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63 Ideas to Get Rid of Depression – Take Charge of Your Brain

May 7th, 2021

No matter what kind of depression you have, the pain is the same-caused by a chemical imbalance in your brain. No matter what you’re depressed about, or even if you don’t know why you’re depressed, there are some simple things you can do to reduce your pain and anxiety, and get yourself feeling better.

Simple cognitive behavior techniques and exercises can lessen pain and stimulate more productive thinking. Low-key physical and mental activity can also speed recovery.

1. Relax your shoulders, take a deep breath and don’t panic! Millions of perfectly normal people have struggled with all kinds of depression and learned how to get out of it. You are not alone. You have options.

2. First, why do you feel so bad? It’s not because of your problems. It’s because of your brain chemistry. There are two main parts of the brain, the thinking part (the neocortex) and the emotional part (the subcortex). When you’re depressed, your subcortex is reacting to stress chemicals, and producing excruciating pain and panic.

3. To add to your misery, your subcortex sucks up additional neural energy from the neocortex until it is practically non-functioning. So you can’t think straight, plus you’re in agony.

4. You feel helpless, but there’s a lot you can do. Your body is experiencing a perfectly normal reaction to the over-supply of stress chemicals in your brain.

5. You need to reduce the neural energy in the subcortex and re-power the neocortex. You can do this with cognitive behavioral mind techniques that will spark up neural activity in the neocortex. With a little practice you will be able to do this any time depression hits you. A few facts about how your brain works will also help you cope.

6. Your first task is to free yourself from the kinds of negative and downer thoughts that power the subcortex and support the pain of your depression. Get rid of thoughts like:

• ‘I’m depressed’
• ‘I feel terrible’
• ‘What’s the use’
• ‘I can’t stand this pain anymore’

7. Switch your Thoughts! To get rid of any depressive thoughts, simply switch out of thinking them. Since the brain is basically a ‘yes brain,’ it’s hard to not think something. The way to not think a negative or depressive thought is to think another thought instead of it.

8. The best way to think another thought instead of a depressive thought is to use the simple cognitive behavioral technique called ‘brainswitching.’

Choose any neutral or nonsense thought, in advance, to have ‘at the ready’ to substitute for any depressive thought that pops up. When you’re depressed, you’re in too much pain to think one up.

• Make it a thought that will not stimulate any negative emotional association. It could be
• a silly song or rhyme fragment like ‘Row, row, row your boat’
• a mantra like ‘Om Padme’
• a neutral or nonsense word like ‘hippity-hop, ‘green frog,’ or ‘yadda yadda’
• a prayer like the 23rd Psalm.

9. It may seem silly to suggest that saying ‘green frog’ over and over to yourself can get rid of depression, but there’s a scientific reason for the exercise. Thinking a neutral or nonsense thought interrupts the depressive thought pattern and weakens it. How? See #10.

10. The brain always follows the direction of its most current dominant thought. When you make your neutral or nonsense thought dominant by thinking it over and over repetitively, it automatically kicks the depressive thought out of its dominant position and the brain ceases tracking it so actively. It turns toward the neutral thought.

11. Brainswitching will automatically increase neural activity in the neocortex, and reduce neural activity in the subcortex. It will continually interrupt the message that you are depressed from one part of the brain to the other.

12. Brainswitching distracts your attention from your emotional brain and directs it to the thinking part of the brain. Depression only happens in the subcortex. There’s never any depression in the neocortex.

13. You can brainswitch for a few seconds the first time you try it. With practice you can do it longer. You may be surprised to know that, even in the worst depression, your neocortex always remains calm and immediately available to you. And you can always brainswitch to it.

14. Keep choosing your neutral thought again when you lose concentration. You must actually do this exercise to activate the neocortex. It’s not just an idea. Ideas don’t work for depression. Only behavior works. A thought is just a thought but thinking a thought over and over again is behavior!

15. Always brainswitch to break the continuity of depression’s grip on you. Depression, like any other anxious emotion or feeling, can’t maintain itself unless you think it repetitively. Think something else instead-like ‘green frog.’

