Depression and Cognitive Behavioural Therapy
by Chris Williams and Ben Wiffen
Using CBT with individual Christians
CBT is an approach that is compatible with the Christian faith, and can be of benefit to many Christians with depression. Indeed, Christians are called to ‘take captive every thought to make it obedient to Christ’ (2 Cor. 10:5), and to put off our corrupted old self and to be made new in the attitude of our minds (Eph. 4:22-23).
CBT can incorporate Christian activity in simple, specific ways. For example, a Christian with depression may find prayer a struggle. Rather than trying to get back immediately to praying like they did before they became depressed, which would have a high chance of ending in failure, a CBT approach would suggest starting with very short prayers, and building gradually up as they becomes able to manage more. A similar approach can be taken to reading the Bible. Similarly, if a Christian has stopped attending church in order to avoid having to have any awkward conversations afterwards, a start may be for them to attend church but arrive late and leave early, or to ask a trusted friend to meet them beforehand.
It is likely that a Christian could benefit more from CBT delivering by a highly-trained and skilled non-Christian psychological therapist than from a well meaning, but untrained Christian, who is less experienced in the effects and realities of depression. However, many Christians may also prefer to receive support from a Christian professional, from within a Christian community or from someone with a Christian perspective. Consequently, there are important ways that the church can help, and also that CBT techniques can be augmented to incorporate a Christian worldview more explicitly.
Although the evidence base suggests that CBT is the most effective intervention for depression, many Christians have found Christian counselling to be of benefit too. This may be particularly the case when problems relate more specifically to faith issues, or where CBT’s ‘here and now’ focus has not dealt with the important past issues. However, there can be a risk that an emphasis on personal testimony and allowing ‘space to talk’ may create more distress. The evidence suggests that CBT approaches should be offered as a first line of treatment. This can be accompanied by faith-based supports and ministry from ministry teams, church leaders or fellow Christians. Also, increasing numbers of Christian counselors are trained in CBT approaches and may be able to draw from both.16
Resources are available that combine the CBT approach with an explicit Christian focus17, and can be used by Christians, whilst at the same time using an evidence-based approach. Commonly recommended free, secular online course include Living Life to the Full and Moodgym.18 A faith-based version of Living Life to the Full is also available.19
How Churches Can Help
Churches can play an important role in supporting people with depression, both those who are Christians and those who are not. The church is often seen to have a role to welcome those in society who may feel unwelcoming elsewhere, and those who are struggling. Indeed many ministers will know that a large amount of their time is taken up providing pastoral care. Many with and without church background may see the church as a place to go in times of difficulties. Consequently, it is important that church workers feel competent to provide appropriate support can be found.
Some churches have recently begun running groups based on CBT principles to reach out into their local communities, as well as to support Christians struggling with common problems like low mood and anxiety. Living Life to the Full is also available as a series of eight weekly classes/seminars that can be delivered in churches or communities.20 As well as teaching important CBT skills, this course includes additional notes for use i churches and allows fellowship between Christians with depression, and encourages them to engage with each other about the interaction of their faith and their low mood or anxiety, providing a potentially helpful social support, and knowledge that they are not alone in their experience. Church workers may benefit from seeking training in how to use a basic CBT approach in their pastoral work and regular training courses are available.
It can also be helpful for church leaders to give a clear message that depression and mental health are things that can be spoken about in church. This might mean talking about depression within sermons, pointing to examples of well-known Christians who faced it personally, or encouraging open discussion about the issue within the church community. Indeed, Paul did not shy away from speaking about the suffering he endured for the sake of the gospel, but that God, who can raise the dead, can deliver Christians from this despair (2 Cor. 1:8-12). This may help to reduce the stigma surrounding the issue as well as providing guidance for those struggling with it. It may also help to make it clear that biblical joy is not about smiling all the time and never feeling low or anxious, but the opportunity to rejoice in the fact that any present sufferings do not compare with the future glory that will be revealed in us (Romans 8:18) and that nothing can separate us from the love of God (Romans 8:28).
Depression is a debilitating condition that affects millions of people in the UK every year. Christians are not immune from depression, and may find particular struggles associated between the interaction between their faith and their depression. Evidence-based interventions are available such as CBT, which can be beneficial to Christians and non-Christians alike. Although some Christians may feel they need specialist support, CBT is compatible with the Christian faith, and can be modified to appeal specifically to Christians. Future research could helpfully investigate the specific challenges and struggles of Christians with depression, and the efficacy of interventions that incorporate their faith. The church can also
play an important role in both supporting people with depression, and reducing the stigma surrounding the condition within the Christian community.
Dr Christ Williams is Professor of Psychosocial Psychiatry at the University of Glasgow
Dr Ben Wiffen is a Trainee Clinical Psychologist at the University of Glasgow
Acknowledgements: CW is author of the Living Life to the Full books, website and classes. The term Five Areas is a registered trademark of Five Areas Resources Ltd and is used with permission.
- McManus S, Meltzer H, Brugha T, Bebbington P, Jenkins R. Adult Psychiatric Morbidity in England, 2007: results of a household survey. National Centre for Social Research, 2009
- National Institude for Health and Care Excellent. CG123: Common mental health disorders: Identification and pathways to care. NICE, 2011
- Singleton N, Bumpstead R, O’Brien M, Lee A, Meltzer H. Psychiatric Mordibity Among Adults Living In Private Households 2000. London: The Stationery Office, 2001
- American Psychiatric Association. Diagnostic and Statistical manual of mental disorders 4th ed, text rev. Washington, DC. American Psychiatric Association, 2000
- Beck AT, Rush AJ, Shaw BF & Emery G. Cognitive therapy of depression. New York: Guilford, 1979
- Koenig HG. Faith & Mental Health. Philedelphia: Templeton Foundation Press, 2005. See also: www.mindand soul.info, a useful source of information about faith and mental health.
- Kirsch I, Deacon BJ, Huedo-Medina TB, et al. Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration. PLoS Medicine 2008;5(2)
- National Institute for Health and Care Excellence. CG90: The treatment and management of depression in adults. NICE, 2009
- National Institute for Health and Care Excellence. CG113: Generalised anxiety disorder and panic disorder (with or without agoraphobia) in adults. NICE, 2011
- Beck et al. Op Cit
- Layard, R. The case for psychological treatment centres. BMJ 2006;332:1030-1032
- William CJ. Overcoming Depression and low mood: A Five Areas Approach, 4th Edition. London: CRP Press, 2014
- Dimidjan S, Hollon S, Dobson K et al. Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. Journal of Consulting and Clinical Psychology 2006;74(4):658-70
- Williams C. Living Life to the Full Class Resources. Glassgow: Five Areas, 2009 www.llttfshop.com
- Find a Christian Counselor: www.acc-uk.org. Find an accredited CBT therapist: www.cbtregisteruk.com
- Williams C, Richards P & Whitton I. I’m not supposed to fell like this. Edinburgh: Hodder & stoughton, 2002 and Van der Hart W & Waller R. The Worry Book. UK: Inter-Varsity Press, 2011
- www.llttf.com, www.moodgym.anu.ed.au
- Living Life to the Full with God: www.llttfwg.com
- William C. Op Cit, 2009
Christian Medical Fellowship (CMF) Files No. 53, 2014