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With so many people suffering from depression in today’s complex and accelerating world matrix, it seems like depression will probably visit all of us at one time or another. The World Health Organization says in a few years, depression will be the leading cause of global mental and physical disability (Schlein, 2017). Based on the findings of the second Singapore Mental Health Study in 2016, major depressive disorder is also one of the top three mental illness in Singapore (Choo, 2018).
In fact, due to the COVID-19 situation, there has been reports of increasing cases of people showing signs of clinical depression (Fava, 2020). There are a few possible factors (Fava, 2020) that played a part in this rising trend of depression cases, namely fear of getting sick, financial concerns due to loss of jobs & incomes, loss of community support, and reduced access to caregivers. With prolonged circuit breaker measures, some may suffer from social isolation (Tai, 2020), a result of being cut off from their usual support systems while others may experience intense emotional tensions due to poor & conflictual relationships with family members at home (Tai, 2020).
So is it possible to have depression instead of depression having us, even during this COVID-19 pandemic? Is it possible to control it instead of it controlling us – driving us towards self-destruction, alcohol and drugs – and creeping in as disengagement and self-isolation? How can we deal with depression in a healthy way? With small gains in psychological flexibility, even when we’re depressed, we may be better able to say “yes” to living and engaging a better quality of life.
What could life be like if you no longer struggled with your depression? Is it possible to have some level of acceptance of it, reducing the amount of time and emotional energy invested in fighting or running from it? Is that possible?
How Does the Depression Sneak into Our Lives without Us Noticing?
Depression is insidious as it often moves into your life, progressing slowly and gradually with most or all of the symptoms easily attributed to something else: crying relating to sadness and loss, insomnia and moodiness relating to stress, and low energy to physical illness. Even more, all of these symptoms HAVE been experienced when we haven’t been so depressed. Another reason for depression being a sneak: it’s difficult to recognize because of the negativity and stigma associated with it – it could be socially destructive and shaming! Admitting a depression may be difficult. Depression is hard to recognize because it appears differently for different people and may not disturb you like it does with other people you may know. It even may have triggered you months before you realize it’s effects – like missing your friend who moved away – even more than you thought. A delayed onset of depression may come months or even years after a traumatic experience (Gillihan, 2019).
Depression is insidious as it often moves into your life, progressing slowly and gradually with most or all of the symptoms easily attributed to something else.
Understanding the Solutions for Healing and Increasing Psychological Flexibility
Some days are better than others, but on some days, life becomes painful and difficult to bear with – even for the most resilient individuals. Mother Theresa suffered from depression and life was painful for her as well (Kolodiejchuk, 2007). In everyone’s life, there is some measure of pain and suffering, though to varying intensities, and that is normal. However, the suffering of depression often comes when we try and run away from the pain. These efforts may eventually become more of a problem than the depression itself - controlling through avoidance, through addiction, through self-harm and sabotage – all efforts that may help in the short- term but may be more damaging in the long-term. By not accepting our pain, even in small measure, causes us to suffer more. Instead, the deepest transformation occurs when pain is accepted and maybe even understood a bit, moving us away from potential self-destruction, towards new psychological terrain.
The deepest transformation occurs when pain is accepted and maybe even understood a bit, moving us away from potential self-destruction, towards new psychological terrain.
With this, there are six interdependent and overlapping behavioral processes that help to answer,“What is influencing the depression, and what may be causing the weight of how I’m feeling?”
Experiential Avoidance vs. Willingness and Acceptance - How do we face the inevitable painful experiences in life – through experiential avoidance, through baby steps of action, or through jumping into the deep end of the pool? It depends. Each one of us handles pain, grief, loss and the fear of the unknown differently. Avoiding both the external and internal experiences may manifest through many types of behaviors. One of the most profound avoidance behaviors is suicide. Founder of DBT Marsha Linehan candidly states, “If (someone) kills themselves, therapy isn’t going to work (Linehan, 2017).”Also, “the desire to commit suicide, has at its base, a belief that life cannot or will not improve. Although that may be the case in some instances, it is not true in all instances. Death, however, rules out hope in all instances and we do not have any data indicating that people who are dead lead better lives (Linehan, 1993).” With the choice of life then, comes a certain level of willingness to not just tolerate living but to take in what is offered.
Cognitive Fusion vs. Cognitive Defusion – How do we stand or approach our own thoughts? Cognitive fusion occurs when a person fuses with the content of their thoughts or emotions so that the content is experienced as objective truth rather than as a mental construct seen from alternative perspectives. Example: you see someone wildly driving towards you and get very upset – you say, “The world is filled with insensitive crazy people – everything in my life is out of control! Now I feel out of control!” Later, on the news, you see the same driver and find out he was having a heart attack. In this case, you assigned a false attribution to the event and now, with this new perspective, hopefully your rage can be replaced with empathy and compassion (Berkelhammer, 2012). Learning from depression then, requires a self-compassionate act of creating distance between yourself and your thoughts, so alternative perspectives may be found. Cognitive defusion is about looking at thoughts rather than from thoughts (Harris, 2009), and choosing to respond to thoughts only if they move you towards what you value. Their power over you is a self-imposed illusion (Schenck).
