Summary
Depression can bring exhaustion, withdrawal, and recurring negative thoughts. This article explains the CBT connection between thinking, feeling, and behavior, then introduces a simple exercise for noticing those connections.
At a glance
Recognizing recurring negative thoughts can help you see how thoughts, feelings, and behavior interact in depression. When you feel low or distressed, the exercise described here is to record your emotion, the situation, and the associated thoughts. This awareness can be a beginning in improving depressive symptoms; it is not a guaranteed cure or a complete treatment program.
Perhaps getting up in the morning feels difficult. You struggle to concentrate at work or find the motivation to do anything. You feel lonely, yet keep your distance from family and friends. You turn to food, alcohol, or drugs to make the pain less intense. It may have been a long time since you felt any pleasure.
Life can feel as though it is happening beneath a sky that never clears. Many people have encountered depressive feelings at some point in their lives and struggled to find their way through them.
If you have experienced depression, you may know that it brings much more than a low mood. There can be exhaustion, emptiness, and hopelessness. Things you once loved lose their appeal. You may even push away the people you care about.
Depression reaches far beyond sadness. But improvement is possible. Monique Thompson’s self-help book on depression explores what depression is and the behaviors that can accompany it. One starting point is understanding what you are experiencing—and learning to notice your thoughts.
What depression can feel like
Depression encompasses a range of symptoms and behaviors. Someone experiencing depressive feelings may feel sad, hopeless, or empty, or lose interest in life and activities they previously enjoyed. Others describe irritability, anger, fatigue, headaches, or stomach discomfort.
Symptoms can range from mild to severe and can take several forms:
- Worthlessness and guilt. You may lose sight of the things that give your life meaning and purpose. You may also believe that the misfortunes in your life are your fault, leaving you with guilt or regret.
- Slowed activity or physical agitation. Everyday activities can become difficult. Even a small task may feel like walking through mud. Other people experience heightened restlessness or agitation, which may appear as irritability or rage.
- Difficulty thinking, concentrating, or deciding. Depression can impair thinking and problem-solving. Some people describe living in a fog, unable to focus on the ordinary demands of daily life.
- Thoughts of death, self-harm, or suicide. Many people with depression report thoughts of death or other morbid thoughts. A depressive episode may also involve thoughts of self-harm or suicide.
A specific diagnosis, major depressive disorder, is described in the American Psychiatric Association’s 2013 Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, or DSM-5. In that account, a person has experienced at least one major depressive episode and has no history of manic or hypomanic episodes. Major depressive disorder may involve a single episode or recurrent episodes.
Depression also differs from sadness and grief. The end of a relationship, the death of someone you love, or an unexpected job loss can bring painful feelings that are normal responses to difficult circumstances. Grieving involves a natural process of adapting to loss, and over time people can find their way through those difficulties.
When someone struggles to process a loss and reengage with meaningful daily activities, however, depression may develop.
How depression can keep itself going
Depression affects thoughts, feelings, and behavior, reaching into every part of life. It can also drive you toward actions that make you feel worse.
You may withdraw from friends and family or seek numbness through drug misuse, heavy drinking, binge eating, or excessive sleep. You may avoid pleasurable experiences that could help ease depression. As this pattern continues, you can feel increasingly lost, as though you have misplaced the directions back to your own life.
“There is no hope. There is no solution to what you are facing.” This is one of depression’s most insidious lies.
Although the figures around depression can be discouraging, there are grounds for hope. Depression is one of the most common mood disorders and one of the most thoroughly researched and understood mental disorders.
Beck’s book on depression discusses maintenance treatment, which may involve cognitive behavioral therapy or antidepressant medication. It states that nearly half of depression can be prevented through maintenance treatment and that relapse is much less likely among patients receiving psychological intervention than among those receiving medication alone. The book presents these findings as showing that depression is treatable to a large extent.
Cognitive behavioral therapy, or CBT, is one established treatment shown to help people improve and cope with depression.
Why CBT pays attention to thoughts
Aaron Beck, often called the father of cognitive behavioral therapy, developed CBT in the 1960s. He observed that people with depression repeatedly experienced negative thoughts, particularly about three areas: themselves, the world, and the future.
In this account, CBT defines depression as the result of thoughts, behavior, and feelings. These three areas are interconnected, and a change in one affects the others. Changing how you think, for example, can change how you feel and act. Conversely, holding negative beliefs and acting in accordance with them can create a vicious cycle that worsens depressive symptoms.
CBT therefore works with the idea that changing negative thoughts and beliefs can improve mood. It pays attention to the negative thinking involved in depression, including thoughts such as:
“I have no value.”
“Nobody likes me.”
“This is too hard.”
“I can’t do it.”
“I will always feel this bad.”
These thoughts can draw you into patterns of behavior that keep negative thinking going. In the approach described here, changing thinking is the first step. That begins with recognizing what you are telling yourself.
Recognizing familiar negative thoughts
Read through the following thoughts. Do any feel familiar?
- I always mess things up.
- Nobody will ever love me.
- People don’t understand me.
- I will never be happy.
- I have to do everything well, or nobody will love me.
- It is all my fault.
- I have never been able to relax and rest.
- Life has become harder for me.
- I am not good enough.
- There is no hope.
- Bad things always happen to me.
What other negative thoughts return again and again? What thoughts are in your mind right now?
Start by writing them down
Developing a habit of recording negative thoughts helps you pay closer attention to your thinking. It also gives you a way to consider how those thoughts affect your feelings.
A simple place to begin is your journal. Whenever you feel low or distressed:
- Write down the emotion you are experiencing.
- Recall the situation in which that emotion arose.
- Record the thoughts associated with that feeling.
Bringing these elements together lays a foundation for identifying and changing problematic thinking. When you recognize a negative automatic thought and connect it with a feeling, the relationship between your thoughts and emotions becomes easier to see. That awareness is a first step toward taking action and making a change.
Recognizing negative automatic thoughts and building a habit of recording them can be a beginning in improving depressive symptoms. The road may be long and difficult; continuing to walk it is how you move toward your destination.
Frequently asked questions
What should I record when I feel low or distressed?
Write down the emotion you are experiencing, recall the situation in which it arose, and record the thoughts associated with that feeling.
Why does CBT pay attention to negative thoughts?
In the account described here, thoughts, feelings, and behavior are interconnected. Negative beliefs and actions shaped by them can reinforce a cycle that worsens depressive symptoms; changing negative thoughts and beliefs can improve mood.
Is recording negative thoughts a complete treatment for depression?
The article presents recognizing and recording negative automatic thoughts as a beginning in improving depressive symptoms, rather than a guaranteed cure or a complete treatment program.
