Will a CBT session banish my winter blues?
New studies show that talking therapy can ease seasonal depression.
‘I’ve learned to see the season as a time to be enjoyed, not endured’
What does autumn mean to you? I have friends who love this time of year, when they bundle up under chunky sweaters and yomp in wellies through piles of wet leaves. For me, though, the turning back of clocks makes my heart sink.
Summer is when my batteries recharge. On a sunny June morning, I can bound out of bed and be running in my local park first thing. On a warm evening, I feel energised enough to be spontaneous and sociable. But when autumn days get shorter and, in particular, greyer, I just want to shut myself away. Now, in November, my batteries are draining. I feel lethargic and can’t be bothered to exercise, to socialise or to eat healthily.
I’ve experienced seasonal affective disorder (SAD) for much of my adult life. It is a recognised form of depression, which can last for weeks or months, a pattern that repeats itself year after year, beginning in autumn and ending in spring. Its causes are believed to be tied to levels of serotonin and melatonin – in people with SAD, lower levels of the former and higher levels of the latter – and the lack of light’s effect on our body’s circadian rhythm. Symptoms can include a persistent low mood and feelings of worthlessness, irritability, a loss of interest in everyday activities and social withdrawal, a desire to eat more carb-heavy foods and lack of energy. For some, it triggers a desire to crawl into bed and just sleep excessively.
While for me SAD is relatively mild, for others it’s more serious. Nikki Bayley, a creative consultant from Staffordshire, emigrated to Vancouver and despite never having suffered from SAD in the UK, became overwhelmed by the Canadian city’s dank winters. “I always thought it was total rubbish,” she says. “But here, winters hit me like a hammer. I had no energy whatsoever. Getting up and going for a walk was as likely as flying around the room.”
She continues: “Things got nastily suicidal and frightening. A friend called me and was concerned. I’d asked her if she could take care of my dog if something happened to me. She came over to see me and wondered if I had SAD, so she marched me to a local store and bought a light-therapy lamp. The effect was immediate – it was like I’d had 20 cups of espresso. All of a sudden, that darkness and exhaustion disappeared. It was amazing. Every year around now, the lamp comes out of storage and when I have my cup of tea in the morning, I bathe in the light and I feel better.”
Light therapy is considered the gold standard for SAD sufferers, though it doesn’t work for everyone. Interest is now growing in the benefits of talking therapy, in particular cognitive behavioural therapy (CBT) – a type of psychotherapy where negative thoughts are challenged to alter unwanted behaviour patterns.
Research by the University of Vermont, published last year, showed people with SAD who are given CBT see their symptoms improve and are less likely to experience relapses in subsequent winters than those given light therapy. The study tracked 177 people with SAD over two winters, with half treated with six weeks of light therapy and half with CBT. In the first winter after the initial treatment, the two groups reported comparable relief from SAD, but two winters later, 46 per cent of those who had light therapy experienced a recurrence compared with 27 per cent of those in the CBT group.
“Light therapy is a palliative treatment, like blood pressure medication, that requires you to keep using the treatment for it to be effective,” said Prof Kelly Rohan, the study author. “Adhering to the light therapy prescription upon waking for 30 minutes to an hour every day for up to five months in dark states can be burdensome.”
I have a SAD lamp blaring from October onwards, but CBT is not something I’ve tried, so I book to see Dr Robin Hart, a psychologist and psychotherapist who’s a co-founder of Companion Approach, an app for mental health in the workplace.
One of Hart’s first tests is for me to fill out Beck’s Depression Inventory and Hopelessness questionnaires on which I score relatively low; those, combined with wide-ranging discussions on how I function in autumn and winter compared to spring and summer, leads him to conclude I have the winter blues – not a medical term, but recognised as being milder than full-blown
SAD. It’s important, he tells me, to understand how seasonal depression affects us, by giving us a tendency to withdraw, impacts on our thinking patterns and makes us see life negatively. “Remember, we were all cavemen once,” he says. “We would have been up when it was light, hunter gathering, and resting when it was dark. It would have been much more dangerous to hunt in the dark so there would have been a much greater desire to stay in the nest and stay safe.” Through CBT we can learn to recognise the symptoms of SAD so we know what’s likely to happen, and can uproot and reframe those underlying negative beliefs, he explains. In our sessions, we focus on the negative thought patterns that I fall into with the change of seasons, and Dr Hart encourages me to do things I’d otherwise resist or avoid at this time of year. So, I send out emails to meet friends after work, and set up more sessions with a personal trainer at my gym. He also gets me to think of a new daily routine: not to lie awake thinking first thing in the morning, but spring out of bed, take a shower and listen to Radio 4.
“Structure is hugely important,” he tells me. “Sensory change and physical activity can be beneficial, so first thing in the morning put your therapy light on, but also a radio that’s slightly too loud to ignore, ideally spoken word, then get up, straight to the shower. You can ruminate later, but by that stage the behavioural activation of getting on with things will have promoted a whole load of neurotransmitters to fire that weren’t while you were lying in bed.”
Kari Leibowitz, a health psychologist, spent 10 months in northern Norway studying how the locals faced winter 200 miles north of the Arctic Circle. Her research convinced her that those whose mood dips in winter can be helped by reframing their outlook to see the darker seasons as an a opportunity rather than something to be endured.
“People in Tromsø really didn’t see winter as limiting,” she tells me from her home in California. “They saw it as a positive time both for outdoor recreation and indoors…it’s a season to make things cosy – it’s not just drinking hot chocolate, it’s also the psychological feeling of safety and contentment, maybe in front of a fire with friends.”
One of her main tips on adopting a positive winter mind-set is to bundle up and get outside.
“If you’re dressed properly, being outside in winter can really be invigorating. And moving can be one of the best things for your mental health.”
Since my CBT work, already this autumn isn’t seeming as bad as previous ones. I’ve been given the structure and mental tools to stop seeing this season as one merely to be endured, and to not mope around before lighter days return.
I’ll always be at my best on a hot summer’s day where I’m in shorts and flip flops firing up a barbecue in the garden.
But a walk in my local park bundled up in a warm jacket, followed by a roast chicken with family and friends surrounded by candles and laughter both seem pretty good reasons to enjoy winter.