Cognitive behavioural therapy (CBT) for depression

Cognitive behavioural therapy (CBT) is a form of talking therapy that's used to treat lots of different mental health conditions. It can help people with conditions such as depression learn how to change their typical thought patterns so they have the opportunity to think more positively.

CBT is the result of Dr Aaron T Beck’s research at the University of Pennsylvania in the 1960s. He discovered that many depressed patients experienced negative thoughts about themselves, the world or the future. Beck then began to help people assess these thoughts and think more realistically about how they felt about themselves and the world around them.

Using these findings, early cognitive therapy (CT) and behaviour therapy (BT) methods have developed to become CBT. Today, it is known as the 'gold standard' technique of psychotherapy.

How does CBT treat depression?

If you regularly have negative thoughts as a symptom of depression – things like ‘what is the point of getting out of bed?’ or ‘my colleagues will think I’m worthless no matter what I do' - then attending CBT sessions can be particularly useful.

A therapist will work with you to identify any recurring negative or irrational thoughts you may have, as well as how they affect your behaviours. The will then work towards replacing these beliefs with healthier and more practical thoughts.

Because your attitude towards yourself and your position in the world around you directly impacts how you behave, CBT not only makes you aware of the negative thoughts you're having and how they're affecting your actions, but also allows you to act on them and change your thought patterns, which can lead to more positive actions in your life.

If you often find it difficult to motivate yourself in the morning, for example, you can learn to reflect on these negative feelings, and start thinking more along the lines of 'if I can get out of bed then I know I'll feel the benefits'.

What can I expect from a CBT depression session?

Coming in for your first CBT session can be daunting. It’s understandable to be a little nervous, but once you arrive you’ll quickly realise this is a safe, friendly, clinical environment that has just one objective – helping you to learn how to cope with depression and continue to live a fruitful life.

If you’re wondering what to expect from a CBT session or if you're feeling nervous before your first appointment, a typical CBT session will usually involve the following:

• Meeting your therapist and beginning to explore some of the problems, thoughts or symptoms you're having trouble with
• Outlining what you want to achieve from the CBT sessions with your therapist, and beginning to plan what future sessions will involve
• Taking part in various exercises that help you understand and reflect on how your thoughts are linked to your emotions and behaviours, through diagrams or worksheets
• Practising exercises outside of the session
• Reviewing your progress and recapping on what has previously been learnt

There’s no need to spend hours preparing for therapy or worrying about what might happen, but to get the very best from CBT, there are a few things you can do in advance:

• Try to be as open and honest as possible with your therapist, and think about what that might mean ahead of time. Of course, you can share whatever you like in a strictly confidential environment, but you shouldn’t feel as though you have to hold anything back. Therapists are objective and non-judgemental. The more honest you are, the more likely they are to be able to help you
• When it comes to sessions two, three and beyond, think about how you felt immediately after your last session and how you've felt in between. Take notes at home if you need to. This will help to guide you and your therapist in what you cover in your current session
• Part of the CBT approach asks that you complete behavioural ‘homework’ assignments. If you’ve been given a small task to do at home in between sessions, try to make sure this is ready and be prepared to talk about it

How are CBT depression sessions structured?

Treatment for depression or anxiety usually needs between 10 and 20 CBT sessions. These will be spread out so you attend for an hour each week, for as many weeks as you need to help you get back on track. You’ll work with your therapist or consultant to come to an agreement on the general structure of your therapy sessions.

CBT sessions can be delivered in several ways, including:

• 1:1 - with your therapist face-to-face, over the phone or as part of online therapy
• In a group - where you have the chance to share and learn from other people who are experiencing similar mental health problems
• Practise at home - in addition to 1:1 and group therapy, you may also be asked to work through exercises in your own time and practise these techniques in your day-to-day life

Does CBT work for treating depression?

While you might not notice an improvement in your depression symptoms straightaway, CBT is often cited as the most effective form of talking therapy (otherwise known as psychotherapy) that currently exists.

The industry’s confidence in CBT has grown, as more and more studies are conducted that show how effective it is at treating depression. One example, published in the Lancet in 2016, found that 43% of people who received CBT in addition to their usual care had seen their condition improve over a 46-month period. This compared to 27% of people whose condition improved with their usual care alone (source).

Depending on the severity of your depression, CBT can also be used alongside antidepressant medication, which can help make therapy sessions more effective as your symptoms of depression are reduced.

Because many of the techniques for managing your thoughts and behaviours can be used long-term once you've completed a number of CBT sessions, the effectiveness of this treatment in preventing your depression from returning can help you reduce the impact of depression on your life well into the future.