Emotions follow thoughts, whether they’re positive or negative.

For over 2,000 years, people have thought about how our thoughts influence our feelings. In the late 20th century, doctors started focusing on changing negative thoughts to help treat depression. To have a feeling about something, you first need to understand it, and this understanding starts with your thoughts.

Janet feels down because her long-term boyfriend isn't ready to propose. She might think, “Maybe he doesn’t love me, and maybe there’s something wrong with me. I’ll never find happiness in a committed relationship.” These negative thoughts can worsen her feelings, especially if she compares herself to her married friends. Instead of assuming she’s unlovable or that he doesn’t care, Janet could think, “He might not be ready now, but that doesn’t mean he won’t be later. And even if we never get married, it doesn’t mean I’m not lovable.” By viewing her situation this way, Janet can avoid unnecessary negative feelings and maintain her self-esteem.

The idea that our thoughts shape and influence our feelings has gained popularity in recent years, extending beyond just treating depression. For example, Louise Hay, who published her ideas in 1984, has built a successful self-help career based on this concept. She suggests that by choosing positive and uplifting thoughts, people can improve their overall happiness and create better life experiences. Although she doesn't specifically focus on treating depression, her philosophy emphasizes the benefits of thinking positively.

Negative thoughts can greatly distort our perception of reality.

Research shows that unpleasant thoughts often come from distorted views of reality. When people have negative thoughts, they usually make mental mistakes. For example, they might assume the worst-case scenario or focus only on the negative aspects of a situation.

Psychologist George Bonnano shares the story of Heather Lindquist, who faced a very tough situation when her husband suddenly died, leaving her to raise their two young children alone. Though she might have expected to be overwhelmed and fall into deep depression, she found new strength and even joy in her situation. Instead of thinking her life was over, Lindquist took on the challenge and found renewed purpose. Her experience shows that, even in extreme circumstances, it’s possible to cope and grow, rather than give in to despair.

Beat depression needs consistent effort to change thoughts.

Feeling a bit better is not the same as fully recovering from depression. While long-term recovery is achievable, it requires a strong commitment from individuals to help themselves. Cognitive Therapy (CT) relies on people’s willingness to notice and change their thoughts.

A young man struggling with severe depression might feel so drained that he can't do his job. He may think that taking medication is the only way to improve his condition. However, if he focuses only on drug therapy, he might miss a key part of recovery; his ability to manage his thoughts. Regardless of the severity of his symptoms or the treatment he chooses, he can still take steps to monitor and adjust his thinking patterns. This self-awareness is crucial for healing.

Weekly mood self-assessments are a great way to shift perceptions.

The Burns Depression Checklist (BDC) helps you assess how severe your depression is. This self-assessment tool can guide you in choosing the right treatment and decide if you need professional help in addition to self-help strategies like cognitive therapy.

Over the last 40 years, various tools have been created for people to evaluate their own need for depression treatment. For example, the Leeds Scale helps measure anxiety and depression symptoms and gives a diagnostic score that's useful in both clinical and research settings. Other tools include:

• Hamilton Depression Rating Scale
• Zung Self-Rated Depression Scale
• Beck Depression Inventory (developed by Dr. Aaron Beck, a key figure in Cognitive Therapy)

The growing number of these tools shows how common depression is and how important it is for doctors to get an accurate understanding of a patient's symptoms and condition.

When depressed, trace back to the negative thought.

It’s common to get stuck in negative emotions without thinking about the negative thoughts that started them. To change these feelings, first identify the thought behind them and then rethink it. For example, if you feel anxious about a test, recognize that it might be because you’re worried about failing. By addressing this thought, you can reduce your anxiety and feel more positive.

Dr. Lisa Miller, a psychology professor at Columbia University, faced depression after several failed fertility treatments. Initially, she viewed depression as a disease, but her situation changed when she began noticing meaningful interactions with strangers. These encounters helped her realize that her negative thoughts were fueling her depression. She believed she was alone and that she and her partner would never become parents. Eventually, Dr. Miller had two children—one through natural means and one through adoption. By recognizing and addressing her negative thoughts, she was able to improve her mental health.

10 types of thinking cause depression.

Negative thoughts can often lead to depression, so it’s important to recognize and understand these thinking patterns. There are 10 common types of distorted thinking, such as always expecting the worst in situations or focusing only on the negative aspects of an event while ignoring any positive points. Identifying these patterns can help in managing and changing them.

People can influence their healing by being aware of their thoughts. For instance, a young woman who has just finished massage school might worry about how to earn a living as an independent practitioner. This fear could lead her to accept a job at a well-known massage chain, even if she has concerns about how the chain operates. If she is then asked to stay with the chain for two years and not take any of her clients with her when she leaves, she might fall into a depression. This depression isn't due to her being unable to negotiate better terms or find another job. If she often thinks negatively, she might quickly decide that her job at a massage chain she doesn’t like is a dead end. By correcting these negative thoughts, she could start to feel better. Learning to manage her thoughts better could help in many areas of her life, including negotiating a better job contract.

Rational thought comes before feelings about a situation.

Cognitions help us understand what's happening to us and around us. Events themselves aren’t good or bad; how we feel about them depends on how we interpret them. Mindfulness can stop us from creating unnecessary stories about situations. Even though telling stories is an instinct, these stories can sometimes lead to more stress. For a calmer mind, it's best to avoid getting caught up in thoughts that don't match reality.

