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Using Cognitive Behaviour Therapy (CBT) to Combat Depression 

Using Cognitive Behaviour Therapy (CBT) to Combat Depression 

 

Photo credit: The Depression Project
https://www.facebook.com/RealDepressionProject/

 

Depression! It’s a common term for many things. “I feel depressed!”, “This is so depressing.”
The medical definition of depression, however, takes a more definitive approach than just the typical expression of exasperation. If you display five or more of the above symptoms over a period of two weeks or if the symptoms cause clinically significant distress or impairment to normal functioning, there is a chance that you may be diagnosed with depression.

Is it that serious?

A study was done by IMH in partnership with MOH and NTU to find out about Singapore’s mental health. In Singapore, one in 16 people may have depression at some point in their lives. That is just one of the most common mental disorders in Singapore! The percentage of lifetime prevalence of depression has seen a steady increase from 12% in 2010 to 13.9% in 2016. What’s scary is that 3 out of 4 (78.4%) people with mental disorders are not seeking help!

To find out more about depression you can read our recent article: What Is Depression & How to seek help?

So, what is CBT, and how does that help with depression? Glad you asked! Cognitive Behavioral Therapy, otherwise known as CBT, is considered the “gold standard” treatment for depression. It is a combination of cognitive and behavioral therapy that targets our limiting or unhelpful thoughts and behaviors which most of the time can be untrue to reality.

What is CBT

Photo credit: https://med.uth.edu/psychiatry/2019/11/27/what-is-cbt/

Normally the therapy takes 8-12 sessions where the patient and therapist work together to identify problem thoughts and behaviors. With that as a reference, the therapist will equip the patient with tools and techniques to change the way they think, feel or behave in the situation. The basis of this model is the assumption that a person’s thoughts, feelings, and behaviors are deeply connected. Thus, by actively taking part in changing the way we think or behave (which is honestly easier than changing our emotions), we can affect how we perceive certain situations that might have given us a hard time. Also, “homework” between these therapy sessions is useful to help practice the skills acquired during therapy.

That sounds complex and great but the big question is, does this work well for depression?

Well, over the last few decades there have been a plethora of studies to assess just how efficient CBT is. These studies have shown that CBT is not only effective but also produces solid results as a treatment not only for depression but also other mental illnesses!
One study that has shown just how effective CBT would be is a study done by Hollon et al (2005). The study found that patients who underwent and withdrew from CBT were less likely to relapse than those who underwent and withdrew from medications. In another six studies, CBT combined with medications added a 61 lower relapse/ recurrence rate (Vittengl et al, 2009, in Otto, 2013).

To conclude, CBT is efficient and definitely better than not doing anything about our mental health. If you do want to seek help or learn more about CBT therapy, feel free to contact us.


Photo credit: https://adaa.org/finding-help/treatment/therapy 

References:

https://www.todayonline.com/singapore/more-people-singapore-have-experienced-mental-disorder-their-lifetime-study-finds (Accessed 08/12/2020)

https://www.mentalhealthacademy.co.uk/catalogue/courses/using-cbt-with-depression (Accessed 07/12/2020)

Types of Psychotherapy Methods (DBT vs ACT) Used To Treat Depression

Types of Psychotherapy Methods (DBT vs ACT) Used To Treat Depression

Many of us are absorbed in an endless, self-defeating rat race. The nature of modern society has instilled in us a “winner/loser” mindset, and its systems highly prioritise external rewards and punishments as measures of our personal success and social worth. This oftentimes forces us to shift our perception of self-worth from the satisfying efforts of personal endeavour, to the critical imperative of achieving yardsticks of success defined by the rest of society. When we are constantly striving to win a race while focusing on external factors largely beyond our design or control, we’re surely putting ourselves at a disadvantageous position.

The overwhelming pressure to conform to societal expectations, or to outrun others in the race of life, can make one particularly susceptible to depression if negative emotions are not managed well. As we aim for perfection – as most people would – we need to understand that total perfection is unattainable. The more we believe that we have failed to reach a certain state of “perfection”, the greater the extent to which we experience low self-esteem, self-hatred, and depression. Depression can be extremely debilitating to one’s mental health. Apart from the diminishing enthusiasm for life and self-esteem, depressed individuals may self-isolate and pull away from their social circles, making it all the more difficult for them to get the help they need. 

Perhaps one of the healthiest things we can do for ourselves is to accept who we are. Self-acceptance might just be the antidote to excessive self-resentment and discontentment. It is important that we fight against influences that force us to conform to certain standards rather than to accept ourselves.  Presented below are a couple of talk therapy methods that we use to guide you towards achieving that. 

