How cognitive behavioural therapy can help depression

Cognitive Behavioural Therapy (CBT) is widely used to treat depression and evidence has shown that it is effective in treating depression. The reason for this is because depression involves our thinking and our behaviour, and CBT looks at both of these areas.

When we are depressed we tend to see the world through a 'negative filter'. We also tend to be more self critical and feel hopeless about the future. As a result, people who are depressed often withdraw from others and get stuck in a cycle of doing less. This cycle ends up reinforcing itself. The less we do, the more negative we become in the way we look at the world and the more negative we feel, the less we do.

CBT therapists often start by looking at current activity levels. A positive step forward could be small, such as encouraging a depressed client to get out of bed at 2pm instead of 4pm each day. Small steps can feel like huge steps to a depressed person but every small success can help to shift a depressed person's negative thinking. CBT works on the premise that our thinking affects how we feel and our thoughts and feelings affect our behaviour.

Behavioural activation (slowly introducing more activity into a depressed person's day) is one of the basic building blocks of CBT. Once we have some momentum with the behavioural activation, a CBT will also look at what a depressed person is telling themselves about their life. Depressed people tend to have negative thinking in three main areas:

• About themselves - very critical, often feel they can't do anything right.
• About others - others can't be trusted, others will let them down.
• The future - the future is bleak and there is nothing to look forward to.

CBT helps to challenge these thoughts. Are they really true? Where is the evidence? Are these thoughts helpful? (A big hint - no, they aren't).

CBT helps us to figure out what is keeping us stuck and to make changes in our thinking and behaviour in order to improve our lives. CBT also teaches how to problem solve and how to reframe our thoughts into something more rational.

For example:

A depressed person may think: I am useless and no one cares.

Reframed thought: I am not always useless. Last week I helped a friend out and my neighbour phoned me yesterday to check in on me. Creating doubt is key to challenging negative thoughts, called NAT's in CBT. NAT's stands for - negative automatic thoughts.

When we are depressed we tend to use black and white thinking - we are either useful or useless with no grey areas inbetween. CBT sheds light on the grey area in between and helps us to understand the importance of challenging our thinking and looking for more rational alternatives.

So if you are feeling depressed, try to slowly increase your activity level. For some who find it difficult even to attend to their personal hygiene, a successful day might mean that they had a shower. Baby steps initially can help with confidence and slowly improve our mood as well. If you have had recurrent depression it may be an idea to seek the help of a professional. At times we need that extra support to help us through.