Cognitive Behavioural Therapy (CBT) for Managing Depression in Young Adults: A Nursing Perspective

Depression remains one of the most pressing mental health challenges faced by young adults globally (Watson et al, 2023). World Health Organization’s (2023) research indicates that depression among young adults has significant consequences for their academic performance, social relationships, and overall quality of life.

Recent epidemiological studies indicate that nearly 20% of individuals aged 18–25 experience at least one major depressive episode, with many facing recurrent or chronic symptoms (Kessler et al., 2023). This demographic is particularly vulnerable to mental health crisis due to transitional life stages, academic pressures, and social media influences, which exacerbate emotional distress (Twenge et al., 2018).

In response, Cognitive Behavioural Therapy (CBT) has emerged as a gold-standard psychological intervention (Sutton, 2022). Endorsed by the National Institute for Health and Care Excellence (NICE, 2022b), CBT is known for its efficacy in modifying maladaptive thought patterns and behaviours. From a nursing perspective, CBT aligns with the core principles of patient-centred care, empowerment, and holistic health promotion, among other principles that make it a critical tool in contemporary mental health practice (Rees & Whitehead, 2023). 

To ensure a comprehensive review of literature relating to Cognitive Behavioural Therapy (CBT) for managing depression in young adults, a preliminary search was undertaken via the Sheffield Hallam University (SHU) library gateway. with a focus on subject guides relevant to Mental Health Nursing, as well as access to journals and databases. The author also conducted a systematic search using the SPIDER framework (Sample, Phenomenon of Interest, Design, Evaluation, Research Type), tailored for qualitative and mixed-methods research (Methley et al, 2014). The following databases were selected for their disciplinary relevance:

PubMed: Indexes high-impact medical and nursing literature, including MEDLINE. It also grants scholars access to clinical trials and RCTs (National Library of Medicine, 2023). 

PsycINFO: Covers psychological interventions like CBT with depth, including grey literature and dissertations (APA, 2022).

CINAHL: Focuses on nursing and allied health, providing practice guidelines and patient engagement strategies (Rees & Whitehead, 2023).

The search strategy started with the keyword teen. The author applied truncation (teen*) to capture variations such as “teens” and “teenagers.” Other related terms included in the search are “adolescents,” “youth,” “young adults,” and “high school students.” Quotation marks were used to indicate compound phrases.

The second key concept “depression” was expanded to include related terms such as “anxiety,” “stress,” “distress,” “mental health,” and “mental illness.”

The third key concept focused on causation. For example, the author used truncated form “caus” as (caus*) to retrieve variations like “causes” and “caused.” Other relevant terms used in the search included “factors,” “determinants,” “contributing factors.” and “determining factors.”

To demonstrate effective database search strategies that allow identification of relevant literature, the author conducted a focused search on the topic The Population, Exposure, and Outcome (PEO) framework guided development of the search terms in combination with Boolean operators (AND / OR) to enhance comprehensiveness and accuracy of search results. Search terms combining Boolean operators and truncation was structured as follows: 

Population: “Young adult” OR “adolescent” OR “18–25”

Intervention: “Cognitive Behavioural Therapy” OR “CBT”

Outcome: “Depress” AND “effectiveness” OR “recovery”

Methodology: “Data collection” OR “self-report” OR “clinical interview”

Initial searches yielded 12,530 results (2015–2025) but filters for peer-reviewed, English-language articles and participant age (18–25) narrowed this figure to 1,842. Manual screening excluded reviews and non-CBT interventions, leaving 28 studies. Fitzpatrick et al (2017) and Weersing et al (2020) were selected for this study due to their methodological contrast (digital vs. clinician-administered) and nursing applicability.

Research design means the plan, structure, and strategy applied to study a phenomenon and obtain answers to research questions or problems. Research design is generally separated into quantitative and qualitative (Zimmerman, 2024). This research critically examines the techniques and procedures used in the context of the qualitative primary research conducted by Fitzpatrick et al (2017) and Weersing et al (2020), with a focus on participant recruitment and/or sampling methods.

