In seven simple steps, Uncovering Happiness uses cutting-edge mindfulness and self-compassion techniques along with innovations in neuroscience to help you combat depression and take back control of your mind, your mood, and your life.
Most of us believe when we’re depressed that our situation is hopeless. That’s a mistake. Dr. Elisha Goldstein reassures us that the secret to overcoming depression is in harnessing our brain’s own natural antidepressant power to create a more resilient mind.
Uncovering Happiness is grounded in two key foundations: mindfulness, which research shows reduces the risk of relapse and can be a powerful alternative to medication, and self-compassion, a state of mind in which you understand your own suffering with an inclination to support yourself. Dr. Goldstein explores these tools—as well as purpose, play, and confidence—and the specific techniques we can use to put them into action. Together, these elements can transform an experience that would typically force us into a downward spiral into an opportunity to establish self-worth.
At its core, Uncovering Happiness is a persuasive argument for hope. Just because you’ve suffered from depression in the past doesn’t mean you must do so in the future. By learning to build up the sections of the brain that protect you from the disease and slow down the sections that foster it, you can enjoy the good times, survive the difficult times, and open yourself up to a life that truly feels worth living.
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About the Author
Read an Excerpt
Understand the Depression Loop
Clint, a middle-aged executive, had experienced bouts of anxiety and depression off and on since childhood. Raised by an overly critical father, Clint grew up believing that having negative emotions was a sign of weakness, so he buried them deep inside. When Clint was a child, his father would call him a sissy and embarrass him in public when he cried. Later in life, when Clint felt sadness or other difficult emotions, he would close himself down and become numb, avoiding his partner, and burying himself in work to try to hide from his feelings. Clint didn’t realize it at the time, but he was caught in a depression loop: complicated feelings (such as sadness) would trigger reactionary thoughts (negative self-talk) and sensations (emotional numbness) that would in turn cue certain behaviors (withdrawal from loved ones and escape to his computer and his work). Anxiety and hopelessness left Clint feeling pessimistic that he’d ever emerge from his depression, creating a negative feedback loop that made him feel trapped.
Working together, Clint and I focused on understanding the cyclical nature of his responses to his feelings. Clint began to see and recognize his own personal depression cues. He began to learn to step outside of his habitual mindsets when uncomfortable feelings emerged in order to take a closer look at those feelings and the reactions they elicited. He identified triggers, thought patterns, and behaviors that were associated with his depressive experiences.
Clint had a breakthrough experience one morning. After hearing some bad family news, he paid attention to his reactions and noticed himself becoming numb and withdrawn. He felt an urge to head to his computer to work, as he had so often before. He saw himself trying to flee from his sadness instead of allowing himself to feel it. This time, though, things were different. Because he had learned how to recognize the activation of his familiar depressive loop, he was more aware and able to interrupt it. He was able to make the choice to step out of the cycle and let himself feel sad rather than hiding from the feeling. As he gave himself permission to experience an uncomfortable emotion, the tension in his body dissipated, and within a half hour, the sadness passed. Clint felt elevated by a sense of freedom he hadn’t experienced in quite some time. By recognizing his own personal depressive stimulus, Clint was able to change his response and avoid a negative spiral that would lead him down the path of negative feelings, thoughts, sensations, and behaviors.
Learning to identify the cyclical nature of the depression loop and to recognize your own depression cues, as Clint did, is crucial for uncovering happiness. We’re going to focus on that in this chapter, because knowing what triggers your own depression loop is a powerful first step toward being able to overcome depression. Having awareness gives you space to make choices: instead of responding automatically and without thought, you can make informed, mindful decisions that can protect you from depression and open you up to possibilities you didn’t see before.
FINDING THE FREEDOM IN THE “SPACE”
As you work through the steps in this book, I hope you’ll keep in mind a wonderful quote from Viktor E. Frankl, an Austrian neurologist, psychotherapist, Holocaust survivor, and author of the book Man’s Search for Meaning: “Between stimulus and response there is a space, in that space lies our power to choose our response, in our response lies our growth and our freedom.”
The space between stimulus and response is the space in which automatic, unconscious thinking often takes over. When a stimulus appears, we may initially think we have no choice in how we respond to it. Someone cuts us off in traffic, and we respond with anger. A critical remark from an employer fills us with shame. But even though it may feel as if those responses are inevitable, they are not. There is a space between stimulus and response, and within that space we have the freedom to choose. That philosophy is at the very core of Uncovering Happiness. Start to recognize the space between stimulus and response in your everyday life. Once you become aware of that space, we can use it to make reasoned, conscious choices.
The Truth About Depression
Having a clear understanding of depression, what depression is or isn’t, helps sharpen your ability to recognize it in your own life, acknowledge how it affects you, develop proactive responses to your own personal depressive cues, and lay the groundwork for cultivating a brain with natural antidepressants.
