by Robert Duff
Before we move on to the next sections of this book where we will break down some of the different issues that are present in depression and talk about ways to fight back against them, I want to dive a little bit deeper into defining depression. If you already get the picture and want to skip ahead, please do, but I know there are some of you out there that will kill me if I don’t at least mention some of the other disorders that are related to depression, but are unique beasts in their own right. Diagnostically speaking, major depression is in a category of issues called “mood disorders”. Let’s talk about a few other ones.
You have probably heard of bipolar disorder right? It used to be called manic-depressive disorder because it is characterized by two different states: mania and depression. Depression you already know about, since you have been paying close attention and taking vigorous notes throughout this chapter. Mania is the flip side of the coin. Instead of feeling down in the dumps, you feel like a superhero. Someone with mania will often experience a great surge in energy that leads them to go for long periods without sleeping. They might rapidly start new projects and be overly productive. There is this sense of euphoria that is often marked by delusional thinking. By that I mean that the person who is in a manic phase will often have unrealistic thinking such as, “I have the best idea for a new company. It’s like Uber for drug dealers. I need to sell my house and move to Silicon Valley because that’s where tech startups live. Time to start researching plane tickets and places to list my house for immediate sale.” There are different types of bipolar and some nuances to diagnosing it, which I will not get into here, but essentially someone with bipolar goes through distinct periods of depression and that mania that I described. Both of the “poles” of this disorder can be devastating. It is hard to treat as well, because regardless of the danger, it can feel fucking awesome to be manic. Even though you might be wrecking your body, making poor decisions, and freaking everybody out… beats the hell out of depression right? At least that’s what it feels like. In reality, mania can be even more dangerous than depression because you are more likely to actually get off your ass and do something that you are going to regret later. If you are in the bipolar camp, you can certainly learn a few things from this book, but I would urge you to pay particular attention to the chapter about getting professional help.
Another one to mention is persistent depressive disorder, which used to be known as dysthymic disorder. That is where you don’t tend to go into full blown depressive episodes, but you continuously have a low-grade depression that just never seems to lift.
Then you have seasonal affective disorder, which is basically depression that is only expressed during certain seasons. Most often this shift in mood occurs during the more dreary winter months. Mothers can also have postpartum depression, which is when “baby blues” following the birth of a new little one continue to be strong and persistent after a few weeks. It is often still a temporary issue, but it can transition into major depression if left unchecked.
Okay, that’s about all I want to dive into right now. I think it’s important to arm yourself with some knowledge about the different symptoms that you might be experiencing, but I know this chapter was also kind of a bummer. On one hand, you might recognize that you are not alone in your struggle. On the other, realizing that you are depressed can be… well… fucking depressing. That’s okay. Depression sucks because it is a “sticky” problem that can be really hard to shake on your own, but there is actually a lot that can be done to facilitate the process. You have taken the first step toward kicking these issues by reading this far. Give yourself a nice little pat on the back. In the rest of the book, I will talk about specific issues that are often encountered in depression and give my thoughts about how you can work around them. We will cover things like motivation, thinking patterns, ways to set yourself up for success, and finding professional help. Let’s get into it!
Ch. 2 Getting the Ball Rolling
So this is ironic. I am having the hardest time finding the motivation and desire to write this chapter. I mean, I want to have the desire to write it, but I have tried a bunch of times to bring myself to actually start writing and have failed. Well, when I say that “tried”, I guess I mean that I have sat there and waited to feel motivated enough to start writing. Of course, that is where I went wrong. I am not motivated right now, but I have already written 6 sentences. Swag. One of the superpowers that this evil villain named depression has is the ability to drain you of your energy and motivation. To make you feel hopeless and stuck. Often you are left trying to internally search for this feeling of motivation that you remember having at some point in your life, but that has not been present for quite some time. That is a trap. If you wait to feel motivated before you move forward with the things that you want or need to do, you will never do them. Low motivation and low energy are symptoms of depression, and they suck. Interestingly, one of the most effective forms of treatment for depression was invented by Nike. Okay, it wasn't actually invented by them, but they coined the tagline that I want you to remember: Just Do It.
In the world of psychology, we call this type of treatment for depression Behavioral Activation. Behavioral Activation acknowledges that when you are depressed, you fall into a negative behavioral pattern where you not only lose motivation to do the important stuff that you need to take care of, but you also stop doing the things that bring you happiness and pleasure. Basically, everything feels like it sucks, so what is the point of doing anything? I think of Behavioral Activation as the science of "duh" because you basically need to start doing the opposite. You need to push yourself to do things anyway even though you don't want to. Especially because you don't want to.
Have you felt anhedonia? This is that feeling that everything is just "meh." Cute picture of a cat wearing an ugly Christmas sweater? Meh. Top 10 laugh out loud clips on Youtube? Meh. Someone pays you a huge compliment, acknowledging the wonderful qualities that they appreciate about you as a person? Meh. Promotion at work? Meh. You get the idea. Everything just feels very bland and all of the things that used to have an effect on you basically fall flat. It is very common for people with depression to experience that feeling of anhedonia, which is separate from those more sharply painful feelings of sorrow, which can also be present. Awesomely, this can be undone. Essentially, you have learned to stop feeling pleasure, and you need to re-train your brain to recognize and benefit from the things that should be having a positive impact on you. How? You guessed it - Just Do It.
