There are a couple of schools of thought around depression and how best to treat it. Medication alone, medication and talk therapy, talk therapy alone…… Different things work for different people.  For me, medication and talk therapy is a combination that works.
But, here’s where it gets confusing. What kind of talk therapy? CBT is generally touted as the best form of talking treatment. My understanding of CBT (I’m not an expert so I may not have this right) is that it is brief, solution focused therapy, aimed at teaching the client to catch the negative thought and change it – change the thought, change the feeling, change the behavior. Humble apologies to any CBT therapist reading this for reducing years of research to such a crude explanation!!!
However, while I was in hospital, I was encouraged to begin mindfulness, which seems to me (again, and I can’t stress this enough!! -this is my personal understanding) to be the exact opposite of CBT. Rather than catching the negative thought or emotion and changing it, mindfulness encourages the practice of sitting with difficult feelings, allowing them to be felt, because if they are forced to one side, they’re not being addressed and will simply resurface at another time, with greater intensity. I’ve heard it argued that CBT teaches clients that there’s something fundamentally wrong with how they think, that therefore the fault is theirs, whereas mindfulness encourages acceptance of what is, and that over time, the simple act of acknowledging difficult feelings diminishes them.
So can you see why I’m confused?? For my part, I’ve found the mindfulness approach to be more useful, a more gentle way of looking after myself. Trying to catch and change the negative thought generally turns into an internal shouting match, and I usually end up feeling kinda crappy about not being able to think more positively in general.
Here’s an example. While I was in hospital, I missed a trip to Denmark to see my sister. The flights had been booked for months, I rarely get to see her, and I had really been looking forward to catching up with her and her family, and having some quality cuddle time with my gorgeous niece. Understandably, I was pretty inconsolable on the day I was due to head out. But here’s the thing. Every time one of the staff saw me being upset, I’d get a pep talk…..’ cheer up, there’ll be plenty of other opportunities to see her etc etc.’ This was missing the point entirely. I genuinely felt really sad. I missed my sister. It was as if they didn’t want me to be upset, to feel what I was feeling. But I had to. I had to get it out of my system. So I duly ignored them and continued to feel miserable fir a few hours, before eventually crying myself into feeling better.
So is there a simple, one size fits all solution? I don’t think so, and a lot of people with far greater knowledge than me have devoted considerable time to this debate. I can see the benefits to both CBT and mindfulness, as well as potential pitfalls. Likewise medication works for some people, not for others.  Our mind is such a weird and wonderful thing, and in reality so little is really known for sure about how it works. All I can comment on with 100% certainty is what works for me. Medication, no matter how much I resent it. Psychotherapy, long term. Mindfulness. CBT? So far,  not a huge fan. But hey, that’s just me.
What works for you? Where do you stand on this debate?

This article has 16 Comments

  1. If it's any consolation, your sister had a good oul' cry that day too : )

    I'd pretty much agree with what you say above, in terms of my own life experience. The sadness that emigration can bring with it is something that I tried to ignore in the beginning, with the result that the bottled up feelings became overwhelming. I've since learned to be kind to myself – get a cosy blanket and a bar of chocolate and let myself cry it out. It also makes me think of the pedagogic approach the child minders at Aoife's creche use. When the kids cry, the don't say, 'cheer up, stop crying!' they verbally acknowledge how the child is feeling ('I can see that you're sad/angry/disappointed/frustrated') and comfort them as they need. The kids are 'allowed' to feel what they're feeling. So why don't we let adults do the same?!

    I've only recently started looking into mindfulness (thanks to your blog actually!) and think it's also something that could really work for me in terms of accepting and dealing with the curve balls that life throws along the way. So I'm learning to be happy that I'm an occasional crier : )

    Miss you today but love reading your thoughts. Trí x

    1. 🙂 Miss you too!! You're right, we have a whole different approach, both individually and increasingly as a society, in terms of handling emotion when it comes to kids, but it seems to be something that we all find very difficult to apply to ourselves or other adults. Feelings are there for a reason!!
      I love that you're looking into mindfulness now, have you tried the headspace app?

