CBT for Depression Treatment: Part 3 of 14 | Start Addressing Depression Now

Hey there everybody, and welcome to this episode of the Week by Week guide to Depression Treatment. This is part three of 14 and I'm your host, Dr. Donnellice Snipes. Remember, you can find in depth videos on just about every topic we discuss on my YouTube channel@docsnipes.com YouTube in this session we're going to track your progress toward your goals, work on enhancing motivation, help you identify strategies to improve your sleep and any pain you're experiencing, discuss the importance of adding happiness moments, learn about schema and how they can cause you to misinterpret current situations and learn about cognitive distortions and ways they can contribute to that misinterpretation and increase your anger, anxiety and depression. The third session starts out by reviewing your progress on your change plan. You know, the one you made last week with your smart goals and identifying reviewing your baseline data worksheet. So we're going to look and we're going to see for your baseline data for your sleep, for example, or your energy level or you're doing meditation. How many times did you do it? How effective was it? We'll review the motivation worksheets on each of your goals. That was the last thing that we talked about last week, reviewing how each of the goals, each of the things that you were trying to do. Last week you had done a sheet that identified how it would help you feel better physically, affectively or emotionally, how it made sense that what you were doing was going to help you feel better, what you could put in your environment to remind you to do those tasks and how it would improve your relationships when you started doing those tasks. We'll discuss how effective you were at using your distress tolerance skills. Remember, you made a list of five different distress tolerant thoughts, three activities, three types of guided imagery that might be helpful, and three sensations, sight, smell, sounds that you could use when you are feeling distressed, angry, anxious, depressed that can help you down regulate so you can get out of your emotional mind and into your wise mind and think more logically about how to improve the next moment. And we will talk about examples of how you used your distress tolerance skills. So I generally ask people for one or two examples of how they used them in the past week and if they didn't, how they could have used them. And if they did, I usually ask them to think back. Were there any times that you could have used distress tolerance skills that you didn't think to use them or that you forgot? And you know, let's replay that and see how things might have gone differently had you used those skills at that time? Then we move on to discussing the types of meditation that you learned about and the one types you found helpful for reregulating. Not every type of meditation works for every person, so I encourage you to really explore different types to find what works for you. Somebody with adhd, for example, may have difficulty with meditations that encourage them or require them to stay still and seated for a long period of time, for example. So try out different things. And if someone I'm working with didn't find something that worked for them, we might brainstorm. You know, when I was little, my grandmother used to have a lava lamp that tells you how old I am. But I used to love just, I could sit there for, you know, 30 minutes or more just watching that lava lamp move. I can sit outside to this very day and look at clouds and make cloud animals. When there's clouds in the sky. We may talk about, you know, simple ways to meditate, simple ways to practice that, because a lot of times people try to make meditation too hard. Then we'll review strategies you've identified to improve your sleep quality and quantity. Remember, you went through and you did a sleep hygiene evaluation and you identified at least three ways to improve your sleep. We'll talk about what those are and how they're working for you. And then we'll go through your morning and evening mindfulness activities together and identify any themes that seem to be present. You know, maybe each day it seems like you're dreading work. You know, if that is a theme, then we're going to talk about that in session. Then I'll move on to talking about pain assessment for stress and sleep. When you are in pain, it triggers your fight or flight response. It triggers tension, which is kind of counterintuitive, but that's what it does because your body says, if I'm in pain, I. I'm vulnerable, so I need to be on guard. When you're in pain, you don't sleep as well, not only because it hurts, but again because that fight or flight system is triggered. Your body is not going to let you get that quality sleep that you really need. We'll talk about how often you experience pain, and we're going to all kinds of pain. It can be headaches, neck aches, backaches, stomach aches, whatever kind of ache there is. We're going to talk about how often you experience it. What's the cause, if known, you know, I know, for example, that sometimes if I don't sleep with the right pillow I know I'm going to wake up with a kink in my neck. So that's something that I can intervene, I can prevent. But other times I may get a stomachache and not know why. So identifying when you any causes that you know of and ways to intervene and then how do you cope with the pain when it occurs? Massage TENS units. TENS units are transcutaneous electronic nerve stimulation, which sounds awful, but they sell these units online now. You can buy them, you know, at the drugstore. And it provides a very, very low electrical current that bombards the nerve endings. So they get confused, basically, and they