Depression is one of the most common mental health conditions in the world, with 280 million people globally living with it every day. Depression can cause painful symptoms like a sad or empty mood, and a lack of interest in activities you used to enjoy. If you’re battling depression, you might feel like there’s no light at the end of the tunnel.
Although depression is a chronic condition — there are effective treatments that can help. And getting treatment for depression is essential, as it’s a serious health condition that doesn’t usually go away on its own.
Cognitive behavioral therapy is one treatment option, out of many, that can help you overcome symptoms of depression.
What is cognitive behavioral therapy?
Cognitive behavioral therapy, or CBT, is a very common category of talk therapy that’s used to help people overcome limiting thought patterns and beliefs. It was created in the 1960s by Aaron Beck, who combined cognitive therapy (psychotherapy that explores and changes thoughts) and behavioral therapy (an intervention that helps people change their behavior).
CBT is used for a wide variety of different health conditions. Research has found that CBT is effective in the treatment of:
- Anxiety disorders
- Substance use disorder
- Problem gambling
- Bipolar disorder
- Bulimia nervosa
- Binge-eating disorder
CBT can also help with:
- Reducing anger problems
- Reducing criminal recidivism rates
- Reducing psychological distress associated with health conditions like cancer, spinal cord injury, HIV, and chronic pain conditions
Concepts of CBT
CBT is a category of therapy that includes some very specific therapy strategies (like Exposure and Response Prevention). But the basic idea behind all CBT interventions is that our thoughts, emotions, and behaviors are all connected. Often, when people feel painful or unpleasant emotions, there are negative thoughts or unhealthy behaviors linked to these emotions.
CBT practitioners support people by helping them identify and change, when necessary, the common thinking patterns that lead them to feel and behave in the ways they do.
The CBT triangle
Often, the shape of a triangle is used in CBT to explain the connection between thoughts, feelings, and behaviors. This is referred to as the CBT triangle.
In one corner of the CBT triangle lies thoughts, and this is often what CBT therapists focus on. After any event (sometimes called stressors, precipitating events, or triggers), we all have automatic thoughts that come up.
These thoughts may cause us to feel a certain way — which, in turn, affects how we react. Our reaction can make the stressful event worse, which makes us feel worse, and so on in a never ending cycle.
For example, let’s take the precipitating event of another driver cutting you off during your morning commute. You may have a thought like, “What a jerk! Why does this kind of thing always happen to me?”
This thought would likely lead to emotions like anger, frustration, and despair. It could lead you to act in a certain way in the moment, such as honking at the other driver. You might also feel stressed and pessimistic upon arriving at work, which could affect your performance.
On the other hand, if you had a different thought (or were able to replace your original thought), then you might react differently both emotionally and behaviorally.
Let’s say that instead of the above, you thought, “Wow, that guy must be in a hurry. I’m sure it’s not personal.” You might not feel as angry as a result of the event and perform better at work.
This is what the CBT triangle represents: the intimate interconnection between thoughts, emotions, and behaviors.
How does CBT work for depression?
CBT is used for many different people and situations, but it’s one of the most well-proven treatment methods for depression.
Depression is a serious health condition that affects people’s moods. Many different factors, like your genes and stressful life events, can increase your likelihood of developing depression at any given time.
Although there’s no single cause for depression, CBT experts say that people who live with depression often fall prey to irrational thinking patterns that negatively affect their mood. These thoughts can be about yourself or about your environment.
For example, people with depression often have negative thoughts about themselves. This could lead to low self-esteem, feelings of worthlessness, and depression.
If you have depression, a CBT therapist can help you to explore the underlying thoughts that make you feel the way you do. By becoming more aware of your irrational or unhelpful thinking patterns, you may become more empowered to change the way you think (and, therefore, according to CBT, change the way you feel).
CBT can also help people with depression by working on positive behaviors. One common CBT technique used with people with depression is behavioral activation. Using this technique, your therapist can help you find ways to be motivated to engage in healthy behaviors, even when your depression takes that motivation away.
CBT sessions usually are held once a week on an outpatient basis, but some people receive this treatment more or less often. It can also be delivered at a residential treatment center for depression. Your therapist may give you assignments to complete in between sessions, as well.
CBT is a popular choice for depression treatment because it can be effective quickly — some studies have shown that people with depression can start to feel relief from their symptoms in as little as weeks. Some research suggests that CBT could be most effective when combined with antidepressant medication; other studies show that CBT alone is as effective as medication.
