CBT or counseling for depression?

[Mumofboy93]

I've self referred to the NHS mental health team in my area and have been offered counselling or CBT for depression and some anxiety. Any experiences of either? How do I choose which?

Counselling. I think there's free cbt online. A counsellor could maybe recommend some in conjunction

For me, counselling helps much more when I'm in a bout of depression. I really struggle with the "positivity" of CBT when I'm unwell. It's something I find more tolerable when I'm not struggling to get out of bed....

Counselling will help you talk through and make sense of stuff that's happened and happening in your life, how you're feeling at the moment, how your relationships are going, the kind of relationships you have and the way you tend to be in them, how the past affects the present, what your worries are, that sort of thing.

CBT will help you look at the way you think about and react to things, and come up with strategies to change the way you think about and react to things, use techniques that allow you to gradually become more comfortable with things you're anxious about, etc.

CBT involves more explicit homework and worksheets and tends to be quite present-focused and fairly solution-oriented, while counselling feels more like a conversation.

Counsellors are trained only to listen, not to give advice.

CBT therapists are more highly trained in theory, and CBT has better recovery rates in multiple scientific studies than active listening alone.

Is there are third option which could be to see a psychologist or psychotherapist trained in a different/more than one therapeutic approach so that they can do more than just listen, but it would not have to be CBT, or not only CBT? There are many other therapies available that are effective and could suit you.

By the way CBT when done properly is not about being positive or simplistic. It gets a bad rap because the nhs only offer too few sessions to get anywhere and often the therapists are not brilliantly well trained or experienced.

@rattleskittle The CBT I'm being offered is low intensity, 30 minute session a week for 8 weeks. Is that going to be useful??

I've never had any therapy before so am slightly sceptical as to how any of this works. But I just feel sad alot of the time and need to do something to help myself

Should add, I have a baby under 2 years so I think still count as postnatal? Don't know if that matters or not

Counsellors are trained only to listen, not to give advice.

It's true that don't give advice, but they should also be doing more than passively listening, which might be the impression someone would get is they don't know anything about counselling — ideally they listen in a way that invites you to talk about and talk through things, in a way that helps you. And a CBT therapist wouldn't give advice, either.

*if they don't

The basic foundation of CBT is the assumption that 'Your behaviour/actions influence and shape the way you feel'. The way you behave can set your mood, in the simplest example: a brisk walk in fresh air, a tidied room or any form of self care might uplift you.

Do you like that idea? Are you currently able to motivate yourself to do things, starting with very small changes?

If that speaks to you, then CBT can guide you onto a path of positive behaviours that will then influence the way you feel, making you gradually better and better.

CBT can support you changing your behaviour and state in the here and now starting a positive spiral of getting better and better - without examining the root cause of WHY you feel sad.

But you could reflect and journal that out yourself.

OR with the counselling you'll look at the root causes and help you analyse those (and hopefully that will motivate you to coach yourself into more positive behaviours).

CBT can be one of the more effective and fast therapies at getting patients out of a dark hole, but it all depends on what philosophy you prefer.

I assume the NHS has done all the due diligence regarding possible postnatal depression? As that might require a more medical treatment (and I'm not qualified at all to comment on this but I know that it would be good if your doctor checks this thoroughly and keeps an eye on you)

OP, sending you lots of love, having little children and depression is so challenging and I'm so glad you want to do something to feel better .

Do let us know what you decide.

Counselling wouldn’t have helped me. I needed medication to sort out chemical imbalance and CBT helps me to change my behaviour to improve my mood. You wouldn’t offer counselling to improve any other chemical imbalance. If you’re sad because of historical family stuff etc then that’s different.

@MaryVee that sounds like a description of Behavioural Activation (which came out of CBT) rather than CBT more broadly? Though there are CBT therapists who will do mostly BA with a particular client.

It's not that CBT sessions can't end up being pretty much BA sessions, or that there's anything wrong with either BA or CBT, I just wouldn't want OP to choose the CBT option expecting what you've described, and be faced with either worksheets or cCBT that's heavily based around, say, thought records and psychoeducation.

