Sadness versus Depression

It is understandably common for people to mix up sadness and depression. Unfortunately, this confusion is often one of the things that has been causing people a lot of suffering by the time they come to work with me.

The reason that sadness and depression are so easy to mix up is that feeling blue is (almost always) common to both. And the reason that it's so important to be able to learn how to distinguish these two experiences is that we need to respond to them in opposite ways.

As a core emotion, sadness has a very important evolutionary role to play. Like all core emotions sadness provides us with invaluable information about what is important to us in our lives, and then produces an action tendency that helps us respond to our situation in the most appropriate way (for more on core emotions and what they are see my video on Emotions in AEDP on the resources page). The theme of sadness is around loss/damage to the self or to something that we value. Therefore, the action tendency of sadness leads us to take some time out from life to soothe ourselves, and also to reach out for comfort and soothing from others.

So, for example, imagine that there was a big promotion at work that you really hoping for and you didn't get it. The feelings of sadness that would come afterwards would actually be a healthy sign that you just lost something that really mattered to you. So if you miss the promotion it would be healthy to follow the action tendency of sadness and, for example, spend the next weekend on the couch feeling down, watching movies and/or calling a friend to share your feelings with them. The key with sadness is to listen to it and express it (without becoming overwhelmed by it). Avoiding or repressing healthy, albeit painful, feelings of sadness makes it harder to treat ourselves with compassion, to let go of unattainable goals, and finally, to find a path toward new goals that we can achieve. In fact, over-controlling a healthy sadness can actually lead to depression.

On the other hand, depression is much more then just sadness. It is a whole cluster of experiences which together are a sign that your system has become dysregulated and out of whack. Feelings of sadness are only one feature of depression, along with a cluster of other symptoms including: loss of interest in things; problems with sleep; changes in appetite; concentration problems; lowered sex drive; fatigue; feeling worthless; sluggishness or restlessness; and thoughts about death or, at times, thoughts of suicide.

Not all of these symptoms need to be there in order for depression to be present, but at least some of them do, and of these sadness is perhaps the most common symptom we experience when we become depressed.

However, unlike with “pure” sadness, it is  not in your interest to listen to depression. Depression will always tell you to avoid engaging fully in life and/or will tell you to socially isolate. The more we listen to depression, the more we end up leading lives that are empty, lonely, and depressing. So this leads to more depression, and a very powerful cycle can be created that becomes like a vortex which pulls us in. A “pure” sadness will lessen over time, while a depression that has tricked us into listening to it does just the opposite, it becomes more and more intense.

This is why we need to do exactly the opposite with depression than with sadness; we need to not listen to the depression and instead re-engage with life in a self compassionate manner that will actually work. This approach, often  involving SMART Goal setting (see my blog post on this topic) involves returning to engagement with life at a tolerable pace, where you're not asking yourself to do more than you can manage but you're also no longer allowing depression to get you to do too little.

The ability to sense or taste the difference between sadness and depression is a skill. And sometimes we might need help figuring out which is really going on. It can be very difficult sometimes to tease out the difference between these two things, especially when we are feeling down. Getting help with understanding what's really going on, deciding if it's more of a sadness based experience or a depression based experience, is one of the vital roles that psychologist or other qualified mental health practitioner can play. And once in counseling, learning how to taste the difference between these things for themselves becomes a very important goal for many clients in therapy.

Once therapy has helped people learn how to sense for themselves the difference between healthy sadness and depression, this is a very valuable skill that they can then use to keep themselves healthy for the rest of their lives.

THINKING OF OURSELVES AS MADE UP OF MULTIPLE SUB-SELVES

From the time that we are  brought into this world were taught  to think of ourselves as a unitary being. I am a person named "Douglas".   In a common sense way this is true,of course  It is also very useful and practical to think of ourselves a a single entity. For example, it is way easier to order  a coffee at Starbucks if we just give our name when they ask, rather then explaining that we are in fact " a complex, emerging  being made up of multiple subselves".  

 But when it comes to psychotherapy, especially  experiential psychotherapy like AEDP, being too rigidly attached to the idea of ourselves as a unitary being can actually  sometimes be counter-productive. I say this because my years of experience as a therapist have  led me to the firm conviction that, in  a very real way, we actually are “an integrated overall being made up of multiple subselves”.  

