DIAGNOSIS: Depression
TREATMENT: Cognitive Therapy for Depression

2015 EST Status: Treatment pending re-evaluation Very strong: High-quality evidence that treatment improves symptoms and functional outcomes at post-treatment and follow-up; little risk of harm; requires reasonable amount of resources; effective in non-research settings

Strong: Moderate- to high-quality evidence that treatment improves symptoms OR functional outcomes; not a high risk of harm; reasonable use of resources

Weak: Low or very low-quality evidence that treatment produces clinically meaningful effects on symptoms or functional outcomes; Gains from the treatment may not warrant resources involved

Insufficient Evidence: No meta-analytic study could be identified

Insufficient Evidence: Existing meta-analyses are not of sufficient quality

Treatment pending re-evaluation

1998 EST Status: Strong Research Support Strong: Support from two well-designed studies conducted by independent investigators.

Modest: Support from one well-designed study or several adequately designed studies.

Controversial: Conflicting results, or claims regarding mechanisms are unsupported.

Strength of Research Support

Empirical Review Status
2015 Criteria
(Tolin et al. Recommendation)
Very Strong
Insufficient Evidence
Treatment pending re-evaluation
1998 Criteria
(Chambless et al. EST)

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Brief Summary

  • Basic premise: Aaron T. Beck’s cognitive theory of depression proposes that persons susceptible to depression develop inaccurate/unhelpful core beliefs about themselves, others, and the world as a result of their learning histories. These beliefs can be dormant for extended periods of time and are activated by life events that carry specific meaning for that person. Core beliefs that render someone susceptible to depression are broadly categorized into beliefs about being unlovable, worthless, helpless, and incompetent. Cognitive theory also focuses on information processing deficits, selective attention, and memory biases toward the negative.
  • Essence of therapy: In cognitive therapy (CT), clients are taught cognitive and behavioral skills so they can develop more accurate/helpful beliefs and eventually become their own therapists.
  • Length: In most randomized clinical trials or efficacy trials, CT for depression is typically delivered over 8 to 16 sessions. There is a significant interaction between initial symptom severity and length of CT (Shapiro et al., 1994). Clients with mild or moderate depression do well with either 8 or 16 sessions of CT. However, clients with severe depression demonstrate significantly better response rates with 16 sessions as compared to 8 sessions. It is recommended to allow for booster sessions after termination for enhanced relapse prevention 3, 6, and 12 months after termination (Beck, 2011). A caveat to the 8-16 sessions finding is that since these results were obtained in efficacy trials, one can extend treatment in the community past 16 sessions depending on: 1) the severity and chronicity of the client’s depression, 2) comorbid disorders, and 3) other psychological, physiological, and psychosocial factors (all of which may complicate the client’s recovery from depression). For example, a study assessing the effectiveness of CT in an outpatient CT clinic found that clients attend an average of 15.9 (SD = 16.2) CT sessions, with a range of 0 (clients who completed an intake, but never entered therapy) to 97 (Gibbons et al., 2011). The modal number of CT sessions was 1 and the median was 11 (Gibbons et al., 2011).

Treatment Resources

Editors:Ramaris E. German, Ph.D.; Michael Williston, PsyD; Rachel Hershenberg, PhD

Note: The resources provided below are intended to supplement not replace foundational training in mental health treatment and evidence-based practice

Treatment Manuals / Outlines

Treatment Manuals

CT for Specific Populations and Formats: Manuals Available Through External Sites

Books Available for Purchase Through External Sites

Training Materials and Workshops

Training Centers in North America

  • Beck Institute: Cognitive Therapy Training Center (1 Belmont Avenue, Suite #700, Bala Cynwyd, PA 19004)
    • Contact: (610) 664-3020
  • Academy of Cognitive Therapy: Supporting Professionals, Educating Consumers, and Connecting Individuals with Truly Effective Care (Multiple locations worldwide)


  • Workshops under the direction of Judith Beck, PhD at the Beck Institute
  • Workshop listing for the annual conference of the Association for Behavioral and Cognitive Therapies (ABCT)


Measures, Handouts and Worksheets

Self-help Books

Important Note: The books listed above are based on empirically-supported in-person treatments. They have not necessarily been evaluated empirically either by themselves or in conjunction with in-person treatment. We list them as a resource for clinicians who assign them as an adjunct to conducting in-person treatment.

Smartphone Apps

Computer-Based CBT for Depression

Video Demonstrations

Videos Available for Purchase Through External Sites

Clinical Trials

Major Depressive Disorder


Dysthymic Disorder


Bipolar Disorder


Group CT


Brief CT

Meta-analyses and Systematic Reviews

Other Treatment Resources