CBT & Depression and Suicidality

Central component of CBT conceptualization of depression is negative thinking

Negative cognitive triad (Beck)

Learned helplessness/attributional style

• Seligman, 1970s

• An individuals tendency to perceive negative events as something you have no control over because you could not get out of past negative events.

• Attributional Styles

  • Internal (Self Blame)

  • Stable (The situation is permanent)

  • Global (It will affect everything I do)

Deficit of positive reinforcement (Response contingent positive reinforcement; RCPR)

• Lewisohn, mid 1970s

• The theory that behavioral activation is built on

• When depressed there is a loss of external events that promote RCPR because of withdrawal and lack of motivation

• Social skills deficits

• Intervention > Behavioral Activation

Biopsychosocial models of depression

• Biological factors

  • Research suggests that genetics may influence mood disorders (across group of mood disorders, not just single diagnosis). Specifically that depression can be found in multiple generations of a family.

  • Association with endocrine, immune, and neurotransmitter functioning

• Psychological factors

  • Negative thinking patterns

  • Deficits in coping skills

  • Poor judgement or problem solving skills

  • Deficits in emotional intelligence

  • Learning history

• Social factors

  • Traumatic situations

  • Lack of social support

  • Environment (social and physical)

  • Chronic stress

Course of Therapy for Depression

• Early goals

  • Rapport, identify concerns, introduce CBT, baseline measures, etc.

• Middle goals

  • Interventions

    • Behavioral activation, activity scheduling

    • cognitive restructuring

    • follow up measures (6-7 weeks out)

• Later goals

  • identifying maladaptive beliefs and schemas as needed

  • developing relapse prevention strategies

  • Complete outcome measures

    • sessions 11+

Relapse prevention

• Compare/contrast outcome measures

• Re-visit goals

• Teach client how to monitor symptoms

• Identify possible or likely problematic future situations

• Practice skills & promote mastery

• Apply skills & coping strategies

• Assess & continue to build self-efficacy

  • Their ability to know what to do then do it

Suicidality