This article was first published on ProHealth on May 27th, 2018. It was later removed for reasons outlined in this notice. Most of the links on this post are informational, but a few are affiliate links to help maintain this website.
Feeling hopeless is a sign of depression; it's also an example of a negative thought pattern that, if reinforced, can be a difficult habit to break. That's where cognitive behavioral therapy (CBT) comes in. CBT is all about identifying maladaptive "cognitions," or thoughts and beliefs, and working with a therapist to realign those thoughts into something more productive.
As a therapist, depression is one of the most common problems I see in my office. In fact, it's a leading cause of disability in the United States, according to the National Institute of Mental Health (NIMH). An estimated 16.2 million adults experience depression every year—that’s 6.7% of the population!
It's a serious illness that is often misunderstood or minimized. Depression is an umbrella term that includes major depressive disorder and persistent depressive disorder, among other less common diagnoses with similar symptoms like low mood, loss of pleasure, and some manner of disruption to a person’s daily functioning.
The good news is there are treatments for depression. Unfortunately, NIMH reports only about half of all people diagnosed with depression access those treatments. No one knows exactly why this is the case. Maybe it's related to the stigma of asking for help. Or, maybe it's because the symptoms of depression itself are a barrier to treatment. Either way, it keeps people from the chance at a better life.
If you've been diagnosed with depression but aren't in treatment (or feel like your treatment isn't working), it may be time to consider CBT as a possibility for you.
What exactly is CBT?
The basic premise behind CBT is that changes in harmful thought patterns lead to changes in behavior. Also, it’s about becoming aware of long-held beliefs that do not serve you and working to shift your perspective. These negative beliefs can be about yourself, life circumstances, or the world in general.
CBT is commonly considered a short-term treatment model, meaning the goal is to address the problem in a limited number of therapy sessions. Many therapists use CBT in one form or another in their practices due to empirical evidence of its effectiveness, especially with depression and anxiety.
One important thing to know about cognitive behavioral therapy is that it was specifically designed to treat depression. In the 1960s, a psychiatrist, Dr. Aaron T. Beck, noticed that most of his patients with depression also had negative thought patterns. By bringing attention to these thoughts and reframing them in a positive way, his patients started feeling better. Eventually, behavioral therapists (think Pavlov and his dogs) took an interest in this new approach, and CBT was born.
Studies have shown that CBT is effective alone or in combination with medication to treat depression and other mental illnesses. CBT is like the trunk of a tree with many branches such as exposure therapy and dialectical behavior therapy (DBT). Within these different therapies, there are multiple strategies and techniques that a therapist uses to get to the heart of an issue.
What does a negative thought pattern look like in a person diagnosed with depression?
A depressed person may replay a negative, internal conversation like, "I'm never going to be happy."
This belief is an example of "catastrophic thinking" or "overgeneralizing." In CBT, a therapist may challenge those beliefs and encourage the client to change their inner dialogue to something like, "I may not feel good now, but there will be a time in the future when I will feel better."
Then, the therapist will help the client identify what’s getting in the way of feeling better and assist in developing new strategies. CBT helps people learn and accept the things they can and cannot control about their life.
You may have heard of a "breakthrough" in therapy. It’s the aha moment when a client understands something in a new way. There tends to be multiple breakthroughs in CBT, because it’s about finding new ways to view a personal challenge like depression. As viewpoints shift over time and breakthroughs happen, it can be very rewarding for both the client and therapist.
What happens during a CBT session?
If you've never participated in therapy before, you may be wondering what to expect during an appointment. In the initial session, the therapist will get to know you and learn about the areas you might want to address. You and your therapist may also identify realistic goals and establish a treatment plan. In future sessions, you will work on reframing cognitions and identify successes, as well as, acknowledge areas where you still may need to make improvements. The therapist will act as your accountability partner, cheering you on with each success and helping you adjust your strategy when you face a setback.
CBT is a solution-focused therapy, so don't expect to spend too much time digging into your past. However, there may be moments when it's necessary to explore why the negative thought patterns began in the first place. Each therapist has a different style, so you may have to see more than one therapist to find a good fit. A therapist is there to facilitate change—if it's not working, try communicating your concerns. If you don’t make any headway, move on to a different therapist.
Over time, the hope is that you no longer need help in reframing negative beliefs, and you're able to do it without the assistance or reinforcement from your therapist. Through CBT, you should experience a reduction in your symptoms and increase your sense of satisfaction about life—ultimately, these are the goals of CBT.
What are the outcomes associated with CBT?
Proponents of CBT see it as a widely-researched method with high rates of success. For example, research has shown there is a lower chance of relapse after CBT as compared to antidepressants. But studies vary on the effectiveness of CBT, and some find that unless a skilled therapist implements the model, it lacks effectiveness.
Remember, CBT is not a guaranteed solution. There are many contributing factors to why someone experiences depression, making outcomes different for everyone. As with any treatment, it’s all about individualization.
If you're struggling with depression, remember it's a treatable illness. Hang onto hope and keep searching until you find what works for you.
"We're designed to heal and grow. By nature, humans gravitate toward resolving trauma, and it’s possible to make a lot of progress over time." - Jill Manning
This article was first published on ProHealth on May 17th, 2018. It was later removed for reasons outlined in this notice. Most of the links on this post are informational, but a few are affiliate links to help maintain this website.
