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Depression is defined by bleak mood, lowered energy, reduced ability to feel pleasure, guilty or self-hating feelings, difficulty making decisions, sleep and appetite changes, crying spells, and hopelessness. It is frequently accompanied by suicidal urges or behavior. The pharmacological treatment of depression is increasingly familiar, with antidepressant commercials widespread. On this page I want to mention some nonpharmacological strategies. Nonpharmacological Strategies for Depression 1. Cognitive restructuring, or revision of thought patterns. I believe that there is one central "depressogenic" idea: "Things are bad, and there is nothing I can do about it." A paraphrase of this idea is that "Nothing that I do makes any difference." Anything that one can do to undermine this belief will usually improve depression. Even the belief that "Things are very bad, but my choices make at least some difference in how things eventually turn out," can get one out of the "given up" state that characterizes depression. Thus the thought pattern, "What are my options? Which one will work the best?" tends to be an antidepressant. Click here for more on cognitive restructuring and cognitive therapy. 2. Activity. The most severely depressed people spend most of their time in bed. It's hard to discover an activity that is rewarding or pleasant if there is no activity. Thus most cognitive-behavioral programs for depression attempt to persuade people to schedule activities for themselves and carry them out. And if any of these activities give a sense of usefulness or pleasure, it's important to notice these payoffs. 3. Contingent Reinforcement. Contingent reinforcement means that you are in a situation where you get rewarded for some behavior, but you don't get rewarded for other behavior. Thus it makes a difference what you do. Getting people out of environments where what they do doesn't matter, and into environments where their effort brings them rewards, can be a powerful antidepressant. For example, suppose that a child is in a classroom where the reading the child has to do is hopelessly over his head. Whether the child works hard or does not work hard, it is clear that he will get failing grades. The child is glum and demoralized. Suddenly the child is moved to a learning situation where the material is at just the right level of difficulty. If the child expends enough effort, he can get right answers on at least 80% of the challenges he is given. The child begins to smile, laugh, converse, and look happy. The child has gone from noncontingent punishment to contingent reinforcement. 4. Exercise. Throughout most of the centuries of human existence, people have been "hunter-gatherers." Most days consisted of roaming around scrounging up food. The "desk job" and the day consisting largely of sitting is a very recent invention in human culture. Perhaps because the human body was not built for inactivity, exercise seems to help in many ways. More and more evidence points to the positive effects of exercise on psychological variables. A recent study found aerobic exercise to be an antidepressant, and one that was in some ways superior to a pharmacological antidepressant. 5. Consistent circadian rhythms. Circadian rhythms are the daily rhythms of temperature, hormone secretion, activity levels, and sleep and wakefulness that play a large role in how we feel. Jet lag is the set of unpleasant side effects of jumbled-up circadian rhythms, and some of the effects of jet lag can resemble depression. Conversely, keeping your circadian rhythms regular and consistent can be an antidepressant. How does one keep circadian rhythms consistent? There are four main influences upon circadian rhythms; you try to keep these recurring at the same time each day. These are: 5.1 going to bed and getting out of bed, 5.2 exposure to bright light, 5.3 exercise, 5.4 and food intake. Suppose you want to move your circadian rhythm earlier, so that you go to bed earlier and get up earlier. As soon as possible after awakening, you would get some food, exercise, and bright light. Doing these things in the morning signal the body that the "subjective day" has clearly begun. And of course you would get out of bed earlier and try to go to bed earlier. On the other hand, if you wanted to move your circadian rhythm later, you would try to get food, exercise, and bright light in the evening, to signal to your body that the "subjective day" has not ended. To keep your circadian rhythm consistent and regular, you do these four things according to a regular schedule, day after day. 6. Bright light. Bright light can be a powerful antidepressant, particularly for those people who have Seasonal Affective Disorder, i.e. the tendency to get depressed in the winter. It is now well known that "winter blues" are caused by the decreased light in the winter months, and that depressions can be lifted by supplying artificial bright light. In addition, at least one study has found bright light helpful for garden-variety, nonseasonal depression. Here are some links to sellers of bright lights constructed to be effective against depression and not harmful to the eyes. Northern Lighting Technologies
7. Nice people, good relationships. A variety of studies have found negative effects of living with or being in important relationships with people who are very critical, disapproving, insulting, and verbally abusive. This finding is really a special case of what was mentioned previously about noncontingent punishment versus contingent reinforcement. Some people are ready to approve when you do good things; others tend to dish out punishing verbalizations almost no matter what you do. The more you can get into relationships with the approving, contingently reinforcing types, the happier and less depressed you're likely to be.
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