Cognitive Approach To Treating Depression

Question 1

Cognitive and Behavioural elements of CBT

Answer 1

• The cognitive element aims to identify irrational and negative thoughts and replace these negative thoughts with more positive ones.
• The behavioural element of CBT encourages patients to test their beliefs through behavioural experiments and homework.

Question 2

Central premise of CBT:

Answer 2

thoughts, feelings, ad behaviours impact each other, so if an irrational thought can be identified it can also change other people’s emotions and behaviour.

Question 3

Key features of CBT:

Answer 3

• Initial assessment: CBT therapist work with the patient to identify their problems.
• Goal setting: patient and therapist agree on a set of goals and a plan of action to achieve them.
• Identify automatic and negative and irrational thoughts in relation to themselves, their world, and their future (Beck’s Negative Triad) or activating events and beliefs (Ellis’ ABC model).
  [These are common to both Beck and Ellis’ model – they differ in how they aim to address the negative and irrational thoughts.]

Question 4

What is patient as scientist?

Answer 4

‘patient as scientist’: generating and
testing hypotheses about the validity of their irrational thoughts; when they realise their thoughts don’t match reality, this will change their schemas, and the irrational thoughts can be discarded, leading to cognitive restructuring, in which perspectives are reframed, leading to a change in feelings and behaviours.

Question 5

What is thought catching?

Answer 5

Patients engage in thought-catching: identifying irrational thoughts coming from the negative triad of schemas,

Question 6

What is behavioural activation:

Answer 6

engaging in more active and enjoyable activities (eg sports, socialising, travelling). This is especially important to combat depressive symptoms of isolation and loss of interest.

Question 7

Ellis extended his ABC model of explanation and added 2 stages (ABCDE) of treatment:

Answer 7

→ Dispute - the therapist asks the client to dispute/ challenge their irrational thoughts and beliefs as utopianism; often involves a vigorous argument (hallmark of REBT).
→ Effective new responses – at this stage the therapist asks the client to think of more rational responses.

Question 8

Types of disputing:

Answer 8

• Empirical Disputing: assessing whether there is evidence for the thought.
• Logical Disputing: assessing whether the thoughts follow from the facts.
• Pragmatic Disputing: assessing if the thought is helpfu

Question 9

P: A strength of CBT as a treatment for depression is that there is a large body of evidence to support its effectiveness, especially in combination with antidepressant treatment.

Answer 9

E: March et al. (2007) examined 327 adolescents with a diagnosis of depression and looked at the effectiveness of CBT, antidepressants and a combination of CBT plus antidepressants. After 36 weeks, 81% of the antidepressant group and 81% of the CBT group had significantly improved, demonstrating the effectiveness of CBT in treating depression. However, 86% of the CBT plus antidepressant group had significantly improved.
E: This shows that CBT is an effective treatment as 81% of patients’ symptoms improved demonstrating its efficacy, but the research also suggests that a combination of both treatments may be the most effective.
L: This suggests that the cognitive treatment of depression is effective, but not comprehensive, and that physiology also need to be taken into account which can be addressed using drug therapy.

Question 10

P: A limitation of CBT is that it may not be suitable for all patients, such as those with learning disabilities.

Answer 10

E: Sturney (2005) proposed that patients with learning disabilities may not be able to access the complex rational thinking of any form of ‘talking therapy’. Similarly, patients whose depression is so severe, may not be able to motivate themselves to engage with the cognitive work of CBT.
E: This suggests that CBT may not be appropriate for all patients with depression.
C: However, recent evidence conflicts with this: Lewis & Lewis (2016) found that efficacy of CBT for severe depression was as equal to antidepressants, and Taylor et al. (2008) found that CBT, with appropriate adjustments, could be used with patients with learning difficulties.
L: This supports the idea that the use of CBT may be more broadly applicable than has been previously considered, but that its application may need to be modified in certain populations.

Question 11

P: A limitation of CBT for the treatment of depression is its high relapse rates.

Answer 11

E: Ali et al. (2017) assessed depression in 439 clients every month for 123 months following a course of CBT. 42% of the patients relapsed into depression within 6 months, and 53% within a year.
E: This suggests that relatively few earlier studies had looked at the long-term effectiveness, which may not be as high as was assumed. One reason for this is that CBT requires motivation, so patients with severe depression may not engage with CBT or even attend the sessions. Drug therapy does not require the same level of motivation, and so may be more effective in these cases.
L: This evidence supports the concern that a limitation of CBT is that it lacks prolonged efficacy, which may limit its application to patients of moderate severity, whereby motivation can be maintained for longer duration.