Unhelpful thinking styles

The information here is consolidated from half a dozen documents from various sources that I have found over the years as I’ve learned about depression and how to battle it.

People experiencing depression or anxiety (or both) often have automatic ways of thinking which can exacerbate the emotional state. Because these thinking styles are automatic they can be difficult to change, but simply identifying when they occur is a good step on the road to changing our default thinking mode.

All or nothing thinking

Viewing things in absolute, black-or-white terms, without recognising any middle ground.

  • success or failure
  • perfect or worthless
  • either I do it right or not at all

Blaming

Focusing on who is to blame for a problem rather than what can be done to solve it.

Mental filter

This is a sort of tunnel vision in which you focus on only one part of a situation and ignore the rest. Usually it involves focusing on only the negatives and ignoring the positives.

Jumping to conclusions

It would be nice to think that whenever you have a hunch about something is is correct, but the reality is that often we are wrong in our hunches. If we rely on this type of thinking it can lead to problems. There are two key types of jumping to conclusions:

  • Mind reading: Imagining you know what others are thinking, feeling or intending to do. This is a very common way of thinking.
  • Fortune telling: Predicting the future. Making negative predictions about how something will turn out.

Emotional reasoning

Assuming that because you feel a certain way then what you think must be true. Have you ever felt anxious about something and thought to yourself, “I know this isn’t going to work out well” yet everything turned out just fine? This is emotional reasoning. “I feel, therefore it is” is not valid logic.

  • I feel embarrassed so I must be an idiot.
  • I feel anxious, something bad is going to happen.

Labelling

Assigning global, negative labels to yourself or other people. By defining yourself or other people by one specific behaviour, usually one you consider negative, you are ignoring all the other positive aspects of yourself or others.

  • I’m such an idiot.
  • I’m completely useless.
  • They’re so inconsiderate.

Over-generalising

Drawing sweeping conclusions based on a single incident. Seeing a pattern based upon a single event, or being overly broad in the conclusions you draw.

  • Everything is always rubbish.
  • Nothing good ever happens.
  • Things never turn out well for me.

Catastrophising

Blowing things out of proportion. Viewing a situation as terrible, awful, horrible. Taking what might be a slight problem and viewing the most extreme negative version of it.

  • What if… !!!
  • Oh no …

Downplaying positives

Minimising or dismissing your positive qualities, achievements or behaviours by telling yourself they are unimportant or do not count. This may include exaggerating the positive qualities of other people while downplaying your own attributes.

  • That doesn’t count, I was just lucky.
  • They didn’t really mean it, they were just being polite.

Shoulds and musts

Focusing on how things or people ‘should or ‘must’ be. Treating your own standards or preferences as rules that everyone must live by. It is not always unhelpful to think, “I should get my work done on time”, but if the ‘shoulds’ or ‘musts’ become unreasonably demanding it leads to guilt and disappointment.

Personalisation

Blaming yourself or taking responsibility for something that wasn’t completely your fault. Telling yourself that events relate to you when they may not.

  • This is my fault.

Intolerance of uncertainty

Struggling to accept things being uncertain or unknown.

  • What if something bad happens?

Serotonin and Depression

This post is an attempt at summarising and explaining a paper called 5-HT and depression: is the glass half full? Authored by Trevor Sharp and Philip J. Cowen which was published in Current Opinion in Pharmacology, 2011 volume 11 pages 45–51.

The theory that abnormally low levels of the neurotransmitter serotonin (also called 5-hydroxytryptamine, 5-HT) can cause depression is now 50 years old.

The theory arose when it was noticed that depressed patients had low serotonin levels in cerebrospinal fluid, and also that the first effective antidepressant drugs had the effect of increasing the amount of serotonin in the gap between neurons (the synaptic cleft). Since then the old tricyclic antidepressants have been replaced with medications that more accurately target serotonin, the ‘selective serotonin re-uptake inhibitors’ (SSRIs) which have fewer adverse effects and tend to be more effective at relieving depression symptoms.

Despite the progress since 1967, up to half of the patients prescribed antidepressants do not get enough relief from their symptoms, and pharmacologists still don’t clearly understand how changes in serotonin translate to altered mood.

That 5-HT (serotonin) is associated with mood and depression has been shown by pharmacological studies and also positron emission tomography (PET) studies looking at the distribution of 5-HT receptors in the brains of depressed patients. Other studies have shown that artificially restricting dietary intake of the amino L-tryptophan can cause a return of depression symptoms in patients with a history of depression. This is significant because L-tryptophan is the precursor (chemical building block) of 5-HT. Similar L-tryptophan depletion in people who have a high family incidence of depression but themselves have not had depression caused a less severe lowering of mood.

