CBT for Depression | Mental Health Webinar

Well, continue, hello everyone and welcome to one of Ada's

webinar

s. My name is Dr. Debra Kissin. I'm the co-chair of Ada's public education committee and that's the Anxiety and Depression Association of America. Welcome everyone to our

webinar

on CBT for

depression

the basics and I'm very excited to present this and learn along with you so we have a treat for us today and I'm happy to join so today we have the doctor our presenter is the Dr. Rob Hyneman and let's go. I will tell you a little about ada and then also about dr. hyman, who will present today.

Like I said, my name is dr. debra kissin. I am the clinical director of the light on anxiety treatment center in chicago and also the co-chair of the public education committee and when you are done with this webinar, I encourage you to check out all the resources, not all, but some of the resources on The website is empirically supported and consumer friendly, vetted to be high quality information, so it's really good. place to get answers to some of your questions and these webinars are brought to you by ada. It is a leading nonprofit organization in the field of anxiety and

depression

.

Our mission is to improve the diagnosis and promote the prevention treatment and cure of anxiety, depression and stress. disorders through educational webinars like this one today, so also on the website one of the great features is finding a list of therapists, so if it depends on your geography, there are providers all over the world that are available and especially these days. We've all gotten a little better at web-based interactions, so no one has to feel isolated because there's no support available because ADA and partner providers are available to help and there's also a free peer-to-peer support group that you can find at through the ada org website and if you have any questions while watching this webinar, we are constantly seeking questions from

mental

health

consumers and posting answers, so feel free to reach out and we'll keep the conversation going.

I'm going to turn the presentation over to Dr. Rob Heinman and just to give you a little background, he's a clinical psychologist at the Beck Institute in Philadelphia, where he provides therapy to clients with a wide range of presenting problems, in addition to the clinical of the. Work Rob teaches workshops and has written book chapters and articles on topics related to cognitive therapy, depression, anxiety, personality disorders, and mindfulness, so I'll stop sharing if I can find my hmm, let me think that if I escape it could be easier. stop sharing, okay, are you able to take the power?

I've got it right, take the power, sometimes I love power, okay, then I'll get going, so thanks for having me. My name is Rob Hyndman. I get it at the Beck Institute. Philadelphia and I'm going over the basics of depression in terms of CBT, which is a cognitive behavioral therapy, so what I think I'm going to do today is I'm going to start talking briefly about the diagnosis of depression and then I'm going to spend most of the time . time talking about what we do with CBT and depression, so let's talk about behavioral interventions and then cognitive interventions, so start with what depression is, this is just based on the diagnostic and statistical manual 5th edition or the dsm- 5 So, for depression to be diagnosed, you must have at least two weeks of five of the following nine symptoms.

First of all, you need at least one of these two. Depressed mood most of the day, almost every day, which is feeling sad, empty, and hopeless. So this is what most people think with depression: I feel depressed, I wake up, I feel sad, I feel a little down, hopeless and nothing seems worth it. You also have decreased interest or pleasure in almost all of your activities. most of the day, almost every day, so this is that part of depression where you know if you've talked to someone with depression or you've felt depressed, you just don't feel like doing anything you know when you think about what to do during the day. activities let's say like going and doing something social if you have that ability you might think well what's the point of doing that because I'm not going to enjoy it at all not that it doesn't seem like something like that it's worth it for other symptoms it has changes in weight it could be loss or weight gain, which means a decrease or increase in appetite you have difficulty sleeping, which in turn can be on both sides where you have insomnia and you have trouble sleeping and you are sleeping less or it could be oversleeping or hypersomnia, you may have differences in the type of movement or agitation, so some people feel very sluggish, they move at a slower pace than others, it's more like a agitation feels faster than fatigue or loss of sleep. energy, so one of my depressed clients said that every day he feels like he's wearing a backpack full of bricks.

Another client described the depression as if he were wearing one. of those capes that they put on you in the dentist's office when they do an decisions and then recurring thoughts about death or suicide, so again of those nine symptoms you need one of those first two and then also having five of those nine and again it has to be for at least two weeks. of a period of time and then within those two weeks at least more days happen than not so just a quick overview of depression now in terms of what causes depression yeah go ahead I'm just thinking about different questions that we get from potential clients or just

mental

health

consumers in terms of what if you don't meet all the criteria what if you have some of these symptoms and does it necessarily matter why is it important to have a full diagnosis of depression?

I mean, I have a little bit of a different view of this than I think a lot of therapists have, but the way I really describe any type of mental health condition is the normal human experience on a continuum, so I don't really There is a direct way to say it. Here's this line that says you have it versus you don't have it and if you're a little bit on this side you don't have it versus this side so I like to say you know feeling a sense of sadness is a typical human experience we all feel sadness sometimes, but on that continuum of sadness, if it gets to the point where it's really intense or frequent to the point of causing distress or negatively impacting your life, then that's technically a depressive disorder.

