What Is Underneath Depression
Like anxiety, one of the most difficult aspects of depression is trying to figure out what are the underlying roots of it. But without properly identifying its underlying roots it’s possible that one may see depression simply as a feeling, rather than as a symptom of some deeper feeling. And if you don’t identify this underlying feeling you will find yourself chasing after the symptom of depression, without really being able to treat it in a way that provides healing. In this post I want to discuss some ways to think about depression and how to focus on identifying its underlying emotions.
Depression Is Something That We Do
When clients come into my therapy practice and we are beginning to realize that we are dealing with the issue of depression, I will often hear them saying things like “I feel depressed”, or “I am feeling down” or perhaps “I am feeling blue today”. They are describing depression as something they feel, but I try to reframe the discussion around this idea that depression is not something we feel, but it is rather something we do. We literally do depression, and start acting depressed. I know at this point it may sound like I’m splitting hairs here, and I’m quick to express that sentiment in session to clients as well. But the distinction here is critical. If we don’t distinguish depression as a behavioral response, or coping response to an underlying feeling, then it’s possible that one will only focus on the depression itself and end up treating the coping mechanism long term, without really addressing the root issue. The difference can be life changing.
In the Restoration Therapy model, depression, to become depressed, is placed under the section of Violations of Trust in the Pain Cycle, and is referred to as a coping strategy when one feels unsafe, and needs to escape or numb out.
This insight has been life changing for me because I think that in the early years of my training and work as a therapist I would often just take a client expressing their feeling of depression at face value. Meaning, they said they felt depressed, and I often didn’t take the time to try and understand what underlying feelings drove the depression. I would explore potential triggers, and why and how they thought they ended up depressed, but it never went beyond the inciting event to the emotional level. I have talked at length about my anxiety in my book The Anxious Christian: Can God Use Your Anxiety for Good? as well as in many other forms, but I have talked less about the depression I experienced upon my mom’s death and during other times in life. I think the reason for this is because I understood less about depression than anxiety, and that is probably due to the fact that I focused more on my coping behavior of anxiety. But when I have taken time to explore depression as a behavior, that is as something I do, rather than a feeling, the insight I gained has led to tremendous growth for me. I can say that the same is true for people I work with. When I help them not just stop at saying they feel depressed, but I help guide them to plunge into the depths of feelings underneath the depression, healing and transformation has occurred for them as well.
So how does one try and identify the underlying feelings driving their depression?
Identifying Your Pain Cycle in Regards to Depression
Being that depression falls under Violations of Safety in the Restoration Therapy model, you can begin to deduce that the feelings that are most likely being triggered for someone at a deep level, have to do with their sense of safety. Essentially, their sense of safety is being challenged, and how they respond is to move to a position of escape and numbing out, which in many ways takes on the coping behavior of depression. Whereas, anxiety is attack upon one’s identity and sense of self, depression is attack upon one’s trust and sense of safety in their relationships and life. Knowing this is critical, but how do you start to really zero in on the particulars?
There are several ways that I help someone begin to identify, name, and understand the underlying feelings to their depression. And remember, if you have read my posts on anxiety, the process will sound very familiar. In fact, the statistics for a person being diagnosed with both depression and anxiety, if they are being diagnosed with one of them, are very high. So a similar process can be undertaken for both, and in many cases, I find that it simplifies things, rather than making a complicated procedure for each one.
One, is that in my conversation with them I listen closely to what they are saying about their situation, and I reflect back to them what I believe are some of the feelings they identify or struggle with. This is a powerful way to identify underlying feelings, but it requires someone opening up, and another person listening intently. Two, I love to hand a client a piece of paper in session that has a bunch of feeling words listed on it. I have created a list of feeling words that I culled from the Restoration Therapy book and The Five Days to a New Marriage book, and I find the list to be a very powerful guide for people looking to identify their depression. Often I will give it to clients to take home and sit with and explore for a week or two. Most clients are able to look at the list and begin to clearly define some of the feelings they feel…perhaps for the first time…and then they are able to trace it to their depression as a behavior.
Being able to know what you feel, and then being able to communicate it is so powerful for most people. It not only helps them understand themselves better, but it helps them communicate how they feel to other people. And when they do this, people they are in relationship also have a better understanding and more empathy for them. And this dynamic changes relationships. Let me give you an example from my own life that helps you understand how depression plays out for me from both a violation of trust and safety perspective, as well as from a violation of trust and relationship perspective.
What I have begun to understand about myself is that whenever I start feeling like life is unpredictable, and my future feels unknown, I tend to cope by moving into depression. Whereas my anxiety takes on behaviors that are controlling in nature, my depression takes on behaviors like checking out of life, and numbing out to the feelings that I have. I can trace a lot of these feelings back to my experience after my mom died from breast cancer. I specifically remember feeling depressed every Sunday night when I realized I had to go back to school on Monday. It’s complicated and tricky for me because my anxiety and depression where so often inter-weaved in my experience. But because I felt anxious about going back to school and struggling with my stuttering that I talked about in previous posts, I would then become depressed thinking about this prospect, and I would find myself feeling really down and just wanting to sleep sometimes, or not wanting to go to bed, in order to not have to wake up and face the day again. Of course I am looking back in hindsight and it can be hard at my age today to try and remember what my teenage self was feeling underneath the depression. But I think in my depression I would mainly move into sleeping in and not wanting to get up to face the day. These violations fall under the violation of trust in the Restoration Therapy model, and they are ultimately struggles around my sense of safety.