16. Do not think a depressive thought twice. No depressive thought can, by itself, turn into depression if you continually refuse to think it. A depressive thought is over as quick as any other thought. Don’t choose to think it again. Depression hits you with a first thought but you can refuse to think the second thought. For depression to ‘take hold,’ you must continuously think it.

17. Move into Action! Always brainswitch whenever a depressive or stressful thought threatens to ‘ take over.’ An unhappy thought is just a thought. It can pop into your mind at any moment. It is an event that happens to you. Choosing to think an unhappy, anxious or depressive thought over and over is behavior. It is something that you do and you can learn not to do it.

18. Be aware of the ‘early warning’ sad or negative feelings that usually precede a full-blown depressive episode. Confront your depression right away. ‘Okay I know what this is. This is depression coming. I have to side-step it with a neutral thought.’

19. Get out of depression at earlier stages by checking out the passive thinking that happens when you just let your mind wander. Passive thinking can often ‘go negative’ on you. When it does, switch to on-purpose thinking before negative thinking becomes dominant in your brain. The way you do ‘on-purpose’ thinking is to choose a specific thought to think, or by deciding to do some task which then directs your thinking in line with the task at hand.

20. Pry yourself loose from being fused with the pain of your depression before you disappear into it.
Find a small thinking space between you and your pain. Yes, you feel agonized and hopeless, but you can also focus slightly aside from your agony and hopelessness. You are not hopeless, you are the observer of your feeling of hopelessness. Accept some discomfort in a more detached way. Depression is a horrible feeling. It is not you! YOU are you! You are not a feeling. You are a person who is having a feeling.

21. Focus your mind on some low-key physical action:

• Brush your teeth.
• Clean your desk.
• Swing your arms in circles.
• Jog, or take a walk, and keep on walking until you feel tired.
• Smile! -not because you’re happy, but to relax your tense face muscles.

22. Get yourself up and going with any kind of moving-around exercises. The more you move into physical action, the less depression has a chance to settle in on you. Put on some music, dance around the room. Not because you will feel like dancing, but because depression hates you to dance. Do something your depression hates.

23. Distract yourself from the pain of depression with small chores. Do them while thinking your neutral or nonsense thought. Do your chore. Think your thought. Ignore your depression by thinking objectively about what you are doing not subjectively about how you are feeling. Your stress and pain will begin to lessen.

24. Look around you if you can’t think of any chores to do. There is always some ‘next thing’ that can distract you from your pain. Any outward-focused action can help you turn away from self-focus on the pain of your depression. Take out the trash.

25. Do the ‘next thing’ when paralyzed by fear or depression. Life never abandons us without giving us the ‘next thing’ to do. It is security for our sanity and for the healing power of positive behavior. The next thing may just be to take a shower.

26. After the first task, the second task will become even more obvious. Do what you decide to do, not what you feel like doing. Depression never deprives you of ‘will,’ only motivation. You won’t want to do anything, but you can do it.

27. Focus on Behavior, Not Feelings! Since depression kills motivation, use your ‘neutral thought’ exercise as if it is a motivation pill. Quick! Slip a neutral thought in on your depressive thought.

28. Decide ahead of time to do your exercise anyway, even though you feel like it won’t work. Anticipate the fact that depression always robs you of all hope, including hope that any exercise will work.

29. Behavior always trumps feelings. But for a trump to win, you have to play it. No fearful or depressive feeling is powerful enough to prevent you from engaging your body in some kind of mental or physical behavior. You just need to stand up to your fearful feelings and show them ‘who’s boss.’ Behavior is boss.

• No fearful or depressive feeling can rise up and conquer you. It must frighten you into surrendering.
• Feelings are just your own neural patterns twanging for attention.
• Accept fearful feelings; move forward with positive behavior.
• When you accept fearful feelings, they finish and die. Fear feeds them and keeps them alive
• Feelings cannot be more powerful than you are–behavior rules!

30. Depression is not something that you are, it is something you do and you can learn not to do it. Depression is a terrible feeling. Feelings are very powerful but they are not intelligent. They can be wrong. You don’t have to do feelings. You can change the thinking that caused the feelings and then the feelings will change to reflect the new thoughts. On-purpose thought always trumps passive or automatic thought.

