Depression and Cognitive-Behavioral Therapy (CBT)
Cognitive behavioral therapy (CBT) was developed in the 1960s by Aaron T. Beck. CBT aims to change a person’s maladaptive behaviors through identifying and changing distorted thought patterns and negative emotional responses. Treatment is done through conversation and collaboration between the patient and the therapist. CBT has received an incredibly substantial amount of empirical study, validation, and clinical application.
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Effect of Cognitive-Behavioral Therapy (CBT) on Depression
Cognitive behavioral therapy (CBT) works to treat depression by changing an individual’s faulty information processing and negative belief systems1. CBT views depression as rooted in unhealthy thought patterns, such as blaming oneself for negative events or generalizing the negativity of one situation to a wide range of unrelated situations. The desired outcome of CBT is to enable the individual to create healthier interpretations of situations, thus enabling them to react appropriately to people.
CBT can be distinguished by the detailed structure of each session with its specific agendas, and the very deliberate therapeutic style in which the therapist interacts with the patient by asking a series of questions. This type of therapy encourages patients to examine negative styles of thinking and behaving that may be contributing to their depression. During sessions, the patient and the therapist will define problems, identify assumptions, determine significance of events, and point out the disadvantages of retaining negative beliefs and behaviors. This way, erroneous views can be evaluated and disconfirmed. This collaborative process is called “hypothesis-testing”4. The therapist assists the patient in developing new skills to increase awareness of and ability to alter maladaptive thought processing. In the final sessions, patients are asked to imagine themselves in difficult situations and describe their decision-making processes.
General guidelines suggest 15 to 25 (50 minute) sessions at weekly intervals with a psychologist or therapist at weekly intervals, with more seriously depressed clients usually requiring twice-weekly meetings for the initial 4-5 weeks. To avoid an abrupt termination, a “tapering-off” process is recommended, wit the last few sessions occurring once every 2 weeks. After termination, some clients may also need a few “booster sessions” (4 or 5 are common).
Research Evidence on Cognitive-Behavioral Therapy (CBT)
Cognitive behavioral therapy has shown to be effective for mild to moderately severe acute depression2. Furthermore, despite a limited amount of studies, beneficial results have also been found in treating depressed inpatients with cognitive behavioral therapy.
Some studies suggest that CBT is just as effective as antidepressant medications3.
Outcome research has consistently found that cognitive therapy is at least as effective as tricyclic antidepressants (TCAs) in the treatment of outpatients with non-bipolar depression at the termination of treatment. In one group of studies, the mean percentage changes in the level of depression for such outpatients immediately after treatment were as follows: 66% for those receiving CBT alone, 63% for those treated with TCAs alone, and 72% for patients receiving some combinations of the two. Researchers (Gloaguen, Cottraux, Cucherat, & Blackburn, 1988) commenting on the results from a recent meta-analysis of clinical trials conducted between 1977 and 1996 concluded that “… cognitive behavioral therapy has been demonstrated effective with patients with mild or moderate depression and its effects exceed those of antidepressants”. A study by Hautzinger and de Jong-Meyer (1996) found CBT to be an efficient, short and long-term alternative to the standard drug treatment of patients with a major depression or dysthymic disorder. Hautzinger and de Jong-Meyer (1996) concluded, “Drug treatment along produced more drop-outs and less clinically significant responders than CBT along or the combination treatment”.
Side Effects and Warnings
While there are no serious side effects stemming from Cognitive Behavioral Therapy, CBT is not for everyone and another type of treatment may work better for different individuals. CBT is also not a quick fix. A therapist is like a personal trainer that advises and encourages - but cannot 'do' it for you. This will take an investment of time and money on the individual’s part. Moreover, if you are feeling low energy, depressed, or anxious, it can be difficult to concentrate and get motivated and CBT relies on the individual engaging with the process, trying new strategies, and completing “homework” in between sessions. You need to have a certain degree of motivation to benefit from CBT. Lastly, to overcome anxiety or any other psychological disturbance, you need to confront it. This may lead you to feel more anxious for a short time.2 However, if you are able to tolerate this, you may benefit from CBT and ultimately feel some relief from your symptoms. A good therapist will pace your sessions. You decide what you do together, so you stay in control and take on what you feel comfortable with.
Panic disorder, phobias
1 DeBaffista, C. (1997). Medical Management of Depression. Durant: EMIS, Inc.
2 Scott, J. (2001). Cognitive Therapy for Depression. British Medical Bulletin, 57. Oxford University Press.
3 Elkin, I., Shea, M. T., Watkins, J. T., et al (1989) National Institute of Mental Health Treatment of Depression Collaborative Research Program. General effectiveness of treatments. Archives of General Psychiatry, 46
4 Hollon, SD & Garber, J. (1980). A cognitive-expectancy theory for helplessness and depression. Human Helplessness: Theory and applications. New York: American Press.
5 Beck et al., 1979; Blackburn & Bishop, 1979, 1980; McLean & Hakstian, 1979; Rush, Beck, Kovacs, & Hollon, 1977.