According to the cognitive model of depression, ones negative beliefs develop as the result of:

Diagnosis: Depression

2015 EST Status: Treatment pending re-evaluation Very strong: High-quality evidence that treatment improves symptoms and functional outcomes at post-treatment and follow-up; little risk of harm; requires reasonable amount of resources; effective in non-research settings

Strong: Moderate- to high-quality evidence that treatment improves symptoms OR functional outcomes; not a high risk of harm; reasonable use of resources

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• Diagnosis: Depression
• Brief Summary
• Treatment Resources
• Treatment Manuals / Outlines
• Training Materials and Workshops
• Measures, Handouts and Worksheets
• Self-help Books
• Smartphone Apps
• Video Demonstrations
• Clinical Trials
• Meta-analyses and Systematic Reviews
• Other Treatment Resources
• What explanation does the cognitive model give for depression?
• Which of the following are biological explanations of depression?
• Which of the following is a major risk factor for developing a social anxiety disorder?
• Which of the following is seen as an effective treatment for severe depression that does not respond to drug therapy?

Weak: Low or very low-quality evidence that treatment produces clinically meaningful effects on symptoms or functional outcomes; Gains from the treatment may not warrant resources involved

Insufficient Evidence: No meta-analytic study could be identified

Insufficient Evidence: Existing meta-analyses are not of sufficient quality

Treatment pending re-evaluation

1998 EST Status: Strong Research Support Strong: Support from two well-designed studies conducted by independent investigators.

Modest: Support from one well-designed study or several adequately designed studies.

Controversial: Conflicting results, or claims regarding mechanisms are unsupported.

Strength of Research Support

Very Strong

Strong

Weak

Insufficient Evidence

Treatment pending re-evaluation

Strong

Modest

Controversial

Brief Summary

• Basic premise: Aaron T. Beck’s cognitive theory of depression proposes that persons susceptible to depression develop inaccurate/unhelpful core beliefs about themselves, others, and the world as a result of their learning histories. These beliefs can be dormant for extended periods of time and are activated by life events that carry specific meaning for that person. Core beliefs that render someone susceptible to depression are broadly categorized into beliefs about being unlovable, worthless, helpless, and incompetent. Cognitive theory also focuses on information processing deficits, selective attention, and memory biases toward the negative.
• Essence of therapy: In cognitive therapy (CT), clients are taught cognitive and behavioral skills so they can develop more accurate/helpful beliefs and eventually become their own therapists.
• Length: In most randomized clinical trials or efficacy trials, CT for depression is typically delivered over 8 to 16 sessions. There is a significant interaction between initial symptom severity and length of CT (Shapiro et al., 1994). Clients with mild or moderate depression do well with either 8 or 16 sessions of CT. However, clients with severe depression demonstrate significantly better response rates with 16 sessions as compared to 8 sessions. It is recommended to allow for booster sessions after termination for enhanced relapse prevention 3, 6, and 12 months after termination (Beck, 2011). A caveat to the 8-16 sessions finding is that since these results were obtained in efficacy trials, one can extend treatment in the community past 16 sessions depending on: 1) the severity and chronicity of the client’s depression, 2) comorbid disorders, and 3) other psychological, physiological, and psychosocial factors (all of which may complicate the client’s recovery from depression). For example, a study assessing the effectiveness of CT in an outpatient CT clinic found that clients attend an average of 15.9 (SD = 16.2) CT sessions, with a range of 0 (clients who completed an intake, but never entered therapy) to 97 (Gibbons et al., 2011). The modal number of CT sessions was 1 and the median was 11 (Gibbons et al., 2011).

Treatment Resources

Editors: Ramaris E. German, Ph.D.; Michael Williston, PsyD; Rachel Hershenberg, PhD

Note: The resources provided below are intended to supplement not replace foundational training in mental health treatment and evidence-based practice

Treatment Manuals / Outlines

• Individual Cognitive Behavior Therapy for Depression (ENRICHD Intervention Manual of Operations, Volume 2, Pages 2-16, Version 2)
• Individual Therapy Manual for Cognitive-Behavioral Treatment of Depression (Muñoz & Miranda; also available in Spanish)
• Treatment Manual for Cognitive Behavioral Therapy for Depression, Individual Format Therapist’s Manual: Adaptation for Puerto Rican Adolescents (Rosselló & Bernal)
• Treatment Manual for Cognitive Behavioral Therapy for Depression (Rossello & Bernal)
• Cognitive Behavioural Therapy Skills Training Workbook (Hertfordshire Partnership University NHS Foundation Trust)
• Manual for Group Cognitive-Behavioral Therapy of Major Depression: A Reality Management Approach (Muñoz, Ippen, Rao, Le, Dwyer)

CT for Specific Populations and Formats: Manuals Available Through External Sites

• Group Therapy Manual for Cognitive-Behavioral Treatment of Depression (Muñoz & Miranda, 1996)
• Treatment for Adolescents with Depression Study (TADS): Cognitive Behavior Therapy Manual (Curry et al., 2000)
• Cognitive Behavioral Therapy for Depression in Veterans and Military Servicemembers: Therapist Manual (Wenzel, Brown, & Karlin, 2011)

• Cognitive Therapy of Depression (Beck et al.)
• Cognitive Behavior Therapy: Basics and Beyond (2nd Edition; Beck)
• Overcoming Depression: A Cognitive Therapy Approach Workbook (Gilson et al.)
• Cognitive Therapy for Bipolar Disorder: A Therapist’s Guide to Concepts, Methods and Practice (Lam, Jones, & Hayward)

