Loss, disappointment and other difficulties are unfortunately a part of life, so we are all likely to feel sad at various points in our lives. Sadness is a core emotion and is a normal part of the human experience. Most of the time after a disappointing event or a loss, sadness passes after a couple of days. Feeling sad occasionally is not a problem, however if it lasts longer than a few days at a time or occurs frequently it may be good to learn some strategies to keep it check.
Depression is different from sadness as depression is characterised by persistent low mood for weeks, months and even years in some cases. Depression interferes with our ability to experience pleasure, interact with other people or function in our usual way.
If you have had experience with depression or know someone who has, you are not alone. It is estimated that six percent of Australians suffer a depressive episode each year, and 15 to 20 per cent will experience at least one episode of depression at some stage in their lives.
The good news is that depression usually responds well to treatment. Depression can pass on its own without intervention, but treatment from a qualified mental health professional can speed up recovery by months or years, and may help to prevent future relapse.
The Effects of Depression or "Why do I feel so Bad?”
Global Pessimism –
When depression has been triggered our cognitions (thoughts) change. Our mind becomes preoccupied with negative thoughts and everything feels bad and pointless. It becomes very difficult to recall positive events from our past, and it becomes impossible to believe we will ever feel good again. Problems can seem overwhelming, giving us a sense of not even knowing where to start, and making us feel helpless.
When we are depressed, we ruminate. Rumination is having repetitive thoughts that focus on our problems, analyse the details of past mistakes, speculate on possible reasons for things and about possible past and future consequences (Why did this happen?, If only I’d….., It’s my fault, It’s never going to get better etc.). Rumination is unhelpful because it keeps us stuck in self-defeating thoughts and behaviours, contributing to the downward spiral of depression.
The Depression Spiral –
Due to the nature of the symptoms of depression, once we start to become depressed, it is very easy for that depression to become worse quite quickly. The negative cognitions and loss of motivation lead us to withdraw and reduce activity. Inactivity makes us feel bad and spending too much time alone gives us a lot of time to ruminate with these thoughts, leading to further despondency. This leads to further withdrawal, further rumination, and further reduction in mood and so on. This is how depressive episodes are are maintained, and how something that starts as low mood can spiral in more severe depression.
The Cognitive Triad –
Depression seems to cause people to take a negative view across the three areas of;
1. Themselves (eg. I am no good),
2. The world (eg. People are uncaring) and;
3. The future (eg. It will be this way forever).
These distorted cognitions can give rise to feelings of hopelessness, helplessness and worthlessness.
How do I break the cycle?
There is good evidence for several treatment strategies for depression. One of the most effective appears to be Cognitive Behavioural Therapy. This therapy combines cognitive and behavioural strategies to address the symptoms of depression.
Cognitive Strategies for Depression
Negative thoughts and ruminations are important perpetuating factors in the maintenance of depression, so strategies that focus on these can assist recovery. These strategies include;
Labelling the Unhelpful Thinking – By keeping track of the negative thoughts that occur in our mind we can identify any unhelpful thinking associated with the thought. By labelling the thought, it can give us some distance from it and reinforce the idea that the thought is not the “truth’. For example, the unhelpful thinking style of “catastrophizing” relates to assuming the very worst will happen, by labelling the thought as catastrophizing it easier for us to see that the worst case scenario is not a forgone conclusion.
Disputing Self-Critical Thoughts – By becoming aware of the thoughts we are having in which we are being harsh on ourselves and “beating ourselves up”, we can dispute them and thus take the emotional power out of them. For example;
Self-critical thought – "This is my own fault – I’m a weak person for becoming depressed.”
Reasonable thought – "Depression affects one in six people at some stage in their lives. It is not a measure of character or personal worth. It affects people from all walks of life."
Behavioural Strategies for Depression
The symptoms of depression lead us to withdraw from events we usually find pleasurable and lead us to become inactive. Inactivity itself can physiologically lower our mood and withdrawing from activities prevents us from having the experience of doing something enjoyable, both of which contribute to depression getting worse. Behavioural treatment for depression starts simply with trying to link someone back with activities previously enjoyed. Behaviours such as physical exercise, listening to music and spending time with friends can have direct mood enhancing effects, both physiologically and emotionally. Other benefits include gaining a sense of achievement, providing evidence to challenge our negative thoughts, and disrupting negative ruminations.
There is a wealth of research evidence collected over many years to support the benefits of these interventions in the treatment of depression. However, due to the nature of the symptoms of depression it can be hard to implement these strategies on your own, thus the support of a qualified mental health professional can assist a faster recovery.
Greta Neilsen is a clinical psychologist working in Bowen Hills in Brisbane who has experience with, and a special interest in treating depression. For more information please return to the main site at www.gretaneilsenpsychology.com.
Carr, A., & McNulty, M. (2006). The handbook of adult clinical psychology – An evidence based approach. Routledge: New York.
Edelman, S. (2013). Change your thinking. HarperCollins: Sydney.
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