Combatting Depression: Strategies for Your Relationships

by: Dr. Dino Zuccarini and Tatijana Busic

Finding a path toward recovery from your depression symptoms can be challenging, but is doable! In this third post in our depression blogs, we provide strategies to help you deal with depression symptoms associated with your thinking and how you might be processing your feelings, emotions, and needs.

We’ve offered you some tips to help take the first few steps toward feeling better. We suggest that you start your recovery journey by employing strategies for your self first, and then once you’ve started on those, our fourth blog post offers you strategies for your relationships.

Strategies for Your Self: Develop Structure, Routine, and Self-Care into Your Life

When we are depressed, we tend to become depleted of energy. We move less and feel tired. These circumstances can drain us of important mental and physical stimulation that we need for our well-being.

Put structure and everyday routine back into your life and begin to increase your level of self-care. Create a routine. Make sure to schedule activities that are meaningful or pleasurable to you. Include 20 minutes of physical exercise each day. Prepare healthy meals that will nourish your body and mind. Get good rest. If you are having difficulties sleeping, consult resources that will assist you to develop a soothing nightly ritual that will help you to unwind and relax and ultimately improve your sleep.

Learn How to Regulate and Soothe Stress, Negative Feelings and Emotions

With depression, we can struggle with our feelings and emotions – we feel too much or too little. When we are overwhelmed by strong, intense feelings and emotions, it is important to develop practices and strategies to effectively deal with these internal reactions.

Pause before you act on your thoughts and feelings and try to restore a sense of calm and ease. Learning how to restore calm and ease within ourselves is an important life skill. Make a list of activities that are calming and soothing for you, and engage in these activities when you are emotionally distressed. For example, sipping tea in a peaceful place, going for a walk, engaging in deep body and muscle relaxation, taking a warm bath, learning how to breathe rhythmically and deeply, visualizing peaceful and tranquil settings, quietly reading a book, and listening to calming music are examples of ways to enhance coping.

Try to remember, intense feelings and emotions mellow with time. Try to reassure yourself that these feelings and emotions will pass and you will be okay once again. Once we are calmer, we can begin to think about the thoughts and feelings we are experiencing that are contributing to our depression.

Challenge Negative Thoughts and Feelings about Your Self and Others

Negative views of our ‘self’ and of other people can create a deep sense of hopelessness, as discussed previously. In the midst of feeling depressed, pay attention to the thoughts, interpretations, assumptions, and beliefs you have about yourself or others. Do you notice a negative bias in how you are thinking or feeling about yourself and others?

Try to challenge these negative views and find counter-examples to these negative thoughts. Try to recognize good things about yourself and others at home, work, and in play. Practice noticing positive attributes about you and other people—at least once a day. You can also develop a list of positive things about yourself and other people in your life. Have your list handy and read it whenever you are feeling negative. Do not be surprised if your list of good things begins to grow as you start to engage in this exercise of positive appreciation.

Sometimes our negative thoughts and feelings towards others are grounded in real experiences in which others are behaving inappropriately toward us. If people are behaving toward you in a negative manner that is harmful (i.e., verbal, physical, emotional or sexual abuse), it is important to seek out support and professional help to find a way to address these circumstances.

Develop Self-Compassion in Place of Harsh Self-Criticism and Perfectionism

Sometimes a negative, critical voice toward our ‘self’ and others may be at the root of our depression. When left unchecked, this voice can make life unbearable.

Do you notice a highly critical or perfectionistic inner voice that pervades your life? How do you feel while and after you have berated, attacked, or criticized yourself? Probably not very good. Try to develop a more compassionate and understanding counter-voice at these times. Making mistakes and not meeting expectations and demands are bound to happen throughout our lives. It is part of being human. Remind yourself that no one is perfect nor do we need to be in order to be worthy, lovable, and valuable as human beings. Ask yourself if you would be as harsh toward others, such as a family member, partner or friend if they had not met an expectation? Would you be more understanding of others? Try to develop a kind, gentle, understanding and reassuring voice toward yourself in these moments.

