There are so many reasons texting is preferable to calling. 

1. You can think before typing. When you're speaking over the phone, the pressure is on to immediately have a response. Especially when emotions are running high, it is hard to have a clear train of thought. Writing it out and having the ability to edit before hitting send helps you get clear on the message you want to send.
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2. It's efficient. Phone calls simply add time. When you make a phone call, you need to dial, wait for the phone to ring, maybe there's some hold time, and then when someone answers you introduce yourselves and maybe exchange some niceties, and then finally you can get to the point. All of that can be bypassed with a text. 

3. It's more private. When you talking on the phone, anyone with functioning ears nearby can overhear you. Speaking in a hushed voice might actually call even more attention to you. Trying to get to a private place takes some effort. Whereas by text, you can be anywhere, anytime discussing the most sensitive information and people around you are none the wiser. 

4. It's less awkward. For some of us, social interactions are painful and anxiety-producing. Texting all but removes that. 

5. It's easier to reveal harder stuff. When you speak your deepest, darkest thoughts, it's almost like you're the lead role in a live performance. Most of us have a much easier time writing it down or filling in a bubble on a survey than actually saying the words out loud. 

You don't have to be suicidal to text a crisis line. You just have to be in a "hot moment" of emotions and could use some help cooling things down. Program it in your phone under a fake name. Share it with your friends. 

More information at www.crisistextline.org.

Commercials during the holiday season lead us to believe that everyone else is joyously sipping on egg nog by the fire, snuggling up with their perfect families. Husbands are buying expensive gifts of jewelry for their wives, who squeal with delight in the perfect reaction while their adorably innocent children peer around the corner feeling safe and fulfilled watching their loving parents. Large sums of money are being spent on gifts and travel and parties and party dresses. Santa has spared no expense. Everyone is getting along, surrounded by loved ones, and sipping on no more than two festive cocktails. These portrayals of holiday cheer  are no one's reality, and high expectations can actually result in a lot of stress and sadness, particularly for those who are prone to depression.

The holidays can bring up a lot of painful feelings for a lot of people. Disappointment in not having a life like the commercials, loneliness from not having family nearby or loved ones with whom to celebrate, anxiety from financial struggles, painful memories from an imperfect childhood, or renewed grief from a loss that is felt by an absence from gatherings. With a little planning ahead, the pain may be avoidable with these tips:

1) Remember that commercials and movies are fiction. Most of us do not have a Norman Rockwell life. 

2) Avoid family conflict. You may need to be around that family member who drives you crazy. Keep your contact limited and cordial. This is not the time to settle a beef.

3) Let go of perfection. The right food, the right gifts, the right outfit, the right activities, the right conversation.... are not as important as just spending time together. Try to relax into the moment and enjoy it for what it is.

4) Accept painful emotions as much as you accept pleasant ones. The quickest way from pain to joy is through. Embrace, allow, experience, and move through them.

5) Prioritize your workout and sleep routines. These are two self-care basics that have a huge impact on mood and our ability to cope with challenges.

6) Seek support if you need it, whether that's a friend or a professional. Now is a time of year many people seek extra support. 

Happy Holidays!

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.

Did you know that shame is learned? We are not born knowing how to feel shame, we are taught. Shame is 
a painful feeling of humiliation or distress caused by the consciousness of "wrong" or "foolish" behavior. It is the result of a judgement by ourselves - or by someone we admire - that we are not good enough in some way. We have all experienced shame at different times throughout our lives. For example, when my husband and I entered couples counseling because we were having difficulty in our relationship, I felt shame for not having relationship mastery as a therapist. I judged myself as not good enough.

Like all emotions, shame serves us and it has many functions. Sometimes shame works well for us. First, shame can function as a motivation to achieve. Many people work hard to avoid a shameful situation. Avoidance of failure (which would be shameful) is extremely motivating. Also, shame can communicate to and influence others. Facial expressions and body language are a hard-wired part of emotions. For example, if you are walked in on while using the toilet, you might try to cover up and hide yourself.  This communicates that you do not want a private act to be exposed, and influences the person to leave quickly and close the door. 

