The decision that matters in depression

One of the things that characterizes many mental health problems, particularly depression is the vicious cycle that a person finds himself caught up in. The lack of ability to pull oneself out of problematic behavior patterns, contributes to more problems with self esteem and hopelessness which in turn sap a person’s strength more. The result is a state of inaction and stagnation. A person starts doubting their ability to do much of anything, if this cycle continues.

I will illustrate this point with a single example. Most people with depression are too tired (both physically and emotionally) to go out of the house and do things. They will not wake up in the morning on weekends. They will not go out of the house for a walk at sunset. They will not go look at the flowers. They will not pick up the phone and invite someone for lunch. And most of the time these things are discounted as superfluous. “How much effect can one action have on the persistent sadness that pervades me”, they think. “Even if I can just manage to meet my responsibilities that would be more than enough”. “I need to rest, so I have energy to do the important things. I do not have time to do anything else”.

This kind of thinking is usually because of a cognitive distortion. That means that the depressed person will rely on a finite number of thought patterns that have been found to propagate depression. These are thoughts that are part of the vicious downward spiral and they deserve to be noticed. A lot cognitive behavioral therapists work with these thoughts. A stage in cognitive behavior therapy is called behavioral activation. This is the stage in which a person acts and take initiatives that they were previously not taking.

Just like there is a negative spiral that can spin out of control, similarly, there is a positive spiral that can help us. Part of our job is to identify and then make use of the wafting currents of the positive spiral.

For example, the person who decides instead of sleeping at 8pm, goes out for dinner with a friend will find that her one decision does not help her only in terms of that night. One positive decision multiplies. At dinner, she might find herself enjoying the food and decide to find a way to replicate it at home. Or that person might see the lights and people laughing and decide that she should get out more often. Or the friend that she meets might make her laugh. Or the friend might invite her to another lunch where there would be more people to connect with. Or that friend might talk about catching a movie together. Or she might want to go to see an interesting movie by herself. Or she might learn something about the new interest her friend has and she might start thinking about picking it up. Or her friend might share something sad about his life. It is possible that she might find herself as someone who is giving comfort rather than someone who is seeking it. Or she might find herself humming a song at the end of the night. Or she might think of a funny moment at dinner, while trying to go to sleep. Or next day she might have a thought about the dinner and reach out and say thank you to her friend. Or follow up on something else.

I will invite you to compare this with her having gone to bed at 8pm and waking up in the morning. The one decision to pick up the phone and plan a dinner with her friend does not give dividends for just that evening. One decision followed through has the potential for giving structure to multiple other times. And this gift of life multiplies with every decision that we make. Not every dinner goes perfect. But not every dinner is a disaster. Chances are there will be some fun stuff, some boring stuff, some cheerful thoughts, some depressing thoughts. But regardless there is the promise of future happiness. And sometimes promises are the things that keeps us going on in life. So when it is time to make the decision that is positive for your goals; make it! Faith is about making the decision without knowing what is out there but hoping for the best. It does come down to one decision at a time.

By | 2017-03-13T21:23:46+00:00 March 13th, 2017|Holistic Medicine, Psychotherapy|0 Comments

About the Author:

Dr. Qazi Javed is a double board certified physician practicing Adult, Child and Adolescent Psychiatry. His Austin, Texas practice is focused on a holistic and integrative model of care.