Bio - Psycho - Social Understanding of Emotional Well Being.

One of the first points I like to visit with any new patient is the wider picture of emotional difficulties. When people come to therapy we are focussing on the psychology of their difficulty - the thought processes that underlie the problem, including the results of these thought processes (ie. physical sensations you might experience as a result of being anxious, or the self isolation you might adopt when feeling depressed).

However our emotional difficulties are not just the result of psychological processes. Anxiety and depression are both bio - psycho - social difficulties, and if we completely ignore one area, we run the risk of making it much harder (or even impossible) to get better. 

The bio aspect refers to our biology and includes aspects that are both more or less under our control. Diet and exercise are part of the picture ( a really important part) but so is our individual brain chemistry, physical expression of genetics and hormonal balance. Different people - and different professions - have strong views on how best to heal these imbalances but I am of the strong view that, for some individuals, medications to address imbalances (including anti depressants) are hugely helpful. 

Your social situation also impacts your emotional wellbeing and, for some individuals, it is less a question of changing how they think and more a question of changing how they live. Prevalent anxiety is often an indicator that we are not living a life in line with our values and prevalent depression is often a sign that we feel somewhat trapped. Again there is balance between changing what is under our control, and either practicing acceptance with or gaining some external support with, what is less under our control. The purist approach to CBT asserts it is not our circumstances that impact how we feel, but how we respond to these circumstances. There is some truth to this, but we also have agency and there is space for changing what we can  - an easy win for mood in many instances. 

So, the next time you experience a mood change that feels uncomfortable, I encourage you to consider all three of these aspects. In therapy, we put the focus on understanding our psyche and thought patterns - but this should never come at the expense of the bigger picture. What’s going on in your body? How is your diet, exercise, what do you know about your body as an individual and what it needs? Are you meeting those needs at the moment? Is there anything you have struggled with for as long as you can remember, and how does this fit into what you know about your family history?

How are things for you socially? Do you have a balance of achievement, enjoyment and connection? Are there family issues, financial stressors - are you in a relationship that is fundamentally no longer serving you? These issues often do not have easy solutions (and a part of it can be psychological - how are we thinking about these challenges) but sometimes its genuinely difficult to get a mood shift within an environment that doesnt serve us. Sometimes our attention is better spent going to the gym, saving some money or applying for different jobs, than it is going to therapy.