Depression can often be brought on by life stress, or by a sudden loss, such as relationship breakdown or the loss of a job. It is characterised by low mood, pessimistic thoughts, hopelessness, poor sleep and the thought that life is not worth living. People with depression are often also anxious; they can feel restless and irritable, worried that they have too much to do but unable to settle to any task. They may also feel so low and unable to do anything that they stay in bed and stop doing even the smallest tasks.
Research has shown that depressed people suffer from negative and pessimistic thoughts. They often feel that they are bad or worthless, that their situation is hopeless and that the future will be worse. This can make it difficult to tackle any task because one feels that one will not be successful. For example, many sufferers will not open their post or will put off the simples household chores. At the same time, sufferers feel too low and pessimistic to enjoy themselves.
As in all CBT, therapy begins with a Formulation, which is developed in collaboration between patient and therapist. The formulation helps both patient and therapist to understand what has caused the depression and what is maintaining it.
One part of Cognitive-Behavioural Therapy can involve Behavioural Activation, which involves helping the depressed person to begin a programme of more positive activities. Initially, the therapist may ask the sufferer to keep an Activity Schedule, to see what activities are most helpful in raising their mood. Exercise, even very moderate exercise can be very helpful, and activity also helps the sufferer to feel that he or she is achieving something.
Therapists will often ask patients to keep records of their thoughts, especially those thoughts that seem to trigger changes in mood. Thought Records are used to understand what negative thoughts are important in maintaining the depression, and therapy can help patients to take a fresh look at these thoughts.
Depression can begin to lift after a few sessions of CBT. As the client’s mood improves, patient and therapist can look at long-term factors that might cause depression to recur as well as client strengths and ways of preventing relapse.