This is the last in a four part series. You can read the whole series here. In this article, we investigate: If depression is not just the result of a broken brain, if you start from the assumption that your wiring is fine and it’s just a matter of your thinking being off track, what can you do about it?

When people talk about psychological characteristics like perfectionism, it’s easy to see them as negatives.  The perfectionist can be crippled by their inability to put everything in order, many people with very cluttered and disorganised houses are actually perfectionists who gave up.  Perfectionism can also lead to anxiety and depression, when the constant battle to create order becomes overwhelming.  You might wonder, what’s the good of perfectionism?  But next time you drive across a bridge, or go up to the tenth floor of a building, you can probably thank an engineer who is a perfectionist that you survived the experience. If we medicate all these supposed flaws away, there’s a lot we could lose.  So too with the ‘ruminative’ factor associated with depression.  But for those of us with that ‘deep thought’ tendency, how can we get the most from that side of ourselves – create art, study literature, understand history, design products, solve problems, write computer programs,  perform theoretical physics – without getting trapped in a depressive spiral?

Martin Seligman is a psychologist at the University of Pennsylvania, who started challenging the ‘disease model’ of psychology way back in the late 1960′s.  Rather than psychology’s ‘normal’ aim of making miserable people less miserable, broken people less broken, he helped to pioneer the idea of positive psychology – finding what makes positive and strong people able to stay that way, what thought habits and activities characterise authentic happiness, and teaching them to all people as an ‘immunisation’ against depression.  This isn’t the magical ‘power of positive thinking’ guff, the affirmation nonsense of saying  “every day I’m getting better and better” being enough to make it true, but a scientific approach to finding what characterises a complete, whole and happy life.  This is a ten minute video but it covers it well.

I’ve had a number of responses from friends to these posts, including two people with similar stories – they are aware they have a tendency to dwell on things, and both have a parent who is constantly depressed and negative.  Having that parent as a reminder of what can go wrong meant that both of them learned early on to catch themselves before it got too bad, one with the occasional bit of counselling, so they’ve kind of performed behavioural therapy on themselves.  Likewise, discussing this with a staff member at work (an art teacher – creative, ruminative) she mentioned that her father had taught them a lot of these optimistic thinking skills when they were young, deliberately to help them avoid these pitfalls.  Where some of us succumb to what Seligman calls ‘learned helplessness’, others learn they can take charge of their thinking in a situation, and these are the skills I believe you need to conquer depression.

Cognitive behavioural therapy is an approach to counselling/psychotherapy based on making you aware of the way you think, and teaching you to make changes in that thinking.  CBT came from a rejection of Freud’s belief that analysing past experiences could help patients get better, the classic TV psychology on the couch.  Instead, it works on the way your thoughts and beliefs inform your feelings, so rather than spending years dwelling and rehashing things that went wrong in the past, you analyse how you think about what is happening now, what you believe about situations, people and yourself.  By thinking about the way that you think (cognition) and changing the way we respond and act in situations (behaviour), CBT seeks to create a positive way of moving forward, rather than dwelling on a past that can’t be changed or fixed.

With anxiety and depression there are a lot of underlying assumptions and habitual thoughts happening, CBT can help to challenge the beliefs that flow on to anger, anxiety and depression.  You learn to analyse the thoughts you are having, the beliefs you currently have that these thoughts are based on, and the reasons you are reacting the way you do. Rather than feeling helpless in a situation, you can learn to manage the anxiety and hopeless feelings, and without that clouding your mind you can learn to tell what you can change, and what you have to accept and look at differently. I’m lucky enough to work only four days a week, this decision was made in response to Mon and I analysing some of the things that didn’t work for me and looking at ways to change them.

A couple of books that you might find helpful are The Optimistic Child by Martin Seligman, and Change Your Thinking by Sarah Edelman. Optimistic Child is aimed at parents, it is some dry, academic reading, but it also has examples and exercises to help build children’s resilience. It’s still good reading for adults who suffer depression, but is more aimed at the idea of ‘immunising’ children against depression.  Change your thinking is easier to read, and aimed at the current sufferer of anger, anxiety and depression.  Again, there are lots of examples and exercises to help you build your own strategy.

You don’t have to do it on your own from books either.  Psychologists are expensive – the Australian Psychological Society recommends a fee of $212 for a one hour consultation, although many psychologists will charge less.  However, if you have a referral from your doctor, you can get a rebate from Medicare with a GP Mental Health Care Plan, which covers you for 6 visits and a possible 6 more if needed.  With CBT the idea is that this is enough to teach you skills which you can then practice on your own, as opposed to a lifetime of weekly psych visits like on TV. I was lucky enough to find a psychologist that would bulk bill, so it cost me nothing.

Also, exercise.  You sleep better, you are healthier, and it’s a free dose of endorphins to the brain, which encourages positive thinking without disrupting the good side of your deep thinking brain.  Also gets you away from moping on the couch, so if you find it hard to get motivated try and find a team sport or group activity with friends so you have a regularly scheduled exercise to get to.  The achievements you make in getting fitter, faster, thinner, buffer or whatever, can also help you to feel better about your whole self.

It probably seems like I’m quite against medication for treating anxiety and depression, but this is not entirely the case.  What I’m against is medication being the first and/or only tool, and being the lifelong treatment.  It takes considerable effort and motivation to change the way you think and act and live, and for many people their depression is far too deep by the time it is recognised, and pulling yourself far enough out of the mud to even start this is impossible. In my own case I have been medicated for some years while I’ve been learning and going through the rest of this process, and it’s only in the last few months that we’ve been talking about the possibility of me coming off them. When formulating a mental health care plan, a GP should be assessing the need for medication in the whole plan, and you should certainly feel comfortable asking your doctor whether it’s feasible to start the process without medication, but it’s not a failure if you need to take something for some time before you have enough stability to face other steps.  Coming off them later is then a conversation to have with your doctor as well as those people around you who will have to put up with you if it doesn’t go well.

Recovering from depression is a journey, and can be long and painful for the sufferer as well as friends and family.  However I believe it’s important to value the whole person by looking at the problems and issues as real and life based, and not the results of a mere fault in brain chemistry, and addressing the problems directly.  Certain personality traits and characteristics can make people more prone to depression, but by learning to understand and control the way are thoughts shape our feelings we can also learn to get the most out of those traits, and eventually live our lives whole and unencumbered by mental illness.