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January is depressing.

Updated: Feb 27

Have you ever noticed that? Some people I work with have hit the doldrums and yet some are using this quiet boring grey season to get real introspective and double down on new goals. It's awesome.

If you're not there yet, let me share some stuff I learned at a recent training. It was on CBT for Depression and Suicidality. Therapists have to do continuing education, it's one of the conditions of our licenses. Just so you know.

I don't always love CBT techniques, because I'm not comfortable as a teacher. I think often it's used with a tone of "your thinking is wrong/irrational, that's why you're depressed, dummy."

(This guy. Always with the lectures. Sheesh.)

Instead, I believe therapists are here to listen and reflect back to people what they hear, remind them of what they've said before, offer possibilities to try on, keep people accountable for what they (say they) want, offer support for important hard steps. All that stuff. This is your life, we're just here to help.


But here is some stuff from CBT I do think is useful.

CBT people -and insurance companies- really like the Beck Depression Inventory. It's a way to measure depression symptoms, so hypothetically you can see where you started and what's improving and what's not. It really treats depression like a medical condition. We have thermometers and BP cuffs and the BDI. But it's self-reported. When you're depressed, you have trouble remembering things, and seeing patterns. Noting on paper how often you have thoughts of blaming yourself or rating how hard it is to make decisions might clarify patterns and shock you into change. Or it might just be guesses, if you are not a data-driven person. Aaron Beck was the father of cognitive therapy and believed cognitive distortions are the bedrock of depression and anxiety. Identifying and disputing problematic ways of thinking such as arbitrary inferences, selective abstraction, overgeneralization, magnification, minimization and personalization, he thought, was the way to feel better.

But CBT brings behavior into the picture. Which is way more useful for us experiential learners. When someone points out to us how our thoughts may be influencing our behavior, (or lack thereof- when depression hits, we may start doing less and less), and then how this behavior/ lack of forward motion makes us really hate ourselves in such an ambitious, achievement-driven culture- when we see the cycle from a zoomed out neutral perspective, we can change...maybe?

But trust is necessary, to do the work in therapy. To make big changes that feel incredibly uncomfortable. To share how we see the world, and eventually get to our core beliefs. Core beliefs are formed early - the world is unpredictable, people in power will screw you over, family loyalty is the most important thing- all examples of core beliefs. Negative ones make us miserable. But the problem with changing the negative ones is that we're primed to see evidence of them all around us. And dismiss data that don't (I know this grammar sounds wrong but data is plural, guys) support these ugly hypotheses. Guhhhhhh! But of course we do.

This is where CBT comes in handy. Your therapist can help you notice the evidence to the contrary- but unless you trust her, you'll roll your eyes. Core beliefs were formed over time from the combination of really intense or repetitive experiences and your juvenile brain. It's hard to put yours into words, but your therapist knows all the common ones and you can correct her if you need to refine yours a bit.

That's the identifying part. The changing part is harder.

We believe what experiences tell us. Especially repeated ones. We know in our bones that we when we cry, we get yelled at, when we're quiet, we get praised, because that's what happened circa 1989-1996. (Insert your learning, your years here.) A good therapist can lead you toward corrective experiences so that you learn that in your adult life, these beliefs are no longer true. And the resulting behavior is no longer necessary. You see that you got through some hard shit in your formative years and you gotta grieve it a bit before you can completely move on. Ok so that last bit is me. Aaron Beck would be like huh? Just listen to common sense! And maybe that works for some people. The rest of us have emotions. We trust them. We're pretty sure we're not idiots.

To be continued.

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