Try to lighten the impact of this oppressive voice by reframing the self-criticism in positive terms. For example, ask yourself what you can learn from the present situation that may help you grow as a person in the future as opposed to harshly attacking yourself. Try to find constructive solutions to your mistakes or problems, rather than senselessly depleting your energy and berating yourself.

Try to find ways to challenge harsh self-criticism. Ask yourself, “How realistic are the expectations and demands that I hold of myself and others?”. Remember that human beings are limited in terms of what we can achieve. We can’t always meet all of our or others’ expectations or needs. In addition to negotiating our needs with those of other people in our lives, we also have to balance a lot of competing needs in different contexts, including work, family, and play.

Find counter-examples that contradict the extreme and global way you are putting yourself down. Create a more balanced and accurate view of yourself. Think about what is good enough and possible in your current life situation rather than how things should be in order to be perfect.

Be Mindful, Build Awareness of the Present Moment

When we are depressed our thoughts are often focused on worrying about the future or ruminating about the past. Depression impedes on our ability to live in the present moment, which often further aggravates the cycle of worry and negative rumination.

Try to notice these moments as they are happening without any judgment. Simply notice your ‘self’ thinking or feeling something that is connected to worry about the future or rumination about something that happened in the past. As you notice what is happening, try to gently shift your attention to your body. For example, if you are walking notice how the soles of your feet feel with every step you take. Practice using your senses to notice how things look, feel, taste and smell around you.

By gently shifting your attention to the present moment, you rest your awareness in the here and now of being alive. This mindful practice can help you to build an inner sense of refuge from the stresses of life. Also, this practice can occur under any circumstances and over time, will help you to develop greater resilience and freedom from the negative thought and emotional patterns associated with depression.

Identify, Label, and Access Emotions and Needs and Make a Plan of Action

Emotions provide us with important information about what our concerns, goals, and needs are for ourselves and in our relationships with others in the world around us. Depression is a signal, calling for us to listen to what our feelings are telling us about what concerns or goals have gone unmet, or what we might want or need for ourselves or in our relationships with others.

Being able to identify, label, and express these feelings in words is important if we are to appreciate what our concerns are and what we might need as individuals and from our relationships. When we figure out what our emotions are telling us, we can then develop a plan of action toward taking care of ourselves more effectively. We can develop strategies to address our goals and concerns, and meet our wants and needs in a manner that does not create further difficulties for us.

Try to identify and label your emotions. Pay close attention to the feelings that underlie what you are experiencing. For example, you may be feeling numb, but masked underneath resides hurt and sadness. Or you may feel outwardly sad, but are also angry deep down. This may not be easy to do at first and takes practice.

Also, try to tune into what the concerns, unmet goals or needs are that come with these feelings and emotions. What do you need for yourself in your sadness or anger? Write about your feelings in a journal with a particular focus on what these feelings are telling you about what you might need for yourself or in your relationships with others.

Begin to plan and create strategies of how you can go about meeting your goals, wants, needs, or desires in a manner that is constructive for you and for those around you. You may require support from others to help you organize your thoughts and to develop plans to have your goals, wants, or needs met.

Seek out Professional Support: Consulting with your Physician and a Registered Clinical Psychologist

Consulting with a physician may also be an important first step to assess your current mental health status. Depression can be associated with many biological and medical causes that require medical interventions.

Seeking the professional support of a registered clinical psychologist may be important to help you address the negative thoughts and feelings you are having about yourself, or others. Learning how to address perfectionism, self-criticalness, and process your emotions and clarify wants, needs, and goals can be challenging. Contact a registered clinical psychologist if you find that dealing with your thoughts and feelings on your own has become unmanageable.

Read more additional posts from the ‘Depression’ series:

Learn more about our Depression, Mood & Grief Treatment Service.

