Mindfulness, Depression and Acceptance

Acceptance helps us respond to negative and unpleasant experiences in ways that don’t make things worse, and prevent vicious cycles and downward spirals. Acceptance can be a difficult concept to grasp. In the videos below I do my best to explain the nature of acceptance in the context of mindfulness and psychotherapy, but it’s probably the topic that causes the most confusion in my comments.

Acceptance

I’m not sure how to try to clarify the difference between acceptance and resignation beyond what’s in these videos. I think part of the confusion is that there are various ways to define acceptance, and in some senses acceptance is very similar to resignation. But unlike resignation, in psychotherapy, acceptance is an acknowledgement and recognition of the current state of affairs, but without giving up.

Perhaps the most well-known use of this type of acceptance is the Serenity Prayer from Alcoholics Anonymous:

Grant me the serenity to accept the things I cannot change,
Courage to change the things I can,
and Wisdom to know the difference.

The video below elaborates on the nature of acceptance.

Allowing and Letting Be

If you have any questions or comments, please leave them on the YouTube video page.

Depression and Relapse Prevention

At some point I’m going to cover preventing relapse of depression in more detail. But for now we’re going to just consider two important aspects. In this post and the next we’ll learn how mindfulness and acceptance helps prevent depression relapse by disrupting vicious cycles before they can get started. Then we’ll look at how we can change negative core beliefs that make us vulnerable to depression with CBT.

MBCT and Depression

Mindfulness-based cognitive therapy (MBCT) was originally developed as a relapse-prevention treatment for depression. I have a whole course on MBCT, but these one aspect in particular we’re going to talk about here. The Parable of the Two Arrows teaches us that the way we respond to unpleasant experiences determines how they affect us, and that pain doesn’t need to lead to suffering.

This video looks once again at the interrelationships between our thoughts, feelings and emotions, behaviors, and physical symptoms. But instead of focusing on how unpleasant experiences pull us into vicious cycles, we learn how to react to these negative or painful experiences in ways that prevent vicious cycles from forming.

The Difference Between Pain and Suffering

If you have any questions or comments, please leave them on the YouTube video page.

Emotion Regulation and Depression

One of the main features of depression is a depressed mood. In CBT we focus on modifying our thoughts and behaviours in order to improve our moods and how we’re feeling. We can’t modify our moods and emotions directly the way we can our thoughts and behaviours. But we do have the ability to influence our moods and how we feel. We can this emotion regulation, and it’s one of the main components of Dialectical Behavior Therapy (DBT).

Emotion regulation helps us regulate our moods and emotions so they become more manageable and feel less intense. This helps relieve our depressed moods. And as our depressed moods start to lift, our thoughts become less negative and we become more active, and so we begin to reverse the vicious cycle of depression.

Emotion Regulation

If you’d like to explore emotion regulation further, there’s a whole Emotion Regulation section in my DBT Skills Course. If you have any questions or comments, please leave them on the YouTube video page.

Automatic Negative Thoughts in CBT

We constantly have all sorts of thoughts automatically popping into our heads. In CBT, it’s our automatic negative thoughts (sometimes referred to as ANTs) that we’re most concerned with. Automatic negative thoughts play a huge role in both initiating and maintaining our negative moods. And they often set off vicious cycles and downward spirals that are extremely difficult to break. If we struggle with depression, we can experience an endless barrage of automatic negative thoughts all day long.

Automatic Negative Thoughts

This transcription was auto-generated by YouTube. I’ve only added minimal editing, so I apologize for any errors, run-on sentences, etc.

A lot of our thoughts are automatic. A thought just pops into our head without us even thinking about it. Some of our automatic thoughts can be pleasant or neutral, but more often than not they tend to be negative.

Automatic negative thoughts have a strong effect on our mood and how we’re feeling, and learning how to respond to our automatic negative thoughts in ways that help us feel better is an important part of mindfulness based cognitive therapy. So now we’re gonna look at some common automatic negative thoughts that people have that tend to be associated with depression, anxiety and anger.

When we’re feeling depressed we tend to have very negative thoughts. And these thoughts center around three themes: negative thoughts about ourselves, negative thoughts about the world, and negative thoughts about the future. Examples of automatic negative thoughts about ourselves are things such as: I’m such a loser. I’m no good. I keep disappointing everyone. What’s wrong with me? I can’t do anything right. I’m a failure. I feel so helpless. Nobody even cares about me.

And automatic negative thoughts about the world, which is just a general sort of negativity about everything: life is so unfair. Things should be easier. The whole world’s falling apart. Everything’s so stupid. Life stinks.

And automatic negative thoughts about the future: things are never gonna work out for me. There’s nothing i can do about it. I’m always going to feel this way. I’m never going to be happy. There’s no point in trying anymore. It’ll never get any better.

And when we’re feeling anxious we tend to have thoughts that overestimate the likelihood that something bad will happen. And we overestimate the severity of what will happen. And we underestimate our ability to cope with things.

And so we have automatic negative thoughts about threats and danger: oh no! What’s happening? This is terrible.

And automatic negative thoughts about our ability to cope with things: i can’t handle this. I’m never gonna be able to do this. People are gonna wonder what’s wrong with me. This is just too much. What am i gonna do? I should just quit now.