Let’s begin with what depression is.
First and foremost, it is an illness—and like many illnesses, the experience of depression can vary from person to person. Some people have major depression, striking the brain just as an acute case of pneumonia strikes the lungs. People with this kind of depression experience extreme symptoms that can severely curtail their normal everyday functioning for varying amounts of time. Others have less serious symptoms that are more akin to the allergies that may last for weeks, months, or years, interfering with their happiness but not necessarily preventing them from living a functional life.
Because depression is not talked about openly, many people are ignorant about it. People sometimes think that depression is made up, a kind of chosen laziness, lack of self-discipline, or character flaw. But they’re wrong. Thanks to advances in brain imaging, we know that the brains of people who have depression actually look different on scans than the brains of those who don’t, just as the lungs of people with pneumonia look different on scans than those of people with healthy lungs.
Depression causes a range of symptoms that interfere with daily life, happiness, and the ability to sleep, work, eat, make decisions, socialize, and enjoy pleasurable activities. It is so prevalent that nearly 7 percent of adults in the United States will face an episode of major depression this year. Millions more will experience a sense of chronic unhappiness.
There is no one cause for depression. It can be the result of someone’s genetics, difficult experiences early in life, or both. Episodes of depression can be triggered by outside events and situations such as a physical or emotional trauma, the loss of a loved one, an accident, a natural disaster, a change of seasons, hormonal changes, pregnancy or childbirth, stress, relationship problems, unemployment, and a host of other causes. Or they can have no visible trigger at all.
Like most other illnesses, depression can be treated successfully in a variety of ways, including medication and several kinds of therapy. Even the most severe cases of depression can improve with and at times be prevented by treatment.
Now let’s consider what depression is not.
The biggest, most important thing that depression is not is your fault. Depression occurs as a result of a combination of genetic, biological, environmental, and psychological factors. People don’t choose to have depression, and it’s not something they can just snap out of when someone tells them to cheer up.
Depression is not who you are—it involves a conditioned habit that your brain has learned, and that your brain can unlearn. A habit is a routine of some process that we learn and that after being repeated tends to occur subconsciously. Even in someone who is genetically predisposed to depression, the habit is how the brain reacts to the relapse signs when they arise that fuels the downward spiral. After even a single depressive event, all your brain needs is a cue and a conditioned combination of thoughts, emotions, and sensations arise and go to work beneath your conscious awareness. The brain perceives this as a threat and then begins to engage in common behaviors that can be used to avoid this discomfort. Maybe you tend to overeat, isolate from friends, become a couch potato, or procrastinate. Like any habit, the result of these behaviors is predictable, bringing up self-loathing, hopelessness, anger, or sadness, and keeps you stuck deeper in the conditioned reaction that I call the “depressive loop.” But one of the biggest errors we make is identifying with this depressive loop as if this is who we are.
You are not your depression.
As this depressive habit loop unfolds in your life, the brain eventually creates a story with you as the main character as a depressive person. If you’ve struggled with this throughout life, family and friends have likely reinforced this identity, calling you a “depressed person.” When something is part of who you are, it becomes fixed, unchanging, and a draw for feeling deficient or defective. But when we truly investigate depression, even chronic unhappiness, it’s just a passing, fluctuating pattern of thoughts, emotions, and sensations that comes and goes like all other things. It’s not fixed at all, and clinging to this identity can be a source of deep shame and sorrow that repeatedly cues chronic unhappiness or more acute episodes. But it doesn’t have to stay this way. For the past fifteen years, scientists have discovered the dynamic nature of our brains and how we can create new neural connections throughout the life span.
At the moment it may be difficult, but for now, see if you can begin holding any story that states “I am a depressed person” lightly. As you do, you may come to understand that the all-too-familiar feeling that “something is wrong with me” is not something to be ashamed of, any more than having pneumonia or allergies is something to be ashamed of. You don’t choose depression—it chooses you.
Depression occurs in all types of people. Although women are 70 percent more likely than men to become depressed at some point in their lives, millions of men develop it as well. But many try to keep it a secret because men are taught from a young age that you need to be “strong” and that depression is a source of shame, implying “weakness.” From an evolutionary perspective, if you’re weak, the clan doesn’t value you, you’re not a desirable mate, and you don’t belong. If you’re cast out of the clan, your life is at risk. The brain of the modern-day man doesn’t see it much differently. Hiding depression only keeps us identified with it and doesn’t let it do what it’s meant to do: come and go. An increasing number of men understand this better and are speaking up about it and seeking support. On the other hand, many kids can’t hide it, as depression comes out as anger, irritability, and willfulness.
