Recently at the Kripalu Center for Yoga and Health I had the opportunity to attend a three-day workshop presented by Rick Hanson, author of Buddha’s Brain. As many know, particularly those in the world of psychology, there is much documented evidence indicating that we can change our brains from a negative perspective to a more optimistic one by developing certain skills. Changing or reshaping the brain is known as neuroplasticity. The fact that we have the capacity to reshape our brains means we have the power within us to lead happier and more optimistic lives. This is indeed good news.

The bad news is as Dr. Hanson pointed out is that, “The brain is like Velcro for negative experiences and Teflon for positive ones. The natural result culminates in an increasing residue of emotional pain, pessimism, and numbing inhibition in our memory banks.”

Most of us expend a considerable amount of thought and energy focusing on the negative or potentially negative events in our lives. Focusing on the negative strengthens the part of the brain that  creates generalizations and we interpret old and new experiences in a negative light. According to Dr. Rick Hanson our brains have a “negativity bias.” This suggests that we continually scan the environment looking for the negative, which in turn shapes our minds, resulting in depressed and anxious moods, anger and overreactions.

But (we’re back to the good news) just as we have the capacity to strengthen our negative perspective on things, so too do we possess the ability to fortify the part of the brain that is responsible for positive thought. Even though most of us have internalized the negative bias, positive thoughts can also generalize in the brain. The neural circuitry of memory occupies the heart of the mechanism responsible for changing the brain. If we can learn how to generate and internalize positive experiences into the brain and the self, we can establish greater resilience, optimism, happiness, and better relationships.

Since our thoughts have the power to reshape our brains, it behooves us to learn the skills that are most likely to lead us to a positive perspective. When practiced regularly, certain exercises will help foster a change in brain circuitry and make us happier.

The more conscious we are about perceiving an event as being good or ‘good enough’ the more this perception will generalize to other parts of our brain. However, just having positive experiences is not enough, as these sentiments tend to pass fleetingly through the brain while negative experiences are more tenacious. We must actively work to integrate positive experiences into the brain, in order for the beneficial effects to endure. The question remains, “How do I do this?”

Dr. Hanson teaches a simple visualization exercise, which he refers to as “Taking in the Good.” Although there are many other strategies, I found his method for weaving positive emotions into the brain to be quite compelling. He suggests that this visualization process be practiced routinely, until the effects are noticed and so forth.

How to Take in the Good

The idea is to take in the good in a relaxed state and savor these experiences. The more this is practiced the more deeply ingrained the positive will become.

1.  Look for positive facts and traits about your self and your life. Broaden them to become positive experiences (i.e. a great conversation with a friend, a good night’s sleep, an unexpected compliment).

2.  Savor the positive experience or memory of the experience and sustain it for about 30 seconds. Allow yourself to feel it in your mind and body. Keep bringing your attention back to the experience when your mind wanders. Intensify the feeling and be with that for another 30 seconds. Practice several times in succession.

3.  As you feel this positive, truthful fact allow it to soak into the recesses of your mind and body. Marc Lewis and other researchers have shown that the longer something is held in conscious awareness, the more neurons that fire and thus wire together, and the stronger the trace in memory. The idea is to continue building a positive collection of experiences into the brain. This will cast an optimistic perspective on other experiences and will penetrate the unconscious mind.

Practice “Taking in the Good” and truly appreciating positive experiences and notice how you feel. This may be a bit challenging at first; it gets easier with practice. Remember this is about being kind to yourself and cultivating positive resources in your mind.

Please let me know if you have any questions about how to “Take in the Good.”  Your comments are welcomed.

Linda, a 42 year old attorney with two young boys, felt guilt and disappointment both on the job and at home. She never quite felt that she was where she needed to be at any given time. For all of her accomplishments, she felt like a failure as a lawyer and as a mother. She strove for perfection in all facets of her life, but now was finding that juggling motherhood and her professional life made this impossible. The standards that Linda set for herself were unattainable and therefore an innate form of sabotage.

