Lifting depression is easy to do — when you know its cause

This article about the human givens approach first appeared in the major American publication, Family Therapy Magazine.

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Depression is a fascinating route into understanding how the brain works: it raises so many questions. Depressed people, for example, will often ask, "Why am I so exhausted all the time?" They might not be working, perhaps hardly getting out of bed or spending their time slumped in front of the TV. It doesn't seem to make sense. Surely they're not expending much energy; so why do they feel so dreadfully tired? We will explain why, offering an understanding that, in our experience, dramatically improves therapeutic outcomes for depressed patients.

New insights are typically rare, but here is one from human givens psychology: The symptoms of depression arise when excessive worrying upsets the balance between the amount of energy burned during REM sleep and recuperative slow-wave sleep. The result of this imbalance is that depressed people wake up tired and unmotivated.

Three factors generated this insight: Discovering what naturally motivates people; the causes of worrying; and the expectation fulfilment theory of dreaming. We will look at each in turn and show how they are linked.

The Universal Law of all living things

The healthy feeling that life has meaning and purpose comes from being motivated to actively engage with the world. Only when we lose the motivational energy that promotes action does the sense that life is meaningful drain away. Human givens psychotherapy grew out of a desire to find out why this should be so (Griffin & Tyrrell, 2003).

As with the start of any scientific endeavour, we had to begin by establishing an undeniable truth that everyone could affirm. Since we are living beings, we asked the question: What does it mean to be alive?

The answer, clearly, is that we are an animate life form and what all life forms have in common, and distinguishes them from inanimate forms such as a rock, is that they are complex orderings of matter that must continuously rebuild themselves, or they cease to exist. A lump of granite will pretty much stay a lump of granite for millions of years if you leave it alone, but a living thing will quickly degenerate, disintegrate and die unless it is continually rebuilt. So the first law of life is that a living thing, whether rose, maggot or horse, has to take in nourishment from its environment so it can continually rebuild and maintain itself as it takes its allotted form throughout its life cycle. We are all subject to this universal law; it's as fundamental as the law of gravity and equally capable of being observed: When we are nourished and our innate needs are met, we flourish; when we are not nourished, we wither away. If you drop a rock, it falls to the ground; if a living organism doesn't get nourishment, it quickly deteriorates.

That was our starting point: Every baby, like every other living thing, must take in nutriment in order to survive and grow in ways appropriate to our species. The knowledge of how to do this is given to us at conception from our parents' genes. Because our genetic knowledge patterns are innate, we call them human givens. They evolved from the collective experience of all mammalian species over millions of years and include our core instincts and reflexes, such as how to breathe, suckle, swallow, grasp, build rapport with our mother, swim, learn the language we hear, and, when the time comes, procreate. Throughout our lives, this wisdom of the phylum works day and night to help us survive.  

Our innate knowledge motivates us to engage with the world

We all continually experience the effect of this innate knowledge as "needs.” Our physical needs (air, water, food and sleep) are obvious because, if they are not met, we quickly die. But many psychologists and psychotherapists before us, indeed, throughout the ages, have observed that emotional needs are equally crucial for human wellbeing. These include the need for:

• Security — safe territory in the home and outside where we can live without experiencing excessive fear and anxiety
• Volition — a sense of autonomy and control over what is happening around and to us
• Attention — receiving it, but also giving it — an essential nutrition that fuels the development of each individual, family and culture
• Emotional connection to other people, both individually (friendship, love, intimacy) and in the wider community (respect, status)
• Privacy — time to reflect and consolidate our experiences
• A sense of competence and achievement (ensuring we don't feel low self-esteem)
• The need for meaning and purpose that comes from being stretched mentally or physically (or both).  

There are three main ways we achieve meaning:

Serving and being responsible for other people (as in childrearing, caring for the sick and elderly, managing or employing people); pushing oneself to learn and do more (as in developing our career, business, art, craft, music, sport, developing new skills or in an academic sense); and having a belief framework (religious, spiritual, political or philosophical). These help us focus our fragmented consciousness on a bigger picture.

