TORONTO — Treatment-resistant depression poses a significant challenge for psychiatrists, but cognitive-behavioral therapy (CBT) may be an effective method for cutting through barriers to care in those hard-to-treat cases, according to an interactive session presented at the American Psychiatric Association Annual Meeting.

“CBT has been shown to reduce the suicide attempt rate by half compared with standard treatment,” said Jesse H. Wright, MD, PhD, of the University of Louisville in Kentucky. “One of the key aspects of [CBT] is cutting through the despair and hopelessness and having some sense of what is that keep [patients] going.”

“It’s important for all depressed patients, but the more depressed a patient is the more important it is to start behavioral activation,” added co-presenter Judith Beck, PhD, of the Beck Institute for Cognitive Behavior Therapy in Philadelphia.

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In patients with resistant, chronic, or severe depression, psychiatrists may need to be more active in care than they would with patients diagnosed with anxiety disorders, explained Wright, because patients with treatment-resistant depression often times do not have the energy to stay with one topic for long when talking to a psychiatric healthcare professional.

“It seems so overwhelming to these patients to make any change,” said Wright. “If they don’t do anything, they feel more discouraged. Finding an area in which they can make progress is very important.”

Especially in cases where suicidal thoughts accompany hopelessness and despair, helping patients create a suicide help kit — a list of reasons to live, comforting activities, and people to call for support — may yield more beneficial results than standard care alone. Generating hope is a vital aspect of care, Wright emphasized.

Goal setting is another important aspect of CBT therapy for treatment-resistant depression. Asking patients how they would like to see their life change for the better as a result of treatment, or what they’d do differently if they weren’t depressed, introduces patients to new, more positive perspectives.

“CBT isn’t just putting on rose-colored glasses,” Wright cautioned. “Clinicians still have to endorse and listen to patients’ anguish in order to help patients entertain new ideas.”


Wright JH, et al. Challenges in Cognitive-Behavioral Therapy:  Overcoming Barriers to Effective Treatment. Presented at: APA 2015. May 16-20, 2015; Toronto, Canada.