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Therapy for depressed people
We understand the brain a lot better than we used to, and the same is true of depression. Instead of treating every occurrence of the illness with drugs, it is now common to use a form of therapy derived from clinical psychology. Here we explain the background to that therapy, along with some example questions and responses from people who have tried it and found it useful. We also have a short list of quick thoughts that might be useful for depressed people. It's been said that if you could paint a picture of the way life is when you're not depressed, and show it to yourself when you're depressed, you'd recover immediately. It can't be done, unfortunately, if only because it's very hard to remember perceptions instead of events. But this page may help to some extent.
As mentioned elsewhere on this site, comments such as 'Pull yourself together' and 'Cheer up, it's not that bad' are not particularly helpful to depressed people. Part of the confusion arises from the mis-use of the word 'depression', which many people use to describe general feelings of unhappiness. Depression is far worse than that, and anyone who suggest that sufferers can simply 'Cheer up' doesn't understand that depression is a physiological illness.
That said, there are ways in which depression can be fought. The brain is a powerful organ, and can be used to combat depression, by using cognitive therapy. This is not the 'tell me about your childhood' kind of therapy where you lie down on a plush leather couch while a bored, over-paid quack lightens your wallet. Cognitive therapy is a very powerful tool, developed from studies in clinical psychology, with which the sufferers of depression can significantly alleviate their symptoms and often recover from the illness completely.
The pioneer in this field is an American psychologist called Aaron T. Beck, who came up with an analysis of depression in the late 1960s and early 1970s that described the illness - or at least its symptoms - as errors of thinking, or 'cognitive distortions'. Put very simply, the depressed person interprets events around himself or herself incorrectly, always assuming the negative. The thoughts that trigger such feelings, called negative automatic thoughts, are so plausible that they pass unnoticed by the sufferer, who merely feels their negative effects. As an example, you may see a group of friends across the street, who don't respond when you wave to them. The sensible interpretation is that they simply didn't see you, but a depressed person would have the negative automatic thought that his or her friends had turned into enemies, and would therefore feel sad. Negative automatic thoughts are so strong that, even if those same friends behaved in a friendly manner later in the day, the depressed person would assume that they were just pretending to be friendly. The sufferer doesn't notice the automatic thought, only the negative feeling that comes from it.
Cognitive distortions come in many shapes or forms. Some of these include all-or-nothing thinking ('I passed that exam, but I only got a B. I'm a total failure'), over-generalisation ('I'll never get a job'), disqualifying the positive (being told that you've been very helpful, but rejecting the comment because 'He's just trying to be nice to me'), mind-reading ('Everyone can tell what a miserable person I am'), negative prediction ('I won't go to the party because I'll make a fool of myself'), emotional reasoning ('I feel guilty, so I must be a bad person'), so-called 'should statements' ('I should do this' or 'I must do that'), and personalisation (basically a form of paranoia).
Whether or not you agree that cognitive distortions are the cause of depression, or merely symptoms of it, there's no denying the evidence that counteracting negative automatic thoughts can have a hugely beneficial effect on the depressed person. In addition, depressed people who recover using cognitive therapy are less likely to suffer depression in the future than those who recover solely using anti-depressants, because the therapy gives the sufferer the tools with which to fight off depression in the first place. Here's how to give it a try.
First, draw a table on a piece of paper with the following columns; date, emotion, strength of emotion, situation, automatic thought, rational response, outcome. Now, as you go through the day, record each negative emotion as it occurs, along with the strength of that emotion and the situation you were in at the time.
Then, try to identify the negative automatic thought that led to that emotion. This will take some practice, as humans are not used to analysing their thoughts. It may take you quite a while to get used to the idea of looking for the thoughts behind your feelings, but once you can do it, you'll have made a big step in the right direction. Beck compares this to standing by the side of the road counting cars, instead of standing in the middle of the road and letting them hit you.
For each automatic thought, write down a rational response. For example, the thought 'I'm a useless mother' can be rationally answered with 'I'm not a useless mother - I may have made a mistake under difficult circumstances, but that doesn't make me a bad parent'.
In the last column, record the outcome. Did you believe the rational response? How do you feel now? You'll probably find that you don't believe any of the rational responses at all initially, and that's perfectly normal. It can take a lot of practice before depressed people can identify their negative automatic thoughts, counteract them and believe the responses. But the more times you have the same thought, and write down the same rational response, the more likely you are to start believing that perhaps the rational response is correct after all.
Cognitive therapy is a massive subject, and we've merely scratched the surface here.
