How to recover from depression

Well, that was a very good introduction. Thank you. I want to say that I am very grateful to Anthony for organizing this program. This idea of ​​the psychology of it opened to the public. To me, it is the most important thing we, as psychologists, can do. The information is so excellent and the quality of the information has improved so dramatically over time that there is a lot to share and we have relatively little time tonight, but I hope to give you a good perspective on the things that matter most when learning to manage

depression

, so let me tell you I'm going to talk for about 45 minutes or so and then I'll open it up to questions.

Let me start with a story and make you think about this topic when I was a young psychologist in 1829, my first job. I was working at a psychiatric facility and I was the admissions person. My job was to admit new patients to the unit. Now this is a closed center. They don't lock people up because they are doing well, in reality they are not 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 expectations were for their hospitalization, what medications they were taking, what the treatment plan was, all that kind of stuff now that I'm young.

I have no experience and for me having the opportunity to interview many hundreds of people in a relatively short period of time turned out to be essential and of all the things that I am going to talk to you about tonight, I would interview people who had been through the worst experiences you can imagine, people who had been raped, tortured, mutilated, people who had literally fled their countries of origin with bullets whizzing past, people who lost their entire family and in one fell swoop in an accident air or car, people who had suffered the worst adversity you can imagine and when I interviewed these people it was easy to appreciate why they were broken, why they were so desperate, why they had given up on life, that was, of course, a lesson Interesting, to say the least, compassion.

Empathy was very easy, but what fascinated me clinically and has complete relevance to what we're going to talk about tonight is when I interviewed people who had gone through these horrible experiences, people who probably should have been depressed but weren't. . and I wanted to know why not, what is it about the way these people deal with the situation that somehow serves to insulate them against

depression

, thus giving rise to the research questions that have guided my career for more than 40 years. Think about your answers. To these questions because we are going to talk about them, the first question was: are there skills that people have that serve to isolate them?

It's very interesting when you ask people directly. Anyone who has gone through your circumstances would get depressed, isn't that why? no and people would give me very revealing answers like I don't know or they would say well I guess it's just luck or I guess it's good genetics, but they couldn't really give me any idea what they are. just living it, just being who they are, doing what they do, like a young researcher interviewing people and asking a million questions. It's a slight exaggeration and you find out that they like murder mysteries and they like to walk in the park and they like to play with their children grandchildren and they like ice cream and they like all kinds of things and there I am trying to figure out what it is, well , we've answered that question now it's ice cream if only it were that simple, so let's start identifying what patterns are present in the way this person thinks about things in the way they define problems in the way they define your relationships what you are doing there and what emerged from that with great clarity if certain patterns of self-organization are maintained that phrase in mind patterns of self-organization then the question was okay if I think I have an idea of ​​what is going on with these people what can we learn of them leads us to the second question: can we say that these skills that these people have?

Isn't this the purpose of therapy is to help people acquire these skills that are not intuitive to them and that are intuitive to these other people? So the third question became the most prominent research question. We can learn? demonstrate scientifically empirically that when people are taught these particular skills, it makes a difference, it reduces their level of depression, it reduces the frequency of depression, it reduces their vulnerability to relapse, it reduces the impact on people around them, this is one of the things about depression. It not only affects those who suffer from it individually, one of my recent books is called depression, it is contagious and not in a viral sense, nor in a bacterial sense, but in a social sense, what is it about depression that is transmitted so easily to children of depressed parents?

