Depression (ALL)

Cognitive treatment of Depression

What does CBT stand for + what are the types?

Cognitive-Behavioural Therapy → CT + REBT = types of CBT

Cognitive treatment of Depression

What does REBT stand for?

Rational Emotive Behavioural therapy

Cognitive treatment of Depression

REBT adds D and E to the ABC model. What does D and E stand for?

D= dispute

E = effect

Cognitive treatment of Depression

What is the aim of CT?

Identify + challenge automatic thoughts about world/future/self (the negative Triad)

Cognitive treatment of Depression

What are the cognitive + behavioural elements of CBT?

Cognitive elements:

• Assessment of clients cognition

• Identification of goals

• Irrational thoughts challenged

Behavioural elements:

• Working to change negative thoughts

• Put positive behaviours in place

Cognitive treatment of Depression

What are the 5 stages/steps of CT

1. identifies thoughts

2. challenge AT

3. help test the reality of AT

4. set HW (eg: record enjoyment)

5. future sessions prove you did HW

Cognitive treatment of Depression

How do therapists challenge irrational beliefs in REBT?

Vigorous arguments

Cognitive treatment of Depression

(REBT) Give two examples of vigorous argument and briefly explain them:

1. empirical (is there evidence to support negative beliefs?)

2. Logical (does the negative thought logically follow fact?)

Cognitive treatment of Depression

What is behavioural activation?

• when depression is worse, avoidance of difficult situations and isolation increases

• BA decreases avoidance/isolation by increasing engagement in activities that increase mood (eg: exercise)

Cognitive treatment of Depression

What is REBT based off of?

ABC model

Cognitive treatment of Depression

What is CBT based on?

Negative Triad

Cognitive treatment of Depression

Evaluation: Supporting research CBT

March et al (2007) longitudinal study of depressed adolescents CBT vs anti-depressants vs combination → symptom improvement: CBT = 81%, antidepressant = 81%, combination = 86% → Effective over relatively short time period, as effective as drugs, made drug therapy more effective → strength bcs shows potential to improve quality of life

Cognitive treatment of Depression

What is a limitation of March et al (2007)?

• Only uses adolescents

• brain is more plastic when younger than older → easier to learn things than when older

• so older people would probably find it harder to change their automatic thoughts → harder to generalise to general population

Cognitive treatment of Depression

Evaluation: less effective for neurodiverse people

Sturmey (2005) suggests 'talk therapy' (eg: CBT) = less effective for neurodiverse individuals → suggests that CBT may only be appropriate for certain individuals, limitation of nomothetic approach (universal laws don’t apply to everyone)

Cognitive treatment of Depression

Evaluation: less effective for neurodiverse people CONTRADICTION

Taylor (2008) the WAY CBT’s used that matters most when treating neurodiverse patients

contradicting evidence impacts reliability, so makes it hard to draw conclusions about effectiveness of CBT

Cognitive treatment of Depression

Evaluation: limitation → lack of motivation

Not all clients will want to deal w/ depression by tackling negative thoughts head on → can be traumatic SO might prefer medication → Yrondi (2015)’s survey of depressed people found CBT was least preferred psychological therapy → Have to be motivated/believe/committed in it - if not its less likely to work

Cognitive treatment of Depression

Evaluation: Supporting research REBT

Ellis (1957) - 90% success rate w/ average of 27 sessions to complete treatment

Cognitive treatment of Depression

Evaluation: alternative treatments (anti-depressants)

Drug therapies require less client effort (Ellis (1957) required 27 sessions of REBT, which is a lot of commitment) → can be used in conjunction w/ CT → may be useful bcs a distressed client may be unable to focus on the demands of CBT, but drug treatment could enable them to cope better → suggests using both CBT and drugs might be best option

Cognitive explanation of Depression

What are two models for explaining depression?

• Ellis’ ABC model (1962)

• Beck’s negative triad (1967)

Cognitive explanation of Depression - Beck’s negative triad

What are the two parts of Beck's cognitive explanation of depression

• negative schemas

• cognitive triad

Cognitive explanation of Depression - Beck’s negative triad

What does Beck argue depression is rooted in?

a patient's automatic thoughts - personalised thoughts that are triggered by a stimuli and lead to emotional responses

Cognitive explanation of Depression - Beck’s negative triad

what is the cognitive triad?

consists of three types of automatic thoughts rooted in a patient’s automatic thoughts:

• negative views of the world - ‘there is no good in the world’

• negative views of the future - ‘I will always be on my own’

• negative views of the self - ‘I am undesirable’

Cognitive explanation of Depression - Beck’s negative triad

what are the three types of negative schema?

• ineptness schema - everything I do is a failure

• self-blame schema - blaming yourself for things out of your control

• negative self-evaluation schema - consistently evaluating yourself as performing poorly

Cognitive explanation of Depression - Beck’s negative triad

what is overgeneralisation?

