Clinical - Treating depression with CBT

Who did the research into CBT for depression?

Beck

How is CBT for depression carried out?

Around 20 sessions over 16 weeks (sessions around 50 mins). It is an active and directive treatment (patient involved)

What does CBT aim to do?

Aims to make the irrational thoughts rational by challenging their thought processes. It directly challenges the negative thoughts (thought distortions)

What are the thought distortions to know?

- Magnification

- Overgeneralisation

- All or nothing thinking

(definitions in cognitive explanation of depression quizlet)

What does CBT for depression focus on?

It focuses on the present rather than the past

What are the four stages of CBT for depression?

1. Therapist listens to pt discuss experiences so they understand person

2. Therapist helps person identify what they would like to gain and create manageable targets

3. The targets are reviewed each week to encourage progress

4. They then begin focusing on pts automatic negative thoughts

5. Therapist will challenge these thoughts and try to identify things that trigger them

6. These skills can then be tested in real life situations

How does the therapist identify automatic negative thoughts?

The pt is encouraged to keep a diary of these thoughts and evidence that matches the belief to be discussed at the next session

What sorts of things do therapists do that challenge patients negative thoughts?

Reality testing e.g. create hypotheses about what might be the case and then search for evidence that this is not the case

What must be built between therapist and patient?

Rapport

Why can CBT for depression be challenging?

It forces people to face the illogical nature of their thoughts and produce evidence. This can be conflicting and challenging

List reasons CBT is appropriate as a treatment for depression.

- Appropriate if person has strength for it

- Successful and long lasting for many

- Deals with cause not just symptoms

- No side effects or withdrawal symptoms

- Appropriate for people who want to have autonomy in their treatment (patient actively involved)

List reasons CBT is inappropriate as a treatment for depression.

- Can be very uncomfortable/upsetting for some people (can feel like they are being blamed)

- People could get angry and pose risk to others and selves

- Can't tell how people will respond to treatment

- Not suitable to those resistant to change or those with very high stress levels

- Patients have to be committed and organised e.g. complete diaries etc which some are not

- Very long term (not appropriate for those who want a quick fix)

- Doesn't focus on why people have -ve beliefs, only on changing them (some beliefs may be realistic)

- People can become dependent on their therapist

- People do still relapse

List reasons CBT is effective as a treatment for depression.

- Study found that CBT is effective in reducing symptoms and preventing relapse

- Study found that CBT and drugs are equally effective in patients with severe depression

- It actually targets the cause of depression, not the symptoms (if the -ve thoughts are the cause as the cognitive explanation says)

List reasons CBT is ineffective as a treatment for depression.

- CBT is the most effective in combination with medication (alone both treatments had around 50% success but together had 85%)

- Can CBT be effective if it is the NT levels causing it?

- Many studies are small scale or case studies which decreases generalisablity