If you are the child of a depressed parent, your chance of suffering from depression is three to six times greater than if you are the child of a person who is not depressed. Just having a depressed parent is a huge risk factor, not a small one, but a big one, can we too? Show that when people acquire and develop skills, it really makes a difference and then the fourth question is about prevention. Please note that I am asking these questions over 40 years ago, when we did not have good antidepressant medications. They had medications that weren't particularly effective and people didn't want to take them, they had annoying little side effects like death and in the span of 40 years all of those things have changed, we have better medications, we have better psychotherapy The therapies offer a much better view of what depression is, who is vulnerable and under what conditions, but the idea at that time of even thinking about depression in terms of prevention was pure fantasy, we didn't have good treatment let alone good opportunities for prevention, so I will summarize My answer to these four 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 that someone will suffer from a particular disease or condition and at the time when I started studying. depression we knew exactly two risk factors gender and family history now we know that there are dozens of risk factors that increase vulnerability to depression and tonight I'm going to talk about some of the most key ones, now part of what emerged from that initial study It was the recognition that it's not just what happens to you, you know, for people who say well, the reason I'm depressed is because this is what happened to me as a child or the reason 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 a lot less about what's really happening to you and it's a lot more about about how you interpret how you give importance to what kind of meaning you attribute to the events in your life and part of what we have learned is that there is a phenomenon called attributional style, a pattern of how people reflexively and unconsciously interpret the meaning of events and this is something that is imperative to appreciate for everyone. because this is where some of the strongest risk factors lie, as I'll get to in a moment, but let's go back to the most basic questions if we ask what depression is.

Well, depression is technically considered a mood disorder, but it is much more than that, the tentacles of depression reach into every aspect of a person's life; It affects not only your mood, but it affects your physiology, your physical health, and how depression serves as a risk factor for many different conditions, especially cardiovascular disease. In fact, there are cardiologists all over the world. world that recommend screening for depression as the first screening test for cardiovascular diseases, but also others, and it affects the ability to think and make decisions, and one of the things that I will talk about a little later is the quality of people's decisions and how their decision-making actually unintentionally reinforces depression affects job performance and your ability to function at the job you do affects concentration how many work-related accidents that harm people and damage their lives are caused by lack of attention caused by depression it affects relationships it is difficult to be around depressed people it ends up damaging relationships and of course all that leads to is more isolation and more depression so I can go on and on.

We will go on about the different tentacles of depression, but you should understand that this is not just a bad mood, there are many things that are very persistent and long-lasting in the patterns that give rise to depression in the first place and that affect the quality of life. throughout life, so if I came to the question, What causes depression? Is depression caused? Look at this list. If you were to investigate each of these factors, you would discover that there is abundant evidence for all of them and more, and if you look at this list, you will discover that some of these factors are biological factors, some of these factors are psychological factors, some of these factors are social and the more we have learned about depression, the more we learn about how important the social side of the equation really is. of the risk factors for depression when I talk about depressed parenting and why children of depressed parents are depressed, the risk is much higher, it is not through genetics, but through modeling, as a parent you cannot teach children children what you don't know, etc.

It becomes an interesting field of research what is the relationship between family structure, family coping styles, family environment and depression and leave it in general for the moment, there are some very important factors that operate in that area, it is for That's why I wrote the book Depression is Contagious because These factors are now being recognized in a variety of fields, so to summarize that point, how important it is to appreciate and have a multidimensional point of view. Yes, biology matters, but surprisingly not as much as you might think when we look at what is called genetic variation.

What role do genes play in depression? Is there a depression gene? No, are there genes that make people definitely vulnerable to depression? So if we look at the biochemistry, yes, it is a factor. If we look at disease processes, there are many diseases in which depression is a factor. 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 the genetic variation that appears between point three and point four, it represents a slight, moderate genetic influence, at best of cases, so when we look at the power of the site psychological factors individual history individual problem-solving styles individual coping styles these are the types of things that are in the domain of individual psychology another one I mentioned a moment ago attributional style the person's habitual or reflexive way of giving meaning to life events and that the social side of the equation, as we have learned from studies on the prevalence of depression in a field called epidemiology, this has been particularly revealing.

I don't know if you saw last year's big announcement from the World Health Organization correctly. In 2004, the World Health Organization, which monitors health problems of all kinds around the world, including depression, but also other things, cancer helps MS, you name it. In 2004, the World Health Organization declared depression to be the fourth leading cause of human suffering and disability behind cancer and heart disease. and traffic accidents predicted in 2004 that by 2020 depression would rise to number two; In fact, depression reached the number two spot at the end of 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 decreasing , in all demographic groups the numbers are increasing when we look at the epidemiology, it is people aged 25 to 44 who represent the largest group of people suffering from depression, but the fastest growing group is their children and this is a One of the things that worries me deeply now, when you see that a 14 or 15 year old child who is already suffering from depression shows signs, has symptoms, how to deal with it, that is a cause for concern, which is even a stronger reason for concern.

