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?