I don't know what your opinion is. Mind you, and I would also sometimes tell my potential clients that we don't always have to wait for you to meet all the criteria anyway and that the good news is prevention or early detection, so maybe for billing or insurance these things matter, but even if you don't have significant criteria, who doesn't benefit from a little help anyway, so yes, definitely, yes, yes, I often tell clients that the reason why the one I give a diagnosis is really for insurance purposes, but I definitely like it. If you can start some type of treatment or catch it early, it will be much easier than you think, wait years and years and years, and I think if you look at the research, you know that most of the psychological disorders that people suffer from on average, like Five years to seek treatment so you know it can become more ingrained and ingrained at that point so I'm definitely with you on that so in terms of the general idea of ​​what causes it in terms of nature and nurture you can think . from nature, you know, biological, genetic, hereditary upbringing is more environmental, your experiences, anything psychological tends to be a combination of both, but since I'm focused on the psychological part, I'm only going to talk about that part, so in terms of the cognitive behavioral therapy model of depression this is what we have, so you have some type of stressor the stressor is anything that can be experienced as stressful or distressing it can be something like in the external environment, so I know a lot of clients who I have had a relationship breakup that can be a stressor, it can also be something internal, like when I had a client who was depressed and had a back injury and started experiencing a constant chronic pain and that was the stressor.

I've had other people who just The stressor is an emotional state in itself, so you have some kind of stressor and it's not necessarily the stressor, but it's the negative view of the stressor, so when you have this stressor stressful you think about it from a negative perspective. In CBT there is something called negative cognitive. triad of depression where there are negative thoughts about oneself, about the world and others in the future, and we specifically try to focus on those types of thoughts, so my client with chronic back pain considered himself a broken person and really thought that Basically, things aren't fair and you thought it would never get better and your life would never be the same again, so that leads to problematic coping and coping responses, so when you have the stressor you see it negatively and then with that coping is not where it could be.

In terms of coping, the main maladaptive coping or problematic coping is isolating you from others, so it's like when you start to feel depressed, like that first diagnosis that you don't feel like making. things so that you don't feel like hanging out with people, whether it's friends, family, whoever you think about it and say, well, it's just not going to be the same, so you start isolating yourself from other people, which also comes with a general withdrawal, so you just pull. coming back from life not doing the things that you would normally do, even if they're social, is isolating the non-social, withdrawing and then you have something called ruminating, so ruminating is when you're basically thinking about what the stressor is or the type of problem.

In your life now you're thinking about why it's happening and you're thinking about how bad it is and the implications going forward, so here you have an ex and then with that is where you get all these symptoms and the symptoms are It's really just the thing. We talked earlier about diagnosing depression, so here's just an example from one of my current clients. One of my current clients was laid off from his job at the start of Covid. From there, he has these different types of negative views on the situation. stressor, he thought to himself, I'm not good at my job, so I basically got fired, while some people didn't because of me, when in reality it turned out that he was just a junior at his job and all the juniors were fired, but he thought it's really me like I'm just not good at what I do, similar to my client with chronic back pain.

He thought the world is not fair with that kind of thing as if nothing was going to work for me, which extends to the future. I will never find a job as good as this, so with this negative view of the stressor, how did you cope when he started isolating? So he's someone who came from a very high-achieving family whose focus is on what you do. as a career, I don't want to say I'm actually from the Chicago area and I always say that growing up in Illinois is completely different than being in the Northeast because in Illinois, when you talk to people, it's more about what you do.

For fun, who do you know? How do you spend your free time? Compared to in the northeast. Every time I meet people, the first thing they ask me is what you do, so it's a very achievement-oriented and work-oriented culture, so he doesn't. I don't want to socialize with people because he thought well. I don't want my friends and family to know about this. I don't want other people to think negatively about me because I'm not working right now and then withdraw from life. Overall, he became less active, spent a lot of time lying in bed watching TV, and I think a lot of therapists have realized that all of this, like streaming services and cell phones as people, is a common depressed activity. . watching episode after episode of any TV show or you know one of my depressed clients is ticking all the time just watching video after video because it's kind of a distraction, but in it you're not participating in what's important to you and then in terms of rumination you just think about how bad your life is now, so you look at your life, you are just sitting in bed at home watching tv, not going out with friends and family, you wonder why this happened and again you think It happened because he's just not good at his job, so when he blames it on himself, he starts to think about what does this mean for the future if I can't do this?job and this was just an entry level position, how am I going to do anything with my job?

