CBT for Depression: How It Works, Examples, & Effectiveness

How Does CBT Help Depression?

Cognitive behavioral therapy (CBT) is a type of psychotherapy that uses a combination of cognitive and behavioral approaches to reduce depression.¹ CBT therapy for depression focuses on changing a person’s feelings to help improve their thoughts and behaviors. CBT therapists may challenge depressive thinking patterns that lead to inaction or self-harming behaviors.

Cognitive Methods to Change Depressive Thinking Patterns

Cognitive methods teach you to challenge negative or irrational thoughts, eventually reducing their power over you. Techniques like cognitive restructuring can help you understand your thought patterns, the emotion behind them, and the actual reality of the situation. A therapist can help present a more realistic perspective to help reduce cognitive distortions. You can also use the free CBT for depression worksheet below to practice cognitive restructuring.

A common cognitive distortion among those with depression is “mind reading,” where you believe you know what others are thinking. By challenging this and other depressive thoughts, you can build a healthier pattern of thinking and self-talk.^{1, 2}

Types of CBT for Depression

Cognitive behavioral therapy is not only a treatment type, but it is also the main branch for a number of different therapy styles. There are three common types of CBT used for depression symptoms and episodes.

Along with standard CBT, here are three other common types of CBT used for depression:

Acceptance & Commitment Therapy (ACT)

ACT engages a number of techniques to increase someone’s mental flexibility. ACT for depression can help with reducing the difficulties of negative thoughts and self-talk, anxiety, and judgment, and increase the individual’s ability to focus.

ACT techniques include strategies for each of these pillars:⁹

• Acceptance: allowing a thought or feeling to exist without judging it or pushing it away
• Mindfulness: encouraging the individual to be able to focus on the present
• Commitment to behavioral change: if something is not in line with the meaning or values the individual holds, then change this behavior to meet that value

Dialectical Behavioral Therapy (DBT)

Similar to ACT, DBT helps people learn how to accept difficult feelings and thoughts. In addition, DBT for depression teaches how to balance between the ability to accept and address irrational thoughts and behaviors to be able to make healthy and maintainable changes in their ability to cope with life’s stressors.⁹

DBT is most frequently used to treat those with borderline personality disorder (BPD). However, it was initially developed to treat people who had frequent suicidal thoughts. In addition, those with BPD or bipolar disorder engage in significant amounts of self-harm—regardless of suicidal intent—that can be seen in depressive episodes across disorders.

Rational Emotive Behavior Therapy (REBT)

In treating depression, rational emotive behavioral therapy (REBT) uses the approach of utilizing the desire to feel happy or fulfilled to reduce depressive symptoms. The REBT approach uses many CBT techniques for depression to help people change their thought processes, helping to create healthier behavior patterns, and eventually helping someone move out of their depressive thoughts and behaviors.¹⁰

REBT was created with the idea that individuals make choices in their lives to meet needs that allow them to survive and feel fulfilled. In turn, REBT teaches individuals how to address irrational and unhealthy behaviors and thoughts so that they can change them for a more functional and fulfilling life.

Behavioral Methods

Behavioral methods are highly effective in treating depression. They typically involve rewarding yourself for small behavioral changes. For example, depression can cause a lack of motivation or low energy. By rewarding yourself for engaging in a task like putting away a dish or two, you change the chemical outputs in your brain. Adding a reward makes you more likely to repeat the behavior in the future.¹

CBT employs several methods to reduce the power of not engaging in behaviors as well, like reducing self-harming or self-sabotaging behaviors that often accompany depression.

What Types of Depression Can CBT Treat?

Cognitive behavioral therapy for depression can be an effective treatment for various depressive disorders and episodes that may be impacting your life, especially in the mild to moderate range of symptoms.³

CBT can be effective in treating these types of depression:³

• Major depressive disorder (clinical depression)
• Persistent depressive disorder (PDD)
• Seasonal affective disorder
• Postpartum depression
• The depressive episodes of bipolar disorder
• Situational depression
• Schizoaffective disorder, depressive type

9 Common CBT Techniques for Depression

Common CBT techniques used for depression include cognitive restructuring, thought journaling, and mindful meditation. Many of these techniques are used together to show the connections between thoughts, emotions, and behaviors.

