COGNITIVE BEHAVIORAL THERAPY FOR DEPRESSION
Cognitive behavioral therapy helps improve people’s moods and behavior by changing their way thinking; also, how they interpret events and talk to themselves. This form of psychotherapy helps guide people into thinking more realistically and teaches them coping strategies to deal with their depression. Cognitive therapy is in most cases a short-term treatment that can have long-term results. I will discuss depression in adolescence and how it effects personal adjustments, which may often continue into adulthood. I will also discuss depression in the elderly. There are different approaches to treating depression, the main approach that will be discussed is cognitive behavioral therapy, which is a way to break the cycle for depression.
What is Cognitive Behavioral Therapy?
Cognitive behavior therapy helps people break the connections between difficult situations and their habitual reactions to them. This can be reactions such as fear, rage or depression, and self-defeating or self-damaging behavior. It also teaches people how to calm their mind and body, so they can feel better, think more clearly, and make better decisions. Cognitive therapy also teaches people how certain thinking patterns are causing their symptoms. This is accomplished by giving people a distorted picture of what’s going on in their life, and making them feel anxious, depressed or angry for no good reason.(Francis, 2000) When people are in behavior therapy and cognitive therapy, it provides them with various tools for stopping their symptoms and getting their life on a more satisfying track. In cognitive therapy, the therapist takes an active part in solving a patient’s problems. He or she doesn’t settle for just nodding wisely while the patient carries the whole burden of finding the answers they came to therapy for initially. Cognitive therapists teach patients to identify their negative thoughts, recognize their erroneous nature and devise a corrective plan that leads to more positive assessments and an ability to deal more realistically with every day problems.(Burns, 1996-2000) Dr. Frances M. Christian, a clinical social worker and cognitive therapist at the Medical College of Virginia in Richmond, says, ?Thoughts and beliefs have a lot to do with how people feel and behave. Early in life, people develop core beliefs about themselves and other people and about how the world operates.?
Cognitive behavioral therapy has been very thoroughly researched. In study after study, it has been shown to be as effective as drugs in treating both depression and anxiety. In particular, cognitive behavioral therapy has been shown to be better than drugs in avoiding treatment failures and in preventing relapse after the end of treatment. A cognitive therapist directs a patient’s attention to automatic thoughts, the things people say to themselves, that result in unpleasant feelings. (Stopa, 2000) For example, someone prone to anxiety attacks might automatically think, I’m going to mess up, when taking an exam, participating in a school event or being interviewed for a job. After failing such a task, the person might conclude, again automatically, I’m a loser. In therapy, the person is helped to recognize delusions in thought, which include exaggerating the sense of threat, anticipating disaster as the outcome, and over generalizing from one negative experience and ignoring times when things went well. Finally, once the damaging automatic thoughts are recognized, the person is helped to examine how realistic they are, and they consider alternative explanations, then imagine other outcomes and realize that the symptoms of anxiety are not the prelude to a heart attack or some other medical disaster. (Stopa, 2000) This same approach is practiced for depression.
The difference in the therapeutic approach versus medicating is dramatic, and the relief people feel is immediate. Instead of dwelling on the negative, which the other therapists sometimes do, they acquire therapeutic tools the depressed can apply on his or her own, in case they may find themselves slipping into old patterns of thought or behavior. (Stopa, 2000)
Furthermore, studies have shown that the results of cognitive therapy are long lasting, with relapse rates much lower than with other modes of treatment, including psychiatric drugs. And while medication is sometimes used, at least briefly, to relieve intense emotional disturbances and improve receptivity to therapy, most patients can be spared the side effects of drugs, which may include the inability to function sexually, upset stomach, difficulty sleeping and difficulty concentrating.(Brody, 1996) While no one approach to psychotherapy is appropriate for everyone, many thousands of patients have benefited from the strategies unique to cognitive therapy. In the 30 or so years since the approach was developed by Dr. Aaron T. Beck, a world-renowned psychiatrist at the Beck Center for Cognitive Therapy in Philadelphia, it has become the most scientifically tested model of psychotherapy. (Brody, 1996)
What is Depression?
According to Dr. Judith S. Beck and Dr. Aaron Beck, her daughter, ?Patients have continual unpleasant thoughts and that each thought deepens the depression.? However, these thoughts are not based on facts and result in feelings of sadness this is far beyond what the situation guarantees, it has to do with hypothetical situations. ?Depressed persons make such mistakes over and over,? Quinn has written. ?In fact, they may misinterpret friendly overtures as rejections. They tend to see the negative, rather than the positive side of things. Plus they do not check to determine whether they may have made a mistake in interpreting events.?(Quinn, 1998) Depressed thinking often takes the form of negative thoughts about oneself, the present, and the future. The mood in depression is almost always experienced as sad.
