Depression often occurs when something that has been rewarding, reinforcing, consistent, or available gets taken away. We get depressed when relationships end, when we lose people we care about, and the things that we were taking for granted are suddenly no longer available. Depression is the lack of something. Depression is often associated with loss, change, or a disconnection with the reinforcing aspects of our life.
People are often depressed when they don’t have enough connections, experiences, interactions, or things in their life that naturally bring about joy, peace, or a sense of well-being. Depression can often be associated with lack of activity, becoming withdrawn, and staying in bed. People sometimes get depressed when they don’t have enough to do, or when they are overwhelmed with multiple demands.
Teens can often be depressed because they do not get enough things in their life throughout the day that give them a sense of well-being or joy. Being able to take mental breaks, have activities that they look forward to doing, and have enough “down” or “me” time is critical in mitigating depressive symptoms. Taking a plethora of classes that one really dislikes, being behind in homework, and having non-stop activities scheduled until bedtime can sometimes be enough to get a teenager depressed. Social losses, such as a recent break up, an exclusion from a friend group, or navigating the unfamiliarity and changes of a demanding schedule can negatively impact mood. Try to keep in mind that depression has to do with what is lacking. If your teen is comfortable in social situations, feels as if he or she has choices in making his or her schedule, is not expected to work nonstop outside of school, feels a sense of contribution/ effectiveness/ mastery in some area of his or her life, and engages in activities he/she looks forward to, then he/she will be less likely to be depressed.
What could be more reinforcing for your teen? Try to think of reinforcement as something rewarding, enjoyable, energizing, or even peaceful. Don’t limit your thinking to only adding things, as the demands of having too many things can in and of itself be a problem. Balance is key. Consider how these simple things might really matter: Sleeping in, taking a long hot shower, watching a favorite TV show, hanging out, or interacting with a parent in way that feels appreciative or warm. Consider that finding happiness is not the key to treating depression; rather it is creating a life that is rich, full, balanced, and meaningful.
In addition to time management, scheduling, and navigating opportunities that are reinforcing, a parent might also want to consider key biological factors that really matter when it comes to managing mood. Consider your teenager’s sleep schedule. Is he or she getting enough sleep? Sometimes teens think they can overcome their biological limitations by staying up extremely late and thinking it doesn’t impact mood. Sleep should be a priority, because a lack of sleep often precipitates a big blowup, a heated argument, or other behavioral issues that are clearly difficult for parents. Is he or she getting adequate nutrition, eating at regular intervals, and relying on something besides caffeine, carbohydrates, and sugar for energy? French fries and Coca-Cola will not be adequate. Skipping breakfast or lunch doesn’t help either. Sometimes we like to attribute mood problems to conflict at home, problems with stress, or the demands of homework. However, taking some simple steps to increase pleasant experiences, take enough “breaks”, and manage biological factors can go a long way in treating adolescent depression.
When did you last eat? Irritability because you are hungry is common, but many people underestimate how important it is in managing emotion. Irregular eating habits, using caffeine/ sugar/ carbs to fill oneself up, and overeating when overly hungry can have a big impact on mood management.
Are you going through biological changes? Medication changes, alcohol use, dehydration, sickness, pain, smoking habits, caffeine dependency, and menstrual cycles all affect how we feel. Taking care of your biological wellbeing will help you take care of your psychological well-being. If possible, consider saving that “difficult conversation” for later- and not when you are at your biological worst.
How is your sleep hygiene? Get to bed at a reasonable hour, use the bedroom only for sleeping, and generate calming routines before bed. Don’t overestimate how irritability is more likely to s how up when you stay up extremely late or sleep all day.
Is the weather getting to you? Extreme temperatures can make people irritable. Get out of the cold or the heat. Make use of bright lights, warm temperatures, and potential social gatherings when it gets dark early.
When is the last time you did something you liked, enjoyed, or looked forward to? Doing things you enjoy will put you in touch with positive feelings, even if they are temporary. Do more of what you love, especially if you are in the middle of a crisis. Making time to do so is critical.
