Increased research and advances in clinical psychology have led to the development of many psychiatric therapeutic modalities over the years. Sigmund Freud pioneered this field in the 20th century by developing psychodynamic therapy. His work led to the development of other expansions of the psychological perspectives that gave rise to many psychiatric therapeutic modalities seeking to address mental health issues. These treatment approaches use different principles and techniques to improve people’s mental well-being. Psychiatric nurse practitioners and other mental health practitioners use them to help clients address and manage psychological problems. The use of these modalities extends beyond mental health problems. They equip clients with skills to overcome daily challenges and other issues like chronic illnesses, grief, and employment difficulties. Cognitive behavioral therapy (CBT) connotes one of the most empirically studied psychiatric therapeutic modalities. Many researchers, scientists, and mental health professionals support its effectiveness in treating mental health conditions (Gautam et al., 2020). This paper will provide its overview, theory, and practice techniques and evaluate research on its effectiveness in depression treatment.
Overview
CBT focuses on helping manage and cope with their problems by changing their thinking and behavioral patterns. It is a time-limited directive. It is a structured and talking therapy that treats many disorders. According to Samaan et al. (2021), its tenets are behaviors, thoughts, and behavior, which are all interconnected. It assumes that maladaptive thoughts and feelings trap people in a negative cycle that perpetuates mental health disorders. It helps people break down overwhelming problems into small parts and shows people how to change their negative thought patterns to improve their emotions and actions. It helps clients find practical methods of enhancing their state of mind. Healthcare professionals initially used it to treat depression, but now its applications have increased to assist in the treatment of many mental and medical problems. Its increased adoption has been because of its effectiveness in treating these conditions, as supported by numerous empirical sources (Li et al., 2020). It applies evidence-based cognitive and behavioral principles that enhance its effectiveness.
The clinical modality is present and problem-oriented. It focuses on the current challenges and distressing situations. It does not concentrate on what past issues caused the client’s symptoms. Instead, it focuses on their mental state, aiming to solve their problems effectively. It acknowledges the difficulties the client is facing currently and concentrates on solving them in a structured and consistent manner to achieve treatment gains quickly. While the therapist may need specific info about the client’s history, the main goal is to move forward and develop effective coping mechanisms. The clinical modality is also goal-oriented, making it an action-focused psychotherapy (Jin et al., 2021). It focuses on setting SMART goals for behavioral change. Psychiatry professionals enable clients to break down these objectives into smaller milestones. They also structure the CBT sessions to help clients learn skills that will help them achieve their goals and solve their current problems.
CBT also emphasizes collaborative empiricism. It focuses on establishing a trusting and helpful therapeutic relationship where therapists and clients work together to solve problems. Both parties work together to identify negative thoughts and behaviors, assess their validity, and make necessary revisions (Ovenstad et al., 2020). The collaborative nature of this form of talking therapy enables clients to clearly define and understand their problems and acquire skills and knowledge to manage them. It allows clients to take an active role in their treatment. For example, when therapists and clients work together to develop practical solutions to identified problems, they learn new ways of handling them independently, making them active participants in the treatment process.
Cognitive behavioral therapy is also brief. It is shorter than conventional talk therapy. Clients can stop the treatment once they have the skills to manage their problems or achieve significant symptom relief. Most people finish this treatment within a few months (Lungu et al., 2020). However, the treatment of chronic severe mental issues may last from half a year to several years. Even in these cases, CBT takes a shorter duration than other types of conventional talk therapy.
Theory and Practice Technique
Cognitive behavioral therapy is based on a cognitive model highlighting the relationships among behavior, emotion, and cognition. It emphasizes the impacts of underlying beliefs, automatic thoughts, and dysfunctional assumptions. According to Leahy et al. (2021), core beliefs influence how people interpret and perceive events. Life experiences shape people’s beliefs. They shape self-perception and how people view the world, environment, and the future. They can have a significant impact on an individual’s feelings and behaviors. Dysfunctional beliefs can lead to negative emotions and actions. Dysfunctional assumptions are cognitive distortions. Compelling evidence has shown that people often pay more attention to the negative things than the positive (Meng et al., 2021). Such damages one’s thought patterns, causing errors in logic and leading to a distorted perception of reality. It leads to erroneous conclusions about occurrences, contributing to negative emotions and behaviors.
Automatic thoughts entail a person’s involuntary, unpremeditated, and immediate perceptions and interpretations of events and reality. They shape how people feel and behave in response. It can be challenging to identify negative automatic thoughts because they are brief but lead to negative emotions. For example, an individual may call their friend who fails to pick up their phone. An automatic negative thought of “he is ignoring me” may cause negative moods, upsetting the person. The individual can respond by ignoring the friend when they call them back. Such depicts how automatic negative thoughts can lead to negative feelings and behaviors. CBT seeks to help people learn to change how they think or respond to a situation to avoid maladaptive thought patterns that affect emotions and behaviors negatively. It acknowledges that all people have distorted thoughts. However, CBT can help clients practice responding to their thoughts and challenge them in realistic and helpful ways.
