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July 11, 2016

Cognitive Behavioral Therapy, a Tool in Treating Depression

Reuel S. Amdur

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Cognitive behavioral therapy (CBT) has been found to be an effective treatment for depression and anxiety in two-thirds of cases and is now also used with other psychiatric conditions. Medication is also effective with comparative results. Sometimes both CBT and drugs are used together.

While people often have at least a vague notion about what a psychotherapist does with some form of Freudian “talk” therapy, CBT is less well known.  So what is CBT?  Psychologist Corrine Dalton gave a public lecture on the subject of CBT in depression at the Royal Ottawa Hospital on January 14. 

CBT focuses on developing more realistic understanding of situations and on changing behavior.  Ideally, the patient completes a detailed calendar of events—hour by hour—and reactions to situations.  Then these are examined together with the therapist.  Where the patient sees a reaction in some situation as a slight, the therapist will urge him to identify alternative explanations, not necessarily to adopt them but simply to create greater flexibility.  “Don’t believe everything you tell yourself,” Dalton explained. 

She gave an example of the CBT approach.  A person says that the boss passed by with acknowledging him.  His interpretation: the boss has it in for him.  The therapist asks for other possible explanations: he didn’t notice him, he was wrapped up in thought, he is that way with everyone, etc.  The patient is assisted in being more flexible in thought.

Enemies of flexibility include all-or-nothing thinking, catastrophizing, over-generalization, and disqualifying the positive.  Also, a person may pick one thing out of a situation and ignore everything else.  Other things to be guarded against are jumping to conclusions and faulty inferences: “I know what he is thinking;” “This is not going to end well.”  Matters may be magnified or minimized.  People who are depressed may have a tendency to label, to personalize and blame, and to focus on the “should.” 

Depressed persons may feel helpless, out of control, inadequate, incompetent, defective, undesirable, bad, etc.  These various feelings need to be addressed in the treatment process. 

CBT, Dalton said, has three main areas of intervention—1) cognitive strategies aimed at identifying and changing unhelpful thoughts and biases and 2) behavioral strategies, replacing them with alternatives.  3) The alternatives include helping the patient to expose himself to situations and emotions that have been avoided. 

Dalton pointed out that there is life after depression.  Some people, both patients and those who seek to help and guide them, have the notion that depression is the end of the road.  It is thought that career and family plans need to be abandoned.  Not so.  While some may overstate the seriousness, others understate it.  Those are the people who tell a depressed person to “Just get over it.  Suck it up.”  It is not that easy.  Getting over it is a major undertaking.  CBT involves hard work on the part of the patient in therapeutic sessions and in homework.

While CBT is a relatively new treatment, it has been shown to give relief to many people suffering depression and anxiety.  More recently, it has been used with other forms of mental illness.  In treating schizophrenia, it has helped lessen some negative thoughts and behaviors. 

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