In line with international best practice guidelines for depression, the Depression Recovery Service offers a group based stepped care approach using an ABC model (Activating Depression, Building Recovery, Compassionate Resilience.
The Service is run by a team of Mental Health Care Practitioners that includes Consultant Psychiatrist, Clinical Nurse Specialist and Psychotherapists with expertise in Cognitive Psychotherapy, Compassion focused therapy and Systemic Psychotherapy. In line with international best practice guidelines for depression the Depression Recovery Service offers a group based stepped care approach using an ABC model.
There are currently three programmes offered within the service.
This programme is available for inpatients and day patients.
Activating Recovery – Level A
A three week programme that is offered to inpatients and day-patients who attend the service. Participants attend two half days each week. The programme provides education about depression and introduces various recovery principles and treatment approaches. All participants are encouraged to develop skills through behavioural activation, goal-setting peer support and engagement in group based personal reflection.
Building Recovery - Level B
A four week closed psychotherapy programme. Participants attend a full- day workshop each week through the Day Services. Workshops have been designed around models and approaches of Cognitive Psychotherapy and Compassion Focused Therapy. It also incorporates reflection and mindfulness.
The workshop offers individuals an opportunity to apply the various models to their own experience. This facilitates the development of a personal understanding of how specific situations may trigger negative thinking styles; distressing emotions; physical states and behavioural reactions that maintain depression. Participants are also introduced to the concept of the compassionate mind and emotional regulation systems.
Compassionate Resilience - Level C
Compassionate Resilience is an eight week psychotherapy programme. Participants attend a full-day workshop each week through Day Services. The programme builds on concepts introduced in level B and is therefore offered to people who have completed Building Recovery and wish to develop a deeper psychotherapeutic understanding of the impact of depression in their life. Underlying factors that may have increased vulnerability to Depression are also explored and each individual is encouraged to develop a personal conceptualisation.
“Compassion focused therapy targets the activation of the soothing system so that it can be more readily accessed and used to help regulate threat based emotions of anger, fear, and disgust and shame” (Paul Gilbert, 2012)
Emotions make thoughts more meaningful and credible. We identify more with thoughts when we can link them to an emotional experience. If we have limited memories of feeling soothed or loved in childhood we may struggle to link compassionate and soothing thoughts to emotions that help to validate the thought and activate feelings of soothing. This programme hopes to facilitate the development of compassionate Resilience.
This programme is available for inpatients and day patients.
Cognitive Psychotherapy for Depression
Participants of the Depression Recovery Programme are usually somewhat aware of symptoms of depression through their own lived experience and also through literature available. However symptoms of depression are usually presented as a list and do not reflect the through nature of depression. The list does not explain why most people feel trapped in depression, view it as a complete change in their personality and lose all sense of being able to control symptoms or recover in any meaningful way. As a consequence hope is often completely absent and the individual is left in a state of despair with strong feelings of helplessness or aloneness.
The CBT model explores depression as a cycle that is maintained by the development of a vicious circle with inherent maintaining factors. Exploring Depression in this way promotes the discovery of personal factors that are fuelling and perpetuating the vicious circle of depression. It also provides an opportunity to “unravel depression” through changes that can be planned through goal setting and behavioural activation.
Compassion Focused Therapy
Compassion-focused therapy is based on the principle that our human brains have evolved in such a way that we are very sensitive to threat in all of its formats. As a consequence, anger, anxiety, fear and depression are often natural consequences that are “not our fault”.
As a result of our experiences in early life we may become very threat focused as we have learned to expect and experience the worst in many situations. Many of us also become incentive focused as a means of trying to regulate how we feel- “If I have more status/ power/ material things etc, I will be better”.
As a consequence of being threat focused or incentive focused we may also behave in particular ways. These behaviours, for example, avoidance or perfectionism are aimed at keeping ourselves safe and making us feel better. Sometimes the unintended consequence is that such behaviours prevent us from engaging in situations that help us to learn to overcome our underlying fear. We find ourselves stuck in a vicious circle.
Shame, self-criticism and self-attacking are often other unintended consequences of our earlier attempts to manage our feelings of fear and helplessness. They are styles of communicating that we may learn and adopt from our early life. They are often used as a means of attempting to motivate ourselves towards incentive. People with high levels of shame and self-attacking can have difficulty being kind to themselves or feeling compassion for themselves. This means that they inadvertently fuelling their underlying sense of threat, feelings of helplessness, despair and ultimately, low self-esteem.
Compassionate Mind Training is a means of attempting to strike the balance by becoming more understanding and empathetic towards our self and having compassion for our personal struggles. We move away from being threat or incentive focused as a means of regulating how we feel to becoming more affiliative-focused. It aims to develop personal resilience through building compassionate attributes that are developed and worked on within group using compassionate imagery, compassionate attention, compassionate reasoning, compassionate behaviour and compassionate sensation.
Participants explore early life experience and their personal internal world as a means of connecting with underlying suffering and learning to tolerate their personal distress in a compassionate and understanding way. This means that they feel more self- supported while approaching personal change that may be helpful.