The Three Minute Therapist

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Depression: Your Elusive Secondary Disturbance

Endogenous depression is better understood and treated as Secondary Disturbance.

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Do you get upset about being upset? Do you feel: guilty about getting angry at a loved one, anxious about being embarrassed in front of an audience, depressed about experiencing ever-increasing panic attacks or having life-long depression? If so, you have experienced secondary disturbance.

Getting upset (the secondary disturbance) about initially having been upset (the primary disturbance) tends to be both pervasive and elusive. The primary disturbance occurs (or is anticipated to occur) first, then comes secondary disturbance, since chronologically it occurs second.

Therapists may fail to recognize this secondary disturbance in their clients since it's not anchored in a concrete, external event. In fact, Sigmund Freud mislabeled it as "free-floating." It is, rather, directly tied to irrational thinking.

Use this rule of thumb to nail it: when feeling anxious, depressed, or guilty, ask yourself: am I depressed about my emotion (e.g., anxiety, depression, anger) or about an external situation (e.g., rejection, failure, hassles)? If it's the former, then you probably have a secondary disturbance.

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Here's a client's comprehensive Three Minute Exercise (TME). As a result of writing these two or three times a day, he ultimately beat his secondary disturbance blues:

A. I'm feeling depressed and lethargic again about nothing in particular and everything in general.
B. I absolutely MUST not feel depressed and lethargic so much of the time.

C. Even more depressed and lethargic.

D. What is the evidence I absolutely MUST not feel this way so often?

E. There's no evidence to support my demand. Although I keenly PREFER not to feel so miserable, nothing etched in stone states I MUST not. Since I was born with imperfect genes and an imperfect brain, and I was raised by fallible parents, of course, of course, I'll feel depressed at times.

So I'm depressed--too damned bad! It is unpleasant, but hardly the end of the universe. Though I don't like it, it hasn't killed me so I obviously can stand it. I can still enjoy life somewhat feeling depressed, although I'd enjoy it more if I were happy all the time. It may slow me down, but it can't stop me from working toward my goals--as long as I'm determined to keep pushing myself no matter how difficult it seems.

If I'm depressed, I'm depressed--whining and complaining about my depressed state certainly won't help. There's no reason the universe must protect me from the pain of depression. I've been depressed before and I've gotten through it, and I will again. My depression waxes and wanes as do all emotions.

To have the benefits and pleasures of living it's necessary to have the displeasures, including depression. Why not use this situation therapeutically as a golden opportunity to practice viewing my depression realistically as just a great hassle, never a horror? I'll keep pushing, and keep reminding myself to keep pushing!

F. Concerned, not depressed about my depression and lethargy. Pushing myself to get active.

RULE OF THUMB: the more you write at "E" about why your "must" is false or self-defeating, the more effective your TME will be. Try one now!

Dr. Michael R. Edelstein is a clinical psychologist and the author of Three Minute Therapy and Stage Fright.

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