Depression and Mentalizing
Depression is associated with adverse physiological changes in the brain and the body. As such, depression is notoriously disabling illness and is very different from just feeling sad from time to time. To be ill means that you cannot recover by a mere act of will and recovery entails many acts of will over extended period of time. Understanding the challenge in recovery, while providing a supportive environment, enables individuals to be more patient and kinder to themselves as they work on recovery. The majority of patients recover from depression. Thus recovery from depression is difficult, yet attainable.
Many depressed individuals also suffer from anxiety. Depression and Anxiety are sometimes called “fraternal twins.” One can think as anxious person as someone that has high level of negative (anxious) emotion, that clearly leads to avoidance and paralysis. Different than anxiety, depression is manifested in low positive emotions. The results of low positive emotions is lack of motivation and no interest or incentive to doing anything. Clearly depressed individuals want to enjoy activities and life, but it is hard for them to do so as physiologically the depression is a highly stressed state.
Also, depression is very much associated with substance abuse. One can easily see why as substances, such as alcohol, narcotics, tranquilizers, stimulates, reduce anxiety and increase pleasure (it activates the rewards circuits). Therefore, the use of substances can be very appealing. Yet, it is like a “bad doctor” that provides a short term solution (immediate gratification) without thinking about the negative long term consequences (It puts your nervous system and your life on a roller coaster). Regardless of whether depression or substance abuse (if either) is primary or secondary, each must be treated in its own right. In addition to psychotherapy that deals with the problems and provide healthy skills, medication serves an important role in recovery from severe depression as it deals with the symptom. Medication eases the depression symptoms and enables the patient feels better and be more motivated to act and do the right things that would lead him toward full recovery.
Mentalization is the capacity to understand both behavior and feelings and how they’re associated with specific mental states, not just in ourselves, but in others as well. Mentalizing actively and accurately is essential in restoring a feeling of connection and security in attachment relationships, which is the antidote to depressive isolation and alienation.
Unfortunately, people with high emotional state, including depression has a decreased capacity for mentalization. Depression impairs mentalizing capacity, and impaired mantalizing contributes to depression. Mentalizing requires considerable mental effort and when depressed, you may not have the motivation or energy to mentalize. You may be withdrawn and self-absorbed as well as disconnect with your feelings and thoughts. On the other hand, you may be over-mentalizing and over-obsessed (ruminating) with your thoughts. Effective mentalizing promotes healthy, flexible thinking, while seeing things from different perspectives.
Mentalization Based Therapy (MBT) is a specific type of psychotherapy that is designed to help people with depression and other challenges such as Borderline Personality Disorder (BPD). Its focus is helping individuals to differentiate and separate out their own thoughts and feelings from those around them.
Mentalizing is a skill that can be learned and practiced. As such, in mentalization-Based Therapy (MBT) the concept of mentalization is emphasized, reinforced and practiced within a safe and supportive psychotherapy setting.
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