Brought to you by the Depression Is Real Coalition, The Down & Up Show is dedicated to the reality of depression. Our hosts will talk with some of the world's top experts on depression, as well as people who have been impacted by this illness. The reality of depression is that it is a debilitating and potentially deadly medical condition that affects more than 15 million Americans every year. The other reality of depression is that there is hope.

Down & Up Show #29: Depression Self-Care Guide

The Down and Up Show, on depressionisreal.org, a talk show dedicated entirely to the subject of depression and the reality that there is hope for people living with this disease. Now your host, Dr. Ellen Frank.

ELLEN FRANK QUESTION:
Welcome to the Down and Up show on depressionisreal.org. I'm your host, Dr. Ellen Frank. Our guest this week is Dr. Joti Samra, a clinical psychologist and research scientist with the Center for Applied Research in Mental Health and Addiction on the faculty of Health Sciences at Simon Frazier University in British Columbia, Canada.

Dr. Samra conducts research and clinical work on mental health and addiction with a particular interest in the workplace. Today, she'll discuss a self-care manual she co-authored called ÒAnti-Depressant Skills at Work,Ó dealing with mood problems in the workplace. Dr. Samra, welcome to the show today.

JOTI SAMRA ANSWER:
Thank you very much.

ELLEN FRANK QUESTION:
This manual sounds like a wonderful idea. Depression in the workplace is a very important topic but most of us probably don't recognize how depression can affect our job performance or how it impacts our coworkers. What made you decide to develop this self-care guide in the first place?

JOTI SAMRA ANSWER:
Well, you're absolutely right, depression in the workplace is a huge issue and one of the main things that actually prompted the development of this guide was the recognition that there wasn't an existing self-care manual that addressed depression specific to the workplace.

So as you may be well aware, there's a number of kind of materials and self-help guides that are out there that target depression generally but very few, if any, actually address workplace related issues and we know those are a little different in the sense that work is something that most of us need to be doing.

And we're often not able to kind of make concessions or changes in work in the same way that we may be able to in our home life when we're dealing with mental health issues.

ELLEN FRANK QUESTION:
So we have fewer degrees of freedom, as we say.

JOTI SAMRA ANSWER:
Absolutely.

ELLEN FRANK QUESTION:
What made you write it as a workbook?

JOTI SAMRA ANSWER:
Well, the workbook is based on cognitive behavioral principles and we know that cognitive behavioral therapy or CBT is one of the most strongly evidence-based approaches for dealing with depression, particularly on kind of the mild to moderate end. Now part of CBT requires individuals to do a lot of kind of skills which often requires reading and writing.

And because the orientation of the book is CBT-based, we thought it was really helpful to actually put some of the worksheets in there so that individuals would have an opportunity both to kind of read and write as they're going along and work through particular exercises.

ELLEN FRANK QUESTION:
So who do you think should use this workbook?

JOTI SAMRA ANSWER:
Well, that's a good question and it's intended for a range of people so it certainly can be helpful for individuals that are working and have low moods and perhaps don't yet have depression but maybe are at risk for developing depression. It can be helpful for individuals that are working and that have developed a milder or major depression.

So potentially it's a stand-alone treatment for individuals that are on the lower or milder end of depression and as an adjunct to other treatments as they move into the more kind of moderate to severe spectrum. It certainly can be helpful for individuals that have been off work and are reentering the workplace.

And also really helpful for partners or family members, colleagues, managers that are just really wanting to learn a little bit more about depression and the impact that it can have on work functions.

ELLEN FRANK QUESTION:
Your workbook focuses a lot on problem solving. Can you give our listeners an example of a problem solving technique that's used in your workbook?

JOTI SAMRA ANSWER:
Yes, absolutely, and just in terms of kind of context, one of the commentings that we hear from clients that are struggling with depression is that often kind of problems pile up and it starts to feel like life is becoming one big kind of overwhelming problem and often people get behind in terms of addressing kind of day to day issues that would be helpful.