I like something about myself, so that's for this client how the depression started and then developed and stayed over time. Anything you want to add to that before we get to the behavioral part. I think it's a thought that comes to mind in terms of the rumination function in the sense that we're really trying to get out of the situation and people are trying to figure out how to move forward, it just so happens that we're running in place. and sometimes, uh for people to understand it, you're really trying to help yourself, you're not just trying to punish yourself, it just doesn't work, you have no idea why people ruminate or they do, so you know, rumination. .happens and in CBT we would consider rumination to be a behavior rather than a thought because it is an active process that you know is technically a choice, so the reason people ruminate is that there are positive and negative beliefs about rumination as behavior.

People think it's useful in some way, so exactly what are you talking about. If I can reflect on my problems, I will find a solution. If I reflect, it will help motivate me to stay on top of things. and start taking action, the negative beliefs about rumination are that it is harmful in some way, usually the main negative belief that keeps you going is the uncontrollable belief, so you get stuck in your head, you are going over your problems and especially when your mood is upset. to the type of depression and the stronger the mood the harder it seems to disengage from this then you get the feeling that rumination is uncontrollable so it starts because you think it is useful in some way so my client could see some guy or this happens when he starts looking for a job, then he likes to go to a website looking for a job, well they won't want me, then he thinks about why they wouldn't want him and how his life is never going to end. get better, but then when you get into it, you think I can't get it out of my head, I can't control it, so the whole process continues, in terms of what we can do for treatment, let's start with the behavior.

So, for the behavioral side, one of the treatments is called behavioral activation. It's actually a treatment in itself, but for most CBT therapists we'll do this with depressed clients, it's simply about becoming more active and involved in life, so again with one of the main coping strategies. problematic are going backwards, we want clients to move forward, who benefits and who doesn't, therefore, clients who have that typical depression where they are less active, those are clients who benefit from it, compared to those who do not. they exceed a lot. getting depressed clients too where they are actually too active because they constantly believe they need to be productive for that type of client.

You could actually try to reduce the activity or replace certain activities with other activities, so it's really for clients who have that. standard like lethargic depression and withdrawing from life and what is the goal of being active and engaged in life in terms of that model that I just went over so that one has the problematic coping so that one has the isolation piece if it can involve people in life because the vast majority of people want to connect with others and that's what's really important to us, so that will give you the potential for some kind of enjoyment or meaning, you have the retreat, as I mentioned, to which is addressed, so that's kind of what it addresses directly, but also indirectly rumination and negative thinking, so I think about the client that I just gave the example of who thinks his life is horrible right now, but one of the reasons you think it's horrible is because it's not full.

With anything that's important to him, he thinks he's just wasting time and space watching too much TV, so if he can socialize, if he can start the job search a little more productively, it'll help him with those negative thoughts because he'll see His life is not so bad and he will also see that he is capable of doing things that are important to him. With that you can also indirectly target rumination because you know, think about when you're active versus when you're inactive, so when you're really engaged in something, how easy is it to be really focused internally in your head analyzing something instead of saying something? that you're just sitting on the couch doing nothing?

So if you can get someone more active and engaged, you will succeed. They are less likely to be able to ruminate and with that reduction in rumination there is also the potential to help with depression. This is how I describe behavioral activation to clients. I will say that you know you had this event that kind of triggered the Depression between them again is more of the negative coping and the negative thoughts and that leads to your depressed mood. Now think about when you feel depressed, how is your energy low? And when you feel depressed and your energy is low, how active are you? you tend not to be very active so that leads you to be less active and isolate yourself now when you feel depressed and you don't think you have as much energy and then you are less active, which happens with your mood and some people say their mood mood worsens other people say their mood stays the same.

I'm going to write that down and again, when his mood gets worse, what happens to his energy and now he just shoots up with it, we can't control his mood at will. and we can't control your energy at will, but what we can control is your behavior, so you know, that's what starts the process, where clients can see when I'm feeling depressed and I'm less active, which tends to make things worse. things. Again, how can you improve things by being more active? The problem here is depression. There is a belief that I need to feel better before I become active and again, it's just natural, so let's just say that if you feel bad, you don't really feel like doing it.

A lot because in terms of how your body feels, it's not a good idea when you're emotionally sick, so to speak, so if you're not feeling in a good mood, you think, I should wait until I feel better before doing something and with depression. A lot of clients I've had say I don't want other people to feel depressed because of me, like other people can see how depressed I feel, but then you have this problem with that spiral of depression and when you're less active. your mood tends to get worse so what usually has to happen is you have to become active first and by becoming active first that can affect your mood so it's important for most depressed people, but even more so with severe depression because the stronger the depression. the harder it will be to distance yourself from your thoughts, so you'll have friends, family, or your therapist telling you things like, well, yeah, but that's what you're exaggerating and look what you're thinking, that's not true, but when I feel Absolutely horrible in terms of depression.