• when someone draws broad conclusions based on a single event and apply it to other areas of life

• Eg: you disappointed a teacher by not following through on something you promised to do, you then believe that you are a failure in all of your relationships

Cognitive explanation of Depression - Beck’s negative triad

Why does Beck think that negative schemas develop?

What do they lead to?

• family problems, social rejection by peers, poor school experiences, having depressed members of family or close circle

• lead to errors in logic which is another term for irrational thoughts or cognitive biases

Cognitive explanation of Depression - Beck’s negative triad

what is selective abstraction?

• drawing a conclusion about themselves based on a single incident, only looking at the negative moments and ignoring the positives

• Eg: everyone thinks you were amazing in the school play, however, one person says 'I think you were better in last year's play' and then you believe you are a failure in this year's performance

Cognitive explanation of Depression - Ellis's ABC model

what is Ellis's ABC model?

a - activating event - something that happens in life which could activate a disorder

b - belief - can be rational or (in the case of depression) irrational - musturbatory thinking

c - consequence - irrational beliefs lead to unhealthy behaviours and subsequent disorder

Cognitive explanation of Depression - Ellis's ABC model

What is musturbatory thinking?

• the source of irrational beliefs

• individuals believe that things MUST be a certain way

• eg: must be accepted in order to be happy

Cognitive explanation of Depression - Ellis's ABC model

Musturbatory Thinking - What are the three most important irrational beliefs according to Ellis?

• I MUST be approved of/accepted by people I find important

• I MUST do well/very well, or I’m worthless

• the world MUST give me happiness

Cognitive explanation of Depression - Ellis's ABC model

Musturbatory Thinking - What must happen to the ‘musts’ according to Ellis?

They must be challenge in order to be mentally healthy

Cognitive treatment of Depression - Ellis's ABC model

evaluation of ABC model:

• blames the patient - gives patient power but can lead them to ignore situational factors

• alternative explanation - genetics, ABC ignores any genetic factors

evaluation of Beck's explanation:

• practical application - identifies risk factors

• alternative explanation - ABC model, genetic vulnerability

• practical application - created CBT which treats depression and has 2,000 studies to support it

What are the Positive evaluation points of the explanations?

• supporting research for irrational thinking’s link to depression

• Practical applications

What are the Negative evaluation points of the explanations?

• Blames the client

• Irrational beliefs may be realistic

• ALT explanations

Cognitive explanation of Depression

Evaluation: supporting research that depression is linked to irrational thinking

Bates et al (1999) found depressed Ps given negative automatic-thought statements became increasingly depressed → supports view that negative thinking → depression, BUT correlation doesn’t mean causation → negative thinking may develop bcs of their depression (bidirectional ambiguity)

Cognitive explanation of Depression

Evaluation: suggests the client is responsible for their disorder

placing emphasis on client = good thing bcs gives them power to change the way things are BUT may lead client/therapist to overlook contribution of situational factors, (eg: life events/family problems) → strength of cognitive approach = focus on client's mind and recovery, BUT aspects of the client's environment and life may also need to be considered

Cognitive explanation of Depression

Evaluation: practical application (CBT)

Both ABC + negative tried applied in CBT → consistently found as best treatment, esp when used w/ drug treatments (e.g. Cuijpers et al (2013), March et al (2007)) → usefulness = strength of cognitive approach bcs improves quality of life, ability to work, improves economy

Cognitive explanation of Depression

Evaluation: not all irrational beliefs are irrational

Alloy and Abramson (1979) depressed people gave more accurate estimates of likelihood of a disaster than controls (‘sadder but wiser effect’) → the doubts about whether irrational thinking really is irrational raise questions about value of cognitive approach

Cognitive explanation of Depression

Evaluation: alternative explanation

Zhang et al (2005) - low levels serotonin + a related gene = 10x more common in depressed people → success of drug therapies suggests neurotransmitters play important role → diathesis-stress approach maybe better → genetic vulnerability for depression + environmental stressor → negative irrational thinking → suggest that depression can't be explained by cognitive approach alone

What key words are to do with Beck?

• Negative schemas

• Negative triad

• overgeneralisation

• selective abstraction

What key words are to with Ellis?

• ABC model

• Musturbatory thinking

What is depression?

• A mood disorder when an individual feels sad and/or lacks interest in their usual activities.

• Further characteristics include irrational negative thoughts, raised or lowered activity levels, and difficulty w/ concentration, sleep, and eating

what are the emotional characteristics of depression?

• sadness

• worthlessness

• angry outbursts

• loss of pleasure in usual hobbies

what are the cognitive characteristics of depression?

• irrational thoughts

• negative thoughts

• faulty thinking

what are the behavioural characteristics of depression?

• shift in activity levels

• sleeping disturbances (eg: hypersomnia/insomnia)