Best CBT Techniques For Depression (With Examples)

Cognitive Behavioral Therapy (CBT) is the gold standard for the treatment of depression. It manages both the cognitive and behavioral aspects of the disorder. CBT is a goal-oriented psychotherapy aimed at changing clients’ thoughts and behaviors. It is based on the notion that our thoughts, feelings and behaviors are interrelated. This means that a change in one could lead to a change in others. Then, the maladaptive thought patterns and behaviors are modified to alleviate the symptoms of depression.

The ABC Model can be used to understand the application of CBT for depression. It was developed by Albert Ellis in 1979. It is an acronym for “Activating Events”, “Belief” and “Consequences”. It asserts that, in contrast to assumption, the outcome is not caused by the event. Instead, the effects are as a result of the ideas about the activating events. This can be used to explain the perpetuating factor of depression, such as withdrawal.

For instance, a client can think that their heartbreak is the reason they are depressed. So, they might avoid getting involved in romantic relationships. However, it is the way the person has filtered the ideas (i.e., that it may happen again) that led to the outcome (withdrawal). It is not as a result of the activation event (heartbreak).

CBT Techniques for Depression

1. Cognitive Restructuring

Cognitive restructuring lies at the core of CBT as a psychotherapeutic treatment modality. It involves identifying and challenging the negative thoughts that led to depression. It also involves reframing or replacing these thoughts with accurate ones. They are also known as thinking errors and can fall into predictable patterns. These cognitive distortions in thoughts may include all-or-nothing thinking, catastrophizing, overgeneralizations, mind reading etc.

Example of All-Or-Nothing Thinking

Sarah is a university student who recently got a B during a test. She thinks: “I am a total failure. I’ll never make it in life”. The distortion here is that she views a single setback as a total failure.

Example of Catastrophizing

Mabel is a single mother of two children who recently got a job at a law firm. During a crucial presentation, she made a few minor mistakes in front of her supervisor. She thinks: "I'll lose my job, my family will suffer, and I'll end up homeless," She may be exaggerating the situation's consequences, which is the error here.

Example of Overgeneralization

Antionette is a new mom and is finding it difficult to soothe her newborn. She thinks: “I’m a terrible mother. I can’t do anything right”. The distortion here is that she is making sweeping conclusions based on a single event.

Example of Mindreading

Leonard went on a date with a new lady, after recently recovering from a breakup. He doesn’t receive an immediate response to a text he sent to her. He thinks: “She must be ignoring me. She must think I am ugly”. The distortion here is that he is assuming, without proof, that he knows what the lady thinks.

Clients who are depressed also exhibit a number of other cognitive distortions, such as jumping to conclusions, discounting positives and personalization.

2. Behavioral Activation

Behavioral activation involves encouraging clients to carry out activities that are pleasurable and rewarding. It is designed to counteract the tendency of clients who are experiencing depression to withdraw from activities that improve their mood.

For example, Anabelle used to love going to parties but recently found herself turning down invitations to parties. The mental health therapist would encourage such a client to re-introduce this activity into their routine. It may begin with staying for about ten minutes at the party and then 20-30 minutes, working their way up to an hour or more.

We can change how we think or even feel simply by changing our behavior. Remember how we talked about thoughts, feelings and behaviors being interrelated.

3. Problem-Solving Strategies

Problem solving strategies involve breaking down overwhelming problems into manageable tasks. It helps individuals battling with depression to develop effective strategies for managing situations perceived as stressful or overly demanding.

For example, Oliver is a young lawyer, the family financier and the firstborn in a family of eight children. He is looking at making partner at the law firm where he works. Lately, he has been feeling overwhelmed by the financial demands of his family and work-related stress.

He reported feeling tired at work and experiencing a detachment from activities he used to enjoy (i.e., work). With the help of his therapist, he lists the tasks he needs to fulfill and prioritize them in order of importance. Then he creates a schedule to implement the action plan and delegate the possible timeframe to address each situation.

4. Sleep Hygiene Training

Sleep disturbances are common during depressive episodes. Individuals experiencing depression may find it difficult to fall asleep or stay asleep. They may wake up feeling tired or irritable. Poor sleep has been associated with worry and rumination, which are components of depression. The more clients think about their inability to fall or stay asleep, the more awake they are. This is primarily because the body secretes cortisol and adrenaline during periods of stress.

It causes the body to stay awake and vigilant. This treatment helps the client create sleep hygiene patterns, such as room temperature, sleep regimen, and quietness. A mental health therapist might advise a client, for instance, not to work from bed or their bedroom. This will help associate the bedroom as a place of rest rather than work.

