Health

May 15 2018

How to prevent depression: full transcript

Michael Yapko
By Depression expert

The practical skills you needs to prevent and overcome depression

Watch the video here 

00:00:06               Thanks. Thanks so much. Well, that was a very nice introduction. Thank you. I want to say I’m very grateful to Anthony for arranging this, this program, this idea of his of bringing psychology to the public, to me, is the most important thing that we, as psychologists, can do. The volume of information is so great, and the quality of information has improved so markedly over time, that there’s a lot to share, and we have a relatively short time this evening, but I hope to give you a lot of good perspective about things that matter the most in learning to manage depression.

00:00:51               So, let me say I will be speaking for roughly 45 minutes or so and then I will open it up to questions. Let me start with a story and get you thinking about this topic. When I was a young psychologist, back in 1829, my first job was working in a psychiatric facility, and I was the admissions person. It was my job to admit new patients to the unit. Now, this was a locked facility. People aren’t getting locked up because they’re doing well. They’re not really doing very well at all. So my job was to interview them, find out why they were there, what was going on in their lives, what the expectation was for their hospitalisation, what medications they were on, what the treatment plan was, all those kinds of things.

00:01:43               Now, I’m young, I’m inexperienced, and for me to have the opportunity to interview many hundreds of people in a relatively short period of time turned out to be pivotal in all the things I’m going to talk to you about tonight. I would interview people who had been through the worst experiences that you can imagine, people who had been raped, tortured, mutilated, people who had fled their homelands literally with the bullets whizzing past their head, people who lost their entire family in one fell swoop, in a plane crash or a car crash, people who had suffered the worst adversities you can possibly imagine.

00:02:27               And when I would interview these people, it was easy to appreciate why they were broken, why they were so despairing, why they had given up on life. That was, of course, an interesting lesson to say the least. The compassion, the empathy, was very easy. But, what fascinated me clinically, that has every bit of relevance to what we’re going to talk about tonight, is when I interviewed people who had been through these horrific experiences, people who probably should have been depressed, but they weren’t, and I wanted to know why not. What is it about the way that these people are coping that somehow serves to insulate them against depression?

00:03:20               So, it gave rise to the four research questions that have guided my career now for over 40 years. Think about your answers to these questions, because we’re going to talk about them. The first question was, “Are there skills that people have that serve to insulate them?” Very interesting. When you ask people directly, “Gee, anybody who had been through your circumstances would be depressed. You’re not. Why not?” And people would give me these very insightful answers, like, “I don’t know,” or they would say, “Well, I guess it’s just luck of the draw,” or, “I guess it’s good genetics,” but they couldn’t really give me any insight into that. They’re just living it. They’re just being who they are, doing what they’re doing.

00:04:13               So as a young researcher interviewing people and asking a million questions, slight exaggeration, and you find out that they like murder mysteries, and they like taking walks in the park, and they like playing with their kids and grandkids, and they like ice cream, and they like all kinds of things, and there I am trying to figure out, so what is it? Well, we’ve answered that question now. It’s the ice cream. If only it were that simple.

00:04:44               So, starting to identify what patterns are present in the way this person thinks about things, in the way they define problems, in the way that they define their relationships. What are they doing in there? And what emerged from that, with great clarity, were certain patterns of self-organisation. Keep that phrase in mind: patterns of self-organisation.

00:05:10               Then the question became, okay, if I think I have a handle on what’s going on with these folks, what we can learn from them, it leads to the second question, “Can we say that these skills that these people have are in fact learnable? Are they teachable?” Isn’t this what the purpose of therapy is, is to help people acquire these skills that are not intuitive for them, that are intuitive for these other people?

00:05:40               Then the third question became the salient research question, “Can we prove scientifically, empirically, that when people are taught these particular skills, that it makes a difference, that it reduces their level of depression, reduces the frequency of depression, reduces their vulnerability to relapses, reduces the impact on the people around them?” This is one of the things about depression. It doesn’t just affect the individual sufferer.

00:06:11               One of my recent books is called Depression is Contagious, and not in a viral sense, not in a bacterial sense, but in a social sense. What is it about depression that is so easily transmitted to kids of depressed parents? If you’re the child of a depressed parent, your likelihood of suffering depression is three to six times greater than if you are the child of a non-depressed parent. Just having a depressed parent is a massive risk factor, not a small one, a big one. So can we prove that by people acquiring and developing skills, that it really makes a difference?

00:06:53               Then the fourth question has to do with prevention. Now, bear in mind, I’m asking these questions more than 40 years ago, when we didn’t have good antidepressant medications. We had medications that weren’t particularly effective, and people didn’t want to take them. They had annoying little side effects, like death. So, in the span of 40 years, all of those things have changed. We have better medications, we have far better psychotherapies, a far better insight into what depression is, who’s vulnerable and under what conditions, but the idea at that time of even thinking about depression in terms of prevention was sheer fantasy. We didn’t have good treatment, much less good opportunities for prevention.

