When people visit a therapist’s office for help with their depression, they often don’t find the relief they’re seeking. That’s because much of the counsel that is traditionally given doesn’t offer the context people need to make sense of and preserve their mental well-being.
Here to share these missing pieces of perspective and strategy is Dr. Scott Eilers, a clinical psychologist and the author of The Light Between the Leaves: 6 Truths Your Therapist Won’t Tell You About Healing Depression and Trauma. Today on the show, Scott shares why the world of psychology doesn’t always offer the most useful explanations for why people can sometimes feel alienated from their own lives. We then talk about insights Scott has gleaned from science, nature, and lived experience as to the mindset shifts and habits that can help you stay sharp, steady, and engaged in life — whether you’re struggling with chronic depression, or just adrift in a low-grade funk.
Resources Related to the Podcast
- AoM series on depression
- AoM Podcast #741: The Exercise Prescription for Depression and Anxiety
- AoM article and podcast on Rick Hanson’s method of “hardwiring happiness”
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Transcript
Brett McKay:
Brett McKay here and welcome to another edition of the AoM podcast. When people visit a therapist’s office for help with their depression, they often don’t find the relief they’re seeking. That’s because much of the counsel that is traditionally given doesn’t offer the context people need to make sense of and preserve their mental wellbeing. Here to share these missing pieces of perspective and strategies is Dr. Scott Eilers, the clinical psychologist and the author of the book The Light Between the Leaves: Six Truths Your Therapist Won’t Tell You About Healing Depression and Trauma. Today on the show, Scott shares why the world of psychology doesn’t always offer the most useful explanations for why people can sometimes feel alienated from their own lives. We then talk about insights Scott has gleaned from science, nature, and lived experience as to the mindset shifts and habits that can help you stay sharp, steady, and engaged in life. Whether you’re struggling with chronic depression or just adrift in a low grade funk. After the show’s over, check at our show notes at aom.is/leaves. All right, Scott Eilers, welcome to the show.
Dr. Scott Eilers:
Thanks so much for having me, Brett. I am very excited to be here. I’ve been getting value out of listening to your podcast for a long time, and I’m excited to be able to hopefully give back a little bit.
Brett McKay:
Well, thanks for listening. I appreciate it. So you are a clinical psychologist who specializes in helping people with conditions like bipolar disorder and severe depression, severe anxiety. You got a new book out called The Light Between the Leaves. Basically, you share insights from your career, but also from your own life. You talk about in the book, you began your career as a psychologist because you were trying to seek treatment for your own depression. Can you walk us through your history with depression?
Dr. Scott Eilers:
Yeah, yeah, that’s exactly right. The first time I distinctly remember feeling a deep sense of depression was in seventh grade. I think that probably wasn’t actually the first time I experienced it, but you know how childhood memories are. They can be a little bit foggy. I know I was never exactly what you would call a happy child, but there was one distinct moment. I will never forget it, and it just came out of absolutely nowhere. This was in swimming class. So I’m in a swimming pool with my buddies in school, and all of a sudden I noticed I just didn’t feel any happiness. And it wasn’t even like I was bored or disinterested. It was, it was gone. My ability to connect with anything resembling a positive emotion was just shut down and it came out of nowhere and it didn’t seem to be about anything.
I felt like someone I loved had just died, but nothing had happened. And I was baffled and scared, and I remember I kind of crawled out of the pool and just sat on the edge with my head in my hands and I could hardly even talk. And my friends were like, did something happen? What’s wrong? And I didn’t even know how to answer them. And I remember I just went home and just laid in bed all day and I had no idea what was happening at the time. Only with the benefit of hindsight am I able to say, oh, that was a depressive episode, and it didn’t go away that day. It lasted quite a while. That first one lasted for weeks. And then at some point, I don’t necessarily remember exactly when or why it went away and I felt good again, and I wanted to go to school and I wanted to see my friends.
I wanted to do sports and do stuff. And I was like, okay, that was weird. I’m glad that’s over with. Little did I know I was going to be experiencing those on and off for the next 30 years. And that’s what’s been going on since is typically there’s no rhyme or reason to it. And this is how it is for most people with a cyclical mood disorder. So like major depressive disorder, bipolar disorder, it means we experience these things in episodes or in waves, and so you’ll have periods of time where your symptoms hit you very hard. They don’t have to be triggered by anything. That’s a common misconception. People will say, what are you depressed about? And there’s not always an answer to that question, but as an individual who does deal with chronic depression, there are simply periods of time in my life where I become pretty much unable to feel good about anything.
And for most of my life, I would be very non-functional during those periods disabled by them basically until I started to learn some tricks to stay functional and to navigate them basically. And yeah, as you mentioned in the intro, that’s the main reason I got interested in the field that I did. I thought now that I know, okay, this is a mental illness, I should probably study this. And if I can also do that for a living, hey, I can fix my own problems and help other people. And every time I’d get started in undergrad, getting my bachelor’s, master’s, doctorate, started working in the field and I kept waiting for the moment when I was going to start to hear stuff that would help me because that’s always been my barometer. Would this skill, knowledge, piece of information, whatever it is, would this have helped me at my lowest and about 90% probably of what I learned in my professional education and in my training did not pass that litmus test.
And then I was done. I was fully licensed, I was independent, and I still felt like I wouldn’t know how to help me if 15-year-old me walked through my doors Right now, I wouldn’t know what to do with that guy. So I’ve sought out a lot of other just information and strategies since that time because I realized the field I work in does not have the answers to my questions, not all of them anyway. And that’s when I started working on things like researching and writing and creating social media content because I figured maybe I’m not the only person who feels this way. And that’s kind of the brief summary of my journey with depression and how it relates to my career.
