Introduction

A Mindful Approach to Depression

Our doubts are traitors, and make us lose the good we oft might win, by fearing to attempt.

—William Shakespeare

If you are battling depression right now, you are not alone. Depression is one of the most common emotional health issues in contemporary society. A conservative estimate is that 7 percent of the general public suffers from a clinical depression at any moment in time (Kessler et al. 2005). If we factor in depressions that are associated with other common problems such as posttraumatic stress, chronic anxiety, or drug or alcohol dependence, that figure can easily expand to 20 percent. If we further factor in acute depressions triggered by life stresses such as marital problems, parenting issues, money problems, unemployment, unsafe living conditions, and so forth, that figure could go much, much higher!

Depression is so common that it’s hard to turn on the TV or browse the Internet without seeing some type of advertisement for a new drug, over-the-counter supplement, or other purported cure for depression. Moreover, news stories tend to sensationalize depression, for example, explaining the tragedy of a suicide by describing the victim’s unsuccessful battle against depression. We also receive a grab bag of mixed messages about the causes of depression, ranging from it being heredity to a biological illness to a reaction to life stress or setbacks to the result of distorted thinking or major shifts in daily behaviors.

We also hear emotional appeals about what life is like when depression is treated successfully—that the formerly depressed person is now in a state of bliss, that his or her relationships have been restored and new ones formed. We see public service and commercial ads wherein a person who used to sit dejectedly with head in hands now walks gleefully with children, spouse, or pets and seems to be absolutely carefree. The message being given is that in order to get your life going again, you first must gain control over your depression.

We believe this portrayal of depression is not only misleading, but it also points depressed people seeking treatment in a direction that is unlikely to be of much lasting help. Depression is a far more complex mental process than these stereotypes suggest; no two depressed people are alike in the life circumstances that surround them or in how depression affects their life. What is needed is a different way of thinking about depression, a way that puts you back in the driver’s seat and in control of your own destiny.

A New Perspective on Depression

There are many aspects of modern society that encourage us to live in a mindless kind of way. To keep up with the fast pace of living, our schedules are crammed with responsibilities and duties. We are taught that scheduling “me time” is a form of selfishness. Daily routines are so well practiced that we don’t even think about what we’re doing much of the time. We spend endless hours living in the past and the future rather than in the “here and now.” The irony is that it is only in the here and now that we experience a true sense of being alive.

Unfortunately, the here and now is also where you make contact with emotional pain from current or past events in life. This pain might come from a trauma you experienced as a child or adult, a series of failed relationships or a divorce that left you doubting yourself, ongoing problems with children, a stressful and unrewarding job, and so forth. Whatever the source of your pain, you are faced with an ongoing quandary: in order to experience the vitality of life, you must also be willing to experience the emotional pain that life can give you.

Sadly, one of the rules we learn as children is to control our emotions or risk the social consequences of not doing so. We are taught that painful emotions are bad for us and that the goal is to control or eliminate them. The reality, though, is that emotions cannot be controlled in this way. When you try to control what you feel, your feelings just get bigger and more intrusive. And when you try to run from or avoid your feelings, you are robbed of the important information that your emotions have to offer you.

Your emotions, particularly the painful ones, provide the fuel that will propel you to make important changes that bring your life into better balance. If you avoid your pain, then it is very likely that those problems will just fester—and probably get worse. This is the trap that depressed people fall into. They unknowingly trade the vitality that comes from living in the present moment for the illusion of emotional safety.

Contrary to some other popular stereotypes, it is important to realize that depression is not something you have, it is something you do. Depression is the result of an organized set of behaviors that makes you emotionally numb and unable to act in ways that are consistent with your values. Depression is not an aberration, a fluke, or an accident of nature. It is a logical result of what you’re putting into your life. Depression is a signal that you need to show up, be intentional, take an open and curious attitude toward your emotions, and engage in actions that reflect your values and principles.