When is the last time you worked hard to accomplish something difficult? Building mastery and surviving challenges gives us a sense of accomplishment that can happen despite painful life circumstances.
When is the last time you had a tricky relationship situation and you feel proud of how you handled it? Remember that approaching situations with some element of acceptance can enable us to be more flexible; creating more options for the other party and making them feel less trapped.
Notice what you feel without judging. Sometimes people believe that if they don’t feel a certain way, they are missing out on some kind of grand, spiritual, or wonderful experience. I am reminded of the Charlie Brown Christmas special in which he doesn’t feel like he “should”. Not everyone is awed, exhilarated, or spiritually “moved” this time of year.
Accept and acknowledge the mundane, the everyday, or the not-so-wow experiences this season. Remember that the glue that holds us together in the smaller, everyday nuances of our existence and our relationships also has meaning. Foster the relationships that matter.
If you want to feel more connected and less detached, practice ways to participate willingly, go with the flow, risk being open, and become involved. Volunteer, show up for the holiday parties, attend services, and remain attentive and awake to what is going on around you. Although it is possible that exerting energy takes effort (and may not completely diminish loneliness), it gives you an option to temporarily shift your mood.
Find the stillness within- Crowds, shopping, to do lists, and holiday planning can be overwhelming. Finding stillness within yourself can help you cope adaptively, slow things down, find your wisdom, and stay grounded. Bear in mind that you have the ability to find inner wisdom, but sometimes emotions and other people can get in the way of finding it. Try the suggestions below:
Find 2-5 minutes once a day from now until Christmas to sit quietly, observe your breath, and gently pay attention to whatever sensations arise within you. After sitting quietly, try writing: I notice… I would like… I feel…I sense…I think…I am aware of…I am most worried about…
If you are out shopping or involved in intense holiday planning, make sure that you don’t skip meals or shop on an empty stomach. Take periodic breaks that include sitting down and being away from loud noises, bright lights, and crowds. Consider what you need and the cost/ benefit of overestimating your energy and pushing yourself too hard.
Here are some steps to figuring out your mood- and what to do if, indeed, you want to change it.
Our moods- or our feelings- can be extremely important in helping us understand ourselves, organize our behavior, know what matters, and have better relationships. One of the first steps to figuring out feelings is to be able to describe, understand, and put words on experience. Think beyond just being in a “bad mood”: Try figuring out what, exactly, you are feeling. Instead of thinking about your mood as bad or good, try approaching this task with curiosity. Are you down, flat, depressed, lethargic, or disinterested? Are you irritable, angry, frustrated or impatient? Are you struggling with loss or sadness? Remember that feelings give us information about ourselves, our situations, and the people around us.
Next, consider what is valid, relevant, and sensible about what you are feeling. Some reasons that others tell us to stop being in a “bad mood” is because they want us to behave a certain way. Consider this: If the person telling you to stop being in a “bad mood” got what they wanted, what specific action would that entail? If you stopped being in a “bad mood”, would you stop avoiding conflict, go to work, keep a relationship, participate fully in an activity, or attend a social event or function? We may know and understand our mood, and have a good reason to feel the way we feel, but our mood gets in the way of rising to the occasion and meeting an obligation.
Expressing negative feelings frequently or pervasively can hurt relationships; on the other hand never being to share our innermost pain can prevent us from having more meaningful and connected relationships. In other words, ranting, venting, or complaining can join people in their beef against the universe, while expressing vulnerability can increase caring and intimacy. Consider how acting or expressing how you feel works or doesn’t work for you. Does it bring you closer to the people you care about, or does it tend to push them away?
Next, consider if you want to change how you feel. Is someone else trying to get you to change how you feel? If so, trying to change how you feel can be much less effective.
One way to change how you feel is to act in ways that are incompatible with how you feel. In some situations, acting on how we feel can enable us to feel congruent and genuine with what is going on for us on a more personal level. However, sometimes moods are so pervasive that they interfere with our lives. If your “mood” is interfering with your ability to organize action, meet obligations, make deeper connections with others, keep relationships, or engage in meaningful activity, it might be time to experiment with alternative behaviors to shift gears, engage your brain differently, or do something you wouldn’t typically do.
