• Basic premise: Aaron T. Beck’s cognitive theory of depression proposes that persons susceptible to depression develop inaccurate/unhelpful core beliefs about themselves, others, and the world as a result of their learning histories. These beliefs can be dormant for extended periods of time and are activated by life events that carry specific meaning for that person. Core beliefs that render someone susceptible to depression are broadly categorized into beliefs about being unlovable, worthless, helpless, and incompetent. Cognitive theory also focuses on information processing deficits, selective attention, and memory biases toward the negative.
  • Essence of therapy: In cognitive therapy (CT), clients are taught cognitive and behavioral skills so they can develop more accurate/helpful beliefs and eventually become their own therapists.
  • Length: In most randomized clinical trials or efficacy trials, CT for depression is typically delivered over 8 to 16 sessions. There is a significant interaction between initial symptom severity and length of CT (Shapiro et al., 1994). Clients with mild or moderate depression do well with either 8 or 16 sessions of CT. However, clients with severe depression demonstrate significantly better response rates with 16 sessions as compared to 8 sessions. It is recommended to allow for booster sessions after termination for enhanced relapse prevention 3, 6, and 12 months after termination (Beck, 2011). A caveat to the 8-16 sessions finding is that since these results were obtained in efficacy trials, one can extend treatment in the community past 16 sessions depending on: 1) the severity and chronicity of the client’s depression, 2) comorbid disorders, and 3) other psychological, physiological, and psychosocial factors (all of which may complicate the client’s recovery from depression). For example, a study assessing the effectiveness of CT in an outpatient CT clinic found that clients attend an average of 15.9 (SD = 16.2) CT sessions, with a range of 0 (clients who completed an intake, but never entered therapy) to 97 (Gibbons et al., 2011). The modal number of CT sessions was 1 and the median was 11 (Gibbons et al., 2011).