And all sorts of what-ifs which are probably the most common types of thoughts people have when they’re feeling anxious or worried what if this happens what if that happens what if what if what if

And when we’re feeling anxious, our thoughts are too a future-oriented, and we end up spending a lot of time and energy worrying about how things might be in the future. And even though these things haven’t occurred yet and may never occur, we tend to respond as if they’ve already happened, or that they’re inevitable. And so we wind up suffering the consequences right now. And even if the things we’re dreading never actually occur, we’ve already made ourselves pay the price and suffer over them whether they actually happen or not.

Our automatic negative thoughts that are associated with anger are things around the need for fairness and respect; becoming aggravated, frustrated or losing patience; violations of rules; and revenge.

This is so unfair. Why does this keep happening to me? I can’t stand this anymore. What’s wrong with him? You can’t treat people that way. He’ll pay for that!

And in the next couple of videos we’ll learn how we can improve our mood and help ourselves feel better by managing our automatic negative thoughts through cognitive diffusion and letting go of thoughts and with cognitive restructuring.

The first step towards reducing both the frequency of our automatic negative thoughts, and how detrimental they are, is to learn to recognize and record these automatic negative thoughts when they arise. This is part of what we do in the CBT Interrelationships worksheet from an earlier post. In addition to completing this worksheet, it’s good practice when learning CBT to just pay attention for and write down automatic negative thoughts whenever they come up.

The next step is to assess the accuracy of these ANTs. Then we can reframe our thoughts to look at things from different perspectives that don’t have such a negative impact on our moods. And as a result, we start feeling better. Over the next few posts we’ll learn ways to start changing our negative thoughts that can help relieve our depression. If you have any questions or comments, please leave them on the YouTube video page.

Behavioral Activation and Depression

Behavioral activation is a technique from CBT that is often the initial step in treating depression. When we’re depressed, we can lack motivation and lose interest in activities we used to enjoy. As a result, we become much less active. And this decreased level of activity has a negative effect on our moods, and leaves us feeling even more depressed.

Behavioural activation involves gradually increasing our levels of activity. And as we become more active and start to do more, we begin to feel less depressed. And as we become less depressed, we regain our interest in things we used to like doing, which helps us become more active, and so on. So behavioral activation helps reverse vicious cycles that contribute to depression.

Behavioral Activation For Depression

This transcription was auto-generated by YouTube. I’ve only added minimal editing, so I apologize for any errors, run-on sentences, etc.

When we’re feeling sad and depressed and just don’t feel like doing anything, acting based on how we feel and cutting back on our level of activity, and spending too much time in bed, or wasting time on the Internet, or not wanting to socialize or make plans with friends, just feeds back into how we’re feeling making those feelings even stronger. But when we’re sad or depressed one of the best things we can do for ourselves is to increase our level of activity. We call this behavioral activation and it’s often the first step in lifting our mood or pulling ourselves out of a period of depression.

Behavioral activation involves starting small and gradually increasing our level of activity. And we focus on three types of activities: activities that give a sense of pleasure or enjoyment; activities to give a sense of accomplishment or achievement; activities that involve some social interaction, which is going to be a lot harder now with everyone practicing social distancing.

As difficult as it can be to imagine something being pleasurable when you’re depressed, just doing anything is usually more enjoyable than isolating yourself, or sitting around just doing nothing. And you might find that activities aren’t as enjoyable as they used to be, or as you’d like them to be, but even things as small as getting out of bed having a shower, eating breakfast, or going for a walk can all make a difference in how you’re feeling. And so it’s important to do at least some small things like this every day to give yourself a chance to feel a little better, or at least help prevent yourself from sinking even deeper.

And when you’re depressed it’s hard to imagine you could do anything that could give you a sense of achievement or accomplishment. But there’s no need to be ambitious. These can be simple things—answering an email, doing the dishes, paying some bills—no matter how small these things may seem they can still give you some sense of accomplishment, which in turn usually helps improve your mood even if just a little bit.

And when you’re depressed sometimes you just want to isolate yourself from people. Socializing can seem impossible, and you can feel like nobody would want to be around you the way you are and you’d just be a burden. But a sense of isolation can be a big contributing factor to feeling depressed, so it is important to find some way to have contact with other people.

Things like going to a party or being with a big group of people can seem overwhelming, so focus on things that are more manageable, whether it’s talking to someone on the phone, or texting with them, going for a coffee, or even just going out by yourself and being around other people. Though obviously these last couple are not good ideas right now which makes staying connected to others during the coronavirus crisis that much more difficult as we need to find ways to socialize that don’t involve physically being around other people. But the more you isolate yourself the more depressed you’re likely to feel, and just having any sort of social interaction can help lift your mood and make you feel a little better.

Now if your mood is really low and you go for a little walk everything’s not going to be sunshine and rainbows all of the sudden, but you’ll probably feel at least a little bit better. And being aware of even small shifts in your mood is important, because when you’re feeling this way it can be so difficult to notice anything positive or have any hope. And so even the smallest improvement in how you’re feeling is worth recognizing because it is a big step compared to not being able to get out of bed or up off the couch and just feeling worse and worse as the day goes on.

And another reason why being more active is so important is because when we’re feeling sad or depressed we tend to ruminate a lot. And research has found that the amount of rumination associated with an emotion is the determining factor in how long that emotion lasts. And because we ruminate so much when we’re feeling sad, sadness is by far our longest lasting emotion, and so anything we can do to cut down on how much we’re ruminating when we’re feeling sad or depressed helps limit how long those feelings last. And even something as simple as going for a walk can help us get out of our heads start ruminating less and as a result our mood starts to improve.

