Cognitive and Behavioural Therapy (CBT) is the modality of counselling I use as a day job. Yes, really… I’m not a cyclist for money! I know, you’ve seen my videos, you’re surprised I’m not a pro-cyclist, right? #notreally 😛 But, as I’m sure you know if you’ve looked it up, or had direct experience of clinically diagnosed depression, CBT is almost unilaterally cited as one of the key elements in a treatment plan for depression. CBT can help you understand the emotional causes or maintaining factors in the depression symptoms you’re experiencing. In my experience as a counsellor, it’s of great benefit in helping clients dismantle seemingly enormous problems and leave them with small, manageable tasks to work on in order to alleviate depression symptoms arising from psychological factors – automatic negative thoughts and irrational behaviours that we can all be prone to engage in.
Naturally that leaves the physical and physiological aspects of depression that go hand-in-glove with the psychological and emotional aspects. Again, that’s where cycling comes in. As I outlined in Part 1 of this series on building a cycling plan to help cure depression, exercise is frequently suggested as part of the treatment for depression, but cycling can provide aspects such as a clear space and/or a distraction from depression symptoms in ways that other exercise can’t always do.
But hello, Dear Reader, it’s great to have you back, you’re totally welcome to our second part of three articles aiming to de-fang the torment of depressive symptoms and build to a unique cycling plan to help cure depression. Here, what I’d like to do is to give you an overview of our normal CBT protocol for depression and show how you can, without too much effort, begin to work this for your self in order to understand the emotional and psychological factors that maintain your symptoms with a view to getting rid of those symptoms! 🙂 Don’t worry, nothing too complicated, just some ideas and examples for you to think about 🙂 But take a while to go through this. As with the first part, there is quite a bit of information contained here. And I don’t want to overload you with facts. Take your time is all 🙂
What is the CBT protocol for depression?
CBT is a very hands-on, task-oriented approach to understanding and solving emotional issues. So as a first task I’d ask you to bring in for your first session, a problem list, ie. a list of things that are giving you concern. We’d usually re-work those as goals. What I’d normally do in surgery then is what’s known as the Cognitive Model (some call it the 5-Aspect Model and others the 5-Part Model). See the link below for an overview from the author. The model has been in use like forever it seems. Originated by Christine Padesky – a prominent name in Cognitive and Behavioural Counselling. Here’s a PDF link to the Cognitive Model from Padesky’s site. But it’s essentially a visual tool in therapy sessions (or on your own) to demonstrate the link between…
- The situation or event that’s triggered depressive symptoms in you
- Your thoughts about that situation
- Your feelings at the time of having those thoughts
- Your physical reactions within your body at that point
- Your behaviours or actions you take as a a result of these thoughts and feelings
If you have a look at the diagram in the link you’ll see that each of these things is interlinked. They all impact upon the other and almost conspire together. Let me explain with a quick example.
No particular reason why our example is a female, depression affects anyone of any age, gender or race (though various theories exist as to why depression incidence globally is almost always higher among women than men – some suggest men don’t report it anywhere near as often as their female counterparts!) So Claire presents with a diagnosis of major depressive disorder (MDD) from her family doctor. On her problem list she has a few items relating to work stress and isolation at home. We look at the 5-Aspect Model with Claire and it seems the situation that’s triggered off this episode is the current stress Claire is under at work. She has lot of preparation work to do for a batch of corporate sales presentations, so much that she takes work home every evening plus most weekends she spends away from home and her children to make the actual presentation. Claire’s thoughts about this situation are, “I can’t cope” and “everybody else except me seems to manage ok”, and “I’m not doing as much as I should”. These thoughts leave Claire feeling worried over her future at work, feeling a horrible low mood, maybe a bit angry at herself for somehow falling short on her commitments. This has all got on top of her to the point where she’s even had thoughts of ending her life. The whole idea of having these thoughts she finds very disturbing.
As an aside, suicidal thoughts are highly common in depression. And the thoughts themselves aren’t something to be unnecessarily alarmed or worried about. However, an intention to act on those thoughts most certainly is a concern for any of us in the caring professions and plainly too for those that care for you. I won’t preach, but if that’s you, please, please speak to someone about it! 🙂 As I mentioned in the previous Part 1 article, depression has a way of encouraging us to buy into it’s big hype. Don’t! Don’t act on its dictates! Things can be different. You are endless possibility. Don’t be persuaded otherwise 🙂 #helpisavailable
So, back to Claire, these concerns leave her feeling more confused, stressed and anxious. Physically speaking it’s left her unable to sleep as well as she used to, wakening and being unable to return to sleep. And in her behaviour, Claire has noticed that she’s comfort eating, consuming a lot of fast food and confectionery. She’s also started pushing herself to work even more at home when she’s unable to sleep.
You can imagine how these five aspects are interrelated. When Claire feels worried over her future at work, this affects her physically causing stress and lack of sleep. That lack of sleep leaves her physically lethargic and lacking energy during the daytime. In turn, that also refocuses her thoughts on her inability to cope, making the feeling of worry even greater as well as her low mood. The worry can cause her to engage in comfort-eating behaviour. This also drives home the “I can’t cope” thought as well as doing nothing to actually alleviate her feeling of worry. So you can see how interconnected these aspects all are. You can see too how unfortunately a downward change in one aspect can cause unhelpful changes in all the rest. The good news though is that a beneficial change in one can similarly affect the others beneficially too! 🙂
Now, while the CBT protocol will take this quite a bit further over the client’s counselling sessions – we’d likely discover that Claire had a negative self-belief about her self that she’s somehow not good enough, for example: “I am incompetent” that was causing her to overwork and not acknowledge her efforts. In our counselling plan with Claire we’d likely also focus on rebalancing irrational thoughts that Claire has that are generally automatic to her and negative in content. These thoughts stem from that not-good-enough negative belief Claire has about her self. We all have negative self-beliefs of one form or another but seldom if ever give airtime to! That negative self-belief will have been as a result of some adverse childhood experience (ACE) that Claire had and, as the child she was, inferred something incorrectly about her self such as “I’m not good enough” etc, which was, and is, taken for truth, yet wasn’t true then and nor is it now. Complicated aren’t we all?
