Hey everyone, welcome to Being Well. I'm Forrest Hansen. If you're new to the show, thanks for joining us today. And if you've listened before, welcome back. Today we're going to be exploring a huge topic. Depression and depressed mood, and particularly what we can do to break out of a pattern of depressed mood. There is plenty of good advice out there when it comes to dealing with depression because it's such a big and important topic.
all these different ways we can think or change our circumstances and our social environments, or maybe even changing something like our diet or exercising a little bit more. Now, these can all be useful interventions, and we will certainly talk about them, or at least most of them, to some extent today. And if you can do them, they will probably help you. But what makes depressed moods so challenging is that they attack our ability to do anything about them.
Depression saps our energy, it's demotivating, and as we'll talk about, it can actually change how we view the world itself, which then leads to more of the thoughts and feelings. that then feed our depressed mood. So there's clearly a lot here. It's a tangled knot. And to help me try to figure out how to untie it today, I'm joined as usual by clinical psychologist Dr. Rick Hansen. So dad, how are you doing today?
I'm good. And if you look at findings from, for example, the World Health Organization, depression is very, very widespread throughout the entire world. And it has all kinds of consequences besides sort of... ruining how you feel. It wears down physical health. It disrupts relationships. It disrupts people's capacities to engage in physical health practices. So therefore, in some cases, it's going to take months, if not years.
off a person's lifespan on average. So it's a big deal. It's a big deal. We're all depressed some of the time. It's a rare person who never, ever, ever feels. depressed for 12 hours, maybe, maybe a day and a half. We're going to be focusing more on, unfortunately, when the weather system comes in and sticks around.
Yeah, so I want to start just by asking you about that, Dad. In part because depressed moods are so common, are so ubiquitous, the terminology around them has become really colloquial. in a way that the terminology around more of a less common issue might not just be so widespread. So people might have a sense of what it means to be depressed.
But there are differences here between like being a little bit sad or having a depressed mood versus a clinical diagnosis of a major depressive disorder or something like that. And I would love if you could just draw a couple of distinctions here for people. Major depression or depressive disorder is conceptualized generally in terms of episodes. So episodes have a beginning, a middle, and an end.
And it is the case that episodes of severe depression very often do seem to resolve to some extent. On the other hand, there could be what's called a double diagnosis in which... There's a major depressive episode sitting on top of what's called dysthymic disorder, which can be an ongoing sense of depressed mood, which tends to have different aspects to it.
Often there's a physical dimension in which a person feels like they're kind of walking uphill continuously. You know, they're fatigue, lack of concentration, hard to sustain focus on various things. intrusive thoughts that are highly negativistic, a sense of despair, often a sense of being damaged in some way, being not just
injured, but more like something's wrong with you. You're not adequate. You're not good. You're not worthy. A lot of self-criticism is woven into the max. And what I consider to be probably the hallmark definition. really a depressed mood. It's twofold. One is loss of pleasure or interest in things that were previously interesting and enjoyable. And second, the very, very short half-life.
of emotionally positive experiences. Short of a severe depressive episode that is so severe, for example, that it's really hard for a person to get out of bed, people who are in dysthymic disorder or even in a mild to moderate... episode of major depression can typically experience some pleasure. They can feel a little bit elated when they're hanging out maybe with friends, or they can have a momentary sense of being loved when they're...
Grandchild gives them a big hug. But the positive qualities of that experience tend to last very briefly and not long enough to sink in. So then I would say, pardon me, one more hallmark characteristic, third hallmark characteristic is a flatter learning curve. So in addition to loss of pleasure in things once enjoyable, and second, short duration of beneficial experiences, related to that, there's a lack of a kind of growth.
or positive change while in depression both because people feel very dispirited and de-energized to take positive steps but even when they take those positive steps and have beneficial experiences as a result, they don't seem to sink in. They don't seem to move the person in a better direction. So this, I would say that's an overview. You've done a great job here of articulating what I was speaking to in the introduction to the episode.
Because so much of your work, Thinking About You, focuses on the internalization of positive experiences. Yeah. And we know in general that we feel better about ourselves, we feel better about the world when we have some combination of two things. We have positive experiences that allow us to develop different kinds of useful traits on the one hand.
And we have experiences of success on the other hand. We feel like we did something good. We feel good about that. We're motivated to do more of that good thing in the future. There's a certain Pavlovian aspect to this whole thing. We feel good, want more of it. Depression really attacks that just directly at the source, and it can make it very difficult to have either the experiences of success or the experiences of just good positive emotions that tend to naturally help us.
develop the qualities or step into the world in the ways that can then help us solve these different kinds of practical problems. negatively reinforcing quality is what I really wanted to focus on today. Something I do want to say before we get a little bit too deep in the weeds here is that we're using the phrase depressed mood or the word depression a little bit colloquially during this episode, deliberately, to kind of broaden what we're talking about here.
You may or may not, if you're listening to this and you're interested in this topic, meet the clinical criteria for a diagnosis of depression. But if you've been experiencing some combination of the things that Rick just said,
you know, accompanied by negative thoughts and feelings, then what we're going to be talking about today could be really helpful for you. And I think it would be helpful here at the beginning to talk a little bit about the causes of depression, because sometimes when you know where something comes from,
You could create some ideas of what to do about it. So, Dad, there are a lot of different ways into this question. It's a big and complicated question. I would like to do a pretty simple treatment of it here today. There's this thing called the biopsychosocial model.
