As one would expect given my occupation, I’m often approached by teens and their parents, about feelings of depression and anxiety. It’s troubling to see a child or adolescent struggling, but it’s uplifting to know that there are practical and very effective strategies to improve the situation. Let’s review them today. 😊
What Causes Depression and Anxiety?
First, Let's review what causes depression and bouts of anxiety. This is a complicated topic, but we can simplify it: there are two reasons – situational and genetic.
Situational: in terms of depression, there is a situation, or a series of events, that leads to a loss in a child or youth’s life and this loss contributes to feelings of depression. This could be a loss of a loved one, a relationship, or self-worth, among other things. In terms of anxiety, there are situations the person finds anxiety-provoking, which could be anything from problems that would be seen by anyone as problematic, to mundane events that, nevertheless, are anxiety-provoking.
Genetic: in this instance, depression, mood disorders, or anxiety run in the family, and the child or youth is subsequently vulnerable or predisposed to having issues with his or her mood. The depression or anxiety usually surfaces during a time of stress, which takes us back to the ‘situational’ element cited above. However, more notably, regarding a depression or anxiety that is considered genetic in nature, the condition manifests ‘out of the blue’ and often without an observable cause. Depression and generalized anxiety can persist for days, weeks, or even longer. However, acute panic attacks only last a few minutes.
Bio-Chemical: you may hear that depression or anxiety is caused by a ‘bio-chemical imbalance’. Here’s a brief overview of that theory: there is research suggesting that the manipulation of specific neurotransmitters can improve depression and anxiety, hence, anti-depressant/anti-anxiety medications. However, there is ongoing debate about which came first; an imbalance, the genetic vulnerability, or the negative situation? Also, is it really an “imbalance”, or does the person simply feel better when serotonin levels are increased? Moreover, we really don’t know what’s the optimal ‘balance’ of neurotransmitters for any given person. All we know is that, for some people, increasing the abundance of certain neurotransmitters makes them feel better.
Okay, So What Are the Best Treatment Strategies for Depression and Anxiety?
The protocol for treating depression or anxiety targets the following:
- what a person thinks
- what a person is does
- Nutrition, and if the person is active
- how we breathe
- how we validate
- a person’s connection with God
Let’s look at each of these.
What a Person is Thinking
You’ve probably heard of ‘cognitive-behavioral therapy’, considered to be the clinical standard-of-care for depression and anxiety. The first word, ‘cognitive’, refers to what we think. Moreover, people who struggle with depression and anxiety tend to have depressing and anxiety-provoking thoughts; lots of ‘what-if’s’, catastrophizing, perceiving one minor set-back as generalized failure, and so-on. The remedy is to attack one’s thoughts and replace such maladaptive thinking with more accurate and healthy self-talk. We can do that in lots of ways. A therapist can help to bolster healthy-thinking and, at home, we can, for example, post notes with lists of healthy thinking on the bedroom wall to remind of the successes in the child’s or youth’s life as evidence to support the notion that “I got this!!” in terms of managing whatever problem may arise.
What a Person is Doing
The second part of ‘cognitive-behavioral’, the ‘behavioral’ part, refers to what a person does or how they behave. So, with that in mind, we alter how we act. The subsequent strategies in this category are endless and could involve simply getting out bed, attending to our grooming and hygiene, hanging out with good friends, joining a club, going to church, or going for a walk. This step involves doing the exact opposite of whatever the depression or anxiety is telling us to do. The positive impact of ‘doing’ is also greatly enhanced by ‘doing’ for other people. In that respect, there is nothing more edifying than to ‘get out of our own head’ and help others. This could involve reading stories to younger kids, visiting a nursing home, volunteering at an animal shelter, or whatever floats your boat.
Exercise and Nutrition
I suppose this aspect falls in the ‘doing’ category, but I’ll present it separately. In that regard, we’re referring to taking care of our body. If we don’t eat right, and exercise, we’re going to feel bad. Moreover, the research is abundantly clear that remaining active, and even moving into elevated aerobic pace, is a wonderful antidote to anxiety and depression.
