Paper 2 - Abnormal Psychology - Cognitive Treatments of MDD (CBT)

Psychotherapy

Involve face-to-face interactions with a therapist.

Can be highly individualized to meet the client's needs.

Helps people identify unhealthy thought patterns and behaviors and suggests strategies to manage stress and symptoms.

Can be combined with antidepressants if the person is severely depressed.

Cognitive behavioral therapy (CBT)

Blend of cognitive and behavioral therapy.

According to Beck, psychological problems are associated w/ maladaptive thinking patterns and unhealthy behaviors can be changed through a working relationship btwn a client and therapist. He argues that specific events are not at the core of an individual's problem but rather the way the individual interprets the situation.

In contrast to traditional forms of psychotherapy, which are concerned with a person's past history, CBT focuses on current issues and symptoms.

The client is an active participant in the therapy sessions, and learns to identify unhealthy thoughts and behaviors so they can gradually be replaced by more positive ones.

Typically 12-20 weekly sessions combined with daily exercises to help the client use new skills on a daily basis.

First aim of CBT

- Help the client to identify and change faulty thinking patterns and unhealthy behaviors.

Cognitive restructuring

The client is encouraged to identify which thoughts are associated with depressed feelings, and then work to correct these thoughts. This can include teaching the client to refocus their attention on things that they will do, and take note of their daily successes.

Validity testing

A strategy in which the therapist will ask the client to defend their beliefs, by providing evidence. If the client cannot provide evidence supporting their assumptions and thoughts, the faulty belief will therefore be challenged. By challenging the assumptions, this will help the client realize there is little/no evidence for their beliefs.

Second aim of CBT

- Help the client to develop effective coping strategies and problem solving skills.

Cognitive rehearsal

The client is asked to imagine a difficult situation from the past and then working with their therapist, create and practice how to deal with this problem. This helps them to develop new schema for these types of problems so that they are better equipped to handle them in the future.

Homework

This requires the client to complete additional tasks and put skills into practice outside of the therapy session. This could include keeping a diary of positive experiences, or trying a new strategy learned in therapy.

Elkin aim

To see if there was any significant difference in the effectiveness of the 3 approaches to therapy (CBT, IPT, and drug therapy).

Elkin method

Sample of 250 depressed patients coming from 3 diff treatment centers in Pittsburgh, Washington DC, and Oklahoma City.

Depressed clients were randomly assigned to one of four treatment conditions for 4 months: IPT, CBT, the drug imipramine, or a placebo pill.

The imipramine and placebo conditions were paired w/ clinical management in which minimal supportive therapy was provided because of the ethical need to provide some therapy for clients in those conditions.

Patients had to meet the diagnosis of MDD w/ symptoms present at least in the 2 weeks previous to the study and were excluded if they had any other disorders.

After obtaining informed consent, ppts were randomly assigned to treatment conditions at each site. A total of 28 therapists took part - 8 in CBT, 10 in IPT, 10 in drug therapy. All treatments lasted 16 weeks.

CBT patients received 12 sessions during the first 8 weeks, followed by weekly sessions during the second half of the study.

Patients were carefully monitored. A large number of assessments were carried out before, during, and after. In general, 3 areas were assessed: symptoms, life functioning, and functioning related to the treatment.

The assessments acquired info from the client, a clinician blind to the treatment condition, and a significant other.

Elkin results

There was no significant difference in the reduction of MDD or improvement of functioning btwn CBT and IPT or between either of them and imipramine plus clinical management. The 3 treatments achieved significant and equivalent degrees of success and were superior to the placebo condition.

Imipramine was faster than the other treatments in reducing depressive symptoms during treatment. By the end of the 16 weeks of therapy, the 2 psychotherapies had caught up w/ the drug.

At the 18 month follow up, only 20-30% of the ppts remained completely symptom free of depression, regardless of the treatment received.

Patients in both IPT and CBT reported significantly greater effects of treatment.

Elkin conclusion

While all treatments (CBT, IPT and medication) were effective in reducing depressive symptoms, no single approach was superior. The results emphasize the importance of matching treatment to individual patient needs and the need for a holistic approach to treatment.

