Resultados obtenidos en los proyectos seleccionados

When psychologists explore depression they focus on two key areas. The first is how we give meaning to events and feelings. To one person, a divorce is a tragedy; to another, a relief. To one person, feeling angry is empowering; to another, it’s frightening. The second area is how we cope with life’s difficulties. Some people are able to break problems down into manageable tasks, seek out help from others and plan ways to overcome the difficulty, whereas others feel overwhelmed; they don’t share their problems, but hope they will just go away.

These two processes, how we give meaning to events and how we cope, are key to an approach to therapy called cognitive behavior therapy¹ or CBT for short. As we’ll see as we go on, learning compassionate thinking and behavior uses a lot of CBT ideas and ways of working and is key to helping us work with our depressions. Of course what is happening in your life is important to your feelings. If someone is threatening or assaulting you then you are likely to be experiencing the world in a certain way; our thoughts, feelings and mood states are linked to the contexts of our lives. It is not that our thoughts ‘cause’ depression, but rather that they contribute to depression.

Giving meaning

There are many ways we give meaning to feelings and events, and some meanings are more likely to increase depression than others. The cognitive approach suggests that particular kinds of thinking go with particular kinds of problems (see Table 5.1)

TABLE 5.1 THOUGHTS ASSOCIATED WITH PROBLEMS Problem Thoughts

Panic I am going to die from these symptoms of anxiety.

Social anxiety I will do something that will make me look foolish/stupid and I’ll be rejected or shamed.

Depression I am a bad/weak/inadequate person and the future is hopeless.

Paranoia People are out to get me.

Anger Other people are bad/unkind, are treating me unfairly, or taking advantage, and deserve to be punished.

By focusing on the thoughts that are associated with certain types of problem, we can learn to see how much our depressed moods push and pull us to see things as major threats, stimulating the threat self-protection system. CBT then helps us to test the evidence and usefulness for our thoughts and learn to generate alternatives – to balance our thinking. Being depressed often goes with feeling and thinking in certain ways (e.g., feeling defeated, subordinate, inferior). However, this suggests another

question. How did we get into thinking negatively in the first place?

Early life and core feelings and beliefs

There is now a lot of evidence that early life experiences can biologically sensitize people to certain forms of stress and overstimulate their threat-protection systems.² We know that the types of love and affection children receive have an impact on their brains and how those brains grow and mature.³ We also now know that children with different genetic profiles can be more vulnerable and at risk of mental health problems in the context of difficult early life experiences.⁴ According to CBT, when we are young – and throughout our lives too – a variety of influences (including genetic) and events

create within us emotional dispositions and basic or core beliefs about ourselves, others and the world. Let’s look at how these are formed.

Core beliefs about oneself are fused with emotions

We all have core beliefs about the world – that the Earth goes around the Sun, or the Earth is round and not flat. These are linked to our fundamental ideas and knowledge about how the world is.

We also have another set of core beliefs based on our sense of self and other people. These core beliefs are very different from simple knowledge-based ones because they are fused with emotion. A self-focused core belief is something that you feel is basic to you. You might say, for example, ‘When all is said and done I feel this about me,’ or ‘At heart I feel . . .’, or ‘Right in the centre of me I feel . . .’. Suppose a parent is angry with a child and calls her stupid. The child not only hears this label being used to describe her, but also has a fear. She feels stupid and has a sense of shame. The feeling of fear, shame and the label of ‘stupid’, are fused together in that moment. You can imagine what feelings might come back to her if she makes another mistake. Over time these feelings about herself may become part of her ‘felt sense of self’, the kind of person she feels herself to be.

When something unpleasant happens it is usually the emotions and feelings that strike us first; only later do we recognize that these feelings are associated with core beliefs, memories and ideas about ourselves. Let’s work through an example to explore this. Sally had a fairly neglectful upbringing.

When she was still relatively young, her mother told her that she had got married when she became pregnant with Sally. Unfortunately, the marriage was unhappy and her mother would ponder on how things might have been different for her had she not got pregnant. She would often say, ‘If it hadn’t been for you, I would have done such and such.’ Sally felt that her mother saw her as the reason she had not done more with her life. Generally, these comments were not said in anger but with regret and sadness. At times, Sally’s mother had strongly hinted that she felt like leaving home. Sally had taken these ‘hints’ as serious threats of abandonment, and gradually developed certain beliefs and ideas: ‘I am a nuisance to others. I stop people doing what they want to do. People don’t really want me

around. I must not do anything that might push them away. Others might leave me at any moment.’

Remember, these beliefs will be glued in place with emotion.