What is ACT?

Acceptance and Commitment Therapy (ACT) is a form of talk therapy suitable for the treatment of individuals displaying symptoms of depression. As its name suggests, it’s core aims are to help individuals accept whatever is beyond their control, and to commit to actions or habits that will serve to enrich their quality of life. ACT helps us to clarify what is genuinely important to us (i.e our values), and thus assists us to set more meaningful and life-enriching goals. Along the way, it also guides us to practise useful emotion-coping strategies such as mindfulness in order to equip us with skills to handle negative emotions effectively and healthily. While the number of ACT sessions may differ for each individual, the benefits acquired by clients are largely similar:

  • Learning to be fully present in the “here-and-now”, and to stop obsessive worrying over the past or future
  • Become aware of what they are avoiding (be it consciously or subconsciously), and to increase self-awareness
  • Learning to enjoy greater balance and emotional stability, and to be less upset by unpleasant experiences
  • Learning to observe thoughts such that one does not feel held captive by them, and to develop openness
  • To develop self-acceptance and self-compassion
  • Clarifying one’s personal values and taking the appropriate action towards his goals.

You may be wondering, does it really work? The good news is that ACT is considered to be an empirically validated treatment by the American Psychological Association (APA). Through program evaluation data, research has also shown that Veterans who completed ACT treatment phases displayed a significant decrease in depression in addition to improved self-awareness and a better quality of life.

 

What is DBT?

Apart from ACT, another alternative for the treatment of depression is Dialectical Behaviour Therapy (DBT). While originally used for the treatment of Borderline Personality Disorder, DBT has since been adapted to treat other mental health conditions including depression, anxiety, and post-traumatic stress disorder. A type of cognitive behavioural therapy, DBT aims to help individuals who struggle with emotional-regulation and are exhibiting maladaptive or self-destructing behaviours. It is not an uncommon sight for persons with depression to engage in substance-abuse or self-harm. As such, DBT helps to build on distress tolerance, such that people who struggle with these are able to handle negative life-circumstances better and to avoid falling back on such devastating coping methods.

DBT can be considered a holistic approach to depression treatment. Apart from tackling maladaptive behaviours, it encourages a shift in the clients’ perspective on life, for it equips them with the necessary skills to cope with intense emotions. In short, it empowers you to cope with them with a positive outlook. DBT also recognises that interpersonal effectiveness is key, and hence it strives to help these troubled individuals to reconnect and enhance their relationships with others. 

 

ACT Versus DBT

ACT and DBT are both highly effective methods of treatment for depression. Both forms of psychotherapy allow for individuals to tackle the notion of suffering head-on, and to avoid suppressing undesirable or uncomfortable feelings. Both promote psychological flexibility, and encourage people to behave in a conscious or effective way towards their life-choosing directions. The practice of mindfulness is also a commonality between both therapy methods, and it plays a crucial role in ensuring that persons are well aware of their values, goals and emotions.

However, overlaps between the two are considerably limited too. The main differences between ACT and DBT would be that DBT leans towards a more educative approach while ACT emphasises an experiential one. Perspective wise, DBT adopts a biosocial perspective on behaviour while that of ACT is contextual. Moreover, the underlying philosophy behind each form of therapy also differs. DBT philosophy is dialectical (i.e using logical reasoning and analysis), while the philosophy behind ACT is functional contextualism. With that said, the analysis of clients’ experiences, the use of languages as well as experiential exercises will be different for each type of therapy.

Seeking professional help can be rather daunting, but we need to recognise that psychotherapy is called for if one struggles to accept himself. Don’t deal with depression alone, lean into your support systems and mental health professionals when you need to – your future self will thank you.

 


References:

  1. Richard Hill, The Rise and Rise of Depression in a Competitive Winner/Loser World, video recording, Mental Health Academy

<https://www.mentalhealthacademy.co.uk/dashboard/catalogue/the-rise-and-rise-of-depression-in-a-competitive-winner-loser-world/video> (Accessed 13/02/2021)

  1. https://www.mentalhealth.va.gov/depression/act-d.asp  (Accessed 13/02/2021)
  2. https://behavior-behavior.org/act-fap-dbt/ (Accessed 13/02/2021)
What is Depression & How to seek help?

What is Depression & How to seek help?

Depression has been portrayed extensively in pop culture and media, from R.E.M.’s hit song “Everybody Hurts”, to the television series “13 Reasons Why”. The phrase “I’m so depressed” is thrown around casually when someone has had a bad day or when they can’t get their favourite brand of ice-cream. But what is depression, really? How does it affect us, and can it be treated?

