Most people who enter therapy for depression improve. It's a diagnosis whose prognosis, with treatment, is very good! We use measurement instruments to diagnose depression and also to assess progress and treatment effectiveness. Almost all of the time that correlates to people saying they feel better, happier, more hopeful about the future, and that their lives are just working better overall. Usually, after a sustained positive shift in mood, that's the time we end therapy. In that last session I like to reflect on progress, what changes were most effective that a person wants to continue, and, very importantly, how to know when things are starting to slide. Unfortunately, for most people with depression, it is episodic and there will likely be another episode in the future. Therapy helps to reduce the frequency, duration, and intensity of these episodes by building effective management strategies and coping skills. When the cloud of depression starts to creep in - or we are just in a challenging period in our lives - our basic self-care starts to slip. When self-care slips, we are even more vulnerable to low mood. It can be a downward spiral.
So how do you recognize when you're not attending to your needs? I like the following checklist:
1. Sleep. Are you sleeping more or less than usual? Are you going to bed at roughly the same time and waking up at the same time every day? Have you started taking daytime naps? Tweaking your sleep habits can make a world of difference in your mood.
2. Eating habits. How's your appetite? Are you eating more or less than usual? Have you had any sudden unintended weight gain or loss? Has there been a change in your eating habits? Are you drinking enough water? Pay particular attention to relying on substances to "get going" or "relax" such as caffeine, sugar, or alcohol as these can get you in a cycle that is hard to break.
3. Leaving the house. Are you making sure to leave the house at least once during the day, if only to walk around the block? Stay-at-home parents, retirees, and people who work from home in particular can get in a rut of not leaving the house, which we know can negatively impact mood.
4. Project or task. Do you have at least one agenda item every day? Most of us do better with some level of daily structure, so be sure to schedule something each day. Accomplishing even the smallest of tasks boosts self-esteem and mood.
5. Showering. This is one that tends to slip when we're really not doing well. Are you bathing, brushing your teeth, and putting on clean clothes each day? Is that happening before noon? These behaviors signal a fresh start to our brains and improve mood.
6. Move your body. There is evidence that moving your body in some way for at least 10 minutes a day is just as effective as antidepressant medication in improving depression. It doesn't matter how intense or for how long. Find something you like and are more likely to actually do.
7. Seeing other people. Has it been a week since you made social contact with anyone outside of your household members? Are you isolating? Strive to be around others at least once a week. Make a lunch date with a friend, or just go to a free talk at the local bookstore. Being around others helps distract us from self-defeating thoughts in our minds and provides support, even when not talking about mood.
So how do you recognize when you're not attending to your needs? I like the following checklist:
1. Sleep. Are you sleeping more or less than usual? Are you going to bed at roughly the same time and waking up at the same time every day? Have you started taking daytime naps? Tweaking your sleep habits can make a world of difference in your mood.
2. Eating habits. How's your appetite? Are you eating more or less than usual? Have you had any sudden unintended weight gain or loss? Has there been a change in your eating habits? Are you drinking enough water? Pay particular attention to relying on substances to "get going" or "relax" such as caffeine, sugar, or alcohol as these can get you in a cycle that is hard to break.
3. Leaving the house. Are you making sure to leave the house at least once during the day, if only to walk around the block? Stay-at-home parents, retirees, and people who work from home in particular can get in a rut of not leaving the house, which we know can negatively impact mood.
4. Project or task. Do you have at least one agenda item every day? Most of us do better with some level of daily structure, so be sure to schedule something each day. Accomplishing even the smallest of tasks boosts self-esteem and mood.
5. Showering. This is one that tends to slip when we're really not doing well. Are you bathing, brushing your teeth, and putting on clean clothes each day? Is that happening before noon? These behaviors signal a fresh start to our brains and improve mood.
6. Move your body. There is evidence that moving your body in some way for at least 10 minutes a day is just as effective as antidepressant medication in improving depression. It doesn't matter how intense or for how long. Find something you like and are more likely to actually do.
7. Seeing other people. Has it been a week since you made social contact with anyone outside of your household members? Are you isolating? Strive to be around others at least once a week. Make a lunch date with a friend, or just go to a free talk at the local bookstore. Being around others helps distract us from self-defeating thoughts in our minds and provides support, even when not talking about mood.
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