Finding a pathway to hope: reflections from a psychiatrist

You may be feeling hopeless. That wouldn’t be shocking, under the current circumstances. Reading the headlines, one can’t help but remember the beginning of the pandemic, when we were reading about “flattening the curve” and overrun, understaffed hospitals.
Additionally, the dark days of winter can be a difficult time for many, even under the best of circumstances. Losses from the year become highlighted, family dynamics are under strain, and we may expect to feel far more hopeful than our reality allows.

As a psychiatrist, I help others find ways to cope with hopelessness and move forward, rather than sinking into despair. Fortunately, many brilliant and dedicated individuals have provided me with tools and techniques to utilize in this effort.

For example, a description of hope that I have found helpful, particularly in recent months, was developed by Dr. James Griffith, a professor and chair of the department of psychiatry at George Washington University. Dr. Griffith proposes that hope is an action we can take, rather than an elusive feeling we await.

Designed as brief interventions to target demoralization in patients with chronic illness, Dr. Griffith teaches his psychiatry residents his concept of “hope modules” during their training.

Following Dr. Griffith’s guidance when working with patients, I encourage them to shift from the question of “What has happened to me?” to, instead, “How did I cope?” Not only does this stimulate a mindset of action and resilience, it also activates different structures in our brain, including the prefrontal cortex. I think of this area as the “competent, reassuring parent” of the brain, assessing risk, making decisions, and confirming things are getting done.

Additionally, this shift encourages us to mine our past for coping mechanisms that resonate with us individually. For example, when we have had painful or difficult experiences, did we reach out to our family or friends for more support? Or perhaps we sought comfort through spiritual practices or by engaging more fully in our work or volunteer roles?

Returning to these options, rather than attempting a laundry list of coping skills suggested by experts, has a higher probability of benefit due to its specificity and prior efficacy. We then can move more readily into action mode, rather than feeling overwhelmed by sadness or demoralization.

Another potentially helpful approach to mitigate feelings of hopelessness is based on the concept of mindfulness—awareness and acceptance of the present moment. When we are under stress, our minds may take us either to the past, where we ruminate on mistakes or missed opportunities, or to a catastrophic, frightening future.

Often, my patients suffering from depression will not only view their prior decisions through a negative, self-critical lens, but they will also perceive these regrets as part of an ongoing and pervasive tendency to mess up. A singular argument with their spouse after a forgotten task generalizes to “I can’t get anything right.”

Another journey our thoughts can take is imagining a future filled with disastrous events. Faced with uncertainty, our anxious mind starts making predictions, but the only outcomes it entertains are destructive. “What if case numbers continue to climb and my children’s school closes again?” Our brains then drag us through all of the potential calamities this feared outcome will create.

Why do our thoughts take us to these dark places? What could possibly be the benefit of living in a painfully negative past or an imagined, terrifying future? We are back to our desire for certainty again. Perhaps by agonizing over past mistakes, we can be certain to never repeat them. Or by anticipating a threatening outcome, we can get a head start coping with it, rather than feeling blindsided.

Fortunately, though these experiences are common, applying evidence-based treatments like cognitive behavioral therapy, we can begin to notice, categorize, and shift our thoughts. Additionally, by practicing mindfulness, bringing our awareness to the present moment, we are neither reliving nor anticipating negative events.

Take a moment and ask yourself, “How am I right now? Am I safe? Am I healthy? Is my family safe and healthy? Am I making choices to keep moving forward?” Remind yourself that the only true certainty is what we are doing at this exact moment. The more we can engage our attention in the present, the less our mind can torture us with what might have been, or could possibly be. There is only now.