What is CBT treatment of depression

April 30th, 2008 by Farya Barlas

What is depression?

Depression has a variety of symptoms such as loss of energy, loss of interest in activities and in life, sadness, loss of appetite and weight, difficulty concentrating, self criticism, feeling of hopelessness, physical complaints, withdrawal from other people, irritability, difficulty making decision and suicidal thinking. Many depressed people feel anxious as well. They often feel worried, nauseated or dizzy and sometimes have hot or cold flashes, blurred vision, racing heart beat and sweating.
Clinical depression varies from mild to severe. For example some people complaint of a few symptoms that occur some of the time. Other people suffering from severe depression may complain of a large number of symptoms that are frequent, long lasting and disturbing.

Clinical depression is not the same as grieving after a loss of a loved one through death, separation or divorce. Feeling of sadness, low energy and lack of interest are normal during grief. Anger and anxiety can also be part of a normal grieve process.
Clinical depression differ from normal grief in that clinical depression may occur without a significant loss. In addition depression may last longer than grief and includes feelings of self criticism, hopelessness and despair.
It would be unusual for a person to say they never felt depressed. Mood fluctuations are normal and help inform us something is missing in our lives and that we should consider changing things. But clinical depression is worse than simple mood fluctuation.

What causes depression?

No single cause for depression has been found. Usually there is more than one reason and this differs from person to person, but sometimes it can happen without any obvious reason. Distressing events can make someone start to feel depressed and at times this may turn into a more serious depression from which it is difficult to emerge.
Circumstances can play a part. So, being alone, having to live on a very low income, physical illness and unemployment can all contribute. Sometimes several different factors cause depression. At times, even events that you might think of as good and positive, such as getting married, or starting a new job can be stressful enough to cause depression.

How does behaviour affect depression:

The following is a more specific list of behavioural factors involved in depression:

1) Loss of rewards: have you experienced significant losses in your life recently, for example loss of work, friendship, relationship.
2) Decrease of rewarding behaviour: are you engaging in a few activities that were rewarding for you in the past. For example depressed people spend a lot of time in passive and unrewarding behaviour such as watching television, lying in bed. They spend less time engaged in challenging and rewarding behaviours such as positive social interactions, exercise, learning and productive work.
3) Lack of self rewards: Many depressed people fail to reward themselves for positive behaviour for example, they hardly praise themselves or they are hesitant to spend money on themselves. Many times depressed people think that they are so unworthy that they should never praise themselves.
4) Skills deficits: are there any social skills or problem skills that you lack? Depressed people often may have difficulty asserting themselves, maintaining friendship or solving problems with spouse, friends or work colleague.
5) New demands: are there new demands for which you feel ill prepared? Starting a new job, becoming a parent or ending a relationship can cause significant stress for many people.

How does thinking affect depression?

Certain ways you think can cause depression. Some of these are described below:

1) Dysfunctional automatic thoughts: the examples are as follow:

Mind reading: People think I am a failure

Labelling: I am useless, I am a failure

Fortunetelling: I will get rejected; I will make a fool of myself

Catastrophizing: it’s terrible if I get rejected

All or nothing thinking: I fail at everything, I don’t enjoy anything, everything is wrong

2) Maladaptive assumptions: These include ideas about what you think you should be doing. They are the rules by which depressed people think they have to live. Examples include the following:

I should get the approval of everyone.
If someone does not like me that means I am unlovable.
If I fail at something then I am a failure.
I should not be depressed.

The negative thoughts associated with depression have the following characteristics:

1. Negative thoughts tend to be automatic. They are not actually arrived at on the basis of reason and logic, they just seem to happen.
2. Often the thoughts are unreasonable, and unrealistic. They serve no purpose. All they do is make you feel bad and they get in the way of what you really want out of life. If you think about them carefully, you will probably find that you have jumped to a conclusion which is not necessarily correct. For example, thinking someone doesn’t like you because they haven’t phoned recently.
3. Even though these thoughts are unreasonable they probably seem reasonable and correct to you at the time.
4. The more you believe and accept negative thoughts, the worse you are likely to feel. If you allow yourself to get into the grip of these thoughts, you find you are viewing everything in a negative way.

How can I understand these feelings?

