The Shrinking Universe
I think, therefore I feel
VIJAY NAGASWAMI
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Apart from medication, psychotherapy too plays an important role in treating depression…
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with a combination of medication and psychotherapy, most people with depression recover completely...
Photo: K.K. Mustafah
Attitude counts: The world is what you make of it…
Last week I had written about the causes and treatment of depression (In the Times of Prozac, Magazine, July 19). Owing to constraints of space, I had not explored the role of psychotherapy in the management of clinical depressions, thereby inadverte
ntly leaving the reader with the inaccurate impression that anti-depressant medication is the only treatment available for this modern epidemic. Although medication is one of the cornerstones of treatment of Major Depression, psychotherapy plays an equally important role. A review of the research literature reveals that with a combination of medication and psychotherapy, most people with depression recover completely and are able to approach their lives with a fresh enthusiasm that seemed so elusive when they were down in the dumps.
The talking cure
Psychotherapy, which has been described by one of Sigmund Freud’s patients as “the talking cure”, has evolved considerably over the last few decades and today a bewildering plethora of psychotherapies exist, ranging from the more pragmatic approaches to the more esoteric ones. The basic object of psychotherapy is to help us understand what’s happening in those parts of our mind that are not readily accessible to us. Or put differently, what precisely our thoughts are doing to our feelings, and our feelings to our thoughts. One form of psychotherapy, called psychodynamic psychotherapy, helps people to create a better life for themselves by understanding their past experiences and helping them deal with these. It can and does help people when they recover from depression. But, of the different psychotherapies available, Cognitive Behaviour Therapy or CBT as it is popularly known, is the best researched and probably the most valuable when it comes to treating people going through a depression.
Negative blinkers
“If I think negatively, I feel depressed” is the maxim that constitutes the basis for CBT. The starting point of cognitive theory is that when an event takes place, the way we evaluate and think about it (cognition), determines how we feel about it. For instance, if we lose a job, we could evaluate it either as an inevitable consequence of these recessionary times or we could interpret it as a signal that the death knell of our career has been sounded. If we do the former, we will doubtless feel bad, but we will still be in a position to rewrite our resume, get in touch with a head-hunter and so on. But if our thought process is along the latter lines, we sink into a depression, feel anxious, angry and resentful, and approach our next job interview with so much negativity that a prospective employer may not want to hire us. And this ends up making us feel even more depressed.
According to cognitive theory, when we perceive an event using a negative filter (cognitive distortion), the emotion we experience is anxiety or depression, When this happens, we feel helpless and want to avoid the situation, as a result of which we may end up making inappropriate choices. And when we do this over a prolonged period, most of the filters we use become negative and we experience what are called “negative automatic thoughts”. In other words, we don’t even do it consciously any more. It happens pretty much on its own. When we get into a fight with the auto-rickshaw or cab driver in the morning, a negative automatic thought flashes through our mind to the effect that “today’s going to be a lousy day”. This heightens our anxiety and we set ourselves up to have a bad day and actually end up having one. Since all of us do have a fair number of negative experiences in the course of our lives, we do experience different types of negative automatic thoughts on a regular basis, but we build our own coping strategies, with which we can dismiss these and substitute them with more positive ones. However, if these thoughts cross a certain threshold or if we are experiencing a depression, we lose the capacity to do so. And this is where CBT can come to the rescue.
Troublesome threesome
Aaron T. Beck, an American psychoanalyst, was the person who originally formulated the technique of CBT. He believed that people with depression have what he referred to as the “cognitive triad” — a negative view of the self, a negative view of the world around, and a negative view of the future. As a result of this, they develop what are called negative “schemas” and they interact with the world through these. The object of CBT is to help people identify and correct their negative automatic thoughts and cognitive distortions, thereby giving themselves more accurate schemas with which they can engage positively with themselves, their world and their future. It is a simple, though not simplistic way of dealing with life’s problems, provided you are in the safe hands of a well trained cognitive therapist. And if you’re going through a depression, it might be a good idea to find yourself one in consultation with your psychiatrist. This way, your medication gives you a lift out of your depression and CBT helps ensure that you stay that way.
The writer is a psychiatrist and author of The 24x7 Marriage.
He can be contacted at: vijay.nagaswami@gmail.com
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