15 Ways to Support Someone with Depression | CBT Relationship Counseling Tools

Hey there, everybody, and welcome to this presentation on 15 strategies for supporting someone with depression or anxiety. I'm your host, Dr. Donnellice Snipes. In this presentation, I'm going to help you develop an understanding of depression and anxiety, including common and often unnoticed symptoms. We'll explore additional impacts of depression and anxiety and also identify other causes of symptoms like hypothyroid or hyperthyroid. Then I'll move on to listing 15 strategies that you might be able to use to support a person with depression and or anxiety. It's important to understand a little bit about depression and anxiety in order to be able to effectively support someone who has it. Depression and anxiety both have physical components and involve imbalances in neurotransmitters, transmitters and hormones. So it's a physiological imbalance. Now, our thoughts and our feelings and our environment can contribute to that physiological imbalance, but it's important to recognize that there is a physical component to it. So just like you wouldn't tell somebody to get over having the flu, you're not going to be able to tell them to get over being depressed, because it's just not that easy. Both anxiety and depression have multiple causes and many people experience both at the same time. They may be depressed and have anxiety about whether the depression is going to get worse, about whether people are going to reject them, etc. They may be anxious and feel so helpless and hopeless to to address the things that are causing them anxiety that they also start to feel exhausted and depressed. So we see these two things occur more often than not together. So let's start out with what is depression really? People who have depression have either a low or depressed mood or a lack of pleasure or a lack of color or feeling in their day for a period of at least two weeks for major depression. But there's something called persistent depressive disorder that can last for two years or more. It's important to recognize if somebody has a depressed mood or a just a sense that they don't feel much of anything, they feel numb all the time, or there's no color in life. That is not necessarily the way it has to be. So that is one symptom. Sleep changes are another symptom of depression. A lot of people who are depressed are exhausted, so they want to sleep a lot, but they don't get quality sleep. And a lot of times they may fall asleep at the wrong time and wake up in the middle of the night, or they even go to sleep at reasonable time and they still wake up in the middle of the night, and then they can't get back to sleep. So sleep disturbances are very, very common. It's important to recognize that serotonin is one potential neurochemical involved in depression. There are others that can cause depressive symptoms, including norepinephrine and dopamine. But serotonin is broken down to make melatonin, and melatonin helps us fight asleep and stay asleep. So people who are depressed, especially if their depression is caused by an imbalance in serotonin, are often going to have difficulty getting quality restful sleep. And it's not because of anything specific that they're doing necessarily. It can be because of that imbalance. Those sleep changes cause changes in their circadian rhythms. Therefore, their body may start losing its normal internal clock, and it may start not knowing when it's sleepy, when it's time to be awake, when it's time to be hungry. And that also affects every other body system, including sex hormones. So estrogen, testosterone, progesterone, those may get out of whack as well. We see eating changes in people with depression. A lot of people with depression may crave high fat, high sugar foods, because those foods prompt the release of serotonin and dopamine. But some people, when they're depressed, just have no appetite at all. Either way, the body is probably not getting all of the other healthy nutrients it needs in order to make serotonin and dopamine and control inflammation and all those other things. So eating changes are a symptom of depression. But eating changes can also contribute to depression. Low energy is another symptom of depression. When people are not sleeping well, it impacts their energy levels. When they're not eating well, it impacts their energy levels. When their serotonin, their dopamine, and their norepinephrine get out of whack, it impacts their energy levels. So a lot of people have low energy, but there can be a lot of different causes for that. Psychomotor retardation is a really clinical term for slowing. It feels like everything they're doing, they're doing in a wind tunnel. And it's just harder and takes more energy and effort for them to do everything. And it's not just feeling that way, but other people actually notice that they're kind of slower at doing everything. Irritability is another common symptom. When people feel depressed, when they feel hopeless, when they feel helpless, when they feel exhausted. Somewhere in the back of their primal brain, there's a little voice telling them, hey, you don't have a lot of Energy, you're vulnerable right now. And when people feel vulnerable, they tend to more easily respond with fight or flee. And irritability is common in people who are depressed for that reason. It's sort of their body's way of going, I don't have energy to fight right now. I don't have energy to deal with anything else. Please stay away. I barely have enough energy to go on. Guilt is very common in people with depression because they don't want to be depressed, they don't want to be exhausted all the time. They feel guilty that they are not able to do the things that they think they, quote, should be doing. And they spend a lot of time shoulding