What is depression and how can CBT help?

“Heavy”, "burdensome", “lost”, “empty”, and “exhausting”. As a psychotherapist, these are some of the words I have heard people use to describe their experiences living with depression. For many, the feeling of emptiness can be all consuming and leads people to experience negative thoughts about themselves which then increases feelings of sadness and anxiety that leads to a loss of interest in the things that once brought them joy. As the loss of interest persists, they further disengage from the people, hobbies, and places that held meaning and excitement, pushing them further away from their connections and deeper into the dark tunnel of despair. It's this cyclical experience that can make depression feel debilitating and as though it is never ending as people get caught in the cycle of negative thoughts, negative moods, and depressed behaviors. 

Depression is experienced as a feeling of prolonged sadness that lasts for a period of two weeks or longer, a loss of interest in activities that once brought joy,  which impacts a person's day to day functioning from sleeping, eating, and the ability to complete day to day tasks. A large part of the cycle of depression are the thoughts about the experience of depression itself which can further exacerbate the negative moods and lead to all sorts of avoidant behaviors, which is why cognitive behavioral therapy a.k.a. CBT, has been found to be an effective treatment for depression.

What is Cognitive behavior therapy?

Created by Aaron Beck in the 1950’s, Cognitive behavioral therapy (CBT) is an evidence based form of talk therapy. This form of talk therapy emphasizes the connection between our thoughts, feelings, and behaviors suggesting that it’s not so much the situation or life circumstances that leads a person to feel a certain way but rather, it's the way a person thinks about the situation that leads to an emotional response which can then 

lead people to engage in certain behaviors. 

In other words, if we adjust or change the way we think about things we will change the way we feel and this will have an effect on how we behave. 

When beginning cognitive behavioral therapy, your therapist will introduce you to this model and help you become more acquainted with your own thoughts and thought patterns. A common practice in CBT is helping you to learn to identify thoughts that you experience in different situations by using what is referred to as a thought log.

Situations	Thoughts	Feelings	Behaviors	Alternatives

Using a thought log, you will be encouraged to keep a record of different situations you experience throughout the week, mostly the ones that lead to heightened emotions. 

Once you are comfortable with identifying thoughts your therapist will introduce you to what is referred to as “cognitive distortions” a.k.a. thinking errors. Thinking errors are different ways that people think about their experiences which are sometimes exaggerated or unsubstantiated and as a result can create heightened emotional responses in people. Experiencing emotions is natural and necessary, however, when our thinking becomes distorted or exaggerated it can lead to distress. When this is happening a technique referred to as the “evidence technique” , another CBT tool, is helpful for people to assess the validity of their thoughts. This process often helps people see that there is limited evidence supporting their initial thought and more evidence that counters it. Once this is realized the person is better able to rationalize their experience and to replace the thought with one that has less emotional impact. 

When it comes to depression, the experience can feel like all of the words described at the beginning of this blog and the longer the depression persists the harder it can be for people. When a person struggling with depression begins CBT, their experiences of depression are validated and they are supported to reflect on the ways that their thoughts about what they are experiencing may be getting in the way of their healing. Once a person works through some of the negative thinking patterns, and begins creating new and more realistic thoughts about their situations they begin to feel less “stuck”, less distressed, and more willing to take small but necessary steps that will lead them out of the dark tunnel and back to their friends, families, hobbies, and ideally, joy.