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Depression and Anxiety Special Report

Could You Benefit From Cognitive-Behavioral Therapy?

Johns Hopkins Health Alerts Depression and Anxiety Cognitive-Behavioral Therapy

Fast, inexpensive, and effective, cognitive-behavioral therapy (“talk therapy”) helps break the pattern of negative thoughts that lead to depression. Learn how cognitive-behavioral therapy works and what kinds of habits it can help break.

Over the past 20 years, cognitive-behavioral therapy has become increasingly popular for the treatment of depression. Like standard cognitive therapy, cognitive-behavioral therapy is based on the idea that mood problems stem from irrational thoughts and that identifying and changing these distorted thought patterns can improve emotional symptoms. In cognitive-behavioral therapy, this theory is combined with the principles of behavioral therapy, which is aimed primarily at modifying specific problematic or unwanted behaviors.

Several factors have contributed to the growing use of cognitive-behavioral therapy by today’s mental health professionals. Because cognitive-behavioral therapy is a short-term treatment -- typically requiring 15 to 20 visits over the course of several months – it’s favored in today’s era of managed health care, which places a high value on its relative brevity and low cost. Moreover, cognitive-behavioral therapy is one of the most heavily researched forms of psychotherapy; hundreds of studies over the past several decades have supported its safety and effectiveness for treating major depression, dysthymia, and anxiety disorders.

How Cognitive-Behavioral Therapy Works

Therapists who practice cognitive-behavioral therapy employ a variety of techniques, but they all have certain common goals. Unlike many other forms of psychotherapy, cognitive-behavioral therapy focuses specifically on the patient’s present problems rather than delving into the underlying causes for these problems (for example, childhood conflicts). For this reason, cognitive-behavioral therapy often produces relatively quick and tangible results. Cognitive-behavioral therapy involves simple, structured exercises to change distorted thoughts and inappropriate behaviors; it also includes “homework” assignments so that patients can practice and reinforce in their everyday lives what they have learned. For cognitive-behavioral therapy to be successful, patients must be motivated and willing to put in hard work, both during and outside of the regular therapy sessions.

People with depression tend to make a number of negative or pessimistic assumptions about themselves, the world, and their future. Over time, responses to these assumptions become automatic. For example, depressed patients are often plagued by faulty thought patterns such as all-or-nothing thinking (“If I can’t make dinner for my family, then I’m a bad person”), personalization (feeling irrational guilt for external events: “It’s my fault that my grandson’s soccer team didn’t win”), overestimating the negative (“I was five minutes late for my appointment, so the doctor isn’t going to treat me anymore”), or discounting the positive (“The only reason my daughter visits me is because she feels she has to”).

According to the principles of cognitive-behavioral therapy, these errors in thinking lead to depressive feelings and self-defeating behaviors. By helping patients to identify and change faulty thoughts and behaviors, cognitive-behavioral therapy helps to alleviate the depression. These changes can be seen as well as felt: A study published in the Archives of General Psychiatry found that people who respond to cognitive-behavioral therapy have changes in two areas of the brain that regulate emotions -- increased activity in the limbic system and decreased activity in the cortex.

Cognitive-Behavioral Therapy, Step By Step

The first step in cognitive-behavioral therapy for depression is to help patients identify distortions in thinking. Patients are typically instructed to keep a written log of any negative thoughts or bouts of intense unhappiness as well as when and where they take place throughout the day. This written record is a valuable tool. It not only helps patients to understand how common their negative thoughts and behaviors are and what situations trigger them but also is useful for monitoring improvements in their occurrence.

Next, patients learn to replace irrational thoughts with reasonable ones. This does not mean they are taught to “always think happy thoughts;” instead, patients learn to ask themselves questions to test the validity of their thinking (for example, “Does my son visit me because he thinks he has to, or does he really care about me?”). Thus, patients learn to analyze their distorted thoughts objectively until they eventually gain control over them. Although this process is primarily an intellectual one at first, over the course of therapy, it gains emotional resonance.

In addition, cognitive-behavioral therapy for depression usually begins with simple behavioral exercises, because it’s generally easier to change abnormal behaviors than to alter long-held thought patterns. Together, patient and therapist establish concrete goals and structure exercises to meet these goals. In one common behavioral technique, called “graded task assignment,” activities that overwhelm the patient are broken down into smaller, more manageable steps to be accomplished one at a time.

Another common approach is positive reinforcement, in which patients reward themselves for making healthy changes. This method often helps to alter negative habits associated with depression, such as overeating, staying in bed, or becoming socially isolated. In mild depression, cognitive-behavioral therapy is often effective on its own. In moderate to severe depression, it should be combined with medication for more effective treatment. Severely depressed patients may be unable to do the work required for cognitive-behavioral therapy; once they begin improving, however, cognitive-behavioral therapy may be a useful adjunct therapy.

  • For more Depression & Anxiety articles, please visit the Depression & Anxiety Topic Page

    Posted in Depression and Anxiety on April 13, 2006

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