The following prescription is from my recently released book, Prescriptions Without Pills: For Relief From Depression, Anger, Anxiety and More. The prescription can ease most depression, and also helps to reduce anxiety and anger.
AGGRESS-N is my acronym for eight factors that can strengthen you emotionally vis-à-vis depression. The same eight factors can also help you to reduce anger, anxiety, and addictive habits. Use them to create a surge of positive energy and, with it, emotional sunshine.
Notice the similarity between the words aggression and AGGRESS-N. Getting aggressive by taking the anger route to get what you want also can prevent depression. As a young man once said to me, “When I fight, I feel good.” If you fight for a positive cause, that kind of fighting can, in fact, give your life meaning, purpose, and an energy boost. Aggression, however, in the usual sense of fighting carries the risk that you may feel better by making the receiver of your angry words and actions feel worse. While that outcome may sometimes feel tempting, hurting others is likely eventually to have unfortunate impacts on everyone involved.
The eight AGGRESS-N factors, by contrast, like the other prescriptions in this book, have little to no apparent downside, yet bring many benefits.
Rate yourself from 0 (not doing this at all) to 10 (totally) on how willing you might be to incorporate this factor into your anti-depression treatment plan.
Switch your view of yourself from seeing yourself as a victim to seeing yourself as a primary actor. A poor me victim stance perpetuates depression. “Look what you have done to me!” keeps you feeling powerless. Believing that you are the victim of circumstances, others’ misbehaviors, or anything external can leave you waiting helplessly for others to change. Instead, seize control by asking yourself, “What could I do differently to get a better outcome?”
Remember, depression is a disorder of power. Regain your sense of personal empowerment by reminding yourself that there always are actions that you can take to address your problems. Already your depression will begin to lift.
Interestingly, even the simple act of starting your sentences with the word I can put you back in the driver’s seat of your life. Rx 6.2 will explain this phenomenon more fully, but for now, here’s a preview of coming attractions.
“He made me feel . . .” creates feelings of powerlessness. By contrast, “I feel . . .,” puts you in control. When you make yourself the subject of your sentence by starting sentences with the pronoun I, this small wording change has big impacts. It raises your power level and points you toward problem-solving.
Feel the difference between these two approaches:
“He makes me mad.”
“I feel mad when he’s late for dinner . . . so I think I’ll start aiming for us to eat a half hour after the time we agree on. Then we can sit and enjoy a few quiet minutes together before dinner if he’s on time. If he’s late, we’ll be right on time.”
Keeping an empowered attitude can help you in even the most difficult situations. Rx 1.6 introduced this potent secret to emotional resilience. The examples there of the former Soviet political prisoner Natan Sharansky and of my client Burt illustrated staying activated instead of succumbing to believing that you are a helpless victim of external circumstances.
The following case, a Holocaust story, illustrates this principle. Selma died more than a decade ago. This is the only example in this book in which I use the person’s actual name. I say Selma’s name to honor her memory.
I met Selma over thirty years ago when she attended a lecture on depression that I was giving for the staff at the hospital where my office is located. I still remember Selma clearly because she exemplified so dramatically the refusal to slide into a victim mode.
During the lecture, I suggested a dilemma. What would you do if you stayed late at work and then discovered, as you were ready to leave, that the exit door was jammed? Most people in the group offered a suggestion or two and then gave up, succumbing to a depressive collapse. Selma, by contrast, offered one idea, then another, and another, and then yet another ingenious way to exit the building.
I was impressed. After the session, I asked Selma how or why she had become so inventive, never giving up in a situation that others quickly regarded as hopeless.
“When I was growing up in Eastern Europe in the 1940s, my mother, my sister, and I lived for three years fleeing the Nazis. We hid in forests and barns, moving on each time our hiding places looked at risk. We knew that giving up meant death. Each time we faced a new danger, we found yet another option. That’s how we survived, taking care of each other and always thinking of alternatives.”
Selma and her family faced life-threatening challenges every day. Their attitude of persistent determination to Find Solutions, even in the most seemingly hopeless circumstances, can inspire us all.
What are the costs of defining yourself as a victim?
When have you been effective at active problem-solving?
Remember the old saying about seeing a glass as half empty or half full? Even if you feel understandably depressed about a negative circumstance, somewhere in your life there are elements you can feel grateful for. Gratitude is empowering. Empowerment counters depression.
Burt, in Rx 1.6, accessed gratitude to counter the impulse to give up and sink into depression. So did the couple in the following example.
Dana and his wife, a vibrant newlywed couple, traveled to Hawaii for a vacation. As soon as they arrived at their seaside condo, they headed to the beach where the sparkling surf lured them in for a quick swim. The first wave surprised Dana with its power. The wave pummeled him, head-first, straight into the sand. Dana intuitively protected his head by reaching out with one hand to cushion his fall. As he stood up after the wave had receded Dana realized that the wave that had slammed him down had broken a bone in his arm.
