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Diamond2 ThoughtsThis part of the Diamond comes from a powerful model of therapy, developed over the past several decades, that has proven to be incredibly powerful in reversing depression, anxiety, low self esteem, and other emotional challenges. The model is called "cognitive therapy," and the basic idea is – you are not so much troubled by "what happens" to you, as you are by "what you think" about what happens to you – good or bad.

In therapy over the years, I have seen even minor "trigger" experiences set off major depressive episodes – not so much because of "what happened," but because of how the individual interpreted the experience, and what kind of thoughts they continue to think thereafter.

In contrast, I have also seen individuals weather even significant trigger experiences, and NOT develop depression or other emotional challenges. The major difference I have observed is – those who are devastated by their trigger experiences interpret them in a more universally negative way than those who weather the storm.

A depressive mindset is a pessimistic mindset. Martin Seligman, PhD, in his insightful book Learned Optimism identified pessimism as an "interpretive style," which when encountering adversity tends to interpret it as:

  1. Pervasive ("It's not just this; it's everything.")
  2. Permanent ("It's not just for now; it's forever")
  3.  Personal ("It's an evidence of my failings.")

For example, let's suppose a college-age girl meets an attractive young man in one of her classes. They talk for a while after class; and he takes her phone number and promises to call her that evening. She sits by the phone all night – and he never calls. She finally goes to bed at midnight, feeling profoundly depressed. What is her "trigger?"

She has experienced "disappointment." It's a mild circumstance. But it gets her down, because perhaps she thinks, "Guys never call me when they say they will; You can never depend on anyone" (pervasive); "I'll probably never meet anyone; I'll be single forever" (permanent); "I guess I'm just not attractive; guys just don't like me" (personal.) In the process, she takes a short-term disappointing experience, and views it through a devastating long-term lens – increasing its hurtful and destructive impact.

Meanwhile, another girl going through the same disappointment may process it through an "optimistic interpretive style." She may say to herself "He must have had something come up tonite; he'll probably call me tomorrow – or I might run into someone even better!" (specific); "When the time is right, the right guy will come along – it just wasn't tonite." (temporary); "He might have had a class go long tonite; or ran out of gas on the way home; or gotten a call from his family out of state that kept him busy tonite" (multiple causes.)

This second girl is viewing the situation through an "optimistic" mindset. She'll still be disappointed when the young man doesn't call – but she won't be devastated, and she won't get depressed. She'll be able to weather the experience, and move on from it, cheerfully and with resilience.

Epictetus, the ancient Greek philosopher, once observed, "Men are disturbed not by things, but by the view they take of them." When we take a positive, empowering view of our life circumstances, even severe challenges can help us grow, and bring us joy and meaning. When we take a pessimistic view, even small challenges can derail us - shattering our self-confidence, and bringing us down.

Besides the "pervasive, permanent, and personal" mindset that characterizes pessimism, other interpretive styles of thought can also launch us into depressive feelings and symptoms. These include :

  • black and white thinking (anything less than perfect is unacceptable);
  • mental filter (noticing only the negative aspects of a situation); and
  • should statements (focusing on deviations from a predetermined expectation.)

How we think – especially about the big and small "trigger experiences" we all experience – largely determines how we feel, and how we respond. Negative, pessimistic thinking is a significant contributor to depression and other emotional ailments. (For help in turning around depressive thinking, two books are recommended: The Feeling Good Handbook , by David D. Burns, MD; and Learned Optimism, by Martin P. Seligman, PhD.)

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

Impact, Part 1: Effect on Spirituality

Diamond4 SpiritualityThe fourth element of the Diamond addresses the impact of the previous factors. First - As depressed individuals deal with their relationship triggers by engaging in depressive thinking and behavior, inevitably this will have a negative impact on their spirituality: their sense of positive meaning and connection to something bigger than themselves.

For religious individuals, this change often occurs in a religious context. They may find it difficult to attend church, read religious literature, pray, or keep faith in God. They may question core beliefs that had formerly sustained them. They may even withdrew entirely from a religious affiliation that had previously be important to them (which may be frightening to loved ones who have shared the religious affiliation with them.)

Both religious and non-religious individuals experience spiritual impact from depressive thinking and behavior. Life may feel purposeless, directionless, and hopeless. Depressed individuals frequently feel disconnected – from other people, from the world, from God, even from themselves. Depressed thinking leaves them questioning their own value, the dependability of other people, even the purpose of life itself. Depressed behavior often leads them in directions that are inconsistent with their chosen values – which leads to a painful disconnect within their inner self.

In short, they may experience a profound spiritual disruption – whether of a religious nature or not. This sometimes constitutes the most painful aspect of depression – compounding, again, the pain of the original trigger experience; and leading to the final dimension of the Diamond.

Impact, Part 2: Effect on Relationships

DiamondFullCycleAfter cycling around the four elements of the Diamond (relationship triggers, depressive thinking, depressive behavior, and impact on spirituality) the cycle ends where it began – in the realm of relationships and triggers. This has two dimensions – first, the impact on the depressed individual; second, the impact on those around him or her.

First, let's explore the impact on the individual. The cycle of depression almost inevitably adds relationship trigger upon relationship trigger. Important relationships may get disrupted – leading to more loss, disappointment, conflict, transition, etc.

Depressed persons tend to have one of three relationship styles: withdrawal, attack, or compulsive caretaking. Withdrawal is most common – individuals simply "fade away" into their own depressive thinking and behavior, not engaging with those around them. This can be deeply painful and confusing for loved ones, who may try for a time to re-engage the depressed individual, and then often finally withdraw themselves. Some depressed individuals, alternatively, resort to attacking others - thus externalizing the pain and confusion they may feel. This obviously brings conflict and pain into relationships. Finally, some depressed individuals become compulsive caretakers – taking care of the needs of others while neglecting their own. This creates an imbalanced relationship which is difficult to sustain long-term : and which may contribute to the ongoing erosion of the depressed person's self-esteem, feeding the depression further.

