Mental Health

Cognitive Therapy Looks Beyond Childhood to Help Depressed Patients

Suzanne Leigh of San Franciso Chronicle wrote an excellent article about cognitive therapy as a depression treatment modality.

“Don’t Tell Me About Your Childhood” began with the general idea of talk therapy we’ve come to know. Whenever we think about psychotherapy, we’d have an image of a patient on a couch speaking with a somewhat disinterested therapist who would be asking the patient about his or her mother or childhood.

Some psychiatrists and psychologists in San Francisco are now using cognitive therapy to engage their patients in the present instead of helping them ruminate too long in the past. While discussing early childhood years may help us understand the formation of our personalities and perceptions, continual rumination may not help us move forward in our lives.

The basis of cognitive therapy is on our thought process. The article quoted a good example from a psychiatry professor:

If you waved to a friend and she ignored you, you would -

1) shrug it off and think the friend was distracted if you were an emotionally healthy person

2) become dejected and think that the friend hates you and is purposely ignoring you if you were an emotionally unhealthy person

Cognitive therapy is easily accused of “too much positive thinking” but cognitive therapists and clinicians say that it is focused on removing a patient from his distorted perceptions and recalibrating these distortions. Additionally, many clinical studies have shown that the effects of cognitive therapy may outlast those of medication therapy, even though most clinicians and therapists would agree that depression treatment modalities may include medication therapy.

When I was experiencing severe depression during my late twenties, I had severely distorted thoughts and perceptions, so I could relate to examples like the one above. The world of emotions was a caricature, and I was trapped in a maze. I originally received both psychotherapy (traditional) and medication therapy, and at the time, it wasn’t until I was on the right medication that I also began experiencing some benefits of traditional psychotherapy. I talked at great length about my childhood, what my mom did to me, how I felt about it, and traumatic events I had experienced and how I felt about those. Because of my personal experience with depression and what worked for me, I became a great believer of medication therapy combined with psychotherapy.

When I experienced a depression relapse a few years since my depression “remission”, an interesting turn of events occurred that made me a great believer of cognitive therapy. I became allergic to, or physically intolerant of, many antidepressants the doctor prescribed. One gave me severe rash, another made me so dizzy I could not stand up straight. I didn’t want to take the original antidepressant I took years ago even though my depression had responded, becuase it severely disturbed my sleep. At one point I was taking benadryl twice a day, every day, to manage the side effects of antidepressant that were not at levels high enough for me to gain therapeutic benefits. During this depression relapse, I depended almost entirely on psychotherapy.

While I wasn’t sure that the psychotherapy sessions I went to were “cognitive” sessions, it was certainly different for me. Part of this was because my mental perceptions were not as severely distorted as when I had severe depression. Another part was because my physical health was much better than when I was in my twenties (I was getting enough sleep, eating more regularly, exercising, etc.). A third part was the psychotherapist - she was very much a “no bullsh*t” therapist who pointed out my self-defeating thoughts and how my thought process was framing me to fail no matter what. It seriously made me consider an alternative reality that most people lived in, but I was a foreigner to. All these factors may help explain why I was able to kick my depression relapse without medication.

One of the most visible differences I had seen in my thought process about the world is how I used to react, and how now I respond. In a depressed state, I would react to people as if I was being personally attacked. In an undepressed state, I would respond to people with different possibilities that I would choose from (maybe they had a bad day, maybe they were being a jerk, “it’s their stuff, not my stuff”). It is a conscious mental choice that I make.

This takes daily and constant practice, but I notice myself becoming better at it, and the world becomes one less emotionally threatening.

© 2008 by Jane Chin, Ph.D. (email) All Rights Reserved.
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