Cognitive Behavioral Therapy

What is cognitive behavioral therapy?

Cognitive behavioral therapy (CBT) is one of the most researched and scientifically supported forms of psychotherapy for people who have mild to moderate depression. It is also used to treat many other disorders, including anxiety.

CBT is a short-term treatment that focuses on a patient’s current problems, and aims to help him or her learn how to deal with practical issues. It is based on the idea that unhelpful thinking impacts how each of us feels and behaves, a cycle that is often reinforcing.

For example, if you had depression and received feedback from your boss that you needed to improve your communication with the team, you might think, "I can never do anything right." This might then lead to you feeling sad, and inturn make you want to withdraw from your coworkers and responsibilities at work. This withdrawal may lead to more negative feedback from your boss, which then reinforces your thinking that you can’t do anything right. This pattern is often represented by the picture below.

Cognitive Behavioral Theraphy diagram, thought, behavior, feeling triangle

How does cognitive behavioral therapy work?

In CBT, the therapist first assists the patient in identifying unhelpful thoughts and the negative feelings and behaviors they produce. The patient and therapist focus on problems that the patient would like to address now. They work together to evaluate the patient’s current thought process in order to find more helpful ways to respond to problems in the future. In the above example about dealing with negative feedback at work, CBT might help someone in this situation realize that perhaps they have done many things well at work and communication is just one area that needs improvement.

Next, CBT focuses on the actual behaviors that contribute to the problem. The patient begins to learn and practice new skills that can be put into use in real-world situations. Patients also learn self-help skills that impact the way they think, feel and behave, and they practice these skills in homework assignments throughout treatment. Patients learn how to schedule activities, deal with distractions and techniques to help them relax. Journaling and role playing help teach patients about their own behavior. If we look again to our example, after CBT, someone in a similar work situation might start practicing new coping skills and rehearsing ways to respond more effectively to feedback received at work.

Cognitive behavioral therapy in the ASCEND trial

In the ASCEND trial, CBT will comprise of 10 one-hour sessions during a patient’s regular dialysis treatment. Normally, patients must see therapists at a separate appointment, adding to a patient’s already busy schedule. In this trial, we will see if CBT during an already scheduled health appointment helps patients stick with treatment and improves depressive symptoms. Therapists will meet their patients at the dialysis facility, holding the therapy session at the same time patients get their dialysis treatment. The therapy sessions will happen once a week for the first eight weeks and every other week for the following four weeks. If the patient’s depressive symptoms show no improvement at the end of 12 weeks, we will let their doctor know and will give them other available options for treating the patient’s depression.

CBT has proven that it works. However, it may not be the best treatment option for all patients. That’s why we’re also researching the impact antidepressant drug therapy has on patients with depression who are on hemodialysis.