Engagement and Depression

So much is written and discussed about how cognitions are important when examining depression. As a cognitive-behavioral psychologist I appreciate that this is true. However, I see time and time again how behaviors can rule depression. They can increase depression, and they can hold the keys to decreasing depression as well.

Engagement is a term thrown around quite a bit. Often this means getting more involved with people. Being engaged in social opportunities can be a big factor in treating depression. I like to encourage my clients to consider “engagement” much more broadly. There are many activities to be engaged with. There are many aspects of life and yourself to be engaged with. Examining the opportunities that you have, to focus your time and attention upon, can go a long way in changing mood.

Our lives are filled with patterns of behavior. These are not simply social behaviors. Our alone time is often predictable, with behavior patterns and habits that we have held on to for years. We sometimes don’t even think about the things we do, or think. We simply live our lives unaware of our choices. But we have many choices with what do with our time; and many options on how to behave.

Choosing to behave differently can change the way you think. Selecting those behaviors wisely can change your life. Moving away from behavior patterns that reinforce depression and anxiety, and deciding to engage in behaviors that bring you happiness and satisfaction, can be life changing. Much of my practice is focused on helping clients do just that. 

Failure to Launch

I often hear jokes made about “failure to launch.” In fact, it has become so prevalent that people have accommodated this term as just something some families need to go through. In fact, young adults who are experiencing this developmental crisis do not find anything funny about it. Nor do their parents, who struggle to find some way of getting their grown child to experience adulthood in a positive way.

People love to laugh at the family who still has a twenty-something living in their basement. The jokes may be about him becoming a “professional gamer,” or about how spoiled he or she has always been. Parents laugh it off, while secretly they are worried about what they can do to help their child make it to the next step in life.

At the heart of this crisis is the lack of internal motivation to achieve something meaningful. College may seem like someone else’s dream. Work seems depressing because it lacks meaning or personal reward. The person does not know what to commit to, or what to begin to focus on in their life. When I speak with these clients they tearfully explain the agony of feeling lost, stuck, and confused. They feel left behind by friends. They search for a path that they fear they will never find.

The depression and anxiety that grows from their internal conflict can be debilitating. They lack any faith in their ability to live as an independent adult. The simple risks that society has learned all young adults must take seem terrifying to these individuals as they “fail to launch.” They require a focus on not only career or academic goals, but also social goals. It is critical to consider the importance of building an ability to think independently, to reach out to others, to build faith in taking action, and to be planful and resilient. These are people who need strength, confidence, and direction.

Many psychologists and writers have looked at failure to launch as a developmental curiosity. What is causing it? What psychological processes are at work? What has the family done wrong? I prefer to look at it much more behaviorally. This is a person suffering, and in need of perspective and skills. There is anxiety to overcome, and motivation to be found. The most helpful first step is understanding how to turn fear into positive motivation. Then, apply that motivation to a rational plan. This is the opposite of being frozen with anxiety. This is the opposite of feeling lost and hopeless.

I recently read an “expert” say that these individuals simply need to find a passion. I found that to be ridiculous. Most of us did not wait at home until a passion filled our hearts. We went out in the world in hopes of finding a passion. We met others. Learned from them. Explored interests and career options and SHAPED OURSELVES into what we became. Having someone wait for a passion to consume them feeds into their fear that they may never find what they need to be a successful adult.

Therapy can help in reducing anxiety and seeing the world as a manageable place. This means building an understanding of how you take control of the barriers in your mind and the barriers in your relationships and daily behaviors. Momentum grows with action. And planful and deliberate action can overcome depression and anxiety. Oftentimes the answer is learning basic self-regulation skills to create movement towards independent living; and cognitive-behavioral strategies to begin healthy goal setting and value-driven action.

There is nothing funny about failure to launch. But there are some effective strategies to move people suffering from this crisis in the right direction.

Anxiety Epidemic in Teens and Young Adults

There is currently a documented epidemic occurring in our country. Teens and young adults are experiencing anxiety disorders at an alarming rate. Over 60% of undergraduates report having a level of anxiety that is overwhelming and debilitating. When their parents were in college the number was under 20%. Related to this epidemic, hospitalizations for suicide attempts have more than doubled in just the last 10 years. This heartbreaking phenomenon is confusing parents, and some professionals. But, research is being conducted to try to understand what is causing this flood of anxiety across our country.

