cognitive approach to treating depression Flashcards
what is cognitive behaviour therapy (CBT)?
- 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
what does the cognitive element of CBT involve?
- client & therapist work together to clarify client’s problems
- jointly identify goals for therapy and create a plan to achieve them
- central task is to identify negative / irrational thoughts that will benefit from challenge
what does the behavioural element of CBT involve?
- working to change negative and irrational thoughts
- putting more effective behaviours into place
what is beck’s cognitive therapy?
- application of beck’s cognitive theory of depression
- involves identifying and challenging automatic thoughts about the world, self and future (negative triad)
CBT
how are clients helped to test the reality of their negative beliefs?
- set homework eg. record when people were nice to them
- in future sessions, if clients say no one is nice to them, therapist can show evidence, proving the client wrong
what does ‘client as scientist’ refer to?
when clients investigate the reality of their negative beliefs (eg. record when people were nice to them) in the way a scientist would
what is ellis’s rational emotive behaviour therapy (REBT)?
- ABC model to an ABCDE model
- D = disput, E = effect
- central technique is to identify and dispute irrational thoughts
how might a typical session of REBT play out?
- client talks about X
- REBT therapist identifies irrational belief and challenges it through rigorous argument
- intended effect is to change the irrational belief, breaking the link between negative life effects and depression
what other different methods of disputing did ellis identify?
- empirical argument - dispute whether there is actual evidence to support the negative belief
- logical argument - dispute whether the negative thought logically follows from the facts
what is the goal of behavioural activation?
- to gradually decrease avoidance and isolation
- to increase engagement in activities shown to improve mood (eg. exercising)
- therapist aims to reinforce such activities
why is behavioural activation needed?
- as individuals become depressed, they tend to increasingly avoid difficult situations and become isolated
- this maintains or worsens symptoms
evaluation: evidence for effectiveness (march et al. 2007)
- compared CBT to antidepressant drugs and combination of both when treating 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
evaluation: useful
- fairly brief therapy, requiring 6-12 sessions
- cost-effective
- CBT is widely seens as first choice of treatment in public healthcare systems eg. NHS
evaluation: lack of effectiveness for severe cases of depression
- clients may not be able to motivate themselves to engage with the cognitive work of CBT
- unable to pay attention to what is happening in a session, so ineffective
evaluation: lack of effectiveness for clients with learning disabilities
- complex rational thinking involved in CBT may make it unsuitable for treating depression in clitents with learning disabilities
- CBT may only be appropriate for certain groups of people, limiting its applicability
evaluation: clients with learning disabilities (sturmey 2005)
any form of psychotherapy is unsuitable for people with learning disabilities, including CBT
evaluation: evidence challenging the idea that CBT is unsuitable for severely depressed clients (lewis and lewis 2016)
concluded that CBT was as effective as antidepressant drugs and behavioural therapies for severe depression
evaluation: evidence challenging the idea that CBT is unsuitable for clients with learning disabilities (taylor et al. 2008)
- concluded that whenused appropriately, CBT is effective for people with learning disabilities
- CBT may be suitable for a wider range of people than once thought
evaluation: high relapse rates
- CBT is effective in tackling symptoms, but there are some concerns about how long the benefits last
- relatively few early studies of CBT looked at its long-term effectiveness
evaluation: evidence for high relapse rates (ali et al. 2017)
- assessed 439 clients every month for 12 months following a course of CBT
- 42% relapsed within 6 months of ended treatment and 53% relapsed within a year
- CBT may need to be repeated periodically
- long-term outcomes may not be as good as once assumed
evaluation: client preference
- not all clients want to tackle their depression by identifying and changing unhelpful patterns of thinking and behaviour
- some may want their symptoms gone as quickly and easily as possible, preferring medication
- others (eg. survivors of trauma) may wish to explore the origins of their symptoms
evaluation: study of client preference (yrondi et al. 2015)
depressed people rated CBT as their least preferred psychological treatment
