Treating Depression Without Medication: A Presentation by Bill O. Hanlon PDF

This is a presentation of the School of Behavioral Sciences at California Southern University. Good morning and welcome all of you. It has become fashionable in therapy circles to hold two beliefs. The first, you can\'t change another person only yourself and B, you shouldn\'t change yourself for...

This is a presentation of the School of Behavioral Sciences at California Southern University. Good morning and welcome all of you. It has become fashionable in therapy circles to hold two beliefs. The first, you can\'t change another person only yourself and B, you shouldn\'t change yourself for a relationship for another person. But we change each other all the time. People change for those they love quite often. The relationships that call forth positive change are those that provide a ground of accepting that person. Relationships can illuminate, flaws in one\'s approach to life, by exposing one to other ways of thinking and doing things. Through relationships, we can learn to recognize and change deeply unconscious patterns. So this is a quote by Bill O. Hanlon on Change Relationships and Love. But I ask you, how can we do all these things if we\'re depressed? That\'s why Bill O. Hanlon we\'re so pleased that he\'s going to be speaking today about treating depression without using psychopharmacological approach. So when thinking about Bill Hanlon, these are some words that come to mind. Affirmation, change, diet, echo travel, energy, environment, gardening, green living, happiness, intention, healthy eating, love, meditation, organic recycling, resolutions, self-love, stress relief, transformation, workouts and yoga. So we\'re very pleased to have Bill O. Hanlon with us with a fresh approach to the treatment of a very plaguing problem in today\'s society. Let me tell you a little bit about Bill O. Hanlon. Mr. O. Hanlon is a licensed author, a licensed mental health professional, a certified professional counselor and a licensed marriage and family therapist. He\'s known for his innovative therapeutic approach to the treatment of depression. Bill O. Hanlon has authored and co-authored over 35 books on the touch on hypnosis, one of which is solution oriented hypnosis, another a guide to transplant, tap roots and uncommon case book, and currently is the author of Out of the Blue, six non-medication ways to relieve depression. He has appeared on Oprah, has had over 35 hundred presentations around the world and was awarded the Outstanding Mental Health Educator of the Year in 2001 by New England Educational Institute. So without further ado, let me introduce to you Bill O. Hanlon. Thank you. Thank you very much. Appreciate that introduction. That quotation read that surprised me that you found that, but I was on Oprah\'s show, but also that quotation got in a shortened version got in Oprah\'s magazine. So those are my two big claims to fame that I was in Oprah\'s magazine and on Oprah\'s show. Yes, today we\'re going to be talking about depression and a different approach, and I want to clarify something right away. My fiance is a psychiatrist and she uses the biological approach to depression and mood disorders typically. I am not a medication basher. If I were depressed and nothing else was working, I would certainly go for medications. What I wanted to do today though is talk about, for those of us who don\'t use medications because we\'re not physicians or nurse practitioners, and we can\'t prescribe, what are the other things that one can do? And the other thing is those of us who are therapists and helping people who are depressed, sometimes they\'re seeing psychiatrists, they\'re getting medication, and they\'re still depressed. That is the medication don\'t solve everything. So I just want to make that clear up front. These are six alternate approaches to helping people get traction out of deep and severe depressions or lighter depressions, I guess, if they have those. But most of the time, the ones we see that we\'re having difficulties with are the ones that are so challenging for people and for us as treaters. So we\'re going to be talking about these six alternate approaches that will help people get traction out of it. And one other point I want to make is if you believe in the mind body connection, that is you believe that the way you think, the way you act, the way you eat, the stress levels, the interactions that you have around you, the environments in which you find yourself having influence on your body and your cells. And now they\'re even talking about epigenetics and the gene expression that depending on what environment you have, you can change your biochemistry, you can change your neurology, you can change your physiology. That\'s what we\'re talking about in this presentation, that there are other doors to come in besides the medication doors. So I\'m going to share some slides with you and these slides are going to be available. I edit them all the time. I edit them like up until the morning of the presentation because I\'m always trying to tweak a little, make things a little more clear. They will be on my website for the next while. And my website is billohamlin.com and that\'s B-I-L-L-O-H-A-N-L-O-N.com. And then just go on there and click the free stuff tab and under that free stuff there\'ll be a section called slides. And I will put those up there. I have to strip out anything that I don\'t own the copyright for. So this is a multimedia presentation. There\'ll be some audios. There\'ll be I think maybe even a video of in some pictures and photos and things like that. So those won\'t be in there but most of the content will be in there. So give me a couple of days to get that up on my own webmaster. So you can go to that just billohamlin.com, look at free stuff, click slides and you\'ll be able to download a PDF I think because these are keynote slides and not everybody has keynote which is an Apple based program. So I will put the PDF of these slides up on the site in a couple of days and they\'ll be up there for a while. So if you\'re watching this later after the live presentation where streaming online you can get those slides and you\'re free to use these slides to help colleagues share them with other people. I\'m totally fine with that. I\'ve said I had some handouts as well and you\'re welcome to copy those handouts and share them with colleagues or even clients if you find them helpful or you think they will be helpful to those people. So I called this presentation out of the blue six non-medication ways to relieve depression and again there are other ways to relieve depression. We\'re just going to focus on these particular six. Most people know the typical ones again either medications, psychotropic medications, mood altering medications, neuro psychotropics and most people know the typical cognitive ways that we treat depression. I\'m going to give you six alternate ways because I come from a different background than either that pharmacological approach and that cognitive approach. This is the book that the presentation is based upon. I wrote this for Norton. I came out in 2014, mid-2014 if memory serves and it\'s called out of the blue. Same thing, six non-medication ways to relieve depression. So if you want to go over this stuff I will give you the cliff notes, the summary version of what\'s in this book. There\'s a little more in the book obviously and sometimes I do this as a whole day or two-day presentation. So we\'re going to move through this stuff very, very quickly but if you want to follow up you can get the slides. As I said, you can look at the handouts that I\'ve sent ahead or you can check out the book. So here we go. So the first thing that I can tell you is that I\'m going to be talking about some ways that may surprise you in terms of treating depression and I want you to know I take this seriously and the reason I wrote this book and the reason I teach on this subject is that I was depressed when I was younger. I grew up in a big close-knit family around Chicago area, a big Irish Catholic family, seven brothers and sisters and I went away to college. I went 2,000 miles away. I went from Chicago to Arizona State around the Phoenix area and I was a very shy guy at the time and first time away from home kind of freedom. I didn\'t have much money. My parents weren\'t that wealthy. I\'d saved up money and I doled it out to myself every week or my parents helped me kind of set a budget because I wasn\'t very good at that and I was pretty irresponsible with my money so I wasn\'t eating well. I was buying books and records with my money rather than food and those were priorities for me and I had freedom and I was, I found it hard to make friends because I was so shy and I made a couple of friends but they were about as shy and introverted and also troubled as I was. So I started to be more and more troubled and I found myself sleeping 20 hours a day. I just didn\'t go to class after a while. I didn\'t know what depression was. I never heard of depression and there wasn\'t so much education or public awareness about at the time. I couldn\'t get myself to a therapist. I didn\'t even know that\'s what I needed but I basically became extremely depressed and I became suicidal after a while and so I will tell you a bit of that, a bit more of that story as we go along but I want you to know that when I treat people and when I talk to people about depression I take this seriously because it was almost a fatal problem for me. That is, I almost killed myself and I didn\'t and the fact that I didn\'t and the fact that I came out of my depression is part of what this whole presentation will be based upon. So I will just skip the details for now because I want to save them for another section. I think it will have more impact and so you\'re going to see me there in my hippie days back in the 70s and when I was sitting playing guitar mostly that was what I did or read or slept and I spent most of my time alone. I had a couple of friends as I said but we didn\'t see each other that much and I became more and more depressed and this story, this picture is going to mean something a little later. So the first thing I want to talk about just so we\'re on the same page is challenging some myths about depression that are pretty widespread and believed about it. First because there\'s a lot of advertising now and drug companies have a you know they have a financial incentive to get us to believe certain things they will show you a commercial at least in the US some of you are watching this outside the US but I think this has been spread all around the world that we know the cause of depression and it\'s biochemical and genetic and to tell you the truth if you go deeply into research about depression no one knows the cause of depression or maybe a better way to say it is that it\'s you know genetic components obviously have an influence on everything that we think or do or feel or experience and things that happen in our bodies things that happen in our neurology but most people who know genetic research really well say for common here\'s a quotation from a CEO of a gene discovery company for most common diseases specific genes are almost never associated with more than a 20 to 30 percent chance of getting sick so genes don\'t explain everything the strongest predictor of major depressions has another psychiatrist is still your life experience there aren\'t genes that make you depressed there are genes that make you vulnerable to depression just like