Depression is not always obvious. The shame associated with depression leads people to often hide their illness from friends, family, and even their doctors. So if you’re walking around thinking that you’re the only one you know who’s struggling with this illness, chances are pretty good that you’re wrong. You may very well have friends, neighbors, coworkers, and family members who are depressed. They hide it from you just as you may hide yours from them.
SIGNS AND SYMPTOMS OF DEPRESSION
• Persistent sad, anxious, or “empty” feelings
• Feelings of hopelessness or pessimism
• Feelings of guilt, worthlessness, or helplessness
• Irritability, restlessness
• Loss of interest in activities or hobbies once pleasurable, including sex
• Fatigue and decreased energy
• Difficulty concentrating, remembering details, and making decisions
• Insomnia, early-morning wakefulness, or excessive sleeping
• Overeating or appetite loss
• Thoughts of suicide, suicide attempts
• Aches or pains, headaches, cramps, or digestive problems that do not ease with treatment
Source: US National Institute of Mental Health
Depression as a Side Effect
Depression can sometimes be caused by medical conditions such as thyroid disease, cardiovascular disease, diabetes, and brain disorders. It can also be brought on by medications: dozens of drug classes list depression as a possible side effect, including (but not limited to) calcium channel blockers, beta-blockers, benzodiazepines, statins, painkillers, cancer treatments, therapeutic hormones, and birth control.
People don’t choose to have depression, and it’s not something they can just snap out of when someone tells them to cheer up.
The Depression Loop
I’ve found during my work with depression that it’s helpful to envision it as a kind of circular process: an automatic loop rather than a linear set of events. Clients find it useful to think of it as a cycle, a spiral, or even a traffic circle. However you picture it, understanding the circular nature of events that lead to or keep depression alive is an important step toward recognizing how it can pull you into its sphere of influence.
For now, let’s use the image of a traffic circle to explain how the depression loop works. If you live someplace where there are lots of traffic circles or if you have ever driven on one, you know how confusing and maddening they can be.
You’re driving on a straight road, minding your own business, maybe humming along with a song on the radio, and suddenly a traffic circle looms ahead. It just kind of appears on the street ahead of you. Your mind instantly starts anticipating entering the circle, how the cars may stream in, and how you’re going to exit. A feeling of fear or anxiety arises; your hands start to sweat and grip the steering wheel. As you enter, you search for a sign for a way out, and halfway through the circle you realize that you have to switch lanes to jockey for position so you’re ready for your exit. Meanwhile, you drive by other entrance points that each admit streams of new cars into the circle. You see your exit, but you realize that you either have to speed up or slow down. If you miss your exit—which is so easy to do—you have no choice but to loop around again hoping that next time you’ll make your way out.
Falling into the depression loop is a lot like entering a traffic circle. You’re living your life, feeling fine, minding your own business, and all of a sudden you find depression looming. Maybe it’s just a feeling you wake up with, a moment when you suddenly fall prey to a shaming inner critic that says something like “there’s something wrong with me/you,” or a response to hearing some negative news. Once you’re in it, you try valiantly to get out. But it’s so easy to get stuck.
Just as various roads lead you into a traffic circle, the depression loop has four entrance points: thoughts, feelings, sensations, and behaviors. Any one of these can lead you into the depression loop. Once you’re caught inside the loop, your mind goes around and around struggling to get out. Streams of thoughts enter the loop as your brain struggles to figure out “What’s wrong with me?” As one of my students says, “The bloodhound is sniffing around for the villain (and much analysis is required).” The brain anxiously defaults to reaching back into the past, referencing and rehashing negative events to try to figure it out. Simultaneously, the brain jumps into the future, planning, rehearsing, and anticipating some upcoming hopeless catastrophe. As all this happens, the brain pours stress into an already stressful situation.
You may see an exit, but as you try to leave the loop, you find yourself blocked by more depressive thoughts, feelings, sensations, and behaviors. Before you know it, the traffic gets even heavier with the addition of streams of fear and anxiety when you begin to perceive that you’re becoming trapped in the self-perpetuating depression loop. You’re desperate for escape, but, sideswiped by fear and negativity, you become so overwhelmed that you just keep going around and around and around. Soon a sense of learned helplessness sets in: you can no longer even see the exit, so you stop trying to break free and begin to believe you may never escape.
This was a common occurrence for one of my patients, thirty-year-old Sandy, who had experienced bouts of depression her whole life. Typically she would feel fine for a while, but then at times, seemingly out of nowhere, she would become depressed. Sandy would lose interest in activities she usually enjoyed and have trouble finding the motivation she needed for everyday tasks. Feelings such as unworthiness and guilt would begin to flood her mind, and in response, she tended to isolate herself from her family and friends and make choices that fueled her depression rather than pull her out of it.
