Cognitive Behavioral Therapy (CBT) for Depression
Cognitive Behavioral Therapy (CBT) is a very frequently recommended therapy for depression (and other mental disorders), but what is it?
Firstly, it's probably not what you're thinking of when you think of talk therapy in a psychologist's office; you'll spend very little or no time talking about your past or childhood! CBT is a therapy that looks at the present and the way you feel today and examines how your thoughts influence your moods and behaviors. CBT helps people change the way they think about themselves (wrongly) so that they feel better and enjoy life more.
CBT offers someone with depression a way to start feeling better.
An Example of CBT
Here is an example that illustrates how our thoughts influence our moods and our behaviors.
- Situation – 2 work colleagues are laughing and looking in your direction.
- Thought – You assume they are laughing at you.
- Feeling – You feel embarrassed and saddened.
- Behavior – You ignore them and then later give them dirty looks.
When we are depressed we often use "distorted thinking" to evaluate our world. When we are depressed, we often feel low self esteem, guilty or ashamed and this distorts our perceptions of environmental events.
Someone with low self esteem might assume that others were laughing at him and thus feel even lower – and by later giving dirty looks and acting negatively, he would increase the likelihood that next time, those work colleagues really would be laughing at him. Our thoughts influence our feelings and actions, and our negative thoughts can create real world negatives (very much like self fulfilling prophesies).
Someone who had received CBT training might look at those same work colleagues laughing, fight the negative impulse to assume they were laughing at him and evaluate the situation more objectively. An objective evaluation would reveal no reason for them to be laughing at him, and so he might look over with a smile and ask to be included in the joke. His work colleagues would then come over and point out the humorous scene unfolding directly to his rear.
In this second scenario, a cognitive restructuring led to his enjoying a joke, feeling included and accepted by work colleagues, and building a base of friendship for the future.
Distorted Thoughts Can Perpetuate Feelings of Depression
When we process an environmental situation using distorted thinking, our negative thoughts produce negative emotions and negative actions.
In the example above, the dirty looks given by the man who thought he was being laughed at would likely earn his colleagues' animosity, increasing the likelihood of future negative situations and future negative feelings.
The way we think and act can perpetuate depression.
CBT Therapy Sessions
Patients will typically attend CBT therapy once a week (or more) and practice CBT techniques with homework assignments to be done daily. CBT therapy can be individual or group based and is even offered online.
CBT is a combination of cognitive therapy and behavioral therapy
CBT therapists will try to change:
- Negative thinking patterns (distorted thinking) that propagate negative feelings and behaviors
- Behaviors that propagate negative feelings
Clients are taught how to look at a situation objectively and to evaluate thoughts using more rational judgment.
If you apply for a job and don't get it – don't automatically think you're worthless and feel bad, look at the situation objectively and realize that 200 applicants applied for a single position.
Thinking you were worthless might lead you to feel hopeless and give up a job search, which would lead to continuing unemployment and continuing low feelings.
Realizing that 200 applicants had applied for the job you didn't get might cause you to send out many more resumes that would lead to interviews and an eventual position – and increasing self esteem.
Changing thoughts to change feelings and behaviors – which in turn change thoughts once again; CBT is nothing if not cyclical in nature!
The CBT therapist will work with you to root out the distorted thinking that occurs and will then help you to recognize when distorted thinking may be influencing your judgment. Once you can recognize erroneous thinking in daily life, you will practice techniques to change these ways of thinking.
Using cognitive therapy, clients learn:
- To understand the difference between feelings and thoughts
- To understand that our thoughts can influence our feelings, and that this can be a bad thing
- That since our thoughts can influence our emotions in negative ways, we must evaluate our thoughts to ensure that they are accurate before allowing them to create a negative mood
CBT is a practical therapy that offers you tools to manage your life.
Clients are also encouraged to change behavior patters to induce more positive thoughts.
Most people who are depressed tend to avoid or minimize social interaction and fun outside activities, yet this isolating behavior only entrenches feelings of depression. A CBT therapist will encourage a depressed patient to schedule and engage in frequent enjoyable social outings; knowing that social outings are likely to elevate mood and that elevated mood can lead to increased social outings; again, a cyclical improvement.
How Well Does CBT Work?
CBT is the most effective psychotherapy for moderate and severe depression and works about as well as medication for many types of depression. Many doctors will recommend that CBT be used in conjunction with anti depressant medications, especially for more severe depression.
CBT Lowers the Risk of Relapse
Some studies have shown that those treated with CBT or CBT and medication are less prone to relapse than those treated with medication alone. The sudden discontinuation of medication can lead to the reemergence of symptoms, but since CBT offers learned strategies to help manage negative thoughts and moods, preempting their effects, CBT offers lasting protection against the re-emergence of depression.
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