Negative automatic thoughts and rational responses
If you're attempting to counteract your own depression using cognitive therapy - and we recommend that you do - you may find the following useful. It's a selection of negative automatic thoughts and their associated rational responses from the diaries of depressed people. Adding the '(remember: this is a negative automatic thought)' phrase at the start, and 'These bad emotions are not real. They are due to a temporary chemical imbalance in my brain.' at the end of each of your own rational responses may help you believe them. Obviously your thoughts and answers are likely to be different to these, but at least this might give you a guide as to how to fight each thought when it occurs. Note that cognitive therapy can be much easier when carried out with the help of a good psychologist. Ask your doctor for more details.
(remember: this is a negative automatic thought)
That's not true. It will end because depression always ends. Nearly everybody experiences depression at some time or other. Some get so low that they think about suicide, but nearly all recover. These bad emotions are not real. They are due to a temporary chemical imbalance in my brain.
(remember: this is a negative automatic thought)
That's pretty natural. The chemicals in my brain are out of balance, so my perception is distorted. Fear is a logical result of that. These bad emotions are not real. They are due to a temporary chemical imbalance in my brain.
(remember: this is a negative automatic thought)
Not true. I'll look back at this in months or years to come and think "That was a bad time", but I won't remember the details. I will be able to enjoy life 100 percent. Looking back on past pleasures may taint them with the depression of my current mood, but that doesn't mean that they weren't enjoyable at the time, and will be again in the future. These bad emotions are not real. They are due to a temporary chemical imbalance in my brain.
(remember: this is a negative automatic thought)
That won't help me get better. First, get up, get dressed and either go for a bike ride or, if it's raining, do some exercises in the house, until I'm sweating and out of breath. Then look at what I can do that will be constructive or fun. Mow the lawn, clear out the shed, put up some shelves, buy a magazine and read it, go to the cinema, etc. These bad emotions are not real. They are due to a temporary chemical imbalance in my brain.
(remember: this is a negative automatic thought)
The thought that things are not real is just a lie created by the depression. Once I am over this, things will again feel completely real. These bad emotions are not real. They are due to a temporary chemical imbalance in my brain.
(remember: this is a negative automatic thought)
No I won't. This is not some sort of game, this is my life. It may be hard, and it may give me headaches and other pains, but I must concentrate hard on combatting all the negative automatic thoughts that come into my head. Once I can successfully combat them, I can realise that they are just lies generated by the temporary chemical imbalance in my brain. Only then will I start to recover from this depression. If I need to rest, wait until late evening when things feel better. These bad emotions are not real. They are due to a temporary chemical imbalance in my brain.
(remember: this is a negative automatic thought)
So what do I believe? Do I believe that being depressed is the normal state of affairs? Do I believe that I've been depressed all my life, and that anyone who has ever been depressed has stayed depressed? No. I am depressed, it's a temporary chemical imbalance in the brain that is affecting my thought processes by tainting them with negative automatic thoughts. I can get over the depression by being positive and believing what I have written here. I may not believe these words right now, because I'm having a bad time, but they are true and no amount of depression-induced disbelief will change that. These bad emotions are not real. They are due to a temporary chemical imbalance in my brain.
(remember: this is a negative automatic thought)
Yes I can go on, because eventually I will be well again. If I can't look that far forwards, consider this; do whatever is necessary to occupy myself until the evening, when things get better. That's all it takes; one day at a time and things will improve. These bad emotions are not real. They are due to a temporary chemical imbalance in my brain.
(remember: this is a negative automatic thought)
Fair enough. If I've really tried my best to cope using cognitive therapy and still things are getting markedly worse (compared with, say, a month ago), then the anti-depressant pills will help. Bear in mind, though, that once I take one I have to continue the course for several months and come off them slowly, and I must also continue with the cognitive therapy and change my lifestyle to a more sensible, enjoyable one. These bad emotions are not real. They are due to a temporary chemical imbalance in my brain.
(remember: this is a negative automatic thought)
No it isn't. Before this happened, I didn't even really know what depression was. This will pass and I'll be free of it again. These bad emotions are not real. They are due to a temporary chemical imbalance in my brain.
(remember: this is a negative automatic thought)
That's right. Life isn't fair, it just is. Sometimes good things happen, sometimes bad things happen. This depression is one of the bad things, but it will pass, and life will be enjoyable again. These bad emotions are not real. They are due to a temporary chemical imbalance in my brain.
(remember: this is a negative automatic thought)
Don't jump to conclusions. Considering the length of time I've been depressed, I can't really expect everything to get better in just a week or a month. If it's taken nearly three months for me to get this low, it may well take me just as long to get back up again. Be patient, continue the therapy and I will get better. These bad emotions are not real. They are due to a temporary chemical imbalance in my brain.
(remember: this is a negative automatic thought)
That's unlikely. Depression affects a lot of people, including intelligent and creative people. Therapy merely teaches me to see the depression for what it is, and counteract it. Saying that it won't work on me is just a negative automatic thought. I am strong enough to get through this. These bad emotions are not real. They are due to a temporary chemical imbalance in my brain.