Here are some suggestions: Express appreciations to other people, talk about what you value in the relationships you have, avoid “complaining”, practice not talking about anything negative, shift gears by doing an activity that demands your attention, shift gears by doing a something physical (washing dishes, raking leaves, taking care of a child), become invested in someone else’s problem or dilemma, try generating compassionate reasons for why people behave the way they do, soften your body and facial expression, wish other people well, do something that challenges you, do an activity you like or enjoy, or do an activity for someone else that they like or enjoy. Doing these things even if you don’t feel like it- may help you change your mood all by yourself.
How group therapy works: Behavioral activation, personal relationships, groups, intimacy, connection, and growth.
Newer behavior therapies are looking at how people can change their behavior despite how they feel. The difficulty with focusing on behavior change is that most clinicians think that by focusing on behavior, private experiences such as thoughts and emotions are ignored.
The truth is, most people exhibit certain behaviors when they are feeling a certain way. For example, an anxious person might become overly chatty, focus on “safe” topics, avoid talking about anything personal, or present as very “intellectual”. Someone who is afraid of being disliked or judged might acquiesce easily, become a people pleaser, and become excessively compliant. Someone who is afraid of being excluded might become critical and judgmental in order to avoid the vulnerability of feeling more ostracized. Someone who has a hard time with intimate relationships might inhibit self-disclosure, refrain from sharing personal information, or lie to avoid the risk of discovery. Someone who has a lot of self-hatred might be dismissive of compliments, avoid positive feedback, or avoid rewarding activities.
The benefit of looking at how you behave when you feel a certain way increases opportunities for therapeutic interventions. All of the examples listed in the above paragraphs are behaviors that matter in personal relationships- and will likely show up in group settings. Being able to identify what you do when you feel a certain way is one of the steps to understanding what alternatives are available. Knowing where and how you get stuck is the first step to experimenting with how you can get yourself unstuck.
Here are some examples:
If you are anxious and tend to be chatty or intellectual, try experimenting with the following: Tolerate pregnant pauses, awkward silences, and situations in which there doesn’t seem to be anything to say.
If you have a tendency to be a people pleaser, try asserting yourself in minimally threatening situations. Ask for one thing and then change your mind at the deli counter or a restaurant. Experiment with introducing small things that may be somewhat different from the norms of your social circle.
If you tend to have prickly relationships and often feel threatened, try softening your facial expression, making gentle eye contact, focusing on what you have in common with others, and refraining from criticism.
If you struggling with intimacy, connection, feeling visible, or being “known”; or you have extreme social anxiety, you may want to consider small ways that you make yourself a bit more visible or known. If being the center of attention is too much, find ways in which you can start to voice your thoughts, feelings, and opinions in less riskier situations.
If you have a lot of self-hatred, practice being receptive to the positive things. Make eye contact when receiving positive feedback, allow yourself to feel the warm fuzzies, and treat yourself with kindness on purpose by doing things that are personally rewarding and enjoyable.
Part of identifying how services can be helpful is being able to observe and describe one’s own behaviors. This includes being sensitive to the impact it has on other people the consequence of how it makes you feel- as well as the ways in which current behavior simply doesn’t work. Being able to figure out what specific alternative behaviors you can do when you have the urge to do what you’ve always done is one of the keys in successful treatment. Increasing meaningful relationships and creating a fulfilling life takes work, feedback, sharing, and challenges. Changing one’s behavior often puts people in touch with emotional discomfort. What is the benefit? The benefit is that if one acts and behaves in a way that signifies being “better”, one will be less controlled by emotions and thoughts- especially thoughts and emotions that don’t “go away”! Taking risks is scary, but the cost of not making these changes is sometimes worse.
When people tell you that everything is going to be okay, sometimes it is helpful to hear. Sometimes it is soothing, and can give you a sense of hopefulness and shared understanding. There are many ways in which other people try to soothe us, and which we find help and assurance in cases of extreme distress.
