Author: Gina Capobianco

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Battling Depression’s Impact on Self-Esteem: Gina Capobianco

Self-esteem is something that everyone likely struggles with at some point in their lives. Some of us struggle more than others. Low self-esteem can prevent us from living our best lives. It can keep us from taking risks in our careers and can lead us to shy away from relationships. 

I have struggled with my self-esteem since I was a child. My struggle with self-esteem is likely tied to different aspects of my life. I don’t think I grew up with much self-confidence. I’m Gen X. When I was growing up, we didn’t have participation trophies or people looking out for our self-esteem. Depression also attacked when I was young. Maybe that is where my struggle with my self-esteem started. 

Depression affects self-esteem. After years of therapy, I have learned that one major factor affecting my struggle with self-esteem is depression. Depression uses its voice to point out all the negatives. For me depression leads to me devaluing myself. The darkness depression covers me with also covers up the positives in my life. I hear depression telling me I am worthless; I am not good enough. I know I am not alone in this. 

Varied definitions can be found for self-esteem1. A common definition for self-esteem is a person’s sense of self-worth2. One study suggested a strong association between levels of self-esteem and the development of depression3.  As a person who has lived with depression for decades I can attest to this association based on personal experience. Even as I write this article messages of self-doubt, a sign of my low self-esteem, fill my head. I question if I should be writing this article. Depression’s voice is in my head telling me I don’t know what I am talking about and that I am not a good enough writer. This voice of depression fills other areas of my life. It is always speaking to me like a cd stuck on repeat. 

Self-esteem is tied to our opinion of ourselves. For many of us living with depression, our view of ourselves is not positive. It has been damaged. We see ourselves through the lens of depression. That lens is dirty. That lens presents a negative picture of who we are and what we can do. As a result, our self-esteem is damaged. 

People with depression face many obstacles. Believing in oneself can be one of those obstacles. When struggling, depression can get louder. It can scream that you are not enough. 

There are people with depression who are successful at many things. They can push through the depression with the help of therapy, medication, or other treatments. This doesn’t mean they don’t struggle with self-esteem. Maybe they are able to push the voice of depression to the back of their mind. Maybe that voice is a low hum in their head that they can work through. 

I struggle to push the voice of depression to the back of my mind. My low self-esteem has told me to start this article over several times. Depression has led to me question myself and my abilities. It is something I have struggled with throughout my life. Through therapy I have learned strategies to help me cope with the negative messages I hear in my head. It has taken a lot of practice within the confines of therapy to be able to use these strategies in my day-to-day life.

Here are some strategies you can try:

Self-talk

One strategy that can help battle low self-esteem is self-talk. I employ self-talk by allowing my thoughts to have a “conversation” with the negative thoughts in my head. Sometimes it is as short as a one-word response, such as “stop” or “no”. I can also say something like “I know you are trying to keep me down, but I am not going to listen to you.” It has taken a lot of practice to use self-talk. My psychologist has modeled it with me. That has been helpful because if left to myself, I would struggle to employ self-talk. I need to practice using it. Self-talk scripts can be useful. Try writing down what you want to say when depression starts attacking your self-esteem. This provides a little assistance when you need it.

Reframing

Reframing involves taking a thought and turning it around. It is similar to self-talk. I have used reframing as I work on this article. When depression tells me I can’t write I take that thought and I turn it around. I tell myself “I can write. I have written for years. I know how to write. The words will come.” For me it is not enough to just say this once. I need to repeat it to get myself to accept it as a truth. Depression has a strong voice. It wants to be right. So, repeating my reframed message is necessary to combat depression’s effect on my self-esteem. The difference between self-talk and reframing is subtle. With reframing there is more of an effort to turn depression’s words around while self-talk can utilize general scripts and be more focused on telling the thought to stop.