there are genes that make you vulnerable to obesity or anxiety or getting cancer or whatever it may be genes do influences so the second myth that I want to talk about is that if we knew the cause and we determined totally the cause which we haven\'t these typically multifactored I think that that would be related to how we intervene so I think cancer is another good analogy for this because sometimes the researchers in cancer research are saying forget what causes it let\'s see if we can intervene in the process of it and so some people are working on angiogenesis starving the cancer cells from blood and so they will give people drugs that will withdraw the blood make sure that the blood vessels can\'t grow very well and then the cancer cells which are a little more vulnerable than the healthy cells die off a little more quickly than the other cells so that\'s an approach that has nothing to do with the cause of cancer but it\'s the process of cancer and that\'s what we\'re going to be talking about in this presentation is intervening in the process and creating solutions so another the myth is that antidepressants are the only effective treatment in there all that\'s needed and I think we\'ve talked about that a bit so we\'re going to be talking about six strategies new possibilities probably that you either have somewhat considered or never considered for effective intervention and these are alternate approaches to use with your clients or patients for those people that aren\'t responding to usual interventions or aren\'t responding to medications if they\'re on medications all right so that\'s the book out of the blue it\'s published by Norton and here\'s an interesting set of statistics we\'re not going to get into too much in the way of diagnosis or statistics but I think this one is illuminating the first is that rates of depression have radically increased in recent years now that could be because of better diagnosis but there was pretty good diagnosis back in the 70s and between treatment for depression has increased between 300 by 300 percent between 1987 and 1997 has gone up a little more since then by 1997 40 percent of psychotherapy patients doubled the percentage of the decade before had a diagnosis mood disorder so either we\'re changing our diagnostic procedures or depression is growing the percentage of population for depression grew from 2.1 percent in the early 80s to 3.7 percent in the early 2000 and increase of 76 percent so are people\'s biochemistry changing perhaps are there genetics changing probably not use of data depressants has nearly tripled from 1988 to 2000 and here\'s a really interesting to me statistic immigrants tend to have the same rates of depression as their adopted culture or country rather than rates from the places from which they came so if they came from Thailand and Thailand had a let\'s say a 4 percent depression rate in the culture and then they came to the United States which has about a 9 percent depression rate in general population they tend to have depression at 9 percent rates if you took a bunch of people who came from Thailand to America so that\'s curious it\'s maybe that they\'re eating different foods and maybe there\'s more stress in this country than there was in Thailand but that does tell you something that it\'s not all genetics and biochemistry right so I\'m gonna go back for this one there\'s a great interview that I heard by Andrew Solomon who\'s the author of this book The New Day Demon and Anatomy of Depression Terry Gross who\'s an interview in the US on a radio show called Fresh Air great interviewer she has him on and he\'s talking about the experience of depression when I heard this I was struck by this because it was the most clear and poignant description of the depression that I\'ve experienced and that a lot of people that I work with in psychotherapy have told me has been their experience now everybody\'s experience is a little different but if you haven\'t experienced depression or you don\'t know it from the inside out very well as I do and other people have experienced to I think this description is a really good one so let\'s just take a moment and listen to it I have my first release of your breakdown in about 1994 I have been going along about my life and I\'ve been through some things that were quite traumatic and quite difficult the most striking one being the death of my mother at the end of a long battle with cancer and I was feeling very down and very blue and rather grief-stricken I had some additional personal traumas and then I began to feel really increasingly sad and then I began to feel sort of numb and then I began to find that things were just a little bit effortful and that I didn\'t seem to be able to muster very much in motion about anything and then things began to become more effortful and I would get home and have messages on my answering machine and I would think all those people I need to call back all of those people and I think I have to go out and I have to get things to eat I have to get through the day and it all seemed like somehow more than I could manage to do and I thought that was very strange but I was still able to keep up with the solid functioning reasonably well and I assumed that it was just a temporary thing and I didn\'t really pay very much attention to it and then it began to get more severe and I began to have this feeling of grit and anxiety which was sort of like the feeling you might have if you had tripped and you were about to fall that sort of middle of the air feeling before you quite hit the brown but it was extended and this feeling of grit got worse and worse and I began coming home and fearing messages and answering machine and thinking not simply that I didn\'t want to call people back but that I didn\'t know how I ever could have ever think who are those people how am I ever going to catch up with them what am I ever going to do how am I going to and there were just messages from friends and people who wanted to be in touch and I think I have to get dressed I have to put on my clothes I have to put on both socks I have to put on both shoes and the whole business of ordinary daily life began to seem so effortful and so overwhelming and I really didn\'t understand what was happening to me but I kept trying to battle through it still thinking this doesn\'t make any sense this is so so weird and then I became more anxious and more and more know and I had more and more this feeling that was a mix of sadness and fear until finally I thought I simply couldn\'t do anything and I found myself at last line in bed one day thinking I can\'t get up and I\'m either thinking I can\'t put the toothpaste on my toothbrush I can\'t brush all of my teeth it just seemed like such an overwhelming task it seemed much more frightening and much more overwhelming that at this point it seems to me for example to come and do any interview on national public radio and I thought how am I how am I going to get out of bed and I lay there in bed just shaking with fear and feeling completely unable to do anything and feeling no emotion of any kind except that fear and anxiety and I thought I have to call someone I have to get out of my apartment and I couldn\'t reach for the telephone I say they\'re staring at the telephone thinking you just pick it up and you don\'t know that I simply couldn\'t do it unfortunately someone called me and I said something has come terribly terribly wrong with me so again I think that\'s a very pointed description very close to my description or my experience of being depressed and again many people with whom I\'ve talked about that if I don\'t know I don\'t know if you know that Lincoln our American president was suffered what was called at the time melancholy suffered from melancholy basically depression and that he had two really severe depressions in which he was suicidal and friends had to keep suicide watch on him 24 hours a day in the first one they had to hide all the sharp objects in his house and they had to sit with him for 24-7 and he had very good friends he was a very good friend maker Lincoln and I found this in one of the letters he wrote to his best friend and he said on his second depression his friend had moved to a different part of the country I am now the most miserable man living if what I feel were equally distributed to the whole human family there would not be one cheerful face on the earth whether I shall ever be better I cannot tell I awfully forebowed I shall not to remain as I am as impossible I must die or be better it appears to me now we\'ll get back to something that moved Lincoln you know in a little while when we go through one of these strategies but Lincoln did not kill himself in part because he thought he had something to do on this planet and he couldn\'t die before he left a legacy and had contributed to his fellow human beings so we\'re going to get back to that as one of the parts of one of the pathways out of depression so here are the six strategies and I\'m just going to give you an overview of them and then we\'ll get into the details of each of them one I call marbling and I\'ll explain what that means in a moment it\'s probably a little confusing to you or known to you at this point second one is I call undoing depression the third one is shifting the relationship with depression the fourth one is challenging isolation and restoring and strengthening connections as a pathway out of depression fifth one is a future with possibilities and this one really worked for me so to work for Lincoln as well and the sixth one is called restarting a brain growth so let\'s just get into him one at a time the first one is marbling and what I mean by marbling is my father was in the meat business when I was growing up he had studied to be a lawyer rebelled against his father gone to the meat business because he started sweeping the docks at a meat company and then he worked his way up and he owned his own company and he taught me about meat because he said this little white part in the meat is called marbling and it\'s the fat part and it\'s what gives the meat some different flavor and I really like that there most of its meat there\'s a little fat and that\'s called the marbling I started using this technique when I was working with people with depression because one of the things that characterized depression is sort of all or nothing thinking it\'s like oh everything\'s terrible and when I was suppressed I would look back on the past and I couldn\'t remember a good memory I would only remember the bad things or even good things I would have a sort of an opposite of rose colored glasses view of them I would have a negative view of even good things that had happened I would dismiss them or I wouldn\'t remember them and so marbling is this sense of helping people have a more complete view of their experience rather than this one side of view that their current experience the depression leans them towards that they\'re remembering and they\'re perceiving things in a very negative or dreary light or horrifying light or flat light one of those one of those things and those are typical in the depression experience so what I\'ll do is I\'ll go back and forth between tell me about depression tell me about times when you aren\'t depressed tell me about your experience of when you can\'t get out of bed tell me experience when you can get out of bed so instead of being positive and just saying cheer up or it\'s not so bad I\'ll sort of smuggle in a more nuanced view of their experience and what I find