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Comment by lkadr | Hacker News Reader

After years of depression, I'm sure my personality is one of the cause of me still being depressed. And if I went to therapy, I'd expect and want it to change. But change is scary, and I suppose that's why some depressed persons don't want to seek help. There's sometimes comfort in suffering. Another reason is that the not-desesperate me feels shallow and boring. But there's probably a hopeful me that's not. I haven't found it yet, it requires more effort.

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As someone who suffers from depression and has gone to therapy for over 5 years (I am also on medication), please try and force yourself to go.

It will most likely change your life for the better, if not, what have you wasted? A bit of money and a few hours of your time? It could make you better at dealing with your depression and, as a consequence, make you feel happier.

You might need to try a few different therapists until you find one you like, and it's not a quick fix either. Think of it like getting (physically) fit, you need to keep at it - maybe for years. You might not also get better in a linear curve, it's up and down, you just have to stick with it.

Therapy has helped me to know myself better, understand why I do what I do and feel the way I do, and, as cheesy as it sounds; learn to accept my limitations. It's changed my life and the life of many of my friends.

You deserve to be happy, everyone does.

Please try it - if it doesn't I will buy you a beer/coffee.

Do you think it was necessary to go through this process with a therapist, or could a less expensive alternative have had the same effect?

I’ve heard plenty of writers describe their writing as therapy. “Free-writes” where I write exactly what I’m thinking with no filter have helped me. At some point I just get tired of retelling whatever story is affecting me and move on. Work outs have helped before (mostly cardio), etc.

As with many things, a therapist offers one to exchange money for time spent figuring out things on your own

I've found success without therapy through minimal exercise over no exercise & framing things as neutral

Framing things as neutral: I'm Canadian, so during Winter I've made a point to perceive the statement "I'm cold" as a neutral statement. A sensory experience as opposed to an affliction of pain. Also focussed on relaxing my muscles in the cold, which made it less uncomfortable. Shivering & clenching up are unnecessary until the temperature has dropped to a point that you really are in pain & should either get inside or get better atire

I started taking cold showers in the morning about two months ago to practice this exact thing.

After about a week, you sort of learn to neutralize the feeling of being cold as just that, a feeling. And a temporary one.

It’s a good reminder for other “negative” feelings, and something I can point my brain to with other emotions I don’t like, anger, anxiety, etc. They all pass fairly quick the less I dwell on them.

This is an approach that worked for you. You have employed your own CBT technique it sounds like, and that's great! Bit I think it's unfair to imply that you can just work harder and come to the same conclusions without a professional. A physiotherapist is often highly educated in psychology and has had, usually, years of experience dealing with a range of people, issues and scenarios. Some people, due to what ever is going on in their head (myself included) can't see the wood for the tree's and a therapists job is to help bring that clarity. Mental health is complex and unique to the individual, there isn't a thing that works for everyone, even therapy.

For sure. When I say "time is money" that might involve more time than you'll ever have available. & a friend once reflected on seeing a therapist: "It's not the job of my friends to be my therapist" ie there's value in bouncing ideas off someone who you don't have to worry about stressing a casual friendship over

No, a (good) therapist helps you find things that would be difficult or impossible to find on your own, it's literally an outside perspective. If what you did works for you, you either didn't have any serious mental health issues to begin with, or you figured out a hack to avoid thinking about the things which trouble you, which isn't much different from people avoiding problems by losing themselves in work, alcohol, religion, whatever. It's essential to have techniques to help yourself stay on an even keel, but it's damaging to other people who actually have problems to encourage them to dismiss their problems as insufficient detachment.

I think you've misunderstood me; I'm not suggesting people avoid therapists. I agree with what you're saying

I think a therapist is necessary, at least to bootstrap the process. You can listen to podcasts and read books by therapists. You can think and try to reason about it yourself. You can expose yourself to the ideas. You can learn about cognitive behavioral therapy and try out worksheets etc... But that takes time and you may not cover everything or know what will be effective for you. A therapist can keep you accountable but mostly it takes a long time. Plus it's hard to do that when you are depressed. Even with a therapist you will be reading a lot on your own anyway.

This. It's similar to a personal trainer. People don't hire personal trainers because they can't figure out how to exercise, they hire personal trainers so they have someone guiding them, supporting them, keeping them on track.

