It's Not Always Depression

Working the Change Triangle to Listen to the Body, Discover Core Emotions, and Connect to Your Authentic Self

About the Book

Fascinating patient stories and dynamic exercises help you connect to healing emotions, ease anxiety and depression, and discover your authentic self.
Sara suffered a debilitating fear of asserting herself. Spencer experienced crippling social anxiety. Bonnie was shut down, disconnected from her feelings. These patients all came to psychotherapist Hilary Jacobs Hendel seeking treatment for depression, but in fact none of them were chemically depressed. Rather, Jacobs Hendel found that they’d all experienced traumas in their youth that caused them to put up emotional defenses that masqueraded as symptoms of depression. Jacobs Hendel led these patients and others toward lives newly capable of joy and fulfillment through an empathic and effective therapeutic approach that draws on the latest science about the healing power of our emotions.
Whereas conventional therapy encourages patients to talk through past events that may trigger anxiety and depression, accelerated experiential dynamic psychotherapy (AEDP), the method practiced by Jacobs Hendel and pioneered by Diana Fosha, PhD, teaches us to identify the defenses and inhibitory emotions (shame, guilt, and anxiety) that block core emotions (anger, sadness, fear, disgust, joy, excitement, and sexual excitement). Fully experiencing core emotions allows us to enter an openhearted state where we are calm, curious, connected, compassionate, confident, courageous, and clear.
In It’s Not Always Depression, Jacobs Hendel shares a unique and pragmatic tool called the Change Triangle—a guide to carry you from a place of disconnection back to your true self. In these pages, she teaches lay readers and helping professionals alike
• why all emotions—even the most painful—have value.
• how to identify emotions and the defenses we put up against them.
• how to get to the root of anxiety—the most common mental illness of our time.
• how to have compassion for the child you were and the adult you are.
Jacobs Hendel provides navigational tools, body and thought exercises, candid personal anecdotes, and profound insights gleaned from her patients’ remarkable breakthroughs. She shows us how to work the Change Triangle in our everyday lives and chart a deeply personal, powerful, and hopeful course to psychological well-being and emotional engagement.
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It's Not Always Depression


Getting to Know the Change Triangle

What This Book Will Do for You

i first encountered the Change Triangle in 2004 at an academic conference on the science of emotions and attachment in New York City. There I was staring at a giant upside-down triangle projected on the auditorium screen. It was a representation of how emotions work and can lead, if mismanaged, to psychological symptoms like depression. Defenses, anxiety, and these very important things called core emotions were mapped out in such a way that something suddenly clicked. The elements of psychological experience, which had seemed random and chaotic, fell into place, like the final turn of a Rubik’s Cube. I felt understood. I felt relief. I was excited. With all of my science and psychological education—Bronx High School of Science, a biochemistry degree from Wesleyan University, a doctor of dental surgery (DDS) from Columbia University, a master’s degree in social work, and since then a certification in psychoanalysis—why had I not seen this simple map before? I had the thought then, This should be basic education. Every one of us can benefit from understanding how our emotions work and how to work with them to feel better.

When I saw videotapes of emotion-informed psychotherapy, I saw radical transformations that occurred in one session. For these patients, work that would have taken a traditional psychotherapist years to accomplish was achieved in an hour. I couldn’t help wondering if it was too good to be true. Was this a method with scientific basis that could be taught and duplicated? My last decade of practice has proved that the answer is yes.

Having meticulously studied the last hundred years of psychological thought and the science and anatomy of the brain, and having practiced psychotherapy for more than a decade, I believe that the Change Triangle can help anyone, not just those in psychotherapy. My mission is to translate the theory behind the Change Triangle into a tool that everyone has access to, not just people training to practice psychotherapy. I’ve adapted the clinical literature and science to make the Change Triangle easy to understand and nimble enough to be used anytime, anywhere. I will explain how to use this important tool to help you feel better.

Life is tough. We all suffer. Modern humans experience more stress, burden, emptiness, anxiety, self-judgment, and depression than ever. Most of us don’t know how to deal with emotions effectively. Instead we work hard to manage them through avoidance. That coping strategy is the very thing that leads to symptoms of mental distress such as depression and anxiety. Avoiding emotions just does not work in the long run. The Change Triangle is a map to moving past our distress so we can spend more of our time in calmer, more vital states of being. The Change Triangle is grounded in the latest scientific research on emotions and the brain. Despite its complicated scientific roots, it feels intuitively right and is a resource for managing emotions that none of us should be without.

Emotions are powerful forces that in an instant overtake us and make us feel things, do things, and react in ways that are often hurtful. In response, we use other parts of our mind to bury emotions, believing that won’t affect us. But emotions are biological forces that move in accordance with physics. They cannot be ignored without consequences—hence the rising rates of anxiety and depression in the world. Our cultural and educational systems fail to equip us with the education, resources, and skills to understand and work with emotions, and our society lacks a basic understanding of how they function biologically. What our culture does teach us, quite well, is how to dismiss and avoid emotions. The Change Triangle is a challenge to this cultural norm.

