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Mechanism of CBT in Patients with Depression: The Role of
Transforming Negative Thinking
Yian Chen1,a,*
1New York University, 50 W 4th St, New York, NY, 10012, USA
a. yianchen12@aol.com
*corresponding author
Abstract: Depression, as a prevalent and serious mental health issue, profoundly impacts an
individual's daily life and social functioning. Among various treatment methods, Cognitive
Behavioral Therapy (CBT) is widely recognized for its evidence-based effectiveness. The
core philosophy of CBT lies in the belief that cognitive processes—particularly negative
thinking—play a crucial role in the development and maintenance of depression. However,
despite its widespread application in clinical practice, the mechanisms by which CBT treats
depression remain a subject of debate. Some studies highlight the role of CBT in altering
automatic negative thinking, a pattern of thought commonly encountered in individuals with
depression. Other research suggests that repetitive negative thinking, such as persistent worry
and rumination, is a key characteristic of depression. CBT has shown potential effectiveness
in disrupting these repetitive thought patterns. Additionally, defensive negative thinking is
also a focus of CBT. This is a pattern of thought developed to avoid emotional pain, leading
individuals to avoid facing real issues, thereby maintaining or exacerbating symptoms of
depression. Therefore, one of the goals of CBT is to help patients recognize the presence of
this defensive thinking and transform it into more adaptive thought patterns through various
strategies. This paper aims to delve into the role of CBT in treating depression, especially
how it corrects various types of negative thinking to achieve therapeutic effects. Through a
critical analysis of existing literature, this paper will provide a more comprehensive
understanding of the mechanisms of CBT and guide effective practices in treating depression
with CBT.
Keywords: Cognitive Behavioral Therapy, Depression, Negative Thinking, Treatment
Mechanisms, Mental Health
1. Introduction
Depression, as a prevalent and serious mental health issue, profoundly impacts an individual's daily
life and social functioning. According to reports from the World Health Organization, depression has
become one of the leading causes of disability worldwide, affecting the quality of life of millions.
Among various treatment methods, Cognitive Behavioral Therapy (CBT) is widely recognized for its
evidence-based effectiveness. The core philosophy of CBT lies in the belief that cognitive processes
particularly negative thinking, play a crucial role in the development and maintenance of depression.
However, despite its widespread application in clinical practice, the mechanisms by which CBT treats
depression remain a subject of debate. Some studies highlight the role of CBT in altering automatic
Proceedings of the 2nd International Conference on Social Psychology and Humanity Studies
DOI: 10.54254/2753-7048/41/20240794
© 2024 The Authors. This is an open access article distributed under the terms of the Creative Commons Attribution License 4.0
(https://creativecommons.org/licenses/by/4.0/).
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negative thinking, a pattern of thought commonly encountered in individuals with depression. For
instance, Seeley et al. [1] in their study noted that CBT, by identifying and challenging these
automatic negative cognitions, helps patients develop more positive and realistic ways of thinking,
thereby alleviating symptoms of depression. Other research suggests that repetitive negative thinking,
such as persistent worry and rumination, is a key characteristic of depression. CBT has shown
potential effectiveness in disrupting these repetitive thought patterns. As demonstrated in the study
by Kim and Hwang [2], CBT effectively reduced the frequency of repetitive negative thinking and
achieved positive therapeutic outcomes. Additionally, defensive negative thinking is also a focus of
CBT. This is a pattern of thought developed to avoid emotional pain, leading individuals to evade
facing real issues, thereby maintaining or exacerbating symptoms of depression. Therefore, one of
the goals of CBT is to help patients recognize the presence of this defensive thinking and transform
it into more adaptive thought patterns through various strategies.
Nonetheless, the applicability and effectiveness of CBT across different populations still require
further exploration. For example, CBT for adolescents and adults may necessitate different
approaches and focuses. Moreover, cultural factors might also influence the acceptance and
effectiveness of CBT, which is particularly important in multicultural societies. This paper aims to
delve into the role of CBT in treating depression, especially how it corrects various types of negative
thinking to achieve therapeutic effects. Through a critical analysis of existing literature, this paper
will provide a more comprehensive understanding of the mechanisms of CBT and guide effective
practices in treating depression with CBT.
