“I just don’t enjoy anything anymore.”

What is depression?

Symptoms of depression include:

  • Emotions like sadness, lack of enjoyment and satisfaction, guilt, irritability, loss of interest in others, feeling inadequate, and hopelessness;
  • Behaviors like not doing things that were previously enjoyable, withdrawal from others, suicidal behaviors, self-criticism and self-blame, crying; 
  • Cognitions (thoughts) like, “I’m worthless,” “No one cares about me,” “the future is hopeless,” as well difficulty making decisions, difficulty concentrating, and repetitive negative thoughts and memories
  • Physical symptoms like fatigue, insomnia or oversleeping, loss of appetite or increased appetite

Depressive symptoms can result from and cause many other difficulties, including interpersonal difficulties, anxiety, over-use of substances, and difficulties at work and in relationships.

Cognitive-behavioral models of depression

Several cognitive-behavioral models of depression have been proposed and are supported by data from scientific studies. All of the models view depression as made up of emotional, behavioral, and cognitive components. In the most important model, which was developed by Dr. Aaron T. Beck at the University of Pennsylvania, negative emotions result from negative thinking and dysfunctional behaviors. Thus, for example, in response to arriving five minutes late for work, a man might have the thought, “I never do anything right,” emotions of worthlessness and inadequacy, and behaviors of repeatedly criticizing himself and focusing on his faults. These emotions, cognitions, and behaviors feed can feed one another, sending the person on a downward spiral of negative emotions, behaviors, thoughts, and experiences.

Other cognitive-behavioral models point to other factors that can cause or contribute to depression, including

  • overwhelming or intractable life problems,
  • poor problem-solving skills,
  • loss of important sources of pleasure and satisfaction,
  • difficulty maintaining consistent action in support of one’s goals and values

All of the models agree that biological factors can also play a key role in causing and maintaining depression.

Cognitive-behavior therapy for depression

Cognitive-behavior therapy for depression is so-named because it emphasizes teaching the depressed person to identify and change the thinking (cognitions) and behaviors that accompany depressed emotions, with the notion that the cognitions, behaviors, and emotions are tightly linked, so that if the cognitions and behaviors change, the emotions will also change.

Therapy may also focus on helping the depressed person develop and use skills to solve overwhelming life problems, find new or regain old sources of pleasure and satisfaction, and develop skills to maintain consistent behavior in support of personal goals and values. Because depression is a recurrent disorder, therapy also emphasizes teaching the depressed person to identify and manage early signs of depression in order to prevent or limitnew episodes of illness.

Additional resources

What is cognitive behavior therapy?

Deciding to Take Medications: A Patient's Perspective

Burns, D. D. (1999). Feeling good:  The new mood therapy. New York, NY, William Morrow and Company.

Greenberger, D. and C. A. Padesky (1995). Mind over mood:  A cognitive therapy treatment manual for clients. New York, NY, Guilford Press.

Miklowitz, D. J. (2002). The bipolar disorder survival guide: What you and your family need to know. New York, Guilford.

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