00:07:43               So I will summarize my response to all four of these questions: yes, yes, yes, and yes. What we have learned is that there are certain vulnerabilities, risk factors. A risk factor is anything that increases the likelihood of somebody suffering a particular disease or condition, and at the time that I started studying depression, we knew of exactly two risk factors: gender and family history. We now know that there are scores of risk factors, factors that increase vulnerability to depression, and I’m going to talk about some of the key ones this evening.

00:08:25               Now, part of what came out of that initial study was the recognition that it’s not just what happens to you. You know, for the people who say, “Well, the reason I’m depressed is because here’s what happened to me when I was a kid,” or, “The reason that I’m depressed is because I lost my job,” or, “The reason I’m depressed is because this person broke up with me,” that’s only partially true at best. It’s far less about what actually happens to you and it’s far more about how you interpret, how you give the significance to, what kind of meaning you attach to the events in your life. Part of what we’ve learned is that there’s a phenomenon called attributional style, a pattern of how people reflexively, unconsciously, interpret the significance of events. And this is something that is imperative to appreciate for all of us, because this is where some of the strongest risk factors reside, as I’ll get into in just a little while.

00:09:35               But let’s backtrack to the most basic of questions. If we ask the question, “What is depression?” Well, depression is technically considered a mood disorder, but it’s far more than that. Depression’s tentacles reach into every part of a person’s life. It affects not just your mood, it affects your physiology, your physical health, and how depression serves as a risk factor for many different conditions, most notably cardiovascular disease. In fact, there are cardiologists around the world who are recommending screening for depression as the first screen for cardiovascular disease, but others as well.

00:10:21               It reaches into your ability to think and make decisions, and it’s one of the things I’m going to talk about a little bit later, is the quality of people’s decisions, and how their way of making decisions actually unintentionally reinforces depression. It affects job performance and your ability to function in the work that you do. It affects concentration, how many work-related accidents that damage people and damage people’s lives are caused by inattention, caused by depression. It affects relationships. It’s hard to be around people who are depressed. It ends up damaging relationships, and of course, all that leads to is more isolation and more depression.

00:11:07               So I can go on and on about all the different tentacles of depression, but you should get the idea that this isn’t just a bad mood. There are a lot of things that are very persistent, very enduring about the patterns that give rise to depression in the first place, that affect quality of life over the span of a lifetime.

00:11:27               So then, if we come to the question, “What causes depression? Is depression caused by …” now look at this list. If you were to research every one of these factors, you would find that there is abundant evidence for all of them and more, and if you look at this list, you’ll notice that some of these factors are biological factors, some of these factors are psychological factors, some of these factors are social factors. And the more that we have learned about depression, the more that we learned how important the social side of the equation really is, that so many of the risk factors for depression, when I talk about depressed parenting and why kids of depressed parents are at so much higher a risk, it isn’t through genetics. It’s through modeling.

00:12:26               As a parent, you can’t teach kids what you don’t know, so it becomes an interesting field of research. What is the relationship between family structure, family coping styles, family atmosphere and depression? And to leave it general for the moment, there are some very significant factors that operate in that arena. It’s why I wrote the book, Depression is Contagious, because these factors now are being recognised across a variety of fields.

00:12:58              So to summarize that point, how important it is to appreciate and have a multidimensional viewpoint? Yes, biology matters, but surprisingly not as much as you would think, that when we look at what’s termed genetic variance, how much do genes play a role in depression? Is there a depression gene? No. Are there genes that make people vulnerable to depression? Definitely. So if we look at biochemistry, yes it’s a factor. If we look at disease processes, there are many diseases where depression is a predictable consequence. If we look at drugs, there are many drugs that have depression as a predictable side effect. Biology matters, but when we look at genetic variance, that figure is between .3 and .4. That represents a mild, moderate at best, genetic influence.

00:14:03               So when we look at the power of the psychological factors, individual history, individual problem-solving styles, individual coping styles, these are the kinds of things that are in the domain of individual psychology. Another one that I mentioned just a moment ago, attributional style, the person’s habitual or reflexive way of attaching meaning to life events. And the social side of the equation.

00:14:33               As we’ve learned from studies of depression’s prevalence, a field called epidemiology, this has been particularly revealing. I don’t know if you saw the big announcement last year from the World Health Organization. Well, in 2004, the World Health Organization, which monitors health issues of all types around the world, including depression but other things as well, cancer, AIDS, MS, you name it.

00:15:04               In 2004, the World Health Organization declared depression the number four cause of human suffering and disability, behind cancer, heart disease, and traffic accidents. They predicted, in 2004, that by the year 2020, depression would rise to be number two. In fact, depression reached number two in late 2013. Last year, just around this time, depression was declared the number one cause of human suffering and disability, and the numbers are increasing. There is no demographic group where the numbers are going down. In every demographic group, the numbers are going up.