This finding highlights that while biological treatments like antidepressants can be effective, their success may improve when combined with therapies addressing psychological factors, such as CBT and IPT. Integrating biological and psychological treatments allows for a more comprehensive approach, targeting both the neurological and behavioral aspects of depression.

Elkin evaluation

- The Elkin study is criticized for inconsistencies and high drop out rates. Jacobson and Hollon (1996) found that treatment outcomes varied across sites. For example, CBT and IPT were as effective as imipramine at different sites. Additionally, 33% of imipramine patients dropped out before completing treatment, unlike in other groups. These inconsistencies and high attrition raise concerns about the generalizability of the results and the tolerability of imipramine, which could have biased findings. This highlights the need for further research to confirm the study's conclusions.

+ The study's use of data triangulation strengthens its findings. The effectiveness was assessed using info from the patient, therapist, and an objective observer, reducing potential bias. This approach minimizes the risk of demand characteristics from the patient, or observer bias from the therapist, providing a more reliable evaluation of treatment effectiveness. Therefore, the use of multiple data sources enhances the validity of the study's conclusions.

Hollon et al (2005) aim

To determine if cognitive therapy has a more enduring effect than medication.

Hollon method

They used a randomized control trial which consisted of three groups of moderate-to-severely depressed patients:

· Patients who responded positively to cognitive therapy and were withdrawn from treatment for 12 months

· Patients who responded to medication and continued medication

· Patients who responded to medication and continued to receive a placebo.

Hollon results

Results showed that patients withdrawn from cognitive treatment were less likely to relapse than patients withdrawn from medication (31% compared to 76%) during the first 12-month period, and even slightly less likely to relapse than the group that continued to take medication (47%).

Hollon conclusion

In conclusion, while both antidepressants and CBT are effective for treating depression, CBT offers a lasting impact that extends beyond the treatment period by addressing the underlying causes of the disorder. In contrast, drug therapy primarily reduces symptoms without targeting these root causes, which may result in a higher risk of relapse once medication is discontinued. Therefore, CBT may provide a more sustainable solution for long-term recovery.

Hollon evaluation

- The sample only included participants with moderate to severe depression, which limits the study's generalizability. By focusing on a specific population, the study's findings may not apply to individuals with mild or less severe depressive symptoms. As a result, the effectiveness of treatments like CBT or antidepressants might differ for those with varying levels of depression, meaning the study's conclusions cannot necessarily be extended to all cases of depression. This suggests that further research is needed to assess how these treatments perform across a broader range of depressive symptoms for a more comprehensive understanding of their effectiveness.

+ Longitudinal design, which is a strength in assessing the long-term effectiveness of treatments for depression. By tracking participants over an extended period, the study could observe not only immediate treatment effects but also rates of relapse after treatment ended, providing a clearer picture of each treatment's lasting impact. This approach highlights the durability of treatment effects, showing that CBT had lower relapse rates compared to antidepressants after discontinuation. The longitudinal design thus adds depth to the findings by revealing the long term benefits of CBT over time.

Strength of CBT

It is effective in reducing relapse rates for individuals with depression. Rush et al. (1977) found that patients treated with CBT experience lower relapse rates compared to those who received only drug therapy. This difference is likely because CBT equips clients with coping skills and strategies to manage depressive symptoms, which are not typically developed through medication alone. CBT's focus on teaching coping mechanisms enables clients to handle future depressive episodes independently. In contrast, drug therapy mainly addresses symptoms without providing these long-term, practical skills. Therefore, CBT's ability to build lasting coping skills makes it an effective treatment option to reduce the risk of a relapse.

Limitation of CBT

While CBT is effective for treating depression, it may not be suitable for all clients, particularly those with severe or urgent symptoms. For individuals who are suicidal or severely depressed, CBT may not take effect quickly enough to address their immediate needs. In these cases, drug therapy can help reduce symptoms more rapidly, stabilizing the patient so they can later engage meaningfully in CBT. This approach suggests that combining drug therapy with CBT, particularly in severe cases, can provide both immediate symptom relief and the tools depressed patients need to cope, leading to more comprehensive treatment outcomes.