The contributing factors to depression can be described by a cycle diagram in which emotional state, physiological problems and cognitive distortions feed each other. This suggests that a three pronged attack should be used in treating depression. One would be to address the cognitive distortions, the other would be to treat the physiological problems with medicine and the third would be to try and raise the persons emotional state. The emotional state of the depressed person could perhaps be raised by putting them with someone they love and having them do an activity they normally enjoy. When I (Karl Ericson) was a teenager in a mental hospital I remember that the male nurses would play me a challenging game of Ping Pong which I always won. Playing a game I enjoyed and of course winning made me feel better.
Many years later I encountered a woman suffering from serious depression. I knew that she adored her grandchild. I started to talk about her grandchild with her and she smiled. I spent some time talking to her and trying to help her by trying to correct her cognitive distortions. I explained to her that her emotional state was convincing her that the worst was true. I challenged her pessimistic beliefs with evidence that they weren't true. I told her to try not to believe the worst and that if she succeeded she'd overcome her depression. I may have helped her for a few minutes but soon after she was convinced of her negative beliefs again and extremely depressed. She told me that I was wrong but didn't explain why.
Why do depressed people believe negative beliefs with so much conviction that they are convinced that those who challenge those beliefs are wrong? Some of the contributing factors are described in the previously discussed cycle diagram. Another contributing factor is that the distorted beliefs of depressed patients lead them to interpret events to support their negative beliefs. If for example a depressed person believed that they would be fired from their job because their boss doesn't like them and their boss walks by without saying hello the depressed person might conclude that their boss didn't say "Hello" because their boss doesn't like them. This then becomes evidence supporting their belief. These beliefs can develop into a set of beliefs or as Aaron Beck calls them a schema. I think there is another answer as well. Patients resist challenges to their beliefs so strongly that I think they have a motivation to do so. What possible reason could someone have to believe a negative depressing belief? One possible reason is in order to defend themselves against a perceived threat. It may be that if one is afraid of something happening one is motivated to defend oneself against it's happening by believing that it will happen. For example, if one is afraid that there is a murderer outside who is planning to climb in one's bedroom window when one is asleep, one has take some kind of defensive action, e.g. locking the window, calling the police and so on. If one called the police and told them and they said "No one's going to climb into your window" one is likely to try and convince them that they are wrong and that someone really is going to climb through the window. One doesn't know this for a fact but in order to defend oneself one is trying to convince them. For the same reason one may be motivated to convince oneself. A depressed emotional state may cause one to fear that the worst is true and so set off such defensive motivations. Motivations that lead to unhappiness are discovered further on the Happiness is a Choice web page of this web site.
In case you are wondering what happened to the friend who I tried to cheer up she was hospitalized. In her case I think cognitive therapy and distraction with pleasant activities would not have been enough and it was necessary to address the physiological cause with medication as well. The hospital that took her only admits mentally ill people who are a danger to themselves or others. Anyone who is severely depressed is potentially dangerous to themselves. Hospitalization besides protected the patient from herself will also insure that she take her medicine which she may not take on her own even though she needs it. The patient has to believe that the medicine will help them for them to take it. If a patient is developing negative thoughts because of mental illness, they may develop negative thoughts about their medicine and not want to take it. In fact whenever my friend's mother tried to get her to take an antidepressant, my friend grimaced as if it was painful for her.
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