This series by BLOC Staff Coach Brooke Haubenstricker about coaching lifters with depression has been a welcome addition to Barbell Logic’s content on lifting and mental health. Here, Part 1 lays a framework for thinking about depression as a coach. Often, we fill an important supporting role at the nexus of a person’s physical and mental health. Part 2 analyzes the myriad of benefits lifters with depression get from training and looked at some comparisons between strength-based training and other types of physical activities. Part 3 gives us practical advice, including building or maintaining trust and having conversations about depression. And Part 4 helps shore up many coaches’ concerns about programming and how to provide value as a coach while supporting lifters through challenging times.

Coaching Lifters with Depression (Part 1): An Introduction

By: Brooke Haubenstricker, BLOC Staff Coach

Almost every adult has had a back tweak before, whether from lifting or some other activity. The more severe the back tweak, the more it grabs our attention and distracts us from everyday life, affecting everything we do: standing, walking, bending over, laying down, even breathing. We may have to make modifications to our movements or be careful about what activities we participate in. In the meantime, we are left grumbling about the pain and waiting impatiently for things to get back to normal.

As coaches, we encounter physical health issues like this frequently. We’ve learned how to identify them, work around them, and guide our lifters through the healing process. But what about mental “tweaks”? While less visible, mental health issues can have just as significant of an impact on a person’s life. Being able to identify these issues and guide lifters through them will improve their wellbeing and training progress in the long-run.

The most prevalent mental health issue is depression. It’s estimated that two to six percent of the population suffers from depression,1 and it’s one of the leading causes of disability worldwide as measured by years lived with disability (YLD).2 This series of articles focuses on depression, and it is designed to serve as a starting point for determining if, and what, changes may be necessary when coaching a depressed lifter.

While the process of getting stronger does not change for someone who is depressed, you may need to modify your coaching strategies and programming. You do not need to be a mental health expert in order to coach someone with depression: a baseline understanding of depression, exercising patience and appropriate communication with your lifter, and a few more tools for your coaching toolbox will go a long way in guiding your lifter through depressive episodes. This first article will serve as the foundation for this knowledge. Because, in order to move forward, you need to know, “What is depression?”

Defining Depression

The first step in understanding depression is understanding that depression is different from sadness or grief.

Sadness is a universal human emotion characterized by feelings of unhappiness, ranging from disappointment to anguish. It can be experienced on its own, as well as during episodes of depression and grief. So, even though sadness is an important element, it’s not the whole picture. Furthermore, while being sad is not exactly enjoyable, it’s completely normal and healthy to experience it from time to time.

Grief is a natural response to loss, such as the death of a loved one or the termination of employment. During the grieving process, painful feelings tend to come in waves and can be mixed with positive feelings, and the person usually maintains self-esteem. Resolution, acceptance, or the passing of time can improve grief. Grief can develop into depression, but this is not always the case.

In contrast, depression is characterized by a sad, empty, or irritable mood, as well as a loss of interest or pleasure in almost all activities. These feelings are constant and can result in serious impairments, affecting a person’s ability to complete everyday tasks. Depression is not a purely psychological phenomenon either. There are physiological characteristics, although the complex neuroscientific explanations are well beyond the scope of this article. While depression may stem from an identifiable event, this is not always the case. Other variables may trigger depression or worsen it, such as illicit substances, life stress, or negative thinking patterns—called cognitive distortions. Resolving the cause or triggers may improve symptoms but will not necessarily end the episode. Most people with depression need psychotherapy, medication, or both in order to control it.

Keep in mind that depression length, intensity, and symptoms vary from person-to-person and may not be exactly the same episode-to-episode. Episodes can last from weeks to years and range in intensity from mildly disrupting to incapacitating.

According to the National Institute of Mental Health (NIMH), symptoms of depression include the following:

• Persistent sad, anxious, or “empty” mood
• Feelings of hopelessness or pessimism
• Irritability
• Feelings of guilt, worthlessness, or helplessness
• Loss of interest or pleasure in hobbies and activities
• Decreased energy or fatigue
• Moving or talking more slowly
• Feeling restless or having trouble sitting still
• Difficulty concentrating, remembering, or making decisions
• Difficulty sleeping, early-morning awakening, or oversleeping
• Appetite and/or weight changes
• Thoughts of death or suicide, or suicide attempts
• Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment

Please note that depression can be difficult to spot. As a coach, you may or may not be able to observe all of an individual’s symptoms during your interactions with them, even if you see them frequently and have known them for a long time. Seemingly normal-behaving or upbeat individuals can still be experiencing depression. Do not attempt to diagnose your lifters, prescribe treatments, or disregard depression claims, as these can have harmful consequences. As with any serious medical condition, lifters should be referred to a professional for official diagnosis and treatment.