Brett McKay:
Well, there’s a lot to unpack there. The first thing I want to unpack and point out is this idea that your depression wasn’t caused by something like you said, I think it’s a common misconception people have about depression. It’s like, well, if you’re depressed, did you lose your job? Or did you have a traumatic childhood? And you talk about your childhood was pretty happy, no abuse or anything like that. But you nonetheless still had these depressive episodes. Do we know what causes that? Why are some people prone to depression like you experienced?
Dr. Scott Eilers:
Yeah, that’s a fantastic question. And really quick, I want to mention what you said about people asking why you’re depressed. Our terminology in psychology or in mental health, I honestly think probably needs a revamp. The same thing happens with anxiety, by the way. So depression and anxiety are diagnoses, major depressive disorder, generalized anxiety disorder. However, they’re also emotions and they’re emotions that every human being is acquainted with. Everyone knows what it feels like to be depressed or to be anxious. It’s just that people who don’t have a chronic mood disorder or chronic anxiety disorder only experience those emotions when they’re triggered by an event or a stressor or a problem. And so I think what that results in is a lot of people think they understand these things better than they do. Yeah, they think about, man, yeah, I lost a job and I was horribly depressed for a while, and then I got another job and it got better.
And so then they conclude if depressed people would just get jobs, they wouldn’t be depressed anymore. What cured my depression? And I don’t think there’s any malicious intent there. I think this is just a person not realizing that this same word is being used to describe two very different things and thinking that what worked for them, what also worked for someone who is chronically depressed. Unfortunately, while employment can be one of many, many things that can help with depression, it is most certainly not a cure all. But your question then was basically then what is this? Why does this happen to people? And that’s been one of my big disappointments in my field honestly, is that we don’t really know. We know some of the causes, some of the time there definitely appears to be some chemical or biological component to it. There are two neurotransmitters or brain chemicals that facilitate communication between your neurons or your brain cells.
Actually three really that seem to be implicated in many people’s depression. And they are dopamine. And that’s sort of like your reward chemical. So dopamine is the neurotransmitter that is used to produce feelings of joy or achievement or accomplishment. So you build something or you get a good grade on a test and you look at what you’ve done and you say, yeah, I did a good job at that. And you get that good feeling, right? That’s dopamine. Serotonin is usually a little bit more associated with anxiety, but it has some implications with depression as well. And serotonin is a neurotransmitter that makes you feel calm, relaxed, peaceful, at ease. It gives you that kind of just life is good. I’m pretty content kind of feeling. And then norepinephrine is more about regulating your physical functioning. So it helps you with energy, it helps you have an appetite, it helps you fall asleep at night, wake up in the morning.
And we do appear to see some disruptions in the functioning of these neurotransmitters in many individuals with depression. And that’s where psychiatric medication often plays a role in managing these conditions. But the exact functioning and makeup of those neurotransmitters seems to vary a lot from person to person. And there seem to be some individuals with depression who don’t really respond well to any medication which kind of makes people think is it not chemical in this person’s case? So it’s really, really difficult to pin down unfortunately. And that’s why we still to this day don’t have a foolproof like blueprint. We don’t have a treatment protocol that has a 95% success rate. The way a surgical procedure might have are most effective treatments for depression. And I would say there’s three, by the way, therapy, medication and physical activity, they’re about equal in terms of efficacy, but all three of those, generally speaking, have efficacy rates of about 60%.
So there’s a large number of people, a large proportion of the treatment seeking population that for one reason or another, don’t respond to one of those treatments. And my theory, well, I have multiple theories on that, but what I think that means as far as the causes of depression is I don’t think there is one. I think that at the risk of overcomplicating matters, what we currently call depression probably is more than one thing. If we really fully understood it, I think we would see this as a cluster of similar looking conditions that we’ve lumped together. But that’s purely a theory. I have no data to back that up.
Brett McKay:
Yeah, so it sounds like there might be a genetic component to this. Essentially the wiring you were born with makes you predisposed to that. In my life, I’ve had a couple of those more traditional depressive episodes and they were precipitated by stressful events. But sometimes I just get into these funks for no reason at all. And I think it’s because I just have this ingrained tendency to focus on the negative, and I’ve gotten a good handle on it over the years, but I think I’ll always have a disposition that’s more melancholic than average. And so I don’t think of myself as someone who struggles with depression, but it’s like I’m part of that cluster of similar things.
Dr. Scott Eilers:
Well, to your point there another factor that a lot of people, including myself think play a role is just simply a person’s personality. Some of us are just more prone to maybe bigger feelings in general. We know that emotional intensity varies from person to person. Some people just feel all feelings, pleasant and unpleasant, more strongly than others. Some of us are obviously more pessimistic and more cynical than others, and that’s just kind of the way we’re built or the way we’re wired. Some of us are more social than others, and while that’s not inherently a good or a bad thing, something else I see a lot, and I would very much say this has been a piece of my story is some of us are just our natural personality types that we’re born with that don’t really change, at least at their core throughout our lives.
Some of us are just a better fit for the world than others. And I seem to have a personality type that just doesn’t gel real well with society or at least most of mainstream society. And that’s an experience I had a lot growing up, especially when you’re with people your own age, the vast majority of your day, if you’re kind of in introverted, quiet, pessimistic, cynical, naturally kind of moody type person, a lot of times people aren’t real excited to be around you and you have a hard time, maybe especially in K through 12 years, maybe seeing the purpose of what you’re doing, not necessarily seeing how the things you’re spending the majority of your time on play in with bigger picture life goals or just anything that feels good or fulfills, you get pretty jaded and burnt out pretty fast. And so I feel like another piece of it for me, it’s like, yeah, as you said in the intro, I would not lay claim to have had an unusually difficult life.