is even during the session when I\'m doing that people get a little less depressed because and again this sort of goes back to brain science this new stuff we\'re learning the brain tends to get grooved and the more you think of depression and the more you talk about depression typically the more depressed you get but what are we doing as therapists we\'re talking to people about their depression which of course we have to do to find out about it and to help them about it but if we do it too much we\'re part and parcel of the problem sometimes and we\'re helping them groove in those depression kind of grooves so I want to investigate times and aspects of non-depression while finding out about the depressive experience so I go back and forth and I want to get a map of tell me about what depression looks like tell me about what non-depression times and as I do that they tend to get a little less depressed and also I find some resources which we\'ll use in a little while so there\'s been some research on this focusing mainly on depression could actually add to the problem a recent study had people talk to each other about problems and they found that their stress hormones increased which predicts you know cortisol they had more cortisol in their system which predicts increased anxiety and depression over time so people are sometimes kind of talking themselves into and we as counselors or therapists are talking them into more depression not realizing it when we focus only on the depression now you can\'t not talk about the depression because you don\'t want to deny it or minimize it but if you exclusively talk about the depression it could be a problem so there are some research studies that have come out of the positive psychology field this this study of what helps people feel better and feel happier and feel life is more meaningful and all that stuff and one study found that when people who are naturally pessimistic which is correlated with depression who spent one week doing exercises in which they identified they had them do three or four different exercises so they had three or four different phases of this or sections of this study this was done by Martin Seligman and his colleagues some of you know his work one is they had a bunch of people who rated themselves severely to moderately depressed and they wrote down identified wrote down three times in the past when they were at the best they had another group write down their personal strengths they had another group expressed gratitude to people they\'d never properly sang and they had another group write down three good things that happened when they measured their depression level six months there and their happiness levels they were all less depressed and happier they did another one they had people fill out a survey on their website and they found people who are severely depressed and they asked them for 15 days to just recall and write down three good things that happen each day for 15 days and 94 percent of them took that it was a Hamd scale for depression Hamilton D and 94 of them went from severely depressed to mildly or moderately depressed during that time now if I could get my clients from severely depressed to mildly or moderately depressed I could get them to a lot of other things that would help them get out of depression so I thought that was quite shocking to get these very simple interventions that help people kind of bring in some positive things in the midst of their depression and that\'s the case that I\'m making in this particular particular thing there\'s been an overview of meta-analysis done by Leah Brimersky, Sonia Leah Brimersky, and a colleague and they found that 51 positive psychology interventions over over 4,000 individuals when they threw all these studies together they found that positive psychology interventions do significantly enhance well-being and decrease depressive symptoms so this idea that you only have to talk about or deal with the depression you can\'t bring in anything else into the sessions I think is was wrong-headed and these studies point us in that direction so be careful of course of just minimizing or being positive and the way I do this is what I call acknowledgement and possibility I move back and forth between depression and non-depressive moments and experience this just you know validates people in their depressive experience and it gives them the other message that it\'s not always going to be that way and it\'s not all that way at this moment it hasn\'t been all that way in the past so it gives them a reminder that they aren\'t always and haven\'t always been depressed they can also eliminate and give hints to skills abilities and connections that could potentially lead out of depression or at least reduce depression level so sometimes I\'ll say so you know really hard for you to get out of bed to come to the session today how did you get out of bed I\'m really curious about that and so we\'ll go back and forth between acknowledging how hard it was to get out of bed because they had very little energy very little motivation they could barely move but somehow they did get dressed and come into the office so I want to find out about both sides of those and this is a letter from Abraham Lincoln who he sent it to a woman a young woman who was suffering depression from depression and this woman young woman was the daughter of one of his generals and he knew he had known this young woman since she was a child and she was in her 20s and she was so devastated by her father\'s death that she got depressed and she hadn\'t been out of bed in months maybe close to a year and he found out about and he wrote her this wonderful letter which for me illustrates this whole acknowledgement and possibility acknowledging the pain and inviting the person out of the pain acknowledging the depression and the hopelessness and inviting people out so I\'ll just read it to you dear fanny this is Abraham Lincoln writing to this young woman it\'s with deep grief that I learned of the death of your kind and brave father and especially that is it affecting it is affecting your young heart beyond what is common in such cases in this sad world of ours sorrow comes to all and to the young it comes with bitterest agony because it takes them unawares the older have learned to ever expect it so he\'s normalizing grief is a part of life and this terrible experience is part of life here\'s the next part of the letter I\'m anxious to afford some alleviation of your present distress not all alleviation he\'s saying some alleviation perfect relief is not possible except with time I loved how he slipped that in like you won\'t get better except over time you cannot now realize that you will ever feel better is this not so I really love these lines because I studied with Milton Erickson who was an eccentric psychiatrist and he used to do double negatives sometimes you can\'t not change weird stuff like that and that he\'s Erickson once said to me if you can\'t say the no the patient will say the no and there\'s a lot of no in here but it\'s ultimately saying yes you cannot now realize that you will ever feel better is this not so and yet it is a mistake you\'re sure to be happy again to know this which is certainly true will make you some less miserable now I have had experience enough to know what I say and you need only believe it to feel better at once I just thought this was such a great example of acknowledgment and possibility so what I typically do is like I just ask people teach me what depression looks like when you\'re living in Depresso land tell me what that looks like and when you\'re living in non-depresso land or when you have lived in non-depresso land or when you might in the future live in non-depresso land so I just make a map of both things and so I had a client who was having trouble getting out of bed she wouldn\'t get out till noon she\'s staying up for jamas all day she\'d take a shower at seven o\'clock at night she wouldn\'t see her friends she would quit her job or call in sick and I said well so tell me about a day when you\'re not depressed she said well I get out of bed I get dressed right away and I get out of the house now that\'s a big difference between those two days so I\'m just asking her about tell me about a day like this tell me about a day like this tell me about your experience here tell me about your actions here and I\'m just comparing and contrasting and what she ultimately worked out is she had to make appointments with friends because she would feel too guilty canceling them and get herself out of the house even on days when she was depressed and she was able to move herself out of depression a lot quicker than she usually did the medications weren\'t working and other things weren\'t working and she was able to do that given this that we found some of the patterns of non-depression and imported them into depressal it all right so I usually make sure that I\'m including the negative and the positive so I\'m not just polyanish and positive about this because when people are depressed they sometimes can\'t take in the positive so the first thing I do is give permission to be depressed and not to be happy or cheerful and so it\'s okay to feel depressed you don\'t have to have hope right now I also want to acknowledge that they sometimes have opposite experiences you can be hopeless and have hope at the same time and I talk about exceptions you feel hopeless except when you don\'t I mean sometimes people who feel hopeless come to therapy now why would they come to therapy if they didn\'t have some measure of hope so I want to include and there are three ways to include as you see here on the slides permission to and not to inclusion of opposites and exceptions to the usual rules all right so what I want to do another thing I want to do is part of this marbling is discover exceptions to the rule of depression or the patterns of depression discover resources and solutions so I find out about moments of non-depression I find out what happens when the depression starts to lift differently from when they\'re in the middle of it and I ask why they\'re not more depressed or why you know and without being provocative why they haven\'t if they\'re feeling suicidal why they haven\'t killed themselves what stop them they say oh I wouldn\'t do that to my kids or you know I couldn\'t do that to my family or I feel that I\'m on this planet for some reason you know like Lincoln thought so I sometimes will get the other side of things when I ask about resources and solutions and exceptions and I sometimes find out of area about areas of competence where they can import some resources and solutions and some patterns and some ways of thinking and some ways of interacting that again bring in a little more nuanced difference from the depressed kind of all or nothing it\'s all terrible kind of experience all right so moving on pretty quickly because it took us a little while to do this introduction here and we\'ve got to get through five more here I\'m doing depression the second one and it\'s related to the first one in some ways what I I mentioned that I studied with Milton Erickson and Milton Erickson did this thing he wasn\'t so interested in the diagnosis he was interested in the pattern of things like the pattern and cognitive therapy does this too what\'s the pattern of thinking what\'s the pattern of behaving what\'s the pattern of interaction what\'s the pattern of perception what\'s the pattern of memory and so what I\'m trying to do is figure out if you were