Level II: Emotions (see chapter 12).
Even though tests for depression and anxiety correlate moderately (about .60), most depression treatment programs have neglected anxiety (Biglan & Dow, 1981). This is changing because going through high stress has been found to sometimes trigger the onset of depression. About half the time serious anxiety accompanies sadness and surely anxiety is almost always associated with guilt, shame, and low self-esteem. Biglan and Dow suggest that anxiety increases our tendency to withdraw when depressed. So, avoiding stress and reducing anxiety may help increase our activity level and decrease our chances of becoming depressed. See chapter 5.
Anger is also frequently associated with depression, especially with marital problems, guilt, shame, and dependency. Likewise, it is speculated that dependency and "love bonds" are especially important in women's depression (Scarf, 1979). Women are 2 to 6 times more likely than men to be depressed; they tend to be more lonely and dependent while men are more self-critical. So, chapters 5, 7, and 8 may help cope with sadness too.
Sorrow with his pick mines the heart, but he is a cunning workman. He deepens the channels whereby happiness may enter, and he hollows out new chambers for joy to abide in, when he is gone.
Use relaxation, desensitization, meditation, and elation training to counteract sadness, worry, anger, etc.
There is clear evidence that high stress increases the risk of getting depressed. So, learning to cope with stress helps prevent depression. Also, if sadness, anxiety, anger, guilt or shame are associated with specific situations or memories, the unwanted emotions could be reduced by desensitization. Example: if feeling sad about being rejected by a graduate school or for a job, one could remember the events leading up to the rejection and to the rejection itself while being very relaxed (see chapter 12). This should make the rejection less painful (especially if new exciting plans are also being developed).
Desensitization and stress inoculation. If the depressing event is anticipated, desensitization and stress inoculation could be used in advance to reduce the impact. Example: Suppose you suspect that you are about to be fired. Advanced planning of how to handle the situation could help, e.g. requesting that your work be evaluated by an unbiased outsider, offering to work for less, insisting that the decision be taken to the next higher level, or threatening to sue. Also, you can rehearse ways of calming yourself and responding to criticism. Planning or actually starting to search for another job might also be reassuring.
Whenever possible, anticipating, talking with a friend, and "emotionally working through" a loss in advance is usually a lot better way of handling the situation than pretending the loss is not going to happen.
Express feelings. Some feelings can be reduced by getting them off your chest--getting them "out of your system." A good cry can sometimes relieve sadness. Beating a pillow can release rage.
Get plenty of rest. Insomnia, especially waking up early, plagues many depressed people. Relaxation and stimulus control procedures have helped many people get the sleep they need (see chapter 5 and Bootzin & Nicassio, 1978, or Catalano, 1990, or Perl, 1993).
Pursue happiness. Overall happiness is not produced by occasional intensely positive events but rather by frequent mildly positive experiences. Many people feel those pleasant moments must be unplanned and spontaneous but the evidence is otherwise, namely, happiness can be self-generated. How? (a) Focus on achieving emotional closeness with loved ones. (b) Find things about work that you enjoy and want to work hard on. (c) Help others. (d) Exercise, doing something you enjoy. (e) Plan to do new fun things too. (f) Have lots of nice "moments," not just big highs (Diener, Sandvik, & Pavot, 1990).
The above isn't just the opinion of therapists. Many people who have overcome depression say that the best signs that the depression is over are re-engaging and enjoying the family, finding new career or hobby interests, exercising, and getting involved in community service. In short, they are enjoying life and people again. Anyone who has been depressed realizes it is vastly different from being fully recovered.
For some people, the return of the joys of living seems to automatically occur after getting over the basic physical aspects of depression (feeling really down and tired, loss of appetite, under or over sleeping, lacking interests, negative thoughts, especially of death...). For other people, they need to find hope and to be given encouragement to seek interesting, exciting, enriching activities in their lives. Many people get some relief from the physical/biochemical symptoms by taking anti-depression medication but full recovery is still a long way away. They may just wait expecting the medications to eventually completely cure their depression, but this may never happen. Many experts, however, believe your full recovery would come quicker if you set about planning and trying to learn how to re-capture the joys of living you want so badly.