  2. I wrote something fantastically clever and insightful then deleted it by accident…doh. Anyway, I think managing depression is like learning how to be a parent. You make mistakes, you're often too close to pick up signals, it's a highly emotive topic and you're bombarded with advice and opinions wherever you turn. Oh, and everyone else seemed to get the memo on how to cope…except you 🙂 You've got to find your way through the haze and learn to trust your instincts to do what's right for you…even if a professional may disagree. Keep up the fantastic blogging…you've got a skill R xx

    1. Thanks R! The above is plenty insightful, I think you make a really good comparison with parenting. It's all new territory, it can't be fully understood until you go through it, no matter how much you read about it, and it's utterly terrifying. There's no one size fits all solution. We're all just trotting along doing the best we can!

  3. I find a mixture of the two is good for me, but I'm happy to admit I don't have depression so my perspective would be different.

    Talking helps, we all know that.
    But I try also to build in some 'quiet' time when I get a chance during the day. On the way home for example, I'll leave the radio off and just let my thoughts wander. If my mind is agitated from the day, then I let it agitate. My point is my 'quiet' time isn't about meditating in a room per se, but just about stopping external stumuli for a bit and let my thoughts wander.
    It's very helpful to me – there's a background buzzing in all our minds of things going on all the time and I find it so good to let it come to the fore every day for a bit. Somedays I find my mind is peaceful and quiet time is just spent looking at trees. Invariably I find I'm settled after it; it's like soothing an irritable discontented child – sometimes a bit of dedicated attention is all that's needed.
    As for CBT, I don't know if I've tried it. I guess we all have really in terms of 'having a word' with ourselves to look on the bright side of things.
    Luckily for me I haven't had any serious brushes with depression so I haven't needed to work hard at my outlook. Your blog has been very insightful to me though, so many thanks and keep it up!

    1. Thank you for your comment, I'm so glad you're finding the blog helpful.
      Quiet time is so important, for everyone. Looking at trees, looking at water, just zoning out for a while – makes a world of a difference. It's clearly working for you, keep it up!!

  4. Well, for me, that's a good summary of several approaches. Which seem to contradict each other. Mindfulness – like meditation really, isn't it, and I think it works best for me. I don't think I could just "cheer up" if I'd missed a flight to see someone that I love. I would cry and cry and cry. And then some more.

    About 6 or 7 years ago, I joined a meditation group and it has been the very best thing for me. Just to share other people's experiences, have some valuable quiet time in my own head – being mindful of how I actually feel amid all the clutter and noise of life. I go most weeks to the group meetings – I am not sure what I would do without it now. That makes it sound very formal, but it isn't at all! We drink tea, have some guided meditation and then more tea and we talk to each other. Really friendly and helpful. Compassionate. Understanding. Stuff like that.

    Still get depressed though. Mindfulness seems to be not so much a cure, more a way of coping. But it helps to ponder, acknowledge the feelings and work with them. I cannot imagine the CBT approach, where I would have to tell myself that the feelings that I have are somehow wrong. And the thought of anti depressant medication? I find that a bit scary.

    I could not manage to rewrite what I deleted accidentally. That seems to be gone forever!

    1. There is nothing scary about medication once you find the one that works for you. I am taking medication(sorry the correct medication) for 10 years and have no intention of stopping as I never want to go back to that place again. I live a perfectly normal life,(with some blips!) and have raised three children on my own, so dont knock it until you try it, I cant see or fathom any good things coming from CBT, Mindfulness would be the better option I think. but who am I to say, we are all different, take care.

    2. Hi Merryn, sorry you had so much trouble posting, I've no idea what the problem was!

      The meditation group sounds wonderful! So supportive. If it's helping you cope with depressive episodes as the arise then you've found what works for you which is great.

