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2013/12/23 at 7:59 am
by Joy Vondra

Cognitive therapy for depression has its roots in the cognitive theory of depression (Beck, 1967) and has a tremendous success rate.  As a matter of fact, studies have shown that cognitive therapy works at least as well as antidepressants in helping people with mild to moderate depression. The goal is to help the patient recognize and reassess his patterns of automatic negative thoughts and replace them with positive thoughts that more closely reflect reality.

Click here to watch bestselling author and leading expert Joan Borysenko explain reframing NLP, cognitive reframing of a situation:

It is an active, structured, problem-focused, and time-limited approach to treatment which is based on the premise that depression is maintained by negatively biased information processing and dysfunctional beliefs. Cognitive therapy can be an effective way to defuse those thoughts, which is imperative to recovery.

Patients are taught to monitor and write down their negative thoughts and mental images to recognize the association between their thoughts, feelings, physiology, and behavior.

On the east coast of the United States, the Beck Institute for Cognitive Therapy and Research provides on-site and off-site intensive training in cognitive therapy for depression. The general approach involves guiding patients through a number of structured learning experiences.

Activity scheduling, self-monitoring of mastery and pleasure, and graded task assignments are commonly used early in therapy to help patients overcome inertia and expose themselves to potentially rewarding experiences.

Treatment with medication and/or psychotherapy can shorten depression’s course and can help reduce symptoms such as fatigue and poor self-esteem that accompany depression.

Cognitive Therapy Basics

When used for depression, cognitive therapy provides a mental tool kit that can be used to challenge negative thoughts. Treatment is designed to help patients learn to think more adaptively and thereby experience improvements in affect, motivation, and behavior.

It does this by helping them analyze and change thinking that is negative or distorted, which can lead to problems like depression, anxiety, interpersonal and relationship problems, alcohol or drug abuse, or stress. Some examples of this negative behavior include:
Overgeneralization: Taking an isolated case and assuming that all others are the same.
Mental Filter: Mentally singling out the bad events in one’s life and overlooking the positive.
Jumping to Conclusions: Assuming the worst about a situation even though there is no evidence to back their conclusion.
All-or-Nothing Thinking: Failing to recognize that there may be some middle ground.
Magnification and Minimization: Downplaying positive events while paying an inordinate amount of attention to negative ones.
Emotional Reasoning: Allowing your emotions to govern what you think about a situation rather than objectively looking at the facts.
Should Statements: Rigidly focusing on how you think things should be rather than finding strategies for dealing with how things are.

Cognitive therapists use a variety of strategies and techniques to help depressed patients address their negative thinking including psycho-education, guided discovery, Socratic questioning, role playing, imagery, and behavioral experiments.

For people considering cognitive therapy for depression, sessions follow a structure that includes a brief check on mood and symptoms, agenda setting, bridging from the previous session, reviewing homework (self-help assignments that the patient does between sessions), discussing issues on agenda, setting new homework, and summarizing and getting feedback from the patient about the session. A full course of treatment is considered to be 14-16 sessions although severe cases can take longer.

During regular cognitive therapy sessions, a trained therapist teaches the tools of cognitive therapy. The therapist also teaches (or reactivates) adaptive coping skills such as breaking down large problems into smaller, more manageable steps, and decision-making by cost-benefit analysis.

As therapy progresses, patients learn to identify, evaluate, and modify underlying biased assumptions and dysfunctional beliefs that may have predisposed them to depressive reactions.

They learn to evaluate the validity and utility of these cognitions, test them out empirically, and change dysfunctional cognitions to reflect a more adaptive viewpoint. A significant reduction in symptoms often occurs during this initial stage of therapy.

Cognitive Therapy: Beyond the Basics

After the person undergoing therapy has identified these negative or faulty cognitions, the remaining sessions are used to evaluate and modify dysfunctional beliefs that impair functioning and make the patient vulnerable to future depressive episodes, build relapse prevention skills, and discuss termination issues.

Follow-up studies of the patients treated in the major controlled trials suggest that cognitive therapy of depression is more effective than pharmacotherapy alone in preventing relapse. As a matter of fact, responders to cognitive therapy in these studies were only half as likely to relapse or seek further treatment following termination than responders to pharmacotherapy alone.

Overall, cognitive behavior therapy for depression is effective because it teaches people how to think positively instead of negatively. If depression is situational or behavioral, an adjustment in the thought process may be all that’s needed. Even if the depression is chemical, avoiding negative thought behaviors is still a powerful tool to help a person recover with the help of pharmaceuticals. Knowing how to think positively and how to turn off negative thoughts is never a bad thing. Keep smiling!

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