31. On-purpose thought is always more current than passive thought, so automatically it’s more dominant than passive thought. Your brain always follows the direction of its most current dominant thought. If your depression patterns are well-imprinted from practicing them, don’t worry. Practicing new thinking forms new brain patterns without depression. You can use the new get-out-of-depression patterns instead of the old get-into-depression ones.

32. During depression, the physical pain, the psychological fear, the feelings of worthlessness, helplessness, and despair, are all bound up and entangled in a neural pattern that takes on a life of its own, seemingly independent of our will. The key here is seemingly. We are not usually aware that we focus our attention away from our will when we’re depressed. We focus only on the depressive pattern. We can focus on our behavior instead.

33. Decide to concentrate on something–a book or some work. Depression doesn’t prevent you from concentrating. That’s a myth. Depression makes you forget that you are already concentrating on something-on depression! Don’t let depression interrupt work. Let work interrupt your depression.

34. Whenever depression interrupts your concentration, interrupt it back! You have one attention only. If you are thinking a neutral, nonsense, rational, or productive thought, you cannot, at the same instant, be thinking a depressive thought.

35. Pay attention to your self-talk. It will indicate what kind of thinking you’re doing-passive or on-purpose, self-focused or outer-focused, subjective (about your feelings) or objective (about other things). Self-talk is that on-going conversation you have with yourself in your own mind that you usually don’t pay any attention to.

36. Don’t Forget-Your Mind is Tricking You! Your mind tricks you into anxious thinking via unnoticed self-talk. Trick it back! Replace negative self-talk. If you hit a red light, self-talk might be ‘I’m going to be late!’ Change to ‘Relax, I’ll be fine.’

37. You think you’re depressed because of your problems. This is a mind trick. You’re always depressed because of your depression. It’s the chemistry! Anxious thoughts trigger the fight-or-flight response that produces stress chemicals, causing a chemical imbalance in your brain.

38. It seems your whole self is depressed. This is a mind trick. Depression only occurs in the subcortex. There’s never any depression in the thinking part of the brain.

39. Depression seems like present reality. This is a mind trick. Depression is a feeling, already past, which you must then replay (rethink) in memory ‘as if’ it is present reality. This is due to the instantaneous process of ‘pain perception.’ To experience any feeling of physical pain or emotion (which is always produced in the subcortex) we must first think (acknowledge) the feeling in the neocortex-after we have it.

Cases are recorded of athletes who break a bone during a game and don’t experience any pain until the game is over. Neocortical concentration on the game blocked pain signals sent to the neocortex that should have alerted them to the pain of their injury.

Hope for the Hopeless – Depression and Eating Disorders

March 7th, 2021

Approximately 80% of all severe cases involving anorexia or bulimia have a coexisting major depression diagnosis. Depression is a very painful and all consuming disorder in and of itself. However, in combination with an eating disorder, depression is beyond devastating and is often masked within the eating disorder itself. Depression in eating disorder clients looks different than it does in clients who have mood disorder alone. One way to describe how depression looks in someone who is suffering with an eating disorder is: hidden misery. For eating disorder clients, depression takes on a heightened quality of hopelessness and self-hatred, and becomes an expression of their identity, not a list of unpleasant symptoms. The depression becomes intertwined with the manifestations of the eating disorder, and because of this interwoven quality, the depressive symptoms are often not clearly distinguishable from the eating disorder. One purpose of this article is to highlight some of the distinctions and differences in how depression manifests itself in someone suffering with anorexia or bulimia. Another purpose is to provide suggestions that will begin to foster hope for these hopeless clients within the therapy setting.

