Self-help strategies and complementary therapies

Bibliotherapy, which is often used in addition to other types of therapy, involves the use of specific reading materials and workbooks to learn about and treat a variety of mental health concerns. Imaginative literature such as novels, short stories, and poetry, can also be used to guide discussions around mental illness and help people with self-discovery. Bibliotherapy has been shown to increase self-awareness and self-esteem, help people understand the issues they are experiencing, normalize experiences with mental illness, and offer hope for healing. Some studies have shown effectiveness of bibliotherapy in treating depression.

Peer support is when someone uses their own experiences to support others who are going through similar challenges. Within the context of mental health, peer support is typically delivered by a person with a mental health condition. Peers can serve as proof that recovery is possible and provide needed inspiration on your journey towards wellness. Peers are in a unique position to develop a relationship of trust with their peers since people are often more willing to share their real issues and concerns with a peer specialist than with clinical staff.

Peers can facilitate education and support groups or work one-on-one as role models, mentors, coaches, and advocates. Peer support may include phone calls, group meetings, or online discussion groups like Facebook where people can share their experiences in public or closed groups.

What is the role of peer support?

Skills and practical knowledge for daily management

Peer supporters use their own experiences (e.g. following a medication routine, applying coping skills, and sticking with a treatment plan) to help people manage their illness in their daily lives.

Emotional support

Peer supporters offer encouragement and empathy to help individuals cope with problems and reach their goals.

Connecting people with resources and communities of support

Peer supporters can help individuals communicate with medical professionals and encourage them to seek out resources when needed.

Ongoing follow-up

Peer supporters stay in contact with individuals over time in order to keep them engaged and proactively managing their condition.

Practicing relaxation techniques can have many benefits, including:

• Lowering blood pressure
• Improving digestion
• Reducing activity of stress hormones
• Increasing blood flow to major muscles
• Reducing muscle tension and chronic pain
• Improving concentration and mood
• Improving sleep quality
• Reducing fatigue
• Reducing anger

Calm breathing

Calm breathing is sometimes called “diaphragmatic breathing” because it is from your diaphragm (the large muscle located at the base of your lungs). It is a technique that helps you slow down your breathing when you’re feeling stressed or anxious.

How can calm breathing help me?

Breathing is something we usually do not pay much attention to. With calm breathing, you take the time to focus on slowing your breathing and relaxing your body from head to toe. Calm breathing has been suggested to help with symptoms of anxiety, sleep problems, chronic pain, and stress. When we feel anxious, we tend to take short, shallow breaths or even hold our breath for short periods of time. Calm breathing helps you to focus on your breath in order to calm yourself and relax.

How can I practice calm breathing?

• Sit comfortably in a chair with your feet on the floor. You can lie down if you wish.
• Fold your hands on your belly.
• Breathe in slowly and calmly. Fill up the lower belly with a normal breath. Try not to breathe in too heavily. The hands should move up when you breathe in, as if you are filling up a balloon. Avoid lifting the shoulders as you inhale or filling up your chest. Rather, breathe from your diaphragm (the large muscle located at the base of your lungs) or stomach. Your shoulders and chest area should stay relaxed and still.
• Breathe out slowly to the count of “5.” Try to slow down the rate of the exhale.
• After the exhale, hold for 2-3 seconds before inhaling again.
• Continue to slow down the pace of the breath.
• Practice this for about 10 minutes.
• This works best if you practice this 2 times each day for 10 minutes each time.
• Try to find a regular time to practice this each day.

How can calm breathing help me when I am stressed out?

A benefit of calm breathing is that you can practice it at any time, in any location. Breathing is a built-in coping mechanism. Calm breathing can be used when you are alone or when you are around others, and it can help with a variety of stressors you might be feeling. The next time you find yourself in a stressful situation, try taking a few calm breaths and focus on relaxing your body and mind. Below are a few examples of times you may find calm breathing useful.

At home:

• When you are tossing and turning as you try to fall asleep.
• As you feel yourself becoming frustrated or upset while having a stressful conversation with a family member, friend, or roommate

In public:

• Before an exam, interview, meeting, or any other anxiety-inducing event
• When your day has been busy or hectic, and you are feeling overwhelmed

Where can I get more information?

• You may try searching for “Calm Breathing” or “Diaphragmatic Breathing” on YouTube to find videos that will walk you through the process of calm breathing.
• Mindful is an informative website that provides information about simple techniques, including deep breathing, that will help you to relax and reduce stress in your everyday life.

