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Cognitive Therapy for Depression: How It Works

Cognitive therapy posits that most problems have several parts. Those parts include:

  • the problem as the person sees it
  • the person's thoughts about the problem
  • the person's emotions surrounding the problem
  • the person's physical feelings at the time
  • the person's actions before, during, and after the problem occurs

The way cognitive therapy works is a patient learns to "disassemble" problems into these various parts. Once a person does that, problems that seemed overwhelming become manageable.

During regular cognitive therapy sessions, a trained therapist teaches the tools of cognitive therapy. Then between sessions, the patient often does homework. That homework helps the person learn how to apply the tools to solve specific life problems.

"They make small changes in their thinking and behavior every day," Beck says. "Then over time, these small changes lead to lasting improvement in mood and outlook."

Cognitive Therapy for Depression: Evidence It's Effective

How well does cognitive therapy for depression work? And how well does it stack up when compared to other treatments for depression?

Robert DeRubeis, PhD, is professor of psychology and associate dean for the social sciences at the University of Pennsylvania. He tells WebMD, "The evidence is consistent and convincing that cognitive therapy is an effective treatment for depression. And," he adds, "[that means] not just the milder forms of depression."

Large, well-designed studies that include hundreds of subjects have shown the following:

1. Cognitive therapy works as well as antidepressant medicines alone to improve mild to moderate depression.

"When conducted well, cognitive therapy works as quickly and as thoroughly as antidepressant medications," says DeRubeis, who has led several large studies of cognitive therapy for depression. "Used consistently, cognitive therapy may work better than antidepressants in the long run," he adds.

2. Cognitive therapy works as well as antidepressant medicines at preventing depression relapses.

DeRubeis tells WebMD that when a person continues using the skills he learned with cognitive therapy, those skills help prevent relapses, a common problem with depression. "Cognitive therapy appears to prevent the return of symptoms as well as taking medication," he says. "And it does it without medication."

3. Cognitive therapy reduces residual symptoms of depression.

After a "successful" treatment for depression, many people continue to have mild depressive symptoms. Adding cognitive therapy to the treatment plan helps reduce these residual symptoms.

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