Psychology essay 23

Discuss the cognitive approach to treating depression

The Cognitive Approach to treating depression goals. The cognitive treatment for depression is known as CBT – cognitive behavioural therapy

The aim of CBT is to replace maladaptive thoughts experienced by depressed patients with more adaptive ones, leading to more constructive emotional and behavioural responses.

CBT begins with an initial assessment in which the patient and therapist identify the patient’s depressive symptoms and agree on a set of In order to help the client achieve their goals and change their negative thinking, most CBT therapists use techniques taken from both forms of CBT – Beck’s cognitive therapy and Ellis’s rational emotive behaviour therapy.

AO1: Beck’s Cognitive Therapy

The idea behind this therapy is to identify negative thoughts the client has about the world, the self and the future (the negative triad). Once identified, these thoughts must be challenged.

Patients are often set homework such as to record when they enjoyed an event or when someone was nice to them. Homework can also be used to encourage depressed clients to become more active and to engage in pleasurable activities. For example, a patient who is anxious in social situations may be set a homework assignment to meet a friend for a drink.

Cognitive therapy also aims to help patients test the reality of their negative beliefs. This is referred to as the ‘patient as scientist’, investigating the reality of their negative beliefs in the way a scientist would.

AO1: Ellis’s Rational Emotive Behaviour Therapy (REBT)

REBT extends the ABC model to an ABCDE model - D stand for disputing irrational beliefs and E for the effects of disputing the beliefs. (Please do NOT describe the ABC model)

REBT focuses on challenging or disputing (D) the irrational beliefs and replacing them with effective, rational ones. For example,

• Logical disputing – self-defeating beliefs do not follow logically from the information available

(e.g., ‘does thinking in this way make sense?’)

• Empirical disputing – self-defeating beliefs may not be consistent with reality (e.g.

‘where is the proof that this belief is accurate?’)

• Pragmatic disputing – emphasises the lack of usefulness of the beliefs (e.g. ‘How is this belief likely to help me?’)

The ‘Effect’ (E) of challenging these irrational thoughts is that the patient will develop more rational beliefs. This is turn helps the client become less depressed, leading to constructive behaviours.

Evaluation – Cognitive treatment for depression (A03)

P: One strength of CBT is that it has proven to be effective in treating depression.

E: For example, March et al (2007) compared CBT with drug therapy (antidepressants).

E: After 36 weeks they found 81% of patients showed improvement in both groups.

L: This is a strength because it shows that CBT is just as effective as drug therapy at treating depression but without the unpleasant side effects that most people experience whilst taking anti-depressants.

ALSO: CBT has clear economic benefits. It is estimated that mental health issues cost the English economy around 300 million per year. CBT has proven to be an effective treatment (see March’s study above) therefore, it reduces unnecessary healthcare costs on treatments that are ineffective and also enables people to return to work, thus helping the economy.

(Optional counterargument) However, it should be noted that CBT is not the preferred method of treatment for most patients. Unlike CBT, drug therapy requires little effort and is just as effective at treating depression. Additionally, drug therapy is less expensive as it does not require trained therapists. Thus, drug therapy may prove to be more beneficial to the economy than CBT.

P: One issue with using CBT as a treatment for depression is that it may not work for all people with depression.

E: This is because CBT requires patients to commit to attending regular sessions with a therapist, completing homework and putting into practice the techniques learnt. This is more disruptive to patients’ lives than just taking medication.

E: Additionally, many patients lack the motivation to engage successfully in these programmes.

L: This is especially true for those who are severely depressed, suggesting that this method of treatment is not suitable for all people with depression.

The cognitive approach to treating depression consists of two types of cognitive behavioural therapy (CBT)- Beck’s cognitive therapy and Ellis’s rational emotive behaviour therapy (REBT). Beck’s cognitive therapy is based on identifying negative thoughts a person has about the negative triad (the world, the self and the future), and challenging them. This is often done by setting homework, which consists of identifying what patients expect to happen in situations, and challenging that belief by putting themselves in those situations. This is known as the ‘patient as a scientist’ approach, as the patient tests the reality of their negative beliefs.

Ellis’s REBT therapy extends the ABC model (activating event, belief and consequences) to an ABCDE model-D for disputing irrational beliefs and E for the effects of disputing these beliefs. It focuses on challenging, or disputing the irrational beliefs and replacing them with effective, rational ones, using logical, empirical and pragmatic disputing. The effect of disputing these beliefs is that the client will become less depressed, leading to constructive behaviours.

One strength of CBT is that it has been proven effective at treating depression. Research from March et al compared CBT with drug therapy (antidepressants). After 36 weeks they found 81% of patients showed improved in both groups. This is a strength because it shows CBT is as effective as drug treatments, but without the side effects.

Another strength is that it has clear economic benefits. It is estimated that mental health issues cost the English economy around 300 million per year. CBT has proven to be an effective treatment, and so therefore it reduces unnecessary costs on treatment that may not be effective, as well as enabling people to return to work, which helps the economy.

However, one weakness is that CBT is not an effective treatment for all with depression. This is because it requires patients to commit to multiple regular sessions with a therapist, as well as completing homework. This is more disruptive to patients lives than medication. Additionally, many patients lack motivation to engage successfully in CBT, especially those who are severely depressed. This suggests this method may not be suitable for all those who suffer from depression.