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Individuals’ Long Term Use of Cognitive Behavioural Skills to Manage their Depression: A Qualitative Study

  • Lydia R. M. French (a1), Laura Thomas (a1), John Campbell (a2), Willem Kuyken (a3), Glyn Lewis (a4), Chris Williams (a5), Nicola J. Wiles (a1) and Katrina M. Turner (a1)...


Background: Cognitive Behavioural Therapy (CBT) aims to teach people skills to help them self-manage their depression. Trial evidence shows that CBT is an effective treatment for depression and individuals may experience benefits long-term. However, there is little research about individuals’ continued use of CBT skills once treatment has finished. Aims: To explore whether individuals who had attended at least 12 sessions of CBT continued to use and value the CBT skills they had learnt during therapy. Method: Semi-structured interviews were held with participants from the CoBalT trial who had received CBT, approximately 4 years earlier. Interviews were audio-recorded, transcribed and analysed thematically. Results: 20 participants were interviewed. Analysis of the interviews suggested that individuals who viewed CBT as a learning process, at the time of treatment, recalled and used specific skills to manage their depression once treatment had finished. In contrast, individuals who viewed CBT only as an opportunity to talk about their problems did not appear to utilize any of the CBT skills they had been taught and reported struggling to manage their depression once treatment had ended. Conclusions: Our findings suggest individuals may value and use CBT skills if they engage with CBT as a learning opportunity at the time of treatment. Our findings underline the importance of the educational model in CBT and the need to emphasize this to individuals receiving treatment.


Corresponding author

Correspondence to Lydia R. M. French, Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK. E-mail:


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Adler, A. D., Strunk, D. R. and Fazio, R. H. (2015). What changes in cognitive therapy for depression? An examination of cognitive therapy skills and maladaptive beliefs. Behavior Therapy, 46, 96109.
Barnes, M., Sherlock, S., Thomas, L., Kessler, D., Kuyken, W., Owen-Smith, A., et al. (2013). No pain, no gain: depressed clients’ experiences of cognitive behavioural therapy. British Journal of Clinical Psychology, 52, 347364.
Beck, A. T., Rush, A. J., Shaw, B.F. and Emery, G. (1979). Cognitive Therapy of Depression. New York: Guilford Press (pp.171186).
Braun, V. and Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77101.
Butler, A. C., Chapman, J. E., Forman, E. M. and Beck, A. T. (2006). The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clinical Psychology Review, 26, 1731.
DeRubeis, R. J., Hollon, S. D., Amsterdam, J. D., Shelton, R. C., Young, P. R., Salomon, R. M., et al. (2005). Cognitive therapy vs medications in the treatment of moderate to severe depression. Archives of General Psychiatry, 62, 409416.
Glasman, D., Finlay, W. M. L. and Brock, D. (2004). Becoming a self-therapist: using cognitive behavioural therapy for recurrent depression and/or dysthymia after completing therapy. Psychology and Psychotherapy: Theory, Research and Practice, 77, 335351.
Hollon, S. D., Stewart, M. O. and Strunk, D. (2006). Enduring effects for cognitive behavior therapy in the treatment of depression and anxiety. Annual Review of Psychology, 57, 285315.
Hundt, N. E., Mignogna, J., Underhill, C. and Cully, J.A. (2013). The relationship between use of CBT skills and depression treatment outcome: a theoretical and methodological review of the literature. Behavior Therapy, 44, 1226.
Kovacs, M., Rush, A. J., Beck, A. T. and Hollon, S. D. (1981). Depressed outpatients treated with cognitive therapy or pharmacotherapy: a one-year follow-up. Archives of General Psychiatry, 38, 3339.
Kroenke, K., Spitzer, R. L. and Williams, J. B. (2001). The Phq-9. Journal of General Internal Medicine, 16, 606613.
Powers, D. V., Thompson, L. W. and Gallagher-Thompson, D. (2008). The benefits of using psychotherapy skills following treatment for depression: an examination of “afterwork” and a test of the skills hypothesis in older adults. Cognitive and Behavioral Practice, 15, 194202.
Strunk, D. R., Hollars, S. N., Adler, A. D., Goldstein, L. A. and Braun, J. D. (2014). Assessing patients’ cognitive therapy skills: initial evaluation of the competencies of cognitive therapy scale. Cognitive Therapy and Research, 38, 559569.
Sturges, J. and Hanrahan, K. (2004). Comparing telephone and face-to-face qualitative interviewing: a research note. Qualitative Research, 4, 107118.
Wiles, N., Thomas, L., Abel, A., Ridgway, N., Turner, N., Campbell, J., et al. (2013). Cognitive behavioural therapy as an adjunct to pharmacotherapy for primary care based patients with treatment resistant depression: results of the CoBalT randomised controlled trial. The Lancet, 381 (9864), 375384.
Wiles, N., Thomas, L., Turner, N., Garfield, K., Kounali, D., Campbell, J., et al. (2016). Long-term effectiveness and cost-effectiveness of cognitive behavioural therapy as an adjunct to pharmacotherapy for treatment resistant depression in primary care: follow-up of the CoBalT randomised controlled trial. The Lancet Psychiatry, 3, 137144
Williams, C.J. and Morrison, J. (2010). A new language for CBT: new ways of working require new thinking as well as new words. In Bennett-Levy, J., Richards, D.A., Farrand, P., Christensen, H., Griffiths, K., Kavanagh, D., D., et al. (Eds), The Oxford Guide to Low Intensity CBT Interventions. Oxford: Oxford University Press.
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Behavioural and Cognitive Psychotherapy
  • ISSN: 1352-4658
  • EISSN: 1469-1833
  • URL: /core/journals/behavioural-and-cognitive-psychotherapy
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Individuals’ Long Term Use of Cognitive Behavioural Skills to Manage their Depression: A Qualitative Study

  • Lydia R. M. French (a1), Laura Thomas (a1), John Campbell (a2), Willem Kuyken (a3), Glyn Lewis (a4), Chris Williams (a5), Nicola J. Wiles (a1) and Katrina M. Turner (a1)...
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