Depression is characterized by an extended period of low mood, anhedonia, and reduction in activity. Dysthymia (persistent depressive disorder) is characterized by a depressed mood that occurs for most of the day, more days than not, and has been present for at least two years. Depression is a heterogeneous condition with many different triggers, presentations, and maintaining factors. Cognitive behavioral therapies (including acceptance and commitment therapy (ACT), cognitive behavioral therapy (CBT), compassion focused therapy (CFT), and dialectical behavior therapy (DBT) are effective evidence-based treatment for depression, and mindfulness-based cognitive therapy (MBCT) is an effective intervention for preventing the recurrence of depression.
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To meet DSM-5 diagnostic criteria for major depressive disorder an individual must have experienced five of the following symptoms for at least two weeks:
a depressed mood that is present most of the day, nearly every day
diminished interest in activities which were previously experienced as pleasurable
fatigue or a loss of energy
sleep disturbance (insomnia or hypersomnia)
feelings of worthlessness, self-reproach, or excessive guilt
a diminished ability to think or concentrate, or indecisiveness
recurrent thoughts of death or suicide, or suicidal behavior
changes in appetite marked by a corresponding weight change
psychomotor agitation or retardation to a degree which is observable by others
Beck’s cognitive theory of depression (Beck, Rush, Shaw, & Emery, 1979) forms the basis for cognitive behavioral approaches for the treatment of depression. Beck’s theory proposes that there are different levels of cognition that can be dysfunctional in depression: core beliefs, rules and assumptions, and negative automatic thoughts. CBT aims to balance negatively biased cognition with more rational and accurate thoughts, beliefs, and assumptions. CBT also systematically aims to increase levels of rewarding activity.Acceptance and commitment therapy (ACT) proposes that distress, including symptoms of depression, are the result of psychological inflexibility (Hayes, Luoma, Bond, Masuda, & Lillis, 2006). Indicators of psychological inflexibility include:
‘buying in’ to negative thoughts and narratives;
engaging in worry or rumination that takes us away from the present moment;
losing contact with our values—what is important to us.
Many psychological therapies have an evidence base for working with depression:
Mindfulness-based cognitive therapy (MBCT) for preventing relapse
Psychology Tools resources available for working therapeutically with depression may include:
psychological models of depression
information handouts for depression
exercises for depression
CBT worksheets for depression
self-help programs for depression
Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford Press.
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44(1), 1–25.