If someone was recently fired or lost a loved one, it would be natural to feel grief at such events. However, grief is not depression. Depression is classified as a mood disorder that causes unusually low moods for an extended period of time and may impair one’s ability to function at work and at home. Grief or other stressful situations may sometimes trigger depression, but unlike grief, there is often no discernible cause for the hopelessness and despair a depressed individual feels. Depression affects everyone differently, and factors such as one’s family background, environment, or physical state can impact their chances of developing depression, and how severely it impacts them.

Depression has a variety of symptoms that can vary in intensity, including;

  • Low mood;
  • Loss of interest in typically pleasurable activities;
  • Sudden weight loss, or gain;
  • Changes in appetite;
  • Sleeping too much, or too little;
  • Restlessness or being slowed down;
  • Lethargy;
  • Feelings of worthlessness, or excessive guilt;
  • Inability to concentrate;
  • Recurrent thoughts of death or suicide.

Individuals who display five or more of these symptoms over a period of at least two consecutive weeks may be diagnosed with depression.

There are several different types of depression, with the most common being Major Depressive Disorder (MDD). According to a study conducted by the Institute of Mental Health (IMH), 1 in 16 people in Singapore have experienced MDD in their lifetime. Major depressive episodes last about eight months and have a 70% chance of recurring within five years, though this varies with each individual.

There is also Persistent Depressive Disorder (PDD), also known as dysthymia. This type of depression can last for several years, with symptoms receding for no more than two months at a time. PDD is much harder to spot, as the symptoms are often not as severe as MDD. Due to the length in which PDD affects individuals, friends and family may eventually brush it off as part of their personality. Others may think that they are just naturally “gloomy”, or “introverted” and “withdrawn”. Some individuals may also experience major depressive episodes while in the midst of PDD. This is known as double depression.

If any of the above sounds like they might apply to you or someone you know, you may be wondering “what can I do?”. The first step would be to speak to a mental health professional, who can properly assess the situation and make a diagnosis if necessary. They can then recommend a form of treatment. However, there is no “one size fits all” treatment. It may take many tries to find one that works for you. To help find that, here are some proven methods of treatment.

Medication

Antidepressants prescribed by psychiatrists help to stabilise one’s mood by adjusting specific parts of their brain chemistry. SSRIs are the most commonly prescribed class of antidepressants and help to boost the effects of serotonin in the brain. Antidepressants take time to produce full effects so don’t be discouraged if you don’t experience any effects immediately. However, if the antidepressants do not work after an extended period of time, or produce unpleasant side effects, speak to your psychiatrist about changing medications. When taking antidepressants, be sure to adhere to the prescribed dosage in order to see the best results. There is a common misconception that if someone feels better after taking antidepressants for a while, they can stop taking it immediately. This is not the case, and can instead cause their mood to suddenly crash back down again. If you are feeling better after taking antidepressants, speak to your psychiatrists, and together you can work out a plan to reduce the dosage of antidepressants.

Therapy

While medication can help to reduce symptoms of depression and improve one’s mood, they may not cure depression. Speaking to a counsellor or therapist can help to uncover underlying issues that are causing distress. The therapist can then focus on addressing these issues and equipping you with appropriate techniques to cope. Contrary to what is depicted on television, therapy does not involve lying on a couch and talking about your childhood. It is important that you feel comfortable with your therapist and develop a relationship with them where you are able to share openly about your struggles. One of the most commonly used forms of therapy is Cognitive Behavioural Therapy (CBT), which takes a goal-oriented approach to tackle negative behaviours or emotions.

Other forms of treatment

Aside from talk therapy, some individuals may find it helpful to find new ways of expressing the emotions that they are struggling with. This could be done through art therapy or psychodrama. Psychodrama allows individuals to explore different roles in a safe space using actions as well as words. For those worried about the side effects of taking medication, there is Transcranial Magnetic Stimulation (TMS). TMS Therapy is a non-invasive treatment that uses strong magnetic pulses, similar to those in an MRI, to stimulate areas of the brain that are underactive in depression.

Unfortunately, even with the wide variety of treatments available, the majority of people suffering from depression do not actually seek professional help. In many cases, this is due to the stigma associated with mental illness and the fear of what others may say. People with depression are often told “just stop being sad”, or “you should be happy, you have so many things to be thankful for”. So they hide it. They struggle each and every day and they hope that they’ll just get better on their own. But that makes the process so much harder. Support from friends and family is crucial in the recovery process.

