Unhelpful Thinking Styles

The information here is consolidated from half a dozen documents from various sources that I have found over the years as I’ve learned about depression and how to battle it.

People experiencing depression or anxiety (or both) often have automatic ways of thinking which can exacerbate the emotional state. Because these thinking styles are automatic they can be difficult to change, but simply identifying when they occur is a good step on the road to changing our default thinking mode.

All or nothing thinking

Viewing things in absolute, black-or-white terms, without recognising any middle ground.

  • success or failure
  • perfect or worthless
  • either I do it right or not at all

Blaming

Focusing on who is to blame for a problem rather than what can be done to solve it.

Mental filter

This is a sort of tunnel vision in which you focus on only one part of a situation and ignore the rest. Usually it involves focusing on only the negatives and ignoring the positives.

Jumping to conclusions

It would be nice to think that whenever you have a hunch about something is is correct, but the reality is that often we are wrong in our hunches. If we rely on this type of thinking it can lead to problems. There are two key types of jumping to conclusions:

  • Mind reading: Imagining you know what others are thinking, feeling or intending to do. This is a very common way of thinking.
  • Fortune telling: Predicting the future. Making negative predictions about how something will turn out.

Emotional reasoning

Assuming that because you feel a certain way then what you think must be true. Have you ever felt anxious about something and thought to yourself, “I know this isn’t going to work out well” yet everything turned out just fine? This is emotional reasoning. “I feel, therefore it is” is not valid logic.

  • I feel embarrassed so I must be an idiot.
  • I feel anxious, something bad is going to happen.

Labelling

Assigning global, negative labels to yourself or other people. By defining yourself or other people by one specific behaviour, usually one you consider negative, you are ignoring all the other positive aspects of yourself or others.

  • I’m such an idiot.
  • I’m completely useless.
  • They’re so inconsiderate.

Over-generalising

Drawing sweeping conclusions based on a single incident. Seeing a pattern based upon a single event, or being overly broad in the conclusions you draw.

  • Everything is always rubbish.
  • Nothing good ever happens.
  • Things never turn out well for me.

Catastrophising

Blowing things out of proportion. Viewing a situation as terrible, awful, horrible. Taking what might be a slight problem and viewing the most extreme negative version of it.

  • What if… !!!
  • Oh no …

Downplaying positives

Minimising or dismissing your positive qualities, achievements or behaviours by telling yourself they are unimportant or do not count. This may include exaggerating the positive qualities of other people while downplaying your own attributes.

  • That doesn’t count, I was just lucky.
  • They didn’t really mean it, they were just being polite.

Shoulds and musts

Focusing on how things or people ‘should or ‘must’ be. Treating your own standards or preferences as rules that everyone must live by. It is not always unhelpful to think, “I should get my work done on time”, but if the ‘shoulds’ or ‘musts’ become unreasonably demanding it leads to guilt and disappointment.

Personalisation

Blaming yourself or taking responsibility for something that wasn’t completely your fault. Telling yourself that events relate to you when they may not.

  • This is my fault.

Intolerance of uncertainty

Struggling to accept things being uncertain or unknown.

  • What if something bad happens?

Serotonin and Depression

This post is an attempt at summarising and explaining a paper called 5-HT and depression: is the glass half full? Authored by Trevor Sharp and Philip J. Cowen which was published in Current Opinion in Pharmacology, 2011 volume 11 pages 45–51.

The theory that abnormally low levels of the neurotransmitter serotonin (also called 5-hydroxytryptamine, 5-HT) can cause depression is now 50 years old.

The theory arose when it was noticed that depressed patients had low serotonin levels in cerebrospinal fluid, and also that the first effective antidepressant drugs had the effect of increasing the amount of serotonin in the gap between neurons (the synaptic cleft). Since then the old tricyclic antidepressants have been replaced with medications that more accurately target serotonin, the ‘selective serotonin re-uptake inhibitors’ (SSRIs) which have fewer adverse effects and tend to be more effective at relieving depression symptoms.

Despite the progress since 1967, up to half of the patients prescribed antidepressants do not get enough relief from their symptoms, and pharmacologists still don’t clearly understand how changes in serotonin translate to altered mood.

