How Cognitive Treatment for Anxiety and Depression Works

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Why Choose Cognitive Therapy?

Cognitive therapy is basically a problem-solving method of treatment involving the achievement of goals agreed between the therapist and their client. The aim of therapy is to target core beliefs and patterns of thinking known to underpin and reinforce certain psychological problems such as anxiety and depression and replace them with more adaptive alternatives.

Therapy focuses on your own goals, so it may be particularly useful if you are the kind of person who is predisposed towards a rational problem-solving way of thinking. Cognitive treatment for anxiety and depression is broadly similar although the amount of time needed for therapy may vary according to need.

The Stages of Therapy

The very first step in the therapeutic process involves establishing what is termed a ‘therapeutic alliance’. Basically this is a scene-setting and information giving stage that should help to clear up any misgivings or questions you may have about the cognitive therapy approach or the techniques used. At this stage your therapist is very much a giver of information.

During the second stage of treatment your therapist will try to understand the thoughts and beliefs that underpin your situation. The therapist may also set up some behavioral experiments to test certain assumptions. In the case of panic disorder, for example, it is not uncommon for some clients to believe their symptoms will lead to a heart attack or loss of consciousness. Techniques can be used to simulate the circumstances of panic and to demonstrate such beliefs are unfounded.

The third stage of therapy involves a direct challenge to some of the thoughts and beliefs you and your therapist believe may be reinforcing your problems. You may be confronted with examples of some of the negative automatic thoughts you use and alternative, and more realistic alternatives will be suggested. Thought challenging often reveals some very stubborn core beliefs such as ‘I am less capable than most other people’, or ‘I am weak’.

The Format of Therapy

The way we interpret events has a big influence on our mood and behavior. The more distorted these interpretations the more likely they are to lead to emotional problems. Such negative automatic thoughts are particularly obvious in depression and involve a single brief and inflexible impression of what is perceived to be a truth. Examples of automatic thoughts are ‘I can’t do it’, ‘nobody likes me’, ‘nobody cares’.

If you have depression, the number of therapy sessions can range from 6-8 for mild depression and up to 20 for moderate-to-severe depression. Although the basic format for cognitive therapy is always similar, setting goals for treatment may be modified according to the severity of depression. A mixture of mainly cognitive, but also behavioral techniques, are initiated. These start with strategies aimed at identifying and challenging automatic thoughts before progressing towards dysfunctional assumptions and core beliefs. Towards the end of therapy a few sessions are directed towards preventing relapse and preparing you to go it alone.

If You Are Considering Cognitive Therapy . .

Cognitive treatment for anxiety and depression involves understanding the ways in which thoughts, beliefs, emotions, physical feelings and actions interact and affect each other. Once a person grasps these essentials and applies the principles to their own situation they can begin the process of recovery.

If you are considering cognitive therapy you must be prepared to be actively involved in the treatment process. If you are depressed, it will require a level of motivation and concentration you may find hard to discover and sustain. If you are anxious, the process does require some level of confrontation with anxiety which, for a time at least, may make you feel worse. Although cognitive therapy doesn’t suit everyone, take heart from the fact that most experts believe it to be one of the most effective forms of treatment for anxiety and depression. It is certainly as effective, and sometimes more so, than drug treatments used for both anxiety and depression.


Davey, Graham. Clinical Psychology. Hodder Education. London. (2008).

Field, Andy. Clinical Psychology. Crucial. Glasgow. (2003).