I think that would be dishonest for me to say that at least in terms of events, like things that have happened in my life, but I’ve just never really felt like I belonged here in a super easy, natural way. And it frankly takes me a lot of mental effort to do things that I think come naturally for most people. Things like going to school, holding down a job, keeping friends. I have to work really, really hard at these things, and I have to reframe a lot of my natural thoughts and reactions because they tend to skew very quickly towards nihilism. Honestly, why am I even doing any of this? What does any of this even matter? And I’ve learned that if I don’t keep those in check, I pretty quickly just stop doing stuff and that gets dark pretty quickly. So I think there very much is just a personality component to it as well. And in particular, how does that personality interact with the world and with the way society is built, I think most of us probably see that some people just have a personality that’s naturally a better fit for sort of the norms of society and the expectations that get placed upon you. And for some of us, it just takes a lot more mental and sometimes physical effort to achieve those same outcomes.
Brett McKay:
So you mentioned you spent 10 years getting an education, you got your master’s, your doctorate in psychology, and then you didn’t find the answers that you were hoping you’d find. What do you think is going on there? Is it the way that traditional psychotherapy approaches treating people with depression that’s causing the problem, or is it just what you talked about? Depression is caused by a whole bunch of different stuff so no one really knows and you’re just kind of throwing spaghetti on the wall?
Dr. Scott Eilers:
Yeah, I think there’s a lot. I’ll give you kind of a broad overview here. I have a few different theories. One is definitely what you just said, and this is not unique to depression, by the way. I think this is many mental health conditions, but I think they’re far more varied and complicated than we currently recognize them to be. We see these clusters of symptoms and we say these people have fairly similar symptoms, so they probably have the same thing. I’m just not convinced that that’s the case. What I describe as depression, I’ve done real deep dives on my YouTube channel, for example, explaining all my symptoms, and there’ll be people that are like, I also have depression, but this doesn’t sound like me. So then is that even really the same thing? Are we calling some relatively similar things the same thing? And if so, treating them the same and possibly doing people a disservice.
So that’s one is I don’t think we fully understand what we’re dealing with. I think probably the biggest issue though is professional mental health is kind of at an odd crossroads where we’re a young field. I mean really a hundred years old, that’s nothing for a scientific discipline. And we’re at this odd place where we’re trying to respect the work of people pioneers in the field, people like Sigmund Freud, Carl Rogers, and then we’re also trying to become a more hard science through empirical research and double blind studies and our history and our data. I don’t think they sync up real well. So to give you an example, a really, really popular form of therapy or therapeutic orientation is what’s called person-centered or humanistic therapy. And there’s going to be people who are mad at me when I explain it this way. This is a super, super quick overview, but a large part of a person-centered therapy practice is the idea that the client, the person seeking therapy basically knows what they need to do, that they have the ability to kind of self-actualize and basically solve their own problems through having time and focus and support and reflection from the therapist to essentially just enable them to think out loud in the therapy session.
That would never have worked for me. I very much did not have the answers, no amount of me sharing how I felt was going to accomplish anything. That’s all I did. I spent 10 years basically wallowing and ruminating and telling anyone who would listen how I felt. Obviously they weren’t trained therapists, but I don’t think that was the limiting factor. I needed help. I needed direction, I needed strategy, I needed guidance. And these are things that we are somewhat discouraged from providing as professional therapists, and there’s a degree of wisdom in that. I don’t know what job a person should do. I don’t know what house they should live in. I don’t necessarily know which of these people they’re dating should they commit to, but there are things we know about mental health, and I get very frustrated when therapists refuse to acknowledge that we know roughly how a person needs to sleep more or less.
There’s a little bit of individual variation in that, but we know on average a person who’s getting about eight hours of pretty high quality sleep at around the same time every night is going to enjoy better mental health than a comparative person who isn’t doing that. We know we know. No, no, this is critical. That regular physical activity is literally equivalent in reducing symptoms of depression and anxiety to regular weekly therapy or psychiatric medication, like top of the line treatments, exercise matches it, and in some areas beats it. And yet there are so few therapists who will even ask a depressed person, what’s your physical activity level? Obviously I know that’s a little bit of a chicken or the egg thing. It’s hard to get anyone to work out regularly. It’s really hard to get a depressed person to work out regularly. I do understand that, but we’re not even having those conversations.
We’re not even planting those seeds. We’re not even asking those questions. It’s this very client-led process in so many cases, and that fundamental idea that this client has the ability to self-regulate and self-actualize and figure out their own answers, I’m sure it is true for some people. I can tell you it wasn’t true for me and it’s not true for the majority of the people I serve. These are people who are on the bottom of life looking up at everybody else, and they are lost and they are miserable and they are stuck and they don’t know what to do. They need way, way more than a sounding board in order to help them move forward. That’s what I think is probably the biggest issue in my field.
Brett McKay:
One question I had for you, and I’ve had to grapple with this as well. So this idea of depression might not necessarily be caused by something you just have, you’re predisposed to it. I mean, understanding that I can see can help you, okay, well, this is how I am and now there’s things I have to do to manage it, mitigate that, and we’re going to talk about some of those things that people can do. Exercise. I want to dive deeper into that for sure. But also I’ve experienced that when I think, man, this is just who I am, that even gets more depressing where you’re just like, ah, you kind of go in this death spiral. I was like, why do I have to do all this stuff just to be functional? So how do you avoid that, do you think?
