Depression

Depression-5-Christian-Jonathan-Haverkampf-common-mental-health-conditions

Depression

Christian Jonathan Haverkampf, M.D.

Depression is one of the most common medical conditions, which can interfere significantly with a person’s quality of life, relationships and ability to work. Several effective treatments are available, including psychotherapy and medication. This article contains a brief overview of both areas, while focusing on psychotherapy, particularly Communication-Focused Therapy® (CFT), as developed by the author.

Keywords: depression, treatment, psychotherapy, psychiatry

Contents

Introduction. 5

Adaptation. 6

Genetics. 6

Psychotherapy. 7

The World is Not Enough. 8

Negative Thoughts about Oneself 8

Medication. 9

Major Depression vs Reactive Depression. 10

Stress. 10

Depression and Health. 10

Age. 11

Differential Diagnosis. 11

Computer-Based Treatments. 12

Communication. 13

Inside-Outside Reflection. 14

Connectedness. 14

Social Connectedness. 15

Social Identification. 15

Depression Treatments and Connectedness. 16

Adolescents and Young Adults. 16

Technology and Connectedness. 17

Autonomy and Connectedness. 17

Connectedness and the Elderly. 18

Connectedness and Groups. 18

Causes of Depression. 18

The Monoamine Hypothesis. 18

Communication Factors. 19

Symptoms. 20

Physical Symptoms. 21

Treatment. 21

Medication. 21

Psychotherapy. 22

Separating Thoughts from Emotions. 22

Body Work. 23

Communication-Focused Therapy®. 23

Change. 24

Analysing Communication Patterns. 25

The Process. 26

Communication Patterns and Structures. 27

Transfer. 28

Meaning. 29

From Meaning to Meaningfulness. 29

Motivation. 31

Interacting with the World. 32

Powerlessness. 32

Insight into Communication. 33

Building the Sense of Self 34

Resonance. 35

Relevance. 35

Communication Exchange. 36

Experimentation. 37

Observing. 37

Integration. 38

Values, Needs and Aspirations. 38

Internal Communication. 39

Meaningful Messages as the Instrument of Change. 39

Broader Experience. 40

References. 41

Introduction

Depression affects a good size of the population. Although it is relatively common and the impact of the individual quality of life can be enormous, there is still a stigma attached to it. A common belief is that it is not treatable, which is in the vast majority of cases untrue. Another misconception is that it lowers a person’s intelligence or changes one’s personality, which is equally untrue. While someone suffers from depression, the ability to focus and concentrate may be reduced, it does not lower a person’s cognitive abilities when the person recovers from the depression. However, the most serious misconception must be the one that there are no effective treatments. In truth, there are many effective treatments available, but their effectiveness often depends on matching the correct treatment modality to the right patient.

The proportion of the global population living with depression is estimated to be 322 million people—4.4% of the world’s population—according to a new report, “Depression and Other Common Mental Disorders: Global Health Estimates,” released by the World Health Organization. The report also includes data on anxiety disorders, which affect more than 260 million people—3.6% of the global population. The prevalence of these common mental disorders is increasing, particularly in low- and middle-income countries, with many people experiencing both depression and anxiety disorders simultaneously. Depression is, in short, the leading cause of disability in the world (Friedrich, 2017).

Depression is also one of the most common comorbidities of many chronic medical diseases including cancer and cardiovascular, metabolic, inflammatory and neurological disorders. (Gold et al., 2020)

Some possible pathophysiological mechanisms of depression include altered neurotransmission, HPA axis abnormalities involved in chronic stress, inflammation, reduced neuroplasticity, and network dysfunction. All of these proposed mechanisms are integrally related and interact bidirectionally. In addition, psychological factors have been shown to have a direct effect on neurodevelopment, causing a biological predisposition to depression, while biological factors can lead to psychological pathology as well. The authors suggest that while it is possible that there are several different endophenotypes of depression with distinct pathophysiological mechanisms, it may be helpful to think of depression as one united syndrome, in which these mechanisms interact as nodes in a matrix. Depressive disorders are considered in the context of the RDoC paradigm, identifying the pathological mechanisms at every translational level, with a focus on how these mechanisms interact. Finally, future directions of research are identified. (Dean & Keshavan, 2017)

To accommodate, they learn to censor themselves, to devalue their experience, to repress anger, to be silent. Examining moral themes in depressed women’s narratives, Jack demonstrates how internalized cultural expectations about feminine goodness affect women’s behavior in relationships and precipitate the plunge into depression. In a brilliant synthesis, Jack draws on myth and fairy tale for metaphors to further our understanding of women’s depression. (Jack, 1991)

Depressive disorders are frequently associated with significant and pervasive impairments in social functioning, often substantially worse than those experienced by patients with other chronic medical conditions. The enormous personal, social, and economic impact of depression, due in no small part to the associated impairments in social functioning, is often underappreciated. Both pharmacologic and psychotherapeutic approaches can improve social impairments, although there is a lack of extended, randomized controlled trials in this area using consistent assessment criteria. (Hirschfeld et al., 2000)

Adaptation

Many functions have been suggested for low mood or depression, including communicating a need for help, signalling yielding in a hierarchy conflict, fostering disengagement from commitments to unreachable goals, and regulating patterns of investment. A more comprehensive evolutionary explanation may emerge from attempts to identify how the characteristics of low mood increase an organism’s ability to cope with the adaptive challenges characteristic of unpropitious situations in which effort to pursue a major goal will likely result in danger, loss, bodily damage, or wasted effort. In such situations, pessimism and lack of motivation may give a fitness advantage by inhibiting certain actions, especially futile or dangerous challenges to dominant figures, actions in the absence of a crucial resource or a viable plan, efforts that would damage the body, and actions that would disrupt a currently unsatisfactory major life enterprise when it might recover, or the alternative is likely to be even worse. These hypotheses are consistent with considerable evidence and suggest specific tests. (Nesse, 2000)

Genetics

Data are from 2,302 adolescent sibling pairs (mean age = 16 years) who were part of the National Longitudinal Study of Adolescent Health. Although genetic factors appeared to be important overall, model-fitting analyses revealed that the best-fitting model was a model that allowed for different parameters for male and female adolescents. Genetic contributions to variation in all 3 variables were greater among female adolescents than male adolescents, especially for depressed mood. Genetic factors also contributed to the correlations between family and school environment and adolescent depressed mood, although, again, these factors were stronger for female than for male adolescents. (Jacobson & Rowe, 1999)

Psychotherapy

There are many kinds of psychotherapy, but they all derive from the concept of the ‘talking cure’ developed by Freud and Breuer. Over time, various brands have been developed, but the interaction between the patient and therapist, insight, reflection, and learning are still the basic building blocks of psychotherapy or counselling.[1]

Depression very often does not come ‘out of the blue’, and it is important to understand the factors that contribute to it. While some people have a greater predisposition for depression than others, psychological factors usually play a significant role. The three main schools of therapy are cognitive-behavioural, interpersonal, and psychodynamic therapies. Major differences are that the first one focuses more on learning and the last one more on insight and understanding, but many practitioners combine elements of each of them. I have developed a communication-focused approach, that works with both insight and learning, which is described in more detail below.

Depression comes with negative thoughts and feelings, where one influences the other. It can begin with difficulties and interpersonal problems, such as in a relationship or at the workplace. The more one doubts oneself, s self-critical or blames oneself, the more the spiral of depression reaches down. Communication patterns often change, both on the inside and the outside. Internally, ruminations, negative feelings, despair, hopelessness, and doubts can lead to increasing questioning of oneself to the point where one feels a physical pain or pressure. In severe cases of depression, the communication reaches a point where internal communication, feelings and thoughts flatten out. Depression does not necessarily mean that one feels sad all the time. In the more severe cases, it means that one feels less to the extent that one cannot cry anymore and feels a physical pain of emptiness. Thoughts about ending everything, as in self-harm, can occur quite frequently. They need to be taken seriously, and one should look for immediate help, which can also include a hospitalisation where a more intensive treatment and a secure environment are possible.

The outside communication reflects the internal communication to a large extent. And often it has become impossible on the inside to take a step back from the ruminations and circulating negative thoughts and watch what is happening from the outside. This step back would, however, be very important. Most often people then try even harder to run with their head against the invisible wall. The brain’s job is to think and to solve problems in the world by thinking through them. In a rumination the brain tries to ‘think its way out’. However, this usually just makes it worse. To get the view from the outside of what is happening and to find new strategies through changes in perspective are important steps in therapy.

Psychotherapy should address various factors, such as current stressors, unresolved conflicts, also internal emotional ones, past experiences, and patterns of relating with oneself and the world around. Identifying own needs, values, and aspirations in helpful in finding a life ath that is more aligned with what satisfies and makes happy.

Psychotherapy should be tailored to the individual needs of the patient. The main task of the therapist is understanding. All psychotherapeutic techniques are really a support towards this goal. As every patient is different, one begins in some ways from scratch. Being empathetic, mindful and aware of the other are crucial towards understanding the dynamics, needs, and suffering a patient is experiencing. Understanding can be accomplished in many different ways. Some focus more on the narrative, some on the interaction and communication patterns, others more on behavior patterns, or on past experiences. But all this is just to help the therapist understand in a way, that tools for healing can be applied/

The World is Not Enough

Often in depression there is the sense that nothing is very helpful anymore. One feels alone with a situation where there does not seem to be a way out. One experiences feelings that are unpleasant, as mentioned to the extent of being painful. The internal communication revolves around questions that can lead deeper and deeper into depression. As our mind is programmed to solve problems, it pursues the questions as far as it can. However, if the questions are the wrong ones, this will not lead to a resolution.

Negative Thoughts about Oneself

Depression and risk for depression are characterized by the operation of negative biases, and often by a lack of positive biases, in self-referential processing, interpretation, attention, and memory, as well as the use of maladaptive cognitive emotion regulation strategies. (LeMoult & Gotlib, 2019) Depression is in that sense different from fear or anxiety in that one has negative thoughts about important attributes about oneself, such as personality, resources, strengths and weaknesses. At the same time, it is important to realize that this is I not directly about the innermost core sense of self. It is more about the facilities one has than about the feeling of self. Thus, one approach of the therapy is to connect with oneself on the level of the felling of self, which is below the surface of personality and skills (Haverkampf, 2010b). Straight forward mindfulness exercises in combination with any therapeutic approaches that also pay attention to communication can accomplish this. As the self is one’s perceptions of the internal flows of information (Haverkampf, 2010a, 2018a), the ability to take back a step and observing, while connecting with oneself is a key skill.

Medication

There is little doubt that medication is effective in depression. Increasingly, we also understand why it works, and how. The challenge can sometimes be to select the right antidepressant for a specific patient, but the miss rate usually declines with experience of the therapist. Generally, the side effects are low or non-existent and over a couple of weeks to a few months there is in about seventy percent of cases a marked improved in mood, motivation, focus and the energy to engage in activities. Sleep, appetite and other parameters can improve as well, depending on the medication selected. If a drug does not show an effect, or only an unsatisfactory one, after some time, it is often a good idea to switch the antidepressant, which frequently works.

When it comes to medication, it is important to understand that an antidepressant has usually other effects aside from its effect on mood. This also needs to be fitted to the patient. As mentioned, when psychotherapy was discussed, a depression is not the same for everyone. There are different types and flavours of it, which are unfortunately not capture adequately by the diagnostic systems we have. So, there can be a patient with severe mood lows and paralysis in life with a history of depression in the family, while another patient experiences anxiety and panic attacks with depression in the background after a relationship breakup, and a third one who does not feel that low, but who has severely disturbed sleep, libido and appetite in waves. In all those cases one would diagnose depression, but the treatment could be very different, both on the psychotherapy and the medication side. Understanding the patient, the individual history, the fear, needs, symptoms, aspirations, and more, is important not only to select and plan a course of psychotherapy, but also as regards the medication.

Good communicating is the foundation of good medicating. It not only indispensable in building compliance, but also in selecting the right medication. Too often the profile of a drug does not fit the patient. For example, a patient with insomnia may benefit more from an antidepressant that also has a sleep-inducing effect or another patient with anxiety may find it easier to gradually and slowly titrate up a softer serotonergic antidepressant. Potential or current pregnancy leads to its own unique considerations. Although randomised controlled trials on pregnant women are ethically impossible, we have a lot of data on women who took various antidepressants in pregnancy.

Even with medication one should not lose sight of the overall situation the patient is in, the patient’s past and desired future. The medication needs to fit in. For a patient to whom an active sexual life is a major factor in the level of quality of life, a medication that is very likely to impact libido negatively may be an inferior choice if there are other good alternatives.

Major Depression vs Reactive Depression

A depression, if it is not primarily a reaction to a life event, is called in psychiatry a major depressive disorder (MDD). It is a condition characterized by at least two weeks of low mood that is present across most situations. (APA, 2013) It is often accompanied by low self-esteem, loss of interest in normally enjoyable activities, low energy, and psychological pain without a clear cause. There may also be false beliefs and – in the more severe cases – acoustic or visual hallucinations. Major depression needs to be differentiated from sadness. Depression often actually means the subjective absence of feelings, such as sadness. Patients often cannot feel themselves anymore as before, which can cause additional anxiety.

Another form is the reactive depression, which occurs as part of several conditions, such as post-traumatic stress disorder (PTSD). These forms of depressions are discussed within the articles on these conditions. The following will focus on the depression, which is not primarily a part of these conditions, the major depression.

Some people have periods of depression separated by years in which they feel normal while others nearly always have symptoms present. The first line of treatment is a combination of psychotherapy and medication. Some common antidepressants are mentioned below. This combination has allowed most patients to live normal lives and in the clear majority leads to a significantly higher quality of life.

Stress

There is growing interest in moving away from unidirectional models of the stress-depression association, toward recognition of the effects of contexts and personal characteristics on the occurrence of stressors, and on the likelihood of progressive and dynamic relationships between stress and depression over time—including effects of childhood and lifetime stress exposure on later reactivity to stress. (Hammen, 2005)

Depression and Health

Major depression significantly affects a person’s family and personal relationships, work or school life, sleeping and eating habits, and general health. Major depressive disorder can negatively affect a person’s family, work or school life, sleeping or eating habits, and general health. Between 2-7% of adults with major depression die by suicide (Richards & O’Hara, 2014) and up to 60% of people who die by suicide had depression or another mood disorder (Lynch & Duval, 2010). But depression has also been linked with several physical health conditions, such as cardiovascular and autoimmune illnesses. These conditions make up a large share of the costs society incurs when depression remains untreated. Depression causes the second most years lived with disability after low back pain. (Vos et al., 2015)

Age

Depression can strike at any age, and the main tools we have, psychotherapy and medication as well as supportive therapies, mostly apply to all ages. However, the psychological issues for the different age groups can seem quite different. What may be an identity crisis in college aged adults can be a deeper crisis for meaning and purpose in the middle-age. The reason why I used the word ‘seems’ is because the underlying motives are not really age specific. Self-connectedness and connectedness with the world run like a thread through all these different manifestations. The identity crisis in young adults and the search for meaning in the middle-aged mean that one’s own basic parameters, the needs, values, and aspirations and information about the world feel insufficient. These feelings are a need for greater internal and external connectedness. It is important to keep in mind, however, that these two themes are just gross oversimplifications to cast the spotlight at the core theme of connectedness.

