Mini Review - (2021) Volume 7, Issue 4
Sebastian Salicru*
PTS Psychology, Canberra, Australia
Received date: July 12, 2021, Accepted date: July 26, 2021, Published date: August 02, 2021
Citation: Salicru S (2021) Purpose and Meaning: The Re-Emergence of a Timeless Cure for Depression during COVID-19: A Practitioner’s Perspective. Clin Psychiatry Vol.7 No.4:101.
This paper reviews the re-emergence of existential psychotherapy themes (death, isolation, emptiness, meaning, authenticity, responsibility, freedom and choice), some of which are predictors of overall psychological well-being, as effective strategies for the prevention and treatment of depression-and other internalizing disorders during the COVID-19 pandemic. The paper outlines the current challenges within this context, the key focus, conceptualization, research evidence effectiveness, and unique strengths and benefits of meaning-making approaches, as well as recommendations in moving forward.
COVID-19; Pandemic; Depression
The current COVID-19 pandemic is associated with distress, fear of contagion, anxiety, depression, and insomnia, among healthcare professionals and in the general population [1]. Restrictive life measures and uncertainty about the future are making people vulnerable to feelings of helplessness and hopelessness, as well as increasing the risk of anxiety, depression, and suicide worldwide [2]. Depression is a pernicious and growing condition across the lifespan, affecting over 300 million people worldwide and is spreading globally like never before [3]. It has become a significant public health issue, projected to become the leading cause of disability worldwide by 2030 [4].
The pervasiveness of depressive disorders has not subsided in recent times despite significant investment and efforts made to contain them, mostly using pharmacological and psychosocial interventions [5]. This is because most efforts have focused on treating rather than preventing depression, and there are deficiencies in the quality of existing treatments and overestimation of their effectiveness. Hence, more judicious prescription of antidepressants, and more timely and highquality interventions, is needed, as well as consideration of psychological alternatives, offering more psychosocial treatment in primary care, and embedding more socially structured interventions [6].
Since the pandemic started, one in three adults among the general population has had anxiety or depression [7]. This surge has resulted in experiences of emptiness, sadness, and loss of meaning in life [8]. Depressed individuals report lower levels of meaning, and meaninglessness is linked to depression. Meaninglessness is the sense of an absence of purpose and direction. This absence of meaning underlies most suicide attempts. Hence, suicide rates are likely to rise or have risen already [9,10]. Conversely, within the context of COVID-19, people with high meaning in life enjoy better mental health than those with low meaning in life [11].
Contemporary living has also increased the prevalence of mood disorders among younger populations. Adolescence is a critical time to formulate peoples’ identity, which impacts the rest of their lives. Ineffective coping during adolescence makes individuals emotionally and behaviorally vulnerable to depression, health risk behaviors, and poor psychological health. Developing purpose and meaning in life are protective factors for positive youth development, as they predict a sense of direction, mental health well-being and a satisfying life. Hence, tackling depression today by embracing meaning-making approaches matters more than ever before.
Dating back to the 1920s, existential psychotherapy is one of the oldest forms of psychotherapy and constitutes evidencebased practice, yet it is one of the least understood [12]. Meaning-making, or existential, approaches encompass a range of Humanistic-Experiential Psychotherapies (HEPs). Their common focus is on understanding the core human experience by focusing on the individuals themselves and their life struggles, as opposed to their symptoms only. Hence, existential therapies conceptualize depression as an experience resulting from encountering and confronting some of the most painful, harsh or challenging facts of life (e.g. adversity, suffering, loss, change, disappointment), which can result in despair, meaninglessness, and loss of purpose. From this perspective, being depressed means being stuck in the present by holding onto the past, and being unable to connect with the future (e.g. people, relationships, projects, possibilities). A body of research spanning 70 years, including large pre-post client change in controlled comparative outcome studies that are statistically and clinically significant, demonstrates that the effectiveness of HEPs is equivalent to other psychotherapies; thus offering adequate well-established evidence-based practice [13]. HEPs offer the following six unique strengths and benefits, some of which are not offered by antidepressant medication or other psychological treatments, while being compatible with such treatments.
Protective against depression
Meaning-making approaches act as protective factors against depression and suicidal tendencies by buffering against the effects of stress on well-being. These include normalizing distressing COVID-19-related experiences and offering opportunities for personal growth and development during the pandemic.
