Cognitive Behavioral Theory (CBT) And Its Application In Treating Depression

Cognitive Behavioral Therapy (CBT) is a therapeutic approach that focuses on identifying and challenging negative thought patterns, feelings, and behaviors to bring about positive change. In the context of depression, CBT addresses distorted thinking associated with depressive symptoms and aims to modify dysfunctional beliefs. Research consistently supports the effectiveness of CBT in managing depressive symptoms, demonstrating its capacity to alleviate distress, reduce the risk of relapse, and empower individuals with practical coping strategies. Many professionals consider CBT one of the most highly structured therapeutic modalities because it offers clients tools they can implement in their daily lives after completing 12 weeks of one-hour, weekly CBT sessions.[1]

Cognitive theories rose to prominence in response to the early behaviorists’ failure to take thoughts and feelings seriously. The cognitive movement did not reject behavioral principles, however. Rather, the idea behind the whole cognitive theory movement was to integrate mental events into the behavioral framework. 

Cognitive Behavioral theories (sometimes called “cognitive theories”) are considered to be “cognitive” because they address mental events such as thinking and feeling. They are called “cognitive-behavioral” because they address those mental events in the context of the learning theory that was the basis for the pure behavioral theory described above. The rise in popularity of cognitive theory and behaviorism continues today; it forms the basis of the most dominant and well-researched form of psychotherapy available today: Cognitive-Behavioral Therapy (CBT).

Cognitive Behavioral Theory and Depression

Cognitive behavioral theorists suggest that depression results from maladaptive, faulty, or irrational cognitions taking the form of distorted thoughts, core beliefs, and judgments.

Erin L. George, MA-MFT, says, “Perhaps one of the best things about CBT therapy is that the focus on behavioral patterns that can alter thinking can help people identify how to help themselves when they catch themselves repeating those patterns. Instead of relying so heavily on weekly sessions with a counselor, clients who have CBT tools are able to quickly build confidence in their own ability to catch and spot unhealthy behaviors or thinking patterns.”

An individual can learn depressive cognitions socially through observation. For example, children in dysfunctional families may learn depressive thoughts when they watch their parents fail to cope successfully with stress or trauma. Or, depressive cognitions can result from a lack of experiences that would facilitate the development of adaptive coping skills. However, CBT can help clients notice unhealthy relationships, learned patterns, poor boundaries, and more. Being able to identify unhealthy learned behaviors is one way to empower yourself to make positive changes in your life and relationships.

According to cognitive behavioral theory, depressed people think differently than non-depressed people, and this difference in thinking causes them to become depressed. For example, depressed people tend to view themselves, their environment, and the future in a negative, pessimistic light.

Cognitive distortions in depression involve systematic errors in thinking that contribute to negative perceptions of oneself, the world, and the future. Common distortions include:[4]

• All-or-nothing thinking (black-and-white thinking): Seeing situations in extreme terms, without recognizing middle ground or shades of gray
• Catastrophizing: Expecting the worst possible outcome, even when evidence suggests otherwise
• Overgeneralizing: Making broad negative conclusions based on limited evidence, applying a single negative event to all aspects of life
• Discounting the positive: Minimizing or dismissing positive experiences, achievements, or qualities, reinforcing a negative self-view.
• Mind reading: Assuming one knows what others are thinking and that they view the individual negatively, even without concrete evidence
• Personalizing: Taking excessive responsibility for events, attributing negative outcomes to one’s own actions or characteristics
• Making should statements: Holding rigid and unrealistic standards for oneself and others, leading to feelings of guilt and frustration when these standards are not met
• Emotional reasoning: Believing negative emotions reflect objective reality, assuming feelings as evidence for the truth of a situation
• Labeling and mislabeling: Applying negative labels to oneself or others based on specific behaviors instead of considering the broader context.
• Selective abstracting: Focusing only on negative details while ignoring positive aspects of a situation, contributing to a distorted overall perception.

Recognizing and addressing these distortions is a crucial aspect of cognitive-behavioral interventions for depression.

Understanding Cognitive Behavioral Therapy (CBT)

CBT has three core principles or levels of cognition, including:[2]

• Core beliefs: People’s core beliefs are informed by their past and are deeply rooted in their environment, how they view themselves, and the future.
• Dysfunctional assumptions: People experience irrational cognitive patterns that distort how they view reality.
• Automatic negative thoughts: These are involuntary and habitual negative thoughts about reality that can lead to distressing emotions. Examples are all-or-nothing thinking and statements about what you “should” do, believe, or think.

CBT addresses depressive thought patterns by using specific strategies to identify and challenge distorted cognitions. Therapists work with individuals to recognize negative automatic thoughts, cognitive distortions, and maladaptive beliefs contributing to depressive symptoms.

Erin L. George, MA-MFT, explains, “One example of a behavior many clients struggling with depression often exhibit is negative self-talk. CBT therapy works to help a client replace negative self-talk with positive self-affirmations that become a habit and ultimately a healthier way of thinking of one’s self.”

Through various techniques such as cognitive restructuring, individuals learn to reframe negative thoughts, replace them with more balanced and realistic perspectives, and develop healthier coping mechanisms. This process helps break the cycle of negative thinking associated with depression, fostering more adaptive responses and improved emotional well-being.

