Depression is one of the most prevalent psychiatric disorders, affecting individuals of all ages worldwide. It can manifest across a spectrum of conditions, ranging from mild transient symptoms to severe debilitating states, leading to significant impairments in social and occupational functioning.

Cognitive Behavioral Therapy (CBT) is one of the most evidence-based interventions for the treatment of various psychiatric disorders, including depression. Studies have demonstrated the efficacy of CBT in treating depressive disorders, with evidence that its combination with pharmacotherapy significantly improves outcomes compared to pharmacotherapy alone.

The indications for using CBT include patient preference, the availability of trained therapists, special situations, and the inability to tolerate psychopharmacological treatments. Although there are no absolute contraindications, patients with severe personality disorders or low intelligence may present challenges in management.

The advantages of CBT in treating depression include the reduction of depressive symptoms, modification of underlying beliefs that perpetuate depression, addressing psychosocial problems, reducing the risk of recurrence, and improving adherence to medical treatment.

CBT can be applied in different settings, such as outpatient clinics with regular sessions of 45 minutes to 1 hour, and, in specific cases, in inpatient environments, especially for patients with severe depression, high suicide risk, or multiple comorbidities.

The cognitive model of depression postulates that individuals are influenced not by events themselves, but by their perception of those events. The negative cognitive triad, comprising feelings of helplessness, hopelessness, and worthlessness, contributes to dysfunctional cognitive reactions that lead to depressive symptoms.

CBT treatment involves steps such as mutual problem definition, goal setting, familiarization with the five-area CBT model, awareness of cognitive and behavioral activity, modification of thoughts and behaviors, application and consolidation of new skills, relapse prevention, and therapy conclusion.

Patient-related factors, such as the ability to articulate their feelings, intellectual level, motivation, and preference for psychological treatments, influence the response to CBT. Additionally, the availability of trained therapists and the ability to establish a therapeutic alliance are also relevant factors.

The clinical interview in CBT involves identifying associated symptoms and cognitions, the impact of depression on overall functioning, coping strategies adopted, the onset of current symptoms, and the patient’s background information to develop a cognitive conceptualization of the case.

Treatment management includes session structuring, establishment of the therapeutic alliance, implementation of behavioral interventions, working with negative automatic thoughts, and preparing for therapy termination, aiming to develop the patient’s resilience against future depressive episodes.