Sampling in research involves identifying and selecting a specific group of individuals from a target population. On the other hand, recruitment means enrolling individuals who meet predefined inclusion criteria to take part in a study. Techniques used in both Sampling and recruitment vary, depending on the objectives of the research (Stanyte et al, 2023).

The methods described (sampling and recruitment) provide significant advantages, particularly in their capacity to engage underrepresented and hard-to-reach populations that are often overlooked by traditional research approaches (Arrow et al, 2023). The resource efficiency of both methods as evident in considerable reductions of both time and cost makes them particularly suitable for research projects with limited budgets. Yet, the dependence on indirect recruitment methods can create sampling biases, which alter the representativeness of a population demographic in a study. Regardless of these setbacks, both methods serve as practical and adaptable solutions for conducting scholarly inquiries in challenging environments.

The rising prevalence of depression among young adults has prompted urgent calls for scalable, evidence-based interventions. Traditional treatment models often face barriers such as stigma, cost, and limited access to mental health professionals (Andrade et al, 2023). CBT addresses these challenges through its structured, skills-based approach, which can be adapted to diverse delivery formats, including individual therapy, group sessions, and digital platforms (Cuijpers et al, 2023). Meta-analyses confirm that CBT achieves moderate to large effect sizes in reducing depressive symptoms (Hedges’ *g* = 0.72) compared to waitlist controls, with sustained benefits at 6- to 12-month follow-ups (Hofmann et al., 2023). For nurses, these findings underscore the importance of integrating CBT into stepped-care models, where low-intensity interventions (e.g., digital CBT) are offered first and supported by high-intensity therapies for complex cases (NICE, 2022b). 

To evaluate CBT’s real-world applicability, this analysis focuses on two landmark studies employing contrasting methodologies: Fitzpatrick et al.’s (2017) trial of Woebot (an automated conversational agent), and Weersing et al.’s (2020) multisite RCT of clinician-delivered CBT. Fitzpatrick et al. (2017) recruited 70 young adults (18–28 years) via social media and randomised them to Woebot or an information-only control group. The scholars assessed outcomes using the PHQ-9 and GAD-7 which are validated self-report tools with strong psychometric properties (Kliem et al, 2024). Results showed a statistically significant reduction in depression scores (*p* < 0.01) post-intervention, with effect sizes comparable to face-to-face CBT (*d* = 0.53). The study’s strengths lie in its scalability and accessibility—key priorities for nurses working in under-resourced settings (Villarreal-Zegarra et al., 2024). However, limitations include self-report bias (Stone et al., 2015) and the absence of clinician input, which may overlook nuanced clinical presentations (Zimmerman, 2024).

Conversely, Weersing et al. (2020) evaluated manualised CBT in 77 adolescents (12–21 years) using a multimodal assessment strategy: semi-structured clinical interviews such as Kiddie-SADS), clinician-rated scales (e.g., Children’s Depression Rating Scale), and parent-reported outcomes. This approach yielded high internal validity (Cronbach’s α > 0.85) and demonstrated CBT’s superiority over treatment-as-usual (TAU) at post-treatment (*d* = 0.67) and 6-month follow-up (*d* = 0.59). The inclusion of longitudinal data and multi-informant perspectives aligns with nursing’s biopsychosocial model which, according to the American Psychiatric Nurses Association (APNA, 2023) emphasises comprehensive assessment and family involvement. Yet, the study’s resource demands—that is, requiring trained therapists and repeated in-person visits—highlight implementation barriers in overburdened healthcare systems (Okpara et al., 2023).

