Editor’s note: This is the second of two stories speaking with Dr. Tammy Heskeyahu about depression and anxiety. The first covered the signs of anxiety and depression.

By Kristine Porter

kporter@tnonline.com

Depression and anxiety can be brought under control.

At one of Lehigh Valley Health Network’s online therapeutic support groups, Dr. Tammy Heskeyahu, a clinical psychologist with LVHN-Pocono, talked about depression, anxiety and gave some tips on how to deal with it.

It’s important to learn ways to cope with stress, because stress can cause headaches, insomnia, gastrointestinal upset and even disturb the immune system.

“Cortisol is a stress hormone. When we get stressed, our cortisol levels go up. When it goes up, we get a lot of physical ailments,” she said. “If your cortisol levels are high, your immune system goes down.”

Heskeyahu outlined three steps to managing stress.

1. Eliminate stressors

2. Reframing your thoughts

3. Self-care

Eliminating stressors

A person should stay away from things that causes stress for him or her. Of course, some things can’t be eliminated, but change what can be changed. For instance, if the commute to work is causing stress, then try moving closer to the job or look for a job closer to home.

Reframe thoughts

This is good to do when eliminating the stressor isn’t possible.

“If we are thinking happy thoughts, then we can’t really feel a negative emotion. We’ll feel a positive emotion,” she said.

Of course, thinking happy thoughts doesn’t just cure a person of depression. This is a technique to use to alleviate the pain of negative thoughts, and reduce stress and anxiety.

Still for some people, they can’t just think a positive thoughts. They need to know that there is no evidence to support the negative thought before they can allow themselves to think positive about it.

If there is evidence to support the negative thought, then they need to solve that problem so the evidence is removed.

For example, Heskeyahu said two people could lose their jobs and have very different viewpoints about it. One could look at it as an opportunity to try something new. While the other one dwells in negative thoughts and despairs about bankruptcy and never finding a new job. This is catastrophizing, she said. In reality, a new job will be found eventually.

Self-care

If a person can’t reframe the thoughts, because he or she has been dwelling in that narrative for too long, then the next thing to do is self-care. Heskeyahu suggested these options.

• Limit watching television programs that are upsetting.

• Start a hobby.

• Exercise. It reduces cortisol levels.

• Use technology to see family and friends.

• Engage in social activities online, such as attending church or a book club.

• Read a book or listen to an audio book.

• Do home improvement tasks, such as fix things or clean out the closet.

• Journal in a book. This helps to get thoughts on paper and out of the mind.

• Online support groups.

• Free online courses.

• Mindfulness, which involves being present in the moment using the senses to take in everything. For example, when washing dishes, smell the lemon in the soap, feel the slippery bubbles, listen to the water dripping from the faucet.

“If you are in the present moment, you can’t be in the future and you can’t be in the past,” she said.

• Be aware of overthinking. Some people don’t realize they are thinking all the time, nor do they realize what they are telling themselves. Turn it off, and let it flow away.

• Increase behavioral activation. Go out and do things that used that have been enjoyable. This will stimulate a good mood and helps to dissipate depression.

• Do relaxation exercises.

Heskeyahu said relaxation exercises help a person to focus on the body and breathing, instead of thoughts.

It works by focusing on a positive image, then slowly breathe in deeply and out. Do a cycle of 10 or however many is needed to relax.

Another relaxation technique is called progressive muscle relaxation. It involves a tightening and loosening of the muscles and focusing on that process for each muscle group of the body. It’s relaxing and gives a nice stretch similar to yoga and Pilates.

The last technique is guided imagery where a person thinks of a special place where he or she feels secure and peaceful. There are apps with music or words that a person can use to help the technique.