Depression has spiked in Americans during the pandemic, according to a study published in JAMA Network last week. Lowered incomes and having less than $5,000 in savings contributed significantly to depression rates. Cognitive behavioral therapy may help.
According to a new study surveying approximately 1,500 people, the number of Americans exhibiting symptoms of depression has tripled to over 27% as the novel coronavirus spread throughout the United States. Stated in the survey, “As an event that can cause physical, emotional, and psychological harm, the COVID-19 pandemic can itself be considered a traumatic event.”
“In addition, the policies created to prevent its spread introduced new life stressors and disrupted daily living for most people in the U.S. This survey study found that prevalence of depression symptoms in the U.S. increased more than three-fold during the COVID-19 pandemic, from 8.5% before COVID-19 to 27.8% during COVID-19.”
Cognitive behavioral therapy (CBT) is a popular field in psychology and it features four stages of therapy to treat depression.
Education and Behavioral Activation
Dr. Jason M. Satterfield is Professor of Clinical Medicine, Director of Social and Behavioral Sciences, and Director of Behavioral Medicine in the Division of General Internal Medicine at the University of California, San Francisco.
According to Dr. Satterfield, the first stage in treating depression is to educate the patient about the disorder and about CBT. Dr. Satterfield said collecting data about their depressive episodes could be “maybe on behaviors, maybe on cognition, maybe on both.” He continued, “We have our theory, but we want to see if it actually works in an individual’s life.”
The second stage is called behavioral activation. “If a patient has been spiraling downward [because of their depression], we want to help and to reverse that spiral and start spiraling up,” he said.
One way to do this is to start scheduling activities that the depressed person used to enjoy. Often, he said, depression tells us that we shouldn’t do something we used to love because we won’t enjoy it anymore. However, in virtually every case, the person finds that after doing the thing they used to love, they find it more enjoyable than they thought they would. Then after the activity, they need to make a record of their mood.
“This relatively simple exercise isn’t just about activities, and it isn’t just about creating those tiny little bumps in mood,” he said. “It’s helping to break through a depressed person’s sense of helplessness. It shows them that change is possible.”
Cognitive Restructuring and Environmental Changes
Dr. Satterfield said there is a “constellation of cognitions” which cluster around negative thoughts about the self, other people, and the world at large. Depressed people may consider themselves unlovable or unworthy; they may think other people are exploitative and uncaring; and they may see the world as a wholly uncaring and dangerous place, respectively.
Learning to combat these thoughts and stop them in their tracks is the third stage of CBT for depression: cognitive restructuring.
“Often, we make particular shortcuts that aren’t very rational in terms of how we understand or explain the events happening in our world,” Dr. Satterfield said. “We may selectively attend to all of our failures or things that just didn’t go so well; we may use ‘all-or-none’ thinking. We may imagine and tell ourselves what we believe other people are thinking.”
Several tools, such as self-monitoring for these thoughts, can help people learn to be more compassionate with themselves.
The fourth and final stage is making social and/or environmental changes. While this is pretty self-explanatory, Dr. Satterfield gave several examples. A depressed person might reach out to a friend with whom they’ve lost touch. They could join a support group for people facing similar problems so they can hear from people who have “been there.” Finding a way to take some time off from work or being a caregiver to their children may also help.
The novel coronavirus pandemic won’t end in the blink of an eye, so the depression rate is likely to remain high among Americans until it does. In the meantime, please consult a qualified medical professional before making any health decisions.
Dr. Jason M. Satterfield contributed to this article. Dr. Satterfield is Professor of Clinical Medicine, Director of Social and Behavioral Sciences, and Director of Behavioral Medicine in the Division of General Internal Medicine at the University of California, San Francisco (UCSF). He earned his BS in Brain Sciences from the Massachusetts Institute of Technology and his PhD in Clinical Psychology from the University of Pennsylvania.