It is very difficult to distance yourself. Simply being active is what you have to start with. So, yeah, I was thinking about that great image from one of your clients of carrying a backpack full of bricks, etc. the kind that the more depressed, the more bricks there are in that backpack and it's not impossible to do the behavioral activation, to get moving, but it becomes harder to move with those bricks, so forgiving that the more depressed you are, maybe the movement is more difficult, but still not impossible, and lightning. that happens as you do more, so I really think that's a great analogy, thank you, yeah, and in a few slides I'll talk about what you can do and also what thoughts I can get in the way.

No, I'm pretty sure I have it if I don't remember it, so in terms of how to actually do this behavioral activation, first take a look at what your typical day is like, so for my client there's no difference from Monday to Friday to weekend because I wasn't working, so it was okay, when did you wake up? He tended to wake up around 12 p.m. m., so he slept in very late, from then on, he basically he would be fine, well, he slept in very late. It was time to eat, so he would go to our local store called wawa and get a prepared meal there, but that contributed more to his depression because he would think: well, I'm just wasting money.

I wouldn't even make my own food from there, he would come home, I could use his computer to look for a job or two, but that would lead us to think that no one was going to hire me in the first place, so then he would sort of binge TV and then when evening came I would often switch to video games so that was your typical day so have an idea of ​​what you are doing day to day and again if their day of the week is different than yours. On the weekend, let's say you're working or at school, figure out what those differences are as well and when you have what your typical day looks like, you want to ask yourself what am I doing too much and too little so and so much?

It tends to be inactivity, so too much time in bed for my client too much time on TV too much time on video games. Right now I have a 15 year old client who just binge watches the ticking on her phone and she likes it. that's her way of trying to distract herself from her depression, but then she just feels bad and then she falls behind in school and then what are you doing? In general, you tend to be sociable and socially engaged and connect with people, but also just with things. that you value, so once you have this idea of ​​okay, what am I doing too much and too little based on my current schedule, now it's time to figure out what to bring to next week so that you've valued the activities and I'll go. about how I do this with clients, you can do fun activities and also activities that lead to a sense of accomplishment, so you may think that there are some nice things, like a lot of people enjoy watching movies, but in reality they don't give you any feeling of achievement.

So after watching a good movie, maybe your mood improves a little during it, but you don't necessarily feel like you've done anything. There may be other things, like exercise, where you might absolutely hate the exercise and get no pleasure from it, but you feel good about yourself for having done it, so like in standard CBT, we'd say you try to strike a balance of these things. The way CBT has developed is more focused on value and meaning rather than simply enjoying and feeling accomplished. I tend to just focus on values ​​and when I do this, my colleague and I developed this little worksheet, but it's just getting a sense that there are different areas of life, so you can have work love and free time, like that.

That works. you have a job and a career, if you have a job and the idea here is not like your current job, it's just the idea of ​​work in general, you have the idea of ​​education or learning and again, this is not like going to school, it's just the idea of ​​learning and then volunteering because many people like me can think of my parents who are retired and you know that they are volunteers, they don't have jobs for love, there is intimacy, which are romantic relationships, you have friendships, you have family and we also put spirituality and religion here and then leisure, you have recreation, entertainment, health and fitness, so what I will do with clients is I will look at each of these categories and I will ask you how important this is to you from zero to ten. or how much do you value this year in ten, you get a number there and then you get a sense of why they value that, why it's important to them, so you know in terms of work for this client, this is a lawyer that I was dating. and who they are depressed with, it makes them feel productive and they want to make an impact, you know what specific activities can be part of the category, it is spending social time with colleagues and doing pro bono work, so with this they are also very interested in learning, so they learn why. it's important to learn, it'll keep me from getting stuck it's being an interesting person I feel like I'm evolving and challenging myself and then what activities are involved in that for them was reading they liked autobiographies historical fiction they would listen to podcasts and then go to conventions and seminars, as well as traveling, so in doing this with this client I said, "Okay, so let's see what's important to you and then get a sense of what your life is like now, so they realized that actually just They dropped out of the learning part because they felt tired after working and then they didn't really want to do much and then they just got caught up in doing more work because they had a very demanding job or they just got distracted by TV.

I know you're married. And that's the most important thing, besides health. You know, they said it's everything that connects, they support each other, it's reading together,exploring the city, going on date nights, and just talking to each other, but again they had retreated from this sort of thing. activity because they were feeling tired from depression and work as well as health and fitness, you know, health and fitness is part of my way of thinking, it's good for mental health and just having a healthy routine for them they like tennis, yoga, cycling and exercise, and again, they really did it.

I came back to this, so when I did this with my client, she said, well, I really gave up on learning, I gave up on doing more in my relationship, and I gave up on perfect health and fitness, so let's schedule this on So, starting From there, what you want is to like it in general, again, you want to strike a balance between these types of activities, so if a client has like you know what they value in terms of recreational entertainment, it's like watching movies, not I'm just going to love them. to add movies and that's it, you want to have different types of activities with this, although what I'm going to ask you to do is rate your mood before and after, so part of this is you know when you're feeling down thinking about activities to do. you say to yourself you say to yourself I'm not going to enjoy this well, it's not going to have any impact on anything, so if you can rate your mood before you do one of these things and then rate your mood after that , serves as a small experiment.