Here are nine common CBT techniques for depression:²

1. Cognitive Restructuring

In challenging your thought patterns, tone, and self-talk, you learn about potential cognitive distortions and unhealthy thought patterns that could be increasing depressive emotions or suicidal thoughts. Cognitive restructuring, sometimes called reframing, forms healthier thought patterns, reduces cognitive errors, and helps you practice ways to rationalize distortions and untrue beliefs.

Here’s how to try the five steps to cognitive restructuring:

• Set up your list: draw a line down the middle of a piece of paper. Title the left-hand column “Unproductive Thoughts” and title the right-hand column “Replacement Thoughts.”
• Write down your unproductive thoughts: on the left-hand side of your paper, list your negative and self-critical thoughts, or any automatic thoughts you have regularly that make you unhappy, something like “I can’t do anything right.”
• Identify your replacement thoughts: for each of your unproductive thoughts, create a replacement thought and write it down on the right side of your paper, such as “Here’s a project I did well.”
• Review your list regularly: so you begin to memorize the unproductive thoughts and their replacement thoughts.
• Notice your thoughts in real time: pay attention to your thoughts throughout each day. When you think of one of your unproductive thoughts, stop yourself and remind yourself of the replacement thought. With practice, you’ll begin to challenge your unproductive thoughts and naturally start to replace them with rational ones.

2. Activity Scheduling

Activity scheduling involves rewarding yourself for scheduling activities that encourage positive experiences and self-care. By scheduling these activities and rewards, you learn to motivate yourself to complete necessary tasks even when you are feeling low. It also increases the chances of continuing to complete these tasks after you end your formal therapy sessions.

3. Thought Journaling

By journaling for mental health, exploring things like your emotions, thoughts, and behaviors, you create a space to process and identify any potential triggers, as well as how your thoughts have been influencing your behavior. This can increase self-awareness and help you learn coping techniques to use in the future.⁴ You can also use specific journal prompts for depression to understand more where your beliefs and moods have been coming from.

4. ABC Analysis

Similar to journaling, the ABC model is solely focused on breaking down the behaviors that are related to depression, like snapping at people or sleeping all day. In analyzing your triggers and consequences, you can explore the “consequential” behaviors and look to find common causes in your depressive triggers.

The ABC model works by using the following structure:

• The “Activating” event
• Your “Beliefs” about that event
• The “Consequences” of the event, including your feelings and behaviors surrounding the event

5. Fact-checking

Fact-checking encourages you to review your thoughts and understand that, while you may be stuck in a depressive or harmful thought pattern, these thoughts are not facts but opinions based on your emotions (e.g., “I am a failure”). Fact-checking can also help you identify what behaviors you engage in due to your opinions or emotions instead of the actual facts.

6. Successive Approximation or “Breaking It Down”

Breaking down large tasks into smaller goals will help you feel less overwhelmed. By practicing successive approximation, you will be more likely to complete your goals and be better able to cope with large tasks in the future, even during times when your depression is heightened.

7. Mindful Meditation

By engaging in meditation for depression, you will learn to reduce focus on negative thoughts and increase your ability to remain in the present. Meditation can help you recognize and learn to accept your negative thought patterns and detach from them instead of letting them take over.

8. Behavioral Experiments

Therapists use behavioral experiments as a tool for challenging irrational thought patterns that may be contributing to your depression. You’ll learn how to replace these thoughts with healthier thoughts. By engaging in these experiments, you can spot and learn to stop catastrophic thinking and develop a more realistic view of the world.

9. Role Play

Your therapist may have you role play a specific situation you find challenging. You will act out the situation alongside the therapist, while learning to practice healthier responses and depression coping mechanisms. Role playing helps you gain a better understanding of your emotional responses and how to manage your reactions in a real-life situation.

Examples of CBT for Depression

CBT uses cognitive and behavioral techniques to improve depression symptoms, but the exact CBT treatment plan for depression might depend on the type of depression someone is experiencing.

CBT For Major Depressive Disorder (MDD) Example

Jody, a 35-year-old female, has recently started to feel tired all the time. This began about two and a half weeks ago. Along with “sleeping all the time,” she reports these other symptoms that all started around the same time.

