In the spirit of World Mental Health Day in Oct, our long-time partner, Bearapy, published a book to mitigate the gendered stigma surrounding mental health. Facing mental wellbeing is a challenging task in itself, but imagine having to tackle it from an even more disadvantaged position? Though many may not realize or be willing to admit, it is more taboo for men to open up about their feelings and emotions as compared to women. Part of this is due to cultural reasons, but it is something we can work together, as a community, to change. Sharing stories about those that have struggled or are struggling with mental health is the first step to acceptance. This book provides the perfect example for this. This book includes a collection of personal stories shared by men in China. Knowing that other people out there share similar troubles as you do makes each challenge appear less daunting, and makes it just a little easier to face. Besides personal anecdotes, the book also emphasizes the importance of sustaining a healthy lifestyle. Eating well, eating on time; sleeping more, sleeping on time. These are basic steps to improving our mental wellbeing that are often overlooked by those who are overly driven towards work and success. So, what are you waiting for? Click here to read the book: https://view.joomag.com/noch-noch-going-mental-men-do-get-it-going-mental-men-do-get-it/0390556001526482910?short #reading #mentalhealth #mentalhealthstory #Bearapy

As we approach the end of summer, we will be saying our farewells to another generation of high school students leaving Beijing to study abroad. Though many have taken notice of the difficult transition from going to high school in one’s hometown to living independently in a country 7000km away, we often overlook that it is an equally, if not more, challenging transition from the parents’ perspective too. In collaboration ESC, a college counselling firm, CandleX held a Parent Support Workshop on June 24 2018, aimed to address advice on how to support your children for when they leave college and how to deal with it as a parent, too. After the workshop, parents had the opportunity to ask our speaker specific questions and also to discover local resources for continuing their education in mental health development. This event is only one of the many CandleX organizes. We pride ourselves in our proactive outreach in the local Beijing community. One of the ways in which we like to do so is by organizing and facilitating workshops for different community groups. So, if you have any questions regarding emotional support and guidance, or any interest in collaborating with CandleX in organizing mental-health-related events, do not hesitate to reach out to us via our email (info@candlex.cn) or visiting our website for more information (www.candlex.cn). CandleX’s Resources Read CandleX psychoeducation articles to learn essential knowledge on depression CandleX Classroom https://www.candlex.cn/classroom Depression stories from our community members CandleX Column | My Story with Depression https://www.candlex.cn/my-story-with-depression A CandleX production on Depression The Tiny Little Box | A Documentary on Depression Bipolar Disorder Campaign MoodLab Book #B Support Group Support Group Sign Ups Support Group: Interview with the Beijinger

Wow. Can’t believe it has already been a month since our CandleX Dinner and Bingo Night on 27th April 2018. CandleX dedicates itself towards the Beijing community by creating opportunities for anyone and everyone to gather, converse and share ideas. For those of you that came to this dinner, or have attended any CandleX event, we are sure that you can speak for how welcoming and friendly the environment is, and how inspiring it is to speak to people you may not have had the chance to before. This Dinner and Bingo Night was a great testament of just how much fun everyone can have when we take that step into our community, and we were so thrilled that the tickets for this event were sold out in a matter of days! A huge thank you for all of those who came to this amazing event; thank you Melena, for being an exceptional host; Thank you to our sponsors Q2U and Arcade by Hatchery, for providing us with a beautiful venue to host this event at, New World Beijing Hotel and CHEERS for generously providing awesome bingo prices. Special thank you to Clarissa and Sharon for donating their time and making the effort to make a change on mental health. Incredible work for keeping the event so incredibly organized (not to mention Sharon’s yummy homemade soup!) The night was filled with excitement and laughter. Who knew bingo could get so competitive? All the proceeds of this event will be going towards the continuation of our biweekly mental support groups, specifically to support the attendees who are students or unemployed. This Dinner and Bingo Night is just one of our many events to come! So, for those of you that couldn’t make it to this event, keep an eye out for other upcoming opportunities for you to bond with the community. We look forward to seeing even more of you at our next event. #Community #CandleX #support #mentalhealth #Beijing #mentalsupportgroup

Third year completed! Today marks the third year anniversary of CandleX. Instead of an article specifically written for the audience, it seems to be more like one of my journal entries: I decided to just let my thoughts flow. The CandleX media platform is for public education, raising awareness, and publishing newsletters regarding recent events or outstanding achievements. I am truly grateful and proud that we’ve been running for 3 years, with programs that make meaningful changes to people’s lives. Celebrations are usually devoted to achievements; this article, however, is about our challenges- something behind the curtains. As Maya Angelo once said, “Maybe the hardest part is, if you teach, you have to live your teaching”. We promote being honest with our feelings, acknowledging them all, and accepting them. One of my personal advocacies have always been allowing yourself to be vulnerable. Now this journal is my effort in embracing my own learnings and teachings. Three