Externalization

Another strategy to deal with the thoughts or voice of depression is to place those thoughts outside of you. An example of this might be if I take a thought depression is telling me and imagine myself saying it to my niece or other young person. As I do it, I realize I would never say those words to her. It would be hurtful and unkind. This realization allows me to see that it is also hurtful when I listen to depression saying it to me. Just as I wouldn’t say these things to my niece, I tell myself I shouldn’t allow depression to say them to me. You can try this strategy by imagining yourself saying what depression is telling you to another person. You likely wouldn’t talk to a loved one the way depression speaks to you.

Self-hypnosis

I was first introduced to self-hypnosis about 20 years ago by my psychologist. Self-hypnosis involves getting myself into a relaxed state and then giving myself hypnotic suggestions. To get into a relaxed state I use a form of progressive relaxation. I close my eyes and focus on my breathing. I imagine a safe place. Then I count as I go down ten steps to reach that safe place. This is followed by focusing on relaxing each part of my body. Then I whisper a hypnotic suggestion. It might be something like “I am able to get through X situation. I have the tools I need to do it.” Once I have given myself the hypnotic suggestion, I imagine myself climbing back up those ten steps. When I open my eyes, I can re-engage with whatever I need to do. 

Distraction

Distraction is a strategy I use frequently. Often, I find myself needing to block out the self-esteem damaging messages depression is feeding me. I need something else to focus on in order to block the messages. Music is a frequent distractor for me. If I can get myself to focus on the lyrics instead of what I am hearing in my head, I can push the thoughts to the background. I have created several playlists on my phone. I can choose the playlist that contains songs that will be most effective for me in the given moment. Think of something that is distracting for you. Some distractions that might work include watching a movie, gardening, exercising, cooking, or creating art. Find what works for you.

Practice Is Important

Just as with anything in life that is difficult, employing these strategies takes work. Some strategies will work better than others for different individuals. A key component is practice. We can’t expect these strategies to work without practice. It is important to gain familiarity with how we are going to utilize these strategies. With self-talk, reframing, and externalization it is beneficial to write scripts that can be practiced. This helps us utilize the strategies when we need to employ them. Making self-hypnosis part of our daily routine allows us to engage in it with more ease when we are struggling with our self-esteem. We all need a little distraction at time. Knowing in advance what can serve as a distractor for us is useful. 

Depression can affect many aspects of our lives. Self-esteem is one aspect that can be negatively impacted by depression. Having strategies to fight back against depression’s voice is helpful. These strategies are not going to make depression go away on their own. Practice is important. Depression is complicated and treatment is necessary, but employing these strategies can help us deal with the day-to-day battle.

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Creating a Safety Plan for Times of Suicidal Crisis: Gina Capobianco

I have lived with depression for decades. Suicidal thoughts have accompanied the depression most of my life. While facing a difficult time a couple years ago, the psychiatric nurse practitioner (PMHNP) I was seeing brought up the idea of a safety plan. I had never heard of this type of plan but was willing to try it.

Like many people with suicidal thoughts, when the depression is not bearing down on me, I don’t want to die. It is just when the thoughts get going and the depression turns everything dark that dying seems like my only escape. I needed a plan for dealing with the suicidal thoughts.

My PMHNP explained what a safety plan is and how it works. A safety plan is an intervention that helps a person survive a suicidal crisis by providing them with a set of steps, which they have helped create, to follow during the crisis that will decrease the chances they will engage in the suicidal behavior.  My PMHNP described the plan as my action steps for when I feel that the suicidal thoughts are becoming overwhelming. Together we laid out the plan. It has been necessary for me to use the safety plan a couple of times, and it has been effective each time.

Let’s go through the steps my PMHNP and I used when creating my safety plan.

Purpose of a Safety Plan

First, we identified the purpose of the safety plan. The main purpose of a safety plan is to prevent suicide. The plan provides a way to cope with the crisis of suicidal thoughts using a guide to get help in a way that is comfortable and not overwhelming. The plan allows an individual to reach out to family or friends, who will serve as a support person, as well as provides connections to mental health professionals. The plan lets the support person know how to help you in a crisis.  