going to teach an actor to do depression like a really good actor a method actor who really knew how to get into a character and you say do you know I want to I want you to be a depressed person in her next play or movie they would you know they would wear certain clothes they would act certain ways they would talk in certain voice tones there are patterns and the way I think about this is maybe there are parts of depression that you can\'t do much about the genetic biochemical parts but there are parts that you have some influence about how you speak how you act where you are what you wear all that stuff and I want to find the patterns of how the person does depression I don\'t mean this in a blaming way it\'s like you create your own depression and you\'re responsible for it I\'m trying to find out the leverage points the places where they could have a moment of choice and dress a certain way or look up instead of looking down at the floor whatever the patterns that repeat when they\'re depressed I want to find out what are the opposite of those patterns how could they undo depression rather than do depression so I want to discover repeating patterns involved with and associated with oh sorry there\'s a typo there depressive experience and help the person change those patterns in smaller big ways and the three places I typically look are patterns of doing that is what they do and that includes what they say how they act and how they interact patterns of viewing and that includes what they\'re paying attention to and how they\'re making meaning of things and patterns of context that is where they are around whom you know they spend time or do they spend time alone are they in nature are they in their bedroom are they in their living room are they where are they and around what\'s surrounding them there\'s some evidence of being out nature is healing but most people of course when they\'re depressed spend a lot of time inside polishes they\'re not even seeing nature so I\'m trying to find what repeats again and again in the doing the viewing the context and I\'m trying to find anything to move them out of that any other patterns so any place that they have a moment of choice and again you don\'t want to do this in a blaming way or you know of a way that maybe if they don\'t have a choice in that area you\'re not going to focus on that but I want to find any patterns and so you know I study with Milton Erickson as I said and he was a hypnotherapist and after I studied with him I started to look and think and hear of my clients who were depressed as like being in a bad trance and what I mean by that is they repeated the same thoughts the same feelings the same actions the same patterns over and over again and it was almost like a bad trance induction it was like you know when the when the hypnosis goes you\'re feeling sleepy you\'re feeling very tired you\'re going deeply they repeat things in this rhythmic way well I started to think of symptom trance depression trance as the repetition of things and if I could help people change those patterns or break those patterns they would come out of that bad trance so that repetition I\'m not going to tell you this story is going to take a long time but one of the first places I realized this is I was studying with Milton Erickson as I mentioned the psychiatrist with whom I studied amazingly creative hypotherapist and therapist and one time he told me he was working with this guy this guy was depressed and he just couldn\'t get anything going with this guy and he said to the guy okay I want you to go to be depressed in a library and I\'m thinking as he told me to start I\'m like what difference will that make and this guy goes to the library and every day he\'s sitting there depressed but because he\'s at the library you know he gets a little bored and he goes to the you know the stacks of books and magazines and he he\'s kind of curious about exploring caves spelunking they call it and he\'s never done this but he\'s at the library so he gets out a few books and a few magazines he asks the library and the library shows him where the section is and he\'s there and he\'s taking down books and he\'s looking at it he\'s not really going to do anything but he\'s just learning about this stuff because he\'s bored and he\'s depressed at the library all day this is days the hey days at public libraries and so one day when he\'s going to the stacks and he\'s picking up some magazine or book a guy is there looking at the same kind of material and the guy turns to him and says hey I just read about this I\'ve never actually done it have you ever explored a cave in the the depressed guy of that\'s Erickson\'s client patient says no I haven\'t he said well how about this weekend we try it together because neither of us know what we\'re doing but if we read some of this stuff we\'ll know how to do it a little better and so they make a date they go out there and they explore some caves and this guy makes a friend and they start exploring caves and the guy gets kind of excited the depressed person gets kind of excited and he\'s made a new friend he\'s less isolated and Erickson\'s telling me his case the guy ultimately comes out in depression and I\'m thinking how did Erickson know that sending him to the library would do that and later as I learned more about Dr. Erickson\'s work I realized he didn\'t know and he didn\'t tell me about the 100 cases where he said someone to the library and it didn\'t work but he just knew that if the guy was staying home he was probably repeating the same patterns if he could get him in a new environment something new might happen and it did in this particular case all right so sometimes I joke with my clients when they come in depressed you know when I use humor in my even with depressed people I don\'t I don\'t do it if it\'s inappropriate or if they\'re not going along with it but what I find is often they do get with it and they start to laugh even in the midst of a deep depression so I\'ll say look it teach me how to do a good depression your style because I majored in depression at college you know I told you that story and I tell them a little you know I was really depressed when I was younger and plus I\'ve treated all these people who are depressed so I know how to do a good depression so I\'ll just list all these things and say which one of these you typically do and so first thing if I were going to create a good depression I would stand still stay still don\'t do anything like exercise that makes you breathe faster hard because that will put your depression at risk and all of a sudden people are smiling a little even when they\'re depressed when I\'m using this kind of language and I say you know so if you can stay in bed if not sit in the same chair or lay on the couch make sure you don\'t move a lot secondly isolate and avoid other people right make sure you\'re not around other people and if you can avoid other people try to talk to the same person or few people and talk to them about the same subject usually how depressed or unhappy you or they are you know pick somebody who\'s depressed as well or who\'s very unhappy and you can commiserate with one another sleep during the day and having somebody at night which is part of the isolation you\'re sort of out of rhythm with other people brewed on the past your fears your faults and resentments imagine that\'s future will be the same or worse than the past or the present eat terribly overeat or under eat whichever one you specialize in eat junk food sugar fat you know eat terribly basically don\'t pursue your hobbies or passions their spiritual interests drink alcohol smoke cigarettes or use other drugs again whatever you might specialize in don\'t ask for help and by the time I get to the end of this lesson I say now which one of these do you specialize in people are chuckling sometimes laughing as I\'m reading the list and they say oh I do that brewed on the past you know or I do that sleep during the day and having somebody at night they\'ll tell me which one or sometimes I\'ll say I don\'t do any of that I do this but by then I\'ve sort of prompted them to describe it in action terms rather than being terms like I\'m just depressed and there\'s nothing I can do about it so this makes it so that they it empowers them in some way so they might be able to do something about it so what I do is I try to identify patterns locations and places activities timing and duration of something that they do or think and then sequences what happens first what happens next what happens next and I try and help them mess around with those patterns and do anything that\'s not depression so that\'s why I call this one undoing depression who are they around that kind of stuff all right third one again moving on fairly quickly here and just for time purposes shifting the relationship to depression now this doesn\'t involve actually changing the depression but changing how you experience it or view it or relate to it so the first thing is mindfulness there\'s a lot of research is coming out that mindfulness can reduce suffering in the midst of suffering so people have chronic pain and people are experiencing depression they practice and learn a mindfulness technique it doesn\'t have to be you know any religious or spiritual thing it\'s just a technique of noticing without judging and noticing variations in your sensations feelings thoughts and experiences around depression so you can actually practice formal mindfulness meditation or you can just become mindful and be attend to your experience without judging like this is terrible I can\'t stand it you notice that your mind is telling you this is terrible I can\'t stand it you don\'t have to change that or fix it you just notice without judging and then you notice when it goes up and down and changes a little because most people when they think about their depression experience they think it\'s all the same I\'m always depressed but if you actually pay closely to close attention which some people who\'ve been trained in mindfulness do like Buddhists who get depressed they notice when they just stay with their experience that there are ups and downs and sometimes they\'re actually out of depression during moments in the day but most of us miss that because we go oblivious and we don\'t attend to our experience same thing with physical pain so externalizing is the next one this comes from a technique of psychotherapy called narrative therapy and narrative therapy has this really interesting method of depersonalizing the problem that is most of us they say start to take it in I\'m not just depressed I\'m a depressive personality or I suffer from depression or I have depression or I am depressed it\'s an internal experience and narrative therapy has this way of kind of helping people move it out of themselves they say when depression comes to visit how do you relate to it do you always believe everything the depression tells you that you can\'t get out of bed or that you\'re a terrible person or that life is meaningless and there are there\'s a set of procedures and again we won\'t have time to go into all these procedures here just for time purposes but it\'s a powerful technique with a set of questions that externalizes it\'s like you know they talk about the depression in therapy as if it\'s an external unwanted influence and then it\'s a sort of a bullying and undermining influence and again we don\'t have time to go into all the details about this but there\'s a rich literature in narrative therapy so