At the top of the list of potential culprits is the rise of social media. Teens and young adults have always been prone to insecurities related to being afraid of failure and judgement. It is a time of identity creation and finding one’s way in the world. That can be some scary stuff. Social media can be brutal to someone who is vulnerable. Social media directly challenges us to compare ourselves to friends and peers. It also is an escape from the stressors of life. As teens go to social media to avoid the anxiety in their head they are invited to see all the (supposedly) amazing things others are doing. They see posts of people in their stage of life who have hundreds of friends, are confident and cool, and are accomplishing so much more than they are. As a result, they judge their own worth against the fantasy others are flaunting. We know that, in reality, people don’t typically post their low moments. They are not likely to share their failures and insecurities. They create a mostly false online reality to show to the world. Young adults, however, don’t fully understand that they are immersed in false perception. They only see that they don’t measure up. Their minds scramble to make sense of why they are failing and how they can possibly make it in the world.

Parents can mistake anxiety for shyness, avoidance, or even laziness. Meanwhile the teen is overwhelmed with demands such as trying to increase their peer status, getting good grades, trying to figure out what they want to be, getting into a good college, or finding a job. They may be being cyber bullied, which is a very real problem that is only getting worse. They may also be getting less than half the sleep they need as they struggle with their uncontrolled anxiety. Depression is a common co-occurring disorder that results from untreated anxiety. Many parents who see their teen struggling with mental health issues get stressed or angry by what they perceive as a weak or lazy child who needs to be pushed harder. “Stop slacking,” “Why is your homework not done yet?” “What is wrong with you!”

What can we do to help? In treatment, an important goal is to see what fantasies the mind is producing, and to understand that those false impressions do not have to control us. All of those teens and young adults are watching each other and wishing they were someone else. Few are embracing their own values, setting their own paths, and coping with stress in a healthy way. Of course, we want them to learn to manage their addiction to social media. But, we also want them to learn to make healthy choices about their outward behavior. We want them to set goals, and to reward themselves for meeting those individual daily goals of healthy living. Those goals are more than just sleep, exercise, and diet. Their goals should include reaching out to friends and peers in an honest way. They will learn to be brave and genuine. They will learn to accept that growing up is scary but also exciting and fun; and that they can take control and experience both, without being governed by fear. Ultimately they do need to decide who they want to be; but not in some future self. They need to decide who they want to be right now, and learn to live in their world on their own terms.

Helping Children with Attention Issues

ADHD is used by some as a catchall diagnosis for children who are having either behavioral or learning difficulties. This has happened historically with other diagnoses, and it is problematic for parents and professionals. Why? Because it becomes difficult to select the appropriate treatment when so many behavioral concerns become labeled ADHD or ADD.

Do not get me wrong; ADHD is a real disorder that can result in serious learning and behavioral difficulties. But for many children the diagnosis is not helpful to professionals trying to figure out how to treat it. It is important to identify the internal tools the student needs to get beyond their behavioral responses to the realities of their world.

The primary treatment we see for children labeled with ADHD is medication. The medication focuses on the inattentiveness that is at the heart of this disorder. It does a relatively poor job treating the issues that cause other behavior problems. In fact, it can make them worse. But even with true ADHD a combined approach (medication and behavioral treatments) is what most experts recommend. Medication may create better opportunities for learning, but it doesn’t teach the child how to learn, or how to behave.

Ultimately, even when effective, the mediation does not point your behavior in a particular direction.  And that is what behavioral approaches to ADHD and behavioral problems can do. That part of the formula cannot be neglected. Therapy addresses the issues of how to make good decisions, evaluate your own behavior, and behave within the expectations of the context.

Children struggling with attentional problems and challenging behavior will benefit greatly from a behavioral/educational approach to treatment. I have no problem with a medical approach as well, but I’ve found that children thrive when learning self-regulation strategies. Self-regulation is well-researched and incredibly effective. It gives them some control over the problem, and helps them learn how to manage it independently, and improve over time.

There are different approaches to teaching self-regulation. I would be happy to share them with you, and come up with an individualized program for your child.

Your Mind is Just Trying to Help

Where does anxiety come from? Why can it so easily take over? Whether it is social anxiety, Obsessive-Compulsive Disorder, or a fear of flying, anxiety has its roots in the same evolutionary function. Our mind is built to keep us alive as long as possible. In our earlier stages, it told us to be aware of predators; to keep low, keep quiet, keep out of sight. Now that function is less critical, but still very much intact.