Genetic components

Depression does run in families, with a moderate to high heritability (heritability is a measure of how likely a trait is inherited, low means less likely and high indicates it is more likely to be inherited in a population).

One particular gene, slc6a4, which codes for the 5-HT transporter protein, has been well studied. Levels of the 5-HT transporter can vary by up to sevenfold within the general population. Individuals with low levels of this 5-HT transporter have increased risk of depression when associated with stressful life events. The region of this gene where it is regulated (i.e., ‘the volume control’) is rich in methylation sites which can result in semi-permanent changes to gene expression as a result of environmental influences (such as a stressed or depressed mother during pregnancy, stressful events, childhood trauma).

Neuronal Repair

Current thinking is that increased synaptic 5-HT activates a downstream gene programme that leads to enhanced neuronal plasticity which has failed because of the adverse effects of stress and other environmental and genetic factors.

In effect, some sort of stress derails the ongoing repair and maintenance of brain ‘circuitry’ which can be overcome by bumping up serotonin levels in neurons.

This idea of serotonin enabling improved neuronal plasticity in depressed patients dovetails nicely with ideas of how psychological treatments (such as counselling, CBT, DBT) function to help treat depression. Psychotherapists help a patient to reframe situations and learn more positive ways to view situations. With increased serotonin levels enabling neural repair and realignment of neural pathways, learning is facilitated and so the therapy and drug treatment work together.

serotonin effects

I don’t want to know the future

The notebook I’m currently using for writing has some notes in the back of it written in mid-2008 when I was trying to find a way forward from being in a state of burnout. Looking back on the almost ten years since then I’ve come a long way, yet am now glad I could not see much of the path ahead at the time.

In June 2008 I applied for a job as a technical writer for a software company but was unsure if I would get the job so tried to plan how to cope with the next six months in the job I already had. As it turned out I did get the new job, which was a real blessing and gave a reprieve from the stress I had previously been carrying. What I didn’t see but is now obvious to me reading what I wrote back then, is the warning signs of depression.

The change in work enabled me to recover somewhat but two years later the black dog returned and this time there was no denying it. At least his forced me to seek help, beginning a long journey of trying to find a medication combination that worked for me. By this time I’d moved on to what in many ways was a dream job for me, but it came with the downside of a 24/7 roster. In time the shift work messed with my body clock enough to make the next cycle of depression much worse than any before, necessitating a week’s stay in a psychiatric hospital. Recovery that time was long and painful, at least a year before I could consider myself ‘normal’ and not a joyful normal at that.

This is why I’m glad I could not see the future for me in 2008. If I could have seen what was ahead I probably would have given up or run away and hidden from the world. But if I had known what was to come, could I have taken steps to avoid it?

On this I’m not sure. Certainly I’ve learned signs to watch for  so now seek help sooner than I did in the past. I also know some of the circumstances and situations that can precipitate depression so take steps to avoid or reduce the effects of those situations. However, life always carries a certain amount of stress and my depression has a definite cyclic pattern so I doubt that I could have completely avoided it.

The approach I now take is to have fences to keep the black dog out, a stick handy to push if back if it gets too close, and I try to live as fully as I can when it is not around. Yet I still hear it barking in the distance.

Practical Biblical Advice for Despair

Elijah is one of the outstanding characters of the Old Testament. His epic contest with the false prophets of Baal on Mt Carmel is the high point of his career (see 1 Kings chapter 18). But Jezebel cuts short any celebration of victory, threatening Elijah with death when she catches him. So he runs for his life. I can understand that, I’d skip the country too.

He also becomes quite bummed out by the whole situation, seeing no hope for himself or the nation.

There is plenty of speculation that Elijah was depressed at this time. I’m wary of projecting 21st century psychological ideas onto a person who lived 2,800 years ago. We only have an outline of the highlights of Elijah’s life and that’s not enough information to base a diagnosis on.

Elijah goes from outstanding courage in chapter 18 to despair in chapter 19. Despair is a bad headspace to be in and one current tool used in combating it is summed up with the acronym HALT. This stands for:

  • Hungry
  • Angry (or afraid)
  • Lonely
  • Tired

I can see all of these in Elijah.

He was hungry, so an angel provided food for him. He was afraid to he ran 200km (120 miles) to get away from Jezebel (he was probably also angry at her). He was lonely, telling God he was the only prophet left. And he was tired, sleeping under a broom tree in the desert. He was so fed up that he asked God to take his life.

The idea behind this acronym is that when we are hungry, angry, lonely, tired or any combination of the four, our actions, reactions, and choices can be coloured by how we are feeling. If I am feeling tired, angry or hungry, I am more likely to over react to irritations and inconveniences. By being aware of this I can try to address these things, making it easier to constructively cope with things I don’t have control over.

