Commitment: Can negative thinking cause depression? If so, why do some people get caught in a cycle of thinking negativity that they can't seem to escape from?
Peter J. Bieling, Ph.D. and Martin D. Antony, Ph.D.: We don't know this in a completely definitive way. We do know for sure that depression is strongly associated with cycles of negative thinking- where you find depression, you find streams of negative thoughts and where you find negative thoughts you find depression.
As to the "some people" part of the question that actually taps into the huge nature versus nurture question.
There is no question that some people are more prone to negative thinking and depression. It may be partly due to their genetic make-up which can help to set a person's emotional "tone".
But negative life events, especially early on in life, also set the stage for depression.
Commitment: What is the negative triad of pessimistic views that often is associated with depression? How can a person stop these negative thoughts and turn them to positive thoughts?
Dr. Bieling and Dr. Antony: We often say that negative thinking can be about self, others, and the world and the three components make a triad. The best evidence is that changing these negative thoughts requires some looking in to them, testing them, and trying alternatives. The best shot at doing that is in Cognitive Behavior Therapy. It isn't as simple as "shouting down" negative thinking or trying to see the glass half full.
Commitment: Can you tell us about a new treatment for depression called interpersonal psychology? How is this treatment different and what can it offer a depressed person?
Dr. Bieling and Dr. Antony: Interpersonal Therapy (IPT) focuses on the interpersonal relationships in a person's life. What makes it different is that most therapies see depression as something "intra-personal" or within the person. Interpersonal therapy is quite successful and turns that conventional wisdom on its head. It turns out that improving our relationships with other people is enormously impactful.
Commitment: Once a person experiences depression, why does it often return? What can a person do to prevent a recurrence of depression?
Dr. Bieling and Dr. Antony: The best models we have, whether they are biological or psychological, suggests that depression wears grooves or ruts into a person. These ruts involve certain feelings, thoughts, and behaviors. Once a person has been depressed once, it seems to take less of a push to get them following these ruts, and it seems harder to break out of them.
We believe too that, in addition to getting treated for acute symptoms of depression, its important for people to work on relapse strategies, to put effort into making sure they stay recovered.
Commitment: What are some strategies for preventing a return of depression?
Dr. Bieling and Dr. Antony: You have to know yourself, know those ruts, know what situations make you vulnerable.
People have the best chance of staying out of depression if they take the time and energy to re-construct their lives around them so as to reduce stress, maximize enjoyment, and ensure they look after themselves (eating right, sleeping well, and exercising). There is a promising treatment called Mindfulness Based Cognitive Therapy that helps with these goals.
Commitment: What beliefs, also known as compensation strategies, can lead to depression? Are there certain beliefs that can set us up to feel bad?
Dr. Bieling and Dr. Antony: In depression the "Core beliefs" that seem to drive depression usually center on themes of inadequacy (not being good enough) and unlovability (no one loves me). People will often do a lot to prevent themselves from having to confront these beliefs. For example, they may work hard to be perfect or try to maintain relationships with others at all costs.
Commitment: What are some positive everyday activities, lifestyle choices and habits that can help a person heal from their depression? Can you explain how the behavorial model of depression works, and what a person can do to bring positive rewards and reinforcements into their everyday life?
Dr. Bieling and Dr. Antony: The behavioral model of depression is simple, but deceptively smart and works very well. If we picture life as a kind of game, one in which certain behaviors lead to rewards and others don't, we're halfway there. The model says that we only feel good when we get enough rewards, and we can get enough rewards only if we're active enough and pulling on the right levers.
Translated into everyday life that means a constant stream of rewards, either pleasure or accomplishment.
It's incredibly important for us to stay on top of the daily things, like bills, e-mail, chores, but also to reward ourselves for doing that with healthy treats, and big dreams. Human beings, generally speaking, do not respond that well to rest, we're made to move, to enjoy, and to challenge ourselves.
Commitment: How is being a perfectionist and being self-critical linked to depression? How can a person change these tendencies that might be the cause of their depression?
Dr. Bieling and Dr. Antony: Perfectionism and self-criticism are strategies related to the belief that one is inadequate. Both are examples of "over-doing", almost as if to stave off what a person believes is really true of them.
We might call them "defensive strategies", if I can just hold on and do everything perfectly, I'll be ok.
But people wear themselves out they forget that "doing" is no more or less important than having fun or pleasure. People like this often burn out, or wear out. They then emotionally collapse, often doing nothing at all, and that's when depression hits them really hard. These core beliefs about the self are hard to change unless one goes to formal CBT.
Commitment: You write that a core motivation that drives depression is dependency. What is dependency? What type of behaviors and thoughts does dependency lead a person to that can cause depression? And if a person feels basically unlovable, what can they do to change the way they look at themselves, that causes dependency strategies that lead to depression?
Dr. Bieling and Dr. Antony: Dependency is usually defined as an over-reliance on other people, sometimes it takes the form of people needing others around them at all times, when decisions need to be made or when something needs to get done.
One of the aspects of dependency that is probably most troubling is when people seek out a lot of reassurance from others. This seems kind of benign, but excessive reassurance seeking actually undermines the relationship.
When we "check in" with others constantly, it seems to be aversive to the other person.
This is what makes dependency hard to tackle without the help of a therapist. In some ways, the dependent person's instincts are off, what they naturally want to do is usually the opposite of what would be healthy. The key thing to getting past dependency is that you're no more or less lovable than anyone else. Relationships with others only work when we're confident in ourselves, this can take a long time for people to understand.
Commitment: If a person's depression is caused by the relationships in their life, what can they do to develop healthy, intimate relationships? What behaviors and ideas regarding interpersonal relationships can cause depression?
Dr. Bieling and Dr. Antony: The main thing, and it takes multiple forms, is that the person isn't confident in themselves enough to let go, to not try to control everything. There are lots of rules to having good relationships. When things are going well, it's easy not to think about the give and take, the compromises, acceptance, and responsibilities that are involved in a healthy relationship. More than that, we sometimes have to end relationships that aren't healthy enough. There's a certain amount of creative destruction in relationships with others.
All this makes it tough to come up with a simple answer. But usually the problem is in expectations that aren't being met. And the solution can be simple; either the expectation is unreasonable and needs to be adjusted, or one needs to find a person who will meet that expectation.
About The Authors: Peter J. Bieling, Ph.D. is a practicing psychologist as well as Manager for Mood and Anxiety Services at St. Joseph’s healthcare in Hamilton, Ontario. He is also an Assistant Professor in the Department of Psychiatry and Behavioural Neurosciences at McMaster University in Hamilton.
Martin M. Antony, Ph.D., is the Chief Psychologist and Director of the Anxiety Treatment Research Centre at St. Joseph’s Healthcare in Hamilton, Ontario. An Associate Professor in the Department of Psychiatry and Behavioural Neurosciences at McMaster University in Hamilton, he is also the author of nine books, including The Shyness and Social Anxiety Workbook and When Perfect Isn’t Good Enough.
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