In an open-access edition of Nature magazine this week (‘The Great Depression’) science journalist Emily Anthes took a look at the current state of research into Cognitive Behavioural Therapy (CBT): Depression: a change of mind.
Here are a few of the highlights:
Cognitive behavioural therapy (CBT) lifts depression
CBT aims to help people to identify and change negative, self-destructive thought patterns. It’s designed to equip patients with the skills they need to ‘become their own therapists’, by critically examining their negative beliefs.
It doesn’t work for everyone, but the stats on recovery show an interesting story when compared to pharmacotherapy:
- 42–66% of patients no longer meet the criteria for depression after CBT.
- 22–40% of patients emerge from depression with drugs alone.
What are the ‘active ingredients’ of CBT?
CBT ‘works’ (for 42-66% of depressed people) but no-one really know what the ‘active ingredients’ are—changed thought patterns? Positive thinking? The bond with the therapist?
Does the therapy relieve depression by changing someone’s thought patterns or is the new pattern of positive thinking a consequence of someone’s improved mental health?
Research into the CBT mechanism
To begin to unravel the mechanisms researchers studied recordings of CBT sessions.
“…what you really want to do is get inside the moment or moments when someone has a positive therapeutic change and try to understand what’s shifting in just those moments.”
Research has revealed any depressed adults undergoing CBT experienced ‘sudden gains’, in which their symptoms lessened significantly between two therapeutic sessions. These rapid changes accounted for more than half of the patients’ total improvement over the course of treatment. Indeed, altering a person’s thinking style may indeed lead to recovery.
Researchers have also shown that learning mental coping skills may be the most important kind of cognitive change during CBT.
“The cardinal skill is catching your thoughts in a moment where your mood takes a turn for the worse and thinking through the accuracy of your thoughts in that moment.”
Brain imaging studies have focussed on two brain areas—the prefrontal cortex, which is responsible for complex mental tasks such as self-control and planning, and the limbic system — including the amygdala — which is involved in emotional processing.
In healthy people, the prefrontal cortex can inhibit amygdala activity, keeping emotions in check. But imaging shows that in many people with depression, the prefrontal cortex seems to be less active.
“Depressed people have what you might think of as a trigger-happy amygdala.”
One study showed that depressed adults had increased levels of activity in the amygdala when performing an emotional task and reduced levels of activity in the dorsolateral prefrontal cortex when performing a cognitive task. CBT reversed this situation.
Researchers speculate that CBT — with its focus on controlling thoughts — re-engages the underactive prefrontal cortex, which, in turn, helps to quieten the hyperactive limbic system.
“Cognitive therapy teaches you to step in and use your prefrontal cortex rather than letting your emotions run away with you.”
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About Dr Sarah
I’m an Oxford University-educated neuroscientist, presenter of ABC Catalyst, director of The Neuroscience Academy, and author of The Women's Brain Book. The neuroscience of health, hormones and happiness.
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This in a comment in an email today …
Hi Dr McKay,
Thank you for your really interesting communications. I’m a 57 year old hospital social worker (for about 16 years) and I’m fascinated by the emerging area of neuroscience. In my own practice I undertook a CBT (REBT) course which profoundly changed my life and made my challenges much more bearable I think I was extremely fortunate as there were two presenters on the course but only one was a really gifted teacher. I found the course very confronting at times and truly in the beginning if I could have pulled out I would have! But like a lot of difficult situations there were great rewards in completing the course.
For me it was the consistency of the therapy with the ABC technique plus the teaching of unconditional self acceptance which I think many of us completely miss. It’s quite different from ‘self-esteem’ as we tend to refer to an internal belief of value and confidence. And not “positive thinking” at all – rather rational thinking via a series of disputing techniques. It’s incredible to watch a skilled therapist teach a depressed (or anxious) person how to think differently about how they see the situation. And understand the underlying often dysfunctional beliefs that we all learn.
Best Wishes
Jane MacArthur (who said she was happy for this comment to be share 🙂
I am a retired English language teacher for adult migrants – now involved in a range of voluntary work: helping translate texts into English, SRE (Special Religious Education) once a week with Year 2 children, a 1:1 arrangement for teaching Tai Chi and some advocacy.
My personal experience with CBT combined with medication was quite brilliant, thanks to the psychiatrist who worked with me for 11 years (1993 – 2005) and bulk billed the entire treatment. My amygdala had been previously been so hyperactive that at one point an acupuncture treatment normally used to sedate elephants just barely calmed me down.
Dr Quinn, the psychiatrist who helped me so much, died last year. I am sure that his professional training in CBT, combined with an excellent knowledge of the effects of medications and brilliant intuition, has kept me out of trouble from both hypomanic and depressive episodes for the last 16 years. I had two hypomanic episodes prior to seeing Dr Quinn – one in January 1991 and one in January 1996. I had never experienced anything like these episodes before, though I believe I had several undiagnosed depressive episodes in my 20s. Dr Quinn diagnosed severe PTSD and Bipolar Disorder II (bipolar disorder triggered by traumatic memories).
I experienced these memories primarily emotionally and mentally, sometimes physically, as body memories, and on two rare occasions, which I found the most devastating, as brief visual vignettes which included with emotion, mental awareness and the sense of touch.
On reading this article it is clear to me that Dr Quinn gave me the best possible treatment by being able to combine CBT with medication. In addition, I have been married for over 30 years and my husband has been incredibly supportive at all times.
I am willing to share this response to your article. I look forward to learning more!
This is common sense I feel. Or maybe I have been very lucky to have a small group of very close friends where I feel comfortable to discuss my life warts and all. Family ties are also very important to stability and well being. Actually probably in my opinion the most important.
I have had what I consider bouts of depression over the years, a bad relationship, death in the family and a family member who was in trouble with police. I coped on a daily basis because I managed to switch off my negative thoughts when I was at work. This ability helped me through. No one I worked with knew what I was going through.
On the whole I realise my problems are nothing compared to others and I certainly have not had any traumatic issues to deal with.