Depression

Safety

If you are in immediate danger, call 911 immediately. 

If you are having thoughts of wanting to hurt yourself or kill yourself reach out for support immediately. The following resources can provide immediate support and resources:

Suicide Prevention Lifeline: 988 (Text Available)

Trevor Project - 24/7 LGBTQIA+ Support: 1-866-7386 (Text “start” to 678-678)

Trans Lifeline: 1-877-565-8860

RAINN - National Sexual Assault Hotline: 1-800-656-4673

Crisis Text Line: 741-741 

Making a safety plan 

Your safety plan is meant to help you feel less distressed so that you can cope with the situation. Your safety plan is not meant to solve the problem you are dealing with. It is meant to keep you safe so that you can be better able to solve your problem. It is meant to keep you safe so that you can begin to comfortably express your feelings. In the long-term, expressing your emotions will help relieve the pressure that has been causing suicidal thoughts. Make sure to set up your safety plan before you’re in a distressing situation, so that you don’t have to think about it in the moment. You can just follow your plan! 

Identify warning signs

What are the situations that typically make you upset? When do you notice your thoughts of self-harm or suicide increase? What experiences are most distressing to you? When is it hardest for you to distract yourself and cope to feel better? Everyone’s warning signs are different. They could be anything – driving, spending the holidays with family, seeing an ex-partner, being at school, etc. Knowing which situations are hardest for you lets you ANTICIPATE the thoughts so that you can better use all your resources to support yourself! 

Identify your favorite ways to cope

After experimenting with different distractions and ways of supporting yourself, identify what coping skills are the most effective for you. Identify a few that you can you can use when you’re having thoughts of wanting to hurt yourself or kill yourself. Remember, that coping skills take a bit more time and energy to work when we are more and more distressed. So be sure to give yourself enough time to try all your coping skills fully. 

Identify people and activities that are positive distractions 

Distraction is a great tool for us when we are feeling distressed. Spending time with people we like or doing things we like can help to distract our mind from thoughts of self-harm and suicide. Distraction can also help change our mood because we’re now doing things we enjoy! Even if being around people you like or doing activities you enjoy doesn’t change your mood, it can be very helpful in giving your thoughts the time they need to become less intense. 

Identify family and friends who can help 

Connecting with others is a powerful tool that can help you feel safe. Think of anybody you can share with. Letting them know what you are experience or feeling will help to relieve some of the pressure that has been building up for you. Letting others know about your safety plan will also make your safety plan more successful because you’ll have help using it. Over time, you’ll find that as you share with others about your experience and your feelings, self-harm and suicidal thoughts will reduce too. 

Know your professional supports 

It is always recommended to talk to a professional about your self-harm or suicidal thoughts. Those thoughts are very common, and there are trained professionals ready to help you. You are not too much. You are not a burden. The resources listed above, as well as your therapist, would love to support you. 

Making your environment safe for you 

We want to make sure your environment is as safe as possible for you. That way, if you go through your whole safety plan, it is still as hard as possible for your to hurt yourself or kill yourself. Keeping your environment safe helps delay and danger that could be coming your way. So think of anything that could be dangerous to you in the future – knives, medication razors, rope, guns, other weapons, etc. And remove them from the home, have them locked away safely, or ask a trusted person to hold onto those things for you. This is meant to be inconvenient to you. The inconvenience is what helps keep you safe.

What does it mean that I have thoughts of killing myself? 

Experiencing thoughts of death are very common. The most common thoughts are usually questions and wishes. What if I wasn’t around anymore? I wish I could get away. Would it be better if I were dead? What if I were dead? I wish I could start over. 

It’s very common for those thoughts to become more active and intentional. I want to hurt myself. I want to die. I want to kill myself. I am going to kill myself. It is very important to reach out for support immediately when having active thoughts of death. 

We can actually use thoughts of death as a very important tool, though! Remember that in depression, all our emotions are blocked behind a giant dam. That dam is to keep the painful emotions from flooding and overwhelming us. Eventually, though, water leaks out of the dam. No matter what. This helps release some of the pressure. Thoughts of death are an example of the water trying to escape from behind the dam. 

That means it’s possible for us to recognize thoughts of death as our emotions needing to be expressed. By recognizing that we’re feeling overwhelmed by our emotions we can attend to those emotions. Which, in turn, will reduce our thoughts of suicide. To do that we have some options. We can use our coping skills. We can distract ourselves with enjoyable activities to shift our mood. Or we can make space to feel our feelings. This will naturally relieve the intense pressure our depression has been holding back. Using a combination of all of these options is usually most helpful. But work with a psychologist to make a specific plan that works for you! 