In my personal battle with depression, a big part of it has been self-distrust. So I could reason about it all day but I struggled to make any actual changes because I was always questioning. Having someone there actively giving me permission to reshape my thought patterns and giving me confidence that I'm on the right track has been absolutely essential.

Totally agreed. When I pay a therapist, it's not really for facts, which I can get from books. It's for their long experience with a lot of different people. That gives them the ability to immediately spot patterns in my life that might take me years to recognize. And also the skill to point out my self-fooling BS in a way that I can listen to and understand the point.

To piggy-back on the personal trainer analogies earlier, alternatives like CBT tools, podcasts, books, etc. are good augmentations once you’ve learned “good form” on how to work with your depression through a therapist.

The alternatives aren’t going to really push you to unpack thoughts that might be holding you back or know to switch things up if your situation becomes very dire.

The evidence is fairly clear - reading self-help books or using an internet-based CBT programme is similarly effective to in-person psychotherapy. That doesn't mean that these approaches will be effective for you, but they're viable treatment options that are vastly more accessible. I'd still suggest trying in-person therapy if it's available to you, but don't be disheartened if that isn't an option - there's no evidence to suggest that self-help is significantly inferior to therapy.

https://doi.org/10.1016/j.janxdis.2018.01.001

https://doi.org/10.1016/j.cpr.2017.09.006

> reading self-help books…is similarly effective to in-person psychotherapy

That was not the outcome of the CPR paper, and even the authors' statement in the abstract is considerably more hedged than you imply here.

iCBT and bibliotherapy have both demonstrated the greatest efficact in subclinical or extremely high functioning populations; their utility in more severe cases or those where there are comorbid psychiatric or bio-social issues is less clear.

I absolutely believe in using telehealth to broaden access to behavioural health services and think they're an excellent first line treatment, but stating there's nothing to suggest that they're a fungible good with equivalent value to human-delivered psychotherapy risks dissuading people who're already struggling and fail to improve with self-guided resources from seeking out more comprehensive services.

A therapist can be a useful tool. I spent a total of about 3.5 years of my life in therapy.

I also briefly was in couple's counseling and my husband was seeing a therapist as well during that time. He was extremely introverted and he truly hated discussing private matters with a therapist.

One day I told him "I don't care if you see a therapist. I just want our marriage to get better. Therapy is just a means to an end. That's it."

He happily quit therapy and couple's counseling promptly. He also promptly was a better husband to me and never fell down on the implied promise that he would rise to the occasion somehow.

I continued with therapy because I had a lot to sort out and I saw it as a useful tool.

In the long run, learning how to live well was the best therapy for me, so to speak. But I didn't personally know how to get there without first talking to someone about bad things that had happened to me and how they shaped me. My husband didn't want to go through that step and he was somehow able to just behave different towards me once I made it clear "I just want a better marriage. That's it. I don't actually care if you go to therapy."

Part of many personal issues is that you "cheat yourself", or simply avoid tough topics (psychoanalysts call that resistance). A good therapist uncovers these topics, helps you to face them, and supports you in finding ways to deal with them. It is hard for me to imagine how one could do that without a human counterpart.

Thank you for sharing. Sincerely curious what you mean by "A bit of money". I'm lucky that I didn't have to have therapy. My guess is unless your insurance/job covers mental health, it's at least $50/hour (closer to $100 or $150 if in a major city). Surely not much for the possible benefits (and on a developer salary), but I'm wondering how expensive such services are.

> closer to $100 or $150 if in a major city

If therapy is just talking, surely there must be options for cheaply video chatting a therapist in a state with lower cost of living?

In my experience, you need to be there face to face. I can't explain it, but it's all the nuances and the uncomfortable silences. I was seeing my therapist for a while via Skype, even though he lives a few miles up the road. I now make the effort and see him face to face. It's so much better. But, like anything, what works for you.

There's something about physical communication that can't be replicated. You see the posture, the gears turning, immmediate reactions. You can't formulate what to say, you say whatever is at the forefront of your thought.

