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Depression

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. Read more
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Therapy tool

A Guide To Emotions (Psychology Tools For Living Well)

Cognitive behavioral therapy can help your clients to live happier and more fulfilling lives. Psychology Tools for Living Well is a self-help course ... https://www.psychologytools.com/resource/a-guide-to-emotions-psychology-tools-for-living-well/

Chapter

ABC Model

ABC is an acronym for Antecedents, Behavior, Consequences. It is used as a tool for the assessment and formulation of problem behaviors and is useful ... https://www.psychologytools.com/resource/abc-model/

Worksheet

Activity Diary Worksheet with hourly time intervals

Activity Diary (Hourly Time Intervals)

Activity diaries can be used for activity monitoring during an assessment phase of therapy, symptom monitoring during therapy, correlating activity wi ... https://www.psychologytools.com/resource/activity-diary-hourly-time-intervals/

Worksheet

Activity Diary Worksheet with no time intervals

Activity Diary (No Time Intervals)

Activity diaries can be used for activity monitoring during an assessment phase of therapy, symptom monitoring during therapy, correlating activity wi ... https://www.psychologytools.com/resource/activity-diary-no-time-intervals/

Worksheet

Activity Menu

Helping clients to choose which activities to target during behavioral activation (BA) can be accomplished in a variety of ways: activity monitoring c ... https://www.psychologytools.com/resource/activity-menu/

Information Handout

Activity Planning

Research suggests that an activity is more likely to be completed if it is planned and scheduled in advance. The Activity Planning worksheet can be us ... https://www.psychologytools.com/resource/activity-planning/

Worksheet

Activity Selection

Activity selection is a tool for rating the difficulty of different activities. It is a helpful tool when clients have difficulty choosing between act ... https://www.psychologytools.com/resource/activity-selection/

Worksheet

Assertive Communication

Communicating and acting assertively is an interpersonal skill that helps people to maintain healthy relationships, resolve interpersonal conflict, an ... https://www.psychologytools.com/resource/assertive-communication/

Information Handout

Assertive Responses

Being able to communicate assertively is an essential skill for developing and maintaining healthy relationships and positive self-esteem. Individuals ... https://www.psychologytools.com/resource/assertive-responses/

Exercise

Avoidance Hierarchy

Avoidance and safety-seeking behavior serves to maintain anxiety, and exposure to the fear stimuli/situation is an effective treatment for anxiety. Th ... https://www.psychologytools.com/resource/avoidance-hierarchy/

Exercise

Behavioral Activation Activity Diary

Behavioral Activation Activity Diary

Behavioral activation (BA) is an effective treatment for depression. Different behavioral activation protocols include a variety of treatment componen ... https://www.psychologytools.com/resource/behavioral-activation-activity-diary/

Worksheet

Behavioral Activation Activity Planning Diary

Behavioral Activation Activity Planning Diary

Behavioral activation (BA) is an effective treatment for depression. Different behavioral activation protocols include a variety of treatment componen ... https://www.psychologytools.com/resource/behavioral-activation-activity-planning-diary/

Worksheet

Behavioral Experiment

Behavioral experiments are planned experiential activities to test the validity of a belief. They are one of the most powerful techniques available to ... https://www.psychologytools.com/resource/behavioral-experiment/

Worksheet

Behavioral Experiment (Portrait Format)

Behavioral experiments allow individuals to test the validity of their beliefs and assumptions. They are a core experiential technique for therapeutic ... https://www.psychologytools.com/resource/behavioral-experiment-portrait-format/

Worksheet

CBT Appraisal Model

The CBT Appraisal Model worksheet is a transdiagnostic formulation tool. The centrality of appraisals underpins all of the disorder-specific cognitive ... https://www.psychologytools.com/resource/cbt-appraisal-model/

Worksheet

CBT Daily Activity Diary With Enjoyment And Mastery Ratings

Activity diaries can be used for activity monitoring during an assessment phase of therapy, symptom monitoring during therapy, correlating activity wi ... https://www.psychologytools.com/resource/cbt-daily-activity-diary-e-m/

Worksheet

Psychology Tools Guide To Challenging Your Negative Thinking

Challenging Your Negative Thinking

A cornerstone of cognitive behavioral therapy is that an individual’s interpretation of an event determines how they feel and behave. We all experie ... https://www.psychologytools.com/resource/challenging-your-negative-thinking/