Does this really help? So, for the most part, you realize that even if your mood, let's say, is not good, I will do it. I usually say that zero is a horrible mood. 10 is a great mood, even if it's not, say, even above 5, you might notice that when you started something you were at a two out of ten and then it changed to a four out of ten, indicating If you do these things you can make a difference again, even if it's not where you'd like it to be, it's also very important to grade this right after the activity because with depression, let's say right after you feel a little better if you wait, if you want, wait often another, say, an hour more to write down how you felt, if your mood plummets since then that will really distort the way you view the activity and you'll just see it in that negative light, so I want you to rate it immediately Then what this does is, as I said, it is set up as an experiment.

Do these things help you feel better or help you stay the same? They just lead you to stay the same and that will help you figure out what to continue with the delete verse, so I was seeing this teacher who had retired and during his retirement he became depressed because he really saw himself as a teacher and that was very important to him and because he lost that part of his life that began. Thinking about things from a negative perspective now with him, you can imagine that learning education was extremely important, so I asked him to start his reading time again, so he used to read a lot, he had quit, he came back and said that reading was a zero at the end of the reading was zero.

What happened is that his depression was so intense that he couldn't really concentrate and he realized it. When he was reading, he just didn't understand what he was reading. I'm going to go back and reread. so much so that we had to give it up for now, okay, so let's put that aside for now and wait until your mood improves before you can do it again, but for the most part people come back and say that No. I didn't think I was going to really enjoy this or get anything out of it, but I really wanted to add something on the behavioral side.

Yeah, I guess that's just a thought that comes to mind that I see a lot clinically: that sometimes clients set a behavioral activation goal of what they're going to work on for the week and it feels like a nice s, it doesn't feel too extreme and it feels like something in line with that could be valuable and meaningful to them if they were able to get it done, but it was actually a lot harder than they imagined trying to get it done and that's really good information, great data and good for them for trying to do it and evaluate. that, but sometimes you have to punish yourself that, oh, I can't even read for 10 minutes, so I try to be gentle as you say, look, it really is an experiment to determine, wow, I had no idea about that for me at the moment.

Reading became a time to think about how pathetic my life is. Maybe that's not the best thing I can do, so it's going to be difficult, but trying not to be kind to yourself while you're assigning yourself these behavioral activation tests, yeah, that's a very good point. and that's why it can be very helpful to try to start small, especially if your depression is a little more severe, like the other week I had a client who I started seeing with depression and you know she's someone who I liked to exercise a lot and I told her that was fine, based on these values ​​and what is important to you, what do you want to do next week and she said, well, I want to go back to exercising every day currently, she is not doing any exercise, so in my mind I'm thinking.

This is too big a jump, let's start small, so like I said, you know it feels like you're not doing any exercise right now and you know, I can imagine it could be a big jump to get back to exercising every day. Thinking about starting something smaller? What would that be like? So she was two days in the next week so yeah try to start small because you know with depression things are going to be harder to accomplish just because that's part of depression and that fatigue so start little by little and with that that reminds me of the thought too, be careful and we will talk about thoughts next, but be careful about thoughts that get in the way, so like a big thought that gets in the way, don't I do.

I don't feel like doing this and I don't have the energy to do it, so a typical question I'll ask clients is like let's say it's someone who's working. I'll say, "You know," every day you wake up, do you feel? how you can and have the energy to work, you know, most people say, well, no, and that means you don't actually go to work on any of those days when you don't feel like going and almost everyone says, well , No. I'm going so I can ask you, do you know what that tells you about this belief that I need to feel like doing something and I need to feel like I have the energy to do it so I can do it because you know there's so many things?

In life we ​​do things we don't feel like doing, but then when you're depressed and low on energy, you start telling yourself you know what I call giving thoughts of permission for their thoughts to convince you why you don't have to. than to do it as if it were not going to make any difference. People are going to like to notice that I feel depressed and that leads to distraction, but when you don't put yourself in those situations there is no opportunity for any guy. of improvement and mood and that goes into different thoughts that can happen during these activities as well, so a lot of times what happens during is like you're talking about things not going to seem the same as before. before, with my client who is exercising, they probably won't be able to exercise at the same level and then what tends to happen is we compare ourselves negatively to how we used to be.

