Cognitive Therapy for Depression


Talk to An Experienced Cognitive Therapist

Most people occasionally feel down in the dumps. But sometimes feeling this way signals a problem that needs to be taken more seriously. Clinical depression is distinguished by the persistent presence of other symptoms, including apathy, remorse, worthlessness, sleep disturbance, weight or appetite change, decreased energy, problems with concentration or decisiveness, and preoccupation with death or suicide. Fortunately, effective treatment options are available, and most people benefit from appropriate treatment.

depression, depressive disorders, mood disorders, bipolar disorder, mania, hypomania, cognitive therapy, cognitive behavioral therapy
Dr. Garamoni specializes in the assessment, diagnosis, and treatment of depression and other mood disorders. He receives referrals from other health care professionals to help people suffering from these conditions. He specializes in the practice of Cognitive Therapy, a very effective treatment for these problems.

Cognitive Therapy (CT) is also known as cognitive behavioral therapy, cognitive behavior therapy, or cognitive behavioural therapy (CBT). Cognitive therapy is based on the idea is that what we feel is largely determined by what we think. Cognitive Therapy holds that distorted and biased thinking patterns cause of a variety of serious emotional problems, including depression and anxiety. A cognitive therapist teaches people to think in more rational, realistic, balanced, and constructive ways.

The research supporting Cognitive Therapy’s efficacy is quite impressive. There is evidence that Cognitive Therapy is as effective and possibly more effective than pharmacotherapy (antidepressant medication) in managing mild to moderate unipolar depression. One large-scale study found that a year after treatment was discontinued, depressed patients who had been treated with Cognitive Therapy had half the relapse rate of depressed patients who had been treated with antidepressant medication.

Dr. Garamoni has now been practicing Cognitive Therapy for over 20 years after he went through a three-year training program in the Cognitive Therapy Clinic at the University of Pittsburgh School of Medicine. During that period, he managed a three-year study of clinically depressed patients treated with Cognitive Therapy. He also participated in other important studies of depression and co-authored peer-reviewed articles on cognitive therapy and depression:

  • Garamoni, G.L., Reynolds, C.F., Thase, M.E., Frank, E., & Berman, S.R. (1992). The balance between positive and negative affects during episodes of major depression: A further test of the states of mind model. Psychiatry Research, 39, 99‑108.

  • Garamoni, G.L., Thase, M.E., Reynolds, C.F., Frank, E., & Yeager, A. (1992). Shifts in affective balance during cognitive therapy of depression. Journal of Consulting and Clinical Psychology, 60, 260‑266.

  • Garamoni, G.L. (1990). A reformulation of the states of mind model and a related study of euthymic, depressed, and hypomanic states of mind in a nonclinical population. Dissertation, University of Pittsburgh. Chairman: Scott M. Monroe, Ph.D.

  • Nofzinger, E.A., Schwartz, R.M., Reynolds, C.F., Thase, M.E., Jennings, J.R., Frank, E., Fasiczka, A.L., Garamoni, G.L., & Kupfer, D.J. (1993). Correlation of nocturnal penile tumescence and daytime affect intensity in depressed men. Psychiatry Research, 49, 139‑150.

  • Nofzinger, E.A., Schwartz, R.M., Reynolds, C.F., Thase, M.E., Jennings, J.R., Frank, E., Fasiczka, A.L., Garamoni, G.L., & Kupfer, D.J. (1993). Affect intensity in phasic REM sleep in depressed men before and after treatment with cognitive behavioral therapy. Journal of Consulting and Clinical Psychology, 62, 83‑91.

  • Nofzinger, E.A., Thase, M.E., Reynolds, C.F., Frank, E., Jennings, J.R., Garamoni, G.L., Fasiczka, A.L., & Kupfer, D.J. (1993). Sexual functioning in depressed men: Assessment using self‑report, behavioral and nocturnal penile tumescence measures before and after treatment with cognitive behavioral therapy. Archives of General Psychiatry, 50, 24‑30.