The concern is what will happen ten years from now, when this depressed teenager becomes a father. We now have three-generation studies that show remarkably clearly that from one generation to the next the prevalence of depression increases. The severity of depression increases. I am especially concerned about the The youngest among us who are at very high riskhigh 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. Well, the social structure has changed radically over time and when. We analyze things like the influence of technology, that smartphone you carry with you represents one of the strongest risk factors that exist for young people today, there is no other way to describe it, addicted to technology, survey after survey which shows that if you ask If someone stops checking their phone for two hours, they react very badly, it is so ingrained in their quality of life and as a general principle, the more time they spend in front of a screen, whether small or large, it is most likely If you are going to suffer from depression, you will have heard about what people call the loneliness epidemic.

Paradoxically, in this terribly overcrowded world people are dying of loneliness and the fact that people are as disconnected as they are plays a big role, so when I think about the causes of depression, the best answer I can give you is many. things and that is precisely why each person's path to depression is different, that is why whatever path this person finds out of depression will have to be unique to them. The best treatment for depression, absolutely, there is no best approach, absolutely, the best approach is the one that works for you and that's an important thing because as a consumer, as you approach the decision to seek help, you must take advantage of the fact that it exists.

They are experts who have been studying these things for a long time and have learned a lot and know how to do the treatment quite well, their path will be different and unique, there is no standardized treatment, there is no standardized way to do it, etc. this is an important point. I am talking now about your risk factors, yours as an individual, they are not the same as others when I say that each person has their own path in and will have to develop their own path out of your task. is learning what your vulnerabilities are learning what your risk factors are what is very problematic for one person is not in the least problematic for another what a person avoids with every ounce of energy they have someone else enters openly and happily everyone is different and So when we look at that point which is actually 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 you can do, when we look at the fact that Currently, the most common form of treatment, the most popular form of treatment, also had antidepressant medications.

Now the antidepressant medications have really arrived. They became popular in the late 1980s with the first release of Prozac, the first of the new generation antidepressants. I'm not going to say much. on antidepressants right now, you know, just a couple of general comments, what I will definitely say is that there is too much reliance on medications, they are seen as somehow being the answer and I can tell you that the more we understand the social aspect of depression, more With more confidence I can tell you that there will never be a medicine that will cure depression, nor will there be a medicine that will cure racism or poverty.

Looking at it through the lens of biology is an exceptionally limited perspective, which is why I decided to show you the slide that shows the biological factors psychological factors social factors now it's not that I'm against antidepressants, you know, part of a writing for the Encyclopedia Britannica. I can't just say it because it's my opinion, where is the evidence in favor? Antidepressants can reasonably do two things. Well, they can help you control vegetative symptoms, such as sleep disturbances, appetite disturbances, and they can raise the level of depression now. That will be true for about half of the people who take medications.

If you take medications alone, this is something you should reconsider. Medications have the highest rate. of relapse anyway, so even if you are a medication fanatic and believe me, there are people who tell me all the time that medication saved my life. I believe them, there is no reason not to believe them, but the more important point is that What I am saying is that it is not enough, it is not enough and here is why it is not enough. No amount of medication will help you develop skills and manage stress. None. No amount of education will help you develop a better attributional or explanatory style. building and maintaining positive relationships with other people or has helped you develop the kind of cognitive skills that help you think critically about experience rather than simply getting caught up in your feelings will not help you develop problem-solving skills will not help you develop better decision-making strategies, it won't teach you how to build support and a network with people, it won't help you come to terms with whatever unpleasant things have happened in your life, and it certainly won't help you build one.

