Ways to Relieve Somatization of Depression

Formal medical intervention prioritizes the control of moderate to severe symptoms, combined with personalized physical and mental adjustments to reduce the frequency of attacks, and then relies on stable social support to reduce triggering factors - there is no universal formula, and all methods must match your current state to be effective.

For those who have never been exposed to this concept, the essence of somatization of depression is that emotional stress cannot be released through psychological channels, and instead turns into physical symptoms such as headaches, chest tightness, gastrointestinal disorders, heaviness, and chronic pain. Routine medical examinations often fail to detect organic diseases, and can easily be regarded as "hypocrisy" or "malingering" to delay intervention.

A junior girl I met last year was like this. She always felt migraines and breathless at the beginning. She went to the neurology department three times and the cardiology department twice, and the test reports were all normal. The counselor said she was stressed and thought too much, so she endured it for three months. In the end, she struggled to even get out of bed to go to class. Only after a friend reminded her did she go to the psychiatry department, where she was diagnosed with moderate depression with somatization. After taking SSRI antidepressants for two weeks as prescribed by her doctor, the first thing she noticed was her headaches. The frequency of attacks dropped by half. Before, it hurt even to turn over a book, but now she can sit down and watch online classes for half an hour.

Oh, by the way, there are always different opinions on whether to use medication for somatization of depression. Some psychodynamic counselors prefer to explore the root of the emotion first, believing that medication only "covers symptoms." However, the conclusion of evidence-based psychiatry is clear: if somatization has affected eating, sleep, and basic actions, giving priority to medication is the most cost-effective option - after all, when you can't even get out of bed, you don't have the energy to do any psychological exploration. Stop the pain first and increase your strength before you can talk about subsequent adjustments.

When your symptoms stabilize and you can take control of your daily life, you can try some adjustment methods that suit you. Don’t blindly copy the “universal strategies” on the Internet. I have seen too many people force themselves to sit for half an hour every day after seeing others saying that mindfulness is useful. They are already flustered, and the longer they sit, the more irritable they become, which in turn aggravates their symptoms.

For example, if you have an acute attack of high-arousal symptoms such as palpitation, trembling hands, and numbness all over the body, most counselors in the cognitive behavioral school will recommend you to use the 5-4-3-2-1 grounding method: name 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, and 1 thing you can taste. The essence is to draw attention away from physical discomfort and return to the present moment, activating the parasympathetic nerve responsible for relaxation. It does work for many people. However, some exercise physiology researchers have suggested that it is better to go out and walk briskly for 15 minutes at this time, raising the heart rate to about 110, and using muscle metabolism to consume the excess excitement of the nerves, which will lead to faster results. I have a client who works on the Internet. He is prone to nausea and hand tremors before every meeting.

If you are in a low-arousal state where your whole body feels heavy, like lead, and it is difficult to even raise your hands, don’t listen to people’s lies about “just exercise more”. There is really no need to force yourself. I usually advise clients to do "one minute of bed stretching" first. Just move your fingers, turn your wrists and ankles, turn over, or even just pull the quilt to a comfortable position. You don't need to pursue any effect, just move and you will win. Of course, there are also mindfulness counselors who recommend doing a body scan and following the attention to be aware of the body's sensations. However, many clients I have contacted reported that they were already in pain, but once the scan focused all their attention on the painful area, it made them even more uncomfortable. So there is really no need to force it, and it will be as comfortable as possible.

There is another point that is easily overlooked: don’t suppress your emotions all the time. Many people will experience somatization. The essence is that they are used to "tolerance". They don't say anything when they are wronged, and they hold back when they are angry. They don't even realize that they have emotions, and the body yells "stop" for you first. It's a bit like you always throwing garbage into the trash can and not emptying it when it's full. Eventually it will overflow all over the floor. Those symptoms of headache and chest tightness are the overflowing emotional garbage. Different schools have different methods for this part. The cognitive-behavioral school will recommend that you keep an emotional diary. Every time a symptom occurs, write down what happened before and whether there are any unspoken emotions. If you look for more patterns, you will find that many times you are not in pain "for no reason", but because you suppressed something before and did not have an attack. ； The psychodynamic school is more inclined to explore whether there are unfinished complexes behind these emotions. For example, whether they have been taught not to cry or get angry since childhood, and have become accustomed to using the body to express emotions over time. Both methods have a large number of proven and effective cases. There is no need to distinguish between them. Choose whichever one you believe in and whichever is comfortable.

Finally, let’s be honest, you don’t have to shoulder everything. I had a client who had been undergoing adjustment for half a year, and his symptoms kept coming back. Later, I asked him to report his diagnosis to his parents, and I took them to the outpatient clinic together. The doctor made it clear that somatization was neither "lazy" nor "pretending." Later, every time he had a headache, his mother would no longer urge him to "just get up and take a few steps," but would only give him a cup of warm honey water and sit with him quietly for a while. With this change, his frequency of attacks dropped by two-thirds in the next three months. Of course, not everyone can gain the understanding of their family members. If the people around you don’t understand or support, don’t force yourself to explain to them. Chatting in a community of like-minded people, finding a reliable counselor to complain, or even raising a soft kitten or puppy. Having a little living creature waiting for you and nuzzling you when you come home every day is also very useful support.

In fact, after all, the key to relieving the somatization of depression is never that you "get better" immediately, nor that you force yourself to do the "right thing", but that you must first learn to stand with your body. Don't call it hypocritical when it hurts, don't force it to hold on when it's tired. After all, these seemingly annoying symptoms are just your body sending you a signal: you haven't taken care of yourself for too long, it's time to stop and take a good rest.