if you haven\'t found out about it there\'s a book by friends of mine Gene Combs and Jill Friedman called narrative therapy that I think is a good introduction to and published by Norton and so if you want to find out about it it can be a really powerful and I\'ve seen some videos of people who do narrative therapy working with people who are depressed and it\'s a pretty brief therapy and rapid approach when it\'s done with art and with respect next one is valuing depression is you know I just went through a terrible loss of my my adult son died last month and I had therapist friends call me or write me and say hey I\'ll do therapy with you and I thought why would you do therapy I mean I\'m just in grief I\'m just experiencing what you do when people die when you\'re sad now if you get stuck I can understand going through therapy but grief is just an experience same thing with depression if you have a particular relationship to it you say you know there\'s a value to going through hard times in life there\'s a value in Milton Erickson my teacher said the Erickson family in the Erickson family we think of troubles in life as the roughage of life that helps life keep moving and I think of the same thing after being a therapist for 40 some years I think you know emotions are just emotions trouble is just trouble depression even as terrible as it is if you stop resisting it you can sometimes reduce the suffering and again that goes back to mindfulness but even more if you can mind the experience for something that transforms you or helps other people you know because I\'ve been through tough stuff in my life my own depression and other things I can be more sensitive and pathic with other people so can you mind the depression for value the last one is follow your wound I became a therapist in part because I\'d been depressed when I was younger and I\'d come out of it and I wanted to help other people so I made meaning out of my suffering and I found a direction in life from the crisis and pain of depression now I\'m going to go through some fast stuff here there\'s a bunch of research on mindfulness partly because just you know time purposes I\'m a little behind where I wanted to be here there\'s a whole bunch of research on what\'s called mindfulness-based cognitive therapy where they teach people this approach to not judging your thoughts and just noticing your thoughts and they found that in these studies that mindfulness-based cognitive therapy is definitely as cost-effective as prescription drugs and it also helps people stay better longer that is in comparison with people just being on medications they get better and stay better longer when they use mine from the space cognitive therapy so again when you get these slides you can get all the research here I\'ll give you some of the references on the slide so if this is something you\'re interested in you can learn about it you can find out about the research and also find about the methods of how they do it externalizing again there are techniques for externalizing and I\'ll just give you the quick overview on the slides and then this valuing depression can there there\'s some evidence that depression can help focus attention and reduce its distractibility help people think more deeply about their situations so following your wound that certainly was true for me and it\'s certainly true for some other people that have experienced deep troubles in life but depression being one of those troubles and I say that there are two energies that are negative energies that if you can transform them become the things that tell you what you\'re supposed to do with your life so I call these pissed and diss you\'re angry about how people responded to you or other people that had depression or you\'re sensitized that\'s the dist energy to to this particular problem because you\'ve been through this problem all right so again we\'re going through this pretty quickly here and the key is to transform these things rather than just use them as wounds so the fourth method here I\'m just making sure I\'m staying on time here it\'s challenging isolation most people who have emotional psychological behavioral problems they suffer from this that is other people either push them away or withdraw from them or they pull away from people or withdraw from other people and what it turns out is that human beings generally do not do well in isolation that is we were evolved in groups and tribes and it\'s partly how we succeeded on the planet we were able to band together and help each other and raise the vulnerable infants because other animals are born already able to be functioning on their own but human beings aren\'t so you need a tribe around you to protect the infants to protect each other against predators that have sharper teeth and stronger muscles than we do and can run faster than we may isolation is not good for human beings and depression invites people to isolation and disconnection and it turns out there\'s a bunch of research that says the more you connect the better you do the that is the quicker you come out of depression again I mentioned I\'ve just been going through grief experience and I post every day on Facebook I play music and I post a song a day and when my son died or was dying I said to my fiance oh I\'m not going to post a song all the day and she said no you have to that\'s part of your daily thing and I think it\'d be really good to continue it and I did because I was a little messed up and she was clearer thinking than I was and it\'s been an extraordinary experience to grieve with a community of support and I realized how powerful that is the grief was a lot you know it was still difficult but it was a lot easier to bear when I had so much love and support and kindness surrounding me and I think that the problem is when people to get depressed they don\'t want to be around people because it\'s too painful or it\'s too embarrassing or they feel like they are burdened on people so they either pull away from people or they act kind of irritable sometimes when you\'re depressed it\'s hard to be around people and you\'re not as patient and you\'re irritable or you\'re just no fun to be around even if you\'re not irritable you\'re kind of negative or depressed or flat and other people naturally withdraw from you so challenging that isolation is the fourth method and I\'m sorry we\'re not going to have time to play that it\'s an interesting example so sites here\'s the problem why are we having more depression one of the explanations is that social isolation is becoming much more common in modern society you get the family that goes on vacation and they\'re all four of them are looking at screens rather than being on vacation with one another so shared family dinners and family vacations are down over a third in the last 25 years having friends to your house is down by 45% over the last 25 years participation in clubs and civic organizations is down by over 50% in the last 25 years church attendance is down by a third since the 60s all these places where we naturally connected with people socially the average number of people we consider close confidants dropped nearly one third from 2.94 in 1985 to 2.09 in 2004 and it may have gotten worse since then the average American has only two close friends one of four Americans 25% report they have no one to confide in average household size has decreased by about 10% during the past 20 years we live in these big houses pretty much on our own in 1990 more than one half five households were headed by a single parent currently is one in three 6.27 million people in the US live alone that\'s expected to increase this was old statistics to 29 million by 2010 people with five or more close friends this is from the general social survey at the University of Chicago excluding family members are 50% more likely describe themselves as very happy than respondents with fewer so you\'re at risk if you\'re isolated i heard uh Robert Putnam who wrote the book uh bowling alone say that it\'s more of a risk than than smoking is for health conditions if you have few friends that isolation is a worse stressor risk factor health wise and now we\'re talking about depression stuff of course than than that so i think there are seven pathways to help people connect the first juror within themselves help people connect to their inner selves their deep self their heart their soul their intuition the second one is connect to their body their physical self and sensations and people are depressed tend to dissociate a bit they aren\'t so in touch with themselves because it\'s painful or difficult but if we can help them make that connection back to their inner resources then to their social resources another being that may be an animal if they don\'t want to be around people one close friend who understands and is accepting and doesn\'t pressure them or doesn\'t you know shame them for being unhappy or flat or hopeless or whatever it may be and maybe that we as the therapists are that connection uh others to see if they can connect with a group or community as i mentioned going through grief in this community setting was quite a different experience than i think it would have been then the last three are connecting with something beyond yourself or beyond others connecting through art some people transform their experience through art some people through being in nature as i mentioned there\'s some good exam the good research that says being in nature is healing you know you can be depressed inside or outside or with a view of the outside and it seems to help to have connection to nature the last one is to have a bigger meaning and purpose that that\'s what Abraham Lincoln did when he was suicidal depressed and suicidal he couldn\'t kill himself because he thought he had a bigger purpose for being here turned out he was right obviously he made a big contribution in the world he just wouldn\'t let himself kill himself before he\'d fulfilled his life purpose so that for some people the bigger meaning is god or higher power but that connection if people if it frays or they\'re lost they sometimes lose their way and so it can be any of these or any combination of these and i investigate where people have lost their connection and help them restore their connection all right number five and we\'re moving on pretty quickly as i said because we just got a few more minutes and then i\'ll take some questions number five is a future with possibilities and this is my story actually when i was suicidal when i was depressed i had three friends and i thought well if i\'m going to kill myself it\'s kind of rude my friends will be really shocked i\'m going to go say goodbye to them my first two friends were about as depressed and alienated as i was and they understood and they said oh yeah i\'m just too afraid to kill myself so i admire your courage was basically the the gist and they offered me you know condolence and support sorry you\'re gonna have to die but you know we were hippies and we had these woo-woo beliefs and they said i\'ll see you next life basically the third friend i went to was more normal and she was like what are you killers why would no you can\'t kill you and i said oh you know i just don\'t think i\'m meant for this life you know i\'m just too sensitive i can\'t be around people i\'m depressed you know i didn\'t know the word depressed but i\'m unhappy and i feel like i have no skin and when i\'m around people everything hurts i just feel all nerves and you know i want to write my poetry i don\'t