The Cold Chill of Seasonal Depression

When seasonal affective disorder (SAD) —also called seasonal depression—gets you down, your own resilience skills can help. On this episode of Road to Resilience, we hear resilience strategies on how to cope with SAD from Dr. Jelena Kecmanovic, PhD, a practicing clinical psychologist. Dr. Kecmanovic is the founder and director of the Arlington and D.C. Behavior Therapy Institute and an adjunct professor int he Georgetown University Department of Psychology.

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Transcript

[00:00:00] Stephen Calabria: From the Mount Sinai Health System in New York City, this is Road to Resilience, a podcast about facing adversity. I'm Stephen Calabria. On today's show, we welcome Jelena Kesmanovic, PhD, a practicing clinical psychologist. Dr. Kecmanovic is the founder and director of the Arlington and D.C. Behavior Therapy Center.

[00:00:21] Institute and an adjunct professor in the Georgetown University Department of Psychology. In both her clinical practice and her numerous writings, Dr. Kecmanovic discusses at length the roles of resilience and mindfulness in navigating tough times. 

[00:00:34] She's particularly vocal about maintaining resilience through this time of year because seasonal depression has a way of testing our resilience more than we realize. And with October being depression awareness month, we're honored to have Dr. Kecmanovic on the show. 

[00:00:48] Dr. Jelena Kecmanovic, thank you so much for joining our show. 

[00:00:52] Jelena Kecmanovic: Thank you so much for having me on. 

[00:00:53] Stephen Calabria: Could you give us a bit of a background on your work in behavioral therapy, particularly regarding resilience? 

[00:01:00] Jelena Kecmanovic: I started being interested in human condition and psychological functioning very early on. First time I was introduced to those concepts in general, and then in particular, to behavioralism and behavioral therapy was in the eighties. 

[00:01:13] Eventually, you know, in my undergraduate work, and then later in my master's and PhD in clinical psychology, I very much got into this general umbrella term, termed cognitive behavioral therapy or cognitive behavioral therapies, which are the type of psychotherapies, which do have the largest evidence base in terms of their effectiveness and working with all kinds of populations.

[00:01:37] So through that work, one of the things that you can do is, when working with patients, is, figure out what are their natural sources of resilience and emphasize those and strengthen those. And really, you know, as I often talk to a depressed patient, a patient who is prone to very serious depressive episodes, the goal is not to never have you feel depression, never have you feel all these different even symptoms of depression. 

[00:02:06] What we are hoping for is to make you resilient enough so when either external or internal circumstances are such that they lead you to start slipping into sadness, difficulty sleeping, not having much fun doing enjoyable things, that you can kind of catch yourself and instead of going deep down, into the profound, intense depressive episode, you can just have a kind of a shallow dip. And that's really, when you think about it, that's an essence of resilience.

[00:02:38] I think resilience has been somewhat misunderstood in recent years, because of this idea that, we should be able to withstand difficulties and, you know, resilience means that you just kind of, you focus on positivity and positive thinking and positive emotions, and you really don't need to get to the point where you feel negative emotions.

[00:02:57] I think that's very unrealistic. I think that negative emotions are very much part of life and that resilience really doesn't mean not having negative emotions. That resilience doesn't mean reacting to hardships and stressors with just being always positive or staying positive or getting over it quickly or anything like that, it doesn't mean that. 

[00:03:19] What it means is that you can react with negative emotions, human negative emotions with whether it's fear or sadness or anger or disappointment or regret, or, you know what, whatever it might be, and that you can tolerate those and that you can have them sort of come and go as, as they will, because that's what emotions do, and that you will not fall down kind of completely psychologically fall apart, or fall down completely, because those resilience factors are gonna kick in.

[00:03:55] And you're gonna be able to still function in the world even with the negative emotions and thoughts and physical sensations and able to focus on what matters in life. And, and then eventually if you do that again and again, you develop this mindset where you have expectation that it'll be hard and I'll feel crappy, and I'll be okay. And sometimes I'll be even better for it, for having survived the hardships. 

[00:04:24] Stephen Calabria: There's a concept in psychology and the study of mental health known as intolerance of uncertainty, which mental health experts have identified as a risk factor for poor mental health and which seems to be a recurring theme in your work. Could you talk a little bit about that? 