One of the most important things when receiving treatment is how to build a compelling future. You know the past. Any de-stressor. Any trauma. Any situation you have faced. I understand that I hear those experiences all the time. and they are tragic, but if we ask ourselves who overcomes depression and who doesn't, people who find themselves looking forward and who start thinking in terms of what I want my life to be do better than people who continue to focus on the afterlife of the unchanging past and that's really the key and these medications are not going to help you achieve that so if we look at what are these risk factors that I was referring to when I said there are dozens of risk factors literally dozens and dozens. of risk factors things that, separately or in combination, can very easily lead to depression.

I want to highlight for you some of the key factors, some of the risk factors that have a greater impact than others and I will describe them for you and give you an idea of ​​what they look like, sound like and what you can actually do about it. How are we doing well? So the first one let me name them first. Internal orientation. Generation of stress. Rumination. Global thinking. And finally unrealistic expectations. Let's look at each risk factor. individually and how it influences the overall quality of your experience. The first, internal orientation. What I'm talking about about internal orientation is very simple: what people do is use themselves as a reference point.

They use their feelings to make decisions. They use their own feelings. feelings to interpret things you are interpreting events happening in your life internal orientation drives you to the mundane actually there are some writers on depression who have framed depression as the most narcissistic of all states, that is clearly an exaggeration, but speaks to the quality of self-absorption what I mean by internal orientation and when you use your feelings as an indicator of what to do you are going to make mistakes now I know there are people loose in the world who will say Trust your feelings, listen to your feelings, listen what your heart tells you.

I can tell you, as a psychologist and depression expert, that that is really bad advice, really bad advice because your feelings can fool you too easily. People can so easily think that things are worse. than they really are, people can think that things are better than they really are, being able to have the ability to step outside of yourself and learn something about what's really happening out there. When I say internal orientation, it's subjectivity, this is what I believe, this is how I feel like this is how things are and when people make bad decisions that unintentionally make their life worse, that really speaks to what I'm going to talk about next with generating stress, but the point I want to make now about what this means in In terms of what to actually do, I put the goal here is to learn to test reality.

One of the most important skills you can develop in life is reality testing. How do I get outside of myself to know if this is really what is happening and if Look at the times when people get into the most trouble is when they get wrapped up inside themselves and whatever they believe may have almost nothing to do with what is really happening. Doctors call this cognitive rigidity in plain language what it means. The key problem with depressed people is that they think things and then make the mistake of believing that thinking is potentially dangerous and without the ability to learn to get outside of themselves, in reality all they can do is be a prisoner of themselves. thoughts and if your own thoughts are depressing you are in trouble and that is why especially here in Australia where CBT is one of the most commonly applied approaches and appropriately it helps people learn the cognitive skills of how to gather information and how to use it instead. of simply drawing unfounded conclusions and believing things that happen and of course this also relates to social isolation.

One of the values ​​of relationships is when you have people close enough to you that you can tell them: this is what is happening, this is what I think and I hope that they care enough about you and are close enough to you enough to be able to tell you that I don't think you're right about that, which is why the most important skill to counteract cognitive rigidity is cognitive flexibility. How can you train yourself to generate multiple explanations for things that happen? Simple example I'm calling you, you're not at home I'm leaving you a message Hi, I'm Michael, it's 10:00 a.m. m., call me now it's 10 p.m. m. at night and you haven't called me back if I'm a depressed person what is my attribution or predictable explanation for why you didn't call me back you don't care about me anymore that will make me happy but it doesn't It doesn't stop there so it goes on to the next level of how come people don't care about me, why people never respond to me, why people never stay friends with me and the next thing you know this person built this and built this up until it's literally a suicidal crisis. because you didn't call them back that's how it works that's the internal orientation that trains people to generate multiple explanations why this person called back could be this could be this could be this could be this could be this which one I don't know Master the art of recognizing what you don't know instead of making things up and then believing yourself.

