Defeat Depression through Psychotherapy

By Carol Goh  |  Published on 12 May 2021

Depression is a mood disorder that can affect the feelings and thoughts of a person. It can give rise to persistent sadness that lasts for weeks or months. Depressed people feel guilty, hopeless, or worthless. They are also found to have a variety of emotional and physical problems.

For example, a research study conducted by Sowislo (2013) showed there is a strong link between low self-esteem and depression. Sufferers may even be suicidal if they do not go for therapy treatment.

Based on an article published in Straits Times on 25 June 2019, depression is the most common mental health issues with 72% of those suffering from mental health issues having depression. (Results based on 1,095 Singaporeans surveyed by YouGov Omnibus, https://sg.yougov.com/en-sg/news/2019/06/25/sg-mentalhealth-selfharm/)

Symptoms of depression

Based on DSM-5, you can check if you are experiencing at least 5 of the following symptoms in the past 2 weeks:

1. Depressed mood most of the day, nearly every day (e.g., feels sad, empty, hopeless)

2.  Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day

3.  Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month)

4.  Insomnia or sleeping too much nearly every day

5.  Psychomotor agitation or retardation nearly every day

6.  Fatigue or loss of energy nearly every day

7.  Feelings of worthlessness or excessive or inappropriate guilt nearly every day

8.  Diminished ability to think or concentrate or indecisiveness nearly every day

9.  Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

If you are experiencing at least 5 of the above symptoms, you are likely to be suffering from depression.

Besides the above symptoms, another common symptom of depression is called “derealisation” or dissociation - which is a feeling that nothing you are doing is authentic or real.

You are suffering from “derealisation” if you find it difficult to face the world as the pain is too great to bear. It is as if the future has vanished and is unimaginable. This gives rise to a state of hopelessness, preventing you from foreseeing yourself 5 or 10 years down the road. You may even cringe when asked about what you would like to do in the near future. Any urgings to plan for the future will cause anxiety and will immediately shut you down mentally and emotionally.

To a person suffering from depression, the future seems so scary and unfathomable. You are stripped of hope with nothing to cling onto. Any sense of identity is stripped to the core and you are left with shame, worry and fear.

“What are you?” To which you reply: “I am nothing.” “Who are you?” To which you reply: “I am a nobody.” “Why are you here?” To which you reply: “That‘s a good question which I have no answers for.” Living becomes meaningless, and thoughts of suicide seem palatable to ease your pain. It is this loss in hope of the future that drives the rising suicide rates in all nations in today’s world.

Interestingly, according to Kessler (2017), depression is a label used to describe a group of symptoms. It is not a cause. To treat depression, we need to dig deeper into the actual causes of depression.

Causes of depression

In a research study conducted in 1998 titled “The Adverse Childhood Experiences (ACE)”, the researcher interviewed 17,000 people using a questionnaire asking about ten different categories of terrible things that can happen to the respondents when they are a kid — from being sexually abused, to being emotionally abused, to being neglected and whether they are suffering from depression.

The results showed that for every category of traumatic experience that the respondents had gone through when they were a kid, they were much more likely to develop depression as an adult.

If the respondents had six categories of traumatic events in their childhood, they were five times more likely to become depressed as an adult than somebody who didn’t have any. If they had seven categories of traumatic events as a child, they were 3,100 percent more likely to attempt to commit suicide as an adult (Felitti, 1998).

This research study reveals a startling finding: childhood experiences are closely linked to an adult’s future mental health development. Does it mean that a positive childhood will lead to a depression-free life in the future? Not really. Even if a person’s childhood experiences were healthy, there might be other traumatic experiences encountered beyond childhood that could cause depression. Examples of other common traumatic experiences are:

- Being bullied, ostracized in workplace
- Betrayals by significant others
- Failed relationships/marriage
- Failures in studies, not meeting expectations
- Traumas encountered during adulthood (such as sexual abuse, physical abuse, or emotional abuse)

"Childhood experiences are closely linked to an adult’s future mental health development."

Depression is a natural response to abnormal life experiences. It’s not about what’s wrong with you. It’s about what has happened to you.

