Dr. Selena Snow
The long sunny days of summer can seem like a time for relaxation and fun as school is out and work slows down. Yet mental health challenges can continue despite the warm season. People who struggle with depression or anxiety can feel even more isolated and alone when they believe that others are having a wonderful time at the pool or traveling, but that only they failed to get the life memo on how to live a carefree life and frolic with friends and family during the summer.
Cognitive Behavioral Therapy (CBT)
Depression and anxiety are distinct, but there are several overlapping symptoms. They often co- occur, regardless of which one develops first. People may also become anxious about how depression affects their life, roles, and relationships, or become depressed and hopeless about how anxiety limits them. Cognitive Behavioral Therapy, known as CBT, is an evidence-based treatment, meaning that extensive empirical research has proven its effectiveness. CBT focuses on changing thoughts and behaviors in order to change the way that someone feels.
Mistakes in Thinking
Both depression and anxiety cause distorted thinking (“thought traps”) involving harsh self- judgments and hopelessness as well as unhelpful behaviors such as avoidance. Thought traps can distort how people think about themselves, others, and the future. They may believe negative thoughts about their own competence, worth, and lovability. They might see themselves as fundamentally flawed and inadequate, feeling shame or embarrassment about their perceived shortcomings. A common pattern of thought traps is the overestimation of threat or difficulty of situations coupled with an underestimation of the ability to cope with discomfort (e.g., “I couldn’t handle that if it happened”). These negative thoughts often contribute to withdrawal and avoidance of other people and activities.
Unhelpful Behavior: Short-Term vs Long-Term
Avoidance plays a key role in many mental health conditions, including depression and anxiety, by maintaining a vicious cycle. The more you avoid, the more you tend to avoid. As individuals rely on avoidant coping, their world shrinks, with fewer opportunities for positive experiences and to collect evidence against negative thoughts and expectations. The short-term relief that comes from escaping or avoiding a difficult situation reinforces the belief that someone can’t handle uncomfortable thoughts, feelings, or sensations. For example, they might think, “Phew, thank goodness I didn’t go to class today when I felt unprepared!” This pattern can lead to a downward spiral of more avoidance of situations and interactions, which can worsen depression and anxiety
in the long run. For example, someone may come to think, “I’ve missed so many days of class that I can’t go back now; I’d better drop the course. What’s wrong with me? I’ll never be able to graduate”.
Fighting Depression and Anxiety
Fighting depression and anxiety involves resisting urges to engage in avoidance or safety behaviors. Safety behaviors are things people do to reduce anxiety and help them feel safe, such as scrolling on their phone in a social setting to look busy so they feel less anxious that others will think they are weird standing alone. (Another vicious cycle- if you do look busy, it will prevent someone from coming over to talk with you!) Instead of avoidance, people are encouraged to tolerate discomfort and make decisions based on personal goals and values.
Related to reducing avoidance, another essential strategy for combating mood and anxiety difficulties is Behavioral Activation. There is a link between mood and activity such that when we don’t engage in activity, we tend to feel worse, whereas we get a mood boost and a sense of accomplishment from engaging in activity. People often tell me that they will resume activities when they feel better AFTER their depression or anxiety has improved. I gently ask, how will that happen? We can’t directly control our mood but we can have much more control over our behavior. Planning to first change mood and THEN change behavior keeps a person stuck waiting to feel better before they can take the steps that we know can help to decrease depression and anxiety. Behavioral activation flips the script and empowers people to FIRST change their behavior and increase activity, in spite of not wanting to do so because they feel depressed or anxious, in order to bring about the desired change in mood.
Engaging in CBT with a trained licensed professional can help modify the unhelpful patterns of thought and behavior that keep people stuck and serve to maintain avoidance, depression, and anxiety. Below are 5 tips to consider implementing on your own.
Summer strategies to combat depression and anxiety:
1) Create structure. A lack of structure during summer can make it difficult to feel motivated to get up and start the day, which can lead to spending more time in bed. This may be especially true for teens and young adults who were registered for programs in Israel this summer but had their plans canceled due to the war. Consider scheduling an activity in the morning to push yourself out of bed. Plan an activity with someone else to increase accountability and improve the chances of following through, such as taking a walk with someone or attending a shiur together. It will be harder to cancel at the last minute.
- 2) Take small steps to reduce avoidance and reliance on safety behaviors. Take small, manageable risks and notice what happens. If socializing after shul feels uncomfortable and you usually leave right after davening, try staying just a few extra minutes. Instead of avoiding eye contact (a safety behavior) and hoping that nobody notices you, make eye contact with one person and start a brief conversation. Even if the situation does not go as you would have liked, you may notice that, nonetheless, you were able to get through it. As you learn that you are more resilient than you think and can handle situations even when things don’t work out, you may feel emboldened to try other activities or interactions. You are not a delicate flower and you can do hard things!
- 3) Put down your phone and go outside. Summer offers us longer days with more opportunity to catch some sunlight and fresh air in the late afternoon/early evening, which can help boost mood and increase physical activity. Give yourself some respite from incessant political stress and war updates and leave your phone behind.
- 4) Medication changes. Summer can be a good time to consult with a medical professional to start or change psychiatric medication when the stakes at school or work may be lower, in the event of side effects from beginning or tapering off medication.
- 5) Be realistic and plan ahead for Fall. If you or a loved one experienced significant depression or anxiety before the summer but seem to be feeling better during the summer (especially true for college students who suddenly have several months of reduced academic and social demands), consider whether some of those symptoms are likely to return when stressors resume in the fall. Summer can be a good time to research licensed clinicians who provide CBT and begin therapy to address depression and anxiety when there are fewer demands on your time. Proactive steps during the summer can prepare you to face returning fall stressors with new tools in your psychological toolbox and greater confidence to effectively cope with challenges, both now and in the future. This article is provided as psychoeducational information for the community and is not intended as psychological treatment and does not constitute creation of a doctor-patient relationship. If you are experiencing a mental health emergency, call 9-8-8, the national behavioral health emergency number, or go to your nearest emergency room.
Dr. Selena Snow is a licensed psychologist. She is the founder and director of The Snow Psychology Group, a private practice of psychologists specializing in CBT and other evidence-based treatment for depression, anxiety, OCD, and trauma for ages 12+. They also conduct neuropsychological evaluations for ages 18+. Services are provided In-Person in Rockville, MD and via Telehealth in over 40 states. For more information, visit www.snowpsych.com or call the office at (240) 676-4206 x1.
