ADHD and Autistic Depression
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Today, I’m diving into all things Neurodivergent depression (to access the Depression workbook here). I’ll be looking at some of the behavioral, physical, and cognitive aspects of depression and providing links to several resources. However, before I get there, I want to explain the depressive cycle, sometimes referred to as the lethargy cycle, to explain how depression quickly becomes self-perpetuated. Understanding this cycle is key to understanding what perpetuates depression and what actions and practices can be taken to help a person reverse the cycle.
Depressive Cycle Unpacked
The cycle of depression is self-perpetuating. For many reasons, a person’s mood may be low (perhaps impacted by the seasonal affective disorder, neurotransmitters imbalances, environmental stressors, or more). Once a person’s mood is low, the depressive cycle is up and running. It goes something like this:
Mood—>Thoughts: Once mood is low, it is common for more negative thoughts to take center stage. These thoughts tend to be overly negative both about the self and the world. This causes the future to seem bleak. And at the same time, we are simultaneously underestimating our ability to cope with the future.
Mood/Thoughts—>Behaviors: A key aspect of depression is a loss of a sense of pleasure. Activities that once brought a sense of pleasure no longer do. This paired with the more negative thoughts we have, means we’re more likely to withdraw. We begin to spend less time engaging in the activities and relationships that once brought us joy and helped lift our mood (movement, meaning, connection). As the depression sets in, we typically begin to disengage from activities that provide meaning, connection, pleasure, and a sense of accomplishment. This sets us up to become more depressed and to have more negative views of ourselves. This then influences our mood, and the cycle is off and running again, deepening with each spin around the depressive orbit.
Resource: This 1 page PDF, developed by clinical psychologists, provides a great view of the depressive cycle and discusses methods of reversing the cycle.
Reversing the Cycle
While the lethargy cycle creates a self-perpetuating depressive cycle, on the flip side, this also gives us information about where we can reach and reverse the cycle. At any one point in this cycle, we can reach in and get the cycle moving in the opposite direction—toward health, healing, meaning, and revitalization. The key part of this step is to identify where we can create an agency to interrupt and create a new cycle toward healing in this cycle.
Generally, there are three main areas where we can take targeted steps to intervene:
Mood: Anti-depressant (SSRI), and exercise. Both have been demonstrated to improve mood and work on a neurochemical/neurotransmitter level to disrupt the cycle.
Thoughts: Through mindfulness and CBT strategies, a person can interrupt the negative thought-loop cycle. I also like to use a social constructivist lens here (to understand the thoughts from within the larger social-cultural context). For example, for a person with multiple marginalized identities addressing internalized ableism, and becoming critical of cultural scripts that perpetuate racism, sexism, ableism, etc. can be a powerful way of breaking the hold of some of these negative thoughts. When working with neurodivergent people, the clinician must situate negative thoughts within the context of neurodivergence. I find the social model of disability helpful here. lacing negative thought patterns within the larger context of social disability helps address internalized ableism and shame.
Behavior: Behavioral activation is another powerful way of reversing the cycle of depression. “Behavioral activation” essentially involves scheduling activities that bring connection, pleasure, meaning, or a sense of accomplishment into your daily rhythm. Behavioral activation should be adapted for the neurodivergent client-- consideration of burnout, sensory load, and special interests is ideally considered and incorporated into behavioral activation (see below for ideas on how to do this). To learn more about behavioral activation, you can see this one-page PDF.
Breaking the Cycle-Addressing “Depressed Mind”
Depression has a stark influence on our thought life. Here are some ways "depressed mind" keeps us feeling down (and some practices you can use to reduce their impact).
Negative views of self and others and cognitive distortions
Depressed mind tends to have overly negative views of self, the world, and our future. These thoughts are often magnified and perpetuated by cognitive distortions. We all have cognitive distortions. You can think of these as filters that your mind puts on. They are called distortions (or "thinking errors") because these filters tend to distort reality. Here is a list of some of the most common ones. Cognitive distortions tend to keep us feeling inadequate and down. When depressed mind is in the pictures, many of these distortions exaggerate the negative. While some therapies (CBT) focus on identifying "false beliefs" and changing them to more accurate thoughts, I find this is not always as helpful for the neurodivergent person (for some, it is, but for others, it can reinforce negative cycles). So, while it is not always helpful to try to change our thoughts, increasing our awareness of the filters we currently have can be helpful.
