“Mr. Rodrigo walks into my psychology practice. He tells me that he hasn’t felt the need to live for a long time: he’s been sad for a long time, that he doesn’t want to do anything or sees anything that can do. him, even the smallest things that once thrilled him are now just a nuisance, on top of that he indicates that he does not see that the situation needs to improve at any time. moment, having wanted to be a nuisance to her ones.
They got along well with him at first, but eventually got tired, and now he’s alone. As for the results obtained from the various tests and evaluation measures that he applied, everything suggests that we are dealing with a case of major depressive disorder. However, when the time comes to reflect, what can I do as a professional to help you improve your situation? “.
Analyze the case: depression
Depression. This word is commonly used, in everyday language, to denote a state of sadness that persists for some time. However, this use of the concept in everyday language loses much of what the term implies at the clinical level.
Clinically, the presence of a major depressive disorder is considered to be the presence for at least two consecutive weeks of depressive episodes, which are defined by the presence of five symptoms, one of them being a sad mood and / or the presence of apathy (Lack of motivation / interest) or anhedonia (lack of pleasure). Other symptoms include changes in appetite / weight, fatigue, restlessness or slowing down, guilt, and thoughts of suicide. To be considered as such, it must interfere with daily life and not be due to other disorders, such as psychotics. It is one of the most common mood disorders in the population.
Although these are the typical symptoms of depression, the question is: how to interpret and treat it?
There are many models that attempt to explain the depressive process and its causes. Fortunately, this great diversity offers a large number of techniques for treating depression. One of the best known, successful and used today comes from Beck’s cognitive theory.
Beck’s cognitive model
This theory considers that the most important elements in depression are the cognitive elements. According to this theory, the main problem of depressed subjects is cognitive distortion when interpreting phenomena of reality, focusing attention on knowledge patterns consistent with our cognitions. As a result of these patterns and distortions, we have negative thoughts about ourselves, the future ahead, and the world around us (thoughts called the cognitive triad).
Based on this theory, Beck himself devised cognitive therapy to treat depression (although it has since been adapted for other disorders).
Beck cognitive therapy for depression
This therapy was developed so that patients discover more positive ways of interpreting reality., Move away from depressive patterns and cognitive distortions inherent in depression.
It is intended to act from a collaborative empiricism in which the patient actively participates by creating situations that allow him to conduct behavioral experiments (that is to say to test their beliefs), which will be proposed between the therapist and the patient himself. Likewise, the psychologist will not directly confront dysfunctional beliefs, but will promote a space for reflection for the patient, so that ultimately he is the one who sees the inaccuracy of their beliefs (this way of proceeding is known under the name of the Socratic method).
To act in this area, we will work on cognitive, behavioral and emotional techniques.
These types of techniques aim to alleviate lack of motivation and eliminate passivity in depressed patients. In the same way, they also allow to test the own beliefs of guilt and worthlessness, being their basic operation the performance of behavioral experiments.
1. Assignment of graduate tasks
It is based on negotiating the performance of different tasks, classified according to their difficulty, So that the patient can test his beliefs and increase his self-image. The tasks should be simple and divisible, with a high probability of success. Before and after their realization, the patient must record his expectations and results, in order to contrast them later.
2. Planning of activities
The activities that the patient will perform are planned, including the schedule. It aims to force the elimination of passivity and apathy.
3. Use of enjoyable activities
Designed to eliminate anhedonia, it is about doing activities that are or are rewarding, Propose as an experiment and seek to monitor the effect of the self-fulfilling prophecy (i.e., there should be no failure for the belief that it will fail to bring about this). To be considered successful, it is enough that there is a decrease in the level of sadness.
4. Cognitive tests
This technique is very relevant. in the patient is asked to imagine an action and all the steps necessary to carry it out., Indicating any difficulties and negative thoughts that could interrupt it. It also seeks to generate and anticipate solutions to these possible difficulties.
These types of techniques are used in the field of depression for the purpose of detect dysfunctional cognitions and replace them with more adaptive cognitions. Some of the most commonly used cognitive techniques are:
1. Three column technique
this technique it is based on self-registration by the patient, Indicating in a daily newspaper the negative thought he had, the distortion committed and at least one alternative interpretation of his thought. Over time, more complex tables can become.
2. Down arrow technique
On this occasion it aims to deepen the patient’s beliefs more and more, Bring to light the deeper and deeper beliefs that provoke negative thoughts. That is, it starts from an initial statement / thought, then go on to see what makes you believe such a thing, then why you are thinking this second idea, and so on, looking for some more meaning. more personal and deep.
3. Reality tests
The patient is invited to imagine his perspective of reality as a working hypothesis, To design and plan later activities that may contrast it. After performing the behavioral experiment, the results are evaluated and the initial belief is worked on to modify it.
4. Record of expectations
A key component of many behavioral techniques **, it aims to contrast the differences between initial expectations and actual results ** of behavioral experiences.
these techniques they seek to reduce the negative emotional state of the patient through management strategies, Dramatization or distraction.
An example of such techniques is time projection. The goal is to look to the future and imagine an intense emotional situation, as well as how to deal with and overcome it.
Cognitive therapy for depression has been proposed as a treatment to be applied between 15 and 20 sessionsWhile it can be shortened or lengthened depending on the needs of the patient and his evolution.
Sequencing of therapy must first go through a prior assessment, then move on to carrying out cognitive and behavioral interventions, and finally help to modify dysfunctional patterns. A Possible phase sequencing might look like this:
Phase 1: making contact
This session is mainly dedicated to collecting information on patients and their situation. It also seeks to generate a good therapeutic relationship which allows the patient to express himself freely.
Phase 2: Start of the intervention
Is proceeds to explain the procedures to be used throughout the treatment and problems are organized the most urgent work is therefore carried out first (therapy is structured differently, for example in case of risk of suicide). Expectations for therapy are established. The psychologist will try to visualize the presence of distortions in speech, as well as elements that help maintain or resolve depression. Self-registrations are prepared.
Phase 3: Realization of techniques
The performance of the activities and behavioral techniques described above is considered. Cognitive distortions are worked on with cognitive techniques, taking into account the need for behavioral experiences.
Phase 4: Cognitive and behavioral work
Cognitive distortions are worked on from the experience gained from behavioral experiences and the contrast of self-recordings in terms of actual performance.
Phase 5: Reallocation of responsibilities
Responsibility for setting your agenda begins to be delegated to the patient, Increase their level of responsibility and autonomy, by exercising the supervising therapist.
Phase 6: Preparation for completion of treatment
The continuation of the strategies used in therapy is encouraged and reinforced. Little by little, the patient is prepared to be able to identify possible problems on his own and avoid relapses. It also prepares the patient at the end of the treatment. Therapy ends.
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. Fifth edition. DSM-V. Masson, Barcelona.
Beck, AT (1976). Cognitive therapy and emotional disorders. International University Press, New York.
Belloch, A .; Sandín and Ramos (2008). Manual of psychopathology. Madrid. McGraw-Hill (vol. 1 and 2). Revised edition.
Sants, JL; Garcia, LI; Calderon, MA; Sanz, LJ; of rivers, P .; Left, S .; Román, P .; Hernangómez, L .; Navas, E .; Lladre, A and Álvarez-Cienfuegos, L. (2012). Clinical Psychology. CEDE PIR preparation manual, 02. CEDE. Madrid.