CBT: A Depression Therapy That Works

Cognitive Behavior Therapy, or CBT for short, is becoming popular with psychologists and those working in the mental health field because it’s a depression therapy that actually works.  Contrast that with SRI’s that – when taken alone – have a questionable track record.

Treatment for some types of depression, OCD (Obsessive Compulsive Disorder), and problems such as eating disorders usually involve one-on-one counseling, medication, psychotherapy or a combination of all three. Usually, the patient undergoes treatment, then returns to normal life – hopefully a better person for the experience.

Post-treatment individuals fall into one of three categories:

  • Those who are fully recovered, with no further need for medication or other intervention.

  • Those who fully recover, but will be on medication for the rest of their lives.

  • Those who recover, but then suffer relapse after relapse.

It is this relapse (or recurrence) of mental illness after treatment that disturbs mental health professionals the most.

Research has shown that although approximately two thirds of patients with depression are treated successfully with medication alone,1 many patients do not respond to antidepressants,2 have residual symptoms,3 or frequently relapse.4

So, why is the treatment success rate so uneven? The answer may lie in the methods used to help individuals overcome depression and other psychological problems.

Until recently, standard practice was to conduct screening, confirm the diagnosis, and then refer the patient to a therapist. The therapist, usually performing their analysis based on Freudian theory, would then work with the patient to discover the true nature of their trouble. Then the therapist would recommend a course of action: counseling, medication, or a combination of both.

Contrast this with cognitive behavior therapy (CBT), a form of treatment intervention first used in the 1970′s. Unlike Freudian theory- the belief that negative moods and behaviors are the result of unconscious forces from one’s past- proponents of cognitive therapy believe that distorted thoughts and beliefs are the major causes of depression, bipolar disorder and other forms of mental illness. And though all psychotherapy has cognitive components, CBT focuses exclusively on cognitive experiences (“Cognitive Therapy for Depression”; http://www.aafp.org/afp).

The fundamental principle behind cognitive therapy is that a thought precedes a mood, and that both are interrelated with a person’s environment, physical reaction, and subsequent behavior.5 It naturally follows, then, that if one can change his or her way of thinking, behavior, mood and physical reactions will also be altered- hopefully for the better.

CBT identifies- and deals with- the following cognitive factors in depression:

  • Self-evaluation, which is generally negative and critical

  • Awareness of a skill deficit, coupled with negative self-evaluation

  • Negative evaluation of life experiences

  • Negative self-talk

  • Consistent and negative automatic thoughts

  • Irrational ideas and beliefs

  • Overgeneralizing about inconsequential mistakes

  • Cognitive distortion- a distorted view of the world around us

  • Pessimistic thinking

(Source: Cognitive Therapy for Depression. Http://www.psychologyinfo.com).

CBT treatment consists of several steps during which the patient:

  1. Accepts that some of his or her perceptions and interpretations of reality may be false… and that these interpretations lead to negative thoughts.

  2. Learns to recognize the negative thoughts and discovers alternative thoughts that reflect reality more closely.

  3. Decides internally whether the evidence supports the negative thought or the alternative thought.

  4. Learns how to “re-frame” deeply held or core beliefs about self and the world.

(Source: Rupke, Stuart, Blecke, David, Renfrow, Marjorie; “Cognitive Therapy for Depression.” http://www.aafp.org/afp).

Studies show that CBT effectively treats depression, and that its results are comparable to the use of antidepressants and interpersonal or psychodynamic therapy. Furthermore, the combination of medication and CBT has been very effective in relation to eating disorder treatment, and management of severe and chronic depression.

Cognitive therapy reduces relapse rates in patients with depression, as well as being an effective treatment for adolescent depression (American Family Physician, 2006; 73:83-6, 93. American Academy of Family Physicians).

Apart from the clinical evidence supporting CBT, one other important point must be stressed. Cognitive therapy is participatory in nature- the patient being emotionally and intellectually engaged in the process of his or her recovery. Every step of the way, the therapist is leading the patient along:

  1. First by raising his or her awareness of their actions;

  2. Then the thought that preceded the action;

  3. Followed by a judgment on the patient’s part about the validity of said thought.

The bottom line? The longer the patient continues having success with CBT, the more empowered he or she becomes. And when a person knows that they have helped make themselves well- by becoming more cognizant of their own thoughts, actions and beliefs- they are less likely to suffer a relapse.

In summary, CBT – or Cognitive Behavior Therapy – has proven to be a most effective alternative depression therapy. Not only does it enhance the effects of antidepressant medication, but it also effectively treats unipolar major depression and adolescent depression, as well as managing relapse and residual symptoms.

References

1. Scott, J. Cognitive Therapy of Affective Disorders: A Review. J Affect Disord 1996; 37: 1-11.

2. Keller, MB; Klerman, G.L.; Lavori, P.W.; Coryell, W.; Endicott, J.; Taylor, J. Long-term Outcome of Episodes of Major Depression. JAMA 1984; 252: 788-92.

3. Ramana, R.; Paykel, E.S.; Copper, Z.; Hayhurst, H.; Saxty, M.; Surtees, P.G. Remission and Relapse in Major Depression. Psychol Med 1995; 25:1161-70.

4. Evans, M.D.; Hollon, S.D.; DeRubeis, R.J.; Piasecki, J.M.; Grove, W.M.; Garvey, M.J.; et al. Differential Relapse Following Cognitive Therapy and Pharmacology for Depression. Arch Gen Psychiatry, 1992; 49:802-8.

5. Beck, A.T. Cognitive Therapy and the Emotional Disorders. New York: International Universities Press, 1976.