Well, I'm doing this, but I'm not enjoying it as much as before, I should have more fun, this shouldn't seem so difficult, so that's where you have the opportunity to do this as an experiment, so if you're thinking, don't do it. I'm doing. am I going to be able to do this or I don't have the energy, try it and see what really happens and then during the process what I will tell clients, especially in terms of their mood, is to let whatever emotions happen happen. , don't try to control it, don't try to make it different, so let's say you're going to like a picnic outside with some friends, you say to yourself well like I'm reading my mood, I'm at a 4 out of 10. the minute you say to yourself same thing that you know should be like a seven or eight out of ten, you're just going to go down to one or two, so it goes back to that idea that we can't control our emotional experiences at will, we can just put ourselves in situations that are important to us. and that can lead to a better emotion, but the moment they start telling themselves that they should do better or that there should be a better experience, that's just going to ruin them, so I usually ask clients to, you know?

Think about the last time you were happy to some extent like this might have been years ago for some clients and during that activity you talked as if you were having thoughts like oh this and this and this is happening and this is how I am feeling this and this is a situation and this is what people are doing or you were just there experiencing it and almost everyone says no, like it's focused on the moment, so that's what we can do, we can really put ourselves in these experiences focus on the moment and then whatever emotion appears, so talking about those thoughts, let's get into them now, so in CBT we talk about something called the cognitive model, the cognitive model is just the idea that it's not the situation in which we are. or our stressor is what causes our reaction, it's how we see it, automatic thoughts, what are they?

They are these quick evaluative thoughts, they usually go unnoticed, we call them automatic because they are out of our control, like before I talked about rumination. when you're actively thinking about something, automatic thoughts appear on their own with automatic thoughts, you know, we tend to recognize the emotion, we may not catch what we're thinking and in the case of depression, they tend to be overly negative and they're like that. . negativity in terms of ourselves, the world, others and the future that I talked about earlier in terms of the negative cognitive triad, so I actually had a client, I think it was three or four months ago, who had the same situation where he lost his job, but his reaction was actually relief because what he thought about it was, you know, he was really hesitant to leave just because he had stability and he had a family and he thought it was great, this will push me to really do what I want to do.

Of course, there was some stress with the whole financial situation, but he felt relief only because he thought it was an opportunity to move into a field that was more aligned with his values ​​unlike my other client who thought this. It means I can't really do my job and will never be hired again, so this is the situation I will use to describe the cognitive model. You know you've texted a friend like a family member. Five hours have passed. You haven't gotten an answer to what's going on in your mind, so in terms of this, what could be a thought that leads to depression?

You know a lot, it could be that they don't want to date me, it could be that they are ignoring you. Me because they don't like me versus what could be a thought that leads to a more neutral reaction, let's say it's like you know maybe their phone is off or not, they don't have access to their phone right now, maybe I'm busy doing something else, so the idea here is that just like with the situation of my two clients who lost their jobs, this is the exact same situation where you text someone, it's been a while without receiving answer, but again it's the way you think. is really going to drive that emotional reaction, it's not the situation itself, so in terms of focusing on the thoughts, what do we get in that CBT model, do we get the negative thoughts about the world of self and the future of others?

They really can be negative thoughts. about anything and with that we come to rumination because in rumination there are these individual thoughts and if you can look at them more closely, you can cut off that process, so the first step is just to discover what you are thinking. First of all, it's basically good when you notice a change in mood and suddenly feel more depressed. One time this happens a lot with depression is at night before you go to bed because, again, what's happening before you. When you go to bed you don't have all those distractions or you don't have anything to occupy you, you're just with yourself with your thoughts, which is why many people will say that they feel more depressed when it's night before you go to bed when you notice that you feel more depressed, you just ask me what was going on in my mind or what I'm thinking, so once you figure out what those thoughts are, there are a few and these are all of them, there's a strategy called Socratic questioning, it's taking a Look at your thoughts to see if they're accurate or not, so one strategy is something called gathering evidence, where you really just take a look at what the evidence is for this thought that led me to feel more depressed instead of being against it. , so this is a college student of mine with kind of joint depression and anxiety, whichWhat happened to them is that they failed the midterm exam and then they thought they were going to fail the university.

They came to the next session very distraught because they had been reflecting on this, as well as how they failed, to what extent they failed and then they would worry about failing college and what that would mean to disappoint their parents and their future, so I said, well , let's look at the evidence here, what is the evidence that you are going to go? Failing college, well, I failed my geology semester. I don't really understand my classes much and I haven't attended all my classes. What about the other side here? Well, I have never failed any class in my academic studies.

I have been told by career professors that I am smarter than the average student. I have many resources to help. I asked them specifically who it was. Well, my roommate in the student center. I can go to office hours and I put them in italics just because I took. this information here and I asked if there was another way to look at it, so in terms of failing the geology midterm, I asked, well, do you know how important this midterm is? They said, well, it's only 15 of my grades, so I can make it up in terms of understanding, you know I've been able to understand the class material when I went to class and completed the readings, so this is someone who, with a mix of anxiety and depression, I would face avoidance and withdrawal to not go to class if they felt bad in the morning and they felt depressed in the morning then they wouldn't understand why they didn't go to class and with that I have attended some classes and I can work to improve my sleep habits to be more consistent so with the tightness and anxiety also his sleep was all over the place so that had an impact uh that and then once you have both sides of the equation I'll just ask which sides are stronger, so they said the evidence against it was stronger.

