How to recover from depression

How to recover from depression

well that was a very nice introduction thank you I want to say I'm very grateful to Anthony for arranging this this program this idea of his abrini psychology to the public to me is the most important thing that we as psychologists can do the volume of information is so great and the quality of information has improved so markedly over time that there's a lot to share and we have a relatively short time this evening but I hope to give you a lot of good perspective about things that matter the most in learning to manage depression so let me say I will be speaking for roughly 45 minutes or so and then I will open it up to questions let me start with a story and get you thinking about this topic when I was a young psychologist back in 1829 my first job was working in a psychiatric facility and I was the admissions person it was my job to admit new patients to the unit now this is a locked facility people aren't getting locked up because they're doing well they're not really doing very well at all and so my job was to interview them find out why they were there what was going on in their lives what the expectation was for their hospitalization what medications they were on what the treatment plan was all those kinds of things now I'm young I'm inexperienced and for me to have the opportunity to interview many hundreds of people in a relatively short period of time turned out to be pivotal and all the things I'm going to talk to you about tonight I would interview people who had been through the worst experiences that you can imagine people who had been raped tortured mutilated people who had fled their homelands literally with the bullets with whizzing past their had people who lost their entire family and one fell swoop in a plane crash or a car crash people who had suffered the worst adversities you can possibly imagine and when I would interview these people it was easy to appreciate why they were broken why they were so despairing why they had given up on life that was of course an interesting lesson to say the least the compassion the empathy was very easy but what fascinated me clinically that has every bit of relevance to what we're going to talk about tonight is when I interviewed people who had been through these horrific experiences people who probably should have been depressed but they weren't and I wanted to know why not what is it about the way that these people are coping that somehow serves to insulate them against depression so it gave rise to the for research questions that have guided my career now for more than 40 years think about your answers to these questions because we're going to talk about them the first question was are there skills that people have that serve to insulate them very interesting when you ask people directly gee anybody who had been through your circumstances would be depressed you're not why not and people would give me these very insightful answers like I don't know or they would say well I guess it's just luck of the draw or I guess it's good genetics but they couldn't really give me any insight into that they're just living it they're just being who they are doing what they're doing so as a young researcher interviewing people and asking a million questions slight exaggeration and you find out that they like murder mysteries and they like taking walks in the park and they like playing with their kids grandkids and they like ice cream and they like all kinds of things and there I am trying to figure out so what is it well we've answered that question now it's the ice cream if only it were that simple so starting to identify what patterns are present in the way this person thinks about things in the way they define problems in the way that they define their relationships what are they doing in there and what emerged from that with great clarity were certain patterns of self-organization keep that phrase in mind patterns of self-organization so then the question became okay if I think I have a handle on what's going on with these folks what we can learn from them it leads to the second question can we say that these skills that these people have are in fact learn about are they teachable isn't this what the purpose of therapy is is to help people acquire these skills that are not intuitive for them that are intuitive for these other people then the third question became the salient research question can we prove scientifically empirically that when people are taught these particular skills that it makes a difference that it reduces their level of depression reduces the frequency of depression reduces their vulnerability to relapses reduces the impact on the people around them this is one of the things about depression it doesn't just affect the individual sufferer one of my recent books is called depression is contagious and not in a viral sense not in a bacterial sense but in a social sense what is it about depression that is so easily transmitted to kids of depressed parents if you're the child of a depressed parent your likelihood of suffering depression is three to six times greater than if you are the child of a non depressed just having a depressed parent is a massive risk factor not a small one a big one so can we prove that by people acquiring and developing the skills that it really makes a difference and then the fourth question has to do with prevention now bear in mind I'm asking these questions more than 40 years ago when we didn't have good antidepressant medications we had medications that weren't particularly effective and people didn't want to take them they had annoying little side-effects like death and so all in the span of 40 years all of those things have changed we have better medications we have far better psycho therapies a far better insight into what depression is who's vulnerable and under what conditions but the idea at that time of even thinking about depression in terms of prevention was sheer fantasy we didn't have good