Progressive muscle relaxation

When you feel anxious or stressed, your body often responds with muscle tension. Progressive muscle relaxation is an exercise that helps relieve this tension by tightening and relaxing various muscle groups. It will help you recognize the difference between how your muscles feel when they are tense versus when they are relaxed.

• Set aside 15 minutes each day to complete this exercise.
• Find a comfortable place to sit or lie down, close your eyes, and let your body go limp.
• Breathe in while tensing your first muscle group (firmly but not enough to cause you pain) for 5 to 10 seconds.
• Breathe out while fully and suddenly relaxing the muscle group for 10 to 20 seconds.
• Move on to the next muscle group.
• Try to keep the muscles you are not working on in a relaxed state.
• When you’ve finished with each muscle group, sit quietly for a few moments and feel the relaxation. Then gently stretch and open your eyes.
• Here is a sample sequence of progressive muscle relaxation.
  • Hands – clench each fist
  • Upper arms – bend elbows and make a muscle
  • Shoulders – lift shoulders upwards
  • Neck – stretch neck upwards
  • Forehead and scalp – raise eyebrows
  • Face – scrunch up face
  • Tongue – press tongue against roof of mouth
  • Chest – tighten chest muscles
  • Upper back – pull shoulders forward
  • Lower back – roll your back and reach towards toes
  • Buttocks – squeeze
  • Stomach – tighten ab muscles
  • Thighs – tense thigh muscles
  • Calves – lift toes off ground towards your shins
  • Feet - curl toes down so they are pressing into the floor

Where can I find guided Progressive Muscle Relaxation?

It can be helpful to listen to someone guiding you through these steps, especially until you learn all the muscle groups. There are many audio recordings available online, on the App Store or Google Play, or on podcasts for free. You may try searching for “Progressive Relaxation” on YouTube to find a recording you like.

Body scan

• Find a quiet spot. Sit or lay down in a comfortable position.
• Gently let your eyes close.
• After a few minutes of deep breathing, “pay a mental visit” to your muscles, stopping at each area of the body from head to toe to pay attention to touch, pressure, and areas of tension. Move your attention to whatever part of the body you want to investigate. You might choose to do a systematic body scan beginning at the head or feet.
• Related to progressive muscle relaxation is the body scan. During a body scan you mentally “scan” your muscles looking for areas of tension. Close your eyes. Start with your head and move down your body. Ask yourself, “Where am I tense?” Scan your muscles looking for signs of tension. Ask yourself, “Is my forehead relaxed? Is my jaw relaxed?” and so forth. Scan your face, neck, shoulders, arms, hands, chest, back, stomach, buttocks, legs, and feet. Whenever you discover an area of tension, gently move the muscle to loosen it, and then relax it. In a body scan, you do not necessarily need to tense the muscle before you relax it.

Visual imagery

For this technique, take a mental “vacation.”

• Imagine yourself in a pleasant, relaxing place such as on the beach or in the woods. You can find free apps and online recordings of scenes that you find calming and soothing.
• Imagine tension flowing out of your body, down your shoulders and arms and out through your fingertips into the air, down your thighs and legs, and out through the soles of your feet into the ground.

Meditation

This practice involves focusing on your breathing and observing your own thoughts and experiences as they occur, without judgment. By keeping your focus “in the moment”, it is possible to acknowledge the source of your stress, without attaching too much meaning to it. Some people prefer to meditate at the start of their day, while others prefer to meditate at the end of their day.

• Find a quiet spot to meditate. Sit comfortably on a chair, couch, or the floor.
• Set a timer for 5-10 minutes or try a 5-to-10-minute guided meditation app. You can extend the length of time as you become more used to meditating.
• Gently close your eyelids.
• Focus on your breathing or on an object in your surroundings such as the flame of a candle. People often also use a mantra, which is a simple word or phrase repeated over and over again. For example, as you inhale say to yourself “opening” and as you exhale say to yourself “releasing”.
• The goal is to train your mind for continuous focus. Your mind will probably be filled with many thoughts, feelings, or physical sensations such as tingling, tightness, or itching. When you notice these, let them fade away, gently returning your attention to your breath or the object you have chosen. Remember that the goal with mindful meditation is to practice returning to the breath. The goal is not to push away thoughts or strive for a blank mind.

Mindful self-compassion

Things will not always go the way you want or expect. Many of us judge, criticize, and think negatively about ourselves when this happens. Mindful self-compassion involves accepting ourselves as worthwhile human beings that make mistakes and experience issues like everyone else. When you are self-compassionate, you respond in the same way you would with a close friend when you fail or believe you have failed, make a mistake, fall short of your goals, or have a tough time. The goal of mindful self-compassion is to respond to ourselves with support and understanding. To build mindful self-compassion:

• Write a list of 10 positive statements about yourself that you can use when you are feeling down. This helps teach you to not only focus on your negative traits or behaviors.
• Each night, do your best to write three positive things about yourself or your day before going to bed.

