Depression: The sticking points

Depression: The sticking points

There are certain habits of mind that can make depression stick around and that can make a person more vulnerable to depression relapse. These features of 'mindlessness' also apply for things like anxiety and other mental health problems. Fundamentally this is based on your relationship with your own mind. Learning to be aware of these sticking points of the mind can help you keep an even and 'mindful' keel in your journey through life (rather than a mindless rudderless one).

DEPRESSION: THE STICKING POINTS....

By Ben Bruce

Psychologist

We have come to realize that depression (and anxiety) is a disorder which is typically experienced inepisodes. That is, a person will not always feel depressed; rather the malaise will overwhelm them in waves, punctuated by episodes of relatively healthy normalcy. This is clearly the case with Bipolar disorder. Specific factors have been highlighted that increase a person’s risk of suffering from depression and other mental health disorders. These comprise such general factors as genetic predispositions and family history, nutritional issues, underlying diseases and medication side effects, lack of sunlight, traumatic experiences, and cognitive, behavioural and mind factors. This article will focus more on what is in our control, specifically cognitive behavioural features, and especially mindful underpinnings of depression and mental health. Mindful refers to the way in which the mind operates; a person’s relationship to his or her mind and the way in which mind patterns can railroad a person into states of joy or states of despair. Depression can be seen as resulting from an underlying mind pattern based on features of mindlessness. The three major mind features which predict depression are:

-          Emotional reactivity

-          Experiential avoidance

-          Rumination

We will clarify each feature in turn and come up with ways they can be altered for a person suffering from depression, such that the pattern of mind can change and the outcome will also therefore change. Where a person has been heretofore depressed, he or she will now not be so depressed. They will be well adjusted, living a more full, rich and meaningful life acting in accordance with their deeper values, living as who they really are, authentically driven by being at the centre of their life. Dare I say it....the person can be happy. This approach is based on Acceptance and Commitment Therapy. This does not mean the person will not experience lows at times; it’s just that these lows will not be such a big deal. You can learn to be more comfortable with feeling uncomfortable at times. Being at the centre of your life will enable you to be who you really are and do what comes naturally to you. Disorders like depression lead to and result from living at the periphery of your life; being far away from your true, inner nature. Liken this to a storm. The calmest point is at the eye of the storm and the worst place to be is in the tail winds at the periphery. Finding your way back to the centre of your life is about creating meaning in your life and doing things which have meaning for you. It’s also about making amends, connecting with your deeper values, expressing your feelings safely and compassionately. Stop living someone else’s version of your life and attain true freedom. This means taking a few risks and trying new things, especially if you have been depressed for a long time and you have forgotten who you really are and what you stand for. You will need to discover yourself again and this can be a great adventure. Acting courageously, even though you feel fear, will have a profound effect on your self esteem and confidence. Through lived experience you will develop wisdom.

One of the major predictors of whether a person will experience depression is their experience of depression in the past. That is, if a person has suffered from depression before, they are more likely to get depressed again. The probability of relapse correlates with the number of depressive episodes a person has had as well as the age at initial onset. That is, the earlier a person has suffered from depression, and the more recurrent relapses they have had, the more likely they will experience depression again later on in their life.

Most people would agree that this makes sense. I would also guarantee that a person who is reading this, if they are or have been depressed , would probably be feeling quite gloomy about the idea. It may feel like one’s destiny is pre-arranged and that they are cursed to relive depression again and again. This itself is a depressing thought.

This also brings up one of the main sticking points of depression and that is the degree to which a person is reactive to their thoughts and feelings: termed ‘emotional reactivity’. A person may become sad, for example, due to the normal ebb and flow of life and the fact that saddening things are bound to happen from time to time. If they have been depressed in the past, however, and have recovered to a point of functional wellness and dare I say it ‘happiness’, then the person may start to worry that the sadness may signify depressive relapse.

What if this thought alone was a major culprit in the potential relapse probability? What if the reactive thoughts and feelings to preceding thoughts and feelings was a major predictor of depression recurring? In deed – this is actually the case. Consider this for a moment.

Let’s go back to basics here. The cognitive model of depression is the most popular way of understanding the disorder in current times, and in my opinion has great merit. The model points out that thoughts, feelings and behaviours are intimately related. Therefore an event ‘A’ leads to thoughts and beliefs ‘B’ which lead to a combined outcome, an emotional consequence ‘C’. It stands to reason that the antecedent trigger event ‘A’ is something that has happened randomly, outside of a person’s control that cannot be changed. However, the thoughts and beliefs ‘B’ are open to scrutiny and change. The cognitive model stipulates that ‘B’ is the major cause of depression, and that people who experience depression and other mental health disorders actually have cognitive distortions that play a significant role in filtering a person’s experience of reality such that they are depressogenic (depression creating).  Cognitive therapy therefore focuses on modifying these cognitive distortions; by enhancing a person’s awareness of the role and impact of their (often unconscious) thoughts and underlying belief systems, a person can dispute, challenge and replace their thoughts and beliefs with more helpful, healthful and constructive alternatives. This is the ABCD pattern of understanding and also treating depression:

‘A’ Antecedent event => (evokes) ‘B’ Beliefs => (combine to make) ‘C’ emotional Consequences => (which in therapy or self-help regimes you learn to) ‘D’ Dispute => ‘E’ new Emotional outcomes.

