Feeling Better

Beat Depression and Improve Your Relationships with Interpersonal Psychotherapy

Cindy Goodman Stulberg, Ronald J. Frey

• Publisher: New World Library
• Year: 2018
• ISBN:
  9781608685691
• Topic: Psicologia
• Subtopic: Relazioni interpersonali in psicologia

Beat Depression and Improve Your Relationships When it comes to treatment for depression, we have been getting it all wrong. Instead of focusing on just the biochemistry, we need to focus on the importance of relationships. Feeling Better offers a step-by-step guide using a research-proven approach called interpersonal psychotherapy, or IPT, which can help you deal with the issues that may be contributing to your unhappiness. Therapists Cindy Stulberg and Ron Frey have used IPT with clients for more than twenty years and achieved dramatic, lasting results after only eight to twelve weeks. They have now created this accessible, first-of-its kind guide. Feeling Better teaches skills and tools that will allow you to set and achieve goals, articulate feelings, and make constructive decisions. You'll learn to identify and engage with allies and supporters, deal with difficult people, and, if need be, walk away from harmful relationships. Cindy and Ron have taught clients — diagnosed with depression or not — to use these skills in virtually every life situation, from preventing divorce to "consciously uncoupling, " raising healthy children, coping with loss, and dealing with addiction. Writing with wisdom, warmth, and humor, they are savvy coaches and inspiring cheerleaders who can offer a lifeline to the depressed and life enrichment to anyone.

WEEK 1

What If You Had a Broken Leg Instead?

Our first step is to discover what depression is — and what it isn’t. (You might be surprised!) You’ll learn why you may need to take a temporary break from some of your activities and how to talk to the important people in your life about what you’re going through.

A woman’s life had been turned upside down by a car accident. She was coping with a lot of pain, had given up her successful business, and was struggling with depression.

“Who have you talked to about what you’re going through?” Ron asked her.

“No one,” she answered. “I don’t want to burden my friends. If they saw me like this, they’d be shocked. And I’d be embarrassed. I’ll just wait until I feel better, and then I’ll talk to them.”

“What if you broke your leg instead?” Ron asked. “Would you still go out for coffee with them?”

“Sure,” she said.

“How would it make you feel if you went out for coffee with them even though you had a broken leg?”

“It would feel awkward and like a hassle and a little painful, but I’d probably feel better for having seen my friends,” she said.

“And how would you feel if you didn’t go out?” Ron asked.

“If I stopped socializing, I’d feel isolated and lonely,” she said. “It’d be depressing.”

Bingo. If we don’t see our friends and family, we feel worse. If we do see them, we feel better.

But Ron wasn’t done. “And what if you did go out? How do you think your friends would feel if they saw you with a broken leg?” he asked.

“They’d probably be happy to see me,” she answered. “It wouldn’t bother them that I had a broken leg.”

“So how is that different from going to see your friends when you’re feeling depressed?” Ron asked. “They’ll be happy to see you, and you’ll feel better — so everybody wins. But if you don’t go out to see your friends, you’ll feel socially isolated and they’ll miss you. Everybody loses.”

TRY THIS: Use questions to explore how you’re feeling. Ask them of yourself, or get a friend to help you!

That’s why we need to look at our mood difficulties as if we had a broken leg — so everybody wins.

It’s hard to do. When we have a broken leg, people line up to sign our cast, but when we’re depressed, there’s no cast to sign — so we sign out of our social lives, ashamed and embarrassed by our invisible illness. It’s way better to take a risk, reach out, and break the silence. And we’ll show you how.

Diagnosis: Depression

You don’t have to be diagnosed with depression to benefit from the strategies we’ll teach you. If you feel bad or down or stressed, we can help you feel better.

Understanding what depression is — and what it isn’t — is important, though. Depression is a highly treatable medical illness that negatively impacts how we feel, think, and act. It comes in all different shapes and sizes. Sometimes it’s short-lived (though according to most authorities on mental health, it always lasts more than two weeks). Sometimes it’s mild. Other times it’s severe.

Sadness is part of being depressed. So is losing interest in things that used to get you jazzed. But there’s also a whole list of symptoms that people don’t usually associate with depression: trouble concentrating, indecision, loss of appetite, irritability, difficulty sleeping, and even body aches and pains with no apparent physical cause.

PEP TALK: Depression is a highly treatable medical illness. Yes, highly treatable.

One in six people will experience depression at some point, and the numbers are even higher for women. In fact, some studies show that one-third of women will experience a major depressive episode during their lifetime. So even if you feel alone, you definitely aren’t. Half of those who have one episode of depression will have another if they don’t get treatment. Eighty percent of those who’ve had two episodes without treatment will have a third.

Those last two stats aren’t meant to make you feel worse. Quite the opposite. Studies have shown that the techniques we’ll teach you, which are based on the treatment model called interpersonal psychotherapy (IPT), can help you avoid experiencing this soul-crushing illness again.

Depression goes by many labels: disruptive mood dysregulation disorder, major depressive disorder, dysthymia, premenstrual dysphoric disorder, persistent depressive disorder, clinical depression, postpartum depression, perinatal depression, seasonal affective disorder, and even unspecified depressive disorder.

PEP TALK: If you find it hard to believe you’ll ever feel better, that’s probably the depression talking. It’s common to feel negative and pessimistic when you’re depressed — but stick with us.

