Using A Depression Chart

Developed in the 1970s by the American psychologist Marsha Linehan, dialectical behavior therapy (DBT) builds on several concepts associated with cognitive behavioral therapy (CBT), one of the most common types of talk therapy today. However, DBT was designed for individuals who experience emotions especially intensely and is often used to treat those living with a personality disorder––specifically borderline personality disorder (BPD). In some cases, this treatment may also help address symptoms of depression, as its emphasis on skills training and managing painful emotions may help reduce the prolonged low moods of depressive disorders. If you are looking at therapeutic modalities for depression, it may be beneficial to look into DBT.  

What are depression and major depressive disorders (MDD)?

Depression is a general term that refers to all depressive disorders in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) but it is often used to refer specifically to major depressive disorder (MDD), the most common type. This mental health condition is characterized by a sense of persistent sadness or hopelessness lasting over two weeks, along with other symptoms.  

Depression is more complex than “feeling down.” Instead, it's marked by various, persistent physical and emotional symptoms that can significantly impact a person’s ability to function. Below are some of the common physical and behavioral symptoms of this condition:  

• Exhaustion and general lethargy, including slower speech and movements 
• Isolation from others and increased time spent alone 
• Substance misuse 
• Dramatic changes in one’s sleep schedule, including insomnia or hypersomnia  
• Significant shifts in eating habits 
• Agitation and restlessness 
• Worsened personal hygiene  
• Pain or achiness with no clear physical or medical cause 
• Withdrawal from work, school, or other responsibilities 
• Difficulty concentrating, remembering events, or making decisions  
• Self-harm or self-destructive behaviors 

Emotional symptoms of depression according to a depression chart

The following are common emotional symptoms of depression that individuals may experience,

often reflected in patterns observed in a depression chart.

• Persistent feelings of sadness 
• Hopelessness  
• Apathy or a feeling of being “empty”  
• Irritability, including outbursts of disproportionate anger  
• Decreased self-esteem, including a heightened sense of self-blame  
• Sensitivity to criticism  
• A loss of interest in previously enjoyed activities  
• Deteriorating relationships with friends, family members, or partners  
• Feeling guilty or worthless 
• A bleak outlook toward the future  
• Frequent thoughts of death or suicide 

What is dialectical behavior therapy? 

Dialectical behavior therapy (DBT) has some of the goals and treatment methods included in cognitive behavioral therapy but focuses more on developing new coping skills for intense emotions. DBT can involve training in four key modules that can significantly impact overall well-being: mindfulness, emotional regulation, interpersonal effectiveness, and distress tolerance. 

Mindfulness 

The mindfulness module of dialectical behavior therapy (DBT) discusses mindfulness, the practice of grounding yourself in the present moment, not dwelling on the future or the past, and recognizing what is currently occurring within your body and in your environment. Mindfulness skills can be developed through techniques like breathing exercises, meditation, and journaling. Mindfulness is not about changing one’s reality but understanding it for what it is without judgment.  

Emotional regulation 

Developing a mindfulness mindset can enhance one’s ability to learn the second dialectical behavior therapy (DBT) skill: emotion regulation. Emotion regulation involves recognizing and understanding your emotions, including sources of intense or distressing feelings.  

Some emotions are primary emotions, which result from your initial reaction to a thought or situation, and some are secondary emotions, which are a reaction to your initial reaction.  A common example of this relationship between primary and secondary emotions is feeling angry, followed by a sense of guilt for feeling angry.  

Practicing emotion regulation can mean acknowledging that your emotions exist and are valid while understanding they don’t necessarily need to control your thoughts or impact your behaviors. Emotional regulation skills through DBT teach that you can have agency over yourself, regardless of your emotional experiences. The act of understanding two opposing realities at once (dialectics) is what makes dialectical behavior therapy unique compared to other modalities.  

Interpersonal effectiveness 

Interpersonal effectiveness continues to build on the dialectical behavior therapy (DBT) skills of mindfulness and emotion regulation. Interpersonal effectiveness focuses less on knowledge and awareness and more on behaviors in interactions and relationships. Interpersonal effectiveness involves healthy communication skills, including understanding your own needs and the needs of other people and knowing when you need to say no. This kind of assertive communication and boundary-setting can help an individual develop healthy self-respect.  

Distress tolerance 

The final component of DBT, distress tolerance, involves skills training for coping with distress. When faced with an intense or stressful situation, a natural reaction is a fear response, often resulting in avoidance or minimization. Such techniques may not address the source of distress. Hence, distress tolerance teaches a person how to exist in a stressful situation and recognize aspects of the situation they can change as well as those that may be beyond their control. New skills to learn in this category may include changing your environment and learning to accept situations outside of your control.  

What are the potential benefits of DBT for depressed mood?

Depression can involve distressing symptoms, and people with the condition may sometimes be tempted to avoid acknowledging or addressing their emotional state. The four key skills of DBT may be an effective treatment for helping people with depression better understand what is occurring with their feelings and behaviors, cultivate a mindset of acceptance and grace, and learn to shift maladaptive behavior patterns that may be worsening symptoms in order to improve quality of life.  

Developing emotion regulation and coping skills through DBT

Emotion regulation skills could expand this recognition by helping individuals develop skills to process unwanted emotions like sadness and hopelessness instead of allowing these emotions to worsen over time. Interpersonal effectiveness may address relationship concerns that could contribute to one’s depression or connections that may have been impacted by depression. Distress tolerance may also be valuable, helping people learn healthy coping skills and behaviors to address unhappiness and other intense emotions. A licensed therapist can be a key support system in developing these DBT skills.  

An alternative to in-person therapy for depressed mood and other mental health conditions 

Depression can feel overwhelming, and those experiencing the condition may find it difficult to seek treatment. If you are experiencing low energy levels, physical pain, or other depression symptoms that make it hard to leave the house, online therapy sessions may be a more convenient way to receive support. Through an online therapy service like BetterHelp, you can match and meet with a licensed therapist from home or anywhere you have an internet connection. 

Effectiveness of online therapy

Individual therapy using DBT can be an effective treatment method when provided in-person or through an online platform. For example, one scoping review of 11 studies examined the effectiveness of online DBT for a range of concerns, including depression. Its findings suggest that outcomes for clients enrolled in online DBT were comparable to those of individuals receiving traditional face-to-face DBT. If symptoms of mental health conditions like depression make it complicated to attend in-person therapy or if you have a busy schedule and prefer to engage in therapy from home, online therapy may be helpful.