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about depression & anxiety, and why cognitive behavioural therapy rocks
There were two articles in yesterday's Evening Standard that I thought warranted a wider audience, and as is typical, whenever I find a newspaper article I really like, they're not visibly on the web site. Grrr.
One is by Liz Hoggard, and is an interview with Linda Kelsey, who used to be the "high-flying" editor of Cosmopolitan and She magaines, then suffered a bout of serious anxiety and depression that "destroyed" her career. Apparently she's written a novel called Fifty is Not a Four-Letter Word that is, at least, in parts, autobiographical - although her character in the book only has "a mini breakdown" not "a major, major depression". There are some very interesting quotes in the interview. I particularly liked the description of cognitive behaviour therapy, and her insistence on how exercise can fight depression.
She talks about walking the way I talk about cycling. "For the duration of the walk my head would clear and my anxiety would recede. ... Getting out of doors stops you obsessing and silences that awful inner critic."
Of course, it's difficult to get out of doors and do the exercise when you're anxious. In the past few weeks I've had several days where it's taken me over 3 hours to get out of the house from the time I first wanted to until I actually managed it, and some more days when I haven't managed to leave the house at all. But every time I have dragged myself out, I've felt better for doing it. Walking doesn't work for me - I can brood and obsess, and even have panic attacks while walking, unless I listen to music loud enough to drown out the negative thought voices (which doesn't work when I'm truly anxious, as then I worry about not hearing important danger warning noises because my music is too loud). But cycling does clear my head in the way she describes - and I need to remember that, and force myself to do it more often.
I agree with just about everything she's said. A lot of this article could be about me, especially the parts about how the illness changes your priorities. I'm sure people I was at school with would be horrified to find out I'm a part-time self-employed tutor rather than some sort of high-powered management type in a major scientific multinational. But my health doesn't hold up to that kind of work, and doing this makes me happy while providing enough for me to live on.
This is my favourite part of all:
Yes. That. Exactly.
There are people who have one episode of major depressive disorder and get better, and are cured for the rest of their lives. But for those of us who've had it going over years, the best we ever get is a remission, or "temporarily not depressed". Which sounds negative, but isn't, necessarily. It would be negative if we thought we had no choice but to give in to the illness every time it comes back, but people who've learned cognitive therapy have started to learn the techniques for stopping it from returning. Most of us are aware of the early symptoms of depressive episodes, and can make lifestyle changes and/or ask for help to stop wibbles turning into full-blown depression. In my worst states now, I am still tons better than I was Back In The Day.
I seriously think they need to put cognitive behavioural therapy on the school curriculum, and teach it to everyone to prevent stress, rather than only using it as a short-term therapy for those already experiencing severe stress. And there need to be enough people trained in the techniques to help everyone, and it needs to be taken as seriously as medication by the medical practitioners. CBT doesn't help absolutely everybody (you have to be at least willing to try to change your thought patterns, and it doesn't work so well for people with the more psychotic kind of depression or personality disorders, who have destructive thoughts coming into their heads that are completely uncontrolled). And it can take several courses of CBT before it is as "loud" in your head as the negative thoughts, and before it becomes intuitive to fight off the negative thoughts before they take hold. Nonetheless, it is quite seriously a life-saver for many people who don't get better from antidepressants.
The other article was about a "47-year old unfit woman" called Caroline Phillips who decided to do a triathlon for charity in some sort of midlife crisis. It's not terribly interesting in itself, and rather self-indulgent - but the description of her "mental performance lifestyle coach" Midgie Thompson is cognitive therapy in action.
Frankly, I'd have liked to read less about her training programme, and more about what Midgie said.
One is by Liz Hoggard, and is an interview with Linda Kelsey, who used to be the "high-flying" editor of Cosmopolitan and She magaines, then suffered a bout of serious anxiety and depression that "destroyed" her career. Apparently she's written a novel called Fifty is Not a Four-Letter Word that is, at least, in parts, autobiographical - although her character in the book only has "a mini breakdown" not "a major, major depression". There are some very interesting quotes in the interview. I particularly liked the description of cognitive behaviour therapy, and her insistence on how exercise can fight depression.
Gradually, the "menacing fog" lifted. Her medication started working. But her real saviours were cognitive behavioural therapy (CBT), which taught her to challenge negative thoughts and stop turning crises into catastrophes, and exercise. Today, she walks an hour a day. She still takes a minute, placebo-sized portion of antidepressant -- but walking is her "chemical-free and cost-free wonder drug".
She talks about walking the way I talk about cycling. "For the duration of the walk my head would clear and my anxiety would recede. ... Getting out of doors stops you obsessing and silences that awful inner critic."
