Depression Therapy
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Depression Therapy in New Jersey, New York, and Online
Most people don’t come in saying, “I’m depressed.”
They say things like:
“I can’t feel anything anymore.”
“Even things that used to make me happy don’t.”
“I’m just getting through the day.”
“I don’t have the energy for anything.”
It is not always sadness.
Sometimes it is numbness. Disconnection. Going through the motions without really feeling present.
And over time, that can feel heavy and hard to explain.
Depression Is More Common Than You Think. And More Treatable.
Depression is one of the most prevalent mental health conditions in the United States. According to the CDC, more than 1 in 8 Americans ages 12 and older experienced depression in 2021 to 2023. That number has nearly doubled since 2015. In 2021, an estimated 21 million adults had at least one major depressive episode.
Depression is also the leading cause of disability worldwide.
And yet, nearly 4 in 10 people with depression never receive treatment. That gap matters, because depression responds very well to treatment. Research consistently shows that the majority of people who engage in evidence-based therapy experience meaningful improvement. The skills and shifts that happen in treatment do not just reduce current symptoms. They protect against future episodes too.
If you have been struggling and wondering whether things can actually change, the short answer is: yes. Depression is very treatable. You do not have to stay stuck in it.
What Is Depression?
Depression is more than just feeling sad.
It is feeling low, flat, or disconnected for most of the day, nearly every day. Things that used to feel meaningful can start to feel distant or out of reach.
Energy is often affected. Even small tasks can feel like a lot.
Sleep is usually impacted too. Some people have trouble falling or staying asleep. Others sleep more and still feel exhausted.
Depression also affects how you think. Thoughts can become more negative, more self-critical, or more hopeless. It can feel like things will not change, or like you are stuck this way.
Over time, people often start to pull back. Doing less. Seeing fewer people. Stepping away from things that used to matter. That makes sense when energy is low, but it also keeps the cycle going.
Depression can overlap with other challenges. For some people, that includes using alcohol or other substances to cope. It might help in the short term, but it usually makes mood and energy harder to manage over time.
In more severe cases, people may have thoughts about death or suicide.
If that is happening for you, it matters. You do not have to handle that alone. You can call or text 988, the Suicide and Crisis Lifeline, to connect with support right away.
How Depression Can Show Up
Depression looks different for different people. It is not always visible from the outside. Some common signs include:
- Persistent low mood, emptiness, or numbness that does not lift
- Loss of interest or pleasure in activities that used to feel meaningful
- Fatigue and low energy, even after rest
- Changes in sleep, either too much or too little
- Changes in appetite or weight
- Difficulty concentrating, making decisions, or thinking clearly
- Feelings of worthlessness, excessive guilt, or harsh self-criticism
- Pulling back from relationships and social connection
- Moving or speaking more slowly than usual
- Thoughts about death or that things would be better without you
For some people, depression does not look like falling apart. It looks like holding everything together. Staying productive. Keeping things running on the outside while feeling flat, empty, or joyless on the inside. This is sometimes called high-functioning depression, and it is just as real and just as worth treating.
The Inner Critic and Self-Compassion in Depression
One of the most painful parts of depression is what it does to the way you talk to yourself.
Depression almost always comes with a loud inner critic. It says things like:
“You should be doing more.”
“What is wrong with you?”
“Other people handle this fine.”
“You are a burden.”
That voice is convincing because it sounds like the truth. But it is not the truth. It is a symptom.
Depression narrows how we see ourselves. It filters out evidence that contradicts the negative story and amplifies everything that confirms it. The inner critic is not giving you an accurate picture of who you are. It is giving you a depressed picture of who you are.
A significant part of the work we do involves learning to recognize that voice, understand where it comes from, and respond to it differently. Not by arguing with it, not by forcing positive thinking, but by building a more balanced and genuinely self-compassionate relationship with yourself.
Self-compassion is not about letting yourself off the hook. It is about treating yourself with the same basic kindness you would offer someone you care about. Research shows that people with higher self-compassion tend to have lower rates of depression and anxiety, and recover faster when they do experience difficult periods.
Learning to soften the inner critic is not a side project in depression treatment. It is often central to it.
Our Expertise in Depression Treatment
The CBT Center was founded by Dr. Michelle Drapkin, a licensed psychologist with specialized training in Cognitive Behavioral Therapy. Dr. Drapkin and Dr. Andrew Keenan are both board-certified in Cognitive Behavioral Therapy through the American Board of Professional Psychology (ABPP), the oldest and most rigorous board certification body in psychology, founded in 1947. ABPP certification requires credentials review, peer-reviewed practice samples, and a formal oral examination. It is not a certificate course. It is a peer-verified demonstration of advanced clinical competence in the specialty.
Dr. Drapkin and Jamie Schwartz are also Diplomates of the Academy of Cognitive and Behavioral Therapies (A-CBT), the leading certifying organization specifically for cognitive and behavioral therapy.
