Or a different therapeutic approach to deal with depression.
The comparison will be made with reference to a successful CBT approach developed by Christine A. Padesky in her book “Mind over Mood-Change How You Feel by Changing the Way You Think” I purchased and used the first edition of her book in the late 1990’s. Her second edition has now sold over 1,000,000 copies and is still winning awards in 2016.
The CBT approach:
Thoughts-Moods-Behaviors-Physical reactions
The CPT approach:
Thoughts-Moods-Principles-Behaviors-Physical reactions
If we use an example from Padesky's original book on page 8:
Understanding Marissa’s problem:
· Environmental changes/life situations- Sexually molested by father; two alcoholic abusive husbands; single parent of two teenagers; negative feedback from work supervisor.
· Physical reactions- Tired most of the time.
· Moods-Depressed
· Behaviors-Difficulty working; isolating self from other people; crying, suicide attempts.
Page 17-Marissa
“ Marissa thinks she is unlovable. This belief seems absolutely true to her.”
When a work colleague, Julio begins to fall in love with her she has the following experiences:
· Not notices positive information, when a friend tells her she has an admirer.
· Discounts positive information, when Julio compliments her.
· Jumps to negative conclusion, when Julio asks her out to lunch.
· Discounts positive feedback, When Julio says she is attractive.
Since Marissa is convinced she is unlovable, she ignores or distorts information that counters this conclusion.
Step 1
CBT then says “What is the thought/mood connection”
“Marissa was sexually and physically abused throughout her childhood and early adult years. It is understandable that Marissa’s earliest attempts to make sense of her experiences led to her to devalue herself and be on the lookout for negative reactions of others”
CPT says “What is the thought/principle connection”
“What were the principles that were weakened by her experiences that lead to her core belief and subsequent behaviors?”
· Trust- She has lost trust in authority figures, particularly men
· Respect-She was abused throughout her life by her father and husbands.
· Acceptance-She wasn’t accepted as an equal person, she was used by her father for his sexual purposes.
Step 2.
CBT looks at:
· Thought/ behavior connection
· Thought/physical connection
· Thought/environmental connection
· Identifies and rates moods
· Creates a “Thought Record” as follows. Responses provided by Marissa in [ ]
1. Situation -who, what, when and where? –[In therapist’s office looking at Thought Record]
2. Moods -determine the hot mood-what do you feel? [Overwhelmed 95%]
3. Automatic thoughts-What was going through your head? [This is too complicated for me to learn]
4. Evidence that supports the hot thought [I look at this thought record and don’t know what to do]
5. Evidence that does not support the hot thought [At work, I have learned the computer filing system which is complicated]
6. Alternative/Balanced thoughts [Even though this seems complicated now, I’ve learned other complicated things in the past]
7. Rate moods now [Overwhelmed 40%]
The situations are processed each week in CBT counselling, re-assessing the new mood outcome rating for each hot thought that arises.
Techniques are taught to overcome Marissa’s issues related to depression.
Depression: [Page 133 “Marissa’s depression symptoms include suicide attempts, low self-esteem, and feelings of guilt”
Page 157 “ I must be worthless for all these awful things to happen to me. “ If I were a good person, I wouldn’t have been sexually abused”
The core belief underlying these thoughts is “I’m worthless” or “I’m no good”
CBT therapy moves from “automatic hot thoughts” to address the underlying “core beliefs” Weekly Activity Worksheets are provided to record moods, activities and thoughts related to events during the week. These are reviewed in therapy.
When treating depression the goals in therapy are:
· Change not only mood, but thinking, behavior and biology.
· Learning to change how to think, is a main focus.
· Rating moods can create awareness between behavior and depression
· Analyzing the weekly activity sheet can suggest behavioral changes to help the client feel better.
· Pleasurable activities will be introduced to make the client feel better.
CPT looks at
Explains to Marissa how her subconscious brain processes unresolved issues from the past and gives her a simple technique to do as homework, called the “stop, find, method” which will subconsciously reduce her anxiety whenever a trigger arises. This cognitive approach is given while modelling trust, respect and acceptance to her.