quit sending those pain messages back to the brain. So TENS units can be helpful and they've shown that they actually do increase endorphins when they're being used. So that's kind of cool. Ice or heat stretching, those can be very helpful depending on what the pain is. Obviously, if you've got a belly ache, stretching may not help, but if you've got a stiff neck or pain somewhere in your musculature, stressing stretching can help. Focused breathing. Now, this doesn't necessarily address the pain itself, but just like in the morning and evening meditations, when you're inhaling, you're holding and you're exhaling and you envision yourself inhaling, you know, something positive and exhaling something unpleasant, Focused breathing can be the same way. When we inhale, hold and exhale, it triggers rest and digest, which is the opposite of fight or flee. So by virtue of slowing our breathing, we're actually forcing ourselves out of the fight or flight stage. For children as well as people who are big kids like me, blowing bubbles can be a fun way to do this. You can obviously do it anywhere without bubbles, but if you try to blow a really big bubble, you have to take one big breath in and then slowly exhale so it doesn't pop or, you know, go away. And that can be a sort of a fun way to practice focused breathing. It's really helpful for kids because they don't feel silly blowing bubbles. They actually like it. And so it can be a helpful distress tolerance skill for children to help them down regulate that HPA axis or that fight or flight response. Meditation can help. It does similar to focused breathing. It helps you slow your breathing, slow your body down. You're teaching your body through meditation to focus on relaxing things and relax. When you're relaxed, you can't be in fight or flee. So see, we're trying to trigger the opposite response. When you trigger the relaxation response, your body releases gaba GABA helps with muscle relaxation. When you trigger the relaxation response, your body releases more endorphins, which are sort of your natural opioids, if you will. Meditation can be extremely powerful guided imagery that works. And some people have to take medicine and you know, no judgments here. It's important to know what helps you cope with the pain when it occurs. I had a friend who had chronic migraines and there were a lot of things that she could do to prevent them. But once a migraine started, there was nothing that she found that was effective at helping to get her through that migraine episode besides medicine. And so I, I think this notion of shaming people for using medicine as prescribed is really harmful. Leave it, I'll leave it at that. And then what can you do to prevent flare ups? What can you do to mitigate this? If I know that reading in bright light without sunglasses or reading without my glasses is going to cause me to have a headache and guess what? I know that I should probably make sure I've got an extra pair of glasses with me in order to prevent that should I have to read. I know that I need to take my pillow with me wherever I go because a bad pillow is guaranteed to muck up my sleep and I'm likely to wake up with a kink in my neck. So those are things you can do. Identifying anything you can do to to prevent pain is helpful. It's important that people also start to recognize how their pain level relates to their mood, their sleep, and even what they eat. When we're in pain, a lot of times we want to self soothe. So we eat things that are less healthy. We eat things that may trigger dopamine and serotonin and endorphins. Remember, endorphins are your body's natural painkiller. Unfortunately, those tend to be high sugar, high fat foods. Keeping track and thinking about when your pain is high, what does your mood tend to be? I know mine tends to be really crappy when my pain is high. When my pain is high, my sleep tends to be. For me it would be very disrupted. When my pain is high, I tend to change my eating by well, because I'm not sleeping well, I tend to drink more caffeine. When I'm not sleeping well, I tend to forget to carry my water bottle and I tend to eat more highly processed foods. That's me. Some people may increase their use of medications like opioids in addition, obviously as prescribed. But it's important to know how does your nutrition change when your pain is high. When I'm depressed, anxious, angry, it impacts my pain by a lot of people when they get anxious or angry, they start feeling pain, back pain, neck pain, belly pain, headaches. When I do not get adequate sleep, it impacts my pain by a lot of times. When you're sleep deprived, pain seems even more poignant. And when I eat the following foods, it tends to increase my pain and inflammation. There actually is something called an anti inflammatory diet because there are certain foods that are known to trigger inflammation. Now some people, it doesn't really bother them that much. Other people are acutely sensitive to it, like gluten. It's important to know how your body responds to the foods you eat and make good choices. We'll talk about non pharmacological approaches to pain management like the ones we went through. Tens, stretching, ice, heat, meditation. And I will encourage you over the next week or 14 weeks if you don't have a pain episode in the next week to identify several strategies that might work for you to help mitigate your pain and make sure you have them handy. Obviously, guided imagery you just keep in your head. But if it's something like ice or heat, making sure that you have ice packs or heating pads at your disposal, you don't have to go around when you're in pain and try to figure out where you left it. Been there. And we're going to talk about increasing happiness. Happiness is the opposite of