Behavioral activation can often be hard to put into practice because when we’re feeling depressed we tend to be very pessimistic and have lots of negative thoughts, and these thoughts can sometimes get in the way of increasing our level of activity. To help counteract this type of negative thinking and these negative expectations one thing that we encourage with these activities is that you use a behavioral activation diary, which you’ll find a link to below in the description, to help you predict beforehand how much pleasure or enjoyment, sense of achievement or accomplishment, or sense of social connection you’ll get from doing the activity.

And then after you’ve done it record the actual amount of pleasure you got, the actual sense of accomplishment that you felt, and the actual sense of social connection you experienced, as often these will be higher than predicted. And this can help counteract that negative thinking you have that tells you there’s no point in doing anything, why bother, it’s not gonna help, or it’s gonna make you feel worse.

And then this is a way of giving yourself some evidence that even though you don’t want to do anything, can’t see the point in doing anything, when you actually do do something you tend to get more out of it than you think you will. And then this can help motivate you to do more in the future even if your depression and negative thoughts are telling you not to bother.

Download a copy of the Behavioral Activation Diary in PDF or Word format. If you have any questions or comments, please leave them on the YouTube video page.

Introduction to CBT for Depression

The first approach to treating depression we’ll look at is Cognitive Behavioral Therapy for depression. Cognitive Behavioral Therapy, or CBT, is one of the most effective treatments for depression. The main idea behind CBT for depression is that our thoughts and behaviors are a big influence on our moods, feelings and emotions. And when we change the way we think or act, we also change our moods and how we feel.

But our moods and how we’re feeling also affect how we think and act. So in CBT for depression we focus on how our:

  • thoughts and cognitions
  • behaviors and actions
  • moods, feelings and emotions
  • and physical or physiological symptoms and sensations in our bodies

all influence and interact with each other.

Vicious Cycles and Downward Spirals of Depression

CBT Downward Spiral od Depression

Depression involves a number of vicious cycles between all of the above elements that can lead us into downward spirals:

  • When we’re depressed we have lots of negative thoughts. And these thoughts feed back into our depression, making us even more depressed.
  • Depression impacts our behaviours. It leads to decreased interest and pleasure in activities. And as a result, we can significantly reduce our levels of activity. But decreased levels of activity leave us feeling even more depressed.
  • Depression also affects our bodies. Depression can leave us feeling sluggish, fatigued and worn out. And this makes us not want to do anything, which, as we just noted, leaves us even more depressed.

The video below describes the relationship between our thoughts and feelings. Then it explores the interconnectedness of our thoughts, actions and behaviors, feelings and emotions, and physical symptoms and sensations in our bodies.

The ABCs of CBT for Depression

CBT for depression involves reversing these vicious cycles and downward spirals by:

  • changing our behaviors with behavioral activation, which we’ll look at in the next post
  • changing our thoughts with cognitive restructuring, which we’ll look at after that

This pdf worksheet is a good way to get started with CBT for depression. Whenever we notice a change in our moods, we note what triggered it or what we were doing at the time. And then we record our thoughts, feelings and emotions, actions and behaviors, and any physical symptoms or sensations.

The more we do this, the more we’ll start recognizing how our thoughts, feelings and emotions, actions and behavior, and physical symptoms and body sensations interact with and influence each other. And this helps us figure out how to make changes that can lead us to feel better.

If you have any questions or comments, please leave them on the YouTube video page.

What Causes Depression and Why Do We Get Depressed?

What causes depression? First we’ll look at a simple diathesis-stress model of depression. Under the diathesis-stress model, if our levels of predisposition or vulnerability to depression, plus levels of life stressors, exceed our tolerance levels, then we become depressed.

Then we’ll learn a more comprehensive model of depression proposed by Aaron Beck. Aaron Beck is the founder of cognitive behavioral therapy (CBT), and the person most responsible for how we treat depression with psychotherapy. In Beck’s model, there are a number of factors that predispose us to depression, such as genetics, childhood adversity, biology and negative cognitive bias.

These all contribute to the formation of a negative cognitive triad. The negative cognitive triad is a set of negative core beliefs about:

  • Ourselves as worthless, unlovable and/or helpless
  • The world and other people as hostile, unfriendly and/or rejecting
  • The future as hopeless

This negative cognitive triad then leads us to interpret life stressors in ways that can trigger depression.

After going over Beck’s model of depression in detail, we’ll consider the implications of this model for treating depression, and reducing vulnerability to depression and depression relapse.

What Causes Depression and How Do We Get Depressed

This transcription was auto-generated by YouTube. I’ve only added minimal editing, so I apologize for any errors, run-on sentences, etc.

What causes depression and how do we become depressed? Well we don’t know exactly what causes depression in the way we know that for example the influenza virus causes the flu, but we’re going to learn a model of depression and how depression comes about and then see what we can take away from this model that can help us treat depression and make it less likely that we become depressed.

So a common explanation for how we develop mental health issues in general is what’s known as the diathesis stress model, diathesis meaning a predisposition or vulnerability to something, and stress just meaning stress, a stressful situation or circumstance or experience or event, or the accumulation of a number of stressors.

And then if our levels of predisposition plus our levels of stress exceed what we’re able to tolerate then that predisposition becomes activated and we become, for example depressed. And we all have different levels of predisposition, and we’re all able to tolerate different levels of predisposition plus stress, so the amount of stress necessary to trigger depression will be different for everyone.

So we can imagine having a cup of a certain size that represents our levels of tolerance. And if we pour into this cup more predisposition plus stress than the cup is able to hold, our tolerance cups start to overflow and we become depressed.

