Keeping Score on Depression, Anxiety, and Stress

I’ve taken two courses, The Science of Happiness and The Science of Well-Being where I was asked to answer a “happiness” survey each week and keep track of my scores to determine how the weekly material impacted my happiness.

When it comes to depression, anxiety, and stress, we’re usually aware when we’re suffering. But how do we bring awareness to times when we’re not? How do we gain insights into what helps us feel okay so we can do more of it? How do we recognize when we’re starting to slide so that we can apply some antidotes?

I was elated when Alex Korb’s Upward Spiral newsletter introduced me to the DASS 21 Depression Anxiety Stress Scale.

It’s a great way to improve awareness of areas you’d like to target, try an exercise to work on it for a week, and test again to notice progress or regress.

“The DASS 21 is a self report evaluation scale aimed at revealing the severity of symptoms that the patient suffers from and which can be associated with depression or anxiety or are consistent with stress manifestations.

“The scale can be used for screening, however, for diagnosis, the patient should be referred for specialist consultation.”

Give it a try.

Movies That Get Depression Right

“In thinking about depressing movies, many people don’t realize that all bad movies are depressing, and no good movies are.”–Roger Ebert

Movies in a Minor Key

In the year 2000 I experienced the blahs when it came to the movies. I couldn’t put my finger on what was missing. Were the comedies not funny enough? The action films not active enough? Then I saw The House of Mirth, a period piece about Lily Bart, an attractive New York socialite who starts drawing the wrong kind of attention. Her social standing takes a downward spiral as a result.

I came away from that movie feeling refreshed. It wasn’t that I disliked the character and felt that she got what she deserved. It was that I’d seen a film acknowledge that sometimes despite our best efforts things just don’t go our way. Instead of envying the protagonist’s triumph against all odds or wishing my life could be like hers, I felt compassion for Lily’s misfortune and gratitude that my day-to-day problems seemed more manageable by comparison.     

Movies That Get Depression Right

While escapist action and comedies can lift our mood when we’re having a bad day, when those days start to string together and there’s no end in sight, it’s surprisingly reassuring to spend time with others who have been there. At the very least, we feel less alone.

My favorite episodes of John Moe’s The Hilarious World of Depression feature listener recommendations of songs, books, and now movies that get depression right. The 45-minute episode brought back a flood of fond movie memories for me, and you can listen to it here. But, if you only have ten minutes to choose your evening’s entertainment. Here goes. 

Holy Wedlock! 

The pitch-black comedy-drama Melancholia starts with Earth getting obliterated by a slow-motion collision with the title planet, then flashes back to the fairy tale wedding reception and sibling squabbles that preceded our collective demise. “Even though the planet is about to be completely destroyed, Justine’s sister Claire is still telling her that she has to eat, and she has to take a bath, and things like that, and that’s ridiculous.”

In the ensemble comedy Bridesmaids, Annie’s life is falling apart. But when she finds out her lifetime best friend Lillian has gotten engaged, she’s determined to do whatever it takes to be the perfect maid of honor. “Annie has lost her bakery, her income, and her self esteem. Seeing the success of her best friend’s wedding and her new friend, the replacement friend, shows her another way she’s losing at life.”

The Writing Life

World’s Greatest Dad, Lance Clayton, dreamed of being a rich and famous writer but has only managed to make it as a high school poetry teacher. His only son Kyle is an insufferable jackass whose death in a freak accident offers him the greatest opportunity of his life. “He is not valued by anyone in his life around him, from his students to the girlfriend who seems to be drifting away, to his son. And then he finally gets recognition, and it’s even lonelier, even more isolating than it was before.” A dark comedy with a truly twisted premise.

The very funny odd couple road picture Sideways tags along with two old friends on a pre-wedding tour of wine country. Jack is a has-been actor and groom to be. His best man Miles is a never-was writer. “Miles suffers from nagging doubts and circular thoughts that keep him from really being present in the moment, anger with himself, and disgust mixed with envy toward Jack. He feels that maybe things would be so much easier if he could live a life like Jack where he just doesn’t care.”

The Hours tells the story of three women from different times and places linked by their yearnings, fears, and  search for more potent, meaningful lives. “It’s an extraordinarily accurate portrayal of being in such acute all-encompassing pain that the only thing you think can end that pain is death.”

Girls, Interrupted

Horse Girl is Sarah, a socially isolated arts and crafts store employee whose strangely surreal dreams challenge her ability to distinguish her visions from reality. “Alison Brie nails the secretive disorientation of psychotic depression perfectly.”