(remember: this is a negative automatic thought)
That's OK, I'm working hard at helping myself. Initially this therapy will be difficult, of course, but it will get easier as time goes by, until eventually it will become an automatic part of my life, like breathing or eating. These bad emotions are not real. They are due to a temporary chemical imbalance in my brain.
(remember: this is a negative automatic thought)
That's true, but clouds and darkness on the outside can't hurt me. So it's a gloomy day, so what? That doesn't stop me doing anything, does it? I may not feel too cheerful, but it's only weather, it can't hurt. These bad emotions are not real. They are due to a temporary chemical imbalance in my brain.
(remember: this is a negative automatic thought)
It is a bit strange, but it's actually very good for me. All of these bad thoughts are negative automatic ones generated by the temporary chemical imbalance in my brain. They can all be countered with the truth, at which point they are harmless. This thought technique will give me a more positive outlook on life once the depression is passed. These bad emotions are not real. They are due to a temporary chemical imbalance in my brain.
(remember: this is a negative automatic thought)
No I won't. It doesn't matter how hard it is to deal with, I will face it and examine it rationally and logically. I must remember that these thoughts are not real; they are just symptoms of depression - negative automatic thoughts. Each time one appears I can face it, examine it and see it for the lie that it is. These bad emotions are not real. They are due to a temporary chemical imbalance in my brain.
(remember: this is a negative automatic thought)
My brain is a complex thing, and the depressed part of it is trying as hard as it can to make me feel down, by coming up with new and ever more unrealistic black thoughts. They're nothing, not real. I can defeat all of them. I should remember that 50 or even 100 thoughts may need to be written down before the depression starts to lift. Who knows, I may need to record even more than that, but it doesn't matter; I will get over it. These bad emotions are not real. They are due to a temporary chemical imbalance in my brain.
(remember: this is a negative automatic thought)
They may be strong, but they're not real and they don't apply to me. They just come from the part of my brain that's suffering from a temporary chemical imbalance. Instead of worrying about them, just recognise that they are negative automatic thoughts. Count them, shoot them down, dodge them, do whatever I want to do mentally, but don't take any notice of them. They aren't real, they won't affect my sanity and they can't hurt the real me. These bad emotions are not real. They are due to a temporary chemical imbalance in my brain.
(remember: this is a negative automatic thought)
This is a tough one to bear, isn't it? It's called depersonalisation, and is a classic symptom of depression. There's not much to say except that it will pass, as will all the other symptoms. Remember that I am a single entity - body, brain and mind are all one, and what affects one will affect the other. The detachment will pass, but for the moment, just concentrate on this cognitive therapy and be thankful for what I have in life. I may feel that I can't touch what I love at the moment, but that will pass soon enough. Remember that classic description of depression; the bell-jar. That means that I can see the rest of reality but not quite touch it. Like everything else it will pass with time and concentration. These bad emotions are not real. They are due to a temporary chemical imbalance in my brain.
(remember: this is a negative automatic thought)
There's no need to be. I can concentrate on the present. I should relax, enjoy myself and generally have fun. The future will take care of itself. I can neither predict it nor control it, which makes it all the more exciting. These bad emotions are not real. They are due to a temporary chemical imbalance in my brain.
(remember: this is a negative automatic thought)
That's OK. These are normal symptoms of depression/anxiety, so don't worry too much about such things. Go for a walk in the cold air and things will get better. These bad emotions are not real. They are due to a temporary chemical imbalance in my brain.
(remember: this is a negative automatic thought)
Fighting depression is not easy, but I should also be aware of the causes for my current state, namely over-work, possibly with a sprinkling of SAD. Taking a holiday somewhere sunny would probably be a really good idea, as would doing considerably less work, exercising a lot and going out in the evening with friends. Keep in touch with family, take up new pursuits, and enjoy the good things in life. These bad emotions are not real. They are due to a temporary chemical imbalance in my brain.
(remember: this is a negative automatic thought)
This negative automatic thought is the wrong way round; the truth is that I feel good now and the chances are I will feel good again, even if there's a temporary lapse - which there may not be. If there is a lapse, I'll recover again. These bad emotions are not real. They are due to a temporary chemical imbalance in my brain.
(remember: this is a negative automatic thought)
I've been perfectly happy with my own company in the past. What I'm scared of is not my own company but the thought that the depression will get to me if I stop to think. There's no need to be scared. I have the mental weapons with which to combat the depression. These bad emotions are not real. They are due to a temporary chemical imbalance in my brain.
(remember: this is a negative automatic thought)
Without getting too metaphysical here, how can I feel good if I'm not feeling good? That's like saying 'My leg is broken, but really it's not broken'. If I'm feeling better, then I'm feeling better. If I have the nagging feeling at the back of my mind that things aren't quite right, that's just negative automatic thoughts, probably of the 'This will never end' and 'I'm really concerned about the future' variety. These bad emotions are not real. They are due to a temporary chemical imbalance in my brain.
