dcsimg
GET MATCHED TO A SCHOOL
In Seconds
Where do you want to take classes?
Online
Campus
Either
When would you like to start?
What's your zip code?
GO ›
What degree are you interested in?
GO ›
You're almost there...
Processing your information

Cognitive Behavioral Therapy (CBT) for Depression

Explore the methods and positive results associated with CBT

cbt for depression

Cognitive-behavioral therapists focus on changing thoughts and behaviors that contribute to mental disorders, such as depression. In this type of therapy, the therapist does not work to help the patient uncover “insights” in order to change, nor is change dependent on the therapist-patient relationship, as in other forms of psychotherapy.

Rather, a patient learns how to adapt or change their thoughts and behaviors in order to distinguish impaired thoughts from healthy, functional thinking that correlates directly with healthier behaviors. To change thoughts and behaviors, the therapist teaches the patient skills that the patient practices outside of the clinical setting, eventually integrating these skills automatically into every part of his or her life.

Treating depression with CBT employs the same key principles as using CBT for other mental health disorders (see Mental Health Disorders), but customizes the approach as it applies to depression (see Depression), and to the individual’s specific problems.

And although change is not dependent on the therapist-patient relationship, the therapeutic alliance between the two is critical. This means that both the therapist and the patient work together, collaboratively, to identify problems, set goals, assign and plan homework assignments, and challenge negative thoughts, emotions, and behaviors. In CBT, the therapist is said to be an “active” rather than a passive listener.

Problem solving and goal setting

After the therapist and patient establish a therapeutic relationship, which involves the therapist educating the patient on CBT and its central concepts, and the patient explaining the reasons for seeking treatment, therapy begins.

Mental Health Counseling

For depression, the patient and therapist prioritize problems and state the goals that will ameliorate the problems, talking through them and writing them down. This serves as the groundwork for all therapy sessions, being constantly reviewed and reworked if necessary.

Establishing this list places the problems in context, and employs a positive approach that demonstrates the manageability of problems. This takes the patient’s focus off of depressive symptoms and feelings. For instance, instead of focusing only on the sadness and pain one feels with depression, the problem-goal list emphasizes that solutions exist, that actively pursuing solutions ultimately lessens the sadness or other negative emotions associated with this disorder.

The following is a list of problems and goals for a hypothetical patient dealing with depression:

Problems Goals
  • Social isolation or withdrawal from activities
  • Identify a social activity(ies) to join or get involved with
  • Lack of self-esteem or self-worth
  • Increased sense of worth and self-acceptance
  • Working excessive amounts of overtime
  • Decrease work hours to 40-hour weeks
  • Conflict with significant other/partner
  • Improve relationship with partner

The progression of therapy

CBT attempts to be focused and solution-based, and tries to keep the total amount of sessions short, usually from 14 to 16 sessions. For this reason, therapeutic progress is measured from the first session.

Depressed individuals often walk into the first session feeling overwhelmed and hopeless. Many start to feel their burdens lift simply by stating them and writing them down. For many, they need a therapist to help articulate their problems since a constant stream of negative thoughts about many areas of their life consume and confuse them.

During the first phase of therapy, the therapist begins to identify the thoughts and behaviors contributing to the problems. Using the hypothetical patient above, the therapist first tackles one of the most common and disabling problems of depression – social withdrawal. Depression causes individuals to disengage from activities and social pastimes. Yet these pastimes with others, the activities that provide distractions from problems, and the inherent sense of fun and enjoyment they offer, are what keep individuals from developing or feeding depressive thoughts.

In other words, therapists identify avoidance behaviors. Questioning the patient about why he or she refuses to go out and socialize, the therapist hears that the patient feels too tired, wouldn’t actually enjoy the activity anyways, or feels that he or she is not likable or fun to be around.

The therapist helps the patient see that it’s first easier to change a behavior – such as going out or joining a social group or event – than a feeling. Feelings are much harder to willfully control than behaviors.

Also feeding the problem of social isolation, the second problem of low self-esteem is evident in the patient’s claim that no one likes him or her anyways. This is also a common dysfunctional thought that many who are depressed express.

The therapist challenges this negative thought through Socratic questioning, asking for specific examples, questioning assumptions, detailing misconceptions and showing the patient that this is only a “theory” and not a “fact.”

Working on self-esteem skills, the therapist might begin working on interpersonal communication skills, assertiveness training, posture, and actions with others, such as making eye contact, and active listening skills.

In between sessions, the therapist has the patient practice all the skills taught in the session, and also encourages taking action before giving into feelings that are loaded with self-doubt and distress. Soon the patient observes a difference in feelings and ways of thinking about activities simply by doing them.

The therapist might also have the patient list or keep a journal of activities attempted and the results. For instance, if a goal is to reduce the number of overtime hours worked, and to work on assertiveness skills, the patient is instructed to use constructive “I” statements with a boss or coworker to explain why he or she has to reduce work hours. Such an example might be: “I don’t mind working overtime during peak times of business, such as during tax time, but I can’t continue to work the same amount of hours the entire year. My overall productivity is suffering because of the amount of work I am expected to do.”

