Thursday, November 24, 2016

What is cognitive behavioural therapy (CBT) and does it help manage depression?

CBT theory says there's a relationship between thoughts and behaviour.  For example, let's say you scream and run every time you see a wasp. You run so wildly, that you've banged into walls.

Suppose that you want the change the behaviour?  Suppose you want to stop screaming and running every time you see a wasp?

With CBT you would see how your thinking links to your behaviour. You'd sit with a therapist and look at the last few times you saw a wasp. You'd figure out exactly what you were thinking and feeling.

Suppose this leads you the discovery that you think all wasps sting.  With the help of your therapist, you would focus on changing your thinking. Instead of seeing the wasp as a wild beast that's gunning for you, you might change that thinking to acknowledging that wasps are nature's most effective insecticides.

Yup, wasps eat aphids and blackfly, the insects that eat crops, fruit, flowers and other plants. If you have a few wasps around, you don't need nasty chemicals to control garden pests.

You work then work out a plan with your therapist to identify your trigger points and to change your thinking patterns. Over time, you will learn to look at a wasp and instead of screaming and running off, you'll say, "Hello, beautiful wasp! Please eat up all my aphids!"

So, what does that have to do with depression? 

If your depression is a reaction to your personal fears and stressors, then CBT can be a real help.  For example, many of us suffer from all kinds of doom and gloom thoughts that we know aren't necessarily true but that suck all the joy out of our real life successes. 

Like the man who just got a good annual review and a bonus but who can't enjoy it because he secretly thinks his boss hates him, that he will be fired, and that he will end up unemployed because he's a failure. 

Or the woman who gets As in her continuous assessments while doing her degree but worries herself into a depression by convincing herself that she will fail the exam, fail the course, and end up working as a part time street sweeper.

If your depression comes from that kind of 'faulty thinking' then a few sessions with a therapist and some CBT can be very effective.

The thing about depression is that we tend to talk about it as if it's a problem that can be clearly defined and that has clearly visible causes.  But that's not true.

Depression manifests in different forms. Some people feel sad, some feel blank, and some cycle between the two. You have people who sleep a lot when they're depressed and others who can't sleep. For some it's something that hits hard and vanishes just as quickly. For others it creeps up like a fog, lingers, and then slowly vanishes.  (There are other symptoms too, but this is a blog post so we'll keep it short.)

Also, it appears that depression can come from all kinds of situations. Some reasons include having a faulty thyroid, or that it is an effect of medicine taken for various conditions. For that reason, you should read this first: Feeling depressed? What you should do before seeing a therapist...and a tip on avoiding crooks
Target, my cat, who always makes me happy

As for others causes of depression, well, we're fairly certain that sometimes it is a reaction to an emotional shock. Some scientists think some depression may be a result of issues with brain chemicals not working as they should while others suggest it's a consequence of the immune system not working as it should when fighting inflammation.

So the bottom line is that when you are looking at all the different ways there are to manage depression, you have to start by figuring out what the root cause of it is. Once you know why you're depressed, you can see what treatment options are available.

Me, I work with perfectly normal people who are under a lot of stress and who need a bit of mental plumbing.  I like CBT and I tend to mix it up with positive psychology because I think the two work well together.

If you're suffering a lot, and you want a little extra help from an antidepressant, then you should also see a psychiatrist. You can read about that here: "I'm depressed. Should I pop a pill, go for therapy, or both?"

I think the real problem isn't with whether CBT works or not but at the way people tend to look for help when they're depressed. If you're depressed, don't start off by looking at solutions, like "I want CBT" or "I won't take pills".  Instead, identify root causes and then see what's on the table in terms of treatments. Because if the root cause is your thyroid, then CBT isn't going to work.

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