Cognitive Therapy for Depression
Status: Strong Research Support
Cognitive therapy (CT) for depression evolved from Beck's (1967) cognitive theory that depression is maintained by negatively biased information processing and dysfunctional beliefs. CT is a structured, problem-focused, and time-limited therapy. Patients are taught to monitor and record their negative thoughts so that they can recognize the associations between their thoughts, feelings, physiology, and behavior. They learn to evaluate the validity and utility of these cognitions, test them out empirically, and change dysfunctional cognitions to a more adaptive viewpoint. As therapy progresses, patients learn to identify, evaluate, and modify underlying assumptions and dysfunctional beliefs that can put them at risk for relapse. Behavioral techniques such as activity scheduling, self-monitoring of mastery and pleasure, and graded task assignments are used early in therapy to help patients overcome inertia and expose themselves to potentially rewarding experiences. Patients also learn adaptive coping and problem-solving skills. Cognitive therapists use a variety of strategies and techniques to help depressed patients address their thinking, including psychoeducation, guided discovery, socratic questioning, role playing, imagery, and behavioral experiments. CT is typically 14 to 16 sessions, although therapy can take longer if symptoms are more severe and chronic. Cognitive therapy can be delivered individual and group formats, and it has been applied to geriatric populations.
Maintenance of treatment gains is enhanced by booster sessions during the first year after termination. Several variants of cognitive therapy have been developed as more structured relapse prevention programs. Cognitive Therapy- Continuation (Jarrett & Kraft, 1997) provides 8 to 10 monthly sessions. Patients learn to use emotional distress and depressive symptoms to practice the coping and other skills learned in the acute phase of therapy and to enhance generalization of these skills. Well-Being Therapy (Fava & Riuni, 2003) provides 8 to 12 sessions designed to facilitate well-being after recovery from depression and reduce the risk of relapse. This therapy is not symptom-focused but rather focuses on building the components of mental health in Ryff's (1989) model: autonomy, personal growth, environmental mastery, purpose, positive relations, self-acceptance. Cognitive restructuring, activity scheduling, assertiveness training, and problem solving skills are used. Mindfulness-Based Cognitive Therapy (MBCT; Segal, Williams, & Teasdale, 2001) is an eight-session relapse prevention program that combines mindfulness meditation with cognitive therapy techniques. Patients learn to recognize the negative thought processes associated with depression and to change their relationship with these thoughts. By unhooking from these thoughts and recognizing their transient nature, patients can learn to prevent the downward spiral from negative mood to rumination to depression. MBCT is especially helpful to reduce the risk of relapse in those with chronic depression.
Key References (in reverse chronological order)
Vittengl, J. R., Clark, L.A., Dunn, T. W., & Jarrett, R. B. (2007). Reducing relapse and recurrence in unipolar depression: A comparative meta-analysis of cognitive-behavioral therapy's effects. Journal of Consulting and Clinical Psychology, 75, 475-488.
Scogin, F, Welsh, D., Hanson, A. Stump, J. & Coates, A. (2005). Evidence-based psychotherapies for depression in older adults. Clinical Psychology: Science and Practice, 12, 222-237.
DeRubeis, R. J., Hollon, S. D., Amsterdam, J. D., Shelton, R. C., Young, P. R., Saloman, R. M., et al. (2005). Cognitive therapy vs medications in the treatment of moderate to severe depression. Archives of General Psychiatry, 62, 409-416.
Hollon, S. D., DeRubeis, R. J., Shelton, R. C., Amsterdam, J. D., Saloman, R. M., O'Reardon, J. P., et al., (2005). Prevention of relapse following cognitive therapy vs medications in moderate to severe depression. Archives of General Psychiatry, 62, 417-422.
Miranda, J., Bernal, G., Lau, A., Kohn, L., Hwang, W., & LaFromboise, T. (2005). State of the science on psychosocial interventions for ethnic minorities. Annual Review of Clinical Psychology, 1, 113-142.
Ma, S. H., & Teasdale, J. D. (2004). Mindfulness-based cognitive therapy for depression: Replication and exploration of differential relapse prevention effects. Journal of Consulting and Clinical Psychology, 72, 31-40.
Hollon, S. D., Thase, M. E., & Markowitz, J. C. (2002). Treatment and prevention of depression. Psychological Science in the Public Interest, 3, 39-77. (review article)
Jarrett, R. D., Kraft, Doyle, D., Foster, B. M., Eaves, G. G., & Silver, P. C. (2001). Preventing recurrent depression using cognitive therapy with and without a continuation phase: A randomized clinical trial. Archives of General Psychiatry, 58, 381-388.
Teasdale, J. D., Segal, Z. V., Williams, J. M. G., Ridgeway, V. A., Soulsby, J. M., & Lau, M. A. (2000). Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology, 68, 615-623.
Fava, G. A. (1999). Well-being therapy. Psychotherapy and Psychosomatics, 68, 171-178.
Gloagen, V., Cottraux, J., Cucherat, M., & Blackburn, I. (1998). A meta-analysis of the effects of cognitive therapy in depressed patients. Journal of Affective Disorders, 49, 59-72.
Elkin, I., Shea, M. T., Watkins, J. T., Imber, S. D., Sotsky, S. M., Collins, J. F., et al. (1989). National Institute of Mental Health Treatment of Depression Collaborative Research Program: General effectiveness of treatments. Archives of General Psychiatry, 46, 971-982.
Williams, J. M. G., Teasdale, J. D., Segal, Z. V., Kabat-Zinn, J. (2007). The Mindful way through depression: Freeing yourself from chronic unhappiness. New York: Guilford
Muņoz, R. F., & Mendelson, T. (2005). Toward evidence-based interventions for diverse populations: The San Francisco General Hospital prevention and treatment manuals. Journal of Consulting and Clinical Psychology, 73, 790-799. Manuals available at: www.medschool.ucsf.edu/latino/manuals.aspx (these programs include cognitive and behavioral components).
Fava G. A., & Riuni, C. (2003). Development and characteristics of a well-being enhancing psychotherapeutic strategy: Well-being therapy. Journal of Behavior Therapy and Experiential Psychiatry, 34, 45-63.
Laidlaw, K., Thompson, L. W., Dick-Siskin, L., & Gallagher-Thompson, D. (2003). Cognitive behaviour therapy with older people. New York: Wiley. (includes cognitive and behavioral components)
Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2001) Mindfulness based cognitive therapy for depression: A new approach to preventing relapse. New York: Guilford.
Jarrett, R. B., & Kraft, D. (1997). Prophylactic cognitive therapy for major depressive disorder. Journal of Clinical Psychology: In session, 3, 65-79.
Beck, J. S. (1995). Cognitive therapy: Basics and beyond. New York: Guilford.
Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford
Training opportunities and resources are available from the Beck Institute for Cognitive Therapy and Research website
Training opportunities from the Academy of Cognitive Therapy
Training opportunities from Behavioral Health Associates
Training opportunities and resources for Mindfulness-Based Cognitive Therapy are available at: www.mbct.com
Judith S. Beck. Cognitive therapy. Produced by American Psychological Association's APA Psychotherapy Videos, April 2007.
Segal, Z. V. Mindfulness-Based Cognitive Therapy for Depression. Produced by American Psychological Association's APA Psychotherapy Videos, April 2007.