themselves. I should be able to get up, I should be able to handle this. And that just compounds their sense of hopelessness and helplessness when they tell themselves they should, but they just, they can't. Difficulty concentrating is another common symptom of depression. And it's one of the, you know, clinical features. All of these are clinical features of depression. When people are not getting enough sleep, a byproduct of brain activity called adenosine can build up in the brain and that contributes to daytime fatigue. It also makes it difficult to concentrate. Dopamine is one of our attention chemicals, as is norepinephrine. And as I mentioned before, in people who are depressed, it's often all three of those serotonin, dopamine and norepinephrine that are out of whack because when one gets out of balance, it brings its buddies with it. So people may start having difficulty concentrating. Concentration takes energy. When you ain't got no energy, then it's more difficult to concentrate even if you were sleeping well. Those are what we call the clinical criteria. That's what's in the DSM for depression. But we also see people who have depression that experience increased pain and stiffness. Well, if you're sleeping a lot, if you don't have energy to move, you're going to start feeling stiffer, you're going to start having more aches and pains and stuff because you're probably not following proper ergonomics when you're sitting there watching TV or lying in bed. So people start having more stiffness. Additionally, serotonin is one of our neurochemicals that is involved in pain perception. And when serotonin is low, pain perception starts going up. We start feeling more pain. That is real. It's not something people are just making up. Anxiety is, remember I said they often co occur. We talked about irritability and depression. People who have a sense of feeling, being keyed up on or on edge. Most of the time, that's anxiety, worrying about a variety of things. Most of the time, that's what we call generalized anxiety. And it's not something that they're willfully doing. They're not deciding, hey, I want to fret about this or I want to fret about that. There's something in our brain called the default mode network, and it's sort of our autopilot. And people who have generalized anxiety, their default mode network often has kind of taken on a life of its own, and it is constantly telling the person about things that could go wrong. And the amygdala, the fear area of our brain, tends to be larger and more active in people with generalized anxiety and people with chronic post traumatic or complex post traumatic stress disorder. So it's important to recognize that this is not a choice. They're not choosing to. To worry about everything. Every time they sit still, they've got what Linehan sometimes calls monkey mind, and those thoughts just start popping up, and it feels like they're just being bombarded by them constantly fatigue. Well, imagine if you were keyed up or on edge most of the time and your brain was just constantly worrying about stuff. That's exhausting. It's difficult to concentrate when you're worried. When you're in that fight or flight state, your brain is secreting cortisol and glutamate and norepinephrine to give you the energy to fight or flee. This is not the time to concentrate. Your brain says, you know, we're going back to primitive responses, fight or flee. And glutamate actually is a excitatory chemical that is responsible for impairing memory. Go figure. And they hypothesize that this might be because when glutamate is being secreted, especially during a trauma, high levels of glutamate keep memories from forming. And that may be a protective mechanism that our body has. But people who are experiencing chronic anxiety have chronically high levels of glutamate. So it's harder to concentrate because of that. It's harder to concentrate because of the monkey mind. It's harder to concentrate because they may be what we call hyper vigilant and constantly scanning for threats in the environment. They may be more irritable. Well, if you're keyed up and worried about a bunch of things and exhausted, I can see why you'd be irritable. So that doesn't need a lot of explanation. They experience Sleep changes. And just like people who are depressed, they may not be able to sleep at all. They may have insomnia, they may not be able to stay asleep and they may feel exhausted, they may feel tired all the time because guess what, they are constantly revving their engine. They are constantly expending energy and keyed up or revved up because of that anxiety. And that's exhausting. Like people with depression, they may also have increased pain. With anxiety. They've noticed that a lot of times serotonin may be too high, but anxiety can also be caused by increased levels of glutamate or norepinephrine or other things. So we don't, there is no test. We can't, you know, give somebody a blood test and say, hey, you're too high in this and too low in this. So here's a medication. Unfortunately, that's not the case. What we can do is help the body rebalance itself. But as a result of anxiety, people often have, have increased pain. And that can be because of the neurochemical imbalance. It can be because they're tense all the time. And just like after you work out, your muscles get sore when you're tense all the time, it causes muscle soreness. People with anxiety often also have tmj. They grind their teeth at night, so they wake up in the morning and their teeth may hurt, their jaw may hurt, their ears may even hurt. And that can contribute to increased irritability as well as difficulty sleeping and maybe even worrying about what's causing that and GI distress, gastrointestinal distress, and I didn't talk about this in depression. Although people who are depressed