As mentioned, depression is common in older adults. (Kok & Reynolds, 2017) Efficacious psychotherapies for late-life depression exist, but are underutilized in part because of their complexity (Alexopoulos, 2019). Although antidepressants may effectively treat depression in older adults, they tend to pose greater risk for adverse events because of multiple medical comorbidities and drug-drug interactions in case of polypharmacy (Kok & Reynolds, 2017). They are also rather ineffective in treating depression of demented patients, but long-term use of antidepressants may reduce the risk of dementia. However, confirmation studies are needed. (Alexopoulos, 2019)

Differential Diagnosis

A diagnosis is only a tool in working out a treatment that offers a greater likelihood of success. It is important to keep this in mind because in medicine frequently a diagnosis seems to be an end in itself, but it should not be. Depression, a lowering of various feeling and cognitive states, is something that has been around for a very long time. However, increases in complexity and demands in the world quite often lead from stress and burnout to symptoms of depression. These demands can come from professional, personal and social areas of life.

There are many conditions, somatic, psychiatric or iatrogenic, which can induce symptoms similar to that of a depression. A host of other possibilities should thus be considered, and, if appropriate, be actively searched for. In most instances the situation is quite clear, especially in an outpatient setting, but even here it is advisable to explore alternative explanations aside from depression. At the same time, about 85% of patients with depression have significant anxiety, and 90% of patients with anxiety disorder have depression. (Tiller, 2013) In some cases, a patient may also suffer separately from a depression and another condition. In other cases, the full symptoms of depression occur as part of the condition, such as in a schizoaffective disorder, which combines both, the symptoms of a psychosis and a depression.

One should also not forget that medication can also induce depression-like symptoms, even though they do not match those of depression fully, such as the emotional flattening observed sometimes in several antipsychotics (Haverkampf, 2013b) In any case, a full list of the somatic and psychiatric medication the patient takes should always be scanned for anything that could lead to the symptoms the patient is experiencing.

Computer-Based Treatments

Psychotherapy aims at changing how patients communicate and process information, and the important tool are information and communication. Helpful and meaningful information can be provided in many forms. Some people who suffer from depression, anxiety, or OCD work successfully with self-help books. This is essentially a one-way communication, and the hope is that the information presented changes a perspective, a way of thinking or acting, reflection and insight, and internal and external communication in general.

There are also internet-based treatment applications. While a book cannot provide feedback, a computer-based system can do so to some extent. However, a patient cannot assume or hope that the computer will offer real understanding similar to that of another human being. While programs that mimic therapists have been around for a long time, as one only needs to think of ‘Eliza’ from the late 1970s, they can hold the illusion only for a limited time. ‘Eliza’ was a very short program, by today’s standards, running on 8-bit computers with small memory even for the time, but it was ingenious. It would take sentence fragments and ask the user ‘How do you feel about …?’or ‘Tell me more about …’ and the like. The effect was really striking, which also illustrates how easy it can be to convey psychological support in real life.

A computer-based system also cannot replicate the many information channels that are usually available in human interactions. Still, internet-based systems have shown to be of some use in the treatment of depression. Josephine and colleagues conducted a systematic review of randomized controlled trials investigating internet- and mobile-based interventions targeting adults with diagnosed depression. They found that these interventions significantly reduced depression symptoms in adults with diagnosed depression at the end of treatment and at follow-up assessments when compared to waitlist conditions. (Josephine et al., 2017)

One should also not forget media that show human connection. The stereotypical image of the lovelorn on a couch self-soothing with ice cream and watching a film is not so far from the truth. Self-soothing is often underrated in working with depressed patients, and the movie temples of Hollywood’s golden age, where people could experience connectedness with themselves or others, have become the on-demand streaming services of today. My home is my cinema, where I can be distracted and feel connectedness. Good movies are those where one can feel connectedness between the characters of some kind, whether in the positive or in the negative. In the milder and more moderate forms of depression the withdrawal from others is usually accompanied with a greater need for connectedness. A greater need for connectedness, coupled with the negative thought and feelings about oneself, such as self-criticism, self-blame, and guilt, actually lead to greater withdrawal. The auto regulation seems to malfunction, which can be corrected through psychotherapy, for example. However, in some cases, a change in scenery, such as travelling abroad, or a provocative book brought about the needed change.

Doing things for oneself that make one feel better is vital in depression, because it helps regain a sense of control over the own feeling states. What makes depression worse is the sense of helplessness and powerlessness in ending the state. Often this is what prolongs or maintains it. Children self-sooth autonomously by, for example, using a finger, or by asking a caretake for help in the form of a hug, a pacifier, or something else that aligns with the present needs. In both cases, internal and external communication is important. In the former, it is the internal reading and processing of signals and the self-soothing activity, in the latter communication with the outside world is added. As both, internal and external communication are linked, they reflect each other.

Communication

Since communication is the main instrument we have for diagnosis and treatment, words play an important role. Sigmund Freud highlighted the importance of ‘mistakes’ people make in everyday language that reveal something about unconscious content, and the deeper meaning of jokes people make. The rich symbolism in myths and sacred texts often relies on the subtle meaning of words and word constellations. Depression does not create content, but it has an impact on content and on how content is processed. The shift in focus towards negative thoughts and feelings could have the function of pushing the individual towards the positive, but this becomes more difficult because of the disconnectedness one experiences internally and externally in depression. Thus, meaningful communication and connectedness can help to bridge the depression by enabling the move to the positive.

Communication is also important in identifying the type of depression. Communication patterns give away the fingerprint of the condition (Haverkampf, 2010c, 2013a). However, content can be helpful as well. The words individuals use in their communication can give us an insight into depression. Eichstaedt and colleagues showed in their study that the content shared by users on Facebook could predict a future occurrence of depression in their medical records. Language predictive of depression included references to typical symptoms, including sadness, loneliness, hostility, rumination, and increased self-reference. (Eichstaedt et al., 2018) As the world is becoming technologically more connected, more information is available on what and how one communicates. This could be used for good

Again, understanding and empathy are important in identifying where the depression affects the internal communication flows. Through its impact on information flows and processing a mental health condition can be identified. Depression has effects on the flow of cognitive information associated with thoughts, information associated with feelings, information associated with sensation, and so on. Psychosis, for example, also has distinct effects, one of which is the failure in separating whether a source of information is inside or outside the person. Connectedness is usually a good thing, but this really requires that we are all smart enough to make the most and best of it. This smartness in turn requires connectedness.

Inside-Outside Reflection

The communication patterns in the outside world and those on the inside are closely linked. So, the disconnectedness a patient with depression is experiencing can be felt on the outside and on the inside. Helping the patient to achieve greater connectedness in the outside world can so also transfer to better connectedness on the inside, while helping the patient to better connect with himself or herself also improves the connections the patient has with others. In Communication-Focused Therapy®, for example, awareness, reflection, insight, feedback, and experimenting with communication follows similar rules for the internal dialogues as well as for the outside dialogues (Haverkampf, 2010b, 2017b)

Connectedness

The feeling of connectedness with others is a powerful antidote to depression, anxiety and other mental health conditions (Haverkampf, 2020b). Important is that one feels connected in a meaningful way. One could feel lonely in a crowd of people or even when with family and friends. Meaningful connectedness means that one feels understood by others, that communication really works. The human touch is at its most powerful if one is in the presence of people where worlds can connect. A shared history can make connectedness easier in some cases, but by itself it is not enough. Connectedness between individuals requires interest and the effort to try to understand the other. However, it is effort well spent, as connectedness, both internally and externally, can decrease fear and other feelings, that often are at the foundations of the various conditions mentioned.

Why is connectedness so important? When we are connected, we lessen the effect of time and external circumstances. Connectedness happens in the present moment, and the feeling is about the now rather than the past and the future. Also, the more connected we are, the less will be our fears and anxieties. The fear of death is a fear of disconnect, and by feeling connectedness we reduce the sense of disconnect. Depression and anxiety, though in different ways, are also related to the internal sense of connectedness. This does not necessarily require the actual physical proximity of others, but the feeling of being connected into the world. Various mindfulness techniques and approaches that work with feeling at home in the body and in one’s environment can be helpful because they can increase the sense of connectedness.

Social Connectedness

Connectedness is different from mere social support. In a testing model in 272 college students, indirect paths to self–esteem and depression through the mediating variable of social connectedness were more strongly supported than direct pathways from social support or social competence to psychological outcomes. (Williams & Galliher, 2006) However, in a meta-review of fifty-one studies, the strongest and most consistent findings were significant protective effects of perceived emotional support, perceived instrumental support, and large, diverse social networks. Little evidence was found on whether social connectedness is related to depression, as was also the case for negative interactions. (Santini et al., 2015) A secondary analysis of a waitlist-controlled trial with 29 patients was conducted to evaluate treatment response and process of change in social connectedness within a 10-session positive activity intervention protocol—Amplification of Positivity (AMP)—designed to increase positive affect in individuals seeking treatment for anxiety or depression. The AMP group displayed significantly larger improvements in social connectedness from pre- to post-treatment compared to waitlist; improvements were maintained through 6-month follow-up. Within the AMP group, increases in positive affect and decreases in negative affect both uniquely predicted subsequent increases in connectedness throughout treatment. However, experiencing heightened negative affect throughout treatment attenuated the effect of changes in positive affect on connectedness. Improvements in connectedness predicted subsequent increases in positive affect, but not changes in negative affect. (Taylor et al., 2020) A convenience sample of rural residents in a western Colorado county. Self-reported survey data collection with hierarchical multiple regression analyses. The investigators found that the more socially connected a person felt, the better they perceived themselves as physically and mentally healthy. Additionally, the more socially connected the individual felt the less depressive symptoms they reported. Spiritual perspective was not found to correlate significantly with either self-reported depression or perceived health. (Galloway & Henry, 2014)

Social Identification

Cruwys and colleagues ran two studies. In Study 1 (N=52), participants at risk of depression joined a community recreation group; in Study 2 (N=92) adults with diagnosed depression joined a clinical psychotherapy group. In both the studies, social identification predicted recovery from depression after controlling for initial depression severity, frequency of attendance, and group type. In Study 2, benefits of social identification were larger for depression symptoms than for anxiety symptoms or quality of life. (Cruwys et al., 2014)

Depression Treatments and Connectedness

Trials with psylocybin for treatment-resistant depression also support the link between connectedness and depression. It has been argued that connectedness is key in understanding the effectiveness of psychedelic drugs against depression, and there is preliminary evidence to support this. (Carhart-Harris et al., 2018) In a study with twenty patients enrolled in an open-label trial of psilocybin for treatment-resistant depression, it was reported that medications and some short-term talking therapies tended to reinforce their sense of disconnection and avoidance, whereas treatment with psilocybin encouraged connection and acceptance. (Watts et al., 2017)

Adolescents and Young Adults

Much of the data on the association between depression and connectedness comes from school and college settings. Data from Waves I and II of the National Longitudinal Study of Adolescent Health (Add Health)  indicated that higher school connectedness and getting along with teachers were significantly associated with fewer depressive symptoms. (Joyce & Early, 2014) In a study of students at an international university in Japan, a high prevalence of depression was associated with acculturation stress and social connectedness. (Nguyen et al., 2019) In an American study of 248 students aged between 15 and 20 years old showed that family ritual meaning was positively related to social connectedness and negatively related to depression. Social connectedness was negatively associated with anxiety and depression. Family ritual meaning was found to be negatively linked to both depression and anxiety symptoms via social connectedness. (Malaquias et al., 2015) However, recent literature suggests that school connectedness may be a key determinant of adolescent mental health. The relationship between social connectedness and low mood was reduced by the inclusion of self-esteem  and peer attachment style. Peer attachment style was the largest predictor of low mood. (Millings et al., 2012) In a 2001 population-based sample of 4746 students in public schools, adolescents’ perceptions of low parental caring, difficulty talking to their parents about problems, and valuing their friends’ opinions for serious decisions were found to be significantly associated with compromised behavioral and emotional health. Interventions aimed at improving the parent–child relationship may provide an avenue toward preventing health risk behaviors in youth. (Ackard et al., 2006) In a longitudinal study of 142 youth recruited from an emergency department, who screened positive for elevated levels of bullying victimization, prospectively, family and school connectedness were negatively associated with depression and suicidal ideation. Across time points, community connectedness was negatively associated with suicidal ideation. The three subtypes of interpersonal connectedness among victimized youth (family, school, community) were associated with depression and suicidal ideation. (Arango et al., 2019)

Technology and Connectedness

a systematic review of recent research addressing the associations between adolescents’ sense of social connectedness and Internet technology use. Although Internet technology might provide additional opportunities for adolescents to seek emotional connection with friends and school, this study suggests that real-life social skills are still a necessary foundation for them to use technology in a beneficial way. (Wu et al., 2016) Hwang and colleagues investigated whether social connectedness on a support website protects older adults against depressive symptoms over the course of a year, above and beyond the protective effect of offline social connectedness. 197 adults aged 65 years or older. The more messages older adults read on the web-based forum for the first 6 months of the study, the less depressed they felt at the 1-year follow-up, above and beyond the availability of offline support networks at baseline. This pinpoints the substantial potential of web-based communication to combat depressive symptoms in this vulnerable population. (Hwang et al., 2021) Results from a study by Grieve and colleagues suggested that Facebook use may provide the opportunity to develop and maintain social connectedness in the online environment, and that Facebook connectedness is associated with lower depression and anxiety and greater satisfaction with life. Limitations and future directions are considered. It is concluded that Facebook may act as a separate social medium in which to develop and maintain relationships, providing an alternative social outlet associated with a range of positive psychological outcomes. (Grieve et al., 2013) A multidatabase search was performed. Papers published between January 2005 and June 2016 relevant to mental illness (depression and anxiety only) were extracted and reviewed. Results: Positive interactions, social support, and social connectedness on social networking sites (SNSs) were consistently related to lower levels of depression and anxiety, whereas negative interaction and social comparisons on SNSs were related to higher levels of depression and anxiety. SNS use related to less loneliness and greater self-esteem and life satisfaction. Findings were mixed for frequency of SNS use and number of SNS friends. Different patterns in the way individuals with depression and individuals with social anxiety engage with SNSs are beginning to emerge. (Seabrook et al., 2016)

Autonomy and Connectedness

The relationship between autonomy–connectedness, and depression and anxiety was investigated in 94 primary mental health care patients and 95 psychology students. All participants completed the Autonomy–Connectedness Scale–30 (ACS‐30), the Beck Depression Inventory (BDI), and the Symptom Checklist–90 (SCL‐90). Results indicated that the primary mental health care group compared with the control group scored lower in Self‐Awareness and Capacity for Managing New Situations, and higher in Sensitivity to Others. Women compared with men had higher levels of self‐reported Sensitivity to Others. Regression analyses showed that both (low) Self‐Awareness and (high) Sensitivity to Others predicted depression, as well as anxiety; also, (low) educational level had predictive value. These results indicate that low autonomy–connectedness might be a risk factor for depression and anxiety. (Bekker & Belt, 2006)

Connectedness and the Elderly

Relationship of loneliness and social connectedness with depression in elderly: A multicentric study under the aegis of Indian Association for Geriatric Mental Health. The study sample comprised 488 elderly patients (age ≥60 years) with depression recruited across 8 centers. About three-fourth of the elderly patients with depression also have associated loneliness. Loneliness is associated with higher severity of depression, anxiety, and somatic symptoms. Severity of depression is associated with loneliness but not with social connectedness. Lower social connectedness among elderly females with depression is associated with higher loneliness, but this is not true for elderly males with depression. (Grover et al., 2018)

Connectedness and Groups

In a further study, Kaniuka and colleagues examined depression and anxiety as mediators of the linkage between perceived stigma and suicidal behaviour, and the moderating role of LGBTQ community connectedness. Among their sample of 496 LGBTQ persons, psychopathology mediated the association between perceived stigma and suicidal behaviour. Connectedness moderated the relation between perceived stigma and depression, and between perceived stigma and suicidal behaviour in the anxiety model. (Kaniuka et al., 2019)

Causes of Depression

Its impact on functioning and well-being has been compared to that of other chronic medical conditions such as diabetes. The biopsychosocial model proposes that biological, psychological, and social factors all play a role in causing depression. The cause is believed to be a combination of genetic, environmental, and psychological factors. (APA, 2013) Risk factors include a family history of the condition, major life changes, certain medications, chronic health problems, and substance abuse. (APA, 2013) About 40% of the risk appears to be related to genetic variations.

