Winter Blues Survival Guide: A Workbook for Overcoming SADby Norman E. Rosenthal, Christine M. Benton
If you have seasonal affective disorder (SAD), take heart. A range of effective treatments and preventive measures can help you feel healthy and productive, even on the darkest days. Yet when depression kicks in, it's tough to mobilize yourself to find and use the information you need to feel better. That's where this skillfully crafted workbook comes in. Leading
If you have seasonal affective disorder (SAD), take heart. A range of effective treatments and preventive measures can help you feel healthy and productive, even on the darkest days. Yet when depression kicks in, it's tough to mobilize yourself to find and use the information you need to feel better. That's where this skillfully crafted workbook comes in. Leading SAD expert Dr. Norman E. Rosenthal guides you step by step to:
• Record your symptoms, such as low moods, fatigue, sleep problems, and food cravings.
• Gain awareness of your seasonal patterns-to anticipate problems before they arise.
• Determine which remedies to try, including light therapy, meditation, lifestyle changes, antidepressants, and psychotherapy.
• Keep track of what works and how long it takes for symptoms to improve.
• Spend your high-energy months equipping yourself for the times when energy is low. By working through the book's simple checklists and fill-in-the- blank forms (you can download and print additional copies as needed), you'll create your own blueprint for greater well-being all year long. Let there be light! See also Dr. Rosenthal's Winter Blues, Fourth Edition, which provides a comprehensive overview of SAD and its treatment.
Description: This is a wonderfully written workbook for those dealing with seasonal affective disorder (SAD). The author employs a wide variety of effective techniques while maintaining a friendly tone in the presentation of the material.
Purpose: The purpose is to give readers the opportunity to work with their therapists and with themselves to gain awareness of their SAD, record their signs and symptoms, evaluate and implement the various remedies, and take advantage of the tools to handle the low-energy time points by focusing on those high-energy time points. The author is an expert in the field.
Audience: This workbook can be used across all mental health disciplines and, more importantly, by the clients themselves. As it is written in an easy-to-read format, it is both a great teaching tool and a strong reference guide.
Features: The first of the book's two parts is a strong overview of SAD that enables readers to determine their seasonal profile and the triggers that make them feel sad, identify the various treatments, and tailor a treatment plan called Awareness, Preparation, and Prevention. Part two discusses the various treatments, tools, and strategies. The most commonly accepted treatment, light therapy, receives appropriate coverage as do dietary strategies and meditation and relaxation. There is also a decent discussion of the use of medications for SAD.
Assessment: It is quite refreshing to have such a strong resource for SAD when one considers how many self-help books there are. This workbook is full of examples, worksheets, practical tools, and resources. It is not simply a self-help book, it is a self-empowerment workbook.
"This book makes effective use of the best scientific information about treating SAD. You'll find all the tools you need to develop and implement your own plan to feel like yourself again and be more productive all year round."Chris Thompson, MD, FRCP, FRCPsych, Chief Medical Officer, Priory Hospitals Group, United Kingdom
"This outstanding book will be of great interest to everyone who experiences seasonal mood changes."Leo Sher, MD, Associate Professor of Psychiatry, Icahn School of Medicine at Mount Sinai
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Winter Blues Survival Guide
A Workbook for Overcoming SAD
By Norman E. Rosenthal, Christine M. Benton
The Guilford PressCopyright © 2014 Guilford Press
All rights reserved.
What Do You Know about Your Relationship with the Seasons?
What is your favorite season? rank them in order of preference, 1 for the time of year you like best, 4 for the season you'd most like to erase from the calendar:
The goal of this little exercise is not to reveal that you almost surely ranked summer or spring number 1 and winter number 4 (if you have winter SAD) but to show how easily you made these choices. You're probably aware on some level that you've been greeting the darker months the way you would a recurring nightmare, and yet it may have taken you years to seek help for SAD. Why? The answer lies in the complicated relationship that human beings have with the seasons and how it has evolved through history. Understanding this relationship is an important first step in developing the awareness you need to make your relationship with the seasons an amicable one.
