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When you feel depressed

One of the most common things that people come to me for is help with depression. Depression often occurs when one loses access to sources of positive reinforcement or enjoyment. You are no longer doing much of anything that is enjoyable.

So one of the things I work on in therapy is accessing sources of positive reinforcement again. We make a list of reinforcing activities. Maybe it is going on a walk at Tod's Point (a beautiful beach here in Greenwich), going on a weekend adventure to NYC, getting a massage, or even something small like a fancy latte. We also talk about how to get joy out of anticipating these things, how to be present when they are happening, and how to savor the memories. Interestingly, research has shown that sources of reinforcement related to exercise and social activities are particularly helpful for improving mood.

The behavior often has to come before the feeling. Treatment involves setting small, achievable goals to start being active, even if you don't feel like doing much of anything (which is often the case in depression).We also talk a lot about working on being present while you do these things. Using skills like mindfulness when your mind jumps to ruminations or worries to come back to the present moment. This requires practice and patience, and a regular mindfulness meditation practice can help.

Depression can also result due to not living to your preferences. Maybe you value family and would like to be home with your children, but financial and social pressures keep you working. Maybe you value adventure and want to be backpacking the world, but your responsibilities make you feel trapped in suburbia. In therapy, I work with patients to identify their preferences and shift their lives to align with their preferences, to the extent that it is feasible.


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