Treating the depression syndrome

  The depression syndrome is characterized by feelings of sadness, negative thinking and the desire to withdraw, give up, surrender and accept defeat. When people are depressed, they feel low in mood, tearful, troubled by thoughts and feelings of low worth, guilt and self-reproach. They may be more irritable than usual, have little energy or motivation, lose interest in things that they previously enjoyed and everything seems like a big effort. They become less active, lose their appetite, and experience sleep problems and loss of sexual desire. In severe cases of depression, there is a risk of suicidal behaviour. In the context of this chapter, depression refers to the less severe end of the spectrum. If the individual is feeling ‘suicidal’, it is essential that they seek expert help immediately through their doctor. The treatment of choice for depression is cognitive behavioural therapy. The CBT approach teaches the individual to identify and change the unhelpful patterns of thinking and behaviour associated with the depressive syndrome. The techniques used to challenge depressive thinking and behaviours are outlined below.

Challenging depressive thinking

  Depressive thoughts are identified through the use of a thoughts diary (see pp. 157–159). The negative thoughts identified are then systematically challenged using a range of specific cognitive techniques (as outlined in Chapter 9). To recap briefly, these include looking at the evidence for and against the negative thoughts being true (rather like a jury in a court of law), coming up with more balanced and realistic alternative (less distressing) explanations for distressing situations, looking at the advantages and disadvantages of thinking in that way and challenging their distortions. If the individual learns to successfully challenge their negative automatic thoughts and replace them with more positive and healthy ones, this leads to a corresponding improvement in their mood state.

Challenging unhelpful behaviours

  The two main techniques used to challenge the unhelpful behaviours associated with depression are activity scheduling and conducting behavioural experiments.

Activity scheduling

  When an individual is depressed, they tend to withdraw from and stop doing the activities that previously they used to enjoy. They become unmotivated and inactive, which in turn provides even more time to ruminate on their negative thoughts. This creates a downward spiral of inactivity, which tends to make their mood even worse. Activity scheduling involves keeping a daily timetable of activities, which prevents the depressed individual from being inactive and spending too much time ruminating. It allows the individual to structure their day better and also to plan a gradual increase in activity. They are also asked to rate these activities on ‘mastery’ (how good they are at it) and ‘pleasure’ (how much they enjoy it) using a ten point scale (where 0 = lowest on mastery or pleasure and 10 = maximum mastery or pleasure). Rating the activities they do enables them to identify which ones they are good at and also which ones they find most enjoyable. Once they have identified these, they can then introduce more of the enjoyable activities into their daily schedule.