Depression affects 5 in 100 people worldwide (about 322 million people); it has a higher incidence in the female population (3 out of 4 patients, about 75%) between the ages of 55 and 74 (WHO data), and would affect the West and Southeast Asia more frequently.
What is depression?
It is a clinical condition recognizable through the following symptoms (APA, 2013) :
- depressed mood most of the day, most days;
- marked decrease in interest or pleasure in all, or almost all, activities; significant weight loss or weight gain (or appetite);
- insomnia or hypersomnia?
- psychomotor agitation or slowing;
- fatigue or lack of energy; feelings of self-worth or excessive guilt; impaired ability to think or concentrate (or indecision); recurring thoughts of death or suicidal ideation.
To diagnose a Major Depressive Episode, 5 or more of the symptoms listed above must be present for a period of 2 weeks, and their severity can be divided into three levels: mild, moderate, severe.
What is the cause of depression?
It is not possible to describe a precise etiology of the disorder.The most accredited hypothesis is that the individual would develop the depressive episode due to the presence of a series of vulnerabilities:
- Genetics , which refers to the genetic makeup present in the individual.
- Biological , given by the presence of certain neurotransmitters in specific brain areas;
- Psychological , that is, the way of thinking and reacting to life events;
- Social , the availability of healthy and functional relationships.
In other words, we can say that depression develops in genetically predisposed people and that they are exposed in environments that accentuate their vulnerability.
What to do to get out of depression?
First of all, it is necessary to realize that the depressed individual has developed a clinically significant picture, and this can be seen because usually the person withdraws socially, decreases activities during the week or even the day, eats less, sleeps a lot and has a thought. prone to rumination; Frequent crying fits and references to “get it over with” or thoughts of failure may also be noted.
In most cases the onset of the depressive episode coincides with a triggering event such as, for example, job loss, retirement, university entry, school change, city / town transfer. neighborhood, the loss of a loved one, the end of a relationship, and so on. general practitioner.
9 Tips for Overcoming Depression
Here are some tips that people generally find very useful and decisive:
- Healthy nutrition . Following a healthy diet is the basis for general well-being. Specifically for depression, you need to supplement your diet with foods that raise serotonin, such as dark chocolate, omega-3-rich fish and eggs.
- Regularizing sleep. Avoid sleeping more than 8 hours a day. Depression generally brings with it disabling, insomnia, sleepiness and a feeling of fatigue and being tired. But sleeping a lot reinforces the depression. Try to postpone the daytime “naps” in the evening: you will have a homeostatic drive to sleep that will make you sleep well at night. Remember that sleep efficiency decreases the longer you stay in bed before falling asleep and upon awakening.
- Non-catastrophic thinking . When you are depressed you have a tendency to amplify your feelings and experiences related to external events, and being “catastrophic” reinforces the depression. You don’t have to be optimistic, but realistic. Realists does not mean that you are a failure or that the events that lead to negative consequences are related to you in some way, otherwise you make a cognitive error called “personalization”.
- Don’t ruminate . A peculiar symptom of depression is rumination. Most people ruminate because they have the belief that this mental operation can be a problem-solving strategy, or that through it they can get better or even that it can be a tool for not ” feeling ” emotions.
- Valuing positive events and one’s qualities. Another way to turn the tide is to note and write down all the positive happenings during the week. Some therapists prescribe a so-called “positive diary”, and you can also write your qualities on a post-it using the pronoun I (for example: I am available, I am good, etc.); you can also write what you are capable of doing (for example: I can dance, I am painting, etc.).
- Be kind to yourself / Have compassion for yourself. Don’t punish yourself, don’t judge yourself, and don’t criticize yourself for being depressed. Treat yourself with kindness, as you would a person you love; allow yourself to feel bad and listen to your suffering and pain and make sense of it.
- Live in the present (Be Mindful). Most of our disturbing emotions arise from the fact that we focus our attention on thoughts that do not belong to the sphere of the present, but to that of the past and the future. Living in the present means listening to your body and focusing on the activities you are experiencing in that moment.
- Cultivate social relationships. Social relationships are a protective factor for those vulnerable to developing depression. Do not stop seeing and hearing your friends and relatives, and remember to be assertive, that is, express your opinions, your emotions and your needs without stepping on others but not even yourself.