Avoiding emotions has a multitude of costs. Emotions tell us what we want and need and what is bad for us. When we don’t use our emotions it’s like navigating a boat across tumultuous ocean waters without sonar or even a compass. Emotions also connect us to our authentic Self and allow us to feel intimately connected to other people. When we are out of touch with emotions, we suffer loneliness, because the connections to both ourselves and the people we care about are enriched through empathy, the emotional connector. A deeper connection to our most authentic Self comes through experiencing the seven universal, inborn, prewired core emotions: sadness, joy, anger, fear, disgust, excitement, and sexual excitement. These core emotions help us to navigate life effectively, starting the day we are born and continuing until the day we die.

Emotions are survival programs deeply embedded in the brain and not subject to conscious control. In the face of a physical threat, fear is triggered. Let’s say a wild dog was chasing you; fear makes you instantly move. Anger protects us by compelling us to fight in self-defense. Sadness is the core emotion we feel when we suffer losses, like losing one’s hair, losing a cherished possession, and losing loved ones. When we succeed and connect with others in enriching ways, emotions such as joy and excitement propel us to engage further, so humans grow, expand, and evolve. Emotions are immediate responses to the present environment. Emotions stand in stark contrast to intellect. Our thinking brain allows us time to consider how we want to respond. Our emotional brain just responds.

Despite the fact that we truly need emotions to live effectively, they also cause us problems. What a fundamental conflict! From a biological perspective, we need emotions, but they also hurt us. The human mind has evolved in such a way that we have an incredible ability to ignore emotions to push through life. In fact, this ability helps us get things done. We need to work, feed our families, secure shelter, and take care of other basic needs. We use defenses so that we can carry on. But researchers now know that blocking emotions is detrimental to mental and physical health. Blocked emotions lead to depression, anxiety, and a wide variety of other psychological symptoms caused by chronic stress. Additionally, chronic emotional stress causes changes to our physical health by increasing the amount of stress hormones, called corticosteroids, coursing through our body. Emotional stress has been linked to heart disease, stomach pain, headaches, insomnia, autoimmune disorders, and more.

Furthermore, the challenges of modern life—such as the pressure to succeed, the pressure to fit in, the desire to “keep up,” the “fear of missing out” (FOMO), and the desire for good relationships and work satisfaction—evoke combinations of emotions that are often in conflict with one another. For example, Frank could not afford the kind of car he really wanted. Something as simple as Frank’s thwarted car desire could cause a mixture of sadness, anger, humiliation, and anxiety. Needless to say, all those feelings together are hard to manage or bear without defenses. Life’s challenges and conflicts create complex emotional cocktails.

Based on our genetics, natural disposition, and childhood experiences, we each navigate emotions differently. The type and amount of adversity we faced in youth directly affects how we feel today even if we cannot consciously perceive the connection. Furthermore, how our parents and caregivers responded to our individual emotions directly affects how we feel about and deal with our own emotions and the emotions of others in the present, now.

Some of us disconnect from our emotions to cope with the challenges we face. That has ramifications. We turn off. We shut down. We become numb. Eventually, we live in our heads with only our thoughts and intellect to guide us. We have lost our emotional compass. Alternatively, some of us cannot disconnect and instead become easily overwhelmed by emotions. That has ramifications as well. People who become easily overwhelmed expend a tremendous amount of energy managing their feelings, and that is exhausting. You might recognize yourself as someone who is quick to anger or who cries at the drop of a hat. Or maybe you recognize that you often feel scared even though intellectually you know there’s actually nothing to fear. Some of us are easily hurt or insulted by others, taking even the smallest misunderstandings so personally that being around people becomes strenuous. When our emotions are so intense and easily set off, we sometimes react in ways we later regret, making our lives even harder.

Ideally, we create a balance between our emotions and thoughts. We need to feel our feelings, but not so much that they overtake us, impair our functioning and ability to be productive. We need to think, but not so much that we ignore our deep and rich emotional lives, sacrificing vitality.

The Change Triangle is a map to move us out of our defenses and put us back in touch with our core emotions. When we contact our core emotions, feel them, and come out the other side, we experience relief. Our anxiety and depression diminish. When we are in touch with core emotions, our vitality, confidence, and peace of mind increase. Biologically, our nervous system resets for the better.

Working the Change Triangle makes the brain more flexible so we have much more control and power over how we feel, think, and behave. When people learn about the Change Triangle and understand how emotions work, they are transformed.

