Understanding Depression to Better Support Your Clients
As a private coach, fitness trainer and writer, I realize that depression can be masked. The first time I knew, and I mean knew in my bones that something was really wrong, I was less than half a mile into a run. At the time, I ran 30–50 miles a week. But on that day, I couldn’t shake out the stiffness. The heaviness in my feet and legs made it feel like I was running with wet shoes in the sand. I found myself, standing alongside the road, hands on my knees, trying desperately to will myself on for the rest of the run. Yet, physically, it was all I could do to even get back to my house. And once I got there, I spent the rest of the day on the couch.
According to the Centers for Disease Control and Prevention nearly one in 12 adults report having depression.1 Of that total, the prevalence of depression among women is almost double of that seen in men.
It’s very likely that someone that you work with, run with, or go to book club with is facing their own battle with depression.
Not long after that failed run, I was diagnosed persistent depressive disorder (PPD), also called dysthymia, which manifests as episodes of major depression in between long periods of mild to moderate depression.
The Mayo Clinic describes PPD as “_a continuous long-term (chronic) form of depression. You may lose interest in normal daily activities, feel hopeless, lack productivity, and have low self-esteem and an overall feeling of inadequacy. These feelings last for years and may significantly interfere with your relationships, school, work and daily activities.”_2
It took me a long time to realize that I didn’t have to feel that way.
In retrospect, it’s not surprising that it was the physical symptoms I experienced that finally led me to a diagnosis of depression. I’d been experiencing the mental effects of depression for years — sadness, worthlessness, trouble sleeping, trouble concentrating — but I always managed to remain physically active, which helped me to cope with my depression, while also masking some of what was really going on.
I assumed that because I could function well enough to at least go for a run every day, nothing was wrong. I also assumed that it was always up to me to try harder. This led me to berate myself for not trying hard enough whenever I struggled. With the onset of a major depressive episode however, it was the physical effects that finally pushed me to consult a doctor.
Depression affects people in different ways, and according to the National Institute of Mental Health (NIMH), a high percentage of patients with depression who seek treatment in a primary care setting report only physical symptoms.3 Some of those symptoms might include joint pain, limb pain, back pain, and gastrointestinal problems, among others.
As a coach, it’s helpful to remember that there are ways in which depression makes the physical things we ask of our clients that much harder. The strong mind-body connection makes the body feel heavier, the mind feel heavier, and the body hurt. People’s experience of pain increases and it’s important to take these factors into consideration when coaching.
According to the Anxiety and Depression Association of America, PDD specifically affects approximately 1.5 percent of the U.S. population age 18 and older in a given year (about 3.3 million American adults). Only 61.7 percent of adults with PDD are receiving treatment.4
Fortunately for me, at the time of my failed run, I was already working with a therapist. Anytime she had asked me if I thought I was depressed, my answer was the same: I was in a funk. “What’s the difference between a funk and depression?” she asked. “Well,” I said. “I function.”
“And how’s that working for you?” she asked.
I had always thought that my ability to plod on with my life meant that I wasn’t depressed. I knew from the media and some other people what depression could look like, and I didn’t think it looked like me. I got up every day, showered, exercised, and showed up to work. Sure, I often wished I were dead, so I wouldn’t have to deal with life some days, but didn’t everyone think that? (The answer to this is no — wishing I was dead is a form of suicide ideation — another symptom of depression.)
Like many of us, I grew up in a time and environment where mental health was never talked about — or if it was, the discussion was in whispers. I grew up in Western Pennsylvania, the descendant of coal miners, steel mill workers and farmers who carried a strong blue collar work ethic. To me, that work ethic meant grinding through everything on your own. Go to work when you’re sick, and if you don’t feel like doing something well you just pull yourself up by the bootstraps and do it anyway. We grind through physical pain and never talk about emotional pain.
