Feeling hopeless is a sign of depression; it’s also an example of a negative thought pattern that, if reinforced, can be a difficult habit to break. That’s where cognitive behavioral therapy (CBT) comes in. CBT is all about identifying maladaptive “cognitions,” or thoughts and beliefs, and working with a therapist to realign those thoughts into something more productive.
As a therapist, depression is one of the most common problems I see in my office. In fact, it’s a leading cause of disability in the United States, according to the National Institute of Mental Health (NIMH). An estimated 16.2 million adults experience depression every year—that’s 6.7% of the population!
It’s a serious illness that is often misunderstood or minimized. Depression is an umbrella term that includes major depressive disorder and persistent depressive disorder, among other less common diagnoses with similar symptoms like low mood, loss of pleasure, and some manner of disruption to a person’s daily functioning.
The good news is there are treatments for depression. Unfortunately, NIMH reports only about half of all people diagnosed with depression access those treatments. No one knows exactly why this is the case. Maybe it’s related to the stigma of asking for help. Or, maybe it’s because the symptoms of depression itself are a barrier to treatment. Either way, it keeps people from the chance at a better life.
If you’ve been diagnosed with depression but aren’t in treatment (or feel like your treatment isn’t working), it may be time to consider CBT as a possibility for you.
What exactly is CBT?
The basic premise behind CBT is that changes in harmful thought patterns lead to changes in behavior. Also, it’s about becoming aware of long-held beliefs that do not serve you and working to shift your perspective. These negative beliefs can be about yourself, life circumstances, or the world in general.
CBT is commonly considered a short-term treatment model, meaning the goal is to address the problem in a limited number of therapy sessions. Many therapists use CBT in one form or another in their practices due to empirical evidence of its effectiveness, especially with depression and anxiety.
One important thing to know about cognitive behavioral therapy is that it was specifically designed to treat depression. In the 1960s, a psychiatrist, Dr. Aaron T. Beck, noticed that most of his patients with depression also had negative thought patterns. By bringing attention to these thoughts and reframing them in a positive way, his patients started feeling better. Eventually, behavioral therapists (think Pavlov and his dogs) took an interest in this new approach, and CBT was born.
Studies have shown that CBT is effective alone or in combination with medication to treat depression and other mental illnesses. CBT is like the trunk of a tree with many branches such as exposure therapy and dialectical behavior therapy (DBT). Within these different therapies, there are multiple strategies and techniques that a therapist uses to get to the heart of an issue.
What does a negative thought pattern look like in a person diagnosed with depression?
A depressed person may replay a negative, internal conversation like, “I’m never going to be happy.”
This belief is an example of “catastrophic thinking” or “overgeneralizing.” In CBT, a therapist may challenge those beliefs and encourage the client to change their inner dialogue to something like, “I may not feel good now, but there will be a time in the future when I will feel better.”
Then, the therapist will help the client identify what’s getting in the way of feeling better and assist in developing new strategies. CBT helps people learn and accept the things they can and cannot control about their life.
You may have heard of a “breakthrough” in therapy. It’s the aha moment when a client understands something in a new way. There tends to be multiple breakthroughs in CBT, because it’s about finding new ways to view a personal challenge like depression. As viewpoints shift over time and breakthroughs happen, it can be very rewarding for both the client and therapist.
What happens during a CBT session?
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If you’ve never participated in therapy before, you may be wondering what to expect during an appointment. In the initial session, the therapist will get to know you and learn about the areas you might want to address. You and your therapist may also identify realistic goals and establish a treatment plan. In future sessions, you will work on reframing cognitions and identify successes, as well as, acknowledge areas where you still may need to make improvements. The therapist will act as your accountability partner, cheering you on with each success and helping you adjust your strategy when you face a setback.
CBT is a solution-focused therapy, so don’t expect to spend too much time digging into your past. However, there may be moments when it’s necessary to explore why the negative thought patterns began in the first place. Each therapist has a different style, so you may have to see more than one therapist to find a good fit. A therapist is there to facilitate change—if it’s not working, try communicating your concerns. If you don’t make any headway, move on to a different therapist.
Over time, the hope is that you no longer need help in reframing negative beliefs, and you’re able to do it without the assistance or reinforcement from your therapist. Through CBT, you should experience a reduction in your symptoms and increase your sense of satisfaction about life—ultimately, these are the goals of CBT.
What are the outcomes associated with CBT?
Proponents of CBT see it as a widely-researched method with high rates of success. For example, research has shown there is a lower chance of relapse after CBT as compared to antidepressants. But studies vary on the effectiveness of CBT, and some find that unless a skilled therapist implements the model, it lacks effectiveness.
Remember, CBT is not a guaranteed solution. There are many contributing factors to why someone experiences depression, making outcomes different for everyone. As with any treatment, it’s all about individualization.
If you’re struggling with depression, remember it’s a treatable illness. Hang onto hope and keep searching until you find what works for you.
Kerry J. Heckman is a freelance writer and therapist based in Seattle. She authors a wellness & lifestyle blog called Words Heal and writes about health, chronic illness, and travel. You can also follow her healing journey on Twitter @kerryjheckman and Instagram @kerryjheckman.
Beck Cognitive Behavior Therapy (n.d.) History of Cognitive Behavioral Therapy. Retrieved from https://beckinstitute.org/about-beck/our-history/history-of-cognitive-therapy
Driessen, E. & Hollon, S.D. (2010). Cognitive Behavioral Therapy for Mood Disorders: Efficacy, Moderators and Mediators. Psychiatric Clinics of America, 33(3), 537-555.
Leahy, R.L. (2011, November 11). Cognitive-Behavioral Therapy: Proven Effectiveness. Retrieved from https://www.psychologytoday.com/us/blog/anxiety-files/201111/cognitive-behavioral-therapy-proven-effectiveness
Mayo Clinic Staff (n.d.) Cognitive behavioral therapy. Retrieved from https://www.mayoclinic.org/tests-procedures/cognitive-behavioral-therapy/about/pac-20384610
National Institute of Mental Health (2010, January 4). Just Over Half of Americans Diagnosed with Major Depression Received Care. Retrieved from https://www.nimh.nih.gov/news/science-news/2010/just-over-half-of-americans-diagnosed-with-major-depression-receive-care.shtml
National Institute of Mental Health (2017, November) Major Depression. Retrieved from https://www.nimh.nih.gov/health/statistics/major-depression.shtml