Cognitive Behavioural Therapy (CBT) is one of the most researched treatments for depression. For some people, it’s highly effective. For others, it’s not the right fit.
As a psychotherapist working with clients in 20+ countries, I help people figure out whether CBT alone, or a blended approach, is best for them.
How CBT Works
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| How Beliefs Behaviour and Emotions are Linked |
CBT and Depression: When It Works Well
Depression can sometimes be fuelled by "faulty thinking." These are patterns of self-talk that don't match reality. They drag down your mood and can lead to depression.
For example, Sally gets an amazing annual review and a huge bonus. However, she tells herself her boss secretly hates her, and worries she is destined to fail.
In CBT, Sally would learn to challenge these thoughts. In sessions we might ask: "What evidence do you have that your boss doesn't like you?" and "How has your boss treated other people she then fired?" Through this process, Sally learns to recognize unhelpful patterns of thought, and replace them with balanced thoughts based on actual evidence.
CBT is most effective when your depression is driven by negative thought patterns that don't match reality.
When CBT Doesn't Help
Depression isn't one single illness with one single cause.
It shows up differently for different people. Some feel deeply sad, others feel emotionally flat. Some sleep too much, others can't sleep at all. For some, it appears suddenly and fades quickly; for others, it creeps in and lingers.
And the causes can vary just as much. I think of depression as spots—you need to figure out what's causing the spots before you know how to treat them. A rash from chickenpox needs different treatment than a rash from asoap allergy.
Depression might be linked to a thyroid problem, side effects from medication, an emotional shock, grief, trauma, genetics, or a mix of factors.
Here's when CBT won't help or won't be enough:
If your depression has a physical cause. If you have a thyroid condition or your depression is a side effect of medication, CBT won't help—you need medical treatment first. No amount of talk therapy will fix a thyroid problem.
If your depression stems from your life circumstances. If you're depressed because you're in an abusive relationship, hate your job, or are dealing with poverty, changing your thoughts won't change your reality. You may need practical support, life changes, or a different therapeutic approach alongside CBT.
If you're in a severe depressive episode. CBT involves homework, worksheets, and active participation. If you're so depressed you can barely get out of bed, CBT's practical approach may be too much too soon. You might need medication to lift you enough to engage with therapy, or a different therapeutic approach that requires less active work initially.
If your depression involves unprocessed trauma or grief. While CBT can help with some aspects, trauma and complicated grief often require approaches that address emotional processing more directly. Trying to "think differently" about trauma before processing it properly rarely works.
If you have treatment-resistant depression. Some people's depression doesn't respond to CBT or any single approach. In these cases, a combination of treatments—therapy, medication, lifestyle changes—is usually necessary.
How to Choose the Right Approach
Instead of starting with "I want CBT" or "I won't take medication," start with a proper assessment.
First step: see your doctor to rule out physical issues. If you have a wonky thyroid, no amount of talk therapy will change that. Click here to read more about why this matters.
Second step: talk to a qualified therapist. This is exactly what I do with clients. We work out how your depression operates: what is going on in your life, if there are triggers, if family history may be at work, and so on. Then we create a customized approach that will help you manage.
In my experience, CBT alone can work well for depression driven by unhelpful thought patterns. However, many people benefit from a blend of approaches. I often combine CBT with positive psychology techniques which focus on building strengths and wellbeing alongside addressing problems to create a more comprehensive treatment plan.
The key is matching the treatment to your specific situation, not forcing you into a one-size-fits-all approach.
If you want help figuring out what approach will work best for your depression, send me an email. That's exactly what we'll do together in our initial consultation.
What About Medication?
Medication can be a useful tool alongside therapy, especially if you're struggling to function or if your depression has a strong biological component.
The choice between medication, therapy, or both depends on your specific situation. Read more at: "I'm depressed. Should I pop a pill, go for therapy, or both?"
The Bottom Line
CBT is a powerful tool when your depression is driven by unhelpful thought patterns. But it's not a magic bullet for every type of depression.
Knowing whether CBT is right for your situation requires proper assessment—understanding what's causing your depression, how severe it is, and what you need to manage it effectively.
If you're trying to figure out whether CBT or another approach is right for you, that's exactly the work we do together. Send me an email to get started.
