Depression is probably one of the most difficult states to describe. Clinically we have a checklist of symptoms (see below) that gives us an idea of how much a person is suffering and how we may best help them. However, truly understanding a person's experience and how they got there is another story. It is often the case that a person who has become severely depressed with no organic reason for being so, have often lost sight or have no clue of how they got to the place they are at.
When working with a person with depression we need to use tools and ideas to get them to a safe and workable place. When we have helped them to this better place it is then our job to find out what happened to bring them to this place, how we may prevent it from happening again and to resolve scars and troubles ensued by life and the experience of depression.
Depression is a serious disorder which needs careful diagnosis. It can be the result of external events or organic origins such as a physical disorder, an imbalance of brain chemistry, or a medication problem.
The duration of this illness is important, as all people tend to experience a few days bout of a depressed mood that does disappear. Severe depression can last for weeks, months or years. Major depression is characterized by a series of symptoms which may include many of the following:
- Most days have a lack of energy
- Recurring thoughts of death or suicide
- Agitated Feelings
- Changes in sleep pattern
- Depressed mood most of the day
- Feelings of worthlessness or guilt
- Changes in appetite
- Inability to concentrate
- Reduced interest in pleasurable activities
We initially use this way of working in order to help pull you out of your cave and get you to a safe place in which you can work:
Cognitive Behavioural Therapeutic depression procedures involve both verbal and behavioural interactions. Firstly, we will find a way to be aware of the connection between your cognitions, behaviour, and mood. Through means of written homework, we monitor negative thought patterns, examine the evidence for or against any distorted conclusions, and then learn how to substitute reality-oriented beliefs. This procedure requires us to keep a daily log of activities and mood. You will also be encouraged to complete a series of challenging tasks, starting with very easy ones, and working up to more difficult ones.Behavioural strategies:
People with depression usually exhibit poor social skills, experience many negative events, engage in few pleasing activities, and think in ruminative and depressing ways. They tend to exhibit specific behaviours which unfortunately enhance the depression.
Behavioural treatments address these problems with a variety of strategies. Usually these involve some forms of self-monitoring activities in order to make you more aware of the relationship between activity and mood. The treatments emphasize the importance of structured activity, helping you learn that you can get some control over your environment.
Social skills training can be important too, as your depressive state will tend to lead to social isolation. This often leads to an erosion of social skills and an increasing feeling of social inadequacy. Building a structured program so that you can increase the number of rewards in life is also essential. Depression tends to result in a reduction of activity and as a consequence, lack of reinforcement.
Many therapists tend to combine the cognitive and behavioural techniques into one single customized package to help reduce depressive symptoms and increase awareness of opportunity and achievable desired goals.
When there has been hospitalization and diagnosis of bipolar or psychotic depressions, medication tends to be more often the treatment of choice as an adjunct to psychological therapy. Some studies have shown that these strategies can be very effective with a large number of unipolar or "neurotically" depressed patients. Usually we share this responsibility of care with a psychiatrist and a social work team.