There are many forms of depression, and everyone experiences depression differently. However, let me share three main types of depression that I work with in my practice.
When you have experienced a loss, a pain, or a life set-back, it's common to feel depressed. For a while, you might experience sadness, a loss of energy, a sense of powerlessness or helplessness — even hopelessness. Most of us experience depression of this sort from time to time. The depressed mood might last a few days or weeks, and sometimes longer. Some therapists call this "normal depression" because it is such a common experience.
Other people experience a low-grade sense of depression that sticks around for a very long time. We call this type of depression "dysthymia" or "dysthymic disorder," and it is measured in years of duration. People who suffer from dysthymia may manage to hold a job, have relationships, and work toward life goals. However, they experience a nearly-constant low mood, a sense of fatigue, difficulty concentrating, or other symptoms. These symptoms last for at least two years (and often much longer.)
Still other people experience intense depressive episodes that fill them with a sense of acute hopelessness and helplessness. These depressive episodes might last weeks or months. When people talk about "clinical depression," this is usually what they are referring to. These episodes might be a part of a diagnosis we call "major depressive disorder." Although it is an intense experience, major depressive disorder is surprisingly common. As many as 25% of women and 12% of men will fit the criteria for MDD at some point in their lives.
Cognitive-behavioral therapy was originally developed as a treatment for depression, and it remains as one of the most effective approaches. The focus in therapy is on shifting both thoughts and actions in order to create a shift in emotion, or mood. Let me share a little history on the development of cognitive therapy.
Cognitive therapy originated in the 1960s with a doctor named Aaron Beck.
At the time, Dr. Beck was testing the popular theory that depression was "anger turned inward." However, he didn't find much support for that theory. Instead, he found that folks who were depressed often had a pattern of negative thinking.
Specifically, he found that there were three types of thought-patterns that seemed to accompany depression. His clients tended to have negative thoughts about:
Dr. Beck found that by helping his clients to shift this "cognitive triad" — thoughts about themselves, the world, and the future — the depressed mood could be altered. This finding helped to spark a whole new development in the world of psychotherapy.
In my own therapeutic work, I find that the first part of this cognitive triad is the most powerful. Changing beliefs about ourselves (including what we call "core negative beliefs") is perhaps the deepest form of cognitive therapy. These core negative beliefs have an extremely strong influence on our mood.
As an example of this, let's imagine that a woman named Marcia who is experiencing persistent depression. We find that Marcia has the following core negative belief about herself:
That core negative belief will lurk in the background of Marcia's mind, giving rise to a series of "automatic thoughts" — thoughts that flow habitually on their own. These daily, habitual thoughts might include things like:
Not only will these thoughts fuel a sense of depression; they will also contribute to isolating, withdrawing, self-defeating behaviors. All three of these elements — the thoughts, the feelings, and the behaviors — may end up cycling, keeping the depression pattern in place.
As a cognitive therapist, I always try to help my clients alter negative thoughts about themselves. I find that if we can begin to shift (even gradually) some of the core beliefs, it creates room for new daily thoughts to arise. This will often spark a shift in mood — and make it easier to try new behaviors.
To return to Dr. Beck's work in the 1960s: with his focus on changing automatic thoughts and core negative beliefs, Dr. Beck helped launch the field of cognitive therapy.
In parallel with this development, behaviorally-oriented therapists began to address the fact that many depressed clients tended to withdraw from friends and family, stopped exercising, and set aside fulfilling or pleasurable activities in their lives.
These therapists found that when clients were encouraged to make time for positive social connection, exercise, or other fulfilling activities, they often experienced an improvement in mood.
Today, cognitive-behavioral therapy (or CBT) involves a combination of both these approaches. In CBT, we support our clients in:
CBT is based on the idea that as we change both our thoughts and our actions, our feelings will follow.
Although our goal as cognitive-behavioral therapists is to help people feel better, we also want to support our clients in thinking and acting in more self-supportive ways. We believe that this is one of the best methods for maintaining a sense of peace, fulfillment, and empowerment.
Please contact me if I can answer any questions about cognitive-behavioral therapy for depressed mood. For more detail on treatment techniques, you can also read the following Q&A's: