The impact of depression on your daily functioning and overall quality of life can be significant, and trying to find professional support to actively work through negative thoughts can be just as difficult. Additionally, the list of different options for therapy can be overwhelming and may prevent you from seeking help entirely. Thankfully, understanding the importance of finding the right therapeutic approach can set you up for mental health success.
Depression cognitive behavioral therapy (CBT) stands out as one of the most effective and examined types of therapy.1 Here’s a look at what CBT is and how it can be used in sessions to alleviate symptoms of depression, providing you with a better understanding of how this modality addresses unhelpful thoughts.
Understanding Depression Through the Lens of Cognitive Distortions
Depression exists on a spectrum from situational low mood to a severe mental illness, and typically involves unhealthy patterns of negative thinking that distort how you perceive yourself, others, and the world around you. These distorted thoughts can create a cycle where negative beliefs reinforce depressive feelings, making it difficult to break free without understanding how these patterns work.
The cognitive model of depression
Since its creation over 60 years ago, the model of cognitive therapy for conditions like major depressive disorder (MDD) has evolved, and it currently views this category of mental health conditions as one that is maintained by environmental, psychological, and biological factors.2 Environmental factors include trauma and stressful life events, psychological factors include inherited biases and beliefs, and biological factors include genetic predispositions and imbalances in brain chemistry.
This perspective evolved from the “cognitive triad,” which understood depression as something that is fueled by negative views involving self (“I’m worthless”), the world (“existence is suffering”), and the future (“I’ll never get better”). This model can help you understand that this triple threat of negative beliefs — otherwise known as cognitive distortions — is driving your ongoing depression.
Common cognitive distortions in depression
An important part of rebalancing your brain is identifying learned patterns of negative thinking that may be perpetuating depression. As humans, we have a natural tendency to create stories for ourselves to help us make sense of the world. While this can be helpful when the stories are constructive, cognitive distortions can lead to counterproductive beliefs that negatively influence your mood, behavior, and in some cases, contribute to conditions like eating disorders and substance use disorders (SUDs).
Some common cognitive distortions that may contribute to maintaining depression include:
- All-or-nothing thinking is when you struggle to recognize the middle ground or nuances of situations, viewing outcomes, perceptions, or decisions as either entirely good or entirely bad.
- Catastrophizing is when you think the worst outcome is inevitable despite lack of proper evidence, and you reinforce catastrophic beliefs until you’re overwhelmed.
- Discounting the positive is when you discredit or disregard anything positive that happens in your life.
- Emotional reasoning is when you struggle to distinguish between your emotions and reality.
- Negative self-labeling is when critical views of yourself are normalized through negative self-talk — whether that be about your looks, personality, or behavior — reinforcing a cycle of poor self-esteem.
Other cognitive distortions common in those struggling with depression include overgeneralization, mental filtering, “should” statements, and personalization.
The behavioral component of depression
Depression isn’t a condition that just lives in the mind. When depressive thoughts and emotions persist, it can impact your daily behaviors. You may find that decisions become guided by the fog of your negative automatic thoughts, persistent sadness and loneliness, or feelings of inadequacy, lack of energy, and isolation.
This can create issues with your everyday functioning, preventing you from completing basic tasks, participating in social events, attending work or school, and in some cases, may increase risk of self-harm or self-destructive behaviors. The less you engage with your support system, self-care, and routine, the more vulnerable you are to negative thoughts, which perpetuates an entrapping cycle of depression.
Related: The Dangerous Cycle of Alcohol and Depression and How To Break It
What Does CBT for Depression Do?
CBT can treat depression by transforming negative thought processes to be more constructive and positive through several core principles that distinguish it from other forms of therapy. Here’s an overview of how it works to alleviate symptoms of depression, so you can set proper expectations for care.
Overview of the structure and process of CBT
Generally speaking, traditional CBT will have a limited amount of structured, goal-oriented sessions taking place over the course of 12 to 20 weeks. However, the intensity and format of sessions will depend on the severity of your depression. For example, severe depression may require inpatient psychological treatment, and depression with suicidality may involve beyond-session crisis management. Additionally, there are many modalities that are based on the principles of CBT, and your therapist may use cognitive restructuring as the foundation of care.
Overall, CBT is a collaborative technique where you and your therapist will create, track, and monitor treatment goals, modifying them as needed. CBT sessions will include progress check ins and insight on how to move forward. It extends beyond the therapy office — you’ll typically be assigned homework and be gently encouraged to practice teachings in day-to-day life.
What are the five steps of CBT for depression?
Different programs implement different structures, and there isn’t a standardized sequence of steps that CBT must follow. However, most CBT therapists treating depression typically follow a similar structure: identify thoughts and beliefs that aren’t serving you; understand how these thoughts and beliefs influence behavior; reframe negative thoughts; learn coping skills to manage thoughts; and develop a daily practice of using these new skills as part of your routine to reinforce new habits.
1. Identify depressive thoughts and beliefs
Identifying and acknowledging habitual negative thoughts is a process that may be difficult, but it is possible. For example, you may find success collecting your thoughts into a “thought record,” which is an easily accessible diary or journal to document negative thoughts when they come up. Or perhaps you prefer a less formal approach where you take mental note of physical symptoms that are associated with depression. By tracking thoughts and beliefs, a therapist helps you become more aware and mindful of depression symptoms, painting a more clear picture of how thoughts manifest.
2. Evidence examination of negative thoughts
Once you’ve identified negative thought patterns, the next step is evidence examination. This core CBT technique is when you analyze a thought’s legitimacy by evaluating supporting and contradicting evidence. By observing and examining the validity of thoughts rather than automatically accepting them, most people find that their negative assumptions lack reasonable justification.