The way you think about things affects the way you feel, which affects the way you behave. It is difficult to change the way you feel, but you can change the way you think. When you are feeling depressed you might have negative thoughts a lot of the time. With each negative thought the feelings of depression are likely to increase.
Sometimes negative thoughts can stop you from doing the things that you would normally do. As a result, you may get critical thoughts about being lazy, or irresponsible which make you feel even worse. In other words, you get caught up in a vicious cycle.

For example:
Suppose you are walking down the street and you see a friend who appears to ignore you completely. You might wonder why your friend has turned against you and you feel a little sad. Later on, you mention the incident to your friend, who tells you that he was preoccupied at the time and he didn’t even see you. Normally you would feel better and put what happened out of your mind. But if you’re depressed, you
probably believe your friend has rejected you. You may not even ask him about the incident, and then the mistake goes uncorrected. If you’re feeling depressed you’re more likely to make mistakes like this over and over again.

How can I help myself to feel better?

Even if you have a doctor or mental health worker involved in your treatment there are things you can do to help yourself in overcoming depression.

1. Do something active

Physical activity is particularly helpful. Walk, run, cycle, skip anything which begins to increase your activity can help to improve how you feel. Plan 15 or 20 minutes of activity every day, or every other day to begin with. This kind of physical
activity can actually begin to make you feel less tired. Find something that interests you and spend some time on it. Plan to focus on things you usually enjoy and build some time into each day for these activities. You might find it helpful to take up a new interest. Some people find that creative activities such as painting, writing poetry or playing music that helps them to express their feelings, can help them to feel better.
Make a small start on tasks that you may have been avoiding, break big tasks down into smaller stages and tackle these one by one. For example, there might be jobs in the house or the garden that really need to be done, but you have been putting off doing them. If that is the case begin on day one by tackling just one small area. This way, by not taking on too much you are more likely to achieve your goal and that will
make you feel good.

2. Talk to others

Try and tell those close to you how you are feeling. They may be able to listen and help you to think things through. Having a cry can help to relieve tension and let things move on. You may be surprised to find those you talk to have felt depressed themselves at sometime and can understand how you feel.

3. Look after yourself

Resist the temptation to cope with your depression by misusing medication. These
may give some immediate relief but quite soon create further health and psychological problems for you to cope with. Eat well; a good diet can help to keep you in good health so recovery is easier. Try and ‘treat‘ yourself to things you normally enjoy.

4. Challenging Negative Thinking

Don’t allow gloomy thoughts to go unchallenged. When someone is experiencing depression they often tend to think and expect the worst of themselves, their life and the future. Don’t just accept these thoughts try to : identify when your mood is very low; write down the unpleasant thoughts you are having during that time; try and counter these thoughts by writing down arguments against them. Imagine what you would say to a friend if they had such negative thoughts about themselves try and keep a diary of things you have enjoyed or achieved during the week. This can help you to concentrate on the good things rather than the bad things in your life.

6. Try and remember details

Research tells us that the person who is depressed doesn’t remember detail of events but tends to think in general statements, such as “I’ve never been any good at anything”. Try and train yourself to remember details so that good times and experiences are easy to recall. Think of particular times. A daily diary can help you to do this. Make lists of actual achievements and good aspects of yourself such as “I’m always on time”, “I helped my friend on Tuesday”, “My partner complimented me on my work last week”. Try to keep a diary of events, feelings and thought. Look out for errors in thinking.

What is cognitive behavioural treatment of depression

The cognitive behavioural treatment of depression is a highly structured, practical and effective intervention for patients suffering from depression. This type of therapy treats depression by identifying and addressing the behaviours and thinking patterns that cause and maintain depression. This therapy focuses on your present, here and now thoughts and behaviour. There are actions you can take to start feeling better. We will be looking at the negative and unrealistic ways of thinking that may make you feel depressed. Therapy can give you the tools to think more realistically and feel better.

How effective is cognitive behavioural therapy for depression

Numerous research studies conducted at major universities throughout the world have consistently demonstrated the cognitive behavioural therapy is as effective as antidepressant medication in the treatment of major depression. More ever, most patients in cognitive behavioural treatment maintain their improved mood when checked 2 years after ending therapy.