Examples of CBT for Depression
CBT uses cognitive and behavioral techniques to improve depressive symptoms, but the exact CBT treatment plan for depression might depend on the type of depression someone is experiencing.
Here are some examples of what CBT treatment might look like for different forms of depression:
CBT for Major Depressive Disorder (MDD)
Jody, a 35 year old female, has recently started to feel tired all the time. This began about two and a half weeks ago.
Along with “sleeping all the time,” she reports these other symptoms that all started around the same time:
- Experiencing negative thoughts
- Constantly worrying about different aspects of her life
- Finding it difficult to stay still
- Does not have an appetite
- Has generally been feeling sad, hopeless, irritable , and numb
She reports that she had other times of feeling this way in her teens and mid-20’s; she also experienced brief suicidal thoughts in her 20’s.
Jody began meeting with her therapist last week and the therapist diagnosed major depressive disorder after they finished their assessment. During sessions, her therapist began asking her to challenge her thoughts and restructure her thought process. She also recommended journaling every day. Part of the journaling homework includes documenting something that she chose to do to make her feel happy or productive daily, a CBT technique called behavioral activation.
When Jody started reporting an increase in her worry and rumination, the therapist encouraged her to add meditation to her daily work, to help reduce the incessant worrying and increase calm in Jody’s mind.2,5
CBT for Persistent Depressive Disorder (PDD)
Matt, a 28 year old male, has been experiencing a low and depressed mood, difficulty sleeping, low self-esteem, and difficulty with concentration for the last two and a half years. He works a difficult job and felt it was related, but was informed by family that they noticed this low-grade depression even when he was in less stressful positions.
Matt reached out to a therapist, who diagnosed him with persistent depressive disorder.2,5,6,9 His therapist began working with him on journaling about his day on a regular basis, especially if something made him happy. The therapist encouraged him to write down and challenge his negative and irrational thoughts.
Matt and his therapist also worked noting triggers for aggressive thoughts towards himself to increase his awareness. Matt’s therapist began encouraging him to engage in problem-solving tasks to help him function and build resilience when his depressive symptoms flared up.2
CBT for Seasonal Affective Disorder (SAD) & Situational Depression
Jamie, a 37-year-old male, began experiencing depressive moods, difficulty concentrating, increased fatigue, lowered energy, feeling tense, and negative thoughts in his early 20’s. He reports that he never reached out for help because even if the symptoms tended to start in October to November almost every year, they always stopped around March.
This year, Jamie’s symptoms began around the same time, although he noticed that his negative thoughts were worse than normal and that his sleep schedule was off. As a result, he reached out to a local therapist, who diagnosed Jamie with “unspecified depressive disorder with seasonal pattern,” which is more commonly known as seasonal affective disorder (SAD).9
Jamie’s therapist began working with him to reduce the impact of his symptoms by having him engage in regular meditation to reduce his anxiety and challenge his thoughts outside of session to reduce the negative thought patterns impacting his perspective. They also worked together to create a daily schedule of activities to help increase self-fulfillment and self-care, and journaling to increase acknowledgement of positive things during the difficult season, as well as to track Jamie’s mood.2,5,9
CBT for Postpartum Depression
Julia, a 32-year-old female, had her baby about three weeks ago. About two weeks ago, Julia began experiencing significant levels of anxiety, panic attacks, low mood, feelings of depression and worthlessness, and loneliness. This was Julia’s first child and she had never experienced these feelings before, nor had anyone else in her family.2,9
Julia sought out a therapist to figure out her feelings and was diagnosed with “unspecified depressive disorder with peripartum onset,” more commonly known as postpartum depression. Her therapist knew that research indicated that CBT had improved long- and short-term symptoms of depression and had some impact on anxiety in postnatal depression.10
Julia’s therapist encouraged her to journal her feelings each day to increase awareness as well as acknowledge the positive things she was doing. She also had her engage in a daily short meditation and breathing regulation technique to lower anxiety and panic attacks, engage in gratitude practices with her journaling to increase her mood and lower depressive symptoms, and to discuss her emotional concerns with her support system and partner to allow herself time to meet her own needs. Julia was encouraged to explore her thought patterns influencing the anxious thoughts, especially leading up to panic attacks, to help reduce anxiety and become more aware of her triggers to be able to feel comfortable with her baby.4,12
Types of CBT for Depression
Cognitive behavioral therapy (CBT) is not only a treatment type, but it is also the main branch for a number of different therapy styles. While CBT is the basis of these styles, it is not the only one that can be effective for treating depressive symptoms and episodes.