Sandy experienced depression as a persistently reinforcing loop that dragged her down. Negative thoughts would trigger troubling feelings (or vice versa) that in a short time would turn into an ever-present depressed mood state. This would make it tough for Sandy to get out of bed in the morning. Doing the activities she usually enjoyed felt nearly impossible, and instead of partaking in life, Sandy would often end up sitting in her apartment feeling terrible about herself, eating too much, drinking too much, and sinking deeper and deeper into a morass of gloom.
Your Changing Brain
Sandy didn’t know this, but each time she experienced a bout of depression and got lost in the depression loop, her brain actually changed. When we practice anything in life over and over again, it starts to become automatic; in psychology, we call that a conditioned habitual reaction, and in neuroscience, it’s called experience-dependent neuroplasticity. Right now eighty billion to one hundred billion nerve cells, or neurons, are interacting with what some have said are one trillion connections, called synapses, in an unimaginably fast and dynamic network. When we do something over and over—whether it’s something we’re trying to learn, such as improving our tennis swing; or something we’d rather not learn, like an anxiety response to dogs after being bitten by one—neurons in our brains fire together. As we repeat these actions, they eventually wire together, making the process an unconscious habit. This is called top-down processing. It is the brain’s process of drawing from our implicit memories to make sense of the present moment, and it’s how the neuroscience of decision making works.
Do you have to think about how to pick up the spoon to eat your morning breakfast cereal, or how to step on the accelerator or brake when driving your car? No, and you can thank top-down processing for that: your brain directs you to do these things automatically. Top-down processing comes in handy when the habit is something positive or neutral. But the brain also has the ability to make decisions beneath our conscious awareness that keep us stuck in the depression loop.
A good way to understand how top-down processing plays a part in depression is to think about its connection to trauma. A trauma reaction is so shocking to the nervous system that it instantly wires the brain to be highly sensitive to any signs of it coming again. The trauma of being bitten by a dog, for example, is enough to create a neural bridge between all of the thoughts, emotions, sensations, and behavior associated with the dog bite. After experiencing the trauma of being attacked by a loose German shepherd, simply walking by a leashed Chihuahua can cue the snap judgment of insecurity and the emotion of fear even though the Chihuahua presents no actual danger. This causes the stress hormone cortisol to flood the brain, cutting off access to the part of the brain that recognizes the context of the situation: that the Chihuahua is harmless and really not a threat. Instead, the cortisol launches you into a fight, flee, or freeze response governed by fear and irrationality rather than by reason and judgment. You fear the Chihuahua because of your own automatic emotional and physical responses, not because any real danger exists.
This played out in a less dramatic but equally troublesome way for my client Sandy. One day when she came in to see me looking particularly distressed, she told me that she received an email that a client of hers was angry with her work. In exploring it together, we realized that this kind of cue triggered worries about losing that client, increasing her anxiety, and making her heart race and her breathing to become shallow. Her mind spiraled with negative hopeless thoughts about the future of her business, and she began to avoid doing her work. Sandy knew she was getting depressed, and this spiraled more fear. Her response prevented her from dealing with the client’s email in a logical, objective way.
Sandy was ready to start breaking this cycle when she finally recognized her depressive loop for what it really was: a deeply conditioned habit (or trauma reaction). In fact, just understanding the concept of the depression loop was enough for Sandy to start effecting a change in her relationship to depression. She was able to see it in action in her daily life and name it. The moment she saw it occurring, she was able to stand apart from it in a space of awareness that was separate from the loop itself and to gain perspective—as did Clint, the client I described in the beginning of this chapter. She no longer felt that she was the loop—rather, she was the aware person viewing the loop. In this space, she found a sense of freedom and a “choice point,” a moment in time when she was aware enough to choose a healthier response.
The first step in uncovering happiness and experiencing freedom from the depression loop is learning how to objectively see this loop in action instead of getting lost in it. The moment we notice the depression loop in action is a moment we’ve stepped outside of it, into a space of perspective and choice. The beauty is that science is now showing us that through intentional repetition and action, we can change our brains for the better. This is what psychiatrist and researcher Jeffrey Schwartz, of the University of California, Los Angeles, School of Medicine, has coined self-directed neuroplasticity. It may seem impossible, but it’s not. You’ll soon see that you can turn the volume down on the fear that keeps it going and catch the signs that cue the habit in the first place.
The moment you notice the depression loop in action is the moment you’re able to step outside of it, into a space of perspective and choice.
Learning to Be Helpless
As I mentioned in the introduction, something called learned helplessness plays a significant role in the depression loop. Before we go any further, I want to tell you more about what learned helplessness is and the hold it very likely has on you.
