FREE ESSAY ON COGNITIVE THERAPY FOR DEPRESSION

COGNITIVE THERAPY FOR DEPRESSION

COGNITIVE BEHAVIORAL THERAPY FOR DEPRESSION
Introduction
Cognitive behavioral therapy helps improve people's moods and behavior by changing their
way thinking; also, how they interpret events and talk to themselves. This form of
psychotherapy helps guide people into thinking more realistically and teaches them coping
strategies to deal with their depression. Cognitive therapy is in most cases a short-term
treatment that can have long-term results. I will discuss depression in adolescence and
how it effects personal adjustments, which may often continue into adulthood. I will also
discuss depression in the elderly. There are different approaches to treating depression,
the main approach that will be discussed is cognitive behavioral therapy, which is a way
to break the cycle for depression.
What is Cognitive Behavioral Therapy?
Cognitive behavior therapy helps people break the connections between difficult
situations and their habitual reactions to them. This can be reactions such as fear, rage
or depression, and self-defeating or self-damaging behavior. It also teaches people how
to calm their mind and body, so they can feel better, think more clearly, and make better
decisions. Cognitive therapy also teaches people how certain thinking patterns are
causing their symptoms. This is accomplished by giving people a distorted picture of
what's going on in their life, and making them feel anxious, depressed or angry for no
good reason.(Francis, 2000) When people are in behavior therapy and cognitive therapy, it
provides them with various tools for stopping their symptoms and getting their life on a
more satisfying track. In cognitive therapy, the therapist takes an active part in
solving a patient's problems. He or she doesn't settle for just nodding wisely while the
patient carries the whole burden of finding the answers they came to therapy for
initially. Cognitive therapists teach patients to identify their negative thoughts,
recognize their erroneous nature and devise a corrective plan that leads to more positive
assessments and an ability to deal more realistically with every day problems.(Burns,
1996-2000) Dr. Frances M. Christian, a clinical social worker and cognitive therapist at
the Medical College of Virginia in Richmond, says, "Thoughts and beliefs have a lot to do
with how people feel and behave. Early in life, people develop core beliefs about
themselves and other people and about how the world operates."
Cognitive behavioral therapy has been very thoroughly researched. In study after study,
it has been shown to be as effective as drugs in treating both depression and anxiety. In
particular, cognitive behavioral therapy has been shown to be better than drugs in
avoiding treatment failures and in preventing relapse after the end of treatment. A
cognitive therapist directs a patient's attention to automatic thoughts, the things
people say to themselves, that result in unpleasant feelings. (Stopa, 2000) For example,
someone prone to anxiety attacks might automatically think, I'm going to mess up, when
taking an exam, participating in a school event or being interviewed for a job. After
failing such a task, the person might conclude, again automatically, I'm a loser. In
therapy, the person is helped to recognize delusions in thought, which include
exaggerating the sense of threat, anticipating disaster as the outcome, and over
generalizing from one negative experience and ignoring times when things went well.
Finally, once the damaging automatic thoughts are recognized, the person is helped to
examine how realistic they are, and they consider alternative explanations, then imagine
other outcomes and realize that the symptoms of anxiety are not the prelude to a heart
attack or some other medical disaster. (Stopa, 2000) This same approach is practiced for
depression.
The difference in the therapeutic approach versus medicating is dramatic, and the relief
people feel is immediate. Instead of dwelling on the negative, which the other therapists
sometimes do, they acquire therapeutic tools the depressed can apply on his or her own,
in case they may find themselves slipping into old patterns of thought or behavior.
