Cognitive treatments for depression

Rationale behind cognitive therapies for treating depression

-Assume faulty thinking/thought processes make a person vulnerable to depression

-CBT involved both cognitive and behavioural elements

-Aim is to replace negative and irrational thoughts after their identification, which is the cognitive side, and the behavioural element encourages patients to test their beliefs through behavioural experiments and homework

Reality testing

Process where an individual challenges their irrational thoughts, by comparing them against real-life evidence, so the individual can distinguish between their mind and reality

Beck’s CBT process

-Aims to identify and challenge negative, automatic thoughts surrounding the world, the future and the self

— Reality testing

— Homework

—- - Thought journaling

—- - Findings are used in future sessions

-Challenging and replacing irrational thoughts

Ellis’ REBT process

-Extends ABC model to ABCDE

-Challenge irrational beliefs through disruption

— More direct and confrontational

— - Recognise beliefs are irrational/self-defeating

— - Change the negative belief and break the link between the event and depression

-Replace the irrational beliefs with a more effective/positive emotional outcome

Behavioural activation

-As the individual becomes depressed, they tend to increasingly avoid difficult situations and become isolated

— Maintains and worsens symptoms

-Aims to gradually decrease avoidance and isolation

Strengths of cognitive treatments for depression

-Strong evidence showing its effective

— March et al (2007) compared CBT with antidepressants and a combination, and got the same result for both, and an even higher score for the combined (81,86)

— Effectiveness of CBT alongside drugs as a combination therapy is more effective

-Challenging limited effectiveness for multiple groups in society

— More recent evidence challenges the idea that CBT is unsuitable for severe depression and those with learning difficulties

— Lewis and Lewis (2016) concluded that CBT was as effective as antidepressants and behavioural therapy for severe depression

— This means CBT may be suitable for a wider range of people than originally thought

Limitations of cognitive treatments of depression

-Reduced effectiveness with learning disabilities/trauma

— CBT requires motivation, which may not be present in those who have had a traumatic experience or more severe case of depression

— It is also possible that the hard cognitive work associated with CBT could make it unsuitable for those with learning disabilities, which has been suggested by Sturney (2005)

— Suggests CBT may only be available and helpful to a specific range of people

-Long-term benefits

— Some recent research suggest that the long-term outcomes aren’t as good as once thought

— Ali et al. (2017) assessed depression in 439 clients for 12 months after a CBT course

— - 42% relapsed after 6 months

— - 53% relapsed after a year

— This suggests CBT may need to be periodically repeated