Depression therapy and counselling Edinburgh

Depression is a serious condition which is a form of mental health illness. It can be a long term clinical condition, or a short term reaction to a serious event such as a bereavement. It is usually treated with either or both psychological therapies and medication.

Stuart works as a specialist in Complex trauma and is an Advanced Clinical Certified Trauma Specialist. Depression often co-exists with trauma, hence this information.

In different cultures depression, then known as melancholy, was recognised in ancient Greece, China and Egypt. Hippocrates (460-370 BC) referred to it and thought it was caused by excess “black bile”, or an imbalance.

If you are suffering from depression you should always consult your medical doctor. Even if you do not choose to take medication right away, it is important for them to be aware that you might need support for this condition at some point. If you are in crisis contact the Samaritans immediately and then seek treatment.

“I get the sweats and feel shaky”
“My breathing gets fast and I get chest tightness”
“I blush / flush and feel self conscious”
“I wish the ground would open up and swallow me”
“I can’t face seeing people”
“There’s no way I could go out”
“I feel so nervous I feel sick”
“I need a drink to talk to anyone, and sometimes then I get a bit nuts”
“It’s Hopeless, there is no way out of this!”
“I feel trapped, there’s no escape!”
“I can’t see a way out of this, there is no solution”
“Things will never change, I’m stuck”
“I do not see the point in carrying on”
“I  can’t see the point anymore”
“People would be better off without me”
“I feel down and depressed”
“if I was gone my partner would be better off with someone else”

Forms of depression including bipolar depression are usually either treated directly with cognitive behavioural therapy based psychological therapies or high intensity psychological interventions (as recommended by NICE), or it can be addressed by looking more holistically at the person using counselling, psychotherapy methods, mindfulness and other therapies chosen to meet the needs of the individual client. Other NICE recommended methods include behavioural therapy focusing on relationships, psycho-dynamic psychotherapy, couples behavioural therapy or counselling. http://www.nice.org.uk/guidance/CG90/chapter/1-Guidance#psychological-interventions

Generally therefore there are three options, but of course these can be combined into a course of treatment so it is not “either or”.

1. CBT based psychological therapies as recommended by NICE and the NHS, although this is often a rather “cold” and functional approach, and does not really look in any depth as to personal patterns and causation. NICE recommend 16-20 sessions.

2. Psychoanalysis, counselling and psychotherapy based work looking at the individual and working them them rather than “treating” the depression. In other words looking at the person, not the symptoms. Mindfulness, meditation, hypnotherapy and and other methods like life coaching can be useful too. NICE do recommend “short term” (16-20 sessions) psycho-dynamic therapy.

3. Cognitive Behavioural Analysis, a hybrid of Cognitive behavioural theory and psychoanalytic theory, which combines looking at function, and looking at why. It has a strong emphasis on relationships, experiences, personal understanding (perception / interpretation) and behaviour. It incorporates NICE recommended features of psycho-dynamic, cognitive behavioural and relationship behavioural therapy. Some studies have shown success rates of 85% combining forms of cognitive analysis with medication support from a GP [Keller, M. et al. A Comparison of Nefazodone, the Cognitive Behavioural-Analysis System of Psychotherapy, and Their Combination for the Treatment of Chronic Depression. New England Journal of Medicine Volume 342:1462-1470 May 18, 2000. ]

In reality the best approach is usually to combine elements of all three to help the individual, since no two clients are the same!!

Studies indicate that there is no clear “better” method comparing behavioural and other psychological therapies* Likewise there is little clear evidence to suggest “3^rd way” versions of CBT are better than original CBT methods (does not examine Cognitive Behavioural Analysis which is different and has good evidence of additional success) ^.
* http://www.cochrane.org/CD008696/DEPRESSN_behavioural-therapies-versus-other-psychological-therapies-for-depression ^ http://www.cochrane.org/CD008704/DEPRESSN_third-wave-cognitive-and-behavioural-therapies-versus-other-psychological-therapies-for-depression

Other useful approaches including relaxation techniques such as self hypnosis or hypnotherapy, which reduces symptomatology but not as much as linked up psychological therapy. http://www.cochrane.org/CD007142/DEPRESSN_relaxation-for-depression

It may be worth noting that studies do show that receiving short term psycho-dynamic therapy (such as psychoanalysis or cognitive behavioural analysis) does lead to greater improvement in patients compared with control groups for persons with common mental health issues. http://www.cochrane.org/CD004687/DEPRESSN_short-term-psychodynamic-psychotherapies-for-common-mental-disorders

Depression is often thought of in psychodynamic theory as a surface symptom, in other words how something deeper rooted “turns up”. Analytic work therefore looks to address the deeper causes, while mindfulness based or cognitive behavioural therapies might better manage the surface levels.

