Cognitive Behavioural Therapy: Depression Programme

SESSION 1: Introduction to CBT & the Depression Model

Recommended Duration: 90 minutes

Time

Activity

Notes

0:00–0:10

Welcome, introductions, housekeeping

Emphasise no clinical experience assumed; all levels welcome

0:10–0:20

Pre-session reflection: "What do you already know about CBT?"

Pair share or chat box (online)

0:20–0:50

Presentation + video: What is CBT? Evidence base, cognitive model

Session 1 PowerPoint + Video S1

0:50–1:05

Small group discussion: Beck's 4-domain cycle in your work

Break-out rooms or table groups

1:05–1:15

Workbook activity: Reflection prompts S1

Individual written reflection

1:15–1:25

Knowledge check: 4 questions (show-of-hands or Mentimeter)

Debrief answers with evidence citations

1:25–1:30

Preview Session 2; signpost quiz app and workbook

Set pre-reading if blended format

Key Points to Emphasise:

CBT is not "positive thinking" — it is evidence-based thinking

The 4-domain cycle is bidirectional — any entry point is valid for intervention

d = 0.79 means CBT has one of the largest effect sizes in psychological therapy (contextualise with "0.5 = medium, 0.8 = large")

Relapse prevention advantage of CBT over medication is clinically significant

Discussion Prompt S1: "Think of someone you have worked with recently. Can you identify an example of each of Beck's four domains operating in their presentation?" (Use anonymised examples only)

Recommended Duration: 90 minutes

Time

Activity

Notes

0:00–0:05

Bridge from Session 1: "Name one thing that struck you"

Quick round or chat box

0:05–0:10

Pre-session reflection: "How confident are you in explaining depression to a client?"

1–5 self-rating; revisit at end

0:10–0:45

Presentation + video: DSM criteria, epidemiology, neurobiology

Session 2 PowerPoint + Video S2

0:45–1:05

Case activity: Apply DSM-5-TR criteria to 2 vignettes

Workbook or handout; small groups

1:05–1:20

Discussion: "Which neurobiological model is most relevant to your practice?"

Pairs; report back

1:20–1:28

Knowledge check: 4 questions

Debrief with citations

1:28–1:30

Preview Session 3; workbook risk factor reflection

Individual

Key Points to Emphasise:

Both (1) depressed mood AND (2) anhedonia are required at least one of — not both

280 million global figure comes from WHO 2023 — not an estimate, based on GBD data

The neuroplasticity model is clinically relevant because it explains WHY CBT produces durable change (BDNF increase)

Treatment gap (75% untreated globally) makes equitable identification a professional responsibility

Common Misconception to Address: "I thought depression was just a chemical imbalance." — Use the neuroplasticity model to show that biology and psychology are not separate. BDNF changes produced by CBT are equivalent to those produced by antidepressants (De Wandeler et al., 2022). The biopsychosocial model integrates all levels.

Recommended Duration: 90 minutes

Time

Activity

Notes

0:00–0:08

Bridge: "What maintaining factor is most common in your caseload?"

Brief open discussion

0:08–0:40

Presentation + video: 5-part model, distortions, thought record

Session 3 PowerPoint + Video S3

0:40–1:00

Thought record practice: work through example as group

Use whiteboard/flipchart; facilitator models first

1:00–1:15

Small group: Identify distortions in 6 sample statements

Handout or workbook activity

1:15–1:23

Knowledge check: 4 questions

Debrief

1:23–1:30

Preview Session 4; set thought record homework

"Between now and Session 4, complete one thought record"

Facilitator Modelling Note: When modelling the thought record, use a facilitator example (not a clinical one) — e.g., "I delivered this training last week and someone challenged a statistic. My automatic thought was: 'I've got it wrong and they'll think I'm incompetent.'" This normalises NATs and reduces stigma without clinical disclosure.

Distortion Identification Activity — Sample Statements:

"I failed the driving test — I'm just a failure at everything." (Overgeneralisation)

"My manager said nothing about my report, so it must have been terrible." (Mind Reading / Mental Filter)

"If I don't get this promotion I might as well give up." (All-or-Nothing Thinking)

"I feel embarrassed, so I must have done something stupid." (Emotional Reasoning)

"I should be coping better than this." (Should Statements)

"This will definitely end badly." (Fortune Telling)

SESSION 4: Identifying & Challenging Negative Automatic Thoughts

Recommended Duration: 90 minutes

Time

Activity

Notes

0:00–0:10

Homework review: thought record sharing (voluntary)

Pairs; no compulsion to share with group

0:10–0:45

Presentation + video: NAT characteristics, Socratic questioning, techniques

Session 4 PowerPoint + Video S4

0:45–1:05

Socratic questioning role play

Pairs: one plays "client", one plays "therapist" — 5 min each, then swap

1:05–1:15

Debrief: "What was difficult about asking Socratic questions without correcting?"

Open discussion

1:15–1:23

Knowledge check: 4 questions

Debrief

1:23–1:30

Preview Session 5; set BA monitoring homework

"Monitor your own activity and mood for 3 days using workbook diary"

Role Play Instructions:

"Client" describes a situation with a clear NAT (use their own or a provided vignette)

"Therapist" uses ONLY Socratic questions — no advice, no corrections, no "have you considered..."

After 5 minutes: "What did you notice about the experience as the client? As the therapist?"

