What is Depression – and how to deal with it
Would you know if someone you care about has depression? Most people probably think that they would, but it isn’t necessarily as obvious as you might expect. Indeed, until some simple screening questionnaires were introduced for GPs to use, half of them were missing the diagnosis in patients that came to consult them.
Depression: some distortions of fact
To be deeply depressed is just about the most awful feeling we can experience, apart from sheer terror. It can disable anyone. But the topic is surrounded by false ideas and myths: Depression, as experienced by the vast majority of sufferers for example, is not a biological illness; neither is it ‘anger turned inward’; it is not a ‘chemical imbalance in the brain’ and it is not usefully divided into ‘clinical depression’, ‘post-natal depression’ and ordinary ‘depression’; and is not, in most cases, hard to come out of.
Suppose, for instance, you have a friend who used to come to a class with you, perhaps a sport or exercise class. Then one week they don’t want to go. Perhaps they say they have strained a muscle or that they are working late more often. You believe them – why not? Time passes suddenly you realise that you haven’t spoken for quite a while. Perhaps you feel hurt and think it must be something you said. Or perhaps they have depression.
Very many people will not say that they are depressed or may even deny it. They may manage a smile even though they are feeling deadened inside. But one important tell-tale sign is loss of interest in activities that someone used to enjoy. When people start to experience low mood (perhaps they have had a disappointment or a bereavement or have been made redundant or, for some other reason, start not to feel good about themselves or their lives), they gradually tend to withdraw from social activities. The more time they spend alone, however, the more time they have to dwell on whatever is worrying or upsetting them.
The more they dwell, the more hopeless they may feel. They are very often filled with feelings of worthlessness and guilt (because depression gets everything out of proportion) and, unbeknownst to you, may have fleeting or not so fleeting thoughts of killing themselves. They find it hard to get to sleep or to stay asleep, feel exhausted in the mornings and lack motivation to get going with their day. They may comfort eat or avoid eating – both are common symptoms of depression particularly in women, whereas males are more likely to cut off their feelings through drinking or other substance abuse.
How to break the cycle of depression
And they find it hard to think straight, so that even making unimportant decisions feels overwhelming. Perhaps you notice that they seem less focused or more tearful. So the first alarm bells that should ring are when the person you care about stops engaging in and enjoying whatever used to give them pleasure. This is especially often the giveaway for adolescents in whom symptoms of depression can manifest as negativity, irritability, not feeling understood, behaving antisocially, etc, which may easily be mistaken for ‘normal’ adolescent behaviour.
Depression is a horrible, too often hidden, condition. But the good news is that, once recognised, there are simple, speedy straightforward ways to treat it that don’t require medication.
Why people get depressed
People sink into a depressed mood when their innate physical or emotional needs are not being met and, instead of dealing with this situation, they begin to worry about it — misusing their imagination. All depressed people worry. This increases the amount of dreaming they do, upsetting the balance between slow-wave, recuperative sleep and dream sleep. Consequently, they start to develop an imbalance between energy burning dream sleep and refreshing slow-wave sleep. Soon they start to wake up feeling tired and unmotivated. (Depressed and anxious people dream far more intensely than non-depressed people.) This makes them worry even more as they feel that, “something is wrong with me”.
Depression is a human vulnerability. Suppose we have a setback or suffer some traumatic event that interferes with getting our emotional needs met. This arouses negative expectations in the autonomic nervous system — feelings of frustration, being ‘stressed’, anxious, angry, guilty etc. — but, instead of taking action to bring the arousal down, which is what the autonomic nervous system is designed to help us do, we start to worry even more, going over and over what’s troubling us: ‘Why did I lose that job?’…”Why do they treat me like this?”… ‘What is going to happen to me?’… ‘How am I going to pay my bills?’ — on and on creating a mountain of negative expectations. This over-stimulates the autonomic arousal system which is why depression is such a strong emotion.
All strong emotions focus and lock attention and, with depression, attention stays focused on all the bad things that seem to be happening to us, whether real or illusory. Every little thing we worry about and do not resolve in the day is translated into a bad dream that night. All these worries have to be worked through in extended and intense periods of dream activity in REM sleep as the brain attempts to rebalance your arousal levels. This upsets the relationship between slow wave sleep and REM sleep.
Why depressed people are always tired
Extended dreaming is exhausting, not just because it deprives us of restful and restorative slow-wave sleep (that should make up three-quarters of our sleep time), but also because it stimulates the orientation response. This is a vital pathway in the brain that alerts us to interesting things in the day, generating motivation to act, but it can’t do this so well if it has been over-used in dream-sleep the previous night. So, the next morning we awake feeling terrible because we haven’t really slept, and we find it much harder to get motivated to get up and do anything because the brain mechanism that generates that interest in life is exhausted as well.
Exhaustion on waking and lack of motivation are features common to all depressed people. Because our normal sense that life is meaningful comes from the actions we take, when our motivation levels are low, life quickly comes to seem meaningless. The natural delight we take in being alive and doing things drains away.
How does human givens therapy relieve depression?
Human Givens therapists work with the fundamental truth that people do not develop mental illness when their innate emotional needs are being met in balance. Working with this organising idea they employ techniques from various therapies that have proven effective (interpersonal, cognitive behavioural, solution focused) plus they add the new knowledge you have just read above that shows the importance of vividly creating new expectations in the mind of the patient to ‘kick-start’ them again.
Because depression, like any strong emotion, fogs our thinking, emotional arousal is reduced to start with. The therapist has a range of ways to do this so that the patient can begin to think more clearly about the situation that is causing them to worry. When the patient has calmed down, the therapist will usually explain what depression is and how it is caused. This in itself is hugely therapeutic for most people since no one else is likely to have explained how and why the feelings arose and they were probably imagining that there was something wrong with them. Simultaneously the therapist will do an informal emotional needs audit to find what needs are not being met so they can begin to tackle the worrying that is causing the problems.
Whilst doing this the patient’s past achievements, skills and good qualities are also looked for and given as much attention by the therapist as the troublesome history. If it emerges that there is trauma behind the depression, this will be resolved using the HG version of the rewind technique. This organic mind/body approach can bring about the remission of depression in a fraction of the time taken by cognitive or behavioural or interpersonal therapy.
The therapist will almost certainly use guided imagery to help the depressed person change their negative expectations into more positive, realistic and concrete ones to help them re-connect with previously enjoyed activities and rehearse in their imagination doing the things they need to be doing. This helps them become more confident about using their own resources to pick up their life and get on with taking the actions that will help them start meeting their emotional needs once more. Learning how to fulfil these innate needs resolves depression and prevents relapses.
Usually much progress is made on the first session but the therapist will always want to see a person who has been deeply depressed a number of times to make sure that progress is maintained and that the patient is taking steps to change their expectations. In our experience, when patients know that their negative ruminations are causing their poor nights’ sleep and their exhausted days, they are quickly motivated to work to break the cycle of depression. Most cases of postnatal depression can be treated very effectively in exactly the same way. Human givens (HG) therapy is effective on its own but can also be done alongside drug treatment.
Note: Depressed or anxious people should not have forms of counselling or psychotherapy that concentrate on the past and encourage introspection or emotional arousal. Research shows this is often unintentionally harmful.
You can speak to Janette Houghton at the Orchard Clinic, Huntingdon Road in Thrapston – telephone 01832 733686
Janette Houghton MHGI, HG.Dip.P
Human Givens Practitioner