Cognitive Behavioral Therapy for Depression
What Is Cognitive Restructuring? continued...
The idea in CBT is to learn to recognize those negative thoughts and find a healthier way to view the situation. The ultimate goal is to discover the underlying assumptions out of which those thoughts arise and evaluate them. Once the inaccuracy of the assumption becomes evident, the patient can replace that perspective with a more accurate one.
Between sessions, the patient may be asked to monitor and write down the negative thoughts in a journal and to evaluate the situation that called them up. The real goal is for the patient to learn how to do this on his or her own.
What Is Behavioral Activation?
Behavioral activation is another goal of CBT that aims to help patients engage more often in enjoyable activities and develop or enhance problem-solving skills.
Inertia is a major problem for people with depression. One major symptom of depression is loss of interest in things that were once found enjoyable. A person with depression stops doing things because he or she thinks it's not worth the effort. But this only deepens the depression.
In CBT, the therapist helps the patient schedule enjoyable experiences, often with other people who can reinforce the enjoyment. Part of the process is looking at obstacles to taking part in that experience and deciding how to get past those obstacles by breaking the process down into smaller steps.
Patients are encouraged to keep a record of the experience, noting how he or she felt and what the specific circumstances were. If it didn't go as planned, the patient is encouraged to explore why and what might be done to change it. By taking action that moves toward a positive solution and goal, the patient moves farther from the paralyzing inaction that locks him or her inside the depression.
Is There a Standard Procedure for Therapy Sessions?
Mental health professionals who practice CBT receive special training and follow a manual in their own practice. Although actual sessions may vary, they typically follow this outline:
- The session begins with a check on the patient's mood and symptoms.
- Together, the patient and therapist set an agenda for the meeting.
- Once the agenda is set, they revisit the previous session so they can bridge to the new one.
- The therapist and patient review the homework assignment and discuss problems and successes.
- Next they turn to the issues on the agenda, which may or may not all get addressed.
- New homework is set.
- The session ends with the therapist summarizing the session and getting feedback from the patient.
A typical session lasts 50 minutes to an hour.
What Does It Mean to Say That Cognitive Behavioral Therapy Is Time-Limited?
Some other types of therapy are open ended in that there is no clear end date established. With CBT, the goal is to terminate therapy at a certain point, usually after 14 to 16 weeks.
It takes about eight weeks for the patient to become competent at the skills that are being taught in therapy and to reasonably understand the model. While this is going on, the patient usually experiences a significant reduction of symptoms. Between eight and 12 weeks patients often experience a remission of symptoms. During the remaining time, they continue to practice the skills learned and to address issues related to ending the sessions.
More severe cases of depression may take longer to resolve, but for most patients, 14 to 16 weeks with occasional sessions during the first year to reinforce the new skills is adequate.