Yoga

Yoga combines breath control and simple meditation with a series of specific body postures or flowing movements. These features can help relax the nervous system and calm the mind while also energizing you when you are feeling down. Try out a yoga class or watch a video online and follow along.

Light Therapy

Light therapy is a way to treat seasonal or mild to moderate depression. Light therapy uses a special light box to help restore chemicals in your body and reset your body’s internal clock, which can improve both your mood and your sleep. This light is at least 10 times stronger than normal light bulbs, is very similar to natural daylight, and won’t harm the eyes. You don't need a prescription to buy a light therapy box, but it's best to ask your doctor if light therapy is a good option for you.

How is light therapy used?

• Light therapy is often most effective in the morning when you wake up.
• Sit or work near the light box so that the light is indirectly on your face. Don’t look directly into the light.
• Most people do their light therapy while they read, eat, watch TV, or sit at the computer.
• Generally, therapy begins with daily sessions of 10 to 15 minutes, which are gradually increased to 30-to-45-minute sessions.
• It is recommended that people begin light therapy in the early fall and continue the therapy until spring, when outdoor light alone is sufficient.

How soon does light therapy work?

Most people notice improvement in 2 to 4 days. In some cases, symptoms may not improve for several weeks. If symptoms get worse or do not improve after 4 to 6 weeks, consider additional treatment options.

Are there any side effects or risks with light therapy?

Side effects are uncommon but may include:

• Headache
• Irritability
• Fatigue
• Difficulty sleeping (if used late in the day)
• Eye strain

**We recommend trying out several of these techniques to see which one works best for you. Try to practice for at least 20 minutes a day, although even just a few minutes can help. Your ability to relax improves with practice, so it’s important to be patient. The longer and the more often you practice these techniques, the greater the benefit**

Broadly speaking, spirituality involves how we seek and interpret meaning and purpose in our lives. Your personal definition of spirituality may change throughout your life based on your experiences.

Research suggests that cultivating some sense of spirituality can help people build their own sense of identity, meaning and purpose, find more significance in relationships, handle adversity, and experience life more fully. Studies have also indicated that having a sense of meaning or purpose in one’s life (even while struggling to understand exactly what that meaning is), is associated with better mental health.

Developing a spiritual practice

Spiritual development is a lifelong process that is unique and personal to every individual. This process occurs within almost everyone, regardless of their specific beliefs, whenever they pause to consider the meaning of life and their place in the world. If you are interested in developing your own sense of spirituality and/or your own individual spiritual practice, you might consider pursuing one or more of the following:

Study

There are many books and websites devoted to spirituality. You can visit your local library or look online for resources that might help you explore your own path of spirituality.

Meditation

For centuries, people of all different beliefs have practiced meditation as a strategy for connecting with their own sense of spirituality, and disconnecting from the demands of everyday life. Meditation can be helpful in reducing stress, speeding recovery, and increasing quality of life.

Prayer

Prayer is often used to create a stronger spiritual/religious connection, ask for guidance to cope with difficult life events, seek forgiveness or help in forgiving others, or express a sense of gratitude. There are many resources for learning more about prayer. Books, websites and information provided by specific religious organizations can all be helpful in understanding more about how others have benefitted from prayer, and how you might incorporate prayer into your own life.

Community

Many people find comfort, strength and guidance on their spiritual path by sharing with others. The most familiar examples of spiritual community are religious organizations, or congregations, which are organized around a specific set of beliefs. If you think you might benefit from connecting with a specific spiritual or religious community, you might want to explore the possibilities in your area.

Regardless of your specific beliefs, engaging in your own personal spiritual journey may provide you with an additional source of strength and insight as you recover from depression.

Acupuncture is one of the most popular complementary or holistic therapies. In acupuncture, the practitioner inserts very thin, solid needles into certain points of the body that are thought to correspond with specific organs, correct imbalances, and improve functioning. While acupuncture is best known for treating pain, evidence suggests that it may also be effective in decreasing depression at three months, compared to usual care. More high-quality randomized clinical trials are needed to evaluate the clinical benefit and long-term effectiveness of acupuncture in the treatment of depression.

Listening to music can really relax our minds and bodies. In particular, slow, classical music can benefit our physiological functions by lowering blood pressure and decreasing stress hormones. Music also acts as a distraction from stressful situations and can help you express and process your emotions.

