Managing Your Depression by Susan J. Noonan Page B

When intrusive thoughts come into your mind, let them go without judging them or yourself. Return your focus to your breathing. Over time it will become easier to focus your mind in this way.
    Distress Tolerance
    Sometimes the intensity of depression is so deep, it feels like a crisis situation. You may feel a sense of urgency or a desire to act impulsively. You may feel there is no way out. These feelings can interfere with your efforts to manage depression and maintain stability. Learning to tolerate distress for a short time can help you get through a difficult moment, when you cannot change the situation. Distress Tolerance strategies help you do this by using skills to distract yourself, soothe yourself, provide solace, and improve the difficult moment.
    These strategies are not a cure for the problems of life. They are not meant to dismiss the seriousness of your problems. Practicing Distress Tolerance is more like taking a break from your situation for a short while. Use these skills when you feel overwhelmed by your depression. Eventually the intensity of the moment will fade away.
    Strategies to Achieve Distress Tolerance
    Distraction
Decrease your contact with events that trigger distress using:
• Activities, such as hobbies, sports, or gardening, to distract your attention
• Other thoughts or sensations to distract your mind (such as by doing puzzles, reading)
• Contribution—reach out, volunteer, find a sense of meaning
• Comparison—with those less fortunate
• Emotions—replace a current emotion with another one (such as by watching a funny or scary movie)
Note: Keep in mind that short-term distraction is not the same as avoiding a problem. Don’t push away—avoidance is not helpful as a regular strategy.
Self-Soothing
Be kind to yourself and provide comfort and nurturing by engaging the five senses:
• Vision: enjoy looking at flowers, art, or other objects of beauty; visit museums; get out in nature; see a play, musical, or dance production.
• Taste: have a favorite food or beverage; take it slow and savor the experience.
• Smell: use a favorite fragrance or lotion; buy flowers or walk through a flower garden or shop; bake cinnamon rolls or cookies.
• Touch: take a bubble bath, get a massage, wear comfortable fabrics, hug someone.
• Hearing: listen to beautiful, soothing music or sounds of nature; sing; play an instrument.
Note: Some people feel they are not deserving, or they feel guilt or shame when using self-soothing strategies. If these are problems for you, work on them with your therapist or treatment team.
Improve the Moment
To replace the immediate negative event with a positive experience or image, try the following:
• Visualization—sit and focus on a calm, serene image or a place where you feel relaxed
• Meditation—Dr. Herbert Benson’s book The Relaxation Response gives detailed information on getting started
• Focusing on one thing in the moment (see the Mindfulness section of this chapter, on page 110 , and the following exercise)
• Breathing exercise—sit quietly and focus only on your breathing, taking slow deep breaths, for 3 to 5 minutes; if your mind wanders, refocus on each breath
• Prayer
• Relaxation techniques
• Encouraging self-talk (be your own cheerleader)
• Thinking of pros and cons—the positive and negative aspects of tolerating distress
Basic Principles of Distress Tolerance
• Tolerating distress requires the ability to accept yourself and the current situation.
• Acceptance does not mean you approve of the distressing situation. It is not the same as judging it good.
• Acceptance is a skill for tolerating and surviving the crisis in the moment, until the intensity fades. It will fade.
    Communication Skills
    With depression, speaking up and advocating for yourself can be hard to do. You may feel that your needs, feelings, or opinions are not important or deserving. However, symptoms of depression can worsen if you hold things