Rest. Some depression seems to be associated with physical symptoms such as fatigue and pain. Resting to reduce these symptoms can also improve mood. Here’s how one student described the connection: “I can usually tell when I am doing more than my body can handle because I start to get depressed, not to mention short tempered and cranky. If I am well rested I am much happier.”

Reach Out to Others. Simple human contact is often very soothing. Family and friends can also be important sources of support. Calling a friend or getting together to talk, share a meal or see a movie counteracts the sense of isolation, preoccupation with problems and the low mood often associated with chronic illness. Just explaining yourself can often give you perspective. As one patient said, “I find it very helpful to talk to others who are going through the same thing. For me, it’s important to be able to identify with others so I don’t feel so alone in this.”

Get Out of the House: Just like contact with others, getting out of the house counteracts isolation and boredom, provides stimulation and can reduce depression.

Consider Medications. Tranquilizers and narcotic painkillers intensify depression. If you are depressed, it may be in part a medication side effect. Check with your doctor. On the other hand, if your depression is bio-chemical in origin, you may be helped by an anti-depressant.

Exercise. Exercise is a natural anti-depressant. It relieves tension, lessens stress and improves mood. Most exercise also involves being out of the house, thus bringing the added benefits of a change of scene.

Practice Problem Solving: Taking action to solve a problem lifts the spirit as well as having practical benefits. Doing something counteracts the sense of helplessness and replaces it with a sense of control and power. In the words of one student, “I handle emotions better if I do something rather than passively suffer.”

Change Your Thinking. Being ill over an extended period of time can be associated with a sense of helplessness. Changing your habitual ways of thinking to be more positive can change your mood, as explained in Chapter 10. To improve your mood, notice what’s going well and what you have accomplished. Reduce the impact of a low mood by speaking to yourself in consoling voice, reminding yourself that similar moods haven’t lasted in the past. In the words of one student: “If I feel down, I remind myself that life is a series of hills and valleys, and that even though I may be presently in a valley, eventually I will be once again on a hilltop.”

Do Something Pleasant. Pleasurable activities counter depression and help create a good mood. Doing something in which you can become absorbed distracts from bad moods and puts you in touch with positive forces. Such activities might include reading, playing or listening to music, sitting in the sun, solving jigsaw puzzles, doing needlework, spending time with friends, being out in nature and laughing. One student said, “I use my fun activities to divert my down moods. I force myself to let go of my ‘to do’ list and do something I know will set me in a better state of mind.”

Get Help. If you are seriously depressed, suicidal or have been depressed for some time, get help now. Phone a suicide prevention center, talk to your doctor, see a psychologist or call a friend. If your problems are less severe, consider seeing a psychotherapist. Look for one who has experience working with people who have chronic illness. A therapist can provide an outside view of your situation, help you to accept your illness and support you in your efforts to improve. If you have family tension because of illness, you might also consider couples or family counseling.

Establish Good Daily Habits. Keeping to a daily routine regardless of how you feel can help counteract depression. Your daily round of activities will depend on the severity of your illness, and might include things like getting dressed, making the bed, cooking meals, taking a walk and watching a favorite TV program. Forcing yourself to do things, even if you don’t want to, counteracts the inertia of depression.

Help Others. Get involved with something larger than yourself to counteract the isolation and preoccupation that often accompany illness and to rebuild self-esteem. We usually feel better if we do something for another person. Helping others might involve a regular commitment like leading a support group or something as simple as a phone call to an older relative or checking in with an old friend.

Manage Your Stress. Controlling stress can help you manage your emotions, because stress tends to make emotions more intense. Living within your energy envelope and managing the stresses in your life will make emotions more manageable.

Use Problem Solving. Taking action to solve a problem has a double payoff. You reduce or eliminate a practical concern that is bothering you. Also, the process of taking action often reduces worry.

Practice Stress Reduction. Learning relaxation and other stress reduction techniques can help reduce the intensity of your emotional reactions and, by doing so, reduce the echo effect in which emotions and symptoms amplify one another. A regular stress reduction practice can also lower “background worry,” the ongoing anxiety that results from long-term stresses like chronic illness. Relaxation is the key. Remember: it is difficult to be worried and relaxed at the same time.

Change Your Thinking. If you have a tendency to think of the worst that might happen, you can take steps to short-circuit the process in which your thoughts increase your anxiety. One antidote is to retrain yourself to speak soothingly when worried, saying things like “I’ve been here before and survived” or “this is probably not as bad as it seems.” Also, you can do “reality checks” by testing your fears against facts and by asking for feedback from others. Learn to distinguish between toxic worry, which is unproductive and paralyzing, and good worry, which helps you plan. Act decisively to stop the former.

Connect with Other People. Feeling that you are part of something larger than yourself counteracts worry. Also, contact soothes worry, distracts you from preoccupation with problems, and provides reassurance.

Exercise. One of the best treatments for worry, exercise is both relaxing and distracting.

Pleasurable Activity. Reading, music, good conversation and other activities in which you can become immersed help change mood.

Don’t Worry Alone. The act of sharing a worry almost always reduces its size and emotional weight. Discussion may help you find solutions, but almost always makes the worry feel less threatening. Putting a worry into words translates it from the realm of imagination into something concrete and manageable. Seek out people who can offer support and reassurance.

Medications. Just as drugs can help with depression, some people find that medications help them deal with anxiety. A drug will not be a complete solution to problems of anxiety, but it can be part of a comprehensive response.

Talk It Out. Expressing anger by talking it out with someone who is not the target of your frustration can release the feeling. As one student said, “The frustration and rage I felt about becoming ill has eased considerably since I joined a supportive group. I feel lucky to find a place to vent, be accepted and feel understood.”

Write. Putting experience in words can be helpful. Psychologist James Pennebaker has found that people have fewer health problems if they write about traumatic events in a way that combines factual description and emotional reactions. Giving verbal form to emotionally powerful experiences brings understanding. A related technique is to write a letter to the person you are mad at, and then tear it up.

See Things from a Fresh Perspective. The amount of anger you experience may be related to your thoughts, to how you see your situation. Imagine, for example, that you are waiting at a restaurant for a friend who is a half-hour late. You feel irritated. When the friend arrives, she reports that she was delayed because she was in a minor accident. Suddenly your emotion changes from anger to concern. Here’s what one student said about the effects of seeing things in new ways:

Plan Your Response. If you are irritated by comments like “I’m sure you would feel better if you would try this new remedy,” you can prepare a response so that such comments don’t bother you. In this case, you might say something like “Thanks for your suggestion, but I’m under my doctor’s care and I’m following his treatment plan.”

Accept and Acknowledge the Feeling. Some people report that they are able to dissipate the power of anger and other feelings by naming them. The exercise produces a detachment from the feeling. As one student said:

Get Professional Help. Sometimes talking with a counselor can ease the pressures created by having a long-term illness. If your anger is making your relationships more stressful, you might consider getting professional help. Look for a therapist who specializes in helping people with chronic illness.