She made little time for her own self-care and felt exhausted all the time. Linda ran from home to work and back home again. The multitasking and quest for perfection was taking a toll on her physical and emotional self. Linda also began to isolate herself from her friends as she could not justify taking the time to make plans. Everything and everyone became a distraction, taking her away from her children and work. She began suffering from headaches and displayed early symptoms of depression.

Perfectionism is the belief that mistakes cannot be made and that the highest standards of performance in all aspects of one’s life must consistently be met. It is a state of mind where there exists an imbalance between one’s standards of success and the ability to achieve success. Worry, fear, guilt and self-doubt usually weave their way into the mind of the perfectionist. The pressure of this self-imposed demand can take a severe toll, mentally and physically.

Characteristics of a perfectionist

• Sets unrealistic goals and standards
• Views mistakes personally–as a lack of self-worth
• Preoccupation with fear of failure depletes energy levels
• Interprets comments and suggestions as criticism
• Tends to be rigid in behavior styles and afraid to experiment with the unfamiliar due to fear of failure
• Constantly frustrated, since perfection is unattainable which can lead to anxiety and depression

How to manage the frustrations of the perfectionist

• Set standards in one’s personal and professional life that are high but attainable; aim for your best performance, rather than perfection. Remember setting perfection, as a goal is invariably a setup for failure.
• Listen to suggestions and remind yourself that comments are your opportunities for growth and expanded learning potential.
• Understand and if possible accept that disappointment is unavoidable, the faster you recover from setbacks, the faster you can move forward on your goals.
• Learn some mindfulness techniques to allow you to be more fully in the present, without having to go back in you mind to old voices in your past, reminding you of your inadequacies.
• Practice affirmations to train your mind that you can accomplish your goals and dreams and although the outcome may not be perfect, it can be “good enough.” Satisfaction can be derived from “good enough.”
• Learn to live in the moment and enjoy the experiences along the way that lead to the accomplishment of your goals. Allow you to “stop and smell the roses.” This can help you stay grounded in your wish for success.
• Remain flexible when it comes to unexpected transition and change because it is likely going to occur.
• Celebrate accomplishments.

Linda’s need for perfection came from early childhood messages. I listened to her story carefully and then reinforced that she had to give up this unrealistic fantasy of perfection. If not she would remain frustrated and unhappy. “This is the age of the death of perfection.” I assured her. It is a time in the evolution of women to adapt and integrate a kinder and gentler self-perception. The notion of the “good enough mother” or the “good enough lawyer” does not suggest that we compromise our integrity and commitment to our jobs, but rather that we embrace the multidimensional roles of our lives fully and authentically.

Eventually Linda found relief in the notion of being “good enough” and gradually gave up the notion of perfection. She found herself enjoying her family and work life once she eased up on the self-criticism and adapted an attitude of greater self-love.

Would love to know any tips you have for being less self-critical.

No one can make you feel inferior without your consent. ~ Eleanor Roosevelt

Julia, a dental assistant in a local dentist’s office has a distinct twinkle in her eye that never fails to light up a room. That is, until February hits. Something happens in the cold, dark months in New England that slowly builds within Julia. Perhaps it is Seasonal Affective Disorder, although she has never been formally diagnosed. It’s as if she hits the wall for the midwinter months and then by late in April she slowly begins to emerge from her cocoon. Julia is in good company with those among us coming undone in February and suffering from the “winter blues.”

Holidays well behind us now, the snow plows this year in perpetual motion, a general malaise seems to have settled throughout New England. Unless you’ve managed to get up to ski country, it’s easy to go into hiding. The roads are difficult to navigate and who wants to leave the warmth and safety of their abodes, unless it is to bask in the sun some place far, far away.

What I observe in my office and among my friends is that this is the time of year when depression typically sets in for many – with or without Seasonal Affective Disorder. Complaints like lethargy, flu-like symptoms, lack of concentration, weight gain, stress, anxiety and increased pain issues abound.

It takes determination and commitment to win the battle against the “winter blues,” but it can be done. Taking certain proactive steps can counteract the doldrums and despondency that this season sometimes brings.

Here are ten strategies that are guaranteed to guide you back to a place of balance, well-being and heightened energy.