Once again, learned helplessness is a mental state when our minds decide that we don’t have control over problematic situations—even if we actually do have some control. Being depressed induces a sense of learned helplessness that blinds us to our choices and discourages us from trying to help ourselves even when we have the capacity to make things better.
We first became aware of learned helplessness in the late 1960s, when University of Pennsylvania psychologist Martin Seligman and his colleague Steve Maier designed a study to determine what would happen when someone experienced pain repeatedly without any way out. Would he learn to feel helpless and hopeless?
Seligman used thirty dogs in his now-famous study. He randomly divided them into three groups: The dogs in group one were put into harnesses for a short period of time and then released. The dogs in group two were put into harnesses and then received mild electrical shocks that they could stop by pressing on a panel with their snouts. The dogs in group three were put in harnesses and shocked, but they had no control over the shocks and could not stop them. (This kind of research sounds cruel to us today, but fifty years ago, there were different opinions about the treatment of laboratory animals.)
The dogs in group three learned that no matter what actions they took, there was nothing they could do to stop from being shocked.
Seligman wondered what effect a traumatic experience like this would have on the dogs’ ability to learn to avoid future suffering. To figure this out, he placed the dogs inside a kind of “shuttle box” like the one you see on the next page, with electrical grids for a floor and a short partition separating it into two spaces. A light would come on shortly before the shock to alert the dogs of the impending electrical current. After a little while, the group two dogs learned that they could escape the shock by jumping over the partition when the light came on. But the group three dogs, who had learned to be helpless, just laid there stoic, immobilized, not expending any energy to leave. Their past experience of not being able to relieve their suffering interfered with their ability to learn to relieve future suffering. This was the first time researchers had shown that having experienced helplessness in the past can interfere with the ability to learn to escape future relapses.
Years later, researchers conducted similar studies with people in which they used brain imaging technology to show what happens in the brain in situations like this. They found that the areas of the brain involved in helping a person make clear decisions and feel motivated to follow through are distressed. Even though people who are depressed would love nothing more than to help themselves feel better, their brains become habituated to thinking there is no way out.
When people see someone who is depressed, they don’t think of learned helplessness; they often think it’s just an issue of laziness, or a lack of motivation or willpower. Unenlightened people believe that if someone with depression simply exerted more effort, he or she would get better. But that’s not how it is. This depression myth couldn’t be more wrong.
Like the dogs in the shuttle box, how can we learn to see “the light,” or signs of relapse that come in order to learn to escape the shock of depression? How can we resolve the longstanding insecurities, unresolved traumas, or limiting core beliefs that continue to keep us stuck?
Another interesting example of this is a study performed in 2011 by researchers at a small lab at the University of Colorado Boulder. They split rats into three groups; mild shocks were administered to the tails of the rats in group two and group three, while group one received no shocks. Group two had control over escaping the shocks, whereas group three did not. When the researchers studied the rats’ brains, they discovered that the rats in group two showed neuron growth in a part of the brain known as the prefrontal cortex. (See next page.) Not only did those rats escape the shocks, but their brains actually changed in reaction to the experience.
This research contributed to a growing awareness of the fact that the brain has the ability to break out of the trap of learned helplessness. Like the animals in these studies, we can discover how to escape the “shocks” of depression. As we do so, we cultivate an antidepressant brain by bolstering activity in the prefrontal cortex and slowing down the action in the amygdala.
Thanks to research on learned helplessness, we have better insights and tools for breaking free from depression.
The brain is an amazingly complicated organ. You don’t have to know all its ins and outs in order to uncover happiness, but it helps to know the names of a few of the most important brain structures related to depression:
• The amygdala (a-mig-da-la) is an almond-shaped structure in the center of the brain that regulates memory and emotional reactions. The amygdala processes and interprets information gathered by the five senses and then tells the body how to react. It has been coined the “fear circuit” for its pivotal role in our fear reactions. It is often enlarged in a depressed brain, suggesting that we may be more sensitive to fearful cues.
• The prefrontal cortex (PFC) is located in the front of the brain, just behind the forehead. It’s the executive function center of the brain, which is responsible for complex cognitive behavior such as abstract thinking, analyzing thoughts, decision making, rational perspective, and predicting outcomes of choices. It’s the most evolved area of the brain. Your PFC lights up when you’re engaging in rational and deliberate decision making. It manages your goals and the appropriate responses to achieve them. A depressed brain will often show a general reduction in PFC activity, but with heightened activity in the right prefrontal cortex (known for more negative emotions) and less activity in the left prefrontal cortex, which lights up with positive emotions.