On the flip side, shame can also get in our way. Every emotion has an action urge, and shame's action urge is to hide, avoid, and shrink up. It's a sort of pushing ourselves away. If we're busy hiding and avoiding, we're certainly not taking any risks that may be necessary to grow and be our best selves. Also, shame is a result of a discrepancy of who we think we "should" be and who we really are. Our beliefs about who we "should" be may or may not be helpful, in fact, they might be self-defeating beliefs. They may be undermining our self-esteem. For example, a man believes that showing sadness is a sign of weakness, so when he cries at the loss of his dog he then also feels shame on top of the grief. With this in mind, it probably isn't a surprise that shame is highly correlated with depression and anxiety.

So what can we do about shame that isn't serving us?

The antidote is acceptance. Acceptance is the action of consenting to receive or undertake something offered; a willingness to tolerate a difficult or unpleasant situation. Acceptance is saying that We Are Enough.  Acceptance is challenging self-defeating beliefs. Acceptance is knowing that this situation and our reactions make sense, it's what is, at least for this moment in time. Acceptance is acknowledging that "failure" is just a stepping stone toward our goals. Acceptance is understanding that no person is perfect all of the time and having compassion for those parts of us that are not. Acceptance is an attitude of openness, a willing stance. Taking an opposite action to shame's action urge of hiding: being willing to be open and show our true selves without judgement. 

Try this exercise of a willing posture for acceptance:
1) Sit with your arms and legs uncrossed
2) Relax your body
3) Put your arms out, elbows slightly bent, with palms facing up
4) Tilt your chin slightly up and elongate your neck
4) Sit in this position for a minute or two and notice your thoughts and feelings. It is nearly impossible to feel shame.

Resources:
Brene' Brown's Listening to Shame TED Talk
Marsha Linehan's Dialectical Behavior Therapy, Emotion Regulation Module
 

What do you see in this illustration? A young girl? Or an old woman? Or both? Most of us see one easily, and need more information to see the other. (Hint: the young girl's chin is the old woman's nose)

Our brains are wired to problem-solve, to fill in blanks, to put together puzzle pieces, and to make sense of things. Often this process happens so fast and so instinctually that we don't even notice we're doing it, let alone question the accuracy. In fact, this process happens with all of us, many times over, every single day. Our interpretations of events are informed from many sources: our upbringing, a similar event happening in our history, our education or professional background, relationships, culture, where we live, our mood in the moment, something that happened earlier in the day, etc. So when two people have different reactions to the same situation, this is why. Sometimes we label it a miscommunication or a misunderstanding. At minimum it's a blip on the radar and at maximum it's a big emotional response resulting in extreme behavior.


Consider the following scenarios. What are your interpretations? Are they accurate?

1) You're home alone with your infant. You've been up all night with her and you're exhausted and bleary-eyed. All of a sudden you see a strange man move across the backyard, and he's heading toward your house!  

A: It's the meter reader from the utility company.

2) You're driving to work, it's pouring rain, and you get a flat tire. You pull to the side of the road, get out, and get your car jack and spare tire from the trunk. As you're out in the rain getting ready to use the jack, you see your good friend drive by. You try to wave him down and he looks at you for a long moment but continues on. You know he saw you!

A: Your friend's dog is in the backseat, the dog was just hit by a car, and they are on their way to the hospital.

The antidote is a little bit of mindfulness and asking yourself, "What am I missing?" 
We will never know everything about a given situation, there are just too many variables in life. For example, we will never know exactly what it is like to be anyone else on the planet. Even if it is explained in seemingly simple terms, an interpretation still takes place based on the meaning we put onto words. Acknowledge and honor that there is more than one way to see the world.

• Begin by noticing when you have a strong emotional reaction to something, pause, and put your attention on it. 
  
• What interpretation of the event prompted your reaction? In other words, what thoughts were running through your head? 
• Now, look at the facts that you know. Observe and describe what you could see, touch, hear, taste, and smell. 
• What information were you missing? What are other possible interpretations of these facts? 

