subject: CBT for Depression [print this page] Cognitive Behavioural Therapy, or CBT, views emotions as a complex mixture of these three different realms of human experience - cognitions (thoughts, mental images and memories), physical sensations, and behaviours. A depressed person will typically show depressive thinking (such as believing they're a failure), feel depressed in a physical sense (like being tired all the time), and will behave in a depressed fashion (such as taking to their bed). These three realms all interact and influence one another. For example, if someone habitually thinks in a depressive way, then they will begin to feel and act in a depressive way. Conversely, changing depressive thinking should diminish the feeling of depression, and consequently their depressive behaviours. To understand how one can counter depressive thinking, it can be helpful to divide a persons cognitions (mental processes) into two categories - thought contents and thought patterns. Thought content is familiar to us all - it's simply what we're thinking. It's the answer to the question "A penny for your thoughts?" For instance, my thought content just now is what I'm going to write in this paragraph. Depressed people have depressive thought content - common themes include that they're a failure, things are hopeless, the future's bleak, they're cursed by bad luck, they're nasty or evil in some way etc. Our thought patterns are less obvious to us, but they are still accessible. Our thought patterns are our ways of thinking (or our thinking habits) rather than what we actually think from minute to minute. They're our ways of viewing our experience of ourselves, others, and the world around us. Depressed people will have thinking patterns that emphasise the bad and unpleasant aspects of their experience, and diminish or even totally negate the good aspects. For example, a depressed person is likely to remember unpleasant or embarrassing events from their past, and rarely recall the fun times they had. The content of our thoughts will change rapidly as we go through our day, and will depend greatly on what we're doing at the time. Our thought patterns are stable and can persist throughout our lives - unless we find that they're causing us (or others) emotional problems and we want to change them! And it is our underlying thought patterns that ultimately determines what our thought content is. Depressive thought patterns produce depressive thought content (and then on to depressive sensations and behaviour). CBT aims to improve depression by changing a person's depressive thinking patterns and helping them develop more balanced, rational and helpful ways of thinking. This will (hopefully!) lead to less depressive thought content and therefore less feelings of depression. The first step is for you to learn to identify your depressive thoughts. You do this by noting what you're thinking about (your thought content) when you feel particularly distressed. This thought or thoughts (it can also be a mental image or memory) is what we call a Negative Automatic Thought, or NAT. You will need to monitor and record your NATs over a period of weeks. NATs are unpleasant but they are very useful to us - they allow us to identify your negative thinking patterns. An example of a NAT might be if you suddenly get depressed or distressed when your partner makes a joke after you've miss-pronounced a word that you're not familiar with. You may think "He's always saying things like that. He thinks I'm stupid, and he's right". Now we will do two things with this NAT. We will want to examine it for depressive thinking patterns, and we will want to "challenge" it in order to test it's truthfulness. Firstly, we will examine it for typical depressive thinking patterns. These are ways of "looking at" things (yourself, others, and the world in general) that tend to generate depressive thought content. Common examples include "Negative Filtering" and "Discounting the Positive" - where a person will focus exclusively on the bad or unpleasant features of themselves, others or the world. Other examples are "Over-Generalising" (taking one comment or event as indicative of things in general), "Mind-Reading" (where you believe you know what someone is really thinking even if they deny it), "Catastrophising" (assuming the very worst in a given situation) and "Black or White Thinking" (assuming that something is either all-good or all-bad, and that there is no in-between these two extremes). In the example NAT I gave earlier, we might say that there are several depressive thought patterns evident. I'd say the person was showing patterns of "Mind-Reading" (she knows what her partner really means), "Over-Generalising" (does he really say these things all the time?), and "Black or White Thinking" (he's right and I am stupid). Identifying these depressive thought patterns allows us to become our own critics - not of ourselves but of our thinking habits. It is common to find that a person will show the same few thinking habits again and again in all areas of life. By being aware that you are (for example) in the habit of Catastrophising and Mind-Reading means that you can pull yourself up when you find yourself doing it. The next time someone passes an ambiguous (to you at least) comment in your hearing, you will be able to take a moment to remind yourself that you tend to "Mind-Read", and that you don't actually know for sure what he or she means - the comment may not necessarily be bad, or even about you at all. And the next time you're having a tough time at work, you'll remember that you're in the habit of "Catastrophising", and that work won't necessarily keep getting worse and worse. It may even improve! Such awareness of our thinking habits can protect us against developing emotional problems. In addition to identifying our negative thought patterns, we will want to challenge the NATs themselves. We do this by holding a mock "trial" for these thoughts, where we ask ourselves to present real, hard evidence both for and against the truthfulness of the NAT. We usually find that the evidence stacks up against the NAT, showing it for what it really is - the unhappy product of depressive thinking patterns - not at all the rational, considered, "obvious" thought based on reality that it had been pretending to be! Taking the example given earlier, we'd look for evidence for and against the truthfulness of the statement "I am stupid" (I'd leave it up to them as to how they defined the term!). What sort of evidence does he or she have that supports the statement? Their partner (occasionally) says that they are. Does anyone else say it? Their boss? No. Their friends? No. Strangers in the street? No. So what about evidence against this statement? They finished school with some qualifications. Maybe they went to college afterwards. They're quick witted and likeable. They can hold down a job. They can look after themselves. Drive a car. Even read and write... "Stupid" people would surely struggle with all of these things. The verdict - the thought "I am stupid" - is guilty of irrationality and is hereby sentenced to oblivion. It is replaced by the more realistic and helpful thought "My partner sometimes says I'm stupid, but he's ignorant himself for saying that because it's clear that I'm not!". This thought certainly isn't depressive. So now, all being well, you will have learnt to identify and challenge your NATs and to recognise your depressive thinking patterns. You are able to think in a less depressed way, and you therefore feel and behave in a less depressed way. But that's not the whole story. Many people who experience emotional problems want to know why they have these difficulties. CBT can help here as well, allowing the individual to have a fuller understanding of themselves and their emotional lives. CBT hypothesises that every one of us has a set of "Core Beliefs (CB)". These are the fundamental views we have of ourselves, others, and the world at large and largely dictate our thought patterns, and hence our thought content. It seems likely that CBs are formed during our childhood and adolescence (and very occasionally in adulthood), and that the influence of our parents, siblings and schooling are critical. Positive and negative experiences during these years help to mould our CBs that can then (potentially) influence us for the rest of our lives. Some CBs are beneficial. CBs such as "I can cope with most things" or "Others usually don't mean me harm" or "The world is generally an OK place in which to live" are an excellent platform from which to launch into life. They have properties that make people very resistant to emotional problems. Of course bad or unpleasant things will happen to these people (or people they love), but their emotional response will be appropriate and not exaggerated or prolonged. Most people who do have emotional problems have unhelpful or damaging CBs, and these issue in problematic thought patterns and NATs. Common examples of such CBs are "I'm a failure", "I'm unattractive", and "I'm nasty/evil". CBT challenges such Core Beliefs in the same way as it challenges NATs - after all, the two are closely related. Successfully (and repeatedly) challenging unhelpful CBs will loosen their grip on your life, allowing more balanced and realistic CBs to replace them. This in turn makes it less likely for you to view life in unhelpful and problematic ways, and will reduce the occurrence of NATs. And this will make you feel less depressed.