Sally carried these basic beliefs inside her throughout her life. Whenever there were conflicts, she would feel anxious and think/feel, ‘Maybe I’m being a nuisance’ or ‘I must let others do what they want to do.’ If she ever felt that she was putting others out, or letting them down, she would feel very guilty. A major unintended consequence of this way of being was that in trying to protect herself from others not wanting her around, she found it difficult to assert herself. She was constantly on the

look-out for clues that she was being a burden to others. When an important long-term relationship with a boyfriend broke up, her automatic thoughts were: ‘Well, I guess nobody really wants me. I am just a nuisance. I will never be loved for myself.’ So her self-protection system quite understandably made her rather submissive, but the safety strategy had unwanted consequences.

As you might guess, underneath Sally’s surface set of beliefs was another set. Here there was a high degree of anger. Having to give in to others all the time (in effect, subordinating herself to the needs of others) had led to feelings that this was unfair. After all, Sally hadn’t asked to be born. Why should she have to keep doing what others wanted? Why was she so unlovable? But, of course, she thought that if she asserted herself, this would expose her to threats of abandonment and feeling a nuisance. If anyone made her very angry these inner rage feelings would be very frightening to her, because then she would feel others really wouldn’t like her. These feelings had to be ‘repressed’ and avoided. She also felt, since her mother had done her best for her, that she had no right to be angry with her mother. Even thinking about her anger towards her mother for her threats of abandonment made Sally feel bad, like a traitor, and more stressed.

As you can see, and we will go over this many times, our thoughts are complex and can take us on a downward spiral into depression: as we become stressed and depressed, we have more negative thoughts; emotions of shame or fear of abandonment come back, we become more depressed with more negative thoughts and feelings.

Here is an overview of Sally’s beliefs and feelings and how they affected her:

EARLY CHILDHOOD EXPERIENCES

Mother said that had it not been for me she would have done more with her life.

Worried that mother might leave one day.

BASIC BELIEFS FUSED WITH EMOTIONS

I am a nuisance to others.

I stop people doing what they want to do.

People don’t really want me around.

I must not do anything that could push them away.

I must be to others what they want me to be.

Expressing anger and/or asserting my needs could lead to rejection.

I am a bad/ungrateful person if I express my dissatisfactions.

BASIC SOCIAL BEHAVIORS AND SAFETY STRATEGIES

I am not assertive.

I avoid conflicts.

I don’t initiate things I want to do.

DEPRESSION-TRIGGERING EVENT

Break-up of a relationship; loss of a valued person who blamed me for being rather boring.

TYPICAL THOUGHTS

I am a nuisance to others.

It would be better if I weren’t here.

Relationships are too difficult.

I can’t bear to be alone.

SYMPTOMS

Poor sleep and exhaustion.

Constant thinking about loss and self-blame.

Feelings of worthlessness.

Loss of pleasure and capacity to enjoy things.

Feeling that the future seems hopeless.

Weight loss.

Inner feelings of emptiness.

Increased fear and general feelings of disorientation.

You may have noticed two things about Sally. First she was very anxious about forming close relationships, and felt vulnerable to being left and abandoned. That anxiety and fear fuelled the underlying stress. Second, the way she behaved and coped with this – her self-protection strategy – was to act like a subordinate or even a servant. Her relationships did not boost her self-esteem very much. Indeed, apart from making herself ‘fit in with others’, she felt that she had no power to hold on to good relationships. When it came to asserting her own needs and opinions, she felt that she had neither the right to do so, nor any justification for doing so. Without a lot of reassurance, she felt empty and vulnerable, and often felt inferior and subordinate to others.

Sally’s threat self-protection strategy was designed to help and protect her as best it could when she was a child. Being subordinate and trying to make Mum love and want her was very sensible for a vulnerable child, but through no fault of her own this strategy got her into serious problems later in life and stunted her growth. This is one example where we can see that depression is not our fault and neither is it the fault of the threat-protection strategies – it is an unintended effect of early efforts to get safe. The same is true for children who learn to be aggressive to defend themselves; this attitude may well get them into serious trouble later in life. These early self-protection strategies can be tricky to spot and to change. That is why training our minds becomes so important to understand.

Try this: Sit quietly for a moment and then focus on as much kindness as you can within you and reflect if there is anything about Sally’s story that resonates for you. If there is, be gentle and kind about that. If you feel upset, go back to focusing on your inner kindness. If that is difficult – notice this and return to reading.

The role of early traumas

One powerful way in which some individuals learn how to judge and rate themselves is through having very painful experiences in childhood. For example, if they have been sexually abused, they might come to feel that sex is bad, disgusting, dirty or dangerous, and that they themselves are in some way bad or dirty and their sexual feelings are dangerous. In effect, the trauma robs them of their

sexual lives and feelings of goodness.⁵

Sometimes parents are unable to cope, and when things get tense, they lash out at their children or

call them names. This is intensely painful for the children, who find it difficult to recognize that their parents have a low tolerance for frustration. The children on the receiving end of this rage may blame themselves and think that they really are very bad. Sometimes parents are unable to give their children physical affection, perhaps because they don’t know how or because they feel very awkward about it.

