Cognitive-behavioral therapy is one of the most widely used theoretical schools of psychotherapy in the world. It was first founded by American clinical psychologist Albert Ellis in the 1950s as Rational Emotive Therapy, followed by Aaron Beck in 1960 as Cognitive Therapy. It is based on the theory that cognition mediates emotion and behavior, and that cognition, emotion, behavior, and physiology interact, with prior learning leading to current maladjustment and thus triggering illness. The treatment model integrates both behavioral therapy (alleviating maladaptive emotions and behaviors by modifying the behavior itself) and cognitive therapy (alleviating maladaptive emotions and behaviors by modifying the individual’s cognitive appraisal and thought patterns) to achieve treatment goals and attempts to create a continuous, short-course, structured intervention model that focuses on the current problem and requires the active participation of the client, guiding the client to learn to identify, monitor and eliminate false ideas, beliefs, and interpretations related to the target symptom/problem; learn a set of coping skills for the target idea, belief, and M or problem, and reduce maladaptive behaviors or provide new, more adaptive learning experiences by eliminating such learning. The ultimate goal of its treatment is to educate the visitor to become his or her own therapist. After more than half a century of development, cognitive behavioral therapy has developed into a treatment system that incorporates different treatment strategies such as rational emotion therapy, exposure therapy, systematic desensitization, relaxation training, social skills training, and supportive therapy. 1, cognitive-behavioral therapy for depression treatment concept Beck et al. established a cognitive model in which the cognitive structure of individuals is divided into, in order from superficial to deep: automatic thinking (the rapid emergence of ideas in the brain induced by a certain situation); cognitive distortion (including arbitrary inference, selective generalization, overgeneralization, all or nothing, etc.); dysfunctional assumptions (the individual’s attitudes, beliefs or Beck believes that the onset of affective disorders is closely related to the schemas formed by the patient’s early experiences, which exist in the patient’s subconscious mind and are not easily perceived. This leads to the occurrence of adverse emotions and behaviors. Therefore, cognitive-behavioral therapy for depressed patients focuses on the negative cognitive and maladaptive behaviors that lead to depression, corrects cognitive evaluations at different levels, develops rational thinking at the conscious level, and strengthens positive behavioral patterns and applies positive coping strategies to solve problems, forming a positive interaction among the four levels of cognition, behavior, emotion and physiology, so that emotional and behavioral patterns spiral up to the positive and rational level. The treatment aims are ultimately achieved by spiraling upward from the cognitive, behavioral, emotional, and physical levels. Therefore, it is important to create a safe, warm, and supportive therapeutic atmosphere in the early stages of treatment, so that the client can fully trust and accept the therapist. A systematic cognitive-behavioral assessment is essential to clarify the diagnosis and severity of the disorder. Another important element in the early stages of treatment is the initial formation of a case analysis of the client at the cognitive-behavioral level, which is the soul of cognitive-behavioral therapy and provides a reference basis for the formulation of treatment goals and treatment plans and indicates the direction of treatment. It is important to note that the cognitive-behavioral assessment and case analysis will continue to be revised and improved throughout the treatment process. Stage 2: Cognitive-behavioral strategies to promote adaptive change Depression is a complex illness with many different factors, and depression can manifest itself in different forms for different clients, reflecting different inner needs in treatment. Treatment is therefore extremely flexible, depending on the client’s clinical presentation, subjective needs, introspection, motivation, and progress in treatment to determine which techniques to choose and how much effort to expend. The main areas of intervention during this phase of treatment involve the following: (1) Reduction in daily activities: Behavioral activation is the primary key step in the intervention technique, which involves guiding the visitor in self-monitoring daily activities and conducting quantitative assessments of pleasure and accomplishment, developing a step-by-step task activity plan, and activating his or her withdrawal behaviors. These behavioral activation strategies were found to be very effective in alleviating depression and creating opportunities for visitors to identify and modify negative cognitions. (2) Decreased social functioning: Since many visitors have interpersonal problems to deal with, effective interventions through behavioral techniques can help increase the frequency of enjoyable social activities; improve basic social skills and decrease the tendency to social withdrawal when depressed; and increase the experience of interpersonal