Depression

What to Do If You Are Depressed: Adaptive Thinking

A blog series guiding folks who are depressed.

Posted Aug 08, 2019

Welcome to Part XIV in our “What to Do If You Are Depressed” blog series. The last post focused on relationships, and the post before that was about emotions. Today’s entry is about “thinking” and learning about how to think about thinking and what kind of thinking is adaptive versus maladaptive. How you think has a profound impact on how you feel and what you do, and it also influences how situations unfold. In addition, people can actively learn how to catch their thoughts, check them, and change them to be more adaptive.

The “cognitive model of depression" is one of the most well-known models of depression. It was developed by Aaron T. Beck, who is often considered the "father" of cognitive therapy. I am very familiar with it because I worked with him for four years at the University of Pennsylvania (1999-2003). Cognitive refers to thinking, especially verbal thoughts and what we might call “self-talk,” which refers to how you make sense of things, others, the past, and possible futures. In the language of the unified theory of psychology, this kind of thinking stems from a person's "justification system" because it is the system of thought that functions to verbally justify what is happening and what ought to be done about it. 

The cognitive model points out that how you think about things plays a key role in how you feel and what you do. To see what I mean, let’s imagine Mark is a college student who is feeling depressed and is stressed. When asked how his weekend went, he states:

“It was not great. I couldn't go to the party I wanted, which sucked because I missed out. Instead, I had to stay home and do homework.”

Notice that Mark’s "justification system" frames the world as acting on him and controlling him through costs and threats of punishment. This suggests he has an “external” locus of control and means he will likely be reactive and defensive in his stance in the world. We can see this if we contrast it to a frame that reflects an “internal” locus of control. For example, imagine if he had said:

“A part of me wanted to go to the party, but I decided it was best if I stayed home and finished my homework since I want to do well in school.”

Here Mark's system of justification frames his place in the world such that he is an agent and is in much more control of his decisions and is choosing to act based on his values. If things are framed in terms of “I am doing what I am choosing to do because this is the best option for me,” then the emotional system is in more of an “approach” state. Given our discussions about depression as a state of behavior shutdown, I am sure you can see why framing things defensively and in terms of punishment is much more consistent with shutting down. This means that how you think about and frame your place in the world might play a major role in your mood.

Beck’s cognitive model teaches people to first recognize that interpretations matter for how they feel and what they do. Second, it teaches people to recognize that interpretations of the world are not facts about the world, even though our emotional system treats our interpretations as if they were facts. Let’s imagine Joe is in a depressed and anxious mood state. He gets an email from his boss at work that reads:

“Joe, there is a problem with the report you handed in. Can you give me a call?”

Joe’s heart jumps into his throat upon reading this. Immediately his mind goes to all the possible outcomes, virtually all of which are catastrophic. He runs through all the questions that he had when he put the report together and starts envisioning that he made all the wrong choices. He then starts to resent his boss for giving this assignment to him in the first place. He knew he should have refused because he was not in a place where he could handle this assignment.

After an hour of mental torture, Joe finally feels the pressure strong enough to calls his boss. He picks up his phone feeling fearful, defensive, and guilty all at once.

From the cognitive model, we can see how Joe engaged in a massive amount of interpretation based on relatively few facts. The only facts here are that his boss wants to talk to him about a problem with a report. Of course, it is possible that there is a major problem with the report. But it is also possible that the problem is either minor or not even something Joe did. Maybe someone else did something to it that created the problem and the boss wants to problem-solve, rather than blame Joe.

There are a couple of lessons that we can learn from this. First, interpretations are very different from facts. Second, we operate much of our lives off of interpretations that carry assumptions that we have filled in. Beck was fond of saying, “Check your assumptions because if you are wrong, they can make an ass out of u and me."

Beck’s cognitive model divides the justification system into three levels. The content on the surface of one's justification system is called one's "automatic thoughts". Automatic thoughts refer to the “ticker tape-like” stream of interpretations that people are constantly making as they narrate things to themselves. They are "automatic" because they often come as habituated forms of interpretation and are not generated with much conscious effort. When people are depressed, their automatic thoughts tend to shift into what Beck called the “negative triad,” which refers to negative thoughts about oneself, one’s future and the world (especially other people). We can see lots negative automatic thinking in Joe.