This exercise is most easily conducted in hindsight. Later, with practice, you will be able build more awareness in the moment and create opportunities to change course. 


Further reading:
The Cognitive Model
"Watching Your Mind" Mindfulness Exercise

Consider the case of the doctor who counsels his patients every day about abstaining from tobacco use for the sake of their health, then takes a smoke break. Or the person who wants open communication and closeness in a relationship, then avoids bringing up difficult topics. These people are both experiencing distress because their choices are not aligned with their personal values. This is called value incongruence. 

We know that when a person acts in opposition to their values and beliefs, their overall wellbeing declines - mental, emotional, physical, spiritual, etc. For example, a person working for an organization whose policies go against some of their personal values results in faster burnout. The more important the value, the bigger the impact on wellbeing.

Value Incongruence Self-test:
Read through this list and write down your top 10 values. Include anything that comes to mind that isn't on this list. Don't put too much pressure on yourself to get it right, just do it quickly and follow your gut.

From your list of 10, now circle your top three values.

Reflect: 
What are you doing (or avoiding) that is aligned with these values? Keep doing it! 

What are you doing (or avoiding) that is NOT aligned with these values? Consider making a change.

Resources:
Acceptance and Commitment Therapy (ACT) for Depression
Some research here and here. 

Even if you don't suffer from Seasonal Affective Disorder, a type of depression during the fall and winter, this is the time of year when the weather in many parts of the country has been dreary for months and can really get you down. Here are five simple, evidence-based acts to combat the blues or even just the blahs:

1. Turn on the light. Light therapy is a proven treatment for seasonal affective disorder and can be used for other types of depression, too. The light mimics natural light and is thought to affect chemicals in the brain to improve mood. It's a special type of light available to anyone, but follow the directions because it's meant to be on for short periods of time.
   
2. Go for a walk. Research has shown over and over that exercise is actually just as effective as antidepressants in treating depression. It doesn't matter what, or for how long, just move your body somehow. Put an appointment in your calendar to go for a walk around the block and honor it just as you would any other appointment. 
3. Fake laugh. Seriously! Even just making our bodies go through the motions of laughing sends signals to our brain that boost mood. And I don't mean "ha ha." I mean "HAHAHAHAHAHAHAHAHAHA!!" So close your door and throw yourself into a giggle fit.
4. Pick your playlist. I think we can all relate to the power of song. Whether you prefer to listen to a sad song when you're feeling down ("Taylor Swift, you really get me") or a more uplifting song, it's really about what works for you. And if you can make the music yourself, even better.
5. Take a break from screen time. The average American has 8 1/2 hour of screen time a day. A day! That includes computers, television, smartphones, GPS navigation, and even in-cinema movies. And - get this - it's not kids who get the most screen time. Adults ages 45-55 average 9 1/2 hours daily! The link between screen time and depression is well-established. Try turning it all off, just for an evening.

Resources: 
American Music Therapy Association
Exercise for Depression (Cochrane review)
Laughter and Depression (review) & Laughter Yoga website
Light Therapy for SAD
Screen-Free Week: May 5-11, 2014
Seasonal Affective Disorder
Verilux HappyLight natural spectrum light (there are many options but this is a brand I know)

It is well-established that volunteering combats depression and boosts happiness, including this recent systematic review and meta-analysis of 26 studies on the matter. Giving to others gets us out of our heads and away from our own inner struggle. Putting our attention on helping others makes us feel less alone or even less bad-off than we realized. And, let's face it, it just feels good to contribute to a larger cause. 

So, in honor of Volunteer Week, here are 10 small ways to pay it forward today. Try one and notice how it makes you feel.

1. Pick up a piece of litter. 

2. Tip your barista/server/hairdresser a little extra.

3. Open the door for a stranger.

4. Write a letter and send it through snail mail.

5. Give a flower to each of your officemates.

6. Give a bottled water and a snack to a homeless person.

7. Let someone use your frequent shopper card who forgot theirs.

8. Go through your house and fill a bag to donate.

9. Leave encouraging post-it notes in random places.

10. Buy a coupon for a car wash and leave it on someone's window.