cognitive interventions for depression

cognitive interventions for depression According to the CT model, depressed and anxious people think their way
into suff ering. Specifi cally, they have maladaptive basic views, or schemas
(“I’m unlovable,” “I’m helpless”), associated maladaptive rules or underlying
assumptions (“Unless I’m perfect, people won’t like me”), and related automatic
thoughts that misinterpret everyday reality (Leahy, 1997; Sperry, 1999).
Depressed people in particular hold negative views of themselves, the world,
and the future—the “cognitive triad” (Beck, 1976). Anxious people’s negative
thoughts revolve around threats, insecurities, and “what if” scenarios.
CT is nothing if not thorough in providing techniques to heighten awareness
of and refute negative and irrational thinking. Patients can learn to
categorize their errors, such as mind reading, black-and-white thinking, overgeneralizing,
or personalizing. Th ey can learn to examine the costs and benefi
ts of their views, analyze the evidence, argue back at their thoughts, and
supply more rational and positive alternative explanations (Leahy, 1997). Th e
general approach is well suited for college students, who are bright, verbal, and
drawn to the power of ideas. But in our experience it isn’t necessary to follow a
manual or use multiple techniques, which can come across as intellectualized
and formulaic. Th e important thing is simply to help students recognize and
question their self-defeating habits of thought. Such successes do happen, but habits of mind are diffi cult to break.
Unless students remain vigilant, their worries, self-criticism, and fears will
insidiously return. What’s more, the success of cognitive therapy depends
on students’ buying into the idea that their core assumptions and automatic
thoughts are actually wrong. Some students reject this notion, insisting that
they attack themselves because they deserve criticism and frighten or worry
themselves for good reason. Th ey are ugly or selfi sh or unlovable or at risk—
it’s not in their mind. Taking this argument an ingenious step further, some
even fault themselves for being self-critical or worry about their proclivity to
worry, as if their negative thinking somehow justifi ed negative thinking. We
therapists can point out the self-defeating circular logic of these rebuttals; but past a certain point, challenging students’ beliefs is futile and ends in a
therapeutic stalemate.
As the popularity of CBT makes clear, CT works best when coupled with
behavioral exercises such as setting behavioral targets, following graded task
assignments, and role-playing assertive behavior (Leahy, 1997). In other words,
for constructive thought patterns to take root, they must be accompanied by
constructive behaviors. Conversely, behavioral changes depend on acquiring
healthy cognitions. Th us, it makes no sense to urge avoidant students to ask a
question in class, turn in a homework assignment, or start talking to classmates
if they are wedded to the idea “I must do everything perfectly or I’m a failure” or
“It’s devastating to be rejected.” Before they’re ready to take behavioral risks, students
fi rst need to be cognitively inoculated against life’s inevitable frustrations
and disappointments: “Of course you won’t say something brilliant every time,”
or, “It’s possible she won’t go out with you if you ask. Th e important thing is to
give it a try.” Ideally, avoidant students will learn to interpret striving as inherently
rewarding, and will take pride in their eff ort, regardless of the end result.
Th us cognitively prepared, they are ready to take behavioral risks.
Still, human beings can derive only so much satisfaction from noble failures
and nice tries. Ultimately, everyone needs success sometimes as a reward for
eff ort. And that, in turn, requires another cognitive accomplishment—learning
to set realistic goals, so that success is really a possibility. For college-age
patients, discovering where and how high to set their sights—neither shooting
for the unattainable nor selling themselves short—can be a vital therapeutic
step and good protection against depression and anxiety: “Suppose you don’t
end up making medical school. Any ideas what else you could strive to achieve?
What other professions would allow you to enjoy a satisfying career and feel
good about yourself?”