Depression has become the most prevalent and common mental disorder which has been shown to occur across various age groups worldwide. However, it is during adolescence that the onset is usually triggered and in females, it is twice as more impactful than in males.
Typically, depression is demonstrated in various modes including cognitively, behaviourally, physiologically, interpersonally, and socially. The disorder itself can manifest at different intensity or severity levels which causes significant disturbance in their day-to-day lives.
Depression may also co-occur with other psychiatric disorders such as anxiety, obsessive-compulsive disorders, substance abuse, and even medical illnesses such as cardiovascular disease, diabetes, and hypertension.
In treating depression, Cognitive behavioral therapy (CBT) has been one of the most effective treatments as it is highly evidence-based and has been proven to help tackle the symptoms and psycho-social problems that come with a host of disorders such as marital conflict, dealing with stressful life events, psychotic disorders, and other clinical states.
A wide body of research has demonstrated the efficacy of CBT among those with depressive disorders and symptoms. For example, in one meta-analysis of 115 studies, CBT was indeed the most effective treatment for treating depression but its effects increased significantly when supplemented by pharmacotherapy compared with pharmacotherapy by itself.
Empirical evidence additionally shows that the relapse rates of individuals treated with CBT are much lower compared with patients who relied on pharmacotherapy only.
How does CBT work?
CBT is a kind of psychotherapy better known as ‘talk’ therapy by many people but what CBT is really about is, modifying thought patterns to help change behaviors and moods. The foundation of CBT is based on the notion that negative emotions and actions are a consequence of distorted patterns of thought or beliefs, rather than the unconscious influences of the past.
In CBT the role of the therapist is to aid you in recognizing these problematic patterns of thoughts that are usually false and replace them with alternative thoughts which are in line with reality, which leads to healthier ways of thinking, and thus healthier outcomes reflected in outward behavior.
For example, a patient may express feelings of worthlessness and hold onto the belief that life is terrible and it will never get any better. Other times patients might express their obsession with their shortcomings or flaws, problems which are often related to low self-esteem.
In such scenarios, CBT firstly helps bring greater self-awareness of these problem thoughts, then it will help you learn to replace these with more positive thoughts. When this happens a change in attitude is inevitable which results in changing your behavior as well. These can ease depressive symptoms if not completely ‘eliminate’ depression which is never the case as CBT gives you the time to make slow but gradual progress to allow you to lead a better life day by day.
Sometimes people wake up in the morning and think ‘‘what’s the point in trying?’’ In CBT this person comes to ask themselves instead ‘’this isn’t a very helpful thought. Putting in the effort to get up has many rewards. I can start by getting out of bed’’ It can take several weeks or months before you start to see improvement during CBT.
In each session, you together with the therapist will work on identifying situations in your life that could be making a contribution to or having causal effects on your depression. When these events, in relation to distorted beliefs and thoughts, are unraveled, then these patterns of thinking are worked through one by one.
Therapists can ask you to keep a diary or journal of your thoughts and emotions to keep track of various events and your responses to these which guides the therapist when breaking down your patterns into several categories of negative thoughts. These are the most commonly appearing categories in depressed people:
- Overgeneralization- making conclusive statements that are too broad for a single event e.g. ‘‘I failed my exam. Now I’ll always fail on future exams because I’m no good’’.
- All-or-nothing thinking– seeing your world as black-and-white with no gray areas e.g., ‘’I lost the love of my life…I’ll be lonely forever’’.
- Automatic negative thoughts– these are habitual thoughts that have a bitter and negative tone e.g. ‘‘I’m good for nothing’’
- Rejecting positives- ignoring and overlooking the positive experiences and thinking they ‘don’t count e.g. ‘‘I just got lucky’’.
- Minimizing or maximizing– putting too high or low of a value on events by reducing or hyping them in ways that aren’t consistent with reality e.g. ‘‘It’s only a certificate, it’s no big deal’’.
- Taking things too personally– believing and thinking that things happening around you is due to something you said or feeling that others’ unrelated behaviors are targeted at you e.g., ‘’she didn’t wave back at me, she must not like me’’.
