AO3 The cognitive approach to explaining and treating depression: Beck's negative triad and Ellis's ABC model; cognitive behaviour therapy (CBT), including challenging irrational thoughts

There is evidence that depression is associated with negative thinking

Grazioli and Terry (2000) assessed 65 pregnant women for cognitive vulnerability and depression before and after giving birth. Women judged high in cognitive vulnerability were more likely to suffer post-natal depression. This supports Beck’s notion that cognitive vulnerability and negative thinking comes before depression and is not a consequence of the depression.

Practical application of the cognitive approach in depression

If it is true that cognitive vulnerability is a cause of depression then young people could be screened for vulnerability, identifying those that are most at risk of developing depression in the future and monitoring them.

Suggesting Ellis’s explanation is only a partial explanation

Some cases of depression follow activating events this is called reactive depression, this supports the ABC model. However, it cannot account for cases of depression that occur as a result of no obvious cause. This means that Ellis’s explanation only applies to some kinds of depression.

Therapy based on Beck and Ellis’s theories has been very effective in treating depression

This provides strong support for the cognitive approach. All cognitive aspects, including the negative triad, can be identified and challenged in CBT. Ellis’s REBT has also been effective in treating depression. Disputing negative thinking reduces depression, suggesting it was the irrational beliefs that had some role in the depression in the first place.

The cognitive approach ignores biological factors

There is strong evidence that biological factors play a very important role in depression. Wender found that adopted children who develop depression are more likely to have a depressive biological parent. A better explanation might be the diathesis stress model which suggests some people inherit a vulnerability to disorders such as depression.

Effectiveness of CBT

Hollon studied the relapse rates of those with moderate to severe depression and found rates of 40% in those who’d had 16 weeks of CBT, 45% in the drug therapy group and 80% in the placebo group. This suggests CBT is more effective than drug therapy and much better than no treatment at all.

CBT is provides a better long term solution

Attempts to deal with the cause of depression not just the symptoms of it. It offers a long term solution for dealing with mental distress that other therapies, such as drug therapy may not offer. The client can use the techniques beyond the therapeutic setting, whereas drugs seem to just suppress the symptoms.

CBT appropriateness

Not appropriate for all clients, as they need to have the ability to rationalise and talk about their thoughts and feelings. For those suffering from very severe depression it might be very difficult to motivate themselves to engage with and complete CBT. For those patients, they may have to take anti-depressants before commencing CBT, suggesting that CBT cannot be used as the sole treatment for all patients.

Focuses only on thoughts

There is a risk that too much emphasis is placed on thought processes and not enough on the circumstances in which a patient is living, e.g. poverty, poor housing etc. If therapy focuses just on thoughts when circumstances need changing, this may prevent a client from dealing with a major source of their problems.

CBT takes a long time to complete

Ellis claimed that clients would need on average 27 sessions to complete the treatment. Therefore, the client will have to be motivated to attend all sessions and may have to pay for treatment, which could be expensive. It may therefore be an inappropriate treatment for some.