- Regularity of activities. Choose 1 or 2 useful and / or enjoyable activities to do per day and strive to complete it and do it again in the following days. At first it will be very tiring due to apathy and anhedonia, but you will see that the usefulness and pleasure of doing the activity is in itself a positive reinforcement; and the sense of mastery in doing that activity will bring you an increase in self-esteem.
Which psychotherapy is most effective?
As reported by the website of the APA division 12, and of the NIMH (National Institute of Mental Health), the treatments that have received a classification with strong empirical evidence from scientific research are: behavioral activation, cognitive therapy, cognitive therapy- behavioral therapy, interpersonal therapy and problem-solving therapy.
In any case, cognitive-behavioral therapy represents the therapeutic path that offers greater integration of evidence-based therapeutic techniques that combine behavioral activation with the change of dysfunctional beliefs and thoughts.
Behavioral Activation
It is the elective therapy for depressive disorders and is based on the reactivation of the actual behavioral activities of the person who, during the period of depression, is deactivated, inhibiting behaviors, socially withdrawing, withdrawing into himself and not performing the previous actions anymore and not carrying out the pleasant and useful activities that he previously performed due to anhedonia and apathy (Lewinsohn, Schaffer, 1971; Ferster, 1973).
It is based on the principle of reinforcement (Skinner, 1953). The depressed person by stopping doing activities also stops self-reinforcing and therefore taking pleasure in doing the activities. By not gathering any reinforcement, the person is not motivated to carry on his life because he cannot get pleasure and see the sense of it. Behavioral activation therefore aims to plan during the week activities that are evaluated as useful and pleasant by the subject that can bring it. to feel a sense of mastery of the activity itself and therefore to increase self-esteem. These two very important components reinforce the person by pushing him to do the same activity again. How do I find useful and enjoyable activities? In most cases, people find pleasure by carrying out the activities they performed before the depressive period or in a period of life that was particularly productive and positive. However, in the most serious cases, it is possible that the person cannot find pleasure in the activities he / she did before, so the subject is invited to experience what could be in his or her mind according to the knowledge of his own personality.
How quickly can I get results? This question depends on the severity level of the depression and even more on the patient’s commitment and motivation. It is not possible to trace back to a rough timing. The subject should not expect results right away, because he will see them in the medium to long term. Behavioral activation requires you to engage yourself several times a day every day for a long time. In cases of severe depression, the parallel use of pharmacotherapy to strengthen the serotonergic and noradrenergic systems is recommended. What activities should I start from? In cases of depression it is very easy to find a general deactivation in several areas of life: family, work, friends, hobbies and passions, sports. Behavioral activation should gradually aim to re-establish all these activities according to the person’s values and goals. If the goal is too big it must be broken down into small achievable goals, otherwise it is frustrating.
Treating Depression with Cognitive Therapy
This psychotherapy (Beck et al., 1979) integrates the behavioral part of activation and aims to help the subject to have a more functional and adaptive way of thinking. The goal of cognitive therapy is to restructure thoughts about oneself, the world and the future (ibidem) which are strongly influenced by one’s beliefs about failure and the lack of internal resources to cope with stressful situations. It is of fundamental importance that the person changes his attributional style, that is, the person’s way of establishing the causality of an event.
It is very important for cognitive therapy to make the patient aware of his internal depressive dialogue (negative automatic thoughts). The typology of automatic thoughts reveals how the person activates his cognitive distortions (Beck, 1976) such as generalization, dichotomous thinking (black or white, all-or-in), idealization and devaluation, but also many others. These cognitive distortions derive from the patient’s basic beliefs, elsewhere referred to as patterns, formed throughout the person’s history.
Scientific research reports how the union of these two forms of psychotherapy is capable of strongly preventing possible depressive relapses in the future. It should be emphasized that in certain situations it is useful to resort, in addition to cognitive behavioral psychotherapy, to pharmacotherapy as a crutch at least for the first period, so that the subject is helped to produce those neurotransmitters involved in restoring psychophysical balance.
Is it possible to cure depression without drugs?
Yes in cases of mild depression; in all other cases it is advisable to combine cognitive behavioral psychotherapy with an antidepressant (serotonergic or noradrenergic). In cases of severe / severe depression it is useful to use a dopaminergic combined with an antipsychotic because due to the strong rumination the subject is particularly obsessive as well as deactivated.
Cases have been reported in which the drugs have had the same efficacy as a placebo therapy or cases in which the symptoms resolved after 6 months without the use of psychotherapy or pharmacotherapy. In any case, in most cases, as already mentioned, cognitive behavioral therapy is combined with a simple serotonergic antidepressant.
