What Does a Course of CBT for Depression Look Like?
When someone is struggling with depression, it can feel all-consuming—like a heavy fog that makes it hard to think clearly, feel motivated, or even believe that change is possible. One of the most evidence-based ways of addressing depression is Cognitive Behavioural Therapy (CBT). But what does a course of CBT for depression actually involve? What can you expect if you begin this process?
In this post, I’ll walk you through the typical journey of CBT for depression, from the first session to the final stages of therapy, giving a sense of what it might look and feel like—while acknowledging that each person’s journey is unique.
1. Initial Sessions: Understanding the Landscape
The first few sessions of CBT are often about laying the groundwork. The therapist will take time to understand what you’re going through, including your current symptoms, how they’re impacting your life, and any past experiences that may be relevant. You won’t be asked to go into every detail of your history—CBT tends to focus more on the here and now—but understanding the broader picture helps to guide the work.
These sessions are also a chance to build trust. Feeling comfortable with your therapist is key. You can ask questions, express any doubts you might have, and discuss your hopes or concerns about therapy.
Together, you’ll start to identify the patterns in your thoughts, feelings, and behaviours that are keeping the depression going. This is sometimes called developing a formulation—a shared map of what’s contributing to your difficulties and what might help.
2. Setting Goals and Focusing the Work
CBT is a structured therapy, so once you’ve established a shared understanding of the problem, you’ll begin to set goals. These aren’t always big life goals—in fact, they’re often quite modest to begin with, especially if your energy and motivation are low.
You might work towards things like:
Getting out of bed at a regular time
Reconnecting with friends
Returning to an old hobby
Managing critical thoughts about yourself
Feeling more hopeful or in control
Goals help anchor the therapy and give direction to the sessions. They can be revised as things progress.
3. Behavioural Activation: Rebuilding from the Outside In
A key component of CBT for depression is behavioural activation. Depression often leads people to withdraw from the world—cutting back on activities, avoiding social contact, and neglecting self-care. While this is completely understandable, it can unfortunately create a cycle that keeps depression going.
Behavioural activation helps reverse this by identifying small, meaningful activities that can be reintroduced into your day, even when you don’t feel like it. The idea is that mood often follows action—not the other way around.
You and your therapist might work together to:
Track your current routine and identify patterns of avoidance or inactivity
Explore which activities give you a sense of pleasure, mastery, or connection
Plan these activities into your week in a manageable way
Problem-solve around any barriers or challenges that come up
Over time, even small changes—like taking a short walk, calling a friend, or making a simple meal—can start to shift your mood and rebuild a sense of purpose.
4. Working with Thoughts: Challenging the Inner Critic
Another central aspect of CBT is exploring how our thoughts influence our feelings and behaviours. Depression is often accompanied by harsh self-criticism, hopelessness, and black-and-white thinking. These thoughts can feel automatic and unquestionable—but CBT helps you take a step back from them.
You might learn to:
Notice negative thinking patterns, like “I’m a failure” or “Nothing will ever change”
Understand how these thoughts affect your motivation and emotions
Question the evidence for and against these thoughts
Consider more balanced or compassionate perspectives
This isn’t about “positive thinking” or simply telling yourself to cheer up—it’s about developing more realistic and helpful ways of viewing yourself and your situation. Over time, these shifts in thinking can help lift the emotional weight of depression.
5. Practising Skills Between Sessions
CBT is an active therapy, and much of the change happens between sessions. You’ll often have home practice to complete—this might be tracking your mood, experimenting with a new behaviour, or trying out a thought-challenging technique.
These aren’t tests, and you won’t be judged—rather, they’re opportunities to bring what you’re learning into your everyday life. Your therapist will work with you to make these tasks feel manageable and relevant to your goals.
6. Reviewing Progress and Preventing Relapse
As the course of therapy progresses—typically over 12 to 20 sessions, though this can vary—you’ll take time to review your progress. What’s changed? What’s still difficult? What strategies have been most useful?
CBT places a strong emphasis on relapse prevention. Together, you’ll create a toolkit of strategies you can return to in the future. You might:
Identify your early warning signs if depression starts to creep back
Create a plan for how to respond to those signs
Reflect on what’s helped you feel more empowered or in control
The aim is for you to leave therapy not only feeling better, but with a sense of confidence that you can handle future challenges.
Final Thoughts: Starting Where You Are
Beginning CBT for depression can feel daunting—but you don’t need to wait until you feel motivated or “ready.” In fact, starting therapy often helps people reconnect with a sense of hope and possibility they didn’t know was still there.
Every journey through CBT is different. It’s not a quick fix, but with the right support, it offers a structured, compassionate, and practical way forward. You’ll be met where you are, and you’ll move at a pace that respects both your challenges and your strengths.
If you’re considering CBT for depression, it might just be one of the most important steps you take towards reclaiming your life.
