Divorce can bring out depression

The Patient:

Robert, 58 and recently divorced, was depressed and feeling like a failure. He felt sad and empty and found himself tearing up and getting emotional over small matters. He wasn’t interested in doing anything with friends, lacked energy, wasn’t exercising, and was experiencing more frequent bouts of insomnia. After he declined doing anything to celebrate Hanukah with his family, his brother recommended he work with a professional to sort things out.

Robert felt a lot of pressure around the holiday to “act” in a certain manner with his family. He was having trouble with finances again, and he didn’t want that to be the topic of the holiday dinner. The thought of being with his family made him feel worse. He didn’t want to have to explain everything because it was too painful and humiliating. He had made a lot of progress but lately began slipping back into self-sabotaging ways. He started distancing himself from others, being self-critical about his money troubles, and constantly comparing himself to his brother, making him feel worthless and hopeless.

The Diagnosis: 

Major depressive disorder is one of the most common mental health conditions. Depression can occur after traumatic or stressful life events like a divorce or financial hardship. It can negatively interfere with your relationships, your job, and your own feelings of self-worth. I observed that Robert had a number of the typical symptoms of depression such as anxiety, sadness, withdrawal from normal daily activities, and emptiness, which had persisted for an extended period of time. He was also having difficulties sleeping at night and was feeling exhausted all the time.

Since the divorce less than a year ago, Robert found himself becoming increasingly stressed about his living circumstances, finances, and work. He noticed he was neglecting numerous tasks around the house, his financial responsibilities, and avoiding activities he used to enjoy. He was feeling very negative. He was having a hard time getting unstuck and back into his old routines.

The Treatment:  

Divorce can be challenging; each person must move through it at their own pace and process in their own way. Developing a support network can help as you move through the process. Therapy can assist you in developing new coping mechanisms and in managing your emotions and deal with symptoms of depression.

In order to help Robert see and change the negative thinking and behavioral patterns that he had developed since the divorce, we started his treatment with mindfulness-based cognitive therapy (MBCT). It is a type of psychotherapy that combines mindfulness, cognitive therapy, meditation. The practice of mindfulness is the cultivation of a present-oriented, non-judgmental attitude. With this approach, as well as and cognitive restructuring, we could gently address the cognitive and behavioral causes of his feeling depressed. He displayed several cognitive traits that included negative thoughts about himself, such as “I am no good” or “Things are not going to get better.” Cognitive restructuring helps build new skills to reframe negative thinking by identifying and challenging negative beliefs and irrational thoughts. The objective was to enable him to experience his feelings free from any sense of shame or guilt, and to help him move forward and thrive.

Letting go of the negative thinking was difficult for Robert at first, but I provided him with practice assignments to help him recognize patterns and incorporate mindfulness practices when they appeared. He was thinking in the typical cognitive distortion patterns, where irrational and inaccurate thoughts show up and undermine our sense of self-confidence and ability to succeed. As an example, to prepare him for being around his family, we used an exercise where he would write down a painful scenario and identify what triggered his maladaptive belief.

He noticed he was comparing himself whenever he had to be around his more successful brother and it triggered thoughts that he would never be good enough or as successful which put him in a depressed mood. As an exercise, I had him recall when he felt sad and hopeless in the past and then explained how thoughts affect our mood and can change the way we feel in any given moment. He was able to see how is maladaptive thoughts had been impacting his mood. That gave him the opportunity to analyze and evaluate his thoughts and beliefs for truth.

When he was able to notice the triggering situations, he could address the associated uncomfortable or painful emotions in the moment and manage his response differently. It takes time and practice to recognize and consider the evidence for and against the thoughts you are having and to identify whether they are accurate or not. The goal was for him to be able to determine if the thoughts were based on facts or feelings. As he became more conscious of his faulty thinking, he was able to become more aware of his negative thinking and more easily pinpoint what triggered his behaviors.

To get Robert to relax and bring his anxiety under control, we engaged sound-healing techniques. Sound therapy, a non-aggressive and gentle approach, helped him relax and focus in a natural and soothing environment. That approach gave him the emotional room he needed to evaluate his current circumstances in a safe place and diffuse the sensitivity and overwhelm he was feeling.

The Results: 

Therapy helped Robert make progress and gain new perspectives and fresh insights into what was triggering his depression and emotional responses, which were both helpful. It provided him with tools and coping mechanisms he could use to refocus when he felt anxious or wanted to isolate himself from being around others. The techniques helped him change how he was thinking about himself and adjust his unhelpful beliefs to more empowering ones to manage his stress. Therapy helped get him back on track more quickly and feeling at ease. He saw immediate improvement in his sleep patterns, which helped him feel more rested and focused throughout the day. As he felt calmer, he was able to tackle the things he had been avoiding, like his finances, and get them back in order. He noticed improvements in his psychological state, he was becoming more active socially and getting back to the gym.