For people with Lyme disease there is no one-size-fits-all approach to treatment. Each patient will have a unique treatment plan that will most likely change over time. The most common treatments are antibiotics and herbal protocols, but outside of that there are emerging therapies, such as IV nutrition/light therapy and Hyperbaric Oxygen Therapy (HBOT). With so many options it’s difficult to determine what approach or combination of approaches is right for you. If you've been considering HBOT, here is everything you need to know from a Lyme patient's perspective.
As a complication from Lyme disease I developed osteomyelitis, otherwise known as a bone infection. It was while I was doing research for treatment of bone infections that I first learned about Hyperbaric Oxygen Therapy. Later I found out HBOT is beneficial for symptom reduction in Lyme patients even without osteomyelitis.
So how does Hyperbaric Oxygen Therapy work? To receive HBOT, a person is placed in an enclosed, pressurized chamber. This chamber can be a small room that fits multiple people or a large tube-like structure that fits one person. Chambers can be hard or soft-sided and vary in levels of pressure. During therapy medical grade oxygen may be administered through a cannula, mask, or special hood. A typical session lasts from 45 minutes to two hours depending on your condition and tolerance.
The theory behind HBOT is that the tissues of the body cannot perform properly without oxygen, and in some illnesses oxygen is not able to reach where it needs to go. The pressure of the chamber assists the lungs in acquiring more oxygen than is possible with normal breathing, which is then carried by the blood to the tissues. This therapy is approved for multiple conditions, such as carbon monoxide poisoning, decompression sickness, burns, diabetic wounds, and certain types of infections. In Lyme disease, HBOT is used to increase oxygen to the body in order to kill off anaerobic (can't exist in an oxygenated environment) bacteria. It also has the capacity to increase immune function and repair damaged tissues.
I am fortunate, because there is a clinic near me that uses HBOT as part of comprehensive Lyme treatment. Because it is a relatively non-invasive treatment, I decided to pursue it. Then I saw the size of the chamber and I almost changed my mind. I have claustrophobia and need sedation for MRIs. The HBOT technician at the clinic talked me through the process and told me that most people with claustrophobia don't have problems, because the chamber is more spacious than an MRI. After my first treatment, I found this to be true for me; however, it should definitely be a consideration for others with claustrophobia. Especially, because due to the pressurization, the chamber needs a few minutes to depressurize before you are able to get out.
Prior to my first treatment the HBOT technician walked me through what to expect and provided me with a walkie talkie in the chamber in case I had any questions or concerns during the session.
Once you are in the chamber, the technician will start pressurization. Once it begins, your ears will pop multiple times like you are going up in an airplane. This can be slightly uncomfortable, but not painful. Your ears will no longer pop once the chamber is fully pressurized. In the pressurized chamber, you will likely not feel anything during the treatment, with the exception of a sense of heaviness to your body. It tends to be a relaxing experience and a good time to take a nap or meditate. At the end of the session, when the chamber is depressurizing your ears will pop again.
It is possible for Lyme patients to have detoxification or Herxheimer reactions from HBOT, because of the antibacterial properties. Personally, I've had four sessions. After the first session I only had minor fatigue, but after the second session I had a huge Herx. I experienced a severe headache, nausea, and had to stay in bed for a few days to recover. The following two sessions, I only experienced slight fatigue that lasted about a day. The reaction to treatment is different for everyone, just like with antibiotic or herbal treatments.
When doing HBOT, make sure you are doing a lot of detox. A few supplements that may be helpful during HBOT are binders, like activated charcoal and bentonite clay, magnesium, and the B vitamins. Other common detox strategies, like good nutrition, infrared sauna, and Epsom salt baths may also decrease any Herxheimer reaction you may experience.
If you do not have one of the approved conditions and have HBOT prescribed by a medical doctor, it is rarely covered by insurance. You will most likely need to find a private clinic and pay out of pocket. The number of sessions per week and number of weeks/months you need will all depend on your tolerance, doctor's recommendation, cost, and patient preference. As an example, my current treatment plan is weekly for 8 weeks, then every other week for 2-3 months, then monthly on an ongoing basis. However, I've heard of people doing as many as one hundred sessions. Some people use HBOT as a maintenance treatment after antibiotic treatment is completed.
Lastly, it is very important to find a skilled practitioner, because improper administration can be dangerous. There are some risks, such as ear injuries and lung collapse. These are rare and HBOT is generally considered to be a safe treatment. Read reviews of the clinic you are considering and try to get feedback from other patients. Another good idea is to interview your technician before starting treatment. Write up a list of questions and concerns and ask your technician to talk you through what to expect both during and after a session.
So far, I have a positive impression of my experience with Hyperbaric Oxygen Therapy and have decided to continue with the protocol. Time will tell if this is a miraculous treatment or simply another tool in my healing toolbox.
"Breath is the link between mind and body." - Dan Brule
I'm Kerry (She/Her/Hers) and I am a licensed therapist, group facilitator, poet, writer, & speaker. This is a place to acknowledge and validate our suffering and trauma, while also learning how to turn toward aliveness and spaciousness.