The second risk factor is called stress generation. This is actually one of the most recently developed. models of depression and has already achieved a significant level of empirical support. What stress generation talks about is how people make decisions that complicate their depression, exacerbate their depression, they do not do it intentionally but rather it talks about the quality of their decision-making strategies. of decisions and when people do not have good strategies for making decisions, when they simply follow their heart, they simply follow their feelings, they are going to make mistakes. So, for example, I can tell my depressed client that I can see from all the cobwebs on you that you really don't move much and knowing that exercise has a treatment success rate that matches antidepressants with a relapse rate much lower, it would really be a good idea for you to exercise and invariably my client says I know that but I don't. you feel like a bad decision your friends say wow you're really discouraged you're depressed you need help go to the doctor and you say it's not a bad decision you go to the doctor the doctor says here is the name of three therapists choose one you need to help him take the names quickly, crumple them, throw them in the trash, 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 found, this comes from the field of affective neuroscience, which is just a fancy title about how moods influence decision-making processes.

It's a fascinating field and speaks to the fact that these are not 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 the choices you make obvious examples if you are angry you will be more or less willing to take risks more if you are afraid you are more or less likely to take risks less your mood influences your perceptions mood influences the quality of decisions and helping people make better decisions. Filtering the mood of the process is one of the most important things we do clinically in the therapeutic work we do, so notice these things, don't isolate, socialize.

I don't feel like stopping drinking I don't feel like stopping why I say stop drinking if you are depressed if you are vulnerable to depression your alcohol consumption should be zero alcohol is a bad drug for people who are depressed or prone to It has been shown that theDepression aggravates the same neural pathways as depression. If you're a depressed person, your alcohol consumption should be zero and when you say that to someone, especially if they're Australian, they say, I don't think so. IM not going to do it. making that bad decision, so part of the task is learning to take actions that are consistent with goals rather than taking actions consistent with feelings, feelings come and go, consequences last and starting to think in those terms becomes a very difficult task. 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 that alcohol is a bad drug I am underestimating it when we look the next risk factor rumination rumination means turning over the same thoughts over and over and analyzing and analyzing an animal at the expense of taking action rumination drives anxiety symptoms rumination drives depression symptoms for people who ruminate they make a lot of mistakes they have a harder time even with the most basic things, like sleeping, because their brain doesn't stop, they're always thinking about their problems, always thinking about the problems, trying to figure out what to do next and the idea, of course, is that thinking about problems is generally useful.

Depending on how you think about them, if you keep analyzing but never take action, you will feel worse. If there is a cure for rumination, your action, but it has to be a timely action, it has to be an effective action, it is not just action for the good. of action that doesn't count as action, so the ability to turn reflection into action and when we look at the things that people reflect on, it's almost invariably about relationships. And probably number two is school-related problems. and work, but relationships are the most prominent and 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. Each diagnostic tag has components. of the components of depression is what is called past orientation people come and say that my past controls me it is because of these traumas in my past it is because of these things that my parents did it is because of these things that happened to me when I was a child and they don't just reflect on the past, although they do, but when I say they also use the past as a reference point, I say they use the past to predict the future, so they say things like: I will never be happy prediction for the future why not because I have never been one I will never get a good job why not because I have never had one I will never have a good relationship why not because I have never had one and of course, the most popular of all.

I won't be happy until my parents treated me better as a child and as long as someone gets caught in that loop they're not going anywhere. Why does it become so incredibly important to convert? to action and I constantly have to remind people whatever your story is you are more than your story you are more than your story you are more than any characteristic you are more than your job you are more than your title you are more than your income you are more than the The size of your body is more than how many likes you get on Facebook or Instagram or any of these other social networks, all of those things ultimately don't matter and can't be the basis for defining yourself and when people define themselves, the problematic thing about having to tell people that you are more than your story is that when people learn that a therapist says who they are, you are a trauma survivor, you are an abuse survivor in one. level that sounds very empowering on another level you are literally adopting the label that says you can define yourself globally by your immutable history the last thing you want to do is define yourself by your immutable history why that future orientation what are the possibilities are if you could get each person absorbed that simple phrase create possibilities there are no guarantees in life but we can take actions that create possibilities for the future there is a danger in thinking too much that the unexamined life is not worth living said Socrates, there is a danger in thinking too much and there is to make a specific discrimination when it is a useful analysis and when it is a useless rumination and I will answer the question if it does not lead to a timely response and effective action it is a useless reflection the next risk factor one of the strongest is what is called a global cognitive style if there is a typical depressed person, which obviously there is not, but if there was such a thing, one of the main characteristics is global cognition global cognitive style means the person engages in overly general thinking their boyfriend breaks up with them she says men his girlfriend breaks up with her women that is too general a thought as if everyone is the same someone has a bad day and no They don't say I had a bad day, they say why life is so unfair now we just move on from a bad day to the life.