Depression is a disease that can happen to anyone. It could happen to the quiet kid that sits in the corner. Or to your best friend who’s always been bubbly and lively, and now seems like someone else that you can barely recognise. But just like other diseases, it is possible to recover from depression with the right support from friends, family, and therapists. So be kind to one another, love one another, and when things get tough, be there for one another.


Photo by Paola Chaaya on Unsplash

Overcoming The Fear of Failure

Overcoming The Fear of Failure

At its most elemental level, people avoid the risk of failure for one simple reason – it hurts. Every single person has experienced failure. If you were to interpret failure by its definition in the dictionary, “the neglect or omission of expected or required action”, wouldn’t you, as a child, have stumbled along the way to achieving those long strident steps you take when strutting along the sidewalk? Yet, nobody feels ashamed of failing to learn to walk as a toddler. Why’s that? You could say that no-one in the right mind would expect that of a human child – we aren’t deer, or gazelles that need to shake off the afterbirth and walk – or risk predation. Our success as a species which put us at the top of the food chain negates that need. Fear is a function of the amygdala, yet failure isn’t. There’s a distinction here that we need to be mindful of. If you’re a parent or have access to YouTube, you’ve probably noticed that there’s an innocence in children that can be quite uplifting to watch, as they try multiple times to succeed at a simple task. They don’t puff their cheeks out and sigh in despair, or bury their heads in their hands. At most, they demonstrate frustration.

Shame is learned behaviour that children integrate into their developing moralities, either from being taught or through observation. Studies done on athletes have shown that perceived parental pressure (or pressure from authority figures) have deleterious effects on how sportspeople experience and interpret failure. Simply put, the fear of failure is a construct of how societies function. For some people, the avoidance of shame that failure brings weighs too heavily on them, and that is the crippling fear of failure. Dr Guy Finch puts this rather more succinctly: “fear of failure is essentially a fear of shame”. How then, do we begin to become more self-aware in the face of these deeply ingrained avoidance mechanisms to start building our best selves?

Evidence-based science suggests that the most efficient way to bring oneself out of the debilitating spiral of negative self-talk – one of the most insidious culprits in perpetuating avoidance based behaviours that stymie growth – is Psychotherapy method, Cognitive Behavioural Therapy (CBT). 

After all, overcoming fear of failure is all about reversing negative thought patterns, and Cognitive Behavioural Therapy (CBT) is designed to help you identify the underlying belief that causes a negative automatic thought (which in turn guides the feelings that come with it).

With the help of a qualified mental health professional, which can be anyone from a trained psychologist, psychotherapist or even psychiatrist, you can be empowered to break the circuit of the pervasive vicious cycle of negativity that prevents the unfettering of fear of failure’s heavy chains.

For instance, think of each deeply held criticism that you can’t let go of as a block in a Jenga game with your friends and the tower represents your thought life as a whole. Even though you’ve suffered through failure after failure, you can’t seem to jettison them from your psyche. Can you imagine a game of Jenga that doesn’t end in peals of laughter? It seems that some re-evaluation is needed to turn the way you handle each soul-sucking gut-punching failure from the darkness of your room. The grip of negativity steadying your trembling hand, an extension of your mind, putting each block up on autopilot because you believe you are not good enough. Instead, we suggest turning the lights on, invite someone you trust into your sanctum of despair, to play the game of Jenga with you. As you ease into their presence, you’ll begin to notice that the tower doesn’t look so intimidating anymore. It’s no longer just a congealed mess of all your shortcomings and toxic thinking, but a simpler thing that can be deconstructed. If each block represents a negative conviction you have about yourself that is too painful to touch, reach for the piece that looks more well-shorn and polished (which represents a perceived positive character trait or accomplishment that you hold dear). Put it back on top of your tower. It is yours, isn’t it? Or perhaps let your confidant handle that splintery block. 

Of course, we all know that Jenga isn’t all laughter and grand gestures. There’s physical tension and the cogitation of making the right choice so the tower doesn’t crumble prematurely. Maybe you aren’t too good at Jenga. That’s fine. But if you start thinking of this special game of Jenga as a collaborative effort instead of a competitive one, you’ll start getting the picture. Who would you like to invite to collaboratively play a game of Jenga?

 

 


  1. Sagar, S and Stoeber, J. Perfectionism, Fear of Failure, and Affective Responses to Success and Failure: The Central Role of Fear of Experiencing Shame and Embarrassment. Journal of Sport and Exercise Psychology, 2009, 31, pp 602-627.
  2. https://www.psychologytoday.com/sg/blog/the-squeaky-wheel/201306/10-signs-you-might-have-fear-failure. Accessed 2/6/2020.
  3. Photo by John Moeses Bauan on Unsplash
Youth Depression in times of COVID19 Pandemic: How Can We Help?