When dealing with eating disorder cases, it is important to understand that if major depression is present, it is most likely present at two levels. First, it will be evident in a history of chronic, low level, dysthymic depression, and secondly, there will be symptoms consistent with one or more prolonged episodes of acute major depressive disorder. The intensity and acuteness of the depression is not always immediately recognizable in how the client is manifesting their eating disorder. Clinical history taking will reveal chronic discouragement, feelings of inadequacy, low self-esteem, appetite disturbance, sleep disturbance, low energy, fatigue, concentration troubles, difficulty making decisions, and a general feeling of unhappiness and vague hopelessness. Since most eating disorder clients do not seek treatment for many years, it is not uncommon for this kind of chronic dysthymic depression to have been in their lives anywhere from two to eight years. Clinical history will also reveal that as the eating disorder escalated or became more severe in its intensity, there is a concurrent history of intense symptoms of major depression. Oftentimes, recurrent episodes of major depression are seen in those with longstanding eating disorders. In simple words, eating disorder clients have been discouraged for a long time, they have not felt good about themselves for a long time, they have felt hopeless for a long time, and they have felt acute periods of depression in which life became much worse and more difficult for them.

Unique Characteristics
One of the most unique characteristics of depression in someone who is suffering with an eating disorder is an intense and high level of self-hatred and self-contempt. This may be because those who have these major depressive episodes in conjunction with an eating disorder have a much more personally negative and identity-based meaning attached to the depressive symptoms. The depressive symptoms say something about who the person is at a core level as a human being. They are much more than simply descriptive of what the individual is experiencing or suffering from at that time in their life. For many women with eating disorders, the depression is broad evidence of their unacceptability and shame, and a daily proof of the deep level of “flawed-ness” that they believe about themselves. The intensity of the depression is magnified or amplified by this extreme perceptual twist of the cognitive distortion of personalization and all-or-nothing thinking. A second symptom of major depression shown to be different in those who suffer with severe eating disorders is that their sense of hopelessness and despair goes way beyond “depressed mood most of the day, nearly every day.” The sense of hopelessness is often an expression of how void and empty they feel about who they are, about their lives, and about their futures. Up until the eating disorder has been stabilized, all of that hopelessness has been converted into an addictive attempt to feel in control or to avoid pain through the obsessive acting out of the anorexia or bulimia.

Thirdly, this hopelessness can be played out in recurrent thoughts of death, pervasive suicidal ideation, and suicidal gesturing which many clients with severe anorexia and bulimia can have in a more entrenched and ever-present fashion than clients who have the mood disorder alone. The quality of this wanting to die or dying is tied to a much more personal sense of self-disdain and identity rejection (get rid of me) than just wanting to escape life difficulties. Fourth, the feelings of worthlessness or inadequacy are unique with eating disorders because it goes beyond these feelings. It is an identity issue accompanied by feelings of uselessness, futility, and nothingness that occur without the distraction and obsession of the eating disorder.

A fifth, distinct factor in the depression of those with eating disorders is that their excessive and inappropriate guilt is tied more to emotional caretaking issues and a sense of powerlessness or helplessness than what may typically be seen in those who are suffering with major depression. Their painful self-preoccupation is often in response to their inability to make things different or better in their relationships with significant others.

A sixth factor that masks depression in an eating disorder client is the all consuming nature of anorexia and bulimia. There is often a display of high energy associated with the obsessive ruminations, compulsivity, acting out, and the highs and lows in the cycle of an eating disorder. When the eating disorder is taken away and the individual is no longer in a place or position to act it out, then the depression comes flooding in, in painful and evident ways.

Compassion for the Hopelessness
The reality of working with people who are suffering in the throws of depression and an eating disorder is that it is difficult not to feel hopeless for their hopelessness. Their hopelessness is extremely painful. It is an inner torture and misery, and it is encompassed by intense feelings of self-hatred and self contempt. For many, their emotional salvation was going to be the eating disorder. It was going to be thinness, physical beauty, or social acceptability. Many come to feel that they have even failed at the eating disorder and have lost the identity they had in the eating disorder. Hence, the hopelessness goes beyond hopeless, because not only is there nothing good in their lives, there is nothing good in them. Not only is there no hope for the future, there is nothing hopeful at the moment but breathing in and out the despair they feel. It feels to them like the suffering will last forever. Therapists who work with eating disorders need to be prepared for the flood of depression that pours out once the eating disorder symptoms and patterns have been stabilized or limited to some degree.