One of the saddest things is that some parents still think that being physically affectionate towards their children, especially their sons, will turn the boys into sissies. As we have seen, affection is in fact very good for our brains (see pages 23–26).

AFFECTIONLESS CONTROL

Research has suggested that many depressed people can look back and see that their early life was often rather barren of affection, and sometimes even very harsh. Parents may have demanded high standards or have been very controlling. This is called affectionless-control parenting. Because most of us, as children, are unable to see our parents as flawed individuals with problems of their own, we tend to think that the way they treated us was our own fault; there was something about us that made them behave in the way they did. If they were very critical of us, we tend to carry on the tradition and be critical of ourselves. However, with understanding, insight and hard work, we can change these habits and learn to be compassionate towards ourselves.

UNPREDICTABILITY

Another very common pattern we see in the lives of depressed people is that their parents were

unpredictable. These are parents who can be very loving and kind, but then are not available, leaving the child with yearning; or they can become aggressive, say hurtful things and even be physically abusive. It is very difficult for the child’s threat self-protection systems to sort out what is safe and what is not. A parent can be seen as a source of comfort, but also a great threat. This kind of conflict is known to cause difficulties in how our brains deal with relationships. Sometimes people find it very difficult to sort out the feelings of both love and also fear, at times even hatred, of the parent.

Moreover, because the child (and later the adult) wants to be loving, they can have a negative view of their own anger towards the parents, or even be in denial about that.

UNRELIABILITY

Unreliable parents can also be problematic for our emotional development. These are parents who talk a lot about love and being in a loving family but don’t always behave like that. For example, Kay’s mother was so preoccupied with her career and marital problems that she did not really attend to her daughter’s mood changes just before adolescence. Kay was being bullied at school and abused by the next-door neighbour, but felt unable to tell her mother. She found her mother was never really there to get close to, although she was constantly saying ‘what a loving family we are’. Children who experience their parents as unavailable for protection or support, or for forming a bond with them, can be left with ongoing desires and searching for closeness. They often anticipate that people will be superficially nice but with no real depth to their affections.

RESCUER CHILDREN

Some children grow up in circumstances – maybe with both parents working or in single-parent

homes – where they have to take on responsibilities (e.g., looking after siblings). Gradually they see themselves as needing to achieve things, to help or rescue the family. Their expectations of

themselves and the demands they put on themselves get out of proportion and they end up feeling overwhelmed and fearful of failure and being unable to live up to the expectations they have set themselves – becoming very perfectionistic (see Chapter 21). They can have dark feelings of defeat and inner collapse.

These are some of the relational backgrounds that a depressed person may experience early in life.

There are many others. The key thing is the way in which people experience a sense of connectedness and safeness in the world because they know they can turn to and rely on others.⁶ Our early

relationships help us to experience the world as safe or dangerous, and this influences the balance of the threat and positive emotions systems we saw in Chapter 2.

Relationships and social needs

A lack of positive experiences (e.g., love, affection, support and care) in human relationships can be depressing. One reason for this is that the brain needs certain levels of positive inputs to maintain reasonable levels of mood chemicals and low levels of stress. On the whole, human beings

throughout the world tend to be happier in some situations and unhappy in others (see Table 5.2).

TABLE 5.2 HAPPY AND UNHAPPY SITUATIONS Happy situations Unhappy situations Loved and wanted Unloved and unwanted

Close to others Abandoned

Accepted and belonging Not accepted/rejected

Have friends Do not have friends

Accepted member of a group An outsider or ostracized Have value to others Have little value for others

Appreciated Taken for granted

Attractive to self and others Unattractive to self and others

Have status and respect Losing status or forced into low status

The situations in the left-hand column are associated with low levels of stress hormone and tend to boost our mood chemicals. They are ‘feel-good’ things. Those on the right-hand side are associated with increased stress and dips in our mood chemicals. The reason for this is that the brain is wired up to want the ‘feel-good’ things. Individuals who were able to have these needs met, who were

‘socially successful’, did better in evolutionary terms than those who did not – they survived better and left more offspring. We are biologically inclined to try to achieve the things in the left-hand column and avoid the things in the right-hand column. Desires for social success are wired into our emotions. The more our beliefs begin to shift towards the things in the right-hand column, the more threatened and unhappy we are likely to become.

Core beliefs, caring and relating

As described above, we can develop core beliefs about ourselves that ‘at my core I am this or that’.

Given how important relationships are to our feelings and moods, our feelings and beliefs about relationship can be important to how we create them, maintain them and cope with ending them.

Depressed people can have very negative ideas about their ability to gain support, help, affection and

Depressed people can have very negative ideas about their ability to gain support, help, affection and