Depression’s Vicious Circle

Here’s a brief discussion of how depression leads to hurting yourself, sometimes in ways you’re not even aware of.

Depression is best understood as a vicious circle, the result of current stress acting on a vulnerable individual to push him or her into this cycle that feeds itself: depressed moods lead to depressed thinking and behavior, which leads to a more depressed mood, and so on in a downward spiral. Depression is also accompanied by negative thinking (I can’t. . .The cards are stacked against me. . .There’s no use trying) and hopelessness.  In addition, depression affects the brain directly:  we stop producing dopamine (hence have less drive and energy) and the cells that are meant to receive endorphins, the happy hormones, shrivel away so that we can’t experience good feelings.  The depressed person is usually slowed down, stuck in molasses, unable to think clearly or see a better future; his/her speech is often a slow monotone that sounds like an effort and conveys no feeling at all.  What does it matter. . .why bother. . .it’s useless. 

If you have a mood disorder, by definition you have trouble with self-destructive behavior.  It’s usually a passive form of self-destruction—staying home isolated, giving up hope, expecting the worst—though there are angry depressed people who get into fights and emotionally abuse others.  You may turn to alcohol or drugs to help comfort you.  Depression is usually accompanied by suicidal thoughts and impulses, and suicide is often a real risk.  Impulses like driving into a bridge abutment or stepping off a high place can come out of nowhere and convince you that you are going crazy, though they’re very common with depression.

Your assumptive world changes drastically with depression, and the depressed assumptions turn into self-fulfilling prophecies that just make you feel worse.  Depressed people tend to take too much responsibility for the bad things that happen in life, but feel that the good things are just accidents that they had nothing to do with and are unlikely to happen again.  If you’re depressed, you are probably quite pessimistic in your thinking, assuming that everything is getting worse all the time, and there’s nothing you can do about it.  You feel that you have to be in control every moment, and if you relax, things will fall apart; at the same time you don’t really believe that your efforts to control will really do any good.  The glass is always half empty, good things are temporary and unreliable, bad things are permanent and pervasive, other people are always better, more attractive, more successful than you.  When you know what you ought to do to feel better, but are too depressed to do it, you blame yourself for lacking will power, as if it’s a character trait that you either have or don’t have, and that adds to your low self-esteem.

Here are some of the self-destructive behaviors most commonly associated with depression:

  • Overeating to comfort yourself, a consolation prize
  • Social isolation because you don’t feel worthy of attention
  • Substance abuse
  • Procrastination—for all kinds of reasons
  • A cycle of overwork and collapse
  • Staying in destructive situations—letting your partner, boss, or coworkers take advantage of you
  • Neglecting your health because you don’t feel you’re worth the effort
  • Poor sleep—insomnia or waking at 4 AM and obsessively ruminating is a classic sign of depression
  • Not exercising—you don’t have the energy and you don’t think it’ll do any good
  • Won’t ask for help because you’re ashamed and guilty
  • Suffering in silence—not expressing your feelings is both a cause and symptom of depression
  • Depressed shopping, spending money you don’t have to buy things you hope will make you feel better
  • Parasuicide—nonfatal suicide attempts, suicidal gestures
  • Self mutilation
  • Anorexia/bulimia
  • “Wearing the victim sign”—unconsciously communicating that you can be taken advantage of
  • And many more

All these things obviously interfere with recovery, but they also make your mood problems worse.  Every time you try to get control over these patterns and fail, you have another experience that confirms your own shame about your illness.  You blame yourself, and you become more hopeless.

If you ask depressed people to spend ten minutes thinking about their problems, they become more depressed (because of all their negative thinking patterns).  If you give them another subject to spend ten minutes thinking about, they become less depressed.  Pay attention to this, because it’s counterintuitive; it’s important to our worldview to believe that if we just apply mental power to our problems, we’ll find a way out.  But that just backfires with depression, because the illness has so pervaded our minds that our beliefs and assumptions are twisted, and our ability to concentrate and make decisions is damaged.  In fact, it’s rather obvious that if the ordinary powers of the conscious mind were able to counter depression, we wouldn’t be depressed to begin with.  This is a very ironic form of self-destructive behavior, and why I refer to depression as the Catch-22 of mental illness; trying your best to figure out what’s wrong and what to do about it just makes you feel worse.  But no one recognizes this without help.

