CBT as a treatment for depression

CBT

- Most commonly used psychological treatment for depression and a range of other mental health issues

- 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. For example, they will identify where there might be negative or irrational thoughts that will benefit from challenge

- Also involves working to change negative and irrational thoughts and putting more effective behaviours into place

Beck's cognitive therapy

- The idea behind this is to identify automatic thoughts about the world, the self, and the future- this is the negative triad. Once identified these thoughts must be challenged. As well as this, it aims to help clients test the reality of their negative benefits. They might therefore be set homework, such as to record when they enjoyed an event or when people were nice to them

- 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' rational emotive behaviour therapy

- This therapy extends the ABC model to an ABCDE model- D stands for dispute and E for effect. The central technique of this is to identify and challenge irrational thoughts

- For example, a client might talk about unlucky they have been or how unfair things seem. A therapist using this therapy would identify these as examples of utopianism and challenge this as an irrational belief. The intended effect is to change the irrational belief and so break the link between negative life events and depression

- There are different methods of disputing: empirical argument (disputing whether there is actual evidence to support the negative belief), logical argument (disputing whether the negative thought logically follows from the facts)

Behavioural activation

- As individuals become depressed, they tend to increasingly avoid the situations and becomes isolate, which may worsen symptoms

- The goal of this is to work with depressed individuals to gradually decrease their avoidance and isolation, and increase their engagement in activities that have been shown to improve mood, e.g. exercising. The therapist aims to reinforce such activity

Evaluation- Strengths

- Many studies show that CBT works. For example, March et al (2007) compared CBT to antidepressant drugs and also to a combination of both treatments when treating 327 depressed adolescents. After 36 weeks, 81% of the CBT group, 81% of the antidepressants group and 86% of the CBT plus antidepressants group were significantly improved. CBT was just as effective when used on its own and more when used alongside antidepressants.

- This means that CBT is widely seen as the first choice of treatment in public health care systems such as the NHS

Evaluation- Limitations

- In some cases depression can be so severe that clients cannot motivate themselves to engage with the cognitive work of CBT. They may not even be able to pay attention to what is happening in a session. Furthermore, it also seems likely that the complex rational thinking involved in CBT makes it unsuitable for treating depression in clients with learning disabilities. Sturmey (2005) suggests that, in general, any form of psychotherapy is not suitable for people with learning disabilities, and this includes CBT

- This suggests that CBT may only be appropriate for a specific range of people with depression

Evaluation- Limitations

- Although CBT is quite effective in tackling the symptoms of depression, there are some concerns over how long the benefits last. Some recent studies suggest that the long-term outcomes of CBT are not as good as had been assumed. Shehzad Ali et al (2017) assessed depression in 439 clients every month for 12 months following a course of CBT. 42% of the clients relapsed into depression within six months of ending treatment and 53% within a year

- This means that CBT may need to be repeated periodically in order to be effective in the long-term

Limitation

Expensive + high commitment