By definition, an innate need is incomplete; a partial pattern that motivates us to complete it by matching up to something that it recognizes as "answering" its call in the world — as when a baby knows how to suckle on its mother's nipple and does so. This instinctive pattern matching process is happening from the moment we are born and continues throughout life, determining many aspects of our personality and character. If this process goes well, life is good to us. If not, we soon feel frustrated and stressed, and that can quickly lead to disturbing psychological states; anger or anxiety disorders, depression, addictive behavior, or psychotic breakdown. Then, as if that were not bad enough, our disturbed behavior impacts on those around us — family, friends, and colleagues — and puts a strain on the wider community.

Nature also gave us resources to help us get our needs met. These givens include:

• Long-term memory, so we can learn new skills, improve our understanding, absorb language and pass our learning on to the next generation
• Imagination, which enables us to focus our attention away from our emotions and problem solve more creatively and objectively
• The ability to build rapport, empathize and connect with others
• The ability to "know" the world through metaphorical pattern matching — hence our delight in discoveries, exceptions, resonances, harmony, music, biographies, stories and jokes.
• A brain that dreams; as we shall see, dreaming is nature's way of metaphorically discharging the autonomic nervous system of accumulated expectations we got worked up about during the day and did not deactivate by taking action in the real world.

So another fundamental law: If our innate needs are met well, we are mentally healthy—we cannot be otherwise. When they are not being met, however, our anxiety levels rise and we start to worry. This is the beginning, not only of depression, but of all mental illness.

Why do we worry? 

Misusing our imagination by worrying is a very human vulnerability and the short answer to why we do it is, we become emotional when one or more of our innate physical or emotional needs are not satisfied. All strong emotions, positive or negative, focus and lock our attention to prepare us for action. (As a consequence, because they narrow our viewpoint and prevent us from seeing a bigger context, they also lower our intelligence.) Depression is a strong emotion and, when we feel there is nothing we can do about a situation, the low mood becomes even stronger, unrealistically biasing our view of the world and our life. Because our attention is locked, this state of affairs can seem permanent and all pervading. What stops people from getting physical and emotional nourishment? It seems there are three possibilities.

1. The environment is sick and unable to provide It properly

Crops don't grow in a drought. Fish die when the water dries up, as do people when there is nothing to eat and drink. Equally, anything that prevents us from matching up our innate emotional needs in the world threatens our mental health. For many people, some aspects of modern living — in the family, the workplace and wider culture — are disrupting their ability to use their internal guidance systems effectively. The working practices of some large government or corporate institutions, for example, create high levels of stress that are palpable and affect huge swathes of the population. Clearly, we can no longer take for granted, as past generations did, that our existing family, neighborhood, religious, educational or government institutions can ensure social stability — those days are over. Things will only improve when more flexible responses become available to these institutions so they can adjust their procedures to work in harmony with a shared understanding of the human givens. Only then might we reduce the damage being done to people.

2. A person doesn't know how to operate their 'Internal Guidance Systems' to get their emotional needs met

This can occur when one wasn't properly socialized in the early years, or failed to learn how to engage and disengage their attention at will, or they misuse their imagination by worrying, which leads, as we've seen, to depression. The more complex an animal organism, the more learning input from the environment it needs to survive, over and above what it inherits from its genes. Higher mammals that hunt, like wolves, learn how it's done from older members of the pack. But our capacity for learning is vast and requires far more input from the surrounding culture than a wolf does, and the input has to be sufficient and of the right quality for healthy development. For many it is not.