Those symptoms include:

• Experiencing negative thoughts
• Constantly worrying about different aspects of her life
• Finding it difficult to stay still
• Does not have an appetite
• Has generally been feeling sad, hopeless, irritable, and numb

She reports that she had also felt this way in her teens and mid-20’s; and she also experienced brief suicidal thoughts in her 20’s.

Jody began meeting with her therapist and the therapist diagnosed major depressive disorder after they finished their assessment. During sessions, her therapist began asking her to think about what thoughts are making her feel sad and to change her thought process. She also recommended journaling every day.

Part of the journaling homework includes documenting something that she chose to do to make her feel happy or productive daily, a CBT technique called behavioral activation. When Jody started reporting an increase in her worry and rumination, the therapist encouraged her to add meditation to her daily work, to help reduce the incessant worrying and increase calm in Jody’s mind.^{1, 5}

CBT For Persistent Depressive Disorder (PDD) Example

Matt, a 28-year-old male, has been experiencing a low and depressed mood, difficulty sleeping, low self-esteem, and difficulty with concentration for the last two and a half years. He works a difficult job and felt it was related, but was informed by family that they noticed this low-grade depression even when he was in less stressful positions.

Matt reached out to a therapist, who diagnosed him with persistent depressive disorder (dysthymia).^{1, 5, 6, 7} His therapist began working with him on journaling about his day on a regular basis, especially if something made him happy. The therapist encouraged him to write down and challenge his negative and irrational thoughts.

Matt and his therapist also worked on noting triggers for aggressive thoughts towards himself to increase his awareness. Matt’s therapist began encouraging him to engage in problem-solving tasks to help him function and build resilience when his depressive symptoms flared up.¹

CBT For Seasonal Affective Disorder (SAD) & Situational Depression Example

Jamie, a 37-year-old male, began experiencing depressive moods, difficulty concentrating, increased fatigue, lowered energy, feeling tense, and negative thoughts in his early 20’s. He reports that he never reached out for help because even if the symptoms tended to start in October to November almost every year, they always stopped around March.

This year, Jamie’s symptoms began around the same time, although he noticed that his negative thoughts were worse than normal and that his sleep schedule was off. As a result, he reached out to a local therapist, who diagnosed Jamie with “unspecified depressive disorder with seasonal pattern,” which is more commonly known as seasonal affective disorder (SAD).⁷

Jamie’s therapist began working with him to reduce the impact of his symptoms by having him engage in regular meditation to reduce his anxiety and challenge his thoughts outside of session to reduce the negative thought patterns impacting his perspective.

They also worked together to create a daily schedule of activities to help increase self-fulfillment and self-care, and journaling to increase acknowledgement of positive things during the difficult season, as well as to track Jamie’s mood.^{1, 5, 7}

CBT For Postpartum Depression Example

Julia, a 32-year-old female, had her baby about three weeks ago. About two weeks ago, Julia began experiencing significant levels of anxiety, panic attacks, low mood, feelings of depression and worthlessness, and loneliness. This was Julia’s first child and she had never experienced these feelings before, nor had anyone else in her family.^{1, 7}

Julia sought out a therapist to figure out her feelings and was diagnosed with “unspecified depressive disorder with peripartum onset,” more commonly known as postpartum depression. Her therapist knew that research indicated that CBT had improved long- and short-term symptoms of depression and had some impact on anxiety in postnatal depression.⁸

Julia’s therapist encouraged her to journal her feelings each day to increase awareness as well as acknowledge the positive things she was doing.

She also had her engage in a daily short meditation and breathing regulation technique to lower anxiety and panic attacks, engage in gratitude practices with her journaling to increase her mood and lower depressive symptoms, and to discuss her emotional concerns with her support system and partner to allow herself time to meet her own needs.

Julia was encouraged to explore her thought patterns influencing the anxious thoughts, especially leading up to panic attacks, to help reduce anxiety and become more aware of her triggers to be able to feel comfortable with her baby.^{4, 9}

How Effective Is CBT for Depression?

