Important strategies for dealing with modern problems that can trick our natural psychology!
Our moods and emotions are signals to tell us about how our lives are going. When things are going well, we tend to feel good. When something goes poorly, our moods or emotions tend to shift towards an unpleasant internal state. In this way, moods and emotions act as feedback systems to help us act in productive ways to keep going in the same direction if things are going well, and to change direction if things are going poorly.
When much in our lives is going poorly, it is not uncommon to experience depression. Depression acts as a signal, and as a motivating force, to help us look carefully at what is not going well, and to consider alternative courses of action. In order to deal with depression most effectively, it can be useful to understand how we sometimes come to be depressed, and what actions we can take to restore better mood functioning.
Feelings and feedback
Moods and emotions, our psychological feelings, are feedback systems that can indicate the effectiveness of our actions. They work in a similar fashion to physical pains and pleasures. If we sprain an ankle, for example, we feel physical pain because our behavioral error has resulted in physical damage and has potentially compromised our survival. The pain of walking on the injured ankle helps discourage us from doing anything that could cause further injury, and thus aids the healing process.
On the more pleasant side, we often feel physical pleasure when we eat calorie-rich foods when we are hungry, or while we stand in front of a warm fire when we are chilled. These and other physical pain/pleasure mechanisms assist us in our survival by encouraging some behaviors, while discouraging others.
Our psychological feelings include moods and emotions. These two experiences have subtle, but important, differences. Moods are the gentle, long-term states that can last for hours at a time. We can say, often with accuracy, that we were "in a good mood all morning" or even "all day long." In such instances, our internal states are quite positive, though with fluctuations, possibly throughout the whole day.
Emotions, on the other hand, are very intense experiences, usually lasting only a few minutes. Emotions, like moods, are signals of a positive or negative relationship between person and environment, but they reflect the person's perception of something as immediately important. We cannot be intensively emotional for very long, because our neurochemical machinery cannot sustain intense emotional reactions for hours on end, as is possible with mood states. Like an "emergency" signal, for good or for bad, emotions tend to be intense and short-lived. When a football team wins a big game, for example, the players and fans may celebrate intensively for several minutes, but then the celebration tends to run out of steam. The cheering quiets, and the stadium empties. A good mood may come after the celebration, and linger for hours or even days, but the intense positive emotions following victory quickly will fade.
It has long been recognized that physical pains and pleasures are fairly reliable guides with respect to physical dangers (injury and illness) and positive survival values (food, water, and appropriate temperature). Less recognition has been given to the connection between our psychological feeling, our moods and emotions, and their utility at signaling dangers and positive survival values.
Important signals
Throughout much of history, moods and emotions often have been considered independent of reason. of being unpredictable and sometimes nonsensical. Psychologists now understand that this is not the case. Just as physical pains and pleasures are important signals, so, too, are moods and emotions. For example, we may feel anxiety when we are not certain that we can perform a given task.
Anxiety is generally a useful guide, signaling us that our proposed endeavor may require our very best effort to succeed, and, in fact, may require talent beyond our current abilities. Anxiety signals us to consider carefully whether the action is a worthwhile risk. It is unusual to feel anxiety over "nothing." While people sometimes experience anxiety attacks "out of the blue," this is not the most common pattern.
The survival value of anxiety is obvious if you are contemplating a trek across dangerous terrain, you had better be anxious. You had better consider carefully whether this is an intelligent undertaking. And if it is, your anxiety will help to facilitate careful planning, checking and rechecking of supplies, the rehearsing of potentially needed skills, worrying about things that could go wrong, and so forth.
Depression
In this short article, it is not possible to address psychological functioning per se (that would require an entire book). So let's focus on one particularly problematic experience: that of depressed moods. The approach I take begins with recognizing that depressed moods may best be thought of as "psychological pain" and be taken seriously as signals that some life issues may be out of balance.
A sensible approach to pain is to attempt to identify the cause of the pain, remove it if possible, and try to create the conditions most likely to lead to recovery. For example, if a person has pain from a sprained ankle, the prescription of painkillers should not be the first option considered.
While in some circumstances painkillers might be useful, their use carries substantial risks. When pain is masked by painkillers, damaging behavior is more likely to continue. Similarly, while medications for depressed moods may be useful and sometimes necessary, they should not be considered ideal treatment, and they are not risk-free.
Many medical professionals consider depression to be a "disease," an aberration of normal neurochemical functioning that is best treated with powerful antidepressant drugs. The success of these drugs is sometimes remarkable, and it would be both foolish and irresponsible for a mental health professional to ignore their utility. However, the view that depression is always, or even often, simply a function of aberrant brain chemistry is probably incorrect. In my opinion, aberrant brain chemistry should not be considered the "first hypothesis" by mental health professionals, or by their patients.
Instead, depression should be first considered as a signal, a symptom that a person's life is out of balance and may need examination, reorganization, and personal growth. Very often, there are legitimate reasons for a person being depressed, and those reasons cannot and should not be ignored or hidden behind the power of antidepressant drugs.
Many mental health professionals disagree with this view. Their argument goes something like this: "It doesn't matter what causes depression, what matters is that it is unpleasant. Therefore, it doesn't matter how we get rid of it, what counts is that if we can get rid of it, we should get rid of it!"