Dr. Scott Eilers:
That’s a really good question. For me, a big part of it has been prioritizing because really there’s only two reasons a mammal does anything. They’re engaging in an activity because they’re either trying to move towards a desired outcome or away from an undesired outcome. That’s motivation. That’s all of human motivation can be boiled down into one of those two categories. And I think this answer might expand a little bit even beyond mental illness, but it has a lot of implications for chronic mental illness. If we accept that premise and say basically everything worthwhile that I can do either makes me feel more good or less bad, then it simply becomes a question of, well then what are my highest conviction actions? What are the things I can do that are going to move the needle the most? I think it’s really critical to think of that not just in the present moment, but as more of a cumulative outcome throughout your life.
What got me stuck for a long time is I tried to cope with depression by doing things that felt good in the moment. Some of those were blatantly unhealthy things like impulsive spending or substance abuse. Some were things that don’t necessarily appear unhealthy on the surface. I used to play a lot of video games. I don’t really believe there’s any direct harm in doing so. The problem is most of the things that feel best when you do them do nothing beyond that moment, they give you this big rush of acute pleasure and then they’re over and you’re back to square one. And so for a long time I was trying to treat air quotes, my depression by just doing lots of things that felt good, and I always just felt like I was chasing something I could never hold onto. And a big perspective shift for me was thinking of how I allocate my time and my energy and my attention, not just what would feel best right now, but trying to measure those things in terms of cumulative impact.
So like this morning when I woke up, well, I don’t work out instantly when I wake up, but I work out in the mornings, so I have a decision to make. I could spend 30 minutes playing a game on my phone or 30 minutes exercising. Now I like exercise more than most people, and yet even I will not make the claim that those 30 minutes of my life will feel better if I’m working out than if I’m playing a video game. At least not from a mental or emotional stimulation perspective. No, the game wins, but the exercise pays off again and again and again. I will feel good all day long from getting a workout in the morning. I will not feel good all day long from playing a video game for 30 minutes in the morning. In fact, I probably won’t even remember that I did it.
It’s just a downtime activity. And when I started thinking of my life in that way, when I started thinking of cumulative impact, that completely changed my framework. And once I realized these are high value activities because they produce not only some amount of joy right now, but future joy, I started to see everything in that realm, taking care of my nutrition, taking care of my sleep, taking care of my physical health, investing in relationships that matter to me. I really started to view all these things as almost like the equivalent of a financial investment. And metaphorically, if I somehow came into $5,000 today, the most pleasurable thing I could do with that $5,000 today is spend it. But I’d spend it on a bunch of stupid stuff I don’t even need. Whereas if I invested it, I get money for the rest of my life from that, from compound interest.
And I think that the activities or the strategies that help manage a chronic mental illness, I think of those as the equivalent of investments. And once you realize that that thing you’re doing isn’t just going to make you feel good right now, it’s going to make you feel good over and over and over again. You start to anticipate that reward. You start to anticipate that outcome and it actually becomes a more pleasurable experience. It becomes more enjoyable because you see the value in it at this phase of my life where I’m at my goal that the thing that feels best to me is basically to just keep my system as close to 100% as possible, as close to 100% of the time as possible. And being near that benchmark feels better to me than anything I can do just as an acute activity. In other words, I find it more enjoyable to do things that make it feel good to be me than to do things that feel good because again, I’m inclined in that same direction you are.
I’m not the guy who opens his eyes and hears birds chirping and says, God, I’m happy to be alive. I have to work for that. It doesn’t come naturally to me, but I have found that I can get there. If I take excellent care of myself and my mental health, I can live that way. And that does more for me than any hobby, any activity, any recreational thing could. So once you start to see kind of the proof of that, that’s when that least for me. I don’t know if this is a thing that works for all people or if this is just an idiosyncratic Scott thing, but once I really saw that starting to work, that’s when the switch flipped and I’m like, this is the top priority. And I don’t approach it as a grudging grueling, oh, I have to do all my mental health stuff today. It’s like, this is what I need to do to feel my best and that is my goal. And so there’s really not much else to think about. Once you get to that point.
Brett McKay:
So in this book, The Light Between the Leaves, it’s called that because what you do to figure out strategies or philosophies to help you manage your depression is that you look back at your life when you were the happiest. And a lot of the time you’re either at your family’s cabin in northern Minnesota or your grandparents’ farm, and you started thinking about those experiences and what they taught you, some metaphors that you observed from them that gave you insight on life. And the first lesson you talk about you got from your family’s cabin in Minnesota. What insight did you get from the isolation of your family’s cabin about how the mind works when we’re depressed?
Dr. Scott Eilers:
Yeah, that’s interesting because, so this cabin was on a peninsula between two lakes, and so there’s only one road in and out, and it ended a few houses beyond ours. And being in very rural northern Minnesota, this is a poorly maintained, it was like a forest road basically. And so there were quite a few times when we were there that we were stuck because if there were snow, mud, fallen tree, you can’t get anywhere if this road is blocked. And every time that would happen, the whole vibe would just change because even a very, very pleasant and wonderful place can feel like a prison if you’re trapped inside of it, especially if you can’t access anything that you need. And I remember those vibe shifts when we were kind of stranded there growing up. And I remember looking back on that first depressive episode that I mentioned earlier, it had a very similar feeling where it’s like I felt trapped inside of my own mind, and I knew that there were good things out there.