That doesn’t mean there’s nothing you can do about it.  I ask people to keep a log of their depressed mood shifts, what’s going on around them at the time, and what their thoughts and feelings were.  They thus learn to identify their triggers, and develop some control because they can strategize how to avoid or respond differently to things that make them feel bad.  At the same time, they develop some of that metacognitive awareness that accompanies mindfulness; the fact that there are explanations for their mood shifts means that they’re not crazy or out of control, and lends hope.

By Richard O’Connor, Ph.D.

Dr. O’Connor is a psychotherapist in NYC and Connecticut who specializes in treating those with depression. He is the author of the bestselling books, Undoing Depression: What Medication Can’t Give You and Therapy Can’t Teach You.

 

Pushing Back Against Depression

Depression will push our backs up against the wall. It often seems bigger than us: a bully. If we let it, it will pound us down. So, we’ve got to push back.

If we don’t fight back, together with the help of others, depression can consume our lives leaving only our pulse and some air in our lungs, but precious little else. The vitality, the passion and full array of emotions that make life worth living may be sucked up out of us as if by an alien ship from above.

There are many tools to fight depression. They can certainly help us regain our footing and make our lives functional and productive again. But isn’t life more than just about a return to “normal”? We all have dreams and aspire to live them. Theres’s something wild about dreams.  So often, they are outside our “normal”. And regaining them is a big part of recovery for it is these passions that bring us most fully alive in the cosmos. And we have to fight for our dreams.

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Just like fighting a bully, pushing back against depression takes courage. We have to reach deep down inside ourselves to listen to that part of our life force in us all that gives us the grit to say to depression,“no more”. We must say to ourselves, “I’m sick and tired of being ‘sick and tired’”.

When we’re ready to make some changes, we push the bully back. A small push in the beginning will do. We gain some space and separation from this goblin. We stop defining ourselves as a “depressed person,” as if our identity were wholly made up of our affliction. We are not our depression. It is a part, albeit a very painful part, of our lives. But it need not be all of it.

To fight back against depression, we need to empower ourselves to level the playing field. One of the best ways is learn mindfulness. With it, we gain detachment from our negative thoughts and emotions. Mindfulness teaches us that pessimistic thoughts and disturbing emotions are clouds passing in the sky, not reality.  Check out the excellent book, The Mindful Way Through Depression to learn more.

If we don’t buy into the depressed stories our minds spin out, we can begin to see them for what they are: puffs of cerebral and neurochemical smoke. We don’t have to buy into them.  We don’t have to live by that script.

This takes a lot of practice and we have to start slowing. This is, by no means, a quick “fix”. But in detaching ourselves from our mental jumble and the over reactive emotions that accompany my anxiety and depression, we gain freedom. We again have choices in life. We need not walk in the deep ruts of depression anymore.

And this is empowering.

Poet, Mary Oliver in her poem, “The Journey,”beautifully captures the sense of determination we need to recover from depression:

One day you finally knew
what you had to do, and began,
though the voices around you
kept shouting
their bad advice–
though the whole house
began to tremble
and you felt the old tug
at your ankles.
“Mend my life!”
each voice cried.
But you didn’t stop.
You knew what you had to do,
though the wind pried
with its stiff fingers
at the very foundations,
though their melancholy
was terrible.
It was already late
enough, and a wild night,
and the road full of fallen
branches and stones.
But little by little,
as you left their voices behind,
the stars began to burn
through the sheets of clouds,
and there was a new voice
which you slowly
recognized as your own,
that kept you company
as you strode deeper and deeper
into the world,
determined to do
the only thing you could do–
determined to save
the only life you could save.