Lifetime rates are higher in the developed world compared to the developing world. Maybe a heightened stress level in a more complex living and working environment contributes to that, but it may also be a lower rate of diagnosing this condition in the developing world.

The Monoamine Hypothesis

The monoamine hypothesis has been partially questioned, but it is still the leading, and also most coherent, hypothesis there is in providing a biological explanation for depression, as well as some anxiety disorders. Over time, its emphasis on particular neurotransmitters has shifted to a limited extent, while the focus on the neurotransmitter serotonin has endured. The monoamines are serotonin, norepinephrine, and dopamine. The antidepressants act on the neurotransmitter levels or on the receptors.

Serotonin is hypothesized to regulate other neurotransmitter systems; decreased serotonin activity may allow these systems to act differently and become less stable. According to this hypothesis, depression arises when low serotonin levels promote low levels of norepinephrine, another monoamine neurotransmitter. Some antidepressants enhance the levels of norepinephrine directly, whereas others raise the levels of dopamine, a third monoamine neurotransmitter. These observations gave rise to the monoamine hypothesis of depression.

In its contemporary formulation, the monoamine hypothesis postulates that a deficiency of certain neurotransmitters is responsible for the corresponding features of depression. The main effect is, however, believed to be due to changes in the receptor densities on the cell membrane rather than the changes in the neurotransmitter levels. This also explains why antidepressants can take a few weeks to work. This may be the time needed by the cell to change the receptor density and patterns in the cell membrane through recycling and protein synthesis.

Communication Factors

Humans are constantly in a web of relations with other people. External communication from birth and even before influences how information is processed in the brain and how an individual communicates and interacts with others. The individual learns certain communication strategies and patterns that are shaped over time in response to the environment, internal communication and the biology underlying the neuronal network.

As children we pick up communication patterns from our parents or other important people in our lives which can then be internalized and also influence how we communicate with ourselves internally. And this process continues throughout or life, practically with every interaction we have with others. Our awareness of the flows of internal information then give rise to the sense of self.

Trauma committed by people can have such a devastating effect on individuals because of the communication it contains. Being exposed to someone who communicates that they negate our worth as a human being, our autonomy and integrity, traumatises and hurts us deeply. There need not be physical scars in a somatic medical sense. Our mind and our body form a union, however, and harm to one also harms the other. The body is the means that we can communicate with ourselves and others, while the mind connects us mentally with others. If that delicate fabric of connectedness between ourselves and others is torn or ruptured, we lose some of the safety and security it gives us. Trauma can be healed when we understand that its nature is in the communication that cause it. Awareness, insight, adapting communication patterns and learning new ones, as well as feedback are helpful in overcoming trauma (Haverkampf, 2016, 2020a) as they are in recuperating from depression.

Symptoms

A person having a major depressive episode usually exhibits a very low mood, which pervades all aspects of life, and anhedonia, the inability to experience pleasure in activities that were formerly enjoyed. Depressed people may be preoccupied with, or ruminate over, thoughts and feelings of worthlessness, inappropriate guilt or regret, helplessness, hopelessness, and self-hatred.

Changes in the communication with oneself and others changes when an individual is depressed. This is a consequence of the symptoms of depression but often works also to deepen and prolong the condition. Loss of interest in things that were once enjoyable, seeing less meaning in activities and events and withdrawal from the world, and to an extent from oneself, are often the result and may worsen the depression, while more communication with oneself and others can help to reverse the depression.

In severe cases, depressed people may have symptoms of psychosis. These symptoms include delusions or, less commonly, hallucinations, usually with negative and unpleasant content. A good indication that a psychotic symptom is maintained by a mood disorder is that the value of the content of any delusions or hallucinations is consistently in the direction of the mood disorders, such as negative content in a depression or alternating positive and negative content in bipolar disorder.

Other symptoms of depression, which are commonly observed, include

  • poor concentration and memory
  • withdrawal from social situations and activities
  • reduced sex drive, irritability,
  • insomnia
  • and thoughts of death or suicide (which requires immediate professional help).

Insomnia is a common symptom. In the typical pattern, a person wakes very early and cannot get back to sleep. Hypersomnia, or oversleeping, can also happen. In an atypical form of depression, it is even possible that a patient experiences primarily insomnia, loss of concentration and poor memory retrieval, without a clear lowering in mood.

Physical Symptoms

The physical symptoms of a depression are often underestimated. A depressed person may report multiple physical symptoms such as

  • fatigue
  • headaches, or
  • digestive problems.

Appetite often decreases, with resulting weight loss, although increased appetite and weight gain occasionally occur. Family and friends may notice that the person’s behaviour is either agitated or lethargic.

Treatment

The two types of treatment, for which there exists broad empirical and conceptual support, are medication and psychotherapy. Generally, the best approach is to use both together. However, in very severe cases of depression only medication may be feasible, while in cases of mild depression psychotherapy may be sufficient.

Medication

There are various groups of antidepressants, often with regards to their function on neurotransmitters and neuroreceptors. The selective serotonin receptor inhibitors (SSRIs) are the ones most commonly used. They can also help against anxiety and panic attacks, as well as various other symptoms and conditions, such as emotional instability and eating disorder. Examples are escitalopram (Lexapro®) and sertraline (Zoloft®). The serotonin and norepinephrine reuptake inhibitors can also help against anxiety, but may be more activating, which can lead to increased nervousness and anxiety in the beginning. The best way to reduce an increase in anxiety in the first days, which can happen with most antidepressants, is to start the medication at a very low level and increase it in small increments in patients with anxiety, especially if there are also panic attacks.

Psychotherapy

As already mentioned, there are various brands of psychotherapy which are designed to help in the long run. Cognitive behavioural therapy (CBT) and interpersonal psychotherapy (IPT), as well as Gestalt therapy and others, are also focused at the short-term, while psychodynamic psychotherapy aims at a more permanent resolution of the depression in the long-run. (Haverkampf, 2017a) Communication-focused therapy (CFT), which was developed by the author to more closely work with the mechanism that underlies many forms of psychotherapy, communication. (Haverkampf, 2017f)

Psychotherapy should be targeted at the long-run. Short fixes for depression often do not work, and only in the short run. The reason is that a patient’s interaction patterns with herself and the environment often need to change, which requires some time. Good communication helps against a depression, but it often requires a change in perspective, as well as awareness and reflection, which ensures an enduring effect but requires time.

There is a significant amount of research which shows that the effect of psychotherapy may to a large extent be due to the personality and communication approach of the therapist, and there is a debate to what extent the specific viewpoint of a school of psychotherapy plays an actual role in the outcome of psychotherapy. This is one reason why communication-focused therapy (CFT) puts an emphasis on the communication patterns and dynamics that unfold, and are induced to unfold, in a psychotherapeutic session.

For any form of psychotherapy to work, it has to lead to some form of change. To achieve a lasting adaptive and helpful change, it has to come from the patient himself or herself, because if the change is not in sync with the patient’s basic parameters, any change will over time revert back, either to the state before the therapy or a state that is somewhere half-way between the pre-existing one and the desired state. If change is lasting nevertheless, it is often due to factors outside a manualized and structured therapy. One explanation could be that even a manualized approach contains elements that may help the patient to develop in a direction that correlates with the patient’s basic needs and aspirations on some level.

Separating Thoughts from Emotions

In many schools of psychotherapy there is unfortunately an almost complete separation between thoughts and emotions. However, from a communication perspective they both are signals, containing information. When a thought triggers and emotion, or an emotion leads to certain thoughts, it is in both cases some meaningful information which leads to new sets of information. This is also useful in the therapy, because communication patterns that apply to one kind of information also apply to the other.

The uncrossable dividing line between thoughts and emotions has largely contributed to a situation where we understand neither. We could arbitrarily categorise information, but it still does not bring us closer to understanding the dynamics in which the information, or the categories of information, flow. For example, a question as one of the most powerful communication tools can elicit an emotional signal in a person without a cognitive thought, because it is information which can under certain circumstances be retrieved directly.

Regarding both, emotions and thoughts, as bundles of information does not reduce their individual qualities, but these qualities are part of the information that makes up the thought or emotion. Whether a message is emotional or cognitive cannot be extrinsic to it. However, where a piece of information flows is in a sense intrinsic to it. Thus, the thought of pain and the feeling of pain can be quite similar in information content, but where the information flows in the neural network, and in what way, may be vastly different.

Body Work

Focusing on the mind often neglects the wider dimensions of the body. In a study with a group of women with major depressive disorder, experiences of yoga were that it served as a self-care technique for the stress and ruminative aspects of depression and that it served as a relational technique, facilitating connectedness and shared experiences in a safe environment. (Kinser et al., 2013)

Communication-Focused Therapy®

Communication-Focused Therapy (CFT) was developed by the author to focus more specifically on the communication process between patient and therapist. (Haverkampf, 2010b, 2017b, 2017f, 2018b) The central piece is that the sending and receiving of meaningful messages is at the heart of any change process. Communication processes are at the same time the instruments of change and their target. Any therapy needs to lead to change in some form. (Haverkampf, 2010b)

register them as emotions; thus, severely depressed patients are as in-capable of experiencing sadness as of feeling joy. Their feelings are diffuse, are not registered as emotions, and are not properly identified. (Bucci & Freedman, 1981)

Change

Change can include changes in acceptance levels, new insights, learning processes and more. All these aspects are determined by communication processes and some are communication processes themselves. For the acceptance of a certain situation or emotion, for example, with the aim of reducing conflicting emotions and anxiety, one needs to learn about the situation or emotions and identify them and then put them into context with information from memory and use internal and external communication flows to reflect on them.

There are various factors that may stand in the way. If fear inhibits the information retrieval from memory this will not fully work. However, this fear is again a signal, information that is transferred from one point to another and triggers certain information processing patterns. If these patterns are not helpful in supporting the larger goals of need fulfilment with respect to the internal and external world, they can lead into such stationary and change inhibiting dynamics as indefinite loops, or vicious cycles, in which a fear signal just leads to another fear signal, rather than inducing change. These dynamics include

  • looping of information
  • disconnects
  • misdirected information

and many others. They are a consequence of inhibited change. To break out of these communication predicaments, changes in communication patterns are needed that compensate, interrupt, reconnect, or act in another positive way.

Michael feels a lump in his throat. His therapist looks at his with an encouraging trace of a benevolent smile. Michael is not helped much by it, he feels under even more pressure. The therapist than finally asks a question, while Michael is about to despair. “Described the lump.” At first Michael does not know what to do with this question. However, he begins describing the lump and develops increasing investigatory spirit in doing so. After he has been talking for a little while, Michael discovers that his narrative has actually shifted to talking about his feelings …

CFT aims, among other things, at reducing the fear of information retained in memory or communicated from others. This requires more meaningful information rather than less which can be communicated more freely as the fears or other inhibiting factors decrease. The freer and more open the communication processes become, the easier it is for autoregulatory processes to counter unhelpful diversions from health affect states. However, this requires insight, reflection and experimentation in therapy.

The goal is thus not to simply provide information, to communicate information from one point to another, but to understand the flows of information, to better use communication patterns and to recognise if something is not working. The objective is really to understand flows of information rather than to get caught in a specific content. Since change comes from the detection, decoding and processing of meaning in a message, a patient suffering from depression, and several other mental health conditions, will see a decline in symptoms over the time, the better he or she becomes in spotting meaning.

Many popular forms of psychotherapy, such as Cognitive-behavioural Therapy (CBT), psychodynamic psychotherapy and Interpersonal Psychotherapy (IPT) define a format in which communication patterns take place that can bring about change. However, they do not address and work with the communication processes directly. In psychodynamic psychotherapy, communication constructs like transference and counter-transference have been formulated, which focuses on the outcome of communication processes. CFT in contrast attempts to focus on the process itself.

CFT attempts to analyse how information is exchanged, the various channels involved and how meaning is generated. Messages do not have to be contained in words, they can also be transmitted by facial gestures or any behaviour of the send. To contain meaning they have to be relevant to the recipient and have the potential to bring about a change in the recipient.

Analysing Communication Patterns

The first important step in therapy is to create awareness for communication in general. Humans are sending and receiving countless of messages every minute, and most of this runs automatically. However, for messages that can be processed by higher brain functions, whether from internal and external sources, there is the option to make these communication processes conscious. Particularly in interactions with other living organisms, particularly humans, communication patterns have evolved that facilitate the exchange of meaningful information between one brain and another. While most of this communication is outside consciousness, there are processes that let some of it pass the filter and bring it into consciousness. Creating greater awareness means putting the focus on these flows of information by observing the observable. For example, if a patient focuses just on her right hand, for example, while she is talking or on the timber in her voice, this creates awareness for a small aspect of the information in her interaction with another. Becoming aware of a thought that is repeatedly coming back and is followed by a feeling of anxiety may lead to the observance of internal communication flows. While the majority of the information exchange in the human body, particularly on a cellular body, is not accessible to conscious awareness, the aggregate result is.