Personally, I like to have an idea of ​​how much stronger it is and they said, I'll say if you had 100 points to divide between the sides, what would it be? 60 40 70 30 80 20 90 10 they put theirs at 80 20. So as you do this again, think about this. client before, so he failed this semester he feels terrible thinking about how terrible it is how they are going to fail college from time to time. They've been thinking about this idea of ​​failing college until they got to the session instead of taking this as a We actually look at the evidence, what's the solid evidence for and against.

Through this they came to this new understanding going forward. Now you don't have to worry and reflect on this. They can also ask for another explanation, so this is really good. for interpersonal situations, so thinking about that texting example, I hear this all the time, like I texted this person and they didn't text me back. I had a depressed high school student I saw the other day where he texted a friend to hang out because it was like the end of summer, he was leaving his weekend place and the friend was like oh, like I couldn't tonight, I have to do family things, his interpretation was that he doesn't want to be my friend, actually it's about me, he is lying to me, there could be another explanation.

Has this person ever lied to you about this kind of thing? Well, no, then the other explanation is that he was just being honest, he really had to do family things that night, so you can wonder, you know? And again, this is really good for similar social interpretations: other people are doing something and we make it look like something negative, particularly in terms of us as people, so could there be another explanation for this? Is there another way to interpret this? What's another way to look at this? A strategy for future-oriented thinking is something called decatastrophic, but when we think about the future we often think of worst-case scenarios so we can think about my client with work, so when he said to himself I will never find a job again. , I asked him what's the worst that could happen.

He said well, he wouldn't find a job now with that. I'm going to ask what you could do if that happened, so when we think about worst case scenarios a lot of times we just stop at the worst case scenario and we don't think about how we could actively deal with it, so he basically said, well, if I can't find it really I like to work, not indefinitely, but as you know, for months or potentially years, he said I can always go back to live with my parents, they support me and help me, they won't object to that, so worst case scenario, he He could move back in with his parents while he continues to try to find work.

He also said that if I can't find a job in this field, because he again thought he had lost his dream job, he could always broaden his search criteria so that I like him. other types of jobs, so that was the worst case scenario and he again got stuck on this idea. I will never find something I haven't thought of. What are my options moving forward from there? I wonder what's the best that can happen. So for him, she found a job that is even better than his current job and he finds it right away. So what is most likely for him?

He probably he said we'll probably find something like someone's going to hire me, but maybe that's not the case. exactly what I want because again we tend to focus on the worst case scenarios, we don't really think about what the most likely option is, even if the most likely option is not necessarily exactly what we wanted to be and this is a really easy question. that I use all the time is just asking what I would say to a person that I trust, so we hold ourselves to double standards a lot and when we have our own automatic thoughts because they're our own, like we don't really distance ourselves from them. and especially if you feel depressed thinking about it, depression will really distort the way we see it, so you can just ask yourself what would I say to a trusted person, what would I try to say to my good friend if we were thinking this in this situation , so one of my current clients is like a really successful student and she's entering her final year at university, like she's already arranged an internship, she's taking a full course and she's starting to study. stoneware and then one of her friends is also an outstanding person and the friend is like starting this company so she came in saying I'm like I'm not doing enough so she was feeling depressed thinking that I'm not doing enough.

He had enough of his life, so what I asked him was, "You know, what if I told you that I was going to start my last year of college, that I was going to sign up for an internship, that I was taking a full load of courses, I was studying for stoneware and I told you that I wasn't doing enough, what would you say to me? She said well, I'll tell you that you're already doing too much, you just need to relax, so from there you know, does this apply to you? So if we can think about what advice we would give. give it to someone else really try not to impose the same double standard on yourself now for those questioning strategies, those are good if you are not sure if your thoughts are true or not, but if your thought is true, ask for evidence for and against , it will not work. to really be that helpful so here are some strategies to tell if the thought is true so one really wonders how helpful it is for you to keep repeating this to yourself so like one of my clients has a full-time job, she is single. mom, she has three kids under five, she does housework like housework and she just thinks I hate doing this so it's going to be like cleaning, she thinks I hate this and then she feels more depressed because she hates doing that the more she tells herself She hates it because she will feel worse, so what I asked her was: do you know why you do this?

Because it is important for you? And you know she was doing it for her family. she tells herself how much she hates it, which is to remind herself that you know what I'm doing this for my family and the idea is not to make it a pleasurable experience, it's just to eliminate that kind of negative emotional connection with Another thing is focusing on problem solving, so with depression, when you go backwards and you get stuck in your head, you know you mentioned you get stuck in this loop and you don't get out of it, you don't get out. to a solution, so it's just about solving a problem, especially if it's a thought related to a problem like a client of mine who is having trouble finding a job, just ask yourself what can I do about it.