Vishen Lakhiani, an entrepreneur and author, emphasizes how mindfulness can lead to a happier life. During his "40 Days of Zen" meditation program, he used biofeedback to see real-time data on his brain activity. He learned that higher alpha waves, which indicate relaxation and creativity, were significantly boosted by forgiveness. Lakhiani revisited painful moments in his past and changed his perspective on them. For instance, he forgave a former business partner who had betrayed him. By developing compassion for this person, he was able to let go of negative feelings and change how he thought about the situation.

Depression often traps you in a cycle of negative thoughts.

Negative feelings that come from negative thoughts can feel so real that they reinforce harmful thinking patterns. This can trap someone in a cycle of depression. For example, in You Can Heal Your Life (1984), Louise Hay describes how she changed her attitude toward her landlord, who was known for being stingy and grumpy. When she decided to move out, she needed his cooperation. Instead of adopting her neighbor's negative view of him and getting angry when his response seemed to confirm that view, she chose to approach the situation differently.

Instead of letting negative thoughts like, “He’ll never help me. My move will be chaotic and costly,” take over, she chose to stay positive and believe he would assist her. This decision helped her avoid a downward spiral of bad thoughts and feelings. By focusing on a positive outcome, she prevented the negative thinking that could have led to stress or sadness. In the end, he responded better than expected, proving that while she couldn't control his reaction, maintaining a positive attitude helped her manage her mindset effectively.

Boost self-esteem helps prevent depression.

Often, distorted thinking comes from feeling like you’re not good enough. For instance, if someone gets criticized by their boss or partner, they might quickly think it's their fault and that they are a failure. Cognitive Therapy (CT) teaches that everyone has inherent value. When people realize this, they can handle criticism and disapproval more healthily, without letting it damage their sense of self-worth.

Low self-esteem can make people more prone to long-term depression because they tend to blame themselves for things that go wrong. One effective way to tackle depression is to build up self-esteem. For example, if an actress with low self-worth is turned down for a role, she might think she made a huge mistake, even if the real reason was that the director wanted someone with a different look. To improve her self-esteem, she could ask her agent for honest feedback to understand why she wasn't chosen. If she learns that the director needs someone taller, she can realize it wasn't about her personal qualities. By focusing on her long-term career and future opportunities, she can see that rejection isn’t a reflection of her worth. Understanding that others can't control how she feels will help her handle setbacks better and reduce the risk of depression.

Replace distorted thinking with positive thoughts boosts self-esteem.

Cognitive Therapy (CT) offers straightforward methods to change negative beliefs. For example, using a wrist counter can help people who often have negative thoughts by tracking how often they think pessimistically. This way, they can become more aware and reduce their negativity. Another useful technique is writing down negative thoughts. You can do this by dividing a piece of paper into three sections: the first for distorted thoughts (like “I never succeed”), the second for the type of inaccurate belief (such as “Overgeneralization”), and the third for a balanced response (like “That’s not true. I got a great job and beat other candidates”).

Cognitive Therapy (CT) has been shown to help with various psychological issues, such as love addiction, suicidal thoughts, grief, and substance abuse. For instance, a 2010 study found that 60% of cocaine users who underwent CT were drug-free a year later. Another study revealed that CT could even reduce criminal behavior in high-risk offenders.

Use Cognitive Therapy for OCD

Cognitive therapy (CT) can be effective for various mental health issues. Jackie Lea Sommers struggled with obsessive-compulsive disorder (OCD) for years, trying medications and traditional therapy with no success. She then met a doctor who introduced her to CT and a method called "exposure and response prevention." Jackie's OCD involved a deep, irrational fear of going to hell. Her therapist created a recording of a fictional story about hell, which Jackie had to listen to four times a day while avoiding her usual coping strategies like excessive prayer. Although she didn’t see improvement for weeks, the therapist later advised her to tell herself, "My OCD wants me to think X" when experiencing negative emotions. After using this technique for another week, her symptoms disappeared.

Regular sadness is normal; depression is not.

Cognitive Therapy (CT) doesn’t guarantee that people will always feel good or that their depressive symptoms won’t come back. It helps individuals understand that the key difference between temporary sadness and longer-term depression is often distorted thinking. With the rise of antidepressant medication use—up by 400 percent in recent years—people might confuse passing sadness with a need for medication. This is an important distinction to keep in mind.

A 2015 study revealed that 69% of people taking selective serotonin reuptake inhibitors (SSRIs), a common type of antidepressant, had never been diagnosed with major depressive disorder (MDD). Furthermore, 38% had no diagnosis of other mental health issues like OCD, panic disorder, social phobia, or generalized anxiety disorder. This indicates many people may not fully understand the difference between normal mood changes and a serious mental health condition. Learning about Cognitive Therapy (CT) and how false beliefs can contribute to depression might help people better recognize when they need antidepressant medication, reducing unnecessary use.

Treatment success depends on the patient’s attitude.

If patients worry that medication will negatively change their personality, it can reduce its effectiveness. This is also true for any form of therapy. For example, someone who had been on a combination of antidepressants and benzodiazepines for a year and a half to manage severe depression, anxiety, and insomnia decided to stop taking the medication. Despite their doctor’s advice, they chose to taper off the medication themselves. Their positive attitude towards this decision was a key factor in their success.