(Stopa, 2000)
Furthermore, studies have shown that the results of cognitive therapy are long lasting,
with relapse rates much lower than with other modes of treatment, including psychiatric
drugs. And while medication is sometimes used, at least briefly, to relieve intense
emotional disturbances and improve receptivity to therapy, most patients can be spared
the side effects of drugs, which may include the inability to function sexually, upset
stomach, difficulty sleeping and difficulty concentrating.(Brody, 1996) While no one
approach to psychotherapy is appropriate for everyone, many thousands of patients have
benefited from the strategies unique to cognitive therapy. In the 30 or so years since
the approach was developed by Dr. Aaron T. Beck, a world-renowned psychiatrist at the
Beck Center for Cognitive Therapy in Philadelphia, it has become the most scientifically
tested model of psychotherapy. (Brody, 1996)
What is Depression?
According to Dr. Judith S. Beck and Dr. Aaron Beck, her daughter, "Patients have
continual unpleasant thoughts and that each thought deepens the depression." However,
these thoughts are not based on facts and result in feelings of sadness this is far
beyond what the situation guarantees, it has to do with hypothetical situations.
"Depressed persons make such mistakes over and over," Quinn has written. "In fact, they
may misinterpret friendly overtures as rejections. They tend to see the negative, rather
than the positive side of things. Plus they do not check to determine whether they may
have made a mistake in interpreting events."(Quinn, 1998) Depressed thinking often takes
the form of negative thoughts about oneself, the present, and the future. The mood in
depression is almost always experienced as sad. 
According to a patient's letter written and later published with the permission of
William Morrow and Company, (publisher of Moodswing): from the book, "Depression and it's
Treatment", her experience with this mood disorder was despair and uselessness.
Eventually she found herself going to sleep earlier at night just to stop the anxious
thoughts entering her mind. The patient says her appetite got worse and she became
physically ill with the progression of her depression. The statement later reads, "If I
had to see a psychiatrist, it meant that I was probably going insane, and this thought
made me even more frightened. It was more than I could stand. The fear of being mentally
ill was so horrible that I decided to take my entire bottle of sleeping pills rather than
face the shame of being a mental patient."(Griest & Jefferson, 1992) 
Depression can strike anyone at any given time. It affects 5% of the population at any
time and at least 10% of the population at some point in their lifetime. At least 10% of
the people with major depression end their lives by suicide. (Greist & Jefferson1992)
Depression in Adolescents
How prevalent are mood disorders in children and is an adolescent with changes in mood
considered clinically depressed? Oster has said the reason why depression is often over
looked in children and adolescents are because "children are not always able to express
how they feel."(Oster & Montgomery 1997) Sometimes the symptoms of mood disorders take on
different forms in children than in adults. Adolescence is a time of emotional turmoil,
mood swings, gloomy thoughts, and over sensitivity, it is also a time of rebellion and
experimentation. Therefore, the diagnosis should not lie only in the physician's hands
but be associated with parents, teachers and anyone who interacts with the child on a
daily basis. Unlike adult depression, symptoms of adolecent depression are often
camouflaged. Instead of expressing sadness, teenagers may express boredom and
irritability, or may choose to get involved in risky behaviors. (Oster & Montgomery,
1995) The key indicators of adolescent depression include a drastic change in eating and
sleeping patterns, significant loss of interest in previous activities, aggression and
boredom. The signs of clinical depression include marked changes in mood and associated
behaviors that range from sadness, withdrawal, and decreased energy to intense feelings
of hopelessness and suicidal thoughts. Depression is often described as an exaggeration
of the duration and intensity of "normal" mood changes (Oster & Montgomery, 1995),
constant boredom, disruptive behavior, peer problems, and increased irritability and
aggression. (O'Connor 1997) 
For many teens, symptoms of depression are directly related to low self-esteem coming
from increased emphasis on peer popularity. For other teens, depression arises from poor
family relations which could include decreased family support and perceived rejection by
parents (Quinn, 1998). Adolescent suicide is now responsible for more deaths in children
age 15 to19 than cancer (Oster & Montgomery, 1997).
