Depression! It’s a common term for many things. “I feel depressed!”, “This is so depressing.” The medical definition of depression, however, takes a more definitive approach than just the typical expression of exasperation. If you display five or more of the above symptoms over a period of two weeks or if the symptoms cause clinically significant distress or impairment to normal functioning, there is a chance that you may be diagnosed with depression.
Is it that serious?
A study was done by IMH in partnership with MOH and NTU to find out about Singapore’s mental health. In Singapore, one in 16 people may have depression at some point in their lives. That is just one of the most common mental disorders in Singapore! The percentage of lifetime prevalence of depression has seen a steady increase from 12% in 2010 to 13.9% in 2016. What’s scary is that 3 out of 4 (78.4%) people with mental disorders are not seeking help!
To find out more about depression you can read our recent article: What Is Depression & How to seek help? So, what is CBT, and how does that help with depression? Glad you asked! Cognitive Behavioral Therapy, otherwise known as CBT, is considered the “gold standard” treatment for depression. It is a combination of cognitive and behavioral therapy that targets our limiting or unhelpful thoughts and behaviors which most of the time can be untrue to reality.
Normally the therapy takes 8-12 sessions where the patient and therapist work together to identify problem thoughts and behaviors. With that as a reference, the therapist will equip the patient with tools and techniques to change the way they think, feel or behave in the situation. The basis of this model is the assumption that a person’s thoughts, feelings, and behaviors are deeply connected. Thus, by actively taking part in changing the way we think or behave (which is honestly easier than changing our emotions), we can affect how we perceive certain situations that might have given us a hard time. Also, “homework” between these therapy sessions is useful to help practice the skills acquired during therapy.
That sounds complex and great but the big question is, does this work well for depression?
Well, over the last few decades there have been a plethora of studies to assess just how efficient CBT is. These studies have shown that CBT is not only effective but also produces solid results as a treatment not only for depression but also other mental illnesses! One study that has shown just how effective CBT would be is a study done by Hollon et al (2005). The study found that patients who underwent and withdrew from CBT were less likely to relapse than those who underwent and withdrew from medications. In another six studies, CBT combined with medications added a 61 lower relapse/ recurrence rate (Vittengl et al, 2009, in Otto, 2013).
To conclude, CBT is efficient and definitely better than not doing anything about our mental health. If you do want to seek help or learn more about CBT therapy, feel free to contact us.
Many of us are absorbed in an endless, self-defeating rat race. The nature of modern society has instilled in us a “winner/loser” mindset, and its systems highly prioritise external rewards and punishments as measures of our personal success and social worth. This oftentimes forces us to shift our perception of self-worth from the satisfying efforts of personal endeavour, to the critical imperative of achieving yardsticks of success defined by the rest of society. When we are constantly striving to win a race while focusing on external factors largely beyond our design or control, we’re surely putting ourselves at a disadvantageous position.
The overwhelming pressure to conform to societal expectations, or to outrun others in the race of life, can make one particularly susceptible to depression if negative emotions are not managed well. As we aim for perfection – as most people would – we need to understand that total perfection is unattainable. The more we believe that we have failed to reach a certain state of “perfection”, the greater the extent to which we experience low self-esteem, self-hatred, and depression. Depression can be extremely debilitating to one’s mental health. Apart from the diminishing enthusiasm for life and self-esteem, depressed individuals may self-isolate and pull away from their social circles, making it all the more difficult for them to get the help they need.
Perhaps one of the healthiest things we can do for ourselves is to accept who we are. Self-acceptance might just be the antidote to excessive self-resentment and discontentment. It is important that we fight against influences that force us to conform to certain standards rather than to accept ourselves. Presented below are a couple of talk therapy methods that we use to guide you towards achieving that.
What is ACT?
Acceptance and Commitment Therapy (ACT) is a form of talk therapy suitable for the treatment of individuals displaying symptoms of depression. As its name suggests, it’s core aims are to help individuals accept whatever is beyond their control, and to commit to actions or habits that will serve to enrich their quality of life. ACT helps us to clarify what is genuinely important to us (i.e our values), and thus assists us to set more meaningful and life-enriching goals. Along the way, it also guides us to practise useful emotion-coping strategies such as mindfulness in order to equip us with skills to handle negative emotions effectively and healthily. While the number of ACT sessions may differ for each individual, the benefits acquired by clients are largely similar:
Learning to be fully present in the “here-and-now”, and to stop obsessive worrying over the past or future
Become aware of what they are avoiding (be it consciously or subconsciously), and to increase self-awareness
Learning to enjoy greater balance and emotional stability, and to be less upset by unpleasant experiences
Learning to observe thoughts such that one does not feel held captive by them, and to develop openness
To develop self-acceptance and self-compassion
Clarifying one’s personal values and taking the appropriate action towards his goals.
You may be wondering, does it really work? The good news is that ACT is considered to be an empirically validated treatment by the American Psychological Association (APA). Through program evaluation data, research has also shown that Veterans who completed ACT treatment phases displayed a significant decrease in depression in addition to improved self-awareness and a better quality of life.
