Approaches to working with depression

Depression is one of the most common mental health conditions: between four and 10% of the UK population will have an experience of depression throughout their lifetime.

Depression is characterised by persistent low mood, low motivation and loss of interest in activities that are usually seen as pleasurable. Depressive symptoms vary in their intensity depending on the severity of the depressive episode. Symptoms may include a lack of appetite, insomnia, morbid thoughts, feelings of hopelessness, restlessness, decreased energy, feelings of guilt or lack of concentration. We talk about a clinical depression if a person’s life has been impacted to such an extent that it interferes with daily life and functioning.

It is often argued that depression is due to a chemical imbalance in the brain; anti-depressants prescribed by GPs are SSRIS (for example, Sertraline or Citalopram) which work on increasing serotonin levels in the brain. This in turn is thought to improve mood, sleep and emotions.

The underlying causes of depression are complex and can be manifold including a faulty mood regulation by the brain, medical problems or distressing life events.

In the world of therapy an understanding of the underlying causes of depression as well as subsequent treatment varies significantly.

Below is a very brief and necessarily simplified summary of some of the main approaches in the conceptualisation and treatment of depression. Depression here is largely thought of as a developmental issue (psychodynamic and humanistic approaches) or as an issue to do with faulty cognitive processing (cognitive behavioural therapy).

Psychodynamic approach

In psychodynamic theories (including Freud’s psychoanalysis) depression is understood as an experience of loss or rejection by a parent. Depression is like a form of grief for a relationship that never was. Rather than expressing their frustrations, people with depression often tend to turn their sadness and anger inward. Instead of airing their grievance they think of themselves as worthless. As a child, a depressive person has learned that their parents’ care was inconsistent or not readily available. The child may have angry feelings about this but cannot voice them for fear of being completely abandoned by the parent. Instead these feelings are internalised; the child may start to think of themselves as not worthy of love or as a bad person. In order to gain the parents’ love, the child may try to be extra ‘good’ in their behaviour; negative feelings are necessarily suppressed in the process. If the love is still not forthcoming, the child has learned that s/he will never be quite good enough no matter how hard they try.

Depressed people struggle to have a healthy concept of relationships; contact with other people is often fraught with anxiety. The depressed person has a heightened need for reassurance which in turn often initiates rejection from the other person who feel imposed upon. This in turn will confirm the depressed person’s belief that they are not worthy of love.

Cognitive behavioural (CBT) approach

In CBT the focus is on thought processes, feelings and subsequent behaviour. Depressed people have negative thought patterns about themselves and the world and they interpret the world accordingly. For example, a depressed individual might see a person they know on the other side of the road and wave at them. When they are ignored, they would interpret this as not being worthy of attention or being purposefully ignored. Depressed people often actively seek negative clues that feed into their interpretation of the world, they have a negative bias from the outset. A depressed individual will have to identify their negative automatic thoughts first and then lean to challenge them.

Humanistic approaches

Humanistic approaches emphasise personal growth, self-determination and the achievement of human potential.

Humanistic approaches would look on depression as a disturbance in a person’s ability to grow to their full potential. Every individual holds the key to their own ability to facilitate change given the right conditions for growth and self-actualisation. A depressed person can be helped if the core conditions of empathy, unconditional positive regard and congruence are in place. If a depressed person experiences these conditions, healing can begin to take place. Each depressed person is seen as an individual with their own unique set of circumstances. Given the right interpersonal environment where real contact can take place, depression can be lifted by the individual as the individual experiences more self-acceptance and self-worth.

References:

McManus S, Meltzer H, Brugha T, Bebbington P, Jenkins R (eds), 2009. Adult Psychiatric Morbidity in England 2007: results of a household survey. NHS Information Centre for Health and Social Care. [online] Available at: http://www.hscic.gov.uk/pubs/psychiatricmorbidity07 [Accessed 9 June 2016].