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Coping with Anxiety and Depression Part 2: Additional strategies

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While medication, Cognitive Behavioural Therapy (CBT) and mindfulness meditation have the most evidence showing they decrease anxiety and depression, there are a number of additional interventions that have been found to help.

Acceptance and Commitment Therapy (ACT) is a newer form of therapy than Cognitive Behavioural Therapy, so it has been less studied, but has been typically found to be as effective as Cognitive Behavioural Therapy. There is some overlap between the two. The main difference is that while Cognitive Behavioural Therapy tries to suppress unhelpful thoughts, Acceptance and Commitment Therapy teaches people to accept that these thoughts exist but not let them influence you. For instance, if you think, “If If I go to the party, everyone will see what a loser I am”, the CBT approach would be to think whether this is rationally true and find evidence for it being untrue in the hopes that you will correct these thoughts. Meanwhile ACT would encourage you to accept that you’re a person who has these negative thoughts, but you don’t need to let those thoughts rule your life. Those are just sounds your brain is producing and are pretty meaningless, you can still go to the party even with negative thoughts telling you bad things will happen.  ACT can teach you metaphors which help you understand those negative thoughts. For instance, it’s like you’re driving a bus and some very rude passengers get on. They yell at you that aren’t driving right and ask you to swerve this way or that way, to stop or turn around. If you followed their directions, you would start to drive very badly. But, you, as the bus driver can continue driving in the way the know is best, despite that voice yelling at you. Some people prefer this approach to dealing with negative thoughts. For these people, there are lots of resources available which teach Acceptance and Commitment Therapy, including counsellors, books, and apps.

There are also other methods that have been proven to help decrease anxiety and depression. These should be seen as things you can do in addition to what your mental health provider suggests. One step is to get your body healthy through diet and exercise.

Exercise helps prevent and reduce both anxiety and depression both in people with no mental health problems and people with major depressive disorder or panic disorder. Exercise may be the last thing you want to do when you’re depressed, but even 30 minutes of brisk walking in a day, 3 times per week is enough to see benefits in mild to moderate depression. If you want to spend less time, you can do more intense exercises. For depression, it doesn’t seem like it matters what kind of exercise: everything from walking, to running, to weight lifting, or yoga seems to help. For generalized anxiety disorder (GAD), aerobic exercise, exercises that get your heart pumping like cycling or running, is more beneficial than strength training like weight lifting. While there isn’t as much evidence for exercise as Cognitive Behavioural Therapy, studies that have investigated exercise have found it to be more effective than medication at preventing relapses and as effective as Cognitive Behavioural Therapy at reducing symptoms of depression and anxiety. What is yet unknown about exercise as a treatment for depression is what the optimal amount of exercise is and how to keep motivated to do exercise when your mood is so low you don’t want to do anything at all.

There is better evidence that diet improves depression than improves anxiety. Making sure you have enough vitamins and minerals, particularly omega-3, calcium, Vitamin D, and zinc is important [5]. Fish especially, is very good for decreasing depression. Studies find that an improvement in depression through diet is best done with the help of a qualified dietician.

Higher levels of Vitamin B12 is associated with better mental health and can often be low in people who are vegetarian or vegan. Eggs and milk are good sources of Vitamin B12 for vegetarians. For vegans, getting enough Vitamin B12 can be quite tricky. Though some foods such as seaweeds and fermented foods like doenjang, a Korean soybean paste, contain some Vitamin B12, it’s hard to consume enough Vitamin B12 using only vegan sources. So vegans should consider either eating foods fortified with B12 or taking supplements.

Research has found that St. John’s Wort can help reduce mild depression. However, I would not recommend taking St. John’s Wort unless it’s under medical supervision. A lot of people assume that because it’s a natural supplement, it’s harmless. Yet many herbal supplements, including St. John’s Wort can interact with other medication. For instance, St. John’s Wort can make birth control pills and heart medication less effective.

People who experience seasonal affective disorder (SAD), where they feel depressed during a particular season, typically the winter when there is less sunlight, may benefit from a lightbox. People with seasonal affective disorder have a disrupted release of a hormone called melatonin which is controlled by light exposure. A lightbox is a device specially designed for people with seasonal affective disorder to get more ‘sunlight’ at the right time. It is a lamp with extremely high brightness, at least 10,000 lux. Before starting light treatment, you should consult your doctor to make sure you’re a good candidate, as some people with eye conditions such as glaucoma or cataracts should avoid such bright lights. A good light box should emit little UV light. To use the light box, each morning, sit half a meter from the light box for 20-30 minutes per day. You can discontinue treatment during seasons with more sunlight.

Social support is also related to better recovery from depression [8], [9]. Reaching out to friends, family, and other community members such as spiritual leaders, can help you in your journey. There are also 24/7 helplines such as ours which you can call at any time.

 

 

Mariana Kishida is a researcher and community health educator who received her PhD in Psychology from King’s College London.