Although I first learned about the Change Triangle at a conference for professionals, it is a map that all of us can easily learn and begin to apply immediately. By the end of this book you will understand yourself, your loved ones, friends, and co-workers in a new way and be able to put that understanding to use. Because all of us are the same when it comes to how emotions work, the Change Triangle makes sense for everyone. You will be more informed about how to improve your relationships with both yourself and others. You will feel better and your life will be easier.

The Story of Me

i was born into a family of Freudians and a culture where mind over matter was the mantra. My mother had been a guidance counselor and my father was a psychiatrist. They believed that I could and should control my feelings with intellectual insight. Emotions were rarely discussed at home and, if they were, it was the goal to master them or “fix” them.

My clear memories begin around the fourth grade, when I started to feel self-conscious. My mother always told me I was beautiful and smart, but I didn’t feel it. I felt stupid and ugly. When I looked in the mirror I felt that I came up short. I wasn’t bullied and was friendly with the cool kids, but I always felt separate and insecure. As an adult, I realized that what I was feeling was anxiety and shame.

In middle school, I excelled academically. With each good grade and honor society mention my confidence grew. I developed the belief that if I worked hard, I would succeed and be recognized. With each success and recognition, I felt relief from insecurity.

Around that time, my seventh-grade English teacher had us read Freud and I became obsessed with psychoanalysis. In retrospect, it must have helped me understand myself in a way that made me feel in control. My passion for psychoanalysis continued to grow through high school to the point that my friends begged me to stop analyzing everyone. So I curbed my hobby of providing free—albeit unwanted—psychoanalysis and, instead, read voraciously on the topic.

By that time, I had decided I wanted to be a doctor like my father. I loved and was good at science, and I received a tremendous amount of positive attention for that decision. Up until my junior year in college, I never questioned my path, but I had never really considered what the day-to-day life of a doctor looked like.

In college I signed up for a course called Contemporary Psychoanalysis. Much to my chagrin, I realized that in fact it was an anti-Freudian course in feminism. For the first half of the semester, I sat righteously in the small seminar, me against ten radical feminists. Confident in my position, I argued fervently about why Freud was brilliant and his theories valid. After about five classes, I realized that my arguments were falling on deaf ears. In fact, my classmates had brought up some solid counterarguments and research that I found incredibly persuasive. The thought occurred to me that maybe I could learn something if I wasn’t so busy arguing.

By the end of the course, I had started to question everything, including the values and beliefs of my parents, my society, and my culture. I started to consider why I had decided to be a doctor. As embarrassing as it was for me to admit at the time, I realized that my fantasy of being a doctor had everything to do with achieving a certain lifestyle and nothing to do with wanting to treat physical illness. When I imagined myself dealing with very sick people and having to deliver a dire diagnosis to their loved ones, I found the prospect too difficult—too anxiety provoking. I bristled at the responsibility. I didn’t want to deal with such heavy issues of loss and death—topics we had always avoided in my family—on a daily basis.

I was too scared to abandon the medical track and I needed an immediate plan or I would be lost, out of control. Starting from childhood and up until this point I had been driven by the desire to minimize my anxiety. I was making decisions, big and small, with the goal of having a long-term plan for my life to ensure I would be happy. I had many fears festering under the surface that I believed I could avoid if I just stayed on course to achieving a good career and finding a good husband. So . . . I decided to become a dentist.

In dental school, I met my first husband and I thought everything was working out perfectly. I had an amazing partner, I was ready to start a family, and my lucrative career was on track. Then step-by-step everything fell apart. I became a dentist but hated it and left the field a year after graduation. My decision to leave dentistry upset my husband, my in-laws, and my father terribly—I lost their approval and esteem. After six years of marriage, my husband and I were unable to manage the conflicts that had arisen between us. I was lost, alone, and afraid. Couples therapy didn’t help. We had no way to solve our problems; our marriage ended.

I was single again, with two little children and no career. Everything I thought I knew and was confident about proved wrong for me. I loved my daughters, but I felt lost and without a compass. For the first time in my life I was off track and without a plan.

About the Author

Hilary Jacobs Hendel
Hilary Jacobs Hendel, LCSW, received her BA in biochemistry from Wesleyan University and an MSW from Fordham University. She is a certified psychoanalyst and AEDP psychotherapist and supervisor. She has published articles in The New York Times and professional journals. Jacobs Hendel also consulted on the psychological development of characters on AMC’s Mad Men. She lives in New York City. More by Hilary Jacobs Hendel
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About the Author

Diana Fosha
Hilary Jacobs Hendel, LCSW, received her BA in biochemistry from Wesleyan University and an MSW from Fordham University. She is a certified psychoanalyst and AEDP psychotherapist and supervisor. She has published articles in The New York Times and professional journals. Jacobs Hendel also consulted on the psychological development of characters on AMC’s Mad Men. She lives in New York City. More by Diana Fosha
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