...What is depression? see case study

Depression is a very strong emotion. That might sound odd, but its true. Depressed people have a high level of physiological arousal which is demonstrated, for example, by taking a simple blood test which will typically show that a higher level of the stress hormone, cortisol, than normal.  Even if, to a casual observer, a depressed person seems inactive, they are in fact exhausted, sometimes to the point of not being almost unable to move or get out of bed in the mornings. This emotional arousal affects the way they think. 
Depressed people have difficulty in thinking.  Strong emotional arousal locks our attention so we can’t see the bigger picture. There are times, of course, when this is essential for survival, but it has the drawback of effectively making us stupid, which is why we never think intelligently when we are angry, nervous or in love. In the same way the strong emotion of depression stops people thinking properly. They become locked in the pessimistic, black-and-white thinking style of the emotional brain.

How does emotion change our thinking? The answer lies in the way mammals and our early humans ancestors evolved – with a powerful instinct for self-preservation. When an animal appeared on the horizon they had to decide immediately: is this a threat? If it was, they had to be ready to run away or defend themselves. Or, if the animal was edible, they had to aggressively pursue and kill it in a very focused way. So decision-making was fairly straightforward: fight or flight. That fight or flight response is still with us, only now it can now easily be fired off by imagined dangers instead of by a real threat. Every time our emotions are aroused by worrying or stress, for example, our thinking is automatically locked into a narrow, binary, all or nothing view, from where we are unable to see reality more objectively and thereby solve problems. The strong emotion of depression locks attention on the immediate problem, shutting out the possibility that things can be different and might get better. 
 

Why is depression so exhausting?  One of the strangest things about talking to depressed people is how many of them comment on the fact that they wake up exhausted. This is easy to answer thanks to an important new breakthrough in our understanding of brain functioning. 
Depression is best thought of as a cycle. What happens is this: some kind of setback starts us worrying, maybe the loss of a job or a problem in a relationship. This gets raises our emotional levels, and, if we have a slightly anxious or pessimistic orientation to life, our ability to use our higher cortex and frontal lobes well is cut off from us and we remain in our low mood. The strong emotion closes our higher brain down to the point where we can no longer see how to change things. 
New research shows that worries and other emotional arousing thoughts that are not acted out in the daytime are metaphorically acted out in our dreams at night. So, someone who worries a lot will dream a lot too. Sleep laboratory research shows that depressed people dream far more than non depressed people. And dreaming uses far more energy than slow wave sleep and, if you dream excessively you wake up exhausted. The REM sleep state, when most dreaming happens, is also called paradoxical sleep because it uses as much or more energy in the brain than is used when we are awake. 
Why do depressed people lose motivation and often come to think life is meaningless?   During dreaming the brains orientation response is continually firing.  It is the same response that orientates us when we are awake. If it becomes exhausted we cannot motivate ourselves. So the sufferer wakes up exhausted, and doesn’t have the energy or interest in the world to go out and do the things that might produce pleasure. Without a poorly functioning orientation response we experience difficulties in getting going, there is no motivation. Without motivation to stretch ourselves and do things there is no meaning in life.

Is it really that simple? It is. A normal nights sleep is around 25% dream sleep and 75% slow-wave sleep (when the brain's sugar stores are refilled). A depressed person may have as much as 75% rem sleep and just 25% slow-wave sleep. That's why they wake exhausted. Antidepressant drugs reduce the amount of rem sleep, and this is probably why they work - when they do. The problem with antidepressants, apart from the side effects, is that they do not deal with the thinking style or the problems in the person's life that are making them worry or introspect excessively.
For a full explanation and all the scientific references that support this get hold of ‘Breaking the cycle of depression’ available here published by the European Therapy Studies Institute.

