Chronic Depression (sometimes referred to as Dysthymia, Recurrent Depression, Treatment Resistant Depression or High Functioning Depression) is a term used to describe those of us who experience long standing problems with our mood.

Chronic Depression is characterised by feeling low in mood and/or empty. With Chronic Depression we also experience high levels of self doubt and self criticism. We often feel exhausted and have difficulties sleeping. Our concentration is terrible and we only experience small amounts of pleasure in life, if any at all. We also can have intense feelings of anger and irritability which are sometimes misunderstood as a problem with “anger management” rather than an expression of chronic sadness.

Chronic Depression is very different to a “Depressive Episode” which most people consider when the word “Depression” is mentioned. A Depressive Episode can be diagnosed after two weeks of symptoms and is an isolated experience of sadness that usually follows a clear objectively distressing trigger like a job loss. A Depressive Episode responds very well to self help interventions, behavioural change like increasing activity levels, or addressing the initial trigger such as finding a new job.

With Chronic Depression the sadness, emptiness or anger is evident for a minimum of two years and it's really common to be unable to remember a time without these experiences. Chronic Depression doesn’t always have one clear trigger but difficult circumstances can exacerbate existing symptoms further. Those of us with Chronic Depression tend to find little benefit from self help interventions or behavioural change such as increasing exercise. Some of us will objectively have “everything”, a great job, a loving family, friends, stable finances and a nice home. Chronic Depression is not about our external life but about how we relate to ourselves and others.

The Theory

CBASP is a highly specialised and innovative subtype of Cognitive Behavioural Therapy designed specifically to treat Chronic Depression; especially for those of us who have tried traditional talking therapies and have experienced no benefit.

CBASP is an integrative therapy which draws upon Cognitive, Behavioural, and Psychodynamic therapeutic principles.

Unlike traditional Cognitive Behavioural Therapy which focuses purely on thoughts and behaviours, CBASP considers symptoms associated with Chronic Depression as a consequence of long standing difficulties with relationships.

CBASP suggests that early interpersonal trauma or difficult relationships (such as problematic relationships with parents/siblings/friends/teachers/ organisations, childhood abuse, childhood neglect, parentification, bullying from others, criticism from others, isolation from others) unfairly shape our understanding of ourselves and others.

From these early relationships we learn how to relate to ourselves/others. As we grow we repeat these learned relational patterns, but because they were unhelpful they lead us to feel in a state of disconnect and experience the symptoms associated with Chronic Depression.

CBASP suggests that in order to improve symptoms associated with Chronic Depression problematic relationship patterns need to be identified and remedied.

The Therapy

CBASP sessions start with an extended assessment focused on understanding your early relationships and how these experiences may have contributed to how you relate to yourself, how you relate to others and your experience of Chronic Depression.

Some of us with Chronic Depression are clear that our early relationships have contributed to our current difficulties. However, many of us have never considered our difficulties from this angle or consider our early life as impactful. CBASP sessions support you to reflect in depth on your early relationships and the messages you were taught about yourself and others from these relationships.

Following our assessment together, when you think we have discussed your early life enough, I write you a letter summarising what we have spoken about and outlining a personalised treatment plan. This letter is not a clinical report but an active part of the therapy.

We talk through this letter together and any changes you may want to make to ensure we are both happy with the content of the letter and the therapy plan before we proceed with treatment.

We regularly review our therapy plan together throughout future sessions and make changes to the plan as we both move forward together.

Treatment plans are different for each person as we all have a unique relationship with ourselves and others, and a unique experience of Chronic Depressive symptoms. However the plans are focused on improving how you feel about yourself, improving your relationship with others and addressing symptoms associated with Chronic Depression.

Treatment plans can also include addressing symptoms not typically associated with Chronic Depression but that are distressing to you including but not limited to flashbacks, nightmares, intrusive thoughts, obsessive behaviours, phobic responses, anxiety and worry as often comorbid difficulties can occur along side Chronic Depression all of which I am formally trained to treat.