Cognitive approach to treating depression

What is Cognitive Behavioural Therapy (CBT)?

CBT is a talking therapy that aims to identify, challenge, and change irrational thoughts and beliefs, and replace them with more rational and adaptive cognitions, alongside behavioural change.

What is the aim of CBT?

To break the link between negative thinking patterns and maladaptive behaviours, improving emotional state and functioning.

What is Beck’s CBT?

Beck developed CBT as a 16–20 week structured therapy, focusing on present experiences and current problems rather than the past.

What is thought-catching?

A process where patients are trained to identify and record automatic negative thoughts (ANTs), increasing awareness of cognitive distortions.

What happens after thought-catching?

Negative thoughts are:

• Challenged

• Evaluated for evidence

• Reconstructed into more rational alternatives

What is reality testing in CBT?

Patients test their irrational beliefs through homework tasks, gathering evidence to evaluate whether their thoughts are accurate.

What role do diaries play in CBT?

Diaries are used to:

• Record thoughts and behaviours

• Provide evidence for cognitive restructuring

What is behavioural activation?

Encouraging patients to engage in enjoyable or meaningful activities, which:

• Improves mood

• Challenges avoidance behaviour

• Breaks the depression cycle

What is REBT?

Ellis developed Rational Emotive Behavioural Therapy (REBT), a form of CBT focusing on irrational beliefs.

What is the ABCDE model?

• A → Activating event

• B → Beliefs

• C → Consequences

• D → Disputation

• E → Effective new beliefs

What is disputation in REBT?

Challenging irrational beliefs through:

• Logical disputation → does it make sense?

• Empirical disputation → is there evidence?

What is the outcome of REBT?

Replacing irrational beliefs with rational alternatives, leading to healthier emotional and behavioural responses.

What evidence supports CBT effectiveness?

March et al. (2007):

• CBT = 81% effectiveness

• Combined with medication = 86% effectiveness

✔ Shows CBT is as effective as medication
✔ Suggests cognitive approach is valid

What does March et al suggest about combined treatments?

CBT + medication is more effective, suggesting:

• Depression may have both cognitive and biological causes
  ❌ CBT alone may not be a complete treatment

Limitation – severity of depression

CBT is less suitable for severely depressed patients because:

• They may lack motivation

• Unable to engage in cognitive work

👉 Medication may be needed first

Limitation – cost and accessibility

• Requires 16–20 sessions

• Needs trained therapist

• Expensive and time-consuming

❌ Less accessible in public healthcare systems

Strength – empowerment

CBT makes patients:

• Active participants in recovery

• Develop long-term coping strategies

✔ More sustainable than medication

Strength – long-term effectiveness

CBT addresses root causes (cognitions) rather than symptoms, leading to long-lasting improvement.

Limitation – may not address all causes

CBT focuses on cognition but ignores:

• Biological factors (genes, neurotransmitters)
  ❌ Not a complete explanation/treatment

Economic benefit of CBT

Improved mental health leads to:

• Fewer sick days

• Increased productivity

✔ Benefits individuals and the wider economy