Teletherapy outcomes have yet to be thoroughly researched, but anecdotally most clinicians report a strong preference for face-to-face sessions. Part of the discomfort stems from legal concerns – how do you handle a patient who reports intense suicidal ideation with a plan being one of the big ones – but also the limitations of teleconferencing. Neither the typical therapist nor their patient is like to have access to a fancy $$$ teleconferencing setup; both are likely stuck using whatever $0.50 on the BOM selfie camera Apple chose for their latest iDevice. Seeing only the face, and a 720p at that, denies the clinician a lot of valuable information about the client's internal state, their physiological responses, and their body language. Not to mention connection issues. Imagine being someone who's kept a secret about their sexuality or childhood abuse and finally developed enough trust and worked up the courage to discuss it to your therapist only to be met with a "Connection lost…" or frozen image of their face.

Additionally, licensure for mental health professionals is handled on a state-by-state basis, making CoL arbitrage difficult.

There are some companies trying to do teletherapy (eg BetterHelp), but video conferencing is a poor substitute for meeting in person, especially when a therapy session may often have the client crying, or panicking, or emotionally reacting very strongly. "Just talking" trivializes the contents of the conversation as well as the psychologist's role in the healing process.

Also body language and eye contact (or lack of it) is a very important part of the session which cannot be recreated online.

In the UK you can get therapy on the NHS, but it's mostly CBT and not for any extended period. Psychotherapy, which is what is what most people need with long term mental health issues (like myself) is mostly private. You can pay anything from £50-150 p.h In the US, I'm not sure.

The NHS also offers a range of other talking therapies /counselling, e.g. counselling for depression. The waiting times here can be shorter than for CBT.

If you're in dire need for help (depends on your scores and initial phone interview), you will be seen or referred quickly (within less than a month).

Any GP will refer you. If you need help with your mental health, just ask your GP for a referral, fill out the form and you will get help. It's a great system. (Did I mention that this doesn't cost anything?)

For long-term psychotherapy, you need to go private, but in many cases, a short-term intervention (e.g. over 12 weeks) is sufficient to get you through the worst and on the right track.

I think most people who suffer from actual depression, not a just a bout of sadness need long term treatment. The NHS is poorly provisioned in this way, sadly. Just like a diabetic who needs insulin everyday people with serious psychological conditions need regular treatment. I'm lucky enough to be able to afford it, I don't know how I would cope if I couldn't.

There are different variations of depressions. In particular, it differs between acute and chronic occurrence.

As far as I know, acute occurrences tend to be more intense (as experienced and reported in standardised tests) on average than chronic ones. Here, the risk of, e.g. suicide is also highest. However, long-term depression has a much more long-lasting impact on one's life, so I don't want to downplay it in any way.

Acute episodes tend to have a duration of only a few weeks or months so short-term therapy can be of great help here.

I agree that chronic depression requires long-term support. Your analogy with insulin and diabetes is excellent. And yes, the NHS falls short in this area, unfortunately. It would be great if more people could get the care they need and I hope it will become possible.

So yes, the NHS is not without its flaws. But considering the little funding it receives, it provides excellent care. It just shouldn't be so underfunded. I also think that it is also remarkably well-organised compared to other countries, e.g. Germany, where everything is much more bureaucratic and expensive. I also think it's significantly that countries with more privatised health care like the US.

European perspective incoming:

Every resident of Switzerland has to have obligatory health insurance. Therapy is part of the basic package that every insurance provider has to cover (for up to N sessions per year). The patient has to pay a cover of 10% of the cost on top.

This shifts the cost of therapy from $150/hr to $15/hr + basic health insurance premiums (<$500/mo). Note that this is general health insurance, so this will also cover physical health etc. (apart from dentistry for some reason).

I notice this trend of not covering dentistry through many countries. I think the issue is that a lot of dentistry work tends to be aesthetic and because of that it's hard to draw the lines on what should be covered.

> a lot of dentistry work tends to be aesthetic

Is this true? This is so far from my experience I'm actually curious what the numbers are. If you have a study on this, I'd love to read it.

Just a guess from my personal experience. Might probably be wrong.

AFOAF went through a tough time basically between the end of high school and a year out of college. Family stuff that was so hard to emotionally grasp and make sense of it absolutely paralyzed her. She went through many different forms of therapy; from affordable counselors, to a professor at her college (don't try that, they usually just want you to pay to be in a study), to a relatively average psychologist (~150/hr) who made her feel better able to cope with her mental state but did not provide her any tools to go beyond it.

