Cognitive-Behavioral Therapy (CBT) and Depression
CBT refers to the combination of cognitive and behavioral therapies and has strong empirical support for the treating both mood (i.e.: depression) and anxiety disorders. The basic premise of CBT is that negative emotions cannot be changed directly, therefore it targets thoughts and behaviors that are contributing to distressing emotions. CBT focuses on building an individual’s skillset or coping skills that enable one to become more aware of their thoughts and feelings, identify how situations, thoughts, and behaviors impact one’s feelings and improve the negative feelings by changing dysfunctional thoughts and behaviors. CBT differs from traditional talk therapy because it places a strong emphasis on clients’ skill acquisition and the use of homework assignments. The goal in therapy is not only to solve clients’ current problems or improve clients’ negative feelings but also to build up clients’ toolkits so that they can become effective in solving their own problems in the future.
The cognitive element in CBT is a theoretical paradigm explaining how thoughts, feelings and behaviors are associated. Most people believe that situations or events (A – Activating events) cause their negative emotions (C – consequences) directly. However, the cognitive model suggests that it is not the activating event that creates one’s distressing feelings directly, rather it is the thoughts and beliefs (B – beliefs) one has about the situation that are responsible. This is known as the ABC model. Clients who experience depression tend to display patterns of irrational beliefs or dysfunctional thinking. The CBT therapist can work with the client to first identify these irrational beliefs and then challenge or dispute them. Replacing irrational beliefs with more rational, flexible beliefs has a positive effect on clients’ mood and depression.
The behavioral aspect of CBT focuses on how behavior affects mood. The goal here is to increase behaviors that improve one’s mood while reducing those behaviors that create negative moods.
Behavioral activation is a set of techniques aimed at increasing clients’ activities and reinforcing situations that improve mood and functioning. From this behavioral standpoint, depression is maintained by a variety of characteristics such as hopelessness, fatigue, or passivity. These characteristics also function to increase avoidance and reduce one’s ability to cope effectively. The problem is that a depressed person’s negative mood increases his avoidance of pleasant events or activities, which could help alleviate depressive symptoms. Through behavioral activation therapist and client work together to reintroduce pleasant events into the client’s life and this helps to improve the client’s mood by reversing avoidance, increasing physical activity, increasing self-confidence, and increasing feelings of usefulness and purpose as well as reducing negative thought. Behavioral activation can include many different behaviors. The most common ones are re-introducing prior pleasant activities, introducing new pleasant activities, and coping behaviors that will reduce certain life stressors such as filing taxes, cleaning a messy apartment, or calling an estranged family member.
Another effective CBT intervention for depression is problem-solving. Problem-solving is a process by which an individual attempts to identify and use effective coping skills with problems in everyday living. This includes analyzing a problem, identifying options for coping with the problem, evaluating these options, deciding on a plan and developing strategies to implement the plan. Problem-solving techniques help clients feel more in control over life issues that previously felt overwhelming or unmanageable. So problem-solving is not only effective for the practical resolution of problems but also for emotional coping by increasing one’s sense of control, reducing stress, and increasing hopefulness and self-efficacy. Problem-solving strategies are highly effective for depression but can also be used with a wide range of problems including anxiety, anger, stress management, illness, substance abuse, or family issues.
Finally, relaxation techniques are designed to reduce tension, stress, worry, and anxiety that often interfere with client functioning. These feelings are often so uncomfortable for patients that they are not able to benefit from counseling. Providing help to alleviate clients’ distress can create rapport with the therapist early in treatment and increase positive treatment expectations. Relaxation techniques are a way for clients to increase control over their negative symptoms and do not include an actual discussion of mental health difficulties, which makes them a great intervention very early in treatment. Moreover, relaxation skills are easy to learn and highly effective for most clients, therefore using them early in sessions can be very advantageous. Relaxation techniques can be tailored to clients’ presenting problems and personal preferences. Some clients do well with exercises that focus on physical sensations such as paced respiration or muscle relaxation. Others prefer cognitive exercises like guided imagery.
Although it is not specific to CBT, the quality of the therapeutic relationship is also crucial for client improvement. Patients who perceive the therapeutic relationship with their therapist as safe, trusting and collaborative are in a better position to benefit from treatment, be less resistant and more open to exploration and change. As the therapeutic relationship gets stronger, client and therapist can safely and effectively move into more complex and meaningful therapeutic issues and create lasting change in the client’s mood and life.
CBT and Depression References
Cully, J.A., & Teten, A.L. 2008. A Therapist’s Guide to Brief Cognitive
Behavioral Therapy. Department of Veterans Affairs South Central MIRECC, Houston.
Beck, J.S. (1995). Cognitive therapy: Basics and beyond. New York: Guilford Press