How do I make real, lasting progress towards being better?

January 26, 2010 2:49 PM

How do I make real, lasting progress towards being better when I have social isolation/anxiety and depression?

** Posted for my brother, will relay his questions/answers **

I am a 21-year-old guy. Last September, I withdrew from my senior year at a challenging, small engineering school, citing health reasons, because I felt alienated and lacked motivation. I essentially stayed in bed and skipped classes. I moved home, got some therapy, and ran into issues with my controlling father who thought a laundry list of activities could fix all my problems. My therapist never actually came out and said "depression", but our talks weren't focused on diagnosing.

In December, I took up my sister's offer to come visit her for an extended period of time to get some distance from my father. I never really explained everything to her, so while she and her husband have been trying to help for the last two months, most of their efforts have been focused on helping with the surface symptoms, not the underlying issue.

Over the last two months, I've been getting exercise (the C25K program) and eating healthier. I got a haircut, my acne cleared up, and I've gotten contacts, all of which have improved my confidence some. I've been feeling better but haven't really been making progress toward my long-term goals.

I've decided not to go back to school for spring quarter and am applying to some in-state schools as a transfer student. I'm also thinking about ROTC, but am not sure if externally-applied motivation will help or not.

My main issues are feeling socially isolated/alienated, feeling like I'm wasting my life and will never do anything meaningful, and feeling social anxiety. My goals, as I expressed two months ago, are to get back in shape and to be more social, but those are fairly general.

Is there some way to attack these issues directly instead of just treating the superficial problems? I'd like to avoid antidepressants/medications for this.

posted by bookdragoness to human relations (16 answers total)

Anxiety is often a symptom of an underlying depression, which itself can have one or more root causes - one which you are unlikely to uncover without spending some time with a qualified psychiatrist.... with extra emphasis on qualified. See a psychiatrist, not a psychologist or MFA or unlicensed therapist. The extra education and experience go a long way....

http://en.wikipedia.org/wiki/Major_depressive_disorder

Although medication is often part of a treatment plan for depression, it doesn't have to be. Just do a search on Amazon for depression and you'll find some worthwhile suggestions on behavior, diet, and lifestyle changes you can make to help support your treatment.

You may also explore treating the anxiety with Cognitive Behavior Therapy techniques, which you can learn about in therapy or through self-education. There is even a decent book on the topic in the Dummies series.

http://en.wikipedia.org/wiki/Cognitive_behavior_therapy

CBT techniques you might employ include social exposure, re-framing your internal thoughts, learning to recognize cognitive distortion and mindfulness.

Specific to your question, the way to treat the issues directly is to first identify the issues, which are likely related to your depression; which in turn could be caused by psychological, social, and biological causes.

HTH, recognizing you want to be better and doing something about it often bring positive results.
posted by pmikal at 3:17 PM on January 26, 2010

IANYD, but I have experienced these symptoms my whole life, in addition to having a multi-year reluctance to being medicated. But for me (everybody's response will be different) the medication actually helped.

I had good results with the prozac/buspar combo. In addition you need to find a therapist you like and can be honest with. It takes time and there will be setbacks. One or the other ( therapy and meds) wasn't an option for me. I needed them in tandem. I would reccomend finding a Psychiatrist (not a family doc or a GP) to perscribe the meds and a therpaist for the talkin'

good luck and feel free to PM if you have any Q's.
posted by macadam9 at 3:27 PM on January 26, 2010 [1 favorite]

What are your plans in life?
posted by Jazzwick at 3:34 PM on January 26, 2010

Seconding macadam9. And I went through much the same when I was in college. It's a tough transition.

First, you are NOT a failure. And though Jazzwick means well, don't worry if you don't know what your plans are in life. I'm 43 and not sure I know what mine are!

You have so much time left in your life, and the good news is that now you know what you DON'T want to do. It's like having a total do-over. That can be scary, but it can also be liberating.

Go easy on yourself, take it slowly, and do go see a therapist as macadam9 recommends.
posted by misha at 3:58 PM on January 26, 2010

Is there some way to attack these issues directly instead of just treating the superficial problems?

Yes, therapy. Why did you stop? You can specifically tell the therapist that you are not interested in medication.
posted by desjardins at 4:02 PM on January 26, 2010

From him:

I stopped going to therapy because I moved three states away from my therapist when I moved away from my dad. Really, my father was an unhealthy enough influence on my life that I didn't think that I could make any more improvement.

How would CBT help me, and do you have any recommendations for books or websites to read to learn how to use it on my own?
posted by bookdragoness at 4:14 PM on January 26, 2010

How would CBT help me, and do you have any recommendations for books or websites to read to learn how to use it on my own?

