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Depression - Promising Treatment Approaches

by Jonathan Brown(more info)

listed in depression, originally published in issue 117 - November 2005

Symptoms of Depression

Depression is a debilitating mental illness. An affected person can feel extremely low and worthless. They often develop an extremely negative outlook on life and see no way out of the black mood which has gripped them. A loss of appetite and sex drive is common, as is sleep disturbance and a feeling of being constantly tired and 'flat'. There seems to be no point in attempting anything and the future can look incredibly bleak. The victim can see no way out.

Depression

It has been said that living with depression is akin to a purgatory between a healthy fulfilling life and complete insanity. Like eating crisps while holding your nose, you are going through the motions, but the pleasure and flavour is just not there. Experts in the field generally agree that if an individual displays five of the following nine symptoms for two weeks or more, they are probably suffering from Depression.

  • Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g. feels sad or empty) or observation made by others (e.g. appears tearful). Note: In children and adolescents, it can be an irritable mood;
  • Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others);
  • Significant weight loss when not dieting or weight gain (e.g. a change of more than five percent of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains;
  • Insomnia or hypersomnia nearly every day;
  • Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down);
  • Fatigue or loss of energy nearly every day;
  • Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick);
  • Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others);
  • Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

Expressions of Depression

There are various types of depression, and symptoms can vary. It's this wealth of depression symptoms and the broad scope that confuses many people as to what depression actually is. Explanations rarely cover all the symptoms, and everybody's experience is different. A person who suspects that they or someone they know is depressed should keep in mind that a depressed person would more than likely identify with many statements on the following list.

  • You feel miserable and sad;
  • You feel exhausted a lot of the time with no energy;
  • You feel as if even the smallest tasks are sometimes impossible;
  • You seldom enjoy the things that you used to enjoy – you may be off sex or food or may 'comfort eat' to excess;
  • You feel very anxious sometimes;
  • You don't want to see people or are scared to be left alone. Social activity may feel hard or impossible;
  • You find it difficult to think clearly;
  • You feel like a failure and/or feel guilty a lot of the time;
  • You feel a burden to others;
  • You sometimes feel that life isn't worth living;
  • You can see no future. There is a loss of hope. You feel all you've ever done is make mistakes and that's all that you ever will do;
  • You feel irritable or angry more than usual;
  • You feel you have no confidence;
  • You spend a lot of time thinking about what has gone wrong, what will go wrong, or what is wrong about yourself as a person. You may also feel guilty sometimes about being critical of others (or even thinking critically about them);
  • You feel that life is unfair;
  • You have difficulty sleeping, or wake up very early in the morning and can't sleep again. You seem to dream all night long and sometimes have disturbing dreams;
  • You feel that life has/is 'passing you by';
  • You may have physical aches and pains, which appear to have no physical cause, such as back pain.

Causes and Effects

Despite the wonderful advances in medicine in recent years, depression is on the increase. The World Health Organization (WHO) in its report, 'The global burden of disease', estimates that depression will be second only to ischaemic heart disease as a cause of injury and disease worldwide by the year 2020. In fact, recent NHS statistics show that half of all women and a quarter of all men in the UK will be affected by depression at some point in their lives (NHS National Service Framework for Mental Health).

There are no definitive reasons why an individual will develop depression or what exactly 'causes' it. There certainly is a biological effect. The advent of Positron Emmission Tomography (PET) scanning and brain imaging technology has meant that the neurological activity of depressives is being revealed. The frontal lobes appear to play an important role in the mediation of depression. Depressed (reduced) function of the left frontal lobe results in:

  • Tearfulness/weeping without relief;
  • Apathy;
  • Emotional blunting;
  • Loss of motivation;
  • Confusion;
  • Disinterest.

What is unclear a lot of the time is whether this change in brain function and chemistry is a cause of depression, or an effect of depression. "Regarding depression as 'just' a chemical imbalance wildly misconstrues the disorder. It is not possible to explain either the disease or its treatment based solely on levels of neurotransmitters," says Yale University neurobiologist Ronald Duman, PhD. Indeed there is (especially in more severe cases) an inherited element passed through genes. However, there is no doubt that sociological factors and life circumstances play a huge part also. In the past, humans lived in tribes and close-knit communities where everyone knew everyone else. This had obvious advantages, as each individual had a community of friends, family and extended family for emotional help and support. In today's hectic environment it is much more common for a child to move away from their birthplace and have less contact with close family and childhood friends. Can the person at the next desk in work have the same interest in our wellbeing as someone who watched us grow up? In many ways we lack the network of support that our ancestors enjoyed.