Guide

Cognitive Behavioral Model Of Intolerance Of Uncertainty (2019)

Cognitive Behavioral Model Of Intolerance Of Uncertainty (Hebert, Dugas, 2019)

Intolerance of uncertainty (IU) has been defined as “an underlying fear of the unknown”. Intolerance of uncertainty is a risk factor for the deve ... https://www.psychologytools.com/resource/cognitive-behavioral-model-of-intolerance-of-uncertainty-hebert-dugas-2019/

Information Handout

Cognitive Case Formulation

A CBT case conceptualization tool to help therapists derive core beliefs from an analysis of current events. ... https://www.psychologytools.com/resource/cognitive-case-formulation/

Worksheet

Compassionate Thought Challenging Record

Thought challenging records are commonly used in CBT to help people to evaluate their negative automatic thoughts for accuracy and bias. This Compassi ... https://www.psychologytools.com/resource/compassionate-thought-challenging-record/

Worksheet

Core Belief Magnet Metaphor

Core beliefs (schemas) are self-sustaining. They act to ‘attract’ confirmatory evidence and ‘repel’ (or distort) disconfirmato ... https://www.psychologytools.com/resource/core-belief-magnet-metaphor/

Information Handout

Daily Monitoring Form

Activity diaries can be used for activity monitoring during an assessment phase of therapy, symptom monitoring during therapy, correlating activity wi ... https://www.psychologytools.com/resource/daily-monitoring-form/

Worksheet

Depression Self-Monitoring Record CBT Worksheet

Depression – Self-Monitoring Record

Developing self-monitoring skills teaches clients to systematically observe and record specific targets such as their own thoughts, body feelings, emo ... https://www.psychologytools.com/resource/depression-self-monitoring-record/

Worksheet

Developing Psychological Flexibility

Developing Psychological Flexibility is a client information handout which can be used to familiarize clients with the ACT model. ... https://www.psychologytools.com/resource/developing-psychological-flexibility/

Information Handout

Dysfunctional Thought Record

The Dysfunctional Thought Record is a worksheet to record and challenge dysfunctional thoughts. It encourages clients to identify the involvement of a ... https://www.psychologytools.com/resource/dysfunctional-thought-record/

Worksheet

Embracing Uncertainty

Intolerance of uncertainty (IU) was first described in individuals suffering from Generalized Anxiety Disorder (GAD). Many behaviors associated with G ... https://www.psychologytools.com/resource/embracing-uncertainty/

Exercise

Emotions Motivate Actions

Many clients find it helpful to recognize the range of actions that are motivated by different emotional states. This worksheet encourages clients to ... https://www.psychologytools.com/resource/emotions-motivate-actions/

Information Handout

Exercise For Mental Health

Exercise is an evidence-based treatment for depression and anxiety and research suggests that, in the treatment of depression, exercise interventions ... https://www.psychologytools.com/resource/exercise-for-mental-health/

Information Handout

Functional Analysis

Functional analysis examines the causes and consequences of behavior. This classic A-B-C Functional Analysis worksheet can be used to collect informat ... https://www.psychologytools.com/resource/functional-analysis/

Worksheet

Functional Analysis With Intervention Planning

This classic A-B-C functional analysis worksheet can be used to collect information about what came before a behavior (antecedents), the behavior itse ... https://www.psychologytools.com/resource/functional-analysis-with-intervention-planning/

Worksheet

Gratitude Journal

Cultivating gratitude is an evidence-based positive psychology technique. This information handout describes reasons to cultivate a grateful attitude ... https://www.psychologytools.com/resource/gratitude-journal/

Exercise

Interpersonal Beliefs And Styles CBT Worksheet

Interpersonal Beliefs And Styles

Interpersonal issues and relationship problems form an important part of what clients bring to therapy: they might present as clients’ current conce ... https://www.psychologytools.com/resource/interpersonal-beliefs-and-styles/

Worksheet

Intolerance Of Uncertainty

Uncertainty is a normal part of life – we can never be 100% sure about what will happen next. Many people feel good about uncertainty and live lives ... https://www.psychologytools.com/resource/intolerance-of-uncertainty/