00:15:52               When we look at the epidemiology, it’s the 25 to 44 year olds who represent the largest group of depression sufferers, but the fastest-growing group is their children, and this is one of the things that I am deeply concerned about, that when you see a 14 year old or a 15 year old who’s already suffering depression, shows the signs, has the symptoms, is dealing with it, that’s a basis for concern. What’s an even stronger basis for concern is what happens 10 years from now, when this depressed adolescent becomes a parent.

00:16:32               We now have three-generation studies that show remarkably clearly that from one generation to the next, depression increases in prevalence, depression increases in severity. I’m worried especially about the youngest among us, who are at a very elevated risk right now for all kinds of reasons. One of the points about the social side of depression, why is depression increasing so dramatically? Think about your response to that.

00:17:06               Well, the societal structure has changed radically over time, and when we look at things like the influence of technology, that smart phone that you’re carrying around represents one of the strongest risk factors there is for young people today, who are, no other way to describe it, addicted to the technology, survey after survey showing that if you ask somebody to stop checking their phone for two hours, they react really badly. It’s so ingrained into their quality of life, and as a general principle, the more time you spend in front of a screen, whether it’s a small one, whether it’s a big one, the more likely you are to suffer depression. You’ve been hearing about what people are calling the epidemic of loneliness. Paradoxically, in this terribly overcrowded world, people are dying of loneliness, and the fact that people are as disconnected as they are plays a significant role.

00:18:14               So when I talk about what causes depression, the best answer I can give you is many, many things, and that’s precisely why each person’s pathway into depression is different. It’s why whatever pathway this person’s going to find out of depression is going to have to be unique to them. Is there a best treatment for depression? Absolutely not. Is there a best approach? Absolutely not. The best approach is the one that works for you, and that’s an important thing as a consumer, that as you approach the decision to seek help, to take advantage of the fact that there are experts who have been studying these things for a very long time, and have learned a lot, and know how to do treatment quite well, that your path is going to be different and unique. There is no standardized treatment. There’s no standardized way of doing this.

00:19:14               So, this is an important point: I’m talking now about your risk factors, yours, you as an individual. They’re not the same as others. When I say each person has their own pathway in and is going to have to develop their own pathway out, your task is learning what your vulnerabilities are, learning what your risk factors are. What is very troublesome for one person isn’t the least bit troublesome for someone else. What one person avoids with every ounce of energy they have, somebody else walks into openly and happily. Everybody’s different, so when we look at that point, which is really nothing to sneeze at, we really have to appreciate that it’s that level of individual attention, learning about yourself, that becomes one of the most important things that you can do.

00:20:07               So when we look at the fact that currently, the most common form of treatment, the most popular form of treatment, is the antidepressant medication. Now, antidepressant medications really became popular in the late-1980s, with the first release of Prozac, the first of the newer generation antidepressants. I’m not going to say a lot about antidepressants right now, you know, just a couple of general comments. What I will say definitively is medications are too heavily relied upon. Medications are viewed as somehow going to be the answer, and I can tell you, the more that we understand the social aspect of depression, the more confidently I can stay to you there will never be a drug that cures depression any more than there will be a drug that cures racism or depression anymore than there will be a drug that cures racism or poverty. Looking at it through the lens of biology is an exceptionally limited perspective, why I made a point of showing you the slide that shows you the biological factors, psychological factors, social factors.

00:21:19               Now it’s not that I am against anti-depressants. Part of writing for Encyclopedia Britannica is I can’t just say it because it’s my opinion. Where’s the evidence for it? Anti-depressants can do two things reasonably well. They can help you manage the vegetative symptoms, things like sleep disturbance, appetite disturbance, and they can raise the floor on depression.

00:21:44               Now that will be true for roughly half the people who take medications. If you take medication alone, it’s something to reconsider. Medications have the highest rate of relapse of any form of treatment. So even if you happen to be a fan of medication, and believe me, there are people who say to me all the time, “That medication saved my life.” I believe them. There’s no reason to disbelieve them, but the larger point I’m making is it’s not enough. It’s not enough, and here’s why it’s not enough.

00:22:22               No amount of medication is going to help you develop skills in managing stress. None. No amount of medication’s going to help you develop a better attributional or explanatory style or help you build and maintain positive relationships with other people or help you develop the kinds of cognitive skills that help you think critically about experience instead of just getting sucked in by your feelings. It’s not going to help you develop problem-solving skills. It’s not going to help you develop better decision-making strategies. It’s not going to teach you how to build a support network with people. It’s not going to help you come to terms with whatever crummy things have happened in your life, and it’s certainly not going to help you build … one of the most important things, one of the most important things in getting treatment is how to build a compelling future.

