What is Cognitive Behavioral Therapy (CBT) For Depression and Anxiety?
CBT teaches the connection between thoughts, feelings, and behaviors. Patterns of unrealistic thinking and unhealthy behavior are believed to fuel disorders such as depression and anxiety. The goal of CBT is to:
- Identify these patterns
- Replacing distorted thinking with more realistic thinking
- Substituting healthy, effective behaviors for maladaptive ones
The Result Is a Decrease in Symptoms of Depression and Anxiety.
Clients sometimes find it helpful to think of depression as seeing the world through pair of scratchy grey sunglasses. Everything looks gloomy and dark. It feels flat and cold. Just as scratchy, grey glasses distort what we see, so does depression. Thoughts such as “there is nothing to look forward to” contribute to feeling sad and hopeless. We have less energy. We do less. We create a self fulfilling prophecy where there really isn’t much to look forward to. We stay stuck.
CBT helps to challenge, or question, some of the automatic thoughts we have, that we assume are accurate. CBT helps clarify that the world isn’t actually gloomy and dark, it seems that way because of the “lenses” we wear. When we are able to remove those lenses, we can see a more realistic picture. We are able to question how true it is that there is “nothing to look forward to. We recognize that what our thoughts tell us is not necessarily true. We learn to talk back to our distorted thoughts, to say “Of course there are things to look forward to. Life has ups and downs. Things will most likely turn around for me.”
Many people find it helpful to think of depression as seeing the world through a pair of scratchy grey sunglasses.
How Does Cognitive Behavioral Therapy Help Depression and Anxiety
CBT also teaches us how unhelpful behavior plays a vital role in keeping us stuck in our depression and anxiety.
CBT teaches us that behavior such as:
- Calling out of work and staying in bed all day when feeling depressed
- Putting off an important project until the day before because of anxiety
are more hurtful than helpful and, rather than relieving our depression and anxiety, actually make it worse. CBT helps us to recognize our unhelpful behavior, and teaches us how to use more healthy coping skills, instead.
If I can recognize that hiding under the covers has never helped before, I may be more likely to force myself to do something different, like get out of bed, take a shower, and get something accomplished, even if it’s just returning a few emails.
In the latter example I am more likely to feel better, sooner, than in the former.
Long established, habitual, unhelpful patterns of thinking and behavior fuel depression and anxiety. To experience relief of symptoms, distorted thinking and maladaptive behavior need to change. With practice, coaching, trouble-shooting, and more practice, evidence shows that CBT works.
Medication and Therapy for Depression and Anxiety
- What’s the role of medication in treating depression and anxiety?
- Is therapy even necessary if I’m on medication and, conversely,
- Is medication necessary if I’m already in therapy?
Research over the last several decades has shown that a combination of medication and therapy (specifically, CBT) is most effective in alleviating symptoms of depression and anxiety.
Myths About Antidepressants
For many years, there was a belief that antidepressants like SSRIs reduced depression by regulating the re-uptake of serotonin. By preventing serotonin from being reabsorbed, and therefore making more of it available in the brain, the person experienced less depression.
The problem is, if that was the mechanism, the medications would offer instant relief, rather than the 2-6 weeks that is typical.
Modern Views of How Medication Helps Depression and Anxiety
More recently, there is research suggesting that antidepressants actually work by increasing neuroplasticity of the brain. Through this process, over a period of a few weeks, our brain adapts to the higher levels of serotonin. Research suggests this allows the neurons in the brain to readjust, and even grow new connections. Through a process known as “neurogenesis” the brain becomes more flexible in it’s ability to adapt, to cope, and to change.
How Medication Works With Psychotherapy
Increased neuroplasticity enables the conditions necessary for learning to take place, therapy provides the necessary insight, understanding, and skills training for change to occur. High quality Cognitive Behavioral Therapy teaches the connection between thoughts, feelings, and behaviors. To decrease the intensity of anxiety and depression, the distorted thinking and unhelpful behavior that has maintained those feelings must be changed to more realistic thinking and more adaptive behavior. In therapy, patients learn to recognize when thinking is distorted and they learn to think in a less distorted, more realistic manner. They also learn how to respond in a more healthy and adaptive manner. The change in thinking results in a decrease in depression and anxiety.
The brain, through a process known as “neurogenesis” becomes more flexible in it’s ability to adapt, to cope, and to change.