You are somebody who's taken an undergraduate course in psychology. You've probably heard of this, but for those who may not be familiar with it, could you explain that, Dad, and the relevance that it has here for thinking about depressed mood? It's a simple three-part. way of understanding how it is that depressed mood would arise. And the bio has to do with our own biology. So, for example, interestingly, depression
is a very common symptom of a physical illness or injury. You know, depression is a common symptom of or correlate of inflammation in the body. Okay, that's interesting. there can be dysregulation of neurochemistry in complex ways, not reducing it strictly to one neurochemical system like serotonin, but really understanding the brain as a whole. It's kind of a mess. It's incredibly complicated. It's very dynamic. And it's easy for things to go awry.
imbalance of neurochemistry might be due to genetically rooted reasons. It, who knows, could also be the result of, for example, some key nutrient that's lacking. So, for example, serotonin is involved in depression to some extent, and one of the cofactors that enables tryptophan to become serotonin is iron. So that if a person is... anemic or even subclinically anemic. And I believe that some large fraction of women who are premenopausal, not yet in menopause, are actually subclinically anemic.
Maybe also not a surprise, you know, depressed mood is quite common among young women. So it's worth thinking about biology, right? And then briefly, psychology, a lot of material there in the psycho aspect. belief systems about yourself and the world and then we have social like events in including broad events like losing a loved one, getting laid off, or being a member of a class of people that are picked on routinely.
or worse, they're biased against, discriminated against in some kind of society. So that gives you a biopsychosocial. The good news about that, it gives you multiple places to intervene. To kind of cut to the chase here, certain pathological, unhappy, broadly, conditions, like having a broken leg or having the measles, they're very clear. It's specific.
Being swept away in a genuine manic episode is very clear. It's very specific. Having a paranoid delusion, a real full paranoid delusion, that's very specific. Depression is more like a syndrome. It has multiple aspects that vary from person to person that occur due to multiple kinds of causes, which, happily...
can be addressed by multiple kinds of interventions. And so that's how we're thinking about it here. That's how we're talking about it here. I thought that was a really... good, approachable, understandable overview of what could be like a very, very complicated topic here to try to summarize that even more than you already had.
we got these three buckets. We got stuff in our mind, we got stuff in our bodies, we got stuff out there in the world, right? And in any of these places, things could happen that could lead us to become depressed or trigger a depressive episode. Throughout history, there have been people who tried to isolate the causes of any mental health condition, really, but really kind of depression in particular, in part because it is so pervasive.
to just one of those buckets. An example of this might be like the serotonin theory of depression, which essentially reduces everything to how much serotonin do you have. This was essentially discarded by serious people.
years ago, and then every once in a while makes like a resurgence on social media because there's been some new finding, but okay, sure, whatever. The truth is most of the time when people study this, they find that it's a mix of all of the above. It all matters. And for any individual person, those different aspects are going to matter to different degrees for them.
But because it's what we do, it's what we focus on in a podcast like this, we're going to kind of focus from here on mostly on that what's going on in your mind or what's going on in your thoughts category here. And I'm going to paint a kind of structure here of how depression normally works most of the time for people. There will be people listening to this where this map does not apply to you.
There's some kind of an inciting event most of the time that kicks things off. Your life was going along in a pretty normal way, and then something happened. The something that happened might be one big thing, or it might be multiple smaller things. extended over a period of time. Then this event leads to the creation of some negative beliefs. These beliefs can live in different places. They could be about ourselves. For example, I'm a bad person because I did this thing that happened.
Or they could be about other people. They're a bad people because they did that thing that happened. Or maybe they could just be about the world in general. Like, everything sucks, it's all going to hell, and there's nothing I can really do about it here. These beliefs typically have a key core characteristic, and that's that they are very absolutist in nature. They have a lot of internal stickiness.
There's not a lot of space in I'm a bad person. It's really hard to intervene with that belief because it's so complete, right? And most of these beliefs find their way back to that. to some kind of a belief about the self. And these negative beliefs then crowd out positive experiences for people because
All of the experiences that we have in life start being funneled through the lens of that negative belief. We have a hard time enjoying the good things that happen. We forget them quickly, as you said, Dad. And then we fixate on any… problematic things that do happen to us. And then those negative experiences that we've had then reinforce that negative belief.
see, I told you so, life really is bad, I really am a bad person because I keep on having these bad experiences. And so what does that person think? They think, well, nothing good is happening to me and there's no real reason to believe that good things will happen to me in the future. And that creates that self-sustaining quality that depression has. What do you think about that overall structure that I've painted? I think it's in my experience and
my understanding of the research literature, it's applicable in many, many cases. And I think there are people who just simply start feeling depressed. Or would say that they've been grappling with depressed mood ever since they became a teenager, really. And I think of tragically...
well-known situations like Anthony Bourdain comes to mind, in which there was no marked change for the worst. If anything, his life was this ongoing escalator of amazing improvement in which his whole... life and brand was about seeking and enjoying one wonderful experience after another with lots of friends, wonderfully appreciated, and yet, he just was...
sucked under the undertow. So I think that is a category for some people. And overall, I want to stress that there's a sweet spot in which we can both recognize whether we're depressed. or we're helping people who are depressed, we can recognize the constructed nature of it to some extent based on how people, for example, are believing things or relating to their own mind. We can appreciate that.
while also being careful, especially for people who are depressed, that we're not blaming the victim, that we're not adding what it could be interpreted as additional criticism, additional shaming. to a person who already feels kind of like a failure and sort of bad about themselves. I should add one more thing kind of in the culture. You know, America in particular has this sort of cheerful, happy, smiley culture.