So we’ll usually focus on thoughts like that and also on Claire’s behaviour because these are two aspects most efficiently changed. Hence the Cognitive and Behavioural therapy 🙂 It’s a protocol that’s proven in study after study to work which is why it’s recommended by Federal and Government health agencies for depression. I’ve seen it in action as a counsellor too. It’s worthwhile therapy.
And so what exactly do I do with that information?
Well, I don’t expect you to do anything with it. Or maybe you might consider using it to seek your own sources of help if you haven’t already. Otherwise, it’s purely for your information, food for thought, evidence that often depression makes itself out to be more daunting than it really is 🙂 Likewise, if I can be of any direct help, just get in touch here or on the CyclingQuestions YouTube. I’m more than happy to point you in the right direction 🙂 But naturally if you haven’t already, confide to someone in whom you trust about your situation and feelings. Your first port of call beyond that would likely be your family health practitioner. Depression is a hugely common issue today. You certainly wouldn’t be on your own in your concerns, I promise 🙂
In the meantime and for our purposes what I’d like to focus on in the above 5-Aspect Cognitive Model is behaviour. Why? Because that’s exactly where we can make our intervention here in this cycling plan for depression. And, as I hope we’ve seen, making a positive change there can, and will have a beneficial effect on the other aspects too.
Back to Claire again…
So Claire is a cyclist. Or at least she was prior to the onset of these low moods and plethora of other symptoms. I hope the 5-Aspect Cognitive Model demonstrates that rather than you being a huge collection of complex symptoms, actually, they’re all related to the one condition. It’s one we can indeed rid our selves of. And we can do it with the help of our bike!
Do you think Claire’s had time to read through our first part of this plan, our mindset primer? If so she’ll hopefully from it have been able to at least find a more beneficial starting-point frame of mind with which to approach the idea again of getting back on her bike. She’ll hopefully have been able to take that decision to do so! And if that’s you, Dear Reader, you have my sincerest wishes that you are too! 🙂
Not only is cycling a great mood enhancer creating brain-pleasing endorphins and monoamines, but within depression itself, cycling is what we’d call a functional coping mechanism. It’s a good thing all round in other words!
How does cycling fit into the overall protocol?
Remember we mentioned how changing one of the five aspects of the Cognitive Model had an effect on the others? Well that’s what we’re suggesting for Claire. And for you likewise! In Claire’s case, and possibly your own, it’ll take a little bit of rebalancing the automatic negative thoughts. However, if you are able to put your mind in the right place following what we discussed in the first part. If you’re able to take that one decision to get out on your bike, well, you’re actively making an intervention for your own health and wellbeing. And if so, well done to you for managing it! The decision takes no effort. The follow through does though. But as I’m always stating, I know you can do it. I’ve seen it a great many times in ordinary folk. You can get shot of depression. And as a cyclist this is a magic way to put those wheels literally in motion.
Change the behaviour! Go cycling!
Claire took a few low-intensity bike rides. She started with just 2.5 miles around her local park one morning she was wakened early. She gave her self easily achievable goals. And acknowledged completion as success and congratulated her self for that achievement. She noticed from our 5-aspect Cognitive Model, copies of which she was given in her session, that when she changed her behaviour this way, when she’d have been inclined to start her morning with chocolate (!) that physically her energy levels actually rose during that day. She didn’t experience nearly as much lethargy. As a result, her thoughts were less unhelpful. She wasn’t quite able to see clear of her workload and stress. But she was, after a few rides at least able to see the possibility that her previous thoughts “I can’t cope” and “everybody except me manages fine” were her own cognitive distortions, catastrophising the situation and overgeneralising. At that point she’d be more amenable to rebalancing those thoughts for something less weighted against her own interests. After the rides, in terms of her feelings, Claire noticed her mood brighten, even though nothing in particular had changed at work. The cycling seemed to give her the sense that she was more able to cope with the stress. And perhaps even with the workload.
As an aside, were Claire an actual client, we’d later deep dive into her “I am incompetent” negative self-belief, and show her how to evaluate her unconditional and unhealthy assumptions arising from this that caused her to overwork. This would give Claire back the confidence to address her workload without fear of the notion of incompetence.
So here’s a quick accompanying vid. It’s just taken on an easy ride along the river towpath to put forward the idea that when attempting to activate our selves during depression our ride doesn’t have to be anything grand – no particular training targets, distance or speed goals – it’s just a ride out and back 🙂
But that’s for another day! For now, I’d like you to just try to imagine how this form of behavioural intervention and activation on your own part might be allowed to work for you too.
And at that point, let’s take another well-deserved break. You’re doing great 🙂 As I said at the beginning, a lot covered here. Take your time in reading through. Read over it a few times if you need. Your bike is waiting, you just need to take the one decision to get on it and ride 🙂 I know you can 🙂 But thank you for getting this far in a fact-heavy article. But I hope in amongst it there’s the start of the end of these symptoms! I’ll see you for the final part when we’ll put together what we’ve learned into a cycling plan that’s customised to your own abilities right now.
Meantime, go easy on your self, find time for self-compassion. You are how you are right now. But that needn’t be the case too much longer 🙂 Take care of your self and kindest, warmest regards to you, Dear Reader, David.