treatment much less good opportunities for prevention so I will summarize my response to all four of these questions yes yes yes and yes what we have learned is that there are certain vulnerabilities risk factors a risk factor is anything that increases the likelihood of somebody suffering a particular disease or condition and at the time that I started studying depression we knew of exactly two risk factors gender and family history we now know that there are scores of risk factors factors that increase vulnerability to depression and I'm going to talk about some of the key ones this evening now part of what came out of that initial study was the recognition that it's not just what happens to you you know for the people who say well the reason I'm depressed is because here's what happened to me when I was a kid or the reason that I'm depressed is because I lost my job or the reason I'm depressed is because this person broke up with me that's only partially true at best it's far less about what actually happens to you and it's far more about how you interpret how you give the significance to what kind of meaning you attach to the events in your life and part of what we've learned is that there's a phenomenon called attributional style a pattern of how people reflexively unconsciously interpret the significance of events and this is something that is imperative to appreciate for all of us because this is where some of the strongest risk factors reside as I'll get into in just a little while but let's backtrack to the most basic of questions if we ask the question what is depression well depression is technically considered a mood disorder but it's far more than that depressions tentacles reach into every part of a person's life it affects not just your mood it affects your physiology your physical health and how depression serves as a risk factor for many different conditions most notably cardiovascular disease in fact there are cardiologists around the world who are recommending screening for depression as the first screen for cardiovascular disease but others as well and it reaches into your ability to think and make decisions and it's one of the things I'm going to talk about a little bit later is the quality of people's decisions and how their way of making decisions actually unintentionally reinforces depression it affects job performance and your ability to function in the work that you do it affects concentration how many work-related accidents that damage people and damaged people's lives are caused by inattention caused by depression it affects relationships it's hard to be around people who are depressed it ends up damaging relationships and of course all that leads to is more isolation and more depression so I can go on and on about all the different tentacles of depression but you should get the idea that this isn't just a bad mood there are a lot of things that are very persistent very enduring about the patterns that give rise to depression in the first place that effect a quality of life over the span of a lifetime so then if we come to the question what causes depression is depression caused by now look at this list if you were to research every one of these factors you would find that there is abundant evidence for all of them and more and if you look at this list you'll notice that some of these factors are biological factors some of these factors are psychological factors some of these factors are social factors and the more that we have learned about depression the more that we learn how important the social side of the equation really is that so many of the risk factors for depression when I talk about depressed parenting and why kids of depressed parents are it's so much higher risk it isn't through genetics it's through modelling as a parent you can't teach kids what you don't know and so it becomes an interesting field of research what is the relationship between family structure family coping styles family atmosphere and depression and leave it in general for the moment there are some very significant factors that operate in that arena it's why I wrote the book depression is contagious because these factors now are being recognized across a variety of fields so to summarize that point how important it is to appreciate and have a multi-dimensional viewpoint yes biology matters but surprisingly not as much as you would think that when we look at what's termed genetic variance how much do genes play a role in depression is there a depression gene no are there genes that make people vulnerable to depression definitely and so if we look at biochemistry yes it's a factor if we look at disease processes there are many diseases where depression is a predictable consequence if we look at drugs there are many drugs that have depression as a predictable side effect biology matters but when we look at genetic variance that figures between point three and point four there represents a mild moderate at best genetic influence so when we look at the site power the psychological factors individual history individual problem-solving styles individual coping styles these are the kinds of things that are in the domain of individual psychology another one that I mentioned just a moment ago attributional style the person's habitual or reflexive way of attaching meaning to life events and that the social side of the equation as we've learned from studies of depressions prevalence a field called epidemiology this has been particularly revealing I don't know if you saw the the big announcement last year from the World Health Organization well in 2004 the World Health Organization which monitors health issues of all types around the world including depression but other things as well cancer aids MS you name it in 2004 the World Health Organization declared depression the number four cause of human suffering and disability behind cancer heart disease and traffic accidents they predicted in 2004 that by the year 2020 depression would rise to be number two in fact