Like I said, I was swimming, which I loved with my friends, who I really liked. There was good stuff right there in front of me, but it felt like there was some kind of gap or barrier between me and all that stuff. And even though I knew it still existed, I couldn’t access it. And that was the exact same thing that would happen when that road was blocked. Like the hospital still existed, the grocery store still existed, but we can’t get there. We can’t access them. And I noticed that especially in my worst depressive episodes, I would feel further and further away from the world. I could feel myself withdrawing inside of myself, if that makes sense. And I don’t always find that an unpleasant place to be. I like thinking I often enjoy being in conversation with myself again, I’m a more introverted person, so that’s kind of my comfort zone, but not when I’m depressed.
When I’m depressed, it becomes a dark, abusive, scary place to be, but I can’t get out. I find it hard to engage with people. I find it hard to do things. And that I think was the biggest lesson there is that if you can’t access anything else, if you’re trapped within yourself, you cannot fix that problem by having good things outside of you. And that goes back to our earlier point. You don’t fix depression by just having a really good life. And if you could, I don’t think these aren’t people I claim to know, so I’m kind of speaking out of ignorance here, but you see celebrities, you see famous people who would appear at least to a naive observer like me on the outside looking in to have all of the things in life that most people want. They have respect and they have financial security, and they have time and freedom to chase their goals.
And yet these people, some of them struggle with depression and addiction and even suicide in some cases. And without knowing them, I can only conclude they had those things, but maybe they weren’t really able to feel them. Maybe they were trapped inside of their own minds, trapped inside of themselves and not able to access any of that goodness that they theoretically could touch in their own lives. And maybe that’s just me self inserting into their story, but I know that’s how I felt during those episodes. And that’s why I mean this kind of goes basically that my proposed solution to that problem is what I just said before you asked this question, which is that which I mentioned as being analogous to maintaining that road, your ability to care for your own mind. That’s the road connecting you to the rest of the world. And if that road gets blocked, if that road falls into disrepair, it doesn’t matter who or what you have because if you can’t feel any of it, it won’t be able to touch your depression and you will be miserable.
Brett McKay:
And so yeah, the things you can do to maintain that road to the cabin of your mind, like you said, that self-care stuff, getting enough sleep is a good one. Not too much sleep. Sometimes when you’re depressed you don’t want to do with sleep. So seven to eight hours of sleep eating. And then we talked about exercise. I want to talk about this. This is something you talk a lot about and your big proponent of exercise as a, we’ll call it a treatment for depression. What is it about exercise that makes it such an effective way to alleviate or keep your depression in check?
Dr. Scott Eilers:
Yeah, I think it’s so effective because it is multifactorial, and that goes back to our conversation earlier that depression in and of itself is likely multifactorial and therefore just any one thing is probably not going to be the answer for a person. But exercise really is more than one thing if you break it down to its core elements. So we know that there are neurochemical changes that occur when a person gets regular physical activity that are very, very similar to the changes that occur when a person is taking an antidepressant medication, for example. So there very much is a chemical component with exercise, but there’s also an achievement component. We know that if a person sets goals and then achieves those goals or even works toward those goals, that facilitates the release of dopamine. Now, sometimes depression blocks that, but if you have tangible proof, and that’s one of the things I love about exercise is you can track it, you can have data, you can have metrics.
Your depression can make you say, well, am I really doing a good job? But if you can prove like, no, I am getting stronger, I’m getting faster, my endurance is going up, my flexibility is going up, whatever your goals are. If you have data that says, no, I have demonstrable evidence that I am in fact achieving my goals, it’s pretty hard for your depression to argue against that. In many cases, physical activity is often something we do with other people. You take a class, you maybe play a sport, or even just joining a gym, even if you don’t talk to ’em, just depression is so isolating. And this is one thing I emphasize to people is even just being in a place where people can help with those feelings of isolation, even if you don’t talk to ’em, just doing something and then looking around your environment and seeing there are other people here doing what I am doing gives you a little bit of a sense of connection to other people and to the world in general that depression can often take away from us.
Many forms of physical activity can become hobbies, and so they are inherently pleasurable activities in and of themselves. When I say exercise, you don’t have to run or do weight training. Certainly you can, those things count. You could take up hunting, which might involve a lot of walking or fly fishing in a stream where you have to walk a mile against a current. There’s no reason it has to be an isolated thing that isn’t also fun or enjoyable. So I don’t believe in any magic bullets, but I would say if you asked me what is the single most impactful thing you have ever done for your own mental health, easy answer. It is getting into regular physical activity, which I really didn’t start doing until I was in my early twenties. That was the single biggest shift I experienced in my mental health. It did not fix everything.
It was not the cure. But that was a huge turning point for me where I did start to feel like I think I am actually turning the tide and winning this battle and maybe feeling okay more often than I feel miserable. And so it would be my highest conviction recommendation for anyone struggling with their mental health. It also, one more thing, I can’t even, there’s so much good it does. It’s hard to even remember it all. It also improves cognitive performance. So if you think like executive functioning focus, concentration, memory, organization, time management, it literally makes your brain work better because your brain uses blood and oxygen to do its job. And improving your cardiovascular fitness increases the amount of blood and oxygen that are available to your brain. We know that depression and many mental health conditions, they give you that brain fog, they make you feel slower, dumber, frankly. You get more forgetful. You need to take breaks more often. So it can help you get some of your efficacy back, some of your edge back. It makes you more effective at work, at school, in social situations. It’s hard to even give a full overview of everything physical activity does for your brain and your mood, but it is one of, if not the most powerful tools in our toolbox, in my opinion, and so underutilized in therapy. Yeah,
Brett McKay:
I agree with you. Exercise has been a game changer for me and with all these self-care things, with the sleep, the eating right, exercising, you talk about this, one of the things they do is they help your prefrontal cortex and your prefrontal cortex. I’m sure people have heard this sort of like the manager of your brain, it’s executive function. And one of the problems I noticed whenever I get into my funks is my prefrontal cortex is basically checked out and my brain does whatever it wants to do. And so I will go down this sort of negativity spiral, but when I’m living right, I’m exercising, getting enough sleep, not stressed out, that prefrontal cortex is there. Whenever I notice myself slipping into a funk, it can kick in and be like, oh, hey, we’re going to stop this now. We’re not going down that path. I’ve noticed that as well.