It is virtually impossible to sustain a healthy, nurturing relationship with another human being while also sustaining negative thoughts and behaviors. Any of the three styles interfere with the development and maintenance of healthy relationships. "Relationship triggers" can multiply over time, under the influence of depression, and its destructive impact on relationships – leading to even more pain for the depressed individual.

Second, let's explore the impact on others. Few experiences are more challenging than watching a loved one go through the cycles of depression. Loved ones are often caught in the crossfire of the thinking, behavior, and impact described. For this reason, depression is notoriously contagious – even among persons who are not genetically related. Within families, this impact is often interpreted as genetic predisposition. However, even among roommates, neighbors, and coworkers with no family connection, the "contagious" nature of depression has become evident. It is depressing to be around depression – the depressing thoughts, behaviors, worldviews, and dysfunctional relationship styles that it engenders. So frequently, the depression of one individual, as it revolves around the Diamond, provides not just triggers for their own subsequent cycle of depression – it may also kick off someone else's cycle of depression – beginning, again, with a depressive trigger (loss, conflict, disappointment, etc.)

Summary: Understanding the Causes of Depression

Depression, then, is not the result of a single random cause. It is a logical progression from factor to factor :

  • beginning with one or more relationship triggers (recent or in the past)
  • complicated by pessimistic, depressive thinking;
  • which is then acted out in depressive behavior (mild, moderate, or serious);
  • that thinking and behavior then negatively impacting spirituality and relationships,
  • triggering further cycles of depression – within the individual, and in those around him or her.

Help is availailable to resolve all of these contributors to depression. In addition to these 4 factors, certain lifestyle factors have been shown to predispose individuals to the development and maintenance of depression. These factors include: nutrient-poor diet; sedentary living; lack of sleep; and other conditions which have become increasingly mainstream in developed nations. More will be said of these lifestyle factors in the upcoming section.

Understanding the causes of depression, then, is never a streamlined or "cookie cutter" process. In this individual, within this particular depressive episode – what were the triggers? the thought processes? the depressive behaviors involved? What has been the impact in spirituality, in relationships, and in the cycling of depression in the individual and in those around him or her? What is the impact of various lifestyle factors?

Medication is frequently used in our culture to soften the impact of the symptoms of depression. But until the actual causes are identified and resolved, the condition will persist – often intensifying over time until it is corrected and healed in a comprehensive way. Such healing begins with clear understanding of the range of causal factors. Once these factors are identified, solutions can be identified to effectively resolve them.

Click below for a printable worksheet (PDF) to help streamline this process of understanding the causes of your depression. This worksheet will provide crucial information, in an organized way, to help you and those assisting you to formulate a comprehensive, effective plan for recovery.

icon-pdf-     PDF, "Understanding the Causes of YOUR Depression"

Circle or highlight those items that seem relevant to this depression. Use the empty space to fill in additional or explanatory information. Use additional paper if you need more room. Remember – identifying clear causes is the first step to resolving them - and then putting them behind you forever.

Once you've completed the worksheet, you have completed Step 2 (Understanding Causes) and are on to the fun part! Move ahead to...

Step 3 - Identify Solutions

Diamond3 BehaviorThis third element of the Diamond comes from the observation that thoughts always set the foundation for behavior. How I think and what I believe, always precedes how I respond and what I do. This is as true in depression as it is in life. A powerful variation on cognitive therapy, mentioned in the last section, is "cognitive-behavioral-therapy," which addresses this connection between thought and action.

To continue the example of the girl in the last section – if she adopts the pessimistic mindset described (pervasive, permanent, and personal) she will be likely to display depressive behaviors, such as withdrawing from others, crying, and staring off into space blankly. She'll have a hard time eating, sleeping, exercising, studying, socializing. She'll slump over dejectedly, speak in a quiet and troubled tone, and avoid eye contact with others.

Such behavior, if continued, can significantly interfere with her social life (even, for example, if she encounters the same young man she was interested in the day before – creating a self-fulfilling prophecy – "No one will ever call me or engage in a relationship with me.") Such self-fulfilling prophecies – depressive behavior acting out negative depressive thinking – are extremely common, interfering with successful social, educational, and professional goals. Perfectionism; avoidance of needed tasks; social withdrawal; neglect of physical health; and hours of time drained in depressing rumination or in "escapist" entertainment (such as TV, internet, novels, or negative music) are very common manifestations of depressive behavior.

Depressive behavior usually begins with these garden-variety, milder versions. If unchecked, it can grow into much more dangerous forms. Depressive behavior – fueled by depressive thinking – can even grow to the level of serious addictive or self-harm behavior, even suicide. Individuals contemplating suicidal behavior are almost always thinking something like, "This pain is unbearable, and it will never stop – there's no other way out;" "Everyone will be better off without me;" "There is no hope – I've always been miserable, and I'll always be miserable, so I will end this pain." The thinking sets the foundation for the behavior.

Whether mild or serious, depressive behavior complicates the original problem immeasurably, and gets in the way of resolving it. It is one of the ways in which depression tends to become more serious over time, and to have a "contagious" effect on others.

Cognitive-behavioral therapy and effective skills training can help depressed individuals to learn a healthier set of behaviors that can stop this destructive tide. Both the depressive thinking and the resulting depressive behavior can be turned around, and replaced with better, more functional alternatives.

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

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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