Beck’s Cognitive Model of Depression

According to Beck’s Cognitive Model of Depression, negative and distorted thought patterns influence depression. This model suggests that people prone to depression interpret life events through a negative lens, leading to prevalent negative beliefs about themselves, the world, and the future—and these beliefs then feed the cycle of depression. Moreover, Beck posited that these patterns were likely to be activated by distressing life events that perpetuate these negative automatic thoughts and reaffirm people’s biases. [3]

Beck also asserts that there are three main dysfunctional belief themes (or “schemas”) that dominate depressed people’s thinking:

1. I am defective or inadequate.
2. All of my experiences result in defeats or failures.
3. The future is hopeless.

Together, these three themes are described as the Negative Cognitive Triad. When these beliefs are present in someone’s cognition, depression is very likely to occur (if it has not already occurred).

This is called the Negative Cognitive Triad, a key concept in cognitive theory, especially when it comes to understanding depression.[3]

This triad is important because it informs CBT treatment plans for depression. Therapists using CBT techniques collaborate with patients to identify, challenge, and change these negative thought patterns. Through cognitive restructuring, patients learn to replace negative automatic thoughts with more constructive and adaptive ones, breaking the cycle of the Negative Cognitive Triad and promoting positive change.

Example of How the Negative Cognitive Triad Works

An example of the negative cognitive triad themes will help illustrate how the process of becoming depressed works.

Imagine that you have just been laid off from your work. If you are not in the grip of the negative cognitive triad, you might think that this event, while unfortunate, has more to do with the economic position of your employer than your own work performance. It might not occur to you to doubt yourself or to think that this event means that you are washed up and might as well throw yourself down a well. If the negative cognitive triad dominated your thinking process, however, you would likely conclude that your layoff was due to a personal failure, that you will always lose any job you might manage to get, and that your situation is hopeless.

Based on these judgments, you will begin to feel depressed. Furthermore, these negative thoughts might lead you to feel anxious about the future. They could even manifest as anxiety or panic attacks, worsening your mental health and/or ultimately turning into a chronic anxiety disorder like generalized anxiety disorder.

In contrast, if negative triad beliefs did not influence you, you would not question your self-worth too much and might respond to the layoff by dusting off your resume and initiating a job search.

Depression and Faulty Information Processing

Beyond the negative content of dysfunctional thoughts, these beliefs can also warp information processing and shape what someone pays attention to. Beck asserted that depressed people pay selective attention to aspects of their environments that confirm what they already know and do so even when evidence to the contrary is right in front of their noses. This failure to pay attention properly is known as faulty information processing.[3]

Particular failures of information processing are very characteristic of the depressed mind. For example, depressed people will tend to demonstrate selective attention to information that matches their negative expectations and inattention to information that contradicts those expectations.

Faced with a mostly positive performance review, depressed people will manage to find and focus on the one negative comment that keeps the review from being perfect. They tend to magnify the importance and meaning placed on negative events and minimize the importance and meaning of positive events.

All these maneuvers, which happen quite unconsciously, function to help maintain a depressed person’s core negative schemas in the face of contradictory evidence. This allows them to remain feeling hopeless about the future even when the evidence suggests that things will get better.

What Are the Theories of Depression?

Several theories of depression have been proposed over time, each with its own set of underlying causes and influences on mental health. The cognitive theory of depression suggests that negative thinking patterns and beliefs can lead to feelings of hopelessness and helplessness. The psychoanalytic theory emphasizes the importance of early life experiences in the development of depression. In contrast, behavioral theory focuses on the role of reinforcement and punishment in shaping depressed behavior. Other theories have looked at the influence of genetics, hormones, and neurotransmitters on the development of depression. Regardless of the specific theory, the treatment of depression is important to address the underlying causes and help individuals find relief from their symptoms.

How Does the Cognitive Approach Explain Depression?

The cognitive approach attributes depression to negative thinking patterns and beliefs that people develop over time. For example, Beck developed the concept of “schemas,” which are the core beliefs and views of oneself, the world, and the future. Depressed individuals often have negative schemas, leading them to view themselves, situations, and the world in a negative light. They may focus on failures and evidence that supports their negative beliefs, leading to a cycle of negative thinking. This negative thinking can lead to feelings of hopelessness and helplessness and a sense of being trapped. The whole cognitive therapy approach aims to help individuals identify and change these negative thinking patterns to improve their mood and quality of life.

How Does CBT Help Depression?

Cognitive Behavioral Therapy (CBT) is a type of talk therapy that is effective in treating depression. CBT helps people identify and change negative thoughts and behavior patterns contributing to their depression, with therapists guiding this process. The therapist works with the individual to challenge and change these negative patterns and develop more positive ways of thinking and behaving. CBT can also help individuals develop coping skills and strategies to manage their symptoms, such as relaxation techniques and problem-solving skills. CBT is a time-limited treatment that typically involves weekly sessions over several months. The therapist provides support and guidance throughout the process, and individuals can learn ways to manage their depression on their own after treatment is complete.

What’s the Difference Between Cognitive Therapy and Cognitive Behavioral Therapy?

Cognitive Behavioral Therapy and Cognitive Therapy (CT) are closely related therapeutic approaches with some differences.

CBT is a broader term that encompasses a range of techniques and strategies to address the connection between thoughts, emotions, and behaviors. It focuses on identifying and modifying maladaptive patterns of thinking and behavior to improve overall well-being.

CT, on the other hand, specifically emphasizes identifying and challenging negative or distorted thoughts that contribute to emotional distress. It targets specific cognitive processes and aims to replace negative thinking patterns with more balanced and realistic thoughts.

While CT primarily focuses on thoughts, CBT incorporates behavioral interventions as well, emphasizing the role of actions and behaviors in shaping thoughts and emotions. CBT is often considered a more comprehensive and integrated approach, incorporating both cognitive and behavioral techniques to facilitate change.