We don't tend toward grim melancholy. You know, so there's this cultural thing. And if you're depressed, and I've known many people who feel ashamed of being depressed. They would say to me, Rick, I don't get it. I have two lovely children. My husband's a good guy. We're okay financially. Nothing's wrong. I'm, you know, I'm 35. Why do I feel depressed? I feel like such a loser that I'm depressed.
And meanwhile, all these people in the world are dealing with horrible conditions. Who am I to feel depressed, considering all that they're putting up with? So I feel depressed about being depressed. Buddhist lingo, dukkha dukkha, suffering that we suffer. So I think a lot of kindness is important here, and it is very interesting. We're going to be getting into what to do. I think of processes.
That's the way I'm going to talk about things that can really help people. What are some key processes? And one of certainly the key processes is self-compassion. And so I think I want to really foreground that, even as we talk about... you know, the sources of depression, the importance of considering those sources, including the ways that you yourself are in some ways constructing factors of depression, let's say, in your own mind.
To recognize that and relate to that in a framework of self-compassion is really important. I really appreciate what you're bringing in here, Dad, particularly the self-compassion part of this whole thing, which I think is absolutely a huge piece of... the puzzle for people. And one of the things that is so hard about dealing with all of this is that self-sustaining quality that I was talking about at the very beginning of depression. Because depressed mood
makes it harder for us to have good experiences. When we have good experiences, like you were talking about in the Bourdain case, it becomes harder to internalize them. And then for many people… It creates this vicious cycle of negative experiences that they're having. There's this kind of logicalness to the depressiveness of it all, because the longer that you go without being able to get out of bed, the harder it is.
becomes to come up with a justification for why you should get out of bed, right? There's just not a lot out there to get excited about. And that's this kind of like catch-22 of depression, right? Because depression is characterized by lack of energy and lack of motivation. So we can say things like, hey, depressed people are supported by exercising more until we're blown in the face. But if they can't access exercise as an intervention?
then it has no utility for them, right? Like if they can't get themselves to get up and do it, then it's not actually a useful intervention. banging my head against this, as many people have for years and years and years. I've just been doing it while I've been prepping for this episode. And I have a really hard time coming up with a good answer for that.
It's kind of the crux of the problem in some ways. And so as somebody who spent a lot more time thinking about this than I have, I'm wondering what your thoughts are here. If you've seen any ways or seen any things that tend to help people break through that stagnation aspect of the whole thing. Will you name me something? really important and very poignant. That's one reason why I kind of say I'd rather have a client who's
mad, that's angry, than a client who's depressed. Because that angry client, there's energy there that you can work with. That depressed client, you know, as someone who just sits in the chair kind of slumped. almost feeling guilty that they're a burden on me, the therapist. Yeah, totally. Even though I'm not communicating that, but it's poignant. And I'll say, well, if you tried this, they'll say, well...
I did sort of, but I didn't get anything from it. And I just kept on banging my head against that while I was prepping for it. I kept on coming up with, like, great intervention, this, good idea, that, ooh, change the... But it's like... It's funny. It's almost like it's a sinkhole. And even as you start thinking about the idea, you can get kind of sucked down into it in a weird sort of way. It has this strange energy with it. That's right. And to be crystal clear about it, it's really poignant.
And my heart really goes to the person. So what to do? I kind of think about pilot light interventions. Because you're describing the pilot light is out. That's where I'm at. Yeah. Because once you get into movement, there's so much material out there of things that people can do. You know what I mean? The trick for me is how do you get into movement?
Yeah. So we have igniting the pilot light and then we have sustaining the gas, let's say, kind of loosely. So a pilot light intervention has got to be easy. and it has to be immediately effective. Self-compassion, generally easy and generally immediately effective, with one exception, which does unfortunately predominate. in the population of people who are depressed. And these are people who are very prone to self-criticism.
Yeah, when you said self-compassion is relatively easy for people, my eyebrows went to my hairline, essentially. I was surprised by that. I think a lot of people find self-compassion so hard. Yeah, exactly right. I meant it easy in the sense I should have said simple. direct, but to do it. Yeah. So that's a pilot light. And for some people, just the feeling, because self-compassion is emotional. The feeling of tenderness applied to oneself.
often related to the person who's talking about self-compassion like a therapist, being themselves tender and kind toward a person, that can sometimes, you know, ignite the pilot light. Second, Much research on this one is really good. It's essentially mindfulness approaches to depressed mood in which you teach a person something that is easier than self-compassion. which is to step back from and witness what's going through your mind as if you're observing it from a bit of distance.
And so, for example, then if a person starts to feel sad, which might lead them to spiral down because they start being afraid that they're going to relapse, let's say, into a real episode of major depression. They just observe the sadness. There is sadness. There is sadness. There are the body sensations of it. There are the emotions of it. Oh, it's passing. It's increasing. It's decreasing. Oh.
Not a problem. That's really useful right there. So those are two immediate pilot light things. And then I'll name a third, which is tricky. Because for some people, it's out of reach. But if they can find it, it could really be good. It's to find some simple way that is still real for them, that they can be... kind and loving toward another being. It could be their pet. It could be a friend, something relatively easy. I find that that can also ignite the pilot light.