1. Start your day with a positive affirmation. Create a simple, positive statement that resonates with you about yourself, your family, or your work that you can resort to as you move through the day. Remember your higher purpose, rather than focusing on the annoyances of the day. Think about the big picture. For example, “I feel balanced, blessed and happy.” When negative thoughts come up, reframe them with a more optimistic perspective. Positivity is a skill that can be learned with regular practice.

2. Build exercise into your day: a brisk walk, floor exercises, a swim, dancing in the living room, watching a yoga tape, visiting the gym. Movement will keep you warm as you feel good energy flowing.

3. Practice a meditation or relaxation exercise. Ten to twenty minutes of meditation or relaxation changes you psychologically and physiologically. It’s one of the most concentrated actions you can take to feeling more centered, focused and happier. If you don’t want to meditate, then build in some extra down time, since the winter can be more demanding on your body physically.

4. Spend some time with a friend(s). If you cannot get together physically, then catch up with a friend on the phone, skype or some form of social media. Face-to-face contact is best, but connecting via any mode of communication trumps isolation. You might also consider enlisting a friend’s support in following through with some of these strategies.

5. Maintain a healthy diet. White sugar and white flour products can seem quite comforting on these dark and cold days. However, foods that are devoid of nutrients tend to zap your energy level and can affect your mood and ability to concentrate. It is better to stabilize your blood sugar levels and go for the fruits, vegetables, complex carbohydrates, lots of water and foods rich in Vitamin D.

6. Get sunshine whenever possible. Try to get some sunshine (again Vitamin D) and fresh air when possible. Sunlight releases neurotransmitters, which positively affect mood and feelings of well-being. On sunny days you might consider cranking up the heat in the car and keeping the sunroof open, even if just for a few minutes at a time; the cold air can be quite exhilarating.

7. Embrace the beauty of the winter season. Perhaps take up snowshoeing, cross-country skiing, downhill skiing or buy crampons for the bottom of your shoes so that you can safely walk outside. Once you find a way to enjoy the season, you will find it not only easier to tolerate, but you may begin to appreciate the magnificence of a cold, crisp wintry day!

8. Make a fire at home and get cozy. If you’re lucky enough to have a fireplace, make a ritual of snuggling up with a book or game with friends or family and enjoy the cozy time. You can relax and not feel as pressured to be outside as sometimes happens when there’s warm weather in New England.

9. Engage in flow activities. Flow activities are any activities that you find pleasurable in which you lose track of time. For example: singing, dancing, painting, yoga, writing, long walks, nature, photography, connecting with friends. These activities help enliven the spirit and bring you back into a state of equilibrium and happiness.

10. Focus on the big picture. What are your priorities? Are you moving forward with the realization of your priorities? Everyday that you put energy into A-list goals and don’t fritter the time away sweating the small stuff, you bring yourself a sense of satisfaction and accomplishment. Finding balance and happiness is about making your day, even in the dead of winter, by combining all of the elements that make you feel good physically, psychologically, and spiritually.

What do you do to take pleasure out of the winter months?

Waking up in the morning to a clean, de-cluttered space brings me a sense of balance and happiness. Even when my children were young I managed to maintain a space where I could sit, if only for a few precious moments and enjoy the calm and peace of a minimalist space.

Of course we all know that life is messy business and cannot really be controlled. There are however ways to make daily life less stressful. Getting rid of extra stuff is one of the keys to diminishing stress.

Simplifying Life

Simplifying your life means doing what you enjoy or being with the people you love and eliminating whatever gets in the way of feeling good. Getting to simplicity is about discovering what truly has value to you and getting rid of the rest. The de-clutter journey liberates the mind and spirit and frees your energy for deeper levels of fulfillment.

The more stuff you acquire, the more time and attention you need to expend caring for and managing that stuff. Taking stock of what is most important to you and eliminating the rest is the essence of the simplification process.

We accumulate material objects for a variety of reasons:

• Sentimental value; memories associated with a lost loved one
• Believing our lives will be happier and more fulfilling
• Feeling more valued ourselves for having more stuff
• Experiencing peer pressure to keep up materially
• Inability to let go; feeling a personal connection with belongings
• Thinking someday the objects will fill a need

The clutter that continues to build in your world creates chaos and anxiety, which can be alleviated by making some changes in your daily routine. When the space you live and work in is pared down and organized, you will feel more in control and able to focus on the things that matter most to you in life.

