Depression
What can depression look like?
Major depressive disorder is more than simply feeling sad.
Depression can affect your mood, motivation, relationships, thinking, sleep, appetite, sense of self, and ability to participate fully in everyday life.
Symptoms may include:
A persistently low, sad, or depressed mood
Loss of interest or pleasure in activities you once enjoyed
Low motivation
Social withdrawal or isolation
Difficulty concentrating or making decisions
Difficulty falling asleep, staying asleep, or sleeping significantly more than usual
Changes in appetite or weight
Fatigue or low energy
Feelings of worthlessness
Excessive guilt or self-blame
Harsh self-criticism or a diminished sense of self-worth
Feelings of hopelessness
Thoughts about death or suicide
For some people, depression occurs in episodes with periods of improvement in between. For others, symptoms may feel more persistent.
Regardless of how depression presents, it can gradually make everyday life feel smaller, more difficult, and less meaningful.
Why can depression be so difficult to get out of?
One of the particularly challenging parts of depression is that it can push us away from many of the experiences that might otherwise support our well-being.
When you feel exhausted, disconnected, unmotivated, or hopeless, withdrawing can make sense.
You may stop seeing friends.
You may spend less time doing things you once enjoyed.
Responsibilities may begin to feel overwhelming.
Exercise, hobbies, relationships, routines, and even basic self-care can start requiring more effort than they once did.
The problem is that this withdrawal can create a cycle:
Low mood and low motivation → withdrawal or avoidance → fewer opportunities for connection, accomplishment, pleasure, or meaning → deeper depression
Over time, it can become increasingly difficult to imagine doing something differently because depression itself is telling you that nothing will help.
Therapy can help interrupt that cycle.
How can therapy help with depression?
An important part of depression treatment can involve helping you gradually reconnect with your life, even before motivation fully returns.
Rather than waiting until you feel better to begin doing meaningful things again, therapy can help you take manageable steps toward behaviors that support connection, accomplishment, health, enjoyment, or a sense of purpose.
As you begin engaging more consistently with life, there are more opportunities to experience reinforcement, connection, mastery, and meaning.
Over time, this can help loosen the cycle of depression and withdrawal.
What is Behavioral Activation?
One evidence-based treatment for depression is Behavioral Activation.
Behavioral Activation focuses on understanding the relationship between your mood, your environment, and the behaviors you engage in—or have stopped engaging in.
Together, we may look at patterns such as:
What activities have you withdrawn from?
What relationships have become more distant?
What situations are you avoiding?
What parts of your routine have disappeared?
Which activities provide a sense of accomplishment?
Which experiences help you feel connected?
What has mattered to you in the past?
What might provide meaning even when it does not immediately feel pleasurable?
Treatment then involves gradually and intentionally increasing behaviors that reconnect you with these areas of life.
Importantly, Behavioral Activation does not assume that you will immediately feel like doing these things.
In depression, motivation often follows action rather than preceding it.
The work may begin with very small, realistic steps and build from there.
Behavioral Activation has a substantial evidence base for treating depression. Recent large-scale reviews have found it to be effective for adults with depressive symptoms and comparable in effectiveness to other established psychotherapies.
How can CBT and ACT help with depressive thoughts?
Depression can also change the way you think about yourself, your future, and your experiences.
Thoughts may begin to sound like:
“Nothing is going to change.”
“I'm a failure.”
“I'm a burden.”
“I should be doing better than this.”
“There's no point in trying.”
When these thoughts occur repeatedly, they can begin to feel less like thoughts and more like facts about who you are.
Treatment at Mauna Psychology may incorporate principles from Cognitive Behavioral Therapy, or CBT, and Acceptance and Commitment Therapy, or ACT.
CBT can help you examine patterns in thinking and develop more flexible and balanced ways of responding to them.
ACT adds another important skill: learning to recognize that having a thought does not necessarily make that thought true or require you to act according to it.
Rather than becoming completely fused with a thought such as “I'm worthless,” therapy can help you begin noticing:
“I'm having the thought that I'm worthless.”
That small shift can create more psychological distance between the thoughts generated by depression and your sense of identity.
You are not the thoughts that depression produces.
As that distinction becomes clearer, it can become easier to choose how you want to respond rather than allowing depressive thinking to determine your next action.
How do values and meaning fit into depression treatment?
Depression frequently involves hopelessness.
It can become difficult to imagine a meaningful future, particularly when you feel disconnected from activities and relationships that once mattered.
ACT places a strong emphasis on identifying your values—the directions and qualities you want your life to reflect.
You may explore questions such as:
What kind of relationships do I want to build?
What kind of person do I want to be with the people I love?
What gives my life meaning?
What would I want to invest my time and energy in if depression had less control over my choices?
Treatment can then help you begin taking small, realistic actions toward those values.
The goal is not to wait until depression disappears before you begin living.
It is to gradually build a meaningful life while learning how to carry difficult emotions along the way.
Taking committed action toward things that matter can also provide evidence that change remains possible, even when depression tells you otherwise.
What role does self-compassion play?
Depression often comes with a harsh internal voice.
You may blame yourself for struggling, criticize yourself for not accomplishing more, compare yourself unfavorably to other people, or interpret your symptoms as evidence that something is fundamentally wrong with you.
Unfortunately, self-criticism often adds another layer of suffering to an already difficult experience.
Therapy may include developing greater self-compassion.
Self-compassion does not mean ignoring responsibilities or pretending that everything is okay.
Instead, it means learning how to respond to yourself with the same understanding, patience, and encouragement you might offer someone else who was struggling.
This can involve learning how to notice self-critical thoughts, understand where they come from, and practice responding in ways that support change rather than reinforcing shame and hopelessness.
What is the goal of depression treatment?
The goal is not simply to eliminate sadness.
Treatment can help you regain greater choice over how you participate in your life.
Over time, this might mean:
Reconnecting with important relationships
Returning to meaningful activities
Developing healthier routines
Experiencing greater flexibility around depressive thoughts
Responding to yourself with greater compassion
Increasing experiences of connection and accomplishment
Rediscovering sources of meaning
Developing greater hope in your ability to influence the direction of your life
Depression can make life feel as though it is happening around you while you remain disconnected from it.
Therapy can help you begin stepping back into that life, one manageable action at a time.
Do you offer depression therapy in person or online?
Mauna Psychology offers in-person depression therapy in Provo, Utah, as well as telehealth services for eligible clients.
If depression has begun interfering with your relationships, motivation, sense of self, or ability to participate in the life you want to live, therapy can provide a supportive and evidence-based space to begin making meaningful changes.