So that’s a general model of how we get depressed, now let’s look at a much more detailed model, proposed by Aaron Beck, the person who founded cognitive behavioral therapy, and whose research is most responsible for how we now treat depression with psychotherapy.

So what predisposes someone to depression? First there are genetic risk factors and or some sort of childhood trauma or negative childhood experiences, that lead us to develop increased biological reactions to stress and cognitive biases that prioritize and emphasize negative experiences and information.

And these can lead to the formation of what’s called the negative cognitive triad, which are negative beliefs about ourselves, about the world and other people, and about the future. And these beliefs affect how we interpret or appraise various life situations and stressors and how they impact us. So this is the diathesis side of the equation, the things that predispose us to depression.

And then if in conjunction with our predisposition we’re faced with more stress than we’re able to tolerate, this combination of predisposition plus stress leads to depression.

And then the symptoms of depression feed back into our negative beliefs and reinforce them which prolongs our depression and makes us more vulnerable to depression in the future. And these symptoms can also act as stressors themselves that feed back into our depression.

So now let’s break this down and look at each of the individual components of this model in more detail. And there are a few parts of this that are a little dry so i’ll try to get through them quickly.

So first up genetics. Although we know that depression can have a genetic component there’s no consensus about the specific genes that can predispose us to depression. But for example there’s evidence that the short allele or genetic variant of 5-httlpr is associated with higher levels of depression following a life stressor. 5-htt is a serotonin transporter and is a main regulator of serotonin in our brains and there’s a lot of evidence that links lower levels of serotonin to depression. And there are other genetic variants that may predispose us to depression and depression is probably poly genetic or influenced by more than one gene.

Now genetics alone is not enough to make us vulnerable to depression: not everyone with genetic risk goes on to develop a predisposition to depression. But also genetic risk isn’t necessary in order to become predisposed to depression: we can become vulnerable to depression from childhood developmental and environmental factors alone. Childhood adversity makes us vulnerable to depression for example the loss of a parent at an early age is a big risk factor as is childhood neglect or abuse negative interactions with parents and any other type of major childhood stress or adversity.

These genetic risks in childhood developmental factors lead to biological differences in how we react to stress and cognitive biases in how we process information increased biological reactivity to stress, in other words our bodies react more to stress, predisposes us to depression.

Depression is correlated with hpa access Dysregulation. The hpa axis is a network of hormones that gets activated by stress and produces the stress hormone cortisol, and people with depression exhibit an elevated cortisol response to stress.

In people with depression there’s also an elevated activation of the amygdala region of the brain in response to stress. The amygdala plays the central role in emotional processing and has an activating influence on the hpa axis. And both the short allele variant of 5-httlpr and adverse childhood experiences are associated with increased amygdala reactivity.

Another thing that predisposes us to depression is that we selectively pay attention to negative information and experiences and ignore positive information. We also have a memory bias and remember negative information more readily than positive information. And we’re more sensitive about making mistakes and receiving negative feedback.

And while this type of negative cognitive bias predisposes us to depression, depression also causes cognitive biases in favor of negative information, resulting in a negative feedback loop or vicious cycle that can prolong or intensify depression and make us more vulnerable to depression in the future.

And adverse childhood experiences predict these sorts of negative cognitive biases later in life. And the 5-httlpr short allele is also associated with these types of cognitive processing biases as is increased amygdala activation.

So now let’s look at the heart of this model. According to Aaron Beck’s research into the relationship between thinking and depression, what makes us most vulnerable to depression is the presence of what he calls the negative cognitive triad, which is a set of negative core beliefs about ourselves as helpless unlovable or worthless; and negative core beliefs about the world and other people as hostile unfriendly or rejecting; and negative core beliefs about the future comprised of hopelessness and pessimism. And these negative core beliefs develop as a result of our negative information processing biases and our increased biological reactivity to stress as well as directly out of our adverse childhood experiences

Now our core beliefs affect how we interpret information, and so given a similar set of circumstances and similar information, our cognitive appraisals and what we make of this information and how we interpret it will be different depending on our core beliefs.

So for example let’s say we text a friend and ask them to meet up for coffee and they respond, sorry I’d love to but I’m too busy right now, let’s do it sometime soon.

So if we don’t hold negative core beliefs about ourselves about the world and other people, or about the future, our cognitive appraisals or interpretations of this situation could be something straightforward and relatively neutral like, they’re just too busy to meet up right now but we’ll probably see each other soon. Or maybe our beliefs about the world and other people would lead us to appraise this situation as something like i guess they don’t want to hang out and they’re just being polite.

But if we have really negative core beliefs these could lead to a cognitive appraisal along the lines of, of course they don’t want to hang out with me I’m such a loser nobody wants to hang out with me. I thought we were friends but i guess i just can’t count on anyone. Everyone always lets me down. Nobody’s ever going to really want to be my friend, and I’m going to be lonely and alone forever.

And so it’s not the stressor alone that determines our cognitive appraisals about the situation, but how that stressor interacts with our core beliefs. If we have that negative cognitive triad of negative core beliefs we end up interpreting situations like this in very negative ways that feel really bad and can set us up for becoming depressed.

But these negative cognitive appraisals alone aren’t enough to make us depressed. Whether or not we become depressed will also depend on the nature of the stressor or negative experience or life event that we’re exposed to.

