Treatment for Depression: A Method that Works
As a Christian therapist, many clients call my office wanting to know if they will receive counseling from a “Christian perspective.” Since professional counseling is concerned with practical application on theories of how the human psyche functions or heals when damaged, it is natural that believers would be concerned about receiving counseling that does not conflict with their faith.
The Bible isn’t written like a science textbook and doesn’t attempt to explain things like organic chemistry. However, it does explain things about our human experience. For example, Jesus taught about different parts in us, like “our heart, soul, mind, and strength.”I feel that one my responsibilities as a therapist who provides Christian counseling is to pick theories or psychological approaches that either are reflected in Biblical teaching or at least do not contradict matters of faith. It is particularly encouraging when I find an approach that has both.
This article will summarize a counseling treatment for depression that has strong parallels in Biblical teaching. I will examine key elements of the treatment and reflect on the Biblical parallel found in Scripture.
Treatment for Depression
Cognitive Behavioral Therapy (CBT) has existed as an effective treatment for depression for decades. It works based on the idea that depression is a cycle of activating events in a person’s life that trigger a pattern of negative thinking, which in turn has a negative effect on coping behavior.
Because the end result of depression is withdrawing from activities that may lift the depression sufferer’s mood, treatment usually starts with behavioral activation – engaging in activities that were previously rewarding or removing obstacles in little steps of things that prevent activity.
The second phase of treatment for depression then focuses on negative thinking and self-defeating beliefs. Learning how to balance thoughts and avoiding negative extremes helps lessen the intensity of emotions so the depressed person can learn to cope more effectively.
Finally, I have found that assertiveness training and managing stress have a positive effect against relapse into depression once the person is doing better.
Engaging in Activity
Depression is a problem that ends up in the mind. One way it influences a person’s reality is by convincing them there is nothing they can do to make it better. The result is that the person withdraws from activity and stops receiving any possible life rewards.
Mood and activity have a mutual influence on each other. Sometimes what we do has a positive effect on our mood and sometimes how we react to life events can have a negative effect on our mood. The key in breaking a cycle of depression is picking activities that have a high chance of improving mood symptoms.
Jesus taught that there is a relationship between mind change and doing. In John 8:31 (NIV), it reads “To the Jews who had believed him, Jesus said, ‘If you hold to my teaching, you are really my disciples. Then you will know the truth, and the truth will set you free.’”A person couldn’t just give mental assent to his teachings to experience their truth, they had to take action in following them in order to be “set free.” Similarly, James 2:26 (NIV) reads, “As the body without the spirit is dead, so faith without deeds is dead.”
The idea here is that if a person wants a strong faith, they have to engage in activities that strengthen that faith. Targeting activities to break up depression works in a similar way. Activities associated with a positive mood must be targeted and engaged in to strengthen positive mood symptoms.
The key in picking activities that will break up depressive symptoms is starting with activities that historically have brought pleasure. For example, if historically having a clean room makes you feel less overwhelmed, start by cleaning your bedroom. Going for a hike, preparing a favorite food, and listening to positive music are all examples of activities that are easy to engage in and may impact a low mood.
The key is just doing it. Rating your expectations of whether the chosen activity will affect your mood can be illuminating. On a scale of 1-10, with one being low confidence, a depressed person may rate going for a walk with an expectation of “1” in their confidence in improving their mood. After doing it, people frequently find they rate the activity’s actual impact on their mood as much higher (like a 5 or 6). Just like a lack of obedience kills faith, depression does not allow the accurate prediction or experience of how much positive activity affects mood.
There is a direct relationship between what we think and how we feel. The more polarizing the thought, the more intense emotion it will generate (positive or negative). For example, if I get a traffic ticket and tell myself, “You’re such a loser” versus “I am disappointed with myself,” I will feel much more negatively in reaction to the first thought than the second.
A big part of healing depression is learning to detect and modify extreme negative thoughts. The goal isn’t to lie to oneself. I am naturally going to feel negative emotions when I get a traffic ticket, but if I am able to modify my thoughts I am more likely to feel less intensely and be able to cope more effectively. Depression occurs when we get overwhelmed by emotions and can’t think clearly on how to cope.
The Apostle Paul seemed to understand this concept as he wrote to the early church, who was facing internal and external challenges. The early Christians faced external pressure like jail, loss of property, and death from the Roman society in which they lived. Further, there were internal pressures from “teachers” who taught that Christians needed to obey different aspects of Old Testament law like circumcision.