Youth Depression in times of COVID19 Pandemic: How Can We Help?

Youths these days have a lot on their plate. Teenagers have to cope with the highly competitive education system, and the fresh graduates are worried about employment opportunities or career advancement. Coupled with the need to maintain good relationships with their friends and family, these individuals may be experiencing high levels of stress. Some people do thrive well under stress, but what happens when stress levels exceed the healthy range? For those who are unable to cope, chances are their mental wellbeing would take a toll.  

 

With young people unable to attend school in person regularly or go into the workplace during the circuit breaker, they might have felt increasingly isolated due to the lack of face-to-face social interaction over this extended period of time. Furthermore, having to fight for their own space while at home with their family members may have caused some conflict and frustration for some. Undoubtedly, cabin fever may have also kicked in for some of them. Although circuit breaker measures have recently been eased, youths may not be able to adjust back to the norms as easily as one might expect. Reports have shown that it is expected that more youths will be prone to developing mental health issues such as depression due to the various implemented COVID 19 pandemic coping measures. 

 

Depression is one of the world’s leading mental health disorders, and youths have become increasingly prone to it. Studies have shown that depression affects up to 18% of Singaporean youths. People with depression may turn to self-harm or experience thoughts of suicide. These are often methods they adopt in order to cope with their difficult emotions. According to the suicide prevention agency Samaritans of Singapore (SOS), suicide remains the leading cause of death among youths aged 10 to 29 in Singapore, and as of 2018, 94 of them had succumbed to suicide. In order to curb the rise of depression cases among youths, it is important that we are able to identify the early stages of depression. Doing so will allow them to seek treatment earlier and to help them get back onto their feet. Depression, if left untreated, will severely impact people’s lives in a negative light, causing personal, educational and familial difficulties. 

 

Here are some of the most common symptoms of depression that you should look out for (not exhaustive): 

 

  • Extreme sadness and low mood
  • Lack of interest in activities once enjoyed
  • Lack of self-worth
  • Increased lethargy
  • Experiences sleep disturbances and loss of appetite
  • Poor concentration and impaired memory
  • Sense of hopelessness and helplessness
  • Excessive self-criticism and self-blame

 

If you notice a friend or family member of yours showing such symptoms for long periods of time, perhaps it is time to seek help from a professional mental health expert. 

 

But how can we first better support troubled youths? When it comes to dealing with depression, individuals with mild depressive conditions could adopt self-help strategies such as trying to maintain a balanced diet, to pick up on relaxation techniques, embark on daily gratitude journaling exercises (e.g. 3 things I can be thankful for today) and get some exercise in, even if it’s just a stroll around the estate or exercises from ATHLEAN-X™ or Athlean-XX for Women. Try encouraging them to live a healthy lifestyle and maybe create a ‘Daily Wellness Plan’ – a list of little and big things they can accomplish on a daily basis to comfort and keep their moods up. However, it is key to take note that even though their depression may be perceived to be mild from a third person’s point of view, we should never make assumptions as to what they truly feel on the inside. We should never, under any circumstance, tell them to “snap out of it”. It is very important for us to be patient and listen to what they have to say if they do approach and confide in you. Stay empathetic and show your concern for the individual. Acknowledge and respect their feelings and worries. Listen actively by using active listening skills. Encourage them to join mental health support groups like those conducted by PSALTCare – journeying with others that are going through similar struggles can encourage social healing.

 

On the other hand, for those coping with moderate to severe conditions, we might need to encourage them to seek a multidisciplinary approach to recovery like psychiatric help and look to taking medications, with supporting psychotherapy or counselling sessions and support groups. They might also be afraid of the stigma attached to seeing a Psychiatrist or what would transpire in that session. Try to assure them that there is nothing to be ashamed of. In fact, it is a lot more common in Singapore now, and a trip to the Psychiatrist is as straightforward as seeing your family doctor.  Alternatively, these youths can book appointments for psychotherapy first. With appropriate treatment and support, it is entirely possible for them to move on and lead a more productive and happier life. Here’s a questionnaire that is widely used by Psychiatrists to help determine depression to help you with next steps decisions: www.mdcalc.com/phq-9-patient-health-questionnaire-9

 

If you or anyone you know are struggling and are unable to cope with the post-lockdown blues, we strongly encourage you to get professional help.  Do not hesitate to contact us when necessary. 

 


 

References:

  1. Teen Mental Health: Depression (Accessed 22/05) 
  2. CNA: Under pressure at home and in school, youths battle depression (Accessed 22/05)
  3. Photo by Yuris Alhumaydy on Unsplash