00:23:19               The past, whatever distresses, whatever traumas, whatever situations you’ve faced, I get that. I listen to those experiences all the time, and they’re tragic, but if we ask the question, “Who overcomes depression and who doesn’t,” the people who find themselves facing forward, who start thinking in terms of, “How do I want my life to be,” do better than the people who keep focusing on the past, the unchangeable past, and that’s really the key in this. Drugs aren’t going to help you do that.

00:24:01               So if we look at what these risk factors are that I’m talking about, when I said there are scores of risk factors, literally dozens and dozens of risk factors, things that singly and in combination can give rise to depression very easily. I want to highlight for you some of the key ones, some of the risk factors that have a greater impact than do others, and I’m going to describe these for you and give you an idea of what they look like, sound like, and what you can actually do about them. How we doing? Okay.

00:24:35               So the first one … let me name them first. The internal orientation, stress generation, rumination, global thinking, and finally, unrealistic expectations. Let’s look at each risk factor individually and how it influences your overall quality of experience. The first one, the internal orientation, when I’m talking about the internal orientation, very simply I mean what people do is they use themselves as the reference point. They use their feelings to make decisions. They use their feelings to interpret the things that they’re interpreting, events that happen in their life.

00:25:24               The internal orientation drives you inwardly. There are actually some depression writers who have framed depression as being the most narcissistic of all states. Now that’s clearly an exaggeration, but it does speak to the quality of self-absorption, what I mean by the internal orientation, and when you use your feelings as the indicator of what to do, you’re going to make mistakes.

00:25:54               Now I know that there are people running around loose in the world who will say to you, “Trust your feelings. Listen to your feelings. Listen to what your heart tells you.” I can tell you as a psychologist and depression expert that is really bad advice, really bad advice, because your feelings can too easily deceive you. People can so easily think things are worse than they really are. People can think things are better than they really are. To be able to have the ability to go outside yourself and learn something about what’s actually going on out there.

00:26:36               Well, when I say internal orientation it’s the subjectivity. Here’s what I believe. Here’s how I feel. This is the way it is.” When people make bad decisions that unintentionally make their life worse, that really speaks to what I’m going to talk about next with stress generation, but the point I’m making now about what does this mean in terms of what to actually do?

00:27:08               I put here, “The goal is to learn to reality test.” One of the most important skills you can develop in life is reality testing. “How do I go outside myself in order to know whether this is really what’s happening?” If you look at the times that people get in the most trouble, it’s when they get wrapped up inside in whatever they happen to believe that may have next to nothing to do with what’s actually going on out there. Clinicians call this cognitive rigidity.

00:27:42               In plain language, what it means is the key problem with depressed people is that they think things and then make the mistake of actually believing themselves. Thinking is dangerous, potentially, and without the ability to learn how to go outside yourself and reality test, all you can do is be a prisoner of your own thoughts, and if your own thoughts are depressing, you’re in trouble. It’s why, especially here in Australia where CBT is one of the most commonly applied approaches and appropriately so, helping people learn the cognitive skills of how to gather information and how to use it instead of just jumping to unfounded conclusions and believing the things that go on, and, of course, this also relates to the social isolation.

00:28:41               One of the values of relationships is when you have people close enough to you that you can say to them, “Here’s what’s going on. Here’s what I think about it,” and hopefully they care about you enough and they’re close enough with you to be able to say to you, “I don’t think you’re right about that.” It’s why the most important skill to counter cognitive rigidity is cognitive flexibility. How can you train yourself to generate multiple explanations for things that happen?

00:29:12               Simple example. I call you up. You’re not home. I leave a message. “Hi, it’s Michael. It’s 10:00am. Call me back.” It’s now 10:00pm at night, and you haven’t called me back. If I’m a depressed person, what is my predictable attribution or explanation for why you didn’t call me back? “You don’t care about me anymore.” That’ll cheer me up, but it doesn’t stop there. Then it goes to the next level of, “How come people don’t care about me? Why aren’t people ever responsive to me? Why aren’t people every staying my friends?” The next thing you know, this person’s built this up and built this up until it’s literally a suicidal crisis because you didn’t call them back.

00:30:03               That’s how it works. That’s the internal orientation. Training people to generate multiple explanations, why didn’t this person call back? Could be this. Could be this. Could be this. Could be this. Could be this. Which one is it? I don’t know. To master the art of recognising what you don’t know instead of making stuff up and then actually believing yourself.

00:30:31               The second risk factor is called stress generation. This is actually one of the most recently developed models of depression, and it has attained already a significant level of empirical support. What stress generation speaks to is how people make decisions that complicate their depression, exacerbate their depression. They don’t do it intentionally, but it speaks to the quality of their decision-making strategies, and when people don’t have good decision-making strategies, when they just follow their heart, just follow their feelings, they’re going to make mistakes.