 

 

 

Depressive Rumination and the Idling Brain

Depressed people often find themselves preoccupied with guilty, shameful and self-defeating thoughts for large parts of the day.  A new study sheds light on the brain mechanisms that give rise to depressive realism.  Read the News

God and Depression

“Does God care about me?”

“Why do I suffer so, Jesus?”

“Please help me, God”

“Where are you? Do you even exist?”

People suffering from depression ask these questions in the silence of their hearts. They cry out to God just as others have for millennia when faced with great sorrow:

“My tears have been my food day and night.” Psalm 42:3.

Beyond therapeutic and psychopharmacological bromides, we all seek loving comfort. Sometimes we get it from others – – sometimes we don’t.

We’ve reached our limit to cope, to keep it all together. We’re worn out by the battle.

We’re searching for answers: “Why me?”we ask. Even when we get answers (e.g. it’s “biochemical” or too much negative thinking) from others, the pain may not abate. And so we ask more existential questions about the nature of our suffering.

Barbara Crafton, an Episcopalian Minister and depression sufferer, writes in her book, When Jesus Wept: When Faith and Depression Meet, about this mystery:

“In several ways, above and beyond the genetics, family upbringing and “slings and arrows” of our existence that has brought us to this point in our lives, there is a real mystery to suffering. Why do some people suffer tremendously while others not so much? Why do some people with a certain makeup come down with depression while someone with a similar history do not? It’s a mystery. Often, while people who get treatment and help come to find out some of the reasons that they’re depressed, it often isn’t enough. The answers don’t always heal us.”

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Abraham Lincoln, who struggled with depression his entire life, was quoted in the book Lincoln’s Melancholy: How Depression Challenged a President and Fueled his Greatness:

“I have been driven many times upon my knees by the overwhelming conviction     that I had nowhere else to go. My own wisdom and that of all about me seemed insufficient for that day.”

Much like Lincoln, we can feel powerless to stop our depression. It is BIG and we are small. Anything other than the crushing experience of depression feels unreal. We’re not in the normal stream of life that everyone else is swimming in: we’re drowning.

I had never encountered any pain greater than depression. Other types of pain I could deal with and recover from: a burst appendix in college and blown out ligaments in my knee years ago. But depression? There wasn’t any surgery I could have, no caste that could be fitted. I felt like I was dying. In the book Unholy Ghosts: Writers on Depression, writer Susanna Kaysen captures this experience:

“The worst thing about depression – the thing that makes people phobic about it – is that it’s a foretaste of death. It’s a trip to the country of nothingness. Reality loses its substance and becomes ghostly, transparent, unbearable. This perception of what’s outside affects the perception of the self, which explains why depressed people feel they aren’t ‘there.’”

So in the face of so much pain, we look for power outside of ourselves. We place our hope in Someone bigger than our depression – – God.

It’s tough to pray when we’re depressed

Praying when in the throes of depression is a challenge. We might not be able to muster the energy, feel like it isn’t making a dent in our depression; or, worse yet, our faith falters and we stop believing.

We grow despondent.

We give up hope.

We give up on God.

We want salve on our wounds, but depression just keeps throwing salt in them. We yearn so badly for God’s direction (“Show me the way out of this darkness”), but it always doesn’t come.

Barbara Crafton writes:

“It makes every bit of sense for a person to whom faith is a matter of importance – even one who doesn’t think that all human sorrow can be magically prayed out the window – to hope that it will somehow illuminate the darkness of depression. We understand that nobody ever promised us a rose garden, but could we perhaps have a little light?”

Depression is a terrible liar

In a sense, depression is a temptation. It calls us. It whispers in our ear that all is lost and that we’ll never find our way back home. It’s a terrible liar, really.  It spins the yarn that we’re worthless and there’s no point in living.  And these messages repeat themselves over and over again in our minds and souls.  And they all seem so true and unchangeable.