distress. It doesn't mean you're ignoring your distress. It means you're recognizing that you can feel distress and have moments of happiness. And those moments of happiness are like rescue breaths, if you will. They allow your body, they allow your stress response to downregulate for a moment. You're not ignoring the pain. After my mother died, it was agonizing. However, I also allowed myself the ability to not feel guilty. If I experienced happiness when I've been depressed in the past, I've actually forced myself to do things that in the past used to make me happy. Why? Because triggering those memories, triggering those neurochemicals can actually help tamp down some of the distress that you're feeling just for a minute. Like I said, it's like a rescue breath. It's not something that's going to stick around forever, but it gives you a break from the agonizing weight of whatever you're carrying. Then we move on to talking about schema. Schema are tools the brain uses based on prior experiences to help you know what to expect. You have a schema about going to school or to Work. You have a schema about stoplights. You have a schema about what to expect when you interact with a particular person or about job interviews. Your brain has acquired all this knowledge and it's kind of made cliff Notes Guides, CliffsNotes, guides for you to help you predict what's going to happen. Unfortunately, your schema are only based on past experiences. They don't take into consideration the current situation, the current person, or even ways you've changed since the last similar experience. Schema are sometimes pretty accurate. Green lights almost always go to yellow. You know, they rarely go from green to red. Now, every once in a while, they may, you know, if an emergency vehicle is coming through, it may switch the light to red so it can get through the intersection. So that's going to conflict with your schema. Yellow lights don't always turn to red. Sometimes it'll be a flashing yellow light. Then your brain's going, well, what do I do with that? Childhood experiences. Maybe you had an experience in childhood that taught you that all people are unsafe. You know, and I'm so sorry if you experienced a traumatic childhood like that. So now you may approach other people just expecting them to be unsafe, expecting them to mean you harm. And prior relationships. A lot of people carry baggage from prior relationships into future relationships. So something that Jim Bob did, I'm holding Steve accountable for in the present. And that's not fair to Steve because Steve's like, I didn't do that. Schema, remember, are based solely on past experiences, and they're designed to help you predict but not know what's going on. It's important to use your logical mind to say, okay, in the past, this has happened, so I need to be prepared. However, let me factor in all this new information. We'll talk about at least one schema you have for each of your top three triggers for anger, anxiety, and depression. What is one schema? What is one belief you have that triggers your anger? What is one belief you have that triggers your anxiety? What is one belief you have that triggers your depression? And then you're going to use that schema, that belief, and you're going to apply what we're getting ready to learn about, called the cognitive distortions log. Cognitive distortions are so nefarious because we often have been taught to use them or they were formed when we were younger and we thought differently. Change. Children actually think differently than adults. You start out by identifying what is the thought. Maybe your thought is, all people are only out for themselves or all people are dangerous. Then you ask Yourself, what are the facts? Not what am I assuming, what are the facts for and against this belief in the current context? So looking around at the people you know, are all of them dangerous? I can think of people I know who are very, very kind people, and they would almost literally give me the shirt off their backs, and I would do the same for them. That would be a fact against my belief that all people are dangerous. So identifying the facts in the current context. Ten years ago, everybody that surrounded you, you may have been in a really bad situation, and all the people in your environment at that point in time may have been dangerous. I don't know. However, in the current context, is that still true? Evaluate your beliefs for mind reading or jumping to conclusions. Make sure that you know the facts. Don't assume that Jim Bob meant you harm because he looked at you sideways. Maybe he was thinking about something else. So jumping to conclusions about what somebody thinks or wants or is getting ready to do can be unhelpful. Now, obviously, you need to keep yourself safe, but it's important to not assume. And I find that couples do this a lot, where they start completing each other's sentences, assuming they know what the other person is getting ready to say. And that can be so detrimental to the relationship. It's important, even if you've been together for 40 years, to let the other person finish speaking so you know exactly what they were thinking and you're not trying to read their mind. Don't make decisions without getting enough information, going back to those facts, getting the facts, and playing the tape through. If I make a choice here, if I push everybody away because I think everybody's dangerous, how is that going to work out for me? Emotional reasoning. Sometimes we make decisions based on our emotions. We're afraid, therefore, we look for reasons to be afraid instead of identifying the facts and then deciding how to feel. If you're feeling a feeling, that's your brain based on prior schema saying, warning, there might be a problem. Okay, it's