(remember: this is a negative automatic thought)
What do I expect, permanent joy? Nobody in the world is permanently happy. Some days are good, some days are average, some days are crap. That's life. Just because I'm not happy doesn't mean that I'm depressed. There's a big difference, and although it may take me some time to realise it, that is a perfectly normal - and necessary - aspect of life. So don't worry. These bad emotions are not real. They are due to a temporary chemical imbalance in my brain.
(remember: this is a negative automatic thought)
There are two things to consider here. First, I can't do cognitive therapy in my sleep, so if there is still a chemical imbalance in my brain, it may appear in the shape of bad dreams. But secondly, I've had bad dreams in the past, so it's really nothing to worry about. These bad emotions are not real. They are due to a temporary chemical imbalance in my brain.
(remember: this is a negative automatic thought)
I am not shallow, and I am thinking about what I do. But because I am nearly over this depression, I'm not thinking about everything I do from the perspective of how it will affect my future life in years to come. In other words, I'm living life as it comes and enjoying the moment, which is exactly what I should be doing. I don't need the deep insights of depression. I know that I have to change my life - work less, play more - so the depression would now just get in the way of me changing my life appropriately. These bad emotions are not real. They are due to a temporary chemical imbalance in my brain.
(remember: this is a negative automatic thought)
Am I? Some days I may be a bit grumpy, but that's the same for everyone. Most of the time, though, I'm pleasant to people, not rude or insulting. These bad emotions are not real. They are due to a temporary chemical imbalance in my brain.
(remember: this is a negative automatic thought)
This seems to happen mostly in the mornings. I think it's partly due to the remnants of last night's dreams, whether I remember them or not, but it's also a form of depersonalisation. Don't worry about it, just go through it and remember the last time of clarity. These bad emotions are not real. They are due to a temporary chemical imbalance in my brain.
(remember: this is a negative automatic thought)
I am sorting myself out on my own. That's exactly what I am doing with this therapy. When I get a bad thought, I'm analysing it and seeing whether it's true or not. So far they've all been false, so there's no need for me to be depressed. Once I have answered all the negative automatic thoughts, I will start to get better. These bad emotions are not real. They are due to a temporary chemical imbalance in my brain.
(remember: this is a negative automatic thought)
Try not to be too melodramatic. I've experienced some bad times recently, but they were due to an illness, nothing else. I can get on with enjoying life, changing some aspects of my lifestyle to make sure that nothing like this ever happens again. That's really all there is to it. These bad emotions are not real. They are due to a temporary chemical imbalance in my brain.
(remember: this is a negative automatic thought)
No it's not, it's most definitely depression. Depression includes feelings of anxiety, stress, choking, panic, depersonalisation, fear of the future, loss of self-esteem, paranoia, etc., etc. There are so many symptoms, and all the symptoms I have felt and am feeling are due to depression, nothing more. Time, rest and most importantly this cognitive therapy will allow me to recover from this completely. These bad emotions are not real. They are due to a temporary chemical imbalance in my brain.
(remember: this is a negative automatic thought)
There's no need to be scared. Since I've been depressed I haven't done anything irrational, and everything I've written has been sensible and reasoned. I can relax and enjoy my life without planning how a particular event will go. There's no reason at all to be scared. I am a sensible person and depression doesn't change that. These bad emotions are not real. They are due to a temporary chemical imbalance in my brain.
(remember: this is a negative automatic thought)
That's OK. This is partly due to the depersonalisation, which will pass given time, and partly due to the fact that I'm busy watching my negative automatic thoughts. Just as long as I know when to relax and enjoy myself (which I will), all will be well. These bad emotions are not real. They are due to a temporary chemical imbalance in my brain.
(remember: this is a negative automatic thought)
No chance. I've been through Hell, and I'm not repeating that again. It's been horrible, and I know that my lifestyle must change. These bad emotions are not real. They are due to a temporary chemical imbalance in my brain.
(remember; this is a negative automatic thought).
Why? With the exception of one or two incidents, my past was interesting, exciting and enjoyable. I made the most of it all at the time and enjoyed myself with good friends, so there's no need for any regrets or other nonsense. Don't worry about such things. My past is what has made me what I am, so remember it with good feelings. I don't want to go back because I've been there. I can move on to new adventures. These bad emotions are not real. They are due to a temporary chemical imbalance in my brain.
The following may be useful as a day-to-day reference when you don't have access to your 'rational response' sheet. Again, these reminders are taken from the diaries of depressed people - some may help you, some may not apply to you.
The 'two-pronged attack'
Therapy is often combined with anti-depressant drugs, in a two-pronged attack on depression that can be more effective than either approach on its own. See our TREATMENT FOR DEPRESSION page to find out more.
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