often experience stomach upset and constipation. People who are anxious or often experienced stomach upset pain and maybe even diarrhea. Other consequences of both depression and anxiety? Reduced libido. When people are in fight or flight, the brain says, hey, not the time to procreate. So it alters the response of the sex hormones. When people are depressed, they just don't got, they got the energy do it. Reduced immunity. When cortisol is high, our stress hormone is high, our immunity goes down. And we recognize in both depression and anxiety that people's immunity tends to be disrupted. We also know that in people with depression, they often have systematic inflammation. So their immune system is sort of hyperactive that and causing inflammation at that point in time. And there's a whole, I have a whole video on the impact of chronic stress and trauma on the brain. But ultimately the short version is prolonged exposure to cortisol. Contributes to inflammation. Cortisol normally is an anti inflammatory substance, but when your body's exposed to it chronically, it loses its ability to suppress inflammation. So inflammation starts running haywire. And when that inflammation runs haywire, we start seeing more sickness, more depression, more pain. Flare ups of autoimmune issues can also occur as well as concurrent anger, guilt, depression, anxiety, grief. And as I mentioned, poor memory. Well, I guess I didn't mention memory specifically. I talked about concentration. But when we can't concentrate, we can't remember things. If you're not focused on something, like when you're reading a book or maybe even watching this video, if you're not concentrating, you're not going to remember what's said. And when people have poor memory, when they have difficulty concentrating, a lot of times they forget things and they make mistakes which can cause them to feel guilty, feel bad, and it can cause other people to get frustrated with them. So it's really important to examine, for example, if you are in a relationship with somebody struggling with depression or anxiety and they're really forgetful, is this something that they're doing on purpose? Are they being disrespectful or is it more likely they truly just don't remember? They, they're trying to concentrate, but they are not able to. And if they're not able to concentrate, what can you do? And hint, write it down, send them push notifications, do something where they have it. They don't have to store it in their brain, they've got it somewhere where they can see it. Other diagnoses that can have symptoms that are similar to depression and or anxiety. Anemia, which is caused by iron deficiency, can cause symptoms that look both like anxiety and depression. Malnutrition can also cause not just deficiency in iron, but deficiency in a variety of other vitamins and minerals can keep the body from being able to break down the food that you eat to make the neurotransmitters and the hormones. So malnutrition does contribute to depression, does contribute to anxiety symptoms. Low vitamin D has long been associated with low energy and depressive symptoms and even seasonal affective disorder. Hypo, which means not enough or hyper, too much thyroid, can mimic depression or anxiety. And hypo or hyperthyroid can happen at any point in life. It can happen in children as well as in, you know, old people who have never had a problem with it in their life. And then all of a sudden at 65, they're diagnosed with hypothyroid and need to take a supplement but all of these are pretty easily addressed if they're diagnosed. Circadian rhythm disorders can also contribute to anxiety or depression, because when your circadian rhythms get out of whack, everything gets out of whack. Circadian rhythms regulate your immunity, your neurotransmitter creation, your sleep, your eating, your libido. The list goes on. If somebody starts having disrupted sleep for some reason, it's important to look at whether that is the cause or a cause of their symptoms. Along with that, obstructive sleep apnea or sleep apnea can cause symptoms of depression and anxiety. When people are routinely stopping breathing throughout the night, it deprives their brain of oxygen and wakes them up, you know, multiple times during the night, sometimes even hundreds of times during the night, which means they're not getting good sleep. And that can contribute to depression, can contribute to stress, and some people also have anxiety as a result. But generally, obstructive sleep apnea is strongly associated with depression. Interestingly, obstructive sleep apnea is also far more common in people who have a history of trauma and have a diagnosis of PTSD or cptsd. So if somebody has that diagnosis, it's important to also assess for sleep apnea if you are treating them low testosterone or estrogen. Remember I said if the body is stressed, if the brain thinks that either the body doesn't have enough energy or the situation's helpless and hopeless, or there's too much threat, then it's going to alter the levels of gonadal hormones. Cardiovascular disorders. Now, I don't want people to get freaked out about this because this is one of those that can occur, but it's generally not the cause of people's symptoms. But especially in elderly people, people who have COPD that may contribute because of the reduced amount of oxygen throughout their body and to their brain, it can contribute to mood symptoms. PTSD or CPTSD can have a lot of symptoms that overlap with anxiety and depression. Now, you can have ptsd, anxiety, and depression all at once. It's also important if somebody is diagnosed with depression or anxiety to rule out, make sure they don't also have a trauma history that needs to be addressed, because that PTSD can be contributing to the depression or the anxiety and burnout or exhaustion, and