7. The Cognitive Approach To Treating Depression Flashcards
What is cognitive behaviour therapy (CBT)?
A method for treating mental disorder based on cognitive and behavioural techniques. From the cognitive standpoint, the therapy aims to deal with thinking, such as challenging negative thoughts. The therapy also have behavioural techniques such as behavioural activation.
What did Ellis’ model and therapy define irrational thoughts as?
Thoughts that are likely to interfere with a person’s happiness. Such dysfunctional thoughts lead to mental disorders such as depression.
Who developed cognitive behavioural therapy?
Beck
What therapy did Ellis develop?
Rational-Emotive-Behaviour Therapy
What is the main method in Rational-Emotive-Behaviour Therapy?
Rational confrontation- the therapist has vigorous arguments with the patient to challenge/dispute their irrational beliefs.
It is the task of the therapist to directly challenge the negative assumptions people make through their thinking - Automatic Negative Thoughts (ANTs).
Therapists using REBT are attempting to change thinking patterns; they tend to be more argumentative and confrontational with their clients than in other forms of therapy (squash the ANTs)
How does REBT extend the ABC model?
It extends it to the ABCDEA model:
D for dispute (challenge) irrational beliefs
E for effect (improved mood and fewer negative thoughts)
What other exercise may clients undergo in REBT?
Shame attaching exercises (such as taking a banana out for a walk) to challenge their negative schemas - Ellis would remind clients to think ‘what’s the worse that can happen?’.
EVALUATION OF COGNITIVE BEHAVIOURAL THERAPY
Give one strength of CBT
A strength of CBT is that it is effective.
March et al compared the effects of 3 different treatment methods - CBT, antidepressant drugs and a combination of the two in 327 depressed adolescents. After 36 weeks the CBT group and antidepressants group both had an improvement rate of 81% and the combined group had one of 86%.
This suggests that CBT is just as effective as antidepressants and even more so when the two are combined. There is a good case for making CBT a primary course of action as the NHS needs something that will work.
EVALUATION OF COGNITIVE BEHAVIOURAL THERAPY
Outline 4 limitations of CBT
- a limitation of CBT is it may not work for the most severe cases of depression
- success may be due to the therapist-patient relationship
- a limitation is that some patients really want to explore their past
- there may be an overemphasis on cognition
EVALUATION OF COGNITIVE BEHAVIOURAL THERAPY
Explain the limitation of CBT in that it may not work for the most severe cases of depression
In some cases depression can be so severe that patients cannot motivate themselves to take on the hard cognition work required for CBT. Where this is the case it is possible to treat patients with antidepressant medication and commence CBT when they are more alert and motivated.
This is a limitation of CBT because it means CBT cannot be used as the sole treatment for all cases of depression.
EVALUATION OF COGNITIVE BEHAVIOURAL THERAPY
Explain the limitation of CBT in that the success may be due to the therapist-patient relationship
The differences in effectiveness of CBT and other methods is psychotherapy might be quite small. All psychotherapies share an essential ingredient - the therapist-patient relationship. It may be the quality of this that determines success rather than any particular technique.
This suggests that CBT may not be more effective than any other methods of psychotherapy as it may simply be having someone to talk to and listen that is important.
EVALUATION OF COGNITIVE BEHAVIOURAL THERAPY
Explain the limitation of CBT in that some patients really want to explore their past
One of the basic principles of CBT is that the focus is the therapy is on the patient’s present and future rather than past. In some forms of psychotherapy patients make links between depression and past experiences in their childhood.
The ‘present-focus’ of CBT may ignore an important aspect of the depressed patient’s experience which could be a weakness.
EVALUATION OF COGNITIVE BEHAVIOURAL THERAPY
Explain the limitation of CBT in that there may be an overemphasis on cognition
CBT may end up minimising the importance of the circumstances in which the patient is living. A patient living in poverty or suffering abuse needs to change their circumstances, and any approach that emphasises what is in the patient’s mind rather than their environment can prevent this.
CBT techniques can demotivate people to change their situation which is a weakness.
What does CBT encourage people to do?
It encourages people to examine the beliefs and expectations underlining unhappiness, and to challenge irrational thoughts and replace these with more positive, adaptive thinking patterns.
Give the 6 steps involved in cognitive behaviour therapy
- Identification/recognition of negative thoughts to determine baseline to monitor improvement.
- Generate hypotheses to test thoughts. For example if the client says “I am useless, I always fail”, they will be asked, in reality, if they have been successful at something.
- Scientific testing of negative thoughts - the therapist may ask the client to do something to demonstrate their ability to succeed.
- Patient as ‘scientist’ - this may involve gathering data through homework e.g. Diary keeping:
- Reinforcement of positive thoughts - client is rewarded/praised for optimistic thinking.
- Cognitive restructuring- over time, irrational thoughts are replaced by more rational beliefs.
