Depression is the most common mental health disorder in the United States, with nearly one in 10 U.S. adults experiencing some form of it. Depression is affecting younger and younger generations, and sadly, it is on the rise. According to the World Health Organization, by the year 2020, depression will be the second most common health problem in the world. With October being Depression Awareness Month, I'm probably not the first to bring this subject to your attention, but what if we took pause to think about what these numbers really mean?
Once we recognize the real impact of depression, not just on a broader world health level, but on the individual lives that it affects every day, we must abolish whatever remains of the stigma that depression is something to be ashamed about, or that it's just a bad mood, so "snap out of it." And we must start thinking about what works in terms of treatment, a subject I'll talk more about in a free Webinar "Empowering Strategies to Fight Depression." How can each of us take up arms against this painful condition and offer ourselves, our children, and our loved ones their best chance at overcoming depression?
When it comes to finding ways to empower ourselves against depression, I believe that one of the most important things to consider is the effect of the "critical inner voice." The critical inner voice represents a damaging internal thought process, a form of destructive self-talk that perpetuates feelings of shame, self-hatred, negative rumination, and low self-esteem. Studies have shown that low self-esteem predicts depression. Even in toddlers, a negative self-concept has been found to be associated with depression.
Although, most of us experience low self-esteem and are familiar with the commentary of a critical inner voice, for those who are depressed, this critical inner voice can have a powerful, debilitating influence on their state of mind. The critical inner voice can cause people to dwell on perceived problems or sorrows. It can also make it even more difficult to take actions that would help individuals emerge from a depressive state. This voice is often critical and highly distorted. In a blink of an eye, it can fill our heads with thoughts like: "You're so pathetic. You're just a drain on everyone. You're worthless/ stupid/ ugly. Why can't you just be normal? You don't really have anything to look forward to. There's nothing to feel good about."
The critical inner voice is also tricky, as it can seem both self-soothing and self-punishing. It lures us into engaging in actions or situations that then perpetuate our anxiety and depression. "Just go home and be by yourself," it suggests. "You should just have a drink and relax. There's no point in trying to be active. Why go through all the trouble of going out and seeing those people?" When we give in to these "voices," our inner critic is then there to punish us. "What's the matter with you? All alone again. What a loser. You never succeed at anything. No one wants you around anyway." This type of cyclical thinking turns us completely against ourselves and leaves us at the mercy of a mean and ruminating inner enemy. To combat depression means taking on this inner voice or "anti-self."
My father, Dr. Robert Firestone, created Voice Therapy as a therapeutic approach to conquer your critical inner voice, and in our book of that tile, which I co-authored with my father, we discuss specific ways people can start to challenge this inner enemy. Here are some of the valuable steps that can help people to start to recognize and counter these destructive thought processes.
1. Identify the negative thoughts and beliefs you experience. Notice the events and circumstances that trigger these "voices" and the feelings that arise.
2. Write the thoughts down in the second person as if someone is talking to you. So, instead of writing "I don't have anything to offer," write "You don't have anything to offer." This allows you to shift perspective and see the voice as an external enemy instead of your own point of view.
3. Respond rationally and compassionately to these "voices," as you would to a friend, except this time, write your responses in the first person, as "I" statements. "I have a lot to offer. I have many qualities that people appreciate, and I care about others. I am fine the way I am."
4. Talk to a close friend who tends to have a more optimistic outlook. This can help you align with your real self and counter the negativity of your anti-self.
5. Make yourself engage in activities that you have enjoyed in the past. Even if you don't feel like it right now, taking these actions will help reinvigorate you and interrupt the destructive thought process that's taking place.
One of the most important principles you can adopt in facing off against this inner critic that fuels depression is to practice self-compassion. Research findings have consistently shown that greater self-compassion is linked to less anxiety and depression. Despite the fact that people who suffer from depression may have lower levels of self-compassion, studies also show that practicing self-compassion can reduce symptoms of depression, in large part because it helps us not get stuck in our negative thoughts.
Dr. Kristin Neff describes three key elements of self-compassion: 1) self-kindness over self-judgment, 2) mindfulness over over-identification with thoughts and feelings, 3) common humanity versus isolation. Self-compassion asks us to value ourselves as human beings without judgment or evaluation. It allows us to notice our suffering and to feel compassion for ourselves without getting caught up in the rumination that comes with assessing ourselves or our state of being. Dr. Neff's research has confirmed the benefits of this practice when fighting depression. One of the rewards of self-compassion is that it's proven to better help us to achieve change in our lives.
Depression is a real disorder, but there are real ways to fight it. And when we do, no matter what treatment approach we take, we must be on our own team. We must see our critical inner voice as the enemy it is and reconnect with our real selves, the part of us that embraces our basic human right to live our lives on our terms.
Learn more about the Webinar "Empowering Strategies to Fight Depression."
Read more from Dr. Lisa Firestone at PsychAlive.org