Depression and CBT

Depression sufferers have an overall negative view of themselves, the world outside them, and what is likely to happen to them in the future. These beliefs are called 'thinking errors'.

CBT was developed by Aaron T. Beck in the 1960's to first lessen the symptoms associated with depression. By first identifying these thinking errors and then standing back in the position of observer to reality test these negative thoughts as hypotheses, rather than accepting them as facts. Then alternative ways of thinking can be substituted for the original negative automatic thoughts which are more balanced, and reflect the persons experience more accurately.

As an information processing model clients are shown that it is not what they experience but how they interpret it which determines how they are. CBT in the treatment of depression has statistically proven to change brain chemistry without medication, and is endorsed right across the board from within the NHS and throughout the private sector.

How Does CBT Work

Cognitive Behavioural Therapy begins with an assessment using diagnostic tests to measure the intensity of the symptoms associated with depression (see depression questionnaire). Then a problem list of five or six of the presenting problems are drawn up with the therapist. Clients collaborate with the therapist to decide how they will be at the end of the therapy.

The first stage of the therapy is aimed at bringing depression scores back to the normal range. Using a series of behavioural techniques (breathing, daily activity schedules, pleasure ratings and experiments) to help clients monitor their ability to change their life experience. Usually a minimum of 5 sessions is necessary to achieve depression scores in the normal range.

The second stage of the treatment works at the identification and challenging of negative automatic thoughts. Negative automatic thoughts are plausible, and are generated around specific themes (i.e. “I'm not good enough”, “I'm worthless”, “I'm never going to change” etc.). Clients either use a voice activated dictaphone or write them down to catch them, asking themselves “What was going through my mind just before I started to feel this way?”

These negative thoughts are then analysed against errors in logic which depressed people normally make, and through socratic questioning and guided discovery clients learn how to challenge and rewrite these thoughts in a more balanced way. Five sessions minimum are set apart to learn to identify and challenge negative automatic thoughts. The last five sessions work with deeper core beliefs and schemas which were previously known as the unconscious.

Modifying these deeply held beliefs which were formed in the first fifteen years of life mitigate against relapse. Core beliefs function like absolutes or prejudices in a persons life and identifying these through diagnostic tests target specific areas which are at the root of depressoganic thinking. They have cognitive, affective and behavioural components, and by modifying them (“I'm stupid”, “I'm not good enough”, “I'm a failure” etc.) by using evidence and experience of a new belief, over time, alters the original template at the heart of the way people see themselves, others, and the future and aid relapse prevention

CBT shows the relationship between negative thoughts about oneself which are critical, feelings of depression, sadness, anger, and behaviours which are defeatist and avoidable.

Changing negative thoughts by substituting for valid positive ones will aid in changing mood.

Depression Questionnaire
(Pdf)

The Goals of CBT

The purpose of Cognitive Behavioural Therapy is to first identify thoughts and beliefs by self monitoring and education to raise self awareness and understanding of the relationship between thoughts (arrow) feelings (arrow) and behaviours.

Cognitive therapy is a short term, here and now approach which can help you eliminate the symptoms associated with depression. It will improve your present coping strategies and give you more effective ways to improve your mood. Through this your moods will be more easy for you to control.

Through CBT you can see that the negativity of your thoughts, although appearing valid, are probably not formed by accurate perception of what is real but are usually distorted. At the Centre for Cognitive-Behavioural Therapy we use a holistic approach which includes diet and nutrition, exercise and relaxation techniques, aromatherapy, massage, breathing techniques, and a battery of visualisation and imagery work. There is a great emphasis on psycho-educational training to help clients use both sides of the bicameral mind.

The neuroscientist M.Choudhary in his Reith Lectures 2005 emphasised that the future would include an integration of both hemispheres of the brain (the low arousal goal within goal left side of the brain and the imaginative take it as it comes, 'smell the roses' right half of the mind). Daniel Pink (link) in his new book 'The Whole Mind' states that the creative right brain problem solver is the one that will be in demand for his original lateral thinking.