1. Managing Depression 1 : Cognitive and Behavioral Therapies John D. McKellar, PhD Clinical Psychologist Department of Veteran Affairs, Clinical Educator Stanford University

2. Cognitive Behavioral Treatment Model Mood Thoughts PhysiologyBehavior

3. Common Cognitive Distortions All-or-nothing thinking- Thinking that things are all good or all bad Over generalization- Taking one instance and thinking it is always true Mental filter- Only attending to negative aspects of a situation Discounting the positives- When positive information is attended to it is made less important or dismissed Jumping to conclusions: Mind-reading- Making assumptions about what another person might think, and then acting as is the assumptions are true Fortune-telling- Assuming that negative predictions are already true

4. Common Cognitive Distortions Magnification or minimization- Making negative situations seem larger, or making positive situations much smaller Emotional reasoning- Allowing one’s current emotions to influence our interpretation of situations Should statements- Having a list of “rules” for how we or others should act that we apply regardless of the situation leading to us feeling guilty or angry Labeling- Placing negative labels on ourselves or others that assume that we or others “always” act a certain way Personalization and blame: where a person believes that everything others do or say is some kind of direct, personal reaction to the person

5. Components of Cognitive Therapy for Depression 1. Engage Pleasant Activities- The most rapid way to improve mood is to engage in pleasant activities. Clients encouraged to schedule and monitor activities 2.Monitor Thoughts- The first step to changing or improving negative thoughts is to monitor them. This is particularly challenging as negative thoughts in depression typically become so “automatic” that the depressed individual fails to notice them. 3.Challenging Thoughts- Once an individual becomes aware of automatic negative thoughts (ANTS), the next step is to check out the thoughts and test their accuracy using something called a Thought Record. 4.Examining Negative Assumptions: Negative assumptions about oneself, others, or the world are the result of ANTS running wild. These negative assumptions need to be subjected to the same scrutiny as negative thoughts.

6. Situation Moods Automatic Thoughts Evidence In Support Evidence does not Support New Way of Seeing Things Moods See another couple that looks happy Sad- 9 Lonely-9 No hope-8 -Never have another boyfriend - I am hopeless at relationships - I will be alone - It has been 18 months since last Boyfriend - My last 3 relation- ships only lasted 2 Months - My mom is alone - I have had boy- friends for years at a time - I have lots of friends - I am not my Mom - It has been a little while since my last b.f. but I have had relationships that have worked, look at my friendships. What happens to my Mom is not about me Sad- 6 Lonely-7 No hope-6

7. Behavioral Activation

8. 1.This approach does not make any assumptions about causes of depression other than making the observation that people with depression fail to engage in rewarding activities 2.Instead, Behavioral Activation, directly attacks negative mood by focusing on one of the oldest findings in psychology: The most rapid way to improve mood is to engage in pleasurable activities.

9. Components of Behavioral Activation for Depression 1. Monitor Activities 2.Identifying Important Areas of your Life 3.Identify the “Values” associated with your Important Areas – 4.Identify Activities that are consistent with Values and Important Life Areas 5.Leverage Individuals in your Social Network

10. Monitor Activities

11. Important Life Areas Family Relationship Friendships Marriage Education Work Art

12. Values Being a loving parent Being an attentive and caring friend Caring for the needs of your partner Getting more formal education Learn new skills for work Be more knowledgeable about the world Being artistic and creative Helping others less fortunate than you

13. Finding Activities Value: Being a loving parent – Activity: Tell my child I love them every day – Activity: Make a special breakfast for my child on Saturday – Activity: Pick up my child from school promptly each day Value: Being an attentive and caring friend – Activity: Call my friend once per week – Activity: Text my friend – Activity: Ask my friend about his/her week Value: Caring for the needs of your spouse – Activity: Make special plans with spouse – Activity: Tell spouse I love them every day – Activity: Buy my partner a surprise gift

14. Using Your Social Network Tangible support- getting a ride, being a companion Commitment support- tell a friend your goal and have them hold you to i t Bonding support- involving a friend with your goal increases your bond

15. Self-help Resources Mind Over Mood: Change How You Feel by Changing the Way You Think Dennis Greenberger, Christine PadeskyDennis Greenberger, Christine Padesky Overcoming Depression One Step at a Time: The New Behavioral Activation Approach to Getting Your Life Back by Michael Addis and Christopher Martel Overcoming Depression One Step at a Time: The New Behavioral Activation Approach to Getting Your Life Back by Michael Addis and Christopher Martel