Cognitive behavior therapy assumes that unhelpful and faulty thinking patterns contribute to mental health problems. Such leads to learned patterns of unhelpful behavior. Individuals with these conditions can learn how to cope with them and become more effective in life. CBT helps in this process by helping people recognize distorted cognitions that are causing their psychological problems. It empowers them to re-evaluate and change these thoughts (Ovenstad et al., 2020). For example, individuals with depression can implement small changes in their cognitions, which can have significant changes in their moods, enabling them to feel better. CBT treatment seeks to help clients replace distorted thoughts with realistic ones that are more appropriate for the situation.
CBT treatment also seeks to help clients adopt beneficial behaviors to improve their well-being. From a liberal perspective, most individuals often engage in actions that aggravate their problems. For example, a highly anxious individual may drink excess coffee, making them more nervous. CBT encourages and teaches clients to adopt healthy behaviors, like exercises that can reduce anxiety. Beneficial behaviors will lead to healthy emotions that positively impact psychological health. Cognitive behavioral therapy also facilitates the use of problem-solving skills to deal with difficult situations in one’s life. It empowers clients to become their therapists. It uses techniques like exposure, role-playing, and practicing mindfulness that clients can use independently (Leahy et al., 2022). Therapists provide numerous activities during sessions and homework exercises outside the session that enable clients to develop skills to handle difficult questions independently and change their thinking patterns and negative emotions and behaviors. It empowers them to build confidence in their abilities, increasing their capacity to manage difficult situations and psychological problems.
The CBT process begins by identifying the client’s problems. Psychiatric health professionals work together with clients to help them break down their issues into different parts, like actions, thoughts, and feelings. It enables them to be aware of these elements. Both parties work together to evaluate whether these beliefs, cognitions, or emotions are realistic or unhelpful. Such helps identify maladaptive thinking and behaviors that may contribute to the client’s problems. Therapists then help clients to reshape their unhelpful thinking and behaviors. The process entails the use of cognitive and behavioral techniques.
Cognitive techniques in CBT include guided discovery, cognitive restructuring, mindfulness, cognitive defusion, and problem-solving. Guided discovery involves comprehending the client’s perspective to help understand their underlying assumptions and expand their thinking. The therapist asks questions to help in this process, with the Socratic questioning method being the most common (Leahy et al., 2022). Such involves asking thought-provoking questions to help clients see things from different and new viewpoints, enabling them to choose the most helpful path. Cognitive restructuring entails learning how to identify negative thought patterns. When clients are unaware of these unhelpful cognitions, they can learn how to reframe them to be more productive and positive. It helps them reframe challenging situations rationally, thus improving their thinking process and eventually improving their emotions, behaviors, and psychological well-being.
Cognitive defusion involves detaching from one’s thoughts. The technique teaches clients to look at thoughts without allowing them to control their actions. In other words, individuals can choose whether or not to engage with their cognitions. For example, they can decide to distance themselves from negative thoughts, giving them more control over their behaviors. Mindfulness teaches clients to disengage from cognitive processes that cause or elevate their psychological problems (Leahy et al., 2022). The technique involves detaching from negative things and focusing on what is happening at the present moment. Problem-solving is a cognitive technique that entails confronting one’s problems. Clients divide overwhelming issues into small and manageable parts to develop straightforward answers with the help of mental health professionals, enabling them to overcome their challenges.
Some behavioral practice techniques in CBT include activity scheduling, skills training, exposure therapy, behavioral experiments, and stimulus control. Activity scheduling enables clients to engage in productive and pleasurable activities, thus improving their moods. It involves planning, thus eliminating the likelihood of procrastination. It entails identifying helpful and enjoyable activities for the client and scheduling when to undertake them (Gautam et al., 2020). The technique motivates clients to pursue them and enables them to develop good habits. Skills training entails equipping clients with the tools to navigate difficult situations and life challenges. It helps them develop skills to achieve their goals. It makes up for the abilities that the clients may be missing. For example, therapists can provide emotional regulation training for individuals with difficulties managing their emotions. The technique empowers individuals to solve problems on their own.
Exposure therapy involves divulging people to their fears and phobias. It enables clients to confront situations they would otherwise avoid. Therapists expose them to these fears gradually as they guide them on how to cope. Exposure makes people less vulnerable to these situations and enhances their coping abilities. A study by Leahy et al. (2022) has shown that the technique has a 90.0% effectiveness rate with anxiety disorders. Behavioral experiments entail experiential activities that assess the accuracy of one’s beliefs or thoughts. It enables clients and therapists to gather the information that empowers them to test the validity of the client’s thoughts, underlying assumptions, and beliefs. Stimulus control seeks to transform environmental cues that cause specific behaviors. It enables clients to recognize the trigger for their emotions and actions, empowering them to make changes.
Effectiveness with Depression
Researchers have demonstrated the effectiveness of CBT in the treatment of many mental health disorders (Gautam et al. (2020); Samaan et al. (2021); Verhey et al., 2020). They have contended that this psychiatric therapy modality improves people’s functioning and quality of life. Samaan et al. (2021) have shown that it is equally effective or even more effective than other therapies and psychiatric medications. There is a lot of empirical and scientific evidence highlighting that CBT produces a change in psychological problems.