Here are the three most common offshoots of CBT used for depression:
1. Acceptance and Commitment Therapy (ACT)
While ACT therapy is not as common, it can be helpful in treating depression. ACT engages a number of techniques to increase someone’s mental flexibility.
The techniques used in ACT include different strategies:12
- Acceptance (i.e. allowing a thought or feeling to exist without judging it or pushing it away)
- Mindfulness (encouraging the individual to be able to focus on the present)
- Commitment to behavioral change (i.e. If something is not in line with the meaning or values the individual holds, then change this behavior to meet that value)
In the treatment of depression, ACT can help with reducing the difficulties of negative thoughts and self-talk, anxiety, and judgment, and increase the individual’s ability to focus.
2. Dialectical Behavioral Therapy (DBT)
DBT is a commonly known therapy type, although it is most frequently used to treat those with borderline personality disorder (BPD). This being said, it was initially developed to treat individuals who had frequent suicidal thoughts. In addition, those with BPD or bipolar disorder engage in significant amounts of self-harm—regardless of suicidal intent—that can be seen in depressive episodes across disorders.
Similar to ACT, DBT helps people learn how to accept difficult feelings and thoughts. In addition, DBT teaches how to balance between the ability to accept and address irrational thoughts and behaviors to be able to make healthy and maintainable changes in their ability to cope with life’s stressors.12
Rational Emotive Behavior Therapy (REBT)
REBT was created with the idea that individuals make choices in their lives to meet needs that allow them to survive and feel fulfilled. In turn, REBT teaches individuals how to address irrational and unhealthy behaviors and thoughts so that they can change them for a more functional and fulfilling life.
In treating depression, REBT uses the approach of utilizing the desire to feel happy or fulfilled to reduce depressive symptoms. The REBT approach uses many CBT techniques to help people change their thought processes, helping to create healthier behavior patterns, eventually helping someone move out of their depressive thoughts and behaviors.13
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Cognitive behavioral therapy (CBT) is a type of psychotherapy. This form of therapy modifies thought patterns to help change moods and behaviors.
It’s based on the idea that negative actions or feelings are the results of current distorted beliefs or thoughts, not unconscious forces from the past.
CBT is a blend of cognitive therapy and behavioral therapy. Cognitive therapy focuses on your moods and thoughts. Behavioral therapy specifically targets actions and behaviors.
A therapist practicing the combined approach of CBT works with you in an agreed-upon location, offering guidance and direction. You and your therapist may work to identify specific negative thought patterns and behavioral responses to challenging or stressful situations.
This type of therapy is commonly used for a wide range of mental health challenges and diagnoses, including:
- depression
- anxiety
- eating disorders
- post-traumatic stress disorder (PTSD)
- insomnia
- obsessive-compulsive disorder (OCD)
- bipolar disorder
- phobias
- chronic pain
- panic attacks
Treatment typically involves developing more balanced and constructive ways to respond to stressors. Ideally, these new responses will help you cope with or recover from challenging mental health conditions or unwanted behaviors.
The principles of CBT can be applied outside of the therapist’s office, providing you with coping tools to help you through life’s challenges. CBT teaches you to become aware of and adjust negative patterns, which can help you reframe your thinking during moments of heightened anxiety or panic.
It can also provide new coping skills, like meditation or journaling, for those struggling with a substance use disorder or depression.
How does CBT work?
CBT is a more short-term approach than psychoanalysis and psychodynamic therapies. Other types of therapies may require several years for discovery and treatment.
CBT often requires only up to 20 sessions, according to the National Health Services, but you can continue seeing your therapist for as long as you need. Every situation is unique, so how long you pursue treatment is up to you and your therapist.
CBT sessions provide opportunities to identify current life situations that may be causing or contributing to your mental health conditions, like anxiety or depression. CBT allows you and your therapist to identify patterns of thinking or distorted perceptions that are no longer serving you.
This is different from psychoanalysis. This type of therapy involves working backward through your life history to discover an unconscious source of the problems you’re facing.
You may be asked to keep a journal as part of CBT. The journal provides a place for you to record life events and your reactions. Your therapist can help you break down reactions and thought patterns into several categories of self-defeating thought (also known as cognitive distortions).