[00:04:39] Jelena Kecmanovic: Absolutely. So it's, it's one of the factors that I think very nicely maps onto a concept of resilience. Just like I mentioned a couple of minutes ago, the this idea of learning to tolerate and be with negative emotions without succumbing to them completely, which is, that's one of the crucial things when it comes to the resilience, ability to also tolerate and kind of go with the uncertainty of life is also a, a big component of resilience.

[00:05:11] Why? Well, you know, uncertainty is of course, very much part of life. Sometimes we lull ourselves into believing that it's not, or, or wanting to believe that it's not. I think in developed countries like America, sometimes we, we organize our lives in such way that, that we plan everything way in advance.

[00:05:35] We have these elaborate calendars. We have phones that we run over to when any kind of ambiguity or uncertainty plagues us. So we, have organized a way of life, minute to minute, day to day, but also kind of globally, we've organized life in, in such way to, to reduce uncertainty, right? 

[00:05:55] To, to increase predictability, which helps people function. However, the problem with that is that muscle that kind of allows us to be flexible enough to withstand some uncertainty, which is gonna come to life anyway, has atrophied a little bit. 

[00:06:11] So you know, there are actually research studies that show that, since especially the phones became ubiquitous since the global penetration of smartphones, generally, people in this country, at least, have become more intolerant of uncertainty. And why is that a problem? 

[00:06:30] Well, because however much we plan the lives, however much we try to eliminate uncertainty from our lives, of course it's still part of life. And as the pandemic very, very much proved, we were thrown into this massive uncertainty in so many ways during the pandemic.

[00:06:48] But even during regular lives, you don't know exactly what life holds and being able to, again, not to be crushed by that uncertainty and anxiety that's showing up because of it. Because, you know, I don't know, I don't know how it's gonna go.

[00:07:05] And if I can't be certain, I can't be settled and then I'm freaking out and then I worry and then I catastrophize, you know, I'm filling in the gaps of not knowing with the most negative scenarios. And so we can really go down this rabbit hole that's not helpful for our mental health. 

[00:07:21] And so, you know, ability to open up to the uncertainty and not knowing, as well as to deep emotions that will naturally arise from those facts of life is, you know, is really important so that we can say, Okay, this is, this is uncomfortable. Humans don't like uncertainty. 

[00:07:39] No wonder I'm reacting this way. Evolutionarily, it makes sense why we aren't comfortable with uncertainty because ancestors who are more risk averse ended up surviving better and promulgating their genes.

[00:07:51] So this is all normal and I can still act in accordance to what I wanna live for, what do I, what I value, what I wanna stand for, even with these uncomfortable sensations, even while facing uncertainty, I can, you know, move in the directions that I have control over, which is basically my behaviors, my actions. 

[00:08:14] Stephen Calabria: Even when we've made a decision, regret can be a powerful force for people. You've written extensively about regret and its relation to mental health challenges like depression and anxiety. What do you advise when treating patients who are overcome with regret over their decisions and even just their circumstances? 

[00:08:36] Jelena Kecmanovic: Regret is, is an interesting emotion. Psychologists describe it as "cognitively laden" emotion. What does that mean? It means that it's emotion, but it comes with a lot of, "if this,if that" thoughts, basically. So, it's emotion that comes as often as a wave. We can be overcome with this sadness, melancholy, guilt, remorse, shame about things we perceive we've done wrongly, or things we haven't done, chances we haven't taken. 

[00:09:07] So it can be really regret over commissions and omissions. What we've done and what we haven't done. But it's connected with this constant spinning in the circles of, "If I only did this, if I only did that." 

[00:09:23] And it's like any emotion. It actually can be very useful if we can just go into the emotion and listen what's it's telling us. If we are very avoidant of all, again, all the uncomfortable feelings and thoughts and sensations that regret brings, then we are gonna go into distraction. 

[00:09:50] We're gonna go to the next video game, next Netflix show, next glass of wine, next whatever the distraction du jour is, right? The next phone distraction. And so, email, social media, whatever it might be. And we do this again and again and again. And what happens when we avoid, we've run away from when we escape these uncomfortable feelings, is that, one, they actually go away only temporarily, and they come back with a vengeance later on.