Paul wrote in Philippians 4:8 (NIV):
“Finally, brothers and sisters, whatever is noble, whatever is right, whatever is pure, whatever is lovely, whatever is admirable – if anything is excellent or praiseworthy, think about such things.”
This must have been an incredible coping guide to believers who were facing constant trials. Considering the ideas presented in the above verse assisted them in pushing forward in their faith during very difficult times.
Human beings are designed to be relational. Just like we need air, food, and water, we need relational connection to function properly. A primary way we harness connection is through communication. Fear of conflict or rejection drives most forms of dysfunctional communication, which are: being aggressive, passive, passive-aggressive, and manipulative.
Aggressive communicators try to use force and intimidation to get what they want. People can’t be connected to someone they fear. Passive people do for others what they hope will be done for them someday. As a result, their needs to get overlooked and ignored. Passive-aggressive communicators display their anger indirectly, often leaving people confused about what they really want.
Finally, manipulators use sympathy and guilt to get other people to do for them what they really could do for themselves. None of these styles result in authentic relational connection.
By surveying the Bible book of Proverbs, the reader will find many verses that deal with these types of dysfunctional communication. Proverbs 13:2 reads, “From the fruit of their lips people enjoy good things, but the unfaithful have an appetite for violence.”
Personal assertiveness is a direct and honest way of communicating that assumes personal responsibility for one’s feelings and focuses on eliciting cooperation for the mutual benefit. Making a complaint about someone’s behavior, instead of criticizing the person is where it starts. For example, if we carpooled to work together and you were frequently late, I might say “I have concerns about you being on time” instead of “You are a disorganized person.”
The next step is to describe feelings from the “I” position. Instead of saying “you make me feel stressed when you are late,” I would assume responsibility for my feelings by saying “I get stressed when you pick me up late.”
Finally, I would make a request reinforcing the positive aspects of the person cooperating. People tend to react defensively when we reinforce a request with negative consequences. “If you don’t pick me up on time, I am cancelling our ride share” would be an example of negative reinforcement. A positive framed request would be, “I need you to be on time so I am not stressed and we can both continue to benefit from ride sharing.”
The main challenge with being assertive is not being overly focused on what the other person decides to do with the honest communication. From a depression standpoint, there is a much higher chance of making a real connection by being honest and direct.
During the times that requests are not met, it is still a win. Harboring frustration and unmet needs is a huge contributor to depression due to anger turned inward. Being “personally assertive” is like taking emotional vitamins to inoculate against depression.
Ecclesiastes 7:17-18 (NIV) reads, “Do not be over wicked, and do not be a fool –why die before your time? It is good to grasp the one and not let go of the other. Whoever fears God will avoid all extremes.”
Depression can be thought of as living in a world of extremes. Meaningful work, social/family connections, spiritual development, rest, and recreation are different dimensions of an adult’s life that mitigate stress. I often find in a depressed person’s life an exaggerated focus in one of these areas with complete neglect in several others.
For example, I have clients who dump all their personal energy into their job. It may be that their job is a predictable way of feeling good about themselves, but eventually they get burned out and can’t sustain their performance. Learning how to cultivate supportive relationships and finding hobbies that promote relaxation would be ways of balancing out how this person experiences their worth.
Further, regular exercise seems to offset the effects of stress. People who are stressed often feel they don’t have time for the thing that would help them cope with stress more effectively.
The concept of balancing one’s life is a simple concept, but by no means easy to achieve. A person from a broken family may really need social support to assist with depression symptoms, but they are functioning on a lifetime of self-reliance as way of coping with their past. How does a person who has been isolated throughout their life learn to have meaningful social connections?
This is where enlisting the help of a professional therapist can be really helpful. Being able to work with a professional to help you consider what parts of your life are out of balance and what areas need strengthening can make all the difference in overcoming depression.
Many people get discouraged about treating depression because they have focused on one area and didn’t get results. Since depression may be caused by multiple things at once, getting a comprehensive plan can yield better results.
Sometimes additional help from medication combined with therapy is what is needed to move toward life balance. The key is working with a professional who tailors the plan to fit your needs and experiences. Depression is treatable. It just takes perseverance and a comprehensive plan that includes the elements outlined in this article.
“Down,” courtesy of Nik Shuliahin, unsplash.com, CC0 License; “Drowning,” courtesy of Ian Espinosa, unsplash.com, CC0 License; “Contemplating,” courtesy of Jad Limcaco, unsplash.com, CC0 License; “Slow Down,” courtesy of Daniel Monteiro, unsplash.com, CC0 License