How We Breathe
You might be confused: why am I including ‘breathing’ on this list? Of course, breathing is fundamental to life, and tends to cause us problems as we begin to feel stressed. In fact, a primary symptom of a panic attack is disturbed breathing, or what’s sometimes called ‘hyper-ventilating’. Surprisingly and interestingly, when we control our breathing, we control how we feel. The regimen is called ‘mindful-breathing’, and here’s how it looks:
- We breathe in through our nose. Very deep breath - takes 3-4 seconds to completely breathe in
- Once we inhale completely through our nose, hold that breath for 2 seconds
- Breathe out through the mouth, very slowly and completely
- Once completely exhaled, hold for 2 seconds
- Then breathe-in again through the nose, repeating the process four times.
You’ll find mindful breathing to be very calming; it slows things down and it’s like rebooting a computer. Mindful breathing is very powerful and can be accompanied by closing one's eyes and imagining oneself in a peaceful and pleasant place. With practice, you can become better at mindful breathing and more quickly move into a deeper state of relaxation. Mindful breathing can be done in-the-moment of experiencing anxiety or done throughout the day to lower baseline anxiety. Give it a try!
A powerful way to help somebody struggling with strong feelings is to validate those feelings. We may believe the child or youth is overreacting but, if we want to help the person to calm down, the first thing we do is validate those strong feelings. So, instead of saying something like “why are you getting so upset, it’s not that big a deal” (which only serves to further infuriate the child or youth) instead we say “I can see that it makes you really upset (sad, angry, frustrated…) when you lose that game… a friend says something mean to you… did not get an A+ on the exam… you have to stop playing video games… “ whatever the issue may be. Find the feeling being conveyed and reflect that feeling. You may reflect 4-5 times before moving into problem-solving.
If you move on to problem-solving too soon, before the child or youth feels as though you have fully heard and understand their feelings, it will only cause frustration as a result. In that respect, it is very calming and reassuring for any of us to feel that we’ve been heard, and that the person is on-the-same-page as us. That’s as true for you as for your child.
Connection With God
We are, by our very nature, spiritual beings. Upwards of 90% of people around the world believes in a higher power; there are over two billion Christians, just under two billion Muslims, almost 20 million Jews, over a billion Hindus, and 84 million Buddhists. Any number of research findings and even a recent meta-analysis that included 48 longitudinal studies show that spirituality is significantly associated with positive mental health outcomes. The research is clear, those who consider their walk with God as an important aspect of their lives have far lower rates of depression, anxiety, suicide, substance abuse, and have greater self-control, self-awareness, empathy, concern for others as opposed to preoccupation with one’s-self, and an enhanced sense of comfort and calm.
Of course, this makes sense. When you have an all-knowing, all-powerful God who is by your side and in your corner, well, that’s kind of reassuring. I am a Christian, so that’s my frame-of-reference. In the Christian walk, God is more than just ‘in your corner’; you become an actual adopted child of God and His Spirit is inside you, changing you from the inside-out. As it’s written in 2nd Corinthians, “if anyone is in Christ, he is a new creation, the old has passed away; behold, all things have become new”. The ‘new’ is different from our old self and our old ways of thinking and doing; instead, we become increasingly free from sin, but also free from our fears and sadness.
Of course, it’s not that we don’t experience tough times as a Christian (we still live in the same corrupt and difficult world), but we have a different perspective and inner-power to better-manage those tough times. I wrote above about the ‘cognitive’ strategy of reminding about positives and strengths in a child’s life; this is where memorizing scripture becomes super calming and comforting, such as “The Lord is my rock, my fortress, and my deliverer, in whom I take refuge” Psalm 18:2. If you’re not sure where to start, I’d suggest a church youth group, or children’s ministry for your youth or child. It gets them involved and active in a structured and uplifting environment.
It’s clear that for more severe cases of depression and anxiety, when the strategies listed above are working but not to the extent we’d prefer; medication can be very helpful. The more severe the depression and anxiety, the greater the benefit of medication. Comparatively, for example, it was found that medication works much better than placebo and many experience notable relief in their feelings of depression and anxiety through the use of prescribed medications.
And That’s a Wrap!
There you have a summary of the strategies to effectively treat depression and anxiety. I hope and trust you found this overview to be helpful. It’s typically best to obtain professional guidance in walking through these steps, and all of here at Community Psychiatric Centers would welcome the opportunity to provide such support. Feel free to email me at DrCarosso@aol.com or call 724-850-7200 to schedule. May God deeply bless you and your kids.