The Cognitive approach to treating depression (8)

CBT (1)

Cognitive behaviour therapy (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 includes behaviourist elements.

CBT (2)

Cognitive element = CBT begins with an assessment in which the client and the cognitive behaviour therapist work together to clarify the clients 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 changed.

Behaviour element = CBT then involved working to change negative and irrational thoughts and finally put more effective behaviours into place.

Beck’s cognitive therapy (1)

Beck’s therapy is the application of his cognitive theory of depression. The idea behind becks therapy is to identify automatic thoughts about the world, self and the future.

(These three elements constitute of the negative triad).

Once identified, these thoughts must be challenged, this is the central component of the therapy.

Beck’s cognitive therapy (2)

As well as challenging these thoughts directly, cognitive therapy aims to help clients test the reality of their negative beliefs.

They might therefore 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 not point in going to events, the therapist can then produce this evidence and use it to prove the clients statements are incorrect.

Elli’s rational and emotive behavioural therapy (1)

Rational and emotive behaviour therapy (REBT) extends Ellis’s ABC model to an ABCDE model - D stands for dispute and E for effect. The central technique to 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.

This would involve a vigorous argument. The intended effect is to change the irrational belief and so break the link between negative life events and depression.

Elli’s rational and emotive behavioural therapy (2)

This vigorous argument is the hallmark of REBT. Ellis identified different methods of disputing.

1. 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.

Behaviour action (1)

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

The goal of behaviour activation is to work with individuals with depression to gradually decrease their avoidance and isolation, and increase their engagement with activities that have been shown to improve mood (going out for dinner, exercising), the therapist aims to encourage such activity.

A03 - evidence for effectiveness

One strength of CBT is the large body of evidence supporting its effectiveness for treating depression.

 

Many studies show that CBT works. A psychologist compared CBT to anti depressant drugs and also to a combination of CBT and/ or drugs when treating 327 adolescents with depression.

 

After 36 weeks, 81% of the CBT group, 81% of the anti- depressant group and 86% of the CBT plus antidepressant group were significantly improves.

 

So CNT was just as effective as antidepressants when used on its own, and even more so when used alongside anti-depressants.

CBT is usually a fairly brief therapy requiring 6-12 sessions so it is also cost-effective. The CBT is widely seen as the first choice of treatment in public health care systems such as the NHS

A03 - less useful for depression following trauma

Many people with depression have also experienced trauma. Waldron, studied 318 adolescents diagnosed with major depressive disorder.

 

The adolescents were given 36 weeks of CBT, antidepressant medication or a combination of the two.

 

All treatment groups improved but improvement took longer in those with a history of trauma.

This suggests that CBT may not be effective for people with a trauma history in real-life settings where only a short corse of treatment is usually offered.

A03 - relapse rates

A limitation of CBT for the treatment of depression is its high relapse rates.

 

Although CBT is quite effective in tackling the symptoms of depression, there are some concerns over how long the benefits last.

 

Relatively few early studies of CBT for depression looked at long-term effectiveness. Some more recent studies suggest that long-term outcomes are not as good as had been assumed.

 

For example assessed depression in 439 clients every month for 12 months following a course of CBT. They found that 42% of the clients relapsed into depression within six months of ending treatment and 53% relapsed within a year.

This means that CBT may need to be repeated periodically.