459 – Biopsychosocial Impact of Depression and Strategies for Prevention and Intervention

CEUs are available for this presentation at AllCEUs

 Biopsychosocial Impact of Depression and Strategies for Prevention and Intervention
Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC
Executive Director, AllCEUs
Podcast Host: Counselor Toolbox, Case Management Toolbox, NCMHCE Exam Review
• Define depression (symptoms)
• Explore the biopsychosocial impact
• 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 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 and be caused by depression
• Emotions: Anger, anxiety, grief, guilt, shame
• Thoughts: Cognitive distortions
• Relationships: Poor self-esteem, unhealthy/unsupportive relationships, need for extremal validation
• Physical: Neurochemical imbalances, poor nutrition, exhaustion, insufficient sleep, medication side effects
• Environmental: High stress environments that prevent relaxation/rest and increase hopelessness/helplessness

Strengths-Based 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 times when you are NOT depressed?
• How do you expect life to be different when your depression is gone?
Neurotransmitter Imbalances
• 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

• 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
• Opioids
• Improve Nutrition
• 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
• Thyroid
• Are altered in response to chronic stress
• Impacts 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
• Testosterone
• 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.

• 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”).
• Insufficient cortisol (glucocorticoid resistance) can lead to HR and BP reductions as well as reductions in energy and motivation
• DHEA levels decrease as we age
• DHEA can 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.

• 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.
• 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 and depression, genetic susceptibility, and toxicity
• Natural treatments include eating an anti-inflammatory diet, consuming enough omega-3s, getting good sleep, exercising and controlling stress


• Low serotonin is associated with increased pain perception
• Depression contributes to muscle tension as well as stiffness and achiness
• Interventions
• Exercise
• Guided imagery
• Muscle Relaxation
• Alternate focus
• TENS therapy
• Physical therapy
• Hydrotherapy
• Ice/Heat
• Hypnosis
• 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 lead to depression when it
• Exhausts the stress-response system
• Contributes to negative cognitions
• Impairs relationships
• 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
• Jealousy may contribute to feelings of hopelessness and helplessness
• 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 your ability to live a rich and meaningful life?
• What is a more productive way to use this energy?
• 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

• 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?
• Let it go?
• Guilt Bill of Rights
• 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?
• Forgiveness fire activity
• 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?
• Is this a current threat or something from your past?
• Does this threat keep you from living an RML?
• How can you address each trigger to feel safer and more empowered?
• 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 à apathy
• Anxiety makes it harder to sleep exhaustion  hormonal imbalances  depression

• 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
• Fact checking
• Guided imagery
• Dialectics (See it as a challenge)
• 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

• 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, fearful or hopeless (depressed)
• Develop an action plan to deal with those unpleasant feelings
• Give yourself permission to grieve

• 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
• Other Activities
• Narrative therapy (chapters or letters)
• Wind chimes
• Sun/light catchers
• Happiness… (Duh!)
• Happiness chemicals reduce stress and depression chemicals (I know, real clinical explanation there!)
• It is possible to be depressed about one aspect of your life and happy about 5 others.
• Generally you will not be happy and depressed in the EXACT same moment.
• Increase the happy times
• Comedians
• Focus on what is going right
• Congratulate yourself for progress not perfection
• Exercise
• Environmental happiness triggers

• Negative thinking styles
• Contribute to exhaustion
• Highlight what is out of your control
• Embrace the dialectics by identifying the parts that are in your control
• Heighten a sense of helplessness/hopelessness (depression)
• Cognitive distortions
• All-or-Nothing (Nobody ever)
• Find the exceptions
• Self-fulfilling prophesies
• Positive mental imagery
• Personalization
• Find 3 alternate explanations

• 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: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?
• Activity: Group Snowflakes
• Activity: Sell Yourself
• 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 à exhaustion  neurotransmitter imbalances depression
• Interventions
• Enhance adult attachment with people who CARES (Consistency, Attention, Responsiveness, Empathy, Solution Generation) Explore what each looks like.
• Do CARES activities for yourself
• Address prior abandonment experiences
• Enhance mindfulness

• 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
• Turn the negative into a positive
• Noisy family
• Have to go to work

Why I Care/How It Impacts Recovery
• We experience emotions through neurochemical signals
• Imbalances in the neurochemical system à problems in mood, concentration, energy, libido, sleep and eating behaviors  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?
• 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.