10 Ideas to Simplify Your Life

• Make a list of your top 5 priorities in your life.
• Evaluate your daily schedule and commitments. Eliminate whatever doesn’t line up with your priorities.
• Consider the appointments and commitments you make. Are they in alignment with your values?
• Think about all the stuff in your life that feels irrelevant or superfluous, and start clearing the decks i.e. donating books, clothes, utensils.
• Pare down your wardrobe. Eliminate clothing that doesn’t make you feel good and confident.
• Spend more time with friends and less time in the stores. You’ll be happier.
• Create morning and evening rituals. Your life will feel not only feel more in control with rituals, but you might also notice that you have more energy in the morning and better sleep as night.
• Find a regular time to de-clutter. Make it a routine, as it’s a process, not a destination.
• Learn the feeling of having enough, so you are not trapped in the perpetual cycle of wanting, seeking and getting.
• Make sure you are doing at least one of your top priorities daily.

Please leave your comments about other ideas you have for simplifying your life.

Michele lapsed into feelings of despair and darkness every November. For years she did not particularly notice the change in her temperament or energy level, but it became strikingly apparent to her husband.

She dragged herself out of bed in the morning and begrudgingly got the kids off to school and then herself to work. She described her mornings as being physically painful. She yearned for sleep much of the time. Michele became moody, lethargic and alienated herself from friends this time of year.

Michele learned that she suffered from Seasonal Affective Disorder (SAD), which is a type of depression that occurs at the same time every year and seems to develop from inadequate sunlight during the winter months. Researchers have found that exposure to sunlight alters brain chemistry. Factors like low levels of vitamin D in the blood are also associated with a higher occurrence of SAD. Problems with SAD are typically mild at first and then become increasingly severe as the season progresses.

SAD Symptoms

• Depression
• Anxiety
• Hopelessness
• Difficulty concentrating
• Loss of energy
• Mood shifts
• Social withdrawal
• Appetite changes and cravings
• Loss of interest in activities otherwise enjoyed
• Chronic fatigue

Successfully Managing SAD

• Spend time outside every day. The effects of daylight are beneficial even when it’s cloudy.
• Get adequate but not excessive sleep.
• Exercise routinely for at least 30 minutes.
• Eat healthy, regular meals – minimize sweet and starchy foods.
• Meditate or learn a relaxation technique.
• Keep a journal of thoughts, feelings and mood fluctuations.
• Take a sunny vacation if possible.
• Minimize alcohol intake.
• Take prescribed medication if indicated.
• Connect with friends even when not completely in the mood.
• Take vitamin D3 daily – check with your physician for dosage.
  

Light Therapy Treatment

Some people respond well to light box therapy for SAD. The rays from a light box mimic daylight, which is believed to change the brain chemistry that elevates your mood and eases other symptoms associated with SAD. Light therapy is also used to adjust the circadian rhythm or daily sleep cycle, which seems to play an important role in mood alteration.

Light boxes are generally used for 30 minutes or more every day, with the lamp shining indirectly toward the eyes. There is limited research on light boxes which makes it challenging to know which one would be most effective for you. According to the Mayo Clinic there are some important parameters to consider before buying a light box.

Michele understands that treating her SAD optimally means making some life style changes. She takes it one day at a time and commits herself to eating better, walking her dog outside every day and most importantly connecting with friends. As she says, “I am a work in progress, but I feel armed with the tools I need.” Now she knows that when symptoms predictably appear, she is empowered to change the outcome of her experience of the darker months. Michele understands that she is responsible for her own balance and happiness.

What’s a strategy you use to stay light in the dark months?

The short conversation on the phone left my husband, Martin with a look of shock. “What was that about?” I asked. Martin stood in silence, took some forced deep breaths and softly spoke. “There’s been an accident. A terrible accident.” As it turned out, one of my son, Max’s dear childhood friend was killed in a car crash hours before. He left a party in the early morning hours feeling it would be safe to drive. He got into his car, still slightly intoxicated from the night before neglecting to put on his seat beat. He drove off and almost immediately crashed into a tree.  He wanted to get home; it was such a short distance. This was a great kid who made a terrible decision.