00:31:11               So, for example, I can say to my depressed client, “I can see from all the cobwebs all over you that you really don’t move much, and knowing that exercise has a treatment success rate that matches anti-depressants with a much, much lower relapse rate, it really would be a good idea for you to exercise.” Invariably, my client says, “I know, but I don’t feel like it.” Bad decision.

00:31:46               Your friends say to you, “Wow, you are really bummed out. You are depressed. You need help. Go to the doctor,” and you say, “No.” Bad decision. You go to the doctor. The doctor says, “Here’s the name of three therapists. Pick one. You need help.” You take the names, promptly crumple them up, throw them away. Bad decision. That’s what I mean by stress generation. How many decisions do you make in the span of a day, and this is what we find. This comes out of the field of affective neuroscience, which is just a fancy title for how do moods influence decision-making processes?

00:32:33               It’s a fascinating field, and it speaks to the fact that these aren’t just cognitive processes that happen. Mood influences them. Your mood influences what you remember. Your mood influences how you remember. Your mood influences the quality of choices that you make. Obvious examples. If you’re angry, are you going to be more or less willing to take risks? More. If you’re afraid, are you more or less likely to take risks? Less. Your mood state influences your perceptions. Your mood state influences the quality of decisions, and helping people make better decisions, filtering the mood out of the process, is one of the most important things that we do clinically in the therapeutic work that we do. So you look at these things. “Don’t isolate. Socialize.” “I don’t feel like it.” “Stop drinking.” “I don’t feel like it.” Why do I say stop drinking? If you are depressed, if you are vulnerable to depression, your alcohol intake should be zero. Alcohol is a bad drug for people who are depressed or prone to depression. It has been shown to aggravate the same neuro pathways as depression. If you are a depressed person, your alcohol consumption should be zero. When you say that to somebody, particularly if they’re Australian, they say, “I don’t think so. I’m not going to do that.” Bad decision.

00:34:22               So that’s part of the task is learning how to take actions that are consistent with the goals more so than taking actions consistent with the feelings. The feelings come and go. The consequences last, and to start to think in those terms becomes a very different paradigm for people who are used to following their feelings so closely, the internal orientation I was talking about. “That is not one of the seven habits of highly effective people.” When I say alcohol’s a bad drug, I am understating it.

00:35:01               When we look at the next risk factor, rumination, rumination means spinning around the same thoughts over and over and over again and analysing and analysing and analysing at the expense of taking action. Rumination drives the symptoms of anxiety. Rumination drives the symptoms of depression. For the people who are ruminators, they have much more difficulty with even the most basic things like sleeping because their brain doesn’t stop. They’re always thinking about their problems, always thinking about the issues, trying to figure out what to do next.

00:35:41               The idea, of course, is thinking about problems is generally useful, depending how you think about them. If you keep analysing but never take action, you’re going to feel worse. If there is a cure for rumination, it’s action, but it has to be timely action. It has to be effective action. It’s not just action for the sake of action. That doesn’t count as action.

00:36:10               So the ability to be able to convert rumination to action, and when we look at the things that people ruminate about, it’s almost invariably about relationships and probably number two is school and work-related issues, but relationships are the most prominent. Many of the relationships, of course, are relationships from the past. This is one of the factors of depression. Every problem has a structure. Every problem, every diagnostic label, has components.

00:36:44               One of the components of depression is what’s called a past orientation. People come in and they say, “My past controls me. It’s because of these traumas in my past. It’s because of these things my parents did. It’s because of these things that happened to me when I was a kid.” They don’t just ruminate about the past, although they do that, but when I say they’re also using the past as a reference point, I’m saying they use the past to predict the future.

00:37:18               So they say things like, “I’ll never be happy.” Prediction for the future. “Why not?” “Because I never have been.” “I’ll never get a good job.” “Why not?” “Because I’ve never had one.” ” I’ll never have a good relationship.” “Why not?” “Because I’ve never had one.” And, of course, the most popular one of all, “I won’t be happy until my parents treat me better when I was a kid.” For as long as somebody gets caught up in that loop, they’re not going anywhere, why it becomes so incredibly important to convert to action.

00:37:55               I’m constantly having to remind people, “Whatever your history is, you’re more than your history. You’re more than your history. You’re more than any one characteristic. You’re more than your job. You’re more than your title. You’re more than your income. You’re more than your body size. You’re more than how many likes you get on Facebook or Instagram or any of these other social media things.” All of that stuff doesn’t ultimately matter and can’t be the basis for defining self.