depression reached number two in late 2013 last year just around this time depression was declared the number one cause of human suffering and disability and the numbers are increasing there is no demographic group where the numbers are going down in every demographic group the numbers are going up when we look at the epidemiology it's the 25 to 44 year-olds who represent the largest group of depression sufferers but the fastest-growing group is their children and this is one of the things that I am deeply concerned about now when you see a 14 year old or a 15 year old who's already suffering depression shows the signs has the symptoms as dealing with it that's a basis for concern what's an even stronger basis for concern is what happens ten years from now when this depressed adolescent becomes a parent we now have three generation studies that show remarkably clearly that from one generation to the next depression increases in prevalence depression increases in severity I'm worried especially about the youngest among us who are at a very elevated risk right now for all kinds of reasons one of the points about the social side of depression why is depression increasing so dramatically think about your response to that well the societal structure has changed radically over time and when we look at things like the influence of Technology that smartphone that you're carrying around represents one of the strongest risk factors there is for young people today who are no other way to describe it addicted to the technology survey after survey showing that if you ask somebody to stop checking their phone for two hour they react really badly it's so engrained into their quality of life and as a general principle the more time you spend in front of a screen whether it's a small one whether it's a big one the more likely you are to suffer depression you've been hearing about the what people are calling the epidemic of loneliness paradoxically in this terribly overcrowded world people are dying of loneliness and the fact that people are as disconnected as they are plays a significant role so when I talk about what causes depression the best answer I can give you is many many things and that's precisely why each person's pathway into depression is different it's why whatever pathway this person is gonna find out of depression is going to have to be unique to them is there a best treatment for depression absolutely not is there a best approach absolutely not the best approach is the one that works for you and that's an important thing because as a consumer that as you approach the decision to seek help to take advantage of the fact that there are experts who have been studying these things for a very long time and have learned a lot and know how to do treatment quite well that your path is going to be different and unique there is no standardized treatment there's no standardized way of doing this and so this is an important point I'm talking now about your risk factors yours you as an individual they're not the same as others when I say each person has their own pathway in and it's going to have to develop their own pathway out your task is learning what your vulnerabilities are learning what your risk factors are what is very troublesome for one person isn't the least bit troublesome for someone else what one person avoids with every ounce of energy they have somebody else walks into openly and happily everybody's different and so when we look at that point which is really nothing to sneeze at we we really have to appreciate that it's that level of individual attention learning about yourself that becomes one of the most important things that you can do so when we look at the fact that currently the most common form of treatment the most popular form of treatment so had the antidepressant medication now antidepressant medications really came became popular in the late 1980s with the first release of Prozac the first of the newer generation antidepressants I'm not gonna say a lot about antidepressants right now you know just a couple of general comments what I will say definitively is medications are too heavily relied upon medications are viewed as somehow going to be the answer and I can tell you the more that we understand the social aspect of depression the more confidently I can say to you there will never be a drug that cures depression any more than there will be a drug that cures racism or poverty looking at it through the lens of biology is an exceptionally limited perspective why I made a point of showing you the slide that shows you the biological factors psychological factors social factors now it's not that I am against antidepressants you know part of writing for encyclopedia Britannica's I can't just say it because it's my opinion where's the evidence for it antidepressants can do two things reasonably well they can help you manage the vegetative symptoms things like sleep disturbance appetite disturbance and they can raise the floor on depression now that will be true for roughly half the people who take medications if you take medication alone it's something to reconsider medications have the highest rate of relapse of any form of tree so even if you happen to be a fan of medication and believe me there are people who say to me all the time that medication saved my life I believe them there's no reason to disbelieve them but the larger point I'm making is it's not enough it's not enough and here's why it's not enough no amount of medication is going to help you develop skills and managing stress none no amount of Education is going to help you develop a better attributional or explanatory style or help you build and maintain positive relationships with other people or it's helped you develop the kinds of cognitive skills that help you think critically about experience instead of just getting sucked in by your feelings it's not going to help you develop problem-solving skills it's not going to help you develop better decision-making strategies it's not going