Could we make it bigger than that? But what translates is when people walk and sit and tell me. well, all I want is to be happy, that's a lot to ask, all I want is a good relationship, that's too much to ask, and then I'll ask the details, so what do you think it takes to build a good relationship and the person? comes back with an equally global answer when they say chemistry, if you think in those global terms you metaphorically 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 now this is not global In everything, of course, someone can be very specific about the way they manage their bank account and very global in the way they approach relationships and it's the things you don't know about it.

You are inevitably global for general understanding, but you can't learn skills that way. If I want to teach you how to drive a car, I can't tell you to become one with the car. You'll do much better if I say. Look at this, this is a steering wheel, look at that, it's a brake pedal. Getting the details and learning to think in specific terms is a real challenge when your cognitive style is global. Why is it so important to have goals, but goals must be defined? The goal without steps is simply a wish. What that translates to is one of the most important exercises is called step flow.

This is how we train people to move their thinking from global to linear. I will give you the task as your selection therapist. something you know how to do something simple you know how to dress you know how to go shopping you know how to shower well you don't just take a shower that's a global phrase take a shower is a global phrase that represents how many steps are involved so I'll give the client the task of I want that you outline each step involved in taking a shower. I want you to pretend that someone who has never done it before will follow your sequence and your job is to ensure that they succeed, bring it to me next time.

They come back next time. They have three steps. Wet, soap, rinse now, if that's what you think taking a shower entails, what does that say about your ability to be specific and problematic? -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 get in the door and how do you turn? on a light switch and how you close the door and remember to take off your clothes and how about you open the shower door, move the shower curtain and reach in and turn on the hot water and the cold water and then try it and then pressing the switch from tub to shower, by the time you sequence it, depending on the amount of detail, there will be at least fifty steps involved in taking a shower and what if you miss one of them and you didn't know that did you have to press? the change from the bathtub to the shower, so there you are standing, naked, watching the water run down the drain.

I'm a loser, yeah, everyone else can shower and I can't. What's happening to me? And that's the point once I've exhausted myself. take a shower flow of steps then I give them the following now that you have made the flowchart of how to take a shower now I want you to make the flowchart of how to be happy and that is the first time the person realizes that has done it they have no idea and then they instantly discover why it's not happening if you can't sequence what you're trying to do it's not going to happen this requires a very specific quality of thinking that global thinkers find difficult to achieve is a training process that trains your brain to think in more linear terms in the specific areas where you need help, otherwise all you can do is shine, men, women and mists, how to tell who are the good guys from who are not so good. a flowchart for that, okay, so the last one I'm going to talk to quickly, unrealistic expectations, our expectations are the filter of how we judge everything, if I'm doing what you think I should do as a speaker talking about the depression tonight, then you are very happy with me if I am not doing what you think I should be doing then you are not happy with me our expectations are the filters on how we make judgments about anything, whether it is a movie we watch, whether it is a restaurant we Let's ask if it's a party we're going to and the question arises of how to know if your expectations are realistic.

What happens so commonly as a path to depression for many people is that they have unrealistic expectations that they don't know they have. unrealistic expectations so they are always hurt and disappointed. I swear to God every morning. I want to call the White House and say, let me talk to Milania and call her on the phone and say Milania. I understand why you value loyalty. I understand why. Fidelity in the relationship matters to you, but look at who you are married to. The closest this guy will come to saying no to someone is when she says no how are we getting what she wants, it makes sense, but not from him if you really loved him.