That 5-HT (serotonin) is associated with mood and depression has been shown by pharmacological studies and also positron emission tomography (PET) studies looking at the distribution of 5-HT receptors in the brains of depressed patients. Other studies have shown that artificially restricting dietary intake of the amino L-tryptophan can cause a return of depression symptoms in patients with a history of depression. This is significant because L-tryptophan is the precursor (chemical building block) of 5-HT. Similar L-tryptophan depletion in people who have a high family incidence of depression but themselves have not had depression caused a less severe lowering of mood.

Genetic components

Depression does run in families, with a moderate to high heritability (heritability is a measure of how likely a trait is inherited, low means less likely and high indicates it is more likely to be inherited in a population).

One particular gene, slc6a4, which codes for the 5-HT transporter protein, has been well studied. Levels of the 5-HT transporter can vary by up to sevenfold within the general population. Individuals with low levels of this 5-HT transporter have increased risk of depression when associated with stressful life events. The region of this gene where it is regulated (i.e., ‘the volume control’) is rich in methylation sites which can result in semi-permanent changes to gene expression as a result of environmental influences (such as a stressed or depressed mother during pregnancy, stressful events, childhood trauma).

Neuronal Repair

Current thinking is that increased synaptic 5-HT activates a downstream gene programme that leads to enhanced neuronal plasticity which has failed because of the adverse effects of stress and other environmental and genetic factors.

In effect, some sort of stress derails the ongoing repair and maintenance of brain ‘circuitry’ which can be overcome by bumping up serotonin levels in neurons.

This idea of serotonin enabling improved neuronal plasticity in depressed patients dovetails nicely with ideas of how psychological treatments (such as counselling, CBT, DBT) function to help treat depression. Psychotherapists help a patient to reframe situations and learn more positive ways to view situations. With increased serotonin levels enabling neural repair and realignment of neural pathways, learning is facilitated and so the therapy and drug treatment work together.

serotonin effects

I don’t want to know the future

The notebook I’m currently using for writing has some notes in the back of it written in mid-2008 when I was trying to find a way forward from being in a state of burnout. Looking back on the almost ten years since then I’ve come a long way, yet am now glad I could not see much of the path ahead at the time.

In June 2008 I applied for a job as a technical writer for a software company but was unsure if I would get the job so tried to plan how to cope with the next six months in the job I already had. As it turned out I did get the new job, which was a real blessing and gave a reprieve from the stress I had previously been carrying. What I didn’t see but is now obvious to me reading what I wrote back then, is the warning signs of depression.

The change in work enabled me to recover somewhat but two years later the black dog returned and this time there was no denying it. At least his forced me to seek help, beginning a long journey of trying to find a medication combination that worked for me. By this time I’d moved on to what in many ways was a dream job for me, but it came with the downside of a 24/7 roster. In time the shift work messed with my body clock enough to make the next cycle of depression much worse than any before, necessitating a week’s stay in a psychiatric hospital. Recovery that time was long and painful, at least a year before I could consider myself ‘normal’ and not a joyful normal at that.

This is why I’m glad I could not see the future for me in 2008. If I could have seen what was ahead I probably would have given up or run away and hidden from the world. But if I had known what was to come, could I have taken steps to avoid it?

On this I’m not sure. Certainly I’ve learned signs to watch for  so now seek help sooner than I did in the past. I also know some of the circumstances and situations that can precipitate depression so take steps to avoid or reduce the effects of those situations. However, life always carries a certain amount of stress and my depression has a definite cyclic pattern so I doubt that I could have completely avoided it.

The approach I now take is to have fences to keep the black dog out, a stick handy to push if back if it gets too close, and I try to live as fully as I can when it is not around. Yet I still hear it barking in the distance.

Do not be afraid

Be strong and courageous. Do not fear or be in dread of them, for it is the LORD your God who goes with you. He will not leave you or forsake you. (Deuteronomy 31:6 ESV)

Do not fear or be in dread, the Lord your God goes with you. He will not leave or forsake you. For those of us who live in the ambiguity of faith and depression these are astonishing words.

An impossible command

Firstly, to be depressed and told not to fear or dread is an impossible thing. Fear, dread, anxiety are hallmark traits of this mental illness and those who are unwell cannot prevent these emotions and associated thoughts from occurring. Yet the Bible consistently commands us to do the impossible, for example:

Count it all joy, my brothers, when you meet trials of various kinds, (James 1:2 ESV)

Normal people do not consider it joy when things are going badly, they get upset, annoyed, grumpy and sad. Joy in such situations springs either from some sort of delusion or from a hope or goal which is unaffected by the current circumstances. The command to have joy or to rejoice is rife in the New Testament.

