Cognitive behavioral psychotherapy is one of the most recommended treatment for depression. By understanding how depression functions, we were able to dress a panel of features to counter it, halt its progress and try to inverse its mechanisms.
Click here to view a description of depression, in part 1 of this article.
As usual, the first steps of treatment aim at determining the problematic environment/thoughts/behavior that entertain the vicious circle of the disease.
Depression works in intricate biological, thought, behavior and emotion processes coexisting every day . We tackle them together, in order to maximize our chances of efficacy – which is why it is also recommended to view a medical doctor in order to prescribe medical treatment if needed.
The following article describes the main line of treatments’ strategy. It does not constitute an exhaustive view of treatment.
Cognitive Therapy
“Of course it is happening inside your head, Harry, but why on earth should that mean it is not real?”
J.K. Rowling
Depression gets entertained by several unconscious cognitive biases. These are specific distortions working hand in hand to entertain a negative view of both the world, and one’s self.
Let’s take an example:
Fact: A person you know walks by the other side of the road, but does not say hello.
This ambiguous event can lead to different interpretations, for example:
- Cognitive Interpretation of the Fact #1:
“Oh he did not see me, too bad!” - Cognitive Interpretation of the Fact #2:
“I am sure he’s avoiding me. It must have something to do with that thing I did the other day…”
This just aims to show the impact of a cognitive bias in a daily situation. The person using cognition number 1 is more likely to maintain a positive view of him/herself after this event. Of course, not everyone holding an interpretation similar to example 2 is likely to have depression. Yet a person with depression is more likely to hold negative cognitive biases, that distort their realities on a day-to-day basis and confirm the belief “you are not enough” and “life isn’t worth it”.
“They don’t need walls and water to keep the prisoners in, not when they’re trapped inside their own heads, incapable of a single cheerful thought. Most go mad within weeks.”
J.K. Rowling
Consequently, cognitive therapy for depression is going to be based a lot on cognitive bias modification. This consists of taking single life events like this one and considering different ways to look at them. We won’t necessarily be looking for a more positive way, just a slightly different way, each time. It is important to doubt yourself, you are not as objective as you think you are.
Neurologically speaking, these biases are your brain’s tendency to automatically view the negative outcome before the good one. In this sense, you will notice a sad face more quickly than you notice a happy face, unconsciously omit information that disconfirm your beliefs, and select those that confirm it. The aim of cognitive therapy is to make this process conscious, and work on developing broader views of the world in order to halt this destructive cycle and restore a healthier perspective on life.
“Happiness can be found, even in the darkest of times, if only one remembers to turn on the light.”
J.K. Rowling
Behavioral Therapy
Under depression’s spell, everything loses its sense. When the world seems against you, when life seems pointless, when all hope is gone: it no longer makes sense to get up in the morning. As the theory of learned helplessness states it, people often have their reasons, their own share of negative experiences to entertain this hopeless belief.
In addition to that, the physical constraints of depression are such that your body is literally crumbling under its own weight: every single move seems daunting, breathing is itself tiring.
Take the absence of motivation, add to it the unlimited fatigue, and you get a tremendous difficulty to leave bed in the morning. That is why the second part of cognitive-behavioral treatment consists of behavioral activation. We want to counter that very same cycle that sucks you into your bed every morning by giving you subjective pleasure. Functioning without joy, is like a machine functioning with no fuel. So we are going to go out there and search for this fuel, in whichever corner we can find it!
In order to do that, we will dress an inventory of pleasurable situations you identified, prior to your depression. Anything you can remember that seemed pleasurable to you will go into this list: it can be as simple as eating a piece of chocolate, as long as you enjoy it and take pleasure into it. On the long term, the goal will be to maximize those pleasurable incidences, no matter how long it will take: we need to systematize the everyday rendering of joy in your body and mind!
This step may seem simpler than it actually is: it is far from easy and requires a lot of patience and understanding. Since one of the main symptoms of depression is loss of pleasure and interest, it is important to understand that a person with depression, is really doing his/her best in surviving. Some days, obtaining this understanding will be of great help. Others, will require more time… we will take these steps together, one day at a time.
Emotional Therapy
People with depression often find it hard to go about their days, with so many reasons not to. This is why Mindfulness can be a brilliant tool for relapse prevention. Going about your day while listening to every reason your head has found to hold you back can be quite of a challenge, and not such a useful one for the matter!
“Stop minimizing and discounting your feelings. You have every right to feel the way you do. Your feelings may not always be logical, but they are always valid. Because if you feel something, then you feel it and it’s real to you. It’s not something you can ignore or wish away. It’s there, gnawing at you, tugging at your core, and in order to find peace, you have to give yourself permission to feel whatever it is you feel. You have to let go of what you’ve been told you ‘should’ or ‘shouldn’t’ feel. You have to drown out the voices of people who try to shame you into silence. You have to listen to the sound of your own breathing and honor the truth inside you. Because despite what you may believe, you don’t need anyone’s validation or approval to feel what you feel. Your feelings are inherently right and true. They’re important and they matter — you matter — and it is more than okay to feel what you feel. Don’t let anyone, including yourself, convince you otherwise.“ — Daniell Koepke
It is very helpful to let yourself feel, without projecting yourself in the past or in the future: there are so many sensations worth looking at, in the present. Once you succeed in developing a larger panel of emotions, they can regulate each other just fine and play your life like a musical instrument playing a melody.
But it is important do so without judgment! One of the problems with the human mind is that it’s been accustomed to judging everything we think, feel, or do. It’s okay not to judge. It’s okay to accept things, label them and recognize them for what they are. It’s okay to feel anything, as long as you know that this feeling will pass.
Because one of the wonders someone who’s been through depression can learn for sure, is what we psychologists like to call resilience. It is the ability to live something, let it transform you, and use it as a strength, rather than a weakness. At the end of the day:
“The flower that blooms in adversity is the rarest and most beautiful of all.”
Walt Disney Company