00:38:31               And when people define themselves, the thing that’s troublesome about having to tell people, “You’re more than your history,” is that when people learn, a therapist says to them, “You are a trauma survivor. You are an abuse survivor,” on one level, that sounds very empowering. On another level, you’re literally adopting the label that says that you can globally define yourself by your unchangeable history. The last thing you want to do is define yourself by your unchangeable history, why that orientation to the future, what the possibilities are. If I could get every person to absorb that simple phrase, “Create possibilities.” There aren’t any guarantees in life, but we can take actions that create possibilities for the future.

00:39:36               There is a danger with rumination, of thinking too much. “The unexamined life isn’t worth living,” said Socrates. There is a danger in thinking too much, and there’s a specific discrimination that has to be made. When is it useful analysis, and when is it useless rumination? And I’ll answer the question for you. If it doesn’t lead to timely and effective action, it’s useless rumination.

00:40:17               The next risk factor, one of the strongest ones, is what’s called a global cognitive style. If there is such a thing as a typical depressed person, which, obviously, there isn’t, but if there was such a thing, one of the core features is global cognition. Global cognitive style means the person engages in over-general thinking. Her boyfriend breaks up with her. She says, “Men.” His girlfriend breaks up with her. “Women.” That’s over-general thinking, as if they’re all the same.

00:40:56               Somebody has a bad day, and they don’t say, “I had a bad day.” They say, ” Why is life so unfair?” Now we just went from a bad day to life. Could we make it any bigger than that? But what it translates into is when people walk in, sit down, and they say to me, “Well, all I want is to be happy. Is that too much to ask? All I want is a good relationship. Is that too much to ask?” Then I’ll ask the specifics. “So, what do you think it takes to build a good relationship?” And the person comes back with an equally global response when they say, “Chemistry.”

00:41:39               If you think in those global terms, metaphorically you see the forest, but you don’t see the trees, then you can’t be an effective problem solver. You can’t solve problems specifically by taking a global approach to it. Now this isn’t global about everything, of course. Somebody can be very specific about the way they manage their bank account, somebody can be very specific about the way they manage their bank account, and very global in the way that they approach relationships. And it’s the things that you don’t know about that you are inevitably global for, a general understanding, but you can’t learn skills that way. If I want to teach you to drive a car, I can’t say to you, “Become one with the auto.” You’re going to do a lot better if I say, “See this. This is a steering wheel. See that. That’s a brake pedal.” To get the specifics and learn to think in specific terms is a real challenge when your cognitive style is a global one.

00:42:45               Why it’s so important to have goals, but goals have to be defined. A goal without steps is merely a wish. What that translates into, one of the most important exercises, is called a flow of steps. This is how we train people to go from global to linear in their thinking. I will give you the homework assignment as your therapist of picking something that you know how to do, something simple. You know how to dress yourself. You know how to go grocery shopping. You know how to take a shower. Well, you don’t just take a shower. That’s a global phrase. Taking a shower is a global phrase that represents how many steps involved.

00:43:38               So, I will give the client the task of I want you to delineate every step involved in taking a shower. I want you to pretend that somebody who’s never done it before is going to follow your sequence, and your job is to guarantee that they succeed at it. Bring it back to me next time. They come back next time. They have three steps. Get wet. Lather up. Rinse off. Now, if that’s what you think goes into taking a shower, what does that say about your ability to be specific and problem solve? I’m the one who then has to say, “Excuse me, but how do you find where a shower is? And when you find where a shower is, how do you open the door? And how do you walk through the door? And how do you turn on the light switch? And how do you close the door? And do you remember to take your clothes off? And what about opening the shower door or moving the shower curtain and reaching inside and turning on the hot and turning on the cold and then testing it out, and then flicking the switch from tub to shower.

00:44:43               And by the time you sequence it out, depending on your amount of detail, there’s going to be at least 50 steps involved in taking a shower. And what if you miss one of them? You didn’t know you had to flick the switch from tub to shower, so there you are standing there naked watching water running down the drain. I’m such a loser. Everybody else can take a shower, and I can’t. What’s wrong with me? And that’s the point. Once I have exhausted this taking a shower flow of steps, then I give them the next one.

00:45:21               Now that you’ve done the flow chart for how to take a shower, now I want you to do the flow chart for how to be happy. And that’s the first time the person realizes they have not a clue. And then they discover instantly why it isn’t happening. If you can’t sequence what you’re trying to do, it isn’t going to happen. This requires a very specific quality of thinking that global thinkers have a hard time doing. It’s a training process, training your brain to think in more linear terms in the specific areas where you need help. Otherwise, all you can do is go globally, “Men,” “Women.” And miss how to distinguish who the good ones are from who the not so good ones are. Do a flow chart for that.

