by Joel Lewin 

Depression is particularly common among addicts. About half of addicts will experience depression at some point in their lives. Struggling with either addiction or depression alone can be hard enough, but together their impact is compounded.

So it is crucial to understand depression and deal with it. The potential consequences of not doing so include relapse and suicide.

Here we’ll take a look at depression from a CBT (Cognitive Behavioural Therapy) perspective.

We have more information on the symptoms and types of depression here.

To understand how depression develops and progresses there are a few questions we need to ask.

Why me?

There are a number of background factors that can make people more vulnerable to depression. These include:

Why now?

Once the background factors are in place, there is a trigger that sparks the depression. These might include:

Why still?

Our thinking plays a crucial role in the initiation and maintenance of depression. There are a number of thinking traps that lead us to interpret situations in very unhelpful ways. These include black-and-white thinking (something goes wrong so our whole life seems ruined) and fortune telling (making negative predictions about the future).

Identifying and disputing unhelpful thought patterns is an important step to overcoming depression. We have more on how to do this here.

Our unhelpful beliefs and interpretations lead us to feel even worse, and to behave in ways that compound our negative thinking and our low mood.

Thoughts–>Feelings–Behaviours–>Thoughts–>Feelings–>Behaviours

Sometimes we try to cope with the feeling of low mood by doing things that offer short-term relief but have unintended consequences that actually make it worse. These behaviours can fuel a downward spiral into full-blown depression. It also serves to prolong and intensify the depression.

The Vicious Flower

It’s not often that you get to call a flower vicious, but this one is truly nasty.

Here is a hypothetical situation (this isn’t real!) to demonstrate the vicious flower in action.

Let’s imagine that Donald gets fired from his job. This unleashes, in Donald’s mind, a slew of negative thoughts about himself his future: “I’m not good enough… I’m a failure… My life is going to be miserable.” Consequently he begins to feel even worse.

Donald’s friends know he’s been fired and they invite him out to try and cheer him up. He feels uncomfortable and ashamed talking about his sacking, so he keeps making excuses. He stays at home. This feels easier and more comfortable initially. But then they stop calling. Donald feels lonely, his thinking becomes more negative (“Nobody cares”) and he feels even worse.

He’s feeling lethargic so he sacks off his usual exercise routine. Having a lie in feels good for a while, but then he starts to feel even more apathetic and demotivated.

He wakes up one morning and decides to treat himself to a big tub of Häagen-Dazs for breakfast. It feels great and cheers him up, until he has a sugar crash. So he gets a tub of Ben and Jerry’s Fish Food for lunch, which perks him up, until he crashes again. Soon his ice cream diet has him gaining weight and Donald feels even worse about himself.

He ruminates on his time at work, thinking about the injustice. The anger acts like a justification for his current spiral and it gives him a bit of a stimulating buzz. Anger can be like a drug. But soon it boils down into lingering resentment. He feels even worse, and his thinking becomes even darker.

Donald closes the curtains and decides to give himself a treat: he will re-watch all five seasons of Breaking Bad. The first season feels good; it’s a nice escape. But half way through the second season he gets bored and becomes painfully aware that he has been watching TV for two days and nothing has changed. Donald feels even worse. His self-esteem plummets, and his life seems meaningless.

Like most addicts in pain, Donald turns to the “best” quick fix he knows. He buys a bottle of whiskey. After a few slugs he feels better, but soon the drunk misery kicks in. In the morning he wakes up, hungover, guilty and hopeless. All the quick fixes and escapes he tried have only compounded his suffering and launched Donald into a full blown depression.

What can we do?

We can evaluate and dispute our unhelpful distorted thoughts. More on this here.

We can also focus on behaviours that can help slow the spiral and even reverse it. These can be as simple as getting out for a walk or run or speaking to a friend.

Putting protective factors in place

These can protect us from depression, or help lift us out of it when we’re already in it. These can also apply to other mental health challenges such as anxiety. They overlap conveniently with the pillars of recovery.

Social support

People with whom you can share your problems

People you can ask for practical support

The nourishment of connection, intimacy and friendship

Physical health

Exercise can help restore neurotransmitter balance, boosting production of serotonin and endorphins

Healthy diet promotes good mental health

Take medications as prescribed

See doctor if necessary

Purpose

Living in accordance with your values

Occupying yourself with something meaningful to you- work, parenting, volunteering etc.

Coping skills

Being able to handle emotions in healthy ways

E.g. meetings, calling friends/sponsor/therapist, using ABCs, meditation

Awareness of thoughts, feelings and behaviours, through meditation and journaling etc.

Self-esteem

Belief in your ability to overcome hardship and challenges

Gained by stepping out of your comfort zone and recognising your achievements

Healthy thinking

Being able to put things in perspective

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