Dimensions of Depression
Depression is a surprisingly common experience. The Centers for Disease Control (CDC) report that approximately 1 in 10 adults struggles with depressive symptoms that meet the diagnostic criteria for some form of depression (e.g., major depression, dysthymic disorder). There are varying dimensions of depression—that is, ways in which depression manifests and explanations for what causes it. It is often difficult to discern the causes of depression from its symptoms. By looking at the different dimensions of depression, you have framework for understanding how your depression may affect your life.
Behavioral dimension: The behavioral perspective of depression maintains that depression results from low levels of activity caused by unfulfilling rewards in the environment. Primary symptoms of depression include fatigue, lack of enjoyment, and poor motivation. When attending to the behavioral dimension of your depression, we focus on increasing activities in your life by creating a schedule for you to follow that includes pleasurable activities.
Cognitive dimension: In the cognitive perspective, depression results and is maintained by negative thoughts and beliefs you hold. Extensive research on depression tells us that when you are depressed, you tend to think negatively about yourself, others, and the future. Cognitive therapists believe that thoughts lead to feelings and behaviors. When attending to the cognitive dimension of your depression, we address the negative thoughts and beliefs you hold, for example, by helping you to become mindful of how you think and to begin to replace negative thoughts with more realistic ones. This, in turn, leads to improved mood and increased activity.
Emotional dimension: Emotions are very complex and there is not one single perspective on the relationship between emotions and depression. There is, however, evidence that tells us two things about the relationship. First, depression can result from unresolved grief related to previous losses. When we do not adequately grieve life’s difficulties—for example, the loss of a job, the death of a friend or pet, a traumatic experience—our grief remains, unprocessed and heavy in the psyche. Additionally, there is a large body of evidence that tells us that if we “stuff” our emotions—that is, if we avoid feeling and expressing them—our chances of becoming depressed increase. Hence the importance placed on being able to talk about your feelings. When we attend to the emotional dimension of your depression, we put words to your feelings and, in doing so, understand them and the important information they contain.
Biological dimension: The biological perspective of depression reflects what happens in the brain and other parts of the body when you are depressed. Low levels of certain neurotransmitters like serotonin, dopamine, and norepinephrine are linked with depressive symptoms. The physical symptoms of depression, including fatigue, lack of motivation, sleep disturbance, and increased or decreased appetite point to the biological dimension of depression. This is where antidepressants can be most helpful, as they target neurotransmitter levels in the brain to reduce these symptoms. Additionally, this is also where exercise becomes essential for individuals struggling with depression. Several studies have shown that regular moderate to high intensity exercise everyday can be as effective as certain types of antidepressants. When we attend to this dimension of your depression, we consider the role of increased exercise and the possibility of a referral for a medication and nutritional consultation.
Social dimension: In the social perspective, depression results from and is maintained by difficulties in your relationships. Interpersonal psychotherapy—a form of treatment for depression—focuses specifically on things like role transitions in relationships and communication skills. When we attend to the social dimension of your depression, we help you to increase your social contact and to improve your current relationships so that they are more fulfilling and meaningful.