So if you can’t control your emotions or hide from them, what can you do? You can choose to experience your feelings and thoughts, both wanted and unwanted, and do what is meaningful to you. This is a vital life—a life worth living—and pursuing it is not a feel-good exercise, with one pleasant event leading to another. Rather, it is a commitment to living with whatever shows up on your life path.

We can become sad, anxious, or discouraged when the things that matter are not going well. It is what you do with these reactions that makes all the difference. Allowing yourself to feel what you feel, think what you think, and, at the same time, act according to your values is going to promote a sense of vitality, purpose, and meaning. If living life mindlessly and avoiding painful emotions is the way into depression, then living mindfully and accepting your pain is the way out. In this book, we are going to teach you how to do just that!

The Acceptance and Commitment Therapy Approach

The new perspectives, strategies, and skills we teach in this book come from a proven-effective therapeutic approach called acceptance and commitment therapy (ACT; pronounced like the word “act”). ACT is a cognitive behavioral therapy that has gained increasing prominence in both the popular press (Hayes and Smith 2005; Strosahl and Robinson 2014) and within the mental health and drug and alcohol treatment communities (Hayes, Strosahl, and Wilson 2011). ACT has proven to be a good treatment for depression in adults (Fledderus et al. 2012; Forman et al. 2012; Kohtala et al. 2015; Zettle and Hayes 1987; Zettle and Rains 1989) and adolescents (Hayes, Boyd, and Sewell 2011), and it seems to produce benefits that last long after treatment has stopped (Lappalainen et al. 2014).

One of the core goals of ACT is to teach you how to use mindfulness strategies to bolster present-moment awareness, foster emotional acceptance, and live your life based upon personal values. Mindfulness is a widely used term that means many different things to people, but, broadly speaking, we see it as the ability to pay attention to the present moment in a nonjudgmental, detached way; to practice compassion for self and others; and to behave with awareness, intention, and purpose in daily life. People who live according to these key principles may run into significant life challenges, as we all do, but they tend to be emotionally resilient and much less prone to depression.

Mindfulness and Depression

When we published the first edition of this book in 2008, research on the impact of mindfulness on mental health generally, and depression specifically, was just beginning to show up in the literature. Now we now have an abundance of research studies showing that mindfulness is a very powerful treatment not just for depression but also for promoting long-term physical health and mental well-being (Sundquist et al. 2015).

Interestingly, even people who have experienced repeated episodes of depression (Teasdale et al. 2000; Teasdale et al. 2002) or have failed to respond to other treatments seem to benefit (Eisendrath et al. 2016). Thus, even if you have been experiencing depression for many years and have not responded to treatment, or you got better with treatment and now are in the midst of another depression, it is still quite likely you will benefit from the strategies presented in this book. Equally encouraging is that practicing mindfulness skills, at whatever level you currently possess, using the ACT approach is going to strengthen them and make them easier for you to use in daily life (Bohlmeijer et al. 2011). Further, changes in mindfulness abilities resulting from ACT have been associated with better treatment results (Arch et al. 2012; Forman et al. 2012; Zettle, Raines, and Hayes 2011).

Contemporary brain science tells us that mindfulness strategies literally snap the depressed person out of the mental fog of daydreaming, mind wandering, and rumination (Farb et al. 2010). Practicing mindfulness strategies isn’t just a “feel good” strategy; it is actually a highly beneficial form of brain training (Levenson et al. 2014). Just like you exercise your body to strengthen your muscles and improve your circulation, exercising your brain strengthens your mindfulness muscle. We can say without reservation that, if you put the time into learning and practicing the mindfulness strategies we introduce in this workbook, you have a very good chance of getting on top of your depression.

But Is This Approach Right for Me?

