Depression and Reasoned Choice

[DISCLAIMER]

As Rational Emotive Behavior Therapy (REBT) is informed by Stoic philosophy, this blog entry is part of an ongoing series regarding a book entitled The Daily Stoic: 366 Meditations on Wisdom, Perseverance, and the Art of Living by Ryan Holiday and Stephen Hanselman.

The authors quote ancient Stoic philosopher Epictetus who stated, “Where is Good? In our reasoned choices. Where is Evil? In our reasoned choices. Where is that which is neither Good nor Evil? In the things outside of our own reasoned choice” (page 148).

When providing psychoeducational lessons on REBT, I invite people to consider thinking and beliefs which are rational (in accordance with both logic and reason). Perhaps some clarification of terms is in order so that I may expand upon my interpretation of Epictetus’s perspective.

First, it may be worthwhile to distinguish between thoughts and beliefs. A thought is an individual act or product of thinking. A belief is a state or habit of mind in which trust or confidence is placed in a person or thing.

Whereas a thought is merely a fleeting idea, a belief is a thought that one strongly holds as true and that influences one’s perspective and behavior. Essentially, a belief is a thought that has been affirmed and integrated into one’s cognitive framework. It’s considered true, though not perfect.

Second, I draw a distinction between description and prescription. A description is simply a thought or discourse intended to give a mental image of something experienced. On the other hand, a prescription is the thought or action of laying down authoritative rules or directions.

Last, logic is the interrelation or sequence of facts or events when seen as inevitable or predictable, and reason is a statement offered in explanation or justification. For instance, a modus ponens syllogism uses the following logical form: If p, then q; p; therefore, q.

Before I provide a syllogistic example, further context is needed. First, the American Psychological Association (APA) defines depression as:

[A] negative affective state, ranging from unhappiness and discontent to an extreme feeling of sadness, pessimism, and despondency, that interferes with daily life. Various physical, cognitive, and social changes also tend to co-occur, including altered eating or sleeping habits, lack of energy or motivation, difficulty concentrating or making decisions, and withdrawal from social activities. It is symptomatic of a number of mental health disorders.

Here, additional definitions are warranted. The APA referenced an “extreme feeling of sadness.” When providing psychoeducational lessons on my approach to REBT, I find it useful to describe what feelings are and what they are not.

A feeling relates to either: 1. Emotion (i.e., joy, fear, anger, sorrow, disgust, surprise, etc.) or 2. Sensation (e.g., tightened or stiffened jaw). If the word “feel” (or any derivative thereof) can be replaced with “hunch,” “thought,” or “belief” (or any derivative thereof), it’s not a feeling.

Thus, it’s improper to say something along the lines of “I feel like you did that to get back at me,” because what one typically intends on communicating is “I believe that you did that to get back at me.” Noteworthy, there’s a foundation for quibbling with this sort of misuse.

In REBT, unfavorable beliefs which cause unpleasant consequences are rigorously challenged. However, feelings (i.e., emotions and sensations) aren’t confronted. Thus, proper use of feelings-based language affords a person the opportunity to examine the logic and reason one uses.

Noteworthy, depression is a different matter than mere sadness—which the APA defines as “an emotional state of unhappiness, ranging in intensity from mild to extreme and usually aroused by the loss of something that is highly valued (e.g., by the rupture of a relationship).”

Whereas sadness is a naturally-occurring emotion (e.g., sorrow regarding the death of a loved one), REBT theory maintains that people can unnaturally self-disturb into a depressive state (e.g., believing that something is useless, awful, it can’t be tolerated, and that it shouldn’t exist).

Regarding the latter condition, there’s a distinction between situational and clinical depression. Specifically, the APA defines the condition of major depressive disorder (MDD) thusly:

[A] mood disorder characterized by persistent sadness and other symptoms of a major depressive episode but without accompanying episodes of mania or hypomania or mixed episodes of depressive and manic or hypomanic symptoms.

Per one source, “triggers for situational depression include specific stressful events or life changes, while clinical depression has a wider range of potential causes and is typically a longer-lasting condition.” Now, you have enough facts about depression for a syllogistic example.

If an undesirable event occurs (p), then you may disturb yourself into situational depression (q). An undesirable event occurs (p). Therefore, you may disturb yourself into situational depression (q). In REBT, this situational depressive episode is represented by use of the ABC model.

REBT uses the ABC model to illustrate that when an undesirable Action occurs and you Believe an unhelpful narrative about the event, it’s your unfavorable assumption, not the occurrence itself, that causes an unpleasant Consequence. This is how self-disturbed depression occurs.

For instance, your loved one dies (Action) and you unfavorably Believe, “Life is useless without my loved one! In fact, it’s downright awful that she’s gone! I can’t tolerate this experience, because it shouldn’t have happened!” With this script, you endure depression (Consequence).

