The existential layers of depression: An exploration of depression as an affective, embodied and relational experience

Summary

Heidi Pellens (2025). The existential layers of depression: An exploration of depression as an affective, embodied and relational experience.

Supervisor: Prof. dr. Vanhooren, Co-supervisors: Prof. dr. Jessie Dezutter, Prof. dr. Patrick Luyten

In depression, difficulties in the ability to experience meaning are central in clients' experiences. Earlier empirical research has demonstrated the link between meaning difficulties and depressive symptoms. This thesis aims to make a contribution in exploring how difficulties in experiencing meaning are linked to symptoms of depression. To answer this question, this thesis relies on a phenomenological-existential theoretical framework. With this framework as a starting point, this dissertation examines the associations of depressive symptoms with phenomenological-existential constructs and investigates the lived experience of depression.

Chapter 1 unfolds the theoretical framework upon which all studies in this dissertation are based. The constructs that are investigated in this thesis are embedded in the literature.

Chapter 2 presents a survey-based study among therapist and counselors, which examines the association between the severity of their depressive symptoms, the extent to which they are able to experience meaning in their lives, the degree of anxiety that existential questions evoke in them, and the extent to which they are able to connect with the embodied experience of life events. Anxiety toward existential questions appears to contribute in the explanation of the link between difficulties in experience of meaning and the severity of depressive symptoms.

Chapter 3 examines the associations between difficulties in the experience of meaning, depressive symptoms, existential anxiety, and the degree of connectedness to the embodied experience in an international group of participants from 97 different countries. In addition to anxiety regarding existential questions, the degree of connection to the embodied layer of life experiences of daily events appears to contribute to the explanation of the relationship between difficulties in the experience of meaning in life and depression severity. Moreover, this study shows that when people live in a context where connection with others is valued and encouraged, this has a tempering effect on the relationship between difficulties in the experience of meaning and the severity of depression.

Chapter 4 focuses on the lived experience of depression among therapists and counsellors. Experiences with a “negative valence” were found to predominate in therapists' individual responses and group responses. An experience within the category of “constriction,” was the most common herein. Moreover, constriction unfolds on different dimensions of experiencing. At the same time, most therapists stressed the importance of an attitude of “staying with the client and his experience.”

Chapter 5 zooms in on the therapeutic attitude of presence in the context of therapy by examining the relationship of clients’ and therapists’ perceptions of therapist’s presence, with the existential anxiety and depressive symptoms of the client. Both the quality of therapist's presence and changes in the level of anxiety regarding existential questions were found to be important factors in the process of change of the severity of the client's depressive symptoms. Qualitative data on important life events of the participants are integrated with these quantitative results.

Finally, Chapter 6 summarizes the main results of the four studies of this thesis and integrates them in the existing research field. Furthermore, it translates the research findings into clinical practice and presents ideas for future research.