Girl, Interrupted is Susanna Kaysen’s account of her 18-month stay at a mental hospital in the 1960s. “The girls often feel like no one gets them, and even though they’re fighting with each other, they know that the only real people who understand what they’re going through are their fellow patients.”

The title character in Where’d You Go, Bernadette is a loving mom compelled to reconnect with her creative passions after years of sacrificing herself for her family. “It’s really hard to find movies that show people with depression who still have to get through each day like everything is fine. It isn’t all crying in a corner and fifteen minutes later everything is fixed.”

Wherever You Go, There You Are

Sam Bell is living on the far side of the Moon completing a three-year contract with Lunar Industries to mine Earth’s primary source of energy, Helium-3. It is a lonely job, and though his time on the moon is almost over, his physical and mental health are deteriorating. “At one point he drives away from the moon base and you see and hear him from a distance just break down and weep at his total alienation from the world and the apparent impossibility of escape from that prison of his deceptive mind.”

Aniara, one of the many spaceships transporting Earth’s fleeing population to their new home–planet Mars–collides with space junk and is thrown off her course. “One of the most fascinating and insightful explorations of hopelessness and despair that I’ve ever seen.”

Lost in Translation in Tokyo, and suffering from insomnia, Bob, a middle-aged American actor cashing in on his fame by making TV commercials for the Japanese market, and Charlotte, a neglected young American wife, cross paths one night in a luxury hotel bar and form an unusual friendship. “The main characters are functional depressives who arrive at similar emotional states from different directions and find common ground.”

Animated Alienation

Anomalisa is the stop-motion animation tale of Michael Stone, an author of customer service books, to whom everyone looks and sounds the same. One night, while on a routine business trip, he meets Lisa, a stranger with a unique voice. “It’s such a good representation of someone feeling numb to the world while also being a jerk.”

Inside Out is how adolescent Riley feels her life has been turned when her father takes a job in San Francisco and she’s uprooted from her Midwestern world. Pixar animation brings to life the emotions Joy, Fear, Anger, Disgust, and Sadness, who live in the control center of Riley’s mind. It’s “The movie that depicts depression the best because the character sadness fits it.”


Eternal Sunshine of the Spotless Mind‘s Joel is stunned to discover that his girlfriend Clementine has had her memories of their tumultuous relationship erased and seeks to do the same. “It spoke to the part of me that just doesn’t want to feel anymore, the desire to erase what’s in my brain and replace it with something that allows me to just be a normal happy person.”

Groundhog Day never ends for TV weatherman Phil Connors who is sent to Punxsutawney, Pennsylvania, to cover the annual Groundhog Day festivities, gets caught in a giant blizzard that he failed to predict, and finds himself reliving the same day over and over again. “It is another day like many before and many after that you wake up into and feel the same daunting inadequacies.”

Fantasy Figures

Lord of the Rings – Return of the King reveals the ultimate fate of Middle Earth in the final film of Tolkien’s fantasy trilogy. “The ring has such a powerful hold on Frodo, as did my depression, that he struggles with parting from it. But its release, of course, is the only way to save Frodo’s world.”

The Babadook is the sinister titular figure of a disturbing pop-up storybook that shows up on Amelia’s doorstep six years after the violent death of her husband. Her efforts to get rid of the nasty book prove every bit as challenging as the out of control behavior of her six-year-old son. “It’s a very creepy movie, but it is equally creepy about the possible supernatural explanations and maybe the psychological ones.”

Finding Strength in Numbers

Stand by Me, based on the Stephen King novella “The Body,” is the semi-autobiographical story of an overnight hike by four adolescent Oregon boys who seek the body of a boy who had been struck by a train. “The kids in that movie were all processing some kind of trauma in ways that any middle school kid would immediately recognize.”

The Station Agent is a film about three people with nothing in common, except their shared solitude, until chance brings their lives together. “I just love how it speaks to the reality, without exaggerating it or making it larger than life, that we can be in pain with other people but still not be on the same page of pain.”

Four Tendencies Toward COVID-19

“Knowing our Tendency can help us set up situations in the ways that make it more likely that we’ll achieve our aims. We can make better decisions, meet deadlines, meet our promises to ourselves, suffer less stress, and engage more deeply with others.” – Gretchen Rubin

COVID-19 Anxiety

Since we’re living in the midst of a global pandemic, there was never a question whether I would write about COVID-19 anxiety, but how I would write about it.