Finally, when we moved to a larger area she found a first-rate CBT practitioner and the results were nothing short of outstanding. In less than 4 months she went from being completely dependant - afraid to drive a car, visit stores, or pretty much leave the house alone - to regaining her independence and returning to the person she was before everything happened. The downside was she had to wait 3 months for an opening and I believe sessions were in the neighborhood of 300$ and needed to be 2x a week at first if I remember correctly. Regardless it is the absolute best money she had ever spent, and was so much cheaper than the years of seeing a different psychologist who didn't help her move forward.

I guess the moral is if you are in a situation where you are incredibly anxious or depressed to the point where you feel it is irrationally preventing you from making progress or following through on things you want to do, CBT (from the right place) can change things you may have never thought possible.

AFOAF = A friend of a friend?

That's a rather obscure acronym.

Is that not code, for me?

I believe you're thinking of SWIM, or "Someone who isn't me," which is apparently used to avoid self-incrimination

Its literally just to protect privacy of someone close, nothing more. Shouldn't be interesting anyways but you never know how far doxxers will go.

"FOAF" is well-known, http://www.foaf-project.org/

Recently went canvassing myself. In NYC it ranges from 50-350/hr depending on who you're talking with and their exact licensing. Licensed psychologists will be more expensive than licensed mental health workers or counselors. Psychiatrists are the most expensive. However, depending on your level of therapy needed, online can be much cheaper.

From a US perspective, many therapists have a sliding scale based on income. "A bit of money" is the best description for it, as it won't be free but should never break the bank either.

In my experience, therapy made me more productive by enough to pay for itself. Also in my experience, your estimates are accurate.

IIRC, part of the health care reforms in the states requires them to cover mental health much like physical health, doesn't it?

Data point, $250/visit, SF Bay. I had great insurance, so it was between 60-90% covered, though out-of-network so I spent plenty of hours on the phone with insurers trying to get them to do their jobs.

One thing that may help is to label your depression as it's own independent thing. Something that exists outside of your core self. Even give it a name, say Dave. Then when you are feeling depressed say, hey that's just Dave, why is Dave feeling this way? Is there another perspective that Dave isn't seeing etc...

This mind trick works for some and at its core it's the same idea of compartmentalizing. There are different ways to get to compartmentalizing and yes, it does help clear the mind, reduce anxiety/mind chatter by grouping and labeling things/thoughts somehow (by personal choice) such that when something arises to the conscious mind it can be located, acknowledged and dealt with at a later time if needed.

Yep, this helps me with my anxiety and depression.

Being able to recognize "I'm feeling anxious, and these thoughts are a product of that anxiety" allows me to process them and move on. It doesn't immediately relieve that anxiety, but it keeps me from spiraling downward, and lets me know that I should take care of myself until I feel better.

There's nothing about 'comfort zone' that suggests it's always a happy place. It's just a familiar one. It's so easy to become accustomed to pain or suffering that it becomes scary to imagine how things might be different, even if that change is positive.

I would recommend giving therapy a shot, but I would recommend even strongly that you find the therapist who is right for you. It won't always be the first one you meet, or even the most recommended one. It's a relationship just like any other so it requires trust.

I've been going through this for 6 years and if I had to go back and decide differently, I'd travel this same path again. Pitfalls and all.

Because I haven't seen it mentioned in any of the other comments: nutrition plays a role in this.

I do have heard several times about people fighting depression, who bettered their lot by improving their diet. Granted, these are just anecdotes, but, if you are suffering from depression you might want to investigate that angle.

As someone that has gone to therapy for several years I can tell you that eventually you get to a place where you need more than talking - action. People tend to need some sort of organizational philosophy to go with their view of life along with habits that comfort them in times of mental disarray. You are not ever going to be able to avoid suffering, times of boredom, or anything else, but you also don't have to be stuck. This is going to sound cliche, but talk is cheap. Practicing what you are discovering about yourself into habitual evidence is what becomes important as you broaden your self-awareness and dig yourself out of the depressive holes in life. In the words of Jocko, discipline = freedom. I've found that a combination of therapy and seeking out actionable things I can do to be more disciplined has been fundamental in getting beyond the ego of the self and out into the world.

I know people who have done LSD and said it was one of the most life-changing things they ever did.

My first thought is, holy hell. I'm pretty happy. I don't want to "find out" I have the wrong career/partner/residence/etc. So, I hear ya.

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