Dr. Scott Eilers:
Yeah, it’s exactly that. So one of the most important jobs of your prefrontal cortex is emotion regulation. So your emotions are generated in your midbrain and they’re managed in your prefrontal cortex. So there’s a little bit of a communication process that happens there. So your brain makes a feeling then tries to figure out what to do with the feeling. And so your ability to regulate your own emotions, which is to put ’em into context, figure out this feels like a catastrophe. Is it, am I overreacting? What would be a skillful response to this thing I’m feeling that will help me feel it less and not screw up my life? These are all prefrontal cortex tasks. And when your prefrontal cortex is functioning properly, sometimes you won’t even notice that you’re managing your emotions. I’ve made the metaphor as a big former gamer, anyone who’s played any realtime strategies games will get this.
It’s kind of like having anti-air turrets in your base. It will defend you from attacks that you don’t even know you’re under because it will just work and it will take the edge off those big scary feelings. Sometimes it’ll make you irritated instead of angry, stressed, instead of anxious, moody instead of depressed. It takes some of the edge off. It repackages things into a more manageable, more palatable form. And that’s why taking care of that road, taking care of your brain is so important because you will start to win some of your battles without even realizing you are fighting them. Some of your problems will seem as if they have magically disappeared and you won’t even know where they’ve gone. And the truth is they haven’t actually disappeared. Your brain is just finally managing them the way it’s able to when it is properly cared for. And then your emotions don’t require constant babysitting from you to deal with them, which is I think a place we’d all like to get to.
Brett McKay:
And going back to exercise, like you said earlier about as effective as psychotherapy and medication, but it’s not that expensive. You can go out and take a walk or jog that’s free. And unlike with medication where there can be negative side effects like loss of libido, the side effects of exercise are all positive.
Dr. Scott Eilers:
That’s true. And there’s two other areas where exercise actually wins out over therapy and medication. One is the onset of relief. So if you look at therapy and medication, average amount of time it takes to start feeling better in either of those treatment conditions is four to six weeks. And so those first few weeks of trying a new maybe get a placebo effect of like, oh, I’m feeling better in therapy or on this medication, but they haven’t actually really started to do anything yet. Whereas with exercise it’s two to four weeks. And so you potentially feel better more quickly with exercise than with therapy or medication. The other area where exercise wins is lower symptom relapse rates. So now that might be a little bit misleading because that might simply be because it’s easier to maintain. But if you get on an antidepressant medication, and by the way, I’m just going to give a brief side here.
I’m in no way against medication. This is not an anti-medication conversation, but this is just the truth. If a person’s on a medication and the medication makes them feel better, they basically have two choices, get off the medication later and feel the way they used to feel or stay on it forever. And I don’t know that either of those are super appealing, whereas with physical activity, you should keep doing it forever. It’s good for you, it’s a beneficial thing to maintain. And so we see lower symptom relapse rates with exercise than with therapy or medication probably because people keep doing it. It’s not like it’s magically, I don’t want to overstate my case. It’s not like fixing your brain structure or anything. It’s continuing to work because ideally you’re continuing to do it. And most people don’t want to be on medication for the rest of their life.
Most people probably also don’t want to be in therapy for the rest of their life. That’s not necessarily feasible. But we can stay physically active for our entire lives. And in fact we should. And there are other reasons I, I’m only approaching this from the mental health angle. Obviously it goes without saying that there are tremendous physical health benefits for staying physically active as well. But I’m saying even if you only looked at the mental health side of things, it’s still a pretty compelling argument. And there is a strong case to be made that that is the most effective treatment, at least for mood and anxiety disorders. If you look at other things, maybe not so much, but for what we’re talking about, you could make a pretty compelling case that it’s the gold standard.
Brett McKay:
Alright, let’s talk about another lesson that stood out to me. And it’s the idea that envy is ignorance. And you got this lesson while you were fishing in the lake by your family’s cabin and you and your sister had only caught little fish, but one day you caught this big monster fish and that got you thinking about what else might be lying in the dark depths that you couldn’t see at the bottom of the lake. And you compare that to how people, especially people with depression, because they have that stronger than average negativity bias, they feel like they’re just, they’re more screwed up than everyone else and they envy that other people seem to have better lives and that just puts them into more of a funk, but they can’t see to the bottom of other people’s lives you couldn’t see to the bottom of the lake.
Dr. Scott Eilers:
Yeah, that’s kind of a metaphor I’ve used to understand other people’s lives. Now, especially as a therapist, I often obviously am privy to some of those deep dark secrets. And that’s just reinforced the idea that everybody has them because many of the people I work with, you would never think there’s anything going on based on their family, their careers, their attire, their appearance. And so it’s just an important reminder for me that everybody’s got stuff. Everybody’s got darkness. You can’t see, and you may not ever know what it is, but don’t ever let yourself think it’s not there because that’s going to draw you to some really problematic conclusions about your own life. And this is not the most eloquent way to say it, but I said it this way in the book, everything that sucks about being you, but you don’t know what sucks about being somebody else, but something does, I guarantee you, something does. You just don’t know what it’s, and you got to remember that there is something so that you don’t end up just feeling despair and hopelessness about your own own life just because everything that sucks about being you.
