The need for an innovative treatment like Well-Being Therapy hits you hard when you learn a bit about relapse. It happens – a lot. In fact, the majority of people who recover from depression will relapse in the months or perhaps years following the end of symptoms.
Medications don’t prevent it, neither does cognitive behavioral therapy, and those are the frontline treatments now in use to maintain recovery. They have a good record at helping people get over a devastating attack. But beyond the acute episodes of depression, it’s another story.
That’s where Well-Being Therapy comes in. Its focus on improving the quality of life rather than ending symptoms seems well-suited to the task of heading off relapse. That approach fits the idea of recovery that most people have. Even if all your symptoms disappear, you won’t feel recovered if the quality of your life is still pretty bad.
Well-Being Therapy goes directly to that problem by helping you increase your ability to lead a confident and fulfilling life. Rather than push you toward a fixed idea of happiness, it tracks your condition according to six major dimensions of well-being: mastery of everyday situations, a sense of purpose in life, personal growth, self-acceptance, the independence to live by your own standards, and the ability to form close relationships.
How does it work? How can it help prevent relapse?
The therapy is a highly structured, short-term strategy, designed to be completed in 8 weekly sessions, though that could run to 12 in more difficult cases. The therapist works with you through three phases of two or three sessions each. But the process doesn’t start with a lecture about the six dimensions and all the characteristics of each one.
The method relies on your learning through your own work about the dimensions of well-being most important in your recovery. That work consists of intensive self-observation. In between sessions, You keep a detailed diary recording every experience that gave you a sense of well-being. You also grade it on a numerical scale to capture the level of intensity of good feeling.
A great many patients immediately object that the diary will remain blank since they never feel well. In response, the therapist might point out that there are always good moments during a day, no matter how fleeting. The problem is that you usually don’t notice them or you dismiss them for a variety of reasons related to depressive thinking.
That’s the exactly the way it works for me. I may feel satisfied when something goes well – for a change. However, I throw that out because “it doesn’t count,” – it’s just a fluke or dumb luck. Or I bury it in shame since I don’t have a right to feel good about anything I do. Or I’ll whittle down the positive by paying much more attention to the shortcomings. It was good enough to meet my standards.
Acknowledging the feeling of satisfaction, however quickly you may explain it away, is the most important step. It can also be useful to step back from negative phase of your reactions and record the facts of what happened. You could then try to imagine how someone else might react in the same situation.
This type of exercise can help you break the habit of interpreting experience in a consistently negative way. When you’re depressed, it takes practice to learn how to shift your attention to the positive side of an event.
Ending the Interference with Well-Being
In the next phase, the therapist works with you to figure out what interferes with a sense of well-being. You have a lot to go on at this point from your diary and perhaps from “fun” experiences that you torpedoed. The method for turning off the kill-joy depressive thinking is straight from cognitive behavioral therapy. Develop awareness of the triggers and interrupt your typically negative reaction as quickly as you can. Unlike CBT, however, the triggers for using this technique are not the automatic negative thoughts themselves but the positive events you’re responding to.
Learning from what you observe and writing it down takes you only so far. To change what you do and feel each day takes repeated action. That means making time for activities you find enjoyable or rewarding. As with the diary, however, the first reaction might be resistance. You can’t think of anything you like doing – well, almost nothing.
So you do the almost nothing. Go for a walk, listen to music you love, call someone you haven’t talked to in a long time. These little things might seem trivial, but they’re not. Each one is a tiny step toward letting yourself feel good about something. Each helps you get around a block you’ve set between yourself and a sense of well-being.
Perhaps you’re typically negative about seeing people. The first reaction might be that you’ll stay home rather than be “dragged” to an event you “know” you won’t enjoy. Instead of passively responding to an invitation, you can take the initiative in the context of this therapy to meet an old friend.
You can observe just when and how your mind starts fighting off a good feeling about the meeting and focuses of something you don’t like. The therapy emphasizes this sort of problem-oriented approach both through tracking experiences through the diary and by taking the lessons learned into your daily life.
Identify Improvements in Dimensions of Well-Being.
In the final phase, the therapist introduces the formal definitions of the well-being dimensions that stand out as most relevant to your experience. Your experience, as recorded in the diary and reviewed with the therapist, is always the guide, not the abstract definitions. You discuss the specific impairments you live with as well as the strengths in various dimensions.
For example, you may believe you have no guiding purpose and that you feel you’re not growing as a person but always going around in circles. On the other hand, you may operate with a lot of independence and be able to form close friendships. Developing a clearer idea of where you are in terms of these different aspects of well-being helps break up the all-or-nothing thinking that condemns you in every phase of your life.
The therapy can also help limit the expectation of failure, that nothing will work out well for you. Through the practice of recording the positive side of daily living, you can compare experiences where you did well in the past with similar events in the present or expected to occur in the future. This helps you challenge the automatic assumption that you won’t ever do well at this type of event. Each step of the therapy helps you focus on the possibility of well-being and dislodge the assumption that you can’t get satisfaction or success simply because you believe you can’t.
Well-Being Therapy is new and will have to be tested in larger studies before it is widely accepted and practiced. But in terms of coping with depression, I think its fundamental insight that enhancing well-being helps limit your vulnerability to recurrence of depression is a powerful one.
For me, the shift in attention from negative to positive experience feels like learning how to use muscles I’d long forgotten about. Perhaps it leads to a retraining of the brain at the neuronal level in a different way than symptom-oriented therapies do. Whatever the mechanism for its effectiveness, the therapy offers an important set of tools that you can continue to use long after the sessions are over.