Winter. That great gloomy period of the year, where people get to meet their loved one's. For expats it can be hard to remain positive, considering they may not be able to be in touch with all their family, as they may be scattered across the globe. I personally always have to chose between whether to spend the Christmas vacation with my family in Spain, in Germany, or with my partner's family in The Netherlands.
For others, the winter time can be an even worse time as they may feel even more depressed when suffering from clinical depression. That's why I decided to focus today's blog on depression, in particular:
What is Depression: feeling depressed versus having a clinical depression
The Depressive Cycle
How to Break Free from the Depressive Cycle
Extra Tips to Try out Immediately
What is Depression: feeling depressed vs. having a clinical depression
Feeling depressed - defined as sad, empty, or having low energy - can be a normal and useful feeling, but a clinical depression can be understood as a severe psychiatric condition. In a clinical depression, though similar feelings of sadness may arise, there are a multitude of biopsychosocial factors that lead to strong dysfunctions in one's regular life: from having a prolonged low mood, social isolation, to changes in one's eating, sleeping, concentration, and suicidal thoughts just to name a few. If you are suffering from depression go see your doctor or psychologist.
What is depression? Living with a black dog.
The complexity of factors influencing depression are related to one's genes, traumatic life events and other stressors, possible biochemical imbalances in one's neurotransmitters, and medical conditions someone may suffer from. In some cases depression can be even caused as a side effect of taking drugs/medication. This Harvard page gives a good overview of factors causing depression: https://www.health.harvard.edu/mind-and-mood/what-causes-depression
The Depressive Cycle
From a psychotherapeutic standpoint another major factor I frequently see contributing to people having depression is when you develop an inner negative downward spiral. For a simplified model see the image below.
When we develop a lower mood, we tend to be less active (e.g. stop going out as much) which can have a direct effect on our environment (e.g. seeing less friends, skipping work days, becoming more isolated). This in turn makes us feel worse about ourselves (worse self-image), and for a good reason, since we now have the evidence to prove that our environment changed! This can lead us going down a negative spiral even more, with more negative thoughts popping up and an even lower mood. Do you see what I mean with it being a cycle?
Thus when someone says to a person suffering from depression to simply "think positive and change your attitude" they are doing them a disservice and not helping! Can you imagine how frustrating this can be for a person who already may have a low self-esteem, be isolated, and struggle to do small tasks like getting out of bed on time?
As shown by the artist Sow-ay, who has opened up about his own mental health struggles, it's not that easy to change one's thinking, nor realistic.
How to Break Free the Depressive Cycle?
Commit to change
Ask yourself - are you ready to commit to change? At least some part of you has to be motivated to change yourself. You have to commit. If you are not motivated to change your dysfunctional habits and beliefs, it is hard for others to support you. It is normal to have doubts and set-backs, but at least some part of you has to sufficiently wish to change the current life you are living.
Be more active
When I ask clients what would be the one thing they could do to change their downward spiral into an upward spiral when looking at the diagram above, most say that being more active would help (step 2 in the diagram above) and is realistic. Once you realize that being more active is one of the best ways to get started, you have to take action. This is one of the most promising ways to start turning a downward spiral into an upward spiral.
Lower your expectations. Break your goals down into smaller goals. Even if you think that going for a 20 minute walk every day would feel easy, challenge yourself to walk at least 5 minutes. Why? Because if you walk 15 minutes, expecting to walk only 5 it will feel like an achievement, instead of you thinking that you did not even manage to walk the expected 20 minutes.
Extra Tips to Try out Immediately
(Please note that a severe depression cannot be cured by reading a blog post. Go see a professional.)
Move. Change your posture (e.g. straighten your back), stretch your limbs, or take a 5 min walk. If you feel very adventurous you can even go and exercise!
Breathe. Try breathing exercises or simply breathing a bit deeper than you are used to. You can simply count the seconds you are breathing in and out (e.g. 1-2-3) and add a few more seconds between each in and out breath if possible.
Smile. Or laugh if you can. No, this won't solve all your problems, but some studies suggest that your mirror neurons will most likely react, creating a positive impact for your brain (also known as facial feedback hypothesis). In the worst case, you might even make someone else happy seeing you smile.
Freshen up. Walk outside, get some fresh air, splash water in your face, or take a shower.
Practice gratitude. Write down three things that you are thankful for (a previous meal, still being alive, or maybe a joyful interaction you had with someone?). It can be both small and big things. Making this a daily habit, can help re-frame our thinking.
Accept that it will take time to heal, and that it is good to reach out for help. Most likely, even if you improve there may be times that you may feel worse again. Accept that this is part of the process, and that by reaching out, other people can help you go through it.
Don't give up! Your story may inspire others. Eventually, you can help others by sharing your story knowing that there is light at the end of the tunnel.
Reed, L. I., Sayette, M. A., & Cohn, J. F. (2007). Impact of depression on response to comedy: A dynamic facial coding analysis. Journal of Abnormal Psychology, 116(4), 804-809.
Kraft TL, Pressman SD. Grin and bear it: the influence of manipulated facial expression on stress response. Psychol Sci 2012, 23:1–7
Blogs on Depression:
How you can help someone with depression (video):
Art related to depression: http://sow-ay.tumblr.com
About Patric Esters
Patric Esters, MSc is an expat psychologist who provides psychological counseling and diagnostics to expat teenagers and young adults living in The Hague. Patric speaks and treats clients in English, German, and Spanish, but also in Portuguese, Catalan and Dutch. Patric Esters has been working for several years as a child and adult psychologist in a renowned international clinic for expatriates. He has a vast background in psychology and psychotherapy and first-hand expat experience, being born in Germany and raised in Spain at an international school.