Cognitive defusion is about looking at thoughts rather than from thoughts and choosing to respond to thoughts only if they move you towards what you value.
Dominance of Past & Future vs. Being in Contact with the Present Moment – Do difficult internal experiences show up that cause you to immediately start worrying about how your history is beginning to repeat itself, or, do these difficult internal experiences cause you to catastrophize about the future? Psychological flexibility requires practicing the skill of mindfully and intentionally choosing to live in the moment, actively creating new experiences with your five senses – without problem solving or making judgments. This process is important as it helps find new meaning to present experiences calmly, without attacking them with worry and dread. With this, you’re better able to tune your five senses towards non-judgmental, emotionally regulated experiencing (Gillanders, 2014) both during non- stressful and stress-filled events. This helps create a neutral baseline of calmer self-awareness so that when you do start to move away from this state, you are better able to notice, scale, and regulate difficult approaching thoughts, emotions and sensations.
Rigid Attachment to Self-Story vs. Flexible Perspective on Self-Story – As we live our lives, we build up reasons, or stories about why things happened to us and what kind of person we believe we are as a result. If we get too attached to this story and define ourselves by it, it dominates and we become less psychologically flexible (Gillanders, 2014). Fortunately, in therapy, these problem-saturated narratives may be identified as outdated, and no longer self-serving. They also may be helpful in finding seemingly absent, yet implicit alternative preferred and more useful narratives laden with undiscovered personal skills and resources.
Ambiguous Personal Values vs. Clarity and Contact with Personal Values – Moving away from depression may mean moving towards clarifying personal values and more clearly identifying what you care about. Are you in touch with the things that matter to you? This is difficult as some people havenever been asked “What do you really care about? What matters to you?” How often have you been asked these questions? Therapy can help give you space to answer these questions about what you want to choose to be in your present world (Gillanders, 2014).
Inaction, Impulsivity and Avoidant Persistence vs. Committed Action Towards Values – Depression is often associated with inaction or withdrawal, or sometimes, trying things impulsively and not being able to persist. For others, they are able to function at some level, but only within a state of avoidant persistence – with a kind of persistent quality, but not really experiencing their thoughts and feelings in totality. Therapy can help with this too, guiding you in gaining a clearer sense of what you find important, and translating these values into committed action (Gillanders, 2014).
Diagram illustrating the above 6 interdependent and overlapping behavioural processes (Based on Acceptance Commitment Therapy, ACT):
How Can Counselling Help?
Counselling can help you sort out the workability of your strategies for living with depression. Are some things you are doing effective, and others less effective? If there are effective strategies in place, we talk about what obstacles are in the way of doing more of the same, and if the strategy isn’t working, thenwe work together to find behavioral strategies that do work. It’s not about getting rid of depression first before living, it’s about accepting the depression and at the same time, taking small steps forward, living out personal values – and what you care about, living the life you choose to live now – with hope.
References
Berkelhammer, L. (2012, December 11). The Danger of Cognitive Fusion and the Solution [Video File]. Retrieved from https://www.youtube.com/watch?v=L0YNTyT8Tx0
Choo, C. (2018, December 11). More people in Singapore have experienced a mental disorder in their lifetime, study finds. Retrieved from: https://www.todayonline.com/singapore/more-people-singapore-have-experienced-mental-disorder-their-lifetime-study-finds
Fava, M. (2020, June 25). Depression on the Rise during COVID-19: Resources for Patients and their families. Massachusetts General Hospital. Retrieved from:
https://www.massgeneral.org/news/coronavirus/depression-on-rise-during-covid-19
Gillanders, D. (2014, July 23). Acceptance and Commitment Therapy for Depression. [Video File]. Retrieved from https://www.youtube.com/watch?v=_qJzWUThXzA
Gillihan, S. J. (2019). Depression Can Sneak Up – Even When You’re a Therapist. Retrieved from https://blogs.webmd.com/mental-health/20191010/depression-can-sneak-up-even-when-youre-a-therapist
Harris, R. (2009). ACT made simple. Oakland, CA: New Harbinger Publications, Inc. Kolodiejchuk, B. (2007) Mother Teresa – Come Be My Light. New York, NY: Doubleday Religion.
Linehan, M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder. New York, NY: The Guildford Press.
Linehan, M. (2017). Marsha Linehan – Goals of Therapy: Cutting and Suicide Likely Won’t Get You There. [Video File]. Retrieved from https://www.youtube.com/watch?v=j_6j43zKNFw
Schenck, L.K. (2016). Cognitive Defusion in a Nutshell. Retrieved from https://www.mindfulnessmuse.com/?s=Cognitive+Defusion+in+a+Nutshell
Tai, J. (2020, May 9). Mental Health Fallout: How COVID-19 has affected those in Singapore? The Straits Times. Retrieved from https://www.straitstimes.com/singapore/health/mental-health-fallout
About the Author
Leaving behind a career in dental work, Charlie dedicates himself into a work that gives hope to others. He is serving in Grace Oasis Counselling Services as a counsellor, and is passionately involved in helping others to uncover their unique innate potential to learn, to grow and to gain wisdom and strength from their own life experiences, that they may navigate through complex issues in life such as depression and anxiety with Hope.