7. cognitive approach to treating depression Flashcards
COGNITIVE BEHAVIOUR THERAPY
Cognitive behaviour therapy (CBT) is the most commonly used psychological treatment for depression and a range of other mental health issues.
CBT begins with an assessment in which the client and the cognitive behaviour therapist work together to clarify the client’s 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 challenge.
CBT then involves working to
change negative and irrational thoughts and finally put more effective behaviours into place.
BECK’S COGNITIVE THERAPY
Cognitive therapy is the application of Beck’s cognitive theory of depression The idea behind cognitive therapy is to identify automatic negative thoughts about the world, the self, and the future (the negative triad). Once identified these thoughts must be challenged. This is the central component of the therapy.
As well as challenging these thoughts directly, cognitive therapy aims to
help clients test the reality of their negative beliefs. They might therefore be 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 no point in going to events, the therapist can then produce this evidence and use it to prove the clients’ statements are incorrect.
ELLIS’S RATIONAL EMOTIVE BEHAVIOUR THERAPY
Rational emotive behaviour therapy (REBT) extends the ABC model to an ABCDE model - D stands for dispute and E for effect.
The central technique of REBT is to identify and dispute (challenge) irrational thoughts.
An REBT therapist would identify 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.
This vigorous argument is the hallmark of REBT.
Ellis identified different methods of disputing.
Describe empirical and logical arguments
Empirical argument involves disputing whether there is actual evidence to support the negative belief.
Logical argument involves disputing whether the negative thought logically follows from the facts.
BEHAVIOURAL ACTIVATION
As individuals become depressed, they tend to increasingly avoid difficult situations and become isolated, which maintains or worsens symptoms.
The goal of behavioural activation is
to work with depressed individuals to gradually decrease their avoidance and isolation and increase their engagement in activities that have been shown to improve mood.
The therapist aims to reinforce such activity.
AO3: strength of COGNITIVE APPROACH TO TREATING DEPRESSION
research support - March et al
One strength of CBT is the large body of evidence supporting its effectiveness for treating depression.
March et al. compared CBT to antidepressant drugs and also to a combination of both treatments when treating 327 depressed adolescents. After 36 weeks, 81% of the CBT group, 81% of the antidepressants group and 86% of the CBT plus antidepressants group were significantly improved. So, CBT was just as effective when used on its own and more so when used alongside antidepressants. CBT is usually a fairly brief therapy requiring 6 to 12 sessions, so it is also cost-effective.
This means that CBT is widely seen as the first choice of treatment in public health care systems such as the NHS as it is effective in treating depression in 4 out of 5 people.
AO3: limitation of COGNITIVE APPROACH TO TREATING DEPRESSION
lacks effectiveness for severe depression and learning disabilities
One limitation of CBT for depression is the lack of effectiveness for severe cases and for clients with learning disabilities.
In some cases, depression can be so severe that clients cannot motivate themselves to engage with the cognitive work of CBT. They may not even be able to pay attention to what is happening in a session. It also seems likely that the complex rational thinking involved in CBT makes it unsuitable for treating depression in clients with learning disabilities. In general, any form of talking therapy is not suitable for people with learning disabilities, and this includes CBI.
This suggests that CBT may only be appropriate for a specific range of people with depression.
AO3: limitation of COGNITIVE APPROACH TO TREATING DEPRESSION
high relapse rates - Ali et al.
A further 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, in one study, Ali et al. assessed depression in 439 clients every month for 12 months following a course of CBT. 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.
