Behaviour Therapy for Depression - Essay Example

Behaviour Therapy for Depression The psychological and physical cost of depression in human terms is incalculable. The medical condition affects the way individuals interact with others as well as the negative way in which they feel about themselves which often includes thoughts of suicide. Depression triggers a combination of thoughts and feelings that often causes an individual to stray from their normal behaviour. The symptoms of depression may appear suddenly for no specific reason or may occur following a medical condition or life-altering event. Either way, depression is an emotionally crippling disorder. The monetary cost is calculable, however. In 2001, the estimated cost of adult depression was estimated at more than £9 billion, £370 million of this was a direct result of treatment costs. In 2000, more than 100 million total working days were lost in addition to 2615 deaths attributed to depression (Thomas & Morris, 2003). The Greek philosopher Epictetus probably described it best when he said, “It is not circumstances themselves that trouble people, but their judgments about those circumstances” (Seddon, 2002). Cognitive behavioural therapy in essence, seeks to alter the perceptions of circumstances. Cognitive therapy, according to Aaron T. Beck, “... is based on an underlying theoretical rationale that an individual’s affect and behaviour are largely determined by the way in which he structures the world” (Dubord, 2004: 1). At one time this was simply referred to as behaviour therapy but today is known as cognitive behaviour therapy. This discussion outlines CBT and its approach to the treatment of depression. The primary interventions preferred in the treatment of chronic clinical depression are behavioural in nature. Efforts to augment a person’s sense of self-worth and to re-connect them socially through physically exertive exercises is a widely used and effective strategy for reversing behaviour associated with depression. Because of the behavioural nature of the condition and the treatment, it is strongly recommended that those in the health care services employ the same vigilance regarding behavioural treatments as they would prescribe drugs used as treatments. When the depressive cognitions are restructured, this generally increases the disposition benefits for an individual and positively affects changes in behaviour. There are many examples of depressive cognitive statements offered by patients that doctors often hear such as, ‘I can’t do anything to improve my outlook on life,’ ‘I’m just waiting for a cure which will come when I’m prescribed the correct drug,’ ‘I just need to be in a steady relationship,’ or ‘One day I’ll wake up and be fine.’ The tools utilised to restructure cognitive abilities assist patients in abandoning self-destructive viewpoints such as the examples previously listed. A great deal of the strategy involved in behavioural therapy is the knowledge of which strategy or strategies to employ depending on the manner of the particular cognitive issue observed. The following are but a few of the examples of approaches a doctor may choose to deal with depression in their patients. ‘View-pointing’ is the method by which a patient is shown how to examine their perceptions through the perspectives of others they respected. “If your father were to hear you say ‘all I really need is a steady relationship and I would feel better,’ how might he respond to that? ‘Evidence examination’ is the doctor and patient’s examining the perceived evidence together and formulating a list of questions that either confirms or denies answers to statements such as, ‘Nothing I do improves my outlook on life.’ The ‘Didactic method’ describes when the doctor is very forthright with the person by informing them of the reality of a particular statement such as ‘people don’t just wake up one day to find their depression has disappeared. Only through sustained therapy, medication and effort on your part will you eventually heal.’ The ‘cost-benefit analysis’ allows the patient to examine the costs of a belief as opposed to the benefits. An example would be for the doctor to ask ‘you said that you are waiting for someone to prescribe you the correct drug that will ‘cure’ your disorder, how will it help you to wait while doing nothing?’ (Dubord, 2004: 1). The connection between behaviour, psychological difficulties and flawed patterns of thought are demonstrated by Aaron Beck’s innovative explanation of depression. He proposed that negative thoughts experienced during a depressive state originate in the assumptions and attitudes occurring in early life experiences. These assumptions are capable of being “positive and motivating, but they can also be too extreme, held too rigidly, and be highly resistant to revision” (Beck, 1976). Problematical psychological situations can ensue when crucial episodes transpire which oppose an individual’s beliefs and ambitions. For example, if a person assumes that their value depends on their level of success this perception may cause that person to be susceptible to depression following an incident such as failing a test or being fired from their job. “Once activated by the critical incident, the core assumption leads to the production of spontaneous negative automatic thoughts such as ‘I am a worthless failure.’” (Teasdale, 1988). These types of thoughts decrease a person’s general disposition and increases the probability of supplementary negative habitual thoughts. Research has demonstrated that certain types or degrees of negative thought will automatically enhance the access of similar thoughts paralleling that mood. When a person becomes depressed a collection of cognitive misrepresentations identified as the ‘cognitive triad’ applies wide-ranging influences on an individual’s functions on a daily basis while negative involuntary thoughts become progressively more enveloping. The cognitive triad involves a negative view of oneself in addition to current and potential future experiences. Negative preconceptions when a person is processing information acts to exacerbate the depression. In this case, people over-generalise and exaggerate their minor setbacks and selectively focus on events that corroborate this negative analysis of their lives (Beck et al, 1979). Behavioural dynamics also aggravates depression causing the afflicted person’s level of activity to decrease. Depressed moods are often associated with a reduction of motivation. Depression causes people to withdraw from society and stay at home more often. They