Navigating the different options for therapy to treat depression can be overwhelming. That’s why we’re going to focus on one of the most effective treatments: CBT, or cognitive behavioral therapy. Let’s look at the following questions:
- What is CBT and how does it work?
- How does it compare with other treatments?
- How does it help with depression and how do I access it?
- What CBT techniques can I use right now?
What is CBT?
Cognitive behavioral therapy (CBT) is a type of mental health therapy focused on the interaction between how we think, how we feel, and how we act. CBT sees persistent unhelpful thought patterns as a critical component of how depression arises and why it lasts. By addressing this underlying mental pattern, you can also shift how you feel and how you live your life.
CBT is primarily attributed to Dr. Albert Ellis, who created rational emotive behavioral therapy (REBT) in the 1950s, and Dr. Aaron Beck, who developed cognitive therapy (CT) in the 1960s. Since then, CBT has evolved to address multiple conditions and has been studied extensively.
Though not all cognitive behavioral therapy approaches are the same, cognitive behavioral therapy for depression generally has the following characteristics:
Although thought patterns, such as feeling like you have to be “perfect” at everything, may connect to your past, CBT stays focused on your current lived experience.
There’s sometimes a fear that therapy will take years. CBT is usually delivered in 5-20 weekly sessions, but this can vary depending on you and your therapist.
CBT requires active participation. For example, between sessions, clients are asked to track thoughts, feelings, and behaviors. CBT also uses workbooks, worksheets, and apps as training tools.
Can CBT help me with depression?
The short answer is yes. CBT can help you address the symptoms of depression and prevent falling back into depressive thinking. Health care providers often recommend CBT for depression because of the large body of research that backs its effectiveness.
CBT isn’t just effective—it’s also convenient. You can access this tool in therapy, online, or even through credible self-help books when seeing someone live or online is out of reach.
How effective is CBT for depression?
Overall, there’s a broad consensus that CBT is beneficial for depression. Precisely how effective it is and how it compares to other forms of treatment is more nuanced.
A 2017 analysis of 82 studies found that CBT led to, on average, a 53.66% reduction in symptoms of depression. The same analysis found that a placebo can lead to a 29% reduction, showing how significantly CBT impacts depressive symptoms.
A 2013 meta-analysis of over 115 studies reinforces the consistent finding that CBT is effective but not necessarily more effective than other approaches. Another 2012 meta-analysis confirmed that CBT for depression often shows similar effectiveness to other types of therapy and medication.
These findings relay an essential point about treatment: You have a choice when it comes to how you want to care for your mental and emotional health.
Findings also suggest that CBT and medication together can be a powerful combination, particularly for moderate and severe depression.
How does cognitive behavioral therapy for depression work?
Dr. David Burns, another pioneer in CBT, tells us that we feel the way we think. He writes, “Depression and anxiety are the world’s oldest cons.”
He means that with both depression and anxiety, there’s a strong tendency toward negative beliefs about yourself, your future, and the world. But these beliefs aren’t true.
By updating your beliefs and challenging the thoughts that make you feel hopeless, lethargic, avoidant, as well as those contributing to other challenging emotional states, you can change how you feel and ultimately change your life.
Dr. Aaron Beck used a framework called “the negative triad.” Negative views of yourself contribute to negative views of your future, which contribute to negative views of the world. And the cycle continues until you can address the negative thoughts perpetuating depression.
What disorders can CBT treat?
CBT is considered to have strong research support for many conditions, including:
- Generalized anxiety disorder
- Panic disorder
- Irritable bowel syndrome
- Obsessive-compulsive disorder
- Social anxiety disorder
- Eating disorders
The reality is that mental health conditions often overlap. And practitioners increasingly recognize the importance of techniques that treat multiple issues simultaneously. Some practitioners use a transdiagnostic approach, meaning that a mental health treatment targets multiple conditions at the same time.
Often, depression and anxiety co-occur in the same person. So if you’re experiencing these or other overlapping mental health conditions, CBT is an effective way to combat them all at once.
Using CBT for depression
CBT is traditionally employed in the context of one-on-one therapy sessions, delivered in person or online. But you can also find therapy groups that use CBT.
Plus, CBT is often covered by insurance. If you don’t have coverage, or if it’s not accessible for other reasons, there are lower-cost options. These include:
Universities, training centers, & local mental health clinics
You can often see a therapist in training for a reduced fee. In many cases, these therapists have years of experience and are undergoing additional training and supervision.
