Cognitive approach to treating depression

Cognitive Behaviour Therapy

A method for treating mental health conditions based on cognitive and behavioural techniques.

Aims to deal with thinking such as challenging negative thoughts.

Includes behaviourist techniques like behavioural activation

Irrational thoughts

Also called dysfunctional thoughts. In Ellis’s model and therapy, these are thoughts that are likely to interfere with someone’s happiness.

Dysfunctional thoughts lead to mental health conditions like depression

Cognitive element of CBT

Assessment where the client and therapist work together to clarify their problems. They identify goals for the therapy and put together a plan to achieve them.

One of the central tasks is to identify where might be negative or irrational thoughts that benefit from being challenged.

Behaviour element of CBT

Involves working to change negative and irrational thoughts and put more effective behaviours into place.

Beck’s cognitive therapy

Applying his cognitive therapy of depression.

Aims to identify automatic thoughts aligning with the negative triad. These thoughts are then challenged as the central component of the therapy.

‘Client as scientist’ approach is the idea where the patient is given ‘homework’ to write down when they have enjoyed a part of their life. They write this in a diary. This can be used as evidence for the therapist if the client says they never enjoy themself.

Ellis’s Rational Emotive Behaviour Therapy

Extends ABC model to ABCDE

D = Disputing irrational thoughts and beliefs

E = Effective new beliefs replace irrational ones.

Therapist challenges mustabatory irrational thoughts and helps to turn them into rational ones.

They get the patient to assess whether their negative statements are accurate and help them to practise positive and optimistic thinking

Thoughts can be disputed for being:

• Illogical

• Inconsistent with reality

  • Lacking in usefulness

Behavioural activation

Client is encouraged to engage in activities they once found pleasurable and are helped to deal with any cognitive obstacles.

Unconditional positive regard

Client feels valued as an individual and a sense of self-worth. Therapist must not judge

Difference between CBT and REBT

Vigorous argument and disputation that the therapist uses to challenge the patient with empirical argument in REBT e.g. “is there any evidence for this”.

Logical arguments in REBT e.g. “your conclusions are not coherent”

CBT S March

Supporting evidence for effectiveness.

Compared CBT to antidepressant drugs and also a combination when treating 327 adolescents with depression.

After 36 weeks, 81% of CBT, 81% of drugs, 86% of combination group were significantly improved.

So CBT is as effective as drug treatments but even more so when combined with it.

CBT S Flexible

Doesn’t have to be delivered face-to-face and is successful when delivered via self-help materials, telephones or video chat.

Interactive computer programmes are developed and 2 are supported by the NHS.

Suggests they can be delivered to large numbers of people without a face-to-face therapist

CBT S Hollon

Effective in the long-term.

40% of patients treated with CBT relapsed within a year compared to 45% for drug treatments. For placebo drugs, relapse rate was 80%.

Suggests that CBT was more effective in the long term than drug treatments or no treatment.

Provides support for CBT over biological treatments.

W Not cost-effective

The NHS recognise that there is an issue with being able to deliver weekly face-to-face sessions.

Effectiveness of CBT depends on the skills of the therapist. Better trained therapist = better outcome.

May be limitations to the use of CBT

W Waldron

Not as effectiveness for those experiencing trauma.

Studied 318 adolescents diagnosed with Major Depressive Disorder.

Adolescents were given 36 weeks of CBT, drugs or a combination of the 2. All groups improved but it took longer for those with trauma history.

Suggests that CBT is not as effective for people with a trauma history in real-life settings where a short-course of treatment is usually offered.

W Relapse rates

Ali

CBT is effective in tackling depression symptons but there are concerns about how long the benefits last.

Few early studies of CBT for depression looked at long-term effectiveness.

Ali assessed depression in 439 clients every month for 12 after CBT. Found 42% relapsed within 6 months and 53% within a year

Suggests that CBT may need to be repeated periodically.