What will treatment and therapy be like?
Therapy will involve you attending regular sessions (once or twice weekly, sometimes daily if you are an inpatient in hospital), usually an hour long with a therapist who will ask you lots of questions and encourage you to talk about your thoughts and your feelings. You will regularly complete questionnaires about your mood over the last week or so. Therapy will likely be uncomfortable and cause you to reflect on difficult things from the past as well as what is happening to you now. You will probably be asked to keep records between sessions, of your thoughts and feelings around events. Depression is characterised by negative thoughts about yourself, the world and about the future. These beliefs fuel negative thoughts which in turn reinforce your negative emotions. You may be asked to perform behavioural “experiments” which test out these negative beliefs and challenge them. Similarly, taking medication can be unpleasant and may cause uncomfortable side effects, which may last for some time before you begin to feel any benefit or reduction in your depressive symptoms.
Frequently Recommended Talking therapies
UK CAA guidelines identify Cognitive Behavioural therapy (CBT) and Interpersonal Psychotherapy (IP) as acceptable treatment for pilots experiencing depression. You can view the UK CAA depression flow chart here.
The National Institute for Health and Clinical Excellence (NICE) provides independent evidence based guidance for the NHS on the most effective ways to treat disease and NICE similarly identifies CBT as the recommended psychotherapeutic approach for depression, with and without antidepressant medication, dependent upon the nature and severity of the depression.
Cognitive Behavioural Therapy (CBT) for Depression
A core feature of depression is pervasive negative thinking and tackling this is at the heart of CBT. The content of depressive thinking has been described in terms of a “cognitive triad”.
CBT helps develop strategies for identifying, questioning and testing out negative thoughts, (sometimes referred to as cognitive distortions). Cognitive distortions are simply ways that our mind convinces us of something, that isn’t really true. These inaccurate thoughts are usually used to reinforce negative thinking or emotions — telling ourselves things that sound rational and accurate, but really only serve to keep us feeling bad about ourselves, the world and the future.
For instance, a person might tell themselves, “I always fail when I try to do something new; I therefore fail at everything I try.” This is an example of “black or white” (or polarized) thinking. The person is only seeing things in absolutes — that if they fail at one thing, they must fail at all things. If they added, “I must be a complete loser and failure” to their thinking, that would also be an example of overgeneralization — taking a failure at one specific task and generalizing it their very self and identity. CBT encourages people to re-evaluate their thinking through eliciting alternatives e.g. What is the evidence for this? What alternative views are there? (how might someone else see this?) what are the advantages and disadvantages of thinking this way? What logical errors am I making?
CBT encourages “behavioural experiments”, to test out the validity of these negative thoughts. It is therefore a very practical, logical, skills based therapy which has been robustly evaluated and together with antidepressant medication has been found to decrease depressive symptomatology and reduce the likelihood of relapse.
Interpersonal psychotherapy (IPT)
The main focus of IPT is on difficulties in relating to others and helping the person to identify how they are feeling and behaving in their relationships. When a person is able to interact more effectively, their psychological symptoms often improve.
IPT typically focuses on the following relationship areas:
Conflict with another person: No relationship is perfect, but sometimes a significant relationship at home or at work can become very stuck in disagreements or arguments, and is a source of tension and distress.
Life changes that affect how you feel about yourself and others: Life changes all the time. As it does it throws up new challenges, such as when we have a child or lose a job. These changes, whether wished for or not, can leave us feeling unable to cope with the demands of the new situation and what is expected of us.
Grief and loss: It is natural to feel sad following the loss of a significant person in our life. Sometimes, however, it can be very difficult to adjust to life without that person and we may then put our life on hold, unable to carry on with our normal activities and with our relationships.
Difficulty in starting or keeping relationships going: Sometimes relationships are difficult because of what is missing, for example not having enough people around us or not feeling as close to others as we would like.
IPT is particularly relevant to the transient lifestyle of a pilot and the challenges this creates for developing healthy and sustained personal and professional relationships.
It almost certainly won't involve laying on a couch! We hear people talking about 'therapy' a lot - so what does it actually involve?