DEPRESSION

Depression; as described from- Acceptance and Commitment Therapy literature

Depression is not just a feeling. Depression is an action, so says Steven Hayes author and one of the foremost researchers who have brought this model of therapy to the treatment forums of psychological health.

Depression is one the most common emotional health problems in contemporary society. It is characterised by a set of unhelpful thoughts, distressing feelings, and internal sensations like tiredness, lack of energy and apathy. Sometimes depressed people sleep too much or perhaps their sleep is broken and disturbed and even after a night in bed they wake up tired. Appetite can also be affected, again over eating or not eating enough. Very often the lack of self care can become evident, where patients don't cook or otherwise provide adequate food for themselves. In the following paragraphs, I intend to give some more detailed information on thoughts, feeling, memories, body sensations.

Thoughts.

Humans generally experience more negative/unhelpful thoughts than positive thoughts, even when we're not depressed. In the 'depressed' cohort of the population negative/unhelpful thoughts are the starting point of the vicious cycle of unhelpful thoughts, sad feelings, body sensations and behaviours. Depressed thinking is very often described as 'black and white thinking'. All or nothing thinking. Self critical thoughts are quite common such as; 'I'm a failure' , 'I'm a loser' I can't get anything right'. Thinking is often focused on the past where the person will select out areas of their lives where they believed they failed others or indeed where they failed themselves. At this point feelings of guilt and shame can be quite common. All this 'activity' leads to an almost permanent pattern of rumination, this in turn leads to more unhelpful thoughts, like; "What's wrong with me?", "Why I can't be like everyone else?". All this of course adds to the person's distress and to a continued state of depression.

Feelings

Depression often involves chronic sadness, anger, shame, guilt and irritability. Sometimes sad feelings seem to come from 'nowhere'. Periods of extreme sadness and crying seem to go hand in hand. Depression also involves a sense of emotional numbness. When a depressed person experiences a positive emotions, they are often muted. This is referred to as anhedonia, which means the inability to experience pleasure. In my practice when working with a depressed client I find they are reluctant to become involved in any activity until they are 'feeling better'. Being depressed they genuinely believe that they are unable to do even the smallest task or activity.

Behaviours

Depression tends to lead to reduced levels of behaviour and activity which can lead to increased isolation and loneliness. Depressed individuals also tend to engage in excessive amounts of certain behaviours, such as eating, smoking and sometimes drinking alcohol and neglect behaviours such as exercise and social events. They tend to spend more time ruminating and as a result they gradually move away from friends and family, thus completing the vicious cycle of thoughts, feelings, body sensations and behaviours.

Body sensations.

Being depressed can also lead to several unpleasant physical symptoms, such as pains in various parts of the body. Pain in the head and pain in the muscles are very common. Breathing patterns can be shallow, resulting in less oxygen in the blood, this may in turn effect concentration, which can then lead to a whole raft of reduced activities. Tension may increase which of course leads to restlessness, particularly at night.

Patterns of depression.

It now accepted that from time to time most people will experience low mood or some sad periods during their lives. This is normal, because we're only human and therefore we are subject to these little fluctuations in our moods. So then the question must be asked, is depression abnormal? Of course not. Acceptance and Commitment Therapy philosophy suggests all emotions experienced by us humans are normal. We create these emotions in response to life events. These feelings are used as a signal to ourselves in the first instance and then to our family and friends that there is a gap between what we have and what we believe we should have. One of the original principals of behaviourism suggests that there is at least one function and sometimes more than one function to each behaviour we humans create. One good example of this behavioural theory is when a person looses a spouse or life long partner, some people recover over a reasonable period of time. However, another person may choose to isolate themselves, and cut themselves off from friends and society. This behaviour can be described as a protective strategy so that they will not be hurt by loosing some else again in the future.

TREATMENT

The Acceptance and Commitment Therapy (ACT) and Cognitive Behaviour (CBT) approach used when working with a depressed client starts with establishing what the client has tried up to now. How have they dealt with their thoughts, feelings, body sensations and their behaviours? Usualy clients will say I have tried to 'block' out the unhelpful thoughts or they have tried to ignore their feelings. We now know that this approach doesn't work. If it did there would'nt be a need for counsellors and psychotherapists. After the initial assessment during the first session the six processes of ACT are are used to get started. My own belief is that I like to get some little bit of 'first aid' done in the first session, so that the client will feel that they have made a start on their journey of personal development. Learning to live in the present moment with whatever we may be experiencing at that time is a good place to start. Acknowledging and accepting that there are some events in our lives that we cannot control. On the other hand the things that we have control over are introduced into the session over the period of therapy. On subsequent sessions the client and the therapist will work through the six processes of ACT

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