John Piper wrote in When Darkness Will Not Lift: Doing What We Can While We Wait for God – And Joy:

“…We should all fortify ourselves against the dark hours of depression by cultivating a deep distrust of the certainties of despair. Despair is relentless in the certainties of its pessimism. But we have seen again and again, from our own experience and others’, that absolute statements of hopelessness that we make in the dark are notoriously unreliable. Our dark certainties are not sureties.”

Who do You say I am?

One of the most powerful scenes in the Bible is when Jesus turns to Peter and says, “Who do you say I am?”

I like to imagine Jesus standing across from me. He’s looking directly into my eyes. I reach out to Him. and say, “Lord, who do You say I am?” It clearly isn’t what my depression judges me to be. Jesus is always affirming, always loving, always telling us just how precious we are. THAT is the voice we need to listen to and embrace.

A Light in the Darkness

Mother Teresa once wrote:

“If I ever become a saint—I will surely be one of ‘darkness,’” After her death, Many suggest that she suffered from clinical depression and long periods where she sought to understand God’s absence in the face of so much inner pain.

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Therese Borchard writes:

“I spent a week with Mother Teresa and her Sisters the winter of 1994. I stood beside her for about two hours as we distributed Christmas gifts to orphaned children. I sensed sadness in her. But her light overshadowed it. Unlike a person wrapped in severe depression, wearing the expression of despair, she exuded light and hope. When she prayed, her deep love for God was visible, even contagious.

This saint of darkness has much to teach me about how to live with inner anguish.

First of all, I should stop referring to my depression and anxiety as the “Black Hole,” (singular and capitalized), and call it, as Mother Teresa described her difficult places, the “dark holes.” Because the darkness is never black, or without any light at all. Her legacy is proof that hope and faith and love prevail, even in the dark night.”

A few years ago, I composed this prayer.

Dear God,
I am on my knees, because I don’t have the strength to stand up.
My strength is gone. I can’t deal with my depression by myself any longer.
I am lonely.
I call on You.
I have faith that Your strength is bigger than my depression,
that Your mercy and healing white light will show me the path home.
I am not alone.
You’re rod and staff comfort me as I walk through the valley of the shadow of depression
and there is nothing I shall fear.

Amen

So don’t lose hope. Don’t lose God. He’s working somewhere in the pain to heal you.

As Pope John Paul, II wrote:

“Do not abandon yourselves to despair. We are the Easter people and hallelujah is our song.”

By Daniel T. Lukasik, Copyright 2015

 

 

 

 

Helpful Repetitive Thinking in Depression

In a previous blog, I noted that rumination – repeated dwelling on feelings, problems, and difficulties – is an important process maintaining depression. I also discussed the finding that repetitive thinking about upsetting events and unresolved problems is a normal and natural response – and that sometimes it can be helpful. For example, focusing on our difficulties can help us to come to terms with them and to solve problems. These contrasting effects of repetitive thinking led to the key questions of what factors determine whether repetitive thinking is helpful or unhelpful, and how does such thinking go wrong in depression?

These questions have been the primary focus of my research over the last 15 years and we are beginning to get some preliminary answers. This research is summarized in a research paper I published in Psychological Bulletin (2008).

First, it appears that the content and focus of the repetitive thinking is important. If you keep thinking about something positive, it is likely to make you feel better, whereas if you keep dwelling on something negative it will make you feel worse. In a nice meta-analysis of the field, Mor and Winquist (2002) found that attention to negative aspects of the self was strongly related to increased levels of negative mood, whereas attention to positive aspects of the self was related to lower levels of negative mood. The act of repetitively thinking about anything acts as a form of mental rehearsal for the content of inner speech, strengthening and elaborating the mental representations, making them easier to come to mind in future. It also tends to polarize and exaggerate thinking, making it more extreme. So, repetitive focus tends to exacerbate the current state and mood – if you are in a sad mood with negative thoughts, and you dwell on them, the mood will get worse, and the thinking will get more negative. Thus, repetitive thought acts as an amplifier of thoughts and feelings.