00:46:18               Okay. Then the last one I’m going to speak to quickly, the Unrealistic Expectations. Our expectations are the filter for how we judge everything. If I’m doing what you think I should do as a speaker talking about depression tonight, then you’re very happy with me. If I’m not doing what you think I should do, then you’re not happy with me. Our expectations are the filters for how we make judgments about anything, whether it’s a movie that we see, whether it’s a restaurant that we go to, whether it’s a party that we go to, and it begs the question, how do you know whether your expectations are realistic? What happens so commonly is a pathway into depression for so many is that they have unrealistic expectations. They don’t know they have unrealistic expectations, so they’re always walking around hurt and disappointed.

00:47:19               I swear to God every morning I want to call the White House and say, “Let me talk to Melania,” and get her on the phone and say, “Melania, I understand why you value fidelity. I understand why faithfulness in a relationship matters to you, but look at who you’re married to. The closest this guy’s going to come to saying no to someone is when he says, ‘Not now, we’re landing.'” What she wants makes sense, but not from him.

00:47:59               “If you really loved me, you’d win the lottery.” She doesn’t look so happy. And what I’m really curious about is his response to it. I’d love to hear what he says next. Does he say to her, “Your expectations are a little off since I’m not the one in control of the lottery,” or is he going to say, “Ah, I wonder if that’s true. Maybe I don’t love you enough. Maybe I don’t know how to love. Maybe I’m defective emotionally. Maybe …” and he’ll go off into a whole thing about his ability to love. So, when we look at how important expectations are, it’s a really good idea before you walk into your professor’s office, before you ask a friend for a favor, before you ask your boss for a special consideration, before you ask your husband or wife or boyfriend or girlfriend or partner for whatever it is you want, it would first be really nice to know can this person do this? Is this a part of this person’s makeup? Is it realistic to expect that this person can do honesty or that they can do integrity or that they can do patience or anything else that you would want from this person.

00:49:16               How often people get into relationships with other people and they’re forever pulling on them. I want affection. You never give me affection. Well, the fact that you’re dating Mr. Spock poses a problem. You’ve got to know who you’re dealing with and whether the expectations are realistic before you walk into a situation that’s charged, before you walk into a job interview, before anything. Lay it out. What are your expectations? How do you know whether this is realistic or not? If you get good at doing that, you will save yourself a lot of disappointment.

00:49:57               Well, I mentioned just in passing the thing that impresses me the most about all the things I’m talking about to you is that when we have integrated these things into prevention programs, the very skills that I’m talking to you about now. When we have run prevention programs with high risk populations and been able to demonstrate very scientifically that when people learn these skills, their vulnerability to depression drops dramatically. So, for example, we did a program that lasted six months with elementary school kids who were at high risk. High risk because they came from very unstable family environments, divorce, violence, abuse, all kinds of things that were really bad in these kids’ lives. And for two hours every other week for six months, a total of 24 hours, these kids were trained in problem solving, social skills, and then we followed these kids for almost 10 years. They had less than half the rate of depression, less than half the rate of teenage pregnancy, less than half the rate of drug abuse as the kids who did not go through the program. That’s impressive and that’s 24 hours’ worth of basic teaching of skills. These skills I’m talking to you about tonight not only have treatment value, they have prevention value.

00:51:23               Well, let me highlight for you then some very direct advice to bring this lecture to a close. Getting professional help is an important thing to do. You don’t know your own blind spots. You’re blind to your own blind spots. The stuff that you struggle with and struggle with and struggle with, you go see somebody who knows what they’re talking about, and they can say in five minutes, “Here’s what you’re missing. Here’s what we can do about it.” Problem solved. It’s not always that easy by any stretch of the imagination. But the point being there’s a good value in having trained eyes and ears on what you’re dealing with.

00:52:04               So, how do you know when you need professional help? First and foremost, suicidal thoughts. If somebody’s even remotely contemplating that, that is the first cue you need help now before you do something impulsive. Secondly, when you’re feeling stuck and hopeless. When you don’t have the support or people around you that you can reality test with. Before it reaches a crisis point. How often people wait until everything’s in flames, and then they go get help. Well, you don’t have to wait until it’s in flames. How about you take care of it before things get worse? That requires foresight.

00:52:46               The ability to make good decisions I have emphasized. When you have to make big decisions, am I going to go to this school or that school? Am I going to live here or live there? Am I going to marry this person? Am I going to move in with this person? Should we have Mom live with us or not live with us? Should I take this job in another city? What should I do? You have big decisions to make. You really don’t want to make them through the filter of depression. I spoke about how depression affects the quality of decision making. Good idea to have somebody else to reality test with.

00:53:22               When you know that you’re affecting other people, the only responsible thing to do is to get help so you are not contaminating them. Every depressed person on average affects at least three other people negatively. And if you know that that depression makes you irritable and angry and over-reactive and critical and harsh and all the nasty things that come out of people when they’re not feeling good, you owe it to the people that are in your sphere of influence to make sure you get the help that you need.