Dr. Christina Contrastano and Dr. Teri Preddy have both completed comprehensive Dialectical Behavior Therapy (DBT) training. DBT is an evidence-based treatment that builds skills in emotional regulation, distress tolerance, interpersonal effectiveness, and mindfulness, all of which are highly relevant to depression treatment.
Dr. Drapkin and Dr. Contrastano also have specialized expertise in Radically Open Dialectical Behavior Therapy (RO-DBT), an approach specifically designed for overcontrolled presentations, including treatment-resistant depression. RO-DBT is particularly effective for people who are high-functioning on the outside but privately struggling, which you can read more about below.
Dr. Drapkin is a member of the Anxiety and Depression Association of America (ADAA) and will be presenting at the ADAA 2026 Annual Conference in Chicago in a State of the Art Clinical session, a designation reserved for presentations on the leading edge of evidence-based practice.
Depression is one of the most common reasons people come to us, and one of the most treatable conditions we work with. We bring the full depth of our training to it.
Why Cognitive Behavioral Therapy Works for Depression
Cognitive Behavioral Therapy (CBT) is the most studied psychological treatment for depression in the world. The research base is enormous and the results are consistent.
The largest meta-analysis ever conducted on a specific type of psychotherapy examined 409 randomized controlled trials involving 52,702 patients. Published in 2023, it confirmed that CBT produces significant, meaningful reductions in depressive symptoms across a wide range of populations and settings.
What makes CBT particularly valuable is not just that it works now, but that the effects last. A 2022 meta-analysis of 28 randomized controlled trials with nearly 4,000 participants found that CBT significantly reduced the risk of depression returning after treatment ended, with relapse rates of 31.6 percent in the CBT group compared to 41.3 percent in the control group. The skills built in therapy continue to protect against future episodes.
CBT works for depression because it targets the two things that keep depression going: the way you think, and the way you behave. Negative, self-critical thoughts and withdrawal from meaningful activity reinforce each other. CBT addresses both, directly and practically.
When Depression Is About Keeping It All Together: RO-DBT
Not everyone with depression looks depressed.
Some people are highly accomplished, reliable, and appear to have everything under control. They show up. They perform. They keep things running. But inside, there is a growing sense of flatness, disconnection, or quiet exhaustion that they cannot quite explain or shake.
This pattern, sometimes called overcontrol or high-functioning depression, often involves working very hard to mask what is really happening. The effort required to keep everything looking normal is itself exhausting. And somewhere along the way, the things that used to bring genuine joy, connection, or meaning have quietly faded out.
Radically Open Dialectical Behavior Therapy (RO-DBT) was developed specifically for this kind of presentation. Unlike standard DBT, which focuses on building emotional regulation skills for people who feel too much, RO-DBT focuses on openness, flexibility, and reconnecting with genuine emotion and social connection for people who have become too controlled, too closed off, or too focused on doing everything right.
RO-DBT has strong research support for treatment-resistant depression, meaning depression that has not fully responded to other approaches. It works by addressing the deeper patterns underneath the surface, including perfectionism, self-criticism, social signaling, and the tendency to override genuine feelings in favor of appearing capable and composed.
Dr. Drapkin and Dr. Contrastano both have specialized expertise in RO-DBT and work with clients for whom this approach is the best fit.
How We Treat Depression
The first step is understanding the cycle.
Depression pulls you out of your life. Less activity. Less connection. Less engagement. And the less you do, the harder it feels to do anything at all.
So we do not wait for motivation to show up. We help you start building momentum.
That means identifying small, meaningful steps that reconnect you with your life, even before you feel like it. Over time, those steps begin to shift energy, mood, and a sense of possibility.
We pay close attention to how you are talking to yourself. We help you notice the inner critic and respond to it differently, not by forcing positivity, but by building a more balanced and self-compassionate way of relating to yourself.
We integrate evidence-based treatments including Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), Dialectical Behavior Therapy (DBT) skills, and Radically Open Dialectical Behavior Therapy (RO-DBT), always tailored to what makes most sense for you.
What Depression Therapy Looks Like in New Jersey, New York, and Online
Depression therapy at The CBT Center follows a clear structure, but it is never rigid.
We start each session with a check-in: what has been feeling hardest, where your energy is, and what has been most difficult to engage with. At times, we may use brief structured measures like the PHQ-9 (Patient Health Questionnaire) to track progress and stay grounded in what is actually changing.
From there, we focus on getting you moving again in ways that make sense for your life right now.
Behavioral activation is a core part of the work. That means gradually re-engaging with life, even when you do not feel like it yet. We do not wait for motivation. We build it.
We combine cognitive and behavioral work. That might mean noticing patterns in how you are thinking, especially self-critical or hopeless thoughts, while also taking meaningful action in your day-to-day life.
We are not aiming for big, dramatic changes right away. We are building momentum.
We wrap up sessions with a clear plan for what to try between appointments, so the work carries into your real life.