Brett McKay:
And so any tactics that you found, I mean you talked about this idea of identify, locate and pursue to overcome this tendency. Can you walk us through that?
Dr. Scott Eilers:
Yeah, so that’s about recognizing what do you have in your own life that is already good because with that negativity bias, it is so easy for us to fixate on what we don’t have and on what we see in other people’s lives and identify, locate, and pursue, which is kind of a blueprint I use to help us really see and appreciate what we do already have. All of my therapy clients want something that another one of my therapy clients has and isn’t happy with. I’ll have a client who has a big family but has no time to herself, no free time. And she’s like, I just wish I had time to think and could just go on a vacation whenever I want and didn’t have to arrange all these things. And then I have a client who can’t have kids and she has all of that.
She has the freedom and the time and the money, but she just wants more people to share it with. And it’s like so often I see that where I’ll have two people thinking that the solution to all their problems is a thing that somebody else I know has and isn’t happy with. And what that has led me to believe is there’s no certain configuration of life that’s going to make you happy or not happy. And the biggest dividing line is the extent to which people are able to appreciate what they do have and accept what they don’t. There’s no way to put a life together where you get all the stuff you just don’t like kids versus time. I know I made that example already, but it’s hard to have a big family and a lot of free time. You kind of got to go one or the other there, or time versus money is another one.
Some people I guess have careers where they can make a great amount of money, not working a ton, but for most of us, we either got to pick, do I want to be able to achieve my financial dreams by working more or harder than most people or do I want to appreciate the fact that while money is tight, I have more free time, I have more autonomy, I have more flexibility. And so that I think is the biggest difference is not do you have all the stuff, but are you able to pull the joy out of what you do have and practice some acceptance of the fact that the things you don’t have, if you were to pursue them, you’d lose some of what you do have. Ultimately, once we get to adulthood, we’re all busy. We all have limited resources. Almost every move you can make is a lateral move.
Very rarely can you do something that just makes every part of your life better. And it’s usually, I could trade a little bit of this for a little bit of that and that makes one thing better and one thing worse, which is actually better. And I see people just constantly doing that, just trading and then being like, oh, I didn’t like that. I should go back. It kind of reminds me of people I know someone who kept moving back and forth from the city to the country. They’d live out in the country and they’d be like, I love the space, I love the nature, but I feel isolated. Then they move in the city and they’re like, this is cool. I got people around me. This is vibrant, this is exciting, but I feel confined, I feel trapped. My space is too small. And they just go back and forth for decades and it’s like, how do you not see what this is? There’s no perfect solution here. There’s pros and cons to each and you got to just pick one. And I think that’s how most things in our life work, to be honest. And it’s so easy to end up chasing something that just doesn’t exist, some perfect idealized solution.
Brett McKay:
This reminds me, we’ve had Rick Hanson on the podcast talk about this idea of hard wiring, happiness, and the big takeaway I got from him was, when you do experience those good things, first off, recognize, be open to those good things in your life and they could be small things and time with your kids a good morning just even you have a house you’re alive and really focus on that and soak it in and think, yeah, things are actually good. They’re not as bad as I think they are. I think that’s a useful practice to kind of, it’s basically counting your blessings essentially. And it sounds cliche, but it’s cliche. It works if you do it. So let’s talk about another lesson and this lesson that stood out to me was called Pull the weeds, and this is about an invasive species of plant and also some muscles that were in the lake near your family’s cabin that you got a lesson. I think we talked about this a little bit earlier about how things that look pretty or good and may not be that bad can actually crowd out the things that are better for you to manage your depression.
Dr. Scott Eilers:
Yeah, exactly. The muscles in particular is a perfect example because yeah, so they’re an invasive species. They’re not supposed to be in that lake. This is the same lake we were talking about before. But what’s interesting about them is they have a filtering effect on the water, and so they actually make the water more clear. And I loved how clear, I remember when I was a kid, there weren’t mus in there and I actually wish I was like, I wish, I hope we get zebra mussels because then the water will be even more clear to look like the ocean. And my dad was a big environmentalist and he was always like, no, you don’t want invasive species. I never understood, I get it. If they’re poisonous or carnivorous, if there’s direct harm, yeah, I get we don’t want that. But if all it does is make the water clearer, if it’s a flower that grows in a field and looks beautiful, what’s the harm in that?
But what I eventually came to understand is there’s direct harm and there’s indirect harm. And the reason that a lot of invasive species are undesirable, even if they don’t do anything, even if they’re not killing other native species, is they take up space, they take up resources. A flower that’s not supposed to be in a certain ecosystem still requires soil, still requires water, and it’s taking that from something that does need to be there. And that flower, while it may be beautiful, doesn’t necessarily provide any value to that ecosystem because it’s not part of the food chain there. The animals might not eat it. It’s just a pretty waste of space basically. And I think there are so many things in our lives that essentially function that way that are invasive species and that are basically pretty wastes of space. The biggest one for me personally was video games.
I really enjoyed video games and I think that they can be a great hobby for a lot of people, but what I noticed in my own life is that I enjoyed video games so much that everything else in my life kind of came second. And all these fundamental mental health behaviors that we’re talking about here today, those are things that I had to try to grudgingly jam into my day because I wanted to have several hours a day available for leisure time. Now, again, for me that was gaming. For some people that’s going to be binge watching your favorite shows doing whatever on social media. This could be anything, but I think it’s really, really important for us to all keep an eye out for what are the things in our lives that aren’t actually providing value to our ecosystem. They might be metaphorically beautiful, meaning this feels really good when you do it, and that’s fine.