It's like I had a client last month. she was feeling depressed, so she's someone who's retired and lives alone, but she really thrives on connection and, um, she got divorced a long time ago, she doesn't have any family, um in the area, she thought I'm alone, so she was thinking that I'm alone, that she doesn't have anyone in the area in this family, which is true and then she feels a kind of depression and loneliness and what I basically told her is to think of that loneliness as meaning important connections for you. and whether connection is important to you.

What can you do? She simply used that as motivation to reach out to her friends. So what we did with her was we scheduled weekly meetings with her friends, so with one of her friends she scheduled a weekly dinner with another friend. She scheduled a weekly lunch and also joined some organizations where she would volunteer and where she could connect with people there, so if there is a question about an issue again, instead of getting stuck in the cycle, just ask what can I do about. this about this develop a plan for it and then act the last thing I'll talk about is you can tell if you're making something called a thinking error this is also called cognitive distortion our thoughts tend to be biased to certain types of thinking errors, like I'll just go over some examples like emotional reasoning, so this happens a lot with depression, where you feel a certain way and you believe it's true because you feel it so strongly like my client, um, who lost his job felt like a failure and felt very depressed thinking about it so because I feel like a failure it must be that I really am a failure just like that idea of ​​thinking about the worst that's something called catastrophizing so you're making these negative predictions about the future without considering less problematic outcomes, a mental filter is that you only pay attention to the negative details instead of seeing the big picture, so like I had one of my clients who was depressed right now, I had like a zoom meeting with friends and It went really well, but they made a joke and they saw on the small screen and like one person wasn't laughing, so the whole Zoom meeting was a great moment, they had fun but they only focused on that person. who didn't seem to laugh at his joke, you also have mind reading, which is very common, where you just think you know what other people are saying, so the idea here is that you know you get stuck in your head, your thoughts tend to to be biased towards the negative, but the problem is not the first thought that appears, but rather it is followed by more and more negative analysis or reflections on it, so the idea here is that you can take a look at that thought through of those questioning strategies I reviewed or you.

You may ask yourself: am I making a thinking error because it serves the same kind of purpose? Well, I'm just catastrophizing because what we're looking to do is just cut that process off because we like to think about the cognitive side of things you know we feel a certain way because emotions are useful, they give us communication, they give us motivation, so that emotions should be proportional to the situation, so if you are sitting with a friend watching a movie, if you like movies. and enjoy connecting with friends your mood should be quite positive or maybe closer to neutral, let's say now what happens with depression is that you are not focused on the movie, you are focused on having a conversation with your friend, you are focused analyzing something internally. that's skewed towards the negative, so I'm like, well, they don't really want to be here with me like they're just doing this out of pity, uh, like this, like this movie isn't as good as I thought it would be, so we're all trying To do with the cognitive pieces, we're just trying to cut through that rumination to get more experience in life.

What I will tell clients is that they know that we cannot control emotions. You know, I always say if we could control our emotions. at will I would be out of a job what we can control is that we control where we focus our attention, we control the meaning we give to experiences and we control our behavior, so all we can do is put ourselves in situations that we value when we are in those situations where we can be fully engaged and focused on what we are doing and thenWe can let whatever emotion appears, typically happiness or enjoyment appears when we are fully engaged in something we value, so again there is the behavioral activation piece that is involved and the thinking piece that we are really trying to get out of our heads. heads and not let the thoughts get in the way of us starting this and continuing it or later when we have a negative view of what happened, I think that's all I have except that we have to promote the organization beckinstitute.org where we have resources , we developed a complete resource like cova 19, there are CBT worksheets, there are blogs, articles, it's for therapists and clients, how wonderful.

And I'm thinking there was so much information included that maybe this is part one because we would love to find the time to have you back for part two and for all of those who are watching while we said at the beginning, feel free to email us questions and we're happy to pass them on to Dr. Hyman and maybe at some point we can invite him back to share additional tips and just the funny thing about CBT, CBD for anxiety, CBT. food for depression makes a lot of sense, it always feels good, this is pretty easy and then there are times when it also feels like the most complex thing in the world and the hardest thing to do, let's get back to the moving brick, so for anyone. who's watching it, on the one hand it's simple, on the other hand it's the hardest thing in the world to create change in your life, so the fact that you're watching it right now is an incredible first step and building on this in meaningful little things.

The ways that Dr. Hyman discussed it is how it's going to progress, so thank you very much for joining us today and providing such clear and helpful communication in such clear and helpful terms that it's really helpful whether you're a professional or a consumer. of mental health. to listen to this and remind us of the path to overcoming depression, so thank you very much, thank you, oh and that's my meter, okay, thank you very much.