a lot of us are experiencing this right now. That may look a lot like depression or anxiety. Burnout or exhaustion often doesn't quite meet the level of what you would need for diagnosis of depression or anxiety, but it can lead to depression or anxiety. And somebody who is Depressed can have developed a sense of hopelessness and helplessness because of continuing to be in an environment that was burnout prone. So what do you do about it now? You have a little bit more understanding of what might be going on and all of the complex features and hopefully you recognize it's not something you can tell somebody, just shake it off, Recognize it is not intentional or personal. People don't want to be anxious or depressed. People are not choosing to do that. If they're feeling that way, they're likely doing the best they can with the tools they have right now. Accept that you cannot fix them, you cannot flip a switch, you cannot make it better. You may be able to educate them about some things like, hey, you know, did you know that it could be anemia? Have you gone to the doctor recently? You know, you can potentially put suggestions out there, but you can't fix them. It's going to be up to them to fix themselves, however. And you're like, okay, fine. It's also important to remember if they're struggling with depression or anxiety or both, they're plumb exhausted and the thought of doing anything else may be completely overwhelming. Which is why it's really important to break it down into micro goals. Depression is a complex condition with physical, emotional and cognitive components. Like the flu. It takes the body time to recover and rebalance. After all that stuff's gotten out of whack. It takes a minute for people to recover. Don't expect them to recover in a week, or if they've been depressed for a while, even a month. It's important to recognize or look for gradual improvements over time. Depression and anxiety often are associated with a feeling of hopelessness and helplessness. When you are in a relationship with someone who is depressed or anxious, be assertive and authentic. Tell them what you need. Tell them what you're feeling nicely. Of course, you know, if you're frustrated that they are, they seem to be stuck in this depressive episode, they're probably frustrated too. Make sure you say it in a way that doesn't come off as blaming. You know, say something like, you know, I can only imagine what it must be like to be in your shoes right now, because it's frustrating for me to, to see you struggling with this still, you know, that's far different than going, this really sucks that you're still depressed. See, the way you present it is very different. Make sure that they understand if they are experiencing depression, for example, or anxiety, and they're regularly canceling plans with you, and that's hurting your feelings or, you know, you really want to spend time with them, being assertive and authentic and saying, you know what? I hear that you don't have a lot of energy right now. I hear that you're depressed and you're anxious and it's important for me to be able to spend some time with you. I'm wondering if there's a way we could do that together. Maybe we could. I could come over and watch a movie or you could come over and watch a movie here or something that is low energy, low stress, low threat. You can suggest, you can put out there. They may still say no. But it's important if you have a need in a relationship not to swallow all of your needs forever. You know, there are going to be times when their needs need to come first, but as they start to emerge from their depressive episode, and it's important to put your needs out there in the beginning when they're really depressed. Your need may be, I really need you to go to the doctor. You know, I'm really worried about you and it's causing me a lot of stress and I would feel a lot better if you would go to the doctor. So I'm telling you what I need in order to allay my fears. Encourage them to be authentic. If they're having a bad day, encourage them to let you know. That way you can adjust accordingly. They say, I'm having a bad day. You can say, all right, what can we do differently? How do we need to modify our plans to work within what you're capable of doing today? Validate how they're feeling. If they tell you it feels like they are, you know, pulling a hundred pound sled, validate how exhausting that must be. You're not experiencing the same thing. You know, if it seems overwhelming to them to get up and take a shower, to go grocery shopping, you may not understand, you may not be feeling the same way, but it's important to validate their perception and how, how much energy it feels like it will take to even do that. Empathize with them and in empathy. A mentor of mine once suggested that empathy is like putting on repelling gear and going down in a dark well with somebody who's stuck down there, you can get yourself out of the well, you've got that repelling gear on, but. But you're. Instead of looking down and going, well, sucks to be you, you're actually trying to experience it yourself to a certain extent. So empathize with them. Think about a time when you've been overwhelmed or depressed or anxious. Maybe you've never had a full blown anxiety episode, but everybody has felt anxious about something at some point. You know, take that and imagine feeling that for days on end. You know, that can give you a little bit of perspective, help allay their guilt and shame. A lot of people, like I said, will get stuck in these shoulds. I should be able to do this. I shouldn't cancel on you today. I should, but they can't. They're not able to do that right now. So instead of shoulding, figure out what can they do? Okay, we intended to go, you know, running together today but or on a walk together today, but