My son was on his way to a concert in Boston, ready to savor his last night in town and then finish up the packing in the morning. Martin called him to tell him of the tragedy so he didn’t read it on facebook or hear it on the news or from a friend. Somehow we thought perhaps we could soften the blow from the sickening news. He began to wail over the phone. He uttered a sound I had never heard come from him before. I could hear the ghoulish cries even as I stood several feet away from the phone.

How could this be? They were such great buddies. So many childhood memories shared. Max came home, locked himself in his room and sobbed. One by one Amy, Martin and I offered to talk to him or just be with him. “I need to figure this out alone. I need to think. I need…” His cries could be heard throughout the house. Amy left to walk the dog, just so she could shield herself at least temporarily from Max’s anguish.

My heart aches for the family that suffered the greatest loss of all. Their lives forevermore changed and broken. My heart aches for the young man with such promise that will never see age twenty. My heart aches for my son who lost his dear boyhood friend along with his innocence. No one is impervious. Yes, we need to train our children to be ever vigilant in making good choices and decisions. Even then we cannot save them from senseless catastrophe.

Last night I found myself murmuring prayers for the unspeakable loss of this family and for the protection of my own children.

How do you best protect your children from catastrophe?

Years ago I conducted workshops and seminars to physicians at the Boston University School of Medicine. The well-attended meetings were about “Who Takes Care of the Physician?” This subject continues to warrant attention, however I’ve come to realize that nurses, aides, home health care providers and our reliable family members, also need to be cared for. They too need tools for their own self-care during these stressful times.

Of course the primary focus is on the sick or post-operative patient, but little attention is paid to the family members that are in the trenches day in and day out with their loved ones. The responsibilities thrust upon the spouses and children can be not only overwhelming, but disorienting and exhausting.

Effects on Family Members

• Fear of the unknown; fear that the family member may never be the same
• Guilt over whether there might have been something you could have done to prevent your family member’s diagnosis
• Helplessness; feeling that there is nothing you can do to really make a difference
• Anxiety over whether the recovery will be sound and complete as possible
• Depression over family member’s inability to live her life the way she used to before the diagnosis
• Frustration about one’s own sleep deprivation, lack of control of one’s own time, and the litany of demands needed on the part of the patient – and shame with feeling the need to take care of the self when needed by the impaired loved one

Ways For Family Members to Manage Successfully while Care Taking:

• Know that recovery involves a partnership of the patient and caretaker.
• Share your feelings of frustration with a friend, loved one or, if appropriate, the person you are caring for.
• Share your positive feelings too, as in reminding the patient that you love him and are willing to do all that you can to help him.
• Get an education. This will help you be more patient, compassionate, and understanding. It will also prepare you for any physical or psychological changes your family member may have to endure.
• If you are not the primary caretaker make your visits short, positive and upbeat.
• Keeping in touch with friends and other family members enables you to get the moral and emotional support needed.
• Make time for yourself. Build in the coverage you need so that you can take breaks to rejuvenate and care for your own physical and psychological needs. Lose the guilt.  The timeout will make you a more effective and loving caretaker.

When have you had to be a caretaker? What psychological impact did the role have on you?

Getting a difficult medical diagnosis is challenging at best. Elizabeth Kubler Ross wrote extensively about the five stages of grief that accompanies the experience of loss. Although her work originally described the reaction to the death of a loved one, the same cycle applies to those experiencing health issues requiring surgical intervention.

Elizabeth Kubler Ross’s Five Stages of Grief:

• Denial: “This can’t be happening to me.”
• Anger: “Why is this happening? Who is to blame?”
• Bargaining: “Please God make this not happen and in return I will ____.”
• Depression: “I’m too sad or down to do anything.”
• Acceptance: “I’m at peace with what happened.”

This is a simplistic model of what any of us experience when we are struck with a tough reality that we need to integrate into our consciousness. The process of getting a difficult diagnosis or dealing with any loss issue is considerably messier and less predictable than the one Kubler Ross describes. Nevertheless all of these five stages appear eventually on the horizon of one’s experience.