It seems that God did this for Elijah – he slept, then an angel woke him to eat some food, let him sleep some more and provided more food (1 Kings 19:5–7). Then Elijah took a long walk and was reassured that he was safe and would be given someone to take over the burden of being a prophet from him (1 Kings 19:15–17). God showed him that spectacular signs were not what he needed (1 Kings 19:12). The outworking of seemingly ordinary events under God’s control would fulfill God’s plans.

This is a good reminder to me when I am feeling down and just want a way out. The way out of my current situation is by living through it and God will answer my prayers within the bounds of the ‘ordinary’.

Sometimes when life sucks I just need to have some dinner and get an early night. Once I am fed, rested, and have connected with those I love, I’m better able to seek God.


Elijah-Daniele_da_Volterra
Related posts:

Image: The Prophet Elijah by Daniele da Volterra, courtesy of Wikimedia Commons

Scripture references:
Ref 1 Kings 19:1-14 Ahab told Jezebel all that Elijah had done, and how qhe had killed all the prophets with the sword. Then Jezebel sent a messenger to Elijah, saying, “So may the gods do to me and more also, if I do not make your life as the life of one of them by this time tomorrow.” Then he was afraid, and he arose and ran for his life and came to sBeersheba, which belongs to Judah, and left his servant there. But he himself went a day’s journey into the wilderness and came and sat down under a broom tree. tAnd he asked that he might die, saying, “It is enough; now, O Lord, take away my life, for I am no better than my fathers.” And he lay down and slept under a broom tree. And behold, an angel touched him and said to him, “Arise and eat.” And he looked, and behold, there was at his head a cake baked on hot stones and a jar of water. And he ate and drank and lay down again. And the angel of the Lord came again a second time and touched him and said, “Arise and eat, for the journey is too great for you.” And he arose and ate and drank, and went in the strength of that food uforty days and forty nights to vHoreb, the mount of God. The Lord Speaks to Elijah There he came to a cave and lodged in it. And behold, wthe word of the Lord came to him, and he said to him, “What are you doing here, Elijah?” He said, “I have been very xjealous for the Lord, the God of hosts. For the people of Israel have forsaken your covenant, ythrown down your altars, and killed your prophets with the sword, aand I, even I only, am left, and they seek my life, to take it away.” And he said, “Go out and stand on the mount before the Lord.” And behold, the Lord passed by, and ca great and strong wind tore the mountains and broke in pieces the rocks before the Lord, but the Lord was not in the wind. And after the wind dan earthquake, but the Lord was not in the earthquake. And after the earthquake a fire, but the Lord was not in the fire. And after the fire the sound of a low whisper. And when Elijah heard it, ehe wrapped his face in his cloak and went out and stood at the entrance of the cave. And behold, fthere came a voice to him and said, “What are you doing here, Elijah?” He said, “I have been very jealous for the Lord, the God of hosts. For the people of Israel have forsaken your covenant, thrown down your altars, and killed your prophets with the sword, and I, even I only, am left, and they seek my life, to take it away.” (ESV)

Rock bottom

The inside of an old industrial chimney shaft photographed from the bottom - circular stone wall with tree growing from it and blue sky with white clouds in the opening in the centre, vertical

In 2014 I hit rock bottom.

In just one year I dug myself into a huge credit card debt, gained 10 Kg of excess weight, was admitted to a psychiatric hospital in a suicidal state, and almost ruined my marriage. Not my best effort.

Fortunately my depression has improved and my wife is graciously giving me a chance to make things better. I urgently need to change how I “do life”. This year my blog will trace my journey to ‘a better me’.

This is not about ‘radical’ or extreme changes, there is no room for such things when I am in debt, have health problems and have to work full time to support my family. It is also not a quest for perfection, all of us let ourselves and others down every day. What I am aiming for is to be a better person. Not perfect, not even ‘the best’, just better than I am now.

Because I have made such a mess of things and failed in a multitude of ways, this self-improvement project will range over many areas. Of particular interest to me is how to make changes stick and finding what will have the biggest payoff for even small improvements.

Do not be afraid

Be strong and courageous. Do not fear or be in dread of them, for it is the LORD your God who goes with you. He will not leave you or forsake you. (Deuteronomy 31:6 ESV)

Do not fear or be in dread, the Lord your God goes with you. He will not leave or forsake you. For those of us who live in the ambiguity of faith and depression these are astonishing words.

