Cognitive behaviour therapy

CBT

CBT is the most commonly used psychological treatment for depression as well as a range of other mental health issues.

It is an example of the cognitive approach to treatment, though it also includes behaviourist elements  

Cognitive element: CBT begins with an assessment in which the client and the cognitive behaviour therapist work together to clarify the client’s problems. They jointly identify goals for the therapy and put together a plan to achieve them. One of the central tasks is to identify where there might be negative or irrational thoughts that will benefit from being challenged  

Behaviour element: CBT then involves working to change negative and irrational thoughts and finally put more effective behaviours into place 

Beck’s cognitive therapy

• Beck’s therapy is the application theory of depression. The idea behind Beck’s therapy is to identify automatic thoughts about the world, the self and the future- these three elements constitute the negative triad. Once identified, these thoughts must be challenged. This is the central component of the therapy 

• As well as challenging these thoughts directly, cognitive therapy aims to help clients test the reality of their negative beliefs. They might therefore be set homework, such as to record when they enjoyed an event or when people were nice to them – this is sometimes referred to as the ‘client as scientist’, investigating the reality of their negative beliefs in the way a scientist would  

• In future sessions if clients say that no one is nice to them or there is no point in going to events, the therapist can then produce this evidence and use it to prove the client’s statements are incorrect

Ellis’s rational emotive behaviour therapy (REBT)

• Rational emotive behaviour therapy (REBT) extends Ellis’s ABC model to an ABCDE model – D stands for dispute and E for effect. The central technique of REBT is to identify and dispute (challenge) irrational thoughts  

• For example, a client might talk about how unlucky they are or how unfair things seem. An REBT therapist would identify these as examples of utopianism and challenge this as an irrational belief and so break the link between negative life events and depression  

• This vigorous argument is the hallmark of REBT. Ellis identified different methods of disrupting. For example, empirical argument involved disputing whether there is actual evidence to support the negative belief. Logical argument involves disputing whether the negative thought logically follows from the facts

Behavioural activation

• As individuals become depressed, they tend to increasingly avoid difficult situations and become isolated, which maintains or worsens their symptoms  

• The goal of behavioural activation is to work with individuals with depression to gradually decrease their avoidance and isolation, and increase their engagement in activities that have been shown to improve mood e.g. exercising, going out to dinner etc. The therapist aims to encourage such activity