to teach you how to build a support and network with people it's not going to help you come to terms with whatever crummy things have happened in your life and it's certainly not going to help you build one of the most important things one of the most important things in getting treatment is how to build a compelling future you know the past whatever de-stresses whatever traumas whatever situations you Fath you've faced I get that I listen to those experiences all the time and they're tragic but if we ask the question who overcomes depression and who doesn't the people who find themselves facing forward who start thinking in terms of how do I want my life to be do better than the people who keep focusing on the past the unchangeable past and that's really the key and this drugs aren't going to help you do that so if we look at what these risk factors are that I'm talking about when I said there are scores of risk factors literally dozens and dozens of risk factors things that singly and in combination can give rise to depression very easily I want to highlight for you some of the key ones some of the risk factors that have a greater impact than do others and I'm gonna describe these for you and give you an idea of what they look like sound like and what you can actually do about them how we doing okay so the first one let me name them first the internal orientation stress generation rumination global thinking and finally unrealistic expectations let's look at each risk factor individually and how it influences your overall quality of experience the first one the internal orientation what I'm talking about the internal orientation very simply I mean what people do is they use themselves as the reference point they use their feelings to make decisions they use their feelings to interpret the things that they're interpreting events that happen in their life the internal orientation drives you in wordly there are actually some depression writers who have framed depression as being the most narcissistic of all states now that's clearly an exaggeration but it does speak to the quality of self-absorption what I mean by the internal orientation and when you use your feelings as the indicator of what to do you're going to make mistakes now I know that there are people running around loose in the world who will say to you trust your feelings listen to your feelings listen to what your heart tells you I can tell you as a psychologist and depression expert that is really bad advice really bad advice because your feelings can too easily deceive you people can so easily think things are worse than they really are people can think things are better than they really are to be able to have the ability to go outside yourself and learn something about what's actually going on out there well when I say internal orientation it's the subjectivity here's what I believe here's how I feel this is the way it is and when people make bad decisions that unintentionally make their life worse that really speaks to what I'm going to talk about next with stress generation but the point I'm making now about what does this mean in terms of what to actually do I put here the goal is to learn to reality test one of the most important skills you can develop in life is reality testing how do I go outside myself in order to know whether this is really what's happening and if you look at the times that people get in the most trouble it's when they get wrapped up inside and whatever they happen to believe that may have next to nothing to do with what's actually going on out there clinicians call this cognitive rigidity in plain language what it means is the key problem with depressed people is that they think things and then make the mistake of actually believing themselves thinking is dangerous potentially and without the ability to learn how to go outside yourself in reality test all you can do is be a prisoner of your own thoughts and if your own thoughts are depressing you're in trouble and it's why especially here in Australia where CBT is one of the most commonly applied approaches and appropriately so helping people learn the cognitive skills of how to gather information and how to use it instead of just jumping to unfounded conclusions and believing the things that go on and of course this also relates to the social isolation one of the values of relationships is when you have people close enough to you that you can say to them here's what's going on here's what I think about it and hopefully they care about you enough and they're close enough with you to be able to say to you I don't think you're right about that it's why the most important skill to counter cognitive rigidity is cognitive flexibility how can you train yourself to generate multiple explanations for things that happen simple example I call you up you're not home I leave a message hi it's Michael it's 10:00 a.m

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call me back it's now 10 p.m. at night and you haven't called me back if I am a depressed person what is my predictable attribution or explanation for why you didn't call me back you don't care about me anymore that'll cheer me up but it doesn't stop there then it goes to the next level of how come people don't care about me why aren't people ever responsive to me why aren't people ever staying my friends and the next thing you know this person's built this up and built this up until it's literally a suicidal crisis because you didn't call them back that's how it works that's the internal orientation training people to generate multiple explanations why did this person call back could be this could be this could be this could be this could be this which one is it I don't know to master the art of recognizing what you don't know instead of making stuff up and then actually believing yourself the second risk factor is called stress generation this is actually one of the most recently developed models of depression and it has attained already a significant level of