Information Handout

Intrusive Memory Record

Intrusive (unwanted, involuntary) memories are a common feature of PTSD, but also depression and other conditions. This Intrusive Memory Record is des ... https://www.psychologytools.com/resource/intrusive-memory-record/

Worksheet

Mastery And Pleasure Activity Diary

Activity diaries can be used for activity monitoring during an assessment phase of therapy, symptom monitoring during therapy, correlating activity wi ... https://www.psychologytools.com/resource/mastery-and-pleasure-activity-diary/

Worksheet

Mindful Attention Audio

Mindful Attention (Audio)

Mindful Attention is a technique for becoming aware of one’s thoughts and experiences, and being able to observe these as transient mental events. ... https://www.psychologytools.com/resource/mindful-attention-audio/

Audio

Motivational Systems (Emotional Regulation Systems)

At the heart of Compassion Focused Therapy (CFT) is an evolutionary model of human motivational systems. Developed by Paul Gilbert it is a helpful len ... https://www.psychologytools.com/resource/motivational-systems-emotional-regulation-systems/

Information Handout

Negative Thoughts Self-Monitoring Record CBT Worksheet

Negative Thoughts – Self-Monitoring Record

Developing self-monitoring skills teaches clients to systematically observe and record specific targets such as their own thoughts, body feelings, emo ... https://www.psychologytools.com/resource/negative-thoughts-self-monitoring-record/

Worksheet

Problem Solving

Problem Solving is a structured worksheet which encourages solution-focused thinking. Clients are encouraged to identify a problem, identify multiple ... https://www.psychologytools.com/resource/problem-solving/

Exercise

Problem Solving (CYP)

Effective problem solving is an essential life skill and this Problem Solving worksheet is designed to guide children and adolescents through steps wh ... https://www.psychologytools.com/resource/problem-solving-cyp/

Exercise

Psychology Tools For Living Well

Psychology Tools For Living Well

Cognitive behavioral therapy can help your clients to live happier and more fulfilling lives. Psychology Tools for Living Well is a self-help course ... https://www.psychologytools.com/resource/psychology-tools-for-living-well/

eBook

Psychology Tools For Mindfulness Audio Collection

The Psychology Tools For Mindfulness Audio Collection is the perfect way to introduce your clients to the practice of mindfulness. Developed by a clin ... https://www.psychologytools.com/resource/psychology-tools-for-mindfulness-audio-collection/

Audio Collection

Reciprocal CBT Formulation CBT Worksheet

Reciprocal CBT Formulation

CBT therapists often describe finding it difficult to apply CBT skills when clients bring relational problems to therapy. Familiar methods of visua ... https://www.psychologytools.com/resource/reciprocal-cbt-formulation/

Worksheet

Recognizing Depression

Depression is characterized by an extended period of low mood, anhedonia, and reduction in activity. Recognizing Depression compares the DSM-5 and IC ... https://www.psychologytools.com/resource/recognizing-depression/

Information Handout

Recognizing Persistent Depressive Disorder (Dysthymia)

Dysthymia 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. It is ... https://www.psychologytools.com/resource/recognizing-persistent-depressive-disorder-dysthymia/

Information Handout

Rumination Self-Monitoring Record CBT Worksheet

Rumination – Self-Monitoring Record

Developing self-monitoring skills teaches clients to systematically observe and record specific targets such as their own thoughts, body feelings, emo ... https://www.psychologytools.com/resource/rumination-self-monitoring-record/

Worksheet

Rumination Self-Monitoring Record (Edition 1)

Rumination-Focused CBT (RF-CBT) takes a functional-analytic approach to rumination and aims to help depressed clients to identify the contexts in whic ... https://www.psychologytools.com/resource/rumination-self-monitoring-record-edition-1/

Worksheet

Self Critical Thought Challenging Record

Disputing thoughts is a critical skill in cognitive therapy. The Self-Critical Thought Challenging Record helps clients to identify and challenge thei ... https://www.psychologytools.com/resource/self-critical-thought-challenging-record/

Worksheet

Self-Criticism Self-Monitoring Record (Edition 1)