Depression: How Your Thinking Can Lead to the ‘Blues’

by Dr. Dino Zuccarini and Tatijana Busic

Are you tired of struggling with low energy, negative thoughts, and feelings that seem to absorb so much of your day? You may be suffering from the debilitating symptoms of depression.

This is part one of four in our blog series about depression. These posts have been created to help you consider what might be at the root of your feelings of depression. In the first two blogs, we write about some common causes of depression; particularly, about how you’re thinking and how the way you deal with your emotions might be causing or contributing to your feelings of depression. Finally, in the last blog, we provide you with strategies you can use to deal with depression on your own, or in your relationships with others.

What is Depression?

Depression has many different symptoms. When we’re depressed, we experience symptoms, such as, chronic negative feelings and emotions (e.g., sadness, worthlessness, guilt, irritability, restlessness or lethargy), loss of interest or pleasure in previously enjoyed activities, difficulties with attention, concentration and decision-making, changes in appetite or weight, fatigue, bodily aches and pain. Individuals suffering from depression are also typically bombarded by a chorus of negative thoughts about themselves, others and the world around them. These negative thoughts and feelings may be at the root of your depression.

How Our Thinking Paves the Road to Depression

There are several biological and psychological causes of depression. Let’s review a few ideas about how your thinking can contribute to depressed feelings.

1.  Negative Views of Our Self and Others

Your depression may be linked to negative thoughts and feelings you are having about yourself, others or the world around you. These negative thoughts and feelings can emerge from difficult life experiences at any time in our life—from childhood onward to present-day challenges we are facing in our lives. These difficult life experiences can affect how we might think and feel about our self and others (i.e., thoughts and feelings of inadequacy, worthlessness, incompetence, a sense of being unlovable and insignificant). When you think and feel negatively toward yourself and others for a long period of time, you can become hopeless. You can begin to attribute negative situations and events in your life to negative thoughts you have about your self. A sense of hopelessness about our self further blocks us from being able to achieve our goals and get our needs met. You might also believe that others think and feel the same way about you, which further deepens the hopeless feelings.

As a result of childhood or present-day challenging life experiences, we may have also developed a negative view of others. Others may have been harsh, inaccessible or unsupportive to us during some difficult life moments—and now, it may seem to us that all others are unreliable, undependable and untrustworthy, or potentially harsh and judging. These views of others may diminish the likelihood that we’ll be able to connect with friends or family for support when we are facing challenges and need others the most.

When we hold a negative view of ourselves and others as a result of past or present-day life experiences, we can begin to feel hopeless and less capable of meeting our goals, concerns, and needs, and unable to reach out during times when we are in need of others support and care. These negative views of ‘self ‘and ‘other’ cascade into feelings of depression over time.

2.  Unrealistic Standards, Ideals and Expectations Fuel Perfectionism and Self-Criticism

We all have standards and ideals that create expectations that then guide our thinking, behaviours and emotional reactions toward others. From childhood onwards, the outside world through our parents, teachers, and employers place expectations and demands on us. We also develop our own expectations about our own and other people’s behaviour (i.e., how we and others ‘should,’ ‘ought to,’ or ‘must’ think, feel, and behave). Our expectations can sometimes be unrealistic and unachievable, which can create a great deal of pressure and stress in our lives. Unrealistic expectations of others may also create difficulties in our relationships with others. When we are too overly driven by our own and other’s unrealistic expectations, we can become hopeless trying to keep up with all of these demands. We can also lose touch with what we are really feeling, preferring, desiring, wanting or needing for ourselves.

Some individuals maintain unrelenting, rigid standards and ideals about how they or others should perform in the world. In these circumstances, some individuals may have unyielding and high expectations about their performances. They may strive for perfection in their endeavours, and be self-critical and harsh toward themselves when they do not meet these expectations. A self-critical internal voice may emerge that continuously judges or berates the individual (e.g., ‘you dummy’, ‘you’re lazy’, ‘you’re weak’, ‘you screw things up all the time’). Research affirms that self-criticism and perfectionism are often cornerstones of depression.