Depression is often thought of as an affect regulation difficulty. In other words developmental psychology has caused the person to be unable to manage triggers and stimulation and resolve their own depression. This is the link between the underlying developmental cause, and the surface presentation.

Various forms of depression are referred to at diagnosis by medical professionals. Generally:

• Clinical Depression / Major depressive Disorder
• Persistent Depressive Disorder (about 2 years mild but fairly constant)
• Post natal and antenatal depression
• Bipolar disorder
• Seasonal Affective Disorder (SAD)
• Variations of these (such as long term clinical depression, treatment resistant depression, and variations on pre and post natal)

Physical / neurological effects include:

•  Physical low energy, low sex drive and disrupted sleep
• Effects on the Hippocampus, effecting cortisol stress hormone production, memory handling, and knock on hormone levels. Serotonin production thought to be effected partly from here.
• Effects on Prefrontal cortex, ability to make decisions, regulate emotions, form memories, think “clearly”
• Effects on the Amygdala: the “fire alarm” or panic centre of the rear brain, effecting sexual drives, basic emotions, sleep patterns and anxiety levels. Links to cortisol, adrenaline and other levels.

Neuro plasticity studies at Oxford Centre of Mindfulness (part of Oxford University) show how anxiety and stress levels are different in depressed and anxious patients, in particular in comparison with those using mindfulness.

Depression with Complex trauma

Depression is a common and often debilitating consequence of complex trauma. It can manifest in various ways and significantly impact an individual’s emotional, cognitive, and behavioral functioning. Here’s how depression can present with complex trauma: 

Emotional Symptoms:

• Persistent Sadness and Low Mood: Individuals with complex trauma may experience chronic feelings of sadness, emptiness, hopelessness, and despair. These feelings can be pervasive and interfere with daily life and relationships. 
• Loss of Interest and Pleasure: They may lose interest in activities they once enjoyed and find it difficult to experience pleasure or joy. This can lead to social withdrawal and isolation. 
• Feelings of Worthlessness and Guilt: Complex trauma can lead to deep-seated feelings of worthlessness, shame, and guilt. Individuals may blame themselves for the trauma or feel as if they are fundamentally flawed or damaged. 
• Emotional Numbness: In some cases, individuals may experience emotional numbness or detachment as a way to cope with overwhelming emotional pain. 

Cognitive Symptoms:

• Negative Thoughts and Beliefs: Complex trauma can lead to negative thought patterns and beliefs about oneself, the world, and the future. These thoughts can be intrusive and persistent, contributing to feelings of hopelessness and despair.
• Difficulty Concentrating: Depression can impair cognitive function, making it challenging to concentrate, remember things, and make decisions. 
• Rumination: Individuals may engage in rumination, which is repetitive and unproductive dwelling on negative thoughts and experiences.

Behavioral Symptoms:

• Changes in Sleep and Appetite: Depression can disrupt sleep patterns, leading to insomnia or excessive sleeping. It can also affect appetite, causing changes in eating habits and weight.
• Fatigue and Low Energy: Individuals may experience persistent fatigue and low energy levels, making it difficult to engage in daily activities.
• Social Withdrawal and Isolation: Depression can lead to social withdrawal and isolation, as individuals may avoid social interactions and feel disconnected from others. 
• Irritability and Anger: Depression can also manifest as irritability, anger, or agitation.
• Self-Harm and Suicidal Ideation: In severe cases, individuals with complex trauma and depression may engage in self-harm or have thoughts of suicide.

Impact on Daily Functioning:

• Impaired daily functioning: Depression can significantly interfere with daily life, making it challenging to work, go to school, or maintain relationships.
• Reduced quality of life: The persistent emotional pain and functional impairment associated with depression can significantly impact an individual’s overall quality of life.

Treatment Considerations:

• Trauma-Informed Approach: Addressing depression in the context of complex trauma requires a trauma-informed approach that recognizes the impact of trauma on the individual’s experiences and symptoms. This needs to clearly identify PTSD (single event) or C-PTSD (complex trauma with traumatic events over a prolonged period requiring different treatment protocols)
• Integrated Treatment: Treatment may involve a combination of psychotherapy, medication, and lifestyle changes. 
• Psychotherapy: Trauma-focused therapies, such as Trauma-Focused CBT, EMDR (PTSD), Stage based recovery model (C-PTSD) can help individuals process trauma and develop coping skills. 
• Medication: Antidepressant medications may be used to help manage depressive symptoms.
• Self-Care: Encouraging self-care practices, such as exercise, healthy eating, and relaxation techniques, can support overall well-being. 

If you or someone you know is experiencing depression related to complex trauma, seeking professional help from a qualified mental health professional is crucial. They can provide appropriate assessment, diagnosis, and treatment to help manage depression and improve overall well-being.

