We are going to explore one major depression treatment path for people with depression and it is none other than Cognitive Behavioral Therapy (CBT) which is highly effective for the majority of depression sufferers. No treatment path will look exactly the same, but this will give you a general idea of what treatment might look like and will explore the initial sessions of CBT.
Depression may look different for every individual and there are a lot of symptoms that occur with depression that are not in the diagnostic manual. So the therapist may start by asking for each symptom the person has when it started and will also inquire about the time period of the symptoms. The therapist will ask more details about your life before and the life after commencement of the symptoms, to get a better picture about your condition. You are asked to share the triggering factor that worsens your condition and also the things that alleviates your condition at least by a thin margin.This evaluation helps the therapist to know about the potential causes of certain symptoms and about the skills already possessed by the depressed person that will play a major role in treatment.
Generally psychotherapists try to identify the physical factors that cause depression or the physical disturbances caused as a part of depression. For example sleep disturbances may be a result of depression or those people who don't sleep may suffer depression. Excessive eating or lack of appetite may be another issue like that and it is utmost important to identify such issues to initiate the treatment plan.
Another major distress faced during depression is constipation that occurs due to the slowing down of their whole system including gut. Constipation and pain in the gut is seriously considered as part of depression treatment because depression can lower your pain tolerance.
When someone is depressed, things that never used to be painful or even noticeable can suddenly become painful. We want to recognize that this is a legitimate symptom of changes in brain chemistry.
People who are depressed often don’t move around much and may sleep a lot more. This can lead to muscle imbalances and contribute to physical pain. So let’s talk about pain for a moment—because pain can also cause depression.
Low energy is another common symptom. It can come from sleep disturbances, poor nutrition, chronic pain, or other factors. And when your energy is low, it's really hard to feel motivated. It’s hard to feel like you've got any "get up and go." You just want to sit on the sofa all day.
Now, there’s a difference between just having low energy and something we call slowing. Slowing is what it feels like to move through a 60-mile-an-hour wind. Every small task—walking, showering—takes 10 times more effort than it did before.
Addiction often comes up too. People who are depressed sometimes try to self-medicate in order to make the feelings go away. This might include behavioral addictions like shopping, gaming, or gambling, or substance use like alcohol, drugs, and even nicotine. All of these can alter brain chemistry and worsen mood symptoms.
Then there’s impulsivity. Some people feel too drained to even think, while others may have short bursts of energy and use them to engage in impulsive or risky behaviors—just to feel something. That adrenaline rush can feel incredible in the moment.
Let’s talk about immunity too. When your immune system goes haywire, it can cause inflammation throughout your body. People with autoimmune disorders know this well. And inflammation has been linked to increased depressive symptoms. Likewise, depression and stress can increase inflammatory cytokines—so it's a two-way street.
When someone presents with depression, they may also experience apathy or low motivation. That’s when you just don’t care about anything. Or they may experience anhedonia, which is not feeling much of anything—numbness, not sadness, not happiness, just nothing.
Guilt, anger, and anxiety are also really common. During treatment, we’ll work on identifying what’s triggering these emotions and process them, but right now we're just getting a picture of what depression looks like for that person.
Cognitively, people who are depressed often have trouble making decisions and thinking clearly. This can be due to lack of sleep, poor nutrition, or depression itself. But it makes it even harder to complete daily tasks, and that leads to hopelessness and helplessness.
Sometimes pessimism comes first and contributes to depression, especially in people who tend to focus on the negative. But often it goes the other way—when people are depressed, they naturally start noticing more of the negative things, and that creates a cycle.
Ruminations—those critical, pessimistic thoughts—are common too. These thoughts just bounce around and get louder. That negative inner critic can become overwhelming.
Environmentally, people’s surroundings often reflect what’s going on inside them. If their space is disorganized or cluttered, that may mirror their internal state.
This all adds up. People may struggle at school or work, which can lead to financial difficulties, and that increases stress and often worsens depression.
Relationally, depressed individuals often withdraw. They may not have the energy to deal with their own problems, let alone anyone else’s. Sometimes they pull away because others try to cheer them up—and that can feel invalidating. Other times, others pull away from them because it's hard being around someone who is so low.
Depression often brings irritability and impatience too. When you’re overwhelmed and someone brings you a new problem, your brain might jump straight into fight-or-flight mode.
Low self-esteem is incredibly common. When someone is depressed, they may not be doing things they think they should be doing, and that makes them feel even worse about themselves. Sometimes, low self-esteem existed long before the depression and contributes to it. It’s a feedback loop.
Toxic relationships are another big factor. When people are depressed, they may tolerate toxic behavior more because they don’t have the energy to stand up for themselves.
So, what do we do in that first session?
We start by identifying what each symptom looks like for that person—when it started, what makes it better, what makes it worse. Then we identify what recovery from each symptom looks like.
We use an anchored Likert scale. For example, a mood scale might go from:
Most people won’t hit a five regularly, and that’s okay. The goal is to track progress, not reach perfection.
Then we set SMART goals: Specific, Measurable, Achievable, Rewarding, and Time-limited.
For example:
We never set goals for 100% of the time—because that’s setting yourself up for failure.
Next, we build a support plan. Change—even positive change—takes a lot of energy. It causes stress, and stress causes more change.
Frequently Asked QuestionsTherapists encourage clients to carve out three blocks of time daily:
They talk about what can be simplified—maybe prepping meals ahead of time, or getting help with cleaning—to free up energy for recovery.
Then we talk about the environment. How can you set up your space to keep you motivated? We might use mobile apps to schedule reminders, just like people do with medications.
Clients are asked to identify their support system:
Also, how can you help yourself feel safe? When you’re triggered? When you’re overwhelmed?
A list of three coping strategies is created when someone starts to spiral. Because spirals will happen. The goal is to be ready, not surprised.
Next, we pick two or three symptoms to focus on first. Because when you start improving one area of life, it often creates a ripple effect. But you can only work on a few things at once effectively.
We decide how to measure these symptoms—frequency, intensity, duration—and keep track of what triggered them, what helped, and what didn’t.
Then we introduce the feelings awareness worksheet. This helps identify emotional patterns, triggers, and early warning signs of distress—before it becomes a full-blown crisis.
We also start morning and evening mindfulness the day after the session. Morning involves deep breathing and a quick check-in:
In the evening, it's the same idea—but reflecting back on the day:
Also:
Generally depression sufferers are encouraged to schedule a full physical exam by week six. There are many biological contributors to depression—hormonal imbalances, low vitamin D, anemia, thyroid issues. These need to be ruled out or addressed.
Ask your doctor to check:
Lastly, we address living conditions. Without a safe, stable living environment and security, it’s incredibly hard to feel better. Over the next 12 weeks, we evaluate whether these areas need attention and what changes might help improve stability.
So, in this first session, the person:
Yes, it’s a lot—but it’s manageable. These are first steps, not finish lines. If you are a person suffering from these symptoms please feel free to contact us and book an appointment. Cognizant Psychotherapy, the best depression treatment service provider is there for you to lift you from depression.