Perfectionism and self-criticalness may initially work together inside of you to ensure that you perform well. You may criticize yourself to improve your performance so that you will see your self or others will see you in a more positive manner. The more we drive ourselves in this manner, the more we wind up feeling overwhelmed and stressed. We start living an unbalanced life that can feel overwhelming and stressful. Over time, perfectionism and a self-critical voice can create a sense of guilt for not performing adequately, and hopelessness about our self (i.e., global, negative view of your own self as inadequate, not good enough, and worthless). Some individuals can also be critical and harsh toward others for failure to live up to their demands. This can create difficulties when you are engaged in either constant conflict with others or others decide to disconnect from you and you becoming increasingly isolated over time.
CFIR psychotherapists can support you to deal with your negative views of self and other, and the unrelenting self-criticism and perfectionism that might be at the root of your depression. We integrate cognitive-behavioral, mindfulness and acceptance and commitment, and psychodynamic-based approaches to help you deal with the thinking that might be contributing to your depressed feelings.

Read more additional posts from the ‘Depression’ series:

Read more about our Depression, Mood & Grief Treatment Service.

Grief and Loss of a Child

by: Dr. Dino Zuccarini, C.Psych.

Parent’s Grief Process in the Aftermath of Loss of a Child

Parents vary in terms of how they deal with loss—most parents will cycle through a wide range of emotional reactions. 

All parents face profound painful feelings and absorbing experiences of grief when a child dies. There can also be intense shock, confusion, and even denial about the loss. There is no loss more devastating than the loss of a child. This loss leaves parents disoriented and disorganized. Hopeless despair can immobilize parents from dealing with the tasks of everyday life, connecting to each other or other children. In hopeless, despair states, parents can experience existential distress—finding life to be meaningless and purposeless.

Parents will also vary in terms of how long the grieving process takes. Some parents will move toward sadness and grieving the loss, trying to make sense of the loss and what life will be like with the loss of their beloved one. They will reach out and connect to others (i.e., their partner, support systems), memorialize the loss of the loved one (e.g., scrapbook, rituals), and re-organize themselves and create a new sense of family identity with the remaining children—although the loss will continue to be felt, the intensity of the emotions will lift. Some parents, on the other hand, will hold onto grief for longer than others—remaining disoriented and disorganized in the aftermath of the loss—not being able to make sense of the loss in the present and the meaning of the loss in terms of the future. Some parents will be over-consumed by guilt and self-blame–feeling that they didn’t do enough to protect or care for their child, and even possibly feel shame and a sense of inadequacy and failure. Many parents will have an increased sense of fear about the surviving children, and a deep sense of isolation and loneliness in feeling disconnected from others who they feel may not understand their experience.

Others may experience intense anger at themselves, their spouse, hospital staff or whomever as a reaction to the loss of a loved one, and even resentment toward those who have children—while experiencing deep sadness and deep fears underneath. Some will enter into a state of numbing, withdrawal to escape the pain, and even turn to other maladaptive soothing behaviours, such as increased alcohol or substance use. Being stuck in guilt, shame, anger and resentment, or numbing withdrawal can prolong the grieving process and block a parent, couple and family from re-building a renewed sense of hope for the future and reshaping a new family identity in the aftermath of the loss of a beloved child.

Parents might express and deal with emotions differently—which will affect the grief process and how parents will journey through this difficult period. Parents who are able to express themselves and journey through this painful experience together can help assuage each other’s distress, make sense of the loss together, deal with the changes to the family, and re-build a sense of hope and future for themselves and remaining family members. A renewed sense of family identity can be created while holding onto the loving memories of the lost child.  Parents must re-define their family identity together. Parents who are emotionally isolated or withdrawn block the necessary engagement to deal with emotional distress and to engage in this meaning-making process that allows the couple and family to re-organize their sense of family identity and future in the aftermath of a loss.