experience lesser amounts of outside stimulation which greatly reduces their opportunities to experience positive influences. The cognitive behaviour theory doesn’t allege that negative thought and atypical behaviour instigates depression. It’s these factors that aggravate and sustain emotional instability. Treatment for depression is built upon a two-phased approach. “First, using cognitive techniques to alter maladaptive assumptions containing negative information about the self in relation to the world and the future; and, second, ameliorating reduced levels of behavioural activity, exercise, and positive experience” (Beck et al, 1979). Consistently reproducing negative thoughts causes regular patterns of negative interpretation and thus perception of incoming information which consequently underscores the physical and behavioural symptoms associated with depression. Cognitive behavioural techniques guide patients to recognize, appraise, and modify the flawed thinking that acts to distort their perception of reality. Behavioural methods are complementary and activate patients to test out alternative assumptions in reality. The effectiveness of cognitive treatments for depression is widely recognised within the medical and psychiatric communities. An assessment of 15 studies found that “cognitive behaviour therapy was at least as effective as medication in treating depressed outpatients, the combination of the two treatments was more effective than either one alone, and most of the studies found that cognitive behaviour therapy was equally applicable to more severe and more endogenous types of depression” (Blackburn & Twaddle, 1996). Cognitive behaviour treatments also did well when compared with other psychological therapies addressing depression. Research regarding long-term cognitive behaviour therapy consistently demonstrated that this type of treatment positively impacts the devastating affects of depression. At the one year follow-up exam, more than half of patients who received cognitive behaviour therapy during routine treatments remained at a comparable level of wellness. However, of those that did not receive behaviour therapy, less than one-fifth remained well at the end of a year (Miller et al, 1989). Another study concluded that about 80 percent of depression patients were considered well two years following behaviour therapy. This number grew slightly to 85 percent when considering those that had received a combination of medication and behaviour therapy (Evans et al, 1992). Cognitive distortions are misrepresentations of thought and behavioural therapies assist individual patients in identifying these flaws in thinking. However, some people are hypersensitive to someone informing them that their thinking is distorted in some way. In light of this fact, it’s important for health care professionals to emphasize to the patients that all people are at least somewhat of a propensity for distorted thought. While patients should learn to acknowledge their particular thought distortions, the overall application of behavioural therapy must always remain positive. It was negativity that brought them to the emotional position of seeking therapy in the first place and undue focus on identifying the distorted thought may lead to further self-criticism. Not all uncomfortable emotions are considered negative. Some rather negative emotions have roots in humans survival skills. “If there’s no emotion triage, cognitive therapy may have the side effect of distancing patients from some of their emotional wisdom. Emotions are vital in helping patients stay adapted to their environment” (Dubord, 2004: 3). Examples of beneficial negative emotions include an abused woman who has developed negative anxiety but this is a self defence mechanism that will drive her away from the abusive relationship. Because of this reason, it’s improper to attempt to treat all emotions considered objectionable. Health care providers should assist their patients in interpreting these beneficial yet negative emotions. Cognitive behavioural therapy is concerned with changing the perceptions of those afflicted with the crippling affects of depression. Negative thoughts can be initiated by childhood experiences, the stresses of the teenage years or the pressures of adulthood and possibly at all three stages in life. Negativity is self-perpetuating and the sooner it is recognised and clinically addressed, the better the chance for a full recovery. The way people perceive and interpret their thoughts determines their conception of themselves and the world. Teaching people to alter their obtrusive negative perceptions is the goal of cognitive behavioural therapy. Cognitive behavioural therapies, often when applied in concert with medication, have proved to work exceptionally well for people of all ages who suffer from depression. It has been successful in remedying an assortment of conditions extending from lesser difficulties and developmental problems to acute disorders which are not curable but can be made, to some extent, more controllable. This technique helps to free depressed persons from the overwhelming thoughts of hopelessness and helplessness which are sustained by self-defeating attitudes. References Beck Aaron T. (1976). Cognitive Therapy and the Emotional Disorders. New York: International Universities Press. Beck AT, Rush AJ, Shaw BF, Emery G. (1979). Cognitive Therapy of Depression: A Treatment Manual. New York: Guilford Press. Blackburn I-M & Twaddle V. (1996). Cognitive Therapy in Action. London: Souvenir Press. Dubord, Greg. (June 2004). “Cognitive Behaviour Therapy: The Physician-Patient Relationship Predicts Outcome.” Clinical Talk. Parkhust Exchange. Retrieved 17 November 2006 from Evans MD, Hollon SD, DeRubeis RJ, Paisecki JM, Grove WM. Garvey MJ, et al. (1992). “Differential Relapse Following Cognitive Therapy and Pharmacotherapy for Depression.” Archives of General Psychiatry. Vol. 49, pp. 802-8. Miller IW, Norman WH, Keitner GI. (1989). “Cognitive-Behavioural Treatment of Depressed In-Patients: Six and Twelve Month Follow-Up.” American Journal of Psychiatry. Vol. 145, pp. 1274-9. Seddon, Keith H. (2002). The Handbook of Epictetus: A New Translation. London. Retrieved 17 November 2006 from Teasdale, JD. (1988). “Cognitive Vulnerability to Persistent Depression.” Cognitive Emotion. Vol. 2, pp. 247-74. Thomas, Christine M. & Morris, Stephen. (2003). “Cost of Depression Among Adults in England.” The British Journal of Psychiatry. The Royal College of Psychiatrists. 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