[00:10:24] So they actually persist longer and they linger. And two, we are robbing ourselves of opportunity to, again, look into what's actually going on. What kind of information can we glean from this? What we can learn about ourselves, about what we value, about how we've lived our lives up to that point so that we can then improve going forward.

[00:10:49] Because regret, again, there's a reason, evolutionarily, why we have that. It's a signal that we feel we haven't aligned our actions with what we deem important. And, you can really look into it. Where is regret showing up and why is it showing up? And how can I learn from it so that I can improve my actions this minute, this hour next year, whatever it might be? 

[00:11:14] Stephen Calabria: You talk about social media use. Social media use has been linked to negative feelings. On the other hand, you've pointed out that people can often crave browsing their social media when they're confronted with a difficult situation. What explains that dichotomy? 

[00:11:29] Jelena Kecmanovic: So, the, what explains the dichotomy -- and, and it's not just dichotomy. I mean, we can have all kinds of, actually, reactions to social media usage. It is the function of usage. 

[00:11:42] What are we using this social media for? And, if we check in with ourselves prior to actually going on that app on your phone or opening up a, a browser or app on your computer and just literally just ask yourself very, very quickly, why? Why now?

[00:12:03] You know, what am I hoping to accomplish? What, what, what is the function of me doing that? Is it going on Facebook to connect with my social circle, whatever it might be. Whether it's my professional circle or my family, or my family that lives all over the world. 

[00:12:16] I mean, there's some very potentially positive aspects, and they are, of social media, like people staying connected, especially in a mobile society, or people living all over the world, for example, or connecting with professional circles and so forth.

[00:12:29] It can also be a place where if you feeling badly and you express it, you get support from kind, compassion individuals that you're connected with. So that's the potential upside. 

[00:12:43] However, both research, pretty extensive research and, I think, our experience, shows us that --and I see this with a lot of my patients, too-- shows us that more often than not, we end up going to social media and sort of falling down these rabbit holes very mindlessly. Not deliberately, not intentionally, but mindlessly to run away from boredom, distress, insomnia, a difficult project we are facing. 

[00:13:12] Whatever is the uncomfortable situation or feeling at the time, we just run away from it and then end up often using it in a way that's very unproductive, which is passive usage, meaning you're not posting anything, you're not interacting actively with people who you're connected with, but you're just kind of, you know, going down, down that you know, slippery slope, right?

[00:13:36] That next posting, next posting, next posting, next posting, and people lose track of time. And when we ask them before and after using Facebook, for example, or Twitter, overwhelmingly, actually, people are in worse moods, they feel worse after having used it. And again, especially if it's passive, especially if it was mindless, especially if they lost track of time.

[00:13:58] So, like anything else in life, the social media, not unlike anything else, any product of humans, I guess of human civilization, social media is not in itself bad or good. It's, it's how we engage with it, how we use it. 

[00:14:11] Stephen Calabria: You discussed recently how autumn is a time for building mindfulness and resilience. Walk us through, if you would, some of the research around seasonal depression and why autumn in particular seems associated with greater risks of mental illness. 

[00:14:29] Jelena Kecmanovic: Well, in terms of seasonal changes in mood, they're very well documented for, actually, generally, for people. People, generally speaking, feel slightly sad or slightly more melancholy during cold winter months and it seems to mostly be related with less exposure to daylight and to sunlight. So, it's not that the temperature, it's, how long our days are. 

[00:14:52] And so, in more extreme cases, we have a situation with, it's called SAD- Seasonal Affective Disorder, which is a type of mood disorder, type of depressive disorder, that shows up either exclusively or mostly during the winter months. 

[00:15:06] And not surprisingly, the incidence of these kinds of problems is higher in countries that are colder, that are in, in northern hemisphere, that are very north, so in Scandinavian countries, in Canada, and so forth.

[00:15:18] And part of the treatment, actually, is exposure to artificial light that, that mimics natural light. So, so they are biological reasons. They're very much biological reasons why this happens. 

[00:15:30] And I believe there are also psychological and social reasons why we are prone more to negative emotions as the, as the fall leaves start to fall as we are confronted with death, really, with mortality in nature, when the, you know, the exuberance and the life of the summer is dwindling. 

[00:15:53] I think we are confronted with not just being sad, but with, you know, in the end of the day, with our own mortality because we are part of nature and so that can absolutely bring up those hard feelings.

