Recovery from Depression: The Power of Expectation

Recovery from depression depends in part on what you believe is possible for the future. If you are to recover at all, you have to take action at some point. It could be a series of small steps about your daily routine – eating breakfast, walking out the door to get fresh air and natural light, making a point of talking to someone each day.

Or it could be much larger, like going to a psychiatrist and starting treatment, regularly meditating, exercising frequently, taking long walks. Whatever it is, you need to feel motivated to overcome the inertia, to stop the loss of warming energy to the cold stillness of depression.

To feel motivation, you need to believe, however tentatively, that you can change for the better, to expect recovery from the worst symptoms. You’re likely to hit a lot of barriers, though, that make it hard to keep up positive expectations.

When you expect to fail, it often happens that you stop taking action to help yourself recover. The deeply ingrained habits of depressive thinking and belief can quickly take over. You might start making rules and setting goals.

If recovery is not total and permanent, it’s not recovery. Treatments can’t fail, depression relapse can’t happen. You can’t be recovered if you’re still on medication. You have to get better in six months or a year, or some fixed period of time.

Of course, the rules and goals are entirely your invention, but they’re part of the expectations you feel in your gut. If you can’t meet them, the disappointment confirms your deepest conviction that you can never succeed.

Rewire Your Burned-out Brain

Burnout often results from extended periods enduring the emotional stress precipitated by unaccomplished expectations or failure to fulfill unreasonable demands. The symptoms can include intensified emotional exhaustion, physical fatigue, lowered self-worth, changes in eating and exercising habits, social withdrawal, sleep disorders, anxiety, and depression.

If You’re Burned Out, Your Brain Has Rewired to Survival Mode

There are specific and reproducible patterns of changing neural activity and brain connectivity associated with the stress buildup that leads to burnout. In the high-stress state subjects’ neuroimaging scans reveal less activity in the higher, reflective brain (Prefrontal cortex/PFC) and more activity in the lower, reactive brain that controls involuntary behaviors and emotional responses. Prolonged stress correlates with structural increases in the density and speed of the neuron-to-neuron connections in the emotion-driven reactive networks of the lower brain and corresponding decreases connections in prefrontal cortex conscious and reflective control centers.

The explanation of these changes is attributed to the brain’s neuroplasticity defined by the phrase: “neurons that fire together, wire together.” The brain literally rewires to be more efficient in conducting information through the circuits that are most frequently activated.

When stress is frequent, the more frequent activation of the neural pathways to the lower, stress-reactive brain results in their strengthening from enhanced wiring (dendrites, synapses, myelinated axons). These pathways can become so strong that they become your brain’s fast route to its lower, reactive control centers. The stressful, burned out state when the lower, reactive brain is in charge overcomes the calm, reflective, and productive higher neural processing in the (PFC) – the preferred brain locale for control of behavior and emotional self-management.

As your efforts to achieve unreasonable goals are thwarted or increasing demands recur, and the lower brain dominates more frequently, you lose touch with your reflective brain. With less management coming from your reflective PFC, it becomes harder and harder to logically see these challenges in realistic perspective or to solve problems creatively.

Disappointments take on more emotional power and without your higher brain’s perspective, they are interpreted as personal failures. Your self-doubt and stress further activate and strengthen your brain’s involuntary, reactive neural networks. The spiral down to burnout accelerates as these circuits become the automatic go-to networks. Your brain achieves less success in problem-solving and emotional control and ultimately reacts by withholding efforts to escape the burnout state.

Reset Your Brain’s Default Neural Network from Retreat to IGNITE!

The good news is you can apply what we’ve learned from neuroscience about your brain’s survival mode to take actions to retrieve voluntary control of your choices and emotional wellbeing.

You can activate the same neuroplasticity, that gave dominance to the lower brain networks in the burnout state, to construct a new, stronger positive default response. With increasing successful experiences in achieving goals, you can reset the circuits to redirect your brain to access its highest cognitive resources. You can build up newly improved circuitry switching your responses from retreat to IGNITE for mindful awareness and creative problem-solving!

