Assessment of Automatic Thoughts in Patients with Depressive Illness at a Tertiary Hospital in Nepal

  • Mita Rana Department of Psychiatry and Mental Health, Institute of Medicine (IOM), Kathmandu, Nepal
  • Sabitri Sthapit Central Department of Psychology, Tribhuvan University (TU), Kirtipur, Nepal
  • Vidya Deb Sharma Department of Psychiatry and Mental Health, Institute of Medicine (IOM), Kathmandu, Nepal
Keywords: Automatic thoughts, CBT, Pharmacotherapy.


Introduction: Cognitive functions have significant influence on psycho-social and general wellbeing. The quality, content and processing of negative thoughts initiate depressive symptoms; i.e. low mood, decreased self-worth and diminished interest in pleasurable activities. The study assessed the automatic thoughts of patients having depressive illness and evaluated and compared the changes after therapy; i.e. Psychotherapy and pharmacotherapy.
Methods: Diagnosed cases of depressive illness (n=135),  according to ICD-10 and study criteria, attending the out-patient clinic of Department of Psychiatry and Mental Health, Tribhuvan University Teaching Hospital, were included. Beck Depression Inventory was used to screen level of depressive symptoms. Automatic thoughts were assessed by the Automatic Thought Questionnaire-Revised before initiating therapy and after completion of therapy for comparison.  Depressive patients received either of the three treatment procedures after randomization of the study sample into three different treatment groups; i.e. Cognitive behavior therapy, pharmacotherapy or combined therapy receiving both cognitive behavior therapy and pharmacotherapy.
Results: Among the total 135 patients, 53 (39.3%) had moderate, 47 (34.8%) had severe depressive and 35 (25.9%) had mild depressive symptoms before therapeutic interventions. Negative automatic thoughts were significantly present in depressed patients and reduced after all three interventions. Negative automatic thoughts of hopelessness, anxiety and inability coping were significantly reduced after therapy.
Conclusions: Automatic negative thoughts were significantly correlated with depressive disorder. Combined therapy CBT with pharmacotherapy or CBT alone was found to be more effective in modifying automatic negative thoughts than pharmacotherapy alone, ultimately reducing depressive symptoms to a significant degree.
Keywords: automatic thoughts; cognitive Behavior therapy; pharmacotherapy. [PubMed]