It is my personal observation that clinicians need to change what they emphasize in treating depression in those engaging in recovery from eating disorders compared with those for whom depression is the primary and most significant disorder. Therapists need to find ways to foster hope for the hopeless, much more so for someone with an eating disorder because oftentimes these clients refuse comfort. They refuse solace. They refuse support. They refuse love. They refuse encouragement. They refuse to do the things that would be most helpful in lifting them out of the depression because of their intense inner self-hatred.

For the therapist, the pain that fills the room is tangible. Clients are often full of sorrow and anger for who they are, which takes the symptoms of depression to a deeper level of despair. In working with eating-disordered clients with this level of depression, it is important for the therapist to show a deep sense of respect, appreciation, and love for those who feel so badly about themselves and who are suffering so keenly in all aspects of their lives. In spite of all the suffering, these people are still able to reach out to others with love and kindness and function at high levels of academic and work performance. They are still able to be wonderful employers, employees, and students, but they are not able to find any joy in themselves, or in their lives. These clients tend to carry on in life with hidden misery, and a therapist’s compassion and respect for this level of determination and perseverance provides a context for hope. As therapists it is important that a sense of love and compassion grows and is evident in these times when the client feels nothing but hopeless and stuck.

Separating Depression from Self-hatred
One of the key components of working with the depression aspects of an eating disorder is to begin to separate the depression from the self-hatred. It is important to help the client understand the difference between shame and self-hatred. Shame is the false sense of self which leads someone to believe and feel that they are unacceptable, flawed, defective, and bad, an inner sense that something is wrong with their “being.” They feel unacceptable to the world and to themselves, and feel that somehow they are lacking whatever it is they need to “be enough.” Self-hatred is the acting out of that shame within and outside of the person. The self-hatred can be acted out in the negative mind of the eating disorder, that relentless circle of selfcriticism, self-contempt, and negativity that is a common factor in all who suffer with eating disorders. The shame can be acted out through self-punishment, self-abandonment, emotional denial, avoidance, minimization, self-harm, self-mutilation, and through impulsive and addictive behaviors both within and outside of the eating disorder. Self-hatred is the ongoing gathering of evidence within the client’s own mind that they are broken, and unacceptable. In time, the eating disorder becomes their main evidence that there is something wrong with them and that they are unacceptable. And so, in a sense, the eating disorder is their friend and their enemy. It is a source of comfort and it is the reason they will not be comforted, and until they can achieve perfection in the mind-set of an eating disorder, they have great cause to hate themselves for who they are and who they are not.

All of these examples of self-hatred become intertwined with the symptoms and the expression of the depression, and so it becomes important in therapy to help the client to separate what depression is and what self-hatred is for them. It has been my experience that focusing on the aspects of shame and self-hatred has been more helpful to those who have eating disorders than focusing only on the depression itself. The self-hatred amplifies the intensity and the quality of the depressive symptoms. By focusing on the self-hatred aspects we begin turning the volume down on how the depressive symptoms manifest themselves with the client.

I have found that emphasizing the separation of self-hatred from the depression and its symptoms, and then beginning to change and soften the expressions of self-hatred fosters hope and generates hopefulness. Clients begin to see and sense that maybe the problem is not entirely who they are. Some hope comes from knowing that the feelings and the sense of self they have may not be accurate and true. They may recognize that some of what they have done forever and what has felt very much a part of their identity is really a chosen and acted out pattern of self-hatred. Somewhere in this separation of self hatred and depression they begin to feel hope in themselves, hope in letting go of pain, and hope in having their life feel, look, and be different.

