Diamond1 RelationshipsWhile "the TV version of depression" suggests that depression just "comes," randomly and for no other reason than assumed "misfiring" of circuits in the brain – clinical experience suggests something very different. In 20+ years of counseling, I have yet to encounter a client who was unable to identify a clear trigger for their depression. Always, there is some kind of circumstance – usually in the context of an important relationship – that sets it off.

I originally thought this was a unique observation on my part. Later I learned that this hypothesis – that depression is often triggered by relationship difficulties – had been carefully studied for several decades at the University of Michigan. It had then been developed into a treatment system called Interpersonal Therapy (IPT) that taught people how to deal effectively with these relationship triggers. (For more information on IPT, see http://www.med.umich.edu/depression/ipt.htm .)

IPT identifies 4 kinds of relationship triggers that frequently set off depression:

1) Grief – losing someone important to you. This can come through death, divorce, separation, romantic breakup, infant loss, moving, or in other ways. Grief can also appear when a loved one chooses a destructive lifestyle, or becomes disabled. A certain amount of pain is inevitable and normal in these circumstances – but can become complicated, becoming more intense and enduring longer than normal - triggering depression.

2) Conflict – with someone important to you; or between different parts of yourself. Interpersonal conflict with a spouse, child, parent, employer, neighbor, or significant other – especially when it endures for a long time without resolution – is a frequent trigger for depression. A tug of war within oneself - intrapersonal conflict, between one set of ideas, and an opposing set – can also trigger depression. For example, experiencing persistent unwanted impulses of same-gender attraction or other impulses not consistent with a chosen values orientation, may trigger internal conflict and depression.

3) Transition – an important, significant life change. Transition is certainly part of the grief experience – the need to learn to move on without a loved one lost to death, divorce, breakup, etc. But transition also occurs with happy, positive changes – such as puberty; leaving home for school, or for religious or military service; graduation; a pregnancy; becoming a parent (with a first or subsequent children); moving; midlife transition; becoming an "empty nester;" retirement; etc. Surprisingly, these "happy transitions" are frequent triggers for depression, as people scramble to make sense of their new experience. Though often explained solely as "hormonal problems" (especially puberty, postpartum, and midlife transitions) these changes represent major life shifts, that can require effort and attention to navigate successfully- and that can easily mutate into depressive triggers.

4) Lack of Interpersonal Skills. When people lack these essential skills (such as building friendship; sharing an opinion assertively; listening to others; etc) it can interfere with the building and sustaining of effective relationships. Relationship after relationship may suffer, causing a painful repeated pattern of disappointment and disruption in relationships – which is very depressing! This is commonly the case, for example, in the lives of those who grew up in dysfunctional families, lacking exposure to functional models for effective relationships.

Besides these 4 "triggers" identified by IPT, in my practice I have observed 3 others:

5) Abuse – the most enduring and destructive of triggers. This is far and away the most potent, lethal trigger for depression and other emotional problems. Whether the abuse is verbal, emotional, physical, or sexual; whether it happened recently or decades before, it can have lingering impact, triggering not just depression but anxiety, low self esteem, addiction, and other problems. Almost always, abuse requires specialized professional help to work through effectively.

6) Loss – a common factor with all the triggers. Whereas grief involves losing someone important to you, loss is more general, involving losing something important to you. This can be a physical object, a relationship, an opportunity, or an intangible characteristic (such as confidence, youth, patience, etc.) Loss almost invariably accompanies all the other triggers, in some form or another – and can also appear independently as a sole trigger for depression.

7) Disappointment – when life doesn't measure up to your hopes and expectations. When we believe something positive will occur, and it doesn't, that engenders disappointment. This can occur in marriage, in competition, in romantic relationships, in employment, in performance, and in life. Disappointment happens to everyone – but can also mutate into a lethal depressive trigger.

Clearly, all 7 of these triggers, in some form or another, are experienced by most if not all human beings at some point or another in their lives. Yet they do not always result in depression. Sometimes, in fact, these "trigger experiences" are triggers for the most significant growth, development, and meaningful learning in an individual's life, and are looked back on after the fact with deep appreciation, even reverence.

So what determines what a challenging experience will "trigger" – depression, or growth? Ultimately, it depends not so much on the nature of the experience itself, but the nature of the individual's chosen response to it. We have very little control over what happens to us – but we have almost limitless control over how we respond – in thought, in word, and in action. That's where the rest of the Diamond comes in.

1-Triggers > 2-Thoughts > 3-Behavior > 4-Impact

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