You are really going to have to take my word on this because, so far, this probably seems like the most obvious bullshit you have ever heard. If it was that simple, you would have already done it, right? Well, yes and no. You haven't done it because it is really hard to claw yourself out of this stupid pit that you have fallen in. You need an action plan, and you need a kick in the ass. Let me be that kick in the ass. Let's do an exercise.
I want you to get out a piece of paper and write down 10-15 things that you used to provide you happiness, pleasure, motivation, laughter, or any other positive experience. Please do not write things that suck. I am sure that you used to do chores more often than you do now, but that's not the point of this list. If you write down "do laundry" or "finally clean the garage" I am going to stab you with a fork. I can't predict the exact things that make you happy, but you might write down things like "go to the movies", "take a walk", "play some video games", "read a book", "get the dog a new toy to play with", "invite a friend for lunch", "get a pedicure", "go surfing", "cook dinner for my kids", or "play some music". These are things that once felt great to you, but are currently falling flat. You need to reconnect to these things, and you need to re-train your brain to feel good about these things again. So, go ahead and make that list. If some emotion comes up for you while you are writing it, that is totally okay. It can be hard to recognize how many things have fallen by the wayside during the battle with depression.
You have probably seen the
cartoons where someone has an angel on one shoulder and a devil on the other, right? Well, depression is that devil that sits on your shoulder and whispers in your ear to tell you this exercise is useless. It will tell you that you don’t deserve to do fun, pleasurable things for yourself. Especially when there are more important things that you are neglecting. If depression is going to be that devil, let me be the angel on the other shoulder telling that devil guy to shut the fuck up. Being stuck in the weeds does not mean that you don’t deserve to take time to re-engage with these activities. We will most certainly get to the “important” stuff as well. This is just step one.
Alright, so back to the exercise. Once you write down those 10-15 things, I want you to think about two different variables. The first one is how much happiness, pleasure, reward, etc. you are likely to get from the activity. I’ll give a few personal examples for my life. Going out to get some coffee would be pretty nice, but it’s not necessarily going to be a top 10 of the month sort of activity. I’d rate it at about a 5 out of 10 on my reward scale. Playing some videogames for a couple hours might be more like a 6 or 7. Going out to a nice dinner and getting an expensive bottle of wine (provided the money is there) would be closer to an 8 or a 9. This is all very personal and subjective. Here’s the thing: these ratings can shift depending on the context. If it is freezing out and I am tired as all hell, that pumpkin spice latte is suddenly going to be worth 8 points instead of 5. Why don’t you go through and rate all of the activities that you listed on the same 0-10 scale, where 0 is nothing special and 10 is pee-your-pants exciting.
Great. Now that you have rated how rewarding each of those activities are, I want you to think about the second variable, which is the difficulty of the activity. Again, this is very personal to you and can change over time. If you are a seasoned runner and you haven’t given up that activity despite your depression, running 2 miles might be very low on the difficulty chart. If you are just trying to get started with running, it will be much higher. Something a bit easier might be watching your favorite show on Netflix, which would be more like 2 out of 10 on the difficulty scale. Go back through your chart and add difficulty ratings to each of your activities that you listed on that 0-10 scale where 0 is something you could do in your sleep and 10 is your most herculean effort.
Awesome. So now, we have a nice little chart set up with a bunch of activities that your asshole depression has told you to stop caring about, and each item on that chart has a rating for reward and a rating for difficulty. We already know that your motivation has probably been obliterated through the depressive process, so what we need right now is an easy win. Let’s do a little math here. All I want you to do is subtract your difficulty from your reward. For instance, if getting coffee is a 5 in the reward column and a 3 in the difficulty column, you are left with a value of 2. Going to dinner with friends might be a 9 in terms of reward for you, but if it takes 9 units of effort, you are left with a value of 0. Your easy win is the activity that has the highest “win value” after performing that calculation. This is where you start.
A few things to keep in mind: Remember that this list of activities are things that you used to enjoy but have let slide since depression dug its stupid claws into you. That means that for me, I am not allowed to use playing video games as one of these activities. Even though I get a high value from it (7 reward - 2 difficulty = 5), it is something that I have not stopped doing. More of the same isn’t what we are looking for here. I want you to shake things up. We are fighting against the pattern of sameness, not reinforcing it. The other thing to keep in mind is that this simple calculation is for finding your first easy wins. This does not mean that these are going to have the biggest impact on your mood and wellbeing in the long run. These are just the easiest places to start. Running a marathon is going to be off the charts in terms of difficulty, but it might also be off the charts in personal meaning and change your life forever, if you can get yourself to that point. For now, we want to start simple and break the cycle of negative actions leading to negative emotions.
