How to Help Your Clients Get Over a Fear of Depression Relapse

About 75% of people who have experienced severe depression harbour recurring fears about its resurgence.

“Depression is being colourblind and constantly told how colourful the world is.”

– Atticus, anonymous poet

Valerie was happier than she could remember being in a long, long time. The depression had gone. Yet here she was calling me again only three weeks after our (supposedly!) final session.

“Mark, can I see you again please?”

The following Monday there she sat facing me. She looked infinitely happier than when I’d first met her… and yet. Like a distant and portentous cloud on an otherwise fine day, something was clearly bothering her.

“Mark, it was so bad before. I’m terrified that…” she trailed off.

I widened my eyes a little, inviting her to speak in her own time.

“I’m scared I’ll get like I was before, like it might come back, even though I’m not depressed at all right now.”

I had guessed it might be fear of the depression returning that had caused her to return to my door. Fear of depression relapse is an issue we don’t often seem to discuss, but it’s definitely a thing.

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Fearing the return of the darkness

A study found that approximately 75% of individuals who have experienced severe depression harbour recurring fears about its resurgence.¹

The research highlights that common triggers for these concerns are circumstances or emotions associated with previous episodes of major depression, such as work-related stress, feelings of isolation, and experiences of loss or grief.

Study author Stephanie Gumuchian said:

“Many of our patients talk about depression in a very cyclical sense, with key moments or dates throughout the year that would scare them because they were associated with periods when they suffered from acute depression.”

Not surprisingly, many people felt more anxious and hopeless the more they feared recurrence of depression. But there was something wonderful in the findings of this research.

Knowledge really is power

Not everyone in the study reacted with fear of depression returning when life got hard. Around 40% of those studied used these times as a cue to increase self-care.

For example, they purposefully did more exercise, instigated stress management routines, socialised more, sought out support, and generally focused on self-care and emotional management. They would also reconnect with their support network and mental health care providers.

As Ms Gumuchian put it: “They would do everything in their power to address their fears.”

There was something else intriguing in this study.

One-third of those who instigated intentional self-care during stressful times (including certain times of year associated with past depressive episodes) reported that thinking about depression coming back actually increased their confidence, making them more aware of what they needed!

I find that really encouraging.

Now we know that one thing in particular is toxic for depression.

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Too much time in your own head

Mulling, ruminating, going over and over in your mind without resolution or solution, seems to fuel depression.²

Unfulfilled emotional arousals turn into dreams, the mind’s way of trying to clear the nervous system of these emotive ruminations through ‘metaphorical enactment’, which in turn exhausts the ruminator… and so the cycle of depression continues.

So when we worry without any kind of resolution, depression tends to thrive, and when we ruminate less, depression tends to fall apart, so to speak. It follows, then, that ruminating about depression may provide the fuel for depression to come back.

But there’s one factor that can moderate the insidious effect of rumination on depression.

One study found that if excessive rumination was done with hope, it didn’t cause people to depress.³

If I could help Valerie feel hopeful that depression wouldn’t come back, or that if it did it wouldn’t last long, then not only would any rumination be done with hope, but she may not feel the need to ruminate so much at all.

In retrospect I should have done a better job of reassuring Valerie before we ended her depression therapy that, if she felt that way again it needn’t, perhaps couldn’t, be anything like as bad as it had been before.

Anyway, here are some useful ideas to help your depressed clients feel confident about a depression-free, or at least depression-light, future.

Tip one: Ask them what they know now

I asked Valerie what she had learned from our work together that would mean she’d know what to do if she ever started feeling depressed like that again.

She told me: “Thanks to the work we did I can spot my own depressive thinking styles, you know, all-or-nothing thinking.”

She said that had been really useful for her, and several times after our work she’d caught herself thinking in classic depressive styles and challenged it. But it seems she hadn’t really thought to do that with the fear of depression itself. She also said that she now knew how to relax deeply and quickly.

So ask your clients what they know now that they didn’t before and how that’s going to keep them free from depression, or at least help them spot it quickly and ‘head it off at the pass’.

Next I asked Valerie what else might make it very hard for her to slip down to the same depths of depression as before.

Tip two: Knowing what you need

She thought for a moment.

“Well, from what we explored of my emotional needs, I now have a kind of tick list and can spot when I’m not meeting a particular need enough, like if I haven’t seen anyone for a while or haven’t exercised much.”

“So,” I reiterated, “that’s another tool you have now that you didn’t before.”

I let that sink in for a moment then added:

“So in some ways, you are a different Valerie than you were then. You understand depressive thinking patterns and can spot them in yourself and therefore challenge them, you can relax yourself deeply – and we know depression hates stress reduction! – and you understand your basic emotional needs and ways to meet them. I’d say that’s quite a protection from depression.”

It’s always important to teach your clients about the fundamental shared needs of humanity, and to ask them to remember and nurture them.

Then I looked at Valerie quizzically and asked:

“Is there anything else, Valerie, anything more that would help you stop any future depression before it really even got started?”

Tip three: Lean on me, when you’re not strong

She thought hard. Nothing came to mind. Eventually I broke the silence: “Maybe it’s staring you right in the face!”

She laughed. “Ah yes! I at least hope I could call on you again, if I needed to!”

I told her of course she could. We also explored who else she might reach out to if she ever started feeling that way again. She mentioned her best friend and her sister, and a few other contacts.

Support is vital. So explore with your client who they might call upon should they ever start feeling that way again – and one of those supporters might be you!

Discover How to Treat Depression Fast with Mark Tyrrell

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About Mark Tyrrell

Psychology is my passion. I've been a psychotherapist trainer since 1998, specializing in brief, solution focused approaches. I now teach practitioners all over the world via our online courses.

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