Psychological support for depression

If you are experiencing trouble sleeping, appetite changes, libido changes, or difficult feelings such as despair, melancholy, misery, sadness, hopelessness, worthlessness, unmotivated, and low energy, you are not alone. According to the National Survey of Mental Health and Wellbeing, one-in-five Australians experience a mood disturbance or change in feelings or emotions. Around one-in-twenty Australians experience a mood disturbance or change in feelings or emotions that interfere with daily functioning, People experiencing depression are more likely to think about suicide, another good reason for seeking support.

Talking to your GP, to rule out potential underlying physical causes such as theroid, cardiac, infections and autoimmune issues, is an important first step. You and your GP can discuss suitable treatments such as evidence-based therapy from a psychologist. If you obtain a Mental Health Treatment Plan from your GP, you will be eligible to receive a Medicare rebate of $84.80 (for a general psychologist such as myself) per individual session for up to 10 sessions per calendar year. 

Frequently asked questions about depression

Does depression increase the likelihood of thoughts of suicide?

Feelings of worthlessness and helplessness are difficult to bear. Unsurprisingly,  research tells us that people who are experiencing more severe depression, are more likely to have thoughts of suicide.  Combining the results of 27 research studies, depression (along with PTSD) was found to have a large effect on the likelihood of suicidal idealisation. The flip-side is also true, as the severity of depression decreases, so too does the frequency and intensity of thoughts of suicide. So it is important to seek support for your depression.

If you are in crisis please contact either Lifeline 131114, or to access your local Queensland Health Mental Health Acute Care Team call 1300 MH CALL (1300 642 255). If requiring prescriptions, contact your local GP.

If your matter is very urgent or life threatening, always call “000”, or present to your nearest Hospital Emergency Department immediately if you are able to do so.

Is ACT an evidence-based treatment for depression?

Acceptance and Commitment Therapy (ACT) is a modern form of cognitive behaviour therapy (CBT), that teaches specific, structured evidence-based skills to help you better manage difficult thoughts and feelings, so they are less an obstacle to values-guided life actions.

ACT is an evidence-based approach for psychological problems, with an impressive research base. Over 200 Randomised Control Trials (RCTs) have been published supporting the effectiveness of ACT. ACT helps depressed people, as effectively or better than other established psychological treatments.

Will my depression ever improve?

It is common for people experiencing depression to feel like things will never change, or that any gains made during therapy in managing difficult thoughts and feelings will “wear off”.

Recent research is much more optimistic. In one Finnish study, over two-thirds of depressed participants who received ACT treatment, no longer met diagnostic criteria for depression. And when the followed the participants up 3 years later, to see if the gains had worn off, changes achieved made during ACT therapy are still detectible. A similar study found gains achieved during ACT treatment were still detectable 5 years later.

How does my relationship with my thoughts affect my depression?

Difficult thoughts such as “I am worthless” “I don’t want to face the day” “this is hopeless”, are unpleasant, and it makes sense that people try to avoid having these thoughts. Common strategies include distractions such as the internet (Facebook, computer games), opting out (socially withdrawing and staying in bed), and self-medicating (drugs, alcohol). Avoidance of these experiences sometimes brings short-term relief, however all too often it comes at the expense of living with vitality. Having a break from intense thoughts, for example going to the movies with a friend, can be really helpful. However,  inflexible and fixed  avoidance of difficult experiences, especially if our default behaviours are not working in the long-term, can impact our mental health.

Our minds are great problem solving machines. However when we try to problem solve, why we have depression, it is easy to fall into a trap of going over and over (round and round) the same questions with out making progress. This pattern of thinking has us taking our thoughts seriously and literally. In short we feel like we are fused with our thoughts (like two metal plates that have been melted together).  Ruminating, can feel like we are doing something useful, however when we are “fused” with our thoughts, much of our mental energy can get consumed, leaving us tired and less able to engage in values-based living. Rumination is one kind of pattern of thinking that gets us hooked by our thoughts.

Struggling with our inner experiences, such as thoughts, feelings, memories, and body sensations increases the likelihood  of psychological distress such as depression. Watch this 3-minute video (by Russ Harris) to get a brief overview of the downsides to struggling with our emotions.  And, watch this 3-minute video (by Rob Archer) to get a easy to understand overview of experiential avoidance. Research shows that the more we use inflexible psychological strategies, such as fusing with our thoughts and experiential avoidance, the more likely we are to meet clinical criteria for depression.

Fortunately, acceptance and commitment therapy provides skills to unhook (defuse) from our thoughts and make space for difficult experiences (acceptance), with the goal of living a more values-based life.

 

 

What is rumination and how does rumination predict depression?