want to be around people i want to play music i can\'t imagine making a living because i can barely get out of bed and she said look it i have three aunts they live in Nebraska i\'m their favorite niece they don\'t have any children they tell me when then they die i\'ll inherit everything they have and one of the things that they\'ve done is invested in farmland in Nebraska when the farmer when the you know food prices were down the farmers would sometimes sell or if they retired they invested in these farmland they would lease it out to the next door neighbor farmer and she said when i inherit one of these there\'s always an empty farmhouse on one of these farms and i promise you if you\'ll promise me you won\'t kill yourself you can go live in one of these farmhouses rent free you can write your poetry play your music you don\'t have to be around people and you can grow your own food which in my delusional state at 19 i actually thought i could do i tried it years later it was very difficult um and she said you don\'t have to be around people you don\'t have to make a living you could sleep all day you know if you need to and i thought well that\'s a possibility but i didn\'t bite too quickly and i said how old are your aunts and she said they\'re in their 60s and you know i was 19 and i thought well they\'re almost dead they\'re like ancient but it turned out they lived till their 90s but um i didn\'t know that at the time and so i thought well the odds are in the next few years when i was in university and sort of this protected environment one of them was going to kick off and i wouldn\'t be able to go live in that farmhouse what happened for me immediately as i wasn\'t suicidal i was still depressed but a little less depressed because i connected to a future with hope where i\'d have less pain and less suffering and so for me that was really really powerful to connect to that future and i think one of the things that happens for people are depressed is there\'s a collapse of the future that most people in life are a little future-minded but people are depressed are so stuck in the flat present or focused on the unhappy past and when they look forward all they can see is a repetition or an increase in that unhappiness or that flatness so if we can restore their whole connection to a hopeful future it can really make a difference so that\'s this strategy the fifth one we\'re talking about i call this future poll that you know victor franco once told once told a story that i heard that was really moving to me he almost died in the death camp and he imagined himself after the death camp doing something meaningful and brought him out of that so that farmhouse in my future was like what victor franco said these difficult moments we can be pulled through them that\'s why i call it future poll by something that\'s worth living towards even when you\'re suffering in the present so i think that most of the time in psychotherapy we\'re focused on the past which is typical for psychotherapy or the difficult present and i sometimes turn that on its head and when people are depressed i don\'t talk too much about the past or i don\'t ask them too much i don\'t ask them too much about the present i do a little as i\'m doing that marbling we talked about it first i definitely want to know a little about that but then i start to focus on where would you like to be if life was how you wanted to be if you could come out of this depression and then i start to say and when you come out of this depression so that\'s part of it so that farmhouse in my future was my experience of being pulled through my depression and so i sometimes do a technique that i call problems into preferences so when people tell me about what they don\'t want or how depressed they are i invite them to tell me what they would want by saying okay so you haven\'t been able to get out of bed very easily when you\'re able to get out of bed how will that be so i focus on the future instead of the past and i do this with positive expectancy language when you\'re able to get out of bed first i say if you\'re able to get out of bed and then after a while i start to seed in a little when you get out of bed when you come out of the depression when you\'re feeling more hopeful when you have more energy i sometimes have them write a letter from themselves in the future when they\'re through depression they\'ve come out the other side to their present self who\'s suffering and discouraged and then one of the first questions i ask when they come to therapy is how will you know when we\'ve done enough so that you can leave therapy now that\'s a different question than what brings you here or when did you start suffering from depression i\'m usually starting therapy in the future rather than the past and so all these techniques are future-oriented techniques which again is counterintuitive a lot because most psychotherapy is focused on the present or the past i\'m often doing psychotherapy focusing on the future and so the sixth one and this is the last one we\'ll cover and this is one i say the best for last because this is one the most exciting to me there\'s a whole bunch of research on the new brain science and i think it\'s really relevant to how we can help clients who are depressed when we don\'t have access to medication or when the medication hasn\'t helped so much and this will also give an alternative explanation for why some of these antidepressants might work different from the theories you see on television or you\'re here touted by a lot of neuropsychiatrists and that is this is called a neurogenic and neuro atrophy hypothesis of depression and how to use it in treatment so let me give you a quick overview of the new brain science there\'s been in the last 30 years 25 to 30 years has been a revolution in neurology and brain science understanding when i was an undergraduate i went to Arizona State as i mentioned out near Phoenix and Tempe and i took neurological psych and what they told us in neurological psych and this wasn\'t that long ago it was in the 70s that\'s when i was a psychology student they told us that the brain once you went past you know childhood and early adolescence it was pretty much fixed you didn\'t grow any more brain cells and you didn\'t make any new connections the brain function was pretty static at that point there was a occipital lobe that had to do with this and there was the you know the broken brain you know that had to do with processing light and things like that they were fixed areas of the brain well that has all changed in the last 25 to 30 years revolution in brain science so the old views said the brain had a fixed structure set number of brain cells one of my teachers told me don\'t ride a motorcycle because you only got so many brain cells and when you jiggle your brain some of them die so you\'re gonna be killing off brain cells turns out there\'s billions of brain cells so that\'s crazy idea the other crazy thing is so basically the idea is those brain cells were fixed the brain function of the number of brain cells was fixed they decline over the aging process and with damage from trauma so if you give traumatic brain injury you lose a bunch and they never come back it turns out that\'s not true the new view is brain plasticity brain can grow new cells and make new connections throughout life and this was radically and not a radical view when it first came in the in the 70s in the late 70s early 80s and really came to its uh to the fruition in the 90s in the early 2000s now almost all neurologists and all psychiatrists believed this but at first they didn\'t they fought it brains can grow new cells and make new connections throughout life brain and body experience alters destruction structure and connections in the brain strengthening and growing and weakening them and changing structure based on your experience one of the first evidences they had is cabbies in London if they\'ve to become to just be a cabbie you can strive with cab but to become a master cabbie which you earn more money and you get more routes and you get better better hours and everything if you take this master cabbie exam which means you have to memorize what they call the a through z the street names you have to be able to take a test and find any street in London some of which are half a block long and because London you know as an old city and grew over many many centuries and these master cabbies have an amazing visual memory and what they found was that the and they don\'t start studying the aid through z and until they\'re adults they found when some of these cabbies were able to have brain scans first and later donated their brains to for study after they died and they do autopsies on them they found that the part that had to do with visual processing was way more complex and much more developed and much more massive than average everyday cabbies or everyday people and so they knew that adult brains could change and there was there\'s much more evidence as well but that was one of the first ones they did that showed them that I read this book that is like a novel by my friend Norman Doris a psychiatrist and neurologist talking about this new point of view of brain plasticity it\'s a terrific book I recommended to you and it really shifted what I thought in terms of treating depression because what we\'ve discovered in this neurogenic and neural atrophy hypothesis is that you know this isn\'t a set theory no nobody knows what causes depression or what treats it the best I\'m giving you my ideas but this hypothesis has a lot of evidence and more and more accumulating evidence and more and more psychiatrists and neurologists are leaning in this direction now so it\'s not a proven theory as is as the broken brain theory isn\'t a proven theory and the neuro the neurotransmitter theory is not a proven theory either the one that medications are based on so this is called the neurogenic and neuro atrophy hypothesis and here\'s what it\'s about stress which plays a key role in triggering depression suppresses neurogenesis which is the birth of new brain cells in the hippocampus which is typically where they\'re born in the brain and adult and all the brains but especially adult brains that\'s what we\'re talking about here and scientists have found evidence that the hippocampus shrinks in people who have long-standing depression and long-standing stress so what are the implications antidepressants encouraged the growth of new brain cells now so they may not be treating those neurotransmitters that they think they\'re treating that may be bathing the brain in these neurotransmitters or these precursors to growing new brain cells and that may be why neuro treatment works why these pharmacological treatments were different from the way psychiatrists often think they work and so there\'s a lot of evidence for this at this point and again some people are starting to do this here\'s the thing in animals because you know again not not subject to the placebo effectively animals must take antidepressants two or three weeks before they bump up the birth rate of new brain cells and the cells may take another two or three weeks to start functioning and that\'s very consistent with the time lag that antidepressants show before they lift mood in people who are depressed so here\'s the idea if antidepressants are giving during a period of chronic stress which usually results in fewer brain cells being born then it prevents that decline in what they call the neurogenesis new brain cells being born so people