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.

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Assessment

  • Valued Living Questionnaire (Version 2) | Wilson, Groom | 2002
  • Ruminative responses scale | Treynor, Gonzalez, Nolen-Hoeksema | 2003
  • Edinburgh Post Natal Depression Scale (EPDS) | Cox, Holden, Sagovsky | 1987
    • Scale
    • 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
    • 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
    • MADRS Score Card
    • 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 – Adult (Adapted from the Patient Health Questionnaire–9 (PHQ-9)) | APA (Spitzer, Williams, Kroenke and colleagues)
  • Zung Self-Rating Depression Scale | Zung | 1965
    • Scale
    • Reference Zung, W. W. (1965). A self-rating depression scale. Archives of General Psychiatry, 12(1), 63-70.
  • Clinically Useful Depression Outcome Scale (CUDOS) | Zimmerman, Chelminski, McGlinchey, Posternak | 2008
    • Scale
    • Zimmerman, M., Chelminski, I., McGlinchey, J. B., & Posternak, M. A. (2008). A clinically useful depression outcome scale. Comprehensive psychiatry, 49(2), 131-140.

Case Conceptualization / Case Formulation

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

Guides and workbooks

  • Mood And Substance Use | NDARC: Mills, Marel, Baker, Teesson, Dore, Kay-Lambkin, Manns, Trimingham | 2011
  • The Path to Positivity: Six Practical Sections for Becoming a More Positive Person | Caroline Lavelock, Everett Worthington | 2013

Information Handouts

Information (Professional)

Self-Help Programmes

Treatment Guide

  • Metacognitive Training For Depression (D-MCT) Manual | Jelinek, Schneider, Hauschild, Moritz | 2023
  • Suicide and self injury: a practitioners guide | Forensic Psychology Practice Ltd | 1999
  • Depression In Adults: Treatment And Management (NICE Guideline) | NICE | 2022
  • Behavioural activation treatment for depression (BATD) manual | Lejuez, Hopko & Hopko | 2001
  • Metacognitive Training For Depression | Jelinek, Hauschildt, Moritz & Schneider | 2022
  • Cognitive-behavioral therapy for depression in young people: a modular treatment manual | Orygen | 2015
  • Depression In Adults: Recognition And Management | National Institute for Health and Care Excellence (NICE) guidelines | 2009
  • Individual therapy manual for cognitive-behavioural treatment of depression | Ricardo Muñoz, Jeanne Miranda | 1996
  • Manual for group cognitive-behavioral therapy of major depression: a reality management approach (Instructor’s manual) | Muñoz, Ippen, Rao, Le, Dwyer | 2000
  • Cognitive-Behavioural Therapy (CBT) Group Program For Depression | Milner, Tischler, DeSena, Rimer
  • Cognitive behaviour therapy for depression in young people: manual for therapists | Improving Mood with Psychoanalytic and Cognitive Therapies (IMPACT) Study CBT Sub-Group | 2010
  • CBT For Depression In Veterans And Military Service Members – Therapist Manual | Wenzel, Brown, Carlin | 2011
  • Group therapy manual for cognitive behavioral treatment of depression | Muñoz, Miranda | 1993
  • Behavioural activation treatment for depression – revised (BATD-R) manual | Lejuez, Hopko, Acierno, Daughters, Pagoto | 2011

Worksheets

Recommended Reading

  • Behavioural activation treatment for depression: returning to contextual roots | Jacobson, Martell, Dimidjian | 2001

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. Behaviour Research and Therapy, 44(1), 1–25.

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