The basis of depression
Clinical depression is defined as a mood disorder. In which changes to brain chemistry lead to anhedonia, low mood, lethargy and tiredness. However, these changes in mood are the symptoms, not the cause of the problem.
The real cause of depression are the hopeless thoughts in which we become entrapped in reaction to some unwanted life event. That could be loss of employment, the end of a relationship, bereavement, or some other problem we are struggling to overcome. In my last article on the subject Seven Keys to Unravel Depression, I describe how the problem emerges from learned helplessness when we get stuck in our disempowering thoughts about life problems.
The cycle of depression
One major complication is that the depressed state can become self-perpetuating.
Depressive thoughts lead to symptoms such as anhedonia (loss of pleasure) and lethargy, which trigger the feeling that nothing is worth doing, which in turn leads to more hopeless thoughts. This cycle is illustrated in the diagram on the right.
Within this cycle the two keys that keep it going are a) a pre-occupation with those hopeless thoughts, leading to more depressed symptoms and b) withdrawal from potentially rewarding activities that could overcome learned helplessness. Each time we give in to symptoms of depression, and stay in bed we reinforce the state of apathy that underlies the condition.
As the cycle continues we become more and more entrapped in the depressed mind set, the symptoms that follow, and the inactivity that confirms our helplessness.
Breaking the cycle of depression
The main key to treating depression lies in recognising, and overcoming the thoughts that keep us stuck and helpless. More advice on how to do that is contained in this article here. In what follows I show how to break the depressive cycle that keeps us marooned in the problem.
The two keys to breaking it (as shown at the bottom of the diagram on the right) are:
Defusing from hopeless thoughts and refocusing, instead, on coping thoughts.
Bypassing feelings of lethargy and inertia, and activating behaviours that move us towards rewarding activity. Even (or especially) when we don’t ‘feel’ like doing anything.
Focus on coping thoughts
Once we have defused from the thoughts that keep us stuck we can turn our attention to thoughts that help us to get moving again.
Where depressing thoughts proclaim that ‘nothing is worthwhile’, ‘it’s all too much’, and ‘I might as well stay in bed’, coping thoughts encourage us to move in a more hopeful direction. Coping thoughts remind us that we are not defined by our depressed state, and that we retain the power to act. Examples of coping thoughts include:
‘I’m going to focus on what I can do, rather than what I can’t do.’
‘One small step at a time.’
‘I don’t have to listen to the depression talking, I have better thoughts.’
‘I’ve had bad days before, and here’s what works.’
‘I will feel better when I complete this.’
Doing more of what matters
One difficulty is that the feeling of lethargy seems to dictate that we are too ‘tired’ to do anything. However, this is misleading as lethargy is merely a symptom that we are doing too little rather than the reverse. The trick lies in refusing to be gulled by the lethargic state, and in refocusing beyond it.
Behavioural activation will lead to an uplift in mood as we complete small, but significant activities that restore personal agency. The activity selected does not have to be large-scale; even quite small activities will work. Examples include:
- Moderate exercise
- Calling a friend
- Completing a task
- Making or creating something
- Helping someone
As smaller activities are completed my clients often tell me that the impetus for larger activities returns, leading to the progressive spiral illustrated in the last diagram. I have seen many cases in which behavioural activation alone is enough to propel the person out of depression.