However, people sometimes use this statement in a way that is unhelpful. For instance, the statement that everything is going to be okay may be an attempt to avoid the subject, offer a platitude, or inhibit communication of distress. Sometimes it is more helpful to obtain some acknowledgment or understanding of how you really feel. Sometimes worries, fears, or concerns about the future just need to be openly expressed. In addition, it is hard to know that things are going to be okay when you don’t have a way to solve the current problem.
The statement that everything is going to be okay is a statement of expressed hope. It can be offered to the person who is going through the most severe of all crises, and even though there may be some irony to it, there is some truth to it as well. Sometimes when we feel very hopeless it is hard for us to hear the usefulness of this statement. Sometimes in the worst of moments we can find and create experiences of hope and joy- despite significant loss. Being able to find and participate in these moments help people survive.
Thinking about the ways in which this statement is both helpful and not helpful at the same time can help us to create space for different perspectives. When we can see things from different angles, we have more flexibility in addressing situations, responding to our environment, and finding help that may actually be helpful. There is always some element of truth to things turning out okay, but there are also moments when hopelessness prevails. Sometimes it is nice to consider the kindness of another person’s intentions, even if their attempts to be helpful aren’t always exactly what we need to hear in our moment of our pain.
People tell me all the time that they don’t deserve to feel the way they feel. When they start to feel sad/distressed/upset, they immediately think of all the positive things they have in their lives, convince themselves that they have no reason be upset, and spend a considerable amount of time in their heads trying to argue away the existence of their emotions. The problem with this kind of response is that it doesn’t make emotions disappear in the long run.
If you are one of these people who has “no reason” to feel the way you feel, here are a couple of things you can try:
1) Make a list of all the stressors going on in your life. Brainstorm every little thing, even if it seems small. Little things (like an annoying smell) can actually create a lot more stress than actually realize. Doing this exercise can help you actually identify the extent of your stressors. Some people find it quite validating.
2) Identify if there have been recent changes, losses, or shifts in relationships or life situations that have been hard on you. Sometimes these things seem subtle; such as no longer being able to have lunch with a friend who is suddenly preoccupied with something else in his/her life. This person may have a good reason to stop meeting with you, but the interactions and what they meant to you are suddenly no longer available. This naturally may elicit sadness.
3) Consider if your environment tends to diminish, dismiss, or ignore your requests to be heard, get your point across, or communicate what you feel. Sometimes people end up in pretty harsh environments and then blame themselves when others ignore or dismiss them.
4) Even if you can’t figure out why, try focusing instead on the what. What you feel is experienced in your body. A tightness in the chest, a pit at the bottom or your stomach, or a sense of restlessness and agitation are all feelings. When you focus on the what, try to make space for the experience of your feelings to simply exist, without you trying to change them. Your feelings are probably trying to tell you something! This is the opposite of what you do when you can’t figure out why (i.e., ruminate endlessly, suppress feelings, and try to talk yourself out of experiencing what is felt). Give yourself the opportunity to simply allow feelings to be-without a wordy, logistical, or rational explanation.
The problem with figuring out if anger is “good” or “bad”; “healthy” or “unhealthy” doesn’t allow any opportunity to figure out what anger does, how it works, and why it makes sense.
Think of your living room couch. Is it a “good” couch or a “bad” couch? Wouldn’t it sort of depend on a bunch of different things- such as comfort, style, how old the couch is, how many people can fit on the couch, or if the couch actually suits you? Usually if a couch has a use, serves a purpose, or does what it is supposed to it is considered valuable. While it is possible that you are sick of your living room couch- perhaps you think it is time to get a new one- your couch may be necessary to hang on to for now. On the flip side, you may be very happy with your living room couch. This could make it more likeable and increase your tendency to say, “It is a good couch.”
Emotions- like anger- are like couches. Instead of thinking about anger as being “good” or “bad”, it is more important to consider the following:
How is anger serving a purpose, fulfilling a function, or doing something useful? Anger can function to communicate, get someone to back off or change behavior, or change a situation for the better. Think of it like a red flag, a signal, or a message.
