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CBT for Depression: Why we so often fail

David A. Clark

20 Oct 2023


On October 20th 2023, Dr. David A. Clark deliverd a half-day workshop on the cognitive-behavioural treatment of depression and the processes that may contribute to treatment failure. This on-demand webinar is a recording of that presentation.


After decades of outcome and dismantling research, cognitive behavior therapy (CBT) for depression still remains one of the most effective psychological treatments for all levels of depression severity.  Estimates of significant symptom improvement with competent CBT therapists range from 40% to 60%, leaving a sizable number of individuals with suboptimal treatment response.  
In this workshop we consider seven treatment processes that may contribute to failure to achieve symptom improvement.  These are (a) inadequate patient education into the CBT model, (b) reliance on noncollaborative goal setting, (c) failure to incorporate behavioral intervention early in treatment, (d) insufficient attention to low motivation and poor homework engagement, (e) failure to address therapeutic alliance issues, (f) inadequate attention to hopelessness, and (g) overreliance on futile evidence gathering and ill-designed behavioral experiments.  Participants will learn how to identify these negative treatment processes and use strategies to rectify their deleterious impact on treatment outcome.  Case illustration and interactive discussion with webinar participants is encouraged to discover an array of innovative responses to processes that can undermine the effectiveness of CBT for depression in older adolescents and adults.

Learning Objectives

At the end of the session, attendees will learn to: 
• Increase self-awareness of therapeutic processes that cause poor treatment response to CBT for depression. 
• Include treatment monitoring for early detection of possible treatment failure.
• Develop a risk assessment for treatment failure that features into the cognitive case formulation.
• Implement therapeutic strategies that counter negative treatment processes.
• Promote a more positive orientation to client needs that boosts CBT treatment effectiveness.

Training Modalities

The workshop will combine didactic components with interactive elements and case illustrations. 

Key References

1. Beck, J.S. (2020). Cognitive behavior therapy: Basics and beyond (3rd ed.). New York: Guilford Press.

2. Greenberger, D., & Padesky, C.A. (2015). Mind over mood: Change how you feel by changing the way you think (2nd ed.). New York: Guilford Press.

3. Leahy, R.L. (2010). Beat the blues before they beat you: How to overcome depression. Carlsbad, CA: Hays House.

4. Cuijpers, P., Miguel, C., Harrer, M. et al. (2023). Cognitive behavior therapy vs. control conditions, other psychotherapies, pharmacotherapies and combined treatment for depression: a comprehensive meta-analysis including 409 trials with 52,702 patients. World Psychiatry, 22, 105-115.

About the presenter

David A. Clark, PhD, is Professor Emeritus, Department of Psychology, University of New Brunswick and a practicing clinical psychologist with 30+ years in providing cognitive behavioural treatment for depression, anxiety and OCD.  He received his PhD from the Institute of Psychiatry and pursued postdoctoral work at the University of Pennsylvania Medical School under Professor Aaron T. Beck.  He maintained an active research program on the cognitive features of depression, anxiety and OCD and continues to provide advanced CBT workshops globally.  He is a Fellow of the Canadian Psychological Association, Founding Fellow/Trainer Consultant of the Academy of Cognitive and Behavioral Therapies, ad hoc consultant with the Beck Institute and recipient of the Aaron T. Beck Award in 2008.  He has co-authored several publications with Dr. Beck including Scientific Foundations of Cognitive Theory and Therapy of Depression (Wiley, 1999), Cognitive Therapy for Anxiety Disorders (Guilford, 2010), and The Anxiety and Worry Workbook (Guilford, 2012).  He is sole author of The Anxious Thoughts Workbook (New Harbinger, 2018), Cognitive-Behavioral Therapy for OCD and Its Subtypes (Guilford, 2020), The Negative Thoughts Workbook (New Harbinger, 2020), and The Anxious Thoughts Workbook for Teens (New Harbinger, 2022).  He has a blog with Psychology Today called the Runaway Mind.

Who should attend

This workshop is at an intermediate level, and is suitable for mental health professionals with a rudimentary knowledge of CBT and some clinical experience with older adolescents or adults with major depression. 

Low Intensity clinical contact hours survey - BABCP Low Intensity Special Interest Group

Please click below if you are interested in contributing to the survey.


The BACP Low Intensity SIG are interested in the impact of clinical contact hours on Low Intensity/Wellbeing Practitioner wellbeing. This questionnaire contains six multi-choice questions and a free text box for you to share your experiences. The answers to these questions will help the BABCP SIG plan how to meet CPD topics and other developments within the SIG.  The SIG hope to produce a write up of the answers to this questionnaire to be shared with SIG members and to be used in training.

View Survey

This FREE conference is for Psychological Wellbeing Practitioners working in Talking Therapies for Anxiety and Depression services and is brought to you by Bespoke Mental Health in collaboration with the NHS England Talking Therapies National PWP Leads Network

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