Disrupting Depression – Conversations that matter With ourselves, with each other, with the young people we care for and those we love.
Ever worked with someone stuck in the rut of depression? Whether a young person in your class, a colleague, or maybe working with your own tendencies – depression is and always has been – a fact of life. And as the wear and tear, the losses, missed steps in the dance of life, and anxieties resulting from pandemic strain continue to unfold, we see depression on the rise in adults, and young people. This short article aims to give some basic ways to understand ways to engage with depressive mindsets with greater traction. If you are interested in going further as part of your professional development, or because you have a child or colleague particular in mind who you are working with, you may like to contact me for a twilight or lunch session with selected colleagues. AS this is a joint newsletter for teachers AND my parent readers, you may be a parent bearing witness to your child’s struggle – and this is no easy place to be. If you’d like to have a one-off session for a deeper dive, let me know. What do we understand about depression? What purpose does it serve? It is primarily a protective mindset, a response to a nervous system outside of its window of tolerance – along the lines of freeze / flop as opposed to fight / flight. The trouble is, it ushers in rigid thinking – an internalization of that way of being with the declarative self-diagnosis ‘I am depressed’ which fuels low motivation and inaction. Here’s where the mindset can spiral into a more destructive nature – driving poor decision making that tends to be overly influenced by the tendency to self-soothe by withdrawal.
If anxiety is an active, energetic avoidance of difficult feelings, depression can be seen as submission to them in their present moment – and this can have that pervasive influence. ‘I can’t do my homework, do my hobbies, go to school – I truly don’t feel I can.’ And I do not say this lightly. I am not minimizing the power of these feelings – one of the core drivers of my work is my own experience as a young person of growing up with my mother’s battles with being bipolar.
We often associate depression with sadness – it can be – but it can also be as a result of iron deficiency. So an early port of call may be to get the bloods checked for any physical trigger. Depression can also be associated with the suppression of feelings – eg anger and irritability. Unfortunately, we can’t cut off one area of our emotional spectrum, without affecting another. If we refuse to face, express, process more energetic negative feelings, or if we refuse to acknowledge deep sadness, then we flatten off our capacity for joy and enjoyment. There can be gender-based cultural aspects to this. For some time various studies have observe a greater propensity for depression in women, and some writers and researchers have noted that frequently in women, the suppression of anger is at the core – it being rather more taboo to be an angry young girl and woman, than it is to be an angry boy or man. Similarly, it is harder for boys and men, culturally, to express vulnerability and fear, and the suppression of these elements also takes their toll. Women can tend to be very present to their feelings and talk about them – which is their superpower, meaning there is an inbalance between the numbers presenting to clinicians to get help at much earlier stages in men and women. However talking about these difficult feelings ruminatively is not helpful – they need disrupting. In contrast – and of course this is a generalization – men will tend to use avoidance strategies and be super adept at distracting from the rood difficult feelings – but this means they are not as present to them, and you can’t really change what you can’t see. Of course each gender would benefit by more balance between the two -often culturally-driven tendencies. Women could help themselves and each other more by having more disruption strategies, and men could help themselves and each other more by having a little more curious exploration of the core feelings. Of course – it is a great hope that education around empowering young people around their mental health, emotional intelligence, and emotional agility will change this picture. As will the ongoing inquiries disrupting traditional notions of gender. The cut-out and keep guide to disrupting depression.
Reframing and relocating ‘I’m feeling depressed right now…’ How we frame things affects our perceptions very profoundly. Maintaining the temporal nature of the situation in how we name it helps shape a meaning of what’s happening internally that still allows for shifts to exist. Disrupt the identity-based framing. Instead, find a place-name for it. IN the NICBAM (See below ‘Resources’) training modules on working with depression, Bill O’Hanlon speaks of working with a client who was profoundly stuck in rigid identity-based thinking about her state of mind and found that naming it ‘Depresso land’ helped his client observe an externalise her feelings as a place not a state. In contrast, he would encourage the client to look at what things were like in ‘Confidence-land’. Now Bill O’ Hanlon is a clinical practitioner. But what I think is powerful about this technique for teachers, especially form teachers, who may be mentoring young people – or parents who often want to – but struggle with – talking to their children and teens about their big and difficult feelings – is that it is a slightly different and can even be a more playful approach to opening up about ‘what it is’ they are going through. And it gently detaches that state of being from who they are to where they go from time to time. Most importantly, it enables them to explore, express, expand and remind them of times when they are not in ‘Low-land’. Shifting and disrupting the identity-based beliefs is the key. And obviously this isn’t going to be a one and done silver bullet conversation – but once you’ve established the settings, of ‘Depresso-land’ and ‘Can-do land’, these can form hyperlinks to follow-up conversations. ‘When did you visit ‘Can-do land?’ is a more playful and inviting approach… ‘Did you get to the beach? Or did you just get to the border? Immigration? Did you check in at the airport? Were the flights to Can-Do land disrupted?’ You can see that this is a lot less tricky to talk about than being and feeling unhappy. Especially in relationships between children and parents…where the emotional investment in their happiness can almost make it a matter of guilt and shame to be and feel flat – and a pressure or a worry to not be able to access happiness.
Quick additional disruption techniques: Depression goes hand in hand with low motivation and inaction which can make it really hard to respark self-worth and some positivity. So we are looking for uplift to help reinstall perspective when life flattens. In Barbara Fredrickson’s work, we want to create virtuous spirals of uplifting feeling – or positive affect in clinical terms. So here’s a quick how-to.