empirical support what stress generation speaks to is how people make decisions that complicate their depression exacerbate their depression they don't do it intentionally but it speaks to the quality of their decision-making strategies and when people don't have good decision-making strategies when they just follow their heart just follow their feelings they're going to make mistakes so for example I can say to my depressed client I can see from all the cobwebs all over you that you really don't move much and knowing that exercise has a treatment success rate that matches the antidepressants with a much much lower relapse rate it really would be a good idea for you to exercise and invariably my client says I know but I don't feel like it bad decision your friends say to you wow you are really bummed out you are depressed you need help go to the doctor and you say no bad decision you go to the doctor the doctor says here's the name of three therapists pick one you need help you take the names promptly crumple them up throw them away bad decision that's what I mean by stress generation how many decisions do you make in the span of a day and this is what we find this comes out of the field of affective neuroscience which is just a fancy title for how do moods influence decision-making processes it's a fascinating field and it speaks to the fact that these aren't just cognitive processes that happen mood influences them your mood influences what you remember your mood influences how you remember your mood influences the quality of choices that you make obvious examples if you're angry are you going to be more or less willing to take risks more if you're afraid are you more or less likely to take risks less your mood state influences your perceptions your mood state influences the quality of decisions and helping people make better decisions filtering the mood out of the process is one of the most important things that we do clinically in the therapeutic work that we do so you look at these things don't isolate socialize I don't feel like it stop drinking I don't feel like it why do I say stop drinking if you are depressed if you are vulnerable to depression your alcohol intake should be zero alcohol is a bad drug for people who are depressed or prone to depression it has been shown to aggravate the same neural pathways as depression if you are a depressed person your alcohol consumption should be zero and when you say that to somebody particularly if their Australian they say I don't think so I'm not going to do that bad decision so that's part of the task is learning how to take actions that are consistent with the goals more so than taking actions consistent with the feelings the feelings come and go the consequences last and to start to think in those terms becomes a very different paradigm for people who are used to following their feelings so closely the internal orientation I was talking about that is not one of the seven Habits of Highly Effective People when I say alcohol is a bad drug I am understating it when we look at the next risk factor rumination rumination means spinning around the same thoughts over and over and over again and analyzing and analyzing an animal at the expense of taking action rumination drives the symptoms of anxiety rumination drives the symptoms of depression for the people who are ruminate errs they have much more difficulty with even the most basic things like sleeping because their brain doesn't stop they're always thinking about their problems always thinking about the issues trying to figure out what to do next and the idea of course is thinking about problems is generally useful depending how you think about them if you keep analyzing but never take action you're gonna feel worse if there is a cure for rumination its action but it has to be timely action it has to be effective action it's not just action for the sake of action that doesn't count as action so the ability to be able to convert rumination to action and when we look at the things that people ruminate about it's almost invariably about relationships and probably number two is school and work-related issues but relationships are the most prominent and many of the relationships of course are relationships from the past this is one of the factors of depression every problem has a structure every problem every diagnostic label has components one of the components of depression is what's called a past orientation people come in and they say my past controls me it's because of these traumas in my past it's because of these things my parents did it's because of these things that happened to me when I was a kid and they don't just ruminate about the past although they do that but when I say they're also using the past as a reference point I'm saying they use the past to predict the future so they say things like I'll never be happy prediction for the future why not because I never have been I'll never get a good job why not because I've never had one I'll never have a good relationship why not because I've never had one and of course the most popular one of all I won't be happy until my parents treat me better when I was a kid and for as long as somebody gets caught up in that loop they're not going anywhere why it becomes so incredibly important to convert to action and I'm constantly having to remind people whatever your history is you're more than your history you're more than your history you're more than any one characteristic you're more than your job you're more than your title you're more than your income you're more than your body size you're more than how many likes you get on Facebook or Instagram or any of these other social media things all of that stuff doesn't ultimately matter and can't be the basis for defining self and when people define themselves the thing that's troublesome about having to tell people you're more than your history is that when people learn a therapist says who them you are a trauma survivor you are an abuse survivor on one level