years ago, when I first had this thought of promoting mental health in Beijing, I felt my life had finally aligned with the universe. There’s no formula to know what the best job for you is, and what the meaning of life is. But I trusted this- you know it when you know it. In that moment, I was so certain. Without hesitation, on 1st April 2015, a few days after that thought emerged, I founded CandleX. In these three years, four major programs kicked off, one after another. We are on the media, and in people’s daily conversation. The founding of CandleX was like travelling in a rock that I wasn’t even aware that I was boarding. I’ll figure it out along the way, I thought. The first ‘figuring out’ was the Mental Health Peer Support Meeting. When CandleX first started out, we were mostly doing public education on depression and bipolar, in schools and communities. Half a year in, after the first program became stable, I started thinking about setting up a peer support group for people going through depression. Why? Because I was looking for one during a major episode I was going through, and I couldn’t find community support with the culture that was the most suitable for me. I had to go through that alone, and I don’t want others to go through the same thing. I remember going through a round of consultation with people of different backgrounds regarding this idea. One important question was raised: what if a suicidal participant joined the group to seek for support, but still took their own life; it puts the organization at such high risks. I know the risks are real: I volunteered at a NGO in Thailand that provide services to people with alcohol and depression issues. They’ve had many issues being in close contact with the group, and one did took his own life. The unfortunate truth is, for some others, getting just support group help is not enough. Was I fearful of running into this risk? I was. I was afraid that if someone died, people would say: “But they came to the support group. It mustn’t have been helpful!” Or even having the responsibility fall onto the group: “Did something happen in the group?” Without clarification and understanding, outsiders may have this impression. Should I just play it safe and not go through with this idea? But when I sat down, in the silence of it, I heard another voice: it came from me, the old me who was in despair and sunken in hopelessness. If someone is on the fence about their life and death, we should taken upon the responsibility of placing some more meaning and weight on ‘life.’ With compassion and empathy, they will lean towards life. There will be many lives saved I cannot give into fear. Some fear is toxic, and we won’t be able to live free and full. With toxic fear, lives that could have been saved will be lost. Without knowing how many would actually use this service, in Oct 2015, the first CandleX mental health meeting was posted online. I waited in the meeting room by myself. To my surprise, seven of us came together for the first meeting. Since then, I’ve facilitated countless meetings on this very sofa that sat many who needed love and support. Behind this closed door, tears are shed and stories are told: some cry during our opening meditation, and some even step in and find their friend or acquaintance that are already here. I would hear people say “It’s a relief to know X came to the support group too. I always admire X.” Being in the support group free us from the pain of feeling like a failure. We all sometimes feel like a failure. You don’t have to be alone on this. My job as a facilitator of the support group is to create a place for people to listen- listen with our minds and our hearts, and listen without judgement. Just listen, for real. How easy is that! I want to create a safe space. That’s why there’s the screening process ensure the intention of the participants. Come here to heal, not to prey, not to give advice and not just to simply “help others”. Sometimes, these meetings make me slightly anxious. Even with the screening, you don’t know whether there would be someone there with a personal, hidden agenda. Over the last 3 years, there were many bumps along the way. There have been many moments when I felt stressed out, disappointed and frustrated, as well as many moments I felt proud, grateful and truly happy to be running CandleX, because it gives me a sense of direction and meaning. It was, after all, the path I chose for myself. This is my three-year letter to CandleX for holding me true to what I teach the public. “Be honest with our feelings; it’s okay to be vulnerable.” That has made me a better version of myself. “Maybe the hardest part is, if you teach, you have to live your teaching.” - Maya Angelo. Happy 3rd Year Anniversary, CandleX. With love, Xiaojie

Starting today, we are going to bring to you our “Depression Essential Series” that answers all of your questions about depression. This series is composed of multiple coherent, and progressive articles to complete your picture of “What is depression?!” In this series, you’ll find information that will help you to understand the basics of depression. For example, “What is the average age of onset of depression?”, “I am feeling bad, am I depressed?”, “What causes depression really?”, and “I have a friend who’s depressed, how can I help?” Without further ado, fellow students, lesson 1 begins. Stepping out of bed. It’s easy to take for granted. You work, eat, play, sleep, and get out of bed the next morning. Seems simple. But if you’re one of 1 of 25 million individuals in the United States living with major depression [1], sleep isn’t always so easy. Neither is navigating your daily life, or having the ability to enjoy time out with friends, make simple decisions, enjoy hobbies or go to work. Depression is More Common than You Think According to the WHO (2016), an estimated 350 million people of all ages suffer from depression around the world [3]. Globally, major depression is the leading cause of disability. While major depressive disorder can develop at any age, the median age at onset is 32 [4]. As many as 1 in 33 children and 1 in 8 adolescents