According to a patient’s letter written and later published with the permission of William Morrow and Company, (publisher of Moodswing): from the book, ?Depression and it’s Treatment?, her experience with this mood disorder was despair and uselessness. Eventually she found herself going to sleep earlier at night just to stop the anxious thoughts entering her mind. The patient says her appetite got worse and she became physically ill with the progression of her depression. The statement later reads, ?If I had to see a psychiatrist, it meant that I was probably going insane, and this thought made me even more frightened. It was more than I could stand. The fear of being mentally ill was so horrible that I decided to take my entire bottle of sleeping pills rather than face the shame of being a mental patient.?(Griest ; Jefferson, 1992)
Depression can strike anyone at any given time. It affects 5% of the population at any time and at least 10% of the population at some point in their lifetime. At least 10% of the people with major depression end their lives by suicide. (Greist ; Jefferson1992)
Depression in Adolescents
How prevalent are mood disorders in children and is an adolescent with changes in mood considered clinically depressed? Oster has said the reason why depression is often over looked in children and adolescents are because ?children are not always able to express how they feel.?(Oster ; Montgomery 1997) Sometimes the symptoms of mood disorders take on different forms in children than in adults. Adolescence is a time of emotional turmoil, mood swings, gloomy thoughts, and over sensitivity, it is also a time of rebellion and experimentation. Therefore, the diagnosis should not lie only in the physician’s hands but be associated with parents, teachers and anyone who interacts with the child on a daily basis. Unlike adult depression, symptoms of adolecent depression are often camouflaged. Instead of expressing sadness, teenagers may express boredom and irritability, or may choose to get involved in risky behaviors. (Oster & Montgomery, 1995) The key indicators of adolescent depression include a drastic change in eating and sleeping patterns, significant loss of interest in previous activities, aggression and boredom. The signs of clinical depression include marked changes in mood and associated behaviors that range from sadness, withdrawal, and decreased energy to intense feelings of hopelessness and suicidal thoughts. Depression is often described as an exaggeration of the duration and intensity of ?normal? mood changes (Oster & Montgomery, 1995), constant boredom, disruptive behavior, peer problems, and increased irritability and aggression. (O’Connor 1997)
For many teens, symptoms of depression are directly related to low self-esteem coming from increased emphasis on peer popularity. For other teens, depression arises from poor family relations which could include decreased family support and perceived rejection by parents (Quinn, 1998). Adolescent suicide is now responsible for more deaths in children age 15 to19 than cancer (Oster ; Montgomery, 1997).
Whereas, Oster ; Montgomery stated that ?when parents are struggling over marital or career problems, or are ill themselves, teens may feel the tension and try to distract their parents.? This ?distraction? could include increased disruptive behavior, self-inflicted isolation and even verbal threats of suicide. So how can the physician determine when a patient should be diagnosed as depressed or suicidal? Quinn suggested the best way to diagnose is to ?screen out the vulnerable groups of children and for the risks factors of suicide and then refer them to treatment.? Some of these ?risk factors? include verbal signs of suicide within the last three months, prior attempts at suicide, indication of sever mood problems, or excessive alcohol and substance abuse. Many physicians tend to think of depression as an illness of adulthood. In fact, Quinn stated that ?it was only in the 1980’s that mood disorders in children were included in the category of diagnosed psychiatric illnesses.? In actuality, 7-14% of children will experience an episode of major depression before the age of 15. An average of 20-30% of adult bipolar patients report having their first episode before the age of 20. (Quinn, 1997) Oster & Montgomery, added that an estimated 2,000 teenagers per year commit suicide in the United States, making it the leading cause of death after accidents and homicide.
Furthermore, Clarke stated that it is not uncommon for adolescents to be preoccupied with issues of mortality and to contemplate the effect their death would have on close family and friends. Once it has been determined that the adolescent has the disease of depression, what can be done about it? Clarke has suggested two main avenues to treatment: ?psychotherapy and medication.? The majority of cases of adolescent depression is mild and can be dealt with through several psychotherapy sessions of intense listening, advice and encouragement. (Clarke, 1999) On the other hand, for the more severe cases of depression, especially those with constant symptoms, medication may be necessary and without pharmaceutical treatment, depressive conditions could escalate and be fatal.
However, Oster & Montgomery added that regardless of the type treatment chosen, ?it is important for children suffering from mood disorders to receive prompt treatment because early onset places children at a greater risk for multiple episodes of depression throughout their life- span.? Until recently, health professionals have ignored adolescent depression. Now there are several methods of diagnosis and treatment. Although most teenagers can successfully over- come the emotional and psychological obstacles that lie in their paths, there are some that find themselves overwhelmed and full of stress. (Franklin, 2000) How can parents and friends help out these troubled teens? And what can these teens do about their constant and intense sad moods? With the help of teachers, school counselors, mental health professionals, and of course parents, the seriousness of a teen depression can be accurately evaluated and plans can be made to improve their contentment and ability to live life fully.
Depression in the Elderly is becoming more prevalent in today’s society as people add stress and pressure to their daily lives. The elderly population is not eliminated as a candidate for a disorder just because they may be retired. In fact, mental disorders affect 1 in 5 elderly people.(O’Conner, 1997) Some elderly people may not exhibit the traditional symptoms of depression. These individuals may have symptoms of depression that go unnoticed due to the fact that those symptoms are being attributed to a different illness. ?One half of all depressed patients seen by general physicians are not identified as depressed?. (Quinn, 1998).