• The hippocampus, located right next to the amygdala, is involved in learning, memory, and context. It draws on memories to help us gain perspective and make conscious choices. When the amygdala perceives danger, it cuts off access to the hippocampus. After all, there is no need to learn in that moment, because it’s time to fight, flee, or freeze, not to stand still and draw inferences. This is what makes it difficult to learn new ways of coping in the midst of depression. The hippocampus is also negatively impacted by repeated surges of cortisol, flooding the brain in response to states of fear, which ambush us often during the depression loop. This may be why in a depressed brain, the hippocampus is often smaller in size.
Escaping the Loop
Thoughts, emotions, sensations, and behavior. When it comes to depression, these four elements feed off one another to create a depressive feedback loop. While nobody knows what causes depression, we do know that as this feedback loop repeats over time, it becomes a conditioned habit, so that a single stimulus—perhaps a negative thought, or feeling sad or physically tired—can trigger the looping.
But here’s the upside to all this: just as the brain can be conditioned into making the depression loop an ingrained habit, it can also be conditioned away from it. You truly can rewire your brain so that you don’t automatically fall into depression whenever certain thoughts, emotions, sensations, or behaviors occur. Having had depression in the past doesn’t mean that it’s your fate to be in its grip the rest of your life. Understanding how the depressive loop works is the first step to stepping outside of it, gaining perspective, and dropping into a space of choice, possibility, and freedom. When you’re driving down a road and see a traffic circle looming, you don’t have to enter it. You can veer onto a different road.
This isn’t easy, but it’s possible—and the more you practice it, the better you’ll get at not only pulling yourself out of the loop but also preventing yourself from entering it in the first place.
Depression cues have a range of possible triggers. Some are obvious: major negative life events such as the death of a loved one, health problems, caring for an aging parent, losing a job, the end of a relationship, or financial difficulties. Some are more subtle, such as rejection by a friend, a missed career opportunity, or discovering a family member’s disloyalty. Depression cues can be linked to the calendar, and can be set off by changes of season, birthdays, holidays, and anniversaries of losses or traumatic events. Paradoxically, even seemingly positive, happy events—buying a new house, landing a new job, getting married, celebrating a wedding anniversary, going on vacation, becoming a parent, or achieving a long-anticipated dream—can trigger depression cues. Our own individual personalities, histories, life events, and brain chemistry influence what our depression cues are and how they are activated.
Depression often starts with a cue, or trigger: an initial sense of unease that can be brought on by a subconscious thought, memory, physical feeling, emotion, or some external life event. It can be something as mild as a friend’s disapproving expression or as severe as the loss of a job or loved one. The cue is usually followed by:
• Thoughts: After the cue, the mind starts to think, and the stories begin. The brain anxiously defaults to reaching back into the past, referencing and rehashing negative events to try to give the cue meaning and context. Simultaneously, the brain jumps into future planning, rehearsing and anticipating all kinds of possible catastrophes that could result from the cue. As it does this, more stress pours into an already stressful situation.
• Emotions: The blues or anxiety set in (or set in deeper). As they do, new thoughts continue to flow as you say to yourself, “Why am I getting depressed?” or “What did I do wrong?” or “This always happens to me,” or “I’m hopeless.” This habitual looping can happen instantaneously and last for days. The more you identify with the narrative, the deeper the spiral of anxiety and depression goes.
• Sensations: As thoughts and emotions darken, physical sensations and symptoms such as heaviness, fatigue, insomnia, and appetite change set in.
• Behavior: Negative thoughts, difficult emotions, and uncomfortable sensations skew your perception and influence your ability to make healthy choices about behavior. This in turn can lead to even more negative thoughts, difficult emotions, and uncomfortable sensations.
What Are Your Depression Cues?
The first step to stopping the cycle of depression is recognizing your own depression cues and triggers. It’s good to think about this when you’re feeling better—when you’re not trapped in the depression loop—because it’s easier to be objective and have perspective. If you keep a journal, you may be able to discern your depression cues by rereading sections you wrote before or during periods of depression.
When you identify your depression cues, put them down on paper and reflect on them. By doing so, you stamp them into your short-term memory and increase your chances of recognizing them in action when you’re at the cusp of becoming depressed. Being aware of your own cues and triggers makes it more likely that you’ll notice when you’re about to be pulled into a depression loop.
When you have a better idea of what your personal cues are, you can become aware of them while they’re happening and use them as a depression barometer.
Look back into your past and ask yourself what some of the stimulus points for depression may be for you. Was there a certain event that set it off? If not, can you think of specific thoughts, feelings, sensations, and behaviors that have led you into a depression loop?