Because it pulls people into getting in touch with the goodness inside themselves, the heart inside themselves. So now they're resting more in that than in their self-criticism and so forth. Okay, so three. ways to ignite the pilot light so far? What do you think about them? When we're talking about depression, part of what we're talking about is how do we manufacture change when change seems to be a little bit out of reach, right? And part of the...
the fundamental of being a therapist is helping people change when change is hard. That's a big part. That's kind of your job description in some ways. That's right. Helping people achieve whatever. Internal realization gets them to a place where they can access these things that were once out of reach. And so for almost everybody who walked into your office, I would imagine there was a period of time where they had essentially plateaued.
They've gotten stuck, like we talked about in a previous episode on this topic. And I'm wondering if there would be anything that you would do with people in different kinds of circumstances that helped them trigger a moment. of turning the corner around something. A moment of breakthrough, a moment of catharsis, a moment of just they woke up one day and suddenly they can kind of do the thing they weren't able to do the day before.
Because when people talk about therapy, when therapists talk about therapy, that's often what they're talking about. They talk about these kind of, it's weird, it's sort of invisible, everything just coalesces and one day the person can't access. Does this make sense, Dad, or am I just kind of rambling here? It's a course right on. And I'll say, of course, that sometimes I find it helpful to look outside of...
the typical psychological psychiatric frame, especially when people are stuck. So several things here. One is, I think for a lot of people, the depressed mood lingers. as the result of not fully experienced experience. Not fully experienced loss or sadness or remorse. Freud wrote a famous paper, you probably know it, Mourning and Melancholia. In other words, he was pointing out the similarities between grief responses and depressed mood.
He wasn't acquitting the two, but he was saying there are a lot of similarities and there are ways that recognizing those similarities can help us understand things. So if the depressed mood is lingering... It could be helpful to ask what perhaps has gotten bottled up inside you and sort of stagnant and rancid even deep down inside that would be really useful to release. What might that be? Maybe there's nothing there. Maybe there's something there. A second thing that I've seen sometimes...
And these are things that, by the way, help to ignite the pilot light, because one way to put it, they remove factors that are continually putting out the pilot light. Okay. Second category is... Is there some kind of underlying material that has emotional associations that are sad, depressed? Is there some kind of underlying material that's wanting to move forward?
from your childhood, from previous jobs, and exploring that material and opening up to it. And again, focusing on releasing it. So you enter into it to help it out the door. You open the door. to it so it can move on through the room and out through the exit and then there's a a third outside the typical frame maybe although maybe other people are
using these methods, I don't know. Sometimes people might say, oh, I'm depressed as a kind of pathological condition, when in fact, they're really experiencing very normal. and reasonable quantities of sadness, concern about the future of the world, worry about their children, a sense of the light and life gradually going out of their marriage.
concern about aging and what it will be like for them as they get older. I mean, these are normal, normal kinds of dysphoria of various kinds that are adaptive. They help us take action that is useful. They can. They're very, very normal. And if we could just relabel them, reframe them as normal kinds of... unpleasant emotions, unpleasant experiences that are normal and common in this life, then a person's relationship to them can become different.
They stop seeing themselves as, I am depressed. They start seeing themselves as, well, of course, I'm still rocked by the death of my beloved grandmother a year and a half later. Of course I am. Or, yeah, I feel... Unhappy. Unhappiness is not depression. I feel unhappy because I'm going nowhere in my job. Or I feel jealous of my friends. They're getting married. And, you know, I'm just kind of marking time and I'm still alone. I'm still single. And it's not that it goes away.
when you acknowledge that that's what's really true, but it takes you out of the depressed frame somehow and draws you into these normal, natural kinds of experiences. So right off the top, you're not pathologizing yourself as much, which could help you. You feel less depressed, maybe, because if you're depressed about being depressed, well, this could remove that factor. And also, it starts moving you into the driver's seat about what you might do about them.
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Sometimes we are depressed because of an accurate assessment of depressing circumstances. And the intervention in those cases most of the times is doing things to improve those circumstances if we can. One of the challenges here is that for somebody who's in a pattern of depressed mood, it's really easy for them to find circumstances depressing or uninspiring.
You've got to be a little bit careful here about over-inferring from that underlying feeling. But that discernment, I also think, is a really good point of intervention for people. And it gets to what you were saying, Dad, about getting a little bit better at stepping back from the flow of thoughts that we have inside of us. And can we do just little practices?
that allow us to go through some kind of a discovery process of the mindset that we have, or the self-view that we have, maybe. The thoughts and feelings we have about ourselves, which are often so core to a depressive mood episode. And if we can get a little bit of space around them, whether it's through something like mindfulness practice or more of a therapeutic process that a person might go through, I think that we can...
have some realizations about how we really are thinking about ourselves and the way we are actually, that can be very powerful for a person. Because we stop interpreting information as like, that's the way it is. with that kind of very tight factual attachment to it. And we start shifting more toward, oh, this is a thought that I have. So you kind of get where I'm going here.