Addressing how people upset themselves with unhelpful attitudes, the ABC model incorporates Disputation of unproductive philosophies of life in order to explore Effective new beliefs. Whereas rigid beliefs cause self-disturbance, flexible beliefs result in an un-disturbed condition.

Regarding my interpretation of Epictetus’s perspective, he apparently maintained that reasoned choice is what causes one’s own outcomes, and that matters outside of such choice aren’t good or evil. Bear in mind that there are natural stages of grief—which the APA defines as:

[T]he anguish experienced after significant loss, usually the death of a beloved person. Grief is often distinguished from bereavement and mourning. Not all bereavements result in a strong grief response, and not all grief is given public expression.

Grief often includes physiological distress, separation anxiety, confusion, yearning, obsessive dwelling on the past, and apprehension about the future.

Intense grief can become life-threatening through disruption of the immune system, self-neglect, and suicidal thoughts. Grief may also take the form of regret for something lost, remorse for something done, or sorrow for a mishap to oneself.

With my approach to REBT, I draw a distinction between natural distress and unnatural disturbance. Understanding this difference can help you recognize whether or not your sadness (i.e., sorrow) represents depression or MDD (i.e., a collective of symptoms and behaviors).

Distress may be defined as “the negative stress response, often involving negative affect and physiological reactivity: a type of stress that results from being overwhelmed by demands, losses, or perceived threats.” Distress, even of the self-distressed variety, is natural.

Alternatively, disturbance is an interruption of a state of peace, quiet, or calm, or an interference with or alteration in a planned, ordered, or usual procedure, state, or habit. Specifically, one REBT source states of the distinction between distress and disturbance (page 71):

REBT conceptualizes this distress as healthy even though it is intense. Other approaches to therapy have as their goal the reduction of the intensity of negative emotions. They take this position because they do not keenly differentiate between healthy negative emotions (distress) and unhealthy negative emotions (disturbance).

Now, REBT keenly distinguishes between healthy distress and unhealthy disturbance. Healthy distress stems from your rational beliefs about a negative activating event, whilst disturbance stems from your irrational beliefs about the same event.

This is where the ABC model comes in handy. From a psychological standpoint, people disturb themselves using a Belief-Consequence (B-C) connection. Yet, this isn’t to suggest that in the context of the naturalistic or physical world there is no Action-Consequence (A-C) connection.

As an example, from an A-C perspective, if your loved one experiences catastrophic organ failure (Action), then your loved one may die (Consequence). If this occurs (Action) and you Believe, “I miss her so much,” then you may endure natural B-C distress (Consequence).

However, given Epictetus’s interpreted perspective, if your reasoned choice isn’t natural or healthy, then you may experience unnatural B-C disturbance. Addressing Epictetus’s outlook, authors of The Daily Stoic state (page 148):

Today, as things happen and you find yourself wondering what they all mean—as you find yourself contemplating various decisions, remember: the right thing to do always comes from our reasoned choice. Not whether something is rewarded. Not whether something will succeed, but whether it is the right choice.

When presenting people with a similar proposition, I sometimes receive pushback. Those who are unfamiliar with the content of my blog may ignorantly say, “It’s wrong to tell people that depression is a matter of choice.” About this, I stated in the post Diagnoses Feel Empowering:

When I’ve behaved poorly in the past, and as I inevitably won’t behave perfectly in the future, I assume personal ownership for the manner in which I treat myself and others. And for the reader who’s disgruntled by irrational beliefs regarding what I’m stating herein, I also have diagnoses attributed to so-called chemical imbalances – ADHD and major depressive disorder.

Nothing with which I’ve been diagnosed gives me a pass for poor behavior. Likewise, and albeit that one may “feel” as though diagnoses are empowering, I invite the reader to dispute beliefs which result in disempowerment and deprive one of personal ownership regarding behavior.

My diagnosis of MDD doesn’t give me a license to disregard personal responsibility and accountability (collectively “ownership”) for my experience. For instance, I’ve endured symptoms of a significant depressive episode for the past several days—an A-C matter.

My chemical imbalance (Action) has caused depression (Consequence). Rather than bemoaning the matter through use of a B-C connection, I’ve instead taken a Stoic approach to the matter by applying reasoned choice. Thus, I’ve committed to writing at least one blogpost per day.

In this way, I helpfully use the REBT tool of unconditional acceptance (UA) to relieve suffering. This is accomplished through use of unconditional self-acceptance (USA), unconditional other-acceptance (UOA), and unconditional life-acceptance (ULA).

Whereas the ABC model is a scientific approach to wellness, UA serves as a philosophical method for un-disturbing oneself. I view the former as an abortive approach to disturbance and the latter as a preventative method. Of course, not all REBT practitioners use the same style as I.