Of course, it's difficult to get out of doors and do the exercise when you're anxious. In the past few weeks I've had several days where it's taken me over 3 hours to get out of the house from the time I first wanted to until I actually managed it, and some more days when I haven't managed to leave the house at all. But every time I have dragged myself out, I've felt better for doing it. Walking doesn't work for me - I can brood and obsess, and even have panic attacks while walking, unless I listen to music loud enough to drown out the negative thought voices (which doesn't work when I'm truly anxious, as then I worry about not hearing important danger warning noises because my music is too loud). But cycling does clear my head in the way she describes - and I need to remember that, and force myself to do it more often.
If ever she feels anxious out walking, she has trained herself to focus her eyes on the horizon. "When you are depressed you don't see beyond yourself. Everything is internalised. But if you keep fixing on the horizon, everything opens up."
She thinks depressed people should try to say yes to things -- even when it feels impossible. "Inactivity is the worst thing because it feeds on itself. When a friend asks to see you and all you want to do is crawl under the duvet, force yourself to agree. Isolating yourself makes things worse."
I agree with just about everything she's said. A lot of this article could be about me, especially the parts about how the illness changes your priorities. I'm sure people I was at school with would be horrified to find out I'm a part-time self-employed tutor rather than some sort of high-powered management type in a major scientific multinational. But my health doesn't hold up to that kind of work, and doing this makes me happy while providing enough for me to live on.
This is my favourite part of all:
She is not definitively cured -- she compares it to being like a cancer patient in remission -- but the shame has gone. "Starting to forgive myself actually helped me get better."
Refreshingly, Kelsey rejects the idea that depression makes you more creative. "There is nothing at all glamorous about being depressed. I think I'm a wiser person as a result of it -- more understanding, more sympathetic -- so there have been benefits. But I don't understand this business of being grateful for illness. Getting all humble because you survived cancer or depression. Why would you ask for this if you could avoid it?"
Yes. That. Exactly.
There are people who have one episode of major depressive disorder and get better, and are cured for the rest of their lives. But for those of us who've had it going over years, the best we ever get is a remission, or "temporarily not depressed". Which sounds negative, but isn't, necessarily. It would be negative if we thought we had no choice but to give in to the illness every time it comes back, but people who've learned cognitive therapy have started to learn the techniques for stopping it from returning. Most of us are aware of the early symptoms of depressive episodes, and can make lifestyle changes and/or ask for help to stop wibbles turning into full-blown depression. In my worst states now, I am still tons better than I was Back In The Day.
I seriously think they need to put cognitive behavioural therapy on the school curriculum, and teach it to everyone to prevent stress, rather than only using it as a short-term therapy for those already experiencing severe stress. And there need to be enough people trained in the techniques to help everyone, and it needs to be taken as seriously as medication by the medical practitioners. CBT doesn't help absolutely everybody (you have to be at least willing to try to change your thought patterns, and it doesn't work so well for people with the more psychotic kind of depression or personality disorders, who have destructive thoughts coming into their heads that are completely uncontrolled). And it can take several courses of CBT before it is as "loud" in your head as the negative thoughts, and before it becomes intuitive to fight off the negative thoughts before they take hold. Nonetheless, it is quite seriously a life-saver for many people who don't get better from antidepressants.
The other article was about a "47-year old unfit woman" called Caroline Phillips who decided to do a triathlon for charity in some sort of midlife crisis. It's not terribly interesting in itself, and rather self-indulgent - but the description of her "mental performance lifestyle coach" Midgie Thompson is cognitive therapy in action.
I'd confide in Midgie during our telephone consultations that I was too fat / nearly 50 / that everyone else would be better and faster / that I hadn't done enough training / and that I lacked motivation. Midgie would help me turn the internal dialogue into positives: what a fantastic achievement, many younger people couldn't do this / I've done ample given my other commitments.
Frankly, I'd have liked to read less about her training programme, and more about what Midgie said.
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(It's not being a very good day, in exactly that brooding-and-anxious sort of way.)
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I do find that when I can actually achieve peaceful inactivity and isolation, they do help. The episodes of inactivity and isolation that will be interrupted before I'm done with them are the ones that make me worse; and since I don't live on my own, that's most of them.
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Oh yes!
One of the many things which would be of more use than what we actually got taught :-/
yes no maybe
good CBT is also good (but there's some frightenly badly applied CBT-lite out there which discourges people from questioning anything outside themselves and trying to make the world less-crazymaking and/or to supress and stuff away totally reasonable and actually potentially useful "negative" feelings like anger and grief). It prolly works best for inteligent people with typical cognitive patterns but you can't have everything.
inactivity is good too - silence and peacfulness and being in nature and retreats and getting enough sleep and not trying to do too much and things like that.
I think baking fits more under creativity/craft (unless it's bread baking which is pretty physcial) and that's a good thing too.
Feeling listened too and supportive is pretty darn important too - i don't think any of the other things can work without that.
Re: yes no maybe
i realy can't spell or use that terible lj spellchecker today, sorry
Re: i realy can't spell or use that terible lj spellchecker today, sorry
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In fact I'd say that is good, since managers/management are *evil*. There is always too much management, and because that causes productivity problems, the problem is "solved" with *more* management.