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Wednesday, February 22, 2006

Supporting the Depressed Person

Yesterday, I said that I would write something about how to best support the depressed person. I basically said what not to do. It can be difficult to be supportive when one sees the depression going on and on. But there are some things which I believe to be helpful.

First of all, there are different levels of depression. Even within the diagnosis of major depression, there are mild, moderate, and severe levels. A person with severe major depression will need more support than a person with mild major depression. And a person with milder forms of depression (dysthymic disorder, adjustment disorder, etc.) will not need the same kind of support. Persons with more severe depressions need practical as well as emotional support (such as filling out forms to be absent from work, setting up therapy sessions, making sure that the person takes their medication accurately, or driving them to therapy). Persons with milder levels of depression need more emotional support. For them, the practical support may be helpful, but it may have more of a symbolic helpfulness (showing that you care).

So, keeping in mind that it is difficult to give guidelines that would apply to all depressed persons, here are some suggestions:

First of all, support the person being in treatment. Don't criticize them being in treatment. If they are still depressed after being in treatment, that doesn't mean that they need to stop it and "buck up." It may mean, however, that some type of change is needed in their treatment strategy.

If you don't think that their current psychiatrist or therapist is helping, you can suggest that they seek a second opinion without criticizing their current doctor. Or alternatively, you could even ask if it would be okay for you to speak to their doctor and give feedback about your concern that they are not improving.

Realize that they don't want to be depressed. They most likely want desperately to feel good. They are trapped in a maze. They don't know how to get out. Communicate to them that you understand that they want to feel better and that you are there to help.

If they talk negatively, give them gentle feedback. For example, if they said "I'm just stupid," you could reply that you don't believe that and that there is no evidence for it. They may not accept your reassurance or believe you, but it is probably better to provide a gentle confrontation than to say nothing.

Help them to get out of the house. Staying at home allows them to ruminate over their negative thoughts more. They may not want to get out, but give them encouragement to do so. Make it easy. You do the footwork. Buy the tickets to the movie or make the babysitter arrangements.

Don't take their depression personally. It can be helpful to look to see if you are doing anything that is contributing to their depression. By all means. But oftentimes, you will have nothing to do with their depression. If you don't take it personally, you can be of more help because you won't be defensive. Support the person, but don't take responsibility for them getting well.

If on the other hand, your self-examination leads you to believe that you are part of the problem, then try some marital therapy sessions to work on those issues.

If the depressed person is also abusing substances of some sort, don't assume that this is their only problem. Oftentimes, there is depression behind their alcoholism or drug abuse. AA can be helpful for alcohol abuse, but it is not likely to be an effective treatment for depression.

Give the other person positive reinforcements. These can be in the form of positive verbal statements ("You did a good job cleaning house today," or "You look nice") or taking them out. Don't be surprised if they disqualify your positive statements (finding ways of saying that they are not true or don't deserve compliments).

Look for a local depression support group. Take them and or attend with them, if they wish it.

Educate yourself about depression. Very thick books have been written about depression. You don't need to know everything that is in them. But it is helpful for you to realize that depression is sometimes a severe, complex illness. It is not just a feeling. Educate yourself about some of the complexities of depression.

Help them manage their medications if necessary. Depressed people may not take their medications correctly because of a variety of reasons. They may forget to take them. They may become pessimistic about the medication helping and stop taking it. They may not believe that they can afford the medicine.

Take care of yourself. Make sure that you have a social support network, too. That way, you don't burn out, and you have something to give.

Be ready to deal with your own feelings of resentment. It can be difficult being the spouse of a depressed person. Don't feel guilty about feeling that way, but don't just stew in your resentment either. Find someone with whom you can talk through your feelings.

Don't Blame the Victim

Psychological research has documented that there is an unfortunate tendency in people to blame victims. Part of the reason for this appears to be the need to reassure ourselves that bad things are not going to happen to us. When we see someone who suffers misfortune, we may feel anxiety and want to believe that it could not happen to us. Or we may feel a twinge of guilt that our lives are so good. For example if we hear of someone being robbed or attacked at night, we might think that they shouldn't have been out at night by themselves--they should have known better.

Some of my patients experience the same type of blaming. Depressed persons often report to me that their families do not understand their depression and tell them to snap out of it. People imply that they could be well if they wanted to be, that they simply want to be sick. Or there may be the implication that the person is morally weak and bad for not choosing to be well. This is also blaming the victim.

There may be some people out there who want to use their psychiatric symptoms for some reason (disability, etc.). I rarely encounter them. In my practice, I find people want to get well. If they could get better on their own, they would. One of the ways they work on getting better is by coming to see me. It does no good to tell them to snap out of it. It does no good to blame them and imply they are weak. Even worse is when people imply that their depression or anxiety is because they are out of right relationship with God.

There are ways of encouraging a depressed person to get better, but blaming them is not one of those ways. In my next piece, I will talk about some positive ways of encouraging persons who are suffering through psychological symptoms.

Friday, February 10, 2006

The Anxiety Spasm

I have sometimes referred to anxiety as a spasm. I believe that this is an excellent metaphor. As a spasm grows, it only makes itself worse. The muscle can't pull out of it. The more it spasms, well, the more it spasms. Usually, there has to be some sort of intervention to make it stop, such as pulling the muscle.

My patients often find themselves in just the same situation. Anxiety focuses their attention on the problem, and the problem increases their anxiety, and the increased anxiety focuses their attention even more on the problem. They want the anxiety to go away. But strangely, they are often reluctant to go do something else which might distract them and make them less anxious. It is not clear why this is. Perhaps, they already feel at their limit, and they just want to rest somewhere away from any demands. However, physical rest does not bring mental rest when there is an anxiety spasm. It generally gives their brain the freedom to keep focusing on the problem, obsessing, and worrying.

The cure for many spasms is to pull the muscle so that the spasm gradually subsides. The cure for the anxiety spasm is often to pull away from the worry and get into another situation until the anxiety gradually subsides. This may involve an uncomfortable feeling at first, focusing the mind on something else when the mind seems keenly bent on dealing with the problem and only the problem. However, after pulling away and focusing on something else, many people start to feel better.

I sometimes suggest to my clients that they keep a chart of their anxiety, rating it from 1 to 100 over time. It can be useful to do this when they just stay home and don't do anything special, letting their mind think and feel what it will. And then other times, the chart can be done when they get out and do something else which pulls their attention away from the anxiety. This gives the client concrete data to work from. What is going to make me feel better? How long will it take for me to feel better? How much better will I feel?

Some clients have had antianxiety medication prescribed for them. Such medication can be useful, especially when it is combined with learning psychological ways of coping with anxiety. I do not believe in any client being tortured by anxiety, and severe anxiety is a type of torture. But I also believe that it is always important to combine anti-anxiety agents with psychological coping techniques so that in the long run, persons do not become dependent on the medication.