What is DBT?
Apart from ACT, another alternative for the treatment of depression is Dialectical Behaviour Therapy (DBT). While originally used for the treatment of Borderline Personality Disorder, DBT has since been adapted to treat other mental health conditions including depression, anxiety, and post-traumatic stress disorder. A type of cognitive behavioural therapy, DBT aims to help individuals who struggle with emotional-regulation and are exhibiting maladaptive or self-destructing behaviours. It is not an uncommon sight for persons with depression to engage in substance-abuse or self-harm. As such, DBT helps to build on distress tolerance, such that people who struggle with these are able to handle negative life-circumstances better and to avoid falling back on such devastating coping methods.
DBT can be considered a holistic approach to depression treatment. Apart from tackling maladaptive behaviours, it encourages a shift in the clients’ perspective on life, for it equips them with the necessary skills to cope with intense emotions. In short, it empowers you to cope with them with a positive outlook. DBT also recognises that interpersonal effectiveness is key, and hence it strives to help these troubled individuals to reconnect and enhance their relationships with others.
ACT Versus DBT
ACT and DBT are both highly effective methods of treatment for depression. Both forms of psychotherapy allow for individuals to tackle the notion of suffering head-on, and to avoid suppressing undesirable or uncomfortable feelings. Both promote psychological flexibility, and encourage people to behave in a conscious or effective way towards their life-choosing directions. The practice of mindfulness is also a commonality between both therapy methods, and it plays a crucial role in ensuring that persons are well aware of their values, goals and emotions.
However, overlaps between the two are considerably limited too. The main differences between ACT and DBT would be that DBT leans towards a more educative approach while ACT emphasises an experiential one. Perspective wise, DBT adopts a biosocial perspective on behaviour while that of ACT is contextual. Moreover, the underlying philosophy behind each form of therapy also differs. DBT philosophy is dialectical (i.e using logical reasoning and analysis), while the philosophy behind ACT is functional contextualism. With that said, the analysis of clients’ experiences, the use of languages as well as experiential exercises will be different for each type of therapy.
In this episode En Ullae on Postnatal Depression, Dr Rajesh Jacob shed light on what some still view as a taboo reaction to what society views as a blessing – the birth of a child. Postnatal or Postpartum Depression is marked by a dip in mood, emotional turmoil, sleeplessness, and changes in eating habits. It can haunt a mother who has borne her flesh and blood for over a year, or the pall might lift after just two weeks.
This episode started out light and buoyant, with scenes of carefree courtship. But the fortuitous chemistry of an arranged marriage that might have heralded exemplaries of the nuclear family, under different circumstances, was to be tested by the wife’s struggle with Postnatal Depression. The coming child would serve as a lightning rod, bringing strife into the relationship. Even before the little baby girl’s conception, the couple disagreed on whether to have one – but cultural pressures enveloped the mother with a pained acquiescence with living up to the status of an “ideal mother” – at odds with her inner values, although she scarcely knew it. Dr Jacob noted that the immense pressure of a cultural belief in the Indian community that a child was “God’s gift” would serve only to create uncomfortable dissonance within a mother who is not ready to bear fruit.
At some point during one of their many arguments, the husband even goads his partner with the suggestion of abortion, despite the medical impossibility of aborting a 6-month old fetus in Singapore. The child, inevitably emerging from the womb, healthy, would only highlight the difficulties that the couple would face.
Dr Jacob was quick to point out the boorish behaviour of the husband, noting that in such situations, the support of family members, especially partners, is crucial in alleviating the symptoms of Postnatal Depression. Dr Jacob went on to warn potential mothers that past depressions were risk factors and that difficulties during the birthing process that might, for example, warrant emergency Caesarean sections, would prove additional risk factors.
The working mother and father were presented with additional difficulties simply by virtue of the husband and not being able to support the wife when needed. Her slow descent into Postnatal Depression began with the naggings of a vague sense of agitation, exacerbated by tiresome nights and a feeling of malaise. Eventually, she would begin comparing herself to an idealised version of what a Mother should represent, having taken care of relatives’ kids at the age of 13, she felt she had no excuse for her failures. Dr Jacob noted that the unfortunate situation should serve to highlight the dangers of an internal dissonance that would only elevate the crisis. At her nadir, she even contemplated the act of suicide, pulled back from the edge by her maternal instinct. Her child’s cry saved her.
In these situations, Dr Jacob made clear that she should ideally have been separated from her child, for the family’s sake and checked in to a mental health clinic for treatment. Luckily for them, her husband initiated contact with his own mother, seeking her assistance in caring for the baby. Taking pressure off the mother in situations such as these is of critical importance, who has to learn that she needs time and space to soothe her own mental health crisis. The health of the family unit is somewhat predicated on the stability of the maternal figure, so such a step makes a whole lot of sense. Much attention needs to be shone on the precariousness of these unfortunate situations, so that other prospective mothers are aware of the risks and the steps they can take to avert such crises.