      I resisted anti-depressants for a long time, and still do for the most part as I've tried a few that didn't work at all, but the combination I have now seems to be working and stopping would not be a good plan. They allow me to be stable enough to address problems as they arise. I can understand your fear around taking them, but if things ever got so bad that you found yourself unable to cope, or that meditation etc was no longer enough to get you through, it would probably be worth seeking further help. With any luck that's not a bridge you'll ever have to cross and the support you're getting from the group will continue to be the best way forward for you.
      Thanks so much for taking the time to comment.

  5. I’m no expert on CBT, so feel free to correct me, but to my mind the functions of CBT and mindfulness are quite different. CBT is not really designed to deal with general emotions ..sadness, anxiety, grief etc but rather to change underlying patterns of thinking in order to hopefully over time reduce the instances of feeling depressed, or sad or anxious. CBT isn’t about feeling sad and then saying to yourself cheer up, stop feeling so sad – that will probably just serve to make you feel guilty (or selfish) for feeling sad in the first place and end up making you feel worse..

    Instead CBT is designed to stop the intrusive and compulsive thoughts …. the thoughts you call Bitchface. So everytime one of those alien thought pops in to your head: I’m stupid, I’m fat, I’m worthless etc ., the idea is that you catch it and repeat to yourself a positive thought instead. For example if your thought is I’m fat, you repeat to yourself I’m gorgeous. While this may seem simplistic at first, over time you can basically train your brain to stop and weed out the negative thoughts before you even become aware of them, it’s effectively like building a new filter in your mind.
    This can be useful for treating any condition that is based on compulsive and intrusive thoughts – anxieties and phobias for example. My fear of heights means that anytime I get up high I usually have some godawful image or thought of the absolute worst case scenario – the stairs collapsing, or falling over the ledge of a balcony etc etc. CBT would work to replace those thoughts with positive ones, so that in time I may be able to stop them altogether. The basic idea of CBT is to get your mind working with you rather than against you…

    I hope that makes sense and again I may be wrong – that’s just my understanding of it.

    1. That makes a lot of sense Sarah, thanks for sharing. There are a couple of other approaches as well, one in particular which seems to be a combination of the two – mindfulness based CBT. I've no personal experience of this, but maybe it takes the best of both? I can definitely see how CBT would help in terms of changing a negative thought, the problem for me is catching that thought before the emotion that goes with it takes over!

      As for being wrong? I'm only able to speak for myself, and it's really interesting to hear other peoples' opinions – it brings a fresh perspective and we can all learn something from each other. So thank you!

  6. I have been on meds for ten years plus but haven't really started feeling better until about two months ago when I started psychotherapy. Medication can dull the ache but the therapy helps me feel like a real person. My thoughts are so many I confuse myself even and she helps me sort through it all. I just wish it was cheaper. But I guess 168 bucks a session (after insurance) is a small price to pay for sanity I guess. I just wonder how long I'll need it. I'm open to try anything that could possibly make me feel better. CBT sounds interesting and it makes since. I am always glad when I feel SOMETHING. Anger, saddness, disappointment. Feeling anything is better then feeling nothing at all.

    1. Hi Amy Jane, I'm glad to hear you're making progress with therapy, talking is so important. For me, I definitely see medication as getting me to the place where I can talk and make sense of things, rather than being the solution in its own right.
      I've links to a few free online CBT programmes that you might find useful, just scroll down a bit:
      Hope you continue to be well, thanks for joining in the conversation!

  7. Thank you sunny spells and scattered showers. Love the title.
    Your blog is acknowledgment to what I feel. I will keep reading.

  8. Fine short-hand description of the difference between MF and CBT. As a therapist, I'm always looking for the unique combination of tools that will help each client. As a person, I experience CBT as a useful tool, but I experience MF as more deep, foundational, and lasting.

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