Cognitive behavioral therapy (CBT) aims to use cognitive restructuring to identify negative thoughts or distorted thinking and replace them with more realistic ones. Common types of negative thinking found in depressed patients include catastrophizing – exaggerating things so they become more serious than they actually are and personalization – seeing yourself as the cause of the negative events that are not actually your fault. Furthermore, CBT involves the use of practical self-help strategies, which are designed to affect positive and immediate changes in the person’s quality of life. As a result, CBT can be as effective as medication in treating some mental health disorders and may be helpful in cases where medication alone has not worked.
On the other hand, another moderately effective treatment option for depression is antidepressants or reuptake inhibitors. As such, Eric Endlich, a clinical psychologist in Boston, states, “antidepressants can help jump-start mood and give people the boost they need to get over their symptoms of their depression. This allows people to start doing the things they enjoy again and make better choices for themselves.” Whilst the use of antidepressants such as serotonin, noradrenaline and dopamine, are thought to have an important effect on your mood, individuals can have very different responses to one antidepressant compared with another so it can be a case of trial and error to find one that works effectively. Furthermore, like all prescription drugs, it may take at least three to four weeks before one notices a significant change in their mood. Often, mild to severe depression sufferers will be prescribed antidepressants in combination with CBT. This is because antidepressants can change the levels of certain chemicals such as serotonin in one’s brain, which can help one to feel well enough to attend the therapy sessions. For example, one may feel worthless or wake up one morning and think, “what is the point of trying?” As such, in conjunction with antidepressants, CBT teaches the patient to swap the irrational thoughts for more positive ones.
Over the years, extensive research has been conducted into the effectiveness of CBT to re-train one’s thoughts and alter behaviors. Although this therapy can be completed in a relatively short period of time compared to other talking therapies, to benefit from CBT, one needs to commit their time and energy to the process. Furthermore, as CBT can involve confronting your emotions and anxieties, a client may experience initial periods where they are more anxious or emotionally uncomfortable. The overtly structured nature of CBT may also not be suitable for people with more complex mental health needs or learning difficulties. Hence, positive rapport with the treating therapist/practitioner is essential to reduce stress or other negative emotions for the client. Furthermore, the skills one learns in CBT are useful, practical and helpful strategies that can be incorporated into everyday life to help one cope better with future stresses and difficulties, even after the treatment has finished.
In fact, research into the effectiveness of CBT can be summarized in “meta-analyses” whereby numerous studies have been surveyed, combined, and effect sizes extrapolated. Two such analyses published online from The National library of Medicine and the National institutes of Health entitled “Is cognitive-behavioral therapy more effective than other therapies? A meta-analytic review” and “The empirical status of cognitive-behavioral therapy: a review of meta-analyses” both found that CBT is effective for a wide range of disorders. For example, the abstracts of these meta-analytic reviews state “the superiority of CBT over alternative therapies was evident only among patients with anxiety or depressive disorders” and “CBT was somewhat superior to antidepressants in the treatment of adult depression. However, CBT was equally effective as behavior therapy in the treatment of adult depression and obsessive-compulsive disorders”. Additionally, a study published on BBC News in 2012 following 469 patients with treatment-resistant depression in Bristol, Exeter and Glasgow over 12 months concluded CBT was effective in reducing symptoms and improving patients’ quality of life. For example, one group of patients only used anti-depressant medication, while the second group was also treated with CBT. After six months, researchers found 46% of those who had received CBT reported at least a 50% reduction in their symptoms, highlighting its effectiveness over other forms of treatment for depression.
Before conducting studies into the effectiveness of CBT, researchers are required to obtain the informed consent of the participants, ideally in written and oral form. These consent forms should use language that is reasonably understandable to describe the nature and purpose of the research, the length of time the subject is expected to participate, any foreseeable risks or discomforts, a statement that the data gained from the participants must be kept anonymous and be used for the stated research purposes only, participation is voluntary and refusal to participate will not result in any punishment or consequences that the individual is otherwise entitled to receive. Taking such ethical concerns into consideration as well as the positive research outcomes for this specific therapy, it is suggested that for those experiencing mild depression, exercise and/or complementary medicines may be the best treatment option. However, for moderate or severe depression sufferers, the most effective treatment program may be a combination of CBT and antidepressants.