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Cognitive behavioural therapy: Prevent depression before it starts

The Bottom Line

  • One in eight adults in Canada will experience depression at some point in their lives. 
  • Psychological or educational approaches like cognitive behavioural therapy could help prevent depression. 
  • More research is needed to determine which preventative approach is the most effective for depression. 

Nobody chooses to go down the often long, hard road of depression. And yet, many people—as many as 1 in 8 adults in Canada—find themselves on it at some time in their life (1). In fact, when it comes to older adults 60 years of age and older, depression is the most widespread psychiatric disorder (2;3;4;5).


When depression hits, it can be like a heavy fog that settles in, enveloping a person in sadness and a loss of interest in doing the things they once enjoyed. Anger, frustration, and exhaustion may also latch on (6). Although depression can affect people of any age, it can be particularly hard to diagnose in older adults (2;7). Symptoms to watch out for in this age group include memory difficulties, personality changes, physical pain, fatigue, low appetite, staying home, or suicidal thinking (6).


When someone is in the midst of depression, happiness can seem a million miles away. Fortunately, there are a variety of options—both medication and therapy—to treat depression. There is also research exploring ways to escape its grip before it takes hold.


One of those ways is cognitive behavioural therapy (CBT). CBT is a type of psychotherapy that aims to identify negative or false thoughts, and replace them with healthier, more positive ones. This allows people to respond to challenging situations more effectively (8;9;10). We already know that CBT can help treat depression and mindfulness-based cognitive therapy can help avoid relapse. But, can CBT or other approaches help prevent depression all together?


What the research tells us

One systematic review explored whether psychological or educational approaches—such as CBT, self-help, counselling, education, or support—can help prevent depression. The impact of these strategies on preventing depression was assessed among individuals who did not have an actual depression diagnosis, although some may have had depression like symptoms, while others may have been at high risk for depression.


This review found that CBT—the most commonly used approach—and other psychological and educational approaches, delivered by a variety of providers, had a modest effect on preventing depression. What’s more, the benefits of these therapies increased when the participants receiving them did not already have symptoms of depression. Although the current evidence is promising, more research is needed to determine which types of depression prevention programs are the most effective, and how these effects hold up in the long-term (8).


As the saying goes, prevention is the best medicine. Fortunately, psychological and educational approaches, including cognitive based therapy, do appear to help ward off depression before it grabs hold. Prevention programs developed around these approaches just might help people steer away from this difficult road.

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References

  1. Pearson C, Janz T, Ali J. Mental and substance use disorders in Canada. [Internet] 2013. [cited December 2018] Available from http://publications.gc.ca/collections/collection_2013/statcan/82-624-x/82-624-x2013001-2-eng.pdf  
  2. Heinzel S, Lawrence JB, Kallies G, et al. Using exercise to fight depression in older adults: A systematic review and meta-analysis. Gero Psych. 2015; 28(4):149-162.
  3. Blazer DG. Depression in late life: Review and commentary. J Gerontol A Biol Sci Med Sci. 2003; 58:249–265.
  4. Mulsant BH, Ganguli M. Epidemiology and diagnosis of depression in late life. J Clin Psychiatry. 1999; 60(Suppl 20):9-15.
  5. Steffens DC, Skoog I, Norton MC, et al. Prevalence of depression and its treatment in an elderly population: The Cache County study. Arch Gen Psychiatry. 2000; 57(6):601-607.
  6. Mayo Clinic. Depression (major depressive disorder). [Internet] 2018. [cited December 2018]. Available from https://www.mayoclinic.org/diseases-conditions/depression/symptoms-causes/syc-20356007
  7. Birrer RB, Vemuri SP. Depression in later life: A diagnostic and therapeutic challenge. Am Fam Physician. 2004; 69:2375–2382. 
  8. Bellón JÁ, Moreno-Peral P, Motrico E, et al. Effectiveness of psychological and/or educational interventions to prevent the onset of episodes of depression: A systematic review of systematic reviews and meta-analysis. Prev Med. 2015; 76 Suppl: S22-32. doi: 10.1016/j.ypmed.2014.11.003.
  9. Liu TW, Ng GYF, Chung RCK, et al. Cognitive behavioural therapy for fear of falling and balance among older people: A systematic review and meta-analysis. Age Ageing. 2018. doi: 10.1093/ageaging/afy010. 
  10. Mayo Clinic. Cognitive behavioral therapy. [Internet] 2017. [cited December 2018]. https://www.mayoclinic.org/tests-procedures/cognitive-behavioral-therapy/about/pac-20384610

DISCLAIMER: The blogs are provided for informational purposes only. They are not a substitute for advice from your own healthcare professionals.

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