with head injuries in early adult experience higher rates of depression over their lifetimes now that may be because they have traumatic brain injury or maybe that they\'d lost some of that functioning and some of the brain cells have died off because that\'s really severe kind of brain damage typically exercise which combats depression people also increases the rate of neurogenesis to the birth of new brain cells in the hippocampus so we can get people moving which is hard to do when people are depressed we\'re going to be talking about that then we can make a difference so does ECT electroshock therapy or electro compulsive therapy when people are really depressed sometimes they\'re they have recommended shock treatment and people are like oh no that\'s like out of the cuckoo\'s nest you know no that it actually can save their lives because I started exercising as a result of learning this hypothesis and I was kind of a couch potato before that and one of the things I found was when you exercise and you\'re running that is that\'s what I typically do is run or walk and when you\'re running you\'re stressing the bones and you\'re creating little micro fractures in your bones I didn\'t know this before I exercised and I was reading a book about exercising and then your bones go back stronger you create little micro fractures and your body says hey hey damage damage let\'s send some repair stuff here and your bones get stronger well it\'s the same thing in the brain when the brain gets stressed the brain sends out a signal create new brain cells repair this and it turns out that the electroshock or electro compulsive therapy which is sometimes done with with you know a sort of insulin shock treatment it it shocks the brain and it sends healing mechanisms there or you know it puts into place these healing processes so that may be why it works you know they don\'t know why it works exactly again this is part of the hypothesis so here\'s some of the research stuff you can look at but there\'s stuff in the brain that are hormones that encourage the growth of new brain cells and typically these are the the one there are four four hormones that typically encourage the growth of new brain cells and one is called BDNF which some people have called the miracle grow of the brain if you\'re not from the states miracle grows the thing that helps plants grow it\'s a sort of a product in the United States and makes plants grow a lot and so BDNF is brain-deprived neurotropic factor and that helps create new brain cells so post-mortem studies have shown that depressed people have decreased hippocampal and cortical BDNF levels and when people take anti-depressants they have increased rates of BDNF so it goes along with this hypothesis and again let\'s just skip this here\'s the typical things you can have insulin-like growth factor vascular endothelial growth factor which helps more brain blood get into the brain and then therefore supports brain growth and this BDNF for the brain-derived neurotrophic factor these are the things that if we can encourage them either with medications exercise stimulation of the brain learning into a language anything that stimulates the brain can sometimes do this being in good health eating healthy food all this stuff can support brain growth all right so what affects brain growth learning new things to stretch your ability not too much and repeating these things to deliver practice so it might be physical thing or might be cognitive things like learning a new language music seems to be good for overall brain growth and new physical abilities juggling typing writing a bike anything anything you learn that\'s new and exercise an exercise turns out to be one of the best things to grow new brain cells and what do depressed people do they move less and less as they get more and more depressed so what we need to do is to help people start to exercise so exercise helps blood vessel growth you can increase the blood flow and the size of the blood vessels it\'s just like the heart if the heart is functioning well you have good heart health and good body health with the same thing with the brain if you get more blood in there your supporting brain growth it helps you avoid cognitive decline with aging but it also helps you avoid depression so there\'s growing evidence that exercise works better than antidepressants and it lasts longer so let me give you this example this was the most the the best research that\'s been done so far and it\'s called smile the smile research project it\'s done at Duke standard medical intervention long term exercise and they studied a lot of different conditions but one of them is they had a bunch of people in this study and 156 of the people in this study were diagnosed with major depression MDD major depressive disorder and they were randomly assigned to three treatment groups the first one is exercise treatment and that involved brisk walking jogging or stationary bicycle riding three times a week with a 10-minute warmup 30-minute exercise five-minute cool down Zolov treatment and again if you\'re not from the state Zolov is an antidepressant medication it\'s an SSRI and so combined treatment that is they did exercise and the medication now here\'s what blew my mind when I found the results of this at the end of four months medications and exercise helped everybody or not everybody but a lot of people 60 to 70 percent of the people were vastly improved or symptom-free in all three of these experimental conditions but here\'s what blew my mind on 10 month follow-up 38 percent of the medication subjects had had a recurrence of their depression 31 percent of the combined condition had had a recurrence that is they exercise and took Zolov but only 8 percent of the people who are exercising had a recurrence and people continue to exercise we\'re even less likely to have a recurrence of their depression so here\'s what\'s amazing is that the amount of exercise made a difference every 50 minutes five zero minutes of exercise per week collated with a 50 drop in depression levels so the more exercise you do up to a limit helps with people are depressed there\'s a whole bunch of research about this this psychiatrist when he found out about this research down in Texas got named Traviti said you know I have some patients that are treatment resistant no matter what medication I use they don\'t seem to they don\'t seem to come out of their depression I wonder if I tried this exercise thing so he got people who participated in moderately intense aerobic such as exercising on a treadmill or stationary bicycle three to five days a week experienced a decline in their depressive symptoms by an average of 47 percent after 12 weeks so essentially you know three months those in low intensity groups just were walking or moving a lot less or riding the bicycle at a very reduced level had a 30 reduction in their depressive symptoms and exercise helped these people who are called treatment resistant because they weren\'t responding to medication so he\'s done a bunch Traviti is his name and you can again the research is there middle-aged runners this is a correlational study who\'d been running three to five times per week for three to ten years with markedly less depressed than a matched comparison group now correlation studies maybe they were running more because they were less likely to be depressed but there is some correlation there they did some not exercise ones but they gave people these cognitive brain training things that you see on TV and there\'s some you know on your computer on your iPhone or your apps they when they got seniors to process things faster which some of these brain training things do they also decrease their likelihood of developing depression compared with a control group that weren\'t using these brain training apps by 38 percent a year out so they were less likely to be repressed when they were exercising their brains with just cognitive exercise not physical exercise so obviously both seniors who\'d never experienced exercise before experienced a mood lifting effect less depression and anxiety better reported quality of life from regular aerobic exercise three times a week on alternate days for six months and again there\'s study after study of this and so I when I started exercising I actually didn\'t feel any mood lifting effect but I wasn\'t depressed but it turns out that exercise has the most profound mood lifting effect on people who are depressed that is they experience it and the effect increase with the amount of exercise they also found reductions in anger and anxiety through exercise now this is aerobic exercise anaerobic like lifting weights there\'s mixed evidence it can increase your anxiety but decrease your depression so you have to be a little more careful with anaerobic which is just muscle training strength training and the other thing is you have to be aware of over training some people you know and people who do anorexia or people are super compulsive and exercise all the time they sometimes get more depressed famous example is a kind named Salazar who was ran the New York City marathon won the New York City marathon and he got depressed the next year because he\'d over trained and most of us don\'t have this problem most of us under train so the evidence shows that over exercising which is exercising several times a day of training levels that are at or near your maximal training levels is correlated with depressed moods so don\'t over exercise but up to a limit most people will benefit obviously physically but they\'ll also do this so how do you translate that it\'s into clinical work if people are depressed how do you get them to move because they\'re saying I can\'t get out of bed when they come don\'t sit in your office go walk around the block if you\'re in a cold place go walk around the mall and have your session walking around the mall anything you can do to get them moving get them to park a little farther away from your clinic get them to park you know if they go out shopping a little farther away and get a little more exercise get them to take the stairs instead of the elevator anything you can do encourage clients and patients to move as much as they\'re able so you know walking sessions is one way baby steps getting to do a little more exercise the solution or method what helped them exercise before or do anything that was difficult have amused that method get them to walk or move with a buddy there\'s been studies saying if you commit to exercising with someone else you\'re much more likely to exercise and stick with that exercise program than when you do it along now some people are self motivating and they can do it but again depression is in part a problem of motivation because the parts of the brain that have to do with motivation and dopamine production you know they get you excited and fear rewards about things are under functioning typically in people to press so that buddy system is a connection ability we talked about connection being important as well as kind of a guilt-inducing way if you don\'t want to go out one day or your friend wants to go out they tend to pull you out if they don\'t want to go out you tend to pull them so link it to motivation when i started exercise i found out about the brain stuff i loved having my brain i love learning so for me even though i was a cot potato i got motivated because i wanted my brain to function better as i aged and then i had a little mid-life stomach so i had an away from motivation i want to get rid of my mid-life tummy