have clinical depression [5]. When can Depression Happen? Depression can happen at any time in a person’s life. According to the American Psychiatric Association, “the peak period of development is between the ages of 25 and 44 years; onset most often occurs in the mid-20s.” [7] In our next lesson from CandleX Classroom, we’d elaborate on the depression symptoms. How Long can Depression Last? This is when they experience many of the symptoms of depression for 2 weeks or more. The American Journal of Psychiatry has found that a depressive episode can last up to 6 months, and that “between 50% and 85% of people who experience 1 major depressive episode will experience another in the future” [8]. Not everybody experiences depression for the same amount of time, or the same number of times, so it is important to be understanding when a person is going through cycles of episodes in depression. It is important to realize how common depression is so that we can get rid of the stigma towards it. Now that we have taken the first step in learning about depression, in the next CandleX Classroom lesson, we will look at what it feels like to have depression – its symptoms. You can always come back to our library by clicking on “Learning-Classroom”,or go to our website for the archives under ”Columns-Classroom”. References Serious Mental Illness (SMI) Among Adults. http://www.nimh.nih.gov/health/statistics/prevalence/serious-mental-illness-smi-among-us-adults.shtml http://www.healthline.com/health/depression/facts-statistics-infographic#1 WHO Depression Fact Sheet.http://www.who.int/mediacentre/factsheets/fs369/en/ U.S. Census Bureau Population Estimates byDemographic Characteristics, 2005 Center for Mental Health Services, U.S. Dept. ofHealth and Human Services, 1996 MayoClinic, 2013 http://i1.wp.com/knowingneurons.com/wp-content/uploads/2013/10/depression_k3.png American Psychiatric Association. Diagnostic andStatistical Manual of Mental Disorders, 4th Edition, Text Revision. Washington,DC: American Psychiatric Association; 2000. Mueller TI, Leon AC, Keller MB, et al.Recurrence after recovery from major depressive disorder during 15 years ofobservational follow-up. Am J Psychiatry. 1999;156:1000-1006.

Welcome to the second class in our first chapter of “Depression Essentials Series”. Our last lesson was on general background of depression mainly on the prevalence of depression. Now, today we are going to dive into the core essentials: the symptoms of depression. Without further ado, fellow students, Lesson 2 begins Symptoms of Major Depressive Disorder What is it like to experience depression? What are its symptoms? Depression is more than just feeling sad, or having a rough patch, it changes how you function day-to-day. Although people going through an episode of depression may not experience all the symptoms, here are the most common symptoms of depression according to the Diagnostic Criteria for Major Depressive Disorder and Depressive Episodes: Zoom in on your phones to get a better look at these words associated with depression Symptom Differences in Men and Women Depression can happen differently in men and women, even though they share the common signs and symptoms. By understanding the differences between depression and men and women, it can help those who are suffering. Below are charts taken from Diagnostic and Statistical Manual of Mental Disorders, giving the difference in symptoms for men and women, and also some common symptoms they both share: A New Perspective: Teenage Depression According to the World Health Organization, “Worldwide 10-20% of children and adolescents experience mental disorders. Neuropsychiatric conditions are the leading cause of disability in young people in all regions.” [8] Although the signs and symptoms can be seen clearly in older ages, sometimes it can be difficult to tell whether teenagers are experiencing depression, or if it is behavior that is associated with teenage behavior. From the official Help Guide for Parents to Teenage Depression, they advise: “A certain amount of moodiness and acting out is normal for the course with teens. But persistent changes in personality, mood, or behavior are red flags of a deeper problem. If you’re unsure if your child is depressed or just “being a teenager,” consider how long the symptoms have been going on, how severe they are, and how different your child is acting from his or her usual self. Hormones and stress can explain the occasional bout of teenage angst—but not continuous and unrelenting unhappiness lethargy, or irritability.” Severity of Depression Symptoms Not all depression episodes are the same, so it is important to keep in mind that two people going through the same illness may experience different levels of severity in their symptoms. The symptoms of depression are categorized into three levels: Mild, Moderate, and Severe. To understand what these mean, we will use a chart taken from the Diagnostic Criteria for Major Depressive Disorder and Depressive Episodes: What do we mean by moderate and severe impairment? The symptoms that we experience with depression have an impact on our daily lives. How severe our symptoms are can also show how much it can affect the quality of our social life, our personal life, and also our relationships with ourselves. Sometimes Depression Can Look Different but Similar The circles above represent other conditions that can share the same symptoms as depression. It is important to know that depression can even happen at the same time as these conditions as well, and is equally as important to pay attention to. Knowing that there are different levels of severity of symptoms in depression can help us all have a better understanding of why the same treatment can work differently for two people who are experiencing the same mental illness. Just because one treatment was effective for one person may not be the same for the other person, because they can be going through a different level of severity when it comes to depression. Now that we know about the different levels of symptoms in depression, join us next class where we will talk about all of the different causes