Cognitive Behavioral Therapy for Depression (CBT-D)

According to the National Institute of Mental Health, Major Depressive Disorder is the leading cause of disability in the U.S. (among ages 15-44) and it is estimated that about 6.7% of the US adult population is affected by Major Depressive Disorder in a given year.  While depression may not always commonly be associated with the military population, in the 2011 Survey of Health Related Behaviors among Active Duty Military Personnel (2013), 9.6% of Service Members reported high levels of depression.

Fortunately, depression is a treatable disorder.  Cognitive Behavioral Therapy (CBT) is an empirically-validated psychotherapy that is recommended as a first-line treatment for depression in the VA/DoD Clinical Practice Guideline for Management of Depressive Disorder (2009).  CBT is a structured, short-term, present-oriented approach to psychotherapy that helps patients modify unhelpful patterns of thinking and behavior in order to resolve current problems.

CBT generally includes three broad phases: an initial phase, a middle phase, and an ending phase.  During the initial phase the therapist assesses both the patient’s motivation and expectations for treatment.  During the middle phase cognitive and behavioral strategies are implemented to help address the patient’s unhelpful thoughts and/or behaviors.  The ending phase of CBT generally includes an emphasis on relapse prevention and a plan for termination.

Additionally, CBT follows a general session structure in order to maximize efficient use of time during the therapy hour (Wenzel et al., 2011).  The components of a typical CBT session include:

• A brief mood check
• A bridge from the previous session
• The setting of an agenda
• A review of the previous session’s homework assignment
• A discussion of agenda items
• A homework assignment
• A final summary

Periodic summaries also occur throughout the session.  These summaries communicate empathy and prompt collaboration between the therapist and the patient by ensuring that they both have a mutual understanding of what is being discussed.

Learning Objectives:

1. Examine prevalence rates of depression in military populations.
2. Identify military specific implications regarding diagnosing and treating depression in Service members.
3. Review the theory relevant to Cognitive Behavioral Therapy (CBT).
4. State the key principles of CBT.
5. Understand the CBT formulation of depression.
6. Learn how to develop an individualized case conceptualization for patients based on the cognitive behavioral model.
7. Understand the role of assessment in developing a CBT case formulation.
8. Examine the components of Cognitive Behavioral Therapy for Depression (CBT-D) sessions.
9. Determine cognitive strategies utilized in CBT-D in order to modify unhelpful cognitions in Service members.
10. Summarize behavioral strategies utilized in CBT-D in order to modify unhelpful behavioral patterns in Service members.
11. Apply the use of Socratic Method in CBT.
12. Identify common cognitive distortions of military personnel.
13. Illustrate CBT techniques to treat depressed Service members via video and experiential approaches.
14. Demonstrate increased skills and confidence to use CBT skills when working with depressed Service members.