So part of the kind of background in putting this (inaud.) was to help individuals be able to break down what often feels like one unmanageable big problem. And one of the examples that we've given in the workbook is a woman who's dealing with an overwhelming workload, so things are piling up, she's working long hours, and despite all of her efforts, keeps getting further and further behind.

And is finding that talking to her boss about workload issues isn't really leading to any kind of changes. So the whole situation is leading to a sense of being out of control and then mood starts to dip a little bit. And (inaud.) kind of a worksheet and the idea is to brainstorm all the possible kinds of actions and really kind of thoughtfully consider advantages and disadvantages of different actions.

So one of the examples that we given, potentially what somebody could do is continue going, which is often what people tend to do. If we look at individuals that become at risk for depression, they're often quite perfectionistic and aren't wanting to kind of say too much to other people.

So one action, if you keep on going, maybe the boss will eventually notice how overloaded you are and get someone to help. And that's the thing that we identify as a passive action. Some of the advantages are certainly it's what the hypothetical woman in this story is used to doing.

It doesn't create any conflict. It maintains the status quo. But then some of the disadvantages are that the workload will probably keep getting worse and she'll keep falling further and further behind and her mood may start to become lower. Now one of the other options is march into the boss's office and let her know that you've had enough and tell her to stop being so unreasonable.

Now that's an aggressive action. Some of the pros are that you're speaking your mind, perhaps it will lead to change. The disadvantages are that may lead to other conflicts in the workplace. And then finally we go through kind of an assertive task which is write down all the tasks, note which ones are urgent to do today, which ones need to be done this week.

And start to focus energy on high priority tasks and start planning a little bit to help feel like there's some dent that you're putting in the workload.

ELLEN FRANK QUESTION:
I think all of us feel like our lives are increasingly stressful and that our jobs are increasingly stressful. Is there good evidence that stress is a major factor that can lead to depression?

JOTI SAMRA ANSWER:
Yes, absolutely, and just to echo your sentiments, certainly if you look at the world that we live in now, even compared to 20 or 30 years ago and most families, if there's two partners, they're both needing to work financially to sustain a family. Many of the jobs that we are entering now require cognitive skills so it's the brain-based economy which is much different than 20 or 30 years ago in terms of the kinds of jobs the average person had.

Now that's important to recognize because mental health issues, by definition, affect cognitive functions so we start to see the impact a lot more. And we do know that there's a very good relationship between the cumulative effects of stress and eventual development of depressed mood.

But important to quality that there's a lot of variables that can impact this relationship. A certain amount of stress is good for us and, in fact, they're the kinds of things that help us feel stimulated at work, challenged at work. And too little stress is also not a good thing.

Now when stress is chronically high, consistently, there's little predictability or little control over it and little other kind of support mechanisms in place such as a supportive workplace or a supportive boss or a supportive spouse at home, supportive friends, those are times when the effects of stress can start to become much more damaging and harmful.

ELLEN FRANK QUESTION:
Given is that the average person spends more time with co-workers than with a spouse or partner and children, it makes sense that depression can affect the workplace just as much as one's personal life. How do you feel your book helps both employers and employees to deal with depression or help to prevent it?

JOTI SAMRA ANSWER:
Well, one of the main goals that we've had is to really start to increase awareness to businesses and organizations of the prevalence of depression. You know, if we think of historically the roles of mental health and work, there are two very different languages.

Unfortunately, there continues to be a tremendous amount of stigma with respect to mental health issues. The very first step is to start to let organizations know if you look at your workplace, probably at any one point in time, you're going to have anywhere from 5-10 percent of employees that are dealing with depression.

Here's the impact that it can have on your kind of bottom line issues and here are kinds of things that you can do. And the first step is really understanding. We started to do a number of training modules and workshops with human resources staffs, some with managers and just really starting to educate people on how prevalent depression is and educating what it looks like.

So often if somebody themselves has not experienced depression and doesn't have someone that's close to them, they often just equate low mood or sadness and tearfulness with depression but it looks like all different kinds of things and people can be irritable, they can be angry, energy can be low and things that the average layperson doesn't necessarily equate with depression.