of depression. Class dismissed! You can always come back to our class by clicking on “Learning-Classroom”, or go to our website for the archives under “Columns-Classroom” References http://ereidmiller.com/wp-content/uploads/2016/03/signs-and-symptoms-of-depression-anxiety-and-depression.jpg http://mindyourmind.ca/sites/default/files/images/illness/Depression_Infographic.jpg http://a3145z2.americdn.com/wp-content/uploads/2015/04/these-are-the-first-signs-of-depression-that-everyone-ignores.jpg https://www.uspharmacist.com/article/women-and-depression-does-gender-matter-43010 http://www.helpguide.org/articles/depression/teen-depression-signs-help.htm Diagnostic Criteria for Major Depressive Disorder and Depressive Episodes http://www.psnpaloalto.com/wp/wp-content/uploads/2010/12/Depression-Diagnostic-Criteria-and-Severity-Rating.pdf University of Washington, PSychiatry and Behavioral Scienceshttp://uwaims.org/nyscci/files/slides_dsm5-diffdiagnosis_2014-01-30.pdf World Health Organization http://www.who.int/mental_health/maternal-child/en/

Depressed in Beijing? Sometimes we do not know if our bad mood has gone out of the norm and become a depression. Welcome to lesson 2.2: How do I know if I have depression? Please read lesson 2.1 if you need a refresher about what the symptoms of depression are. Today we will be speaking about self-assessment. When we speak about depression within a community or at an event, one of the most frequently asked questions is: “I sometimes feel sad, very stressed, and depressed. But how do I know if I have depression or not?” Do I have depression? Online depression self-assessment tools provide great access to awareness of your mental health. Sometimes, they are called “mood-assessment tools.” The tool is often designed in the format of a questionnaire, which with your answers generates a score to determine your mood, and, accordingly, to recommend some excellent resources to help you better understand how you feel. While there are many tools available online, the quality of these platforms varies. It’s very dangerous to use tools from unknown resources as they can misguide or mislead you. Find out about your mental state by using the Patient Health Questionnaire (PHQ) One of the most recognized, reputable, well-researched, and widely used tools is the Patient Health Questionnaire (PHQ). It was designed for use in the primary care setting, but later became a public domain resource that is available without cost in several languages. If you want to take this test, we recommend you to take the test on the website of Mental Health America, a leading community based NGO in the United States since 1909 with the mission of helping people to achieve wellness by living healthier mental lives. Here’s PHQ-9 in an online assessment friendly format. Resources and reminders will be provided after your submission of your answers. We particularly like the remarks for results that show signs of depression: they recommend you to also take the bi-polar disorder screening to increase the accuracy of the self-assessment. It’s very important to know this, so as to consider the appropriate treatment (e.g.: medication, etc.). While the causes and effects of different psychiatric disorder are often worlds apart, their symptoms can be misleadingly similar. Important Reminder to our Audience Never ever trust an assessment from an unknown or unverified resource. Self-assessment tools are not diagnostic tools, they are meant only for self-assessment. You can use this questionnaire to monitor your moods and patterns over time but remember, it is not meant to replace a consultation with a psychologist if you are struggling. If your score comes out alarming, please know that it’s common to experience depressive episodes in life. Our “Depression Essential Series” provides you with the fundamental knowledge you need to cope with depressive moods or episodes: Lesson 1: an overview of depression around the world; ŸLesson 2: the symptoms of depression in detail to be used as a reference for your own moods; ŸLesson 3: the causes of depression in detail (looking at neurological, biological and genetic factors). Just know that when our brains are unwell, it takes time to get recover. There is no shame in experiencing difficulties with any organ (just like our liver or lungs), brains included. Your own awareness, patience and self-love during this time will help you to heal faster. Lastly, if you find yourself struggling alone, just know that you don’t have to struggle alone. We have a peer support group in Beijing that meets every other Tuesday, and we support each other when we go through episodes of depression, mania or anxiety. Take a look at what Kristen Bell recently said about anxiety and depression. It's a heartfelt and informative read. #Beijing #depression #China

For people in Beijing, have you noticed that your mood changes depending on AQI (Air Quality Index)? Yes, environment has a big influence on our mood, and when it’s getting too much, we say: the pollution in Beijing really makes me depressed! So what else makes us depressed? Let’s begin today’s lesson by looking at the most common causes from the angle of environment. The causes of depression are probably the most difficult one to explain. There are so many factors involved: genes, biology, and psychology (which we have it in a separate lesson.) Not to try to complicate things, today we are adding one more fact: environment. Oh yes, this one more factor of environment alone is like an ocean. So many fish is in here, but we are going to pick out only the biggest and most obvious ones for you folks. We are dividing the environment factors into the following categories, which we will go into details one in each lesson: Life events Early losses and trauma, medical problem In today’s class, we are going to take at the various life events that can lead to depression. Life Events Some of our life events are adverse that can increase our chance for depression. We list here the most common factors cross culture, nations, and race in this chart. These are all major life events that can cause a great deal of stress in a short