Socratic questioning: One technique therapists use that really helps depressed patients

Some depressed patients may be hoping for answers from their therapists, but a new study suggests questions may be the key.

Researchers examined how cognitive therapy for depression achieves its positive effects. Their study is the first to show that depressed patients see substantial improvements in their depressive symptoms when their therapists use a technique called “Socratic questioning.”

These are a series of guided questions in which the therapist asks a patient to consider new perspectives on themselves and their place in the world.

“People with depression can get stuck in a negative way of thinking,” said Justin Braun, co-author of the study and a doctoral student in psychology at The Ohio State University.

“Socratic questioning helps patients examine the validity of their negative thoughts and gain a broader, more realistic perspective.”

Cognitive therapy is an evidence-based treatment that helps patients to reduce their depression and protects against future depressive episodes.

Many other studies have focused on how the relationship between the patient and the therapist may foster a positive therapeutic response, said study co-author Daniel Strunk, associate professor of psychology at Ohio State.

“We found that Socratic questioning was predictive of symptom improvements above and beyond the therapeutic relationship — the variable that has been most examined in previous studies,” Strunk said.

The study appeared in a recent issue of the journal Behaviour Research and Therapy.

The study involved 55 patients who participated in a 16-week course of cognitive therapy for depression at the Ohio State Depression Treatment and Research Clinic.

The patients completed a questionnaire at the beginning of each session that measured their depressive symptoms.

Researchers analyzed video recordings of the first three sessions for each of the patients and estimated how often the therapist used Socratic questioning techniques.

Sessions in which therapists used more Socratic questioning tended to be followed by greater improvements in patients’ depressive symptoms.

“Patients are learning this process of asking themselves questions and being skeptical of their own negative thoughts,” Braun said. “When they do, they tend to see a substantial reduction in their depressive symptoms.”

For example, a patient may tell his therapist that he is a total failure and life isn’t worth living because his marriage ended in divorce.

A therapist may ask a series of Socratic questions to challenge that belief: Is everyone who experienced divorce a failure? Can you think of anyone for whom that is not true? How does being divorced seem to translate into being a failure as person for you? What evidence is there that you have succeeded, and thus not been a “total failure?”

The goal is to help patients learn to use the same type of questions on themselves, Strunk said.

“We think that one of the reasons that cognitive therapy has such enduring positive effects is that patients learn to question their negative thoughts, and continue doing so even after the treatment ends,” he said.

“They find out that they may be overlooking information that is contrary to their negative thoughts. They often aren’t looking at the whole situation, positive and negative.”

The researchers are continuing their research with new patients at the Depression Treatment and Research Clinic. One of the aims of the new studies will be to characterize for which patients the use of Socratic questioning may be most effective.