Online Coaching

It is especially difficult to tell if someone is depressed when you only communicate with them online. Conversations are predominately in writing and tend to come in periodic, short bursts. However, there are red flags indicating a possible depressive episode, which you may observe in an online setting:

• Changes in writing style or tone, including expressions of guilt, an increase in negativity or self-criticism, or a loss of training enthusiasm
• A sudden, drastic decrease or halt in communication
• A significant decrease in training motivation, with current goals holding little to no importance
• Increase in missed reps, particularly due to lack of focus, tightness, or grind
• Skipped exercises or workouts without an explanation
• An inappropriate increase in workout length
• An inappropriate increase in perceived heaviness or RPE ratings
• Abnormal and largely inexplicable changes to recovery habits

Of course, these items being present doesn’t automatically mean that a lifter is depressed. They could be incredibly busy or feeling unconfident in their abilities. But, when working with someone whom you suspect is suffering from depression or has a history of depression, these signs can help guide your actions and communications.

If you suspect that a lifter is suffering from depression, get a conversation going. Reach out to schedule a video call or phone call right away, or at least start a conversation over text or in an online messenger. Ask them about life changes and attitudes toward training, and try to flesh out probable causes to their behavioral changes. I would be careful about bringing up the topic of depression directly as some people may not feel comfortable talking about it, especially if they haven’t been working with you for very long. Communication will be discussed more in part 3 of this series.

Types of Depression

In the coaching context, knowing these signs and symptoms of depression are more important than having an official diagnosis. However, a diagnosis can provide a clearer understanding of how the lifter experiences depression, which can, in turn, guide coaching decisions. Here are some of the ways people experience depression:

• As a stand-alone mood disorder. These can be categorized as unipolar, like Major Depressive Disorder (MDD) or Seasonal Affective Disorder (SAD), in which depression is the only element, or as a bipolar disorder, in which there are elements of depression and mania or hypomania (elevated mood) that can occur separately or at the same time (“mixed state”).
• In conjunction with other psychological disorders (“comorbidity”). For instance, many individuals who have Borderline Personality Disorder (BPD) also have a bipolar disorder, and depression is often experienced in individuals who have Post-Traumatic Stress Disorder (PTSD).
• Caused by medical conditions. This can include certain injuries, infections, hormonal changes or imbalances, and chronic illnesses.
• Substance-induced. Alcohol, illicit drugs, and certain medications can cause and exacerbate depression.

Here are two examples of how lifters may experience depression:

Greg is in his early 20s and was diagnosed with Bipolar Type I, which is characterized by manic episodes and depressive episodes. When he experiences depression, he says it’s like “being hit with a tranquilizer gun for your emotions.” Although it’s predominantly an emotionally-numbing experience, it can also magnify negative emotions and events. He struggles to get out of bed and eat appropriately, often binge eating processed foods. While it’s not difficult for him to go to the gym, he has trouble being productive and focusing, which leads to longer rest periods and overall workout times. It’s also more challenging for him to objectively rate the RPE on his programming and complete lifts that are already physically or mentally challenging when he’s not depressed. Communication with his coach is difficult as well, as he perceives that his coach will not understand his depression and subsequent behavioral changes.

Sandy is in her 30s and has Major Depressive Disorder (MDD), meaning she has intense depressive episodes that last for at least two weeks. She would describe her depression as having feelings of either emptiness or overwhelming despair that periodically spike in intensity. She can complete all her normal daily tasks, but it takes a greater toll on her than usual, so she ends up eating minimally and sleeping excessively. Her activities are often interrupted by crying fits as well, which can be embarrassing if she’s in a public place like the gym. When she does do her workouts, she’s more likely to second-guess her abilities, leading to many missed reps and incomplete workouts. She has trouble communicating with her coach as well because she feels shame about missing or failing her workouts, perceives normal workout feedback as harsh, and believes that she is wasting her coach’s time and energy.

By this point, it should be clear that depression is an incredibly complex issue. There are an unfathomable number of variables involved that can inflict an enormous amount of emotional pain on the sufferer. It’s not a coach’s job to help a lifter overcome their depression; that’s a task for a skilled therapist or psychiatrist. It’s a coach’s job to help a lifter continue to be active for their own physical and mental wellbeing and to be patient and understanding when depression rears its ugly head.

Continue reading with Part 2: Training Benefits—>

References

[1] Ritchie, H., and Roser, M. (2018, April). Mental Health. Our World In Data. Retrieved from https://ourworldindata.org/mental-health#depression

[2] World Health Organization. (2020, January 30). Depression. Retrieved from https://www.who.int/news-room/fact-sheets/detail/depression