Strengths Based Biopsychosocial Approach to Recovery from Depression
Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC
Executive Director, AllCEUs
Podcast Host: Counselor Toolbox and Happiness Isn’t Brain Surgery
Objectives
~ Define depression (symptoms)
~ Learn how to ask strengths-based assessment questions
~ Identify a range of potential causes for depression
~ Explore activities and interventions that can help people address some of the underlying causes

Depression
~ Depression represents a cluster of symptoms
~ Diagnosis with depression only requires people to have a few of the symptoms
~ A variety of different things can cause depression
~ Emotions: Anger, anxiety, grief, guilt, shame
~ Thoughts: Cognitive distortions
~ Relationships: Poor self-esteem, unhealthy/unsupportive relationships, need for external validation
~ Physical: Neurochemical imbalances, poor nutrition, exhaustion, insufficient sleep, medication side effects
~ Environmental: High stress environments that prevent relaxation/rest and increase hopelessness/helplessness

Depression Assessment
~ What does this mean to you? (apathy, sadness, mood swings)
~ Which symptoms are most bothersome for you and why?
~ For each symptom
~ What makes depression worse?
~ What makes depression better?
~ How was life more pleasurable prior to getting depressed?
~ What is different during when you are NOT depressed?
~ How do you expect life to be different when your depression is gone?
Neurotransmitters
~ Ability to feel pleasure/Apathy/Emotional Flatness
~ Memory issues
~ Difficulty concentrating
~ Sleep issues
~ Lack of motivation
~ Fatigue
~ Pain
~ Irritability/Agitation
~ Fight or flight stress symptoms

Neurotransmitters
~ Get quality sleep
~ Create a routine
~ Address pain and apnea
~ Improve the sleep environment
~ Other factors: Shift work, time zones, daylight savings time
~ Relaxation
~ Biofeedback
~ Progressive muscular relaxation
~ Address medication side effects
~ Psychotropics
~ Opiates
~ Improve nutrition
Neurotransmitters
~ Address addictive behaviors
~ Address chronic or extreme stress
~ Refresher
~ Both of these increase the amount of neurotransmitters flooding the synapses.
~ To protect the body from overload, the brain shuts down some of the receptors so the body does not overload (tolerance/desensitization)
~ When the neurotransmitters return to a normal level, the receptors are still shut down, so not enough neurotransmitter gets sent out.
~ Things that normally caused a reaction, no longer are strong enough to cause a reaction
Hormones
~ Thyroid
~ Impact mood, libido and energy levels
~ Estrogen
~ Boosts neurotransmitters that affect sleep, mood, memory, libido, pain perception, learning and attention span.
~ Increased estrogen may increase the availability of serotonin Behavioral and Cognitive Neuroscience Reviews Volume 4 Number 1, March 2005 43-58
~ Low testosterone may be implicated in reducing the availability of serotonin
~ Testosterone is manufactured by the adrenal glands,
~ Enhances libido, improves stamina and sleep, assists brain function, and is associated with assertive behavior and a sense of well-being.

Hormones
~ Cortisol
~ Cortisol is made by the adrenal glands.
~ Helps the body adapt to stress by increasing heart rate, respiration, and blood pressure.
~ Cortisol levels increase early in the morning to prepare to meet the demands of the day, and gradually decrease throughout the day (“circadian rhythm”).
~ DHEA
~ DHEA can also increase libido and sexual arousal. It improves motivation, engenders a sense of well-being, decreases pain, facilitates the rapid eye movement (REM) phase of sleep, enhances memory and enhances immune system function. Dr. Elise Schroder http://womeninbalance.org/about-hormone-imbalance/hormones-101/

Hormones
~ Get a physical to identify and address what may be causing any imbalances
~ Eat a low-glycemic diet
~ “The less sleep you get, the higher your cortisol will be; the more sleep you get, the lower your cortisol will be.” John Romaniello, co-author of Man 2.0 Engineering the Alpha: A Real World Guide to an Unreal Life.
Hormones
~ Final Thoughts on Hormonal Imbalances:
~ Hormonal imbalances affect many millions of people
~ Symptoms include feeling anxious, tired, irritable, gaining or losing weight, not sleeping well and noticing changes in your sex drive, focus and appetite
~ Causes for hormonal imbalances include poor gut health, inflammation, high amounts of stress, genetic susceptibility, and toxicity
~ Natural treatments include eating an anti-inflammatory diet, consuming enough omega-3s, getting good sleep, exercising and controlling stress

http://draxe.com/10-ways-balance-hormones-naturally/

Pain
~ Exercise
~ Guided imagery
~ Muscle Relaxation
~ Alternate focus
~ TENS therapy
~ Physical therapy
~ Hydrotherapy
~ Ice/Heat
~ Hypnosis
Emotions
~ Anger/Resentment/Jealousy/Envy/Guilt
~ Anger is half of the fight or flight
~ It pushes people away and/or asserts dominance/control
~ Excessive anger can
~ Exhaust the stress-response system
~ Contribute to negative cognitions
~ Impair relationships
~ Cause physical harm
Emotions
~ Anger/Resentment/Jealousy/Envy/Guilt
~ Activity (Group or Individual)
~ When you are angry, what do you notice?
~ What are your anger triggers?
~ Why do those triggers make you feel vulnerable?
~ Is it an external threat?
~ Is it an internal threat?
~ How can you address each trigger to feel safer and more empowered?
Emotions
~ Anger/Resentment/Jealousy/Envy/Guilt
~ Jealousy and envy can be thought of as:
~ Anger at someone else for having something you want
~ Self anger for not having it
~ Existential anger for the universe not being fair
~ Activity
~ Make a list of people you envy or are jealous of?
~ Identify why you are jealous of them?
~ In what way are they better or better off than you because of those things?
~ How does envy/jealousy affect you?
~ What is a more productive way to use this energy
Emotions
~ Anger/Resentment/Jealousy/Envy/Guilt
~ Guilt can be thought of as shame, embarrassment or self-anger for something you did or should have done
~ Some people have difficulty letting go of guilt because they think
~ They deserve to suffer
~ If they forgive themselves they might do it again