- Normalise ups and downs. In the same way we can have tendencies to have really bad colds, so it is with our feeling states. We have weather, and climate. But we can work with these. Help reduce the feelings of shame and otherness and reconnect with a sense of an emotional range. Using a happiness line index (Dr John Ivens, Maudsley Hospital School) or scaling technique can help. ‘If you’re at 3 now…when were you at 6? When have you been closest to 10? What was happening, what was going on? What was the feeling? What was your thinking about it? What was important to you about that?).
- Mine for the gold. What have been their sources of pleasure and even joy in the past? What was it about those events or situations that gave them such an uplift. Help them dwell on that, expand on it, explore it in as rich a way as possible. Are there ways in which they can practically recreate similar experiences of uplift. We’re trying to find simple things that will resonate with those moments, and lift. Hobbies, reading, films, magazines, music, art, poetry, colour, role models…Explore how to bring in perspectives, energies, associations from these sources…
- Thinking of the virtuous spiral – one positive thing can open up the space for receptivity to the next positive thing. Generally, when depressed, we tend to make decisions that compound the misery. To NOT do things, to withdraw from life, energy, stimulus, variety. Here it’s about finding small things that step by step will be big enough to bypass the avoidance, but small enough to avoid emotional flooding. So co-creating these and ensuring they are both meaningful and manageable is the way. Eg encouraging an elite sportsman / woman to go back into competing after some time of giving it up is likely to be too much. BUT, encouraging them to go to a session where they might help coach some younger hopeful might be both connecting, and sociable, and a great reminder of their capabilities. The point is to find entry points to disrupt the pattern.
- Seek out opportunities for playfulness – games, silly games, comedy…Jaak Panksepp (Affective Neuroscience) talks of depression as being a seeking disorder – it reduces and flattens curiosity because we’re in a panic/grief modality. He puts forward the notion that play stimulates seeking, and this can have a kindling effect once ignited. So playing card games…word games…etc…
- Celebrate, extend, and expand the capacity for savouring, reliving and rekindling positive emotions. In your supportive conversations, really look at strengthening their inner resources by talking about the impact and importance of the good stuff to help them feel that they can resist the present moment of darkness and know that there are things that they can do. It’s all about activation, sparking into activity.
- I am also a fan of the 3 good things journal – to do before bedtime or close to bed time. Find 3 good things (not just success related) that happened in the day, and list them and reflect on what impact they had, and why they were important – what matters…Very effective in stoking up the capacity to see and savour and internalise the good stuff – seeing the small flowers in the meadow, not just the weeds and sheep-poo…!
- Normalise recurrent aspects of slipping up and down the mood spectrum so they don’t see that as a failure, or a destiny. Help grow the gold of what might help through relapses so they can desensitize from their power – to an extent. So explore how they can be equipped to prevent and reduce their power, rather than deepening and extending each time.
So a summary: Depression ushers in a sense of low mood, low motivation, inactivity, rigid thinking. Gently disrupting this helps reintroduce flexibility of thought and the beginnings of emotional agility. Points of enquiry: When are you not depressed? What’s that like? What’s the impact? What’s important? What do you see in yourself? What do you see differently from this standpoint? What would it be like to have more of? What can you do? What help can you get? What might be going on that is contributing to what is going wrong here? What is happening or has happened externally? What are you doing that also contributes to this? Be concrete – what are the observable, tangible behaviours, what are the internal dimensions of the self-talk… What have you done in the past that makes this better? What are the things that you are doing that increase your mood? Generate a list. Be concrete. Observable, tangible behaviours, and creating / strengthening self-talk statements.
I have often written about anxiety connected with the pandemic over the past 2 years. But equally, and especially in the aftermath, we have had a sharp rise in rates of depression. One of the training workshops I have been leading most frequently is about how you support young people through loss, change and grief. And of course, the flight path to access treatment is subject to delay with CAMHS having long wait-lists even for severe cases. Private clinicians, and even lowly coaches like me, are operating with waiting lists, such has been the surge in demand. My purpose here with the newsletters and my coaching and training, is always to remind people of the power of connection and attunement – bringing the healing capacity to be emotionally available to each other. In my work I seek to empower people who are not clinicians to understand some of the frameworks of what’s going on and to have some practical, useful strategies to use. In supporting parents, and professional caregivers like teachers and teaching assistants, we are able to strengthen the holding environment around children who are also undergoing the highs and lows and stuckness of the human situation. It is worth remembering that in many ways, depression can been seen as one of psychiatry’s success stories. I am quoting US data from Terry Real (Of the Relational Life institute and author of Us) – over 90% who get treatment report substantial relief – but lower than 2 in 5 get help. Getting people moving is important. I hope the article today has helped. Clearly these techniques can’t be the be-all and end-all – especially where clinical depression is at stake. But this is a matter for medical practitioners to diagnose. What lies here, I hope is some insight into how we might use key moments in our relationships on the ground in life right now to help create leverage and simply help find moments of ‘sparking’ that will start kindling the flames and access to the warmth and light. Contact me about any speaking, training, coaching interests. Or just ping me a question, reaction, or reflection. It’s always good to know how these land. YOU inspire me to live well, work well, do better…and pay it forward. With love and gratitude, Emma.
NICABM – National Institute for the Clinical Application of Behavioural Medicine- online traininghttps://www.nicabm.com/Respark – Graham MusicChange 101, Do One thing Different – Bil O HanlonResilient – Dr Rick HansonUS – Terry RealAffective Neuroscience – Jaak Panksepp