Depression is a serious problem in the United States. According to the Anxiety and Depression Association of America, a major depressive disorder affects about 6.7 percent of the U.S. population over 18 and is the leading cause of disability in the country for those aged 15 to 44. Depression can arise from a combination of biological susceptibility and early childhood experiences that leave an individual more vulnerable, in addition to significant stressful life events such as loss. Like any affliction, depression requires attention and targeted treatment. Yet, contrary to the hopelessness those suffering often experience, depression should be seen as an eminently treatable disorder.
Depression is striking people at younger and younger ages, making it all the more important to treat depression early and well. There are now many therapies that are effective. In deciding on which is best, it is helpful for a person suffering to address what might be the underlying issue. People who have a history of trauma seem to benefit more from talk therapy with a therapist with whom they form a good alliance. Those with no history of trauma may benefit from medication in addition to psychotherapy. For any individual, treatment should always be case-specific, and for many, a combination of therapy and medication may be most effective to reduce symptoms.
One method with great potential to treat depression is mindfulness-based cognitive therapy. Learning mindfulness skills, through meditation and breathing exercises, helps people develop a different relationship with their feelings, allowing them to better regulate and tolerate their emotions. Mindfulness can help people achieve a calm and integrated state, in which they are less likely to be overtaken by their emotions. These practices also allow them to be more present to their here-and-now experience, rather than bemoaning their past or castrophizing about their future. In this balanced state, people are better able to combat anxiety, stress and feelings of depression. Research by Mark Williams, Ph.D. has proven that mindfulness practices can help prevent relapse in recovered patients who’ve struggled with recurrent depression.
Another therapy that can help to combat the “critical inner voice” that underlies depression is Voice Therapy, a cognitive/affective/ behavioral methodology developed by my father Robert Firestone, Ph.D. The five steps of Voice Therapy target a person’s inner critic or critical inner voice. This “voice” represents a vicious anti-self that is formed out of negative early life experiences. The anti-self can fuel depression, leading people to experience a cycle of self-criticism and a feeling of worthlessness. The steps of Voice Therapy, involve:
Step I: The person identifies the content of his or her negative thought process. He or she is taught to articulate any self-attacks in the second person (i.e. “You are so stupid. No one respects you.”) The person is encouraged to say the attack as he or she hears it or experiences it. If the person is holding back feelings, he or she is encouraged to express them.
Step II: The person discusses insights and reactions to verbalizing the voice. He or she attempts to understand the relationship between voice attacks and early life experiences. The objective here is to help the person to develop compassion for themselves.
Step III: The person answers back to the voice attacks. This is often a cathartic experience. Afterwards, it is important for the person to make a rational statement about how he or she really is, how other people really are, what is true about his or her social world from his or her own point of view (i.e. I am not stupid. I have a lot of good qualities that people respect me for.”)
Step IV: The person is encouraged to explore how the voice attacks are influencing his or her present-day behaviors.
Step V: The person then collaborates with the therapist to plan changes in these behaviors. The person is encouraged to resist engaging in self-destructive behavior dictated by his or her negative thoughts and to also increase the positive behaviors these negative thoughts discourage.
In my Oct. 22 CE Webinar “Helping Clients Overcome Depression,” I will further illustrate the techniques of Voice Therapy, as they apply to the treatment of depression as well as other effective treatment approaches.
In dealing with depression, it is also important for individuals to uncover any anger that could be underlying their depressed feelings. Anger can lead to depression when, in attempting to suppress it, they turn it on themselves. Even though they may feel uncomfortable at first, people who suffer from depression should be encouraged to acknowledge, explore and express their anger in a healthy environment, such as in therapy. People have to tolerate their angry feelings; if they don’t allow themselves to feel their anger, they run the risk of turning these emotions on themselves, a process that strengthens their critical inner voice and exacerbates their depression.
One physical way people can combat their depression is through exercise. Physical activity is extremely beneficial to those suffering from depression. In fact, there are many proactive ways for individuals to ameliorate their symptoms, which I’ve highlighted in my blog “8 Ways to Actively Fight Depression.” It may feel tough initially to engage in these behaviors when feeling depressed, but it is important to take the actions that have been proven to help, even when a person feels hopeless about his or her condition. These actions help shatter this sense of hopelessness and help people to overcome their depression and cope more effectively with stress in their daily lives. The ultimate goal is to help people triumph over their anti-self and strengthen their real sense of self, enabling them to lead a meaningful life.