Since an effort-failure pattern sets up the brain’s survival response to withhold effort, you’ll need to strengthen your brain’s recognition that effort toward your goals can result in success. Your weapon of mass reconstruction can come from your brain’s very powerful drive for its own intrinsic neurochemical reward— dopamine and the deeply satisfying and motivating pleasure it brings. When the brain releases dopamine in rewarding bursts, you experience a deep intrinsic satisfaction along with increased motivation, curiosity, perseverance, and memory. Dopamine is particularly released when your brain recognizes that you’ve achieved a challenge (from the “I get it” of figuring out a joke to the satisfaction of completing a marathon).

To get the dopamine-pleasure response from challenges achieved, you’ll need to plan for your brain to experience frequent recognition (feedback awareness) of incremental progress. The choices of what you set as a goal should be guided by their desirability and the goal’s suitability to be broken down into clear segments. You want to set goals, the progress of which, you can chart or easily recognize with each stepwise challenge and success. The pleasure burst of dopamine’s intrinsic motivation accompanying your brain’s recognition of each progressive increment achieved in the goal pathway will keep you motivated to persevere.

Goal Buy-In for Your Brain’s Neural REWIRING

Buy-in and relevance are important in choosing your rewiring goal. Since your goal is to rewire your brain’s expectations that your goal efforts do yield progress, despite increasing challenge, you need to really want the goal. This is not the time to challenge yourself with something you feel you should do, but won’t really look forward to, such as dieting, climbing stadium stairs, or flossing after every meal.

The idea of planning and achieving goals as a burnout intervention is probably not new to you. These are likely to be activities you’ve considered but didn’t do for the obvious reason. They take time. when it comes to adding another activity to your schedule, past experiences have left you with the expectation that there is not enough time.

These first goals that can provide ongoing awareness of your progress are often tangible (visible, such as planting a garden or making pottery on a wheel, or auditory such as playing an instrument, or physical such as learning tai chi), but your goal can also be spending more time at something you already do, but want to do more frequently or successfully, such as journaling, practicing yoga, or sketching.

You’ll Find Your Own Goal for Buy-In, but Here are Some Examples of Planning 

Physical goals: Notice I didn’t say exercise. That’s not as motivating as “training” for a physical goal you want to achieve, even though they often overlap. If you want to run a 10K, and you enjoy running, the goal for an achievable challenge could first be building up to the distance starting with your baseline distance you comfortably run now. Then, plot out the increments that you’ll consider progressive successes, such as adding 100M each day or a week (with increments based on what you consider both challenging and achievable). Once you reach 10K goal, speed can become the next goal again plotted out in segments of incremental progress before you start.

Hobbies: From woodworking to shooting wooden arrows, hobbies really are opportunities for brain rewiring. Again, plan your stepwise achievable challenge increments. If you select darts, start with a home dartboard—low initial investment and throw from a close, but challenging distance at first. As you get better in accuracy move back further. Record your results with the notations of the distance of each improvement you set as an achievable challenge. If you get so good that you are no longer challenged by the dartboard, try that archery!

Mindfulness and meditation are certainly positive interventions for burnout and will be topics of a subsequent blog.

Your Rewired Brain’s Default Changes from Defeat to Ignite

With your understanding of what happened in your brain to create the hopeless frustration of burnout, you’ll hopefully have more positive expectations to help you put in the effort to try (or retry) suggested interventions. Your own natural dopamine-reward system will then be at work deconstructing the resistance network built by your burnout as you reset your circuits of motivation.

The repeated experiences of dopamine-reward you’ll experience as you monitor your goal progress will literally change your brain’s circuitry. Repeated effort-reward experiences promote the neuroplasticity creating neural networks that expect positive outcomes in your new default network. This is because your brain will build stronger connections into the memory pattern. The expectation in achieving this challenge will bring pleasure. As with other less used networks, the previous lower brain stress-activated go-to response network you developed in burn-out, that caused you to react negatively to stressors, will be pruned away from disuse.