You may assume that your past hurts and pains can be healed on their own through time. However, the reality is that it will not. Throughout your life’s journey, such hurts and pains will just keep adding on until you reach a point when you feel so overwhelmed that you cannot function anymore. You feel that your life has been stripped of the things that used to make life worth living.

Bel (not her real name) has been verbally abused by her mom since young. Her mum will often shame her through the use of words like: “monstrous, ugly, freak”, “a burden to the family, should not live on earth”. All these past verbal attacks made her feel insecure and have low self-esteem.

Bel was constantly fearful of people around her, thinking they would attack her inner core. She became paranoid and has severe anxiety with occasional panic attacks. She was suicidal, has attempted suicide twice and was soon diagnosed as suffering from severe depression.

She would act out and get into a state of derealisation when the pain of rejection and abandonment became too much to bear. She will either get into fits of anger or withdraw into her room and sleep, refusing to leave her room. She will depend on withdrawal to help her avoid facing people in the real world. As a result, she could not make friends and was made to live a lonely life.

"Depression is not about what’s wrong with you. It’s about what has happened to you."

There are many other people just like Bel who are suffering from depression because of past hurts and abuses. The good news is that there is a way out of this misery.

The role of negative thoughts in depression

What is the mechanism that works behind depression? The simple answer is because of irrational and negative thoughts because of past hurts. Such thoughts will only gain strength if they are not challenged. Negative thoughts beget further negative thoughts and soon, they will flood your mind with many negative thoughts which often cause your mood and emotions to spiral downwards.

Research showed that when we feel depressed, it’s hard to think of anything positive because our brains are primed to bring up only memories that have those downbeat emotions. Negative emotions will reinforce the negative thoughts and beliefs we have been holding on to. It will culminate to a point when you will not want to get out of bed. When your depression problem worsens, you may even entertain suicidal thoughts. Hence, get help early and prevent depression to have a hold on you.

Do some people have a predisposition to feel depressed?

There have been many books and research studies to support the finding that one is not born with depression. In the international best seller book ‘Lost Connection’ written by Johann Hari, he interviewed many experts in this field and concluded that we are not born with depression. Brain research studies have proven the plasticity of our brain in adapting to the environment. This neuroplasticity allows the brain to continue to restructure itself based on external stimuli.

"One is not born with depression."

Based on a research study conducted by Maquire (2006) in which he scanned the brain of several London taxi drivers, he found out that their part of the brain which is related to spatial awareness is much bigger than that of a normal person; as these taxi drivers have to memorize the entire map of London in order to get their license. Maquire concluded that these taxi drivers were not born different. It is, rather, because of different uses of the brain that made the difference.

That means that your brain is constantly changing to meet your needs. It does this by pruning the synapses that you don’t use and by growing the synapses you use. In the same manner, the negative experiences encountered in the past wire a depressed person’s mind. Hence telling a person who is depressed that he or she has a natural predisposition to become depressed makes no sense in the current context because brains are changing their wiring all the time.

In short, depression is caused by the outside world and our interaction with it and affects our internal world. To overcome depression, we will have to rewire our internal world. In Johari’s groundbreaking book, he quoted many research studies to support biology is not the cause of depression, it’s not serotonin, it’s society, traumatic childhood experience. “It’s not your brain; it’s your pain”

"It’s not your brain; it’s your pain."

Overcoming depression using psychotherapy

Many people have the misconception that to get out of depression, we just need to change the current situations that make us depressed. It is common that people change job hoping to escape from being depressed. Some even change spouse to improve their state of depression, putting the blame on the ex-spouse for their current depression.

"Many people have the misconception that to get out of depression, we just need to change the current situations that make us depressed."

However, in no time, we are likely to be depressed again in our new job. We continue to feel depressed in our new marriage, in which small quarrels have now escalated to big fights. We tried hard to read books on how to improve productivity at work, learning new communication skills in marriage, but yet our efforts to improve our life somehow all ended up in vain. As the new environment becomes more dire, most of us will end up becoming even more depressed than before, pushing us to the brink of serious breakdown.