Learning about a difficult medical diagnosis can be challenging, but like most things, being prepared makes the process a lot less daunting.

How to prepare for surgery and manage post-operatively:

• Keep a positive attitude. People who are facing surgery undoubtedly experience fear, worry and anxiety. Keeping a positive attitude can help lessen those emotions. Write a few affirmations pertaining to your surgery and repeat them often. Focus on a positive outcome. When your mind wanders away from a positive outcome, give it a gentle nudge back. Peggy Huddleston illuminates mind-body techniques that help patients mentally prepare for surgery and in turn, heal faster.

• Use meditation as an effective tool to mentally prepare for surgery and to handle difficult situations after surgery. When meditating focus your thoughts on breathing, calmness, and healing.

• Talk about your fears and apprehension with a relative or friend. Verbalizing your feelings can make a profound difference on your inner experience, even when nothing changes externally. A partner or friend you can talk with openly and honestly will diminish the intensity of complicated feelings around a surgery.

• Rely on your faith. If you are religious put your trust in God and leave the surgery in His/Her hands. Ask family members and friends to pray for you during the surgery and afterwards for a full and speedy recovery. Even if they do not share your religious beliefs you can still derive benefits from other’s prayers. Have faith in the surgeon’s ability as well as your body’s ability to heal.

• Consult with your physician regarding any concerns you have about your health condition or the surgery. He/she can answer any questions you may have and help to alleviate your fears. Your physician will understand your feelings and will be happy to reassure you in any way possible.

• Surround yourself with loving, supportive people. You may feel like keeping your upcoming surgery to yourself but it may actually be best to share the information with friends and co-workers. If they are aware of your health condition and surgery they will no doubt support, encourage you, and offer their assistance to help you and/or your family. Knowing that you have people who love and care for you can be the best preparation.

• Get informed. Learn everything you can about your health condition and the surgical procedure. Being informed is being prepared.

• Talk to other people that you trust who have had the same surgery. Glean from those conversations kernels of information that might be of value to you while keeping in mind that no two people experience a surgery in the same way.

What strategies do you employ to get through periods of grief and anxiety?

Only in recent years have we come to understand the positive effects of exercise on the brain and mental health. Exercise is also good for one’s physical health. Reduced body fat, stronger muscles,  bones, and heart, and lower blood pressure are among the benefits. It also helps us look and feel healthier and fit.

During exercise the levels of neurotransmitters – the “feel good chemicals” serotonin, dopamine, and norepinephrine – increase. Exercise, therefore, has powerful antidepressant properties. In a study conducted at Duke University researchers found that 60% of the participants who exercised for 30 minutes 3x week over a four week period successfully overcame their depression without the use of antidepressant medication. This is the same percentage as people who benefit from taking antidepressant medication. This is not to suggest that people stop taking medicine for depression, but it does suggest that exercise would significantly help in the management of this prevalent psychological disorder.

You certainly don’t need to have a depression diagnosis to derive the psychological benefits from exercise. Even short workouts (under ten minutes) have been shown to improve mood, self-esteem, confidence, and feelings of well-being, and to decrease feelings of sadness, anger, anxiety and stress.

Physical activity also improves the quality of one’s sleep, diminishes the experience of pain and may protect against the debilitating effects of dementia.

More active people also perceive themselves as having a better quality of life than their nonactive counterparts. Some studies link exercise with higher levels of alertness and mental capacity, including the ability to learn.

Most importantly we can usually count on feeling better after just about any form of working out. It’s the natural antidote for much of what ails us.

Top 10 Reasons to Stay Physically Active

1. Improve energy level
2. Burn more calories at rest
3. Improve physical appearance
4. Tolerate stress better
5. Recover faster from injuries and surgeries
6. Stay focused longer
7. Increase lean body mass
8. Build endurance and flexibility
9. Decrease risk of illness
10. Key to balance and happiness

Still for some, the idea of exercise seems more like a punishment than a pleasure. You might have to train your brain to make positive associations with exercise, until the physical activity itself becomes a reward.

