Sad, Empty, Alone...
Sad, empty, alone, low, miserable, overwhelmed, cold, tired, worthless, hurt, insignificant — these are just a few of the words used to describe the “black cloud” that affects people experiencing depression. When teens or young adults arrive at Evoke, they usually have little insight into the symptoms that affect them. As we dig deeper with family members, a more far-reaching list of symptoms usually includes: isolation, loss of interest in school or hobbies, loss of friends, inattention, impulsivity, threats or attempts of suicide, personal dissatisfaction, empty feelings, little connection to or awareness of self, and feelings of anxiety and shame. Parents report, “He gets home from school, goes to his room, shuts the door and never comes out,” and “She used to love playing sports, she was always out with friends, and now she spends afternoons and weekends sleeping”. They talk about weight gain or loss — “She never eats, and when she does it’s only junk food”. They talk about fights that quickly escalate — “When he is around, we are constantly yelling at each other”. They express worry, frustration, disconnection, and confusion.
Many people can get stuck in a cycle of behaviors, thoughts, and emotions that negatively affect their daily lives and the lives of those around them. It is exactly this cycle that we, as clinicians and staff, hope to explore, create understanding around, challenge, and shift with a whole-health approach to healing and wellness.
The cycle of depression can begin anywhere, but one thing is always certain: it will usually affect every dimension of life. This multidimensional symptomology may render the traditional approaches of medication and talk therapy inadequate for successful treatment.
This is where the approach of a wilderness program transcends traditional treatment. Primitive living in a community setting becomes about understanding and supporting the whole person, in the context of self and others. Mirroring the dynamics seen in the home setting, along with the removal of distractions, escapes, and unhealthy relationship patterns, the individual’s emotional, physical, mental, and spiritual life can be given the space to be understood and experienced in a new context, challenged, embraced, and transformed, into a more effective and healthy lifestyle.
Discussions around the difficulty of hiking, sleeping on the ground and eating meals “I would never eat at home” usually make their way into the initial session with their therapist. As the client comes to acclimate to the new setting, however, these changes serve the purpose of facilitating a decrease in their depressive mood. Endorphins released during physical activities such as hiking and “Mandatory Fun Time” serve to improve mood and reduce feelings of pain in the body associated with depression. Eating a balanced, nutritional diet serves to decrease fatigue and feelings of irritability, as well as prepare the body for increased physical activity. Healthier sleep-wake cycles improve emotional health, cognitive functioning, and support increased physical activity. Many clients report feeling a decrease in depressed emotions, as well as feelings of positive self-worth for completing challenging hikes.
Cognitive interventions for depression in the wilderness are facilitated through a number of activities, and are processed in group therapy throughout each day, as well as individual therapy weekly. Completing assignments on thinking patterns related to the here-and-now process of completing chores, working on hard skills, interacting with others, as well as an exploration of past events and patterns of thinking, give each client a chance to recognize any negative thought processes and mistaken beliefs they may hold. Many times, clients experiencing isolation due to depression have created thinking patterns that have become very distorted due to the fact that they have had no outside perspective on these thoughts. “I am stupid,” “No one likes me,” “I am a failure,” “I’ll never be good enough,” are some of the negative thought patterns clients have been operating from for months or years. When clients create a narrative based solely on these negative thoughts, their beliefs about themselves and the world around them tend to get skewed, and slowly but surely, their perceptions of others become very distorted as well. Over time, these “stories” about the self and others become “truths”. Cognitive behavioral therapy can create a more positive self-talk loop. We use affirmations, journaling, and other activities to create awareness and challenge negative talk. Within the group context, peers and staff are able to challenge these distorted patterns of thinking, as well as normalize the tendency to operate from this new perspective. The result is that the individual feels understood and supported.
Emotions associated with depression are typically what people seek relief from. It is exactly these attempts for “relief” and efforts to change or “fix” the emotions that lead the individual further into a depressive episode. Creating a setting in which self-destructive and self-defeating feelings, and other emotions related to depression can be explored and shared is in and of itself a healing power. Clients are taught assertive communication techniques, and as the individual comes to experience these emotions and share them, they typically experience relief. They begin to understand that emotions are more transient than they once believed, that undesirable emotions serve a purpose, that “bad” or “negative” emotions can be managed and do not need to be “fixed” or “bandaged” with the use of drugs, alcohol, self-harm, or other quick escapes. They begin to navigate through these undesirable emotions more effectively. Mindfulness practices utilized at Evoke reinforce this relationship to emotions—one can observe emotions related to depression without trying to change or fix them. Creating meditation practices of compassion and gratitude generates a deeper, healthier relationship with the self, and allows for more positive emotions. Practicing yoga strengthens vagal tone, which in turn increases stress resilience (by decreasing levels of cortisol in the body) and increasing levels of oxytocin, a hormone that plays a part in bonding.
Spiritual growth and connection come in many forms through wilderness therapy. Isolation, avoidance, ruminating in the past, feelings of shame and worthlessness, and anxiety over the future are all hallmarks of depression, which can cause an individual to become disconnected with the world around them, their loved ones, and themselves. The wilderness experience brings the individual out of isolation into a group setting, and into the natural, physical world around them, and creates the context for self-exploration through logistical and emotional work. The connection to self is deepened through feelings of self-efficacy, self-reliance, self-esteem, and a realization that the individual is part of a “whole”. Connection to others is fostered in the context of the group, as they form an emotionally safe place to understand and support one another through exploration, change, and growth.
The inherent challenges posed by primitive living foster a connection to the natural world and increased need for assertive communication within the group context. Physical health is attended to through increased activity, stable sleep-wake cycles, and healthier eating habits that positively affects their mood. Through attending to the physical, mental, emotional, and spiritual dimensions of each individual, we hope to create understanding, challenge old patterns of beliefs and behaviors, and foster change and growth in holistic, meaningful, and lasting ways.