How Depression Interferes with Getting Things Done (GTD)

How Depression Interferes with Getting Things Done (GTD) - Cassandrastout.com

When you have depression, your natural inclination when faced with a to-do list is to crawl back into bed, right? Trust me, I’ve been there. When I’m depressed, I’d rather stick my hand into a box of tarantulas than load the dishwasher.

It’s rare that you do get the motivation to tackle something on your list. But, when you do, have you noticed that staying focused on that getting that task done is impossible?

Have you tried to complete a task like “pick up the living room,” only to end up staring at the mountain of toys, not knowing what to do next? I’ve been there, too.

Turns out there’s a scientific reason behind the inability to get things done (GTD) with depression. It’s called a “lack of cognitive control,” or, more colloquially, “executive dysfunction.” There’s even a disorder for it: executive dysfunction disorder.

Getting things done, or GTD, is a productivity system developed by David Allen. GTD encourages people to “brain dump” everything in their heads out onto paper, and then file that away into a trusted system. A trusted system involves calendars, your phone, and anywhere you’d like to schedule tasks.

But executive dysfunction interferes with GTD because a brain dump can be overwhelming for people with depression. I’ve written about executive dysfunction and how it relates to bipolar disorder before. But it’s been a while since that post, so I figured a refresher is in order.

What is Executive Function?

Executive function, when things are going well, is the ability to set goals and self-monitor. This means that you can recognize that picking up the living room requires you to pick up one toy at a time, rather than staring down a mountain of them.

Executive function is, in so many words, the ability to break tasks down into compartmentalized parts.

Most of the time, executive function, for people who have learned it (which is a whole ‘nother post), is automatic. But studies have shown the depression (and bipolar disorder, and attention deficit hyperactivity disorder) interferes with executive functioning. Breaking down tasks into parts is extremely difficult when you’re suffering from depression.

Which is why you end up being overwhelmed when looking at that mountain of toys. you literally cannot comprehend the steps it would take to clean the living room.

How to Cope with Executive Dysfunction

The good news is that executive dysfunction can be managed with ideas like these:

  1. Consciously break projects up into steps. I’ve written recently about how to break tasks and projects into steps, so I’ll just summarize here. Next time you’re facing a task, try writing down every step you can think of. Then put them in the order that you need to accomplish. Then tackle the task, one step at a time.
  2. Use time management tools such as colorful calendars and stopwatches. Once you write down the steps of a task, try timing yourself to get each step done. Make a game of it, and you’ll be able to complete the steps more quickly.
  3. Schedule repeating reminders on your computer or phone, using sites like Remember the Milk. Reminders can be extremely helpful. Use a calendar app on your phone to make appointments, and set notifications for thirty minutes ahead (or however long you need to get to the appointment). “Set it and forget it” gets the task out of your head and into a trusted system.
  4. Set goals in advance to coincide with ingrained habits, such as flossing your teeth right after brushing. Setting goals to follow ingrained habits is a great way to build new ones. They’re called “triggers,” and they’re a positive way to  build upon a foundation that you already have. When you do one habit, you immediately follow it with another. If you’re a tea drinker, try taking the trash out every time you boil water, and you’ll never have to remember to take the trash out again.

Final Thoughts

Structure is extremely important for people who suffer from depression. Executive dysfunction is a real problem.

Consciously breaking projects down into steps, using time management tools such as calendars and repeating reminders, and setting goals to coincide with ingrained habits are all ways to improve executive functioning.

You can do this. You can improve your executive functioning.

I wish you well in your journey.

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Brain Training Shows Promise For Patients With Bipolar Disorder

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Credit to flickr.com user m kasahara Used with permission under a Creative Commons license.

Researchers at McLean Hospital, an affiliate of Harvard Medical School, have discovered for the first time that computerized brain training can result in improved cognitive skills in individuals with bipolar disorder.

In a paper published in the October 17, 2017, edition of The Journal of Clinical Psychiatry, the researchers suggest that brain exercises could be an effective non-pharmaceutical treatment for helping those with bipolar disorder function more effectively in everyday life.

“Problems with memory, executive function, and processing speed are common symptoms of bipolar disorder, and have a direct and negative impact on an individual’s daily functioning and overall quality of life,” said lead investigator Eve Lewandowski, PhD, director of clinical programming for one of McLean’s schizophrenia and bipolar disorder programs and an assistant professor at Harvard Medical School. “Improving these cognitive dysfunctions is crucial to helping patients with bipolar disorder improve their ability to thrive in the community,” Lewandowski added.

Lewandowski and her colleagues knew from previous studies that this type of intervention had helped patients with schizophrenia improve cognitive functions. “There is considerable overlap in cognitive symptoms between bipolar disorder and schizophrenia,” Lewandowski noted.

