DiscoverCounselor Toolbox PodcastBiopsychosocial Impact of Depression and Strategies for Prevention and Intervention
Biopsychosocial Impact of Depression and Strategies for Prevention and Intervention

Biopsychosocial Impact of Depression and Strategies for Prevention and Intervention

Update: 2020-01-182


459 – Biopsychosocial Impact of Depression and Strategies for Prevention and Intervention

CEUs are available for this presentation at AllCEUs

 Biopsychosocial Impact of Depression and Strategies for Prevention and Intervention

Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC

Executive Director, AllCEUs

Podcast Host: Counselor Toolbox, Case Management Toolbox, NCMHCE Exam Review


• Define depression (symptoms)

• Explore the biopsychosocial impact

• Learn how to ask strengths-based assessment questions

• Identify a range of potential causes for depression

• Explore activities and interventions that can help people address some of the underlying causes


• Depression represents a cluster of symptoms

• Diagnosis with depression only requires people to have a few of the symptoms

• A variety of different things can cause and be caused by depression

• Emotions: Anger, anxiety, grief, guilt, shame

• Thoughts: Cognitive distortions

• Relationships: Poor self-esteem, unhealthy/unsupportive relationships, need for extremal validation

• Physical: Neurochemical imbalances, poor nutrition, exhaustion, insufficient sleep, medication side effects

• Environmental: High stress environments that prevent relaxation/rest and increase hopelessness/helplessness

Strengths-Based Assessment

• What does this mean to you? (apathy, sadness, mood swings)

• Which symptoms are most bothersome for you and why?

• For each symptom

• What makes depression worse?

• What makes depression better?

• How was life more pleasurable prior to getting depressed?

• What is different during times when you are NOT depressed?

• How do you expect life to be different when your depression is gone?

Neurotransmitter Imbalances

• Ability to feel pleasure/Apathy/Emotional Flatness

• Memory issues

• Difficulty concentrating

• Sleep issues

• Lack of motivation

• Fatigue

• Pain

• Irritability/Agitation

• Fight or flight stress symptoms


• Get quality sleep

• Create a routine

• Address pain and apnea

• Improve the sleep environment

• Other factors: Shift work, time zones, daylight savings time

• Relaxation

• Biofeedback

• Progressive muscular relaxation

• Address medication side effects

• Psychotropics

• Opioids


• Improve Nutrition

• Address addictive behaviors

• Address chronic or extreme stress

• Refresher

• Both of these increase the amount of neurotransmitters flooding the synapses.

• To protect the body from overload, the brain shuts down some of the receptors so the body does not overload (tolerance/desensitization)

• When the neurotransmitters return to a normal level, the receptors are still shut down, so not enough neurotransmitter gets sent out.

• Things that normally caused a reaction, no longer are strong enough to cause a reaction


• Thyroid

• Are altered in response to chronic stress

• Impacts mood, libido and energy levels

• Estrogen

• Boosts neurotransmitters that affect sleep, mood, memory, libido, pain perception, learning and attention span.

• Increased estrogen may increase the availability of serotonin

• Testosterone

• Low testosterone may be implicated in reducing the availability of serotonin

• Testosterone is manufactured by the adrenal glands,

• Enhances libido, improves stamina and sleep, assists brain function, and is associated with assertive behavior and a sense of well-being.


• Cortisol

• Cortisol is made by the adrenal glands.

• Helps the body adapt to stress by increasing heart rate, respiration, and blood pressure.

• Cortisol levels increase early in the morning to prepare to meet the demands of the day, and gradually decrease throughout the day (“circadian rhythm”).

• Insufficient cortisol (glucocorticoid resistance) can lead to HR and BP reductions as well as reductions in energy and motivation


• DHEA levels decrease as we age

• DHEA can increase libido and sexual arousal. It improves motivation, engenders a sense of well-being, decreases pain, facilitates the rapid eye movement (REM) phase of sleep, enhances memory and enhances immune system function.


• Get a physical to identify and address what may be causing any imbalances

• Eat a low-glycemic diet

• “The less sleep you get, the higher your cortisol will be; the more sleep you get, the lower your cortisol will be.” John Romaniello, co-author of Man 2.0 Engineering the Alpha: A Real World Guide to an Unreal Life.


• Final Thoughts on Hormonal Imbalances:

• Hormonal imbalances affect many millions of people

• Symptoms include feeling anxious, tired, irritable, gaining or losing weight, not sleeping well and noticing changes in your sex drive, focus and appetite

• Causes for hormonal imbalances include poor gut health, inflammation, high amounts of stress and depression, genetic susceptibility, and toxicity

• Natural treatments include eating an anti-inflammatory diet, consuming enough omega-3s, getting good sleep, exercising and controlling stress


• Low serotonin is associated with increased pain perception

• Depression contributes to muscle tension as well as stiffness and achiness

• Interventions

• Exercise

• Guided imagery

• Muscle Relaxation

• Alternate focus

• TENS therapy

• Physical therapy

• Hydrotherapy

• Ice/Heat

• Hypnosis


• Anger/Resentment/Jealousy/Envy/Guilt

• Anger is half of the fight or flight

• It pushes people away and/or asserts dominance/control

• Excessive anger can lead to depression when it

• Exhausts the stress-response system

• Contributes to negative cognitions

• Impairs relationships


• Jealousy and envy can be thought of as:

• Anger at someone else for having something you want

• Self anger for not having it

• Existential anger for the universe not being fair

• Jealousy may contribute to feelings of hopelessness and helplessness

• Activity

• Make a list of people you envy or are jealous of.

• Identify why you are jealous of them.

• In what way are they better or better off than you because of those things?

