CBT may backfire with severe depression.

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Apparently, attempting to intentionally change your depressive thoughts (CBT) can exacerbate negative emotions for severely depressed people. (Shout out to my Wisconsin Badgers for conducting this brain imaging research.)

So what’s the application?

Hmmm…..

I’ve often observed that the depressive thoughts of severely depressed people often follow the pattern of a compulsion: Invasive, persistent, and existing as a misguided means to manage anxiety (if I count to seven, seven times, my unease will be quelled.). In fact, obsessive compulsive disorder is a form of extreme anxiety. A severely depressed person may compulsively remind themselves of how empty, bad, worthless, or guilty they are, experiencing an unease akin to anxiety when these repetitive thoughts are absent.

And if these thoughts are compulsive behaviors, it makes perfect sense that trying actively to RESIST these thoughts would show increased fear activation on brain-imaging of the amygda in severely depressed people. Everyone knows that the best way to increase anxiety is to put pressure on someone to not be anxious. (That’s why if you have trouble sleeping, your best course of action is to cover up the clock and tell yourself you don’t give a damn if you fall asleep or not.)

The only logical implication for treatment? Score one for Buddhist psychology and DBT, because, besides medication, these patients need some radical acceptance of their thoughts (accepting thoughts as they are without judgement, even the bad ones.) and mindfulness (observing, riding-out, without judging or adding-to the thoughts.)

Read these:

http://psychcentral.com/blog/archives/2014/08/26/when-happiness-isnt-a-choice/

http://m.psychologytoday.com/blog/prescriptions-life/201310/overwhelmed-negative-emotions-try-radical-acceptance

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