Cognitive approach to treating Depression

Question 1

What is cognitive-behavioural therapy (CBT)?

Answer 1

A combination of cognitive therapy (a way of changing maladaptive thoughts and beliefs) and behavioural therapy (a way of changing behaviour in response to these thoughts and beliefs)

Question 2

What are the two types of cognitive-behavioural therapy?

Answer 2

1. Beck’s cognitive therapy – challenge negative schemas about the world, themselves and the future
2. Ellis’ rational emotive behaviour therapy (REBT) – turn irrational thoughts into rational ones

Question 3

How does REBT extend Ellis’ ABC model?

Answer 3

Extends ABC model to ABCDE model: D – disputing irrational thoughts E – effects of disputing/revising beliefs

Question 4

What are three ways you can dispute irrational thoughts?

Answer 4

1. Logical disputing – make client aware of how self-defeating beliefs don’t follow logically from information available
2. Empirical disputing – make client aware of how beliefs are not consistent with reality
3. Pragmatic disputing – emphasis placed on lack of usefulness of self-defeating beliefs

Question 5

How can disputing make a person with depression feel better?

Answer 5

Helps them turn irrational thoughts into rational ones and stops them from catastrophising- become more self-accepting

Question 6

What are two methods used in CBT?

Answer 6

1. Keeping a diary – monitoring events where negative thoughts occur and target them
2. Homework assignments – carry out tasks to test their irrational beliefs/negative schemas against reality (‘patient as scientist’) or engage in previously enjoyed activities to raise mood = behavioural element of CBT

Question 7

What is ‘patient as scientist?’

Answer 7

When patient is encouraged to investigate the reality of their negative schemas/irrational thoughts in the way a scientist would and evaluating evidence, e.g. recording any time they enjoyed an event

Question 8

What are the two strengths of the cognitive approach to treating depression?

Answer 8

Research support for behavioural activation- There is research support for the idea that the behavioural aspect of CBT is effective in alleviating depression. Babyak et al. (2000)- studied 156 adult volunteers diagnosed with major depressive disorder. They were randomly assigned to a course of aerobic exercise, drug treatment or a combination of the two. 6 months after the end of the study, those in the exercise group had significantly lower relapse rates than those in the medication group. This reveals that a change in behaviour (i.e. physical activity) can be beneficial in treating depression.

Research support for effectiveness- There is extensive research support demonstrating the effectiveness of CBT for depression. March et al. (2007)- compared the effects of CBT with antidepressant drugs and a combination of the two in 327 adolescents with a diagnosis of depression..
After 36 weeks:
- CBT group= 81% showed improvement
- Antidepressants group= 81% showed improvement
- CBT + antidepressants group= 86% improvement CBT is just as effective as antidepressants.
Counter- CBT may not be effective for everyone. CBT appears to be less suitable for people who have high levels of irrational beliefs and cannot motivate themselves to engage with the hard cognitive work of CBT. Not all want to engage in the direct sort of advice that CBT practitioners tend to dispense; they prefer to just share their worries with a therapist without getting involved in the cognitive effort associated with recovery.

Question 9

What are the two limitations of the cognitive approach to treating depression?

Answer 9

Relapse Rates: Although CBT is quite effective in tackling the symptoms of depression, there are concerns over how long the benefits last. There are very few early studies of CBT for depression which have looked at long-term effectiveness. More recent studies suggest that long-term outcomes are not as good as had been assumed. E.g. Shehzad et al. (2017)à assessed depression in 439 clients every month for 12 months following a course of CBT. 42% of the clients relapsed into depression within 6 months of ending treatment and 53% relapsed within a year. This suggests that CBT may need to be repeated periodically.

Success may be due to the therapist-patient relationship: Rosenzweig (1936)- the differences between different methods of psychotherapy might actually be quite small. The aspect that could be resulting in effective treatment is not the cognitive and behavioural basis of the psychotherapies but the therapist-patient relationship. It may be the quality of this relationship that determines success rather than any particular technique that is used. E.g., Many comparative reviews find very small differences between psychotherapies, which supports the view that simply having an opportunity to talk to someone who will listen could be what matters the most.