You’ll be rewired with optimism and renew positive expectations about your self-efficacy. With your higher, reflective brain back in control, as you access your perseverance, innovation, and creative problem-solving when you need them.

Just be sure to take the time to break down big challenges into opportunities to recognize incremental progress as you achieve each small step en route to your goals. With that positive recharge, your well-deserved dopamine reward will sustain your brain’s motivated perseverance on to the next step of the path to your goals.

Dr. Judy Willis is a board-certified neurologist and middle school teacher, specializing in brain research regarding learning and the brain. With a unique background as both a neurologist and classroom teacher, she writes extensively for professional educational and parenting journals and has written six books about applying the mind, brain, and education research to classroom teaching and parenting strategies. The Association of Educational Publishers honored Dr. Willis as a finalist for the Distinguished Achievement Award for her educational writing. Check out her website.

 

 

Will Meditation Help Stressed-out Lawyers?

Western cognitive psychologist John Paul Minda is collaborating with San Francisco-based lawyer and author Jenna Cho on a project designed to investigate the relationship between mindfulness training and the well-being of attorneys. “We’re hoping to uncover whether or not there are specific things in relation to lawyers,” said Minda, a member of the Brain and Mind Institute. “The specific kinds of stress attorneys deal with is something research really hasn’t done. We just don’t know because this is a relatively new venture. This is definitely exploratory work which will allow us to generate a more specific and targeted hypothesis.” Read the rest of the story.

Why Lawyers Should Embrace, Not Ridicule, Mindfulness

Lawyer Susan Cartier Liebel blogs, “I find this war ridiculous but professional infighting is unfortunately nothing new.  And it stems from the idea that if you talk about anything else other than the client,anything lawyer-centric, somehow you are not client-centric and hardworking and are unworthy of your license. Practicing mindfulness and being client-centric are not mutually exclusive concepts, people.”  Read the Blog

One Trial Lawyer’s Journey From Severe Depression to Greater Fulfillment

I do not consider myself a lawyer. I am a human being who took on the role and career of a lawyer for 25 years. Unlike some people who entered law school with a burning passion to practice law, I ended up there because I was confused about my career direction and had no career counseling. Stop here. If you don’t feel excitement and joy when thinking about a career my hindsight advice is don’t enter it!

After a couple of years in NYC working for a small firm I quit because I hated following orders due to my anti-authoritarian streak dating back to early childhood. When I left for California I passed the CA bar exam, worked briefly for a solo practitioner, and then opened up my own solo practice. During my first few years I took whatever I could get including cases involving wrongful employment termination, wrongful eviction, workers compensation, and personal injury. I gradually steered my practice completely into plaintiff’s personal injury because I come from a family of physicians and I was truly fascinated by the medical aspects of these cases.

After I while I became rather successful as a lawyer, especially because I had a nose for what made a good case, I enjoyed investigating the facts, I cared about my clients (most of them anyway), and I frequently knew more about the medical/psychological aspects of the client’s injury than the defense. My Achilles heel was my biological tendency toward anxiety and depression which, to my mind, are two sides of the same coin.

Although I got excellent results in my cases I was plagued by fears of failure and so I worked myself to the bone when it came to preparing for depositions, hearings, and trials or opposing motions to compel discovery or obtain summary judgment. Although I was never sued by a client in 25 years I always worried that the innately disgruntled ones who complained about everything in their lives might sue me. So I worked extra hard to make sure their cases turned out well. To put in all these hours I gave up on exercise, sat more, and ate unhealthy, high salt, high sugar foods to give me some compensatory pleasure. Stop. If you are doing these things you will damage your physical and mental health. Our bodies crave outdoor exercise in the fresh air and they crave real food, not the processed crap made in factories.