A mindful approach to depression would add to this model. Where antecedent events trigger underlying beliefs and thoughts; the mindful model would also state that these thoughts and emotional consequences would trigger other thoughts and feelings, and it is the connection between the first and second order thoughts and feelings that is the major culprit of depressive relapse. If a person has been depressed before, they are well aware that it was (typically) a horrible chapter in their life. So if they suspect a feeling or thought process might mean they are getting depressed the usual reaction is fear and avoidance of those thoughts and feelings. You’ve probably heard the phrase ‘if you fall out of the saddle, get back on’. The reason for this is because what we avoid just gets bigger. If you run from the bully he keeps chasing you and you just get worn out. Learning to accept the thoughts and feelings that you have within the normal backdrop ebb and flow of the ups and downs of life will serve to diminish the impact they have over you. They are just thoughts and feelings, not facts afterall. Whilst they are important to be aware of, they are not facts. They come and go. Learning to experience these thoughts and feelings, allowing them to come and go, acknowledging them and letting them go is very therapeutic. This will enable you to put things in perspective. When you acknowledge a thought or feeling that you were previously afraid of, when you can observe it as it comes up and acknowledge it as ‘just a thought’ or ‘just a feeling’, you are essentially confronting it and not letting fear dictate to you. You are acting courageously and authentically in one fell swoop.

Focussing on a meditation exercise essentially involves focussing on one thing for an extended period of time until a relaxation or trance state emerges. This is a naturally healing state or being. Most people utilise meditation to escape their incessant mental activity and to get respite from the stresses of the day. The second step to meditation is to integrate meditation or ‘mindfulness’ into the continual process of living. In this way, when you practice meditation, allow yourself to settle, and then start to notice what comes up. If you are, say, focussing on your breathing and then you get distracted by a thought or feeling, practice acknowledging the thought, feeling, image or memory – whatever it is. Label it from the observer perspective ‘this thought’ (whatever it is) or ‘this emotion’. Then return to your breathing focus ‘breathing in, one, breathing out, two’ etc. (or whatever your practice involves). This allowing, noticing, acknowledging, labelling and then returning to your practice will help you to stop avoiding the processes of your mind. It will help you stop making a bigger deal out of things than you actually need to. As a result, in the course of your day to day life, pressure will stop building up so much behind the dam wall and that feeling of impending doom will subside. This is because you are expressing the emotions and the thoughts that you are having, from the perspective of a detached yet experiential observer so you don’t get so caught up in them. You are expressing yourself rather than suppressing, repressing or depressing. You are dealing with your issues rather than ignoring them. Bringing things into the light of consciousness causes a natural healing effect. Ignoring them causes them to fester in shadow.

The other two features of mind that are involved in causing depression are rumination and experiential avoidance. These go hand in hand with emotional reactivity. What we are afraid of, we tend to avoid. If you are avoiding your own experiences they can build up like the water pressure behind a dam wall. Learning to acknowledge your experiences will reduce the pressure you would otherwise feel due to avoiding them. Additionally, rumination is often a factor in depression, where you go over and over past experiences. This takes you out of the moment and is often due to being caught up in what has happened to you in the past. Learn to acknowledge what has happened, and just like in your meditation /mindfulness practice, after acknowledging a memory from the past, come back to what you are doing, what is happening right Now. Now is the only moment that exists and where all your energy resides. Tap into it by paying attention to it. What might you be overlooking and taking for granted? Are you making assumptions? What beauty is there around you right now? Simply by holding these questions in your mind will bring you into the present moment. In many ways, we are what we focus our minds on. So where is your mind right now?

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2 Responses

  1. michael
    Thankyou so much for this article Ben. This is extremely helpful info, i found that ABCD method very interesting. From start to finish i can say i will be letting it all sink in. "In many ways, we are what we focus our minds on. " I was pondering similar thoughts the other day. For example how much of your life is reality and how much is illusion. The degree of pain and suffering in everyday life is measured on your mind(thoughts) and perspective. Hyperthetically speaking it could be possible that two people could live the exact same lives from start to finish with the same challenges and troubles, childhood, highs and lows. When they die one could have experienced very different degree's of pain and suffering from the other just due to the way they thought and used there mind. The perspective one had on life. That might not be the perfect example but you know what I'm getting at :)
  2. Ben
    Hi Michael Thanks for your thoughts here - I agree that the mind is a huge factor in our experiences. A good term for this is subjective or perceptual filter, alongside of cultural conditioning and personal idiosyncratic sensitivity factors. What you basically have in the human being is a maelstrom or matrix of overlapping factors with both moderating and mediating variables. If you think back to Venn diagrams in high school maths, the overlapping circles present new interaction patterns. Then we need to consider the overall identity where the whole is greater than the sum of the parts; thus by dissecting all of these variables and patterns that make up a human being you get distracted from the real whole thing of the person. So all of this awareness of what makes up a persons persona needs to be balanced with an overall awareness of the big picture and that any particular angle of understanding or theory or model is an abstraction. This is going into chaos theory - which of course was superseded by complexity theory to describe the big picture of the universe..... Anyways, I may have blown the dialogue out a bit far there!! But you are right, the mind is a massive mediating and moderating factor; two people could have the same experiences and feel and think completely differently about them. Of course we are never passive with our experiences - we interact all the time with what we are experiencing so you get a huge interaction effect. Anyhow - am currently in Florence, Italy staying at the Machievelli hotel, so am probably in danger of political scheming!!! Off to see the Medicci palace now, the medieval family largely responsible for the rennaissance, imo. Take care Ben.

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