Treating depression notes

Cognitive Behaviour Therapy (CBT)

A psychological treatment for depression and other mental health issues combining cognitive and behavioral approaches.

A talking therapy that can help you manage your problems by changing the way you think and feel.

Aim of CBT

Building on the theories of Beck and Ellis, the aim of CBT is to change negative schemas people have and change the irrational thoughts people have

Focuses only on present problems, doesn’t explore any childhood traumas/issues

Length of CBT

5-20 sessions, so requires commitment

Both CBT and REBT involve homework

Treatment built on Beck’s cognitive triad theory

1. Negative Self-Schemas

2. Cognitive Biases

3. The Negative Triad

Process:

Thought Catching

The patient identifies their irrational thoughts and their negative triad by keeping a thought diary

Patient as Scientist

The patient is encourages to generate hypotheses to test how rational their thoughts are. They are set tasks or 'homework' to achieve this.

Behavioural Activation

The patient is set specific tasks to help change their behaviour.A CBT technique aiming to decrease avoidance and isolation in depressed individuals by increasing engagement in mood-improving activities.

Ellis's Rational Emotive Behaviour Therapy (REBT)

Extends ABC model to ABCDE (Dispute, Effect) model, emphasizing identifying and disputing irrational thoughts through empirical and logical arguments.

Disputing Irrational Beliefs include:

Empirical Disputing

• Involves disputing whether there is actual evidence to support the negative belief or is there any evidence for this belief?

Logical Disputing

• Involves disputing whether the negative thoughts logically follows from the facts or is the belief rational?

Pragmatic Disputing

• is this belief helpful?

Effects- The effect of disputing irrational thoughts is to help the person be more rational in their thinking about the situation. And to change the way they Feel about it.

Strengths of CBT

John March et al (2007)

Compared CBT to antidepressent drugs and also to a combination of both treatments when treating 327 depressed 12-17 y.o teens. After 36 weeks saw improvement of:

• 86% in the CBT group

• 81% in antidepressants group

• 81% in the CBT plus antidepressants group

  So it was just effective as antidepressants

CBT vs Drug treatment

• No negative side-effects that often come with drugs

• For drugs, it’s difficult to get the dosage level correctly

• Patient will need to gradually weaned off the drug once they’ve improved, which can be challenging as they can experience withdrawal-like symptoms

Cost-effective:

Requires six to 12 sessions

Limitations of CBT

1. Individual differences, may not be suitable for all patients

   • According to the same March et al study, it took 24 weeks for the improvement rate for CBT to almost match with drug treatment, and on 36 weeks to get up to around 80%. How many people are motivated enough and able to stick with the program for that lengths of time?

   • Drug treatment can work much quicker, doesn’t have the demands of motivation and commitment

2. CBT may not be as effective for severe cases or clients with learning disabilities, as rational thinking may be challenging.

• Peter Sturmey (2005)

• Suggests talking therapy is not suitable for people with learning disabilities