Cognitive Behavioral Therapy (CBT) for the Depressed Step 2

In the previous post, Step 1, we discussed the viscous cycle between thoughts, behaviors and emotions and the affects they have on each other and our depressed mood.  Today we will go through part 2 of using CBT to help overcome depression.

Step 2

Part 2 is about understanding the relationships/links between thoughts, emotions and behaviors.

In yesterday's post we discussed how Dave woke up in the morning and thought to himself, "There's no reason, no point!" "I'll only screw up one more time!"  These thoughts will most definitely cause Dave to feel depressed and wanting to stay in bed.  With the continued negative/depressed thoughts, Dave continues to feel depressed and thus stays in bed and pulls the sheets over his head.  The self-defeating, depressed thoughts continue to grow as he stays in bed.  His initial thought of "there is not point!" is exasperated by his decision to stay in bed and his depression grows.   So, the viscous cycle continues.  

Depression can happen to anyone.  In fact, one in four people report being depressed at some point through out a given year.  Different variables increase the  occurrence of depression: biological make-up, childhood events, how you where raised or reaction to life events. The most important factor that keeps it going though, is the way we think about the variables. The way we think can make us feel depressed and often times depression can lead to feelings of shame, anger, guilty etc.  Feelings we will go into detail in future posts.  But for now, we are focusing on the one thing we can control, our thoughts.  Learning to control your thoughts will help learn to deal with depression.  

So, what are some common thoughts that lead to the feeling of depression.

1. There is no hope.  Nothing can change
2. I'm worthless; I do nothing right.
3. It's all my fault.
4. The world is an awful place.  It sucks. 
5. All of my friends are successful but I just do not have what it takes.

So, we could go on and on listing negative thought patterns.  The key is to recognize them. Write them down.  I have provided you with two worksheets you can use to recognize the negative thoughts that are causing you to feel depressed.  So, we know the thoughts that lead to depression.  Now we will briefly discuss what depression feels like.

What are the physiological sensations of depression?

1. Tired
2. Lethargic/fatigue
3. Lack on concentration
4. Lack of motivation
5. Short-term memory loss
6. Sleep too much
7. Sleep too little
8. Eat more or less
9. Not interested in hobbies or interests
10. Lack of interest in sex

So, our negative thoughts and the physical changes above have  a direct influence on our behavior.  If we think there is no hope, sleep more, eat less and lack motivation we will most certainly do less and less.  We will stay in bed more, miss more work and isolate ourselves.  We stop doing the things we love and enjoy.

Summary

In CBT, we aim to break those cycles by changing something - what we think or what we do. We might start by looking at what might be easiest to change. Perhaps in this case, it might be easiest to change what we do.

How would Dave have felt if he had got up anyway, in spite of how he was feeling. Maybe ate some breakfast, had a shower, got dressed, and perhaps went out for a walk. How would that affect his depression? What would that do to the way he was thinking?It's very likely that his mood would have improved, and that he would have started to think a little more realistically. He might have even enjoyed his day,or got a sense of achievement from having done something.

Have a look at what you've written down on your sheets of several examples of distressing situations (Step 1 practice). What links can you see between what you think and what you do, and how they affect the way you feel.

In the next step, you'll be starting to make some changes that will help you learn to cope with your depression.

But in the mean time, take a look at the chart below and see what Dave can do differently.

So, what can Dave do? He can change his thoughts or he can change his behaviors.  Both actions will have the same impact; make him feel  less depressed, help him learn how to deal with depression.

Think Differently

Act Differently

I may make mistakes like every one else on this planet, but I’m certainly not worthless.  Worthless means I have nothing to offer.  I have much to offer.  The world is filled with negativity, but on  a whole the world is a good place.  A place that I can make better.  I do not have to participate in the negativity. I proud of my best friend for getting his promotion.  He worked hard and deserved it.  I know that if I work hard, I can get promoted too. I can’t sit in bed and do nothing.  I was made to move and be productive.This is not a dress rehearsal..  I don't have time to waste. I’m not alone in this battle against depression.  If I get up and get out, I can share my story, help others and learn from them. It’s okay to feel sad about this situation, but I can get through it. I’m looking through those ‘gloomy specs’ again. What would be a more helpful way of looking at things? If I do something anyway – I’ll feel better.

Do things anyway – in spite of how I’m feeling. Get up. Get out. Do something enjoyable or useful. Be with or contact others. Focus attention outside of me and my situation. Help others. Exercise daily. Journal daily. Meditate daily. Stop watching the news and reality TV. Read self-help books and blogs.