What is Cognitive Behavioral Therapy (CBT)?
Cognitive Behavioral Therapy (CBT) is a psychotherapeutic treatment approach that teaches people how negative thoughts and beliefs about the self, others, and the world can impact feelings and behaviors. You can use CBT for depression and is one of the most widely used treatment methods for numerous disorders, from mental health concerns to every day stress and even physical problems like chronic pain or other medical issues.
Therapists who treat patients with Major Depressive Disorder (MDD) often use CBT or will incorporate CBT interventions and approaches into the client’s treatment. CBT is also often applied through self-help methods, where people can learn and apply CBT principles in their lives; however, it is best applied with the guidance of a therapist and in the structure of therapy sessions.
How Depression is Triggered: The Core Belief System
According to Cognitive Behavioral theory, depression develops (or is triggered) when one or more core beliefs are triggered by a major life event or a major life stressor. These events can include losing a job, experiencing the death of a loved one, a relationship break-up, or even less severe events such as moving to a new city.
Core beliefs are the basic or most fundamental beliefs people have about themselves, other people, and their environment. They are often rigid and reflect people’s values. The reason core beliefs are so influential in our lives is because we consider these beliefs to be ultimate truths and we tend to believe information that supports our core beliefs while refuting most information that disagrees with our core beliefs.
Core beliefs often develop very early on in life and can stay with us for a lifetime (unless the core beliefs are challenged and replaced with more positive beliefs). It is a challenging task to try to convince someone to believe ideas or concepts that are contrary to their core beliefs because core beliefs are very deeply engrained in the way we see things and interpret reality.
Examples of core beliefs include:
If I become attached to someone, they will leave me.
If I am not liked and accepted by others then there is something wrong with me.
I am not good enough to be loved by a decent person.
Everyone else is good at their job except me.
I am a weak person.
How Depression is Maintained: Intermediate and Automatic Thoughts
Cognitive Behavioral theory explains that core beliefs can remain dormant for many years. Think of core beliefs like sleeping cells in our minds that can remain silent, sometimes for decades, until (or if) they are triggered by a major life event/stressor. However, once triggered, core beliefs lead to intermediate beliefs, which are the rules or attitudes people follow in their lives for various situations. An intermediate belief is a bit more specific than a core belief. For example, a core belief may be, “I am unlovable” while the corresponding intermediate belief would be, “If my body is thin and fit, I will be lovable.”
Intermediate beliefs can then lead to negative automatic thoughts, which are dysfunctional or distorted beliefs about a situation that a person can accept as truth. For example, an automatic thought that corresponds with the core belief and intermediate belief stated above would be: “I am fat and disgusting.”
According to CBT, automatic thoughts have a direct impact on a person’s mood, emotions, and behaviors. The automatic thought, “I am fat and disgusting” can cause the person to become sad, hopeless, feel worthless or unworthy, and even cause the person to isolate themselves from others and avoid social interactions. Negative and dysfunctional thoughts and beliefs can perpetuate depression, as these thoughts can occur constantly, creating a negative feedback loop where the depression worsens and, in turn, the negative thoughts become more frequent and severe.
How CBT Can Help
A CBT therapist helps to guide the patient in identifying the negative, dysfunctional, and distorted (or unrealistic) beliefs and thoughts that trigger and maintain depression. These beliefs and thoughts become so habitual that oftentimes the person with depression does not realize the link between thoughts and corresponding emotions/feelings and behaviors. When the person is able to understand this connection, the therapist can work with them to begin challenging these negative beliefs and thoughts.
The reason the process of challenging dysfunctional beliefs and thoughts is so critical is because the person strongly believes that these beliefs and thoughts are reality. The truth is that more often than not, these beliefs and thoughts are exaggerated and/or simply unrealistic. The cycle is broken when the person is guided in developing possible alternatives to these beliefs and thoughts. For example, a person who believes they are only worthy of love if they are physically fit and thin can be encouraged to consider other realities such as whether they have other good qualities that make them lovable or if they truly want someone to love them only for the way they look physically. The person can also be guided to consider whether calling themselves “fat and disgusting” is an accurate description of themselves or if they may be being overly harsh or strict with themselves.
There are numerous other interventions and strategies that are a part of treatment with CBT. It is an empowering, practical, and insight-oriented approach that serves to teach and guide the client to learn ways to cope with depression and ultimately become their own therapist.
Dr. Michael Messina