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Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is an effective treatment for depression. At the heart of CBT is an assumption that a person’s mood is directly related to his or her patterns of thought. Negative, dysfunctional thinking affects a person’s mood, sense of self, behavior, and even physical state. The goal of cognitive behavioral therapy is to help a person learn to recognize negative patterns of thought, evaluate their validity, and replace them with healthier ways of thinking.

At the same time, therapists who practice CBT aim to help their patients change patterns of behavior that come from dysfunctional thinking. Negative thoughts and behavior predispose an individual to depression and make it nearly impossible to escape its downward spiral. When patterns of thought and behavior are changed, according to CBT practitioners and researchers, so is mood.

How Does Cognitive Behavioral Therapy Differ From Other Depression Treatments?

The focus and method of cognitive behavioral therapy sets it apart from other, more traditional therapies:

  • CBT is based on two specific tasks: cognitive restructuring, in which the therapist and patient work together to change thinking patterns, and behavioral activation — in which patients learn to overcome obstacles to participating in enjoyable activities. CBT focuses on the immediate present: what and how a person thinks more than why a person thinks that way.
  • CBT focuses on specific problems. In individual or group sessions, problem behaviors and problem thinking are identified, prioritized, and specifically addressed.
  • CBT is goal oriented. Patients working with their therapists are asked to define goals for each session as well as longer-term goals. Longer-term goals may take several weeks or months to achieve. Some goals may even be targeted for completion after the sessions come to an end.
  • The approach of CBT is educational. The therapist uses structured learning experiences that teach patients to monitor and write down their negative thoughts and mental images. The goal is to recognize how those ideas affect their mood, behavior, and physical condition. Therapists also teach important coping skills, such as problem solving and scheduling pleasurable experiences.
  • CBT patients are expected to take an active role in their learning, in the session and between sessions. They are given homework assignments at each session — some of them graded in the beginning — and the assignment tasks are reviewed at the start of the next session.
  • CBT employs multiple strategies, including Socratic questioning, role playing, imagery, guided discovery, and behavioral experiments.

Who Can Benefit From CBT?

Anyone with mild or moderate depression can potentially benefit from cognitive behavioral therapy, even without taking medication. A number of studies have shown CBT to be at least as effective as antidepressants in treating mild and moderate depression. Studies also show that a combination of antidepressants and CBT can be effective in treating major depression.

CBT can be an effective treatment for mild and moderate depression in adolescents as well. It’s also been shown to be effective at reducing relapses in patients who experience frequent relapses after having gone through other treatments.

Nearly two out of every three patients who are treated successfully for depression are treated with medications alone. Other patients, though, have lingering symptoms even when medication is partially working. CBT can be effectively used to treat many of these patients.

Although a wide range of people respond well to cognitive behavioral therapy, experts point out that the type of person likely to get the most benefit is someone who:

  • is motivated
  • has an internal locus of control
  • has the capacity for introspection