Thursday, February 26, 2009

Depression Seminar Session 4

Cognitive Behavioral Therapy: Change The Way You Think, Change The Way You Feel

The stereotypical depressed person looks like this sad cookie,

mopes around in pajamas all day and eats a lot while watching daytime TV or napping. But there are so many other images of what depression looks like. The depressed person is more prone to gossip, having bad feelings about others--even hostility, a range of cognitive disorders, inefficiencies, anti-social tendencies and poor decision-making among other things.

By far the most common thing to do and the "easy way" is to take anti-depressant drugs. The problem is that drugs don't cure the underlying problem but, instead, tend to create a whole new range of side effects. So, while 70% of patients who opt to take the prozac-like drugs for depression do improve their overall mood, less than 20% of those same patients feel they are cured. Also, 25 - 30% of patients don't improve at all with the drugs. Furthermore 50% of patients report troubling side-effects, so that 1/2 of patients quit taking the drug, 2/3 are not satisfied and 3/4 feel that overall the medications are not effective. Another drawback to taking the medications is that there is a high relapse rate after quitting. So if there is any improvement at all, that improvement is lost when the medications are stopped.

Having said that, medicatons do have a place and that place is when they are reserved only for those with moderately high to severe depression. These should not be used as the only treatment for someone with depression and medications should be used in combination with proven treatments for depression, one of which will be discussed here.

Some of the most common symptoms of the prozac-like medications: improved mood, decrease in crying and in ability to grieve, decrease in hostility, increase in sociability, increase in impulsiveness, may increase 'I don't care' attitude, weight gain, sexual dysfunction, and gastro-intestinal disorders.

The 2nd most common treatment for Depression after medication is counseling. This may not be a good alternative, depending on what method of counseling is used. Often, through counseling, a patient can often get worse because the counselor can manipulate the social situation and bring up past experiences, causing unnecessary recollection of a painful event. So rather than helping the patient heal, these recollections of past experience only make the patient feel worse because it brings these memories to the surface where they can again be hashed out and lived all over again. Studies show that this type of technique is no better than a placebo, in terms of healing.

There is, however, a counseling method that is shown to have an improvement rate at least as great as the paxil-like drugs. The method is known as Cognative Behavioral Analysis System of Psychotherapy (CBT), pioneered by Dr. Albert Ellis and Aaron Beck. Furthermore there are no side-effects, less likely that relapse after completion of therapy would occur, and there is an actual chemical change in the brain with CBT. We were referred to a study wherein the subjects had been chronically depressed for at least 20 years and had tried everything except for CBT. For the study, they were put on medication and intensive CBT psychotherapy. After the trial study, 85% of these patients improved and some very significantly.

Depression is not the only disorder that CBT can help. It treats a number of anxiety disorders, including Anerexia, Obsessive-Compulsive Disorder and Post Traumatic Stress Disorder.

CBT starts from the premise that a cognition, thought or perception has a direct impact on how you feel. Feelings result from messages that you give yourself. So your thoughts have much more to do with how you feel, rather than what is actually happening in your life. If you learn to recognize and control those thoughts which may be distortions or untruths and replace them with positive and self-building kinds of thoughts, you can actually change the chemical makeup of the frontal lobe of the brain, which is the major center for feelings.

Here are the ABC's of CBT:
A - Activating Event
B - Your Beliefs
C - Emotional Consequences

A correct sequence of thought would be A to B to C in that order. Example: Something happens that could shake you. You apply your belief system to what happened. Because of your belief system and correct self-talk the emotional consequences are not serious and they do not hurt your emotional psyche. Unfortunately many people jump from A to C, not utilizing the belief system, either because they have no belief system or the belief system they have is failing them and taking them into undesirable emotional waters.

Here are some examples of cognitive distortions that if plugged into step B, could really damage ones emotional outcome and contribute to depression and other yukky, undesirable symptoms. The examples are true incidents.

