Major depression is one of the most common mental disorders, according to the National Institute of Mental Health. The most recent figures from 2017 show that an estimated 17.3 million adults in the United States have had at least one major depressive episode. That’s about 7% of all adults.
People struggling with depression often complain of sleeping too much and feeling fatigued. They will put off getting help until the depression starts having major impacts on their home and work life - until they feel overwhelmed and like they can no longer keep up. When they do finally get counseling, they may show up for therapy exhausted and stuck in negative thought patterns, ruminating over the same dark scenarios.
Counselors are faced with trying to motivate clients who may have used up most of their energy just getting to the session. This is where telehealth can really be helpful. It takes much less energy to turn on a webcam or pick up the phone than to drive several miles to therapy.
But which telehealth interventions work best for depressed clients?
Dr. Margaret Wehrenberg, a clinical psychologist and internationally known trainer for mental health professionals, is the author of “Pandemic Anxiety: Fear, Stress, and Loss in Traumatic Times” and “The 10 Best-Ever Depression Management Techniques.” She’ll be speaking at the Telehealth Certification Institute’s upcoming “2021 Summit: Telemental Health Tailored to Your Practice.” She is noted for her down-to-earth, pragmatic teaching style.
“When clients come to us lethargic and negative, it’s hard to get them moving,” Dr. Wehrenberg said.
She trains counselors to use interventions that lift the client’s energy, and to turn their thoughts toward more positive thoughts and actions. The therapeutic interventions she uses include teaching clients to:
- Enhance motivation and mobilize the client with lethargy
- Diminish the impact of negative attention bias
- Build the brain circuitry for joy and positive emotions
- Stop the damage of chronic stress
- Interrupt the plunge to despair common in trauma survivors and learn new, healthy coping styles
- Replace their automatic thoughts of hopelessness and despair with more optimistic thoughts
For example, Dr. Wehrenberg says clients need to learn to recognize triggers for their depression and to plan new responses.
Clients also have to learn to keep moving and to fight the depression urges telling them to just stop and plop down in a chair or on the bed.
Dr. Wehrenberg encourages clients to seek satisfaction - not a huge cheery feeling. Satisfaction is more sustainable.
Clients can also learn to “talk back” to their depression. In her book, “The 10 Best-Ever Depression Management Techniques,” Dr. Wehrenberg suggests teaching clients how to practice healthier self-talk with phrases like:
- I can think what I want. And I want to think I have many good traits.
- I don’t have to leave my negative brain on autopilot. I can override it to think something positive.
- What I think affects what I do. I will think about using my strengths.
Counselors using video conferencing can use screen share to show phrases like these to clients during sessions. Encourage clients to create their own positive phrases and to write them down on sticky notes or a notebook that they can easily access. It’s very important they practice.
Dr. Wehrenberg also suggests a good old-fashioned “to do” list - but with a therapeutic twist: Have clients create a list of easy-to-do, simple activities that they can actually accomplish. Examples include:
- Read an article
- Call a friend
- Take a bath
Again, using telehealth, you can have these examples ready to share on your screen during your video conference with the client. You can even add images for illustration if you want to share the list on a document or Powerpoint.
If your video conferencing tool doesn’t allow for screen-sharing, or you’re using the phone for your session, send the exercise as an email attachment before the session.
To learn more ways to get your depressed clients moving again, you can hear Dr. Wehrenberg speak on March 22nd, 3:30 p.m. - 7:00 p.m. EST at the pre-summit for TCI’s “2021 Summit: Telemental Health Tailored to Your Practice."
By Amanda Barnett, LPC, NCC, EdS