we are, how worthless we are,how we should avoid specific situations in order to protect ourselves from pain and rejection. That may make sense to us at the time but heeding advice from our inner critic makes the message stronger, leading to permanent low self-esteem. We fail to realise that following this inner voice stops us meeting the very challenges that will help us recover.
You may wonder where this inner critic comes from and why it has such an effect on our lives. There, we need to look at early influences, inconsistent parenting styles and being set impossible targets by parents who were never quite happy and always wanted more or something different from their child. While these influences set the seed of low self-esteem, it is generally our own lack of ability to recognise and disarm the inner critic that allows it to re-run these stories over and over again.
The first step needed to rid yourself of the inner critic is to recognise what its purpose is. In therapy, many questions are asked in order to probe for answers to this. A skilled therapist will quickly work out why the inner critic appears at specific points and what it is urging the patient to avoid. Once this is done, the long process of disarming the critic takes place using, for example, affirmations, visualization and mindfulness. Hugely important in order to increase self-esteem is to identify personal strengths and weaknesses. In therapy, weaknesses will be made more realistic and the strengths boosted.
As stated, many of the problems associated with lack of self-esteem come from the past. These dysfunctional thought patterns lead us to over-generalisation, should statements and mind-reading,amongst others. It is important to challenge these thoughts and realise that they are thoughts associated with that particular situation and not a general indication of self-worth.