Paul is at home alone. It is close to midnight, he feels low and cannot sleep. He does not really know why. The day has been good overall, but sporadically a melancholic feeling strikes, as if out of nowhere. He looks at the clock in the living room, as the hands seem to stand still. Everything is still. It has been an intense week, and it is maybe the first time when everything seems to quiet down. In this stillness, he notices something new, a tension he cannot put his finger on. It seems as if from nowhere and he cannot identify it.

Rather than thinking about, he just sits there, experiences, is open and curious. The point of tensions takes on more detail, and he feels he can make out some context, bits of emotions and thoughts, faint signals that are becoming more defined. While he is curious about what they may grow into and become, he enjoys the changes that are taking place before his inner eye …

The Process

The emotional signals contained in a message are important because own emotions one becomes aware of can contain a lot of information. The brain uses a lot of information to form an emotion. To yield an emotion of sadness requires not only the information that a relationship has ended, but also the information about the relationship itself and potentially the relationships before, including information from interactions with one’s parents, and so forth. In a therapeutic setting, all this information can be helpful to adapt strategies, or to design new ones, and help the patient to integrate all this information into his or her life.

The communication between therapist and patient gives clues about thought patterns and beliefs, which affect how messages from others are interpreted and how own messages are assembled and communicated. It also helps to get an idea for how a patient constructs meaning. What someone sees as meaningful and relevant is largely determined by own needs and wants, but also past experiences. When the patient begins to form new communication patterns or adapts old ones, it is helpful to help in identifying patterns that have worked well for him or her in the past. Sometimes new ones have to be constructed from scratch, if a patient has been socially isolated for a while, for example. It is then useful to rely more on the therapeutic interaction as a model to train new communication patterns. In some patients who have suffered from depression for a long time with social isolation this may be necessary, but also important to maintain the patient’s motivation for the therapeutic work.

The importance of awareness is that it gives the patient a greater sense of hope and control when the depression causes hopelessness and despair. The journey patient and therapist take together in exploring and experimenting with communication in itself has a major antidepressant effect. It requires openness and insight which cannot be manualized. Communication has, however, universal rules which can be understood and worked with.

Communication Patterns and Structures

Communication patterns are basic units of communication dynamics which make spontaneous communication in everyday situations possible. A certain form of question may be such a communication pattern, which humans use instinctively without further thinking about the pattern they are using. Some basic communication patterns may be hardwired, but many are also learned. Since they all have to adhere to basic laws of information exchange, the patterns themselves adhere to certain rules. The author has focused more specifically on the origin and nature of communication patterns elsewhere. (Haverkampf, 2018c)

An awareness of communication structures and patterns begins with an inventory of what is there. An analysis reveals the constructivist nature of conversation, how the therapist uses rhetorical devices in an interactive manner to pursue his therapeutic agenda and how the dialogue is a systemic process. However, it goes deeper as the same laws of communication do not only apply in the external world but also in the inner realms of a person. This makes communication less constructivist, but as natural processes that follow universal laws.

Humans interact on millions of communication channels at one point in time. Cells have their communication channels, and every information coming into the system and leaving it uses communication patterns. Communication has certain rules, and in a context communication patterns emerge that help the organism survive, evolve and prosper. A language can be seen as sets of symbols and signals that are used within communication patterns. We all communicate in patterns because they make communication more efficient within a given context, However, people spend little time observing and reflecting on their communication patterns on the inside and in the external world.

Two cardinal symptoms of depression are ruminations and selecting negative information. Many therapeutic approaches focus on the negative, for example, and try to unlearn them. This may work in the short-term but often fails in the long-term if the communication patterns with oneself and the world do not change. An external pattern may be how one could ask for information that could dispel the negative thoughts or an internal testing of the information. All these are modifications in external and internal communication patterns because they change which and how information is sent, how it is received and how meaning is extracted from it. All these steps can either be adaptive or maladaptive. Depression comes with maladaptive communication patterns which then cause even more maladaptive communication patterns. The way out is to create awareness for, reflect and experiment with these communication patterns, at first in a therapeutic setting and then in the real world.

Passive social media use (PSMU)—for example, scrolling through social media news feeds—has been associated with depression symptoms. More time spent on PSMU was associated with higher levels of interest loss, concentration problems, fatigue, and loneliness. (b) Fatigue and loneliness predicted PSMU across time, but PSMU predicted neither depression symptoms nor stress. (Aalbers et al., 2019)

Facebook depression is defined as feeling depressed upon too much exposure to Social networking sites (SNS). Researchers have argued that upward social comparisons made on SNS are the key to the Facebook depression phenomenon. Our literature search yielded 33 articles with a sample of 15,881 for time spent on SNS, 12 articles with a sample of 8041 for SNS checking frequency, and 5 articles with a sample of 1715 and 2298 for the general and the upward social comparison analyses, respectively. In both SNS-usage analyses, greater time spent on SNS and frequency of checking SNS were associated with higher levels of depression with a small effect size. Further, higher levels of depression were associated with greater general social comparisons on SNS with a small to medium effect, and greater upward social comparisons on SNS with a medium effect. Both social comparisons on SNS were more strongly related to depression than was time spent on SNS. (Yoon et al., 2019)

A search of PsycINFO, Medline, Embase, CINAHL and SSCI databases reaped 13 eligible studies, of which 12 were cross-sectional. Findings were classified into four domains of social media: time spent, activity, investment and addiction. All domains correlated with depression, anxiety and psychological distress. However, there are considerable caveats due to methodological limitations of cross-sectional design, sampling and measures. Mechanisms of the putative effects of social media on mental health should be explored further through qualitative enquiry and longitudinal cohort studies. (Keles et al., 2020)

There are growing concerns about the impact of digital technologies on children’s emotional well-being, particularly regarding fear, anxiety, and depression. A growing body of research confirms the relationship between digital media and depression. Although there is evidence that greater electronic media use is associated with depressive symptoms, there is also evidence that the social nature of digital communication may be harnessed in some situations to improve mood and to promote health-enhancing strategies. Much more research is needed to explore these possibilities. (Hoge et al., 2017)

Transfer

Considerations of psychopathology and a greater understanding of child and developmental psychology provide a greater insight into the question how depression may be transferred from mother to child, for example. (Goodman, 2020) From a communication perspective this is easily understandable. The child’s first experiences of the world internally and externally is shaped through the communication with others, mainly the primary caretakers. Depressed parents have been found to interact with their children differently, in ways that affect child development. Depressed mothers have been found in some studies to use less emotion and expressivity in their language with their babies. Non-verbal communication is especially important at an early age, and depressed mothers tend to make less eye contact. Through withdrawal, depression can also lead to a wider social disconnect, which can then affect both, the mother and the child.

Meaning

Individuals suffering from depression often see less meaning in the things they do. In therapy an important part is to rediscover meaning and find it in the things that are relevant to the patient. Relevant is anything that is close to his or her values, basic interests, aspirations, wants, wishes and desires.

Information that contains meaning has the potential to bring about a change. This means it that it has to contain something that is not entirely predictable. If we were fully certain of that piece of information, it could not lead to change. Thus, any therapy that does not work with meaning and meaningful information must be quite useless and ineffective. Even a highly manualized and structured therapy contains some novel information, which can be relevant and meaningful to the patient. In fact, practically all interactions with other people contain some elements of novelty, relevance and meaning. If communication is all pervasive, chances are high that there will also be some meaningful communication.

By focusing more specifically on the communication process, it is possible to increase the density of helpful change, and thus to make therapy more effective. A positive effect is also that as the patient experiences the relevance and practical workings of the therapeutic process, motivation and optimism about the positive outcomes of therapy increase. These effects come through connectedness, but also increase connectedness in the future.

Meaning is here used in the sense of understanding the information behind information, its symbolic content. For example, even the simple sentence “How are you?” can have a broad range of meanings from “Hi!” to “Are you feeling better?” Our thoughts and feelings affect how we decode meaning. They affect the questions we ask about another’s comment and the context in which we understand it. This applies to our own internal communications, and external ones. Learning communication in different contexts is like learning foreign languages.

Important is also how we interpret our own thoughts, the meaning we give to them and to our feelings. How we interpret our own thoughts, the internal communication in general, influences how we see ourselves. Thus, by changing our internal communication strategies we can also affect how we feel about ourselves. Primarily cognitive and psychodynamic psychotherapies offer many strategies in this area, while the former tends to be more manualized and the latter organically growing out of the psychotherapeutic work.

From Meaning to Meaningfulness

To be able to help patients with depression it is important to understand the road from meaning to meaningfulness. While meaning is relevant content, meaningfulness is a measure of how much relevant content one sees in something. At the same time, meaningfulness can be a feeling, which imputes relevance to something, a relevance, which, as has been described above, contains hope for some change in emotional, cognitive or other state or process. The importance in getting patients to see more meaningfulness has been borne out in many studies. Carstens and colleagues, for example, administered in their study the Sense of Coherence scale and the Beck Depression Inventory to fifty patients diagnosed with major depressive disorder and to fifty control subjects. Significant negative correlations were found between scores on Depression and total scores on the Sense of Coherence scale as well as all three of its subscales (Comprehensibility, Manageability, and Meaningfulness). A significant positive correlation was found between scores on the Sense of Coherence scale and age. Of the three subscales, a low score on Meaningfulness was the best predictor of scores on Depression. (Carstens & Spangenberg, 1997)

How do we achieve the perception of more meaningfulness? That is linked to the ‘demands’ of our basic parameters, our needs, values, and aspirations. Identifying them through information we already have about ourselves from the past, in terms of situations that were fulfilling or unfulfilling, and through observation and reflection on our communication patterns can make it easier for us to find what is meaningful to us. Once things that are meaningful are identified, one not only gravitates more towards those things, but can also seem more of them in present activities and situations.

As an example, consider a social get together, a party, where people stand around and talk to each other.

Last year, Randy felt uncomfortable at Bob’s birthday party, particularly on a day where he does not feel his best. Bob always invites lots of people Randy does not know. He would stand there and do his best to mingle. Was that not the point of it to mingle? But Randy was not entirely sure what he was doing at the party? Yes, sure, he wanted to have a good time, had to have a good time, but it would be over after a couple of hours anyway, and then he would be by himself again.

Since last year, Randy had looked into Communication-Focused Therapy and several other therapeutic approaches, which seemed to help people. He also worked with a therapist. He found out that he likes being with people and is interested in them at a deeper level, rather than just pleasantries. He probably had learned at home not to look into things too deeply. Don’t scratch the surface. But that did not lead to very fulfilling relationships.

This year, Randy is at Bob’s birthday party again. He walked into the main room. He sees a woman looking at a photograph hanging at the wall. Since last year he has discovered his interest in other people’s lives, their perspectives and insights. He walks over to her and talks about the photograph, and asks what she thinks about it? How she feels about it? An hour later they were talking again about things that were important to them. This was a new experience for Randy.

What this everyday occurrence illustrates, that if one zooms in on the meaningful, such as talking with another human being about what they find important, it is less likely to get caught in the meaningless, small talk for the sake of small talk. While small talk fills an important role in building relationships, one needs to see it only as a transition phase, in which the focus should already be on the next phase in relationship building. Far too many people, particularly those with social anxiety or depression, stay in the small talk for its own purpose state. One reason may be, what we already discussed under the topic of connectedness, the longing for connectedness and, at the same time, the apprehensiveness about it. Ways to see more meaningfulness are powerful antidotes to this dilemma.

Meaningfulness is frequently something that is seen within the context of one’s life story, or part of the life story. However, it should not be dependent on the story, because the story in turn depends again on the individual needs, values, and aspirations, the basic parameters of the person. On the other hand, a story is a frame for communication that takes place within it. At the same time, the communication dynamics that develop within a story are meant to get the person closer to the fulfilment of the individual needs, values, and aspirations. Thus, identifying the latter can help to construct a story, in which more meaningfulness can be found. It is in the story where past present and future can come together and support one in the creation of more meaning and more meaningfulness. Stories, as long as they are flexible and align with oneself, can also speed up the decoding process of messages and facilitate communication.

Motivation

Decreased motivation is a central symptom of depression which often makes therapy more difficult. It is no different in a communication focused approach. Experiencing what is possible in therapy can raise motivation significantly, but this requires at least some motivation to begin a therapy and makes it through the early stages. A communication focused approach may have the advantage here that it has material to work with from the time the therapist opens the door and makes eye contact with the patient. Another advantage on the motivational side is that a communication focused approach places emphasis on the interaction between patient and therapist, and thus the relationship, which helps to motivate the patient to wait and see what the therapy has to offer.

Motivation often comes when one has already started on a task. This is even more true in depression. Once one is engaged in a task, the depression tends to become less of an issue. The thoughts and feelings we build up before engaging in a task can be coloured significantly by mood and other factors, so that depression can influence the motivation and initiative to begin on a task quite directly. Here it is again to zoom in on what is really important to oneself, and also to see the communication aspects when one engages in a task. Any task is an interaction with the environment and with oneself, and as we already discussed, our communication or interaction patterns with the environment shape the enjoyment and satisfaction we derive from it. One valuable task in therapy is to look at, reflect, and experiment with these patterns.

Interacting with the World

At the core of Communication-Focused Therapy® is interaction. Interacting with the world is an important pillar in moving away from depression. Anything that helps to interact with the world in a meaningful way can help to overcome negative thoughts, feelings, and ruminations, as well as to find energy, initiative and motivation again. But how to get back into the world if one cannot find the energy and initiative to do so, and the world seems bleak?

As already mentioned, an important part in reintegrating in the world is just to do things. Action. However, it is not mindless action we are looking for, but mindful action; the kind that gives one the feeling of progressing rather than regressing. The first steps are often the most difficult steps, and anything that helps us to get moving is usually leading one in the right direction. Important from a Communication-Focused Therapy® perspective is to examine the pattern one usually used to interact with the world and to see where changes can be helpful. One often also needs to develop new ones, either in combination with old ones or by themselves. Through experimentation one can then adjust them so that they fit and are effective in getting one’s needs, values, and aspirations met in the world.

Powerlessness

The feeling of powerlessness is one of the hallmark features of depression, which often leads into a vicious cycle, which further paralyses the patient. This powerlessness often goes hand in hand with a sense of disconnectedness. After all, communication is how we can exert power by changing our environment and ourselves. As depression inhibits meaningful communication, the latter can help overcome the sense of powerlessness.

