Meet Lin. She is in her 30’s and living in Beijing, China. Lin is successful, smart and likeable. She has many of the things she always wanted: a great job, a loving husband, a nice apartment and a car. But recently Lin has been suffering from depression. She has been feeling low, hopeless and has very little energy. Even daily tasks seem like a huge challenge. She thinks, why do I feel this way when I am so lucky? Why do I have these feelings and not my friends?
You may think that depression only happens to those who are unfortunate, mentally weak, or traumatized. The truth is, it can happen to anyone (according to our CandleX’s mental health peer support group review 2016, many who seem to have it all can also be suffering from depression). Many of us have been in a similar situation to Lin where we question why we experience depression even when things seem to be going well and we know the intense guilt that goes along with this question. If life events and family history (genes) don’t fully explain who is at risk of depression, what are the other factors that can contribute?
In today’s class, we are going to tap into another factor: psychological factor.
We are going to present to you two opposite words: vulnerability and resilience. Some people have a higher vulnerability to depression than others. This is not their fault or due to personal weakness. People with high vulnerability have a higher risk of developing depression, especially when they experience stressful life events that can trigger depression such as, the end of a relationship, losing their job or losing a loved one (Go to Lesson 3.1 for environmental factors). On the opposite end of the spectrum some people have high resilience. Resilience is the term psychologists use for the ability to adapt to stressful life events and ‘bounce back’. Having higher resilience reduces the risk of depression and other mental health problems.
Our vulnerability/resilience to depression is linked to our genes, social support and environment but it is also linked to psychological factors: how we think and respond to stress. There are many psychological factors that affect resilience. In this lesson we will be looking at 4 factors from the smallest level, our individual thoughts, to more holistic factors such as self-esteem.
All of these factors are important because factors at the higher levels can affect factors at the lower levels and the other way around. We will also explain practical steps that you can take to help strengthen your psychological resilience.
Let’s start by looking at the smallest level we can: our individual thoughts. Can the thoughts we have make us more vulnerable or resilient to depression?
The short answer is yes. According to Cognitive Behavioural Therapy (CBT) principles what we think has a big influence on our emotions and our emotions effect how we behave. It’s not just the external events that happen to us that make us feel a certain way – it’s the thoughts we have about them.
David Burns (1981) developed a list of common “thinking errors” or “cognitive distortions” still widely used in CBT today. These thinking errors increase our vulnerability to mental health problems and negative emotion.
Any of these sounds familiar to you?
Mathew Whalley, 2008, www.psychologytools.com//unhelpful-thinking-styles.html
CBT is an evidence based treatment which helps to prevent unhelpful thinking through several techniques including straight talking- becoming aware of our own thinking errors and using sets of questions to see if they are really true or not. Using CBT techniques to combat thinking errors can help reduce symptoms of depression and build resilience.
If you are interested in learning more about thinking patterns and CBT try Moodgym, a free CBT skills development program produced by the National Institute for Mental Health Research (NIMHR) at the Australian National University. The program includes exercises and quizzes to identify your own thought patterns and is totally free. Just follow the link below and create an account.
Note this program is not designed to treat clinical levels of depression and should not be used as a replacement for seeking advice from a health professional.
Areas of Personal Vulnerability
Moodgym looks at areas of personal vulnerability that can feed into or result from our thought patterns. These areas are bigger than just our individual thoughts and tap into the needs and beliefs we have.
The need for approval
The need to be loved
The need to succeed
The need to be perfect
The sense of feeling deserving
The sense of being able to influence all things
The sense that happiness is contingent upon external things
People who score highly in these areas tend to be more vulnerable to depression. Some of the areas may seem surprising. For example, we all have a need to be loved- why should that make us more vulnerable to depression? It’s true we all need to be loved but if this need is very high it can make us more psychologically vulnerable because when others reject us or don’t show us love we think this means we are unlovable and are likely to have thinking errors such self-blame and personalization.
