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CBT for Depression

Nicole Bitter, LMFT

Cognitive Behavioral Therapist

Schedule a complimentary, 15-minute consultation, today!

Over the past two decades, I have helped many patients make a significant recovery from depression. Treatment begins with establishing the type of depression, the severity and impact to your daily life and function. We begin with a full assessment and set an agenda, test for motivation and employ an array of creative, motivating and challenging methods whereby you can expect to experience a shift in your mood and begin to experience a higher level of engagement in life and improved function.


Untreated depression is a highly distressing experience. This can then spiral into a vicious cycle, making it harder to cope, to do the things that you used to do; thinking continues to be negative or unhelpful. This then reinforces how low we feel physically and mentally.


Our thoughts can be very negative when we're depressed. We can be unkind and critical of ourselves. We might over generalize or catastrophize, we might jump to conclusions, or we might think that we know what other people are thinking (mind reading), finding it very challenging to see anything positive in ourselves and situation; only the bad. We might even think that our feelings are indeed facts.

Behaviorally, we may withdraw from work or social activities. In the short term, it is easier to cope with not seeing people or going out. On top of that we may have difficulties sleeping, or eating well. We may feel guilty if we are irritable towards our friends and family or if we overeat. Thoughts such as "What's the point?" may make it difficult to motivate ourselves to get up and dressed.

Research has shown that the main causes for low mood can be linked to genetics, biology, early difficult experiences in life, ongoing stress or life events. Different factors contribute to people's depression, but the symptoms are very common to all. It is thought that a combination of low serotonin (a chemical within the brain), inactivity and unhelpful thoughts all lead to depression.

CBT Therapy for Depression



In general, symptoms may include:


Emotional changes:

  • Feelings of unhappiness

  • Moodiness and irritability

  • Emptiness or numbness 

  • Tearfulness or frequent crying

  • Feelings of worthlessness 

  • Guilt, sadness and/or hopelessness  

  • Loss of interest and pleasure in activities that were once enjoyable 

  • Tiredness, lack of energy and motivation 

  • Feeling worried or tense


Cognitive changes:

  • Difficulty concentrating and making decisions  

  • Being self-critical and self-blaming 

  • Having negative thoughts about the self (e.g. negative body image and low self-esteem), others, the future and the world  

  • Thoughts of death or suicide


Behavioral changes:

  • Poor attention to personal hygiene and appearance 

  • Decreased participation with peers and normal activities 

  • Self-harm 

  • Avoidance of family interactions and activities  

  • Being withdrawn, spending more time alone  

  • Easily upset or quick to get angry

  • Possible increase in substance use and avoidance

Physical changes:

  • Low energy  

  • Changes in appetite and weight (either a decrease or an increase) 

  • Changes in sleep pattern, including difficulty sleeping or over-sleeping 

  • Lowered libido  

  • Restlessness and agitation  

  • Unexplained body aches and pains

  • Frequent and unexplained headaches

Treatment follows a step-by-step approach:


  1. Assessment stage

  2. Cognitive stage

  3. Behavior stage

  4. Learning stage and Relapse Prevention


Even a low level of depression (dysthimia) can impact our wellbeing. Treatment starts with a full mental health survey followed by examining our thinking styles and identifying thought errors, including core and self-defeating beliefs. Behavioral activation is a vital element in treating depression and must be included to change patterns of both thought and action. Learning and practice is essential to reinforce and maintain change with unique homework assignments customized for you in between sessions.

In the final stage of treatment, relapse prevention is reinforced to recognize the gains you have made and facilitate maintenance of treatment benefits.

If you're ready to change the negative thinking patterns that underlie your depression and are keeping you from fulfilling your life goals, I encourage you to contact me today at 408-680-3811 with any questions you have, or click the button below to schedule an initial assessment. I look forward to working with you!

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