A special thanks to Emily Shurr for her research assistance on this
month's article.

This month we address another epidemic in mental and emotional health - that of Depression. What do we need to know about it?  How does it work? And, how can we treat it effectively?

One of the primary experts on treating depression using direct and indirect approaches is Michael Yapko, Ph.D. (NOTE: Michael is teaching our July 25 teleseminar-see above). His specializations include using hypnosis with clients and educating therapists and psychiatrists about the shortcomings of medication in treating the condition:

"Depression is more a social problem than a medical one, and no purely biological cure will be found for it, any more than biology alone will cure other social ills such as poverty or child abuse."

                                                                        - Michael Yapko, PhD

According to Yapko-and you may have noticed similar dynamics in your own practice-medication alone doesn't solve the problem. Antidepressants can, of course, alleviate symptoms of depression, but they can't change a person's relationships, lifestyle, decision-making, or attributional style. And since depression is the result of many causes-not simply a chemical imbalance-most courses of treatment should consist of several concurrent approaches.

Dr.Yapko is notably practical in his outlook: "Of the many different therapies that have good treatment success rate, it's interesting that none of them analyze childhood. None of them focus on symbolic meanings of things. All of them teach skills. All of them have an orientation towards the future that help the client come to understand how the future can be different in very specific ways." 

What are the mechanisms of depression and the remedies for this widespread and complex problem suggested by those mechanisms?  Here are some answers to these questions based on a recent review of Yapko's work.

Social: In our culture, depression is deeply tied into interpersonal challenges. Both as a cause and as a result, loneliness, isolation, lack of relationship skills, and challenges with trust & intimacy all feed into each other and make it even harder for someone who's depressed to escape the cycle. Depression appears to run in families and groups-not necessarily because of genetics, but because 

being engaged with negative, pessimistic, or uncaring people tends to have a contagious effect.

We can help our clients and loved ones learn new ways to value, choose, create, and sustain supportive and positive friendships and love relationships. Among the skills we can teach are: Helping them notice which interactions and relationships work for them, discover how to seek positive social experiences, and practice speaking their needs to others.

Physical: Some of the physiological factors of depression are a sedentary indoor lifestyle and random or compulsive food intake. People may not know which foods produce an energetic state in their bodies. They may try to change their emotional state by binge eating, or they may not eat enough due to lethargy that's characteristic of lasting depression. And it's hard to get enough vitamin D when the sluggishness of the condition keeps a person indoors day after day.

We can encourage patients to exercise outdoors regularly-widely recognized as the single most effective treatment for depression, as well as a host of other emotional issues. Mood is also positively affected by daily deep breathing exercises. And we can, of course, support people in changing their food intake habits, helping them develop a habit of eating deliberately for fuel & flavor.

Mental/Cognitive: The signature root experience of depression is a sense of helplessness and hopelessness. Almost universally, depression sufferers report a sense of being trapped and unable to act on their own behalf. On the cognitive level, this takes the form of reflexively interpreting events through a 

negative storyline, of automatically assigning the worst possible meaning to experience, and focusing attention on everything that's wrong.

We can help depression sufferers shift their thinking style by teaching them mindfulness practices. When practiced regularly, meditation can help a person become aware of those thought patterns and change the direction of thoughts deliberately. They can then turn their attention to their personal strengths and accomplishments, and focus on what's going right instead.

How do we accomplish these goals in treating depression?

Raising public awareness of these dynamics to understand that depression results from these and other social and cultural factors is a big part of Yapko's overall mission. Among all the factors contributing to the depression epidemic - biological, relational, social, cultural, historic, ancestral - he believes that elements of focus most affect outlook:

              "What you focus on determines your quality of experience."

Yapko reports impressive results from uses of hypnotherapy, guided imagery, suggestion and most recently, mindfulness, to meet the multiple challenges of depression. His strategies include:

Directed focus & quality of attention, orientation to growth, expanding beyond self-limiting perceptions, noticing what's right, and shifting from ruminating on past defeats to reflections on the self that is unfolding in present and future time.

To learn more about how these and other strategies can help you work effectively with depressed clients, please join Dr. Yapko and me for our teleseminar on depression on Friday, July 25 (with anytime replay and download). Go here now to register!

Thanks for taking the time to read this newsletter. Please send any questions to Peggy.

Enjoy the heart of summer,

Maggie