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Depression is characterized by an extended period of low mood, anhedonia, and reduction in activity. Dysthymia (persistent depressive disorder) is characterized by a depressed mood that occurs for most of the day, more days than not, and has been present for at least two years. Depression is a heterogeneous condition with many different triggers, presentations, and maintaining factors. Cognitive behavioral therapies (including acceptance and commitment therapy (ACT), cognitive behavioral therapy (CBT), compassion focused therapy (CFT), and dialectical behavior therapy (DBT)) are effective evidence-based treatment for depression, and mindfulness-based cognitive therapy (MBCT) is an effective intervention for preventing the recurrence of depression. Read more
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What Do People Think About Themselves (CYP)?

People are not born with low self-esteem. Instead, we develop ideas about ourselves and our place in the world as a result of our life experiences. Pe ...


What Does Exercise Do For the Mind And Body?

Exercise is an evidence-based treatment for depression and anxiety and research suggests that in the treatment of depression, exercise interventions l ...

Information handouts

What Is Burnout?

Our ‘What Is … ?’ series is a collection of one-page information handouts for common mental health conditions. Friendly and explanatory, handout ...

Information handouts

What Is Imagery Rescripting?

Unwanted images are a feature common to a variety of problems including PTSD and depression. Imagery rescripting is an evidence-based treatment techni ...

Information handouts

What Is Rumination?

Rumination and repetitive thought is a transdiagnostic maintenance process underpinning a range of difficulties. This information sheet explores the c ...

Information handouts

What Keeps Depression Going?

The “What Keeps It Going?” series is a set of one-page diagrams explaining how common mental health conditions are maintained. Friendly and concis ...

Information handouts

Links to external resources

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  • Clinically Useful Depression Outcome Scale (CUDOS) | Zimmerman, Chelminski, McGlinchey, Posternak | 2008
    • Scale
    • Zimmerman, M., Chelminski, I., McGlinchey, J. B., & Posternak, M. A. (2008). A clinically useful depression outcome scale. Comprehensive psychiatry, 49(2), 131-140.
  • Edinburgh Post Natal Depression Scale (EPDS) | Cox, Holden, Sagovsky | 1987
    • Scale
    • Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale. The British Journal of Psychiatry, 150(6), 782-786.
  • Hamilton Rating Scale For Depression (HAM-D) | Hamilton | 1960
    • Scale
    • Hamilton M. (1960). A rating scale for depression. J Neurol Neurosurg Psychiatry, 23, 56–62.
  • Montgomery & Asberg Depression Rating Scale (MADRS) | Montgomery, Asberg | 1979
    • Scale
    • MADRS Score Card
    • Montgomery, S.A., Asberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134 (4): 382–89.
  • Patient Health Questionnaire 9 (PHQ-9) | Kroenke, Spitzer | 2002
    • Scale
    • Kroenke, K., & Spitzer, R. L. (2002). The PHQ-9: a new depression diagnostic and severity measure. Psychiatric annals, 32(9), 509-515.
  • Severity Measure For Depression – Adult (Adapted from the Patient Health Questionnaire–9 (PHQ-9)) | APA (Spitzer, Williams, Kroenke and colleagues)
  • Zung Self-Rating Depression Scale | Zung | 1965
    • Scale
    • Reference Zung, W. W. (1965). A self-rating depression scale. Archives of General Psychiatry, 12(1), 63-70.
  • Valued Living Questionnaire (Version 2) | Wilson, Groom | 2002
  • Ruminative responses scale | Treynor, Gonzalez, Nolen-Hoeksema | 2003

Case Conceptualization / Case Formulation

  • Cognitive conceptualisation (excerpt from Basics and Beyond) | J. Beck
  • Developing and using a case formulation to guide cognitive behaviour therapy | Persons | 2015


  • Mood And Substance Use | NDARC: Mills, Marel, Baker, Teesson, Dore, Kay-Lambkin, Manns, Trimingham | 2011

Information Handouts

Information (Professional)