Socratic thinking techniques can also encourage deep, analytical thinking while exploring a subject rooted in depressive thoughts. It works by unearthing principles and challenging assumptions to help distinguish the authentic feelings driving depressive thought patterns to find the root of them.
3. Cognitive restructuring thoughts associated with depression
Now that you’ve identified and examined negative thought patterns, it becomes easier to transform them in a process known as cognitive restructuring. This is not the same as positive thinking, which despite its well-intentioned premise, actually has its pitfalls.3
Rather, cognitive restructuring targets negative thinking by teaching you to replace those thoughts with more helpful ones. For example, instead of thinking “I’m a failure,” a reframe for a more helpful thought could be “I’ve made mistakes, but I’ve also accomplished things I set my mind to in life.” As a result, transforming thinking patterns will in turn change unhelpful behaviors and emotions.
4. Learn coping skills to manage depressive thoughts
When you analyze counterproductive thoughts with CBT, you’ll look at depression through a solution-oriented lens and learn practical coping strategies that you can use every day. Understanding what stressful situations triggers your depression can help you learn long-term coping strategies to appropriately handle them, including behavioral experiments to test and challenge your assumptions. Coping strategies for depression may include mindfulness and grounding techniques, proper diet and exercise, achievable goal setting, and spending quality time with your support system.
5. Practice coping skills in daily life for sustained mood
The final step of the informal five-step CBT process is to maintain progress by practicing learned skills in your day-to-day life. Over time, your actions will have a reciprocal impact on your thoughts and behaviors, and what was once a downward spiral transforms into a positive feedback loop. Behavior will change as well, which may start with brisk walks that lead to runs that lead to exercise classes or the gym.
The more you introduce behavioral activation strategies and work towards integrating meaningful, positive activities in your life — like journaling, exercise, socializing with others, and learning new hobbies — the more you can enhance your mental well-being. Consistently practicing these skills helps emotional resilience become second nature. When you stay physically and socially active, you directly support your brain’s ability to maintain positive thought patterns.
Related: How To Find the Right Therapist for You
Integrating CBT Into Comprehensive Depression Treatment
While CBT is considered the most widely practiced form of psychotherapy for both depression and anxiety disorders, it can be integrated as a complement to other depression treatments for the most effective results. One of the benefits of therapy is that it can enhance the positive effects of other treatments, including:
- CBT and medication for depression: As useful as CBT is for many, it’s a first-line intervention, and some may require more intensive treatment. If this applies to you, your psychiatrist might prescribe antidepressant medication to be used in tandem with CBT to bring a greater margin of relief from symptoms.
- CBT and TMS for depression: For people who don’t respond adequately to antidepressants and other first-line treatments, or who have treatment-resistant depression (TRD), transcranial magnetic stimulation (TMS) therapy provides a hopeful option for relief. TMS for depression is safe, effective, and approved by the FDA, and its long-term benefits may be enhanced when used with CBT.
- CBT and holistic treatments for depression: Utilizing CBT can help you identify and intimately understand your negative thinking patterns. Meanwhile, mindfulness-based interventions and holistic treatments can ground you during thought spirals and reconnect your body and mind. These include breathing techniques, meditation, and yoga.
A multimodal approach that accounts for the various factors that influence your unique expression of depression is best. A therapist for depression may consider factors like your upbringing, cultural background, beliefs, religion, and support system to tailor an approach that works for you.
Related: Psychiatrist for Depression
How Effective Is CBT for Depression?
CBT is one of the most effective and observed types of therapy, and research consistently backs up this sentiment. One notable study found that 43% of those who completed a CBT course reported at least a 50% reduction in symptoms of depression.4 This promising statistic demonstrates why CBT has earned the title of being the “gold standard” of talk therapy.
Related: Is Online Therapy Effective? Mental Health Solutions for Digital Platforms
How Neuro Wellness Spa Can Treat Depression With CBT
At Neuro Wellness Spa, our mental health professionals are able to utilize different therapy modalities tailored to your needs. Since the unique presentation of depression differs from person to person, the modalities we use also differ. It’s important to remember that CBT is just one technique out of many that can be used in mental health treatment.
Our clinicians, psychiatrists, licensed counselors, and trained therapists are well versed in other therapies as well, such as dialectical behavior therapy (DBT), addiction counseling, and psychiatry. If more intensive care is deemed appropriate, our medication management and TMS therapy service can provide additional support. If you prefer online therapy, we offer virtual CBT as well.
Don’t let depression continue to affect your daily life. Call Neuro Wellness Spa today so we can help you make the most informed decision about CBT treatment. Our care team of informed and compassionate mental health professionals are here to guide you every step of the way.
References
- Cuijpers, P., Miguel, C., Harrer, M., Plessen, C. Y., Ciharova, M., Ebert, D., & Karyotaki, E. (2023). Cognitive behavior therapy vs. control conditions, other psychotherapies, pharmacotherapies and combined treatment for depression: a comprehensive meta‐analysis including 409 trials with 52,702 patients. World Psychiatry, 22(1), 105–115. https://doi.org/10.1002/wps.21069
- Beck, A. T. (2008). The evolution of the cognitive model of depression and its neurobiological correlates. American Journal of Psychiatry, 165(8), 969–977. https://doi.org/10.1176/appi.ajp.2008.08050721
- Chaturvedi, S. K. (2023). The Good, Bad and not so Bad of Positive Thinking and Recovery. Journal of Psychosocial Rehabilitation and Mental Health, 10(2), 129–130. https://doi.org/10.1007/s40737-023-00348-1
- Study finds CBT offers long-term benefits for people with depression. (2016, January 7). Haiku. https://www.psych.ox.ac.uk/news/study-finds-cbt-offers-long-term-benefits-for-people-with-depression