April 03, 2017 at 8:56 PM
After completing trauma healing therapy (such as EMDR, PC, etc.), most clients report feeling and doing a lot better. But a few do not, for a variety of reasons addressed in a previous post. Another reason? Bad habits that maintain depression.
Trauma healing clears depression by reducing emotional pain, and by changing the thought and behavior patterns that feed it. Clients initially presenting with depression typically indicate a marked decrease in symptoms, post-treatment, as well as an increase in positive feelings and experiences. However, occasionally we don’t see the decrease in depressive symptoms that we expect.
Here is an example of how it usually goes. “Jane,” a woman in her 50s presented with significant depressive symptoms she associated with a car accident she experienced over 20 years ago. She was driving with her two children when she was rear-ended. She and her youngest were fine, but her oldest had a brain injury and continues to have symptoms in adulthood. Prior to trauma-focused therapy, she held beliefs such as “I am incompetent,” “I don’t deserve to be happy,” and “everything is my fault.” These beliefs were associated with sadness, guilt, and social isolation. After successful treatment, Jane was able to let go of the accident and adopt more positive beliefs about herself. She reported feeling more energetic, social, and involved in the community. She even got engaged within a year. Jane was able to change her depressive habits (e.g. negative self-talk, avoidance of social situations) simply by healing from her trauma and loss memories.
“Michael,” on the other hand, did not experience complete remission of depression. Michael was a young man in his late 20s presenting with depressive symptoms that had been present for most of his life. He functioned adequately at work, but afterward went straight home and watched TV all evening. He didn’t exercise, return friends’ calls, or engage in hobbies other than watching movies or TV. On the weekends, he stayed at home trying to get his energy together to begin the work week. In therapy, he successfully addressed painful early memories associated with feeling unloved and unwanted. He was able to discard negative beliefs he once held true such as “I’m not good enough” and “I’m unlovable.” Though he resolved all prominent trauma and loss memories, he continued to have some residual symptoms of depression in the weeks after the trauma work was completed.
Why did Jane seem to respond to trauma healing so much better than Michael? Probably because Michael did not spontaneously improve his behaviors. Researchers have identified four types of activities that are most associated with healing from depression (Ekers, Webster, Van Straten, Cuijpers, Richards, & Gilbody, 2014), namely:
- Tasks that help give a sense of mastery
- Social outings
- Exercise or physical activity
- Pleasurable leisure activities
Jane was able to increase her engagement in these types of activities spontaneously when her trauma memories were resolved. Michael, on the other hand, continued his old habit patterns. He remained sedentary, cut off from others, and disengaged from meaningful activities. In order to experience more complete remission of depressive symptoms, he had to work on changing his habits.
Michael then worked with his therapist to figure out what habits he needs to change in order to feel better. Michael and the therapist identified realistic goals pertaining, respectively, to each the four types of activities listed above, for example: taking short walks, calling one friend back that week, writing for a few minutes each evening. Each week, he and his therapist would discuss his progress and modify the plan as needed. As his engagement in these types of activities slowly increased, his depressive symptoms receded and he was able to more fully experience the benefits of his trauma healing work.
Ekers, D., Webster, L., Van Straten, A., Cuijpers, P., Richards, D., & Gilbody, S. (2014). Behavioural activation for depression; An update of meta-analysis of effectiveness and sub group analysis. Public Library of Science, 9(6). Retrieved from http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0100100
Thanks to guest author Rebecca Chapman, PsyD who wrote this post.
Please add a comment
What struck me about the article--even though cognitive and behavioral therapies are frequently linked together as CBT--there can be value in making a distinction. While Michael's change in behavior no doubt impacted his cognitions, the emphasis on a behavioral approach was what was needed.