Symptom Management

By Rebecca Floyd, PhD, Kimberly Lewis, PhD, and Lara Stepleman, PhD

“There is no medicine like hope, no incentive so great, and no tonic so powerful as expectation of something tomorrow.” – Orison Swett Marden
 
Conventional depression treatments typically focus on reducing negative behaviors, thoughts, and feelings. Positive psychology promotes daily practice of self-management strategies that increase positive mood and thinking. These strategies empower you to feel happier by changing perceptions and capitalizing on your positive qualities.
 
By identifying and incorporating your positive qualities into daily routine, you are less likely to feel worthless and damaged by MS and more likely to feel good about yourself. Finding and recognizing opportunities for applying the positive qualities you like about yourself and retain in spite of MS, even if now expressed in different ways, fosters HOPE, which is often absent in depression.
 
Happiness-building activities are the core of positive psychology. Increasing happiness does not mean denying the reality of your situation. By increasing positive experiences, you broaden your perspective in ways that promote constructive change and adaptive coping, or prevent worsening a situation. Three basic techniques for building positives into your life include practicing optimism, mindfulness, and gratitude.
 
Optimism is the tendency to have positive expectations. Optimists pay attention to the things that go well and anticipate potential for positive outcomes, fostering hope and a positive mood. In depression, individuals tend to expect a bad situation to remain the same or worsen (pessimism) and become highly attuned to things that went wrong during their day, failing to notice the many things that went right. Pessimism fosters feelings of sadness, hopelessness, and despair. While some people are naturally more optimistic than others, optimism can be a learned perspective. How? This can be done by shifting attention to focus on the positives of a situation.
 
Optimism activity: Reflect on the events of the day, identifying what went right. Initially, it may be challenging to identify these positive events because we take for granted the things that went “right” – they escape our notice and don’t receive proper credit. For example, we may take for granted and fail to appreciate getting out of bed, finding a good parking space, or making it to an appointment on time. What went “right” for you?
 
Present-focused, nonjudgmental attention to thoughts, feelings, and sensations underlies mindfulness. In depression, it may feel that you’re drowning in negative thoughts or that you’re running on autopilot. Mindfulness skills teach us to press pause and pay attention to the present moment – effectively ending the stream of negative thoughts. The purpose isn’t to change thoughts but simply to accept thoughts as just thoughts (not facts), which have no power over your life. The goal of mindfulness is awareness and acceptance of experiences, which leads to freedom and choice to engage in purposeful activities. 

Mindfulness activity: Mindfulness breathing is a simple strategy to begin developing mindfulness skills. The act of practicing mindfulness can be challenging; the key is practice, practice, practice.
 

• Start by bringing your attention to your breathing. 
• Breathe in through your nose, allowing the air to fill your lower belly.
• Then, breathe out through your mouth. Notice the sensations of each inhalation and exhalation.
• Continue the breathing exercise for a while. Then, begin to broaden your focus by noticing thoughts, feelings, and sensations that arise in the moment.
• Notice each thought or sensation as it arises, without judging it good or bad and without pursuing it (i.e., letting it become a center focus).
• If you become distracted, return focus to your breathing and then expand your awareness again.

 
Expressing gratitude, or being thankful, is another important skill to develop. Gratitude develops appreciation of life’s positive aspects, encouraging a lasting sense of satisfaction, which is essential to happiness. Depression creates tunnel vision, narrowing focus to the things that are felt to be wrong in life. This blinds us to our blessings or things we feel fortunate about (such as people, activities, things, or personal qualities), leading to a deep dissatisfaction with life. Chronic illness can become the sole source of focus, blinding individuals to other aspects of their identity or circumstances that remain positive despite illness. We may be grateful for essential things in our lives (such as a spouse or one’s home), but expressing gratitude includes finding the small things each day for which to feel grateful.
 
Gratitude activity: Identify at least three things for which you are thankful. Be careful not to discount “the small stuff” (such as enjoying a favorite smell or the taste of a favorite food). Expressing gratitude to as many people as possible can also increase your positivity.

HOPE (Happiness, Optimism, Present-focus, and Expressing Gratitude) is essential to coping with a chronic illness, overcoming depression, and living life as you choose. Positive psychology focuses on accumulating positive experiences through a variety of practices such as mindfulness, optimism, and gratitude that complement conventional depression treatments.