• How does envy/jealousy affect your ability to live a rich and meaningful life?

• What is a more productive way to use this energy?


• Guilt can be thought of as shame, embarrassment or self-anger for something you did or should have done

• Some people have difficulty letting go of guilt because they think

• They deserve to suffer

• If they forgive themselves they might do it again


• Activity: Guilt

• Make a list of things you feel guilty about (aka fearless moral inventory)

• How can you:

• Make amends?

• Learn from it?

• Forgive yourself?

• Let it go?

• Guilt Bill of Rights

• Forgiveness

• What does forgiveness mean to you?

• How does the concept of forgiveness make you feel?

• What does the phrase “Forgiveness is for you” mean?

• Forgiveness fire activity


• Activity (Group or Individual)

• When you are angry, what do you notice?

• What are your anger triggers?

• Why do those triggers make you feel vulnerable?

• Is it an external threat?

• Is it an internal threat?

• Is this a current threat or something from your past?

• Does this threat keep you from living an RML?

• How can you address each trigger to feel safer and more empowered?


• Anxiety

• Anxiety is the other half of fight or flight

• Chronic anxiety/worry/stress will also exhaust the stress response system causing neurochemical and hormonal imbalances and increasing muscle tension and pain

• This causes the body to adapt to excessive stress chemicals by shutting down the receptors à apathy

• Anxiety makes it harder to sleep exhaustion  hormonal imbalances  depression


• Anxiety

• Activity

• For each of the following fears, identify three situations in which you experience it

• Rejection/Isolation

• Failure

• Loss of control

• The Unknown

• Explore why those situations trigger anxiety

• Brainstorm ways to deal with them

• Fact checking

• Guided imagery

• Dialectics (See it as a challenge)


• Grief

• Grief is sadness/depression experienced as a result of loss

• The grief process involves

• Anger (at self, other, existential)

• Depression

• Helplessness to change the situation

• Hopelessness that you will move on

• Losses are not just about death


• Grief

• Activity Part 1: Loss Identification

• Identify your losses

• Existential (dreams, hope, faith, safety, independence, innocence…)

• Social (moves, death (people & pets), relationships ending)

• Physical (abilities, health, appearance)

• Property (houses, favorite bike, grandmother’s broach)

• Explore what about each of those losses makes you angry, fearful or hopeless (depressed)

• Develop an action plan to deal with those unpleasant feelings

• Give yourself permission to grieve


• Grief

• Activity Part 2: Acceptance

• True losses cannot be reacquired.

• The final step in the grief resolution process is acceptance.

• What does acceptance mean to you?

• For each of your losses, describe what acceptance means

• Other Activities

• Narrative therapy (chapters or letters)

• Wind chimes

• Sun/light catchers


• Happiness… (Duh!)

• Happiness chemicals reduce stress and depression chemicals (I know, real clinical explanation there!)

• It is possible to be depressed about one aspect of your life and happy about 5 others.

• Generally you will not be happy and depressed in the EXACT same moment.

• Increase the happy times

• Comedians

• Focus on what is going right

• Congratulate yourself for progress not perfection

• Exercise

• Environmental happiness triggers


• Negative thinking styles

• Contribute to exhaustion

• Highlight what is out of your control

• Embrace the dialectics by identifying the parts that are in your control

• Heighten a sense of helplessness/hopelessness (depression)

• Cognitive distortions

• All-or-Nothing (Nobody ever)

• Find the exceptions

• Self-fulfilling prophesies

• Positive mental imagery

• Personalization

• Find 3 alternate explanations


• Poor self-esteem

• Contributes to self-loathing, shame and a feeling of unlovability

• Negatively impacts relationships (loneliness/rejection)

• Often causes a person to seek external validation

• Activity:Self-esteem inventory

• For all the characteristics you don’t have, answer the question:

• If your child/best friend had this flaw, would I still love them?

• Activity: Group Snowflakes

• Activity: Sell Yourself


• Unhealthy/unsupportive relationships

• Negative relationships can take a toll on self esteem

• Fears of abandonment can maintain high levels of stress and feelings of helplessness

• Fail to buffer people against stress à exhaustion  neurotransmitter imbalances depression

• Interventions

• Enhance adult attachment with people who CARES (Consistency, Attention, Responsiveness, Empathy, Solution Generation) Explore what each looks like.

• Do CARES activities for yourself

• Address prior abandonment experiences

• Enhance mindfulness


• High stress environments

• Prevent relaxation/rest

• Increase hopelessness/helplessness

• Increase stress hormones / decrease relaxation hormones

• Activity

• Design a low stress area in

• Your home (bedrooms are good)

• At work/school

• Turn the negative into a positive


• Noisy family

• Have to go to work

Why I Care/How It Impacts Recovery

• We experience emotions through neurochemical signals

• Imbalances in the neurochemical system à problems in mood, concentration, energy, libido, sleep and eating behaviors  imbalances in the neurochemical system

• Depressive symptoms are huge triggers for relapse

• Identifying what causes these neurochemical imbalances for each individual and addressing them is crucial to recovery

• What helps?

• What makes it worse?

• What is different when the problem doesn’t exist?


• Depression is the cluster of symptoms created when there is a neurochemical imbalance in the brain.

• What causes the imbalance can be emotional, cognitive, physical, interpersonal, environmental or some combination of the above.

• Part of the strengths based approach means helping people see what they already are doing to prevent or deal with the symptoms

• Biopsychosocial means

• Examining all causative factors

• Recognizing that all factors are reciprocal in nature.









Biopsychosocial Impact of Depression and Strategies for Prevention and Intervention

Biopsychosocial Impact of Depression and Strategies for Prevention and Intervention

Charles Snipes