  • 1. All or Nothing--Examples: A man ran for a community office and lost. Now he feels that he is a big nobody and that no one likes him. A very intelligent college student who gets all A's got a B. The student is now of the belief that she is a total failure.
  • 2. Overgeneralization--Example: A very shy guy finally got enough courage to ask out a girl he really likes. Unfortunately, she turned him down. He knows that nobody will ever date him.
  • 3. Mental Filler--When a person takes one or two negative thoughts and obsesses over these to the point that it blows everything else out of proportion.
  • 4. Disqualifying the Positive--Not only emphasizing the negative, but disqualifying everything else that is positive. Example: A patient in a psychiatric ward being treated for depression says "no one in this world cares a whip stitch about me," and believes it. When told that the staff on the floor she is on has really grown to like her, she says that it's only because they have to pretend they like her. When told that her family loves and misses her, she says that they don't know the real person that she is.
  • 5. Jumping to Conclusions--There are various ways that you can quickly make erroneous judgments because the conclusion is often made based on your negative feelings rather than fact.
  • Mind-reading - "He didn't say hello to me because he has a problem with me."
  • Fortune teller error - "I won't call back because I already called once and she didn't answer so if I call again she will think I'm stalking her."
  • Magnification or minimalization of facts - It's important to have as much information as possible about the situation to get an accurate conclusion.
  • Emotional Reasoning - "I feel like a jerk, therefore I am a jerk.", "I feel mad at you, therefore you are doing things to make me mad at you.", "I feel inadequate, therefore I am worthless."
  • Labeling and Mislabeling - Labeling someone in general is harmful because it creates distortions about that person. Labels such as "irritable idiot", or an "insensitive chauvanist", or a "selfish know-it-all" are damaging for you and the other person.
  • Personalization - Example: A mother feels like a failure because her child is doing poorly in school.
CBT helps people identify what kinds of Cognitive Distortions may be happening in their own minds and then gives tools to help them overcome these thoughts and replace them with more positive and truthful thoughts. This can actually change your belief system and create a whole new reality for you, making you a much more balanced and happy individual. There are quite a number of books on CBT. Some authors and therapists approach CBT from a secular point of view and others approach the therapy from a christian or spiritual point of view.

'Feeling Good - The New Mood Therapy' by Dr. David Burns (Also comes with a workbook called 'The Feeling Good Handbook') Written from a secular viewpoint
'Learning To Tell Myself The Truth' by Dr. William Backus This book is from a Christian point of view
'Overcoming Destructive Beliefs, Feelings and Behaviors' by Albert Ellis
'Cognitive Therapy of Depression' by Aaron Beck
'Depression - The Way Out' by Neil Nedley
'Bonds That Make Us Free' by Terry Warner
'Be Still' by Victoria Anderson

The scriptures emphasize correct thinking as a way of becoming like our Heavenly Father. The 13th Article of Faith teaches that "if there is anything virtuous, lovely, or of good report, or praiseworthy, we seek after these things." And Proverbs 23:7 states "for as a man thinketh, so is he."

There were many more things taught about how our thoughts can imprison us and also how they can set us free and that if we have the correct tools, we can use our thoughts as great instruments of power to make us well and happy. It is very exciting to know that even though we may have some distorted thinking now, there are ways to change it and ways to help us be the best we can be. So although truth therapy is initially hard work because we are changing the thought patterns we have relied on for all of our lives, it is very simple. We just need to get into the habit of listening to our thoughts, analyzing them and replacing the distorted belief with truth.

I know I have had at least one pattern of distorted thinking. You see, I wasn't able to take a compliment. I was like the lady in the pshyco ward--if someone complimented me, I just knew there was something that was wrong with that. So my poor husband--he tried to compliment me and many times I wouldn't even accept it. I'd get mad at him for having an agenda. Fortunately, I have started getting better with this and am able to simply say "thank you, I appreciate that", knowing that there must be at least one shred of truth to what was just said! Yay for progress!


Anonymous said...

I've really enjoyed your posts on this depression seminar. The "Feeling Good" book is a great tool. My husband and many of his colleagues recommend it to many of their patients. One thing I've started to do is that when I feel angry or frustrated I try to take a moment and think about why I feel that way. So often what I actually responded to with those feelings, isn't actually what made me feel that way. It's usually the automatic thoughts that come shortly before or after that have nothing to do with what I was angry or frustrated about.

helena said...

Hi Angela! Thanks for sharing. That's exactly what I learned from the last session. It's so easy to have erroneous and distorted thinking and just go with it. It's good to stop and analyze and see what may be truth and what may be total fiction, then adjusting accordingly.