Depression


 

Contrary to common belief, depression is not primarily a biological illness, inherited through the genes (although it can run in families and one may have a predisposition to suffer from depression). Nor is it the setbacks, crises or tragedies in our lives, per se, that cause depression. It is our response to adverse events that determines whether we get depressed or not. Research shows that people most likely to suffer depression are those who react to adversity by taking it personally, seeing all areas of their lives as blighted by it, and the misery as going on forever. Depression is always a second and unnecessary problem, and just makes problematic circumstances worse. This is good to know because it means that, instead of feeling helpless or hopeless, people can learn to take back control over their lives. They may not be able to change certain circumstances but they always have options about how they react to them.

 

The symptoms of depression include low mood, loss of interest or pleasure in usual activities, loss of appetite and energy, sleep disturbance, feeling agitated or lethargic, worthless or guilty, difficulty in thinking straight and having repeated thoughts about suicide. Antidepressant drugs may help some people because they lift levels of a ‘feel-good’ chemical in the brain; unfortunately, they do nothing to change the underlying circumstances or thinking patterns that led to the depression. Depression is very commonly related to unmet essential emotional needs and that is why the pragmatic approach, which focuses on helping people in distress find healthy ways to meet their emotional needs, can be really helpful.

 

Depressed people may seem deflated and flat but, in actual fact, they have raised levels of a stress hormone called cortisol, which means that they are in a state of constant high emotional arousal. When our emotions are aroused we can’t think rationally, so this is why people deep in the grip of depression can’t concentrate well or even make simple decisions. Learning simple relaxation techniques to calm themselves down will start reducing those cortisol levels.

 

The main reason that depressed people are so emotionally aroused is that they spend a vast amount of time worrying about the future or beating themselves up about past events. Perhaps they still feel guilty about something that happened recently – or years ago; perhaps they are frightening themselves with dire ‘what if?’ scenarios (likely or unlikely), in which loved ones encounter dangers or they themselves lose their jobs or their homes; perhaps they feel beaten down by chronic pain or anger (“Why did this have to happen to me?” “How could he have been so cruel?”); or maybe they experience a combination. They also have a huge tendency towards negative thinking – “I’ll never be good enough”; “I’ll never cope”; “nothing ever goes right”; “the pain will only get worse”. All this kind of negative imagining and thinking saps an enormous amount of energy – and makes people utterly miserable.

 

Far from feeling more refreshed after a night’s sleep, most people with depression wake up next day still exhausted and feeling totally unmotivated. It is hard for them to get out of bed and do anything at all. While the various stages of sleep have been demonstrated to be involved in memory consolidation, the function and purpose of dreaming is less clearly and conclusively understood and it remains of enormous interest and fascination to sleep researchers. Psychologist, Joe Griffin suggests that when we dream at night, we are discharging unexpressed emotional arousals from the previous day. If earlier we were upset about something our spouse did or didn’t do, but kept it to ourselves, we would later dream that out, perhaps in the form of getting angry with someone else (dream content is never straight forward); that would have the desired effect of lowering our levels of emotional arousal, so that we can start next day afresh, even though we are unlikely to remember we had the dream. (If we did express our feelings with our spouse at the time, we wouldn’t need to dream about it. And, of course, if we wake up and remember what our spouse did or didn’t do, we may get emotionally aroused about it all over again, requiring more dream discharge that night, if we still don’t resolve it.)

 

Research shows that depressed people dream much more than non-depressed people, distorting the balance between recuperative slow-wave sleep and energy-burning dream sleep. Clearly, because they spend so much time worrying and imagining, they have far higher amounts of unexpressed arousal to discharge. With so much energy spent on all the excessive dreaming they have to do, they wake up exhausted and lacking in motivation.

 

It is necessary for people in depression to be helped to challenge their negative thoughts, imagine more realistic outcomes and futures and to find ways to put meaning and purpose back into their lives. This could be through exercise, team sports, doing something for other people, learning a new skill, calling up old friends, and so on. Very often, people who are depressed start to withdraw from their usual routines, stopping going out or phoning or seeing friends, and this makes them dwell on their misery even more. It is essential, therefore, that they are helped to start meeting their emotional needs again, in healthy and satisfying ways. If the depression is due to post-traumatic stress, it is also necessary to stop the traumatic memory from continuing to interfere with life in the present. The rewind technique, a simple, non-invasive method of detraumatisation that we use, can sometimes achieve this, often providing relief quite quickly.

 

Dwelling on and digging up the past is dangerous. Neuropsychological research has shown that this has a physical effect on the brain, strengthening the neuronal connections with misery and negative thinking. We get better at piano or football with practice and, unfortunately, we get better at depression with practice too! So, it really is important to think to the future instead – to learn to shift unhelpful thinking patterns, take back control, find ways to bring meaning and purpose back into life and to look forward with hope. 

 

Pragmatic Therapy integrates the human givens approach with established evidence-based treatments approved by the National Institute for Health and Clinical Excellence (NICE). Special thanks to Denise Winn, Editor of the Human Givens Journal, for her assistance with the self-help articles on this website.