💭 Thinking
Spot negative thoughts and challenge them. Is the thought really true? What is the evidence for and against it? Is there a fairer way to see it?
Treating Depression » Cognitive Behaviour Therapy for Depression
What you'll learn this session
Study time: 30 minutes
AQA spec: 3.2.4.5
- What cognitive behaviour therapy (CBT) is and how it works
- The main CBT methods: thought diaries, testing beliefs, homework and behavioural activation
- How CBT improves mental health, and its limits
- How CBT compares with antidepressants, using reductionist and holistic perspectives
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Unlock This CourseTreating depression by talking
Last lesson you saw that antidepressants work on brain chemistry. The other treatment you need to know is a talking therapy. Cognitive behaviour therapy (CBT) is based on the psychological explanation of depression. It helps a person change the way they think and the way they act.
A trained therapist meets the person, usually once a week, and they work as a team. The therapist does not just give advice. Together they look at what the person thinks, how that affects how they feel and what they do, and then they try out new ways of responding.
Key terms:
- Cognitive behaviour therapy (CBT): a talking therapy that helps people identify and challenge negative thoughts and change their behaviour.
- Thought diary: a record of upsetting thoughts, what set them off and how the person felt.
- Behavioural activation: planning and doing activities that give a sense of achievement or enjoyment, even when motivation is low.
Challenging negative thinking
Remember, a negative schema is a fixed negative way of thinking about yourself, the world and the future, and attributions are the reasons we give for why things happen. In depression these thoughts can be harsh and automatic, like "I always fail" or "nobody likes me".
CBT has two aims:
🏃 Behaviour
Change what the person does. People with depression often stop doing things, which makes them feel worse. CBT helps them start again, one small step at a time.
The CBT methods
📓 Thought diary
The person writes down a negative thought when it happens, what set it off and how it made them feel. Over time they begin to notice patterns, such as always blaming themselves.
🔍 Testing beliefs
The person treats a belief like a theory to test. If they believe "no one wants to talk to me", they try talking to someone and see what really happens.
📋 Homework
Between sessions the person practises what they have learned, for example filling in the diary or trying out a plan. This builds skills they can use for themselves.
Behavioural activation is also used. The therapist and person plan activities, such as a short walk or meeting a friend, and the person does them and notes how they feel. Often the mood is better than they expected, which is evidence against the belief that nothing will help.
Worked example
Zara, 16, did badly in a test and thinks "I am useless at everything and always will be." In CBT she writes this in her thought diary. With her therapist she lists the evidence against it: she did well in her last two tests and she is good at art. She decides a fairer thought is "I found this test hard and I need to revise more." For homework she plans a revision session and a walk with a friend. Her thinking is fairer and she is active again.
How CBT improves mental health
- Negative thoughts become fairer and less automatic, so the person feels less sad and hopeless.
- Doing more activities improves mood and gives a sense of achievement.
- The person learns skills they can keep using, so they can cope better with problems in the future.
Limits of CBT
⏳ Time
It takes many sessions over weeks or months, and there can be a wait to start.
💪 Effort
The person has to do the diary and homework. This is hard work, especially when feeling low.
😴 Motivation
Depression drains energy and interest. Someone who is not motivated may stop attending or skip the homework.
CBT may also not be enough on its own for people with very severe depression. They may find it too hard to think clearly or take part, so a doctor may also suggest medication.
CBT or antidepressants?
Both treatments can help, but they are different. Remember that reductionist means focusing on one level, and holistic means looking at the whole person.
💊 Antidepressants
Reductionist: they treat brain chemistry only. Easy to take and need less effort, but they take weeks to work, have side effects and depression can return when they stop.
💬 CBT
More holistic: it looks at thoughts, behaviour and daily life. It teaches skills that last, but it needs time, effort and motivation.
CBT is more holistic than drugs because it deals with the whole person, including how they think, what they do and their situation. It also tries to deal with why the person is low, not just the symptoms. Because it is less reductionist, it fits the idea that depression has many causes. Some people use both together.
Common mistakes
Writing that CBT "just means talking". It is a structured therapy with methods such as diaries, testing beliefs and homework. Another slip is saying CBT cures depression quickly. It takes time and effort. Finally, do not just say drugs are better or CBT is better. Always give a reason linked to reductionist (brain chemistry only) or holistic (the whole person).
Exam-style question
Ali has depression. He often thinks "I always get things wrong." His doctor offers him CBT.
(a) Describe two methods a therapist might use in CBT. [4 marks]
(b) Give one limit of CBT. [1 mark]
(c) Explain why CBT is more holistic than antidepressants. [2 marks]
Model answer
(a) A thought diary (1): Ali writes down his negative thoughts and what set them off, so he can spot patterns (1). Testing beliefs (1): he tries something to see if "I always get things wrong" is true, for example asking for feedback on his work (1).
(b) It takes a lot of time and effort, or it needs motivation, which is hard when he is depressed (1).
(c) CBT looks at the whole person, including how Ali thinks and acts (1). Antidepressants only change brain chemistry, which is reductionist (1).
Exam tip
In "describe" questions about CBT, name the method and then say what the person actually does. A name on its own earns only one mark.