Depression is essentially a cycle of “experience” rather than part and parcel of “who we are”. When we are depressed, we can worry about things that haven’t happened yet. We may also worry about things that happened a long time ago but still bother us today. These emotions arise in the brain and if we are unable to resolve the worries before we sleep, the brain will attempt to “dream” them out so that our minds are clear for the next day.

We dream during a specific part of sleep called REM sleep. It’s been known for some time that depressed people dream more than those who are not depressed as they attempt to process the events from the day before. So the more we ruminate and worry, the more Rem-ing our brain has to do whilst we sleep. REM sleep is ideal for processing worries but too much time spent in REM is exhausting.

We also need to spend time in slow wave sleep which rejuvenates us, boosts our immune system and helps us to feel rested after we wake. Depressed people however, wake up exhausted from over-Reming. When we are tired, we are more emotional and more prone to the “black and white”, “all or nothing thinking” styles of depression. This leads to more worry, more introspective rumination and so the cycle starts again. I find that depression immediately seems more explicable and manageable to people when it is presented in this way

Relaxation
Relaxation to a depressed person is like water to a thirsty man. People with depression may appear to be functioning at a much slower level – their speech and movements may be slower and their facial expressions less. In fact the depressed brain is actually a stressed brain and relaxation helps the mind to unwind and let go of the worries and troubling thoughts.
Relaxation also helps the acquisition of new skills such as problem solving and new ways of thinking. The brain learns better when it is relaxed.

Techniques such as self-hypnosis is an incredibly effective way to help people to relax. Some people worry that they aren’t “hypnotisable” enough (whatever that means!) I find that people experiencing anxiety and depression usually go into hypnosis very quickly. Hypnosis requires the ability to imagine and people who have grown accustomed to overthinking and worrying a lot are usually excellent at using their imagination. In hypnosis, the imagination is gently but powerfully utilised to help the client create a compelling future free from their difficulty.

Problem solving
Chronic worrying that doesn’t lead anywhere is like an old broken record – it just goes round and round and round. We have already seen how unresolved, emotionally arousing thoughts can lead to over dreaming and emotional exhaustion. Effective problem solving is the next step on from worrying. This helps to close some of the “worry loops” that can play incessantly in the imagination. It helps us to feel more in control, and ultimately exercises the “problem solving muscle” improving our self confidence in the face of challenges. Of course, not all challenges are within our capacity to solve and here I am reminded of the words of the Serenity Prayer:

“God grant me the serenity to accept the things I cannot change,
The courage to change the things I can,
And the wisdom to know the difference”.

The skill is to know the difference, and with challenges that cannot be resolved, for whatever reason, there are techniques to help us to relax with this knowledge. One technique is to encourage the client to think about how they would need to feel differently about the issue in order to resolve the worries. For example, “I need to accept that (this particular thing) happened and that nothing I have done could have changed it.”

Getting our emotional needs met

Depression can cause people to negatively ruminate about what is lacking in their life. People experiencing depression may not know how to get their emotional needs met or may have tried before and failed. The experience of depression is like looking at the world through mud tinted spectacles and it can feel to the person as if their needs are not valid or worth seeking.

To be emotionally healthy, we need to:

• Feel safe and secure.
• Feel a sense of control over our life.
• Feel part of a wider community.
• Feel love, intimacy and friendship with people we care about.
• Feel a sense of status.
• Regularly give and received quality attention.
• Feel stretched but not (stressed) to avoid boredom and stagnation.

When I see patients and clients who have been diagnosed with depression, I help them move from negative rumination to solution focused thinking by asking specific questions such as:

* How would things have to be in your life for you to feel happier?
* What will you be doing day to day once this depression has lifted?
* What will people start to notice about you as you start to get better?

These kinds of positive visualisation questions help the brain to “unstick itself” from the negative cycle of depression to look towards a happier future.