Depression

How do I approach the treatment of depression?

Here’s a bit about the three modalities that I use:

Cognitive Behavioral Therapy (CBT) for Depression

CBT is based on the idea that our thoughts, feelings, and behaviors are interconnected, and changing one can shift the others.

When you’re depressed, your thinking tends to become distorted. You might catastrophize, overgeneralize (“I always mess things up”), or engage in negative views of yourself and the world in general. These thoughts feel completely true and rational from the inside, even when they’re not. This can lead to negative feelings and then a tendency to avoid engaging in the behaviors that would help alleviate your depression. Suddenly, your thoughts, feelings, and behaviors are all reinforcing the depression.

CBT is structured and goal-oriented. In our sessions, we might work to identify specific negative thought patterns that are keeping you stuck and examine the evidence for and against those thoughts to find a more accurate, balanced perspective. I also use a technique called “behavioral activation” to gradually re-engage with activities that bring meaning and pleasure, even when motivation is low.

CBT helps you approach your thoughts from a more objective place and to act in ways that serve your mental health, even when your brain is telling you to latch onto the most negative thoughts.

Psychodynamic Psychotherapy for Depression

Whereas CBT focuses on changing thoughts and behaviors, psychodynamic therapy is interested in understanding them. The core idea is that much of our emotional life is shaped by experiences and patterns that operate outside of conscious awareness such as early relationships, losses, ways we learned to protect ourselves, stories we absorbed about who we are and what we deserve.

Depression, from a psychodynamic perspective, is often connected to unresolved grief, internalized self-criticism, or patterns of relating to others that were once adaptive but are now causing pain. Rather than targeting symptoms directly, psychodynamic therapy works by helping you understand yourself more deeply and that insight leads to genuine change.

Acceptance and Commitment Therapy (ACT) for Depression

ACT was developed in the 1980s and 90s and is backed by a substantial body of research. It takes a somewhat different approach to depression and in my experience works well when combined with CBT tools and psychodynamic psychotherapy.

ACT works to change your relationship to those negative thoughts and feelings that arise, so that they have less power to dictate your behavior. It involves a shift in perspective, the use of mindfulness techniques and supports committed action that is anchored by values clarification.

ACT doesn’t focus on eliminating negative feelings. It focuses on how you can live a life that feels worthwhile and rich even when you are struggling with anxiety or depression. That shift in your relationship to your moods and feelings can be transformative.

• Values clarification. Identifying what matters to you independent of others’ approval
• Defusion from the anxious thoughts that make saying no feel catastrophic
• Acceptance of the discomfort that comes with authentic self-expression, rather than avoiding it through compliance
• Committed action toward a more honest, self-directed life even before the anxiety goes away
• Mindfulness of people-pleasing patterns as they arise in real time, creating a moment of choice before the automatic yes

I often integrate all three approaches . We work to build self-understanding through psychodynamic work, change specific patterns through CBT, and develop values-based direction through ACT. The balance depends on who you are and what you most need.