Training Materials and Workshops

Training Centers in North America

• Beck Institute: Cognitive Therapy Training Center (1 Belmont Avenue, Suite #700, Bala Cynwyd, PA 19004)
  • Contact: (610) 664-3020
• Academy of Cognitive Therapy: Supporting Professionals, Educating Consumers, and Connecting Individuals with Truly Effective Care (Multiple locations worldwide)

Workshops

• Workshops under the direction of Judith Beck, PhD at the Beck Institute
• Workshop listing for the annual conference of the Association for Behavioral and Cognitive Therapies (ABCT)

Measures, Handouts and Worksheets

• Beck Depression Inventory, Second Edition (BDI-II)
• Dysfunctional Attitudes Scale
• Beck Hopelessness Scale
• Worksheets for Depression

Self-help Books

• Mind over Mood: Change How You Feel by Changing the Way You Think (2nd Edition, Greenberger, Padesky, & Beck)
• Feeling Good: The New Mood Therapy (Burns)

Important Note: The books listed above are based on empirically-supported in-person treatments. They have not necessarily been evaluated empirically either by themselves or in conjunction with in-person treatment. We list them as a resource for clinicians who assign them as an adjunct to conducting in-person treatment.

Smartphone Apps

• Depression CBT Self-Help Guide (Excel at Life)
• Anxiety and Depression Association of America, Mobile Apps
• MacAnxiety Research Centre, Depression Apps
• MoodKit (ThrivePort, LLC)

Computer-Based CBT for Depression

• Beating the Blues (Ultrasis)
• Moodcalmer (Cobalt)
• MoodGym (National Institute of Mental Health in Australia)

Video Demonstrations

• Beck Institute YouTube channel

• Depression: A Cognitive Therapy Approach (Freeman)

Clinical Trials

Major Depressive Disorder

• Effect of cognitive therapy with antidepressant medications vs antidepressants alone on the rate of recovery in major depressive disorder: A randomized clinical trial (Hollon et al., 2014)
• Cognitive therapy vs medications in the treatment of moderate to severe depression (DeRubeis et al., 2005)
• Prevention of relapse following cognitive therapy vs medications in moderate to severe depression (Hollon et al., 2005)
• Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents With Depression Study (TADS) randomized controlled trial (March et al., 2004)
• Prevention of depression in at-risk adolescents: A randomized controlled trial (Garber et al., 2009)
• Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression (Dimidjian et al., 2006)
• Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the prevention of relapse and recurrence in major depression (Dobson et al., 2008)
• Treatment and prevention of depression (Hollon, Thase, & Markowitz, 2002)

Dysthymic Disorder

• Controlled randomized clinical trial of spiritually integrated psychotherapy, cognitive-behavioral therapy and medication intervention on depressive symptoms and dysfunctional attitudes in patients with dysthymic disorder (Ebrahimi et al., 2013)

Bipolar Disorder

• A randomized controlled study of cognitive therapy for relapse prevention for bipolar affective disorder: Outcome of the first year (Lam et al., 2003)

Group CT

• Randomised controlled trial of group cognitive behavioural therapy for comorbid anxiety and depression in older adults (Wuthrich & Rapee, 2013)
• An effectiveness trial of group cognitive behavioral therapy for patients with persistent depressive symptoms in substance abuse treatment (Watkins et al., 2011)
• A waitlist-controlled trial of group cognitive behavioural therapy for depression and anxiety in Parkinson’s disease (Troeung, Egan, & Gasson, 2014)

Brief CT

• A randomized effectiveness trial of brief cognitive-behavioral therapy for depressed adolescents receiving antidepressant medication (Clarke et al., 2005)
• Efficacy trial of a brief cognitive-behavioral depression prevention program for high-risk adolescents: Effects at 1- and 2-year follow-up (Stice et al., 2010)

Meta-analyses and Systematic Reviews

• A meta-analysis of cognitive-behavioural therapy for adult depression, alone and in comparison with other treatments (Cuijpers et al., 2013)
• A meta-analysis of the effects of cognitive therapy in depressed patients (Gloaguen et al., 1998)
• The efficacy of cognitive behavioral therapy: A review of meta-analyses (Hofmann et al., 2012)
• Is cognitive–behavioral therapy more effective than other therapies?: A meta-analytic review (Tolin, 2010)
• Cognitive processes in cognitive therapy: Evaluation of the mechanisms of change in the treatment of depression (Garratt et al., 2007)
• Reducing relapse and recurrence in unipolar depression: A comparative meta-analysis of cognitive-behavioral therapy’s effects (Vittengl et al., 2007)
• Does cognitive behaviour therapy have an enduring effect that is superior to keeping patients on continuation pharmacotherapy? A meta-analysis (Cuijpers et al., 2013)
• The effects of cognitive behavior therapy for adult depression on dysfunctional thinking: A meta-analysis (Cristea et al., 2015)
• Cognitive behavioural therapy for the treatment of depression in people with multiple sclerosis: A systematic review and meta-analysis (Hind et al., 2014)

Other Treatment Resources

• Can psychotherapies for depression be discriminated? A systematic investigation of cognitive therapy and interpersonal therapy (DeRubeis et al., 1982)
• Depression: Causes and Treatment (2nd Edition; Beck & Alford)
• Cognitive Therapy and Emotional Disorders (Beck)
• Scientific Foundations of Cognitive Theory and Therapy of Depression (Clark, Beck, & Alford)
• Cognitive Vulnerability to Depression (Ingram, Miranda, & Segal)