Key insight to draw out: Guided discovery feels different from being corrected — it produces more durable belief change because the client reaches their own conclusions

Socratic Questioning Pitfall to Name: The most common facilitator/therapist error is the "Socratic question" that is actually a leading question disguised: "Have you ever considered that maybe you're being too hard on yourself?" — This is not Socratic; it is corrective. The client's answer is determined by the question.

Recommended Duration: 90 minutes

Time

Activity

Notes

0:00–0:08

Bridge: review activity monitoring homework (3 days)

Pairs: "What patterns did you notice?"

0:08–0:40

Presentation + video: avoidance cycle, evidence, activity scheduling

Session 5 PowerPoint + Video S5

0:40–0:58

Activity scheduling practice: build a personal activity menu

Individual workbook activity

0:58–1:12

Small group: "What are the barriers to activity scheduling you see clinically?"

Table or break-out groups; facilitator notes on flipchart

1:12–1:20

Barrier problem-solving: address top 3 barriers with evidence-based strategies

Facilitator-led; use NICE CG90 guidance

1:20–1:28

Knowledge check: 4 questions

Debrief

1:28–1:30

Preview Session 6

Common Barriers to Activity Scheduling and Evidence-Based Responses:

Barrier

Evidence-Based Response

"I don't enjoy anything anymore"

This is anhedonia — a symptom, not a permanent state. Schedule activities anyway; wait rating (predict enjoyment before) vs actual rating (after) typically diverges.

"I'm too tired to do anything"

Grade the activity to current capacity. Walking to the end of the street counts. BA improves energy over time — not the reverse.

"I'll do it when I feel better"

This is the inverse of the BA rationale. Action precedes feeling in depression — not the other way around.

"My client refuses to try"

Explore function of avoidance collaboratively. What does the avoidance protect from? What does the activity threaten?

Recommended Duration: 90 minutes

Time

Activity

Notes

0:00–0:08

Bridge: review Session 5; any activity scheduling reflections

Open brief sharing

0:08–0:40

Presentation + video: cognitive hierarchy, clusters, downward arrow, change methods

Session 6 PowerPoint + Video S6

0:40–1:00

Downward arrow demonstration + practice

Facilitator demonstrates first; then pairs

1:00–1:15

Positive data log introduction: complete day 1 entry

Workbook activity; explain rationale carefully

1:15–1:23

Knowledge check: 4 questions

Debrief

1:23–1:30

Preview Session 7; set positive data log homework

7-day log

Downward Arrow Facilitation Notes:

Always model the technique before asking participants to try it

Emphasise: this is a clinical technique requiring therapeutic alliance and supervision — not for impromptu use in any professional conversation

If participants feel emotionally activated during the exercise, normalise this and offer a break

Debrief question: "What core belief did you arrive at? Was it surprising or familiar?"

Caution for Non-Clinical Participants: Some participants will not be trained therapists. Clarify that: (1) Core belief work is described here for awareness and clinical literacy; (2) Application in practice requires supervised clinical training; (3) The positive data log is a general wellbeing tool that is safe for self-use.

Recommended Duration: 90 minutes

Time

Activity

Notes

0:00–0:08

Bridge: positive data log review (voluntary sharing)

Pairs; normalise if no evidence found yet

0:08–0:38

Presentation + video: relapse epidemiology, kindling, MBCT, wellbeing plan

Session 7 PowerPoint + Video S7

0:38–1:10

Wellbeing plan completion: work through all 7 sections

Individual workbook activity; facilitator circulates

1:10–1:20

Pair share: "What was the most useful section of the wellbeing plan and why?"

Brief sharing

1:20–1:28

Knowledge check: 4 questions

Debrief

1:28–1:30

Preview Session 8; set final reflection task

"Before Session 8, identify 3 practice changes you will make"

MBCT Clarification Note: MBCT is mentioned in this programme as an evidence-based relapse prevention tool. It is not delivered within this CPD. If participants ask where to access MBCT: Recommend Segal, Williams & Teasdale (2013) Mindfulness-Based Cognitive Therapy for Depression (2nd ed.) as the practitioner text; and the MBCT.com resource directory for trained MBCT providers.

Recommended Duration: 90 minutes

Time / Activity / Notes

0:00–0:10 Full programme review: "One thing that has changed in how you think about depression?"

Quick round — all participants

0:10–0:40 Presentation + video: evidence synthesis, destigmatisation, case integration

Session 8 PowerPoint + Video S8

0:40–1:00 Maria case formulation: complete 5P in small groups
Workbook p.8; groups of 3–4; debrief as whole group

1:00–1:12 Professional practice action plan: 3 SMART changes
Individual workbook activity

1:12–1:18 CPD assessment instructions: demonstrate quiz app
Project quiz app; walk through navigation

1:18–1:28 Assessment time (or set as post-session task)
24 questions; 70% pass; unlimited resits

1:28–1:30 Closing, certificate instructions, signpost further reading

Case Formulation Debrief — Maria:

Expected formulation elements:

Presenting: Moderate-severe depression (PHQ-9 = 18); 6 months duration; significant functional impairment; social withdrawal; self-critical cognitions

Predisposing: Critical early attachment (mother); pattern of perfectionism; possible early maladaptive schema: Unlovability/Helplessness

Precipitating: Occupational stress; possible recent performance-related trigger

Perpetuating: Avoidance of friends; stopped exercise; negative automatic thoughts ('worthless', 'a burden'); rumination; perfectionism maintaining standard

Protective: High insight; strong motivation; supportive partner; two close friends available; no prior treatment (good prognosis indicator)