3. An individual's Internal Guidance System is damaged

When things go wrong in the transmission of genetic knowledge, children, unfortunately, can be born damaged. In addition, damage can be done to us by direct physical assaults on the brain due to attack, accident or poisoning by drug or alcohol use later in life. But these represent a comparatively small number of cases. Overwhelmingly, the harm to human guidance systems today arises from three sources: insufficient intake of nourishing food to rebuild the actual physical apparatus itself; psychological damage due to trauma; and unhelpful conditioning. Fortunately, enough information is widely available about what food we should eat to be healthy. Fortunately too, effective psychotherapists know how to treat psychological trauma, even the most severe symptoms of PTSD. But the way our culture conditions us, and the harm this can cause, is more problematic and less widely known. We lack enough objectivity to recognize our own conditioned behavior and responses, so we don't examine them consciously (Griffin & Tyrrell, 2007).

It follows that depression is always secondary to another problem: a signal that there are obstacles preventing a need, or group of needs, from being met, and the person is worrying about this. Clearly, the feeling that life has meaning and purpose comes from being motivated to actively engage with it to get our needs met. When we lose motivational energy and cease to engage, meaning quickly drains away. Naturally enough, the additional distress this causes compounds the worrying, which further depresses mood and can even lead a person to think of killing themselves. We now need to explain why worrying causes excessive REM sleep and how this leads to exhaustion and anomie.

Why we evolved to dream

Dreaming takes place in the stage of sleep known as REM (rapid eye movement). All mammals and some birds show REM sleep. The other stage of sleep, non-REM slow wave sleep, is the vital recuperative period when the brain is reinvigorated and the immune system boosted so we feel refreshed when we wake up. For many years, one fact puzzled sleep scientists—the finding that depressed people have proportionally more REM sleep than non-depressed people, and that their REM sleep was more intense. To explain this, we need a little diversion into biology.

When warm-blooded mammals evolved, they consumed five times more energy than reptiles, so a means had to be found to conserve energy. But, from a physiological perspective, any emotional arousal of their autonomic nervous system was an expectation that action was required. And action burns up energy. Moreover, every arousal is only a part of a larger cycle that includes taking the action to dearouse the expectation and, since not all expectations are fulfilled, and some had to be suppressed for expedience sake, this raised a problem: To conserve energy and not be driven manic, mammals had to find a way of dealing with unfulfilled expectations left over in the autonomic nervous system, otherwise they could not maintain the integrity of their instinctive responses. Nature's solution was to translate these expectations into dream scenarios during REM sleep and metaphorically act them out. That's why dreaming deals with the whole gamut of emotions — any anticipations not fulfilled before we slept — so dreams can be happy, sad, angry, anxious, fearful, loving, sexy, etc. This is known as the expectation fulfilment theory of dreaming (Griffin & Tyrrell, 2003).

The dreams of the depressed are never happy

Depression, of course, is a very powerful emotion, and incessant worrying about things that the person believes can't immediately be solved generates a huge number of unfulfilled negative expectations, every one of which gets added to the list and has to be deactivated in order to complete the autonomic nervous system's arousal/dearousal circuit. This puts enormous pressure on the brain's dreaming process as it furiously fires off the orientation response, causing excessive autonomic arousal discharge in REM sleep, burning up energy and reducing the amount of recuperative slow wave sleep, leading, in turn, to physical exhaustion, loss of motivation to do things and subsequent depression.

So waking unrefreshed, and with no motivation, occurs because one's sleep pattern is unbalanced, which is physically exhausting due to the decreased amount of restorative slow-wave sleep, and mentally draining due to the increased firing of the orientation response (which normally fuels our daytime motivation and attention capacities, which is why depressed people find concentration so difficult) during dreaming. Motivation drains away, as if the brain's battery is flat when our orientation response is overused.

This also explains other symptoms, and why so many depressed people have nightmares! Not being able to fall asleep, for example, is the worry circuit — catastrophic thoughts going round and round in their heads, preventing them from doing the hemispherical switch that normally precedes falling asleep. And waking up early is a sort of survival mechanism for the brain, a response to energy depletion in the glial cells, which are not getting enough sugar to compensate for the energy being used up by the excessive dreaming. When we lose motivational energy and cease to engage, meaning quickly drains away. Naturally enough, the additional distress this causes compounds the worrying, which further depresses mood. 