Another reason for the emphasis on self-hatred is to help clients begin to recognize and challenge the unique quality of the all-ornothing thinking that leads them to filter everything about their lives in this most negative, personal, and self-contemptuous way. Hope is generated by learning that everything does not say something bad about who they are, that normal life experiences are not evidence that there is something wrong with them, and that negative feelings do not prove as true, what they have always felt about themselves. The unique perfectionism inherent in this all-or-nothing thinking allows no room for anything but perfection in any area of thought, feeling, or behavior. To be able to let go of the self-hatred filter and begin to see many of these thoughts, feelings, and behaviors they experience every day as typical, usual, and acceptable begins to foster hope, more importantly the kind of hope that is not tied to the false hopes of the eating disorder itself. Part of what has made the eating disorder so powerful is that clients put all of their hope in the eating disorder itself. Eating disorders are hopeless because after clients have done everything in their power to live them perfectly, they have only brought misery, despair, dysfunction, and more hopelessness. The attempt to generate hope through anorexia and bulimia has failed. By focusing on the self-hatred, they begin to separate their eating disorder from themselves. They also begin to separate the eating disorder from their source of hope. They begin to recognize that hope is within themselves and hope is within reach if they will soften how they view themselves and if they will change how they treat themselves internally and externally. Separating the depression from the self-hatred can help clients see the eating disorder for what it really is, with all its lies and consequences, and can help them begin to see who they are in a more honest and accurate way.

Renaming the Depression
I have also found it helpful in working with this clientele to rename or re-frame the depression and its symptoms within some kind of specific pain they are experiencing. I emphasize the pain aspects because part of what makes the depression so painful for those with eating disorders is the internalization of hopelessness. We can remove the global, ambiguous, and future sense of the depression, and break it into smaller pieces, more specific, immediate, and emotionally connected to their experiences rather than to their identity. We talk a lot about their feelings of hurt and sadness, and explore and deepen their understanding about their sense of feeling unloved, or their sense of inadequacy, or their feelings of rejection and disapproval, etc. I try to underpin the depression in very specific and emotionally-connected understandings and expressions. Rarely do I talk to them about their depression explicitly while we are trying to understand, validate, and generate hope in specific areas of their pain. I have found it more helpful to spend sessions talking about how to generate hope for themselves over a sense of loss, a sense of powerlessness, a sense of disappointment, etc., rather than to keep talking about depression and what to do to help lessen it. The realization is that in the process of fostering hope by focusing on and discussing the different kinds of pain, we are also de-amplifying and de-escalating the depression. It is impossible to get to the bottom of depression and avoid the specific pain, since avoiding the pain is what clients have been trying to do through the eating disorder.

It is important to note here that there certainly can be, and usually is, biochemistry involved in the quality, intensity, and type of depression they are experiencing, and that careful evaluation and utilization of antidepressant medications is strongly encouraged as an active part of the treatment. It is also important to remember that clients with severe eating disorders often resist the notion of medication or sabotage use of the medication as an attempt to control their body and weight, and to foster a sense of control. It is important to be very attentive and regularly follow up on taking medication and continue to help them in the positive interpretation of the use of medication. Too often, medicine represents weakness and becomes evidence to again engage in self-hatred rather than being viewed as one more piece of the puzzle that will help generate hope in their recovery. It is my experience that clients often respond to and benefit from medication if we can reframe the medicine as a hopeful part of their healing and their recovery from both the depression and the eating disorder.

When dealing with eating disorders it is also important to continue to evaluate and recognize the impact of malnourishment on clients’ ability to process and/or modify the way they process information about themselves and about their lives. It is important to stabilize the eating disorder as a primary intervention and to emphasize renourishment before there will be a lot of success in treating the depression. Renourishing the brain and body is an important early framework for fostering hope.

Reducing Isolation
Another important component in treating depression among eating disorder clients is moving them out of isolation. It is often a very powerful intervention for clients to re-engage and reconnect with other people. Moving out of isolation and reconnecting with others in their lives generates hope. Pursuing a re-connection with others emphasizes opening themselves up to feel connected, to feel the love, compassion, and interest from others towards them and in expressing their own compassion and love toward family members, friends, other clients or patients, etc. Involving families in family therapy, partners in couple therapy, and friends in the treatment are often very powerful ways to lessen the depression and increase hope for clients because they feel comforted and supported by those who love them and care for them. Helping clients to communicate again with people in their lives brings hope and renewed ability to feel something different than self-hatred. To receive expressions of someone else’s love, concern, and genuine caring is hopeful and becomes a very important part of treatment for the depression.