The hardest part is when partners are in different places emotionally and cannot be present for each other (e.g., one is disorganized and the other sad). It is important to be able to reach out to other family members at this time as well for emotional and practical support in dealing with everyday tasks.

Strategies to cope with the loss of a child

1.  Express your emotions and needs to supporting, caring others. It is important to authentically express the wide range of emotions and reactions that are experienced in the aftermath of loss to maintain an emotional connection. It is important that parents take turns expressing their feelings, acknowledging each other’s emotional reactions and listening to what each parent might need. For example, Sara might be feeling hopeless, despair. It is important that she express her needs to her partner, Paul. She may need contact-comfort (e.g., a hug) or verbal reassurance from him (i.e., that the family and the rest of the children will be okay and that they will get through this together). Expressing needs for support and care when distressed is important in sustaining the connection and taking care and soothing each other’s emotional distress.

2.  Reach out for support and care. Isolation increases emotional distress. Ask loving family members and caring friends for practical support for tasks (e.g., helping with other children, home tasks etc.). This allows parents to deal with their emotions and other tasks related to the loss.

3.  Prepare yourself to deal with questions about the loss. Telling the outside world about the loss of a child can bring up emotions. Find a way to tell your story in a way that is comfortable for you (i.e., the amount of details that you feel comfortable sharing). If you feel others are asking too many questions, it is okay to let them know your limits (i.e., I only feel comfortable sharing this amount of information). 

4.  Healing takes time. Expect strong emotional responses for a sustained period of time and accept differences in how you are reacting to the loss. It is important to acknowledge emotions and accept that the intensity of these emotions will diminish over time. In the midst of painful emotions associated with loss, parents might benefit from reminding themselves that these emotions shall pass over time. It is important to accept that there will be moments in which you are both experiencing different reactions and will differ in your grieving process. Talk about your child and use his or her name—avoiding names does not allow you to come in touch with your feelings. Eventually, parents will be able to talk about their child with less of a reaction.

5. Ensure all family members emotional needs are addressed, including other children. If there are other children in the home, it is important to ask them about their sadness and help them along with their grief. Children can feel a wide range of emotions and have several needs at this time for contact-comfort, reassurance and physical affection.

6. Don’t make any big decisions in the immediate future (i.e., doing anything with clothing or toys of your loss child, returning to work, moving, making big changes to family routine and structure). During the initial phases of grief, the disorganization and disorientation may lead parents to make decisions that may not be beneficial for themselves or their family in the long run. Take time to deal with your child’s personal items. 

Some parents will want to return to work soon to restore some sense of normalcy in their lives, while some will return too early without having  healed enough and completed their grieving process—with dire consequences on their family and work life. Making big changes creates further disruption and emotional distress that may block the grieving process from unfolding. Other children will require structure and routine to hold them emotionally through the turmoil of loss—routine and structure allows for a sense of normalcy and provides children with a sense of safety and security.

7.  Rituals and honouring memories of the child. It is important to make sense of the loss and to create a narrative about the beloved child—the meaning of the child to the family and the positive experiences of love, joy, and connection that were experienced in the relationship with the child. Creating a scrapbook or ritual to construct this narrative will allow parents to hold onto the positive and loving memories of the child. Involve children, if appropriate developmentally, in this process. Also, plan on how you are going to deal with birthdays and the anniversary of your child’s death. Planning ahead of time can minimize distress. Creating a ritual around these dates can be helpful to deal with the emotions associated with the loss and remind parents and other children of the positive joy and loving memories of their beloved one.

8. Join a support group. Isolation makes emotional distress harder. Being able to share your feelings, and learn from others who have experienced the loss of a child can make the healing journey less isolated.

