Depression and CBT

Depression in DSM5

depressed mood, loss of interest, non dieting weight loss, insomnia, psychomotor agitation, fatigue, worthlessness, diminished cognitive function, thoughts of death

WHO Depression Statistic

5% among adults, one of the most common MH issues

Butch & Liston (2020) Depression definition

heterogenous and etiologically complex psychiatric syndrome, encompassing a broad spectrum of psychopathology from distinct pathopsychological mechanisms, with emotional physical and cognitive manifestations

Neurotorium (educational site) depression manifestation

Emotional - sadness, irritability, suicidal ideation

Cognitive - low attention, judgement, memory

Physical - fatigue, headaches, sexual dysfunction

Remes et al., (2021) Review Aetiology of Depression

Biological - physical health, genetic, inflammation, microbiome

Psychological - low self esteem, rumination, coping styles

Social Determinants - poverty, ACE, gender, social support

Other - air pollution, low light levels, night time working

Cognitive Behavioural Theory (Beck, 1979)

individual’s perception of a situation is more based on their reaction than the situation itself. works to change these inaccurate delusions and distorted perceptions, evaluating how realistic they are

CBT Facts (Llewelyn and Murphy)

Most prominent model in psychology, clear evidence base, short term treatment, assuming distress is due to incorrect encoding of autobiographical memory

Cujipers et al (2021) Meta-analysis on CBT for depression

Medium-to-large effects for a wide range of ages and participants, better than control (waiting list/care as usual) and significantly but only moderately better than other interventions (until sensitivity analysis)

seemed mostly better than other interventions in the long term (6+ months) but not significantly better in the short term. Superiority of CBT unclear

Johnson and Friborg (2015) meta-analysis on CBT

Studies from 1977-2014, concluded CBT was providing less relief compared to the older trials, less useful over time

Cristea et al (2017) meta-analysis

Challenged Johnson, redid same acceptance criteria but with 30 more studies and only using randomised control trials, found that year of publication was not a reliable moderator for depression

Beck’s 1967 Cognitive Model

Early life experiences leads to core beliefs leads to conditional assumptions leads to trigger leads to a hot cross bun self-sustaining cycle of negative automatic thoughts, physiological respones, emotions and behaviours

Etiology of CBT

Pathology due to faulty information processing resulting in distorted and dysfunctional cognitions. Disorder characterised by different but predictable patterns of information processing distortions.

CBT Intervention

Build an assessment and formulation with collaborative goals, understand patterns of thinking with a thought diary, try activity scheduling to tackle behavioural manifestations, identifying difficult thoughts and building self compassion, and tackling physical issues like insomnia, then evaluating and finding next steps

Types of challenging thoughts

Black and white thinking (this or that), mind reading (all think like me), blaming self, emotional reasoning (feelings as evidence), catastrophising (worst possible outcome), all or nothing thinking

Criticisms of CBT

Locates problem in the individual rather than wider society, based on white middle class mindset, lack of focus on physical symptoms, assumes all negative thoughts are maladaptive and not potentially justifiable