00:53:59               It’s important to shop for a therapist like any field. It wouldn’t matter if we were talking about plumbers or electricians. In any field there are people who are more well-trained, people who are better skilled, people who have more experience, and it means that your job is going to be to shop and to have the kinds of questions handy that you need to have answered. Is this person experienced with depression? What is their general approach to it? What’s their style? How active are they in the treatment process? Will they assign homework to you? Will they involve other people? Couples work? Family work? Other people who are involved in this problem for you? Are they available for appointments? What do they charge? How long are their sessions? That’s what I mean by shopping, to have plenty of questions ready for as you interview different therapists for who you click with, who you discover just by talking with them you can tell that there’s some juice there that you want to be with this person.

00:55:08               So, I gave you all these things about choosing a therapist. Let me just give you the last couple of slides of very specific bullet point pieces of advice if you’re dealing with depression. First, get a thorough physical exam. When I say that biology matters, this is the starting place to make sure that there isn’t anything going on medically that would give rise to depression as a consequence. Avoid alcohol completely, yes, you. Strive to learn about your vulnerabilities and develop ways to manage them. What are your specific risk factors? What are the things that you’re reactive to that other people are not particularly reactive to? Learn to distinguish facts from feelings, beliefs from facts. Sleep is such a critically important issue. It’s the number one complaint of people who suffer depression, how it affects their quality of sleep, creates insomnia. No surprise then that fatigue is the second most common complaint. A very important thing to be able to take sleep seriously. Sleeping with your Smartphone, not a good idea. Having your computer on, not a good idea. Having roommates that are blasting Jimi Hendrix at three in the morning, not a good idea. Being very, very careful about the environment you create.

00:56:37               Challenge yourself 50 times a day. Here’s what I think. How do I know? Reality testing, such a critically important skill. Exercise: easy, available. It works, and part of the reason it works is not just because of the neurochemical. That hypothesis is a reasonable one, but the other thing about exercise is the gains are to be made very quickly. You start exercising today. You can barely walk half a block, and you stay with it, and two weeks from now you’re walking a mile. The gains happen very quickly and for people who typically have low frustration tolerance, this is a good way to get ahead relatively quickly.

00:57:18               Do fun things and do them often. One of the first things to go when somebody is depressed is their sense of humour. There’s nothing worse than when you crack a joke to somebody, and their response to it is uh-huh, and it ends there. To do fun things, to follow the motto that at least some of the time, dare to be superficial.

00:57:47               Get and stay connected to other people. Learn to relax. Relaxation processes, meditation, visualisation, guided imagery, hypnosis, any kind of relaxation process is going to be beneficial. Be goal-oriented in the important areas of your life. But again, they have to be realistic goals. If you can’t do the flow of steps, if you don’t know what the steps are, then you’re caught up in that ‘you wish, but you don’t really have a plan.’ Prioritize and problem solve. Get support. Get help. Don’t wait.

00:58:25               If I’m going to talk about the things to do, I might as well talk about the things not to do. Don’t dwell on the past. It’s gone, but tomorrow hasn’t happened yet. Really focus on what can I do that’ll be different in the future that’ll change how I feel about the past? Don’t compare yourself to others. This is one of the worst things about social media. If you watch social media, if you participate in social media, how easy it is to conclude everyone else is having fun, everyone else is lovable, everyone else is popular, everyone else is going places that are cool, everyone else is and I’m not. Guaranteed pathway into feeling lousy, comparing yourself to other people, particularly when you don’t have any information. You can’t look at a picture and say that that’s this person’s life. That’s global thinking. Don’t catastrophise. It helps to understand the probabilities. Don’t leave important things unsaid or unresolved. Closure counts for a lot. Don’t analyse too deeply. Move on. Don’t ignore reality. Get the facts. Don’t ignore your own needs. Self-care is not the same as being selfish.

00:59:53               You’re the only one who can manage yourself, and here’s a key point. No mood expert that I know of would ever talk about curing depression. Keep this point from this lecture. The goal is not to cure depression. The goal is to learn how to manage your moods. That phrase ‘manage your moods.’ You don’t exercise once, and now you’re done with the exercise thing. You don’t discipline your kid once, and now you’re done with the parenting thing. You don’t make a bank deposit once, and now you’re done with the banking thing. These are things you have to manage every day of your life, and managing your mood requires the skills. Psychologists call it self-regulation, but the simple phrase managing your mood counts. It’s what I’m really speaking about. It helps to have a realistic expectation. Who gets depressed? Everybody. Everybody’s vulnerable. If you are capable of moods, you’re capable of mood disorders. Learning how to manage that aspect of yourself is so critically important.

01:01:13               Don’t give up or be passive. Try again but do something different. Don’t isolate. Find good people to be with, and don’t leave time unstructured. There is so, so much more I could say. I feel like I have hit many of the key things to get across to you. I hope you feel the same way.