9. Consult a psychologist.  Psychologists can support you to understand your own, your partner’s and other family members’ emotional reactions to loss. Some parents, couples, and children will need extra support to move through a grieving process. Couple and family problems can emerge when the residue of unprocessed grief persists. 

What types of programs does the Centre provide to parents who have experienced the death of a child?

CFIR has several services that can support parents in dealing with the impact of loss of a child on the individual parent, the couple relationship and the family (i.e., other children and family relationships).

The Grief and Loss Service offers psychotherapy services to individual parents to support them through the devastating and intense emotional experiences in the aftermath of significant losses of loved ones, such as the loss of a child. Psychologists who are part of this service are experienced in supporting individual parents to deal with the different, and sometime complex, emotional reactions experienced in association with the loss of a child (see grief process below). Individual parents will vary in how they will deal with their own emotional reactions and how they will respond to their spouses or other children’s emotional reactions to the loss. Over time, and as the grieving process unfolds, most parents can expect that their emotional distress will lighten—although the loss of a child can continue to trigger emotional reactions upon reminder of the loss in future years. Loss of a child can be extremely disorienting, especially since a parent’s sense of self and family identity was so closely tied to the child who has died. For some parents, the emotional reactions and distress will seriously affect their ability to return to work and affect their sense of connection to their partner and/or other children. Some parents will have complex grief reactions that will be accompanied by symptoms of traumatic stress, depression and anxiety that are unremitting over time and that affect their capacity to function in their relationships at home or at work. One’s sense of self and the future can be shattered when the hopes and wishes held for a child and one’s sense of self and family identity is altered as a result of the death of a child. Psychologists at CFIR accompany individuals through their grieving process and support them to cope with losses and minimize the devastating impact of loss of a child on emotional well-being, relationships and occupational functioning. 

Psychologists in the Child and Family Psychology Service can support parents to address the emotional needs of other children in the family to adapt to these circumstances. Children grieve deeply as adults do—and sometimes they are blocked by their inability to put words to their complex emotional experiences. Helping children make sense of loss is a challenge to parents undergoing their own grief process, yet other children in the family will need more support than ever to make sense of the loss of a sibling. Losses of a sibling can create deep sadness and fears about future losses, create a sense of unpredictability, and increase insecurities that require increased parental emotional attention to their children. Psychologists in this service support children through their own grief process and support parents to deal with their children’s emotions and the impact of the loss on the entire family system. Children will deal with grief in developmentally appropriate ways—a psychologist can help you to understand how your child’s grief process varies depending on their stage of development and the types of strategies that should be used for connecting to them emotionally. Sustaining a healthy emotional connection with a partner and other children is important in supporting all members to grieve, make sense of the loss, and re-build a new sense of family identity and future in the aftermath of the loss of one member of the family.

The Relationship Service provides services to individuals and couples who are experiencing relationship difficulties. The loss of a child can have an impact on a couple’s emotional connection with each other. For some couples, each parent will be able to express their grief and respond to the other with nurturance, warmth, care and support that will decrease the emotional distress of loss. A parent’s connection to the other parent and their other children can be an antidote against the painful emotional distress associated with loss.  Connecting with a partner and children at a time of loss can buffer us from the distress of these painful emotions. The loving responsiveness and the accessibility of partners to each other’s emotions and the deeper meanings associated with the loss of a child helps each partner cope better with the intense emotional experiences in the aftermath of loss. When one partner shuts down, or withdraws by numbing and emotionally withdrawing to deal with their painful emotions, the other partner can feel rejected and abandoned during a critical moment of need for connection, support and care. Emotional distancing can create relationship distress and have a negative impact on the couples attachment bond. Psychologists at CFIR support couples to deal with loss together in a manner that deepens each partner’s capacity to express their emotions and needs to each other in the aftermath of loss, and to enhance each partner’s responsiveness to the other’s emotional reactions during this painful experience of loss.  

Read more about CFIR’s Depression, Mood & Grief Treatment Service.