CBT helps by teaching you to recognize and dispell negative or faulty thinking. Try the books by David Burns. He wrote one specifically for dealing with anxiety called When Panic Attacks. Keep in mind the tools taught in CBT are not a magic fix. It takes commitment to make it work and it's easy to "fall off the wagon" so to speak. I catch myself returning to my old faulty thinking sometimes and I realize I haven't kept up on using the tools.
posted by dchrssyr at 4:39 PM on January 26, 2010

IANAD but I would suggest you don't need a psychiatrist, particularly if you don't want drugs. It sounds like you are moving in the right direction and if you want a therapist any bona-fide therapist who you got along well with would be useful.
posted by y6t5r4e3w2q1 at 7:17 PM on January 26, 2010

The Mood Gym is an online CBT workbook; free, and modules can be worked on at your own pace. Haven't done much in it, but have heard good things (a search on AskMe will no doubt turn up other recommendations.)

I own and really like the 'Thoughts and Feelings' workbook by McKay. It's the most recent one I've used. Another one that has been highly recommended to me is 'Mind over Mood.'

Whichever you choose, give it a little time. If the book doesn't feel right for you after several exercises or a couple of chapters, then try another one. There's more than one approach in the books; not everything was to my tastes in the first one I tried. The key thing of course (which you're already doing) is to keep trying.
posted by Hardcore Poser at 7:24 PM on January 26, 2010

My bad' here's the link to the online workbook 'Mood Gym.'
posted by Hardcore Poser at 7:25 PM on January 26, 2010 [1 favorite]

There's now research out that suggests the type of therapy you do, be it medication, cbt or some other type of therapy isn't as important as the fact that you are doing *something* directed with a professional that you resonate with. Statistically, medication and cbt (or some other method) work for the same amount of people, the key elements are the relationship you have with your therapist and your actual involvement in the process. Just having a good talking relationship isn't enough; you need to have behaviors to back it up. That could be sticking to a pill-taking schedule, journaling, etc. There's no way for anyone to know which is going to work for you, but when you find the right one, it will get better.
posted by ohisee at 9:08 PM on January 26, 2010

Also, the research I read was directed at therapists, and I am definitely not an expert on this. I'm not sure what the results would be for someone following therapeutic behaviors on their own. I don't mean to discourage you from pursuing self-directed cbt. My point is mostly that people vary, and you have to find out what works for you.
posted by ohisee at 9:11 PM on January 26, 2010

Sounds like you are doing better already, keep on it! Be patient too and give yourself time..

One thing I wanted to say, college is a peculiar environment that isn't the same as the professional world, and some people (lots?) just aren't suited to it. You are trying to juggle several classes, getting yourself motivated to go and to do homework and projects in your time outside class, there's no set schedule for that. It can all get overwhelming very quickly. So maybe it's not the best place for you. I'm not saying don't finish! You got very far and it must've been tough, congrats! - finish up at the state school if that's better. What I'm saying is, after college once you find a regular job with a regular schedule, you might find it's a much better environment because of the way it's structured, and you'll have a lot less anxiety.
posted by citron at 9:17 PM on January 26, 2010

Depression isnt your diagnosis, it's the confidence that was taken away from you through your controlling father that's the problem. I understand this, because I've been there. The best way... go back to see a good therapist. A good therapist will validate your feelings and empowerment. They won't tell you what you should do. They will only guide you through your feelings and once you realize that you have control over what happens in your life, and accept the person you are... you will find that you'll care less if people don't appreciate you because you will find others who are going to appreciate you. Just treating your depression isn't going to help you in the long run. Get to the root and then work upwards and out in dealing with your symptoms. It's crucial to get the mind and heart on the same track before masking your depression and anxiety with "tricks." Good luck to you, you will do fine!
posted by InterestedInKnowing at 10:19 PM on January 26, 2010

My main issues are feeling socially isolated/alienated,

Well, you've moved twice in three months - you probably are socially isolated. The best remedy for that is to meet people. Get a hobby, play D&D at a game store, check out Meetup.com, take a yoga class - do something to meet people. During a period of profound funk, I read that the average happy person has 22 social interactions a day and made an effort to hit that target. Say hello to the mail woman, the guy who pours your coffee, the bus driver, etc - it actually helps.

feeling like I'm wasting my life and will never do anything meaningful,

If you feel like you're wasting your life, going back to school to get your degree is a good mid-term goal. But realise this: most of us do not do particularly meaningful things with our lives and that's OK. There are a very limited number of Nobel prizes given out each year. Most people in western culture are focused on making rent, having reasonably okay careers, and partnering with one or more people for fun and intimacy. The problems we have - credit card debt, dead end jobs, mortgage issues - are generally problems of privilege. If you're not living in Darfur, have access to medical care and a life expectancy greater than 50, you're doing better than vast swathes of the planet's population and that ain't worth nothing.

and feeling social anxiety.

CBT in some form or another will likely be helpful here.
posted by DarlingBri at 4:30 AM on January 27, 2010 [1 favorite]

I strongly recommend Taming Your Gremlin.
posted by etoile at 3:24 PM on January 28, 2010