Particularly problematic can also be the feedback a depressed person receives from others, which can maintain the depression. Coyne tested the hypotheses that (a) normal Ss respond differentially to the behavior of depressed patients, (b) this differential response is due to the fact that the target individuals are depressed, and not that they are patients, and (c) this pattern can be related to the symptomatology of depression. Each of 45 normal female undergraduates conversed on the telephone with either a depressed patient ( n = 15), a nondepressed patient ( n = 15), or a normal control ( n = 15). It was found that following the phone conversation, Ss who had spoken to depressed patients were themselves significantly more depressed, anxious, hostile, and rejecting. Measures of activity, approval responses, hope statements, and genuineness did not distinguish between S groups or between target groups, but important differences were found in the Ss’ perception of the patients. It was proposed that environmental response may play an important role in the maintenance of depressed behavior. Furthermore, special skills may be required of the depressed person to cope with the environment his behavior creates. (Coyne, 1976)

Insight into Communication

In many instances, reflecting on one’s communication patterns and strategies with oneself and others in concrete situations leads to insight about them. This is quite practical in nature. Observing communication patterns and trying out new ones is an important part of therapy. Since communication has different components one can focus on its components:

Person A

  • Selecting information for a message (e.g. I am not OK with our weekend plans because I rather stay in the city; I need to communicate this to my partner)
  • Encoding the information in a message (I will say it to him verbally; I want to be clear but cautious because we had a fight yesterday and he is feeling low today)
  • Sending the message through a communication channel (using the speech system to say the words)

Person B

  • Receiving the message through a communication channel (using the auditory system)
  • Decoding the message into information (my partner is unhappy)
  • Processing the information further (is she unhappy with me? I better don’t go there.)

It is obvious from this example that communication has failed, as the feeling “I rather stay in the city” gets converted into “is she unhappy with me?” Some vital information is not transmitted even though both individuals have the capability to communicate anything they want. It is not difficult to imagine that person A could be an anxious person and person B a depressed person. The communication patterns they use may have served some function in the past, as they both seem to be protecting themselves from some negative emotional consequence. However, in the present they do not promote a more optimal outcome, which could take into account both their needs, values and aspirations. On the other hand, it is also easy to see how awareness, reflection and experimentation with new communication patterns can resolve the problem, reduce the anxiety in A and lift the mood of B. That is what a communication-oriented therapy should do.

Maladaptive communication pattern can lead to the perception of more negative consequences and less meaning in the world. The former can be a filtering and interpretation deficit, the second often follows the first in the form of a disconnect or disengagement from the world. Insight does not have to lead to a change of current communication patterns, but in many cases also the development of new ones. In practice, this may also include considering situations which can facilitate better communication patterns, as the communication patterns one uses also depends on the communication patterns of the people one interacts with. This is also the basic dynamic when an individual is constantly exposed to other people who are stressed, anxious or depressed. Especially in infants and children who are still in the process of acquiring and forming communication patterns, an anxious parent, for example, can pass on some of the maladaptive communication patterns to the child. Depending on any helpful communication patterns already in memory and the effectiveness of autoregulatory processes, the child may adopt less of the maladaptive communication patterns than it might otherwise.

Observing and insight into internal and external communication patterns are both important. An individual suffering from depression is less likely to see messages as relevant and meaningful if the communication patterns that make up the feeling of being oneself have been compromised. The feeling of being oneself is itself the own observation of internal flows of information or communication. There is thus a strong link between internal and external communication patterns, which also explains how individuals can spiral into a vicious cycle of depression where engaging with the world can make the internal sense of dread and depression even greater, and vice versa. For example, a depressed person who pushes himself or herself to be more outgoing in a social situation often feels worse in the end.

Building the Sense of Self

Seeing relevance in a message requires knowing what one needs, wants, as well as one’s values and aspirations. In short, it means knowing some basic parameters about oneself. When the self becomes more meaningful, the motivation and desires to learn or try out something new, including therapy, increase. To give the sense of self texture requires awareness and identification of the own needs, values and aspiration, thereby attaching more subjectively perceived value to it.

The sense of self is awareness of certain communication flows in one’s own body. These information flows can be sensory, emotional or other signals from cognitive processes or from memory. This is the reason why internal and external communication patterns play such an important role for the sense of self because they influence these information flows. If a patient uses an external communication pattern which interferes with social exchanges, the information flow from the outside world in this respect will be reduced which has as effect on the sense of self. Thus, exposure to meaningful communication and improvements in communication can be very effective in treating the symptoms of depression. Negative perceptions of oneself are reduced and the interactions with the environment improve, which in itself has an antidepressant effect. As the moods lift concentration, focus and memory problems tend to decrease because things feel more relevant consciously and subconsciously.

Resonance

Resonance is when new information becomes meaningful because of the information the other person possesses, whether consciously or subconsciously. The interaction between therapist and patient is meaningful to the patient if what is happening resonates with the values, basic interests or aspirations of the patient. This also means that the therapist, consciously or subconsciously, needs to have a good sense of the patient’s values, interests and aspirations, of what is relevant to the patient, which can also show in the symptoms and the situations in which the symptoms are triggered.

In therapy, patient and therapist look for resonance because it is necessary for the communication of meaning, which brings about a change in the patient. Often resonance can only be guessed by either patient or therapist, and it takes some amount of communication to find resonance. A good starting point is listening to what the patient is saying and otherwise communicating, since it reflects the information the patient already has, and which represents the foundation for resonance.

Depression makes the own information, particularly the emotional information less accessible, which can also lower resonance. However, while in most depressed patients resonance may become narrower, it does not cease to exist. Reflecting with a patient on everyday activities can help to find spots of resonance. If the therapist then uses an inquisitive and interested communication pattern to get information on what about this activity is valued, needed or aspired to by the patient, the patient’s internalization of this pattern can help to form more adaptive communication patterns which can help against and prevent a depression.

Relevance

Depression makes everything seem less relevant as it reduces the spectrum of information that is available, including emotional signals. Less available information leads to less resonance, and thus less meaning which is extracted from messages form internal and external sources as well as less openness to new messages. Looking at a tree may, for example, not be as enjoyable anymore. The visual information about the tree still arrives in the brain as it always did, but the information stored in memory about the good feelings associated with a tree is tuned down. The actual tress has not changed, but it has become less relevant to the person.

Less relevance also means less focus, which could support an evolutionary explanation of depression. In times of stress, it can be helpful if one sees less relevance in the situation and withdraws. However, this may not feasible in the world we live in today. One cannot just leave one’s job form one day to the next. Rather, a common response to stress is often to work even harder, which can the lead into burnout.

Relevance is a connection one has with things, people and situations. If something is relevant to what one needs, wants, values or aspires to, one is more likely to be open to information associated with it. If one values being in a relationship, for example, one is more likely to be receptive to messages from a partner, if they are seen as relevant to the maintenance of the relationship. Although, one may not have enough information to judge what is relevant, and therefore focus on the wrong messages, or one may not understand a message. All this can be remedied with better communication patterns which lead to better information, and exposure to meaningful communication.

Changing a situation or one’s perception of it requires taking stock of one’s needs, wants, values and aspirations and then to make a change. If one is working in a job which does not seem relevant to oneself, an option, aside from quitting and finding another one, is to assess if a change in the work or one’s perspective of it is possible that could align it more closely with one’s needs and wants. This can be worked out in therapy. But whatever action one takes, just the doing it already helps against depression.

In therapy, rebuilding relevance through new communication patterns which bring a different focus and more useful information changes how the own person and the world are seen. It also puts the focus on better sources of meaningful messages. For example, if a patient gains the insight that he values staying in touch with a particular group of friends because they share his interests, he is more likely not to decline a lunch invitation by someone who is a part of that group. At lunch, this friend may tell him then what the other members of the group have been up to, which may help the patient with his own career choices as he shares their interests. Raising the level of resonance, and thereby the relevance one sees in oneself, others, activities, things and so on, is very effective in the treatment of depression and other mental health conditions because it lets through more and better information to make better decisions and raises the mood as the world as a whole seems more meaningful now.

Communication Exchange

Meaning is built within the communication processes in the therapy. The interaction between two minds can give rise to a dynamic, which carries the flow of meaningful messages and brings the process forward. Motivation for the process is usually maintained if the messages feel relevant and meaningful to the patient in the present. If emotions or thoughts about the past are brought to the centre of attention, they are important to the extent that they are still relevant in the present. This relevance depends on the emotions they can induce in the moment.

The exchange of messages can be influenced by both partners to the interaction. The depression can be felt by both, since it interferes with the construction and free flow of messages. As long as the therapist is open and receptive to the patient’s messages and tries to understand the communication dynamics and the patient sees the process as relevant, it can move forward. Since the patient and therapist have different neuronal networks and past communication (life) experiences they can induce change in each other through the communication of meaningful messages.

Experimentation

Experimenting with communication patterns is a central element of Communication-Focused Therapy®, which is shared by therapist and patient. As a therapist, one has to continually find new ways of doing things, mostly quite spontaneously in the situation. This is where creativity is an important skill of the therapist. At the same time, the patient needs to learn to also experiment with different ways of doing things, particularly in communicating and interacting with themselves and the world around them. Depression, anxiety, OCD, fears, psychosis, and many other conditions, lead to a narrowing of the breadth of communication and interaction patterns. The result is often a rigidity in these patterns also within oneself. Thoughts and feeling become more monotone and lead back to themselves in endless cycles. It seems as if there is no way out of them. A reset often can be helped by several techniques that bring the focus to new and potentially meaningful information, such as in mindfulness practices, for example, where one may focus on an object and investigate it mentally at deeper and deeper levels. One positive outcome is to prevent thoughts spirals triggered by irrelevant questions. Also, new information of any kind is like a ray of sunlight shining into the prison cell of depression. One at least has to grapple with the fact that there is a sun out there, which leads toa greater desire for change. Action for change may be much more difficult to accomplish in more severe cases of depression, but new meaningful information can contain a chance for change.

Core benefits of experimentation also include practice of great flexibility, which can break the rigidity in depression and lead to the openness, which lets through more meaningful information from more sources. This increases the perceived connectedness with oneself and the world, which is a powerful antidote against depression, fear and anxiety. Experimentation also helps to instil the connectedness with more life through constant change.

Observing

Observing is a skill that usually leads to many of the other skills. Important is the ability to observe without asking any specific questions. The communication patterns we use today have their origin in our past interaction and experiences on a bed of biology. Observing our own actions and those of others in various situations help to bring us insight into the underlying dynamics we repeat again and again in interactions with others, as well as the patterns we repeat within ourselves. Some of them work and some less so. An important and very basic question is whether they serve the aim of greater connectedness with ourselves and others, whether they help us to identify more closely our own needs, values, and aspirations, and whether they support us in achieving these basic parameters with others. Communication is how things are create, evolve, and are put into practice in the world, and the more one feels one understands and can make one’s communication patterns work for oneself and others, the less helpless, alone, and powerless one feels. Thus, working with them has a direct effect on the feelings that underlie and come with depression.

Observing one’s internal communication patterns has a similar effect on the feelings of depression from the inside.

Integration

As change in the communication pattern occurs, the information flows within the individual also change. Since the self is a reflection on these communication flows, it can bring about a change in how a person experiences the own self. In the long run, the identified meaning is integrated into the self, which, depending on the meaningful information perceived, can make the self itself more meaningful and valuable. One derives meaning from interacting with oneself and with other people, and this is also how people build their sense of self. Thus, while personality stays largely constant, the sense of self can get a boost from exposing oneself to the right communication environment.

Values, Needs and Aspirations

Depression blurs what feels important to a patient, and the fit between values, needs and aspirations and the current life situation is usually reduced. Whether in professional or personal life, getting what one needs, values and aspires to makes happiness, contentment and satisfaction more likely in the long run. If I value helping people, I know what makes me happy and gives me satisfaction. Communication, whether internal or external, is the instrument, that makes individuals aware of these basic parameters and helps them to pursue them.

The basic parameters, values, needs and aspirations, change little over time. One may alternate between being hungry and not being hungry within hours but eating as a basic need does not change and nor does someone who is happy with being a vegetarian. To some extent these basic parameters seem to be built into our biology, and it is not the therapeutic task to change them but to arrange the world around in such a way as to be able to live one’s values, needs and aspirations. Working with and improving communication with oneself and others usually accomplishes that.

Internal Communication

Exploring interests, values, needs and wants requires becoming sensitive to one’s own thoughts, emotions and physical sensation, to be open and receptive to the information coming in from one’s body and mind. It is about feeling what makes one feel good and what does not. At the same time, it has to make sense and should fit together. If specific values and needs appear to be in conflict with each other, a combination of emotions and rational thinking is often helpful. For a depressed patient, this may not be an easy task, but to bring more structure and sense into a seemingly chaotic and disconnected world, can be helpful.

Internal communication can be practiced in therapy. Since there is a correlation between the communication with others and one’s own internal communication, rehearsing and going through communication patterns in therapy, is often helpful to the patient outside of therapy, not only for the interactions with others, but also for the interaction with oneself. Values and needs can be clarified by talking to someone else and engaging in soul searching on one’s own. An important experience in therapy should be that one can clarify one’s needs and values by reflecting and communicating about them.

Meaningful Messages as the Instrument of Change

Communication in its various forms needs to be the target of therapy because it can be fined tuned and a change here can bring lasting change. The author has described this elsewhere (Haverkampf, 2017b, 2018b) Communication-Focused Therapy has been developed by the author for several psychiatric conditions. (Haverkampf, 2017g, 2017c, 2017e, 2017d, 2017h, 2017i). In depression, the desired change is for a broader emotional experience, seeing more relevance in oneself, one’s thoughts, emotions, and in the world as a whole. Adjusting, discarding and forming new communication patterns can lead to a reduction in symptoms that is more permanent than techniques the focus less on communication.

The actual instrument of change are, however, the meaningful messages which, provided they are encoded, sent and decoded, induce the change. As information in a message resonates and is processed with the already existing information, meaning is created which leads to changes in the future.

Broader Experience

If there is more meaning in oneself and the world, it is easier to focus on aspects of oneself and of the world. This expands one’s experience of oneself and of the world around. Seeing more relevance and more sources of novelty and change in the world, increases one’s experience of the world and makes this experience richer. However, it also requires that one engages with the world, which may be difficult due to anxiety cause by fears and other unresolved emotions. However, working with communication early in the therapeutic process often reduces any anxiety quickly as the patient learns to become aware of and experiment with communication and appreciates and gains insight into the predictability of communication.


Dr Jonathan Haverkampf, M.D. MLA (Harvard) LL.M. trained in medicine, psychiatry and psychotherapy and works in private practice for psychotherapy and counselling in Dublin, Ireland. He is the author of several books and over a hundred articles. Dr Haverkampf has developed Communication-Focused Therapy® and written extensively about it. He also has advanced degrees in management and law. The author can be reached by email at jonathanhaverkampf@gmail.com or on the websites www.jonathanhaverkampf.ie and www.jonathanhaverkampf.com. He is also a frequent guest on www.askdrjonathan.com.