Self-monitoring of thoughts, feelings, and symptoms is an essential skill in cognitive behavioural therapy (CBT). This Self-Criticism Self-Monitoring ... https://www.psychologytools.com/resource/self-criticism-self-monitoring-record-edition-1/

Worksheet

Task Planning And Achievement Record

The Task Planning and Achievement Record can be used to plan daily tasks and record goal attainment. It is most suited for encouraging frequent or rep ... https://www.psychologytools.com/resource/task-planning-and-achievement-record/

Worksheet

Therapy Blueprint

Since the publication of this version of the therapy blueprint we have also developed a more sophisticated version: Therapy Blueprint (Universal) A th ... https://www.psychologytools.com/resource/therapy-blueprint/

Worksheet

Things To Do List

The Things To Do List is a form of activity record. It encourages the client to think about the priority of each item and to record (and celebrate!) c ... https://www.psychologytools.com/resource/things-to-do-list/

Worksheet

Thought Record (Considered Response)

Thought Record (Considered Response)

Thought records exist in multiple variants, depending on the needs and abilities of the client. This Thought Record (Considered Response) is a cogniti ... https://www.psychologytools.com/resource/thought-record-considered-response/

Worksheet

CBT Thought Record Evidence For And Against A Negative Automatic Thought

Thought Record (Evidence For And Against)

CBT Thought Records exist in multiple variants, depending on the needs and abilities of the client. This Thought Record (Evidence For And Against) is ... https://www.psychologytools.com/resource/thought-record-evidence-for-and-against/

Worksheet

Thoughts And Depression

Depression is associated with cognitive biases, one of which is a failure to notice positive information. This information handout presents this conce ... https://www.psychologytools.com/resource/thoughts-and-depression/

Information Handout

Transdiagnostic Processes

A ‘transdiagnostic process’ is the label given to a mechanism which is present across disorders and which is either a risk or maintaining factor f ... https://www.psychologytools.com/resource/transdiagnostic-processes/

Information Handout

TRAP TRAC

TRAP & TRAC worksheets can be usefully used as part of a behavioral activation programme as a way of overcoming responses which result in avoidanc ... https://www.psychologytools.com/resource/trap-trac/

Exercise

Uncertainty beliefs experiment record

Uncertainty Beliefs – Experiment Record

Situations which are uncertain, novel, or ambiguous trigger a state of uncertainty. Evidence indicates that individuals who are dispositionally high i ... https://www.psychologytools.com/resource/uncertainty-beliefs-experiment-record/

Worksheet

Understanding Depression CBT Psychoeducation Guide

Understanding Depression

Our ‘Understanding…’ series is a collection of psychoeducation guides for common mental health conditions. Friendly and explanatory, they are co ... https://www.psychologytools.com/resource/understanding-depression/

Guide

Unhelpful Thinking Styles

Human thinking is subject to a number of characteristic biases. In the 1960s, Aaron Beck identified several of these biases which were common in his d ... https://www.psychologytools.com/resource/unhelpful-thinking-styles/

Information Handout

Using Behavioral Activation To Overcome Depression

Using Behavioral Activation To Overcome Depression

Using Behavioral Activation To Overcome Depression is a guide written for clients who are currently depressed. It provides clear information about dep ... https://www.psychologytools.com/resource/using-behavioral-activation-to-overcome-depression/

Guide

What do people think about themselves

What Do People Think About Themselves (CYP)?

People are not born with low self-esteem. Instead, we develop ideas about ourselves and our place in the world as a result of our life experiences. Pe ... https://www.psychologytools.com/resource/what-do-people-think-about-themselves-cyp/

Exercise

What Does Exercise Do For the Mind And Body?

Exercise is an evidence-based treatment for depression and anxiety and research suggests that in the treatment of depression, exercise interventions l ... https://www.psychologytools.com/resource/what-does-exercise-do-for-the-mind-and-body/

Information Handout

What Is Imagery Rescripting?

Unwanted images are a feature common to a variety of problems including PTSD and depression. Imagery rescripting is an evidence-based treatment techni ... https://www.psychologytools.com/resource/what-is-imagery-rescripting/

Information Handout

What Is Rumination?

