Coping with Stress in Depression

What’s the best way for coping with stress? Sometimes, when I’m starting to feel overwhelmed, it’s easy to forget everything I’ve ever learned and every skill I’ve ever mastered to stay sane.

So then I have to retrace my steps and go back to first principles. It’s like being a musician who practices scales every day. The basic skills need to become second-nature.

The Basics about Stress

Shelley E. Taylor (best known for The Tending Instinct), one of the foremost researchers on coping with stress, has a helpful way of reviewing the basics. As she puts it, coping is our intervention between the stresses we face and the effects they have on our mental and physical health.

The links between chronic stress and depression are well-established, and stress-related changes in the immune system seem to tie depression to a process of inflammation as well. Instead of the normal rhythm of response to stress followed by relaxing back to a normal state, depression tends to keep our sensitivity to stress on high alert.

The sudden increase in heart-rate and blood pressure, the release of cortisol and other chemicals that turn up certain reactions and turn down others become more chronic in nature. In depression, events that others can handle without stress can become triggers for intense reactions.

Origins of Coping Resources and Processes

The question is why do some of us react to stress in a way that leads to chronic or recurrent depression and some do not. Taylor has sketched out a picture of the origin of coping skills that gives some answers.

Genetic traits create vulnerabilities relating to stress responses, the immune system and depression, but they need not result in problems. Whether or not they do depends on the environment in which children are raised.

Studies have shown that a harsh early environment, especially when combined with neglectful or abusive parenting, prevents children from developing the coping skills they need to relate to people and handle high levels of stress. I think it’s not so much isolated disastrous events as the pattern of abuse and neglect that undermines the skills of coping and increases the likelihood that depression will eventually emerge.

The fact that problems arise through the interaction of genetic inheritance and harmful early life points to possibilities for intervening. Even if the conditions themselves can’t be changed, the skills for coping with them can, and later positive experience can offset, to some extent, the damage of early years.

Coping Resources

The raw material for coping well consists of the attitudes and beliefs we develop about how we interact with other people and the events of daily life. It’s a familiar list.

• Optimism refers to the habit of expecting that good things rather than bad things will happen to one’s self.
• Personal mastery refers to whether a person feels able to control or influence the way things turn out.
• A positive sense of self or high self-esteem is a primary protector against mental and physical health problems.
• Social support is defined as the belief and experience that you are loved and cared for by others, that you are esteemed and valued, and that you are part of a social network in which people help each other.

If you have these basics, you have a much lower likelihood of living with constant psychological distress in the form of depression or anxiety. You’re much more likely to be able to handle chronically stressful conditions and stay healthy, both mentally and physically.

Coping Processes

Those basic beliefs and experiences work because they lead you to adopt effective coping strategies. Mostly, these involve a willingness to approach rather than avoid a stressful situation. Avoiding stress does work sometimes, especially when physical danger is present, but for ongoing sources of stress, it makes things worse in the long-run.

One of the lasting contributions of cognitive behavioral therapy is the skill it teaches you to reappraise a situation you usually experience as agonizingly stressful. If the stress is coming from your own way of perceiving and thinking about it, then you have a moment to regroup and choose a coping strategy that is aimed more toward problem-solving than automatic shame or avoidance.

Reaching out to friends and colleagues for support is another approach-oriented strategy. Sometimes the trigger for stress is having a strong feeling. In that case, finding an expressive emotional outlet is a good way to cope.

Trying to Cope in Depression

Depression brings on all the opposites of healthful coping. The beliefs that nothing good will happen, that you’re not a worthwhile person, that life is overwhelming, that you need to get away from people – all these mean that your coping is limited to avoiding as much as you can.

Everyday life becomes a struggle. As the physiological stress responses stay on most of the time, you succumb to a variety of physical as well as emotional ailments.

Pathways to Intervention

Shelley Taylor and her colleagues have helped to refine the focus of efforts to improve coping. They make a simple point.

It’s more helpful to work on specific coping skills and processes than the beliefs and attitudes (coping resources) that give rise to them.

To use one example, thinking positive thoughts as a way of enhancing optimism falls flat. Learning the skills of cognitive reappraisal of stressful situations works for me – at least as the first step. Rethinking has to be followed by changing how I react to a familiar stressful event.

Every time I can do something to manage a stressful situation, I gain a sense of accomplishment that starts to rebuild the larger sense of mastery. My system also starts to get back to a more normal alternation of stress and relaxation responses.

This is why reviewing the basics with a simple model like Taylor’s has been so helpful to me. Making the distinction between the belief or capacity behind a coping strategy and the skills and methods themselves helps me move more quickly to the practical things I can do to get better.

Storied Mind - Recover Life from Depression