These may include:
- all-or-nothing thinking: viewing the world in absolute, black-and-white terms
- disqualifying the positive: rejecting positive experiences by insisting they “don’t count” for some reason
- automatic negative reactions: having habitual, scolding thoughts
- magnifying or minimizing the importance of an event: making a bigger deal about a specific event or moment
- overgeneralization: drawing overly broad conclusions from a single event
- personalization: taking things too personally or feeling actions are specifically directed at you
- mental filter: picking out a single negative detail and dwelling on it exclusively so that the vision of reality becomes darkened
You and your therapist can also use the journal to help replace negative thought patterns or perceptions with more constructive ones. This can be done through a series of well-practiced techniques, such as:
- learning to manage and modify distorted thoughts and reactions
- learning to accurately and comprehensively assess external situations and reactions or emotional behavior
- practicing self-talk that is accurate and balanced
- using self-evaluation to reflect and respond appropriately
You can practice these coping methods on your own or with your therapist. Alternately, you can practice them in controlled settings in which you’re confronted with challenges. You can use these settings to build on your ability to respond successfully.
How can CBT help with depression?
If you’re someone who struggles with depression, your therapist may use CBT techniques to help you uncover unhealthy patterns of thought and identify how they may be affecting:
- your mood
- beliefs about yourself
- your overall outlook on life
You may also be assigned “homework” so that you can practice replacing negative thoughts with more positive thoughts in real time.
How well does CBT work for depression?
CBT has been proven to be effective in treating mild to moderate levels of depression. In some cases, it can be combined with other treatments, like antidepressants or other medications, to treat depression.
What other conditions can CBT treat?
Cognitive behavioral therapy is widely used to treat an array of mental health conditions in children, adolescents, and adults. These may include:
- antisocial behaviors (including lying, stealing, and hurting animals or other people)
- anxiety
- attention deficit hyperactivity disorder
- bipolar disorder
- conduct disorder
- depression
- eating disorders such as binge eating, anorexia, and bulimia
- general stress
- personality disorders
- phobias
- schizophrenia
- sexual disorders
- insomnia
- social skill problems
- substance use disorder
In certain cases, cognitive behavioral therapy may be combined with other treatments to help with depression.
Are there any risks?
There is little long-term emotional risk associated with CBT. But exploring painful feelings and experiences can be stressful. Treatment may involve facing situations you’d otherwise avoid.
For instance, you may be asked to spend time in public places if you have a fear of crowds. Alternately, you may need to confront difficult sources of trauma, like the death of a loved one.
These scenarios can provide opportunities to practice altered responses to stressful or adverse situations. The eventual goal of therapy is to teach you how to deal with anxiety and stress in a safe and constructive manner.
What experts say
“There is a massive tidal wave of evidence for cognitive behavioral therapy that suggests it is very effective at treating certain problems,” Simon Rego, PsyD of Montefiore Medical Center in New York, told Healthline. “The breadth of evidence isn’t as extensive for other forms of psychotherapy.”
That’s not to say other therapies aren’t equally effective and beneficial. “They just don’t fit as neatly into anything that can be studied,” Rego says. “More evidence-based studies have been conducted on the results of cognitive behavioral therapy than any other kind.”
Online therapy for CBT
If you feel that you or a loved one could benefit from CBT, there are several telehealth platforms that can virtually connect you with a trained therapist. Here are some to consider:
- TalkSpace. After taking an initial assessment and choosing your subscription plan, you’ll be connected with someone from their network of over 3,000 licensed therapists.
- BetterHelp. This telehealth company has one of the largest networks of licensed therapists and offers individual, couples, and family counseling.
- Amwell. Along with talk therapy, Amwell can also connect you with online psychiatrists who can prescribe medications.
- 7 Cups. This telehealth network is significantly less expensive than other online therapy platforms. Plus, 7 Cups offers emotional support and access to speak to a trained volunteer (not a licensed counselor) at no charge.
FAQs
How can I find a CBT therapist?
If you think CBT may be a fit for you, there are several ways to find a therapist.
You can:
- talk with your doctor
- search the directory of certified therapists
- reach out to an online therapy program
- contact your health insurance company to see if your plan covers therapy visits
What can I expect from CBT?
Your CBT experience will be unique based on your situation but know that there is no right or wrong way to experience therapy.
Your therapist will take time to get to know you, so be prepared to discuss:
- what brought you to therapy
- your mental health history
- current circumstances
Will CBT help my depression?
CBT has been found to be effective in treating those with mild to moderate depression. It has also been proven effective when combined with other treatment options, like antidepressants or other medications.
Remember that change is often gradual, requiring a time commitment and the willingness to be open to the experience.
Takeaway
Cognitive behavioral therapy (CBT) is a type of psychotherapy that helps you recognize and replace negative or unhelpful thought and behavior patterns. It can be a highly rewarding and effective form of mental health support for those affected by anxiety, depression, OCD, insomnia, substance use disorder, and more.
CBT requires a willingness to be open to change, along with a time commitment to do the work with your trusted therapist.
The goal of CBT is to help you develop the skills to help deal with difficulties on your own, at the moment when they come up, ideally giving you tools that last a lifetime.
