I think it was her second or third admission (I’m not quite sure) but prior to all her admissions she had attempted taking her life. On all these occasion she felt very lonely and assumed that the only way out was to end the misery once and for all. She had been in the ward for weeks now and was feeling much better but she feared that once she got back into the system she would soon have issues that will bring her back to the same spot of wanting to take her life, for her, this was the real problem.
As I engaged her in a discussion she quickly blurted out that she did not feel I, or any other doctor, could understand what she struggled with. I went on to explain to her that I understood because I had struggled with depression myself and then I went further to share how to overcome it (you could read the full account on my article titled when the clouds gather).
There are many useful articles on the net on this topic but I want to briefly talk about a method which I and many others have proven to be very effective. Actually, I had been practicing it before I knew about it; it is called the cognitive approach/therapy. This approach is effective in mild to moderate cases of depression with or without antidepressants however it is said to be more effective with antidepressant but it doesn’t work in severe cases of depression rather in such cases drugs or electroconvulsive therapy is used.
BACKGROUND TO THIS APPROACH
A.T Beck (1976) developed this approach based on the observation of a distorted thinking pattern that was common to people that were depressed; they had negative view about self, the world, and the future. These thoughts were disturbing and people who were depressed seem to have had no control over them, hence, they were called automatic thoughts. They were also noticed to have had beliefs and assumptions that made ordinary situation seem stressful; and illogical reasoning that propagated these beliefs and assumptions despite contrary evidence.
Here are some of the illogical reasoning (called cognitive distortions by Beck) that are seen in people who are depressed
· Overgeneralization…drawing general conclusion on the basis of a single incident; thinking that the bad outcome of one event will be repeated in similar future event, for example, having lost a partner the individual concludes they will never have a lasting relationship. So words like ‘always’, ‘never’, ‘everybody’ fills their minds- I’m always messing things up, I never get things right etc.
· Magnification (Catastrophising)-Minimization…expecting serious consequences of minor problem and inappropriately shrinking the importance of an attribute or event. I’ll like to term it fear and false humility respectively.
· Selective abstraction…focusing on a detail and ignoring more important features of a situation; for example, they constantly compare themselves with little information or on the basis of an isolated event so they either feel superior or inferior.
· Personalization…they see themselves as the cause of an external negative event which in fact they were not primarily responsible for and this usually results in guilt.
· Arbitrary inference… drawing a conclusion when there is no evidence for it and even some against it.
The above illogical thinking captures the common thinking pattern of people who are depressed hence the cognitive approach aims at modifying, or you could say renovating, this thinking pattern thereby reducing the burden of depression.
THE COGNITIVE APPROACH
As much as these thoughts are called automatic thoughts, which suggest that these individuals don’t have control over these thoughts, they can be challenged and with time checked to the barest minimum and sometimes, completely overcome.
Here are some tips to help challenge and restructure this distorted thinking pattern
1. Distraction…this involves focusing attention away from distressing thoughts, a conscious attempt to refocus usually on things in the immediate environment since automatic thoughts come on unconsciously. Sometimes it may involve engaging in a demanding mental activity to take the mind off the depressive thoughts…ever heard, ‘the idle mind is the devil’s workshop’?
2. Neutralizing…the emotional impact and distress caused by these thoughts can be reduced by rehearsing (either muttering or speaking aloud) a reassuring response. I use to muter words like “God has given me a sound mind; I’m a new creature; the joy of the LORD is my strength”.
3. Challenging Beliefs…like already stated above they make illogical conclusions and have abnormal belief system of themselves, the world, and the future. You will most likely need the help of someone here. You will also have to learn to communicate more rather than brood over imagined assumptions. This may entail choosing to believe the best of you and others, in other words, consider the alternative. For me, I replaced my low self esteem for God’s picture of me as revealed in the bible.
4. Reassess responsibility… some beliefs persist because people who are depressed overestimate the extent of their responsibility for events that have multiple determinants. So try and see the big picture; a lot of factors contribute to a singular event and this will help address the issue of guilt that arises from personalization (distorted thinking listed above).
Like I had earlier said there are other forms of treatment including medications, exercise and diet and they are very important but various researches has proven this approach as also being effective in mild or moderate cases.
It is said that nature does not allow for a vacuum so to overcome these automatic negative thoughts one has to replace them with positive thoughts. These cognitive exercises should be persistently practiced until you gain mastery then you will notice that the tendency to be and stay depressed will be greatly reduced with time. I will like to leave you with this quote from Philippians 4 verses 8 in the bible
“…whatever things are true, whatever things are noble, and whatever things are just, whatever things are pure, whatever things are lovely, whatever things are of good report, if there is any virtue and if there is anything praiseworthy…THINK ON THESE THINGS”.