Many patients with disabling depression have no appetite for sitting on a couch recounting childhood traumas or last night's dreams for monthsor yearsbefore they start to feel better. Antidepressants may help in such cases, but even if they do, when patients stop taking them there's a good chance they'll end up back at square one.
One alternative, cognitive-behavioral therapy (CBT), an umbrella term that includes several related talk therapy techniques (including cognitive therapy), offers hope. Studies suggest it offers relatively fast, effective, and lasting treatment. The concept underlying CBT is that, in many cases, depression is primarily caused by negative ways of thinking about oneself and the world, not necessarily by life circumstances or biochemistry.
The goal of CBT is to teach patients to break out of harmful thinking patterns by recognizing negative thoughts, testing their validity, and substituting positive (or at least more realistic) thoughts in their place. Studies have shown that the benefits of the treatment often happen abruptly, in a single session or between two sessions, when patients suddenly realize that their own negative thinking is largely responsible for their symptoms.
CBT differs from traditional talking therapy in several respects.
- Length. Unlike with psychoanalysis, which can last for years, the average number of CBT sessions is 16. The length of the therapy is often determined in advance, at the beginning of treatment.
- Structure. Most CBT therapists have a "lesson plan" for each session that includes a set of specific techniques and goals for the patient to learn.
- Homework. More so than other forms of therapy, CBT requires the patient to actively identify the triggers of their negative thinking and to "practice" alternative responses. Patients may be asked to keep a journal of their thoughts or to actively schedule challenging situations for themselves.
Research suggests that CBT is at least as effective as antidepressants for patients with major depression. The treatment has also shown promise for anxiety and other mood disorders.
Perhaps the greatest selling point of CBT is that it appears to be more effective than medication in the long term. Patients who are successfully treated with cognitive therapy, for instance, are roughly half as likely as patients taking antidepressants to relapse after the end of treatment.
For severely depressed patients, one potential downside of CBT is that for the treatment to be effective they have to (as the saying goes) really want to change. Research suggests that patients who believe in their ability to improve and who complete their homework assignments get better results.