There is a new online organization, GOAL! Go On And Live (http://www.GoOnAndLive.com), which provides help in overcoming depression by seeking satisfaction and meaning in several aspects of your life. Check out the New Patient Survey mentioned on the main page. This survey of patients, who have fully recovered from depression, lists these kinds of efforts that helped them come out of the depths of depression: re-building good relationships with family, finding anew or reviving love relationships and friendships, developing or re-capturing satisfying work or professional roles, contributing to a meaningful Community Service, finding hobbies and interests that add to your life, and just enjoying the little things.
In no way do I want these comments to seem as though I am blaming the victims for their own unhappiness. I merely want to offer you some hope that active seeking to add some joy and excitement to your life may actually work and further reduce the oppressing depression. See the earlier discussion of Happiness. Perhaps, once the hopeless lethargy has lifted, joy-seeking efforts should become a regular part of one's conscious efforts to defeat the remaining depression.
Level III: Skills (see chapter 13)
For most of us, sadness is associated with increased isolation--we just don't feel like socializing--and with more anxiety when we do interact. However, some depressed and socially insecure people become social addicts, even sexual addiction is not unknown (Scarf, 1980). Since our social-emotional reaction during a downer varies so greatly, obviously different social skills are needed by different people. After assessing your social strengths and weaknesses, use your assets and reduce your liabilities by gaining new social skills. Which ones? Several are mentioned below.
In spite of massive social skills training research, relatively little has been done in this area with depressed persons (except for Peter Lewinsohn's work). Intuitively, social skills ought to certainly help with loneliness, low self-regard, and boredom. Communication skills (e.g. "I" statements and empathy responses), relationship contracts, greater tolerance, and counseling should also help with relationship problems.
Social skills training
Social skills training improves your talents at meeting people, conversing, telling stories, selecting a friend or partner, and having a good time. Social skills don't come naturally to everybody; many of us have to learn and practice good communication skills, often involving close observation of others, role-playing, and other methods. Research has shown that having good social support is beneficial if you are depressed and it helps prevent depression in the future (Bennett & Bates, 1995). So, how do you get more social support? By acquiring more social skills.
Depressed people may not talk much or talk too much about their problems. Neither makes friends. After about 5 minutes, the self-put downs, pessimism, dependency, and whiny helplessness of talkative depressed people becomes unpleasant to most people. Yet, most depressed people long for meaningful contact; therefore, they must learn to interact differently. So, give the potential friend "equal time" and be an empathic listener during his/her time. Let the friend know you are down but suggest doing some fun things together too. Do things for others. A friend is different from a therapist--he/she has to benefit from the interaction too. Practice making light conversation; use your sense of humor.
Assertiveness training has had mixed success with depressives (Biglan & Dow, 1981). The interpersonal skills should add to self-confidence and encourage standing up for one's rights, instead of being submissive. Assertiveness is not fighting, it includes disclosing and expressing emotions, like personal needs and positive feelings, and should deepen relationships. Don't prematurely over-disclose; don't become self-centered or pushy.
Empathy response training
Empathy response training is quite effective in deepening and improving relationships. Use empathy statements for helping someone else. Make "I feel..." statements to help yourself express your problems and concerns to another person who is, hopefully, a good empathizer.
Training in marital communication skills, fair fighting, conflict resolution, and self-disclosure could greatly improve relationships. Intimacy and closeness, i.e. continued sharing of personal history, opinions, feelings, and dreams, could do wonders for one's attitude about life.
Decision-making and time management training may relieve depression, if one has neglected and made poor decisions or mismanaged his/her time. A series of mistakes can cause disappointment and a low self-concept.