It is helpful if the plan is written in the individual’s own words. This ensures the person understands the steps and can enact the plan in a crisis. The words should be simple and easy to follow. The person should keep it in a place that is easily accessible. The people involved in enacting the safety plan should also have a copy. 

Components of a Safety Plan

Identifies When It Will Be Used

The safety plan should spell out when it will be enacted. I discussed this with my PMHNP.  Discussing this with your mental health professional can ensure that you are aware of when to utilize it.  When the plan is used differs for each individual. So, the plan should include when to enact it in language that can be comprehended in a crisis. My plan is enacted when I recognize my thoughts becoming overwhelming and I start thinking about acting on my suicidal thoughts.

Provides Coping Strategies 

Coping strategies are going to vary from person to person. These may include breathing exercises, meditation practice, distractions, or anything that helps the person cope with suicidal thoughts. The plan should include how to know if the strategies are working. If the coping strategies are not working or the person recognizes they are beyond the use of coping strategies, it is time to reach out for support. My coping strategies include journaling and listening to music. When these are not working it means it is time to reach out for help.

Identifies Individual(s) Who Will Support You

When you are in a suicidal crisis, you need to be able to reach out to others for support. When developing your plan, identify a friend or family member who you can reach out to. The individuals on the safety plan need to be willingly involved and consent to being a part of the plan. It is not enough to just be willing to be part of the plan. The individuals need to be able to be an active part of the plan. You need to be able to reach them in a crisis. Share your plan with them and make sure they understand the plan. Your plan should also include who your mental health professionals are and their contact information. In addition, the 988 number, the Suicide and Crisis Lifeline, should be a part of your plan. 

Provides the Questions Your Support Person Will Ask You

Your support person refers to the safety plan when you contact them. My support person has the safety plan on her phone, so she does not have to look for it.  The first question the support person should ask is if you are safe. If you are not safe, they may need to call for emergency support. My plan is set up so that I am asked if I need comfort or support once it is established that I am safe. This gives the person an idea of how severe my suicidal thoughts are at that moment. 

If I respond that I need comfort, my support person will ask me if I need to be listened to or distracted? She then responds accordingly. If I respond that I need support, she will ask me if I need her to help connect me to my mental health professional or if I need her to do it for me.  If I respond that I need help, she reminds me of who to call and may need to provide the number. As I make the call, she stays in contact with me through texting. 

Provides Steps to Be Taken to Get Professional Help

If I need her to make the contact for me, she asks me for my location and what I am thinking. She will relay this information to my mental health professional when she contacts them. 

The 988 Hotline can be called if it seems like I need professional support, and it is at a time when my mental health professionals would not be able to be reached. Some people may not have mental health professionals that can be contacted. In this situation, if the person is not in imminent danger 988 can be contacted. The person can make the call themselves or the support person can call for them. 

If I say or indicate that I am not safe, my support person may need to call 911. While waiting for emergency help to arrive, my support person needs to stay in contact with me. It is important not to leave a person who is in crisis alone. The responders on the 988 hotline and at 911 have the ability to transfer a caller to the other line depending on the need and the level of safety concern.

Plan for Follow-Up

Once intervention has taken place the support person should follow-up with the individual. When my support person does this, it lets me know that I am not alone.  The support person should check in to see how the individual is doing and to ensure that the care provided was helpful. My support person calls me to just talk.

Conclusion

Having a safety plan has made a difference in how I cope with suicidal thoughts. It ensures that I am safe even in my darkest moments. Being a part of a safety plan requires a commitment on the part of the support person. I am grateful that I have a friend who is willing to fill this role. If you deal with suicidal thoughts, talk to your mental health professional about creating a safety plan. Your plan may look different than mine. That is okay. We each have our own needs and cope with our suicidal thoughts in our individual ways. Despite the differences, a safety plan can prevent a suicide attempt and save a life.