They also often downplay the "side effects" (the unwanted effects) of medications (antidepressant drugs). Their argument might continue as, "The pain and suffering of a depressed person is awful, and if there is a quick, effective, and low-risk method for eliminating the suffering, that should be the treatment of choice."
Pills not always best
While there is understandable logic in the above view, recent scientific evidence gives us reason to dampen the enthusiasm regarding the use of antidepressant drugs. In addition to the substantial issue of potentially dangerous side effects, there is the issue of long-term effectiveness. When the long-term effects of antidepressant medications are compared with cognitive-behavioral therapy, a treatment style that attempts to address underlying psychological issues, the medications perform relatively poorly.
Both antidepressant medications and cognitive-behavior psychotherapy for depression work effectively in 60-70% of cases, within a few weeks. Medications tend to work a bit more quickly. But after the discontinuation of their medication, about 50% of patients can be expected to relapse into a depressive episode within the following year. This is in stark contrast to patients who receive cognitive-behavior psychotherapy, with periodic maintenance therapy, for depression. Their risk of relapse is perhaps 10-15%.
This remarkable distinction in relapse rates suggests the possibility that patients who receive effective psychotherapy may be getting "to the root" of the causes of their depression, putting them in more control of their psychological lives. The suggestion is that cognitive-behavior therapy results in the self-examination, reorganization, and personal growth needed to meet challenges that previously were overwhelming.
Dealing with depression
Many people experience periods of time during which they have recurrent depressed moods. When depressed moods begin to dominate a person's day-to-day life for several consecutive weeks or longer, professional assistance may be indicated. Persistent depression can be a sign that 1) the person needs assistance in developing more effective happiness strategies, or 2) a serious biochemical disturbance exists that may benefit from antidepressant medication. It is a myth that mental health professionals can easily tell the difference between these two alternatives. Future research efforts may help us learn to better clarify what the most appropriate treatment alternative should be for a given patient.
Mental health professionals, such as psychiatrists and psychologists, often have very different views about the most appropriate initial intervention strategy for a given situation. My own bias is to focus on the possibility that persistent depressed moods are at least partly, if not largely, due to the person needing assistance in developing more effective happiness strategies. If these strategies appear to be ineffective, medical management may then be indicated.
Good basic strategies
Many people have found the following three mood-supporting strategies to be helpful. They are not complicated and require no professional assistance.
1. Make a list of pleasant activities and then schedule them into your calendar. Too often, we get caught in the routine of familiar patterns and habits that do not challenge or motivate us. Our negative moods may be a signal that our actions are not being sufficiently directed towards activities that we most value.
2. Take on new challenges that lead to personal growth. Sometimes depression comes about because we are stymied in personal growth. Taking on new challenges can rekindle the excitement of youth, when everything was new, much was exciting, and things were often worth doing to the best of our abilities.
Take steps to eliminate your unhealthful lifestyle habits. Unhealthful lifestyle habits sometimes can contribute to depression. If you are having recurrent depressed moods, one place to start taking control is by addressing the following three basic issues, eating properly, exercising regularly, and getting enough sleep. In some cases, therapeutic fasting may help, since a properly conducted fast provides the opportunity for a period of profound physiological and psychological rest.
When you need help
There are times when these basic strategies are not enough. Sometimes our depressed moods may be signaling the need to examine major life issues carefully, make difficult choices, and find creative ways to expand our self-confidence. Sometimes such processes are done better with the assistance of a skilled professional. The psychotherapy medium that I recommend (and practice) is called cognitive-behavior therapy (or sometimes just "cognitive therapy"). This style of therapy is recommended because it represents the best-researched, most apparently effective style of psychotherapy currently available. While other styles may have merit, none at present can claim the solid foundation of scientifically-demonstrated success of this approach. This is the approach we use at the TrueNorth Health Center.
Clearly, there are times when antidepressant medications are indicated, and the assistance of a psychiatrist can be important (psychiatrists are medical doctors who work with mind-altering medications). I don't want to give the impression that such interventions should be viewed only as a "last resort." Rather, I am uncomfortable with the view that medications should be "first resort," which too often is the case. If depression persists in the face of cognitive and behavioral therapeutic strategies, it can be comforting to know that medications exist that may make a difference.
Reasons for good cheer
There are many reasons why we no longer need to feel overwhelmed or intimidated by a period of depressed moods. Earlier this century, a depressed patient seen by a Freudian analyst was thought to be, in effect, psychologically healthy! Freud considered misery to be reflective of rationality; that life was inherently miserable and that only those who were somewhat oblivious to the facts of their lives could be reasonably happy. Little wonder that treatment approaches of those times were notoriously unsuccessful!
Today, we no longer view depression as a sign of psychological health or clarity of insight. Depression is perhaps best viewed as a symptom, a signal that there are life challenges that may need to be examined and addressed. Sometimes our thinking can be so unclear as to require the services of a skilled professional, and the results are often very positive. There are excellent books that can help people treat themselves, such as Feeling Good: The New Mood Theory, by the cognitive therapist/psychiatrist Dr. David Burns. And should medical intervention be indicated, we now have access to antidepressant medications that are safer and more effective than ever before.
Depressed moods are no fun. And if they persist, your life can sink into a depressive episode that can last for months, and sometimes longer. The good news is that depressive processes are understood better than ever. If you cannot solve it yourself, get help! Take action. This is one problem that you can definitely learn to live without.