The methodological divergence between these studies by Fitzpatrick et al (2017) and Weersing et al (2020) reflects broader debates in mental health research. Digital CBT tools like Woebot offer unparalleled reach, particularly for digital native young adults who prefer mobile health interventions (Lattie et al., 2019). Recent innovations, such as AI-driven chatbots with natural language processing (NLP) now achieve 80% adherence rates in CBT homework completion (Schleider et al, 2024). This achievement surpasses traditional methods (Graham et al., 2020). For nurses, these tools expand capacity for early intervention and population-level mental health promotion (Alhaiti, 2025). However, critics like Norcross and Lambert (2023) argue that digital platforms lack therapeutic alliance (which is a key predictor of CBT success) and may fail to detect crises (e.g., suicidality) without human oversight as noted by Luxton et al. (2023). Therefore, hybrid models—where nurses monitor digital progress and provide adjunctive support—are increasingly advocated to balance efficiency and safety (Chen et al, 2024).

Ethical considerations are paramount in CBT delivery, particularly for vulnerable youth. Both studies— Fitzpatrick et al (2017) and Weersing et al (2020)—adhered to Declaration of Helsinki principles, including informed consent (electronic for Woebot; written for Weersing et al.) and GDPR-compliant data protection (Garcia-Iglesias et al., 2024). Yet, digital interventions introduce unique dilemmas (Alhaiti, 2025). For instance, algorithmic bias can marginalise minority groups like racial/ethnic communities and LGBTQ+ youth if training datasets lack diversity (González et al, 2024). Data security breaches in mental health apps also remain a persistent risk (Yourell et al., 2025). Notably, nursing codes of ethics (e.g., NMC, 2018) emphasize mandatory vigilance in addressing these issues thereby ensuring equitable access and safeguarding confidentiality.

The translation of CBT research into nursing practice requires attention to contextual factors (Beauchamp & Childress, 2019). Nurses in primary care often deliver brief CBT interventions (e.g., 20-minute sessions) as part of collaborative care models, thus, achieving 50% remission rates in mild-to-moderate depression (Archer et al., 2023). School nurses also leverage CBT techniques to address academic stress, using behavioural activation to improve attendance and engagement (Walter et al., 2023). However, challenges that include inadequate CBT training and organisational barriers (e.g., lack of supervised practice time) still persist. According to data from the Royal College of Nursing (RCN, 2023), only 30% of UK nurses report confidence in core competencies like cognitive restructuring. Policy initiatives, such as Health Education England’s (2023) £10 million CBT training fund for nurses, aim to bridge these gaps (Brown & Mitchell, 2023).

Future directions in CBT emphasise personalisation and technology integration (Chen et al, 2024). Predictive analytics using machine learning can now identify youth who are most likely to benefit from CBT (with an accuracy rate of 78%; according to Dwyer et al., 2024). Virtual Reality (VR) CBT modules show promise for treatment-resistant cases (Freeman et al., 2023). Therefore, the roles of nurses will evolve to include “digital triage,” which Ball and Michalowski (2024) noted will guide patients to appropriate interventions based on severity and preference.

In conclusion, CBT remains a cornerstone of depression management for young adults (Cummings & O’Donohue, 2023). Research indicates there is robust evidence supporting CBT’s efficacy across delivery formats (Fergusson et al, 2022). From frontline delivery to ethical oversight of digital tools, nurses play a pivotal role in optimising the reach and impact of CBT. As the mental health nursing field advances, priorities include (a) addressing workforce training gaps (b) advocating for equitable access, and (c) fostering interdisciplinary collaboration to meet the complex needs of this vulnerable population—depressed young adults (Khan & Lewis, 2024). By embracing innovation while upholding humanistic values in nursing practice, mental health practitioners can ensure CBT continues to transform lives in an increasingly digital age.

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Appendix: Summary of Included Studies

Study	Design	Sample/Population	Data Collection Methods	Strengths	Limitations
Fitzpatrick et al. (2017)	RCT	70 young adults (18–28) with depression/anxiety	Online self-report: PHQ-9, GAD-7	Efficient, scalable, validated tools	Self-report bias, no clinical verification, short duration
Weersing et al. (2020)	RCT (Multisite)	77 adolescents (12–21) with clinical depression	Semi-structured interviews, clinician/parent ratings	Clinical validation, long-term follow-up	Resource-intensive, risk of attrition

Source: The Author (2025)