period of life. In some situations, this environment can be more long lasting than one likes it to, and that’s chronic adverse life situations. (This list is not exhaustive) Now, sometimes we might have more than just one stressor at one time. That’d increase our chances for depression. One stressor weighs down like dozens when even just one more is added on life. Once these stressors are removed, one would start to feel better. However, it takes great deal of energy, patience and time to remove that especially when you are recovering from a major relationship breakup, or trapped in a bad job. It’s also important to know that, just having stressors do not cause you depression. Your own threshold for depression holds the bar. This is where other factors are important: genes, psychological factors (https://candlex.org/2016/07/01/depression-essentials-series-lesson-3-symptoms-of-depression/). When we talk about personal resilience, we mean our resilience to life adverse. (it’s okay. We put it here just so you know how difficult it is to peel off the depression factors as they are so intertwined. The chart only shows the relationship between two variables: gene and adverse events. Don’t forget we are not looking at psychological factors, air pollutions, and biological factors here yet. So the treatment is complicated and healing takes time too.) So really don’t place too much blame on yourself or label you as weak. Some people got the long genes; while some of us got the short ones. Yes, you can partly blame it on your ancestors temporarily and partially. Self-blame is the enemy for self-healing. Now you know the importance of life style, or life choices. These are often situations that you get into little by little, and sometimes without even realizing it. How do we make sure that we are on the right track? Self-awareness is the foundation for all other building blocks. Realize your strength and weakness and fully accept yourself, cultivate love and kindness in our life value that underpins all key pillars that hold up your life, and setting boundaries in your social and professional life can all help. We are all different, but these things have proven to be effective in building up a healthy life. In our next class, we will explore how trauma and childhood loss can be related to depression. (This article is edited based on Harvard Medical School Mental Health article：what causes depression? http://www.health.harvard.edu/mind-and-mood/what-causes-depression )

Welcome to the third class in our “Depression Essentials” series. In our first lesson, we learned about the prevalence and general background of depression. In our second lesson, we learned about the symptoms of depression. Now, today we will jump into the next lesson of CandleX Classroom series, the causes of depression. What are the causes of depression? One often asks why depression happens. Is it a real sickness? Does depression only happen to people with weak will power? Can I get it from my family? What’s happening when someone is depressed? What do you mean that your brain get sick some times? Well, mental illness is an outcome of a complex malfunction of the brain. Science has made significant progress in understanding the causes, but there’s no single answer. We now know that, mental health is related to genes, biology, neurology and psychology. Neurological Changes But why do these symptoms happen when someone experiences depression? What is going on inside that brain that causes it? As it turns out, depression affects the connection between the cells in your brain, called neurons. [1] So what that means, is depression can cause a decrease or increase in these connections and increase or decrease in cell growth in three areas of the brain: the hippocampus, the amygdala, and the thalamus. The picture above shows you where the Hippocampus is. The hippocampus is in charge of your mood and your memories. Depression causes decrease in cell growth here. The amygdala is associated with emotions, such as anger, fear, and pleasure. When you are remembering past experiences, your hippocampus brings back the memory, and the amygdala brings back how you were feeling when you experienced a memory. The thalamus receives most sensory information and sends it to the cerebral cortex. Think of the thalamus like the secretary that sorts out your emotions and sends the information to the rest of the brain. Depression can cause too much cell activity here. Biological Changes Depression has biological explanations, and can be triggered by environmental factors, like stress. When depression is triggered by stress, it affects the hippocampus. That’s why treatment that uses the molecule serotonin can be helpful for people with depression! Serotonin is a chemical molecule (neurotransmitter) made in the brain that sends messages between brain cells that affects things such as mood, also known as the happy chemical because when you are feeling good, there is serotonin being released. More importantly, serotonin helps to trigger a process called neurogenesis, which pretty much means that it helps your brain cells make new connections, as seen in this picture below. Our brain has SO many neurotransmitters that help us function, and serotonin is not the only neurotransmitter that can be affected when someone has depression. Some other important neurotransmitters include dopamine, norepinephrine, and GABA. When our neurotransmitters are out of balance, they can change the signals between our neurons, and can make them either too strong of a message or too weak of a message. We focused mainly on serotonin here, but for more avid learners, we will release a more detailed explanation of neurotransmitters in the future! Genetic Is depression genetics relevant? Yes. When looking at genetics, studies have found that changes in certain spots of your genes can make you more vulnerable to depression. According to the National Institute of Health, the serotonin transporter gene can have a long version or a short version. Having the short version makes people more vulnerable to depression, because the shorter gene will cause the cells to produce less