3.7. Depression Treatment: Cognitive Approach

Question 1

What does CBT start with?

Answer 1

The patient and therapist carrying out an assessment to clarify the patient’s problem

Question 2

What do the patient and therapist jointly identify in CBT?

Answer 2

Goals, then put a plan together to achieve them

Question 3

What is the main task of CBT?

Answer 3

To identify where there might be negative or irrational thoughts that need challenging.

Question 4

What did Ellis call his CBT based therapy and why?

Answer 4

Rational Emotional Behavioural Therapy (REBT)

It resolves emotional and behavioural problems.

Question 5

What did Ellis extend his model to become?

Answer 5

ABCDEF

Question 6

What do the D, E and F stand for in the ABCDEF model?

Answer 6

D: disputing irrational thoughts and beliefs
E: effects of disputing and effective attitude to life
F: feelings that are produced

Question 7

What does REBT focus on?

Answer 7

Challenging irrational thoughts and replacing them with rational ones

Question 8

What are the three elements REBT looks at?

Answer 8

• Logical disputing
• Empirical disputing
• Pragmatic disputing

Question 9

What is logical disputing?

Answer 9

Self defeating beliefs don’t follow from the event

Question 10

What is empirical disputing?

Answer 10

Self defeating beliefs are inconsistent with reality

Question 11

What is pragmatic disputing?

Answer 11

The pointlessness of self-defeating beliefs

Question 12

What does effective disputing do?

Answer 12

Changes self-defeating beliefs into more rational beliefs, replacing catastrophising with more rational interpretation of events.

Question 13

What should patients do alongside therapy?

Answer 13

• Homework
• Behavioural activation
• Unconditional positive regard

Question 14

How should a patient do homework alongside therapy?

Answer 14

Patients are asked to complete homework material outside therapy sessions to test irrational beliefs against reality and put new rational beliefs into practice.

Question 15

How should behavioural activation be used alongside therapy?

Answer 15

Based on the assumption that being active leads to rewards that act as an antidote to depression, CBT often involves encouraging patients to become more active and engaged in pleasurable activities.

Question 16

How should unconditional positive regard be used alongside therapy?

Answer 16

• If a patient feels worthless, they will be less willing to consider change.
• If the therapist provides respect for the client without judgement, a change in beliefs and attitudes should be facilitated.

Question 17

What should be identified in the therapy?

Answer 17

Automatic thoughts about the world, self and future

These thoughts must be challenged

Question 18

What does CBT also aim to do?

Answer 18

Reality test -> the way in which a scientist would, look at the reality of their beliefs

Question 19

What can happen in future sessions?

Answer 19

If a patients says a negative thought, then the therapist can present the evidence to prove the statement is incorrect

Question 20

Strength: research support

Answer 20

• Ellis claimed a 90% success rate for REBT, taking an average of 27 sessions to complete the treatment.
• However, Ellis said that the therapy was not always effective, he suggested this could be because some patients didn’t put their revised beliefs into action.
• REBT and CBT do well in outcome studies of depression
• Cuijpers found that out of 75 studies, CBT was far superior to no treatment.
• March et al compared effects of CBT with antidepressant drugs and a combination of the two in 327 depressed adolescents, after 36 weeks found: 81% of CBT group, 81% of antidepressant group, 86% of CBT and drugs group were significantly improved.

Question 21

Strength: support for behaviour activation

Answer 21

• Babyak randomly assigned 156 depressed adults to four months of aerobic exercise, drug treatment or both.
• All patients improved, but 6 months later, the exercise group had lower relapse rates than the medication group, especially if they had continued with an exercise regime.

Question 22

Strength: combination with alternative treatment

Answer 22

• Cuijpers found that CBT was especially effective when used with drug therapy
• e.g. SSRI may alienate symptoms enough to allow the patient to focus on the demands of CBT.

Question 23

Weakness: individual differences

Answer 23

• Elkin states that CBT works less well with people that have high levels of irrational beliefs that are rigid as well as resistant to change, or when realistic stressors cannot be resolved by therapy.
• The directness of REBT doesn’t suit everyone, some people want to share their worries without expending the cognitive effort necessary for recovery.
• In severe cases, clients may not be able to pay attention in a session.
• Sturney suggested that any form of psychotherapy in not suitable for people with learning difficulties

Question 24

Weakness: the Dodo bird effect

Answer 24

• Rosenzweig argues that all methods of treatment for mental disorders were pretty much equally effective, he called this the Dodo bird effect, based on Alice in Wonderland, everybody wins
• Luborsky reviewed 100 different studies that compared different therapies and found that there were only small differences -> Rosenzweig argued that this was because of common factors in different psychotherapies, such as being able to talk to a sympathetic person, which may enhance self esteem and having an opportunity to express ones thoughts.

Question 25

Weakness: high relapse rates

Answer 25

Ali et al found 42% relapsed within 6 months of ending treatment, 53% within a year