If you’ve struggled with depression in the past, you are likely all-too-familiar with how easy and subtle it might be to slide back into a depressive state. It can sneak up out of nowhere, kick you into auto-pilot and before you know it you feel like you are “back to square one.” When working with depression it is very important to get in touch with our relapse signatures that are the tell tale signs that we are beginning to slide. When I ask people to think of their signatures they say that more negative thoughts begin to visit them, there may be a feeling of wanting to isolate from friends and family, or the phrase “what’s the point” comes up over and over again.
Here is a step-by-step process of increasing awareness of when relapse is happening and what you can do to pre-empt it:
1) Relapse Signatures - Take a moment right now or make a plan to write down some of your relapse signatures just to increase awareness when they’re happening.
2) Breathing Space - When you notice one of these signatures occurring it is going to be important to ground yourself to the present moment so you can increase you chance of making a choice in that moment. Here is where you introduce mindfulness and bring your attention to the breath to anchor yourself to the present moment. Then take a moment to sense into the body to check-in with how you are feeling physically and emotionally.
3) Thoughts are not facts - It is important to remind yourself that thoughts are not facts. We know this because the same event can happen (e.g., a friend walking by us without saying hello) and our interpretation would be different depending on our mood. Therefore, it’s important to remind ourselves that thoughts are not facts, they are mental events in the mind that are temporary and mood dependent. What is a fact is that negative thoughts are circling and however we are feeling physically and emotionally.
4) Take Action - Now that we are grounded to the present moment and have come down from the mental rumination, we want to take action with 2 things that can support us in this moment. That is either an action that brings us pleasure or an action that brings us a sense of mastery or accomplishment. Here you want to make a list with two columns. Column 1 will include actions in your life that you consider to be pleasurable (e.g., having tea with a friend, taking a walk, giving yourself a manicure/pedicure). Column 2 will include those things that give you a sense of accomplishment (e.g., paying the bills, getting exercise, going to the post office). These lists may overlap in some areas, but have the list down so you have access to it and don’t have to think as much when you notice this relapse occurring.
5) A letter of encouragement - Sometimes when relapse is happening, the thought “what’s the point” comes on really fast. When you’re feeling well, write yourself an empathic letter spelling out the importance of engaging in this process. Be kind to yourself in this letter see if you can think of the words that would be supportive and helpful for you to here when in the midst of a slide into relapse.
Remember, this is a process to engage in when you are noticing yourself sliding into relapse and you have not fallen into the depths of depression. See if you can keep your lists and letter in a space that you can remember and have easy access to. Community is also an important aspect of this work, so share this plan with friend so they can gently help point out when they notice relapse signatures. Or look into online communities such as Therese Borchard’s Community at Beyond Blue.
As always, please share your thoughts, stories, and questions below. Your interactions here provide a living wisdom for us all to benefit from.
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From Psych Central's Dr. Elisha Goldstein:
Mental Health: Break from Routine and Back into Play | Mindfulness and Psychotherapy (June 19, 2009)
Have you investigated the simple problem I suggested to you?
Remember, this is a phenomenon that was discovered and solved forty years ago.
Today it is believed to cause only a harmless episode of confusion. When my wife had the mental break it causes I discovered the phenomenon is unknown by anyone in medicine or psychiatry.
Fear, paranoia, panic attacks, depression, and thoughts of suicide can be connected to Subliminal Distraction exposure.
If this simple problem is the source of depression would it not be better to investigate and expose that connection?
Yes I am feeling depression circling right now. Its comes on with frustration, discouragement, anger, stress that happened all yesterday. Now I feel that sinking “I don’t feel like doing anything” feeling, that heavy weighty feeling and the thoughts: Why bother, it never gets fixed, I try and try and try and what I am trying to accomplish remains problematic.
This morning I rescued 2 birds who flew down my chiminey into my living room. I heard them flapping frantically to get out the window. They could see where they wanted to be on the other side of the glass outdoors and they flew up and down and across and to another window thinking that if they were persistent and tried hard enough they would get through the glass. I opened the door but their mindset was on the belief that they could get through the window glass to the other side. I wondered if I do that. Can I look for another way out? Is there a door opened that I am not aware of. Can I even get out of the depressed state I am in.HOw is my thinking causing me to not seek alternatives? I like your thought about the encouraging, kind letter of words that we need to hear. I read my scripted letters of encouraging daily. When I veer off I relapse back into discouragement. Those self talk scripts really work. I will be digging them out this morning. Also forgive and forget helps. Also leaving the bad stuff that happened yesterday in the past of yesterday, today is a new opportunity to sculpt my life to my pleasure and delight. Also making a daily to-do list and doing those chores on that list gives the pride that comes from accomplishing something meaningful which raises the self-esteem. All that you mention is good. I will start to take stock of my depression signature. Yes with the negative, critical, discouraging thoughts subtlely entering. Its like algae bloom in a swimming pool. You let that chlorine be a tad low and within 2 hours you have algae that rapidly metastisizes. Thats how my depression is–kind of like cancer cells multiplying and then spreading. Its hard to get rid of the stuff.
So this really works, this approach. You have tried it with patients, or people have told you it works? Just wondering because sometimes I feel like DEPRESSION has a mind of it’s own, and it doesn’t necessarily have anything to do with a bunch of disappointments, but more with ‘timing’. (like, it’s time because you have had a pretty good stretch lately?)
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