- Fixing on a negative issue– staying adamant on something to the point that your perception of reality is dimmed down
In CBT, doing journal work is crucial as it gives you prompts to:
- Utilize your self-evaluative work to reflect and respond in healthier alternative ways
- Practice more accurate and harmonious self-talk
- Discover how you can carefully and truly evaluate emotional behavior and peripheral responses and circumstances.
- Understand how you can alter and monitor warped reactions and opinions.
What are the goals of CBT in the treatment of depression?
The primary aims of CBT are to help patients learn about their cognitive patterns and then apply mechanisms for coping that challenge negative or irrational thoughts or actions, particularly harmful ones, as well as behaviors and attitudes.
The core focus of CBT is to aid one in taking what one learns from the sessions and applying all those skills to the outside world. Methods that target behaviors are especially effective in treating depression because depression involves a lot of activities, low energy, lack of motivation, and fatigue.
Thus, to tackle these, CBT provides rewards or incentives for behavioral changes, even the smallest of things such as getting out of bed and brushing your teeth.
Clients learn to apply these rewards to themselves too outside of therapy. By rewarding yourself, the chemical processes in the brain are also altered which may create boosting effects as a positive reinforcement was provided. This is likely to increase the probability of carrying out the behavior in future instances as well.
In depressed individuals, the hormone or neurotransmitter called dopamine is typically in significantly lower levels than in an average person hence CBT uses strategies that promote the production of dopamine which helps to elevate low moods and low energy.
What can you expect in CBT sessions?
If you’re looking to receive CBT then it should be from a psychologist, licensed clinical worker, licensed counselor, or other mental health professionals with training. The sessions can be held either one-to-one, but they can also be held in groups or with self-help resources under the supervision of your therapist. Therapists will collaborate with you on setting goals and deciding which treatment goals need to be fulfilled which will be unique to each patient and case.
For example, your goal could be to feel low moods less often or to reduce alcohol consumption. However, therapists won’t focus on your past or personality traits (like in psychoanalysis), rather their primary focus will be on what, how, and why you think or feel a certain way, and then help you change that using a variety of strategies.
To help you use the skills taught during CBT, therapists can assign homework or tasks that you will need to complete before coming to the next session.
Therapists will also show you skills that can prevent your depression from relapsing but if it does return, then coming back to therapy is always a good idea to work on areas that caused you the most trouble. You can always return to therapy if you feel like things are getting worse, or you need to work through a difficult problem that appears later.
What are the most effective CBT techniques for depression?
The most common yet effective techniques used in CBT for depression are the following, and may be used in conjunction with one another:
1. ABC Analysis
This is based on Albert Ellis’s ABC model which focuses on breaking down behaviors associated with depression e.g., sleeping all day, isolation, etc. It follows a structure where ‘A’ is the activating event, ‘B’ is the beliefs regarding the event, and ‘C’ is the consequences of the event which includes behaviors and feelings surrounding it.
This technique prompts us to analyze our own triggers and discover the behaviors that occur as a result of the event. It is useful as it allows patients to recognize the causes of their depressive triggers, and work on changing these.
2. Cognitive Restructuring
This involves challenging existing thoughts or beliefs which helps you learn about possible distortions and unhealthy trends which worsen depressive symptoms such as low moods, self-harm, or thoughts about suicide.
This includes addressing negative self-talk patients often engage in. The technique focuses on reframing errors in thought and aims to help patients create rational ways of thinking that form healthier trends.
This technique prompts patients to recap and review thoughts and understand that despite being trapped in harmful patterns, these thoughts or beliefs do not represent facts, rather they are based on emotions.
Often patients label themselves as emotions ‘’I am hopeless’’ or ‘’I am distressed’’. Fact-checking helps you realize that you are not your emotions, and identifies behaviors expressed because of these opinions and emotions. They are reminded of the fact that they ‘feel’ hopeless or distressed, but it’s not their identity, thus feelings can be overcome with some help.
4. Thought Journaling
Journalling basically means writing down your thoughts, feelings, and behaviors to encourage self-awareness about possible triggers, and how thoughts can impact behaviors e.g., thought: ‘my friends don’t want me around’ behavior: stays home on most days.
By keeping track of your own thoughts, you can learn techniques to cope with these in the future or better yet, challenge these.
5. Activity Scheduling
Much of this involves giving yourself a reward for making schedules for low-level tasks that promote self-care and positive regard. When these are planned and scheduled, it brings motivation to complete these even if you’re feeling down, but it also increases the likelihood of completing these tasks in the future consistently after therapy formally ends.