that sounds very empowering on another level you're literally adopting the label that says that you can globally define yourself by your unchangeable history the last thing you want to do is define yourself by your unchangeable history why that orientation of the future what the possibilities are if I could get every person to absorb that simple phrase create possibilities there aren't any guarantees in life but we can take actions that create possibilities for the future there is a danger with rumination of thinking too much the unexamined life isn't worth living said Socrates there is a danger in thinking too much and there's a specific discrimination that has to be made when is it useful analysis and when is it useless rumination and I'll answer the question for you if it doesn't lead to timely and effective action it's useless rumination the next risk factor one of the strongest ones is what's called a global cognitive style if there is such a thing as a typical depressed person which obviously there isn't but if there was such a thing one of the core features is global cognition global cognitive style means the person engages in over general thinking her boyfriend breaks up with her she says men his girlfriend breaks up with her women that's over general thinking as if they're all the same somebody has a bad day and they don't say I had a bad day they say why is life so unfair now we just went from a bad day to life could we make it any bigger than that but what it translates into is when people walk and sit down and they say to me well all I want is to be happy is that too much to ask all I want is a good relationship is that too much to ask and then I'll ask the specifics so what do you think it takes to build a good relationship and the person comes back with an equally global response when they say chemistry if you think in those global terms metaphorically you see the forest but you don't see the trees then you can't be an effective problem solver you can't solve problems specifically by taking a global approach to it now this isn't global about everything of course somebody can be very specific about the way they manage their bank account and very global in the way that they approach relationships and it's the things that you don't know about that you are inevitably global for a general understanding but you can't learn skills that way if I want to teach you to drive a car I can't say to you become one with the auto you're gonna do a lot better if I say see this this is a steering wheel see that that's a brake pedal to get the specifics and learn to think in specific terms is a real challenge when your cognitive style is a global one why it's so important to have goals but goals have to be defined a goal without steps is merely a wish what that translates into one of the most important exercises is called a flow of steps this is how we train people to go from global to linear in their thinking I will give you the homework assignment as your therapist of picking something that you know how to do something simple you know how to dress yourself you know how to go grocery shopping you know how to take a shower well you don't just take a shower that's a global phrase taking a shower is a global phrase that represents how many steps involved so I will give the client the task of I want you to delineate every step involved in taking a shower I want you to pretend that somebody who's never done it before is gonna follow your sequence and your job is to guarantee that they succeed at it bring it back to me next time they come back the next time they have three steps get wet lather up rinse off now if that's what you think goes into taking a shower what does that say about your ability to be specific and problem-solve I'm the one who then has to say excuse me but how do you find where a shower is and when you find where a shower is how do you open the door and how do you walk through the door and how do you turn on a light switch and how do you close the door and do remember to take your clothes off and what about opening the shower door moving the shower curtain and reaching inside and turning on the hot and turning on the cold and then testing it out and then flicking the switch from tub to shower and by the time you sequence it out depending on your amount of detail there's gonna be at least fifty steps involved in taking a shower and what if you miss one of them you didn't know you had to flick the switch from tub to shower so there you are standing there naked watching water running down the drain I'm such a loser yeah everybody else can take a shower and I can't what's wrong with me and that's the point once I have exhausted there's taking a shower flow of steps then I give them the next one now that you've done the flowchart for how to take a shower now I want you to do the flowchart for how to be happy and that's the first time the person realizes they have not a clue and then they discover instantly why it isn't happening if you can't sequence what you're trying to do it isn't going to happen this requires a very specific quality of thinking that global thinkers have a hard time doing it's a training process training your brain to think in more linear terms in the specific areas where you need help otherwise all you can do is go glow men women and mists how to distinguish who the good ones are from who the not so good ones are do a flowchart for that okay then the last one I'm going to speak to quickly the unrealistic expectations our expectations are the filter for how we judge everything if I'm doing what you think I should do as a speaker talking about depression tonight then you're very happy with me if I'm not doing what you think I should do then you're not happy with me our expectations are the filters for how we make judgments about anything whether it's a movie that we see whether it's a restaurant that we go to whether it's a party that we go to and it begs the question how do you know whether your expectations are realistic what happens so