You can also visit your local or county mental health clinics, which often serve low-income or Medicaid residents. If you’re interested in finding a resource in your area, call your county behavioral health office and ask what’s available. This is likely the most widely available resource for folks in marginalized neighborhoods.
Leverage online resources
Make use of self-help
Although more research is needed, evidence suggests that bibliotherapy, or reading books based on CBT to address the symptoms of depression, can have a significant positive impact.
3 CBT techniques to try now
The benefits of CBT and other forms of therapy happen one step at a time. Here are some ways you can practice CBT techniques right now.
1. Pay attention to your mental chatter.
We all have moments where we feel terrible. Maybe you met up with a friend and, seeing that they looked upset, found yourself thinking, “Oh no, they’re mad at me.”
Or perhaps you stayed in bed when you sincerely intended to get outside for a walk. When moments like these occur, see if you can be curious about what thoughts are happening in your mind. If it’s helpful, you can also write down your inner dialogue. Sometimes, seeing our thoughts on paper can help us find some distance from believing that they’re reality.
2. Identify unhelpful automatic thoughts.
CBT has helpful labels for common patterns of negative thinking. When depression strikes, there’s a strong tendency for negative beliefs about yourself, your future, and the world around you. But these beliefs aren’t true and you can use cognitive behavioral therapy to work with depression.
Here are some labels from CBT to describe common thought distortions:
Focusing on the negative aspects of an event. Example: “My work review was just okay (even though I got all top scores with the single request to be mindful of punctuality.”
Presuming that emotions and feelings represent reality accurately. Ex. “I don’t feel good emotionally, so I must look bad.”
Turning small things into big deals Ex. “I was 5 minutes late—I’m definitely getting fired.”
Believing that everything should go a certain way. Ex. “I have a home to live in, so I should feel grateful for it.”
Black and white thinking:
Thinking in absolutes without shades of grey. Ex. “Going to work is always awful.”
Playing down the significance of events and interactions. Ex. “I didn’t really do a great job. My boss was just being nice when she said I did.”
Making assumptions about what others are thinking. Ex. “That person thinks I’m dull because of what I said earlier.”
Assuming things about the future based on present feelings or experiences. Ex. “I will always feel like this.”
Taking responsibility for things that you can’t control or assuming that another person’s behavior is personal. “I wasn’t asked to go on the hike because no one likes me.”
Discounting the positive:
Downplaying positive events or contributions. Ex. “I got an A on my paper because I’m lucky, not because I’m a good student.”
3. Question unhelpful thoughts.
In CBT, you can learn techniques for challenging unhelpful thought patterns. One place to start is to simply say this word: “maybe.”
Even bringing in the shadow of a doubt can help you separate the ultimate truth from the voice of depression. And in that small space, you may find a surprising amount of freedom.
- Cognitive behavioral therapy (CBT) is an effective type of treatment for depression.
- You can use CBT to identify and shift unhelpful thought patterns that trigger feelings of hopelessness, loss of interest in activities, and other symptoms of depression.
- You can use CBT alone or in conjunction with medication as a treatment for depression.
- Researchers also emphasize that CBT is not the only effective form of therapy. You have choices when it comes to how you want to care for your mental health.
- Barlow et al. (2017). The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders Compared With Diagnosis-Specific Protocols for Anxiety Disorders: A Randomized Clinical Trial. https://doi.org/10.1001/jamapsychiatry.2017.2164
- Beck (2002). Coping with Depression. https://beckinstitute.org/wp-content/uploads/2020/09/Coping-with-Depression.pdf
- Burns (1980). Feeling Great: The revolutionary new treatment for depression and anxiety. Eau Claire, WI, U.S.A: Pesi Publishing & Media. https://feelinggood.com/
- Cuijpers et al. (2013). A Meta-Analysis of Cognitive-Behavioural Therapy for Adult Depression, Alone and in Comparison with other Treatments. https://doi.org/10.1177/070674371305800702
- DeRubeis et al. (2005). Cognitive therapy vs medications in the treatment of moderate to severe depression. https://doi.org/10.1001/archpsyc.62.4.409
- Hofmann et al. (2012). The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses. https://doi.org/10.1007/s10608-012-9476-1
- Lepping et al. (2017). Clinical relevance of findings in trials of CBT for depression. https://doi.org/10.1016/j.eurpsy.2017.07.003
- Naylor et al. (2010). Bibliotherapy as a treatment for depression in primary care. https://doi.org/10.1007/s10880-010-9207-2