How therapy helps with depression and anxiety

Does therapy work for depression and anxiety?

Yes, for many people. The National Institute of Mental Health (NIMH) describes psychotherapy as helping people with depression by teaching new ways of thinking and behaving and changing habits that contribute to it, and lists talk therapy, medication or both as the usual treatments. For milder depression, NIMH notes, psychotherapy is often tried first.

Therapy is not one thing. Several approaches have been tested in many trials, and a good therapist will draw on them according to what you bring. What they have in common is a structured, confidential conversation that aims to change something specific: the thoughts that keep you stuck, the habits that shrink your life, or the relationships and transitions that are weighing on you.

Cognitive behavioral therapy (CBT)

CBT works on the links between thoughts, feelings and actions. In NIMH's words, people learn to challenge and change unhelpful thoughts and behaviors to improve their depressive and anxious feelings. In depression, that might mean noticing the automatic thought that you always fail and testing it against the evidence. In anxiety, it often includes gradual exposure: facing, a step at a time, the situations, sensations or thoughts that anxiety has taught you to avoid.

CBT is the most studied therapy for depression. A 2013 meta-analysis by Pim Cuijpers and colleagues, covering 115 studies, concluded there is no doubt CBT is an effective treatment for adult depression, while noting that the effects were probably overestimated in earlier, lower-quality studies. The same review found no sign that CBT was more or less effective than other psychotherapies or medication on average.

For anxiety, a 2018 meta-analysis of 41 placebo-controlled trials by Joseph Carpenter and colleagues found moderate effects of CBT on anxiety symptoms, with larger effects for generalized anxiety. How counseling helps anxiety goes further into the anxiety side.

Behavioral activation

Depression narrows life. You stop doing the things that used to give you pleasure or a sense of accomplishment, which makes you feel worse, which makes it harder to do them. Behavioral activation interrupts that loop. The NHS describes it as focusing on the links between your activities and your mood, and making practical changes to your behavior, especially when depression has led you to withdraw.

In practice it is concrete: tracking what you do and how you feel, then scheduling small, manageable activities that matter to you, whether or not you feel like it, and noticing what changes. A 2014 meta-analysis led by David Ekers, covering 26 randomized trials, found behavioral activation more effective than control conditions for depression, while noting that many of the studies were of low quality. Our page on depression and motivation explains why waiting to feel motivated rarely works.

Interpersonal therapy (IPT)

IPT starts from the observation that mood and relationships affect each other. NIMH describes it as focusing on interpersonal and life events that affect mood, and helping people improve communication in relationships, build social support and set realistic expectations for dealing with crises. It often centers on a particular area: grief, a conflict with someone important, or a role transition such as divorce, retirement or becoming a parent.

A 2016 meta-analysis of 90 studies led by Cuijpers found IPT had moderate-to-large effects for depression compared with control groups, with no significant difference from other therapies or medication, and some evidence that it helps prevent relapse. That makes it a natural fit when depression is tangled up with a life transition or a loss.

What the approaches share

One of the most consistent findings in psychotherapy research is that the working relationship between client and therapist is linked to outcome. A 2018 meta-analysis by Christoph Flückiger and colleagues, pooling 295 studies, found a reliable association between a stronger alliance and better results, across different types of therapy.

That means fit matters. It is reasonable to expect to feel heard, to agree on what you are working on, and to be able to say when something is not helping. NIMH also suggests asking a prospective therapist about their approach, goals and how progress will be assessed. If depression and anxiety are both present, as they often are, the work usually addresses both together; see when depression and anxiety come together.

• A clear focus: what you want to be different, in your own words.
• Something to try between sessions, whether a thought record, an activity or a conversation.
• Attention to the body: sleep, movement, and what anxiety or low mood feel like physically.
• Regular check-ins on whether things are moving, and a willingness to change course.

What therapy with Laura Bass looks like

Laura Bass is a psychotherapist in Charlotte, North Carolina, who works with adults, individually and as couples. Depression and anxiety are among the concerns she sees, along with grief, stress, burnout and life transitions. She works with the whole person, mind, body and spirit. Some clients choose to include spiritual or energy work alongside talk therapy and some do not; that choice is the client's, and it is not a substitute for medical or psychiatric treatment.

Which methods Laura draws on with a particular person is a good question to ask her directly. The first conversations are usually about what has been happening, what you have tried, and what you hope will change. You can read more on the individual counseling and psychotherapy pages, or contact Laura.

Laura does not prescribe medication. If you take medication or are considering it, that stays with your physician or psychiatric prescriber, and many people do both; see therapy, medication or both. Weekly therapy is also not crisis care. If you have thoughts of suicide, call or text 988 at any hour, and in an emergency call 911.

Common questions