Depression Counselling

DEPRESSION COUNSELLING AND LOW MOOD

What is Depression?


Depression

Being depressed is more than just experiencing the normal ups and downs of life. Depression is a mood disorder that is brought on by overly negative interpretations and maladaptive beliefs about ourselves, others or/and the events in our life.

Why do we get depressed?

Dysfunctional thinking is largely what causes depression. In the early 1950s, Beck proposed that people who are depressed tend to have a negative view of self, the world and the future. For example, someone who wants to set up a new business may express the following negative automatic thoughts leading to anxiety and low mood, "I can't do this, I'll never be able to do this and I deserve to fail. I will never be able to set up the business because I'm not good enough".

Therefore, simply experiencing adversity is not enough to make someone depressed. If that were the case, everyone who lost something or someone important in their lives, was rejected or made a mistake, would develop depression. Instead, these events are only triggers or activating events, which may or may not lead to a mental health problem. In reality, people get unhealthily disturbed and depressed only when they hold a number of dysfunctional beliefs about certain events.

Rumination also plays an important role in the development and maintenance of depression. Rumination is a mental process in which someone goes over the same thoughts repeatedly and becomes very distressed about them as a result.

Cognitive Behavioural Therapy can be quite effective as a way to identify and modify the types of beliefs that CAUSE depression. Unfortunately, we cannot change the past, but with CBT, we can change how we perceive our present and our future and cope with the challenges that life throws at us from time to time. Depression counselling also helps reduce rumination, shows people how to use more effective coping mechanisms, or better ways to deal with those challenges, reduces avoidance and allows you to enjoy life more fully.

How do I if I am depressed?

It is important to understand, if you are diagnosed with depression, that this is not a label placed on you as a person, only on the symptoms you experience. Most often, depression arises out of other problems such as excessive and uncontrollable worry (characteristic of Generalised Anxiety Disorder), panic disorder (because one feels limited in what they can do) social anxiety (excessive worry about being negatively evaluated by others), post-traumatic stress disorder (due to not coping with the symptoms of the trauma), Obsessive Compulsive Disorder or some other disorder.

In your initial online session with either Sylvia or John, you will be assessed for other issues which may explain the development of your possible depression and work on what seems to be at the root of your low mood rather than just work on the most obvious manifestations of depression.

Just "thinking positively" is not going to decrease depression in any lasting way. Though depressed people do not engage in a great deal of positive thinking, it is not just the absence of positive thoughts but the frequency of negative thoughts and the dysfunctional patterns of thinking that perpetuate the depressed mood. Advice to "think positively" or to engage in "positive affirmations" such as "I'm a good person" often does not work.

Positive thinking alone will not alleviate depression. CBT is never about thinking positively but rather more healthily or realistically. Saying "I'm doing a great job" will not work when for the majority of the day, your automatic thoughts are self-critical or catastrophic in nature. Therefore, even though you are telling yourself positive things, you still believe negative things. Those ingrained negative thoughts and personal core beliefs, along with assumptions and rules you associate with external or internal events, are examined in depth and modified within the course of the CBT therapy.

In what ways is depression different

Below you can find a list of common symptoms associated with depression. This information is not intended for diagnostic purposes, as this will be done comprehensively by either John or Sylvia during your first consultation. The intention is to elucidate the fact that sadness and depression are two different mental states. There are other types of mood disorders, and while depression is one of the most common ones, it is not the only one. That is why it is important to get a proper assessment from a qualified Cognitive Behavioural Psychotherapist rather than attempting a self-diagnosis.

CBT treatments for Depression

1. Thorough Assessment: The treatment of depression relies primarily on an accurate assessment of the symptoms and a case formulation of the exact elements. During the first online interview, John or Sylvia will ask questions about your mood, times when mood improves, or the opposite, suicidal ideation, avoidance of situations or people, behaviours which make you feel safe or inside your safety zone, motivation for change, previous treatments for the problem as well as your expectations and goals of therapy.

