CBT week 6: staying well

This is the last week of our six-week, self-guided course in cognitive behavioral therapy (CBT). You have learned to catch thoughts, test them, try behavior experiments and look at deeper beliefs.

This week is about keeping what you have learned. Most people have hard days again, even after real progress. A plan made now, while you feel steadier, helps you act early and get back on track faster.

Why this step matters

Practice between sessions is a key part of why CBT works. When a course ends, the advice is to keep using the skills you learned.² Like any habit, the more you use them, the more automatic they become.¹

Depression and anxiety can come back, especially in times of stress. The risk is higher for people who have had two or more episodes, or whose recovery is still shaky.⁴ This is not a sign that CBT failed. It is a reason to have a plan ready.

Setbacks: a lapse is not a relapse

Researchers who study relapse describe it as a process that unfolds over time, not one moment of failure. A first slip, called a lapse, raises the risk of a full relapse. But the slide from one to the other is not automatic.³

Much depends on how you read the slip. People who blame a setback on a fixed flaw, such as "I have no willpower," are more likely to give up. People who see it as a problem with one hard situation are more likely to learn and cope better next time.³ This idea came from research on drinking, but the lesson fits low mood and worry, too.

So when a bad day or week comes, watch for thoughts like "I'm back to square one." Thinking this way tends to make mood worse.¹ Treat it as a thought to test, just as you did in week 3. Most people have down days. A setback can show you what to watch for next time.¹ For example, "All that work was for nothing" might become "This week was hard because of the hospital visit. I still know the skills."

Know your warning signs

Early warning signs are the first small changes before you feel very low or anxious. They differ for each person. Think back to your last hard time. What changed first?

Common signs of depression include:⁶

• Sleeping much more or much less, or waking very early
• Losing interest in hobbies or people
• Feeling tired, slowed down or restless
• Pulling away from family and friends
• Drinking more, or neglecting tasks

Older adults may feel numb or "flat" rather than sad.⁶ Your own signs may be smaller, like letting mail pile up. Write those down.

Make your staying-well plan

1. List what helped. Look back over weeks 1 to 5. Write the two or three skills that made the biggest difference, such as a thought record, a behavior experiment or planning pleasant activities.
2. Name your warning signs. Write three to five early signs that you are slipping. Ask someone close to you what they notice first.
3. Name your high-risk times. Think of situations that tend to set you off. Strong negative feelings and conflict with others are common triggers.³ Others might be anniversaries, illness, holidays or caregiving strain.
4. Plan your response. For each warning sign or trigger, write one or two things you will do. Keep them small and clear, such as "Call my sister" or "Do a thought record that evening."³
5. Build a "healthy me" routine. Write one action for each area of life: balanced thinking, social support, social activities, pleasant activities, exercise, self-care, relaxation and goals.¹
6. Choose your support people. Name someone you trust to talk with. Talking things over often makes problems feel more manageable.¹
7. Write when to get help. Decide ahead of time what tells you to call your doctor or a therapist. Add the 988 Lifeline for a crisis.⁵
8. Keep it handy and update it. Put the plan on the fridge, in a notebook or on your phone. Review it and change your goals as your life changes.¹

Our calm plan tool can hold your coping steps and support people. If you have ever had thoughts of suicide, also make a safety plan.

Here is a short made-up example of one part of a plan:

Booster practice

Booster practice means using your skills on purpose, on a schedule, even when life is going well. For some therapies, the American Psychological Association notes that booster sessions with a therapist can help keep skills strong and may help prevent future episodes.⁷ You can also give yourself short boosters at home:

• Every week: spend 10 minutes on one skill. Do one thought record, or plan one pleasant activity.
• Every month: reread your staying-well plan. Rate your mood, and ask if any warning signs have shown up.
• After a big change or a slip: go back to the lesson that helped most. You do not need to start the whole course again.

Notes for later life

Later life often brings changes that can trigger low mood: retirement, health problems, moving or the loss of someone close. Plan ahead for the ones you can see coming.

Group CBT is a recommended treatment for depression in older adults.⁷ A class or group can also be a good place to keep practicing after this course. If memory is a concern, keep the plan short, in large print and in one place. A family member or friend can help with monthly reviews. See depression in later life.

Common problems

I had a bad week and feel like I failed the course.

A hard week is a lapse, not proof of failure. Ask what made this week hard, then pick one step from your plan. Most people have setbacks, and you can learn from them.^1,3

I stopped practicing once I felt better.

This is very common. Start again with just one skill, 10 minutes a week. Regular practice is what turns skills into habits.¹

Can I stop my medicine now that I feel better?

Do not stop or change a medicine on your own. A guideline from the VA and Defense Department advises staying on an antidepressant for at least six months after you feel well, to lower the chance depression comes back.⁴ Talk with your doctor or pharmacist before changing anything.

You finished the course

Well done for working through all six weeks. You can revisit any lesson, starting with week 1, or return to the CBT course overview. If sleep is still a problem, try our CBT for insomnia lessons. If low energy keeps you stuck, see behavioral activation.

When to get more help

Self-guided CBT has limits. Talk to a doctor or therapist if your warning signs last two weeks or more despite your plan, if daily life is getting harder, or if you have had depression two or more times.

For people at high risk of depression coming back, the VA and Defense Department guideline suggests a course of CBT, interpersonal therapy or mindfulness-based cognitive therapy (MBCT) after recovery.⁴ In a pooled study of nine trials with about 1,250 people, those who took MBCT had about a 31% lower risk of relapse over 60 weeks than those who did not.⁸ Strong evidence If problems remain after a course of CBT, a doctor may suggest more sessions or a different treatment.²

See how to find a therapist, paying for therapy and treatment for depression.

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.