Cognitive behavioral therapy (CBT) is a brief, goal-based, semi-structured form of psychotherapy that approaches mental health from a problem-solving perspective, aiming to lessen negative or unhelpful thoughts and behaviors. Weekly sessions, which are generally about 50 to 55 minutes, have been observed to be effective in the treatment of many types of depressive disorders.
Central Concepts of Cognitive Behavioral Therapy (CBT)
The basis or foundation of CBT is the connection between emotions, thoughts, and actions. The goal is to help you learn and apply coping mechanisms that challenge negative thoughts, actions (especially harmful behaviors), beliefs, and attitudes.1,2 Its core focus is on helping you take what you learn in sessions and check-ins and apply it to your outside life.
How Can CBT Help With Depression?
CBT uses a combination of cognitive and behavioral approaches to reduce your depressive symptoms.3
Cognitive Methods
Cognitive methods teach you to challenge and rationalize negative thoughts, eventually reducing their power over you. When using cognitive restructuring and other similar techniques, you will study the thought, the emotion or trigger behind it, and the reality of the situation. Then, you will consider a more rational or realistic perspective to help reduce cognitive distortions like “mind-reading,” a common distortion where you believe you know what others are thinking. By challenging these thoughts, you build a healthier pattern of thinking and self-talk (what you tell yourself in your head).3,4
Behavioral Methods
Behavioral methods are a highly effective form of clinical treatment for depression that require you to reward yourself for small behavioral changes. For example, depression can cause a lack of motivation or low energy. By rewarding yourself for engaging in a low-level task like putting away a dish or two, you change the chemical outputs in your brain. Doing so makes you more likely to repeat the behavior in the future.3 CBT employs other behavioral methods to reduce the power of not engaging in behaviors as well.
7 Common CBT Techniques for Depression
Common CBT techniques used for the treatment of depression include cognitive restructuring, thought journaling, ABC analysis, fact-checking, “breaking it down,” and mindful meditation. Many of these techniques are applied to show the connections between thoughts, emotions, and behaviors.
Here are seven common CBT techniques commonly used for treating depression:
- 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. You form healthier patterns, reduce cognitive errors, and learn ways to rationalize distortions by engaging in this technique.1,3
- Activity scheduling:This is rewarding yourself for scheduling low-level activities that encourage positive regard and self-care. By scheduling, you learn to motivate yourself to complete tasks even when you are feeling low. It also increases the chances of continuing to complete these tasks.3
- Thought journaling: By journaling about your emotions, thoughts, and behavior, you create a space to process and identify the trigger, as well as how the thought influenced your behavior. This can increase self-awareness and help you learn coping techniques to use in the future.1
- ABC analysis: While similar to journaling, this skill is solely focused on breaking down the behaviors that are related to depression like snapping at people or sleeping all day. In analyzing the triggers and consequences, you explore the behaviors and break them down for common causes.1
- Fact-checking: This encourages you to review your thoughts and understand that while you may be stuck in a depressive and/or harmful thought process, these thoughts are not facts but opinions based on emotion (e.g., “I am a failure.”). In doing so, you also explore unhealthy influences.1,3
- Successive approximation or “breaking it down:” Breaking down large tasks into smaller items will help you feel less overwhelmed. You will be more likely to complete the task and better able to cope with large tasks in the future, even if your depression is heightened.3
- Mindful meditation: By engaging in guided or short meditations, you will reduce focus on negative thoughts and increase your ability to remain in the present. By reducing how often you’re plagued by negative thoughts about the present, you will begin to feel more positive about it.3
Examples of CBT for Depression
CBT was created to treat depressive symptoms, but it has become the root of a number of techniques used to treat many different disorders. Depression itself encompasses several disorders, including major depressive disorder (MDD), persistent depressive disorder (PDD), bipolar disorder, seasonal affective disorder, and reactive or situational depression.
Major Depressive Disorder (MDD)
If you have MDD, cognitive restructuring, successive approximation, journaling, behavioral activation, and mindful meditation can all effectively decrease symptoms.3,5 Each of these techniques may be applied regularly during your once-a-week session. You may also be required to practice at least one of these outside of the session through journaling or symptom monitoring. This encourages you to challenge your thoughts, break down tasks when feeling overwhelmed, manage and pull away from negativity and rumination, and increase enjoyable or necessary activities throughout the week.
Persistent Depressive Disorder (PDD) or Dysthymia
For those struggling with PDD or dysthymia, techniques like cognitive restructuring, journaling, problem-solving, and mindful meditation can reduce symptoms.3,5,6 Each of these techniques may be reviewed at every session (or every other session) as part of your “homework.” By engaging in cognitive restructuring, journaling, and mindful meditation each week (or daily, if needed), the hope is to reduce depressive emotions and increase positive emotions. Plus, engaging in problem-solving techniques can help you build resilience.3
Bipolar Disorder (Type I or II)
By applying a combination of techniques from CBT and dialectical behavior therapy (DBT), a form of CBT, you can reduce mood swings, increase management of symptoms, reduce risk to your safety, and increase stability in your livelihood. DBT is a highly structured program that can go on for a year or longer. It generally includes at least one weekly 50-minute individual session and multiple weekly two-hour group sessions. In some cases, DBT is provided without the group, but still teaches mindfulness skills.3,7
Seasonal Affective Disorder (SAD) & Situational Depression
SAD and situational depression can be treated with mindful meditation, journaling, some cognitive restructuring, and activity scheduling.3,5As symptoms tend to be more mild, these techniques—when used on a regular basis—will help you decrease negative emotions and thoughts and stay in the present moment They also remind you that emotions are temporary. Meditation and journaling can be especially effective if you’re struggling with a specific situation like the anniversary of the death of a loved one.
Is CBT Effective for Depression?
In 2014, it was reported that the behavioral activation techniques used in CBT were useful in the treatment of those with severe depression. Studies also identified that when compared to antidepressant prescription, CBT on its own may be effective in continued recovery and response.5 CBT may also be helpful in the treatment of anxiety disorders.8
How to Find a CBT Therapist
If you’re looking for a CBT therapist, ask your primary care provider or a trusted family member for a list of recommendations. If you’d prefer, you can search through an online directory like Choosing Therapy. This will guide you through the process of identifying the preferred type of therapist, counselor, social worker, or psychologist in your area. Remember to look for proof of licensure when exploring your best fit. Some therapists or counselors prefer CBT treatment but haven’t gotten the certifications yet.
5 At-Home CBT Exercises For Depression
Here are five at-home CBT exercises for depression:
- Journaling: Even if you aren’t seeing a therapist, keeping a journal of your thoughts, feelings, and behaviors can be helpful. Through writing and monitoring, 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.1
- Scheduling enjoyable activities: Have things scheduled that improve your mood like concerts, lunch dates with friends, or road trips. Even on the smaller scale of making a general to-do list, scheduling can inspire you to keep moving forward.1
- Meditation (guided or music): 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. There are many apps and free videos available online that can help you clear your mind and connect to the present.1
- Practice challenging your thoughts: Although you could use your journaling to do this, it is helpful to challenge or reframe your thinking in the moment. By processing contrasting thoughts or affirmations in your head, you may be able to learn to stop negative thoughts in their tracks.1
- Practice gratitude: It might feel difficult at times, but it’s helpful to identify the positives in your life. Gratitude is highly effective for lessening depression, especially if used daily. Try to write down three things you’re grateful for every day.1
Final Thoughts on CBT for Depression
If you are experiencing depression of any kind, CBT can help in so many ways. In accessing CBT services, whether through a therapist or by practicing at-home skills, you can start feeling a bit better and getting back to the things that are most important to you.
