Earlier, you learned that cognitive therapy is a way to treat depression that tackles thoughts and beliefs. Thoughts influence feelings, and thus feelings can cause depressive symptoms. Attacking those negative beliefs and thoughts leads to better management of feelings and therefore a decrease in depressive feelings.
Aaron Beck was a major force in the cognitive therapy movement. He explained depression through three concepts: the cognitive triad, schemas, and cognitive errors.
The cognitive triad refers to the way a child sees herself, her world and her place in it, and her future. A depressed child is likely to see herself as worthless, incompetent, and unlovable. You can spot this self-image by listening to how your child describes herself. “No one likes me.” “I never do anything right.” “The teacher hates me.” Obviously, these statements alone do not spell depression. But if your child is saying negative things about herself more often than not, it's something to consider.
When your child talks negatively about himself, he may really mean it or he may be manipulating you to get what he wants. Don't give in. Rather, if he continues acting this way, pick a less heated moment and confront him about it. If he reacts defensively, he is probably trying to evoke sympathy rather than expressing true depression.
In this triad is also the way a child interacts with her world and interprets the way it communicates with her. It is negative and pessimistic. The same is true about the way a child sees her future. The depressed child believes that what she encounters will be nothing but bad. She sees her future the same way — dark and hopeless.
Schema is a fancy word for perception. How a child perceives situations and people affects how she will interpret future events and people. When this is done in a negative way, a pattern of pessimistic anticipation occurs. It doesn't matter that the way a child sees things is not accurate. She perceives it that way, and that becomes her reality. It's easy to see then how depression is formed.
The thinking is irrational and distorted, but yet it continues. These irrational thoughts become beliefs and are called cognitive errors. Children begin to see things in terms of black and white, with absolutely no gray. For example, a child who has never made anything but straight As in school will respond to a B with “I never make Bs. What is wrong with me?” Perfectionistic thinking for children is a great way for them to develop depression.
Cognitive errors also come in the form of expecting the same result from different situations. Generalizing a negative outcome leads a child to avoid certain opportunities and to believe nothing good will come out of anything. Even if something positive does happen, it gets discounted as a fluke or “no big deal.”
Never forget that your child is a sponge! He is absorbing how you act, react, and communicate. If you are behaving in a negative, pessimistic fashion, he is likely to model what he sees. You can be a powerful preventative against depression just by changing the way you interact with the world.
Depressed children jump to conclusions and overreact to negative outcomes. Rather than seeing a mistake or a bad experience as part of life, he will interpret this as something he should have been able to control or something he doesn't deserve. He will blame himself, and in turn a negative self-image is developed. And you know what that leads to — depression.
So how do you battle this cognitive triad if it exists in your child? Cognitive restructuring is a technique that forces an individual to identify the negative, irrational, and distorted thoughts and to challenge them. Aaron Beck broke it into four techniques. The first requires that one look for the evidence that the thought or belief is true. The second technique is to ponder whether there is another way of looking at that thought or belief. When a child expects nothing but a negative outcome, the third technique can be useful. Challenging that negative expectation by asking “what if” questions can help a child see that the worst might not happen at all or might not be so bad. The fourth technique encourages testing the thoughts and beliefs and then replacing them with more reasonable ones.
Cognitive restructuring works well with kids who don't believe they have any control over themselves or their world. As they get older, these are the children who cannot control their behavior and get into trouble. Teaching these skills whether a child is depressed or not can actually prevent future behavioral problems.
Let's take a look at John. He is ten years old. John is an overachiever in everything he does and has gotten a lot of positive reinforcement for it. So far, whatever he has tried, he has done well. He has been invincible!
All of a sudden, John starts having trouble with math. He gets a C on a quiz, a B on the next test, and at the end of the semester he is barely passing. John is devastated and his parents are a bit dismayed.
He continues to do well on his soccer team and makes straight As in all of his other classes. His father is an accountant and makes comments pretty regularly that it is impossible that a child of his cannot master math. His teacher says she doesn't know why he can't get with the program.
John hears this, and for whatever reason he still cannot overcome his problem with math. He even quits trying to do his homework, deciding there's no use since he will fail anyway. When it comes time to learn a new skill in English, John becomes paralyzed with the belief that he can't master this task either. In soccer, the goals that once were so easy for him to make don't happen. His teammates ridicule him for not taking the team to victory. He starts to see himself as what he calls a “loser,” and believes he can now do nothing right. His mother tries to console him and negate his feelings. Nothing works and he becomes depressed.
In therapy, John is asked, “Where's the evidence that you are a loser and that you do nothing right?” John cites his problems with math and recent soccer troubles. Although there are some instances in which he is correct, that he can't do some things well, he is then asked about other activities. Didn't he just win the spelling bee? Doesn't he have one of the major roles in his school's play? What the therapist is doing is trying to get him to investigate whether his assumptions about himself are really true. It turns out that there is evidence that contradicts his feelings and thoughts.
The next task the therapist will have to accomplish is to help John come up with alternative interpretations about his math difficulties and soccer playing. John is in the fifth grade, a time where school often becomes harder. Perhaps he wasn't totally prepared for the skills he is learning in math. Or maybe not doing his homework, which is really practice for mastering a skill, is making it worse. Maybe there is a learning problem that is just now showing up and interfering with the way he acquires information. What if the way in which he studies needs to change?
There are many ways to help a child reinterpret his experiences, and they don't have to be negative. Perhaps John's soccer mistakes lately are due to an injury. Maybe there is a new goalie on the other team who is especially good at blocking the kinds of shots he takes.
It's also healthy for the therapist to help John develop a more balanced view of himself. In other words, he doesn't have to be perfect. Parents often overemphasize a child's strengths to the point that a child has a very unrealistic view of himself and expects that everything he touches should turn to gold.
How do I boost my child's self-esteem without inflating his ego?
It's often a hard line to draw, but it can be done. Help your child understand that while he is good at certain things, he also has weaknesses and that is to be expected. Foster a sense of humor that allows him not to take himself so seriously.
Next, a therapist can get a child to explore possible outcomes that might not be so dire as the one the child has currently. For example, what if John doesn't make an A in math? John believes that his father will be disappointed and that he won't be a straight-A student, which is a horrible notion for him.
When pushed, John came up with some other scenarios. He was able to realize that making something less than an A will not undermine his other achievements. When he talked with his dad, he realized he wasn't really a disappointment. If he can't make a goal in soccer, it isn't up to him totally to make the team win.
Last, to test his beliefs, John is challenged to think these new alternative responses whenever he encounters negative feelings. For example, when faced with math homework, he is told to find a math problem that he thinks he might be able to do. He is also told that if he can't master it the first time, ask his dad for some help. He does this and finds that indeed, with some practice, he can get the answer! Discovering this leads him to try another problem, and then another. He begins to develop some confidence, and while he still might not be perfect in math, he has much more confidence to try it.
Sometimes a child has trouble learning these skills. A therapist may then try to offer her own alternative thoughts to the child. The therapist can directly challenge a child's thoughts and feelings and debate alternatives with him. Then a child can see the technique in practice and learn to model it.