Cognitive therapy can be as effective as depression medication in initially treating moderate to severe depression, although its success often relies on the therapist’s level of experience. Studies show that when CBT is delivered by skilled therapists, it can lead to substantial improvements in depressive symptoms.¹¹

Other research studies have proven the effectiveness of CBT for depression:

• Studies show that the behavioral activation techniques used in CBT are useful in the treatment of those with severe depression.⁵
• When compared to antidepressant medication, CBT alone may be effective in continued recovery for depression.⁵
• Cognitive therapy shares efficacy with medication in treating moderate to severe major depressive disorder, although this can be impacted by the level of the therapist’s experience with CT/CBT.¹¹
• CBT was found to be an effective intervention in lowering depressive symptoms and depression relapse rates, especially in comparison with a control group.¹²
• A study on bipolar disorder, including depressive episodes and symptoms, found that the group with CBT treatment had fewer bipolar episodes, shorter bipolar episodes, and less hospitalization admissions. In addition, this group’s depressed mood and mania symptoms were noted to be significantly lower.¹³

What to Expect During CBT Treatment

Those seeking CBT for depression will typically attend 12-20 weekly sessions, although many will experience improvements after just a few sessions. CBT treatments can be done in-person or with a CBT therapist online.¹⁴ Most insurance companies cover CBT to help reduce the cost, but if paying out of pocket, you can expect to pay between $100 and $200 per session.

While CBT may involve some rigor and homework, CBT treatment was intended to be short-term to allow people to thrive with the help of their therapist, but then on their own. Each CBT session will generally last about 50 to 55 minutes, and happen once a week. The format of each session is usually quite structured.

Each CBT session consists of:¹³

• Setting a goal or a problem to process for that day
• Working on the problem reported (this might include processing barriers in the problem as well as the person’s thoughts on these)
• Creating an action plan to address the problem in and out of session
• Measuring the person’s movement on the problem (like discussing homework, a reported issue, communication, etc.)

While this may not always be the case in a CBT treatment plan or the model of every single session, this is the expectation for treatment. Your therapist may take some different approaches, but CBT treatment tends to be short-term and active in attempting to reduce the impact of your mental health symptoms on your life.

How to Find a CBT Therapist

If you’re wondering how to choose a therapist, ask your primary care provider or a trusted loved one for a list of recommendations. You can also search a local therapist directory to find a licensed CBT provider in your state who specializes in CBT for depression. Many therapists now offer video-based therapy that has enabled many people to get CBT online.

If you’re ready to begin online CBT, Online-Therapy.com is an excellent choice for those without insurance. There are also several online therapy options that take insurance.

At-Home Cognitive Behavioral Therapy Exercises For Depression

While you should always seek help from a professional if you think you may have depression, there are CBT exercises you can try on your own or through the use of CBT apps to help relieve mild symptoms, like journaling, scheduling out activities you enjoy, and starting a gratitude practice. A therapist can also help you develop these techniques so you’ll be prepared when depressive symptoms arise.

Here are some at-home CBT exercises for depression:³

Journal

Even if you aren’t seeing a therapist, keeping a journal of your thoughts, feelings, and behaviors can be helpful. Through writing in a notebook or through a journaling app like the Sensa app, you may begin to learn more about yourself and identify difficulties that regularly impact you. This way, you can prepare for them in the future.⁴

Schedule Enjoyable Activities

Have events scheduled that improve your mood, like concerts, lunch dates with friends, or road trips. Even on a smaller scale like making a general to-do list, scheduling can inspire you to keep moving forward.

Try Meditation

Meditation can be helpful in managing your emotions, decompressing, and even falling asleep. It has been proven to help with addiction, depressive disorders, anxiety disorders, and more. If you’re not sure where to start, using  meditation apps and free videos available online can help you clear your mind and connect to the present.

Practice Challenging Your Thoughts

You might want to start this practice in a journal, but it is also helpful to challenge or reframe your thinking in the moment. By reframing thoughts or saying affirmations in your head, you may be able to learn to stop negative thoughts in their tracks.

Start a Gratitude Practice

It might feel difficult at times, but it’s helpful to identify the positives in your life. One study showed that the use of gratitude helped to significantly reduce continuous negative thought processes (and reduced the risk of negative thoughts in individuals experiencing anxiety and depression).¹⁴ It can help to try writing three things you’re grateful for every day.