So what kind of stressors can trigger depression? Usually it involves some sort of loss or perceived loss. Interpersonal loss is a common trigger. It could be the loss of someone we love through death or the breakup of a relationship. Or it could be the loss of our health or vitality: there could be a serious or chronic health issue where we could just start feeling older or we get injured and can’t do some of the things we used to enjoy or that are important to us, or we can’t do them as well as we used to be able to.

Or we could get laid off or fired or lose our jobs. Or it could be the perceived loss of control over certain aspects of our lives. Or a loss of status or acceptance among our peers or colleagues or any group we identify with.

What constitutes a loss capable of triggering depression will be different for everyone depending on what we value and what’s important to us. And it may not just be one thing that triggers depression: there may be various contributing factors going on at the same time; or just the accumulation of a number of factors.

And whether or not this loss or stress triggers depression will depend on how severe it is and how we interpret the loss. We’re particularly vulnerable to losses that negatively affect our self-image and result in a loss of self-esteem self-confidence or self-worth or to a loss of purpose direction or meaning in our lives

So going back to the example of texting a friend to hang out and they decline that situation in itself probably isn’t going to be a strong enough stressor to trigger depression. But imagine if instead the situation were something like a partner breaking up with us. That’s a much bigger stressor with the potential to trigger much harsher cognitive appraisals depending on: a) our core beliefs; and b) how important it is to us to be in a relationship.

And the more value we place on being in a relationship, the more that relationship brings a sense of meaning or purpose or fulfillment to our lives, then the greater the loss we experience if the relationship ends. Because we’re not just losing the relationship ,our self-image takes a big hit and we’re losing self-esteem and self-worth and purpose and meaning.

And so if this is the case the negative cognitive triad is going to interact with the loss of the relationship in ways that lead to very negative cognitive appraisals: I’m worthless; I’m unlovable; my life has no meaning; if i care about someone they always end up hurting me; I’m never going to meet anyone like this again; I’m never going to be happy; I’m always going to be alone. And so it’s probably pretty clear how these sorts of cognitive appraisals could leave us feeling depressed.

But if we had a different set of core beliefs that weren’t so negative, and if being in a relationship wasn’t as important to us in terms of our self-esteem self-worth and meaning and purpose in our lives, then we’d make different sorts of cognitive appraisals about the end of the relationship that wouldn’t necessarily trigger depression. I’m really sad right now but it’s going to be okay. I’m lucky to have such good friends that care about me and will help me through it. I’m a good person with lots going for me and i know eventually the right person will come along.

Or maybe we lose our jobs. And again whether or not this is a kind of stressor that could lead us to become depressed will depend on how we appraise the situation, which will depend on our core beliefs. And it’ll depend on the importance we placed on having this job. If it’s a job we don’t care about that much and we can easily find a similar job and we can afford not to work for a while, sure nobody likes getting fired, and it’s a pain to have to find another job, but losing the job can be seen as just a temporary setback that isn’t that difficult to overcome, and isn’t necessarily going to damage our self-image or self-esteem or self-worth. And so it’s not the type of loss or stressor that tends to lead to depression.

But if this is our dream job and a lot of our self-esteem and self-worth is connected to our jobs or careers, and this job brings a sense of meaning and purpose and direction to our lives, and we’re really pessimistic about our abilities to find a similar job in the future, then losing our jobs is the type of loss that, if we have a predisposition to depression, could very likely lead us to become depressed.

So whether or not a negative life experience or stressor leads us to become depressed will depend on the subjective severity of that stressor, how significant was that stressor or loss to us based on our core beliefs and our values and what we find important in life, and how much we have invested in what we’ve lost. And it’ll depend on the cognitive appraisals we make about the situation.

And whether or not this loss triggers depression will depend on our levels of tolerance and on how resilient we are and how well we’re able to cope with the loss through things like resourcefulness and problem solving; and with the help of our social supports; and through our own internal resources such as our ability to regulate our emotions cope with stress and deal with and manage the consequences of the loss. And so if our levels of predisposition and vulnerability to depression plus the severity of the loss or stressor we’re facing outweighs our levels of tolerance and resiliency then we become depressed.

So what are the implications of this model in terms of treating and preventing depression and depression relapse? Well we can reduce how likely it is we become depressed by doing things that decrease our predispositions and vulnerabilities to depression and by doing things that increase our tolerances for stress and our resilience.

Let’s start with the negative cognitive triad because this is a part of the model where all of the predisposition roads lead and determines how we appraise the stressors that can lead to depression. Our core beliefs are long-standing and develop over the course of our lives and are resistant to change but that doesn’t mean we can’t change them. When we modify our core beliefs to make them less negative then we reduce our levels of predisposition to depression. And cognitive behavioral therapy can help us do this.

And cbt and mindfulness based therapies can also help us counter negative cognitive biases and change how we interpret and appraise life stressors and losses that can lead to depression, increase our tolerances for stress and loss, and make us more resilient, as can various strategies from positive psychology and research into happiness and well-being. And while we can’t go back and change our early childhood experiences therapy can help us work through issues from our childhoods that are contributing to a predisposition to depression.

Now what about biology? Neuroplasticity refers to our brain’s ability to physically alter its structure and form new neural pathways and connections and change how it responds to various stimuli throughout our lives. And we can do this, actually alter our brain’s biology with cbt and with mindfulness.

And then there are antidepressant medications. Now how do we know if we should be on an antidepressant? Well the short answer is we don’t we don’t really understand the biology of depression that well, and it’s possible that there are different subtypes of depression that we’re not able to differentiate right now, and that some who will respond to drug treatments better than others, some may be very hard to treat without medication, and some may respond better to psychotherapy than to medication.

