Because of its prevalence in our society, depression is often referred to as the “common cold” of mental illness. It may be common, but depression is a serious illness. Depression interferes with daily life making it difficult to function or engage in the activities that otherwise would have been pleasurable. As common as depression may be the complexity of depression challenges individuals, whose vulnerability and resilience will be determined by medical issues, the schemas formed in childhood, current cognitive style, and coping skills, and available social support. The challenge lies not only in correctly assessing factors that contribute to dysfunction, but also in formulating a plan that includes interventions that will result in positive outcomes for the disturbance.
Although the notion of external causation is a popular view regarding depression and other mental health issues, a cognitive-behavioral therapy (CBT) conceptualization is less likely to create a state of helplessness and blame, and is more likely to support empowerment of the individual and potentially a more rapid healing. A CBT conceptualization leads the depressed individual away from a negative view of the future and external circumstances, and instead emphasizes an internal locus of control, where internal resources of empowerment and strength are discovered, regardless of the existing external circumstances. Of course a wide variety of external events or life circumstances that generate stress can be contributing factors in precipitating a depressive episode. Nonetheless, despite an association between stress and depression, many people who are subjected to high levels of stress do not develop depression, and ongoing stressful experiences, do not lead inevitably to vulnerability, failure to adapt, and psychopathology. Cognitive behavioral theory attempts to deconstruct individual differences in vulnerability, adaptation, and development of psychopathology, through systematic assessment of ones thoughts and behaviors, and use of empirically validated interventions.
In a study done by The World Health Organization, common elements of depressive experiences were identified in subjects across four different countries: Iran, Japan, Canada, and Switzerland. The symptoms included sad affect, loss of enjoyment or pleasure (anhedonia), anxiety, tension, lack of energy (lethargy), loss of interest, inability to concentrate, and ideas of insufficiency, inadequacy and worthlessness. Depressive experiences around the world appear to share a common foundation.
So where does one begin in addressing the symptoms? The research demonstrates that two best initial interventions for depression are behavioral activation and CBT. Peter Lewinsohn and colleagues at the University of Oregon were the first to develop Behavioral Activation as a treatment for depression, and developed the treatment to increase pleasant activities for depressed individuals. It is natural for a person that feels sad and is no longer finding pleasure in activities that were previously enjoyed, to attempt to cope by withdrawing socially, ceasing to engage in activities and lying on a sofa waiting for something to change. The problem is that such coping strategies do not help alleviate depression, they make it worse.
The other intervention that has been shown to be efficacious in the treatment of depression is cognitive restructuring, or changing ones beliefs to beliefs that are more reality based, i.e. rational. The normal ratio of positive to negative thinking is 1.7 positive to 1 negative thought. Themes of hopelessness about the future, guilt about past behaviors, blame, worthlessness, disinterest, and sometimes death can permeate the inner thinking lives of depressed clients. These cognitive symptoms are powerful factors in terms of perpetuating dysfunction, particularly from the perspective of a cognitive model. If a depressed individual can become increasingly competent at identifying and restructuring cognitive distortions, the dark cloud of depression will often lift. The key to interventions directed at distorted, dysfunctional or irrational cognitions is to challenge oneself to change the cognitions related to environmental stressors, life’s daily struggles, self-evaluations, and predictions about the future. The solution is not to change negative thoughts to positive thoughts or to think positively. The solution is to become conscious/aware of the cognitions that are maintaining the depression, and change those negative thoughts to more reality based thoughts.
Let’s take the example of Alex who is depressed. She may be thinking, “I shouldn’t be depressed“…”This is catastrophic”…”I can’t stand feeling this way”….. “I am worthless and will never amount to anything”. These thoughts will likely either bring on a depression or maintain it. Thinking in this manner is simply not helpful. A more helpful way of thinking would be to say to herself the following, “I wish I wasn’t depressed, but it isn’t catastrophic or horrible. I don’t like being depressed, but I can stand it. I am a fallible human being. I am not perfect and like everyone else, never will be.” With this more flexible thinking and engaging in activities that were pleasant prior to the depression, the depression will likely alleviate, as the brain metabolism goes back to its normative state.
Submitted by Lili Daoud, LCSW. As a cognitive behavioral therapist and Supervisor certifi ed by the Albert Ellis Institute, I use evidence based interventions that get clients feeling better quickly. My style is genuine, supportive, empathic and directive. Unless someone has experienced trauma, there is often little need to delve into one’s past, as current thinking and behaviors maintain most dysfunction in life. My training is in Rational Emotive Behavioral Therapy through the Albert Ellis Institute, as well as with experts in the area of anxi-ety disorders. My clients are often pleasantly surprised by the quick positive results they are able to experience, if they choose to engage in the process. Center for Cognitive Therapy, 176 West Main Street, Avon. 860.677.2991, TeenPsych1@aol.com, www.ct-cbt.com