that's overwhelming to you. So what can we do? You know, instead of getting angry about what they can't do, turn the attention to what can you do instead? Have a support system for you. That's really important because when you are, when you care about somebody who struggles with a mental illness, it can get exhausting sometimes. You can get frustrated sometimes not only at the condition but also with the person because sometimes they will make choices that seem counterintuitive. Get curious. Why did they make that choice? Why did they decide to sleep for four hours in the middle of the day even though they know that's going to screw up their sleep at night? Well, it could have been. They didn't feel like they had any ability to keep going on. So get curious and then figure out what you need to do for you. Holding on to anger at them for what they're doing or what they're not doing is, is just draining your energy. It's really important to be able to get some objectivity on that so when you are with that person you can focus your energy on the relationship and if you want to, on helping them set boundaries and take care of yourself. When somebody is anxious or depressed and it may be easy to fall in the trap of trying to do everything for them and that may not be helpful, especially if you're doing it at your own expense. Where you're getting run down, where you're getting exhausted, where you're skipping things that are important to you in order to tend to their needs. It is important to set boundaries and make sure that you don't lose yourself in being a caregiver for them. Let them know how important they are to you. A lot of times people with depression and anxiety because of their guilt, because of the condition, their self esteem takes a hit, they feel unlovable, they feel unworthy. So it's important to let Them know that they are important to you and they are worth effort. Help them consider ways to live in the. And. And this is a technique in acceptance and commitment therapy. And, and I have a video on that that I just did on the YouTube channel. But basically helping them figure out, what is your rich and meaningful life look like? How can you live your highest quality of life and be experiencing anxiety or depression? How can you be happy and be depressed at the same time? And generally you can't do it at exactly the same time. But sometimes this gives people permission, if you will, to have happy episodes throughout the day and not feel guilty about it. Many people, you know, the criteria for depression is that you feel depressed most of the time, most days, not all the time, every day. And it's important to not to shame people if they have a good day or a good moment and say, see, you're getting better now. Why all of a sudden did you take a nosedive again? It's important to remember and seize on those times and go, wow, you're having a great day today. Let's capitalize on that. Let's have a picnic or whatever you want to do and support them during the good times, recognizing that having blips of happiness are, you know, normal even during a major depressive episode and helping them identify, okay, you're depressed right now. There are things that are still important. I know when I've had depression, you know, my kids were still important, my animals were still important, my job was still important. And it was a matter of figuring out, all right, I have like a third of the energy that I normally have, and I have even less motivation. What can I do with what I do have in order to nurture what's important in my rich and meaningful life? Ask them. Instead of assuming you know what they need, ask them what would be helpful? What can I do for you right now that would improve the moment that can be going on a walk with them, that may be drawing them a bath, that may be just sitting with them. It's important to ask them what's helpful. Ask them to consider doing 15, but don't force the issue. Doing 15 means trying to do something for 15 minutes, and if they just absolutely hate it, then stop. And that's a technique my husband used to with me when I had depression was, come outside with me, let's go walk around. We live on a farm, so we've got places we can walk. Let's go walk around. And if you really hate it, then in 15 minutes we can come back in and generally, once I got my butt up off the couch and got my shoes on, I would end up staying out there for an hour, two hours, you know, pulling weeds and messing around with the chickens and doing those sorts of things. And I would actually start to feel better. And guess what bonus I was getting? Sunlight and vitamin D. But consider doing 15 again. If they won't do it, don't force the issue. He didn't force me to go out there. If I said no, he'd say, all right, it usually helps you feel better, so if you change your mind, let me know. And then he would let it go. Ask them, what can we do to create a low stress environment? Stress of any sort drains people's energy. If you've got a. And think about maybe a house that doesn't have good insulation, and when it gets cold outside, it runs your energy bill up. Well, that's kind of what's going on with people. Stress of any kind drains your energy. So how can you help that person create a low stress environment? Insulate the house, fortify themselves, whatever you want to call it. Because the less energy they waste to miscellaneous stress, the more energy they have to focus on a rich and meaningful life, the more energy they have to do the basics. And for a lot of people with depression and anxiety, and doing the basics is a struggle. Getting up, getting dressed, brushing your hair, brushing your teeth, that can actually be a struggle. Celebrate those successes. Offer assistance to reduce the demands on them and be curious about lack of follow through. So offer, for