When Dana returned from the hospital with a cast, he and his wife sat on their patio and talked over what had happened.
“At first I was so mad,” he told his wife. “I won’t be able to play tennis or swim or do any of the sports I had thought we’d be enjoying here. Then I realized how lucky I am. Good thing I’ve always done so many sports. If I weren’t so strong and didn’t have such quick reflexes, that wave could have given me a major head injury or even cracked open my skull so I ended up dead. I feel so fortunate!”
If you have been feeling down, how might you shift your focus toward more gratitude?
Most people have heard the saying, “Pick a card, any card.” It turns out that if you pick a recipient, any recipient, and give attention, affection, or money—if you give in any positive mode to any person or cause—your body will spurt forth a quick shot of the chemistry of feeling good. Lovingly taking care of a child, elder, pet or even a stranger can help you as much as you help them.
Cole was driving in his car, feeling discouraged about his life. His girlfriend had left him, and now his work situation was showing signs of fraying. While he waited at a traffic light, a disheveled older man standing in the center of the road walked up to his car. “Can you spare some change?” Cole reached into his pocket and pulled out a five-dollar bill.
The old man’s pale blue eyes looked straight at Cole. “God bless you, sir. I’m so appreciative,” the man said.
Suddenly Cole’s spirit perked up. He felt fortunate now. His small act of giving had led to him feeling profoundly blessed.
Feeling depressed often creates an impulse to cocoon at home. Interacting with others can feel like it would take too much energy. Isolating feels safer, less overwhelming.
Contrary to the isolationist impulses you may feel when you feel depressed, talking with others can lift your mood. Even exchanging a few words with someone in the grocery checkout line can grant you a small energy boost. Chatting, receiving smiles, and enjoying shared humor all stimulate positive energy. When you talk with others, your emotional state and theirs eventually will match. Moods are contagious. If yours has been low, others’ more positive moods may raise yours.
Social interactions offer opportunity also for fresh perspectives. If you feel flummoxed by a practical problem, discussing it with someone you trust may offer you an alternative way of seeing it. Therapists use the term reframe for a new and more positive outlook on a dilemma. A reframe can bring you hope.
Socializing can also have its downsides. While connecting with others re-energizes most people, even those who crave solitude, it can sometimes add to discouragement. Seeing others’ apparently comfortable emotional states can heighten your awareness of your own state of discouragement. You do need to protect yourself too from encounters with critical folks. For the most part, though, mingling with almost anyone who is in a normal to happier-than-normal mood can lighten yours.
The following case illustrates the importance of social connection and also several of the remaining AGGRESS-N factors: exercise, sleep, and sunshine.
Teresa, an attractive woman in her mid-sixties, suffered one of the most profound depressions I have treated in my clinical practice. She was the only client I have worked with whose depression was so intense that she would curl up in fetal position in my office.
When Roy and Teresa both had retired the prior year, Roy had said that he’d like to move to a larger city in a warmer state. He was bored now that he no longer went each day to work. Especially in the dark, cold, and icy winters he felt housebound and stir-crazy.
Teresa said no. The thought of moving terrified her. She felt safe and loved in her familiar, decades-old friendship group. Moving sounded totally unappealing.
Roy nonetheless scanned the Internet for houses in sunnier cities. When Teresa reiterated her strong desire to stay where they had lived for more than thirty years, Roy replied dismissively, “That’s foolish. Living in a city will be fun. You’ll make new friends there.”
Roy found a house and bought it. Within weeks of their move, Teresa slid into a deep depression. She seldom left their new home and either slept or cried most of every day. Reeling from a decision to move for which her input had not been considered, living in a new city where she had no friends, grieving the loss of her community, and angry at her self-centered husband, Teresa descended into depths of despair.
While Roy’s dominant-submissive mode of decision-making plus the loss of her former close-knit friendship group had triggered Teresa’s profound depression, the lack of social connections in her new city perpetuated it.
If you have been feeling depressed, how might you increase your social interactions?
If you are seriously depressed, the last thing you may feel like doing is anything that takes output of energy.
Paradoxically though, pushing yourself to expend energy in physical activity, such as walking, biking, dancing, going to a gym, or doing virtually any sport, will generate more energy. The more you apply energy to moving your body, the more energetic you will feel. Paradoxically too, the harder the workout, the more positive energy you are likely to experience at the end of your workout.
Living now in the sunshine of Denver, Roy encouraged Teresa to join him in his new morning routine of after-breakfast walks. At first Roy had to reach out and take Teresa’s hand to ease her off the sofa. Gradually, exploring their new neighborhood together became a fun activity that helped Teresa begin to re-energize. The more she walked, the more energy Teresa seemed to have to do other activities during the day.