Common cognitive distortions in depression
Cognitive distortions are a common concept in CBT. Cognitive distortions are unhelpful patterns of thinking that all people fall into sometimes. But people with depression may find themselves experiencing cognitive distortions more often. These thoughts aren’t true or rational and can negatively affect your mood.
Some of the most common cognitive distortions that people with depression can experience are:
- Black-and-white thinking: Also known as all-or-nothing thinking, this distortion leads people to think in extreme measures with no gray area. For example, someone might think that their friends “always” reject them or that they are a “terrible person” after making one mistake.
- Catastrophizing: When people fall into this distortion, they always think of the worst-case scenario. For example, after getting disciplined at work, someone could think, “Now I’m going to lose my job, and that means I’ll lose my house and become homeless.”
- Personalizing: People with depression often take things personally when in reality, they’re not personal at all. For example, they may think, “My friend hasn’t called me because they don’t care about me. No one cares about me.” In reality, there are many different reasons that a friend may not call.
- Discarding the positive: It’s also common for people with depression to focus only on the negative aspects of every situation. For example, someone who is receiving treatment for depression may disregard the days in which treatment is working well and only focus on days when their symptoms are high.
- Fortune-telling: This cognitive distortion leads people with depression to predict negative events in the future (when, in reality, they can’t be predicted). For example, someone with depression may think, “I am going to feel this way forever,” even if they are in treatment and may feel better in the future.
- Mind-reading: Similar to fortune-telling, mind-reading leads people to assume they know what others are thinking. For example, someone with depression might think, “They only invited me to their party out of pity. They don’t really like me at all.”
These thinking patterns are called distortions because they’re irrational, unhelpful, and untrue. And thinking in these ways can lower your self-esteem and make depression worse.
It’s difficult to say which comes first: depression or cognitive distortions. But either way, CBT supposes that by changing your thinking patterns, you will feel less depressed.
How effective is CBT for depression?
CBT is one of the most well-studied and effective methods of treatment for depression and other mood disorders. Examples of conclusions from the research include:
- One 2012 meta-analysis found that CBT was an effective intervention for major depression and dysthymia (now named persistent depressive disorder).
- Some studies have found that CBT is superior to other types of psychotherapy, but experts have indicated these findings are likely inflated.
- Other studies have found that CBT is effective for depression, but no more effective than other types of therapy (like psychodynamic therapy).
- A review determined that the effect size for CBT is d = .67, which is medium in comparison to other treatments.
- A 2020 analysis determined that a combination of antidepressant medication and CBT may be the most effective treatment for depression.
CBT may not be effective for people with severe depression.
All in all, CBT has been found to be an effective and safe way to treat depression. Many professional organizations, including the American Psychological Association, have named it the first-line treatment for the major depressive disorder.
Helpful CBT exercise for depression
CBT is a professional therapy that only a licensed therapist can deliver. However, there are ways to use its principles as a form of self-help.
Here is a helpful CBT-based activity that you can use at home if you have depression. Keep in mind that this activity is not intended to replace CBT as a professional mental health intervention.
One way to use CBT principles yourself is to keep a thought diary.
A thought diary is an easy way to log your thoughts so that you can identify common cognitive distortions and see clearly how your thoughts affect your emotions.
Your CBT therapist could provide you with a template, but you can also create your own thought diary by separating sections for:
- Precipitating Event
- Automatic Thought
- Cognitive Distortion
- Initial Feeling
- New Thought
- New Feeling
First, write about the precipitating event; this is the situation that has caused you to feel depressed or sad. What was your first automatic thought when you went through this event? For example, perhaps the precipitating event was that your boss reprimanded you at work. Your automatic thought may have been, “I can never do anything right.” Jot this thought down.
Then, identify whether or not this thought falls into a category of cognitive distortions — and if so, which one. The thought above could fall into black-and-white thinking or discarding the positive.
After you’ve named the cognitive distortion, pay close attention to how this thought makes you feel. When having the thought above (“I can never do anything right.”), most people would likely feel defeated, worthless, or guilty. Write all of these emotions down. Take a good look at how this thought, and other thoughts like it, contribute to your symptoms of depression.
Next, replace the irrational thought with a more accurate and helpful one. It may help to examine the evidence that tells you the thought is not true.
Taking the thought, “I can never do anything right,” as an example, you may be able to think of past times when you succeeded and were even applauded at work. This negates the thought that you can never do anything right.
A more accurate thought could be, “I messed up this time, but I don’t mess up every time. I make mistakes sometimes, but most of the time I do a great job. My boss even thanked me for my work last week. Every human makes mistakes sometimes.”
