Cognitive Techniques For Depression

Question 1

Distinguishing thoughts, feelings, and reality

Answer 1

Socialize the patient in recognizing how thoughts and reality may differ, and how thoughts are related to feelings.

Question 2

Monitoring automatic thoughts

Answer 2

Encourage the patient to track situations, thoughts, feelings, degree of belief in thoughts; degree of emotion.

Question 3

Identifying distorted automatic thoughts

Answer 3

Train the patient in recognizing and categorizing the different types of distorted automatic thoughts (mind reading, fortunetelling, catastrophisizing, etc.)

Question 4

Examining costs and benefits

Answer 4

Help the patient to weigh the costs and benefits of a belief.

Question 5

Defining the terms

Answer 5

Examine how depressive thoughts and terms and defined by the patient (eg, what is a “failure”?) Defining the opposite of the construct (eg, what is a “success”?)

Question 6

Vertical descent

Answer 6

Ask, “why would it bother you if X were true? What would happen next?

Question 7

Identifying and challenging underlying assumptions

Answer 7

Examine the patient’s “rule book” - the “shoulds”, “musts”, and “if-then” statements that underlie the depression.

Question 8

Externalizations of Voices

Answer 8

Have the patient argue back at his or her negative thoughts, using role plays

Question 9

Double standard

Answer 9

Ask the patient whether he or she would apply the same standards to other as to the self; why/why not?

Question 10

Acting in opposition to a thought

Answer 10

Have the patient develop a plan of action to act against a thought.

Question 11

Identifying and challenging negative schemas

Answer 11

Examine the patients negative view of self and others. (Eg, self as defective or having demanding standards, and others as judgemental or abandoning) , challenge these negative beliefs.

Question 12

Attribution retraining

Answer 12

Help the patient change from personal, stable attributions for failure to attributions emphasizing universal, variable, and external attributions. (Eg. from “ I must be a failure” to “Almost everyone would have done poorly, I can change in the future, and it does not reflect on me); have the patient re-examine the importance of the goal (perhaps there are other goals that can be pursued)