The answer: with a little help from Gretchen Rubin, who is “known for her ability to distill and convey complex ideas with humor and clarity in a way that’s accessible to a wide audience.”

I laughed more while reading her book The Four Tendencies than at any comedy series I’ve seen in recent years. Its insights into human nature are so spot on.  

She writes, “We all face two kinds of expectations—outer expectations (meet work deadlines, answer a request from a friend) and inner expectations (keep a New Year’s resolution, start meditating). Our response to expectations determines our “Tendency”—that is, whether we fit into the category of Upholder, Questioner, Obliger, or Rebel.”

In this time of worldwide uncertainty, let’s see if we can use it to “suffer less stress, and engage more deeply with others.”

If you’re not certain of your tendency, click here to take the quiz

Obligers Need Outer Accountability 

Obligers meet outer expectations (work deadlines, answering a request from a friend) but are challenged by inner expectations (keeping a New Year’s resolution, starting a meditation practice).

They are likely to do well with all of the outer expectations recommended by the Centers for Disease Control and Prevention.

The challenge obligers most likely face is the inner expectation of managing anxiety and stress.

I spoke to an obliger friend on the phone yesterday. We were scheduled to meet in a city park where we could enjoy some Vitamin D producing sunshine, get some exercise, and have a conversation while maintaining the appropriate social distancing. He was too anxious to leave his apartment.  

I disclosed that I’m a member of the high-risk group because I have asthma, but I feel it’s more important than ever to remain physically and emotionally healthy. Outdoor exercise is ideal for that. 

We laughed a lot during the phone conversation, also good for boosting the immune system, and agreed to touch base next week.

Fellow Obligers, Upholders, Questioners and Rebels can all be accountability partners to help Obligers manage stress.

Upholders Need to Know the Rules

Upholders meet both outer expectations and inner expectations. To the extent that they have clear rules about what to do, (like the CDC instructions above) they’ll follow them. 

The challenge upholders most likely face is disruption to routine.

On Monday, March 16, my partner and I had tickets for an Oregon Symphony concert. On Thursday, March 12, I learned that all March Oregon Symphony concerts had been canceled.

As a writer, I’m used to scrapping my first idea when it doesn’t pan out, so I found a live performance of the piece by the featured artists from the canceled symphony concert on YouTube. We heard the same music, by the same performers, in concert, via video. 

Upholders sometimes have trouble thinking outside the box when schedules change, but Obligers, Questioners, and Rebels, who are more used to changing plans, can offer alternate solutions.  

Questioners Need Reasons

Questioners meet inner expectations and outer expectations only if they make sense. I am a Questioner.

Before I read Mark Manson’s article “Things Are Not As They Seem,” I wasn’t sure whether the COVID-19 scare was as big a deal as the media made it out to be or just a really bad flu.

His blog post explained that it was both. 

On a personal level, I should be extra vigilant and follow guidelines so as not to get or spread infection. On a societal level, the pandemic could overwhelm the healthcare system and create a worldwide economic depression.  

Since the media tends to focus on the sensational, they are exacerbating the problem by fueling the exact anxiety and stress that weakens our immune system. 

It made sense for me to follow social distancing recommendations, wash my hands, avoid touching my face, and continue exercising, meditating and other healthy practices, but not to dwell on the larger societal issues I could not control.

The information I’d share with my fellow Questioners is that our individual risk is low if we follow the guidelines, but our social risks are high if we don’t.

Rebels Need Freedom to Choose

Rebels don’t meet inner or outer expectations.

While out walking, I happened upon a Rebel who was speaking to a neighbor about how this whole face touching thing was nonsense. He demonstrated his lack of fear by rubbing his hands over his face. The neighbor, whose wife was in a high risk group, looked horrified.

I spoke to the Rebel from a safe social distance, but didn’t mention that the reason for not touching your face with unwashed hands is that it’s easiest for coronavirus to enter the respiratory system through the eyes, nose, or mouth. That would have worked for a fellow Questioner, but not for a Rebel.

Gretchen Rubin suggests the way to persuade a rebel is to appeal to their values of freedom and self identity and to offer information, consequences, and choice.

To appeal to freedom, I might have tried:  

“You know, if we don’t social distance, wash our hands, and avoid touching our faces, the next step is likely to be martial law. How might we avoid that?”