When I work with groups of clients or students, we do a brainstorming exercise that helps everyone identify his or her depression cues. Standing in front of a group of people who experience all levels of depression—from chronic low levels of unhappiness. to occasional bouts of moodiness to repeated episodes of major depression—I ask, “What are your depression cues? How do you know that depression is coming on?” For a moment, it’s quiet, and then some murmurs begin as one person says something like, “I sleep too much.” Another says, “I notice my thoughts become a lot more negative.” Another says, “I start isolating from friends and family.” As they continue speaking, I write everything down on the whiteboard. This brings an awareness of the many kinds of cues that might ignite depression. Equally importantly, it calls attention to the fact that no one is alone in this, and that although our cues may be very different, we all share this deeply human experience.
At first it may feel uncomfortable for you to identify and write down your depression cues, because it forces you to confront them face-to-face. But try to think of it this way: knowing them will help you protect yourself from being sucked into the depression loop in the future.
Here is a list of common depression cues. Use it to help you identify what can trigger your depression.
• “I am fat.”
• “I am stupid.”
• Loss of energy
• Eating a certain food, such as ice cream
• “I’ve messed up again.”
• Feeling heavy
• Talking too much
• “Nobody likes me.”
• Sleeping too much or too little
• “I am unlovable.”
• Feeling wound up or wired
• Drinking too much
• “People are avoiding me.”
• Going on shopping sprees
• “I am a fraud.”
• Blurry thinking
• “I am never going to feel better again.”
• Appetite changes
• Risky sexual behavior
• “I am worthless.”
• Loss of memory
• Avoiding friends and family
• “I make so many mistakes.”
• Body aches
• Not bothering with activities you usually enjoy
• “I am a bad spouse, parent, child, friend, sibling, student, employee,” and so on.
• Not exercising
• “Things are never going to get better.”
• Gastro-intestinal symptoms such as nausea or diarrhea
• Watching too much television
• “I don’t deserve to live.”
• Dry mouth
• Spending too much time at the computer or playing video games
• “Everything is hopeless.”
• Nail biting
• Increased or decreased interest in sex
• Hair pulling
• Trouble seeing or hearing
• Obsessive-compulsive behavior
• Excessive crying
Worksheet: My Personal Depression Cues
Using the chart below, write down the thoughts, emotions, sensations, and behavior cues that sometimes act as depression triggers for you.
Once you’ve drawn up your list of depression cues, make sure you keep a copy where you can refer to it often: in your wallet, on your refrigerator, in your online scheduler, and so on. Start paying attention to yourself and your moods. You may want to check in with yourself a few times a day—stop everything you’re doing, be quiet for a moment, close your eyes, and ask yourself, “Where am I starting this moment from?” Be mindful of what you’re feeling, thinking, sensing, and doing. Go over your list of depression cues. Do you notice any of them occurring now? (As you do this, you may think of other potential depression cues. Keep writing them down; the more you add to your list, the more likely you are to start recognizing them.) If this seems like too much work, then you are welcome to just do a check-in at the end of the day or even the end of the week and see if you noticed any cues. See what feels right for you.
When you give yourself a moment to pause and be aware, you are training your brain to be present and opening up the opportunity to see if any depression cues have been activated. If everything is fine, it can turn into a moment of gratitude, and you can go back to what you were doing. But if you recognize that one of your depression cues has been triggered, you can take action. You can start by acknowledging it and labeling it, and this in and of itself can take the wind out of its sails.
For example, perhaps one of your depression cues is that you start to engage in more frequent and intense thoughtless overeating. Or it may even be more specific: thoughtless overeating of chocolate-chip ice cream. When you take a mindful pause and check in with yourself, you may identify the fact that there has been an increased craving lately for chocolate-chip ice cream. When you recognize this increase, you can acknowledge that a potential depression cue has been activated. When this happens, I want you to label it: tell yourself, “My chocolate-chip-ice-cream depression cue has been triggered. I could be on the verge of entering a depression loop.”
Now, the fact that you recognize an increased craving for chocolate-chip ice cream may not mean that you’re about to experience a major bout of depression. The cue could, in fact, be completely benign and mean nothing more than that you just feel like having your favorite ice cream. But if you decide to indulge in a scoop or two, it becomes a mindful choice instead of a mindless habit.
You’ll learn over time that sometimes your cue is a false alarm—as the joke about Sigmund Freud goes, sometimes a cigar is just a cigar. But sometimes your chocolate-chip-ice-cream cue really will be the sign that you’re starting to enter a depressive loop. And if it is, you can take action to protect yourself.
In the next chapter, I’ll describe some of the specific actions you can take in response to the triggering of a depression cue. For now, let’s focus a little more on why understanding the depression loop and recognizing and labeling your depression cues is such an important first step.
Once you’re aware that one of your depression cues has been signaled, you can learn to objectively see this loop in action instead of getting lost in it. It may seem impossible, but it’s not. You’ll soon see that you can turn down the volume on the fear that keeps the loop going and catch the signs that cue the habit in the first place.