1. World Health Organization 2008, The Global Burden of Disease 2004 update. [Full text]
2. Frank E, Prien RF, Jarrett RB, Keller MB, Kupfer DJ, Lavori PW, Rush AJ, Weissman MM. Conceptualization and rationale for consensus definitions of terms in major depressive disorder. Remission, recovery, relapse, and recurrence. Arch Gen Psychiatry. 1991 Sep;48(9):851-5. [ Pubmed]
3. International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) Version for 2010. World Health Organization; 2010. Available from: [Full Text]
4. Gable SL, Nezlek JB. Level and instability of day-to-day psychological well-being and risk for depression. J Pers Soc Psychol. 1998 Jan;74(1):129-38. [Pubmed]
5. Thorsteinsson EB, Ryan S, Sveinbjornsdottir S. The mediating effects of social support and coping on the stress-depression relationship in rural and urban adolescents. Open Journal of Depression. 2013;2(1):1-6. [Full Text | DOI]
6. Institutional Review Board (2004), Research Department, Institute of   Medicine, Tribhuvan University, Kathmandu, Nepal. [ Web link]
7. International Classification of Disease-10 Diagnostic Criteria for Research (ICD-10 DCR). World Health Organization 1992. [Full Text]
8. Beck AT, Ward CH, Mendelson M, et al. An inventory for measuring depression. Archives of General Psychiatry. 1961 June;4:561–71. [Pub Med]
9. Beck AT, Rush AJ, Shaw BF, Emery G. Cognitive therapy of depression. New York: Guilford Press. 1979 [Weblink]
10. Kohrt BA, Kunz RD, Koirala NR, Sharma VD, Nepal MK. Validation of the Nepali version of Beck Depression Inventory. The Nepalese Journal of Psychiatry. 2002; 2(4):123-30. [Weblink]
11. Ekeblad A, Falkenström F, Andersson G, Vestberg R, Holmqvist R. Randomized Trial of Interpersonal Psychotherapy and Cognitive Behavioral Therapy for Major Depressive Disorder in a Community-Based Psychiatric Outpatient Clinic. Depress Anxiety. 2016 Dec; 33(12):1090-1098. doi: 10.1002/da.22495. Epub 2016 Mar 31. [Pub Med]
12. Hollon SD, Kendall PC. Cognitive self-statements in depression: Development of an automatic thoughts questionnaire. Cognitive Therapy and Research. 1980 December; 4(4): 383-395. [Web link | DOI]
13. Kendall PC, Howard BL, Hays RC. Self-referent speech and psychopathology: The balance of positive and negative thinking. Cognitive Therapy and Research. 1989 December; 13(6): 583–598. [Web link | DOI]
14. Hill CV, Oei TP, Hill MA. An empirical investigation of the specificity and sensitivity of the Automatic Thoughts Questionnaire and Dysfunctional Attitudes Scale. Journal of Psychopathology and Behavioral Assessment. 1989; 11(4): 291–311. [Web Link | DOI]
15. Risal A, Manandhar K, Linde M, et al. Anxiety and depression in Nepal: prevalence, comorbidity and associations.BMC Psychiatry. 2016 April; 16:102. [Full Text | DOI]
16. Patel V, Kirkwood BR, Pednekar S, Pereira B, Barros P, Fernandes J, Datta, J, et al. Gender disadvantage and reproductive health risk factors for common mental disorders in women: a community survey in India. Archives of General Psychiatry. 2006; 63(4):404–413. [ Full Text ]
17. Bebbington PE. The origin of sex differences in depressive disorder: Bridging the gap. International Review of Psychiatry. 1996 July; 8(4):295-332. [DOI]
18. Marco A, Piccinelli GW. Gender differences in depression, Critical review, The British Journal of Psychiatry. 2000 Dec; 177 (6): 486-492. [Full Text |DOI ]
19. Kendler KS, Kessler RC, Neale MC, Heath AC, Eaves LJ. The Prediction of Major Depression in Women: Toward an Integrated Etiologic Model. American Journal of Psychiatry. 1993 Aug; 150(8):1139-48. [ Full Text | DOI]
20. Dobson KS, Dozois DJA. Historical and philosophical bases of the cognitive-behavioral therapies. In: K.S. Dobson, ed. Handbook of cognitive-behavioral therapies. New York: Guilford Press. 2001; 3rd Ed:3-15 [Full Text]
21. Szentagotai A, David D, Lupu V, Cosman D. Rational emotive behavior therapy versus cognitive therapy versus pharmacotherapy in the treatment of major depressive disorder: Mechanisms of change analysis. Psychotherapy: Theory, Research, Practice, Training. 2008 Dec; 45(4):523-538. [ PubMed | Full Text | DOI]
22. Conte HR, Plutchik R, Wild KV, Karasu TB. Combined psychotherapy and pharmacotherapy for depression. A systematic analysis of the evidence.Arch Gen Psychiatry. 1986 May; 43(5):471-9. [PubMed | Full Text]
23. Hollon SD, DeRubeis RJ, Evans MD, Wiemer MJ, Garvey MJ, Grove WM, Tuason VB. Cognitive therapy and pharmacotherapy for depression. Singly and in combination. Arch Gen Psychiatry. 1992 Oct; 49(10):774-81. [PubMed | Full Text]
24. Jonghe DF, Kool S, Aalst VG, Dekker J, Peen J. Combining psychotherapy and antidepressants in the treatment of depression. J Affect Disord. 2001 May; 64(2-3):217-29. [PubMed | Full Text]
25. Hollon SD, Thase ME, Markowitz JC. Treatment and Prevention of Depression. Psychological science in public interest. 2002 Nov; 3(2):39-77. [Web Link | Full Text]
How to Cite
Rana, M., Sthapit, S., & Sharma, V. D. (2017). Assessment of Automatic Thoughts in Patients with Depressive Illness at a Tertiary Hospital in Nepal. Journal of Nepal Medical Association, 56(206).
Original Article