1. Explains how 90% of everything we do is habitual and how the subconscious mind process triggers in emotional order, not time order which is used by the conscious mind.
2. Explains how were learn by repetition, but also how we solve unresolved issues by repetition. The latter point is rarely discussed in counselling. For Marissa the lack of trust, respect and acceptance she endured as a child/teenager was unresolved, that means she is highly likely to subconsciously pick a husband who will disrespect her. Being aware of this process is 50% of the solution to moving on with life. Understanding that everyone with unresolved issues is doing the same thing. This normalizes her experiences.
3. Explains how her core beliefs were formed. For example, Marissa stated “If I were a good person, then I wouldn’t have been sexually abused.”
Teach Marissa how a child needs to feel safe and secure and control is the key to this. Any child who is emotionally, physically or sexually abused will take responsibility [ up to 100%] for the outcome because then they can try to fix it [take control]. If they believe the perpetrator is 100% responsible they have no control and feel helpless. Their motto becomes “try harder to please the perpetrator”, but it cannot work. Teach Marissa this was a normal response and appropriate at a young age, but not appropriate now. Marissa as an adult has control, however, her core belief is that she doesn’t have control.
4. Explain to Marissa that we have four brains, the head, the heart, the gut and spirit. All core beliefs and impulse control are located in the gut brain. Emotions are in the heart brain. The head brain directs and the spirit brain supports. We will use the head brain and the spirit brain to change the gut brain.
But first we teach Marissa the connection between the principles:
Heart--------------Gut-------------------Heart
Fear---------------Courage-------------Trust
Anger-----------Assertiveness-------Respect
Critical----------Evaluation----------Acceptance
The head brain will explain the connections and the spirit brain will provide hope to Marissa, that is, if she follows the process she will overcome her depression.
Fear: There are two types of threat which cause fear, namely, physical and emotional. The rule is, that a physical threat is taken personally, if there is no escape.
An emotional threat is taken behaviorally, never personally. Emotional threats are first dealt with by the gut brain. Marissa has never been physically assaulted at work, so we will start there to overcome her issues.
· Be assertive by following this simple rule: “Go for the ball, not the man” That means no matter what happens you attack the behavior, not the person. Don’t make it personal or take it personally. A simple technique is taught for this rule. This improves impulse control in the gut brain.
· Don’t become a “yes” person trying to earn respect. This is an old habit of “trying too hard” to please your father. Evaluate the situation using the following technique:
Ask-Who am I, now [You are only ever in the now, not the past or the future]
What do I want, now [Focus on the task to be achieved.]
How do I get it? [If you know how, then do it. If you don’t know how accept that you don’t know and pass it over to the subconscious brain. Explain to Marissa how the predictive mind works, which leads to intuition. Depression and anxiety kill intuition. “What is your gut feeling”, but sometimes you have to be patient and wait. Teach the spiritual principle of suffering and growing, not suffering and blaming, which becomes personal and breaks the rule.
· Use courage to overcome fear. Teach Marissa the rules about fear. That is, fear is only meant to work with the five senses to detect a physical threat from an emotional threat. All internal generated fears are emotional threats and are treated as described above. Teach Marissa about the predictive mind, how for 40,000 years it predicted that an emotional threat would lead to a physical threat. The body reacts by sending blood with chemicals to the muscles for flight or fight. Why would you predict a physical threat at work and get anxious or over stressed if you have never been physically attacked? You should be calm and relaxed to optimize your performance. [Everyone does this, but that is only because the conditions in western society have changed, but the body has not had time to adapt] Marissa is given a technique called “Emotional threat-physical threat” with subconsciously trains the brain to form a new habit.
Once Marissa has practiced the above at work then she can practice this at home or in other more personal situations. Work provides rules, boundaries and consequences. Marissa’s boundaries were violated as a child and she has to learn how to create them again.
CPT will teach Marissa how to build rules, boundaries and consequences around the relationship principles of trust, respect, acceptance and commitment and then she can test these on Julio if she is still interested in him.
