How Effective Is Cognitive Therapy?
Can a person think their way out of depression? Jillian Ball of the Black Dog Institute at the University of South Wales believes the answer is yes. In the cognitive therapy model, depression grows out of negative thinking, and that thinking shapes how someone acts. Take a person who decides "nobody likes me." They start pulling away from others and stop building new relationships, and the withdrawal itself becomes part of the problem.
So what is cognitive therapy? A lot of clinicians hold that positive thinking can lift depression, and that idea sits at the center of the approach. Across more than two decades of study, therapists and psychologists have argued that cognitive therapy ranks among the most effective treatments for depression (Ball, 2015). The work is about swapping negative thoughts for positive ones. You learn to catch irrational thoughts as they happen, with attention on how you feel about things right now rather than what happened long ago.
Is it better than cognitive-behavioral therapy (CBT)? Opinions split here. Ball argues that people across a range of severities can get something out of cognitive therapy. In her article Thinking Your Way Out of Depression, she points specifically to reactive depression, mild depression, and bipolar illness as responding well (2015).
Her case has limits, though. Drawn-out negative thinking is one path into depression, not the only one. Ball doesn't say much about people wrestling with major depression or conditions like severe anxiety, and she leaves other forms of therapy out of the discussion. Getting help is a good move. But the wrong kind of help does little for someone who is struggling. Plenty of people become depressed because of what is happening in their lives: strained family situations, loss, trauma. Would cognitive therapy, on its own, be the fix for someone living with Post Traumatic Stress Disorder? For many people, recovery takes long-term care, more than one kind of therapy, and sometimes medication alongside it.
There is also cognitive-behavioral group therapy, which is the method clinicians reach for most often. CBT blends the cognitive and behavioral sides together. Some view the group version as the most affordable starting point for treating depression: patients work as a group to examine how they think and act, using reasoned analysis and critical thinking. The stance is roughly, "Are these negative thoughts and behaviors justified? Let's find out" (Thimm & Antonsen, 2014).
Jens Thimm and Liss Antonsen ran a study with 143 patients living with depression. Of those who took part in group CBT, 44 percent improved more than people who did not take part, and 30 percent of the ones who improved went on to recover with steady, ongoing treatment (2014).
What if neither cognitive therapy nor CBT is helping? Start by finding out whether you actually have depression, and which type. That means seeing a therapist for a clinical assessment. A local hospital or a day treatment center for mental illness can point you toward one. Many licensed professionals rely on the Beck Depression Inventory, or BDI-I, a 21-item self-report that measures how severe the depression is (Thimm & Antonsen, 2014). Once the assessment is done, the therapist can match you with a fitting approach.
If cognitive and cognitive-behavioral therapy turn out not to be the right fit, there are other routes. Depression hits people in individual ways, so one treatment will not reach everyone. Among the other options: psychoanalysis, psychodynamic therapy, interpersonal therapy, and experiential therapy.
Psychoanalysis is the familiar one that took shape in the early 1900s. The patient lies on a couch for one-on-one, intensive sessions, and the relationship between patient and therapist is where the work happens. People often keep at it for years, even decades, meeting several times a week. Psychodynamic therapy is the scaled-back cousin: patients rarely use the couch, and treatment might run up to a year.
Experiential and interpersonal therapy tend to suit people whose depression traces back to troubled family relationships. The experiential approach pushes patients to name and work through buried issues from the past and the present, which can help those carrying a traumatic history or event. Keep in mind that events from your past and your present shape how you connect with everyone around you.
By Heather Browning, MBA, BA