In addition, there appear to be a few fundamental differences between depression in the adolescent and old. Elderly people tend to have more ideal symptoms, which are related to thoughts, ideas, and guilt. Elderly depressed individuals are also more likely to have psychotic depressive and melancholic symptoms such as anorexia and weight loss. Finally, older people tend to have more anxiety present in their depression than adolescent patients do (Quinn, 1998).
On the other hand, some believe that low blood pressure can cause fatigue and anyone with these two symptoms could possibly be diagnosed with depression. This is a snowball effect where the low blood pressure causes the fatigue, which in turn causes someone to feel useless, which further develops into other possible depressed symptoms. In addition low blood pressure found in the patients this was not directly related to any chronic health condition. (Quinn, 1998). Low blood pressure is not the only risk factor for the development of depression. Some other factors include people dealing with loosing their jobs, finances, physical ability to do things, or relocation. Family problems dealing with divorce, siblings, children, or a death can also send one on a downward spiral. Changes in the brain such as decreased adaptive capacity, neurotransmitter and receptor changes, cognitive impairment, and dementia increase the risk of depression (Oster & Montgomery, 1995). Many senior citizens take medication regularly for various ailments. Due to the fact that they take multiple prescriptions daily, the physician must also be familiar with how the various drugs interact with each other.
Nevertheless, the biggest challenge when treating depression is convincing the patient to stick with any type of therapy. Patients become stubborn and quit taking their medication or visiting the doctor as soon as they begin to feel better. This is a huge mistake because it will only cause the individual to fall back into the old patterns and problems. Depression is one of those conditions that can return if proper preventative measures are not taken. Patients need to understand that depression can return at any time and certain precautions must be taken. The elderly deserve our respect and support through their physical and emotional difficulties because we would not be around if not for them. The diagnosis and treatment of depression in the elderly may not be a simple task, but it is one that deserves more attention and further advancement.
Effective Treatment for Depression
Cognitive Therapy is an effective treatment for depression. It is based on the idea that how people think largely determines how people feel. This form of Therapy teaches people to recognize and challenge upsetting thoughts. Learning to challenge negative thoughts makes the patient feel better and helps them to think more realistically.
Lusia Stopa explains that people cannot simply just decide to think positive. (Anyone who has suffered from depression knows that there are no simple magic answers!) Instead, she shows that people can begin to notice when and where negative thoughts occur, systematically decide how accurate these thoughts are, and where necessary, to change them to something more helpful to people. (Stopa, 2000) According to the behavioral aspects of Cognitive Behavioral Therapy it recommends to monitor daily activities with a ?Weekly Activity Schedule?. Activity schedules are important because they help patients to see what there’re actually doing as well as how much pleasure and sense of achievement (if any ) people get from particular activities. When they are feeling depressed, it can be very difficult to motivate themselves to get going again or to start changing behavior. The three main techniques for overcoming this are: planning ahead, identifying pleasurable activities, and breaking tasks into small manageable steps. (Quinn, 1998).
Lusia Stopa says that the process of challenging negative thoughts is important to overcoming depression, but that learning the skills can take time. However, it gets easier with practice. Challenging bad thoughts and substituting them with more realistic thoughts makes people feel better about themselves and begins to break the cycle of depression. Also, these skills stay with the patients for the rest of their life and in the future help protects against the recurrence of depression. (Stopa, 2000).
Psychotherapy or Cognitive therapy, is the preferred treatment of choice for depression, regardless of the depression’s severity or symptoms. Multiple Meta-analyses have come to this conclusion, so that it is not a conclusion based on just one case study. (Stopa, 2000). Combined treatment of psychotherapy and medication should be the second choice, when choosing effective treatment options for depression. This is likely the most commonly used treatment for depression today and there is absolutely nothing wrong with it. A patient should never go against professional advice given with regards to a patient’s treatment, unless he or she has first discussed it with their doctor. Especially with depression, it is better to play it safe, than be sorry. According to The Depression Source Book, by Brian R. Quinn, medication alone should be a person’s last choice and only used as a last resort. Although people will likely gain some short-term relief of the most outward symptoms of their depression, studies have shown that medications don’t work very well in the long-term. Those who choose to take psychotropic medications should be informed as to the negative and adverse side effects of those medications. Cognitive Behavioral Therapy is considered the preferred clinically proven therapy for depression. (Stopa, 2000)
Cognitive behavioral therapy, in most cases, is a short-term treatment that can have a long-term end result. In any case, this form of psychotherapy does help people think more realistically whether they are an adolescent or an elderly patient. Cognitive behavioral therapy without the use of medication is a good way to break the cycle for depression. Additionally, it is also a powerful self-help technique for dealing with depression and other negative emotions by consciously changing the way we think. To conclude this discussion, depression is a serious mental disorder that can strike anyone at any given time. However, anyone who is suffering from mood disorders can climb their way out a downward spiral of misery, with the strategies behind cognitive behavioral therapy.