Cognitive behavioral therapy is one of the most extensively researched and well supported treatments for depression. It can help clients understand and reduce depression by addressing negative thoughts and unhelpful behavioral patterns that perpetuate depressed mood. I often explain to my patients that when we are depressed, we tend to think in very characteristic ways. In cognitive behavioral therapy (CBT), this is referred to as the cognitive triad of depression, and it involves a pattern of negative thoughts that individuals with depression tend to experience about themselves, their environment, and their future. According to the cognitive triad of depression, many depressed individuals tend to have automatic, spontaneous, and seemingly uncontrollable negative thoughts that contribute to their depressive state. These thoughts often revolve around a negative view of oneself (e.g., "I'm worthless"), the world (e.g., "No one cares about me"), and the future (e.g., "Things will never get better"). CBT aims to help individuals recognize and challenge these negative thought patterns, develop more balanced and constructive ways of thinking, and thereby alleviate depressive symptoms.
How Cognitive behavioral therapy addresses the cognitive triad of depression:
Cognitive Behavioral Therapy (CBT) has been proven to be effective in treating depression. It is a structured, time-limited therapy that is goal-oriented and focuses on the present. CBT operates on the principle that our thoughts, feelings, and behaviors are interconnected, and that changing negative thought patterns can lead to changes in feelings and behaviors.
When applying cognitive behavioral therapy to help a client with depression, I focus on the following three main goals:
1. Negative Thought Patterns: My first goal is to help clients recognize their own negative thoughts that contribute to depression. This is extremely important even when negative thoughts are based on real situational experiences. I often find that when clients have had a history of recurrent painful and traumatic events, they are at risk for developing learned helplessness and predicting the worst-case scenario in future situations. This can create more suffering and skew thought processes toward the cognitive triad that is typically seen in depression.
2. Challenging and Reframing Thoughts: Once my client and I identify negative thought patterns, I will then assist them in challenging these thoughts and reframing them in a more positive and realistic way. Keep in mind that the key is realistic thinking. CBT is not about the power of positive thinking. In fact, CBT examines the evidence in all situations and helps clients to develop a more balanced perspective, taking all evidence into account. This means that if the evidence supports an unfavorable outcome, then clients can choose to take action and problem solve, or practice acceptance and lean into the here and now.
3. Behavioral Activation: Not only are addressing thought patterns important in CBT, but behavioral changes can also help to reduce depressive symptoms. By encouraging the patient to engage in activities that they enjoy or used to enjoy, we are working to break the cycle of depression that keeps a person feeling stuck and inactive.
4. Developing Coping Strategies: CBT also equips patients with coping strategies to deal with difficult situations, which can reduce the symptoms of depression. I try to build on my clients’ preexisting strengths and interests when helping them to develop coping skills. This can include use of physical activity, artistic expression and creativity, or community engagement and service to others. I find that building on the strengths and values my clients bring to therapy is an effective way to help them tap into their innate coping skills to manage stressful life circumstances.
Final Caveat:
It's important to note that the success of CBT depends on clients’ commitment and the skill of the therapist. Clients who are open to exploring their thoughts and behaviors, and who are willing to put in the work outside of sessions, often see the best results. If you are considering CBT and would like to learn more about my therapeutic approach, feel free to reach out to me by email at thomas@ochealthpsych.com or by phone at 949-431-7069.
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