Breaking the cycle of depression

When we explain all this to our depressed patients, after calming them down tso that they can access their ability to think rationally again, it is as if a light clicks on in a dark room. For the first time, they see why they are locked into a cycle of negative thinking and are so exhausted. They intuitively realize this explanation correctly explains their condition and recognize that, if they can stop the worrying, the depression will lift.

Two factors are crucial to getting them to this point: helping them understand that our genes are driving us to get our innate needs met, and the expectation fulfilment theory of dreaming. We then reach agreement with them as to what they must do to stop the worrying and rebalance their sleep pattern and, using guided imagery, rehearse the actions they need to take. In other words, we harness their imagination to solve problems instead of worrying about them. This last step is vital because, whatever the brain focuses attention on, it tries to bring about (Griffin & Tyrrell, 2004).

Of course, those who are depressed because of traumatic experiences, we de-traumatize. They usually recover quickly after that. And if the environmental pressures need addressing, other agencies might be brought in to help. The Human Givens approach draws no artificial boundaries between mental, physical and social problems, but aims for a seamless service that helps address all of a person's needs. We are also developing techniques for helping depressed people with Asperger's syndrome, because they don't respond well to guided imagery.

The Therapeutic Protocol for Lifting Depression

Step one
Build rapport. Lower arousal—calm the depressed person down so that they can think rationally again. Find out which emotional needs are not being met (what are the causes of worry). Find out about his or her good qualities, achievements, abilities, etc. Don't just history-take.

Step two
Use any means to stop the worry cycle and help create new, positive expectations to replace the old, negative ones. (Depressed or anxious people should not have forms of counseling or psychotherapy that encourage introspection or emotional arousal since this tends to increase the number of worries a patient can ruminate about and is therefore unintentionally harmful.)

Step three
Refocus attention away from negative expectations towards getting needs met (encourage physical activity, getting pleasure back in life, improving relationships, solving the problems that cause worry and challenge negative thinking).

Step four
Stimulate the imagination (using guided imagery) to enable them to appreciate their resources, see how things can be different, build hope and rehearse new behaviors. Include helpful metaphors, stories, etc.

As much as possible, this should be attempted in the first session in order to bring about sufficient improvement to give the client hope that he or she can get better if treatment is continued. Treat postnatal depression in the same way.

Down the ages, whenever the environment failed to provide healthy, balanced and appropriate physical and emotional nourishment, children and adults became mentally unstable or insane, just as is happening now. It follows from what we have outlined that the only answer there ever will be to mental distress is to create a culture where as many people as possible get their innate needs met on an ongoing basis.  

In the UK, human givens psychotherapy is often referred to as "the missing heart of positive psychology" and recognition of its contribution to mental health and education is growing. As well as psychotherapy, where it leads the field in gathering robust, practice-based outcome data, the human givens approach is influencing parenting, education, social work, back-to-work programs and management skills training. Americans, however, are unlikely to have heard of it because it arose in the 1990s in the UK and Ireland, and the resources to spread it beyond those shores are not available. We would like, therefore, to thank Michael Yapko for suggesting we contribute our ideas about depression to this issue of Family Therapy Magazine.

 

 

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This article, now updated, first appeared in Family Therapy Magazine Volume 7, No, 6 (2008)

References

• Griffin, J., & Tyrrell, I. (2003). Human givens: The new approach to emotional health and clear thinking. Chalvington, UK: HG Publishing.
• Griffin, J., & Tyrrell, I. Editors (2007) An idea in practice: Using the human givens approach, Chalvington, UK: HG Publishing
• Griffin, J., & Tyrrell, I. (2003). Dreaming reality: How dreaming keeps us sane or can drive us mad. Chalvington, UK: HG Publishing.
• Griffin, J., & Tyrrell, I., & Winn, D. (2004). How to lift depression […fast]: The human givens approach. Chalvington, UK: HG Publishing.