For me, you would win the lottery. She doesn't seem that happy and what really makes me curious is her response. I'd love to hear what she says next. Does she tell him that your expectations are a little off since then? the one who has control of the lottery or is going to say I wonder if that's true maybe I don't love you enough maybe I don't know how to love maybe I'm emotionally defective maybe I'm not wrong Something important about your ability to love, so When we look at how important expectations are, it is a very good idea before you walk into your teacher's office before asking a friend for a favor before asking your boss for special consideration before asking your husband or wife for a favor or boyfriend or girlfriend or partner for whatever you want, first it would be very good to know if this person can do this, is it part of the makeup of this person, is it realistic to expect that this person can be honest or that they can? have integrity or that they can have patience or whatever else you want from this person how often do people get into relationships with other people and they are always pulling on them you know I want affection you never give me affection well you know the fact that you are dating mr. .

Spock poses a problem. You have to know who you are dealing with and what. If expectations are realistic before entering a complicated situation. Before entering a job interview. Before anything. Explain it. What are your expectations? As? Do you know if this is realistic or not, if you are good at doing it you will save yourself a lot of disappointment, well, I mentioned it in passing, what impresses me most of all the things I am talking about is that when we have integrated these things into the programs of prevention, the same skills that I'm talking to you about now, when we have run prevention programs with high-risk populations and we have been able to demonstrate in a very scientific way that when people learn these skills, their vulnerability to depression decreases dramatically.

So, for example, we did a program that lasted six months with elementary school kids who were at 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 children were trained in social problem-solving skills and then we followed them for almost ten years. They had less than half the rate of depression, less than half the rate of teen pregnancy, less than half the rate of drug abuse as the kids who didn't go through the program, that's impressive and they are 24 hours of basic skills teaching.

These skills that I'm talking about tonight not only have treatment value, but they also have prevention value. Well, let me highlight. So for you, I'm going to give you some very direct advice to get you through this lecture. Getting professional help is important. You don't know your own blind spots. He is blind to his own blind spots. The things you struggle with and struggle with. and fight with you go see someone who knows what they are talking about and can tell you in five minutes this is whatWhat you're missing here's what we can do about it Problem solved isn't always that easy by any stretch of the imagination, but The point is that it's a good value and having trained eyes and ears on what you're facing, so how do you Do you know when you need professional help?

First of all, suicidal thoughts. Someone is contemplating, even remotely, that is the first sign that you need help now before. you do something impulsive, secondly, when you feel stuck and desperate, when you don't have the support or people around you who you can test reality with before it comes to a head, how often do people wait until everything is on fire and then they go looking for him. help well you don't have to wait until it's on fire how about you take care of it before things get worse that takes foresight the ability to make good decisions I've emphasized when you have to make big decisions I'm going to get to this school or that school I'm going to live here live there I'm going to marry this person Am I going to move in with this person?

Should we let mom live with us or not live with us? Should I accept this job in another city? What should I do? Do you have big decisions to make? You really don't want to take them through the filter of depression. I talked about how depression affects the quality of decision making. It's a good idea to have someone else to test reality with when you know you're affecting other people, the only responsible thing to do is to seek help so as not to contaminate them. Each depressed person, on average, negatively affects at least three other people, and if you know that depression makes you irritable, angry, overly reactive, critical and harsh. and all the nasty things that come out of people when they don't feel well, you owe it to the people who are in your sphere of influence to make sure you get the help you need.