2. Behavioural Activation (BA) is used to increase positive reinforcement and reduce avoidance by making the person become more active and functional. This component may or may not be present in your treatment. Sometimes a more cognitive approach is recommended. At other times, a behavioural approach, such as Behavioural Activation is preferred. On occasion, the combination of both will achieve the best outcome. Following the assessment, your CBT therapist will be able to tell you whether you may benefit from one of these components. Both Cognitive and Behavioural interventions are equally effective for depression.

Behavioural Activation incorporates different elements. For example, we ask clients to monitor all the activities they perform during the day. Ideally, clients should schedule and plan in advance, hour by hour, all the activities they could perform in order to maximise their level of achievement and satisfaction with the task. If this is not possible, or clients fail to do what they schedule, they can just record what they do every day, hour by hour, by taking note of the activity and the associated levels of satisfaction and achievement.

Another component of Behavioural Activation involves "Graded Task Assignments". Activities which need to be improved in frequency can be broken down into more manageable steps until the person succeeds in achieving that goal.

3. Examining the validity of thoughts and beliefs (Socratic Questioning):

As the CBT treatment continues, one essential component is examining your beliefs from many different perspectives until you are able to gain insight into the situation that may be more realistic and less dysfunctional. Sylvia or John will help gather evidence in favour of or against your beliefs by looking at the logic of your thoughts or assumptions. This process involving the modification of your beliefs is normally referred to as Socratic Questioning.

4. Assertiveness Training and Social Skills Training.

People suffering from depression are likely to be unassertive. When you have lost confidence in yourself, you may not be using your social skills in ways that are beneficial. In CBT, this is an important component since it helps you regain a sense of control and the ability to deal with others in a brief period of time. The result of becoming more assertive is normally a decrease in depression, an increase in confidence and a perception of self-worth.

John and Sylvia tend to include assertiveness training in their online sessions with depressed clients at some point during the therapy because, in addition to making them feel more confident or less worried in social domains, it also serves to prevent relapses. If clients do not learn how to deal with making or rejecting requests, giving or accepting criticism, respecting their own human rights, or dealing with conflictive situations, some situations they may face could activate schemas of inadequacy, defectiveness, or undesirability and get depressed again.

Moreover, being unassertive makes people more likely to hold resentment because they may have problems expressing dislike or giving/accepting criticism. Therefore, they may feel misunderstood, criticised, and/or rejected. These negative feelings may cause them to ruminate excessively and return to a depressed state. If this is your case, you will learn with online therapy how to leave behind these unhealthy emotions and patterns of thinking.

5. Anti-depressive medication

When people have severe depression, it is advisable to combine online CBT with medication. Some antidepressants will be more appropriate for specific clients than others. For example, some antidepressants contain anti-anxiety components and some do not. CBT works best in combination with antidepressants and prevents further relapses more often than CBT alone. This is true of clients with severe depression (BDI>30). Only general practitioners and psychiatrists can prescribe drugs. However, John and Sylvia can recommend a specific medication because they are well versed in psychotropic drugs.

6. Behavioural Experiments

Finally, another important intervention for depression is the use of behavioural experiments. The objective of this technique is to test dysfunctional beliefs in order to promote a more adaptive way of thinking. Sylvia or John will assess the predictions, assumptions or inferences you hold about a specific situation. Then, an experiment is carefully designed to test those predictions and gain insight about the validity of those beliefs.

Behavioural experiments can also be designed in order to make a client stop using their safety behaviours or reduce avoidance associated with pleasurable activities. Reducing or eliminating avoidance is important as this may have a positive impact on levels of depression by allowing the client to receive more positive reinforcement from the environment.

How to diagnose a Major Depressive Episode

Depresion is not just about feeling low, uninterested, or demotivated. Depression is also associated with a change in thinking patterns and behaviours.

In order to obtain a proper diagnosis, you would be required to attend an assessment session at Anapsys. Self-diagnosis by searching on the Internet tends to mislead people. Moreover, in most cases depression is only secondary (or comorbid) to another disorder. Sylvia and John are qualified CBT therapists who can help you identify whether you suffer from a depressive episode, and whether or not another disorder is causing it.

