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Why does psychotherapy favorably compare to medication in treating depression? One reason may be rooted in the evolutionary origins of depression. Scholars suggest humans may become depressed to help us focus attention on a problem that might cause someone to fall out of step with family, friends, clan or the larger society-an outcast status that, especially in Paleolithic times, would have meant an all-but-certain tragic fate. Depression, by this account, came about as a mood state to make us think long and hard about behaviors that may have caused us to become despondent because some issue in our lives is socially problematic. Steven D. Hollon, a professor of psychology at Vanderbilt University, explores the implications of helping a patient come to grips with the underlying causes of a depression-which is the goal of CBT (cognitive behavioral therapy), and is also in line with an evolutionary explanation. The anodyne effects of an antidepressant, by contrast, may divert a patient from engaging in the reflective process for which depression evolved-a reason perhaps that psychotherapy appears to produce a more enduring effect than antidepressants. Hollon notes that depression has a purpose--it spurs rumination about complex social problems, and that CBT can expedite rumination and make it more effective. He states, "For most people, depression motivates them to think more deliberately about the causes of their problems and the solutions they can apply. In most instances in our ancestral past this worked well enough; most depressions remit spontaneously even in the absence of treatment. Cognitive therapy, at the least, hurries the process along and, at the most, helps unstick that subset of individuals who get stuck making negative ascriptions about themselves, typically about personal competence or lovability."

How to identify what you are saying to yourself; how to determine if your self-talk is unproductive