CBT for Depression

There is no one way to experience depression. It can be easy to lose hope that life will never feel good again. But evidence suggests that CBT is at least as effective as medication and leads to lower relapse rates. I have worked with countless clients experiencing all severities of depression, and am confident in harnessing the right tools at the right time. 

From time to time we can all feel sad, miserable and fed up. These are understandable reactions to upsetting or stressful events, and experiences which most of us would relate to. Sometimes we can experience these feelings for no discernible reason at all, however, if they persist, they can be signs of a clinical level of depression.

Depression affects more than 264 million people worldwide, (WHO, January 2020) with triggers including severe stress, major life changes, significant loss and serious illness. NICE guidance recommends CBT as the treatment of choice for mild-moderate depression. If symptoms are severe and medication is required, then it is most effective when paired with CBT.

Symptoms of Depression

It could be that you are suffering from depression if you have several of the symptoms listed below:

  • Difficulty concentrating and making decisions
  • Feeling restless, irritable or agitated
  • Feelings of hopelessness
  • Lack of interest in sex
  • Social withdrawal
  • Feeling useless, inadequate and hopeless
  • Difficulty sleeping, or sleeping more than usual
  • Physical symptoms such as pain, headaches, lack of energy
  • Feelings of guilt or worthlessness
  • Tearfulness
  • Getting no pleasure from life or activities you used to enjoy
  • Thoughts of suicide

If you’re experiencing depression, it’s important to remember that you’re not alone, help is at hand. Therapy can be tailored to each person’s needs at a number of levels of intensity, so it’s never too early to reach out.

CBT gets to the heart of the vicious cycle of the thoughts, feelings and behaviours that depression can trap you in. 

CBT for depression: Thinking

The meanings we give to events and our emotions is key. For example, for one person losing a job is a tragedy, to another, a relief. To one person feeling sad is a natural part of life, to another it’s frightening.

Research shows that those who are depressed, are more likely to focus on the negative aspects of a situation while ignoring the positives. This process of distortion and misinterpretation is known as cognitive bias. An example would be:

He/she hasn’t phoned
That’s because they’ve forgotten about me
Maybe they had better or more fun things to do
If they cared they would have phoned – they don’t really care
I don’t seem ever to find someone who cares about me, what’s wrong with me?
Maybe I’m just too boring
I’ll never find a relationship – I’ll end up alone
Life is pointless and empty

(Excerpt from Overcoming Depression by Paul Gilbert)

This cascade of thoughts can be so rapid that we hardly notice it, and when we enter into depression, we often experience these spirals. Our thoughts literally run away with us to the worst possible scenarios – usually within seconds.

Then we often dwell (ruminate) on these thoughts and ideas, and so spiral even deeper into more depressed feelings.

The CBT approach is to highlight the thinking biases that are fuelling your negative emotions, and evaluate them objectively, often testing them out in designed ‘experiments’. That way they can be confirmed or dis-confirmed, and potentially replaced with more balanced and accurate beliefs. 

CBT for Depression: Behaviour

How we naturally cope with life’s difficulties is also important. Coping can change the implications of events for us, and this can reduce the stressful impact on our bodies and therefore, minimise impact on mood chemicals such as dopamine and serotonin. Many depressions are triggered and maintained by stress.

A simple but key CBT intervention early on in therapy is to reverse the social withdrawal, reduction in pleasurable activities and loss of a sense of achievement that are often seen in depression. This evidence-based technique is behavioural activation, and research tells us that planning a day that includes a balance of these three types of activities is one that leads us to have a better mood. 

Help is at Hand

Often clients realise through therapy that depression has been present on and off in their lives for a number of years. Experiences earlier in our lives shape our beliefs about ourselves, others and the world, and over time, these beliefs exert an important influence on our  behaviour and choices much later in life. CBT looks at first understanding, then intervening in these thinking and behavioural spirals.

You are the expert on you and your depression, but you do not have to suffer alone. Engaging with therapy, either face to face or online can stop your depression in its tracks and start you on the road to recovery. Get in touch now to discuss how I can help.

Further reading about depression:

Overcoming Depression by Professor Paul Gilbert

Further info about CBT:

Let’s Talk About CBT podcast