Create a Plan for Your Exercise Routine

• Try different activities then decide what form of exercise you would most enjoy.
• When can you build the time for exercise into your day?
• Is there someone you can coordinate schedules with so that you have a partner for your scheduled workout?
• Create a simple positive affirmation about the joy of movement and the benefits you will derive. Repeat often.
• Keep a journal of your workouts so you can track your successes.
• Reward yourself with a latte or something (not a cupcake!) after a workout.

What form of exercise gives you the greatest pleasure?

Maggie, a single thirty-six year old teacher, began each school year feeling energized and optimistic. Once daylight savings time arrived, her mood spiraled downward. Invariably in the weeks following the winter break Maggie’s energy dragged. It became harder for her to get out of bed in the morning and her enthusiasm for work subsided.

Maggie told me she hibernated in the winter. By each February her level of fatigue felt deep and relentless. Her social life suffered to the point that she did not attend social activities because getting together with friends required too much effort. She essentially isolated herself during the darkest months yet felt deep pangs of loneliness.

After work, Maggie routinely flopped on the couch, turned on the tube, ate crackers or another starchy food, and then usually ended up sleeping for several hours. Most days she managed to get herself off the couch and into bed, sleeping until the next morning, when the cycle repeated.

Seasonal Affective Disorder

All the signs pointed to Maggie suffering from seasonal affective disorder (SAD), which is a form of depression that occurs and reoccurs along with shorter periods of daylight during the fall and winter. SAD is a biochemical imbalance triggered by the brain’s response to diminished exposure to natural daylight.

It is believed sunlight might play an important role in the brain’s production of melatonin and serotonin, which help regulate sleep, mood and energy levels. Most SAD sufferers are women and the age of onset is usually between 18-30. The severity of SAD depends on a person’s particular sensitivities combined with their geographical location.

SAD Symptoms

Symptoms include feelings of hopelessness, fatigue, anxiety, social isolation, irritability, oversleep, loss of interest in activities usually found to be pleasurable, weight fluctuations, carbohydrate cravings and difficulty concentrating and processing information. These symptoms can be mild or can run serious interference in one’s sense of well-being. In the most extreme cases SAD can be associated with suicidal ideation.

Treatment for SAD

Regular exposure to natural light is one of the best ways to treat SAD. I suggested to Maggie that whenever the sun is shining to make a point of getting outside and walking. When driving in the car crank up the heat if necessary and open the sunroof. Whatever natural sunlight can be had on any particular day will help.

There are also ‘light boxes’ that provide phototherapy or light therapy. These light boxes can be bought on-line and are about 25 times stronger than the typical light found at home. The problem for most people is that they need to sit under these light boxes for about 30-90 minutes daily and compliance to follow through with this regimen is often a challenge.

Of course relocating to a part of the country that is sunnier could also help considerably, but this is not always a viable option. Vacationing someplace sunny helps, but once returning home the symptoms quickly return and sometimes with a vengeance.

Anti-depression medication is also used to help alleviate this debilitating form of depression. However, it is important to keep in mind that medication alone is not considered to be a complete treatment modality for SAD. When one is taking anti-depression medication it is always best to combine this treatment with a ‘talking therapy.’

Maggie Manages Her SAD

Maggie came to therapy to talk about her feelings and managing her stress level more productively. She also took a low dosage of medication. Motivating herself to come to therapy once a week was helpful in a number of ways – connecting instead of isolating herself and not succumbing to her couch habit at least one day a week.

After a few weeks of working together Maggie also agreed to institute a walking program on the sunnier days. Taking her outdoor activity to another level, I instructed her on mindful walking. She also kept a gym bag packed in her car so she had the option of exercising after work. Maggie immediately felt that short walks in the sun positively affected her mood and energy level, as did her workouts.

Maggie is now armed with some strategies for managing this disorder. She understands the cyclical nature of SAD and can prepare for the next round well in advance. Maggie also makes sure to connect with others now whether she is in the mood or not, for invariably her friendships buoy her sense of control, balance and happiness.

Have you noticed your moods changing with the seasons and what have done to help yourself feel better?

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