2. How CBT Treats Depression by Correcting Negative Thinking
2.1. Reducing Automatic Negative Thinking
In the application of Cognitive Behavioral Therapy (CBT), reducing automatic negative thinking is
a key component in treating depression. Automatic negative thinking, typically unconscious and
deeply ingrained, profoundly affects the emotions and behaviors of individuals with depression.
These thought patterns are often pessimistic, including negative evaluations of oneself, the future,
and the surrounding world. Due to their subconscious nature, patients may initially find it difficult to
recognize these patterns. Even when identified, changing these deeply rooted thought patterns
requires time and sustained effort.
CBT employs a structured and goal-oriented approach in addressing these automatic negative
thoughts. Through cognitive restructuring, CBT helps patients identify, challenge, and change these
negative automatic thoughts. For example, according to the research by Moorey and Hollon [3], CBT,
with the strongest evidence base in psychological treatment for depression, emphasizes that all CBT
models assume emotional states are created and maintained through learned patterns of thoughts and
behaviors. Although CBT has been successful in changing automatic negative thinking, its
effectiveness can vary due to individual differences. This requires therapists to demonstrate great
patience and empathy during the treatment process, along with active participation and continuous
self-reflection from patients.
2.2. Stopping Repetitive Negative Thinking Mechanisms
Within the framework of Cognitive Behavioral Therapy (CBT), disrupting and changing repetitive
negative thinking mechanisms is a crucial treatment step for individuals with depression. Repetitive
negative thinking, such as persistent worry and rumination, not only deepens depressive emotions but
can also lead patients into a vicious cycle of negative emotions. CBT uses techniques like cognitive
restructuring and attention shifting to help patients identify these patterns and take measures to
interrupt them.
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Some studies have emphasized the effectiveness of CBT in disrupting repetitive negative thinking.
For instance, research by Spinhoven et al. [4] indicates that CBT treatments targeting repetitive
negative thinking (RNT) may have more pronounced effects than treatments not specifically targeting
rumination. By teaching patients how to identify and challenge these repetitive negative thoughts,
CBT helps reduce the severity of depressive symptoms. The core of this method is making patients
aware of their thought patterns and encouraging the development of healthier thinking habits.
Repetitive negative thinking is often a long-term habit deeply rooted in an individual's core beliefs
and life experiences, so changing these thoughts might encounter resistance. This process requires
therapists not only to teach skills but also to combine personalized methods and a deep understanding
of individual differences to provide emotional support and encouragement.
2.3. Transforming Defensive Negative Thinking
Defensive negative thinking is typically a pattern of thought developed by individuals to avoid
emotional pain, including self-deprecation, pessimistic expectations, or overgeneralization. While
this thinking pattern might offer short-term psychological protection, it can lead to the persistence
and exacerbation of emotional issues in the long term. This thinking pattern may be closely related
to an individual's self-identity, so changing these thoughts might encounter additional obstacles. CBT
takes a proactive approach in transforming this defensive negative thinking, helping patients identify
these patterns and challenge their rationality and effectiveness. For example, according to the study
by Bulut and Gümüşsoy [5], the foundational theory of CBT is that all psychological disturbances
depend on dysfunctional thinking. Patients might be taught to recognize overgeneralization patterns
and learn to replace them with more specific and realistic thoughts. Some patients may benefit quickly
from CBT, while others may need more time to see significant changes. These differences might
relate to individual psychological resilience, life circumstances, and social support systems.
3. Discussion
In discussing the efficacy of Cognitive Behavioral Therapy (CBT) for patients with depression,
particularly in terms of transforming negative thinking, it is crucial to adopt a critical perspective to
evaluate its effectiveness and limitations. CBT, widely used in treating depression, primarily focuses
on helping patients identify and change illogical or unrealistic negative thought patterns. However,
the complexity of this process and individual differences demand a deeper understanding of its
mechanisms and influencing factors.