I believe a big part of reducing the stigma of any mental health struggle is to give those struggles a voice. I decided to tell my story and I’m glad I did. Because if helped even one person to open up and share her story, or better yet, reach out for help, then it is worth the vulnerability of sharing.
Depression is a lonely thing to experience. The trouble is, the more depressed you become, the harder it is to reach out. Anything we can do to make reaching out more accessible will help. As coaches, there are a few things we can implement that fall squarely within our scope of practice.
When I worked in a college environment, faculty and staff members placed rainbow stickers on their office doors so that students could more easily identify a safe space. I often feel like the rest of the world would benefit from similar practices for mental health concerns.
If we are working with a client with an acute injury — a broken foot, a sprained ankle, or plantar fasciitis — we make a plan to work with them around that injury. As coaches, we honor our scope of practice — we refer our clients to a doctor and we work with physical therapists and chiropractors and other professionals in a team effort to provide the best care possible for a client.
In many ways, depression is no different — except that in our society, the stigma of talking about our mental health is so strong.
“The stigma of mental health in our culture and the internal resistance to reach out for help are two of the primary ways that depression continues to progress and really take hold,” says Dr. Lisa Lewis, a licensed psychologist who teaches at Northeastern University in Boston.
A client might feel comfortable enough with you as their coach to tell you that their back is bothering them, but they’re much less likely to mention that they also struggle with chronic depression and anxiety. Unless we make the space safe enough for them to acknowledge that depression.
The most important step I took as a coach was opening up about my own experience with depression — because it allows clients to feel comfortable acknowledging their own struggles to me. This does not mean that I step outside of my scope of practice — but it does mean that clients know that I’ve been there too, and that they can feel free to acknowledge depression or anxiety as part of their overall health, the same way they might acknowledge back pain.
If you are around a friend or a client whom you know struggles with depression, remember that depression literally “hurts.” If you know that a client is depressed because they have shared this with you, take that into account when you’re working with them. Some days 10 pounds feels like 50, and two minutes on the treadmill feels like a marathon. Keep the lines of communication open and reinforce the fact that your client showed up and that any movement is good movement. Remind them that everything they feel is OK.
Remember that you can be supportive without going into a “counselor” role.
“Don’t be afraid to check in,” says Dr. Lewis. “But also don’t hesitate to turn the attention back to a workout. That is the best way you can help your depressed client and you can be supportive and caring in a boundaried, time-limited way and then keep it moving to the reason why they’re there.”
Someone who suffers from depression often can feel less alone just by a simple check in, and the reminder that they are not walking this wellness journey alone.
I have the business card of at least two therapists that I keep on hand at the gym. It’s a very delicate process to hand someone who is struggling the business card of a therapist, and I don’t always do it. Often, in telling my own story, I’m open about working with a therapist. This self-disclosure alone can lead a client to ask if I know anyone they can contact.
If I had one message to share with anyone reading this, it’s that you’re not alone, even though it feels that way. It can feel as if no one understands. It can feel hopeless.
If you or someone you knows needs immediate help or support, the National Suicide Prevention Lifeline is a 24-hour resource; call, chat, or text at 1-800-273-TALK. The Lifeline can also refer you to resources and counseling in your area.
There is help. There is hope. And there is a light that can shine through that darkness.
- Centers for Disease Control and Prevention, National Center for Health Statistics, Prevalence of Depression Among Adults Aged 20 and Over: United States, 2013–2016. https://www.cdc.gov/nchs/products/databriefs/db303.htm
- Mayo Clinic, Persistent depressive disorder (dysthymia). https://www.mayoclinic.org/diseases-conditions/persistent-depressive-disorder/symptoms-causes/syc-20350929
- National Institute of Mental Health, Depression: What You Need to Know. https://www.nimh.nih.gov/health/publications/depression-what-you-need-to-know/index.shtml
- Anxiety and Depression Association of America, Facts & Statistics, https://adaa.org/about-adaa/press-room/facts-statistics
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