[00:16:05] Stephen Calabria: You've advocated for leaning into the uncertainty of autumn because of its opportunities for growth amid the change. What might that look like? 

[00:16:16] Jelena Kecmanovic: I generally, I would say, you know, whether it comes to autumn, which is, it's a great reminder of the finitude of life. It's also a great reminder of change being the only constant in life. It's also a reminder of uncertainty of life. 

[00:16:33] I think fall is an opportunity for us to practice facing life's givens in a courageous, in a brave way where we don't run away from it, where we don't have to hide from it or, even delude ourselves into believing that somehow we've overcome these, you know, existential givens, because we haven't. 

[00:16:58] You know, existential givens are existential givens because we all have to deal with those. We all have to, in the end, deal with the fact of us and everything else in the nature dying, at the most extreme side of things. We also have to deal with the unpredictability and uncertainty and groundlessness of life. And we have to deal with negative emotions being part of life and sickness and illness --of body and soul and mind-- being part of life. 

[00:17:27] And those are givens and, and it's really not in trying to prevail over them. And sometimes I think our western society, our culture, leads us to believe there's a next cure, miracle cure, next fad that's gonna cure you from this and that. 

[00:17:48] Well, you know, when it comes to this, you know, underlying existential givens, all we can do is really bravely, courageously, face them and instead of crumbling under their weight, on contrary, finding almost inspiration, that in spite of them or actually maybe because of them, we have to focus on what we can control in our lives, which are, of course, our choices, and behaving according to our choices, which hopefully we can align with what matters.

[00:18:23] And in the end of the day, we are creators of our own lives, as existentialist philosophers have taught us for a hundred years at this point. As Sartre said, we are choices. 

[00:18:33] So, you know, coming back to, this is something that I can control and by controlling my choices, and making wise choices that align with my values, and by, you know, coming back again and again and again to, how I can live my life literally this second, this next minute, this next hour that aligns with who I wanna be, a compassionate, kind person, a supportive mother, wife, daughter, a creative person, person who does something good for the humanity, whatever it might be, you know, focusing on that, which is what matters and what we can control.

[00:19:16] And by doing that, we not only provide meaning to our lives and recreate meaning for ourselves, but I think we realize, that allows us to bravely then face the givens and, given that we are facing the uncertainty and death and so forth, it almost can light a fire under our belly and say, Well, you know, we never know how long we have.

[00:19:38] We never know what external circumstances are gonna come upon us. So we better, in a way, seize the day. Carpe diem. I better orient myself toward myself, toward the others and toward the world in the way that I believe is gonna express my values. Because, guess what? I never know. None of us know how long we have. And in the end of the day, this is the only reality we have. 

[00:20:03] Stephen Calabria: It sounds like resilience through autumn is difficult enough when you're an adult and have some measure of control over your circumstances. Would you say that resilience at this point is also especially difficult for children and young adults?

[00:20:19] Jelena Kecmanovic: It is, and epidemiological studies support a really, really difficult situation currently in our country in terms of mental health problems of children and teens. Through this pandemic and now in the sort of aftermath of it, young people have suffered the most. Their mental health has deteriorated the most. 

[00:20:43] Many possible reasons why that's the case, but we know that that's the case and we see it again. Research shows us, you know, and my experience at leading a group practice in Washington, DC area has showed us that very clearly. 

[00:20:56] We get to now many more requests for help for therapy from younger people, from parents of teenagers and tweens and kids. And so, the parents have a big role in orienting kids to life in the way that builds and strengthens their resilience. 

[00:21:15] And I think the decades, now, are very, you know, decades of stubborn epidemic of what's been termed over-parenting, helicopter parenting, snowplow parenting. I've heard all kinds of terms for this. 

[00:21:32] We've been talking about it now for a couple decades and it's stubbornly persisting, and I think it's persisting because, at the kind of surface level, it really seems to parents that, you know, I'm doing my best, I'm doing my best to protect my kid from all possible hardships, from interpersonal strife, from their own negative emotions, from uncomfortable situations, from uncertainty.

[00:21:54] And, by sort of trying to rescuing them from that, we have developed this belief that we are doing great by them. And yet while in, in the moment we are helping them out, we are really setting them up for less resilience and more problems in the future.