For example, a depressed patient might reward himself for scheduling a meet-up with a friend by watching his favorite tv show or reading a book.
6. Successive Approximation
This is also referred to as ‘’breaking it down’’, which like the name suggests, involves reducing larger tasks into smaller parts which helps you deal with feelings of being overwhelmed which come especially with trying to meet big goals.
In this, you can break your goals into more doable goals and work on them bit by bit which will make it easier to achieve them and cope better. This in turn will make coping and meeting goals easier in the future and you’d be more likely to do it when you’re able to complete them even if you feel very low.
7. Mindful Meditation
Mediation is effective for depression as it helps to reduce the focus you have on negative thoughts and heightens the ability to remember and stay in the present.
It also aids you in identifying and learning to accept that negative patterns do exist and detaching from these will be more beneficial to you than allowing them to dominate your being.
What are the types of CBT that can be used for depression?
CBT isn’t just one set of guidelines, it isn’t a simple and rigid formula that everyone must follow, rather CBT is of different types, as one type may not be effective for a person whereas another type would yield excellent results.
Below are subsidiaries of CBT, branches that all work from the basic premises of CBT but differ in the nature of their goals.
1. Rational Emotive Behavioural Therapy
This was formulated on the concept that people make certain choices in their lives to attain certain needs which promote their survival and feelings of fulfillment. REBT helps people learn how they can address unhealthy and irrational behaviors or thoughts in order to change these to alternative, positively functioning ones.
For depression, this approach makes use of the wish to feel happier or to reduce symptoms of depression, and to do these many strategies are applied to create order and rationality in cognitive patterns. The component of emotions is of great importance in this type of CBT. Emotions and feelings are recognized, accepted, and open to a change in course of direction to trigger healthy behaviors and emotions
2. Dialectical Behavioural Therapy
This is frequently used to treat a range of disorders including borderline personality disorder however originally it was used to treat people with suicidal ideation, and additionally used for patients with bipolar disorder who would engage in self-harm significantly.
Patients are taught how to embrace feelings and thoughts that give them the toughest time. But it also teaches them to foster balance between accepting and addressing thoughts and making doable and healthy changes that will help them cope with the stressors that life brings.
3. Acceptance & Commitment Therapy
This therapy type is not commonly used but is still helpful in treating depressed patients. ACT aids a person with lessening hardships of negative thoughts, anxiety, self-talk, and judgment and enhances the capacity to focus. It involves several techniques which aim to promote greater flexibility mentally. The techniques are…
- Acceptance: this is giving permission for a thought or feeling to exist but not pushing it away or judging it
- Mindfulness: this encourages the person to keep their focus on the present and the here and now
- Commitment to change: if a thought or action is inconsistent with the values or meanings a person holds then this behavior is changed to meet that value.
How effective is CBT?
Cognitive behavioral therapy (CBT) is accredited and supervised by the Beck Institute, which was started by the founders of CBT. In order to maintain the provision of mental health training in CBT, the Beck Institute continually checks research to guarantee its effectiveness on mental conditions.
Countless other research analyses have established the efficacy of CBT for depression. Studies find that behavioral activation techniques utilized during CBT are effective in treating severe depression. In comparison to antidepressant medication, CBT on its own is effective in continued recovery from depression thus in the long-term it is influential.
Cognitive therapy (CT) also contributes to effectiveness alongside medication when treating moderate to severe forms of depression such as major depressive disorder however this may be affected by the therapist’s experience with using CBT or CT. CBT was also found to be an effective treatment in terms of reducing depressive symptoms and relapse rates when compared with control groups.
For example, a study on bipolar individuals found they experienced depressive episodes and with CBT intervention they ended up with less frequent episodes, shorter bipolar episodes, and less frequent admissions to the hospital. Furthermore, this group had significantly lower mania symptoms and depressed mood.
What are the Benefits of CBT for depression?
