By Thanos Napolias, MA
As any living being can attest, problems are unavoidable. Some problems are simple and their solutions are relatively immediate, such as figuring out an alternative route to work when there is heavy traffic and running late to work. Other problems are more distressing and complex, like dealing with an unexpected expense that throws an entire family out of budget. In both cases though, it’s essential to carefully examine the problem and then apply specific solutions to address each aspect, one at a time.
Like most mental health concerns, depression can be seen as a problem, since it causes significant distress and functional impairment for over 15,000,000 American adults each year, according to the Anxiety and Depression Association of America. Therefore, when it comes to depression, a similar strategy of examining the problem and applying specific solutions to address each aspect can enable individuals who struggle to overcome their symptoms. Even though mental health challenges seem more complex than everyday unwelcome matters, therapy models that concretely address the various parts of depression have been showed to be very effective.
Traditional Cognitive Behavior Therapy conceptualizes depressive concerns as having four parts: (1) Negative emotions, (2) Distressing physiological responses, (3) Maladaptive cognitions (thinking), and (4) Maladaptive behaviors. As such, the first step in Cognitive Behavior Therapy for depression is to teach individuals to break down their experiences into these four parts, in order to come up with step-by-step solutions to each one.
For instance, we can think of a fictional person “Sally”, who is a college student experiencing depression. Sally feels sad all the time and is also afraid that she has fallen too far behind with her assignments (negative emotions). Sally also has no energy to attend her classes, feels tense in her neck and back, and she has a hard time falling asleep at night (distressing physiological responses). As a result, Sally starts to think of herself as a failure and wonders whether she will be able to graduate (maladaptive thinking), and she starts to spend more and more of each day in bed, avoiding classes, exercise, and social activities (maladaptive behaviors).
When Sally came to us for therapy, using the above cognitive-behavioral approach we helped her to realize that when a stressor came up she tended to feel sad, down, and somewhat anxious. On a thinking level, she tended to make unhelpful predictions about her future and for herself, such as “I am going to fail that class,” “The professor will think that I am lazy,” “Even if I try to go out with my friends, I will feel as miserable as staying in bed.” When she thought this way, it triggered Sally’s physiological sensations such as tiredness, muscle tension, as well as feeling “unreal and detached” from the world. In these difficult moments, Sally’s behaviors included staying in bed, withdrawing from friends, dropping out of her favorite workout class, and avoiding returning to her classes, which paradoxically reinforced her unhelpful thoughts and feelings.
Once Sally understood how her feelings, thoughts, sensations, and behaviors worked together to maintain her depression, she began with the help of her therapist to identify more helpful interpretations about her stressors and adopt small behavioral changes that significantly reduced her depression. With appropriate guidance, Sally made gradual shifts in her behavioral patterns, such as returning to her work out class and inviting a friend over, which had a positive impact on her mood and eliminated many emotional and physiological symptoms of sadness and fatigue. Similarly, over time she began to notice and challenge her unhelpful thoughts. At times she even tested her thoughts by approaching the professor and explaining her situation, and other times she started observing her thoughts without necessarily believing their content. Over time and with consistent practice, Sally overcame her depression, one step at a time.
Sally’s brief story is an example that mental health disorders are not permanent and that it is not overly simplistic to view them as problems to be overcome. Like Sally, individuals who struggle with depression can develop methods to live much happier and meaningful lives!