One of the clearest examples of this idea comes from witnessing client after client exhibiting a split between a more rational, conceptual part of themselves and a more embodied, emotional part of themselves. Inevitably these two subselves see the world in a very different ways. The more rational part is often the "goal setter" or the "driver" who has all sorts of very clear ideas of how things "should" be and what you "should" be able to achieve. The more emotional part often ends up feeling oppressed and pushed around by the rational part, because he or she is the one who actually has to actually bear the deep emotional costs of facing fears and/or continually  failing to achieve unrealistic expectations.  

One of the most striking things that I have learned over time is that psychological wellness does not involve sacrificing either of these parts. Each has so much of value to offer us. Without the rational part it would be really hard to navigate in the world or to move toward long-term goals. But without the more emotional self it would be difficult  to really know what we actually wanted to set as goals in the first place, or to move toward those goals in a sustainable, self-compassionate way.  

Rather then getting rid of either of these sub-selves, the key seems to lie in getting them to respect each other and to listen to each others' points of view, even though those points of view will always be different (because their perspective on the world will always be different). In short, the more the relationship between these two sub-selves contained within a single person comes to look like a healthy intimate relationship between two seperate people, the healthier and more resilient people seem to become.  

This idea of the self as made up of sub-selves can seem a little weird or flakey to many people at first.  But I have seen  healing the realtionship between these two main subselves become a key element in so many successful  therapies, including one of my own, that I have now strong faith in this model. Given my faith in this perspective, it is  a relief that, over my years of reading, I have found that this perspective is  actually very consistent with both Buddhist psychology and with neuroscience research.

 This perspective does not make sense to all of my clients I work with. If that is the case, then that is, of course, perfectly fine. It is not essential to adopt this perspective in order to have a successful course of experiential therapy. But for those clients  who are open to exploring themselves as comprised of seperate but realted sub-selves, this can often offer a very helpful path toward healing.

Why yoga is so helpful to psychotherapy

A passion for yoga is one of the things that most strongly distinguishes Vancouver's culture, especially in the Kitsilano neighborhood where I work. I have practiced yoga for many years and have derived tremendous benefit from it. I also recommend yoga to many of my clients because I believe that it can both speed and deepen the processes of transformation that psychotherapy is designed achieve.  

So, what is it about yoga that makes it such a good support  for the therapy process?  There are many different reasons. Among these, are that  yoga increases physical flexibility, reduces stress, and increases heart rate variability. For me though, the most psychologically valuable aspect of yoga is that it is essentially  a form of moving mindfulness (see my recent blog post on mindfulness and therapy). I believe that this particular aspect of yoga is often realized most strongly  in the slower forms of yoga, such as yin yoga (the form that I currently practice).

 In yin yoga we hold pauses for a very long time, typically up to 5 minutes each. This allows for stretching of the fascia, the body's dense connective tissue. Yin encourages us to start a pose at a gentle “edge”, or at a depth where we are initially only aware of subtle stretching sensations. However, because we hold the poses for such a long time, these sensations usually deepen a lot over time. As this happens, we are encouraged to develop our capacity to stay mindfully present with this increasing discomfort, neither avoiding the sensations (by zoning out etc.) or by allowing our thoughts to make them worse than they actually are (“this pose is awful...it will never end!”). However, we are also instructed to practice self-compassion by backing off if the sensations ever begin to change from discomfort to actual  pain.  

So what does this have to do with therapy?  A lot actually.  Yin gives us  chance to develop exactly the skills we need to overcome anxiety and avoidance, which are at the very heart of most of our suffering as human beings. When we look closely enough, we will find  that the concrete “thing” that actually stops us from doing many of the things that we long to do (things like standing up for ourselves, being explicit about our love for a partner, or fully letting in a partner's love for us with an open heart) is a physical sensation. It is our desire to avoid experiencing the tightness of anxiety in our chest that  leads us to tell a joke rather then to say “I love you”. It is our desire to avoid the sinking sensation of shame at pride in our stomach that leads us to minimize and deflect when a partner says that they love us.  So a big part of being able to begin get what we want in life, and especially in relationships, is to develop some tolerance for these uncomfortable bodily feelings. It is only after you have developed some of this tolerance (by, like in yoga, pushing ourselves to intentionally experience the unpleasant sensations in a  self-compassionate way that always stays within your window of tolerance) that you can become confident enough to have these uncomfortable feelings and to still follow your heart anyway. So that, for example, you can begin  allowing the sensations of anxiety that come with being deeply vulnerable to arise, and  still chose to say “I love you” anyway.

When this kind of shift happens you can begin to reap the incredibly rich rewards of living in this braver, less avoidant, more connected way.  So I encourage you to try out a yin yoga class if you haven’t already done so.  

