Could positive diurnal variations in severe depression be the key factor for delivering effective cognitive behaviour therapy?

Abstract

Cognitive behaviour therapy (CBT) has been demonstrated to be the leader in the field of talking therapies concerned with the treatment of severe depression. However, this form of therapy has its limitations in that it is ineffective if given during a severe depressive episode. This is usually because patients suffering from severe depression have difficulties in concentration which severely limits the ability to take in new information such as the practice of strategies that encourage more helpful ways of thinking which could aid recovery. The severely depressed patient who experiences diurnal variations typically experiences low mood in the morning but mood improves towards the evening. Conversely, there are cases where mood is better in the morning becoming worse in the evening. There can be cases of positive diurnal rhythms where adverse symptoms disappear all together and the patient regains something resembling their pre-morbid normality. With this lifting of mood, it could mean that the patient may be more receptive to absorbing new information. Consequently, the hypothesis is that when patients are experiencing positive diurnal rhythms, this could be the optimum time to deliver effective talking treatments such as CBT.