“Problem-solve” out of Depression

When we talk about depression, a lot of times our first impression would associate to whether this person had gone through some big changes, or whether he has experienced a huge shock that led to a depressive mood. But in fact, a small incident is sufficient in triggering depressive emotions. Mild depression does not have to rely on medications only, have you thought about what we always say ‘problem-solving’ could improve low mood?

Feeling useless due to impaired mobility after accident

As an extrovert, Pacey loves outdoor activities. Being over 50 does not stop him from being energetic at all. Unfortunately, he accidentally fell while climbing a mountain a year ago, which had a huge impact on his mobility. Since then, his temperament has changed drastically. He became taciturn, spending most of the time at home, and is uninterested in work or other activities. Other than going to the hospital for physiotherapy, he spends most of his time sleeping or watching TV at home. Even though his wife proposed to go shopping or attend gatherings with friends, he rejected it every time, sometimes he even gets mad and drives his wife out of their bedroom. As time passes, their relationship becomes more and more intense.

Until one day, while the physiotherapist was talking about the rehabilitation process with Pacey, he noticed that Pacey’s immobility has led to low mood and avoidance to leave the house, and hence recommended him to join New Life Psychiatric Rehabilitation Associations’s eGPS service. At first, Pacey was reluctant to seek help from mental health institution, but encouraged by his wife, he finally accepted to try this service and met with a psychological well-being officer (PWO).

During his first assessment, Pacey still felt reserved about joining eGPS. He thought such service will not be able to help him at all. In the process of talking with the PWO, he eventually talked about the changes in lifestyle after the accident, for example, fewer outdoor activities and more time at home sleeping or watching TV. He also thinks that he lost the ability to do anything, therefore thinks he is ‘very useless’ and is a ‘failure’. These changes made him sad and frustrated. He had always thought that the cause of such negative moods and thoughts is due to the accident which had made him handicapped, hence the thought that his problems are unsolvable.

Set up a goal, explore feasible options

After understanding Pacey’s situation, the PWO explained and analysed the relationship among emotions, body reactions, behaviours and cognition. Pacey gradually realised that low mood interacts with his physical conditions, behaviours, and cognition, and how these interactions create a vicious cycle. He soon became less reluctant in accepting the service and was willing to discuss and explore different treatment methods with the PWO, including “problem-solving skills”. After Pacey heard about the principle behind “problem-solving skills”, he thought that this method might suit him the best, which he believes is going to be useful in improving his low mood.

In the following meetings, the PWO suggested Pacey to first identify a problem that he wanted to solve. Pacey proposed that he wanted to ‘regain the habit of running’. He stated that he used to feel trouble-free and happy whenever he ran along the waterfront before the accident. However, Pacey has lost the confidence in picking up this habit again not only because he has given up running for a long time, but also his mobility and stamina are not as good as before. Encouraged by the PWO, Pacey tried to set up a goal and think of different ways to solve possible upcoming problems. Initially, he felt anxious, as the goals and solutions he set seemed difficult to carry out. Then the PWO suggested that he should not exclude any methods that may appear impossible; instead he should try and write out all options that he could think of. After that, the PWO analysed the pros and cons of each option with Pacey, and eliminated options that are relatively harder to implement. Finally, they have come up with two feasible options, which are ‘to run in the morning when I feel more energetic’ and ‘to start with jogging before running’. After this analysis, Pacey decided to go for the first option, and under the guidance of the PWO, he tried to split the plan into different little steps, which clearly map out when, where, and with whom to run. Pacey finds this way of clearly outlining his plan makes him more confident in executing his plan.

Plan clearly, gain confidence through making record

Throughout the process, Pacey recorded his progress and achievements while carrying out his plans in a diary. Pacey shared the difficulties and emotional changes that he had encountered with the PWO. For example, since he had pursued his plan, he seldom feels tired again, and he felt more cheerful after exercising. Lastly, what makes him happy is that he has finally regained confidence and that he would even meet with his friends to exercise. Next step, Pacey planned to go for a hike with his wife when he feels better and energised. On one hand, he hopes to ameliorate the relationship with his wife. On the other hand, he wishes to experience the joy of doing outdoor activities.

In fact a lot of people are like Pacey, they will be emotionally disturbed by some unpredictable reasons. As long as you face the problem and seek help, there must be a way out.

Text:Clinical Psychologist Yeung Tsui Yee