The next level of thinking Beck identified occurs at the level of inferences or “if… then… conclusions” people draw from bits of information. Beck noted that many depressed folks make lots of “cognitive errors” in the negative direction. That is, they take ambiguous information and then jump to strongly negative conclusions. I did my dissertation on this concept, showing that people who tended to make negative cognitive inferences felt significantly worse after receiving ambiguous feedback than people who made positive cognitive inferences. Here is a list of the kind of negative cognitive errors people who are depressed or anxious tend to make. I recommend learning this list and seeing if you recognize any of these tendencies in your own thinking style.

The deepest level of Beck’s model was “core beliefs”. These are the core organizing “schema” that frame how someone thinks about themselves and the direction of their lives. Beck argued that depressed people tended to have core beliefs that they were either incompetent or unlovable or both. When folks are not depressed these core beliefs can be dormant. But depression charges these modes of thinking, and then this becomes a basic frame for understanding what is going on.

We can see this with Joe, as he interprets the message as meaning that he likely was not competent to handle the report. If we were to dig a bit deeper, it would not be surprising to see that Joe has struggled to feel competent his whole life and when he gets depressed, he has the experience that he is fundamentally incompetent.

The cognitive approach to depression is a systematic approach that teaches you how to think about your thinking in a more adaptive way. It helps folks realize that interpretations are not facts and that negative interpretations can fuel negative feelings and avoidance and shutdown tendencies. That is, negative thinking can drive you into the neighborhood of depression. Sometimes absolutist negative thinking can “dead-end” folks so much that they start contemplating suicide as the only solution.

We should note that it is also the case that depressed moods activate tendencies to think in negative, pessimistic and avoidant ways, so there is a vicious cycle here that can feed back on itself. That is why learning about how to think can be so helpful. It helps keep this cycle from spiraling out of control. It is worth noting that thinking has been the focus of self-help books for depression more than any other domain. Most self-help approaches fall under the heading “cognitive behavioral”. This is because they attend to both behavioral activation principles and help people identify their problematic thought patterns, learn to consider adaptive alternatives, and learn how to replace rigid, or maladaptive thoughts with more adaptive ones.

When I was at Beck’s research lab, we framed the basics of the cognitive model in terms of the three Cs. What we meant by this was that we taught folks how to “Catch it” (i.e., identify the thought), “Check it” (ask whether the thought is accurate and helpful, or not) and if necessary then “Change it” (replace the thought with a more realistic and adaptive interpretation).

So, if we were working with Joe, we would help him “catch” the fact that he was “catastrophizing” (a common cognitive error) and help him evaluate his interpretation and then change it to be more accurate and helpful and frame his situation in a more adaptive way. Ideally, his self-talk would be transformed into something like: “There is a problem, but I don’t know exactly what it is. Before reacting, I should calmly find out what the problem is. If it is my fault, I will need to summon the strength to deal with that maturely. Regardless, I want to try and help fix it to the best of my ability.”

For more reflections on how to think adaptively, see this post. If you are interested in diving into the cognitive approach, here are two excellent book-length resources that many people have found to be valuable. First, Feeling Good: The New Mood Therapy by David Burns is a classic in the field. I think it is the most popular cognitive self-help book ever developed. Another good book that is grounded in a cognitive perspective is Mind Over Mood. It provides readers with strategies that can help them learn to manage their minds, control their negative thoughts, and end for good the distress of depression.

Over the past 15 years or so there has been a debate in the cognitive behavior community about how to relate to one’s thoughts and feelings. Should folks be taught to “catch, check and change” their thoughts as I have argued here? Or is it better for them to learn to become aware, accept them as thoughts, and then just move toward valued goal states without trying to engage and change the thoughts? The latter is the philosophy of Acceptance and Commitment Therapy (ACT). My professional opinion is that awareness, acceptance and active change are all good ways to go, so I don’t think we need to choose between them. But ACT does provide a different way of learning how to relate to one’s thoughts and feelings. Readers may recall that I used a common ACT metaphor of the “beast” of depression in an earlier post. I support both the traditional cognitive frame and ACT. Here are two excellent books on depression from an ACT perspective. 

Steve Hayes is the founder of ACT and he co-authored the first ACT self-help book in 2005, which was Get Out of Your Mind and Into Your Life. It reviews the basic principles of ACT. Robinson and Strosahl developed more traditional workbook/self-help based on ACT for depression called The Mindfulness and Acceptance Workbook for Depression.

That brings us to a close on how to think adaptively when you are depressed. The next post focuses on identity, defenses and the shadow, and move toward a general philosophy of living. That will be the final official entry in the series.

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