Our modern technological age brings with it problems which our ancestors did not have to contend with. The world is getting smaller due to the Internet, movies and newspapers, and thus we have never been so aware of what opportunities are out there, and how others live. The movies, in particular, bombard us with the rich and famous living their glamorous lives. We need to be aware that these programmes are edited to keep them interesting. The same thing goes for unrealistic soap opera story lines, which give us an idealistic and false portrayal of how life should be.

Although it is good to strive to achieve all that one can, not everyone can be a millionaire with a beautiful partner and 2.4 children (and it would be a pretty dull world if that were the case!) and so these 'pantomimes' can leave many feeling like under-achievers in comparison, by encouraging unrealistic expectations with regard to our homes, relationships and even our physical appearance. Today physical appearances and unrealistic body ideals are just as prominent for young men as for young women, and I think it is important to be aware of this. Financial worries can be a big factor. An individual living in a council estate and claiming benefits to survive is obviously much more likely to become overwhelmed by depression than someone who lives in a pleasant area and has a much higher income.

On a similar note, technology is constantly changing. In this modern age of computer games, mp3 players and personal PCs, we are encouraged to stay indoors and not interact with other human beings directly. This isolated existence can lead us to miss out on important social interaction, which is essential to our wellbeing. I think it is rare nowadays for a young man or woman to stop and appreciate the smaller things in life, for example, a walk in the countryside or talking around the dinner table with friends or family.

Our childhood can play a huge part in our adult view of the world. A child, for instance, who is encouraged and nurtured will grow up to face challenges with confidence and see setbacks in their true context, as temporary obstacles which are to be overcome. A child who, however, is criticized and does not receive affection and encouragement is much more likely as an adult to lack confidence, blame themselves for setbacks and see them as personal failures. This second child is much more likely to develop depressive tendencies in adulthood. This is where Hypnoanalysis can be very effective – to find and address such childhood issues and bring adult understanding to them. The therapist can use various techniques to find and reframe these experiences and, in the case above, to identify them as failings of parenting rather than as failings of the child.

There is no doubt that biological, sociological and childhood experiences all play a part in defining who is likely to develop depression. Below, I have only touched very briefly on each.

Treatment Approaches

Cognitive Behavioural Theory
Now to the question of "What treatments get good results with depression?" Cognitive Behavioural approaches have preformed very well in studies and show that how a person looks at the world will greatly influence their mental wellbeing. Cognitive-Behavioural Therapy (CBT) combines cognitive therapy, which involves examining how thoughts affect emotions, and behavioural therapy, which involves changing a person's reactions to challenging situations. CBT is goal-oriented and works best when the patient takes an active role. The cognitive aspect of CBT helps a person recognize the automatic thoughts or core beliefs that contribute to negative emotions. The therapist helps the person see that some of these thoughts and beliefs are false or don't make sense and helps the person change them. Types of automatic thoughts may include focusing on one negative detail (an unkind person) and applying the negative quality to everything (the human race in general); perceiving things as all good or all bad; or applying labels such as loser, no good, or worthless. Types of core beliefs may include:

  • I have to succeed at everything;
  • Everyone has to love me;
  • It's a disaster if things don't go the way I plan or expect;
  • I can't change the miserable way I am.

We can draw a parallel here with Freud's ideas of 'transference and projection' or indeed NLP's (Neuro Linguistic Programming) META questioning.

The behavioural aspect of CBT takes place after a person achieves a more calm state of mind. The person can then take actions that help him or her move closer to planned goals. For example, if depression has caused someone to withdraw from life, that person may be encouraged to participate in hobbies or spend time with friends. Or a person may be gently coached, under supervision, to confront situations, things or people that cause fear or panic. This can be achieved through visualization in a trance state if necessary. It has been shown that the brain can often not tell the difference between a vivid 'fantasy' and a real life physical situation. Through practice, a person learns new, healthier behaviours.

A person who, for example, sees the worst in every situation, will expect the worse and in effect probably display behaviour which will bring about the worst. It can be a vicious circle. On the flipside, however, those who 'look on the bright side' are more likely to just get on with things and less likely to develop depression.

If I neglected to wash my windows for a long time they would become dirty. When I then looked through them, everything else would appear dirty to me no matter how clean it actually was! The trick is to try to enable the client to see each situation as objectively as possible, rather than them projecting and finding negativity everywhere.

