How Does Cognitive Behavioral Therapy Treat Depression?

Cognitive behavioral therapy (CBT) is a treatment for depression.

Cognitive behavioral therapy (CBT) is a type of psychological counseling approach that treats a variety of different psychological and psychiatric disorders. It employs both cognitive strategies that can help people change their thought patterns and behavioral strategies that can help people change behaviors that may be unhelpful or harmful.

CBT is founded on several principles, including the following:

• Psychological problems are based, in part, on disordered thinking.
• Psychological problems are based, in part, on learned patterns of behavior that are not helpful.
• People can learn better ways to cope with psychological problems.

Unlike traditional talk-based psychotherapy that may involve years of counseling, CBT is usually designed for short-term treatment over the course of 12-16 sessions, depending on the severity of the patient's condition. CBT also emphasizes a collaborative and cooperative relationship between patient and therapist, where both set an agenda and determine goals for therapy, and the therapist provides regular feedback to the patient.

Homework assignments are also an important part of CBT and usually include recording thoughts, scheduling specific activities, and challenging automatic negative thoughts when they occur.

Cognitive behavioral therapy treats depression, including major depressive disorder. It is generally recommended for certain patients who are depressed, including

• those who have mild-to-moderate major depressive disorder;
• women who are pregnant, trying to become pregnant, or are currently breastfeeding;
• and any patient who wishes to employ cognitive behavioral therapies.

In patients who have more chronic, severe, or complex cases of depression, the American Psychiatric Association recommends combining CBT with medications (pharmacotherapy).

A doctor (psychiatrist or psychologist) will assess a patient for depression and come up with a plan of cognitive and behavioral techniques to help reduce depressive thought patterns and symptoms of depression.

The first part of CBT for depression usually involves behavioral strategies. This part of the therapy consists of changing behaviors that may cause or worsen depression and replacing them with behaviors that can cause happiness. People learn to face their fears, calm their mind, and use role playing to prepare for social interactions.

• Develop strategies to replace negative avoidance behaviors (such as spending less time in social settings, avoiding work or school, not performing household tasks) with activities that will produce pleasure or feelings of accomplishment (such as going to a party or finishing a report for work).
• Patients with more severe depression may begin with simple activities to accomplish such as reading or making their bed.
• Patients may be asked to rate the pleasure they felt on a scale of 1-10 after completing each activity to help them realize they can experience joy and a sense of accomplishment.
• Patients with other problems that can affect depression may be taught techniques that help with those aspects.
• Patients with sleep problems may be given skills to improve their sleep.
• Patients who have problems interacting with others may be given specific activities to help improve their social skills.

The cognitive part of CBT involves figuring out what a patient's distorted thought patterns that create problems, testing those thoughts, and assessing how those thoughts influence how they see and interact with the world around them. The goal is for the patient to gain a better understanding of themselves and the behaviors and motivations of others, to learn problem-solving skills to cope, and to develop confidence in one's self and abilities.

• Automatic thoughts (thoughts that occur frequently, are usually not noticed by the individual, and are usually accepted as true without evaluation) tend to be negative in those with depression and can worsen symptoms.
• Examples of automatic negative thoughts include "nobody likes me" or "I am worthless."
• A therapist teaches a patient to recognize these thoughts when they occur and to pay attention to their mood following the thoughts. Patients may then have to record these thoughts and moods.
• The next step involves challenging these negative automatic thoughts when they occur so the patient can learn more realistic explanations, which are less likely to be negative.
• Another way to help identify and evaluate automatic negative thoughts is to complete behavioral tests. For this to work, a patient must be at a point in the counseling where they agree the thoughts can be challenged and possibly changed.
• An example of this would be for a patient to agree to challenge the thought that "no one wants to spend time with me," by calling 10 people to see if they will spend time together in the future. Noting the results can help a patient challenge this automatic thought.

Cognitive behavioral therapy for depression is based on a theory that individuals with depression exhibit the "cognitive triad" of depression:

1. A negative view of themselves
2. A negative view of their environment
3. A negative view of their future

This can manifest in thought distortions such as:

• all-or-nothing thinking (viewing things as black or white);
• overgeneralization (assuming one negative event represents a pattern of never-ending negative events); and
• fortune telling (making predictions about the future that are negatively biased).

In relation to the cognitive triad, patients with depression have cognitive distortions that perpetuate these negative beliefs. With this in mind, cognitive behavioral therapy for depression often emphasizes specific behavioral strategies (such as scheduling activities) along with cognitive restructuring aimed at changing automatic negative thoughts.

Therapists use cognitive behavioral therapy to treat depression and many other types of mental illnesses, and there are generally no risks or complications to the therapy.

Some people may not be good candidates for CBT, including patients who have

• major depressive disorder with suicide risk,
• alcohol or substance abuse problems,
• a psychotic disorder,
• organic brain syndrome, and
• mental retardation.

Family members and friends can support patients with treatment by reminding them to attend therapy sessions, complete homework assignments, and take any prescribed medications. A therapist may ask family members to attend therapy to learn ways to support their loved one.