HOW AWARE ARE YOU OF THE SEASONS' EFFECTS?
This book is all about increasing your awareness so you can beat SAD. If you are just starting to look at the possibility that you have some version of seasonality, you may have gone for years without fully recognizing your symptoms and their impact on your life. If you are already addressing your seasonality but think you could feel even better, there's probably more you can discover about your relationship with the seasons to gain additional improvements.
Our senses tell us when the seasons are changing—we feel the temperature dropping or rising, we smell flowers blooming or fallen leaves decaying, we're greeted by varying degrees of sunlight when we open our eyes to the new day. The calendar confirms what time of year it is. so why delve more deeply? Paying attention to exactly how the current season affects your mood, your energy, your appetite for food or sex, or how well you sleep may have seemed as useful as asking yourself how one breath of air differs from the next—at least until the pang of regret for the end of picnic weather and beach days is replaced by full-blown dread that's hard to shake. Now your relationship with the seasons is more complicated. A number of preconceived notions can keep you from understanding why you may have a love–hate relationship with this aspect of the natural world and from finding a comfortable place in it.
 Have you assumed that you shouldn't "let the seasons get you down" since they don't seem to trouble those around you?
It's true: Many people can feel generally as happy in winter as in summer, just as upbeat and productive in fall as in spring. If you're surrounded by these people, as you probably have been all your life, you may very well have concluded you should be equally resilient. As a result, you've probably tried to shrug off the fact that for you the changing colors of autumn are accompanied by fear of the cold, cold months to follow. You may have tried to put on a good face at the holidays even though you were in a serious funk and didn't feel like joining the party.
Efforts like these may even have helped to an extent. Maybe you pushed yourself to go to that new Year's eve party (perhaps because you felt you ought to) and ended up feeling much better in the company of friends than if you had hunkered down alone at home. (socializing when you don't feel like it, at least sometimes, is one measure that I advocate.) But if you didn't succeed in acting cheerful during holiday gatherings or in leaving home at all for a party, you may well have blamed yourself. In that case, with your mind caught up in guilt and shame, you could hardly be fully aware of how the seasons were affecting you. And if you persisted in pushing yourself to act like nothing was wrong, denial of the problem also limited your awareness of exactly what was going on between you and the seasons. Sadly, with awareness blocked, so is the understanding that could help you manage or even solve the problem.
 Or do you believe the opposite—that everyone feels the way you do when winter comes, and puts up with it—so you should too?
One woman I treated had endured SAD for several decades before seeking treatment. When asked why, she said she had assumed everyone felt the same way she did! Many people with varying degrees of SAD believe that everyone deals with winter without complaining, and therefore complaining would be a sign of weakness. As noted above, everyone doesn't dislike winter. The people around you aren't all being stoic; some even love winter. And for those who do dislike winter, not everyone puts up with winter difficulties. Many adopt the remedies outlined in this book. (The fact that you aren't talking about your winter problems may be what's keeping you from hearing about how many others have SAD and what they're doing about it!) As to those who do try to grin and bear their winter blues, I respectfully suggest that they would feel better if they beat the winter blues—and so would you.
 Do you believe you're to blame for your winter problems, and therefore you should just keep trying to deny them?
Most people with SAD do feel different, but many believe they shouldn't be different. As explained above, some believe everyone has the same problems but puts up with them, and others believe no one has the same problems and therefore they must be imagining them. Both assumptions can lead to self-blame—either you're causing the problems or you're just not "tough enough" to rise above them. Feeling like you are to blame for your SAD symptoms can be a disempowering feeling, leading you to believe that you are not entitled to relief because it is your fault. When you believe you're not entitled to relief, the only solution is to try to pretend the problem doesn't exist. Limiting your awareness in that way can keep you from discovering exactly what you need among the remedies in this book to feel better.
The remedy if you're blaming yourself for SAD is (1) to recognize that it is a biological variant and therefore not your fault and (2) to ask yourself "Why not treat it as you would any condition?"
