Nathaniel D. Smith, LPC, NCC provides cognitive behavioral therapy (CBT) for depression — in person in Plano and via secure telehealth anywhere in Texas.
of people with depression respond to CBT — comparable to antidepressants
NICE Guidelines, 2022sessions is a typical course of CBT for depression
Beck Institutelower relapse rate with CBT compared to medication alone after treatment ends
Hollon et al., 2005years of clinical experience treating depression and anxiety
Nathaniel D. Smith, LPCDepression is not sadness, and it is not a personal failing. It is a self-sustaining cycle — negative thoughts reduce motivation, reduced activity deepens low mood, and low mood confirms the negative thoughts. Once this cycle is running, it tends to maintain itself regardless of external circumstances.
This is why "trying harder," waiting it out, or simply knowing things could be worse rarely breaks depression. The cycle operates through specific cognitive and behavioral patterns that require targeted intervention to interrupt.
CBT was originally developed specifically for depression by Aaron Beck in the 1960s and has since accumulated more clinical trial evidence than any other psychotherapy. It works by making the maintaining patterns visible — and systematically dismantling them.
Depression presents differently across individuals and diagnoses. Each type has its own maintaining patterns — and its own targeted CBT approach.
Persistent low mood, loss of interest, fatigue, and cognitive changes that significantly impair daily functioning. CBT directly targets the negative thought patterns and behavioral withdrawal that sustain major depression.
A lower-grade but chronic depression lasting two or more years. Often described as "always feeling this way." CBT is particularly effective at breaking the long-standing patterns that keep dysthymia entrenched.
Depression and anxiety co-occur in roughly 50% of cases. CBT addresses both simultaneously — the overlapping cognitive distortions that drive each condition respond to the same structured approach.
Depression that has not fully responded to medication. CBT targets the cognitive and behavioral maintaining factors that antidepressants do not address, making it a powerful complement or alternative.
CBT for depression is structured and goal-directed. Here is what the process looks like in practice.
Depression is maintained by a self-reinforcing loop: negative thoughts reduce motivation, reduced activity deepens low mood, which confirms the negative thoughts. In early sessions we map your specific version of this cycle precisely.
Depression produces predictable cognitive distortions — all-or-nothing thinking, overgeneralization, mind-reading, catastrophizing. CBT teaches you to identify and evaluate these patterns rather than accept them as facts.
Withdrawal from meaningful activity is both a symptom and a cause of depression. Behavioral activation — strategically re-engaging with rewarding activities — is one of the most powerful interventions in CBT for depression.
The final phase of CBT for depression focuses explicitly on recognizing early warning signs and applying skills independently. Clients who complete CBT have significantly lower relapse rates than those who use medication alone.
Antidepressants work by altering brain chemistry — they can reduce the intensity of depression while you are taking them. But they do not change the cognitive and behavioral patterns that generate and maintain depression. When medication stops, those patterns remain.
CBT works differently. It teaches you to recognize and change the specific thought patterns and behaviors that sustain your depression. These are skills you keep. Research consistently shows that people who complete CBT have significantly lower relapse rates than those who use medication alone — because they have learned to interrupt the cycle themselves.
For many clients, the most effective approach combines both. If you are currently taking antidepressants, CBT complements rather than conflicts with that treatment.
CBT and antidepressants produce similar response rates for mild to moderate depression — roughly 60–80% of clients improve significantly with either approach.
After treatment ends, clients who completed CBT relapse at roughly half the rate of those who used medication alone. The skills learned in CBT continue working.
CBT produces no physical side effects. For clients who cannot tolerate antidepressants or prefer not to use them, CBT is a fully evidence-based alternative.
Medication manages symptoms. CBT changes the cognitive and behavioral patterns that generate those symptoms — a fundamentally different mechanism of action.
Nathaniel D. Smith is a Licensed Professional Counselor (LPC) and National Certified Counselor (NCC) with over 20 years of clinical experience. His practice focuses exclusively on cognitive therapy for anxiety and depression — not a generalist approach, but deep specialization in the methods with the strongest evidence base.
CBT for depression was developed by Aaron Beck, and Nathaniel has spent two decades applying and refining these methods with clients across the full spectrum of depressive presentations — from first episodes to chronic, treatment-resistant cases.
The first session is a detailed clinical interview — understanding the history, severity, and specific patterns of your depression before any treatment begins.
By the end of the first or second session, you will have a clear picture of what is maintaining your depression and a structured plan for addressing it.
Even early sessions include practical tools. You will not leave empty-handed — each session builds toward skills you can apply between appointments.
Telehealth sessions are available to clients anywhere in Texas — Dallas, Houston, Austin, San Antonio, Fort Worth, and beyond. Secure, HIPAA-conscious video sessions that fit your schedule without a commute.
Reaching out is often the hardest step. Send a note and Nathaniel will respond personally to schedule a brief consultation.
7150 Preston Road, Suite 100 · Plano, TX 75024 · Telehealth available statewide