At the very least you will have earned yourself a coffee and a treat afterwards.

The Transformative Power of Effective Goal Setting

In this blog entry I want to write a little bit about setting effective goals.

This might not sound like a very sexy topic . But in my experience, both as a therapist and as a person, it's one of the most important topics around.

By setting goals I don't mean so much what particular goals we set (although this is also very important) but the process we use to set goals. This topic is passionate for me, and very closely connected to a story that I'd like to share.

About 15 years ago, when I was first beginning to train as a therapist, I had the opportunity to be a student co-leader in two consecutive cognitive behavioral therapy (CBT) groups for depression. SMART goal setting was one of the basic interventions used in this group program. When I first looked at the manual, I remember thinking to myself “Oh this goal setting stuff, it's so basic. I already know this stuff and so does everyone else. So why are we wasting valuable time on a skill that everyone already know?”

All these years later I couldn't see effective goal setting any more differently. To me now, effective SMART goal setting is a very potent mix of mindfulness, self compassion, and commitment. Let me explain why I say this.

The process of SMART goal setting requires you to do a number of things. The first is to decide what it is that you want to change in your life, for example to get into better shape. The second, in the spirit of friendly curiosity (which is the essence of mindfulness), is to simply notice and record how you have been doing in the chosen area in the last week or so. And the third is to set goals for the coming week from a self compassionate stance which accepts that whatever you discovered during the recording phase is what you are able to do at this particular point in our life and then starts setting goals from there (as opposed to the more familiar, judgemental stance in which we set goals instead based on what we think we she really “should” be able to do).

This sounds very simple and as a concept it is. I just explained it in 100 words or so. But in practice I have come to see that for many people this process is actually remarkably difficult. And I have come to believe that this difficulty is largley because of one thing, a defecit of self compassion.

As I led the first CBT group all those years ago I began to notice that the group seemed to break more or less into two separate subgroups.

There was a subgroup who allowed themselves to simply note what they seemed to be capable of doing, no matter how simple that was, started from there. For example, someone in this sub-group might say something like this to themselves “ I've always been an athlete. Before I got depressed a year ago I used to get to the the gym at least 4 days a week. But since I've been really depressed my monitoring tells me that in the last week I have done no exercise at all. I'm going to really give this SMART approach a try. I'm going to start where I am. This week I will go to the gym and ride an exercise bike for 10 minutes. I'll see how that goes and then take it one step at a time after that.” People who did this would usually get to the gym and achieve their goal because they were starting from a place of self compassion. As a result, they would feel a sense of success. This feeling of success would fuel them to set a slightly higher goal for the second week, of spending perhaps 15 minutes at the gym. Over time, this feeling of success would create a positive cycle, so that often by the end of the 8 weeks they had fully recovered from their depression, and had also armed themselves with a powerful tool to stop depression from coming back.

On the other hand, the second subgroup never really bought into the self compassionate stance that SMART goal setting  requires. They would tend to say something like this to themselves at the beginning of the group “I'm an athlete. A year ago I went to the gym 4 days a week. I haven't been to the gym at all in the last 6 months. So I'm going to “cut myself a break”. I will “only” make myself get to gym three times this week instead of four.” These people tended to get to the gym maybe once, like the people in the first sub-group. But rather than feeling a sense of success around this very real accomplishment they would instead feel like failures. This would lower their motivation for the second week. Often they would respond to this by getting even harder on themselves and say something like “Well I failed to get there 3 times last week so I'm really going to push myself and get there 4 times this week”. Which of coure they wouldn't. So while members of the the more self compassionate sub- group had a gradual but accelerating upward spiral, these people tended to stay pretty much where they were when started, continuing to set unrealistic goals and then punishing themselves as faliures.

I was so struck by what I had observed that, despite my intial skepticism, during the second CBT group I decided to set goals alongside the group members. I had recently been diagnosed with Type 2 diabetes. I was about 40 pounds overweight and was very unhealthy. I had been telling myself for years that I “should” get to the gym four times a week, without getting there hardly at all. So during my first week co-leading the new group I set a very different goal: walking around my neighborhood for 10 minutes, twice during the week. By the end of the group I was running for 20 minutes, four times a week. I had lost 10 pounds and was well on my way to losing another 40. I have kept (most of) that weight off for all of these of these years, and even more importantly, I have much more energy then I did when I was 30. These are accomplishments that I'm really proud of.

So , if we end up working together, I hope you'll understand if I end up talking excitedly about SMART goal setting with you, because I've seen the the power of this apparently simple approach to help transform people's lives. Including my own.