Depression is one of the major disorders for which psychiatric health professionals use CBT as a form of treatment. The condition is highly debilitating as it causes impairments that affect one’s ability to perform daily activities. According to Zenebe et al. (2021), it ranks as the leading contributor to worldwide disability. As of 2021, 21 million American adults had this mental health disorder (National Institute of Mental Health, 2023). The risk of recurrence is high, with a 60.0% risk after the initial major depressive episode (Lye et al., 2020). Recurrent depressive episodes and symptoms escalate the likelihood of developing chronic depression, which elevates the risk of suicide, functional impairment, and comorbid physical health problems.
A substantial body of research has shown the effectiveness of CBT in depression treatment. In line with Gautam et al. (2020), a meta-analysis of 115 studies showed that this psychiatric therapy modality is an efficacious strategy for mental health disorders. The analysis concluded that combining CBT with psychiatric medications is more effective than solely relying on pharmacotherapy. These findings align with those from a study by DeRubeis et al. (2022) that highlights the effectiveness of multimodal treatment in depression involving the combination of anti-depressants and CBT. Depression patients undergoing cognitive behavioral therapy also have a low relapse and recurrent rate compared to those using medications alone. Such shows that the treatment has sustained benefits.
Individuals with depression often have negative feelings about the world, themselves, and others. The habitual maladaptive thinking pattern becomes automatic, making it difficult for them to notice irrational judgments. CBT provides these people with tools and skills that can help them counter these maladaptive cognitions and replace them with more helpful and positive thoughts. Aaron T. Beck’s cognitive theory of depression is essential in explaining this process. The theory contends that people with depression have cognitive patterns biased toward negative interpretations of events. They acquire a negative belief system as they grow and experience stressful events. In other words, their learning histories lead them to develop inaccurate beliefs about the world, others, and themselves. According to Leahy et al. (2022), these beliefs can remain dormant for prolonged periods and are often activated when individuals experience similar situations later in life. CBT is effective in treating depression because it seeks to change these negative underlying beliefs.
Aoran T. Beck also proposed the negative cognitive triad of depressed people. The triangle contends that people with this disorder have negative self-perceptions and view the world and future negatively. Their cognitive bias and unhelpful schemas fuel these irrational perceptions. Beck’s concept of depression guides CBT interventions in depressed patients.
It takes this cognitive model of depression further by ensuring clients eliminate cognitive distortions and automatic thoughts and change their behaviors. It helps depressed individuals recognize their negative thoughts and beliefs, making a connection between these elements and depression. It also encourages them to challenge these thought patterns. According to Gautam et al. (2020), it teaches patients to drive attention from negative ruminations to positive aspects. For example, if depressed client has negative views about the future and why they believe that they will always be a failure, CBT enables them to challenge these beliefs by allowing them to reflect on times when they were successful. Such empowers the client to reframe their automatic unhelpful thoughts into a helpful and realistic evaluation of the situation at hand. CBT then encourages the depressed individual to cultivate positive thought patterns. It equips them with the skills to solve problems and manage stress healthily, thus improving their psychological well-being.
The enduring positive effects of CBT highlight its effectiveness in treating depression. A randomized trial by DeRubeis et al. (2020) uncovered that depressed individuals treated with anti-depressant medications had a higher risk of relapse through twelve months of follow-up than those who received cognitive behavioral therapy. A study by Hollon et al. (2021) supports this notion, contending that this psychiatric therapy modality has a sustainable effect that safeguards depressed persons against relapse and possible recurrence following treatment termination, unlike patients kept on anti-depressant drugs to the point of recovery. Such is because the medicines focus on dulling the condition’s distress, whereas CBT focuses on solving the problem. These research findings show that cognitive behavioral therapy is effective in the treatment of depression because it has long-term outcomes that prevent recurrence and relapse. While substantial evidence has demonstrated the effectiveness of CBT in depression in the general population, Gautam et al. (2020) contend that this form of therapy may not work in individuals with severe depression with suicidality and psychosis. Meng et al. (2021) have also shown that the psychiatric modality is only effective in moderate and mild depression levels. Severe levels may require medications before seeking CBT. However, overall research on this psychiatric therapy favors its efficacy in treating depression.
In conclusion, CBT is a well-supported psychiatric therapeutic modality. It focuses on helping people change their thinking patterns to manage their problems. It emphasizes solving current issues that the client is facing, embracing a goal-oriented approach. It is a talk therapy and thus relies on collaboration between mental health professionals and clients. It is grounded in the theory that emotions, behaviors, and thoughts are interrelated. It acknowledges that automatic thoughts, underlying assumptions, and beliefs shape people’s feelings and actions. As such, it empowers clients to adopt healthy and positive cognitive processes. It also uses cognitive and behavioral techniques to help clients achieve their goals. Substantial research has supported its effectiveness and efficacy in treating depression.
References
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