The patient is coached by the therapist on how to use these “I” statements, as well as how to speak, refrain from becoming emotional, and even how to stand when facing his or her manager. Role-playing is an important aspect of CBT.

The all-or-nothing syndrome

Therapists who work with depressed patients see cognitive distortions as factors that affect almost all the problems that patients report, and one of the most common is the “all-or-nothing” attitude or way of thinking. Also called black and white thinking, this underlying belief distorts reality. By addressing this type of thinking, therapists are able to help patients address each problem and work toward each stated goal.

An example of all-or-nothing thinking from the hypothetical patient above is present in each problem. The patient believes that he or she will be rejected by every person in every social situation encountered, that when any activity is attempted, such as doing artwork, exercising, or trying to find a new job, that he or she will be unsuccessful so that means he or she is a failure. Or if a partner in a relationship gets mad or upset, that means the partner is going to leave the patient.

For each of these statements, the therapist challenges the patient on their veracity, getting the patient through Socratic questioning, to realistically prove their validity. Sometimes just bringing an awareness to the patient of this type of thinking helps the patient identify the negativity and maladaptive assumptions on which he or she bases these thoughts.

Therapists might use some form of a dysfunctional thought record with the patient, having the patient write down a negative or maladaptive thought each time it is experienced, identifying the situation, emotion, and automatic thoughts that take place. Then during a therapy session, alternative, healthier thoughts and responses are identified and added to the patient’s log. This gives the patient repeated practice at confronting negative thoughts, and replacing them with more healthy, constructive thoughts. It’s a powerful self-empowerment tool that shows patients that they control their thoughts, their minds, their lives – that no one person or situation can take over and destroy their lives.

There are many other distorted beliefs linked to depression, such as negatively predicting the future. The patient predicts that he or she can’t keep a partner, that regardless of what happens the partner will always leave, or that getting a new job is impossible.

Other distorted beliefs focus on “shoulds,” such as “I should work overtime,” or “I should give in to whatever my partner asks of me;” or focusing only on negative aspects of him or herself, such as weight, thinning hair, or poor eyesight.

The therapist must act as a detective, identifying all negative or distorted thoughts, and, through coaching, guiding, homework, and role-playing, challenge and restructuring these thoughts. As the therapist and the patient work through each problem, they examine how maladaptive thoughts and maladaptive behaviors become a vicious, endless cycle, and how to break the cycle.

The patient as therapist

The goal of therapists working with the CBT model is to get the patient to become his or her own therapist, to be able to quickly identify maladaptive thoughts and behaviors during difficult situations, and to implement their own action plans. CBT trains patients to view each negative thought as a possibility or hypothesis, not an actual fact. By challenging and changing beliefs, the patient implements a form of cognitive restructuring, a main tenet of CBT.

Relapse prevention

An important aspect of CBT is to set realistic goals. Setting a goal of never getting down or sad again is not a realistic goal. Chances are, a patient with depression must manage depression his or her entire life. So the purpose of CBT is to give the patient the skills and tools needed to manage symptoms when they reappear.

According to the “Oxford Textbook of Psychotherapy,” edited by Glen O. Gabbard, Judith S. Beck, and Jeremy Holmes,” relapse prevention consists of four components:

  1. Identifying high-risk situations
  2. Learning coping skills
  3. Practicing coping skills
  4. Creating a lifestyle balance

During therapy, the therapist helps the patient determine which situations are likely to cause a relapse. For the hypothetical patient above, that patient might identify a fight with a partner, or constant demands by a manager to work overtime as possible triggers for relapse.

In addition, lifestyle balance is especially crucial for managing depression, and includes the proper amount of sleep and sleeping patterns, exercise, participation in social activities, relaxation techniques, eating healthy, and refraining from excessive consumption of alcohol.

From time to time, a recheck with the therapist is a good idea. However, the overall goal of CBT is to get individuals to see how they have the power and ability within themselves to tackle and control this mental health disorder.

Mental Health Counseling Schools & Colleges
Refine School Matches
Hide filters
  • SUBJECT

    See More

  • DEGREE

    See More

  • PROGRAM TYPE

  • START TIME

    LOCATION
    Please enter valid US or Canada Zip.
            Results open in new window

            Searching Searching ...

            Matching School Ads
            5 Program(s) Found

            Regent University prepares students with the knowledge to excel and the faith to live with purpose. Our 20,000 alumni, from more than 110 countries, are changing the world as accomplished professionals. Named a top-15 school nationally for online bachelor's programs (U.S. News & World Report, 2015), Regent is among the most affordable undergraduate Christian colleges (CCCU 2015). Fully accredited, challenging programs are available online and on campus. New classes begin every eight weeks.