With my approach to REBT, I incorporate author Stephen Covey’s concepts regarding the circles of control, influence, and concern, as well as an area of no concern. UA maps onto the circle of control (USA), circle of influence (UOA), and circle of concern and area of no concern (ULA).

The circle of control encompasses only oneself, the circle of influence encapsulates elements which may be subject to one’s sway, the circle of concern engrosses most matters one can imagine, and the area of no concern relates to all content which isn’t yet imagined.

In my case, I acknowledge that the only thing over which I have control during a clinically depressive episode is my reaction to the undesirable event (USA). As well, I don’t rigidly expect others to understand what I’m going through, because this is my issue and not theirs (UOA).

Moreover, I acknowledge that I’ve endured symptoms of MDD since I was in elementary school, as I’ve established resilience through high frustration tolerance regarding this lifelong condition (ULA). Concerning reasoned choice of this kind, authors of The Daily Stoic state (page 148):

Epictetus’s dictum helps us cut through all this with clarity and confidence. Is something good or bad? Is this right or wrong? Ignore everything else. Focus only on your choices.

I know not to morally describe MDD as good, mad, right, wrong, or otherwise, because I’d then unhelpfully prescribe what should, shouldn’t, ought, oughtn’t, must, or mustn’t be (e.g., depression is bad and I mustn’t be inflicted with its symptoms). That’s how disturbance occurs.

Rather, I’m currently tolerating the natural distress of my system bringing itself down. Still, with this bout of depression, I’m making reasoned choices which better serve my interests and goals (i.e., staying out of a box [incarceration] and above ground [death]). I have control in this regard.

In closing, I’m not suggesting that depression is a matter of choice. I didn’t choose my experience of intense symptoms over the past several days. Nonetheless, I do propose that my reasoned choice is within my ability to control. Ergo, I’m depressed though still functioning.

For a number of clients with whom I’ve worked, who also have the diagnosis of MDD, sometimes it’s all one can do within a day to get out of bed and shower. That’s a win! For me, posting a poorly-written blogpost per day is a win. Truly, that’s within my ability to control.

Now, I invite you to consider that rather than assuming a victimhood narrative concerning whatever symptoms you experience, take personal ownership over your outcome. That’s what remains in your ability to control! We all make our choices, so why not make reasonable ones?

If you’re looking for a provider who tries to work to help understand how thinking impacts physical, mental, emotional, and behavioral elements of your life—helping you to sharpen your critical thinking skills, I invite you to reach out today by using the contact widget on my website.

As a psychotherapist, I’m pleased to try to help people with an assortment of issues ranging from anger (hostility, rage, and aggression) to relational issues, adjustment matters, trauma experience, justice involvement, attention-deficit hyperactivity disorder, anxiety and depression, and other mood or personality-related matters.

At Hollings Therapy, LLC, serving all of Texas, I aim to treat clients with dignity and respect while offering a multi-lensed approach to the practice of psychotherapy and life coaching. My mission includes: Prioritizing the cognitive and emotive needs of clients, an overall reduction in client suffering, and supporting sustainable growth for the clients I serve. Rather than simply trying to help you to feel better, I want to try to help you get better!

Deric Hollings, LPC, LCSW

Photo credit, fair use

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Hollings, D. (2023, September 6). The absence of suffering. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/the-absence-of-suffering

Hollings, D. (2022, December 23). The A-C connection. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/the-a-c-connection

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Hollings, D. (2024, January 8). The baseball rule of life. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/the-baseball-rule-of-life

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Hollings, D. (2025, January 9). Traditional ABC model. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/traditional-abc-model

Hollings, D. (2025, September 26). Triggers all around me. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/triggers-all-around-me

Hollings, D. (2025, July 3). Trust the process. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/trust-the-process

Hollings, D. (2024, October 20). Unconditional acceptance redux. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/unconditional-acceptance-redux

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Hollings, D. (2023, February 25). Unconditional other-acceptance. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/unconditional-other-acceptance

Hollings, D. (2023, March 1). Unconditional self-acceptance. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/unconditional-self-acceptance

Hollings, D. (2025, March 13). Unscientific thinking and believing. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/unscientific-thinking-and-believing

Hollings, D. (2022, November 25). Victimhood. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/victimhood

Hollings, D. (2024, August 20). We all make our choices. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/we-all-make-our-choices

Hollings, D. (2024, September 29). Well, well, well. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/well-well-well

Hollings, D. (2025, April 12). What’s the big idea? Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/what-s-the-big-idea

Hollings, D. (2025, July 22). You almost always end up with regret. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/you-almost-always-end-up-with-regret

Hollings, D. (2025, August 26). You are not your image. Hollings Therapy, LLC. Retrieved from https://www.hollingstherapy.com/post/you-are-not-your-image

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