How to work with this: Review the list of thinking errors and identify your mind's most common distortions to increase awareness of the various "tricks" your mind plays on you. I also find that putting our thoughts through a reality filter is helpful for some people. However, when a person has multiple marginalized identities who experiences oppression, racism, ableism, and more, I find that the reality filter can be dismissive. Therefore, as a clinician, I use caution when using the "reality filter" for thoughts. The world is unsafe for many people with marginalized identities, and people are critical of them. Trying to reality test out of the belief can be dismissive and increase the negative thought loop. So, while I appreciate this technique, I use it cautiously and incorporate social constructivist views (understanding the thoughts in the context of social-cultural messages that have become internalized).
Cognitive Fusion: Depressed Mind gets fused more easily
Cognitive fusion is a fancy way of saying that when we're depressed or anxious, we more easily get fused and entangled with the thoughts we're having. For example, when depressed, I may have the thought, "I am so inadequate" or "I am worthless." When depressed, this thought becomes reality-it becomes fact. When fused, I now see every interaction and experience through this lens of worthlessness (which means, thank you confirmation bias, that I am also unconsciously scanning my environment for evidence that supports this belief. So depressed minds both have more negative beliefs and are more vulnerable to getting completely entangled with them and experiencing them as facts. This equation is what can turn depression so dark so quickly.
How to work with this: One of the coping strategies for this is to use strategies that help us unhook from these thoughts. It doesn't make the thoughts go away but rather creates enough distance that you're able to see it for what it is—a thought your mind is throwing at you. When you defuse from a thought, you gain some space from the thought and recognize this it is simply that-a thought-not a fact, not reality; it's a thought. And this is what minds do-they create thoughts and try to convince you to "buy them" (get hooked on them). Defusion techniques help a person separate from the experience so they can see the moment for what it is--a moment where their mind is giving them particularly painful thoughts.
To unhook from the thought, you may say something like, "I am noticing I am having the thought I am worthless." Or my personal favorite is to practice naming scripts. For example, when I am down, my mind starts down a whole spiral of thoughts that cluster around the ways I fail my children. When my mind starts down that path, I may say something like, "The Bad Mom" Script is playing right now. The "I am Incompetent" Script is another favorite of my mind's to play. To learn more about cognitive fusion and different defusion strategies, see Dr. Gabriela Sadurní Rodríguez post (includes videos!).
Recalling Negative Memories
When people are depressed, this influences their memory and ability to recall positive memories. There is something called mood-congruent recall, which speaks to the fact that the brain more easily recalls information and memories that are consistent or congruent with their current mood. When a person is in an upbeat mood, their mind more easily recalls positive memories. When the mind is depressed, it more easily recalls sad memories. Depressed people often have a dominant-negative recall.
How to work with this: One intervention to counteract this is an activity known as gratitude journaling. With gratitude journaling, a person intentionally spends 5-15 minutes at the end of the day reflecting on things they are grateful for. This has been shown to improve symptoms of depression, improve sleep and reduce sickness. It can be as simple as listing three bullet points or a more involved process. To access a free gratitude journal, see this pdf. If you want a more robust approach to gratitude, consider checking out Even Happier: A Gratitude Journal for Joy and Lasting Fulfilment, or for the more visual-oriented processor, consider checking out Happy Journal, Happy Life.
Rumination
Depressed mind tends to ruminate, and it tends to get stuck in a spiral. The image that comes to my mind is of a knotted-up spool of yarn. It can be challenging to unwind from these thought spirals. Again, it's a self-perpetuating cycle.
How to work with this:
Mindfulness and Defusion techniques (naming the scripts as mentioned above)
Processing. Processing helps it shift from a spiral to a more flowing/linear thought process. Processing can be internal (alone) through journaling (remember journaling can include visual journaling!), writing, or drawing brain maps of your thoughts. For external processors speaking with a friend or family member, therapist or others can be helpful. Several apps do text listening. For example, 7 cups is a free app that will connect you to a peer listener, and you can connect over text.
Distraction: Intentionally choosing to distract your mind from the rumination through engaging in vigorous exercise, watching a movie, playing a video game can all be ways of distracting your mind from the rumination pattern.