An impossible command

Firstly, to be depressed and told not to fear or dread is an impossible thing. Fear, dread, anxiety are hallmark traits of this mental illness and those who are unwell cannot prevent these emotions and associated thoughts from occurring. Yet the Bible consistently commands us to do the impossible, for example:

Count it all joy, my brothers, when you meet trials of various kinds, (James 1:2 ESV)

Normal people do not consider it joy when things are going badly, they get upset, annoyed, grumpy and sad. Joy in such situations springs either from some sort of delusion or from a hope or goal which is unaffected by the current circumstances. The command to have joy or to rejoice is rife in the New Testament.

What is the point in commanding something that is humanly impossible to fulfill?

Moses, the prophets, the apostles and God Himself are well aware of our weaknesses and that while we might be willing in spirit to live a life of purity, holiness and discipleship, in the messiness of real life it is usually only a short time before we stumble and fail to live up to our high aspirations (see Mark 14:38). This is true for each of us as individuals and even on a national scale for historical Israel.

Failure in obedience to God to inevitable, but sometimes we are like Peter and cannot be told so have to experience it first hand. Then once we are faced with the shattering truth of our failure, inability and sin, we say to God, “don’t come near me, I am too sinful” (see Luke 5:8). At this point we are given the promise of God’s presence:

The LORD your God who goes with you.

The unshakeable promise

Like the kid facing a bully whose Dad says, “Don’t worry, I will come with you”, God promises to cross over the Jordan river into the land of Canaan with the Israelites to face their enemies.

Remember that this is the God who parted the Red Sea and destroyed the Egyptian army, who opened the earth to swallow those who challenged His authorised spokesman, and faithfully provided food for the horde of Isrealites for 40 years in a desert. God is powerful, well worth having beside you in a fight.

How about when the ‘enemy’ is from within? When my fear is fueled by my own heart and mind? Power and strength are great but I am anxious that could crush me.

In Jesus we see much more of who God is than unlimited power, Isaiah says this about Him:

Surely he has borne our griefs
and carried our sorrows;

(Isaiah 53:4)

In fact, to make it clear, Jesus also promised, “I will never leave you nor forsake you” (Hebrews 13:5) and “I am with you always, to the end of the age” (Matthew 28:20). Whenever the same idea is repeated in the Bible it is to emphasise that it is important and can be trusted. Even in the depths of despair when it feels as if God has deserted me, I can trust that He determined long ago not to do so.

An unseeable promise

But I still do not see or sense God near me. This is not surprising when God is described in the Bible as “the invisible God” (Colossians 1:15), and “eternal, immortal, invisible” (1 Timothy 1:17) with Jesus telling us that, “No one has ever seen God” (John 1:18).

What then did Jesus mean when He said, “I will never leave you nor forsake you” yet about a month later the disciples saw with their own eyes as He ascended into heaven?

God is spirit, and Jesus had previously told His disciples, Nevertheless I tell you the truth: It is expedient for you that I go away; for if I go not away, the Comforter will not come unto you; but if I go, I will send him unto you. (John 16:7 ASV). The Comforter, (also translated as ‘Helper’, ‘Counselor’, ‘Advocate’) is the Holy Spirit and this is the One who is promised to never leave us or forsake us.

As Spirit we cannot interact or sense God through our physical senses. However, we are not only physical beings, we have a spirit too and God gives life to our spirit through rebirth by faith in Jesus as the Son of God. This means that my spirit can commune with the Holy Spirit who is always present.

I may not be able to feel it through my senses, but I can worship God, pray to Him, cry out to Him and be heard and helped by Him all in the realm of the spiritual no matter what my physical, mental or emotional state. He will not leave, He will not abandon me, and He can strengthen me by His Spirit. Fear and despair may come, but they need not overwhelm me.

Vitality

The true opposite of depression is vitality — the ability to feel a full range of emotions, including happiness, joy, pride, but also including sadness and grief.

Christians Get Depressed Too

I have recently finished reading Christians Get Depressed Too by David Murray (the Kindle version). The overall thrust of the book is to correct the common idea amongst Christians that depression is caused by sin or a broken relationship with God and that taking antidepressants is to exhibit a lack of faith.  Murray outlines the various factors which appear to contribute to depression and presses the point that for many people their depression has an organic, physiological  cause.
David Murray also points out that the biblical counselling movement falls short in it’s common assumption that pharmaceutical treatments for depression are simply masking the real problem. While from a neurochemical perspective there is grounds for thinking that current drug treatments do not necessarily target the true physiological cause of depression, they certainly do have more than just a placebo effect.

Something I do appreciate is the author’s reassurance that for most Christians who are depressed being ‘unspiritual’ is not the main issue and that going overboard on reading the Bible and praying is unnecessary. In fact it may compound the problem by causing the person to get even more introspective when they would do better to get out and simply be around other people.

It is a fairly light read but an OK introduction to the topic. For all that, it is a good summary and I think pastors in particular would do well to read it.