Oh, it's beautiful. It gets something that you've brought up a lot in our recent conversations around self-concept and shifting away from self-concept. All this said, we are now starting to get at... the role of the will. And it's tricky because, for example, as you know, a major factor of the maintenance of depressed mood is negative rumination.
over and over and over again. Or we also know that it really helps people to come out of depressed mood if they engage in what's called behavioral activation. They start doing some things, including maybe starting to solve the problems in their life that make their life depressing, like moving forward in their career or their dating life, their job search, things like that.
And yet, it's really hard to mobilize the will when you're just depressed. And so the question becomes how to do that. And I'm very interested in some of your thoughts about that and what you found in the research. I will throw in... another funky pilot light igniter. Of course, you have to get the person to do this initially, but if you're willing to do it, it's to do intensive, even aggressive physical activity.
of some kind suitable for your body you know strap on your your skates and go play hockey Put yourself in a rock climbing situation in a safe place like a climbing gym with a good top rope and totally go for it. Anything that involves intensive, even aggressive, even angry. activity can really be mobilizing and in the moment at least as you're mobilized then you can
build on that by doing other things. Now that I'm mobilized, I will sign up for a class, let's say of some kind, that would be good for me, where I'm going to meet more people that I've just been procrastinating about day after day after day after day after day. But at least now that my aggressive revving up kind of activity has ignited my pilot light, until that pilot light goes out, I'm going to take as much advantage of it as possible.
I think for me, it's about which category are you in? Are you in the, I do experiences and they just don't feel good category, but I can get myself to do the experiences? I think for that person, that intervention is fantastic. I think for the has a tough time doing anything person, and again, I don't mean that judgmentally. I just mean that kind of as a fact statement. That kind of an intervention is tough because it could feel like, whoa, that's a lot. I have a hard time.
cleaning up my room a little bit. You're asking me to go out to a climbing gym, oh man. And that actually speaks to an intervention, I think, which is trying to figure out what we can do. It's the small bites approach, is sometimes what I call it. What's the smallest bite that you can take?
so you know that you can succeed at taking that bite? And is there something that you can do to take a slightly larger bite tomorrow and the day after and the day after and the day after? And that kind of snowballing can sometimes help people a lot. This is also sometimes called the clean your room theory. Start just by cleaning your room and then go from there. Because that can be a task that can seem approachable enough for a person that it can get them into movement.
And then they can use that behavioral activation to go out and try to take larger bites over time. That makes me remember something that has been really found to be a major factor, which is social support. Yeah. Sometimes depressed mood can isolate us. I get that. We get embarrassed about it. We don't want to tell our friends our problems yet again and all that. Okay. Still.
Having relationships that are positive for you, they're good enough for you is really important. And here's another pilot light igniter. Sometimes, really, we need someone to do it for us. We need someone to sit next to us while we flick through OkCupid or whatever people are using these days. We need someone to go with us to knock on our door at nine o'clock every morning. Hello, time for the walk. We're at the door. You know, we just need that. And it can be...
Very intimate and touching to let somebody else help you. Sometimes we need growth buddies. People will just be our buddy. And it's an honor. to be invited into that role. So intimate, so vulnerable, so important. And who knows, someday the tables might be turned and you're going to be asking that other person to be your own growth buddy. down the road. So it's okay. But this thing about letting people into your life and letting them help you.
You know, letting them come over and help you straighten up your closet with you, right? So you feel better about it. Anything like that can really make a difference for people. that depression is closely tied to the function of this particular brain region. It's called the default mode network, and it's also really associated with...
rumination, ruminatory processes in the brain. And rumination is when you're just chewing a memory over and over and over again. And most of the time, it is not your favorite memory. or a thought or a feeling, whatever it is that you're just kind of chewing on. And so remember, a lot of the time, depression is linked to negative self-concept. Well, what does rumination do? It reinforces negative self-concept because you keep on going back.
to this thing that was not a good experience and is generally tied to a lot of pain, a lot of shame, and a lot of judgment about whatever happened. It goes over and over again on the movie internally. It gets reinforced, reinforces that self-concept, gets harder and harder to change. Okay, what can we do about this? Rumination is really hard to deal with.
We have dedicated episodes on rumination. I would recommend going and taking a look on them. I have a workshop about it, actually. Dad's got a workshop on rumination. Yeah, a lot of material out there. And it's good that there's a lot of material out there because it is a major problem for people really, really quickly.
there is one thing that has been found over and over again to help with ruminatory processes by deactivating the default mode network. Guess what it is? It's mindfulness practice. It's meditation. Now, telling somebody who is depressed. oh, just go meditate, bro, is really not that helpful most of the time. But if you are able to access that very, very simple mindfulness-based processes that are specifically focused on experiencing right now,
are often really helpful for people because it really clarifies where our suffering is, particularly where our suffering is temporally. For most people, most of their suffering is in what they regret in the past. or what they're anxious about in the future there are certainly people where there is a lot of suffering in the present moment and i'm not trying to downplay that but for most of us that's where most of the suffering lives
So the more that we can do to kind of come into right now, the more that we can start to untangle from those ruminatory processes, and we can start to get more evidence. We can start to get more evidence of, actually, you know what? I'm not doing anything wrong right now. I'm just being a person. I feel the way I feel. It's a normal human experience. It's not great, but here I am that can support some of those self-compassion practices.
You can get more evidence of what you're doing right now that's not that bad thing that you did in the future that you feel a lot of regret or remorse or shame around. You know, yeah, that was a moment of time in my life. I don't feel great about it, but hey, here I am right now.