serotonin. [5] This can explain why depression can possibly run in the family, since you get a copy of the gene from each parent. There is psychological factor that plays a big role in mental health. Stress, trauma, anxiety also contributes to depression. There are much more factors involved than we explored today. So we are going to expand on these later in this column one by one. By now, we hope that you would stop thinking that depression is a sign of weakness. We all get sick sometimes, some people are more prone to breast cancer or a heart disease, and others might be prone to depression. It’s tied to the genes, and the environment. Next time you see someone with depression, be kind and caring like you would be to a patient with cancer. After all, depression already takes away their ability to love and care for themselves, your love and care for them can help them to recover. Reduce the stigma, don’t take part in the stigma! Stay tuned for our next CandleX Classroom lesson, where we learn what to do when someone is depressed, and how to seek support. Class dismissed! Reference ASAP Science (2014, August 19) The Science of Depression http://v.youku.com/v_show/id_XNzU4NzUxMjIw.html?f=20321745 http://www.health.harvard.edu/mind-and-mood/what-causes-depression Medscape http://img.medscape.com/news/2015/dt_150204_hippocampus_800x600.jpg https://www.mdc-berlin.de/40955216/en/news/archive/2013/20130513-serotonin_mediates_exercise-induced_genera/Nervecells_After_Running.jpg Short Serotonin Transporter Gene Increases Risk of Depression NIH Study http://www.nimh.nih.gov/news/science-news/2003/gene-more-than-doubles-risk-of-depression-following-life-stresses.shtml

Meet Lin. She is in her 30’s and living in Beijing, China. Lin is successful, smart and likeable. She has many of the things she always wanted: a great job, a loving husband, a nice apartment and a car. But recently Lin has been suffering from depression. She has been feeling low, hopeless and has very little energy. Even daily tasks seem like a huge challenge. She thinks, why do I feel this way when I am so lucky? Why do I have these feelings and not my friends? You may think that depression only happens to those who are unfortunate, mentally weak, or traumatized. The truth is, it can happen to anyone (according to our CandleX’s mental health peer support group review 2016, many who seem to have it all can also be suffering from depression). Many of us have been in a similar situation to Lin where we question why we experience depression even when things seem to be going well and we know the intense guilt that goes along with this question. If life events and family history (genes) don’t fully explain who is at risk of depression, what are the other factors that can contribute? In today’s class, we are going to tap into another factor: psychological factor. We are going to present to you two opposite words: vulnerability and resilience. Some people have a higher vulnerability to depression than others. This is not their fault or due to personal weakness. People with high vulnerability have a higher risk of developing depression, especially when they experience stressful life events that can trigger depression such as, the end of a relationship, losing their job or losing a loved one (Go to Lesson 3.1 for environmental factors). On the opposite end of the spectrum some people have high resilience. Resilience is the term psychologists use for the ability to adapt to stressful life events and ‘bounce back’. Having higher resilience reduces the risk of depression and other mental health problems. Our vulnerability/resilience to depression is linked to our genes, social support and environment but it is also linked to psychological factors: how we think and respond to stress. There are many psychological factors that affect resilience. In this lesson we will be looking at 4 factors from the smallest level, our individual thoughts, to more holistic factors such as self-esteem. Thinking patterns Personal vulnerabilities Self esteem Coping style All of these factors are important because factors at the higher levels can affect factors at the lower levels and the other way around. We will also explain practical steps that you can take to help strengthen your psychological resilience. Thought Patterns Let’s start by looking at the smallest level we can: our individual thoughts. Can the thoughts we have make us more vulnerable or resilient to depression? The short answer is yes. According to Cognitive Behavioural Therapy (CBT) principles what we think has a big influence on our emotions and our emotions effect how we behave. It’s not just the external events that happen to us that make us feel a certain way – it’s the thoughts we have about them. David Burns (1981) developed a list of common “thinking errors” or “cognitive distortions” still widely used in CBT today. These thinking errors increase our vulnerability to mental health problems and negative emotion. Any of these sounds familiar to you? Mathew Whalley, 2008, www.psychologytools.com//unhelpful-thinking-styles.html CBT is an evidence based treatment which helps to prevent unhelpful thinking through several techniques including straight talking- becoming aware of our own thinking errors and using sets of questions to see if they are really true or not. Using CBT techniques to combat thinking errors can help reduce symptoms of depression and build resilience. If you are interested in learning more about thinking patterns and CBT try Moodgym, a free CBT skills development program produced by the National Institute for Mental Health Research (NIMHR) at the Australian National University. The program includes exercises and quizzes to identify your own thought patterns and is totally free. Just follow the link below and create an account. https://moodgym.anu.edu.au Note this program is not designed to treat clinical levels of depression and should not be used as a replacement for seeking advice from a health professional. Areas of Personal Vulnerability Moodgym looks at areas of personal vulnerability that can feed into or result from our thought patterns. These areas are bigger than just