[00:22:11] Because kids have to have space. They have to have space to learn how to deal with difficult situations, with difficult problems, whether it's academic, whether it's scrapes and injuries, whether it's interpersonal problems, whether it's disappointment, whether it's anxiety about something they're trying they haven't tried before, and they're trying for the first time. 

[00:22:36] Giving them, basically, space, opening up a space for them to experiment, to learn through trial and error what works in life, what works for them, and also that, you know, having them experience that they can feel bad and that's okay. It's okay to not feel okay, right? And I will get through this and be fine, you know, even with all my negative emotions, and I'll come on the other side.

[00:23:05] And not only that, I would've learned something from it. That's, I think, you know, such an important message. And again, it's really interesting how long we've been talking about deleterious effects of this overprotective parenting style. And yet it's stubbornly continuing and, and it's not surprising, I think to some extent, because parents are overwhelmed. 

[00:23:26] Parents are stressed out in dealing with the modern world and all the demands of the modern world and the heightened competitiveness and heightened perfectionism and the sped-up nature of the modern, modern world and modernity and all these demands that they're trying to juggle with their kids.

[00:23:44] And they, almost out of, maybe their own stress and out of this misguided attempt to protect kids from the bad stuff, end up really handicapping them in a way and not allowing for their own resilience, kids' resilience, to develop. 

[00:24:01] And then what happens? They come to high school, the kids, you know, grow up in high school, especially in college, when they go away from home, if they go away from home, their depressive, anxious symptoms end up skyrocketing.

[00:24:14] We have another whole epidemic of student mental health. Ask anybody who's working in a counseling center in this country, and they're flooded. They're absolutely flooded with kids just now out of the nest and not knowing how to deal with the world or their own negative emotions.

[00:24:30] Stephen Calabria: Looking at the mental health crises faced by children and young adults today, which subpopulations would you say are at the greatest risk, and what are even the risk factors involved? 

[00:24:44] Jelena Kecmanovic: it's unclear whether kids or teens are more at risk. I mean, they're definitely, they have the highest rates.

[00:24:50] if you look at the whole population, the kids and teens that are faring the worst, some studies suggest that tween girls are doing particularly, unfortunately, particularly badly, and it's again, a confluence of factors. It's partly, you know, what happens biologically to girls as they go through puberty and the puberty has been pushed in a population earlier.

[00:25:12] And so it's a conflict of sort biological vulnerabilities that show up as girls go through puberty and societal changes, like invention of social media that, you know, almost kind of, it's almost, that is a stress model, right? That's, that's a model that's used in medicine very often, right? When, when certain vulnerability, you know, unfortunately, in a bad way clicks with a particular societal stressor.

[00:25:36] Stephen Calabria: And if the seasonal doldrums of autumn weren't enough, you've also written about how winter and the holiday season can exacerbate loneliness. What are some of the mental health-related problems you've observed around the holidays in your patients and just in your research?

[00:25:53] Jelena Kecmanovic: Well, this is a hard time of the year. As, as I mentioned, you know, all these things are happening in the fall as days are getting colder and shorter. And then we face in America this, punch of a couple of holidays, one after another. 

[00:26:08] Thanksgiving and, Hannukah and Christmas and New Year's. And these situations can be particularly hard for people who don't fit neatly into this category of, I have a very close supportive family that I can go to and I celebrate with them and we all gather and we have great time and maybe rekindle our relationships because we haven't seen each other for a while and support each other and almost find more strength to go on.

[00:26:41] So the holidays can be, working with my patients, many of my patients, and observing just humanity in general, I think people are sometimes surprised to hear that holidays can be really hard for a lot of people. And again, as I said, if you don't fall very neatly into, you know, I think, a pretty small category of people who have very close family relationships. 

[00:27:04] They love getting together with extended families. They don't put too much pressure on themselves in terms of how holidays need to look like. They can just kind of go with the flow, focus on the joy and meaning of, of these seasons, not be too materialistic, caught up in materialism of Christmas in particular.

[00:27:21] And, the beliefs tend to coincide with mainstream beliefs. Those, those folks can, I think, get a lot out of holidays, right? That they can, they can get closeness and support and joy and meaning.

[00:27:35] However, for lot of people, that's not the case, because maybe they're extremely lonely. Maybe they don't have a big family. Maybe they're not in touch with their family. Maybe they have very contentious relationships with a lot of family members. Maybe they haven't seen them in such a long time, so then when they get together, you know, it's, it's really not easy, but all kinds of family dysfunction shows up during holiday time.