Whereas, Oster & Montgomery stated that "when parents are struggling over marital or
career problems, or are ill themselves, teens may feel the tension and try to distract
their parents." This "distraction" could include increased disruptive behavior,
self-inflicted isolation and even verbal threats of suicide. So how can the physician
determine when a patient should be diagnosed as depressed or suicidal? Quinn suggested
the best way to diagnose is to "screen out the vulnerable groups of children and for the
risks factors of suicide and then refer them to treatment." Some of these "risk factors"
include verbal signs of suicide within the last three months, prior attempts at suicide,
indication of sever mood problems, or excessive alcohol and substance abuse. Many
physicians tend to think of depression as an illness of adulthood. In fact, Quinn stated
that "it was only in the 1980's that mood disorders in children were included in the
category of diagnosed psychiatric illnesses." In actuality, 7-14% of children will
experience an episode of major depression before the age of 15. An average of 20-30% of
adult bipolar patients report having their first episode before the age of 20. (Quinn,
1997) Oster & Montgomery, added that an estimated 2,000 teenagers per year commit suicide
in the United States, making it the leading cause of death after accidents and homicide.

Furthermore, Clarke stated that it is not uncommon for adolescents to be preoccupied with
issues of mortality and to contemplate the effect their death would have on close family
and friends. Once it has been determined that the adolescent has the disease of
depression, what can be done about it? Clarke has suggested two main avenues to
treatment: "psychotherapy and medication." The majority of cases of adolescent depression
is mild and can be dealt with through several psychotherapy sessions of intense
listening, advice and encouragement. (Clarke, 1999) On the other hand, for the more
severe cases of depression, especially those with constant symptoms, medication may be
necessary and without pharmaceutical treatment, depressive conditions could escalate and
be fatal. 
However, Oster & Montgomery added that regardless of the type treatment chosen, "it is
important for children suffering from mood disorders to receive prompt treatment because
early onset places children at a greater risk for multiple episodes of depression
throughout their life- span." Until recently, health professionals have ignored
adolescent depression. Now there are several methods of diagnosis and treatment. Although
most teenagers can successfully over- come the emotional and psychological obstacles that
lie in their paths, there are some that find themselves overwhelmed and full of stress.
(Franklin, 2000) How can parents and friends help out these troubled teens? And what can
these teens do about their constant and intense sad moods? With the help of teachers,
school counselors, mental health professionals, and of course parents, the seriousness of
a teen depression can be accurately evaluated and plans can be made to improve their
contentment and ability to live life fully. 
Elderly Depression
Depression in the Elderly is becoming more prevalent in today's society as people add
stress and pressure to their daily lives. The elderly population is not eliminated as a
candidate for a disorder just because they may be retired. In fact, mental disorders
affect 1 in 5 elderly people.(O'Conner, 1997) Some elderly people may not exhibit the
traditional symptoms of depression. These individuals may have symptoms of depression
that go unnoticed due to the fact that those symptoms are being attributed to a different
illness. "One half of all depressed patients seen by general physicians are not
identified as depressed". (Quinn, 1998). 
In addition, there appear to be a few fundamental differences between depression in the
adolescent and old. Elderly people tend to have more ideal symptoms, which are related to
thoughts, ideas, and guilt. Elderly depressed individuals are also more likely to have
psychotic depressive and melancholic symptoms such as anorexia and weight loss. Finally,
older people tend to have more anxiety present in their depression than adolescent
patients do (Quinn, 1998). 
On the other hand, some believe that low blood pressure can cause fatigue and anyone with
these two symptoms could possibly be diagnosed with depression. This is a snowball effect
where the low blood pressure causes the fatigue, which in turn causes someone to feel
useless, which further develops into other possible depressed symptoms. In addition low
blood pressure found in the patients this was not directly related to any chronic health
condition. (Quinn, 1998). Low blood pressure is not the only risk factor for the
development of depression. Some other factors include people dealing with loosing their
jobs, finances, physical ability to do things, or relocation. Family problems dealing
with divorce, siblings, children, or a death can also send one on a downward spiral.
Changes in the brain such as decreased adaptive capacity, neurotransmitter and receptor
changes, cognitive impairment, and dementia increase the risk of depression (Oster &
Montgomery, 1995). Many senior citizens take medication regularly for various ailments.