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[1] Both terms, psychotherapy and counselling, are often used interchangeably. In academia and research ‘psychotherapy’ has been used traditionally more frequently. Many patients, however, find the term ‘counselling’ less stigmatizing and ‘pathological’. I will use the term psychotherapy as a matter of habit and convenience.

Connectedness

Connectedness-3-Christian-Jonathan-Haverkampf-life-improvement-series

Connectedness

Christian Jonathan Haverkampf, M.D.

Connecting with others and others in a meaningful way is a requirement for happiness and success in life. Many mental health issues are the result of disconnectedness. Connectedness requires engaging with oneself and the world and being open to meaningful messages from others. In this sense, connectedness serves as a foundation in the creation of meaning. Since meaning has the potential to induce change, connectedness not only helps realising one’s needs, values and aspirations but also to adapt better to the world, which increases the level of well-being and happiness.

Keywords: connectedness, communication, psychotherapy, psychiatry

Table of Contents

Introduction. 4

The Illusion. 5

Beyond the Illusion. 6

The Happiness of Connectedness. 7

Connectedness to Find What Makes Happy. 8

Disconnectedness and Fear. 9

Needs, Values and Aspirations. 10

The Call of Happiness. 11

The Ego. 12

The Fear of Disconnect. 12

Curiosity and Wonder. 13

Peace. 13

A Disconnected World. 14

Intimacy. 14

Example: The Romantic Date. 16

Avoiding Rejection. 16

Communication Structures. 17

Clarity and Openness. 18

Transition. 18

Communication about Communication. 19

Relational Uncertainty and Communication. 20

Digital Communication. 21

Communication Styles. 21

Transition and Uncertainty. 23

Not Communicating. 23

Connectedness is also a Feeling. 24

The Stability of the Self and One’s Values. 25

Alignment. 26

Knowledge and Focus. 26

Connecting Across Time. 27

Connecting the Inside and the Outside. 27

References. 29

Introduction

Connectedness with other people allows us to change our world. It broadens horizons and understanding, and generates positive feelings. Returning the smile of a stranger makes the world a better place and conveys understanding, while empathically understanding a loved one can be a special moment for oneself and the other. Connectedness is when we exchange meaningful information with another person over time. Any feelings or thoughts associated with it are the consequences of information flows.

When looking at another person we feel something special in that person and in ourselves at the same time. All this is due to our ability to translate meaning into messages, encode, transmit and decode information and translate the messages back into meaning. Resonance, how information within oneself is brought to interact with the new information, plays an important role in the awareness and identification of meaning.

Connectedness with others expands how we feel about ourselves. Exploring the other is similar to exploring ourselves. There is a feedback between the outside and inside worlds.  Connecting to another means opening up to flows of information in both directions. Feeling is an aggregate of all the information that we are exchanging with the other person. With a wink or another small gesture, a massive amount of information can be shared with another person, all at once. This may also cause fears  to surface that one is becoming more vulnerable because of the insight another person might gain, and insight into an area we may not want to make visible.

Why do we need to connect? It is not only about the connection itself, but also the feelings and the peace that can come with it. In a connected world where information can flow freely between people, negative feelings are reduced. The goal of life is greater connectdness and more fluid information flows across the world. Connectedness is thus an expression also of hour humanity and our connection with life on this planet overall. Information scuttling back and forth only stops when life stops. Conenctedness is thus life sustaining. There ia tremendous power in connectedness, which many people unfortunately cannot explore to the fullest. Fears can stand in the way of connecting with others. Maybe we have learned from our past experiences not to fully trust ourselves or others, not t fully trust either. This can make it more difficult to connect. However, once we can see how we are connected with the world and with others, the fear decreases. It may take a leap at first, but experiencing this connectedness makes it easier to be connected.

The feeling of connectedness can also have an effect on the other person, which can make any interaction with them easier. Radiating contentment and happiness tells a love interest or a business partner that we feel confident in ourselves and trust them, which makes these encounters more rewarding for everyone involved. It also helps form bonds and relationships with other people. A first important step is the openness to experience the contentment and happiness one could feel within oneself. This may sometimes not so easy, because of the things we feel we have to do to attain these feelings. But once we realize that these feelings actually serve the connection with another person, they become easier.

The better we can communicate with ourselves, the better we can communicate with other people. Openness and empathy help to understand others, but also show that one is at ease with oneself. Happiness is an important prerequisite to be able to engage in fulfilling interactions, and this requires connecting with the own happiness on the inside. With the right information we can activate centers of the brain that allow us to feel more happiness. The information from connectedness lets us do this as well.

The Illusion

Everything outside connectedness is really an illusion. When we connect with ourselves and with others, real and meaningful information can flow. This is the information that maintains life and our connectedness into life. Where no meaningful information flows, it is our mind that projects meaning into it, where there is non, however. This meaning is then coming form ourselves rather than the person or object outside. However, when we connect, and there is a meaningful exchange of information, we begin to see beyond the illusion. If we see, for example, a rock on our way and certain thoughts and feelings come up in us, that is really because we are connecting with ourselves, while having the sensory information about the rock, rather than us connecting directly with the rock.

The illusion can also apply to oneself. If we feel we may appear in a certain way to someone else or to ourselves, these thoughts really come from connecting with ourselves. The only way we can really know what someone else things about us can only come from connecting with the other person, by, for example, asking them. Thus communication helps us experience reality more deeply rather than the illusion of what may seem real. We often go through life making assumptions about other people, including whether they like us or not or if we cause another person distress, without knowing whether this is just our projection of self-criticism into the other person or if it is true. Since you cannot mind read, the best option is often to ask and talk about it. One does not even have to ask about it specifically, but can put a question or s statement out there, whose acceptance or rejection by the other shows if the feared assumption is true or not.

Experiencing connectedness itself means getting in touch with something very fundamental to life in general, which can be described as the all-persvasive devine. When we go beyond connecting with a pecific person, but feel a general connectedness with everything, feelings of separatedness, loneliness, helplessness, and anxiety usually wither away. This in turn can make it easier to connect with a specific person as the anxiety to do so decreases.The uncertainty leading to anxiety and fears is reduced when there is more and better information about oneself and the other person. Meaningful communication with oneself and others through greater connecteness provides this information and thereby reduces anxiety, fears, doubts, helplessness, and powerlessness.

Beyond the Illusion

When you feel connected with everyone and everything you have moved beyond the illusion of a concrete thought concept, and many everyday fears begin to fall away. How should I feel connected with an angry neighbor? Important is that you do not just connect with the present form and attributes of the neighbor, their personality, emotional state, and so forth, but with what underlies both of you. You are both human beings and you are both alive. From there one can then go beyond form and sense that fine existence that suffuces everything. Feeling grounded in this common existence can be helpful in regulating fears, anger, and other emotions that can stand in the way on one’s path.

What did I mean by the ‘fine existence’? It is one of the many things that religion and physics can agree on. In physics, even empty space is by no means ‘empty’. In quantum field theory, for example, a quantum vacuum is the state with the lowest possible energy and generally contains no physical particles. However, according to quantum mechanics, the vacuum state is not truly empty but instead contains fleeting electromagnetic waves and particles that pop into and out of the quantum field. So, even the seemingly informationless contains information in the form of these transient events. We are never alone, even, and maybe particularly, in the seemingly ‘empty’. Maybe it is apparent absolute emptiness that provides a clearer view on the true essence of things. In true connectedness one is plugging into this essence that underlies all, which is the ultimate reality and no illusion.

Whether you are on a date or in a high stakes situation in work, you will notice that the more you plug into the deepest layers of understanding and connectedness, communication with the other will also be much more meaningful because you are going behind external appearances and forms that would just slow you down. Communicating about them without seeing them as the ultimate goals and reasons for the interaction with the other, will free you of fears and make it less likely that you are getting side trick by the irrelevant. It also makes it easier for the other person to understand you, as you understand the other person better.

The Happiness of Connectedness

Happiness is an emotion we often feel when we are engaged in something that is meaningful and valuable to us. When we are engaged in something that is meaningful, that contains the promise of something novel that can change us, we feel happiness. Whether solving a science problem, observing another person, having sex or talking to someone else, we are engaged in processes that produce new meaning, new information, and often a sense of happiness. Communication with oneself and others, the exchange of meaningful information, is ultimately what leads to more meaning and greater happiness.

To create meaning with another person, however, also means that one has to contribute something meaningful. In a situation where people are on a date, for example, there needs to be an actual exchange of information to create more meaning, and, as a consequence, more connectedness. Happiness is often a result of this.

Connectedness can come in many shapes and forms, but it appears that the more meaning can also be generated about the relationship through meaningful communication, the more satisfying the relationship is. For example, in ‘friends with benefits’ who lack the deeper romantic relationship, one would expect that there is less satisfactions and less communication in some areas. And this was also shown in a study using an online survey (Lehmiller et al., 2014). In this study, friends with benefits, who were also found to be less sexually exclusive,

  • had a lower frequency of sexual interaction and were less sexually satisfied,
  • generally communicated less about sex than romantic partners did, and
  • communicated more often about extradyadic sexual experiences.

In other words, happiness has a lot to do with meaning, and communication is how we feel more meaning. Memories of laughter with friends can make us smile because the information has meaning to us. It resonates with other information that we have on the inside. The emotions are triggered because this memory links to our needs, values and aspirations. The brain also associates it with other information, which can trigger positive emotions.

Unfortunately, there is much unhappiness is our world because of disconnectedness, internal and external. Wars, social injustice, and many other phenomena that plague our societies have psychological roots that can be traced back to how people connect with themselves and others. Unfortunately, we do not learn in school how we better get in touch with ourselves and others. We learn to operate on information, but usually in a very narrow, external, and technical way. We spend much more time on how to do research at a library than identifying our own needs, values, and aspirations, only to haunt us after decades in personally unfulfilling work. Learning how to better communicate with oneself and others should be considered an important toolset for survival and happiness.

Connectedness to Find What Makes Happy

Connectedness with oneself and others is closely related. Through connection with ourselves and others we can gain insight into the things and activities that can increase our happiness, satisfaction and contentment. However, the connection with oneself, also on a feeling level, is fundamental to this discovery process. Without this internal connectedness, it is impossible to find insight into one’s own basic parameters of needs, values and aspirations (Haverkampf, 2017b, 2018f). Many people feel the pressure from what they think the world expects of them. Simply internalizing external expectations will not bring happiness. My thoughts and actions have to make sense in relation to how I see myself and what I value.

The right information can increase happiness. Throughout life we learn what works and what does not work. All this is valuable information. This does not mean one needs to make a lot of mistakes, but that one should be where there is high quality information. Connecting with oneself and others makes it more likely that one acquires the right information. The more information I have about options in the world and what I truly value, the easier will it be to find greater happiness in the world. Meaningful information, which can be anything from a fact to an emotional signal when engaging in a task, coupled with reflection about it leads to better decision making, greater success in all areas of life, and a greater sense of happiness, contentment and satisfaction. Connectedness is a very important aspect.

Disconnectedness and Fear

Disconnectedness causes fear, but at the same time fear can lead to a greater disconnect. People are often afraid to approach on another. This may have to do with how they see themselves. If one is self-critical or has learned not to show too much of oneself, whether emoions or otherwise, the apprehensiveness in making contact or deepening contact is often greater. Thus an internal disconnect in feeling one’s strengths and resources can then lead to an external disconnect.

Many types of fear and anxiety become less intense or vanish when we feel connected with others around us (Haverkampf, 2017b). This is something that can be observed in the fear of flying, for example. If I am talking to others on the airplane as it takes off, and even if the topic is my fear of flying, the anxiety will be lower. Even if the anxiety is a shared anxiety, it usually helps to reduce the anxiety. Sharing it is helpful, but if I also feel that the other understands what I experience, the effect on the anxiety will be even more powerful.

An important objective in therapy is to help patients in building the skills to experience better connectedness, which is one of the main components of Communication-Focused Therapy® (Haverkampf, 2010b, 2017a) Greater connectedness helps to build greater self-confidence and sense of self-efficacy and offers significant protection from anxiety, low mood, and other mental health issues. Clinically, there are also indications how patients with OCD can benefit from greater connectedness. Even psychosis can be more manageable for the patient if they experience a more solid connectedness with themselves and others. Since all the conditions mentioned come with feelings of instability and overlap with fear to some extent, greater connectedness can reduce fear also indirectly.

Needs, Values and Aspirations

One’s values and basic interests determine what is valuable to oneself. Happiness requires that one engages in an activity that is meaningful and of value to oneself. Engaging in these activities and situations brings more positive emotions, happiness, and a greater sense of fulfilment in life. Wants and Needs that create greater happiness correlate with one’s values.

The basic values (Haverkampf, 2018f), the needs, values and aspirations are an important foundation in connectedness because they determine whether the connection will be maintained and intensified. The benefit from a communication is greater when needs, values and aspirations are shared. Since information about them is exchanged in everything one does, it would be difficult to hide them. Maybe sometimes people feel misled by a connection with another person, but it is often that they are ignoring signs which are there to be detected.

At the same time, conectdness should further what one truly needs, values and aspires to. Some of those things are material to keep us alive, but many are beyond the material. Many entreprenerus who built successful businesses and large companies did so because they enjoyed working on something and the challenge as well as changing the world. Money is a poor end in itself. What drives people is to do what is meaningful and relevant to do them, and one’s true needs, values and aspirations.

On the other hand, internal connectedness is needed to better identify the own needs, values and aspirations. Memory can be an important tool. I can remember what I enjoye in the past, which helps me identify what I may also enjoy in the present and in the future. Our needs and value stay relatively constant over time, as long as they are authentic in the sense that they represent what you want and not what you think you need to fulfill another deeper need or meet a deeper value. Unfortunately, much of what people believe that they want or need is just something that appears to contain a promise of fulfilling a deeper need. You may think of someone who is pursuing ‘a career’ in order to be respected and loved. There is nothing wrong witch achievement, but many feel they need to have a career without being able to say where the journey should go and how it satisfies their authentic needs and values, the ones that align with who they are. A general problem in most modern societies is that there is little emphasis on the question of self-awareness and self-knowledge that goes beyond the impaatives of the ego.

The Call of Happiness

Almost everyone strives for happiness in life, and the pursuit of happiness is enshrined in the US constitution and many other important documents, but many people feel it is beyond their reach. Some may suffer from a mental health condition like depression, which reduces the amplitude of one’s felt emotions overall, including happiness, and may require treatment. A larger problem is possibly missing direction in life and decision-making, which often is a result of being disconnected from oneself. If one feels what is valuable and meaningful to oneself, this leads to actions and thoughts that generate greater happiness.

Disconnectedness is widespread in our society. People often try to connect with others before they connected with themselves, which makes it impossible to connect with another on a deeper level. The magic word here is resonance. When we have information about ourselves in the right form, when we have awareness and insight into ourselves, we can recognize it in other people. This also allows to see the uniqueness of the other person. Experincing the uniqueness of the other person and the common thread behind it can lead to more positive feelings and make us happier.

