Nonpharmacological Antianxiety and Antidepressant Strategies

1. An “effort-payoff connection” – finding external circumstances, and cultivating your own skills, so that your effort gets you something you want. Having challenges that are neither too hard nor too easy, at the “right place on the hierarchy of difficulty,” is important for this.

2. Choosing goals, especially “worthy” goals, and keeping track of your progress toward meeting those goals. (Succeeding in school, helping your family members with the family work load, creating good relationships, are examples of “worthy” goals. Getting a certain number of kills in a shooter game is not a particularly “worthy” goal.) Writing goals down, making plans for how to achieve them, checking progress regularly, being accountable to someone, being driven by a vision of what you want in the future, "keeping your eyes on the prize."

3. Cultivating and maintaining positive relationships (giving and receiving kindness, having fun together, resolving disagreements calmly)

4. Skill in choosing self-talk (see 12 thought classification). Do the “12 thought exercise” and the “4 thought exercise.” Choosing self-talk is central to cognitive therapy.

5. Celebrating your positive examples of thought, emotion, behavior. (See list of 16 skills – it helps to identify the skills that the positive behaviors are examples of.)

6. Relaxation/meditation practice, with or without biofeedback. (see handout for 10 different techniques). Technique #1 is to relax a group of muscles each time you breathe out. Another technique is the “Kindness to self and others” meditation.

7. Exercise (Can be done without equipment and without going to a gym! Google “bodyweight exercise.”)

8. Turmeric (in the region of a couple of g a day)

9. Omega-3 fatty acids (in fish oil or oil from algae) (in the region of a couple of g/day)

10. Bright light in the morning (10,000 lux for >15 min)

11. Regular sleep schedule, with enough sleep (Exercise is the best sleep-promoting agent)

12. Avoiding Tetrahydrocannabinol (THC, weed) ethanol (alcohol, booze), nicotine, opioids, and generally avoiding drugs meant for short term pleasure (Problem: the pleasure centers get numbed to the pleasures that come from positive life events)

13. Reading about psychological skills (includes “inspirational” and “instructive” and “models” and others)

14. A healthy diet, with limits on sweets, refined starches, fried food, processed meats, and sugary drinks, and more fruits and vegetables

15. The “middle path,” or “middle way,” or balance, between too much work and too little work, too much goofing off and not enough, too much wish for achievement and not enough, too much self-denial and not enough self-discipline. (Play-oholism seems to be more common than work-oholism.)

16. Figuring out which activities give you the most feeling of accomplishment and fun, and putting these activities into your schedule and doing them, even if at the time you feel like doing “nothing.” This has been called “behavioral activation.”

17. The desensitization strategy: You list situations that give you unwanted fear or aversion; rate how unpleasant each is (the SUD level); start with the least difficult and work your way up; imagine being in the situation and handling it as you would like; relaxation techniques are an option while doing exposures; keep practicing “exposure” and desirable response until the fear or aversion falls; also when possible get into the situation in real life and practice handling it there, moving along a “hierarchy of difficulty” with the real-life situations as well.

18. For people who have traumatic experiences in their past, writing out or letting someone help you write out a narrative of what happened to you. This may be thought of as a variant of the desensitization strategy – you are practicing “exposure” to the scary memories each time you work on making this, or read it once it’s written.

19. For people who have ever had a panic attack with hyperventilation involved: anti-hyperventilation training includes learning about the physiology of hyperventilation; learning to recognize the “too low carbon dioxide” state; learning to slow your breathing in response. Doing 3 breathing exercises enough times, including the “5 seconds in and 5 seconds out” exercise.

20. Fantasy rehearsal: Practice, in imagination, doing the thoughts, emotions, and behaviors that you would like to be able to do in the important situations you are likely to encounter.

21. Use good decisions to figure out how to make yourself and others happy. Think of SOIL ADDLE for good decisions. Situation: Be aware of and try to understand the situation you're in. Objectives: What are your goals, what are you trying to make the outcomes be? Information: Get information that will help you decide. List options. Advantages and Disadvantages of the options. Decide what to do. Do it. Learn from the Experience, to help in the next decision.

22. Use good joint decisions to work things out with conflicts or other decisions that affect more than one person. Think of Dr. L.W. Aap for good joint decisions. Defining: Each person defines the problem, without accusing, blaming, or commanding the other person. Reflecting: Each person says back the other person's point of view, so they can make sure they understood it right. Listing: They list options for solving the problem. Waiting: They wait until they are finished listing before evaluating the options. Advantages: They talk about the advantages and disadvantages of the options, the positive and negative consequences they predict, and they don't talk about the badness of the other person. Agreement: They agree on something, even if only to think about it more and try later on. Politeness: They don't insult, interrupt, or yell.

Nonpharmacological Antianxiety and Antidepressant Strategies: Abbreviated List

1. Effort-payoff connection

2. Worthy goals

3. Positive relationships

4. Choosing self-talk

5. Celebrate your positive examples

6. Relaxation/meditation/biofeedback

7. Exercise

8. Turmeric

9. Omega-3 fatty acids

10. Bright light

11. Regular sleep, enough sleep

12. Avoiding “recreational” drugs

13. Reading about psychological skills

14. A healthy diet

15. The “middle path”

16. Behavioral activation

17. The desensitization strategy

18. Trauma narrative written

19. Anti-hyperventilation training

20. Fantasy rehearsal

21. Good decisions; SOIL ADDLE.

22. Good joint decisions: Dr. L.W. Aap.