CBT has achieved certain success in reducing automatic negative thinking, interrupting repetitive
negative thinking, and transforming defensive negative thinking. For instance, Jessica Price's [6] case
study illustrates how a patient managed to alleviate symptoms of depression by learning to question
thoughts, take assertive actions, and handle relapses. Such changes are not always direct or
immediate. Individual differences, such as cognitive styles, life experiences, and treatment
expectations, can significantly impact the treatment's effectiveness. Moreover, the success of CBT is
also influenced by patient engagement and therapist skills. As J. Matthews [7] points out, the level of
patient commitment and the professional skills of the therapist are key factors affecting the outcomes
of CBT. The empathy, patience, and understanding of individual differences by therapists are vital
for successful treatment.
However, CBT may have limitations in addressing deep-seated emotional issues and core beliefs.
For example, K. Dobson's [8] research discusses the development and effectiveness of Cognitive
Therapy (CT), emphasizing the importance of core negative beliefs in the onset of depression. While
CBT is significantly effective in changing superficial negative thinking, it might need to be combined
with other treatment methods for better outcomes with deep-rooted core beliefs and emotional issues.
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This suggests that CBT alone may not be sufficient to comprehensively resolve the problems of some
patients.
4. Conclusion
In this paper, we have explored the application of Cognitive Behavioral Therapy (CBT) in treating
depression, especially its role in transforming negative thinking. CBT effectively helps patients
change their negative thought patterns through cognitive restructuring, thereby alleviating symptoms
of depression. This indicates the significant value of CBT in addressing automatic negative thinking,
repetitive negative thinking, and defensive negative thinking. However, despite its notable
effectiveness in altering superficial negative thinking, the success of CBT is influenced by patient
engagement and therapist skills, meaning that the success of the treatment depends not only on the
method itself but also on the interaction between the patient and the therapist.
5. Research Limitations and Future Directions in Cognitive Behavioral Therapy for
Depression
Exploring the effectiveness of Cognitive Behavioral Therapy (CBT) in treating depression, especially
its role in altering negative thinking, requires a critical perspective that acknowledges the current
research's limitations and anticipates future research directions.
One significant limitation in the existing research on CBT is the insufficient consideration of
individual differences. Studies often generalize the effectiveness of CBT across diverse populations
without adequately accounting for variations in cognitive styles, life experiences, and treatment
expectations of individual patients. This oversight can lead to a skewed understanding of CBT's
effectiveness and applicability. Another area where current research falls short is in addressing deep-
seated emotional issues and core beliefs. Much of the focus has been on modifying surface-level
negative thinking, potentially overlooking the more profound, underlying emotional and cognitive
patterns that contribute to depression. This gap highlights the need for a more nuanced approach to
CBT that can effectively address these deeper aspects. Additionally, there is a lack of extensive
research on the long-term effects and sustainability of CBT. While short-term benefits are well-
documented, understanding how CBT contributes to long-lasting change and prevents relapse is
crucial for its broader application in clinical settings.
Looking ahead, future research should prioritize developing more personalized CBT approaches.
Tailoring treatment to individual needs, considering their unique backgrounds and specific
circumstances, could enhance the therapy's effectiveness and relevance. Integrating CBT with other
treatment modalities is another promising direction. Combining CBT with pharmacotherapy,
psychodynamic therapy, or other therapeutic approaches could offer a more holistic treatment for
depression, addressing a wider range of symptoms and underlying causes. Finally, future studies
should focus on the long-term outcomes of CBT. Investigating how CBT impacts patients over
extended periods and its role in maintaining treatment gains and preventing relapse will be crucial for
establishing its long-term efficacy and guiding clinical practice.
References
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Internet-facilitated cognitive behavioral intervention for maternal depression. Cognitive Behaviour Therapy, 47(5),
377-390. https://doi.org/10.1080/16506073.2018.1513554
[2] Kim, Y., & Hwang, S. (2020). The role of rumination in the effectiveness of cognitive behavioral therapy for
depression: A systematic review. Clinical Psychology Review, 40, 51-63. https://doi.org/10.1016/j.cpr.2020.101860
[3] Moorey, S., & Hollon, S. (2021). Cognitive Behavioral Therapy for Depression. Oxford Research Encyclopedia of
Psychology
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[4] Spinhoven , P., Klein, N. S., Kennis, M., Cramer, A., Siegle, G., Cuijpers, P., Ormel, J., Hollon, S., & Bockting, C.
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