How does this inform the treatment of severe anxiety? When you are avoiding people, struggling to sleep, or constantly worrying, how does knowing that your mind is trying to help you provide any relief? In fact, knowing why your mind is behaving this way leads us directly to a treatment that can reduce your anxiety and lead to a happier life. This highly researched approach demonstrates that if you accept why your mind seems to constantly being talking to you about worry and fear it results in a major first step to reducing your anxiety. The goal is then to engage with your mind less about its agenda, and more about your agenda. This means having a plan on how you want to live your life, and readily engaging that plan as you defuse from your minds constant need to protect you. For those who are interested in mindfulness, many have found that this takes it to the next level… behavior change.

Reducing Depression

Depression can be one of the most misunderstood human states. Some people live with depression for many years without understanding how it maintains its hold on them. In fact there may be dozens, if not hundreds of mechanisms that result in depression. Some biological. Some social. Some situational. Depression can also result from a very early approach to looking at the world.

I don’t want to diminish the complexity of depression. But there are certainly treatments that have proven to be quite effective at reducing it dramatically. The most researched, and most effective approaches rely on action. Not just any activity, but deliberate and focused action. As it turns out, learning to manage the negativity in our heads, while simultaneously choosing to move our behavior in a meaningful direction makes it much harder to remain depressed. Similar successes have been found with anxiety. How we act and how with think are very much connected.

I’d love to share more with you; and discover how to tailor such a treatment for your personal situation.

High-Functioning Autism and Asperger Syndrome

I have long worked with adolescents and adults on the autism spectrum. The issues are complicated and require a broad understanding of psychological and behavioral approaches. Successful outcomes require a therapeutic program that includes anxiety reduction, coping strategies, social skills development, self-regulation, leveraging social supports, and healthy planning for the future. Individuals who are "on the spectrum" come to me with a variety of initial issues; but as we dig into their needs there are similarities that inevitably require a broader program. These clients have often gone many years without true support and understanding. While their outcomes are usually quite hopeful, it takes time for them to understand that. As a psychologist and board-certified behavior analyst I draw from a pretty large tool box when I'm developing programs for high-functioning clients on the autism spectrum. While these are complicated programs they are a delight to see in motion, as they bring hope and success to people who often have been offered very little in the past.

I believe the key to successful therapy with these individuals is the use of self-regulation across their goals. This allows them to take control of their gains over time, as they plan their successes, measure their improvements, and better understand what they want to make them happy. I am a firm believer in a collaborative approach. This involves not just planning what therapy should look like, but executing treatment variables, recording progress, and putting all into a context that makes sense for the individual client. As they go through life with a new "dashboard" in front of them, they come back to session each week with tangible data to chew on. What worked well? What needs tweaking? What is the next treatment variable to consider? What do we celebrate?

Mortality Related to Quality of Social Relationships

There have been so many studies conducted on the importance of building quality relationships that I wonder why people are not more comfortable discussing this topic. We are all getting more isolated; more tied to our devices. As a society we are defining "friends" and "socializing" in dramatically different ways than just 10 years ago. Yet, quality social relationships are tied to our health, and our mortality. Did you know that being lonely and isolated equates to smoking 15 cigarettes a day? That is the toll on your health when you are struggling with acquiring and maintaining social support.

For most people who struggle with relationships there are proven therapies to help. Whether it be a struggle with social anxiety, emotional struggles, or social skills there is help. This is a specialization of mine, and a growing area of research that is very exciting. For those suffering with social relationships please know that there is hope.

Misperceptions When Seeking Help

Someone recently asked me if “self-help” approaches actually worked. And it dawned on me that my answer was sounding like a “yes.” In reality, all paths toward feeling better require you to do most of the work yourself. There is nothing a therapist can say to you that results in a lasting change. Improving how you feel, lowering stress and anxiety, or bettering your relationships will always require work.

The therapist role is similar to that of a good sports coach. The players provide the talent and effort to get the job done; while the coach provides them tools, strategies, and ongoing advice. The struggle for some patients comes from our societies growing perception that quick fixes exist. We see it in the constant barrage of drug commercials, the powerful pitches in the weight loss industry, and the books that tell us that there are easy ways to get rich.

The good news is that a great coach can get a lot done if he has a willing player to work with!