* You may find it difficult to shed the belief that you are somehow to blame for your seasonality. Accepting SAD as a legitimate illness that limits what you can do when depressed can be an ongoing struggle. Even if you recognize the facts above, they are easy to forget, especially when you're feeling down. You may find yourself accepting on some days and resisting on others. Because lack of acceptance can make you feel so much worse and may lead you to deny yourself the help you need, I'll take the liberty of gently reminding you throughout this book that you have a right to get the help you need and to minimize stress so you can cope with SAD.
 Have you told yourself that fighting the seasons is futile?
Maybe you've told yourself there was nothing you could do about the seasons' effects on you because summer, fall, winter, and spring are going to keep cycling through the year, taking you along with them. Happily, this assumption is usually wrong. You certainly can't stop the seasons from coming and going. But you can prepare for them in ways you haven't done so far. Instead of bracing themselves for the inevitable crash (while hoping against hope that they won't get so depressed this winter), many people anticipate SAD symptoms: they take specific steps. For example, they book winter trips to sunny locales or repaint their living quarters a bright, light color.
Myth Buster: some people hesitate to seek help for SAD symptoms because they figure if their depression occurs only at certain times of the year it's not "real depression." the fact is that SAD falls under the umbrella of major depression. And that doesn't mean SAD is milder across the board or less significant or worthy of help. SAD can be just as severe as any other type of major depression.
 Do you believe that looking back at the discomfort you've suffered in the past is simply wallowing and self-indulgent?
There's a distinct difference between reflection and wallowing. Reflection leads to solutions; wallowing does not. At risk of overgeneralizing, it may be no coincidence that the cultures inhabiting the regions of the world where SAD is most prevalent (northern North America and Europe) tend to value independence and self-determination highly. Winter has taught us that it is important to fend for ourselves. But we can take this attitude too far—especially these days, when so much information and help is available. By all means, be independent, but also make use of these resources.
Sarah Sank into a deep depression 3 years ago after losing her job in marketing in November. She managed to pull herself out of it in April and started looking for a new job in earnest. She got a position as an assistant curator at a local museum—her dream job. But the new field was a challenge for her, and by fall she was starting to get negative feedback from her boss. At the end of the year she was fired. Sarah had another tough winter but found a new job in March. she also started dating someone that she really liked, and everything was great until October, when she started fighting with her boyfriend and calling in sick at work. Looking back, she describes the winter that year as "gloomy." But it was all forgotten once the summer returned. In the fall, her boyfriend broke up with her, saying she was just too irritable to be around. She went to see her doctor for "exhaustion," and he prescribed a new diet, exercise, and asked her to come back in 6 weeks.
Examined along a straight timeline (remember those datelines you had to draw in social studies class?), Sarah's recurrent problems may seem unconnected. Naturally she got depressed after her job loss and subsequent relationship problems. But if you look at her recent history in a cyclical sense, it's pretty obvious that her depressions and related problems always started in the fall and eased in the spring. Viewed through this more useful lens, her doctor might have considered SAD as a diagnosis right away.
Of course, I am not suggesting that we rid ourselves entirely of our sense of linear time. That perspective does make progress possible—including, ironically, the progress that we've made in insulating ourselves from the effects of the seasons, from the development of air conditioning to the prevalence of artificial light.
Fortunately, in recent years scientists and the general public have renewed their interest in the cycles of our natural world by exploring biological rhythms, and this shift laid the foundation for the discovery of the phenomenon now known as SAD. Throughout this book I'll ask you to do some exploring of your own, taking a new look at the biological rhythms that connect you with the cycle of the seasons and also with the cycle of sunlight and darkness. Understanding how we are all connected to these grander rhythms of the world is the first step in getting acquainted with your own unique form of seasonality. It is a love–hate relationship for anyone suffering the symptoms of SAD, but as with an irritating relative that you can't disown, it's a relationship that you can manage by knowing exactly what you're dealing with.