Rumination has been defined as a negative form of repetitive focusing on the causes, meanings, and consequences of negative mood and depressive symptoms. Rumination seems to predict the beginning of depressive episodes, predict the maintaining of depression as well as the likelihood of the recurrence of depression.

Research suggests that ruminative thinking predicts depression because it interferes our ability to actually notice and experience emotionally relevant events going on around us, and respond in a way promotes valued-living.

I ruminate all the time – how can I decrease it?

ACT helps you notice when you are ruminating and skills to respond more flexibly to difficult thoughts and feelings. The focus of  ACT is not to try to change your negative thoughts (although your thoughts might change) or make them go away. When you notice yourself hooked by a particular thought, ACT teaches you how to unhook from that thought and focus more of your energy on living a meaningful life, rather than struggling with your thoughts. One recent study showed that even a brief two-session ACT intervention targeting rumination can help unhook from difficult thoughts and increase valued living.

Self criticism and depression – how can CFT help?

Self-criticism can lead to and maintain depression. Compassion Focused Therapy helps people be more open and responsive to care and support from others. Reduced fear of compassion from others is associated with reduced symptoms of depression.

Shame and depression – how can CFT help?

Humans have evolved to experience the emotion of shame as a warning signal. Shame is a warning that others may perceive him/her negatively and therefore at increased risk of ejection, exclusion, being passed by, harmed or even persecuted. Shame is experienced as a social threat  Our brain based threat system activates the automatic response to fight, flight or freeze. All of us have memories of feeling shamed.  People who can recall feeling loved and cared for as a child tend to experience less depression as adults, despite the presence of shame memories. Compassion Focused Therapy targets shame by helping individuals shift from a treat based response to activation of the affiliation system including a sense of soothing and safeness.

 

Treatment resistant Depression – how can Compassion Focused Therapy help?

Nearly half of depressed people who receive medication and/or therapy, do not make a full recovery. These people seem to have particular difficulty accepting compassion from others, and also difficulty showing compassion to themselves. This fear of compassion  seems to be linked to increased depression, anxiety and stress. Compassion Focused Therapy (CFT), which is an evidence based therapy for treatment of depression, seems particularly helpful in reducing the fear of accepting compassion for oneself and others.

What happens in therapy for depression?

You probably will not be surprised the hear that no two sessions are the same, individuals are unique, and effective therapy needs to be tailored to in individuals situation and personal recovery journey. That said there are some common components to therapy for depression.

Initial depression therapy session.

  • Once you book a session, emailing you a basic welcome letter. The welcome letter will provide information on finding the office, contact details, administration and payment details, and a few sentences about our first session.
  • In the waiting room, completing some brief psychological measures to get a baseline before we start our work together. The common ones I use are:
    • a short measure of depression, anxiety and stress
    • an ultra-brief session-by-session assessment of areas of life functioning known to change as a result of therapeutic intervention
    • a brief measure of valued living
    • a brief measure of psychological flexibility (the main ingredient of ACT).
  • Initially covering confidentiality, administration and billing and checking to see if you have any questions.
  • What brought you to therapy (presenting issue) and clarifying what symptoms, such as depression that may be a concern.
  • Collaboratively developing clear and realistic goals therapy. It is more effective to set behavioural goals (for example I want to go out socially with my friends once a week) rather than symptom reduction goals (for example I want to feel less lethargic).
  • Getting to know each other – to build trust.
  • A quick tour of your life – relationship with your parents, school experiences, salient experiences during childhood, adolescent and adulthood. Helpful to put your presenting issue in some wider context.
  • Exploring together a recent example of the presenting issue. Applying what we learnt together from the tour of your life, to make sense of how the presenting issue is playing out in your life.
  • Identifying what skills and experiences are needed to help you achieve your therapy goals.
  • Agreeing on some skills and exercises to experiment with between now and next session.
  • End the session by completing a brief measure of the effectiveness of the therapeutic relationship and discussing what to do differently in the next session.

 Subsequent depression therapy sessions

  • To gauge progress (therapy effectiveness), complete the same brief measures for progress on goals, life functioning, valued living, and psychological flexibility. Discuss what  the measures are telling us about therapy effectiveness so far.
  • Debrief on the skills and exercises you experimented with between sessions
  • Choose a focus for the session, informed by progress to date.
  • Explore a resent real-life example of a challenging situation and experiment with applying different ACT skills to what is happening in the session
  • Identifying what further skills and experiences are needed to help you achieve your therapy goals.
  • Agreeing on some skills and exercises to experiment with between now and next session.
  • End the session by completing a brief measure of the effectiveness of the therapeutic relationship and discussing what to do differently in the next session.

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