It is important to look for a therapist as in any field. It would matter if we talk about plumbers or electricians in any field, there are better trained people, better trained people, people who have more experience and that means that your job will be to go shopping and have on hand the type of questions that you need answered. Has this person experienced depression? What is your general approach? What is your style? How active are they in the treatment process? Will they assign homework? you will involve other people couples work family work other people who are involved in this problem for you are available for appointments how they do what they charge how long their sessions are that's what I mean by buy to have many questions ready to interview different therapists with who you click with and who you discover by just talking to them, you can tell that there's some juice there and you want to be with this person, so I gave you all these things about how to choose a therapist, let me give you the last two slides with bullet points of very specific advice, if you are dealing with depression, first get a complete physical exam when I say biology matters, this is the starting point to make sure nothing is going on from a medical standpoint. that would lead to depression as a consequence avoiding alcohol completely yes, you make an effort to know your vulnerabilities and develop ways to manage them what are your specific risk factors what are the things that you are reactive to and that other people are not particularly reactive to reactive learn to distinguish facts from feelings beliefs from facts sleep is a vitally important issue it is the number one complaint of people who suffer from depression how it affects their quality of sleep it creates insomnia it is not surprising then that fatigue is the second most common complaint something very important being able to take sleep seriously sleeping with your smartphone it's not a good idea to have your computer on it's not a good idea to have roommates who are playing Jimmy Hendrix at 3:00 in the morning no it's a good idea to be very careful with the environment you create challenge yourself 50 times a day this is what i think how can i know the reality try such an important skill easy exercise to achieve it works and part of the reason why it works is not It is only because of the neurochemical that hypothesis is reasonable but because of another thing about exercise is that the benefits can be achieved very quickly you start exercising today you can barely walk half a block and continue doing so in two weeks you will walk a mile the games happen very quickly and for people who generally have low frustration tolerance this is a good way to get ahead relatively quickly do fun things and do them often one of the first things to go when someone is depressed is their sense of humor there is nothing worse than when you You tell a joke to someone and their response is and it ends there do fun things follow the motto that at least part of the time dare to be superficial stay connected with other people learn to relax relaxation processes meditation visualization guided imagery hypnosis any type of process of Relaxation will be beneficial.

Be goal-oriented in the important areas of your life, but again they have to be realistic goals. If you can't follow the flow of steps, if you don't know what the steps are, then you are stuck in what you want, but you don't really have a plan. Prioritize and solve problems. Get support. Get help. Dont wait. If I'm going to talk about things to do, I might as well talk about things you shouldn't do. Don't dwell on things. The past has passed, but tomorrow has not yet happened. Really focus on what I can do. That will be different in the future.

That will change how I feel about the past. Do not compare yourself with others. This is one of the worst things. social media if you look at social media if you participate in social media how easy it is to conclude that everyone else is having fun everyone else is adorable everyone else is popular everyone else goes to cool places everyone else is doing it and I don't have a path Guaranteed it makes you feel bad comparing yourself to other people, especially when you don't have any information, you know you can't look at a photo and say this is what this person's life is like, that's global thinking, not catastrophes, it helps understand the probabilities. leaving important things unsaid or unresolved closure counts for a lot don't analyze too deeply move on don't ignore reality understand the facts don't ignore your own needs self-care is not the same as being selfish you are the only one who can handle yourself and here there is a key point, as far as I know, no mood expert would talk about curing depression keep this point in this lecture the goal is not to cure depression the goal is to learn to manage your mood death phrase control your state In the mood, you don't exercise once and you're done with exercise.

You don't discipline your child once and now you're done with parenting. You don't make a bank deposit once and you're done. Banking, these are things that you have to manage every day of your life and managing your mood requires skills that psychologists call self-regulation, but the simple phrase managing your mood counts, it's what I'm really talking about, it helps to have a realistic perspective. expectation who gets depressed everyone everyone is vulnerable if you are capable of having moods you are capable of having mood disorders learning to manage that aspect of yourself is vitally important don't give up or be passive try again but do something different don't isolate yourself Find good people to be with and don't leave your time unstructured.

There is much more. I could say that I feel that I have achieved many of the key things to communicate to you. I hope you feel the same. Well, Michael, it's difficult. I think our time has already come to an end. It truly has been a time warp experience in this room. It has been a fascinating insight into depression. Please join me in thanking Michael. We have an Australia that can take. Oh, thank you very much, Anthony. That's how it has been. My pleasure, thank you, it's a Porsche, thank you very much, I really appreciate it, thank you for coming tonight, everyone, I hope it was useful, thank you for coming.