Emotions
~ Anger/Resentment/Jealousy/Envy/Guilt
~ Activity: Guilt
~ Make a list of things you feel guilty about (aka fearless moral inventory)
~ How can you:
~ Make amends?
~ Learn from it?
~ Forgive yourself?
~ Activity 2: Forgiveness
~ What does forgiveness mean to you?
~ How does the concept of forgiveness make you feel
~ What does the phrase “Forgiveness is for you” mean?
Emotions
~ Anxiety
~ Anxiety is the other half of fight or flight
~ Chronic anxiety/worry/stress will also exhaust the stress response system causing neurochemical and hormonal imbalances and increasing muscle tension and pain
~ This causes the body to adapt to excessive stress chemicals by shutting down the receptors y

Emotions
~ Anxiety
~ Activity
~ For each of the following fears, identify three situations in which you experience it
~ Rejection/Isolation
~ Failure
~ Loss of control
~ The Unknown
~ Explore why those situations trigger anxiety
~ Brainstorm ways to deal with them
Emotions
~ Grief
~ Grief is sadness/depression experienced as a result of loss
~ The grief process involves
~ Anger (at self, other, existential)
~ Depression
~ Helplessness to change the situation
~ Hopelessness that you will move on
~ Losses are not just about death

Emotions
~ Grief
~ Activity Part 1: Loss Identification
~ Identify your losses
~ Existential (dreams, hope, faith, safety, independence, innocence…)
~ Social (moves, death (people & pets), relationships ending)
~ Physical (abilities, health, appearance)
~ Property (houses, favorite bike, grandmother’s broach)
~ Explore what about each of those losses makes you angry or fearful
~ Develop an action plan to deal with that anger and fear
~ Give yourself permission to grieve

Emotions
~ Grief
~ Activity Part 2: Acceptance
~ True losses cannot be reacquired.
~ The final step in the grief resolution process is acceptance.
~ What does acceptance mean to you?
~ For each of your losses, describe what acceptance means
Emotions
~ Happiness… (Duh!)
~ You cannot be happy and depressed at the same time
~ Happiness chemicals reduce stress and depression chemicals (I know, real clinical explanation there!)
~ Increase the happy times
~ Comedians
~ Children (even youtube videos of babies laughing)
~ Animal Videos
~ https://www.youtube.com/watch?v=Ln2Xq8fCNI8
~ https://www.youtube.com/watch?v=FMBchZmPlXA

Cognitive
~ Negative thinking styles
~ Contribute to exhaustion
~ Highlight what is out of your control
~ Heighten a sense of helplessness/hopelessness (depression)
~ Cognitive distortions
~ All-or-Nothing (Nobody ever)
~ Self-fulfilling prophesies

Relationships
~ Poor self-esteem
~ Contributes to self-loathing, shame and a feeling of unlovability
~ Negatively impacts relationships (loneliness/rejection)
~ Often causes a person to seek external validation
~ Activity:
~ Complete a self-esteem inventory
~ For all the characteristics you don’t have, answer the question:
~ If your child/best friend had this flaw, would I still love them?
Relationships
~ Unhealthy/unsupportive relationships
~ Negative relationships can take a toll on self esteem
~ Fears of abandonment can maintain high levels of stress and feelings of helplessness
~ Fail to buffer people against stress
Environmental
~ High stress environments
~ prevent relaxation/rest
~ increase hopelessness/helplessness
~ Increase stress hormones / decrease relaxation hormones
~ Activity
~ Design a low stress area in
~ Your home (bedrooms are good)
~ At work/school
~ Identify ways to reduce the stress in your environment in both places (noise, interruptions, poor lighting, negativity)
~ Identify ways to turn the negative into a positive

Why I Care/How It Impacts Recovery
~ We experience emotions through neurochemical signals
~ Imbalances in the neurochemical system
~ Depressive symptoms are huge triggers for relapse
~ Identifying what causes these neurochemical imbalances for each individual and addressing them is crucial to recovery
~ What helps?
~ What makes it worse?
~ What is different when the problem doesn’t exist?
Apply It
~ Identify 3 ways you could have used this information in the past week.
~ What intensified your depression over the last week
~ What made you happy or helped you feel better
~ If you would have had this new information, what could you have done differently?
~ How would that have helped you feel less depressed?
~ How can you start integrating this knowledge into your routine
Summary
~ Depression is the cluster of symptoms created when there is a neurochemical imbalance in the brain.
~ What causes the imbalance can be emotional, cognitive, physical, interpersonal, environmental or some combination of the above.
~ Part of the strengths based approach means helping people see what they already are doing to prevent or deal with the symptoms
~ Biopsychosocial means
~ Examining all causative factors
~ Recognizing that all factors are reciprocal in nature.