However, the connectedness with others is also a reflection of the connectedness we have with ourselves. Connecting with oneself means perceiving a whole universe within oneself. Unfortunately, to many people who do not fully connect with themselves see an inner desert rather than rich, open and wide spaces that contain many magnificent objects. As our external world is built on information, so is this internal world. While information is already built into our brains biologically, they are constantly suffused in oceans of information that they are exposed to from all directions. It is not just or even primarily the information from the outside world that shapes our thoughts and feelings, but how we process this information. And this is the beauty of the nervous system’s reality, that information changes information by altering how it is processed. If I am told the ending of a book, I will read it differently, have different thoughts and feelings while reading it, and even remember it differently in the future, which can have a real impact on my future thoughts and behaviors and literary buying choices. And the cycle continues.

The Ego

The ego is in much literature see as something that needs to be destroyed, or at least seriously truncated, in order to find happiness. Our ego is what clings to things and causes much suffering. At the same time, it is important to remember that people with ‘huge egos’, classic narcissits, to whom it is never enough, actually need to compensate for the perception of a weak and somewhat fragile ego. As the ego is where much of the action in the wrold, good and bad, comes from, whould we really get rid of it? One answer to this question that we cannot, because it does not really exist. It is merely a figment of our imagination, something that makes sense to us within the marvelous information processing dynamics of our brain. But to realise that it does not really exist, helps to focus on the real issue. What we perceive as ‘ego issues’ are really an experienced disconnectedness from ourselves, and as a result from the world. With greater connectedness, these pathologies of the ego disappear, because connectedness replaces them with a healthy experience of oneself.

The Fear of Disconnect

One reasons for the ego may be to prevent us from disconnecting, yet at the price of making a disconnect even more painful. The ultimate disconnect an organism faces is, of course, death, at least in most modern Western societies. It is easily forgotten that not long ago, just a mere couple of centuries, in Europe and elsewhere people saw themselves more as a part of a whole, as integrated to a larger degree into the rhythms and cycles of nature. The birth of the separate individual as autonomous actor as we know her or him today is a fairly recent invention. And it may be the greater focus on the individual and individual histories, memories, and accomplishments that provides us witha greater pressure to achieve and the sense to ‘make the most’ of one’s life, but at the same time increases the visibility and sense of being an island disconnected from others. All of these consequences of a certain brand of individuality, without the psychology and spirituality to complement it, contribute to anxiety, depression and burnout in many. As I have explored in greater depth in my book The Lonely Society (Haverkampf, 2010e), it is not the technological advances in communication or greater flexibilities in communicating which are causing the problems, but the lack of communication in society about communication. It is not taught in school, and everyone is too busy in having a socially acceptable career to pause and reflect on how to use the tremendous powers of communication to effect real change within and without.

The fear of disconnect from the world and others often drives people to withdraw even more. Why expose oneself to potential hurt? However, the real antidote is a greater connectedness with others and the world. Helpful is here often to start communicating about communicating, which is done in psychotherapy. I have developed Communication-Focused Therapy® particularly to address this, whereby greater awareness for communication patterns, reflection, experimentation, and feedback can bring about a lasting change within and without (Haverkampf, 2010b, 2017a, 2018c).

Curiosity and Wonder

Connectedness can be facilitated by the attitude one takes towards engagement with the world and other people. An attitude of curiosity and wonder, for example, affects how one selects and takes up information and processes it. At the same time, it creates also changes in the other person if one is communicating with someone else. If I talk to someone who is interested, curious and open to what I am saying, this not only changes how I perceive them, but also how I interact with them. It is therefore helpful to go mentally into oneself and light a candle of curiosity and wonder when communicating with another, be it at the workplace, on a date or in a shop.

Peace

Greater connectedness with ourselves and others brings about feelings of peace. Where there is nderstanding and insight, the disturbance of everyday life comes to rest. Anger, hate and resentment can only exist where there is a lack of understanding and insight, a lack of meaningful information. Communication is what allows us to see things with the eyes of the other and to understand what they must be feeling and thinking. However, fear is often in the way, a fear not only of the other but a fear also of themselves. Understanding another human being changes our world, even if that readjustment seems small. But it is this change which can cause enormous fears. When a new view of the world comes along, often people try to protect their own views, their own ego, because it seems to impart stability and safety. But what actually happens is a further instability and fragility by holding on rigidly instead of opening the heart and mind to more meaningful information.

Peace is not necessarily the full absence of any emotional pain and suffering one might still experience, but it means that there is at least insight into it, an awareness of them, for if we become aware of suffering it begins to self-transform and resolve itself. However, this requires connectedness with oneself, an inner meaningful communication, being open to internal information flows.

A Disconnected World

As I have outline before (Haverkampf, 2010e), we live in a world that is on one hand increasingly connected but on the other hand also increasingly disconnected. There is much on the Internet which provides us with the illusion of greater connectedness, but at the same time makes the exchange of information less meaningful. The emphasis is on meaningful information, that is information, which can bring about a change in another. Whether it is a change in perspective or a smile, meaningful communication changes how we process information in the future, it has a regulatory effect on communication among all that are directly or indirectly effected by it, which ultimately means the entire planet.

As peace is based also on understanding and meaningful communication, pockets in the world that do not communicate with each other can be at peace, but they do not contribute to the improvement and well-being of each other. Cutting off communication has been the instrument of dictators, but this is becoming less and less possible. While it is possible to cut a cable, information can travel in som many other ways. There is a point when it will ultimately seep through. The only question is then whether it will be decoded and processed adequately by the receiver or receivers. Decoding and understanding a message are skills that are to some extent innate, but mostly learned throughout life. And how do we learn them? Through practice, by exposure to meaningful information, together with curiosity, reflection, and feedback. The more meaningful communication there is around us and in us, the easier it becomes for us to work with messages from wherever they come. So, the best way to promote a connected world is to make available communication channels that stimulate the flow of meaningful information.

Intimacy

Intimacy, when it is fulfilling, is a mental and physical escalation of connectedness. While the dopamine rush of physical sex can lead to a transient high, research shows that sex just for the purpose of sex is usually less fulfilling if emotional and other forms of connectedness are missing. Practicing intimacy is the ability to make close connections with the openness to receive sensations, perceptions and other information which could be potentially hurtful. This means that one needs to overcome fear to be able to be intimate with another. The fear of being hurt is something that can arise from early experiences in life that are no longer accessible to conscious awareness. But it can also manifest at any later stage in life. Like a physical hurt, an emotional hurt occurs if something disturbs the sense of integrity, in this case the emotional one. Feeling hurt calls for repair of this loss of the sense of integrity, whether outside or inside. This does not mean reconstituting an original status quo, but to use the healing process to feel whole again. Connectedness with oneself and others is the means to get there. And, if one has confidence in one’s ability to connect, the fear of being hurt can be reduced considerably, which also increases the capability to be intimate.

Intimacy comprises the exchange of much information, tactile, visual, and otherwise, through a large number of communication channels synchronously. At the same time this information resonates with the information that already exists. A romantic date and intimacy are built on past communication experiences with the other person and on future expected ones. They have meaning and intensity because of their context within these past experiences and expectations of the future. Intimacy is exciting because of uncertainty, the mystery of how communication unfolds in the present and may be affected in the future. Emotionally powerful moments are powerful because they drive us towards change in some way, internally and externally.

That communication apart from the sexual act is the most powerful determinant of intimacy becomes clear in those cases where the communication is missing or gone horribly wrong, such as in cases of rape. One may speak here of sex, but not intimacy. It is ultimately not fulfilling and extremely destructive. The lack of meaning generated in such situation, the meaninglessness, reflects back on people will also feel internally. Communication can be highly destructive when it leaves a large hole where there should be meaning.

A fear of intimacy is quite common and basically not different from any other fear of connectedness. As will be illustrated in the example on romantic dating, the possibility that a connection can end, as in the form of rejection, for example, may lead to a fear of making the connection in the first place. The dilemma is that we want to see and feel a connection as important to us, but at the same time this raises the stakes, when the connection is lost.

Example: The Romantic Date

The author has explored the details of the communication dynamics of romantic dates elsewhere (Haverkampf, 2010c, 2010d, 2017e, 2020). What makes a romantic date so unique is that from an evolutionary perspective communication in the dating situation determines the future of the species. It is thus no wonder that it is one of the situations where we can observe communication at its most complex, even though it follows the same rules of communication and information.

The quality of communication seems to be related to attraction and the desire to see the other again. Its importance in a study by Sprecher and Duck, however, was greater for women than for men and greater for friendship attraction than for romantic attraction. (Sprecher & Duck, 1994) The connectedness itself is the important criterion whether a date will be successful. Maybe at first only some needs become clear, while values and aspirations develop over time. But they shine through the space between spoken words and within them, in gestures and all other behaviors and interactions which may constitute communication. If one makes another person laugh, it also shows an understanding of another person’s basic parameters. This can be quite general in the case of a comedian or quite specific as in two people on a date. The sense of connectedness facilitates communication, reducing the fears and increasing meaningfulness. Thus, building the feeling of connectedness can already have a significant positive influence on the dynamics of the interaction, whether a romantic date, a job interview or a presentation in an academic environment.

It may be possible to pretend, but only if there is inherently a disconnect with oneself, which in the future will make a real connection more difficult. A deep connectedness with oneself usually makes one strive for the connections that are really meaningful rather than wasting time and resources on the ones that are less so. However, it may first take some time to find out what really works for oneself. Over time it becomes clearer.

Avoiding Rejection

The emotional risks from rejection can influence how we choose our communication channels to make a connection (Haverkampf, 2010a). For example, online daters exploit certain communication features provided by dating website messaging services which allow new ways for romantic refusals to be performed that were not previously available in face-to-face communication or earlier forms of computer-mediated communication. (Tom Tong & Walther, 2011) No one likes to be rejected by another person, but there can be large individual differences in how bad it feels. Not taking it personally may be impossible, but the perspective one has and the communication patterns one uses with oneself and with others can make a large difference. Uniqueness and a perceived need for this uniqueness in another person can make rejection more hurtful. However, this is often a problem of misidentified needs. The better the basic parameters, the needs, values and aspirations are identified, the lower will be the emotional shock of rejection and the easier it will be to connect with another human being. Over time, we gain the insight that there is no rejection but only signals of imcompatibilty, and if there is no match on a deeper values in the parameters that count, the values, interests and aspirations, it is better not to invest energy in trying to make the impossible work.

You may disagree and say, we were ‘soulmates’. However, reality is that no matter what you say and do, the soulmate will remain in your life. Logic, on any level, just requires that. If there is a breakup, it means there is a misalignment in some area or areas that are important to the partners. But does that not negate the usefulness of any form of couples’ therapy? No, it doesn’t. Couple’s therapy, and psychotherapy in general, is often misunderstood as ‘changing’ someone. Instead, the real objective is to facilitate meaningful communication, outside and inside, that allows atoregulatory processes to readjust communication patterns in such ways that the partners can see, hear and understand each other again. But no therapy in the world will change who one is. It would be an apocalyptic world in which this were possible. Rather, connectedness creates confidence in oneself and others, awareness, and understanding to be able to experience that what connects a couple, and, in a broader light, underlies it all.

Communication Structures

Connecting with another human being has an emerging and changing dynamic within a structured framework (Haverkampf, 2010a, 2010c). This framework is determined by biology, psychological, social and situational factors, as well as the basic parameters (Haverkampf, 2019). Motives and expectations affect the courtship sequence as a function of a variety of individual and social variables (Cunningham & Barbee, 2008). Cunningham and Barbee describe three stages in the courtship process (Cunningham & Barbee, 2008):

  1. attract attention
  2. notice and approach
  3. talk and reevaluate
  4. touch and synchronize

It is easy to see how changes in communication patterns and variations in an individual’s effectiveness at the different stages of communication, from encoding a message to decoding it, can affect the progress along the phases of the courtship process. Since any communication process and structure serves the overall purpose of building and sharing meaning (Haverkampf, 2010a, 2018g), the romantic partner’s ability to communicate and create meaning keeps the romance alive and moves it forward. The dynamics of changing communication patterns and the overall communication structure are the manifestations of changing relationships (Haverkampf, 2017d). To be aware of them and to work with them is key in establishing the level of connectedness one desires.

Clarity and Openness

The sheer quantity of dating advice, seminars and conferences out there, from little tips and tricks to reprogramming one’s personality, is mind boggling. It seems much of their appeal is to be able to communicate what one wants without saying it. Research, however, shows that the best strategy is actually saying it. Whether something is communicated or not determines what happens next, and connectedness with another person, which is the precondition for any form of relationship, requires communicating something about one’s needs, values and aspirations (Haverkampf, 2018b). There is some support that directness in communicating has a negative association with relationship uncertainty and with partner uncertainty that is mediated by relationship uncertainty (Theiss & Solomon, 2006). The communication dilemma (Haverkampf, 2018a) is that communication becomes easier if there is more certainty, but to reach more certainty one needs communication to provide the information.

Clarity and openness help to reduce uncertainty as more meaningful information is available. Relational uncertainty and intimacy are related. Relational uncertainty tends tobe high in non‐ intimate associations and substantially lower in highly intimate associations. (Solomon, 2015)Clarity and openness are thus important steps in intimacy.

Transition

As connectedness increases, a relationship usually goes through transitions. Changes in communication patterns and in the framework of the communication structure signify these transitions. In the case of a developing romantic relationship, Mongeau and colleagues describe three changes that occur (Mongeau et al., 2006):

  1. two people meet and talk for the first time,
  2. they communicate regularly and get to know and like each other,
  3. the discovery and consummation of mutual romantic interest; the romantic relationship transition between a man and a woman, when the relationship changes from being either platonic or nonexistent to being romantic

What these three changes have in common is that they describe changes in communication. But it goes even further, as relationship transitions are changes in both internal and external communication patterns (Haverkampf, 2010a, 2010c, 2018b). As relationships are kept alive and progress through communication transitions, they require an openness for external and internal changes. Communication-Focused Therapy (CFT), as developed by the author, works on both the internal and external communication patterns, which to a large extent reflect each other (Haverkampf, 2017a).

Communication about Communication

Communicating about how we communicate, internally and externally, is a powerful tool in changing communication (Haverkampf, 2010b, 2017a, 2018e). Since relationships and our experiences in them are determined by the communication dynamics in them, experience and communication are linked. Marston and colleagues found empirical evidence for the a strong coherence in lovers’ experience of love and in their reports of how love is communicated (Hovick et al., 2003; Marston et al., 1987). The link between our experience and the communication patterns we use is not only valuable from a therapeutic perspective, but it also provides an insight for the considerable stability of communication patterns and relationships patterns over time (Haverkampf, 2018e).