You might be wondering if the ACT approach is the right one for you. That’s a good question, because no single approach works for everyone. To help you determine whether you might benefit from the skills we teach in this book, take a few moments to mentally complete the following brief quiz. See if any of the statements below describe you most of the time, or at least some of the time:

If one or more of these statements remind you of you, this book can help you! That’s because all of these statements describe an important barrier to living mindfully. When you live mindfully, with awareness, you can better manage and overcome your depression. By learning and practicing the skills in this book, you will become more mindful. This book will teach you how to:

A Mantra: Accept, Choose, and Take Action

Another way of thinking about ACT is as a prescription for healthy living:

“Accept, choose, and take action.” Say this aloud several times now and really take it to heart. It may be helpful to you as you read and practice ACT strategies over the coming weeks. Write it on several pieces of paper and tape them to your refrigerator, your vanity mirror, your toilet seat, the edge of your computer screen, and wherever else you’ll see it often. We want these three simple concepts to become your daily mantra. Say it to yourself twenty times a day or more! Sometimes we’re accused of functioning more like cheerleaders than therapists, but heck, if cheerleading helps you build the life you’ve always wanted to live, we’re sold on it.

Accepting the Uncertainty of Change

Even if this program may seem like a perfect fit for you, you may be thinking, “I don’t know if I’m ready to move out of my depression. I’ve tried different things to control my depression and they didn’t work then. I’m worried. How do I know it’ll work this time?” That’s a very good question—and an important one. After all, doesn’t our culture suggest that we should let sleeping dogs lie?

The reasons not to deal with your depression might seem clear: You could be exposed directly to more anxiety, fear, sadness, guilt, shame, anger, rejection, criticism, and disapproval from others. Things definitely could get worse before they get better. Being depressed is at least familiar. You know exactly what depression feels like, and you may have modified your daily life to fit depression in as part of your ongoing reality. You don’t know exactly what will happen if you try something different. Things could get better or worse. But you do know exactly what will happen if you stay where you are: you’ll probably get some of the same results in your life you’ve been getting up to now.

One reason you might want to explore the strategies we share in this book is the simple fact that you have an inherent desire as a human to have a say about how you live your life. It is in choosing that we bring purpose and deeper meaning to our life experiences and directions. This option is there for you. It’s a birthright of all human beings, but that doesn’t mean it’s delivered to you on a silver platter—you have to seize it. Only you can do this, and it won’t be easy. You need to be willing to fail sometimes, to feel sadness and loss, to experience guilt and shame, to think distressing thoughts, and to sometimes remember unpleasant and frightening experiences from your past. The choice to deal with difficult aspects of your life might require you to face a variety of unpleasant and painful experiences—and it offers you the opportunity to grow as a human being in the process.

In all honesty, you won’t know how this turns out until you start trying some different behaviors. You might be thinking that you have absolutely no clue what the future will look like. You might even be predicting that you’ll fail somehow, or that you’ll be even more dissatisfied than you are now. That’s completely understandable! In this book, we’ll actually teach you how to say, “Hi there” to your mind when it starts to worry. It might sound silly now, but you’ll soon discover that changing how you relate to your mind is a huge step toward overcoming depression!

How This Book Is Organized

This book is organized into three major sections to help you in your quest to transcend depression. Part 1 is called “Preparing for Radical Change.” To begin, you need to understand what your depression experiences are, how they affect your current life, and the ways that depression might be preventing you (or protecting you) from dealing with personal problems you need to deal with. This will allow you to understand how your depression operates, both between your ears and in the outer world.

We will also introduce you to the ways that living mindfully can enhance your sense of vitality and well-being. We’ll help you assess your mindfulness skills and develop a plan to begin improving them over time. Finally, we will introduce you to the key ACT concept of workability. This approach encourages you to shift from looking for strategies that should help your depression to looking for strategies that will help your depression. You will likely discover that although many of the strategies you use to cope with your depression might be working in the short run, they inevitably turn out to be unworkable in the long run and actually worsen your depression

Part 2, “9 Mindful Steps to Transcend Depression,” is designed to help you clarify what you want your life to be about. We will teach you how to accept unpleasant realities, step back from them so they don’t consume you, and then act in ways that promote better results for you. This part of your journey will sometimes be confusing, and involve thinking and behaving in ways opposite to those you might have used in the past. If you stick with it—and you can!—you’ll begin to see the paradox that underlies depression and be able to do something about it. Each chapter in this section will expose you to several state-of-the-art brain training exercises, based on the results of neuroscience studies of depression, that are designed to help you strengthen the neural pathways in your brain that produce feelings of centeredness and well-being.