At the beginning of the 1990s I took on some new challenges. I moved to a larger, more expensive office. I became a homeowner. And, my wife became pregnant with our first child. In the mid-1990s, I developed a bridge phobia, a phobia involving the fear I would fall out of the window of a tall office building, and panicky dread over crime in our neighborhood which seemed to be getting worse every day. To help myself through these irrational fears I became a good friend of Jack Daniels. This nearly led my wife to divorce me. The threat of divorce woke me up like a cold shower. I went to see a psychiatrist who put me on Zoloft and I stopped drinking. Things got better. We had a second child, a son. In the coming years I became a very good father. I adore my kids. They adore me. Both kids are flourishing. This is something I am very proud of.

In the decade between 1995-2005 I handled an increasing number of cases involving traumatic brain injury and made significant income. Initially these cases were very exciting. Over time they became a drag. Why? The defense, which had paid up relatively quickly in the early days, now used scorched earth tactics by hiring experts in human factors, biomechanics, neurology, psychiatry, neuropsychiatry, neuroradiology, etc. I had to hire counter experts in each field and I had to pay to depose every over-priced, hostile defense expert who gave me all their specious reasons why each client was a neurotic, a hysteric or a malingerer.

I felt like Sisyphus, the man condemned by the gods to roll a boulder up a steep hill every day. The litigation costs drained my coffers to the point where I was late on my rent, my copier machine rental, my records fees, and witness fees every month. In the midst of these depressing circumstances my mother suddenly died of a brain virus. And then, one day, my wife noticed we were completely out of money and our home equity lines were maxed out. I instantly plunged into what my psychiatrist called a psychotic depression in which I heard a voice from within me tell me to die over and over again, relentlessly 24/7 until after 4 days of it, I went to a hospital emergency room.

The psychiatrists who cared for me in the hospital told me I had snapped as a result of an inborn vulnerability to depression, years of stress from legal practice, and the trauma of my mother’s death and insolvency. They told me never to return to legal practice. My past 8 years have been a journey back from severe depression and into a new, more fulfilling life. Thanks to a private, own-occupation disability policy I was able to pay my family’s living expenses while recovering.

upward-spiral

I researched and wrote my book for lawyers, The Upward Spiral: Getting Lawyers from Daily Misery to Lifetime Wellbeing, on stress and depression while studying and practicing Buddhist meditation. I became ordained as an interfaith chaplain and sat with dying patients at a local hospital. More recently I entered an MS program in mental health counseling at Capella University. I anticipate becoming a Licensed Professional Clinical Counselor at the beginning of 2017. I am finding my studies, practicums, and internships in mental health graduate school to be very meaningful and fulfilling.

Law is a very stressful profession which produces severe depression in one out of every five lawyers. What is my message to my colleagues in the law who suffer depression?

First, face the depression. Do not deny it and self-medicate it with unhealthy substance or behavioral addictions.

Second, try medication. For a depression with obsessive, suicidal rumination (like mine) it can be life-saving.

Third, see a therapist (a psychologist, MFT, counselor or social worker) so you can explore and understand the bio-psychosocial roots of your depression and choose the best form of therapy to resolve your depression.

Fourth, consider couples counseling or family therapy so your spouse and children can understand your depression and have an opportunity to educate you as to how it is affecting them. This can lead to improved understanding, communication, and cooperation at home within the family system.

Fifth, consult experts in nutrition, exercise, and sleep to develop ways for you to eat healthier, exercise more, and sleep better. A wonderful book on these topics is Go Wild by Dr. John Ratey.

Sixth, spend more time in nature because there is nothing better to quiet the mind, ease the sore psyche or restore the spirit.

Seventh, take time to actualize your potential as a unique self through whatever activity calls to you, be it photography, calligraphy, water color painting, baking, cooking, etc.

Good luck. I know you can beat depression and be happier.

Harvey Hyman, J.D. spent 25 successful yet stressful years practicing personal injury law in New York and California.  Thanks to an episode of severe depression in 2007, he found happiness and joy that had always eluded him.

 

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