Highly experiential and pragmatic
Pragmatism means enabling individuals to move towards their potential and fulfilment, while realizing their goals through selfdirected living. HEPs are highly experiential and pragmatic in nature because they attempt to connect individuals with reality, by exploring their most meaningful aspects of everyday life. Individuals presenting to psychotherapy with depressive symptoms implicitly or explicitly question their life’s meaning and purpose. HEPs assist them to understand that being themselves is inseparable from their agency, as a way to experience themselves through their enactments in the world.
Promote authenticity
Authenticity relates to having a lucid and true consciousness of facts or situations, while assuming responsibilities and risks involved in accepting them with pride or humiliation, sometimes with apprehension or hatred [14]. Hence, authenticity entails proclamation of self-defining choices and transcendence of situations by exploring how to live a free life [15]. Individuals become authentic when they take full responsibility for their lives. It is not uncommon to hear individuals undergoing psychotherapy use expressions such as, “I need to find myself” or “I sometimes feel that I’m wearing a mask”. HEPs assist these individuals experiencing distress to realize by themselves that they need to become more authentic by reducing or removing the gap between their true and false selves, as the means to find themselves behind their masks. Youngsters, in particular, struggle to live authentically. They feel the tension that arises between their desires to be popular at the expense of being themselves. Being strongly influenced by the opinions of others, and feeling they need to do what others expect them to do, they find it difficult to stand by what they believe in. As a result, they subjugate to others, as a way to feel accepted and experience a sense of belonging to a group. Sadly, over time, this leads to feeling alienated from themselves and out of touch with their real or true selves; that is, without a voice or sense of identity, extremely vulnerable and disempowered. This state of affairs becomes the perfect storm for chronic depression. As a quick and easy way out, many youngsters turn to alcohol and/or drugs to cope.
Build strength of character, confidence and resilience
Rooted in phenomenological and existential philosophies, meaning-making approaches are concerned with the understanding of individuals’ position in the world and clarifying what it means to be alive. To this end, such approaches focus on a broad range of values and principles that emphasize the fundamental aspects of the human experience, including the search for meaning, while promoting individuals’ responsibility and freedom of choices. Consequently, HEPs develop individuals’ strength of character-the foundation of lifelong development and thriving-which helps them to deal with everyday challenges and move forward in life with confidence and resilience.
Beyond symptom relieving–promoting awe and wonder
Meaning-making goes beyond symptom relieving, which is the main focus of medical diagnoses of depression, as way of explaining experiences of extreme sadness or fear. Using recent advances in neuroscience and related disciplines, existential approaches focus on assisting individuals to discover or rediscover meaning and purpose in their lives. The therapeutic outcomes of such approaches are that individuals often achieve unexpected outcomes beyond their specific therapeutic goals (e.g. relief, reduction or elimination of unwanted symptoms). The terminology used by patients to describe their experiences when reaching this point includes declarations that indicate their own consternation as result of transcending their own expectations. Some examples are: “having a sense of awe”; “stupefaction”; “wonder”; “adventure”; “liberation towards existence” or “feeling ecstatic”. Other patients have reported experiencing an unusual sense of “calmness”, “serenity”, “composure” or “peace of mind”, for the first time in their lives.
Compatibility and integration with other treatments
Existential, or meaning-making, approaches are compatible, and can be easily integrated, with other contemporary validated psychological treatments, such as Interpersonal Psychotherapy (IPT), traditional Cognitive Behavioral Therapy (CBT), or Schemafocused cognitive Therapy (ST). Similarly, they can also be used in conjunction with pharmacological treatment for cases of resistant depression.
The current COVID-19 pandemic has aggravated previously existing challenges related to prevention and treatment of depression. To make sense of this new context, both clinicians and researchers need to re-think more effective ways to prevent and treat depressive disorders. Existential or meaning-making interventions have re-emerged as highly effective means of generating and building purpose and meaning in life, which in turn act as preventative and protective factors of depression, as well as drivers of positive youth development. Such interventions buffer against adversity, depression and suicidal tendencies in high-risk individuals with vulnerability to depression. They can also be easily integrated into most therapeutic modalities to treat depression, and be used in conjunction with pharmacological treatments against resistant depression. In moving forward, the identification and processing of existential material is highly recommended, as this is very likely to add value or offer an alternative and invaluable framework for the prevention and treatment of depression, as well as promote and restore positive mental health, during our uncertain and turbulent times of the coronavirus crisis.
