SAMAR HAFEEZ, BENGALURU

Almost everyone feels down from time to time. Getting a bad grade, having an argument with a loved one, not achieving a positive appraisal at work, disagreements with siblings and many other life instances that pose a demand or pressure on you can make you feel sad.

Most of the times, these negative thoughts and feelings last for a couple of days and fade away, they usually don’t seem to disrupt or extensively impair your day to day activities, and most of us feel fine after having a healthy constructive conversation or a good laugh with a family member, colleague or a friend.

However if you have depression, these negative thoughts and feelings seem to be leeched onto you, sucking the fun out of your life. The negativity does not seem to improve or subside and may carry on for months perhaps years, causing significant distress or impairment in social, occupational and other important areas of functioning. Depression is more than just sadness; it has been called world’s number one public mental health problem.

With Covid 19 wreaking havoc on mental health of people around the globe, with so much death and suffering around, it is absolutely imperative that we channel all our attention towards understanding and recognizing the importance of mental health in tackling this pandemic, which has now become a mental game. Covid 19 is testing our resilience, mental tenacity and perseverance each day. Most importantly, the impact of pandemic has been significant on people with pre-existing mental health conditions.

With social life curbed and work life halted, many people are feeling disassociated and bored. Work roles form a vital part of our identities. When the self-improvement opportunities are taken away, people tend to feel low and dejected. Also when talents and abilities go unutilised, there occurs a sense of unhappiness and dissatisfaction, which further extends into causing depression and even suicide. In the midst of self- loathing, hopelessness and helplessness, a person can think of no other escape but death.

Severity of symptoms varies with individuals and also varies over time. Some of these signs and symptoms include anhedonia (inability to experience pleasure from activities usually found enjoyable), feeling gloomy, guilty, melancholic, worthless and hopeless most of the day, almost everyday; negative thinking, significant weight loss when not dieting or weight gain (i.e. a change of more than 5% of body weight in a month), decreased or increased appetite, insomnia (sleeplessness), or hypersomnia (excessive sleepiness) nearly everyday, psychomotor agitation or retardation (ie; restlessness or sluggishness), fatigue or loss of energy nearly everyday, inability to concentrate recurrent thoughts of death and suicidal ideations, or suicide attempts.

Presence of five or more of the above symptoms over a two-week period and representing a negative change from previous functioning will indicate the onset of depression.

Depression being a heterogeneous problem can have numerous risk factors including a combination of genetic, environmental and psychosocial factors. It is likely to appear at any age.

Major life changes (including the current pandemic situation), social isolation, extended quarantine period, loneliness, trauma, sexual abuse, chronic stress, substance abuse, pregnancy, chronic physical illnesses such as cancer, stroke and diabetes can be among its causes.

You feel the way you think

Depression is an illness that mostly results from thoughts that are distorted in some way. Every bad feeling you have is the result of your negative thinking. Illogical pessimistic attitudes play a central role in the development and continuation of depressive symptoms.

Over 30 years of research confirms that people with depression tend to have more negative thoughts leading to being more and more depressed. These negative thoughts are the most frequently overlooked symptoms of depression. These cognitions contain the key to relief and are therefore the most important symptoms. For many, these thoughts seem to occur almost spontaneously.

Emotions and actions result entirely from the way you interpret things. It is an obvious neurological fact that before you can experience any event, you must process it with your mind and give it a meaning before you can feel or react to it.

Following is a list of cognitive distortions (simple ways in which our mind convinces us of something that is not really true) that form the basis of our depressive state.

All-or-nothing thinking: In this cognitive distortion, we see things in black or white categories. For example, if your performance falls short of perfect, you see yourself as total failure. There is no middle ground in this type of thinking.

Overgeneralization: In this mind trap you see a single negative event as a never ending pattern of defeat.

Mental filter: You pick out single negative detail about an issue or situation and dwell on it exclusively, like wearing a pair of eyeglasses with special lenses that filter out anything positive.

Disqualifying the positive: You reject positive experiences by insisting they “don’t count” for some reason or the other. By using this distortion, even if not intentionally, you can easily turn golden joy into emotional misery.

Jumping to conclusions: You arbitrarily jump to conclusions without definite facts that convincingly support your assumptions.

Magnification (catastrophizing) and minimization: This mental trap, also called “binocular trick”, is likely to have you magnify your imperfections and minimize your good points.

Emotional reasoning: You assume that your negative emotions necessarily reflect the way things are. “I feel it, therefore it must be true”. One usual and prominent side effect of emotional reasoning is procrastination.

Should statements: You try to motivate yourself by saying “I should do this”, “I ought to know this” etc. Overtime these statements cause you to feel pressured, resentful and demotivated.

Labelling and mislabelling: This is an extreme form of overgeneralization. Instead of describing your error, you label yourself as “a loser”. This is similar when someone else upsets or annoys you and then you attach a negative label to them.

Personalization: This distortion is the mother of guilt! You assume sole responsibility for every negative event that occurs in your life even though there is no basis for doing so.

Once you invite depression through these cognitive distortions or “mind traps”, your feelings and actions will reinforce each other in a self-perpetuating vicious cycle.

What you can do?

While depressed, although it is really hard to will yourself to recover, it is not altogether impossible. By taking the following small but positive steps day by day, you will feel happier, healthier and more hopeful again.

Triple column technique: For milder forms of depression, I would request the readers to mindfully identify their thoughts and respective feelings and reactions. Jot down in a diary using a “triple column technique”. In the left column, write down the negative thoughts that drift in your mind, in middle column, identify your distortions and in right hand column, write down more realistic interpretations or rational responses to specific distortions. This daily written exercise will accelerate your personal growth and provide substantial emotional relief.

Practise meditation: The best form to do this would be to attain spiritual closeness to God Almighty; it is a great protective factor against depression and suicide. Offer daily prayers with sincerity and hope. Spiritually inclined individuals forgive and forget any negative or cruel event quickly, thereby saving themselves from chronic stress and anxiety, which are among the causes of depression.

Positive self-talk: Practice positive self-talk daily, while reducing self-defeating statements. Surround yourself with people who encourage and motivate you. Look for opportunities in every challenge and you will develop inner strength.

Gratitude journal: Keep a record of all positive, rewarding and pleasant experiences of life. Everyday practice will keep your spirits up.

Mindfulness: Practising mindfulness and to teach the same is lifesaving. Most of our misery is connected with negative thoughts about our bygone past or invisible future. Being present in the ongoing moment is extremely important, now more than ever.

Physical exercise: Include moderate exercises at least four days a week; go out in nature for fresh air often. Restart your hobbies and do things which you love. Get more sunshine as production of vitamin D in body reduces depressive symptoms.

Avoid isolation: Do not isolate yourself for long periods. Associate with friends and supporters, even if it is a virtual meeting.

When depression is moderate to severe, it can be crippling and can seize one’s ability to think and reason clearly.  In these cases, it is recommended to see a mental healthcare professional for an entire mental status examination as soon as possible.

Fortunately, you don’t have to live with depression; you can always show it a way out!! Even the most severe cases are treatable with help of medications, psychotherapy and social support.

If you know anyone with depression, please offer emotional support which involves patience, understanding, affection, empathy and encouragement. Engage the depressed person in conversation and listen carefully. Do not ignore signs of depressions; if a person engages in any suicidal ideations or attempts, immediately seek help on behalf of that person. Suicide is often preventable with a right and timely approach.

The most crucial thing is to offer hope! This eradicates almost every existing problem.

Composed by: Samar Hafeez, a clinical psychologist and certified holistic health coach, Bangalore, India.