Name Them to Tame Them
Labeling a depression cue—literally saying its name out loud or writing it down in a journal—is incredibly valuable. Giving it a name can actually take away some of its power and can reduce your chances of falling into a depression loop.
We know this because of some fascinating research by psychologist Matthew Lieberman and his colleagues at the UCLA Social Cognitive Neuroscience Laboratory. They found that the simple process of putting feelings into words—referred to by psychologists as affect labeling—can help people do a better job of managing those feelings.
Lieberman and his collaborators showed this in a kind of creepy study—creepy if you don’t like spiders, that is. They found that spiderphobic people who label and express their fears about a nearby spider actually reduce their fears and are able to get closer to a spider than are spiderphobes who see a spider but don’t label and express their fears. Simply by acknowledging and labeling their fears and putting them into words reduced the distress felt by the spiderphobic volunteers.
Why does acknowledging and labeling feelings help diffuse their power? Lieberman and his colleagues answered this question by conducting studies on subjects while their brains were being scanned by functional magnetic resonance imaging (fMRI). The fMRI machine shows us where the blood is flowing in the brain, which is a direct connection to the brain’s activity. They found that labeling feelings actually activates a specific region in the prefrontal cortex, which is less active in depressed people, and reduces the activity in the amygdala, which is more active in depressed people. “If the amygdala is like an alarm clock alerting us to potential threats, putting feelings into words is like hitting the snooze button,” Lieberman wrote in an article about his work in the New York Times. “The end result is being less distressed in the face of something we fear . . . and less stressed over the long term, which can contribute to better physical health.”
When a depression cue is triggered, we begin to feel fear and anxiety as the amygdala heats up. But we want to cool it down by releasing our fears. Recognizing, acknowledging, and labeling a depression cue—and actively understanding that a depression cue can push us into a depression loop—can interrupt fear, cool down the amygdala, and bring the brain back in balance.
As you practice and repeat this, you literally begin to change your neurological wiring and cultivate an antidepressant brain by creating more activity in the prefrontal cortex and less activity in the amygdala.
Here’s an interesting psychological fact: when people see a picture of an angry face, their amygdala becomes more active. That’s because the amygdala’s job is to interpret the data we gather through our senses. Seeing an angry face sets off an alarm of sorts in the amygdala, which activates a series of physiological responses in the body (known as the fight, flee, or freeze response) that is designed to help us protect ourselves from danger. However, Lieberman and his colleagues discovered that when subjects see a picture of an angry face and give it a name—anger—brain activity shifts from the amygdala to the prefrontal cortex, which is responsible for analyzing data and making decisions based on that analysis. This is a very simple explanation of Lieberman’s work, but it helps explain why it is so useful for people who are prone to depression to use words to label their feelings. Doing so shifts the brain’s focus from an emotional reaction driven by fear to a balanced reaction with greater perspective.
As my good friend Dr. Dan Siegel, a psychiatrist at the UCLA School of Medicine says, when it comes to feelings, if you can name them, you can tame them.
We’ll talk more about this later. For now, the most important takeaway is that you can begin to make real progress in breaking the depression loop by taking the following steps:
• make a list of your common depression cues;
• take breaks to pause throughout the day, or at the end of the day, to check in with your thoughts, feelings, sensations, and behaviors;
• recognize and acknowledge whether any of your depression cues have been triggered;
• label the cue and put into words the possibility that you may be entering a depression loop; and
• recognize that as soon as you notice the loop occurring, you are in a space of awareness—a choice point—where you can begin to take action.
You can’t prevent yourself from ever falling into a depression loop, especially if you’ve experienced depression in the past. But you can devise a custom-tailored plan and get better and better at putting it into action as soon as you notice your depression cues.
Table of Contents
Part 1 "A Naturally Antidepressant Brain 1
Step 1 Understand the Depression Loop 3
Step 2 Reverse Bad Habits 32
Part 2 The Five Natural Antidepressants 63
Step 3 Change the Brain Through Mindfulness 65
Step 4 Nurture Self-Compassion and Its Wonderful Side Effects 87
Step 5 Live with Purpose-Know Why You Matter and What You Can Do About It 123
Step 6 Go Out and Play-Rediscovering the Joy of Life 145
Step 7 Learn to Get Better and Better 166
Part 3 The Natural Antidepressant Tool Kit 199
Uncovering Happiness 203
Five Strategies to Stick to Healthy Habits 217
Three Yoga Poses for Depression 220
Five Steps to a Growth Mindset 225
Twenty-One Days of Purpose 227
Strengthen Your Natural Antidepressants: Longer Practices 230
Uncovering Happiness: The Recap 245
Uncovering Happiness: The Discussion Guide 252
Find Out More 257