Over time, people often notice:
- A gradual return of energy
- More engagement in daily life
- Less dominance of the inner critic
- Moments of connection or enjoyment starting to come back
- A renewed sense of what matters and what they actually want
Who We Work With
We work with adults experiencing a wide range of depressive presentations. That includes:
- People experiencing a first episode of depression who want help before it gets worse
- Those who have struggled with depression for years and have not yet found an approach that truly helps
- High-functioning people who look fine on the outside but feel empty, flat, or disconnected inside
- People dealing with grief, loss, or major life transitions that have tipped into depression
- Those whose depression is intertwined with anxiety, making it hard to know where one ends and the other begins
- People who have tried medication but want skills-based therapy, either alone or alongside it
- Those with treatment-resistant depression who have not fully responded to previous approaches
- Anyone who has been told to just push through it and knows that is not working
You do not need a formal diagnosis to work with us. If things have been feeling flat, heavy, or harder than they used to, that is enough of a reason to reach out.
When to Consider Depression Therapy
If you’re here reading this, something brought you here.
And at the same time, depression can make even this step feel like a lot.
You might be thinking:
“What’s the point?”
“I don’t have the energy for this.”
“Maybe I should just push through.”
That makes sense. Depression affects energy, motivation, and the ability to take action, even when something might help.
You do not have to feel ready. You do not have to have the energy for everything.
You just need a place to begin.
Get Started
We serve clients in New Jersey, New York, and across 40 or more states through PSYPACT, a national compact that allows licensed psychologists to practice across state lines. Wherever you are, we can likely work together.
We’ll follow up within a few hours to connect, learn a bit more about what you’re looking for, and help you figure out next steps.
Related Services
Cognitive Behavioral Therapy (CBT)
CBT is the most researched, most effective talk therapy available. We don't just use CBT — we're board-certified in it. This is what we do, and we're really good at it.
Individual Therapy
One clinician, focused entirely on you. Full-hour sessions, real follow-through between appointments, and a team that actually picks up the phone.
Virtual Therapy
Great care shouldn't depend on where you live. We're licensed in NJ, NY, and 40+ states — so wherever you are, we can likely work together.
Anxiety Therapy
Anxiety is exhausting — the racing thoughts, the avoidance, the "what ifs." CBT gives you real tools to break the cycle and get your life back.
OCD Therapy
You don’t have to stay stuck in the pattern. With the right support and strategies, it’s possible to regain control, build resilience, and move toward a calmer, more balanced mind.
Trauma and PTSD Therapy
What happened to you matters — and so does what comes next. We use evidence-based approaches to help you process the past and move forward.
Frequently Asked Questions
They can work very well together. Medication can help take the edge off symptoms like low mood, low energy, or sleep difficulties, making it easier to engage in therapy. Cognitive Behavioral Therapy (CBT) focuses on changing patterns in thinking and behavior, building skills that continue to protect you long after medication ends. For some people, therapy alone is enough. For others, a combination is most effective. We are happy to coordinate with your prescribing provider.
That is part of depression. We do not expect motivation at the start. In fact, waiting for motivation is one of the things that keeps depression going. We begin with very small steps, and motivation tends to follow action, not the other way around. We will meet you exactly where you are.
That is worth talking about. Not all therapy is the same, and not all therapists are trained in evidence-based approaches for depression. We use specific, structured treatments with a strong research base. If something has not worked before, we want to understand why and figure out what might be different this time. For people with treatment-resistant depression, RO-DBT may be a particularly good fit.
There is a lot of overlap. Burnout and depression can look very similar and often co-occur. Part of the work is figuring out what is driving what, and tailoring the approach accordingly. Both are real and both respond well to treatment.
It depends on the severity and how long it has been going on. Some people notice meaningful shifts within 8 to 12 sessions. For others, especially those dealing with longer-standing or more complex depression, it takes more time. We check in regularly and adjust as we go, so you always have a clear sense of where things stand.
Fatigue is one of the most common and disruptive symptoms of depression. It is not laziness and it is not a character flaw. We start where you are and build gradually. Even small increases in activity tend to improve energy over time, which is one of the reasons behavioral activation is a core part of how we treat depression.
High-functioning depression describes something very real: still managing work, relationships, and daily responsibilities, but privately feeling flat, empty, disconnected, or joyless. Because things look fine on the outside, it often goes untreated for a long time. It is absolutely worth addressing, and it responds very well to treatment, including RO-DBT for people who have been working hard to mask what is really happening.
The inner critic is one of the hallmarks of depression. It is not a personality flaw or a sign that you are weak. It is a symptom of how depression distorts the way we see ourselves. A significant part of the work we do involves learning to recognize that voice, understand it, and respond to it with more self-compassion. That shift alone can change a great deal.
It can, but therapy significantly reduces that risk. Research shows that people who complete CBT for depression are meaningfully less likely to have a future episode than those who only used medication. The skills you build in therapy become tools you carry with you, and they keep working long after treatment ends.
Please know that you are not alone and that support is available right now. You can call or text 988 to reach the Suicide and Crisis Lifeline at any time. If you are in immediate danger, please call 911 or go to your nearest emergency room. When you reach out to us, we will ask directly about safety and make sure you have the right level of support.
Depression treatment is available virtually throughout NJ, NY and 40+ states.