Broadly speaking the more severe the symptoms of depression the greater the benefits of antidepressant medication compared with placebo. But that doesn’t mean that all severe depression needs to be treated with medication. And so if you have questions about treating your depression with medication you should consult your doctor or a psychiatrist.

So i think the key takeaway from this model is that there are lots of things that factor into depression and we have the ability to change all or almost all of them in some way and that any positive change we make in any of them is going to help reduce depression and reduce future vulnerability to depression. Or as Aaron Beck puts it, “any intervention that targets key predisposing precipitating or resilience factors can reduce risk or alleviate symptoms of depression.”

Beck AT, Bredemeier K. A Unified Model of Depression: Integrating Clinical, Cognitive, Biological, and Evolutionary Perspectives. Clinical Psychological Science. 2016;4(4):596-619. doi:10.1177/2167702616628523

Here’s some more recent research regarding serotonin and depression, and some expert reactions to that article.

If you have any questions or comments, you can leave them on the YouTube video page.

Self-Help For Depression Course

In this self-help course for depression, we’ll learn the most effective ways to manage and treat depression. We’ll look at how we become depressed, and the symptoms of depression and how they affect us. And then we’ll explore various ways to relieve and recover from depression, with a focus on cognitive behavioral therapy (CBT) for depression and mindfulness-based approaches to treating depression.

Coping With Depression: What To Do If You’re Depressed

This transcription was auto-generated by YouTube. I’ve only added minimal editing, so I apologize for any errors, run-on sentences, etc.

In this video we’re going to look at what happens when we’re depressed: how depression affects our moods, thoughts, behaviors and bodies. And then we’ll explore what we can do and what needs to happen in order to relieve our depression so we can start to feel better.

So the main thing that usually comes to mind when we think of depression is a depressed mood, which is a feeling of prolonged sadness, emptiness, or hopelessness. And while depression is a mood disorder it affects much more than just our moods. Depression also affects our thoughts and our cognitive abilities. We can experience an endless stream of negative thoughts. And we can find it difficult to focus or concentrate which can interfere with our ability to work or get things done or even carry on a conversation.

Depression also affects our behaviors. When we’re depressed we can lose interest in doing most of the things we used to enjoy. And it can be difficult to motivate ourselves to do anything because we have no desire or lack the energy to do them. And when we do do things they’re not as enjoyable as they used to be, and they don’t give us that much pleasure.

And depression affects our bodies. We can experience aches and pains or uncomfortable feelings in various parts of our bodies. And we can feel sluggish and slowed down. And everything feels so hard because we’re so tired or worn out or just don’t have any energy.

Depression doesn’t just affect each of these elements independently of one another. When we’re depressed they all act together, influencing and interacting with one another, through a series of vicious cycles and downward spirals, that maintain and prolong depression and can leave us feeling even more depressed. So let’s take a look at how this works.

Our moods have a big influence on our thoughts. And when we’re feeling sad or depressed, we tend to have a lot of very negative thoughts. And at the same time if we’re having a lot of negative thoughts, it leaves us feeling depressed. And so we get a vicious cycle, where the more depressed we are, the more negative our thoughts. And the more negative our thoughts, the more depressed we feel.

And so when we’re depressed we can get caught up in this vicious cycle between our moods and how we feel and all of these negative thoughts that can pull us into a downward spiral and leave us feeling even more depressed.

And our moods have a big impact on our behavior. If we’re feeling sad or depressed we often don’t feel like doing anything. But the more inactive we become and the less we do, and especially the less we participate in activities we used to enjoy and the less social interaction we have, the more depressed we feel; which makes it harder to get ourselves to do things; so we do even less; and we become even more depressed.

And there are similar relationships going on between our thoughts and our behavior. And also between our moods and our bodies. And our thoughts and our bodies. And our bodies and our behaviors.

And these sorts of relationships and vicious cycles aren’t limited to just two aspects of our experiences at a time. They can all act together, creating a big vicious cycle, which is one of the reasons depression can feel so overwhelming, and so hard to recover from. So for example, we’re feeling down, we have a depressed mood, so we have a negative thought.

And this thought has a negative effect on our moods and our behavior, each of which lead to more negative thoughts, and maybe affect us physically as well; which then negatively influences our behavior making us feel even worse; and generating more negative thoughts, and so on. And any one negative thing in any of these areas reverberates throughout the whole system and sets off this cascade of other negative experiences that leave us feeling more depressed.

But the flip side of this is that any positive change in just one area regardless of how small, leads to positive changes in the other areas as well, which then generate further positive changes, and so on, reversing this negative feedback loop and helping us start to feel better. So how do we do this? How do we start to reverse this cycle?

In cognitive behavioral therapy we focus on changing our thoughts and our behaviors. And these are usually the two main things that we need to change in order to start feeling better. Our thoughts have to become less negative. And we need to become more active and engage in behaviors that improve our moods and promote recovery instead of contributing to our depression.

Now sometimes we can also change the situation that’s triggered our depression, but it’s not always possible to change these situations, whereas we do have some agency over our thoughts and behaviors. And it’s not even always clear what situations have triggered our depression. So back to our thoughts and behaviors.

If we can change the way we think and modify our thoughts to make them less negative and pessimistic, we change the way we feel and we become less depressed. This can also have a positive effect on our behaviors as well.