Executive Functioning Difficulties
Depression influences the brain's ability to remember things, concentrate and focus. This can make daily tasks like remembering doctor appointments (remembering to take medications!) and completing tasks for school and work much more difficult. For the neurodivergent person who already struggles with executive functioning, depression amplifies those challenges! Using, even more, executive functioning supports through outsourcing executive functioning tasks (through the use of alarms, schedules, post-its, and more) can be helpful. Here are some things to help support strained executive functioning:
How to work with this: Outsource your Executive Functioning. The more you can outsource your executive functioning, the less your brain must keep in mind. Executive outsourcing involves developing external structures that hold things in mind for you. This can look like having a solid calendar system, post-its, a notebook you write things down in, setting up alarms on your phone, and so forth. It can be tedious to set up but save you buckets of energy and stress in the long-term (consider working with a coach to help set this up). Some frequent ways to outsource executive functioning:
Make frequent use of:
◦ Whiteboards and color post-its
◦ Lists
◦ Phone alerts/reminders (via calendar function)
◦ Notes to self (shower notes are especially a lifesaver)
◦ Rituals
◦ Automation
*To check out some of my favorite executive functioning aids, go here.
Where to go from here-Coping Strategies
That was a lot of information. While it can be tempting to try to incorporate many strategies at once, it’s generally recommended to incorporate one at a time until you have mastered it. So first, I'd recommend going through the list and noticing what struck you the most? Which of these depressed mind tactics resonated the most? I would focus on that first and then return to this list as it is helpful.
Behavioral and Physical Experiences of Depression
Depression doesn't just influence our emotions and thoughts; it also influences our bodies and behaviors. Many people socially withdraw and experience changes to their sleep, appetite, and energy levels. Depression is physical—it is a full-body experience. The physical elements of depression make it even more challenging to engage in activities that lift our mood and spirit.
Behavioral activation is one way of reaching in and shifting the lethargy cycle and reversing it to move in a positive direction. To learn more about behavioral activation, see this 1 page pdf developed by clinical psychologists, or download this entire module on behavioral activation. Many activities help to energize a person and shift them away from the lethargy cycle. It can be helpful to focus on activities that bring:
A sense of accomplishment
A sense of pleasure
A sense of connection
A vast list of activities can be included within "behavioral activation". See this Activity List worksheet for a list of activities.
When making a list of possible behavioral activities, a form such as the Positive Activities for Behavioral Activation can be helpful. In this form, you create a list of behavioral activities and chart out the relative ease and the reward of each activity. Ideal activities will have mild to moderate ease and moderate to high reward. Activities that are difficult with low reward do not make for good behavioral activation activities. You may also consider tracking the "sense of accomplishment" provided by activities chosen and intentionally choosing activities that bring a sense of accomplishment.
It can be helpful to schedule activities into your weekly schedule. Consider scheduling it into your week, using a calendar like this: Behavioral Activation Schedule.
Adapting Behavioral Activation for the Neurodivergent Person:
Consider Burnout: When neurodivergent people are experiencing depression, it is essential to distinguish between burnout and depression. For many ND folk's burnout leads to depression. If the depression is burnout-driven, then behavioral activation should be used with caution. For example, a person experiencing autistic burnout should be considering ways of reducing sensory input and prioritizing resting when thinking about behavioral activation.
Consider Sensory Load Particularly for the ND person whose depression is mixed with burnout they should consider the sensory load of the activities being scheduled. If an activity is a high sensory experience (for example going to coffee with a friend-yes, enjoyable, but also this is a high-sensory experience), they should be mindful not to schedule these high-sensory activities on back-to-back days and should schedule activities that incorporate sensory soothers (a warm bath, reading a pleasurable novel, etc.). It may be helpful to think about Green light-Yellow-light-Red-light sensory activities. For example, a high-sensory activity would be a red-light activity, while a sensory soother would be a green-light activity. Making sure to limit red-light activities and to have green-light and yellow-light activities between them is helpful.
Incorporate Special Interests: Special interests are a powerful source of motivation, energy, and meaning. They also serve to regulate difficult emotions. Special interests are emotionally regulating. Thus, incorporating special interests into behavioral activation can be powerful.
To summarize, neurodivergent behavioral activation will incorporate:
Pleasurable activity that is also sensory soothing
Rest and sensory "detox" time
Spending time on special interests (which serve to regulate and energize)
Where to go from here
In several ways, starting with behavioral activation can be easier for many folks (vs. starting with interventions aimed at targeting depressed mind). It is a tangible, concrete place to start that typically leads to fast results.
To start, begin with identifying a small list of activities to try in the next week (2-5); again, these can be as simple as scheduling a warm soak or a 5-minute walk.
Create a schedule (try and include one a day and then build up),
As you complete the activities record (either through internally checking in with yourself or paper and pencil), your mood before and after, the ease of activity, and reward of activity. The reward can include a boost to mood or energy, a sense of pleasure, or a sense of accomplishment.
This information is for education purposes only and should not be seeing as a substitute for mental health or medical care.