Letting go of False Guilt
Another aspect of the treatment of depression relates to the intense and unrealistic levels of guilt. Again, the reason the guilt becomes unique for those with eating disorders is because of the self-hatred. The guilt tells them to feel bad and terrible about themselves because they are not perfect, or not in complete control, or not accomplished, or not accepted or liked by everyone, or because there are people in their lives who are unhappy. A pain that will not heal is the false guilt associated with untrue or inaccurate realities. It is helpful in working with eating disorder clients to help them clarify the difference between real guilt and false guilt. We can help them recognize that real guilt is associated with having literally done something wrong. Their recognition of that fact can lead them to correct it. False guilt tells them to feel bad and terrible about themselves, and whatever has happened becomes the evidence against them which supports the feeling of guiltiness. Oftentimes I try to help clients understand specific ways that false guilt enters the picture and feeds the self-hatred. It is frequently tied to areas of their lives where they feel or have felt powerless but have made themselves emotionally responsible. An example of this might be feeling bad about themselves because they feel responsible for a specific relationship outcome they do not really have the power to create on their own. They may feel badly about themselves because they cannot fix a situation or problem someone they love or care about is experiencing, or because they could not prevent a tragedy. False guilt is a sense of shame, feeling like they “should have known better” or had it “figured out” beforehand. False guilt is often an expression of what they are not, rather than who they are or what they are capable of doing. Sometimes the false guilt is just an active expression of the intense pattern of negative comparison between themselves and others that is so common with eating disorders. Eating disorder clients are constantly comparing themselves to someone else, both physically and behaviorally, and end up feeling a great deal of guilt about who they are because they do not match up in their comparison with someone else. Sometimes false guilt is an expression of self-hatred for some wrong done in the past, something they will not let go of or forgive themselves for. They continue to actively punish themselves for what happened or what they felt bad about doing, sometimes a very long time ago. They hold it against themselves mentally as support for their self-rejection.

Often the false guilt and feeling bad about themselves is tied directly to how important people in their lives are behaving or acting. They tend to somehow feel responsible or accountable for someone else’s negative choices or behaviors. False guilt gives them a sense of hopelessness because their ability to change it or re-frame it differently is impeded by their all-ornothing filter of self-contempt. They may compare themselves to unreasonable self-standards that no one could live up to, and therefore they become the exception to all the rules of normalcy. Somehow they have to live above acceptable, and the sense of guilt is evidence that they are not living at that expected, higher level of performance. Oftentimes when they hear feedback from other people about their behaviors, in particular their eating disorder, it becomes another encouragement to feel false guilt. The problem with self-guilt is that it produces intense feelings of fault, blame, guiltiness, shame, anxiety, and sadness, but instead of moving them to correction and change, it moves them to selfhatred, self-criticalness, self-doubting, and self-punishment. False guilt always leads to more hopelessness. Releasing false guilt fosters hope because it leads to an increased sense of freedom and choices through the setting of clear emotional boundaries.

In conclusion, it is important to emphasize that in order to truly intervene in the area of depression with those who have an eating disorder, we need to first stabilize and lessen the intensity and the acting out of the eating disorder. Until we do that, we are probably not going to truly see the depth and the extent of the depression and the very personal nature of how the depression manifests itself in eating disorder clients. It is also important to increase our awareness and understanding of how depression is uniquely different in those who suffer with eating disorders because it gives us therapeutic options and a framework to intervene in a more compassionate and hopeful way with those who have these coexisting disorders. The most helpful thing we can do in every session with these clients is to generate hope. Nurturing hope is not always a clear-cut and obvious list of techniques or interventions, but rather a willingness by both client and therapist to face the hopelessness in a kind and loving context. I hope that these therapeutic distinctions and suggestions will begin to foster some hopefulness for clients suffering with a coexisting depression and eating disorder. In facing the hopelessness, pain, selfhatred, guilt, and isolation, we can, little by little, foster and generate hope and decrease the depression. New hope will lead to answers. Ge