Out of the Blue: Challenging Myths • Myths about depression: Six non-medication ways to • Cause is known (biochemical and genetic) • Despite the ads one sees on TV, the cause of depression is not known and has not been established as biochemical or genetic relieve depression • “For most common diseases, specific genes are almost never associated with more than a 20-30% chance of getting sick,” explains Bryan Welser, CEO of gene discovery company Perlegen Sciences. (Quoted in Wired , Nov. 2009, p. Bill O’Hanlon 121) For a copy of these slides • “The strongest predictor of major depression is still your life experience. There aren’t genes that make you depressed. There are genes that make you Visit: BillOHanlon.com vulnerable to depression.” –Kenneth Kendler, M.D., Professor of Psychiatry and Click FREE STUFF Genetics Medical College of Virginia, TIME, March, 2001 • Cause determines intervention Then Click SLIDES • Antidepressants are the only effective treatment 1 2 What This Presentation Offers Latest book • The six strategies: New possibilities for effective intervention • These are alternate approaches to use with clients/patients with whom your usual approaches have not helped or to supplement your current methods and approaches 3 4
The Rise in Depressive Disorder The Costs of Depression • Rates of depression have radically increased in recent years. • WHO estimates that • Treatment for depression has increased by 300% between 1987 and 1997; by depression is the leading 1997, 40% of psychotherapy patients, double the percentage of a decade before, cause of disability for 15- had a diagnosis of a mood disorder. to 44-year-olds • The percentage of the population for depression grew from 2.1% in the early 80s • In the US, economists to 3.7% in the early 2000s, an increase of 76%. • Use of antidepressants nearly tripled from 1988 to 2000. estimate that depression is • Immigrants tend to have the same rates of depression as their adopted culture/ responsible for $43 billion country rather than the rates of the place from which they came in costs every year Wega, W. and Rimbaut, R. (1991). “Ethnic minorities and mental health,” Annual Review of Sociology , 7:351-383. 5 6 Emily Dickinson Depression can be devastating I felt a funeral in my brain I felt a funeral in my brain and mourners to and fro Kept treading, treading 'til I thought that sense was breaking through And when they all were seated, a service like a drum Kept beating, beating 'til I thought my mind was going numb Andrew Solomon And then I heard them lift a box and creak across my soul (author of “The NoonDay Demon”) With those same boots of lead again then space began to toll As if the heavens were a bell and being were an ear And I and silence, some strange race wrecked solitary here Just then a plank in reason broke and I fell down and down and hit a world at every plunge and finished knowing then 7 8
Lincoln’s description of depression Depression as multi-factored “I am now the most miserable man living. If what I feel were equally distributed to the whole human family, there would not be one • Biochemistry is only part of the story cheerful face on the earth. Whether I shall ever be better I cannot tell; I awfully forbode I shall not. To remain as I am is impossible; I must die or be better, it appears to me.” 9 10 The Six Strategies #1 Marbling #1 Marbling #2 Undoing depression Mapping depresso-land and non-depresso-land • Investigate times and aspects of non-depression while #3 Shifting relationship with depression #4 Challenging isolation/restoring and strengthening connections finding out about depressive experience #5 A future with possibilities #6 Re-starting brain growth 11 12
Focus mainly on depression could Therapy often focuses on what is wrong add to the problem • A recent study shows that extensive discussions of problems and encouragement of ‘‘problem talk,’’ rehashing the details of problems, speculating about problems, and dwelling on negative affect in particular, leads to a significant increase in the stress hormone cortisol, which predicts increased depression and anxiety over time. Byrd-Craven, J., Geary, D. C., Rose, A. J., & Ponzi, D. (2008). “Co- ruminating increase stress hormone levels in women,” Hormones and Behavior, 53, 489–492. 13 14 Challenging pessimism and building Positive Psychology can help optimism alleviate depression • One study found that even naturally pessimistic people who spent one week doing exercises in which they identified and wrote down times in the past in which they were at their best, their personal • A meta-analysis of 51 positive psychology interventions with 4,266 individuals strengths, expressing gratitude to someone they have never properly thanked, and writing down three • The results revealed that positive psychology interventions do indeed significantly good things that happened were happier when their happiness levels were measured six months later. enhance well-being (mean r 5.29) and decrease depressive symptoms (mean r 5.31). Seligman, M., Stern, T., Park, N & Peterson, C. (2005) “Positive Psychology progress: Empirical validation of interventions,” American Psychologist, 60: 410-421. • Seligman reports a study done by himself and Jeff Levy with people who scored as severely depressed Sin, Nancy and Lyubomyski, Sonya. (2009). “Enhancing Well-Being and Alleviating in a depression inventory. Participants were instructed to recall and write down three good things Depression with Positive Psychology Interventions: A practice-friendly meta- that happened each day for 15 days. 94% of them went from severely depressed to mildly to analysis,” 2008). Journal of Clinical Psychology , In Session 65: 467–487. moderately depressed during that time. Cited in Authentic Happiness , Seligman, Martin E. P ., 2002, NY: Free Press. 15 16
Letter from Abraham Lincoln to Fanny McCullough after she Acknowledgment and Possibility was distraught over the loss of her father in the Civil War Dear Fanny It is with deep grief that I learn of the death of your kind and brave Father; and, • An alternative is to move back and forth between discussions of especially, that it is affecting your young heart beyond what is common in such cases . In depression and non-depressive moments and experiences. this sad world of ours, sorrow comes to all ; and, to the young, it comes with bitterest • This not only respectfully acknowledges the person’s painful and agony, because it takes them unawares. The older have learned to ever expect it. I am anxious to afford some alleviation of your present distress. Perfect relief is not discouraging experiences, but gives them a reminder they aren’t and possible, except with time . You can not now realize that you will ever feel better. Is this not haven’t always been depressed. so? And yet it is a mistake. You are sure to be happy again. To know this, which is • It can also illuminate and give hints to skills, abilities and connections certainly true, will make you some less miserable now. I have had experience enough to know what I say; and you need only believe it to feel better at once. that can potentially lead out of depression or at least reduce depression levels. 17 18 Make maps of depresso-land and Elaine’s maps non-depresso-land Depresso-land Confident/Competent-land Gets out of bed by 9 a.m. Stays in bed until noon Doesn’t have a job Contacts friends or quits job Plays music • Compare and contrast and build maps of feelings, actions, thoughts, Eats breakfast Focuses on good things foods all day focus of attention, interactions and contexts associated with both she has accomplished in the past Stays alone; talks only to depressed depressive experience and non-depressive experience Has a job; friend or therapist Goes to work Focuses on bad Spends time with things happening in women friends the future Goes to lunch alone 19 20
Inclusion Discover exceptions, resources • Permission and solutions • To and not to • “It’s okay to feel depressed.” • Find out about moments of non-depression • “You don’t have to have hope right now.” • Find out about what happens when the depression starts to lift differently than during it • Inclusion of opposites • Ask why the problem isn’t worse • “You can be hopeless and have hope at the same time.” • Import strengths and abilities from contexts of competence • Exceptions • “You feel hopeless except when you don’t.” 21 22 #2 Undoing depression Depression as a bad trance • Pattern intervention • Discover repeating patterns involved with and associated iwth • Symptom trance vs. coming out of bad trance depressive experience and help the person change those patterns in small or big ways • Repetition as trance induction • Patterns of doing, viewing and context • “Your nostrils are closing; your nostrils are closing.” • Highlight any places around depression that the person has moments of choice 23 24
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