Due to the fact that they take multiple prescriptions daily, the physician must also be
familiar with how the various drugs interact with each other. 
Nevertheless, the biggest challenge when treating depression is convincing the patient to
stick with any type of therapy. Patients become stubborn and quit taking their medication
or visiting the doctor as soon as they begin to feel better. This is a huge mistake
because it will only cause the individual to fall back into the old patterns and
problems. Depression is one of those conditions that can return if proper preventative
measures are not taken. Patients need to understand that depression can return at any
time and certain precautions must be taken. The elderly deserve our respect and support
through their physical and emotional difficulties because we would not be around if not
for them. The diagnosis and treatment of depression in the elderly may not be a simple
task, but it is one that deserves more attention and further advancement.
Effective Treatment for Depression
Cognitive Therapy is an effective treatment for depression. It is based on the idea that
how people think largely determines how people feel. This form of Therapy teaches people
to recognize and challenge upsetting thoughts. Learning to challenge negative thoughts
makes the patient feel better and helps them to think more realistically. 
Lusia Stopa explains that people cannot simply just decide to think positive. (Anyone who
has suffered from depression knows that there are no simple magic answers!) Instead, she
shows that people can begin to notice when and where negative thoughts occur,
systematically decide how accurate these thoughts are, and where necessary, to change
them to something more helpful to people. (Stopa, 2000) According to the behavioral
aspects of Cognitive Behavioral Therapy it recommends to monitor daily activities with a
"Weekly Activity Schedule". Activity schedules are important because they help patients
to see what there're actually doing as well as how much pleasure and sense of achievement
(if any ) people get from particular activities. When they are feeling depressed, it can
be very difficult to motivate themselves to get going again or to start changing
behavior. The three main techniques for overcoming this are: planning ahead, identifying
pleasurable activities, and breaking tasks into small manageable steps. (Quinn, 1998).
Lusia Stopa says that the process of challenging negative thoughts is important to
overcoming depression, but that learning the skills can take time. However, it gets
easier with practice. Challenging bad thoughts and substituting them with more realistic
thoughts makes people feel better about themselves and begins to break the cycle of
depression. Also, these skills stay with the patients for the rest of their life and in
the future help protects against the recurrence of depression. (Stopa, 2000). 
Psychotherapy or Cognitive therapy, is the preferred treatment of choice for depression,
regardless of the depression's severity or symptoms. Multiple Meta-analyses have come to
this conclusion, so that it is not a conclusion based on just one case study. (Stopa,
2000). Combined treatment of psychotherapy and medication should be the second choice,
when choosing effective treatment options for depression. This is likely the most
commonly used treatment for depression today and there is absolutely nothing wrong with
it. A patient should never go against professional advice given with regards to a
patient's treatment, unless he or she has first discussed it with their doctor.
Especially with depression, it is better to play it safe, than be sorry. According to The
Depression Source Book, by Brian R. Quinn, medication alone should be a person's last
choice and only used as a last resort. Although people will likely gain some short-term
relief of the most outward symptoms of their depression, studies have shown that
medications don't work very well in the long-term. Those who choose to take psychotropic
medications should be informed as to the negative and adverse side effects of those
medications. Cognitive Behavioral Therapy is considered the preferred clinically proven
therapy for depression. (Stopa, 2000)
Conclusion
Cognitive behavioral therapy, in most cases, is a short-term treatment that can have a
long-term end result. In any case, this form of psychotherapy does help people think more
realistically whether they are an adolescent or an elderly patient. Cognitive behavioral
therapy without the use of medication is a good way to break the cycle for depression.
Additionally, it is also a powerful self-help technique for dealing with depression and
other negative emotions by consciously changing the way we think. To conclude this
discussion, depression is a serious mental disorder that can strike anyone at any given
time. However, anyone who is suffering from mood disorders can climb their way out a
downward spiral of misery, with the strategies behind cognitive behavioral therapy.