A deeper connectedness means that there are also deeper interactions with the ability to communicate about communicating.  The ability to change communication patterns by calling them into awareness and reflecting about them together, not only solidifies a relationship but also enables it to regulate itself better. When two partners in a relationship can talk about how they communicate, they are far less likely to get lost in details or in destructive exchanges. Awareness of the communication patterns also lets both of them look behind the veil of the seemingly important. If they watch their communication, they may, for example, see that behind the anger, that seems to drive then apart, is  really a helplessness, which drives them closer together.

Relational Uncertainty and Communication

The level of connectedness is determined by and determines the communication patterns we use, but it also influences the content of the communication. As we have seen above, the more meaning that can be communicated, the stronger the connectedness will be. Meaning and connectedness go hand in hand, which is one reason why helping a person communicate better also creates more meaning in the life of that person (Haverkampf, 2010a, 2017a, 2018b). However, it is also possible that the individual meaning a person sees in life effects the openness and communication about meaning. At the same time, openness may be lower the less one knows about the other person and the nature of the relationship. In a study by McCurry and colleagues, results indicated that relational uncertainty was inversely associated with the frequency and comfort with which dating partners discussed religious and spiritual topics (McCurry et al., 2012). There is thus a vicious cycle between the fear of greater openness and less communication about meaning which could reduce the fear.

Uncertainty in the context of interpersonal interactions generally refers to an inability to predict and explain a communication partner’s behavior (Berger, 1997). Relational uncertainty is the degree of confidence people have in their perceptions of involvement in a relationship (Knobloch & Solomon, 1999). According to Knobloch and Solomon, relational uncertainty stems from three sources: doubts individuals have about their own involvement in the relationship (self uncertainty); questions about a partner’s participation in the relationship (partner uncertainty); and ambiguity about the status or future of the relationship itself (relationship uncertainty). Relational certainty exists when people clearly understand their own commitment to the relationship, when they are confident in their perceptions of a partner’s involvement (or lack thereof), and when they have few doubts about the enduring or fleeting nature of the association; relational uncertainty occurs when individuals are unclear about these aspects of the relationship. Indivdiuals experiencing relational uncertainty are more likely to describe their relationship as unsteady or unstable (Knobloch, 2007).

Meaningful communication by its definition can reduce uncertainty, if it is related to the locus of uncertainty. In every scenarios, whether on a date or at the workplace, it is not so much the quantity of communication but the quality that counts. There is too much ‘empty’ talk out there, which does not help the people involved in any of the situations mentioned. The reason is often that one ‘performs’ instead of being oneself, centered in oneself and mindful to the other person and the situation. Feeling like a guest in someone else’s reality does not help to communicate more authentically and meaningfully. On the other hand, if one watches with interest, communicates to build meaning, and is aware of one’s true needs, values and aspirations, something real can evolve, which maintains and kindles more meaningful communication.

Digital Communication

Online spaces are used infrequently for meeting romantic partners, but play a significant role in how teens flirt, woo and communicate with potential and current flames. (Lenhart et al., 2015) Digital communication offers fewer communication channels and a more controlled space than would be available when meeting another person in real life. It can make it easier for an individual to overcome the fears of direct communication and being overwhelmed by information. Many relationships have been made possible because they started with a small set of only a single communication channel. In times past, this may have been an exchange of letters. In today’s world, it may be a chat on a dating app.

Digital communication has the advantage that it allows the observation of how people connect and what their topics are when they do if they consent to it. A study by Dong and colleagues based on a survey of 240 individual MySpace users found that (Dong et al., 2008)

  • low self-esteem encourages young adults to engage in romantic communication (such as having intimate communication with the opposite sex and looking for romantic partners)
  • higher emotional intelligence discourages such activity
  • those who have a higher self-image, such as thinking themselves attractive and happy with their appearance, tend to engage in romantic communication.

Communication thus seems to fulfil an essential role in emotional regulation. It also appears that merely engaging in it can already have a positive effect. In many forms of digital communication, the other person is not physically present, but an image and a felt emotional connection with that person

Communication Styles

An overview of communication structure and patterns has been provided by the author in greater depth elsewhere (Haverkampf, 2019). All communication follows particular rules, which also gives rise to the evolution of distinct patterns and structures. Working with them is an essential pillar in Communication-Focused Therapy (CFT) (Haverkampf, 2010b, 2017a), and understanding them can be helpful in all situations in daily life, which required internal and external communication.

It is crucial to keep in mind that communication patterns depend on the kind of relationship one has with another person (Haverkampf, 2010a). Both cross‐sex platonic and romantically involved partners use flirtation to varying degrees. However, how flirtatiousness is actually displayed and how it relates to evaluations of appropriateness and communication competence differs between the two types of relationships. (Egland et al., 1996)

From a much more macroscopic perspective in the area of romantic dating, there is empirical support for five styles of communicating romantic interest in others (Hall et al., 2010): physical, sincere, playful, polite, and traditional. Following the argument above that open and full communication can help strengthen the connectedness, one would expect communication styles that help to share relationship affirming messages facilitate escalating a relationship faster. In a study by Hall and colleagues, dating success correlated with physical, sincere, and playful styles. The physical and sincere styles correlated with rapid relational escalation of important relationships with more emotional connection and greater physical chemistry. (Hall et al., 2010) In other word, it appears that

  • the physical style and
  • the sincere style

correlate with both dating success and the development of greater emotional connection and physical chemistry. These also appear to be the styles of communication which are less influenced by social convention (as in the polite and traditional style) or conscious communication techniques in response to what the other may be expecting (as in the playful styles). This would support the general communication hypothesis that people are at their most effective when they directly communicate the basic parameters, their needs, values, and aspirations (Haverkampf, 2018f, 2018b).

One has to marvel at the wide range of communication styles that are used in connecting with others. But this may not be as surprising when one considers that the use of particular communication patterns and styles also carries meaning (Haverkampf, 2018d, 2018g). This applies to all areas of human communication. Egland and colleagues identified four types of flirtation behaviour in their study through factor analysis (Egland et al., 1996), namely display, stereotyped, attentiveness, and conversational behaviours.

Transition and Uncertainty

The transition from casual to serious involvement in dating relationships largely corresponds with changes in internal and external communication patterns and changes in the overall communication structure (Haverkampf, 2010c). These changes often happen without conscious awareness of them. The partners do not even have to know that they are transitioning, but the communication patterns always change.

The relational turbulence model is an example of a framework that explains the increased conflict, negative emotions, and heightened relationship thinking in transition times. Relational uncertainty and interference from a partner are heightened when intimacy transitions from casual and independent relating to serious and mutually committed involvement. Empirical findings show that doubts about the relationship are salient even within very casual associations and resolving relational uncertainty may be an important part of forming an intimate bond. (Solomon, 2015) An existential uncertainty is present from the beginning of any relationship, and navigating through it with the use of communication can lead it through the transitions that ultimately result in a fulfilling committed partnership (Haverkampf, 2010a, 2017e, 2017d, 2017c).

Relational uncertainty and interference from a partner have been linked to more pronounced experiences of negative emotions, such as hurt, jealousy, anger, and sadness, both in response to a partner’s behavior and in general. (Solomon, 2015) They can impair communication and lead to cognitive biases. Relational turbulence theory links cognitive appraisals and emotions to communication. It describes how episodes characterized by biased appraisals, intense emotions, and volatile communication coalesce into global evaluations of relationships as turbulent (Solomon et al., 2016). McLaren and colleagues proposed that relational communication (specifically, perceptions of dominance, and disaffiliation) is the mechanism linking relational qualities to hurt. Empirical data shows that people’s experiences of hurt vary as a function of both relationship characteristics and relational inferences, although there are differences between the sexes. (McLaren et al., 2012)

Not Communicating

While it may be impossible overall not to communicate, it is possible not to exchange specific information. Since meaningful information can trigger other meaningful information, for better or for worse, the fear of talking about a controversial subject is often greater when there is less certainty about the other person. In the beginning of any relationship, from business to romantic, there is usually a lack of knowledge about the other person, which impacts communication patterns and content (Haverkampf, 2010a, 2018d). It has been shown that the higher (or lower) is the relational uncertainty the higher (or lower) is topic avoidance in romantic relationships (Knobloch & Carpenter-Theune, 2004). Knobloch and colleague also showed that relational uncertainty mediates the (convex) association between intimacy and topic avoidance.

One may wonder how deeper relationships get started at all. One reason why they can evolve is simply because they develop gradually and in stages. Even if the partners seem to skip a stage because it may be short or not as visible, usually they go through all of them. But all this can end when communication stops. How can people then still feel connected when they no longer communicate?

Connectedness is also a Feeling

People who do not communicate can still feel connected. One needs to keep in mind that the feeling of connectedness can be triggered by any information, which can also be the memory of a past event or the image of a future one. There does not have to be a constant stream of external information to feel connected. Information on the inside is fully sufficient. Another feature of the feeling of connectedness is that it can contain a wish, and quite often does so. It has a gravitational pull that aims at bringing the two individuals closer together. In an autoregultory feedback loop, connectedness breads greater connectedness.

The feeling of connectedness thus not depend on the actual physical presence of another being. Once could sit in a hut in the forest and still feel connected with people one know or imagines and with nature overall. One could even be drifting in a capsule in outer space and feel connected with people, animals, plants, or even the universe as a whole. The feeling is caused by flows of internal information, that may be influenced by external information. But the latter does not seem to be a requirement for it.

The Stability of the Self and One’s Values

Our values are mostly stable over time and allow us to pursue goals in life. Having insight into one’s true needs, values and aspirations can help to find greater stability in the world and to pursue and reach what is important to us. Sometimes they may appear to be in conflict, but the more basic needs and values can be explored by paying closer attention to the communication patterns used when engaging in activities and behaviors. When someone does something which brings about feelings of fulfillment or happiness it happens within flows of information that are sustainable (Haverkampf, 2012, 2018b, 2018a). Let us look at an example where this is not the case:

Peter talks to Jane. He tells her that he really believes in the common business venture of starting a steak restaurant. The more he talks about what this may grow into the future and how he feels this will be important to him also in the future, the more strenuous it becomes. The following days he reluctantly answers Jane’s calls. When he opens a new account for the business at the bank, he feels anxious.

Peter may not even know himself that he would rather start a vegetarian restaurant. However, once he observes his communication patterns with himself and others, it very likely would become clear to him that something is out of sync. In the moment, when he talks to Jane, it may not become clear to him, because he thinks about a specific content rather than how the content is being communicated. However, by observing how he communicates a specific content he can gain clarity and insight into the basic parameters of needs, values and aspirations (Haverkampf, 2018b, 2018f).

The meaning we see and share in the world depends on the exchange of information, both with ourselves and with the environment. One can be happy in solitude, but this happiness depends on how one communicates with oneself and interacts with the living world around. Most people need companionship on a regular basis, because they need more varied communication and a at least a certain minimum level of interactions with others to create and maintain meaning. Connectedness can thus take many forms, and it is important to find the right communication and interaction styles and intensities which lead to a high level of satisfaction, contentment and happiness.

Because connectedness offers more insight into the own needs, values and aspirations, it also helps to stabilize the own perception of them and the perception of those in others, which can contribute to a greater sense of stability within oneself and with the world. Thus, all opportunities to connect more deeply with another human being can further the sense of stability in the world. When the ability to connect with others in a meaningful way is impaired, the world is often a more frightening place. ‘Meaningfulness’ is an important criterion. For example, an inability to be intimate on a deeper level often causes those affected by it to try to compensate with more sex with more partners. However, sex without a deeper connection is usually not fulfilling and leads to a hunger which is not stilled no matter how often one tries.

Alignment

Connections need to align with the basic parameters, the needs values and aspirations. Otherwise the connection is not sustainable over the long-term. This does not mean that people in a relationship have to have the same basic parameters, but it requires that the connection aligns with them. As we have connections with many different people in different types of relationships, each connection has to have mutual benefits on a deeper level to be sustainable. ‘Deeper’ simply means that is not solely transaction based, such as the temporary connection between a customer and a shop assistant; the relationship has to have potential benefit over time to be sustainable, which goes beyond the benefit of a momentary transaction.

Communication that serves to test and experiment with the potential alignment between partners can be likened to a trial dance to see if sharing a rhythm is possible. This may also explain why the the choice of communicatioon patterns and styles in a dating situation may be more important than the actual content that is being talked about. The alignment manifests itself when new meaning is created.

Knowledge and Focus

A connection flourishes if there is some knowledge in each partner of the own needs and values to at least know what does not work for them. While explicit knowledge grows through awareness, an implicit knowledge which comes from experience is enough. There is thus a positive cycle between communication which delivers greater insight into needs, values and aspirations, and the latter, which help maintain and deepen the connection. Having a greater understanding of the own basic parameters and the communication patterns one uses with oneself and others is the key towards a better connectedness with oneself and with others (Haverkampf, 2010a). Communication-Focused Therapy (CFT), as developed by the author offers several approaches (Haverkampf, 2010b, 2017a) Finding meaning in things leads to greater happiness, and the basic parameters are ways to find and communicate what is meaningful. This requires doing what feels important, which can be a radically new way of doing things.

Connecting Across Time

Can we connect with someone we never met because they lived hundreds of years ago or with someone who is not present anymore? If that person leaves information, which we all do, we can connect. As mentioned, connectedness is a feeling that facilitates and s the result of the exchange of meaningful information. And wherever there is meaningful information, we can transform it in us and create new information from it. We do it all the time with a person who is in front of us. We cannot get immediate feedback to something we say from a person that is not present, but our mind can take the available information and create something new.

Connecting the Inside and the Outside

Sustainable happiness is when we are connected to the inside and outside worlds, when we can communicate freely within both. When an organization strives to be optimally adapted to itself and the environment, when it allows itself to be changed by it and to change it in beneficial ways, it can induce positive feelings and productivity. Fears, however, can be a significant hindrance.

Happiness does not require great activity. Even sitting in one’s chair at home can bring about happiness, when the feeling of connectedness with oneself and the world around is present. Happiness and the flow of meaningful information are linked. Happiness as an emotion is an indicator of how we process information, of how we think. Taking a step back and ‘observing’ how one process information on the inside (thinks and feels) and how one processes information on the outside (interacts with others) leads to greater connectedness and usually also higher satisfaction in life. Connectedness helps to optimize how we arrange our surroundings and ourselves in these surroundings.


Dr Jonathan Haverkampf, M.D. (Vienna) MLA (Harvard) LL.M. psychoanalytic psychotherapy (Zurich) trained in medicine, psychiatry and psychotherapy and works in private practice for psychotherapy and counselling in Dublin, Ireland. He is the author of several books and over a hundred articles. Dr Haverkampf has developed Communication-Focused Therapy® and written extensively about it. He also has advanced degrees in management and law. The author can be reached on the websites www.jonathanhaverkampf.ie and www.jonathanhaverkampf.com. He is also a guest at http://www.askdrjonathan.com.

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