I’m not saying you shouldn’t have those things, but you want to be mindful of how much space they’re taking up. Because as a therapist and a coach, one of the biggest things I hear from people when I try to give them guidance is like, I don’t have time. And don’t get me wrong. I know we’re all busy. I know that this life requires a lot out of us. If you really look at even just the amount of time most of us have to work to make a living, it’s a lot. And so I’m not trying to push back on that, as in you have 10 hours of free time a day, but the people who tell me they don’t have time to work out or to get eight hours of sleep, when we really look at their day, there’s usually several hours a day for most of them where they’re doing something that just produces acute pleasure.
And again, it’s okay to have a little bit of that, but if that becomes a cornerstone of your routine, if that becomes a thing you need, if that becomes a thing you prioritize over actual health, necessary behaviors and becomes a reason why you don’t do them, then your ecosystem is out of balance and your life has started to, or maybe has been taken over an invasive species by a thing that is growing unchecked and uncontained. And that can eventually take over your life, even if it’s not something with a physiological addictive element to it. Like drugs, for example. I personally, I identify as a video game addict. I believe that was an addiction to me. And even once I got to a point in life where I had a career and a family, obviously I wasn’t playing games eight hours a day. It wasn’t physically possible, but even when it was something that was only a couple hours, it was the only thing I really looked forward to because it felt so much better to me than everything else I did.
And so work and taking care of myself and even family to a degree, they started to feel obligatory. They started to feel like the things I had to get through to get to the part of my life that I really wanted to get to. And I hated that. I found that to be a miserable and unacceptable perspective for me. It’s like a full removal. I played games with my son and that’s, it was something I had to really pull out by the weeds. And a short while after doing that, I realized that I was starting to rediscover the joy that used to only come from games in the other parts of my life, in my work, in my family, in my relationships, even in things like working out and going to bed on time. Those started to feel good to me because they weren’t constantly being compared to this artificial source of stimulation and joy that provided me with this incredible audio visual experience that nothing consistent in a person’s regular day-to-day life can really replicate. And so it was basically addition by subtraction. My life got better by taking away something that I loved because it raised the average enjoyment of everything else that I did by comparison.
Brett McKay:
Alright, this last lesson I want to talk about, and it’s keep the water flowing, and you got this lesson from some backwater. What lesson did this backwater in the river teach you about depression?
Dr. Scott Eilers:
So that one, yeah, that one was a stream by my parents’ house and it was a pretty small stream, so there were places where there was no water flowing. And it’s interesting because a stream that has water flowing usually is very beautiful. It’s this clean, pristine looking water. But then you’ll see these little pools where the water doesn’t flow and it’s completely different. These plant matter and even dead fish, they start to decay in there and gases build up. They smell horrible, the water looks brown and disgusting, and this is the same body of water. So I look at these same two things that have very different properties, and the only difference between them that creates that different outcome is that one moves and one doesn’t move. And that is also something I have noticed in my own life is when there are periods of my life, when I’m stagnant, when I don’t really have a thing that I’m working on or moving towards, that gets dark quickly for me, that’s when I start to fall into those patterns of kind of hopelessness and nihilism and why am I even here?
What am I even doing any of this for? And when I have any goal to work towards, even if it’s not, I talk to people about uppercase P and lowercase PE purpose, uppercase P is like, why am I here as a human being lowercase P is like, it’s not something that helps all of humanity, but it’s something that’s meaningful to you. And as long as I have something that I am moving towards in life that gives me the internal feeling of a flowing stream of things are getting cleared out and cleansed, and I feel like I’m moving in a good direction. But when I hit those patches of life where I can’t find that and I lack that, I just feel stuck. I feel muddy. I feel gross. And so the lesson for me in that has been to try to always have something to be moving towards. It doesn’t always have to be something grandiose. It doesn’t always have to be something that benefits all of humanity, but just something that’s meaningful to you. And when you achieve that, move the goalpost again and find something else. Because I think we all need that sense of achievement or that sense of purpose to feel like our lives are meaningful or worth living. And if we don’t have that, things are going to get bad pretty quickly.
Brett McKay:
Okay. So yeah, find a hobby,
Dr. Scott Eilers:
Basically. Yeah.
Brett McKay:
Yeah. That’s basically it. And make sure the hobby doesn’t become one of those invasive species. Hobbies, like video games..
Dr. Scott Eilers:
Exactly.
Brett McKay:
I mean, you have a nice list here. Working out can be a hobby in of itself. That’s my big hobby. Of course, reading. My family likes to backpack. I enjoy that. So yeah, find stuff you like to do, stuff that helps you feel like you’re moving forward towards something and gives you some purpose. Something to look forward to. Well, Scott, this has been a great conversation. Where can people go to learn more about the book and your work?
Dr. Scott Eilers:
Yeah, I got a few options there. So I’m pretty active on basically all social media platforms. I have a YouTube channel and a podcast of my own, which is just the videos from my YouTube channel with the audio extracted. I also post short content on Instagram, TikTok, and Facebook. My personal website is Dr. Scott eilers.com. That’s got both my books on there. I also offer some personal one-on-one coaching. Those are the main areas to find me.
Brett McKay:
Fantastic. Well, Scott Eilers, thanks for your time. It’s been a pleasure.
Dr. Scott Eilers:
Thank you so much, Brett. I really appreciate it today. I hope people get good value out of this content.
Brett McKay:
My guest today was Dr. Scott Eilers. He’s the author of the book, The Light Between The Leaves. Until next time, this is Brett McKay reminding you to not only listen to the podcast, but to put what you’ve heard into action.
