How does CBT help with low mood and depression?

What is the difference between low mood and depression? 

We all can experience low periods in life. This might be triggered by stressful events, being in pain or physically unwell, relationship problems, stress at work, life changes such as change of job or redundancy, a loss or a bereavement. Low mood lifts after a few days or weeks. And with the implementation of some life changes, such as talking about your problems, addressing work-life balance, exercising, resolving a situation, mood is likely to improve.

Depression is when you feel persistently low and sad for weeks or months rather than just a few days and your mood is impacting on your ability to function day-to-day. Symptoms vary from person to person and can vary in severity. You might feel hopeless, unhappy and lose interest in things you used to enjoy. You might withdraw from people and not want to socialise. You might have problems with sleep, either sleeping too much or not getting off to sleep or frequent waking; feeling tired and lacking energy. Your appetite may be affected, either comfort eating or loss of appetite.

You may feel unmotivated and start to avoid doing things or just do the bare minimum or be struggling to do the things you need to do such as your basic self-care. You may feel more emotional and tearful. You may be struggling with concentration, not be able to watch TV or read. You may feel bad about yourself or feel that you have let yourself or family down. When very low, you may experience suicidal ideation or thoughts of self-harm which can be very distressing (if this is the case it is important to see your GP or seek professional help).

Often when low in mood or depressed you can also feel anxious or panicky and experience low self-esteem, i.e. not feel good enough, feeling that you are letting others down.

So how does CBT help with low mood and depression?

Whether low in mood or depressed, CBT can be helpful. CBT is one of the National Institute for Health and Care Excellence (NICE) guideline treatments of choice for depression. CBT is the most evidenced based and clearly researched treatment for mood disorders.

When low or depressed we get into negative cycles, our thoughts tend to be negative and self-critical and our behaviours tend to be unhelpful. We often get into ‘avoidant’ behaviours in an attempt to make ourselves feel better, however, in the long run, these can inadvertently maintain the negative cycle. For example, we may cancel a social arrangement with a friend and then feel bad about ourselves for having let our friend down and feel more isolated and alone because we are withdrawing and avoiding connecting with others. We may put off doing things (procrastinate) such as housework or dealing with paperwork and life admin. Procrastination can then lead to further problems down the line leading to more stress and a perpetuation of low mood. Another unhelpful behaviour might be to comfort eat, which at the time makes us feel a bit better but then later, we
may feel guilty and that we’ve let ourselves down, or lethargic and lacking in energy. Our unhelpful behaviours may then feed into how we are thinking, we are more likely to be self-critical and berate ourselves. The impact of these thoughts and behaviours is that we continue to feel low in mood or depressed and so the cycle continues.

CBT helps us to break these cycles. It firstly breaks our experience down into thoughts, moods, physical symptoms and behaviours. We then look for what is unhelpful and what we might be doing/not doing that is inadvertently maintaining the cycles. We look to make changes in these behaviours by setting small manageable goals. We look at activity levels and getting a spread of activity across all the areas needed for mental wellbeing (i.e. bodily self-care, achievement, connecting with others, and enjoyment – see my blog on Back to ‘BACE’ics). We look at identifying unhelpful thoughts, recognising unhelpful thinking patterns and learn how to challenge these and come up with alternative perspectives.

Often in depression we can get into ruminative thinking about the past or we can overthink. CBT sees rumination and overthinking as unhelpful behaviours and looks to make changes here too. With this type of thinking we aim to not get into the content of the thought, but notice the thought, then disengage with it by shifting focus of attention to the external world.

It is also important to consider basic lifestyle changes, which can often get overlooked. Such as taking regular exercise, reducing alcohol intake, eating a healthy diet, getting enough sleep, connecting and talking with others and doing things that you enjoy. It may also be necessary to consider medication.

By making changes in our behaviours and learning to manage our thoughts we can have an impact on our mood and break the negative cycles of low mood and depression.