And if we can change our behaviors and become a little more active, start doing things we used to do, and find some enjoyment in these activities, then our moods begin to improve, and our thoughts become less negative and we start to feel less depressed.

With mindfulness we don’t try to change things directly like we do in cbt. For example we’re not concerned with trying to modify our negative thoughts. Instead we change how we relate to our experiences. And this allows us to react differently to our negative experiences in ways that prevent things from escalating and disrupt the connections that generate the vicious cycles that can leave us feeling so depressed.

When we’re mindful of our thoughts, instead of trying to change the content of our thoughts, we change how we relate to our thoughts. We just become aware of our thoughts, acknowledge them, and then if our thoughts aren’t related to what we’re doing at the time, we don’t need to give them any more attention, and we can just let them go, which helps prevent them from setting off vicious cycles. And it reduces ruminating and dwelling on things which can play such a big role in depression.

And mindfulness helps us avoid acting in ways that promote depression. Because when we’re depressed we often act on automatic pilot and engage in habitual behaviors that aren’t that helpful to us and feed into our depression. But when we become more mindful of our behaviors and the impact they have on how we feel, this allows us to act more intentionally and in ways that can help relieve our depression.

And mindfulness is one of the best ways to regulate our moods and emotions, which can help reduce the severity of our depressed moods. And mindfulness also helps reduce the impact of the physical discomfort that often accompanies depression.

Now a common question is how long is this going to take? How long until i’m not feeling depressed anymore? And that’s a perfectly reasonable question, but there is no simple answer because it depends on so many factors, and everyone recovers at their own pace. Recovering from depression usually involves a series of small improvements over a number of weeks. And it may be difficult to notice changes in a positive direction certainly from day to day but even from week to week, because if we’re really depressed we can start to feel a little better, but still be really depressed.

For example we often rate how we feel on a scale from zero to a hundred. So let’s say right now we were to rate our depression at ninety five out of a hundred. Now over a couple of weeks we could experience a 20% reduction in how depressed we feel, and that would be great progress but our level of depression would still be at 76. And 76 out of 100 still feels really depressed.

So if we’re not looking for gradual changes and recognizing small incremental improvements in how we feel, it’s easy to just come away thinking, i’m still feeling so depressed, i’m not getting any better, when in reality we have started feeling better, and we’re already 20 less depressed than we had been a few weeks ago.

One of the reasons it’s easy to overlook these small changes is because when we feel a certain way we pay attention to things that confirm how we feel. So when we’re depressed we notice when we’re feeling lousy. And the times when we are feeling a little better can pass undetected because they fall outside of our depressed frames of reference. So it’s not even that we’re ignoring them, we may not even be aware of them.

And if we do notice some small improvements, because we have the tendency to be so negative and pessimistic when we’re depressed, we can just dismiss them: yeah but that doesn’t really count, it doesn’t make any difference, i still feel so depressed. And so our negative thoughts automatically kick in and we perpetuate the vicious cycle of depression.

So learning to recognize any improvements in how we’re feeling and to not just write them off is a big part of recovering from depression, because it helps shift our negative depressed mindsets, and it provides some positive or at least less negative information into the feedback loops and vicious cycles that are maintaining our depression.

And so a good way to notice these changes isn’t to try to compare how we feel today to how we felt yesterday, or even how we feel this week compared to last week, because those comparisons can be difficult to assess. Instead we want to try to be more aware in the moment when we’re having experiences that are at least a little better than usual. And this is important because when we’re depressed it often feels like we’re completely depressed all day every day. And even when we’re really depressed there are going to be moments in the day when we feel at least a little bit better. And so we need to notice any of these less negative or even slightly enjoyable moments, give these some recognition, because this helps to slow down or even reverse the vicious cycle of depression.

So one way to do this is an exercise called three good things. At the end of each day we look back over our day and write down three things that went well. And this can sound trivial and maybe a little patronizing, the idea that all we need to do is focus on things that go well and we’re not going to feel depressed anymore, but this doesn’t have to be the only strategy we use to relieve depression. And this video is just the introduction to my free self-help for depression course that has a couple of dozen other videos with strategies that can help in recovering from depression.

But there is research that correlates doing this exercise for just one week with increased happiness and decreased symptoms of depression for up to six months. And the reason this works is because focusing on things that go well helps shift our mindsets away from the negative biases we have when we’re depressed—and can get a kind of tunnel vision where we only notice the negatives things that don’t go well, or don’t work out, and how terrible we feel—knowing we’re going to do this exercise at the end of the day helps us notice more things during the day that are going well and pay them some attention.

And there’s no need to wait until the end of the day to start reflecting on these things that go well. We can try to be aware of them in the moment as they’re happening. And so the sorts of things we can look for are any activity that gave us some pleasure, some small amount of enjoyment. We had coffee with a friend and it was actually kind of nice. We tidied up the kitchen a bit and we felt like we accomplished something. Or we noticed ourselves having a thought that was a little optimistic or hopeful or at least not as negative as they usually are. Or we gave ourselves some credit for something, or were a little kind to ourselves instead of being so self-critical.

Or we had an hour in the afternoon where we had a little more energy than usual. Or we went for a walk and felt a little better and maybe that lump in our throats went away for a while. Or at the end of the day we were able to relax for a bit and actually enjoy watching tv and follow what was going on.

The more we start to look for these types of things the more we’re going to start to find them we’re going to start to notice things we’d otherwise overlook and every time we do notice them we add some new data into our feedback loops that can slow down the vicious cycles and downward spirals that are contributing to our depression and even start to reverse them.

