When you think therapy
do you imagine lying on a leather couch five days a week for twenty years or doing the California touchy-feely thing with
a guru sitting in the lotus position?
For heavens sake, you’re in midlife! You
don’t have twenty years to waste. And you would rather spend your money on one good outfit from Saks
Fifth Avenue—if you could just get over this depression thing and go shopping.
Are you good
at following straightforward common-sense advice? At least willing to try? Then COGNITIVE-BEHAVIORAL
THERAPY, along with medication (when appropriate) may be just the ticket.
Cognitive refers to the
thought-changing part of this therapy. Behavioral refers to the action-changing part of this therapy.
Cognitive-behavioral therapy can be accessed in many ways. Although the in-person support and expertise
of a helping professional is great, it isn’t always necessary. There are several excellent books
that provide suggestions for self-help.
Addressing your depression involves practicing new
You practice new skills throughout your life—from taking
your first step to taking your last breath. Better feelings emerge from the combination of new thoughts
and new actions.
The hardest part of treating your own depression, is overcoming the inertia and
lack of energy that keeps you from making even the simplest improvements in your life.
When a woman fails to improve:
- It is NOT because she doesn’t want to change,
is NOT because she isn’t capable of change,
- It is because she hasn’t found A SMALL ENOUGH STEP to start
Start by separating function and feeling.
you WAITING to take that first step until you FEEL better? Are you avoiding that walk because you FEEL
too tired? If so, you are trapped in a model of illness that applies to physical illnesses or injuries.
Mom and the doctor always told you to rest until you FELT better. This approach is truly deadly
when it comes to depression.
Restin’ is for
creaky bones, Restin’ is for old folks homes,
is for stomach flues,Restin’ ain’t to cure the blues.
In the treatment
of depression, function always comes before feelings.
You have to change your behavior
or how you are functioning, FIRST. The Nike slogan Just Do It applies here. Have someone
buy you a Nike T-shirt. Better yet drag yourself to the outlets and buy yourself one. With
the slogan emblazoned across your chest, forge out into the world. Don’t ask yourself how you FEEL.
The answer will always be, “LOUSY!”
One sure cure.
Put on the walking outfit, at least the shoes, and stand outside your front door. Yes…that’s
the ONLY goal. Just outside the front door. You’ll discover that 99% of the time
you WILL take that walk.
Try tracking changes in FUNCTION
separate from changes in FEELING.
Every day, rate your FUNCTION and FEELING
on a monthly calendar.
Use this self-anchoring scale:
- 1 = Much
worse than average
- 2 = Somewhat worse than average
- 3 = About average for me
- 4 = Somewhat better than
- 5 = Much better than average
Each evening, rate how you FUNCTIONED that day:
- Did no more or no less than usual? Give yourself a three.
- Took a walk for the
first time and did the breakfast dishes? Give yourself a four.
- Had been walking daily but stayed
on the couch all day? Give yourself a two.
- Then, rate how you were FEELING
- Felt just as depressed as usual? Give yourself a three.
- Laughed at a TV show? Give yourself a four.
- Cried for six hours
instead of the usual two? Give yourself a two.
on upping your FUNCTION scores as the days go by. I guarantee that your FEELING scores will follow along
in a few weeks.
Next, try to structure your days.
been trying to improve your functioning but the hours roll on by and you’re still on the couch. You’ve
lost your TO-DO list along with your marbles. If someone doesn’t remind you, you don’t even
comb your hair or take a shower.
Try to complete ONE activity for EACH hour of the day.
Shower or wash face and hands and put on sweats
Eat cereal, milk, and strawberries
Take 10 minute walk around block
Wash the breakfast dishes
Eat muffin and yogurt
Sit outside on the patio for 15 minutes
Eat turkey sandwich, carrots with dip, ice tea
Take the cleaning to the cleaners
Call Judy and ask her to walk with me tomorrow
Eat piece of fruit and string cheese
Take Fluffy for 10 minute walk
Fix the meatloaf and put it in the oven
Eat meatloaf, baked potato, vegetables, and salad
Eat dessert and watch Jeopardy
Watch one favorite TV program
Take warm bath with lavender in water and put on PJs
Put Fluffy out and kiss Bill (or vice versa!)