commonly as a pathway into depression for so many is that they have unrealistic expectations they don't know they have unrealistic expectations so they're always walking around hurt and disappointed I swear to God every morning I want to call the White House and say let me talk to Milania and get her on the phone and say Milania I understand why you value fidelity I understand why faithfulness in the relationship matters to you but look at who you're married to the closest this guy's gonna come to say no to someone is when he says not how we're landing what she wants makes sense but not from him if you really loved me you'd win the lottery she doesn't look so happy and what I'm really curious about is his response to it I'd love to hear what he says next does he say to her your expectations are a little off since on the one in control of the lottery or is he gonna say I wonder if that's true maybe I don't love you enough maybe I don't know how to love maybe I'm defective emotionally maybe I don't go off into a whole thing about his ability to love so when we look at how important expectations are it's a really good idea before you walk into your professor's office before you ask for a friend for a favor before you ask your boss for a special consideration before you ask your husband or wife or boyfriend or girlfriend or partner for whatever it is you want it would first be really nice to know can this person do this is this a part of this person's makeup is it realistic to expect that this person can do honesty or that they can do integrity or that they can do patience or anything else that you would want from this person how often people get into relationships with other people and they're forever pulling on them you know I want affection you never give me affection well you know the fact that you're dating mr

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Spock poses a problem you've got to know who you're dealing with and what that whether the expectations are realistic before you walk into a situation that's charged before you walk into a job interview before anything lay it out what are your expectations how do you know whether this is realistic or not if you get good at doing that you will save yourself a lot of disappointment well I mentioned just in passing the thing that impresses me the most about all the things I'm talking about to you is that when we have integrated these things into prevention programs the very skills that I'm talking to you about now when we have run prevention programs with high-risk populations and been able to demonstrate very scientifically that when people learn these skills their vulnerability to depression drops dramatically so for example we did a program that lasted six months with elementary school kids who were at high risk high risk because they came from very unstable family environments divorce violence abuse all kinds of things that were really bad in these kids lives and for two hours every other week for six months total of 24 hours these kids were trained in problem-solving social skills and then we followed these kids for almost ten years they had less than half the rate of depression less than half the rate of teenage pregnancy less than half the rate of drug abuse as the kids who did not go through the program that's impressive and that's 24 hours worth of basic teaching of skills these skills that I'm talking to you about tonight not only have treatment value they have prevention value well let me highlight for you then some very direct advice to bring let this lecture to a close getting professional help is an important thing to do you don't know your own blind spots you're blind to your own blind spots the stuff that you struggle with and struggle with and struggle with you go see somebody who knows what they're talking about and they can say in five minutes here's what you're missing here's what we can do about it problem solved it's not always that easy by any stretch of the imagination but the point being there's a good value and having trained eyes and ears on what you're dealing with so how do you know when you need professional help first and foremost suicidal thoughts somebody's even remotely contemplating that that is the first cue you need help now before you do something impulsive secondly when you're feeling stuck and hopeless when you don't have the support or people around you that you can reality test with before it reaches a crisis point how often people wait until everything's in flames and then they go get help well you don't have to wait until it's in flames how about you take care of it before things get worse that requires foresight the ability to make good decisions I have emphasized when you have to make big decisions am I going to go to this school or that school am I gonna live here live there am I gonna marry this person am I going to move in with this person shall we put have mom live with us or not live with us should I take this job in another city what should I do you have big decisions to make you really don't want to make them through the filter of depression I spoke about how depression affects the quality of decision-making good idea to have somebody else to reality test with when you know that you're affecting other people the only responsible thing to do is to get help so you are not contaminating them every depressed person on average affects at least three other people negatively and if you know that that depression makes you irritable and angry and over reactive and critical and harsh and all the nasty things that come out of people when they're not feeling good you owe it to the people that are in your sphere of influence to make sure you get the help that you need it's important to shop for a therapist like any field would matter if we're talking about plumbers or electricians in any field there are people who are more well trained people who are better skilled people who have more experience and it means that your job is going to be to shop and to have the