our individual thoughts and tap into the needs and beliefs we have. These are: The need for approval The need to be loved The need to succeed The need to be perfect The sense of feeling deserving The sense of being able to influence all things The sense that happiness is contingent upon external things People who score highly in these areas tend to be more vulnerable to depression. Some of the areas may seem surprising. For example, we all have a need to be loved- why should that make us more vulnerable to depression? It’s true we all need to be loved but if this need is very high it can make us more psychologically vulnerable because when others reject us or don’t show us love we think this means we are unlovable and are likely to have thinking errors such self-blame and personalization. The need to succeed and the need to be perfect can both be seen as great things, especially here in China where the school system pushes students to aim for perfection all the time. Both of these needs can be positive but at very high levels they make us more vulnerable. When we have high levels of perfectionism we see anything that doesn’t meet our own high standards as a failure and often don’t see the positives we have achieved (filtering) and beat ourselves up or are self-critical when we don’t succeed or reach perfection. You are highly encouraged to use Moodgym for self-awareness on areas of personal vulnerability. https://moodgym.anu.edu.au Your thought patterns, and value sets directly affect your two important indicators for your psychological residences: self-esteem, and coping style. Self esteem So our thoughts can affect our emotions- and these feed into our needs, beliefs and goals. All of these influence and can be influenced by our self-esteem, which is how we view ourselves: positively and deserving of happiness or more negatively. Many studies have linked low self-esteem to depression. Low self-esteem is a symptom of depression. When we are depressed we often feel inadequate and worthless. But much research also shows that low self-esteem is a risk factor for developing depression in the future. This is called the vulnerability model: low self-esteem reduces our resilience which makes stressors (difficult experiences) more likely to trigger depression. Jessica Hunt, 2014, www.slideshare.net So why is self-esteem so important for resilience against stressful life events? It has been suggested that people who feel better about themselves less likely to internalize stressful events and blame themselves or be overly self-critical. This might make them less likely to have “thinking errors” such as personalization and self-blame. Luckily, low self-esteem is something we can all work on. One technique to try is this self-affirmation exercise. This exercise aims to help you focus on our positive attributes rather than the negative. Make a list of at least five qualities or attributes you know you have and that you value. Write a short paragraph about why the quality is important and how you tend to express it. Also try noticing your negativity. Try to talk to yourself like you would someone you love. So when you notice a negative thought directed at yourself try to change it to something more positive that you would say to a friend. Coping Style So according to CBT our thoughts affect our emotions but and our emotions affect our behaviors which can reinforce our resilience or make us more vulnerable. For example: what do you do when you face a stressful event? The answer depends on a lot of things including: the type of stressful event and the resources you have at hand. However, it also so depends on your personal ‘coping style’. That is the types of thoughts and behaviors you tend to use to help get you through difficult times and minimize stress. This could be anything from calling a friend to watching a happy film. Some coping strategies make us feel better in the moment but are unhelpful in the long term. This is called negative coping. These coping methods can include actions such as, being aggressive to others, drugs, alcohol, excessive eating and self-harm or mental states such as, denial, withdrawal and blaming others. Relying on negative coping skills increases vulnerability to depression as they do not address the problem or how we think about it. One of the best ways to change the coping techniques you use is to make a coping plan- a list of coping strategies. Here’s how: What do I do now? Write down the coping strategies you use now when you are stressed or something bad happens. Are any negative (help at the time but not long term)? If so cross out the negative coping strategies. If you want you can put them in “try not to….” box. What else could I try? If you want to try some new coping strategies write down some other positive coping strategies you could use. Crisis Plan- sometimes our own coping skills aren’t enough so finish your coping plan with some outside sources who can help in a crisis such as family and friends, hotlines or emergency services. Keep the list somewhere easy to get to when you need it. It is important to write these things down before we feel overwhelmed or are faced with a crisis and can’t think clearly. Two Steps We wanted to finish this lesson with 2 straight forward steps you can do today to have a positive impact on your psychological resilience. Try Moodgym: follow this link https://moodgym.anu.edu.au and sign up for a free CBT skills development program. Make a coping plan: to help you use positive coping strategies next time your stressed. This wraps up the whole lesson 3 on “Cause of Depression”. The reason we name is “causes” is because that’s what’s asked. However, there’s no direct causal relationship that can be simply explained. The “causes” are messy! What we do know is that, your genes matters, your environment matters, and your psychological factors matters. While we cannot change the genes (thus, do not blame yourself for everything), we can do something about our environment, and our psychological patterns. So stay hopeful, work on yourself. Lesson 3.1 Causes of Depression- Neurology, Biology and Genes Lesson 3.2 Causes of Depression- Environmental Factors (Part 2: Life Situations) Lesson 3.3 Causes of Depression- Psychological factors