Part 3, “Creating the Life You Want to Live,” will introduce you to some cutting-edge concepts from the field of positive psychology. We now know that your ability to engage in daily behaviors that produce a sense of relaxation or reward actually inoculates you from the stresses of daily living that can trigger depression. We will help you develop a positive daily living plan that will help you succeed at the daunting task of having some level of fun, relaxation, or reward every day! In the spirit of hoping for the best, while preparing for the worst, we will ask you to identify risk situations in your life that might pull you back into depression. Then, we will help you prepare a specific positive-action plan for those situations that might trigger a recurrence of depression.

Learning to stand up and make a commitment to promoting your sense of vitality in life requires you to be persistent, even when you have a bad day and don’t live up to your promise. Persistence is everything when you want to develop a new way of living. This is why it is so important to connect to what matters to you most in life.

How to Use This Book

Like many people, you may be interested in a self-help book because of a desire to learn how to control your depression without bothering others or incurring the cost of professional help. This strategy can succeed to the extent that you stick with the program, so we’ve designed it to make this easier for you. Each chapter introduces one or two important ACT concepts and illustrates them with stories of real people who have struggled with depression. Each chapter includes exercises to help you develop your awareness of a particular issue and to practice skills that will help you succeed.

It’s less important to be good at every strategy we discuss than to be good at using a few key strategies that fit your personal style. It’s okay to jump around in the book, focusing on chapters that appeal to your interests and needs at the time. If you become adept with just a few ACT strategies, we are confident that you’ll still notice an immediate effect on your quality of life.

To help you use this program over time, you can find accessory materials that support the strategies and activities described in this workbook on this book’s website: http://www.newharbinger.com/38457. There you’ll find free downloadable worksheets and guided audio versions of many mindfulness and experiential exercises. Look for the following icons in the text:

This icon tells you that you can download a copy of the worksheet.

This icon tells you that an audio version is available for download.

If you decide to move forward with this self-help program, we encourage you to download all of these materials ahead of time so that they are easily accessible to you. This will allow you to keep your focus on following along with the exercises in each chapter.

Ask Others to Support You

One strategy that will be useful right now is to mention what you’re trying to do to a friend, intimate partner, sibling, or anyone who can hold your feet to the fire. Making a commitment to try something different in front of someone else is a powerful way to support your success.

You can do the same with your health care provider. Mention that you’re trying to overcome depression and want to use this program. Ask your health care provider to check in with you about how you’re doing with the program at each medical visit.

If you’re working with a therapist, take this book with you to your next appointment and go over the structure of the program together. Then you can come up with a plan for integrating various sections of the book into the therapy process, perhaps using some of the chapters in part 2 as homework that you will complete between sessions.

A Little Story

Before we move on (and hopefully you move along with us!), there is a well-known Buddhist story that might help you find the boldness to commit to reading this book and following through with the ACT program. It’s a story that speaks to having the courage to give life your best shot, despite the inevitable process of change that we all must learn to accept.

A young monk walks many miles, hoping to gain enlightenment from a renowned Zen master. When the student enters the master’s chamber, the master is sitting on the floor drinking from a cup. The master explains to the student that the cup is very precious. The student agrees, and the master asks, “Why do you think this cup is so precious?” The student suggests it is the color and size of the cup and the slender quality of its handle. The master agrees that all of these aspects make it an attractive cup, but these are not its most precious properties. The student becomes confused and asks the master to answer his own question. The master sighs. “It is most precious because it is already broken and it has already held so many cups of tea.”

Your life has a beginning and an end, with everything in between being an exercise in uncertainty and change. As the old saying goes, The only constant in life is change. This is the nature of pursuing your dream of a life worth living. The journey is perfectly made to teach you what you need to know, if you will only accept that everything is destined to change. Is this a reason to avoid starting the journey? We think not, especially as change is inevitable either way! We hope you agree, and we challenge you to keep reading.