Home > Professional > Problems > Depression

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

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:

Cognitive behavioral therapy (CBT)
Behavioral activation (BA)
Acceptance and commitment therapy (ACT)
Mindfulness-based cognitive therapy (MBCT) for preventing relapse
Interpersonal therapy (IPT)

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.

53 languages

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
- Scale outcometracker.org archive.org
- Hamilton M. (1960). A rating scale for depression. J Neurol Neurosurg Psychiatry,
  23, 56–62.
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)
- Scale – Adult download archived copy
- Scale – Child Age 11-17 download archived copy
Zung Self-Rating Depression Scale | Zung | 1965
- Scale outcometracker.org archive.org
- Zung, W. W. (1965). A self-rating depression scale. Archives of General Psychiatry, 12(1), 63-70.

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

Suicide risk assessment guide download copy
Suicide and self injury: a practitioners guide ~~download~~ archived copy

Information Handouts

What is Depression download
What Causes Depression download
Psychotherapy for Depression download
Vicious Cycle of Depression download
Behavioural Activation download
Fun Activities Catalogue download
Improving How You Feel download
Thinking and Feeling download
Analysing Your Thinking download
Changing Your Thinking download
Unhelpful Thinking Styles download
What Are Core Beliefs? download
Problem Solving download
Staying Healthy download
Grief and Bereavement download

Worksheets

Symptoms of Depression download
Behavioural Activation download
Weekly Activity Schedule download
Weekly Goals Record download
Making the Connection download
Thought Diary 1 download
Thought Diary 2 download
Thought Diary 3 download
Thought Diary download
Core Beliefs Worksheet download
Healthy Me download
Goal setting (End of therapy) download

Self-Help Programmes

Behavioral activation for depression

Introduction to BA for depression ~~download~~ archived copy
Monitoring activity for activity and mood ~~download~~ archived copy
Roadmap: The activation plan ~~download~~ archived copy
Finding direction: values, flow, and strengths ~~download~~ archived copy
Avoidance and depression TRAPs ~~download~~ archived copy
Problem solving ~~download~~ archived copy
Thinking habits ~~download~~ archived copy
Next steps ~~download~~ archived copy

Overcoming your depression

Overview of depression download
Behavioural strategies for managing depression download
The thinking-feeling connection download
The ABC Analysis download
Unhelpful thinking styles download
Detective work and disputation download
The end result download
Core beliefs download
Self management download

Antidepressant skills workbook

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