Being human means that we can experience serious bouts of depression, which can make life feel seriously out of balance. There is a sense that we have lost sight of our own vitality and purpose. Depression, however, does not mean that we are “sick,” as much as it means we may be coping with difficulties in such a way as to avoid feeling badly or dealing with problems. Often, in our attempt to not feel painful feelings, we avoid dealing with difficulties regarding our health, our relationships, our work, and our play. We avoid, withdraw, isolate, numb ourselves (through unhealthy behaviors), and paradoxically make ourselves feel worse.
Depression Inventory assessments are questionnaires designed to identify individuals who may be depressed. They also assist with defining the areas of life in which individuals may be practicing avoidance. Avoidance means that rather than mindfully paying moment-to-moment nonjudgmental attention while choosing our daily actions, we are living on autopilot. We are living our life in a rut because we believe it is easier than confronting situations. We are purposely choosing to avoid confronting and working with emotionally loaded problems whether they be related to health concerns, relationship problems, work problems, or social activities. Obviously, this withdrawal can lead to a very contracted experience of life.
It is a radical position to suggest that depression is not as much about biochemistry as it is about avoidance. The pharmaceutical industry’s argument has been that chemical imbalances cause depression, which then influences behavior. It is generally agreed that the mechanism by which anti-depressant medications work, if they do work, is unclear. The consideration I’m presenting is that when something is out of balance, and we avoid dealing with it, we become depressed. The biopsychosocial model of depression advances that depression is multi-determined based on our biology, our psychology and various other social factors. In other words, it is a complicated issue. The above question relating to whether it is our brain or our behavior that needs “fixing” is a chicken/egg conundrum; one position allows us to continue being avoidant and just take a pill to maybe feel better (albeit with some possible side-effects), while the latter requires acceptance and commitment to changing behaviors in order to start to feel better. Taking responsibility to change our behaviors and thoughts is the primary component in cognitive behavioral treatment, an early precursor to acceptance and mindfulness treatment, which has been shown to have positive effects on depression. Assuming responsibility also relates to the dignity of being human–our agency and self-awareness as aspects of decision-making and problem-solving.
The first thing we need to understand is that difficult or unpleasant internal experiences cannot be ignored. Instead, we need to learn how to accept and work with them. In order to do so we explore our history with an emphasis on patterns that can be seen as triggers to depressive reactions. Triggers are cues, prompts towards feeling depressed. There are three key triggers for most people: loss, traumatic stress, and health issues. Once we find the pattern, we begin to make some decisions.
Treatment for depression revolves around the following important considerations:
• Difficult or unpleasant internal experiences cannot be eliminated or controlled; we must learn how to accept and work with them.
• Mindfulness and acceptance strategies can help us step back from spontaneous emotions so as not to feel consumed by them.
• Acceptance of difficult emotions can allow a redirection of our energy into envisioning a reconnection with our lives.
• Reconnection with our personal values and personal vision supports personal dignity as we work through painful aspects of our lives.
The key to understanding here is that depression is often seen as biochemical and not necessarily as related to the constriction that becomes a choice associated with avoidance. We don’t choose to become depressed but we do choose to avoid things with which we don’t wish to deal. We are not choosing to be depressed but we are choosing avoidance as a coping mechanism.
In the follow-up to this article we will explore how to become more flexible by making healthier choices. We will begin by understanding the mind’s role in self-defeating and constricting behaviors.
 I recognize that I’ve taken a reductionistic position for argument’s sake. It should be noted that many individuals use both medication and psychotherapy as resources. It also should be noted that black and white (i.e., either/or) thinking is a key component to depressive reactions.
 Please consider participating in a group that uses these guidelines for treatment. If you cannot avail yourself of a group experience, please consult an excellent self-help workbook entitled, “The Mindfulness and Acceptance Workbook for Depression.” This is a 2008 publication by Kirk D. Strosahl, PH.D., and Patricia J.Robinson, PH.D.
© Copyright 2011 by Linda Jame, LCSW. All Rights Reserved. Permission to publish granted to GoodTherapy.org.
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