Depression and CBT Strategy 101

Musings drawn from Wintering: The Power of Rest and Retreat in Difficult Times by Katherine May

The writing is crisp, evocative and poetic. In the writer’s own words “wintering is a metaphor for those phases in our life when we feel frozen out or unable to make the next step, and that that can come at any time, in any season, in any weather, that it has nothing to do with the physical cold.” The author does so much purposeful activity preparing for her winter/depression, she is canning, baking and taking long walks in the fall blustery weather.  Once winter begins she talks about waking up at 4 a.m. and serious traveling. 

I resonate with much more than the specifics of how the author interacts with “fallow times”.   For instance, allowing oneself to feel sad when one feels sad, accepting that there are times when we are less productive in our careers,  believing that life moves in seasons. In the deep of the winter she even does freezing cold plunges -of note, the description of these cold plunges is absolutely invigorating.  I try the author’s suggestion to wake at 4 a.m., and I read in silence, delighted to find these moments for myself. I actually love this. I realize (again) that having these moments of quiet and reflection restore me. 

I am struck by how the author’s impulse to build in activities that help energize her are in line with Cognitive Behavioral Therapy (CBT). In CBT  a major intervention when people are mired in depression is to develop a schedule of activities.  I have adapted this idea over the years to find a space where we use a compassionate assessment of what we are capable of, and then work with people to develop three different levels of a personalized schedule dependent on the severity of their depression. 

There is the basic schedule, which includes activities of daily living such as brushing teeth and washing ones face, and stepping outside with sneakers on your feet.  The goal here is to do something, and to see it as a total win, if you do.  An intermediate schedule has your basic schedule, embedded into more actions (including physical exercise and a few healthful diet choices, and social interactions).  A high level schedule day includes all of the above, as well as all of the outward facing goals one needs to attend to. Oftentimes, having these structures, and a deep abiding compassion towards how we actually feel, provides a scaffolding where we can actually experience – gentle and appropriate support allows us to do more, than a stern and critical inner voice does. 

Within a therapeutic context, we are working together to find the balance point towards change and growth, but not at a pace or intensity which causes more distress. This is where having a clinical psychologist with a depth of experience really pays off, because there is such variety in pacing and intensity, truly there is no one size fits all. 

This book is so beautifully written, that even if I found the level of activity somewhat exhausting towards the beginning of the book, I will read it again, for the imagery and the tone and the sense of wide ranging exploration the author engages in the latter third of the book.