Overview
Chronic depression often changes the way people think, feel, and behave. Over time, symptoms can lead to withdrawal, reduced activity, disrupted sleep, lower self confidence, and a sense of being stuck. These patterns can become self reinforcing, even when the original triggers have eased.
CBT and ACT are two evidence based therapy approaches commonly used for persistent depression. They focus on improving coping and daily functioning, reducing the intensity of unhelpful thinking patterns, and building a more stable routine. Therapy can also support people who are managing chronic pain, fatigue, or long term health issues alongside depression.
Psychological therapy support is often most effective when integrated with medical care, medication review where needed, and lifestyle based recovery strategies.
Who This Support Helps
CBT and ACT based support may be suitable for people with:
• Long term depressive symptoms affecting motivation, confidence, and routine
• Low mood linked to reduced activity, avoidance, or withdrawal
• Sleep problems and fatigue that worsen mood and coping
• Anxiety symptoms alongside depression
• Negative thought loops such as hopelessness, self criticism, or fear of relapse
• Difficulty managing stress, pressure, or emotional overwhelm
• Depression alongside chronic pain or persistent physical symptoms
A consultation helps identify which approach fits your needs and what outcomes you want to prioritise.
What CBT and ACT Involve
CBT for Depression
CBT focuses on the relationship between thoughts, feelings, physical symptoms, and behaviour. It helps you identify patterns that maintain depression and develop practical steps to shift them. This may include:
• Recognising unhelpful thinking patterns and testing them in a realistic way
• Building behavioural activation to increase helpful activity gradually
• Improving sleep habits and daily structure
• Developing problem solving skills for real life stressors
• Reducing avoidance and rebuilding confidence step by step
ACT for Depression
ACT focuses on reducing the struggle with difficult thoughts and feelings while building a life guided by values and meaningful goals. It helps you create flexibility and resilience, even when symptoms are present. This may include:
• Learning skills to relate differently to negative thoughts
• Reducing avoidance and building willingness to face difficult feelings safely
• Clarifying personal values and using them to guide decisions
• Developing mindfulness based tools to steady attention and reduce rumination
• Building sustainable actions that improve mood through purpose and direction
Your care plan may include one approach or a blended approach depending on your situation.
What to Expect From Therapy Support
Psychological support typically includes:
• An initial assessment to understand symptoms, history, and goals
• A clear plan with agreed targets such as sleep improvement, routine stability, or reduced rumination
• Structured sessions with practical strategies you can use between sessions
• Tracking progress using simple measures such as mood, activity, and functioning
• Tools for managing setbacks and preventing relapse
• Coordination with consultant led care where appropriate
Therapy is collaborative and practical. The aim is to help you build skills that remain useful long after sessions end.
How This Fits With Consultant Led Care
For chronic depression, therapy often works best when integrated with medical oversight. Your consultant may coordinate care to ensure that:
• Medication is reviewed and aligned with therapy goals
• Sleep and physical symptoms are addressed rather than ignored
• Chronic pain or fatigue is managed alongside mood support
• Safety, risk factors, and symptom change are monitored consistently
• Any need for additional mental health input is identified early
This integrated approach supports steadier progress and reduces fragmented care.
Benefits
Potential benefits of CBT and ACT support include:
• Improved coping skills during low mood periods
• More stable daily structure and improved activity levels
• Reduced rumination and self critical thought patterns
• Better sleep habits and stress management
• Increased confidence and emotional resilience
• Improved ability to function at work, home, and socially
• Reduced relapse risk through prevention planning and early warning strategies
Progress is often gradual, but the skills are designed to be long lasting.
Possible Challenges and What to Know
Therapy can involve discussing difficult emotions and making changes that feel uncomfortable at first. It is normal to experience:
• Temporary emotional discomfort when addressing avoided topics
• Ups and downs as routines change
• The need for practice between sessions to build results
Your therapist or care team will pace the work appropriately and focus on safe, realistic progress.
When to Consider Other Options
Therapy can be used alone or alongside other treatments. Your consultant may also discuss:
• Medication review and optimisation if symptoms are severe or persistent
• IV ketamine infusion in selected cases with appropriate screening
• Specialist sleep support if insomnia is a key driver
• Wider multidisciplinary support when chronic pain or fatigue is prominent
Safety Note
If you experience suicidal thoughts, feel unsafe, or are at risk of harming yourself or others, seek urgent support immediately through appropriate urgent services. Therapy support is part of longer term management and is not a substitute for emergency care.
Book a consultation to discuss a personalised therapy support plan using CBT and ACT and how it fits into your overall chronic depression care pathway.