Spotlight Session: Depression

Lyn Worsley is a Clinical Psychologist and Director of the Resilience Centre in Sydney. She is the author of the Resilience Doughnut, an internationally recognised framework that helps identify contexts for building resilience, including managing mental health. On 21st October 2024, she delivered a spotlight session on Depression. This article, written by Guan Un, summarises Lyn’s presentation.

You can learn more about Spotlight Sessions and upcoming events from the Mental Health and Pastoral Care Institute here.

What Is Depression?

All of us have ups and downs—that is normal. But it helps to understand that there are different types of depression:

  • Depressive episodes
  • Reactive depression
  • Clinical depression
  • Bipolar disorder

 

Regardless of which type someone might have – they are all crippling, and affect work, home life and choices. Managing any mental health condition, including depression, is trial and error until you find what works, or what combination of treatment works.

Depressive episodes or reactive depression

Both types of depression can be a reaction to:

  • Change of life circumstances
  • Medical condition or reaction to medication
  • Trauma
  • Drugs/alcohol use
  • Loss of support networks
  • Death of a loved one

 

In particular, Lyn talked about liminal spaces as a catalyst. Liminal spaces are the points in life where our identity comes into question and there is a change of life stage, e.g., school to university, becoming a parent, or the death of a loved one. These things can bring up questions of identity which can trigger a depressed mood. They can also be a point where you can gently ask, ‘What learning is going on for you?’

Clinical Depression

In contrast to the above, for someone to be in clinical depression means they will be in a daily depressive state, for two weeks or more. It might involve unpredictable bouts of low mood and a very fixed thinking pattern. Often people feel a crippling sense of shame, or low personal agency. For example, they may say or think, ‘I can’t be bothered.’ Or, ‘Nothing I do makes a difference’.

Other signs and symptoms of clinical depression include:

  • Feeling sad, anxious or “empty”
  • Feeling hopeless, worthless or pessimistic
  • Crying a lot
  • Feeling bothered, annoyed or angry
  • Loss of interest in hobbies or interests
  • Decreased energy/increased fatigue
  • Difficulty concentrating, remembering or making decisions
  • Difficulty sleeping, waking early, or oversleeping
  • Appetite and weight changes
  • Chronic physical pain
  • Thoughts of death, suicide, self-harm.
Prevention

Prevention is when we stop the thoughts and memories forming. As you learn more about your body and your brain, you may start to get better at noticing the signs that you’re not coping as well as you’d like. Awareness of those things can help you take preventative action. We all need to be aware of when we’re not coping but some of us will likely need more prevention tactics than others. For example, those who have a history of mental illness in the family, if there’s been abuse or neglect, introverts (because they pull back from people more), those with past trauma, or when depression/anxiety have occurred earlier in life.

How Do You Treat Depression?

The Basics

These five basic factors have the most effect:

  1. Stay connected: loneliness can both cause and exacerbate depression. Keeping connected to friends is important.
  2. Exercise: movement boosts brain chemicals and moving outside boosts Vitamin D. Try to get some movement in as many days of the week as you can.
  3. Sleep: focus on healthy sleep routines and aim for 7-9 hours a night (one of the best things you can do for this is exercise!). In deep REM sleep, the unconscious brain processes what happened during the day and is very useful for getting out of a depressive state.
  4. Eat well: if you get used to having too much sugar in your diet, then your body gets used to that level of blood sugar, and you’ll be prone to crashes, which can also lead to feeling depressed.
  5. Limit alcohol: it can make you feel better in the moment but is not effective as a long-term coping strategy and can worsen symptoms.

 

These things seem basic, but depression can make these basic things much more difficult to do. Friends can make a big difference by coming alongside one another and doing some of these things together.

Talking Therapies

These are the types of therapies that work with depression:

  • Cognitive therapy: this is about looking at the patterns of how you think and substituting them for more helpful thinking patterns. Sometimes these patterns of thinking have been passed down from a family of origin, or some other experience.
  • Narrative and Solution-focused therapy: this kind of therapy is about reframing your story based on your values. For example, Lyn was working with a young woman who discovered she had late-stage cancer. This woman said to Lyn, “It’s not about what’s happening to us, it’s about who we are in the process.”
  • Psychodynamic psychotherapy: this kind of therapy looks at depression as information, rather than a disorder. Rather than, ‘What’s wrong with me?’, it asks, ‘What information is my brain and my body trying to give me?’. It asks you to step outside of your life for a moment and consider what your brain is trying to tell you about your situation. Or, from a Christian perspective, “Okay, God, what can I learn here?”
  • Self-awareness: rather than thinking of ‘getting rid of a disorder’, this focuses on learning and what you can use for another time.
Medication

If someone is feeling really stuck, they may need medication. Medication will work differently and have different side-effects for every person. The most important part of medication is having someone who works with you to help track the changes over time to discover what works best.

Social Prescribing

Social prescribing is where social activity is ‘prescribed’ instead of medication. What other research has shown is that social activities can be as good as medication, especially when that activity is based around an activity or common interest. This is why attending church, or a church activity, can be a helping factor. Even if someone’s not in a place to listen to the sermon, it can still help them connect with others socially.

The Resilience Doughnut

The Model

Lyn created the ‘Resilience Doughnut‘¹ to help model the social determinants of good mental health. In the middle of the doughnut, there are three phrases that represent people’s beliefs and how they see the world and themselves: I Have, I Am, I Can. These are the messages we carry around with us, e.g., I havepeople that can help me cope. I am a good person. I can do things that will change my circumstances.

On the outside of the Resilience Doughnut are seven factors where we might get those messages from:

  • The Partner Factor: if you have a partner who is supportive but also gives you room to find agency.
  • The Skill Factor: having something that you’re good at, which reinforces the ‘I Can’ message.
  • The Family + Identity Factor: your family of origin.
  • The Education Factor: involves learning (including this article and other resources from MHPCI!).
  • The Friends Factor: friends who will be able to see where you’re at and know some of what you need.
  • The Community Factor: church or a community group.
  • The Work Factor: your job, or a volunteer group.

 

Some of these factors will be stronger and have more influence than others. In Lyn’s experience, when you can have three of these factors that are strong, then you will start to build resilience, and see a sharp increase in mental and physical wellbeing.

Tipping Points

A tipping point is when one (or more) of these strengths are lost or removed. This might be because of trauma, relocation, or transition from one stage of life to another (e.g., moving out of home, leaving a job). Lyn gave the example of someone who has a job they like (skill factor), in a stable job (work factor), and with good friends in that environment (friends factor). If you stop working because you have a baby or must leave for another reason, all those three factors are suddenly gone. So, it’s important to work on building these factors back up.

For example, Lyn and Sarah Condie ran a pilot program based on some of this research. Sarah noticed that women who had been in high-powered jobs seemed to struggle with the transition from work to motherhood. So, they had new parents meet up together once a month, to connect, and to increase their resilience. The research showed that anxiety, depression and stress all dropped by the end of the program.

Supporting Someone With Depression

Some of Lyn’s top tips are:

— Walk alongside but don’t take over. Let them have agency and remain the agents of change in their lives

— Listen and ask questions more than you dish out advice

— Create opportunities for connection. For example, pick them up for activities and initiate connections.

— Create some dissonance by demonstrating your own good mental health and connections.

Suggested Resources

Phone Numbers 

Websites

References
  1. Worsley, L., & Hjemdal, O. (2020). The psychometric of the adult Resilience Doughnut model, a solution focused, ecological model of resilience. Journal of Solution Focused Practices, 4(2), 15–32.
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