Q: How do cognitive-behavioral therapists treat depression?

A: To begin, it's important to recognize that depression takes many forms. A depressed mood can last a few hours — or it can persist for several years. (For a detailed description of various types of depression, see the depression page.) Therapists recognize that every person experiences depressed moods differently.

Having said this, there are some basic principles that many therapists agree on — especially cognitive-behavioral therapists, who often specialize in the treatment of depression. One of these principles involves taking an active, comprehensive approach to the treatment of depression.

The TEA Cycle

Along these lines, I usually begin the treatment of depression by explaining what I call "the TEA cycle."

The idea behind the TEA cycle is that our Thoughts, Emotions, and Actions (T-E-A) tend to cycle on each other. This cycle can create either an upward or a downward spiral.

Certain types of thoughts, emotions, and actions create a downward spiral which keeps depression in place. For example, a person might think hopeless and self-critical thoughts, feel flawed and alone, and act in ways that lead to isolation and withdrawal. Each of these reinforces the others. Our job in therapy is to reverse that cycle, and create an upward spiral of new thoughts, emotions, and actions.

So how do therapists do this?

Some therapists focus primarily on changing the thoughts part of the cycle. Cognitive therapists have found that depressed people tend to have thoughts that involve a great deal of hopelessness and self-criticism. These habitual thought patterns might include things like: "I'm such a failure. My life will never get better. There's nothing I can do to change things." By helping clients to change these thought patterns, cognitive therapists find that depressed mood can be improved.

Other therapists focus instead on the actions part of the cycle. Behavioral therapists have found that people who are depressed often neglect to exercise, get together with friends, or engage in self-care activities. These therapists find that by supporting their clients to make gradual, positive action changes, the old depressed TEA cycle begins to reverse. These new actions might include such things as enjoyable daily exercise, social activities that strengthen friendships, spiritual practices such as meditation and yoga, and creative expression such as journaling and drawing. By shifting behavior, an updward spiral forms.

Still other therapists focus on the emotions part of the cycle. Traditionally, cognitive-behavioral therapists have focused less on this aspect, as many clients find it easier to shift their thoughts and actions while simply allowing feelings to follow. However, emotions are an important part of the TEA cycle. For clients who are experiencing feelings of depression, I try to encourage a direct emotional experience of hope, self-acceptance, and empowerment. Many clients choose to set aside daily — or even hourly — quiet time to "tap in" to these feelings. Imagery and guided meditation exercises can also be helpful in the development of new emotional patterns.

The old TEA cycle can be reversed at any point — by changing thoughts, emotions, or actions. Ideally, clients can work on all three cooperatively. And of course, other forms of support such as anti-depressant medications can be a helpful component in the treatment of depression. I encourage my clients to consult with a medical doctor to discuss medication options, if they feel that such an approach would be helpful.

If you'd like to review some self-help methods that I occasionally use with clients, you can visit the self-help section. I've included supports for changing each part of the TEA cycle — thoughts, emotions, and actions.

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