Rumination and repetitive thought is a transdiagnostic maintenance process underpinning a range of difficulties. This information sheet explores the c ... https://www.psychologytools.com/resource/what-is-rumination/

Information Handout

What keeps depression going

What Keeps Depression Going?

The “What Keeps It Going?” series is a set of one-page diagrams explaining how common mental health conditions are maintained. Friendly and concis ... https://www.psychologytools.com/resource/what-keeps-depression-going/

Information Handout

Assessment

  • Clinically Useful Depression Outcome Scale (CUDOS) | Zimmerman, Chelminski, McGlinchey, Posternak | 2008
    • Scale download  archived copy
    • Zimmerman, M., Chelminski, I., McGlinchey, J. B., & Posternak, M. A. (2008). A clinically useful depression outcome scale. Comprehensive psychiatry, 49(2), 131-140.
  • Edinburgh Post Natal Depression Scale (EPDS) | Cox, Holden, Sagovsky | 1987
    • Scale  fresno.ucsf.edu  archive.org
    • Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale. The British Journal of Psychiatry, 150(6), 782-786.
  • Hamilton Rating Scale For Depression (HAM-D) | Hamilton | 1960
  • Montgomery & Asberg Depression Rating Scale (MADRS) | Montgomery, Asberg | 1979
    • Scale  veale.co.uk  archive.org
    • MADRS Score Card  veale.co.uk  archive.org
    • Montgomery, S.A., Asberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134 (4): 382–89.
  • Patient Health Questionnaire 9 (PHQ-9) | Kroenke, Spitzer | 2002
    • Scale  phqscreeners.com
    • Kroenke, K., & Spitzer, R. L. (2002). The PHQ-9: a new depression diagnostic and severity measure. Psychiatric annals, 32(9), 509-515.
  • Severity Measure For Depression (Adapted from PHQ-9)
  • Zung Self-Rating Depression Scale | Zung | 1965

Case Conceptualization

  • Cognitive conceptualisation (excerpt from Basics and Beyond) | J. Beck  download archived copy
  • Developing and using a case formulation to guide cognitive behaviour therapy | Persons | 2015 download archived copy

Intervention

Treatment guidelines

  • Depression in adults: recognition and management | National Institute for Health and Care Excellence (NICE) guidelines | October 2009 download archived copy

CBT treatment manuals

  • Individual therapy manual for cognitive-behavioural treatment of depression – Muñoz & Miranda (1996) download archived copy
  • Manual for group cognitive-behavioral therapy of major depression: a reality management approach (Instructor’s manual) | Muñoz, Ippen, Rao, Le, Dwyer | 2000 download archived copy 
  • Cognitive-Behavioural therapy (CBGT group program for depression | Milner, Tischler, DeSena, Rimer  download archived copy
  • Cognitive behaviour therapy for depression in young people: manual for therapists – Improving Mood with Psychoanalytic and Cognitive Therapies (IMPACT) | 2010 download archived copy
  • A therapist’s guide to brief cognitive behavioral therapy | Cully, Teten | 2008 download archived copy
  • CBT for depression in veterans and military service members – therapist manual download archived copy
  • Group therapy manual for cognitive behavioral treatment of depression | Muñoz, Miranda | 1986 download archived copy

Behavioural activation (BA & BATD)

  • Behavioural activation treatment for depression – revised (BATD-R) manual | Lejuez, Hopko, Acierno, Daughters, Pagoto | 2011 download archived copy
  • Behavioural activation treatment for depression (BATD) manual | Lejuez, Hopko & Hopko | 2001 download archived copy
  • Behavioural activation treatment for depression: returning to contextual roots | Jacobson, Martell, Dimidjian | 2001 download archived copy
  • Valued Living Questionnaire (Version 2) download archived copy

Suicide & self-harm

Information Handouts

Worksheets

Self-Help Programmes

Behavioral activation for depression

Overcoming your depression

Antidepressant skills workbook

Antidepressant skills workbook (2nd edition) | Blisker & Paterson download archived copy

What Is Depression?

Signs and Symptoms of Depression

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

Psychological Models and Theory of Depression

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.

Evidence-Based Psychological Approaches for Working with Depression

Many psychological therapies have an evidence base for working with depression:

Resources for Working with Depression

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

References

  • 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. BehaviourResearch and Therapy, 44(1), 1–25.

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