As I begin to do more work around depression, especially as it relates to the Restoration Therapy model, I believe that depression makes an appearance as a coping behavior both under violations of love and trust, and in all the ensuing actions of blame, shame, control and escape. Though depression is most often placed under violations of trust and in the escape category, I think there is plenty of evidence, and I have lots of examples in my work, and in my personal life, where depression can manifest itself in many different ways and areas.
Focusing on the Root Feelings of Anxiety to Promote Change
It can be fairly easy for myself and others to identify the root feelings driving their depression, but it is often an entirely different challenge to tackle the process of healing those underlying feelings. Developing the Pain Cycle is not that difficult for most people, but once we do that, what do we do next?
Again, like anxiety, one of the ways that I like to frame this opportunity for clients, especially those that I work with from a Christian or faith background, is around the idea of taking off the “old self” and putting on the “new self”. If you aren’t familiar with that language, let me share it here with you briefly. In the bible, in the book of Ephesians, Chapter 4:20-24, the apostle Paul writes the following words:
20 That, however, is not the way of life you learned 21 when you heard about Christ and were taught in him in accordance with the truth that is in Jesus. 22 You were taught, with regard to your former way of life, to put off your old self, which is being corrupted by its deceitful desires; 23 to be made new in the attitude of your minds; 24 and to put on the new self, created to be like God in true righteousness and holiness.
Basically, in identifying the underlying roots of our depression, we are constructing the Pain Cycle, which is the pattern that most of us have operated from for probably the majority of our lives. The Pain Cycle is what I developed in my early childhood experience in my family of origin, as well as in other relationships at school, and in other areas of community life. And it’s these early experiences and the ways that I coped with them, which I have continued to reinforce in my later years. So one of the ways I want clients to think about their depression and the way that it works in their lives, is that it is something they have probably been doing most of their lives…it is part of their “old self.” And in order for them to not automatically operate from their Pain Cycle and let those underlying feelings lead them into depression, they have to not only identify their “old self” at work, but they have to begun to go about identifying and operating out of their “new self”. It’s a process of daily identifying and taking off the old, and putting on the new.
I believe that most people already have and are operating at times out of a “new self” , or what is referred to as the Peace Cycle in the Restoration Therapy model. But when we are unaware of our Pain Cycle, we tend to let it control the us, rather than choosing to operate out of the Peace Cycle.
For example, if someone is depressed, and we have identified that the feeling of “unsafe” is the most prevalent underlying feeling that drives their depression, then we want to begin work on healing that feeling. There are several ways to do this, but here are some of the most common that I have explored in counseling with others. One ways is that I want to help them identify truths about themselves, often coming from three different sources: a) truth from God…that is, how does God see them? Does God see them as safe, or provide safety for them, or do they feel they are unsafe, even in God’s eyes (and hands)? This can be a challenge for people struggling spiritually; b) truth from others…that is, what have they heard communicated to them from others over the years? What messages have been communicated in terms of being “unsafe”. Again, this type of truth can be powerful because it comes from an outside source, but it can be challenging because we don’t want to help someone base their truth about themselves on an external source that is not consistent; c) truth from themselves…that is, what do they believe deep down inside about themselves? Do they believe they are safe, or can provide safety for themselves?
Working through these truths is an important component in helping a person transform their underlying feelings that trigger their depression.
Another way to help someone in counseling deal with the root feelingss that trigger their depression is to simply set up some experiments they can practice that put them into contact with their depression in such a way that they learn not only to be okay with depression, but they learn to navigate it. For example, in the case of someone who is depressed, and underneath the depression they would describe themselves as feeling emotionally unsafe in their relationships, one of the major things I would have them focus on and experiment and practice with would be their relational boundaries. I would encourage them to experiment with some specific boundaries in some specific relationships, and ask them to simply notice what that experience is like and how it affects them. The feedback they receive from experimenting and noticing their boundary setting as it relates to emotional safety, and ultimately depression, can and will be a helpful guide for them moving forward.
Chase the Underlying Feeling, Not the Symptom
I know I sound like a broken record at this point, but the point is worth repeating. And that is, like anxiety, if you are someone who is struggling with depression, or you are working with someone who does, do yourself a huge favor…don’t chase the depression because you are only pursuing the symptom. Instead, help that person dive deep into, and explore what underlying feelings may be triggering the depression. Are they questions about their sense of safety and trust, or are they questions about their identity and personhood? Perhaps the depression hits on all those areas. But as you help them identify the underlying feelings, and you keep depression as a response (identifying the Pain Cycle)…as something they do, you will draw some clear distinctions in terms of helping the healing process. This distinction will give you clarity on the feelings that you must work towards treating, and the actions that will help them work towards not being depressed, and moving out of the depression in a positive way (the Peace Cycle). If you can do this, you will be able to help most anyone you work with who has depression problems.
Rhett Smith is a Licensed Marriage and Family Therapist in private practice in Plano, TX. He specializes in helping people struggling with anxiety find new opportunities for growth, as well as spending a majority of his week with couples as they navigate relational issues. He is the author of The Anxious Christian: Can God Use Your Anxiety for Good? and What It Means to Be a Man: God’s Design for Us in a World Full of Extremes. Rhett lives in McKinney, TX with his wife Heather and their two children. You can discover more about Rhett’s work through his writing and podcast at rhettsmith.com