You can get more clarity about how you're not currently experiencing whatever you're afraid about that might happen in the future. Yep, still worried about that. But hey, that's over there. And I'm over here. Again, we get into that localization practice. I'm here. it's there there's more space that can help diffuse your anxiety none of these interventions are perfect but if you are dealing with a problem that's as entrenched as a depressed mood cycle
you kind of got to try whatever's available to you. And often what you'll find is you'll try a lot of different things. And one of them will help you out enough that it can help you light that light and break out of these patterns that we get stuck in. I'd add a little teeny-weeny technical detail around mindfulness that I just stumbled on in brain science. Interoception, tuning into internal sensations like the flow of cool air.
coming in and warm air flowing out or the expansion or falling of your chest as you breathe, that engages a part of the brain, the insula. And when the insula gets engaged, the activation in regions of the default mode. in the midline toward the rear, the cerebral cortex, that diminishes. So in addition to general mindfulness practice, for sure, disrupting rumination, just following your breath.
For some reason, your breath is uncomfortable. You could even just do the movements of your joints in space, which is also interoceptive. So a major problem for people, Dad, who are dealing with depressed mood... is all the stuff that we've been talking about in terms of appraisal of the self in a negative light. And it can be really hard to change that self-appraisal if you think about people you've worked with or people you've known who've gone through a depressed mood cycle.
often really attached to the core of it are beliefs about the self that are not super positive, not super friendly. And this is another topic that we've done a lot of material on, but I'm wondering just kind of quickly at the end here, if you're open to moving through it, if you could give a little bit of advice.
for working with that kind of a negative self concept and what a person might be able to do to develop more positive and also, hey, more accurate thoughts and feelings about the self. Yeah. Well, a couple things about that. First, if you think of the movement from negative self-concept to positive self-concept, that's a big stretch.
But there's an intermediate step. Yeah, love where you're going here. Yeah, in which you make room for not knowing. And that's actually within reach. Don't know. Doesn't take a lot of effort. to don't know. So when you are considering yourself or considering how people might react to you, and instead of trying to directly change the habit...
of negative assumptions about yourself or the future that you'll experience, play around with what is it like to just don't know. That itself can be really, really helpful. In addition to not knowing, as we look here for what can ignite the pilot light and what is really within reach, doesn't take a lot of effort. We can also think about looking for opportunities in the category of social support in which a person with depressed mood is with another person who clearly is friendly.
or respectful, or appreciating, or even loving. And in the field of that other person's positive care and concern and kindness and love, In the field of that, which is undeniable, it really is real, a depressed person can deliberately soften in the face of it and receive it. Again, it doesn't take that much effort to receive what's... palpably present right now in the room with you and another person and receive it and let it in. And in the letting in, there's a natural...
decrease in low self-worth and a natural increase in positive self-worth. Just doing that, I am the kind of person that this person likes. It really helps to be simple about it and to disengage from the yes-but tracks in the mind and to just zero in on the actual feeling of that other person for you. And then third, also looking for what's accessible. And please help me, Forrest, to talk about this clearly. It's always the case that
We are being. We take it for granted. It's in the background. But being and beingness is ongoing. And in my experience of people who are... they're often caught up in rumination, just like you say, and caught up in commentaries on commentaries on commentaries inside their own mind, lifted up and away from...
the ongoing stream of their own being. That's always occurring. They're just not aware of it. They're not in touch with it. And there's something that can happen when you just simply draw people into what's your sense of... of being right now? Presence, it's beyond mindfulness. We can be mindful of being, but being is distinct in its own right. Oh, what's your sense of being beyond?
judgment, beyond good or bad, beyond approval or disapproval, there's simply an ongoing nose of being, which has a legitimacy and a standing innately of its own. much like the ongoing being of a squirrel in a tree. The squirrel doesn't have to justify itself. It's simply being. Yeah, and I wonder if that can help. a person maybe—and I'm just tossing this out there just as an idea—if that could help a person access certain underlying vitality even.
that might be linked to just being. So it becomes less about this justification process because that's what's kind of interesting to me about this. Depression in a weird way has an extremely strong self-justification process. It's very validating of its own existence. And so it can be helpful maybe to subvert that in some ways by going to this being level that you're describing, Dad, where
where you try to tap into just like the ongoingness of living creatures and their desire to self-perpetuate. And maybe there's something there that we can tap into a little bit that could be useful for a person. I wonder if that's maybe… a piece of what you're speaking to here. Yeah, thanks for the help here. It's both very experientially real for me and hard to talk about. Yeah, totally.
Yeah, and it's a little bit like when you're rested in your sense of simply being, it's just not relevant that you're depressed. It kind of doesn't matter. It's at a whole other level. It's there. right? But you're existing. You're okay in simply being. And one thing, the reason I like it is that it's right there. It's available.
You are being, can you be aware of being? It sounds kind of weirdly circular, but it's real. Can you be aware of being and can you rest in simply being? What's it like right now to let go of doing? Let go of working, let go of problem solving, planning, let go of worrying. You don't have to prevent anything right now. What's left when all of that falls away?
When all the stuff that we add falls away, what's left? And what's left is not depressed. And being able to access that directly, immediately, is a great refuge for people. It's an immediate recourse, helps them out of their depressed mood immediately. And the more time I believe and have seen that people clock in simply being, the more resourced. they become and the more their mood sort of lifts over time because in being itself is mildly positive mood.
