Walking In A Spiderweb
How avoiding sad emotions can lead to depression.
There has been tremendous improvement around the importance of mental health in modern society. More people are giving therapy a try. Practitioners are becoming more accessible through online providers like BetterHelp and Talkspace. My children’s generation is also speaking more openly about their struggles and the importance of therapy.
Still, there is a lot of misunderstanding and confusion about mental health. It’s difficult to spend time online or to consume media without hearing psychology terms such as trauma, depression, narcissism, or bipolar. The benefit of this trend is increased awareness to mental health. Less people are struggling in silence, but everyone seems to be an armchair psychologist. As a result, there is a lot of misinformation for public consumption.
One byproduct of mental health becoming mainstream is the emergence of toxic positivity. Toxic positivity involves the use of well meaning statements to encourage someone in distress to believe that positive thinking will cure their worries no matter the level of heartbreak, grief, or pain they may be experiencing. Maybe you have seen it or used it with yourself. It can take the form of:
Dismissing difficult emotions (e.g., “Don’t worry be happy!”),
Feeling guilty for your own emotions (e.g., “Why can’t I just get over it?”),
Using gratitude to avoid emotions (e.g., “Just look on the bright side and be grateful for what you have.”), or
Comparing the painful event to someone else’s experience (e.g., “This person is coping. Why can’t I?”).
These unhelpful statements have the effect of minimizing a person’s painful emotions without consideration of the circumstances or events that may have led to the episode. In essence, it is telling someone (or yourself) that it is inappropriate to be sad and something is wrong with them for feeling that way. This approach can result in unprocessed emotions that will stay buried until the next triggering event, resulting in an unhealthy explosion. It can also result in superficial relationships, conflict avoidance, unrealistic expectations, isolation, and withdrawal from social settings.
In time, unprocessed emotions can only increase the potential for clinical depression and anxiety. I love Disney’s Inside Out and Inside Out 2 because they do a great job in explaining the complex relationship between unprocessed emotions and mental health. The films depict depression and anxiety through the lens of a pre-adolescent girl, Riley. In the first film, Riley reacts to the life stressor of moving across the country to a new city and starting a new school by avoiding her sadness and leaning into toxic positivity. In the end, she loses the ability to feel sadness and joy and no longer appreciates the core memories, people, and experiences that once gave her joy.
This is not to say that gratitude and engaging in joyful activities cannot be powerful and healthy tools for building a positive outlook. These tools are more effective when we use them on a regular basis so that they become part of our daily or weekly routine. A more healthy approach for processing difficult events is to notice when you are experiencing a difficult emotion, name the emotion, identify what led to it, and then implement a grounding tool to soothe yourself such as meditation (see resources below), movement, deep belly breathing, singing/listening to music, art, or tapping (Emotional Freedom Technique).
Once grounded, it is important to give yourself time to process the emotion through journaling, therapy, or talking to a trusted friend. This gives you the opportunity to learn how you respond to life’s stressors so you can take proactive steps to identify how you can best meet your needs in the future depending on the emotion you are experiencing. I am using a cognitive behavioral therapy app to track my emotions daily, identify the source of the emotion, and identify thought patterns that may distort the event so I can reframe my thinking over time. The app even gives me space to process my emotions through journaling prompts.
Sometimes painful events, unprocessed emotions, or maybe even genetics can lead to a more serious illness such as clinical depression (Major Depressive Disorder or “MDD”). You may be wondering, “what is the difference between sadness and MDD?” Mental health practitioners use the Diagnostic and Statistical Manual of Mental Disorders (DSM) to diagnose mental health conditions such as MDD. These diagnosis criteria and symptoms are based on the contributions of subject matter experts and peer-reviewed scientific literature.
The DSM identifies the following diagnostic criteria for MDD:
5+ of the following depressive symptoms during the same 2-week period that are a change from previous functioning and not clearly attributable to another medical condition:
Depressed mood (required): Most of the day, nearly every day; may be subjective (e.g., feels sad, empty, hopeless) or observed by others (e.g., appears tearful); in children and adolescents, can be irritable mood
Loss of interest/pleasure (required): Markedly diminished interest/pleasure in all (or almost all) activities most of the day, nearly every day; may be subjective or observed by others
Weight loss or gain: Significant weight loss (without dieting) or weight gain (change of >5% body weight in a month), or decrease/increase in appetite nearly every day; in children, may be failure to gain weight as expected
Insomnia or hypersomnia (nearly every day)
Psychomotor agitation (excessive/uncontrollable movement or heightened activity) or psychomotor retardation (noticeable slowdown in physical movement or thought processes)
Fatigue (loss of energy nearly every day)
Feeling worthless or excessive/inappropriate guilt nearly everyday (guilt may be delusional; not merely self reproach or guilt about being sick)
Decreased concentration nearly every day (may be indecisiveness; may be subjective or observed by others) or
Thoughts of death/suicide (recurrent thoughts of death, recurrent suicidal ideation without specific plan, or suicide attempt, or a specific plan for suicide)
Patients also must meet the following criteria:
Depressive symptoms (see above) cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
Episode not attributable to physiological effects of a substance or another medical condition
Episode not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders
No history of manic or hypomanic episode (unless substance-induced or attributable to physiological effects of another medical condition)
The American Psychological Association’s Clinical Practice Guideline recommends psychotherapy (usually tried first) and anti-depressant medication as treatment options for MDD. The setting for psychotherapy can vary based on the level of treatment needed. Therapeutic levels of care can include:
Traditional individual therapy (frequency can vary but may be weekly or bi-weekly) in-person or online, or
Group therapy
Outpatient therapy in a full day partial hospitalization program or a half day intensive outpatient program
Short-term inpatient therapy in a psychiatric hospital or a hospital psychiatric unit (for patients requiring more intensive care)
Residential therapy in a group home setting for long-term intensive therapy
Regardless of the setting, psychotherapy can take multiple forms with the underlying goal of teaching coping skills so patients can manage life’s challenges and improve functioning. Some common examples of psychotherapy include:
Behavioral Therapy (recognizing the relationship between behavior and mood, and focusing on changing patterns of behavior that lead to difficulties in functioning)
Cognitive Therapy (modifying pessimistic evaluations and unhelpful thinking patterns with the goal of disrupting these and reducing their interference with daily life)
Cognitive-Behavioral Therapy or CBT (recognizing the relationship between behaviors, thoughts, and feelings and changing patterns that reduce pleasure and interfere with a person’s ability to function)
Interpersonal Psychotherapy or IPT (focusing on problematic relationships and circumstances that are most closely linked to the current depressive episode)
Mindfulness-Based Cognitive Therapy or MBCT (combining strategies of cognitive therapy with mindfulness meditation to modify unhelpful thoughts and develop a kinder, more loving self-view)
Psychodynamic Therapy (focusing on unconscious thoughts, early experiences and the therapeutic relationship to understand current challenges, improve self-awareness and support the patient in developing adaptive patterns of functioning)
Psychotherapy may be beneficial even when you may not meet the above criteria for MDD. It is important to consult a professional mental health provider if you or someone you know is struggling with mental health and need additional support. Here are resources to get you started on your path to healing:
How Do I Find a Good Therapist (American Psychological Association)
How to Find a Therapist (Psychology Today)
Questions to Ask Before Choosing a Therapist (Therapy for Black Girls)
Mood Tracker Apps
Meditation Apps