Psychotherapy and Counselling for Depression, Edinburgh

Some forms of psychotherapy such as CBT or cognitive behavioural therapy seek to assist in self management of conditions such as depression, and NICE recommend CBT based psychological therapies for a wide range of psychological conditions and mental health conditions.

Both the causes of depression, and the experience of depression can be distressing in their own right, and even if you prefer medication as an overall treatment, having counselling can assist you in coming to terms with the condition, managing it’s effects and talking through and resolving historical effects and issues.

If medication is not your preference, then psychotherapy and counselling are useful in understanding the complexities of the individual’s condition and moving forward positively.

According to Goldberg et al (2019) MBCT is effective in addressing depression. According to Khoury et al (2015) MBSR is effective in a range of clinical conditions including depression. Wintera et al (2022) found Body Psychotherapy helpful with depression. Alladin et al (2020) found Cognitive Behavioural Hypnotherapy effective in depression. Markowitz, J.C et al (2022) found psychotherapy benefited depression.

Goldberg, S. B., Tucker, R. P., Greene, P. A., Davidson, R. J., Kearney, D. J., & Simpson, T. L. (2019). Mindfulness-based cognitive therapy for the treatment of current depressive symptoms: A meta-analysis. Cognitive Behaviour Therapy, 48(6), 445–462. https://doi.org/10.1080/16506073.2018.1556330

Khoury, B., Sharma, M., Rush, S. E., & Fournier, C. (2015). Mindfulness-based stress reduction for healthy individuals: A meta-analysis. Journal of Psychosomatic Research, 78(6), 519–528.

David Wintera , Clelia Malighettib , Sabrina Cipollettab,⁎ , Sajjad Ahmedc , Benjamin Bensonc , Frank Röhrichtd (2022) “Construing and body dissatisfaction in chronic depression: A study of body psychotherapy”  

Alladin, A., & Alibhai, A. (2007). Cognitive Hypnotherapy for Depression: An Empirical Investigation. International Journal of Clinical and Experimental Hypnosis, 55(2), 147–166. https://doi.org/10.1080/00207140601177897

Markowitz, J.C et al (2022). ‘The Neglected Role of Psychotherapy for Treatment – Resistant Depression. The American Journal of Psychiatry, 179 (2), 90-93.https://doi.org/10.1176/appi.ajp.2021.21050535

Psychoanalysis for depression, Edinburgh

Psychoanalysis does not treat the condition, in this case depression, but views the depression as an outcome of issues within the individual, such as a history of rejection, detachment, disassociation,  or other relationship or developmental related issues. Thus the overall person is helped.

It can be advisable to use other psychological therapies such as CBT or counselling to stabilize the condition first, or indeed medication. But generally once this is complete, psychoanalysis can often give far deeper insight into causation, and this is designed to give choice and control back to the individual. One way of looking at this is understanding the old narrative, and then designing and writing a new one.

Support for depression in Edinburgh

Stuart runs a psychoanalysis clinic in Edinburgh.  CBT, clinical hypnotherapy, counselling, psychotherapy and eastern psychology (including mindfulness) are available where appropriate.

Who provides assistance in Edinburgh

Stuart trained in Analysis, clinical hypnotherapy and stress counselling from 1993 to 1996, and since graduating with a Diploma from ASM/IHP (externally NVQ accredited and assessed diploma course and CNHC accreditation route via SSM) and an NVQ Level 4 externally accredited award, he has completed CPD training in a range of counselling and psychotherapies. His approach is psychoanalytic at core, but also integrative, using eastern and western psychology methods. He is a CNHC registered hypnotherapist (UK regulator for complementary therapies set up with UK Government funding and support and an AR scheme). He is also registered on the Federation of Holistic Therapists AR Scheme. Accredited registers are maintained by the Professional Standards Authority for healthcare practitioners not subject to statutory regulation. He is also a Fellow of the National Association for Counsellors Hypnotherapists and Psychotherapists. He holds a BSc (Hons) IIT specialising in human resources and modelling, a BA (Hons) Open in psychology and Social Studies based topics, a BA(Hons) in Philosophy and Psychology, and a MSc Psychology. He also completed accreditation with the NACHP in counselling, psychotherapy and hypnotherapy. Although he works exclusively with trauma, because of the co-morbidity with depression he is also a Certified Depression & Mood Disorder Treatment Professional (CDMDTP).

Full range of competencies and qualifications HERE

 Keywords:  Trauma Therapy, Complex trauma therapist, Depression and Trauma, Depression, persistent depressive disorder, mental health, depressed, feeling down, clinical depression, counselling, psychoanalysis, psychotherapy, CBT, hypnotherapy, Edinburgh, Online, long term depression, clinical depression, depressed feelings, anxious depression, psychotherapist, CBASP, cognitive behavioural analysis, mindfulness.

Contact via the contact us page HERE