What is the point in commanding something that is humanly impossible to fulfill?

Moses, the prophets, the apostles and God Himself are well aware of our weaknesses and that while we might be willing in spirit to live a life of purity, holiness and discipleship, in the messiness of real life it is usually only a short time before we stumble and fail to live up to our high aspirations (see Mark 14:38). This is true for each of us as individuals and even on a national scale for historical Israel.

Failure in obedience to God to inevitable, but sometimes we are like Peter and cannot be told so have to experience it first hand. Then once we are faced with the shattering truth of our failure, inability and sin, we say to God, “don’t come near me, I am too sinful” (see Luke 5:8). At this point we are given the promise of God’s presence:

The LORD your God who goes with you.

The unshakeable promise

Like the kid facing a bully whose Dad says, “Don’t worry, I will come with you”, God promises to cross over the Jordan river into the land of Canaan with the Israelites to face their enemies.

Remember that this is the God who parted the Red Sea and destroyed the Egyptian army, who opened the earth to swallow those who challenged His authorised spokesman, and faithfully provided food for the horde of Isrealites for 40 years in a desert. God is powerful, well worth having beside you in a fight.

How about when the ‘enemy’ is from within? When my fear is fueled by my own heart and mind? Power and strength are great but I am anxious that could crush me.

In Jesus we see much more of who God is than unlimited power, Isaiah says this about Him:

Surely he has borne our griefs
and carried our sorrows;

(Isaiah 53:4)

In fact, to make it clear, Jesus also promised, “I will never leave you nor forsake you” (Hebrews 13:5) and “I am with you always, to the end of the age” (Matthew 28:20). Whenever the same idea is repeated in the Bible it is to emphasise that it is important and can be trusted. Even in the depths of despair when it feels as if God has deserted me, I can trust that He determined long ago not to do so.

An unseeable promise

But I still do not see or sense God near me. This is not surprising when God is described in the Bible as “the invisible God” (Colossians 1:15), and “eternal, immortal, invisible” (1 Timothy 1:17) with Jesus telling us that, “No one has ever seen God” (John 1:18).

What then did Jesus mean when He said, “I will never leave you nor forsake you” yet about a month later the disciples saw with their own eyes as He ascended into heaven?

God is spirit, and Jesus had previously told His disciples, Nevertheless I tell you the truth: It is expedient for you that I go away; for if I go not away, the Comforter will not come unto you; but if I go, I will send him unto you. (John 16:7 ASV). The Comforter, (also translated as ‘Helper’, ‘Counselor’, ‘Advocate’) is the Holy Spirit and this is the One who is promised to never leave us or forsake us.

As Spirit we cannot interact or sense God through our physical senses. However, we are not only physical beings, we have a spirit too and God gives life to our spirit through rebirth by faith in Jesus as the Son of God. This means that my spirit can commune with the Holy Spirit who is always present.

I may not be able to feel it through my senses, but I can worship God, pray to Him, cry out to Him and be heard and helped by Him all in the realm of the spiritual no matter what my physical, mental or emotional state. He will not leave, He will not abandon me, and He can strengthen me by His Spirit. Fear and despair may come, but they need not overwhelm me.

Christians Get Depressed Too

I have recently finished reading Christians Get Depressed Too by David Murray (the Kindle version). The overall thrust of the book is to correct the common idea amongst Christians that depression is caused by sin or a broken relationship with God and that taking antidepressants is to exhibit a lack of faith.  Murray outlines the various factors which appear to contribute to depression and presses the point that for many people their depression has an organic, physiological  cause.
David Murray also points out that the biblical counselling movement falls short in it’s common assumption that pharmaceutical treatments for depression are simply masking the real problem. While from a neurochemical perspective there is grounds for thinking that current drug treatments do not necessarily target the true physiological cause of depression, they certainly do have more than just a placebo effect.

Something I do appreciate is the author’s reassurance that for most Christians who are depressed being ‘unspiritual’ is not the main issue and that going overboard on reading the Bible and praying is unnecessary. In fact it may compound the problem by causing the person to get even more introspective when they would do better to get out and simply be around other people.

It is a fairly light read but an OK introduction to the topic. For all that, it is a good summary and I think pastors in particular would do well to read it.