example, to make dinner or to do the laundry or whatever if you think that would be helpful and it's something that you have the energy and time to do. Remember I said maintain your boundaries. That can save them some energy that they can use for something else. People with depression and anxiety have very little energy. If you want them to use that energy to go to a movie or to go out to dinner, then it may require assisting them with some other things to. So they can conserve their energy and do that thing with you. Give positive reinforcement. Notice progress. And I don't mean be patronizing about it. I mean notice when they are doing well, when they're having a good day, when they, you know, actually get up in the morning and take a shower and brush their hair. And I've been there where that was just too overwhelming. It felt monumental to get it done. But once I did it, I felt a lot better. And that's one of the tasks that I have for a lot of my clients that are struggling with especially major Depression is every morning, get up, take a shower, put on your day clothes, and then, you know, if that's all you do until lunchtime, that's fine. But don't stay in bed in your PJs all day long. And that actually helps a lot of people, not only because it gets them out of bed and gets them moving, but those behaviors. Just like behaviors that tell your body it's time to start winding down and get ready for bed. Those morning behaviors of getting up and getting dressed, that tells your body, hey, it's time to be awake. So let's secrete our excitatory or our energy chemicals. Ensure the person has a safety plan. If they are significantly depressed, you can't be there for them 24 7, 365. It's important that they have a plan. If I start feeling really bad, who can I call? Where can I go? What can I do to stay safe? If they have anxiety, ask them, what can we do? What can I do to help you feel safer? You know, they may be anxious about a whole lot of things and what can I do to help you feel safer? If they're seeing a counselor, be willing to or offer to go with them in order to learn some techniques and tools that you can use to help them. For example, address their, their monkey mind, their worry thoughts, and get regrounded when they start feeling like they're spiraling. A few don'ts, don't tell them to shake it off. Don't become complacent and assume that just because they're feeling good right now, they're never going to have another episode. They may, and it's important that they keep living a healthy lifestyle. Don't blame them for the situation, even if they did things to contribute to it. And that can be really, really hard. But if somebody has a depressive episode and you can see that leading up to that they were working 60 hours a week and they weren't taking care of themselves, it does no good to blame them and go, well, you brought this on yourself. They know that. They recognize that most likely it's important to look and say, all right, what was different when you weren't depressed? And what choices did you make that may have led up to this? And, you know, how can you prevent that in the future? But when they're in the middle of the depressive episode, when they wake up and they're just like, whoa, feel like I got hit by a ton of bricks, it's not the time to lecture. It's not the time to Blame. It's the time to say, okay, this is how you feel. Non judgmentally. Be mindful of what's going on. This is how you feel. What can we do to improve the next moment? No judgment. And don't make the relationship contingent on them getting over it. A lot of times people feel like, well, if I set this hard line in the sand, then the person will do something to get better. Now, at a certain point, depending on the situation, you may, for your own health and happiness, have to end the relationship if it is causing you too much distress. But I usually use the analogy of some sort of chronic illness. If somebody you were in a relationship with, somebody that you loved, and they got a chronic illness and couldn't do the things that they used to do, maybe they develop chronic fatigue syndrome. Would you end the relationship because they're not the person that you got into a relationship with? Or would you learn how to live in the and have a rich and meaningful relationship with them, even though they now have this issue that they're contending with? Depression and anxiety are common issues that impact the whole person and their relationships. Physical changes and cognitive habits People developed when anxious or depressed take time to recover from physical changes. Obviously, just like the flu, it takes the body a while to recover. But cognitive changes, that means our thinking styles and our perceptions, when we engage in those repeatedly over a period of time, they become habits, they become almost automatic. So it takes time to sort of reprogram or rewire our brain to look at the whole thing, not just the negative. Helping people recover means helping them feel heard and validated, safe enough to make a change, and supported and empowered to make those changes. Remember I said sometimes for people with major depression, especially, just getting out of bed and taking a shower and getting dressed is a monumental thing to do because it feels like, you know, they've got a hundred pounds that they're toting around on their back while they're doing it. It's exhausting just to do that. And it's important to let them know that you will be there to support them and help them sort of pick up the slack, if you will, while they're going through their recovery process. I hope this provided you some ideas. Obviously this is not a comprehensive guidebook, but it gives you 15 tools that you might be able to use to help yourself as well as to help a loved one who has depression or anxiety or both.