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Cognitive-behavioral Therapy for Depression

Psychological treatment of depression (psychotherapy) can assist the depressed individual in several ways. First, supportive counseling helps ease the pain of depression, and addresses the feelings of hopelessness that accompany depression. Second, cognitive therapy changes the pessimistic ideas, unrealistic expectations, and overly critical self-evaluations that create depression and sustain it. Cognitive therapy helps the depressed person recognize which life problems are critical, and which are minor. It also helps him/her to develop positive life goals, and a more positive self-assessment. Third, problem solving therapy changes the areas of the person's life that are creating significant stress, and contributing to the depression. This may require behavioral therapy to develop better coping skills, or Interpersonal therapy, to assist in solving relationship problems.

At first glance, this may seem like several different therapies being used to treat depression. However, all of these interventions are used as part of a cognitive treatment approach. Some psychologists use the phrase, cognitive-behavioral therapy and others simply call this approach, cognitive therapy. In practice, both cognitive and behavioral techniques are used together.

Once upon a time, behavior therapy did not pay any attention to cognitions, such as perceptions, evaluations or expectations. Behavior therapy only studied behavior that could be observed and measured. But, psychology is a science, studying human thoughts, emotions and behavior. Scientific research has found that perceptions, expectations, values, attitudes, personal evaluations of self and others, fears, desires, etc. are all human experiences that affect behavior. Also, our behavior, and the behavior of others, affects all of those cognitive experiences as well. Thus, cognitive and behavioral experiences are intertwined, and must be studied, changed or eliminated, as an interactive pair.

Brief History of Cognitive Therapy

Many people think that cognitive therapy is a relatively recent development in psychotherapy. However, Albert Ellis published, Reason and Emotion in Psychotherapy in 1962, and Aaron Beck wrote about, The Self Concept in Depression with D. Stein in 1960. To some extent, most or all of the psychodynamic and psychoanalytic theories of depression can be described as having cognitive components.

For example, Freud, in Mourning and Melancholia, published in 1917, suggests that melancholia (depression) can occur in response to an imaginary or perceived loss, and that self-critical aspects of the ego are responsible in part for depression. The main difference between these psychodynamic therapies and cognitive therapies lies in the motivational assumptions made by the therapists, and the techniques used to effect change. Psychodynamic theories presume that the maladaptive cognitions arise from specific internal needs (such as the need for affection, acceptance, sexual gratification, etc.), or from unresolved developmental conflicts from childhood. The cognitive therapists presume that the maladaptive cognitions may arise from faulty social learning, or from a lack of experiences that would allow adaptive learning (such as the development of coping skills) to occur, or from dysfunctional family experiences, or from traumatic events, etc. In other words, psychologists using a cognitive therapy approach recognize that psychological problems such as depression can develop from a variety of life experiences, depending on the individual.

In the 1970s, many psychologists began writing about cognitive aspects of depression, identifying different cognitive components that affected depression, and developing cognitive interventions to treat depression. From this base of theory and research came evidence that cognitive therapy was an effective, and perhaps is the most effective, intervention strategy for treating depression. Since the 1970s, the use of cognitive therapy with depression has increased tremendously, and the number of psychologists using cognitive therapy approaches for the treatment of all psychological problems has also grown. As a result, it appears that cognitive therapy has recently appeared on the scene, in only the past twenty years. But, all psychotherapy has cognitive components. One of the major differences between cognitive therapy and other therapy approaches is the treatment interventions used to change human cognitive experiences.

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Reviewed: 03/2006