The cognitive approach to treating depression

What is cognitive behaviour therapy?

Method for treating mental disorders based on both cognitive & behavioural techniques

From cognitive viewpoint the therapy aims to deal with thinking eg. challenging negative thoughts →therapy also includes behavioural techniques eg. behavioural activation

What is the cognitive element of CBT?

CBT begins with assessment in which client & cognitive behaviour therapist work together to clarify client’s problems →jointly identify goals for therapy & put together plan to achieve them

One central task →identify where there might be negative / irrational thoughts that will benefit from challenge

What is the behaviour element of CBT?

CBT then involves working to change negative & irrational thoughts & finally put more effective behaviours into place

What is Beck’s cognitive therapy?

Cognitive therapy is the application of Beck’s cognitive theory of depression

Idea behind cognitive therapy →identify automatic thoughts about world,self & future - negative triad →once identified thoughts must be challenged = this is central component of therapy

Cognitive therapy also aims to help clients test the reality of their negative beliefs

How might clients be made to test the reality of their thoughts?

Set homework eg. to record when they enjoyed an event/when people nice to them →referred to as client as scientist →as they investigating reality of their negative beliefs in same way as scientist would

In future sessions id client says no one nice to them/no point going events →therapist can produce evidence & use it to prove clients statement wrong

What are irrational/dysfunctional thoughts?

In Ellis’s model & therapy →defined as thoughts likely to interfere with persons happiness →such thought lead to metal disorders eg. depression

What is Ellis’s rational emotive behaviour therapy?

REBT extends the ABC model to ABCDE model →D = dispute & E = effect

Central technique of REBT is to identify & dispute irrational thoughts

How might REBT be carried out?

Client may talk about how unlucky they are/how unfair things seem →REBT therapist identify theses examples as utopianism & challenge this as irrational beliefs →involves a vigorous argument

Intended effect is to change irrational belief & so break link between negative life events & depression

What diferrent methods of disputing did Ellis identify?

Vigorous argument is hallmark of REBT

Ellis different methods include:

Empirical argument - involves disputing whether there is actual evidence to support the negative belief

Logical argument - involves disputing whether the negative thought logically follows from the facts

What is behavioural activation?

As individuals become depressed →tend to increasing avoid difficult situations & become isolated which maintains/worsens symptoms

Goad of behavioural activation - to work with depressed individuals to gradually decrease their avoidance & isolation & increase engagement in activities shown to improve mood eg. excersising

Therapist aims to reinforce such activity

What is a strength of CBT?

Large body of evidence supporting its effectiveness for treating depression

Many studies show CBT works

March et al: compared CBT to antidepressant drugs & also to combination of both treatments when treating 327 depressed adolescents

After 36 weeks, 81% of antidepressant group & CBT group showed improvement & 86% of CBT + antidepressnt group significantly improved

So CBT just as effective when used on its own & more so alongside antidepressants →CBT is a brief therapy of 6-12 sessions →cost effective

Means CBT widely seen as first choice of treatment in public health care systems such as NHS

What is a limitation of CBT for depression?

Lack of effectiveness for severe cases & clients with learning disabilities

Sometimes depression so severe that clients can’t motivate themselves to engage with cognitive work of CBT →may not even be able to pay attention to session

Hard cognitive work involved in CBT →likely to make it unstuitable for treating clients with learning disabilities

Sturmey: suggests that in general any form of psychotherapy not suitable for people with learning difficulties eg. CBT

Suggests CBT only appropriate for specific range of people with depression

What is a counterpoint to the unsuitable nature of CBT for diverse clients?

Although conventional wisdom has been that CBT unsuitable for very depressed people & clients with learning disabilities →recent evidence to challenge this

Glyn Lewis & Gemma Lewis review: concluded CBT was as effective as antidepressant drugs & behavioural therapies for severe depression

Taylor et al review: concluded that when used appropriately CBT effective for people with learning disabilities

Means CBT may be suitable for wider range of people than once thought

What is a further limitation of CBT for treatment of depression?

• High relapse rates

Although CBT effective in tackling depression symptoms →concerns over how long benefit lasts

Very few early studies of CBT for depression looked at long term effectiveness →more recent studies suggest long term outcomes not as good as previously assumed

Ali et al study: assessed depression in 439 clients every month for a year following a course of CBT →42% clients relapsed into depression within 6 months of ending treatment & 53% relapsed within a year

Means CBT may need to be repeated periodically

Why do depressed people not prefer CBT to other therapies?

CBT for depression focuses on identifying & changing unhelpful patterns of thinking & behaviour →large body of evidence probing that for appropriate clients it’s highly effective in tackling symptoms of depression

HOWEVER not all clients want to tackle their depression in this way

Some people want symptoms gone as quick as possible →prefer medication

Others eg. survivors of trauma wish to explore origins of their symptoms

Yrondi: In study of client preference found depressed people rated CBT as their least preferred psychological therapy