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Section 7
Cognitive Functioning in the First Episode of Major Depressive Disorder

Question 7 | Test | Table of Contents

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In the last section, we discussed Changing the Lens through which your client views their world.

In this section, we will talk about another cognitive approach for dysthymic clients. I call this Cognitive Behavior Therapy technique the Negative Mudslide.

The main targets of Cognitive Therapy, as you know, involve the conceptual and behavioral aspects of the disorder. The following technique may enable Waylon, a 49 year old engineer, to think more realistically. As he is able to see the future more objectively and view himself and his external environment with more of a perspective, there was a corresponding improvement in the rest of his symptomology.

♦ CBT: The Negative Mudslide Technique
The Negative Mudslide concept was particularly valuable with Waylon who seemed more upset than the thoughts he's reporting seemed to warrant. I found the visualization of a mudslide helped Waylon see the pattern of his behavior as a trend in a downward mood, and not just as an isolated event.

The negative mudslide showed Waylon a series of events happening, from first to last. As you can see this is a similar concept to the ABC and Lens Changing interventions described on the previous two sections.

When you think of falling down a mudslide, do you think of first losing your balance at the top of a hill because of loose ground beneath you? Because the mud on the hill is soft, it is difficult keep your balance and you will continue traveling downward. For Waylon one single thought caused him to lose his balance, so to speak. Once he began to travel down this hill, he began having numerous thoughts that caused him to panic about something else and slide further. The closer he gets to the bottom of the mudslide, the faster these thoughts come.

By looking into all of his thoughts, from beginning to end, Waylon, a client I had seen for six sessions, was better able to assess when and where his problems started. The mudslide pattern helped Waylon to go through the steps of his problems by focusing on what started the mudslide and what thoughts came from it.

His mood was disturbed by underlying beliefs, assumptions, or fears. This is what made up the soft mud. His "fall" was caused by this soft mud, not by the thoughts or images he was most aware of.

♦ Example: Here is How the "Negative Mudslide" Worked with Waylon

Waylon had been off work for four months because of his depression. He was to start work again in two weeks. He came to one of his therapy sessions in deep distress, because he had, as he said, "fallen apart" last weekend.

Waylon: He'd said, "I am back to square one. I spent all weekend lying on the couch, feeling low." We were able to trace the beginning of his falling mood to a moment when he was helping his wife move boxes in the loft of his house.
Therapist: I asked him, "What was going through your mind when you were moving the boxes?"Waylon: Waylon answered, "Well, we were just shifting some things. Everything seemed OK. Then I felt a little tired and I thought I'd better stop. Then, I suddenly began to feel terrible."
Therapist: I asked, "Can you recall anything else that might have gone through your mind?"Waylon: Waylon responded, "No, it just hit me."
Therapist: Then I said, "You mentioned you felt tired. I wonder if we could just follow that up. If you had kept feeling tired, what would have happened?"
Waylon: Waylon thought a moment and responded, "If I felt tired of doing that little job, how am I going to cope when I go back to work?"
Therapist: I asked, "How do you feel about that?"
Waylon: Waylon said, "My bosses have been great in the past, but they're bound to lose patience sooner or later."
Therapist: I then asked, "You mean, you think you may need more time off?"
Waylon: Waylon responded, "If I get tired just moving boxes around in the loft, maybe I'm not ready for work."
Therapist: Then I asked, "And if you're not ready for work, what do you think may happen when you go back?"
Waylon: Waylon said getting a little upset, "I'll only last a few days. I'll be off again. They won't stand for it any more. I think that'll be the end of it."
Therapist: I asked, "The end of the job?"
Waylon: Waylon said, "Yes. The job, me, my family - I don't know how we'll keep going if I can't work. It will be the end of everything."
Therapist: After some silence, I said, "Do you remember you said you felt a little tired when moving things around in the loft - then felt really bad?"
Waylon: Waylon said, "Yes."
Therapist: I then asked, "Do you think the feeling tired might have triggered off all these feelings and worries about work?"
Waylon: Then Waylon said, "That may be what happened. I was kind of thinking about not being able to cope at work - just everything going wrong - but then I just felt so depressed, I went to lie down and didn't get up all weekend."

We continued to try and identify other such situations where Waylon's fear of the future affected him. With Waylon, it was important to fully assess the times that his underlying assumptions and fears affected his thoughts and mood before I proceeded to challenge theses assumptions and fears. His negative mudslide could be written out during or after this sort of interchange. An example of the negative mudslide, for Waylon, would be something like this...

I asked Waylon to visualize the top of the hill. For Waylon, the top of his hill was feeling tired.

Merely feeling tired moving boxes in his loft led to the following mudslide of thoughts:
• If I feel tired from moving boxes, how am I going to cope with work?
• I probably won't be able to cope with work
• The bosses will lose patience
• I'll get no more time off
• Then they'll have to fire me
• The job will be finished
And finally, at the bottom of the mudslide,
• My family and I will be finished

Until Waylon understands that his beliefs, assumptions, and fears are just that, he probably will find it difficult to move onto challenging these assumptions.
Reviewed 2023

Peer-Reviewed Journal Article References:
Ahern, E., & Semkovska, M. (2017). Cognitive functioning in the first-episode of major depressive disorder: A systematic review and meta-analysis. Neuropsychology, 31(1), 52–72. 

Delgadillo, J., & Gonzalez Salas Duhne, P. (2020). Targeted prescription of cognitive–behavioral therapy versus person-centered counseling for depression using a machine learning approach. Journal of Consulting and Clinical Psychology, 88(1), 14–24.

Fernández-Theoduloz, G., Paz, V., Nicolaisen-Sobesky, E., Pérez, A., Buunk, A. P., Cabana, Á., & Gradin, V. B. (2019). Social avoidance in depression: A study using a social decision-making task. Journal of Abnormal Psychology, 128(3), 234–244.

Geschwind, N., Bosgraaf, E., Bannink, F., & Peeters, F. (2020). Positivity pays off: Clients’ perspectives on positive compared with traditional cognitive behavioral therapy for depression. Psychotherapy, 57(3), 366–378.

Magalhães, P., Alves, G., Fortuna, A., Llerena, A., & Falcão, A. (2020). Real-world clinical characterization of subjects with depression treated with antidepressant drugs focused on (non-)genetic factors, pharmacokinetics, and clinical outcomes: GnG-PK/PD-AD study. Experimental and Clinical Psychopharmacology, 28(2), 202–215.

QUESTION 7
What do the main targets of Cognitive Therapy include, and what model is useful to visualize the trend of a downward mood? To select and enter your answer go to Test.