cognitive treatments for depression Flashcards
introduction
Cognitive behaviour therapy is the most commonly used psychological treatment for depression and a range of other mental health problems.
It is a cognitive therapy, but also includes behavioural elements and it aims to identify and change irrational thoughts.
Cognitive elements:
• Assessment - client and therapist identify the problems and the goals.
• Plan is put in place.
• Identify and negative and irrational thoughts.
Behavioural elements.
• Work to change unhelpful thought patterns and put more effective behaviours in place.
Becks cognitive therapy
Cognitive therapy is the application of Beck’s cognitive theory of depression.
It aims to identify and challenge negative automatic thoughts surrounding the world, the future and the self (negative triad)
• Direct challenging.
• Hypothesis testing / testing the reality of their beliefs.
• Homework → E.g. record when people are nice to you; when you enjoyed an event; received positive feedback.
• Findings can be used in future sessions to prove the client wrong when they make an irrational statement.
Ellis’ rational emotive behaviour therapy
REBT extends the ABC model to an ABCDE model.
• D = Disputing
• E = Effect
The central idea behind REBT is to identify irrational thoughts (e.g. utopianism) and dispute them through vigorous argument.
• Change the negative belief and break the link between the event and depression.
Disputing is the hallmark of REBT
• Empirical dispute-challenging if there is actually evidence to support negative belief
-logical- challenging whether negative thought logically follows the facts
-pragmatic-questions whether belief is helpful in terms of solving problem
behavioural activation
“Getting people to do stuff”
As individual become depressed then tend to increasingly avoid difficult situations and become isolated.
→ maintains and worsens symptoms.
• The goal of BA is to gradually decrease avoidance and isolation by increasing engagement in activities that have been shown to improve mood.
• Exercise, going out for dinner etc.
strength-research support CBT
Research by March et al. (2007) found that CBT was as effective as antidepressants in treating depression.
• 327 adolescents with a diagnosis of depression
• Compared the effectiveness of CBT, antidepressants, and a combination of CBT and antidepressants.
• After 36 weeks, 81% of the antidepressant group, 81% of the CBT and 86% of the combination group had significantly improved.
• This demonstrates the effectiveness of CBT in treating depression and also suggests that it works well alongside medication as a combination therapy and may even be more effective than just one or the other.
limitation-suitability for diverse clients
CBT could be ineffective for more severe cases and people with learning difficulties.
• CBT requires motivation
• Motivation may not be present in the more severe cases of depression → won’t be able to engage with the work or pay attention to what is happening in the session.
• It is also possible that the hard cognitive work associated with CBT could make it unsuitable for people with learning disabilities.
• Sturmey (2005) even suggests that psychotherapy of any kind is unsuitable for people with learning difficulties.
Suggests that CBT may only be appropriate for a specific range of clients.
counterpoint-suitability
More recent evidence challenges the idea that CBT is unsuitable for severe depression and for people with learning difficulties.
• Lewis and Lewis (2016) concluded that CBT was as effective as antidepressants and behavioural therapy for severe depression.
• Taylor et al. (2008) concluded that when used appropriate CBT is effective for people with learning disabilities.
This means that CBT may in fact be suitable for a wider range of people than was initially thought.
limitation-relapse rates
Although CBT seems to be quite effective in tackling the symptoms of depression there are some concerns over how long the benefits last.
• Some recent study suggest that the long-term outcomes are infact not as good was once thought.
• E.g. Ali et al. (2017) assessed depression in 439 clients every month for 12 months following a course of CBT.
• 42% relapsed within 6 months of ending treatment.
• 53% relapsed within a year.
This means that CBT may need a to be repeated periodically.
example paragraph outline
Cognitive Behavioural Therapy (CBT) involves both cognitive and behavioural elements and typically starts with an initial assessment, in which the patient and therapist identify the patient’s problems. Thereafter, the patient and therapist agree on a set of goals, and a plan of action to achieve these goals.
While there are different forms of CBT (e.g. Beck’s cognitive therapy and and Ellis’s REBT) the aim to identify and challenge the negative and irrational thoughts always remains the same, despite the fact their approaches differ.
For example Ellis developed rational emotive behaviour therapy (REBT), which involved developing his ABC model to include D (dispute) and E (effective). The idea here is that the therapist will dispute the patient’s irrational beliefs, to replace their irrational beliefs with more effective beliefs and attitudes. There are different types of dispute which can be used, including: empirical dispute - where the therapist seeks evidence for a person’s thoughts: Where is the evidence that your beliefs are true?’
Following any CBT session, the therapist may set their patient homework. This could take various forms, for example Beck’s cognitive therapy would encourage the patient to test their own irrational beliefs and prove them wrong, which would result in their beliefs beginning to change. Patients could also be given behavioural homeworks e.g. going to out to do some exercise, which would then be reinforced by the therapist.