Depressive episodes begin when we build a wall between ourselves and our feelings. Just as a dam holds back the natural flow of the river, the walls we put up block the natural flow of our emotions. Without the natural flow of our emotions, we can become disconnected, numb, and hopeless. The reason we can’t bring down the dam, is the fear that what is behind it will flood and overwhelm us. What’s behind the dam here are painful emotions – sadness, disappointment, hopelessness, worthlessness, and shame. 

 The reason for these big emotions is rooted in our relationships with others. There is usually no single instance that leads to feeling bad about ourselves. Or that make us feel overwhelmed by our emotions. Those experiences are built on years of experience and practice. 

When a child is very young, they learn about themselves by how the world treats them. A child who is invalidated or bullied or harassed or made to feel bad about themselves will learn that there is something wrong with them. There is something bad about them. The voice on their shoulder will be the collection of those people. During those key times, there’s an opportunity to face those emotions (with the help of adults) or avoid those emotions. Depending on which route is taken, that child begins decades of practice processing their emotions or avoiding them. 

Then, everything changes as a teenager. Problems become bigger. Relationships become more important. Whatever foundation was laid as a child is now used for these new challenges. If self-confidence and coping skills are high, then the teenager will navigate middle school and high school as well as any teenager can. Otherwise, new experiences will build upon the foundation built in childhood. Instead of building pride during this key time in life, shame is solidified, and the muscle memory of avoidance will be locked in. This can set the stage for negative experiences to build up behind the dam, until pressure mounts, and water sneaks out in the form of depressive symptoms.  

Activities/Routine/Outside/Eating well/sleep

Emotions are connected to our thoughts, behaviors, and body’s feelings. That means we can change how we feel by changing what we do. This can be hard because depression saps our energy and motivation. If we change our behavior, though, the motivation and energy will return. We just have to put in some energy to start. 

Overall, starting a routine can jump start our mood. Especially if that routine is filled with key pieces needed to take care of yourself.  Improving sleep can feel intimidating. Luckily there are many specific actions you can take to improve your sleep. One change that will help start your routine is waking up at the same time every single day. Even on the weekend. In a few weeks, the body adjusts to waking up at the same time, and will naturally feel sleepy at a time that makes you feel rested by the morning. Similarly, making time for regularly scheduled nutritious meals will increase your energy, mood, and appetite. Usually depression makes it harder to complete typical tasks like cleaning ourself and our space. Taking care of ourselves in these ways will help improve how we feel about ourselves. That will begin to improve our mood as well. 

Lastly, it will be important to schedule fun into your routine! This will feel hard at first because you may not enjoy things like you typically do. However, once you regularly do fun things, the joy will return too! For that reason, you’ll want to take time to consider what you used to enjoy and what new activities you can try too! 

Connection

Depression also disconnects an individual from those around them. Unfortunately, the feeling of disconnection can deepen the experience of depression. Increasing our connections with people can help with depressive symptoms. Importantly, connection is more than spending time with people. Connection is sharing and being vulnerable. Using our emotions to grow closer to another person. We must tap into our emotions to feel connected, which can be hard at first. It’s always helpful to start slow. Find a trusted person in your world. Start by sharing a feeling that you’re comfortable with. Maybe a happy experience you recently had. You can see how they respond and how you feel. If it went well, you can try and different emotion. Something small and comfortable. Maybe a small disappointment or irritation. And you can keep leveling up until you’re able to share more and more of yourself. The sneaky helpful part of this is that you’ll have begun to release the pressure that has been building up behind the dam. As you do this more and more, the water levels will return to normal and your depressive symptoms will decrease. 

Challenging your thoughts 

Challenging our thoughts is a great first step when choosing which coping skill we want to use. Changing our perspective can change the way we feel and it can help us determine whether Problem Solving or Opposite Action might be more helpful for our specific situation. Writing this out (rather than trying to do it in your head) will make this much easier.