by exercising more and i wanted to have better brain functioning and i don\'t have i don\'t suffer from depression anymore but i wanted to have have a better brain that could learn and take things in as i aged and so i had motivations to figure out what that person\'s motivation is and link it to that motivation so we\'ve covered a lot of material there may be some questions there may not be we\'ll find out in a couple of minutes but remember you can get a copy of these slides because i went over some of them really quickly because again this is a presentation i sometimes do over the course of two days and i\'ve just tried to get all these six methods to you as quickly as possible and these are so exciting to me and you can use these again as supplements to what you do or as treatments in in their own right great bill thank you so much that was just fantastic we do have a number of questions here and i\'ll coordinate the q&a for you we\'ll start with this one when working with the depressed client how do you how do you ascertain which uh which approach or combination of of approaches a particular client might best respond to i\'m sorry i\'m gonna have a terrible answer that which is intuition that is i know all these but you know the thing for me is having all these in your repertoire gives you so many openings in so many places you know if i try inviting them to the future and they go oh no there\'s no future for me then that\'s not the one you know it\'s it\'s a bit of back and forth how do they respond if they say oh you know that\'s pretty interesting yeah i could do that then that\'s the one i\'m going to go with and i usually it\'s like a smorgasbord you lay out this smorgasbord and you see what people are going up and taking from the smorgasbord and having these six in addition to whatever ones you already have i assume you have some yourself the medication ones or cognitive ones or whatever other methods you have just having six more in your repertoire i think is nice it\'s so you can intuitively follow where you think i think this person sometimes they say something that tells me that they like here\'s an example i had a person come in one time and say to me it shows up in my office and she says i have to kill myself and in the back of my mind i\'m thinking wait a minute you know i\'m not i\'m not going to challenge her like this but i\'m thinking she has to kill herself but she rolled out of bed did her makeup fixed her hair got dressed got to my office to come and tell me she\'s going to kill herself and i\'m thinking probably ninety nine percent of her wants to die and one percent of her is hoping i\'ll talk her out of it that\'s why she showed up in my office so for me that\'s an indicator that she needs the intervention of hope for the future so i\'ll probably start there and i\'ll work backwards and if that doesn\'t work then i try one of the other ones so that\'s the best answer i have mostly i just use intuition but sometimes they give me an indication of which one seems to be appealing to them the question i had you know um you were you\'re talking you\'re speaking of uh martin seligman\'s work earlier you know he he um he uh wrote a lot learned helplessness and you know how that can lead to depression and and you know essentially when clients are trying all different types of methods to get through the depression and nothing seems to be working and and you know that learned helplessness starts to set in um and uh you know they they\'re sitting there maybe in that dark room like you were talking about laying in bed watching that commercial telling them about this wonder drug and you know the next thing you know they\'re they\'re scheduling an appointment with a psychiatrist and they\'re getting prescribed this wonder drug and and and they\'re taking it and thinking well that\'s that\'s it that\'s that\'s all i have to do um i really loved all your theories how do we how do we convince the clients how do we convince society at large that there\'s more work to be done that that uh therapy um in in addition to um pharmacological approaches are are so necessary for long term yeah that\'s a good question i think um you know that seligman work on learned helplessness which he did with dogs very interesting stuff maybe i\'ll tell you something about that but let me just answer the question a little more directly first and that is what i\'d say to people i i came across this quotation a while ago as from a french guy at emile shartier said there\'s nothing as dangerous as an idea when it\'s the only one you have and um i i like that uh saying because what i would say to people is yeah you know maybe the medications will work and they\'ll be all you need but i always like to have a little insurance i always like to have two or three things in case the one doesn\'t totally work out or in case it doesn\'t you know you don\'t respond to those medications as well as you hoped and so that\'d be great if the medications work and i want to i want to help you have at least one more method that\'s under your control that\'s not the medications that\'s under your control that i think might be really helpful for you sorry i\'m going to do this thing here um and so that\'s the first thing second thing is that martin seligman thing is very interesting i don\'t know if you\'ve ever heard him talk about how he came up with this but he was in the 60s working with dogs he he was an experimental psychologist and he didn\'t like rats he found him creepy and he\'d always loved dogs when he was a kid so he thought i\'m gonna work with dogs in my lab and what he did was built these cages where the dogs it was sort of a wire mesh bottom to the cage and there were two two parts of the cage and there was a hole in the middle and the dog could go from one side of the cage to another and what the terrible experimenters did is they put on a small shock on one side of the cage and of course the dog would go to the other side of the cage and then they put on the shock on both sides of the cage and there was no escape from the shock and the dogs go back and forth back and forth for a while but after a while they would get depressed that is they developed that learn helpless no matter what they did they couldn\'t get away from the shock and the dogs would sleep most of the day and they looked like human beings who were depressed so seligman had determined that and then years later when he came up with positive psychology he was thinking back to those experiments and he thought well you know always with an experiment in statistics if you have a hundred dogs and 96 of them get depressed or look depressed when they go through his experiment then you\'ve shown the effect with the pretty good probability that it\'s reliable but he said he started think back on the four dogs that never got depressed out of those hundred he thought those are the dogs we should have studied and what do those dogs do differently after a couple of days the experimenters turned off the shock on the other side of the cage from the one the dog was laying in and those psychically optimistic dogs were getting up every couple of hours and moving to the other side of the cage to see if the shock was off the other ones just assume it was always going to be there forever and so i think studying those psychically optimistic dogs that is the ones who keep going for trying to change things so i would tell that story to my clients in my clinic and say yeah medications may work but let me tell you this story about these dogs and there were some dogs that did get out of the shock and that were able to get out by their own efforts because they kept trying something new rather than accepting that this is the situation i can\'t do anything about it okay great one final question knowing how deep-seated and powerful that the patterns of depression are do you have any tools for for clients new clients especially to to keep them on track and keep them from sinking back to these depressive patterns in between sessions for example do you ever enlist spouses or family members to help keep them on track absolutely and the other thing is that i use an analogy sometimes i\'ll say you know look at what we\'re doing in here is like me being the coach by the side or the or the you know you\'re running a race and i\'m by the side of the road and i\'m firing the starting pistol and if you and if i fire the starting pistol and you just look at me and say how come i\'m not feeling better once i fire the starting pistol i say because you have to go you have to move you have to do something and so i\'ll tell them analogies like that and say i know it\'s really hard and this you\'re not going to be running a race you\'re going to be crawling a race at first then you\'re going to be walking the race and then you may get up to a jog eventually but i\'m going to need you to make an effort and yeah i enlist people around them their best friends their family members and see if they can help support them but you know that can backfire because if they\'re saying hey you know the therapist said you have to get up and walk the steps like oh just get off my back i don\'t it can it can backfire so you have to be very very careful about that and but again i\'m searching for the patterns that don\'t work and the patterns that do work in their family members or their friends or their environment so if i say so have you been encouraging him to go out and walk all the time they say yeah i tell them they have to get out of bed that i say then stop doing that because it\'s not working let\'s just stop that pattern let\'s find another one you know you might just tell them i\'m really sorry you\'re feeling this bad and see what that does and we do a bunch of experiments and that\'s the second frame that i use for it is we\'re not telling you this is what you have to do we\'re going to do a bunch of experiments and find out what works for you because everybody is different and that goes back to the first question is how do you decide these things you only decide by experiments and this is the wonder of human beings human beings are natural experimenters almost all other animals are so much more programmed and fixed in their behavior patterns and human beings they\'re about as adaptable on the planet as cockroaches they live in the arctic and they live in the Sahara and you know they live in houses and they\'ve been intense and they can survive really amazing conditions because human beings are constant human experimenters and they\'re just trying to find what works human beings have gone to the moon human beings have invented fax machines and you know video conferencing it\'s incredible because we keep experimenting and what doesn\'t work we discard and what does work we do more of that so i\'m going to ask you to be a scientist with your depression and i\'m going to ask your family members to be a scientist with your depression because some things are going to help and some things are going to hurt and some things they\'re not going to make any difference one way or the other. Bill on behalf of the entire university i\'d like to thank you for such an engaging and informative lecture we\'re so happy you\'re able to join us today. Oh well thank you so much for inviting me and thank you for being here and thank you to all the people that are watching streaming online in a time-shifted way i so appreciate everyone who participated and everyone who\'s watching thank you very much. This has been a presentation of the School of Behavioral Sciences at California Southern