kinds of questions handy that you need to have answered is this person experienced with depression what is their general approach to it what's their style how active are they in the treatment process will they assign homework to you will they involve other people couples work family work other people who are involved in this problem for you are they available for appointments how do what do they charge how long are their sessions that's what I mean by shopping to have plenty of questions ready for as you interview different therapists for who you click with who you discover just by talking with them you can tell that there's some some juice there that that you want to be with this person so I gave you all these things about choosing a therapist let me just give you the last couple of slides of very specific bullet point pieces of advice if you're dealing with depression first get a thorough physical exam when I say that biology matters this is the starting place to make sure that there isn't anything going on medically that would give rise to depression as a consequence avoid alcohol completely yes you strive to learn about your vulnerabilities and develop ways to manage them what are your specific risk factors what are the things that you're reactive to that other people are not particularly reactive to learn to distinguish facts from feelings beliefs from facts sleep is such a critically important issue it's the number one complaint of people who suffer depression how it affects their quality of sleep creates insomnia no surprise then that fatigue is the second most common complaint a very important thing to be able to take sleep seriously sleeping with your smartphone not a good idea having your computer on not a good idea having roommates that are blasting Jimmy Hendrix at 3:00 in the morning not a good idea being very very careful about the environment you create challenge yourself 50 times a day here's what I think how do I know reality testing such a critically important skill exercise easy available it works and part of the reason it works is not just because of the neurochemical that hypothesis is a reasonable one but the other thing about exercise is the gains are to be made very quickly you start exercising today you can barely walk half a block and you stay with it in two weeks from now you're walking a mile games happen very quickly and for people who typically have low frustration tolerance this is a good way to get ahead relatively quickly do fun things and do them often one of the first things to go when somebody's depressed is their sense of humor there's nothing worse than when you crack a joke to somebody in their response to it is and it ends there to do fun things to follow the motto that at least some of the time dare to be superficial get and stay connected to other people learn to relax relaxation processes meditation visualization guided imagery hypnosis any kind of relaxation process is going to be beneficial being goal-oriented in the important areas of your life but again they have to be realistic goals if you can't do the flow of steps if you don't know what the steps are then you're caught up in that you wish but you don't really have a plan prioritize and problem-solve get support get help don't wait if I'm going to talk about the things to do I might as well talk about the things not to do don't dwell on the past it's gone but tomorrow hasn't happened yet really focus on what can I do that'll be different in the future that'll change how I feel about the past don't compare yourself to others this is one of the worst things about social media if you watch social media if you participate in social media how easy it is to conclude everyone else is having fun everyone else is lovable everyone else is popular everyone else is going places that are cool everyone else is and I'm not guaranteed pathway into feeling lousy comparing yourself to other people particularly when you don't have any information you know you can't look at a picture and say that that's this person's life that's global thinking don't catastrophize it helps to understand the probabilities don't leave important things unsaid or unresolved closure counts for a lot don't analyze too deeply move on don't ignore reality get the facts don't ignore your own needs self-care is not the same as being selfish you're the only one who can manage yourself and here's a key point no mood expert that I know of would ever talk about curing depression keep this point from this lecture the goal is not to cure depression the goal is to learn how to manage your moods death phrase manage your moods you don't exercise once and now you're done with the exercise thing you don't discipline your kid once and now you're done with the parenting thing you don't make a bank deposit once and now you're done with the banking thing these are things you have to manage every day of your life and managing your mood requires the skills psychologists call it self-regulation but the simple phrase managing your mood counts it's what I'm really speaking about it helps to have a realistic expectation who gets depressed everybody everybody's vulnerable if you are capable of moods you're capable of mood disorders learning how to manage that aspect of yourself is so critically important don't give up or be passive try again but do something different don't isolate find good people to be with and don't leave time unstructured there is so so much more I could say I feel like I have hit many of the key things to get across to you I hope you feel the same way well Michael it's difficult to believe that our time has already come to an end it's really been an experience of time distortion in this room it's been a fascinating overview of depression join me in thanking Michael we have a Australia that you can take that ah thanks so much Anthony it has been a pleasure thank you it's a Porsche thank you so much I appreciate it a lot thanks for coming out tonight everybody I hope it was useful for thank you for coming