And because depression is accompanied by so much pessimism and so many negative thoughts, if we’re watching a video like this and we’re depressed, it’s common to have thoughts like this is stupid, this is never going to work, i don’t even know why i bother trying. Or like i often see in the comments, something like, this video sucks who’s the idiot making this garbage.

And if we went into watching this video with some hopeful thoughts or some ideas that it might help, or if we’re having some of these now, then that’s a positive sign because it shows that our thought processes aren’t completely negative and pessimistic. And having a less negative outlook and attitude is going to help us as we recover from depression

And even just watching a video like this helps, not necessarily because the content is so great, but because just doing anything for ourselves when we’re feeling depressed feels better than doing nothing. It’s an antidote to any feelings of helplessness or hopelessness we might have. And even if we’re still a little sceptical, it’s a sign that we believe it’s at least possible to start feeling better which in and of itself can improve our moods and help us start feeling better.

And depression is associated with a strong placebo response, perhaps because doing anything for ourselves when we’re depressed tends to make us feel a little better and helps counter our negative thoughts and pessimism. And so if we are trying to do things for ourselves that we think might help there’s a good chance we experience some placebo effect in addition to whatever other benefits we get from it.

So recovering from depression takes some work, and it takes some time, and it can be discouraging and frustrating, especially if we’re not able to notice the gradual progress we’re making, and if we’re not able to counter our natural inclination when we’re depressed towards pessimism and negativity. But if you’re still watching this video it shows that you’re not feeling completely hopeless or helpless which is a big step in recovering from depression.

Depression is considered a mood disorder, but it impacts much more than just our moods. While feeling sad and having a depressed mood is usually a big part of feeling depressed, depression also affects our thoughts, our behaviors, and our bodies.

Depression and Thoughts: When we’re depressed, we can experience an endless stream of negative thoughts, such as feelings of worthless and guilt, regrets, self-criticism, hopelessness and more. And we can find it difficult to focus or concentrate, which can interfere with our ability to work and study, or even read, watch television or carry on a conversation.

Depressed Woman

Depression and Behavior: When we’re depressed, we can lose interest in doing most, or all of the things we used to enjoy. It can be difficult to motivate ourselves to do anything because we have no desire, or lack the energy to do them. And when we do do things, they’re not as enjoyable as they used to be and don’t give us as much pleasure.

Depression and our Bodies: Depression can really affect our bodies. We may experience aches and pain, or uncomfortable feelings in our throats, chests, stomachs or somewhere else. And we can feel sluggish and slowed down, and everything just feels so hard because we’re so tired or have no energy.

In this course we’ll explore how to:

  • Change our behaviours in ways that help lift depression
  • Modify or replace negative thoughts in order to relieve depression
  • Respond mindfully to our negative thoughts so they have less of an impact on our moods and don’t feed in to our depression
  • Regulate our sadness and depressed moods so they become more manageable
  • Reduce the effect of the physical component of depression

CBT for Depression

Depressed Woman

In CBT for depression, we focus on how our thoughts and behaviours contribute to depression. We learn how to change our behaviors in ways that help us feel less depressed:

  • behavioral activation helps us become more active in ways that help up experience some satisfaction and pleasure
  • behavioral experiments allow us to test our negative thoughts and beliefs and see that they’re not always accurate, and then make adjustments in how we think and act that improve how we feel

And we develop strategies to modify or replace our thoughts to make them less negative. This helps reduce depression through:

  • cognitive restructuring to change or replace negative thoughts
  • changing negative core beliefs
  • behavioral experiments to reinforce our new ways of thinking

Mindfulness for Depression

Man Sitting Mindfully

Mindfulness can play an important role in managing depression. And although mindfulness is often associated with meditation, we don’t need to practice meditation in order to be mindful. In this course we’ll learn mindfulness-based approaches to treating depression we can use whether or not we meditate.

With mindfulness we don’t focus on changing the content of our negative thoughts like we do in CBT. Instead, we change how we relate to our thoughts. We become aware of our negative thoughts and acknowledge them. And then we just let these thoughts go, or allow them to be there without reacting to them in ways that initiate vicious cycles and downward spirals that can lead us to feel depressed. Being mindful of our thoughts also reduces the ruminating and dwelling that can play such a big role in depression.

Mindfulness helps us modify our behaviors. When we’re depressed we often act on automatic pilot and engage in habitual behaviors that feed into our depression. Becoming more mindful of our behaviors and their impact on how we feel allows us to choose actions that reduce depression.

Mindfulness is one of the best ways to manage and regulate our moods and emotions, which is important when we’re depressed. Mindfulness also helps reduce the effect of the physical discomfort that often accompanies depression. And mindfulness encourages acceptance and compassion, which combats feelings of worthlessness and negative thoughts about ourselves that are so common when we’re depressed.

Self-Help for Depression Course Contents

I’ll be adding new videos as well as revising some of the current ones on an ongoing basis, so subscribe to my YouTube channel and follow me on Twitter so you don’t miss my new content when it comes out. If you’d like to support my work, please Buy Me a Coffee or join my Patreon

Below is a list of the posts in this self-help for depression course. These links also appear in the sidebar of each post, or below the posts on mobile devices. There is some overlap with my courses on CBT and Anxiety. If you’ve already seen some of these videos, I recommend at least reading the text in each post, as in most cases it’s been updated to reflect how the videos apply to treating depression. Or watch the videos again to reinforce the concepts (and boost my view counts).