Human Givens Approach
Griffen and Tyrell's Human Givens Approach[1] is excellent. They utilize CBT and hypnotherapy in a successful and fascinating blend. They give the therapist a suggested list of 'givens', things which an individual needs to function well in society and avoid depression. These include:

  • Security – A safe environment to develop;
  • Attention – The giving and receiving of;
  • Sense of Autonomy – An element of control over our life (e.g. the ability to work and make money to do the things we want);
  • Be emotionally connected to others;
  • Part of a community;
  • Have a sense of meaning or purpose.

Most non-biological issues in our present situation can be traced to lack in one of these areas.[1]

George Bernard Shaw once said "The secret of being miserable is to have the leisure to bother about whether you are happy or not. The cure is occupation." Griffin and Tyrell seem to agree with him. They have researched depression greatly and, put simply, they suggest that it is due to too much inward focus, or too much negative introspection. They have found that our sleep and dreaming patterns play a huge role in our mental health and suggest that the function of REM dreaming at night is, in fact, to get rid of any unfinished thoughts or worries from the previous day. If I were to have an argument in which I held back and didn't say what I wanted to, then I would say it in real or symbolic form in my dreams that night, thus completing a schema. However, if I run through negative scenarios over and over again in my head all day (as depressed people tend to) then my brain has far too much unfinished business to work through that night. My REM may work overtime for three or four hours, but in the end will tire and wake me early in order to get a break. Thus I am tired for the rest of the day. I don't want to do anything, so I withdraw and sit around the house introspecting all over again. Truly a vicious circle. Griffin and Tyrell found that depressed people on average dream up to three times more than non-sufferers.[1]

Relaxation and Self-Hypnosis

Fortunately the solution is just as simple. First of all, Depression creates anxiety and tension. The first step a therapist must take is to teach the client how to relax. Teaching the client self-hypnosis is ideal. This simple act can have a very profound effect, as our minds work more efficiently when no immediate threat is suspected. An individual suffering from anxiety can be in a constant state of emotional arousal. Next we need to get them to stop thinking so much! When we introspect too much we are miss-using our natural gift of imagination. Along with challenging the depressed person's limiting views and reframing their situation, we can utilize future pacing, hypnosis and metaphor. The client can now begin to use their imagination to imagine positive outcomes and uplifting scenarios. This should be combined with encouraging the client to break through the "I don't feel like doing anything" mentality and get out there. To interact and keep active can put a stop to the negative rumination and thus restore sleeping patterns to normal. They can begin to focus more outwardly. In effect, breaking the cycle.

Psychoanalysis

This raises the question of the old adage that 'talking is good' which is true in many instances, and for many problems (I believe that Hypnoanalysis is unsurpassed for treating many types of neurosis). Indeed there is presently a resurgence of interest in Psychoanalysis and Psychodynamic theory. Developments in neuroscience, linguistics, dream research, gender studies and sexual development research, work in cognition, infant research and, finally, in the philosophy of mind all have recognized the relevance of psychoanalysis and its potential. However, in many cases of depression, most specialists would argue that talking too much about one's problems while depressed can increase introspection and deepen the depression. I believe this is why cognitive behavioural approaches are getting such good results in comparison with other insight therapies in regard to treatment of depression. I think it is very sound advice then to work on this solution-focused approach, to attempt to regulate sleep (REM) patterns and negate negative introspection prior to embarking on any Psychodynamic investigation.

When dealing specifically with depression I think it is important to deal with any past issues which emerge in a positive manner (Griffen and Tyrell pay great homage to the Rewind or fast phobia cure technique from NLP in desensitizing painful memories or trauma, such as those of abuse) and encourage the client to let go, move on and get involved in life, be it in a social club, with family, work or a hobby. Any situations which are affecting our list of 'givens' should be evaluated and a solution looked for. One thing for sure is that a solution will be more forthcoming when the individual is relaxed and in a non-introspective and depressed state. No more time for going over and over problems in our heads. The past no longer exists, the future is coming.

Reference

1. Griffin J and Tyrell I. Human Givens: A New Approach to Emotional Health and Clear Thinking. HG Publishing. 2004.

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About Jonathan Brown

Jonathan Brown Dhp Michp is an award winning Psychotherapist and Medical Hypnotherapist from Belfast, Northern Ireland. His Hypnotherapy and visualization recordings may be purchased on MP3 and CD from  www.hypnotherapyboutique.com and he may be contacted via contact@HypnotherapyBoutique.com

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