Repeat this thought to yourself. How do you feel now? Write down your new thought. This may help remind you of the power of your thoughts the next time your depression symptoms are bothering you.
What to expect
Most people receive CBT once a week. But if you’re in a residential treatment program for depression, CBT may be a part of your daily treatment. You can expect CBT to last anywhere from a few weeks to a long time, even years. How many CBT sessions you need depends on how much you benefit from it, as well as the severity of your depression symptoms.
Like most other therapists, CBT therapists typically start with building a therapeutic alliance with you. No therapy, including CBT, is likely to be beneficial for you if you don’t trust your therapist. If you don’t feel a connection with your therapist after several sessions, then it’s okay to request a new one.
After the therapeutic alliance has been built, your CBT therapist can help you explore the ways in which your thoughts affect how you feel. They may do this by asking you open questions about your experiences, thoughts, and emotions.
Your therapist may bring your attention to the ways in which you are falling into irrational and negative thinking traps, and help you to restructure your thoughts.
Homework assignments are often a part of CBT treatment. Your therapist may ask you to keep a thought diary so that you can keep track of your symptoms between appointments.
Sometimes, your CBT therapist may ask you to do something that feels scary. For example, they may challenge you to invite a friend out for lunch because you’re having the thought, “Everyone hates me. No one wants to spend time with me.”
This is called behavioral experimentation, and it’s a CBT strategy that’s used to help you check the validity of your negative thoughts.
Although some of these assignments might be frightening, they should never make you feel uncomfortable or that your boundaries aren’t being respected. Let your therapist know if anything they ask you to do makes you feel uneasy or violated.
Other beneficial therapies for depression
While CBT has been well-studied and can be very effective for some people with depression, it’s not your only option. There are many other types of psychotherapy that have promising evidence behind them. What works for other people, or even “most people,” may not be the right option for you.
Here are some other types of therapy that are beneficial for lowering depression.
Dialectical behavior therapy
Dialectical behavior therapy, or DBT, was originally created to help suicidal people deal with intense and painful emotions. DBT teaches important skills like self-regulation of emotions and healthy distractions. These skills may help you deal with depression.
In psychodynamic therapy, the therapist focuses on the emotional roots of your current depression symptoms. For example, they may help you return to, and heal from, your childhood traumas.
Interpersonal therapy (IPT) is another type of therapy that’s effective for depression. This type of therapy places the focus of treatment on your relationships. Depression can make relationships challenging, and unhealthy relationships can also contribute to depression symptoms. IPT helps you heal your relationships so your depression symptoms can improve.
Holistic therapies, like mindfulness-based therapies, are gaining more and more research to support their efficacy for depression. Some examples of holistic therapies include yoga, mindfulness meditation, and equine therapy.
Is CBT right for me?
No one can decide for you whether CBT or any other treatment method is the best choice for you. This is a very personal decision that you should make with your primary treatment provider. If this is your first time receiving treatment for depression, your provider may recommend CBT.
Many therapists also use an eclectic mix of various therapy styles to treat depression. They may use many practices from CBT, but also borrow ideas from other therapies like DBT or mindfulness. This means you may not have to choose between CBT and another treatment. For example, many people with depression take antidepressant medication and receive CBT (or another) intervention at the same time.
The main benefits of CBT for people with depression include:
- It has a wealth of evidence backing its efficacy; for many people, it works.
It can be time-efficient; many people start seeing benefits within the first few months, or even weeks, of sessions.
- The strategies you learn in CBT can also be helpful in other areas of your life, like in your relationships.
- CBT can be delivered in a variety of settings, including residential treatment centers and outpatient clinics
- If you have any co-occurring condition, like a chronic pain condition, insomnia, or an anxiety disorder, then CBT may be able to address both things.
Depression treatment at The Center A Place for HOPE
At The Center • A Place of HOPE, we use all of the best evidence-based treatments for depression, including CBT. If you think CBT may be a good option for you, we can work with you to choose the treatment strategy that works best for your situation.
But we also understand that treating depression is about a lot more than simply going through one type of therapy. We use a unique Whole Person Care approach to treatment, which means we know we need to account for your physical, mental, emotional, spiritual, relational, and intellectual needs. You are more than just your depression.
Our clinical team at The Center has decades of experience, and we were voted a Top 10 facility for depression treatment in the U.S. If you’re ready to overcome your depression symptoms (whether it’s with the help of CBT or another treatment), then get in touch with our admissions team today.