- Hi, I'm Dr. David Purves.
In a previous video, I said that depression is a recurring problem and it is a recurring problem as it looks in the scientific literature. However, we do know a couple of things.
First of all, we know that anti-depressants give you no long-term benefits to prevent depression recurring. You get some benefit if you stay on it but if you don't stay on it for the whole of your life, let's say, then you get no benefit from it and even the benefit that you do get appears to be a bit overestimated.
The second thing we know is that if you have CBT, cognitive behavior therapy, your risk of relapse is much reduced and so, thinking about the question of why it is that we relapse, let's think about what it is you might get from cognitive behavior therapy.
CBT For Depression
Now, when I'm doing CBT for depression, I'm always seeing, everybody who comes for CBT for depression, is running some unhelpful dysfunctional beliefs about themselves, the world and the future, and these are probably long-standing and enduring beliefs, but we challenge them through a process of therapy and as people change their beliefs about themselves, they start to feel relief and they start to feel benefit, and eventually their depression goes away; typically with me, it'd be y'know, eight sessions, that kind of thing and we should be able to cure unipolar depression, so a depressive episode; should be able to get on top of it, let's say eight to 12 sessions but certainly not years and years and years. But that's because we change the beliefs people have about themselves.
Now, if you think about what we did in the last video, we said that you progress into depression through a prodromal phase, you progress into depression because the negative beliefs, the dysfunctional beliefs that you have about yourself and the world and the future have gotten deeper and stronger and they've been practiced and rehearsed. Now, when we do therapy, what we do is we change them as best we can, but they don't go away because they exist in memory; you remember what you thought about yourself.
Effects when you stop therapy
When you stop therapy, the effect of therapy persists for a period of time. It really depends on the extent to which you kind of practice and sort of think about the ideas that you learnt in CBT, but the effect of therapy persists. But the old beliefs that you have about yourself have not gone away, they've been overwritten.
So, if you find yourself in stressful situations that kind of trigger and evoke these previous old beliefs about yourself, that can cause a relapse problem.
Also, depending on how long you've had these dysfunctional beliefs about yourself and you could've had them principally for most of your life, they have an established memory and neural network and that's called the scar hypothesis.
You remember how bad you felt and that kind of makes a sort of a psychological scar and something happens in your life that could just like pick the top of that scar and it makes it bleed again and then it brings you back into depression.
So, a stressful situation, a life challenge such as a bereavement or an accident or something happening to you can just like pull the top of that scar and just make it have its effect again. Now, it doesn't make the dysfunctional beliefs you have about yourself true, but it means that the emotional distress you feel about remembering them is increased and that then can be sufficient to push you back into depression.
So, just a recap, in this video I've talked about the power of dysfunctional beliefs that you have about yourself, the world and the future, and also that in CBT we can't completely eradicate them but we overwrite them and that means that they no longer exert their effect but they're not gone away because you've been practicing having them and they exist in your memory and you could've been practicing having them for years and years and years and they exist in your memory but with CBT, what we're doing is we're challenging them and we're enabling you to live a life more accurately calibrated to external reality as opposed to these dysfunctional beliefs which kind of pop in there in your internal reality.
So thanks for taking the time to watch and listen and in the next video I'll be talking about active self-help.
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