Rebels also hate being told what they can’t do. “I’ll bet that you can’t avoid touching your face without washing your hands or remember to cover your coughs for 24 hours, let alone fifteen days.”

Rebels also love choice. “The only three ways I can think of to deal with possibly contaminated surfaces are hand sanitizer, hand washing, and using disposable tissues or towels to touch things with. Can you think of other ways to tackle that problem?”

Twenty Second Exercise

The Ten Percent Happier with Dan Harris podcast posted an episode entitled “How to Handle Coronavirus Anxiety.” 

Two 20-second practices mentioned on that episode, can help us stay safer. 

Washing Our Hands for Twenty Seconds:

To time your hand washing, try reciting these friendly sentences based on the World Health Organization’s definition of mental health: 

May we be well in body, thoughts, and feelings.

May we face and cope with life’s inevitable stresses.

May we work productively to benefit ourselves and others. 

May our actions contribute to our community.

Reason it works: Upholders will follow the rule. Obligers will do it for others. Questioners might appreciate that studies have shown metta (friendliness) practice makes us less anxious. Rebels: give it a try or come up with your own twenty-second habit-forming tool.

Twenty-Second Mindfulness of Facial Sensations

Notice how often you put your hand to your face. Bring awareness to the sensation that immediately precedes it.

When you notice an itch, turn your attention to the sensation for 20 seconds, or as long as it lasts, with genuine curiosity.

Use the time to reflect on whether you’ve washed your hands since last touching a possibly contagious surface. 

Reason it works: Upholders will follow the rule. Obligers will take care of themselves in order to protect their loved ones. Questioners will appreciate the reason for the pause. Rebels might enjoy the freedom this exercise gives them from a life long habit.

Bonus Materials:

How to Do Social Distancing Correctly (8 minutes)

How to Protect Yourself Against COVID-19 (1 minute)

Faith, Doubt, and Small Change

Any small change we make to treat depression has to be an act of faith because built into depression is doubt in its cure.

Faith Without Doubt

Before a Qigong/Tai Chi practice session last Thursday, the instructor asked me if I had other spiritual practices. I mentioned that I meditate daily and participate in a mindfulness discussion group on Saturday mornings. 

He said that he had been reading an article about one of the world’s major religious figures and was trying to understand the difference between faith and faith without doubt.

Though I couldn’t put the difference into words on the spot, it’s something that the authors of the original mindfulness manual had addressed as well.

The next day I took a shot at an answer. The instructor had done enough research on the work of Roger Jahnke to muster the faith he needed to give Integral Qigong and Tai Chi a try. As he practiced it, he experienced the benefits of the movements for himself. By the time he decided to train so that he could teach the technique, he had arrived at faith without doubt.

Doubt Without Faith

In The Upward Spiral: Using Neuroscience to Reverse the Course of Depression, One Small Change at a Time, Alex Korb writes, “The big problem with the downward spiral of depression is that it doesn’t just get you down, it keeps you down. All the life changes that could help your depression just seem too difficult. Exercise would help, but you don’t feel like exercising. Getting a good night’s sleep would help, but you’ve got insomnia. Doing something fun with friends would help, but nothing seems fun, and you don’t feel like bothering people.”

I’ve written about my own seasonal tendency toward a downward spiral in “Depression’s Early Warning System” and “Help to Make it Through the Night.” My sleep cycle gets out of whack, I perceive simple exercise to be much more daunting than it actually is, and I’m less inclined to socialize.

Habit and Neuroscience

Two things keep me doing what’s good for me in the absence of tangible reward. Habit and neuroscience. I’ve made a conscious effort to form habits around sleep, taking walks, and scheduling social connection because neuroscience tells me how and why they’re so beneficial.   

Korb’s neuroscience does a good job calling out the culprits of depression. “The prefrontal cortex worries too much, and the emotional limbic system is too reactive. The insula makes things feel worse, and the anterior cingulate isn’t helping by focusing on the negative. On top of that, the prefrontal cortex has a hard time inhibiting the bad habits of the dorsal striatum and nucleus accumbens. Depression is so hard to overcome because each circuit pulls the others downward.” 

Ironically, it’s understanding why what I’m doing isn’t making me feel better that helps me stick with it…until I feel better.  