What is the depressed person to do? Many people find their depression goes away by itself in the end. But it may take months, it may not happen at all, and the depressed person will have a bad time. Life can feel so awful and empty that some even kill themselves, because they can't see how things could get better. (Suicide rates are going up in EVERY country in the world.) 
Over the decades various drugs have been tried in an attempt to relieve unhappy or anxious moods. Sometimes this appears to work and people have benefited (although many claim this is because of the placebo effect) but, as more is being found out about the delicate balance of chemistry in the mind/body system, it is becoming clear this isn’t a very good idea. The prominent brain researcher, Susan Greenfield, for example, has likened the delicate chemistry of the brain to a system of many seesaws, all balanced on each other — when you move one they all tend to move. So the idea that you could artificially raise the level of, say, serotonin (which has some connection with mood, among other things), and just affect the serotonin “seesaw’, making the patient happier, without affecting anything else, is hopelessly simplistic.
 

What does depression say about a person? Every human being has a set of fundamental physical and emotional needs that have to be met in the environment for that person to live a fulfilled life. These are givens of human nature handed down to us in our genes, the ‘human givens’ as many people are now calling them. Some of these are obvious: as babies we all need security, attention, love and a sense of control over events in our lives. We are also social animals and need to connect in to our peers and the wider community to feel happy and function well. We also need intimacy and friendships in our lives. And we have a need for meaning, which comes from having our capabilities ‘stretched’ (not stressed). In the overwhelming majority of cases when someone is depressed, one or more of these basic human needs is not being met. So depression is an emotion that says, “my needs are not being met”.  It does not mean you are going mad. You are just going about life the wrong way.  To overcome your difficulties you need a different approach.

The human givens approach to lifting depression
The main task in any counselling for depression, which is very commonly accompanied by anxiety, is to lower emotional arousal and help patients stop introspection as quickly as possible.
This can be done by drawing on the human givens in realistic, practical ways.
We routinely find that using a variety of appropriate approaches that are attuned to the human givens, we can make, in one session, much faster progress, even with severe depression, than if we slavishly follow one particular model of therapy. The approach has been demonstrated publicly and filmed for training purposes many times — see the case study.
Some people become depressed because of phobias or trauma in their lives. This is easily dealt with now by psychological means and, once the fear response is removed, the brain can restabilise itself and come out of depression. (see The Shackled Brain (2001), published by the European therapy Studies Institute, for a good explanation of how to release locked-in patterns of trauma.)
Therapists working from the human givens will integrate behavioural, cognitive and interpersonal approaches with relaxation and visualisation techniques, to motivate people to widen their life view, raise their self-esteem and solve problems. We can work alongside patients giving practical guidance for breaking problems down into manageable chunks (focusing outwards on resolution rather than inwards on nonproductive worrying). We can use humour to jerk them out of their black and white thinking; we can refine their negative comments in a novel, positive way; we can inform, set tasks, get patients to exercise, engage again in fun activities or involve themselves in helping others (again, to direct their attention outwards), rouse their curiosity, and so on.
Above all, we use their imagination in guided imagery to help them vividly see themselves making the changes they need to make in order to overcome their difficulties. This works on the time honoured principle that the human brain tries to bring about what it focuses on. Only then can we be sure of getting commitment from a patient to take the action they need to take to bring themselves out of their exhausted state.

Speedy results
The application of this organic mind/body approach brings about the remission of depression in a fraction of the time taken by cognitive or behavioural or interpersonal therapy. In our experience, some patients, after their emotional arousal has been lowered, can quickly take on board an understanding of the true cycle of depression and stop themselves negatively ruminating, thus curing themselves after just one session with a therapist who really understands this. 

For a more detailed exploration of depression and how to treat it, see Breaking the Cycle of Depression by Joe Griffin and Ivan Tyrrell  available here (Human Givens Publishing, 4.95, plus P&P).

This and a series of other books, monographs, audio tapes and videos on mental health issues are available from the website www.humangivens.com

For training in effective counselling for depression, contact MindFields College (+44 1323 811440).