I haven't heard of BA and what I wrote is what I learned about CBT, but I get the feeling that you're raising a good point, @ClumpingBambooIsALie. It might be the case that the basic NHS CBT can be dry (I did some sessions a few years ago)

And OP, please read my post with the disclaimer that I'm not qualified to comment in such depth but perhaps you could find out the syllabus of the suggested NHS CBT to see what they plan to top through with you?

I think Behavioural Activation spun off as an additional labelled therapy to CBT at some point as a purportedly separate thing? but it can definitely be within the CBT remit. For patients like us, rather than people who come from the perspective of a psychologist or something, I think we often only get to see the particular part of CBT techniques that our therapists happened to use with us. I've had the "sooo many thought records" type where you have to analyse sequences of thoughts and feelings and behaviours and identify thought distortions and create counter-thoughts and stuff, but only a much more cursory go at the type of CBT you're describing.

That's a good point, if they can give OP more information about what the CBT they offer might look like, it could be helpful. I guess the therapist might not know until they've assessed, though.

Whichever techniques it is, I think we'd probably agree that CBT involves putting some work in outside of sessions as well as in them, to try to change things in the now. I know some people really get on with the feeling that they're doing something about the problem rather than just sitting talking. Whereas for others, counselling might feel more helpful because it's talking through things, and feelings, in detail, to someone who won't judge, and making links and understandings in a way there isn't so much time to do in CBT.

Personally I would try the CBT even though it is the low intensity version. Its got good evidence for a reason although it's not a panacea. It's likely to give you at least some tools that might help you and you can leave the ones that don't. Once you've done that you can look into other therapies.

It partly depends on the severity of your issues and the cause.

If you have behaviour or thinking patterns you are repeating that are making you unhappy, then CBT is a good way to break them. For example, regularly criticising yourself - CBT would look at reframing that.

Counselling on the other hand would dig deeper and try to help you understand why you are regularly criticising yourself.

Overally, counselling is more effective, but only if you have quite a lot of it - you would probably need more than the 6 sessions or whatever they offer on the NHS to make a real difference.

CBT can make a difference more quickly, but it's a bit like a sticking plaster, because it doesn't address the underlying issues.

You will do a 30 minute session but then you'll have things to read, practice and reflect on in between. It will only be effective if you put time aside to do this.

Counselling should fix the underlying issues causing the depression. CBT is a sticking plaster which works in the short term but doesn't fix the cause of the depression.

I work in a similar service and am trained in psychotherapy and CBT.

if only low intensity CBT offered go for the counselling for depression.

@Perennis my underlying issue is a chemical imbalance. No amount of counselling would fix this.

This has recently been debunked. It's usually a lot more complex than that.

Both my parents have struggled with depression all my life, mostly because of work related stress. My own depressive episodes have been linked with living at home, miscarriages, lack of love and personal fulfilment and stress.

I also now have SAD every year. I took myself off sertraline about 3yrs ago and switched to St John's Wort. This is the most stable I've been in my adult life, with none of the deadening effects I loathed about sertraline and citalopram.

What works for one, doesn't work for all. CBT on the NHS has bent been successful for me due to very poor delivery and of support. Counselling however has been a literal life saver. It's really helped in ways CBT did not.

SAD is not the same. A reaction to work stress isn’t the same. Sorry but counselling would no more help my depression than it would help my asthma.

‘This has recently been debunked. It's usually a lot more complex than that.’

Not really recently, researchers have known since the 70s this wasn’t true. Heavy drug company marketing is what’s kept the myth going.

Sorry but without the medication I can’t function. I also use CBT techniques. But counselling wouldn’t cure me.

Counselling 100%. You can access CBT afterwards quite easily and there are a tonne of resources available. The opportunity to talk to a non-judgemental professional is not something you can replicate outside of therapy. Take the opportunity to be completely honest and vulnerable with your counsellor and trust the process. Good luck OP.