Factors Maintaining Depression Symptoms – Part I (REBT)

Factors Maintaining Depression Symptoms – Part I (REBT)

Depression is like that uninvited guest who overstays their welcome and shows no sign of leaving. As if that wasn’t enough, this guest occupies every inch of your life space and keeps all the doors and windows of your house shut, so all you see is the dark. You know you need to let the light in again, you know you need to show this guest out… but knowing is not enough. You know the ‘what’ and the ‘why’ but it is the how that matters now. 

So what makes depression linger? What makes it stay around? These are what we call the maintaining factors. Unlike physical illnesses that can be cured with prescription drugs, popping pills may not be sufficient for mental illnesses like depression. While antidepressants can help relieve the symptoms of depression, psychotherapy can help in treating the negative thinking pattern that psychologists believe perpetuates depression. 

Defining Depression 

American Psychiatric Association (APA) defines the major depressive disorder as “a common and serious medical illness that negatively affects how you feel, the way you think and how you act.”

Psychologists have thus explored the association of thinking, behaving and feeling, in not just treating but maintaining the symptoms of depression as well. In the 1950s, Albert Ellis developed REBT (Rational Emotive Behavior Therapy), which is believed to have started the new wave of psychotherapy that focused on cognition (thinking) and behavior – Cognitive Behavior Therapy (CBT).

Let us now look at different psychological theories to understand what helps maintain the symptoms of depression.

Individual belief as the factor maintaining depression symptoms

A-B-C Framework

Ellis’s A-B-C Framework from REBT sheds light on how we use our personal belief system to interpret events and situations. 

A = Activating event

B = Belief 

C = Consequence (emotional/behavioral)

An incident / event is not responsible for how we feel and behave. In fact it is our belief that causes our emotional / behavioral consequence. This is why individuals react and respond differently to the same incident. Considering the present pandemic, we all are reacting to it differently even though the virus is the same, which shows that A does not cause C

Musturbation- the three basic musts

We internalise some beliefs based on our sustained emotional reactions. According to Ellis we develop irrational beliefs as a result of the three basic musts we teach ourselves we need to lead a meaningful life.

  • “I must do well and win the approval of others for my performances or else I am no good.”
  • “Other people must treat me considerately, fairly, kindly, and in exactly the way I want them to treat me. If they don’t, they are no good and they deserve to be condemned and punished.”
  • “I must get what I want when I want it; and I must not get what I don’t want. If I don’t get what I want, it’s terrible, and I can’t stand it.


Unknowingly we internalize these irrational beliefs, and so when we face an uncomfortable event we view it from the lens tinted with these irrational beliefs. 

Therefore, to change our consequence ’C’ – emotional / behavioral, we must first address our belief ‘B’.

Understanding the maintenance mechanism

Greek Philosopher Epictetus puts it rightly when he says that people “are disturbed not by things, but by the view which they take of them” and “It’s not what happens to you, but how you react to it that matters.” 

Depression is a disease, a treatable disease. Medication can help you control the hormones that hinders the release of happy hormones. Therapy can help you understand why you react the way you react. Understanding your “self” and what drives you to emotions and behavior can help identify the factors that are maintaining your symptoms of depression. 

In this post, we have highlighted REBT practice to identify your irrational beliefs as the maintaining factor

In the near future, we will discuss the negative thinking / cognitive distortion as the maintaining factor based on Cognitive Behavioral theory. Stay tuned.

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