Depressive disorders are one of the most prevalent psychiatric condition in the world. Although it may present at any age, adolescence to early adulthood is the most common age of onset. It presents with a collection of cognitive, emotional, behavioral, physiological, interpersonal, social and occupational symptoms. Depression can be of various levels of severities and a significant proportion can have recurrent illness.
Cognitive Behavioral Therapy (CBT) is one of the most evidence-based psychological interventions for the treatment of a range of psychiatric disorders including depression and anxiety and stressful life situations. Treatment guidelines for depression indicate that psychological interventions are effective and acceptable strategy for treatment and are used for mild-to-moderate depressive episodes. While there is not contraindication for CBT, clients with severe depression with psychosis and/or suicidality are difficult to manage with CBT alone due to their decreased healthy ego functioning. Clinically, a minimal level of healthy ego functioning is needed to be able to utilise the mentalisation component of CBT talk therapy. It is also reported that patients with comorbid severe personality disorders and subnormal intelligence struggle to use CBT. It is also likely that special clinical expertise is needed for treatment of these client groups.
The core principles of CBT are that psychological problems are based, in part, on unhelpful ways of thinking also referred to as faulty thinking and on learned patterns of unhelpful behaviours. People suffering from psychological problems can learn better ways of coping and therefore, relieve their suffering and become more effective in their lives.
CBT treatment involves efforts to change thinking patterns (cognitions) by identifying the specific faulty thinking that causes problems and reevaluating them in the light of reality. Clients are helped to gain a better understanding of other people’s behaviour and motives towards them. CBT also teaches clients problem solving strategies and with practice, to develop a sense of mastery in one’s abilities.
CBT treatment also seek to change behavioral patterns such as facing one’s fears instead of avoiding them, rehearsing potentially problematic interactions with others and learning to calm one’s mind and relax one’s body. CBT focuses on people developing coping skills with which they can help themselves monitor their own thinking, problematic emotions, and behavior.
Third wave CBT recruits mindfulness to augment its treatment efficacy. For example, one characteristic of depression is a habit of thinking negatively about experience, one’s self or the future. Mindfulness trains people to be more aware of these thoughts and to stand back and simply observe their thoughts passing through their minds — ‘Oh, there I go again, calling myself an idiot’ — instead of trying to control their emotions. Or, in the case of people who have recovered from depression, blaming themselves for feeling down again or worrying about a relapse.
It has been suggested that mindfulness leads to an increase increase in self-acceptance/compassion and a decrease in experiential avoidance through selective attention. By focussing on your breath, there is less bandwidth to ruminate. Research shows that mindfulness prevents relapse in people prone to depression.
