Everyday Grace

thoughts and inspiration on emotional health by colleen p. arnold

Archive for the month “January, 2012”

Zen, Sad Movies and Depression Relapse

Acceptance and non-resistance is a basic tenet of many spiritual traditions, and it appears it may have a biological component as well.

One of the more unhappy statistics about depression is that it has a very high rate of relapse. If you’ve had one Major Depressive Episode, you’re about 5 times more likely to have another one than someone who hasn’t. Add to this the “kindling effect,” or the probability that you will need a higher dose of medication to relieve relapses than you did initially, and it can be, well, depressing.

But not everyone has a relapse, so is there anything we can point to that separates those who relapse from those who don’t? Like almost everything in psychology, there’s no definitive answer, but there is interesting research that suggests that how you respond to sad situations can prevent a relapse. Cognitive psychologists have long known that how you respond to situations is key and Buddhists have long suggested that acceptance of pain is the path to enlightenment and the resistance of pain only leads to suffering….and these MRIs of brain activity certainly seem to support that.

Researchers took patients that had been diagnosed with Major Depression, but were in remission, and scanned their brain activity while they watched a sad movie. Then they tracked those patients and recorded who had a relapse down the road and who did not.

The patients that were more likely to have a relapse had a lot of activity in their frontal cortex while watching the sad movie. The frontal cortex is associated with high level thinking, but also rumination, or obsessive thinking about bad events and feelings. The patients who did not have a relapse had more activity in the back of the brain, associated with visual processing. These patients were thought to have more acceptance of their feelings and less judgment towards them.

One of the best supervisors I ever had told me, “It’s your job to teach clients to have fewer judgments towards their feelings and more curiosity.” That was incredibly powerful for me to hear, for myself as well as for my clients. Although in therapy we often spend a great deal of time trying to figure out why we feel a certain way, sometimes you just have to accept it, flow with it and have faith that, like everything else, it will change into something else. Ironically, it seems that being able to do that is a conduit to actually helping it change.

 We who have faced Major Depression often feel like we’re constantly looking over our shoulders for the dark cloud to return. I have nightmares where I’m falling back into the hole, only to wake up and be relieved to find that the nightmare isn’t real. It’s natural to be afraid that when we’re in a blue mood, it’s a sign of a relapse. So what can you do to accept
sadness and not resist it?

  • Use a mantra. When I find myself over-thinking my moods, I like Hildegard Von Bingen’s quote, “All shall be well, and all shall be well, and all manner of things shall be well.” It’s not a profession of false optimism, it’s a repetitive mantra based on my faith that this too, shall pass. Maybe you need a single word, like “Peace,” or “Faith,” or even “Om.” Anything that will counteract the over-analyzing we tend to do can work.
  • Remember that everyone has sad times. It’s a necessary part of the human condition, and can function to make you appreciate the good times more. The good times will come back…they always do. Just because you’re feeling sad is no reason to panic.
  • Wallow. One trick I suggest to my clients who are terrified of their sadness is to wallow in it for no more than half an hour. Set a timer, and just feel as sad as you possible can for that half hour. Letting yourself tolerate the feelings for a set amount of time can teach you that you can do it, and they won’t drag you down into the black hole again. If you start feeling less sad before the half hour is over, fine. Tell yourself “OK, I guess that’s the end of that,” and be done with it. I also recommend this to people who feel guilty or afraid of self-pity. Go ahead and wallow in it for half an hour. Most people can’t keep it up for the whole time, and  move on.




Original source: Norman A.S. Farb, Adam K. Anderson, Richard T. Bloch, Zindel V. Segal. Mood-Linked Responses in Medial Prefrontal Cortex Predict Relapse in Patients with Recurrent Unipolar DepressionBiological Psychiatry, 2011; DOI: 10.1016/j.biopsych.2011.03.009


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