It's like the pleasure in going on being. You're going on being. You're still here. It's like the engine is idling. It's turning over, though. You're still here. You're okay. It's really interesting, Dad. Man, this is one of those topics that in some ways is a way in to so many other topics because...
Depression is a pervasive issue for people. It touches on so many different systems, like we were talking about with that biopsychosocial model, right? It implicates so many different parts of our life. There are so many different things a person could do in order to do something about it.
And at the same time, it has that self-perpetuating energy that makes it hard to access any of those resources, which just make it a bit of a catch-22. And it leads to a conversation like the one that we're having today. being full of yes ands or yes buts, if that makes sense. This and that, this but that. And I think that just in our positionality, people trying to create something useful here.
it can create naturally a certain haltingness in talking about it because you want to appreciate everybody's different experience. You want to not overclaim about what might be helpful for a person. I think that a lot of the material that's out there that's about depression really overclaims authority in a lot of different ways.
or makes it kind of sound like, hey, if you just do this thing, it'll solve your problem without any acknowledgement of all the other things that are part of the soup. And so I'm really glad that we talked about this today. I hope that people find it really helpful. It's such a tricky topic.
But I hope that, you know, if you were listening to this and you made it this far, there was at least one thing in here. And if you can take that one thing and find it helpful and leave the rest, that's totally great. That's how a lot of this works. Today I talked with Rick about depression and depressed mood, and particularly what we can do to break out of a pattern of depressed mood.
Depression is so difficult to talk about in part because it's very self-perpetuating. The nature of depression itself makes it really difficult for us to do anything about it. It saps our energy. It saps our motivation. We hear other people out in the world talk about all of these interventions.
of these things that we could do, but they just seem completely out of reach for us. And so what's the usefulness of an intervention if the person who needs to use it, needs to access it, is unable to do so? And that's the crux question that I really wanted to explore during this episode. Depression is a very complicated topic. I'm sure there are things that we got wrong, particularly that I, as a non-clinician,
got wrong during this episode. I hope that people give us some grace about it, in part because this is such a complicated topic. And we started by drawing some distinctions. between depression, depressed mood, a diagnosis of major depressive disorder, dysthymia, and just being sad. There's a lot of terminology here.
We tried not to get too bogged down, Annette. During the conversation, we really focused on the more colloquial usage of the word depression as opposed to a formal diagnosis of major depressive disorder or something similar to that. Bottom line for us, if you're somebody who struggles with negative self-appraisal, this pervasive feeling of sadness and emptiness, and particularly if you struggle these days to derive a lot of pleasure or enjoyment,
from things that you once enjoyed. And if that's all accompanied by a lot of negative thoughts and feelings, difficulty energizing yourself, emotions like hopelessness maybe, then what we're talking about during this episode could be really useful to you. We talked during the episode about what causes depression, which is an incredibly complicated question that a lot of people argue about to this day, and we referred to something called the biopsychosocial model.
To simplify this, it basically means that there are three domains that can impact how we think, feel, and behave. Stuff in our lives, out in the world. Stuff in our biology. and then stuff in our mind or in our thoughts. And this idea comes from psychiatrist George Engel, and I think that he first wrote about it in 1977, if I'm remembering that correctly.
So the basic idea here is that medical conditions, and disorders are definitionally medical conditions, are based on more than just our biology. They're based on the interaction of our biology with our social environment and our psychology. And a purely biological approach to something like depression might be the serotonin theory of depression. If you want to Google it and learn about that, you can. It's been basically largely debunked.
Most serious doctors and academics these days really don't think in such simplistic ways about complex problems like depression. And then, alternatively, you might have explanations like social rank theory, which basically focuses on the social aspect of the whole thing. But the truth is that depression is a complex condition, and it's influenced by a whole bunch of different things—genetics, economic status.
whether or not you have a lot of supportive relationships in your life, various developed psychological traits, things we can grow inside of us over time, how resilient a person is. And this is why clinicians have increasingly moved toward this biopsychosocial model. in the approach to the treatment of depression. The upside here is also the downside. There are a ton of different places where you could potentially intervene. You could intervene out in the world.
try to develop more friendships, more relationships. You could intervene in your mind, try to develop more positive traits, courage, compassion, a lot of stuff that we wrote about together, Rick and I, in the book Resilient. Or hey, maybe we could try to intervene in our bodies, doing things like changing our sleep patterns, getting more exercise. If you're into the sauna or the cold shower craze, hey, maybe we can try that on, see if it does much for you.
But the problem with having so many different places to intervene is that first, people can get confused and overwhelmed. And then second, it's a little bit of a vitamin C situation. So this is a example that Rick uses sometimes where if you're struggling with scurvy, you can take all the vitamins. vitamin A in the world, what you need is vitamin C. So if your depression is stemming from a fundamental biological issue that a person has…
it's going to be really hard for them to solve that problem by looking to their social environment or by developing more psychological traits. I then painted a common picture of how a depressed mood pattern starts for many people. They're going along. Life is kind of okay. It's not perfect, but they're...
They're doing all right. They're persevering. And then something happens. There's this inciting event. Then that event leads to the creation of negative beliefs. These beliefs are usually about the self, but they can be about other people or about the world altogether. And then those negative beliefs crowd out positive experiences. All of our experiences start being funneled through the lens of those negative beliefs, so neutral experiences.
interactions that a person could plausibly interpret as being either negative or positive start being interpreted more and more negatively. And positive experiences, like Rick was saying at the beginning of the episode, really just don't have a lot of purchase. They're enjoyable for a moment or two or three, but then they just kind of vanish, or hey, they never really felt that good for a person at all.
