Cognitive Approach to Treating Depression

Cognitive Behaviour Therapy (CBT) Summary

Most commonly used psychological treatment for depression & other mental health issues. Cognitive element: 1) Assessment of client → client + therapist work to clarify the client’s problems. 2) Jointly identify goals for therapy & make a plan. 3) One central task: identify negative/irrational thoughts that will benefit from challenging. Behavioural element: 1) Change negative/irrational thoughts. 2) Put more effective behaviours into place.

Beck’s Cognitive Therapy

Identify automatic thoughts about the s/w/f (negative triad) & challenge these. They may test the reality of these thoughts. May set homework to record nice events.

Ellis’ rational emotive behaviour therapy (REBT)

ABCDE model ( D = dispute , E = effect). Identify & dispute irrational thoughts (e.g. utopianism). Vigorous argument to challenge belief & break link between negative events and depression. Empirical argument = disputing whether there’s actual evidence to support negative belief. Logical argument = disputing whether negative belief logically follows the facts.

Behavioural activation

Depression → avoid difficult situations → isolation → maintains/worsens symptoms. Work with depressed individuals to gradually decrease avoidance/isolation & reinforce activity (e.g. exercise.)

Strength: Evidence for effectiveness

Studies show it works. John March et al (2007): CBT vs antidepressants vs both treating 327 adolescents. 36 weeks → 81% of CBT, 81% of antidepressants & 86% of both had significantly improved symptoms. CBT just as effective on its own as antidepressants. It’s also cost effective.

Limitation: Suitability for diverse clients

Not as effective for those with severe depression or learning disabilities as they struggle to keep up with the complex cognitive work of CBT or the complex rational thinking of it, respectively. Sturmey (2005) → psychotherapies (including CBT) not effective for those with learning disabilities.

Strength: Counterpoint to diversity

Review by Gemma and Glyn Lewis → CBT as effective as antidepressants and behavioural therapies for severe depression. John Taylor et al (2008) → can be altered to be effective for those with learning disabilities.

Limitation: Relapse rates

Long term outcomes not as good as assumed. Shehzad et al (2017) assessed depression in 439 clients every month for 12 months following a course of CBT. 42% relapsed within 6 months. 53% relapsed within the year. CBT may need to be repeated periodically.