So there's a real strong education role. And just to pick up on one other statement that you'd made earlier about, you're right, most of us spend much more time with coworkers and at work than we do at home and one of the important messages that we give is that work is actually good for our mental health as well.

It offers a good source of social connectedness. It gives us social support. It gives us structure. And those are all very, very good things that work can offer and it's also putting that, making sure that you're understanding that concept as well.

ELLEN FRANK QUESTION:
Depression's a very personal topic. Should someone who's feeling depressed talk to his or her employer about it?

JOTI SAMRA ANSWER:
Well, that's a very good question and a very difficult question. One of the Ð we've actually got a short section in our manual titled ÒShould I Tell People at Work about my Depression?Ó And I mean, this is a really, really personal thing. The reality is, unfortunately, there continues to be a huge amount of stigma and the best advice that we can give is for someone, an individual to be thoughtful of the pros and cons of talking to their employer.

Certainly if they've got somebody that's supportive where they feel they would get additional kind of help and so forth, that can often be a wonderful thing to be able to share that with somebody at work. Now other organizations and environments, I mean, people just simply know that it's going to harm them more than help them.

Now legally, we know that there's legislation that even if you're off work, medical information is protected and you're not obligated to share any of that with an employer. And that includes mental health issues. But to the extent that it can help get some support in the workplace, a flag to a boss, for example, that there's some reasons that impacts on work functioned are being seen, try and get other support, it could be a great thing to be able to talk to somebody about it openly.

ELLEN FRANK QUESTION:
Do you think your workbook might encourage people to diagnose and even attempt to treat themselves?

JOTI SAMRA ANSWER:
Well, we would hope not. Our goal, and it's a slippery slope, so we certainly want to educate and increase awareness, and we do go through the beginning of the workbook and talk about kind of what depression is versus not. Depression is one of these words that, as you well know, that people use quite loosely.

I'm really depressed today or I've had a really depressing day. We're educating that that's not what we mean by depression. And that's important to tackle stigma because, if it's a word that individuals generally use as an adjective in terms of describing how they're generally feeling, it's hard then to understand it when someone is really dealing with bona fide depression.

So we do distinguish. In terms of diagnosis, that is something that should be offered by a trained professional but certainly increasing awareness and giving education is helpful. And self care is, I mean, there's a component of that which is kind of guided self treatment.

And what we're very careful to clarify that if someone is dealing with low mood or mild depression, certainly they can work through many of these skills on their own. But as mood symptoms get more intense or severe, that it should be something that's done in combination with other kinds of treatments.

ELLEN FRANK QUESTION:
Well, as you discuss in your guide, people can and do recover from depression. But then the last thing that they want to hear is that depression may and often does return. Is there anything that people can do to reduce the risk of relapse?

JOTI SAMRA ANSWER:
Yes, absolutely. We've actually got, one of our sections is on relapse prevention and the way that Ð I mean, depression is increasingly being recognized within a chronic disease model. So if we look at other chronic diseases like diabetes or arthritis, we know that depression, having a previous episode increases the risk for having a subsequent episode.

Having two previous increases the risk for subsequent and so on. And that in fact, often the tendency is for people to say, well, I feel better now so I should stop using those skills. And if we think of, say, managing diabetes, just because you feel better short term, you actually don't want to stop taking care of doing the self care activities that are important for long term health.

And it becomes really important to continue to practice skills, particularly for the first three to six months post kind of recovery from the depressive episode.

ELLEN FRANK QUESTION:
Joti, it's been a pleasure talking with you today. I think it's important for listeners to know that low mood or depression affect not only their personal life but also their professional life and help is out there. If you're interested in reading about how to deal with mood problems in the workplace, visit depressionisreal.org for a link to the workbook called Anti-Depressant Skills at Work.

Thanks again, Joti. For the Depression Is Real Coalition, I'm Ellen Frank. Join us next time for another segment of the Down and Up Show on depressionisreal.org.

Thanks for listening to the Down and Up Show. For more information, log on to www.depressionisreal.org. You can find us there and at iTunes. And remember, stay subscribed.
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