Working with Depression

Working with Depression

Depression is the most common psychiatric disorder and the fourth major cause of disease burden worldwide (World Health Organization, 2001*). In the UK, one in four women and one in ten men experience at least one episode of depression requiring treatment during their lifetime and more than half of these will have at least one more episode (National Depression Campaign, 1999).

World Health Organisation:. World Health Report: Mental Health – New Understanding, New Hope.  2001. Geneva, Switzerland, WHO.

Main Features Of Depression

• Beck described depressed people as focusing on unrealistically negative views and having a ‘negative cognitive triad; depressed people typically have a negative view of themselves, the world and the future’ (Mytton, 2000)
• Thoughts about loss, defeat, failure will be the main themes of the NATs
• The client will have a negative, rigid bias in most areas of life, e.g. won’t remember good events, or will put them down to ‘fluke’
• This maintains depression (rather than causes it, there is still debate about the cause of depression)

How To Work With Someone With Depression

• Write to GP/consultant telling them you have been approached by the client and asking their agreement that you can work with this client.
• You can use a depression inventory (e.g. HADS or Mind Over Mood Depression Inventory*) to measure how depressed your client is if you choose to. These can be useful to assess how serious the client’s symptoms are and to see improvement and progress.
• Clients need to see how they ‘construct reality’ and maintain their depression
• It is important to educate your client about depression generally and what makes it worse etc. Get to know their triggers, thoughts and biases and help to make them conscious
• Work out what specifically is relevant for this client
• Help clients to uncover, challenge and change NATs
• How has the client experienced coping/achieving/enjoyment? Enable the client to remember positive coping strategies, achievements and pleasurable activities. Make a list of goals about these features.
• Set goals that show progress e.g. sleeping longer at night