Go to bed
Helpful hints for structuring your day:
- Complete your schedule for the next day at your most energized moment the day before
- Post your schedule on
- Make each activity very specific as in the examples above
- Include both recreational activities
- Include meals and snacks
- Include grooming and dressing
- Absolutely include exercise, starting
with 10 minutes
- An activity can take as few as 5 minutes or as much as an hour
- Have at least two activities
a day scheduled for OUTSIDE the home
- Check off DID IT even if you’ve made only a minimal effort to do the activity
About going to work when you are depressed.
Staying on the
job, as difficult as it may be, is a good way to fill some of those hours. If you are able to stay on the
- Work only your scheduled hours
- Walk on your breaks
- Take your lunch hour
- Keep more
notes about TO DO and DONE to compensate for poor concentration
- If he or she is a decent sort, talk to your supervisor
about temporary workload reduction, time off for doctor appointments (including ongoing therapy), or reduced
- If your supervisor is not approachable or your company requires it, bring in a written modified work plan
ordered by your doctor
Consider taking sick leave from work if:
- Your concentration
is so impaired that you cannot perform your duties
- Staying on the job poses a risk to you (for example, you drive
a delivery van)
- Staying on the job poses a risk to others (for example, you’re in charge of dispensing medications
at a nursing home)
When you do stay off work:
- Be sure you obtain a signed doctor’s
note BEFORE you take off work or as soon as possible afterwards. Doctors, in general, will NOT grant you
work leave after the fact.
- Check with your Human Resources Department to see if you are eligible for any type of short-term
disability. It is your responsibility to obtain this information and take the appropriate forms to your
doctor to complete.
- Check with your Human Resources Department for FMLA (Family Medical Leave Act) paperwork to be
completed by your doctor. FMLA does not provide for you to be paid. It does guarantee
your position will be held for up to 12 weeks a year. FMLA can also cover for time off for ongoing treatment.
Most states have laws (in addition to the FMLA) prohibiting employers from terminating an employee when
they are officially off on sick leave. Talk to your Union, the Department of Labor, or an attorney if you
Getting your body in motion.
The most important
single action you can take to alleviate the symptoms of depression is to EXERCISE.
can take the form of any kind of movement.
The goal is to increase your heart
rate and breathing rate.
This type of exercise is called aerobic exercise—think
of aerobic as bringing more healthy air into your body.
Walking is the easiest exercise to add to
your day. You need the least equipment—only low-heeled walking shoes, although running shoes offer
the best cushioning for knees and hips. You don’t have to go to a special place. You
don’t have to put out money. You just have to DO IT.
If you are limited
by pain or other health conditions and cannot walk, the next best bet is doing chair aerobics, designed for seniors or folks
with physical limitations. Water aerobics and swimming are also kinder to worn knees, hips, and achy lower
backs than walking. Running or jogging is only for those with hardy joints or an excellent orthopedist.
Roller blading, downhill skiing, bungee jumping, or skydiving should only be attempted on a major birthday, with your
will updated—but they WILL increase your heart rate!
Your goal should be to walk or do some
type of movement 20 minutes every day if possible, but at least three or four days a week. But don’t
start with 20 minutes; start with 5 or 10 minutes. If you haven’t exercised for months, or
ever, your muscles will feel it even with 5 minutes.
Don’t like to walk? Try
dancing to the radio in your kitchen, doing step aerobics with your telephone book, having sex (full credit), thinking about
having sex (sorry, only half-credit), or hanging up the wash on an outside line (bonus of fresh smelling sheets).
Don’t have a safe place to walk? Make a walking date with a friend (a big, burly
one if necessary) or walk in the mall (most indoor shopping malls are open one hour before the stores open for just this purpose).