Okay, so all of that is well and good, and you might even be feeling pretty motivated right now to get out there and kick ass with your first easy win. That motivation will not last forever, though. As soon as you put down this book for the day, the emotional high from being here with me and inspiring yourself by planning to destroy your depression will slowly fade away. There is nothing wrong with that. It’s totally normal to have peaks in your motivation, and inspiration that don’t last forever. What you need to do is capitalize on your motivation in this moment to set yourself up for success later. One way you can do that is by making more concrete plans to follow through with your first easy wins. Even though I am calling them easy, they are sometimes very hard when you are first starting the depression exterminating process. Therefore, if you simply say to yourself, “Alright, I will go and take a walk tomorrow,” you just might skip that walk. However, if you go on your phone and say, “Remind me to go for a walk tomorrow at 2 pm,” you might be a little more likely to follow through. Be specific and be reasonable. Say going to the gym is on your list because you used to be pretty ripped and enjoyed lifting several times per week. Starting off with one specific time next week to go and lift might be much more feasible at this point in time than saying you’ll go three times per week starting today. Going too hard right away will just turn you off and make you feel bad about yourself.
Getting started is often the hardest part, so I have a few tips to get you moving, even when motivation is lacking. The first is called the 5-minute rule, and it is just like it sounds. You can handle just about anything for at least 5 minutes. When you use the 5-minute rule, you give yourself the option of bailing out from the activity you wanted to engage in, but only after at least 5 minutes of giving it a shot. So, if you start trying something out and after that time period, it is completely unbearable, then by all means call it quits and try another day. However, what you will often find is that once you get the ball rolling on an activity, it’s really not as bad as you thought it would be, and the ball tends to keep rolling on its own. You just have to ignore that annoying ass voice in your head that tries to hold you back for long enough to get started on the damn thing. That whole saying of “fake it ‘til you make it” actually has a lot of validity. Your jerk of a brain is so used to not having motivation and so used to not deriving pleasure from fun activities that you need to beat it back into shape. You don’t have to be motivated to do things that normally take motivation. You just need to act as if you were motivated. I can ask myself, “What would Robert do if he was motivated right now?” That gives you the goal to press toward. Do the damn thing and I promise you that the feelings will start to catch up. If you are having trouble playing that part, regardless of your pre-planning and psyching yourself up, maybe you should enlist some help. If you are the type of person to be fine letting yourself down, but almost never fail to keep commitments with others, you might want to schedule your walk or trip to the bookstore with a friend who can help keep you accountable.
Activity scheduling seems to be most helpful when you can do it for your entire day. Don’t worry. Some parts of the day will always be unpredictable, and you most likely won’t stick to your schedule 100%, but when you are first getting started in this process of behavioral activation, it can be so valuable to literally schedule out every hour of your day. Schedule time to take breaks and be a lazy vegetable, but also schedule time to engage in those activities that you used to love. When you get to the end of your day, take a look at your schedule and notice what your emotional state was like during the different parts of the day. Maybe you had a peak in your happiness and motivation a few hours after lunch, and your personal black rain cloud was most apparent when you first woke up in the morning. You can use this information to your advantage. In that example, you would probably need the most support from your team to get your ass up and moving in the morning. On the other hand, you can trust that you wi
ll have the most motivation to do some solo depression ass kicking during the afternoon. Taking the time to notice and analyze your own patterns can serve as an amazing self-feedback tool that allows you to dial in the awesome work that you continue to put in and amplify the effects of this behavioral activation.
There are a million ways to skin this cat. The bottom line is you need to find the best way for you to start doing those things that you aren’t doing. Start with the easy wins that we talked about and that should start to increase your baseline level of happiness and motivation. Don’t forget that depression is a vicious cycle. Having no motivation and no energy is a symptom of depression, and taking no action is also something that makes you feel more depressed. This cycle keeps going around and around. When you start to break that cycle by doing things, your level of overall depression will start to decrease, which will have the side effect of increasing that reservoir of motivation that you have to spend. Create a positive snowball effect that will enable you to make the shift from re-engaging with pleasurable activities to re-engaging with activities that aren’t always fun, but are necessary for living a meaningful life such as writing your paper, calling your mom to let her know that you are still alive, figuring out your finances, or cleaning your apartment.
I promise I’m not just pulling this stuff out of my ass. There is a physiological difference in the brains of people who have depression marked by low motivation and the stupid lucky people out there who don’t have to contend with it. I want to talk about biology with you for a little bit. I’ll try not to nerd out too hard and keep it straightforward, because it’s important to have a basic understanding of neurobiology to understand just how it can feel so damn hard to get the ball rolling when you are depressed. So, the brain is full of these crazy cells called neurons. These cells carry electrical and chemical impulses throughout your brain and govern just about every aspect of your behavior. There are around 100 billion neurons in your brain, and they constantly communicate with one another through the use of these awesome little chemicals called neurotransmitters. Basically, one neuron produces a neurotransmitter and sends it floating over to another neuron. If that neuron has the right type of receptor and it’s open for business at the time, it will accept the neurotransmitter like a puzzle piece. That will serve as a signal for that second neuron to take some sort of action.