Lifestyle Choices

Depression Cognitive Behaviour Therapy (CBT)

CBT works on the basis that there is a close connection between thoughts (cognitions), feelings and behaviour. The treatment focuses on patterns of thinking that are negative and examines their underlying dysfunctional beliefs. For example, a person who i_sdepressed may have the belief: “I’m useless”. The underlying belief could be: “If I am not as competent as my colleague, I might as well resign from my job”. While the person in distress likely holds such beliefs with great conviction, with a therapist’s help, the individual is encouraged to view such beliefs as hypotheses rather than facts and to test out such beliefs. Furthermore, those in distress are encouraged to monitor and record the maladaptive thoughts which pop into their minds (called “negative automatic thoughts“). They are encouraged to generate alternative perspectives and to develop more rational (or positive) perspectives of their situations. Homework is an essential component of therapy because it enables therapy to go on in between sessions with the therapist. Homework may involve recording negative thoughts and charting emotions related to performing avoided tasks.

Alternative rational thoughts and beliefs are developed. This requires practice and is often simpler than imagined. It is like learning a new skill, once the basics are learnt, practice makes it easier to perform. Problem-solving techniques are taught, which then enables patients to deal with not only present, but future problems.

CBT has been shown to be as useful as antidepressant medications for individuals with mild depression and is effective in preventing relapse. Patients receiving CBT for depression are encouraged to schedule activities that were previously avoided. By completing these activities, they discover that they are able to perform tasks previously thought (erroneously) impossible, hence they gain a sense of mastery and satisfaction. Such mastery and pleasure ratings are recorded as a homework assignment and discussed with the therapist. When progress is made, the patient is encouraged to tackle other previously avoided tasks resulting ultimately in a greater sense of self- confidence and self-esteem. Studies indicate that patients who receive CBT in addition to treatment with medication have better outcomes than patients who do not receive CBT as an adjunctive treatment.

There are a good number of self-help books based on CBT principles. The reader may wish to refer to some of them to obtain help. If the problem seems complicating and relief is not forthcoming, then consultation with professionals skilled in CBT approaches is advised.

Depression Psychodynamic Psychotherapy

Psychodynamic psychotherapy is based on the premise that interpersonal and emotional problems are influenced by early childhood experiences. Symptoms of depression are thought to arise from unresolved internal conflicts. These are activated by loss events. By communicating feelings, the patient understands himself better. Thus we say that the patient develops insight or self-awareness.

In addition, the patient may relate to the therapist as though the therapist were a significant person in the patient’s early life — termed as “transference”. The patient may feel angry towards the therapist during occasions when appointments have to be postponed. The patient might also feel fearful of expressing this anger because something about the therapist “reminded” the patient of a rejecting parent. The more the patient felt he had to express his anger towards the therapist, the more he feared that the therapist would abandon him.

Interpretation of the transference gives insight into the inner conflicts of the patient.

One of the objectives of psychodynamic psychotherapy concerns reduction in the use of unhealthy defence mechanisms, coming to terms with past psychological trauma, and a greater acceptance oneself and one’s family.

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