Cognitive Behavioural Therapy for Depression

Cognitive Behavioural Therapy for Depression

Discussed at length in other posts, depression is a mood disorder which can be seriously debilitating for the person suffering from it. Depression means feeling sad and bored most of the time, to an unusual degree and being unable to do anything about it. Major depression affects many people, with estimates saying that over one million of Canadians are affected by depression. Depressive illness is much more than just feeling under the weather or feeling blue, it means consistently being bored and feeling sad. It also means thinking negative thoughts, sometimes very dark thoughts.

Also, a person with depression loses interest in activities that once brought pleasure and enjoyment. For instance, even watching TV or one’s favourite shows may become a chore instead of an enjoyable activity. Depression means feeling very sad, most of the time. What it does not mean, is that the person who suffers from depression has a personal character flaw or is in some way weak. Depression is a serious mental illness and a person cannot simply wish it away. 

Maladaptive cognitions influence dysfunctional behaviour. Photo by Elena

Pharmacotherapy includes selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine, brand name Prozac. Prozac and other medication of this class works by increasing the amount of serotonin in the brain. Serotonin is one of the neurotransmitters most associated with Major Depressive Disorder (MDD). Serotonin affects both mood and metabolism, and a greater amount of serotonin in the brain regulates mood, helping individuals with depressive illness.

Cognitive behavioural therapy (CBT) is appropriate for depression because depression changes a person’s cognitions (thoughts), actions (behaviours) and feelings (emotions). CBT is an effective treatment for depression. At the heart of CBT lies the assumption that a person’s unhealthy, maladaptive and negative patterns of thought influence one’s mood. In fact, depression is a mood disorder. CBT techniques include writing down one’s thoughts or cognitions and recording how they make one feel. For example, a person with depression may think “I am useless and no one loves me”. Such a negative cognition is sure to negatively influence the way one feels and behaves. Then, the therapist would suggest writing the thought down and record the feelings that the thought brings about, which are likely to be very negative. The thought may then be replaced by more positive and constructive commentary. Dysfunctional thinking also leads to maladaptive behaviour, which in turn  impacts mood.

Catastrophizing is a characteristic of depression. Image: Megan Jorgensen (Elena)

CBT is generally time-limited and focuses on cognitive restructuring. Different people may benefit from CBT, including teenagers and those suffering from mild to moderate depression. A combination of medication and CBT has also been shown by studies to be more effective in treating major depression than medication alone. However, people who are more motivated and capable of insight into their own condition are more likely to benefit from CBT. Likewise, psychologists explain that persons with an internal locus of control are likely to be more motivated. Having an internal, rather than an external, locus of control means believing that one’s actions have an influence on the outcome.

Unfortunately, some people continue to feel depressed even when taking antidepressants. The problem is that even with antidepressant medication, people may feel tired, bored and sad. Another challenge to individuals suffering from depression is that medication or other therapy, such as Cognitive Behavioural Therapy (CBT) does not change reality. The problems which make the individual depressed persist despite medication or talk therapy. Nonetheless, CBT may help with automatic thoughts.

Cognitive Behavioural Therapy (CBT) aims at cognitive restructuring. Image: Megan Jorgensen (Elena)

In CBT, typical automatic thoughts and cognitions that the individual holds are targeted by the therapeutic intervention. Individually or in groups, the therapy is delivered over the course of 14 to 16 weeks and aims at cognitive restructuring. Unlike other therapies it also has an in the moment focus. Many psychotherapies focus on the past. For example, it is common for psychotherapists to inquire about one’s childhood and the trauma that may be causing present day symptoms. In contrast, CBT aims at restructuring dysfunctional thought patterns into positive ones, making the present day and the present moment a more lively and pleasant one.

Negative thoughts may lead to low mood. Photo by Elena