What a CBT Session for Depression Looks Like: A Case Illustration

What a CBT Session for Depression Looks Like: A Case Illustration

Cognitive Behavioral Therapy (CBT) is one of the most widely used and evidence-based approaches for treating depression. Below is an anonymized example of how a CBT session may unfold, illustrating the therapeutic process and techniques involved.

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Client Overview

Client: Adult (identity confidential)
Presenting Concerns:
The client presented with symptoms of depression, including persistent low mood, negative self-talk, reduced motivation, emotional withdrawal, sleep disturbance, and diminished interest in previously enjoyable activities.

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Therapy Approach

Model Used: Cognitive Behavioral Therapy (CBT)
CBT focuses on understanding the connection between thoughts, emotions, and behaviors, and helping individuals develop practical skills to manage distress more effectively.

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Session Focus

This session emphasized:

• Identifying automatic negative thoughts contributing to low mood
• Introducing cognitive restructuring techniques
• Reviewing behavioral activation strategies to increase engagement in daily life

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Client’s Experience

The client reported ongoing feelings of sadness, self-criticism, and hopelessness, particularly related to perceived failures in personal and professional roles. A recurring belief expressed during the session was:

“I feel like I am not doing enough, no matter how hard I try.”

These thoughts were closely linked to feelings of discouragement and withdrawal. Sleep difficulties and loss of interest in pleasurable activities were also discussed.

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Therapist Observations

Throughout the session, the client appeared emotionally subdued but remained cooperative and engaged. Eye contact improved as the session progressed, and the client demonstrated clear insight into their emotional struggles. Speech was coherent, and the client was able to reflect thoughtfully on internal experiences.

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CBT Interventions Used

1. Thought Identification

The client was guided to identify automatic negative thoughts associated with low mood. Common cognitive distortions such as all-or-nothing thinking and overgeneralization were highlighted.

2. Cognitive Restructuring

Together, the therapist and client examined evidence for and against distressing thoughts. The client practiced developing more balanced, compassionate alternatives to harsh self-judgments.

3. Behavioral Activation

Small, achievable activities were planned to counteract avoidance and increase positive reinforcement. Examples included taking short walks and reconnecting with a supportive person.

4. Psychoeducation

The CBT model was reviewed, emphasizing how thoughts influence emotions and behaviors. The client was encouraged by the understanding that change is possible through consistent skill practice.

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Client Response

The client actively participated in the session and demonstrated increasing ability to recognize unhelpful thinking patterns. By the end of the session, the client reported feeling “slightly lighter” and more hopeful about managing thoughts between sessions.

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Between-Session Practice

The client was encouraged to:

• Complete a thought record for at least one distressing situation
• Engage in one planned positive activity before the next session

Homework is an essential part of CBT, helping clients apply skills learned in therapy to real-life situations.

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Clinical Impression and Progress

The client is showing gradual improvement in insight and openness to CBT techniques. While motivation remains variable, it responds well to structured guidance and collaborative goal-setting. Continued CBT is recommended to strengthen cognitive and behavioral skills.

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Looking Ahead

Future sessions will focus on:

• Reviewing thought records and behavioral activities
• Deepening cognitive restructuring skills
• Introducing emotion regulation strategies

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Final Thoughts

This case illustration highlights how CBT emphasizes collaboration, skill development, and empowerment. Through increased awareness of thought–emotion patterns and consistent practice, clients can begin to experience meaningful shifts in mood and outlook.
If you are struggling with depression, working with a trained CBT therapist can provide practical tools to help you regain a sense of control and hope.