Why is it so difficult to get out of depression? The answer is that it is difficult because we are putting out the wrong fire. Changing a new job or a spouse, or doing anything to get away from what is currently making us depressed are not the right solution to overcome depression. I believe those who have tried it before will attest to the fact that changing our current dire situations are just at best temporary fix. We will probably become depressed again in no time.

Differentiating between triggers and root cause

The first step to overcome depression is to differentiate between the triggers and root cause of your depression problem. Triggers are the current situations you are in: your jobs, marriage, relationship, family, social circle, schools, and so on that are seemingly the “source” of your depression. However, these situations are often not the root cause of your depression.

For example, you can become depressed when your boss, your teacher, or your spouse criticize you. However, you may have noticed your colleagues or your classmates are not as much affected by the same criticisms. Why is it you are more affected by such criticisms than others? That is because the criticisms you received are triggers, not the causes.

The explanation why you are more depressed is because of the interactions between current triggers and the root causes, which are often the “invisible” hurts and pains you have kept within you in your life’s journey. Such hurts have remained dormant and well hidden within you and can be activated anytime by an external trigger. However, such hurts will remain secretly hidden behind the trigger whenever you breakdown, making it very hard for you to even notice them. To you, it is the external trigger that is making you feel worse.

"The root causes of depression are often the “invisible” hurts and pains you have kept within you in your life’s journey."

When the hurts that are hiding within you are not resolved, they will be translated into a belief and become embedded within your belief system which distort how you view and react to life’s events. Pessimism will set in and eventually, there seems to be no more colour in your life.

Find the root causes of your depression

The critical step to defeat depression is to resolve all your past hurts, one at a time. To resolve past hurts, you need a professional therapist who can see beyond your current problems and triggers.

Talking to close friends may help. However, most of your close friends will address only your current triggers or your most recent triggers, rather than going deep into the root cause. Another reason talking to close friends may not help is that talking about your past hurts can be overwhelming and unbearable. You may not be comfortable to share your painful past with your close friends as you are not sure how they will react upon hearing your past: will they be able to understand, empathise, and not judge me?

To find out the root causes of your depression, you need a safe and non-judgmental listening ear to understand what your underlying issues are. Questions in response to your struggle will not be like: “What’s the matter with you?” Instead, it will be all about “What matters to you?” During the therapy session, a good therapist will not be sticking plasters all over your wounds, as they are merely symptoms or smokescreens and not the source of your problem.

This is the value of talking to a professional counsellor or psychotherapist. You can be assured that your past will not be judged. In fact, through specialized psychotherapy techniques, you will discover past hurts that even you could not imagine it was in you all these years. During the psychotherapy session, we will use a suite of therapeutic techniques to resolve your hurts one by one. Each source of hurts requires unique protocol or technique for healing.

Psychotherapy intervention for depression

Based on my over 15 years of psychotherapy and counselling experiences with over 1,000 clients, I have developed a proprietary program called RENEW to help you overcome depression.

The first step is to understand what causes depression. As your story unfolds, you will gain an awareness of all probable causes. The process is akin to peeling layers of onion skin to unravel the hidden mystery in your life slowly. You will piece different parts of the puzzle together and be able to purge out all the inner hurts that have been living and wreaking havoc in you all these years.

To help you uncover your past hurts and issues and then to resolve them, a suite of counseling psychotherapy techniques will be used depending on your circumstances and specific issues:

a. Gestalt technique

This technique engages you to ‘talk’ to the party who have been responsible for your hurts. Irrespective of whether the party is still alive or pass on, or whether the party is actively or inactively involved in your life currently, this technique is commonly relied on to help clients to resolve past hurts. The idea behind this is to find closure in any unfinished business that is troubling you.

b. Eye Movement Desensitization and Reprocessing (EMDR)

This technique is an excellent tool to work on the hurts to desensitize the emotions that are still alive in the body, although the hurts may have happened many years ago. The incidents may have long passed, but the body remembers the emotions in the present still. The emotions may not just be depression, and may include anger, fear, and so on.

c. Schema therapy

This technique is used to identify life traps and in a therapeutic environment, the therapist will speak up to the perpetrators to give the victims a voice that they could not defend themselves previously. This is done in the therapy session via visualization.

d. Cognitive Behaviour Therapy (CBT)

CBT attempts to understand your irrational thoughts to help you reframe them to open new channels of new thoughts and beliefs.

