
{"id":33946,"date":"2017-02-07T08:00:48","date_gmt":"2017-02-07T16:00:48","guid":{"rendered":"http:\/\/www.goodtherapy.org\/blog\/?p=33946"},"modified":"2017-02-01T15:37:39","modified_gmt":"2017-02-01T23:37:39","slug":"is-your-depression-an-external-or-internal-job","status":"publish","type":"post","link":"https:\/\/www.goodtherapy.org\/blog\/is-your-depression-external-or-internal-job-0207175","title":{"rendered":"Is Your Depression an External or Internal Job?"},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-medium wp-image-33967\" src=\"https:\/\/www.goodtherapy.org\/blog\/blog\/wp-content\/uploads\/2017\/02\/rear-view-walking-in-rain-e1485992184778-300x200.jpg\" alt=\"Rear view of person in black and red hooded sweatshirt walking alone down the middle of a road on a misty day\" width=\"300\" height=\"200\" data-id=\"33967\" title=\"\" srcset=\"https:\/\/www.goodtherapy.org\/blog\/blog\/wp-content\/uploads\/2017\/02\/rear-view-walking-in-rain-e1485992184778-300x200.jpg 300w, https:\/\/www.goodtherapy.org\/blog\/blog\/wp-content\/uploads\/2017\/02\/rear-view-walking-in-rain-e1485992184778.jpg 724w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/>You may know how common <a href=\"https:\/\/www.goodtherapy.org\/learn-about-therapy\/issues\/depression\">depression<\/a> is\u20146.7% of all Americans age 18 or older experience at least one major depressive episode each year, according to statistics compiled by the National Institute of Mental Health. It might even be expected in certain contexts, such as the loss of a job or a loved one. Other times, it creeps in mysteriously. As a therapist, I see many people who struggled for a long time before they finally sought help.<\/p>\n<p>One of the first things I do when meeting for the first time with a person experiencing depression is try to figure out if their blues are an internal or external job. This can take a little time to unravel, as there are many layers that can lead to someone feeling depressed. It\u2019s important when treating depression to try to change what we can control and learn coping skills that can help us with\u00a0the rest.<\/p>\n<p>So how do you know if your depression is a product of\u00a0your environment\u2014family, friends, job, housing or financial situation\u2014or if it instead stems from unproductive or self-defeating thoughts, <a href=\"https:\/\/www.goodtherapy.org\/learn-about-therapy\/issues\/self-esteem\">self-esteem<\/a> or self-control issues, or possible biological reasons that may warrant a medical assessment?<\/p>\n<div class=\"content-fatwidget align-right\">\n\t<h2><a href=\"https:\/\/www.goodtherapy.org\/find-therapist.html\" target=\"_blank\">Find a Therapist for Depression<\/a><\/h2>\n\t<form action=\"https:\/\/www.goodtherapy.org\/search-redirect.html\" method=\"get\">\n\n\t\t\t\t<input required name=\"search[zipcode]\" placeholder=\"Enter ZIP or City\" class=\"inline-input\" type=\"text\" \/>\n\n\n\t\t\t<input type=\"submit\" name=\"TOS agreement\" value=\" \" class=\"inline-btn\" title=\"Search\" \/>\n\t\t\t<input type=\"hidden\" name=\"search[concern_treated]\" value=\"27\" \/>\n\t\t<a href=\"https:\/\/www.goodtherapy.org\/advanced-search.html\" title=\"Advanced Search\">Advanced Search<\/a>\n\t<\/form>\n<\/div>\n<h2>When It\u2019s an External Job<\/h2>\n<p>Perhaps this winter has been a difficult time in your life. The holidays are past, the weather is cold, and the days are short. The nation is apprehensive and divided about a new presidential term. Maybe you are <a href=\"https:\/\/www.goodtherapy.org\/learn-about-therapy\/issues\/worry\">worried<\/a> about tax season, waiting anxiously on news from college applications, or feeling bad after excess food or drink at the end of the year.<\/p>\n<p>Many people seek therapy after enduring a difficult situation. They have been caring for a sick family member, are going through a <a href=\"https:\/\/www.goodtherapy.org\/learn-about-therapy\/issues\/breakup\">breakup<\/a>, or have failed a class for the second time in a row. They need help for a depression which is mostly a result of a life situation that has happened to them. They feel like a weight has been put on them and can identify what it is.<\/p>\n<p>Right now, many people are feeling the weight of conflict on a global scale. Some are worried about climate change, health care, humanitarian crises, or unemployment. \u201cState of the world\u201d depression, as I call it, is a common woe in 2017.<\/p>\n<p>These cases call for action:<\/p>\n<ul>\n<li>Tools (to date again, for example, or to reconcile with a partner or roommate)<\/li>\n<li>Skills (to interview for a different job or take better care of themselves)<\/li>\n<li>Ideas (for how to ease overwhelm around finals at the end of a semester)<\/li>\n<li>Information (how to sleep better, study better, or manage time more efficiently)<\/li>\n<\/ul>\n<p>Taking action on external depression is an important step toward feeling better and more empowered. Fortunately, <a href=\"https:\/\/www.goodtherapy.org\/find-therapist.html\">therapy can help<\/a>\u2014especially <a href=\"https:\/\/www.goodtherapy.org\/learn-about-therapy\/types\/solution-focused-therapy\">solution-focused therapy<\/a>, which is practical and tool-oriented.