The researchers therefore decided to test the impact of brain exercises in the bipolar population. They randomly assigned patients with bipolar disorder, aged 18-50, to either an intervention group or an active comparison group (used as a control). The intervention group was asked to use a special regimen of neuroplasticity-based exercises from Posit Science — maker of the BrainHQ online exercises and apps — for a total of 70 hours over the course of 24 weeks. These exercises use a “bottom-up” approach, targeting more basic cognitive processes early in the treatment to strengthen cognitive foundations, then moving on to training focused on more complex cognitive functions later in the program. The control group was asked to spend an equivalent amount of time on computerized exercises that focused on quiz-style games, like identifying locations on maps, solving basic math problems, or answering questions about popular culture.

At the end of the study, the participants in the intervention group displayed significant improvements in their overall cognitive performance as well as in specific domains, such as cognitive speed, visual learning, and memory. “The intervention group maintained cognitive improvements six months after the end of the treatment, and in some areas even showed continued improvements,” Lewandowski reported.

Lewandowski is encouraged by the findings, as they demonstrate that “this type of non-pharmaceutical intervention can significantly improve cognition in patients with bipolar disorder,” she said. “These findings suggest that once the brain is better able to perform cognitive tasks, it will continue to strengthen those processes even after patients stop using the treatment.” In addition, Lewandowski said, “The study indicates that affordable and easily accessible web-based interventions can be effective for a broad group of patients.”

Lewandowski noted that further research is needed to determine how the improvements in these cognitive skills impact work and leisure activities and daily functioning in patients with bipolar disorder.

Text provided by McLean Hospital.

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Light Therapy Helps Bipolar Disorder Patients Function

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Credit to flickr.com user Richard Leeming. Used with permission under a Creative Commons license.

Daily exposure to bright white light at midday significantly decreased symptoms of depression and increased functioning in people with bipolar disorder, a recent Northwestern Medicine study found.

 

Previous studies found morning bright light therapy reduced symptoms of depression in patients with Seasonal Affective Disorder (SAD). But patients with bipolar disorder can experience side effects such as mania or mixed symptoms from this type of depression treatment. This study implemented a novel midday light therapy intervention in an effort to provide relief for bipolar depression and avoid those side effects.

Compared to dim placebo light, study particpants assigned to bright white light between noon and 2:30 p.m. for six weeks experienced a significantly higher remission rate (minimal depression and return to normal functioning). More than 68 percent of patients who received midday bright light achieved a normal level of mood, compared to 22.2 percent of patients who received the placebo light.

The group receiving bright light therapy also had a much lower average depression score of 9.2 compared to 14.9 for the placebo group and significantly higher functioning, meaning they could go back to work or complete tasks around the house they hadn’t been able to finish prior to treatment.

The study was published Oct. 3, 2017 in the American Journal of Psychiatry.

“Effective treatments for bipolar depression are very limited,” said lead author Dr. Dorothy Sit, associate professor of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine. “This gives us a new treatment option for bipolar patients that we know gets us a robust response within four to six weeks.”

Patients also experienced minimal side effects from the therapy. No one experienced mania or hypomania, a condition that includes a period of elation, euphoria, irritability, agitation, rapid speech, racing thoughts, a lack of focus and risk-taking behaviors.

“As clinicians, we need to find treatments that avoid these side effects and allow for a nice, stable response. Treatment with bright light at midday can provide this,” said Sit, also a Northwestern Medicine psychiatrist.

The study included 46 participants who had at least moderate depression, bipolar disorder and who were on a mood stabilizer. Patients were randomly assigned to either a 7,000 lux bright white light or a 50 lux placebo light. The light therapy patients were instructed to place the light box about one foot from their face for 15-minute sessions to start. Every week, they increased their exposure to the light therapy by 15-minute increments until they reached a dose of 60 minutes per day or experienced a significant change in their mood.

“By starting at a lower dose and slowly marching that dose up over time, we were able to adjust for tolerability and make the treatment suitable for most patients,” Sit said.

Sit and her colleagues also observed a noticeable effect of bright light therapy by four weeks, which is similar to other studies that test light therapy for non-seasonal depression and depression during pregnancy.

Light therapy has conventionally been tested using morning light at awakening because previous research has suggested that morning light helps reset circadian rhythms and can be helpful in the treatment of SAD, Sit said. However, the mechanism of response is unclear in bipolar disorder. To understand the possible effects of midday bright light on circadian rhythms in patients with depression and bipolar disorder, Sit and colleagues are planning new studies to investigate.

Text provided by Northwestern University.

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