The need to succeed and the need to be perfect can both be seen as great things, especially here in China where the school system pushes students to aim for perfection all the time. Both of these needs can be positive but at very high levels they make us more vulnerable. When we have high levels of perfectionism we see anything that doesn’t meet our own high standards as a failure and often don’t see the positives we have achieved (filtering) and beat ourselves up or are self-critical when we don’t succeed or reach perfection.
You are highly encouraged to use Moodgym for self-awareness on areas of personal vulnerability. https://moodgym.anu.edu.au
Your thought patterns, and value sets directly affect your two important indicators for your psychological residences: self-esteem, and coping style.
So our thoughts can affect our emotions- and these feed into our needs, beliefs and goals. All of these influence and can be influenced by our self-esteem, which is how we view ourselves: positively and deserving of happiness or more negatively.
Many studies have linked low self-esteem to depression. Low self-esteem is a symptom of depression. When we are depressed we often feel inadequate and worthless. But much research also shows that low self-esteem is a risk factor for developing depression in the future. This is called the vulnerability model: low self-esteem reduces our resilience which makes stressors (difficult experiences) more likely to trigger depression.
Jessica Hunt, 2014, www.slideshare.net
So why is self-esteem so important for resilience against stressful life events? It has been suggested that people who feel better about themselves less likely to internalize stressful events and blame themselves or be overly self-critical. This might make them less likely to have “thinking errors” such as personalization and self-blame.
Luckily, low self-esteem is something we can all work on. One technique to try is this self-affirmation exercise. This exercise aims to help you focus on our positive attributes rather than the negative.
Make a list of at least five qualities or attributes you know you have and that you value.
Write a short paragraph about why the quality is important and how you tend to express it.
Also try noticing your negativity. Try to talk to yourself like you would someone you love. So when you notice a negative thought directed at yourself try to change it to something more positive that you would say to a friend.
So according to CBT our thoughts affect our emotions but and our emotions affect our behaviors which can reinforce our resilience or make us more vulnerable. For example: what do you do when you face a stressful event?
The answer depends on a lot of things including: the type of stressful event and the resources you have at hand. However, it also so depends on your personal ‘coping style’. That is the types of thoughts and behaviors you tend to use to help get you through difficult times and minimize stress. This could be anything from calling a friend to watching a happy film.
Some coping strategies make us feel better in the moment but are unhelpful in the long term. This is called negative coping. These coping methods can include actions such as, being aggressive to others, drugs, alcohol, excessive eating and self-harm or mental states such as, denial, withdrawal and blaming others. Relying on negative coping skills increases vulnerability to depression as they do not address the problem or how we think about it.
One of the best ways to change the coping techniques you use is to make a coping plan- a list of coping strategies. Here’s how:
What do I do now? Write down the coping strategies you use now when you are stressed or something bad happens. Are any negative (help at the time but not long term)? If so cross out the negative coping strategies. If you want you can put them in “try not to….” box.
What else could I try? If you want to try some new coping strategies write down some other positive coping strategies you could use.
Crisis Plan- sometimes our own coping skills aren’t enough so finish your coping plan with some outside sources who can help in a crisis such as family and friends, hotlines or emergency services.
Keep the list somewhere easy to get to when you need it.
It is important to write these things down before we feel overwhelmed or are faced with a crisis and can’t think clearly.
We wanted to finish this lesson with 2 straight forward steps you can do today to have a positive impact on your psychological resilience.
Try Moodgym: follow this link https://moodgym.anu.edu.au and sign up for a free CBT skills development program.
Make a coping plan: to help you use positive coping strategies next time your stressed.
This wraps up the whole lesson 3 on “Cause of Depression”. The reason we name is “causes” is because that’s what’s asked. However, there’s no direct causal relationship that can be simply explained. The “causes” are messy! What we do know is that, your genes matters, your environment matters, and your psychological factors matters. While we cannot change the genes (thus, do not blame yourself for everything), we can do something about our environment, and our psychological patterns. So stay hopeful, work on yourself.
Lesson 3.1 Causes of Depression- Neurology, Biology and Genes
Lesson 3.2 Causes of Depression- Environmental Factors (Part 2: Life Situations)
Lesson 3.3 Causes of Depression- Psychological factors