The best news is that once the past hurts and issues are truly resolved, they will never come back to haunt you again. In the subsequent stages under the RENEW program, I will help you structure your thought process to accept and embrace yourself, and gain the mastery to love yourself for who you are. I will equip you to manage challenges more positively in the future. You can begin to live a new and confident life journey, free of depression.

Client’s healing journey…

"It is my first time going for counselling ever since I entered my poly life. So I have been going for counselling sessions for more than a year now. Counselling has helped me to overcome all of my problems by giving me both emotional and physical support. I remembered how miserable I felt when I stepped into my poly life to the point of sinking into depression. But after going for the counselling sessions, I find a big change in myself. I am able to keep my head held high and keep moving forward even though there are a lot of obstacles along the way. It has never been easy for me to go through those hardship but with the support from Ms Carol, I am more than blessed to feel that she is always there to hear me out on my problems and give me useful advice. She has been the one who understands me the most and knows how I feel despite me having a hard time actually expressing in words whatever has been lingering on in my mind. It helps me to lighten my ‘burden’ in a way. Counselling is also not just about sharing my feelings but also involves self-reflection. There is no straight way to resolve things but rather, it is a step-by-step process. Through counselling, I discovered other aspects that contributed to my problem, many of which I did not realise before."

Female teenager

"I still remembered the first time I went for counselling. I was full of tears, drained and I felt really helpless. As it was my first time, I did not really know how it works, but after going through a whole 4 sessions of it, I can say that going for counselling is a great decision I’ve made. It helped me through my lowest points and I felt so much at peace during the sessions. I felt understood and cared for. After the 4 sessions, I am able to walk out stronger as an individual and I’m coping much better now. I strongly recommend everyone of you who are struggling now with their life to go for counselling! Step out of your comfort zone and take small steps into finding hope again!"

Female teenager

"Having the greatest mother’s love”, this is the impression I have in my mind for Counselor Carol. Knowing Carol was a blessing to me. She pulled me back from the jaws of death during the time when I had suicide ideation constantly. I was involved in a car accident and was in a state of coma. When I woke up from coma, my whole world collapsed. I lost my mother and I lost my health! I managed to nurse back my health and had to change to another secondary school to continue my studies. I had to walk with the aid of a walking stick to school and my new schoolmates made fun of me. This caused me to hide in my own world, not trusting people and not talking to them. I was alone for the entire 3 long years, until I get to know counselor Carol during my poly studies. During counselling session, Carol gave me valuable advice and helped me to overcome my grief over the loss of my mother. She also helped me to resolve my tumultuous relationship with my father. Carol made me feel that there is still love in this world. This love made me open my heart to accept the world, to accept my situation to face it and confront it! I am sincerely thankful to counselor Carol. She is caring, compassion and skillful. I would strongly recommend anyone who facing any psychological issue to look for counselor Carol. Thank you."

Female teenager

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Book Recommendation

1. An Unquiet Mind by Kay Redfield Jamison

2. Healing the Child Within: Discovery and Recovery for Adult Children of Dysfunctional Families by Charles Whitfield

3. Lost Connections by Johann Hari

4. On Depression: Drugs, Diagnosis, and Despair in the Modern World by Nassir Ghaemi

5. Taming Your Outer Child by Susan Anderson

6. The Boy Who Was Raised As a Dog by Bruce Perry, M.D.

7. The Journey from Abandonment to Healing by Susan Anderson

References:

David A Kessler (2017) MD Capture; Harper Perennial

Felitti, V.J., Anda, R.F., Nordenberg, D., Williamson, D.F., Spitz, A.M., Edwards, V.J., Koss, M.P., & Marks, J.S. (1998). Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study. American journal of preventive medicine, 56 6, 774-786.

Johann Hari (2018) Lost Connections; Bloomsbury Circus.

Maguire, E., Woollett, K., & Spiers, H. (2006). London taxi drivers and bus drivers: a structural MRI and neuropsychological analysis. Hippocampus, 16 12, 1091-101.

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