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Strengths Based Biopsychosocial Approach to Recovery from Depression
Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC
Executive Director, AllCEUs

Continuing Education (CE) credits can be earned for this presentation at

– Define depression (symptoms)
– Learn how to ask strengths-based assessment questions
– Identify a range of potential causes for depression
– Explore activities and interventions that can help people address some of the underlying causes

– Depression represents a cluster of symptoms
– Diagnosis with depression only requires people to have a few of the symptoms
– A variety of different things can cause depression
– Emotions: Anger, anxiety, grief, guilt, shame
– Thoughts: Cognitive distortions
– Relationships: Poor self-esteem, unhealthy/unsupportive relationships, need for extremal validation
– Physical: Neurochemical imbalances, poor nutrition, exhaustion, insufficient sleep, medication side effects
– Environmental: High stress environments that prevent relaxation/rest and increase hopelessness/helplessness

Depression Assessment
– What does this mean to you- (apathy, sadness, mood swings)
– Which symptoms are most bothersome for you and why-
– For each symptom
– What makes depression worse-
– What makes depression better-
– How was life more pleasurable prior to getting depressed-
– What is different during when you are NOT depressed-
– How do you expect life to be different when your depression is gone-
– Ability to feel pleasure/Apathy/Emotional Flatness
– Memory issues
– Difficulty concentrating
– Sleep issues
– Lack of motivation
– Fatigue
– Pain
– Irritability/Agitation
– Fight or flight stress symptoms

– Get quality sleep
– Create a routine
– Address pain and apnea
– Improve the sleep environment
– Other factors: Shift work, time zones, daylight savings time
– Relaxation
– Biofeedback
– Progressive muscular relaxation
– Address medication side effects
– Psychotropics
– Opiates
– Improve nutrition
– Address addictive behaviors
– Address chronic or extreme stress
– Refresher
– Both of these increase the amount of neurotransmitters flooding the synapses.
– To protect the body from overload, the brain shuts down some of the receptors so the body does not overload  (tolerance/desensitization)
– When the neurotransmitters return to a normal level, the receptors are still shut down, so not enough neurotransmitter gets sent out.
– Things that normally caused a reaction, no longer are strong enough to cause a reaction
– Thyroid
– Impact mood, libido and energy levels
– Estrogen
– Boosts neurotransmitters that affect sleep, mood, memory, libido, pain perception, learning and attention span.
– Increased estrogen may increase the availability of serotonin Behavioral and Cognitive Neuroscience Reviews Volume 4 Number 1, March 2005 43-58
– Low testosterone may be implicated in reducing the availability of serotonin
– Testosterone is manufactured by the adrenal glands,
– Enhances libido, improves stamina and sleep, assists brain function, and is associated with assertive behavior and a sense of well-being.

– Cortisol
– Cortisol is made by the adrenal glands.
– Helps the body adapt to stress by increasing heart rate, respiration, and blood pressure.
– Cortisol levels increase early in the morning to prepare to meet the demands of the day, and gradually decrease throughout the day (“circadian rhythm”).
– DHEA can also increase libido and sexual arousal. It improves motivation, engenders a sense of well-being, decreases pain, facilitates the rapid eye movement (REM) phase of sleep, enhances memory and enhances immune system function. Dr. Elise Schroder

– Get a physical to identify and address what may be causing any imbalances
– Eat a low-glycemic diet
– “The less sleep you get, the higher your cortisol will be; the more sleep you get, the lower your cortisol will be.” John Romaniello, co-author of Man 2.0 Engineering the Alpha: A Real World Guide to an Unreal Life.
– Final Thoughts on Hormonal Imbalances:
– Hormonal imbalances affect many millions of people
– Symptoms include feeling anxious, tired, irritable, gaining or losing weight, not sleeping well and noticing changes in your sex drive, focus and appetite
– Causes for hormonal imbalances include poor gut health, inflammation, high amounts of stress, genetic susceptibility, and toxicity
– Natural treatments include eating an anti-inflammatory diet, consuming enough omega-3s, getting good sleep, exercising and controlling stress

10 Ways to Balance Hormones Naturally

– Exercise
– Guided imagery
– Muscle Relaxation
– Alternate focus
– TENS therapy
– Physical therapy
– Hydrotherapy
– Ice/Heat
– Hypnosis
– Anger/Resentment/Jealousy/Envy/Guilt
– Anger is half of the fight or flight
– It pushes people away and/or asserts dominance/control
– Excessive anger can
– Exhaust the stress-response system
– Contribute to negative cognitions
– Impair relationships
– Cause physical harm
– Anger/Resentment/Jealousy/Envy/Guilt
– Activity (Group or Individual)
– When you are angry, what do you notice-
– What are your anger triggers-
– Why do those triggers make you feel vulnerable-
– Is it an external threat-
– Is it an internal threat-
– How can you address each trigger to feel safer and more empowered-
– Anger/Resentment/Jealousy/Envy/Guilt
– Jealousy and envy can be thought of as:
– Anger at someone else for having something you want
– Self anger for not having it
– Existential anger for the universe not being fair
– Activity
– Make a list of people you envy or are jealous of-
– Identify why you are jealous of them-
– In what way are they better or better off than you because of those things-
– How does envy/jealousy affect you-
– What is a more productive way to use this energy
– Anger/Resentment/Jealousy/Envy/Guilt
– Guilt can be thought of as shame, embarrassment or self-anger for something you did or should have done
– Some people have difficulty letting go of guilt because they think
– They deserve to suffer
– If they forgive themselves they might do it again