Steps for Challenging Thoughts:

1. Identify the situation that is causing us stress.
   • Be as specific as possible about what is bothering you right now. Break a stressful situation down into each of its parts and address each of these separately to keep from feeling overwhelmed.
   • Try to be non-judgmental in your language. The more judgmental we are in describing the situation, the harder it is to evaluate our thoughts.
2. Identify the thoughts that you have about this situation.
   • List the thoughts that are going through your mind automatically during this stressful situation - not just the thoughts you want to be thinking.
   • Try to list your thoughts as sentences, not questions. For example, instead of saying “Why me?” write “This is happening because I was careless.”
3. Identify your emotions when you think these thoughts.
   • Identifying our emotions in the present can be challenging. It may be helpful to practice mindfulness of emotions if this answer is not immediately clear.
   • When identifying our emotions, it is helpful to be as specific as possible. Instead of just naming the emotion as “Anger,” consider more specific words, such as “Irritation,” or “Rage.”
4. Identify your behavior in this situation.
   • Write out what you have already done and what you have a strong urge to do about this situation.
5. Challenge the thoughts.
   • Go back to the thoughts that you identified in Step 2. One at a time, be curious about these thoughts. You might ask some of the following questions:
     • What is the evidence that this thought is true? What is the evidence that this thought is false? (This may show us when we are jumping to conclusions without knowing all the relevant information.)
     • Am I confusing a possible outcome with something that is certainly going to happen? (This may show us when we are assuming the worst-case scenario without considering that outcome may be unlikely to happen.)
     • Is there any additional information that I need to understand this situation?
     • Are there any other ways to see this situation? (Answering this question requires us to be creative, brainstorm ANY other possible explanations for the situation other than the first interpretation we came up with.)
     • What is the source of my information? Is that a reliable source?
6. Come up with a way of thinking that is as realistic and helpful as possible.
   • Sometimes, the way that we were originally viewing a situation is correct  and helping us move towards our goals so no changes need to be made!
   • When we find that we are jumping to conclusions, assuming the worst, leaving out important information, having tunnel-vision, or taking in bad information however, changing that perspective may be best.
   • If you get stuck on this step, take a look at the information below to give you some ideas about what your opposite actions could be.

Example of Challenging Thoughts:

1. Identify the situation that is causing us stress.
   • I spilled my coffee on myself on my way to work.
2. Identify the thoughts that you have about this situation.
   • This whole day is ruined.
3. Identify your emotions when you think these thoughts.
   • Hopelessness, Anger, Sadness
4. Identify your behavior in this situation.
   • Throw the rest of the coffee away, Try to clean up in the restroom at work, Complain to my coworker about my situation
5. Challenge the thoughts.
   • What is the evidence that this thought is true? What is the evidence that this thought is false? 
     I don't have any evidence about what will happen in the rest of the day. I am making an assumption about the future.
   • Am I confusing a possible outcome with something that is certainly going to happen? 
     It's possible the rest of the day will turn out badly, but I don't know that for sure.
   • Is there any additional information that I need to understand this situation? 
     I need to know about the future, and I can't know that until it happens.
   • Are there any other ways to see this situation? 
     I made a mistake, that's pretty normal. I have a spare shirt in the car, so no one needs to know this happened. Whether or not I spill my coffee doesn't affect the rest of the day.
   • What is the source of my information? Is that a reliable source? 
     My thought is coming from my emotions, they are not a reliable source about what may happen in the future.
6. Come up with a way of thinking that is as realistic and helpful as possible.
   • It sucks that I spilled my coffee, but I can still have a good day overall.

Tips for coming up with new ways of thinking:

• When challenging our thoughts it is important that we come up with a new way of thinking that we actually believe! Challenging our thoughts is not about having someone else tell you what to think. It's about you coming up with new ways of thinking that actually make sense to you.
• We don't just want our thoughts to be “positive,” we want them to be realistic. Putting on "rose-colored glasses” might be just as unhelpful as seeing everything as doom-and-gloom.
• Be creative! Creating a new way of seeing a situation might not feel natural at first, but it gets easier to come up with new interpretations with practice.

Treatment of depression at Singh Psychology is understood by looking at our relationships. Our relationship with others, our relationship with ourselves, and our relationship with our emotions. The pattern of our relationships and emotions tells a story that explains why we usually feel depressed.

Emotions hiding under the surface 

Feeling not good enough, or that things will never get better, are common symptoms of depression. Those experiences give us important clues about what emotions we may be hiding. When a person doesn’t feel like things are ever going to get better, they are feeling hopeless. When they think they are not good enough, they are feeling worthless. That feeling is also connected to feeling bad about ourselves. That feeling is shame. 