Self-Help Programmes

Treatment Guide

  • Depression In Adults: Recognition And Management | National Institute for Health and Care Excellence (NICE) guidelines | 2009
  • Individual therapy manual for cognitive-behavioural treatment of depression | Ricardo Muñoz, Jeanne Miranda | 1996
  • Manual for group cognitive-behavioral therapy of major depression: a reality management approach (Instructor’s manual) | Muñoz, Ippen, Rao, Le, Dwyer | 2000
  • Cognitive-Behavioural Therapy (CBT) Group Program For Depression | Milner, Tischler, DeSena, Rimer
  • Cognitive behaviour therapy for depression in young people: manual for therapists | Improving Mood with Psychoanalytic and Cognitive Therapies (IMPACT) Study CBT Sub-Group | 2010
  • CBT For Depression In Veterans And Military Service Members – Therapist Manual | Wenzel, Brown, Carlin | 2011
  • Group therapy manual for cognitive behavioral treatment of depression | Muñoz, Miranda | 1993
  • Behavioural activation treatment for depression – revised (BATD-R) manual | Lejuez, Hopko, Acierno, Daughters, Pagoto | 2011
  • Behavioural activation treatment for depression (BATD) manual | Lejuez, Hopko & Hopko | 2001
  • Suicide and self injury: a practitioners guide | Forensic Psychology Practice Ltd | 1999
  • Metacognitive Training For Depression (D-MCT) Manual | Jelinek, Schneider, Hauschild, Moritz | 2023
  • Depression In Adults: Treatment And Management (NICE Guideline) | NICE | 2022
  • Metacognitive Training For Depression | Jelinek, Hauschildt, Moritz & Schneider | 2022
  • Cognitive-behavioral therapy for depression in young people: a modular treatment manual | Orygen | 2015


Recommended Reading

  • Behavioural activation treatment for depression: returning to contextual roots | Jacobson, Martell, Dimidjian | 2001

What Is Depression?

Signs and Symptoms of Depression

To meet DSM-5 diagnostic criteria for major depressive disorder an individual must have experienced five of the following symptoms for at least two weeks:

  • a depressed mood that is present most of the day, nearly every day
  • diminished interest in activities which were previously experienced as pleasurable
  • fatigue or a loss of energy
  • sleep disturbance (insomnia or hypersomnia)
  • feelings of worthlessness, self-reproach, or excessive guilt
  • a diminished ability to think or concentrate, or indecisiveness
  • recurrent thoughts of death or suicide, or suicidal behavior
  • changes in appetite marked by a corresponding weight change
  • psychomotor agitation or retardation to a degree which is observable by others

Psychological Models and Theory of Depression

Beck’s cognitive theory of depression (Beck, Rush, Shaw, & Emery, 1979) forms the basis for cognitive behavioral approaches for the treatment of depression. Beck’s theory proposes that there are different levels of cognition that can be dysfunctional in depression: core beliefs, rules and assumptions, and negative automatic thoughts. CBT aims to balance negatively biased cognition with more rational and accurate thoughts, beliefs, and assumptions. CBT also systematically aims to increase levels of rewarding activity.

Acceptance and commitment therapy (ACT) proposes that distress, including symptoms of depression, are the result of psychological inflexibility (Hayes, Luoma, Bond, Masuda, & Lillis, 2006). Indicators of psychological inflexibility include:

  • ‘buying in’ to negative thoughts and narratives;
  • engaging in worry or rumination that takes us away from the present moment;
  • losing contact with our values—what is important to us.

Evidence-Based Psychological Approaches for Working with Depression

Many psychological therapies have an evidence base for working with depression:

Resources for Working with Depression

Psychology Tools resources available for working therapeutically with depression may include:

  • psychological models of depression
  • information handouts for depression
  • exercises for depression
  • CBT worksheets for depression
  • self-help programs for depression


  • Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford Press.
  • Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. BehaviourResearch and Therapy, 44(1), 1–25.