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Tuesday 27 March 2012

Depression: The Trouble with Walking

Exercise and mood

Surely by now almost everyone has heard about the research identifying exercise as an effective treatment for depression. Years ago the data were a bit flaky, but as research designs have tightened the effect continues to appear solid.
A pleasant day on Vancouver's sewer outflow (!),
Iona Island. Oddly enough, a popular park.

If I met someone who said “I’m depressed, and I’m willing to work on it. But I’m only willing to do one thing,” I would first tell them that depression is best dealt with using a multiple-front approach. The effects seem to be stronger if we begin shifting several aspects of a person’s life at once. (Not that there’s great and well-controlled research examining this point, however.)

But then I’d give in (it’s not my decision, ultimately, it is theirs) and ask if they were really willing to try anything (in addition to, or instead of a pharmaceutical intervention). If they said yes, and if they lived a standard Canadian sedentary lifestyle, then I’d recommend an exercise program. Thirty minutes of exercise, three times a week appears to be about as powerful as medication or psychotherapy, and there is scattered evidence suggesting that six times a week is better still.

Great, but what kind of exercise?

Eventually we want something that gets the heart pumping and that produces a bit of strain – something that will actually increase the person’s fitness. It doesn’t have to be aerobic, but it should make the person puff a bit. “Gain without necessarily having pain” is a reasonable motto.

The problem is that during depression it’s difficult to leap into that much exercise all at once. We often have to ramp up. So walking makes a good start. It enhances fitness somewhat, it gets a person out of the house, it often puts them into contact with other people or with nature, and it can be measured (potentially giving a sense of achievement as the person sets and reaches their own goals).

So what’s the problem?

The problem is precisely what makes it a good and achievable early goal: It’s easy. Walking takes no great skill or attention. The mind is left free to wander. We can think about anything we like and not fall down or trip over our own feet.

During depression the mind is pulled toward the negative. Left unoccupied, we will focus on bleak elements of the past (regrets, failures, good times now over), the future (catastrophes that may happen), and the present ("that person over there must think I’m a loser"). A more cognitively demanding form of exercise (such as tennis, skiing, or swimming) gives the mind less room to space out and play depressive scripts. But walking can leave a kind of vacuum in the mind, and both nature and depression abhor a vacuum.

Is there a solution?

There are several.

Mindfulness exercises can help us to return to the sensory present, and to recognize the difference between what’s happening and our (often faulty) interpretations about what’s happening. Mindfulness is a tricky skill to cultivate, particularly during depression, but it can still help if the person has specific exercises to work on.

The sense census is one. When we notice the mind wandering into rumination, we can gently refocus the mind on the input we are getting from our senses. What exactly are we seeing? What colour is that tree? Is the sidewalk cracked or smooth? How many storeys is that building? What are we hearing? Just the traffic on this street, or can we hear the traffic the next street over? Are there any birds singing? Can we hear the wind in the trees? What are we feeling? Can we feel our feet bend as we move through each step? The breeze on our skin? The sensation of our left sleeve?

The sense census incorporates the mindfulness element of returning to the present, and encourages us to relinquish much of our interpretive/evaluative thought. We don’t ask whether we like the birdsong, we just notice whether it is present.

This and other mindfulness approaches can be practiced regularly as a form of walking meditation. But in the depths of depression, mindfulness may be too difficult or insufficiently compelling to practice continuously.

Okay, what else?

If the skill involved in walking doesn’t fully occupy the mind, and if mindfulness proves too challenging to practice for long, we can introduce another cognitive task to attract and occupy the mind.
Internally-produced tasks (“Let’s name all the countries in the EU”) require a certain force of will to keep up. Soon we get distracted and can go back to worrying. An external stimulus can often work better. And here’s where the earbuds come in.

One option is to listen to music. If this works, great. But sometimes during depression music loses its appeal – it gets unplugged from the emotions and seems flat or uninteresting. If this occurs, we need to try something else.

Talk radio is one option. Ideally the depressed person should steer clear of all-news-all-catastrophe-all-the-time stations, or the shock or call-in jocks trying to stir up rage, disgust, bigotry, hopelessness, or fear. During depression the mind is good enough at doing this itself; help is not required. Something like CBC radio or NPR is more likely to be thoughtful, interesting, and educational without feeding the low mood. In this day of iPhones fewer people have portable radios, but major networks (including CBC) have apps that will access the feed live.

Podcasts are another option. The iStore, radio networks like CBC, and other sources have plenty of free material that can be downloaded onto an MP3 player. If you like a certain radio show, chances are you can download as many episodes as you want and listen to them without having to follow the broadcast schedule. As well, many people create material solely for podcast.

Courses. In therapy I invite people to consider what they would be doing if they had an ideal life free of depression – then to start doing precisely those things at least a little bit. Many identify things they would like to learn about. The Teaching Company offers audio courses on dozens of topics, taught by award-winning university lecturers. And many universities have taken to posting their courses online for free download – iTunes University is perhaps the easiest source for these.

Audiobooks. Most popular books have audio versions these days, and most e-readers have the capacity to translate print into (admittedly mechanical) speech. Libraries typically have a good supply of audiobooks, and audio content can be purchased and downloaded easily from iTunes and online booksellers such as Amazon. Even murder mysteries can be an improvement over the horrors the depressed mind can dream up.

Ultimately the goal for people with depression is to be able to walk without having the mind gravitate to misery. And, yes, I’m enthusiastic about the capacity for people to improve their mindfulness skills.

But in the early stages, audio content can make walking more pleasurable, and this can make it easier to keep up. As well, even after recovery many people enjoy adding an entertaining or educational component to their exercise, whatever it may be.

Some special recommendations…

We all have different tastes. Here, though, are some good picks:

  • TED audio. TED is a conference series featuring world leaders in a variety of fields, each given under 20 minutes to make their point.  A useful resource for almost anyone, TED talks are available in audio or video format.
  • Lake Wobegon. Garrison Keillor offers a weekly summary of the events in the fictional Minnesota town of Lake Wobegon.
  • Terry O'Reilly. An adman reviews various issues in advertising in an entertaining format for CBC Radio.
  • Jian Gomeshi and Q. The CBC's weekday morning entertainment magazine, available as podcast.
  • The Teaching Company. Source of audio and video courses taught by some of North America's greatest university teachers.
  • The iStore. The iTunes location for university courses of all types, available for free download. The link is to a description website; for the courses themselves open the store in iTunes and look for iTunes U in the menu bar.

1 comment:

  1. Hi Randy...

    Have your book on assertiveness...
    I would like to say that your blog is informative