Second, the style of the repetitive thinking is equally important. It is possible to focus on negative information in helpful or unhelpful ways.

Imagine that you are faced with an upsetting and saddening event such as the unwanted end of an intimate relationship. The break-down of a relationship will be experienced as negative by nearly everyone and will likely lead one to dwell on its demise. However, there are quite distinct ways of dwelling on it.

One understandable way to dwell on this split is to think about why it happened, what it means, what caused it, and its implications for the future. In this style of processing the break-up, you would be focused on the causes, meanings, and implications of what happened. This way of thinking tends to move away from the specific details and contexts of what happened and to more general abstractions, which capture the key gist of the event and what this event might share with past events and with other situations in the future. Hence, this style of thinking is called abstract processing. Typical questions might include “Why did this happen? What does it mean about me? What does it mean about the future?” An extensive social psychology literature indicates that such “why?” questions tend to make thinking more abstract and to distance individuals from the specifics of situations.

This abstract style of processing negative events is typical of depressive rumination and anxious worry. You can see how if you are feeling down and have low self-esteem, focusing on yourself and thinking about a break-up in this abstract way could be unhelpful, because asking these questions about causes, meanings, and implications is likely to lead to negative self-blaming conclusions, e.g., “It is my fault”. Moreover, because abstract processing tends to broaden out across situations, such thinking will pull in past memories of rejection and loss (e.g., “This keeps happening to me”), and may lead to general conclusions about the future, such as “I will never have a lasting relationship”, all of which worsen mood and exacerbate depression.

In contrast, you could repetitively reflect on the break-up by focusing on exactly how it happened, replaying in detail the events that led up to the split and the final few meetings and conversations with your ex, noting in detail what happened. In this style of processing the break-up, you would be focused on the specific details, the sequence and the circumstance of how the relationship came to an end. This way of thinking focuses on the context (when, where, how, what, who) of what happened and how it happened and stays close to your actual concrete experience of the end of the relationship, rather than thinking about its meaning. Hence, this style of thinking is called concrete processing. Typical questions might include “How did this happen? What did I do? What did my ex do? How did I feel? How did this unfold over time?”

A series of experiments in my lab, replicated in other labs, have found that, when faced with problems or upsetting events, adopting a concrete style of processing is more helpful than an abstract style of processing. For example, when asked to generate solutions to interpersonal difficulties such as an argument with a partner or a disagreement with your boss, we found that prompting currently depressed patients, formerly depressed patients and never depressed controls with either no questions, abstract “Why?” questions, or concrete “How?” questions, influenced the quality of solutions generated. Replicating other findings, patients with depression were worse at solving social problems than recovered depressed patients and non-depressed individuals when left to their own devices. However, when prompted to ask concrete questions, patients with depression were as good at solving problems as the other two groups, suggesting that these “How?” questions ameliorated this difficulty. Further, asking abstract “Why?” questions worsened problem-solving in people who were formerly depressed, suggesting that these questions activated their previous difficulties. We believe that concrete processing is more helpful for problem-solving because it makes an individual aware of the specific circumstances and behaviors that occurred in a situation, suggesting possible alternatives to resolve the situation.

In another study, we found that training students to think about the meanings and implications of emotional events for 30 minutes caused them to feel worse to a subsequent stressful anagram task than students who practiced thinking about the concrete details of emotional events. Thus, relative to concrete processing abstract processing increases the negative emotional response to difficulties. Similar effects have been found when studying how quickly people recover from previous upsetting events, with a concrete style of thinking about past sad or traumatic events proving to be more helpful.

Taken together, this research suggests that repetitive thinking about the self, negative feelings and problems in an abstract style will be particularly problematic, driving depression and anxiety. Further, it suggests that shifting to a more concrete way of thinking about difficulties could be helpful for people with depression. Building on this hypothesis, we have investigated whether training people with depression to become more concrete and specific can itself help to reduce depression. This will be the subject of another blog.

Ed Watkins, Ph.D. is a clinical psychologist.

 

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