Want to amplify the impact of your exercise on your moods? Exercise with music. Listening to music even without exercise can boost feelings of well-being. Ever noticed that in stores that play upbeat music, your enthusiasm for buying rises? Similarly, listening to music while you exercise makes your mood more upbeat.[i]
Sexual activity, especially in the context of a loving relationship, can prove to be a particularly potently anti-depressive form of physical exercise. In addition to activating your musculature, breathing, and heart rate, sexual arousal impacts your biochemical system by increasing the flow of oxytocin and other feel-good neurochemicals.
The quadruple positive synergies from combining exercise, music, sexual activation, and relationship connection offer especially significant energy enhancement. Of course, like socializing and exercising, starting to engage in sexual activity when you are depressed can feel like it would take too much effort. Still, the payoffs once you get past the starting gate can be high.
What kinds of exercise could you engage in to increase your energy levels if you have been feeling down?
Sleep rejuvenates your body’s energies. Getting adequate sleep therefore merits top priority if you want to sustain your physical and emotional health.
Depression can cause sleep loss. The reverse also is true. Loss of sleep can cause feelings of vulnerability to depression. Beware of a cycle in which insufficient hours of sleep leads to depression, depression blocks adequate sleep, creating more depression, and you get caught in a downward spiral.
For my PhD dissertation, I studied postpartum depression. The single strongest predictor of which of the forty women in the study would fall prey to a depression in the first weeks after a new baby’s arrival was insufficient sleep. The single best cure: getting more sleep.
Interestingly, both too little sleep and too much sleep can increase vulnerability to depression. When you feel extremely depressed, you may not want to leave your bed. Excessive sleeping, however, can leave you drowsy instead of more energized.
Teresa had been staying in bed until almost lunchtime. With her agreement with Roy that they would breakfast together then take walks, Teresa found that less sleep time seemed to leave her with more energy.
How might you improve the amount of sleep you get?
With the current and well-merited attention to the dangers of sunburn as a precursor to skin cancer, the benefits of sunshine can be overlooked. Yet vitamin D turns out to be a surprisingly strong antidepressant. Absorbing vitamin D straight from the sun boosts your physical health much like vitamin C does, and at the same time boosts your mood.
Sunshine has all the more potent an antidepressant effect if you can access a natural setting. Green grass, leafy trees, and colorful flowers utilize sunshine to grow and then transfer that positive energy into your emotional state.
When natural sunlight is not available, an antidepressant sunlamp can substitute. Seasonal affective disorder (SAD) is a tendency to get depressed in the winter when there is less sunshine. During the months of short, dark days, sit under a lamp while you read, watch TV, or check your favorite websites. You can order lamps for this purpose via the Internet.
Teresa’s morning walks outdoors with Roy energized her as much because of the sunshine as because of the exercise and the social interactions. The morning walks improved Roy’s mood as well. Relaxing into a happier mode, he became a more enjoyable companion. His better mood increased his openness to listening to his wife’s perspectives, adding yet another boost to Teresa’s emergence from depression. Walking with Roy each morning, Teresa appreciated the relaxed kindness that had replaced his former grumpiness and do-it-my-way bossiness.
How might you increase your quantity of exposure to sunlight?
New anything tends to be energizing. Are you reluctant to embrace change, fearing it rather than looking forward to it? That tendency could work to your disadvantage. Even small doses of newness can engender an emotional uplift.
Try a new flavor of ice cream or a new restaurant. Go to a neighborhood you haven’t been to before in your locale. Take up a new activity, anything from knitting to bowling to volunteer work. Make a new friend by inviting someone different to join you for dinner. Plan a trip and travel.
The move to a new city initially overwhelmed Teresa. Over time, however, she began to enjoy launching new activities and meeting new friends. Bit by bit, her depression lifted.
One morning as Roy and Teresa walked together, Teresa smiled. “Good thing you decided on this move. I would never have made this decision. Now though, I can’t imagine being stuck in the dark cold winters we used to suffer through. My new friends are interesting. My study groups and exercise classes here are great. The volunteer work I do at the preschool in the shelter for homeless families feels worthwhile and makes me laugh; the kids are always saying funny things. Life feels more full and more fun. I even enjoy being married to you,” she said, teasing Roy affectionately as she squeezed his hand.
How might you add new elements to your life? ______________________________
In sum, use all 8 AGGRESS-N factors as often as you would like.
Life is not meant to be an endurance contest. Use AGGRESS-N prn, that is, as needed to relax, to feel more upbeat, and to enjoy your work, your loved ones, and your life.
[i] J. Alpert and M. Alpert, “Music Influences on Mood and Purchase Intentions,” Psychology and Marketing Psychology (2006): 109–133, DOI: 10.1002/mar.4220070204.
Dr. Susan Heitler, a graduate of Harvard with a PhD from NYU, is a popular Denver psychologist who has recently published her 5th book: Prescriptions Without Pills for Depression, Anger, Anxiety and More.
For free worksheets and videos on overcoming feelings of depression, anxiety, anger and more, see the book's free website at prescriptionswithoutpills.com