CBT treatments for Depression

1. Thorough Assessment: The treatment of depression relies primarily on an accurate assessment of the symptoms and a case formulation of the exact elements. During the first online interview, John or Sylvia will ask questions about your mood, times when mood improves, or the opposite, suicidal ideation, avoidance of situations or people, behaviours which make you feel safe or inside your safety zone, motivation for change, previous treatments for the problem as well as your expectations and goals of therapy.

2. Behavioural Activation (BA) is used to increase positive reinforcement and reduce avoidance by making the person become more active and functional. This component may or may not be present in your treatment. Sometimes a more cognitive approach is recommended. At other times, a behavioural approach, such as Behavioural Activation is preferred. On occasion, the combination of both will achieve the best outcome. Following the assessment, your CBT therapist will be able to tell you whether you may benefit from one of these components. Both Cognitive and Behavioural interventions are equally effective for depression.

Behavioural Activation incorporates different elements. For example, we ask clients to monitor all the activities they perform during the day. Ideally, clients should schedule and plan in advance, hour by hour, all the activities they could perform in order to maximise their level of achievement and satisfaction with the task. If this is not possible, or clients fail to do what they schedule, they can just record what they do every day, hour by hour, by taking note of the activity and the associated levels of satisfaction and achievement.

Another component of Behavioural Activation involves "Graded Task Assignments". Activities which need to be improved in frequency can be broken down into more manageable steps until the person succeeds in achieving that goal.

3. Examining the validity of thoughts and beliefs (Socratic Questioning):

As the online CBT treatment continues, one essential component is examining your beliefs from many different perspectives until you are able to gain insight into the situation that may be more realistic and less dysfunctional. Sylvia or John will help gather evidence in favour of or against your beliefs by looking at the logic of your thoughts or assumptions. This process involving the modification of your beliefs is normally referred to as Socratic Questioning.

4. Assertiveness Training and Social Skills Training.

People suffering from depression are likely to be unassertive. When you have lost confidence in yourself, you may not be using your social skills in ways that are beneficial. In CBT, this is an important component since it helps you regain a sense of control and the ability to deal with others in a brief period of time. The result of becoming more assertive is normally a decrease in depression, an increase in confidence and a perception of self-worth.

John and Sylvia tend to include assertiveness training in their online sessions with depressed clients at some point during the therapy because, in addition to making them feel more confident or less worried in social domains, it also serves to prevent relapses. If clients do not learn how to deal with making or rejecting requests, giving or accepting criticism, respecting their own human rights, or dealing with conflictive situations, some situations they may face could activate schemas of inadequacy, defectiveness, or undesirability and get depressed again.

Moreover, being unassertive makes people more likely to hold resentment because they may have problems expressing dislike or giving/accepting criticism. Therefore, they may feel misunderstood, criticised, and/or rejected. These negative feelings may cause them to ruminate excessively and return to a depressed state. If this is your case, you will learn with online therapy how to leave behind these unhealthy emotions and patterns of thinking.

5. Anti-depressive medication

When people have severe depression, it is advisable to combine online CBT with medication. Some antidepressants will be more appropriate for specific clients than others. For example, some antidepressants contain anti-anxiety components and some do not. CBT works best in combination with antidepressants and prevents further relapses more often than CBT alone. This is true of clients with severe depression (BDI>30). Only general practitioners and psychiatrists can prescribe drugs. However, John and Sylvia can recommend a specific medication because they are well versed in psychotropic drugs.

6. Behavioural Experiments

Finally, another important intervention for depression is the use of behavioural experiments. The objective of this technique is to test dysfunctional beliefs in order to promote a more adaptive way of thinking. Sylvia or John will assess the predictions, assumptions or inferences you hold about a specific situation. Then, an experiment is carefully designed to test those predictions and gain insight about the validity of those beliefs.

Behavioural experiments can also be designed in order to make a client stop using their safety behaviours or reduce avoidance associated with pleasurable activities. Reducing or eliminating avoidance is important as this may have a positive impact on levels of depression by allowing the client to receive more positive reinforcement from the environment.

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