cognitive approach to treating depression

Question 1

what is cognitive behaviour therapy (CBT)?

Answer 1

• the most commonly used psychological treatment for depression and a range of other mental health issues
• it is an example of the cognitive approach to treatment, but also includes behavioural elements

Question 2

what does the cognitive element of CBT involve?

Answer 2

• 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

Question 3

what does the behavioural element of CBT involve?

Answer 3

• working to change negative and irrational thoughts
• putting more effective behaviours into place

Question 4

what is beck’s cognitive therapy?

Answer 4

• the application of beck’s cognitive theory of depression
• the idea behind cognitive therapy is to identify automatic 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

Question 5

what does cognitive therapy also aim to do?

Answer 5

• help clients test the reality of their negative beliefs
• therefore, they might be set homework, such as to record when they enjoyed an event or when people were nice to them
• 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 client’s statements as incorrect

Question 6

what does ‘client as scientist’ refer to?

Answer 6

when clients investigate the reality of their negative beliefs (eg. record when they enjoyed an event or when people were nice to them) in the way a scientist would

Question 7

what is ellis’s rational emotive behaviour therapy (REBT)?

Answer 7

• it extends the ABC model to an ABCDE model
• D stands for dispute and E for effect
• the central technique is REBT is to identify and dispute (challenge) irrational thoughts

Question 8

how might a typical session of REBT play out?

Answer 8

• a client might talk about how unlucky they have been
• an REBT therapist would identify these as examples of utopianism and challenge this as an irrational belief
• this would involve a rigorous argument
• the intended effect is to change the irrational belief and so break the link between negative life effects and depression

Question 9

what other different methods of disputing did ellis identify?

Answer 9

• 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

Question 10

what is the goal of behavioural activation?

Answer 10

• as individuals become depressed, they tend to increasingly avoid difficult situations and become isolated, which maintains or worsens symptoms
• therefore, behavioural activation aims 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 eg. exercising
• the therapist aims to reinforce such activitiy

Question 11

evaluation: evidence for effectiveness (march et al. 2007)

Answer 11

• many studies show that CBT works
• march et al. (2007) compared CBT to antidepressant drugs and so to a combination of both when treated 327 depressed adolescents
• after 36 weeks, 81% of CBT group, 81% of antidepressants group and 86% of CBT + antidepressants group were significantly improved
• 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 6-12 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

Question 12

evaluation: lack of effectiveness for severe cases and for clients with learning disabilities

Answer 12

• 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
• peter sturmey (2005) suggests that any form of psychotherapy (ie. ‘talking therapy) is unsuitable for people with learning disabilities, which includes CBT
• therefore, CBT may only be appropriate for a specific range of people with depression

Question 13

evaluation: more recent evidence challenges the idea that CBT is unsuitable for very depressed people and clients with learning disabilities

Answer 13

• lewis and lewis (2016) concluded that CBT was as effective as antidepressant drugs and behavioural therapies for severe depression
• a review by taylor et al. (2008) concluded that, when used appropriately, CBT is effective for people with learning disabilities
• therefore, CBT may be suitable for a wider range of people than was once thought

Question 14

evaluation: high relapse rates

Answer 14

• although CBT is effective in tackling the symptoms of depression, there are some concerns about how long the benefits last
• relatively few early studies of CBT looked at its long-term effectiveness
• some more recent studies suggest that long-term outcomes are not as good as had been assumed
• eg. in one study, ali et al. (2017) assessed depression in 439 clients every month for 12 months following a course of CBT
• 42% of clients relapsed into depression within six months and ending treatment and 53% relapsed within a year
• therefore, CBT may need to be repeated periodically

Question 15

evaluation: client preference

Answer 15

• not all clients want to tackle their depression by identifying and changing unhelpful patterns of thinking and behaviour
• some people just want their symptoms gone as quickly and easily as possible and prefer medication
• others, eg. survivors of trauma, wish to explore the origins of their symptoms
• in a study of client preference, antoine yrondi et al. (2015) found that depressed people rated CBT as their least preferred psychological treatment