Some labels you may have heard. Other labels you may have been given. It doesn’t matter whether your depression is chronic and mild, related to your hormones, tied to the low light of winter, or anything else. We can help you with them all.

Only a trained health professional can diagnose depression, but as far as trusted, validated self-administered assessments go, we like the World Health Organization’s Major Depression Inventory (MDI). It only has twelve questions, and you can access it online for free. Just remember, a questionnaire can’t diagnose depression. If a diagnosis is important to you or your score on the quiz has you concerned, see your doctor.

Depression Debunked

Depression is not a sign of weakness, proof that you’re a bad person, or a form of punishment. You don’t deserve to be depressed. And you didn’t bring it on yourself. No matter how many times your mom tells you to buck up, your buddy tells you to get off your butt, or that little voice inside you says, “Suck it up, buttercup,” it’s not a matter of simply trying harder and — poof — bye-bye depression.

You aren’t selfish, lazy, self-centered, a whiner, or to blame — which is hard for a lot of depressed people to believe, since feeling ashamed and worthless are key symptoms of depression. Depression isn’t a curse. And it isn’t a blessing either (even if a well-meaning person tells you it’ll make you stronger). But it is a very treatable illness.

Depression can affect anyone — even therapists. During the weeks after my first child was born I was a mess of emotions. Even now, decades later, it’s still hard to admit. I remember pacing the hallway in my apartment, wishing I wasn’t so tired, wishing my husband understood how I was feeling, wishing I knew what I was doing. I’m not sure who was crying harder, me or my daughter. I was a therapist. Wasn’t I supposed to have all the answers? My feelings of incompetence were overwhelming.

PEP TALK: Depression is not something you deserve. Don’t let anyone — most of all you — tell you it’s your fault!

When my mother-in-law was in palliative care, I experienced mood difficulties again. It was probably while eating my twentieth bag of cookies that I realized it wasn’t just my mother-in-law I was grieving — it was my mom.

You’d think I’d have figured it out sooner. My mother-in-law was in the same hospital that my mom had been in twenty years earlier, and every time I visited I had to walk past the room where my mom had been so ill. Back then, I was too busy being the strong one, the capable one, and the one everyone admired to really grieve my mom’s passing.

Trust me, this is a journey. I’m still learning that experiencing feelings is okay. And I still sometimes turn to the bag of cookies.

PEP TALK: It takes guts to acknowledge you have a problem and work on making things better. You are one brave, smart, and courageous person!

Depression may not be the only thing on your plate. If you have anxiety, a concussion, a learning disability, an eating disorder, or any other physical condition or mental illness as well as depression, you may find it takes longer to feel better. You may also need some extra help from your family doctor, a therapist, or a support group. Think of it as having two broken legs instead of just one. You’ll need some extra time to heal, and a wheelchair, not just crutches. Be patient and you’ll make progress!

Depression definitely has a cultural component. Some languages don’t have a word for depression as we use the term in English; if that’s true of the language you learned to speak first, there’s a greater likelihood that you’ll express your depression physically, as pain, digestive problems, headaches, and more. There may be a strong taboo against talking about mental illness in your culture. It may be seen as bringing shame on your family, as evidence that you’ve sinned, proof you’ve been cursed, or simply that you’re British — stiff upper lip and all that. Be aware that these forces will influence your attitude toward depression and affect who you can feel safe talking to about it.

Depression can be so severe that you feel like harming yourself. First, you need to tell someone how you’re feeling. Then you need to see a doctor. You may worry that you’ll scare the person you tell. You may feel as though there’s nothing a doctor can do for you. But I’m telling you, help is available. Depression is very treatable. Don’t do something you can’t undo. Ask someone for help. Your safety is more important than anything else.

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THIRTEEN SIGNS YOU MAY BE DEPRESSED

If you find you’ve been experiencing a number of the symptoms on this list for at least two weeks and they’ve been affecting your relationships and your day-to-day functioning, you could be depressed:

1. I feel sad a lot of the time.

2. I just don’t care about things anymore.

3. I’m overcome with feelings of guilt.

4. I feel worthless.

5. I can’t concentrate.

6. I’ve gained or lost weight (without dieting).

7. I’m having trouble sleeping, or I sleep all the time.

8. My performance at work or school is suffering.

9. Making decisions seems harder than it used to.

10. I’m experiencing physical symptoms that don’t have a physical cause.

11. I avoid seeing my friends.

12. I think about hurting myself.

13. I just can’t seem to see the positive side of anything.

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Asking Why

It’s not common, but mood difficulties can have a physical cause, such as a vitamin deficiency, Addison’s disease, multiple sclerosis, pancreatic cancer, traumatic brain injury, or Lyme disease. Depression can even be a side effect of some medications. Ron is still embarrassed to admit that one of his clients, who had been working hard in therapy but wasn’t making any progress, ended up having hypothyroidism. As soon as her doctor started her on medication, all of the skills she’d been practicing with Ron worked like a charm. Visit your doctor to rule out any physical illness or condition that could be causing your depression.

Outside of a biological cause like a disease, deficiency, or medication side effect, no one knows exactly what causes depression. Is it a biochemical imbalance? Is it about serotonin levels? Genetics? Is it something we pick up from our parents growing up? Is it our personality? The reasons for depression are controversial and complex. This is one way depression differs from a broken leg — in most cases there’s no defining moment or single event we can point to as the cause of our emotional pain and malaise.

But that doesn’t stop us ...