FIRST STEPS TOWARD AWARENESS: STARTING TO EXPLORE YOUR OWN SAD
to get a glimpse at your own SAD awareness, answer these questions:
When did you first notice a strong preference for one season over another?
 Childhood  Adolescence  Adulthood
How has that preference evolved over the years?
 Weakened  Intensified  Varied from year to year  Stayed about the same
When did these preferences become a problem for you?
______ Year of age or:
 During school years  In college  As a working adult  During parenthood
You may not have been able to answer these deceptively simple questions as quickly as you did the first exercise in this chapter. A habit of ignoring or minimizing seasonal discomfort can make your years with SAD seem like they passed in a blur. One goal of this book is to help you re-create your SAD history because it holds the keys to identifying the best remedies. If your best winters were the four years you spent at the university of new Mexico, you know that having sunshine every day really helps you. If your worst winters were those when you had your first job, where your desk was in a windowless cubicle with low light, you know that even a great job won't be so good for you if it keeps you in the dark all day. If you did better in winter when each of your children was a baby and you took long walks outdoors early in the morning, you know that taking a brisk walk by yourself at that time of day could really boost your mood even in January.
* People between their 20s and 40s seem to be most susceptible to SAD, but many diagnosed during that period distinctly remember disliking winter much earlier—they just didn't think it was important to register their changing feelings back then.
How often have you found yourself brushing off the dread that accompanies another approaching winter?
 Never  Seldom  Occasionally  Often
How many winters in a row have you told yourself to look forward to better times ahead and stop dwelling on the past?
Choose one significant date in fall or winter—Thanksgiving, Christmas, Hanukkah, your birthday or a family member's or friend's, the start of school, etc.—or in summer if you have summer SAD and write down what you remember about your experience that day over the last 3–5 years. Don't spend a lot of time on this; just quickly jot down your general memory of the day—how you felt, whether you enjoyed yourself, and the like:
Last year: ______________________________________________________
Two years ago: ______________________________________________
Three years ago: ____________________________________________
Four years ago: _____________________________________________
Five years ago: _____________________________________________
What did you learn from the preceding exercise? if you can't remember much, it might be because, like many people with SAD, you pass fall and winter days in something of a fog. Or it could be because you would prefer to forget those seemingly endless days—understandable, but somewhat counterproductive. This workbook is your chance to call up those memories to make use of them, not to torment yourself.
For those years you were able to record something, did you notice a pattern? Are your memories generally positive, negative, or neutral? Do you associate that date with a specific feeling—blue, down, cross, angry, elated, content? What about your physical state? tired, energized, comfortable, achy, ill? Do you recall changes in daily sleep length and food intake (more in winter, less in summer)? Observations like these are the jigsaw pieces that will ultimately fit together into a coherent picture of your SAD and will help you solve the puzzle of your seasonality.
LIGHT: CENTER STAGE IN SEASONALITY
Living on planet earth, we are aware that the sunlight envelops us; it's part of our natural habitat. Everyone else seems to take it for granted. But for those of us who have SAD, the only time we may take it for granted is when there is plenty of it (like the grasshopper in Aesop's fable). When it isn't there, we really miss it. We may not be fully aware of the emotional, cognitive, and physical effects that seasonal changes in sunlight exert on us, but we know something feels wrong. The effects of these changes in sunlight are at the heart of seasonality.
Excerpted from Winter Blues Survival Guide by Norman E. Rosenthal, Christine M. Benton. Copyright © 2014 Guilford Press. Excerpted by permission of The Guilford Press.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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Meet the Author
Norman E. Rosenthal, MD, is internationally recognized for his pioneering contributions to understanding SAD and using light therapy to treat it. He is Clinical Professor of Psychiatry at Georgetown Medical School, a therapist in private practice, and the author of six other books, including Winter Blues, the New York Times bestseller Transcendence: Healing and Transformation Through Transcendental Meditation, and The Gift of Adversity. Dr. Rosenthal conducted research at the National Institute of Mental Health for over 20 years and is a highly cited researcher.
Christine M. Benton is a Chicago-based writer and editor.
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