And man, we really fixate on anything and everything that we can that is even a little bit negative or painful or problematic for us. And then all of those negative experiences that we're noticing really reinforce the negative beliefs that we have about ourselves or other people.
And this creates the self-sustaining nature of depression. And that is what makes it so difficult for people to work with. Then from there, I asked Rick about some immediate, what he called pilot light interventions that a person could do. to begin to activate. Because again, it's that beginning to activate moment that is often so challenging for people. He offered three options for people.
All of these might not be available to you. Hopefully one of them is. If none of them are, then hopefully something else that we mentioned during the episode might be available to you. First, self-compassion. Being able to take a step back.
and understand that depression is hard for many, many, many different people. We all have moments in our lives where we feel a bit down, we feel like we're in a depressed mood state, we feel like things are really hard, and we feel that way often because it's true.
And the more that we're able to access self-compassion, the more it becomes a natural antidote for some of the negative self-concept issues that we also talked about at some length during the episode. Second, different kinds of mindfulness practices.
being able to view what's going on in the mind and get a little bit of space around it. Different kinds of practices of observation, even just tracking the breath can be really helpful for people. And then third, if you can, find a small and simple way.
to be kind and loving toward someone or something else. Because the feeling of that inside of yourself can help reinforce for starters positive views about the self because again negative views about the self are such a big part of depression it can also give you a sense of that feeling what it feels like
to be kind or to be loving that can help us connect with more positive emotions of different kinds, which again, feeling those is often really hard when you're in a depressed mood state. And it also can create this nice feeling of energy and change. just help us access the feeling of movement around something at all. Rick also had some really good recommendations for when it comes to breaking through a plateau, if it's a depressed mood plateau or any kind of plateau that you're experiencing.
First, we might explore what feelings are there to feel that maybe we didn't feel yet. A lot of the time, people are depressed because there are real things out there to feel sad about. And sometimes we really need to process those feelings before we're able to move through the mood state that's associated with them. Then second, he asked, what stuck material might be present in a person? And what can we open the door to?
what feelings are in the underbelly of our experience that can move through us, that we can get some kind of a sense of motion around. a sense of seeing them, a sense of releasing them. Is there anything we can do to walk those feelings out the door? And then Thirty talked about really appreciating the normal nature.
of these experiences, which can, again, help us access some more self-compassion around them. Then toward the end of the episode, we talked about a lot of specific practices that if a person is able to access them, might help them if they're dealing with a depressed mood state. For example, Rick talked about if somebody is struggling to feel enjoyment, regardless of what it is that they're doing, can you go rock climbing? Can you kickbox?
These are things that can help us connect to that more vital energy inside of us that has this natural sense of perpetuation and movement around it. Then I talked about taking smaller bites. What can you access that's the right size for you? It's not too big. It's not too small. It feels manageable. We also talked about working with rumination and how mindfulness practices, again, can be a great way in for that.
Then toward the very end of the episode, I asked Rick about developing a more positive self-concept. Because remember, Negative self-concept really attached to depression, so if we can create a more positive self-concept, that normally helps us deal with the depression. First, he talked about moving not from negative to positive, but from negative to, hmm, I don't know.
This is a smaller and more manageable, more approachable step for most people. Can you move into a sense of curiosity about who and how you are, as opposed to a sense of knowing that you are indeed awful? Are there things that we can do to push back against the voice inside of the mind that really tries to sell us on a view of ourselves, and particularly a view of ourselves that we know, even if it's just with 1% of who we are, is not serving us anymore.
Then second, he mentioned when you are around other people in some kind of a positive way. Most people are around some number of other people in some kind of a positive way. When being with that other person, can you center in the factual statement? not the judgment, not the view, the factual statement, that you are with somebody who wants to be with you. I'm the kind of person that this person, clearly, because they're around me, wants to be around.
That can be a really good observation about the self that, again, is just grounded in reality. And that simple approach can really help sometimes.
push against that voice in the mind that is constantly looking for a yes spot. And just here at the end, I'd like to say that if you're somebody who struggles with depressed mood, know that you are not alone in this it is an incredibly common experience i've had many experiences in the course of my life where i went through a real period where it was difficult for me to do any of the things that i wanted to do it was difficult for me to feel good
And I come from a background, from a life circumstance where, man, I had a ton of advantages. My dad's who my dad is. I had a really, by and large, pleasant experience growing up in my home life. And yet, nonetheless, we all have hard experiences in life, and I went through a pretty dysthymic mood-ish period when I was a teenager for a pretty extended period of time.
And so I just say that to humanize this a little bit at the end and to appreciate the ways in which this can be really a pervasive issue for people and a very difficult issue to deal with. And you can have all the tools in the world and this can still… creep up on you. And I think that understanding that can also really help us develop the clear seeing, the accurate appraisal, the self-compassion, and all of these useful things that can really help us deal with these problems.
So I hope there was something in this episode that you found helpful. If you've made it this far, we'd really appreciate it if you would take a moment to subscribe to the podcast, maybe leave a rating and a positive review wherever you're listening to it now on. Hey, leave a comment down below if you're watching on YouTube.
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