Depression kills people — in every country in the world suicide rates are increasing. At all age levels depression rates in the population are rising quickly. Although not a biological illness, it appears to be 'contagious'. Moreover, people's understanding of it is confusingly coloured by myths: it is caused by a chemical imbalance in the brain; it is anger turned inward; it takes a long time to come out of; it stems from childhood events that have to be explored before progress can be made, etc.
It has now clearly been shown that neither non-directive counselling nor cognitive behavioural therapy is more effective as a treatment for depression than a few short visits to a GP over a twelve month period., Extensive research shows that psychodynamic therapy deepens depression and makes it last longer. And, now that antidepressants are being shown to be an unsafe treatment, the need for health workers, counsellors and psychotherapists to understand depression and be trained in treating it effectively has never been greater.
The rapid increase in the incidence of depression revealed by epidemiological studies is one of the reasons we know that depression is not a genetic disease. A large body of evidence, published over the last three decades, shows that most depression is learned, brought about by the way we interact with our environment. It is not caused as a result of the specific events we experience — the majority of people exposed to adverse life events do not develop depression — but by the way we respond to them. Further support for this view comes from evidence that depression responds well to certain kinds of therapy or counselling, — that which is active, time limited, focused on current problems and aimed at symptom resolution, not personality change.
The human givens approach
The human givens approach to counselling works with what we are all born with — our genetic endowment — namely the physical and emotional needs programmed into us by evolution, which seek their fulfilment through our interaction with the environment, and the innate resources provided to help us meet those needs. When emotional needs are not met or when our resources are used incorrectly, we suffer considerable mental distress — most commonly anxiety and/or depression. Therapy based on the human givens looks for what is missing in people's lives and works towards enabling needs to be met.
The resources which are available to help us do this include the ability to build rapport, empathise and connect with others. Imagination is a resource: one that can allow us to focus our attention away from our emotions in order to solve problems more objectively. We have a conscious, rational mind that can question, analyse and develop the ability to 'know' — understand the world unconsciously through metaphorical pattern matching. Central to all these abilities and functions, and in many ways perhaps paramount, is the dreaming brain which preserves the integrity of our genetic inheritance every night. The role of dreaming is key to a full understanding of depression, and why practical therapies help.
Depressed by dreams
We all dream for about two hours a night, even though we often don't recall having done so when we wake up the next morning. There is evidence to show that the function of dreaming, which occurs predominantly during REM sleep, is the metaphorical acting out (not the resolving) of unexpressed, emotionally arousing preoccupations, so that the arousal can be discharged and the brain freed up to deal with the concerns of the following day. The process of discharging, and thus completing, patterns of arousal in this way preserves the integrity of our core personality.
In depression, however, this process goes dramatically wrong. Instead of having about 25 per cent (REM) sleep and 75 per cent slow wave sleep (which boosts energy levels in the brain), these proportions become inverted, with the depressed person having far too much REM sleep and too little slow wave sleep. The prolonged negative self examination and introspection which tends to characterise depressed people creates higher than average arousal levels and greater need for discharge during dreams. The first period of REM sleep occurs much earlier in depressed people, because the pressure for discharge is so great. The first REM sleep period is also more prolonged and shows an especially high rate of discharge. However, so much discharge activity not only reduces the arousal levels in the brain but also depresses and exhausts it, leaving the dreamer likely to lack motivation the following morning. Indeed, very many depressed people say they wake up from sleep feeling exhausted.
In experiments in the sleep laboratory, if depressed people are woken every time they go into REM sleep, their depression lifts. Antidepressants also reduce REM sleep, and this is thought to be why they can help to lift depression. Only those patients whose REM sleep goes back to normal stay out of depression. (However, there are ways to bring this about without using drugs, as we will shortly show.)
The black and white emotional brain
By spending too long on worrying and emotionally arousing rumination (a simple saliva or blood sample from a depressed person will show elevated levels of the stress hormone cortisol), depressed people are misusing the tool of imagination. Unfortunately, all this emotionally arousing introspection not only leads to excessive dream sleep, it also prevents people seeing their life situations objectively. High emotional arousal inhibits the higher cortex, the rational part of the brain, and blocks rational thought.,
To the emotional brain, everything is either black or white, good or bad, right or wrong, safe or dangerous. This is because high arousal locks us into a trance state, a confined viewpoint. It is only the higher cortex that can inject the shades of grey and see the bigger picture.
People who are not habitual black and white thinkers can snap out of this emotional trance state fairly quickly. But those who have a tendency towards endlessly analysing the negative aspects of their lives, catastrophising every little setback and conjuring up more, are more likely to stay locked in their depressive trance. It has been shown that those who take events most personally (blaming themselves for everything that goes wrong), have a highly pervasive view of how negative an event will be (losing a job or a lover means that their whole life is ruined) and also consider its impact permanent (there will never be another job or lover) are the most likely to suffer from depression.
With a clearer picture of what depression is and what causes it, we can set about lifting it more rapidly.
How to lift 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 their negative 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.
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 reframe 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.
This organic mind/body approach can bring about the remission of depression in a fraction of the time taken by cognitive or behavioural or interpersonal therapy. In our experience, when patients know that their negative ruminations are causing their poor nights' sleep and their exhausted days, they are quickly motivated to work to break the cycle of depression.
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This article was first published in Vol 9, No 1 (2002) of the Human Givens Journal and has previously been made available on the Human Givens Institute website. The original article contains an additional case study.
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