Areas of Specialization - Adults
Depressive Disorders Treatment
What is cognitive behavioral therapy for depression?
1. Depressed people tend to lack specific behaviors that enhance mood and functioning.
They typically engage in very few pleasant activities, tending to be inactive and withdraw from others. Depressed people have a hard time sustaining relationships. They frequently avoid being assertive and have difficulty resolving problems with significant others, friends or co-workers. In addition, depressed people infrequently reward or praise themselves for making an effort toward change. Behavioral therapy confronts these problems with a range of strategies.
a. Typically an individual is asked to self-monitor one's activities to increase awareness and understanding of the connection between negative moods and specific behaviors. This treatment emphasizes the value of structured activity as a means of gaining more control over the environment and ultimately improving one's mood.
b. Social skills training is an important component as depressed people may lack essential skills or do not use the skills they possess when relating to others. This can result in increased feelings of social inadequacy, greater interpersonal conflict and consequently reduced opportunities for rewarding things to happen. Thus, the overall goal of these behavioral strategies is to create a structured treatment plan so that a person can increase the number of rewards and reinforcers encountered in life as a means of fighting depression.
2. Depressed people tend to have excessively negative views on life.
People who are habitually depressed concentrate on their short-comings, minimize their positive qualities and magnify the negative. Their distorted view of themselves often results in beliefs such as "Nobody will ever love me." "I am stupid, I never do anything right and fail at everything." "I am so ugly, nobody will ever be attracted to me." "I am the worst person, I am evil." These thoughts in cognitive therapy are referred to as "negative automatic thoughts" since they lead to feeling depressed, angry and anxious.
Automatic thoughts act as a reflex response to situations and are accepted as fact without any verification. Cognitive therapy specifically targets these negative perceptions through teaching an individual to monitor, identify, test, challenge and change maladaptive thoughts and beliefs. Cognitive therapy explicitly teaches the individual to identify certain types of distortions that commonly occur in depression. Examples of these distortions include: a. All or nothing "Nothing ever goes right for me."
b. Mind reading "She thinks I am an idiot."
c. Discounting the positive "It was easy, anyone could have done it" and Labeling "I am a loser."
d. Labeling "I am a loser."
The client is taught to test the accuracy of these thoughts through challenging their underlying maladaptive assumptions. For example, an individual is taught to gather evidence to support or discredit the belief "If I have not done it perfectly, then I am a failure." The client is also taught how to avoid setting unrealistically high or perfectionistic standards and goals. The client learns how to substitute more adaptive, reality based beliefs to combat future negative feelings, behaviors and thoughts. The client is additionally guided through increasingly challenging tasks and activities as a means of gathering further evidence to dispute any unhelpful thoughts or beliefs. Hence, the objective of cognitive therapy is to educate the individual in the skills necessary to identify and change faulty beliefs and perceptions, replacing them with logical, adaptive thoughts. The client is assigned readings and homework during treatment to reinforce various cognitive and behavioral techniques designed to alleviate depression.
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