<\/p>\n<h2>When It\u2019s an Internal Job<\/h2>\n<p>Have you had a time in your life when you just couldn\u2019t seem to get enough sleep? When the things you always looked forward to didn\u2019t interest you or when you had trouble feeling much of anything at all? People with these depression symptoms might say their lives are \u201cbetter than most\u201d and may feel <a href=\"https:\/\/www.goodtherapy.org\/learn-about-therapy\/issues\/guilt\">guilty<\/a> for feeling down. They may struggle with feeling ungrateful because, at the same time, they feel like something is \u201cmissing.\u201d Life may feel like an endless treadmill of nice-but-nothing-great.<\/p>\n<p><span class=\"popout-quote-left\" style=\"font-weight: bold; width: 30%; float: left;\">The No. 1 indicator to me of an internally driven depression is when people can\u2019t tell me anything they\u2019re excited about in their future.<\/span><\/p>\n<p>The No. 1 indicator to me of an internally driven depression is when people can\u2019t tell me anything they\u2019re excited about in their future. When we lose the ability to look forward to the things that historically keep us satisfied, we\u2019re in trouble. People with internally driven depression may have grown used to being on the sidelines, watching the energy of the world bustle around them. They may find it tiring to make decisions or to engage.<\/p>\n<p>These cases call for structured treatment:<\/p>\n<ul>\n<li>Evaluation (by a medical doctor to determine there\u2019s no medical cause, such as anemia, thyroid problems, or other issues that may cause fatigue or apathy)<\/li>\n<li><a href=\"https:\/\/www.goodtherapy.org\/learn-about-therapy\/types\/cognitive-behavioral-therapy\">Cognitive therapy<\/a> (thought charts and other structured homework done daily to encourage the person to engage less with their \u201csideline\u201d-causing thoughts)<\/li>\n<li>A \u201cgood habits\u201d checklist (making sure they are getting enough sleep, sunshine, healthy diet, exercise, contact with others, etc.\u2014all the recommended depression treatments to give themselves the best chance of feeling better)<\/li>\n<li>Journal therapy (structured 5-minute writing sessions that allow a solution-focused therapist to look at the person\u2019s thoughts)<\/li>\n<\/ul>\n<p>Some things are out of my scope of practice (medical evaluations, for example), but since symptoms of depression overlap with some treatable <a href=\"https:\/\/www.goodtherapy.org\/learn-about-therapy\/issues\/health-illness-medical-issues\">medical conditions<\/a>, if there is no identifiable external cause it\u2019s always a good idea to see a doctor, too. Recently someone I work with in therapy felt too tired to socialize or exercise, which was creating problems at work as well as causing him to spiral personally. When he learned he was anemic and started following his doctor\u2019s medical recommendations, his fatigue went away, which started positive momentum toward participating in his usual, satisfying life.<\/p>\n<p>People with internally or externally driven depression can usually expect their symptoms to improve if they use structured, research-based treatment methods such as cognitive therapy. Depression tends to call for a lifestyle tune-up\u2014and you don\u2019t have to go it alone.<\/p>\n<p><strong>Reference:<\/strong><\/p>\n<p>National Institute of Mental Health. (n.d.). Major Depression Among Adults. Retrieved from https:\/\/www.nimh.nih.gov\/health\/statistics\/prevalence\/major-depression-among-adults.shtml<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Depending on whether depression is externally (think death in the family) or internally influenced (think low self-esteem), methods for addressing it may vary.<\/p>\n","protected":false},"author":2445,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_crdt_document":"","_uf_show_specific_survey":0,"_uf_disable_surveys":false,"footnotes":""},"categories":[542],"tags":[31,161,25],"class_list":["post-33946","post","type-post","status-publish","format-standard","hentry","category-featured-articles","tag-psychotherapy-practice","tag-depression","tag-psychotherapy-issues"],"_links":{"self":[{"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/posts\/33946","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/users\/2445"}],"replies":[{"embeddable":true,"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/comments?post=33946"}],"version-history":[{"count":0,"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/posts\/33946\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/media?parent=33946"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/categories?post=33946"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.goodtherapy.org\/blog\/wp-json\/wp\/v2\/tags?post=33946"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}