Framework for tackling depression -
A case example

Theory applied in practice

A counsellor or psychologist uses general theoretical knowledge about depression to help an individual

• understand how depression is affecting them personally, and
• develop appropriate strategies for tackling depression most effectively in their own case.

A framework for understanding and tackling depression in your life

When first meeting someone who has come for help with depression, the counsellor might have something like the following framework in mind:

1. What factors might have made you generally vulnerable to depression?
2. What specific events or experiences, if any, may have triggered the depression?
3. How is depression affecting your daily life and functioning in the present?
4. Which strategies would offer most effective immediate relief from depression?
5. What longer term strategies would help you resist depression in the future?

A case example - Anna

See how this framework might help you use what you have learnt on this website by seeing how it might apply to Anna's story, as an example.

1. Vulnerability

Vulnerability to depression is caused by a combination of biological, psychological and social factors unique to each person (see why me? for further explanation). A counsellor might listen for clues relating to examples such as:

• Inheriting a biological vulnerability to depression.
• Difficult childhood experiences or general life circumstances putting strain on the person's general coping resources.
• Social isolation or lack of social support.
• Difficulty finding a sense of meaning or purpose within the person's cultural value system.
• Longstanding habits of pessimism, low self-worth and negativity.

Anna's story

It is impossible to identify all the factors which may have played a role in Anna's vulnerability to depression just from this brief telling of her story. However, she does describe an example of the kind of difficult experience which often plays a role in vulnerability to depression - abuse or being badly treated as a child. Anna's complicated relationship with her grandfather was clearly the source of a lot of stress and difficult emotion in her life. Without her realising why, it is likely to have negatively affected her habitual way of seeing herself and thinking patterns.

2. Triggers

Depression does not always have an obvious recent 'cause', but in many cases it is possible to identify recent circumstances which may have played a role in setting off the downward spiral. A counsellor might look out for typical examples such as:

• Experiencing of a traumatic event or loss, such as a bereavement or relationship break up, which has temporarily overwhelmed the person's ability to cope.
• A major change in circumstances, or difficulty adapting to new circumstances.
• Recent experiences of failure or the fear of failure (as defined by values important in that person's life).
• Illness or other reason for a period of inactivity or withdrawal from engagement in purposeful tasks.

Anna's story:

Anna mentions her recent experience of an on-off relationship where she was treated with disrespect. A counsellor might be aware that this experience may have touched a sensitive nerve in the context of her earlier experience of betrayal in a close relationship. For Anna it may have been that the negative feelings arising from this experience gave depression an opportunity to reinforce a typical downward spiral.

3. Daily functioning

Because depression tends to intensify itself in a self-reinforcing spiral, even a seemingly 'trivial' triggering event can quickly set off a range of negative effects in the person's life. A counsellor would want to check out the pattern of these effects over a significant recent period. He or she would look out for signs in the following areas:

• Disruption to basic daily habits such as sleep patterns, appetite and weight, sexual function and general activity levels.
• General moods, particularly indicated by persistently sad, anxious, angry and empty moods.
• Thought patterns - a noticeable increase in negative thoughts, guilt, self-blame, or even suicidal thinking.
• Difficulty engaging with work, daily tasks and leisure activities; problems with concentration.
• Withdrawal from relationships or social activities, increasing social isolation.

Anna's story:

Anna describes a typical downward spiral of worsening mood, uncharacteristic behaviour and increasingly negative thinking - finding herself having paranoid thoughts about other relationships, behaving angrily with others, feeling guilty and disliking herself, and even briefly thinking about suicide. She also mentions sleep disruption and not engaging in anything constructive or fun. Her sense of being 'nowhere near her normal self' is a very common experience with depression.

4. Useful immediate strategies

Identifying the specific ways in which depression is affecting the person's daily functioning provides a useful starting point for the counsellor to discuss appropriate strategies for tackling the depression. In general, the most useful immediate strategies for tackling depression are the simplest ones (see finding what works for you for more tips on this):

• Raising activity levels in small steps - trying to do a bit more of some of the activities you used to enjoy
• Focusing outward and setting small, manageable tasks to give yourself an increasing sense of achievement.
• Attending to basic sleep and food needs and working on taking better care of yourself.
• Tackling isolation by increasing social contact and building support networks.

Anna's story:

One of the key ways in which depression affected Anna was to disturb her relationships with her friends and family, through the paranoid depressed thoughts about them and angry behaviour towards them. Anna made the important first step of breaking this isolation and talking to her friend Joe about what she was feeling. This helped her to start to recognise that depression might be affecting her and was an important step towards seeking the kind of help which would suit her - in her case e-mail counselling.

5. Longer-term strategies for resisting depression

Once issues of basic daily functioning have been tackled, longer-term strategies can be planned to deal with the specific vulnerabilities and triggers the person had identified. These longer-term strategies might include:

• The core strategy of challenging the habits of depressed thinking with which depression maintains its hold.
• Addressing the physiological effects of depression with a course of anti-depressant medication.
• Learning techniques to better manage stress levels.
• Identifying areas for development and practising positive habits such as assertive communication and relaxation.
• Consolidating self-care habits and a healthier lifestyle, with regular exercise, good sleep hygiene and healthy eating.

Anna's story:

Anna describes how her e-mail counselling helped her to challenge some of the 'irrational' habits of thinking she'd been having. She was able to challenge the inappropriate guilt she felt about what had happened with her grandfather and also about other things which were out of her control. She learnt more positive ways of dealing with her relationships - becoming more accepting of her own feelings, and more able to be open with others. She also continues to practise a conscious daily technique for recognising and valuing the positive in her life. These longer-term strategies have helped Anna rid her life of depression.