[00:27:57] There are people who feel that they have to put on this big show in terms of, let's say they're hosting holiday gatherings and they just put such humongous pressure on themselves, on how this needs to look like, how I need to be, how things need to be, you know, a lot of shoulds and a lot of shoulds, which are never psychologically helpful.

[00:28:18] They get caught up also in a lot of, you know, materialistic, unhelpful thoughts. Like, you know, you, you have to have the things look this way, presents need to be this way, and so forth. And all of those things really are, are just far from what all of this really were made to be about, which were made to be about connection and joy and purpose and meaning.

[00:28:40] And I think we've, especially maybe in this country, we've really gotten away from it, you know, and it's a lot of show, it's a lot of Hallmark- kind of presentations of holidays that a lot of people watch and really don't find themselves in that. 

[00:28:56] And then also, the diversity in this country has increased dramatically and people who, for example, don't celebrate Christmas, or don't celebrate Christmas or Hannukah might feel that they're really not included in all of this holidays, so that can exacerbate feeling of not belonging and loneliness and so forth. 

[00:29:11] So it's, for many reasons people can feel very, very much as outsiders, as not participating in this American obsession, of sorts, with holidays and that leaves them feeling more sad, more disappointed, feeling more lonely. 

[00:29:31] Stephen Calabria: Finally, as far as your own resilience journey goes and your resilience research, what is it that you think it's most important for our listeners to know? 

[00:29:41] Jelena Kecmanovic: So, that's a big question, but if I were to distill it, in a couple of sentences, I think I would say that being really honest with ourselves and approaching life as it comes in a very open way, without succumbing to illusions. And, realizing and accepting that life is gonna bring hardships sooner later, and the hardships are gonna affect us and our loved ones. And that resilience does not mean not having hardships, not facing hardships.

[00:30:20] It does not mean always thinking positively, or feeling good, or feeling great, for that matter. What it means is, facing those hardships, and all the other challenges in life, head-on, you know, looking them face to face in a way and allowing your mind and body to react with negative emotions, as they will, to these kinds of hard situations. 

[00:30:47] And not avoiding those, not fighting those, not escaping those negative and uncomfortable thoughts, feelings, and physical sensations. Allowing them to show up and learning what you can from them and allowing them to pass. And they'll come again and they'll pass. 

[00:31:04] And trusting that you can go through this while being anchored with behaving, this is the only thing we can control, behaving consistently with what you value, what you wanna stand for in this life, and how you wanna orient toward yourself and others in this life. 

[00:31:23] So, coming back to that again and again, and trusting that, this too shall pass, the negative emotions will pass, the crisis will pass and you'll get to the other hand and you'll be able to withstand it and sometimes even grow from it. 

[00:31:37] I think that's the, the essence of resilience. It's like the metaphor that, that I, you know, say that the resilience is when they build resilient high-rises these days, especially in, um, in hurricane, let's say, prone areas, they don't build them to withstand wind without moving at all. That's impossible, right? They build them so they can flexibly actually move. 

[00:32:00] So if you're on a 15th floor, it can be kind of scary because if there's an earthquake or there's a hurricane or even a strong wind, it's going to move and it's not going to crumble. Right? It's not going to fall apart. It's going to move and it's going to be scary if you're on a 15th floor and the building will withstand the wind and it'll be still standing after the hurricane passes, after the storm passes.

[00:32:23] Stephen Calabria: Dr. Jelena Kecmanovic, thank you so much for your time. 

[00:32:27] Jelena Kecmanovic: Thank you so much for having me today. 

[00:32:29] Stephen Calabria: Dr. Jelena Kecmanovic is a practicing clinical psychologist, the founder and director of the Arlington and D.C. Behavior Therapy Institute and an adjunct professor in the Georgetown University Department of Psychology.

[00:32:41] That's all for this episode of Road to Resilience. If you enjoyed it, please rate, review, and subscribe to our podcast on your favorite podcast platform. Road to Resilience is a production of the Mount Sinai Health System. It's produced by me, Stephen Calabria, and our executive producer, Lucia Lee. From all of us here at Mount Sinai, thanks for listening, and we'll catch you next time.