The Upward Spiral

Korb writes, “It turns out that positive life changes actually cause positive neural changes—in the brain’s electrical activity, its chemical composition, even its ability to produce new neurons. These brain changes alter the tuning of your brain’s circuitry and lead to further positive life changes. For example, exercise changes the electrical activity in your brain during sleep, which then reduces anxiety, improves mood, and gives you more energy to exercise. Similarly, expressing gratitude activates serotonin production, which improves your mood and allows you to overcome bad habits, giving you more to be grateful for. Any tiny change can be just the push your brain needs to start spiraling upward.”

Ten Minute Exercise

In the Upward Spiral section of the book, Korb offers enough scientific information on the effects of each small change (or well-being practice) to give you faith in trying it.

Since most can be achieved with little effort, read through these small changes and decide which you’d like to try first.

Choose a Small Change  

The circuits that allow us to plan and solve problems when we’re not depressed are the same ones that lead to anxiety and worry when we are. The simple act of making a decision, any decision, makes things begin to feel more manageable.

None of these small changes are silver bullets for depression, so there’s no need to worry about choosing the perfect small change to make. 

Soak Up Some Sun 

Getting at least a few minutes of mid-day sunshine helps boost the production of serotonin, which improves willpower, motivation, and mood. It also improves the release of melatonin, which helps regulate your circadian rhythm and improves sleep, which improves just about everything.   

When I mentioned my seasonal (winter) malaise to a friend, he loaned me his light therapy lamp, and the tiny amount of faith I had in it based on hearsay from folks who use them overrode the doubt I had in trying it. I needed only enough willpower to carry it home, set it up, and plug it in. I noticed enough improvement in my energy and sleep cycle to give me faith to buy my own. Stay tuned.

Move Your Body

I have faith without doubt that moving my body is my most effective tool for battling depression. It helps with energy levels, makes decision making easier, reduces stress, and I’ll be devoting a separate post to the laundry list of other well-being benefits soon.  

Notice that I didn’t use the word exercise. I do a few minutes of push-ups, sit-ups, and stretches every morning that I consider exercise, but, perhaps based on how much my gym clothes stank when I’d forget to bring them home to launder on weekends, I still think of exercise as a duty rather than a pleasure. 

By contrast, for most of the year, I enjoy my daily outdoor walks, which is a way to get exercise without thinking of it as exercise. Only when it’s cold and rainy do I think of walking as exercise. 

Over the last several months, I’ve also added Qigong/Tai Chi to move different parts of my body than I move during my walks.


I wrote about the importance of (and tips for) sleeping better in “7 Shocking Links Between Sleep and Depression.” 


This one is so basic that you don’t have to decide to do it. But, if you decide to breathe to alter energy and mood, remember that breathing slowly and lengthening exhales reduces anxiety. Sharper inhales and faster breathing increase energy.


I had one of my biggest a-ha/duh moments when Korb explained that while we might need a biofeedback device to understand our respiration, heart-rate, etc. our brain doesn’t. Monitoring these things is literally what our brain does for a living. A-ha! Duh!

Given that, here are some biofeedback techniques he recommends.  

Splashing cold water on your face quickly calms you down. 

Want to improve your mood? Try singing along with your favorite playlist, smiling, or laughing. The brain doesn’t distinguish between real and fake laughter. (I guess that explains how the laugh tracks on old sitcoms tricked me into thinking that the shows were actually funny.)

Wearing sunglasses can prevent squinting, which keeps our brow from furrowing, which tricks our brain into thinking we’re slightly upset. (I suspect that this has to be balanced with getting enough sunlight.) Other tips include relaxing your jaw if you store tension there, or clenching and deliberately relaxing muscles.

Spend Time with Others

Though I can and do meditate and practice Qigong/Tai Chi on my own, there’s a benefit to spending time with other people. This reduces pain, anxiety, and stress, and improves mood.

Conversations with friends and family are great, but if you’re really not up for it, scheduling time to engage in a shared weekly activity with others is small change. 

If all you’re up for is surfing the web or drinking a cup of coffee, doing it at a library or coffee shop can be beneficial.  


According to Korb, one of the best things about gratitude is that the more hopeless you feel, the better it works. It also greases those social dopamine circuits to make interactions with others more pleasant.

 My two favorite techniques for working with gratitude are three good things and finding silver linings.

Other Small Change

Developing positive habits or breaking negative ones is also helpful, but I’ll save some habit tips and tricks for another post.

And seeing a therapist can help you pinpoint areas to work and a wider range of therapies when the small changes aren’t enough.    

Bonus Exercise:

Alex Korb’s TedX Talk “Simple Steps for Strengthening Your Brain’s Circuits of Resilience” clocks in at under 10 minutes.