Incorporating music into your daily life can have a number of positive effects on mood and mental health, including:

• Elevate your mood and motivation
• Aid relaxation
• Increase the efficiency of your brain processing

Keeping a journal is an opportunity to write down what’s on your mind. Studies have shown that journaling can have a positive impact on both physical and mental health, and can make psychotherapy more effective.

Journaling helps control your symptoms and improve your mood by:

• Helping you organize your thoughts and concerns
• Tracking any symptoms day-to-day so that you can recognize triggers and learn ways to better control them
• Providing an opportunity for positive self-talk
• Providing an opportunity to identify and modify negative thoughts and behaviors

There are 2 key objectives in journaling:

Recapturing the moment

During the course of the day, there isn’t much time “in the moment” for reflection. Spending just a few minutes a day writing in a journal is an opportunity to slow down, look back, and revisit key events of the day. Reflecting on your reactions and how you felt throughout the day in writing can provide useful insights and help you gauge the progress you’re making with your treatment plan.

Learning from the moment

Journaling is a great self-teaching tool. It provides a safe environment for not only looking at what happened during the day, but examining how changing your thoughts or behaviors might have brought about a different outcome. Many people find it useful to spend a few minutes journaling about the lessons of the day and going over alternative ways to react to stress, handle relationships, and recognize and appreciate life’s positive moments.

Here are some tips on keeping a journal:

• Commit to making time to write in your journal on a regular basis rather than making an occasional journal entry. Aim to devote at least 20 minutes a day to your journal.
• Use journaling as a time to destress and unwind. Write in a place that's relaxing and soothing to you. You may consider journaling in the evening when distractions are less likely and you can reflect on the whole day.
• Write whatever feels right to you. There is no need to worry about following a particular format.
• You may find it helpful to share insights you have gained through journaling with your healthcare provider or trusted friends or family.

Self-talk is the internal conversation we have with ourselves as we go through our day. Unfortunately, this dialogue is frequently negative. When our self-talk is optimistic, we are better able to handle everyday stress and manage your depression. Our minds are trained to focus on the negative. This skill involves recognizing negative thoughts that hold you back and actively working to challenge or change your thinking. You can learn to control your thought patterns and increase your positive self-talk by practicing specific strategies that help shift the negative voices and stories that are going on in our minds into positive ones.

Acknowledge your thoughts

Learn to recognize your negative thoughts as they occur and to identify areas of your life that you often think negatively about. Begin by focusing on just one area of your life to approach in a more positive way.

Notice when these thoughts typically occur

This allows you to anticipate and manage negative or untrue thoughts and to notice how your negative thoughts are connected to negative emotions.

Challenge your thoughts

When you identify a negative thought that occurs to you frequently, ask yourself if it’s true. Hit back at exaggerated statements (“Everything I do is wrong”) with facts (“I walked the dog today” or “my boss complimented me on my report”) and positive thoughts about yourself and what you’re thankful for in your life. Ask yourself: What would I tell a friend in this situation? Is there another way to look at this situation? What is the evidence that my thoughts are true? What happened today that was good? Over time, your negative thoughts will lose their power.

Interrupt your thoughts

Use your imagination to help you stop your negative thoughts as soon as you recognize them. Some people visualize a stop light or stop sign, or imagine hearing a buzzer or alarm.

Create a distraction

Take a walk, call a friend, read a magazine, or tackle a chore. This will allow your brain to take a break from negative thinking.

Surround yourself with positive people

Make sure the people in your life are supportive and offer you helpful advice and feedback. Negative people may increase your stress level and make it more difficult to stay positive.

Here are some additional self-help resources from the University of Michigan.

Chan, M. F., Wong, Z. Y., & Thayala, N. V. (2011). The effectiveness of music listening in reducing depressive symptoms in adults: a systematic review. Complementary Therapies in Medicine, 19(6), 332-348.

Chan, Y. Y., Lo, W. Y., Yang, S. N., Chen, Y. H., & Lin, J. G. (2015). The benefit of combined acupuncture and antidepressant medication for depression: a systematic review and meta-analysis. Journal of Affective Disorders, 176, 106-117.

MacPherson, H., Richmond, S., Bland, M., Brealey, S., Gabe, R., Hopton, A., ... & Spackman, E. (2013). Acupuncture and counselling for depression in primary care: a randomised controlled trial. PLoS medicine, 10(9), e1001518.

Ravindran, A. V., Balneaves, L. G., Faulkner, G., Ortiz, A., McIntosh, D., Morehouse, R. L., ... & MacQueen, G. M. (2016). Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: section 5. complementary and alternative medicine treatments. The Canadian Journal of Psychiatry, 61(9), 576-587.