Disclaimer: The following client portrait is fictitious. Many people who exhibit depressive symptoms demonstrate similar behaviors and characteristics. No identification with actual persons is intended or should be inferred.
When Tania feels depressed, she loses sight of all the progress she’s made.
I’d noticed her flat affect and monotone voice in our last few sessions. Her nonverbal cues alerted me to a possible depressive episode for her. So, I took a few minutes before this session to grab a glass of water and breathe deeply before starting our telehealth session. Sure enough, Tania looked disconnected and sad.
“I have this mix of struggles. I’m not making as much money as I need to, and I can’t handle the monotony of life.” Like many 19-year-olds, Tania is juggling college, work, and a relationship. Despite a history of depression, Tania is doing quite well. She has straight As in school, a meaningful job and a supportive relationship. But she’s not happy.
“I feel hopeless, like nothing’s worthwhile. I’m not enjoying my job or school. I’m not doing things for fun on the weekend, even when I have time.”
She reports waves of passive suicidality. She doesn’t want to end her life. She just wants to end this cycle of feeling blah.
“Tania, that sounds really hard. It’s normal to feel blah at this point in your life—working while going to school can be a slog.” She nods her head slowly. “Add to that a global pandemic, at a time in your life when you’re supposed to be out there making new friends and having new experiences, and you have the perfect ingredients for feeling meh.” She laughs the tiniest bit.
Tania isn't alone. There’s been an increase in teen depression in the US since 2011, according to current research. In fact, depression is the main cause of illness and disability for children and adults globally, according to a 2019 study.
This is especially concerning, considering that depression in adolescence can have long-term effects on one’s relationships and socioeconomic standing. Add to that depression's complexity--it has a wide variety of causes and children and adolescents may show different symptoms than adults. Rather than seem sad or depressed they may exhibit irritability or even anger.
As parents, teachers, therapists, and caring adults, how do we combat this mental health crisis in our youth? First, let’s consider the risk factors.
Risk Factors for Teen Depression
1) Biologic—people diagnosed with depression may have a predisposition, whether it be biological, brain chemistry or a family history.
2) Psychological—ineffective coping, negative thinking styles, history of suicide attempts.
3) Environmental—attachment style to parents/caregivers; technological (i.e., time spent on social media and electronics); sociocultural (academic and peer pressure; pandemic); socioeconomic; and trauma.
It’s important to keep in mind that these factors are often intertwined. For instance, a teen who already experiences a lot of negative self-talk (psychological) may struggle with depression when his father is laid off during the COVID-19 pandemic (environmental).
Treatments for Teen Depression
The two main treatments for depression are therapy and medication. A combination of the two is the most effective at the start of treatment. Over time and with clinical guidance, the client will likely decrease therapy and/or medication as their skills grow. But the most predictive hallmark for success is the teen’s level of involvement in their own treatment. Dr. Edmund Chaney is an associate professor of psychiatry and behavioral sciences at the University of Washington. In a 2005 web article he told WebMD, “if patients are active participants in the treatment and have some choice in what they are doing, it becomes something they find much easier to do and to follow through with."
As a therapist, I have a few tried and true strategies for clients suffering from depression. First, I conduct one or more screening tools to ensure I’m accurately diagnosing my client’s issues. I also work closely with the medical provider prescribing antidepressants whenever possible. Finally, I use an integration of neuroscience-informed techniques with yoga therapy to help my clients combat their depressive symptoms. Tania’s session is a great example of this.
Step 1: Regulate – Relate – Reason
When Tania shared her struggles, I simply reflected what she said. I wanted to connect with her, to let her know that her feelings were valid and relatable. But first I had to ensure I felt calm and regulated. What does it mean to be regulated?
Here, the term regulate comes from Dr. Bruce Perry’s Sequence of Engagement model. If you read my December 2021 white paper, you’ll recall Dr. Perry’s model suggests we practice the following when talking to children or adolescents about their problems: Regulate - Relate - Reason. As Dr. Perry says, a regulated adult has a chance of regulating a dysregulated teen or child. A dysregulated adult has no chance of regulating that same teen or child.
I regulated myself before session by drinking water and taking deep breaths. It allowed me to be fully present and relate with Tania. Tania could then put her distressing feelings into words—the reason part of the Sequence of Engagement. This process establishes connection and trust between client and therapist.
Step 2: Co-Regulation through Yoga
Once we’d established the Sequence of Engagement, we could move into co-regulation, which is defined as “the bidirectional emotional linkage of two people that promotes emotional stability."
“Tania, what do you say we do some yoga together?”
“Sure. My neck’s been hurting me a lot. It might help to stretch.”
Tania has been practicing yoga and mindfulness tools with me for the five years. We’ve done everything from sun salutations to mantras to breathing practices to meditations. Practicing yoga together deepens our co-regulation. We’re not just connecting through language but through movement and breath. The beauty of yoga is that coordination of breath and movement are inherent parts of the practice. This means I can help Tania regulate her breathing, which has a regulating effect on her nervous system.
Today I want to help her get out of her head and into her body. In addition, I want to help her find some energy, and amplify positive emotion, or upregulate. But I need to meet her where she’s at—i.e., very low energy. This means I need to increase the energy level of our yoga practice gradually, gently. Lastly, I want to address the neck tension she’s mentioned. I ask her to grab her yoga mat, and I place mine where I know she’ll be able to see me on the computer screen. You can watch the companion video to this practice by clicking the title link below:
Upregulating Yoga Practice (click here to watch a snippet of this practice)
Head rolls
Child’s pose
Asymmetrical child’s pose
Cat cow stretch
Wave sequence
Lying over bolster
After we practiced this sequence, Tania reported feeling energized and “like my head feels clearer.” She easily brainstormed coping skills including practicing the above yoga sequence, texting friends and playing her guitar. A week after this session, she said she’d practiced yoga twice a day three times that week. “I feel like I’m in control of my thoughts and body (when I practice).”
By its nature, depression causes loneliness and helplessness. Individuals suffering from depression often isolate, have low self-esteem, and feel self-conscious. My depressed clients tell me they feel like no one understands what they’re going through. So a healthy dose of co-regulation through neuro-informed yoga therapy can help clients feel connected and understood. As Tania’s session shows, yoga therapy is a powerful tool in the treatment of depression because it facilitates co-regulation and empowers the client to take charge of their own body and thoughts.
Another common symptom of depression is suicidal ideation--in other words, thoughts of suicide. If you or someone you know is having suicidal thoughts, don't hesitate to reach out for help. Call 1-800-273-TALK (8255), the Suicide Prevention Lifeline sponsored by the SAMHSA (Substance Abuse and Mental Health Services Administration).