  • Schwartz, R.M., & Garamoni, G.L. (1989). Cognitive balance and psychopathology: Evaluation of an information-processing model of positive and negative states of mind. Clinical Psychology Review, 9, 271‑294.

  • Schwartz, R.M., & Garamoni, G.L. (1986). A structural model of positive and negative states of mind: Asymmetry in the internal dialogue. In P.C. Kendall (Ed.), Advances in cognitive‑behavioral research and therapy (Vol. 5). New York: Academic Press.

  • Schwartz, R.M., & Garamoni, G.L. (1986). Cognitive assessment: A multibehavior‑multimethod-multiperspective approach. Journal of Psychopathology and Behavioral Assessment, 8, 185‑197.

  • Thase, M.E., Reynolds, C.F., Frank, E., Jennings, J.R., Nofzinger, E.A., Fascizka, A.L., Garamoni, G.L., & Kupfer, D.J. (1994). Polysomnographic studies of unmedicated depressed men before and after cognitive behavior therapy. American Journal of Psychiatry, 151:11, 1615‑1622.

  • Thase, M.E., Reynolds, C.F., Frank, E., Jennings, J.R., Garamoni, G.L., Yeager, A., & Kupfer, D.J. (1992). Early return to REM sleep after nocturnal awakening in depression. Biological Psychiatry, 31, 171‑176.

  • Thase, M.E., Reynolds, C.F., Frank, E., Simons, A.D., Garamoni, G.L., McGeary, J., Harden, T., Fascizka, A.L. Cahalane, J.F. (1994). Response to cognitive‑behavior therapy in chronic depression. The Journal of Psychotherapy Practice and Research, 3, 204‑214.

  • Thase, M.E., Reynolds, C.F., Frank, E., Simons, A.D., McGeary, J., Fascizka, A.L., Garamoni, G.L., Jennings, J.R., & Kupfer, D.J. (1994). Do depressed men and women respond similarly to cognitive behavior therapy? American Journal of Psychiatry, 151:4, 500‑505.

  • Thase, M.E.; Reynolds, C.F.; Jennings J.R.; Frank E; Garamoni G.L.; Nofzinger E.A.; Fascizka A.L.; & Kupfer D.J. (1992). Diminished nocturnal penile tumescence in depression: a replication study. Biological Psychiatry, 31:11, 1136-1142.



FAQs Cognitive Therapy (click here)



Book Recommendations: Mood Disorders, Depression, Bipolar Disorder

Therapists commonly recommend the The Feeling Good Handbook to their clients. This book is a follow-up to Dr. Burns’ classic, Feeling Good: The New Mood Therapy. I recommend the Handbook because it provides help on a broader range of topics. Dr. Burns gives a clearly written summary of Cognitive Behavior Therapy (CBT). He provides written exercises to help you understand the connections between your thoughts, feelings, and behaviors in stressful situations. He then helps you gain control of the thoughts and behaviors that contribute to depression, anxiety, and other emotional problems..

I’ve been using this book in therapy with my clients for years with good results. Warning: You can’t just sit back and read this book passively. You absolutely have to do the exercises to benefit from reading this book. And it is best to have the one-on-one guidance of a licensed professional therapist on how to best use this book in your unique set of circumstances. Professional feedback really helps you acquire skill in monitoring and managing your moods.

Another warning: This is not bedtime reading material. I remember one of my clients had terrible insomnia. I asked him about his nightly routine before going to sleep. He told me he had a stack of self-help books on his bed stand and randomly picked one up to read before going to sleep. By doing this every night, he was seeing how many problems he had and what he could and should do to fix these problems. He didn’t know where to start. He felt overwhelmed by all the things he should do and how little he was really doing. He was unwittingly inducing anxiety, guilt, and demoralization on a nightly basis. No wonder he couldn’t get to sleep! I advised him to put his self-help books in a closet and work with me on mastering one skill at a time. His insomnia soon lifted and he recovered from his depression. There is lesson to be learned here for anyone into these “self-hell” books.





















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