cognitive behavioral therapy
for depression
TL/DR:
CBT is the gold standard treatment for depression, with a strong evidence base supporting its efficacy in treating depression (as well as a range of other conditions).
A skilled CBT therapist will design the treatment based on a highly personalized conceptualization of your case, which means that, when done well, treatment should feel like it’s custom-fit to you.
The. goal of CBT is to teach the patient techniques to change problematic patterns in thinking and behavior that contribute to difficult emotions.
When treating depression, CBT often includes a combination of behavioral activation and cognitive restructuring techniques.
Treatment is designed to be fast-paced, goal-driven, action-oriented, and time-limited.
CBT for depression: An Overview
Cognitive Behavioral Therapy (CBT) is a well-researched and highly effective evidence-based treatment for depression. (Note: it’s also considered an evidence-based treatment for many other mental health conditions but I focus on how it works in the context of treating depression here.)
CBT for depression operates based on the theory that people experience depression because of unhelpful core beliefs about themselves, others, and their world that developed as a result of a person’s early life experiences and learning history. These beliefs in turn shape how people process and interpret information in the present. Those interpretations impact what we do and how we feel in situations — in other words, our thoughts about a situation will impact our behavior and our emotions. Given that, CBT focuses on teaching people techniques that effectively change patterns in behavior and thinking that cause difficult or distressing emotions.
The ultimate goal of CBT is that, by the end of therapy, a patient can function as their own therapist (in other words, you learn all the techniques that the therapist has to teach you so that your therapist eventually becomes obsolete). Just like many other evidence-based treatments, CBT is designed to be fast-moving, goal-oriented, and time-limited. To do that, it requires a highly personalized approach, with the plan for treatment being guided by what’s called a “case conceptualization”, which is a hypothesis about what factors are fueling or maintaining your depressive symptoms. When guided by a well-done case conceptualization, treatment using CBT should feel like it’s customized to you and fits you like a glove.
Core CBT Strategies for Depression
Behavioral Activation: Behavioral activation includes a set of techniques designed to change problematic patterns in behavior that keep someone locked into their depressive symptoms. When people experience feelings of sadness or depression, there is a natural response to pull away or withdraw from different routines and activities that a person would normally engage in. However, over time, these patterns of withdrawal prevent people from having positively reinforcing experiences that can improve their mood. Behavioral activation techniques are designed to first identify whether and how these patterns of withdrawal may be present and contributing to a person’s depressive symptoms and then systematically disrupting those patterns. It can be hard to do on your own, but with guidance from a therapist, behavioral activation techniques often result in substantial improvement in a person’s mood quickly.
Cognitive Restructuring: Cognitive restructuring involves learning to identify and modify unhelpful patterns in thinking that impact mood. This includes learning how to evaluate your interpretation of situations (i.e., your thoughts about a situation) in terms of how true they are and/or how helpful they are to you and your ultimate goals. The goal is to develop a stance of understanding and curiosity about your thoughts that allows you to question whether a given thought or pattern of thinking makes sense and/or is useful to you.