saying, warning, there might be. You need to look at the facts. You need to do something, look at the facts and decide if there's a problem. All or nothing thinking. I encourage people to make sure they're using moderate words, like sometimes, usually, often, but not always, or never, and things that are certain. I also encourage people, when they use all or nothing terms, to find a more moderate word and one exception. So maybe, you know, my son often forgets to change the litter box. However, you know, I do remember sometimes when he's done it, personalization what are three other explanations that have nothing to do with you that could be causing this situation? Maybe somebody comes into work and then your boss, you know, heaven forbid your boss comes in and they're in a awful mood and the first thing you think is, I must have done something wrong, I must have done something to make them upset or I'm getting ready to get fired, you know, all those awful thoughts start pouring in. Well, a, you're jumping to conclusions here and B, you're personalizing. You're assuming that that person is in a bad mood and it has something to do with you. Maybe they got a flat on the way to work. Catastrophizing is another cognitive distortion. And that's when you take something that's going to happen and you assume the worst case scenario, you know, if this happens, then my life is over. Go back to those facts. That's why you started with the facts. What is the probability that the worst case scenario is going to happen? If you're getting ready to go in for surgery, you know, have you have to sign all those waivers and stuff before you go in. And it can feel very ominous based on the facts for whatever surgery you're getting ready to have. You know, how likely is it that you will have significant problems, you know, during the operation or post op? Most likely. With most operations, it's probably pretty small. It's important to recognize the difference between possibility and probability. Fallacies of control and fate also can trip us up. It's important to look at the facts and identify what parts of the situation that you can realistically control. Sometimes you can do something to improve the outcome. Other times, like the weather, you know, a hurricane, a tornado coming, it's completely out of your control. So how can you cope with things that are not in your control? There are some things that you know, you can't move a house by pushing against it with your shoulder. You can't stop a tornado. So how do you cope with things that are not in your control and finally minimizing your abilities or your successes? And this is one we don't talk about a lot with cognitive distortions, but especially in people who are depressed, a lot of times they feel helpless and hopeless and their self esteem is in a crapper. Taking a legit look at what you've done, what your abilities are, what your successes have been, and giving yourself credit where credit is due. If you would, if your best friend had that success, would you congratulate them? Well, if so, if you had that success, then congratulate yourself Doug on it. This week you're really going to spend a lot of time focusing on those schema and cognitive distortions. You're going to continue practicing mindfulness each morning and evening. It should be starting to become sort of second nature now. That probably is part of your wind down routine. Before bed, doing your breathing, going through your mindfulness worksheet. Start taking a 15 minute happiness break each day. For a lot of people that I work with, this is lunchtime. The morning they're doing mindfulness, the evening they're doing mindfulness. During the day, you know, lunchtime, their energy is starting to go down. They've got to get through the rest of the day. So a 15 minute happiness break can be really useful and you can do it. You know, I advocate for mindful eating and focusing on what you're eating, but you can take the last 10 minutes of your lunch break and or 15 and watch cat videos or that's what makes me happy. Whatever makes you happy. Identify at least one schema you have for each of your top three depression, anger and anxiety triggers. So that'll be nine different schema you have nine different beliefs you have regarding your top three triggers. And you're going to apply that cognitive distortions log to each. So you're going to go back through this log and you're going to identify how many of these different thinking errors am I using? And then you're going to use the techniques in parentheses in order to restate those thoughts in a more empowering or more useful way. You're going to also be keeping your baseline data for your top three symptoms. If your top three symptoms are lack of quality sleep, low energy and low mood, then those are the three things you're continuing to track and to identify the progress that you're making. Remember, on a Likert scale. So if you're going on a scale of one to four, my mood today was a two. Okay. So a two is okay. It's not good, it's not great, but it's also not awful. So a two is okay every day for seven days. If you had twos, then you would take two, add it together, divide by seven and your average would be a two. I usually don't make people do the math. We do that in session. But it's important to keep that baseline data because you want to move up incrementally. One week you're at two, you'll shoot for the next week to be at a 2.1 on average, and then the next week maybe a 2.2. You're setting reasonable weekly goals. This show was produced by Mr. Charles Snipes and presented by Dr. Donnelly Snipes. You can learn more about addressing depression@docsnipes.com YouTube and they can be reached at 1633 West Main Street, Suite 902, Lebanon, Tennessee 37087 or by email@supportocsnipes.com.