CBT And Depression
What is depression: Depression is a mental health disorder characterized by symptoms including depressed mood and may range from mild to severe.
Types of Depression
Major Depressive Disorder (MDD): MDD is a type of depression in which the course of the disorder is characterized by one or more Major Depressive Episodes. MDD ranges from mild to severe, depending on the number and severity of symptoms. Major Depressive Episode: lasts for at least two weeks and causes significant impairment in one's daily functioning (e.g., occupational, social, family).
Symptoms of a Major Depressive Episode:
- Depressed Mood: Feeling sad or empty most of the day nearly every day (in children/adolescents this may manifest as irritability).
- Anhedonia: Markedly diminished interest or pleasure in all or almost all activities most of the day, nearly every day.
- Feelings of hopelessness.
- Appetite and/or weight changes: significant weight loss or gain (5% of body weight in a month) or increased/diminished appetite.
- Sleep disturbances: insomnia or hypersomnia nearly every day.
- Feelings of excessive guilt or worthlessness nearly every day.
- Psychomotor agitation or retardation: restlessness and/or lethargy observable by others.
- Poor concentration: diminished ability to think, focus, or make decisions.
- Thoughts of death: may include suicidal thoughts without a specific plan, a suicide attempt, or a specific plan to commit suicide.
Dysthymic Disorder: characterized by a pervasively down or sad mood more days than not for at least two years. Symptoms: increased or diminished appetite, sleep disturbances (insomnia or hypersomnia), low energy, fatigue, low self-esteem, poor concentration, difficulty making decisions, feelings of hopelessness.
Depressive Disorder Not Otherwise Specified: diagnosed when experiencing some symptoms of depression but not meeting full diagnostic criteria for any specific mood disorder.
Cognitive Behavior Therapy – CBT for Depression
Cognitive Behavior Therapy (CBT) is an umbrella term that captures a number of specific types of psychotherapies that use similar techniques to treat various mental health disorders. In general, CBT means that the therapist focuses on changing the client's maladaptive thoughts or cognitions thereby changing his/her feelings (depression) and behaviors. CBT has been shown to significantly reduce depressive symptoms and help people to maintain these benefits. Types of empirically-based CBT methods to treat depression include Beck's Cognitive Therapy, Albert Ellis's Rational Emotive Behavior Therapy (REBT) and Segal's Mindfulness-Based Cognitive Therapy (to treat depressive relapse). While each of these psychotherapy methods differ in their cognitive restructuring approaches, they are similar in that they each focus on the client's thoughts as a means to ameliorate depression. The common thread assumes that one's thoughts are directly related to his/her depression, and likely the cause of it. For example, if I think, “That person did not make eye contact with me because he doesn't like me,” then I may feel sad. However, if I think, “That person did not make eye contact with me for any number of reasons. Maybe he didn't see me, etc.,” then sadness will probably not be the feeling that follows the thought.
Components of CBT
Situation: It is common for people to say things like, “She made me mad” or “What you said made me sad,” which externalizes blame on the situation instead of the client. CBT does not focus on the situation because it is presumed that we cannot change this. Situations are usually beyond our control and to try to change them (especially other people) is self-defeating.
Thoughts/Cognitions: It is one's thoughts about the situation that lead to depression. A person may think a negative way about the situation that causes the person to feel depressed. According to Beck's CT, the client has levels of thoughts. First are “automatic thoughts,” which are at the surface and readily thought every day, multiple times a day (e.g., “I am going to fail that test,” “I am so fat,” “He is mean to me”). Underlying these automatic thoughts are “maladaptive assumptions” about yourself that are deep rooted and a product of the client's learning history (e.g., “I am unlovable,” “I am worthless”). A cognitive therapist works with the client to restructure and dispute both automatic thoughts and maladaptive assumptions, modifying them so the client thinks differently about him/herself and the world.
Feelings: Depression is the feeling that is being treated. CBT dictates that the feeling of depression is the direct result of the person's thoughts, so if the thoughts are changed the depression will alleviate. Other feelings that may coexist with depression include anger, anxiety and guilt. CBT for depression works on reducing all of these negative emotions to improve the client's quality of life.
For an updated, more in-depth look at this topic, see CBT Treatment for Depression.