Feelings of hopelessness, worthlessness, and shame are the most common roots of depression. Importantly, we are not feeling these emotions. If we were able to fully feel these emotions, we would be able to find closure and move forward. Instead, we shut those emotions off like faucets of water. Unfortunately, there is no way to turn off one single emotional faucet. The only way is to turn off the valve that controls all the faucets. So by attempting to turn off shame or worthlessness, we end up turning off our connection to all our emotions. That is the numb and disconnected feeling that depression causes. The way to feel connected is to turn on the faucets to our emotions and let ourselves feel those painful emotions. 

Defenses

Obviously, that sounds like a terrible idea! Feeling pain?? On purpose?? Human beings are specially designed to protect themselves from pain. And people treat emotional pain the same as physical pain. So the idea of emotional pain makes us put up our walls. Imagine a dam. Dams are built for protection and to stop floods. The dam puts up strong walls to make sure nothing breaks through. Just like with a dam, everybody has unique ways of defending themselves from danger. The best way we know to defend ourselves is by getting away from the problem somehow. Just like if a tiger were running towards you, you’re  probably going to run away to safety. And if it’s emotional danger, you’re going to get away too.

You probably get away or avoid the problem by distracting yourself. Playing music, watching your favorite anime, eating a delicious snack, avoiding the topic, making hilarious jokes…These are all great ways to avoid this emotional danger (shame and worthlessness) and defend ourselves. 

Like every good dam, this keeps the flood at bay. That’s super helpful. That dam also keeps other people out. By putting up walls (defenses), we aren’t being vulnerable. This keeps people or fun activities at arm’s distance. We can’t form deep, emotional connections with people that we care about. We also can’t take risks to do something we might enjoy or we want to do. We’re too scared to let down our defenses to let ourselves and others be flooded by these emotions. That’s a tricky spot. We simultaneously want to be close with people and try new experiences, but we’re scared to be vulnerable. 

Anxiety

Anxiety is the alarm bell that tells us something is wrong or that there is danger. In that way, anxiety is really important to our survival. Without anxiety, we wouldn’t be as good at keeping ourselves safe. Our anxiety is also great at finding clues that COULD lead to danger. For example, if we’re afraid of tigers, we’ll start to feel scared when we see a giant orange cat. Even if it’s not next to us and we’re not in immediate danger. That’s helpful. If we’re anxious about running into a tiger, we’ll start to notice other signals that a tiger could be nearby. We could hear leaves rustling or a twig snapping and be scared that it’s a tiger. Neither of those things are tigers, though. So now it’ll be harder to relax in everyday life when we hear leaves. 

Our body doesn’t tell the difference between physical danger and emotional danger. We react the same to all kinds of danger by trying to get out of danger. In that way, anxiety is a great signal that we are near danger. In this case the danger is our emotions. Specifically shame, worthlessness, and hopelessness. Anytime anybody approaches our emotions, our anxiety will sound the alarm. And we strengthen the dam walls to keep our the flood. 

Using emotions as strengths

Emotions are essential to us human beings. Emotions are the only way that we can build deep, meaningful relationships with others. We feel closer and more connected to people when they are vulnerable with us. Being vulnerable does not just mean sharing about your experiences, it means sharing how you feel during those experiences. It’s the difference between sharing that you had a bad day at work, and sharing that Zola made you feel rejected and now you’re annoyed and disappointed. It’s the difference between “I feel LIKE things never go my way” and “I FEEL hopeless.” 

Emotions are also essential because they’re the only way we can process our experiences, get closure, and move forward. We’re always feeling something. If we avoid it, it sticks with us. It’s like if we were on a hike and we came across a rock that’s in our way. We could throw it behind us and keep moving. And we can do that to every rock we see. What we don’t realize is that our backpack is open and it’s catching those rocks. At first, it’s not a big deal, but eventually our backpack gets heavier and heavier until it makes the hike really hard. When we feel our emotions, that lets us empty our backpack. We feel lighter and can move forward easier than ever. So the way to manage our depression is to feel the emotions we have been defending ourselves from feeling - shame, worthlessness, and hopelessness.

To make sure we don’t feel flooded when we lower the dam walls, we lower them slowly to release a little water at a time. Over time, more and more of the pressure behind the dam releases. Similarly the pressure on you releases. Giving you a relieving feeling each time. Eventually, all the water is released. The pressure releases. And like the river the dam was blocking, you return to balance. Now able to use your emotions as tools that can solve any problem that comes your way.