Cognitive Approach to Treating Depression (4)

Cognitive behavioural therapy

• Cognitive behaviour therapy (CBT) is the most commonly used psychological treatment for depression

• CBT includes the following :

  • Cognitive restructuring/reframing: this involves turning negative thoughts into positive thoughts

  • Guided discovery: this involves challenging negative thoughts and irrational beliefs

  • Keeping a journal: this involves the recording of thoughts, feelings and actions between sessions

  • Activity scheduling and behaviour activation: this involves acting on decisions and avoiding procrastination

  • Relaxation and stress reduction techniques: this involves exercises such as muscle relaxation, deep breathing, visualisation

  • Role-playing: this involves working through different scenarios which the patient finds difficult or challenging

What does the CBT therapist aim to get ?

• The CBT therapist aims to get their client to the point where they can be independent and use strategies practiced over the course of the CBT treatment to help themselves

• A course of CBT generally takes between 5 and 20 sessions with the client and therapist meeting every week or fortnight with each session lasting between 30 and 60 minutes

• CBT is very much focused on the 'here-and-now' rather than the past

How is cognitive therapy related to Beck’s theory ?

• Cognitive Therapy is the application of Beck's theory of depression within a CBT framework

• CBT assists clients in identifying their irrational thoughts (from the negative triad)

• The client is encouraged to challenge irrational thoughts directly with help from the therapist

• Clients are often set 'homework' to record positive events, which can be used in the sessions to help them challenge irrational thoughts

  • The client may state that, 'Everyone hates me'; however, in their homework they recorded a social event they enjoyed

    • The view that everyone hates them will thus be challenged as illogical

• The therapist can directly confront the client with evidence to highlight their irrational thoughts or to at least look for other reasons why people may have acted the way they did, e.g.,

  • 'A friend ignores you when you see them in town: they probably did not see you or they were distracted'

Ellis’ Rational Emotive Behaviour (REBT)

• REBT extends Ellis's ABC model to ABCDE (D is for Dispute and E is for Effect)

• REBT (as for CBT) aims to help the client to identify and challenge irrational thoughts, e.g.:

  • A client tells their therapist, 'Everything I do ends in failure or disaster'

  • The REBT therapist presents robust arguments to dispute this idea

  • The therapist's role is to break the link between negative life effects and depression by changing the client's irrational belief

  • The two types of arguments identified by Ellis are

    • empirical arguments: disputing if there is real evidence to support the irrational belief

    • logical arguments: disputing if negative thought follows logically from the facts

Strength 1 Evaluation of cognitive approach to treating depression

• CBT is one of the most popular and successful therapies for treating depression

  • March et al. (2007) found that CBT was more successful at treating depression in adolescents than drug therapy

    • This means that it has good application, as CBT is effective in reducing symptoms of depression

Strength 2 Evaluation of cognitive approach to treating depression

• CBT allows the patient to develop at their own pace with the therapist tailoring the sessions to suit each individual

  • Thus, CBT embraces, to some extent, free will in its approach

Limitation 1 Evaluation of cognitive approach to treating depression

• The emphasis on ‘here-and-now’ may not be appropriate for some people who need to revisit past events as part of their journey to wellness

  • This limits the usefulness of the therapy, as it may not be effective for all individuals as a treatment of depression

Limitation 2 Evaluation of cognitive approach to treating depression

• CBT, as with all 'talking therapies,' does not work very well for people who do not like to express themselves freely or who lack the verbal or intellectual skills to do so

  • This means that the therapy lacks an idiographic dimension, as it ignores the experience of the individual to some extent