Is the way in which the expression of anger is effective? In other words, is the way you communicate your anger working for you? What a person can make use of their anger by being aware of it (experiencing, tolerating, and understanding what it does for them) it increases the opportunity for effective expression (ie, another person heard, understood, and responded accordingly). On the other side, ranting or attacking often hurts relationships and doesn’t always send a clear message about expectations or desired change.
What are the relationship consequences for how the anger is being expressed? Relationships at some point might undergo rifts, misunderstandings, and irritation. The ability for people to tolerate these things in relationships sometimes help people grow, initiate important discussions, and bring about change or intimacy. On the other hand, anger that is overly intense can damage relationships, hurt other people, or add insult to injury.
First of all, I’m going to say that focusing on the why this behavior occurs is probably not the most effective approach to addressing adolescent self-harm. I’ll give you some reasons why teenagers self-harm in a minute, but the one fallacy that people often have is that if they could explain why behavior occurs, then they would actually have the tools to fix or change it. More specifically, teenagers who may not understand the behavior themselves can often be put in an awkward situation in which they are forced to explain the unexplainable. If they don’t understand why the behavior is occurring in the first place, they may end up giving inaccurate reasons simply to appease their environment.
Self-harm behaviors likely have something to do with emotional pain. Possibilities include ways to control feelings, ways to control oneself or one’s behavior, ways to increase intensity of feeling (ie, the need to feel “real” or the need to feel “something”), or ways to decrease intensity of feeling (“If I didn’t cut I wouldn’t have been able to tolerate the situation”). Understanding how emotions work and what they do for people may is critical in understanding the role of self-harm behavior. For instance, feelings are functional in that they give useful information about what matters to us, communicate to ourselves and others, and help us become organized and prepare for action. Without feelings we just wouldn’t care.
In adolescence, self-harm behaviors may play a role in identity, communication, and intimacy. Self-harm may be kept very private or it may be made public. It may be an attempt at controlling one’s environment or letting someone else know that the person doing the self-harm cannot be controlled. The function of the behaviors may communicate to oneself (I know I matter, I know what I have to say is important, I can’t stand by and let nothing happen, I am not pleased by the situation, This is my way of making a statement), or to others (Back off, This is too much, I can control your reactions, I know you will be upset and freak out, There is nothing you can do about this, You can’t claim to know me, You think you know everything and you don’t).
Treatments for self-injury are not as simple as publicizing behavior (ie, making sure that others know about it), invading privacy by doing body checks, or just stopping doing it. If there was no benefit to doing it, no one would do it! That’s just simply how it works. Knowing the benefit can help someone to organize an effective solution. Teenagers who can obtain help in identifying, accurately labeling, understanding, and communicating their feelings effectively will have more options for what they can do when the urges to self harm show up. Increasing options, understanding the short and long term consequences of this behavior, and providing alternatives for how to tolerate intense, painful, and negative emotions is certainly one way to start.
It’s important to remember that teenagers also have their own feelings about this behavior. Some are opposed to changing it, some don’t want anyone to know about it, some want everyone to know about it, and some feel really hopeless that they can’t stop doing it. Most have some degree of mixed feelings. Assuming and communicating that a teenager simply doesn’t want to change is probably not going to help solve the situation. While it might be a likely, blaming a teenager for doing it usually only serves to communicate a parent’s frustration.
Similarly so, parents have their own feelings about it and may feel disgusted, hopeless, overwhelmed, inadequate, or guilty. How parents communicate and address painful emotion will also impact the situation; and thinking through the effectiveness and intensity of one’s own responses may be part of the work involved in addressing teen behavior.
I think it is important to consider that the problem of self-harm behavior has solutions. Sometimes providers, teachers, parents, and community react with an abject horror that stirs the pot, gets everyone all worked up, and in some cases emphasizes the solution (self-harm) and not the problem itself. Emotional problem solving is really just that- emotional problem solving. If a person can figure out how to problem solve (ie, address, tolerate, understand, deal with, validate, survive) painful emotions, then their way of solving problems (ie, self-harm) may decrease. Finding effective solutions means having an adequate way to assess and address these behaviors with a skilled professional who understands the role that these behaviors serve.