Think yourself out of depression: The cognitive model
June 25, 1999
Web posted at: 8:56 AM EDT (1256 GMT)
By Ronald Pies, M.D.
(WebMD) -- Many depressed people wonder: Is depression something I can think my way out of, or is it a medical problem?
Let's say you were hoping to land a big promotion and discovered you were passed over for someone 10 years younger. Or maybe you just got a "Dear John" or "Dear Jane" letter that came like a bolt out of the blue. Right now you might be feeling down, wanting to binge on chocolate chip cookies and sleep most of the day -- generally feeling like a worthless loser. In short, you're depressed. The cause of your depression was being passed over for the job or being rejected, right? Wrong, say practitioners of cognitive-behavioral therapy (CBT).
The cause of your depression may be your own irrational and self-defeating thoughts, according to the principles of CBT. ("Cognitive" simply refers to thoughts, ideas or the ability to process information.) By the same token, the way to pull out of the depression is to change the way you think. If all this sounds hard to swallow, consider the way a three-month-old infant would react to seeing a loaded revolver waved in front of his face. Most likely he would be curious or indifferent or even amused by the strange object. Try the same thing with most adults, and you would probably find a very frightened individual. The difference lies not in the gun, but in the very different ways infants and adults think about guns.
When people become clinically depressed, CBT theorists argue, they're usually tormenting themselves with unproved, exaggerated, self-deprecating thoughts. They may not be aware of them, but these thoughts fuel the depression, nevertheless. For example, the depressed individual may think, "I got passed over for the job, so I must be a total flop in life. I'll never get a promotion now -- in fact, I'll probably never get anywhere in life!" This kind of exaggerated, all-or-nothing thinking leads to the feeling we call depression.
Cognitively oriented therapists help depressed and anxious people challenge these irrational ideas, and replace them with more constructive ones, such as, "It's certainly unfortunate that I got passed over for the job, but it's not the end of the world. It doesn't mean I'm not a worthwhile person or that I'll never get a promotion." In addition to changing thoughts, CBT aims at changing behavior. For example, someone who constantly avoids asking people out might be given a CBT homework assignment like inviting somebody out to dinner or a movie. (Some therapists might even instruct the patient to get rejected deliberately -- just to learn that it's really not the end of the world!)
Are all cases of serious depression entirely due to bad thinking? Almost certainly not. Clinical depression is the result of a complex interaction involving genetic, biochemical, environmental, social and cognitive factors. Recent research by Dr. Laura Jean Bierut and colleagues at Washington University has turned up an interesting difference between men and women who develop major depression. In men, depression is only slightly related to familial or genetic factors, and is heavily influenced by environmental factors. In women, major depression is more closely linked with familial and genetic factors. In both men and women, environmental factors are important in the development of depression. Thus the cognitive theory of depression is only one piece of the puzzle -- though a very important one.
Medication may still help
Can all depressed individuals be treated with CBT alone? Probably not. In the first place, major depression is closely linked with abnormalities in brain chemistry. While these may actually be modified in the course of psychotherapy, many patients with severe or psychotic depression require antidepressant medication. Individuals with bipolar disorder (also called manic-depressive illness) almost always need mood stabilizers such as lithium to control their mood swings. But even when medication is required, CBT and other forms of psychotherapy are important parts of treatment as well.
Copyright 1999 by WebMD, Inc. All rights reserved.
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