social support and intimacy. Most social activities can also elicit treatment-relevant cognitive and emotional responses that guide visitors to identify and challenge negative cognitions that affect social functioning. (3) Ineffective coping patterns: Depression is closely related to the individual’s recent stressful life events. The therapist discusses, evaluates, and identifies effective and ineffective coping patterns with the visitor, identifies real-life problems caused by ineffective coping strategies such as couple conflict, and reduces reliance on poor coping styles such as alcohol abuse and gluttony. Based on this, visitors are instructed to learn to accept, express and vent negative emotions in a positive way, and to use negative emotions as a cue to stop poor coping styles, to rethink, plan and review, and to establish positive coping patterns. (4) Lack of problem solving skills: The key to effective coping patterns is to improve realistic problem solving skills. Depressed patients often lack adequate skills and use a rigid model to solve problems, which tends to produce undesirable consequences. Therefore problem solving skills training as an effective means of treating depression requires developing the visitor’s adaptive attitude to face realistic problems and exploring the best way to solve them through pros and cons analysis, cost-benefit analysis, and other methods. (5) Cognitive distortions and maladaptive schemas: An important part of cognitive-behavioral therapy is to identify negative automatic thinking, challenge cognitive distortions, develop new positive thinking patterns, and perform cognitive reconstruction to improve the patient’s self-control over emotional reactions. Techniques to correct cognitive distortions include: Socratic questioning; guided discovery; role-playing; behavioral testing; and cognitive continuum techniques. Stage 3: Relapse Prevention More than half of depressed patients recover within six months, but 75% of these patients relapse within five years. However, evidence supports a reduced relapse rate in patients receiving cognitive-behavioral therapy, along with a reduction in residual symptoms. The main strategies for relapse prevention include psychoeducation for relapse prevention; identifying signs of relapse; reducing adverse stimuli that trigger depression; correcting cognitive distortions of adverse stimuli; learning positive strategies for coping with relapse; exploring the best solutions to real problems; enhancing positive coping strategies; and filling out relapse prevention cards, among other techniques. 3. Challenges in the development of cognitive-behavioral therapy In the past three decades, a lot of clinical practice and empirical studies have been conducted on cognitive-behavioral therapy for depression at home and abroad, and it is found that the efficacy of cognitive-behavioral therapy for mild to moderate visitors is basically equivalent to that of antidepressants, and the relapse rate is lower than that of pharmacotherapy. It has been reported that the efficacy of cognitive-behavioral therapy can be maintained for 8-14 years. Clinical guidelines for the treatment of depression in Western countries now include it as a first-line treatment. A growing body of research evidence suggests that the efficacy of each step in behavioral and cognitive-behavioral treatment is closely related to cognitive change, that maintenance of efficacy and reduction in relapse rates are also related to the level of cognitive evaluation, and that various therapeutic interventions (including pharmacotherapy) can incidentally induce cognitive change. Some studies have reported that the efficacy of treatment modalities using behavioral activation techniques alone is not significantly different from purely cognitive-behavioral treatment techniques. As the understanding of the actual mechanism of action of cognitive-behavioral therapy is still limited, there is a great deal of disagreement among scholars as to what exactly the visitor benefits from the treatment and what the mechanism of change occurs, and further in-depth research is needed. In addition, most of the treatment manuals used in clinical research abroad implement basic fixed treatment strategies and limit the content and methods of session-by-session treatment, which, if transposed to clinical work and strictly adhered to in treatment manuals, would inadvertently ignore the cultural backgrounds, psychological characteristics, and individual differences of clients and may weaken the therapeutic relationship and thus affect the practicality and efficacy of treatment. However, if practitioners are given great flexibility in clinical practice and do not follow certain treatment rules, the treatment received by clients will not be systematic and standardized. How to effectively combine the contributions of clinical research into clinical practice and create a systematic and standardized cognitive-behavioral treatment model for depression still needs further exploration. Cognitive-behavioral therapy with computer-assisted systems has received a lot of attention from foreign scholars in recent years, and there is considerable evidence to support the effectiveness of this model, but the rather high rate of shedding also makes scholars worry whether the visitors can really accept this approach.