Mental health in China for expats has been an under supported sector. In the capital alone, there are over 200,000 expats (Xinhua Net, 2012). Many are facing the constrains of limited number of psychologists in Beijing, let alone qualified and English Speaking ones; On top of that, mental illness in China is heavily stigmatised, and the ignorance of depression basic knowledge stops the majority to even seek help. One of the great fears for those living with mental illness is that in revealing their struggles to others, even close family and friends, it will result in incomprehension at best and severe judgment and social derision at worst. To open yourself to someone near to you and be judged as weak, melodramatic, crazy or even worse is certainly a terrifying proposition. But what is so easily forgotten is that discovering the compassion of others is how we truly know friendship, and how we know who are true family are, both in blood and heart. And more importantly, that this fear is what may hold us back from an even more amazing experience, the opportunity to show compassion to others. Welcome back to CandleX Classroom! In this session, we’ll discuss the important topic of self-care by answering the Frequently Ask Question #1: “Should I tell others that I have depression?” followed by to who, when, what and how. Lesson 4.1: The Art of Telling- to tell, or not to tell This is the common question people ask themselves when in times of depression, when they know they need help, but have many concerns: My friends probably will think that I am weak if I told them, wouldn’t they? Am I going to lose my job if tell them? But if I don’t, I am not really performing anyway… I don’t want my parents or spouse to worry about me. This is our advice, for major depression, please do tell others. It’s the first step in seeking help, and just be aware that not everyone will understand, or know how to respond to that. But some will, and they’ll be your life pillars through the episodes. Level of Depression is the Primary Factor for Consideration There are different levels of depression: mild, moderate and major depression (for more details on the symptoms, please go to “CandleX Classroom” lesson 2 in classroom) Regardless of what level you are at, the purpose of telling others should always be helping yourself. Everyone has different personalities, environment and coping mechanisms that might work just for them. So there’s never a general yes or no in terms of deciding whether to tell, whom to tell, what to tell and how to tell. It’s to be reminded that, if the possibility of you doing it or not doing it in a certain only serves the “getting out of your chest but not to help you to get support” or saving face” etc., you are not doing it right, it’s not a good decision. Just always use “would this help me to cope with depression better?” as a primary principle. ACTION: Yep, it’s now time to write it on a sticker and put it on the bedroom wall! However, here are general guidelines: For mild-moderate depression: telling others is not as important as following the doctor’s advice: good night sleep, exercise, nutrition, and mental health counseling, etc. If you can manage to get these done, you are on the way to recovering on your own. Telling is only very much needed if you think you need external supervision/support to get you on a healing track. Focus your energy on getting things on track in life, instead of being stuck on the dilemma of telling or not. For severe depression: you have to tell others! One symptom of unavoidable symptom is repetitive suicidal thoughts, which is life-threatening. On top of that, severe depression comes with severe cognitive impairment. It has a substantial negative impact on your social life, intimate relationships, work performance and even daily routine functions like getting out of bed or taking a shower. By that, we mean, you need external help to get you through it because you’ve lost the basic functions temporally. There shouldn’t be any shame in this. Just like any other organs in our body, our brain does get sick, it’s just invisible and less understood by our society. (Go to CandleX Classroom Depression Essentials Series: Lesson 3 Causes of Depression​ to understand why it happens). So when we are sick, we tell people that need to know so your boss will allow you to take sick leave, and your loved ones will bring your chicken soup, for the soul. You remember Marco, CandleX’s Representative, revealed his story of opening up in hope to encourage you to take the step too. 3 years ago, having suffered a severe breakdown, I responded by opening up to my family and friends, of whom there were many, purely as a matter of survival. If those around me were not aware of what was happening to me during a severe episode, they would have no way to help, and if they weren’t there to help, I might not make it the next time. The effects were lasting. I quite quickly had a support group that I could rely on as my faith in them had not been misplaced. What’s more, my openness led to others to reveal to me that they had similar struggles that they had always been too afraid to share, and it was my honesty and lack of humiliation that allowed them to speak up as well. They knew that I had some sense of what they were going through; I would not be one to judge. And I began to see myself as one among a group of people that formed a special sort of club, one in which we shared a language of adversity that only we could truly understand, but to which those who were willing could also listen to. In receiving empathy and compassion I found courage, and in giving it, I found meaning. For it is in the light that we can enjoy the company of others, but only in the darkness that we find true friendship. For Marco’s full story, you can find it in CandleX column: My Story with Depression. Do not forget, our peer support group for people with depression in Beijing is a safe and confidential space for you to start the conversation. Take baby steps. We are here to hold your hand.