– Anger/Resentment/Jealousy/Envy/Guilt
– Activity: Guilt
– Make a list of things you feel guilty about (aka fearless moral inventory)
– How can you:
– Make amends-
– Learn from it-
– Forgive yourself-
– Activity 2: Forgiveness
– What does forgiveness mean to you-
– How does the concept of forgiveness make you feel
– What does the phrase “Forgiveness is for you” mean-
– Anxiety
– Anxiety is the other half of fight or flight
– Chronic anxiety/worry/stress will also exhaust the stress response system causing neurochemical and hormonal imbalances and increasing muscle tension and pain
– This causes the body to adapt to excessive stress chemicals by shutting down the receptors –> apathy
– Anxiety makes it harder to sleep -exhaustion – hormonal imbalances – depression

– Anxiety
– Activity
– For each of the following fears, identify three situations in which you experience it
– Rejection/Isolation
– Failure
– Loss of control
– The Unknown
– Explore why those situations trigger anxiety
– Brainstorm ways to deal with them
– Grief
– Grief is sadness/depression experienced as a result of loss
– The grief process involves
– Anger (at self, other, existential)
– Depression
– Helplessness to change the situation
– Hopelessness that you will move on
– Losses are not just about death

– Grief
– Activity Part 1: Loss Identification
– Identify your losses
– Existential (dreams, hope, faith, safety, independence, innocence…)
– Social (moves, death (people & pets), relationships ending)
– Physical (abilities, health, appearance)
– Property (houses, favorite bike, grandmother’s broach)
– Explore what about each of those losses makes you angry or fearful
– Develop an action plan to deal with that anger and fear
– Give yourself permission to grieve

– Grief
– Activity Part 2: Acceptance
– True losses cannot be reacquired.
– The final step in the grief resolution process is acceptance.
– What does acceptance mean to you-
– For each of your losses, describe what acceptance means
– Happiness… (Duh!)
– You cannot be happy and depressed at the same time
– Happiness chemicals reduce stress and depression chemicals (I know, real clinical explanation there!)
– Increase the happy times
– Comedians
– Children (even youtube videos of babies laughing)
– Animal Videos

– Negative thinking styles
– Contribute to exhaustion
– Highlight what is out of your control
– Heighten a sense of helplessness/hopelessness (depression)
– Cognitive distortions
– All-or-Nothing (Nobody ever)
– Self-fulfilling prophesies

– Poor self-esteem
– Contributes to self-loathing, shame and a feeling of unlovability
– Negatively impacts relationships (loneliness/rejection)
– Often causes a person to seek external validation
– Activity:
– Complete a self-esteem inventory
– For all the characteristics you don’t have, answer the question:
– If your child/best friend had this flaw, would I still love them-
– Unhealthy/unsupportive relationships
– Negative relationships can take a toll on self esteem
– Fears of abandonment can maintain high levels of stress and feelings of helplessness
– Fail to buffer people against stress –> exhaustion – neurotransmitter imbalances- depression
– High stress environments
– prevent relaxation/rest
– increase hopelessness/helplessness
– Increase stress hormones / decrease relaxation hormones
– Activity
– Design a low stress area in
– Your home (bedrooms are good)
– At work/school
– Identify ways to reduce the stress in your environment in both places (noise, interruptions, poor lighting, negativity)
– Identify ways to turn the negative into a positive

Why I Care/How It Impacts Recovery
– We experience emotions through neurochemical signals
– Imbalances in the neurochemical system –> problems in mood, concentration, energy, libido, sleep and eating behaviors – imbalances in the neurochemical system
– Depressive symptoms are huge triggers for relapse
– Identifying what causes these neurochemical imbalances for each individual and addressing them is crucial to recovery
– What helps-
– What makes it worse-
– What is different when the problem doesn’t exist-
Apply It
– Identify 3 ways you could have used this information in the past week.
– What intensified your depression over the last week
– What made you happy or helped you feel better
– If you would have had this new information, what could you have done differently-
– How would that have helped you feel less depressed-
– How can you start integrating this knowledge into your routine
– Depression is the cluster of symptoms created when there is a neurochemical imbalance in the brain.
– What causes the imbalance can be emotional, cognitive, physical, interpersonal, environmental or some combination of the above.
– Part of the strengths based approach means helping people see what they already are doing to prevent or deal with the symptoms
– Biopsychosocial means
– Examining all causative factors
– Recognizing that all factors are reciprocal in nature.