            • Online Courses
            5 Program(s) Found
            Argosy University , Online (campus option available)
            • Designated as a 2015 Military Friendly® School by Victory Media, publishers of G.I. Jobs®.
            • Each program is designed to instill the knowledge, ethical values, and interpersonal skills of professional practice and to foster values of social responsibility.
            • Offers several flexible learning options, including a blended format that combines campus and online learning.
            • Several scholarship opportunities are available for students who qualify.
            • Features a competency-based MBA program that allows students to test out of subjects based on prior professional experience.
            Show more [+]
            Good for Working Adults
            • Online Courses
            • Flexible Scheduling
            • Financial Aid
            • Transferable Credits
            5 Program(s) Found
            • 95% alumni satisfaction rate.
            • Currently holds more than 500 professional alliances, including 19 of the top Fortune 100 companies.
            • Courses are taught by expert faculty, with 86% of professors possessing a doctoral degree.
            • Offers credit for prior experience and learning, as well as scholarships, accelerated programs, and several other ways to help reduce tuition costs.
            • Regionally accredited by the Higher Learning Commission (HLC) of the North Central Association (NCA).
            Show more [+]
            • Online Courses
            • Financial Aid
            • Transferable Credits
            5 Program(s) Found
            • Online school designated as a 2015 Military Friendly School by Victory Media.
            • Commited more than $60 million in tuition savings in 2015 through scholarships.
            • Active-duty military, veterans, and Veteran’s Administration employees can save 15% on tuition.
            • Offers 24/7 student services, including financial aid help, course registration, and career counseling.
            • Regionally accredited by the Higher Learning Commission (HLC) of the North Central Association (NCA).
            Show more [+]
            • Online Courses
            • Financial Aid
            • Transferable Credits
            2 Program(s) Found

            •        Ranked #4 among the 2015 Best Regional Universities in the Midwest by U.S. News & World Report.

            •        Designated as 2015 Military Friendly School by U.S. News & World Report.

            •        Student to faculty ratio of 12:1, with an average class size of 21.

            •        85% of faculty holds a doctorate or terminal degree in their field.

            •        Regionally accredited by the Higher Learning Commission (HLC) of the North Central Association (NCA).

            Show more [+]
            • Online Courses
            5 Program(s) Found
            University of Phoenix , Online (campus option available)
            • Provides career services that help students find careers that match their interests and map out a personalized career plan.
            • Offers mentorships and networking opportunities through an Alumni Association of 800,000+ graduates.
            • Has flexible start dates and class schedules.
            • Offers special military rates and special advisors who have a military background.
            • Gives students the chance to earn credits for applicable military training and education.
            • Locations nationwide and online options.
            Show more [+]
            Good for Working Adults
            • Online Courses
            • Flexible Scheduling
            • Financial Aid
            1 Program(s) Found
            • Designated a 2015 Military Friendly School by Victory Media.
            • Founded in 1885 as one of Minnesota’s first business schools.
            • Features small class-sizes, experienced faculty, and flexible scheduling. 
            • Teaches with a technologically-focused learning model that helps to enhance the student experience.
            • Offers online, on campus, and hybrid classes, with 19 locations across Minnesota, South Dakota, and Wisconsin.
            • Nationally accredited by Accrediting Council for Independent Colleges and Schools (ACICS).
            Show more [+]
            Good for Working Adults
            • Flexible Scheduling
            • Financial Aid
            • Transferable Credits
            2 Program(s) Found
            • Began in 1899 as Draughon’s Practical Business College.
            • Features campuses that are heavily engaged in their respective communities, providing professional service from students and faculty.
            • Offers financial aid, scholarships, and counseling for both active and post-duty military students.
            • Has 15 campuses across the United States, as well as 4 art institutes in North Carolina and Texas.
            • Accredited by the Southern Association of Colleges and Schools Commission on Colleges (SACSCOC).
            Show more [+]
            Good for Working Adults
            • Flexible Scheduling
            • Financial Aid
            5 Program(s) Found
            • Designated a 2015 Military Friendly School by Victory Media for the 4th consecutive year.
            • Listed on the President’s Higher Education Community Service Honor Roll in 2013, for the sixth consecutive year.
            • Links students to hundreds of training opportunities ( beyond their traditional internships and practicum) at their many “partner agencies” in each of their local communities. 
            • Accredited by the Western Association of Schools and Colleges (WASC).
            Show more [+]
            Good for Working Adults
            • Flexible Scheduling
            • Financial Aid
            3 Program(s) Found
            • Ranked among top Regional Universities in the South by U.S. News and World Report in 2015.
            • Ranked 37th among the Best Colleges for Veterans by U.S. News and World Report in 2015.
            • Stands as the largest private, nonprofit university in the nation with 100,000+ students.
            • Offers over 230 programs online, from the certificate to the doctoral level.
            • Has a student-faculty ratio of 25:1, and 42.3% of its classes have fewer than 20 students.
            Show more [+]
            • Accredited
            • Online Courses
            • Financial Aid
            • Transferable Credits