Deconstructing Depression - Page 2

In my initial work with her, I asked her to recall any act or gesture of kindness, no matter how small, that she'd given to her mother. She easily came up with some examples, and then followed immediately with, "But that doesn't count!" When I asked "Why not?" she replied, "Because the bad moments are so many, why should I count good ones? I'm just not a good person." Angel was trapped in the habitual pattern of thinking, common to people with this kind of depression, that bad moments deserve more attention than good.

I explained to her that, given the way neural networks process information, once she got into the mental habit of thinking negatively, her mind frequently became like a runaway train of pessimism, tapping into an ever-growing network of negative thoughts—different versions of "all things wrong." Forcing her mind into a different network—"at least some things right" would require cognitive commitment. In short, Angel needed to train her brain to identify and rehearse positives to shift her default setting away from negativity.

One of my favorite ways to practice the positive is to get into the habit of giving the "Virginia Report." My friend Virginia has had much to be depressed about—losing an adult child to cancer, seeing her family break down from the consequences of grief, having cancer twice herself, and suffering severe, debilitating side effects from treatment. Yet you'll never encounter Virginia without hearing her tell you about an experience she just had that was absolutely "the best!" She just had the best sandwich she ever ate, the most fun she ever had, she laughed harder than ever before. In the "Virginia Report" everything today is better than anything that came before.

Asking Angel to give the "Virginia Report," about her prior week forced her to say something out loud about what was positive. She wasn't unconscious of good things; she simply believed they didn't count. So I wanted to enhance the sense of importance of each positive. She agreed to make a daily record of at least one good action or experience. Then, therapy helped her practice expressing it as "the best" to inject a note of eagerness, enthusiasm, and hopefulness into daily life. She felt awkward using superlatives while telling me about a restaurant meal, so we jokingly exaggerated it. The rigatoni was "sooooo tender" and the meat "sooooo succulent" and the gravy sooooo "intensely garlicky"; she "never had any meal as amazingly fabulous as that meal!" After the laughter, she admitted that she felt great, but quickly added, "Of course, the dinner wasn't really as good as I just said." In that moment, she saw how she continually robbed herself of good feelings. She described the meal again and noted the pleasure derived from her positive perspective. She was able to see that describing her dinner as "the best ever" reinforced an attitude of upward comparison she could use whenever thinking about her experiences.

Charlene presented a different kind of lethargy typical to endogenous depression. Sitting slumped in her chair, she told me that she had unopened mail piled up from the last two weeks, groceries purchased two days before still bagged and sitting on the kitchen table, and unwashed laundry heaped on the floor. The clutter of old newspapers, dirty dishes, toys, and stuff covering every surface of the family room made it nearly impossible for her two kids to find a seat. Since contemplating the task of cleaning all this up was overwhelming to her, I asked if she could clean for just three minutes. She agreed that she could do that, but asked, "What's the point?" adding that things would still be an unholy mess.

I knew she needed to mobilize, and one way was to "prime the energy pump" by doing the work in small, manageable bits—returning one phone call, answering one e-mail—and then rewarding herself for the effort. Like so many low-energy clients, Charlene came home from work and immediately turned on the TV—what she called her "reward" for getting through another day on the job. I suggested she take "commercial breaks" to literally "break" up her pattern of comatose sitting. She should get up and do some tidying just during the commercials, and then sit down to her show again—an immediate reward for about three minutes of effort.

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