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How does Cognitive Behavioral Therapy (CBT) help Depression?

CBT was developed in the sixties as a new treatment approach for depression.1 Depression is a very common and debilitating condition. More than one out of eight people will have an episode of depression in a lifetime and the majority of the patients who have an episode of depression end up having at least one more episode later in life.2 Depression involves losing motivation and interest in things, a decreased ability to enjoy life, and feeling sad or down. People suffering from depression may also have low energy, problems sleeping, too much or too little appetite, feelings of guilt and thoughts about death or even suicide.3 Depression can drastically affect somebody's ability to function interpersonally, socially, and at work. It affects the lives of the sufferers, their families and caregivers, and their employers and coworkers. From a broader view, it has a negative impact on the functioning of society at large.4

There are many effective treatment options for depression,5 including medications, CBT and other forms of psychotherapy. In the case of patients with mild or moderate major depression, CBT by itself has repeatedly been shown to help. In the case of patients with severe major depression, it has been shown to be an effective treatment in conjunction with pharmacological treatment.6-10

The CBT approach to treating depression can be divided into its cognitive and behavioral components. In the cognitive component of treatment, therapist and patient learn to identify the distorted negative thinking that causes negative emotions. 11 Then they question the veracity of these thoughts and come up with alternative balanced thoughts. They also learn about the patient's core beliefs underlying the daily automatic negative thinking. For example, a depressed patient may have the core belief "I am a loser;" when he gets some less than ideal feedback at work he starts having rather drastic thoughts like "I won't be able to finish this task," or "the work I am doing is worthless," or "I'm going to get fired." Almost simultaneously with these negative thinking he starts feeling down, with very low motivation and energy. When he starts undergoing CBT treatment he learns to come up with more balanced thoughts, like "I'm not doing as good a job as I could, but it's not terrible either" or "If I don't improve this level of productivity I could end up getting fired, but I know I can improve it." As a result of this more realistic assessment of the situation, the patient will not feel so depressed. Furthermore, therapist and patient will have the opportunity to question the underlying core belief "I am a loser." Where did that idea come from? What evidence is there for or against it?

In the behavioral component of treatment, the therapist helps the patient assess how the different daily activities have an impact on the patient's mood and how some of them can improve symptoms of depression. Therapists usually help patients develop an action plan, based on the behavioral activation approach.12 In this approach the therapist and patient create a list of activities and then they order them from less to more difficult to achieve. As the patient goes from easier to harder activity his feeling of mastery improves as depression lessens.

Practicing CBT skills with exercises at home is an essential component of treating depression with CBT. Repeatedly applying these skills to stressful situations makes a more rational approach more automatic and negative emotions less intense.

REFERENCES:
  1. 1 Cognitive behavioral therapy. From Wikipedia, the free encyclopedia. History
  2. 2 Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Kessler RC, Berglund PA, Demler O, Jin R, Walters EE. Arch Gen Psychiatry. 2005;62:593-602.
  3. 3 Diagnostic and statistical manual of mental disorders: DSM-IV-TR. By American Psychiatric Association, American Psychiatric Association. Task Force on DSM-IV.
  4. 4 The economic burden of depression in the US: societal and patient perspectives. Paul E Greenberg, Howard G Birnbaum. Expert Opinion on Pharmacotherapy, March 2005, Vol. 6, No. 3, Pages 369-376.
  5. 5 Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry / Edition 10. Benjamin J. Sadock, Virginia A. Sadock. May 2007
  6. 6 A comparison of nefazodone, the cognitive behavioral-analysis system of psychotherapy, and their combination for the treatment of chronic depression. Keller MB, McCullough JP, Klein DN, Arnow B, Dunner DL, Gelenberg AJ, et al. N Engl J Med. 2000;342:1462-70.
  7. 7 Treatment of major depression with psychotherapy or psychotherapy-pharmacotherapy combinations. Thase ME, Greenhouse JB, Frank E, Reynolds CF III, Pilkonis PA, Hurley K, et al. Arch Gen Psychiatry. 1997;54:1009-15.
  8. 8 A meta-(re)analysis of the effects of cognitive therapy versus 'other therapies' for depression. Wampold BE, Minami T, Baskin TW, Callen Tierney S. J Affect Disord. 2002;68:159-65.
  9. 9 A meta-analysis of the effects of cognitive therapy in depressed patients. Gloaguen V, Cottraux J, Cucherat M, Blackburn IM. J Affect Disord. 1998;49:59-72.
  10. 10 Cognitive Therapy for Depression. Stuart j. Rupke, David Blecke, Marjorie Renfrow. Am Fam Physician. 2006 Jan 1;73(1):83-86.
  11. 11 Cognitive Therapy for Depression. Aaron Beck. New York, New York 1979
  12. 12 Behavioral activation. From Wikipedia, the free encyclopedia.