Are there Natural Cures?
In parallel with the treatments described above, some people have found benefits from supplementing with some natural cures such as Vitamin B1, B3, B6, Vitamin D and exposure to sunlight. Please refer to specialized sites for more information, but treatment with natural cures alone, or with homeopathic and / or phytotherapeutic drugs is not recommended.
Are there people who have come out of depression?
Yes, in 70% of cases, but only if you ask for help. The negative outcomes regarding the treatment of depression essentially concern subjects who have other mental disorders in comorbidities such as personality disorders, addictions or eating disorders, or even severe organic pathologies, including neurological ones. A recent WHO study (Thornicroft et al., 2017) on the prevalence and treatment of mental disorders in 21 countries finds that in most of the countries surveyed, people turn to a professional in cases of depression. Far fewer in Italy where, on the other hand, most people with outspoken symptoms do not consider depression a pathology to be treated. An obstacle to access to treatment could be linked to a series of prejudices about the disease and treatment.
Behavioral Activation Treatment for Depression: Returning to Contextual Roots
These strategies are the opposite of avoidance, withdrawal and inactivity patterns that could exacerbate depressive episodes by generating additional secondary problems in people’s lives.Behavioral activation is structured to help people approach and access sources of positive reinforcement in their daily life they serve as natural antidepressants.
The purpose of this article is to describe the treatment and the history of its development.A large clinical trial is underway that compares the efficacy of the authors’ behavioral activation model, cognitive therapy, and pharmacotherapy for individuals diagnosed with depression. The results of the analysis led the authors to develop BA as a treatment in its own right, a process that led to the behavioral literature.
Numerous behavioral and treatment theories for depression have been proposed and evaluated in recent decades. Lewinsohn’s original treatment generally sought to augment a wide range of events to increase positive reinforcement. This program was significant for the emphasis placed on reinforcement contingencies and thus provides an important basis for the authors’ proposed model of BA. In addition to the Lewinsohn model, other behavioral models have been developed with the aim of addressing the problem solving difficulties often observed in individuals with depression. Focused behavioral therapy by D’Zurilla and Goldfried (1971) teaches patients the five steps of problem solving: problem orientation, problem definition and formulation, generation of alternatives, decision making and verification of solutions. Over time, they were supplemented by cognitive interventions. From all these points of view, it was clear that behavioral therapy for depression had moved away from its initial contextual and functional roots.
The current model of BA, including all the techniques present in the first generation treatment, has been structured to bring the behavioral therapy of depression back to these contextual roots.Consequently, the BA model does not deny the presence of genetic or biological vulnerability, however it suggests that a focus exclusively on biology risks ignoring a wide range of contextual factors potentially important in the onset and maintenance of the disorder. a certain percentage of difference in the pathology is linked to a genetic predisposition. In addition, it seems likely that there are many subtypes of depression, and genetic factors may play a greater role in some types than others. Depression varies from individual to individual in both form and severity. The assumption is that for most vulnerable people, life experiences explain the risk.
So what’s new?
Current use of behavioral activation originated from the analysis of the components of cognitive therapy research. As in cognitive therapy, therapists and therapists in our current BA model continue collaboratively setting schedules with patients, assigning tasks between sessions, and requesting feedback.
In any case, the BA differs from traditional cognitive behavioral approaches in its emphasis on the environmental context in which the person lives and in its relentless emphasis on encouraging the patient in activities that will essentially cause them to receive natural reinforcement. that the interaction between negative life circumstances and the person’s difficulty in changing these circumstances can lead to the passivity often characteristic of depression. It is not that passive people become depressed, but repeated punishment or a life that runs predominantly on a negative reinforcement program creates behavioral patterns that are antithetical to behaviors that are more likely to gain positive reinforcement from the environment. BA thus adds to current treatments for depression by focusing on patient avoidance patterns typically used to cope with their life problems. Until now, avoidance has been the focus of interventions for anxiety disorders. , but it has been greatly underestimated in depression. The therapist using BA aims to assess possible sources of reinforcement that the person does not come into contact with and consequently helps the person to act sufficiently to increase the possibility of the anti-depressive behavior being reinforced. The BA also assumes that the client possesses the skills, but has not had sufficient opportunities to practice them or uses avoidance as a way to control negative emotions, thus limiting the consolidation of these skills.