5. Graded Tasks Assignment

When it comes to engaging in activities they used to enjoy, clients with depression typically find that they are turned off. As a mental health therapist, it would be unfair to force your client to resume activities they once enjoyed.

At this point, even simple tasks may seem overwhelming and the client may lack the motivation to do them. Graded task assignments help clients manage their workload by breaking down tasks into smaller, manageable steps and placing them in a hierarchy. You can imagine these steps as climbing a staircase compared to climbing a wall.

For example, Lynette used to be a neat and orderly wife and mother. She noticed that she suddenly finds cleaning daunting. Her therapist could suggest creating a list of smaller tasks such as cleaning one room or even doing the dishes. She could complete this in short bursts so she can slowly develop a sense of accomplishment.

6. Mindfulness-Based Cognitive Therapy (MBCT)

MBCT combines cognitive therapy and mindfulness practices to enhance emotional regulation and reduce rumination. For example, therapists teach clients to focus on their breath or bodily sensations for five minutes daily, reducing fixation on negative thoughts and promoting self-awareness.

7. Cognitive Behavioral Analysis System of Psychotherapy (CBASP)

This is a specialized form of CBT designed to treat individuals with chronic depression. It combines cognitive restructuring with a focus on interpersonal relationships and problem-solving skills.

For example, a person experiencing cognitive distortions may learn to recognize patterns in their interactions with others that contribute or worsen their depressive states. This may include expecting the worst or being overly critical of themselves or others. CBASP would help them develop new ways of thinking and responding in those situations.

8. Addressing Skills Deficits

Some maladaptive behaviors are linked to certain skill deficits which can worsen or lead to depression. Skill deficits are the lack of ability or proficiency in specific skills required to perform a given task. Types of skills include cognitive, social, emotional regulation, communication, adaptive, decision-making, and self-efficacy.

9. Relaxation Techniques

Depression can sometimes feel suffocating. Hence, relaxation techniques can really be helpful. Relaxation techniques can help calm the mind and body. This reduces the symptoms and improves mental wellbeing. In a case of depression, the body tenses up and our minds race. Relaxation techniques counteract this by:

a. Reducing stress hormones (cortisol and adrenaline).

b. Increasing feel-good neurotransmitters (serotonin and dopamine).

c. Enhancing self-awareness and self-regulation.

Top relaxation techniques for depression include deep breathing exercises, progressive muscle relaxation and visualization.

Pros of CBT for Depression

1. CBT has proven to be effective in numerous studies. It is highly recommended by the American Psychological Association.

2. It empowers clients to learn new skills and strategies. Clients are also encouraged to gain control over their symptoms.

3. CBT equips individuals with tools to manage future depressive episodes.

Cons of CBT for Depression

1.  CBT requires active participation and homework which may be challenging for some clients.

2.   It does not suit everyone, especially clients with certain types of depression. This is due to its potential to cause rumination and escalate conditions of obsessive or anxiety traits in some clients. It might also not be suitable for elderly clients or people with brain injury, and dementia.

Conclusion

CBT offers a wide range of techniques which are tailored to address the unique needs of clients living and struggling with depression. Therapists in conjunction with clients can develop a personalized treatment plan. This can empower clients to take control of their mental health and overall wellbeing.

As a mental health practitioner, Mentalyc’s AI Note-taking App can help in client’s documentation. This includes customized templates for both intake notes and progress notes which will help to improve client care.

FAQS

1. How Does CBT Differ From Other Therapies For Depression?

CBT is focused on the present and on teaching clients specific skills to manage their symptoms, whereas other therapies may delve into the past or even use medication as a primary treatment.

2. Can CBT be Effective for Severe Depression?

Yes, CBT is effective for mild to severe depression. However, for severe cases, it is often combined with medication.

3. Is CBT A One-Size-Fits-All Treatment Modality?

No, CBT is highly personalized. Therapists adapt different techniques to suit individual client’s symptoms, preferences and circumstances.

4. Can I Practice CBT Techniques on My Own?

Although self-help resources are beneficial, it is more advisable to work with a trained licensed therapist to tailor the treatment plan to your specific needs.

5. How Quickly Will I See Results From CBT?

Some people can notice improvements within a few weeks, while others may take even longer. The key to recovery is in consistent effort to attend therapy sessions and practice the take-home assignments.

6. What Is The Success Rate of CBT For Depression?

CBT has a very high success rate as studies have shown that it is as  effective as medication for mild to moderate depression and has a lower relapse rate.

7. Does Insurance Cover CBT?

Several insurance plans cover CBT as a treatment for depression. It is however essential to verify your coverage with your healthcare provider.