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I have a number of clients from the US and what has been playing out there over the last few weeks and indeed, for some, over the last four years has been difficult for them. At the moment, the big contentious issue is political and the behaviour of a group of politicians specifically. When this is added to by the threat of an uncontrolled pandemic, not being dealt with effectively, life is not so rosy. Many are suffering from anxiety about the future and this  is leading to depression and an inability to move forward in their daily lives. It is a feature of the times we live in but puts into perspective the much bigger picture concerning depression and anxiety and how we deal with it. Anyone who has a partner, friend or family member that suffers will tell you that the advice often metered out to think positively, get moving, be productive just doesn‘t work. It may do at a later stage but fundamentally it is a question of care and not production.

There are not many people who have not had their lives touched by depression at some point and everybody knows somebody who has had it or is suffering from it. One famous psychologist once described it as “the cancer of mental health” and never a truer word was spoken. Take a look at these general statistics :

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• Recent studies suggest roughly seven of every one hundred people suffer from depression after age 18 at some point in their lives.

• As many as one in 33 children and one in eight adolescents have clinical depression. Suicide is the third leading cause of death for ages 10 to 24.
• Most people diagnosed with major depression receive a diagnosis between their late twenties to mid-thirties.
• About six million people are affected by late life depression, but only 10% ever receive treatment.
• For every one man that develops depression, two women will, regardless of racial or ethnic background or economic status.
• More than half of all people caring for an older relative show clinically significant depressive symptoms.
• By the year 2022, depression will be the 2nd most common health problem in the world.

The figures above do not include those who are unaware of the fact that they are suffering from depression and those who choose not to, or cannot, seek treatment for whatever reason. Given this fact, the statistics are sure to be much, much higher. The general treatment administered by GP’s for depression can range from referral to a therapist, lifestyle changes, anti-depressant medication or a combination of these. While each have their merits, many therapists believe that depression and anxiety are more a result of distorted thought patterns than chemical imbalances or genetics (though both are known to play a role). Change the way you think, change the way you feel is the main argument. Something that I tend to fully agree with but it is not valid in all situations.

Pessimistic thinking does not cause depression, but it appears to be easier to become depressed if you tend to view the world with considerable pessimism. After all, pessimism is a tendency to think that things won’t work out as you wish, that you won’t get what you want. Pessimism feeds negative cognitive distortions and self-talk. On the other hand, optimism appears to create some protection from depression.

Hopelessness is a central feature of depression, along with helplessness. If you view your world as bad, filled with problems, and don’t think you can do anything about the problems, you will feel helpless. If you don’t believe your life will improve, if you think the future is bleak, then you will begin to feel hopeless. Pessimism encourages these negative assessments of your life. Optimism prevents you from reaching those conclusions. In fact, psychologists have researched ways to work with patients on how to learn to be more optimistic, as a way of fighting depression.

So, how can a depressed person have their negative thoughts turned into positive ones and get motivated to take charge and help their issues? Negative and unhelpful thoughts must firstly be acknowledged and logged. Those thoughts can then be evaluated and graded in terms of how useful, true or constructive they are. Questions such as “Is it possible that this way of thinking is not 100% true or realistic? Are you discounting the positive and only focusing on the negative?”. Where negativity is challenged, it will provide reflection on the validity of what the person is saying to themselves. If it’s not true or realistic: “Why not? And then why would you think that way?”.

Crucially, it is also important to come up with a positive and realistic thought, such as: “Well, it’s not completely useless, there is a possibility something good could come out of it, which would be a good start to recognise there are solutions and rewards if one takes a logical and objective approach to a situation. Motivation can be enhanced by asking a depressed person what they would be doing tomorrow or next week if they were not feeling depressed. This can make the mind shift forward and make them think of pleasant things, which can then be incorporated and worked with as a goal. Small steps and stages are also good for keeping motivation going, by breaking down tasks and doing it little by little. Reward and praise for any progress no matter how small will also make sure steady progress is made.

However, life isn’t always as simple as this and many people become confused as to whether thoughts cause emotions or emotions cause thoughts. Additionally, anyone who has suffered from deep depression will tell you that no amount of positive thinking makes the depression go away. Positive thinking seems to help in certain situations – when depression is mild, when we are feeling a bit down, when we were previously unaware that negative thinking could make us feel bad etc. Many suffering from severe depression find the idea that positive thinking could cure them insulting. They know that their condition is much more complex than that and it is. This doesn’t mean that there is no place for positive thinking, but there are times when we need to allow our emotions to play out. This is particularly the case where our depression or low mood is caused by an external event. In this case, it is sometimes helpful to feel the deepest side of despair and emotion to be able to emerge on the other side with a chance of recovery.

This calls for a focus on self-care to be able to deal with these emotions. Many people will resort to more action when they feel down in order to work themselves out of it. This is often what we have been taught but the consequence could be burnout, an emotional and physical deep fatigue. Self-care means just that, to focus on looking after self as a primary method of moving to a healthier place. Basic self-care consists of exercise (walking, gym, running), relaxation (meditation, downtime), sleep (this is a big issue with depression. Depressed people often sleep more than usual. It is important to stick to a healthy sleep routine without escaping into sleep), eating healthily (avoiding instant gratification with junk or sugary foods which fuel depression and feelings of self-loathing). One of the key elements of self care is to face any issues that have been the subject of procrastination. This will initially be difficult but can be seen as a second stage as part of a healthy daily routine after basic self-care has been established. The important thing is not to push it too quickly.