For centuries, many people in colder, cloudier climates have noticed that they feel less cheerful in the fall and winter months. The “winter blues” affect some people more than others, however. In these cases, symptoms go beyond merely feeling down. They can be overwhelming and interfere with a person’s daily activities. It’s estimated that about 10 to 20 percent of people have mild seasonal affective disorder, and 4 to 6 percent of people have a stronger form. Therapists further from the equator, where days are shorter in the fall and winter months, are likely to encounter people who are suffering from SAD. In this post, we’ll look at what SAD is exactly and several strategies you can use to help clients cope with it.
What is Seasonal Affective Disorder (SAD)?
Seasonal affective disorder is considered a type of depression that’s correlated with changes in seasons. While not restricted to fall and winter, most people who experience SAD do so during the months of the year when days are shorter. While it’s unclear why SAD affects some people rather than others, it is thought to be related to a person’s natural circadian rhythm being disrupted and/or a drop in melatonin and serotonin levels. Those who have major depression or bipolar disorder are at greater risk of SAD.
Symptoms are wide-ranging and may include:
- Feeling depressed daily, for long periods
- Losing interest in favorite activities
- Problems sleeping (either oversleeping or inability to fall/stay asleep)
- Changes in appetite or weight
- Feeling sluggish (winter SAD) or agitated (summer SAD)
- Difficulty concentrating
- Having a feeling of hopelessness
- Avoiding social situations
People who have SAD can’t easily “snap out of it.” They need help managing symptoms and reducing the impact of the disorder.
Strategies for Reducing SAD Symptoms
Several therapeutic strategies have been shown to help reduce the symptoms of seasonal affective disorder, and some clients may benefit from SSRIs in combination with one or more of these strategies.
CBT (Cognitive Behavioral Therapy)
Cognitive behavioral therapy is one of the best-proven ways to treat SAD long-term. A 2016 study of 177 patients revealed that CBT-SAD was superior to light therapy two winters following acute treatment. In fact, traditional cognitive behavioral therapy has now been adapted specifically for use with SAD (CBT-SAD). CBT-SAD is similar to standard CBT, using techniques like identifying negative thoughts and replacing them with more positive ones and using behavioral activation. But it is customized to the needs of the SAD client, helping them identify activities that help them to cope with problematic months of the year.
Light therapy is reported to be a helpful treatment for many people with winter SAD. With this treatment, the client sits in front of a light therapy box or visor that puts out very bright light (while filtering out ultraviolet rays). Clients will spend between 20-30 minutes daily using the light, typically first thing in the morning. (Side effects including eye strain, headache, and inability to sleep are often reported when the light is used late in the day, so morning is best.) Most people who benefit from light therapy typically experience improvement within a couple of weeks of beginning treatment. Note that light therapy may induce mania in bipolar patients.
Music or Art Therapy
Music therapy and art therapy have been shown to be helpful in a variety of types of depression. These therapies can provide an emotional release and can help to relax the body for clients who are stressed or anxious about their symptoms. Additionally, these therapies are thought to help clients increase social connection. While no study has shown music or art therapy to be effective on its own, these therapies can be a beneficial supplement to CBT and/or light therapy.
Additional Tactics to Try
In addition to therapeutic strategies, many people suffering from SAD report feeling better when incorporating a variety of different changes into their lives. You may want to recommend some or all of these to your clients as additional tactics to try.
Improved Diet — Excess sugar and starchy foods increase inflammation, which has been shown to aggravate at least some types of depression. Clients who reduce sugar and starchy foods and increase nutrient-dense vegetables and Omega-3 foods have reported feeling better.
Guided Imagery — Guided imagery has been shown to improve mood in a variety of patients, including those with multiple sclerosis and post-partum depression. Many therapists are using it to help manage a variety of types of depression.
Social Connection — Although people suffering from SAD typically want to avoid social situations, social connection has been proven to help improve depression. Clients don’t need to be with large groups of people to experience the benefits — spending a little time with a friend can go a long way in helping to ease symptoms.
Common but No Less Painful
Seasonal affective disorder is common, but those who deal with strong forms of it experience no less pain than other types of depressions. With the tools you’re already using regularly in your practice, you can greatly help clients experiencing SAD. Additional strategies work in tandem with these techniques.
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