According to studies and research, there are numerous benefits of CBT including:
- CBT has been known to reduce symptoms of depression as an independent treatment as well as with medication if the patient chooses to do so
- It digs into the schema and cognitive patterns of the individual and tackles problematic beliefs that maintain depression rather than digging into the person’s past or personality
- It can address a range of psycho-social issues such as the conflict in the family or with a spouse, career stress, life transitions, etc which contribute to or may trigger the onset of depression and its symptoms
- CBT reduces the chances of recurrence (low relapse rates)
- Increases adherence to medical treatments recommended by professionals, but also a commitment to helping themselves get better and improving
Usually, clients or patients will need to attend at least 12-20 sessions that last around 50-55 minutes, on a weekly basis. However, improvements can be observed even after a few sessions. This is dependent on the severity of the depression, and it is likely that those with more severe forms will engage in CBT for several months or even a year until they start feeling better.
CBT can be done in clinical therapeutic settings such as in person, but it can also be conducted online with a CBT therapist.
How to choose a good CBT therapist?
It is important to make sure you choose certified professionals only who are licensed and trained in psychotherapy. What you can look out for are things like whether they have a master’s or doctoral degree with specific training in counseling for psychological problems.
For example, psychiatrists work in the medical field and can prescribe medications to you such as antidepressants or antipsychotics, but they do also provide psychotherapy alongside.
Prior to selecting a therapist, you should also look out for their license in your state, their education, and their area of expertise. For example, some therapists deal with a host of problems aside from depression such as anxiety, PTSD, etc.
Lastly, it’s important that you feel you can trust your therapist and feel comfortable in their presence. If you feel disengaged or uncomfortable with your therapist, you can put in a request, and they will refer you to another therapist.
Where can I find my own CBT therapist?
If you’re considering CBT, then ask your local care provider for a list of references or trusted family or friends who may direct you. However, if this is not possible, you also have the option online. through the online therapist directory. BetterHelp is an online platform that provides CBT services from licensed practitioners starting from $60 a week.
Here are some therapists on BetterHelp who specialize in treating depression and related psycho-social problems:
Online-Therapy.com (CBT-based) is another option you could choose which involves a 45 min session weekly with unlimited texting between sessions but also self-guided activities.
Therapy’s Directory- this will help you find a licensed and experienced CBT therapist. You can search according to availability, specialty, affordability, and the therapist’s personality. Find the right one for you today.
How costly is CBT?
Sessions for CBT usually cost around $100 up to $200 however insurance might cover the costs depending on how they cover mental health interventions. If you would prefer group sessions then the costs are relatively lower because the service is provided by numerous people at the same time and place compared with one-to-one sessions privately.
These can range from $25 to 50 which is dependent on the insurance provider. CBT however is definitely worth the shot if you’d like to see improvement mentally, emotionally, and behaviorally. It is a commitment with worthwhile results.
Will CBT really help with my depression?
YES. CBT’s main goal is to help you in dealing with problems that overwhelm you including your negative thoughts and emotions, by breaking them into smaller parts, showing you how changes can happen to help you feel better unlike other interventions, CBT helps you confront current issues instead of dwelling into your past.
CBT finds practical ways to improve your mental and emotional state on a day-to-day basis. CBT on its own is 50-75% effective for beating depression and anxiety after 5 to 15 modules,
What are the principles/theories behind CBT?
CBT is based on the cognitive behavioral model which means the way we perceive things around us affects how we feel emotionally and how we respond behaviourally. Someone reading this may think ‘’wow this sounds great, it’s exactly what I’ve been searching for’’ and feels happy. But another person may think ‘’this sounds ok, but it seems too hard for me’’. This person feels discouraged and down. It’s not the situation that directly affects them on an emotional level but rather their thoughts about it.
People who are distressed often cannot think clearly and may feel distorted. That’s where CBT comes in, to identify these thoughts and modify them, challenge them, and ultimately replace them with healthier ways of thinking. CBT is all about problem-solving and changing behaviors.
What can I do to prepare for therapy?
An essential single step is goal setting. Ask yourself, “How would I like to be changed by the termination of therapy?” Think exclusively regarding modifications you’d wish to make. Think about what symptoms bothered you most and which you’d wish to reduce or remove.
Think about additional zones that would enhance your life such as mystical, scholarly, or enriching pursuits, doing more exercise, diminishing unhealthy lifestyles, discovering brand new relational competencies, and enhancing managing abilities at work/home.
Your therapist will support you, assess and upgrade these targets and assist you in deciding which goals you could work at independently and which ones you may want to work on in therapy.